Our present hospital regulations do not carry out the purpose for which curtains are intended. It is usual to draw them all back at eight A.M., and they are left open until the doctor's visit is over and the wards have been swept. This lasts till about mid-day. The consequence of this arrangement is that, during the most delicate operations, such as the dressing of wounds, the doctor's examination, and the change of a patient's linen, there is no sort of privacy around the sufferer, no more consideration shown for women and young girls than for others. In the day-time, another regulation prevails. Inspectors forbid concealment behind the curtains on account of the difficulty they would experience on surveying proceedings in the wards. For these reasons, the curtains are elegantly looped aside, and contribute more to the decoration of the beds than to use.
Every ward contains two rows of beds, placed along the lateral walls in such wise that the patient's head is near the wall, and his feet turn towards the centre of the ward. Why could not a low partition, covered over with stucco, be raised between each bed? This separation need not exceed 1 metre 50 centimetres in height, nor 1 metre 50 centimetres in width. It would part the beds, and not obstruct ventilation in the upper regions or down the central passage. If the ward were lighted by a sufficient number of windows to allow of one being opened in each of these "cells," the circulation of so much fresh air would greatly benefit the sick.
The front of each cell being open, surveyors would find their task rendered easy, neither would their inspection be hindered by a small iron rod being affixed to the outer side of each partition, on which two light curtains might be drawn in case of a death, or when it were absolutely necessary that a patient should enjoy privacy. The slight screens would not entail the same inconvenience as those which are in use at present, as they are mounted on a very complicated plan all around the beds. Whenever a decease occurs, the stucco coating of the low divisions should be washed with a sponge. It is well known that stucco is not a receptacle for contagion in the same degree as drapery.
Such is the kind of cabinet each patient should have to himself, and it should be wide enough for a chair and night-table to find place by his bedside. These and a crucifix are the indispensable articles every patient has a right to. This system would greatly simplify our hospital beds, now consisting of so many and such cumbersome pieces.
A little space might possibly be lost; a ward now containing twenty-five patients would only hold eighteen; but, on the other hand, what an improvement, and how much healthier an arrangement in a medical point of view!
Patients have certain communications to make to their friends on the days set aside for public admission which are not intended for the hearing of strangers; and, when the hour of death is nigh, it is but natural they should be allowed to hold converse with their relatives without any witnesses. Even this semi-retirement is denied them under the present system; whereas the plan proposed would secure the preservation of family secrets. It will, perhaps, be alleged that the patient would thus be isolated from his fellow-sufferers. By no means. As above remarked, the cells would be open down the central passage, and each patient could see his opposite neighbor. This, added to the going to and fro of infirmiers, doctors, sisters, and regular visitors, affords quite enough excitement for an invalid.
Neither is this an innovation. It was once tried at Munich, and, if but imperfectly carried out, no hygienic objection was made to it. We find this organization existed in one of the oldest hospitals in France, the Tonnerre Hôtel Dieu—a monument described by M. Viollet Leduc in his work, Dictionnaire Raisonné de l'Architecture Française du XI. au XVI. Siècle. The learned writer says this institution can bear comparison with the most boasted foundations of the present day. In the archives of the Tonnerre Hospital we find the following document. I quote because it forcibly reminds us of S. Vincent de Paul: "The poor are provided for in this institution, and the convalescent are kept a whole week after their cure, when they are sent away with a coat, a shirt, and a pair of boots. A chapel will be added having four altars. The brothers and sisters in charge are twenty in number; they are bound to provide food and drink for the wayfarer; to board pilgrims and strangers, clothe the poor, visit the sick, comfort the prisoner, and bury the dead. The brothers and sisters will not take their meals before the sick have been attended to...."
On closing this paragraph, a question arises whether people in the dark, middle ages were not more solicitous for the poor than in the XVIIIth century. A glance down a report written for Louis XV. on the Hôtel Dieu will corroborate this.
We shall doubtless hear it objected that partitions between hospital beds will inconvenience the doctors and medical students; that it will be difficult to approach patients; and young physicians will declare they cannot follow the chef's instructions near enough. It will be said, further, that, when any operation is going on, the limited space allowed by a narrow cell must exclude the use of surgical instruments.
The following considerations clear the first of these objections; but, in a strict sense of the word, the only essential thing is that the physician should not be impeded in his movements round the sufferer. He, his assistants, and about seven or eight more are all the spectators necessary, and these form a sufficiently large audience. The central passage down all wards affords room for more. Even as the beds are now placed, it is not easy for a larger number to get nearer.