The Construction of Hospitals for the Insane

PART I.

* Chapters 1 - 10

Chapter I
PRELIMINARY REMARKS
Chapter II
DEFINITIONS OF INSANITY
Chapter III
FREQUENCY OF INSANITY
Chapter IV
CURABILITY OF INSANITY
Chapter V
ECONOMY OF CURING INSANITY
Chapter VI
HOSPITALS THE BEST PLACES FOR TREATMENT
Chapter VII
DIFFERENT CLASSES OF HOSPITALS FOR THE INSANE
Chapter VIII
STATE PROVISION TO BE FOR ALL CLASSES
Chapter IX
THE ASSOCIATION OF MEDICAL SUPERINTENDENTS OF AMERICAN INSTITUTIONS FOR THE INSANE
Chapter X
FIRST STEPS TO SECURE A HOSPITAL

* Chapters 11 - 20

Chapter XI
FORM OF LAW FOR ESTABLISHING A HOSPITAL
Chapter XII
BUILDING COMMISSIONS
Chapter XIII
SELECTION OF A SITE
Chapter XIV
AMOUNT OF LAND
Chapter XV
SUPPLY OF WATER
Chapter XVI
DRAINAGE
Chapter XVII
ENCLOSURES
Chapter XVIII
PATIENTS' YARDS
Chapter XIX
IMPORTANCE OF ARCHITECTURAL ARRANGEMENTS
Chapter XX
CHARACTER OF PROPOSED PLANS

* Chapters 21 - 30

Chapter XXI
SIZE OF BUILDINGS AND NUMBER OF PATIENTS
Chapter XXII
POSITION, AND GENERAL ARRANGEMENTS OF THE BUILDING
Chapter XXIII
FORM OF BUILDING
Chapter XXIV
HEIGHT OF HOSPITALS
Chapter XXV
TEMPORARY OR WOODEN STRUCTURES
Chapter XXVI
NUMBER OF PATIENTS IN A WARD
Chapter XXVII
NATURAL VENTILATION
Chapter XXVIII
CELLARS
Chapter XXIX
MATERIALS OF WALLS
Chapter XXX
PLASTERING

* Chapters 31 - 40

Chapter XXXI
SECURITY FROM FIRE IN CONSTRUCTION
Chapter XXXII
ROOFS
Chapter XXXIII
SIZE OF ROOMS AND HEIGHT OF CEILINGS
Chapter XXXIV
FLOORS
Chapter XXXV
DOORS
Chapter XXXVI
LOCKS
Chapter XXXVII
WINDOWS AND WINDOW GUARDS
Chapter XXXVIII
INSIDE WINDOW SCREENS
Chapter XXXIX
STAIRS
Chapter XL
ASSOCIATED DORMITORIES

* Chapters 41 - 50

Chapter XLI
INFIRMARY WARDS
Chapter XLII
BATH ROOMS
Chapter XLIII
WATER CLOSETS
Chapter XLIV
WARD DRYING ROOMS
Chapter XLV
WATER PIPES
Chapter XLVI
DUST FLUES AND SOILED CLOTHES HOPPERS
Chapter XLVII
KITCHENS AND SCULLERIES
Chapter XLVIII
DUMB WAITERS AND DISTRIBUTION OF FOOD
Chapter XLIX
RAILROAD
Chapter L
HEATING AND VENTILATION

* Chapters 51 - 60

Chapter LI
AXIOMS ON HEATING AND VENTILATION
Chapter LII
HOT AIR AND VENTILATING FLUES
Chapter LIII
LIGHTING
Chapter LIV
PATIENTS' WORK ROOMS
Chapter LV
GENERAL COLLECTION ROOM
Chapter LVI
WASHING, DRYING, IRONING, AND BAKING
Chapter LVII
FARM BUILDINGS
Chapter LVIII
COST OF HOSPITALS FOR THE INSANE
Chapter LIX
DESCRIPTION OF THE PLATES
Chapter LX
DESCRIPTION OF THE FRONTISPIECE AND ITS GROUND PLAN

More to come...

CHAPTER XVII
ENCLOSURES.

IT is desirable that the pleasure-grounds and gardens should be securely enclosed, to protect the patients from the gaze and impertinent curiousity of visitors, and from the excitement occasioned by their presence on the grounds. This, therefore, becomes a matter for consideration in the selection of a site.

This enclosure should be of a permanent character, about ten feet high, and so located that it will not be conspicuous, even if it is at all visible, from the building. The site, as well as the position of the building on it, should have some reference to this arrangement. If sufficient inequalities of surface exist, the wall or fence, as it may be, should be placed in the low ground, so as not to obstruct the view; but if the country is too level to admit of this, the same end may be attained by placing the wall in the centre of a line of excavation of sufficient depth to prevent its having an unpleasant appearance, and yet to render it entirely effective. Although the first cost of a wall will be about double that of a fence of the proper kind, still its durability and greater efficiency in every respect, will make it cheaper in the end. The amount of land thus enclosed should never be less than thirty acres, while forty or fifty acres are a more desirable amount, so that the pleasure-grounds of the male and female patients, which, as before observed, should be entirely distinct, may be sufficiently extensive. Even a whole farm thus enclosed has great advantages, and such an expenditure is fully justifiable. This has been done at the Government Hospital near Washington, where more than three hundred acres are thus surrounded by a permanent wall, with the greatest comfort and advantage to the institution, and all concerned feel that few expenditures give more satisfaction than those for properly enclosing the grounds of a hospital.

Important as I regard the permanent enclosure of extensive pleasure-grounds and gardens, in the manner suggested, as protecting the patients from improper observation, keeping out intruders, enlarging the liberty of the insane generally, securing various improvements from injury, and permitting labor to be used as a remedy for more patients than could otherwise be done, still it is proper to add, that high walls around small enclosures, and in full view of the buildings, are even less desirable than a simple neat railing, which would neither keep determined visitors out, nor active patients in. The first of these objects—keeping the public out,—it must not be forgotten, is the prominent one thought of, in recommending a wall to be placed around the pleasure-grounds of a hospital. The presence and watchfulness of intelligent attendants must still be the grand reliance to prevent the escape of patients, and any arrangement that does away wth the necessity of constant vigilance, is to be regarded as undesirable about a hospital for the insane.

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