CHAPTER II.
The Main Entrance
“There is nothing in a hospital small enough to be careless about,” is a remark frequently heard in hospital corridors. It is important for the housekeeper to bear in mind that, although oft quoted, this statement happens to be true. Perhaps no one thing will produce a more lasting impression on a casual visitor than the manner in which he is received at the front entrance. Two trained nurses who spent a couple of days in visiting hospitals in an eastern city related the following experience: At hospital number one the door was opened by a very untidy-looking, irrepressible colored boy, who seemed to feel it his duty to do the gallant thing according to his ideas of gallantry. After an entirely unnecessary speech, his concluding remarks were that he would just love to go through the hospital with them, but he “ain’t got no time,” and he guessed he’d have to ask Dr. —— to go with them. At hospital number two, no one specially seemed to be in charge of the door, and, after repeated rings, a resident physician, who, judging from his hair and general appearance, had been napping, came rushing through the hall—the door was open—getting into his coat by the time he reached the door. The climax was reached at hospital number three, which was a maternity hospital, an adjunct of a large city hospital. Here the door was opened by a colored woman in the last stages of pregnancy. At hospital number four a pert maid, none too tidy, was on duty at the front entrance. Her distinguishing feature seemed to be that she “didn’t know.” At hospitals five and six, the persons in charge knew what was expected, and did the proper thing, but the varied experiences served to show the laxity that exists in that one particular.
The Porter
The careful hospital housekeeper will see to it that the person in charge of the main entrance knows his business and is reliable and courteous. He need not know all the business of the institution, but he should know enough to answer questions properly and when to be silent. If no special uniform is provided, he should be neatly and quietly attired. Parcels, telegrams, messages, are constantly being delivered for the inmates, and he should be responsible for them until they are delivered to the nurse in charge. Letters should be placed in a locked box, the key to be held by some reliable person who will see to their distribution. Mail for the patients should not be given to the inmates direct, but to the nurse in charge, and some nurse should always be in charge. Carelessness at this point may result in an important letter or message not being delivered, or delivered at a time when it is specially important that the patient’s mind be free from disturbance or intrusion of any kind. Complaints are frequently made, of large hospitals especially, that boxes of flowers sent to patients have been thrown carelessly into a parcel room, and not delivered at all, or delivered after their beauty and fragrance had gone. If the person at the door is careless about matters of that kind, he will be just as likely to be careless about more serious things. A temporary substitute at the door should always be arranged for when the porter is obliged to be absent, even for a few minutes.
The Private Rooms
In all apartments intended for the use of patients some degree of uniformity should be observed in the furnishings, though this may easily be carried to extremes. These rooms vary in size and price, but the essentials for all are the same. The chief thought should be to have the furnishings suitable, sensible and restful. Dainty white enameled furniture for hospital rooms is rapidly replacing that of darker hue and adds greatly to the attractiveness of the hospital. For the average room a combination dresser and washstand is preferable to cumbering the room with two separate pieces of furniture. These have the essential features of the dresser, in that they provide a mirror and drawers, and of the washstand by having a towel rack and cupboard. In any case, small dressers are preferable to large ones. Every private room should have its own wash bowl and pitcher, soap dish, mug, receptacle for toilet brush, water bottle and drinking glass. The bed should be placed so that the nurse can have access to it on three sides. The woven-wire springs should be warranted not to sag in the middle.
Combination Dresser and Washstand
Blankets, on account of the frequent washings, should not be all wool, nor too heavy. For warmth it is better to depend on light blankets than on any form of “comforter.”
Rugs may be as bright and handsome as the hospital can purchase. The cheap wool rugs that are everywhere displayed for sale are a poor investment. The most satisfactory rugs are those made to order of tapestry Brussels, or when it can be afforded, the more expensive grade of Brussels or velvet. For small rooms three widths are usually sufficient and these made without border are not an expensive rug. For larger rooms a border is preferable, but in any case such rugs are economical and serviceable.
Long lace curtains should have no place in a hospital. They are always getting in the way and being torn, always collecting dust and always an obstacle to the view and to ventilation. At best they are a nuisance, an unnecessary expense and serve no useful purpose. Soft, plain white sash curtains are the only suitable curtains for the hospital window. Provision should be made for looping them back if the patient desires it, and most patients have a longing desire to see out of doors.
A comfortable, roomy rocker, with arms and without any “squeaks,” is indispensable in the private room.
Hospital Couches
If large enough, the room should also have a couch. It makes an agreeable change from the bed during convalescence. The common couches with elevated head are most unsatisfactory. No patient can lie on an inclined plane for any length of time in comfort. When it becomes necessary for a nurse to sleep in the patient’s room when on “special duty” these couches are an abomination. No nurse could ever get up feeling really rested, after trying to sleep on such a couch. The best hospital couch is that styled sometimes “the den couch.” The bed is flat, a full six feet by two, and the headboard being at right angles, effectually prevents the pillows from slipping off. Such a couch can be made as comfortable as a bed, combining both beauty and utility. They can be made to order by any firm that manufactures couches or beds. When covered with the best grade of pantasote these couches cost usually from fifteen dollars upward and when covered with leather from thirty dollars upward. They are the only kind of hospital couches it pays to invest in.
HOSPITAL COUCH
INVALID TABLE
Other Accessories
A straight-back chair, a wardrobe for the patient’s clothing, a movable screen and a small table or two, complete the essentials in the modern sick room. The newest hospital tables are of iron and glass and may be had in different sizes. An invalid’s table that will extend over the bed is a luxury much appreciated by the patient, especially during convalescence. Plenty of pillows is another luxury that will add to the patient’s comfort. A small pillow or two to tuck around the patient, in places where a little warmth or support is desired, is a sensible addition to the ordinary furnishing of the sick room. Half a dozen will be none too many.
