Hospital floors should be made as impervious as possible, so that
they may not absorb germs and dirt. They ordinarily have a hard
finish and are kept smooth and polished by using on them a solution
of paraffin or paraffin and wax in turpentine, and frequent polishing
with a weighted polishing brush covered with a piece of blanket.
A commonly used preparation consists of six ounces of paraffin
dissolved in a gallon of turpentine, with the addition of an ounce of
soft soap just before using; this is applied with a mop, and when
dry is rubbed in with the floor polisher.
A floor so finished should not be scrubbed with water ; spots may
be removed with turpentine.
After the ward is made ready the lavatory should be attended to;
all urinals, bed pans, and bottles should be thoroughly cleaned,
shelves wiped off, closet-bowls and seats washed, and bath tubs
To clean brass, copper and nickel, a mixture of oxalic acid,
alcohol and kerosense is very effective ; for enameled ware use soap
and hot water, removing stains with chlorinated lime.
For porcelain utensils never use sapolio, oxalic acid or strong
alkalies; they destroy the enamel; warm water and soap, followed
by kerosene, are best.
THE WARD 145
In addition to this daily cleaning a more thorough preparation is
made for Saturday inspection. The walls, window borders, and all
projections and corners, should be brushed with a soft long-handled
brush covered with a damp cloth. Windows and sills, tables, chairs,
and unoccupied beds are washed, and cots and mattresses gone over
To destroy bed-bugs a saturated solution of phenol, or kerosene
oil is usually employed, the solution or kerosene being freely applied
in all cracks and crevices and along the seams of mattresses. Hy-
drocyanic acid gas is very useful for the destruction of bed-bugs,
flies, cockroaches, and other vermin which may infest hospitals.
The gas is generated from cyanide of potash by the addition of com-
mercial sulphuric acid. An ounce each of cyanide of potash and
sulphuric acid and two ounces of water are required for each hun-
dred cubic feet of air space, and the apartment must be tightly closed
for six to eight hours in the same manner as in fumigation with
sulphur or pyrethrum. The objection of cyanide fumigation is the
great danger to human life from breathing the fumes of the gas,
which precludes its employment in any part of an occupied house, or
in a house in a block separated from other houses by party walls only.
Beds and mattresses, however, may be freed from insects by
fumigating them in a tightly constructed chamber or box such as is
used for disinfecting objects with formaldehyde gas. The room
having been made ready, the proper amount of sulphuric acid and
water is placed in a porcelain basin or slop jar to which is quickly
added a thin paper bag containing the corresponding quantity of
cyanide of potash; the operator then immediately leaves the room
and closes the door. After six to eight hours the door is thrown
open for the escape of the gas and the entrance of fresh air, and on
no account must any one enter the room until the odor of the gas
has practically disappeared.
It must never be forgotten that this gas is absolutely deadly to
human life, and that even a mementary exposure to it may be fatal.
Whenever a bed is vacated mattress and bedding should be thor-
oughly aired and sunned, and disinfected if necessary. The same
bed linen should never be used, without washing, for two consecutive
In addition to the daily and weekly cleaning there should be a
thorough disinfection of the wards twice a year or whenever
To prevent the pollution of the ward air, all discharges, such as
urine, feces, sputum, and vomited matter, soiled dressings and linen,
and dirty vessels should be promptly removed. The vessel con-
taining discharges should be covered at once, using a piece of rubber
sheeting or a towel if the vessel has no cover, and should never be
carried through the ward uncovered.
Soiled dressings should be received in a covered pail or paper bag
and promptly burned.
Sputum cups in use should be frequently disinfected by boiling,
and bed pans and urinals scalded with hot water after each use and
always kept clean.
A PATIENT may be able to walk to the hospital or he may be
brought there in an ambulance or on a litter. In either case he
should be examined at once by the senior noncommissioned officer
present; if he has been seen already by a medical officer direction
for his dosposition should accompany him ; if he has not been seen
by a medical officer one should be notified promptly. Pending his
arrival the noncommissioned officer should take the necessary steps,
taking care that no contagious case goes into the general wards.
