806 



HOSPITALS 



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 lava- 

 tory 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 inde- 

 pendently of the ward. 



The form of the ward should be such as to enable 

 the air to be renewed witli the greatest facility. 

 Experience in this climate shows that the win- 

 dows are the best appliance for complete renova- 

 tion 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 con- 

 tain 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 spa,ce 

 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. 



( 6 ) 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 econ- 

 omy 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 regula- 

 tions 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 expendi- 

 ture. 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 pre- 

 serve health to prevent or to cure disease or in- 

 jury. 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 con- 

 ditions 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 medi- 

 cines 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, cleanli- 

 ness 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 treat- 

 ment 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 Infirmaries. Since 1870 poor-law or 

 parisli infirmaries for the sick and infirm, who used 

 to be harboured (not treated) in workhouses 

 and nursed by paupers, have been built, and 

 are served by trained nurses. Some difference 

 exists between the essentials for general hospitals 

 and for poor-law infirmaries 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 incur- 

 ables. A smaller nursing staff in proportion is 

 needed. Some few of the best and largest have 

 now training-schools for nurses. Since 1875 Metro- 

 politan Board asylums, supported also by the rates, 

 nave been built near London for fevers, for small- 

 pox, for idiots and imbeciles, &c. 



Lying-in Hospitals. The lying-in hospitals re- 

 quire special consideration. The continuous use of 

 wards for this purpose appears to be very danger- 

 ous to the patients. Indeed this would seem to be 

 the reason why there are fewer casualties from this 

 cause in workhouse infirmaries 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 con- 

 sidered, 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 estab- 

 lishments for bathing, playing indoors and out, 



