After a careful examination of the question, the first lesson acquired is that home relief is the best solution to the problem of misery and illness in needy families; it encourages the lower classes, besides, to perform their domestic duties.
In one case out of ten, it is highly prejudicial to remove a patient from his surroundings; moreover, it loosens the family tie, and in Paris especially, where these bonds are so slight and so incessantly undermined by false theories, it is a more damaging course than elsewhere.
Statistics are very justly resorted to for the solution of many of our problems, but their conclusions cannot be blindly adopted in medical cases; physicians themselves often warn us against glancing them over without investigation. Figures do, however, undeniably prove that mortality in hospitals is much larger than in private dwellings. A considerable number of patients, to whom fresh air is a boon, cannot breathe a vitiated atmosphere with impunity. Crowding is particularly prejudicial to the wounded and in lying-in hospitals. "In 1861," says Dr. Brochin, in his Encyclopædia of Medical Sciences, "the proportion of patients cured by home relief was 49 to 100, while the proportion of deaths in private dwellings was 9 to 100. During this same period, deaths in the hospitals were 13 to 100. The average space of time required for the treatment of each patient in his own home is from 14 to 39 days; in the hospitals, from 25 to 83. The average cost of a patient per day is 1 fr. 19 c.; the entire treatment of each, 16 frs. 90 c.; whereas, in the hospitals, a patient costs 2 frs. 25 c. per day, and 61 frs. 45 c. for an entire cure. These figures plead in favor of home relief."
A great deal has been said in these latter times of those immense edifices pompously called "Model Hospitals." There is Lariboisière, for instance, and the new Hôtel Dieu. It would have been wiser had the government spent less in one instance, and been more lavish in another; for, while these magnificent buildings were being erected, palaces were also in course of construction all over the capital, and the laboring classes, thus driven from their workshops, were compelled to seek lodgings up in attics or in out-of-the-way localities. If some trouble had been taken to cleanse and widen the poor man's tenement, or had something been done towards putting him in the way of getting food at little cost, we should boast fewer façades, fewer sumptuous edifices, but the work would be more meritorious.
Physicians have energetically opposed the idea of accumulating so large a number of patients in the Hôtel Dieu as it was originally intended it should contain. Let us trust the observations of experienced men will be taken into consideration, and that the number of beds will be diminished before final arrangements are completed.
HOSPITAL BEDS.
Our beds are too close; and another thing which strikes a foreigner on visiting our hospitals is that the divisions which are supposed to seclude one patient from his neighbor, are perfectly useless for that purpose. In many cases, they are done away with altogether. The proximity of beds varies, however, according to the different asylums. Some of the buildings were not intended for hospitals, and their managers have had to turn rooms into wards in the best way they could, in spite of defective architecture. It is difficult to specify the exact distance kept between the beds; but an idea can be conveyed when I state that any patient, by stretching his arm out, without any great exertion could easily touch his neighbor's hand.
In many hospitals, the beds have been coupled by two and two, so that, if two patients are thus closer to each other on one side, the distance is larger from other patients on the opposite side.
There is, however, always space enough left for a night-table between every two beds. In most hospitals, beds are hung round with white calico curtains; but in some asylums they are omitted, and in these there is literally nothing to hide patients from view. Such a system of total exposure is perfectly inhuman. I should say it originates in a spirit of medical socialism; for it compels sufferers to exhibit their wounds to each other during the doctor's visit. Some men and all women cannot endure this ordeal without a struggle. Why not sympathize with that which can be alleviated, if not entirely cured? What would be our feelings if, when brought low by fever and diet, we had to lie near a man who is breathing his last, and to remain in full view of his corpse for long hours after he had expired? But, as before said, the larger number of hospital beds are hung round with curtains, maintained in opposition to our Paris doctors, who have repeatedly protested against them, insisting that all hangings draw unwholesome miasms, and are therefore receptacles of contagion. This objection is not unfounded; eminent practitioners experience great uneasiness on the subject, and the curtain difficulty has often been debated by managers of sanitary institutions.
Endeavors have been made to obviate the evil by a renewal of hangings every six months; in spite of the great expense, the difficulty exists. It is next to impossible to ventilate a ward encumbered to excess with beds and hangings; and, if the principals of hospitals do still advocate curtains, it is because they are actuated by motives of a moral order. In M. Husson's Study of Hospitals we find: "These calico divisions are a great comfort to female patients; it is a great relief to them to be able to conceal their diseases from the public gaze, and thus to isolate themselves from surrounding wretchedness. This feeling of modesty, or shyness in other cases, will long resist the most eloquent exhortations of our doctors on general salubrity."