1. That small wards multiply exceedingly the demand for Watchers:
four wards, of 10 patients each, taking the average of patients as in
London, would not be attended, according to the English notion, by
one Watcher; 40 patients in one ward would be fully attended by one
Watcher. The London Hospital has two Night-Nurses for its quadruple
wards. An extra Night-Nurse has frequently to be put on, on account of
the difficulty the subdivision of the ward gives to the watching.
2. That the average of severe cases in each ward of London hospitals
is very considerably more than the proportionate average of severe
cases in each ward of the foreign hospitals in question. In all foreign
hospitals with which I am acquainted the proportion of accidents is
comparatively small to those of the London hospitals. The docks, the
manufactures, the crowded and dangerous works, &c., &c., with us,
account for this.
3. That, striking the balance for and against, it is necessary that
each London ward should be watched by a Nurse; at the same time, that
without doubt a certain number of troublesome, ill-conditioned patients
(no ward of any Hospital is without such) sleep soundly and let their
neighbours sleep soundly when the Watcher only looks into the ward at
frequent intervals, who would, if the Watcher sate in the ward the
whole night, make it their business to require attendance from the
Watcher during the whole night, or at least much oftener than by the
other plan.
II. The second flaw of the above system, as it applies to London
Hospitals, is, that it renders Extra-Watchers so often indispensable.
The employment of Extra Watchers can never be wholly prevented, but it
should be the endeavour of every Hospital to employ such as seldom as
can possibly be. Extra watching is most injurious to the health of all
ward-servants, and to the sobriety, and therefore morality, of many
paid ward servants.
This is a very important reason, I humbly consider, for avoiding as
much as possible small wards.