Generally there is a standing rule in hospitals that all patients should
be given a bath before being put to bed unless there are orders to
the contrary or the patient's condition is such as to render a bath
undesirable. After the bath the patient is given a suit of hospital
clothing and put to bed. An inventory of his effects is made in
duplicate and signed by the wardmaster, one copy in a book and the
other on a name slip which is attached to the bundle. 1 Take every-
thing out of the patient's pockets and place all valuables such as
money, watches, jewelry, etc., in a separate package, on which should
be written the name of the patient, number of the room and of the
ward, the date, and a list of the effects; the package should be at
once sent to the office for safekeeping. The clothing is then in-
spected and if it requires disinfection is at once sent to the disin-
fecting chamber; otherwise the underclothing should go to the
laundry and the remainder, tied securely in a bundle, to the locker
corresponding to the patient's bed. Valuables should be listed,
placed in en envelope marked with the name, date, and contents,
and at once turned over to the senior noncommissioned officer for
deposit in the hospital safe. Meantime it is well to offer the patient
a glass of water or milk to make him feel that he is being cared for.
After the patient is comfortably in bed, his pulse, temperature, and
respiration are taken and recorded; the first urine passed is saved
in a clean vessel for examination.
i In the larger hospitals a property card is filled out by the wardmaster, and. together
with one of duplicate tags, numbered serially, attached to the property; the otlie
given to the patient.
FIG. 82. Bed Tray.
Bed patients should wear hospital clothing only ; but, on the other
hand, patients allowed up should not be permitted to wear hospital
gowns or pajamas under their own clothes; unless this point is
looked to, hospital clothing will often be missing.
Food and medicines must be administered promptly and in a
The nurses' hands must be
kept clean and free from
odors. Nothing is more dis-
gusting to one who is already
ill than to have food pre-
sented with dirty hands.
One of the most important
duties about the hospital and
perhaps the one most fre-
quently neglected is the serving of diets. The noncommissioned
officer in charge of the mess is responsible tinder the senior
noncommissioned officer and should be in the wards at meal
times to see personally that the diets are promptly and properly
served. Utensils should be clean, plates warmed, and no slopping
over allowed. Food which is intended to be hot should reach the
patient in that condition. Used utensils and unconsumed food
should be promptly removed from the ward and all crumbs and
debris cleaned up.
Patients able to sit up in bed use the bed tray (Fig. 82), those
unable to sit up must be fed by the nurse. To administer liquids the
head and shoulders are raised and a
feeding cup (Fig. 83) or an ordinary
cup or tumbler is used. When the
head should not be raised the liquid
may be taken through a bent glass
tube. When the sick man is uncon-
scious, liquids must be given very
slowly, taking care to avoid choking.
Utensils used for patients with infectious diseases must be kept
separate from others and separately washed. Especially is this im-
portant in the case of syphilitics with mucous patches in the mouth,
and in typhoid fever cases.
Very ill patients on liquid diet should have their nourishment regu-
Fic. 83. Feeding Cup.
WARD MANAGEMENT 149
larly at night as well as by day unless there are special orders that
the patient shall not be awakened. Very often wakefulness is due
to insufficient nourishment, and a glass of milk or a cup of beef tea
will often secure several additional hours of sleep.
Liquid diet includes only liquids, the most useful of which are
milk, meat extracts, broths, gruels, albumen solutions, and, last, but
not least, water.
Milk by reason of containing a proper proportion of all the im-
portant food principles is by far the most valuable single article of
liquid diet. It may be given in many forms : Plain, peptonized, as
buttermilk, whey, or junket; a patient on milk diet alone should
take from two to five pints in the twenty-four hours.
Meat extracts have little value except as stimulants; it should
never be forgotten that a patient fed exclusively on them would
promptly starve ; the same remark applies, in a less degree, to broths
and gruels. Albumen water is valuable when milk is not tolerated.
In all diseases, but especially in fevers, water in large quantities is
indispensable; it flushes out the excretory organs, removing poison-
ous substances, aids the circulation, and lowers temperature in its
evaporation from the skin. In all fever cases the amount of water
given should be noted on the clinical record.
