Henry Burdett

“ In such a hospital no patient can be overlooked, no wrong or imperfect diagnosis can long remain undiscovered and unrectified, and nowhere else have the patients so continuous a guarantee that the treatment they receive will be of the best, while the provision made for their comfort and welfare, owing to the unceasing and ever varying quality of the criticism to which the work of everybody, from the senior physician to the humblest official, is subjected in a clinical hospital, is unequalled anywhere else. ”

“ Looking at the question of hospital provision in Great Britain, and indeed in all countries at the present time, it may be said, that there is everywhere evidence of improvement and development upon the right lines, so that never before in the history of the world has the lot of the sick man or woman been so relatively fortunate and safe as it is in the present day. Probably it is not too much to say that to-day hospitals occupy the most important position in the social economy of nations. ”

“ At a great voluntary hospital, not only do hundreds of medical students and nurses work in the wards, but thousands of people, in the persons of the patients’ friends, and those members of the public who take an interest in hospitals, pass through the wards in the course of every year. Again, each voluntary hospital has to live by competition, a fact which guarantees that everything in the way of new treatment and scientific development shall in due course find its proper place within the walls of such an establishment. ”

“ As the knowledge of hygiene and of the doctrine of cleanliness and purity in regard not only to dwellings and towns, but also in relation to food of all descriptions, including water, became known and appreciated, hospitals were found to be of even greater importance, if that is possible, to the healthy in crowded communities, than to the sick. It took many centuries before sound hygiene really began to occupy the position of importance which it is now known to possess, not only in regard to the treatment and cure of disease, but to its prevention and eradication. ”

“ Every voluntary hospital, while admitting all accidents and urgent cases needing immediate attention, should institute a system whereby each applicant would be asked to prove that he or she was a fit object of charity. The only real attempt at reform, up to 1909, was the appointment by many of the larger hospitals of almoners to ascertain whether certain selected patients were in a position to pay or not. By putting the burden of proof of eligibility to receive free medical relief upon the patients and their friends, all abuse of every kind must speedily cease. ”

“ We believe that the more thoroughly the advantages and disadvantages of rate-supported and voluntary hospitals for the care of the sick are weighed and considered, and the more accurate and full the knowledge which is added to the judgment upon which a decision can be based, the more certain will it be that every capable administrator will come to the conclusion that on the whole it is good for the sick and for the whole community that these establishments should, at any rate in Great Britain, be maintained upon the voluntary system. ”

“ Such an absence of system throughout the world has everywhere led to overlapping, to the perpetuation of many abuses, to the admission of an increasing number of patients whose social position does not entitle them to claim free medical relief at all, and, often too, to the admission of patients belonging to a humbler grade of society who are already provided for by the rates in institutions which they do not care to enter and who find their way to the wards of hospitals which were established to provide for patients of an entirely different social grade. ”

“ History of the Hospital Movement.—We have now to consider the principles upon which the provision of the best form of medical care in hospitals can be secured for all classes of people. Though hospitals cannot be claimed as a direct result of Christianity, no doubt it softened the relations between men, and gradually tended to instil humanitarian views and to make them popular with the civilized peoples of the world. ”

“ Others, on the contrary, through the energy of their original promoters and the excellence of the work they have done, have obtained a position of authority and reputation which has had a very important bearing for good upon the development of medical science in the treatment of disease. If the world had to-day to organize the very best system of hospital accommodation which could be evolved, there is no doubt that few or none of the special hospitals would find any place in that system. ”

“ Hospital Economics.—There is no doubt that the voluntary system of hospital government is far more economical than any system of state or rate-supported hospitals. That the present condition of the voluntary hospitals in regard to economy is all that can be wished is not, of course, true. Still, resting as this system does upon the goodwill of the public for its continuance and maintenance, it is satisfactory to note that there is a continuous improvement in system and method, which makes for economy. ”

“ Such disadvantages might be entirely removed if parliament would decide to throw open every poor-law infirmary for clinical purposes, and to have connected with each such establishment a responsible visiting medical staff, consisting of the best qualified men to be found in the community which each hospital serves. The old prejudice against hospital treatment has disappeared, for the least intelligent members of the population now understand that, when a citizen is sick, there is no place so good as the wards of a well-administered hospital. ”

“ Warming is a question of great importance in most climates, especially in such a climate as that of Great Britain, where every system of ventilation must involve either the warming of some portion of the incoming air, or the contriving its delivery without too great lowering of temperature; at the same time it cannot be too strongly insisted upon that the tendency is too much in the direction of allowing warmth to supersede freshness of air. There are very few cases of disease (if any) that are not more injured by foul air than by low temperature ”

“ Nowadays, despite, or possibly because of, the fact that operative interference is the rule rather than the exception in the treatment of hospital patients, and in consequence of the introduction of antiseptic and aseptic methods, the mortality in hospitals is, in all the circumstances, relatively less, and probably materially less, than it is even amongst patients who are attended in their own homes. ”

