ROYAL VICTORIA HOSPITAL, NETLEY
REPORT ON INSPECTION OF NETLEY HOSPITAL BY SURGEON-GENERAL KEOGH AND DR. PERRY.We have to report that we visited Netley Hospital without notice on Wednesday, 19th November, 1902, and inspected most of the wards, accompanied by the Principal Medical Officer, Surgeon-General Townshend, Colonel Stevenson, Professor of Military Surgery, Lieut.- Colonel Treherne (Registrar), Lieut. – Colonel Johnson, in charge of the Medical Division, and Major Carr in charge of the Convalescent Division. We also visited the hospital for women and children.
[The National Archives WO30/133]
[The National Archives WO30/133]
The general impression gained from out inspection was that the equipment of the wards was by no means up to the standard of the Metropolitan civil hospitals or even Poor Law infirmaries. The pattern of bedstead, though not perhaps the best, was good, and the bedding was satisfactory. The bedside lockers, however, are very ill-designed, if indeed they can be said to show any design having reference to the special condition of a military hospital, and they are somewhat insanitary. The tables are mostly of unsightly appearance and the surface is in bad condition, many requiring to be renewed. Cupboards are either altogether wanting in the wards or insufficient for the tidy bestowal of necessary articles, and hence in one ward we found numerous bottles of lotions, some of them poisonous, placed on what had originally been a bed-table. There did not appear to be any proper table for the scrubbing of mackintoshes, nor was there any convenience for the cleanly application of plaster of paris bandages or jackets. We were glad to note that the chairs for convalescents were numerous and varied. Many of them, we learnt, had been presented from time to time. It seemed to us that in some of the wards the heating was insufficient, and we learnt that at times this is so. On our own visit, which was made on a very cold day, we found the ward temperature low and the radiators in the corridors were cold, but we were informed that the Principal Medical Officer had that morning given orders for them to be heated.
The ward annexes are very bad. In many of them there is no through ventilation to cut them off from the wards and usually a pair of wards has attached to it a common sanitary block, an arrangement opposed to modern ideas of hospital construction. In no single annexe is there a proper sluice or slop-sink for the disposal of bed-pans. The pans have to be emptied down the w.c., and the subsequent rinsing and cleansing of them is carried out at a large porcelain sink at which the patients, who are well enough to dine in the dining-room, wash their own plates on returning to the ward. Even in the blocks which have recently been in the hands of the engineers this disgusting arrangement is perpetuated. Though there is a wash-up place attached to the dining-rooms it is not used, and, as a matter of fact, the plates of all patients, whether convalescent or taking their meals in bed, are washed in this sink immediately contiguous to the w.c.’s. No lavatory had any shelf on which the bed-pans and urinals could be put, they were on the floors of the w.c.’s , and in one case a careful orderly had lessened the chance of breakage by placing under the pan a dirty bit of rug or carpet. To each ward there was only one bed-pan, but the other pans could, it was said, be got on application to the ward-master. We learnt that no orderly cared to have more than one pan and one bed-urinal under his care, as thus there was less chance of breaking them or having them borrowed by a fellow orderly; but it is evident that one bed-pan for so many cases must lead to great discomfort on the part of the patients or to accidents which should be avoided. In the Medical Division some of the annexes were far from clean or well kept, but an excuse is made for the Officer in charge on the ground that he had only just taken up duty. Generally speaking the standard of cleanliness, though, no doubt, as high or higher than often found in military hospitals, was much below what prevails where an efficient staff of women nurses is employed, and this is likely to be the case, so long as the Sisters have no control over the Sanitary Blocks and are not even expected to enter them.
With regard to the accommodation for sick Officers (six beds), Principal Medical Officer reported that it was adequate.
The second report is that of the Matron-in-Chief, Miss Sidney Browne, and is rather fuller on detail. The comments in italics are the notes of the Surgeon-General's office added later in reply to each point:
THE ROYAL VICTORIA HOSPITAL, NETLEY[The National Archives WO243/21]
Inspected, March 7th and 8th 1903
I have the honour to submit this report on my visit as ordered to inspect the nursing arrangements, appliances and general ward equipment at the above-mentioned hospital. I was accompanied throughout this hospital by the superintending sister, Miss M. Cole.
