2. That the average of severe cases in each ward of London hospitals is very considerably more than the proportionate average of severe cases in each ward of the foreign hospitals in question. In all foreign hospitals with which I am acquainted the proportion of accidents is comparatively small to those of the London hospitals. The docks, the manufactures, the crowded and dangerous works, &c., &c., with us, account for this.
3. That, striking the balance for and against, it is necessary that each London ward should be watched by a Nurse; at the same time, that without doubt a certain number of troublesome, ill-conditioned patients (no ward of any Hospital is without such) sleep soundly and let their neighbours sleep soundly when the Watcher only looks into the ward at frequent intervals, who would, if the Watcher sate in the ward the whole night, make it their business to require attendance from the Watcher during the whole night, or at least much oftener than by the other plan.
II. The second flaw of the above system, as it applies to London Hospitals, is, that it renders Extra-Watchers so often indispensable.
The employment of Extra Watchers can never be wholly prevented, but it should be the endeavour of every Hospital to employ such as seldom as can possibly be. Extra watching is most injurious to the health of all ward-servants, and to the sobriety, and therefore morality, of many paid ward servants.
This is a very important reason, I humbly consider, for avoiding as much as possible small wards.
I do consider small wards very objectionable in working a Hospital.
But it is right to remember that we have been told of England, of Austria and of Prussia that the proportion of severe cases in Military Hospitals in time of peace is considerably smaller than in Civil Hospitals. Night watching is not done in the Military Hospitals either of Vienna or Berlin. Orderlies, or an Orderly, sleep in each ward, and watching is only done to bad cases.
How far English Army Surgeons consider night watching desirable in the Army Hospitals I will presently tell.
I should think the convalescent wards, among many important advantages, would receive a number of patients who require no night watching. An Orderly ought to be at hand here, but not watching.
If night duty is considered requisite in the ordinary wards, I do not see how the English standard of things could be met, excepting by having one Watcher in each ward where there is regular night watching.