I must direct the nurse’s attention to the extreme variation there is not unfrequently in the pulse of such patients during the day.  A very common case is this:  Between 3 and 4 A.M. the pulse becomes quick, perhaps 130, and so thready it is not like a pulse at all, but like a string vibrating just underneath the skin.  After this the patient gets no more sleep.  About mid-day the pulse has come down to 80; and though feeble and compressible is a very respectable pulse.  At night, if the patient has had a day of excitement, it is almost imperceptible.  But, if the patient has had a good day, it is stronger and steadier and not quicker than at mid-day.  This is a common history of a common pulse; and others, equally varying during the day, might be given.  Now, in inflammation, which may almost always be detected by the pulse, in typhoid fever, which is accompanied by the low pulse that nothing will raise, there is no such great variation.  And doctors and nurses become accustomed not to look for it.  The doctor indeed cannot.  But the variation is in itself an important feature.

Cases like the above often “go off rather suddenly,” as it is called, from some trifling ailment of a few days, which just makes up the sum of exhaustion necessary to produce death.  And everybody cries, who would have thought it? except the observing nurse, if there is one, who had always expected the exhaustion to come, from which there would be no rally, because she knew the patient had no capital in strength on which to draw, if he failed for a few days to make his barely daily income in sleep and nutrition.

I have often seen really good nurses distressed, because they could not impress the doctor with the real danger of their patient; and quite provoked because the patient “would look,” either “so much better” or “so much worse” than he really is “when the doctor was there.”  The distress is very legitimate, but it generally arises from the nurse not having the power of laying clearly and shortly before the doctor the facts from which she derives her opinion, or from the doctor being hasty and inexperienced, and not capable of eliciting them.  A man who really cares for his patients, will soon learn to ask for and appreciate the information of a nurse, who is at once a careful observer and a clear reporter.

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[Sidenote:  Danger of physicking by amateur females.]

I have known many ladies who, having once obtained a “blue pill” prescription from a physician, gave and took it as a common aperient two or three times a week—­with what effect may be supposed.  In one case I happened to be the person to inform the physician of it, who substituted for the prescription a comparatively harmless aperient pill.  The lady came to me and complained that it “did not suit her half so well.”

If women will take or give physic, by far the safest plan is to send for “the doctor” every time—­for I have known ladies who both gave and took physic, who would not take the pains to learn the names of the commonest medicines, and confounded, e.g., colocynth with colchicum.  This is playing with sharp edged tools “with a vengeance.”