NOTES 
' 
ON 
Naval Hospitals, Medical Schools, 
AND 
Training School for Nurses, 
WITH 
A SKETCH OF HOSPITAL HISTORY. 
BY 
J. D. GATEWOOD, M. D., 
Passed Assistant Surgeon, United States Navy. 
b A L T IMORE: 
PRESS OF THE FRIEDENWALD CO. 
1893. NOTES 
ON 
Naval Hospitals, Medical Schools, 
AND 
Training School for Nurses, 
WITH 
A SKETCH OF HOSPITAL HISTORY. 
BY 
J. D. GATEWOOD, M. D., 
Passed Assistant Surgeon, United States Navy. 
BALTIMORE: 
PRESS OF THE FRIEDENWALD CO. 
1893. Illustrations. 
Fig. i. Royal Naval Hospital, Haslar. 
2. Royal Naval Hospital, Malta. 
Plate I. Royal Naval Hospital, Yarmouth. 
II. Royal Naval Hospital, Yokohama. 
III. Naval Hospital, Rochefort. 
IV. Naval Hospital, Toulon (basement). 
V. Naval Hospital, Toulon (first floor). 
VI. Naval Hospital, Brest. 
VII. Naval Hospital, Saint Mandrier. 
VIlI. Naval Hospital, Cherbourg. 
IX. U. S. Naval Hospital, Portsmouth (second floor). 
X. U. S. Naval Hospital, Boston (second floor). 
XI. U. S. Naval Hospital, Brooklyn (second floor). 
XII. U. S. Naval Hospital, Philadelphia (first floor). 
XIII. U. S. Naval Hospital, Washington (second floor). 
XIV. U. S. Naval Hospital, Norfolk (second floor). 
XV. U. S. Naval Hospital, Mare Island (second floor). 
XVI. U. S. Naval Hospital, Yokohama. Literature. 
Reports of the Surgeons-General of the United States Navy from 1866 to 1892. 
Hygienic and Medical Reports, Bureau Medicine and Surgery, U. S. Navy. 
1873 and 1879. 
Barton, Dr. W. P. C., U. S. Navy. Marine Hospitals in the United States. 
1817. 
Shippen, Dr. E., U. S. Navy. Naval Asylum of the United States. Reports 
upon certain English Hospitals, Bureau Medicine and Surgery, U. S. Navy. 
1873- 
Dean, Dr. R. C., U. S. Navy. Naval Medical Schools of France and England. 
Washington, 1876. 
Wylie, W. G. Hospitals, etc. Tr. N. York Acad. M. 1874-6. 
Anizon. De l’origine des hfipitaux. I. de la sect, de med. Soc. acad. Loire-Inf. 
Nantes, 1847. 
Pre-Christian Dispensaries and Hospitals. Westminst. Rev. London, 1877. 
Nightingale, Miss F. Notes on Hospitals. London, 1863. 
Dake, J. P. History of Hospitals ; Remains of an Hospital in Pompeii. Med. 
Counsellor. Chicago, 188C-1881. 
Simpson, Sir J. Y. Was the Roman Army provided with Medical Officers ? 
Edinburgh, 1856. 
Simpson, Sir J. Y. Antiquarian Notices of Leprosy and Leper Hospitals in 
Scotland and England. Edinburgh, 1841. 
Woodworth, Dr. J. M. Hospitals, etc. Washington, 1874. 
Ballingall, Sir George. Observations on Hospitals. Edinburgh, 1851. 
Lee, Dr. C. A. Hospital Construction, etc. Albany, 1863. 
Sutherland, J. F. Hospitals, etc. Edinburgh, 1882. 
Oppert, Dr. F. Hospitals, Infirmaries, and Dispensaries. London, 1883. 
Armsby, Dr. J. H. Hospitals, their Rise and Progress. Albany, 1852. 
Records Bureau Medicine and Surgery of the United States Navy, 
British Admiralty Reports. 
Report on the Sick-Berth Staff of the Royal Navy. London, 1884. 
Lefevre. Histoire du service de sante de la marine militaire. Paris, 1867. A Sketch of Hospital History. 
Many Christian writers and speakers, both lay and clerical, have 
claimed and are claiming for Christianity the origin of hospitals. 
They picture in glowing language this birth as springing from the 
divine injunction to heal the sick, and from the elevating and soften- 
ing influence upon the hearts of men of this beautiful religion of our 
land. One is forced to believe that such statements are made with- 
out sufficient investigation, as no teacher can afford to build upon 
any other foundation than that of truth. 
The Jews also have made a like contention, though it would ap- 
pear, upon a little reflection, that all civilizations and all cultured 
religions have been associated with the growth of that compassion 
for suffering which, though at times latent, is an inherent quality in 
man. It is to this growth that we must look for the origin of hos- 
pitals, and indeed for much of the effort of the medical mind in all 
ages and nations to heal the sick and the suffering. 
The pages of history are open to all, and though, in looking 
through the centuries, formless ashes are almost everywhere, shapes 
may still be found to more than suggest the beautiful thoughts and 
deeds of the human mind from almost the very beginning of this 
never-ending tragedy of life. 
The study of this question should begin with that of the physician, 
for no individual or state would evolve the idea of a hospital with- 
out the suggestive existence of minds equipped and available for the 
performance of hospital duties. Yet, in this short paper, the account 
of the beginning and rise of that interesting and remarkable person- 
age must be very incomplete. 
It is true that in remote antiquity there was, in some parts of the 
earth, a realization that certain diseases were curable. The people 
of the far and sunny East had, among other dreams, that of the 
removal of the hand of suffering and death from certain cases. The 
sick were exposed on couches in the public places, that they might 
have the benefit of the experience of the masses. It must have been 
an interesting spectacle—this approaching of the restored ones to 
the couches of the sick—to hear their complaints, to listen to the 
statement of symptoms, that those who had been similarly afflicted 
might impart the method of their cure. Thus so early in the story 
of life do we find an extensive attempt to use the guiding hand of 
experience. 
The sight must have impressed the minds of men in many different 214 
GATEWOOD. 
ways and degrees, and the most educated and observing ones would 
soon begin to collate methods and results. The empirical led to the 
question of why, and the question led to the study; and the study 
of one set of questions by a few always creates a class. 
In this case it was a class within a class—the priest-physician. 
This result is not surprising when one recalls how many centuries 
were to pass before the mind could be prepared for the separation 
of medicine from magic, divination and priestcraft. 
So it happened that we find the Egyptians writing systematically 
on medical subjects as early as the 14th century B. C. This med- 
ical papyrus in Berlin contains a treatise on inflammation and other 
subjects, and gives color to the claim of the Egyptians to the inven- 
tion of medicine. This wonderful people, working out their ideals 
under the fostering care of their profound religion, soon had a corps 
of medical men of the sacerdotal order, paid by the state, and as 
early as the nth century B. C. there was in that land a college of 
physicians in receipt of public pay. 
The physicians, required by the state to treat the sick poor, prac- 
tised their healing art in every direction; but it cannot be supposed 
that they could visit their patients except in particular and grave 
cases. There were, therefore, establishments set apart by the state, 
to which the masses could repair at fixed hours. Here we come to 
the beginning of dispensaries—an interesting fact, as it may be taken 
as a maxim that the hospital is the development of the dispensary. 
The existence of such institutions in that land of high ideals, excites 
no surprise when one reads on their sarcophagi such remarkable 
epitaphs as the following : “ He succored the afflicted, gave bread 
to the hungry, drink to the thirsty, clothes to the naked, shelter to 
the outcast, that he opened his doors to the stranger, and was a 
father to the afflicted.” So this land had long become famous, and a 
few inquiring minds from the less advanced countries of the North 
came to seek knowledge. 
Thus it is with no surprise that in the early history of Greece we 
find votive tablets on the walls of the temples. These, while 
exhibiting the superstition of the age, exhibit also, in some degree, the 
medical work of the time. They record the history and treatment 
of individual cases, and are in evidence of the crowds of sufferers who 
flocked to the temples of Hisculapius at Cos and Tricca, to dream 
at the foot of the altar and be guided by the advice of their priests. 
There is no proof, however, that these particular accounts relate to 
the poor of that country; on the contrary, they probably express the NOTES ON NAVAL HOSPITALS. 
215 
thanksgivings of the owners of goods and chattels. Yet they were 
histories of cases, and, one might say, leaves of the medical books of 
the time. 
In the fifth century B. C. the people of Athens were electing and 
paying physicians and building dispensaries and hospitals. One of 
these latter, it is stated, was situated at Piraeus. Physicians and 
surgeons had, however, appeared in the history of Greece and Rome 
much before this date, and accounts of them will be found scattered 
through the history of that time. Pythagoras had visited the East; 
and Hippocrates had appeared, to become the great clinical observer 
and writer, and to separate Greek medicine from priestcraft. 
The Romans were behind the age in refinement and culture, still 
one is not surprised to find that at the defeat of the Hetrurians 
(483 B. C.) the wounded Romans were quartered, by the order of 
the consul Fabius, at the houses of the senators. It was the custom 
in those days, and had been and was to be for many years, to place 
the sick and wounded in the houses of the citizens. However, before 
the time of Hadrian, there probably were government institutions 
among the Romans for the care of those injured in the defense of the 
state, though there seems to be no record of such before that period. 
But to return to earlier times and a more imaginative and profound 
people. In India, the history of hospitals many years before the 
Christian era is most clear and conclusive. The great king Asoka, 
who died in the third century B. C., established by royal edict 
these institutions on the routes of travel throughout his dominions. 
This edict, it appears, is still to be seen bearing the date 220 B. C. 
It was cut on a rock in Guzerat, probably by his successor. It states 
that “ they shall be well provided with instruments and medicines, 
consisting of mineral and vegetable drugs, with roots and fruits ; and 
that skillful physicians are to be appointed to administer them at the 
expense of the state.”* These hospitals were founded at that time 
(220 B. C.) and continued their good work for more than eight hun- 
dred years, when their walls crumbled, after the government under 
which they existed had passed away. 
Here one might mention another civilization which goes back to 
remote antiquity, and whose origin is shrouded in a mystery that 
provokes the research of our own time. The land of this people was 
Mexico. Prescott states, on several authorities, that hospitals were 
found among that ancient and remarkable race. These hospitals 
* Review of the History of Medicine, by Thomas A. Wise. London, 1867. 216 
GATEWOOD. 
were erected and supported by the government, and, as he expresses 
it, were “ for the care of the sick and the permanent refuge of dis- 
abled soldiers.” The date when these people constructed their first 
hospital is a part of the Mexican mystery, but the existence of such 
institutions in that unknown land is a further proof, if any were 
needed, that out of all civilizations and all cultured religions comes 
the growth of that compassion for suffering which is an inherent 
quality in man. 
In the earliest history of the Hebrews the priests were the physi- 
cians and surgeons, as has been the case with all races. The Scrip- 
tures (Genesis xvii) give the first recorded surgical operation after 
the Flood, and (Leviticus xiv) show the relation in very remote 
times of the physician-priest to the people in matters pertaining to 
the preservation of the public health from the attacks of contagi- 
ous and infectious diseases. The Bible (Exodus xxx) also mentions 
the apothecary at an early age, and (2 Kings xx) exhibits the method 
of treatment in a certain class of cases. It is interesting to observe 
how early in the history of this ever-memorable people the physician 
was separated from the priest (Jeremiah viii). These references 
might be multiplied, but they do nothing towards showing that any 
provision was made for the treatment of the sick at the public 
expense. Yet, considering the character of the Hebrews, there must 
be some record of such provision at some time early in their history. 
Returning to less remote ages, it may be observed without sur- 
prise, as Rome drew many of her inspirations from Greece, that, 219 
B. C., a surgery was provided at the public expense, at the Acilian 
Crossway, for a certain Greek physician, who came to exhibit the 
greater advance of his countrymen, and that, as the years rolled by, 
such places became more common in that land. When Vesuvius 
threw a pall over the fair city of Pompeii (Aug. 23, A. D. 79) it 
covered a hospital; and centuries after, when an investigating race 
uncovered this interesting building, it was found to consist of a large 
room—the full depth of the house—divided in part into small rooms 
on each side of a passage. In one of these rooms many surgical 
instruments, now displayed in Naples, were discovered. These con- 
sist of “ scalpels, scrapers, elevators, forceps, drills, and a well-made 
vaginal speculum.” Had some benevolent pagan erected this build- 
ing for the care of the afflicted, or was it a private institution for 
those able to pay ? It was a hospital at any rate, and is worth 
recording on account of its early appearance in the land of the 
Caesars. NOTES ON NAVAL HOSPITALS. 
217 
As early as the 2d century A. D. there was an organized medical 
corps in the Roman army, though physicians and surgeons had long 
accompanied, in a somewhat desultory way, the armed forces of 
all nations. Xenophon (about 400 B. C.) alludes to them in connec- 
tion with the Greek armies. As has been said, mention is made of 
a government hospital for the wounded in war during the reign of 
Hadrian (117-137 A. D.). In an order of Aurelian (270-274 A. D.) 
to his soldiers occurs the following: “Let the soldiers be cured 
gratuitously by the physicians, and let them conduct themselves quietly 
in the hospitia; and he who would raise strife let him be lashed.” 
In the 2d century mention is made of the valetudinarium in camps, 
and the proper place for this camp hospital is indicated in plans for 
winter quarters. In the century preceding, it would seem that the 
wounded were, as a rule, placed in their tents ; as generals are men- 
tioned who excited admiration by visiting from tent to tent the 
wounded under their command. 
Tombstones have been found in England and Rome erected to the 
memory of members of the medical staff of the Roman army in the 
2d century, and in Dresden there appears a tablet “discovered in 
the Elysian fields near Raise, in the vicinity of the famous Pontus 
Julius, and the station of the imperial Misenian fleet, which is to the 
memory of M. Satorius Longinus, physician to the Cupid, a three- 
banked ship.” Though this is later, there is reason to believe that at 
a very early age vessels of war were provided with medical officers, 
and that the sick and wounded of the navy were received into insti- 
tutions erected by the government for them, before the time of 
Hadrian. 
There could be no Christianity without effort to help the poor and 
the suffering. This is a fundamental and essential part of the teach- 
ings of Christ. The Christian life began with it, and the care of the 
poor, the sick and the outcast has been the care of His Church and 
His people from the beginning. It seems the natural outcome, then, 
that so soon as the believers in this beautiful religion could acquire 
property with any reasonable expectation of remaining in possession, 
the hospital should be made to hold high the flag of the cross. So 
we learn without surprise that, as the 2d century was about to expire, 
the Christians seized the idea of hospitals in a practical way, and 
that their efforts increased as the years rolled by. As early as 300 
A. D., several hospitals were founded near Bethlehem under the 
direction of St. Jerome. 218 
GATEWOOD. 
Some of these buildings were retreats for the poorest and meanest, 
the most diseased and despised—the leper—and were thus a fit expo- 
nent of the Christian teaching. Others were used, together with 
those on the roads to Jerusalem, for the accommodation of pilgrims 
and the treatment of the sick. 
A few years after this, the influence of Jerome had extended to 
more distant lands, and his friend, the Roman lady Fabiola, expended 
her wealth in founding in the city of the Caesars a house for the spe- 
cial care of the sick. In the Council of Nice, early in the 4th century, 
hospitals were spoken of with the greatest enthusiasm, as represent- 
ing a glorious part of the church work. 
Indeed, so strongly had their influence been felt, that the very 
intellectual Julian “ The Apostate,” in his endeavors to re-establish 
the religion of his ancestors, availed himself of the power of hospitals, 
by establishing inns for travelers, the indigent and the sick of all 
creeds and nations. 
The famous hospital of Caesarea was founded 370 A. D., and the 
Hotel Dieu in Paris, 600 A. D. Many if not most of these buildings, 
prior to the nth century, were utilized to encourage pilgrimages, 
and thus excite religious enthusiasm ; but they were also equipped 
for the treatment of the sick and the sheltering of the poor. They 
were also, in almost every instance, church institutions, and were 
employed, among other things, to propagate and extend the teach- 
ings of that church. 
As cathedrals and monasteries were constructed to hold high the 
cross all over the European world, hospitals were built close to them 
and were under the supervision of the bishops and monks. This 
consideration is an important one, because it has had much to do 
with the plan and construction of hospitals. The chapel became the 
most important part of the hospital establishment, and around this 
all the other buildings clustered. This was also true of many of the 
convents and monasteries, and furnishes us with the origin of the 
block plan. This idea of bringing the sick in close contact with the 
chapel, where they might hear the masses and see the processions, 
that their hearts, already troubled by sickness, might be touched by 
religion, culminated at the building of the Grand Hospital in Milan 
in 1456, when the Church of Rome was at the height of its power. 
It is a matter for interesting speculation as to how long hospitals 
would have been constructed on that plan, if there had not come the 
separation of hospital and church. But Christendom was in the next 219 
NOTES ON NAVAL HOSPITALS. 
century to experience that great religious convulsion known as the 
Reformation, from which was to come a long period of independence 
in thought and action. Strangely enough, at the same time, Henry 
VIII of England, that fearfully eccentric “ defender of the faith,” was 
confiscating church property and converting certain abbeys and 
monasteries into hospitals; thus starting in the hospitals of St. Bar- 
tholomew and St. Thomas that separation which was to become 
greater with each succeeding year. 
However, much time had to pass before the influence of the old 
days was far enough removed to allow the scientific mind to grope 
its way to higher ground. It was not, perha'ps, until the eighteenth 
century, that this air we breathe, and which for centuries the sick had 
been denied, save in a more or less poisonous state, began to be 
intelligently considered, and ventilation began to be the cry. 
It is thus apparent that it was not until men became free to inves- 
tigate, and science, born, it may be, under the stimulating hope of a 
better life, came with religion to bless our race, that improvements 
in the construction of hospitals took intelligent shapes, and buildings 
intended for the care of the sick ceased to be grand palatial struc- 
tures erected for their death. 
Let us go back a little, to see how the soldier and the sailor fared 
during all these years of Christian influence. In the wars under the 
Cross and against the Crescent, the hospitals of the Church were of 
course open alike to civilians, soldiers and sailors. These wars 
stimulated in an unexpected manner the erection of retreats for the 
sick ; for, as a result of the Crusades, establishments for lepers had 
to be e'rected all over Europe, and great numbers of them were built 
even in England and Scotland. 
When Christian nations themselves appealed to the sword, the 
wounded were in great part distributed in the nearest towns and 
quartered upon the inhabitants. In this we see a repetition of the 
practice of pagan peoples. It is true that in some Christian countries, 
the State insisted that the hospitals of the Church should receive the 
wounded, but it is fair to say that military and naval hospitals have 
never originated from a spirit of humanity, but have been born of 
sheer necessity, and from the spirit of science in war. 
It seems that the first record of a separate hospital for the wounded 
erected by a Christian government bears the date of 1575, when, 
under the immediate influence of Ambrose Par6, and the general 
influence of writers on military science at that time, a military hos- 
pital was built at the siege of Metz. 220 
GATEWOOD. 
In 1666, when Colbert, that wise minister of Louis XIV, founded 
Rochefort and organized the navy of France, necessity created a 
naval hospital in the little priory of Saint-Eloy. Thus, amidst the 
sick and dying in the swampy grounds of the new station, France 
began the lesson which her many naval hospitals show that she 
learned so well. 
In 1694, the partially erected palace at Greenwich, England, was 
converted into a residence for worn-out and wounded seamen. In 
the tax for the maintenance of that hospital can be found the sug- 
gestion to the American colonies, which eventuated in the establish- 
ment of our own marine hospital service and our own naval hos- 
pitals. 
It was not until 1756 that the modern ideas of hospital construc- 
tion found anything like an intelligent expression—when a London 
architect, named Roverhead, designed a naval hospital which was 
built at Stonehouse, near Plymouth, England. The design was a 
compromise between the old block system and the present one of 
separate buildings. This hospital, with its ten detached buildings, 
began a new era in hospital construction just seven centuries after the 
erection of the first general hospital in England. 
Since the founding of Rochefort by Louis XIV, since the conver- 
sion of the palace of Charles II into a harbor of refuge for the 
disabled warriors of the sea, naval hospitals have sprung up along 
the coasts of all civilized nations. Born of no religion, the offspring 
of sheer necessity, they wait for the tocsin of war. As quiet as the 
smile of peace on the face of Europe, their polished wards for the 
most part silent and unused, they stand amid trees and flowers, a 
ready refuge for the heroic lovers of country and of home, or for the 
victims of ambition, greed or revenge. They stand on sure founda- 
tions, and their walls will never crumble until the day of everlasting 
peace. 
