Hospital of St John of Jerusalem

“ The hospital is an immense establishment, covering a large extent of surface; it comprises three departments, for the infirm, the reception of new-born infants, and the lunatic asylum, and contains in all some six hundred persons of both sexes. The sick are in charge of sisters of charity, whose devotion is well known. I can scarcely say what is most painful in this establishment—the groans of the sick and suffering, the pitiful cries of the new-born and abandoned infants, or the wild ravings of the maniacs. ”

“ If a Jewish Hospital had been established there, before the recent operations took place, much unnecessary suffering and many deaths would have been avoided. Men of the Jewish Battalions, who were very ill indeed, were lying about in hundreds on wet ground in Jerusalem, because there was no room for them in the overcrowded hospitals, and it was quite impossible to get our sick evacuated for days after they had really become cot cases. ”

“ Those charitable institutions, which in later and happier times had a separate existence, were, in the twelfth century, included within the walls of the religious houses. Each monastery of note contained its hospital; and the study of medicine was cultivated by the monks as well as by the women of that age. When the terrible disease of leprosy was carried into this country from Palestine—an event which appears to date from the time of the First Crusade—various hospitals, which partook of the hallowed character of monastic establishments, were built for the reception of the sufferers. ”

“ The current system of large hospitals is abandoned, as being equivalent to 'warehousing diseases on the largest possible scale;' while special hospitals are deemed unnecessary—'as if the different organs could walk out of the body and present themselves for separate treatment.' Each hospital has an ambulance ready to be sent out to bring any injured persons to the institution; the ambulance drives straight into the hospital, where a bed of the same height on silent wheels receives the patient, and conveys him or her to a ward. ”

“ For the great mass of the people, cases of severe illness or injury, or those requiring major surgical operations, can be treated more successfully in well-appointed hospitals than in private houses, and as this is becoming generally understood the old feeling against entering a hospital for treatment is rapidly disappearing. ”

“ Nay, even at the least, the alleviation of suffering to those on whom death had already laid his hand has been no small thing; and when we know that of 240,000 out-patients who have received advice and medicines, and 10,400 in-patients whose cases have warranted their admission to the wards, a large number of actual cures have been effected since the establishment of this hospital, we are entitled to regard the institution as one of the most useful that we have ever visited together. ”

“ 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. ”

“ It is a curious reflection that whilst in the present war the base hospital has been given, if anything, an undue importance, in the other war it has been practically neglected. Our great hospitals are almost entirely field hospitals, planted right in the middle of the battle, and there we keep our patients till such time as they are to all intents and purposes cured. A very few convalescent homes will admit cases which still require treatment, but only a very few. ”

“ Men forgot this later and the disease became a serious problem once more in all the hospitals of even a generation ago. The hospital organization worked out by these university men is the finest jewel in the crown of their accomplishment as applied scientists. Pope Innocent III, himself a University of Paris man, founded the Santo Spirito Hospital in Rome, summoning for that purpose the best authority on hospitals in Europe, Guy of Montpellier, and then required the bishops of the world to erect similar hospitals in their dioceses. ”

“ John’s House, if it steers clear of the rock of prudery, undoubtedly possesses great advantages over a system of hospital nursing by promiscuous instruments. Not because it includes a Sisterhood, a system, in which I, for one, humbly but entirely disbelieve; but because the [7] laborious, servile, anxious, trying drudgery of real hospital work (and to be anything but a nuisance it must ever remain a very humble and very laborious drudgery) , requires, like every duty, if it is to be done aright, the fear and love of God. ”

“ Among hospitals are the Italian, the Homœopathic, the National for the paralysed and epileptic, the Alexandra for children with hip disease, and the Hospital for sick children. The Foundling Hospital, Guilford Street, was founded by Thomas Coram in 1739. ”

“ The glorious halls and corridors, the massive marble pillars, the splendid marble staircases, indicate wealth, but the perfection of the sanitary and scientific arrangements tells of long years of anxious thought and study and research. So perfectly is this marvellous hospital built that, in the event of plague or cholera breaking out to such an extent as to infect the building, the whole of the inside of the hospital can be removed and another hospital will still be left standing as complete as the other. ”

“ It was an admirable hospital in every way, and it is doubtful if we to-day surpass it. It was isolated, the ward separated from the other buildings, it had the advantage we so often lose of being one story high, and more space was afforded each patient than we can afford.
Now as to the management of these medieval hospitals. In the monasteries the superintendency was in the hands of the abbot or prior and the institution was subject to monastic rule. Even in the privately endowed hospitals practically all the hospital attendants were members of some religious community. ”

“ The men are fast dying in the hospital, yet they would rather be sent to Patna for some holy oil, than hear the word of eternal life. Two or three of my evening hearers are in the hospital; one is prepared to die: blessed sight! ”

