[Sidenote: Poisoning by the skin.]
In almost all diseases, the function of the skin is, more or less,
disordered; and in many most important diseases nature relieves herself
almost entirely by the skin. This is particularly the case with
children. But the excretion, which comes from the skin, is left there,
unless removed by washing or by the clothes. Every nurse should keep
this fact constantly in mind,--for, if she allow her sick to remain
unwashed, or their clothing to remain on them after being saturated with
perspiration or other excretion, she is interfering injuriously with the
natural processes of health just as effectually as if she were to give
the patient a dose of slow poison by the mouth. Poisoning by the skin is
no less certain than poisoning by the mouth--only it is slower in its
operation.
[Sidenote: Ventilation and skin-cleanliness equally essential.]
The amount of relief and comfort experienced by sick after the skin has
been carefully washed and dried, is one of the commonest observations
made at a sick bed. But it must not be forgotten that the comfort and
relief so obtained are not all. They are, in fact, nothing more than a
sign that the vital powers have been relieved by removing something that
was oppressing them. The nurse, therefore, must never put off attending
to the personal cleanliness of her patient under the plea that all that
is to be gained is a little relief, which can be quite as well given
later.
In all well-regulated hospitals this ought to be, and generally is,
attended to. But it is very generally neglected with private sick.
Just as it is necessary to renew the air round a sick person frequently,
to carry off morbid effluvia from the lungs and skin, by maintaining
free ventilation, so is it necessary to keep the pores of the skin free
from all obstructing excretions. The object, both of ventilation and of
skin-cleanliness, is pretty much the same, to wit, removing noxious
matter from the system as rapidly as possible.
Care should be taken in all these operations of sponging, washing, and
cleansing the skin, not to expose too great a surface at once, so as to
check the perspiration, which would renew the evil in another form.
The various ways of washing the sick need not here be specified,--the
less so as the doctors ought to say which is to be used.
In several forms of diarrhoea, dysentery, &c., where the skin is hard and
harsh, the relief afforded by washing with a great deal of soft soap is
incalculable. In other cases, sponging with tepid soap and water, then
with tepid water and drying with a hot towel will be ordered.
Every nurse ought to be careful to wash her hands very frequently during
the day. If her face too, so much the better.
One word as to cleanliness merely as cleanliness.
[Sidenote: Steaming and rubbing the skin.]
Compare the dirtiness of the water in which you have washed when it is
cold without soap, cold with soap, hot with soap. You will find the
first has hardly removed any dirt at all, the second a little more, the
third a great deal more. But hold your hand over a cup of hot water for
a minute or two, and then, by merely rubbing with the finger, you will
bring off flakes of dirt or dirty skin. After a vapour bath you may peel
your whole self clean in this way. What I mean is, that by simply
washing or sponging with water you do not really clean your skin. Take a
rough towel, dip one corner in very hot water,--if a little spirit be
added to it it will be more effectual,--and then rub as if you were
rubbing the towel into your skin with your fingers. The black flakes
which will come off will convince you that you were not clean before,
however much soap and water you have used. These flakes are what require
removing. And you can really keep yourself cleaner with a tumbler of hot
water and a rough towel and rubbing, than with a whole apparatus of bath
and soap and sponge, without rubbing. It is quite nonsense to say that
anybody need be dirty. Patients have been kept as clean by these means
on a long voyage, when a basin full of water could not be afforded, and
when they could not be moved out of their berths, as if all the
appurtenances of home had been at hand.
Washing, however, with a large quantity of water has quite other effects
than those of mere cleanliness. The skin absorbs the water and becomes
softer and more perspirable. To wash with soap and soft water is,
therefore, desirable from other points of view than that of cleanliness.