[Sidenote: 1. Roman-Catholic Sisters?]
1. It is necessary for a Superintendent-General to have counted the
cost, and to be prepared or not prepared to include Roman Catholic
Sisters among the Nurses. This will deprive her of some valuable women;
of one (speaking for the present time,) who is invaluable; of many
decorous, not very useful women. The question is perhaps settled by
the fact, that where you have the Roman Catholic Sister, you cannot be
secure from the Roman Catholic Direction, with all its many strings,
and machinery of opposition. Abroad the cause of the Roman Catholic
Church is often the cause of religion; and the Romish Priest serves
both zealously at the same time, and with a pure heart. In England,
and in matters of England, the first aim of the Direction is too
often to damage what is not Roman, and the second to promote what is
Christian. Upon the whole I must think Roman-Catholic Sisters are
better out of, than in, the Army Hospitals. It would be right to think
well over how far they could be entirely dispensed with, in the event
of having soon to undertake a War Service.
In the event of a decision being made to dispense altogether with
Roman Sisters, it would be as well to be prepared (though we never can
speculate on the tactics of the Roman faction, and after what occurred
during the Crimean war, it may think it better to take things quietly)
for a battle, (_not_ confined to the Army Medical Department,) for
the production of an Inspector-General’s letter assigning “reasons”
for preferring Nuns to secular Nurses, and for the delivery of sundry
opinions of similar purport, ranging from that line to the one taken
in the paper emanating from the Army Medical Department, extolling the
Russian Nurses, “who were all Sisters of Mercy, and mostly widows of
officers.”
[Sidenote: 2. Anglican Sisters?]
2. The nature of the Service and Rules would, unless in war service,
perhaps exclude English “Sisters” from the Nurses. They supplied us
with some valuable women in the last war, and their Lady-Superior
behaved ever generously, loyally, and well towards us.
The principle and detail of most sisterhoods render them unsuited
for admixture with the secular element; and the comfortable belief
into which the good women (of both branches) practically, if not
theoretically, settle, that secular women are too bad to be mended or
influenced, unfortunately makes their usefulness among Nurses nearly
null. It would never do to unsettle any of the Sisters; but if it so
happened that any voluntarily offered to serve as bonâ fide Nurses,
some valuable individuals might thus be acquired; but this should not
at all be pressed.
It would certainly remove a difficulty in declining Roman Catholic
Sisters, if the rule should be to decline also English Catholic
Sisters, forming the Staff entirely of secular women.
[Sidenote: 3. Whom is the Nurse to summon in case of disorderliness in
the Ward?]
3. In Civil Hospitals there are three distinct elements of government.
First, the Civil Authority; the chief being the Treasurer, or the
equivalent civilian, whose subordinate is called diversely Steward,
Superintendent, House Governor; second, the Physicians and Surgeons
(duly represented, in case of holidays or illness, by the Assistant
Physicians or Surgeons), Apothecary and House Surgeon; and third, the
chief of the Nurses--the Matron.
It requires of course temper, discretion, forbearance, and fortunate
circumstances which do not always happen, for these authorities not to
spend a portion of their time in quarrelling with each other; but the
ruts are old and deep, and the wheels move on, though they often stick.
The Civil Authority is a very important element, especially when the
chief is a man of judgment and firmness, who keeps himself paramount
over all, and does not delegate all to his subordinate the Steward. The
Steward and the Matron generally find their duties disposed to clash.
In some Hospitals the rules are inexplicit in assigning power to the
Matron over all the women. But this apart. The Steward represents and
wields the police of the Hospital. He progresses through the wards, he
perceives, or the Head Nurse reports to him, something disorderly. He
rectifies it (or not, as the case and the man may be). She thus, over
and above her relation to the Matron, has to appeal to, and to account
to, the Steward.
This power of police and discipline, wielded by the Civil Authority
of the Hospital, is of immense moment in regulating the good order
of the Hospital; it acts in sundry important ways which need not be
particularized.
Now, in the case of Military Hospitals, there is one important
simplification of the business, which need not be enlarged upon. All
the patients are men. But there are two things which do not simplify
the machinery of the Military Hospital. The attendants, in the plan
proposed, are not (and cannot be) all Nurses, under the Matron; nor
all Orderlies, under an Officer; there are Nurses under a Matron,
and Orderlies under some Officer; and there is no Civil element.
