[Sidenote: Feverishness a symptom of bedding.]
A few words upon bedsteads and bedding; and principally as regards
patients who are entirely, or almost entirely, confined to bed.
Feverishness is generally supposed to be a symptom of fever--in nine
cases out of ten it is a symptom of bedding.[26] The patient has had
re-introduced into the body the emanations from himself which day after
day and week after week saturate his unaired bedding. How can it be
otherwise? Look at the ordinary bed in which a patient lies.
[Sidenote: Uncleanliness of ordinary bedding.]
If I were looking out for an example in order to show what _not_ to do,
I should take the specimen of an ordinary bed in a private house: a
wooden bedstead, two or even three mattresses piled up to above the
height of a table; a vallance attached to the frame--nothing but a
miracle could ever thoroughly dry or air such a bed and bedding. The
patient must inevitably alternate between cold damp after his bed is
made, and warm damp before, both saturated with organic matter,[27] and
this from the time the mattresses are put under him till the time they
are picked to pieces, if this is ever done.
[Sidenote: Air your dirty sheets, not only your clean ones.]
If you consider that an adult in health exhales by the lungs and skin in
the twenty-four hours three pints at least of moisture, loaded with
organic matter ready to enter into putrefaction; that in sickness the
quantity is often greatly increased, the quality is always more
noxious--just ask yourself next where does all this moisture go to?
Chiefly into the bedding, because it cannot go anywhere else. And it
stays there; because, except perhaps a weekly change of sheets, scarcely
any other airing is attempted. A nurse will be careful to fidgetiness
about airing the clean sheets from clean damp, but airing the dirty
sheets from noxious damp will never even occur to her. Besides this, the
most dangerous effluvia we know of are from the excreta of the
sick--these are placed, at least temporarily, where they must throw
their effluvia into the under side of the bed, and the space under the
bed is never aired; it cannot be, with our arrangements. Must not such a
bed be always saturated, and be always the means of re-introducing into
the system of the unfortunate patient who lies in it, that
excrementitious matter to eliminate which from the body nature had
expressly appointed the disease?
My heart always sinks within me when I hear the good house-wife, of
every class, say, "I assure you the bed has been well slept in," and I
can only hope it is not true. What? is the bed already saturated with
somebody else's damp before my patient comes to exhale into it his own
damp? Has it not had a single chance to be aired? No, not one. "It has
been slept in every night."
[Sidenote: Iron spring bedstead the best.]
[Sidenote: Comfort and cleanliness of _two_ beds.]
The only way of really nursing a real patient is to have an _iron_
bedstead, with rheocline springs, which are permeable by the air up to
the very mattress (no vallance, of course), the mattress to be a thin
hair one; the bed to be not above 3-1/2 feet wide. If the patient be
entirely confined to his bed, there should be _two_ such bedsteads; each
bed to be "made" with mattress, sheets, blankets, &c., complete--the
patient to pass twelve hours in each bed; on no account to carry his
sheets with him. The whole of the bedding to be hung up to air for each
intermediate twelve hours. Of course there are many cases where this
cannot be done at all--many more where only an approach to it can be
made. I am indicating the ideal of nursing, and what I have actually had
done. But about the kind of bedstead there can be no doubt, whether
there be one or two provided.
[Sidenote: Bed not to be too wide.]
There is a prejudice in favour of a wide bed--I believe it to be a
prejudice. All the refreshment of moving a patient from one side to the
other of his bed is far more effectually secured by putting him into a
fresh bed; and a patient who is really very ill does not stray far in
bed. But it is said there is no room to put a tray down on a narrow bed.
No good nurse will ever put a tray on a bed at all. If the patient can
turn on his side, he will eat more comfortably from a bed-side table;
and on no account whatever should a bed ever be higher than a sofa.
