Chapter 21 - Domestic Management of the Sick Room
Choice of the Sick Room
Freezing Mixtures
Bed Sores
Diet in Disease and Convalescence
Fluid Aliments

21.1 Choice of the Sick Room

Choice of the Sick Room, etc. Sleeping Apartment. In every case of disease, however slight its nature, the sleeping apartment of the sick should be airy and well ventilated; but, when Providence visits any member of a family with disease of a serious and protracted description, all other considerations giving way to the necessity of the case, an apartment should be chosen and arranged in a special manner for the reception of the invalid. It should be one calculated to administer to his temporary comfort, as well as to aid his recovery. It is not time, when the alarm is sounded and the danger is already urgent, to think of such arrangements; forethought must be put in requisition; every want anticipated; and whatever is likely to be required should not only be provided, but so arranged that it can be instantly found when it is needed. The sick room should be large, lofty, and, if possible, with a northern aspect, in order to avoid the heat of the mid day, or the afternoon sun; the windows should be capable of being opened by drawing down the uppermost sash. If possible, choose a room with an open fireplace or a ventilator opening into the chimney in the upper part of the room. No article of unnecessary furniture should be permitted to remain in the room; and that which is left in it should be of a description fitted to administer to the convenience of the invalid. Two tables are sufficient. One of them may be small, to stand near the bed, for the immediate use of the patient: namely, to hold his jug of barley water, or toast water, or other beverage; a small tea pot, or what is preferable, a half covered cup with a spout, to enable fluids to be administered without raising the sufferer in bed; his medicines for the day; and any other thing which he may frequently require. The other table should be large, for the accommodation of medicines not in immediate use, and also for spare glasses, jugs, cups, spoons, both large and small, and other necessary articles. This table should have one drawer, at least, which ought to be furnished with the following articles: broad and narrow tape; two or three half worn ribbons; a bundle of old, soft linen ; a sponge; a few ounces of lint; scissors, large and small; a bone spatula for spreading ointment; a couple of rolls of muslin, and the same quantity of flannel bandage two inches broad; a pin cushion well supplied with pins; needles and thread; and about half a yard of simple adhesive plaster. A Sofa or Reclining Chair. A sofa, if the apartment be sufficiently large to admit of it, is a very important piece of furniture in the sick room; the erect or the sitting posture being injurious in many diseases; and, when the sick bed requires to be made, a sofa affords the means of removing the patient from the bed with as little inconvenience to him as possible. If there is not a space for a sofa, there should be an invalid or reclining chair; and, when circumstances will permit, it should be of that kind which is susceptible of a variety of changes, so as to vary, at pleasure, the position of the patient. There should not be more than two other chairs in the room. If there is a looking glass in the apartment, in a situation which admits of the patient seeing himself in it as he lies in bed, its place should be changed, or it should be altogether removed from the room. A chest of drawers is essential; but none of the drawers should be appropriated for the reception of dirty linen, which ought never to be allowed to remain a moment in the sick room. One drawer should be especially allotted for towels, of which an ample supply is, in every case, necessary. The washing stand will require two additional basins; an additional water bottle and a tumbler; and a large water pitcher, under the table, always full of water. No Cooking in Sick room. There should be no kettle, nor any implement of cooking, in the sick room; even in winter, and when a fire is required. In general, a fire in the sick room is only necessary for the comfort of the attendants. The lamp termed a Night nurse, consisting of a water bath placed over a lamp in a wire worked cylinder; a small tin kettle which enters the top of the cylinder; and a covered earthenware vessel which fits into the water bath, are useful for keeping fluids warm, and at the same time for preserving a light in the room, when an un shaded lamp or a candle would be hurtful. In continued fevers, the sense of hearing is often so morbidly acute that ordinary sounds become causes of pain. In this case, if the floor of the sick room be not wholly carpeted, every precaution to lessen the intensity of the sound ' should be taken. One of the most effectual is to have a couple or more pairs of large list shoes outside the door, into which the feet, even of the doctors, may be advantageously thrust, when their shoes make a creaking noise, or when a visitor or nurse treads with a heavy foot. On the same account, when more than one nurse or attendant is required to be in the room at the same time, no conversation, although it may be carried on in a whisper, should be permitted. Whispering, indeed, is apt to excite delirium, and to augment it when it is already present. Beds and Bedding. Beds without curtains are those best adapted for the sick room. In every case of disease, indeed, especially when it is attended by fever, the patient should be kept cool, and the most perfect freedom be given to the breathing; the hair mattress should be used, never a feather bed, and the pillows be firm and elastic. The coverlets, which are spread upon beds during the day, and often retained at night, are heavy, and calculated rather to increase than to subdue fever; consequently they should be wholly discarded from the sick bed. Indeed, when the disease is fever, and when it is accompanied with great restlessness, owing to the evening exacerbation, if the bedroom be sufficiently large, two beds should be placed in it; or if two adjoining bedchambers can be obtained, a bed ought to be put in each, so that the patient can be moved from one bed to the other every morning and evening. This both aids sleep, and it also tends greatly to insure the personal cleanliness of the patient. The