Notes on Nursing Book CoverBy Florence Nightingale

II. Health of Houses.

Health of houses. Five points essential.

There are five essential points in securing the health of houses:
1. Pure air.
2. Pure water.
3. Efficient drainage.
4. Cleanliness.
5. Light.

Without these, no house can be healthy. And it will be unhealthy just in proportion as they are deficient.

Pure air.

1. To have pure air, your house be so constructed as that the outer atmosphere shall find its way with ease to every corner of it. House architects hardly ever consider this. The object in building a house is to obtain the largest interest for the money, not to save doctors’ bills to the tenants. But, if tenants should ever become so wise as to refuse to occupy unhealthy constructed houses, and if Insurance Companies should ever come to understand their interest so thoroughly as to pay a Sanitary Surveyor to look after the houses where their clients live, speculative architects would speedily be brought to their senses. As it is, they build what pays best. And there are always people foolish enough to take the houses they build. And if in the course of time the families die off, as is so often the case, nobody ever thinks of blaming any but Providence[2] for the result. Ill-informed medical men aid in sustaining the delusion, by laying the blame on “current contagions.” Badly constructed houses do for the healthy what badly constructed hospitals do for the sick. Once insure that the air in a house is stagnant, and sickness is certain to follow.

Pure water.

2. Pure water is more generally introduced into houses than it used to be, thanks to the exertions of the sanitary reformers. Within the last few years, a large part of London was in the daily habit of using water polluted by the drainage of its sewers and water closets. This has happily been remedied. But, in many parts of the country, well water of a very impure kind is used for domestic purposes. And when epidemic disease shows itself, persons using such water are almost sure to suffer.

Drainage.

3. It would be curious to ascertain by inspection, how many houses in London are really well drained. Many people would say, surely all or most of them. But many people have no idea in what good drainage consists. They think that a sewer in the street, and a pipe leading to it from the house is good drainage. All the while the sewer may be nothing but a laboratory from which epidemic disease and ill health is being distilled into the house. No house with any untrapped drain pipe communicating immediately with a sewer, whether it be from water closet, sink, or gully-grate, can ever be healthy. An untrapped sink may at any time spread fever or pyaemia among the inmates of a palace.

Sinks.

The ordinary oblong sink is an abomination. That great surface of stone, which is always left wet, is always exhaling into the air. I have known whole houses and hospitals smell of the sink. I have met just as strong a stream of sewer air coming up the back staircase of a grand London house from the sink, as I have ever met at Scutari; and I have seen the rooms in that house all ventilated by the open doors, and the passages all _un_ventilated by the closed windows, in order that as much of the sewer air as possible might be conducted into and retained in the bed-rooms. It is wonderful.

Another great evil in house construction is carrying drains underneath the house. Such drains are never safe. All house drains should begin and end outside the walls. Many people will readily admit, as a theory, the importance of these things. But how few are there who can intelligently trace disease in their households to such causes! Is it not a fact, that when scarlet fever, measles, or small-pox appear among the children, the very first thought which occurs is, “where” the children can have ” caught” the disease? And the parents immediately run over in their minds all the families with whom they may have been. They never think of looking at home for the source of the mischief. If a neighbour’s child is seized with small-pox, the first question which occurs is whether it had been vaccinated. No one would undervalue vaccination; but it becomes of doubtful benefit to society when it leads people to look abroad for the source of evils which exist at home.

Cleanliness.

4. Without cleanliness, within and without your house, ventilation is comparatively useless. In certain foul districts of London, poor people used to object to open their windows and doors because of the foul smells that came in. Rich people like to have their stables and dunghill near their houses. But does it ever occur to them that with many arrangements of this kind it would be safer to keep the windows shut than open? You cannot have the air of the house pure with dung-heaps under the windows. These are common all over London. And yet people are surprised that their children, brought up in large “well-aired” nurseries and bed-rooms suffer from children’s epidemics. If they studied Nature’s laws in the matter of children’s health, they would not be so surprised.