These institutions are not special hospitals, but general hospitals 
for the treatment of a special class. They present marked peculiar- 
ities, which differentiate them from civil establishments. They are 
situated, as a rule, near navy-yards, that they may be accessible to 
the sick of the station and of the various ships, and are surrounded 
by several acres of ground containing trees, shrubbery, flowers and 
lawns. The number of patients is liable to very great variations, 
depending upon the movements of the different squadrons and the 
Naval Hospitals. NOTES ON NAVAL HOSPITALS. 
221 
varying exigencies of the service. The medical officers are all resi- 
dent, and have no duty to perform outside of the institution. There 
are np visiting physicians and surgeons, and consequently no unpaid 
medical talent. 
When a patient is received he has already been under the care 
of a medical officer, and is accompanied by a hospital ticket stating 
the diagnosis and history of his case. All the patients are practi- 
cally under absolute control, and have their movements and dates of 
discharge determined for them. The sick are of different ranks and 
grades, thus requiring more or less segregation, and necessitating 
additional expense to the government, without increased compensa- 
tion. The sick must be kept until they are fit for service at sea, or 
for discharge from the navy. This leads to a much lower general 
intensity of disease than exists in civil hospitals, and to a large 
number of convalescents and semi-convalescents who may perform 
light work about the building. 
the naval hospitals of one nation are conducted under the same 
rules and regulations; and to guard against improper claims for 
pensions, much work is done on Boards of Survey, and in making 
out papers and writing journals. 
The fact that all the medical officers are permanent members of a 
corps including different ranks, requiring good records for promo- 
tions, and necessitating a life under navy regulations, leads to more 
caution, and, may be,to less independent action; and while it throws 
an increased responsibility upon the medical officer in charge, it 
tends, perhaps, to diminish the originality and ambition of the juniors . 
The English navy has 711 ships, 58,142 men and 13 hospitals. 
These hospitals contain 3617 beds, and have daily under treatment 
about 1100 patients. The sick-berth staff onshore numbers 230, 
and is maintained at an annual expenditure of $65,000. At the head 
of the medical department is the Medical Director-General at the 
Admiralty. 
The following titles designate the various ranks included in the 
corps: Deputy Inspector-General of Hospitals and Fleets, ranking 
as rear-admiral (does not serve at sea in time of peace) ; Deputy 
Inspector-General of Hospitals and Fleets, ranking as post-captain 
(does not serve at sea in time of peace); Fleet Surgeon, ranking as 
commander; Staff Surgeon, ranking as lieutenant of eight years 
Naval Hospitals of England. 222 
GATEWOOD. 
service; and Surgeon, ranking as lieutenant under eight years 
service. 
Candidates for admission to the Medical Corps enter an open.com- 
petition before a specially selected board that sits in London. When 
successful, the candidate is ordered at once to Haslar for special 
instruction. The hospitals are situated at Haslar, Plymouth, Chat- 
ham, Haulbowline, Great Yarmouth (lunatic asylum), Malta, Ber- 
muda, Jamaica, Ascension, Cape of Good Hope, Hong Kong, Yoko- 
hama, and Esquimalt. 
It is believed that a study of most of these, and of the Medical 
School and Training School for Nurses, will furnish some desirable 
information. 
The Royal Naval Hospital at Haslar. 
At this hospital, which is on the water’s side, close to Gosport, in 
view of Spithead, and about a mile and a half from the town of 
Portsmouth, is concentrated much of the activity of the Naval Medi- 
cal Service on shore. This one institution comprises not only a large 
hospital, but also the Naval Medical School, the Training School for 
the Nursing Staff of the service afloat and ashore, and a depot of 
medical supplies for the various ships and stations. 
Fig. 1. Naval Hospital, Haslar. F. Front. 
The buildings (52 feet high) are of three stories, made of brick, sup- 
plied with many of the modern improvements and conveniences, and 
arranged around three sides of a square in two rows, one within the 
other, leaving the rather narrow space between of 35 feet. Around 
the inner row on the ground floor is a corridor, which thus borders 
the large enclosed area, and furnishes an outside means of commu- 
nication. The fourth side of the square, 400 feet long, is partially 
occupied by the chapel, which faces the middle or executive part of 
the building (Fig. 1). 
The wards (60 X 24 feet), which are divided into medical and surgi- NOTES ON NAVAL HOSPITALS. 
223 
cal, are, as a rule, supplied with open fireplaces, and with windows 
on both opposite sides. They are thus fairly well ventilated, but are 
rather too wide for their length, and the ceilings (io and 12 feet) are 
too low. They contain as a rule about fourteen beds, and give an 
average of 1100 cubic feet of air space and 103 feet of floor space to 
each bed. The walls are colored plaster, and the floors ordinary 
deal, but some of the surgical wards have teak floors laid in cement. 
The polish of these, under an application of beesw ax and turpentine, 
adds to the appearance of cleanliness visible everywhere. 
The plan of this hospital is a singular one, and presents in more 
than the usual degree all the grave objections inseparable from the 
block system. This establishment was built in 1762, at a time when 
ventilation was being considerably discussed. It is fair to presume 
that economy prevailed, as well as a tendency to cleave to old tra- 
ditions. 
The grounds in which this building stands extend over 60 acres. 
They are beautified with lawns, trees, shrubbery and flowers. Some 
of this could very wrell have been devoted to more ground space in 
construction, lessening the number of floors, and separating and in- 
creasing the number of buildings. However, this hospital has been 
continuously occupied for more than a century, and the mortality 
rate is small even now. This is doubtless due in part to the superior 
administration incident to it as a government institution, and to the 
number of patients being as a rule much below the capacity. This 
latter enables the wards to be more frequently renovated, and allows 
an additional air space. 
This immense hospital has accommodation for 1298 patients, 
including 68 sick officers ; but the average number under treatment is 
somewhat less than 500. The staff consists of seven medical officers, 
including an inspector-general, who is in charge. There are several 
large residences in the grounds near the hospital for most of these, 
while others are accommodated within the building. The staff seems 
small when one considers the large amount of work in the hospital 
and schools. There can be but little time for more than the very 
closest attention to duties. 
An interesting portion of the Haslar hospital is its kitchen, which is 
situated on the top floor. It is connected with the wards by eleva- 
tors, which enable the food to be conveniently distributed. But little 
coal is used in this kitchen. Steam is used to do all the boiling, and 
broiling is done by gas heat. The crockery upon which the meal is to 
be served is kept hot on iron tables heated by steam. One can see 224 
GATEWOOD. 
that this arrangement must be very satisfactory for several reasons, not 
the least of which is the absence from the wards of the kitchen odor. 
The surgical cases in this hospital are about four times the medical. 
About one-half of them are venereal cases, which cause the largest 
amount of invaliding. Several hundred wounds are treated annually, 
with a very small mortality and a reasonable percentage of invaliding. 
The medical cases average about ioco a year; the principal dis- 
eases being rheumatism and pneumonic phthisis. The latter is the 
most frequent cause of death and invaliding. Many cases of remit- 
tent fever reach this hospital, chiefly from the Mediterranean Squad- 
ron. A large proportion of the sick from that and the home squadron 
is received, as well as all the sick from the neighboring dockyard. 
A short time ago there was no separate building for contagious 
diseases, and all such cases were treated in one of the end wards. 
Possibly, this very unsatisfactory arrangement has been changed. 
The laundry is in a separate building, and is supplied with modern 
improvements. 
The storehouse is also separate, and it is large, as it is here that 
many medical supplies are kept for distribution to the various ships 
and stations. In connection with this work there is a permanent 
board, consisting of the senior medical officer and others from the 
hospital staff, for examining and inventing improvements in naval 
medical appliances. The method of packing and transporting medi- 
cal and surgical outfits in expeditions on shore, appliances for 
moving the wounded in battle, improvements in operating cases, 
medicine chests, ventilating apparatus, water filters and the like, 
receive special attention in the effort to keep the service supplied 
with all possible improvements. As soon as anything is approved 
it is sent to one or more ships in actual service for the only true test 
of merit. 
The Naval Medical School. 
The Naval Medical School is for the purpose of giving the medical 
officers recently admitted to the service, instruction in hygiene, 
military medicine and surgery, pathology, and all subjects necessary 
for the most efficient performance of those special duties created by 
naval life. Instruction was formerly given at Netley, but, in 1880, 
the Naval School was removed to Haslar. 
The reasons for this change were many. The young naval sur- 
geon was desirous of learning naval duties, while the army school 
naturally emphasized those pertaining to its own service. Another NOTES ON NAVAL HOSPITALS. 
225 
consideration, probably more potent, was that nothing stimulates a 
corps and develops its talents so much as a school taught by itself. 
In teaching a class formed of recent graduates in medicine who 
have built upon a good general education, the older members of the 
corps are stimulated to greater activity, and a new force is introduced 
to prevent that stagnation to which there is such a marked tendency. 
Haslar, with its larger number of cases, many representing diseases 
incident to naval service, and with its proximity to the great naval 
station at Portsmouth, furnished a place pre-eminently calculated to 
facilitate the special instruction desired. Besides, who are so compe- 
tent to teach the requirements of any service as those who are 
familiar with them by long experience? 
As soon as the graduate has passed the required examination for 
entrance, and has received his commission, he is ordered to Haslar 
for this instruction. The course lasts for four months, and though it 
does not establish precedence in the service, this having been pre- 
viously determined, it does determine the degree of adaptability and 
has much to do with the assignment to duty. All the papers and 
marks of the first examination are sent to this school by the Medical 
Director-General of the Navy. These must furnish eventually some 
interesting data bearing upon the competency of any examination to 
determine that essential quality known as adaptability. 
The class, as a rule, consists of about twenty members, more or 
less. Quarters are provided for them in the hospital, two wards 
being fitted up for this purpose. They also have a special dining 
room and a sitting or reception room. A billiard room is also pro- 
vided, and outdoor sports are encouraged. 
The school is well equipped for its special work. The library or 
lecture room is well provided with the best literature on medical and 
kindred subjects. The museum, which receives additions from almost 
all the medical officers in the service, is provided with collections of 
materia medica, alimentaria, natural history, pathological and geolog- 
ical specimens, and the appliances used in the service. There are 
also models of ships, and diagrams showing ventilating apparatus in 
use, and proposed. 
The laboratory contains many microscopes and all the apparatus 
necessary for bacteriological research, and the analysis of urine, 
water, soil, food, air, and clothing. 
In the wards of the hospital much instruction is given in minor 
surgery and case-taking. Each member of the class is also made 226 
GATEWOOD. 
thoroughly familiar with the various blank forms used in the service, 
the system of making sanitary reports, and the method of keeping 
medical journals. 
Autopsies are made as opportunities occur, and written reports are 
made of all pathological conditions. 
The work of the day begins in the wards. This is followed by 
work in the laboratory, and by a lecture in the library. This lecture 
is often illustrated by various models and diagrams. In the after- 
noon perhaps the dry dock may be visited, where ships in ordinary 
and in various stages of construction are inspected from a sanitary 
point of view, and a draughtsman explains the plan being followed 
in the construction. 
The final examination is made up of oral and written questions and 
practical work. All written questions have been submitted to the 
Medical Director-General of the Navy. The possible total mark is 
3,000. To the principles of hygiene and practical hygiene are 
assigned 1,000 each, while journal-keeping, pathology, and military 
medicine and surgery absorb the other 1,000. 
This school is so practical in its teaching, so praiseworthy in its 
object, and so far-reaching in its influence that it is well worthy of 
imitation by all nations. 
The Training School for the Nursing Staff. 
This school was established at Haslar shortly after the medical 
school. It was the outcome of a report by a special commission 
made in 1884. The old system of civilian nurses led to the change, 
as the material supplied by this method was very often exceedingly 
poor. Now, nearly all the nurses for the navy afloat and ashore are 
being obtained primarily from the Greenwich Hospital School. 
At that school a fair general education is given, and various 
mechanical trades are taught. After some service at sea, if the boy, 
who is about 17 years old, desires to become a nurse in the navy, he 
makes application, and after a rigid physical examination is received 
at Haslar. . Here he finds himself with others quartered in a large 
ward in the third story of the administration building. 
Nine or ten trained female nurses of the highest respectability have 
been procured to facilitate the education, and he is taught by lectures 
and in the wards by seeing the things done that he is to learn to do. 
A certain amount of minor surgery, such as bandaging, is also taught, 
and when the student is considered qualified, he is sent to sea. After NOTES ON NAVAL HOSPITALS. 
227 
a cruise he is eligible, if his record be good, for service in the hos- 
pitals, and can enlist under special regulations providing promotions 
and increased pay. 
The Royal Naval Hospital at Plymouth, 
or rather at Stonehouse, was built in 1764, and is next in import- 
ance to that at Haslar. It consists of ten separate buildings, or 
rather eleven, including the chapel, each constituting a separate hos- 
pital. These surround a large square laid out in grass plots and 
gardens. A colonnade ornamented by one hundred and fifty mono- 
liths connects them, and extends around the sides next the court. 
There are 44 wards. Each ward contains fourteen beds, sepa- 
rated by over five feet. They accommodate six hundred and 
sixteen patients, and give an air space of twelve hundred cubic feet 
to each. The ventilation is good, the buildings are remarkably 
clean, and the absence of hospital odor is noticeable. The plan of 
this hospital permits a free circulation of air within the court, a good 
general ventilation, and a very desirable segregation of patients. 
House cleaning and painting can be carried on with little or no incon- 
venience or annoyance. 
Generally there are six wards in each building in use for the sick. 
Quarters are provided for fifty-one sick officers, and room is given 
for a smoking room and library. The water supply is good, and 
there are rooms supplied with hot, cold and vapor baths. The water- 
closets are excellent. 
The plan of this hospital is considered the best of any of England’s 
naval hospitals, and it has frequently served as a model. 
The total capacity of this institution is considered to be six hundred 
and sixty-seven, but in 1780 the remarkable number of fourteen 
hundred and twenty-three were treated here at one time. Probably 
many were placed under canvas. 
It has an easy approach for boats by way of Plymouth Sound, and 
receives sick, not only from the fleets, but also from the dockyard 
and marine barracks. 
The total number of admissions each year approaches thirty-five 
hundred. The surgical wards receive about twice as many as the 
medical. The average number daily under treatment is about three 
hundred. 
In the medical wards rheumatism and pneumonic phthisis are the 
principal diseases, the latter being the chief cause of death. In the 228 
GATEWOOD. 
surgical wards, venereal troubles are in the large majority, these 
amounting in a year to about one thousand. Syphilitic and gonor- 
rhoeal troubles divide the honors. About two hundred cases of 
injury are treated annually. The loss by death is small, but the 
invaliding is not inconsiderable. 
There are over fifty in the nursing staff, while the hospital staff 
consists of an inspector-general in charge, a deputy inspector-general, 
two staff surgeons, and three surgeons. The wards are visited four 
times daily or oftener by the surgeon having the day’s duty, while 
those in charge of particular wards make routine visits morning and 
evening. A very good library is provided for the medical officers, 
and the seniors have separate residences for themselves and families. 
Royal Naval Hospital (Lunatic Asylum) at Great Yarmouth. 
Great Britain has made generous provision for the insane of the 
navy. Probably there is no institution better supplied and more 
ably managed than the asylum at Great Yarmouth. 
So desirous is the Admiralty that the guiding shall be by the most 
experienced hands, that there is no rotation of officers assigned to 
this special work, the inspector-general in charge retaining the duty 
permanently. All recommendations made by this officer, who has 
absolute local control, meet with more than the usual compliance, 
and all requisitions for supplies are considered in a spirit more than 
usually generous. 
No government can really afford to do otherwise; for nothing 
increases the tendency to cheerful work, or acts so constantly to 
maintain discipline in a service, as the belief on the part of all that 
they will be well cared for in sickness, misfortune, or death. This 
consideration has at times been forced upon the attention of authori- 
ties, and has had much to do with improvements in all services in all 
governments. 
The hospital at Great Yarmouth was built early in this century, 
but was used for a naval hospital only a few years. In days of peace 
it passed into the hands of the army for use as a barrack. However, 
when the century was a little more than threescore years old, it 
became a naval establishment again, and was devoted to the care of 
those wrecked in mind as well as in body—patients living in a realm 
of their own. 
This hospital is another illustration of the block plan, but in this 
case there are four two-story brick pavilions arranged around a NOTES ON NAVAL HOSPITALS. 
229 
square of one and three-quarter acres, with the corners sufficiently 
open to allow the free circulation of air (Plate I). There is an arched 
corridor eight feet wide around the lower inner face of each build- 
ing, and forming their only connection. This plan or arrangement 
is considered one of the best of any of the older hospitals in the 
United Kingdom, and though the situation is rather bleak, the 
selection of this hospital for the present duty is regarded as most 
wise. 
Each pavilion is two hundred and sixty feet long, and, with the 
exception of the one in front, is divided into two sections by a cen- 
tral structure unoccupied by beds. These sections are subdivided 
by staircase and nurses’ rooms. This results in the formation of 
eight well separated wards in the pavilion. However, the wards on 
the lower floor of the rear pavilion have been divided into rooms 
opening on the corridor, for the use of those too restless to occupy 
beds near others. 
The wards are forty feet long, twenty-three wide, and fourteen and 
a half high. They have windows on both opposite sides, with beds 
between. They were originally designed to be occupied by fourteen 
persons, but the number under treatment is so very much less than 
the capacity that this overcrowding is made impossible. Indeed, the 
space unoccupied by beds is so great that it is used for several din- 
ing rooms and day wards. 
The water-closets are in small towers outside of the line of the 
wall, and the connections have lattice-work sides, to allow the to 
sweep through. The bathing facilities are ample, and include even 
a Russian bath. This part of the building is not for show, but is used 
regularly and systematically under the rules of management. 
The front pavilion has the second story divided into rooms for the 
officers under treatment. There is a dining room in connection with 
these, while a very large parlor on the first floor is set apart for the 
reception of friends. This lower floor is used, however, chiefly for 
administration purposes. All the buildings are heated by hot water 
pipes, and to a certain extent by open fireplaces. 
The position of the nurse rooms between wards facilitates their 
work very much, as, with a suitable division of patients, two wrards 
can often be watched at night by one nurse. 
Wherever practicable, a certain amount of ornamentation is used 
to give as homelike an appearance as possible, and even curtains 
have not been discarded. This is probably more or less wise as a 
part of the treatment. 230 
GATEWOOD. 
Regulations are strictly enforced in regard to a frequent change of 
bedding. This change is made immediately when needed in cases 
confined to bed. Close-stools are cleansed at once, night and day, 
and frequent visits are made to the restless ones in the separate 
rooms. There are padded rooms in this institution, but the idea 
governing the treatment leads to only an occasional use of them. 
There is one nurse for eight patients. This does not seem a large 
allowance. Yet much work is done by the patients themselves. 
Such occupation is considered a valuable part of the treatment in 
many cases. It keeps the mind from (as it were) feeding upon itself, 
and, in the accomplishment of something that can be seen, tends to 
bring back the interest in life. Trades are encouraged, and places 
are provided for the pursuit of such pleasant occupations. The 
nurses are carefully selected, and can be instantly discharged for 
incompetency or carelessness. 
This institution is surrounded by more than nine acres of ground, 
some of which is divided by walls into exercising courts. Arbors 
and covered ways have been built for use in bad weather. The 
outdoor plan of treatment is pursued here whenever advisable, as it 
often is, and every attempt is made to take away from the mind the 
idea of prison life. 
The kitchen is in a detached building, and is well equipped and 
managed. The laundry, which is near it, is kept as busy as all such 
should be. Comfortable houses are in the fore-court of the hospital 
for the two medical officers comprising the staff. At present there 
are about one hundred and fifty patients, including forty officers, 
more or less. 
The mortality averages ten per cent, and the recoveries are 
relatively many. Mania designates more than one-half the cases; 
and dementia, melancholia, and paralysis of the insane, follow in the 
order named. The admissions are sufficient to keep the total number 
under treatment about the same. 
Royal Naval Hospital at Malta. 
This hospital is situated near the walled city of Valetta, on the 
north side of the island of Malta, in the Mediterranean Sea. Malta is 
a sand and limestone formation, eighteen miles long and eight wide, 
with its long axis approximately northwest and southeast. A range 
of hills forms its backbone. It is from these that an ancient and 
leaking aqueduct conveys a limited supply of good water into NOTES ON NAVAL HOSPITALS. 
231 
Valetta. Cisterns are used for storing this and rain-water; but as 
these are often polluted by leaks, intestinal disorders and typhoid 
fever are not uncommon. 
The climate is very delightful from October to April, the thermo- 
meter ranging from 50° F. to 70°; the atmosphere, under the north 
winds, fairly dry, and the days almost invariably full of sunshine. 
