DIGEST.

PAGES

THOUGHTS SUBMITTED BY ORDER1–28

CONCERNING

I.Hospital Nurses.

II.Nurses in Civil Hospitals.

III.Nurses in Her Majesty’s Hospitals.

I.Hospital Nurses1–9

Twenty Observations on how to improve Hospital Nursing.

II.Nurses in Civil Hospitals9–14

Twenty-three Heads for Regulations as to Nursing in Civil Hospitals.

III.Nurses in Her Majesty’s Hospitals15–19

Twenty-two suggestions in the event of the introduction of Female Nursing into Military Hospitals.

Various systems of Female Nursing during the Crimean War in the Military Hospitals19–28

Of the French and Sardinians19–22

Russians22, 23, 26–28

English23

Proposed Duties of Female Nurses in Military General Hospitals23, 24

The Hospital Serjeant, or Ward Master will not be superseded—he will still have too much to do for any one man properly to perform, and part of his duties must be given to another officer24–26

Note in regard to the Russian Nurses employed in the War-Hospitals of the Crimea26–28

SUBSIDIARY NOTES AS TO THE INTRODUCTION OF FEMALE NURSING INTO MILITARY HOSPITALS IN PEACE AND IN WAR1–133

I.Five Conditions essential to this service1–3

II.Our Nurses were of four kinds3

Absolute subordination to the Medical Officer as to Medical Orders essential and practised by us4

III.1. Qualified subordination essential of Superintendent-General to Director-General and Principal Medical Officer4–6

2. Also of Matron and Nurses to Principal Medical Officer and Staff-Surgeons6, 7

3. Female service can only be introduced gradually, and introduction regulated by Director-General7–9

IV.1. Shall Roman Catholic Sisters be introduced?9, 10

2. Or Anglican Sisters?10

3. Power of Police in Civil Hospitals11

Power of Police in Military Hospitals12–15

4. Pay and Rations of Nurses15–20

On the whole it would seem best, where practicable, to board the Nurses, not to “ration” them, nor to let them “find themselves.” Community of cooking implies economy of nourishment17–20

5. Washing to be “put out”20, 21

6. Cleaning their own Rooms21–23

7. Nurses to keep keys of closet in Wards23

8. Pay, dress, and duties of Matrons24–28

More properly named Superintendents27

Lady Volunteers had better begin by being Nurses, not Superintendents ex-officio28

9. Sundry Regulations as to Nurses29–31

10. Have the Patients’ Diets sent hot, and ready divided, from kitchen31

11. What Ward duties the Nurses should do themselves31

And why32, 33

Patients should not be made quasi Orderlies34

Visitors in Military Hospitals35

12. Regulation-Number of Orderlies—depends on the size of wards whether sufficient35–41

What is the regulation-attendance in Naval Hospitals37

What in Civil Hospitals38

Comparative Cost of Nursing in larger and smaller wards39–41

13. Hospital floors 42–51

Sanitary necessities42

Trial of Hospital floors, oiled and polished with “laque” as in Berlin Hospitals, recommended on sanitary grounds and for ease of cleaning43–51

14. Ventilation of Wards51–52

15. Special Wards, whether desirable or not53–54

16. Opinion as to Superintendent-General paying Nurses’ wages, and as to Governor’s jurisdiction over Nurses54–56

17. Wages and Pensions of Nurses56–60

Three rules in raising Wages56

Five general principles as to Wages and Pensions58

Six applications of the foregoing principles58, 59

Seven heads for Regulations as to Nurses’ Wages and Pensions59, 60

18. Proportion of Nurses to Patients61, 62

19. Precautions in sending Nurses on Foreign Service62

Hospital Laundries63

Addenda, with regard to Female Nursing in a Military Hospital on the Pavilion, or Lariboisière Plan63–90

I.Four conditions to be considered in adopting the Pavilion Plan63

1. Economy of attendance64

2. Facility of supervision65

3. Desirableness of doubling the Pavilion, in a Military Hospital, in order to give to each Nurse but one floor to serve65

4. Nurse to sleep near her Ward66

Importance of lighting by gas67

II.1. One Nurse must serve the whole Pavilion, in a Military Hospital, if single Pavilions be adopted68

2. Nurses’ day in such a Pavilion68, 69

3. What the responsibility of Nurses is for

discipline of Ward or Pavilion70, 71

4. Importance of Lifts71

III.1. “Casualty” Cases should be in a completely appointed set of Wards, apart72

And why73

2. Restraint or non-restraint in Violent Cases74

IV.Simplicity of Construction essential to Discipline75

Polished impervious Walls.

