Hospitalization

“ Such was the exclamation, in no very amiable tone, which greeted my ear, as I opened the door of one of the wards of our hospital.
“What is the matter, Wilson?” said I, to our usually cheerful wardmaster.
“Oh! nothing, miss; I beg your pardon, only there’s a young fellow, just brought in, who, the doctor thinks, can’t live over the day, and I hate to have them dying on my hands, that’s all.”
“Wounded or sick?”
“It’s the typhoid, and as bad a case as ever I saw yet, and I’ve seen a heap of them, too. There he is, but he’s past speaking; he’ll never rouse again.” ”

“ The reports from this institution show that during the year the hospital has been free from any of the diseases usually occurring in lying-in asylums, no adult death being recorded in the obstetrical department. Only one death is recorded in the medical and surgical division, although many of the operations performed were regarded as among the most severe and dangerous in surgery.
The number of patients treated in hospital during the year was 294; the daily average was 29.48. The number treated in the dispensary was 485. ”

“ No longer ago than yesterday, in one of the most widely circulated papers of this city, there was published an assertion that the mortality in several Homoeopathic Hospitals was not quite five in a hundred, whereas, in what are called by the writer Allopathic Hospitals, it is said to be eleven in a hundred. An honest man should be ashamed of such an argumentum ad ignorantiam. The mortality of a hospital depends not merely on the treatment of the patients, but on the class of diseases it is in the habit of receiving, on the place where it is, on the season, and many other circumstances. ”

“ The question of infection or non-infection [131] has nothing to do with the arrangement. No stronger condemnation of any Hospital or ward could be pronounced than the simple fact that any disease has attacked other patients than those first affected by it. “Infection” and incapable management, or bad construction, are, in Hospitals, convertible terms.
It may be useful to mention what the meaning is of the words “epidemic,” “endemic,” “sporadic,” and “zymotic.”
When a large number of people are attacked simultaneously with the same form of disease it is said to be epidemic. ”

“ In the largest hospitals the administration of drugs and the dressing of wounds devolves entirely on the medical students, and nurses, whether Sisters of Mercy or lay, merely stand in the wards to watch the patients, and in case of need they have to go and summon a student. While I was in the hospital, I witnessed some shocking examples of the way in which sufferers were treated. I remember one night when a patient, who was suffering from a most serious attack of jaundice, cried out to the Sister on duty for a basin. ”

“ 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. ”

“ They are much more easily and for a longer time kept free from the infectious qualities likely to attach to a permanent hospital, and the patient is relatively secure from the peril from poisonous influences which he is sure to incur in a city hospital. ”

“ If the case be a common one, you get so much familiarity with a phenomenon that it will be continually presenting itself. If a rare one, you have seen what you may seldom see again. There is every reason for taking the practice of the hospital exactly as you find it. It represents the diseases of the largest class of mankind—the poor; and, although in some of the details there may be a difference, upon the whole the forms of disease that are the commonest in hospitals are the commonest in the world at large ”

“ Let us take, for example, a State hospital of one thousand patients. The staff would consist of a medical superintendent, five assistant physicians, and a woman physician. In a hospital of that capacity there would never be more than one hundred patients who would be considered curable, and the number would probably not exceed sixty. More than nine hundred patients would be hopelessly incurable, for the most part the wrecks of past disease, who practically need nothing but kindly custodial care with incidental medical treatment. ”

“ It might also be right to have reserve wards for what must occur every now and then in a Military Hospital, an influx of patients beyond the usual number, or an outbreak of cholera, or some malignant epidemic, which it might be desirable to isolate from the other patients. ”

“ Public hospitals, or proper places of reception for the sick, provided they were kept clean, well ventilated, and placed in an open situation, would likewise tend to prevent the spreading of infection. Such places of reception would prevent the poor, when sick, from being visited by their idle or officious neighbours. They would likewise render it unnecessary for sick servants to be kept in their master’s houses. Masters had better pay for having their servants taken care of in an hospital, than run the hazard of having an infectious disease diffused among a numerous family. ”

“ He added that it is the medical advice and decisions that the Bureau has to depend upon regarding the care and treatment of the men.
DR. SNELL, (N.H.D.V.S.) asked if a man should be hospitalized if he presented himself to Dwight, Illinois, for example, but his disability was not of service origin.
COL. FORBES: said that the man is to be hospitalized, and his case determined later; that is he has a contagious disease the city will take care of him. ”

“ In a Military Hospital, the proportion of heavy cases is in ordinary times considerably below the average proportion of such cases in a Civil Hospital, open, as the latter is, to accidents, and to the cases of dangerous disease always more or less rife in low and crowded neighbourhoods. ”

“ In conducting the Military Hospitals, we found that it was always right to discharge the Patients from the sick Hospitals as soon as they were recovered, and to send them either to Billet, or to a convalescent Hospital; because recovered Men are always the most riotous; besides they crowded the Hospitals, and were in Danger of catching fresh Disorders from those who were sick; and therefore the recovering Men in every Hospital ought to be reviewed once or twice a Week by the Physician or Surgeon, and the Names of such Men as are well enough, to be marked ”

