[Sidenote: The Problem of Waste]
Next in importance to the three vital questions which daily confront
the hospital housekeeper, in common with other mortals—“What shall
we eat, what shall we drink and wherewithal shall we be clothed?”
comes the question of how to prevent waste of the money and materials
supplied for carrying on the work of the hospital. Few institutions
afford such abundant opportunities for waste, along so many different
lines. The sources of leaks seem to be endless. The individuals
who are responsible for waste may be found in all departments, and
represent all degrees of intelligence. The varied composition of the
hospital household, the emergencies of the life and the fact that of
necessity in a hospital of even moderate size the work is divided into
departments with separate heads, renders the problem of the prevention
of waste exceedingly complicated. Then the lack of any thorough
system of inspection, the loose method of keeping accounts, and
rendering reports of expenditure and income, the absence of uniformity
of methods, makes intelligent comparison with other institutions
difficult, if not impossible. Because of these conditions, waste may
constantly go on in an institution where apparently everyone is trying
to be economical.
[Sidenote: Main Causes]
There are usually three or four main causes existing where habitual
waste goes on:
Lack of an accurate system of accounting for supplies.
Lack of careful supervision in the use of supplies.
Lack of a general knowledge as to the average amounts of supplies
necessary for each department for a given time.
Unwise purchasing and ignorant or careless handling.
(Employing people who “do not know how” is also a frequent source of
waste.)
[Sidenote: First Steps]
It has been well said that the first step toward thrift is taking
account of the items. A proper system of accounting for the daily
supplies sent to each department will go a long way toward checking
extravagance. This system of accounting secures facts about the
consumption of supplies, that are absolutely necessary for the
detection of extravagance or waste, and it should be adhered to as an
important part of the work of every department. The surgical department
is one which needs special supervision. While perhaps it would not
technically come under the head of housekeeping, it often is in charge
of the hospital housekeeper, and in considering the sources of waste it
cannot be well omitted. In measures for the prevention of waste, the
departments of a hospital should be a unit. Only thus can the problem
be handled successfully. Referring to the excessive use of surgical
supplies, Dr. John W. Brannan, president of the board of trustees of
Bellevue and allied hospitals, New York, in an open letter to Charities
has said:
[Sidenote: Surgical Department]
“I wish to lay especial stress upon the possibility of effecting a
very material saving in the use of surgical appliances and expensive
drugs in all the hospitals. In order to accomplish this it is necessary
to have the goodwill and co-operation and constant thought, not only
of the superintendent and his staff, but also of the surgeons and
physicians, both attending and house. If the visiting physicians and
surgeons were to exercise the same consideration in the use of surgical
dressings and expensive drugs as they do in their private practice
among people of moderate means, and exact the same of the house staff;
there would be, in my opinion, a marked reduction in the amount of the
supply account.
“The following is an example of what can be done in the way of saving
in surgical supplies: The attention of the visiting surgeon of one of
the divisions of Bellevue Hospital was called about a month ago to the
large consumption of gauze in his wards, some 2,100 yards having been
used in the previous week. He at once made an investigation, with the
result that the next week the amount of gauze consumed was only 1,100
yards, and during the week following that only 610 yards, although the
service continued just as active and the patients were cared for fully
as well as before.”
The author of “The Commissariat” stated that in the hospitals of
London, where the surgical department is diligently supervised, it has
been found possible to effect an annual saving amounting to five pounds
for each bed, and that without in any way lowering the standard of
nursing or treatment.
[Sidenote: Utilizing Hospital Waste]
At the Boston meeting of the Association of Hospital Superintendents,
Dr. F. A. Washburn, Jr., of the Massachusetts General Hospital, in a
paper on “Methods of Utilizing Hospital Waste” described the methods
used in that hospital to reduce the consumption of gauze and soap. The
paper contains so much that is valuable by way of illustrating what
might be accomplished and how, that we have requested permission to
insert it in this connection.
“Two main principles are involved in reducing hospital expenditures:
“1st. Using less new material.
