NURSING.*

OF the three great branches of the profession of the Art of healing, the greatest progress has, no doubt, been made of late in that of Surgery; but it is not, perhaps, too much to say that within the last quarter of a century the greatest reform has been effected in the least conspicuous but all-important domain of Nursing. Medicine, indeed, has not stood still, but its progress has been slow and uncertain. It is a long time since a decoction of blind puppy seethed in the milk of a red cow was exhibited by the faculty in cases of croup, or the great toe of the left foot bored with a red-hot iron to relieve affection of the spine ; but our modern physicians know actually little more of the nature and cause of many diseases, or of the nature and true method of their cure, than Hippocrates or Galen. But the Nursing of the present day is different, not in degree, but in nature, from the nursing of half a century ago. The ideal nurse of our fathers and mothers was presented, even if she was caricatured, in Mrs. Gamp and Betsey Prig; the nurse of our sons and daughters is portrayed in the novel of the day as a lady, possibly of gentle birth, devoted as a matter of course, but also highly skilled, highly educated, understanding much of the theory as well as of the practice of her profession, knowing as much about medicine as many a doctor, and as much about surgery as many a surgeon—qualified by thorough professional training to take her position at the bedside of the sick, and to supply the place of the physician or general practitioner during the twenty-three hours and three-quarters or thereabouts, that the " doctor " is necessarily absent from the patient.

Mr. Arthur Brinckman has given us a handy and most valuable little volume on the care of the sick, embodying not only his own experiences in various capacities, but that of many professional workers and writers on nursing. The work bears little trace of the hasty and " awkward " writing which the author seeks to excuse in his preface, on the ground of its "having been compiled just when he could snatch a few minutes ;" on the contrary, the matter is systematically and practically arranged. The first chapter, on the choice of lodgings, applies, of course, only to those who are to undergo an operation, and can decide where they will be laid up ; the second, on disinfectants, is of universal application, and starting with the old maxim that "the best of all disin- fectants is plenty of fresh air," proceeds to give some very good general advice with regard to the sick-room :—" If a chest, or table, or window rattles and shakes as you walk across the room, put something under the feet, or insert a peg at once As soon as possible remove everything out of the room which is of no use in it, if the illness is likely to be a serious one. It must be done, of course, in such a way that the patient shall not be alarmed or annoyed; it is simply a matter of convenience, and a gaining of air which is all the better for him." The importance of proper ventilation falls very naturally under this head :—" Every one knows," says our author, who evidently possesses a keen sense of humour, " that pure, fresh air is better for human beings than close, foul air; and yet it is perfectly astounding to notice, wherever one goes, how every effort is made to keep out fresh air, and to keep in the foul."

As regards practical suggestions, we think Miss Nightingale's dictum that "the safest atmosphere of all for a patient is a good

• Notes on the Care of the Sat. By Arthur BrInekman. London: G. J. Palmer.

fire and an open window, excepting in extremes of temperature," is excellent; but when this is not practicable, "A piece of wood a few inches high, to fit in the whole length for the bottom sash to• rest upon, keeps a little air coming into the room without a draught,

and gives to the patient the look of the window being shut." We have often seen this adopted in ordinary dwelling-rooms,

with most satisfactory results. Noises, small as well as great, are to be avoided as much as possible in the sick-room, on which point Mr. Brinckman says :—" One has known a doctor pay his visit, enjoin the utmost quiet for his patient, and then leave the house with a bang of the street-door which shook it all over." The plan of saving unnecessary knocks and rings at the front- door, as well as most unnecessary racings to and fro of the servants in the sick-house, by posting a little daily bulletin where it may be read by all who come to the hall-door, is excellent and most practical, and marked, like so many of the author's other suggestions, by a thoughtful consideration for others, as well as for the patient himself.

But there is one order of persons connected with the sick that Mr. Brinckman cannot away with. Having pre • pared the hall-door bulletin partly with a view of keeping Visitors out of the house, he has invented a special form of medical certificate to keep them out of the sick-room, as soon as they have effected an entrance within the first parallels at the hall-door. Once in the room, he has pre- pared three tables de rigueur, one at each side and one at the foot of the bed, to keep them from the patient, and he instructs the nurse to occupy the only available chair in the room with a basin of beef-tea or a roll of bandages, so that the visitor shall not be tempted to prolong his or her visit by the luxury of being able to sit down. "The object of the visit should.

