CHAPTER I._Hospital housekeeping

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HOSPITAL

HOUSEKEEPING

CHARLOTTE A. AIKENS

Late Director Sibley Memorial Hospital, Washington, D. C.; Late

Superintendent of Iowa Methodist Hospital, Des Moines;

Superintendent of Columbia Hospital, Pittsburg;

Former Associate Editor The National

Hospital Record

SECOND EDITION

Detroit, Mich.

DEL T. SUTTON

1910

DEL T. SUTTON

PREFACE

In the preparation of this volume, three classes of readers have

been in mind: the trained nurse who, without practical experience in

hospital management, finds herself in charge of a hospital, small

or large; the practical woman who, having had no opportunity for

special training, has upon her the responsibility of the direction of

the domestic affairs of an institution; and the lady member of the

hospital board of managers who, in the discharge of the duties of her

position, becomes responsible to the public for the proper government

of institutional affairs. It was thought that the latter, especially,

might, through the use of this volume, secure a better grasp of the

details of hospital housekeeping as a whole than is possible without

some such aid. The ability to see all around a situation, to view the

institution as a whole, is essential to good management. As a rule,

such ability comes only by experience. Especial pains have been taken

to make the volume thoroughly practical, and to present clearly and

concisely lessons learned in actual dealing with, and close study

of, the questions discussed. The greater portion of the contents of

the volume have already seen the light of day in the columns of the

National Hospital Record. Since their appearance in that journal, the

papers have been carefully revised, and much new and important matter

added. For assistance in preparation, the author has been under great

obligation to a number of hospital superintendents, who have furnished

information as to methods, and to contemporary writers, especially on

the subject of dietetics. Special mention should be made of the works

of W. Gilman Thompson, M. D., Mrs. Ellen H. Richards, I. Burney Yeo,

M. D., Sir Henry Burdett, and of the literature of the United States

Department of Agriculture. To Miss Emma Lynch, who, as hospital matron,

has been for several years associated with the author in institutional

work, special thanks are due for valuable assistance. Many practical

suggestions have been gleaned from the papers given at the annual

conventions of the Association of Hospital Superintendents. To the

writers of these papers the author expresses grateful appreciation.

Many of the electrotypes used for illustration have been kindly

furnished by courtesy of the business firms whose names accompany them.

These have been introduced because they were deemed essential to a

clear understanding of the subject on the part of such readers as may

not be familiar with the use of such appliances. So far as the author

is aware, no attempt has previously been made to discuss the subject of

hospital housekeeping as a whole. As a pioneer in the field, the book

doubtless has many defects. If it proves of practical value to even a

small number of those for whose assistance it was prepared, it will

have justified its existence.

CHARLOTTE A. AIKENS.

TABLE OF CONTENTS.

PREFACE 7-8

CHAPTER I—The Hospital Housekeeper; The Housekeeper’s

Province; Bookkeeping; Hospital Inventory 13-19

CHAPTER II—The Main Entrance; The Porter; The

Private Rooms; Hospital Couches; Fumigation;

The Daily Cleaning; Dusting; Bath Rooms 20-29

CHAPTER III—The Hospital Ward; Soiled Clothing;

Buying Beds; Bed Making; Ward Lockers; Care

of Patients’ Clothing; Ward Medicines and Records;

Adjuncts to the Hospital Ward; Quiet

Room; Matters Miscellaneous; Destruction of

Appliances; Screens; A Twenty-Bed Ward Equipment 30-42

CHAPTER IV—The Linen Room; Bed Linen; The

Room; Linen Accounting; Discarded Linen;

Emergency Supply; Removing Stains; New Linen;

Shelf Management; Laundry Bags 43-50

CHAPTER V—The Hospital Laundry; Manager’s

Duties; Laundry Workers; Starching; Blueing;

Drying; Ironing; Routine of Work; The Laundry Plant 51-59

CHAPTER VI—The Hospital Kitchen; General

Construction; Kitchen Cabinet; Plan of a Model

Kitchen; Cold Storage; The Storeroom; Dishwashing;

Dishcloths and Towels; The Chief Kitchen Employees;

Training Needed; The Diet Kitchen 60-70

CHAPTER VII—The Purchase and Care of Food

Supplies; Judging Food Values; Bread; Milk; Care

of Milk; Cheese; Eggs; Economy and Care; Meat;

Beef; Veal and Mutton; Chickens; Fish; Pork; Butter;

