[Sidenote: 2. Ward-Master’s Sleeping-room.]
2. The Ward-Master should sleep in his room on the second or highest
floor; should the Nurses sleep in the Pavilion, the Ward-Master should
still sleep in it.
In the event of the Pavilions being arranged end to end, as already
suggested, the difficulty in regard to Nurses’ and Ward-Masters’ rooms
would be materially diminished.
[Sidenote: 3. Where should Orderlies Sleep?]
3. I think, but am not sure, that the Orderlies had better sleep away
from their wards, but I would leave this to be settled by the Doctors.
In cases of sudden outbursts of danger, delirium, or drunkenness, from
the results of concealed spirits, and of the Surgeon being sent for,
it is useful to have, at once, other than the Night Orderly at hand.
And a part of what has been said as to the importance of the Head
Nurse sleeping near her ward, applies to the Orderlies. Yet there are
important reasons why the Orderlies should not be or feel too much at
home in their wards; and if the authorities are disposed to try the
plan of lodging the Orderlies together, away from their wards, they
are probably right, though I should not be surprised if, after a fair
trial, it were found better to revert to the having them near the ward.
The Pavilion Plan, which, on the one hand, gives all concerned more
liberty of doing wrong than the block plan, and which, on the other,
renders it more difficult to call in help, whether of supervisor or of
Orderlies, if help is suddenly wanted in the night, makes it the more
desirable to let the authorities take quite their own way, as to this.
[Sidenote: 4. Where should Orderlies Dine?]
4. I think the Orderlies had better have their cooked meals sent them
into the wards. Of course, they can only eat together in detachments;
but in many cases, the absence of even one of the Orderlies would be
very inconvenient. Perhaps just as the bell rings to summon to the
common meal, something is going on which requires all the ward service;
the man either goes late to a cold dinner, or goes away just when he is
wanted. If his dinner is brought to him in one of these emergencies,
it is put by to keep warm till it is over. Regularity as to meals,
as far as possible, should be strictly attended to; and is, in all
well-regulated wards: and it is well, where, as in some Hospitals,
there is a fixed hour for meals; but it would seem better that the
meals should come to the ward servants than the ward servants go to
their meals.
[Sidenote: 5. Should Orderlies be brought together?]
5. In the case of Civil Hospitals served by women, it is very important
that each Head-Nurse, and each set of Assistant-Nurses, should sleep,
eat, and live in the ward and its appertaining rooms, and not assemble
together more than can be avoided. With Orderlies the case is partly
different. Still I would not unnecessarily bring them all together, any
more than allow them to be too much at home in their wards.
[Sidenote: 6. Should Orderlies have a Day-room in Pavilion?]
6. If the Orderlies do not sleep in the Pavilion they should not have a
day-room.
[Sidenote: 7. Scullery to each Ward.]
7. To each ward should be attached a scullery, small, but not too
small, which only muddles things and work, well provided with cold,
and, if possible, with warm water; and it should be law that no patient
enters the scullery unless sent there by the Nurse to help in washing
up, &c.; and, as a rule, they ought not to be sent there. Make them
useful in the ward; keep the scullery for the Nurse and Orderlies.
[Sidenote: 8. What should be done in the Scullery?]
8. From this scullery let the Nurse get the water she
requires--Orderlies ditto.
Let the Orderlies eat their meals in it, if they do not eat them away
from the ward. The food of the Orderlies is generally different from
that of most of the patients, and it answers better for them to eat
their meals not under the noses of the patients. In emergencies, of no
rare occurrence, the Orderly must watch a patient and eat his dinner at
the same time, and so must the Nurse; but, as a rule, it is undoubtedly
better that ward-servants should not eat under the observation of the
patients.
In the scullery all the cleaning must take place, which is not done in
the lavatory.
In the scullery extras are to be warmed, drinks ditto, hot-bricks
heated, water-bottles filled, &c., &c., &c., and none of these things
are to be done at the ward-fire.
[Sidenote: Poultice-making.]
On the other hand, there is no way so good of making poultices, a thing
humble but important, as for the Nurse to stand at a small table in
front of the ward-fire, to make the poultices there, spread them, and
forthwith apply them.