“2nd. Utilizing waste material.
“In this paper I will dwell principally upon some of the methods which
may be employed in carrying out the second of these two principles,
namely, utilizing material which has formerly gone to waste.
“The item of absorbent gauze is a large one in every general hospital.
At the Massachusetts General Hospital, in 1902, it amounted to
$6,079.81, in 1903, to $5,959.37.
“Up to one year ago, at this hospital, it had been customary to destroy
all gauze which had been soiled by blood or pus, and I believe that
this was the rule at all hospitals, although some had made an attempt
to recover the gauze from their clean cases. In October, 1904, with the
consent of the visiting staff, a process of washing and sterilizing all
gauze was adopted, and its success has exceeded our expectations.
“In the first eight months of 1904 we used over one hundred and forty
miles of new gauze three feet wide. In the first eight months of 1905,
we used fifty-one miles. The new gauze used in the first eight months
of 1904 would have stretched from Boston nearly to New Haven, Conn.,
while in a corresponding period of 1905 it would have reached only five
miles beyond Providence, R. I. Money actually expended for gauze during
the first eight months of 1900 was: 1900, $3,774.01; 1901, $4,275.91;
1902, $3,872.61; 1903, $4,029.22; 1904, $4,366.52; 1905, $1,253.40.
“That shows a saving of about $3,000 in eight months over the cost in
1903 and 1904.
“The method employed is as follows:
“All gauze and bandages from ward dressings, amphitheater and
out-patient department and operating rooms is collected in paper bags
and taken to the laundry. It is transferred from these paper bags to
open work bags made of cord, these bags being only half filled. The
gauze is kept in these bags throughout the rest of the process of
washing and the laundry sterilization.
“It is put in soak over night in cold water which is changed several
times. The following morning it is put in an iron washer capable
of resisting steam pressure up to ten pounds. It is then washed in
cold water until the water runs perfectly clear. The gauze is then
washed with warm water, soap, and sal soda. After this washing it is
rinsed in hot water. After the rinsing, enough hot water is turned
into the washer to cover the bags of gauze as they lie on the bottom
of the washer. Steam is then turned on to a pressure of ten pounds.
A self-registering thermometer placed in the gauze twice showed a
temperature of 239° and 240°. The thermometer, which registers on the
outside of the washer, showed a temperature of 236° at pressure of ten
pounds. This temperature is maintained for one-half hour. During all
this process, the washer is moving with a to-and-fro motion, which
continually agitates the gauze and presents all parts of it to the
action of the water and steam.
“The gauze is then put in the extractor and when dry is sent to the
out-patient department, where it is overhauled under the direction of
an intelligent maid. It is untangled and straightened, and the maid
is instructed to throw out any piece of gauze which is stained or has
anything adherent to it. The gauze is again handled by nurses or maids
when it is cut and placed in packages for the last sterilization. These
women, also, have instruction to look the gauze over carefully for any
stained piece or any piece with foreign matter adherent. The final
sterilization is then done at a temperature of 250° F., with a pressure
of fifteen pounds in the sterilizing room.
“It is found that the washed gauze is softer and more absorbent than
the new gauze. Repeated tests conducted in the pathological laboratory
have shown the safety of the process. The overhauling and straightening
of the washed gauze involves a very considerable amount of labor,
and if it were necessary to hire additional people to do the work
the saving would be much less. At the Massachusetts General Hospital
we utilize labor that would otherwise go to waste. In our large
out-patient department we must have a certain force of messenger boys
and maids when the clinic is at its largest and at the busiest hours of
the day. Much of the time all this force is not required for running
the clinics or cleaning the buildings, and their time is utilized on
the gauze.
“So much for the gauze which is recovered and utilized again as gauze.
