1. Throw warm, not hot, water on the floor, and brush firmly and
quickly, wet and dry. A very little soda in each pailful will be an
improvement. More than very little will injure the flooring.
[A new cloth, which it is economical to cut from a great piece which
makes into some or many dozens, should be steeped for a night in a pail
once filled with boiling water, and in the morning rinsed and wrung
several times in clean cold water, then used at once. Two or three new
cloths can be steeped in the same pail.]
III.--_Cautions in Hospital-Building.--Often repeated, but oftener
neglected._
1. Wherever practicable build the hospital on arches; but, for the sake
of discipline, they should be locked up.
2. If practicable, let the laundry, if served by women, be removed from
sight of the place where the patients take exercise, and of the ward
windows.
3. In a Civil Hospital it is objectionable to give the female patients
right to take exercise in corridors which the officers and servants
have constantly to traverse to go to and from the wards. In a Military
Hospital it is of little comparative disadvantage that the patients
should do this, although,
4. In building a hospital it might be well worth while to contrive
that the covered space, essential to give the patients power of taking
exercise, should be used solely for that purpose.
5. In Germany, the general opinion is in favour of small wards, twenty
beds are considered the desirable maximum; twelve, _per se_, better
than twenty.
Ditto in Belgium, under the same restriction, although, in practice,
there are wards containing larger numbers.
In the old Hospitals at Paris, the number of patients is too large.
The Charité has long great wards of 100 and 120 patients. At St.
Louis (which is mostly for cutaneous, not venereal, diseases, where
the patients usually are long under treatment and able to go about,
and where there is little acute illness,) wards of eighty and seventy
beds are the rule, smaller wards the exception. This may be considered
an exceptional class of patients. The Charité, somewhat densely
pressed upon by neighbourhood, is also not considered a favourably
circumstanced Hospital as to air.
Putting aside for a moment the sanitary question, which we have fully
discussed elsewhere, and which appears to be decided in favour of wards
of from twenty to thirty patients, we will look upon the question of
administration. The moment we consider that a great public Hospital
has to provide efficient attendance for all the sick it receives,
that it must be economical of attendance, both because the expense of
attendance, as well as the other requirements of the sick, commands all
practicable economy; and because efficient attendance in sufficient
numbers is difficult to obtain; it becomes evident that it is far
better for the sick to have larger wards, efficiently served by as few
attendants as is compatible with efficiency.
This, which is the fair statement of the case, strikes those who have
watched the working of the system of small wards in North Germany as
more true than ever.
Such persons consider that the size and numbers of the wards at the
Lariboisière Hospital, viz., thirty-four beds, including the two in the
little ward, are good: that preserving the existing considerable space
between the beds, and supposing the same ratio of conditions as to
windows, &c., and the small ward for two at the end, wards of forty or
fifty would be equally healthy for the sick, but that the number fifty
should not be surpassed.
Assuming, however, that thirty patients in a ward, or thirty-two, are
the maximum number, sanitary and administrative necessities being
conciliated, let us see what we do in our Military Hospitals at home.
In most of our Regimental Hospitals the number of wards and of
holes and corners, in comparison with the number of sick, is quite
extraordinary.
In a hospital for a battalion 500 or 600 strong, we shall find eight
or ten wards of small size, a small kitchen, everything, in fact, on a
small scale, just as if a large French Hospital had suddenly collapsed.
How much more sensible would it not be to have one or, at most, two
large wards for thirty sick each, with a small casualty ward and an
itch ward!
How much less expensive such a structure would be in erecting and
administering, and how much more easy would be the discipline and
oversight, not to mention the greater facility of ventilation!
6. There is nothing at the Lariboisière Hospital answering to
casualty wards. Besides the eighteen wards of thirty-four each, the
Hospital contains two little (and inconveniently placed), wards of
ten beds each, which, when medical cases overflow, are made medical
wards; and which are closed when the ordinary wards suffice. But of
casualty wards, for offensive, or noisy cases, there are none, and the
double-bedded little ward at the end of each large ward is intended to
answer this purpose; also, but subsidiary to this, to allow now and
then a patient of the better class to have the comparative privacy.
This latter consideration does not apply to a Military Hospital. As to
allowing Non-Commissioned Officers for instance to be in the little
wards, discipline would, I think, very soon suffer.
But _if_ casualty wards are provided for extra offensive, and noisy
cases, it seems to me that any Hospital would be much better without
these small wards attached to each larger one.
_Apart from the purposes which the casualty wards answer_, they are
a nuisance. If convalescent patients are put into them, they are
comparatively removed from inspection, and often play tricks there.
Patients requiring much attention can seldom be put there, however
their condition otherwise fits them for the little ward, because the
ward attendants, and especially the Sister (as in secularly served
Hospitals the Head Nurse), find it _impossible_ to serve the inmates of
the little ward properly, if there are also many serious cases in the
large ward.
I submit therefore that the small ward is only an incubus, if casualty
wards are provided. One thing is certain: a patient requiring much
attendance, put into a little ward, ought to have an extra attendant
to himself, by day and by night; otherwise, either he is more or less
neglected, or he unduly monopolises the service of the ward attendants.
It remains a question for far others than women to settle, whether
offensive and delirious cases are under more favourable conditions of
cure when scattered in little wards, than when assembled in a large, or
in several small wards. On this subject, I can only add my confirmed
belief that a large airy ward, provided with a few small wards, and
with complete ward attendance, is a much better place for the care and
attendance of such cases, than small wards attached to the ordinary
wards.
7. Avoid many holes and corners. I could _not_ recommend a dining room
for patients attached to each ward, or floor, or pavilion. If there is
any dining room, let all the convalescent patients of the wards not
being convalescent wards, dine together in a room apart from the wards,
and let the rest dine each at his bed side. If not, let each patient
dine at his bed side.
At the Lariboisière Hospital, each ward has a vestiary, a doubtful
arrangement. The nature of a Military Hospital renders it proper to
have but one vestiary under charge of some man.
8. If possible, let all foul linen be delivered daily, twice perhaps
better than once daily, into the laundry, so as to remain the shortest
possible time in the neighbourhood of the ward; otherwise, do what you
will, foul Hospital linen will fairly, to say the ugly truth--stink,
and its temporary receptacle will stink also. I would not make this
temporary receptacle a room. A large chest in the scullery, a region
under constant purification by fire and air, would be, as already
hinted, p. 88, the least bad place for an accumulation inevitable
to all Hospitals, but which should accumulate for as little time as
possible.
9. Provide from the first room for storing and issuing dried clean
linen, as well as laundry room.
10. In badly-planned Hospitals artificial ventilation is an
excellent auxiliary for expelling the foul air, engendered in the
ward, especially at night; but windows only can be relied upon for
introducing good air. Let Hospitals, therefore, be so constructed as
to admit of opening one or more windows as much as possible all the
year round, with as little chance of draught as may be to individual
patients, which can be done by providing double windows, opening above
and below, or by some similar expedient.