bedclothes of the bed from which the patient is moved, should, on his removal, be immediately turned down and fully exposed to the air; a precaution which will set aside the necessity of so frequent a change of linen as would be otherwise required. When there is only one bed, and when the disease is fever (unless the patient is too ill to permit his being moved), the sheets which have been used at night should be replaced by others in the morning, and hung up in the free air during the day, to be again used at night. But, when it can conveniently be done, in every case of continued fever, especially of an infectious kind, the sheets should be changed once in twenty.. four hours; a practice which is likely to prevent the fumes of infection from being communicated to the blankets, or to any of the furniture of the room. Ventilation is always of primary importance; and that period, happily, is gone by, in which air was carefully excluded from the chambers of the sick, even when they were suffering under febrile disease. Ventilation is particularly demanded in those fevers in which miliary eruptions display themselves; under no circumstances is it so essential as in febrile diseases of an infectious kind. It may, however, be consolatory to those whose duty it is to attend such cases, to know that infection communicated through the air rarely extends above a few feet from the body of the patient; and even in the most malignant diseases, with the exception of confluent small pox, and malignant scarlet fever of the worst kind, its influence does not exceed a few yards, if the room be well ventilated. On the contrary, if ventilation be neglected, the power of infection becomes greatly augmented from its concentration in confined and quiescent air; it even settles upon the clothes of the attendants, and on the furniture of the room; and these imbibe it most readily when their texture is wool, fur, or cotton, or any loose or downy substance capable of receiving and readily retaining the air. Smooth and polished surfaces do not easily receive or retain infectious. matter; consequently the nurses and attendants, in cases of infectious diseases, should have glazed gowns, and aprons of oiled silk. In no infectious diseases are these rules more essentially necessary than in small pox and scarlet fever. It is well known that, if the bedclothes of a patient laboring under either scarlet fever or small pox be closely folded up, they will retain the infectious matter, and communicate the disease at a great distance of time; but the influence of free ventilation is so great, that medical practitioners who are attending small pox patients, and who go from them into the open air, do not spread the disease. Indeed, all infection is weakened by dilution with air. The danger of infection is augmented, if, along with bad ventilation, the atmosphere of the room be moist from any cause. It is further consolatory to know that the infectious matter, even of the most virulent description, is not poisonous to everyone who is placed within the sphere of its influence. A predisposition of the body to receive the infection must exist before it can be communicated; a condition which is augmented by fatigue and watching, defective nourishment, mental depression, or anything which can lower the vital powers. The necessity, therefore, of maintaining these powers by attention to rest, a sufficient quantity of good and generous diet, and cheerfulness of mind, need not be insisted upon. In every case of infectious disease, the attendants, even in the best ventilated rooms, should stand on the windward, or on that side of the sick bed from which the current of air comes; as, by neglect of this rule, and by standing in the current which has passed over the patient, the infectious exhalations are blown upon them in a direct stream from the body of the patient. The attendants should never lean over the sick, nor should they receive their breath. The health also of the nurses should always be supported by nutritious and generous diet; but not by brandy, nor any other ardent spirit. The term infection, in its most extensive signification, implies some deleterious matter, originating from any source, and transmitted through the air, which is capable of causing diseases in the human body. When this matter is emanated from the diseased bodies of men, the term is frequently regarded as synonymous with contagion; but, in strictness of language, the latter refers only to the communication of disease by contact. Whatever may be the matter of infection, it may enter the body through the medium of the lungs, which is the most ready inlet, or by the saliva, or even through the surface, if the skin be abraded, or ff any ulceration be present. The influence of infectious matter is evidently exerted on the nervous system~ displaying itself by debility, inertness, dislike to motion, great susceptibility of cold, irritability and despondency of mind, and by the production of a disease similar to that of the person from whom the infectious matter has proceeded. The infection may be supposed to have taken effect, and to have produced the actual disease, when the person who has been exposed to its influence is attacked with giddiness, pain in the head, irregular heat and chills, nausea, and, if the infectious disease be small pox, convulsions. These symptoms are sufficient to denote the necessity for immediate medical advice. Temperature. Next to ventilation nothing is of more importance than the regulation of the temperature of the sick room, avoiding both extremes of elevation or of depression; but much depends on the nature of the disease. The best general temperature of a sick room is 600 (Fahr.); and it is preferable to regulate this rather by the thermometer than by the sensations of the patients or the attendants. Under some circumstances, however, the feelings of the patient, and his susceptibility of impressions upon the skin, should not be overlooked. Thus if the temperature be a little above that of summer, and the patient, nevertheless,, feel chilly, it should be raised five or six degrees. This chilliness is very apt to be felt in a dyspeptic state of the habit, and more especially when it is accompanied with hypochondriacs. It differs from that more severe but transient coldness which accompanies intermittent fevers, and some other periodical