The Doctors both prescribe, and hitherto have governed. An Officer
orders flogging, &c.; but the Doctors practically both prescribe, and
hitherto have governed. And a Military Hospital must, and should ever
remain, essentially different from a Civil Hospital; both different
in discipline and detail, and altogether a rougher and ruder place.
It should never for a moment be forgotten that the soldier is a very
peculiar individual, old and stern as is his trade. A regiment, if one
thinks _into_ it, is a curious thing. The Hospital which receives these
men when ill and wounded, whether regimental or general, is, and ought
to be, a place essentially different in many things from the great
Civil Hospital. The moral standard of the patients of the Military
Hospital, their readiness to obey, their good feeling to each other,
are strikingly higher than in the Civil Hospital; but the soldier is
what, amidst all his faults, he has been made by the habit and spirit
of discipline, which has become an instinct and a second nature, and
which ennobles his own. Relax discipline, and in proportion as you do
so, there remains of the soldier a being with as much or more of the
brute than the man.
Discipline then being the pivot upon which the good order of all
military things, Military Hospitals included, turns, it follows, that
if you set down a few women (they should not be many) in a great
Military Hospital, unless they can become effectually incorporated into
the general spirit of discipline of the place, they will only injure
themselves and the whole.
As women, the more entirely they are under the government of the
Matron, herself under the government of the Superintendent-General, the
better. As Ward Nurses, the more entirely they are under the orders
of their Surgeons, the better; but they have not only to obey the
Surgeons, they have to enforce the Surgeons’ orders among the patients,
and both for so doing, and for the cleanliness, &c., of the ward, they
have to give orders to the Orderlies.
In the case where a rule will work, by which, if the Nurse has to
complain of an Orderly, she reports the same to the Matron, who lays
the complaint before the chief of the Orderlies (whatever may be fixed
upon as his name); well and good; but a more direct procedure will also
be found necessary.
Every firm and discreet woman (none other is fit for a male ward,
least of all for a military ward), will avoid collisions, reports,
and violent outbreaks in the ward as much as possible. But still,
every now and then these things will happen, and though by all
means to be avoided if possible, when they do come, they clear the
ward-atmosphere like a storm, provided the discipline be strict. Every
now and then--and every experienced Head Nurse will tell the same
story--some disobedience, slovenliness, truculence, or sly impudence,
will arise in the ward, and she will find she cannot put it down
alone. If she remain helplessly deprecating or scolding the men, her
position becomes at once an unseemly and a dangerous one, as that of
all contemned authority is. In such a case, in the Civil Hospital, the
Head Nurse goes straight, according to the nature of the case, to the
House Surgeon or to the Steward, unless the visiting hour be at hand,
and she judges it best to refer to the Surgeon. Discretion is again
here required, as in everything in Hospitals; but between the Surgeon
and the Steward, a firm, discreet Head Nurse will generally get the
ringleader expelled, and two or three others, named or unnamed, warned
of a similar fate. After this sort of explosion, the ward is quiet and
orderly for months. The thing is seldom done, but the patients know it
can be done at any time, and that it will be done, in such or such a
contingency.
Now the soldier cannot be turned out of Hospital, and he knows
he cannot. It becomes the more important not to suffer an hour’s
relaxation of discipline there. If, therefore, such an outbreak, either
on the part of patients or orderlies, should happen in a Military
Hospital, the Nurse ought to be able to summon at once the proper
authority and afterwards to report the whole to the Matron, but first
to bring direct the proper authority into the ward. Whether it be the
Captain of Orderlies or the Orderly Medical Officer, or, as in case
of emergencies, is generally preferable, the Staff-Surgeon himself,
she ought to have power at once to bring the proper authority into the
ward, to put down confusion and restore discipline at once, and then
afterwards to report to the Matron what has passed.
It must never be forgotten, that in every Regiment we must calculate
upon there being two or three thorough scoundrels, five or six men
who are not far off from being so, and an indeterminate number whom
discipline saves from ranking after them. One year with another,
characters no doubt as vile as the worst that disgrace our gaols pass
through the General Hospitals.
Another thing to be remembered is, that whatever classification may
be carried out, we may be certain beforehand that numbers of patients
from a vile cause will be in the ordinary surgical wards of every
General Hospital in time of peace. Very severe cases of this sort give
heavy work, and little trouble. They suffer much generally, alike
from disease and treatment; are frightened, if not ashamed, about
themselves; and are generally extra-submissive and quiet. These cases,
however, generally would belong to the separated wards; which latter
contain usually a large admixture of patients who suffer comparatively
little, and who require to be dealt with with unswerving firmness. For
reasons somewhat too technical to write, it is to be hoped, upon the
whole, that female service will not be, _at first, at all events_,
extended to these wards. The disgusting and comparatively painless
secondary condition will, I fear, find its way into the ordinary
surgical wards, as it does into the equivalent wards of every Civil
Hospital.