“ Owing to the rapidly increasing number of patients affected with stone in the bladder who wished to be operated upon by Frère Jean himself, he established in Paris in 1753, near the Saint Honoré gateway, a special hospital for lithotomy cases, and kept it in active service up to the time of his death. The laboring classes, and the poor in general, were not expected to pay any fees, and indeed money was often bestowed upon these people when they left the hospital, to enable them to return comfortably to their villages ”

“ During its two years of work for the sick and wounded, no military hospital has succeeded in establishing a finer record. To see it is a wonderful experience. The hospital consists of 17 wards, with 578 beds, and is entirely staffed by women—surgeons, doctors, pathologists, oculists, dental surgeons, anæsthetists, dispensers, nurses, orderlies. The only men are the patients.
Sir Alfred Keogh, the Director-General of the Army Medical Service, said, when speaking of it: “The hospital is in every respect a military hospital, differing in no way from any other military hospital in the country. ”

“ Notwithstanding this, he has been perfectly frank in confessing how much is accomplished by the religious management of the hospitals, and even did not hesitate to declare that if hospitals for the poor particularly, are to be successfully managed, there must be a change in the view-point of those who take up the work of hospital nursing, and the attendants must come from better social classes than is at present the custom. ”

“ The hospital must be visited every day during the latter half of the course. It is a large edifice, situated [150] at the west end of the town, close to the sea, but by no means, we should imagine, in a favourable position for health, as a channel of fetid mud passes close under the walls. The building can accommodate about three hundred patients and is tolerably but not scrupulously clean. It contains two wards, one for surgical, the other for medical cases, a chapel, an apartment for sick prisoners and a variety of different lecture-rooms. ”

“ 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. ”

“ 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. ”

“ He was of opinion that in such cases a hospital should be required to terminate its own cases and not dump them off on other institutions and stated that at the Speedway Hospital there is no hesitation about reporting such cases as they are found, and if officers who transfer patients would give specific reasons as to why patients need hospital treatment, there will not be so many men coming into hospitals who do not require treatment anywhere. ”

“ Another problem is the question of creating, in connection with General hospitals, wards where patients of this sort may receive at the beginning of their treatment, their preliminary examination, where they may be evacuated home with compensation or without compensation, or evacuated to a prolonged treatment hospital for further care.
It has sometimes been difficult to get enough men, trained personnel, to man these wards. ”

“ The chief nurses have stated that the care of the patients means only “more patients.” There is no special problem in dealing with them and under the above conditions, they accept the necessary discipline and restriction which are fundamental if hospital treatment is to succeed.
It would seem, therefore, that the problem, as has already been pointed out, exists chiefly in the U. S. Public Health Hospitals where the greater number of patients from the Veterans’ Bureau are receiving care and treatment. ”

“ 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. ”

“ Before the move was made to Spearman's Farm the Hospital was enlarged, and the staff was increased by the addition of eight civil surgeons. It is sad to report that of these two died in the camp and others were invalided. No men could have worked better together than did the army surgeons and their civilian colleagues.
The greatest capacity of the Hospital was reached after the battle of Spion Kop, when we had in our tents about 800 wounded.
Some account of the nurses who accompanied the Hospital is given in a section which follows. ”

“ A dozen doctors, with each his smattering of patients, can learn and teach but little while they work apart: whereas a regular system of inquiry and record, in action where the sick are brought in in battalions, is the best possible agency. Not only are these objects lost when surgeons are allowed to make the great hospital a mere receptacle for a cluster of small and desultory hospitals, but the advantages of a broad study of diseases and their treatment are lost. ”

“ If we close the ward to visitors ... we have never in all the years the hospital has been in existence done ... that! Public confidence is our greatest asset. Has been. What shall we do? The newspapers, the police, the reputation of the hospital, d’y’see?”
“Too well, sir.”
But the tension was wearing itself out in speech and Dr. MacArthur went on:
“The hysteria among the nursing and medical staffs was bad enough, God knows, but before today is over, we must face the hysteria manifesting itself among the menial staff. How can a hospital run without orderlies, electricians, cooks? ”

“ Some of our greatest civilian medical men, in a temporary capacity, are now rendering invaluable aid to the remarkable cases which proceed from the fell work of shot and shell. These hospitals, some of which are due to the magnificent enterprise of private individuals, provide for a very [169] large number of patients. In one centre alone there are eight hospitals, with fourteen beds in each. Here, too, are working the most highly trained nursing sisters, and the wounded man will, to his dying day, remember the patient skill bestowed upon him by these devoted women. ”

“ No money should be paid for the treatment of dependent persons in any private hospital while there is unoccupied room in the city hospitals.
The city maintains its own hospitals, while at the same time subsidizing private institutions which compete with them. During the last few years great improvements have been made in the city hospitals, but their condition is still capable of considerable further improvement. ”