simply be to vary the monotony of the life in the sick- room, and the patient should always feel cheered, and. not tired, after the visit." And certainly the kind of visitor contemplated, and experienced by Mr. Brinckman is not of the cheering sort ! The visitor late at night who informed the nervous patient of the sinking of the Princess Alice,' with full details ; the visitor who "wonders why Dr. — does not give you this thing, instead of that ;" the visitor who speaks to the patient as if the illness was a distinct punishment for some grievous sin, and who writes to him next day to say, "How grieved and shocked I am to find you in this condition. I bid you reflect in time," &c., "and I hope you will prayerfully study this little book which I send you,"—must all be as bad, or nearly so, as the "preaching visitor," whom Mr. Brinck- man especially objects to, and regarding whom he says, with true professional instinct,—" If there is to be any preaching, let it be done by the clergyman." On the same subject he says

"Some visitors seem preternaturally grave, some come in looking nervous, some take their leave so abruptly (always a mistake), some seem so artificial in their brightness, some talk to the patient as if he or she was a little child of five years old I have seen a nurse raise the clothes, look at and feel the feet, and say, Yes, ma'am,. his legs are dead already !' Sometimes sick people can hear, though they can make no sign to show that they can hear. A lady writes to me,—' I was often pained and annoyed by friends talking over me. Some would say, "She cannot live long !" "The doctor says she can- not live the day!" ' "

Certainly, no outworks can be made too strong to keep out such visitors as these !

With regard to Servants, Mr. Brinckman has some good remarks, and in a chapter devoted to the Patient himself he. tells us a good deal that is of practical interest regarding his general treatment. He also tells us, as a curious fact, the result of observation that in public hospitals the male patients are much the most patient and the most grateful, while women shine most in the privacy of their own houses. In a chapter on the Nurse,—the superiority of whose professional care over the unskilled tending of the most loving of hands he vindicates fairly and decidedly, he insists over and over again on the extreme cleanness and neatness, and even smartness, which are to be maintained, not only in the bed, the vessels, and furniture of the sick-room, but also in the person of the nurse herself. Nothing can be better than the following :—

" The nurse ought to have a washing-stand all to herself in every sick-room, and the more she washes her hands at it, whether they want it or not, the more the patient will be edified. Everything should be clean about the cap, everything clean about the dress, but the nice effect of it all may be spoiled by the one black finger-nail that rests on the saucer. The cleaner the nurse, the cleaner the patient will be."

As long as the objects of the Charity Organisation Society are so persistently misunderstood, we fear the following suggestion

has very little chance of being carried into effect, although it is by no means as impracticable as it may seem :—

" Have a Central Office,—say at Charing Cross. Let every Institution send a list of names of their nurses at home, and fit to start for cases. Let the list come in by ten a.m, every morn- ing. Much time would be saved. The name of the nurse and institution, and nature of case given ; the message could be sent at once to the institution, or a reply sent, if all nurses of that establish- ment were engaged. People in the country, and London, too, often do not know where to send when they want a nurse ; and their doctor is as often unsuccessful when he writes for one. If the various institu- tions could meet and discuss it, I think the plan would work admirably. Medical men, too, cannot always get the nurse they want for a par- ticular case, but know of another nurse equally good in the same line, who nursed a case they saw in consultation ; they could find out in a moment at this Central Office if she were engaged or not."

A chapter on "The Doctor," and one on "The Clergyman," call for no special remark, beyond that they are written in a spirit of fairness and discretion which tells of large experience. We have no desire to carp at the few points upon which we differ from Mr. Brinckman, for we cannot but think that most of those who minister by the bed-side of the sick might study his remarks on their position and their duties with advantage. The concluding chapters of the book, "On the Intermediate State," and "Love beyond the Grave," we are glad to be able to pass over without notice. They have nothing to do with nursing, and we only regret that they have been published by Mr. Brinekmau in the present volume, inasmuch as they may offend many of those who go about seeking for theological offence, and who may fall foul of these chapters, instead of paying attention to what all will regard as the practical and valuable portion of the book. We are not sure, too, that a chapter on the treatment of the body "After Death" is completely appropriate in a work like the present. It is not only cakulated to shock any anxious watcher who should turn to the book for advice in the ease of a dearly-loved sufferer, but it is in itself somewhat fan- tastic, as well as lugubrious. Indeed, the tone of the whole book is rather calculated to give the reader an idea that death, and not recovery, is the end of all nursing, and it is not until we had learned the nature of the author's official nursing work that we easily understood this. Mr. Brinckman is chaplain to a hospital -where only those who are "very ill or dying" are admitted, and few of the patients, we presume, leave its walls alive. We have no doubt at all of the value of St. Agnes' Hospital as a charity, but we can quite understand why the visiting Chap- lain should have a somewhat lugubrious impression of hospital

work. The author's experiences, however, are by no means con- fined to this peculiar institution, and he gives us in his book a -very good chapter on hospitals in general. Indeed this par- ticular chapter is full of excellent suggestions, and space alone prevents our dilating upon a subject which is well deserving of an article to itself.