Fresh Vegetables; Approximate Estimate of Quantities

of Food for a Twenty-five Bed, a Fifty-Bed and a

One Hundred-Bed Hospital 71-87

CHAPTER VIII—Preparation of Food; Object of

Cooking; Classes of Diets; Broths; Soups; Cooking

Meats; Cooking Vegetables; Time of Meals 88-97

CHAPTER IX—Diet Lists and Blanks; Serving of

Food; Tray Setting; Bills of Fare; Dishes; Hints

on Serving 98-110

CHAPTER X—Hospital Dietaries; Supplies for One

Hundred Persons for Thirty Days; Menus for

Nitrogenous Diet 110-119

CHAPTER XI—Hospital Hygiene; Prevention of

Disease; Sanitary Kitchens; Pure Food; Filters and

Water; Air; Cleanliness; Flies; Garbage; Garbage

Crematories 120-131

CHAPTER XII—The Help Question; Number of

Servants; Contracts; Merit System; Schedule of

Work; Rules; Servants’ Dining Rooms; Sleeping

Rooms; Attire; Housekeeper’s Relation to Servants 132-143

CHAPTER XIII—The Problem of Waste; Main Causes;

First Steps; Surgical Department; Utilizing Hospital

Waste; Soap making; Drugs; Wasteful Physicians;

Teach Economy; Abuse of Appliances; Careful Accounting;

Watching the Expenditures; Dietetic Department; System 144-158

APPENDIX—Disinfection; Fumigation Can;

Exterminationof Vermin; Care of Floors 159-162

HOSPITAL HOUSEKEEPING

CHAPTER I.

[Sidenote: The Hospital Housekeeper]

Hospital housekeeping is intensely practical business. If it is to

be successfully and satisfactorily conducted, it demands that the

housekeeper be a woman of no inferior or uncertain attainments. All the

elements that make for success in home housekeeping, and many more, are

needed in a hospital. There must be breadth of vision, the qualities

of an organizer, the ability to deal with large problems, a keen

sense of justice, and the executive force needed to manage, without

fear, fuss or favor, the various classes of people that touch the

housekeeper’s realm. Many a man who is a success in managing a village

store would utterly fail when placed in charge of even one section

of a great department store. And the same may be said of the average

woman in hospital housekeeping. Apart from the special knowledge of

the business, that comes only by diligent study, accurate observation

and experience—never by accident—the housekeeper needs special

qualities of mind and heart. Indeed, special qualifications are needed

by every one whose life work is to be wrought out in an institution.

A hospital or any institution that has to deal with infirm, aged or

unfortunate members of society, is no place for a person of strong

racial antipathies. It is no place for the tale-bearer or the

gossip, nor for the person who has a grudge against fate and feels

she has never received justice. It is no place for the person who is

discouraged, or who assumes the air of a martyr, and leads a crushed

life, bemoaning the fact that her highest motives and best efforts are

never appreciated. Those who would live happily in an institution must

be prepared to be misunderstood, and fortified against discouragement

from that source. Sympathy with the aims of the institution is a

primary qualification. No one should enter an institution as a worker,

and especially as head of a department, who is not prepared to have

her interests centered in the people for whose benefit the institution

was brought into existence. Ability to see things from more than one

standpoint, to work comfortably with different classes of people, an

infinite capacity for detail, and systematic business habits—these

are a few of the qualities that should characterize the woman who

undertakes to manage the domestic affairs of a hospital. It need hardly

be mentioned that she needs a healthy body and a strong constitution.

The hospital housekeeper needs, if anyone needs it, reliability of

judgment, and poise of soul. If she is to control others, she must

know how to control herself. The ability to reprimand without arousing

antagonism must be hers. She should endeavor to cultivate the feeling

of personal responsibility in all over whom she has authority, and to

make them understand that the success of an institution depends not on

perfection of equipment, nor in numbers, but in thorough co-ordination

of the work in all the departments, and faithful service on the part of

all.

They should know that a lack of punctuality or carelessness in one

department disturbs the working of the entire system. The influence

of the kitchen and laundry is felt throughout the entire institution.

Skillful management consists not alone in the ability to attend to

the apparently important affairs with ease, but in never losing sight

of the minor details. Nothing is so large as to be of paramount

importance, nothing so small as to be considered immaterial, where

human lives are concerned.

[Sidenote: The Housekeeper’s Province]

To define the exact limits of the housekeeper’s province is impossible,

as institutions vary so greatly in size and in the number of officers.

