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INDEX
TO
THE MODERN HOSPITAL
VOLUME XI
JULY TO DECEMBER, INCLUSIVE 1918
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PUBLISHED BY
THE MODERN HOSPITAL PUBLISHING CO., Inc.
CHICAGO, ILL.
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MODERN HOSPITAL |
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EDITORS |
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HENRY M. HURD |
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FREDERIC A. WASHBURN |
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WINFORD H. SMITH |
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S. S. GOLDWATER |
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W. L. BABCOCK |
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JOHN A. HORNSBY |
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M. K. CHAPIN, |
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Managing Editor. |
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INDEX
This index contains in a single alphabetical sequence the names of authors and subjects of all articles published in The Modern Hospital during the six months covered by this volume. The follovifing abbreviations indicate special departments in which articles appeared: Ab., abstract in Current Hospital Literature; Bk. Rev., Book Reviews; Corr., Letters to the Editor; Ed., Editorials; Q. and A., Queries and Answers.
Accounting Committee of American Hospital Association, Report
o£ 330
Accounting, Hospital— Porter and Carter 102, 173, 266, 371, 448
Adler, Eleanor — An Experimental Employment Bureau for Crip- ples 402
Administrative Articles —
Economy Campaign, Cooperative, in all Departments of the Hos- pital—Bacon 430
Economy Problem, War-Time, in the Hospital— Devan 445
Efficiency System for Medical Work of State Hospitals — Singer.. 260
Food Waste in Hospitals — Pitcher 491
Fuel, Saving of, in Hospitals — U. S. Fuel Administration 250
Heating and Power Plant Economies for Hospitals — Kimball 437
Hospital Administration, Discussion by Massachusetts Medical
Society 131
Hospital Management, Some Problems of — Tuley 169
Hospitalism— Its Causes and Treatment— Clark 53
Housekeeping, Hospital, Its Worries and Cares — Jamieson 15
Laundry System which Has Proved Successful — Fish 433
Medical Stafif, Resident, Self-Government for— Bacon 17
Visitors and Visiting in Hospitals— Geffen 61
Admitting Desk, Friendly Relations with Patients Established at
(Corr.)— Gage 203
Adolescent Clinic of Stanford University Medical School, Work of.
(Ab.)— Gates 151
Advertising the Public Sanatorium — Gammons 409
Aeroplane, Radio-Chirurgical— Nemirovsky and Tilmant (Ab.) 499
After Care of Disabled Men, Inter-Allied Conference on 210
Agatha Hospital, Clinton, Iowa 29
Agostini, C — The Economic Probleni of the Italian Hospitals for the
Insane (Ab.) , 152
Alder Hey Military Orthopedic Hospital 375
Ambulance, Trolley Hospital, First 98
American Association of Hospital Social Workers Organized 205
American Association of Industrial Physicians and Surgeons, Third
Annual Meeting of 133
American Dietetic Association, Atlantic City Meeting of 306, 406
American Home Economics Association, Meeting of 143
American Hospital, Chicago 284
American Hospital Association. Bulletin of 35, 126, 227, 472
Institutional Membership in. Advantages of (Ed.) •,..460
Twentieth Annual Convention, Announcement of ., . .227
Twentieth Annual Convention Commercial E.xhibit at (Ed.) 388
Twentieth Annual Convention, Editorials on 188, 286
Twentieth Annual Convention, Report of 310
American Medical Association. Sixty-ninth Annual Session of 130
American Medico-Psychological Association, Seventy-fourth Annual
Meeting of 45
American Nurses* Club in London 417
American Public Health Association Meeting, Announcement of,... 309
Influenza Causes Postponement of 401
Anjerican Women's Hospitals — Conger 68, 346
American Women's Hospitals in France, Work of 418
Ancker, Arthur B. — The War and the Civil Hospitals (President's
Address) 327
Anesthetic Screen 348
Architectural Articles —
Ashland General Hospital, Ashland, Wis.— Dodd 264
Barlow Sanatorium, New Four-Patient Cottage at — Klotz 378
Brookville General Hospital, Brookville, Pa.— Bailey 165
Buffalo General Hospital. Memorial Hall of— Stevens 20
Construction, Hospital, Details of — Perry 469
Hackensack Hospital, Nurses' Home of — Washburn 84
Tuberculosis Sanatorium Buildings. Small, Planning of — Burt.... 1 Vancouver General Hospital. Military Annex of — MacEachern. . . .257
Argentina, Anti-Tuberculosis Work in— Coni ( Ab.) 499
Army General Hospital, U. S., 2,500-Bed, to be Built in 100 Days,. 309
Army Litter, Field and Hospital Use for 70
Army Nursing, Program of — Goodrich 410
Army Nursing Question (Ed.) 189
Army School of Nursing 50
Army School of Nursinp; and the Civil Hospital 290
Army School of Nursing. Camp Wadsworth, S. C 413
Ashhind General Hospital, Ashland. Wis.— Dodd 264
Atlantic City Meeting of American Hospital Association
188, 227, 2S6, 310, 388
Attendant, Trained— Dakin 198
Audit Committee, American Hospital Association, Report of 329
Australian Institutions, Purchasing Methods Adopted by (Corr.) — MacLennan 346
B
Bacon, Asa S. — Cooperative Economy Campaign in All Departments
of the Hospital 430
Bacon, Charles B. — Self-Government for the Resident Medical Staff. 17
Bahama General Hospital and Asylum— Milne 37C
Bailey, Emmet E.— How to Build an Efficient General Hospital for
a Small Community 165
Baldv, J. M.— Has Every Hospital an Inherent Right to an Intern?. 89
Barlow Sanatorium, New Four-Patient Cottage at— Klotz 378
Bass, Elizabeth and Loeber, Maud— Physical Status of Juvenile De- linquents in the Reformatories of the City of New Orleans.
(Ab.) 151
Beckman. James W.— Floating Hospital of St. John's Guild Again
at Work 92
Bedford Hills Psychopathic Hospital of the Laboratory of Social
Hygiene (Ab.)— Southard and Davis 499
Belgium. A Message from (EJ.) 286
Belgium, America's Help of. After the War— Sand 256
Belgium, Our Opportunity in (Ed.l 460
Bellevue, France, American Hospital for the Study of Gas Cases at. 429 Benedict, Sarah — Food Conservation in Ohio Hospital 206
Blaine Foreign Body Localizing Instrument 347
Blind, St. Dunstan's Hostel for— McCallin 29B
Blind. Who are They? (Ed.) 290
Blood Counting Apparatus 421
Bloomington Girls' Industrial Home 375
Blue. Rupert— Influenza, Epidemic, and the United States Public
Health Service 423
Blue Cross Hospital for Horses — Forward and Lees 349
Blue Triangle Hut— Nissley 416
Bologna, Institute of Reeducation for Crippled Soldiers (Ab.) 476
Bookkeeping, Hospital : See Accounting, Hospital.
Books Received for Review 224, 346, 498
Book Reviews 498
Boschi, G. — The Hospital for Nervous Diseases Villa del Seminario
at Ferrara ( Ab.) 223
Bowditch, V. Y.— .\ Children's Pavilion at the Sharon Sanatorium
( Ab.) 222
Bowen, A. L. — Standardization of State Hospitals 81
Bowman, John G. — The Business of Medicine and the Profession of
Medicine 123
Bradshaw, Emerson O. — Influenza Relief Work of Stock Yards Com- munity Clearing House (Corr.) 497
Brazil, Eugenics in 457
British Columbia. Hospitals of, First Convention of 136
Brooks, W. A.— Out-Door Treatment of Spanish Influenza 427
Brookville General Hospital— Bailey 165
Buenos Aires, Hospitalization of Pulmonary Tuberculosis in (Ab.) —
Coni 222
Buffalo General Hospital, Memorial Hall of— Stevens 20
Bulletin of the American Hospital Association 35, 126, 227, 472
Bunk, Glennan Adjustable — Kerns 194
Bunn, F. S., Death of (Ed.) 465
Burnette, Norman L.— Occupational Therapy in Canadian War
Hospitals 401
Burt, James D.— The Planning of Small Tuberculosis Sanatorium
Buildings 1
Butterfield, C. L.— Hospital Housekeeping and War-Time Economies. 220 Byrne, Miriam — Methods of Indexing Hospital Clinical Records 86
Cabot Course of Case Records — Painter 355
Cabret, D. — The New Tuberculosis Sanatorium "Santa Maria" (Ab.).223
Camp Sevier, Food Conservation in 51
Canadian Civil Hospitals' Part in War Work — MacEachern 257
Canadian National Association of Trained Nurees and Canadian
Association of Nursing Education, Meeting of 46
Canadian Rehabilitation and Reconstruction Work — Kidner 393
Canadian Red Cross, Work Accomplished by, in 1917 49
Canadian War Hospital, Occupational Therapy in — Burnette 401
Carry On 211
Carter, Herbert K. and Porter, Charles A. — Hospital Accounting
102, 173, 266, 371, 448
Case Records of Massachusetts General Hospital— Painter 355
Cassette, Mcintosh X-Ray " Verithin" 80
Catholic Hospital Association, Report of Third Annual Meeting of. 120
Address of President — Moulinier 122
Chapin, M. K. — Hospitals and Hospital System of Chile 440
Chart Rack, Sacred Heart Hospital, Fort Madison, Iowa 29, 112
Children's Hospitals —
Children's Hospital, Columbus, Ohio 187
Children's Hospital, Philadelphia 385
Children's Hospital, Washington, D. C 384
Floating Hospital of Saint John's Guild — Beckman 92
Hospital of Extended Grace to Women and Children, Pyeng Yang,
Korea — Hall 252
Children's Pavilion at Sharon Sanatorium (Ab.) Bowditch 222
Chile, Hospitals and Hospital System of — Chapin 440
Chile, Hospitals of (Ed.) 463
China, North, Pitiable Condition of Insane in (Ab.) — Ingram 152
Chinese Women's Hospital, Work in (Corr.) — Murdoch 345
Cincinnati Public Health Council— Dinwiddle 180
Civil Hospital, Future of (Ed.) 191
Civil War Hospitals 270
Clark, Pliny O. — Hospitalism — Its Causes and Treatment 53
Cleveland Hospital Council, Purchasing Bureau of 107
Clinics, Evening Pay — Warner 143
Clinics. Venereal Disease— Davis 436, 481
Coal, Spontaneous Combustion of (Ed.) 192
Community Hospitals —
Ashland General Hospital— Dodd 264
Brookville General Hospital — Barley 165
Kerrville Sanitarium Hospital — Harrison 5S
Community Hospitals, Efficient, General, Problem of Building of —
Bailey 165
Community Hospitals, Small. Plan for First Unit of (Ed.) 190
Community Nurses : See Public Health Nurses.
Conger, Charlotte M. — Work of the American Women's Hospitals in
France 68, 346
Coni, E. R. — Anti-Tuberculosis Organization in Argentina (Ab.)...,499 The Hospitalization of Patients with Pulmonary Tuberculosis in
Buenos Aires (Ab.) 222
Conlev. Emma— The Red Cross Dietitian Service 407
Connecticut Training School for Nurses— Landis 487
Connecticut Training School of New Haven Hospital, Vacation
Cottages for— Cox 344
Conservation: See Drugs, Conservation of; Economy: Food Con- servation : Fuel Conservation : Gauze, Conservation of.
Construction, Hospital, Details of — Perry 469
Convalescents, Care of, in the Ospedale Maggiore of Milan (Ab.) —
Ronzani 152
Corn, Sweet, Preparation of, and Drying 143
Cottage Hospital, Creston, Iowa 112
Cott.ir:. Soiled. Laundering of, for French Military Hospitals (Ab.).224
County Hospital, Jefferson, Fairfield, Iowa 187
County Jails of Illinois — Hinrichsen 358
IV
INDEX
Cox Simon F. — ^Vacation Shore Cottage for Nurses 344
Crawford, Charlotte H.— Life-Saving Surgical Dressing Squads in
France • ^.' '
Creston, Iowa, Scheme for Rural Hospitalization in (Corr.) — Kep-
ford 200
Crippled: See also Disabled.
Crippled Men, American School of Rehabilitation for— McMur-
trie "*>, 145
Crippled Soldiers. Institute of Reeducation for, in Bologna (Ab.)..476
Cripples, Experimental Employment Bureau for— Adler 40^
Cubic Feet per Patient in Isolation Hospital IQ. & A.) ...420
Current Hospital Literature lol. —-■ *^^
D
Floating Hospital of Saint John's Guild Again at Work— Beckman . 92
Food Conservation in Military Hospitals 51
Food Conservation in an Ohio Hospital — Benedict 206
Food Conservation in Hospitals (Ed.) 289
Food Waste in Hospitals— Pitcher 491
Foreign Body Localizing Instrument 347
Forward. Charles W. and Lees, George Frederick— At The Sign of
the Blue Cross 349
France, Organization of Tuberculosis Work for Soldiers in (Ab.)..498 Fraternal Institution for the Free Treatment of Tuberculosis —
Rutledge • 155
Freyberg Light-? roof Dark-Room Ventilator 600
Fruits and Vegetables. Dehydrated 142
Fuel and Power Plant Economies for Hospitals— Kimball 437
Fuel. Conservation of. in Hospitals— U. S. Fuel Administration 250
Dakin. Florence— The Trained Attendant 198
Dark-Room Ventilator, Light-Proot ■ • ■ • »™
Davis, Michael M.. Jr.— Venereal Disease Clinics .436, 481
Davis, Michael M. and Warner, Andrew R.— Dispensaries, Their
Management and Development (Bk. Rev.) 498
Who Should Be Dispensary Patients? 6^
Davis Suprapubic Drainage Bottle -^^o
Dayton State Hospital, Mental, Dayton, Ohio 186
De Khotinsky Water-Bath ■.■•■• ^^^
De Monclos, Katherine — How the American Red Cross in trance
Mends Mutilated Faces :•■ X'- :•■'"''
De Paoli, G.— Male Divisions Intrusted to Female Nurses in SUte
Hospitals for the Insane (Ab.) 223
Dehydrated Vegetables and Fi-uits -^-j^^-
Delano, Jane A.— The Nursing Program of the American "ed
Delinquents! juvenile, PhyVicai Status of. Based on Examinations of Children in Reformatories of New Orleans— Bass and Loeber..l51
Dench Anesthetic Screen yw,-; ?|S
Dennison Manufacturing Company. Health Work of — Weber 4SS
Devan. Thomas Alan— War-Time Economy Problem in the Hos-
pital "=;
Diabetics. Gluten Flour for 308
Diet and Nutrition, Latest Books on 208
Dietary Department of Hospital, Management of — Graves 394
Dietetic Association. American. Meeting of 306.406
Dietetics. Department of 61. 142. 206. 306, 406. 491
Dietetics. Nurses' Course in 308
Dietitian in Social Welfare Service (Ed.) 189
Dietitian Problem in the Small Hospital (Q. & A.) 79
Dietitian Service. Red Cross— Conley 407
Dietitians. College Course for . ■ • ■ ■ ■ -fS?
Dietitians. News Notes of 209, 409, 496
Dietitians' Question Box 308
Disabled : See also Crippled.
Disabled, Agriculture for 74
Disabled Men. Hostels for. in London 50
Disabled Soldiers and Sailors. Human Factors in the Reconstruction
of— McMurtrie 476
Disabled Soldiers. Sailoi-s and Marines. Aid for in Pennsylvania 297
Dispensaries, Disreputable, Massachusetts Finds Remedy for 73
Dispensaries. Their Management and Development — Davis and War- ner (Bk. Rev.) 498
Dispensary and Out-Patient Work 73, 143, 481
Dispensary Patients. Admission of- Davis and Warner 64
Distilled Water: See Water Still 274
Dodd. J. M.— The Ashland ( Wis.l Community Hospital 264
Douglass, Stephen A. — The State Sanatorium and the Labor Prob-
lem
Drainage. Suprapublic, Vacuum Bottle for 226
Dressing Station. British, Advanced, On Newly Captured Ground... 88
Drew, Charles A.— The Standardization of Hospitals 66
Drug and Other Supplies, Conservation of — MacEachern 66
Dried Vegetables and Fruits 142
E
East Haven Hospital. Richmond. Indiana 38.i
Economies. War-Time. and Hospital Housekeeping — Butterfield 220
Economy : See also Conservation.
Economy Campaign. Cooperative, in All Departments of the Hospi- tal—Bacon 430
Economy Problem, War-Time, in the Hospital — Devan 446
Editorials 30. 114, 188. 286. 386. 460
Educational Work for Children at Lakeside Hospital — Warner 354
Edward L. Trudeau Institution in France — White 247
Efficiency System for Medical Work of State Hospitals— Singer 260
Electric Warming Pad. Safety 153
Electrothermal Applicators 422
Elei Blood-Counting Apparatus 421
Elks. Reconstruction Hospital Presented to Government by 148
Elm City Hospital. New Haven. Connecticut 284
Emery University. Atlanta. Georgia. Syphilis Clinic of (Ab.) —
Emery 152
Emery. W. B.— The Syphilis Clinic of Emery University. Atlanta.
Ga. ( Ab.) 152
Employment Bureau for Cripples— Adler 402
Epileptics. Institutions for the Care of — Shanahan 364
Episcopal Hospitals. Meeting of. Report of 344
Eugenics in Brazil 457
Evangelical Deaconess" Hospital. Marshalltown. Iowa 29
Facial Mutilations: See Mutilations. Facial.
Farm, Garden and Dairy. Institutional Consultant for (Corr.) —
Hoblit 202
Farmer. W. S.— Mrs. Peggy Ann Sutton and Her Quilt (Corr.) 200
Feeble-Minded Inmates of New York Institutions, to be Sifted Out. 5
Field Editors' Note Books 27, 112, 186, 284, 384, 458
Findley, June — Dietary Studies Made in the Missouri State Hospitals
for the Insane 306
Fish, Lina Stryker— Laundry System Which Has Proved Successful . 433
Gage, Harriet — Friendly Relations with Patients Established at
Admitting Desk (Corr.) 203
Gammons, Herbert F. — Advertising the Public Sanatorium 409
Gas Cases, American Hospital for the Study of, Bellevue. France 429
Gates. Amelia E. — The Work of the Adolescent Clinic of Stanford
University Medical School (Ab.) 151
Gauze and Bandage Cutting Machine 225
Gauze. Conservation of — Shilt 66
Gauze Dressings, Knitted 347
Gauze Rolling and Folding Machine 421
Geffen, Joseph— Visitors and Visiting in Hospitals 61
Gelatine Food Products Recognized by U. S. Food Administration. .409
Gelatine, Food Value of 308
Genoa. Neurological Center of the Territorial Army at (Ab.) 499
George F. Geisinger Memorial Hospital. Danville. Pennsylvania —
Robinson 281
Girls. Successful Private Institution for. Bloomington. Ill 375
Glennan Adjustable Bunk— Kerns 194
Gluten Flour for Diabetics 308
Goff. J. R.— The Woman's Hospital in the State of New York (Ab.).222 Goldwater. S. S. — Hospital Disintegration or Hospital Conservation
—Which? (Ed.) 30
Patriotic Duty of Hospitals During the War ( Ed. I 115
Report of the War Service Committee. American Hospital Asso- ciation Meeting, Atlantic City. New Jersey 332
Goodrich. Annie W.— The Nursing Program of the Army 410
Goodwill Electric Heating Pad 422
Grant Hospital, Chicago— Robinson 23
Grant Hospital, Columbus. Ohio 28
Grant Hospital. Columbus. Ohio — Robinson 183
Graves. Lulu G. — The Management of the Dietary Department of
the Hospital 394
Gray. Carolyn E. — Vassar's Response to the Nation's Need for
Nurses 204
Hackensack Hospital, Nurses* Home of — Washburn 84
Hackley Hospital, Muskegon, Mich 284
Hall, Rosetta Sherwood — The Hospital of Extended Grace to Women
and Children 252
Hamilton, Eleanor E. — A Plea for the Hourly Nursing Service as
a War Measure (Corr.) 78
Harpet Hospital. Detroit. Mich 29
Harrison. Mai-garet — The Community Hospital as Viewed by a
Nurse 68
Health and Modern Industry 299. 418. 488
Health Insurance and Hospitals— Howell 414
Health Insurance and Hospitals— Lapp 398
Health Insurance and Its Relation to Hospitals— Howell 466
Health Insurance, Its Medical and Hospital Aspects— Lapp 160
Heat and Light Infuser. Thermolite 153
Heat Applicators 422
Heating Plants : See Fuel.
Helen C. Juilliard, Floating Hospital 92
Heliotherapy and X-Rays in the Treatment of Surgical Tubercu- losis 263
Heliotherapy. Treatment of External Tuberculosis by (Ab.) 476
Hersey, Thomas L. Lee — Influenza Relief Work of Pusey and Jones'
Ship-Building Company 490
Hibbs. Henry H.— The South's First School of Social Work and
Public Health Nursing 147
Hinrichsen, Annie— The County Jails of Illinois 358
Hoblit. Charles T.— The Institutional Farm. Garden, and Dairy Con- sultant (Corr.) 202
Hominy, Hospitals Making Their Own 143
Horses, Blue Cross Hospital for — Forward and Lees 349
Hospital Accounting : See Accounting, Hospital. Hospital Administration : See Administration, Hospital. Hospital Association : See American Hospital Association ; British Columbia Hospital Association ; Catholic Hospital Association ; Minnesota Hospital Association ; New Jersey Hospital Associa- tion.
Hospital Bed. Railway, Glennan Adjustable — Kerns 194
Hospital Construction : See Architectural Articles.
Hospital Disintegration or Hospital Conservation — Which? (Ed.) —
Goldwater 30
Hospital Executives. Red Cross, Needed for (Ed.) 34
Hospital. General. Organization of Ochsner 124
Hospital Life, Stories of. Wanted (Ed.) 192
Hospital. Medical and Special Meetings 43. 130
Hospital of Extended Grace to Women and Children, Pyeng Yang,
Korea— Hall 252
Hospital, Past. Present and Future— Monro 292
Hospital People, Vital Issues to be Decided by (Ed.) 117
Hospital Records : See Records. Hospital.
Hospital Ships: See Floating Hospitals: Ships. Hospital.
