Centinels be placed at the Doors of the Hospital, 1. To prevent all
Visitors, who have not proper Leave, from coming into the Hospitals;
as such People oftentimes crowd the Wards, disturb the Sick, and are
apt to catch infectious Distempers, and to spread them among the
Troops. 2. To take Care the Patients do not go out of the Hospital
without having a Ticket[162] of Leave for that Purpose, signed by the
Physician, Surgeon, or Apothecary, belonging to the Hospital. 3. To
prevent spirituous Liquors, or other Things of that Kind, being
clandestinely carried into the Hospital.
[162] At every Hospital there ought to be a Number of printed
Tickets lying ready to be filled up and signed by the
Physicians and Surgeons, and no Man ought to be allowed to go
out without a Ticket so signed.
The Serjeant of the Guard, attended by the Ward Master, ought, every
Morning, to go round the Wards to call a Roll, and see that every Man
is in his Ward; and to do the same at Night before the Hospital Doors
are shut, and at this Time to order every Person out of the Hospital
who does not belong to it. And the Serjeant, every Morning, ought to
report to the Physician, Surgeon, or Apothecary, every Man's Name who
was found to be absent at Roll-calling; and whether he found every
Thing regular and in good Order in going his Rounds.
Every large Military Hospital ought to have one Head Nurse, and a
sufficient Number of other Nurses, to attend and take Care of the
Sick.
Orders to the following Purport, hung up in every Military Hospital,
would serve to shew the Nurses and Patients what their Duty is, and
to maintain Regularity and good Order through the whole Hospital.
_Matron, or Head Nurse._
Every Matron, or Head Nurse, is to go round all the Wards of the
Hospital at least twice a Day, Morning and Evening; to see that the
Nurses keep their Wards clean; that they behave themselves soberly and
regularly, and give due Attendance to their Patients; and to examine
the Diet of the Patients, and see that it is good and well dressed;
and if she finds any Thing amiss, to report the same to the Physician,
Surgeon, or Apothecary, of the Hospital.
_Common Nurses._
1. The Nurses are to give due Attendance to their Patients; and to
keep them always as neat and clean, as the Nature of their Distempers
will admit of; to give them their Diet regularly; to be particularly
careful to see them take the Medicines ordered by the Physicians,
according to the Directions given; to report to the Physician,
Surgeon, or Apothecary, any Faults or Irregularities which any of
their Patients may have committed; and to acquaint the Ward Matter and
Head Nurse of the Death of any of their Patients as soon as it
happens, that proper Care may be taken of their Cloaths and Effects.
2. They are to keep their Wards extremely clean, to sprinkle them
every Morning with Vinegar, and to fumigate them with the Smoke of
wetted Gunpowder, or of Frankincense, or any other Aromatics that may
be thought proper; in fair Weather to keep open the Windows of their
Wards, twice or thrice a Day; for a longer or shorter Time, as the
Weather will permit; to attend at the Steward's Room for the
Provisions of the Patients at the Hours appointed for that Purpose;
and to pay implicit Obedience to the Matron, or Head Nurse, in what
relates to their Duty; and punctually to obey all Orders they receive
from the Physician, Surgeon, or Apothecary, of the Hospital.
3. They are to keep themselves clean and decently dressed, and to
observe the strictest Rules of Sobriety; remembering, that if any one
is found intoxicated with Liquor, that she is immediately to be sent
to the Guard, and afterwards discharged.
4. They are not to absent themselves from their Wards, unless when
employed in the Discharge of their Duty; nor to go out of the Hospital
to which they belong, without having a Ticket of Leave signed by the
Physician, Surgeon, Apothecary, or Head Nurse, belonging to the
Hospital.
5. They are not to throw Nastiness of any Kind out at the Windows, but
to carry it to the common Necessaries, and to empty the Chamber Pots
and Close-stools as soon as used, and be careful to wash them before
they bring them back.
6. They are not, upon any Pretence whatever, to alter the Diet ordered
by the Physicians or Surgeons to the Patients on the Diet Boards; nor
to suffer their Patients to use any other Diet than what is allowed by
the Hospital; nor are they to bring, or allow others to bring, Meat,
spirituous Liquors, or other Things of that Kind, into their Wards,
except what is allowed by the Physicians or Surgeons. Whenever any
Thing of this Kind is found in any of the Wards, it ought immediately
to be thrown into the common Necessary; and if it be found in the
Custody of a Nurse, she ought to be confined in the Guard, or
discharged.
