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 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 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