Library Collections: Document: Full Text

The earliest lunatic hospitals among us were constructed very much after the fashion of the old establishments of England, with this important difference, that some of their few redeeming qualities were sacrificed to economy, while the loss was counterbalanced by no compensating qualities. The architectural construction of our hospitals, thus bad in the beginning, has rather deteriorated than improved, and it is a mortifying fact that while we have been satisfied with going from bad to worse, in Great Britain hospitals, better than some which have been erected among us since this Association commenced its meetings, have been taken down to make room for others comprising more perfect arrangements.

The first step towards increasing the confidence of the public in our hospitals, will be to deprive them, as far as possible, of their prison-like or peculiar features, and assimilate them to domestic dwellings. Narrow, dark halls, low ceilings, and bare walls, should give way to more spacious and cheerful apartments. The monotonous ranges of windows, row above row, the long, blank wall, extending its dreary monotony for many a rod, a style of building in short, which is no style at all, but that of providing the greatest number of rooms at the smallest expense, should be replaced by more pleasing forms of architecture, reminding us less of a jail or a factory, and more of a comfortable and graceful private residence.

There are many particular arrangements quite common among us, that tend more or less directly, to create ill-feeling, and consequently must be abandoned, if we would diminish this evil. First and foremost among these objectionable points are the apartments for the most violent and refractory patients. The only object which seems to have been sought for, in their construction, is strength, without the least attempt to conceal or soften down those obnoxious features which are always associated with mere strength. The patients who are obliged to occupy them, call them cells or dungeons; they regard them as places of punishment or degradation; think of them with an emotion of horror, and not all the benefits they have derived from the hospital can efface the unfavorable impressions which these rooms have stamped upon their minds. The friends are apt to imbibe the same impressions, and fortunate it may be for all parties, if they are not led thereby to a precipitate removal of the patient. Now, I do not believe there is any necessity for this. Rooms may be made strong without being made like a cell or a cage. A little ingenuity and a little expense are only required, to render them, apparently, like the other rooms in the house. The walls may be covered with an indestructible paint or cement; the light may be admitted through windows out of reach or protected by iron netting; hot air may be discharged by registers at the upper part of the room; the door may be secured by the ordinary lock; and a close-stool may be placed in a corner, discharging into a soil-pipe connected with the main drain. These rooms may open upon a hall arranged in all essential respects like the others, and provided, like them, with dining-room, water-closet, bathing-room, clothes-closet, &c. Not only is the comfort of the patient thereby greatly enhanced, but the friends who sometimes insist on seeing his room, are shocked by none of those disagreeable features which now frequently meet their view.

For the same as well as other reasons, these apartments should form a portion of the main building, or at least, not entirely separated from it. I doubt if any arrangement in our hospitals is so strongly calculated to excite dissatisfaction and hard feeling, as separate buildings for this class of patients, and, judging from my own experience, with such ample reason. In passing back and forth, females are necessarily exposed in a very unseemly manner, sometimes it may be, to visitors on whom the sight will make a disagreeable impression. Although of all classes of patients, that which needs the closest supervision of the officers, it is made the least accessible, and consequently the least attended to. If the plea of necessity could be urged in favor of this arrangement, or if it were chosen as the least of existing evils, it might be tolerated, but I have been led to the conclusion, that in no single respect, does it possess any advantage over the other. The principal, if not the only object supposed to be gained by it, that of having the noise beyond the hearing of the quiet patients, can as well, if not better be obtained in a different way. By a little contrivance, these apartments, though constituting a part of the main building, may be so insulated from it by means of thick partition-walls, entries and closets, that sound cannot be easily propagated from one to the other. In the Butler Hospital, with an insulation of this kind, but much less perfect than it might have been made, I can truly say, after an experience of over four years, that the annoyance resulting from such proximity, is practically so little as to be scarcely noticed by officers, attendants or patients. When we consider the greater facility thus afforded for removing patients, especially in the night, the less danger of making those disagreeable impressions which such a transference is liable to occasion, and the greater ease by which they may be inspected by the officers, the question between the two arrangements is settled, I think, beyond the reach of dispute.