en 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 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 become 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 rathe