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tal building, on which was expended more than $600 for each bed, cost too much; unless in a case where the administrative or school buildings were elaborate and connected with a small hospital. In this country, the hospital run at a cost of less than $250, or more than $350, to each bed in continuous use for a year, is either badly constructed or badly managed.

LISTER'S ANTISEPTIC DRESSING FOR WOUNDS.

Disinfectants have proved ineffectual in the endeavor to make them take the place of cleanliness and good ventilation; and even where the ward is vacated, and perfectly saturated in every crevice with powerful disinfectants, the evil influence of foul air is removed only for a very short time. But antiseptics applied to certain classes of wounds, according to a prescribed method known as Lister's Dressing, have been the means of saving many lives. To protect a certain number of wounds from the bad influence of foul air, is good so far as it goes; but it does not settle the whole question of hospital building. It diminishes the risks of a limited number of patients; but the general effect of foul air on all, and its special influence on many, will continue to keep up the deathrate far beyond what it should be.

NEW YORK, May 20, 1878.

DEBATE ON HOSPITALS.

PROF. R. C. Kedzie, M.D., said that it could be demonstrated that solid walls, when not covered with wall-paper, paint, or similar covering, were porous to such a degree that considerable ventilation of a room could be effected through them, even when doors and windows were shut. He thought it advisable in building hospitals, to observe this law of physics, and not render the walls impervious to air; the constant percolation of air through the walls would serve to disinfect the rooms in some degree.

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DR. REAMY (of Cincinnati) related an instance where, after a man had died of small-pox, his suit of clothes was hung up in an old shed in the open air, and left there for about four months. tramp then came along, and stole the clothes, took the small-pox, and died; thus showing that some of the germs of a disease will be retained even in a porous substance. Therefore, although it does not argue any thing against the kind of buildings suggested, yet it shows that even such a wall may become infected in time,

I am glad this Report favors a plan of small buildings. We have an elegant hospital in Cincinnati, one of the best-managed and best-constructed in the country; and, while we are proud to show it to strangers, yet it is a sad mistake to have but one such. There ought to be ten or twelve kinds of hospitals, and they ought to be classified. There ought to be smaller lying-in hospitals, insane hospitals, surgical hospitals, &c., which could be utilized for medical teaching of students just as readily as the large ones are. If a student wanted to study eye or ear diseases, let him go to the eye and ear hospital. The objection which has sometimes been raised, that small buildings would interfere with the teaching of students, is not valid. The hospitals ought to be small, built in a cheap way, and, when they become infected, they ought to be burnt down, or otherwise destroyed. We ought to have an eye to usefulness, and not to elegance and grandeur.

MR. F. B. SANBORN. There is another point to be mentioned, although at first glance it may not seem to be connected with the construction of hospitals. Whenever a hospital is now built for permanence, some provision should be made for a training school for its nurses. Within a few years past the State Charities Aid Association of New York, of which Dr. Wylie is an active member, has established at the Bellevue Hospital a training school for nurses; but the hospital had been constructed without reference to such a school, and therefore the nurses are obliged to lodge outside the hospital. Of course it will readily be understood that the pupils of a training school, who are in fact nurses in the hospital, should live within the hospital enclosure. I speak from experience, having for some years been connected with a training school at the Massachusetts General Hospital in Boston, where precisely this difficulty met us. We first established a small school of half a dozen pupils (in November, 1873) as an experiment, and succeeded so well that we were allowed to go on from time to time until we now have in our charge every ward in the hospital except a single private ward, where a private nurse is employed. At first we rented a house outside for our pupils who were engaged in nursing; but subsequently, they have been accommodated in the hospital, at some inconvenience and disadvantage to other departments. For instance, we teach them cookery, which requires a different arrangement of the hospital kitchen than when only a hired cook performed these services. I make these remarks to show that the necessity of hospital training

schools, which has been made apparent in some of the larger cities, also necessitates a change in the construction of hospitals. At the new Johns Hopkins Hospital in Baltimore, to which Dr. Wylie has alluded, and which is now building, there is to be, in the hospital enclosure, a separate structure for the nurses' training school, which will be established there as soon as there shall be patients to be nursed and nurses to be trained.

With regard to the training of nurses in hospitals, experience has shown that the difficulty of large cost- which at first sight appears to be very great — vanishes, upon trial. I suppose if any one had told us in Boston in 1873, that in five years we should have the whole Massachusetts General Hospital at our disposal, as a training-school for nurses, it would have seemed wholly improbable ; but we have actually got access, for this purpose, to the oldest and most important hospital in New England. I think, since we have overcome the difficulties in conservative Boston and in New York, they might also be overcome in other cities. By means of these training-schools we not only secure good hospital nurses, but we have also elevated the standard of private nursing.