Hospital Social Workers: See Social Workers. Hospital.
Hospital Staff: See Staff, Hospital.
Hospital Tent: See Tent. Hospital.
Hospital Train : See Train. Hospital.
INDEX
Hospitals : See also Children's Hospitals ; Community Hospitals : County Hospitals : Insane, Hospitals for : Mental and Nervous Diseases, Sanatoriums for; Military Hospitals; Ked Cross Hos- pitals ; Small Hospitals ; State Hospitals ; Tuberculosis Hospi- tals. Hospitals, Civil, and Allied Institutions, Mobilization of. for Na- tional Service (Ed.) 31
Hospitals, Civil, and the War — Ancker 327
Hospitals. Conduct of— Corwin 113
Hospitals. Individual, Descriptions of —
Ashland General Hospital, Ashland, Wis.— Dodd 264
Bahama General Hospital and Asylum— Milne 376
Brookville General Hospital. Brookville, Pa.— Bailey 165
Buffalo General Hospital, Memorial Hall of— Stevens 20
Edward L. Trudeau Institution in France — White 247
Floatinjr Hospital of Saint John's Guild— Beckman 92
George F. Geisinger Memorial Hospital, Danville, Pa. — Robinson. .281
Grant Hospital. Chicago — Robinson 23
Grant Hospital. Columbus, Ohio — Robinson 183
Hospital of Extended Grace to Women and Children, Pyeng
Yang, Korea— Hall 252
Kerrville Sanitarium Hospital. Kerrville, Texas — Harrison 58
Saint Anthony's Hospital, Carroll, Iowa— Robinson 108
Hospitalism — Its Causes and Treatment— Clark 53
Hospitalism. Practical Remedy for — MacEachein 379
Hospitalization. Rural. A Scheme for. Creston. Iowa (Corr.) — Kep-
ford 200
Hot-Air Apparatus 154
Housekeeping. Hospital. Its Worries and Cares — Jamieson 15
Howell. Thomas— Health Insurance and Its Relation to Hospitals. .466 Workmen's Compensation, Health Insurance and Hospitals 414
Ilbarritz. Hospital in. for External Tuberculosis (Ab.) 497
Illinois. County Jails of— Hinrichsen 358
Illinois Course tor Community Nurses 49
Immigrant. Health Standards and Care for 130
Indianapolis City Hospital 385
Indianapolis Methodist Hospital 386
India. Red Cross Work in 168
Industrial Welfare. Department of : See Health and Modern Industry.
Industrial Welfare, Proposed Federal Control of 299
Industrial Home for Girls, Bloomington, III 375
Industrial Physicians and Surgeons. American Association of, Third
Annual Meeting of 133
Industrial Rehabilitation of Soldiers and Sailors : See Occupational
Therapy, Vocational Rehabilitation, and Industrial Reeducation.
Influenza Epidemic and Social Service lEd.) 390
Influenza. Epidemic, and United States Public Health Service— Blue. 423
Influenza Epidemic. Quick Action of Red Cross in 392
Influenza, Measures against 370
Influenza Relief Work of Pusey and Jones Ship-Building Company —
Hersey 490
Influenza Relief Work of Stock Yards Community Clearing House
ICorr. I— Bradshaw 497
Influenza Situation and Hospitals (Ed.) 386
Influenza, Spanish. Out-Door Treatment of— Brooks 427
Ingram. J. H.— The Pitiable Condition of the Insane in North
China (Ab.) 152
Inheritance Tax, Federal, and Hospitals (Ed.) 188
Insane: See also Nervous and Mental.
Insane, Handwork of, (Peggy Ann Sutton and Her Quilt) (Corr.) —
Fanner 200
Insane. Hospitals for —
Davton State Hospital. Mental. Dayton. Ohio 186
Kaiamazoo State Hospital. Mental 458
Sheppard and Enoch Pratt Hospital. Towson. Baltimore 458
Insane in North China. Pitiable Condition of (Ab.)— Ingram 152
Insane, Italian Hospitals for. Economic Problems of (Ab.) Agostini.152 Insane. Missouri State Hospitals for. Dietary Studies in — Findley. . .306
Insane, Standardization of Hospitals for — Sandy 6
Insane. State Hospitals for, Male Divisions of. Intrusted to Female
Nurses (Ab.)— Paoli 223
Insurance. Health : See Health Insurance.
Interns. Duties of (Q. & A.) 221
Interns in Special Hospitals, and War Service 42
Interns. Rights of Hospital to— Baldy 89
Iroquois Memorial Hospital. Chicago 29
Isolation Hospital. Cubic Feet per Patient in (Q. & A.) 420
Italian Hospitals for the Insane, Economic Problem of (Ab.)—
Agostini 152
Jails. County, of Illinois— Hinrichsen 358
Jamieson, Mary A. — Hospital Housekeeping, Its Worries and Cares.. 15
Java, Hospital in. for Royal Navigation Company 302
Jefferson County Hospital. Fairfield, Iowa 187
K
Kahn. Max— The Department of Laboratories 271
Kalamazoo State Hospital, Mental 458
Kepford, Aretas E.— A Great Vision and Its Realization (Corr.) 200
Kerrville Sanitarium Hospital, Kerrville, Texas— Harrison 58
Kidner. T. B.— Canada's Rehabilitation and Reconstruction Work.. 393 Kimball. D. D.— Heating and Power Plant Economies for Hospitals. 437 Klotz, Walter C— New Four-Patient Cottage at Barlow Sanatorium. 378 Korndoerfer. .Aug. — The Nursing Problem : Third-Year Training
Under Government Supervision (Corr.) 202
Korean Hospital Work (Hospital of Extended Grace to Women and
Children. Pyeng YangI— Hall 252
Labor Recruiting Agencies. Government, Medical Examination Card
for
.301
Laboratories. Department of — Kahn
Laboratories. Relation of, to Hospitals— MacCarty 381
Laboratory Technicians, More. Needed (Ed.) 32
Ladd, Mrs. Maynard, Work of, in Repairing Facial Defects — De
Monclos 158
Lakeside Hospital, Cleveland —
Educational Work for Children in— Warner 354
War Time Economies in— Shilt 66
Landis, Maude — Connecticut Training School for Nurses 487
Lapp, John A.— Health Insurance and the Hospitals 398
Insurance : Its Medical and Hospital Aspects 160
Latchstring Out 118, 192, 390
Latin America, Our Relations with (Ed.) 463
Laundry System Which Has Proved Successful— Fish 433
Lay of the Government Lady 209
Lebredo. M. G. — Necessity of Hospitalizing Typhoid Patients (Ab.).224 Lees. George Frederick, and Forward. Charles W.— At the Sign of
the Blue Cross 349
Legislative Committee of American Hospital Association, Report of. 331
Letters to the Editor 78, 345. 497
Liberty Loan, Fourth (Ed.) 286
Limbless Men, Hospital for, at Cardiff (Ab.) 223
Linoleum, Battleship, How to Lay (Q. & A.) 150
Litter, Army. Field and Hospital Use for.... 70
Little Journeys to Places and People Worth Knowing — Robin- son 23, 108, 183, 281, 454
Liverpool, England, Pneumonia Ward of American Red Cross Hos- pital at 429
Loder, Cornelius S. — Report of Audit Committee, American Hos- pital Association Meeting, Atlantic City, New Jersey 329
Loeber, Maud and Bass, Elizabeth — Physical Status of Juvenile Delinquents in the Reformatories of the City of New Orleans.. 161
Logan Sputum Cup 163
Louisville City Hospital, Organization of — Tuley 169
Louisville City Hospital, Social Service Training of Nurses at 206
Luther, Jessie — Occupational Treatment in Nervous Disorders 11
M
McCallin, Mrs. Sidney— Blindness a Temporary Disablement 295
MacCarty, William Carpenter^Relation of Laboratories to Hos- pitals 331
MacEachern, Malcolm T. — A Canadian Civil Hospital's Part in
War Work 257
Conservation of Drugs and Other Supplies 66
Practical Remedy for Hospitalization 379
Mcintosh X-Ray Cassette 80
MacLennon, W. H. — Associated Purchase Method Adopted by Aus- tralian Institutions 346
McMurtrie, Douglas C. — An American School of Reeducation for
Crippled Men 76. 146
Human Factors in the Reconstruction of Disabled Soldiers and
Sailors 476
Maimin Gauze and Bandage Cutter 225
Management. Hospital : See Administration. Hospital.
Martin, Franklin — The Volunteer Medical Service Corps 275
Massachusetts Finds Effective Remedy for Disreputable Dispensaries. "73 Massachusetts Medical Society, One Hundred and Thirty-Seventh An- nual Meeting of 131
Massachusetts Sick. Organized Care for (Ab.) — Whitehill 224
Maternity Hospital in Arezzo (Ab.) — Pagliani 223
Mayo Clinic. Rochester. Minn. (Ab.) — Tange 222
Mc. names beginning with ; see under Mac.
Medea. E.— The Course of Instruction for the Wounded of the
Biffi Pavilion (Ab.) 222
Medical Department of the Army. Some Aspects of Program of. and
Their Effect on Civil Hospitals— Smith 334
Medical Industry Section of War Industries Board — Simpson 278
Medical Staff: See Staff, Hospital.
Medicine, Business of and Profession of — Bowman 123
Medicine, Organized Practice of (Ed.) TB
Memoirs of a Head Nurse 60, 137, 196, 293, 391, 468
Mental Hospitals, Occupational Therapy in 45
Mental Hygiene in the War 196
Mercy Hospital, Philadelphia 385
Mercy, U. S. Hospital Ship 213
Methodist Hospital, Indianapolis 385
Miami Valley Hospital, Food Conservation in 206
Michigan State Nurses' Association. Annual Meeting of 48
Milan. Ospedale Maggiore of. Care of Convalescents in (Ab.) —
Ronzana 152
Military Annex of Vancouver General Hospital — MacEachern 257
Military Hospitals. Food Conservation in 51
Military Hospitals, Vocational Instnictors Needed in 405
Milne. Mrs. T.— The Bahama General Hospital and Asylum 376
Minnesota Hospital Association. First Annual Convention of.... 49, 134 Missouri State Hospitals for the Insane. Dietary Studies in—
Findley 306
Modern Hospital, Consolidation of Editorial and Business Offices
of (Ed.) 118
Modern Hospital — Prospect and Retrospect (Ed.) 191
Modern Woodmen of America Sanatorium. Woodmen, Co. — Rut- ledge 156
Monro. A. S.— The Hospital — Past. Present and Future 292
Moulinier. Charles B.— President's Address. Catholic Hospital Ac-
sociation 122
Mount Carmel Hospital. Columbus. Ohio 186
Mount Sinai Hospital, New York. Nurses' Home of — Robinson 464
Moving Pictures Displayed on Camp Hospital Ceilings 177
Murdoch. Beatrice W. — Work in Chinese Women's Hospitals 346
Mutilations. Facial. Repair of — De Monclos 158
Mutilations, Facial, Work of English Sculptors in Repairing 148
La Panne, Belgium, War Hospital. Site of 113
National Tuberculosis Association. Fourteenth Annual Meeting of.. 46 Nemirovsky, M. A. and Tilmant, M. — Radio-Chirurgical Aeroplane
(Ab.) 499
INDEX
Nervous Diseases, Hospital for, Villa del Seminario at Ferrara
(Ab.)— Boschi 223
Ner\'ous Disorders, Occupational Treatment in — Luther 11
Neurological Center of the Territorial Arniy at Genoa (Ab.) 499
Newell Hot-Air Apparatus 15-*
Newfoundland Orphan's Home at St. Anthony 63
New Haven Hospital, Vacation Shore Cottage for Nurses of— Cox.. 344
New Instruments and Equipment 80, 153, 225. 347, 421, 500
New Jersey Hospitals Organize 401
New York City Hospital, Self-Government for Kesident Medical
StaflE of — Bacon 17
New York Department of Nursing and Health, Special Courses Of- fered by, for Teachers and Supervisors 65
New York Institutions, Feeble-Minded Inmates of, to be Sifted Out. 5
New York Social Service Exchange 145
New York, State of. Women's Hospital (Ab.)— Gofte 222
Night Supervisor, Graduate, A Necessity (Q. & A.) loO
Nissley, Clarice — The Blue Triangle Hut 416
Nurses* Aid : See also Attendant.
Nurses' Aids, A Plea From the Front For (Ed.) r'H?.
Nurses' Appeal for, from Red Cross Department of Nursing (Ed.).. 288
Nurses' Association. Michigan State, Annual Meeting of 48
Nurses, Community, and Nurses, Public Health ; See Public Health
Nurses. Nurses' Homes —
Mount Sinai Hospital, Nurses' Home of — Robinson 454
New Haven Hospital, Vacation Shore Cottage for Nurses of — Cox. 344
Nurses, Red Cross, Enrollment of 303
Nurses, Summer Preparatory Course for, at Western Reserve Uni- versity—Wheeler 486
Nurses, Superintendents of. Duties of (Q. & A.) 221
Nurses, Trained, Canadian Association of. Meeting of 46
Nurses, Training of. How Colleges Can Help in— Stewart 483
Nurses, Training of, in Military Hospitals (Ed.) 114
Nurses, Vacation Cottage for— Cox 344
Nursing. Army School of 50, 290, 410, 413
Nursing, Department of 50, 138, 204, 303, 410, 483
Nursing in Civil Hospitals, The Relation of the War Program to —
Nutting 339
Nursing Problem : Third Year Training Under Government Super- vision (Corr.)- Korndoerfer 202
Nursing Program of the Army — Goodrich 410
Nursing, Public Health : See Public Health Nursing.
Nursing Resources, Nation-Wide Survey of (Ed.l 389
Nursing, Schools of. Standard Curriculum for — Welsh 503
' sing. School of. Plan and Equipment of Model Teaching Unit
for
Nursing Service, Hourly, as a War M Nursing, Teachers and Supervisors of, Speci;
by New York Department of Nursing a Nutting, Adelaide— The Relation of the Wa
in Civil Hospitals
.138
(Corr.)— Hamilton... 78 Courses for, Olfered
1 Health 65
Program to Nursing 338
Obstetrics and the Hospital— Paddock 291
Occupational Therapy —
in Canadian War Hospitals— Burnette 401
in Kalamazoo State Hospital, Mental 458
in Mental Hospitals 45
in Nervous Disorders— Luther 11
in Sheppard and Enoch Pratt Hospital, Towson, Baltimore 458
National Society for Promotion of. Second Annual Meeting of. . .298 Occupational Therapy, Vocational Reeducation and Industrial Re- habilitation 74, 145, 210, 295, 401, 476
Ochsner, A. J.— The General Hospital 124
Ohio Hospital Association, Fourth Annual Convention of 43
Ohio State Sanitorium. Mount Vernon, Ohio, Employment of Prison
Labor on— Douglass 99
Operating Room, Green, Saint Luke's Hospital, San Francisco —
Sherman 97
Operating Room, Redecoration of (Q. & A.) 150
Operating Rooms, Cleaning of, after Septic Operations (Q. & A.).. 420 Operation Barrack of Board of Surgical Ambulances of the Army
( Ab.) 222
Orphan's Home, St. Anthony. Newfoundland 63
Pagliani, L. — The New Lying-in Hospital at Arezzo (Ab.) 222
Paddock, Charles E.— Obstetrics and the Hospital 291
Painter, F. M.— Extending the Influence of a Hospital 355
Painting Hospital Wards (Q. & A.) 420
Parallax Foreign Body Localizing Instrument 347
Parker Hill, Boston, Reconstruction Hospital No. 10 148
Pay Clinics, Evening — Warner 143
Pennsylvania, Aid for Crippled Soldiers, Sailors and Marines of.... 297
Perry, N. V.— Details of Hospital Construction 469
Physicians, Enrollment by. Not Suspended (Ed.) 188
Physiotherapy as War Work for Young Women 416
Pitcher, Charles S. — Food Waste in Hospitals 491
Pneumonia Ward of American Red Cross Hospital, Liverpool, Eng- land ''29
Pons J B. — Sanatoriums for the Tuberculous in the West of the
United States ( Ab.) 223
Porter, Charles A. and Carter, Herbert K. — Hospital Account- ing 102, 173, 266, 371, 448
Power Plant and Heating Economies for Hospitals — Kimball 437
Practical Papers, Some ( Ed. ) 31
Presbyterian Hospital, Chicago 27
Presbyterian Hospital, Chicago, Economies in — Bacon 430
Prince, Ethel Anderson— Mental Hygiene and the War 196
Prison Labor, Employment of, on State Sanatorium Farm — Doug- lass 99
Psychopathic Hospital of the Laboratory of Social Hygiene, Bed- ford Hills. rAb.l— Davis and Southard 499
Public Health. Increased Need for Care of (Ed.) 288
Public Health Nurses, Illinois Course for 49
Public Health Nursing and Social Work. South's First School of — Hibbs 147
Public Health Service, U. S., and Epidemic Influenza— Blue 423
Public Health Work in Cincinnati— Dinwiddle 180
Purchasing, (Centralized, as an Aid to Hospital Economy 107
Purchasing, Hospital, Associated Method of. Adopted by Austra- lian Institutions (Corr.) — MacLennan 346
Pusey and Jones, Influenza Relief Work of — Hersey 490
Quarantine Stations at Didam, Sittard and Venloo (Ab.) 251
Queries and Answers 79, 150, 221, 420
R
.480
Reconstruction Aides, Emergency Training for
Reconstruction from War and Industry, Discussion of, by American
Association of Industrial Physicians and Surgeons 133
Reconstruction Hospital, First, Cornerstone of. Laid 148
Records, Hospital —
Efficiency System for the Medical Work of State Hospitals —
Singer 260
Hospital Clinical Records, Method of Indexing — Byrne 86
Red Cross- American, Nursing Program of — Delano 336
American, Work of, in Repairing Facial Defects— De Monclos. . . 158
Canadian, Work Accomplished by, in 1917 49
Convalescent House at Walter Reed Hospital 217
Dietitian Service — Conley 407
Hospital, American, London 101
Hospital, Edward L. Trudeau Institution in France — White 247
Hospital. Pneumonia Ward of, Mossley Hill, Liverpool, England.. 429
Institute for Crippled and Disabled Men — McMurtrie 76,145
Nurses, Enrollment of 305
Quick Action of, in Influenza Epidemic 392
Work, Executives in. Need for (Ed.) 34
Work in India 168
Red Triangle Tuberculosis Farm Colony (Ab.) 222
Rehabilitation and Reconstruction Work of Canada — Kidner 393
Reid Memorial Hospital, Richmond, Ind 284
Resolutions Presented by the Resolutions Committee of the Ameri- can Hospital Association 328
Re-use Knitted Gauze Dressings 347
Robert W. Long Hospital, Indianapolis 285
Robinson, Max'garet J. — Little Journeys to Places and People Worth
Knowing 23, 108, 183, 281, 454
Ronzani, E. — The Care of Convalescents in the (jspedale Maggiore
of Milan (Ab.) 152
Roosevelt Hospital, New York City 384
Rotating Service, Abolition of. During the War (Ed.) — Goldwater. .115
Royal Navigation Company, Java, New Hospital for 302
Ruhl, Mary R. — Inexpensive and Serviceable Wardrobes 294
Rural Communities, Hospital Service in (Ed.) 464
Rutledge. J. A. — A Fraternal Institution for the Free Treatment of Tuberculosis 155
Sacred Heart Hospital, Fort Madison, Iowa 29
Safety Electric Warming Pad 153
St. Anthony, Newfoundland, Children's Home in 63
St. Anthony's Hospital, Carroll, Iowa — Robinson 108
St. Dunstan's Hostel for the Blind— McCallin 295
St. Francis Hospital, Waterloo, Iowa 112
St. John's Guild, Floating Hospital of. Again at Work — Beckman... 92
St. John's Hospital in Turin, Radiologic Division of 496
St. Joseph's Hospital, Ottumwa, Iowa 112
St. Luke's Hospital, San Francisco. Green Operating Room in — Sher- man 97
St. Luke's Hospital, Chicago 27
Sanatorium, State, and the Labor Problem — Douglass 99
Sand, Rene — How America May Help Belgium After the War 256
Sandy, William C— The Standardization of Hospitals for the In- sane 6
Sargent Water Still 80
Saskatchewan, Schools of. Medical Inspection in 301
School Medical Inspection in Saskatchewan 301
Segard, M. — How to Prescribe Rest and Exercise for Patients with
Pulmonary Tuberculosis ( Ab.) 152
Senior Pupil Nurses, Enrollment of, for Military Service (Ed.) 190
Shanahan, William T.— Institutions for the Care of Epileptics 364
Sharon Sanatorium, Children's Pavilion at, (Ab.)— Bowditch 222
Sheppard and Enoch Pratt Hospital, Towson, Baltimore 458
Sherman, Harry M. — The Green Operating Room at St. Luke's
Hospital, San Francisco 97
Shilt, Nell — The Conservation of Gauze 66
Ship Building, Welfare of Workers in 299
Ship, Hospital, U. S., Mercy 213
Simpson, F. F. — A War Program of Vital Importance 278
Singer, H. Douglas — An Efficiency System for the Medical Work of
State Hospitals 260
Small Hospitals, Affiliation for (Q. & A.) 160
Small Hospitals- Agatha Hospital, Clinton, Iowa 29
Ashland General Hospital, Ashland, Wis.— Dodd 264
Brookville General Hospital— Bailey 165
Cottage Hospital, Creston, Iowa 112
Evangelical Deaconess Hospital, Marshalltown, Iowa 29
Jefferson County Hospital, Fairfield, Iowa 187
Kerrville Sanitarium Hospital, Kerrville, Texas — Harrison 58
Sacred Heart Hospital, Fort Madison, Iowa 29
St. Anthony's Hospital, Carroll, Iowa— Robinson 108
St. Francis Hospital, Waterloo, Iowa 112
St. Joseph's Hospital, Ottumwa, Iowa 112
Tuberculosis Sanatorium Buildings, Small, Planning of — Burt.... 1
Smith-Sears Bill, Passage of 147
Smith, Winford H. — Some Aspects of the Program of the Medical
Department of the Armv and Their Effect on Civil Hospitals. . .335
INDEX
Social Service—
and Hospital Efficiency — Warner 342
and the Influenza Epidemic (Ed.) 390
Exchangre of New York City 145
Made a Part of Nurses" Training at Louisville City Hospital 206
Social Work and Public Health Nursing, South's First School of.. 147
Social Workers, Hospital, American Association of 205
Social Workers, Hospital, First General Meeting of 343
Soldiers, Tuberculous, Rehabilitation of 46
Southard, E. E. and Davis, Katherine—Psychopathic Hospital of the
Laboratory of Social Hygiene, Bedford Hills (Ab.) 499
Spanish Influenza; See Influenza.
