In all large houses there ought undoubtedly to be some provision for infectious illness. Of course I know that there are excellent fever hospitals, where one can be despatched at almost a moment’s notice, where an ambulance will deposit you, and where the best nursing and doctoring can be had at a most moderate outlay; and I, for one, highly applaud those courageous souls who telegraph for the proper conveyance, and depart, cutting themselves off from their homes, and at the same time from any chance of handing on their complaints elsewhere, with one fell swoop. But, much as I admire and applaud, nothing would, I fear, induce me to follow their laudable example. To know how to be ill is a fine art, and this accomplishment is quite thrown away on those who regard one merely as a ‘case,’ and talk about one as if one were a mere chattel left with them to repair, and return with the utmost speed. Moreover, I maintain always that one’s bodily health depends immensely on one’s surroundings, and that it would take double the time to get better in a hospital than one would in one’s own home, where one could see one’s friends out of the window and catch even a far-off whisper of what was happening, and see even from the greatest distance some of one’s old, accustomed sights. In an ordinary house, as at present arranged, it would be absolutely impossible to have even the smallest amount of infectious disease without running the greatest risk of handing it on to all the rest of the family; but there could be in most houses such arrangements made, were the builder a man of sense, that we could have a hospital room, a room sufficiently isolated to ensure immunity from infection, and yet near enough to do away with the hopeless feeling which seizes the ordinary mortal the moment he hears he has ‘something catching,’ and which enables him to understand what were the feelings of the lepers of old, who had to flee from the sight of their fellow-creatures, calling out aloud as they ran, ‘Unclean! unclean!’ Of course we ought not to feel angry with those who refuse to come near us; indeed, had I my way no one should ever enter a house where there was small-pox, scarlatina, or diphtheria; but we do resent it somehow, despite our own common sense and the knowledge that we should forbid the call our friends are so anxious not to make if they attempted to come near us; and there is no more miserable feeling than that which seizes us when we are told that we have a complaint in our midst which may prevent us from being on the same footing as the rest of mankind for several weary weeks, or may be months. But, before going into the matter of what we should do when infection is in our house, let me for a moment speak about the room we should all of us possess ready for an emergency and into which we could retire were we ill at all, not only ‘infectious’ but ill in such a way that we may require careful nursing, many fires, and absolute quiet and rest.

We should select a room at the top of the house unless we are building our house; in that case we should have a couple of rooms added on at one end, with a bathroom, lavatory, and tiny kitchen range in a third room. This should make a sort of annexe to the house; it should be reached from outside, and a passage, closed at one end with a plate-glass door, should communicate with the rest of the house. I once knew such an arrangement as this, and have always hankered after it, more especially as it allowed one member of a family of eight children to have scarlet fever at home without in the least endangering the lives of any others of the family, while the mother could see the child daily through the plate-glass door, although she could not nurse her herself. She ran absolutely no risk; the plate-glass door was as safe as the solid wall, and over it always hung a sheet steeped in carbolic acid. The child was nursed among familiar surroundings; the doctor could visit it without passing through the house; all the food could be placed so that the nurse received it without the smallest risk, and, in fact, the arrangement was so absolutely perfect that I cannot understand why possessors of large houses and good means do not always keep some rooms of the kind ready. No family can go through life without illness; it is much easier to bear when all is prepared for it, and there is no dreadful domestic upset to add to our natural anxiety and trouble when illness comes upon us all.

Now, given such houses as these, or even the single room quite at the top of the house, which would be next best (and although these have their disadvantages, they are generally quieter than any other), I should proceed to decorate them prettily. I should paint the walls first, and then I should paper them with the very cheapest blue paper I could find. I think Maple’s 4½d. blue and white paper would be best, and I should have ivory paint, the 4½d. a piece white and yellow ceiling paper, and curtains of 1s. 6d. a yard serge in art blue double. There is nothing here which cannot be replaced at a very small cost; yet everything would look pretty and bright and fresh; and I should have the floor parqueterie or else covered with matting and rugs. The rugs could be removed in a moment if anything infectious were the matter, while the matting could be disinfected or destroyed; but this should remain. It smells fresh, it never accumulates the dust, and always looks nice, in my opinion. In illness looks are everything, and it is absolutely necessary for things to be neat and pretty; else the patient will be worried to death without really understanding why he is being worried.