There are other ways of having filth inside a house besides having dirt in heaps. Old papered walls of years’ standing, dirty carpets, uncleansed furniture, are just as ready sources of impurity to the air as if there were a dung-heap in the basement. People are so unaccustomed from education and habits to consider how to make a home healthy, that they either never think of it at all, and take every disease as a matter of course, to be “resigned to” when it comes “as from the hand of Providence;” or if they ever entertain the idea of preserving the health of their household as a duty, they are very apt to commit all kinds of ” negligences and ignorances” in performing it.

Light.

5. A dark house is always an unhealthy house, always an ill-aired house, always a dirty house. Want of light stops growth, and promotes scrofula, rickets, etc., among the children.

People lose their health in a dark house, and if they get ill they cannot get well again in it. More will be said about this farther on.

Three common errors in managing the health of houses.

Three out of many “negligences, and ignorances” in managing the health of houses generally, I will here mention as specimens–1. That the female head in charge of any building does not think it necessary to visit every hole and corner of it every day. How can she expect those who are under her to be more careful to maintain her house in a healthy condition than she who is in charge of it?–2. That it is not considered essential to air, to sun, and to clean rooms while uninhabited; which is simply ignoring the first elementary notion of sanitary things, and laying the ground ready for all kinds of diseases.–3. That the window, and one window, is considered enough to air a room. Have you never observed that any room without a fire-place is always close? And, if you have a fire-place, would you cram it up not only with a chimney-board, but perhaps with a great wisp of brown paper, in the throat of the chimney–to prevent the soot from coming down, you say? If your chimney is foul, sweep it; but don’t expect that you can ever air a room with only one aperture; don’t suppose that to shut up a room is the way to keep it clean. It is the best way to foul the room and all that is in it. Don’t imagine that if you, who are in charge, don’t look to all these things yourself, those under you will be more careful than you are. It appears as if the part of a mistress now is to complain of her servants, and to accept their excuses–not to show them how there need be neither complaints made nor excuses.

Head in charge must see to House Hygiene, not do it herself.

But again, to look to all these things yourself does not mean to do them yourself. “I always open the windows,” the head in charge often says. If you do it, it is by so much the better, certainly, than if it were not done at all. But can you not insure that it is done when not done by yourself? Can you insure that it is not undone when your back is turned? This is what being “in charge” means. And a very important meaning it is, too. The former only implies that just what you can do with your own hands is done. The latter that what ought to be done is always done.

Does God think of these things so seriously?

And now, you think these things trifles, or at least exaggerated. But what you “think” or what I “think” matters little. Let us see what God thinks of them. God always justifies His ways. While we are thinking, He has been teaching. I have known cases of hospital pyaemia quite as severe in handsome private houses as in any of the worst hospitals, and from the same cause, viz., foul air. Yet nobody learnt the lesson. Nobody learnt _anything_ at all from it. They went on _thinking_– thinking that the sufferer had scratched his thumb, or that it was singular that “all the servants” had “whitlows,” or that something was ” much about this year; there is always sickness in our house.” This is a favourite mode of thought–leading not to inquire what is the uniform cause of these general “whitlows,” but to stifle all inquiry. In what sense is “sickness” being “always there,” a justification of its being ” there” at all?

How does He carry out His laws?

How does He teach His laws?

I will tell you what was the cause of this hospital pyaemia being in that large private house. It was that the sewer air from an ill-placed sink was carefully conducted into all the rooms by sedulously opening all the doors, and closing all the passage windows. It was that the slops were emptied into the foot pans!–it was that the utensils were never properly rinsed;–it was that the chamber crockery was rinsed with dirty water;–it was that the beds were never properly shaken, aired, picked to pieces, or changed. It was that the carpets and curtains were always musty;–it was that the furniture was always dusty;–it was that the papered walls were saturated with dirt;–it was that the floors were never cleaned;–it was that the uninhabited rooms were never sunned, or cleaned, or aired;–it was that the cupboards were always reservoirs of foul air;–it was that the windows were always tight shut up at night;– it was that no window was ever systematically opened even in the day, or that the right window was not opened. A person gasping for air might open a window for himself. But the servants were not taught to open the windows, to shut the doors; or they opened the windows upon a dank well between high walls, not upon the airier court; or they opened the room doors into the unaired halls and passages, by way of airing the rooms. Now all this is not fancy, but fact. In that handsome house I have known in one summer three cases of hospital pyaemia, one of phlebitis, two of consumptive cough; all the _immediate_ products of foul air. When, in temperate climates, a house is more unhealthy in summer than in winter, it is a certain sign of something wrong. Yet nobody learns the lesson. Yes, God always justifies His ways. He is teaching while you are not learning. This poor body loses his finger, that one loses his life. And all from the most easily preventible causes.[3]