Spray Heater. Electric 422
Sputum Cup 153
St.: Sec under Saint.
Staff, Hospital, Resident, Self-Government for — Bacon 17
Staff, Hospital, Written Versus Oral Instruction for (Q. & A.) 221
Standardization of Hospitals —
Epileptics, Institutions for Care of — Shanahan 364
Insane, Hospitals for — Sandy 6
Standardization of Hospitals — Drew 56
State Hospitals — Bowen 81
Standardization of Staff and Hospital (Ed.) 117
Stanford University Medical School, Adolescent Clinic or (Ab.) —
Gales 151
State Hospitals, Efficiency System for the Medical Work of — Singer. 260
State Hospitals, Standardization of — Bowen 81
State Institutions, Well Directed Offensive Against Political Jobbery
(Ed. ) 288
State Sanatorium and the Labor Problem — Douglass 99
Sterilizing Machine, Large Portable, for Pershing's Troops in
France 218
Stevens, Edward F.— Memorial Hall of Buffalo General Hospital.. 20 Stewart. Isabel M.— How the Colleges Can Help in the Training of
Nui-ses 483
Stock Yards Community Clearing House, Influenza Relief Work of
(Corr.) — Bradshaw 497
Sun Treatment : See Heliotherapy.
Surgical Dressing Squads. Life-Saving, in France — Crawford 178
Surgical Needles, Need of (Ed.) 389
SuperT.-isor, Night Graduate, A Necessity (Q. & A.) 150
Suprapubic Drainage. Bottle for 225
Sutton. Mrs. Peggv Ann and Her Quilt (Corr.)— Farmer 200
Syphilis Clinic of Emery University, Atlanta, Georgia (Ab.) — Emery. 152
Tange, A. — The Mayo Clinics at Rochester, Minn., (Ab.) 222
Technicians, Laboratory, needed (Ed. I 32
Tent, Hospital, Six Hundred-Bed, Prepared in Twenty-five Days —
Watson 195
Tent Ward, Brooklyn Navy Yard Hospital 218
Test-Tube Boiler, Electric 154
Thermolite Heat and Light Infuser 153
Thompson, St. Clair — ^The Value and Limitation of Sanatorium
Treatment for Tuberculosis (Ab.) 224
Tilmant, M. and Nemirovsky, M. A. — Radio-Chirurgical Aeroplane
( Ab.) 499
Toilet Seats. Sanitary (Q. & A.I 420
Training Schools : See Nursing, Schools of.
Trains. Hospital, for Americans in France 218
Trolley, Hospital Ambulance, First 98
Tuberculosis Dispensary, Hygienic Work of (Ab.) 500
Tuberculosis, External, Hospital in Ilbarritz for (Ab.» 497
Tuberculosis, External, Treatment of by Heliotherapy 476
Tuberculosis Farm Colony, Red Triangle (Ab.) 222
Tuberculosis Hospitals, Permanent, Building of. Approved 193
Tuberculosis, Pulmonary, Hospitalization of, Buenos Aires (Ab.) —
Coni 222
Tuberculosis, Pulmonary, Rest and Exercise for (Ab.) — Segard 152
Tuberculosis Sanatorium Buildings, Small, Planning of — Burt 1
Tuberculosis, Sanatorium for, in the West of the United States (Ab.)
— Pons 223
Tuberculosis Sanatorium "Santa Maria," (Ab.)— Cabret 223
Tuberculosis Sanatoriums —
Barlow Sanatorium, New Four-Patient Cottage at — Klotz 378
Edward L. Trudeau Institution in France — White 247
Modem Woodmen of America Sanatorium, Woodmen, Col. — Rut- ledge 155
Tuberculosis Sanatoriums in High Altitudes and on the Plains (Ab.).497 Tuberculosis, Surgical, Heliotherapy and X-Ray in Treatment of. .263 Tuberculosis, Value and Limitations for Treatment of (Ab.) — Thomp-
• son 224
Tuberculosis Work for Soldiers, Organization of, in France (Ab.)...498
Tuberculosis Work in Argentina— Coni (Ab.) 499
Tuberculous Soldiers, Care of (Ab) 496
Tuberculous Soldiers, Rehabilitation of 46
Tuley, Henry Enos — Some Problems of Hospital Management 169
Typhoid Patients, Hospitalizing of — Lebredo 224
u
United States Public Health Service: See Public Health Service, U. S 423
United States Shipping Board, Emergency Fleet Corporation, Wel- fare Work of 299
United War Work Campaign 419
Universal Service, Compulsory— Ministry of Health, A (Ed.) 33
V. A. D. in a French Hospital 212
Vancouver General Hospital, Military Annex of — MacEachern 257
Vancouver General Hospital, War Time Economies in — MacEachern. 66 Van Der Bent, T. J. — War-Time Hospitals Present Ideal Conditions
for Investigation 279
Vassar's Response to the Nation's Need for Nurses— Gray 204
Vassar Training Camp, Students of. Assigned to Duty 305
Vegetables and Fruits, Dehydrated 142
Venereal Disease Clinics— Davis 436. 481
Ventilator, Light-Proof , Dark-Room 500
"Verithin" X-Ray Cassette 80
Visitors and Visiting in Hospitals— Geffen 61
Vocational Instructors Needed in Military Hospitals 405
Vocational Therapy: See Occupational Therapy.
Volunteer Medical Service Corps (Ed.) 287
Volunteer Medical Service Corps — Martin 275
w
Walter Reed Hospital. Red Cross Convalescent House at 217
Wardrobe, Inexpensive and Serviceable — Ruhl 294
Wards. Hospital. Painting of (Q. & A.) 420
War Industries Board and Hospital Supplies (Ed.) 462
War: Its Hospital, Medical and Nursing Aspects 68, 148, 212, 416
War Service. Another Staff Member Called for (Ed.) 290
War Service Committee Conference 35
War Service Committee of American Hospital Association, Report of .332 War-Time Hospitals. Possibilities of Investigation in — van der Bent. 279
War-Time Institution Economies 66. 220
Warming Pad, Safety Electric 153
Warner. A. R.— Educational Work For Children at Lakeside Hospital. 354
Evening Pay Clinic 143
Social Service and Hospital Efficiency 342
Warner, Andrew R. and Davis, Michael M. — Dispensaries, Their
Management and Development (Bk. Rev.) 498
Who Should Be Dispensary Patients? 64
Warner. Mrs.. Death of (Ed.) 390
Warning to Hospitals Against Pretended Representatives of Modem
Hospital 391
Washburn, Frederick P.— The Nurses' Home of the Hackensack
Hospital 84
Water-Bath, Portable 225
Water Still, Inexpensive — Bacon 274
Water Still, Sargent 80
Weber. J. J.— Health Work of Dennison Manufacturing Company.. 488
Weber, .1. J.. Work of 59
Welsh. Mabelle S.— Standard Curriculum for Schools of Nursing 302
West Suburban Hospital, Oak Park, III 27
Western Reserv^e University, Summer Course for Nurses at —
Wheeler 486
Wheeler. Claribel A. — Summer Preparatory Course for Nurses at
Western Reserve University 486
White, Wm. Charles— The Edward L. Trudeau Institution in France. 247 Whitehill, G. E.— Organized Provision for the Care of the Sick in
Massachusetts (Ab.) 224
Wood, Derwent. Work of, in Repairing Facial Injuries 148
Woodward Gauze-Rolling and Folding Machine 421
Women Hospital Superintendents. Training and Rewards of (Ed.).. 387
Women's Hospital in the State of New Y'ork (Ab.)— Goffe 222
Workmen's Compensation. Health Insurance and Hospitals— Howell. 414
Wounded of Biffi Pavilion, Instruction for (Ab.)— Medea 222
Wright. Howell — Report of the Legislative Committee, American
Hospital Association Meeting, Atlantic City, New Jersey 329
X-Ray Cassette, Mcintosh, "Verithin" 80
X-Ray Operators, Protective Glasses for 226
X-Rays and Heliotherapy in the Treatment of Sui-gical Tuberculosis. 263
THE MODERN HOSPITAL
A Monthly Journal Devoted to the Building, Equipment, and Administration oj Hospitals', Sanatoriums, and Allied Institutions, and to their Medical, Surgical, and Nursing Services
Vol. XI
////j, 1918
No. 1
THE PLANNING OF SMALL TUBERCULOSIS SANATORIUM BUILDINGS
Wise Economy a Duty in Employment o£ Public Funds — Attractiveness, Durability,
and Convenience Attainable at Low Cost — Plans Drawn for Use of New York
State Department of Healtb
By JAMES D. BURT, Architect, New York.
WRITTEN across the top of the New York State Department of Health letter-heads is the slogan: "Public Health Is Purchasable. Within Natural Limitations Any Community Can Determine Its Own Death Rate."
This claim, startling and ambitious as it may appear, has proved true by demonstration in the results of the various activities of progressive health departments in our own as well as in for- eign countries ; it would appear that the statement is not a boast, but a well-settled and generally ad- mitted fact.
"How much is the cost?" is a natural question to ask when a statement is made that a thing can be purchased. If the cost of a thing is exorbitant and beyond the ability of the would-be purchaser to pay, then no purchase is made and the dan- gerous condition is not remedied : Public health must he made purchasable at a reasonable price.
What are the things which call for the outlay of money in connection with this purchase of health ? Doubtless professional and expert advice and direction are a necessary and preliminary part of the expense of public health. We are con- cerned, however, in this article, only with that part of the outlay which applies to the building and equipment for the treatment of cases of tuberculosis.
Because the treatment of tuberculosis is so largely hygienic — the living of a normal life un- der favorable conditions — a large part of the first cost is represented by the necessary buildings and equipment ; it is in the economy, or the lack of it.
as applied to this part of the outlay that deter- mines whether or not health may be purchased at a reasonable cost.
In these days of multiplied social activities, when the community and the state are assuming control of and responsibility for the prevention and treatment of communicable diseases, in addi- tion to various other social interests, it is becom- ing more and more urgent that money raised for these purposes shall be wisely used and made to perform its work as efficiently as possible in jus- tice to those who willingly or unwillingly are taxed to meet the financial burden thereby im- posed.
Economy and good judgment have not always characterized the expenditure of public funds, even when so important a matter as the public health is at stake; we still have with us a con- siderable number of those who consider a public enterprise as an occasion of very liberal expendi- ture of money, if not an opportunity for actual plunder. One does not have to go far to find glar- ing examples of buildings and equipment which are monuments of wastefulness and inefficiency.
There is not only no excuse for this, but, in view of the many sufferers who ought to be cared for in sanatoriums, but who cannot be received because of lack of room or the high cost of treatment, it becomes a crime and no building committee or board of supervisors is justified in spending more than a reasonable amount for their ouildings and equipment — such an amount as, when placed in the hands of a trustworthy and
-m* ^^m
^*M%g^'
'tmi
'0BS. "f^
t^
THE MODERN HOSPITAL
Fig. 1. Tubcrculo
fifty patients. Typical design for the De|i:irtmtnt of Health of the Stale of Ne Biggs, M.D,, commissioner ; James D. Burt, architect.
competent architect, will produce structures that are at once attractive, economical, durable, and convenient.
Applying this to the specific matter of the build- ing or buildings for a small tuberculosis sanato- rium, we shall endeavor to illustrate a few simple and commonplace principles which experience has taught us to observe if the foregoing four requi- sites are to be secured.
The matter of appearance and general attrac- tiveness should receive at least as much attention as the design of a private residence of equal cost. The institution is to be the home, for the period of their treatment, of many who come to it under peculiarly adverse circumstances, and it is left to the environment, both physical and social, as well as to fresh air, sunshine, and good care, to estab- lish and to maintain the feeling on the patient's part that he has come to the place where health is to come again, and where for the time, to as great extent as possible, all care and anxiety are to be dissipated.
Nor is it necessary to be extravagant in order to make a building attractive. Usually, and partic- ularly in such a building, simplicity is the keynote of attractiveness ; plenty of sunlight and air with ample opportunity for yet more air, with protec- tion from cold winds; quiet, cheerful colors; a pleasant outlook; opportunity for privacy, so far as may be, with all physical needs easily provided for — these are all a part of the general attactive- ness which appeals to the average patient.
As for economy of construction, of course there is an economy which might better be called parsi- mony, for no method of construction which has only low initial cost to recommend it can be justly called economical if the usefulness of the building
will be of short duration and it must-;oon be re- paired or replaced. The matter of srength and durability should be more accented i public or semipublic institutions than in privat buildings, for the reason that they are given hrder usage in spite of the greatest watchfulness. There will always be a certain number of persos who will never catch the spirit of personal reponsibility in the use of public propertj\
The matter of wise, economical cnstruction and equipment may well be a matter jr coopera- tion on the part of the architect and le hospital board.
Convenience in layout is a very imprtant mat- ter, on the score both of general utilit and satis- faction and of the cost of adminis-ation. A building correctly planned and equippd will save the services of one or more persons o?r a build- ing that is poorly planned, thus avoiing a per- petual loss and a constant irritation.
The example here illustrated is sejcted from a number of model or typical plan designed for the New York State Department if Health, and intended as a guide in the designicr and con- struction of the various county tuberclosis hos- pitals which, under the recently enacte law, must be erected in all counties with a poulation of 35,000 or more which are not alread provided with adequate accommodations for :3berculous patients. The present commissioner f the de- partment, Dr. Hermann M. Biggs, a acknowl- edged international authoi'ity on all latters re- lating to the study and treatment of tuerculosis, from the beginning of his activitiet^ regarding public health in general and tuberculcis in par- ticular, has been very pronounced in hi insistence on the dissemination of all that has ben learned
THE MODERN HOSPITAL
relatin to the causes and treatment of this dread diseasi The best advice and suggestions have been a ailable for the asking ; if there is any per- son of understanding of any nationality in this
These drawings are a part of the liberal propa- ganda in this war against tuberculosis ; the maker of them does not pretend that they are a perfect solution of the problem of sanatorium construe-
|
Fig. 2. Isement |
plar |
of the |
fifty-bed tuberculosis hospital shown in Fig. 1. In |
this |
and the following plans |
the |
scale shown in the lower |
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|
of the drawing represents |
10 feet. |
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|
A. |
Washir machines. |
M |
High-pressure boiler. |
Y. Cabinet oven. |
.=;. |
Boiler room. |
17. |
Milk, butter, eggs. |
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B. |
Soap tlk. |
N |
Vacuum cleaner machine. Z. Vegetable cooker. |
«. |
Toilet. |
IK. |
Recreation room. |
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(;. |
Extraor. |
0. |
Sputum depository. |
AZ. Stock pot. |
7. |
Women's toilet. |
19. |
Sewing and mending |
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|
1). |
Wash T»ys. |
P. |
Dumbwaiter. |
BZ. Range. |
K. |
Store room. |
2(1. |
Medical laboratory. |
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|
K. |
Starchettle. |
Q. |
Coffee and tea urns. |
DZ. Cook's table. |
!). |
Vestibule. |
21. |
Business office. |
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|
F. |
Table. |
R. |
Dish shelves. |
EZ. Steam table dish |
1(1. |
Stair hall. |
22. |
General hall. |
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|
(;. |
Dryer. |
S. |
Dish washer. |
warmer. |
11. |
Help's dining re |
om. |
23. |
Physicians' office. |
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|
H |
Ironei |
T. |
Garbage cans. |
FZ. Meat block. |
12. |
Kitchen coal. |
24. |
Examination room. |
||||
|
I. |
Foldir table. |
U |
Vegetable peeler. |
1. Laundry. |
13. |
Kitchen and bakery |
26. |
Staff pantry. |
||||
|
.1 |
Incinstor. |
V |
Vegetable preparation. |
2. Receiving room. |
14. |
Serving pantry |
26. |
Staff dining room. |
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|
K. |
Hot v.-:er heater. |
W |
Baker's table and bins. |
3. Clean linen room. |
1.1. |
Refrigerator ve |
tibule. |
2V. |
Patients' dining roonr |
|||
|
L. |
Heatir boiler. |
X. |
Baker's proofer. |
4. Coal |
16. |
Meats.fish. |
28. |
Entrance porch. |
' 1,-::.:^:
Fig. 3. First floor plan of the fifty-bed tuberculosis hospital shown previously.
1. Open ^rds.
2. Sittinjrooms.
3. Dressir rooms.
4. Lavatdes, 6. Toilets
6-15. Menelp's quarters.
16. Attendants' toliet.
17. Supplies, linen, etc.
18. Nurses* room.
19. Stair hall.
20. Rear porch.
21. Unassigned.
22. Diet kitchen.
23. General corridor.
24. Book shelves,
25. Linen closet.
26. Bed patients' hall.
27. Closet.
state \ho does not to some extent appreciate the malignnt nature of this disease and the steps to be taka towards a cure, he has dehberately shut his eye and his ears so that he could not see and hear te evidence and the testimony regarding it.
28-33. Bed patients' quarters. 34. Bed patients' porch.
A. Bath tubs.
B. Showers.
C. Dental lavatory.
D. Wash basins.
E. Slop sinks.
F. Utility sink hopper.
G. Water closets. H. Dumbwaiter.
I. Shelves.
tion, but they do contain some principles which should be included in the layout of every tubercu- losis hospital, whether large or small.
The controlling idea in these plans is to provide for fifty cases of incipient tuberculosis with the
THE MODERN HOSPITAL
competent architect, will produce structures that are at once attractive, economical, durable, and convenient.
Applying this to the specific matter of the build- ing or buildings for a small tuberculosis sanato- rium, we shall endeavor to illustrate a few simple and commonplace principles which experience has taught us to observe if the foregoing four requi- sites are to be secured.
The matter of appearance and general attrac- tiveness should receive at least as much attention as the design of a private residence of equal cost. The institution is to be the home, for the period of their treatment, of many who come to it under peculiarly adverse circumstances, and it is left to the environment, both physical and social, as well as to fresh air, sunshine, and good care, to estab- lish and to maintain the feeling on the patient's part that he has come to the place where health is to come again, and where for the time, to as great extent as possible, all care and anxiety are to be dissipated.
Nor is it necessary to be extravagant in order to make a building attractive. Usually, and partic- ularly in such a building, simplicity is the keynote of attractiveness ; plenty of sunlight and air with ample opportunity for yet more air, with protec- tion from cold winds ; quiet, cheerful colors ; a pleasant outlook; opportunity for privacy, so far as may be, with all physical needs easily provided for — these are all a part of the general attactive- ness which appeals to the average patient.
As for economy of construction, of course there is an economy which might better be called parsi- mony, for no method of construction which has only low initial cost to recommend it can be justly called economical if the usefulness of the building
will be of short duration and it must soon be re- paired or replaced. The matter of strength and durability should be more accented in public or semipublic institutions than in private buildings, for the reason that they are given harder usage in spite of the greatest watchfulness. There will always be a certain number of persons who will never catch the spirit of personal responsibility in the use of public property.
The matter of wise, economical construction and equipment may well be a matter for coopera- tion on the part of the architect and the hospital board.
Convenience in layout is a very important mat- ter, on the score both of general utility and satis- faction and of the cost of administration. A building correctly planned and equipped will save the services of one or more persons over a build- ing that is poorly planned, thus avoiding a per- petual loss and a constant irritation.
The example here illustrated is selected from a number of model or typical plans designed for the New York State Department of Health, and intended as a guide in the designing and con- struction of the various county tuberculosis hos- pitals which, under the recently enacted law, must be erected in all counties with a population of 35,000 or more which are not already provided with adequate accommodations for tuberculous patients. The present commissioner of the de- partment. Dr. Hermann M. Biggs, an acknowl- edged international authority on all matters re- lating to the study and treatment of tuberculosis, from the beginning of his activities regarding public health in general and tuberculosis in par- ticular, has been very pronounced in his insistence on the dissemination of all that has been learned
THE MODERN HOSPITAL
relating to the causes and treatment of this dread disease. The best advice and suggestions have been available for the asking ; if there is any per- son of understanding of any nationality in this
These drawings are a part of the liberal propa- ganda in this war against tuberculosis ; the maker of them does not pretend that they are a perfect solution of the problem of sanatorium construc-
Fig. 2. basement pi;
A. Washing machines
B. Soap tank,
C. Extractor,
D. Wash trays.
E. Starch kettle.
F. Table.
G. Dryer. H. Ironers.
I. Folding table.
J. Incinerator. K. Hot water heater. L. Heating boiler.
M. High-pressure boiler.
N. Vacuum cleaner machine.
O. Sputum depository,
P. Dumbwaiter.
Q. Coffee and tea urns.
R. Dish shelves.
S. Dish washer.
T. Garbage cans.
U. Vegetable peeler.
V. Vegetable preparation.
W. Baker's table and bins.
X, Baker's proofer.
Y. Cabinet (
Z. Vegetable cooker.
AZ. stock pot,
BZ, Range.
DZ. Cook's table.
EZ. Steam table dish
warmer. FZ. Meat block.
1. Laundry.
2. Receiving room.
3. Clean linen room,
4. Coal
5. Boiler
6. Toilet.
7. Women's toilet.
8. Sto
9. Vestibule.
10. Stair hall.
11. Help's dining room.
12. Kitchen coal.
13. Kitchen and bakery.
14. Serving pantry.
15. Refrigerator vestibule.
16. Meats.fish.
Milk, butter, eggs. Recreation i Sewing and mendii Medical laboratory. Business office. General hall. , Physicians' office. Examination room. Staif pantry. Staff dining room. Patients' dining rot Entrance porch.
1. Open wards.
2. Sitting rooms.
3. Dressing rooms,
4. Lavatories.
5. Toilets,
6-15. Men help's quarters.