The Boston nurses not only learn the art of taking care of patients, but they also attend lectures on nursing, and learn what many of them did not know before, how to cook. They now generally remain in the hospital after they have graduated, but the point at which the training-schools are aiming, both in New York and Boston, is to provide a class of nurses who will visit the residences of the poor and carry the blessings of sanitary science and of the healing art further than the medical profession alone can. I think Dr. Reamy will allow that indispensable as physicians are, yet, in the sickness of the poor, nurses are the more important. Perhaps I might say this even of private nursing among those who are not poor. During the five years the Boston school has been open, the number of applicants for admission has been about 300, and the number admitted 108. The number now actually in service as pupils and head-nurses at the hospital, is, I think, 56. The number engaged in private nursing is 10 or 12, and the number who have disappeared from the field by death or otherwise is about 30. About one-third of the applicants to whom our tests have been applied, entered the school and maintained themselves there. Both in Boston and New York the pecuniary arrangement is this: the pupil, after her first month's probation, receives compensation at the rate of $10 per month, from the hospital, and is

also boarded by the hospital or the school: at the end of a specified time she receives an advance of compensation. This paying

of pupils may seem a singular way of carrying on a school, byt thus the hospitals are enabled to dispense with the hired nurses who formerly had charge of the patients, while the pupils, who are generally women dependent upon their work for their support, are able to qualify themselves, without too much expense, for a most useful occupation. In this respect, as in most others, the American training-schools have followed the example of the school at St. Thomas' Hospital in London, established in 1862 by Miss Florence Nightingale, and still supported from the Nightingale Fund. The cost of the Boston school, graduating about 20 pupils in a year, is now less than $4,000 above what the hospital itself pays.

MR. ROBINSON, the Chairman, then read the following communication, addressed to one of the secretaries of the Conference :

HOSPITAL BUILDING FOR THE INSANE.

BY REV. F. H. WINES.

SPRINGFIELD, ILL, MAY 18, 1878.

MR. F. B. SANBORN, CINCINNATI, OHIO.

My Dear Sir, -The knowledge of specialists is so much more. minute and extensive than that possessed by occasional students of the same subject, that one who is not a physician, and not a superintendent, may properly hesitate to come in conflict with the superintendents of our.American hospitals for the insane, especially upon points with regard to which there is a general agreement among them.

The internal and external life of these institutions is, however, so far distinct, that persons on the outside may have even a clearer perception of their relations to governments and to tax-payers, than the superintendents themselves. The public, if it is not competent to pass upon the questions of medical treatment, involved in the care of the insane, is nevertheless able to judge of results. The ordeal of criticism through which the hospitals are now passing does not arise from any want of confidence in the medical skill or integrity of purpose of the gentlemen by whom they are managed, nor from any lack of appreciation of the great work achieved by them during the past half-century. On the contrary,

the controversies which have arisen, respecting the care of the insane in this country, are, for the most part, non-medical, and therefore not beyond a layman's province or powers; while, on the other hand, they relate to the future and not to the past development of our hospital system.

The Association of Medical Superintendents of American Hospitals for the Insane, a close corporation, is committed to a certain rigid, almost inflexible type of hospital building (which I need not describe), characterized by two prominent peculiarities, viz., uniformity, verging upon monotony, and the ease with which each individual patient may be subjected to any degree of restraint approved by the judgment of the medical officer in charge. The positions taken by the Association are: that the care of its insane citizens is properly the function of the State; that the State should make provision for all its insane; that the only qualified advisers of the State in this regard are the superintendents and ex-superintendents of hospitals; that the type of building recommended by the Association is the best and only correct type; and that, for all the insane of every State in the Union, buildings of this class should be erected. It is true that a division of opinion exists even within the Association itself, as to some of these positions; but we need not delay here to speak of it.

The Association has gone still further, in the adoption of that famous resolution, in which it is announced that "any supernumerary functionaries, endowed with the privilege of scrutinizing the management of the hospital, even sitting in judgment on the conduct of attendants and the complaints of patients, and controlling the management, directly by the exercise of superior power, or indirectly by stringent advice, can scarcely accomplish an amount of good sufficient to compensate for the harm that is sure to follow." A resolution, the obvious inference from which is, that the gentlemen who express this opinion either fear hostile criticism on the part of the “ supernumerary functionaries referred to, or else feel themselves to be above criticism.

I certainly do not desire to see a single symptom of antagonism between the Conference of Charities and this Association, but rather the most cordial good-will and co-operation, in every thing which concerns the welfare of the insane. But I know of no other body capable of calling public attention to the weak points in the Association's position, and of formulating a more carefully considered statement of opinion, in such a manner as to influence future

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