Local conditions always influence the situation. One lone woman may

have to manage the domestic affairs of an institution, superintend

its entire business, including its nursing, manage its bookkeeping,

do the work of an interne in emergencies, and act in various other

capacities, that readily suggest themselves to those who are acquainted

with life in a small hospital. In another institution her province may

be limited entirely to the purely domestic affairs, the purchase and

preparation of food, care of linen, the cleaning, and the management

of those who work in these departments. In either instance, the

responsibility is great. To meet this responsibility without being

oppressed by its weight, requires that the working force be completely

organized, the work definitely divided and assigned. There should not

be a square inch of the building for which someone is not directly

responsible for its good order and cleanliness. Real success in

management, however, does not alone consist in the work going on as

it should while the housekeeper is there to direct and supervise. Her

own health and efficiency demand that she have recreation and rest,

and, as a matter of fact, depend on her not being always there. Her

skill and generalship of the situation will be shown in the fact that,

whether present or absent, the routine of the work is not noticeably

interrupted. In every institution there should be some individual who

is sufficiently acquainted with her methods to assume control and

carry on the system in her absence.

[Sidenote: Bookkeeping]

In addition to the mastery of the details of the practical work,

the hospital housekeeper must know how to give an account of her

stewardship to those who have a right to demand it. The business

side of hospital work, that which has to do with dollars and cents,

is one of her many duties that has special importance. It is one of

the corner-stones in the hospital foundation, and however much the

housekeeper may dislike the tedious work of adding and subtracting,

and reckoning, and itemizing, if she is a faithful steward of trust

funds, she will give it due attention. The weak point in a great

many hospitals is the looseness of methods of accounting. Frequently

the board of managers are not sufficiently impressed with their

responsibility to plan and demand a system of bookkeeping that will

furnish plain facts in a shape that will be easily grasped; and it

is not to be wondered at that the housekeeper is, if not _careless_,

then _not sufficiently careful_ for her books to be of any value as

institutional records.

The busy housekeeper needs a simple method of accounting that is at

once comprehensive and easy to handle. A simple, convenient form for

a general expense book is here shown. One page can be devoted to each

week’s or month’s expenditures and the use of such method makes the

annual financial statement an easy matter to arrange. It is not claimed

that this is the best method for a general expense account; it is one

method—a simple, workable method.

In addition to this the use of a small day book will be necessary,

which will show on the left-hand page the money received and on the

other side the disbursements for the day. For this an ordinary blank

book that has spaces ruled for dates, items, dollars and cents, will be

sufficient. In this each day will be recorded the article purchased,

the date and the cost. Periodically this itemized account is gone over,

the articles grouped under the several heads and copied in the general

expense book.

GENERAL HOSPITAL

Receipts and Expenditures from _________ to _________

+------------------------------------+---+--+---+

| | | | |

| | | | |

+------------------------------------+---+--+---+

| | | | |

| Ice | | | |

+------------------------------------+---+--+---+

An “order book” should contain an account of all orders given, the

quantity, cost, date ordered, date received. An ordinary blank-book

may be ruled with columns for each of these entries, and the month

and year. This furnishes information that is valuable from several

standpoints. If the housekeeper is suddenly called away, it is easy

to turn to for a list of the firms patronized, or to find the usual

amounts ordered, and is valuable for comparison and reference from

month to month and year to year. All dealers’ checks sent with goods

should be preserved, for comparison with the itemized monthly account,

before indorsing it for payment.

[Sidenote: Hospital Inventory]

In the matter of the hospital inventory, various forms may be adopted,

according to the purposes for which the inventory is intended. It may

be a simple list of the furnishings of the hospital, made up without

any special plan, and with or without the value or cost of the article

attached. In case of loss by fire, this inventory might have special

value as an insurance record. Such books should of course be kept in

the safe, with other documents and articles of value.

As convenient as any way of keeping a hospital inventory, is to have

the contents of the building arranged under the heads of the rooms

for which the articles were purchased. The kitchen, storerooms, diet

kitchens, offices, reception rooms, wards, private rooms, etc., all

have stationary furniture especially for them, and for purposes of

reference it will be most convenient to list this in connection with

the room containing it. If the value of each article is attached a

recapitulation will show at a glance the total value of the hospital

furnishings.

Once each year, at least, the housekeeper should make a business of

finding out the average cost per day of feeding her hospital family,

and the average cost of feeding one patient. This knowledge is valuable

not alone for statistics, but for her own satisfaction. It should give

confidence in her administration, or show whether there is a weakness

that might be corrected.