COLUMBIA HOSPITAL.

Columbia Hospital needs a complete reorganization. The main building was formerly a residence, and was never adapted to hospital purposes. The pavilion, where most of the hospital work is done, is a slight wooden structure of no particular value. The ground occupied by the hospital is very valuable. It might be sold advantageously, and the proceeds might well be applied to the purchase of a less expensive site and the erection of modern hospital buildings. The nature of the cases treated is such that a site in the suburbs, but near some rapid transit street railway line, would answer every purpose.

In this connection the committee would call attention to the fact that of the patients treated at Columbia Hospital in 1896, 125 came from Virginia, 30 from Maryland, and 506 from the District of Columbia. The committee submits that it is no part of the duty of the taxpayers of the District of Columbia to support a hospital for the benefit of the taxpayers of the adjacent States. How great this burden is may be seen from the fact that, according to the statement of the superintendent of charities for the quarter ending December 31, 1897, the average number of patients at Columbia Hospital was 45.33, while the average number of employees and others was 53.95; the total days' maintenance furnished patients was 4,170, while the total days' maintenance furnished employees and others was 4,864.

At the time Columbia Hospital was started there was an undoubted need for a hospital for the treatment of diseases peculiar to women, but at the present time it may well be questioned whether there is any necessity for anything beyond a maternity hospital. Should such a separation be made in the work, the troublesome question of pay patients in a purely municipal institution would be disposed of; the charity maternity cases from the various hospitals could be gathered into one institution, and the gynecological cases could be treated in the regular hospitals, at the cost of the patient where the patient is able to pay, and otherwise at the expense of the District.

In making these recommendations the committee can not ignore the fact that ever since its establishment, in 1866, Columbia Hospital has been the object of more or less severe criticism; that there have been numerous and radical changes in the management; and that for no long period has there been harmony in the board of trustees.

APPENDIX A.

Report on the hospitals of the District of Columbia, by Dr. Henry M. Hurd, superintendent of the Johns Hopkins Hospital at Baltimore, Md., and Dr. John B. Chapin, physician in chief and superintendent of the department for the insane of the Pennsylvania Hospital at Philadelphia, Pa.

WASHINGTON, November 24, 1897.

To the Joint Select Committee to Investigate the

Charities and Reformatory Institutions in the District of Columbia. GENTLEMEN: In compliance with the instructions contained in the letter of your chairman, in which we were asked to examine into and to report upon the condition of the hospitals of the District of Columbia, with special reference to their "organization, equipment, expense, the relations of pay patients, the limits of charity, and methods of admission," we beg leave to submit the following report:

In the performance of the duty assigned to us, we have visited the following-named hospitals, and have carefully examined into their present condition, to wit: The asylum and almshouse hospital; the Children's Hospital; the Columbia Hospital for Women and Lying-in Asylum; the Central Dispensary and Emergency Hospital; the Freedmen's Hospital; the Garfield Memorial Hospital; the National Homeopathic Hospital, and the Home for Incurables. We have also read carefully, in addition, the details of the hearings before your committee, and have examined the financial statements appended to the same. We have been afforded every facility for a thorough examination by the officers of all these hospitals, and have received many suggestions from them as to the needs of the various hospitals under their care. The officers of all, without exception, have displayed an excellent spirit of cooperation, and have seemed most anxious to do everything in their power to promote the object of the inquiry. These hospitals all have high ideals of excellence, and are striving to do good work. Their managers and boards of trustees are actuated by a spirit of true philanthropy, and are devoting their time and means without hope of material reward to the service of the destitute, the sick, and the suffering.

The following is a detailed account of the condition of each hospital visited and such findings and conclusions as have been reached:

1. The Providence Hospital.-The condition of the Providence Hospital is excellent. Every part is clean and orderly. The furnishing is appropriate and attractive. The hospital is well equipped to meet the needs

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of medical and surgical emergency cases. The plans, while fully in accord with the best medical requirements of the date when they were prepared, may be materially improved in any additions which may hereafter be made. The nursing and administrative services are of a high moral character, and such as may be looked for where a Christian consecration to the performance of unselfish duty to the sick and injured exists.

An effort was made to ascertain the proportion of acute and chronic cases under treatment but it was found impracticable to secure definite data. Without more complete returns no accurate statement can be made of the number of acute and chronic cases that may be under treatment at any given date. There are at all times a certain proportion of incurables and chronic cases in the hospital. There is no rule in operation that limits the stay of these cases. They may remain until removed by friends or until they die. The tendency must be toward an accumulation of chronic cases unless some system is provided for their removal elsewhere, and such cases might come to occupy beds that could be used for a larger number of acute and probably curable patients and thus hinder and even put a stop to the most remedial work of the hospital. The policy of aggregating incurables at this well-appointed hospital should be discouraged unless provision is made for their support by private endowments. It should be equipped for doing the best quality and quantity of medical and surgical work to emergency cases and also to such other cases as give a fair promise of relief.

It was understood that but one resident physician was in service. There are always emergencies in hospital service which require the presence of two physicians at least. The resident house staff has also a need of some recreation and relief, and if but a single physician is resident he must either remain always at the hospital, or from necessity the hospital may at times be left without any physician. In our judgment the resident medical staff should be enlarged.

