Part 9 (1/2)
In several forms of diarrhoea, dysentery, &c., where the skin is hard and harsh, the relief afforded by was.h.i.+ng with a great deal of soft soap is incalculable. In other cases, sponging with tepid soap and water, then with tepid water and drying with a hot towel will be ordered.
Every nurse ought to be careful to wash her hands very frequently during the day. If her face too, so much the better.
One word as to cleanliness merely as cleanliness.
[Sidenote: Steaming and rubbing the skin.]
Compare the dirtiness of the water in which you have washed when it is cold without soap, cold with soap, hot with soap. You will find the first has hardly removed any dirt at all, the second a little more, the third a great deal more. But hold your hand over a cup of hot water for a minute or two, and then, by merely rubbing with the finger, you will bring off flakes of dirt or dirty skin. After a vapour bath you may peel your whole self clean in this way. What I mean is, that by simply was.h.i.+ng or sponging with water you do not really clean your skin. Take a rough towel, dip one corner in very hot water,--if a little spirit be added to it it will be more effectual,--and then rub as if you were rubbing the towel into your skin with your fingers. The black flakes which will come off will convince you that you were not clean before, however much soap and water you have used. These flakes are what require removing. And you can really keep yourself cleaner with a tumbler of hot water and a rough towel and rubbing, than with a whole apparatus of bath and soap and sponge, without rubbing. It is quite nonsense to say that anybody need be dirty. Patients have been kept as clean by these means on a long voyage, when a basin full of water could not be afforded, and when they could not be moved out of their berths, as if all the appurtenances of home had been at hand.
Was.h.i.+ng, however, with a large quant.i.ty of water has quite other effects than those of mere cleanliness. The skin absorbs the water and becomes softer and more perspirable. To wash with soap and soft water is, therefore, desirable from other points of view than that of cleanliness.
XII. CHATTERING HOPES AND ADVICES.
[Sidenote: Advising the sick.]
The sick man to his advisers.
”My advisers! Their name is legion. * * * Somehow or other, it seems a provision of the universal destinies, that every man, woman, and child should consider him, her, or itself privileged especially to advise me.
Why? That is precisely what I want to know.” And this is what I have to say to them. I have been advised to go to every place extant in and out of England--to take every kind of exercise by every kind of cart, carriage--yes, and even swing (!) and dumb-bell (!) in existence; to imbibe every different kind of stimulus that ever has been invented. And this when those _best_ fitted to know, viz., medical men, after long and close attendance, had declared any journey out of the question, had prohibited any kind of motion whatever, had closely laid down the diet and drink. What would my advisers say, were they the medical attendants, and I the patient left their advice, and took the casual adviser's? But the singularity in Legion's mind is this: it never occurs to him that everybody else is doing the same thing, and that I the patient _must_ perforce say, in sheer self-defence, like Rosalind, ”I could not do with all.”
[Sidenote: Chattering hopes the bane of the sick.]
”Chattering Hopes” may seem an odd heading. But I really believe there is scarcely a greater worry which invalids have to endure than the incurable hopes of their friends. There is no one practice against which I can speak more strongly from actual personal experience, wide and long, of its effects during sickness observed both upon others and upon myself. I would appeal most seriously to all friends, visitors, and attendants of the sick to leave off this practice of attempting to ”cheer” the sick by making light of their danger and by exaggerating their probabilities of recovery.
Far more now than formerly does the medical attendant tell the truth to the sick who are really desirous to hear it about their own state.
How intense is the folly, then, to say the least of it, of the friend, be he even a medical man, who thinks that his opinion, given after a cursory observation, will weigh with the patient, against the opinion of the medical attendant, given, perhaps, after years of observation, after using every help to diagnosis afforded by the stethoscope, the examination of pulse, tongue, &c.; and certainly after much more observation than the friend can possibly have had.
Supposing the patient to be possessed of common sense,--how can the ”favourable” opinion, if it is to be called an opinion at all, of the casual visitor ”cheer” him,--when different from that of the experienced attendant? Unquestionably the latter may, and often does, turn out to be wrong. But which is most likely to be wrong?
[Sidenote: Patient does not want to talk of himself.]
The fact is, that the patient[31] is not ”cheered” at all by these well-meaning, most tiresome friends. On the contrary, he is depressed and wearied. If, on the one hand, he exerts himself to tell each successive member of this too numerous conspiracy, whose name is legion, why he does not think as they do,--in what respect he is worse,--what symptoms exist that they know nothing of,--he is fatigued instead of ”cheered,” and his attention is fixed upon himself. In general, patients who are really ill, do not want to talk about themselves. Hypochondriacs do, but again I say we are not on the subject of hypochondriacs.
[Sidenote: Absurd consolations put forth for the benefit of the sick.]
If, on the other hand, and which is much more frequently the case, the patient says nothing, but the Shakespearian ”Oh!” ”Ah!” ”Go to!” and ”In good sooth!” in order to escape from the conversation about himself the sooner, he is depressed by want of sympathy. He feels isolated in the midst of friends. He feels what a convenience it would be, if there were any single person to whom he could speak simply and openly, without pulling the string upon himself of this shower-bath of silly hopes and encouragements; to whom he could express his wishes and directions without that person persisting in saying ”I hope that it will please G.o.d yet to give you twenty years,” or, ”You have a long life of activity before you.” How often we see at the end of biographies or of cases recorded in medical papers, ”after a long illness A. died rather suddenly,” or, ”unexpectedly both to himself and to others.”
”Unexpectedly” to others, perhaps, who did not see, because they did not look; but by no means ”unexpectedly to himself,” as I feel ent.i.tled to believe, both from the internal evidence in such stories, and from watching similar cases: there was every reason to expect that A. would die, and he knew it; but he found it useless to insist upon his own knowledge to his friends.
In these remarks I am alluding neither to acute cases which terminate rapidly nor to ”nervous” cases.
By the first much interest in their own danger is very rarely felt. In writings of fiction, whether novels or biographies, these death-beds are generally depicted as almost seraphic in lucidity of intelligence. Sadly large has been my experience in death-beds, and I can only say that I have seldom or never seen such. Indifference, excepting with regard to bodily suffering, or to some duty the dying man desires to perform, is the far more usual state.
The ”nervous case,” on the other hand, delights in figuring to himself and others a fict.i.tious danger.
But the long chronic case, who knows too well himself, and who has been told by his physician that he will never enter active life again, who feels that every month he has to give up something he could do the month before--oh! spare such sufferers your chattering hopes. You do not know how you worry and weary them. Such real sufferers cannot bear to talk of themselves, still less to hope for what they cannot at all expect.
So also as to all the advice showered so profusely upon such sick, to leave off some occupation, to try some other doctor, some other house, climate, pill, powder, or specific; I say nothing of the inconsistency--for these advisers are sure to be the same persons who exhorted the sick man not to believe his own doctor's prognostics, because ”doctors are always mistaken,” but to believe some other doctor, because ”this doctor is always right.” Sure also are these advisers to be the persons to bring the sick man fresh occupation, while exhorting him to leave his own.