Popular Science Monthly/Volume 22/February 1883/Science in the Sick-Room

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THERE is no subject of so much general interest as this, concerning which there is, at the same time, such a widely prevalent ignorance. There are few, especially among women, upon whom will not devolve, at some time in their lives, the care of the sick; fewer still who will not at some time become dependent upon such care; and it might naturally be supposed that matters of such primary and universal importance as sanitary conditions and the practical application in the sick-room of scientific principles would be too familiar to every one to need to be further enlarged upon. But the fact is, it too frequently happens that all the scientific knowledge which ever enters the sick-room comes in with the doctor and goes out again with him.

This state of things requires to be improved. Knowledge, and that correct knowledge we call science, is just as indispensable to the nurse as to anybody else. It is a great mistake to suppose that all women—even all good women—make good nurses. The best intentions and the tenderest heart may coexist with an utter lack of executive ability, and be more than counterbalanced by ignorance and prejudice. Native aptitude gives advantage, but it can not be relied upon alone. Even those who possess in the highest degree the natural gift of ministration which renders them so acceptable to the invalid would find their power of usefulness very largely increased by a familiarity with what may be properly called the science of the sick-room. Physicians are recognizing more and more the importance of hygienic agencies in the treatment of disease, and with this there has come an increasingly urgent call for the scientific instruction and practical training of those who are to take charge of invalids. Science explains the conditions upon which the art of the nurse depends, and lays down principles which can not be violated without injury; but it is not at all necessary to make a parade of technical language in stating its requirements. It is the object of the present article to furnish a few simple directions for the care of the sick that have the warrant of practical experience.

The first thing to be considered is the room itself. And the proper time to consider it is when you build your house. But, as most of us are forced to be content with houses already built, and built with no reference in the mind of the architect to the probability of illness among its inhabitants, it is only left for us to see how we may best avail ourselves of such conveniences—or inconveniences—as we may chance to have. There is always, at least, a choice of evils.

The sick-room should be on the sunny side of the house, and have plenty of windows. Only in exceptional cases, such as inflammation of the eye or brain, is it necessary to have the room darkened, and even then a south room, with the light carefully moderated by blinds and curtains, is to be preferred to a darker one on the north side. In the majority of cases, light, and not only light, but direct sunshine, is to be desired, not only for the additional cheerfulness which it gives, but because of its actual physical effects. Sunlight is a powerful remedial agent. You put the drooping plants which you wish to restore to vigor in the brightest, sunniest spot in your house—do the same with the feeble and sickly human being for whose improvement you arc so anxiously looking, and you will derive similar beneficial results.

The sick-room should be, as far as possible, remote from the noises of the house and of the street. If, as is sometimes the case, this desideratum is quite incompatible with the last-named, still, except where there is great nervous irritability, give the preference to the sunny side, even at some loss of quiet.

Noise which is understood and inevitable is far less annoying than would be a much slighter noise, unexplained or unnecessary. Intermittent is more hurtful than continuous noise. Sudden, sharp, and jarring sounds are especially to be avoided. Manage, if possible, to have the room over your patient unoccupied. Modern houses are so slightly built, and their vibrations so trying, that, unless you can so arrange, you will often find it better to put your patient at the top of the house, in spite of the fatigue of the stairs.

Many slight and apparently unimportant noises, which are nevertheless peculiarly annoying to the sensitive nerves of the sick, may easily, with a little care and forethought, be entirely done away with. If you have coal to put on the fire, bring it in wrapped in a paper, and lay it on paper and all. Oil the hinges of creaking doors. Fix wedges in rattling windows. Keep rocking-chairs out of the room. Avoid wearing clothes that rustle or shoes that squeak. Do not whisper, either in your patient's room, or just outside his door. A low, distinct tone, when conversation is necessary, will seldom annoy. Whispering always will, as will any sound which creates strained attention or a sense of expectation. If you have anything to say which you do not wish your patient to hear, say it somewhere else than in his presence.

The first and greatest requisite in a sick-room is purity of air. This is only to be attained by constant and thorough ventilation. Ventilation is the displacement of impure by pure air. To secure this, there should be two apertures to the room, one for the egress of the foul air, and one for the admission of fresh air. The best possible arrangement is that of an open window and an open fire-place. If you do not wish a constant fire, keep a lamp burning at the mouth of the chimney to create a draught. Arrange a blind or screen so that the air will not blow directly upon your patient, and you may keep the window open day and night without danger of chilling him. Do not make the common mistake of confounding cold air with pure air. You may keep the room at any desired temperature, and still have the atmosphere perfectly fresh; or you may lower the temperature to any extent without removing a particle of the poisonous impurities with which the air is laden. Keep your patient as warn by means of external appliances as his comfort demands, but never shut out the fresh air. Fresh air can only come from outside the house. Opening a door into a passage or an adjoining room, itself imperfectly aired, is not ventilation. Fresh air, may, however, be admitted to the sick-room through an adjoining apartment, first thoroughly ventilated. This is sometimes the best method of procedure. It requires, of course, more care to keep a small room well aired without objectionable draughts than a large one.

