OF Military Hospitals.

Whenever Men are seized with Distempers, they ought immediately to be separated from those in Health, and either sent to the Regimental[148] or General Hospital.

There is no Part of the Service that requires more to be regarded than the Choice of proper Places for Hospitals, and the right Management of them, on which the Health and Strength of an Army often depends; for in wet unwholesome Seasons, if infectious Disorders get into the Hospitals, which possibly might have been prevented by proper Care, they often weaken an Army in a very short Time far more than the Sword of the Enemy.

We have no Account of the particular Manner in which the Antients took Care of their Sick and Wounded in Times of War; for although we read in Homer[149] of Surgeons or Physicians attending the Grecian Camp, and in Xenophon[150] of Cyrus’s having appointed Physicians to his Army; and we learn from Tacitus[151] and Livy[152], that the wounded Romans were received into the Houses of the Nobility, and had Physicians to attend them, and were furnished with Fomentations and other proper Remedies; and from Justin[153], that the Lacedemonians followed the same Method: yet these Authors make no Mention of the particular Oeconomy or Manner in which these Hospitals were conducted.

The Hospitals commonly wanted for an Army acting on the Continent, are,

1. One in the Rear, to follow their Motions, so as to be always ready to receive the Sick from Camp, which is called the Moveable or Flying Hospital. 2. One or more, at some Distance, in Towns, to receive such of the Sick as can be moved from the Flying Hospital, when they are obliged to go from one Place to another; or when a greater Number of Sick is sent to them than they can easily take Care of[154].

Each of the Hospitals ought to be provided with Physicians, Surgeons Mates, Purveyors, or Commissaries, and others, to attend and take Care of the Sick.

Besides the physical People who attend the Hospital, one or two Physicians ought to go along with the Army to attend the Commander in Chief, and the General and Staff Officers, in Case of Sickness; and an Apothecary, provided with a small Chest of Medicines, ought to attend at Head Quarters to make up the Prescriptions of the Physicians.

A Number of Hospital Surgeons also, with Mates, ought to attend the Army, to be ready in Case of an Action. These ought to be attached to the Suite of the Commanders of the different Corps or Brigades, and to be quartered or encamped with them. And each Surgeon should be provided with a Waggon or some Horses loaded with a proper chirurgical Apparatus, as Instruments, Bandages, Lint, and other Things necessary for taking Care of the Wounded.

A small Quantity of Medicines, some Wine, Rice, portable Soop, &c. and Utensils for a small Hospital, and two, three, or four hundred Sets of Bedding, should be carried about with the Army, in Case of an Action, for the Use of the Wounded, till they have Time to receive Assistance from the Flying Hospital. Some of the Bedding ought to be carried on Horseback, so as to be at Hand when any of the Surgeons are sent with Detachments that are going upon an Attack.

To prevent crowding the General Hospitals in Winter Quarters, every Regiment ought to take Care of their own Sick, and to have proper Hospitals fitted up for them.

Dr. Pringle has laid down some very good Directions with regard to the Choice of Places fit for Hospitals, and the Method of preventing infectious Disorders in them; and we find many excellent Hints of this Kind in Dr. Lind and Mons. du Hamel’s Treatises on the Means of Preserving the Health of Seamen, and some likewise in Dr. Brocklesby’s late Treatise on military Disorders.

In the Time of Service the Commander in Chief generally orders the Hospitals to be established in Towns or Villages that least interfere with the military Operations, to which the Sick and Wounded can most easily be conveyed; and which he can best protect from the Insults of the Enemy[155].

In Towns, the Places fittest for Hospitals are public Buildings, which have large dry airy Apartments, situated on a high Ground, where there is a free Draught of Air, and a Command of Water.

In Winter, those Houses, which have open Fire Places in the Rooms, are always preferable to such as have close Stoves, or no Fire Place at all; for an open Fire Place serves to keep up a free Circulation of Air in a Room, as well as to keep it warm. And for the same Reason, where nothing but Stoves can be got to warm the Wards, the Wynd Stoves, which open into the Room or Ward, are vastly preferable to the close ones.

Where there are no public Buildings, private Houses answering nearest to the above Description are most proper for Hospitals. In general, Houses with small Rooms make but bad Hospitals; and very Damp and close Places ought by all Means to be avoided.

In Summer, when the Moveable or Flying Hospital is ordered into Villages, large Barns, and the largest airy Houses, are the best.

Churches, situated on a dry high Ground, make good Summer Hospitals; and in Winter, when Necessity obliged us sometimes to use them in Germany for this Purpose, they were found to answer very well, when we had Bedsteads or Cradles for the Men to lie upon, and the Wynd Stoves to keep them of a moderate Heat.

In making Choice of Houses for Hospitals, particular Regard ought to be had to the Privies or Necessaries; because, where their Smell is offensive, there is always Danger of infectious Disorders. If, therefore, there be no proper Conveniencies of this Kind about an Hospital, such ought to be contrived so as to prevent any Danger from their putrid Effluvia. If there be a River near the Hospital, the Necessaries may be made above it at a Place where there is a rapid Stream below. In Villages deep Pits may be dug in the Ground behind the Hospital, and Seats made over them, as in Camp; and a thick Lay of Earth be thrown above the Fœces every Morning, till the Pits are near full, and then they must be filled up, and others dug to supply their Place.