Sometimes in a large ward, where the Surgeon orders them extensively,
a large iron pot is filled with poultice, and then quickly spread and
applied. Sometimes the pot is filled and the poultices spread in the
scullery or kitchen, to avoid the mess in the ward. When a number of
poultices are thus spread away from the sight of the patients, even by
very clever Nurses, some arrive too large, or too small, or too broad,
or too narrow; and either the poultice has to be returned, or, as of
course usually takes place, to be put on the wound it does not fit.
I would not trust any Nurse, including myself, to make a number of
poultices of the right size, unless within sight of the patients.
Rather than do this it is better to make the poultice-pot (wood does
not hold heat, this must be of iron), in the scullery, to take it into
the ward, and there spread and apply the poultices.
But a large iron pot of linseed poultice seldom contains the article
nearly so well made, as when made in smaller consecutive quantities in
a wooden bowl. The bowl does not keep warm above a certain time. Where
the poultice is made in a mass, even by very clever Nurses, it never is
so well made as when the Nurse makes the poultices in the wooden bowl.
These must be forthwith spread, applied, and the bowl re-filled, if
more are wanted.
This is another reason why the person who washes the wound should also
make the poultice, as also why the Orderlies should clean the ward, why
the Nurse should as far as possible be relieved of all “mental labour,”
and why kept as much as possible to “manual labour.” All severe wounds
she should wash and dress herself, and many a wound becomes severe,
when the patient is allowed to fiddle over it himself. Some wounds will
not bear being left uncovered, and of course in some cases the Nurse
will wash the wound, and immediately afterwards apply the poultice.
In general, the Surgeon will consider the wounds take no harm from
being washed all round, and then poulticed all round. This requires
not to be over-hurried, and not to lose a moment’s time. A careful
Nurse will never apply a poultice without having first seen the wound:
carelessness, haste, idleness, over-work, and prudery, each and all
produce very sorry results as to this.
I think, therefore, poultices should be made in the ward, and
immediately after the table cleared away, and the slight mess also.
In some Hospitals they place a straw carpet just round the table, and
also carry it to any bed which requires an extra mess in dressing or
cleaning.
[Sidenote: 9. Presses in Ward.]
9. A regular store closet is hardly desirable. A good arrangement is
this:--
At the end of the ward, nearest the Nurse’s room, or the ward-door, a
large press for linen.
By it or opposite it another press, for stimulants, dangerous
medicines, stock medicines, such as castor oil and one or two others
which are always to be at hand, though not ordered for any particular
case, stock lotions (as few as possible), lint, old soft linen,
stronger but not coarse ditto for pads, &c., cotton wool, tow, oilskin,
splints and pads, &c., &c. Of all these things, the Nurse should always
have a certain reserve on hand.
It will be well worth while to see that these presses are made
commodiously for their purpose. The linen press should have broad deep
shelves, and the different kinds of things should be sorted apart; the
other press should have broad deep shelves for the heavier things,
and separate shelves for the bottles; the stimulants by themselves in
one row, the stock medicines in another, unless these and the stock
laudanum were together, but they are better apart, and the dangerous
things upon the topmost shelf; another row for sweet oil, mustard,
stock lotions, &c., another row for ointments. Each bottle and pot to
be distinctly labelled in whatever is reckoned the most lasting manner;
opinions differ as to labels and letters cut in the glass. The latter
are boring by night, if something is suddenly wanted, and it is just
then that mistakes are to be guarded against. A strong clear PRINTED
label, securely fastened to the bottle, is preferable, to be renewed
when necessary, as Orderlies’ thumbs even while holding a bottle, if
the Nurse’s hands are on the bed, wear labels out. There is a great
saving of time and of chance of mistakes effected by clearly printing
the directions for the administration of medicine, “once,” “twice a
day,” “every three hours,” &c., and affixing them to each medicine
bottle.
Of both these presses the Nurse should have the key or keys. One key
might do for both, but it may be best to have two keys.