All these things would increase the mistake of laying any bar between
the Staff Surgeon and the Nurse. In all matters of discipline,
generally speaking, the Staff Surgeon will give much more support than
the Assistant Surgeon.
A short definite rule should therefore be made, saying whom the Nurse
is to summon in the event of disorderliness in the ward.
One thing more. There is nothing more dangerous than to undervalue the
objections of opponents. Let us give them their full weight, and while
firmly holding our course, and trusting to God to guide it, draw useful
cautions from the objections which we quietly and steadily confront.
In the great Military Hospitals, of Roman-Catholic countries,
intelligent, well-behaved, Army Surgeons, while explaining everything
with thorough business-like precision, if spoken to of the Paris Army
Hospitals, before the recently introduced Sœurs de St. Vincent served
there, and asked what they think upon the whole of the service of women
in Army Hospitals--after a little hesitation, and being urged to speak
plainly, will generally say that they prefer in Civil Hospitals the
service of Sœurs to those of hired nurses--but they deprecate either
Sisters or any women in Military Hospitals. 1. Because the presence of
women, however virtuous and guarded, would excite passions and produce
unfavourable results in many cases. 2. Because they were unnecessary,
the Orderlies being efficient, faithful, kind, and sufficient.
Of the second reason one can judge nothing by a walk through a
hospital, as it does not always follow that what the master says is
enough is so--though this is one of the mysteries it is good to know
and not good to reveal. Of the first there is no doubt. The question
remains, striking the balance of good and evil--Do chaste, guarded,
and efficient nurses on the whole contribute more to the economy of
human life, the order, cleanliness, and decency of a Military Hospital
than they do harm? Possibly the former effects are usual and general;
the latter exceptional and rare: after all, most soldiers are men and
not beasts. But it is well and necessary to bear in mind both the
existence of this danger, and the exaggerated fears many Army Surgeons
conscientiously as well as unconscientiously have of it.
I therefore very earnestly hope that the work will not be encumbered,
at first at all events, with the charge of the venereal wards. And
it is most important, for the favourable result of the anxious and
difficult experiment about to be made, of permanently introducing
female service into Army Hospitals, that we should be quite clear of
the convalescent patients, and should only attend patients severely ill
or severely injured.
[Sidenote: 4. Pay and Rations.]
4. PAY AND RATIONS.--In the great Civil Hospitals the Head-Nurses
have, on an average, 50_l._ a-year, no board, an allowance of fuel and
light, and the use of one or two, generally unfurnished, rooms. The
Assistant-Nurses, on an average, receive about 12_s._ a-week, [£31 per
annum] no board, lodging, with the use of some furniture, sometimes an
allowance of fuel and light, apart from the use of both in the wards.
Both Guy’s and St. Bartholomew’s Hospitals now give partial board to
the Assistant-Nurses, and St. Thomas’s is about to adopt the same plan.
St. Mary’s Hospital gives board to both Head and Assistant-Nurses.
In the last war Her Majesty’s Nurses received, on an average, 18_s._
a-week, lodging and board, fuel, light, and partial clothing--18_s._
a-week is 46_l._ 16_s._ yearly. Incorporated into a permanent Service,
and with a pension, they ought not to receive the latter amount until
after approved years of Service.
It is certainly a different thing to undertake service in a Hospital
in Smithfield or the Borough, and to undertake to go, at a moment’s
notice, to any part of the world. But the Army Service involves this;
and the pension it involves makes a reasonable equivalent for the
additional wear and tear of climate, travel, &c. Going abroad is a
regular part of the Service undertaken.
Any artificial inducements should be avoided; at the same time their
condition should be made a comfortable one. Wages, say 20_l._, rising
to 50_l._ a-year, rations, an allowance of fuel and light, and a small
furnished room, would be enough, and not too much. To this should
be added a fixed annual gift of a few strong articles of regulation
dress;[6] avoiding multiplicity, and securing the things being all
good of their kind. In the last war they had too many things, and
some were rubbish. They ought to be well able to supply themselves
with linen, shoes, &c., whether at home or when ordered abroad. The
articles to be given annually should be three strong dark gowns, six
strong aprons, six caps, six collars, one bonnet--and let the things
be good--biennially or triennially, one summer and one winter cloak.
