Utensils for a small Hospital, and two, three, or four hundred Sets of
Bedding, should be carried about with the Army, in Case of an Action,
for the Use of the Wounded, till they have Time to receive Assistance
from the Flying Hospital. Some of the Bedding ought to be carried on
Horseback, so as to be at Hand when any of the Surgeons are sent with
Detachments that are going upon an Attack.
To prevent crowding the General Hospitals in Winter Quarters, every
Regiment ought to take Care of their own Sick, and to have proper
Hospitals fitted up for them.
Dr. _Pringle_ has laid down some very good Directions with regard to
the Choice of Places fit for Hospitals, and the Method of preventing
infectious Disorders in them; and we find many excellent Hints of this
Kind in Dr. _Lind_ and Mons. _du Hamel_'s Treatises on the Means of
Preserving the Health of Seamen, and some likewise in Dr.
_Brocklesby_'s late Treatise on military Disorders.
In the Time of Service the Commander in Chief generally orders the
Hospitals to be established in Towns or Villages that least interfere
with the military Operations, to which the Sick and Wounded can most
easily be conveyed; and which he can best protect from the Insults of
the Enemy[155].
[155] The _Roman_ Generals seem to have sent their Sick and
Wounded into Towns, in the same Manner as is done by those of
the present Time. For we read in _Cæsar's Commentaries_ of
this Method having been practised on more Occasions than one.
In the sixty-second Chapter of the third Book, _de Bello
Civili_, we have the following Passage: "Itaque nulla
interposita mora, sauciorum modo & ægrorum habita ratione,
impedimenta omnia silentio prima nocte ex castris _Apolloniæ_
præmisit, ac conquiescere ante iter confectum vetuit. His una
legio missa præsidio est."--And immediately after, in chap.
lxv. "Itaque præmissis nunciis ad Cn. Domitium Cæsar
scripsit, & quid fieri vellet ostendit: præsidioque
_Apolloniæ_ cohortibus iv. _Lissi_ i. tres _Orici_ relictis;
quique erant ex vulneribus ægri depositis; per Epirum atque
Arcarniam iter facere cæpit."
And in the twentieth chapter, _de Bello Africano_, we read:
"_Labienus_ saucios suos, quorum numerus maximus fuit, jubet
in plaustris deligatos _Adrumentum_ deportari."
It would be a right Measure, in the Beginning of every War,
to settle by a Cartel that military Hospitals on both Sides
should be considered as Sanctuaries for the Sick, and
mutually protected; as was agreed upon between the late Earl
of _Stairs_, who commanded the _British_ Troops, and the Duke
_de Noailles_, who commanded the _French_ in the Campaign in
_Germany_ in the year 1743. See _Dr. Pringle's Preface_.
In Towns, the Places fittest for Hospitals are public Buildings, which
have large dry airy Apartments, situated on a high Ground, where there
is a free Draught of Air, and a Command of Water.
In Winter, those Houses, which have open Fire Places in the Rooms, are
always preferable to such as have close Stoves, or no Fire Place at
all; for an open Fire Place serves to keep up a free Circulation of
Air in a Room, as well as to keep it warm. And for the same Reason,
where nothing but Stoves can be got to warm the Wards, the Wynd
Stoves, which open into the Room or Ward, are vastly preferable to the
close ones.
Where there are no public Buildings, private Houses answering nearest
to the above Description are most proper for Hospitals. In general,
Houses with small Rooms make but bad Hospitals; and very Damp and
close Places ought by all Means to be avoided.
In Summer, when the Moveable or Flying Hospital is ordered into
Villages, large Barns, and the largest airy Houses, are the best.
Churches, situated on a dry high Ground, make good Summer Hospitals;
and in Winter, when Necessity obliged us sometimes to use them in
_Germany_ for this Purpose, they were found to answer very well, when
we had Bedsteads or Cradles for the Men to lie upon, and the Wynd
Stoves to keep them of a moderate Heat.
In making Choice of Houses for Hospitals, particular Regard ought to
be had to the Privies or Necessaries; because, where their Smell is
offensive, there is always Danger of infectious Disorders. If,
therefore, there be no proper Conveniencies of this Kind about an
Hospital, such ought to be contrived so as to prevent any Danger from
their putrid Effluvia. If there be a River near the Hospital, the
Necessaries may be made above it at a Place where there is a rapid
Stream below. In Villages deep Pits may be dug in the Ground behind
the Hospital, and Seats made over them, as in Camp; and a thick Lay of
Earth be thrown above the Foeces every Morning, till the Pits are near
full, and then they must be filled up, and others dug to supply their
Place.
