Now what kind of a nurse is this?

[Sidenote:  Difference of excitable and accumulative temperaments.]

I would call attention to something else, in which nurses frequently fail in observation.  There is a well-marked distinction between the excitable and what I will call the accumulative temperament in patients.  One will blaze up at once, under any shock or anxiety, and sleep very comfortably after it; another will seem quite calm and even torpid, under the same shock, and people say, “He hardly felt it at all,” yet you will find him some time after slowly sinking.  The same remark applies to the action of narcotics, of aperients, which, in the one, take effect directly, in the other not perhaps for twenty-four hours.  A journey, a visit, an unwonted exertion, will affect the one immediately, but he recovers after it; the other bears it very well at the time, apparently, and dies or is prostrated for life by it.  People often say how difficult the excitable temperament is to manage.  I say how difficult is the accumulative temperament.  With the first you have an out-break which you could anticipate, and it is all over.  With the second you never know where you are—­you never know when the consequences are over.  And it requires your closest observation to know what are the consequences of what—­for the consequent by no means follows immediately upon the antecedent—­and coarse observation is utterly at fault.

[Sidenote:  Superstition the fruit of bad observation.]

Almost all superstitions are owing to bad observation, to the post hoc, ergo propter hoc; and bad observers are almost all superstitious.  Farmers used to attribute disease among cattle to witchcraft; weddings have been attributed to seeing one magpie, deaths to seeing three; and I have heard the most highly educated now-a-days draw consequences for the sick closely resembling these.

[Sidenote:  Physiognomy of disease little shown by the face.]

Another remark:  although there is unquestionably a physiognomy of disease as well as of health; of all parts of the body, the face is perhaps the one which tells the least to the common observer or the casual visitor.  Because, of all parts of the body, it is the one most exposed to other influences, besides health.  And people never, or scarcely ever, observe enough to know how to distinguish between the effect of exposure, of robust health, of a tender skin, of a tendency to congestion, of suffusion, flushing, or many other things.  Again, the face is often the last to shew emaciation.  I should say that the hand was a much surer test than the face, both as to flesh, colour, circulation, &c., &c.  It is true that there are some diseases which are only betrayed at all by something in the face, e.g., the eye or the tongue, as great irritability of brain by the appearance of the pupil of the eye.  But we are talking of casual, not minute, observation.  And few minute observers will hesitate to say that far more untruth than truth is conveyed by the oft repeated words, He looks well, or ill, or better or worse.