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17
It was generally considered that the conference with the Medical Superintendents of the
hospitals of the Metropolitan Asylums Board, at the reading of the paper and at the adjourned
discussion thereon, would result in increased co-operation and a reduction in the average period of
detention of patients in hospital.
Since the reading of this paper, from the early part of March, 1903, Medical Officers of Health
have received notification of the dates on which it is intended to discharge fever patients from hospital.
Medical Officers of Health are also informed of errors of diagnosis which is very often of great
assistance.
I also gave statistics for the three years, 1899 to 1901, showing that since 1899 there had
been an average reduction of rather more than a week in the period of detention at the Metropolitan
Asylums Board hospitals ; this reduction having almost wholly taken place since 1900, and was of
opinion that Dr. Simpson's valuable investigation and report to the Metropolitan Asylums Board
respecting " return " cases was in no small measure responsible for this reduction, which had been
accomplished without any corresponding increase in "return " cases. A week's reduction possesses a
very great economical value in that it saves the building of a new hospital and its administration. A
new hospital costs at least £250,000, and its maintenance and administration about £35,000 a year.
In my paper I pointed out that many scarlet fever patients were also incubating other
infectious diseases at the time of their admission to hospital, and that in the year 1898, as large a
percentage as 12"57 of scarlet fever cases also suffered from other infectious diseases during their
stay in hospital and that the average for the four years 1898-1901, was about 10 per cent. I therefore
emphasized the importance of every infectious hospital being well supplied with small isolation rooms
or wards and that ordinary wards for scarlet fever, diphtheria and measles should, if possible, be
small rather than large, so as to lessen the risk of spreading other infectious diseases accidentally
introduced, and that patients at different ages should be equally distributed as far as possible through
the wards. In fact Fever hospitals should be constructed so as to secure strict isolation as far as
possible.
This ideal system of hospital construction exists at the Pasteur Hospital, Paris, which is in
connection with the Pasteur Institute. This is a hospital built on the cubicle system except two
wards which are found to be unsuitable, and will be subdivided. At this hospital different infectious
diseases such as scarlet fever, diphtheria, measles and chicken-pox, are treated in different cubicles in
the same ward. All these patients are attended by the same nurse, and yet it has never happened
that the disease of one patient is conveyed to another patient. Full details of the construction and
administration of this hospital were given by Professor Simpson in a paper, followed by a discussion,
which I had the pleasure of hearing at the Liverpool Congress, and which was published in September,
1903, in the " Journal of State Medicine."
The hospital is built on the ordinary pavilion plan with a small verandah on each side on each
story, but instead of the long ward containing two rows of beds, ten or twelve in number on cach side,
separated by the central portion of the ward, it contains the same number of cubicles, separated by a
central passage. Each cubicle has its outside window opening into the verandah, and its outside well
which is the wall of the block. Its other three walls, two of which separate it from the adjoining
cubicles, and the third from the central passage, and so constructel that the masonry part is only 4 to
5 feet in height, and the rest, to the ceiling, consists of glass. The door leading into the passage has
the lower portion of wood, and the upper of glass. The result is a series of well-lighted, selfcontained
rooms, with a well-lighted central passage, and so arranged that while admitting of a certain
amount of privacy, they are all under the direct supervision of the nurses on duty. Each cellule is
provided with its own ventilation and warming, warm air being admitted near the flour, and the
vitiated air being removed near the ceiling. It is also provided with hot and cold water arrangements.
There is no furniture in the room except a small table, chair, and the bed and requisites for the
patient. "When a bath is given, a bath on rollers is brought into the cellule and filled from the taps.
In regard to existing hospitals, many wards could with advantage be converted into the cubicle
system. Glass is now made as strong as ordinary walls, and there would be no difficulty in having
the lower part opaque while the upper pare was transparent fir purposes of administration and light.
One set of cubicles could be used for the admission of patients until it was determined whether two