HOWEVER skilfully designed the arrangements of a house may appear to be, however sumptuously decorated and furnished its rooms, it is impossible to know whether a great law of common sense and practical usefulness has guided such arrangements, until there has been an illness in the house. Then will it be discovered—too late alas!—whether doors and windows open conveniently, whether fireplaces give out proper warmth, how the apparatus for ventilation works, and whether the staircases, landings, cupboards, and a thousand unconsidered items of the architect’s labours have been planned in the best possible way, or in the stupidest. For the comfort and convenience of the patient at such times, it is by no means necessary that much money should have been spent on the construction of the house that chances to shelter him in his hour of suffering, nor that its furnitures or decorations should be of a costly character. Fortunately such things need not aim at anything higher than cleanliness and convenience, and we only require to exert our own recollections in support of this assertion. As far as my individual experience goes, I have seen an old woman, who had been bed-ridden for years, more comfortably housed and tended beneath a cottage roof, and her room kept more exquisitely clean and sweet than that of many wealthy patients in splendid houses. Of course everything depends on the capacity for organisation and arrangement in the person who has charge of the invalid, but the nurse’s task may be made much easier by having to perform it in a bedroom and under conditions which are in accordance with the exigencies of such a time.

Many smart and pretty-looking bedrooms are discovered by their sick owner to be very different abodes to what they seemed to him in health. Awkwardly-placed doors and windows produce unsuspected draughts; the too close proximity of an ill-arranged staircase or housemaid’s closet becomes a serious trouble, and a low pitched ceiling prevents proper ventilation. It is more difficult than one imagines to find in a badly proportioned room a single convenient place for the patient’s bed. It must be either close to the door, or touching the fireplace, or under a window or in some situation where it distinctly ought not to be. I have known such faults—faults which occasioned discomfort every moment, and had to be remedied by a thousand make-shift contrivances, occur in splendid rooms in magnificent houses; and I have known poor little modern dwellings in a colony to be perfectly free from them. When I am told, “such or such a room or house is a very comfortable one to be ill in” then I know that the construction and arrangement of that abode, however simple it may appear, must needs be up to a very high mark indeed. Of course a great deal can be done to modify existing evils, by a judicious arrangement of screens and curtains, by taking out useless furniture, by substituting a comfortable low bed, easy to get at, for a cumbrous couch where the unhappy patient’s nose seems as if it was intended to rub against the ceiling, and various other improvements. But what can remedy a smoky chimney, or a grate where all the heat goes up the chimney, or windows that rattle, and doors that open in every direction except the right one? How can an outside landing or lobby be created at a moment’s notice, or a staircase moved a yard further off? Of course if an illness gave notice before it seized its victim, if people ever realised that a house should be so constructed as to reduce the chances of illness to a minimum, and raise its possible comforts to a maximum if it did come, then everything would go on quite smoothly and we should certainly live, and probably die, happy. But this is exactly what we do not do, and this chapter would never have been written if I had not seen with my own eyes innumerable instances where neither want of money, nor space, nor opportunity for improvement were the causes of a wretchedly uncomfortable sick-room.

I have known bedrooms which looked nests of rosy, luxurious comfort until their owner fell ill, and then turned suddenly, as it seemed, into miserable comfortless abodes of frippery and useless, tasteless finery—where a candle could scarcely be placed anywhere without risk of fire, and where the patient has deeply complained of the way the decorations of the room “worried” her. As a rule, in a severe illness, sick people detest anything like a confusion or profusion of ornaments or furniture. If I am in authority in such a case, I turn all gimcracks bodily out, substituting the plainest articles of furniture to be found in the house. Very few ornaments are allowable in a sick-room, and I only encourage those which are of a simple, correct form. I have known the greatest relief expressed by a patient, who seemed too ill to notice any such change, at the substitution of one single, simple classical vase for a whole shelf-full of tawdry French china ornaments, and I date the recovery of another from the moment of the removal out of his sight of an exceedingly smart modern dressing-table, with many bows of ribbon and flounces of lace and muslin. I do not mean to say that the furniture of a sick-room need be ugly—only that it should be simple and not too much of it. Nothing confuses and worries a person who is ill like seeing his attendants threading their way through mazes of chairs and sofas and tables; but he will gladly look and find relief and even a weary kind of pleasure in gazing at a table of a beautiful, simple form, placed where it is no fatigue for him to look at it, with a glass of flowers, a terra-cotta vase, a casket, anything which is so intrinsically beautiful in form as to afford repose to the eye.

I have often observed that when people begin to take pleasure in colour, it is a sure sign of convalescence—for in severe illness, unless indeed it be of such a nature as to preclude all power of observation, form is of more importance to the patient than colour. One learns a great deal from what people tell one after they are well enough to talk of such things as past, distempered fancies. For instance, I was once nursing a typhoid fever patient, who lay for some days in an agony of weakness. He had been deaf as well as speechless, and all his senses appeared to have faded away to the very brink of extinction. Yet afterwards when he became able to talk of his sensations at different stages of his illness, he mentioned that particular time, and I found he had been keenly conscious of the forms of the objects around. He spoke of the pleasure which the folds of a curtain had afforded him, of the “comfort” of the shape of the old-fashioned arm-chair in which I used to sit, and of how grateful he had felt when he observed that divers gimcracks had been removed from his sight. Later, as he grew better, and the weary eyes craved for colour, I found it necessary to pretend to be busy dressing dolls or making pincushions, to afford myself an excuse for a little heap of brightest coloured silks and fragments of ribbon placed where he could see them, and the daily fresh bunches of flowers were a perpetual delight to his eyes.