This enables invalids and convalescents to live out-of-doors. During 
this period the rainfall is over twenty inches,, but, most conveniently, 
it falls as a rule during the night, and upon a soil that drains rapidly. 
Snow is unknown, and the formation of ice is a surprise. 
The heat during the summer makes sunstroke not infrequent-, 
while in early autumn the moist sirocco or southeast wind debili- 
tates mind and body, and predisposes to neuralgia and malarial 
diseases. 
Valetta is a terraced city, on the end of a high tongue of land that 
makes out to the northeast within one of the many indentations of the 
coast. Its end, however, St. Elmo Point, is so far out as to be on 
the general coast-line, and forms with Ricasoli Point the entrance to 
the harbor or bay which is southeast of the city. 
Across this bay, half a mile from the city, and on a bold promon- 
tory between Forts Ricasoli and St. Angelo, is the largest foreign 
naval hospital of Great Britain. It has a beautiful site, overlooking 
the city and harbor, and its Doric two-story stone buildings present 
an imposing appearance. 
Fig. 2. Naval Hospital, Malta. 
F. Front. W. Wings. 4 C. Court. H. Inspector’s House. 232 
GATEWOOD. 
The building that forms the front looks to the northwest, and the 
detached building on each side extends back perpendicular to the 
line of the main structure. There is a corridor around the inner face 
of each, and the enclosed court, which covers an immense cistern, is 
paved. 
The wards are nearly one hundred feet long, twenty-five wide and 
twenty-two high. There are, however, smaller wards, and many 
rooms for sick officers. They furnish nearly 1800 cubic feet air space 
per bed, and are supplied with a fair number of high windows, open 
fireplaces, and large openings near the ceilings. The ward furniture 
is reduced to a minimum. The beds are iron, and the mattresses 
always look new, as they are frequently re-made. There is a good 
smoking-room and a library. 
The bath-rooms are supplied with modern improvements, and the 
water-closets, though near the wards, are well supplied with seats 
and water and are easily flushed. The floors of these, being tiled, 
are easily kept clean and present a good appearance. A small build- 
ing about three hundred yards from the main buildings, is used for 
contagious diseases. There is also a large storehouse, which is kept 
well filled with medical supplies for the fleet. 
The nursing staff consists often, and these are fairly well provided 
with quarters. The kitchen and laundry are on the ground floor. The 
medical inspector in charge has a large residence east of the build- 
ings. This hospital has accommodations for two hundred and eighty 
patients, including fifty-eight sick officers. 
The wards are divided into medical and surgical, and the average 
number under treatment is about eighty. The number treated 
annually approximates one thousand—about equally divided between 
medical and surgical cases. The number of cases of remittent fever 
treated annually often approaches one hundred ; about fifty per 
cent of these are eventually sent home to recover from the conse- 
quent debility. Typhoid fever is not uncommon, there being, per- 
haps, fifteen or twenty cases each year, with a mortality, it seems, of 
about twelve per cent. -The general death-rate of this hospital is not 
very large, but a considerable number of invalids are sent home by 
the troop-ships to escape the summer and early fall. 
The authorities of this port are exceedingly sensitive on the subject 
of epidemic influences, and as a result the quarantine regulations are 
very rigid. The large number of troops in the garrison, and the 
importance of the island as a naval station and base of operations, NOTES ON NAVAL HOSPITALS. 
233 
necessitate, however, the greatest caution. There have been sad 
experiences with cholera, which is the disease most dreaded, as the 
island is on the line of travel from the East. 
The Royal Naval Hospitals at Bermuda, Jamaica, Ascension, Cape 
of Good Hope, and Esquimalt. 
These hospitals present nothing especially worthy of attention. 
They are, of course, of inestimable importance to the naval service, 
and from that point of view demand some notice. It is believed 
that the following short notes will be considered sufficient: 
Bermuda.—The hospital is situated on Ireland Island, the naval 
station, and occupies rather high ground, overlooking the water to 
the west. It is three stories high, and contains four wards, two on 
the second and two on the third floor. These wards are thirteen feet 
high, twenty-four feet wide, and sixty long. They contain fifteen 
beds each, and furnish a little more than twelve hundred cubic feet 
per bed. Considering the climate, this space should be at least 
doubled. Ordinarily this is the case, as the average daily number 
under treatment in time of peace is only thirty, including sick 
officers, who have rooms on the first floor and are provided with a 
private dining-room and library. 
The whole building is entirely surrounded by broad verandas, 
which are necessarily supplied with Venetian blinds. There are 
water-closets and bath-rooms on each floor. As the ground furnishes 
a rather steep slope the drainage is good. Innumerable gutters 
conduct off the surface water, while the water-closets have a sewer 
leading out into the bay. 
The kitchen and laundry are in a small detached building; but, 
unless there has been a recent change, meals are served on small 
tables in the wards for lack of space for a messroom. It is needless 
to criticise this undesirable condition of things. 
There is no separate building for contagious diseases. Suspicious 
cases are allowed to develop in the hospital, and then, if necessary, 
are transferred to the common pest-house on the island. The water 
supply is rain-water collected in cisterns. 
The deputy inspector in charge has a separate house. He and 
two surgeons comprise the staff. The number of nurses allowed is 
four. The total number of cases treated annually is about two hun- 
dred and fifty. The number of surgical cases is double that of the 
medical. Venereal troubles form about twenty percent of the total. 234 
GATEWOOD. 
Remittent and typhoid fevers are rather frequent. The average 
number of days under treatment per case of all diseases is nearly 
fifty. 
The climate of the Bermudas is exceedingly pleasant and equable 
in winter, but in spring, summer and fall the heat is frequently 
oppressive, though much modified by breezes. The average tem- 
perature during this period is about 77 degrees F. 
Jamaica.—At Port Royal, the naval hospital is an extensive build- 
ing, but only a part of it is kept in operation or in fair condition. 
In the early part of this century, events seemed to necessitate a large 
building for the sick in this part of the world. Its capacity is now 
considered to be one hundred and twelve, including rooms for twelve 
sick officers; but the average number of cases daily under treatment 
is only ten. Five nurses are allowed, as the intensity of disease is 
liable to sudden changes in this climate. In 1882, forty cases of 
yellow fever were treated in this hospital. 
In the event of any increase of the naval force in these waters, or 
even of any interference with the cruise to the north in summer, the 
number of cases and the intensity of the disease would be much 
increased in this building. As it is, the total number of patients 
during a year is usually only one hundred and fifty, the medical 
rather exceeding the surgical cases. About eight percent are 
invalided, and the loss by death frequently approaches the rather 
large number of fifty per thousand. This mortality is due in great 
measure to fevers of various types. Venereal cases number fifteen 
or twenty annually. 
Three medical officers compose the staff. These, in addition to 
usual duties, have charge of the large amount of medical supplies 
kept here for the fleet. 
Yellow fever receives little attention at the quarantine station across 
the bay, but smallpox is regarded as the great enemy, demanding 
constant watchfulness. 
Ascension.—This building is in Georgetown, a very small naval 
settlement on the west coast of Ascension Island. This volcanic 
island has a diameter of six miles. Its surface consists of many hills 
and mountains, intersected by innumerable watercourses and deep 
valleys. The mountains frequently attain an elevation of fifteen hun- 
dred feet. Much of the coast is formed of rough lava rocks, while 
the hills and mountains present many well-formed craters. 
The hospital is at the extreme south of the settlement, high above NOTES ON NAVAL HOSPITALS. 
235 
the water, from which it is distant a fraction of a mile. It has accom- 
modations for sixty-five sick, including fourteen officers. There is 
only one nurse allowed, but the average number of patients daily is 
but six. About one hundred cases are treated annually. The medi- 
cal cases are about double the surgical. 
As might be expected, venereal troubles are rare, and malarial 
fevers are very common. These latter are brought by the ships 
cruising in the rivers and on the coast of West Africa. Indeed, this 
island is used as a sanitarium. Vessels are sometimes almost entirely 
deserted, and the crews placed in the barracks on Green Mountain, 
near the center of the island. From near this mountain, water of 
good quality is supplied to Georgetown. 
At this hospital the mortality is frequently only about ten per 
thousand; tfye invaliding, ten percent; and the average number of 
days treatment per case, less than twenty-five. 
Cape of Good Hope.—The naval hospital here is small. There are 
accommodations for eighty patients, including rooms for six sick 
officers. The average number of patients daily under treatment is 
twenty-five, and the total yearly is three hundred. The surgical 
cases are three times the medical. This is to be expected, as venereal 
troubles are common. 
Ships cruising in these waters have few places where liberty can be 
given. Cape Colony is one of these. About one hundred venereal 
cases find their way to hospital in the course of a year. Of course, 
this is a small proportion of the total number of cases. 
Ships cruising on the West Coast bring, from time to time, large 
numbers of malarial cases to this hospital. The death-rate is rela- 
tively small, but the invaliding is over eighty per thousand. Summer 
is the most healthy season, as it is then that the southeast winds 
prevail. 
Esquimalt.—This is the smallest of all the royal naval hospitals. 
It can accommodate but forty patients. The average number daily 
under treatment is only five, and the total number yearly, less than 
fifty. Only one or two are invalided during the year, but the aver- 
age number of days treatment per case is generally over forty. The 
building is wooden, well-lighted, but poorly ventilated, with two 
wards. It has ten acres of ground on the west coast and south side 
of Vancouver Island, and overlooks Constance Cove, a part of 
Esquimalt harbor. 
The surgeon has a house about thirty yards from the main build- 236 
GATEWOOD. 
ing. In this there are also rooms for four sick officers. There is a 
structure for contagious diseases. 
Across the Cove and distant a small fraction of a mile is the dock- 
yard. This is the British naval station in the Pacific. 
Royal Naval Hospital at Hong Kong. 
This hospital is situated in the eastern suburb of the. city of Vic- 
toria, on the island of Hong Kong. This island, which is just 
within the tropics (latitude 220 north, longitude 1140 east), is eight 
miles long and averages about three miles in width. The long axis 
is nearly on the parallel. A great part of the surface is formed by 
barren mountains of volcanic rock which rise in many places over 
fifteen hundred feet, and are swept during the winter months by the 
northwest monsoon, and in the summer by the southwest. 
The north wind sometimes in January forces the thermometer at 
Victoria down to 40° F., when snow may appear on the mountain 
tops. The mean annual temperature of the city is 730 F. The 
hottest month is July, when with a mean temperature of 86° F. and 
with a humidity of ten grains per cubic foot, sunstrokes are not 
uncommon. The coldest month is January, with a mean of 520 F. 
and a humidity of four grains per cubic foot. The highest barometer 
is in November and the lowest in July. 
The wet months are June and July, and the dry months, January 
and February. The rainfall averages eighty inches, and the rainy 
days over one hundred. 
Victoria, which is on the north side of the island, and one mile from 
the mainland, has a population of over two hundred and twenty 
thousand, including two thousand Europeans and Americans. The 
English rule is strict, so that in spite of the large number of Chinese, 
cleanliness is observed and epidemics are rare. 
The houses are built upon volcanic rock or its derivative laterite, 
which retains the water during the wet and hot months, and increases 
the marked tendency to malarial troubles. Turning up the soil is 
dangerous on that account, but the English authorities have done 
much, by paving and other sanitary precautions, to improve the 
general health. Dysentery and diarrhoea have become less common, 
but smallpox, on account of inoculations, still clings to the Chinese 
homes. 
In the eastern suburb of the city is situated the Royal Naval Hos- 
pital, two hundred feet above high water, and overlooking the city NOTES ON NAVAL HOSPITALS. 
237 
and harbor. It is a fraction of a mile from the coast-line and dock- 
yard. 
The hospital was a private residence, and was bought by the gov- 
ernment for £7000. It consists of four buildings, each thirty feet 
square, built of stone, two stories high, and shaded by verandas. 
The enclosed square, which receives the breeze through the space 
between the buildings, is paved. The water-closets and bath-rooms 
of each building are separated from the wards and placed in offsets. 
The upper stories are the four wards, each containing twelve beds, 
and furnishing thirteen hundred cubic feet to each bed. These wards 
have high ceilings, windows on both opposite sides, and are lighted 
by gas. In the lower stories are storerooms, dispensary, nurses’ and 
officers’ quarters. The Deputy Inspector in charge has a good 
residence. He and two surgeons comprise the staff. 
The water supply is derived from mountain streams and reservoirs. 
Provision is also made for the dry season by storing in tanks. The 
English authorities have done much to protect the water from pollu- 
tion, and have succeeded in increasing its reputation for being the 
best on the coast. 
The hospital has accommodation for fifty-six patients, including 
eight officers. During the yean, about three hundred patients are 
treated—the surgical being only slightly greater than the medical. 
The cases of venereal diseases average about fifty annually. Dysen- 
tery, smallpox, and remittent and typhoid fevers are not uncommon. 
Occasionally cholera claims a victim. The number of cases invalided, 
averaging about eight per cent, is chiefly from the medical wards. 
The death-rate sometimes does not exceed one per cent of the total 
number treated. In the early spring many patients go with the fleet 
to Yokohama, as the moist summer heat materially delays conva- 
lescence. 
Royal Naval Sick Quarters at Yokohama. 
This hospital, which was formerly a barrack for English troops, is 
a plaster and tile building of one story, built .on three sides of a 
rectangle (Plate II). It is situated on a bluff which rises from the sea 
to the height of one hundred and twenty-five feet. The trend of the 
coast here is toward the northwest. As the building faces the east, 
and the sea from which the prevailing winds come, the enclosed 
court is shut off from the breeze. The length of the front is about 
one hundred and twenty-five feet, while that of the wings which 238 
GATEWOOD. 
extend back at right angles is more than two hundred. Around the 
inner face of the entire building there is a veranda which is much 
used in warm weather, and furnishes an outside communication. 
This main structure can accommodate over eighty patients. The 
front and north wings are divided into four wards, each about sixty 
feet long. These wards have windows on both opposite sides, and 
have additional ventilation through openings near the ceiling, which 
discharge near the roof into the air. All these wards are for the 
treatment of seamen and marines. The south wing is divided into 
rooms for non-commissioned and warrant officers. 
The average cubic space per bed is nearly 1500 feet. The build- 
ing is heated by stoves and open fireplaces, the latter, of course, 
assisting much in the ventilation. 
The grounds comprise about five acres, ornamented by grass 
slopes, lawns, groves of trees, and flowers. The locality is a desir- 
able one, and it is on this bluff that most of the foreign residents 
live, and the United States has established its hospital. 
The dispensary and stewards’ quarters are two buildings outside 
of the quadrangle, but facing the unoccupied side. To the south of 
these, and on the other side of the main gate, are the dwellings for 
the two medical officers comprising the staff. These houses have a 
detached kitchen and servants’ quarters. 
South of the main building, and separated from it by about 
seventy-five feet of lawn, are the quarters for sick officers. These 
consist of rooms well fitted up, and usually more than one room is 
assigned to each invalid. 
The mortuary is at the extreme north end of the grounds, and is 
about 50 yards distant from the main building, from which it is 
hidden by a grove of trees. 
At the extreme southwest corner of the grounds are two separated 
buildings for the treatment of contagious diseases. Near-by is a 
spring, a storehouse and a disinfecting chamber. This part of the 
ground is cut off by a grove of trees. A fire-engine house is near 
the north wing of the hospital. 
The nursing staff consists of seven. These are quartered in a 
building near the general kitchen, storehouse and coal shed, at the 
northwest border of the grounds, and distant from the main build- 
ing about thirty feet. 
The method of dealing with the water-closets is one common in 
the East. They can, almost all, be reached from the outside of the NOTES ON NAVAL HOSPITALS. 
239 
building, and natives, under contract, remove every night the large 
earthen jars. 
The water supply is from wells, a spring, and a tank in which rain 
water is stored. All the drinking water is filtered, and in the summer 
is also boiled. 
The total capacity of this hospital is ninety-five (95), including 
accommodations for thirteen sick officers. The average number 
under treatment approaches thirty (30). The surgical cases are 
nearly double the medical. The death-rate is relatively small, and 
the invaliding, which is influenced by the patients received from the 
hospital at Hong Kong, amounts to about five per cent. The total 
number of patients treated annually is about two hundred. Phthisis 
is common, and the number of venereal cases possibly reaches fifty 
—twenty-five percent of the total. Malarial fever and occasional 
cases of smallpox help to make up the record. 
The record of this hospital is influenced by the practice of the fleet 
to cruise north from Hong Kong in the spring. The ships arrive at 
Yokohama about April, bringing all patients from the Hong Kong 
hospital who can be safely moved. They return to the coast of 
China in the fall and carry back with them all who in the interven- 
ing months promise to be ready for duty, or who would be benefited 
by the change. These transfers, however, are chiefly due to the 
relaxing and debilitating summer at Victoria. 
Naval Hospitals of France. 
The French navy has 378 ships, 75,915 men and 5 hospitals. 
The following titles designate the various grades in the medical 
corps : Inspecteur gen6ral, directeur du service de sanffi, inspecteur 
adjoint, m6decin-en-chef, mfedecin professeur, m£decin principal, 
m6decin de premiere classe, and de seconde classe. 
Each member of the medical corps has obtained his professional 
education at one of the three naval medical schools at Rochefort, 
Toulon, and Brest. 
The hospitals are situated at Rochefort, Cherbourg, Brest, Toulon, 
and Saint Mandrier, and offer with the medical schools no uninter- 
esting study. 
At Rochefort, on the Charente river, the French made the begin- 
ning of a regular organized navy. Here in 1666 Louis XIV, under 
Naval Hospital at Rochefort, France. 240 
GATEWOOD. 
the influence of his able minister, Colbert, devoted some of his easily 
squandered money to the praiseworthy object of founding a naval 
station. However well chosen the site was from a naval point of 
view, from that of a sanitarian it was most unfortunate. The work 
was carried on at the frightful cost of many lives. The swampy 
ground, when turned up, engendered intense malarial disorders, 
making a hospital an early necessity. This was established in the 
old priory of Saint-Eloy at Tonnay (Charente). 
Happily there was a village fortunately situated, and abundantly 
supplied with good water. The old priory was soon insufficient, but 
it was not until 1683 that the hospital at the new naval station was 
completed. At that date Tonnay Charente was abandoned and the 
sick were removed to Rochefort. This new hospital consisted 
originally of eight wards, each containing fifty beds. These were 
placed in two buildings, connected by a central structure for admin- 
istration, two wards on the ground floor of each and two on the floor 
above. The beds were of wood, and each constructed for two occu- 
pants. They were also supplied with green serge curtains. Thef% 
was additional room in each building for 40 couches—thus making 
the total capacity 480. 
In a short time, however, in spite of the large mortality brought 
about by the terrible crowding, there was not room for the many 
demanding admission, and, fortunately, tents had to be used. At 
one time there were as many as 700 patients. This occurred during 
the frightful epidemics in the navy during the ten years prior to 1750. 
It was in this latter year that an addition was made in the form of a 
new pavilion. 
It seems that the large mortality and overcrowding continuing, 
plans for a new hospital were devised in 1782, and extensive grounds 
were bought in a more elevated situation outside the ramparts. Here 
work was begun in 1783 on a hospital to cos 400,000 francs, and to 
contain 1002 single beds, with 1400 cubic feet of air to each. 
In the middle of 1787 the work had progressed so far that these 
beds were moved in. Iron beds they were, the first used in French 
hospitals. In 1788 this hospital, the present one (Plate III), was 
opened with much ceremony, and in three days the old one was 
abandoned, one may suppose with a sigh of relief; for during the 
105 years it had been occupied, 30,000 dead had been carried out of 
its doors. NOTES ON NAVAL HOSPITALS. 
241 
In writing of the naval hospital at Toulon, one feels that the task 
is more or less disagreeable. The French Government should have 
destroyed it long ago. It was never suitable for a hospital, and yet 
it has been used as such for more than a century. 
In much less time, even the best-planned hospital is in danger of 
suffering from hospitalism ; but an old seminary, wretchedly designed, 
shut off from sunlight and pure air, when used for the treatment of 
the sick, soon becomes contaminated, and each patient entering its 
doors encounters a new danger, in spite of the best directed and 
most skillful efforts of those having him in charge. 
The walls of this institution have been standing since 1686, at which 
time the Jesuits began the education here of chaplains for the navy. 
A similar enterprise had been initiated the year before at Rochefort. 
The government, at such an early date, considered it advisable for 
priests serving in the navy to have special training. 
Twenty-three years after this, by the effort of that memorable 
medical officer, M. Dupuy, a like conviction was instilled into the 
mind of the king’s minister, in regard to the medical officers of the 
service, and, in 1725, a school was established at Toulon for a like 
purpose, six years after a similar one had been founded at Rochefort. 