Medicines must never be left with a patient to be taken by him ;
the nurse should give them himself and see that they are swallowed
before he leaves the bedside. In giving medicines great care must
be exercised to avoid mistakes. The label indicating the nature
of the medicine and the dose must be carefully read, the bottle
shaken, and the dose measured out by pouring from the side of the
bottle opposite the label so as not to spoil the latter. After the dose
is taken the fact should be recorded, never before. A graduated
medicine glass should always be used to measure doses instead of
spoons which vary so much in size. Medicines ordered to be taken
before meals should be given about twenty minutes before, while
those to be taken after meals should usually be given immediately
after. Sour medicine should not be given within a half-hour of the
time when milk is administered. Sleeping patients should not be
aroused to take medicine unless the medical officer has specially
Pills are administered by putting them far back on the patient's
tongue and giving him a swallow of water.
A powder if small should be placed on the back of the tongue
and washed down with water or placed on a spoon and moistened
with water; if large and bulky it should be stirred up with water in
a tumbler and swallowed quickly before it settles.
The ward medicine closet must be kept locked and the wardmaster
must take care to avoid an accumulation of medicines. When a
patient for whom a mixture has been especially ordered leaves the
ward his medicine bottle should be at once turned in to the dis-
pensary, and the same rule applies to all medicines not in current use.
To give medicines subcutaneously, the hypodermic syringe is used.
Certain rules are necessary to prevent accidents with this instrument.
The solution used must be freshly prepared; the needles must be
clean, sharp, and aseptic; the syringe freshly sterilized; the skin
where the injection is made must be cleansed.
To render the needle aseptic boil it a moment in a spoonful of
water, or draw phenol or cresol solution through it several times.
Disinfect the syringe in the same way, or use 70% alcohol. Never
attempt to use a needle the point of which is dulled or bent. In
making the injection care must be taken to avoid blood-vessels,
nerves, and bones; for this reason a fleshy part should always be
selected and the injection made obliquely; the outside of the fore-
arm or the front of the thigh is usually chosen.
Draw the medicine into the syringe, screw on the needle, hold
the syringe vertically, needle up, and gradually press the piston
until all air has been forced out as indicated by the escape of a drop
of fluid; wash the skin at the point of injection with a little alcohol
or plain soap and water, draw the skin tight, and thrust in the needle
quickly. When the needle has penetrated about half an inch, force
out the liquid slowly, withdraw the needle, and press the ringer for
a moment on the puncture. Before putting the syringe away draw
a disinfecting solution through it, remove the needle, force out the
last drop of fluid, and at once insert the wire.
The bed pan should be warmed before use by dipping it in hot
water or placing hot water in it for a few minutes ; as soon as re-
moved from the patient it should be promptly covered, taken from
the ward, emptied and washed.
Rubber sheets should never be folded, as to do so will crack them ;
when not in use, hang by the edges or roll on a wooden roller.
The patient's nails should be kept clean and special attention should
WARD MANAGEMENT 151
be paid to his mouth and teeth. The teeth and mouth of helpless
patients should be washed with a gauze sponge dipped in a mild
Dying patients should preferably be removed to a separate room ;
but if this is not practicable their beds should be surrounded by
screens so that the other patients may not be unfavorably affected
by the sight. A medical officer should always be notified. As soon
as death occurs the body should be removed with as little disturbance
as possible and given proper attention.
The signs of death are cessation of respiration and of the heart's
action, dilatation of the pupils with flaccidity of the cornea, and
later coldness of the body, rigor mortis, and decomposition.
When respiration can no longer be seen its complete cessation
may be verified by holding a mirror over the mouth ; if there is any
breathing at all the mirror will be clouded. When the heart and
pulse can no longer be felt, tying a string around the finger will
show whether the circulation has ceased; if it has not there will be
some congestion of the end of the finger, while there will be no
change if death has occurred.
In hospitals the sign of death most relied upon is the sudden and
permanent dilatation of the pupils with flaccidity of the cornea;
the latter sign is elicited by touching the cornea with the finger, when,
instead of being firm and resilient, it will be found soft and flaccid.
