[Sidenote:  People overhead.]

One thing more:—­From the flimsy manner in which most modern houses are built, where every step on the stairs, and along the floors, is felt all over the house; the higher the story, the greater the vibration.  It is inconceivable how much the sick suffer by having anybody overhead.  In the solidly built old houses, which, fortunately, most hospitals are, the noise and shaking is comparatively trifling.  But it is a serious cause of suffering, in lightly built houses, and with the irritability peculiar to some diseases.  Better far put such patients at the top of the house, even with the additional fatigue of stairs, if you cannot secure the room above them being untenanted; you may otherwise bring on a state of restlessness which no opium will subdue.  Do not neglect the warning, when a patient tells you that he “Feels every step above him to cross his heart.”  Remember that every noise a patient cannot see partakes of the character of suddenness to him; and I am persuaded that patients with these peculiarly irritable nerves, are positively less injured by having persons in the same room with them than overhead, or separated by only a thin compartment.  Any sacrifice to secure silence for these cases is worth while, because no air, however good, no attendance, however careful, will do anything for such cases without quiet.

[Sidenote:  Music.]

NOTE.—­The effect of music upon the sick has been scarcely at all noticed.  In fact, its expensiveness, as it is now, makes any general application of it quite out of the question.  I will only remark here, that wind instruments, including the human voice, and stringed instruments, capable of continuous sound, have generally a beneficent effect—­while the piano-forte, with such instruments as have no continuity of sound, has just the reverse.  The finest piano-forte playing will damage the sick, while an air, like “Home, sweet home,” or “Assisa a pie d’un salice,” on the most ordinary grinding organ will sensibly soothe them—­and this quite independent of association.

V. VARIETY.

[Sidenote:  Variety a means of recovery.]

To any but an old nurse, or an old patient, the degree would be quite inconceivable to which the nerves of the sick suffer from seeing the same walls, the same ceiling, the same surroundings during a long confinement to one or two rooms.

The superior cheerfulness of persons suffering severe paroxysms of pain over that of persons suffering from nervous debility has often been remarked upon, and attributed to the enjoyment of the former of their intervals of respite.  I incline to think that the majority of cheerful cases is to be found among those patients who are not confined to one room, whatever their suffering, and that the majority of depressed cases will be seen among those subjected to a long monotony of objects about them.