An ideal sick-room then should first of all possess walls which will not weary or worry the sick person, and no good pattern will do this. The low bed should be so placed that whilst it would be sheltered from draught (the aid of one or two screens will be useful here) the light would not fall disagreeably on the patient’s eyes. No rule can be given about light. In some cases the sick person loves to look out of the window all day, whilst in others a ray of light on the face is agony. In such circumstances the bed should, if possible, be so arranged as to allow the light to come from behind, for it is only in rare and exceptional cases that sunshine as well as outer air may not be admitted daily into a sick-room. We are fast getting beyond the ignorance of a north aspect for a bedroom, and most of us know that sunshine is quite as necessary to a bedroom as to a garden. No children will ever thrive unless they have plenty of sunshine, as well as air in the rooms in which they sleep, and a sick-room should also have both in abundance. If the weather be hot, it is easy, in England, to modify the temperature by means of outer blinds, persiennes, open doors, and other means. Few people understand what I have learnt in tropical countries, and that is, how to exclude the outer air during the hot hours of the day. The windows of the nursery or sick-room (for we all need to be treated like children when we are ill) should be opened wide during the early cool, morning-tide, and the room flooded with sun and outer air. Then, by nine or ten o’clock, shut up rigorously every window, darkening those on which the sun would beat, out-side the glass—by means of blinds or outer shutters—until the evening, when they may all be set wide open again. All woollen draperies, curtains and valences should be done away with in a sick-room. If the windows are unsightly without curtains, and the illness is likely to be a long one, then substitute soft, patternless muslin or chintz, or, prettiest of all, white dimity with a gay border, but let there be no places of concealment in a sick-room. Every thing unsightly or inodorous should be kept out of it, and herein is found the convenience of a well-planned and well-arranged house, where clothes-baskets, and things of that sort, can be so bestowed as to be at the same time handy and yet out of the way.

If it were not for the unconceivable untidiness and want of observation which exists in the human race, such cautions as not to leave about the room the clothes the sick person has last worn, hanging up or huddled on a chair in a corner, would seem superfluous. But I have actually seen a girl stricken down by a sudden fever, lying at death’s door, on her little white bed, whilst the wreath she wore at the ball where she took the fatal chill, still hung on her toilette glass, and her poor little satin shoes were scattered about the room.

She had been ill for days; there were two ladies’-maids in the house, besides anxious sisters, parents, and nurses, and yet no one had thought of putting these things out of sight. The first rule, therefore, to be observed in nursing even bad colds, where the sufferer may have to stay in bed a few days, is to send all the linen he has been wearing to the wash at once, and to put away everything else in its proper place. Boots should never be allowed in a sick-room, for the leather and blacking is apt to smell disagreeably and they ought immediately to be removed to another place.

Then there should be if possible outside the door of the sick-room, either on a landing or in another room, a convenient table, covered with a clean, white cloth, on which should be ranged spare spoons, tumblers, glasses, and so forth, and whatever cooling drinks are wanted, all so managed that dust shall be an impossibility. Inside the room, on another small table, or shelf, or top of chest of drawers, according to circumstances, should be kept also on a snowy cloth, just whatever is actually needed at a moment’s notice—medicines and their proper glasses, &c., and a spoon or two, but the instant anything is used, it should be an established rule that the nurse puts the spoon or glass outside, and supplies its place with a clean one. In most cases, a servant need only renew the supply outside twice a day.

As for keeping trays with nourishment in the room, it is a sign of such careless nursing that I should hardly dare to mention it, if I had not more than once gone to relieve guard in a friend’s splendid sick-room at daylight, and seen the nurse’s supper-tray of the night before on the floor whilst the room, in spite of all its beautiful decorations, smelt sickly and disgusting with the odour of stale beer and pickles. It is incredible that such things should happen, but in the confusion caused by a sudden and severe illness, untidy and careless habits are apt to come to the surface, and loom largely as aggressive faults. Sickness is not only a great test of the sufferer’s own character and disposition, but of those of the people around him, and as a general rule, I have discovered more beautiful qualities in sick people, and those about them, who dwell in cottages or even hovels, than in more splendid homes. Everyone knows how really kind poor people are to each other, and never more so than when the angel of disease or death is hovering over the humble roof-tree.