In India, &c., this might be modified. Their room should be furnished,
because, in removing to and fro, it is better to release them from the
cares and the pretences of furniture; also, because, instead of many
gimcracks, you can thus furnish their rooms with a few comfortable,
strong, plain things, presenting a certain military simplicity, which
ought to pervade a Military Hospital.
Their wages abroad should not be increased. Whether they serve at home
or abroad concerns the Superintendent-General alone, and is no merit or
title for additional advantages on their part.
[Sidenote: Shall Rations be commutable for Mess-money in the United
Kingdom?]
If the principle of rations is considered preferable by the War
Department, it is important to give no extra trouble that can be
helped. If not, it is to be considered whether or not it would be well
to get rid of the rations, in the three kingdoms at all events, for
these reasons:
[Sidenote: (1.) Because such commutation allows greater variety.]
(1.) These women are Head-Nurses. They will think themselves more
comfortable “finding themselves” than managing on the substantial and
somewhat unvarying provisions of the rations. Some take coffee rather
than tea; some tea rather than coffee; many would rather pay for white
sugar than not pay for brown. Considering the nature of nursing-work,
when faithfully done, it is better they should enjoy and be refreshed
by simple meals to their taste than by unpalatable larger portions;
especially if _the former can be done at no additional cost or trouble
to the Queen_.
[Sidenote: (2.) Because it averts complaints.]
(2.) You thus relieve the Superintendent and Matrons of all
communication with the department of the Purveyor-General; of all the
mistakes, accidental or otherwise, which might occur; of all complaints
of quantity or quality of provisions; of amenities such as those
experienced at Balaclava General Hospital, &c., &c., &c.
Of five London Hospitals, the three endowed Hospitals pay all their
Head-Nurses in money, and give no board. (This is strictly correct,
although, to avoid a long unimportant detail, I have simplified things
in this paragraph, and in the two concerning the pay of Head-Nurses and
Nurses.) The London Hospital gives its Head-Nurses wages, and a fixed
quarterly payment _vice_ the rations of bread, meat, and vegetables,
to which they are by the rules entitled. This change was made not very
long ago, to end the frequent complaints of quantity, quality, and
price, made, perhaps with foundation, by the Nurses. The Westminster
Hospital paid its Head-Nurses partly in money, partly in rations of
cooked provisions, and there were repeated and general complaints of
the quality, quantity, and cooking of the provisions issued to them.
It is therefore to be considered whether the simpler and better plan
be not to give the Nurses a fixed money payment, and let them “find
themselves,” unless the War Department object to rations not being
issued in part payment.
Abroad in many cases, in war in all cases, rations would be desirable.
A fixed calculation as to expense should be made.
Experience and consideration will probably give rise to the following
conclusion--except in war and in retired stations abroad, not to
have Rations; still less to let the Nurses “find themselves,” for
the following reasons:--(1.) It is important that the Nurses should
not have this excuse for being absent from their duties--“that they
have been to get provisions.” (When absent, it should be in pursuit
of health and exercise.) (2.) If the Nurse is to cook for herself,
greater accommodation will be required than the _one_ room recommended,
otherwise the necessary cleanliness cannot be observed. To commute
the Rations for mess-money, to put this mess-money in charge of the
Matron, wherever there is a market; wherever there is none, to let her
“_draw_” for such provisions on her own indent, as she thinks best,
upon the Purveyor, appears to me the safest course. For with regard to
this question of dieting the Nurses it should never be forgotten that,
in all cases (how much more in those where great physical fatigue and
mental anxiety are involved) that principle is the best, if such can be
established, which settles diet with a view to producing the highest
physical efficiency. Variety and mode of cooking are two essential
elements in this. And there can be no doubt that, if a Matron will
take the trouble to consult the tastes of her Nurses, together with
the above conditions, a better diet might be laid down than could
be secured by leaving them solely to their unassisted vagaries and
ignorance of what is really the best diet. Community of cooking also
implies economy. Also the Nurse ought not to be permitted to starve
herself, to save money. Her time is too valuable to allow of her
cooking her own dinner; but she should always prepare her own breakfast
and tea, when and of what she prefers herself, if she feels inclined to
do so.
[Sidenote: If not commutable,]
Where, however, the system of rations must be adopted, three ways
remain of working it:--
[Sidenote: (1.) Shall the Nurse cook her own Rations?]