When once the Places are fixed upon for Hospitals, every Ward ought to
be made perfectly sweet and clean; first, by scraping and washing with
Soap and Water, and afterwards with warm Vinegar; and then they ought
to be fumigated with the Smoke of wetted Gunpowder and of Aromatics,
and afterwards well dried and aired by lighting Fires, and opening
the Windows, before any Sick are admitted.
After this the Beds ought to be laid; in doing of which great Care
should be taken not to crowd the Wards too much, as nothing corrupts
the Air so much, or so soon brings on infectious Disorders. Dr.
_Pringle_ says, the Beds ought to be laid so thin, that a Person
unacquainted with the Danger of bad Air, might imagine there was Room
for double or triple the Number. In high lofty Apartments, and in
Churches, and other large Places, the Beds may be laid much closer
together than in Rooms with low Cielings. In Churches, or such Places,
thirty-six square Feet, or a Square of six Feet by six, may be allowed
for each Man; but in common Wards we must allow from forty-two square
Feet, _i. e._ six by seven Feet, to sixty-four square Feet, or eight
by eight, according to the Height of the Cieling, the Airyness of the
Place, and the Nature of the Diseases of the Patients.
The Bedding most fit for Hospitals, is Palliasses and Bolsters filled
with Straw, Sheets, and Blankets, as they can easily be washed.
Feather Beds and Matrasses are apt to retain Infection, and cannot be
easily cleansed. In the fixed Hospitals, Bedsteads or Cradles may be
set up for laying the Bedding on: But in the Moveable or Flying
Hospital the Bedding must be, for the most part, laid on the Floor.
When once the Beds are laid, and the Sick arrive, some of the
Gentlemen belonging to the physical Department ought to attend, to
distribute the Sick properly through the Hospitals.
All the Surgery Patients, such as have Wounds, Ulcers, Sores, the
Venereal Disease, &c. should be separated from the Rest, and put
either into particular Wards by themselves, or into an Hospital fitted
up for that Purpose under the Direction of the Surgeons.
Those labouring under infectious Fevers and Fluxes, should each of
them be placed in good airy Wards by themselves, where the Beds are
laid much thinner than in the other Wards of the Hospital. If the Flux
Wards have a Privy near them, where the Men can ease themselves,
without being offensive either to their own Ward, or any other Part of
the Hospital, they are so much the fitter for such Patients. In the
Hospital I attended at _Bremen_, the Flux Ward had a Necessary that
opened into the River _Weser_, and at _Natzungen_ a deep Pit was dug
in the Field about twenty Yards from the Barn where the Flux Men lay,
which kept these Wards always sweet.
Patients that have got the Itch, or any other infectious Distemper,
ought likewise to be put into separate Wards by themselves; and at all
Times a Place should be set apart for those who may be taken ill of
the Measles or Small-Pox. A House separated from the other Hospitals,
with a distinct Set of Nurses and other Attendants, bids fairest to
prevent the Infection from spreading.
When once the Sick are properly ranged, the next Care must be to
prevent infectious and malignant Disorders from being generated, and
from spreading amongst the Sick; which is principally to be effected
by keeping the Sick and the Hospital extremely clean and well-aired,
and the Wards as sweet, and free from putrid and offensive Smells, as
possible.
Every sick Man, as soon as he arrives at an Hospital, should be washed
with warm Water, or if there is a warm Bath, or bathing Tub, to be put
into it; and afterwards be supplied with a clean Shirt[156] well-aired
before he be put to Bed; and his own dirty Linen should be immediately
carried to the Wash-House: And every Morning each Nurse ought to carry
a Bucket full of warm Water, and a Piece of Soap and a Towel, round to
each of her Patients, and make them wash their Hands and Face, and
their Feet, when dirty.
[156] Every military Hospital ought to have a Number of
Shirts belonging to it, for the Use of the Sick who arrive
without having clean Linen with them. As soon as their own
Shirts are washed and dried, or that new ones are provided by
their Regiments, the Hospital Shirts ought to be taken from
them.
Every Morning all the Wards ought to be scraped and swept, and
afterwards sprinkled with warm Vinegar; and when dirty, they ought to
be washed after the Fires are lighted.
Every Thing in the Wards, and about the Sick, should be kept as clean
as possible; the Chamber-Pots and Close-Stools ought to be carried
away as soon as used, and immediately emptied and washed before they
be brought back.
The Windows of the Wards ought to be kept open to admit fresh Air
Morning and Evening, for a longer or shorter Time, according as the
Weather will permit.
