MILITARY HOSPITAL CHATHAM

     We inspected the hospitals at Chatham on 22nd November, 1902, without notice. The Military Hospital is well situated upon an isolated hill, but is at some distance from the barracks.
      The buildings are old and very inconvenient, and were, we were told, in need of constant repair.  The administrative offices are well scattered and inconveniently placed. The floors of the main buildings are good, and we found the wards tidy and clean. The bedsteads were for the most part of an old pattern, and the ward furniture was of the very scantiest possible character. It was all, however, well kept. The bed-pans, and the knives and forks and dishes used for dinner, are washed at the same sink; on the occasion of our visit we found the bottom of the sink occupied by knives and forks in the process of cleaning. The sink had been used earlier in the day for washing bed-pans.
      There is an excellent operating theatre with a mosaic floor, and with generally a good equipment. It was marred, however, by an old-fashioned sink. It was well lit and capable of being well warmed. There is no anaesthetising room. There is one ward kitchen for the whole hospital on the first floor.
      The wards generally were not well warmed. The temperature in those we inspected being between 50 degrees and 52 degrees. The Venereal wards are located in casemates of the old fort. They are mere tunnels and are not fit to be used as wards for any purpose.

A. KEOGH, D.D.G.
FREDERICK TREVES



     We inspected this hospital on 22nd November, 1902, without notice.  It is represented by an isolated one-storey building in an enclosure. Except for the fact that it is 1½ miles from the Military Hospital it is well placed. The building is modern, is in excellent condition, and is admirably adapted for its purpose.
      The hospital has 18 beds. Over 80 per cent, probably 90 per cent, of the cases are lying-in cases. Other cases admitted are for comparatively trifling ailments. In the admission book we noticed admissions for Dysentery, Chlorosis, Abscess, Menorrhagia, Debility, Prolapse of Womb, and the like. No operations are undertaken in the hospital; cases requiring surgical operations are sent as a rule to London. There is an examination room with an excellent examination table. About 150 lying-in cases are admitted in the year. We noted that the number of patients in the wards at any time was between 5 and 12. The matron was a woman of 36, who has a certificate of training as a midwife; she appeared to be a very capable woman. She receives 3s. a day, and has excellent quarters. She has two untrained assistants, each receiving 1s. a day, and also a cook and a general maid receiving the same wages.
      There are two wards containing 10 and 8 beds respectively. There is also an accouchement room. We found the wards clean, tidy, well kept, and well furnished. The hospital is regularly visited by ladies, and evidently a good deal is done to make it cheerful and comfortable.
We inspected the kitchen and offices, and found everything in admirable order. The assistants’ quarters are small.
      The excellent state and administration of this hospital call for high commendation.

A. KEOGH, D.D.G.
FREDERICK TREVES.



To the Matron-in-Chief, Q.A.I.M.N.S.
Madam
I have the honour to submit this report on my visit to Chatham Hospital on March 20th. I inspected the wards in charge of sisters, with their annexes, the nursing appliances, etc.; the sisters’ quarters, and, as far as was possible, the proposed building for the new quarters; and the hospital for soldiers’ wives and children. I did not go inside the Isolation Hospital, as I had not visited the Women’s Hospital, which was some distance off in the garrison. Had I known this I would have arranged differently.

Present staff
     One Superintendent, Miss Grist, and three sisters form the present staff.  The work at the time of my visit was not heavy; the wards appeared somewhat empty; there were no very serious cases. My visit being paid in the morning the wards and annexes were neat and clean.
The wards had the usual complement of furniture, but there seemed a scarcity of easy chairs, and the windows being placed very high up, the wards seemed more than usually gloomy for sick people.
Matron-in-Chief to tell Matron to ask for them.

Bed screens
     The bedsteads are nearly all of the old pattern. Very few screens are provided, and these are of a heavy pattern, very low, and not easy to keep clean.
New Schedule provides, but not enough.

Cupboards
     Additional cupboards are needed, two, however, being provided in each ward, one for the sister and one for the orderly; but they do not provide enough space to ensure the different contents being kept in good order.
The hospital will probably be re-modelled and nothing should yet be done in this direction.

