Hospitals

Hospitals, charitable institutions for the relief or support of persons unable to satisfy their own wants. The term is now usually applied to medical hospitals or infirmaries whether general or special. The two oldest general hospitals in London - St. Bartholomew's (1547) and St. Thomas's (1553) - were originally religious foundations. Five more were added during the earlier half of the 18th century, which was a period of great activity in hospital-building - viz. the Westminster (1719), Guv's (1723), St. George's (1733), the London (1740), and the Middlesex (1745). One of the oldest of the special hospitals is Queen Charlotte's Lying-in Hospital (1752). Hospitals for consumption, ophthalmia, cancer, hip disease, and other specific diseases are now numerous in large towns in this country and on the Continent. Many of these complaints are excluded from the general hospitals. This is almost always the case with smallpox, scarlet-fever, and other contagious diseases, for which isolation hospitals are now provided under the control of the Metropolitan Asylums Board. With the exception of the last-mentioned class, which are supported out of the rates, and the naval and military hospitals, almost all hospitals are dependent on voluntary contributions. The chief hospitals in London and several other large towns serve a two-fold purpose; besides affording medical and surgical aid to the poor, and in cases of emergenoy to more opulent patients also, they furnish the best education in medicine and surgery by means of practical demonstration.

In this manner the members of the medical profession in England receive an invaluable training in the great general hospitals. Up to a recent date very little regard was paid by the administrators of hospitals to the proper treatment of the inmates. The unsanitary condition of hospitals in former times, which is proved by the abnormally high death-rate, especially in lying-in hospitals, was due mainly to overcrowding, insufficient ventilation, a disregard of cleanliness in details, unsuitable diet, and, to a certain extent, the mixture of cases of different kinds. A great improvement has taken place in these respects owing to the greater attention now paid to construction, administration, and nursing. As regards construction, the first point to be considered is the selection of the most suitable site which is accessible to the persons for whom the hospital is intended. A dry soil should be chosen, and a free space should be left between the hospital and the neighbouring buildings. The number of patients placed in a single block should never exceed one hundred. This is now secured by adopting the pavilion form of building, in which a number of pavilions are connected by covered ways. The patients' wards should not occupy more than two storeys; if possible there should be one storey only in each pavilion. The wards should be completely separated from the kitchen and other offices, excepting the lavatories, etc., intended for the use of the patient, and these should have a separate system of warming and ventilation. To ensure proper ventilation, the wards should be rectangular in form, with windows in each of the opposite walls. The breadth should be 25 or 26 feet, with a row of beds along each wall. The importance now attached to efficient nursing must be in great measure ascribed to the efforts of Miss Florence Nightingale. The nurses act under the direction of the medical staff, yet their position is one which requires a considerable amount of judgment, gentleness, and tact.

It is only within recent years that "cottage hospitals" have been erected for the rural population; previously they were obliged to have recourse to those in the larger towns. They are built on the pavilion system, a cottage hospital resembling a detached portion of a larger one. Separate hospitals are now provided for children and convalescents, since in both cases the treatment required is of a special kind. In all civilised countries there are hospitals for soldiers and sailors supported by the State. The most important naval hospitals in England are those of Haslar, Plymouth, and Chatham. The chief military hospitals are situated at Netley, Woolwich, and Aldershot; in addition to these the principal stations have hospitals of their own.

A few words must be said about non-medical hospitals, i.e. those which afford a refuge to persons who are prevented by physical or mental incapacity from taking care of themselves. The alarming increase of poverty in the 16th century led many charitable persons to erect and endow buildings for the support of the aged poor. The number of such almshouses dating back to the 16th and 17th centuries is very large. From the reign of George II. onwards it was sought to secure the same end by means of workhouses, supported out of the rates and administered in connection with the poor laws (q.v.). Most institutions belonging to this class are now known by some other name, but there are instances to the contrary - e.g. Foundling Hospitals (q.v.), and Hospitals for Incurable Diseases, such as chronic rheumatism, paralysis, and gout. To the latter group virtually belong the Poor-law or Parish Infirmaries, which, since 1870, have taken the place of workhouses as a refuge for destitute persons suffering from chronic or incurable complaints.