At that time, however, there was no regular constituted naval hos- 
pital at Toulon. The sick of the navy had been treated for some 
years in the arsenal. 
In 1716, this proving inadequate, the system was inaugurated of 
paying a civil hospital for this service. This, for several reasons, 
always proves very unsatisfactory, and, as a result, the project of 
establishing a naval hospital was constantly being discussed. 
Time passed, and Toulon increased in importance as a naval sta- 
tion. Economy still prevailed; but the need becoming more urgent, 
the king, in 1774, signed the transfer of the house of the Jesuits to 
the medical department of the service. The clergy and the munici- 
pal authorities naturally objected, and their influence was so great 
that the change was delayed. 
In 1783, just after peace with England was signed, the French fleet 
broke its rendezvous at Cadiz, and many of the vessels came into 
the harbor of Toulon, having eleven hundred sick on board. There 
were not accommodations for such a large number, and tents were 
used for this purpose. 
Naval Hospital at Toulon. 242 
GATEWOOD. 
The necessity for a naval hospital was thus greatly emphasized, 
and the long-delayed transfer was made in 1785. The school and 
hospital have worked together in this building ever since. 
The building has a front five stories high, facing the south, and 
occupying the shorter parallel side of a trapezoid; the wings going 
back on the two adjacent sides, and joining a rear building parallel 
to the front. This rear building is again connected with the front by 
two additional perpendicular wings, thus dividing the enclosed 
ground into three small unequal courts—all the wings, and rear of 
three stories, and the extreme west wing extending beyond the rear 
structure its own length. Some idea of this plan is obtained by 
Plates IV and V. 
A massive structure it appears, set down in a densely populated 
city, and separated by narrow streets from the many neighboring- 
buildings. There is a court in the rear, a continuation of the trape- 
zoid, with continuous one-story buildings around it, containing store- 
rooms, attendants’ quarters, and the like; and projecting into it, a 
building for a pharmacy, dissecting room, mortuary, laboratory, and 
other offices. But little air stirs within or without such a hospital, 
and the sunlight shining on its high front reaches but little else. 
There are twelve wards, many of them practically being one, as 
the only separation is an arch. They are one hundred feet long, 
thirty wide and fifteen high. They contain, as a rule, twenty-four 
beds each, between and near six windows on each side. There are 
no additional means for ventilating the fairly great allowance of 
nearly nineteen hundred cubic feet per bed. The floors are tiles laid 
in cement, and the walls are whitewashed. A patient, looking out 
of a window, sees, as a rule, nothing but walls, though he may catch 
a view of the sun for a short while. 
The water-closets are separated from the wards by a narrow pas- 
sage. They have a fairly good upward ventilation, though requiring 
frequent disinfection. The drainage is into open gutters, swept by 
a rapidly moving stream of water. 
The total capacity of this hospital is about three hundred, over 
two hundred and eighty being in wards, and the remaining accom- 
modations, for the officers mainly, being in rooms in the front. These 
rooms are supplied with open fireplaces, and, fronting on the south, 
are more cheerful and comfortable. The greater part of the build- 
ing is, however, heated by stoves. 
It is almost needless to say, that in spite of all the skill practised NOTES ON NAVAL HOSPITALS. 
243 
within its walls, the mortality is great, and patients admitted with 
slight injuries are liable to develop grave troubles. 
The kitchen, though an excellently managed one, is in the base- 
ment, directly under a ward. The bath-rooms are also in the 
basement, but at a considerable distance from the wards, thoroughly 
equipped, and commanding admiration. The laundry work is done 
at a distance, in large stone basins supplied with water by a natural 
stream. There is every attempt made at cleanliness and comfort. 
The linen is frequently changed, and the beds have each two good 
mattresses on well-made springs. 
The efforts of the staff are worthy, too, of every praise, for they 
fight a good fight against a constant and ever-present enemy. This 
staff consists of eight officers, including the m6decin-en-chef in charge. 
In addition to other duties, many of these conduct the school. 
The whole work is performed in the most excellent manner.' Most 
of the nursing is done by men, but the Sisters have the general super- 
vision of them, as well as the care of special cases. These superin- 
tend also the storerooms, kitchen, linen-room, and the general dis- 
tribution of material. 
The Naval Hospital at Toulon is most ably conducted. It could 
not be otherwise, under men who hold their high position by great 
merit only. But France considers herself too impoverished to 
build another, though she listens to the earnest requests and repre- 
sentations of her well-informed medical officers, and continues to 
expand her wonderful navy and army. 
Naval Hospital ( Clermont- Tonnere) at Brest. 
Prior to 1666, the sick of the navy were treated in the civil hospital 
at Brest. At that date, this hospital was destroyed by fire, and an 
old deserted guard-house was taken for this purpose. The building 
was small, in a bad situation, and soon overcrowded. As a result of 
this unfortunate situation, the government was compelled, in 1684, to 
construct a naval hospital. This hospital contained three hundred 
beds, but was too small to accommodate the large number requiring 
treatment, and an addition was built in 1689. 
In 1776, this first naval hospital at Brest was destroyed by fire, 
and it is stated that convicts there under treatment, and still in chains, 
were burned in their beds. After the fire, there was an immediate 
necessity to find accommodations for the many sick. An old Jesuit 
seminary was taken for this purpose—it then being used as quarters 244 
GATEWOOD. 
for the marine guard. The sick were put in this building, and, in 
time, certain additions were made to it, so that it was able to contain 
five hundred beds. 
This seminary was used as the Naval Hospital at Brest until 1834, 
when the present structure was finished. The corner-stone of the 
present hospital was laid in 1822, by Clermont Tonnere, the Minister 
of Marine, from whom it received its name. The site is the same as 
that of the old building burned in 1776. It is an extensive granite 
structure, on a plateau back of the city of Brest, and on the left 
bank of the Penfeld river, commanding a fine view of the city and 
the roads. It has two stories and an attic, and contains 1200 beds. 
It is a pity that this large hospital has such a defective plan 
(Plate VI). Though symmetrically arranged, its wards bear such 
a relation to one another that but little light and air are admitted 
to them. All the wards are parallel, and are connected at one end 
by a corridor, or rather gallery, to which they are all perpendicular. 
From this gallery, or rather in the continuation of the wards into it, 
are the stairs connecting the two stories. The wards are joined in 
the rear, mostly in pairs, by passages in which are the water-closets, 
and from which are back stairs connecting the two stories, and also 
steps leading down into the gardens and courts which the various 
buildings enclose. The whole comprises a series built upon the block 
plan, and containing its worst features. 
Each ward is over 170 feet long, 26 wide and 15 high, containing, 
usually, 50 beds, and furnishing over 1200 cubic feet of air space per 
bed. There are sixteen windows on each opposite side, but no other 
means of ventilation, save the two doors. The next building across 
the court is distant less than fifty feet. The beds are iron, and have 
two mattresses on springs. Strange to say, officers are treated in wards 
just as enlisted men, there being a ward on the second floor reserved 
for them. The number of rooms is very small. These are well fur- 
nished and contain every convenience, but have to be kept for seri- 
ous cases only. 
There is no separate building for contagious diseases, and at a date 
not very remote, many cases of smallpox were treated in the wards. 
The venereal ward is at the extreme end of the building, and this 
connects through a small room with an annex generally used for 
other contagious disorders. This annex is continued so as to form 
a court around the chapel, and contains smoking-room, baths, mor- 
tuary and post-mortem room. The kitchen is to the left of the NOTES ON NAVAL HOSPITALS. 
245 
second entrance, near the quarters of the junior officers on duty, and 
to the right of this entrance is the administration. The grounds 
contain a botanical garden, and a promenade bordered by trees. 
Between these is the building for the medical school. 
The sisters, who have special quarters assigned them near the 
entrance court, nurse special cases and have the supervision of the 
male nurses. They also superintend the kitchen, laundry, store- 
rooms, and the like. There is one nurse for every twelve patients. 
The number of patients treated here is several thousand a year, and 
the mortality frequently exceeds four per cent. The hospital is in 
charge of a m6decin-en-chef. 
Naval Hospital of St. Mandrier. 
The coast in the immediate neighborhood of Toulon forms, as it 
encloses the two roadsteads, a curve somewhat like a parabola, with 
the axis nearly east and west. Toulon is on the north side of the 
curve, and the hospital Saint Mandrier on the south, distant from the 
city more than two miles, and overlooking the Grand Roads. Here 
the ground is high, and the extreme point is commanded by a fort, 
to guard the entrance to the roads. This fort is 900 yards distant 
from the hospital, which is sheltered by the intervening hills and the 
bluff formed by the excavation necessary for a site. 
Unfortunately, in the desire to protect the hospital from shells in 
time of war, so much excavating was done that the wind from the 
south is entirely excluded from it. In doing this a tremendous 
amount of labor was required, so that, though the work was com- 
menced in 1817, under the design of M. Raucourt, an hydraulic 
engineer, it was not completed until 1830. Much of this work was 
done by convicts. The building erected at that time for their occu- 
pation still stands (800 feet long), and is used now for venereal 
cases, the laundry, and quarters for workmen. 
The grounds are 675 yards long and 255 wide, and exhibit by the 
amplitude the great amount of excavation required. The shore here 
can be approached by small boats, for which there is constructed a 
small dock ; but the main landing extends out 400 yards (Plate VII). 
The main buildings consist of three detached pavilions, one front- 
ing the bluff to the south, and the other two placed laterally nearer 
the water, and perpendicular to the first. They are each three hun- 
dred and sixty feet long and twenty-seven wide, but the breadth is 
doubled by strong covered balconies on the faces next the court. 246 
GATEWOOD. 
These immense buildings, with their three stories, and adjoining 
grounds containing a botanical garden, beautiful walks and trees, and 
many detached buildings, including a classical chapel with its dome 
supported by many Ionic and Corinthian columns, present a glorious 
memorial of the greatness, gratitude and justice of France. And 
yet, the never-ending questions: should there be any grand hospitals 
anywhere ?—should not all hospitals be cheaply built, and frequently 
destroyed?—present themselves even here. 
There are 1200 beds within these walls and the many detached 
smaller structures. Most of them, however, are placed in the wards 
of the lateral buildings. These wards are 120 feet long, 27 wide and 
14 high, and contain 36 beds each, with more than 1200 cubic feet 
per bed. The floors are tiled, the walls plastered, and the ceilings 
wofully cut up by arches. There are windows on both opposite 
sides, but no other means of ventilation. The necessary heat is sup- 
plied by three open stoves, symmetrically placed in each ward. The 
climate, however, is remarkably mild, as is demonstrated by the 
tropical growth in the gardens. 
The front building contains, on the first floor, offices for the admin- 
istration, and quarters for the chaplains, chief medical officers, and 
sisters. These last superintend the kitchen, storerooms, laundry, 
and the nurses. On the second floor of this building are quarters 
for the junior officers, and small wards for the treatment of sick offi- 
cers. In the basement or ground floor are the laundry, 
linen room, and the like, and also the pharmacy. 
Strangely enough, there is not a water-closet in the whole building. 
The system employed is that of perambulating closed stools, which 
are kept, for the most part, in the balconies, and emptied into an 
earth-pit. This, of course, entails many inconveniences, and makes 
cleanliness exceedingly difficult. 
Associated with this hospital are many detached buildings. In 
the rear of each lateral building is a series of parallel, temporary, 
detached wards, accommodating many patients. In front of the 
administration building are three enormous cisterns, remarkable for 
the capacity of 10 million litres. In regarding caverns, one is 
impressed by the great work of those galley-slaves. 
Among the objections to this great hospital are the nearness of the 
bluff, and the obstruction presented by those very wide balconies to 
the admission of sunlight to the wards. But this large receiving hos- 
pital has been of immense value to France in her many wars; notably, NOTES ON NAVAL HOSPITALS. 
247 
in the Greek, Algerian, Crimean, Italian, and German campaigns ; 
and to Toulon in her many epidemics. 
In 1850, the botanical garden was transferred here from the hos- 
pital at Toulon. Every year, its connection becomes closer with the 
naval medical school in the south of France, and much work is done 
here now by the students, especially in surgery and clinical medicine. 
Naval Hospital at Cherbourg. 
Cherbourg was not designated as a naval station until 1781, from 
which time until 1793, the sick of the navy were treated in a civil 
hospital. When the large number of workmen in that locality made 
it impossible for this hospital to receive all the sick, an ancient abbey 
was placed at the disposition of the navy, which, after many changes, 
was converted into a naval hospital. Soon this became insufficient, 
and a new pavilion was added, containing three wards, holding forty 
beds each. The capacity was thus increased to three hundred beds. 
The grounds of this hospital contained a chapel, and many small 
buildings for mortuary, laundry, and quarters for workmen; and 
also a botanical garden. 
As Cherbourg increased in naval importance, additional quarters 
for the sick were obtained in a barrack. There were disadvantages 
in having the sick in two establishments so far apart, and, besides, 
the total number of beds was not sufficient for emergencies. Thus, 
after much consideration, large grounds were purchased west of the 
city, for the erection of a large modern hospital to contain 1000 beds. 
This hospital was not completed sufficiently for occupation until 
1870, and a portion of the plan still remains to be carried out. 
(Plate VIII.) 
It consists now of three detached pavilions, arranged like those at 
Saint Mandrier, except that the front one extends beyond the others, 
sufficiently for two additional outside rear-pavilions to be built in 
accordance with the original plan. 
The front looks to the north over the dockyard and Grand Roads, 
so that the rear pavilions have the great advantage of being north 
and south, thus receiving much of the sun. All the buildings are 
three stories high, and contain about six hundred beds, though, 
usually, there are only two hundred and fifty patients. In front is 
a large garden and promenade. The enclosed court is also laid out 
as a garden, and is surrounded by a covered way which connects all 
the buildings, and which can be closed in bad or cold weather. 248 
GATEWOOD. 
The main structure in front is used for the same purposes as the 
corresponding building in Saint Mandrier, while the long, narrow 
wards are chiefly in the rear pavilions. The wards have polished oak 
floors laid in cement, and are warmed by stoves with porcelain sides. 
Besides numerous windows on both opposite sides, there are venti- 
lators near floors and ceilings. Each ward contains forty-eight beds, 
which are supplied with two mattresses and good springs. There 
are water-closets, urinals, and sinks near every ward, but well separ- 
ated from them. A male nurse looks after twelve patients, but as 
in all French naval hospitals, the sisters nurse special cases and have 
the general superintendence. 
The rear pavilions, which are over four hundred feet long, are 
distant from each other more than 200 feet. Occupying a part of 
the space between their rear ends is a large chapel, while in the 
corresponding space at the other end are the baths. These are most 
complete, containing in addition to the usual tubs, a swimming pool, 
a large variety of douches, and shower, sulphur, vapor, and hot-air 
baths. . 
The laundry is in a separate building in the west rear corner of the 
grounds. It is complete in every respect, and has been recently 
erected at the cost of 300,000 francs. The mortuary is in the corres- 
ponding corner on the other side. There is a small wooden structure, 
rather too close to the main buildings, for the treatment of contagious 
diseases. 
A description of the naval hospitals of France, however short, can 
scarcely be separated from some account of the Naval Medical 
Schools so closely connected with them. The French naval hospital 
dates back to the beginning of the regular organized navy in 1666, 
but the school did not follow until more than a half a century had 
elapsed. There were several conditions which finally necessitated 
their establishment. Soon after the foundation of Rochefort it became 
necessary to have capable medical officers at the various naval stations 
where so many officers and workmen were being employed. 
Considerable care was exercised in their selection, with the result 
of obtaining good men. The inducements were sufficient to retain 
them in these positions for many years, as is shown in the case of 
Ollivier, who was, “ ier m6decin du port de Brest” for more than 
forty years. These in turn were succeeded by others, all remaining 
for many years, and attaching importance and dignity to the titles 
The Naval Medical Schools of France. NOTES ON NAVAL HOSPITALS. 
249 
“ M6decin du port” and “ Chirurgien-major du port.” Some of these 
gentlemen represented the best talent in the whole kingdom, and 
were doctors of medicine of the best faculties in France. 
On the other hand, the medical service afloat was made of different 
material. For some time, commanding officers of ships selected their 
own surgeons from such material as presented, and they held their 
places for short times only, and under other great disadvantages. 
Then a few surgeons were appointed at each port who were availa- 
ble for sea service, but their assistants continued to be appointed in 
the same manner. At this time there existed in the navy, as on 
shore, both the physician and the surgeon. The latter was, as a rule, 
illiterate, and had obtained his small knowledge as an apprentice in 
the office of some surgeon in the large cities. 
The former, though the better educated, was generally one of little 
worth, who, in spite of the disadvantages of life at sea, resorted to 
the navy as a means of livelihood. In their education they had also 
imbibed a contempt for the surgeon as a class. Out of this condition 
of things only dissatisfaction could come. 
The various medical officers of the ports soon became aware of the 
great need of improvement. A short time after M. Dupuy was 
appointed “ ier of the port of Rochefort (1712), the estab- 
lishment of a naval medical school became the great object of his 
life. This gentleman, who was a graduate of the faculty of Toulouse 
and a member of the Academy of Sciences, repeatedly urged upon 
the government the necessity for such institutions. 
Disheartened by no failure, he finally accomplished his object, and 
succeeded, in 1722, in having a suitable building erected for the pur- 
pose, at which time this school was opened at Rochefort, with much 
formality. The success of the project was soon assured, and its influ- 
ence became so apparent that two other schools were soon established, 
the one at Toulon, in 1725, and the other at Brest, in 1731. 
These schools have commanded the admiration of the world ever 
since ; and in spite of the many successions of kings and of the Reign 
of Terror itself, they have always been fostered and prized by the 
French people. 
M. Dupuy is marked in naval history by his thorough grasp of 
a subject so important to the future welfare of his country. In 
England the purpose of the Naval Medical School is to complete the 
education of their assistant-surgeons acquired at the various medical 
schools of the country, but in France the object is to begin that edu- 250 
GATEWOOD. 
cation, and carry it on to a high grade of perfection. These schools 
have been so ably described by Medical Director Richard C. Dean, 
of the United States Navy, that all the remaining remarks upon this 
subject may be considered as a r6sum£ of his remarkably complete 
report. 
The student is taken as a youth over eighteen years of age, and 
impressed, from the beginning, with naval methods. He must be a 
citizen of France, without physical fault, and have arrived at the 
dignity of an A. B. or a B. S. Dismissal from one school for defi- 
ciency in studies, or infractions of discipline,bars him from the other 
schools and from naval life. There are two divisions in the school, 
and promotion from one to the other is determined by examination 
at the end of one year. This is a good arrangement, as two failures 
(one year interval) to pass from the lower to the higher division, 
leads to dismissal and rids the school of the trouble of working and 
spending money upon unsatisfactory material. 
The professors are permanently attached to the school. They are 
assisted by “ fellows ” who have arrived at that dignity after a special 
examination. These latter are liable in time to sea service. Every 
subject is lectured on three times a week, and each course is com- 
pleted once in two years. Thus, after two years study, the successful 
candidate becomes an assistant-surgeon; and, after two years more 
study, if successful, a surgeon of the second class. 
An assistant-surgeon is not considered prepared for service at sea, 
as he has been examined only on the following subjects: 
1. Anatomy, performance of dissection (oral). 
2. Pharmacology, extemporaneous pharmacy (oral). 
3. Minor surgery, application of apparatus and bandages (oral). 
4. General pathology and semiology (written). 
After this examination he remains under instruction for another 
two years, with the exception of six months at sea, and is then exam- 
ined for promotion to the grade of surgeon of the second class. This 
examination is on the following subjects : 
1. Anatomy and physiology (oral). 
2. Materia medica and therapeutics (oral). 
3. External pathology, operative surgery, obstetrics (oral). 
4. Internal pathology, hygiene, legal medicine (written). 
Having passed this examination, he is granted six months leave 
for the purpose of procuring the degree of “ doctor of medicine” 
from one of the faculties of France. The government defrays all the 
expenses entailed by this leave in the event of success, and in return NOTES ON NAVAL HOSPITALS. 
251 
demands a written contract to remain in the naval service lor ten 
years. 
The examination for promotion to the grade of surgeon of the 
first class is also held at the school, and embraces the following 
subjects: 
1. Physiology (oral). 
2. Clinical medicine (oral). 
3. Operative surgery, obstetrics, performance of one surgical and 
one obstetrical operation (oral). 
4. Naval hygiene, pathology, a report on medical jurisprudence 
(written). 