(1.) Let each Nurse receive, and cook her own rations.
[Sidenote: (2.) Shall the Matron cook and send them?]
(2.) Let the rations be delivered _en masse_ to the Matron, who has
them cooked, sending her proportion to each Nurse.
[Sidenote: (3.) Shall the Matron have each Nurse’s Dinner cooked for
her, as she likes best?]
(3.) Let the Matron, requiring a small payment to cover expenses,
arrange that each Nurse can receive her dinner cooked as she wishes
it. There is something of this sort at the London Hospital; where the
Nurses (and Assistant Nurses) have the right of sending their joint to
be boiled or baked in one of the kitchen stoves.
Of these different ways, the first would be liked best by the women--a
thing to be considered, in subordination, and as a help to their
respectability and their efficiency--still it is, for some reasons
stated above, objectionable. However, in this, as in far more important
things, it is essential to consider everything as tentative and
experimental for some years to come. Do not be fettered by too many
rules at first: try different things, and see which answers best.
With regard to rations, it is as well to explain that there were two
ways of drawing them for the nurses during the war. In some of the
Crimean Hospitals, it was arranged that the same ration should be
drawn for a Nurse as that appointed by Regulation for a Medical Staff
Orderly. This answered, as may be supposed, exceedingly ill. There
was considerably more of some articles, such as bread and meat, than
the women could eat; and the surplus had to be wasted or returned to
the Purveyor--a serious complication. Of some articles, such as tea
and sugar, there was as much too little; and these had to be drawn as
extras, except such as the Superintendent-General found it easier and
more simple, as she generally did, to provide herself.
The other method was for the Local Superintendent to draw daily on the
Purveyor for such articles as she judged necessary; and by thus drawing
_en masse_, a considerable saving was, of course, effected for the
Queen, the tastes and health of women were consulted, and there was no
complication of accounts.
Where rations are to be drawn at all the latter method should be always
followed; and as the former might be understood by the word “rations,”
it would be better to call them by some other name, as it must be
obvious that such a method could never answer for women.
The experiment which I should wish to try, by which greater variety
could be secured, but which could only be practised where there was
a market at hand, would be for a commutation to be made of rations
for money. Each nurse to supply her quota of “mess money,” the “mess
money” to be all expended on the “mess,” and the Matron to manage the
“mess” day by day, and arrange for the cooking to be done in common. If
each nurse’s dinner is to be cooked separately, it necessarily entails
great waste of nourishment. The Nurses would not like this so well as
“finding themselves,” but it would ensure them a far better diet.[7]
[Sidenote: Wages and Mess-money must be distinct.]
It would be a question whether the Queen should pay the
Superintendent-General so much for each Nurse’s wages, and so much
for board, the latter to be retained by the Superintendent-General,
or whether the Superintendent-General or each Matron, with the
Superintendent-General’s consent, should arrange with the Nurses.
This is important, as which ever way it is settled, there must not be
disputes between Matron, Nurses, or still less Superintendent-General,
as to what amount of wages is to be allotted to the board, or what
savings can be effected in the coals, &c.
On the whole it would seem best for the Nurse’s pay to be so much
in money for herself, and so much in money for food into the
Superintendent-General’s hands. But the question of how much is a
serious business.
[Sidenote: 5. Washing, how to be done? Rule to compel the Nurses to
_put it out_.]
5. WASHING.--Except in war-emergencies, this must not be suffered to
be done by the Nurses, they must be compelled to put it out. I would
not trouble the Authorities about this; the Nurses can afford it, and
the more things are simplified the better. In out-of-the-way districts,
the Matron might arrange with a laundress, the Nurses making a fair
payment. In war-emergencies, if possible, provide a strong washerwoman,
but this would have to be settled each case on its merits. Except in
emergencies they must not wash; it takes up far too much time; it takes
up strength which is wanted for other things; and washing and drying
either in wards or nurses’ rooms is unhealthy and objectionable. There
must be a rule as to this: some worthy souls would scrub at every rag,
rather than pay a few pence weekly. The Nurse ought, however, to be
compelled to have certain changes of linen weekly, which some will not,
if they pay for it themselves.
[Sidenote: 6. Cleaning their own Rooms. No Orderly, on any pretence,
must enter a Nurse’s Room. Scrubbing the only thing the Matron may
arrange for a Soldier’s Wife to do. Nurse must do nothing of her own in
Ward, or Ward-kitchen, or Orderlies’ Kitchen.]
