A. Bureaux.
B. à rez de chaussée Cuisine. au 1ᵉʳ Etage Logements d’employés
--au 2ᵐᵉ Etage Dortoirs des Garcons de Service.
C. idem Pharmacie. idem idem
-- idem Chambres des Elèves internes.
D E F G H I J K. Chauffoirs.
L M N O P Q. Batiments de Malades.
R. à rez de chaussée Buanderie. au 1ᵉʳ Etage Lingerie.
au 2ᵉᵐᵉ Etage Dortoirs des filles de Service.
S. Communauté.
T U. Bains.
V. Chapelle
X Y. Amphithèatres.
Z. Manège et Magasins
W. Ecurie. Remise et Salle des Morts.
]
1. In considering the Pavilion Plan to be in future received as the
sanitary necessity for Hospital construction, we must look upon it as
susceptible of many modifications.
And, particularly in adapting it for a Military Hospital, we must
ask by what modification can it be made, 1. Most economical as to
attendance, a greater amount of which is rendered necessary than by
other plans of construction.
2. Easy as to supervision; and, of course, a Hospital spread over the
extent of space now proved to be essential by sanitary knowledge,
whether built on the Pavilion plan or not, must multiply the amount of
supervision over that required in the concentrated over-crowding of the
old Hospital system (over-crowding not with regard to cubic space in
the wards, but to the superficial area on the ground).
3. Economical as to the number of sick to be accommodated on the same
floor, so as to save unnecessary waste of time and strength on the
stairs to both Ward-Masters and Nurses. Each Nurse should have, in time
of peace, not less than from 50–60 patients under her charge.
4. Efficient as to convenient accommodation for Nurses and
Ward-Masters, near to the wards of which they are in charge.
[Sidenote: 1. Pavilion Plan indispensable on Sanitary grounds. Its
Difficulties, on the score of Discipline in Military Hospitals, to be
openly met and guarded against.]
1. The Pavilion Plan, while it is incontestably superior, on sanitary
grounds, to any other, while it perhaps may be made equally economical,
with regard to building, is more expensive than the older crowded
and badly-constructed Hospitals, not only as to ground, but because
each separate entrance, staircase, set of appurtenances, represents
an additional cost of materials, and of hands to keep them clean and
in order. Human life is, however, a more expensive article than any
other. If human beings, and especially sick human beings, are to be
spread over as much space as possible, which is now known to be an
essential to health and more especially to recovery, this must be done
under any system and can be best done under the Pavilion system. It
of course necessarily entails a greater amount and cost of attendance
and of supervision. Pure air and light are the prime necessities of a
hospital. These are best secured by the Pavilion Plan, and therefore
it is the cheapest in the end. As to the hands, there never ought,
never will, never can, be a superfluity of hands in a well-regulated
Hospital. The duty of the hands consists of two parts--to keep the
Hospital clean; to attend the sick. I had rather not enumerate the
instances where I have seen that, often from the most various causes,
one result arises--that more time and care is given to floors,
stairs, &c., &c., &c., than to the sick. Extreme cleanliness is of
vital importance; this should be combined with extreme simplicity
of detail, and with providing for considerable numbers at once. You
can effectually clean a large ward in much less time than two small
ones; a long stair than two short ones, &c. Extreme, _not finicking_,
cleanliness, thorough ventilation, for which an ample supply of
opposite windows will certainly in the long run prove infinitely the
best plan, and careful nursing, are probably the main conditions,
humanly speaking, of a large proportion of cures--subsidiary to the
medical or surgical treatment.
Sanitary necessities are never to be rejected, on account of the
trouble they give or of the means of cleanliness which they render
necessary. Because the saving of life, not the saving of trouble, is
the object of all sanitary appliances, Hospitals among the number. And
the saving of life is the only real economy. If you have saved “hands”
and trouble, and lost life, you have been extravagant. The object is
not to banish appliances which will cost trouble in keeping them
clean, but to discover those appliances which can be kept clean, at
least cost of labour. And this is perfectly possible.
[Sidenote: 2. Easy Supervision to be provided for.]
2. The Vincennes modification of the Pavilion plan has been adopted,
among other reasons, for the greater facility of supervision it
affords. The Military Superior, the Surgeon, the Matron, can at any
instant pop in upon any ward of a Hospital which has one roof. Each
pavilion may, unless the matter be specially considered with a view
to providing this effectual supervision, perceive the approach of any
inspector. The system of scouts, watch, alarm, is well understood in
many hundred wards, whose patients would be puzzled to give the things
names. Military patients will know both things and names. Remember
that Ward-Masters, Orderlies, and Nurses require inspection as well as
patients. Whatever system of Hospital construction is adopted should
provide for easy supervision, at unexpected times.
[Sidenote: 3. If from 24–30 Patients be the right Number, Sanitarily
speaking, for a Ward, the Pavilion Plan should, in a Military Hospital,
be so arranged that more than one such Ward should be on the same
floor, for facility of Supervision.]
3. The more we see of different systems, the more we see the great
mistake of giving a Nurse too little to do.
Twenty-four ordinary sick or surgical cases are too few for a Head
Nurse.
In a Military Hospital, the proportion of heavy cases is in ordinary
times considerably below the average proportion of such cases in a
Civil Hospital, open, as the latter is, to accidents, and to the cases
of dangerous disease always more or less rife in low and crowded
neighbourhoods.
Upon an average, a third or a fourth of the cases in the ordinary
surgical wards of a Military Hospital will be ulcers from causes honest
and dishonest. What these men will require is rest (the cleanliness
which is often so irksome a novelty to the corresponding Civilian
patient is routine to the soldier), and very simple treatment.
It is most important, if possible, to form a staff of active,
laborious, useful women, who, if ordered on war-service, can at once
cope with numbers, and serve efficiently a considerable number of heavy
cases.
Relieved of all cleaning, and relieved of the great loss of time
incurred by fetching, waiting, &c., &c., none of these Nurses, who
are, in fact, Head Nurses, should serve less than forty men. And, as I
before submitted, I had rather she served fifty or sixty than forty.
Give them twenty-four patients, and either they will become idle,
finicking women, or they will take to petting the patients, a thing to
be sedulously avoided everywhere, most of all in Military Hospitals.
[Sidenote: 4. Importance of the Head Nurse sleeping close to her Ward.]
4. The more we see of different systems, the more apparent becomes the
importance of the Head Nurse (all these are Head Nurses) sleeping close
to the ward:--