The bed should be a good wide one—a double one. This gives room for the patient to move about in. It should have a wire mattress and a good hair mattress at the top, four pillows, and a bolster, and it should have an ample supply of venerable blankets for under use. Those for over use should depend on what is the matter. New blankets and an eider-down are lighter and warmer than anything, and if these are required they must be had, even if afterwards they have to be destroyed. There should be no washing or dressing apparatus visible (these can be kept in the lavatory), but there should be two or three of the stained wooden chairs sold by Pither, 38 Mortimer Street, W., which are comfortable enough for the doctor and an occasional visitor or for the nurse on duty (too much comfort often induces sleep), and which can be wiped over daily. There should also be a wide, deep wicker armchair, nicely cushioned, and there should be a long chair for the invalid, where he or she could rest while the bed is made or remain when convalescence has begun, and the bed may be left for some hours at least. The long deck chairs are not suitable for this purpose, as, being made of wicker, they creak in the most awful manner, and are not comfortable in the least; but there are some long narrow beds used as camp beds, which can be put up at any angle, and have an iron frame filled in with sacking, on which a cushion is placed. This makes the most comfortable lounge of which I know, and should be in every sick room or room set apart for the purpose of nursing. They can be bought at almost any ironmonger’s, or at any place which caters for Volunteers or those who do any luxurious camping out. There should be pictures on the walls, and a bookcase, and above all there should be a screen of some kind or other. The pictures should be of the cheapest; some of those lately issued by the ‘Illustrated News’ people, which resemble old Bartolozzi prints, would do admirably, as the frames could be disinfected, the glass washed, and the pictures themselves destroyed. The bookcase could be varnished or re-Aspinalled, and the books burned. Books are fearful methods of conveying infection, and carelessness about this cannot be too harshly condemned. It is far better to destroy everything, no matter how precious it may be, than run the very smallest risk of passing on even what may be considered a mild complaint, for that which is mild in one patient often causes death or great suffering in another whose constitution is unfitted to cope with that special disease.

Once the room is ready and looking pretty, the next care must be to see that it is kept properly aired and that nothing gets out of order, and that all the things for use are in their places; then we need not think any more about the room, which should be under the charge of the head-nurse of the establishment; but, especially where there are children, it is absolutely necessary that we should be prepared for emergencies, and know exactly what to do should there be any necessity for prompt action. There are a series of rules printed by the National Health Society, which should be hung up in every nursery, and there should be, moreover, a box containing simple remedies for sprains (arnica), cuts (calendula), and burns (oiled silk, oil, and cotton wool), and the nurse should keep the key. But, whatever happens, her remedies can only be temporary ones; all her instructions should end like those to the ambulance experts, ‘Send for the doctor.’

Now, although I am certainly no advocate for constantly sending for the doctor, and though I maintain that for small children a good nurse is worth all the doctors under the sun, I do maintain that immense comfort and safety are procured by an early visit from the doctor if we are fearful that anything is wrong above the common. But I maintain equally strongly that to be able to do this we must be very sure of our man; we must be able to trust him, and we must be quite certain that he is an honest man, who will not trespass on our credulity or fatten on our fears, and who will have the necessary courage to tell us straight out that we have nothing to fear and that we need not send for him again, or at least that he will not come again until we do send for him. Above all, let us, if possible, keep to the same doctor. Nothing is more stupid than to change him, unless we are absolutely obliged to do so, for he understands his patients’ constitutions if he has always had to see after them. A new man cannot possibly do so at first, and much more depends on a doctor understanding what he has to deal with, as far as heredity is concerned, than one quite comprehends. People would not be quite so ready to change their medical attendant as they very often seem to me to be if they thoroughly believed in this.

