[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 on tip-toe, doing any thing in the room very slowly, are injurious, for exactly the same reasons.  A firm light quick step, a steady quick hand are the desiderata; not the slow, lingering, shuffling foot, the timid, uncertain touch.  Slowness is not gentleness, though it is often mistaken for such:  quickness, lightness, and gentleness are quite compatible.  Again, if friends and doctors did but watch, as nurses can and should watch, the features sharpening, the eyes growing almost wild, of fever patients who are listening for the entrance from the corridor of the persons whose voices they are hearing there, these would never run the risk again of creating such expectation, or irritation of mind.—­Such unnecessary noise has undoubtedly induced or aggravated delirium in many cases.  I have known such—­in one case death ensued.  It is but fair to say that this death was attributed to fright.  It was the result of a long whispered conversation, within sight of the patient, about an impending operation; but any one who has known the more than stoicism, the cheerful coolness, with which the certainty of an operation will be accepted by any patient, capable of bearing an operation at all, if it is properly communicated to him, will hesitate to believe that it was mere fear which produced, as was averred, the fatal result in this instance.  It was rather the uncertainty, the strained expectation as to what was to be decided upon.

[Sidenote:  Or just outside the door.]

I need hardly say that the other common cause, namely, for a doctor or friend to leave the patient and communicate his opinion on the result of his visit to the friends just outside the patient’s door, or in the adjoining room, after the visit, but within hearing or knowledge of the patient is, if possible, worst of all.

[Sidenote:  Noise of female dress.]