Home, Sick: Dogs as Nurses (with apologies to Florence Nightingale)

In 1860, Florence Nightingale published her guide to taking care of the sick, Notes on Nursing. Explaining in her introduction that “every woman is a nurse,” she explicitly addresses herself not to professional women, but to mothers and female heads of household--all of whom, she imagined, would at some point have a sick person in their “charge.” While Nightingale discusses issues of diet and medicine, her focus is on what she calls “the health of houses” and the role of women in organizing the house—shutting doors and opening windows, getting rid of “effluvia” or toxic elements in the atmosphere—in such a way as to promote the well-being of the inhabitants. Nightingale was one of the last influential anti-contagionists, resisting all her life any idea of infection from person to person—and indeed any sense that diseases were caused by specific agents. For Nightingale, disease was all about the environment, and the most important environment was the home.

During a recent stint of minor illness, during which I stayed home and was attended to by my dogs for a few days, I returned to a playful Facebook post from several years ago in which I speculated about how Nightingale would have assessed dogs as nurses. It turns out that although they break some of Nightingale’s rules for patient care (and who doesn’t?) they would make surprisingly good home nurses according to the criteria she lays out. Here are some pros and cons of dog nursing. Quotations from Nightingale are in italics.

A nurse who rustles (I am speaking of nurses professional and unprofessional) is the horror of a patient, though perhaps he does not know why. The fidget of silk and of crinoline, the rattling of keys, the creaking of stays and of shoes, will do a patient more harm than all the medicines in the world will do him good.

Innocent of silk or crinoline, dogs almost never rustle as they go about their healing duties. Although some make a slight clicking sound as their tags clink into their collars, creaking is unknown.

Compelled by her dress, every woman now either shuffles or waddles—only a man can cross the floor of a sick-room without shaking it! What is become of woman’s light step?—the firm, light, quick step we have been asking for?

It is not, in fact, “only a man” who can cross the floor without waddling. Except, perhaps for the very obese among them, dogs have the firmness and lightness in their step for which Nightingale searches in vain among women. Firm and light and quick in their inevitable leaps upon the bed, firm and quick if slightly less light as the patient shoves them off it, dogs never cause the patient to wonder who or what is in the room—a state of suspense and anxiety that Nightingale blames for many a relapse. 

Whispered conversation in the room. . ., is absolutely cruel;  for it is impossible that the patient’s attention should not be involuntarily strained to hear. Walking on tip-toe, doing any thing in the room very slowly, [is] injurious, for exactly the same reasons . . . I need hardly say that  . . .  for a doctor or friend to leave the patient and communicate his opinion on the result of his visit to the friends just outside the patient’s door, or in the adjoining room . . .  within hearing or knowledge of the patient is, if possible, worst of all.

Since dogs rarely diagnose, and never whisper, this is a transgression from which the patient nursed entirely by dogs is quite safe. (See “noise”, below) No one has ever accused a dog of overusing an indoor voice, or of being coy about communication. Although Notes on Nursing does not say much about the issue of privacy, other Victorian commentators, like Harriet Martineau, emphasize the need for nurses to respect patient boundaries, especially with regard to letters or papers. Although it is possible that your dog nurse will eat or otherwise destroy a letter addressed to you, it is unlikely that he or she will read it.

Never let a patient be waked out of his first sleep.

This is, alas, a problem for those nursed by dogs. First, second, or last, a patient’s sleep is vulnerable to canine interruption, particularly if dog nurses are allowed on (or otherwise find themselves) on the bed. 

There are certain patients, no doubt, especially where there is slight concussion or other disturbance of the brain, who are affected by mere noise. But intermittent noise, or sudden and sharp noise, in these as in all other cases, affects far more than continuous noise—noise with jar far more than noise without. . . Unnecessary noise, or noise that creates an expectation in the mind, is that which hurts a patient. It is rarely the loudness of the noise, the effect upon the organ of the ear itself, which appears to affect the sick. 

Although, as we have learned, dogs do not tend to rustle, they do tend to bark, and thus to raise “expectation(s)” in the “mind” of the patient. A sick person might wonder about the cause of all the “concussive” noise. Is it a visitor? A burglar? An Amazon delivery person bringing medicine or food? A neighbor daring to walk a dog within smelling distance of the canine nurse(s)? It is not only the “sudden and sharp” sound that is a problem for Nightingale, but the burden on the patient to interpret the sound.