There is a part which is in too small pieces or is too badly tangled to
be worth straightening. This material is run through a rag picker and
becomes a very light and absorbent lint, which is sterilized and used
in dressings where absorbent cotton or oakum is ordinarily used. It is
also used in the boiler house in the place of waste for wiping around
the engines. Another part of the gauze is thrown out because it is
stained with chemicals. These pieces are utilized by the housecleaning
force. This process, therefore, means not only less gauze bought, but
less absorbent cotton, less oakum, less waste for the engine room. All
pieces of compress cloth, many of which have been thrown away in the
past, are washed and sterilized by this same process, used over again
if large enough, run through the picker if small.
“Packages which are sent to the boiler house to be burned are
overhauled and inspected at frequent and irregular intervals, and if
it is found that material which should be saved is being wasted, the
responsible head nurse is called to account. Safety pins, rubber dam,
knives, forks and spoons are recovered from this inspection. I believe
that it will pay to have a systematic inspection by a careful employee
of everything brought from any part of the hospital to be destroyed
or thrown away. Such a man cannot fail to more than earn his pay and
board, nor would his inspection work take the whole of his time.
[Sidenote: Soap Making]
“About one year ago the Massachusetts General Hospital started to make
its own soap. I have endeavored to make a comparison of the cost to the
hospital of buying soap for the seven months, February to August, 1904,
and making it for the seven months, February to August, 1905.
“We formerly used in the laundry a soap chip for which we paid about 4¾
cents a pound. We used a common yellow bar soap for which we paid 5 to
5½ cents per pound. Savogran for the floors, etc., at 6 cents a pound,
and soft soap for ward use at 3½ cents. All these have been nearly or
quite replaced by our homemade soft soap, which we find answers all
these purposes in a satisfactory manner. We still use a small amount
of Savogran on the white tile floors of our surgical building, and a
little bar of yellow soap here and there. This latter we shall make
ourselves as soon as our stock on hand is used up. But soft soap
practically replaces everything except sand soap, toilet soap, soap
polish, etc., which we buy as before.
“In the seven months of 1904 under consideration, we paid $535.26 more
for Savogran than in the seven months of 1905; $108.48 more for yellow
bar soap; $24.99 more for soft soap, and $300.65 more for soap chips,
a total of $969.38 more paid for soap effected by our home soap making
in seven months of 1904 than in the seven months of 1905.
“To counterbalance this we received in the seven months of 1905,
$255.15 less for grease. Soap making takes about a third of the time of
one man, estimated at $177.25 for seven months. Potash cost $293.91.
Steam used in cooking soap estimated at $5 per month, $35. A total
saving of $268.07 in seven months.
“We have less trouble with our washers in the laundry because of the
larger amount of free alkali in the soap made by our recipe, which is
practically the same as that used at the McLean Hospital and the State
Hospital. It is as follows:
“Dissolve twenty-two pounds of potash in six nine-quart pails of water,
add thirty-four pounds of grease and boil very slowly six hours. Then
fill a 100-gallon tank half full of water and let it come to a boil
again. When it becomes stringy turn off the steam and fill the tank
with water.
“The soap has been tested by the hospital apothecary and is found to
correspond to the maximum of free alkali allowed by the 1900 United
States Pharmacopia. Various fabrics have been allowed to soak in this
soap for several days and have shown no detriment. The practical test
of a year’s use shows no injury to clothing.”
[Sidenote: Drugs]
Dr. W. E. Dreyfus, chemist of Bellevue and Allied Hospitals, calls
attention to another leak that formerly existed in those establishments
and the same kind of leak may be found in the majority of hospitals
of the country. In commenting on the hospital deficit question Dr.
Dreyfus says: “You know that all chartered charitable institutions
are entitled to tax-free alcohol, but very few take advantage of it.