affections; and it requires an elevated temperature of the air for its removal, whilst the cold stage of intermittent diseases is best relieved by the warm bath, either general or local. So important is the regulation of temperature, especially in fevers, that it often does more good than any other remedial measure. I have seen patients laboring under high delirium in a close, ill ventilated room become rapidly quite collected by merely lowering the heat of the apartment twelve or fifteen degrees. In convalescence, as the air of the sick chamber should be frequently renewed, the temperature in spring and autumn ought to be maintained as near as possible at 551 to 600 (Fahr.); and it should be very gradually lowered as the invalid acquires strength, so as to enable him to bear with impunity the varying temperature of these seasons in the open air. Even then, if the previous disease has been pulmonary, the air admitted to the lungs should be tempered by the use of the Respirator, or a muslin handkerchief tied around the mouth. When the invalid first ventures out of doors, nothing, indeed, is so essential, in a prophylactic point of view, as avoiding extremes and sudden transitions of temperature. Cleanliness. Although cleanliness in the sick room 1 yet it may be carried so far as to become an annoyance to and consequently to prove injurious. It is not requisite to sweep the room daily, nor to dust and arrange the furniture every morning, provided order be preserved in the room, and nothing but what is immediately necessary for the comfort and convenience of the invalid be permitted to remain in it. It is truly distressing to observe the confusion which prevails in some sick rooms; everything being out of place, and to be searched for when it is wanted. The period chosen for cleaning and arranging the sick room should be the morning, as after a night's rest the patient is more able to bear the little noise and bustle which it always more or less occasions. The carpet should be sprinkled with moist tea leaves, or newspaper torn in small pieces and wet, and lightly swept. It is scarcely requisite to insist on the necessity of the utmost attention to the cleanliness of everything in the sick room. The moment after any vessel or implement is used by the invalid, it should be removed from the apartment, and returned as soon as it is cleaned. Nothing in the form of a slop basin or slop pail is admissible; they only administer to the laziness of nurses. The necessity of cleanliness in the vessels used for the food of invalids is strikingly illustrated in the bad effects arising from the neglect of it when an infant is brought up by band. In such a case, if the feeding bottle which is employed be not instantly cleansed after the meal has been given, the small portion of the pap or food which remains in the vessel becomes sour, and taints the whole of the fresh food mixed with it, causing colic and convulsions in the infant. The same risk of injury occurs in the sick room, if the vessels used for administering food to the invalid be not instantly and well cleansed after every time they are used. It is too common, also, to use one glass or cup for administering medicines, and to leave it un rinsed from time to time, a custom which may prove as deleterious as a defect of cleanliness in vessels employed for food. Some medicines, when they are exposed to the air, rapidly undergo changes which alter their properties; and this alteration having been undergone by the small portion which is always left in the glass or cup, communicates the disposition to be decomposed to that which may be next poured into the cup. An active medicine may be thus rendered inert; or one which is mild in its operation may be so changed as to operate with hazardous energy. The same precaution, as to cleanliness, is also requisite as to the minim measure, when medicines are directed to be administered in a form which requires its employment. Darkening the Sick room It is a common error to imagine that a sick room should always be either partially or wholly darkened. In some diseases, as, for example, fevers, when the eyes are acutely sensible to light, so that they remain half closed, and the eyebrows are contracted, the greatest relief is experienced from darkening the room. When delirium is present, a certain degree of darkening is in some instances serviceable; whilst in others, especially when the delirium is accompanied with visual illusions, nothing so readily dispels these, and consequently abates the delirium, as the admission of the full daylight into the sick room. There is much difficulty, however, in determining which state of the apartment is likely to be most serviceable in any particular case. Observation of the effects of light and darkness, in the individual case, must be our guide. These illusions of the sight are generally the result of former impressions, renewed at a moment when the brain is in such a disturbed condition as to set aside the exercise of judgment. In this condition of the brain, the renewed conceptions are not readily corrected, as in health, by impressions received from the external world; hence, they become more vivid in the mind of the invalid when the sick room is darkened, and all visible objects are shut out. They are usually dispelled by new impressions on the organ of sense chiefly implicated; on which account, those which are connected with sight seldom occur during the day, when real objects are presented to the eye, unless the brain be so over excited as to bring the conceptive faculty into intense exercise, sufficient to awaken those false perceptions which create a belief of the presence of individuals not only not present, but who have been long dead. This state of the mental organ is similar to that on which depend the spectral illusions of the insane, but differing from it in its transient nature. I have frequently witnessed the conversation with one of these spectral beings instantly terminated, and the whole illusion dispelled, on opening the window curtains of the room; whilst the invalid has thus expressed himself: Bless me! I thought I was talking with Mr. just now; I must have been dreaming; for now I recollect he has been dead many years." A twilight obscurity in the sick room is often more productive of these illusions than darkness.

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