THE INFECTIOUS DISEASES HOSPITAL.

New Zealand Herald, Volume XL, Issue 12239, 7 April 1903, Page 3

THE INFECTIOUS DISEASES HOSPITAL.

INTERESTING REPORT BY DR. COLLINS. THE UNSUITABILITY OF THE PRESENT GROUNDS. At an ordinary meeting of the Auckland Hospital and Charitable Aid Board, held" yesterday afternoon at the Board's offices, Dr. Collins, the senior medical officer to the Board, submitted a lengthy report on the proposalsupported by representatives of the local bodies— erect an infectious diseases hospital on the district hospital grounds. The report was as follows: — I have the honour to submit for the information of the Board, at the request of the chairman, a report dealing with the question of the erection of an infectious diseases hospital on the General Hospital grounds, so strongly advocated, and proposed, by the unanimous resolution of the local bodies at their last conference. As I understand this hospital is intended to be a permanent structure for the treatment of infectious cases, I should first like to point out for the information of the Board what is the actual meaning of a suitable permanent hospital for the treatment of infectious diseases, and then apply its construction to the various sites available in your grounds, which may appear advantageous to the minds of several gentlemen who are favouring this extremely Quixotic scheme, irrespective of any valuable medical testimony which may be received as to its inadvisabihty, some of whom have 'actually expressed their determination to enforce their ideas in totaLclisregard of any opposition which may be brought to bear in the interests of public health and common weal. I will now describe such a hospital: For a permanent infectious hospital the site should Be as dry and open as possible, not exposed to smoke or maism borne by wind, and not unduly sheltered by trees, buildings, or hills. Long wards facing east and west, so as to admit sun on each side alternately, and if any deviation is necessary, it should preferably be such as to give a south-east and north-west aspect. Secondly, long wards are more readily ventilated, .warmed, and lighted, more economical in construction and management, and more convenient as regards nursing. Their, width should be 24ft to 30ft, the height 13ft to 14ft, and the length such as to 'allow a cubic space not less than 20Q0ft. It is not permissible to obtain this space by increasing the height; extreme height is of little utility as regards ventilation, and in hospitals it is essential to have plenty of floor space around each bed. Wide separation of beds is important in such cases, 130£t to 140 ft of floor space is imperative, and for convenience, of nursing the number of beds in one ward should not exceed 32, and usually 24 or 23 would be preferable. The beds are arranged with their heads to the wall facing into the ward; each bed should be placed between two adjoining windows, the snace between the windows being not less than a foot wider than the bed; at most two beds may be allowed in one space, the interval between them being at least 3ft. The intervals between the windows? of a ward should be such as to 'allow of this arrangement. The windows should reach to within a foot of the ceiling. All surfaces should be impervious and washable, and all ledges, crevices, and : stagnant corners, in which dust may lodge, must be avoided. The floors may be parafined or waxed, the walls lined with tiles or glazed bricks or Parian cement, or, in the absence of such materials, simply painted. Ventilation must be provided for to the extent of at least 3000 ft per head per hour, and the whole air of the ward ought to be changed thrice hourly, so that the hourly supply of fresh air should be three times the cubic capacity of the ward. In the most modern hospitals for infectious diseases they have an extraction shaft upon a large scale, the foul, germ-laden air being made to pass through a gas furnace. Most, if not all, of the germs are no doubt destroyed in this way, and the rest are prevented from diffusing horizontally. Now the communication with the outside has to be kept under strict control. Infectious disease hospitals should themselves be isolated from other buildings, and even from thoroughfares, by reserving a large open space. The boundary walls should be 64ft high all round the hospital area. Each disease must be isolated separately, and, if possible; in separate blocks not less than 40ft apart, and the same distance from the boundary. There should be no communication whatever between the different blocks, ■and the intercourse with the common administrative department should be. as little as possible. A special block containing at least two or three small wards is necessary for doubtful cases, or cases not received into the principal wards. The essential parts of a hospital for infectious diseases are:— An administrative block, including rooms for medical' officer, nurses, servants, dispensary, kitchen, scullery, larder and pantry, laundry, linenroom, storeroom, coalplace, bathroom, closets. (2) Hospital blocks, viz., at least one for each disease, to be isolated, and in each block at least two principal wards, one for each sex. - Additional wards for one or two beds are desirable. Besides the wards, closets, and sinks, and bathrooms, each block should contain a nurses' room overlooking the ward, and so arranged as to serve as a scullery and ward kitchen for minor cookery, linenroom, storeroom, and coalplace. The nurses' sleeping room must be away from the wards, and is usually placed in the administrative block. • Arrangements must be made for the patients from each