Hospitals are so called from the medieval hospitia, or more properly the class of hospitals established very generally for the reception and relief of lepers, whose malady was one of the scourges of Europe. These leper hospitals were very commonly in England and in Scotland called 'Spitals'; hence the frequency of such names of places as Spital, Spitalfields, &c. The leper hospitals and other kinds of the old hospitia disappeared with the improvement of society, and substitutes for them on a broader scale began to be established in the modern form of hospitals. Of public establishments under this general designation there are now, as is commonly known, three distinct classes—hospitals for the reception and treatment of the sick and hurt, hospitals for the board and education of children, and hospitals for the reception and permanent board of poor old persons of both sexes. As in the present work the more remarkable hospitals receive some notice under their respective heads, we need here only offer a few general observations.
Hospitals for the sick and hurt are in some parts of England and Scotland termed Infirmarys. Under whatever designation, institutions of this kind are now established in all parts of the civilised world. They are supported in most cases on a principle of charity, but in some special instances from the funds of the state or the civic municipalities. The primary or more important object of all such institutions is to mitigate bodily suffering, whether that arises from natural or accidental causes, in which respect they are indispensable as a refuge to all who are unable to pay for private medical or surgical aid, or as a convenient means of succour on emergencies to persons of every rank and degree of opulence. While such is the main object of these benevolent institutions, they are also serviceable as schools for medicine and surgery; as such, no university, at which these and kindred branches of learning are taught, can be said to be complete without the adjunct of a well-organised hospital, where professors can practically educate their pupils by pointing out varieties of disease and injuries, and exemplifying methods of treatment. Hence the best specimens of hospitals are found in university towns—as in London, Paris, Edinburgh, and some other cities famed as schools of medicine and surgery. The older of the London hospitals are St Thomas's (1553), St Bartholomew's (1546), and Bedlam or Bethlehem (1547), to which may be added the Westminster (1719), Guy's (1725), the Lock (1746), St George's (1733), the London (1740), the Middlesex (1745), and University College (1833). A considerable accession to the number took place in the reign of George II., when society became alive to the value of such institutions. It was at this period that the Royal Infirmary of Edinburgh was established (1730). The antiquity of British hospitals sinks into insignificance in comparison with that of some institutions of this kind on the Continent. The Hôtel Dieu in Paris, which is alleged to be the most ancient hospital in Europe, was founded in the 7th century, and, long known as the Maison Dieu, received the benefactions of successive sovereigns.
In London, Paris, and other large seats of population, besides the general hospitals, there are now lying-in hospitals, ophthalmic hospitals, consumptive hospitals, children's hospitals, &c.—each with its peculiar accommodation and staff of officials. Convalescent Hospitals (q.v.) are a valuable adjunct to ordinary hospitals for the sick. Independently of these there are hospitals for the treatment of mental maladies, of which Bethlehem and St Luke's in London, and the establishments in Paris, known as Hospices, are examples. To this class of institutions belong Lunatic Asylums (q.v.), also asylums for the reception and treatment of naturally imbecile children; these last, though in operation for some time in France and Switzerland, being but of recent establishment in Great Britain. To these must be added the isolation hospitals for the treatment of smallpox, scarlet-fever, and other forms of infectious diseases, which have been established in recent years by every energetic sanitary authority out of the rates. Besides these institutions under civil administration are those hospitals which are maintained by the English, French, and other governments for the military and naval services. In the United States, where every medical college has its own hospital, or the right to teach in the wards of public institutions, there are also many hospitals or asylums for idiotics (see INEBRIATES), for opium-users, and those addicted to the use of other narcotics (see also FOUNDLING HOSPITALS, AMBULANCE).
Until the middle of the 19th century the organisation and management of hospitals and the nursing of the sick in Britain and in most parts of Europe were, except in some few instances, extremely defective. Public opinion was then aroused on the question, and certain principles were laid down on hospital construction and hospital nursing which have been recognised and adopted to a greater or less extent since that time. These principles may be briefly summed up as follows under the three heads: (1) Construction, (2) Administration, (3) Nursing.
