the
nurses. Undoubtedly, a London hospital "sister" does sometimes set
relays of patients to watch a critical case; but, undoubtedly also,
always under her own superintendence; and she is called to whenever
there is something to be done, and she knows how to do it. The patients
are not left to do it of their own unassisted genius, however "kind" and
willing they may be.

IV. NOISE.

[Sidenote: Unnecessary noise.]

Unnecessary noise, or noise that creates an expectation in the mind, is
that which hurts a patient. It is rarely the loudness of the noise, the
effect upon the organ of the ear itself, which appears to affect the
sick. How well a patient will generally bear, _e. g._, the putting up of
a scaffolding close to the house, when he cannot bear the talking, still
less the whispering, especially if it be of a familiar voice, outside
his door.

There are certain patients, no doubt, especially where there is slight
concussion 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