It is readily understood that hospital managers may not undertake to rule against any poor person suffering from disease who presents himself at their door asking for admission, and that in the absence of any comprehensive system of granting relief, charity may be blind to every consideration but the desire to afford immediate assistance. Hence it is not surprising that many patients in this hospital are not residents of the District of Columbia or entitled to relief by reason of a legal settlement in the District.

The spirit which actuates the sisterhood which controls the Providence Hospital is further illustrated in the willingness to enlarge the scope of their work so as to make ample provision on their grounds for the reception of contagious diseases, excepting smallpox. (Hearings of Joint Committee, p. 254.) Contagious diseases in their incipient stages are not readily recognized and may develop in wards, exposing other patients in the ward to the danger of infection. No provision now

exists for the reception, isolation, and treatment of contagious diseases occurring in the city of Washington, as we are informed. In view of these circumstances and the commendable offer that has been made, no objection can be properly raised to the erection of a ward on the ample grounds of this hospital without risk of the spread of contagion to the main hospital or the adjacent neighborhood. In our opinion it should be a separate and detached building at least 50 feet from the street or any inhabited building.

No ambulance service has ever been established in connection with this hospital. It seems desirable that a service of this character be established and maintained in connection with every hospital which receives acute surgical and medical cases.

There is no lying-in service at this hospital.

The cost per patient per day during the year 1896 is stated by the sister superior to be 703 cents.

2. The Garfield Memorial Hospital.-The Garfield Memorial Hospital consists of a central administration block and connected pavilions. The grounds are ample, and seem sufficient for the uses of the hospital for many years to come. Its plan is excellent and in accordance with modern ideas of hospital architecture. It can be enlarged by the erection of additional pavilions as may be required. Its wards are clean, and the hospital appears orderly and well administered. It has all the essential equipment for the treatment of acute medical cases, of those suffering from injuries, and of others requiring surgical aid. The rule limiting admissions to this hospital to acute cases, and for a period not exceeding sixty days, and to exclude chronic cases is a good one. It appeared that this rule was generally followed, from the appearance of a majority of patients who were in bed and were evidently needing personal attendance. The managers are to be commended for the appointment of a physician-superintendent skilled in hospital administration.

As in the Providence Hospital, there seemed a lack of definite rules as to the reception of free patients residing outside the District.

No provision is made for the isolation or treatment of contagious diseases outside the hospital building, and such cases are not received. In our judgment, some provision should be made upon the ample grounds of this institution, in order that a case developing within the wards might be properly isolated; also that cases of diphtheria, scarlet fever, and measles might be received when their care outside might endanger the public health. A new surgical operating room seems of prime importance. The operating room at present occupied has been improvised in a basement room, and is not well suited for the purpose. The light is deficient and the surroundings of the operating room are unsuitable. The kitchen building is wholly inadequate to meet the requirements of the hospital. A lying-in service for both white and colored patients has been established at this hospital.

The cost per patient per day in 1896, as stated in the annual report, was 88 cents.

We would commend the general plan of the hospital. There is an appearance of efficient administration and an evident desire to do the best medical and surgical work. The work of nursing seems thoroughly organized and efficiently performed in connection with a training school for nurses. The nurses are active, energetic, and painstaking. There is an ambulance, which is sent out upon call, but no regulations exist for its use by the public. It is seemingly sent out for the sick as a matter of courtesy rather than to meet a public necessity.

3. The Children's Hospital.—The Children's Hospital was inspected and the reports of the managers, the lady visitors, and of the several medical and surgical services have been read. The whole work done here is on a high plane, and is an interesting exemplification of a hospital projected, managed, and administered by a large number of women, properly supplemented by such aid as the Government may grant.

There is a small ward for the isolation of cases of contagious disease, but no separate provision in a detached building for their reception and isolation-a provision so essential in all hospitals for children. The provision for the treatment of orthopedic cases, in our judgment, is very inadequate.

When the helplessness of the inmates of this hospital is considered, we can not feel that our whole duty is performed if we do not call to the attention of the proper authorities the importance of safe-guarding these children from fire. There should be fire escapes and fire walls dividing the buildings, to prevent a total destruction of the hospital in case of fire.

The nursing of children and infants seems efficiently and carefully performed. A training school for nurses exists in connection with this hospital and the Columbia Hospital for Women. The daily per capita cost of maintaining patients during 1896 is stated by the resident physician to be 78 cents.

4. The Central Dispensary and Emergency Hospital.-The large number of persons reported as applying for such relief as a dispensary is expected to furnish is a sufficient warrant for the existence and continued support of this institution. In addition to out patients applying for medical and surgical treatment, accident cases and emergency cases are received. The highest number cared for at one time in beds in wards during 1896 was 17.

The building and site may have been the best that could have been provided at the time of its erection, but they are now inadequate for all the demands upon them. The building is contracted and too high. The superficial space is divided into small apartments, which are too often crowded and imperfectly ventilated. Sufficient attention was apparently not given in the consideration of plans for the classes of persons who crowd into the house day after day. The space set apart