When once the Places are fixed upon for Hospitals, every Ward ought to be made perfectly sweet and clean; first, by scraping and washing with Soap and Water, and afterwards with warm Vinegar; and then they ought to be fumigated with the Smoke of wetted Gunpowder and of Aromatics, and afterwards well dried and aired by lighting Fires, and opening the Windows, before any Sick are admitted.

After this the Beds ought to be laid; in doing of which great Care should be taken not to crowd the Wards too much, as nothing corrupts the Air so much, or so soon brings on infectious Disorders. Dr. Pringle says, the Beds ought to be laid so thin, that a Person unacquainted with the Danger of bad Air, might imagine there was Room for double or triple the Number. In high lofty Apartments, and in Churches, and other large Places, the Beds may be laid much closer together than in Rooms with low Cielings. In Churches, or such Places, thirty-six square Feet, or a Square of six Feet by six, may be allowed for each Man; but in common Wards we must allow from forty-two square Feet, i. e. six by seven Feet, to sixty-four square Feet, or eight by eight, according to the Height of the Cieling, the Airyness of the Place, and the Nature of the Diseases of the Patients.

The Bedding most fit for Hospitals, is Palliasses and Bolsters filled with Straw, Sheets, and Blankets, as they can easily be washed. Feather Beds and Matrasses are apt to retain Infection, and cannot be easily cleansed. In the fixed Hospitals, Bedsteads or Cradles may be set up for laying the Bedding on: But in the Moveable or Flying Hospital the Bedding must be, for the most part, laid on the Floor.

When once the Beds are laid, and the Sick arrive, some of the Gentlemen belonging to the physical Department ought to attend, to distribute the Sick properly through the Hospitals.

All the Surgery Patients, such as have Wounds, Ulcers, Sores, the Venereal Disease, &c. should be separated from the Rest, and put either into particular Wards by themselves, or into an Hospital fitted up for that Purpose under the Direction of the Surgeons.

Those labouring under infectious Fevers and Fluxes, should each of them be placed in good airy Wards by themselves, where the Beds are laid much thinner than in the other Wards of the Hospital. If the Flux Wards have a Privy near them, where the Men can ease themselves, without being offensive either to their own Ward, or any other Part of the Hospital, they are so much the fitter for such Patients. In the Hospital I attended at Bremen, the Flux Ward had a Necessary that opened into the River Weser, and at Natzungen a deep Pit was dug in the Field about twenty Yards from the Barn where the Flux Men lay, which kept these Wards always sweet.

Patients that have got the Itch, or any other infectious Distemper, ought likewise to be put into separate Wards by themselves; and at all Times a Place should be set apart for those who may be taken ill of the Measles or Small-Pox. A House separated from the other Hospitals, with a distinct Set of Nurses and other Attendants, bids fairest to prevent the Infection from spreading.

When once the Sick are properly ranged, the next Care must be to prevent infectious and malignant Disorders from being generated, and from spreading amongst the Sick; which is principally to be effected by keeping the Sick and the Hospital extremely clean and well-aired, and the Wards as sweet, and free from putrid and offensive Smells, as possible.

Every sick Man, as soon as he arrives at an Hospital, should be washed with warm Water, or if there is a warm Bath, or bathing Tub, to be put into it; and afterwards be supplied with a clean Shirt[156] well-aired before he be put to Bed; and his own dirty Linen should be immediately carried to the Wash-House: And every Morning each Nurse ought to carry a Bucket full of warm Water, and a Piece of Soap and a Towel, round to each of her Patients, and make them wash their Hands and Face, and their Feet, when dirty.

Every Morning all the Wards ought to be scraped and swept, and afterwards sprinkled with warm Vinegar; and when dirty, they ought to be washed after the Fires are lighted.

Every Thing in the Wards, and about the Sick, should be kept as clean as possible; the Chamber-Pots and Close-Stools ought to be carried away as soon as used, and immediately emptied and washed before they be brought back.

The Windows of the Wards ought to be kept open to admit fresh Air Morning and Evening, for a longer or shorter Time, according as the Weather will permit.

If the Wards are close, and the Cieling too low, Dr. Pringle advises to remove some Part of them, and to open the Garret Story to the Tiles[157]; and if the Opening of the Windows is not sufficient to air the Wards, Ventilators of different Kinds, such as those mentioned by Dr. Hales and Dr. Pringle, may be used, especially when the Weather is hot.

In Winter, Fires should be lighted in all the Wards where it can be done.

In foreign Countries, when we meet with Hospitals where there are no Places for open Fires, but only close Stoves, different Contrivances may be used to renew the Air. Ventilators of different Kinds may be used, or Openings made in the Doors and Windows. In Winter 1761-62, some of the Wards in the Hospital at Bremen which I attended had such Stoves. In order to keep up a free Circulation of Air in those Wards, I directed large Holes to be cut in the lower Part of the Door in each Ward, and two Grooves to be made on the Outside of the Door, above and below the Hole, parallel to each other, in which a Board slided; by means of which, the Hole could be either quite covered or only in Part, or left entirely open; and I directed a Casement, about eight or nine Inches square, to be made in the upper Corner of each Window. After the Fires were lighted, upon removing the Board which covered the Hole in the Door, and opening the little square Windows, a Current of fresh cool Air rushed into the Ward by the Door, while the heated foul Air found an Exit by the Windows. In very cold Weather, the Opening of the small Windows was sufficient; but in mild Weather, and in Summer, it was necessary to keep both open.