6. CLEANING THEIR OWN ROOMS.--I well foresee sundry difficulties in
the little rooms at the entrance of their wards, where I hope it will
be managed to quarter the Nurses. But there is no other way of fairly
and really working a ward; and I trust this plan will receive a fair
trial. For efficiency, also for comfort, it is most objectionable to
make the Nurse sleep at a distance from the patients. This is one of
the points on which theories, and the practical working of things,
are very divergent. It is an excellent thing when the Head-Nurse’s
room opens into the ward and when part of the upper part is of glass,
with a thick curtain, so that she can see into the ward, without being
seen. Let each Head-Nurse have a small room, with a window opening
into external air, with a curtain making an alcove, behind which there
should be a small iron bedstead, with good bedding, and a washing
table; and in the foreground a table, a small one for meals, a chest
of drawers, and a comfortable arm-chair, two chairs, and I should add
a sofa. Each room should have a few shelves on the wall, and a large
cupboard or small closet with broad shelves, and space at the bottom
to stow away the Nurse’s box. Simplification and avoiding all trouble
which can be spared to the Departments are very important. I would not
therefore insist upon a little kitchen for the Nurses, nor upon a very
capital arrangement in some of the Sisters’ rooms in Guy’s Hospital,
where, behind a decent little door _in_ the sitting-room, there is a
sink, with water laid on, a little safe for meat, &c., at top, and
a complete little apparatus of the very few utensils required for
cooking one woman’s meals; so that a Nurse can cook and wash-up, in
her own room, without carrying things out of it. This is much better
than a kitchen, if the Nurse is to cook her own meals; but, as above
stated, I would rather she did not. One room, with a curtain making an
alcove, is much better than two. The Queen is saved fuel; the Nurse
is saved cleaning two rooms; and if fuel is only issued for one, she
sleeps in a warm room, instead of one where there never is a fire,
and where her things get damp and spoiled. Often, where Head-nurses
have two rooms, one is built without a fire-place. Condense and
simplify all things--one great object is to form a body of useful
hard-working women, of simple self-helping habits. Two Nurses’ rooms
should be together, but separate. Sudden illness might occur, and the
two women should be at each other’s summons. The Quartermaster-General
_must_ grant a _cabinet_ between the two: this is _must_, not _may_.
The Superintendent-General must see to this herself, at first at all
events: there _is_ a singular obtuseness in the small officials, by
whom these things are managed: if not overlooked, they will be sure to
put the construction in a particularly awkward, exposed place. These
things do enter into an Englishwoman’s daily comfort or misery--it is
worth arranging them decently in the first instance.
Now as to the cleaning of these rooms. Head Nurses generally are far
too much disposed to make servants of their nurses; put orderlies for
nurses, and this objectionable tendency would be a hundred-fold more
objectionable. The Matron must make it an absolute rule, that the
only thing an orderly does for a nurse is to carry her box in and out
on the two grand occasions of her entering and leaving the Hospital.
The one thing which in a Civil Hospital, an Assistant Nurse should
be allowed to do for the Head Nurse, is the cleaning her fire-place,
a thing done in a few minutes, and with satisfaction, by women who
have done it all their lives; but a dirty tedious messing business to
those who have not. But never mind: the orderly must never enter the
Nurse’s room: she must do it, and learn to do it. The prosaic little
business of black-lead, ashes, and mess lying on the threshold of the
work will do good rather than harm. And even black-lead is unnecessary,
as a varnish now obtainable looks better. The orderly must never
enter the Nurse’s room--a _sine quâ non_. The Nurses should have, at
their choice, a carpet, not nailed down, or none. In either case the
room will require scrubbing, once a week if no carpet, (which is best
and cleanest in Hospital life), seldomer, if carpet. Now the Nurses
should not be required to scrub their own rooms--it is useless waste
of strength--it makes their hands coarse and hard, and less able to
attend to the delicate manipulation which they may be called upon to
execute--and with all the _nursing proper_ which ought to fall upon
them, and not upon the orderlies, their time can be better occupied
than in cleaning their own rooms. Also, while trying to keep clear, on
the one hand, of the tribe of “fine ladies,” it will be possible, on
the other, if such menial offices are to be performed, to fall into the
opposite mistake and to fail in obtaining the class of women desirable
to fill such important trusts. Let the Matron consent to a charwoman,
soldier’s wife, or some one person named and defined, and found, to be
paid by the Head Nurse, to come for the two hours, which, at furthest,
this business will take. It would be well worth while for the Matron
to look out and provide two or three strong women to do this, by fixed
rotation--each Nurse making a fair payment--and to ascertain that they
are in and out of the Hospital by a particular hour, so as to prevent
these external persons doing other things than scrubbing. But do not
trouble the Departments as to this--the more things are simplified, and
the fewer expenses are in connection with the Nurses, by far the better.
