[1]
[Sidenote: Lingering smell of paint a want of care.]
That excellent paper, the _Builder_, mentions the lingering of the smell
of paint for a month about a house as a proof of want of ventilation.
Certainly--and, where there are ample windows to open, and these are
never opened to get rid of the smell of paint, it is a proof of want of
management in using the means of ventilation. Of course the smell will
then remain for months. Why should it go?
[2]
[Sidenote: Why let your patient ever be surprised?]
Why should you let your patient ever be surprised, except by thieves? I
do not know. In England, people do not come down the chimney, or through
the window, unless they are thieves. They come in by the door, and
somebody must open the door to them. The "somebody" charged with opening
the door is one of two, three, or at most four persons. Why cannot
these, at most, four persons be put in charge as to what is to be done
when there is a ring at the door-bell?
The sentry at a post is changed much oftener than any servant at a
private house or institution can possibly be. But what should we think
of such an excuse as this: that the enemy had entered such a post
because A and not B had been on guard? Yet I have constantly heard such
an excuse made in the private house or institution, and accepted: viz.,
that such a person had been "let in" or _not_ "let in," and such a
parcel had been wrongly delivered or lost because A and not B had opened
the door!
[3]
There are many physical operations where _coeteris paribus_ the danger
is in a direct ratio to the time the operation lasts; and _coeteris
paribus_ the operator's success will be in direct ratio to his
quickness. Now there are many mental operations where exactly the same
rule holds good with the sick; _coeteris paribus_ their capability of
bearing such operations depends directly on the quickness, _without
hurry_, with which they can be got through.
[4]
[Sidenote: Petty management better understood in institutions than in
private houses.]
So true is this that I could mention two cases of women of very high
position, both of whom died in the same way of the consequences of a
surgical operation. And in both cases, I was told by the highest
authority that the fatal result would not have happened in a London
hospital.
[Sidenote: What institutions are the exception?]
But, as far as regards the art of petty management in hospitals, all the
military hospitals I know must be excluded. Upon my own experience I
stand, and I solemnly declare that I have seen or known of fatal
accidents, such as suicides in _delirium tremens,_ bleedings to death,
dying patients dragged out of bed by drunken Medical Staff Corps men,
and many other things less patent and striking, which would not have
happened in London civil hospitals nursed by women. The medical officers
should be absolved from all blame in these accidents. How can a medical
officer mount guard all day and all night over a patient (say) in
_delirium tremens?_ The fault lies in there being no organized system
of attendance. Were a trustworthy _man_ in charge of each ward, or set
of wards, not as office clerk, but as head nurse, (and head nurse the
best hospital serjeant, or ward master, is not now and cannot be, from
default of the proper regulations,) the thing would not, in all
probability, have happened. But were a trustworthy _woman_ in charge of
the ward, or set of wards, the thing would not, in all certainty, have
happened. In other words, it does not happen where a trustworthy woman
is really in charge. And, in these remarks, I by no means refer only to
exceptional times of great emergency in war hospitals, but also, and
quite as much, to the ordinary run of military hospitals at home, in
time of peace; or to a time in war when our army was actually more
healthy than at home in peace, and the pressure on our hospitals
consequently much less.
[Sidenote: Nursing in Regimental Hospitals.]
It is often said that, in regimental hospitals, patients ought to "nurse
each other," because the number of sick altogether being, say, but
thirty, and out of these one only perhaps being seriously ill, and the
other twenty-nine having little the matter with them, and nothing to do,
they should be set to nurse the one; also, that soldiers are so
trained to obey, that they will be the most obedient, and therefore the
best of nurses, add to which they are always kind to their comrades.
Now, have those who say this, considered that, in order to obey, you
must know _how_ to obey, and that these soldiers certainly do not know
how to obey in nursing. I have seen these "kind" fellows (and how kind
they are no one knows so well as myself) move a comrade so that, in one
case at least, the man died in the act. I have seen the comrades'
"kindness" produce abundance of spirits, to be drunk in secret. Let no
one understand by this that female nurses ought to, or could be
introduced in regimental hospitals. It would be most undesirable, even
were it not impossible. But the head nurseship of a hospital serjeant is
the more essential, the more important, the more inexperienced the
nurses. Undoubtedly, a London hospital "sister" does sometimes set
relays of patients to watch a critical case; but, undoubtedly also,
always under her own superintendence; and she is called to whenever
there is something to be done, and she knows how to do it. The patients
are not left to do it of their own unassisted genius, however "kind" and
willing they may be.