The Wards should be daily fumigated by Means of Aromatics, or wetted Gunpowder thrown on burning Coals, put in an Iron Pot or Chaffern, or with the Steams of warm Vinegar placed in the Middle of the Ward. Dr. Lind says, that although Cleanliness and a pure Air contribute much to prevent infectious Disorders, or to check them, yet that they of themselves are not always sufficient; but that he seldom or never knew a proper Application of Fire and Smoke to be unsuccessful in producing the happy Consequence of effectually purifying all tainted Places, Materials, and Substances[158].

In all Military Hospitals, at least in the fixed ones, one Ward ought to be always kept empty; and whenever a malignant Fever, or any other infectious Disorder, breaks out in any Ward, the Men ought to be removed into this empty one; and the foul Ward purified, by washing and cleaning it well with Soap and Water, and then with warm Vinegar; and afterwards purifying it with Smoke, in the same Manner as is practised in his Majesty’s Ships of War; and Fires should be lighted daily, and the Windows kept open for some Time, before any Sick be again admitted into it.

As soon as any Patient dies, the Body ought to be removed to the Dead House; and the Bedding he lay upon should be carried away immediately, and not used again till it has been smoked, well-aired, and washed.

All the Linen of Patients in Fevers, Fluxes, and other infectious Disorders, ought to be changed often; and all the foul Linen and foul Bedding of the Hospital should be smoked with the Fumes of Brimstone, or of wetted Gunpowder, in a Place set apart for that Purpose; and Dr. Lind advises to steep them first in cold Water, or cold Soap Lees, before putting them in warm Water; as it is dangerous for any Person to receive the Steam that may at first arise, where this Precaution is not used.

All the Cloaths, of Soldiers who die in Hospitals, ought to be sent to the Smoke House, and be well fumigated, and afterwards aired, before they are put up in the Store-House.

The next Thing to be considered about a Military Hospital is the Diet of the Patients, which should consist of good wholesome Provisions, that can be purchased easily, and at a cheap Rate[159].

Good Bread[160] is a standing Article of Provisions for an Hospital in all Countries and in all Climates; and a certain Quantity of it ought to be distributed to each Man daily.

The Breakfast and Supper in most Military Hospitals must be made of Water Gruel or Rice Gruel; as either Rice or Oatmeal can be got in most Places, and are very portable.—Water Gruel is in general preferable to the Rice Gruel, because most Patients nauseate the Rice Gruel, after eating it for some Days, but not the Water Gruel, as every Person, who has attended the Military Hospitals, must have experienced. Where both Rice and Oatmeal can be had, Rice Gruel may be used two or three Times a Week by Way of Variety.

But although Rice Gruel is not so proper for constant Use, yet Rice should always make an Article among the Stores for an Hospital, as it is useful for making Rice Water for Drink; and it can be boiled or ground, and made into a light Pudding, and in short may be used in a Variety of Forms to make a good and wholesome Food for the Sick.

Oatmeal is cheaper than Rice, and can be procured almost every-where in Europe, where Armies make Campaigns; as Oats make such a great Article in the Forage for Horses. And a sufficient Quantity can at any Time be ground into Meal for the Use of the Sick, at the Mills which are employed for making Flour for the Bakery, if there be none nearer the Hospital.

In Countries where neither Oatmeal nor Rice can be had, Indian or some other Corn, which is known to be wholesome, and which the Country affords, may be employed in their Place.

When fresh Meat can be got, the Men who are on full Diet, and the Nurses and other Servants about the Hospital, should have Meat for Dinner; and the Meat that is boiled for them ought to make Broth for the Sick who are kept on a low or middle Diet. Some Barley or Rice should be added to the Broth; and a small Quantity of Carrots, Turnips, or other Vegetables, boiled along with them, will make it more agreeable to the Taste.

On Expeditions where nothing but salted Meat can be had, a Quantity of portable Soop should always be carried out for the Use of the Sick; which with Water and some Barley, and fresh Vegetables, when they can be got, will make a good Soop or Broth. On such Occasions, the Dinner ought to consist of Soop and Bread, or of light Puddings made of Flour or of Rice, of boiled Rice or Barley, or of Panado, &c.

Nurses and recovered Men may be allowed salted Meat twice or thrice a Week.

The common Drink of Military Hospitals ought to be Rice and Barley Water, with a small Proportion of Spirits and Sugar. Small Beer is a good Drink where it can be easily procured; as is Wine and Water, or a very small Negus, or very weak Punch in warm Climates.

Besides this Diet, extraordinary Indulgences may be occasionally allowed to particular Patients, as Wine, Brandy, Sugar, Milk. And the Physicians and Surgeons ought to have a discretionary Power to order a Vegetable or any other proper Diet for Patients in the Scurvy, or any other particular Complaints.

The Established Diet of a Military Hospital may be,

Breakfast.Dinner.Supper.

