Part 7 (1/2)

Lehmann, quoted by Dr. Christison, says that, among the well and active ”the infusion of 1 oz. of roasted coffee daily will diminish the waste”

going on in the body ”by one-fourth,” and Dr. Christison adds that tea has the same property. Now this is actual experiment. Lehmann weighs the man and finds the fact from his weight. It is not deduced from any ”a.n.a.lysis” of food. All experience among the sick shows the same thing.[25]

[Sidenote: Cocoa.]

Cocoa is often recommended to the sick in lieu of tea or coffee. But independently of the fact that English sick very generally dislike cocoa, it has quite a different effect from tea or coffee. It is an oily starchy nut having no restorative power at all, but simply increasing fat. It is pure mockery of the sick, therefore, to call it a subst.i.tute for tea. For any renovating stimulus it has, you might just as well offer them chesnuts instead of tea.

[Sidenote: Bulk.]

An almost universal error among nurses is in the bulk of the food and especially the drinks they offer to their patients. Suppose a patient ordered 4 oz. brandy during the day, how is he to take this if you make it into four pints with diluting it? The same with tea and beef tea, with arrowroot, milk, &c. You have not increased the nourishment, you have not increased the renovating power of these articles, by increasing their bulk,--you have very likely diminished both by giving the patient's digestion more to do, and most likely of all, the patient will leave half of what he has been ordered to take, because he cannot swallow the bulk with which you have been pleased to invest it. It requires very nice observation and care (and meets with hardly any) to determine what will not be too thick or strong for the patient to take, while giving him no more than the bulk which he is able to swallow.

VIII. BED AND BEDDING.

[Sidenote: Feverishness a symptom of bedding.]

A few words upon bedsteads and bedding; and princ.i.p.ally as regards patients who are entirely, or almost entirely, confined to bed.

Feverishness is generally supposed to be a symptom of fever--in nine cases out of ten it is a symptom of bedding.[26] The patient has had re-introduced into the body the emanations from himself which day after day and week after week saturate his unaired bedding. How can it be otherwise? Look at the ordinary bed in which a patient lies.

[Sidenote: Uncleanliness of ordinary bedding.]

If I were looking out for an example in order to show what _not_ to do, I should take the specimen of an ordinary bed in a private house: a wooden bedstead, two or even three mattresses piled up to above the height of a table; a vallance attached to the frame--nothing but a miracle could ever thoroughly dry or air such a bed and bedding. The patient must inevitably alternate between cold damp after his bed is made, and warm damp before, both saturated with organic matter,[27] and this from the time the mattresses are put under him till the time they are picked to pieces, if this is ever done.

[Sidenote: Air your dirty sheets, not only your clean ones.]

If you consider that an adult in health exhales by the lungs and skin in the twenty-four hours three pints at least of moisture, loaded with organic matter ready to enter into putrefaction; that in sickness the quant.i.ty is often greatly increased, the quality is always more noxious--just ask yourself next where does all this moisture go to?

Chiefly into the bedding, because it cannot go anywhere else. And it stays there; because, except perhaps a weekly change of sheets, scarcely any other airing is attempted. A nurse will be careful to fidgetiness about airing the clean sheets from clean damp, but airing the dirty sheets from noxious damp will never even occur to her. Besides this, the most dangerous effluvia we know of are from the excreta of the sick--these are placed, at least temporarily, where they must throw their effluvia into the under side of the bed, and the s.p.a.ce under the bed is never aired; it cannot be, with our arrangements. Must not such a bed be always saturated, and be always the means of re-introducing into the system of the unfortunate patient who lies in it, that excrement.i.tious matter to eliminate which from the body nature had expressly appointed the disease?

My heart always sinks within me when I hear the good house-wife, of every cla.s.s, say, ”I a.s.sure you the bed has been well slept in,” and I can only hope it is not true. What? is the bed already saturated with somebody else's damp before my patient comes to exhale into it his own damp? Has it not had a single chance to be aired? No, not one. ”It has been slept in every night.”

[Sidenote: Iron spring bedstead the best.]

[Sidenote: Comfort and cleanliness of _two_ beds.]

The only way of really nursing a real patient is to have an _iron_ bedstead, with rheocline springs, which are permeable by the air up to the very mattress (no vallance, of course), the mattress to be a thin hair one; the bed to be not above 3-1/2 feet wide. If the patient be entirely confined to his bed, there should be _two_ such bedsteads; each bed to be ”made” with mattress, sheets, blankets, &c., complete--the patient to pa.s.s twelve hours in each bed; on no account to carry his sheets with him. The whole of the bedding to be hung up to air for each intermediate twelve hours. Of course there are many cases where this cannot be done at all--many more where only an approach to it can be made. I am indicating the ideal of nursing, and what I have actually had done. But about the kind of bedstead there can be no doubt, whether there be one or two provided.

[Sidenote: Bed not to be too wide.]

There is a prejudice in favour of a wide bed--I believe it to be a prejudice. All the refreshment of moving a patient from one side to the other of his bed is far more effectually secured by putting him into a fresh bed; and a patient who is really very ill does not stray far in bed. But it is said there is no room to put a tray down on a narrow bed.

No good nurse will ever put a tray on a bed at all. If the patient can turn on his side, he will eat more comfortably from a bed-side table; and on no account whatever should a bed ever be higher than a sofa.

Otherwise the patient feels himself ”out of humanity's reach”; he can get at nothing for himself: he can move nothing for himself. If the patient cannot turn, a table over the bed is a better thing. I need hardly say that a patient's bed should never have its side against the wall. The nurse must be able to get easily to both sides the bed, and to reach easily every part of the patient without stretching--a thing impossible if the bed be either too wide or too high.

[Sidenote: Bed not to be too high.]

When I see a patient in a room nine or ten feet high upon a bed between four and five feet high, with his head, when he is sitting up in bed, actually within two or three feet of the ceiling, I ask myself, is this expressly planned to produce that peculiarly distressing feeling common to the sick, viz., as if the walls and ceiling were closing in upon them, and they becoming sandwiches between floor and ceiling, which imagination is not, indeed, here so far from the truth? If, over and above this, the window stops short of the ceiling, then the patient's head may literally be raised above the stratum of fresh air, even when the window is open. Can human perversity any farther go, in unmaking the process of restoration which G.o.d has made? The fact is, that the heads of sleepers or of sick should never be higher than the throat of the chimney, which ensures their being in the current of best air. And we will not suppose it possible that you have closed your chimney with a chimney-board.