Physical degeneration in families. Its causes.

The houses of the grandmothers and great grandmothers of this generation, at least the country houses, with front door and back door always standing open, winter and summer, and a thorough draught always blowing through–with all the scrubbing, and cleaning, and polishing, and scouring which used to go on, the grandmothers, and still more the great grandmothers, always out of doors and never with a bonnet on except to go to church, these things entirely account for the fact so often seen of a great grandmother, who was a tower of physical vigour descending into a grandmother perhaps a little less vigorous but still sound as a bell and healthy to the core, into a mother languid and confined to her carriage and house, and lastly into a daughter sickly and confined to her bed. For, remember, even with a general decrease of mortality you may often find a race thus degenerating and still oftener a family. You may see poor little feeble washed-out rags, children of a noble stock, suffering morally and physically, throughout their useless, degenerate lives, and yet people who are going to marry and to bring more such into the world, will consult nothing but their own convenience as to where they are to live, or how they are to live.

Don’t make your sickroom into a ventilating shaft for the whole house.

With regard to the health of houses where there is a sick person, it often happens that the sick room is made a ventilating shaft for the rest of the house. For while the house is kept as close, unaired, and dirty as usual, the window of the sick room is kept a little open always, and the door occasionally. Now, there are certain sacrifices which a house with one sick person in it does make to that sick person: it ties up its knocker; it lays straw before it in the street. Why can’t it keep itself thoroughly clean and unusually well aired, in deference to the sick person?

Infection.

We must not forget what, in ordinary language, is called ” Infection;”[4]–a thing of which people are generally so afraid that they frequently follow the very practice in regard to it which they ought to avoid. Nothing used to be considered so infectious or contagious as small-pox; and people not very long ago used to cover up patients with heavy bed clothes, while they kept up large fires and shut the windows. Small-pox, of course, under this _regime_, is very ” infectious.” People are somewhat wiser now in their management of this disease. They have ventured to cover the patients lightly and to keep the windows open; and we hear much less of the “infection” of small-pox than we used to do. But do people in our days act with more wisdom on the subject of “infection” in fevers–scarlet fever, measles, &c.–than their forefathers did with small-pox? Does not the popular idea of ” infection” involve that people should take greater care of themselves than of the patient? that, for instance, it is safer not to be too much with the patient, not to attend too much to his wants? Perhaps the best illustration of the utter absurdity of this view of duty in attending on ” infectious” diseases is afforded by what was very recently the practice, if it is not so even now, in some of the European lazarets–in which the plague-patient used to be condemned to the horrors of filth, overcrowding, and want of ventilation, while the medical attendant was ordered to examine the patient’s tongue through an opera-glass and to toss him a lancet to open his abscesses with?

True nursing ignores infection, except to prevent it. Cleanliness and fresh air from open windows, with unremitting attention to the patient, are the only defense a true nurse either asks or needs.

Wise and humane management of the patient is the best safeguard against infection.

Why must children have measles, etc.,

There are not a few popular opinions, in regard to which it is useful at times to ask a question or two. For example, it is commonly thought that children must have what are commonly called “children’s epidemics,” ” current contagions,” &c., in other words, that they are born to have measles, hooping-cough, perhaps even scarlet fever, just as they are born to cut their teeth, if they live.

Now, do tell us, why must a child have measles?

