An Account of the Diseases which were most frequent in the British military hospitals in Germany

by Donald Monro

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.