General Peritonitis; Prolonged Irrigation of the Abdominal Cavity

1907 Boston Medical and Surgical Journal  
vantage to have the nerve trying duties of an attendant upon the dangerous insane daily compared with the less onerous duties of those who guard sane men serving short, sentences for drunkenness or vagrancy. These and other intercurrent influences make against the morale of nurses • and attendants who care for the criminal insane. If we were facing the problem of providing for the convict and criminal insane, with no money invested in a plant, we would like to select a hundred acres of rough,
more » ... d acres of rough, high land adjacent to some railroad and abundantly supplied with water. To build economically the prison population of the state ought to be employed, and Ibis means that the work must be done under the auspices of the prison commissioners, or of the State Hoard of Charity which has jurisdiction over the prison department of the State Farm. But we can build " castles in Spain " and hospitals for the criminal insane, in imagination, without an appropriation or the consent of any one. We appreciate and sympathize with the sentiment which has torn down the walls of the airing courts which formerly offended the eye in connection with many hospitals and asylums, but in building for six hundred or more criminal insane 1 would advise inclosing fifty acres or more with a stone wall that could be depended on to keep the public out and the patients in except by suitably guarded exits and entrances. These walls would be so far distant, from the buildings as not to suggest the conventional airing court of the old-time asylum at all. If the buildings stood on the highest elevation the top of tho walls might, be below the level of the foundations of the buildings and still be effective. If the Avhole surrounding Avail was well lighted at night, and adequately patrolled there would be little incentive for patients truly insane or malingerers scheming with friends outside for saws, or making keys to lead them to liberty. In other words, our outer defenses should be of the most complete prison construction to safeguard the public, while within the gates our construction should be simple and of the most approved hospital designs for the progress of science and the cure of disease. One hospital building proper, thoroughly equipped after the manner of a complete general hospital, should be within the gates, yet some distance from the asylum buildings. It might have four open wards of fifteen beds each, with fifteen single rooms additional for selected cases. It should have its own kitchen and dining-room, as well as sun room and reading room, and have a trained woman nurse in charge, assisted by the necessary number of men nurses. As an adjunct to this acute hospital building there should be an extensive hydriatio plant with a competent physical instiuctor in charge who should teach the Avhole attendant body the art of the masseur and the principles and practice of hydrotherapy and physical training. Not only the acute cases should here be treated, but a considerable percentage of chronic cases capable of physical improvement should be sent here daily as " outpatients " for their own good and for the good of the student body receiving instruction in this department. So thoroughly'convinced arc we of the value of the so-called physiological therapy that we would count money well spent in developing this line of treatment to its highest plane. Another specially constructed building, with its own kitchen, sun rooms and broad porches, where patients could be moved on wheeled chairs and beds to sit or sleep in the open air, and wheeled into a warmed room for change of clothing or bedding, would be needed for the tuberculous. Shacks and tents might well help out in summer for selected cases, but there is usually a reason Avhy a man with a sentence should be provided with substantial accommodations. For other buildings within the gates we would not ask better than duplicates of the more recently constructed asylum buildings at Stale Farm, except a detached building for the convalescing and the quiet men of good conduct and honorable previous record, who are only technically criminals. This should be apart and have its OAvn dining-room, walks, flower beds in summer and sheltering grove. Outside the gates, beside accommodations for the superintendent and other medical officers, Ave Avould have modest cottages built by the State and rented to married nurses and attendants at a price just covering interest on investment, and cost of repairs. A comfortable nurses' home, with reading room and rooms for recreation for those who have not come to their birthright, would be an essential part of the plan. The scheme includes such Avages for competent nurses and attendants as will enable a man to marry and live in modest comfort and be retained for years, if competent, as a professional nurse and attendant, on the insane. Such are some of the essential features of the
doi:10.1056/nejm190701031560103 fatcat:l6kqirsfifcipdkrali5lcvtaa