Hospitals began to run down with the pression of the religious houses in many countries after the religious revolt in the le century. became state institutions uMet paid officials and above all women were replaced by men in control of them. The rule of history is that whenever women are hot at least co ordinate in authority and not mere subordinates in the care of the ailing, t'ae old and children, serious abuses soon creep in. The lowest period of decadence in the history of hospitals came during the later 17th, 18th, and the first half of the 19th century. Jacobsohn, in his (Essays on the History of Care for the Ailing,' says ((it is worthy of remark that attention to the well-being of the sick and improvements in hospitals and institutions generally, had a period of complete and lasting stagnation from the close of the Thirty Years War" (1648). He adds: ((The hospitals of cities were like prisons, with bare, undecorated walls and little dark rooms, small windows where no sun could enter, and dismal wards where 50 or 100 patients were crowded together, deprived of all comforts and even of necessaries. In the mu nicipal and state institutions of this period the beautiful gardens, 'roomy halls and springs of water of the old cloister hospital of the Middle Ages were not heard of, still less the comforts of their friendly interiors.° Garrison in his 'History of Medicine) says that °hospital con struction approached perfection in the 15th cen tury, the greatest care being devoted to these structures. ° He mentions that there were 27 hospitals in Scotland alone by the end of this century. Hospitals for special purposes had begun to be built before the end of the Middle Ages. The earliest of these were for children and particularly for foundlings, and their or ganization in the 13th century was very com plete. The Ospedale degli Innocenti of Florence is still in existence after seven centuries, doing its work The colony system for defective children had gradually come into existence sev eral centuries before, at Gheel in Belgium and in certain towns of North France. The first special hospitals for the insane were erected in Spain. Pinel, the great French psychiatrist, who struck the manacles from the insane of France (circa 1795), declared Spain to be the country in which lunatics were treated with the most wisdom and the most humanity. Before the end of the Middle Ages, Bedlam or Beth lehem Hospital in London received the insane, for Tyndale uses the word as meaning a mad house or a madman. On recovering their reason, patients were allowed to go out of this hospital (the open-door system) wearing a badge to indicate that they had been for some time in the asylum. This index of their pre vious condition made people so kind to them that special provisions had to be made to keep tramps and other °sturdy vagrants') from wear ing these badges and abusing the confidence of the public. The first special hospital for eye diseases in America came about 1820. The first nose and throat hospital in the world was or ganized in New York about 1870. Orthopedic hospitals for the special treatment of crippled children came about the same time.
The modern hospital revival began well after the middle of the 19th century, and in deed did not make itself felt to any serious extent until after Lister's discoveries led to the development of modern surgery. Three things, good hospitals, good nursing, and good surgery, are inseparably bound together Dur ing the period of fine hospital construction in the later Middle Ages, there was an excel lent development of surgery and of nursing. Strange as it may seem, for several centuries at this time, serious operations were performed under an anaesthetic and surgeons boasted of getting union by first intention. They used
linen soaked in strong -wine as primary dress ings for their wounds and this acted as an antiseptic. These mediaeval surgeons declared that it was not necessary to have pus in wounds, but that on the contrary the presence of pus was an index of negligence of the surgeon. Unfortunately, this teaching went out, to be followed, for some five centuries, by the doc trine of laudable pus. As a result, hospitals became surgically unclean, and infections multi plied to such an extent that surgeons feared to operate. Before Lister's time, a mortality• of over 50 per cent of operative cases WRS not unusual in hospital experience. After Lister, die of absolutely clean hospitals came to be appreciated and hospital construction has been largely influenced by the necessity of avoiding infection to as great an extent as possible. Practically all the developments in hospital building in recent years are made with an eye single to facilitating such care of patients as will prevent their becoming infected or com municating any infection to other patients or leaving anything after them that might prove a source of danger to subsequent inmates.
The old-fashioned method of hospitals came to an end when under the initiative of Dr. John S. Billings, Assistant Surgeon-General and Librarian of the Surgeon General's Library, special studies were made for the erection of the Johns Hop kins Hospital in Baltimore (1875). After this, much less attention was paid to the outside of hospital buildings, and the inside became the subject of intensive study so as to be adapted to various purposes of hospital work. Ques tion% of ventilation, of floor space and of ar rangements for the convenience of patients and physicians, with the proper segregation of in fectious cases medical and surgical, and the provision of convenient rooms for laboratories and dietetic equipment, were now the main purpose of hospital architects. A new school of hospital architecture arose and America came to be the centre of world attention in hospital construction. Appropriate rooms were supplied for the hospital resident staff who, as late as the 1860's, were often crowded into a single room, four, six, or even eight together, sometimes with no other place for study or relaxation. This sadly interfered with their work and its usefulness for themselves and the patients. With the coming of the trained nurse, fitting 9uarters had to be provided for her, and training schools gradually added, be cause it was found that it was through them that hospitals could best secure this valuable adjunct. Once these principles were clear, the erection of hospitals excellently adapted to the needs of modern medicine and surgery went on apace here in America, until now there are altogether some 5,000 hospitals in the country. Many large Industrial corporations have met the problem of caring for the injured among their workmen in special hospitals where the nursing and medical and surgical attention is supplied by the employers. Some not using heavy machinery provide a physician and nurse in attendance during the day in special hospital quarters, because it has been shown that in this way the health of working people, particularly women, can be better conserved and absence due to sickness with consequent reduction in commercial efficiency greatly lessened. These hospital quarters are often built with every modern detail and are models of their kind.