I N F I Px M A R V. 



123 



sad d**n- 



taSnwBT. The influence of contaminations of the atmosphere has 

 ^ "Y"* been more accurately ascertained. It is now found that 

 no ili-alv. uitage arises from a plurality of patient- be- 

 ing wic .ill ii,'. All the reformation necessary 

 was to avoid excessive crowding, and to resign the vain 

 fcffgrt of the great numbers of patients contained in these 

 places. The beds of infirmaries are now placed at 



r roper distances. The wards are regularly ventilated. 

 requent whitewashing of the walls, and cleansing of 

 the floors are practised; and, in consequence of these 

 observances, ail lie former evils have disappeared. It 

 IBM been found that even contagious fevers may be safely 

 treated under the same roof with promiscuous diseases, 

 provided they are placed in separate wards to tin 



n of which due euro is devoted. This object, 

 however, has more recently been prosecuted by the 

 on of separate establishments, which we shall con- 

 sider in the sequel. 



. pjrtrr of Serious surgical cases, such a* injuries of the crani- 

 rpcal um, compound fractures of the limbs, and gun-shot 

 cats*, wounds, when a plurality of them are brought toge- 



ther, have a tendency to generate an obstinacy in the 

 healing process, and require still more care than in 

 guarding against febrile contagion. This has often 

 been experienced in military hospitals, in the spread 

 of the hospital sore. When it occurs, the dispersion of 

 the patients i* the most effectual method of -topping it. 



I. noaries are so constructed as to admit of thorough 

 ventilation; the windows are made to open both from 

 above and fr m betow ; in t: way, that fresh 



air may be admitted without a hurtful cold draught, 

 .11 the latter, that the hoavy polluted air, which U 

 apt to rest in the inferior part of the wards, may be 

 nor* effectually dislodged, by seasonably opening the 

 interior sash. The practice of collecting urine for the 

 manufacturer*, to which the servants of infirmaries were 

 formerly templed by money, i* now discontinued. 

 The bedsteads are of iron, a material to which conta- 

 gious and other animal effluvia are less apt to adhere 

 than to wood. The bed clothe* are more frequently 

 washed; and. when it is convenient, they are regular- 

 ly aireu. For this last purpose, there i* probably room 

 lor further improvement. NVe have sometimes c< > 

 plat i- J a plan of having the beds of those patients * 

 up through the day, so contrived, that, with little labour, 

 they might be elevated by some rople machinery, by 

 the windows, to the roof at the building, and brought 

 in again at pleasure. Flock and feather beds are not 

 used The preference i. given to straw, chaff, and 

 other materials, which, I low \alur, ad. 



cnt renewal. In cases in which article* are used 

 which cannot be frequently renewed, they are exposed 

 not only to frequent ventilation, but to purification by 

 water. 



re are other circumstance* apt to occur in infir- 

 manes, unfavourable to the recovery of the patients. 

 They may be exposed to the sight of neighbouring pa- 

 tients in th- atonic* of death. This is remedied by ha- 

 ving curtains or screens for the different beds, an ar 

 rangcrnenl which gives them the advantage of a more 

 comfortable appearance, and more individual |>rivai y. 

 They are not employed in every infirmary, partly o 

 account of the expence, and partly from the obttruc 

 tiou which they give to ventilation ; but they ought 

 always to be at ham), and rods to which they can be 

 should accompany each bed. The sight of epi- 

 leptics, the unpleasant noise which they make in their 

 fit*, and the shocking spectacle, ai noi*e, of 



patient* under insanity, are obviated by providing se- 

 3 



Of |M-illU 



fti isausl 



par Ate wards to which these may be sent, and also such Infirmary. 

 patients, occasionally, as misjht annoy their neighbours '^"Y"*"' 

 by the pii-rcini* cries which under p.-u'n or delirium they 

 emit. In -ume infirmaries, for example that of Glas- 

 gow, every ward has three single bedded rooms at one 

 end, a method admirably adapted to these purposes ; 

 as a patient may be instantly moved to one of them, 

 without formality or trouble. 



For the convenience of the surgeon, it has in some 

 pi ices been common to perform surgical operations at the 

 bed-side, in sight of the other patients of the ward. This, 

 which could not fail often to shock their feelings, is 

 avoided uy the easy regulation of having a separate 

 theatre allotted for all surgical operations. Accordingly 

 no such practice exists in the British hospitals. 



Some disadvantages have arisen from negligence on Negligence 

 the part of the different servants and officers connected oh"""* 1 |v > 

 with these institutions. To obviate these is a difficult ""P 1 *"'" 

 btak, and requires the utmost vigilance. It is equally 

 requisite to see that no abuses are committed by any of 

 the patients themselves, to the detriment of others. A 

 system of inspection is for these purposes evident! , 

 cessary. Monthly or weekly inspections are therefore 

 practised. The nurses are examined apart from the 

 patients about the conduct of the latter, and they, in 

 their turn, about their satisfaction with the nurses. The 

 medical gentlemen who reside in the house are under 

 the direction of the attending physicians and surgeons ; 

 and these, notwithstanding the respectability of their 

 station, and those principles of honour by which they 

 are supposed to be actuated, are not placed above in- 

 spection and admonition. Though a rude and frequent 

 interference on the part of persons who .ire not ade- 

 quate judge* of medical duties is avoided, the inquiries 

 of the bouse visitor- have it for a part of their object, 

 to ascertain how the patient* are satisfied with them. 

 ,'urtunities are thus afforded for friendly and in- 

 structive exp.anatioQ*. The medical gentlemen derive 

 gratification from the interest which others take in their 

 duties; and. where all wish to do their duty, and posses* 

 that degree of patience which is necessary to every pub- 

 lic character, a good understanding is cultivated. On 

 occasions of a different kind, flagrant errors and :ilm-. 



.!iy exposed, and the means have thus been 

 aflordrd of putting an end to them. Different infirma- 

 ries enjoy different advantage* for this specie* of vigi- 

 lance, which often depend on the manner in which 

 are constituted. Where the number of mana- 

 gers U small, they have the best chance of maintain- 

 ing harmony, and of understanding their duty But 

 they are apt to become remiss ; and, from a false de- 

 Uocjr, to overlook the omissions of one another, and of 

 the principal otter rs. The duty of visiting the house 

 is also apt to *Tfff^t too burdensome, when the turn to 

 each fpwHf* frequently round. U here the number df 

 managers is large, amounting, as in some instances, to 

 hundieds, many of them are unacquainted with the na- 

 ture of the institution, and either go through the form* 

 of duty in their turn without intelligence or care, or 

 mar the business of the chanty, by encouraging fre- 

 quent and vexatious complaints. It is pleasing, how- 

 ever, to find, that these ends are in general so effectu- 

 ally and agreeably obtained. 



Infirmaries are liable to a variety of petty abase*, rntj bn- 

 which have a tendency to accumulate in their amount, MS watth- 

 and thus generate much evil. One of these, is the prac- *& 

 lice of nurses taking money from the patients. This is 

 not always easily prevented, as the latter feel a debt of 

 personal gratitude ; and it might appear hard to deprive 