     A certain number of nursing appliances have lately been supplied at this hospital, but the following are still required:

For the Medical wards
     Enema syringe, glycerine syringe. Glass funnel and tubing, these should, I think, be supplied to each sister, and not fetched from the dispensary when wanted. The Superintendent has already applied for these things, and they have been supplied to one ward, together with medicine glasses, in fact they appeared better off in these respects than in the other hospitals I have visited.
A.M.D. 3 should be asked about this by Matron-in-Chief.
     In all these wards, washing basins, together with soap, towel, and nail brush, was ready for the Medical Officer on the table. It would, however, be better if a separate table could be provided for this purpose.
A.M.D. 3 and Matron-in-Chief should confer on this

Surgical Wards
     These contain the same number of cupboards, and one dressing wagon, the sisters have lately been supplied with some glass receivers and dressing trays, but they require the following appliances:
Syringes for dressing purposes, to be supplied and kept exclusively for use in the wards. At present the syringe has to be applied for from the surgery, and is probably used all over the hospital for many cases and purposes.
Aseptic dressing boxes.
Glass bowls.
Glass jars for dressings, swabs, drainage tubes, etc.
White mackintoshes.
Iodoform dredgers of a new pattern.
Sterilizer for the use of surgical wards.
Dressing wagon to wheel easily, the present one is too heavy.
A special table for use of Medical Officer, with jug and basin, etc.
Matron-in-Chief should see A.M.D. 3 about these matters. New Appendix XV provides generally.

Annexes
     The ward annexes are most inconvenient – very small, and contain no proper appliances. One sink only exists for all washing up purposes in both medical and surgical wards, and though there were no cases of enteric at the time of my visit, I understood that if they occur they are nursed in a general medical ward, which would seem very risky with the existing arrangement of lavatories. No shelves are provided for the bed-pans etc., no mops, brushes, or distinctive cloths.
See remarks under cupboards.

Refrigerator
I saw one good sized refrigerator on the second landing, which was clean and newly filled with ice. The patients have each an earthenware crock for bread.

Theatre
     The theatre has lately been tiled for some height round, the walls above this, however, are only distempered.  It seemed well fitted up, but a second glass table is wanted with two shelves for the sister to put her lotion bowls and dressings on. A table for the Anaesthetist’s properties would be useful. The sink is old-fashioned. Glass bowls, glass jars for swabs, and nail-brushes, and improved jars with tubes and taps for lotions are wanted. No jackets or aprons are provided for the operators. Black mackintosh only is provided.
A.M.D. 3 should confer with Matron-in-Chief about these.

Sisters’ duty room
     The sisters use one common duty room on the second landing, a dark room lit by a window on to a staircase; there is therefore no outside ventilation. This room contains two cupboards, a sink, and a small range, where at present all the water has to be heated for operations, but I believe a gas ring is being provided in the theatre.
See remarks under cupboards.

Women’s Hospital
     This hospital was in most beautiful order, every part of it showing signs of capable administration. At the time of my visit there were only two patients in the hospital, both maternity cases. The Matron is assisted by two untrained women, whom she instructs. They were wearing neat, clean uniform.
     The wards looked comfortable and spotless. A room is set apart for labour cases; also a special room for examinations with a suitable table. The instruments are kept in a separate cupboard, and are all carefully wrapped up in lint.
     The laundry is on the premises, and under the Matron’s supervision; all soiled linen is immediately carried out here and steeped. There is a good supply of baby clothes provided by a charitable fund. Spring bedsteads have been supplied for one ward from outside funds.
The Matron said she was always able to get anything she wanted for the hospital or patients.

Sisters’ quarters
See remarks under cupboards.
     The quarters at present provided for the nursing staff are in every way most undesirable. They are situated over those occupied by the sergeant-major and his family, and the recreation room. I think different quarters are urgently needed.
     Each sister has a small bedroom, and there is one small sitting room, but no dining room, the meals are taken in a narrow passage between a window and a staircase; formerly the sisters were obliged in winter to wrap themselves up to sit here, but lately a stove has been provided at the request of the superintendent sister. The bathroom and larder are only separated from the passage and each other by a low wooden partition.
     Several suggestions are made for the proposed new quarters, but I was told that no plans had as yet been officially submitted. One plan is to improve the present quarters, but I could not see how this could ever be satisfactorily done. Immediately in front of this building there is a large shed used as a carpenter’s shop, which completely shuts out all view from the windows; it seemed doubtful whether this could be moved. Another suggestion is to utilise the present isolation hospital, but I think the position of this is most undesirable; the orderlies’ barrack rooms practically overlook it, and the approach to it is by buildings which it would not be nice for the sisters to be continually passing.
     There are two blocks originally intended for officers’ quarters; at present only half of it is occupied, which could be converted into a suitable house for the nursing staff. The two blocks thrown into one would provide fourteen rooms, exclusive of the two basements. The quartermaster’s quarters, containing four rooms and a kitchen, are attached to this building, and would provide extra accommodation if it were possible to obtain them, which would be desirable considering their position.  The unoccupied block, which I went over, is in bad repair, the ceiling and walls in some places are badly cracked.  I was told it was already in the engineers’ hands. The position of this building is convenient and the surroundings pleasant.

Ethel H. Becher
Principal Matron, QAIMNS
68 Victoria Street, 23rd March 1903