The whole curriculum of studies is as follows: 
1. Legal and administrative medicine. 
2. Clinical medicine, medical pathology. 
3. Materia medica and therapeutics, toxicology. 
4. General and naval hygiene. 
5. Clinical surgery, surgical pathology. 
6. Operative surgery. 
7. Anatomy and physiology. 
8. Obstetrics, diseases of women and children. 
9. Chemistry. 
10. Pharmacy and medical physics. 
11. Natural history (medical), pharmacology. 
12. Descriptive anatomy. 
13. General pathology and semiology. 
14. Minor surgery, apparatus and bandaging. 
15. Extemporaneous pharmacy, chemical manipulations. 
To teach these various branches there are various amphitheaters, 
a library, a botanical garden, and a museum of natural history, 
pathology and anatomy. In addition to all this, the wards of the 
hospital form the great school, and in them clinical instruction is 
given in the most thorough manner. 
The final examinations for each grade are conducted at each school 
by professors from all of them. The examination is presided over 
by the director of the school at which the examination is held. He 
is assisted by one professor from that school, who has been deter- 
mined by lot. The other two come, one from each of the other 
schools, and have been selected in the same manner. All the ques- 
tions to be asked have been chosen by the medical council in Paris, 
from the number sent from all the schools. These questions, in a 
sealed envelope, with each question also sealed, and those for the 252 
GATEWOOD. 
different grades separated, are sent to the board of examiners after 
they have met in session. 
The candidate to be first examined is determined by lot, as well 
as the question to be first asked. All other candidates then with- 
draw', and are placed under guard in a distant room. As soon as the 
question is answered, the same question is put to each of the others, 
the order being determined by lot. Thus a separate question is 
drawn at each day’s session. As a candidate answers, each professor 
places after the name his estimate of the value. When the answer 
is written, it is placed in a sealed envelope, and is read aloud next day 
by the candidate in public. After the last question has been answered, 
there is prepared, in secret session, a list of all the candidates, with 
the marks of each professor opposite his name. This list is sent to 
Paris, where a superior commission is appointed, to consider these 
marks and make the final classification. The minimum for each 
grade is 200, and 20 is the maximum for each question. No one can 
serve as a member of the examining board who is, in any degree, a 
relation or a connection of any student. An alternate, selected by lot, 
is available for any such emergency. This remarkable method 
demands no criticism here, but suggests many. At any rate, it pre- 
cludes all prejudice, favoritism, and mercy. 
Before leaving this subject, something must be said about the daily 
routine. The work begins at eight o’clock, before breakfast, and 
starts with an hour’s clinic in the wards, followed by an hour’s lecture. 
The lecture is generally from manuscript. Attendance is obligatory, 
and the subjects to be lectured upon, with the day for each, are posted 
on the bulletin board every week. After the lecture comes the hour 
for breakfast, followed by another lecture lasting an hour. After this, 
there are three hours passed in the dissecting-room or laboratory. 
This routine seems to demand a great deal from young men before 
breakfast, but is in accordance with the French method of living. 
There are generally over 100 students at each school, and of these, 
about 10 per cent come up to the requirements. 
Naval Hospitals of the United States. 
The history of the navy of the United States begins as early as 
October 13th, 1775 ; but there was no attempt to establish naval hos- 
pitals until February 26th, 1811. However, much before that date, 
provision had been made for the treatment of the sick and disabled 
seamen of both the navy and merchant service. 253 
NOTES ON NAVAL HOSPITALS. 
When the partially erected palace of Charles II at Greenwich, 
England, was, in 1694, converted into a naval hospital, the tax for its 
maintenance was levied, not only at home, but also in the American 
Colonies, where each seafarer was required to pay a portion of his 
earnings to support an institution so far distant. The collectors were 
educating the American people then, and continued to educate them 
for many years, in a system which they themselves were to adopt 
after a century, with its many dark days, had been added to the past. 
1776 came, and a new flag was unfurled, which was soon carried at 
mastheads rapidly increasing in number. 
By July 16th, 1798, the number of American seamen had become 
so great, that Congress passed an act for the relief of the many sick 
and disabled. By this act, twenty cents per month were deducted 
from the wage of each seaman in a merchant vessel of the United 
States, and directors were appointed to control the expenditure of 
this hospital fund at the various ports. This was the beginning of 
the Marine Hospital Service, under which the sick of the sea could 
find refuge in various civil hospitals designated by the directors. On 
March 2d, 1799, the act of the previous year was extended so as to 
embrace the naval service; the Secretary of the Navy being author- 
ized to deduct twenty cents each month from the pay of every officer, 
seaman, and marine. The benefits and advantages were to be the 
same as those accorded to the crews of merchant vessels of the 
United States. 
However, as might have been predicated, it was soon apparent that 
the navy could not, without many disadvantages, depend upon civil 
hospitals for the treatment of its sick. The men, passed from the 
control of their own officers, lingered in hospitals for considerable 
periods, and in many instances finally disappeared. It soon became 
the opinion that the good of the naval service demanded that it 
should have its own hospitals. Accordingly on February 26th, 1811, 
Congress passed a law establishing naval hospitals. 
By this law, the Secretaries of Navy, Treasury, and War were 
appointed, for the time being, “ Commissioners of Navy Hospitals,” 
and to them the hospital tax accruing from the navy was to be paid, 
together with all fines imposed upon officers, seamen, and marines. 
This fund was augmented by $50,000 appropriated out of the 
unexpended balance of the marine hospital fund ; this being consid- 
ered the amount belonging to the navy from payments made prior 
to the passage of the act. These commissioners were authorized to 
procure sites for hospitals, and, where suitable buildings could not GATEWOOD. 
254 
be purchased with the sites, to cause such to be erected. They were 
also required “to provide, at one of the establishments, a permanent 
asylum for disabled and decrepit navy officers, seamen, and 
marines.” 
The act goes on further to say, that when any officer, seaman, or 
marine shall be admitted into any hospital, that that institution shall 
be allowed one ration per day during his continuance therein, to be 
deducted from his account, and that when any one is admitted who 
was previously entitled to a pension, this, during his continuance 
therein, shall be paid to the commissioners, and deducted from the 
account of the pensioner. 
Little, however, was done for ten years by these commissioners. 
The Secretary of the Navy, Mr. Hamilton, had hospital plans pre- 
pared by Mr. Latrobe, and was very anxious to execute, as soon as 
possible, the very desirable and very plain law. The other two 
commissioners were not in sympathy with the plans of the man 
knowing best the urgent needs of the service of which he was the 
head ; the opposition being based upon its permanency and stability. 
The importance of the subject increased by time; its advocates 
becoming more earnest each year. The good of the service demanded 
a better provision for the sick than was made by the inconsiderable 
establishments at some of the navy-yards. These were, in some cases, 
cast-off buildings and wretched hovels, destitute of every necessary 
comfort. The method of caring for the sick was constantly under- 
mining the discipline of the service, and diminishing the spirit of 
cheerfulness and content. 
It was more than ten years after the passage by Congress of the 
“act establishing navy hospitals,” that the commissioners, changed 
by the various political currents, began to carry out the real intent 
of the law under which they were created. Then, land was purchased 
at Boston, New York, Philadelphia, and Norfolk, and appropriations 
were made for buildings. The difficulty with which the three com- 
missioners worked together, led, shortly after this (ioth July, 1832), 
to Congress investing the Secretary of the Navy with all their powers. 
After this the work progressed more rapidly, and the navy was soon 
provided with hospitals in keeping with its promising future. As the 
history and description of each hospital are found below, it is only 
necessary here to give some idea of their internal organization and 
government. 
The book of “ Instructions for Medical Officers of the United States 
Navy” gives most of the required information. The medical officer NOTES ON NAVAL HOSPITALS. 
255 
in charge of a naval hospital is responsible for the care and treatment 
of the sick, and for the discipline, cleanliness, and economy of the 
institution, which it is his duty to keep always in an efficient condi- 
tion ; and to this end he shall exact from his subordinates, employes, 
and patients, a proper obedience to his orders and to the laws and 
regulations of the navy. Medical officers, and all persons employed 
in the hospital, shall perform such duties as may be assigned to them 
by the officer in charge. 
No changes, except in cases of emergency, which shall be imme- 
diately reported to the bureau, shall be made in the hospital buildings, 
furniture and grounds—such as destroying or removing trees, or dis- 
turbing the soil around them ; and no bills for purchases or repairs 
shall be contracted without permission of the bureau. 
The medical officer in charge shall inspect all medicines, provisions, 
supplies, etc., that may be received, or shall cause them to be in- 
spected by a subordinate medical officer, who shall report to him 
their condition, etc. A record of the inspection shall be entered on 
the daily journal. He shall direct the medical officers in charge of 
the wards to present their case-papers to him once a week for exami- 
nation, and will assure himself that they are accurately and carefully 
kept. 
The officer in charge of the hospital shall detail a medical officer 
who, in addition to such professional duties as may be assigned him, 
shall perform the duty of “officer of the day ” for twenty-four hours, 
commencing at io A. M. The officer of the day shall make a tour of 
inspection through the wards, kitchens, mess and other rooms occu- 
pied by patients and employes, upon going on duty at io A. M., 
and during the afternoon at a different hour daily, and finally at 
night alter the patients are in bed. A list of patients and employes 
who have received passes shall be furnished him, as early as practi- 
cable every morning, and all patients and others will be required to 
report their return to him. 
A journal shall be kept by him, which he shall sign at the end of 
his term of duty, at io A. M.; in which he shall make a brief record 
of the following points, which are to be noted at the time of occur- 
rence: the condition of the wards, kitchens, mess, smoking and other 
rooms, at each inspection; the condition of the meals served, as to 
quality and quantity ; the names and diseases of the patients admitted, 
and the places from which they are received; the names, number of 
days subsisted, and disposition of patients discharged, and whether 256 
GATEWOOD. 
the necessary papers in each case are correct and complete ; the 
names and conditions of patients and employes who have returned, 
or who have overstayed their leaves ; the confinement and discharge 
of offenders ; the reporting and detachment of officers, or their going 
upon and returning from leave; the record of inspection of all articles 
received; the object and finding of all boards of survey ; and finally 
such other matters occurring during his term of duty as it may be 
desirable to record. 
Medical officers in charge of wards shall be held responsible for 
their order and neatness, and for the good condition of all within 
them. They shall exercise a personal supervision over the comfort 
and welfare of the sick, visiting them at least twice daily, and oftener 
in severe cases; and they shall assure themselves that their direc- 
tions as to medicines, dressings, regimen, etc., are accurately and 
promptly carried out. They will, personally, take the temperature 
of patients, and will never allow this duty to be performed by the 
nurses. 
Patients should be accompanied, upon admission, with hospital 
tickets, but in cases of emergency they may be admitted without 
this paper, when the medical officer shall report the fact to the com- 
mandant of the station, with a statement of the emergency, and cause 
the necessary hospital ticket to be supplied. 
Convalescents may be detailed for light service, but shall not be 
retained in the hospital for that purpose after they are fit for duty. 
No patient in hospital shall be entitled to any service except that 
of the regular hospital attendants, nor shall any one except medical 
officers on duty, patients and employ6s of the hospital, be subsisted 
or lodged, without permission of the bureau. 
In hospitals the following diet table will be followed for patients 
when practicable, but the allowances to attendants’ messes may be 
varied at the discretion of the medical officer in charge, provided the 
value of the ration be not exceeded : 
Sunday. 
Coffee (oz. 1), pt. 1. 
Bread, oz. 6. 
Butter, oz. 1. 
Stewed mutton, oz.4. 
Sugar, oz. 1. 
Milk, oz. 2. 
BREAKFAST. 
DINNER. 
SUPPER. 
Roast beef, oz. 12. 
Bread, oz. 4. 
Potatoes, oz. 10. 
Other veg’s, oz. 4. 
Pickles, oz. 1. 
Tea (oz. i), pt. i. 
Bread, oz. 6. 
Butter, oz. i. 
Sugar, oz. i. 
Milk, oz. 2. NOTES ON NAVAL HOSPITALS. 
257 
Monday. 
Coffee (oz. 1), pt. 1. 
Bread, oz. 6. 
Butter, oz. 1. 
Beef hash, oz. 4. 
Sugar, oz. 1. 
Milk, oz. 2. 
Mutton, oz. 12. 
Bread, oz. 4. 
Potatoes, oz. 10. 
Other veg’s, oz. 4. 
Pickles, oz. 1. 
Tea (oz. i), pt. 1. 
Bread, oz. 6. 
Butter, oz. 1. 
Sugar, oz. 1. 
Milk, oz. 2. 
Tuesday. 
Coffee (oz. 1), pt. 1. 
Bread, oz. 6. 
Butter, oz. 1. 
Mutton hash, oz. 4. 
Sugar, oz. 1. 
Milk, oz. 2. 
Boiled beef, oz. 12. 
Bread, oz. 4. 
Potatoes, oz. 10. 
Other veg’s, oz. 4. 
Pickles, oz. 1. 
Tea (oz. i), pt. 1. 
Bread, oz. 6. 
Butter, oz. 1. 
Sugar, oz. 1. 
Milk, oz. 2. 
Wednesday. 
Coffee (oz. 1), pt. 1. 
Bread, oz. 6. 
Butter, oz. 1. 
Beef hash, oz. 4. 
Sugar, oz. 1. 
Milk, oz. 2. 
Beef soup, pt. 1. 
Pork, oz. 12. 
Beans, oz. 4. 
Bread, oz. 4. 
Potatoes, oz. 10. 
Pickles, oz. 1. 
Tea (oz. f), pt. 1. 
Bread, oz. 6. 
Butter, oz. 1. 
Sugar, oz. 1. 
Milk, oz. 2. 
Thursday. 
Coffee (oz. 1), pt. 1. 
Bread, oz. 6. 
Butter, oz. 1. 
Pork and beans 
(warmed), oz. 6. 
Sugar, oz. 1. 
Milk, oz. 2. 
Roast beef, oz. 12. 
Bread, oz. 4. 
Potatoes, oz. 10. 
Other veg’s, oz. 4. 
Pickles, oz. 1. 
Tea (oz. i), pt. 1. 
Bread, oz. 6. 
Butter, oz. 1. 
Sugar, oz. 1. 
Milk, oz. 2. 
Friday. 
Coffee (oz. 1), pt. 1. 
Bread, oz. 6. 
Butter, oz. 1. 
Fish chowder, oz. 4. 
Sugar, oz. 1. 
Milk, oz. 2. 
Fish, oz. 12. 
Bread, oz. 4. 
Potatoes, oz. 10. 
Other veg’s, oz. 4. 
Pickles, oz. 1. 
Tea (oz. £), pt. i. 
Bread, oz. 6. 
Butter, oz. i. 
Sugar, oz. i. 
Milk, oz. 2. 258 
GATEWOOD. 
Saturday. 
Coffee (oz. 1), pt. 1. 
Bread, oz. 6. 
Butter, oz. 1. 
Beef hash, oz. 4. 
Sugar, oz. 1. 
Milk, oz. 2. 
Bean soup, pt. i. 
Stewed mut’n,oz. 12. 
Bread, oz. 4. 
Potatoes, oz. 10. 
Other veg’s, oz. 4. 
Pickles, oz. 1. 
Tea (oz. i), pt. i. 
Bread, oz. 6. 
Butter, oz. i. 
Sugar, oz. i. 
Milk, oz. 2. 
A special diet list shall be kept for each ward, which shall be 
revised and corrected every morning by the medical officer in 
charge of the ward. 
Admission of Patients. 
The following forms are to be observed: 
(a) When the hospital ticket is found correct, endorse and file it, 
with accompanying papers relating to the case; if defective, return 
to the medical officer signing, when he is at hand; or otherwise, 
through the bureau. 
($) Enter name, etc., as follows: (1) In the general alphabetical 
register of patients, which is the permanent hospital record, for future 
reference. (2) In the abstract of patients. 
(c) Open case-paper. 
(d) If seaman from ,the receiving ship or other vessel, send ration 
notice to commandant of receiving ship as paymaster’s notification ; 
if a marine from the neighboring barracks, send the ration notice to 
the commanding marine officer through commandant. 
Discharge of Patients. 
No person shall be discharged from the service for physical disa- 
bility, without having been previously surveyed by a board of 
medical officers. A copy of the report of survey and of any other 
paper relating to the patient, shall be appended to the case-paper, 
which shall be signed at its conclusion, or on detachment of the 
officer, by the medical officer in charge of the patient’s ward. Case- 
papers will be verified by the signature of the medical officer in charge 
of the hospital. When a patient is discharged from hospital, the fact 
shall be entered upon the register of patients, and also upon the 
case-paper, which is then to be filed with the hospital ticket attached. 
The ration notice shall be forwarded through the commandant of the 
station. On every Monday, a report of the sick for the preceding NOTES ON NAVAL HOSPITALS. 
259 
week shall be made in triplicate, one copy of which shall be sent to 
the commandant of the station, one to the bureau, and the other 
retained for the files of the hospital, as a basis for the report of the 
following week. 
Medical Department, United States Navy. 
By an act of Congress, 31st August, 1842, reorganizing the Navy 
Department, the various bureaus were created, and the management 
of the medical department was vested in a single head, denominated 
Chief of Bureau of Medicine and Surgery. It was required that this 
officer should be chosen from the surgeons of the navy. On Sep- 
tember 1st, 1842, William P. C. Barton, M. D., was appointed the 
first chief of that bureau. On March 3d, 1871, the title of Surgeon- 
General of the Navy was conferred, and with it the relative rank of 
Commodore. 
At the same time the relative ranks of the officers of the medical 
corps were designated as follows: Medical Directors, with relative 
rank of Captain; Medical Inspectors, with relative rank of Com- 
mander; Surgeons, with relative ranks of Lieutenant-Commander 
and Lieutenant; Passed-Assistant Surgeons, with the relative ranks 
of Lieutenant and Lieutenant (Junior Grade); and Assistant Sur- 
geons, with the relative rank of Ensign. With the exception of the 
Medical Directors, these officers serve both afloat and ashore. 
Candidates for admission to the medical corps are examined at 
the Naval Hospital, Brooklyn, New York, by a specially selected 
board. Permission to appear before this board is obtained from the 
Secretary of the Navy. 
Attendants on the sick at the various hospitals are male nurses, 
selected from civil life by the medical officer in charge of the institu- 
tion. They are paid from $15 to $25 per month, and are subject to 
instant dismissal for incompetency or misbehavior. The number 
employed is about one to ever)’’ eight patients. 
The naval hospitals of the United States are situated at Widow’s 
Island, Maine; Portsmouth, New Hampshire; Boston, Massachu- 
setts; Brooklyn, New York; Philadelphia, Pennsylvania ; Washing- 
ton, District of Columbia; Annapolis, Maryland; Norfolk, Virginia ; 
Pensacola, Florida; Mare Island, California, and Yokohama,Japan. 
The total capacity of these is 823 beds, and the daily average number 
of patients is about 225. In the navy are 10,500 officers and enlisted 
men. 260 
GATEWOOD. 
Naval Hospital on Widow's Island, Maine. 
On Widow’s Island, Penobscot Bay, Maine, is a naval hospital, 
specially constructed for the quarantine and treatment of the sick 
with yellow fever. It is a novel hospital, in that the permanent 
building is chiefly for administration, while the wards are portable 
Ducker hospitals, packed away until necessity shall require their use. 
The history of this institution is rather peculiar. In 1885, the 
Isthmus of Panama was the scene of considerable naval activity, as 
the United States was under the necessity of having a force on shore 
and a squadron in that locality. The presence of so many ships in a 
part of the world so often the home of yellow fever, induced the idea 
that it would be wise to provide a suitable refuge for infected vessels. 
This situation was the exciting-cause of the construction on Widow’s 
Island, but a strong predisposing cause is found in the proximity of 
the old quarantine station near Portsmouth, New Hampshire, to 
sections frequented by summer visitors. 
The island had been purchased by the government for lighthouse 
purposes, but, as it was not required for that use, it was offered to the 
Navy Department to meet the supposed necessities of the time. It 
contains 15 acres, has a height of 100 feet above sea-level, is bounded 
by East Rockland Bay and Fox’s Island Thoroughfare, and is 12 
miles from Rockland and 2 miles from North Haven. The place 
could scarcely be more segregated, but, in time of need, special 
transportation of supplies from Rockland could be easily provided for. 
At the time of its selection it was almost barren, being destitute of 
trees and shrubs, and even water. However, the deep water near at 
hand, where the largest ships could swing at anchor, and the situa- 
tion so far north in a summer climate opposed to the spread of the 
yellow scourge, made it a desirable place for the purpose. A well, 
furnishing potable water, was soon made by boring, and a temporary 
wooden building was constructed in 1885, under the design and 
direct guidance of Surgeon A. C. Heffenger of the navy. There was 
fortunately no occasion for its use, but as the idea still prevailed that 
some future time might develop a pressing need for such an estab- 
lishment, Congress appropriated $50,000 for a permanent structure. 