(1) Construction.—The first object is to obtain pure air in and around the building. The purity of air around will depend upon the site. The soil should be clean and dry; the position should admit of free circulation of air untainted by surrounding sources of impurity or damp. The number of sick who can be placed on a given site depends on the form of the buildings in which they are to be placed. It is now considered that more than 100 patients should never be under the same roof. And less is better. This has led to the pavilion form of building being adopted—blocks connected by corridors. Two floors only of patients' wards are admissible, but hospitals with only one floor for the ward accommodation are now universally recognised as best. More than three is insanitary. Hospital buildings consist (a) of the wards for the reception of the sick, and their appurtenances; these necessarily form the basis of the design; subsidiary to these are the operating theatre, &c.; and where there is a medical school instructional accessories have to be provided. (b) The buildings for administration—i.e. for lodging the staff, the kitchen, stores, and dispensary, should be always subordinate to the question of the accommodation for sick. In some hospitals extra out-patients' departments are provided. These should never be placed under the same roof with the wards for the sick. (a) The first principle of the ward unit is that the ward and ward offices should be self-contained within one door commanded by the head-nurse's room, so that at any moment she may know where every patient is. The size of the wards has to be somewhat guided by economy of administration, so as to enable the largest number of patients to be nursed by a given number of nurses. The limit of the ward is practically the number who can be efficiently nursed under one head-nurse. Each ward may have subsidiary to it one or two small wards for bad cases.
The ward appurtenances consist partly of nursing accommodation and partly of offices for patients. The nursing accommodation includes a bedroom for the head-nurse; a serving room in which food can be warmed, drinks and extra diets made, and linen kept and aired, hot water obtained, poultices, &c. made; also a nurses' water-closet near. The head-nurse's room should be so placed as to enable the nurse to exercise constant supervision over the ward and the patients. The offices for patients comprise a lavatory for the patients, a bath-room with a movable bath, which bath-room and lavatory should be large enough for minor surgical operations, and water-closets in the proportion of about 3 to 10 per cent. of the number of patients—the general hospital for acute cases, mostly in bed, requiring the lesser number—one or more slop sinks, a place for keeping ejecta of patients for medical inspection. These appurtenances should be cut off from the ward by ventilated lobbies, and should be always warmed and ventilated independently of the ward.
The form of the ward should be such as to enable the air to be renewed with the greatest facility. Experience in this climate shows that the windows are the best appliance for complete renovation of the air. For this purpose they should be on opposite sides of the ward, and the wards should not exceed from 20 to 28 feet in width. There should not be above two rows of beds between the windows. The rectangular form enables these conditions to be best fulfilled in the case of large wards. Where the wards are not intended to contain more than from four to eight patients a circular form of ward has been in some cases found unobjectionable; but as it is a principal object in hospital construction to provide a large wall space in proportion to the floor and cubic space per bed in the wards, and as the rectangular form affords the largest, and the circular form the smallest wall space in proportion to the area of the ward, it is evident that the rectangular form is that best adapted to sanitary requirements. (b) The subsidiary accommodation should be so arranged as not to interfere with the purity of air in or around the wards. The fewer places in and about the ward the better. Not only the best arrangements, but what use will be made of them, has to be considered. The sleeping accommodation for nurses should be so placed as to ensure purity of air in the dormitories, and complete quiet for the night-nurses to sleep by day.
(2) Administration is intended to enforce economy so far as it is consistent with the provision of requirements for the sick. It is usually in the hands of a governing body, which issues all regulations after consultation with professional advisers; it controls the expenditure and raises the funds to support the hospital. The governing body acts through its treasurer, secretary, and steward for the general discipline and control of expenditure. The well-being and cure of the patients is directed by the professional staff of medical officers, which consists of visiting physicians and surgeons and of resident medical officers, who control the treatment of the patients under their direction and in the absence of the visiting medical officers. The nursing of the sick is under a trained matron or lady superintendent, who should be the head of all the women employed in the hospital.
(3) Nursing the sick and injured is performed usually by women under scientific heads—physicians and surgeons. Nursing is putting us in the best possible conditions for nature to restore or to preserve health—to prevent or to cure disease or injury. The physician or surgeon prescribes these conditions—the nurse carries them out. Health is not only to be well, but to be able to use well every power we have to use. Sickness or disease is nature's way of getting rid of the effects of conditions which have interfered with health. It is nature's attempt to cure—we have to help her. Partly, perhaps mainly, upon nursing must depend whether nature succeeds or fails in her attempt to cure by sickness. Nursing is therefore to help the patient to live. Nursing is an art, and an art requiring an organised practical and scientific training. For nursing is the skilled servant of medicine, surgery, and hygiene.
Nursing proper means, besides giving the medicines and stimulants prescribed, or applying the surgical dressings and other remedies ordered, (1) the providing and the proper use of fresh air, especially at night—i.e. ventilation—and of warmth or coolness; (2) the securing the health of the sickroom or ward, which includes light, cleanliness of floors and walls, of bed, bedding, and utensils; (3) personal cleanliness of patient and of nurse, quiet, variety, and cheerfulness; (4) the administering and sometimes preparation of diet; (5) the application of remedies. See NURSING.