Otherwise the patient feels himself "out of humanity's reach"; he can
get at nothing for himself: he can move nothing for himself. If the
patient cannot turn, a table over the bed is a better thing. I need
hardly say that a patient's bed should never have its side against the
wall. The nurse must be able to get easily to both sides the bed, and to
reach easily every part of the patient without stretching--a thing
impossible if the bed be either too wide or too high.
[Sidenote: Bed not to be too high.]
When I see a patient in a room nine or ten feet high upon a bed between
four and five feet high, with his head, when he is sitting up in bed,
actually within two or three feet of the ceiling, I ask myself, is this
expressly planned to produce that peculiarly distressing feeling common
to the sick, viz., as if the walls and ceiling were closing in upon
them, and they becoming sandwiches between floor and ceiling, which
imagination is not, indeed, here so far from the truth? If, over and
above this, the window stops short of the ceiling, then the patient's
head may literally be raised above the stratum of fresh air, even when
the window is open. Can human perversity any farther go, in unmaking the
process of restoration which God has made? The fact is, that the heads
of sleepers or of sick should never be higher than the throat of the
chimney, which ensures their being in the current of best air. And we
will not suppose it possible that you have closed your chimney with a
chimney-board.
If a bed is higher than a sofa, the difference of the fatigue of getting
in and out of bed will just make the difference, very often, to the
patient (who can get in and out of bed at all) of being able to take a
few minutes' exercise, either in the open air or in another room. It is
so very odd that people never think of this, or of how many more times a
patient who is in bed for the twenty-four hours is obliged to get in and
out of bed than they are, who only, it is to be hoped, get into bed once
and out of bed once during the twenty-four hours.
[Sidenote: Nor in a dark place.]
A patient's bed should always be in the lightest spot in the room; and
he should be able to see out of window.
[Sidenote: Nor a four poster with curtains.]
I need scarcely say that the old four-post bed with curtains is utterly
inadmissible, whether for sick or well. Hospital bedsteads are in many
respects very much less objectionable than private ones.
[Sidenote: Scrofula often a result of disposition of bedclothes.]
There is reason to believe that not a few of the apparently
unaccountable cases of scrofula among children proceed from the habit of
sleeping with the head under the bed clothes, and so inhaling air
already breathed, which is farther contaminated by exhalations from the
skin. Patients are sometimes given to a similar habit, and it often
happens that the bed clothes are so disposed that the patient must
necessarily breathe air more or less contaminated by exhalations from
his skin. A good nurse will be careful to attend to this. It is an
important part, so to speak, of ventilation.
[Sidenote: Bed sores.]
It may be worth while to remark, that where there is any danger of
bed-sores a blanket should never be placed _under_ the patient. It
retains damp and acts like a poultice.
[Sidenote: Heavy and impervious bedclothes.]
Never use anything but light Witney blankets as bed covering for the
sick. The heavy cotton impervious counterpane is bad, for the very
reason that it keeps in the emanations from the sick person, while the
blanket allows them to pass through. Weak patients are invariably
distressed by a great weight of bed-clothes, which often prevents their
getting any sound sleep whatever.
NOTE.--One word about pillows. Every weak patient, be his illness
what it may, suffers more or less from difficulty in breathing. To
take the weight of the body off the poor chest, which is hardly up
to its work as it is, ought therefore to be the object of the nurse
in arranging his pillows. Now what does she do and what are the
consequences? She piles the pillows one a-top of the other like a
wall of bricks. The head is thrown upon the chest. And the shoulders
are pushed forward, so as not to allow the lungs room to expand. The
pillows, in fact, lean upon the patient, not the patient upon the
pillows. It is impossible to give a rule for this, because it must
vary with the figure of the patient. And tall patients suffer much
more than short ones, because of the _drag_ of the long limbs upon
the waist. But the object is to support, with the pillows, the back
_below_ the breathing apparatus, to allow the shoulders room to fall
back, and to support the head, without throwing it forward. The
suffering of dying patients is immensely increased by neglect of
these points. And many an invalid, too weak to drag about his
pillows himself, slips his book or anything at hand behind the lower
part of his back to support it.