These wards containing as they do for the most 10 or 12 beds are not easy to administer, and will be difficult to divide conveniently into a sister’s charge, according to the new nursing arrangements. They were for the most part clean and orderly, and looked as comfortable as it would be possible to make them with such bare, and in many instances, worn furniture, and absence of anything that would help to brighten them.
Tables – Covers
There are some new plain deal tables in these wards, with polished legs, and covers of red baize; if it is not possible to get tables with tiled tops, I would suggest a tablecloth of some bright coloured washing material being provided.
The lockers are nearly all the usual military pattern; if it is not possible to obtain lockers of an approved hospital pattern I would suggest at any rate a brass towel rail being affixed to the back of each locker.
New pattern has brass towel rail
The supply of easy chairs is most liberal, but the washing cover provided at this and other hospitals is not satisfactory, and would never look clean for one day.
New schedule alters
As it would be undesirable to have a darker cover, which would be quite as dirty, without showing it, I would suggest the chairs being covered with a rough surfaced American cloth, in red or green; this can be washed or polished.
New chair has red American cloth cover with Holland ‘anti-macassar’.
Some small cushions for these chairs and sofas, with washing covers, would add to the patients’ comfort.
I believe the matter of a new pattern screen is under consideration, a lighter build is very necessary, and with easily changed washing curtains, not tied in with tapes, as I know from experience these never keep tidy.
New schedule provides new pattern with red Turkey twill, which slip on.
A convenient pattern bed-table is provided in some wards, but the number of them appeared very limited.
Bed – Pillows
The beds presented on the whole a cleanly and comfortable appearance, but the bed linen is not got up with any great care.
Army Service Corps
I would like to urge most strongly that at least one feather pillow be provided to each bed. At present they are only supplied for special cases, and the hair pillow in use is both hard and lumpy.
100 per cent in serious case wards (New Schedule)
The supply of these is most inadequate, in fact, in only 4 out of 16 wards are any provided. It is quite impossible that bottles, etc., can be safely or tidily stowed away unless proper cupboard room is provided in every ward for both sister and orderly. At present the sister has to keep all medicines, poisons, stimulants, and, in fact, all her nursing appliances for each ward under her charge, in her duty room; and the time lost, and labour involved, in running backwards and forwards to these rooms, which are situated at the far ends of the corridor, is great. The orderly, as a general rule, keeps his brushes, brooms, and cleansing materials in a corner of the ward on the floor.
The whole question of cupboards being considered on a York paper and at Woolwich
These are in every instance quite impracticable from a nurse’s point of view. Absolutely no flushing sinks are provided for the efficient cleansing of bed-pans, which are emptied into the ordinary w.c. No small mops or brushes are provided, and the cleansing, such as it is, is done with a stick and tow, or piece of cloth.
Dealt with in Advisory Board report
Besides these most necessary requisites, it is most important that a supply of distinctive cloths, for drying bed pans, etc., should be sanctioned, and hooks placed in a convenient place to hang them on. At present everything is dried on a round towel, and it is useless to suppose they are kept separate.
We are waiting for Woolwich to fix rate
There is only one sink in these annexes in which everything is washed.
I.G.F.: Advisory Board so reported.
There are no shelves for the safe bestowal of bed pans etc., which are left on the stone floor of one of the lavatories.
Want of privacy in lavatories
I should like to point out that it will be very difficult for the nurses to take a share in any duties which take them into these annexes; taking into consideration the number of convalescent patients who are always up and about, unless some alteration is made in the arrangements. At present the different divisions are in no way private, in many instances no doors even existing.
A table for scrubbing mackintoshes on, and a rail on which to hang them to dry, is needed.
To be dealt with
Cleanliness of Annexes
The annexes of the medical wards were on the whole clean and tidy, especially in Sister Fletcher’s division, but in one of the surgical wards a very different state of affairs was revealed, and a pail which was used to carry round the ward for soiled dressings, was in a very dirty condition.