7. Nurses guilty of great Neglect of Duty, or of getting drunk and
using their Patients ill, or of stealing, or concealing or taking away
the Effects of Men who die in the Hospital, are to be immediately sent
to the Guard, and reported to the Commanding Officer of the Place,
that they may be tried by a Court-Martial, and be confined, whipped,
or otherwise punished, as the military Law directs; all Followers of
Armies on foreign Service being equally subject to the military Law as
the Soldiers themselves.
_Patients._
1. All sick Soldiers, on their Arrival at a Military Hospital, are to
be washed all over with warm Water, or to go into a warm Bath; and
afterwards to wash their Face and Hands every Morning, and their Feet
occasionally, with warm Water and Soap, brought round every Morning by
the Nurses for that Purpose; and they ought to comb their Head every
Day. If they be too weak to wash and comb themselves, it is to be done
by their Nurses.
2. Every Patient is to be shaved and have clean Linen twice a Week, or
oftener if requisite.
3. They are punctually to obey the Directions given them, and to take
the Medicines ordered by the Physician; and none to be allowed to go
out of the Hospital without a Ticket of Leave signed by the Physician,
Surgeon, or Apothecary, of the Hospital.
4. They must commit no Disorder or Riot, but in all Respects behave
themselves well.
5. If any Man disobeys the Orders he receives from the Physicians or
Surgeons, or is irregular in Conduct, gets drunk, and commits Riots in
the Hospital, or is found guilty of Theft or other Crimes, the same
is to be reported to the Commanding Officer of the Place, and he to be
tried by a Court-Martial, and punished as soon as his Strength will
permit.
In conducting the Military Hospitals, we found that it was always
right to discharge the Patients from the sick Hospitals as soon as
they were recovered, and to send them either to Billet, or to a
convalescent Hospital; because recovered Men are always the most
riotous; besides they crowded the Hospitals, and were in Danger of
catching fresh Disorders from those who were sick; and therefore the
recovering Men in every Hospital ought to be reviewed once or twice a
Week by the Physician or Surgeon, and the Names of such Men as are
well enough, to be marked; in order that they may be sent the next Day
to the convalescent Hospital, or to Billet. A Return of those marked
for Billet ought immediately to be sent to the Officers on
convalescent Duty.
When a convalescent Hospital is established, it ought to be put under
proper Regulations; the following are those which I drew up for that
established at _Osnabruck_ in _April_ 1761, and which were found to
answer the Purpose intended.
_Regulations for a Convalescent Hospital._
1. That this Hospital be entirely occupied by such Men as are
recovered from Diseases; that no Men be sent there but those whose
Names are returned to the Purveyor's Office by the Physician or
Surgeon of the Hospital.
2. That all the Patients shall be upon full Diet, unless in particular
Cases it be ordered otherwise by the Physician or Surgeon.
3. That all the Patients shall breakfast, dine, and sup, at regular
stated Hours, in the Hall appointed for that Purpose: Breakfast to be
ready at nine, Dinner at one, and Supper at seven o'Clock in the
Evening.
4. That no Patient shall carry up any Victuals into the Wards
appointed for sleeping in; and if any Patient does not attend at the
regular Hours of Meals, no Allowance of Victuals shall be made him in
the Place of such Meals, unless he has been absent on Hospital
Business, or been confined to Bed by Sickness.
5. That as soon as the Men are come down Stairs to Breakfast, the
Wards in which they sleep shall be cleaned out and sprinkled with
Vinegar, and the Windows opened to air them.
6. That the Doors of this Hospital shall be locked every Night at
eight o'Clock, and no Man be allowed to come in or go out after that
Time. The Doors to be opened again at seven o'Clock in the Morning.
7. That the said Hospital is to be visited two or three Times a Week
by the Physician, Surgeon, and Apothecary, who are to see that the
above Orders are complied with; to examine the Diet, and take Care
that every Thing is carried on properly; and to prescribe for any
little Disorders the Men may be affected with.
8. That one of the Hospital Mates be appointed to visit this Hospital
daily, to administer any Medicines which may have been prescribed by
the Physician; to apply any Dressings ordered by the Surgeon; and to
acquaint the Physician or Surgeon if any of the Men be so bad as to
require their Attendance, or to be sent back again to the Sick
Hospital.