Oh because, you say, we cannot keep it from infection–other children have measles–and it must take them–and it is safer that it should.

But why must other children have measles? And if they have, why must yours have them too?

If you believed in and observed the laws for preserving the health of houses which inculcate cleanliness, ventilation, white-washing, and other means, and which, by the way, _are laws_, as implicitly as you believe in the popular opinion, for it is nothing more than an opinion, that your child must have children’s epidemics, don’t you think that upon the whole your child would be more likely to escape altogether?

FOOTNOTES:

[1] Health of carriages.

The health of carriages, especially close carriages, is not of sufficient universal importance to mention here, otherwise than cursorily. Children, who are always the most delicate test of sanitary conditions, generally cannot enter a close carriage without being sick– and very lucky for them that it is so. A close carriage, with the horse-hair cushions and linings always saturated with organic matter, if to this be added the windows up, is one of the most unhealthy of human receptacles. The idea of taking an _airing_ in it is something preposterous. Dr. Angus Smith has shown that a crowded railway carriage, which goes at the rate of 30 miles an hour, is as unwholesome as the strong smell of a sewer, or as a back yard in one of the most unhealthy courts off one of the most unhealthy streets in Manchester.

[2] God lays down certain physical laws.

Upon His carrying out such laws depends our responsibility (that much abused word), for how could we have any responsibility for actions, the results of which we could not foresee–which would be the case if the carrying out of His laws were not certain. Yet we seem to be continually expecting that He will work a miracle–i.e., break His own laws expressly to relieve us of responsibility.

[3] Servants rooms.

I must say a word about servants’ bed-rooms. From the way they are built, but oftener from the way they are kept, and from no intelligent inspection whatever being exercised over them, they are almost invariably dens of foul air, and the “servants’ health” suffers in an ” unaccountable” (?) way, even in the country. For I am by no means speaking only of London houses, where too often servants are put to live under the ground and over the roof. But in a country “_mansion_,” which was really a “mansion,” (not after the fashion of advertisements,) I have known three maids who slept in the same room ill of scarlet fever. ” How catching it is,” was of course the remark. One look at the room, one smell of the room, was quite enough. It was no longer ” unaccountable.” The room was not a small one; it was up stairs, and it had two large windows–but nearly every one of the neglects enumerated above was there.

[4] Diseases are not individuals arranged in classes, like cats and dogs, but conditions growing out of one another.

Is it not living in a continual mistake to look upon diseases, as we do now, as separate entities, which _must_ exist, like cats and dogs? instead of looking upon them as conditions, like a dirty and a clean condition, and just as much under our own control; or rather as the reactions of kindly nature, against the conditions in which we have placed ourselves.

I was brought up, both by scientific men and ignorant women, distinctly to believe that small-pox, for instance, was a thing of which there was once a first specimen in the world, which went on propagating itself, in a perpetual chain of descent, just as much as that there was a first dog, (or a first pair of dogs,) and that small-pox would not begin itself any more than a new dog would begin without there having been a parent dog.

Since then I have seen with my eyes and smelt with my nose small-pox growing up in first specimens, either in close rooms, or in overcrowded wards, where it could not by any possibility have been “caught,” but must have begun. Nay, more, I have seen diseases begin, grow up, and pass into one another. Now, dogs do not pass into cats.

I have seen, for instance, with a little overcrowding, continued fever grow up; and with a little more, typhoid fever; and with a little more, typhus, and all in the same ward or hut.

Would it not be far better, truer, and more practical, if we looked upon disease in this light?

For diseases, as all experiences hows,[Transcriber’s note: Possibly typo for “show”] are adjectives, not noun substantives.

Next > III. PETTY MANAGEMENT


This eBook is for the use of anyone anywhere at no cost and with almost no restrictions whatsoever. You may copy it, give it away or re-use it under the terms of the Project Gutenberg License included with this eBook or online at www.gutenberg.net “Plain Vanilla ASCII” version can be found at: http://www.gutenberg.net/1/2/4/3/12439/

No Comments

Leave a Comment