Full Diet, One Pint of Water or Rice Gruel. Water Gruel made with 3 or 4 Ounces of Oatmeal, a little common Salt, and with or without a little Sweet Oil, and two Spoonfuls of Wine. Rice Gruel made with two Ounces of Rice, one Spoonful of fine Flour, a little common Salt and Sugar. One Pound of boiled fresh Meat. As Breakfast.

Middle Diet, Ditto. One Pint of Broth, half Pound of boiled Meat. Ditto.

Low Diet, Ditto, or according to the Patient’s Appetite. One Pint of Broth, or half a Pint of Panado, with two Spoonfulls of Wine, and a Quarter of an Ounce of Sugar. Ditto.

The daily Allowance of Bread to be one Pound to each Man.

The common Drink for those on full and middle Diet to be Rice or Barley Water, with two Spoonfuls of Brandy to each Pint, and a Quarter of an Ounce of Lump Sugar; small Beer, or very weak Punch; or Wine and Water, two Ounces of Wine to a Pint of Water, and a Quarter of an Ounce of Sugar. The Quantity not to exceed three Pints per Day.

Those on low Diet to have Rice or Barley Water as above, with or without Wine or Brandy.

The Diet Boards hung up in the Hospitals may be made with the following Columns, nearly as they were with us in Germany.

Regiments.Mens Names.Diet F.M.L.Wine. ½ Pints. Brandy. Ounces.Milk. ½ Pints.Sugar. Ounces.

When such Diet Boards are kept in an Hospital, and the Mens Names and Regiments are once wrote down, the Patients may with very little Trouble be put upon the full, middle, or low Diet, with so much of the above-mentioned Extraordinaries as may be judged proper.

If any Thing else be wanted for the Sick, the Physician ought to give a particular Order in Writing for it, the Columns here marked being only for such Things as are most frequently wanted.

It should be a general Rule in all Military Hospitals, that, when a Party of Sick arrives, every Man may have immediately a Mess of Water Gruel given him, and afterwards be put on low Diet till it is ordered otherwise by the Physician or Surgeon who attends him.

It is not to be supposed that the Diet here mentioned can be strictly kept to in all Parts of the World; for it must often be varied according to the Difference of the Climates, and to the Provision of the Countries where the Scene of War may be.

Whenever a Moveable or Flying Hospital is to attend an Army, a Quantity of Bedding, and of all Utensils for forming an Hospital, ought to be put up in the Waggons, together with Provisions of different Kinds, such as Oatmeal, Rice, Sago, Brandy, Wine, Sugar, &c. A Butcher with a Stock of live Cattle, and a Baker with a proper Quantity of Flour for making Bread ought constantly to attend; and a Number of empty Waggons should likewise be always in Readiness, to transport the Sick when the Hospital moves, or when a Party is to be sent to the fixed Hospitals.

When Troops go upon an Expedition, besides the common Hospital Ships, another Ship ought to be properly fitted up for the Reception of sick Officers[161]; and every Hospital Ship ought to be supplied with all Sorts of Provisions, and other Necessaries fit for forming an Hospital, before they leave England.—And one or more armed Vessels loaded with Provisions, Wine, and all Sorts of Necessaries for the Sick, ought to attend them; or if the Expedition be intended for the warm Climates, these Vessels ought to go before the Fleet to take up Wine and Fruits, such as Lemons, Oranges, &c. Vegetables of different Kinds, and a live Stock for the Use of the Sick.

All Hospitals attending Expeditions should carry out among their Stores a Number of large Tents for lodging the Sick and Wounded immediately on making good their Landing. Where a Siege is expected which will take up Time, and where no Accommodations for the Sick can be had till the Siege is over, a Ship or two, with Boards, and other Necessaries for building large Sheds, or temporary Hutts, for the Sick, as proposed by Dr. Brocklesby, ought to go along with the Fleet, or meet them at the Place of their Destination. Such thatched Sheds, or Hutts, are very necessary in the warm Climates, as the perpendicular Rays of the Sun, beating upon Canvass, make Tents intolerably hot. When any of our own Settlements happen to be near the Place attacked, a fixed Hospital may be established there; either in Houses, if proper ones can be found; or in temporary Sheds or Hutts erected for that Purpose; and some Vessels, properly fitted up, may be kept going with the Sick and Wounded, and bringing back the recovered Men.

At every Military Hospital a Serjeant’s Guard ought to mount; and Centinels be placed at the Doors of the Hospital, 1. To prevent all Visitors, who have not proper Leave, from coming into the Hospitals; as such People oftentimes crowd the Wards, disturb the Sick, and are apt to catch infectious Distempers, and to spread them among the Troops. 2. To take Care the Patients do not go out of the Hospital without having a Ticket[162] of Leave for that Purpose, signed by the Physician, Surgeon, or Apothecary, belonging to the Hospital. 3. To prevent spirituous Liquors, or other Things of that Kind, being clandestinely carried into the Hospital.

The Serjeant of the Guard, attended by the Ward Master, ought, every Morning, to go round the Wards to call a Roll, and see that every Man is in his Ward; and to do the same at Night before the Hospital Doors are shut, and at this Time to order every Person out of the Hospital who does not belong to it. And the Serjeant, every Morning, ought to report to the Physician, Surgeon, or Apothecary, every Man’s Name who was found to be absent at Roll-calling; and whether he found every Thing regular and in good Order in going his Rounds.

