ON THE HYGIENE AND CUISINE OF THE SICK-ROOM

Seções: Índice Geral Seção Atual: Índice Obra: Índice Anterior: 24. Sobre a Cultura da Beleza, Graça e Saúde na Juventude – IX Seguinte: 26. Sobre a Higiene e a Cozinha do Quarto de Doentes – II

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25. SOBRE A HIGIENE E A COZINHA

DO QUARTO DE DOENTES – I

DEAR LADY POMEROY, – I am pleased to hear that you are seriously studying the science of nursing. It is a science too much neglected in its essential elements, for although it may be true that women are by nature peculiarly adapted for the duties of the nurse, it is certainly no less true that nature does not suffice to complete the qualification. Technical knowledge is needed to supplement and to correct natural impulses, which, even in the most sympathetic and earnest persons, are liable to mislead in important matters, – such, for example, as the ventilation of the sick-room, the clothing, the dietary, and general treatment of the patient, and the regard which must be paid to his special “fancies” and temperament. No amount of science can replace sympathy and affection, but by means of science their value is enhanced a thousandfold. A good nurse is better than the physician, and her ministry is more potent to save life than all the drags of the pharmacopoeia. This axiom sounds like one of King Solomon’s; and, indeed, it would not be out of place among the proverbs of the wise man. Of course I am not suggesting that the physician is superfluous; I am insisting only on the fact that his part is chiefly that of adviser and overseer; the real duties of healing are in the hands of the nurse. Therefore it is essential that

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she should be intelligent, and capable not only of executing, but of understanding, injunctions laid upon her. Also, it is a decided advantage to her patient if she be a person of refinement, with the instincts and habits of the class to which he himself belongs. The doctor is, or should be, a gentleman; otherwise he cannot be a really efficient physician. So, also, the nurse should be a gentlewoman, if not by station, then at least by nature. She must step lightly, shut the door noiselessly, move adroitly, speak softly, and, above all, be scrupulously clean, neat and “nice” to look at. If the patient is in much pain, very ill or weak, the nurse must remember that silence and semi-obscurity provide the best conditions to promote recovery. There must be no whispering in corners with visitors, servants, or the doctor; all that has to be said – if not for the patient’s hearing – must be said outside the sick-room, for nothing more readily aggravates and disturbs a sufferer than suppressed colloquies held in his presence.

Candles ought never to be used in sick-rooms; the only light allowed should be that of a carefully shaded lamp, giving a soft, diffused glow through a tinted paper screen. The sudden flare of a candle abruptly introduced into the apartment, or placed where the flame is visible to the sick person, constitutes for him an annoyance and irritation often sufficient to induce a return of bad symptoms previously allayed, and to seriously retard rest and convalescence. I have known sudden attacks of neuralgic pain in the head and of vomiting created by nothing else than the entry into the darkened sick-room, of a servant bearing a naked light The best illumination for the sick-room consists of a shaded reading-lamp – the wick half-high only – placed a few yards from the patient’s bed or chair, and yielding a steady subdued

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light. Any lamp the flame of which begins to flicker or fluctuate, must be at once removed.

Wood fuel is healthier than any other, and, when possible, should be always preferred, for although it gives less heat than coal or coke, the latter combustibles largely yield smoky products, and a fine gritty ash, which, being deposited about the room, necessitates a great deal of inconvenient dusting, sweeping, and cleaning, besides vitiating the atmosphere with exhalations of oxide of carbon, carbonic acid, and other deleterious gases.

During the cold season a wood fire should be kept burning night and day, in the sick-room, as much for the sake of ventilation and purification of the air as for that of warmth, for it must be borne in mind that the fundamental condition of ventilation lies in the difference of temperature existing between the inner and outer atmosphere; the warmer the room the freer and more constant is the flow of fresh air into it from without. In order that the supply of fresh air should be sufficient, it is not necessary to create draughts or currents of wind annoying to the persons inhabiting the apartment. On the contrary, draughts must be carefully excluded from doors and windows by means of india-rubber tubing attached to the woodwork in such a manner as to cover apertures while freely permitting opening and shutting. This method is – at least as regards doors – far better than the ordinary expedient of placing sandbags, mats, or other moveables on the floor at the entrance of the room, where such articles frequently form traps for unwary feet, and, being liable to easy displacement, are not always left in proper position by persons entering and leaving. Ventilation is best effected at the upper part of the room, towards which the heated and vitiated air ascends, and

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where the entry of the fresh air engenders no current below the level of eight or ten feet. An ingress of cold air along the floor is extremely dangerous, because it is apt to chill the feet and lower limbs of persons in the room, especially if they be sitting near the fire, since it is always towards the chimney that the air current is drawn. The lower sash of a window should not be raised, but only the upper drawn down. Better still if the room be provided with a ventilator above the window near the ceiling, and clear over the heads of all present.

