Notes on Nursing

Notes on Nursing: What It Is, and What It Is Not is a book by Florence Nightingale, printed in London by Harrison and Sons, with the imprint line naming Harrison, bookseller to the Queen. In its preface she says the notes are not a rule by which nurses can teach themselves, and not a manual for training nurses. They are meant to give hints for thought to women who have personal charge of the health of others. Her reasoning is that almost every woman in England will at some time have charge of a child or an invalid, so in effect every woman is a nurse.

The opening chapters set out a general principle. Nightingale proposes that disease, at some stage of its course, is a reparative process, an effort of nature to remedy poisoning or decay that began unnoticed long before. She expects objections and answers them with a comparison to Mont Blanc: we should finish making the earth healthy at the bottom before arguing about the summit.

Her central claim is that many symptoms and sufferings assumed to belong to a disease actually come from something else. She names the want of fresh air, light, warmth, quiet and cleanliness, and a lack of punctuality and care in giving food. If a patient is cold, feverish, faint, sick after eating or suffering a bed-sore, she says, the fault is generally not the disease but the nursing.

She therefore redefines the word nursing. It had been limited to giving medicines and applying poultices. She argues it should mean the proper use of fresh air, light, warmth, cleanliness and quiet, and the right choice and administration of diet, all at the least expense of vital power to the patient. She also holds that the very elements of nursing are all but unknown, and she rejects the saying that every woman makes a good nurse. She adds that bad sanitary, architectural and administrative arrangements can make nursing impossible.

The text also turns to the well. The same laws of health apply to the healthy as to the sick. Addressing mothers directly, she cites the high death rates of infants in England and asks whether such suffering is necessary. She criticises a society that teaches girls the elements of astronomy while leaving the laws of health unlearnt, and she answers the complaint that circumstances such as the east wind lie beyond our control.

The first numbered chapter, Ventilation and Warming, gives what she calls the first canon of nursing: keep the air the patient breathes as pure as the external air, without chilling him. She warns against taking air from corridors, halls, kitchens or sewers, and against closed, unused rooms with stagnant air. The contents list continues with chapters on the health of houses, petty management, noise, variety, food, bed and bedding, light, cleanliness, chattering hopes and advices, and observation of the sick, followed by a conclusion and an appendix.