Mohammad Al-Ubaydli’s blog

Notes on Nursing

Posted in Books, History, Medicine, People / organisations by Dr Mohammad Al-Ubaydli on September 11, 2008
Book cover for Notes on Nursing

Book cover for Notes on Nursing

In my opinion, England’s greatest contributions to medicine were the creation of the nursing profession by Florence Nightingale, the invention of the hospice by Cicely Saunders, and the discovery of antibiotics by Alexander Fleming.

The main reason I include Fleming is that his discovery was only possible because he was so sloppy in his lab work, giving me hope that I too can one day do something useful. Saunders started as a nurse, trained as a doctor so that her reforms would be accepted, and eventually became Dame Sicly in recognition of her work. But if I understood correctly Nightingale was vilified by anti-feminists in her lifetime.

So it is with great delight that I finally sit down and read Notes on Nursing by Nightingale. The Univeristy of Pennsylvania has the complete version on the web, nicely hyperlinked, but I am reading the Kindle Edition of course. I usually highlight interesting and noteworthy sentences on the Kindle but I find myself highlight almost every sentence within the first few pages.

This is a charming book and I recommend you read it.

Here is my favorite quotation so far, a footnote about the fact that “one in every seven infants in this civilized land of England perishes before it is one year old? That, in London, two in every five die before they are five years old? And, in the other great cities of England, nearly one out of two”.

Upon this fact the most wonderful deductions have been strung. For a long time an announcement something like the following has been going the round of the papers:–”More than 25,000 children die every year in London under 10 years of age; therefore we want a Children’s Hospital.” This spring there was a prospectus issued, and diverse other means taken to this effect:–”There is a great want of sanitary knowledge in women; therefore we want a Women’s Hospital.” Now, both the above facts are too sadly true. But what is the deduction? The causes of the enormous child mortality are perfectly well known; they are chiefly want of cleanliness, want of ventilation, want of whitewashing; in one word defective household hygiene. The remedies are just as well known; and among them is certainly not the establishment of a Child’s Hospital. This may be a want; just as there may be a want of hospital room for adults. But the Registrar-General would certainly never think of giving us as a cause for the high rate of child mortality in (say) Liverpool that there was not sufficient hospital room for children; nor would he urge upon us, as a remedy, to found an hospital for them.

Her grasp of what to do with statistics is better than that of most doctors. I see from the Wikipedia article about Nightingale that she had “had exhibited a gift for mathematics from an early age and excelled in the subject under the tutorship of her father and later the tutorship of mathematician James Joseph Sylvester“.

I am struck by two other ideas from the beginning of the book. First, she keeps on putting forward the view of disease as a reparative process

disease, at some period or other of its course, is more or less a reparative process, not necessarily accompanied with suffering: an effort of nature to remedy a process of poisoning or of decay, which has taken place weeks, months, sometimes years beforehand, unnoticed, the termination of the disease being then, while the antecedent process was going on, determined?

It took me a few repititions before I understood what she meant because I was still in the mindset that disease is a pathological process that doctors treat. Instead her thinking is of diseases as the manifestation of the body’s attempts at healing, attempts that nurses try to help along. This reminded me of a program to help the elderly look after themselves during the winter months as so many die from hypothermia. The social workers tried to teach that, since 25% of heat is lost through the head, wearing a hat indoors is a good thing to minimze heat loss. Few wore a hat. But when they rephrased this as 25% of cold gets through the head, and that a hat prevents entry of the cold, many more of the elderly participants put their hat on.

Second, I am fascinated by her insistance on good ventillation

The very first canon of nursing, the first and the last thing upon which a nurse’s attention must be fixed, the first essential to a patient, without which all the rest you can do for him is as nothing, with which I had almost said you may leave all the rest alone, is this: TO KEEP THE AIR HE BREATHES AS PURE AS THE EXTERNAL AIR, WITHOUT CHILLING HIM. Yet what is so little attended to? Even where it is thought of at all, the most extraordinary misconceptions reign about it. Even in admitting air into the patient’s room or ward, few people ever think, where that air comes from. It may come from a corridor into which other wards are ventilated, from a hall, always unaired, always full of the fumes of gas, dinner, of various kinds of mustiness; from an underground kitchen, sink, washhouse, water-closet, or even, as I myself have had sorrowful experience, from open sewers, loaded with filth; and with this the patient’s room or ward is aired, as it is called–poisoned, it should rather be said. Always air from the air without, and that, too, through those windows, through which the air comes freshest. From a closed court, especially if the wind do not blow that way, air may come as stagnant as any from a hall or corridor.

Her book was published in 1860, so soon after Pasteur was forumlated germ theory and a year before Semmelweiss lost his sanity from trying to explain to doctors how germs spread to patients. (Hint: it’s was iatrogenic.) This was a wonderful woman, well ahead of her time.

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