?. Attendants' toliet.
(. Supplies, linen, etc.
i. Nurses' room,
i. Stair hall,
). Rear porch.
I. Unassigned.
22. Diet kitchen.
23. General corridor.
24. Book shelves.
25. Linen closet.
26. Bed patients' hall.
27. Closet.
28-33. Bed patients' quarters, 34. Bed patients' porch.
A. Bath tubs.
B. Showers.
C. Dental lavatory,
D. Wash basins.
E. Slop sinks.
F. Utility sink hoppe
G. Water closets. H. Dumbwaiter,
I. Shelves.
state who does not to some extent appreciate the malignant nature of this disease and the steps to be taken towards a cure, he has deliberately shut his eyes and his ears so that he could not see and hear the evidence and the testimony regarding it.
tion, but they do contain some principles which should be included in the layout of every tubercu- losis hospital, whether large or small.
Tne controlling idea in these plans is to provide for fifty cases of incipient tuberculosis with the
THE MODERN HOSPITAL
usual proportion of bed patients, together with the staff and all helpers needed in the institution, with as little outlay as possible under the circum- stances and without the sacrifice of any desirable feature or detail.
It is assumed that the site is on a hillside slop- ing toward the south, protected from the north and west winds by the rise of the hill behind. This
1. Entrance halls and corridor.
2. Business office — stenographer, mail, etc.
3. Physicians' office — patients, records, etc.
4. Examination room — nose, throat, etc.
5. Medical and laboratory room.
6. Reception room or general waiting room.
7. Linen closet.
8. Broom clor.et.
9. Staff toilet for men.
1. Open sleeping wards.
2. Sitting rooms.
3. Dressing rooms.
4. Lavatory. B. Toilets.
6. Attendants' toilet.
Fig. 4. Second floor of the :
fifty-bed tuberculosis hospital.
7. Supplies, linen, etc.
8. Nurses' room.
9. Stair hall.
10. Help's sitting room.
11. Diet kitchen.
12. General corridor.
13. Bed patients' hall.
14. Linen closet. 16. Closet.
16-21. Bed patients' quarters.
22. Bed patients* porch.
23. Book shelves.
24. Fire escape.
A. Bath tubs.
B. Showers.
C. Dental lavatory.
D. Wash basin.
E. Slop sink hopper.
F. Utility sink.
G. Water closet. H. Dumbwaiter.
I. Shelves.
3"
'-£]
Fig. 5. Third floor of the tuberculosis sanatorium.
7. Servants' room.
8. Servants' room.
9. Servants' room.
10, Stenographer.
11. Stair hall.
12. General corridor.
13. Servants' linen. 13 A. Slop sink closet.
14. Nurses* linen closet.
15. Head nurse and matron.
1. Roofs.
2. Servants' room.
3. Servants' room.
4. Servants'room, toilet.
5. Servants* room.
6. Servants' room.
allows the placing of the main entrance in the basement about on the level of the ground in front, giving full windows on the south, avoiding a num- ber of outside steps to a first-floor front porch, and leaving the entire front porch of the first and second floors available for patients.
The rooms and accommodations actually needed, allowing for slight modifications one way or the other, are as follows:
16. Bathroom.
17. Nurses' room.
18. Nurses* room.
19. Nurses' room.
20. Nurses* room.
21. Nurses' room, toilet.
22. Roof over porch.
23. Physicians' quarters.
24. Physicians' quarters.
25. Physicians' quarters.
10. Staff toilet for women.
11. Patients' dining room (15 square feet for each).
12. Serving pantry.
13. Kitchen, bakery, and preparation room.
14. Refrigerating room.
15. General storeroom, vegetable cellar, etc.
16. Staff dining room, accommodations for eight persons.
17. Staff pantry.
18. Help's dining room — sink, dish cupboard, etc. Ac- commodations for twelve persons.
19. Help's toilet for men.
THE MODERN HOSPITAL
20. Help's toilet for women.
21. Heating plant and coal storage.
22. Sputum destroyer — incinerator.
23. Laundry.
24. Workroom — mending, repairing, sewing, etc.
25. Recreation room and library for patients.
26. Mortuary.
27. Trunk room — suit cases.
28. Living room, bath, bedroom for physicians.
29. Living room, bath, bedroomfor matronand headnurse.
30. Nurses' bedrooms for six nurses.
31. Stenographer's and bookkeeper's bedroom.
32. Sitting room for nurses.
33. Baths and toilets for nurses.
34. Servants' (women) bedrooms for nine women.
35. Sitting room for servants.
36. Baths and toilets for servants.
37. Men workers' bedroom for three men.
38. Baths and toilets for men workers.
39. Open wards — stalls for each two patients.
40. Living room for patients, 20 square feet to each patient.
41. Dressing rooms 3 by 5 feet, one for each patient.
42. Baths — toilets for patients.
43. Blanket warmer, a fixture 2 by 4 by 6 feet high, coils under shelves.
44. Bed patients' quarters (20 percent and above of total number of patients) .
45. Baths and toilets for bed patients.
46. Separate corridor or hall for bed patients.
47. Room for nurse in charge.
48. Diet kitchen.
49. Supply room — linen, etc.
50. Vacuum cleaner system by motor in basement.
As to the matei'ials to be used in the erection of this building, in order to secure the desideratum of economy and durability, this is largely a matter of local availability and cheapness. Where good lumber is to be had in quantity, the argument would be in favor of a frame building modified to make it as safe as possible from fire risk, whereas in a locality where stone and sand may be ob- tained cheaply, the type of construction would naturally be of masoniy or concrete. This mat- ter may safely be left in the hands of a judicious architect. The cost of the building is naturally governed by the materials used and the expense of assembling them; local rates of wages; these fluctuate greatly, especially in these war times.
The principal reasons for including under one roof the various activities of an entire sanatorium are the economy of first cost and ease of adminis- tration. There are good arguments in favor of building a group of three or four buildings for even so small a number as fifty patients. It is the endeavor to illustrate here the cheapest solu- tion for the problem compatible with satisfactory provision for the treatment of tuberculous pa- tients, leaving to individual and specific cases the expansion of the principles thus set forth.
The details of construction should be such as have been proved best in hospital building. There
are many minor points in this connection which become important when a plant is in operation, and which may be overlooked by an architect who has not had some experience in hospital construc- tion; the so-called major matters are not so apt to be neglected.
It is unnecessary to explain in detail by text the points to be considered ; they are apparent by ref- erence to the accompanying plans. Exception may be taken to the number of persons constitut- ing the staff and coi-ps of helpers for whom quar- ters are provided. Those who are unfamiliar with the operation of such a sanatorium have raised the question. There may be localities where espe- cially favorable conditions enable the institution to obtain certain unskilled help in the immediate neighborhod by the day, but the number here pro- vided for, or closely approximating it, has been proved by extensive experience to be necessary if the institution is to be well served.
Finally, although advocating economy, we strongly advise against that false economy which tends to count a thing cheap because its first cost is low; perhaps in no other kind of building is this so great a fallacy. On the other hand, a thing is not good because it is high in price. There is at every step abundant opportunity for the exer- cise of judgment and discrimination in the outlay of money for professional services, and labor, for materials, and for equipment.
If all our hospitals and sanatoriums are erected with judicious economy as a guiding principle, it will aid materially in stamping out or in bringing under control diseases against which progi'essive thinking and public-spirited men and women have long labored with a good measure of success, but whose unselfish eflforts will be multiplied when the money available is made to do full duty in pro- viding for a greater number without additional outlay.
To Sift Out Feeble-Minded Inmates of New York Institutions
Governor Whitman of New York has signed the Sage- Machold bill adding to the duties of the Hospital Develop- ment Commission, which was created by the last legisla- ture to formulate a systematic plan for more adequate facilities for the insane and feeble-minded. The bill au- thorizes the commission to make recommendations for a reclassification of the inmates of state institutions, except the prisons and the hospitals for the insane, with a \aew to the segregation of the feeble-minded. This will enable the development commission to make inquiry as to whether the inmates of the various state institutions, a large per- centage of whom are feeble-minded, should be reclassified and one or more of the institutions be set aside for de- fective delinquents. The need of accommodations for the criminally inclined among the feeble-minded is one of the most pressing phases of the problem. — S. C. A. A. News.
THE MODERN HOSPITAL
THE STANDARDIZATION OF HOSPITALS FOR THE INSANE*
Advantages of State Over Private and County Institutions — Importance of Fire Protec- tion— Toilet Arrangements, Bathing, Heating, and Lidhtin^ — Governmental and Administrative Conditions
By WILLIAM C. SANDY, M.D., Assistant Superintendent Connecticut Hospital for the Insane, Middletown,
Connecticut.
THERE is probably no special class of hospitals in greater need of standardization than that devoted to the care and treatment of the insane. Vast sums are annually appropriated for the maintenance of the public institutions for the in- sane. From the standpoint of the taxpayer, every effort must be made to establish methods of eco- nomical care. It is of vital importance to the public welfare, however, that such equipment and facilities be furnished as will promote every possible chance for restoration, and that provi- sion be made for prophylactic measures. For it should be generally recognized that the likelihood of recovery may be increased, and recovery itself hastened, by the application of proper methods of treatment, and that in prophylaxis lies the principal hope for the future in combating the ever-increasing problem of the insane.
In general, there are three great classes of in- stitutions for mental diseases — the private, the county, and the state. The private hospitals, usually called sanatoriums, occupy a peculiar and special position, often providing the exclusive and individual care which appeals to those who can afford the high rates commonly demanded. There are many well-equipped and admirably conducted private hospitals where the most modern forms of treatment and the best results may be ob- tained. On the other hand, unfortunately, there are privately conducted institutions, hospitals in name only, with exorbitant rates and bare cus- todial care, the standard being scarcely above that of a first-class almshouse.
The county hospitals, aside from the few large institutions which resemble in management the state hospitals, are generally unsatisfactory. This is, for the most part, due to a close affiliation with almshouses and to political administration. The limitations of this paper will not admit an ade- quate discussion of these institutions with their meager equipment, lack of treatment, and un- trained medical staffs, all of which should be re- garded as relics of the past.
The state hospitals, usually free from serious political entanglements, with the resources of the state behind them, are provided with larger staffs
♦This paper is the third in a series, by various authors, on the standards of the various classes of special hospitals. The first, "Stand- ards for a Children's Hospital,'* by Stafford McLean, appeared in the May issue ; the second, "The Standards of Hospital Education for In- terns," by J. M. Baldy, was published in June.
of trained physicians, better equipment, and more scientific methods. It is the purpose of this paper to consider the state hospitals and to outline briefly what may be regarded as desirable and possibly ideal, according to the present knowledge in respect to equipment, methods, and the like.
In discussing the question of standardization of state hospitals for the insane, one should bear in mind the objects of such hospitals. While in some sections of the country it is still customary to use the term "asylum" and many of the institu- tions are little better than the old custodial type, the best modern hospitals for the insane have far higher ideals and a broader scope. It should be the aim of the hospital to restore, as soon as pos- sible, the recoverable ; to prevent deterioration and to endeavor to reeducate the so-called chronic ; to treat successfully the physically ill ; to guard against injury or accident, such as suicide; to care for and make comfortable the excited, the feeble, and the aged ; to hold those dangerous to themselves or to the public ; to make such full examinations and keep such complete records that the work of the hospital will have present and future scientific value; and, finally, through out- side agencies, to be an active force for mental hygiene. It is needless to say that all of this is to be done in as efficient and economical a way as possible.
Very little will be said as to the proper size of institutions. This is purely a matter of theory, the actual size of hospitals being largely deter- mined by the exigencies of the situation. Econ- omy and the increasing number of patients make necessary, quite generally, large institutions. While it is undoubtedly true that the average executive will be more successful with hospitals of two thousand patients or less, institutions of over five thousand will be found to be efficiently operated, depending upon the capability of the administrator and his assistants.
In selecting the site for a hospital, preference should be given to a location somewhat removed from the large centers of population, in order that sufficient ground for exercise, with desirable privacy, may be obtained for the patients, and also ground for a farm and garden large enough to supply the necessary products for maintenance. Some consideration also should be given to the
THE MODERN HOSPITAL
natural beauties and the hygienic qualities of the site, and it is, of course, essential that it be well drained and supplied with an abundance of pure water. While avoiding large cities, it is desir- able to have the hospital accessible to a small town or city in order to insure the necessary diversion for employees, the obtaining of whom, at the present time, is an increasingly difficult proposition. The hospital should be connected with both steam and electric railways on account of freight facilities and the convenience of visi- tors and employees.
In the early days of state hospital construction, the architectural tendencies were towards mass- ive single buildings of monastery or prison-like appearance, several stories in height and with rather numerous but needless ornate features, especially in the administration portions. While attractive appearance should not be disregarded, the substantial and fireproof qualities are far more essential. The present tendency is more towards detached groups of buildings. The so- called cottage plan is probably the ideal, but is not practicable except on a large scale, that is, single buildings accommodating several hundred patients. Farm colonies, utilizing more cheaply constructed and temporary buildings, have dem- onstrated their usefulness for the chronic, quiet workers. In any case, buildings of more than two stories are seldom, if ever, desirable.
Too much attention cannot be paid to fire pro- tection. The above-mentioned old type of single, lai'ge building, often a veritable firetrap, should be remodeled so as to be divided up into several units separated by fire walls and automatic fire doors. Outside covered fire escapes of approved type and inside fireproof stairways should provide sufficient exits from every floor. These precau- tions are indispensable, as are also outside hy- drants, standpipes, and hose on every floor con- nected with a water system of sufficient amount and pressure supplemented by a fire pump for emergency added pressure. All exit doors should open outwards.
The interior plans of the buildings, an adequate discussion of which would necessitate a volume, will be covered only in a general way. An excel- lent type of ward is one provided with a day room connected with a fireproof porch, a large dormi- tory for sleeping purposes, and a water section with sufficient toilet and bathing facilities. Nec- essary adjuncts are adequate clothes rooms, lock- ers, and the like. The dormitory for sleeping purposes, simplifying the night watch service, is applicable in the case of most varieties of mental disease, but a few single rooms are often desir-
able for certain violent, dangerous, or paranoid individuals.
There should be a sufficient number of wards or units to facilitate proper classification of pa- tients based largely upon their demeanor and physical condition. New patients and those who may be convalescent, feeble, or of the quiet and tranquil type, should not be subjected to the annoyance and undesirable association with the violent, destructive, noisy, and untidy. An idea as to the requirements may be obtained from the following estimated percentage of the different classes. The acute or reception service may be represented by 5 percent ; the hospital or physi- cally ill, 2 percent; the chronic, quiet, and clean, 28 percent; the disturbed and violent, 16 percent; the feeble, aged, and infirm, 20 percent; working, 17 percent; tuberculous, 5 percent; epi- leptic, 5 percent; convalescent, 2 percent. A de- sirable feature, if possible, is a separate building for the acute, reception, or as it is sometimes called, psychopathic department, especially well equipped for treatment, including an operating room. The tuberculous also are preferably cared for in separate and specially designed buildings.
In the matter of toilet arrangements, one seat to ten, or at least fifteen patients, with twice the number of wash basins may be considered a mini- mum requirement. The hoppers should be of the type which flush automatically when used. All hot-water faucets should be provided with safety devices to prevent patients from scalding them- selves. Probably the simplest and safest way is to have the hot water turned off and on by means of a key with which the nurses and attendants only are provided ; although theoretically the plan sometimes adopted of having a thermostatic attachment to the hot-water system is good.
The question of proper bathing facilities is one only too frequently neglected. No longer should bathtubs be deemed satisfactory equipment. It is a regrettable but actual fact that, where tubs are used as the sole method of bathing, many patients may be bathed by careless or ignorant attendants without changing the water. The only safe and sanitary method is by showers, each patient then being assured a clean bath, and a large number being easily bathed in a short time. Tubs are required for special cases, such as some of the infirm, but shower baths are practicable for the majority of patients, both men and women.
Heating by direct radiation is probably, at the present time, the most satisfactory method. All radiators and hot pipes should be covered or placed out of reach of patients who otherwise
8
THE MODERN HOSPITAL
might easily be burned. The heating system should be combined with some method of auto- matic forced ventilation.
Lighting should be by electricity with properly protected wiring, the only special consideration being that the turning on and off of the lights should be under the control of the nurses and attendants, by means of some key device.
It will suffice merely to mention certain other indispensable departments and facilities which for the most part do not acquire any new charac- teristics by reason of the special nature of the institution. Every hospital should have a proper method of sewage disposal. Necessary depart- ments are the kitchen, bakery, dairy, store, laun- dry, the shop, e. g. carpenter, painting and me- chanical, the cold storage and ice plant, the cen- tral lighting, heat, and power plant.
Some thought should be given to the proper housing of resident officers and employees. Com- fortable quarters should be furnished, the hos- pital service being for many a lifetime career. There should be an employees' home with provi- sions for single and married attendants and nurses.
While the physical conditions of hospitals for the insane present many peculiar problems, such as have been briefly outlined, the governmental and administrative conditions are even more spe- cial in type and importance. Good work may very likely be accomplished by capable men even though handicapped by poor equipment, but surely proper methods of government and administra- tion are indispensable.
Most state hospitals are under the general supervision of an unpaid board of managers or trustees appointed by the governor. That this board should be nonpartisan, free from petty political entanglements, fairly secure in office, and not subject to the liability of sudden removal, in the event of change of administration, should be self-evident. This may be accomplished by the provision that the board shall be continuous, the term of office of only a part expiring each year. Among the various duties of the board should be the close inspection of the finances of the hos- pital— this final control of the expenditures, if conscientiously carried out, assuring the safe- guarding of the public's interests.
The selection and appointment of the resident superintendent should be left largely in the hands of the board of trustees, who alone should have the power of removal, giving the executive officer the security in office essential for effective work. The primary aim of the hospital being medical, there can be no question that the chief executive
officer should be a physician, one who has gained his experience in psychiatry by actual residence in hospitals for the insane, and who has demon- strated the necessary executive ability. Many of the difficulties preventing successful administra- tion are due to frequent changes and the inexperi- ence of political appointees. Divided and uncer- tain authority will merely serve to hinder the progress which is otherwise to be expected from the activities of a capable executive.
The assistant officers and heads of departments should be appointed by the board of trustees upon the recommendation of the superintendent and should be entirely under his direction.
Generally speaking, a desirable proportion of physicians to patients is about one to two hun- dred. The different services require a varying number, the acute or reception, for instance, re- quire more than the chronic. In the larger hos- pitals there should be an assistant superintendent and a clinical director, the duties of the former being to relieve the superintendent of certain routine matters, such as the help problem, those of the latter being to supervise and correlate the medical work. In the smaller hospitals these two positions may very easily be combined.
There should be enough resident experienced assistant physicians to take charge of the various services. A requisite number of resident junior assistants and interns are required to assure the proper attention to routine details. The interns may be only temporary officers serving largely for the experience. The other members of the staff, however, should, as far as possible, be reg- istered physicians interested in the study of psy- chiatry as a career. Every hospital for the in- sane should have at least one woman physician on the staff, chief among whose duties should be to make those special examinations and treat- ments so essential to the comfort and welfare of the women patients.
A successful administration of the hospital will depend largely upon the qualifications of the heads of the departments. Executive ability and expertness in the special field coupled with loyalty and cooperation are essentials to be looked for. A business manager, purchasing agent, or stew- ard is required, one who is able to install modern business methods, and who is qualified as a judge and buyer of supplies. Other important positions are storekeeper, farmer, engineer, head carpen- ter, laundryman, and chef, all of which come under the immediate supervision of the business manager. There should be a matron whose duty is the general supervision of the housekeeping and the help therein engaged. More detailed discus-
THE MODERN HOSPITAL
sion of these and similar positions is not neces- sary, as there are no very unusual conditions liable to be met with in these departments, owing to the special nature of the hospital.
The importance of having a sufficient number of reliable nurses and attendants is self-evident. It is in this department, however, that one of the greatest difficulties is encountered, it being almost impossible to secure enough help (in numbers) without much regard to the quality. This has become especial^7 true since the beginning of the war because of the high wages offered by munition and other industries. Many hospitals have been brought to the necessity of hiring prac- tically all applicants without regard to grade and even then being twenty-five percent or more short-handed. In view of the scarcity of appli- cants, it is almost useless to state that there should be at least one nurse or attendant to ten patients, a proportion seldom possible at this time. Especially on the reception and infirmary wards for men, women nurses should be employed. Where it is possible to secure enough competent women nurses, they should be placed in charge of other male wards, with resultant improvement in the quality of nursing and housekeeping, and less liability of ill-treatment of patients.
An adequate force of attendants and nurses should be assigned to the night service, the mini- mum requirements being, generally speaking, one nurse or attendant to forty patients. In any case, there should be a sufficient number of em- ployees to permit the doors of a majority of the patients' rooms to be unlocked at night. This ex- pedient is exceedingly important from the stand- point of fire protection alone, as is also the hold- ing of regular fire drills of both employees and patients, the former being taught the use of fire- fighting apparatus, including hose and extin- guishers, which should be plentifully supplied throughout the hospital, and the quickest way of getting the patients out of the buildings. In con- nection with this, and for additional fire protec- tion, it is well to have two fire companies com- posed of outside employees and provided with hose-carts, chemical apparatus, ladders, life-nets, and so forth, and which hold regular, practical drills. The existence of two companies, each with a chief, will result in a wholesome rivalry and in- creased efficiency. Besides the inside night serv- ice, there should be enough outside watchmen to insure the required order and safeguarding of the buildings and grounds. As a check upon the night service, a modern watchmen's clock system should be installed, or both the inside and outside night employees may be correlated by means of
a system of ringing in to a central office, such as is found in a first-class police department. The latter plan combines the desirable features of both a watchmen's clock and a standard fire- alarm system at probably no greater expense.
In immediate charge of the attendants and nurses of each service should be a day and a night supervisor who are the physicians' representa- tives in respect to discipline, order, and direction.
