Monday, 3 P.M. A goes to bed, after taking his share of the morning
work, eating his dinner, and helping to clear away ward dinner, &c. 9
P.M. A comes on night duty, after 5 hours’ sleep, and allowing 1 hour
for undressing, dressing, and eating his supper.
Tuesday, 9 A.M. A goes off duty, having watched until 6 A.M., having
breakfasted, having taken his share of the morning work, and leaving
the ward clean. Let him have the option of one or two hours’ fresh air,
either now, or before 3 P.M.; let him sleep full three hours; let him
have his hot portion of dinner taken to him at the usual hour, unless
all the Orderlies on night duty are served together at a different
hour; and let him, 3 P.M., return on duty, washed and shaved. B goes to
bed, &c.; 9 P.M. B comes on night duty.
Wednesday, 9 A.M. B goes off duty; 3 P.M., C goes to bed, &c.; 9 P.M.,
C comes on night duty, &c.
I have reckoned 12 hours for the Orderly to be off duty. It is better
for him to have eight than seven hours’ sleep, and one or two hours’
fresh air are more healthy, and make a man last longer than going
to and from his bed and his ward. An English soldier comes on duty
clean, washed, and shaved, a once national peculiarity it is highly
desirable he at all events should retain--at any rate that of thorough
cleanliness--the shaving is unfortunately now not certain; for this and
for his meals, some little time must be given. I think you will get
more, and get it longer, out of the man by giving him 12 hours on night
duty and 12 hours off. Still it will not do to interfere too much with
analogies, and the proper authorities must decide whether this is too
much.
[Sidenote: Exercise for Orderlies.]
25. Again, leaving the question for decision to the proper authorities,
I had rather each Orderly had one hour or two hours for exercise each
afternoon or each alternate afternoon, care of course being taken that
he did not exercise himself in some tap. He should report himself to
the Nurse, or to the Ward-Master, or Assistant Ward-Master on going and
on his return. So should the Night-Orderly when coming on and going
off duty. Also in many emergencies of no very unfrequent occurrence at
home, and constantly abroad, the Orderly must dispense with recreation
time. But as a rule, it is certain that fresh air is necessary to
preserve health in Hospital duty. Doctors of all kinds know and act on
this as regards themselves.
The waste of time and strength, at present too often incurred by the
endless fetching, heavy carrying, &c., of many Hospitals is in a
considerable degree counteracted by its forcing the Nurses into other
than ward air; the air of a Hospital Court is better than that of the
best ventilated wards as it is, not as it might be. The same applies,
in its degree, to Orderlies. But it is better, and far more economical,
to avoid the fetching and carrying as much as possible; to keep the
ward attendants in the ward to their duty under the supervision of the
chief and responsible ward-servant; and to give each in turn a short
daily recreation, if possible.
[Sidenote: Night Refreshment for Orderlies necessary.]
26. Now comes a thing I am very anxious about concerning night duty,
the more anxious because it is important, and because I am afraid it
is an innovation. I have watched the night duty with particularly
anxious interest, in each Hospital I have entered, feeling at once its
importance and its difficulties, and of the following principle I am
thoroughly certain.
The Orderly doing night duty should either be allowed refreshment
during the night, or the recurrence of this night refreshment should be
considered in allotting the rations.
In none of the Civil Hospitals, so far as I know, is night refreshment
given. The Nurses usually on board wages, apportion, when they can,
some from their food. In one Hospital there exists a rule that no
Night Nurse is to take refreshment during her watch, the intention
being to keep her more vigilantly to her duty. This is one instance
among many of the serious and cruel mistakes which men of business or
benevolence, or both, make, when legislating on matters which they do
not understand. It is, fortunately for the fine Hospital where it is
the rule, practically disregarded; the Head Nurses knowing well that a
Nurse watching and fasting in a ward from 9 to 9, or even from 9 till
the breakfast hour of 6, would either soon be unfit for duty, or put
drams in her pocket, or doze through the night.
A strong soldier, required to watch in a ward and fast from 9 P.M. till
9 A.M., or 6 A.M., or shortly before, would stand the trial quite as
ill as a Nurse. There is an admirable rule at two foreign Hospitals
where I have served. Sisters watch in some wards, Men Nurses in others;
and each watcher receives from the house, on going on night duty, a
bottle of beer, a can with about six or eight cups of coffee, milk and
sugar in proportion, and three slices of bread and butter. The Sister’s
bottle of beer is about one pint; the Man-Nurse’s double; his coffee
can is also a good deal larger. The rule of allowing sufficient for
three solid refreshments (which of course can if desired be made by the
watcher two or three) during the night, is an excellent one.
I think it would be very sound economy to allow each Orderly on night
duty, a proportion of beer or porter, of coffee or tea, and of bread
and butter, or bread and cheese, to take at his own time during his
watch, besides his supper before going on duty, and his breakfast just
before 6, (both Nurse and Orderlies ought to have breakfasted by 6,
and to begin the day duty at 6, and I wish it began by opening the
windows and repeating the short prayers for 5 or 6 reverent minutes).
