ion or other disturbance of the brain, who are affected by mere
noise. But intermittent noise, or sudden and sharp noise, in these as in
all other cases, affects far more than continuous noise--noise with jar
far more than noise without. Of one thing you may be certain, that
anything which wakes a patient suddenly out of his sleep will invariably
put him into a state of greater excitement, do him more serious, aye,
and lasting mischief, than any continuous noise, however loud.

[Sidenote: Never let a patient be waked out of his first sleep.]

Never to allow a patient to be waked, intentionally or accidentally, is
a _sine qua non_ of all good nursing. If he is roused out of his first
sleep, he is almost certain to have no more sleep. It is a curious but
quite intelligible fact that, if a patient is waked after a few hours'
instead of a few minutes' sleep, he is much more likely to sleep again.
Because pain, like irritability of brain, perpetuates and intensifies
itself. If you have gained a respite of either in sleep you have gained
more than the mere respite. Both the probability of recurrence and of
the same intensity will be diminished; whereas both will be terribly
increased by want of sleep. This is the reason why sleep is so
all-important. This is the reason why a patient waked in the early part
of his sleep loses not only his sleep, but his power to sleep. A healthy
person who allows himself to sleep during the day will lose his sleep at
night. But it is exactly the reverse with the sick generally; the more
they sleep, the better will they be able to sleep.

[Sidenote: Noise which excites expectation.]

[Sidenote: Whispered conversation in the room.]

I have often been surprised at the thoughtlessness, (resulting in
cruelty, quite unintentionally) of friends or of doctors who will hold a
long conversation just in the room or passage adjoining to the room of
the patient, who is either every moment expecting them to come in, or
who has just seen them, and knows they are talking about him. If he is
an amiable patient, he will try to occupy his attention elsewhere and
not to listen--and this makes matters worse--for the strain upon his
attention and the effort he makes are so great that it is well if he is
not worse for hours after. If it is a whispered conversation in the same
room, then it is absolutely cruel; for it is impossible that the
patient's attention should not be involuntarily strained to hear.
Walking