The saving for our city institutions on tax-free alcohol during 1903
amounted to about $21,000, the indirect benefit therefrom being about
$9,000 more. To give a specific instance: Before the King’s County
Hospitals were supplied from this department, they spent the sum of
$17,771.12 for drugs, liquors, etc. After they were consolidated with
this department we furnished them the same amount at a saving of nearly
$4,000 per annum.” These figures are large, because the institutions
concerned are large, but when smaller institutions buy and continue to
buy alcohol and pay the tax, which amounts to $2.07 a gallon, it is
easy to see that a proportionate sum is being wasted in the majority
of the hospitals of this country through this one channel. There is no
question that hundreds of thousands of dollars in the aggregate every
year are taken from the hospital treasuries of the country and poured
into local liquor dealers’ pockets and various other pockets that ought
to be expended in supplying legitimate needs.
[Sidenote: Wasteful Physicians]
Just what to do with physicians who are habitually wasteful is a
question. It has been a noticeable fact in some hospitals that
physicians who owned hospitals of their own were always more economical
in the use of surgical supplies than others, whose only hospital
experience was gained in institutions supported by the public. They
knew the cost of supplies. They were footing the bills and wasted
material meant money taken directly out of their pockets. Therefore
they had formed habits of economy and were quick to check nurses who
showed a tendency to wastefulness. If the spirit of economy, the spirit
of personal ownership could take possession of the doctors connected
with hospitals it would mean an enormous saving in the course of a year.
[Sidenote: Teach Economy]
[Sidenote: Abuse of Appliances]
The lack of careful instruction in the use and abuse of hospital
supplies and the absence of conscientious, competent supervision
may always be expected to result in general waste. If in the very
beginning of an interne’s or nurse’s course in a hospital, some
pointed, practical and definite instruction could be given as to the
cost of supplies, and the avoidance of common methods of waste, much
might be accomplished. If a sense of individual responsibility can be
cultivated at all, efforts in that direction cannot be begun too soon.
It is lamentably true that there is perhaps no class of employees who
carelessly destroy so much that is useful as those whose names appear
as students and employees of our institutions. Usually what is common
property is no concern of theirs. A loss to the institution is no loss
to them. Whether or not a feeling of responsibility can be aroused in
all hospital workers is an open question, but it is worthy of diligent
and constant effort. One thing specially needs frequent emphasis, and
that is regarding the misappropriation of appliances. “_Use an article
for the purpose for which it is intended and for no other._” This
cannot be too thoroughly drilled into them. How many valuable hospital
instruments are broken annually because nurses persist in using them
to take corks out of bottles because no corkscrew is in sight. This is
only one common illustration out of hundreds that might be cited on
this point. A rigid rule requiring a money return or a replacing of
the article and a careful account of the articles in each department
is the only way to force a study of economy. The abuse of appliances
which renders them unfit for use, in an unreasonably short time, can be
met in the same way, requiring also that every article reported unfit
for use be submitted for the inspection of the head of the department,
before being condemned or thrown away as worthless.
[Sidenote: Careful Accounting]
[Sidenote: Watching the Expenditures]
By careful accounting (and only in that way) can be ascertained the
average amount of supplies that should be required in caring for a
given number of patients. If this average amount is generally known or
understood by heads of departments, internes, and nurses, it will be
found that more care will be exercised to keep at least within ordinary
limits. Very frequently the necessity for economy is never brought to
the attention of the workers. Heads of departments too often seem in no
way to be concerned with the cost or consumption of supplies. When this
condition exists somebody is to blame. The superintendent, if he is
the head of the hospital, as his official title would indicate, holds
more of the power of checking waste in his hands than any other one or
two persons. If he does not keep his financial eye on the expenditures
of different departments, if he does not give time and study to the
question of how to keep current expenses down to the minimum and at
the same time do good work, if he does not, up to a certain point,
regulate the purchase and distribution of the enormous quantities of
supplies needed in the hospital, and insist on his colleagues in charge
of departments doing the same thing, then waste is inevitable. If
the father of a family simply pays bills for supplies without having
a voice in controlling the consumption or use of those supplies he
need not wonder if he finds the figures on accounts creeping higher
and higher each month, and that is probably what is occurring in some
hospitals, where the expense is excessive as compared with other
institutions doing the same amount and same class of work. That economy
and efficiency are quite compatible can be easily shown by actual
results in hospitals that have never adopted the plan of running the
institution on a deficit, that either have to pay their bills promptly
or close their doors.
