But it is right to remember that we have been told of England, of
Austria and of Prussia that the proportion of severe cases in Military
Hospitals in time of peace is considerably smaller than in Civil
Hospitals. Night watching is not done in the Military Hospitals either
of Vienna or Berlin. Orderlies, or an Orderly, sleep in each ward, and
watching is only done to bad cases.
How far English Army Surgeons consider night watching desirable in the
Army Hospitals I will presently tell.
I should think the convalescent wards, among many important advantages,
would receive a number of patients who require no night watching. An
Orderly ought to be at hand here, but not watching.
If night duty is considered requisite in the ordinary wards, I do
not see how the English standard of things could be met, excepting by
having one Watcher in each ward where there is regular night watching.
I think, however, that the foreign system of night watching above
detailed might give very useful hints for women in war service, and for
emergencies of cholera, &c., &c., in home service; and with regard to
supervision in the latter.
I think, with submission to the proper authorities (the two or three
experienced Army Surgeons I have so often adverted to) feeling strongly
that awkward mistakes might occur in several of these matters without
them, as civilians and women cannot and ought not to trust their
own judgments respecting such, that in a large Military Hospital,
an Assistant Ward-Master ought to go round the wards at night. Not
with any idea of his rendering assistance to the Watchers over bad
cases. The Nurses must do their duty of Head-Nurses, and see to this
themselves. Perambulation through a large Hospital at night in point
of fact excludes the possibility of doing anything in any one ward,
unless in some exceptional occurrence which only proves the rule. The
object is the important one of seeing that the Orderlies are awake,
sober, alert, and at their duty, and that the patients are quiet and in
bed. The Nurse would hear any noise, but there is such a thing as quiet
drinking, as well as noisy drinking.
In St. George’s there is a Night-Matron, chief over the Night-Nurses,
who goes through the Hospital every hour during the night-watch.
I have heard this spoken of by experienced Authorities of other
Hospitals with approbation and envy, and some idea was entertained
of introducing it into another great Hospital. In Civil Hospitals, I
think, but I do not know, that the benefits of this Night-Matron may be
perhaps more imaginary than real. The Head-Nurses at St. George’s sleep
away from their wards; a great mistake, I humbly consider.
But Military Hospitals are entirely different in sundry essential
respects. I think a non-commissioned officer, Assistant Ward-Master
for instance, ought to make his rounds every night. When once such a
service takes place, every hour is better than three or four times a
night. He must be “up to” sundry things--taking the wards in uncertain
rotation, sometimes returning suddenly on his steps, &c., &c., &c.
It will be worth securing, if possible (this parenthesis will be
understood), that the Nurse’s water-closet should be within her room,
if not, as close to it as may be.
[Sidenote: Present State of Night-Nursing in Military Hospitals.]
29. The following extraordinary system of Night Nursing is that which
prevails in the Army at present:
The “nursing is managed” either by means of patients “told off in
watches” through the night for the purpose of attending to other
patients, or by means of soldiers sent in from the ranks to attend
specially upon each bad case; or by Orderlies “arranging it among
themselves,” without any exemption meanwhile from day duty.
Upon each and all of these systems or no-systems it is hardly necessary
to make any comment. It is difficult to tell which is the worst.
In the principal, indeed the only General Hospital in England, “Nursing
is managed by comrade-patients told off in three watches of two hours
each for the night.” [_sic._]
“Orderlies are likewise warned and often sit up for the purpose.”
These passages are given _verbatim et literatim_, because they are so
remarkable.
And it is necessary to add that these patients being the relapses among
the “Invalids” are nearly the worst cases we have.
Were it the report of a Head-Nurse in a Civil Hospital to her Resident
Medical Officer, it would undoubtedly cost her her place. One scarcely
knows whether to pity more the sick patient or the orderly patient. One
scarcely knows how to estimate the amount of medical comforts intended
to be consumed by the sick patient which will actually be consumed by
the sitting-up patient, and necessarily so. And the expedient which
turns over the man who is too ill to be left at all to the care of men
who ought to be recovering themselves, but who are pulled out of their
beds for two hours to _nurse_ (for the first time perhaps in their
lives,) and a very “serious” case too, is to say the least of it a
singular one.