Every large Military Hospital ought to have one Head Nurse, and a sufficient Number of other Nurses, to attend and take Care of the Sick.

Orders to the following Purport, hung up in every Military Hospital, would serve to shew the Nurses and Patients what their Duty is, and to maintain Regularity and good Order through the whole Hospital.

Matron, or Head Nurse.

Every Matron, or Head Nurse, is to go round all the Wards of the Hospital at least twice a Day, Morning and Evening; to see that the Nurses keep their Wards clean; that they behave themselves soberly and regularly, and give due Attendance to their Patients; and to examine the Diet of the Patients, and see that it is good and well dressed; and if she finds any Thing amiss, to report the same to the Physician, Surgeon, or Apothecary, of the Hospital.

Common Nurses.

1. The Nurses are to give due Attendance to their Patients; and to keep them always as neat and clean, as the Nature of their Distempers will admit of; to give them their Diet regularly; to be particularly careful to see them take the Medicines ordered by the Physicians, according to the Directions given; to report to the Physician, Surgeon, or Apothecary, any Faults or Irregularities which any of their Patients may have committed; and to acquaint the Ward Matter and Head Nurse of the Death of any of their Patients as soon as it happens, that proper Care may be taken of their Cloaths and Effects.

2. They are to keep their Wards extremely clean, to sprinkle them every Morning with Vinegar, and to fumigate them with the Smoke of wetted Gunpowder, or of Frankincense, or any other Aromatics that may be thought proper; in fair Weather to keep open the Windows of their Wards, twice or thrice a Day; for a longer or shorter Time, as the Weather will permit; to attend at the Steward’s Room for the Provisions of the Patients at the Hours appointed for that Purpose; and to pay implicit Obedience to the Matron, or Head Nurse, in what relates to their Duty; and punctually to obey all Orders they receive from the Physician, Surgeon, or Apothecary, of the Hospital.

3. They are to keep themselves clean and decently dressed, and to observe the strictest Rules of Sobriety; remembering, that if any one is found intoxicated with Liquor, that she is immediately to be sent to the Guard, and afterwards discharged.

4. They are not to absent themselves from their Wards, unless when employed in the Discharge of their Duty; nor to go out of the Hospital to which they belong, without having a Ticket of Leave signed by the Physician, Surgeon, Apothecary, or Head Nurse, belonging to the Hospital.

5. They are not to throw Nastiness of any Kind out at the Windows, but to carry it to the common Necessaries, and to empty the Chamber Pots and Close-stools as soon as used, and be careful to wash them before they bring them back.

6. They are not, upon any Pretence whatever, to alter the Diet ordered by the Physicians or Surgeons to the Patients on the Diet Boards; nor to suffer their Patients to use any other Diet than what is allowed by the Hospital; nor are they to bring, or allow others to bring, Meat, spirituous Liquors, or other Things of that Kind, into their Wards, except what is allowed by the Physicians or Surgeons. Whenever any Thing of this Kind is found in any of the Wards, it ought immediately to be thrown into the common Necessary; and if it be found in the Custody of a Nurse, she ought to be confined in the Guard, or discharged.

7. Nurses guilty of great Neglect of Duty, or of getting drunk and using their Patients ill, or of stealing, or concealing or taking away the Effects of Men who die in the Hospital, are to be immediately sent to the Guard, and reported to the Commanding Officer of the Place, that they may be tried by a Court-Martial, and be confined, whipped, or otherwise punished, as the military Law directs; all Followers of Armies on foreign Service being equally subject to the military Law as the Soldiers themselves.

Patients.

1. All sick Soldiers, on their Arrival at a Military Hospital, are to be washed all over with warm Water, or to go into a warm Bath; and afterwards to wash their Face and Hands every Morning, and their Feet occasionally, with warm Water and Soap, brought round every Morning by the Nurses for that Purpose; and they ought to comb their Head every Day. If they be too weak to wash and comb themselves, it is to be done by their Nurses.

2. Every Patient is to be shaved and have clean Linen twice a Week, or oftener if requisite.

3. They are punctually to obey the Directions given them, and to take the Medicines ordered by the Physician; and none to be allowed to go out of the Hospital without a Ticket of Leave signed by the Physician, Surgeon, or Apothecary, of the Hospital.

4. They must commit no Disorder or Riot, but in all Respects behave themselves well.

5. If any Man disobeys the Orders he receives from the Physicians or Surgeons, or is irregular in Conduct, gets drunk, and commits Riots in the Hospital, or is found guilty of Theft or other Crimes, the same is to be reported to the Commanding Officer of the Place, and he to be tried by a Court-Martial, and punished as soon as his Strength will permit.

In conducting the Military Hospitals, we found that it was always right to discharge the Patients from the sick Hospitals as soon as they were recovered, and to send them either to Billet, or to a convalescent Hospital; because recovered Men are always the most riotous; besides they crowded the Hospitals, and were in Danger of catching fresh Disorders from those who were sick; and therefore the recovering Men in every Hospital ought to be reviewed once or twice a Week by the Physician or Surgeon, and the Names of such Men as are well enough, to be marked; in order that they may be sent the next Day to the convalescent Hospital, or to Billet. A Return of those marked for Billet ought immediately to be sent to the Officers on convalescent Duty.