And now comes the great subject of nursing. I was much amused the other day to see an indignant article from someone who abused the present generation of mothers because they did not nurse their children themselves in cases of infection, and because their first idea in an emergency was to send for a nurse. Now I maintain that that is the very wisest thing anyone can do. A mother, as a rule, is the worst person in the world to nurse her own child; her fearful anxiety makes her nervous and communicates itself to the patient, who ought never to know that anyone is the least anxious about him. Her face betrays her, and her shaking hands play her false, and on a thousand grounds it is far better to have a trained nurse than to trust to unskilled though loving nursing. A mother may never have had the smallest experience of nursing until she is called upon to exercise any little talent she may have for it on behalf of her nearest and dearest. She becomes frantically miserable at symptoms a nurse understands, and are often enough symptoms for good; she cannot raise a patient and give him food comfortably, as does a woman trained to the work, and she cannot be the ‘half-doctor’ all nurses ought undoubtedly to be, and indeed are nowadays, unless she has had training; a course of training, by the way, which would be most distasteful to many and absolutely impossible to the few.

A nurse is born, not made; of that I am absolutely convinced from my own experience. I do not think anything would make me personally fit to nurse anyone, much as I should like to do it. Were I called upon to turn nurse I could undoubtedly keep a room neat, smooth a pillow, and fold a sheet over properly; but I stand by in amaze and watch a friend of mine who has never been trained, but is a born nurse, who knows exactly how to lift her patient, when and how to give beef-tea and medicine, and who does easily and without effort what I cannot do at all, try as hard as I may to follow her excellent example. She may be anxious, she never shows it in the least; she may be tired to death, she does not look it; her voice is always at the right pitch, and though she naturally is not merry when there is danger, she maintains an even cheerfulness which is delightful, and as restful to the patient as it is most undoubtedly restful and reassuring to the patient’s friends. Now, sentiment apart—and sentiment should never be considered in the very least degree where real work has to be done—surely my friend is better able to nurse, and a much safer nurse, than I should be; I, who have honestly and seriously tried to overcome my stupidity and dread of sick people, and who visited at a hospital regularly until I was utterly and completely routed by seeing a man in a fit, since when I have avoided hospitals and have quite come to the conclusion I should never be a nurse. Therefore, is it not wiser for people in real cases of dangerous illness to engage women who understand their work? I am convinced it is, and strongly recommend anyone who is advised by the doctor to send for a nurse to do so. He will always be able to tell them where to send; if not, they can find any amount of addresses in that most useful and excellent little book ‘Dickens’s Dictionary of London.’ But the doctor should find the nurse in infectious cases, for, as a rule, he knows someone with whom he has worked already, and of course these nurses have to be sent for in a hurry; one does not make preparations for and look out for fevers as one does when a small baby is expected; about that I have said all I have to say in my other book, and shall not therefore say anything here on that absorbing subject.

Everybody should remember that illness, instead of deadening our faculties, undoubtedly and at once heightens every one we possess. We see more acutely most certainly; our smell and taste are exaggerated in the most painful degree, and little annoyances and inferior cooking, which we scarcely notice, or indeed notice not at all, when we are well, try us most dreadfully. If we are to eat at all, all must be absolutely clean and free from grease, and sent up spotlessly; there must not be a suspicion of carelessness, or inevitably we shall turn against the food and send it down untouched. Likewise, creaking shoes, rustling paper, banging doors, crooked pictures, dusty tables and chairs must not exist where there are invalids; and, above all, I am convinced that until a person is actually and positively dead no one should talk about them over their bodies, thinking they are insensible. I am certain that insensible people, so called, are often far more sensitive than either doctor or nurse will allow, and I know I myself have often heard things which were never meant for me to hear when people have thought me asleep, but when I have really simply been too tired to open my eyes; and I shall never forget the expression that flitted across the face of a dear old lady who was absolutely dying, who had not swallowed for two days, or spoken for a great many more, when her daughter and maid spoke of the mourning and funeral by her bedside heartlessly. She heard and understood, although she undoubtedly had no power of letting us know that she did so. And I, moreover, have been told by a cousin whose recovery from a frightful attack of blood-poisoning was miraculous, and who most certainly was merely saved from death by her doctor’s unremitting care and the excellent nursing she received from him—he never left her once for over forty-eight hours—that she knew absolutely everything that went on, that she heard every single word and whisper, and that she most certainly would never say a word in the presence of any ‘insensible’ person that could pain or agitate him in the least, for when she appeared most insensible to on-lookers she was really far more sensitive than she had ever been in all her life: her hearing was absolutely acute, and every sense seemed on end, a feeling I can corroborate from my own experience, though I have had no really very serious illness, but have been ill enough to comprehend this supersensitiveness and to understand how absolutely quiet and restful should be the conditions of any invalid. It sounds absurd to say that noise can kill anyone, but noise can; a sudden shock can undoubtedly snap the thread of life, while noise constantly wearing on the brain can do endless harm, especially to those who are predisposed to notice and resent continually unpleasant sounds. And now I want to give a hint to many among us who are abjectly miserable because they fancy they have some incurable complaint, and yet have not the sense or courage to really go to a good doctor and learn what is the matter, or indeed whether there is anything the matter at all. The tiny lump which appears on the neck may be nothing but a little swelling of a gland, or it may be cancer; the dreadful pain that seizes the chest may be heart or it may be indigestion; anyhow, whatever it is, it is far better to know what is the matter than to wear oneself to death in wondering if we have or have not a fatal disease.

