sudden approach of
certain forms of death by violence; and as it is a knowledge of little
use I only mention it here as being the most startling example of what I
mean. In the nervous temperament the face becomes pale (this is the only
_recognized_ effect); in the sanguine temperament purple; in the bilious
yellow, or every manner of colour in patches. Now, it is generally
supposed that paleness is the one indication of almost any violent
change in the human being, whether from terror, disease, or anything
else. There can be no more false observation. Granted, it is the one
recognized livery, as I have said--_de rigueur_ in novels, but nowhere
else.

[38] I have known two cases, the one of a man who intentionally and
repeatedly displaced a dislocation, and was kept and petted by all the
surgeons, the other of one who was pronounced to have nothing the matter
with him, there being no organic change perceptible, but who died within
the week. In both these cases, it was the nurse who, by accurately
pointing out what she had accurately observed, to the doctors, saved the
one case from persevering in a fraud, the other from being discharged
when actually in a dying state.

I will even go further and say, that in diseases which have their origin
in the feeble or irregular action of some function, and not in organic
change, it is quite an accident if the doctor who sees the case only
once a day, and generally at the same time, can form any but a negative
idea of its real condition. In the middle of the day, when such a
patient has been refreshed by light and air, by his tea, his beef tea,
and his brandy, by hot bottles to his feet, by being washed and by clean
linen, you can scarcely believe that he is the same person as lay with a
rapid fluttering pulse, with puffed eye-lids, with short breath, cold
limbs, and unsteady hands, this morning. Now what is a nurse to do in
such a case? Not cry, "Lord bless you, sir, why you'd have thought he
were a dying all night." This may be true, but it is not the way to
impress with the truth a doctor, more capable of forming a judgment from
the facts, if he did but know them, than you are. What he wants is not
your opinion, however respectfully given, but your facts. In all
diseases it is important, but in diseases which do not run a distinct
and fixed course, it is not only important, it is essential that the
facts the nurse alone can observe, should be accurately observed, and
accurately