13. In forming rules for the proportion of Orderlies to sick, it is
important to consider that the duty varies extremely according to the
appurtenances of the ward.
14. I consider extreme plainness and simplicity to be proper and
indispensable to a Military Hospital. Let us take for granted (and may
it prove correct to do so), that in none of Her Majesty’s Hospitals
Orderlies’ time will be wasted in cleaning any ornamental things,
whether unnecessary furniture, flourishes, or cornices, &c., &c., on
necessary furniture; supernumerary shelves, nooks and corners, &c.,
&c. Once provided, all these things must be carefully and constantly
cleaned, or they become receptacles of dust and breeders of fleas; and
to clean them involves enormous waste of time. A few minutes daily
wasted on each of many things, make an enormous sum.
15. But it is very true economy to supply, if possible--which in old
buildings it often is not--every ward of every hospital with a constant
supply of water, (taking care that it is not wasted by mischievous
or childish patients); and to give every ward of every Hospital the
use, under proper control, of a lift by which, at fixed hours, food,
medicine, linen and fuel are brought into the wards.
Believe that this is not theory, but the result of practical
observation, much extended.
16. Now, these two things--supply of water (if hot and cold so much
the better, and supply of water imports, of course, the appliance for
getting rid of it, and of the contents of bed-pans, &c., &c., by one
or more sinks) and the use of lifts can be applied to a new Hospital;
can possibly, not certainly, be applied to some of the old Hospitals
within the Kingdom,--can certainly not be applied to many of the Army
Hospitals abroad.
17. Upon an average, these two things make the difference of one
Orderly’s duty to a ward of 30 men.
18. And a ward of 30 men, so supplied, would be efficiently served by
half a nurse and three Orderlies, including night-duty.
19. Without these two things (it is a mere comparative question as to
loss of time and absence of thorough cleanliness, whether the water is
brought from a pump in the court, or a stream some hundred yards off,
above or below), and many, if not most, Army Hospitals abroad, must
always remain without these two things, I consider that one Orderly to
every seven patients will not be too much; while it is certain that,
other things being equal, the ward with the appliances and the three
Orderlies will be better served than the ward without the appliances
and with the four Orderlies. Where there is no Nurse, one Orderly for 7
patients will always be advisable.
In these memoranda as to Orderlies’ work, &c., no notice whatever
has been taken of the possible abolition of scrubbing, because it
does not do to count unhatched chickens. If, however, that formidable
weekly business could be got rid of, as well as the bi-weekly or daily
washings of bed-head-floors, &c. the labour of the Orderlies would be,
without underrating that required for keeping oiled floors cleaned,
very materially lightened.
_Night-duty of Orderlies._
20. Convalescent wards, which will be of great use in many ways,
will be of use here. With them Nurses will have nothing to do. It
is possible enough that, in course of time, the Medical Officers
will desire to have Nurses there, and that it may be useful to place
there elderly, still efficient Nurses; but let this come or not as it
will, and let us keep quite clear of them, at all events, till the
Nursing-service be tried and established in Army Hospitals. In these
wards, night-duty will probably be quite unnecessary, though in that
case either an Orderly or Assistant Ward-Master ought to sleep at hand;
and night-duty is a service which must be spared wherever it can be
spared, and rendered as efficient as possible wherever it is really
wanted.
I have before submitted that in Paris, Vienna and Berlin, the
average of severe cases in Army Hospitals, in time of peace, is very
considerably lower than in Civil Hospitals.
This quite as much applies to English Army Hospitals. Whether the
ordinary wards would require night-duty I do not know. If they often
did, I should prefer having a regular night-duty in them. If they
seldom required it, I would not have it.
21. In Civil Hospitals, served by women, I should undoubtedly prefer
assigning the night-duty to one Assistant Nurse.
22. But Orderlies are in sundry respects different, and, upon the
whole, I recommend not to have night Orderlies, but to let each Orderly
in turn do the night-duty.
23. It is important to remember--the more so as it is often
forgotten--that to lay more upon human nature than its Maker has made
it to bear, is to do a foolish, let alone a wicked thing. Upon an
average, all men and women can dispense with, or abridge sleep for more
or less time. Upon an average, all men and women, after a laborious
day, require a good night, in the long run. When they do not have it,
either health, efficiency, or sobriety, or all go.
Believe, again, that this is not theory, but the result of practical
observation, much extended.
A strong soldier is no exception to the general rule. In the long
run, if made to do night-duty after a laborious day, he will either
go to sleep, or drink to keep awake, or he will get knocked up before
his time. And this it is part of his business to be in time of war;
therefore, in peace-service, it is economical to let him last his time.
It is then sound economy to give watchers sufficient sleep.
[Sidenote: Scheme of Night-Service for Three Orderlies watching by
turns.]
24. Supposing regular night duty required, in a ward of 30 men,
supplied as above, and served by half a Nurse and three Orderlies,
it might be worked thus: the Principal Medical Officer would decide
whether the same Orderly should do the night duty for a week, or the
three on successive nights: probably the latter. The Orderly might come
on night duty at 9 P.M., and remain on duty until 9 A.M., thus taking
his share in the heavy morning work of cleaning the ward, &c. In all
well-ordered Hospitals it is required that this should be done by 10
A.M., in some by 9 A.M. Earlier is undesirable in the English latitude
(in other climates it is different), unless either the patients are to
be disturbed earlier than English Surgeons consider right; or the ward,
&c. cleaning is hurried through. A large ward, got into thorough order
by 9 A.M., is in very good time. Of course it may happen occasionally
to be got ready somewhat earlier, but this refers to the average.