“ These principles, as civilization grew, education improved, and the tastes and requirements of the common people were developed, made men and women of many races realize that the treatment of disease in buildings set apart exclusively for the care of the sick was, in fact, a necessity in urban districts. The establishment of a hospital freed the streets of the abuses attendant upon beggars and other poor creatures, who made their ailments the chief ground of appeal for alms. ”

“ In Great Britain hospitals for the treatment of general and special diseases are mainly maintained upon what is known as the voluntary system. On the European continent, hospitals as a rule are maintained by the state or municipalities, and this system is so fully developed in Sweden and elsewhere that a sound economical principle has been embroidered upon the hospital system, to the great physical and moral advantage of all classes of the community. ”

“ To-day every really efficient clinical general hospital has within its walls special departments of almost every description, which have been made as efficient and up-to-date as money and knowledge can make them. Unfortunately the causes already referred to led to the establishment of hundreds of the smaller special hospitals, many of which were started in unsuitable buildings, and some of which have ever since maintained a struggling existence. ”

“ Attached to the voluntary hospitals are the principal medical and nursing schools upon which the public depend for the supply of doctors and nurses. The education of students and nurses in a clinical hospital makes that hospital the most desirable place for everybody when they are really ill. ”

“ Within recent years much more attention has been devoted to the details of construction than was formerly considered necessary, but even in the best type of hospital there is still much to be desired in this respect. It is essential for an architect in designing any building to have before him an accurate idea of all the requirements, and the use to which each foot of space is to be put ”

“ Another advantage of the municipal system should be that central control makes for economical administration. Unfortunately a close study of this question tends to prove that municipal hospitals for the most part have resulted in a dead monotony of relative inefficiency, often entailing great extravagance in buildings, and accompanied by much waste in many directions. Existing municipal hospital systems are attended by several grave disadvantages. The administration shows a tendency to lag and grow sleepy and inert. ”

“ Apart from its interest as a new feature which all new hospitals should adopt, the gatehouse or admission block has an importance in the wider sense, that it may come to form the key to the solution of the problem of how best to provide hospital accommodation for the poor in great cities under the best hygienic conditions, while protecting them from the misery and danger of prolonged delay in first treatment, especially in connexion with accidents and other cases of urgency. ”

“ The great missionary and social value of the voluntary hospitals to the whole community cannot be questioned, and they have been of inestimable value to the churches by inculcating the higher principles of humanity, while removing the many acerbities which might otherwise prevail between rich and poor in large cities. ”

“ It is essential that every precaution be taken against the admission of an unsuitable case, or the refusal, without careful examination, of any patient seeking admission. It is only necessary to instance the case of a patient with delirium tremens being admitted to a general ward at a late hour, or a case of infectious disease admitted through an overlook, or a case refused admission and expiring on the way home, in order to illustrate the danger and trouble which might arise should the supervision exercised over this department not be systematic, stringent and thorough. ”

“ The Evolution of the Modern Hospital.—The evolution of the modern hospital affords one of the most marvellous evidences of the advance of scientific and humanitarian principles which the world has ever seen. At the outset hospitals were probably founded by the healthy more for their own comfort than out of any regard for the sick. ”

“ The duties of nurses ought also to be distinctly confined to attendance on the sick, and no menial work, such as scrubbing floors and the like, should be demanded of them; a proper staff of servants ought to be employed for such purposes. It is also desirable that a separate pavilion for lodging the nurses should be set apart, and that fair and reasonable time for rest and recreation should be allowed. Some discussion has taken place as to the advisability of placing the nursing of a hospital in the hands of a sisterhood or a separate corporation. ”

“ Nearly every difficulty in regard to the cost of hospitals and in respect to all the many problems presented by securing the material required, under present systems, for the efficient training of students and nurses, would be removed by the erection of the Hospital City, which, he foresees, must ultimately be recognized by intelligent communities throughout the civilized world. ”

“ Pending such a discovery the experience of the cancer department connected with the Middlesex Hospital in London proves to demonstration that the provision of adequate and special accommodation for the exclusive treatment of cases of cancer is not only desirable but necessary on humanitarian grounds alone. ”

“ Since the contagious character of tuberculosis became known, and improved methods of treatment have been developed, every one agrees that this type of special hospital is desirable, though it is believed by the more advanced school of scientists that before long it may be happily rendered obsolete owing to the discovery of methods of treatment which will stay the disease at its commencement and restore the patient to health. ”

“ It is probable that no single reform has had a greater influence for good upon the administration of charitable institutions than the evolution and enforcement of the uniform system of accounts.
Nursing.—The arrangements for nursing the sick have greatly improved in recent times, although controversy still goes on as to the best method of carrying it out. In arranging for the nursing in a hospital both efficiency and economy have to be considered. No ward in a general hospital for acute cases should contain more than 24 beds. ”

“ Still some hospital authorities prefer the multiple-storeyed system for administrative reasons, contending that single-storeyed pavilions have no special advantages over two or three-storeyed buildings, whereas the difficulties in administration and service of a hospital building on the single-storey principle outweigh any argument against the two- or three-storey building, if it is properly designed and constructed. ”