This was begun June 4th, 1887, and completed, together with the 
pump-house and mortuary, on the following February. A wharf 
was also constructed on the southwest side of the island, where the 
land slopes gently to the water. All the rest of the coast is precipi- NOTES ON NAVAL HOSPITALS. 
261 
tous. By the approval of the Surgeon-General, Surgeon HefFenger 
furnished the design, and the work was also carried on under his 
supervision. 
The following description was written by him in 1888: 
“ The plan of the present hospital embraces a finished basement of 
eight feet, and two stories of twelve feet each. Its dimensions are 
ninety-six by fifty feet. The basement is built of granite, with granite 
water-table; and the-walls are built of brick, with a thickness of six- 
teen inches. It is placed on the highest point of the island, founded 
upon solid ledges, and facing the southeast. A wide verandah 
extends across the entire front and for some distance on either side of 
the hospital. The roof is of slate, and is surmounted by a cupola 
and flagstaff. 
In the basement are the laundry, ironing room, drying room, dis- 
infecting room, and numerous storerooms. On the first floor are the 
dispensary, reception-room, officers’ dining-room, patients’ dining- 
room, attendants’ dining-room, kitchen and pantry. On the second 
floor are three officers’ wards, three wards for men, a linen room and 
two attendants’ rooms. A dumb-waiter extends from the basement 
to the second floor. In the north corner in the basement, and upon 
both floors, is a room fitted with lavatory, water-closets and bath-tub; 
thus there is but one soil-pipe in the building, and that runs direct 
from the basement through the roof, where it is properly covered 
with a ventilating cowl. All the plumbing and plumbing fixtures are 
exposed, and have been thoroughly tested. 
Two water-tanks, with combined capacity of three thousand gallons, 
are placed in the attic, and water is pumped into them from the arte- 
sian well by a Rider caloric engine of six-inch cylinder, and deep 
well pump. To ensure a sufficient volume of water for using this 
pump, a reservoir six feet in diameter and twenty feet deep was 
blasted from the upper end of the well tube, the capacity of which 
more than equals that of the combined tanks. A two-inch distribu- 
ting pipe runs from the tanks down to the basement, and a fire-plug 
with hose attachment is provided on each floor and in the basement. 
The tell-tale and overflow lead into the laundry tubs. 
The drainage is excellent; the main sewer pipe running down the 
southwest slope from the rear of the hospital into Fox Island Thor- 
oughfare, where it terminates below the level of ebb-tide. A manhole 
and trap are provided just outside the building, and again imme- 
diately above high-water mark.” 262 
GATEWOOD. 
“ The barren and altogether unprepossessing aspect of the island 
rendered it advisable to make such improvements upon the grounds 
as the limited amount of the appropriation would permit. A number 
of walks were laid out and graveled. About two hundred and fifty 
spruce, fir, and hardwood trees were planted on the borders of these 
walks, and upon other parts of the island, and a lot for a cemetery 
was ploughed up, leveled and planted in grass seed. The ground 
immediately around the hospital was graded, terraced, covered with 
sea gravel for some distance, and sown in grass seed outside the 
margin of gravel. 
The hospital furniture was received and put in place during June, 
1888. It is plain in design, of excellent quality, and ample for the 
probable requirements of the station. The iron bedsteads with woven 
wire mattresses manufactured in Hartford, Conn., merit special 
notice. The pneumatic tubes and bells which connect all parts of 
the hospital are also worthy of special mention. 
The provision of Ducker Portable Field Hospitals is of great value 
to this station, as it makes it possible, under any ordinary demands, 
to treat all contagious cases outside of the main hospital, which can 
thus be reserved for treatment of non-contagious cases, and adminis- 
trative purposes. 
A small dead-house, with a cast-iron revolving autopsy table and 
concrete floor, is placed some distance from the other buildings, 
and affords excellent facilities for post-mortem examinations. 
The station as now equipped, including main hospital building and 
Ducker pavilions, accommodates fifty patients, and this number 
could be doubled or quadrupled by simply adding more Ducker 
pavilions.” 
U. S. Naval Hospital at Portsmouth, New Hampshire. 
There are two islands close to the Maine coast-line and the city of 
Portsmouth, New Hampshire, that are used by the United States for 
naval purposes. They are called the Puddington Islands, and are 
connected by bridges with each other and the Maine mainland, to 
which State they once belonged. They were a part of the discovery 
of Martin Pring in 1603, charted by John Smith in 1614, and 
included in the grant to Sir Fernando Gorges in 1639. 
In 1800 the government purchased from William Dennett the one 
nearer the mainland, for $5500. The other to the south, known as 
Seavey’s Island, did not become the property of the government 
until 1866, when the 26 owners parted with it for $105,000. NOTES ON NAVAL HOSPITALS. 
263 
The navy-yard was established on the one first bought, soon after 
the purchase. There was, however, no local provision for the care of 
the sick until 1834, when a small vacant frame building, constructed in 
1802, was repaired and furnished for that purpose. It could accom- 
modate but ten patients with any comfort, though occasionally 15 
were treated there at one time. In 1865, certain alterations were 
made, increasing its capacity to 25. It was then, however, more than 
60 years old, and soon the necessity for a new building became 
apparent. This subject was agitated from year to year, until in 1888, 
the Surgeon-General reported the old hospital beyond repair, and in 
every respect unfitted for the treatment of the sick. 
Congress, on March 2, 1889, and on June 30 of the next year, 
appropriated $43,000 for the construction and furnishing of a new 
building. Work was commenced in September, 1890, and the build- 
ing, with its various outhouses, was finished in a year, and commis- 
sioned on December 21, 1891, when the old hospital was abandoned. 
The old frame structure still stands in its dilapidated condition—one 
of the few wooden relics of the early days on the island. 
The new site is on the west shore of Seavey’s Island. This island 
was selected because it was important to have the hospital outside of 
the yard, and yet easily accessible. Next the Piscataqua river, and 
between it and the road connecting the bridges in the north with 
Fort Sullivan in the south, acres were set apart for hospital pur- 
poses. 
The building, which is about 83 feet long and 54 wide, is con- 
structed of brick, and fronts the south, with its length north and 
south. It consists of a cellar, 3 stories and an attic, under a pyramidal 
roof, surmounted by a ventilating cupola. The front projects for two 
stories, forming a small tower, on each side of which are short 
enclosed piazzas. 
The hospital, though new, is built on the corridor plan, there 
being a single central hall 10 feet wide on each floor, connecting the 
back and front. On each side of this are placed the wards and rooms. 
Little more need be said about the arrangement, as a reference to the 
plan submitted will be sufficient. The three wards are on the second 
floor. Sick officers and the resident medical officer have quarters on 
the third floor. The first floor is given up to administration, the 
dining-room and kitchen. (Plate IX.) 
The pitch of the first floor is 10 feet; of the second, 12 feet 3 inches, 
and of the third, n feet. There are beds for 26 patients, with 1060 264 
GATEWOOD. 
cubic feet of air space to each. In the officers’ wards the air space is 
2970 cubic feet for each. 
The floors of all the wards are of Georgia pine, on an under-floor- 
ing. The windows have double sashes, this being necessitated by 
the severe winters. They are provided with hinged lights. There 
are also 3 brick air-shafts extending the whole height of the building 
and connecting with the ventilating stack, while registers are near 
ceilings and floors, and cold air ducts from the exterior lead to the 
bases of the radiators. The radiators, which are placed at conveni- 
ent points throughout the building, are supplied with steam from the 
boiler-house in the rear. Gas for lighting purposes is made on the 
premises. 
The water-closets are at the back of the building, as well separated 
from the wards as the ground plan permits. They are supplied with 
overhead tanks and all modern improvements. The bath-rooms 
near by are well furnished. The traps to all fixtures have ventilating 
ducts, which finally discharge above the roof. The sewer system is 
an independent one, and empties into the adjacent waters. 
The source of the water supply is the ponds formed by damming 
the overflow from the springs near the center of the island. The 
boiler and laundry house is about 30 feet in the rear. The laundry 
has a concrete floor and wood ceilings, and is supplied with the mod- 
ern machinery of the Troy Laundry Company. The dead-house is 
at the northw’est boundary of the grounds, near the water. 
The staff consists of a surgeon and a passed-assistant surgeon. 
The former is also the surgeon of the navy-yard, where he is pro- 
vided with a residence. The total number of patients treated last 
year was 86. 
Seavey’s Island contains 105 acres of uneven and hilly ground, 
well suited for farming purposes. The surface soil is, however, gen- 
erally shallow and covers granite. The views from the island are 
extensive and attractive. The winters are long and severe, while the 
summers are short and mild. Storms are not uncommon, and fogs 
are not rare in summer. July and August are the warmest months, 
the thermometer perhaps reaching 85° F. February is the coldest 
month, as then the mercury may be io° or 150 below zero F. The 
mean annual temperature is 440 F. The location is free from 
malarial influences, but rheumatism, neuralgia and bronchial disor- 
ders are common. However, the climate seems conducive to a long 
life, though typhoid fever is not uncommon in the city, and cases of 
phthisis last, as a rule, but a short time. NOTES ON NAVAL HOSPITALS. 
265 
Naval Hospital at Chelsea, Massachusetts. 
As the policy of the government during recent years has been 
toward the concentration of the work of construction and repair of 
ships at two yards only, the navy-yard at Boston has, for the time 
being, diminished somewhat in importance, and, with it, the naval 
hospital, where the average daily number under treatment last year 
was only 17. 
This hospital is beautifully situated at Chelsea, a suburb northeast 
of the city of Boston, and separated from it by the Mystic river, 
spanned at this point by a substantial bridge, across which street 
cars closely connect the thickly populated suburb with the city 
proper. It is near the Boston end of this bridge that the navy-yard 
lies, less than a mile from the hospital. The hospital grounds are on 
the left bank, and occupy the angle formed just above the bridge by 
the Mystic and Mill rivers. 
On September 22, 1823, this tract, consisting then of 115 acres, 
was purchased for $18,000 from Dr. Aaron Dexter, of Boston, by the 
Secretary of the Navy, Secretary of the Treasury and Secretary 
of War, representing the government as “ Commissioners of Navy 
Hospitals.” This tract has been reduced to nearly 75 acres by 
several encroachments, but this has been since the hospital was com- 
missioned on January 7, 1836. 
The hospital then was much smaller than it is now, as on July 14, 
1862, $71,500 were appropriated by Congress for its extension and 
repair. Adams and Jenkins were the contractors, who, completing 
the new portion by March 2, 1864, and thus furnishing room for the 
sick, were able to remodel and repair the old portion by June 1, 
1865. While this work was going on, Morris Tasker & Co., of Phil- 
adelphia, completed for $18,000 the arrangement for heating the new 
portion, and for the laundry and culinary work, placing the boiler 
and laundry in a detached building in the rear. 
Considerably prior to these changes, the surgeon’s house was 
built. This is a large residence, 250 feet south of the hospital. It 
was erected at a cost of $11,500, this amount appearing in the 
appropriation bill for the year ending 1857. 
The hospital is a large granite house, devoid of any special hos- 
pital plan, 148 feet long and 70 wide, with pyramidal roof, attic, 
three stories and cellar. It is on a slight elevation, and faces the 
river to the southwest, from which it is distant about 100 feet. The 266 
GATEWOOD. 
first floor is only slightly above the ground level, so that there are 
only one or two short steps at the main entrance under the project- 
ing portico. The portico is 27 feet long and 13 wide, extends to the 
level of the second floor, and has four columns of the Doric order 
placed in front. The first story is divided by a central hall, 23J feet 
wide, connecting the front and rear entrances. On the north side of 
this hall are the dining-room (21J by 66 feet), well lighted by seven 
large windows, the dispensary, the kitchen, and two storerooms. On 
the south side are dining-room for the junior medical officers on duty, 
the administration office, reception room, storeroom, and linen 
closet. 
From the rear of the main hall a stairway ascends to the second 
story. The pitch of all the stories is 14 feet, and the arrangement 
of the 2d and 3d stories is the same. There is a hall ward, 23$ by 
265 feet, supplied with one window and containing eight beds, all 
against dead walls. To the north are two wards of nearly the same 
size and arrangement as the preceding one, and a large ward running 
crosswise and corresponding with the dining-room below. This 
ward, 21 £ by 66 feet, with a window at each end and five on one side, 
contains 20 beds—ten against the dead wall and ten between the 
windows opposite. 
The nurse rooms, bath-rooms, and water-closets are between the 
long and smaller wards. The bowls in the water-closets are porce- 
lain, and well flushed from overhead tanks. The closets containing 
no windows are lighted by gas, and ventilated by an air-duct leading 
to the roof. Their very objectionable situation is inseparable perhaps 
from the general plan. 
To the south of the main hall, on the two upper floors, are large 
well furnished rooms for sick officers and resident medical officers. 
The bath-room and water-closets are between the end rooms. Of 
course, all these various rooms and wards are arranged along inter- 
secting halls or corridors. The accompanying plate (No. X) shows 
the arrangement on the second floor, and more than suggests the 
obstruction to the free circulation of air throughout the building. 
It is useless to make any comment on the many beds against dead 
walls, and the many intersecting corridors. Every hospital should, 
of course, be considered with all the beds full, as this is the situation 
which best tests its plan. Here there are 100 beds with from 985 to 
1090 cubic feet air space and from 71 to 78 feet floor space to each ; 
but, as the number under treatment at one time rarely exceeds 30, NOTES ON NAVAL HOSPITALS. 
267 
these figures mean ordinarily but little. The beds in the wards are 
iron, and supplied with a hair and a wire woven mattress. 
The floors are painted soft pine, and the walls are calcimined. 
However, in the third story hard pine floors have been laid, and 
the walls are painted plaster. 
In addition to the windows and doors, ventilation in some of the 
rooms and wards is assisted by shafts leading to the roof. There is, 
however, no complete system of ventilation. 
Electric call-bells are placed throughout the building, and electric 
lights are now being introduced—the work to be completed by July 
1st, 1893. Gas is supplied by the city, as is the case with water, which 
comes from the reservoir of the Mystic Water Company. The water 
is abundant and of excellent quality. The sewer system is complete 
and independent; it discharges into the adjacent waters. 
The Walworth system is used in heating the hospital, the surgeon’s 
house, and certain other rooms, such as the smoking-room in the 
wooden annex. The steam heat is, however, difficult to control, 
and this in the variable climate leads to too great variations in 
temperature. 
The naval hospital grounds surround those of the marine hospital, 
which are off to the east and comprise ten acres. These ten acres 
were inadvertently given by Congress to that service. When it was 
discovered that they, a part of the original purchase of 115 acres, had 
been paid for by money held in trust, $50,000 were added to the 
hospital fund in lieu of them. 
The original purchase was further reduced by several acres taken 
at the beginning of the Civil War for ordnance purposes. It is not 
clear how the Bureau of Ordnance acquired this ground, nor how 
many acres are claimed. 
The acreage left to the hospital is, however, most ample; it, indeed, 
represents quite a farm. Much of it contains many fruit trees, while 
about the building and in other sections are ornamental trees, shrub- 
bery and flowers. 
Off to the west, a quarter of a mile from the hospital, and in the 
low and moist ground near the point where the two rivers join, is the 
smallpox hospital, completed on 25th April, 1869, by Geo. W. Clark, 
of Chelsea, at a cost of $8000. To the north, and at the same 
distance, is the cemetery. This is separated from the hospital by a 
line of hills 100 feet high. These hills, on whose slope the hospital 
is really built, shelter the building from the strong northeast winds 
which often prevail. 268 
GATEWOOD. 
Nearer the hospital, about 40 feet from the north end, is the brick 
mortuary completed in 1865. There are also near-by many coal 
sheds, a new barn, stable, carpenter shop, conservatory, hotbeds, 
paint-shops, and other outbuildings. The grounds are enclosed by 
water and by brick walls. 
The staff consists of a medical inspector and two assistants. Dur- 
ing the last twenty years the total number of patients treated has 
been nearly 3000. 
Until recently this was the only naval hospital on the Atlantic 
coast of the United States entirely free from malarial influences. 
This renders it a desirable place for the treatment of the many 
malarial troubles originating during the southern cruise of the home 
squadron. 
U. S. Naval Hospital, Brooklyn, New York. 
This establishment increases daily in importance as the navy 
gathers strength, and the navy-yard near-by becomes more and 
more the center of great activity in construction and repair. It is 
situated in the city of Brooklyn, in the State of New York, and, 
facing the west, overlooks the navy-yard, half a mile distant, and 
separated from it by a narrow intervening strip of the city. The 
grounds, now enclosed by high brick walls, comprised, originally, 
33 acres, but, on July 2, 1890, the United States Government sold 
to the city a little more than two acres. 
These 33 acres were the hill portion of the Schenck farm, purchased 
on May 1, 1824, together with the mansion and farm buildings, for 
$7650. In this purchase the government was, of course, repre- 
sented by the “ Commissioners of Navy Hospitals,” while the parties 
of the first part were Sarah and Jane Schenck, widows, and Jacob and 
Ida Harris and Isaac and Mary Ann Harris. On April 19, 1833, the 
State of New York ceded to the United States its jurisdiction over 
this property. However, at the time of the purchase, the mansion and 
farm buildings were made ready for the reception of the sick of the 
navy, then treated in a house rented by the government, and were 
so employed until 1838, when the front or main portion of the present 
hospital was first commissioned. In 1840 the wings were added and 
the original plan completed. At the same time was constructed the 
building to the east of the north wing, which is now designated as 
the laboratory, but was originally used as a pest-house. 
The hospital is on an elevation 56 feet above high water, and the wall 
in front, separating the grounds from the city, is distant 200 feet, NOTES ON NAVAL HOSPITALS. 
269 
while that to the south, where the main gate is, is 360 feet away. 
The building, fronting 197 feet, and consisting of full basement, two 
stories and attic, is constructed of marble from the Sing Sing quar- 
ries, originally white, but now a decided gray. The ground plan is 
like a modified H, the wings perpendicular to the front, and 49 feet 
wide, extending back 73 feet, but to the front only 11 feet. These 
forward extensions are really a part of the front or main building, 
the intervening space being occupied by an imposing portico 11 feet 
wide and 100 feet long, which, with its 8 square columns, supports a 
frieze and cornice suggesting remotely the Doric order. 
Though the columns extend from the ground, the floor of the 
portico is on a level with the first floor. As the ground immediately 
in front of the building is higher than that in the rear, the basement 
is partly covered in front; and the broad stone steps leading up to 
the portico spring from a terrace. This terrace is paved with stone 
flagging, and extends along the whole front, and for more than thirty 
feet on each side, where from each end steps ascend to a side entrance 
on the first floor. 
The paved court, which is open to the east, is 100 feet from wing 
to wing, and 60 feet deep; this being also the depth of the main 
building, which has, at the back and thus toward the court, 8 square 
columns similar to those in front, but supporting piazzas 100 feet 
long and 10 wide for each floor. As the court is on a level with the 
ground floor, it is in the rear that the hospital presents its full height. 
A corridor nearly 10 feet wide extends the whole length of the 
mid-line of the front on every floor, and is joined by similar ones 
from the wings. On each side of these are the rooms and wards. 
Thus it is seen that this is a corridor hospital on the block plan. The 
different stories are reached by very broad staircases within the front 
where each wing joins. The staircase wells allow with the corridors 
a free communication of air throughout the building. 
All the sick, except commissioned officers, are on the second floor. 
Here are found 15 wards of varying sizes for the treatment of enlisted 
men, and rooms for laboratory employes and sick warrant-officers. 
The wards, which are divided into many classes in accordance with 
the character of the cases, are in the south wing and the front. The 
rooms are in the north wing, though there are rooms for nurses in 
both wings, and there is an operating room in the south wing. This 
latter is on the south side of the corridor. Its floor, 15X11 feet, is of 
hard pine shellaced, and its height is 17 feet, this being the pitch of 270 
GATEWOOD. 
both stories. It contains one large window, and is bountifully sup- 
plied with instruments and all things necessary for successful work ; 
but, opening upon the corridor, its atmosphere is that common to 
the whole hospital (Plate XI). 
The largest wards are, of course, the four in the front extensions. 
These are 27X21 feet, and two are supplied with four windows each, 
and the inner two with three each. These windows are necessarily 
on adjacent sides ; thus, as is the case throughout the building, leav- 
ing dead walls; and like all the windows, though large, not extend- 
ing nearer the ceiling than 3 feet. All the other wards are about 
15X21 or 22 feet, and have two windows in each on the same side. 
