October 28, 1921] 



SCIENCE 



403 



except those who have had direct experience with 

 it. This waste wUl be eliminated to a large extent 

 by housing patients in separate single rooms. And 

 the keynote of the whole thing wUl be the flexi- 

 bility of the service. 



In the first place, it is the business of a hospital 

 to cure people. No one will say that noise, con- 

 fusion and unsightliness are conducive to cure. 

 A separate room for each patient together with 

 other provisions for privacy and comfort in this 

 new hospital will eliminate noise, confusion, and 

 unsightliness — and with them, fear. What that will 

 save in energy and worry to doctor and nurse and 

 patient is incalculable. 



Next, the single-room system will save the 

 nurse's time. In the ordinary ward all the sup- 

 plies are kept at the end of the ward, and the 

 nurse has to travel its entire length to get what 

 she requires every time she goes to any one of the 

 beds. We shall have each patient's equipment at 

 the patient 's bedside and save the nurse 's time and 

 strength. 



Every bed will be working 100 per cent. We 

 shall not be troubled by the necessity for sex segre- 

 gation or disease classification. 



With the ward system there is often a waiting 

 list for the women's surgical ward, while sevei'al 

 beds are empty in the men's ward. This means 

 that two things happen: People who urgently need 

 surgical treatment are denied it and empty beds 

 add their quota to the overhead without working 

 for it. 



Again, in the classification of diseases, the ma- 

 ternity ward of the old type hospital may be half 

 empty and the surgical and medical wards full. 

 Yet it is impossible to put surgical and medical 

 cases into a maternity ward, for fear of infection. 

 That means more beds wasted, also heat and light 

 and service. It is equally wrong to put children 

 with adults. But in a wardless hospital in case of 

 an epidemic among children the children can easily 

 be put into adults' rooms. 



Pneumonia and typhoid patients should never be 

 put in open wards at all, because it is impossible 

 to control the source of infection. These cases 

 need varying temperatures; some, moreover, are of 

 a virulent form and some are not; and some may 

 be fairly safe at the start and develop into virulent 

 cases later and infect others. 



I have often seen a fifteen-bed ward occupied 

 by only two patients. Of course, in cases like this 

 it would be cheaper to put the patients into single 

 rooms and close the wards; but frequently there is 



no single room vacant, and all the heat and service 

 and light and equipment needed for fifteen people 

 have to be expended upon two. 



On the other hand, when a single room is unoccu- 

 pied the lights are put out, the heat is turned off, 

 the door is locked — ^and that room costs nothing 

 for upkeep until it is occupied again. 



Occupants of wards are invariably distressed by 

 the rigid rules concerning visiting hours. These 

 rules are necessary. People who are critically ill 

 and those who are convalescent are all together in 

 the same ward. Their requirements, of course, are 

 different — ^those who are recovering need to be 

 amused, to see their friends; and this is sure to 

 disturb the critically ill even during a very limited 

 visiting period. When all are in separate rooms, 

 visiting hours will be limited only by the physician 

 in charge. 



The advantages in respect to ventilation and 

 other conditions which should vary with varying 

 types of illness are obvious. A pneumonia patient 

 and one recovering from an operation need totally 

 different conditions, and only by separating them 

 can the greatest comfort be secured for each. 



THE EMPLOYMENT OF MENTAL DEFECTIVES 

 IN ENGLAND 



According to the British Medical Journal, 

 the special schools after-care committee of the 

 City of Birmingham Education Committee 

 has the duty of keeping a record of the subse- 

 quent history of former pupils in the special 

 schools for the mentally defective. The total 

 number of cases included in its records has 

 increased from 2,282 in the year 1919 to 

 2,504 during the past year, males numbering 

 1,503 and females 1,001. These fibres indi- 

 cate very clearly the ratio of three boys to 

 two girls, which is frequently found in the 

 various special schools for the mentally defec- 

 tive. Of the 2,504 cases in last year's records, 

 969 are doing remunerative work, 913 of these 

 earning wages which average 30s. lOd. per 

 week, while 56 are soldiers. The general 

 depression in industrial and trade conditions 

 has naturally had an effect upon the mentally 

 defective eases in employment, and, while 

 the number of men and youths under review 

 this year has increased from 1,380 to 1,503, 

 the number in employment has only risen 

 from 630 to 655; the number of women and 