9. That for the better executing these Regulations, orderly Serjeants
or Corporals be appointed for the Care of the Men; who shall mount a
Guard of six or more of such of the Patients of the said Hospital as
are fit for this Duty--That the Serjeants are to call a Roll of all
the Patients regularly three Times a Day, before Breakfast, Dinner,
and Supper; to see that the Men behave themselves soberly and
decently; and that they keep themselves clean, and commit no Riots;
and to confine in the Guard such as commit Riots and other
Irregularities, or whom they find drunk, or who stay out all Night;
and to report the same to the Officer on Duty.
10. That an Officer on convalescent Duty do visit the said Hospital
daily at the Times of Roll-calling, to see that every Thing be carried
on properly; and to receive the Reports from the Serjeants, and give
what Orders he may think proper for the better regulating the said
Hospital.
11. That if at any Time it should happen that there are more
Convalescents than the Hospital can hold conveniently, a Review be
made of all the Patients, and the strongest and most healthy be sent
to Billet.
12. That a Review be always made, when any Party is going to join the
Army, to pick out the Men who are fit to join their Regiments.
The Physical Officers employed in the Military Hospitals, are
Physicians, Surgeons, and Apothecaries.
No Person ought to be appointed a Physician to the Army, or Military
Hospitals, without previously undergoing the same Examination at the
College of Physicians, as those do who enter Fellows and Licentiates
of the College, that none but proper Persons may be employed. On such
Examinations the Physician General to the Army ought to be allowed to
sit as one of the Censors of the College.
The Surgeons are all obliged to pass an Examination at Surgeons Hall
before they are appointed, and the Apothecaries ought in like Manner
to pass an Examination at Apothecaries Hall.
The Mates employed in the Service ought, previous to their
Appointment, to be examined both in Surgery and Pharmacy, as the
Service commonly requires their acting in both Branches.
The Direction of all Military Hospitals ought always to be committed
to the Physicians, who have the immediate Care of Hospitals.
When an Army is acting on a Continent, and there is a Number of
Hospitals in different Places, the Physician who attends the Commander
in Chief ought to be made Physician General and Director of the
Hospitals, with proper Appointments; and all Orders from Head Quarters
ought to go immediately thro' this Channel.
Every other Physician at the different Hospitals ought to direct every
Thing about the Hospital which he attends, and his Orders ought to be
punctually obeyed; and he ought to keep up a constant Correspondence
with the Physician General; acquainting him from Time to Time with the
State of the Hospital, and what is wanted for it; and he ought
punctually to obey whatever Orders he receives from the Physician
General.
If there be separate Hospitals for the Surgery Patients, the eldest
Surgeon ought to direct every Thing in the Hospital he attends; and
when any Thing is wanted for his Hospital, to report the same to the
Physician General.
The directing and purveying Branches ought never to be entrusted to
the same Person, as the Temptation of accumulating Wealth has at all
Times, and in all Services, given Rise to the grossest Abuses, which
have been a great Detriment to the Service, as well as to the poor
wounded and sick Soldiers, and has occasioned the Loss of many Lives.
And therefore neither the Physician General, nor any of the Physicians
or Surgeons of the Army, or any other Person concerned in the
Direction of the Military Hospitals, ought ever to act as Purveyor or
Commissary; nor ought they ever to have any Thing to do with the
Accounts, Contracts, or any other Money Affairs relating to the
Hospital; and if ever they be found to intermeddle in these Affairs,
they ought to be immediately dismissed the Service.
The purveying or commissariate Branch ought to be entirely distinct
from the physical. The Purveyors or Commissaries ought punctually to
obey whatever Orders they receive from the Physicians or Surgeons; to
provide every Thing for the Hospital; to keep regular Accounts of all
the Men who come into, or go out of the Hospitals; and from Time to
Time to make Returns to Head Quarters of all the Men in Hospitals; and
their Accounts ought to be controuled by such Persons as the
Government may think proper.
Every Physician and Surgeon of a Military Hospital ought to visit the
Sick at regular stated Hours, and the Mates to attend and go round
with them, and receive and execute their Orders.