Stationary basins should never be used in the sick-room. The perfect system of house-drainage has yet to be invented, and the danger from leaky and defective traps is so great that the only safe way is to avoid them altogether. If you have such arrangements in the room which you propose to devote to your invalid, cork up the overflow holes—or, better, stop them with plaster-of-Paris—and fill the basin with water, which must be changed from time to time, or cover it entirely with a board. The increased healthfulness of the atmosphere will more than compensate for the extra trouble which will be occasioned by adherence to this precautionary measure.

No cooking should ever be done in the sick-room. Neither should damp towels or articles of clothing be aired and dried there. All excreta should be promptly removed. Upon attention to these details depends that which should be the first care of every person in charge of the sick—that the air they breathe should be as pure as that outside.

The room, then, which we select for our invalid should be sunny, quiet, the one which affords the best facilities for ventilation and warmth, and without sewerage.

In the arrangement of the room, the same regard for the comfort and welfare of its occupant should be maintained.

The bed should be in the lightest part of the room, far enough removed from the wall to allow a free circulation of air around it, and to be easily accessible from both sides. It should be so situated that the patient can see out of the window. If you can give him a view from two windows, so much the better. Few people who have not experienced it can realize the weariness of mind which arises from long confinement to one set of surroundings. You have but to spend a few days in one room to become painfully familiar with every petty detail of its furnishing, and such variety as may be obtained from a glimpse out-of-doors will often afford an infinite relief.

It is frequently recommended that all superfluous and merely ornamental articles be removed from the sick-room, as useless incumbrances, only affording so many additional lodging-places for dust; but, unless you are dealing with contagious disease, you will find it better to spend a little more time in the removal of dust than to leave the sufferer with only the bare walls to gaze at, and nothing visible to vary the monotony of his thoughts. That a carpet or wall-paper of set pattern, or anything else presenting regularly recurrent figures, is objectionable, does not need to be suggested to any one who has ever been beset by the counting and classifying fiend who so often takes possession of the invalid left with no occupation for his vacant mind beyond such as is suggested by the objects within his limited field of vision.

Let the room be as cheerful as possible in its aspect. Flowers are quite permissible. Growing plants are better than cut flowers. The latter must be removed as soon as they cease to be perfectly fresh.

There should be no medicine-bottles or medical appurtenances of any kind in sight. They belong in the closet, and should be kept there, except when in actual use.

A thermometer is indispensable. Never permit yourself to judge the temperature of the room by your own sensations or by those of your patient. Hang the thermometer as nearly as possible in the center of the room—at all events, neither against a chimney in use or the outer wall. The one will be hotter and the other colder than the mean temperature, which is what you wish to have registered. This should be, unless you have contrary orders from the physician, about 68° Fahr.

The necessity for absolute cleanliness can not be too strenuously insisted upon. Dusting can only be efficiently done with a damp cloth. The ordinary methods in vogue simply serve to transfer the dust from one spot to another. Removal, not distribution, should be the object in view. The room can only be thoroughly swept and cleaned when the patient can be moved out of it for a time; but the dust may be removed from the carpet quite effectively and noiselessly by means of a damp cloth wrapped around a broom.

Not only for the sake of appearances, but from more directly hygienic considerations, are cleanliness and order to be regarded.

Upon the proper arrangement and care of the bed will largely depend your patient's comfort. This should be low and narrow enough for you easily to reach him from either side. The bedstead should be of iron or brass, with springs of woven wire, permeable by the air in every part. This is the only kind which you can be sure of keeping thoroughly clean. On this should be a hair mattress, never a feather bed. Make the under sheet as tight and smooth as possible, and take especial pains to keep it thoroughly dry and free from wrinkles, crumbs, and other inequalities. Neglect in this particular will give rise always to much discomfort and sometimes to serious troubles in the form of pressure-sores—which are extremely difficult to cure, but nearly always preventable by care. Very heavy or very much emaciated patients, and those suffering from affections of the brain, are particularly liable to these. It is often advisable, especially where a bed is prepared for long occupancy, to put next to the under sheet one of rubber, covered with a second folded sheet, or draw-sheet. This can be easily and frequently changed with but very slight disturbance to the patient. The bed-coverings should be such as are warm without being heavy, as their weight is often found oppressive. In some cases even slight pressure is unendurable. The weight of the clothes may then be supported by a wooden frame-work underneath.

