then call to mind all we know about nurses, and consider the proportion which the two classes of sick and nurses seem to bear to each other.
How much good nursing have any of us ever seen? At the mention of good nursing, the heart may spring to the touch of some precious remem- brance of exemplary nursing in a quiet home, where nothing was said about it, because it seemed to be a matter of course. Wherever there are mothers and daughters and sisters, there will be more or less good nursing, as far as it can be taught by good sense and affection, in the common maladies which befal individuals. But nursing is an art based upon science: and the resources of instinct, which are often insufficient in individual cases, are as nothing in the conflict with epidemic sickness, or when accidents and unusual diseases occur, or where numbers are down at once. Such a mortality as our Registrar’s returns show can be contended with only by a great body of trained nurses, whose vocation shall be recognised and respected by society.
To be, to do, and to talk “like an old nurse,” means to be positive, ignorant, superstitious, wrong-headed, meddlesome, gross, and disagree- able, and to speak and act accordingly. The i expression arose out of the deficiency of nurses, by which the occupation was delivered over to I women who coidd do nothing else, or who relished I the power and luxury enjoyed by the monthly nurse in comfortable houses. The monthly nurse was employed in sick -nursing too, no doubt: but the monthly engagement was the inducement, and that class of women were wilful, ignorant, and luxurious in proportion to their importance and their scarcity. We will not spend our space on the familiar story of the tricks and foibles and disgusting selfishness of the traditionary nurse.
The image may be found in a multitude of works of fiction, and the reality in most elderly people’s recollections of their early life. Let her retire behind the curtain to doze and booze and maunder out her queer notions about diseases and remedies. We have to study newer specimens of the same order of functionaries.
In every town, great or small, we know some widow or spinster who gets her living by nursing among the cottagers or small shopkeepers and artisans. She knows how to manage lying-in cases, in a general way, and she is a good creature in all cases. She is kind when called in the night, and she is willing and ready to sweep the room, and wash the patient, and make the cup of tea or gruel. The greater part of the nursing which is done by hire is done by this sort of woman: and she is immeasurably better than nobody; but she knows nothing of the structure of the human body and its various organs and their uses; she is not enlightened about the importance of air, light, or temperature; she has wild notions about food and medicines and infection and the character of diseases; and it is a great thing if she is able to dress blisters or apply leeches or fomentations skilfully. Formerly it was very difficult to find anybody of a higher quality than this when a hired nurse was wanted in a family; and even now, the grand perplexity of physicians is to answer the demands upon them to supply well-qualified nurses in any proportion to the patients who require them.
The census returns of 1851 throw some light upon the facts of the proportion of nurses to the sick. Domestic nurses (meaning nursemaids) are a separate class, though the chief part of the tending of children in sickness is done by them. They amount to nearly 40,000, of whom, strange to say, almost half are between five and twenty years of age. We find under this head the little nurse-girl, who may be met in a town alley, sitting on a door-step, rocking a baby to sleep, or carrying it bent double on her arm, while her own shoulder is growing out, or her spine getting twisted with carrying a heavy weight before she has done growing. Convulsions, croup, accidents kill a multitude of infants in such hands, who might live to die of old age if there was anybody to show how to ward off or treat such misfortunes. But, though the attendants of children are called nurse-maids, the last thing that they are taught is anything about nursing.
Going on, then, to the class which claims the title, in virtue of actually professing to nurse, we find that in Great Britain there are, including monthly nurses, above 25,000 women who take charge of the sick professionally. In comparison with the deaths, and infinitely more with the sickness in the kingdom, this number is almost incredibly small. It would seem a mere nothing if we did not remember that a large proportion of them are hospital nurses — each one taking charge of many patients. In fifteen London hospitals there were, last year, 521 nurses of every class. Every large town in the provinces probably has its infirmary or hospital, with a staff of nurses. It has been proposed to fix twenty-five patients as the proper number to be attended to by a single nurse; and this may serve as some sort of a guide in contemplating the extent of the need of more nurses; but we are told by experienced persons that no such rule can be enforced, nor ever could be, if hospitals were much better organised than they have hitherto been. In military hospitals, for instance, in time of peace, the patients are, on an average, very slightly ill in comparison with the inmates of a civil hospital; and it may be easier to attend upon fifty of the regimental patients than five-and-twenty in a city or county infirmary. There must be endless varieties, too, in the fatigue of the office according to the management of the institution. For instance, in one there may be such arrangements as that the nurses are at liberty to spend their whole time among the beds of their patients, while elsewhere the nurse is expected to carry up coals and water, and carry down trays, and fetch and carry and even wash the linen, and go for the medicine, and cook the diets. Supposing, however, that every hospital was well managed, there would still be a sad deficiency of desirable nurses: and when the number of sick throughout the kingdom are considered, the paucity of qualified attendants is really terrible.
The thought is not new. For half a century at least it has been a subject of speculation, through the press, in lectures, and in conversation, why the deficiency remains so great, and how to supply
it. Considering the vast number of English-