While upon this subject, I think that it will not be amiss to insist at some little length on the necessity of thoroughly aerating all dwelling apartments, whether inhabited by sick or sound folk, for, even in these enlightened times, there exists everywhere much want of information on the point. Nor is it only the restoration and preservation of health that are concerned; Venus and the Graces, as well as Hygeia, have a plea to put in on behalf of fresh air.

Health and beauty are intimately connected, and no advice concerning the preservation and improvement of either can be considered complete without a few words on the subject of ventilation.

Headache, dyspepsia, languor, general debility, and many of the minor disorders of the skin, such as acne, nettle-rash, inaction of the glands, causing dryness and sallow-ness of the complexion, congestion of the circulation in the nose, eyelids, or cheeks, and numberless other inconvenient troubles of the vascular and nervous systems, arise from the habit of passing the night in unaired rooms, the windows, doors, and chimney outlets of which are kept closed. In some houses, especially those built during the preceding century, sleeping apartments may be found entirely unprovided with fireplaces, and in such case it is,

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of course, doubly important to secure the ingress and egress of air by other means. Every adult individual requires three thousand cubic feet of air to breathe per hour if health is to be maintained, and it is, therefore, necessary that a constant inflow of pure air from without and outflow of stale air from within the bed-chamber should be ensured throughout the night. We live upon air as much as, if not more than, upon food, and stale or contaminated air is capable of poisoning us as readily as deadly drinks or unwholesome viands. But it must be remembered that air is rendered unfit for breathing not only by the action of human and animal respiration, but by that also of plants, at night, and especially by the burning of lights, whether candles, gas, or lamps. Flowers breathe like animals; they abstract oxygen from the atmosphere and give out carbonic acid gas, differing in this respect from foliaceous trees and shrubs, the green leaves of which, under the action of daylight, act inversely, withdrawing carbonic acid, and returning oxygen in its stead. For this reason, among others, forests are very invigorating and refreshing retreats during the daytime; the trees not only afford a pleasant shade, but actually purify the atmosphere and exhilarate the nervous system of the wayfarer. At night, however, the proximity of green plants is not so beneficial, and it is therefore unadvisable to keep them then in bedrooms.

In order to ventilate rooms scientifically, it must be remembered that stale or impure air, whether given out by the respiratory organs of our own bodies, or by the lights burning in the apartment, is always warmer than unbreathed and unburnt air, and that, consequently, the latter occupies a lower stratum than the former, which, being heated, mounts and rises to the upper part of the room, near the ceiling. In theatres or churches the

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hottest and most unwholesome atmosphere is always found in the neighbourhood of the galleries; and in closed chambers, constructed for experimental purposes, and lighted with tapers of unequal length, those that are tallest, and therefore higher up than the rest, always go out soonest. But, although for this reason it is desirable that outlets for impure air should be situated in the upper part of our rooms, it must not be forgotten that wherever such outlets are constructed they will not only give exit to heated air, but ingress to cold outside air, and that the latter, being much heavier than the stale air, will fall through it in a steady stream, and make its presence very disagreeably felt by the occupants of the apartment. Ventilators, to be hygienic and convenient, must, then, be devised in such a way as to introduce the outer and colder air in an upward direction, and to prevent it from descending immediately like a shower on the heads of the persons present. To accomplish this object it is necessary to have a good clear space between the ventilator and the ceiling, and to direct the entering column of air obliquely, in such a manner as to avert any sudden draught.

A system of ventilation known as the “Sherrington” has been widely recommended by my professional confrères, and as it is easily adapted to any room, I will give a brief description of it. It consists of an iron valve fitting into an aperture in the wall, which should not be too high, but so placed as to prevent rebound of the cold air from the ceiling. The side of the valve, which faces outwards, is covered by an iron grating. The valve slants forward, and is provided with lateral “cheeks” which prevent the overflow of cold air from its ends in such a manner as to direct the entering current upwards, and cause it to ascend. If desired, the valve can be closed by pulling a string, or it can be kept partly open.