Covered Exercising Place.

Reserve Wards76

V.Nurses’ Meals to be sent them Cooked76

VI.Arrangements for a Pavilion and its Wards77–90

2. Where should Wardmaster sleep?77

3. And Orderlies sleep?77

4. And dine?78

7, 8, Scullery to each Ward, and what to be done in it79

Poultice-making79

9. Presses in Ward80, 81

10. Nurses’ Room82

Lavatory, Water-Closet, Sink83

Baths84

11. Summary of arrangements85

Scullery Appurtenances86

12. Nurses’ Sleeping Quarters86

Ward for Sick Nurses87

13. Classification of Patients88

14. Nurses to be called by their Wards88

15. Foul Linen88

16. Washing Bandages89

17. Splints, &c., where to be kept89

Cotton Lint never to be used89

18. Classification of Nurses90

Superintendent’s Store Room90

Addenda as to Mixed Nursing by Nurses and Orderlies in Military Hospitals on the Double Pavilion Plan91–117

I.Orderlies’ Duties91–108

Proportion of Nurses, Ward Masters, and Orderlies to Sick91–93

Wine to be always administered by Nurse93

Orderlies—their Duties vary according to appurtenances of Ward94

If Hot and Cold Water are laid on, and there are Lifts, one Orderly’s Service saved to each 30 Sick94, 95

Night-Duty of Orderlies95–108

Scheme of Night-Service for three Orderlies watching by turns96, 97

Exercise for Orderlies97

Night Refreshment for Orderlies98, 99

Where are the Night Orderlies to sleep?100

Comparative Merits of different Systems of Night Nursing in Home and in Foreign Hospitals101–3

An Assistant Ward Master should go round the Wards at Night104

Extraordinary System of Night-Nursing in the Army at present105–8

II.Twelve Sundries in organizing a Military Hospital108–114

1. Nurses’ Room108

2. Medical Officer’s Room108

3. Water-Closets109

4. Warm and Cold Water Supply109

5. Corridors109

6. Lobby110

7. Material of Ward Utensils110

8. Reserve Wards111–112

Necessity of Annual Cleansing of the whole of a Hospital

9. Occasional Revision of Rules113

10. Defect in German Organization of Nursing113

11. Nurses’ Exercise113

12. Number of Ward Masters114

III.Regulations114–117

1. Deprivation of Visitors salutary in certain Wards114–16

2. Numbering Patients saves time117

3. Prohibition of Swearing117

Conclusion117

Additional Hints as to Pavilion Hospitals suggested by the Construction of the Lariboisière Hospital at Paris118–127

I.Ventilation118–120

Artificial Ventilation never freshens a Ward

II.Oiled Boards versus Parquets120–124

Cleaning polished and oiled Boards much less laborious, and freshens the Ward much more than the frottage of Parquets.

Mode of Cleaning them at Berlin122–124

III.Ten Cautions in Building Hospital Pavilions124–127

Size of Wards. Our own Regimental Hospitals extraordinary for their many holes and corners125

Casualty Wards126

“Contagion” and “Infection” Defined128–132

Idea of “Contagion” invented by Men to excuse themselves for the neglect of all Sanitary arrangements128

In the ordinary sense of the word, no such thing as “Contagion”129

Nor as inevitable “Infection”130

“Infection” and Incapable Management, or Bad Construction, convertible terms131

“Epidemics” do not spread—they develop themselves in Constitutions made ripe for them by Sanitary neglects131

Note on certain “Observations” by Sir John Hall 132, 133

Thoughts Submitted as to an Eventual Nurses’ Provident Fund1–19

Actual Wages and Prospects of Nurses1–3

Some further Provision desirable4–6

Of what Nature?6–15

With regard to Kind?6–8

With regard to Persons?8

With regard to Objects?9–15

Material Objects?9–12

Children, in the case of Nurses, a Temptation to Petty Dishonesty and taking Bribes11, 12

Sanitary Objects?13

Moral Objects?13–15

Hospitals not places for Penitents14, 15

Rules to be followed in giving Assistance15–17

Prospects of Eventual Support18, 19

Note as to the Number of Women employed as Nurses in Great Britain20, 21

Tables of Ages, &c.21

Note as to Teaching Nursing—Institution at Madras22, 23

PRIVATE AND CONFIDENTIAL.