Fever Hospitals, distinct from those for the treatment of surgical and ordinary medical cases, are essential for securing the isolation of patients in infectious diseases; hospital ships or floating hospitals have been found extremely valuable for securing complete isolation in cases of virulently infective disorders such as Small-pox (q.v.).
Poor-law Infirmarys.—Since 1870 poor-law or parish infirmarys for the sick and infirm, who used to be harboured (not treated) in workhouses and nursed by panpers, have been built, and are served by trained nurses. Some difference exists between the essentials for general hospitals and for poor-law infirmarys—the latter having no medical schools, no visiting or resident medical officers, except the resident medical superintendent and his assistant, no accidents or operations. The large majority of patients in them are chronic, not acute, cases, and incurables. A smaller nursing staff in proportion is needed. Some few of the best and largest have now training-schools for nurses. Since 1875 Metropolitan Board asylums, supported also by the rates, have been built near London for fevers, for small-pox, for idiots and imbeciles, &c.
Lying-in Hospitals.—The lying-in hospitals require special consideration. The continuous use of wards for this purpose appears to be very dangerous to the patients. Indeed this would seem to be the reason why there are fewer casualties from this cause in workhouse infirmarys than in the ordinary lying-in hospital, and why the lying-in at home is safer than either.
In Paris, where this subject has been much considered, two forms have been tried with good results. In one each patient has a small ward to herself, with its scullery or service-room attached, opening through a covered porch into an open veranda. After each confinement the ward is cleaned and lime-whited before further occupation. In these wards fatal results have been very rare. Another form is to have a ward which can hold two or more beds, in one of which the patient is brought for the delivery, and after a few hours she is wheeled out in the bed into a large ward where she remains with other patients who have also been delivered. With this plan also, where the delivery ward is cleaned and lime-whited at short intervals, and where two delivery wards are in use alternately, one always standing empty, fatal results have been rare. Instances of both forms of lying-in hospitals are not unknown in the United Kingdom. But it would be well if they were more universal.
Children's Hospitals must be provided with establishments for bathing, playing indoors and out, large garden-grounds, gymnastic grounds and halls, in and out of doors; the gymnastics should be under a professor, and out-patients should be always admitted. A 'sister' must superintend each of all these places. Singing in chorus is to be taught. It is a matter of universal hospital experience that intermingling of ages is essential. If you have a children's hospital, let the age of admission include fifteen years, especially on the female side. In all hospitals (in a child's hospital much more than in others) the patient must not stay a day longer than is absolutely necessary. Every child's hospital ought to have a convalescent branch at a distance; if possible by the sea. Sick children can never be left alone for a moment. One might almost say a nurse is required for every child. This is why in a general hospital it is much better for the children to be mixed with the adults; and, if they are judiciously distributed, it does the woman in the next bed as much good as it does the child, or the man as it does the little boy. If there must be a children's ward in a general hospital, let it be for the infants.
Convalescent Hospitals must be as like a home and as unlike a hospital as possible. A string of detached cottages is the best, admitting of extension by the addition of similar parts. Convalescent wards in a general hospital are not good; nor are day-rooms. Healthy open position and climate must be carefully selected. The convalescents are only to sleep at night in their rooms, while in the day they are 'out and about,' or occupying themselves—the men in the garden, the women at household work. But there must be strict discipline. There must be two small wards for relapses next the 'sister's' room, in the centre cottage. The convalescent beds may be divided by curtains, to be pulled far back in the day-time. A wash-hand stand to be permitted within—no lavatory. Three or four beds a good number for each convalescent room. Men and women should have separate cottages, and only meet at meals. Every hospital should have its convalescent branch, and every county its convalescent home.
Hospitals for Incurables should admit all diseases certified by competent medical judges to be hopelessly incurable—except mental diseases, which require special arrangements. One well-known hospital for incurables excludes epilepsy because it frightens the other patients; avoids, if possible, congenital and infantile disease; prefers patients of and above middle age; and excludes children and all under twenty years. The cases treated by incurable hospitals are principally cases of chronic rheumatism, gout, paralysis, and various affections which cripple the limbs, &c. These hospitals, while treating cases within their walls, are no doubt productive of great benefit to the community; but the system of granting pensions from the hospital funds to out-patients is very questionable.
A Samaritan fund is generally provided to assist poor patients leaving hospitals who may be deficient in clothing or other necessaries. In public Dispensaries (q.v.), at stated hours, medical advice and medicines are given gratis to applicants; in recent years provident dispensaries have been established, supported by subscriptions, entitling the subscriber to advice and medicine. Valuable establishments are those called in France Maisons de Santé—private hospitals for the reception and treatment of patients who are able and disposed to pay a small sum for board and medical or surgical attendance.