When a convalescent Hospital is established, it ought to be put under proper Regulations; the following are those which I drew up for that established at Osnabruck in April 1761, and which were found to answer the Purpose intended.

Regulations for a Convalescent Hospital.

1. That this Hospital be entirely occupied by such Men as are recovered from Diseases; that no Men be sent there but those whose Names are returned to the Purveyor’s Office by the Physician or Surgeon of the Hospital.

2. That all the Patients shall be upon full Diet, unless in particular Cases it be ordered otherwise by the Physician or Surgeon.

3. That all the Patients shall breakfast, dine, and sup, at regular stated Hours, in the Hall appointed for that Purpose: Breakfast to be ready at nine, Dinner at one, and Supper at seven o’Clock in the Evening.

4. That no Patient shall carry up any Victuals into the Wards appointed for sleeping in; and if any Patient does not attend at the regular Hours of Meals, no Allowance of Victuals shall be made him in the Place of such Meals, unless he has been absent on Hospital Business, or been confined to Bed by Sickness.

5. That as soon as the Men are come down Stairs to Breakfast, the Wards in which they sleep shall be cleaned out and sprinkled with Vinegar, and the Windows opened to air them.

6. That the Doors of this Hospital shall be locked every Night at eight o’Clock, and no Man be allowed to come in or go out after that Time. The Doors to be opened again at seven o’Clock in the Morning.

7. That the said Hospital is to be visited two or three Times a Week by the Physician, Surgeon, and Apothecary, who are to see that the above Orders are complied with; to examine the Diet, and take Care that every Thing is carried on properly; and to prescribe for any little Disorders the Men may be affected with.

8. That one of the Hospital Mates be appointed to visit this Hospital daily, to administer any Medicines which may have been prescribed by the Physician; to apply any Dressings ordered by the Surgeon; and to acquaint the Physician or Surgeon if any of the Men be so bad as to require their Attendance, or to be sent back again to the Sick Hospital.

9. That for the better executing these Regulations, orderly Serjeants or Corporals be appointed for the Care of the Men; who shall mount a Guard of six or more of such of the Patients of the said Hospital as are fit for this Duty—That the Serjeants are to call a Roll of all the Patients regularly three Times a Day, before Breakfast, Dinner, and Supper; to see that the Men behave themselves soberly and decently; and that they keep themselves clean, and commit no Riots; and to confine in the Guard such as commit Riots and other Irregularities, or whom they find drunk, or who stay out all Night; and to report the same to the Officer on Duty.

10. That an Officer on convalescent Duty do visit the said Hospital daily at the Times of Roll-calling, to see that every Thing be carried on properly; and to receive the Reports from the Serjeants, and give what Orders he may think proper for the better regulating the said Hospital.

11. That if at any Time it should happen that there are more Convalescents than the Hospital can hold conveniently, a Review be made of all the Patients, and the strongest and most healthy be sent to Billet.

12. That a Review be always made, when any Party is going to join the Army, to pick out the Men who are fit to join their Regiments.

The Physical Officers employed in the Military Hospitals, are Physicians, Surgeons, and Apothecaries.

No Person ought to be appointed a Physician to the Army, or Military Hospitals, without previously undergoing the same Examination at the College of Physicians, as those do who enter Fellows and Licentiates of the College, that none but proper Persons may be employed. On such Examinations the Physician General to the Army ought to be allowed to sit as one of the Censors of the College.

The Surgeons are all obliged to pass an Examination at Surgeons Hall before they are appointed, and the Apothecaries ought in like Manner to pass an Examination at Apothecaries Hall.

The Mates employed in the Service ought, previous to their Appointment, to be examined both in Surgery and Pharmacy, as the Service commonly requires their acting in both Branches.

The Direction of all Military Hospitals ought always to be committed to the Physicians, who have the immediate Care of Hospitals.

When an Army is acting on a Continent, and there is a Number of Hospitals in different Places, the Physician who attends the Commander in Chief ought to be made Physician General and Director of the Hospitals, with proper Appointments; and all Orders from Head Quarters ought to go immediately thro’ this Channel.

Every other Physician at the different Hospitals ought to direct every Thing about the Hospital which he attends, and his Orders ought to be punctually obeyed; and he ought to keep up a constant Correspondence with the Physician General; acquainting him from Time to Time with the State of the Hospital, and what is wanted for it; and he ought punctually to obey whatever Orders he receives from the Physician General.

If there be separate Hospitals for the Surgery Patients, the eldest Surgeon ought to direct every Thing in the Hospital he attends; and when any Thing is wanted for his Hospital, to report the same to the Physician General.

The directing and purveying Branches ought never to be entrusted to the same Person, as the Temptation of accumulating Wealth has at all Times, and in all Services, given Rise to the grossest Abuses, which have been a great Detriment to the Service, as well as to the poor wounded and sick Soldiers, and has occasioned the Loss of many Lives. And therefore neither the Physician General, nor any of the Physicians or Surgeons of the Army, or any other Person concerned in the Direction of the Military Hospitals, ought ever to act as Purveyor or Commissary; nor ought they ever to have any Thing to do with the Accounts, Contracts, or any other Money Affairs relating to the Hospital; and if ever they be found to intermeddle in these Affairs, they ought to be immediately dismissed the Service.