block to take exercise in the grounds without coming into contact with each other. (3) Mortuary and post-mortem room, disinfecting room, and ambulance shed. I would now draw your attention to the necessity of providing for, extension. The number of beds which should be provided for has been stated as one for each thousand of population, but very few towns have adopted tins standard as far as permanent hospitals are concerned. It is obvious that such an estimate can only be of the roughest kind. Much depends upon the character of the population, upon the number of diseases which it is proposed to isolate, upon the compulsory notification of those 'diseases, upon the thoroughness or the reverse with which the policy of isolation is to be carried out, and lastly upon the question whether the hospital is intended to be a final and inelastic establishment, or merely a permanent provision sufficient for non-epidemic times, but capable of rapid extension at a few days' notice in the evant of serious epidenvc. It is obvious also that averages are of little use as indicating the maximum possible demand for hospital accommodation at any given date, and it is not to be assumed that only one disease will be epidemic at one time. At the present time compulsory notification is becoming generally adopted, and even apart from this hospital isolation of infectious cases is growing in public favour wherever the means are provided. Fence the experience of past years under different conditions is of little service as indicating the amount of accommodation likely to be required. i To sum up, therefore, on the question of adequate provision for extension, the provision of one bed per thousand population has . in the past been found to be unnecessarily large and costly, but is not likely to be in the future. It will not indeed suffice in the event of epidemics according to the experience of those towns in which notification and adequate isolation have now been tried for some years, and if ever such diseases as measles and whooping cough are to be isolated, large additions will be necessary. . It is, therefore, imperative on those who are responsible for this hospital to reserve a' liberal extensive area for future extensions, temporary or otherwise,' and to construct the administrative portions upon such a scale as to suffice in case of such extension of isolation blocks. The wards should be constructed so as to admit of disinfection, so that the greatest number of beds may always be available for whatever disease is prevalent at the time. This can be done with safety, and without difficulty if all the internal surfaces are impermeable. Of course, the time-worn argument that this proposed hospital is only intended for present circumstances, to cope with and prevent the difficulties which the Health Department and the Hospital and Charitable .Aid Board have had to face in the past year, and also those which are likely to arise for the next few years, and therefore will not need extension for some time, will be quoted; and thus wisdom allows the future . to bake care of itself, from which premises the leaders of the public- eager for the monetary advantage thus gained, and conscious of their own self-interest, argue a wooden construction will meet all requirement's. It'will satisfy the public on the one hand, and we' shall thus be able to shield the greed of self-interest, under the estimable Veil of an. exemplified interest in the public welfare, but I would point out for the benefit of the Board that wooden hospitals are very common, and can be run up in two or three weeks. Their comparative cheapness and the rapidity with which they can be erected are important points in favour of temporary hospitals, but, nevertheless, their proper function is to supplement and not to supersede permanent buildings of brick and stone.. They are less attractive in appearance than the latter, less comfortable, and more difficult to ventilate efficiently and to keep warm or cool. True disinfection such as to fit them for the reception of cases of different diseases, if not impossible, is at least less easy and less certain than in buildings with hard non-ab-sorbent surfaces, free from pores and crevices. Their durability is far less than that of a permanent building, and an annually increasing outlay is needed, in order to keep, them in habitable repair. It is often claimed on behalf of temporary hospitals that no disinfecSon is necessary, since they, can be burnt at the end of an epidemic and renewed, but this plan would very soon prove more costly than the erection of permanent hospitals, and has rarely, if ever, been put into practice. The economy in : first' cost is great, but is usually exaggerated. It must be remembered that the cost of erecting a permanent hospital, as ordinarily stated, includes the preparation and laying out of, the site, fencing, draining, water and. gas supply, erection of accessory buildings, such as mortuary, disinfector. etc., and the whole cost of administrative Week. These are not usually included in the stated cost ef temporary hospitals, although just, as essential in the one case as the. other. Furthermore, the cost per bed largely depends on the number of beds that are allowed in the given cubic space, and it will he found that if the standard adopted in permanent hospitals is applied to all, the nominal accommodation in temporary hospitals will often be reduced by,, one-half or more If the comparison is made upon eaual terms, the saving in the first cost is insufficient to compensate for the want \ of durability, and for every I purpose of use permanent hospitals have great

