The question of ventilation is so all-important, so much doubt still
seems to exist as to the comparative merits of natural and artificial
ventilation, so much has been said in favour of the latter, because it
is seen adopted in the finest hospital in the world, the Lariboisière,
that I have added a few practical remarks upon this system. The
conclusion is, that even at the Lariboisière, without opening the
windows occasionally, and especially in the morning, real freshness
is never obtained in the wards, and that, therefore, if there must be
artificial ventilation, that is the best which allows the most of the
windows being opened.
On the men’s side, Thomas’ system, or that of injecting air at given
points, by means of two high-pressure steam engines, each working a
large fan, is adopted. On the female side, Duvoir’s system affords
ventilation by extracting air at given points. In both, a number of
shafts and openings provide for the exit of the air.
Persons at the Lariboisière Hospital, who ought to be good judges,
including foremost the Director, an experienced and able administrator,
consider the ventilation on the male side the most expensive and the
best, both for day and night, being the coolest in summer and the
warmest in winter. In winter two great advantages are assigned to this
side: first, the heating being provided by the Hospital, the wards
are warmable at pleasure; whereas that of the female side is provided
by the contractor at a fixed degree of heat, which, in extra cold
weather, is augmented: from 15° to 18° C are the usual limits of the
winter temperature on the female side, while that on the male side is
usually several degrees higher. Secondly, the system of heating on the
male side permits the windows to be opened: while on the female side
objections are often made to opening the windows in winter, which it is
alleged interferes with the heating.
_Per contrà._ How difficult it is to learn any facts by hearsay we
know. Other persons who ought to be good judges think the male side
apt to be too warm in winter, especially at night, and consider the
temperature on the female side quite sufficient.
Both sides are ventilated both by the windows and by the machinery by
day in summer. Both sides are ventilated, each by its own different
machinery, by night in summer, except that, exceptionally on hot summer
nights, a window is opened two or three times in the night, or five
minutes every hour.
Both sides are considered to be ventilated in winter mainly by the
machinery by day; and both sides are entirely ventilated in winter by
the machinery by night.
As far as can be made out from conflicting accounts, (conflicting
from the very simple reason that one person will consider a ward, or
drawing room, for that matter, airy which another will consider close;
one, pleasantly warm, another too hot or too cold), it is practically
found impossible to freshen the ward of a morning without opening some
windows, and to keep it fresh during the day without now and then doing
the same; and it is easier to open the windows on the male side in
winter than on the female side.
The ventilation on both sides is considered to work with equal
efficiency during the whole of the day.
Of the eighteen wards, the ventilation on entering the wards at five
a.m., when the ward nightwatch has generally not opened a single
window, is certainly surprisingly good; _i.e._ the air is surprisingly
little bad. _But neither here, any more than anywhere else, are the
wards effectually freshened, until the windows are, of course with
proper caution, opened._
In both these particulars, no difference is to be observed between the
male and female side.
In repeating that the Director, and other persons who ought to be good
judges, consider the machinery of the male side the most expensive and
the best, I add these things:
First. Since this machinery was erected, so far as concerns the steam
engine, it is said that equally efficient and much less expensive
engines have been erected in other Hospitals, among others, Necker and
Beaujon. In both Hospitals, the plans of Duvoir and Van Heecke are
in use, one on either side. But certainly, the system of outlets at
Beaujon for the foul air is by no means so good as at the Lariboisière.
Secondly. If an accident happened to the machinery of the male side,
which is in communication with the steam engine, the results might be
very serious. Twice a stove has burst on that side, happily without
damaging anything else than furniture near it; had patients been near
it, they must have been hurt or killed: and an accident on a large
scale might blow up not a small part of the Hospital.
More or less danger is inseparable from powerful steam machinery, or
powerful machinery of any kind: the question is one of degree.