It is a very good plan where the shape of all medicine bottles and of
those for liniments is distinctly different; and where, _e. g._, square
bottles are used for poisons, or blue bottles for poisons, and square
for lotions.
A small narrow shelf over each patient’s bed, or over his locker,
solely for his medicines and wine. When these are on the locker it is
less convenient. Where the medicines are not dangerous, it is better
to have them thus at each bed, than concentrated away from the beds.
Dangerous medicines should never be left at a patient’s bed.
The two presses will answer all demands. As, however, it does not
do not to have a supply of everything that may be wanted always in
readiness, a stand or table in the ward should have upon it a small
supply of whatever may be suddenly wanted--a little lint, linen, tow,
and two or three vessels. The supply of lint, &c., to be small enough
for the Nurse to keep account of it, and for the patients to know that
account is kept of it.
[Sidenote: “Apparat” in German Hospitals.]
In constant daily use in the surgical wards of the great Vienna
Hospital is a thing called in Teutonic style “Apparat.” The Nurse
carries it round for herself, when preparing and dressing the
patients, and carries it after the Surgeon when he makes his rounds.
The system of both dressing and washing is in some respects so
different from the English one, that the fittings would vary.
This concentration of what is wanted for dressing and washing wounds,
and for attending the Surgeon in his inspection of them, and of what
is at once wanted on any bleeding, fit, &c., is very useful; all the
more from its being in a compact portable form, which can be thus
successively carried to each bed. An English carpenter would make a
lighter and handier thing. Brass basins, which are there used, are
not desirable. Of course, one must be most especially anxious not to
introduce any novelty, particularly any foreign novelty, faster than
can be avoided, and we may consider it better either to leave the
general system unaltered of rushing on some emergency to the dressing
table drawer, or closet, and thence bringing successively the things
wanted, or at all events not to extend concentration further than
the excellent plan, so far as it goes, of the London Hospital, where
each Head Nurse attends the Surgeons with a large basket in her hand,
containing most of the dressings required, spunges, and one or two
little matters also usefully at hand. The _apparat_ has the advantage
of carrying with itself the basins used for washing. In the Military
Hospital of Vienna a tray attends each Surgeon, without basins.
[Sidenote: 10. Nurse’s Room.]
10. It is important to have the Nurse’s room opening at once into the
ward, and, upon the whole, I should incline to its having but one door,
although it may be thought better there should be a second, so that she
can leave her room without being seen to do so by the patients. Also,
by all means, let the scullery be opposite the Nurse’s room, and not
between the ward and the room. As an invariable Hospital rule, rather
more than elsewhere in Military Hospitals, publicity may be considered
to be a very great police, and a still greater protection. It is far
better that twenty-four patients should see the Nurse’s door than one
or none; and that her room should open full upon the ward than into an
intervening scullery.
In contemplating a Military Hospital, we contemplate a place through
which, one year with another, all characters, including a few of the
vilest, pass. These are not theoretical matters. The more repulsive the
subject, the more prevention is better than cure. Guard against too
many closets, sinks, &c., &c., &c.
[Sidenote: Lavatory.]
At the end of the ward there should be a lavatory, with a row, or
two opposite rows, of white earthenware basins fixed in a stand,
with outlet tubes and plugs: each basin should have a hot and cold
water-pipe: and there should be not less than one to each four beds.
There should also be in the lavatory a hot and cold water-pipe, from
which a portable bath can be filled.
[Sidenote: Water-closet.]
At the furthest end of the ward should be a water-closet, with not
less than one soil-pan to each eight beds: and white earthen or
porcelain urinals in the same proportion. In the London Civil Hospitals
water-closets are now in general use throughout the wards, but not in
all of the great Hospitals. In all the Civil Hospitals, it is usual
that the patients’ water-closets have no inside bolt or lock, and
that there is only accommodation for one inside. In some London Civil
Hospitals the male patients, able to take exercise, are expected to
make use of urinals out of doors. These matters one, two, or three
experienced army surgeons had better pronounce upon; other things are
to be considered than the recommendations of architect, plumber, or
even sanitarian.
[Sidenote: Sink.]