The purveying or commissariate Branch ought to be entirely distinct from the physical. The Purveyors or Commissaries ought punctually to obey whatever Orders they receive from the Physicians or Surgeons; to provide every Thing for the Hospital; to keep regular Accounts of all the Men who come into, or go out of the Hospitals; and from Time to Time to make Returns to Head Quarters of all the Men in Hospitals; and their Accounts ought to be controuled by such Persons as the Government may think proper.

Every Physician and Surgeon of a Military Hospital ought to visit the Sick at regular stated Hours, and the Mates to attend and go round with them, and receive and execute their Orders.

Every Mate ought to have a certain Number of Patients allotted him, for whom he is to make up all Medicines, dress all Sores, and execute whatever Orders he receives from the Physician, Surgeon, or Apothecary. That the Mates may know and execute their Duty, proper Orders in Writing should be hung up in the Apothecaries Shop for that Purpose. The following are those which I gave out at all the Hospitals I attended in Germany.

Orders for the Mates.

1. That all the Gentlemen do attend at the Apothecaries Shop every Morning at eight o’Clock, to assist in making up the common Medicines of the Day, and afterwards to go round the Hospitals with the Physicians and Surgeons.

2. That every Mate have a Book for writing the Prescriptions of the Physicians in, which is to be kept in the following Order.—First, to mark the Patient’s Name and Regiment; then the Day of his Entry into the Hospital and his Disorder; then the Prescriptions of the Physician; and after all the Day of his Discharge, or of his Death. Ex. gr.

John Clarke, 20th Regiment. Jan. 1. Fever.

Jan. 1. V. S. unc. x.—H. salin. cum pulv. contrayerv. 4^r. die.—2. Emplast. vesicat. dorso, &c.

Discharged or dead Jan. 28.

3. That every Mate make up himself the Physician’s Prescriptions for his own Patients, and afterwards go round and administer them, or give them to his Patients with proper Directions; that he bleed his own Patients, and dress any slight Sores they may have, which do not require their being sent to the Surgery Hospital.

4. That every Mate go round amongst his Patients in the Evening, to see that every Thing is well conducted, and to report to the Physician or Apothecary if any Thing extraordinary happens.

5. That two of the Mates attend all Day at the Apothecary’s Shop to receive any Sick that may arrive, and to place them properly; to make up what Medicines they may immediately want; to order each of them a Mess of Water Gruel; and if any Thing extraordinary occurs, to send an orderly Man to acquaint the Physician or Apothecary with the same. The orderly Mates to make up likewise for Officers, or others, all Prescriptions sent to the Apothecary’s Shop through the Day.

A Joint of Meat, roasted or boiled, for Dinner, and a Bottle of Wine, was allowed to the orderly Mates, by Lord Granby’s Order, that they might not absent themselves from their Duty.—Where there was Conveniency for it, a Mate lodged in the Hospital.

The Apothecary ought to take Care of the Medicines; to go round the Hospitals in the Morning before the Time of the Physician’s visiting; to see that the Wards are in proper Order; that the Nurses and other Servants have done their Duty; to examine into the State of the Sick, and to see that the Provisions are good; and make a faithful Report of all these Things to the Physician when he arrives.—To take Care that the Mates prepare in the Morning the Medicines that are commonly wanted for the Day; and that they afterwards make up faithfully the Prescriptions of the Physician; to go round the Hospital again in the Evening, to see that the Sick have got their Medicines regularly; and to make the same Enquiries as in the Morning.

The Apothecary should always be lodged near the Hospital, to assist in Case of any Accidents happening, or of Sick arriving at the Hospital.

When there are any strong infectious Disorders in Military Hospitals, the physical Gentlemen may use the following Precautions to guard themselves against Infection.

1. Never to visit the Sick with an empty Stomach; but to eat Breakfast before they go into the Hospital.

2. To have a Suit of Cloaths reserved for visiting the Hospital, and a waxed Linen Coat to wear above them in going round the Wards; and as soon as they have come out of the Hospital, to wash and change their Linen and Cloaths.

3. Before they go into the Wards, to order that they be well cleaned out, and sprinkled with Vinegar, and afterwards fumigated, and aired by opening the Windows, or by Working the Ventilators.

4. If the Infection be very strong, to take a Glass of the spirituous Tincture of the Bark just before they go into the Hospital.

5. To put small Rolls of Lint, dipped in camphorated Spirits, up the Nostrils, and to direct a Vessel, with warm camphorated Vinegar, to be carried round, and held near the Patients they are examining.

6. In examining Patients affected with the Petechial Fever, or any other malignant Distempers, to stand at some little Distance, and ask what Questions they may think proper; and when they come near, to feel the Pulse, and examine the Skin, not to inspire while their Head is near the Patient’s Body; but after being fully satisfied in these Points, to retire a little, and ask what other Questions may be necessary.

It would be right to establish some military Rank for every commissioned Officer of the Hospital on Service, and to settle the same Subordination in the physical as in the military Department. By these Means, the Service would be carried on with greater Order, and more Advantage to the Sick.