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Another good method of ventilation, and one that has the advantage of being extremely simple, is the following: – Raise the lower sash of the window, and insert between the woodwork and the sill a “lift,” about an inch deep, extending from end to end, and filling up the whole opening. The air then enters between the sashes, and in an upward direction, because the lower sash, being supported by the lift, is raised an inch above the lower edge of the upper sash. Then; little draught is created by this plan, upon which, however, Mr. Tobin, of Leeds, has improved, by perforating the lower sash-frame with several small holes, into each of which a little case containing cotton-wool is fitted. The wool filters the air, and prevents the entry of smuts, or of too fierce a current. Lids can be fitted over the holes so as to close them at will. Many other contrivances are used, too numerous to mention here, but I will just add a few words in commendation of the double-pane system, which is a modified application of “Louvre” ventilation. Louvre ventilators are made of glass, and can be fitted into windows instead of panes, but as they have metal frames, they are liable to become rusty and unworkable. But the double panes are free from this objection. They consist of two ordinary glass panes, the outer of which has an open space of about an inch or less at the bottom, and the inner an open space of the same dimensions at the top, so that the current of air entering is deflected upwards. If this contrivance be used in large cities, however, dirt is apt to accumulate between the panes, and is with difficulty removed. Cooper’s disc is more suitable for urban ventilation, because it is more easily cleaned. It is a revolving circular glass pane, perforated in five or six places, and fitted over an ordinary window-pane similarly pierced. By turning the disc on

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its pivot the holes can be made to correspond or not, and thus the air can be admitted or cut off as may be wished. To clean it, the pivot must be unscrewed.

Then there is the vertical shaft ventilator, which you may see in most “health exhibitions,” and which, of late, has become very fashionable; and scores of other more or less convenient and hygienic apparatus impossible to describe here. The one thing to be borne in mind, as a general rule, is that all openings for ventilation should slant inwards and upwards, at a point about two feet below the ceiling in a moderately lofty room, and as far as can be from the fireplace. Slides or lids that can easily be drawn over them when necessary, should be provided. Tubes for ventilation on this system have been invented by Shillito and Shorland, McKinnell, Tobin, Tossell, and others.

In warm summer seasons, of course, the windows, whether of the sick-room or of the ordinary dwelling apartment, should be somewhat widely opened at the top throughout the day, because in warm weather the exchanges between the outer and inner air are far less brisk than in winter, owing to the fact that but little difference of temperature exists between the atmosphere indoors and that without. Even at night, in the summer season, the sick-room windows may remain opened, for night air is by no means harmful, as many untrained nurses suppose. Care must, however, be taken to prevent the entry of gnats and other nocturnal insects, by fastening over the aperture a piece of tarlatane or coarse muslin; and the window so opened must not be in the immediate vicinity of the patient’s bed.

It is, moreover, important to the purity and wholesomeness of the air in the sick-room that no utensil containing foetid or evacuated matters, liquid or otherwise,

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should be permitted to remain in the apartment. Such utensils should, immediately after use, be carried away and cleansed, and a night-table provided in which to keep them when not in use.

The sick-room should be large and airy, the bed uncurtained, or, at least, if the weather be cold, only very lightly guarded by washable dimity or chintz hangings, so that the air may have free circulation about the bed on all sides. Floors of polished wood – parquet – which can frequently be swept and cleaned, are greatly superior from hygienic point of view to the ordinary carpeted floors of most English dwellings. Carpets, especially in sick-rooms, quickly become uncleanly, and harbour a vast amount of dust and organic particles, often of an infectious character. Instead of nailed, and therefore immovable, carpets, I would substitute warm rugs and furry hides, strewn loosely about the room, and capable of being daily removed and shaken in the open air outside the house. Parquet flooring is, of course, expensive on a large scale, but oak or even deal boards can, without much cost or difficulty, be planned, plugged, and varnished in such a manner as to completely exclude draughts between the plankings, and to present an even and pretty effect.

The coverings of the patients’ bed should be warm, light, and porous; coverlets of loosely knitted fluffy wool, sufficiently large to tuck in at the sides, are especially commendable. Nor can I sufficiently impress upon you the necessity of always keeping your patients’ feet warm, whether he be in or out of bed. For this purpose a flat thin, filled with boiling water, should be place inside the bed, and enveloped in flannel so as to prevent it from burning the feet, and the nurse must be careful to keep it replenished as occasion requires. When the patient

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leaves his bed, and “sits up,” the hot-water thin may be placed on a stool beneath the soles of his feet, or inside a knitted foot-muff.

In my next communication attention shall be paid to the subject of sick-room cookery, times and methods of administering food, and other details concerning diet in stages of acute malady as well as in those of convalescence.