[Sidenote: Dietetic Department]
No doubt the dietetic department of the hospital can furnish more
concrete illustrations of waste than any other. Some of this so-called
waste is legitimate and inevitable; much of it represents material
that should not be saved, that has been rendered unfit for use by
handling, but there is no question that a large proportion of this
waste of food comes from a failure to fit the amount and character of
the food served to the needs and tastes of the individual patient.
A wise discrimination on the part of the one who serves the food
would prevent much of it. Another important cause of waste comes from
imperfect preparation of the food. Food cooked in bulk, and with no
bond of connection between the one who cooks and those who consume the
cooked product, is almost sure to be handled carelessly, overdone or
under-done or unpalatable. Food that is properly cooked and tastefully
served, so that it will appeal to the eye and to the palate as well, is
much less likely to be wasted or rendered unfit for use by handling.
Pecuniary economy, a large part of it at least, and also hygienic
economy of food and nutrition, depend greatly on the manner of handling
of food in the kitchen, in transit, and in the wards. Success in
fitting the food to the consumer, then, demands skill and care in
cooking and serving. It demands discrimination, a proper sense not
only of the physiological demands of the consumer, but of his tastes,
and it demands, besides, proper facilities for getting the food to
the patient in its most palatable and attractive form. Without these
three factors being recognized, waste is inevitable. Then, too, the
buyer of food must carry a good deal of responsibility. The quality of
food purchased, the place in which it was stored, and various other
features enter into the question of waste. Without proper storage
facilities “intelligent economy” in purchasing and caring for food
is impossible. Buying over the telephone is one of the methods to be
discouraged. Careful selection of perishable goods in open market is
the only sensible way. Some hospitals have succeeded in reducing the
expense from food waste by disposing of the garbage to contractors for
a stipulated sum.
In the heating of a hospital there is room for a great waste of money.
One small hospital, this last winter, one of the most severe seasons in
years, saved two hundred dollars on the cost of fuel as compared with
last year, as the result of “the intelligent economy” practiced by the
engineer. A very considerable reduction in the expense of machinery,
light and repairs is attributed by the board to the same source.
Intelligent economy! The term deserves to be popularized, for of all
things in hospitals it needs to be studied and cultivated.
This system of daily accounting for supplies is one that can be managed
in even the smallest hospital. An inventory book in which is listed all
the articles found in a department at a given time, such as hypodermic
syringes, feeding cups, drinking glasses, medicine glasses, rectal
tubes, catheters, etc., can also be used for requisitions or for
noting, as furnished, additional articles of that class.
[Sidenote: System]
Another book for food supplies should be brought to the kitchen or
storeroom each time supplies are replenished. Another book for keeping
track of surgical supplies should be brought with each requisition.
Some hospitals have also a “linen book,” which tells the amount of
each kind of linen sent to the laundry from each department. Clean
linen is noted in the book also when given out. These books should be
sent to the office each week (Monday morning is usually a good time)
and the amounts supplied to each department reckoned up. When this
amount in any department is excessive an investigation can be made
with facts as a basis. Regarding this system, Sir Henry Burdette in
“The Commissariat” says: “No true economy can ever be expected under
a system by which the persons who order and use supplies, and the
person who is responsible for the bills, both work independently and
pull different ways. It is absolutely essential to a well-balanced
administration that a spirit of responsibility should permeate the
whole establishment, from the manager, on whom the multifarious charges
accumulate for payment, down to the youngest probationer charged
with serving out the rice pudding in her ward. And this spirit of
responsibility must in all cases recognize a double duty. There is
the duty towards those for whom each person invested with authority
of any kind is called on to provide, and there is the duty toward the
institution, represented by the person next in authority. Where this
dual sense of responsibility is nicely balanced in every member of the
institution, the management may be considered perfect.
