306 HOSPITAL ever, crept in, and largo numbers of persons yearly receive medical treatment gratuitously who are quite able to pay for it. The numbers have been stated at one in four in London and one in two in Liverpool of the entire popu lation. To obviate this evil the establishment of paying institutions has been much recommended. There is a large class above the very poor who are but ill able to afford the most skilled attendance and nursing at their own homes, which in most cases do not supply the accommodation necessary for sickness. It is not desirable, nor is it always th jir own wish, that those persons should be objects of ch-.irity, and the establishment of hospitals and dispensaries at which they could contribute something towards the ex pense of their treatment and attendance would meet the difficulty to some extent. Numerous arrangements of the kind are to be found on the continent of Europe, in America, and in the British colonies. Attempts have recently been made to introduce the system into England, and it is highly desirable that it should be accomplished, if it can be done with fairness to all concerned. Administration. In the civil hospitals of Britain this is usually carried on by a body of governors, who are either specially appointed or are benefactors of the institution. From them an executive committee is chosen, or the execu tive power may be vested in a single official, often the treasurer. A secretary or superintendent is usually charged with tli3 financial and general management of the affairs of the hospital, whilst an apothecary superintends the phar- maceutic department. The treatment of the sick is of course entirely in the hands of the physicians and surgeons, whose appointments are for the most part honorary, in the sense of being unpaid, and under whom resident medical officers act. The medical staff ought always to be repre sented on the governing body as a means of preventing un necessary friction. The appointment seems desirable in every hospital of a sanitary officer, whose duty it should be to watch and supervise the carrying out of every detail of ventilation, warming, cleanliness, disinfection, &,c. On the Continent hospitals are more directly under state control, and their arrangement is therefore consider ably modified. Naval and Military Hospitals. These are provided in all civilized countries for the care of the sailors and soldiers of the state. The two great English hospitals of Green wich and Chelsea were founded as asylums for disabled and superannuated sailors and soldiers, but the former is now given up for that purpose, although a part is appropri ated as a hospital for sick merchant seamen of all nations. The chief naval hospitals are those of Haslar, Plymouth, and Chatham. Haslar is the largest hospital in the country, having been originally intended for 2000 sick, and even now, with increased allowance of space per bed, accommodating 1500 patients. There are also hospitals in mo.^t of the principal naval stations abroad, such as Malta, Jamaica, Halifax, Hong-Kong, &c. The principal military hospitals are the Royal Victoria Hospital at Netley (the invaliding hospital of the army and the locality of the army medical school), the Herbert Hospital at Woolwich, the Cambridge Hospital at Aldershott, and numerous others at the principal stations. The cubic space allotted by regulation is 1200 cubic feet at home and 1500 to 2000 cubic feet in the tropics per bed. Formerly every regiment of cavalry and infantry and each battery or troop of artillery had its own hospital, but this ! plan is now given up, and station hospitals with a fixed staff are being arranged at the chief centres of military dis tricts. In both the army and the navy the regulations place the administration and command of hospitals in the hands of the respective medical departments ; in the army this is as yet only partially carried out, but it has been accomplished in the navy with the advantage of both efficiency and economy. In time of war general hospitals are established at the base of operations, whilst field hospitals move with the troops as the campaign progresses. In France there have long been hospitals established for the navy, such as those at Rochefort, Toulon, Brest, &c., as well as schools of instruction for medical officers. The chief military hospital is the Val de Grace at Paris, formerly a convent ; it is there that the medical school for the army is located. Large hospitals are also established in all the great stations. Great attention to military hos pitals is also paid in Germany, Austria, and other countries of Europe. In most of them the administration is in the hands of the medical department, except in France, where the intendance still holds the reins, much to the disadvan tage of efficiency and good working. In the United States of America the army is small and chiefly employed on frontier duties, so that the hospitals are all what are called post hospitals, and as a rule are wooden huts or temporary structures, built to last ten years, and to hold 12 to 24 beds. There are, however, two permanent hospitals, one for cadets at West Point, and the other, the Barnes Hospital, at the Soldier s Home near Washington. All the arrangements are under the army medical department. The navy and the mercantile marine were long amalgamated in America, so far as hospital arrangements went. The [Marine Hospital Service was formed in 1798, and the navy was not separated from it until 1811, although it was not for some years after that special naval hospitals were built. In connexion with the marine hospital service, hospitals have been established at a great number of ports, both sea, river, and lake. Up to 1870 each of these hospitals had its own organization, but since that time a regular service has been established under a supervising surgeon-general. A tax of 40 cents a month is levied for the service upon all seamen or members what soever of a ship s company. One of the finest hospitals is the Mercantile Marine Hospital at Chicago, a pavilion building of several stories, and of considerable architectural pretensions. But in America, as in Europe, the tendency has latterly been to abandon such monumental hospitals, and to construct single-storied pavilions on the hut or "barrack " principle, the word barrack being employed in this sense as equivalent to the French laraque, a wooden hut. Accordingly the new marine hospital at San Francisco has been thus constructed, three one-storied pavilions of California!! redwood radiating from the outside of a curved corridor, from the ends and inner centre of which project the administrative blocks. The cost is about 120 ($GOO) per bed, whereas the average cost of the older ones was fully seven times that amount, with the drawback that in course of time they became extremely unhealthy, and showed all the evils of hospitalism. A brief notice may be added here of the history of hospital con struction in recent times, particularly with reference to the pavilion system. It is to France that we must look for the commence ment of that system, although it has been carried out with even greater succors ill other countries. Its origin may be traced to the discus sions which arose from time to time as to the advisability of recon structing the Hotel-Dicu at Paris. So long ago as the 17th century, Desgodets, architect to Louis XIV. , presented a plan for reconstruct ing the hospital in "rayons." But it was after the fire that took place in 1772 that the question was taken up with real interest. In 1773 it was proposed to transfer the hospital to the plain of Crenelle, and in 1774 M. Petit proposed a radiating building of four stories at the base of the hill of Belleville (probably at no great distance from the existing hospital of Menilmontant). M. le Eoi presented a plan for a hospital at CJiaillot, consisting of long single- story pavilions, arranged alternately, with the roof open at inter vals, each patient to be screened off by partitions. Finally, the committee of the Academic des Sciences reported favourably in 1788 on a proposal of M. Poyet s to construct a hospital on the lie des Cygnes (between Crenelle and Passy), consisting of isolated
pavilions radiating from a central rotunda, the hospital to hold 5000
