Florence Nightingale's Notes on Nursing

What It Is, and What It Is Not

Florence Nightingale's Notes on Nursing was first published in England in 1859 and in America in 1860. Her book clearly establishes her vision of nursing as a genuine natural healing practice, concerned with preventative medicine, and was a far cry from what the profession of nursing would become in the modern health care system.

Nightingale wrote about many of the essential beliefs of the natural hygiene movement. She referred to these hygienic beliefs as the "laws of life" that would give mothers knowledge of "how to give their children healthy existences." Further, she clearly placed the comfort and needs of the patient ahead of the thoughtless pursuit of science; a trait which is more commonly associated today with alternative medicine, than it is with conventional medicine.

Her book documents many different things. How influential science had become in the middle of the 19th century. Her concern with sanitation, hygiene, and miasmas. And, that some sanitary reforms had in fact been made in urban areas. She referred to "scientific physicians" as well as to the chemistry of food; not in terms of carbohydrates, protein and fat, but rather in terms of key elements such as hydrogen and nitrogen. She was obviously somewhat familiar with the existence of chemistry as she threw around terms like "carbonic acid" even though her preference was clearly for using natural hygienic terms like "vital power," "nature's reparative processes," "effluvia," and "putrefaction."

Nightingale made quite a number of astounding comments in this book of hers.

What do the bedridden really die from? "But in chronic cases, lasting over months and years, where the fatal issue is often determine at last by mere protracted starvation." And, "death, as every one of great experience knows, is far less often produced by any one organic disease than by some illness, after many other diseases, producing just the sum of exhaustion necessary for death."

"Almost all superstitions are owing to bad observation, to the post hoc, ergo propter hoc [defective reasoning]; and bad observers are almost all superstitious." Nightingale made quite a few comments on the proper observation of patients. Reading between the lines readers are left with the thought that observation and experience can be an effective tool to maintain health with and to deal with sickness and disease.

Nightingale even managed to knock the mindless pursuit of science. "It is not for the sake of piling up miscellaneous information or curious facts, but for the sake of saving life and increasing health and comfort. The caution may seem useless, but it is quite surprising how many men (some women do it too), practically behave as if the scientific end were the only one in view, or as if the sick body were but a reservoir for stowing medicines into, and the surgical disease only a curious case the sufferer has made for the attendant's special information [and ego gratification]. This is really no exaggeration."

And, how about this natural hygiene motto? "We know nothing of the principle of health, the positive of which pathology is the negative, except from observation and experience. And nothing but observation and experience will teach us the ways to maintain or to bring back the state of health. It is often thought that medicine is the curative process. It is no such thing; ... nature alone cures. ... And what [true] nursing has to do ... is to put the patient in the best condition for nature to act upon him."

Florence Nightingale even commented a few times on the mind-body connection. And, also, made many small observations, such as the English do not like sweet tasting foods in general or that "coffee is a better restorative than tea, but a greater impairer of the digestion."

This tiny book is still worthwhile reading for everyone since it covers the basics of hygiene, explains how to deal with sick people which can be applied to colds, flu and measles, and if you can read between the lines offers tips on how to survive a hospital experience. But, you will need to read it several times before you will pick up on all the subtleness of Florence Nightingale's witty prose.

Introduction

• "Shall we begin by taking it as a general principle--that all disease, at some period or other of its course, is more or less a reparative process."
• "The thing which strikes the experienced observer most forcibly is this, that the symptoms or the sufferings generally considered to be inevitable and incident to the disease are very often not symptoms of the disease at all, but of something quite different--of the want of fresh air, or of light, or of warmth, or of quiet, or of cleanliness, or of punctuality and care in the administration of diet, or each or of all of these."
• "If a patient is cold, if a patient is feverish, if a patient is faint, if he is sick after taking food, if he has a bed-sore, it is generally the fault not of the disease, but of the nursing."
• Nursing "has been [up to this point] limited to signify little more than the administration of medicines and the application of poultices. It ought to signify the proper use of fresh air, light, warmth, cleanliness, quiet, and the proper selection and administration of diet--all at the least expense of vital power to the patient."
• "God had made disease to be, viz., a reparative process."
• "Nursing ought to assist the reparative process [of nature]."
• Nightingale laments that "so deep-rooted and universal is the conviction that to give medicine is to be doing something, or rather everything; [but] to give air, warmth, cleanliness, etc., is to do nothing." Reading between the lines, the reader is left to figure out for themselves that this 'nothing' is precisely what "true nursing" should be concerned with.
• "The causes of the enormous child mortality are perfectly well known; they are chiefly want of cleanliness, want of ventilation, want of white-washing; in one word, defective household hygiene."