There is in a Berlin Hospital a very useful piece of prosaic
apparatus--adjoining the water-closet, a sink, with a high, large,
deep, round, pierced basin of stone, above a _large_ hole, into which
the contents of a bed-pan can be at once emptied, and from which the
bed-pan is at once effectually cleansed. Adjoining this is a sink into
which all other slops are emptied. In mentioning this pierced basin or
sink solely for emptying and cleansing bed-pans, &c., which is used at
the Bethanien Hospital at Berlin, and is far better than emptying the
said vessels into the often-occupied water-closet, and then cleansing
them in an awkward fashion between the water-closet and the sink, it is
necessary to add that the cock ought to extend far enough over the sink
for the bed-pan, &c., to be thoroughly cleansed by a stream of water
falling directly into it. The Nurse stands at the sink, empties the
pail, &c., in it, without fear of splashing, and rinses and fills it,
without stirring from the place. Now this absence of splashing water
and of moving about from sink to pump, or cock, saves mess and time.
The oblong sink, usual in England, has by no means the same advantages.
(The partition containing the sink would be an appropriate receptacle
for the bed-pans to hang by hooks or nails on the wall pending their
use.)
[Sidenote: Baths.]
In Civil Hospitals, two baths, in an airy closet at the end of the
ward, to be locked at all times when not in actual use, are a very
great advantage. Bringing a bath into a ward, which in many urgent
cases must be done when the baths are distant, is a messing discomfort.
Still it had better be left to surgeons to say whether, in Military
Hospitals, it would not be preferable to have, in each ward, only a
portable bath, on wheels, covered with india-rubber, to be brought
into the ward for any urgent case; and to take all the men able to
walk, or safely to be carried, to the Hospital baths. Of these, some
trustworthy, or intended and supposed to be trustworthy, man, who
ought to rank as a non-commissioned officer, should have charge. An
intelligent and respectable-looking man, a serjeant, has charge of the
baths in the Garrison Hospital at Vienna.
In a great London Civil Hospital, St. Thomas’s, it is the very
admirable practice for each patient (of course with necessary
exceptions) to be bathed on his or her admission. The Sisters are
responsible for examining each woman in the bath, which is within the
female wards, and for at once reporting before suffering them to go to
bed, any case of suspected pregnancy, syphilis, or contagious disease.
A man does the same for the men, who are bathed apart from the wards.
This arrangement is an excellent one. On the other hand, severe cases,
just able to be carried to baths, get no good by going through the air,
and being jolted up and down stairs.
In planning a Military Hospital, in which the service of women is to
be introduced, it is important to obtain the advice of experienced
Army Surgeons as to the arrangement of appurtenances of the wards to
be used by the patients alone. Endeavour to prevent the system of
holes and corners. It is best that the Nurse’s door should command the
view of those who come in or out of the lavatory, and in or out of the
water-closet. This whole section is both ugly and important.
[Sidenote: 11. Summary.]
11. To sum up. I think it would work the best to have no store-closet,
only two well-appointed presses, by which a certain amount of cleaning
is saved, and a corner avoided.
Could two cupboards or presses in the wall be arranged for the ward
linen and the ward stores, it would be preferable to presses placed
against the walls. Take care, however, that the wall is sufficiently
thick, so that the presses are not damp, and if this cannot be provided
against, keep to presses separate from the wall.
Believe that all this is neither theory nor fidget--but practice.
The furthest end of the ward should contain a lavatory, a water-closet,
and the pierced basin for emptying and cleaning bed-pans is a very
useful thing. At the other end of the ward, the Nurse’s little room,
her door opening full upon the ward. If the upper half were of glass,
with a curtain before it, allowing the Nurse to see the ward without
being seen, it would be all the more useful. At St. Thomas’s, a window
opens into the ward, the Sister drawing a blind when she chooses, and a
door opens into the passage, just within the ward doors, opposite the
scullery, so that the Sister enters the scullery, in which there is
a water-closet, for the accommodation of herself and Nurses, without
traversing her ward. Whether door or window, the Nurse should see at
once all that is going on in her ward. I prefer a door; yet, if there
is to be a ward for one, it may be best and most central to have the
Nurse’s window on the large ward, and her door open on the passage.
