2420. Under no circumstances is ventilation of the sick-room so essential as in cases of febrile diseases, usually considered infectious; such as typhus and puerperal fevers, influenza, hooping-cough, small- and chicken-pox, scarlet fever, measles, and erysipelas: all these are considered communicable through the air; but there is little danger of infection being thus communicated, provided the room is kept thoroughly ventilated. On the contrary, if this essential be neglected, the power of infection is greatly increased and concentrated in the confined and impure air; it settles upon the clothes of the attendants and visitors, especially where they are of wool, and is frequently communicated to other families in this manner.
2421. Under all circumstances, therefore, the sick-room should be kept as fresh and sweet as the open air, while the temperature is kept up by artificial heat, taking care that the fire burns clear, and gives out no smoke into the room; that the room is perfectly clean, wiped over with a damp cloth every day, if boarded; and swept, after sprinkling with damp tea-leaves, or other aromatic leaves, if carpeted; that all utensils are emptied and cleaned as soon as used, and not once in four-and-twenty hours, as is sometimes done. "A slop-pail," Miss Nightingale says, "should never enter a sick-room; everything should be carried direct to the water-closet, emptied there, and brought up clean; in the best hospitals the slop-pail is unknown." "I do not approve," says Miss Nightingale, "of making housemaids of nurses,—that would be waste of means; but I have seen surgical sisters, women whose hands were worth to them two or three guineas a week, down on their knees, scouring a room or hut, because they thought it was not fit for their patients: these women had the true nurse spirit."
2422. Bad smells are sometimes met by sprinkling a little liquid chloride of lime on the floor; fumigation by burning pastiles is also a common expedient for the purification of the sick-room. They are useful, but only in the sense hinted at by the medical lecturer, who commenced his lecture thus:—"Fumigations, gentlemen, are of essential importance; they make so abominable a smell, that they compel you to open the windows and admit fresh air." In this sense they are useful, but ineffectual unless the cause be removed, and fresh air admitted.
2423. The sick-room should be quiet; no talking, no gossiping, and, above all, no whispering,—this is absolute cruelty to the patient; he thinks his complaint the subject, and strains his ear painfully to catch the sound. No rustling of dresses, nor creaking shoes either; where the carpets are taken up, the nurse should wear list shoes, or some other noiseless material, and her dress should be of soft material that does not rustle. Miss Nightingale denounces crinoline, and quotes Lord Melbourne on the subject of women in the sick-room, who said, "I would rather have men about me, when ill, than women; it requires very strong health to put up with women." Ungrateful man! but absolute quiet is necessary in the sick-room.
2424. Never let the patient be waked out of his first sleep by noise, never roused by anything like a surprise. Always sit in the apartment, so that the patient has you in view, and that it is not necessary for him to turn in speaking to you. Never keep a patient standing; never speak to one while moving. Never lean on the sick-bed. Above all, be calm and decisive with the patient, and prevent all noises over-head.
2425. A careful nurse, when a patient leaves his bed, will open the sheets wide, and throw the clothes back so as thoroughly to air the bed; She will avoid drying or airing anything damp in the sick-room.
2426. "It is another fallacy," says Florence Nightingale, "to suppose that night air is injurious; a great authority told me that, in London, the air is never so good as after ten o'clock, when smoke has diminished; but then it must be air from without, not within, and not air vitiated by gaseous airs." "A great fallacy prevails also," she says, in another section, "about flowers poisoning the air of the sick-room: no one ever saw them over-crowding the sick-room; but, if they did, they actually absorb carbonic acid and give off oxygen." Cut flowers also decompose water, and produce oxygen gas. Lilies, and some other very odorous plants, may perhaps give out smells unsuited to a close room, while the atmosphere of the sick-room should always be fresh and natural.
2427. "Patients," says Miss Nightingale, "are sometimes starved in the midst of plenty, from want of attention to the ways which alone make it possible for them to take food. A spoonful of beef-tea, or arrowroot and wine, or some other light nourishing diet, should be given every hour, for the patient's stomach will reject large supplies. In very weak patients there is often a nervous difficulty in swallowing, which is much increased if food is not ready and presented at the moment when it is wanted: the nurse should be able to discriminate, and know when this moment is approaching."
2428. Diet suitable for patients will depend, in some degree, on their natural likes and dislikes, which the nurse will do well to acquaint herself with. Beef-tea is useful and relishing, but possesses little nourishment; when evaporated, it presents a teaspoonful of solid meat to a pint of water. Eggs are not equivalent to the same weight of meat. Arrowroot is less nourishing than flour. Butter is the lightest and most digestible kind of fat. Cream, in some diseases, cannot be replaced. But, to sum up with some of Miss Nightingale's useful maxims:—Observation is the nurse's best guide, and the patient's appetite the rule. Half a pint of milk is equal to a quarter of a pound of meat. Beef-tea is the least nourishing food administered to the sick; and tea and coffee, she thinks, are both too much excluded from the sick-room.