advantages. The liability to fire must not be forgotten. The only real advantage of temporary hospitals is. therefore, rapidity of erection, and (except as a supplementary provision) this can only be important when the sanitary authority has failed to make a public, swayed by monetary considerations, see its obvious duty "of providing a hospital without waiting for an epidemic. It is then frequently too late, however speedily the hospital is got ready. Means of isolation are needed at all times in every large community, and it is even more important to endeavour to delay and prevent' outbreaks by excluding the few "sporadic" cases, than to grapple with epidemics already hi existence. I would now draw your attention to the question of maintenance. It is of the utmost importance if isolation is to be attempted upon anything like a proper scale, to make such hospital free, and this is only reasonable since the public gain at least as much as the patient by his isolation. The public must not. regard removal to the hospital merely as a privilege, sought by the patient, and his medical adviser, but as a more or less reluctant concession to public safety. Any charges, however small and readily remitted, are deterrent in the very cases in which isolation is most needed. The revenue from salients' fees is at best a small fraction' of the cost of maintenance, and the wholesale remission of them (without which the isolation of cases among working classes is impracticable) has an appearance of charity which is naturally resented.

I would next draw your attention to the site of such a hospital. The Public Health Acts, Amendment Act of 1890,' in England, an adoptive Act, of which part 3 is concerned with sanitary matters, says:—"No new building may be erected upon ground impregnated with animal or vegetable matter, or upon which such matter has been deposited, unless such matter has been properly removed or has become innocuous; if any portion of a room is immediately over any cesspool, midden or ashpit, it is illegal to occupy it, or to suffer it to be occupied." I purpose now applying the foregoing remarks to the available sites at present in the hospital grounds, which are as follows:— Firstly, the ground immediately in front of the hospital now occupied by the tennis court, and running in a vertical line to the isolation cottage. This, lam sure, will be dismissed at once as impossible. Secondly, the space running down from the tennis court horizontally in. the direction of the now destructor. This in area equals about'one acre and a-half, and has running through it £>n open drain, which during the winter mc nths is over 15ft wide, impregnated with vegetable matter, connected with a spring rising underneath the tennis ground, with a fall of nearly 20ft, for building purposes, and quite unsuitable in space for the accommodation of a hospital such as I have described, which will be capable of adequate extension. Besides having the disadvantage of being placed in close proximity to the principal thoroughfare of the hospital, and causing an obstruction to the view from the front of the hospital. Thirdly and lastly, the level space on which our destructor at present stands, and at one time occupied by the Old Men's Refuge, which is 200 ft in length and 120 ft in breadth, having a cesspool in its centre now filled up with ashes, and also has been the receiving ground for past years of the ashes and dirt from the old destructor, and at present is a huge ashpit over-runV'with rats,' totally inadequate in space for such a building, and in very near proximity to the residents of Grafton Road. These, gentlemen, are the available spaces upon your hospital grounds on which representatives of the local bodies would force the building of an infectious diseases hospital, re-gardless-of all warning to the contrary, and would have the public understand that you have available space for the accommodation of such. Now, consider the dangers of infection arising in your hospital wards. Experience has shown that if carried out properly, isolation, disinfection, and quarantine can very greatly reduce the incidence of these diseases, but there is always danger from unrecognised causes, from the early stages of the disease before the diagnoses are made, from importation of infection, and from accidental or wilful neglect of precautions. It must also be remembered that there may be modes of infection in these diseases at present unknown to us, and this is especially probable in respect to diphtheria. . I am sure you will, on reviewing this report and considering it in detail, see the inability of any extension of such a hospital if built on these grounds, the impossibility of crowding such a building on to the narrow space at your command, the unsuitable nature of the' ground on which it is proposed to be built, the danger of infection throughout your main hospital from causes I have mentioned before, from the unsuitable surroundings in the vicinity of such a hospital, namely your nurses' quarters, and the residents of Grafton Road, and from the excessive cost of maintenance and inadequate return, and. lastly., from a truly, conscientious as well as an honourable sense of public duty, which, before deciding on its advisability has urgad von to ask for medical testimony _ on tnis point, and which I am sure will guide your decision in stoutly refusing to allow the building of such a hospital on your ground, and thus protecting the public against themselves from committing a fatal and irremediable blunder, which their leaders at present are driving them to do from the monetary aspect of "the case, and which in years, to. come, as enlightenment advances, their children will unite with the opinions of scientific men at present in Auckland in saying the Hospital and Charitable Aid Board m their wisdom and forethought prevented us at least from, committing one of the most grievous errors which human flesh is heir to, namely, the abandonment of all human forethought and prudence for the sake of monetary advantages thereby gained. The Chairman moved, "That Dr. Collins be thanked for his report, and that it be handed to the press for publication." Mr. Bruce seconded, and the resolution was carried. . . ~,.., Mr. Patterson was of opinion that the report should be supplied to the public in pamphlet form, and Mr. A. P. Friend moved "That 100 copies bo printed and distributed." ■" Mr. Bollard thought that before this was done the matter should bo thoroughly thrashed out. Formerly when the question of erecting an infectious, diseases hospital ill the hospital grounds was mentioned, the hon. medical staff raised no objection. He did not expect the doctors to go against Dr. Mason. Mr. Friend pointed out that the hon. medical staff did not complain formerly because they were not asked to report on the question. Mr. Bollard considered the time near at hand when /the counties would have their own separate hospitals. The present building would then be only the city hospital. An amendment, "That the matter be postponed until the next meeting," was moved by Mr. Bollard and-carried. Intimation has been received from the Hon. Mr. Walker by the town clerk that the representations of the local authorities on the question of the infectious diseases hospital will.be laid before Sir Joseph Ward on his arrival in Wellington. The Minister promised that the representations would have every consideration.