The best finish for the walls of the private room is a coat of oil paint. They can then be subjected to periodical cleaning without being defaced. The shades should be soft and delicate and restful. A pretty shade of greenish blue is a delight to most eyes. On the wisdom of pictures in a sick room, opinion is divided. Some would banish them as unnecessary, and because they afford a lodging place for dust and disease germs. Others would introduce them to banish the monotony and relieve the walls of the bare effect. If used at all, pictures should be carefully selected, and have plain wooden frames, that will not be injured by disinfectants. To many patients the illuminated scripture texts on the walls are a comfort, and few, even of those who in health have no use for such things, object to them when sick. The custom of making memorial rooms, picture galleries or museums where the memory of benefactors is enshrined, is to be condemned. A simple plate on the wall or on the door is sufficient. More than this is unwise and in bad taste. The craze for memorials has reached a point that is embarrassing in many hospitals, and the time must surely come when doctors and hospital officers will interfere, and protest against having the patient forever gazing into the countenance of some member of the family of the benefactor of the institution.
As soon as possible after a patient has left the room, it should undergo a thorough cleaning. Every article but the stationary furnishings should be removed. Carelessness about this matter sometimes proves very embarrassing. Drawers, cupboards, and wardrobes should be washed with a solution of bichloride of mercury. The windows should be cleaned and fresh sash curtains put on. The walls should be brushed, the floor cleaned, the mattress disinfected, the bed clothing washed and all utensils thoroughly aired. If the last occupant was afflicted with a communicable disease, the mattress should be subjected to steam sterilization.
Fumigation
Fumigation of the rooms periodically is necessary to ensure the safety of the coming patients. Formaldehyde for fumigation purposes has largely superseded sulphur. When the room is ready for fumigation, the windows should be closed, the drawers of the furniture opened, all chinks stopped, the keyhole stopped with cotton, and the room left closed for twenty-four hours. It may then be opened, and, when thoroughly aired, is again ready for occupancy. The sheet method of fumigation, using a pint of formaldehyde to every 1,000 cubic feet of air-space, has been thoroughly tested and proven reliable. The drug is simply poured on the sheet, which is hung over a line in the room to be disinfected, which has been prepared as above directed. It should be remembered that formaldehyde has little or no power of penetration, and for this reason all possible surfaces of materials to be disinfected should be exposed.
The Daily Cleaning
In the daily cleaning, the work should be so divided throughout the entire hospital that the regular morning cleaning can be accomplished in a comparatively short time, leaving special cleaning to be completed later in the day. In order to accomplish this, it may be necessary to employ special cleaners by the hour. This does away with the necessity of providing meals and lodging for a large force of cleaners.
By nine o’clock in the morning the halls and stairs should be in order, front steps and walks cleaned, wards swept and dusted and the whole interior presenting a neat appearance. “Dust in a hospital is not only dust, but danger.” Domestic cleanliness and hospital cleanliness are quite different terms. The hospital housekeeper owes it to the public and to the sick whom she serves to keep the wards and rooms in the best condition for the promotion of health.
On the hardwood floors a soft hair brush will raise less dust than the ordinary broom. Wet tea leaves should be sprinkled whenever obtainable. The dust should be taken up frequently. The ward floors, unless polished, should be washed every day. It is well to change the water often and not use it too freely. Special attention needs to be given to corners. After each meal it will be necessary to brush up the crumbs.
Dusting
The dusting is even more important than the sweeping, and must be done with great thoroughness and care. Each patient in the hospital is helping to make the atmosphere impure by throwing off disease germs. Dried particles of pus, blood and excreta, lint from blankets and bedding, scales of epithelium and other matter, more or less dangerous, are flying about in the air and being deposited on ledges, skirting boards, window sills, bedstead rails and the various parts of furniture. To bring in a feather duster or a dry cloth and attempt to dust, is simply to flap the dust from one place only to have it settle in another. It results in a more equal distribution of the dust, but it is not dusting. Dusting is removing dust, and the only way that can be done effectually is by the use of a damp cloth, to which the particles will adhere. Furniture that will be injured by that kind of dusting is out of place in a hospital. Special attention needs to be given to dusting under radiators and in obscure nooks where dust will accumulate if not looked into daily.
Bath Rooms
The bath rooms, toilet rooms and lavatories also need constant supervision, and ought to be as carefully cleaned and ventilated as any part of the hospital. Indeed, special pains are needed if they are to be free from bad odors. Disinfectants should be used freely in these places at least once a week, and any evidence of imperfect drainage promptly reported and attended to. A good disinfectant for this purpose is the one known as the “American Standard,” made by dissolving six ounces of chloride of lime in a gallon of water. For cleaning bath tubs kerosene is recommended. It is a wise precaution to constantly keep posted over closets and sinks a notice prohibiting the throwing of matches, hair and insoluble material into them. More than one plumber’s bill has been caused by a careless maid emptying her bar of soap from her scrubbing pail into the closet. In fact, so common is that occurrence that a careful housekeeper has invented a device for holding the soap, thus preventing such accidents, and also the waste caused by leaving the soap in the water. This device is a tin box about eight inches long by four inches wide and four inches deep in front and six at the back. On the back are two pieces of wire bent over to fasten the box to the outside of the scrubbing pail. These can be made by any tinsmith at a very small cost, and will hold a cake of soap and a cake of sapolio. They will save many times their cost in a year.