Notes on Nursing | Page 5

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 feverish at night, with burning hands and feet,
they are almost sure to be chilly and shivering in the morning. But
nurses are very fond of heating the foot-warmer at night, and of
neglecting it in the morning, when they are busy. I should reverse the
matter.
All these things require common sense and care. Yet perhaps in no one
single thing is so little common sense shown, in all ranks, as in
nursing.[4]
[Sidenote: Cold air not ventilation, nor fresh air a method of chill.]
The extraordinary confusion between cold and ventilation, even in the
minds of well educated people, illustrates this. To make a room cold is
by no means necessarily to ventilate it. Nor is it at all necessary, in
order to ventilate a room, to chill it. Yet, if a nurse finds a room close,
she will let out the fire, thereby making it closer, or she will open the
door into a cold room, without a fire, or an open window in it, by way
of improving the ventilation. The safest atmosphere of all for a patient
is a good fire and an open window, excepting in extremes of
temperature. (Yet no nurse can ever be made to understand this.) To
ventilate a small room without draughts of course requires more care
than to ventilate a large one.
[Sidenote: Night air.]
Another extraordinary fallacy is the dread of night air. What air can we
breathe at night but night air? The choice is between pure night air from
without and foul night air from within. Most people prefer the latter.
An unaccountable choice. What will they say if it is proved to be true
that fully one-half of all the disease we suffer from is occasioned by
people sleeping with their windows shut? An open window most nights
in the year can never hurt any one. This is not to say that light is not
necessary for recovery. In great cities, night air is often the best and
purest air to be had in the twenty-four hours. I could better understand
in towns shutting the windows during the day than during the night, for

the sake of the sick. The absence of smoke, the quiet, all tend to
making night the best time for airing the patients. One of our highest
medical authorities on Consumption and Climate has told me that the
air in London is never so good as after ten o'clock at night.
[Sidenote: Air from the outside. Open your windows, shut your doors.]
Always air your room, then, from the outside air, if possible. Windows
are made to open; doors are made to shut--a truth which seems
extremely difficult of apprehension. I have seen a careful nurse airing
her patient's room through the door, near to which were two gaslights,
(each of which consumes as much air as eleven men,) a kitchen, a
corridor, the composition of the atmosphere in which consisted of gas,
paint, foul air, never changed, full of effluvia, including a current of
sewer air from an ill-placed sink, ascending in a continual stream by a
well-staircase, and discharging themselves constantly into the patient's
room. The window of the said room, if opened, was all that was
desirable to air it. Every room must be aired from without--every
passage from without. But the fewer passages there