While she was not writing about people quarantined in their homes, Florence Nightingale’s Notes on Nursing (1859) were about caring for people in their homes, and doing it well.
Nightingale is known, of course, for her service during the Crimean War and her active reform of nursing and hospital hygiene in the mid-Victorian era. She’s the one who realized that many deaths in military hospitals were unnecessary, caused by unhygenic conditions rather than wounds or injury. And she came to this conclusion when aneasthetics were in early days, and antiseptics as yet unknown (Joseph Lister would start his famous work after the war).
Contrary to her “lady with the lamp” image, Nightingale was a no-nonsense, if not actually abrasive, person. She was once even cussed out by a doctor who might have been the first woman to get a medical degree in Britain, except that s/he identified as a man (more on this person in a future post).
I have had a copy of Nightingale’s Notes on Nursing for awhile. I don’t even recall why I bought it. I assumed it was a book for teaching nurses, since Nightingale founded her school of nursing at St. Thomas’s Hospital. But it’s a book about nursing, not just in hospitals, but in the home. And her emphasis, not surprisingly, in on creating healthy conditions.
It is also not surprising that this was considered a job for women, and in my opinion this book should reside on a shelf alongside Mrs. Beeton’s Book of Household Management, published in series at the same time, and printed as a book only two years later. Most people know that Ms. Nightingale was a big advocate of fresh air. In fact, the odd configuration of the new St. Thomas’s Hospital, opened in 1867, was the result of her promotion of cross-ventilation.
Have you ever opened a window for fresh air, and it became so chilly you wished you could leave the heat on? Nightingale recommends this, or at least keeping the fire going with a window open, so that an ill person can have fresh air. She points out that you can keep the patient warm with blankets, and safely allow fresh cold air into the room.
Her book also notes that opening doors and windows is to no avail if the air that comes in isn’t fresh. If your room opens onto a utility closet, or you leave your chamber pot open under the bed (oh those master bathrooms!), or your window overlooks a refuse heap, you are not doing any good with air. Ill people really should be taken out into the garden to get a little sun and air, which I see done all too seldom. I’ve been in elder nursing homes where the windows don’t open and the only outside is a little paving of cement in a courtyard. Nightingale was not a fan of courtyards — the air isn’t fresh enough, going round and round.
Too much bedding, too many visitors
All of her advice was based not only on her experience, but on research and statistics. Her faith in scientific endeavor was firm. In the early 1860s, when the plot was being hatched for passing the Contagious Diseases Act, she argued against it based on statistics. The idea was that preliminary arrest and examination of prostitutes would prevent venereal disease in the military. The act would give the police power to arrest any woman they suspected of being a prostitute. Many who were against the idea argued on the basis of feminine modesty, or the inappropriateness of making a private disease a public issue, or the likely abuses by the police. Nightingale argued on facts: everywhere that harsh measures arresting and examining prostitutes had been enforced by a state, the V.D. numbers had actually increased rather than decreased.
Her household nursing advice seems so common-sense, and yet is often ignored, then and now. She had to recommend that damp towels be spread out to dry, that one not chit-chat inanely with someone who wasn’t feeling well, and that one should always sit beside the sickbed rather than hovering over it, forcing the ill person to crane their neck. And here’s more:
- Reading the patient the funny bits of a book you’re reading (update: bits and memes off the internet) is extremely annoying to the ill person.
- Quiet is important, because when someone is ill certain sounds can be distressing or even intolerable.
- A bedroom, where one sleeps, is not the same as a sickroom. A person in bed because they are ill needs not only air but light, and should be able to see out an open window.
- The bed needs to be aired daily — in fact Nightingale suggests two different beds so the sheets of one can always be aired. Not doing this, or using too much bedding and thick mattresses, leaves the patient essentially in their own waste of sweat and their own breathed air. (The current metal hospital bed is likely based on the iron ones she recommended.)
- Cleaning must be thorough. Damp cloths, not dusters that just raise the dust into the air. Carpets are horrible even if lifted and beaten 3 times a year (I can just imagine what she’d think of wall-to-wall carpeting). Bad smells indicate organic matter is stuck to things, and it shouldn’t be.
See why I want this filed next to Mrs. Beeton? It’s far less about medical nursing than about good housekeeping. The medical advice reminded me of Hippocrates, especially when it came to diet (“The diet which will keep the well man healthy may kill the sick one”). But at this time, when there is more than the usual concern about people being ill at home, it’s still good advice.