“ After they have been washed in a bath, and placed in a clean bed, in the spacious and well-ventilated ward of the hospital, in a few hours, often before the visit of the physician, the violent delirium has subsided, or the state of coma having passed away consciousness has returned. Although in a great majority of cases the patients are only sent to the hospital in the last stage of disease, this mere change in the locality and external circumstances of the sufferers diminishes the proportion of deaths from one in five to one in seven. ”

“ It must be remembered that many soldiers who have slight attacks of fever do not present themselves at the hospital, whilst of those who do a considerable number are only detained for slight treatment, and are never entered on the hospital books, and so are not recorded on the returns. ”

“ Once launched upon the sea of hospital life, your views undergo a change, and your one interest becomes to receive, nurse, and watch the worst cases; it is the hospital spirit, and you cannot breathe its air without imbibing the feeling. Monday, Tuesday, Wednesday, Thursday, Friday have passed, with only the admittance of a few each day, none badly wounded, and none requiring special care or tending ”

“ 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. ”

“ Nowadays the healthy, whilst they realize that the more efficient they can make the hospital, the more certain, in the human sense, is their own chance of prolonged life and health, are, as the progress of the League of Mercy has shown in recent years, genuinely anxious for the most part to do something as individuals in the days of health in the cause of the sick. Formerly the hospital was merely a building or buildings, very often unsuitable for the purposes to which it was put, where sick and injured people were retained and more frequently than not died. ”

“ Disinfecting apparatus, sterilizers, good water supply and special laundry are other adjuncts essentially necessary for a plague hospital. Greatest care is required in the management of such a hospital, and only trained men should be employed. ”

“ Much more vital, however, is the care patients receive in the hospital, for rigid adherence to surgical cleanliness is exemplified in the hospital as it can be nowhere else. Infections rarely develop there. ”

“ A definite agreement has been reached in regard to the required personnel, nurses, doctors, attendants, social service, workers, etc., to each two hundred patients in a hospital caring for all acute patients, whether they be major surgical, acute active neuro-psychiatric, active tuberculosis, or other type of acute condition requiring active, constructive treatment. ”

“ CIVILIZATION has not reached that state of perfection where hospitals can be dispensed with. 1. As long as armies exist, hospitals will be necessary. Soldiers when sick must be provided with special accommodations; and, after a battle, the wounded cannot be properly cared for except in hospitals constructed especially for the purpose. 2. During epidemics of contagious and infectious diseases, it becomes a necessity to separate those infected from the well, and for their accommodation hospitals must be erected. ”

“ In making Choice of Houses for Hospitals, particular Regard ought to be had to the Privies or Necessaries; because, where their Smell is offensive, there is always Danger of infectious Disorders. If, therefore, there be no proper Conveniencies of this Kind about an Hospital, such ought to be contrived so as to prevent any Danger from their putrid Effluvia. If there be a River near the Hospital, the Necessaries may be made above it at a Place where there is a rapid Stream below. In Villages deep Pits may be dug in the Ground behind the Hospital, and Seats made over them, as in Camp ”

“ Again, if we have a Fever Hospital with over-crowded badly-ventilated wards, or with the air stagnant in them, we are quite certain to have the air become so infected as to poison the blood not only of the sick, so as to augment their mortality, but also of the medical attendants and nurses, so that they shall also become subjects of fever. ”

“ 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. ”

“ No doubt the whole community would benefit if residents in every part of the country could be moved to take a personal interest in the infectious hospital in their immediate neighbourhood. Amongst the smaller of these establishments there has been so marked an inefficiency at times as to cause much avoidable suffering. ”

“ The other serious problem of hospital management was to keep those not really suffering from serious disease, malingerers of various kinds, from occupying beds and claiming attention, to the deprivation of those who were genuinely ill. ”

“ The hospitals are furnished and stored with all things that are convenient for the ease and recovery of the sick; and those that are put in them are looked after with such tender and watchful care, and are so constantly attended by their skilful physicians, that as none is sent to them against their will, so there is scarce one in a whole town that, if he should fall ill, would not choose rather to go thither than lie sick at home. ”

“ Often a severe illness is, and oftener still would be prevented by a week’s change of air, when the peculiar hospital-languor, so well known in hospitals, and so indescribable outside of them, first fairly sets in. ”

“ Military hospitals are established at home and abroad for the treatment of sick officers and soldiers as well as their wives and families. Military hospitals are classified as follows:—First-grade hospitals are large central hospitals serving important districts. These hospitals are complete in themselves and fully equipped for the carrying out of operations of all kinds; they generally contain wards for officers, and may have attached to them separate isolation hospitals for the treatment of infectious cases, and military families’ hospitals for women and children. ”

“ This arrangement brought the three hospital buildings in a line, while the bakery, dead house and pest-house were in a line to the rear. A line of guards paced their beats around the whole.
I supposed when I was sent to the hospital that I had fever of some kind, but in two days the soreness of my throat and the pustules on my face and hands told the story too plainly, that the inoculation of a few days before was doing its work. I was down with a mild form of small-pox, varioloid, the doctors called it, but a Tennessee soldier pronounced it a case of the “Very O Lord.” ”