Opposite the Nurse’s room should be a scullery, not too small. The
scullery should be well provided with cold, and, if possible, warm
water.
If a supply of hot water can be obtained by turning a cock, this
is best. Provision should be made in the ward scullery for keeping
poultices warm which is every now and then wanted. It is not right to
wash eating-vessels and poultice pans, &c., in the same sink; and this
should be considered in arranging the scullery. If each ward washes its
own bandages, which it ought not to do, the second sink will come in
usefully for this. It is worth while, in enforcing extreme simplicity,
to prevent jumbling together eating-vessels and things for wounds and
sores. Sinks are infinitely most handy when made deep, somewhat in
the shape of broad round basins, with hole at bottom; it saves much
splashing and mess; the cock to overhang full the middle of the sink.
The Wall against the sink should have some protection.
Such a scullery, with complete efficient simple apparatus for its
various purposes, places for washing up and cleaning, and for ward
purposes and cookery, so that the Nurse can warm the drinks, prepare
fomentations, &c., without jostling the Orderlies, who are washing up
or cleaning, will be a very great comfort, simplification, and promoter
of order, cleanliness, efficiency, and work. At one corner a decent
little table for Orderlies’ meals, above it their separate safes for
their bread, cold rations, &c., &c.; each to have and keep his key;
each to have his locker.
Each floor and ward will require a scullery. It is far better for each
ward to contain its own appointments--and all the other stores to be
together, apart. On the second floor might be the Ward-Master’s room;
_vice_ the Nurse’s room.
[Sidenote: 12. Nurses’ Sleeping Quarters.]
12. Nurses’ quarters, if we are driven to their not sleeping near
their wards, should be adjoining the Matron’s two rooms, and separate
water-closet, in a part of the Hospital as central as can be managed
without trespassing on our betters. I would simplify these quarters as
much as possible--either a series of very small rooms, or one great
space partitioned off each into a little cell, with a window, bed,
washing table, chest of drawers, and a very small wardrobe, with space
to hang up three or four gowns, deep enough for another row for shawl,
&c., at top a shelf for bonnet and caps, at bottom a deep drawer for
boots and shoes. These things will be a convenient riddance to the
chest of drawers, and comfort to the women. In each cell very strong
hooks to hang up and air a little gowns taken off at night, and one
or two chairs. The nurses must wash their hands, &c., in the rooms
off their wards, and I think it must be understood as a rule that
they leave their quarters in the morning and return to them at night.
Optional carpet.
Each cell to be numbered either with number or with name of Pavilion.
Opposite this space a small lumber room, wherein each nurse may deposit
her box, thereby hindering dissemination of bugs. Opposite also a
running open cupboard, with partitions numbered or named as rooms,
containing each Nurse’s broom, dustpan, &c., each with a key.
Also pump, sink, water closet.
[Sidenote: Furnishing.]
When furnishing begins, it will be well worth while to see that all
articles of furniture, whether for wards or Nurse’s quarters, admit of
being easily swept and scrubbed underneath, and swept and dusted at
top. Chests of drawers, &c., with too narrow space between bottom and
ground, harbour dust, or sadly waste a few precious minutes in the most
busy part of every day. As few high pieces of furniture as possible, to
gather dust and be out of easy reach; as few as possible of cumbrous
articles difficult to move from the wall, to sweep and dust behind, &c.
There ought to be, near the Superintendent’s quarters, one or two
small rooms, where, necessity occurring, sick Nurses might be lodged.
We cannot hope always to escape having sick Nurses; and there would
be serious objection in a Military Hospital, where only one Nurse
sleeps on each floor, to having the Nurse ill in her room for more
than 2 or 3 days at the outside. Or there might be one good-sized airy
room, with two or three dark washable curtains dividing it into little
dormitories, so that one Nurse, whom the Superintendent must engage and
watch, could attend them all. And as Her Majesty’s Nurses must have
allowed them such decent comfort as can be, but no fastidiousness, I
think the cubicles in one room would be best. Not to be called so,
however, by any means, as it would sound Latin and “Puseyitical.” The
Nurse’s ward to be locked and key kept by Superintendent, except when
tenanted. I should hope three beds would answer thoroughly, as well as
that the ward would be empty eleven months out of the twelve.