The floors are, for the most part, painted soft pine, but recently a few 
hard pine floors have been put in. The walls are painted plaster. 
The beds are iron, and supplied with a hair and also a wire- 
woven mattress. Near each bed is a locker, a chair, and a small 
carpet-rug. The number of beds in a ward varies with the size of 
the ward, but as a rule, the allowance of floor space per bed is 65 
feet, and the cubic space 1100 feet. As this hospital, with accommo- 
dations for 125 patients, has most of the time less than 50, the floor 
space and air space given each patient are ordinarily most ample. 
However, occasionally the number of patients reaches 100, and prob- 
ably hereafter this will occur more frequently. The rooms on the 
second floor of the north wing are chiefly for sick w'arrant-officers. 
These are fairly well furnished, and have associated with them a 
dining-room and reception-room. 
On the first floor there are in the south wing, quarters for the three 
junior medical officers on duty ; in the north wing, a counting-room, 
quarters for the apothecary, and 5 rooms for sick commissioned 
officers, with reception and dining-room attached ; in the front are 
administration offices, board rooms, a mess-room for resident medical 
officers, 3 rooms for sick commissioned officers, a chapel and library, 
and a dispensary. The rooms for sick officers are well furnished, and 
have a homelike appearance. 
In the basement, which has a height of about 10 feet, and where 
the corridors are paved with stone flagging, are smoking and mess 
rooms for the men, kitchens, carpenter shop, storerooms, and quarters 
for laborers. The mess-rooms are two, one being for those on full 
diet. 
There are water-closets and bath-rooms on each floor, off the cor- 
ridors at the ends of the wings ; those on different floors being imme- NOTES ON NAVAL HOSPITALS. 
271 
diately above one another. The bath-rooms are 8X16 feet, while 
the rooms for water-closets are about half the size. Some of the bath 
tubs are porcelain and others are copper. There are also appliances 
for various special and medicated baths. The water-closets are sup- 
plied with seats, porcelain bowls, flushed from overhead tanks, and 
urinals. The floors are concrete, and there is a large window in 
each room. The doors of these rooms open directly on the corri- 
dors, but the water supply for flushing is unlimited, and the sewer 
connections are well guarded by traps. 
There are in the building a dark room, and electrical appliances 
for surgical and medical treatment. Fireplaces are in almost all the 
wards and rooms, but the hospital is heated by steam and hot air 
supplied from the engine and boiler house in the rear. The same 
machinery that drives heated air into the building in winter, supplies 
cool air in summer. The means of ventilation are, besides doors, 
windows, and chimneys, air shafts in the walls, and roof ventilators 
over the staircase wells. 
The system of sewers is extensive and complete, not only for this 
building but for all others in the grounds. The manholes and vents 
are open, and the highest point of the system is connected by a ven- 
tilating duct with the chimney of the steam building. The pipes 
connect finally with the sewers of the city. 
The water supply is the same as that of the city, connection being 
made with the city mains. This allows many fire-plugs about the 
grounds. From the city is also obtained the gas which lights the 
whole building. However, the work of introducing electric lights 
has been begun and will soon be completed. 
Walking about the grounds, one notices the laundry close against 
the engine and boiler house, 50 feet in the rear of the hospital. This 
laundry is relatively new and is supplied with every necessary appa- 
ratus. There is also the long building like the wings, and 
built on the same line as the north wing, though 60 feet in the rear. 
It is 100 feet long and 50 wide, was constructed in 1840 at the same 
time the wings were built, and was known then as the pest-house. 
It is now called the Naval Laboratory, though it is simply a large 
reception and storehouse, with basement and two stories, from which 
medical supplies are distributed to the various ships and stations. It 
is in charge of a medical director, who has a co'mmodious house in 
the north division of the grounds. This division is made by a high 
brick wall, extending approximately east and west, about 80 yards 272 
GATEWOOD. 
north of the hospital. Between the wall and the hospital are the 
mortuary, chapel, and a two-story building for contagious diseases. 
This latter building, called the smallpox hospital, is 200 feet from 
the main building to the northeast. Near it is a disinfecting 
chamber. 
The medical director in charge has a large residence in front of 
the north end of the main building. It faces the south, is forty-five 
feet square, with a large back building and has two stories. 
120 yards in rear of the hospital is the cemetery, whose register 
now numbers over 1250. 
The staff of the hospital consists of a medical director, a surgeon 
and two assistant-surgeons. The number of patients is, of course, 
liable to great variations. The mortality ratio has also been very 
variable, at times comparatively small, and at others relatively large. 
V S. Naval Hospital at Philadelphia, Pennsylvania, and Naval 
Home of the United States. 
Immediately after the passage of the law of 1811, entitled “An Act 
establishing Navy Hospitals,” it became necessary for the navy to take 
charge of its sick on shore. It was, however, very poorly equipped 
for such work, as there was not under its control a suitable building 
anywhere for such an undertaking. Necessity demanded something 
in the way of sick quarters at all the navy-yards. At the old navy- 
yard on the Delaware, in the city of Philadelphia, a very small 
building was appropriated to this use. It was represented in 1813 as 
a wretched hovel, destitute of every necessary comfort for sick per- 
sons, and calculated to hold eight patients. At that time it was 
holding twenty-four, and the thought of each was simply to gather 
strength enough to desert. This state of affairs demanded immediate 
correction, and a frame building was accordingly erected by order of 
the department issued the same#year. This was regarded at the time 
as only a temporary structure, but it was not until the 26th of May, 
1826, that the commissioners created by the act of 1811 made a move 
to carry out in this locality the real intent of that law. Then the 
purchase was made of the “Abbot lot,” the site of both the Naval 
Hospital and the Naval Home of to-day. 
This lot of 23 acres is situated on the left bank of the Schuylkill 
river, in the western section of the city of Philadelphia. It cost the 
government $17,000, and, as a part of the Pemberton estate of 150 
acres, has a long and interesting history. It is sufficient here to NOTES ON NAVAL HOSPITALS. 
273 
state that the Pembertons bought their “ plantation ” from the Penns 
in 1735, built a large square brick house and several brick outhouses 
on it, beautified it, and lived outside the city in good old colonial 
style. The British officers, attracted by the beauty of the place and 
its natural advantages, occupied it frequently during the war of the 
Revolution. .Surgeon Thomas Harris, of the United States Navy, 
many years afterwards, influenced by the same qualities, impressed 
upon the “Commissioners of Navy Hospitals” the desirability of 
acquiring possession of the lot of 23 acres, then the property of the 
Abbot family and containing the buildings. 
By the act of 1811 the commissioners were required to provide 
at one of the hospitals a permanent asylum for disabled and 
decrepit navy officers, seamen and marines. It was decided to carry 
out here in Philadelphia this provision of the act. Accordingly, 
immediately after the purchase in 1826, the buildings were made 
ready to receive the sick and also a few beneficiaries, and the hospital 
at the navy-yard was abandoned. Then, under Mr. Strickland as 
architect, and Surgeon Harris as superintendent, the work of con- 
structing the asylum was begun. It was called “Asylum,” as it had been 
so designated in the act establishing it, but soon there were many who 
regarded the selection of that term as unfortunate. The difficulty of 
making asylum and home synonymous was insuperable, but it was 
not until July 1, 1889, that the official designation became “ Naval 
Home.” 
In 1832 the building was under roof, but the Hospital Fund was 
so nearly exhausted that Congress, in July of that year, had to come 
to its relief by appropriating $33,900. So the work progressed, and 
toward the close of 1833 certain parts of the building were occupied. 
The old buildings were then deserted and the sick and the benefi- 
ciaries were transferred to the new home. A short time after this the 
other buildings were demolished and the bricks utilized to improve 
the walks. Work continued on the asylum, and it may be said that 
the building was not really finished until 1848. Over $195,000 were 
expended in construction, and Congress appropriated $93,000 of this 
sum, the remainder having been supplied out of the Hospital Fund. 
It remains now to give a short description of the building and grounds 
before passing on to the Naval Hospital, which is of much more 
recent construction. 
The grounds, in a great part surrounded by high brick walls, 
approximate the trapezoidal shape. The longer (1226 feet) of the 274 
GATEWOOD. 
nearly parallel sides is formed by the Gray’s Ferry road, and the 
shorter (583 feet), to the west and near the river, by Southerland 
avenue. The side (947 feet) nearly perpendicular to these is at the 
south, and the long (1364 feet) side at the north. The home fronts 
the southeast and the long parallel, from which it is 223 feet distant. 
It is a building 380 feet long, composed of a central structure, with a 
pavilion on each side, entering into the formation of the front and 
ending in a transverse building. A basement, two stories and an 
attic, broad verandas on the two floors of the wings, broad stone steps 
with a marble colonnade for the central structure, fine marble stair- 
ways in the interior, and vaulted masonry ceilings, and a domed 
chapel, give a general idea of the building. 
The beneficiaries number over 100, and each has a small room, 
three good meals a day, and a pound and a half of tobacco and a 
dollar each month. All the laundry work is done without any 
expense to him, and every reasonable convenience is supplied. 
Twenty years service, or serious disability in the line of duty, allows 
admission. On entering, all pensions must be allotted to the hospital 
fund. Before the building of the present hospital, the home was, of 
course, as much a hospital as an asylum. For hospital purposes the 
second floor of the south pavilion, the rooms in the transverse build- 
ing and the attic were employed. 
It was in this Home that the germ of the Naval Academy originated, 
as it was under its first “ Governor,” Commodore Biddle, that a class 
of midshipmen was formed, and professors were employed to teach 
them. The students were those preparing for examination, and the 
class was renewed year after year, until the founding of the Naval 
Academy in 1845. 
The Naval Hospital is in the same enclosure, 350 feet in the rear of 
the Naval Home, and 225 feet from the shorter parallel side of the 
grounds near the river. It is, with the exception of the stone base- 
ment, a brick building. It is 320 feet long, faces the southeast, and 
consists of a basement, two stories, and attic with mansard roof. It 
was designed by John McArthur, an architect, in 1865, when the 
appropriation for its erection was made. The work was begun in 
1866, with Dobbins Bros., Philadelphia, as contractors. After an 
expenditure of $172,500, the hospital was commissioned in July, 
1868. 
It consists of a central structure and two wings, all entering their 
full length into the formation of the front. The wings are pavilions, NOTES ON NAVAL HOSPITALS. 
275 
over ioo feet long, ending in transverse buildings, and containing the 
wards,—the central structure being the administration portion. The 
wings, denominated northeast and southwest respectively, were 
originally alike, but in 1886 the former was divided into rooms for 
beneficiaries from the “Home”; but these rooms have never been 
occupied by them. Indeed, no one lives in that part of the building 
but the chaplain of the Home, who has his quarters in the second 
story. 
The southwest wing remains as it was originally designed—on each 
floor is a long ward, 81 by 24 feet, and in the transverse portion a 
smaller ward, 21 by 20 feet, with nurse-rooms, and in the rear and 
across a short corridor, water-closets. The floors are all soft pine 
painted, and the walls are painted plaster. The full height of the 
ceilings is 15 feet. There are 14 windows in the large ward, placed 
symmetrically on the opposite sides, while in the small ward there 
are seven. Twenty beds are in one ward, and five in the other. 
These are of the usual pattern, and are supplied each with a hair 
mattress on a wire-woven base. There are the usual lockers and 
chairs and electric call-bells. As the other wing is not used, the 
total number of beds is just fifty—twenty-five on each floor. The 
air space for each bed is 1400 cubic feet. The hospital was, of course, 
designed for fifty additional beds in the other wing. 
This total of 100 can be increased 50 by using the wards under 
the mansard roof. This space is not used for the sick, as the ceiling 
of the long ward is low. However, in the transverse portion of the 
mansard are two rooms, 20 by 21 feet, with fairly high ceilings. 
These at present are used, one for a bag and hammock room, and 
the other for microscopic and photographic work. In the basement 
of the pavilion are a smoking-room corresponding to the long ward 
and two storerooms. 
The central structure occupies 118 feet of the front, and has a 
depth of 74 feet. This does not include its further extension of 52 
feet in an addition consisting of a basement and one story, contain- 
ing in the former the kitchen, and in the latter the dining-room and 
several pantries. In the basement of the main or central portion, 
there are, besides this kitchen, many storerooms, and quarters for 
employ6s. On the first and second floors are the administration 
offices, quarters for resident medical officers and for sick officers, 
reception-rooms, dining-room, dispensary, diet-rooms, bath-rooms 
and water-closets. Under the mansard roof are an autopsy room, 276 
GATEWOOD. 
and a ward 28 by 45 feet, now used as a lumber-room. In the rear 
of these, and separated by the corridors, are quarters for the servants. 
(Plate XII.) 
The entire building is lighted by gas and abundantly supplied 
with good water from the city. As the water pressure is insufficient, 
tanks have been placed under the roof, which are kept filled by a 
steam pump. Steam for heating purposes is supplied from the boiler 
house in the rear, where also is the laundry, well supplied with all 
necessary appliances. There is good natural ventilation, and conse- 
quently it is seldom necessary to use the artificial means provided. 
These consist of openings near the floors, through which hot air 
comes, heated in its passage by the steam pipes contained in brick 
casings, and openings near the ceilings, through which the air is 
drawn into the chimney of the boiler-house by a fan. The sewer 
system is not altogether satisfactory, as it is too closely connected 
with that of the city, as there is a large sewer running through the 
hospital grounds which has an objectionable manhole not far from 
the building. 
To the north of the Home is the residence of the governor of that 
institution, and to the south is the residence for the senior medical 
officer of the Hospital. There is a garden south of the hospital, and 
various outbuildings, but no separate place for contagious diseases. 
The dead were once buried in the grounds, but the government now 
owns a place in one of the city cemeteries. 
The staff consists of a medical director and two junior officers. 
The beneficiaries from the Home furnish most of the patients. These 
are placed on the lower floor; the paralytics and other helpless 
cases in the small ward. These old men, already near their end, 
furnish, of course, a large mortality, though they have the advantages 
of an almost model hospital. From July 1st, 1868, to December 31, 
1892, there were 5346 persons treated in this institution. Of these, 
648 were discharged from the service or transferred to the Govern- 
ment Hospital for the Insane, and 392 died. As 303 of these were 
beneficiaries, the ratio of 73.32 deaths per thousand should excite no 
surprise. The largest number of patients under treatment at one 
time was 54 in 1872. The average number now is 25. 
U. S. Naval Hospital, Washington, D. C. 
The first naval hospital at Washington was established in a build- 
ing near the navy-yard, rented for that purpose. The price paid NOTES ON NAVAL HOSPITALS. 
277 
was $200 a year. This was succeeded by the one established at the 
navy-yard, and which was discontinued in 1843, when the sick were 
transferred to the Marine Headquarters. Afterwards, the Civil War 
caused these accommodations to be insufficient, and on June 8, 1861, 
a temporary naval hospital was established in the “ Government 
Hospital for the Insane” near Washington; certain wards having 
been “ appropriated by the Secretary of the Interior for naval pur- 
poses.” These wards continued to be used until October 1, 1866, 
and 1488 patients were treated, with a recorded death-rate of 31.6 per 
thousand. 
The increasing importance of the navy-yard, the number of naval 
vessels in the Potomac, the uncertainty attending the condition of 
war, and the disadvantages of having a naval hospital under the same 
roof with insane patients, induced Congress to appropriate $25,000, 
on March 14, 1864, for the construction of a new building. The cost 
of work and material being then very great, additional appropria- 
tions had to be made, until the total aggregated $115,000. The 
building was completed in July, 1866, and commissioned October 
1st of the same year. 
The grounds comprise three-fourths of an acre, and are situated 
near the navy-yard. About one-half was purchased June 4, 1821, and 
the remainder, March 30, 1865 ; the total cost being $7819.50. They 
form a trapezium, bounded by the streets of the city, and enclosed 
by a handsome iron railing, and present, with the building, walks, 
grass and trees, an attractive appearance. 
The hospital is back from the street, fronts the south, and is 90 
feet long and 60 deep. A part of the depth is made by small exten- 
sions back and front, so that the ground plan resembles a cross 
with short arms. It is built of brick, and includes a basement, two 
stories, and an attic under a mansard roof. The pitch of the base- 
ment is 9 feet, and of the two stories 14 feet. The rooms and wards 
open on corridors. A central hall, 10 feet wide, connecting back and 
front, is crossed perpendicularly by a narrower one extending the 
length of the mid-line. The corridors thus form a cross, and divide 
each floor into four sections (Plate XIII). 
In the basement, the floor of which is somewhat below the ground 
level, are the apothecary’s quarters, the kitchen, laundry, boiler 
room, coal-bunker, storerooms, bath-room and water-closets. On 
the first floor are offices, mess-room for the men, and quarters for 
all the medical officers on duty. On the second floor are dispensary, 278 
GATEWOOD. 
officers’ ward, nurses’ room, and four wards for enlisted men. The 
two rear wards are i8i X35 feet, and the other two, one at each end 
of the front, are 24X22 feet. They contain many windows, and have 
pine floors and painted plaster walls. The bath-rooms and water- 
closets on each floor are in the rear extension, which is 9 feet deep 
and 43 long. They contain good tubs, and well trapped bowls with 
overhead tanks. The sewer pipes connect with those of the pity. 
In spite of the plan of this building, the ventilation is remarkably 
good. The large number of windows, the walled duct under the 
hospital communicating at each end with the outside air, and dis- 
charging into stacks containing the steam pipes, and the ventilators 
throughout the building near floors and ceilings, accomplish an excel- 
lent result. 
The water is from the city, but, as the pressure is insufficient, a 
steam pump is provided in the basement, to force the supply into 
two iron tanks placed in the attic. All the water is passed through 
a Loomis filter, to free it from the large amount of matter held in 
suspension. The building is heated by steam supplied from the 
boiler in the basement, and is lighted by gas from the city, but elec- 
tric lights are now being introduced. 
The present number of beds is 26, with an air space of 1392 cubic 
feet to each; but the average number of patients daily under treat- 
ment allows over 3000 cubic feet to each. The hospital was designed 
for 50 beds, with 1155 cubic feet of air to each. In 1871 there were 
63 patients under treatment at one time. The staff consists of a 
Medical Director and a Passed Assistant Surgeon, both of whom 
reside in the building. 
“ Sick Quarters'’ U. S. Naval Academy, Annapolis, Maryland. 
The United States Naval Academy, situated at Annapolis, Mary- 
land, on the right bank of the Severn river, is separated from the city 
by a high brick wall, which, with the river, encloses more than 60 
acres of ground. These are beautified with walks, lawns and orna- 
mental trees, and contain the many buildings necessary for the 
school. 
This school was established in 1845, on 9 acres of ground trans- 
ferred to the Navy Department from the War Department, which 
had here a small fort. Additions have been made by purchase from 
time to time, until the present ample dimensions have been attained. 
The hospital is near the south end of the main building, or “ cadet NOTES ON NAVAL HOSPITALS. 
279 
quarters,” and was built in 1853, to take the place of a small two- 
story frame structure near the fort. It is a brick building, 42 feet 
wide and 67 deep, fronts the east, and consists of a half-cellar, three 
stories and attic. Originally much smaller, it was enlarged and altered 
in 1876, and again in 1886. The cellar has a depth of 7 feet, is well 
ventilated, and its floor is of concrete. The storerooms situated here 
are therefore dry and ample. On each story there is a wide central 
hall connecting back and front, and having rooms or wards on either 
side. Broad iron stairways connect the different floors. 
The hall on the 1st floor is tiled, and ends in a rear vestibule, from 
which the back stairway ascends. This stairway well is connected 
with the water-closets and bath-rooms on each floor, and is shut off 
from the rest of the building by doors. Contagious disorders can 
thus be treated on the 3d floor without any communication with the 
other parts of the hospital. 
It is true that a detached pavilion would be preferable, but the 
writer has known scarlet fever, mumps, diphtheria, and other com- 
municable diseases, to be repeatedly treated here without any exten- 
sion, thus apparently demonstrating the tendency of infection to 
confine itself to the horizontal plane. 
