BY
FLORENCE NIGHTINGALE.
LONDON:
HARRISON, 59, PALL MALL,
BOOKSELLER TO THE QUEEN.
[The right of Translation is reserved.]
PRINTED BY HARRISON AND SONS,
ST. MARTIN'S LANE, W.C.
The following is from pages 18-20
I will tell you what was the cause of this hospital pyæmia being in that large private house. It was that the sewer air from an ill-placed sink was carefully conducted into all the rooms by sedulously opening all the doors; and closing all the passage windows. It was that the slops were emptied into the foot pans;—it was that the utensils were never properly rinsed;—it was that the chamber [Pg 18]crockery was rinsed with dirty water;—it was that the beds were never properly shaken, aired, picked to pieces, or changed. It was that the carpets and curtains were always musty;—it was that the furniture was always dusty; it was that the papered walls were saturated with dirt;—it was that the floors were never cleaned;—it was that the uninhabited rooms were never sunned, or cleaned, or aired;—it was that the cupboards were always reservoirs of foul air;—it was that the windows were always tight shut up at night;—it was that no window was ever systematically opened, even in the day, or that the right window was not opened. A person gasping for air might open a window for himself. But the servants were not taught to open the windows, to shut the doors; or they opened the windows upon a dank well between high walls, not upon the airier court; or they opened the room doors into the unaired halls and passages, by way of airing the rooms. Now all this is not fancy, but fact.
In that handsome house I have known in one summer three cases of hospital pyæmia, one of phlebitis, two of consumptive cough: all the immediate products of foul air. When, in temperate climates, a house is more unhealthy in summer than in winter, it is a certain sign of something wrong. Yet nobody learns the lesson. Yes, God always justifies His ways. He is teaching while you are not learning. This poor body loses his finger, that one loses his life. And all from the most easily preventible causes.[9]
The houses of the grandmothers and great grandmothers of this generation, at least the country houses, with front door and back door always standing open, winter and summer, and a thorough draught always blowing through—with all the scrubbing, and cleaning, and polishing, and scouring which used to go on, the grandmothers, and still more the great grandmothers, always out of doors and never with a bonnet on except to go to church, these things entirely account for the fact so often seen of a great grandmother, who was a tower of physical vigour descending into a grandmother perhaps a little less vigorous but still sound as a bell and healthy to the core, into a mother languid and confined to her carriage and house, and lastly into a daughter sickly and confined to her bed. For, remember, even with a general decrease of mortality you may often find a race thus degenerating and still oftener a family. You may see poor little feeble washed-out rags, children of a noble stock, suffering morally and physically, throughout their useless, degenerate [Pg 19]lives, and yet people who are going to marry and to bring more such into the world, will consult nothing but their own convenience as to where they are to live, or how they are to live.
With regard to the health of houses where there is a sick person, it often happens that the sick room is made a ventilating shaft for the rest of the house.
For while the house is kept as close, unaired, and dirty as usual, the window of the sick room is kept a little open always, and the door occasionally. Now, there are certain sacrifices which a house with one sick person in it does make to that sick person: it ties up its knocker; it lays straw before it in the street. Why can't it keep itself thoroughly clean and unusually well aired, in deference to the sick person?
We must not forget what, in ordinary language, is called "Infection;"[10]—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 régime, 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.
Footnote [10]
Is it not living in a continual mistake to look upon diseases, as we do now, as separate entities, which must exist, like cats and dogs? instead of looking upon them as conditions, like a dirty and a clean condition, and just as much under our own control; or rather as the reactions of kindly nature, against the conditions in which we have placed ourselves.
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.
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 diseases, as all experience shows, are adjectives, not noun substantives.
Florence Nightingale had a belief that the external environment created conditions for people to have infections. Cleanliness and fresh air were imperative for prevention of disease and assisting the healing process. She gives the impression that foul air is the cause of disease and may have been influenced by the concept of miasma, that illnesses were airborne. Yet, in her footnote, under the category of infection, she makes two remarkable statements concerning her observation of smallpox and what appears to be pleomorphism.
Smallpox she asserts appeared in persons who could not have caught the disease externally, because they had been in quarantined conditions within a ward. Interestingly, she could smell the disease, she was so intimate with it. Yet she did not catch it herself. The contagiousness of smallpox therefore becomes doubtful.
Fever she says has morphed into typhoid fever then typhus as the ward has become more crowded. Taking into account what appears to be Nightingale's underlying thesis that environmental conditions are the cause of a disease growing from within the individual rather than being passed on from another who caught it externally, pleomorphism becomes the reason for disease severity as it progresses from its initial stage to its most deadly stage.
Typhoid is supposedly transmitted to humans through fecal affected food or dirty hands. Typhus is supposedly transmitted by fleas. Evidently, they are identifiable by two different types of bacteria. However, it would be interesting to see how reliable these claims are when placed under scrutiny and tests are requested to see whether either typhoid or typhus is detected with controls or when a patient with, say, typhoid is asked to be tested for typhus and vice versa.
From what has been demonstrated by the late President John Magufuli of Tanzania (an industrial chemist himself) testing for disease is suspect. He sent samples of papaya, goat, and other tissue to be tested for the fake human coronavirus. The specimens came back from the laboratory as positive. Laboratories will produce whatever the technicians think will keep them in employment.
While Florence Nightingale may have had a fixation for cleanliness, fresh air and systematic attendance of patients in hospitals or wherever they may be bedridden, she also made some observations that medical professionals indoctrinated into the allopathic mindset of germ theory are not too keen to admit occurred. "I have seen diseases begin, grow up, and pass into one another," she wrote.
Those discussing her writings tend to dismiss her idea about foul air as an emotional conclusion as to why disease might exist and limit her contribution to nursing only, by emphasizing her calls cleanliness and systematic observation of patients, not realizing that by conditions, she was implying that all diseases are actually the response of a malnourished body to an unhealthy environment.
Bacteria, bacteriophages, which are often mistaken for viruses, as are extracellular vesicles, of which include exosomes, microvesicles (MVs), ectosomes, oncosomes, and apoptotic bodies. Now what are being given different names could very well be what have been observed in the past and termed protits, somatids, and microzyma.
At the crux of germ theory is the idea that the germ, whatever it might be, attacks a healthy or susceptible person, creature or plant and begins to destroy it. This might be the case with amoebas such as Naegleria fowleri which is said to enter the brain through the nasal passage, cross the cribriform plate and begin feeding on cerebral tissue, killing the person. But this is better classified as a parasite. It is not contagious, but opportunistic. The same could be said about fungal spores that are known to cause illness when people are living or sleeping in a room that is damp and moss is growing on the walls and ceiling. Even under these circumstances, a healthy individual may not be affected by the fungus. Much depends upon the nutritional intake of the individual. As with scurvy, an element of malnourishment needs to be present for it to ravage the body. Merely having insufficient vitamins to maintain healthy tissue is malnourishment.