Download Patient Environment - Plymouth Medical Society Historic Collection

APPENDIX
THE PATIENT ENVIRONMENT: A HISTORIC PERSPECTIVE
In today’s NHS, good patient care is very important. There are frequent stories in the news about clean hospitals, infection rates
and patient satisfaction. Plymouth Medical Society’s Historic Collection gives an insight into the views of healthcare workers of the
past on these same issues.
The following selection of books offers a starting point for further exploration of the collection. These quotes may be thought of as
divided into five categories - patient comfort, patient mood, aftercare when they leave hospital, ward design and paternalism. At the
end, you will find a mini-glossary of terms which may be different from those used today.
Title
Author
Year
Page
The domestic
Thomson, AT
1841 12
Quote from the text
Category
The intervals between each meal, except during sleep, should
Patient comfort
management
not exceed six hours.
of the sickroom :
35
The depressing emotions, also, strongly predispose to
necessary, in
epidemic fevers, and lay the body open to the influence of
aid of medical
infection.
Patient mood
treatment, for
the cure of
49
diseases
When erysipelas appears in a house, the sick person should
Patient comfort,
be separated from the healthy inmates.
Patient mood
Nothing is so much to be condemned in such cases, as
Patient mood
(PHC288)
60
ridiculing the whims and the caprices of the patient: the mind
may be diverted from them; but ridicule only fixes them more
deeply, and favours a tendency to despondency and
melancholy.
105
The sick room should be large and lofty.
Ward design
109
An invalid may as well sleep in a swamp, as in a room the floor
Ward design
of which is frequently washed.
A treatise on
Philip, APW
1830 316
the means of
The cold bath, when the patient’s state is suited to it, is one of
Patient comfort
the best tonics.
preserving
health : and,
362
It is of great consequence to observe regularity in meals.
Patient comfort
1. The agglomeration of a large number of sick under the same
Ward design
particularly,
the prevention
of organic
diseases
(PHC243)
Notes on
Nightingale, F
1859 3
hospitals :
roof
being two
2. Deficiency of space
papers read
3. Deficiency of ventilation
before the
4. Deficiency of light
National
These are the four radical defects in hospital construction.
Association
for the
7
Sick people are more susceptible than healthy people, and if
Promotion of
they be shut up without sufficient space and sufficient fresh air;
Social
there will be produced not only fever, but erysipelas, pyaemia,
Science, at
and the usual tribe of hospital-generated epidemic diseases.
Ward design
Liverpool, in
October 1858:
11
Direct sunlight, not only daylight, is necessary for speedy
Ward design
recovery…
with evidence
given to the
Royal
Commissioner
s on the State
of the Army in
1857
(PHC229)
15
… There cannot be doubt that washing floors is one cause of
Ward design
erysipelas, etc, in some hospitals.
16
Hospital bedsteads should always be of iron, the rest of the
Ward design
furniture of oak.
72
Not less than one [orderly] to each seven sick, where there is
Patient comfort
no female head nurse.
Clinical
Graves, RJ
1884 18
Now, when bronchitis has lasted so long in persons of his class Aftercare
lectures on
of life it is very difficult to be cured; poverty, want of proper
the practice of
clothing, his liability, from nature of his employment, to the
medicine: vol.
ordinary exciting causes of bronchitis, and the habitual
II. 2nd ed
disregard of self so constantly observed in persons of this
(PHC144/5)
description, are all circumstances which forbid us to entertain
any hope of giving permanent relief.
52
His parents were anxious to remove him to the country, and Sir
Phillip Crampton and I felt much hesitation in sanctioning this
step, as the danger of his immediate dissolution was so
imminent. His friends, aware of his danger, nevertheless
executed their intention; and about five month afterwards I was
Aftercare
astonished to learn the boy had perfectly recovered… [from
pneumonia]
112
Confinement, heat regulated by the thermometer, flannel, low
Patient comfort
diet and venesection, have been recommended as the best
mode of managing phthisis.
116
Take a young man, even with excellent constitution, who is
Patient comfort
labouring under syphilis, shut him up in a close room, dose him
with mercury, put him on a low diet, and prevent him from the
engagement of fresh air, wholesome exercise, and enlivening
conversation, and you will surely make him phthisical, if this
process be often repeated.
121
These draughts, together with the constant gestation in the
open air for an hour and a half at a time, and several times a
day, with nutritious diet – meat, bread, and beer for breakfast,
meat for luncheon, and a dinner, with one or two glasses of
wine, and no tea in the evening – will soon check the
Patient comfort
perspirations, diminish the cough and rapidly recal [sic] the
patient’s strength and vigour.