Write to the P.M.O.
But I cannot think that these places will ever be satisfactorily kept, until the sister has the necessary authority given her for the carrying out of this most important part of her ward management. At present all is brushed up and in order for the morning visit of wardmaster and Medical Officer, after which the orderly takes no further trouble, unless he is a particularly good one, and works willingly for the sister. This has been my own experience. I have purposely written fully on this, as it seems to me an important matter, as the same conditions and want of appliances existed in other hospitals I visited, so that in writing of these separately I need only refer to this report.
See paragraph 161, A.M.S. Regulations
There were not many patients in this ward, and with one exception appeared on the mend. The only precaution taken with regard to the disposal of soiled linen was to put it in a tub without a lid placed in the patients’ bathroom; here it is ‘sprinkled’ with disinfectant, and left until such time that the orderly ties it up in a bundle, and carried it down to the disinfector.
What suggestion? See paragraphs 576, 577, 578, A.M.S. Regulations
I saw a few good-sized ice boxes on the several landings, for keeping the milk, meat juice, etc., for the seriously-ill patients, but no cupboards are provided for the bread, which is kept in an old locker in the wards. The usual earthenware bread crocks are not even provided at Netley.
Medical Officer’s table
A table is needed in the medical wards for the use of the Medical Officer, on which to stand a jug and basin, soap, towels and nail brush. At present a basin is carried in by the ward orderly as required.
To deal with.
The furniture and general appearance of these wards are as bare and cheerless as the medical. No surgical appliances are to be seen in the wards.
A light dressing wagon is wanted in each ward, to wheel from bed to bed, on which the dressings prepared for each ward could be placed. At present, there being no extra tables in the wards, the dressings must rest on the beds or lockers.
Those in present use, though numerous, are not a good pattern, for the most part the lids are very ill fitting.
New Schedule – where there are no dressing waggons.
Other requisites for dressings
Glass jars are provided, but in most cases they have lost their original lids, which have been replaced by tin covers, or tied down with pink jaconet.
Provided in new Appendix XV Regulations A.M.S. (Advisory Board Report).
The following articles which are already provided in the theatre might be supplied to the surgical wards:
White dressing mackintoshes
We can provide on requisition
New Appendix provided
Glass lotion bowls
Glass kidney shaped receivers
New pattern of iodoform dredger, with outside lid
Not asked for. Supplied to Woolwich.
The usual objection to having too many things ‘on charge,’ as it is called, is that though in theory it is easy, in practice it is very difficult to get broken articles replaced in military hospitals.
A table, with washing jug and basin, soap, towel, nail-brush, kept in jar, with antiseptic lotion, should be placed in each ward for the surgeon’s use. A porcelain pail should be provided, to prevent running in and out of the ward to empty the basin.
New schedule. Should be in jar.
The operating table is of an old pattern, with stuffed cushions, and not up to the rest of the fittings. I was told that new wash-hand basins with latest improvements were ordered. A new steriliser has just been supplied. The theatre was under the charge of Sister Walton, A.N.S.R., and appeared in excellent order.
Ward for special cases
In this ward the counterpanes were not large enough to go over the big cradles which were placed over the patients; this, and the fact that a number of pillows were without cases, gave the beds an uncared for appearance. The ward was not cheerful; it would be very desirable if something could be done to specially brighten the surroundings of these sad cases, one of whom had been four years in the hospital. They were all cheerful, and most pleased to be spoken to.
Sisters’ duty room
These rooms, or ‘sculleries’ as they are called, are used by the sisters for the safe bestowal of all their nursing appliances. The cupboard provided is much too high and very inconvenient. They were in all instances well kept, and the different articles carefully put away. These rooms might be made a little more comfortable without being luxurious. Linoleum on the floor and a hearthrug, for instance; the floors are very bad. They contain besides an old bare trestle table and hard wooden chair, a sink, a fireplace, where any extra cooking, such as arrowroot making, is done.
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