The training school for nurses should be an im- portant adjunct to every hospital for the insane. While most of those in immediate charge of the patients will be of the attendant class, perhaps with considerable practical but with little theo- retical knowledge as to proper methods, the pres- ence of a good training school will mean that there will be a certain number of the more intelli- gent men and women undergoing instruction which cannot fail to elevate the standards of care and treatment. The quality of the instruction, of at least two but preferably three years' duration, should be such that with an additional post-gradu- ate course in a general hospital, the graduate of the training school may obtain state registration. At the head of the training school should be a competent superintendent of nurses, a graduate nurse of recognized standing. The lectures should be given by the members of the resident medical staff. The ordinary attendants should also re- ceive instruction in the more practical and neces- sary branches in order that they may have a proper conception of their duties.
While perhaps of less relative importance than in the case of general hospitals, a well-stocked pharmacy is required, presided over by a regis- tered pharmacist. Much of the latter's time will be taken up with prescription compounding, as few drugs will be kept on the wards.
The efficiency of the medical work will depend to a considerable degree upon the routine method of examination and treatment prescribed for the medical staff. Upon admission every patient should be placed in bed in an observation ward for a week or ten days, during which time a thor- ough mental and physical examination should be made. In the physical examination nothing should be neglected. The ordinary laboratory procedures, such as urinalysis, should be supple- mented by such special examinations as that of blood, sputum, gastric contents, feces, and so forth, as may be indicated. A Wassermann blood test should be done in each case with spinal fluid examination where indicated. A detailed mental examination, modeled after that recommended some years ago by Adolf Meyer, should be made. The results of the mental and physical examina-
10
THE MODERN HOSPITAL
tion are then to be typewritten in accordance with a regulation form; the latter being necessary in order that every item of importance in the pa- tient's condition may be covered, for his own wel- fare and so that the statistical and other records may be made of the greatest possible future value. This, of course, presupposes that adequate clerical and stenographic assistance shall be available.
At staff meetings held daily, or frequently enough for the accomplishment of the work, and presided over by a clinical director or other com- petent officer, each case history is to be read and the patient presented in person in order that the benefit of a full consultation as to diagnosis, treat- ment, and other matters of importance may be assured all patients admitted.
Space will not allow a detailed discussion of certain other necessary facilities. To secure thor- ough treatment for all, there should be proper dietetic arrangements, surgical equipment for any operation, a consulting staff of surgeons, electrical apparatus for diagnosis and treatment, a resident dentist with the required equipment, and some provision for ophthalmological and other special examinations when required.
No hospital for the insane is adequately pre- pared without provisions for the application of hydrotherapy. By hydrotherapy is meant treat- ment by means of the continuous bath, the various forms of wet-pack and special baths, such as the needle, rain, shower, the different douches and the like. The lack of hydrotherapeutic facilities (associated also with an insufficient number of attendants, too few wards for the proper separa- tion of the disturbed, and faulty methods of treat- ment) account to a great degree for the practice in some hospitals of restraint and seclusion, which no longer are countenanced in the best modern hospitals except in extreme cases.
Occupation, when properly applied as a thera- peutic agent in the treatment of the insane, not only retards mental deterioration, in many cases, but also frequently hastens recovery and serves to prepare the patient for a return to his normal environment. One or more full-time instructors are required, and the various forms of diversional occupation, such as raffia and reed basketry, rug, brush and broom-making, knitting, crocheting, tatting, embroidery, and the like, cement-work, chair caning, and so forth, should be made avail- able. Of great value, in the same way, and of considerable economic importance are the oppor- tunities for farm and garden work available to the patients. Besides the foregoing, much of the clothing, the shoes, the mattresses, and some of
the furniture may be made by patients under supervision.
There should be a school with a teacher com- petent to apply graded reeducational methods helpful in certain classes of patients.
Recreation also is effective as a means of arous- ing the interest and of combating the tendency to dementia. No community is doing justice to the insane in its care without providing forms of amusement in the shape of dances, moving pic- tures, baseball, and other kinds of games and en- tertainments. There should be an athletic field and also a fireproof assembly hall large enough to accommodate a fair proportion of the patient pop- ulation. Religious services should be held regu- larly, presided over by clergymen of the various denominations.
Some reference has already been made to labo- ratory requirements. Every hospital should be prepared to carry on, as routine measures, the various tests so necessary as aids in diagnosis, not only for mental disease but also for ordinary physical ailments. The medical staff should be on the alert to secure permission for post-mortem examinations in the interest of science and the welfare of humanity. Facilities should be pro- vided for the proper study of the material ob- tained. The laboratory ought to be in charge of a trained pathologist with adequate assistants to enable him to do research work.
One frequently hears of the "ever-widening in- fluence of psychiatry," as a consequence of which institutions for the insane and the officers con- nected with them can no longer restrict their activities to a small sphere of the "asylum," as formerly designated. The facilities for advice, observation, and treatment must Be extended by the establishment of out-patient departments and psychiatric wards in general hospitals in the large centers of population. In this way, as is shown by actual experience, thousands of persons may be reached and benefited in the early and border- line stages of psychosis development and restored to mental health in a short time, avoiding what is now so often wrongfully considered the stigma of commitment in a hospital for the insane. The frequently unwieldly, slow, and public methods of commitment procedures, often treating a pros- pective patient as a criminal, incarcerating him in a jail, escorting him to the hospital, it may be, handcuffed and in the custody of an officer, must be replaced, so far as possible without endanger- ing his constitutional rights, by prompt and expert examination, care of trained attendants, and quick and unobtrusive methods of conducting to the hospital. The system of voluntary admission
THE MODERN HOSPITAL
11
must be extended, bringing within reach of many patients, who themselves often realize the neces- sity for treatment, the early care that insures a brief residence at the hospital. Such facilities are not only of great benefit to the patient, but are really a matter of economy to the state, short- ening the length of care in the hospital, conse- quently lessening the expense and, it may be, re- storing sooner a useful member to the com- munity.
There should be a system of parole of suitable patients by reason of improvement or recovery, affording an opportunity for the trial return to self-support for a period of some months, during which time the patient may return to the hospital for further care and treatment, without a repeti- tion of the legal formalities, should it be deemed necessary. The parole system should be com- bined with an efficient after-care agency, prefer- ably a member of the medical staff or a social worker, who may have a certain amount of super- vision over the paroled patient. Such an after- care w^orker may render service in advising the return of the patient, if indicated, in assisting in a change of habits or environment, in helping to obtain a suitable position, in arousing a kindly.
helpful attitude toward the former patient, in com- bating the feeling of suspicion or lack of confi- dence so often met with, and in adjusting difficul- ties in the home, family, or environment which otherwise might cause a return of the psychosis. The social worker also may be utilized in obtain- ing additional information from the friends and relatives of patients necessary for arriving at a proper diagnosis. In other words, the state hos- pital must be the center of advice for mental health, an active rather than a passive agency for good. Without such facilities for the further- ing of mental hygiene, a state hospital for the in- sane cannot be considered fully equipped for ade- quate service to the public.
It is neither practicable nor essential to elab- orate further as to the business methods or other details of administration. These must be left to the executive officer, whose training and experi- ence should be such as to qualify him to solve such problems. And, finally, it must be realized that while present-day methods are undoubtedly the result of progress, the ultimate stage has not yet been reached. Radical changes in methods will be met with from time to time, it being only nec- essary to exercise judgment in adopting the same.
OCCUPATIONAL TREATMENT IN NERVOUS DISORDERS
Experience of a Lay Instructor— Forms of Occupation Best Adapted to Nervous Patients and Those With Mental Disorders— Newfoundland Hooked Mats
By JESSIE LUTHER, Occupational Instructor, Butler Hospital, Providence, R. I.
THE therapeutic value of occupation as a means of help and cure in nervous disorders is now so well known, and so much has been written of its theory and practice that extended comment on the subject may be supei-fluous. The practical expe- rience, however, of one who has been engaged in such work from the early days of its general in- troduction may be of interest to those who have had similar experiences or are at the threshold of work along those lines, even though this expe- rience is presented from a lay point of view, with no claim to consider the scientific aspect.
Today there are few institutions for the cure of nervous or mental cases, hospitals or sana- toriums, public or private, that lack an occupa- tional department in some form. The idea, as many already know, is not of recent origin, for as early as 1843 such treatment was mentioned and practiced by the first superintendent of the Utica State Hospital, where a flourishing workshop has existed since the eighties, other hospitals and asylums having since adopted that form of treat- ment in certain cases. This treatment, however.
was for the most part employed with the really insane and almost exclusively for men, the occu- pation being brush- and broom-making and gar- dening. The general establishment of such treat- ment, however, as applied to women as well as men and in all phases and degrees of nervous as well as mental disorders, is comparatively recent.
My own experience began fourteen years ago when, in connection with Dr. Hall of Marblehead, a small sanatorium was established off'ering work instead of rest as a means of prevention and cure of such maladies. At the old "Ark" in Jaffery, Dr. Hall and I met as convalescents from illness, and during our long hours of leisure the subject was discussed and the project of such a sanatorium with its attendant details of suitable occupation became concrete and more than a theoretical pos- sibility for the indefinite future.
As I had shortly before that time returned from Hull House and the superintendence of the Labor Museum with its weaving, spinning, and classes in pottery, basketry, wood-carving, etc., it was natural that such occupations, which were appar-
12
THE MODERN HOSPITAL
ently of interest to everyone and with the proc- esses of which I was so familiar, should seem to me to be most fitting for our experiment, and it was decided to introduce the work along those lines.
The question of suitable housing was a problem, for facilities for working out of doors seemed im- portant and houses in Marblehead with that pos- sibility were scarce. It was May before we were finally established in an ideal location on the rocks at the entrance of the harbor, where wide piazzas almost overhanging the waves made open-air work not only possible but delightful.
This effort was tentative and at first more or less experimental. The sanatorium was planned, not for patients mentally unsound or for the more
Fig. 1. Specii
of early work done at the Handcraft Shop.
extreme cases of neurasthenia, but for those who were on the verge of nervous collapse in need of some special interest to check its progress or who had passed through more extreme phases of the malady and, in a state of convalescence which is sometimes almost as uncomfortable as the disease itself, were in need of some stimulus to take them out of the inertia and self-consideration so char- acteristic of that stage and so liable to become chronic.
Realizing how persons in a sensitive state of mind are influenced by their surroundings and general atmosphere, it occurred to me that if they could be introduced at once into a workroom where beautiful and interesting things were being produced as a regular routine by normal people who would create a cheerful atmosphere, it would act as an incentive to their own efforts and tend to make them forget their real or fancied worries and their invalid state.
To this end four normal, cheerful young girls
of the town were engaged and taught weaving and pottery. They were present daily during working hours, and, besides actually producing, assisted the patients as they worked with them. These girls were paid regular wages, and their products, such as woven rugs, table covers, bedspreads, etc., were sold to help defray running expenses.
The work produced by the patients was in most cases excellent, and the pride in accomplishment and interest with its attendant benefit practically universal. Although, as I have stated, the sana- torium was started as more or less of an experi- ment, the results before the end of the first year warranted such extension as a small house in the neighborhood for a dormitory, a plot of land for gardening, and a small out-of-door workshop where wood-carving and the noisier forms of oc- cupation could be carried on. A large pottery kiln in a building of its own was also substituted for the small kiln in the cellar of the main house. On
Fig. 2. Hooked mat made by a patient at Butler Hospital.
every day of possible weather the piazza was filled with pottery- and basket-makers, while the thud- thud of the looms could be heard from the lower workrooms.
Many visitors came to inspect, among them numerous physicians from Boston and other cities much more remote, for general adaptation of oc- cupational treatment was then a novelty.
From this modest experimental sanatorium known as the "Handcraft Shop" has been devel- oped the well-known Devereux Mansion near Mar- blehead, the change of location and its accompany- ing expansion having been made a few years ago.
When the "Handcraft Shop" became fully es- tablished I took advantage of an opportunity to enter what seemed to me a more extended field for work along the same line, at Butler Hospital in Providence, R. I. Here the patients are not con- fined to the mildly neurasthenic or convalescent, but are often cases of actual dementia, some of them of a discouraging type.
During the twelve years of my connection with the hospital the personnel of the patients under my charge has been as changeable as a kaleido- scope, and the number occupied has increased
THE MODERN HOSPITAL
13
from eight in the original class to the present number of between forty and fifty. Only one patient has been with me from the beginning, a dear old lady of whom I am very fond. The only other patient of long standing joined the class in my second year. On entering the hospital she was supposed to have but a limited time to live. Her class membership was an experiment. She was the wife of a race-course book-maker, and her fa- miliarity with her husband's calling influenced her choice of songs ; sometimes when exhilarated her indulgence in race-course music and encour- aging cries to imaginary riders made her connec- tion with a class a problem. Time and patience were necessary to teach her to make a rafiia bas- ket, the only form of work she would attempt, but, the stitch once mastered, she has produced many baskets, all practically alike in size and shape. The choice of colors is her own, and most of her work resembles the proverbial "Joseph's coat." She works continually, and, although at times she remonstrates in strong language with an imaginary enemy, only a word is necessary to bring her back to her surroundings and only once in all these years have I been obliged to send her from the class. Her interest in her work is never- failing and her general mental and physical con- dition far better than on entering the hospital.
Although a great many interesting cases and cures have come under my notice, perhaps one of the most remarkable was that of a woman who for three years could scarcely be persuaded to make the least effort and whose interest in basket-mak- ing when finally aroused effected a veritable trans- formation beyond the hope of the most sanguine. In her case her improvement also had its bearing on the other patients in the ward, for her work was really beautiful and original, and her cheery enthusiasm and unlooked-for energy awakened the interest of many new patients in her constant association with them and was of much assist- ance in carrying on the special branch of work during the interval between class hours. The work was a joy to her, and even before her de- parture from the hospital became a source of needed revenue.
During the early days at the hospital my sym- pathies were so keenly aroused that the class work proved very exhausting. After twelve years' ex- perience my sympathies are no less keen, but I can consider a patient as one to be helped and, in a difficult case, a stimulus to find a means of help- fulness.
Occasionally I have been asked by those espe- cially interested in occupational treatment if any rules could be given as guides in teaching. I can think of no rules except the obvious ones of un-
limited patience and unvarying cheerfulness — I might add tactfulness and vigilance, but those are- also self-evident.
It has seemed an excellent policy to ignore as much as possible the fact that these people are patients and take for granted that they are inter- ested in the things of ordinary life. Many are keenly alive to what is going on in the world, and there are few who fail to become interested in some degree in what is told them of people and events, but the personal element, of course, enters and it is necessary to choose one's subjects with care.
Whenever possible the patients are urged to use initiative — in the character of occupation it- self, in designs if possible, and in choice of colors employed. In regard to the latter it is interesting to notice the colors chosen, pink, green, or blue being the average first choice. Yellow and orange are not so generally popular, in some cases act- ually disliked, and there is often a strong objec- tion to purple and black, though light violet and pale yellow find more favor.
As regards the form of occupation, I have men- tioned basketry in particular. Raffia basketry is very simple, and I often use it as a test in the case of new patients. If sufficient concentration is shown, a choice is given of other kinds of occu- pation as well, weaving, hooked mats, pottery, stenciling, etc., all of which have been successful with the class of patients brought to Butler Hos- pital. Other forms of basketry, of reeds or pine needles, are also offered, but raffia work requires the least effort for a beginner.
The occupational department occupies the en- tire upper floor of the Goddard House, once the nurses' dormitory before the addition of the nurses' home to the hospital. There is a large cheerful central room for convalescents, the privi- lege of occupying it sometimes being offered as a reward of merit to patients who are inclined to be noisy, in the effort to stimulate their self-control, for no disturbance is allowed in that room and there are many smaller rooms which make segre- gation possible for those in a less normal condi- tion. There are looms of various kinds, and rugs and pattern-weaving made on them are really lovely. Stenciling with crayons made for the pur- pose has been popular from time to time. The method is simple and within the power of anyone not especially disturbed.
Pottery has in some cases proved of great help. There is something very quieting in the use of the plastic clay. One can see at once that mistakes are not irrevocable, and patients who doubt their po'.ver of accomplishment are content to give it a trial. It is also valuable in offering an oppor-
14
THE MODERN HOSPITAL
tunity for self-expression which is sometimes a relief or source of amusement to a disturbed mind.
A number of old-fashioned braided mats have been made, and this work, as well as rug-weaving, has the advantage of employing more than one group of patients. Only a few can successfully weave the rugs or properly sew the braided mate- rial into form, but many can prepare the material. Even disturbed patients tear it in strips ; in fact this form of work appeals to some of them par- ticularly; others sew the strips together and roll them in balls ready for use, while still others braid them.
I have found that colors are often a stimulus in engaging a patient's interest, and soft wool of lovely shades has proved an incentive to many to knit scarves or small shawls, offering occupa- tion for the idle moments of the day outside class hours when other forms of work are generally employed. With this stimulus of color in mind I have for the past two years planned a May-day party for which the patients make May baskets of colored paper. They have been a great success and an excuse for an annual tea party.
Perhaps one of the most interesting forms of employment is the hooked mat, also a revival along with the braided rug of colonial days. This kind of rug is found in the rural districts of north- ern New England, but especially in Nova Scotia, New Brunswick, and the northern provinces.
My first acquaintance with them was in New- foundland. Until the past two years my summers, since my connection with Butler Hospital, and two winters as well, have been spent in Newfound- land and Labrador in connection with the Gren- fell Mission, where as superintendent of the indus- trial department I have established weaving and other industries at St. Anthony and small villages on the Newfoundland and Labrador coast. In connection with this work I found the hooked mats which in that country were purely utili- tarian, being the only covering for the floors of the average native house outside the city of St. John's and the few real towns. These rugs are used for warmth as well as decoration and are made from any rags available — the remains of old clothing and bits of remnants sold by the local trader. The workmanship is often beautiful, but the coloring and design very ugly. The rugs were often brought to me and to other members of the mission staff for sale, but for the most part their purchase was only a charity and no outside mar- ket for them would be possible except as curiosi- ties and examples of native work.
One summer about nine years ago it occurred to me that if this excellent workmanship could be turned to account by providing attractive, simple
designs of a local character, subjects with which the workers were familiar, and substituting color- ing that would harmonize with ordinary house- hold furnishings for the crude, nondescript color- ing of the native mat, a market could be found out- side Newfoundland for the product and the mak- ers paid for their work outright with no respon- sibility as to material or choice of coloring. The designs which I made myself were local in char- acter, reindeer, seal, walrus, ducks, komatik, and dogs, etc., treated conventionally as a border, the material of as fast colors as possible and for the most part home dyed. These rugs could be made at home during the long winter and particularly what is known locally as "the matting season" of late winter and early spring.
Every fall on my return from the north I brought with me a shipment of products from the industrial department for an annual sale in Providence, Boston, or New York, and these hooked mats were so popular and so many orders received for them that since being unable to go north during the past two years and having re- signed from the mission, I have given out mats with the same designs here at home, not only to patients of the hospital but to many of the needy Italians and others in this city in need of work that may be done at home to eke out the family earnings. Some of the workmanship has been as satisfactory as that of the north, and among the best is the work of one of the patients, a cut of whose latest finished product is added to this arti- cle, while she is fast completing another of a dif- ferent design.
Although much of the product of the class room, such as woven rugs, table covers, pillow covers, baskets and plain sewing, are for the use of the hospital, a large number of articles are for the annual sale, woi'k with a special object usually acting as an incentive and stimulating enthusi- asm in the workers' efforts. The proceeds from these sales have been for the benefit of the Visit- ing Nurses' Association, the Red Cross, and the British Relief. Since early summer we have joined the great army of those who are striving to "do their bit" in this great emergency by knit- ting for the Red Cross and the Navy League. To work for the soldiers is the greatest incentive, and some of the patients are rarely without a piece of gray or khaki knitting in their hands. One woman alone has knitted fifteen sweaters, and we have been able to send well over a hundred to the Red Cross and a lesser number to the Navy League, besides many mufl^lers and wristlets, and several patients are now making helmets. Only a few socks have been made, and as a rule by those
THE MODERN HOSPITAL
15
who were already familiar with the process before entering the hospital, the intricacies of the knitted heel in most cases requiring too much mental ef- fort. A number of patients are incapable of any work more difficult than plain sewing, and for those the Red Cross has provided articles needed for hospital comforts, so all are able to do their part.
The grounds of Butler Hospital are large and very beautiful, and as soon as the warm, spring days permit, the class is taken to the lawn where it is possible to continue all kinds of work except weaving during the fair days of summer.
To know that the occupational form of treat- ment has been found entirely successful, one need only be sufficiently interested to follow the reports of institutions having already given it a trial.
For my own part there has been the experience of knowing many whom I first saw hysterical, un- naturally passive or without self-control, with ex- cited or dull, expressionless faces, sooner or later arrive at a day when as normal, self-controlled persons they have returned to their own environ- ment It is true there are those who have been unable to endure the contact with everyday life and have returned for another period of help, but others are happy with the members of their fam- ily around them or in the midst of normal, absorb- ing work in the business world and with expres- sions of content on their faces that at one time seemed impossible one could ever see there. If pessimism ever existed in regard to this treatment a realization of cases such as these would con- vince the most skeptical that it is worth while.
HOSPITAL HOUSEKEEPING, ITS WORRIES AND CARES*
Sewing Room, Laundry, and Cleaning Service — Care of Walls — Wa^es of Various Classes of Employes — Saving Due to the Fact That Employes Are Not Fed in Hospital
By MARY A. JAMIESON, R.N., Superintendent, Grant Hospital, Columbus, Ohio.
WHEN I was requested to read a short paper on housekeeping, it rather struck my sense of humor, for of all the various branches of work in the hospital, this is the one that is most dis- tasteful to me.
Each hospital, I find, is a law unto itself along this line. Some think that a good housecleaning once a year is all that is necessary for every pur- pose, and I have about decided that, in many instances, the cleaning at the present time must be governed by the income of the institution, for without a good income no hospital can, at the price of supplies today and the high cost of labor, keep up its housekeeping as it might wish. But I have decided just to give you some idea as to how we have our work done, also the cost.
We have a first-class housekeeper, whose work is simply to look after the housekeeping. By this I mean the keeping of the hospital clean, looking after the linen when it is returned from the laun- dry, taking charge of the sewing room, which includes the making and mending of supplies, also the employing of all the help used in this depart- ment, as I always think it best for the head of each department to both employ and dismiss all employees in that department.