Considering the awkwardness of illness among Nurses, when it did occur
in a Military Hospital, it would be worth while that, adjoining the
little ward, there should be a little room for any one infectious case
which might occur; _e. g._, supposing one Nurse ill in the ward with
bronchitis, it would not do to put another with small-pox into the
ward,--at least it would be very impolitic. The ward should have a
water-closet and a little sink of its own, and a little cell, but with
window and fireplace, for the attending Nurse to lie down in. When not
used, once a month’s, or week’s at the most, cleaning by a charwoman
would be enough. It should be always clean and ready for use. In the
Civil Hospitals, few years pass without sundry Head-Nurses and Nurses
dying, not a few Nurses being warded, and sundry Head-Nurses ill in
their rooms. The peculiarity of Military Hospitals makes this little
preparation for what is certain every now and then to occur seem
desirable and economical; to hire lodgings in the neighbouring town
would be in all ways a worse plan.
[Sidenote: 13. Classification of Cases.]
13. Endeavour, if possible, to obtain a classification of the severe
and non-severe cases, and let the Nurses be only appointed to the wards
of severe cases. The convalescent cases to be successively removed to
the convalescent pavilions, whether they bear or not that name. No
convalescent ward in any of the floors of the Pavilions to be served by
Nurses.
[Sidenote: 14. Nurses to be called by the Names of their Wards.]
14. It will be found excellent in many respects not to allow the
Nurses’ names to be used in the ward of the Hospital, or among each
other, so far as the Matron takes cognizance of. In the great London
Hospitals the name of a Nurse is never heard, except occasionally to
each other as a solace, partly very natural, partly harmless vanity.
She is Sister or Nurse of such and such a ward. In hasty parlance she
is distinguished from the others by the name of the ward only. In it
she is always addressed as Sister or Nurse.
Thus a Sister of St. Thomas’s Hospital, whose services in the War
Hospitals of the East I can never forget, was always at St. Thomas’s
spoken of out of her ward as Sister of George, or, more commonly,
Sister George; and spoken to quickly or called to in a hurry as George.
All this, the only course of all the great and, I believe, of the
smaller London Hospitals, works excellently, in many ways.
[Sidenote: 15. Foul Linen--how to be Disposed of.]
15. Arrangements should be made that foul linen remains for the least
possible time out of the laundry. As regards the laundry deposits, the
best plan is that of the London Hospital, where each ward has a bin of
its own marked accordingly. To similar bins all the foul linen should
be, at least, daily carried, unless it is judged best to receive and
wash all the linen in a heap, returning numbers only to each ward. The
former plan is preferable. In any case the linen of the “foul wards”
should be received and washed apart. During the time, which ought to
be as short as possible, between dirty linen leaving the patients and
reaching the bin or bins, a large box in the scullery is making the
best of a bad business--the presence of foul Hospital linen always is
that--and is preferable to a closet.
[Sidenote: 16. Washing Bandages.]
16. Washing bandages, a very important thing. Shall a washerwoman
be told off for that particular purpose? or shall the Orderlies of
each ward do it _alla meglio_? The former is the better plan; if not
adopted, the Nurse must see well to the matter.
[Sidenote: 17. Splints--Bandages, Lint, &c., where to be kept.]
17. It would depend upon what sort of work is usually going on in the
Surgical Wards of a Military Hospital in peace whether it will be worth
either a press with glass front, in which splints, pads, &c., &c., are
excellently arranged, as at St. Bartholomew’s; or the pad-basket and
splint-rack, which are also excellent, provided in London Hospital.
The splint-rack, enabling the Surgeon at once to see and choose of all
shapes and sizes, is perhaps only suited for an accident ward, and
would be out of place in a military ward in peace. It may be better
to have these stores entirely in some dispenser’s or store-keeper’s
jurisdiction, and to let the Nurse confine herself to padding, &c., any
splint sent by the Surgeon into the ward. Let our masters take exactly
their own way about this.
