Foundling hospital

“ There are also in Paris numerous private charities for the adoption of poor children and orphans. It is impossible here to give even a sketch of the long and able controversies which have occurred in France on the principles of management of foundling hospitals, the advantages of tours and the system of admission à bureau ouvert, the transfer of orphans from one department to another, the hygiene and service of hospitals and the inspection of nurses, the education and reclamation of the children and the rights of the state in their future. ”

“ FOUNDLING HOSPITALS, originally institutions for the reception of “foundlings,” i.e. children who have been abandoned or exposed, and left for the public to find and save. The early history of such institutions is connected with the practice of infanticide, and in western Europe where social disorder was rife and famine of frequent occurrence, exposure and extensive sales of children were the necessary consequences. ”

“ Most people assume that the older generations did not know how to build good hospitals. They did as well as they could, but until the development of modern knowledge of hygiene and sanitation, as well as the demand made on hospital administration by modern surgery, hospitals could scarcely be expected to be anything but the sordid piles of buildings they usually were, thought proper if they but furnished a protection from the weather and sustenance for the sick poor. ”

“ 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. ”

“ Thus, the end for which a hospital is built is the relief of the sick, not the beautifying of the street. To sacrifice the health of the sick to splendour of architectural effect, to place the building in a bad air only that it may present a more commanding front to a great public place, to make the wards hotter or cooler than they ought to be, in order that the columns and windows of the exterior may please the passers-by would be monstrous. But if, without any sacrifice of the chief object, the hospital can be made an ornament to the metropolis, it would be absurd not to make it so. ”

“ Our plan, we reasoned, was analogous to the custom of “private” hospitals, which give free treatment or charge according to the resources of the ward patients. Both private hospitals and visiting nursing are thereby lifted out of “charity” as comprehended by the people.
We felt that for economic reasons valuable and expensive hospital space should be saved for those for whom the hospital treatment is necessary; and an obvious social consideration was that many people, particularly women, cannot leave their homes without imperiling, or sometimes destroying, the home itself. ”

“ We are prone to think that we are the first generation to solve the problem of hospital construction. We know what poorly-constructed, badly-planned institutions were the hospitals of three generations ago. What, then, must have been the hospital buildings of centuries ago? This argument has no place in history; the worst hospitals in the world and in history were erected at the end of the eighteenth and the beginning of the nineteenth century. Some of the best hospitals ever constructed date from the thirteenth, fourteenth and fifteenth centuries. ”

“ Besides this tendency in hospitals as charitable institutions to increase pauperism, another serious objection to the use of public hospitals for the purpose of treating the sick beyond the extent absolutely demanded by necessity is, that every time an individual is removed from his home—let that home be ever so humble—and taken to a hospital, the family as an institution receives a blow. ”

“ 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? ”

“ 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. ”

“ Thomas' Hospitals, now in process of construction at the Surrey Side of the Thames, in Lambeth, opposite the Houses of Parliament, will combine a number of hospitals for Special Diseases, and will accommodate about 2,000 patients, with as many beds, and will have an income of £50,000 a year, or more.
It is impossible to think of any disease, complaint, deformity, or injury to any member or organ of the body, which has not its special hospital or institution for relief or cure, in the English metropolis. ”

“ The hitherto meager hospital facilities are being amplified by the building of a maternity hospital and the enlargement of the children's hospital,—a centralization plan of hospital service being a unique and distinctive feature. In the way of industrial hygiene a full-time nurse is employed in the ship-building plant and here also safety policies have been introduced and have reduced accidents to a minimum. The movement for the control of preventable disease is gaining impetus and a modern tuberculosis hospital is being established. ”

“ 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. ”

“ 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. ”

“ Often, too, these diseases rose to the height of epidemic pestilences, so that patients, however extreme their need, dreaded the very name of hospital, and the most skilful surgeons distrusted their own craft. New hospitals or new wards were built, yet after a very short time the new became as pestiferous as the old; and even scrupulous care in ventilation and housemaids’ cleanliness failed to prevent the devastation. Surgery had enlarged its freedom, but only to find the weight of its new responsibilities more than it could bear. ”

“ But the war came, and with it the gathering of forces and its accompanying evils and sickness. There were but very inadequate accommodations in the camp for the sick; none in fact, for the time. The City Hospital seemed a special providence, sent in the very nick of time. It was exactly what was most needed. The frail, damp structures of the camp could protect the sick but little better than tents; and the dry, clean airy bed chambers that cure far better than medicine, were out of the question. The City Hospital could supply all, and of the best construction. ”

“ 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. ”

“ The disadvantages, inseparable from general hospitals, are such as can never be counterpoised by all the regularities of medicine and regimen. Nature and kind nursing save a much greater proportion in our plain way, at a smaller expense, and with less abuse. One branch only of hospital institution is wanting with us; that is, a general establishment for those laboring under difficult cases of chirurgery. ”

“ My Richmond friends never lost sight of me for one day during my service in that city. Nearly every day my little boy was sent for to play among happy children, far away from the impure atmosphere of the hospital, which was soon filled with patients suffering from almost every form of disease.
As the demand for more room became pressing, the three stories of the main building were successively utilized, as well as a large storage-room in the yard. The ground-floor contained the surgeons' and steward's offices, store-rooms, etc., while the second and third formed two immense sick-wards. ”

“ 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 Pennsylvania Hospital was also a model, for it contained a department for the insane, the only one of the sort in America except the Virginia Lunatic Asylum at Williamsburg. Even there the treatment of these beings, whom a later instinct of humanity thought peculiarly worthy of care and lavish expenditure, was harsh enough,—strait-jackets, whip­pings, chains, and dark-rooms being a part of the pre­scribed treatment in every such hospital in the world but where no hospitals existed, as in New England, New York, and elsewhere, the treatment was apt to be far worse. ”

“ The company erected at a cost of more than $60,000 a thoroughly modern brick hospital of thirty-five bed capacity which furnishes absolutely free to its employees and their dependents every type of medical, surgical and obstetric 78 treatment. No charge is made for any hospital care, operating fees, or for medicines. ”

“ 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. ”

“ Hospitals and infirmaries would be alike nationalised, and, in place of the present antagonism between hospitals and the bulk of the medical profession, every doctor would be in touch with a hospital, thus having behind him a fully equipped and staffed institution for all purposes of diagnosis, consultation, treatment, and research, also serving for a centre of notification, registration, preventive and hygienic measures. ”

“ No doubt this policy of amalgamation will be steadily pursued, and in the course of years every great city will gradually reorganize its hospital methods so as to secure that, whether the patients are treated in a general hospital or in a special hospital, the average efficiency in every institution shall be as high and as good as possible. ”

“ 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. ”

“ While we are inclined to think of these older hospitals as surely lacking in everything that we have developed in our modern hospitals, they prove, on the contrary, to have anticipated most of our hospital improvements. ”

“ Now the plant has its own furnishings. The building is modern but of an obsolete and unsatisfactory type, and has not sufficient grounds for its convalescents. All the other hospitals in the city are private institutions. There is no co-ordination of hospital work among them, and their distribution is such that localities where there are the most ambulance calls are without easily available hospital plants. ”

“ When the centenary of the Hospital was celebrated in 1879, a suggestion was made that an event so interesting in the history of the charity would be most fittingly commemorated by the establishment or a Suburban Hospital, where patients whose diseases are of a chronic character could be treated with advantage to themselves, and with relief to the parent institution, which is always so pressed for room that many patients have to be sent out earlier than the medical officers like. ”