If we have not, well and good; if we have, what, after all, does it matter? We have all fatal diseases, if it comes to that, and we are all absolutely sure, unpleasant as is the fact, that we must die, and it is something to know a little about the means and time by which we shall have to shuffle off this mortal coil; and, moreover, we can undoubtedly save ourselves endless trouble, and stave off the last day of our lives, if we learn early in the day what we have to avoid, and how best we can manage our lives, many having lost them entirely because they literally had not the courage to go to the doctor, or went to him so late that he had sorrowfully to confess he could do nothing, albeit he could have done much had the patient come to him when she or he first began to suspect there was anything amiss. I could, I am sorry to say, quote examples from my own dear and intimate friends of the evil done by this cowardly dislike to face the worst, and I therefore feel very strongly on the subject, and implore any of my readers who may suspect a lurking disease to face it. It may be nothing but fancy; even so, the fancy should be exorcised. It may be fatal; then the doctor will lay down rules at once for guidance, and even if death is imminent it is just as well to know this. There are things to do quietly, and one’s house to set in order, albeit there is no need to make the lives of all one’s relations burdens to them; neither need we make ourselves miserable beforehand by everlasting contemplation of the inevitable parting. Be quite sure, whether it comes at 100, at 20, at 40, we none of us realise or relish the idea, but when a thing must be it is best to accept it gracefully; people will remember us much more kindly if we go cheerfully, and do not make them all wretched by kicking against the pricks.

And, above all, remember if you have a disease to keep the fact to yourself and to your doctor; no one else wants to hear about it, and it is interesting to no one else. If you become an invalid you can be both cheerful and useful, although I know how hateful—how truly hateful—it is to put up the once active feet, and cross the once busy hands, and simply listen to what we once used to do. I know too that a good listener is highly appreciated, and that many a happy home finds the heart of the house round the invalid sofa, where can always be found someone who is always at home, always disengaged, always willing to help and anxious to hear, and who has a most profound interest in all that is going on, despite the fact that she is out of the action, and can only take a passive part in the life that seemed once as if it could never go on without her.

Moreover, an invalid should never become absorbed in herself, in her treatment, her medicine, and the progress of her malady; having found her doctor to be trustworthy, she should do as he tells her, and after his visit she should utterly decline to speak of herself; she should read, if possible work (how I do wish I could sew, or knit, or do anything on earth save read and write!), and, above all she should be absolutely nice and particular about her clothes, which should never degenerate (unless it is absolutely necessary) into the dressing-gown stage. Loose garments are untidy, and anything untidy or ‘dressing-gowny’ assists the invalid idea, which should be kept in the background as much as possible.

Then there is another thing I should like to mention, and that is that invalids should always have their affairs settled, and their wishes as regards the future of their children or their property entirely and properly understood—that is to say, understood and settled as far as anything can be settled that is so unknown as the future—and while a man is an absolute criminal who neglects to make his will, a woman is equally foolish who, having strong feelings on subjects which will concern her children, or may be the place of her burial, does not write such a letter on the subject to her husband, to be opened after her death, as shall lay all her wishes before him, but only as wishes: the dead hand should never fetter anyone; at best it should only indicate the course which the owner would have followed.