Bandages, lint, &c., &c., &c. should perhaps rest entirely with the
Dispenser, otherwise it would be useful in the greater Hospitals, to
have under the Matron a Nurse charged with preparing them and giving
them out, writing in a book the date, amount of each, and the ward they
are given to. In a small Hospital the Matron could do this herself.
[Sidenote: Cotton Lint never to be used.]
While speaking of lint, it seems a duty to state that, in some of
the Military Hospitals, in certain County and even London Hospitals,
and also in Workhouses, and in the practice of private Surgeons, a
preparation of cotton has been recently substituted in the dressing
of wounds for _charpie_ or Surgeons’ lint, properly so called. So
miserable an economy at the expense of the sick is not adopted in
several, at least, of the London endowed Hospitals, probably in none.
For all purposes for which lint is necessary cotton fibre should be
totally disused, in the army and everywhere else. It is irritating
and injurious to wounds. It increases human suffering; it delays
patients in Hospital, and, in doing so, of course, increases the cost
which such a substitution has been intended to reduce. Nurses should
be particularly careful never to use this material, which is easily
distinguished, even by the touch. Any Surgeon may tell the best of it
from lint by submitting it to microscopic examination, and on doing
so he will readily discover that characteristic of cotton fibre which
renders it so ill adapted for surgical dressings. It does not absorb
the discharges from wounds, as linen lint does. The fibre is ragged
instead of being smooth, and it is apt to become matted together, and
to adhere to the surface and edges.
[Sidenote: 18. Classification of Women.]
18. It is essential to have as few women as can efficiently do their
work. Supposing the Hospital were for one thousand patients, not taking
into account that some wards would probably be foul wards, where I
earnestly hope female service will not be, at present at all events,
introduced, and that some wards would be for slight or convalescent
cases, where I hope it never will be--supposing each Nurse served
seventy-five patients, supposing one Nurse, at the very least, was told
off for the linen, fourteen or fifteen Nurses would serve the Hospital.
I conclude the Matron to have no cognizance of the laundry.
[Sidenote: Superintendent’s Store room.]
The Superintendent[18] will require a store room, or at least a store
closet, and hers should be well appointed. It would depend upon the
other arrangements of the quarters, whether the world in general, when
sent for to fetch what it wanted, enter from the same side as the door
of the Superintendent’s bed-room, or from the other side. And it would
depend upon the nature and amount of stores of which she had charge, in
the larger Military Hospitals, whether or not she should have a Nurse
told off for this also. Economy is essential; but useless fiddling
over every duster or scrubbing-flannel given out, &c., &c., &c., sadly
hinders the Matron’s time from more important things.
Housekeepers must be avoided, and every woman must have a distinct
and sufficient share of work, and each be distinctly and equally
under the Matron. Still it would be advantageous if we could from
the first include in the staff of Nurses for the larger Hospitals,
one or two places which could be filled by efficient persons who yet
were unfitted for the ward work, which calling will be, and ought to
be, laborious and wearing enough. Many a woman would never do to look
after a Pavilion and seventy-five men; who yet, in charge of linen or
stores, would be most valuable, and influence most beneficially the
Nurses, whom yet she might be unfit to govern. The system of the Sœurs
de St. Vincent, who, in theory and fact, subject entirely to the will
of the Superiors in general practice, are yet selected and trained for
spécialités, who remain long in these spécialités, which spécialités
include such requiring more or less of physical strength, seems to be
one giving many useful hints for us.
ADDENDA AS TO MIXED NURSING BY NURSES AND ORDERLIES IN MILITARY
HOSPITALS ON THE DOUBLE PAVILION PLAN.
I. After much anxious thought, re-consideration of all things, and
pondering, I submit--
1. That three Orderlies will efficiently serve a ward of from 28 to 30
patients, including night-duty.
2. That each of two wards of 30 each, should there be two such under
the same Head Nurse, on the same flat, ought to be entirely separate in
all other respects.
3. That if night-duty be required, each such ward should have an
Orderly on night-duty.