Subsidiary Notes as to the Introduction of Female Nursing into Military Hospitals in Peace and War

by Florence Nightingale

Reserve Wards.

8. In building a large new Hospital, the question of whether or not reserve wards, or Pavilions, should be provided is an important question, to be referred to the proper Authorities. In one German Hospital is a Sommer-Lazareth, or separate Hospital, which most of the sick occupy during the six summer months. This is considered the best plan; but so expensive that well-considered arrangements in designing the building may render its adoption unnecessary. In another German Hospital is a group of wards on each of two floors, into which the male and female patients, especially the surgical cases, are successively moved; both in order that during this time the other wards may be thoroughly cleaned; also to change the air; also in case of some sudden epidemic, &c.

In every Hospital a thorough cleaning of the wards is essential. In three of the great London Hospitals this is done every year, in one every three years. Nuisance as it is, for the time being, it is such a complete purification of places which want purifying, that having it done every year is preferable to every three years. For the same reasons bare white walls, whitewashed every year, and oftener if there has been some sudden outburst of any zymotic disease or Hospital gangrene are preferable to all colour. But polished impervious cement is, it is needless to repeat, the only really safe Hospital wall. When the cleaning time of a great London Hospital draws near, the number of patients is gradually reduced, and none but urgent cases taken in. The cleaning usually begins with the topmost ward of one part of the building, or of several parts of the building at once. The patients are usually moved to the ward immediately beneath. The ward goes through a complete purification, also reparation of whatever wants repair. All its furniture ditto; the bedsteads in particular. Afterwards windows and doors are left wide open for two or three days, and nights so far as feasible. In about a week from its commencement the cleaning is over; the patients moved back; and the ward or wards so cleaned recommence their usual taking-in—and so on. The cleaning of a great London Hospital usually takes two full months; and a great nuisance it is for the time, but the place benefits by it the whole remaining ten. It is excellent economy to have plenty of hands, so as to have the cleaning part, in distinction to the airing part, done as quickly as thorough cleaning admits of. It is very bad economy to put too much of this great extra cleaning upon the Nurses. This would of course not apply to a Military Hospital, where it is important the Orderlies should become as thoroughly qualified as may be for foreign and war service. It is necessary that whatever exterior help is called in, should be closely overlooked; contractors and contractors’ servants being seldom overmuch troubled with conscience.

Now it might be exceedingly worth while to have one or more reserve Pavilions, with a view to this annual cleaning.

If the flooring of polished oiled boards should be found to answer (that it should receive a fair trial is very desirable, as it might result in a material benefit to our Hospitals), it would be doubly useful, when, every third year or so, the oiling and polishing required renewal, to leave the newly-oiled wards empty for a fortnight. An additional week or two would additionally harden and improve the flooring; but a fortnight would suffice.

It might also be right to have reserve wards for what must occur every now and then in a Military Hospital, an influx of patients beyond the usual number, or an outbreak of cholera, or some malignant epidemic, which it might be desirable to isolate from the other patients.

It may now be confidently expected that, under the new régime, the progress in improvement of Military Hospitals will proceed rapidly; that it will be quietly done is almost as certain—real improvement and noisy philanthropy being fearfully inconsistent with each other, especially in that momentous machine called the Army of England, which is no safe plaything.

Dr. Helm, the Director of the Vienna General Hospital, in a little pamphlet published some time ago, insists on the importance, in designing a new Hospital, of providing Reserve wards, especially with a view to dangerous epidemics. They should admit, he urges, of easy and complete isolation from all the remaining parts of the building.

Occasional Revision of Rules.

9. Dr. Esse, Director of the Charité, at Berlin, in a practical and systematic, but pedantic and pudding-headed, little book on Hospitals, published in 1857, strongly urges the importance of occasionally revising and altering the rules of Hospital Officers and servants, and all the Charité instructions end with this proviso of alteration. It is one of our many unavoidable difficulties that it is necessary to begin our work under definite rules, while it is also necessary to consider the service, for some years to come, as tentative and experimental. It is well to bear in mind what cannot be expressed.