As soon as the body is removed from the ward the rectum, mouth
and nostrils must be packed with cotton to avoid post-mortem dis-
charges, a triangular bandage with an absorbent cotton pad applied
to the perineum, and the limbs straightened out and placed in posi-
tion before rigor mortis or stiffening sets in. A little cotton should
be placed under the upper lids which are then closed. To prevent
the jaw from dropping, a four-tailed bandage is applied to the chin,
or a rolled-up bandage is fixed between the chin and sternum. The
body is then wrapped in a sheet wet with an antiseptic solution and
in hot weather placed in an ice box.
Should an autopsy be necessary preparations are made for it.
The body is placed on a table in the 'dead-house ; the post-mortem
case is procured and the instruments laid out; the other arrange-
ments necessary are three pails, one containing water, another to
receive discharges, and the third for specimens which it may be
desired to keep; a large bath sponge, two pairs of rubber gloves,
basin with water, towels, strong thread and needles.
BEDS AND BED-MAKING
THE regulation hospital bed is of white enameled iron with wire
springs, and is excellent in every way. The mattress is of hair in
three sections fastened together by straps, so that the soiling or
destruction of one section does not necessitate the loss of the entire
mattress ; further to protect the mattress each is supplied with a
movable cover which should always be used.
The bed covering should be warm but light; counterpanes being
heavy and not porous are objectionable, and for occupied beds
should be replaced by sheets.
To prepare a hospital bed first see see that the springs are in good
condition and not sagging; then select a good mattress free from
hollows, cover it with a mattress cover, and place on the springs.
Over the mattress spread a sheet, tucking it in first at the head and
foot and then at the sides.
If the patient is liable to soil the bed a drazv sheet comes next,
otherwise it is omitted. The draw sheet consists of a rubber sheet
about three by four feet, covered by a folded cotton sheet and spread
across the bed where the hips will rest, and tucked in at the sides
or pinned to the mattress. Over this is placed the upper sheet and
blankets, and over the latter for their protection another sheet is
spread; to protect the upper edge of the blankets from soiling, the
outer sheet or spread is folded over it, and finally the upper inside
sheet folded back over the outer one.
When a patient is placed in bed always pull out the covers a little
at the foot of the bed, so that they may not press upon his upturned
feet ; this is a little point, often neglected, but meaning much to the
All of the beds in a ward should be prepared in the same way
so as to give a neat and uniform appearance. Patients are very
fond of tucking things away under the mattress, a practice which
should be carefully .prevented by frequent search.
The bed linen of an occupied bed may be changed easily by a
BEDS AND BED-MAKING 153
single nurse unassisted and that without seriously disturbing the
patient. To change the lower sheet, first loosen all the bed clothes
at top, sides, and bottom, remove all the upper covering except a
sheet and blanket, and roll up the bottom sheet length wise together
with the draw sheet into a tight roll close to the patient's body ; then
in like manner make one side of the clean sheet and draw sheet into a
roll and place it alongside the first roll, tucking the free edges under
the mattress. Now stand on the other side of the bed and with
both hands turn the patient on his side with his face toward you;
tuck in the rolls under his back, turn him back on his other side
on to the clean sheet, then withdraw the soiled one and pull the
clean sheet into place.
To remove the upper bedclothing the covers should first be loosened
as before, then spread the clean sheet and blanket over them and
tuck in at the sides, after which the soiled clothes may be drawn
out at the foot.
Bed linen should be changed whenever it is soiled, when a patient
is discharged, and at least once a week, depending on the nature
of the case; in the infectious fevers it may be necessary to change
daily. Even when the sheets are not changed they should be drawn
tight and straightened up daily.
Sometimes it is more convenient to move the patient to a fresh
bed so that the other may be aired and changed ; this may be done
in several ways. The two beds may be moved close alongside of
each other and the patient gently lifted over on the sheet by two
attendants, one at the head and the other at the foot; the lifting
may be facilitated by rolling the edges of the sheet around a pole
on each side, thus forming an improvised litter.