Every Mate ought to have a certain Number of Patients allotted him,
for whom he is to make up all Medicines, dress all Sores, and execute
whatever Orders he receives from the Physician, Surgeon, or
Apothecary. That the Mates may know and execute their Duty, proper
Orders in Writing should be hung up in the Apothecaries Shop for that
Purpose. The following are those which I gave out at all the Hospitals
I attended in _Germany_.
_Orders for the Mates._
1. That all the Gentlemen do attend at the Apothecaries Shop every
Morning at eight o'Clock, to assist in making up the common Medicines
of the Day, and afterwards to go round the Hospitals with the
Physicians and Surgeons.
2. That every Mate have a Book for writing the Prescriptions of the
Physicians in, which is to be kept in the following Order.--First, to
mark the Patient's Name and Regiment; then the Day of his Entry into
the Hospital and his Disorder; then the Prescriptions of the
Physician; and after all the Day of his Discharge, or of his Death.
_Ex. gr._
_John Clarke_, 20th Regiment. _Jan._ 1. Fever.
_Jan._ 1. V. S. unc. x.--H. salin. cum pulv. contrayerv.
4r. die.--2. Emplast. vesicat. dorso, &c.
Discharged or dead _Jan._ 28.
3. That every Mate make up himself the Physician's Prescriptions for
his own Patients, and afterwards go round and administer them, or give
them to his Patients with proper Directions; that he bleed his own
Patients, and dress any slight Sores they may have, which do not
require their being sent to the Surgery Hospital.
4. That every Mate go round amongst his Patients in the Evening, to
see that every Thing is well conducted, and to report to the Physician
or Apothecary if any Thing extraordinary happens.
5. That two of the Mates attend all Day at the Apothecary's Shop to
receive any Sick that may arrive, and to place them properly; to make
up what Medicines they may immediately want; to order each of them a
Mess of Water Gruel; and if any Thing extraordinary occurs, to send an
orderly Man to acquaint the Physician or Apothecary with the same. The
orderly Mates to make up likewise for Officers, or others, all
Prescriptions sent to the Apothecary's Shop through the Day.
A Joint of Meat, roasted or boiled, for Dinner, and a Bottle of Wine,
was allowed to the orderly Mates, by Lord _Granby_'s Order, that they
might not absent themselves from their Duty.--Where there was
Conveniency for it, a Mate lodged in the Hospital.
The Apothecary ought to take Care of the Medicines; to go round the
Hospitals in the Morning before the Time of the Physician's visiting;
to see that the Wards are in proper Order; that the Nurses and other
Servants have done their Duty; to examine into the State of the Sick,
and to see that the Provisions are good; and make a faithful Report
of all these Things to the Physician when he arrives.--To take Care
that the Mates prepare in the Morning the Medicines that are commonly
wanted for the Day; and that they afterwards make up faithfully the
Prescriptions of the Physician; to go round the Hospital again in the
Evening, to see that the Sick have got their Medicines regularly; and
to make the same Enquiries as in the Morning.
The Apothecary should always be lodged near the Hospital, to assist in
Case of any Accidents happening, or of Sick arriving at the Hospital.
When there are any strong infectious Disorders in Military Hospitals,
the physical Gentlemen may use the following Precautions to guard
themselves against Infection.
1. Never to visit the Sick with an empty Stomach; but to eat Breakfast
before they go into the Hospital.
2. To have a Suit of Cloaths reserved for visiting the Hospital, and a
waxed Linen Coat to wear above them in going round the Wards; and as
soon as they have come out of the Hospital, to wash and change their
Linen and Cloaths.
3. Before they go into the Wards, to order that they be well cleaned
out, and sprinkled with Vinegar, and afterwards fumigated, and aired
by opening the Windows, or by Working the Ventilators.
4. If the Infection be very strong, to take a Glass of the spirituous
Tincture of the Bark just before they go into the Hospital.
5. To put small Rolls of Lint, dipped in camphorated Spirits, up the
Nostrils, and to direct a Vessel, with warm camphorated Vinegar, to be
carried round, and held near the Patients they are examining.
6. In examining Patients affected with the Petechial Fever, or any
other malignant Distempers, to stand at some little Distance, and ask
what Questions they may think proper; and when they come near, to feel
the Pulse, and examine the Skin, not to inspire while their Head is
near the Patient's Body; but after being fully satisfied in these
Points, to retire a little, and ask what other Questions may be
necessary.