263
I have found several cases [of dysentery] which have
Patient comfort
obstinately resisted the most varied remedies assiduously
employed, get well rapidly after a liberal allowance of meat was
given ; and at present, when called on to treat a case of
dysentery of long standing, the first thing I do is to put my
patient on full meat diet.
320
Whenever I was obliged, under the pressure of urgent
necessity, to dismiss a case before healthy action was
completely re-established, or whenever patients left the
hospital prematurely of their own accord, I have observed that
such persons, particularly if placed in the lower ranks of life,
and subject to the numberless accidents and exposures of
poverty, almost invariably returned in a far worse condition
than before.
Aftercare
Elements of
Hawkins, FB
1829 54
In all cities a large proportion of disease and death is to be
medical
assigned to the constant importation from the country of
statistics :
individuals who have attained to maturity; but having been
containing the
previously habituated to frequent exercise in a pure
substance of
atmosphere, and to a simple regular diet, are gradually
the Culstonian
sacrificed to confined air, sedentary habits, or a capricious and
lectures
over-stimulating food.
Patient comfort
delivered at
The Royal
College of
Physicians
(PHC170)
81
The printed report [on St George’s] of 1828 observes: “It is well known that the closeness of the wards in the old
building has long been a subject of deep regret to the
physicians and surgeons who have observed its effect in
preventing or retarding the cure of their patients…”
Ward design
On fractures
Helferich, H
1899 13
Amongst the measures to be taken are – (1) generous diet &c.
Patient comfort
Hall, M
1846 35
Let a patient be impressed with the idea that he will do well,
Patient mood
and
dislocations
(PHC175)
Practical
observations
and he recovers; let him be impressed with the idea that he will
and
die, and his disease terminates fatally.
suggestions in
medicine
41
The physician should inspire hope. There is no more real
Patient mood
cordial. He is not to state a falsehood – he is not to do evil that
(PHC162)
good may come; but also he is not to be the continual augurer
of misfortune.
91
I would that every labouring man in our land reposed, after the
toils of his day, on a bed of such perfect ease! I would that
every inmate of our hospitals, infirmaries, and work-houses,
had such a bed on which to repose his aching, perhaps sickly
Ward design
frame! [on spring beds]
290
It is obvious that, whilst a just degree of exercise does good,
Patient comfort
excessive exertion and fatigue must be as injurious, inducing,
through over-stimulation, a state of fever.
Lectures on
Corrigan, DJ
1853 23
Here in the hospital we are in the habit of admitting light and
the nature and
air, and the mortality is far less than in private life, where it is
treatment of
too often made a rule to exclude every ray of light except from
fever
the flickering flame of a candle.
Ward design
(PHC113)
24
Do not permit him to be disturbed every quarter or half-hour,
Patient comfort
for the purpose of giving him drinks which he does not require.
46
What is to be our rule with regard to nutriment and drink?
Comfort,
Simply this, as long as the patient is conscious, force no drink
Paternalism
upon him. If he turn away from any other drink than cold water
or whey, press no other on him ; and when the arrest of
function reaches to such a degree that even thirst is gone, let
not drink in quantity be pressed.
Clinical
Charcot, J
1889 210
It would not be possible for me to insist too much on the capital
lectures on
importance which attaches to Isolation in the treatment of
diseases of
hysteria ...
the nervous
Yes, it is necessary to separate both children and adults from
system :
their father and their mother, whose influence, as experience
delivered at
teaches, is particularly pernicious.
Patient comfort
The Infirmary
of La
258
Thus it was that the following day, finding P---- just coming out
Patient mood,
Salpetriere:
of an attack which had not modified the state of matters, I
Paternalism
vol III
endeavoured to persuade him that he was paralysed anew.
(PHC095)
“You believe yourself cured,” I said to him, with an accent of
entire conviction, “it is an error ; you are not able to raise your
arm, nor to bend it, nor to move the fingers; see, you are
unable to grasp my hand,” &c. The experiment succeeded
marvellously, for at the end of a few minutes discussion the
monoplegia returned.
Lectures on
Gowers, WR
1885 118
Reassure the patient as to his fancied ailments, and the
Paternalism,
the diagnosis
unmeaning character of his various sensations, and his loss of
Patient mood
of diseases of
memory will vanish. [on “hypochondriacal” patients]
the brain :
delivered at
University
College
Hospital
(PHC140)
Lectures on
the eruptive
Gregory, G
1843 85
Place the patient in a large and cool room and cover him lightly
Ward design,
with bedclothes...