To that end, it is, above all things, necessary that there should be
one person invested with general control and endowed with a grasp of
the whole situation. It cannot be too often repeated that in these
matters to know is to control. There is no other road to economy. It
cannot be compassed by appeals to conscience, not by nagging, not by
a grudging, stingy giving out of necessary articles as though the
consumer were guilty in requiring them. Let each housemaid know how
many yards of cloth she is expected to use in her cleaning in a given
time, let each pound of lint be registered against someone’s name, who
shall be accountable; let each article be given out at the right time,
on the right day, to the right person, and with the understanding that
the transaction, slight though it may be, has been noted down and will
duly find its place in the weekly average and in the record of the
whole expenditure. Let such a system once take root and then, be the
institution large or small, rich or poor, hampered with old traditions
or brimming over with untried theories, a spirit of true economy will
reign throughout every department, worth far more, indeed, than the
trifling secretarial labor expended in its production.”
APPENDIX.
_Disinfection_—Infected clothing from wards should be immediately
placed in a vessel containing sufficient disinfecting fluid to cover
it, and should be kept in it till disinfection is accomplished.
The length of time varies with different disinfectants. By actual
experiment, the length of time to destroy bacteria should be learned.
Too much so-called disinfection is on the shot-gun plan, and no
attempt is made to find out whether it produces the desired results.
Most disinfectants are more powerful if used hot. Other conditions
that modify the power of disinfectants are the kind and number of
bacteria to be destroyed, the quality of associated material, as well
as the strength and temperature of the solution. Bichloride of mercury
destroys all forms of pathogenic micro-organisms and spores. For the
latter a solution of 1 in 500 is needed, the exposure to be not less
than one hour. It should not be used for the disinfection of excreta,
because of its property of precipitating albuminous matter. This forms
a coating around the bacteria, which prevents the penetration of the
solution. This solution may be used in disinfecting clothing or rooms,
but should never be used on metal substances.
A solution that is highly recommended for clothing contains the
following:
Carbolic acid 3 parts
Common soft soap 1½ parts
Water 100 parts
Common laundry soap is first dissolved in water, the carbolic acid is
added and the mixture is vigorously stirred. Experiments with this
solution show that non-spore forming bacteria are destroyed in an
exposure of one-half hour. Commercial carbolic acid may be used, which
is somewhat less expensive than the purified product.
For the disinfection of excreta, a solution known as the American
Standard is officially prescribed in the United States Army, it being
specially stated that the chloride of lime should be of good quality,
and not have undergone decomposition. It is made by dissolving six
ounces of chloride of lime in a gallon of water.
For the disinfection of mattresses, live steam should be used whenever
possible. When no facilities exist for steam disinfection of mattresses
and pillows, a fumigation can will be found very valuable.
_Fumigation Can_—This can is made of galvanized iron, with a
tight-fitting cover. It needs to be about four and a half feet high,
and at least two feet and a half in diameter. A slat shelf, with iron
or wire hooks that fasten over the top of the can, will be useful in
sterilizing small articles. This contrivance is superior to any closet,
as it confines the formaldehyde in small space, and can be made almost
entirely air tight. It should always be remembered that formaldehyde
has almost no power of penetration, and therefore special care is
needed to expose all possible surfaces to the fumes.
_Extermination of Vermin_—To prevent bedbugs in hospital is no easy
matter where patients and visitors are coming from all kinds of homes.
A leading hospital superintendent recommends sulphur fumigation. It
is said to be the only thing that will effectually destroy them. “In
order to secure the desired results the fumes must be very dense.
In preparing for fumigation large pans are used made to hold from
twenty-five to thirty pounds of sulphur, and other pans are filled
with water. The heat from the burning sulphur will cause steam, which
makes the sulphur fumigation more effective. In order to accomplish the
entire destruction of the bedbug, it is necessary to fumigate three or
four times in a month. It takes three weeks for the bugs to be hatched
and eleven weeks to mature. By successive fumigations in this way a
room or ward may be considered safe, but this treatment should be
repeated twice a year.