The sewing room comes first on the list, as here the housekeeper makes her headquarters, having a telephone that is connected with every floor, as well as outside, and here all calls come for the
•Read before the Fourth Annual Convention of the Ohio Hospital Association, Columbus, Ohio, May 28-30, 1918.
housekeeper. The sewing room has three motor machines and is the adjoining room to the laun- dry; here every morning all torn or worn linen is carried and the first thing done in the sewing department is the repairing of this linen; after that the new articles are made up. These include the aprons worn by the student nurses, but not the dresses, which are sent out. The three women are paid $8.32 a week; they room outside, but have their meals at the hospital. The hours are from 8 a. m. to 5 p. m. with one hour for lunch ; no work on Sunday; a half day off every other week.
Since we are dealing with the housekeeper's share of the laundry, it might be wise next to mention our linen man, as he is called. This man brings all the linen from the floors to the laundry (owing to the plan of the building, we have to carry all the linen from the floors to the laundry) . He also takes back in the morning all the clean linen to run the floors, and again in the evening makes a trip to see that there is plenty of linen for the night nurses. This man also takes care of the garbage cans, of which we have two for each service room. In this way, after the can is emptied, it is allowed to stand in the air for some hours before being returned to the floor. Of course, each time the cans are emptied they are washed out with boiling water and made perfectly clean. We pay this man $14 a week.
Now, for the cleaning, on each floor we have a porter, a maid to look after the rooms, and a
16
THE MODERN HOSPITAL
maid in the serving kitchen. The porter (this man is colored) works from 7 a. m. to 5 p. m. with one hour for dinner; he goes out for his meals. He is paid from $12 to $15 a week. He cleans the hall floors, the service rooms, the serv- ing kitchen floor, laboratory, bathrooms, all the windows of occupied rooms, and the hall windows. He also uses the vacuum cleaner on the rugs and carries to the floor the chopped ice for the ice caps.
The maid on the floor is a white woman. She starts to work at 7 a. m. and has one hour for dinner (going out for this) and stops work at 3 p. m. One day out of every nine she remains on duty to help sweep rooms emptied after 3 p. m. and works half a day on Sunday. This woman sweeps and washes all occupied rooms. She is paid $8 a week.
Next is the maid in the serving kitchen. She comes on duty at 8 a. m. and goes out at 10 a. m., has her dinner at home, and returns for work at 12:30, gets through about 2:30, returns to do up the supper work at 5:15, and is generally done about 6:30 p. m., making in all about six hours a day. This maid washes the dishes, and is respon- sible for the condition of the entire serving kitchen aside from the refrigerator. She is paid $7.50 a week. Sunday work is just the same as any other day.
At our hospital when the patients go out we wash the walls of all rooms if they have been occupied for over a week. In this way the rooms never get very dirty and they are not hard to clean. Our routine is as follows :
When the patient leaves the room, the nurse takes care of all the linen, sees that every part of the work that belongs to the nursing depart- ment is done, and then the head of the floor noti- fies the office and the housekeeper that the room is empty. The maid on the floor sweeps the room and then the wall-washers (we keep six who do no other work than washing the walls in the hospital and the windows in the empty room), take charge, wash the walls, and scrub the floors. The wall-washers work nine hours a day and a half day on Sunday. We pay them from $14 to $16 a week.
Then the maids, of which we keep three for this work, go into the room, wash the bed and the furniture, do up the room just as any hotel room is finished, and report the room to the office and the housekeeper as ready. This may seem like a great many people doing the same thing, but it is not ; each person does her part, and after months at this work, they are able in the shortest period of time to report in a room as ready. No person tries to do the other person's work; each
just does her own and gets out and is ready for the next room. For instance, each of the little maids knows her own work; one washes the bed while another washes out the wardrobe, and the dressing table; both then make the bed so as to save walking around it. Meanwhile the third maid changes the window sash curtains, puts on clean stand covers, dusts the chairs, and goes out to get the linen ready for the next room. In all it takes about ten minutes after the room is turned over to them.
If there are not rooms enough to keep the three maids busy, they set the patients' trays, clean the linen closets, and try to make themselves in gen- eral very useful. They are paid $6 a week and have their noon meal at the hospital, getting it from the nurses' cafeteria, but eating downstairs. These girls wear white and are always perfectly clean ; they are girls from good homes. They work half a day on Sunday (four hours). Right here it might be wise to state that after three years of just such washing, our walls look as well as if they had just been painted this year, but I have always been exceedingly careful about the preparation that is used on the walls ; no experi- menting is allowed. If any agent wants us to try out his material, I get a sample and send it away and have it tested to see if it will hurt the paint. In this way we are often saved the need of paint- ing, as many of the so-called cheap preparations are good to take the dirt oflT, and equally good to take off the paint. We use a preparation of lin- seed oil soap; if we cannot get it we use other vegetable oil soaps, allowing 40 pounds of soap and 4 pounds carbo powder to 40 gallons of water. To a bucket of water we add about 6 ounces of the soap solution and wash with a soft cloth.
The walls are painted with a high-polish enamel, and we find that it pays to use the very best, as it is not alone the price of paint that costs, but also the cost of putting it on. We have a perman- ent painter, who keeps up the little repairs that arise about a hospital. He is a union man and is paid union wages. A permanent carpenter and plumber are also kept, being paid union wages.
But to go on with the cleaning, a man is kept busy from morning until night just washing steps. Every step in the hospital is washed at least once a day and those that are used quite frequently are washed three times a day. I have never known this step man to do any other work around the hospital, but he does this one thing well, and that means a whole lot. Just keeping the water from going down the side of the step and in this way marking the wall means so much to the house- keeper. This man is paid $12 a week.
THE MODERN HOSPITAL
17
The woman in charge of the linen room is also under the housekeeper. She, after getting the house count, arranges the linen to be taken to the floors, sorting as she goes along. This woman is paid $8 a week.
Last comes the nurses' residence, this is also under the housekeeper, but, as we have a good woman in charge of the residence, it makes the cares of the housekeeper, for that part of the work, much lighter. This woman in charge of the residence looks after the linen of the home, and also takes charge of the man and the maid who are kept there to do the work. She is paid $35 a month and maintenance.
We feed no one at the hospital but the office force, the women in charge of the nurses' resi- dence, the three sewing women, the three little maids, the nurses, and the nursing officers and the house doctors. During the last year we have found that it has paid us not to feed the help.
Owing to the high cost of food, the difficulty of getting a variety, and the need of more help to serve the seventy odd employees who used to eat here, we find that we would have been out more money than by paying the difference in the salary. At first the help did object to the arrangement, but in time they came around nicely.
I hear of other hospitals saying that they can- not get nurses, and feel that our secret of success along that line is partly due, no doubt, to the fact that the nurses are not supposed to do maids' work. They are taught how to clean, but they are not at the hospital for a course of housekeep- ing, so we do not expect them to do it.
I do not think it will be necessary for me to say that the housekeeper is one of the busiest women in the hospital. I was going to say her hours were — but really think that she has no hours, just keeps on until everything is done, if such a thing is ever true about a hospital.
SELF-GOVERNMENT FOR THE RESIDENT MEDICAL STAFF
A Plan Introduced at New York City Hospital — Trend of the Time Toward Democracy
in Educational Institutions as Elsewhere — First Attempt to
Introduce Self-Government into the Hospital
By CHARLES B. BACON, M.D., Medical Superintendent, New York City Hospital, Department of Public Char- ities, New York City.
THE medical service of the modern hospital is not only a place for fitting young men re- cently graduated from our medical colleges to care properly for the sick; it is also an educa- tional institution. At the termination of an in- ternship these men go forth to engage in the activities of life with a personal responsibility, each one acting his part in the many medical, social, and economic problems, each an honored member of a noble profession. In order best to meet these obligations young men need to have placed upon them, during the years of prepara- tion for life service, responsibilities associated with their training and experience. Self-govern- ment, as it appears to me, has a practical appli- cation in its relation to young men ; I might say, equally so to young women ; and I predict that a modified form of self-government will in the near future be introduced in many of our hospitals and schools of nursing.
Self-government, as applied to student bodies, has for many years been in successful operation in many of our leading universities, colleges, and schools. In certain educational institutions well known to me, it is regarded by the faculty and student body as practical and fundamentally cor- rect, receiving mutual approval. Some months
ago, my interest having become quickened on this subject, and a question arising affecting some- what unusually the conduct and discipline of our intern staff, I asked myself, "Why is not a modi- fied plan of student self-government practical in its application to the members of the intern staff?" A large portion of our interns have an academic, as well as a professional, degree. Furthermore, their academic and professional studies have been pursued in educational institu- tions where self-government is already in oper- ation.
FIRST INTRODUCED AT CITY HOSPITAL
So far as I know, this is the first effort to in- troduce self-government as it relates to the intern staff of hospitals. I decided that it might well be initiated at this hospital. Accordingly, the plan was experimentally placed in operation ap- proximately one year ago. So acceptable and satisfactory was this plan that it recently, at my request, received the official approval of Commis- sioner Wright.
I conceive it to be the duty of every adminis- trative officer, whether he or she is charged with the responsibility of directing the affairs of a hofcpital or school of nursing, ever to keep in mind that the status of the intern has changed, as well
18
THE MODERN HOSPITAL
as the spirit of the age, since we were interns. Furthermore, the whole world is turning toward democracy. I am quite familiar with what has been said concerning interns during the past twenty years, regarding their habits of conduct, welfare, discipline, their relations to the various officers of the hospital and school of nursing, the attending staff, the patients, and the public. For the greater part, nearly all one reads and hears on this subject indicates that interns require close supervision and have a veritable will to violate established rules. I have long since concluded that members of all professions dislike rules, and rules established for disciplinary measures are, to say the least, unwelcome.
To the medical administrative officer is given an unusual and special privilege of relating him- self most intimately with the members of the in- tern staff. This relationship should be one of advice and helpfulness, as well as corrective. For twenty years my work has been thus inti- mately associated with medical students and re- cent graduates, not only as a medical administra- tive officer, but also for seven years as instructor and lecturer at the Long Island Medical College, also beside teaching in the wards of the Kings County Hospital. I appreciate that these men soon realize that the practice of medicine is a sacred art, a responsible calling, and requires the best they can give. Thus their habits of life, work, and play are measured by a scale of justice to all members of the hospital organization, and here let me say that an efficient organization and fraternal cooperation are fundamental require- ments.
No member of the hospital family comes in such intimate touch with the intern as does the superintendent. Our interns receive appoint- ments following competitive examination, con- ducted usually in February, and serve as junior, senior, assistant house, and house officer, for a period of two years. Prior to their entrance on duty, they assemble in my office. This is my first opportunity to speak with them as regards their conduct, work, and welfare, as it relates to each and to one another, and to the entire hospital family. From this moment they are made to feel that they are officers of the hospital and members of our family, that each member bears a definite relationship and position in our hospital organi- zation. In this cordial, helpful, and mutual rela- tionship it is possible for all to live and work.
Honor appeals to all. This has always been impressed upon me from early boyhood days. I expect that a modified form of self-government, based on the honor system, will be the next for-
ward step in our professional administration, particularly as it relates to the resident profes- sional members, whether students, doctors, or nurses. It may not be advisable to adopt this plan in toto at once. Preparation must be made, and the plan acceptable to all. Conferences with the house staff and their cooperation are vital in preparing the way and adopting the plan. This is always necessary whenever a change is to be made. We did not launch forth on this plan with- out devoting ample time and consideration to it. From the very beginning we received encourag- ing support. At our final conference, when a vote was taken, it was unanimously and enthusi- astically approved, each and every member pledg- ing his loyal support. Throughout the considera- tion of this plan I was encouraged by the support and cooperation accorded by Commissioner John A. Kingsbury, First Deputy Commissioner Henry C. Wright, and Mr. Lyman Beecher Stowe, secre- tary of the department. Their helpfulness, to- gether with the splendid spirit of cooperation manifested by every member of the house staff in this and other matters of mutual benefit, is grate- fully acknowledged. The preparation of our plan of self-government, its aim, constitution, and resolutions, received long and careful study, and will, I believe, serve as a guide and control in the conduct, work, and welfare of our intern staff. I am pleased to present to the readers of The Modern Hospital our plan of self-government.
PLAN OF SELF-GOVERNMENT Drafted by Dr. Charles B. Bacon, Medical Superintendent, and the Members of the House Staff, New York City Hospital, Department of Public Charities, New York City Thoroughly believing that a plan of self-government based on the honor system, and already in satisfactory operation in many of our leading universities, colleges, and schools, is fundamentally correct, and pledging our- selves to loyal obedience to such a plan, we enact and sub- mit to the commissioner, Honorable John A. Kingsbury, and deputy commissioner. Honorable Henry C. Wright, the following aim, constitution, and resolutions governing the resident medical staff of the City Hospital.
To observe those proprieties of conduct and courtesies in our relations to one another, to all officials of the hos- pital, the nurses, the patients, and the public, as shall preserve at all times the dignity of the house staff and the honorable standing of the hospital.
CONSTITUTION
Article 1. The name of this association shall be "The Resi- dent Medical Staff Association for Self-Government."
Article 2. The purpose of this association shall be the gov- ernment of the intern staff.
Article 3. The association shall be composed of active and associate members. Active membership includes those having received a regular appointment; associate mem-
THE MODERN HOSPITAL
19
bership includes those serving as special assistants, sub- stitutes, and pathological interns.
Article J,- Active members only shall be qualified to hold office in the association. However, associate as well as active members shall be entitled to vote.
Article 5. The medical superintendent, together with the chairman of the executive committee of the medical board, and the assistant resident physician, shall be ex- officio members. It shall be their duty to give counsel and advice. They shall attend meetings on invitation, also whenever matters of extraordinary or special im- portance arise.
Article 6. Section 1. The association shall have power to deal with all matters concerning the conduct and wel- fare of the staflf members.
Section 2. The association shall have the power of in- flicting penalties, to enforce its decision, even to the extent of recommending the expulsion of a member to the medical superintendent.
Article 7. The house statT shall hold meetings in the staff room, Janeway Hall, at least once a month.
Article S Section 1. The executive power of the association shall be vested in an executive committee of five members — one member to be elected from and by each division (house, assistant house, senior and junior) — and one shall be elected at large by the entire house staff. The medical superintendent, together with the chairman of the executive committee of the medical board, shall be members ex-officio.
Section 2. This committee shall elect a president, a vice- president, secretary and treasurer.
1. The duties of the president shall be to call together and preside over all meetings of the association and the executive committee.
2. The duties of the vice-president shall be to assume the duties of the president in his absence or at his re- quest.
3. The duties of the secretary shall be to keep the min- utes of the association and a list of the members, to post notices of the meetings, and to attend to the correspond- ence of the association.
4. The duties of the treasurer shall be to collect all dues and assessments established by the house staff. Disbursements of $5 or over shall be made only upon the recommendation of the house staff. Disbursements un- der $5 may be made upon the recommendation of the executive committee.
The treasurer shall post on the bulletin board at Janeway Hall the amount due from each member, also on the first of every moi.th a complete financial report. Section 3. 1. The officers of the executive committee shall be semi-annually elected by ballot, by the association, on the 15th day of June and the 15th day of December (or on the following day, should this day fall on Sunday or holiday) they shall enter upon their duties immediately.
2. The executive committee shall bring to the attention of the house staff, assembled in session, any suggestion which shall have been brought to the attention of the committee by any member of the house staff, providing this suggestion receives a majority vote in affirmation at a meeting of the executive committee.
3. The executive committee shall take under considera- tion all matters relating to the conduct and welfare of the house staff.
4. The executive committee shall settle all differences arising between members of the house staff. Appeal from such decision may be made before the house staff in session. Until such decision shall have been appealed
and acted upon by the house staff, the decision of the executive committee shall remain in force. 5. Any member of the executive committee may be im- peached by a majority vote, and removed from office by a two-third vote of the assembled house staff. Election to office, created by such vacancy, shall be by and from the interested division, in the event of a divisional rep- resented vacancy, and by the assembled house staff in the event of a vacancy in the office of the representative at large.
Article 9. Section 1. The legislative power of the asso- ciation shall be exercised by the whole house staff. One- third of the members shall constitute a quorum.
Section 2. A meeting of the association may be called at any time by the president, and must be called by him on the application of three members or the medical super- intendent. Should the president be unable to call a meeting, it shall be called by the vice-president.
Section 3. The rule of a majority shall prevail in all meet- ings where a quorum of the association is present-
Article 10. Section 1. The judicial power of the associa- tion shall be vested in (1) the association, sitting as a judicial body — this body shall constitute the highest court, wherein the rule of the majority, consisting of two-thirds of the members of the association, shall pre- vail— and (2) the executive power, constituting the lower court, before which all matters must first be brought, and from which an appeal may be made to the whole association, sitting as a judicial body.
Section 2. In extraordinary cases, before a decision has been reached, the association sitting as a judicial body, at the request of the executive committee sitting as a judicial body, and upon an affirmative vote of two- thirds of the members of the association, may delegate its supreme jurisdiction to a special court, consisting of the executive committee, the medical superintendent, and the chairman of the executive committee of the medical board. The latter two members shall, if deemed by them advisable, present the matter, for final and official action, to the commissioner.
RESOLUTIONS
Relating to the Resident Medical Staff Plan of Self- Government
1. Resolved, That the constitution and resolutions of the association be semi-annually read aloud by the secre- tary to the members of the association, once during the month of June, again during the month of December.
2. Resolved, That two days previous to any meeting of the association a notice of said meeting be posted on the house staff bulletin board at Janeway Hall, and twenty- four hours previous to the meeting a complete list of subjects to be discussed be likewise posted. In cases requiring immediate or private action this regulation may be set aside by the president.
3. Resolved, That the executive committee, sitting as a court, be empowered to require testimony from any member of the association.
4. Resolved, That members of the house staff shall regis- ter their name, date, time of departure, time returned, together with name of substitute, in the house staff time book to be found at the hospital, in the bureau of in- formation.
5. Resolved, That we declare our intention and will to strictly obey all rules heretofore promulgated, or that may be promulgated by the commissioner, affecting the conduct and welfare of the house staff.
20
THE MODERN HOSPITAL
6. Resolved, That each member of the house staff shall be provided with a copy of the constitution and resolutions.
7. Resolved, That application for leave of absence shall be submitted to the medical superintendent on the regu- lar form for this purpose. This shall be permanently filed.
8. Resolved, That no member of the house staff shall en- tertain visitors without having first secured the consent of the medical superintendent.
9. Resolved, That the executive committee shall exercise supervision over the residence of the intern staff, the rooms, hallways, bathroom, staffroom, and library. This committee shall endeavor to see that the house rules are carefully observed by all members, such as punctu- ality to meals, visitors to the home, quiet, etc.
10. Resolved, That the house staff service schedule shall be tentatively prepared by the assistant resident physi- cian for the consideration and approval of the house officers, not later than the evening of the twenty-fifth of the month. When agreed upon, the schedule shall be posted on the bulletin board at Janeway Hall, for the attention of the association, and shall be delivered to the medical superintendent for his approval, and typing, not later than noon of the last day of the month.
AMENDMENTS
This constitution and these resolutions may be amended or added to at any regular meeting of the association assembled in session, by a two-third vote.
MEMORIAL HALL OF BUFFALO GENERAL HOSPITAL
Protection of Patients From Disturbing Noises One of the Foremost Thoughts in Plan- ning— Every Comfort in Patients' Rooms — Harmonious Color Effects — Oper- ating Room Isolated From Patients* Rooms
By EDWARD F. STEVENS, Architect, Boston.
DURING the past twenty-five years the Buffalo General Hospital has made rapid growth and noteworthy improvements. Its capacity has in- creased from 125 to 375 beds. The plant has been practically rebuilt. First, the east pavilion, a beautiful structure of terra cotta and brick, con-
room ; and now, just completed, the new pavilion for private patients, to be known as "Memorial Hall."
In the designing of this Memorial Hall, the gen- eral outline and type of architecture of the east pa- vilion was duly considered and adopted. The plan
Fig. 1. Memorial Hall, the new private patients' pavilion of Buffalo General Hospital. Buffalo, N. Y. Edward F. Stevens, architect.
taining wards and rooms, an operating depart- ment, and laboratories ; next, the children's build- ing; then within a twelvemonth the new service building, complete with up-to-date equipment and conveniences for the staff, and a nurses' dining
was given much study by the superintendent and the architect so as to come as near perfection as possible for the housing of the sick.
The new building, caring for sixty-two patients, is but a part of the entire pavilion, as the connect-
THE MODERN HOSPITAL
21
ing corridor, with its large day room and airing balcony, owing to existing buildings, has not yet been built; and until this has been finished, the plan will be incomplete. The room portion of the pavilion, however, is quite complete.
One of the foremost thoughts in mind was to protect the patient from the usual disturbing noises caused by elevators and trucks and the clat- ter of dishes and equipment. To accomplish this, the noisy portions of the unit — the elevators, the
Fig. 3. Typical bedroom floor plan of Memorial Hall. Note how quiet is insured by the placing of the noisy portions of the unit, such as ele- vators, sink room, and serving kitchen, on separate and cross corridors, away from the approach to patients' rooms.
Fig. 4 Operating floor of Memorial Hall.
While most well-planned pavilions for the care sink room, the serving kitchen and the staircase —
of private patients are much alike in plan and are placed so as to open on separate and cross
equipment, in this building there are some fea- corridors, away from the approach to the pa-
tures which should be of interest and should repay tienf rooms. The partitions enclosing patients'
a careful study. rooms are deadened with an insulating quilt on
22
THE MODERN HOSPITAL
both sides of the metal studs, preventing the sound from one room being transmitted to an- other room. Floor noises are practically elimi- nated by the use of cork tile for all corridor floors, and linoleum for the floors in patients' rooms. All utility rooms are vestibuled from the main cor- ridor.
The patients' rooms are planned for every de- gree of comfort. The base is gray terrazzo, the floor of gray "Jaspe" linoleum, and the walls tinted in warm, pearl gray. The color effect is carried out even in the electric lighting fix- tures.