Food, or nourishment as it is called in sick-room phraseology, would not so often be refused by the patient if it were properly managed. Who does not know the wearisomeness of being asked, probably in the morning, when the very thought of food is an untold aggravation to one’s sufferings what one could “fancy”? And this is probably followed by a discussion on the merits or possibilities of divers condiments, to each of which as it is canvassed before him the wretched patient is sure to declare a deep-rooted repugnance. A sick person, until he reaches that happy stage of convalescence when it is an amusement to him, should never be allowed to hear the slightest discussion on the subject of his nourishment. Whatever the doctor orders should be prepared with as wide a range of variety as can be managed, and offered to him in the smallest permissible quantities, exactly cold or hot enough to take, and served as prettily and daintily as possible, at exactly the right moment. The chances are a hundred to one that, if it is within the range of possibilities that he can swallow at all, he will take it. If he does not, there should be no argument, no attempt at forcing it on him; it should at once be taken quite away and something different brought as soon afterwards as is prudent. Few people realise how extraordinarily keen the sense of smell becomes in illness, and how the faint ghost of a possible appetite may be turned into absolute loathing by the smell of a cup of beef-tea, cooling by the bed-side for ten minutes before it is offered.

I am always guided in a great degree about nourishment by the instincts of my patient, and I never force stimulants, or anything equally distasteful on a sick person who is at all reasonable upon such matters. I once had a patient to nurse, whose desperate illness had brought him very near the shadowy land. It had left him, and the doctors assured me that his life depended on how much brandy I could get down his throat during the night. I told him this, for he was quite sensible, when he refused the first teaspoonful, and he whispered in gasps, “I’ll take as much milk as you like; that stuff kills me.” So I gave him teaspoonfuls of pure milk all through the night every five minutes, and not a drop of brandy. The doctor’s first reproachful glance in the morning was at the untouched brandy bottle, and he shook his head, but when he had felt the sick man’s pulse his countenance brightened, and he graciously gave me permission to go on with the milk. Of course there are cases when the patient never expresses an opinion one way or other, and then the only safe rule is to obey the doctor’s orders, but I never fly in the face of any strong instinct of a sick person rationally expressed. So now I hope we have some glimmering idea of what a sick-room should be: cool in summer, warm in winter, but deliciously sweet and fresh and fragrant always. Simple in its furniture, but the few needful articles, of as agreeable shapes and as convenient as possible—a room which can be looked back upon with a sort of affection as a place of calm, of discipline, and of organization, as well as of the mere kindness and willingness to help, which is seldom, if ever, absent from a sick-room, but which is not the beginning and end of what is necessary within its walls.

There are bed-rests and bed-tables to be hired for a sick person’s use in almost any town in England; or, if it is preferred, any village carpenter could make a table with legs six or eight inches high, and a top of a couple of smooth light planks, about two feet six long, scooped out in the middle. This is very convenient when the patient is well enough to sit up in bed and employ himself. The bed-rests are equally simple, the upper half of a chair, padded, and made to lower at convenience, while a loose jacket or wrapper, easy to slip on, of flannel, should also be provided to throw over the patient’s shoulders when he uses chair and table. When the patient can sit up and occupy himself this sort of table will be found a great comfort. It might just as well be used when lying on a sofa.

One word more, like a postscript, for it has no real business to intrude itself here. It is only an entreaty to all nurses or those in authority in a sick-room, to wear the prettiest clothes they possess. Not the smartest, far from it; the simplest cottons, cambrics, what you will, but nice and fresh and pleasant to look at. If it is only a dressing-gown it may be a charming one. No hanging sleeves, or dangling chains, or streaming ribbons, but sufficient colour for weary eyes to rest on with pleasure. An ideal toilette for sick-room nursing would be a plain holland or cambric gown, made with absolute simplicity—long enough to be graceful without possessing a useless train—rather tight sleeves, and no frills or furbelows; a knot of colour at the throat and in the hair, or on the cap—only let your ribbons be exquisitely fresh and clean—and a nice large apron, or rather bib, with one big pocket in front. This apron may be tied back—not too tightly, please—with the same coloured ribbons, and a little change of hue now and then is a great rest and refreshment in a sick room. There are charming linen aprons now embroidered in School of Art designs of the shape I allude to, but they can be made equally well in print, or plain holland, or linen.

No garment that rustles or creaks, or makes its presence audible should ever cross the threshold, but the toilette of the nurse should always be exquisitely clean and neat, and yet as bright and pretty as possible. No sitting up at night, no anxiety or unhappiness should be an excuse for a dirty, dishevelled attendant in a sick-room. It is always possible to steal half an hour morning and evening to wash and change, and do one’s hair neatly, and the gain and comfort to the patient as well as to the nurse, is incalculable. This also would not be touched upon if my own recollections did not supply me with so many instances, where all this sort of care was considered to be absolutely worthless, and yet sick people have remarked afterwards how perfectly conscious they had been of all such shortcomings, and how such and such a tumbled cap, or shawl pinned on awry had been like a nightmare to them. Beauty itself is never more valuable than in a sick-room, and if laws could be passed on the subject, I should like to oblige all the pretty girls of my acquaintance to take it in turn to do a little nursing. I venture to say that no ball-room triumphs would ever compare with the delight their possession of God’s greatest and best gift would afford to His sick and suffering creatures. But a nurse may always make herself look pleasant and agreeable, and if she have the true nursing instinct, the ready tact and sympathy which a sick-bed needs, she may come to be regarded as “better than pretty” by her grateful patient.