And so this will explain the apparent anomaly of a physician writing a paper on nursing.
The sick-room must be large and airy, but free from draughts. There should be at least two windows in the room, and, if possible, they should have a south or west aspect. Before the invalid takes to this room, the floor, the windows, all the paint, etc., should be thoroughly cleaned by ways of which you know more than we do. If the ceiling has a cornice this should be dusted. The chimney should be swept and everything seen to so that a fire may be lighted at any minute, and that it may light and draw without any of the unpleasant accidents which so often occur when a fire is lighted in a room for the first time.
Not only in winter but at any season, even in the middle of summer, the fire should be ready. In our uncertain climate we often have a bitterly cold and wet day in the midst of very hot weather. We have seen trouble from neglecting this precaution.
Then everything in the room should be dusted or cleaned. Any superfluous objects which are likely to hold dust should be removed; but do not let the room look like a prison cell. An invalid spends most of his time looking about him, and an empty room will soon become distressing to him. Personally we prefer a carpet in a sick-room—at all events, unless the floor is polished, and there are no cracks. But the carpet should be beaten before the room is occupied.
Of course, we do not know whether you yourself will have to do this work, but if it is done by another, you must see that it is properly done. It is the duty of the nurse to see that the room is in good order, even through she does not clean it herself.
The bed should always have a hard mattress. A water bed may be required, but under no circumstances should an invalid have a feather bed. See that there are one or two good new blankets on the bed. Flimsy quilts may well be dispensed with. It is better to let the bed stand out in the room, and not be placed in an alcove or near a wall.
The bed of an invalid should be made every day—made properly, not merely the sheet pulled up and the upper blanket rearranged. Creases in the lower sheet are very wrong, for they make the patient uncomfortable and predispose to bed-sores. Crumbs in a bed are worse still, and very great care must be taken to see that the bed is perfectly free from them.
The patient must have his hands and face washed every morning and evening. He should always be washed with warm water. To tell if the water is of the right temperature, dip the tip of your elbow into it. Your hands are not sufficiently sensitive to warmth to be safe guides.
Hot bottles are often needed by invalids. They should never be filled with boiling water. They must be made of earthenware and covered with flannel jackets. The water must be of a temperature of about 100° to 120° Fahrenheit. They should never be left in the bed after they have got cold. Another point to remember is that you must see that the bottles do not leak. We have seen a nurse place an uncovered bottle of boiling water at the feet of a patient with paralysis. He did not feel the heat, but next morning the nurse found, to her horror, that the patient’s feet had been burned out of all recognition, and from these burns he died. We have seen and heard of many similar cases, but fortunately the result is not often so disastrous.
The ventilation of the sick chamber is very important. Unless the room is very draughty, it is usual to leave the window open throughout the day. If the weather is gusty, or the situation is exposed, some other method of ventilation may be acquired. A fire is a very satisfactory, though not a theoretically perfect, method of ventilating a room. As a matter of fact, the ventilation of the room depends entirely upon the room itself and its arrangement. On his first visit you should ask the physician how the room should be ventilated, and this will relieve you from any responsibility in the matter. Remember that the commonest of all mistakes in the treatment of illness is insufficient ventilation.