All bedding should be frequently renewed, and always well aired and warmed before being used. If you have a patient entirely confined to bed, it will add greatly to his comfort if you can give him two beds, each provided with its own complement of sheets, blankets, etc. Let him occupy one during the day, and be transferred to the other for the night. If they are of equal height, this can be easily done, and the smooth, fresh condition of the unused bed will do more than any narcotic toward securing for him a good night's rest.

To prop a patient up with pillows, begin by slipping one as far down as possible against the small of the back. Put the next and succeeding ones each behind the last; this will prevent them from slipping. Aim to raise the head, and support the shoulders without throwing them forward so as to interfere with the free play of the lungs. Two or three small pillows, which can be moved from place to place as occasion requires, will be found of great service.

About the person of your patient, no less than about his room, labor to secure the most scrupulous cleanliness. Neglect of this too often arises from a fear that the patient will take cold; but it entails a greater risk than this to leave him in clothing saturated with morbid effluvia, and with the pores of his skin clogged by the noxious products of disease. No patient is ever too ill to be kept clean. If proper precautions are used and unnecessary exposure avoided, no danger need be apprehended.

The proper administration of food is often the great problem of the sick-room. There must be due regard to the kind, quality, and quantity, and to the time and manner of giving it. The kind of food to be given is usually prescribed by the physician. If it is left to your own discretion, consult, as far as possible, the tastes of your patient, try to secure a judicious variety, and do not let him know until you bring it what he is going to have next. Milk is the only article of diet which contains in itself all the essential elements of nutrition. It is, therefore, the only thing upon which you may allow your patient entirely to subsist for any length of time. The most concentrated forms of food are to be preferred, such as convey the greatest amount of nourishment in the smallest bulk.

Whatever you give, be sure that it is the best of its kind—milk perfectly sweet, eggs above suspicion. Remember that you have more than the ordinary fastidiousness to contend with, and never offer a sick person anything which you have not, previously tasted yourself, and so feel absolutely sure of. This does not mean that you are to taste it in his presence. Bring only so much as can be taken at once. A large amount looks so discouraging that it destroys the appetite for even a little. Take away promptly what is not eaten. It is worse than useless to leave it in sight in the hope that it will soon be wanted. Give only a small quantity of food at a time, but give it at short and regular intervals. A capful every two hours is more easily managed by weak digestive organs than would be a large meal three times a day. When a table-spoonful can not be taken hourly without distress, you may give successfully a tea-spoonful every quarter of an hour. The idiosyncrasies of each individual case must be considered. Regularity is, however, always important. When you do not feed your patient again until morning, it is well to give him some light and easily assimilated nourishment the last thing at night.

If you have a helpless patient to feed, do it slowly, and avoid unmanageable quantities. It requires attention and care to do this well without making an external application of it. Fluid food is most easily given, and with the least exertion on the part of the patient, through a bent glass tube.

Serve the food in as attractive a form as possible. If it pleases the eye, it has a much better chance of proving acceptable to a delicate appetite. You can at least have the dishes spotlessly clean, and dry on the outside. Have hot things hot, and cold ones very cold. To successfully cater to the capricious appetite of an invalid requires the faculty of observation, judgment, and no little ingenuity; but it is worth the exercise of them all, for in most cases the question of nourishment is more important than that of medicine.

Give medicine or stimulant ordered always on time, and measure it accurately. Acquire the habit of always reading the label before you open a bottle. Pour the contents from the unlabeled side. Cork tightly after using, as many drugs lose their virtue upon exposure to the air. Use no remedies, however beneficial you may fancy they would be, without the approval of the physician in attendance. You may otherwise most disastrously conflict with his plan of treatment.

The patient himself should have no responsibility about the taking of medicine, the preparation of food, or anything else which can be spared him. In all small matters, relieve him entirely of the onus of decision. If there is any doubt in your own mind as to the expediency of this or that measure, do not let him share it. Let him feel that you know, and can be relied upon to do, what is best for him, without any necessity for thought on his part.

Perfect freedom from anxiety and cheerful surroundings are as essential for his mental, as are free ventilation, absolute cleanliness, and nourishing food for his physical, well-being. These are the elements of good nursing, and surely they are within the reach of all. Secure these, and you will have given the sick person under your care the best possible chance for recovery; at least you will ameliorate his sufferings, and relieve him from many an unnecessary aggravation.