SMALL-POX HOSPITALS.*

The construction and equipment of hospitals is the province of a branch of sanitary science, and of this branch I have selected a portion; viz., that of small, or as they are now commonly termed, cottage hospitals, having special reference in the treatment of the subject, to the use of these small hospitals as small-pox hospitals or pest-houses, or, avoiding those old-fashioned and apparently objectionable names, and adopting a recently recommended euphemism, hospitals for the the treatment of contagious and infectious diseases.

The origin and growth of small hospitals are exceptions to the general rule of the development of the great from the small, for the large hospitals came first and have existed for many centuries, whereas small or cottage hospitals are the product of the last three or four decades..

The great hospitals sprang from the church, and were at first and for a long time afterward devoted to the care of the old and helpless, as we would now say, asylums, and were, some of them, at least, devoted to the care of sick and wounded in comparatively modern times. Some of those enormous establishments still exist, being found in Rome, Naples and other cities of Italy.

The year 1859 saw in England, at Cranleigh, the birth of the first cottage hospital, a lapse of fifteen centuries since St. Jerome used the word "nosocomian " for an institution which must have then existed.

I will not waste the valuable time of the society by attempting to describe the various forms of cottage hospital which have been erected in Great Britain and America; nor is it deemed necessary to dwell upon the important items of site, material, etc. A few remarks may, however, be permitted on the advantages of small hospitals, and more especially of that variety of them peculiarly devoted to the treatment of contagious and infectious diseases.

The general advantages of small hospitals, beside the great one of being comparatively, if not entirely, free from the vice of hospitalism,

*From a paper read before the State Medical Society at its annual meeting January 25, 1882, by R. J. Farquharson, M. D.

so graphically and eloquently described by Sir J. Y. Simpson, are the following:

Affording as they do a home-like refuge for the poor, in cases of sickness and accident, they are not regarded with that superstitious dread, amounting almost to horror, with which all great hospitals are generally invested by the imagination of their intended inmates.

Persons treated in a well-conducted small hospital are actually surrounded with more comforts, more care and more cleanliness than are to be found in the homes of most people, for it is a lamentable fact that most private dwellings, even those of the better class, abound in unsanitary surroundings. But it is when a small hospital is used as a pest-house, i. e., for the seclusion of those sick with infectious or contagious disorders, that its great excellence becomes apparent.

If every person over the age of one month was properly protected by vaccination, as they should be in every civilized community, and as they would be in the Utopian city of Hygeia, there would not be a particle of use or necessity in isolating a single case of small-pox; however this place might be advantageous in regard to scarlatina, measles, diphtheria, and perhaps other diseases.

Unfortunately, however, there are in all communities in this country a number of unprotected, or improperly protected persons for whose safety isolation of small-pox cases is necessary.

What great assistance in stamping out small-pox and kindred diseases the complete isolation afforded by a small hospital lends, is shown by the following quotations:

No sane person doubts that the provision of adequate hospital accommodation for such cases is, in the end, by far the cheapest and most effectual course for the local authorities to adopt. Experience abundantly proves this.

Dr. Buchanan has shown the value of this ready-made provision for infectious cases by recording the results of establishing a small-pox hospital at Cheltenham with fourteen beds.

During six months of the year 1875, small-pox was brought into Cheltenham, no less than six times, from Gloucester, Birmingham, Liverpool and elsewhere. Seven persons ill of the imported disease were taken without delay to the hospital, and, except one individual (who was also removed to the hospital), nobody in the town caught the disease from these centers of contagion.

Dr. Wilson says:-At Hastings small-pox epidemics have been twice stamped out. At Bristol, on many occasions, epidemics from various infectious diseases have been averted, and probably one of typhus in 1877.

At Newcastle on-Tyne typhoid fever (once epidemic) has several times been completely stopped.

At Leet, in Staffordshire, no case of small-pox occurred after removing the first to the hospital.

At Coventry small-pox has been stopped twice, and scarlet fever on many occasions. At Ipswich, in 1877, small-pox was imported into the borough no less than twenty (20) separate times without once getting a foothold.--Burdett, Cottage Hospitals, 2nd ed., Phila., 1881, pp. 265 et seq.

All this evidence comes from England, but had we such carefully prepared statistics of small hospitals in America, which unfortunately is not the case, there is little or no doubt but that it might be duplicated here.

Another and a great advantage of a ready-made small hospital for contagious diseases, is on the score of economy, and from experience, I am fully satisfied that no outlay of public money will yield a greater return in the long run. As an illustration, I may be allowed to quote the following brief chapter of my personal experience.

In 1873, the city of Davenport and Scott county were without a proper hospital for infectious and contagious diseases; upon the outbreak of the cholera, the usual senseless panic occurred, and though the epidemic only lasted a very short time, over $2,000 of public money was expended (the most of it wasted), an amount, as will be seen further on, almost sufficient to build the efficient hospital now in exist

ence.

This brings me now to the proper subject of this paper, which is to demonstrate by example how a small hospital, especially adapted to the treatment of small-pox, cholera, scarlet fever, measles, diphtheria, or any other contagious or infectious disease (and which may be, and is, used for other purposes), may be erected upon a safe and suitable site, and for a comparatively small sum of money.

The use of the word safe, in reference to the situation of the hospital, does not refer, as it might seem at first sight, to the isolation of the building, for, in my opinion, a very slight separation from other houses is necessary, but to the protection of the hospital from destruction by fire; for, strange to say, pest-houses, although isolated from all other buildings, and not in any way peculiarly exposed to the ac tion of the elements, are of all others, in my experience, the most liable to destruction by fire. The neighbors, not near ones, of almost every building used as a pest-house, think it no crime to apply the torch of the incendiary to the humble structure.

This had been the constant experience in Scott county, each suc