At Woolwich Artillery Hospital the cases which require constant
attention are about 2 per cent. There are now 545 patients in Hospital,
and 11 cases consequently, each requiring one Orderly to itself. The
Orderlies, according to Regulation, are 55, so that one-fifth part
of the Orderly service is required for these cases. Yet there is
no system or arrangement for such. The Orderlies arrange (or do not
arrange) among themselves to do the reliefs day and night. Of the 11
cases at this time in Woolwich Hospital with 11 Orderlies sitting
up with them, it so happens, as I am informed, that only one would
require, if such were together in wards where regular night nursing was
established, an attendant specially to itself.
It is needless to enlarge upon the cruelty of the above practice. The
one serious case is disturbed in the day by the goings to and fro, the
noise and bustle of the light cases--while these are disturbed at night
by the sitting-up necessary for the one bad case, which may be besides,
and too often is, a noisy or offensive one. The bad economy is as
obvious. It often happens that 11 cases who might all, if in one ward,
be attended and as efficiently attended, by one Night Orderly, require
each an Orderly to itself in as many different wards.
In the “Garrison Hospital” at Chatham, “when any case assumes such
a character as to require more than the usual care and watching, a
Requisition is immediately sent to the Commanding Officer of the Corps
to which the man belongs for a steady well-conducted soldier and who
generally is the man’s own comrade” [so much the worse] “to nurse him,
and to attend upon him throughout his illness, but who is relieved by
another as often as the Medical Officer in charge of the case considers
necessary.”
The following is the average number of sick in Army General Hospitals
in time of peace at home, for whom night-nursing is considered
necessary by the Medical Officers. But it is important to add that this
number would be probably estimated as very much higher if proper means
of night-nursing were at their disposal.
Of constantly sick mean proportion per cent. requiring night nursing:
General Hospital, Fort Pitt {Medical Division 5
{Surgical ″ 1
Garrison Hospital 2
These cases are usually scattered through the wards.
It is but fair to add that the best Medical Officers themselves
desire another system, or rather are aware that there is at present
no system at all, and would gladly accept one. “With means for good
night-nursing,” they say, “arrangements in accordance might be
introduced. At present we like to have a case requiring much attendance
amongst cases that require little, in order that the patients or
comrades may assist.”
What are the consequences of such “assistance” to the cases in question
has already been fully stated throughout these notes.
[Sidenote: Poor-Law Regulation for Nursing in Union Workhouses.]
“With respect to the use of [the inmates as] servants, they require
the strictest superintendence on the part of the * * officers. The
employment of [the inmates] in offices of trust is inexpedient,
inasmuch as it tends to impair the discipline of the house. In
offices of mere labour, which can be performed under trustworthy
superintendence, [the inmates] may be useful. Where responsibility is
involved, paid servants should be engaged.”
The above is one of the regulations of what?--not of a Charitable
Institution but of the Poor Law; and the house of which it treats so
tenderly and wisely is--a Workhouse![19] If paupers are to be thus
cared for, how should it be with our soldiers? If any “office” can be
called one “of trust,” surely it is that of carrying out the orders
of the Medical man in a critical case, a case of life or death! Can
any “responsibility” be “involved,” greater than this? Yet these are
just the cases left to the “Comrade Patients.” For ordinary cases the
ordinary attendance is given; for serious cases, the untrained and
unskilled attendance. Yet, if the Hospitals are not for these serious
cases, what are they for? For these alone, however, is no systematic
provision made. One would think that every bad case took the Hospital
by surprise. Imagine the orders of the Medical Officers carried out
by nurses (?) changed “every two hours,” and who are, in fact, sleepy
patients!
The system of Military nursing and management, as described by Army
Medical Officers themselves in the above quotations, and which is,
we are expressly told, to be re-enacted at the Royal Victoria Netley
Hospital, is precisely the one which led, as a matter of course, to
the calamities, as far as nursing was concerned, in the Hospitals
in the East, and which will lead to them again so long as it is
continued. Even in the case of invalids, who may not require such
careful attendance as sick, the system of nursing by comrades is most
objectionable; and if the attendance at Netley can only be carried out
on such a plan, it is doubtful whether Netley should be used even for
an Invalid Hospital.
The question has been asked the Netley Committee, By whom are your
Invalids to be nursed, when sick? And it has been answered, that they
are to _nurse each other_!