In but one case should a man or a woman who has property put an emphatic embargo on the future proceedings of the husband or wife, and then only if there are children, and that is in the case of the husband or wife remarrying. Under these circumstances the property should go absolutely into the hands of trustees, to be administered entirely for the use of the children, who are often enough defrauded of their father’s or mother’s money, which goes to keep some lazy man or extravagant woman who in their time may produce children to share that which was only meant for the owner’s own offspring.

This rule should never be departed from under any circumstances: it should be absolutely out of anyone’s power to defraud children of what was intended for them alone by the one parent who had money. This does not prevent a man or a woman marrying again; they had the same chances, if they wanted them, as they had before; but it does prevent the children being robbed, as I have known them robbed, in more than one case, by their silly mothers, who, yearning for the love and protection they have lost, cast themselves into the arms of number two, doubly flattered at being wooed when their first bloom has vanished, and find themselves saddled with men who neglect the business they were supposed to keep together, or squander the money saved so hardly and set aside so carefully for those who cannot help themselves or stay the marriage that will inevitably spoil their home life if it do not wreck their futures.

Let the wife have all control until she marries again; then someone else should step in, as undoubtedly if a woman does not care to remember her husband she will not care to assure herself and protect his children from an extravagant, improvident man; and of course a man should be treated in the same way; all control as long as he remembers his wife, none when he ceases to do so and would maintain a successor out of the money she meant for her children’s welfare.

Now all this can be managed, and, indeed, should be managed, on the wife’s part by a letter written to her husband, and on a man’s by a calm conversation with his wife, who of course will vow that nothing on this earth would induce her to marry again; but, unfortunately for her argument, example can be brought against her of people who have said just the same, who have wept in the marketplace and wrung their hands in high places, ‘so to speak,’ and yet have married generally ‘for the sake of the dear children’ before they had worn out their mourning, and therefore her protestations can be gently set on one side with the quiet statement that in that case the money will be in her own power. This can show no lack of confidence in the wife; it simply shows a lack of confidence in any possible future husband, and a consummate knowledge of human nature, which forgets disagreeables speedily, alas! and accepts hurriedly any chance that may present itself of obliterating a mournful memory and changing one’s trappings of woe for newer and far more beaming garments.

I never could understand the sensitiveness that prevents some wives and husbands from ever speaking of the future that must come when they will be separated. There need be no continual discussion of the mournful subject, but it should be discussed thoroughly when the will is made; it need never be spoken of again until circumstances arise that may cause some alterations to be made, or codicils added; anything that may be too painful to discuss can be written in the final letter of farewell. Then, if one has no accumulations of other folks’ letters, if one’s drawers are tidy, one’s bills paid, and one’s conscience clear, there will be nothing to make anyone extra-miserable after we have departed; we shall have done our work, left everything in order, and shall leave nothing but a pleasant memory behind us.

Death as a rule is either made unduly awful, or is a time of the most extravagant expenditure. The immense quantities of florists’ wreaths sent nowadays have brought into disrepute one of the most charming ideas possible, and the money once devoted to black plumes and undertaker’s millinery of all kinds, to extravagant mourning and absurd woe, is now squandered equally extravagantly and absurdly on wreaths, which cost from 15s. to 30s. each, and which are simply thrown into the earth to perish there untimely. Not for one moment would I deprecate the use of flowers entirely, but let them be arranged by people who loved me, and really bound them together because they knew I loved them. I would rather spend money, or have money spent, on some useful memorial than on a perishable wreath; and were I to die to-morrow I should say, Give me as simple, as cheap a funeral as you can, and give the money to my pet charity. It could be done in my name, and would be a practical remembrance of me, and a far more useful one than hundreds of wreaths. Why, I once saw a funeral in mid-winter where there were over 300 wreaths. This would have almost built a ward in the Hospital for Sick Children; it would certainly have helped the good Sisters at Kilburn, and have done great good to the children there, who had always been loved by her whose funeral it was. And in the same way would I deprecate a ‘handsome’ coffin and elaborate headstone; neither can do any good to the dead, and the memory of those we have loved can be perpetuated a thousand times longer should we content ourselves with the simplest oak coffin we can get and the plain cross, which will last as long as anyone could wish it to, while the money saved can be given elsewhere. Everyone has some pet scheme that could be benefited by his or her death; no one but the undertaker and florist is benefited now.

