# Notes on Nursing: What It Is, and What It Is Not/Chapter X

X. CLEANLINESS OF ROOMS AND WALLS.
It cannot be necessary to tell a nurse that she should be clean, or that she should keep her patient clean, — seeing that the greater part of nursing consists in preserving ​cleanliness. No ventilation can freshen a room or ward where the most scrupulous cleanliness is not observed. Unless the wind be blowing through the windows at the rate of twenty miles an hour, dusty carpets, dirty wainscots, musty curtains and furniture, will infallibly produce a close smell. I have lived in a large and expensively furnished London house, where the only constant inmate in two very lofty rooms, with opposite windows, was myself, and yet, owing to the above-mentioned dirty circumstances, no opening of windows could ever keep those rooms free from closeness; but the carpet and curtains having been turned out of the rooms altogether, they became instantly as fresh as could be wished. It is pure nonsense to say that in London a room cannot be kept clean. Many of our hospitals show the exact reverse.
But no particle of dust is ever or can ever be removed or really got rid of by the present system of dusting. Dusting in these days means nothing but flapping the dust from one part of a room to another with doors and windows closed. What you do it for I cannot think. You had much better leave the dust alone, if you are not going to take it away altogether. For from the time a room begins to be a room up to the time when it ceases to be one, no one atom of dust ever actually leaves its precincts. Tidying a room means nothing now but removing a thing from one place, which it has kept clean for itself, on to another and a dirtier one. Flapping by way of cleaning is only admissible in the case of pictures, or anything made of paper. The only way I know to remove dust, the plague of all lovers of fresh air, is to wipe everything with a damp cloth. And all furniture ought to be so made as that it ​may be wiped with a damp cloth without injury to itself and so polished as that it may be damped without injury to others. To dust, as it is now practised, truly means to distribute dust more equally over a room.
As to floors, the only really clean floor I know is the Berlin lackered floor, which is wet rubbed and dry rubbed every morning to remove the dust. The French parquet is always more or less dusty, although infinitely superior in point of cleanliness and healthiness to our absorbent floor.
For a sick room, a carpet is perhaps the worst expedient which could by any possibility have been invented. If you must have a carpet, the only safety is to take it up two or three times a year, instead of once. A dirty carpet literally infects the room. And if you consider the enormous quantity of organic matter from the feet of people coming in, which must saturate it, this is by no means surprising.
As for walls, the worst is the papered wall; the next worst is plaster. But the plaster can be redeemed by frequent lime-washing; the paper requires frequent renewing. A glazed paper gets rid of a good deal of the danger. But the ordinary bed-room paper is all that it ought not to be.
The close connection between ventilation and cleanliness is shown in this. An ordinary light paper will last clean much longer if there is an Arnott's ventilator in the chimney than it otherwise would.
The best wall now extant is oil paint. From this you can wash the animal exuviæ.
These are what make a room musty.
The best wall for a sick-room or ward that could be made is pure white non-absorbent cement or glass, or glazed tiles, if they were made sightly enough.
Air can be soiled just like water. If you blow into water you will soil it with the animal matter from your breath. ​So it is with air. Air is always soiled in a room where walls and carpets are saturated with animal exhalations.
Want of cleanliness, then, in rooms and wards, which you have to guard against, may arise in three ways.
1. Dirty air coming in from without, soiled by sewer emanations, the evaporation from dirty streets, smoke, bits of unburnt fuel, bits of straw, bits of horse dung.
If people would but cover the outside walls of their houses with plain or encaustic tiles, what an incalculable improvement would there be in light, cleanliness, dryness, warmth, and consequently economy. The play of a fire-engine would then effectually wash the outside of a house. This kind of walling would stand next to paving in improving the health of towns.
2. Dirty air coming from within, from dust, which you often displace, but never remove. And this recalls what ought to be a sine qua non. Have as few ledges in your room or ward as possible. And under no pretence have any ledge whatever out of sight. Dust accumulates there, and will never be wiped off. This is a certain way to soil the air. Besides this, the animal exhalations from your inmates saturate your furniture. And if you never clean your furniture properly, how can your rooms or wards be anything but musty? Ventilate as you please, the rooms will never be sweet. Besides this, there is a constant degradation, as it is called, taking place from everything except polished or glazed articles — e.g., in coloring certain green papers arsenic is used. Now in the very dust even, which is lying about in rooms hung with this kind of green paper, arsenic has been distinctly detected. You see your dust is anything but harmless; yet you will let such dust lie about your ledges for months, your rooms forever.
Again, the fire fills the room with coal dust.
3. Dirty air coming from the carpet. Above all, take care of the carpets, that the animal dirt left there by the feet of visitors does not stay there. Floors, unless the grain is filled up and polished, are just as bad. The smell from the floor of a school-room or ward, when any moisture brings out the organic matter by which it is saturated, might alone be enough to warn us of the mischief that is going on.
The outer air, then, can only be kept clean by sanitary improvements, and by consuming smoke. The expense in ​soap, which this single improvement would save, is quite incalculable.
The inside air can only be kept clean by excessive care in the ways mentioned above — to rid the walls, carpets, furniture, ledges, &c., of the organic matter and dust — dust consisting greatly of this organic matter — with which they become saturated, and which is what really makes the room musty.
Without cleanliness, you cannot have all the effect of ventilation; without ventilation, you can have no thorough cleanliness.
Very few people, be they of what class they may, have any idea of the exquisite cleanliness required in the sick-room. For much of what I have said applies less to the hospital than to the private sick-room. The smoky chimney, the dusty furniture, the utensils emptied but once a day, often keep the air of the sick constantly dirty in the best private houses.
The well have a curious habit of forgetting that what is to them but a trifling inconvenience, to be patiently "put up" with, is to the sick a source of suffering, delaying recovery, if not actually hastening death. The well are scarcely ever more than eight hours, at most, in the same room. Some change they can always make, if only for a few minutes. Even during the supposed eight hours, they can change their posture or their position in the room. But the sick man, who never leaves his bed, who cannot change by any movement of his own his air, or his light, or his warmth; who cannot obtain quiet, or get out of the smoke, or the smell, or the dust; he is really poisoned or depressed by what is to you the merest trifle.
"What can't be cured must be endured," is the very worst and most dangerous maxim for a nurse which ever was made. Patience and resignation in her are but other words for carelessness or indifference — contemptible, if in regard to herself; culpable, if in regard to her sick.
* ↑ If you like to clean your furniture by laying out your clean clothes upon your dirty chairs or sofa, this is one way certainly of doing it. Having witnessed the morning process called "tidying the room" for many years, and with ever-increasing astonishment, I can describe what it is. From the chairs, tables, or sofa, upon which the "things" have lain during the night, and which are therefore comparatively clean from dust or blacks, the poor "things" having "caught" it, they are removed to other chairs, tables, sofas, upon which you could write your name with your finger in the dust or blacks. The other side of the "things" is therefore now evenly dirtied or dusted. The housemaid then flaps everything, or some things, not out of her reach, with a thing called a duster — the dust flies up, then re-settles more equally than it lay before the operation. The room has now been "put to rights."
* ↑ I am sure that a person who has accustomed her senses to compare atmospheres proper and improper, for the sick and for children, could tell, blindfold, the difference of the air in old painted and in old papered rooms, cœteris paribus. The latter "will always be musty, even with all the windows open.
* ↑ If you like to wipe your dirty door, or some portion of your dirty wall, by hanging up your clean gown or shawl against it on a peg, this is one way certainly, and the most usual way, and generally the only way of cleaning either door or wall in a bed-room!