For keeping beds free from bugs, the following prescription is
recommended:
Corrosive sublimate 1 ounce
Spirits of turpentine 1 pint
Coal oil 1 pint
The corrosive sublimate should first be dissolved in alcohol and the
mixture used through an atomizer or oil can.
To exterminate pediculi of the head, saturate the hair thoroughly with
kerosene for three successive days and wash with warm water and green
soap.
For pediculi on other parts of the body the following is recommended:
Salicylic acid, 2 parts; toilet vinegar, 25 parts; alcohol, 75 parts.
Apply with a flannel or piece of absorbent cotton. One application is
usually sufficient.
CARE OF FLOORS.
The best finish, the ideal finish, for wood floors in hospitals,
has yet to be invented. At the Cincinnati convention of hospital
superintendents the subject of floor finishes was discussed, and the
following recommendations made, which were based on experience:
On new maple floors two coats of Berry Brothers liquid granite varnish
is applied, then a finish composed of the following ingredients: One
pound of paraffine dissolved in 1½ pints of linseed oil and 2 gallons
of turpentine. This preparation is applied once a week with a mop by
the ward maids, and is afterwards rubbed down with hair brushes covered
with flannel. Water or alcohol dropped on these floors softens the
wax, but spots can be touched up with the brush when necessary. On old
floors two coats of oil is used and then the above mixture.
Where local conditions render frequent washing of floors necessary the
following preparation has been used with satisfaction:
Grain alcohol 5 gallons
Orange shellac 2 pounds
Canada balsam 2 ounces
Castor oil 2 ounces
This is a government formula, and desirable for use where soft coal is
burned for fuel. It should be mixed thoroughly in a suitable vessel,
and allowed to stand for a day, before using. Add alcohol if it is too
thick. Apply with a brush after the floors have been cleaned, and keep
room vacant eighteen hours to allow time for drying.
Another formula that is used in some hospitals is: Paraffine melted,
6 ounces; turpentine, 1 gallon, thoroughly mix and add soft soap, 4
ounces. Mix well and let it stand 24 hours. Apply with a woolen cloth
and rub in.
THE PRESBYTERIAN HOSPITAL
DIET SHEET
......... Division
New York ............ 190....
Ward No. .........
-----------------+--+--+--+--+--+--+--+--+--+--+--+--+--+--+--+--+
NAMES OF | | | | | | | | | | | | | | | | |
PATIENTS | | | | | | | | | | | | | | | | |
-----------------+--+--+--+--+--+--+--+--+--+--+--+--+--+--+--+--+
House diet |..|..|..|..|..|..|..|..|..|..|..|..|..|..|..|..|
Convalescent diet|..|..|..|..|..|..|..|..|..|..|..|..|..|..|..|..|
Nitrogenous diet |..|..|..|..|..|..|..|..|..|..|..|..|..|..|..|..|
Farinaceous diet |..|..|..|..|..|..|..|..|..|..|..|..|..|..|..|..|
Milk diet |..|..|..|..|..|..|..|..|..|..|..|..|..|..|..|..|
Extra diet |..|..|..|..|..|..|..|..|..|..|..|..|..|..|..|..|
-----------------+--+--+--+--+--+--+--+--+--+--+--+--+--+--+--+--+
No. of patients on house diet ..........
No. of patients on convalescent diet ...
No. of patients on nitrogenous diet ....
No. of patients on farinaceous diet ....
No. of patients on milk diet ...........
No. of patients on extra diet ..........
Total No. of patients in ward ......
............................
Attending Physician—Surgeon
............................
House Physician—Surgeon
SAMPLE DIET SHEET
Sample Page of Hospital Linen Book
MONTH OF .............. 190...
------+---+-----+-----+---------------------+------+-----+-------+-----+-------
Day of| | In | In | | | New |Req’r’d| |
Month | In|Laun-|Resv.| Article | Dis- |Linen| Total |Miss-|Remarks
|Use| dry | | |carded|Added|on hand| ing |
------+---+-----+-----+---------------------+------+-----+-------+-----+-------
......|...|.....|.....|Bed Spreads |......|.....|.......|.....|.......
