22 } there are { 1 Sister.
24 } { 2 Nurses.
{ 1 Sister.
30 ″ { 2 Nurses.
{ 1 Scrubber.
{ 1 Sister.
34 ″ { 3 Nurses.
{ 1 Sister.
40 ″ { 3 Nurses.
{ 1 Helper.
In the Lariboisière Hospital at Paris, where the wards hold 32 beds, 1
Sister, 1 Nurse, and 2 Orderlies on the Men’s side, 1 Sister, 2 Nurses,
and 1 Orderly on the Female side, serve the ward efficiently.
[Sidenote: (6.) Same Number of Men will not do same amount of Work as
an equal Number of Women would.]
(6.) One woman does the work of more than a man in a Hospital, speaking
of the duties discharged by Under Nurses in Civil Hospitals; for men
are not accustomed to these duties in England, as women are from their
childhood.
From this it is by no means to be inferred that women of the class
of Under Nurses in Civil Hospitals should be employed in Military
Hospitals, which unquestionably they should not. But it is to be
inferred that the work will not be done efficiently, with a smaller
number of men than would be employed of women.
[Sidenote: (7.) Hospital Attendance an entirely new subject in the
Army.]
(7.) The question of attendance has scarcely been intelligently
considered in the Army at all. And hardly any practical answer has yet
been given to such questions as the above.
I conceive it to be practically impossible to serve 4 wards, as
proposed at Netley, viz., of 9 beds each, with
1 Head Nurse,
4 Orderlies.
For, as has been said, one bad case in each ward, makes this economy as
unmanageable as nine.
[Sidenote: (8.) Hospital Wards in the Army little else than
Barrack-Rooms at present.]
(8.) A ward in a Military Hospital now may often be little else than a
barrack-room, with an Inspection by a Medical Officer twice a day. It
is designed to make it by the new Regulations into a place where the
sick must be and always will be suitably attended. But this cannot be
done by such a scheme as--
1 Female Head Nurse } to { 50 Patients, in (say)
6 Orderlies } { 6 Netley Wards;
though this attendance would be more than sufficient for 50 cases in
one ward; but such a ward is considered in a sanitary sense too large.
Two wards of 30 beds each on the same floor would be efficiently served
by such a Staff, however; and there would be no sanitary objection.
[Sidenote: (9.) Regulation as to 1 Orderly to 10 Patients requires
modifying.]
(9.) The Regulation number of one Orderly to ten patients therefore
requires modifying. Practically it is broken every day and in the
extraordinary manner above mentioned, which gives the most critical
cases to be attended by the rawest hands.
[Sidenote: (10.) One Orderly should be the _Frotteur_.]
(10.) The question of Hospital floors will be fully discussed farther
on. An Orderly should be trained to be the _frotteur_ to each ward. He
should also be the porter to fetch and carry every thing to and from
the ward.
[Sidenote: (11.) Comparison of Cost of Nursing with larger and smaller
Wards.]
(11.) The plan of Netley, with its wards for 9 sick, is by far the
costliest for administration, as the following facts will prove:
I. It is proposed to provide the Hospital with Orderlies and Nurses
to conduct the nursing in wards of 9 sick, as mentioned.
II. On sanitary grounds wards may safely be large enough to
accommodate 25 to 30 sick.
We may therefore choose the larger wards, being guided only by the cost
of the nursing.
III. A ward of 9 sick would require 1 day and 1 night Orderly, and
a-third of a Nurse (that is, a Nurse could superintend three
such wards.)
A ward of 30 sick would require 2 day and 1 night Orderlies and
1 Nurse = 4 persons in all.
Or if two such wards were on one floor, 1 Nurse could serve both.
IV. We cannot count the cost of Orderlies and Nurses, including
lodging, rations, wages, at less than £50 a year, which when
capitalized at 3 per cent. (33 years’ purchase), would amount to
£1,650 for each.
V. A ward of 9 sick would cost in nursing £1,650 × 2⅓ = £3,850,
or £427 15_s._ 6_d._ per bed.
VI. A ward of 30 sick would cost for nursing, in perpetuity, £1,650
× 4 = £6,600 = £220 per bed.
[One Nurse to each ward is here allowed.]
VII. The cost of the two plans relatively for a Hospital of 1,000
sick would stand thus:
Wards with 9 beds = £427,775
Wards with 30 beds = 220,000
---------
Capitalized difference of cost in } £207,775
favour of large wards }
Netley has cost already Land = £30,000
Works 89,000
---------
£119,000
It hence appears that, if works and site were both sacrificed, and
fresh land purchased, and wards for 30 sick built on it, the country
would actually save the difference between the two sums of = £88,775.
Suppose the sanitary requirement of 25 sick to a ward, which is
the best number, be combined with the greatest economy of
administration, the cost would stand thus:
For each ward of 25 sick, 3 Orderlies, at £1,650 = £4,950
If two such are built in line, close to each
other, with the Nurse’s room between them,
one Nurse could superintend both wards, or
half a Nurse to a ward. The cost would be
for the ward 825
-------
5,775
5775
Or cost for each bed ---- = £231
25
The comparative cost of wards with 9 beds and
25 beds, would stand thus for 1000 sick:
Wards with 9 beds £427,775
Wards with 25 beds 231,000
---------
Saving £196,775
Deduct cost of Netley, already incurred 119,000
---------
Saving from abandoning Netley = £77,775
The cost of the administration per 1000 beds at Netley
and Aldershot would stand as follows:
Netley £427,775
Aldershot, pavilions, with 3 superimposed wards
and 25 sick in each, would require 3 Orderlies
and 1 Nurse[14] to each ward, and would cost
£264 per bed in perpetuity, or per 1000 sick 264,000
---------
Difference of cost in favour of Aldershot £163,775
Some abatement would have to be made, as regards the cost of Netley, as
there are a few wards with 16 or 18 sick.
If we take money at 4 per cent., the calculation will be as follows:
Small wards, 2 Orderlies and a third of a Nurse,
at £50 per annum; money at 4 per cent.,
per 1000 sick £324,000
Wards of 30. 3 Orderlies and a Nurse, money
at 4 per cent., per 1000 sick 166,000
---------
Extra cost of small wards 158,000
Cost of Netley 119,000
---------
Saving in giving it up £39,000
[Sidenote: 13. Hospital Floors.]
13. FLOORS.--In building a new Hospital or laying a new floor we shall
hope to see, by degrees, everywhere introduced the only safe Hospital
floor. In the expense the difference between oak and the best white
deal ought never to be considered. The staircases and passages should
always be of stone. When once an oak floor is well done with bees’-wax
it is no longer an absorbing surface. There cannot be a doubt that the
frequent washing of the floors, in London Hospitals, is one main cause
of Erysipelas and Hospital Gangrene.