reported to the doctor.

I must direct the nurse's attention to the extreme variation there is
not unfrequently in the pulse of such patients during the day. A very
common case is this: Between 3 and 4 A.M. the pulse becomes
quick, perhaps 130, and so thready it is not like a pulse at all, but
like a string vibrating just underneath the skin. After this the patient
gets no more sleep. About mid-day the pulse has come down to 80; and
though feeble and compressible is a very respectable pulse. At night, if
the patient has had a day of excitement, it is almost imperceptible.
But, if the patient has had a good day, it is stronger and steadier and
not quicker than at mid-day. This is a common history of a common pulse;
and others, equally varying during the day, might be given. Now, in
inflammation, which may almost always be detected by the pulse, in
typhoid fever, which is accompanied by the low pulse that nothing will
raise, there is no such great variation. And doctors and nurses become
accustomed not to look for it. The doctor indeed cannot. But the
variation is in itself an important feature.

Cases like the above often "go off rather suddenly," as it is called,
from some trifling ailment of a few days, which just makes up the sum of
exhaustion necessary to produce death. And everybody cries, who would
have thought it? except the observing nurse, if there is one, who had
always expected the exhaustion to come, from which there would be no
rally, because she knew the patient had no capital in strength on which
to draw, if he failed for a few days to make his barely daily income in
sleep and nutrition.

I have often seen really good nurses distressed, because they could not
impress the doctor with the real danger of their patient; and quite
provoked because the patient "would look," either "so much better" or
"so much worse" than he really is "when the doctor was there." The
distress is very legitimate, but it generally arises from the nurse not
having the power of laying clearly and shortly before the doctor the
facts from which she derives her opinion, or from the doctor being hasty
and inexperienced, and not capable of eliciting them. A man who really
cares for his patients, will soon learn to ask for and appreciate the
information of a nurse, who is at once a careful observer and a clear
reporter.

[39]

[Sidenote: Danger of physicking by amateur females.]

I have known many ladies who, having once obtained a