......|...|.....|.....|Sheets |......|.....|.......|.....|.......
......|...|.....|.....|Draw Sheets |......|.....|.......|.....|.......
......|...|.....|.....|Children’s Sheets |......|.....|.......|.....|.......
......|...|.....|.....|Operating room sheets|......|.....|.......|.....|.......
......|...|.....|.....|Bath Towels |......|.....|.......|.....|.......
......|...|.....|.....|Face Towels |......|.....|.......|.....|.......
......|...|.....|.....|Glass Towels |......|.....|.......|.....|.......
......|...|.....|.....|Roller Towels |......|.....|.......|.....|.......
......|...|.....|.....|Surgical Towels | | | | |
......|...|.....|.....| (for wards) |......|.....|.......|.....|.......
......|...|.....|.....|Operating Room Towels|......|.....|.......|.....|.......
......|...|.....|.....|Dresser Covers |......|.....|.......|.....|.......
......|...|.....|.....|Sash Curtain |......|.....|.......|.....|.......
......|...|.....|.....|Blankets |......|.....|.......|.....|.......
......|...|.....|.....|Men’s Gowns |......|.....|.......|.....|.......
......|...|.....|.....|Women’s Gowns |......|.....|.......|.....|.......
......|...|.....|.....|Children’s Gowns |......|.....|.......|.....|.......
......|...|.....|.....|Covers for Dressings |......|.....|.......|.....|.......
......|...|.....|.....|Plain Bandages |......|.....|.......|.....|.......
......|...|.....|.....|Breast Bandages |......|.....|.......|.....|.......
......|...|.....|.....|Many-tailed Bandages |......|.....|.......|.....|.......
......|...|.....|.....|T. Bandages |......|.....|.......|.....|.......
......|...|.....|.....|Special Bandages |......|.....|.......|.....|.......
......|...|.....|.....| Etc., Etc., Etc. |......|.....|.......|.....|.......
------+---+-----+-----+---------------------+------+-----+-------+-----+-------
Sample Page of Hospital Cash Book.
===============================================
Receipts for Month of ............
----+---------------------------------+----+---
....|Bal. on hand from previous month |....|...
....|From In-Patients |....|...
....| ” Out-Patients |....|...
....| ” Private Nursing |....|...
....| ” Special Nursing |....|...
....| ” Sale of Medicine & Supplies |....|...
....| ” Entertainments |....|...
....| ” Interest on Invested Funds |....|...
....| ” Annual Contributions |....|...
....| ” Other Sources |....|...
| Total $..........|....|...
| Balance ..........|....|...
----+---------------------------------+----+---
===============================================
Disbursements for Mo. of ........ 19...
----+---------------------------------+----+---
....|Balance for previous month |....|...
....|For Meat |....|...
....| ” Fish |....|...
....| ” Butter |....|...
....| ” Flour, Bread and Meal |....|...
....| ” Milk |....|...
....| ” Water |....|...
....| ” Ice |....|...
....| ” Potatoes and Vegetables |....|...
....| ” Groceries and Provisions not | |
| above enumerated |....|...
....| ” Soap and Cleaning Appliances |....|...
....| ” Fuel |....|...
....| ” Gas, Oil and Light |....|...
....| ” Bedding and Gen. House Fur. |....|...
....| ” Nurses’ Uniforms |....|...
....| ” Other Training School Ex. |....|...
....| ” Wines and Spirits |....|...
....| ” Drugs and Surgical Appliances|....|...
....| ” Surgical Dressings |....|...
....| ” Advertising, Print. & Postage|....|...
....| ” Repairs |....|...
....| ” Taxes and Insurance |....|...
....| ” Contingencies |....|...
| Total $..........|....|...
| Balance ..........|....|...
----+---------------------------------+----+---