CITADEL HOSPITAL CAIRO: Inspected by Miss Ethel Becher, Principal Matron
7 February 1910

[The National Archives WO24/28]


Condition of Wards and Annexes
This Hospital, once the Palace of Mahomet Ali, has, I am aware, been condemned by many Authorities, but the following points may serve to show under what trying circumstances and in what totally unsuitable surroundings the Nursing is being carried out.

The wards consist of large open pavilions or halls at the head of wide marble staircases, which it is impossible to keep either comfortably warm, or comfortably cool. At the time of my inspection the thermometer stood at 56°, while in summer it rises to 104° to 108° remaining up as high as 96° at night. There are large openings high up in the walls covered with mosquito netting through which the desert sand pours into the wards when a high wind is blowing, in a short time everything, including the patients themselves, is covered with sand, and even with constant sweeping and dusting, what is usually known as cleanliness in a hospital, is an absolute impossibility. These enormous pavilions, which are of very lofty dimensions, with highly decorated walls and cornices absorbing a considerable amount of light, are at night almost in darkness, the oil lamps provided are of a very inferior pattern and give a very poor light and even when burning at their best, it is impossible for the patients to read after the daylight has gone.

On windy nights which are not uncommon in Cairo, these lamps are continually being blown out and then the Sisters are reduced to groping about in the dark, or carrying candles to the bedsides; some lamps bought locally are satisfactory, but the future purchase of these was, I understand, stopped by the War Office. I consider that the provision of adequate lighting in this hospital is from a Nursing point of view an urgent necessity.

Acute Case Wards
The acute cases are nursed in smaller wards leading off the pavilions; these can be kept comparatively warm by means of small stoves, the ventilation, however, is not very satisfactory. The floors of these wards are of rough paving stones, irregular and uneven, most difficult to sweep or scrub.

Officers’ Wards
These are two in number, the overflow of patients has to be nursed in the open pavilion or passage way, for 19 months these wards were never without cases of enteric fever. The wards are comfortably furnished. There is no bath room, and no water laid on, until a few weeks ago hot water had to be carried from the outside hospital kitchen, now a small stove has been fixed in the ward scullery on which a kettle can be boiled. White blankets of a lighter make should be provided for the Officers’ Wards, and long shirts of white flannel are an absolute necessity for the use of officer patients who are seriously ill. I consider that brown blankets are totally unsuitable for use in hot climates, it is impossible to tell when they are clean, and bugs have to be daily looked for, at any rate in the Citadel.

Annexes, Ward Sculleries, Duty Rooms
These are 4 rooms which serve the combined purpose of duty room, scullery and ward kitchen. Small stoves have recently been placed here. There are no sinks, neither is water laid on. The annexes are kept clean by a staff of natives under the supervision of the Sergeant Major.
All ward utensils are emptied and cleansed by the orderlies, and every care is taken to carry out these duties as efficiently as possible with the means at disposal. There is no drainage, so sanitary pails are used into which all utensils are emptied. They are then washed under a tap into a cesspool, soaked in a tub of disinfectant and then washed in a tub of clean water. I visited the places where this is carried out, and found them in excellent order. There are only two patients’ baths, they are very old and discoloured, re-painting would be useless. Earthenware baths should be provided.

The Operating Theatre
As gas is now available, being already in the laboratory, a Bruce Clark Sterilizer should be provided, there is a room leading from the theatre which could be arranged as Anaesthetizing and Sterilizing rooms with a little reconstruction.

Quarters for Nursing Staff
The accommodation provided for the members of Q.A.I.M.N.S. is inadequate and most unsuitable. The bedrooms they occupy are scattered about the hospital, two of these, I consider, should at once be condemned as sleeping apartments, one owing to its isolated position between the Dysentery Ward and the Ophthalmic Ward, the other is very small, ill ventilated, and most unhealthy, situated in a narrow, stuffy passage, leading to the only lavatory provided for the Staff of 11 people. A third bedroom leads directly off the pavilion in which all overflow patients from the Officers’ Wards are nursed, it is not uncommon to have cases of Dysentery here, for lack of room elsewhere. All ward utensils from the Officers’ Wards have to be carried past this bedroom to be emptied. A second and third bedroom occupied by the Sisters have on one side of them the latrines for the officers’ wards and on the other the Pack Store for the patients’ kits.

The Matron’s own bed-sitting room and 2 more bedrooms are only divided from the Officers’ Wards by a wooden partition which does not reach the ceiling. Four of these bedrooms face south, and as they are impossible as sleeping rooms during the hot weather, arrangements have been made for their occupants to sleep upon the hospital roof, this I think is open to objection. By dividing the large bedroom into two, a sitting room has been provided. I represented the urgent necessity for this work to be done before the hot weather commenced, and Major-General Sir John Maxwell very kindly gave the matter his immediate attention. Until this was done the only sitting room was a position of a long passage screened off, this was unbearable in the heat of the day, and was besides the thoroughfare for the servants.

The Mess room has been made very comfortable by the present Matron who has done everything in her power to improve the conditions for her Staff under those trying circumstances. I consider Miss Jones is deserving of great praise for her commendable cheerfulness, and the energy and zeal with which she carries out her work, the conditions she found must have been most discouraging to one coming straight from the hospital in London. The Sisters and Staff Nurses are contented and cheerful; I did not hear one word of complaint, although they have so few comforts; and the loyal devoted way they are doing their work is most encouraging.

The following points I consider require immediate attention if the Members of Q.A.I.M.N.S. are obliged to continue living in this building:-

     1. The Officers' Wards should be moved elsewhere, and other accommodation provided for pack stores.
     2. Bathrooms and a second W.C. are urgently required; I understand that in a scheme for alterations these are provided, but his has been under consideration for a very long time, with no results.
     3. The lighting of the quarters is as bad as in the hospital; it is very depressing to spend the evenings after the day’s work, in rooms so dark, that reading or work are out of the question. The bedrooms are lofty and should each be provided with a good hanging lamp. The sitting rooms will require two, these have been on demand since 1908.
     4. The bedroom floors are of uneven paving stones, quite unsuitable for linoleum. Matting is not advisable, but I consider that much larger rugs or carpets should be allowed, the present pattern rug of which 2 only are provided per bedroom are quite insufficient.
     5. The Matron has only one room, and the sitting room furniture to which she is entitled, together with the furniture for the sitting room for the Sisters and Staff Nurses, has been on demand since June 1908, this seems a very unnecessary delay, and requires some explanation.
     6. The kitchen range is old and inferior; there is no sink for washing up, no scullery, pantry nor larder, and it is quite impossible to have the relays of meals demanded by the regulation Time Tables, when such totally inadequate arrangements exist for their preparation.