Each room is provided with a special pattern hygienic lavatory for washing under running water, a closet, telephone connection, and wall plugs for bedside lights and nurses' calls.
al Hall, showing type of bed,
nd general utilities.
There are general toilets and baths for the nurses, the doctors, the patients, and the visitors. Several suites of rooms have private baths.
The sink room on each floor is completely equipped for all services to the patient not pro- vided by the serving kitchen and the linen room.
The silent electric light system has been in- stalled for the calling of nurses by the patient, with a recording device showing the time elapsed between the making and the answering of each call. The signal is also given by a red light over the door of the room and by an annunciator sig- nal over the desk of the head nurse. The call can be canceled only by the nurse going to the head of the patient who sent the call and using a key to reset or release the call.
The serving kitchen is equipped with all mod- em conveniences for preparing and serving food in the most delicate way. The sink rooms are pro- vided with sterilizers for instruments and basins. A medicine closet, with special plumbing, is placed on each floor.
The operating department for the pavilion is most complete, located, as it is, on the top floor, away from the patients. There are three oper- ating rooms, well lighted and supplied with built-in cabinets for the storage of instruments and supplies. There is a plaster room convenient
to but out of the operating area. The surgeon's scrub-up is in the corridor, near the operating rooms. The nurses have their work room, dress- ing room, and toilet. The surgeons have their locker room and toilet.
The usual sterilizers are provided in the steril- izing room, except for the water boilers. The water for all clinical purposes is distilled in the
Fig. 7. Operating room of Memorial Hall, showing direct-indirect radi- ator behind glazed screen, built-in cabinets, and distilled water reheater.
tower and piped to the various operating rooms, where it is reheated by steam to the desired tem- perature.
In the basement or ground floor will be found the genito-urinary clinic and a small but complete psychopathic department for the treatment of the
THE MODERN HOSPITAL
23
occasional delirium tremens patient, with a con- tinuous bath. On this floor also will be found re- tiring rooms for the special nurses.
The elevators are of the latest type, with special hospital cars and all safety devices.
The group plan is such as to make available large yards to the south. These will be developed into lawns with groups of shrubbery, beautifying the appearance of the institution from the street as well as from the patients' window.
LITTLE JOURNEYS TO PLACES AND PEOPLE WORTH KNOWING
The Second Little Journey— To Grant Hospital. Chicago, an Efficient and Well-Managed Institution in Which Sympathy and Understanding of the Individual Are Key- notes— Some Factors in Its Success
By MARGARET J. ROBINSON, R.N., Field Editor of the Modern Hospital, Chicago.
ported, principally by Americans of German de- scent, through annual memberships, bequests, and
GRANT HOSPITAL, Chicago, was organized in 1883 for charitable purposes, primarily to give care to the sick who could pay little or noth- ing. It was then housed in a small building erected as a residence. Since then the scope of its work has been enlarged to include a hospital
legacies. It has an active woman's auxiliary, which buys linens and needed equipment. The present building was made possible by the gener- osity of Catherina Seipp, who gave the necessary
Fig. 1. Grant Hospital. Chicago. View showing the garden.
of one hundred and fifty beds and an out-patient department which gives high-grade service to pay patients ; but over 30 percent of all cases treated are free bed cases.
The hospital has a gradually growing endow- ment, which gives it an income of a few thousand a year. The institution is maintained and sup-
funds in memory of her husband and son. The building was opened for patients February 16, 1913.
The building presents a dignified exterior of solid construction, and is architectually attractive. Alinough it is in the congested North Side dis- trict of Chicago, the architects so planned it on
24
THE MODERN HOSPITAL
a triangle that enough ground space was left at the rear to have green lawn and shrubs and a place for recreation and the baby tents.
The hospital, since its incorporation in 1883 until quite recently, was known as the German Hospital of Chicago, but at present the bronze name tablet which has ornamented the front of the building is being melted down and is getting ready for its new name. The rubber door-mat at
"I the light, roomy kitche
in Grant Hospital.
my visit still bore the legend "German Hospital," but I was told that this was to be changed by adding a T to the "German" and taking out the E and the M.
The day I visited the hospital, the assistant secretary of the board, Mr. Dilg, who is an official Liberty bond salesman, told me that the em- ployees of the hospital had bought $5,900 worth of bonds of this last issue. The service flag car- ries thirty-two stars, twenty-si.x for the men in the medical reserve and other branches of the service, and six for the nurses over there.
Miss Lewis, the superintendent, was at lunch when I came in, but she finally appeared, attended on the right side by a nurse asking questions, in front by two visitors who wanted to inquire for a patient, on the left by an intern asking more questions and in the rear by one of the girls in the office, who was trying to get her to the tele- phone, and both of her hands were busy knitting on a khaki brown sweater.
When she found time and breath to speak to me, I said, "When in the world do you get time to knit sweaters?"
"Why not?" said Miss Lewis. "I knit a sweater and a cap for every man who goes from here into war service, and they all write to me and I write to them."
"Do you ever sleep?" I asked her, and she said:
"Oh, yes, about six hours every night; that is enough for anybody." I thought, however, that
it was not everybody that could do with the same amount of sleep that was needed by Miss Lewis and Thomas A. Edison.
Soon Miss Lewis and I started over the building, beginning in the lower regions. Down in the engineering department, where the powers that be run the heating plant and laundry and things in general, everything was greased and shiny and busy, and the refrigerating plant thick with its usual heavy frost.
The laundry was busily grinding out clean sheets and towels and nurses' clothes, and the giant mangle ironing things on both sides with very little human help. Soiled cotton is washed and tumbled here, and much of it is saved in that way. In the sorting room the steel cupboards were black on the inside, and the piles of accu- rately folded linen stood out in strong contrast. I should think that this would simplify the work and give less eye-strain to the people who have to work here all day.
The kitchens are big, roomy, light, and well equipped with everything to make the work as easy as possible for the workers. A man who had lost one hand was mopping the floors, and doing it well. Miss Lewis said that he was one
Fig. 3. Maternity ward in Grant Hospital. \v cart de-siKned here for the transporta baskets.
of her best house-men, a permanent employee. In fact, she only wished she could get more like him and another partial cripple, a man with only one leg, who is also on the roll of permanent employees.
There was a pleasant staff and nurses' dining room. Miss Lewis says that restraint and dis- cipline are all off in this room during meals, and that the interns and nurses and office employees may talk and laugh and relax their dignity while they eat.
On the first floor in the rear, and having its own separate entrance, are the out-patient depart-
THE MODERN HOSPITAL
25
ment, the pharmacy, and the radiographic and pathological laboratories. A full-time salaried pharmacist, a roentgenologist, a pathologist, and an assistant are employed; also a social sei'vice worker. There is plenty of equipment to do any diagnostic work needed.
The hospital is provided with a Pfaudler glass enameled linen chute, which can be water-flushed and cleaned ; a light call system for patients ; and the still small voice which announces in the cor-
Fig. 4. Nureery i: dressing table this table.
ridors and the operating rooms that "Dr. Jones is wanted at the telephone, please."
The floors everywhere are covered with battle- ship linoleum. The private rooms are attractive and well furnished and made homelike by the curtains of sunfast wash material, rose-colored in the rooms on the north side, blue in those on the south. There are no shades on the windows, and ventilation is secured by the inlets from the curtained French windows and the oulets of the curtained transoms above them.
In the obstetrical department, which is a most busy and interesting place and a department which has been a particular success in this hos- pital, there are two delivery rooms. There had been sixty-six arrivals in the month of March, I was told. I asked what happened when three new citizens took it into their heads to come to town all on the same evening, and Miss Lewis said, "Oh, we manage all right; if the delivery rooms are both busy, and a third case comes in, we have a big wide cart we can use, and everything else is right handy up here." Sixty-six babies in one month in an hundred-and-fifty-bed hospital certainly shows the confidence of the doctors and the public in that obstetrical department.
In the hall we passed the sectional cart designed here and used by the young ladies and gentlemen in this department to motor to their lunch.
The nursery, of course, was the most interesting place in the whole hospital. On the shelves around the I'oom, in the wire sandwich baskets, were forty-two new live babies. They were all quiet and contented except two. These two were not sick, and didn't have any especial reason for cry- ing, they just wanted someone to notice them.
There were two "teenie weenies" in the incu- bator. Both were doing well, and one of them was making a brave attempt to make himself heard. This one was a premature of only six and a half months, but the nurses seem to think that he is going to "make it" and grow up like other folks.
The table on which the babies are cared for was designed and made especially for this room. It is 36 inches wide and 36 inches high. It is built something like a large flat-top desk, of white enamel finish and is long enough to hold half a dozen babies at one time. It has drawers on both sides in back and front. These contain everything in the way of clothes and toilet accessories that the babies need. The table has an endowment of its own, and bears the name-plate of the donor on the side of it.
In a small adjoining room there are warmed nickel plates where the babies are washed and get their shower baths. Of course, the patients
Fig. 5. The roof-garden of Grant Ho.-spital, with its latticed pergola.
in this department are all thoroughly labeled so that they won't get mixed.
The operating suite was another busy place, and a force of nurses and orderlies were cleaning up after a long morning's work. This department has everything about it to indicate good work and plenty of it to do.
The roof garden is delightful. It has a pergola with latticed sides all ai'ound it, and tiled flooring. Several patients in wheel chairs were up here sunning themselves, and over in a corner was a three-months-old orphan baby in a carriage. You
26
THE MODERN HOSPITAL
know how hospital people love these orphaned babies and make much of them. This baby cooed and laughed and stuck out her tongue at us in most friendly fashion. Miss Lewis said that one of the interns had made her his especial charge and wheeled her out for an airing every day.
Looking over the report of the superintendent, read before the Woman's Auxiliary in 1915, I found so many good things that I am going to take some of them and give them to you in this article just as they are.
"A patient now keeps his identity. It means that every patient has individual attention, from the doctor down to the humblest servant in the house; that an interest is taken in his mental and physical welfare. In just so far as this inter- est increases, and sympathetic attention given promptly and cheerfully, will the name 'hospital' come to mean a place of comfort given and not a place of fear."
Miss Lewis, in the same report, gives credit to each of her assistants who has helped to make the hospital a success. She refers to Miss B — , the dietitian, as a very efficient little woman, and tells of the well-prepared and well-cooked food. Else- where she mentions the splendid work in the oper- ating rooms and gives the credit to the supervisors there. She says that her day and night super- visors are towers of strength and energy. This sounds like team-work, and you feel it in the atmo- sphere when you are in the hospital.
The eight-hour day has been worked out suc- cessfully here, and is one of the things that has helped to produce the team-work and the cheer- fulness. This system is surely an answer to a lot of problems. When it comes into all the hos- pitals to stay, sore feet and aching backs, some of the apparent stupidity in class work, sick nurses and cranky nurses will all pass. The temper of hospital workers will then begin to be what it ought to be, and administrators and doctors who are willing to work a gentle woman of delicate nervous organism twice the length of time each day that a street contractor would dare to work a husky laborer, will pass along too.
Miss Lewis, in an article in the Department of Nursing in the January number of this magazine, tells of the plan for the eight-hour system and the advantages it has brought into their work. She is now working out a definite time-saving plan for the systematizing of the work of the night supervisors of which she will tell later.
The efficiency of the nursing service is due, not alone to the excellent system in force, but also to the helpful, kindly, human spirit that inspires the system. No one in Grant Hospital is a mere
cog in the machine; the human element is never lost sight of. "I have broken down every barrier between my nurses and myself; I want them to come to me with their troubles and problems as freely as they would to their own mothers," says Miss Lewis. She believes in preventing the com- plications which sometimes arise in institutions where young men and women meet in their daily work, not by unnatural repression — by forbidding conversation and social relations — but by recog- nizing the just claim of these young people to acquaintanceship and social relations under proper conditions. Miss Lewis herself introduces her interns to her nurses; she permits the latter, in their evenings off duty, to accept from these young men invitations sanctioned by her, pro- vided reasonable hours are kept. This has not increased the social demands made on the nui'ses — rather the contrary — so much sweeter is for- bidden fruit! Incidentally, Grant Hospital never has any trouble about getting interns.
Miss Lewis believes that the comparatively mature and experienced woman often makes a better nurse than the young high-school graduate. In fact, she prefers, as candidates for her training school, women who have had experience in other lines of work, such as teaching or business, even though some of these may not have had a high- school education.
Each hospital has some one significant thing about it, and you carry memories of each labeled and indexed by that significant feature. You re- member one for its fine social service, another for its beautiful scenic surroundings, another for its cleanliness and order, another for its scientific research work, another for its community spirit and so on.
I think my memory of the Grant Hospital will go down something like this: This hospital is efficient, but in getting efficiency it has not sacri- ficed the individual. There is a human and per- sonal atmosphere about the place. Staff and office, nurses and interns and employees, all seem to have an interest and a share in the work ac- complished. The success of Grant Hospital seems to me to be due to several things: the intelligent administration, of course ; the financial support of its benefactors; its adequate building and equip- ment, and to the forceful personality and kindly spirit of its executive head. In a word, it is a non-institutional hospital.
It was a wise old southern deacon who advised with a chuckle: Keep yo' tempah, son. Doan yo' quarrel with nc angry pusson. A soft answah's alus best. Hit's com- manded, an' furdermo'. hit makes 'em maddah'n anything else yo' could say.
THE MODERN HOSPITAL
27
FROM THE FIELD EDITORS' NOTE BOOKS
Presbyterian Hospital, St. Luke's Hospital, Grant Hospital, West Suburban Hospital,
Evangelical Deaconess' Hospital, Harper Hospital, Agatha Hospital, Sacred
Heart Hospital, Youngstovvn Hospital, and Iroquois Memorial Hospital
Perhaps the most distinctive features of St. Luke's are
Presbyterian Hospital, Chicago
This hospital has taken care of its ward patients with- out raising rates, although the cost to the hospital of each ward patient is more than seventy-five cents a day in excess of what the patient pays for his care.
When the government requested all hospitals to in- crease the number of nurses in training up to the limit of capacity, the Presbyterian Hospital went further than this. It fitted up two houses on the same street and re- moved all the women employees except nurses out of the Sprague Home for Nurses. It then took in probationers to fill every available space left vacant. This move is costing the hospital eight thousand dollars a year.
Unit 13, headed by Dr. Dean Lewis, was largely re- cruited from this hospital, and with it have gone into service 6 attending physicians, 8 associate physicians, 12 assistant physicians, 15 interns, 2.5 nurses, 3 orderlies.
Gauze sterilizer used for general sterilization in Presbyterian Hospital, Chicago.
and 9 other employees. Since then the number of those in service has been added to until now the service flag carries under its one big star the number 126.
In the annual report, when one reads down the pages of the medical board, the executive staff, the house staff and the school for nurses, many names are preceded by a little black asterisk and others by a small black dagger. The foot note below reads "*In government service." "tin Red Cross service in France."
The annual report also contains the following: "Re- sponding to the request of the government for conserva- tion of food, we at once inaugurated a system of serving which has reduced the amount of food used fully 25 per- cent. This has been done with the cooperation of both patients and employees."
The Presbyterian Hospital is not only doing its bit, but doing its best.
St. Luke's Hospital, Chicago
St. Luke's Hospital, Chicago, has been established for fifty-one years and ranks among the best-known of the high-standard institutions. The bed capacity of the hos- pital is about four hundred. From seven to eight thou- sand patients are treated each year. The departments in- clude medical, gynecologic, ophthalmologic, otologic, oral- surgical, dermatological, surgical, obstetric, rhinologic, laryngologic, orthopedic, and neurologic.
the high-grade private-room service, the children's depart- ment, which is doing especially fine work in orthopedics, and the training school for nurses.
The training school admits only young women who have a definite academic educational foundation for nursing edu- cation. This nursing education is given thoroughly and with every means for instruction and equipment. The health and comfort of the nurses and their recreation are carefully provided for. The nurses in the school have the advantage of gymnasium and tennis courts and the privi- lege of one of Chicago's exclusive bathing beaches. Classes in French are given for those who wish to attend them. Only nurses of the best grade are sent into the nursing field as graduates of St. Luke's.
The hospital, believing it to be a duty to comply with the request of the government to increase the number of nurses in the school, has added twenty-five to the usual number in training. This was made possible by renting two flats in the neighborhood and by the generosity of Mr. and Mrs. W. G. Hibbard of Chicago, who turned over their residence to the hospital for use in housing the extra nurses.
The visitors' dining room in the hospital is an especial feature at St. Luke's. It is not a small room, casually furnished for this purpose, but a large well-furnished dining room in constant use by relatives and friends of private patients and staff.
In the children's department there is a special ward for tonsil and adenoid cases, an entrance observation ward, wards for medical, surgical, and orthepedic cases. There is a kindergarten, and a teacher comes every morn- ing to instruct the children who can come to the classroom. There are plenty of small wheeled chairs for the small folks, and in the children's department every meal for the children who are up and about becomes a tea party. Many a child who would otherwise have little appetite enjoys his dinner when served to him while he sits in a little red kindergarten chair at a low table and with all the other children around it, making a playtime of the meal hour.
The orthopedic department does the follow-up work of the infantile paralysis cases of Cook County Hospital, and the hospital is planning to do the reconstruction work for its disabled patients.
West Suburban Hospital, Oak Park, III.
The West Suburban Hospital in Oak Park is a success- ful open-door hospital of 125 beds owned by a body of physicians and surgeons of that suburb. The hospital has surgical, medical and obstetrical service. It takes cai-e of forty-five obstetrical cases a month on an average. Be- sides the regular officers of the hospital and the training school, the hospital employs four interns, a pharmacist, a dietitian, and technicians in the pathological and radio- graphic laboratories.
Mr. Joseph Purvis, the superintendent, believes in women interns for general hospitals. One of the four interns now employed is a woman, and more will be added as needed. The management makes special effort to receive patients and visitors intelligently and cordially, and no discourtesy is tolerated from any employee.
28
THE MODERN HOSPITAL
Fig. 1. Grant H
In the obstetrical department, opposite the maternity room, is a special room for waiting' cases. The patients are brought to this room after the first symptoms of be- ginning labor, and before it is necessary to bring them to the maternity room. The patient is not returned to her ward or room until she is in good condition, and the other patients in this department are spared the sound and knowledge of the progress of a case in labor.
pital, Columbia, Ohio.
features of many private hospitals, where the service to the patient and the education of interns and nurses are sacrificed to the making of dividends, are absent in this hospital. The building is always full to capacity, and the proof of public confidence lies in the fact that the hos- pital has not enough beds to meet the demand for them.
The roof garden, shown in the illustration, is one of the most popular places in the hospital, and patients are
Fig. 2. The roof garden. Grant Hospital, Columbus, Ohio. K
Grant Hospital, Columbus, Ohio
Grant Hospital, Columbus, Ohio, a private hospital, owned and controlled by Dr. J. F. Baldwin, has 529 beds, a high-grade training school, and all the usual atmosphere of a general hospital. The greater part of its service is given in moderate-priced private rooms. The objectionable
;re are cool breezes and a wonderfuJ birdseye view of the city.
anxious to rest here whenever their condition and the weather allows. A more detailed account of the work of Grant Hospital will be given later in these pages. A paper on "Hospital Housekeeping," by Miss Mary A. Jamison, superintendent of Grant Hospital, appears in this issue.
THE MODERN HOSPITAL
29
Evangelical Deaconess Hospital, Marshalltown, Iowa
In the Evangelical Deaconess Hospital in Marshalltown, one sees a well-ordered and cleanly institution which is progressing rapidly and has shown its success by meeting its growing needs. The original building has been recon- structed to add modern hospital facilities and in the near future the hospital expects to add laboratories which will
Evangelical D'
Home and Hospital, Marshalltown, Iowa
give to its patients every advantage of scientific diagnosis.
The new wing of private rooms has everything to make it attractive. The rooms all open on a sun corridor which is surrounded by thoroughly screened French windows. The whole corridor is a sun parlor for convalescent patients.
The Rev. Karl Rest, the superintendent, and Sister Sophie Hublie, the superintendent of nurses, deserve much credit for the advance the hospital is making.
Harper Hospital, Detroit, Mich.
Harper Hospital is surely doing its share. It has sent overseas to France its own base hospital unit, even at the expense of making a shortage everywhere in the organi- zation, in the visiting staff, the house staff, and the train- ing school. The house staff, which usually has thirty in- terns, now has only seventeen. The hospital service flag carries 119 stars on it.
The second floor of the Buhl Memorial Building, the clinical dispensary building, has been given over entirely to the use of the medical reserve, the aviation corps, and the ordnance department, for physical examinations. Over 450 men have been examined here for the ordnance depart- ment. Examinations are also made here for the regiment of expert mechanicians and workmen being raised for the government.
Special arrangements have been made for the quaran- tine of venereal diseases under the new application of the laws controlling communicable diseases in Michigan which the state board of health has applied for the protection of the men in cantonments. Follow-up work is done in these cases and reports made to the state. The emer- gency war fund of this state is helping to pay the ex- pense of this work.
The chef at Harper has made his own particular recipe for war bread, which the hospital will give to other hos- pitals who may wish to know about it.
Agatha Hospital, Clinton, Iowa
The Agatha Hospital in Clinton, Iowa, is another hos- pital which is an example of the good work which can be done in small cities. The hospital has gained the support of the public and will have to enlarge upon its present quarters to accommodate the patients who wish to enter it for treatment.
There is an excellent training school in charge of the superintendent, Miss Tanner, who is a graduate of the Michigan University Hospital at Ann Arbor, and her as- sistants, who are graduates of the Michael Reese and Wesley Hospitals, Chicago.
The hospital has well-equipped pathological and x-ray laboratories, and unusually good surgical technic in its operating and obstetrical departments. It is fortunate in having on its staff of physicians and surgeons men who use the most modern methods of diagnosis.
The nurses' home has a home atmosphere that is not usual in institutions, and I was particularly impressed with the type of nurses, a type that showed distinctly their culture and refinement and an intense interest in the work to be done. Clinton is certainly to be congratulated in having such a standard hospital and such a thoroughly capable woman to administer it.