If the Wards are close, and the Cieling too low, Dr. _Pringle_ advises
to remove some Part of them, and to open the Garret Story to the
Tiles[157]; and if the Opening of the Windows is not sufficient to
air the Wards, Ventilators of different Kinds, such as those mentioned
by Dr. _Hales_ and Dr. _Pringle_, may be used, especially when the
Weather is hot.
[157] In Wards which are too close, it has been found that
one or two square Holes (of about six or eight, or ten Inches
diameter), cut in the Cieling, and a Tube made of Wood fitted
to it, and carried up into the Chimney of the Ward above, so
as to enter above the Grate, is one of the best Contrivances
for procuring a free Circulation of Air; as the foul Air,
which is lightest, and occupies the highest Part of the Ward,
finds a free Exit by these Tubes: We have such Tubes now
fixed in several of the Wards in _St. George_'s Hospital. A
Hole cut above the Door of the Ward, or in the upper Part of
the Windows, and one of what are called the _Chamber
Ventilators_ fixed in it, will answer, where Holes cannot be
conveniently cut in the Cieling.
In Winter, Fires should be lighted in all the Wards where it can be
done.
In foreign Countries, when we meet with Hospitals where there are no
Places for open Fires, but only close Stoves, different Contrivances
may be used to renew the Air. Ventilators of different Kinds may be
used, or Openings made in the Doors and Windows. In Winter 1761-62,
some of the Wards in the Hospital at _Bremen_ which I attended had
such Stoves. In order to keep up a free Circulation of Air in those
Wards, I directed large Holes to be cut in the lower Part of the Door
in each Ward, and two Grooves to be made on the Outside of the Door,
above and below the Hole, parallel to each other, in which a Board
slided; by means of which, the Hole could be either quite covered or
only in Part, or left entirely open; and I directed a Casement, about
eight or nine Inches square, to be made in the upper Corner of each
Window. After the Fires were lighted, upon removing the Board which
covered the Hole in the Door, and opening the little square Windows, a
Current of fresh cool Air rushed into the Ward by the Door, while the
heated foul Air found an Exit by the Windows. In very cold Weather,
the Opening of the small Windows was sufficient; but in mild Weather,
and in Summer, it was necessary to keep both open.
The Wards should be daily fumigated by Means of Aromatics, or wetted
Gunpowder thrown on burning Coals, put in an Iron Pot or Chaffern, or
with the Steams of warm Vinegar placed in the Middle of the Ward. Dr.
_Lind_ says, that although Cleanliness and a pure Air contribute much
to prevent infectious Disorders, or to check them, yet that they of
themselves are not always sufficient; but that he seldom or never knew
a proper Application of Fire and Smoke to be unsuccessful in producing
the happy Consequence of effectually purifying all tainted Places,
Materials, and Substances[158].
[158] Dr. _Lind_ tells us, that the Ships of War in his
Majesty's Service are purified by Fire and Smoke, and gives
the Process by which it is done; and he says, that he never
heard of any Ship, which, after being carefully and properly
smoked, did not immediately become healthy for the Men.--See
_First Paper on Fevers and Infection_.--And he observes, that
these Steams and Smoke, which are inoffensive to the Lungs,
besides correcting the bad Quality of the Air, produce
another good Effect; which is, to make both the Patients and
Nurses desirous of opening the Doors and Windows for the
Admission of fresh Air. _Ibid._ p. 51.
In all Military Hospitals, at least in the fixed ones, one Ward ought
to be always kept empty; and whenever a malignant Fever, or any other
infectious Disorder, breaks out in any Ward, the Men ought to be
removed into this empty one; and the foul Ward purified, by washing
and cleaning it well with Soap and Water, and then with warm Vinegar;
and afterwards purifying it with Smoke, in the same Manner as is
practised in his Majesty's Ships of War; and Fires should be lighted
daily, and the Windows kept open for some Time, before any Sick be
again admitted into it.
As soon as any Patient dies, the Body ought to be removed to the Dead
House; and the Bedding he lay upon should be carried away immediately,
and not used again till it has been smoked, well-aired, and washed.
All the Linen of Patients in Fevers, Fluxes, and other infectious
Disorders, ought to be changed often; and all the foul Linen and foul
Bedding of the Hospital should be smoked with the Fumes of Brimstone,
or of wetted Gunpowder, in a Place set apart for that Purpose; and Dr.
_Lind_ advises to steep them first in cold Water, or cold Soap Lees,
before putting them in warm Water; as it is dangerous for any Person
to receive the Steam that may at first arise, where this Precaution is
not used.
All the Cloaths, of Soldiers who die in Hospitals, ought to be sent to
the Smoke House, and be well fumigated, and afterwards aired, before
they are put up in the Store-House.
