General hospital

“ In the result, especially as such special departments as there were in connexion with general hospitals were too often starved for want of means and men for their development and improvement, the younger spirits called their friends together and began to start special hospitals. 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. ”

“ Special Hospitals.—Up to about 1840 the general hospital was, speaking generally, the only hospital in existence. Twenty years later, as the population increased and medical science became more and more active, some of the more ardent members of the medical profession, especially amongst the younger men, pressed continuously for opportunities to develop the methods of treatment in regard to special diseases for which neither accommodation nor appliances were at that time forthcoming in general hospitals. ”

“ 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. ”

“ 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. ”

“ We know now that from 10 to 40 per cent of the patients of the gynecologist, the gastroenterologist, and the internist generally would be better treated if a study of the life problems were added to that of the special organs and functions. To meet this need it should be possible to have enough workers in this branch of the Hospital to take their share of the consulting and co-operation work in the wards and dispensary of the General Hospital, and perhaps even in the schools provided for the same type of people from which you draw your patients. ”

“ The average cost of each patient, for subsistence, medicines, nursing, and clothing, is given at forty-five cents per day. The surgeon-in-chief concludes his report with the statement: “This is the only general hospital for the reception of all classes of patients within the District. Many of the patients are non-residents, and must be provided for somewhere by the general government when they fall sick in this city. The location of the hospital is central and healthy. ”

“ 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. ”

“ The general health of the institution has been good, and no disease of a hospital or local origin has existed. Although the wards of the hospital are crowded beyond their intended limits, care has been taken to secure ample ventilation, and to this, together with good management in the treatment of patients, the satisfactory sanitary condition of the hospital may be attributed. ”

“ The medical officers attached to the hospital in our model city are allowed to hold but one appointment at the same time, and that for a limited period. Thus every medical man in the city obtains the equal advantage of hospital practice, and the value of the best medical and surgical skill is fairly equalised through the whole community.
In addition to the hospital building is a separate block, furnished with wards, constructed in the same way as the general wards, for the reception of children suffering from any of the infectious diseases. ”

“ Wishing the founders long life, to witness the happiness which they have prepared, the Governor General called for and lead three cheers for the founders and three for Her Majesty.
The Hospital consists of three really separate buildings, connected together by stone bridges. Viewed from the front on Pine Avenue, the hospital appears to form three sides of a square, but it is in reality H-shaped. The central part is the administration block, while the two wings contain the wards and accessory rooms, the theatres and chemical laboratory, etc. ”

“ It would be shocking to humanity to relate the history of our general hospitals in the years 1777 and 1779, when they swallowed up at least one-half of our army, owing to the system of placing nearly all the sick of the army in the general hospitals, where crowds and infection wrought a fearful mortality, and where more surgeons died in the American service in proportion to their number than officers of the line—a strong evidence that infection is more dangerous than weapons of war. ”

“ 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. ”

“ The flexibility of hospitals is a matter of importance. The Public Health Service has divided its hospitals into three general groups, that is, hospitals for general medicine and surgery, for pulmonary tuberculosis and for neuro-psychiatry. ”

“ 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. ”

“ No effort will be spared to render the very best service possible under the circumstances and conditions imposed.
Just what the future will hold for the Public Health Service in this work, it is now impossible to say. It appears, however, that the Public Health Service for sometime to come will be one of the designated agencies for furnishing hospital care and treatment to beneficiaries of the U. S. Veterans’ Bureau. This responsibility of supplying hospital facilities, with all that is implied, will be as adequately met as possible. ”

“ 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. ”

“ 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. ”

“ 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. ”

“ The buildings constituting the Hospital are two fine large airy edifices constructed of white marble, with galleries and piazzas, and surrounded by well-kept grounds which abound with choice fruit trees, and every requisite for the health and comfort of the invalids. The patients remain there only while under treatment for disease. ”

“ At least two physicians should reside in the building. It is unfortunate that reception buildings as a rule are entirely too small. They should be large enough so that the acute and recoverable cases, as well as those found on observation not to require hospital treatment, can be returned to their homes without any further contact with the hospital or the necessity of a protracted residence with the chronic and purely custodial cases. ”

“ 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. ”

“ To-day, under the conditions which modern science impose upon the management, probably few hospital buildings are likely to be regarded as efficient for the purpose of treating the sick for more than from 30 to 50 years. ”

“ 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. ”

“ In other words, it is worth watching to see whether Order 59 will not rather tempt the district managers to make a snap diagnosis on the ground and send away to the hospital to which he has blanket authorization to make transfers, on the one hand, a man whose disease is so far advanced, that it might be unwise to send him; or, on the other hand, men with questionable diagnosis. ”

“ 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. ”

“ In some instances where the state governments have been reorganized and the proposed consolidation of departments effected, the administration of the state hospitals has come under the direction of a single individual without hospital or institution experience of any kind and without any special knowledge of medicine or psychiatry. There is no escaping the fact that the administration of a hospital is a medical problem. ”

“ While one clearing station is filling up and treating the patients, the other will be sending all possible treated cases down the line. From the base hospitals, which are near the sea, the men are forwarded as soon as advisable by hospital ships for distribution among the hospitals of England. ”

“ To avoid these evils, public laundries are established in the outskirts of Hygeia, each with an extensive drying-ground, and all under sanitary inspection.
There is no one gigantic hospital, nor any hospital for special diseases—with perhaps one or two exceptions. Numerous small hospitals are distributed equidistant throughout the city; each constructed according to the most approved and efficient plan, and surrounded by its own open grounds. ”

“ It is intended that the hospital should be a model to the whole kingdom of what such an institution ought to be; the latest and best of modern appliances, both sanitary and surgical, will be introduced. There will be in and out departments, completely isolated one from the other, though with a door of communication. From sixty to seventy beds will be provided, special wards for a certain class of cases, adequate waiting-rooms for out-patients, and the necessary rooms for the officers and medical attendants, all being on an ample scale. ”

“ As the men were discharged from Army Hospitals the burden of the Public Health Hospitals became greater, and many of the individuals who had been active in the Army work became associated with the Public Health and established as a part of their hospital program the Section of Physical Reconstruction, to include Occupational Therapy and Physiotherapy. ”

“ 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. ”

“ The Health Department has expanded its rural health units with the establishment of 33 additional ones, while expansion of hospital services was achieved through the completion of 31 hospitals with a total capacity of 1,050 beds. ”