her with
strangers and to put aside any nurse with whom she may have grown
familiar. As I have sometimes succeeded in treating invalids in their
own homes, so have I occasionally been able to carry through cases
nursed by a mother, or sister, or friend of exceptional firmness; but to
attempt this is to be heavily handicapped, and the position should never
be accepted if it be possible to make other arrangements. Any firm,
intelligent woman of tact, a stranger to the patient, is better than
the old style of nurse, now, happily, disappearing. The nurse for these
cases ought to be a young, active, quick-witted woman, capable of firmly
but gently controlling her patient. She ought to be intelligent, able to
interest her patient, to read aloud, and to write letters. The more of
these cases she has seen and nursed, the easier becomes the task of the
doctor. Young, I have said she ought to be, but youthful would be a
better word. If, as she grows older, the nurse loses the strenuous
enthusiasm with which she made her first entrance into her work,
scarcely any amount of conscientious devotion or experience will ever
replace it; but there are fortunate people who seem never to grow old in
this sense. It is always to be borne in mind that most of these patients
are over-sensitive, refined, and educated women, for whom the
clumsiness, or want of neatness, or bad manners, or immodesty of a nurse
may be a sore and steadily-increasing trial. To be more or less isolated
for two months in a room, with one constant attendant, however good, is
hard enough for any one to endure; and certain quite small faults or
defects in a nurse may make her a serious impediment to the treatment,
because no mere technical training will dispense in the nurse any more
than in the physician with those finer natural qualifications which make
their training available. Over-harshness is in some ways worse than
over-easiness, because it makes less pleasant the relation between nurse
and patient, and the latter should regard the former as her "next
friend." Let the nurse, therefore, place upon the doctor the burden of
decision in disputed matters; his position will not be injured with the
patient by strict enforcement of the letter of the law, while the
nurse's may be. But one nurse will suit one patient and not another: so
that I never hesitate to change my nurse if she does not fit the case,
and to change if necessary more than once.

The degree of seclusion