And it would be right, in Times of War, to add a Clause in the Mutiny Bill to allow any military Officer on convalescent Duty to call in the commissioned physical Officers to assist in making up a Court-Martial, when there are not a sufficient Number of military Officers in a Place, to try convalescent Soldiers guilty of Crimes. For in Times of Service, very often a sufficient Number of military Officers cannot be spared to be on Duty at the different Military Hospitals; and at all such Places the Convalescents are generally very disorderly, when they know that there is not a sufficient Number of Officers to form a Court-Martial for punishing them. Where-ever there are a sufficient Number of military Officers, no physical Officer ought ever to be called upon as a Member of a Court-Martial.

Men, in Time of Service, are often apt to saunter in and about Hospitals, and there learn all Manner of Debaucheries, and lose all Sense of Discipline; and therefore, to keep up Order and Decorum, there ought to be, at every Fixed and every large Military Hospital, a military Inspector or Commander, an Officer of known Activity and Probity; and a Number of Officers on convalescent Duty sufficient to form a Court-Martial whenever required.

The Duty of the Military Inspector, or Commander, should be, to take Care of all Convalescents on Billet; to see that the Officers under him do their Duty, and maintain the same Regularity and Discipline among the Men belonging to their respective Corps, as if they were with their Regiments; and that the Men attend the Parade and Roll-calling; and that they always appear neat and clean.

He ought, from Time to Time, to visit the Hospitals; to see if they are kept clean; to enquire if the Men behave well, if the Diet is good, and the Officers, Nurses, and Servants, do their Duty; and if he finds any Thing amiss, to report the same to the Physicians and Surgeons of the Hospital, or to the Purveyor or Commissary, or others, under whose Department it may be, that the same may be immediately rectified; and if he finds that the superior Officers of the Hospital overlook such Abuses, notwithstanding his Representations, to report the same immediately to the Head Quarters.

He ought to order one of the Officers on convalescent Duty to visit the Hospitals daily, to make the Enquiries above-mentioned, and to give him a Report of the same in Writing.

The Purveyor or Commissary ought to make a Return to him twice or thrice a Week of every Man admitted into, or discharged from, the Hospitals, or who dies in them; marking in the Return the Name of every Man, and the Company and Regiment he belongs to; that he may report the same to the Officers of the different Brigades or Regiments.

The Military Inspector ought to have the Power of providing Billets for all Officers and Soldiers about Hospitals; and the Names of all Men to be discharged from Hospitals should be sent to him the Day before they are discharged, that he may provide Billets for them; and next Day the Men ought to march from the Hospitals to the Parade, to receive their Billets, and the Orders of the Military Inspector, and of the Officers of the Corps they belong to.

The Military Inspector ought to see that the Arms of the sick Men, and the Arms and Cloaths of those who die and are lodged in the Magazines, be properly taken Care of; and that the Stores of the different Regiments be properly looked after.

As the Service often makes it necessary at Military Hospitals, where the Number of Sick is great, to employ the convalescent Soldiers[163] as orderly Men and Servants about Hospitals, all Men thus employed ought to have a special Leave from the Military Inspector for so doing; and no Man should be employed in any Capacity as a Servant about an Hospital, who at that Time is on the Books as a Patient. And all Men employed about the Hospital ought to be reviewed once a Week by the Military Inspector, and likewise whenever a Party of Convalescents is going to join the Army, or their Regiments; that no Man may be allowed to remain with the Hospital, after he is fit to do Duty in his Regiment.

When the Military Inspector is absent, the eldest Officer on convalescent Duty ought to act in his Place.

Every Officer sent on convalescent Duty ought, as soon as he arrives at the Place where the Hospital is, to wait on the Commandant, or Military Inspector; to acquaint him of his Arrival, and to receive his Commands. He ought then to go to the Purveyor or Commissary’s Office, to get a List of all the Soldiers who are in or about the Hospital, and belong to the Regiment or Brigade he is employed for, wherein those on Billet are distinguished from those in Hospitals. The next Day he ought to parade all those marked on Billet, to see if the Number of Men agrees with the List given him, and to examine in what State each Man is, and how he is employed; and then he ought to go round the Hospitals, attended by an orderly Serjeant, to see all the Men in the Hospitals, and to know if the List given him at the Purveyor’s Office was right; and afterwards he ought to send every Day a Serjeant or Corporal to see the Men in Hospitals, and to report to him when any Men are discharged or die.—And he ought to procure from the Military Inspector a Return of all the Men of his Corps, who are either admitted into, or discharged from Hospitals, on the Days when such Returns are made. He ought to make all his Men on Billet appear regularly on the Parade at Roll-calling, and to oblige them to keep themselves clean and their Arms in good Order, and to endeavour to preserve the same Regularity and Discipline as when they are with their Regiments. And whenever a Party is to be sent to join their Regiments, he ought to have all his Men particularly examined; and those Men who are found to be perfectly recovered, should be sent to their Regiments.

If every Officer on convalescent Duty conform to these Directions, no Man can ever be detained without his Knowledge in or about Hospitals, as he must always know where every Man is, in what State of Health, and how he is employed; and may at any Time be able to make a Return to the Brigade or Regiment for which he is employed, of every Man who is admitted, discharged, or dies in the Hospital.

FINIS.

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