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HEALTH IN THE HOSPITAL.
In preparing to do the duty of society towards the wounded or sick soldier, the first consideration is, What is a Military Hospital? No two nations seem to have answered this question in the same way; yet it is a point of the first importance to them all.
When England went to war last time, after a peace of forty years, the only idea in the minds of her military surgeons was of Regimental Hospitals. There was to be a place provided as an infirmary for a certain number of soldiers; a certain number of orderlies were to be appointed as nurses; and the regimental doctor and hospital-sergeant were to have the charge of the inmates. In each of these Regimental Hospitals there might be patients ill of a great variety of disorders, from the gravest to the lightest, all to be treated by the same doctor or doctors. These doctors had to make out statements of all the diets, as well as all the medicines required by their patients, and send in their requisitions; and it might be said that arrangements had to be separately made for every individual patient in the whole army. The doctors went to work each in his own way, even in the case of epidemics. There was no knowing, except by guess, what diseases were the most to be apprehended in particular places or circumstances; nor what remarkable phenomena of disease were showing themselves on any extended scale; nor what improvements could be suggested in the treatment. There was no possibility of such systematic cleanliness and such absolute regularity of management as can be secured by organization on a large scale. Yet the medical officers preferred the plan to any other. One plea was, that the medical officers and the patients were acquainted with and attached to each other: and this was very true. Another consideration was, that each surgeon liked to have his field of duty to himself, and found it an advantage to have a large variety of ailments to treat, to the constant improvement of his experience. They said that doctors and patients and nurses all liked the Regimental Hospital best, and this was clear proof that it was the best. They could at that time say also, that every soldier and every doctor had a horror of General Hospitals, where the mortality was so excessive during the Peninsular War that being carried to the General Hospital was considered the same thing as being sentenced to death.
Such being the state of opinion and feeling in the profession, it naturally happened that British army-surgeons stuck to their Regimental Hospitals as long as they could, and, when compelled to cooperate in a General Hospital, made the institution as like as possible to a group of Regimental Hospitals,—resisting all effective organization, and baffling all the aims of the larger institution.
In busy times, no two Regimental Hospitals were alike in their management, because the scheme was not capable of expansion. The surgeon and his hospital-sergeant managed everything. The surgeon saw and treated the cases, and made out his lists of articles wanted. It was his proper business to keep the books,—to record the admissions, and make the returns, and keep the accounts, and post up all the documents: but professional men do not like this sort of work, when they want to be treating disease; and the books were too often turned over to the hospital-sergeant. His indispensable business was to superintend the wards, and the attendance on the patients, the giving them their medicines, etc., which most of us would think enough for one man: but he had besides to keep up the military discipline in the establishment,—to prepare the materials for the surgeon's duty at the desk,—to take charge of all the orders for the diet of all the patients, and see them fulfilled,—to keep the record of all the provisions ordered and used in every department,—and to take charge of the washing, the hospital stores, the furniture, the surgery, and the dispensary. In short, the hospital-sergeant had to be at once ward-master, steward, dispenser, sergeant, clerk, and purveyor; and, as no man can be a six-sided official, more or fewer of his duties were deputed to the orderly, or to anybody within call.
Nobody could dispute the superior economy and comfort of having a concentration of patients arranged in the wards according to their ailments, with a general kitchen, a general laundry, a dispensary and surgery, and a staff of officials, each with his own distinct business, instead of as many jacks-of-all-trades, each doing a little of everything. Yet the obstinacy of the fight made by the surgeons for the system of Regimental Hospitals was almost insuperable. There was no desire on any hand to abolish their hospitals, which must always be needed for slight, and also for immediately pressing cases. What was asked of them was to give way when epidemics, or a sudden influx of wounded, or protracted cases put a greater strain upon the system than it would bear.
The French, meantime, had three sorts of hospitals,—the Divisional ones coming between the Regimental and the General. Only the very slightest cases ever enter their Regimental Hospital; those which may last weeks are referred to the Divisional; and those which may last months, with prospect of recovery, to the General Hospital. The Sardinian plan was nearly the same. The Russians had Divisional Hospitals at various stations; and all cases were carried to them.
The Regimental Hospitals are wherever the regiments are. The advantage is, that aid can be immediately rendered,—not only in case of wounds, but of cholera, in which it is desirable to lay a patient down in the nearest bed to which he can be conveyed. The disadvantages are the hap-hazard quality of the site, the absence of quiet and seclusion, and the liability of being near the scene of conflict. These things cause the French to prefer the Divisional Hospital, which, while still within reach, is set farther back from the force, in a picked situation, and managed on a large scale and with nicer exactitude.
The General Hospital is understood to be at the base of operations: and this supposes, as a part of its organization, a system of transport, not only good of its kind, but adequate to any demands consequent on a great battle, or the spread of an epidemic in the camp. The nearer the hospital is to the active force, the better, of course; but there are conditions to be fulfilled first. It must be safe from the enemy. It must be placed in a permanent station. It must be on a good road, and within immediate reach of markets. It ought also to be on the way home, for the sake of the incurable or the incapacitated who must be sent home.