Notes on Nursing | Page 4

common sense will point
out that, while purity of air is essential, a temperature must be secured
which shall not chill the patient. Otherwise the best that can be
expected will be a feverish re-action.
To have the air within as pure as the air without, it is not necessary, as
often appears to be thought, to make it as cold.
In the afternoon again, without care, the patient whose vital powers
have then risen often finds the room as close and oppressive as he
found it cold in the morning. Yet the nurse will be terrified, if a
window is opened[3].
[Sidenote: Open windows.]
I know an intelligent humane house surgeon who makes a practice of
keeping the ward windows open. The physicians and surgeons
invariably close them while going their rounds; and the house surgeon
very properly as invariably opens them whenever the doctors have
turned their backs.
In a little book on nursing, published a short time ago, we are told, that
"with proper care it is very seldom that the windows cannot be opened
for a few minutes twice in the day to admit fresh air from without." I
should think not; nor twice in the hour either. It only shows how little
the subject has been considered.
[Sidenote: What kind of warmth desirable.]
Of all methods of keeping patients warm the very worst certainly is to
depend for heat on the breath and bodies of the sick. I have known a
medical officer keep his ward windows hermetically closed, thus
exposing the sick to all the dangers of an infected atmosphere, because
he was afraid that, by admitting fresh air, the temperature of the ward
would be too much lowered. This is a destructive fallacy.

To attempt to keep a ward warm at the expense of making the sick
repeatedly breathe their own hot, humid, putrescing atmosphere is a
certain way to delay recovery or to destroy life.
[Sidenote: Bedrooms almost universally foul.]
Do you ever go into the bed-rooms of any persons of any class, whether
they contain one, two, or twenty people, whether they hold sick or well,
at night, or before the windows are opened in the morning, and ever
find the air anything but unwholesomely close and foul? And why
should it be so? And of how much importance it is that it should not be
so? During sleep, the human body, even when in health, is far more
injured by the influence of foul air than when awake. Why can't you
keep the air all night, then, as pure as the air without in the rooms you
sleep in? But for this, you must have sufficient outlet for the impure air
you make yourselves to go out; sufficient inlet for the pure air from
without to come in. You must have open chimneys, open windows, or
ventilators; no close curtains round your beds; no shutters or curtains to
your windows, none of the contrivances by which you undermine your
own health or destroy the chances of recovery of your sick.[4]
[Sidenote: When warmth must be most carefully looked to.]
A careful nurse will keep a constant watch over her sick, especially
weak, protracted, and collapsed cases, to guard against the effects of
the loss of vital heat by the patient himself. In certain diseased states
much less heat is produced than in health; and there is a constant
tendency to the decline and ultimate extinction of the vital powers by
the call made upon them to sustain the heat of the body. Cases where
this occurs should be watched with the greatest care from hour to hour,
I had almost said from minute to minute. The feet and legs should be
examined by the hand from time to time, and whenever a tendency to
chilling is discovered, hot bottles, hot bricks, or warm flannels, with
some warm drink, should be made use of until the temperature is
restored. The fire should be, if necessary, replenished. Patients are
frequently lost in the latter stages of disease from want of attention to
such simple precautions. The nurse may be trusting to the patient's diet,
or to his medicine, or to the occasional dose of stimulant which she is

directed to give him, while the patient is all the while sinking from
want of a little external warmth. Such cases happen at all times, even
during the height of summer. This fatal chill is most apt to occur
towards early morning at the period of the lowest temperature of the
twenty-four hours, and at the time when the effect of the preceding
day's diets is exhausted.
Generally speaking, you may expect that weak patients will suffer cold
much more in the morning than in the evening. The vital powers are
much lower. If they are