It would be right to establish some military Rank for every
commissioned Officer of the Hospital on Service, and to settle the
same Subordination in the physical as in the military Department. By
these Means, the Service would be carried on with greater Order, and
more Advantage to the Sick.
And it would be right, in Times of War, to add a Clause in the Mutiny
Bill to allow any military Officer on convalescent Duty to call in the
commissioned physical Officers to assist in making up a Court-Martial,
when there are not a sufficient Number of military Officers in a
Place, to try convalescent Soldiers guilty of Crimes. For in Times of
Service, very often a sufficient Number of military Officers cannot be
spared to be on Duty at the different Military Hospitals; and at all
such Places the Convalescents are generally very disorderly, when they
know that there is not a sufficient Number of Officers to form a
Court-Martial for punishing them. Where-ever there are a sufficient
Number of military Officers, no physical Officer ought ever to be
called upon as a Member of a Court-Martial.
Men, in Time of Service, are often apt to saunter in and about
Hospitals, and there learn all Manner of Debaucheries, and lose all
Sense of Discipline; and therefore, to keep up Order and Decorum,
there ought to be, at every Fixed and every large Military Hospital, a
military Inspector or Commander, an Officer of known Activity and
Probity; and a Number of Officers on convalescent Duty sufficient to
form a Court-Martial whenever required.
The Duty of the Military Inspector, or Commander, should be, to take
Care of all Convalescents on Billet; to see that the Officers under
him do their Duty, and maintain the same Regularity and Discipline
among the Men belonging to their respective Corps, as if they were
with their Regiments; and that the Men attend the Parade and
Roll-calling; and that they always appear neat and clean.
He ought, from Time to Time, to visit the Hospitals; to see if they
are kept clean; to enquire if the Men behave well, if the Diet is
good, and the Officers, Nurses, and Servants, do their Duty; and if he
finds any Thing amiss, to report the same to the Physicians and
Surgeons of the Hospital, or to the Purveyor or Commissary, or others,
under whose Department it may be, that the same may be immediately
rectified; and if he finds that the superior Officers of the Hospital
overlook such Abuses, notwithstanding his Representations, to report
the same immediately to the Head Quarters.
He ought to order one of the Officers on convalescent Duty to visit
the Hospitals daily, to make the Enquiries above-mentioned, and to
give him a Report of the same in Writing.
The Purveyor or Commissary ought to make a Return to him twice or
thrice a Week of every Man admitted into, or discharged from, the
Hospitals, or who dies in them; marking in the Return the Name of
every Man, and the Company and Regiment he belongs to; that he may
report the same to the Officers of the different Brigades or
Regiments.
The Military Inspector ought to have the Power of providing Billets
for all Officers and Soldiers about Hospitals; and the Names of all
Men to be discharged from Hospitals should be sent to him the Day
before they are discharged, that he may provide Billets for them; and
next Day the Men ought to march from the Hospitals to the Parade, to
receive their Billets, and the Orders of the Military Inspector, and
of the Officers of the Corps they belong to.
The Military Inspector ought to see that the Arms of the sick Men, and
the Arms and Cloaths of those who die and are lodged in the Magazines,
be properly taken Care of; and that the Stores of the different
Regiments be properly looked after.
As the Service often makes it necessary at Military Hospitals, where
the Number of Sick is great, to employ the convalescent Soldiers[163]
as orderly Men and Servants about Hospitals, all Men thus employed
ought to have a special Leave from the Military Inspector for so
doing; and no Man should be employed in any Capacity as a Servant
about an Hospital, who at that Time is on the Books as a Patient. And
all Men employed about the Hospital ought to be reviewed once a Week
by the Military Inspector, and likewise whenever a Party of
Convalescents is going to join the Army, or their Regiments; that no
Man may be allowed to remain with the Hospital, after he is fit to do
Duty in his Regiment.
[163] In the _French_ Hospitals there are always a Number of
Men who attend their Sick who belong to the Hospital, so that
they have no Occasion to employ their Convalescents, as we
are often obliged to do, where the Sick are attended by
Nurses, who are commonly Soldiers Wives, and not so capable
of doing such laborious Work as the Men.
When the Military Inspector is absent, the eldest Officer on
convalescent Duty ought to act in his Place.