Patient comfort
fevers :
delivered at
The diet of the patient should consist of tea, bread and milk,
St. Thomas’s
arrow-root, rice milk and roasted apples...
hospital in
January 1843
How strongly does this contrast with the plan of stopping up
(PHC157)
every nook and cranny, by which a breath of fresh air could
gain admission, and drenching the unhappy sufferer with
treacle posset and syrup of saffron!
87
A warm bath is always advisable before the patient mixes
Aftercare
again in society.
Lectures on
Graves, RJ
1884 12
… those [patients] who cannot leave their homes, are visited
the practice of
by the senior practicing students, who always seek the advice
clinical
of the professor when the case is urgent or the treatment
medicine : vol.
doubtful.
Ward design
I. 2nd ed
(PHC143)
133
Always bear in mind that it is of the utmost importance to
economise the patient’s strength in fever. The very act of lifting
him up, or moving him from one side to another, tends to
produce exhaustion.
Patient comfort
134
Hence, when you prescribe an opiate, you should not in any
Paternalism
case say anything about it; and it should not be administered in
such a way as to lead the patient or his friends to expect
decided benefit from it.
136
The bed-room of a patient labouring under fever should be well
Ward design
aired, but without what is termed thorough air; and it should, if
possible, be a quiet back room, away from the street.
191
It will be sufficient to observe, that when he [the patient] came
Patient comfort
under our care the chief features of his case were delirium,
accompanied by total want of sleep, and a violence of conduct
and behaviour calling for the restraint of the strait waistcoat.
192
In cases of this kind, where it is necessary to give tartar emetic
(and this is one of the best remedies you can employ in cases
of cerebral excitement in fever), you should be always
prepared to obviate any omission arising from the obstinancy
Paternalism
of the patient; and when he will not take his medications
voluntarily, you may secure its effects in two different ways.
In the first place, it may be secretly mixed with the patient’s
ordinary drink, and as such persons are generally thirsty, and
seldom refuse drink altogether, an intelligent nurse will readily
find means to make the patient take a sufficient quantity of it to
secure its full effect on the cerebral circulation.
217
Indeed, nothing can be more grateful than this removal from a
Patient comfort
tossed, foul, and wet bed, to one that is smooth, clean and in
every respect comfortable. How often have I seen this change
immediately followed by a sound and refreshing sleep.
Clinical
Geddes, W
1846 173
Abundance of cungie, or rice water, was always near at hand
illustrations of
in the ward of the hospital; and when thirst was an urgent
the diseases
symptom, the use of this article, as a drink, was frequently
of India : as
resorted to.
Patient comfort
exhibited in
the medical
413
… and as the patient’s health improves, his diet, and exposure
history of a
to air and exercise were gradually increased, until a final
body of
recovery ensued.
Patient comfort
European
soldiers for a
472
By either, or, as is usual, by both of these disorders [skin and
series of years
hepatic] combined, or succeeding each other, Rheumatism has
from their
occasionally proved fatal; and when such symptoms are in a
arrival in that
less degree, or when the disease has been confined to
country (PHC
frequent attacks of, or long continued rheumatic disorder, it
136)
very often is a cause of men becoming invalided, or discharged
Aftercare
from the service, or of officers being obliged to proceed to
Europe for the benefit of their health.
Notes on
Nightingale, F
1860 10
To attempt to keep a ward warm at the expense of making the
Nursing : what
sick repeatedly breathe their own hot, humid putrescing
it is, and what
atmosphere is a certain way to delay recovery or to destroy life.
it is not
Ward design
(PHC230)
16
A dark house is always an unhealthy house.
Ward design
26
I have often been surprised by the thoughtlessness (resulting
Patient mood
in cruelty, quite unintentionally) of friends or of doctors who will
hold a long conversation just in the room or passage adjoining
to the room of the patient, who is either every moment
expecting them to come in, or who has just seen them, and
knows they are talking about him.
35
Then, this state of nerves is most frequently to be relieved by
care in affording them a pleasant view, a judicious variety as to
flowers, and pretty things.
Ward design
Glossary
Phthisis: Greek term meaning ‘consumption’. Consumption is an old word for Tuberculous infection.
Erysepelas: An infection of the skin.
Pyaemia: Blood poisoning, or septicaemia, resulting in abscesses all over the body.
Parturition: Childbirth.