Florence Nightingale

FROM Notes on Nursing by Florence Nightingale (Harrison, bookseller to the Queen, 1859; p. 23)

“We must not forget what, in ordinary language, is called “Infection;”*** – a thing of which people are generally so afraid that they frequently follow the very practice in regard to it which they ought to avoid. Nothing used to be considered so infectious or contagious as small-pox; and people not very long ago used to cover up patients with heavy bed clothes, while they kept up large fires and shut the windows. Small-pox, of course, under this regime, is very “infectious.” People are somewhat wiser now in their management of this disease. They have ventured to cover the patients lightly and to keep the windows open; and we hear much less of the “infection” of small-pox than we used to do. But do people in our days act with more wisdom on the subject of “infection” in fevers–scarlet fever, measles, &c.–than their forefathers did with small-pox? Does not the popular idea of “infection” involve that people should take greater care of themselves than of the patient? that, for instance, it is safer not to be too much with the patient, not to attend too much to his wants? Perhaps the best illustration of the utter absurdity of this view of duty in attending on “infectious” diseases is afforded by what was very recently the practice, if it is not so even now, in some of the European lazarets–in which the plague-patient used to be condemned to the horrors of filth, overcrowding, and want of ventilation, while the medical attendant was ordered to examine the patient’s tongue through an opera-glass and to toss him a lancet to open his abscesses with?

True nursing ignores infection, except to prevent it. Cleanliness and fresh air from open windows, with unremitting attention to the patient, are the only defence a true nurse either asks or needs.

Wise and humane management of the patient is the best safeguard against infection.

*** I was brought up, both by scientific men and ignorant women, distinctly to believe that small-pox, for instance, was a thing of which there was once a first specimen in the world, which went on propagating itself, in a perpetual chain of descent, just as much as that there was a first dog, (or a first pair of dogs,) and that small-pox would not begin itself any more than a new dog would begin without there having been a parent dog.

Diseases are not individuals arranged in classes, like cats and dogs, but conditions growing out of one another.

Since then I have seen with my eyes and smelt with my nose small-pox growing up in first specimens, either in close rooms, or in overcrowded wards, where it could not by any possibility have been “caught,” but must have begun.

Nay, more, I have seen diseases begin, grow up, and pass into one another. Now, dogs do not pass into cats.

I have seen, for instance, with a little overcrowding, continued fever grow up; and with a little more, typhoid fever; and with a little more, typhus, and all in the same ward or hut.

Would it not be far better, truer, and more practical, if we looked upon disease in this light?

For disease, as all experiences hows, are adjectives, not noun substantives.

[emphasis added]

Thank you, @sebpowell!

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