If there is only one attendant a rubber sheet may be pinned to
the occupied bed and stretched across the interval to form a smooth
surface on which the patient is pulled over on his own sheet ; or
the mattress on which the patient is lying may be pulled a little way
over the other and the patient then rolled over the edge or drawn
over on his own sheet. Where there is only one bed and the mat-
tress is to be changed draw the soiled mattress half way off, and
then place the clean one alongside; draw the patient on his sheet
from the soiled to the clean mattress, remove, the soiled one, and
draw the clean mattress in its place.
A bed is prepared for an operative case the same as for any other
with the following differences : The pillow is removed and a small
rubber sheet covered by a towel pinned to the mattress in its place,
this because nausea is less apt to occur if the head is low; in case
there should be vomiting a couple of towels are hung over the head
of the bed and a basin, several mouth-wipes and a mouth-gag or
tongue depressor placed on the bedside table. A number of hot-
water bags are placed in the bed, and a blanket is put under the
upper sheet; the object of these procedures is to diminish shock by
having the bed as warm as possible. Before the patient is placed in
the bed the hot-water bags are removed lest the patient in his un-
conscious condition should be burned without knowing it. The
covers .on one side of the bed should be turned back to the edge of
the mattress in order that the bed may be quickly opened up for the
reception of the patient.
Beds for fractures of the lower extremities should be firm and
solid so that the sinking in of the bed from the weight of the body
may not cause displacement of apparatus and in order that the
patient may be better handled ; this is accomplished by placing
under the mattress a frame of slats or a number of separate wooden
slats. A great variety of fracture beds and invalid beds have been
invented, but they are all too complicated, and an extemporized bed
To move a patient from dne side of the bed to another; standing
on the left side, pass the right arm well under the patient's shoulder
and back, so that his shoulder will rest upon that of the nurse, and
pass the other hand over the patient's other shoulder; lift gently and
move over the upper half of the body; then place the right arm
under the back lower down, and the left below the hips, and move
the lower half of the body over. Whenever the hips are to be moved,
always flex the patient's knees, and place the feet upon the bed; this
enables the patient to help and lighten the weight. When lifting the
shoulders support the head in the hollow of your arm. When mov-
ing the patient to one side of the bed always move him toward you.
To lift to the upper part of the bed pass the right arm obliquely
under the patient's shoulder and back and the left below the hips
and lift toward the head. If the patient is strong enough to clasp
his arms around the nurse's neck he can assist considerably in these
BEDS AND BED-MAKING 155
To change the pillows one arm should raise the shoulders and
head, while the other hand adjusts the pillows.
To raise the patient to a semi-recumbent position a bed-rest may
be used; or a straight-backed chair turned bottom side up and
padded with pillows answers very well, or the support may be made
of pillows entirely, the first being placed low down beneath the back
and the others packed in above.
Where there is a tendency to slip down in bed, a firm cylindrical
pillow about eight inches 'in diameter is used ; this is placed beneath
the patient's knees and firmly tied to the head of the bed by broad
.bandages fastened to the pillow at each end.
Rubber cushions of various shapes and sizes are very useful about
a sick-bed, and when there are involuntary discharges a " Kelly pad "
or surgical pad is invaluable.
In cases of paralysis or other cases requiring iong confinement to
bed air mattresses and water mattresses are used. The air mat-
tresses may be placed on an ordinary bedstead and inflated with a
bellows or by the mouth.
The water mattress requires a irame on each side of the bed to
keep it from slipping off, and a rubber sheet must be spread over
the springs to prevent sticking. After the mattress is in position
it is filled with water by a hose or through a funnel ; the temperature
of the water must be not less than 98 F., that is, the temperature
of the body. No pins should be used about water and air beds lest
puncture and leakage occur.
When patients are confined to the bed for long periods of time
and their vitality is at the same time very much lowered, as occurs
in cases of paralysis, long-continued fever, and in old persons, bed-
sores are very apt to form ; starting as an inflammation of the skin,
ulceration and sloughing soon follow and the destruction of tissue