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HOSPITALS.

BY GEORGE DERBY, M.D.,

SECRETARY OF THE BOARD.

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HOSPITALS.

The object of this paper is to show that the restoration of the sick to health is better accomplished in hospitals of a simple and inexpensive construction than in those of a more complex plan, and to point out the special advantages which would come from building hospitals, whose wards should be completely detached, the one from the other, and of a height of one story and no more.

Our growing cities and towns feel the need of making benevolent and economical provision for the sick who may otherwise suffer in their helplessness, and for the wounded who stand in need of instant surgical relief.

From present indications it is probable that, within the next ten years, many hospitals will be built in Massachusetts, and we desire to speak no word which would tend to discourage their erection. On the contrary, there are many reasons for believing that, at the present time, small and well-arranged hospitals, in at least twenty of our busy towus, would be the means of saving life, and of preventing needless suffering to both the sick and the well.

But, in building these hospitals, let us know the errors that have been committed in the past, and avoid them; let us profit by existing knowledge of the subject, and, if possible, add to its amount. The State Board of Health, in its annual reports, furnishes a mode of communication between the medical profession and the community at large for the discussion of this and all other subjects relating to the prevention of disease and the prolongation of life, and we believe that such communication may be productive of public benefit.

Although physicians are held responsible for the usefulness of hospitals, they seldom, except in military service, have the opportunity to build them. In civil life they are as likely to be called on for this purpose as schoolmasters to build schoolhouses.

Yet, if building committees could have presented to them, in direct and visible contrast, the power for saving and for destroying life which hospital-walls inclose, they might shrink from the responsibility which they now so readily assume. There is abundant evidence to show that the highest professional skill, and the most careful nursing, are so overmatched by the deadly miasm of hospital atmosphere in many of the great establishments founded by the piety and goodness of past generations, that the chance of recovery to their inmates would be improved by putting them in well-ventilated sheds, or tents, or even in summer by providing only the simplest defence against rain.

A great change is now going on in the opinions of physicians throughout the world concerning hospitals. Their construction, their management, their power to lengthen or to shorten life,--their agency in originating, retaining or distributing certain forms of disease,—their influence for good and for evil, * have been the subjects of constant discussion during the past twenty years. Every one has seen the good they may do to the community, both directly and indirectly, by giving aid and comfort to those who would otherwise be supremely wretched in their helplessness, and by the opportunities they afford the medical profession for the instruction of its younger members. All this is plain, but the other side of the picture has been, until recently, obscure.

Modern inquiries are giving the world more light, and stimulating investigation and comparison. Both the remote and proximate causes of disease are now subjects of general inquiry : the possibility of preventing disease to individuals, to classes and to communities is no longer thought visionary.

Hospital reform has been recently advanced by the studies of pathologists, chemists and philosophers, concerning the obscure something which seems to be the seed of infectious disease.

The writer has in his possession some cases of surgical instruments which were used in the Revolutionary War. They bear this inscription, which would be equally appropriate for the portals of hospitals,-“ Mille mali species, mille salutis habeo(I have a thousand forms of good and evil).

Recent theories of fermentation, of the origin of infusorial life, of the process of decay of organized substances,-problems exciting such interest as to be discussed in the monthly magazines and in popular lectures,-all these are closely connected with our subject. Moreover, it is evident that, independent of these ideas which now perplex the student, there has been in the minds of physicians a tendency (founded on close observation, not on theory) to extend the number of diseases which are capable of direct transmission from one individual to another, or of propagation by some medium like clothing or woodwork in which the infectious element may remain latent for a longer or shorter period and then be suddenly developed. Some very fatal diseases are suspected of becoming convertible, or of being so nearly related that, under certain circumstances, the one may give rise to the other. Erysipelas and puerperal fever, erysipelas and pyæmia, scarlet fever and puerperal fever, are examples. We think it may be said that each of the later generations of physicians finds a larger number of diseases classed as communicable. The inevitable epidemics diminish: the avoidable infections increase. Of those which are now regarded very differently from the teachings of thirty years ago, we may mention scarlet fever, erysipelas, typhus and typhoid fever, diphtheria, puerperal fever, * and Asiatic cholera.

There are now practitioners who are inclined to believe that the catarrhal fever, known as influenza, is not to be looked upon in all cases as an unavoidable epidemic, but as one which may be directly communicated from one member of a household to another; and some careful observers think this contagious character

may

be traced in all affections sf the mucous membranes, attended with purulent discharges.

Our correspondence of last year shows that consumption is now closely questioned in this respect. The drift of medical opinion is all in this direction; increasing the list of diseases which may be regarded as, under certain conditions, communicable.

• Dr. Oliver Wendell Holmes, in an essay on the contagiousness of puerperal fever, published in 1843, brought forward ample evidence to show that this disease could be communicated from the sick to the well. We think it has never since been doubted, at least in New England.

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