Chapter 1: Ventilation and Warming

• "First rule of nursing, to keep the air within as pure as the air without."
• By reading between the lines the reader is asked by Nightingale to compare the difference between a murderer trying to justify his crime by saying that it is alright, to the victim of nursing neglect who often likewise says that everything is alright. And asks are we not all mad for allowing murderers in the form of "musty unaired unsunned room, the scarlet fever which is behind the door, or the fever and hospital gangrene which are stalking among the crowded beds of a hospital" to kill those who are under our care?
• "What will they say if it is proved to be true that fully one-half of all the disease we suffer from is occasioned by people sleeping with their windows shut?"
• "Even in health people cannot repeatedly breathe air in which they live with impunity, on account of its becoming charged with unwholesome matter from the lungs and skin."

Chapter 2: Health of Houses

• "There are five essential points in securing the health of houses:
  1. Pure air;
  2. Pure water;
  3. Efficient drainage;
  4. Cleanliness;
  5. Light"
• "Badly constructed houses do for the healthy what badly constructed hospitals do for the sick."
• "You cannot have the air of the house pure with dung-heaps under the windows."
• "There are other ways of having filth inside a house besides having dirt in heaps. Old papered walls of years' standing, dirty carpets, uncleansed furniture, are just as ready sources of impurity to the air as if there were a dung-heap in the basement."
• "True nursing ignores infection, except to prevent it. Cleanliness and fresh air from open windows, with unremitting attention to the patient, are the only defense a true nurse either asks or needs."

Chapter 4: Noise

• "Unnecessary noise, or noise that creates an expectation in the mind, is that which hurts a patient."

Chapter 5: Variety

• Commenting on the mind-body connection: "Volumes are now written and spoken upon the effect of the mind upon the body. Much of it is true. But I wish a little more was thought of the effect of the body on the mind."

Chapter 8: Bed and Bedding

• "Feverishness is generally supposed to be a symptom of fever--in nine cases out of ten it is a symptom of bedding."
• "Can human perversity any farther go, in unmaking the process of restoration which God has made?"

Chapter 9: Light

• "It is the unqualified result of all my experiences with the sick, that second only to the need of fresh air is their need of light; that, after a close room, what hurts them most is a dark room."
• "Who has not observed the purifying effect of light, and especially of direct sunlight, upon the air of a room?"

Chapter 10: Cleanliness of Rooms and Walls

• "To dust, as it is now practiced, truly means to distribute dust more equally over a room."
• "For a sick room, a carpet is perhaps the worst expedient which could by any possibility have been invented."

Chapter 13: Observations of the Sick

• "The fault here generally lies in the cooking. It is not his 'appetite' which requires 'tempting,' it is his digestion which requires sparing. And good sick cookery will save the digestion half its work."
• "There may be four different causes, any one of which will produce the same result, viz., the patient slowly starving to death, from want of nutrition:
  1. Defect in cooking;
  2. Defect in choice of diet;Defect in choice of hours for taking diet;
  3. Defect of appetite in patient.
  4. Yet all these are generally comprehended in the one sweeping assertion that the patient has 'no appetite.'" [Today, the elderly still often are allowed to starve to death under hospice care.]
• "But if you cannot get the habit of observation one way or other, you had better give up the [idea of] being a nurse, for it is not your calling, however kind and anxious you may be."

Chapter 14: Conclusion

• "The surgical nurse must be ever on the watch, ever on her guard, against want of cleanliness, foul air, want of light, and of warmth."
• "Homeopathy has introduced one essential amelioration in the practice of physic by amateur females; for its rules are excellent, its physicking comparatively harmless--the "globule" is the one grain of folly which appears to be necessary to make any good thing acceptable. Let then women, if they will give medicine, give homeopathic medicine. It won't do any harm."

References

• Florence Nightingale, Notes on Nursing: What It Is, and What It Is Not. D. Appleton and Company, First American Edition, 1860.

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