Florence Nightingale: The Nightingale School: Collected Works of Florence Nightingale, Volume 12

Notes on Nursing: What It Is, and What It Is Not

Notes on Nursing: What It Is, and What It Is Not (library standard edition, 1860) Title page of Notes on Nursing. Library standard edition. Notes on Nursing: What It Is, and What It Is Not T he seldom-read second or ‘‘library standard’’ edition of Nightingale’s most famous book, Notes on Nursing: What It Is and What It Is Not, is published here in full. This is the most elegant of the four editions, and the one sent to Queen Victoria. None was intended for the use of hospital nurses but this one comes closest, adding some material pertinent to the professional nurse. Notes on Nursing for the Labouring Classes, the third edition, was published in Public Health Care, with detailed comparisons with both the first edition and this one.1 All that detail makes the evolution of the text clear, as Nightingale directed it to different types of reader, but makes for a cumbersome read. The intention here is to give the reader a clean text, with minimal intrusion. The brief markings make it easy to see the additions Nightingale made for this more educated readership. The simple title, Notes on Nursing, which was given to the fifth edition , put out by Nightingale’s family after her death, is used here when points are made that pertain to any edition. Read 150 years after it was written, Notes on Nursing appears to be archaic in parts, but is obviously bold and even radical in others. Three themes seem to have guided it: (1) the need to deal with environmental causes of disease by ensuring clean air, adequate ventilation , clean floors, bedding, etc., (2) insistence that the nurse’s role is to put the patient into the best situation for healing to take place, for cures come from God or Nature, not by chemical medicine; and (3) the contention that much suffering is caused not by the disease but prevailing poor environmental conditions. All the chapters on 1 For background see Victor Skretkowicz’s excellent critical edition of this same edition, which also provides a publishing history. For Harriet Martineau’s highly positive reviews of the first edition see ‘‘Miss Nightingale’s Notes on Nursing,’’ Quarterly Review 107 (1860):392-422, and ‘‘A Reverie after Reading Miss Nightingale’s Notes on Nursing,’’ Fraser’s Magazine (June 1860):753-57. / 577 these environmental conditions, notably on warmth, light, food and protection from intrusion, give specifics on how to prevent disease, promote healing and alleviate suffering. The environmental causes of disease are set out without explicit reference to miasmatic theory, Nightingale’s preferred theory when she wrote the book, as germ theory was still decades away from general acceptance in the scientific world. However, it will be perfectly clear that the measures she was proposing, notably high standards of cleanliness, were to keep germs, which she would have thought of as ‘‘miasms,’’ away from the patient. This is obvious in the very first chapter, which makes it the nurse’s responsibility to ensure that the patient has clean air, and that ongoing ventilation is effective. Some of the advice in Notes on Nursing is aimed more at family members and friends, especially difficult visitors, than of nurses. Aptly titled ‘‘Chattering Hopes and Advices,’’ this chapter appears in every edition, and is still a good read. Nightingale’s own experience of illness doubtless was a source, and her ability to empathize with the sick is patently clear. A curious chapter was added to this edition only: ‘‘Method of Polishing Floors,’’ a subject surely more relevant to hospital administrators than nurses. It serves, however, to show Nightingale’s understanding of the spread of disease, where it gives detailed instructions for cleaning floors without the use of water. The object was to remove fecal material brought into hospitals on people’s shoes, which spread germs. Water not only spread this disease source (if thought of as ‘‘miasms’’ rather than ‘‘germs’’) but encouraged their multiplication. Nightingale was a good germ practitioner long before she subscribed to the theory. In the first edition the ‘‘Conclusion’’ was the last chapter; here seven new chapters follow, some of which were included unchanged, some revised for, and some omitted from, the ‘‘labouring classes’’ editions , as indicated: Supplementary Chapter: What is a Nurse? (revised) Convalescence (revised) Children in London (omitted) Method of Polishing Floors (omitted) Note upon Some Errors in Novels (omitted) Note upon Employment of Women (included...