Sacred Heart Hospital, Fort Madi.son, Iowa
The sister superior of this hospital designed herself the chart racks which are used on the nurses' desks on each corridor of the hospital. They are made of var- nished wood, and on the inside are strips of zinc which act as slides for each chart. On the outside, on the left of each open space, is a small round brass number plate for each room and ward and on the right of each space, open metal plates in which the names of patients can be easily placed. These racks cost very little and have proved very satisfactory.
Youngstown Hospital, Youngstown, Ohio
The Youngstown Hospital, of which Mr. Fred S. Bunn is superintendent, has a young but healthy offspring in the form of an evening pay clinic for venereal diseases, which is held once a week. It is being displayed with considerable pride by Miss Lucy C. Catlin, the hospital's social worker. It was born on January 21, out of the throes of a desperate need for some means of taking care of the hospital patients having venereal diseases. Note its steady growth. In January it had 11 patients; in Feb- ruary, 27; in March, 35; and in April, 44. Its total col- lections up to that date were $265.85 ; its total expendi- tures $229.65, leaving a balance on May 1 of $36.20. All veneral disease cases are referred to this clinic from the day clinic; consequently some free cases are treated in the evening. Nevertheless, it is more than meeting ex- penses. While this clinic is considered part of the dis- pensary work, the accounts and money are kept entirely separate, so that the hospital may ascertain how nearly self-supporting it is. The experience of the Youngstown Hospital Association in beginning its evening pay clinics should encourage other hospitals to start similar clinics.
Iroquois Memorial Hospital, Chicago
Reports from Chicago's first municipal venereal clinic, which was started on January 7 of this year at the Iro- quois Memorial Hospital, show results of the most satis- factory and encouraging character. These results, ac- cording to the commissioner of health of Chicago, are in large measure due to the helpful cooperation given by physicians and institutions of the city interested in vene- real prophylaxis.
The clinics are held daily from 6 p. m. to 8 p. m. Tues- day is reserved exclusively for women. Advice and in- formation are given to all and free treatment to those unable to pay.
Few things are harder to put up with than the annoy- ance of a good example. — Mark Twain.
30
THE MODERN HOSPITAL
GZ50
Hospital Disintegration or Hospital Conservation —Which?
The civil hospitals of the country are being gripped by destructive forces. The tendency to disintegration, hardly perceptible in the first months of the war, is now rapidly gaining mo- mentum. It is clearly the duty of those who are conscious of this tendency to examine its causes and, if possible without injury to the military power of the nation, to oppose it.
An effective medical staff is indispensable to the success of the army. Behind the army stand the medical and nursing corps; behind these, the medical and nursing professions; and behind these, the hospitals in which doctors and nurses must be trained. There is sound military reason, then, for asking that steps should be taken to maintain hospital efficiency throughout the war.
The appointment of a national food adminis- trator is the executive expression of the doctrine that "food will win the war." Without develop- ing and making effective use of adequate trans- portation facilities, we cannot win the war, and the President has therefore appointed a director general of railroads. We are told that fuel is an- other essential factor, and in keeping with this idea we find that a fuel administrator has been on the job for many months. Without a rapid ex-
tension of various war industries we cannot win the war, and a war industries board is corre- spondingly busy. In the last analysis it is men who will win the war, but a health administrator, to insure a sufficient supply of healthy men, has not yet appeared on the scene. Congress has con- ferred upon the President the power to act. Is it conceivable that he will fail to do so?
I shall not attempt to indicate all that a health administrator might do to add to the efficiency of the nation in war. I wish, however, to enumer- ate a few of the talks that would immediately com- inend themselves to the consideration of a wise national health administrator, in the hospital field alone :
To standardize hospital staffs in order that every hos- pital might retain in its service the actual number of men required for the care of its patients, and no more.
To complete the organization of the volunteer medical service corps, and to prepare to use the members of the corps to fill dangerous gaps in the service of hospitals, dispensaries, and civilian communities.
The formulation of a plan for the joint use of special- ists by civil hospitals and by the military hospitals which are being established to care for returned soldiers. (Aus- tralia is profiting by a part-time arrangement; why should not America?)
To find the means, both men and money, by which dis- pensaries can be kept going.
To arrange for the training of a sufficient number of medical students to keep up the supply of graduates needed by the army and the civil population. (The schools are now graduating about three thousand men annually. Inasmuch as there are nearly one hundred and fifty thousand practicing physicians in the country, and since the average professional life of a physician is about thirty years, it will take nearly five thousand graduates per an- num to maintain the existing ratio between the population and the profession, without making any allowance for the growth of population.)
To provide interns for the hospitals which have none at present.
To invite the Medical Department of the Army to re- consider its assumption that a single year of clinical training is ample.
To prevent the further breaking up of the teaching staffs of nursing schools.
To take steps to create an adequate supply of pupil nurses. (According to the survey of the American Nurses' Asso- ciation made during the period September, 1917, and March, 1918, Massachusetts, with places for 860 proba- tioners, enrolled in the fall of 1917 only 509; Connecticut, with places for 522, enrolled 205; New York, with places for 3,349, enrolled 1,761; Indiana, with places for 529, enrolled 210; Minnesota, with places for 860, enrolled 509; Texas, with places for 1,200, enrolled 226.)
To promote a uniform system of legislation for the training of bedside attendants.
To arrange with the civil hospitals for the training of a large reserve supply of volunteer war nursing aids.
To discover a means whereby hospitals can successfully compete in the labor market against inflated war indus- tries.
To see to it that the government does not unnecessarily hoard medical and surgical supplies to such an extent that
THE MODERN HOSPITAL
31
civil hospitals are left without surgical instruments, sur- gical dressings, anesthetics, and medicines. (The justice of providing for our soldiers first is conceded; but the necessity of laying by supplies equivalent to ten times the estimated consumption of the current year is question- able.)
To urge the government, in framing war tax legisla- tion, to stimulate rather than to discourage donations and bequests to hospitals.
To come to the relief of communities which, as a result of the war, are left without adequate medical and nursing service.
It is only by facing these problems now and by finding a speedy solution of them that the impair- ment of hospital efficiency can be avoided. Hos- pital efficiency must be maintained, because the efficiency of the medical and nursing professions is dependent on it and on these, in turn, depend to an appreciable extent, the vitality of the nation and its effectiveness in war.
S. S. GOLDWATER. M.D.
Mobilization of the Civil Hospitals and Allied In- stitutions for National Service
To win the war and to repair the havoc made by the war must from now on be the chief end of existence for everyone. This means you and me as well as other folks; it means hospitals as well as other institutions. In order to justify their existence, the hospitals must do more than meet the demands of their own self-interest — more than meet the standards of organization and administration.
The civil hospitals have their part — and a very important part — to play in winning the war. It is true that many of them have already made great sacrifices. Some have sent the best part of their medical, nursing, and even their domestic personnel into army service. What more can they do, besides making the best of the hardships which the war inflicts on all of us ? A great deal, and in particular three most important — nay, in- dispensable— things.
In the first place, the hospital is the workshop of the physician and the school of the nurse, and these two, the physician and the nurse, stand closer than the men and women of any other pro- fessions to the soldier in the trenches. The hos- pitals must train nurses, and more nurses, and then more nurses. They must replace medical men and male employees by women wherever pos- sible. Wherever the services of attendants and volunteer workers can with safety be employed, they should be utilized to release interns and nurses. Graduate nurses, moreover, should not be encouraged to remain on hospital cases which could safely be placed on general care.
In the second place, hospitals, by giving efficient
civilian relief, can do much to sustain the morale of our armies. E.\perience in the armies of our allies has shown that the one thing which is most disastrous to the morale of the fighting man is the worry concerning the welfare of his family at home, and that no greater help to his courage can be given than the assurance that those he has left behind will be cared for when the need arises. The military authorities tell us that a definite sys- tem of civilian relief which will provide hospital care for the families of soldiers will be of im- measurable value in maintaining the courage of our men in the army and navy.
In the third place, the hospitals can render efficient service by cooperating with the army medical examining boards. Many hospitals are giving splendid assistance to the medical examin- ing boards. Others are considering first their own convenience and, in consequence, examining boards in many places are seriously handicapped in the work by a lack of proper quarters and equipment. The men on these boards are giving of their valuable time and experience and deserve the support of the hospitals. This, too, is a part of national service. It is an important part of the war machinery and should be assisted by the hospitals wherever possible.
To sum up: What can the civil hospitals do to help win the war Train nurses — more, and then more nurses. Release those in the hospital who are needed for service elsewhere. Give civilian relief. Assist the medical examining boards. These are the things that the civil hospitals can do now.
Some Practical Papers
A number of especially timely and practical ar- ticles on everyday hospital problems are pub- lished in this issue, and more are soon to follow. Among those appearing this month are the paper by Miss Mary A. Jamison, superintendent of Grant Hospital, Columbus, Ohio, on "Hospital House- keeping," in which she describes the housekeeping methods which she has found effective in her ex- cellent hospital; that by Miss Nell Shilt, super- visor of surgical supplies at Lakeside Hospital, Cleveland, on the subject, just now of such special importance, of washing used surgical dressings; that by Dr. Malcolm T. MacEachern, superintend- ent of Vancouver General Hospital, Vancouver. B. C, on "Conservation of Drugs and Other Sup- plies" ; that by Mr. Pliny 0. Clark, superintendent of Ohio Valley General Hospital, Wheeling, W. Va., on "Hospitalism — Its Causes and Treatment"; and that by Mr. Joseph Geffen, superintendent of Mount Sinai Hospital. Philadelphia. Penn., on the
32
THE MODERN HOSPITAL
often vexing problem of "Visitors and Visiting in Hospitals." A very practical discussion of the subject of "The Standardization of Hospitals for the Insane" is furnished by Dr. William C. Sandy, assistant superintendent of the Connecticut Hos- pital for the Insane at Middletown. Dr. Sandy, it may be remembered, made for the National Committee for Mental Hygiene a survey of Penn- sylvania county asylums, the results of which were published last year.
Two papers soon to be published on important problems arising out of war conditions are one on "The Trained Attendant," by Miss Florence Dakin, superintendent of the Middletown Hospi- tal, Middletown, Ohio, and one on "The Night Pay Clinic," by Dr. A. R. Warner, superintendent of Lakeside Hospital, Cleveland.
Miss Dakin discusses the crisis in the nursing situation produced by the urgent call for trained nurses for the national service. She suggests that many of the difficulties arising out of the present situation may be obviated by establishing training schools for attendants in the small gen- eral hospitals of from fifteen to fifty beds. The attendant should receive a certificate only — not a diploma — at the end of the prescribed course, and should not be permitted to represent herself as a trained nurse. This solution of the problem will be viewed with misgiving by many hospital authorities, but this exposition of the plan, by the superintendent of a hospital in which it has been put into successful operation, is worth a careful reading.
Dr. Warner describes another innovation which would doubtless have been vigorously opposed not long ago. War conditions, however, are demon- strating the absolute necessity of some provision for meeting the needs of the self-respecting work- ingman, who cannot afi'ord to pay specialists' fees, yet shrinks from becoming an object of charity. Dr. Warner shows that the night pay clinic does not compete with the general practitioner — or, for that matter with the specialist — because the work done by the clinic would otherwise either not be done at all, or would be done for nothing or at a loss. On the other hand, the night pay clinic physician receives a remuneration for his work which is not only fair, but well above that re- ceived by the average physician in private prac- tice. As Dr. Warner says, "the exigencies of war may in the near future compel the establishment in many communities of organized practice of medicine to provide medical care not only for the workingman but for all the civilian population." He adds that the pay clinic seems especially well adapted to the small hospital. We feel justified.
therefore, in commending this article when it ap- pears, to the serious attention of our readers.
Another very timely and practical paper to ap- pear soon is one by Miss Caroline L. Butterfield, superintendent of Martin's Ferry Hospital, Mar- tin's Ferry, Ohio, on the solution of the house- keeping problems of a small hospital in an indus- trial community where wages have risen to an almost prohibitive point. Miss Butterfield's in- genious methods of meeting the difficulty by the use of labor-saving mechanical devices, etc., will be of much general interest.
Other practical papers scheduled for the future include one by Miss Mary E. Lewis, whose excep- tional work at Grant Hospital, Chicago, is de- scribed by Miss Robinson in this issue, on ways of conserving the energies of the night superin- tendent ; one by Mr. Charles T. Hoblit, farm, gar- den, and dairy consultant to the Illinois Depart- ment of Public Welfare, on the work of the farm, garden, and dairy consultant to the institutions ; and one by Dr. H. E. Tuley, superintendent of the Louisville City Hospital, on the way in which a large number of administrative problems have been satisfactorily solved in that institution.
In this connection, a number of interesting papers on increasing the usefulness of the hos- pital records, the library, and the annual report should be mentioned, but limitations of space for- bid for the present. We shall have more to say about the articles on these and other subjects a little later.
More Laboratory Technicians Needed
The need for laboratory technicians has grown with the need for laboratories. Time was when a physician guessed at a diagnosis or the need for surgical interference, or did the best that he could to make his diagnosis from symptoms and physical findings alone, but laboratory facilities for diagnosis are as necessary a part of a hospital today as are its operating rooms and its kitchens. Keeping pace with the movement for the stand- ardization of hospitals is the demand for labora- tories and for some one to do the work in those already existing, and in those to be installed to meet the requirements for classification. Hos- pitals in all parts of the country are asking, "Where may we procure a roentgenologist? Where may we procure a pathologist ?"
Many medical men who were doing the labora- tory work for their hospitals are now in service. Interns are at a premium. Many of the large hos- pitals which usually have a large number on their resident staff now have very few, and many of the smaller institutions which have one or two under
THE MODERN HOSPITAL
33
ordinary conditions now have none at all. Even in normal times previous to the war it is doubtful whether the number of trained laboratory work- ers, medical men, interns, or technicians kept pace with the increasing demand for laboratories. The present need is emphasized by the announcement from the Surgeon-General of the Army that one hundred women bacteriologists are needed to take the place of men in the cantonment laborato- ries. This shortage of technical workers may last for some time to come, and it seems that unless some special effort is made to fill the ranks, it may become impossible to utilize this important factor in the adequate diagnosis of disease and the good service to our patients in places where good work had already begun.
This work has really become a specialty in itself, not necessarily attached to the profession of medicine or the degree of bachelor of science. Yet comparatively few of the educational centers are offering laboratory courses which will espe- cially fit the student for work in the hospital labo- ratory, and still fewer offer special courses avail- able for the training of technicians.
The larger hospitals, which have complete labo- ratories and teaching facilities connected with training schools for nurses, could give, during the senior year, a definite short course in laboratory work, and after gi-aduation this could be continued as a special post-graduate course by those who had proved their adaptability and their desire to enter the field. The Catholic Hospital Association plans to give courses to the sisters in hospital service during the summer months. If other agencies and teaching hospitals meet this problem as fairly the need wall soon be supplied.
The field seems to be one in which women have proved their usefulness. Numbers of gi'aduate nurses have made good laboratory technicians, and if sufficient educational advantages are of- fered to them to enter upon this special training, they will in time fill the gaps in the ranks.
Compulsory Universal Service — A Ministry of Health
A rather noteworthy "Plea for Universal Serv- ice," by Edred M. Corner, F. R. C. S., surgeon to St. Thomas's Hospital, London, appears in a recent number of the Lancet. Because it carries even further certain suggestions made in these col- umns some months ago, as well as because it pre- sents briefly some very important considerations which the nations will have to ponder at the end of this war, we call attention to it here.
The examination of British recruits under Lord
Derby's scheme, we are told, almost invariably disclosed physical deficiencies of weight or height or inefliciency due to disease. Under our industrial system, youths reach maturity blemished by dis- ease ; men grow aged when they should be in their prime. In many vocations, as we on this side of the water know too well, in his fortieth year a worker is reckoned an old man. Why is this?
"The core of the matter is," says Mr. Corner, "that men in the working masses wear out earlier than in other classes, not because they are worse men, but mainly because they have no break in their work, no rest, no change, from the day they leave school to take up a trade till the day they cease working for good and all. This tends, per- haps more than anything else, to narro\vness of sympathy and bitterness of heart. Can one feel surprised at the unfairness and deep hates of in- dustrial troubles? This unrest is a very real and great social danger which can be largely averted."
Physical culture — compulsory physical culture — is the remedy, in Mr. Corner's opinion. It will not do to leave such a vital matter at the option of the individual. Like vaccination and educa- tion, such physical culture must be compulsory and universal, nor can it be allowed to stop with the school child. "There is only one method that I know of rejuvenizing and morally cleansing the nation — universal service, a system of drill and physical culture for men and women. Do not let it be termed conscription — that is a conten- tious word — but universal service, which, by im- proving the individual, preventing his aging, in- creasing his health, power, and ability, adds to his value to his family, his polity, and his nation — that is what is meant. ... It would be wrong to claim that universal service would rid us of the whole of this great secular and industrial evil ; but to say that it would help to diminish it is only the truth. It would be an immensely gi'eat economic gain to all."
Team-work, Mr. Corner goes on to say, is the greatest educator of the human race that exists. Commerce allows the individual to woi-k for him- self alone and thereby may induce national decay. War, destructive as it is, encourages teamwork and may thus tend to cure the dry-rot of indi- vidual selfishness. Yet this destructive remedy may be worse than the disease. In universal serv- ice alone may be found the combination of con- structive effort and team-work necessaiy for na- tional well-being. "Not war but universal service is the cure for national ill health." Corner, in short, has rediscovered James' "moral substitute for war." Nor is he the first since James to have made such a suggestion ; but the world has
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THE MODERN HOSPITAL
listened with amused tolerance to all such "vision- ary dreams" of philosophers and humanitarians and has turned away from them to the "practical business" of things as they are — as they were !
As they were — and never shall be again ! Make no mistake; never was there a more unpractical world than that which has broken down in the deadliest and most gigantic of all fiascoes of his- tory. Hereafter statesmen and "practical people" will perhaps regard with less foolish scorn and shipshod, unthinking, misnamed conservatism, all proposals for social betterment. We venture to predict that something similar to "universal com- pulsory service" is going to receive serious consid- eration in the reconstruction of the world after the war.
Need for Hospital Executives in Red Cross Work We ventured the prediction some time ago that the day of opportunity for the progressive super- intendent was not far away. This day of oppor- tunity is already here; the only question seems to be as to the number of executives who are prepared to take advantage of it. The demand still continues for superintendents capable of tak- ing charge of Red Cross hospitals in France and of government hospitals here and abroad. We have had of late a number of requests, which we have been unable to supply, for the names of candidates for such positions. We would suggest that any superintendent desirous of undertaking government or Red Crass work send to this office, inclosing a stamped addressed envelope, for a blank form which, when filled out and returned to this office, will be placed on file for reference in connection with applications for executives in such work.
Some Last Minute Confidences
An unexpected influx of important and timely matter for several of our departments has made it necessary to reduce somewhat the number of leading articles this month. It has been necessary, in particular, to postpone until August the initial instalment of the series of articles on "Hospital Accounting," by Charles A. Porter and Herbert K. Carter. By way of compensation, some exceedingly interesting and valuable articles are presented under de- partmental headings. The Bulletin of the American Hos- pital Association contains a rather full report of the con- ference held under the auspices of the war service com- mittee of the American Hospital Association, on subjects of vital importance to hospitals under war conditions. We wish also to call special attention to the article in the same department on "The War and Interns in Special Hospitals." This should be taken to heart as a message from the Surgeon-General's Department to all concerned, whether members of the American Hospital Association or not. In fact, everything in this month's Bulletin of the American Hospital Association should be widely read by
members and non-members alike. In connection with the reports of several interesting association meetings which appear this month, there is room here only to say that the keynote of most of the important meetings is the subject of the reconstruction, rehabilitation, and reeducation of the handicapped, whether from war, from accident, or from disease. In view of the growing importance of the subject, these meetings have a very vital and general interest.
Hot Tea for the Men in the Trenches
"In addition to hot meals which are carried to the sol- diers in the trenches," says Maj. George de Tarnowsky, writing in the Review of Surgery and Medicine, "the Medical Corps now sends hot tea, flavored with a small amount of brandy, to the front lines twice daily — a most welcome potion, which the soldiers look forward to with eagerness. The prevailing idea of the French Medical Corps is to make the fighting men feel and know that their comfort is being looked after and that everything is being done to mitigate the hardships under which they live. The French are strong believers in the personal element — the little acts of kindness, even of tenderness, towards the individual soldier which have helped to keep up both his fighting spirit and his mental serenity. The 'tisaneries,' as the hot tea stations are called, did not come into exist- ence as the result of army orders; they represent a volun- tary contribution to the soldier on the part of the Medical Corps. Begun in a small way, it was soon noticed that, where the tisaneries existed and the regimental kitchens were installed near enough to the trenches so that the food reached the soldier hot, the morale and fighting edge were of the finest."
An appropriation has been secured for the Initial unit of the new building for the University Hospital at Ann Arbor, Mich. The capacity of the present building is 400; that of the new building will be 1,000. It will be ex- clusively a teaching hospital. There is at present a daily waiting list of 50, the patients coming not merely from the vicinity of Ann Arbor, but from' all over the Middle West, thus showing that it is not necessary that a teach- ing hospital be located in a large city.
Dr. Noboru Ishida, author of the article on "The Non- Restraint System in the Insane Wards of Nagasaki Hos- pital," published last month, wns elected an honorary member of the American Medico-Psychological Association at its recent meeting in Chicago. Dr. Ishida intends to establish communication between the American Medico- Psychological Association and the similar society existing in Japan. Readers of Dr. Ishida's article in The Modern Hospital will be interested to know that Dr. Ishida is the author of the most popular text-book on psychiatry used in Japan, which has gone through seven editions and is about to be issued in an eighth edition. Dr. Ishida says that his advanced ideas in regard to non-restraint of in- sane patients were at first much opposed by government officials, whose respect for precedent caused them to throw many obstacles in his way. He now finds no difficulty in extending the application of the non-restraint principle. The two features of American psychiatric hospitals which particularly impress themselves on Dr. Ishida are their great size and complete equipment and the sympa- thetic understanding of the insane shown in their treat- ment.
THE MODERN HOSPITAL
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BULLETIN OF THE
AMERICAN
HOSPITAL ASSOCIATION
Monthly Bulletin issued from the Executive Office