Thirdly. Both sides of the Hospital have one thing in common. Except
the sculleries of the 3 ground floor wards on the male side, which
have each a stove or fire place, the kitchens or sculleries attached
to all the other wards are warmed by hot water. Undoubtedly this saves
much mess, much cleaning of stoves &c., and much bringing of fuel
and consequent dirt. But the absence of fire is always a loss to the
service of a ward. Sundry things, some one or other, often all of which
are constantly wanted in a large ward, _e.g._ warming broth or drink,
cooking for an extra bad case, warming poultices, warming (not airing)
linen for ditto, &c., &c., &c., are much more slowly done by water than
fire heat, and it is a question, variously answered, whether some of
these things are as well done by the slow water method, as by the quick
fire heat. Occasionally the hot water is not forthcoming, a nuisance
alike to the ward attendants of the ward whose scullery is thus heated,
and to those of the wards supplied with stoves, which have then to do,
in driblets, considerable extra duty.
During the hot months the smell of the latrines is very little
perceptible in the wards, generally not at all: but the test of this,
as of the ventilation, is in winter, when the large window close to the
latrines is generally closed, and the smell is very offensive.
II.--_Oiled Boards_ versus _Parquets_.
1. They have in common the superiority over common floorings--that they
are not scrubbed, and the damp thus arising is avoided.
2. As regards labour, so far as Civil Hospitals are concerned, where
the ward service is done by women, _parquets_ would be more laborious
than scrubbing; a large ward, to be kept in a proper state, requires
a certain amount of _frottage_ (the peculiar polishing of _parquets_)
every day; and this _frottage_ is held to be unfit, from the fatigue
it causes and the strength it requires, to be done by women, and is
always done by men. Certainly Ward Nurses could never be required to
_frotter_; it is altogether a man’s business.
3. As regards labour, so far as Military or Naval Hospitals are
concerned, where men preponderate in the ward service, it is my
impression (for of course I cannot pretend any certainty as to this),
that sailors who are proverbially handy (a different quality from
either laboriousness or endurance, though they have these too) would,
with instruction and painstaking, accomplish in time _frottage_; that
civilians would under the same conditions; that soldier orderlies
(infinitely, I humbly think, the best material for the staple of
military ward service), would generally make bad _frotteurs_.
4. As regards labour, cleaning oiled boards, though a laborious
business, is much less so than either scrubbing or _frottéing_; and
is fully within the power of average strong women: none other should
nurse. (What subdivision of cleaning the ward, and of nursing properly
so-called, might both improve the work done and relieve the Nurses, is
another thing; my impression remains, that it is better to consider
these things to a certain extent as distinct duties, discharged by
women ranking alike; and that in a ward of forty, served by a Head
Nurse and three Nurses, to charge one with the main ward cleaning, is
better economy of strength and time than to divide it among the three).
5. As regards labour, any Orderly giving his mind to it for a day at
the shortest, or a week at the longest, ought to learn thoroughly
how to clean polished oiled boards well, always supposing him to be
properly taught a very simple thing, which, like everything else, can
be done well, ill, or indifferently.
6. Apart from the question of labour augmented or spared, the
advantages of oiled and polished boards I believe to be these:--
(1.) Prevention of dust.
(2.) More easy purification of the air of the ward in the morning.
The air of every ward becomes more or less impure during the night,
and the floor and furniture more or less dusty. Making the beds in the
morning adds to the dust the night has accumulated.
The dust is more thoroughly destroyed by the cleaning necessary to
oiled and polished boards _of the Bethanien variety_, than by any other
cleaning I have seen. It is fairly destroyed; whereas both _parquets_
and boards generally retain a little.
Also, the water, with which the oiled boards after being swept are
cleaned, freshens the ward and purifies it of the closeness remaining
of the night air, in a very speedy and remarkable manner, which is even
more evident as well as more useful in winter than in summer--as in
winter it is not possible to admit as much air from the windows as in
summer, especially when it is most wanted, in the cold, close, early
mornings.
The advantages of oiled and polished boards as counteracting the
spread of miasma, which is strongly dwelt on at Berlin by competent
authorities, I have not alluded to, as probably _parquets_ are
considered equal in these respects to them.
Stains, mess, and dirt falling on polished oiled boards are much more
easily cleaned than on parquets.