The next Thing to be considered about a Military Hospital is the Diet
of the Patients, which should consist of good wholesome Provisions,
that can be purchased easily, and at a cheap Rate[159].
[159] The _French_, and many other Nations, give their
Patients Meat Soops in acute Diseases, and after capital
Operations; and they allow them but little Bread or other
Preparations of Vegetable Substances: But these Meat Soops
without Bread do not nourish the Patient sufficiently, and
tend too much to the Putrescent; and this is one Reason why
more Sick die in the _French_ than in the _British_
Hospitals.
Good Bread[160] is a standing Article of Provisions for an Hospital in
all Countries and in all Climates; and a certain Quantity of it ought
to be distributed to each Man daily.
[160] On Expeditions where a Siege is expected, a Quantity of
Flour ought to be carried out, and a Number of portable Ovens
for baking bread for the Sick, which may be put up after the
Troops have made good their Landing.
The Breakfast and Supper in most Military Hospitals must be made of
Water Gruel or Rice Gruel; as either Rice or Oatmeal can be got in
most Places, and are very portable.--Water Gruel is in general
preferable to the Rice Gruel, because most Patients nauseate the Rice
Gruel, after eating it for some Days, but not the Water Gruel, as
every Person, who has attended the Military Hospitals, must have
experienced. Where both Rice and Oatmeal can be had, Rice Gruel may
be used two or three Times a Week by Way of Variety.
But although Rice Gruel is not so proper for constant Use, yet Rice
should always make an Article among the Stores for an Hospital, as it
is useful for making Rice Water for Drink; and it can be boiled or
ground, and made into a light Pudding, and in short may be used in a
Variety of Forms to make a good and wholesome Food for the Sick.
Oatmeal is cheaper than Rice, and can be procured almost every-where
in _Europe_, where Armies make Campaigns; as Oats make such a great
Article in the Forage for Horses. And a sufficient Quantity can at any
Time be ground into Meal for the Use of the Sick, at the Mills which
are employed for making Flour for the Bakery, if there be none nearer
the Hospital.
In Countries where neither Oatmeal nor Rice can be had, _Indian_ or
some other Corn, which is known to be wholesome, and which the Country
affords, may be employed in their Place.
When fresh Meat can be got, the Men who are on full Diet, and the
Nurses and other Servants about the Hospital, should have Meat for
Dinner; and the Meat that is boiled for them ought to make Broth for
the Sick who are kept on a low or middle Diet. Some Barley or Rice
should be added to the Broth; and a small Quantity of Carrots,
Turnips, or other Vegetables, boiled along with them, will make it
more agreeable to the Taste.
On Expeditions where nothing but salted Meat can be had, a Quantity of
portable Soop should always be carried out for the Use of the Sick;
which with Water and some Barley, and fresh Vegetables, when they can
be got, will make a good Soop or Broth. On such Occasions, the Dinner
ought to consist of Soop and Bread, or of light Puddings made of Flour
or of Rice, of boiled Rice or Barley, or of Panado, &c.
Nurses and recovered Men may be allowed salted Meat twice or thrice a
Week.
The common Drink of Military Hospitals ought to be Rice and Barley
Water, with a small Proportion of Spirits and Sugar. Small Beer is a
good Drink where it can be easily procured; as is Wine and Water, or a
very small Negus, or very weak Punch in warm Climates.
Besides this Diet, extraordinary Indulgences may be occasionally
allowed to particular Patients, as Wine, Brandy, Sugar, Milk. And the
Physicians and Surgeons ought to have a discretionary Power to order a
Vegetable or any other proper Diet for Patients in the Scurvy, or any
other particular Complaints.
The Established Diet of a Military Hospital may be,
_Breakfast._ _Dinner._ _Supper._
One Pint of Water | |
or Rice Gruel. | |
| |
Water Gruel made | |
with 3 or 4 Ounces | |
of Oatmeal, a | |
little common Salt,|One Pound |
and with or without|of boiled fresh |
Full Diet, a little |Meat. | As Breakfast.
Sweet Oil, and | |
two Spoonfuls of | |
Wine. | |
| |
Rice Gruel made | |
with two Ounces of | |
Rice, one Spoonful | |
of fine Flour, a | |
little | |
common Salt and | |
Sugar. | |
-----------------------------------------------------------------
|One Pint of |
|Broth, half |
Middle Diet, Ditto. |Pound of boiled | Ditto.
|Meat. |
-----------------------------------------------------------------
|One Pint of |
|Broth, or |
Low Diet, Ditto, or according|half a Pint of |
to the Patient's |Panado, with |
Appetite. |two Spoonfulls | Ditto.
|of Wine, |
|and a Quarter |
|of an Ounce |
|of Sugar. |
The daily Allowance of Bread to be one Pound to each Man.
