The “Observation of the Sick” is a quality which needs cultivation. “The most important practical lesson that can be given to nurses is to teach them what to observe,” writes Miss Nightingale, also “how to observe,” and to accurately state the result of observation. It is a more difficult thing to speak the truth than people commonly imagine. “Courts of justice seem to think that anybody can speak ‘the whole truth and nothing but the truth,’ if he does but intend it.” It requires many faculties combined of observation and memory to do that. She quotes a little incident to illustrate the point. “I know I fibs dreadful; but believe me, miss, I never finds out I have fibbed until they tells me so,” was a remark once made to her, which is, as she says, “one of more extended application than most people have the least idea of.”
Needless to say, unintentional “fibbing,” or in other words lack of observation, which leads a nurse to wrongly inform the doctor regarding the patient, often leads to disastrous results. “I knew,” says Miss Nightingale, “a very clever physician of large dispensary and hospital practice, who invariably began his examination of a patient with ‘Put your finger where you be bad.’ That man would never waste his time with collecting inaccurate information from nurse or patient.” Nothing leads to inaccurate information more than putting “leading questions” to sick people. “How do you sleep?” “How is your appetite?” A tactful and observant nurse will be better able to answer such questions than the patient himself.
Miss Nightingale thinks that Englishwomen are not naturally good observers, though capable of attaining to it by training. The French or Irish woman is much quicker. She records a homely little example of want of observation. “I remember when a child,” she writes, “hearing the story of an accident related by some one who sent two nieces to fetch a ‘bottle of sal-volatile from her room.’ ‘Mary could not stir,’ she said; ‘Fanny ran and fetched a bottle that was not sal-volatile, and that was not in my room.’ If Fanny had observed the bottle of sal-volatile in the aunt’s room every day she was there, she would have found it when it was suddenly wanted. This habit of inattention generally pursues a person through life, a woman is asked to fetch a large new-bound red book lying on the table by the window, and she fetches five small old boarded brown books lying on the shelf by the fire.”
In contrast to this type of careless person, Miss Nightingale instances the trained observations of a famous actress. “I was once taken,” she writes, “to see a great actress in Lady Macbeth. To me it appeared the mere transference upon the stage of a death-bed, such as I had often witnessed. So, just before death, have I seen a patient get out of bed and feebly re-enact some scene of long ago, exactly as if walking in sleep.” The actress played her part so well because she had actually observed life.
PARTHENOPE, LADY VERNEY.
(From the painting at Claydon by Sir William Richmond, R.A.)
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“The very alphabet of a nurse,” says Miss Nightingale, “is to observe so well that she is able to interpret every change which comes over a patient’s countenance, without causing him the exertion of saying what he feels.... A patient is not merely a piece of furniture, to be kept clean and arranged against the wall, and saved from injury or breakage—though to judge from what many a nurse does and does not do, you would say he was.” Then comes a caution that all sick people dislike being watched, and the nurse must observe without appearing to do so. Miss Nightingale relates that the best observer she ever knew was a distinguished doctor for lunacy. “He leans back in his chair, with half-shut eyes,” she relates, “and, meanwhile, he sees everything, observes everything, and you feel he knows you better than many who have lived with you twenty years. I believe it is this singular capacity of observation and of understanding what observed appearances imply which gives him his singular influence over lunatics.”
In a concluding chapter, Miss Nightingale refers to the dangers of “reckless physicking by amateur females,” and tells of the lady who, having procured a prescription for a blue pill which suited her during one indisposition, proceeded to dose not only herself but her family too, “for all complaints upon all occasions.” Then there are the women who have no ideas beyond calomel and aperients, and the Lady Bountifuls who dose their poorer neighbours with a favourite prescription when it would be doing more good if they persuaded the people to “remove the dung-hill from before the door, to put in a window which opens, or an Arnott’s ventilator, or to cleanse and lime-wash their cottages.”