Take the trouble to see that a tidy useful fire-place is in each
Nurse’s one room. Some fire-places will consume thrice the fuel of one
which can do ten times more work. A compact useful little fire-place,
to burn as little fuel, and do as much business (in a very small way)
as possible, is a thing of daily use, economy, and comfort.
The nurse should not do anything of her own in the ward, or the ward
or orderlies’ scullery, if there is such a place. This is a matter
requiring some decision.
[Sidenote: 7. In each Ward to be Closet, with Shelves, Table with
Drawers, Nurse with Keys. Nothing to be kept in Nurse’s Room. Linen,
Dressings, Stimulants to be kept in Ward Closets.]
7. Let there be in each ward a closet, or, better still, a dresser,[8]
with broad shelves, and a large table with large drawers, of which
closet or dresser, and drawers, the nurse has the sole keys. Let
the articles of linen which are kept in the ward be there; also the
bandages, lint, old linen, oilsilk, ointments, &c., &c., which should
always be, some at hand, some in reserve; also the wine and brandy
ordered for the men. Let the nurse never be allowed to deposit Hospital
property in her room, which, if there is no place for it, she _must_
do, and it is much better she should not.
[Sidenote: 8. Matrons 200_l._ per annum, Quarters, and a Maid. A woman
for the Linen, ranking and paid as a Nurse, but never entering the
wards.]
8. With regard to the Matrons, though as Locke says of tutors, there
are all kinds of persons to be found, it is certain the right persons
are not always found; and these officers will take time to find, at the
outset especially. Let them be (if it be possible) of the middle class;
if it be possible, middle aged, active women, widows of officers or
army surgeons. A vast deal of struggle is ever going on in professional
life; a vast deal of silent, decorous misery ever follows on the
premature deaths, the compelled early retirements, the sundry chances
and changes which ever abound in the army of England. So far as it
goes, and _cæteris paribus_, it would be right, just, and expedient
to give a preference for these matronships to widows of officers and
army surgeons. Try to secure thorough principle, sense, activity, and
steady discreet ways; never mind a little vulgarity of manner; that the
different orders should have their indefinable perpetual distinctions
of manner as of other things, is perhaps for a long time to come in
the essence of things. Two or three women of the stamp of the Matrons
of a few of our Civil Hospitals would be very valuable. If the Matron
do not get tired of what, unless one keeps one’s secret thoughts
fixed on the meaning and the end of all things, is coarse, thankless,
up-hill work enough--she will in the course of years accomplish great
good. But she must have principle, sense, heart, and a firm cheerful
mind. She must be not under thirty and, if possible, not over forty,
on appointment. Should her being without children be made a _sine quâ
non_? Children--poor little things--are wanted nowhere in the way of
business, but do not be too strict about this: they are sometimes
pledges to other things than fortune--thoughts, anxieties, and labours
for them, concentrate and steady a mother’s heart--there will be fewer
adventurers. Maternal _nurses_ must upon the whole be discouraged,
because upon the whole the disadvantages seem to overweigh the
advantages.[9] But the Matron’s office and duties are different; she is
not fixed to a great ward of patients; and her having children should
not be a bar, especially if they did not live with her. Young and
grown-up daughters are much in a Matron’s way; sons matter much less.
The greatest Civil Hospital gives its Matron 200_l._ and a _house_,
the other great Hospitals, 150_l._, and a _house_. The London Hospital
gives 150_l._, and a couple of good well-furnished rooms, and a
servant. A _house_ is an impediment to a Matron’s duty. She is seen
arriving in the wards, and she is more or less hindered in entering
them. From her rooms she issues and re-issues, unexpectedly, and much
more efficiently. 200_l._ and quarters is not at all too much.
The Matron must be responsible for the storing, mending, and
distribution of the linen, and for returning to the laundry any linen
not properly washed or dried. Linen ought never to be dried in the
wards, a process both inconvenient and unwholesome. The Matron ought
to have a steady, respectable woman, certainly not below the rank and
pay of a nurse, to be responsible to, and under her, for the linen,
otherwise the proper care of the linen will take up far too much of
her time. This is important. If, however, a Nurse should be thus set
aside for the Laundry, she must not be allowed to enter the wards;
otherwise she will unconsciously become a gossip and mischief-maker.