The common Drink for those on full and middle Diet to be Rice or
Barley Water, with two Spoonfuls of Brandy to each Pint, and a Quarter
of an Ounce of Lump Sugar; small Beer, or very weak Punch; or Wine and
Water, two Ounces of Wine to a Pint of Water, and a Quarter of an
Ounce of Sugar. The Quantity not to exceed three Pints _per_ Day.
Those on low Diet to have Rice or Barley Water as above, with or
without Wine or Brandy.
The Diet Boards hung up in the Hospitals may be made with the
following Columns, nearly as they were with us in _Germany_.
Regiments.|Mens | Diet |Wine. |Brandy.|Milk. |Sugar. |
|Names.|F.|M.|L.|½ Pints. |Ounces.|½ Pints. |Ounces.|
----------+------+--+--+--+----------+-------+----------+-------+
| | | | | | | | |
| | | | | | | | |
| | | | | | | | |
| | | | | | | | |
| | | | | | | | |
| | | | | | | | |
| | | | | | | | |
| | | | | | | | |
| | | | | | | | |
| | | | | | | | |
| | | | | | | | |
----------+------+--+--+--+----------+-------+----------+-------+
When such Diet Boards are kept in an Hospital, and the Mens Names and
Regiments are once wrote down, the Patients may with very little
Trouble be put upon the full, middle, or low Diet, with so much of the
above-mentioned Extraordinaries as may be judged proper.
If any Thing else be wanted for the Sick, the Physician ought to give
a particular Order in Writing for it, the Columns here marked being
only for such Things as are most frequently wanted.
It should be a general Rule in all Military Hospitals, that, when a
Party of Sick arrives, every Man may have immediately a Mess of Water
Gruel given him, and afterwards be put on low Diet till it is ordered
otherwise by the Physician or Surgeon who attends him.
It is not to be supposed that the Diet here mentioned can be strictly
kept to in all Parts of the World; for it must often be varied
according to the Difference of the Climates, and to the Provision of
the Countries where the Scene of War may be.
Whenever a Moveable or Flying Hospital is to attend an Army, a
Quantity of Bedding, and of all Utensils for forming an Hospital,
ought to be put up in the Waggons, together with Provisions of
different Kinds, such as Oatmeal, Rice, Sago, Brandy, Wine, Sugar, &c.
A Butcher with a Stock of live Cattle, and a Baker with a proper
Quantity of Flour for making Bread ought constantly to attend; and a
Number of empty Waggons should likewise be always in Readiness, to
transport the Sick when the Hospital moves, or when a Party is to be
sent to the fixed Hospitals.
When Troops go upon an Expedition, besides the common Hospital Ships,
another Ship ought to be properly fitted up for the Reception of sick
Officers[161]; and every Hospital Ship ought to be supplied with all
Sorts of Provisions, and other Necessaries fit for forming an
Hospital, before they leave _England_.--And one or more armed Vessels
loaded with Provisions, Wine, and all Sorts of Necessaries for the
Sick, ought to attend them; or if the Expedition be intended for the
warm Climates, these Vessels ought to go before the Fleet to take up
Wine and Fruits, such as Lemons, Oranges, &c. Vegetables of different
Kinds, and a live Stock for the Use of the Sick.
[161] If there be no Ship fitted up for the Reception of sick
Officers, those who are taken ill on Expeditions must be in a
most miserable Situation; as there is no Place to receive
them in the common Hospital Ships, they must remain almost
without Assistance in a crowded Cabin amongst People in
Health; as was the Case in some of our Expeditions during the
late War.
All Hospitals attending Expeditions should carry out among their
Stores a Number of large Tents for lodging the Sick and Wounded
immediately on making good their Landing. Where a Siege is expected
which will take up Time, and where no Accommodations for the Sick can
be had till the Siege is over, a Ship or two, with Boards, and other
Necessaries for building large Sheds, or temporary Hutts, for the
Sick, as proposed by Dr. _Brocklesby_, ought to go along with the
Fleet, or meet them at the Place of their Destination. Such thatched
Sheds, or Hutts, are very necessary in the warm Climates, as the
perpendicular Rays of the Sun, beating upon Canvass, make Tents
intolerably hot. When any of our own Settlements happen to be near the
Place attacked, a fixed Hospital may be established there; either in
Houses, if proper ones can be found; or in temporary Sheds or Hutts
erected for that Purpose; and some Vessels, properly fitted up, may be
kept going with the Sick and Wounded, and bringing back the recovered
Men.