Another reason why we should not encourage the sending of an immense quantity of flowers from our friends is, that there is something almost ghastly about the false air of festivity given by the constant receipt and opening of the parcels and boxes in which they are sent; in the list of names which, must be written out, in order that all who sent may be thanked or their names mentioned in the local paper; and in the smothered remarks of the servants and children as they look at the beauties, and compare the present one with the last one laid on the coffin in the room which is so familiar and yet has become so fearfully and wonderfully strange.

But if flowers need not be sent (and I wish I could think all would send the money instead to some special fund), letters should always be written. They may not be read at first—nay may never be really read at all—but the name of the writer will always be remembered warmly, and as that of one who knew that sympathy is the most precious gift we can any of us receive when we are in the depths, and that dark curtain descends which seems as if it would lie for ever between us and the outside world. Ah me! no matter who has died, it will rise again, and life will flow on just the same as if we had never lost those who were so near and so dear to us.

Undoubtedly, too, though we should none of us ever call at the house to inquire after a scarlet fever, small-pox, or diphtheria case, we should let our friends know through the post that we are thinking of them. If their child is ill we can make up tiny parcels to send. A few flowers; a paper doll; a few old books, which can be burned as soon as read; ‘scraps’ to paste into books; odds and ends which cost nothing and can be destroyed without a pang, often making a small child’s day of tedious weariness and slow convalescence, an entirely different thing to what it might have otherwise been; and the idea of what to-morrow’s post may bring has, to my knowledge, more than once soothed a tired little girl to rest; for she would go to sleep easier when she remembered that the sooner the night was over the sooner the familiar ring would be heard, and the lovely parcel would arrive, which might contain nothing more costly than glass beads for stringing, or some roses and a cheap little vase to put them in, but which was a never-ending source of wonder and delight, until the child was well and able to take her place again among her brothers and sisters.

In the sick room, which may be the death chamber, sympathy, always precious, becomes an absolute necessity, and a tedious day of pain is often borne more courageously than it otherwise would have been, and passes quicker than it otherwise might have done, if we know that people are thinking of us and wondering if there is anything they can do to lighten our time of trouble and to help us bear the inevitable misery of it all. A sick person, or an invalid, should never be forgotten. I verily believe half our dread of death comes from the fact that we know that soon we shall be as if we had never been, and that our place shall be taken by another and shall know us no more.

When we are quite sure that there is an infectious disease in our house, we ought to be compelled by Act of Parliament to register the fact at some convenient place, where a list of houses similarly infected should undoubtedly be exposed in a prominent place. None should be exempt from this law, and the doctor should be the person responsible for the registration, a severe penalty, moreover, being inflicted in any case of wilful misrepresentation or of the withholding of proper information of the outbreak.

That the penalty is necessary is proved by the fact that I once knew a country doctor speak of a bad attack of scarlet fever as a mild case of rose rash, because he was abjectly afraid of losing the patronage of the dame whose child it was, and who objected to the isolation which would have been her portion had the truth been known. Still the disease spread, owing to her selfishness and the doctor’s supineness, and the truth came out, but not before she had done endless mischief and caused the death of a child of one of her relations, who was sent into the house with his nurse to inquire after the ‘rose rash,’ and who would never have been allowed to pass even the same side of the street had his mother known the truth; and both the doctor and the patient’s mother were in consequence ostracised and isolated from their fellow-creatures far more completely and for a much longer period than they would have been had they boldly and at once told the truth.

Nowadays, with the slight exception of the law that we must not wilfully expose anyone suffering from an infectious disease in a public conveyance, we may do pretty much as we like.[A] We can send other members of the family to church or the theatre; we can send our washing to the public laundry, we may let our friends come and see us without mentioning what is the matter, and, in fact, there is no law except the moral law (which governs so few of us) to prevent us handing on the complaint to as many people as we can comfortably manage to infect. The registration would prevent this, as it would prevent us from stopping in a fever-bed or (as happened to me not a month ago) from sending a cat to be doctored in a house where there was a fatal case of scarlet fever; and how that cat didn’t bring it back to us is more than I can understand, but it did not. Albeit, any mother can understand what I felt until I knew all chance of infection was over from that source at all events.

[A] Since the above was written a law has been passed to make the notification of disease compulsory in London; so there is one step already made in advance.