I would term her “Linen Nurse,” not Assistant. The Matron should also
have a steady, properly paid servant. A Matron of the proper sort has
quite other things to do at a leisure moment, than to keep her wardrobe
in order. She must have a servant; but it seems to be advisable to
simplify things, and condense payments as much as possible; and I would
rather consider this in the salary, and let the Matron find and pay
her own servant. Try to have the servant’s room near the Matron’s.
These minutiæ, once provided for, enter much into the daily working and
comfort of things.
The dress of the Matrons is a difficult thing to settle. Sometimes
a Matron is afflicted with a taste for either gorgeous or elegant
apparel, which the Nurses are invariably proud of, admire and humbly
emulate. This sort of thing would be really out of place in a Military
Hospital, and would moreover sadly discompose the Nurses with their
plain caps and gowns. How would it be to allow the Matrons the choice
between a Regulation dress and a plain black or brown silk gown?
It will take much thought to decide whether the Matrons should all be
paid alike, or whether climate and size of Hospital enter into this.
On the one hand they undertake a service, of which almost the first
regulation very properly is, that they undertake to go to all parts of
the world as soon as sent; on the other hand, certainly some climates
wear health and life much quicker than at home.
The Matrons out of the three kingdoms have increased responsibility,
and can do more mischief, if incompetent or untrustworthy.
If the Matron has increased pay abroad, it would not do not to augment
that of the Nurses. This is an important matter; and as it is on all
accounts necessary that Matrons and Nurses should on their engagement
thoroughly understand the nature of the service they undertake and, of
course, a serious part of the service is that it involves sudden and
long removals, it would be necessary to define upon what terms they
go abroad. Yet it never would do, for reasons which will readily be
perceived, to make the foreign stations objects of desire to Matrons
and Nurses. These stations will always be so far the most anxious, that
they will always be the most removed from the Superintendent-General’s
inspection and immediate rectification of anything that goes wrong.
They will also be, in various ways, the most trying to Nurses. The
rules once settled, every Matron and Nurse refusing to go abroad
when ordered, ought at once to be discharged, and to forfeit all
re-admittance into the service and all pensions. On the whole, I
think the Matrons should all be paid alike. But inasmuch as foreign
service necessitates more wear and tear to the constitution, one year
should count as equal to two years of service for pension, in case of
disability. The same should be made applicable to the Nurses. As the
advantage is distant, it would, in a great measure, do away with any
desire for foreign service.
Volunteering for foreign or war-service must be the exception--careful
selection the rule. The “adventurers” will be generally ready to
volunteer, and it would be too much to hope that we shall always,
perhaps ever, be entirely free from that tribe; the most we can hope is
soon to discover and get rid of them. Foreign stations will never do
for an untried Matron or Nurse. At the same time it is most desirable
not to change the Executive officers of any Hospital more than can be
avoided.
But let there not be too many rules at first; see how things work, and
take one step at a time.
The selection of exclusively middle-class Matrons seems to be
important.[10] Their order will disarm one source of opposition and
jealousy; plenty more will remain, inseparable from the work; but it is
good to get this out of the way.
The name of Matron is the same as in Civil Hospitals. In many respects
the office and duties are different: _e. g._, the Matron in Military
Hospitals must exercise a far more constant supervision in the wards.
But this will require great discretion on her part. It is the practice
of most Civil Hospitals for the Matron never to enter the wards till
the Nurse’s dressings are over. It would be advantageous to modify
this. But, at the same time, the Matron must understand Hospital
Nursing, or she may make very serious mistakes in either reprimanding
or directing the Nurse as to technical matters. She must be a person
who knows herself what she has to see that others know; or she will
get herself, with or without the Nurse, into very injurious errors.
There is much in a name; and, in some respects, that of Superintendent
would better denote her office, as regards the Nurses, would add to her
authority, which is desirable, and would point her out as acting under
the Superintendent-General.
Incorporate among the Nurses whatever women of the higher orders may
be admitted into the Service at first. If inefficient and unfit they
are far better altogether eliminated. If thoroughly efficient as Ward
Nurses, if thoroughly obedient and respectful to the Matron, if they
have sense and heart to gradually leaven, not coldly withdraw from
occasional companionship with the other Nurses, they will, in the
course of time, effect quietly a great deal of good.