For the same reasons, always tell a patient and tell him beforehand when you are going out and when you will be back, whether it is for a day, an hour, or ten minutes. You fancy perhaps that it is better for him if he does not find out your going at all, better for him if you do not make yourself “of too much importance” to him; or else you cannot bear to give him the pain or the anxiety of the temporary separation.

This aspect of dog nursing involves assessing canine relations to futurity—a hotly debated topic in animal studies. Given that, in my experience, dogs are rarely comforted by verbal assurances of human return—say from vacation, work, grocery shopping or weeding in the back yard—I would say they are not in a position to offer the kind of information to their human patients that Nightingale so earnestly recommends. There is also, of course, the larger question of language, which cannot, alas, be resolved here. The good news, canine-nursing-wise, is that it is very possible that your dog nurses will almost never leave your side, sharing with you, even in health, the “anxiety of temporary separation.” 

The careful nurse will keep the door shut while she shuts the windows, and then, and not before, set the door open, so that a patient may not be left sitting up in bed, perhaps in a profuse perspiration, directly in the draught between the open door and window.

Unfortunately, this central tenet of ventilation-forward Nightingale nursing is not in the doggie toolbox. Although many dogs can open doors, they have never, to my knowledge, been known to shut them. This deficiency of canine paws and inclinations is perhaps the most serious in the Nightingale nursing schema, which involves constant monitoring of the “skin” of the house, its entrances, exits, and pores. Dogs, like Nightingale--and like the ideal Nightingale mother/nurse--do tend to make a huge fuss about thresholds, but it is probably not the right kind of fuss.

[If] the female head in charge of any building does not think it necessary to visit every hole and corner of it every day. . . how can she expect those who are under her to be more careful to maintain her house in a healthy condition than she who is in charge of it?

Who is better than a dog at visiting every “hole and corner” of a house, both in the presence or the absence of the “female head in charge?” 

Let no one ever depend upon fumigations, “disinfectants,” and the like, for purifying the air. The offensive thing, not its smell, must be removed.

Writing in a culture that thought “all smell is disease,” Nightingale recommends a rigorous –and indeed doglike--search for the origin of smells. Dogs, of course, would never fumigate or disinfect. On the other hand, their very presence as nurses just might increase the possibility that the sick room would include one or more “offensive things,” many of which might smell.

Of the fatal effects of the effluvia from the excreta it would seem unnecessary to speak, were they not so constantly neglected. 

All canine nurses must be house trained.

A careful nurse will keep a constant watch over her sick, especially weak, protracted, and collapsed cases, to guard against the effects of the loss of vital heat by the patient himself.

In a bed that includes one or more dogs, depending on size and general degree of cuddliness, “loss of vital heat” is rarely a problem, although the dreaded “perspiration” may well be.

 Help the sick to vary their thoughts.

This is perhaps the central advantage of dog nursing, especially in multiple-dog households. I can say from experience that being nursed by several dogs make unvaried or focused thought of any kind impossible.

To leave the patient’s untasted food by his side, from meal to meal, in hopes that he will eat it in the interval, is simply to prevent him from taking any food at all. 

While dogs are not, perhaps, good at clearing dishes, they are excellent at clearing away “untasted (human) food.” 

Diseases are not individuals arranged in classes, like cats and dogs, but conditions growing out of one another.

And here we go somewhat meta with dogs, just as Nightingale does. Nightingale prefers to ignore actual dogs in favor of their analogical possibilities for her anti-contagionist arguments. Diseases, she argues, are NOT like dogs or cats, since “dogs do not pass into cats” and one disease can “grow” into another. She uses a canine analogy to explain that diseases are not like distinct species: there is no “first disease” as there is a “first dog” or “first pair of dogs,” acting as ancestors to all future dogs.

Of course, science has proven Nightingale wrong here—despite her argument from experience that typhoid can morph into typhus (in the absence of proper care), we know now that diseases are indeed distinct, caused by discrete agents like viruses and bacteria. Diseases are more like dogs than Nightingale would ever have allowed. Of course, in this age of COVID, we might have attended earlier to miasma theory and to the dangers of aerosols and of ventilation.

Nightingale’s insistence that diseases are not dogs may have blinded her to the narrower question explored here about dogs as nurses. We would do well to remember in (almost) her words that (almost) every dog is a nurse.