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 IX
THE ASSOCIATION OF MEDICAL SUPERINTENDENTS OF AMERICAN INSTITUTIONS FOR THE INSANE.

THE most generally recognized authority in this country on the subject referred to in this volume, is "the Association of Medical Superintendents of American Institutions for the Insane," and its different proposistions on the construction and organization of hospitals and the care of the insane, have usually been received with favor by the medical profession, by legislative bodies and boards of management in every part of the country. This Association was formed in 1844, and has held annual sessions in different sections of the United States and Canada, visiting and critically examining a large number of institutions for the insane, and it has among its members, the chief medical officers of nearly every respectable hospital of this class on the continent. A series of twenty-six propositions in reference to construction, adopted in Philadelphia in 1851, and of fourteen adopted in Baltimore in 1853, in regard to organization, have been abundantly tested, and have given ample proof of their adaptability to a provision for any and every class of the insane. These will be found in the Appendix to this volume, and the different plans of construction, organization, and general management recommended, will be found to be strictly in accordance with their requirements. The same may be said of most of the other resolutions, subsequently adopted by the association, but which have had a less protracted period of observation.

The only exception that may be made to this statement, is in regard to the size of hospitals, about which there is still some difference of opinion among the members of the Association. In the proposition on this branch of the subject originally adopted, two hundred and fifty patients were recommended as the most desirable maximum number, and on this point the Association was, at that time, unanimous. At the meeting in Washington in 1866, by the vote of a bare majority of the members then present, it was decided that under certain circumstances a hospital might be enlarged "to the extent of accomodating six hundred patients, embracing the usual proportion of curable and incurable insane, in a particular community." This was the only instance in which the Association's propositions did not receive the unanimous or almost unanimous approval of all the members present. It will be observed that while this action of the Association endorses to some extent the larger number, it does not do so, as being best or most desirable, but asserts only that under certain contingencies of an institution it "might be" properly carried to the extent of accommodating six hundred patients.

The writer is fully aware that it is often easier to secure appropriations for additions to hospitals, than for the erection of new ones, and for this reason it is often deemed expedient, if not best, to secure the needed additional provision in a State by a steady enlargement of existing accommodations. No one can doubt this being better than not having the accommodations at all; but inasmuch as this book is intended to show what the writer considers best, he has no hesitation in adhering to the maximum number originally recommended by the Association. At the same time he would suggest a mode of enlargement not interfering with this view, and yet making provision for as many as five hundred, or possibly six hundred in one locality, as will be found detailed in a subsequent chapter, and which has been carefully tested for a period of twenty years, with entirely satisfactory results, under the writer's own observation and direction.

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