HEALTH

NEW HAVEN DEPARTMENT OF HEALTH

Vol. XXXVII, No. 10	October, 1920

This article excerpted from p. 3 of the issue.

Nearly every one knows that hospitals are established and maintained for the care of the sick, but very few know anything of the management or the routine work. A few years ago people went to hospitals for treatment only when there was no other place for them to be cared for. Members of a family in which sickness occurred felt it to be a reflection on their common sense, their regard for the patient, and their financial rating if you suggested sending a patient into the hospital. There was much more reason in those days for such an attitude than there is now, for then the equipment was not nearly so good, nor were the medical and nursing staffs so highly trained and efficient as they are to-day.

The medical men serving on a hospital staff have always been chosen from among the most efficient men of their profession, but a generation ago highly trained specialists were very few and found only in the very large cities. There were then but two divisions, medical and surgical, the only difference being that the medical man did not have the courage or liking for surgery and the other did, but both prescribed for the various ills that now are cared for by a specialist. However, the opportunities afforded by hospitals to group the cases and keep accurate records gave them a great advantage and as the data accumulated some began to study the records and give their entire time to acquiring information regarding a specific subject. The people have been quick to recognize an advantage in this and to encourage it until now the "general practitioner" is rapidly disappearing, giving way to the man who devotes his whole time to one branch of medicine.

The modern hospital has on its staff, as a rule, a group of highly trained specialists, each attending strictly to his own business and referring to other divisions such as appear to need attention outside the boundaries of his own specialty. A man entering the wards of a good hospital to-day will have to do very little guessing or listen to very little guessing by the physicians as to what his condition is and how it will terminate. He will be examined on admission and we will say for illustration that the symptoms and appearances indicate that he is strictly a medical case. He will be removed to the medical ward where he immediately is given a thorough physical examination by the specialist on internal medicine, specimens of blood and urine taken and sent to the laboratory for examination. The old hospitals had no laboratory or they were very crude compared with those of to-day, but no first class hospital could get along to-day without a good laboratory. During the course of the physical examination, one or more lesions may be noted on the skin and the patient may complain of poor vision. A little later a skin specialist examines the lesions and an eye specialist will examine the eyes. Each makes a record of his findings and each makes recommendations for the patient's relief, remaining strictly within the boundaries of his own specialty. Later the report from the laboratory is returned and perhaps this, coupled with the physical examination, leads to the decision that surgical interference is necessary. The patient is then transferred to the surgical ward, if the surgeon has also made an examination and agreed with the internist that it is advisable to operate. After being prepared and removed to the operating room, the patient falls into the hands of two more specialists, one is the anaesthetist and the other is the operating room nurse and so it goes. No matter what affliction brings one to the hospital, the various troubles, as they are discovered, are cared for by a specialist.

The nurses have kept step with the doctors and have learned to record a multitude of things that help in the diagnosis, that adds to the comfort of the patient and warn of approaching danger, and their tact, sympathy and gentleness are among the last things forgotten by those who by necessity made their acquaintance. They too are specializing to some extent.

People of the cities have come to realize that hospitals bear somewhat the same relation to sickness that banks do to money. A sick man belongs in a hospital and may reasonably expect better returns from an institution maintained for the purpose and directed by a corps of experts, just as surplus dollars belong in a bank where they are handled by experts and promise reasonable returns with safety. This popularity is spreading to the rural districts where hospitals are beginning to make their appearance. The chief difficulty appears to be in inability to obtain suitably trained nurses and doctors. Hospitals for communicable diseases, in rural districts, are being looked on with great favor in many sections of the United States and many are being successfully operated.

The isolation hospitals of a few years ago were called "pest houses" and they were, just that. Usually an abandoned house outside the city limits was procured and furnished with the cheapest furniture that could be obtained. A room contained a bed, chair, cheap bed clothes, and occasionally a table which might be used to support a glass and pitcher of water. Frequently the table was not available and the glass and pitcher of water sat on the floor near the bed where the patient might reach it if he had sufficient strength. Sometimes an abandoned house could not be found in a suitable place, so shacks were built of undressed lumber and made as simple, cheap and uncomfortable as possible. In some cases the city health officer was required to look after such cases as were so unfortunately situated that they were obliged to go there. More often some physician was chosen pest house officer who needed the money and whose political affiliation was with the party governing the city. There was never any question of experience or ability, but chiefly political expediency. In any case, his residence was usually several miles distant from the pest house and would require an hour or two to send in for him and get back. Rarely was a nurse regularly employed, but one or possibly two would be employed when a number were admitted. Naturally the situation had to be desperate when this occurred and police aid was essential. Frequently no trained attendant was available and some man, most likely a consistent loafer, or some needy woman was employed to do the nursing, that is, they gave medicine left by the doctor when they thought about it and would respond to a call for water or some other request, if they thought that the individual requirements were not too many. If the doctor was a conscientious human being, he visited them one or more times daily, according to their needs and did what he could to overcome the disease and make them comfortable. In many instances the doctors were indifferent and several days might pass between visits.

These pest houses were rarely used for the more common infections unless they became epidemic and very deadly or it became necessary to remove some one from the Jail, for no one voluntarily sought admission there. There being no better place to go, they remained at home and spread the disease to their neighbors and each year the death toll from communicable diseases was very great as compared to that of today. There are a number of fairly large cities in this country that are yet without contagious disease hospitals, but the demand is so imperative that they will be unable to get along without them for long. The larger cities have several such hospitals and require the immediate removal to them of all contagion, the safety of the community receiving the first consideration, so that it is of no avail for a family to oppose the removal of some member to such a hospital, for it will be quickly accomplished by the police if they are obstinate.

The hospitals into which they are carried now are vastly different from those of an earlier day. The equipment is of the best, the buildings are good and every helpful agent is considered. There is provision for plenty of fresh air, sunshine and warmth. There are comfortable beds and cheerful rooms and wards. The physicians and nurses are trained to care for these cases and have every facility for correct diagnosis, safeguarding and caring for these patients.

The well organized efficient health departments of today are able to restrict the movements of infectious cases and contacts and have, by their vigilance and efforts to inform the public of the causes and methods of spreading and preventing diseases, greatly reduced the number of cases and deaths. There are in all cities great numbers who fail to profit by what they are taught and many who will not obey the laws governing such cases and hospitals for communicable diseases offer the only safe means of disposing of them.

We have in this city an excellent hospital for communicable diseases, large enough to accommodate nearly all the infections that appear in the city, except when there is an epidemic such as we had recently of influenza. A certain sum is allowed the Health Department for sending cases there but it is so small that it does not permit us to send more than half of those who should go there for economic reasons alone.

If a family of eight occupy four rooms, as is often the case, having but three rooms in which to sleep, perhaps very small rooms, it is practically impossible to isolate a case and removal to the hospital should be compulsory. The chief objection brought out by parents, particularly foreigners, to having their children in the hospital is that they are denied the privilege of visiting them and of course visiting is not consistent with isolation. When a patient is very sick and in danger of death permission is always granted one or two members of the family to visit them at any hour and continuously until the patient dies or is out of danger.

The advantages of an isolation hospital are chiefly these: the patient is given more intelligent care than is possible at home; it leaves the other members of the family free to pursue their usual vocations without restraint; and removes the danger of infection from the community. When all cases go to the hospitals, instead of only those who are dangerously ill, the mortality rate will naturally be lower than when cared for in homes and the prompt removal lowers the contagion to a minimum in any city. We cannot urge too strongly a greater interest and expenditure of money for hospitals for the care of infectious diseases.

G. HENRY, M.D.,
Epidemiologist.