Of course it may be considered preferable to reckon this night-ration
in the Orderly’s rations. Or suppose the bread and beer or porter to be
reckoned in the rations, and a can of coffee given him for the night
watch. Settle details as is best, and of course analogies must be
considered; but in truth hospital watching is a very peculiar business;
important, unobtrusive, most peculiarly trying, and the bright side of
very few Hospitals. Each watcher should undoubtedly have refreshment
for the night.
The Nurse should have her groceries in the lump, and refresh herself
as she likes out of them. Her watching, if she does her duty, will be,
when she has bad cases, severe enough; but I would not provide her with
extra refreshment; as the watching is not prescribed and regular duty.
There should be as little extra watching on the part of Orderlies as
is possible; when it is indispensable the extra watcher should have
the same night-ration. I submit my strong impressions on the subject
of this night refreshment now, because, small as it may seem, it very
largely enters into the working of a night watch.
I have suggested the division of the Night Orderly’s sleep, because,
if A. comes on duty at 6 A.M., and is sent to bed at noon or 1 to get
ready for his night watch at 9 P.M., he is scarcely fit for a long
sleep, and supposing the patients dine at noon (an excellent hour) he
has not, or scarcely, taken his share of the clearing away which,
got over in time, enables the other Orderlies, one or both, to have a
short recreation in the afternoon. Also if sent to bed at one he has
not eight hours’ sleep, as out of that he has to undress, dress, and
sup. Also he has to remain on duty from 9 P.M. to 9 P.M. next night,
which is much too long as a rule. If he does not go to bed before his
watch, and goes off duty at 9 A.M. next morning, whatever time may be
then allowed him for sleep, he cannot, as a rule, be depended upon for
performing his watch duty efficiently.
[Sidenote: Where are the Night Orderlies to Sleep by Day?]
27. If the Ward Orderlies watch by turns, it should be arranged that
the men who sleep before and after the watch can do so quietly. This
is by no means always attended to, as to Nurses in Civil Hospitals.
Upon the whole, I cannot think it would answer to have always the same
watchers, as regards Orderlies. The other Orderlies, supposing them
lodged apart from the wards, will certainly go seldom enough to their
quarters during day, except during their exercise time. It may be
thought essential to retain soldiers under very primitive notions as
to quarters. So though in a dormitory of women, I think little cells,
parted either with a partition or a curtain, the whole thoroughly
airy, are in all respects preferable to unparted rooms, it may be,
by some, thought better that the Orderlies shall sleep in large airy
wards, not parted by curtains or partitions. I know, however, one high
Military authority, at least; who considers the same reasons apply to
men as to women in this. Soldiers are generally able to go to sleep
whenever ordered. Indeed their general capacity of doing whatever they
are bid is one of their many fine points. The Orderlies’ wards must be
under some sort of inspection, and noise must not be suffered in them.
Non-Commissioned Officers, either Ward or Assistant Ward-Masters, or
some special functionary (but such I would not multiply) must sleep
near, and have general charge of the order and quiet of such wards. I
conclude that one or more Assistant Ward-Masters, at all events, must
watch, and as they must sleep by day, this will fit in well enough.
I should avoid putting the Orderlies in a too much out of the way part
of the Hospital; they should know themselves liable to inspecting
visits any time. I am not sure that Ward or Assistant Ward-Masters
would not be much better guardians of the Orderlies’ wards than any
special functionary. Drink is the vice of these men, noble fellows
as, as a body, they are, and I should avoid quartering any man too
comfortably and solely in one particular post. Cases have been where
the duenna of the Nurses’ dormitory was herself a determined, disguised
drunkard, and reported others accordingly as she was bribed or not with
drink for herself.
The whole question of Orderlies sleeping near or away from their
wards should be well considered by the proper authority, two or three
experienced Army-Surgeons. Upon the whole, I think it would be well to
try the quartering them separately: there is much to be said on both
sides as usual.
[Sidenote: Comparative Merits of Different Systems of Night Nursing.]
28. In several foreign Hospitals a certain number of Night Watchers,
both Sisters, and Men-Nurses, are told off for night-duty for four
weeks, during which they are exempted from all labour by day, and
receive better food than the usual diet. They also receive good
night-refreshment.
In one Hospital the following is the arrangement. The wards usually
contain from 10 to 13 beds, and there are many small wards for three,
two, or one, bad cases or operation cases. All the wards open upon a
corridor. The Sisters do not watch in the men’s wards.
A Sister watches in the female medical wards }
″ surgical ″ } 5
″ children’s wards and girls’ ward }
A Man-Nurse ″ male medical wards } Watchers
″ surgical wards and boys’ ward}
An operation-case, or an extra bad or anxious case, or a case requiring
special attendance and put in a single ward, has an Extra-Watcher.
Often there are no Extra-Watchers: sometimes there are several at once.
The Extra-Watcher is either a Sister or a Man-Nurse, taken from among
the other Sisters or Men-Nurses, who, after his or her day’s duty, does
the extra watch.
As regards all English hospitals, civil or military, the advantages of
this system are these:--
1. It severs certain persons for night-duty, who have full time for
sleep and refreshment in the air during day, and who are allowed to do
no other work.