The water-closets and bath-rooms are separated from the wards 
by doors and the staircase well. They have concrete floors and slate 
walls, two or more windows each, good tubs, and bowls well flushed 
from overhead tanks. All the fixtures are well trapped, and the 
sewer pipes connect with those from the “ cadet quarters,” and 
empty into the river near by. The first story has a pitch of 8£ feet, 
the second 12 feet, and the third 14 feet. On the first floor, on one 
side of the hall, is a large dispensary, communicating in the rear with 
a convenient laboratory, the dining-room, and nurses’ room ; on the 
other side is the officer-of-the-day’s room, communicating in the rear 
with a waiting room, the kitchen, and dentist’s room. The kitchen 
is only used to keep the meals hot before serving. All the cooking is 
done in the kitchen of the “cadet quarters.” The laundry work is 
also done outside of the building in the main laundry. On the 
second story, the hall room is the operating room. This is lighted 
by three large windows occupying most of the walls, and contains 
the necessary appliances. On one side of the hall is the medical 
inspector’s office and library, and two wards; on the other, two 
wards and the apothecary’s room. 
The third floor has a dark room and six wards, one of which is 280 
GATEWOOD. 
called the board room, as the physical examinations of all the candi- 
dates for admission to the school and of all cadets are conducted 
there. The wards are all well supplied with windows extending 
nearly to the ceilings, and with ventilators near floors and ceilings, 
connecting with ventilating shafts. The attic is surmounted by a 
large ventilating cupola. 
Electric call-bells are distributed throughout the building. Large 
steam radiators are in suitable places, and connection is made with 
the boiler-house, from which most of the houses in the grounds are 
heated. Gas is obtained from the Naval Academy tanks, and water 
from the city reservoir, five miles distant. The source of this water 
is a small stream fed by springs. It contains 4 grains of solids to the 
gallon, of which 2.5 are non-volatile. 
The patients having accommodations in the hospital are chiefly 
cadets, of whom there are generally about 250 in the school. Officers 
connected with the academy have, as a rule, quarters within the 
grounds provided for them and their families. 
There are, however, many enlisted men in the marine barracks 
and on the ships located here. Serious cases among these are 
admitted into the hospital, and indeed from this source is almost all 
the mortality—there not having been a death among the cadets at 
the academy for several years. 
The medical officers on duty look out for the sick of over icoo 
people, including many women and children. The official returns 
include, of course, only such cases as occur among the persons in 
the naval service. During the last 3 years there were 3059 cases 
treated; of these, 14 were invalided and 5 died ; the causes of death 
being phthisis, suicide and tetanus. In 1890, out of 240 cadets, 172 
were attacked with epidemic catarrh, but none of these cases ended 
fatally. 
The staff consists of a medical inspector, a surgeon and two passed 
assistant surgeons. The hospital can accommodate 50 patients and 
furnish 3500 cubic feet of air space to each bed. The number in 
sick quarters is, however, as a rule much below this, and each one 
probably has not less than 5000 cubic feet of air. 
In the spring and summer the broad verandas on each floor furnish 
to convalescents opportunities that are not neglected of remaining 
out-of-doors in good weather. 
The mean annual temperature is 550 F., while that of summer is 
76°, and winter 350. The rainfall is about 45 inches. The atmos- NOTES ON NAVAL HOSPITALS. 
281 
phere in summer occasionally furnishes a high degree of humidity, 
but the climate is remarkably good most of the year for a place situ- 
ated on the Atlantic coast. There is a mild malarial influence in 
summer and early autumn, but it is only occasionally noticeable, as 
the grounds are kept in beautiful order and are well drained. 
Indeed, it may be said that few places urnish such grass and trees 
and opportunities for outdoor life. 
U. S. Naval Hospital, Norfolk, Virginia. 
After 1811 the sick on this station were treated in a temporary 
hospital established at the navy-yard. It was a very poor structure, 
and in a few years after its occupation was unfit for use, by reason 
of decay and other causes. It was not, however, until 1826 that the 
commissioners caused the various sites near Norfolk to be examined 
with a view to the erection of a permanent building-. Craney Island 
was first selected, and its transfer from the War Department was 
secured in November of that year. 
This site was not very satisfactory, and the conditions attached to 
the transfer not altogether agreeable. Therefore on January 8, 1827, 
a request was made to the Secretary of War, himself a member of 
the Board of Commissioners, to transfer Fort Nelson, near Norfolk, 
and the public land attached to it, to the Navy Department for hospital 
purposes. The transfer was made, and 25 acres or more of adjoining 
land were purchased for $5000 from Col. Thomas Newton, then a 
member of Congress. The conveyance of the latter was not com- 
pleted until November 29, 1827. 
In December, 1826, a plan for the hospital had been accepted from 
John Haviland, an architect in Philadelphia, and the work was com- 
menced early in 1827, under his personal supervision. He also made 
all the contracts for material and labor *and was responsible for the 
payments. On July 17, 1830, the sick, together with all furniture 
and appliances, were moved from the temporary hospital at the yard 
to the one wing of the new building sufficiently completed. This 
transfer was effected by Surgeon Thomas Williamson, U. S. Navy, 
the first medical officer in charge of the present naval hospital at 
Norfolk. In 1832, after an expenditure of $270,000, the building 
was still more or less incomplete, and indeed the work continued 
from time to time for.several years. 
The hospital is well located on the left bank of the Elizabeth river,, 
opposite the city of Norfolk, and separated from the navy-yard by 282 
GATEWOOD. 
the city of Portsmouth. The grounds comprise 80 acres, of which 50 
in the rear of the building are covered by a pine forest, cleared of 
undergrowth and traversed by roads. The land in front is a broad 
stretch of lawn, ornamented by walks and trees, and surrounded by 
a sea wall terminating in a point projecting into the river 1000 feet 
away. 
This hospital, constructed of granite, presents an imposing appear- 
ance ; its basement and 3 stories being adorned by a portico no feet 
long and 17 feet wide, approached by broad stone steps, and containing 
10 lofty Doric columns supporting a handsome entablature and pedi- 
ment. The block plan was chosen, with a front of 195 feet facing the 
northeast, and two perpendicular wings extending 170 feet. The 
width of each is 44 feet, except for 123 feet of the wings adjacent to 
the front. Here the deficiency is supplied by an outside balcony on 
oach floor. The fourth side of the square is occupied in part by a 
two-story annex, 60 feet long and 20 wide. This is joined to the 
wings by balconies that extend on every floor around the entire court. 
All the wards are in the wings ; each wing has eight on a floor, 
five being 26 X 15 feet, and three 35 X 10 feet. They all connect by 
arched openings forming alcoves on each side, and except on the 
third floor have vaulted ceilings with a maximum height of n£ feet. 
Each has two opposite windows, painted wood floors and plaster 
walls. Each contains 4 beds and furnishes 1087 cubic feet of air and 
98 feet floor space to a bed. (Plate XIV.) 
A hall 12I feet wide traverses the length of the floors of the main 
building, having the rooms in front. Stairs from these halls connect 
the various floors. On the 1st floor are offices, reception-room, and 
officers’ dining-room. On the 2d floor are quarters for resident offi- 
cers and for sick officers. On the 3d floor are storerooms, apothe- 
cary’s room and quarters for employes. The nurses’ rooms are in 
the wings, one at each end of the row of wards in the narrower por- 
tions, with water-closets opposite, and stairs connecting the different 
stories. These closets are used only by special cases, as the main 
water-closets are in the annex, where also are the smoking-rooms, 
wash-rooms, and barber shop. In the general basement are kitchen, 
laundry, mess-room, storerooms and quarters for employes. 
The court covers large cisterns, into which water is pumped from 
a deep well extending into a natural underground current supplying 
30,000 gallons daily. There are also large iron tanks on top of the 
annex for storing this water. The pump and boiler-house are in the NOTES ON NAVAL HOSPITALS. 
283 
rear. Steam is supplied for heating the building, for the pumps in 
storing water, and in connection with a perfect fire system. Ventila- 
tion is accomplished by doors and windows; the long summers and 
mild winters allowing a free circulation of air most of the time. 
The sewer system is complete and independent. All fixtures are 
trapped and the abundant supply of water allows frequent flushing- 
The pipes discharge into the river north of the building. 
A number of electric lamps supply light; though, of course, the 
gas fixtures are retained, and connection with the gas-works of the 
city of Portsmouth. 
Well situated in the midst of pine trees is a frame building used 
for contagious diseases. There are also, of course, the usual out- 
houses, such as woodsheds, stables, greenhouse, and boathouse. 
To the south is a good residence for the medical director in charge. 
His assistants, a passed assistant surgeon and two assistant surgeons, 
reside in the main building. The south wing of the hospital is not 
used, as the average number daily under treatment is 30. This hos- 
pital was, however, designed for 200 beds. 
During the last 3 years 593 patients have been treated. 
The climate is rather debilitating in summer, on account of the 
high temperature; though at night during this period there is gen- 
erally a pleasant breeze, allowing refreshing sleep. The spring and 
autumn are delightful, and the winters, as a rule, mild ; though snow 
and ice are common in January and February. 
In the early autumn, cases of malarial fever are not infrequently 
admitted from the navy-yard, and typhoid fever is not rare in the 
cities. Pulmonary troubles do better than in any of the other naval 
establishments, and patients are occasionally transferred here for that 
reason. 
The increasing importance of the Norfolk navy-yard, and the large 
number of naval vessels seeking these waters, make it very desirable 
to have a hospital so delightfully situated, and so entirely free from 
epidemic influences. 
U. S. Naval Hospital, Pensacola, Florida. 
This hospital is a light frame structure, situated three-quarters of 
a mile to the west of the navy-yard. The hospital and the navy- 
yard, with the little village of Wooster at its north, and the larger 
straggling village of Warrington at its west, are on the naval reser- 
vation, 5 miles by water southwest of the city of Pensacola. This 284 
GATEWOOD. 
reservation is part of the ungranted Spanish royal domain, which 
became the property of the United States by the treaty of 1819, rati- 
fied by Spain in 1821. Florida ceded its jurisdiction over this tract 
to the United States in 1845. The coast here forms an angle that 
includes the reservation, the south and east sides of which are both 
on the Bay of Pensacola, while the Grand Bayou, formed by an arm 
of the bay extending west, forms the north boundary of the “ reserve.” 
The apex of the angle is called Tartar Point, and it is here that the 
navy-yard is situated. The soil is white sand, sparsely covered with 
grass. The trees are pine, and water and live oak. 
In seeking a site for the hospital, the higher ground at the west of 
the naval reserve was selected, and 15 acres were set apart by high 
brick walls. The building is 566 yards from the bay, and 42 feet 
above sea-level. It is a simple pavilion of five wards arranged in a 
row. Each ward has five beds, with 1047 cubic feet of air to a bed. 
This simple structure is 126 feet long and 30 wide, is surrounded by 
a balcony, and faces the south. The surgeon’s house, near by, and 
to the west, has much the same appearance, and is but little Smaller. 
In addition to his quarters it contains two rooms for sick officers. 
These rooms have each 2260 cubic feet of air space. 
The two buildings, with their kitchen in common, were completed 
in October, 1875, by R. E. Anson, contractor, at a cost of $18,872-,. 
and were immediately occupied. They occupy the site of the old 
hospital destroyed by fire during the Civil War. Reminders of the 
old structure can be found in the remains of such outhouses as the 
mortuary, bakery, laundry and engine-house. Since the building 
of the hospital, nothing has been done to improve the grounds by 
repairing or taking away these old relics. This is probably due to 
the relatively small importance of the institution. The sick of the 
fleet seek the northern hospitals, and the navy-yard is now one chiefly 
in name. Money, however, is expended in the way of preservation, 
and the hospital is kept clean and ready for emergencies. 
The ventilation is very good, as, in addition to windows and fire- 
places, there are doors provided with transoms, and in the ceiling of 
each ward are two movable blind ventilators. These latter open 
into the attic, which is ventilated by stationary blinds. The water 
supply is provided for by a cistern in which is collected the rain 
water from the shingle roof of the surgeon’s quarters. The annual 
rainfall is 90 inches. NOTES ON NAVAL HOSPITALS. 
285 
A portion of the grounds in front of the buildings is low, and here 
collect the drainage waters from the slope to the west around Fort 
Barrancas, arid the opposed slope of the hospita grounds. The 
result is a sluggish pond, 210 feet long. The warm climate and the 
decaying vegetable growth so near the hospital furnish, in the early 
fall, conditions not favorable to the health of the locality. The 
winters are very mild, giving but little frost, and the summers are 
long and exceedingly hot. July and August are the warmest months, 
but September is probably the most debilitating. The mean annual 
temperature is nearly 70 degrees F., and the range in 1880, an 
exceptional year, was between 118 degrees and 7 degrees. 
The prevailing diseases are intestinal and malarial. Yellow fever 
is an occasional visitor—the years 1863, 1867, and 1875 and 1883 
marking some of its visits. This disease is not indigenous, but 
sometimes passes from the quarantine station to the southeast on the 
long island of Santa Rosa. The hospital has no separate building 
for such cases, and in 1883, eight were treated in the wards. 
The'staff consists of one surgeon, who, in addition to hospital 
duties, does much work among the poor of the two villages. The 
navy has supplied only 271 cases since the hospital was commissioned 
in 1875. Of these, 12 died (6 from yellow fever), 209 were discharged 
to duty, and 50 were invalided. During a part of 1888 there was 
not an unoccupied bed, as 24 patients were under treatment at one 
time. But during the last four years there have been only 14 sick, 
as the naval force at the yard has been reduced to a minimum. 
U. S. Naval Hospital, Mare Island, California. 
The naval station of the United States on the Pacific is Mare 
Island, a tract of land acquired by the government on January 4, 
1853, at a cost of $83,000. It is situated 25 miles from the city of 
San Francisco, on San Pablo Bay, the northern extension of San 
Francisco Bay, and was originally a grant to Senor Castro, who 
parted with it for money, as several others did before its final 
purchase. 
This island is very extensive if all the marsh land be considered, 
but only 930 acres are at all suitable for naval purposes. These 
include the rolling land, forming approximately an ellipse, com- 
prising the southern portion. The long axis of this is 2! miles, 
extending northwest and southeast, while the short axis is f of a 
mile. 286 
GATEWOOD. 
Between the island and the town of Vallejo on the mainland is 
the Mare Island Strait. At the southern extremity (the Carquinez 
Strait) the waters of the Sacramento and San Joaquin rivers empty 
into the bay. The formation of this part of the island is sandstone, 
covered by 2\ feet of black loam. The climate and soil have been 
so favorable to the cultivation of trees and flowers that the island 
has become celebrated even on that coast. 
Soon after the purchase, the navy-yard was established on the side 
opposite Vallejo, the intervening waters furnishing a quiet anchorage 
for ships of any size. A building was set apart for “sick quarters,” 
and for storing medical supplies for the squadron and station. This 
is employed now as the dispensary and surgeon’s office of the yard ; 
the large number of officers and workmen requiring medical and 
surgical assistance near at hand. It ceased to be used as “sick 
quarters” when the present hospital was completed m 1870. 
This hospital has an isolated position outside and to the south- 
east of the yard, being one mile from the workshops, and on a slope 
facing Mare Island Strait, and ending in an intervening marsh. It is 
66 feet above low water, and consists of a central structure, and two 
pavilions terminating in small transverse buildings. It fronts the 
east and is 250 feet long. It is built of brick, and has a basement, 
two stories, and an attic under a mansard roof. The spaces in front 
between the projecting central structure and the transverse portions 
of the pavilions are occupied by broad verandas on each floor. Each 
floor of a pavilion is a ward ; the transverse projection containing 
bath-room and water-closet. 
Each ward is 68 feet long, 24 wide, and 15 high, and contains 
twenty beds between windows, and furnishes over 1200 feet air 
space and 81 feet floor space to each. There is an open fireplace 
near each end, 10 windows on both opposite sides, and an end window. 
The windows are feet high, and extend within 3 feet of the ceiling. 
The floors are painted Oregon pine, and the walls painted plaster. 
Fresh air is admitted by openings near the floor, connecting with 
ducts. A current is induced by ventilators near the ceiling commu- 
nicating with large Emerson ventilators opening above the roof and 
provided with steam coils. The water-closets and bath-rooms are in 
the transverse projections on opposite sides of the wards. They are 
included in the ventilating system, have concrete floors, windows and 
all modern improvements. 
The basement has 5$ feet of its pitch below the ground level. It 287 
NOTES ON NAVAL HOSPITALS. 
contains mess-room, reading-room, kitchen, storerooms, and quarters 
for employes. The floors of the central building contain offices, resi- 
dent medical officers’ quarters, rooms for sick officers and for special 
cases, operating rooms, and apothecary’s room. (Plate XV.) 
The whole building is heated by steam and lighted by electricity. 
The sewer system is independent. All fixtures are well trapped, and 
the pipes join the 10-inch sewer in the rear, which connects with a 
well ventilated brick sewer nearly 500 feet long, emptying at an 
inclination of one foot in forty into the adjacent waters. 
The steam laundry, drying-room and boiler are in a building 140 
feet south of the hospital. In an annex to this is the mortuary. The 
boiler supplies steam for heating the building, and for forcing water 
into the iron tanks under the hospital roof. Water is obtained from 
the water-works of Vallejo and from the reservoir on the island. 
The latter holds 13,000,000 gallons of rain-water, but this supply is 
regarded as a reserve: the large number of people living on the 
island making it unadvisable to trust entirely to the connection with 
Vallejo. 
The staff consists of a medical director, who is provided with a 
delightful residence, a surgeon and a passed assistant surgeon. Patients 
are received from the Pacific and Asiatic squadrons, from the station, 
and the Yokohama hospital. The 80 beds are, however, rarely 
filled, as the average number of patients daily under treatment is 
about 40. During the last three years 581 cases have been treated. 
The climate is regarded as salubrious. During six months of the 
year there is almost no rain. The rainy season begins in May and 
lasts until October, though during this period there are usually con- 
siderable periods of fine weather. The mean annual temperature is 
570 F. The thermometer occasionally falls to 28° in January, the 
coldest month. In summer there is a period of northwest winds, 
fogs and dust, that produces influenza and various respiratory 
troubles. Malarial influences are rarely noticeable, and epidemics 
unknown. 
U. S. Naval Hospital at Yokohama, Japan. 
This beautiful little establishment, constructed in 1872, and com- 
missioned on May 16 of that year, accommodates 34 patients, includ- 
ing 8 officers. It is delightfully situated amid the residences of 
the foreign population, and near the English and German naval 
hospitals, on the bluff southeast of the main or lower section of the 
city of Yokohama. 288 
GATEWOOD. 
It consists of a main quadrangular building of two stories and two 
detached buildings of one story. One of these, called the wing, is 
situated to the east and rear, so that its front is nearly on a line with 
the rear of the main building, with which it is connected by an out- 
side passage. The other building, containing the dining-room, 
kitchen, pantry, cooks’ room and store-rooms, is nearly 36 feet in 
rear of the main portion, and is connected with the wing by a pas- 
sageway. The whole hospital is constructed of tile and plaster, 
fronts the south, and is nearly surrounded by verandas on all stories. 
A smallpox hospital, with a disinfecting chamber near by, is no 
feet from the main building, and near the northwest limit of the 
grounds. It is a one-story building, containing a ward 25X54 feet, 
and two rooms 14 X 15 feet. The ward has 8 windows and a door, 
and contains 18 beds, with only 644 cubic feet of air space to each. 
Each room has 3 windows, a door and two beds, with 987 cubic feet 
to each bed. All these doors are 87X41 inches, and the windows 
are 58X85 inches. 
The main building is 85 feet long and 35 feet deep. On the first 
floor are quarters for the resident medical officer, offices, dispensary, 
bath-room and water-closets. On the second floor is a ward contain- 
ing 8 beds, with 902 cubic feet to each ; 4 rooms, having 2 beds each, 
for sick officers, with 1200 cubic feet to each bed, and 2 rooms for 
nurses. The ward has 4 windows and 3 doors, and each room 3 
windows and a door. The windows are inches, and the 
doors 88X38 inches. 
In the wing are the main ward, 54X24 feet, and nurses’rooms 
and water-closets. The ward contains 18 beds with 1717 cubic feet 
to each. It is lighted by 8 windows, each inches, and has 
4 doors inches each. The water-closets all have earthen 
jars under the seats, which are removed from the outside of the 
building every night. 
The grounds contain i£ acres, and are shaped somewhat like an 
arrowhead with blunted barbs. They are beautified with grass plots, 
trees, walks, and a pretty shaded mound 20 feet high. East of the 
wing is the residence of the medical officer in charge. 
The ventilation of this hospital is good, as the many windows and 
doors are assisted by the badly fitted woodwork. All the buildings 
and grounds are lighted by electricity. Water is obtained from a 
well, and by storing rain-water in large iron tanks. The well is 67 
feet deep, and furnishes an ample supply of water containing 13J NOTES ON NAVAL HOSPITALS. 
289 
grains of solid matter to a gallon—silicic acid, chloride of sodium, 
carb. magnesium, sesquioxide of iron, and sulphate of calcium (trace). 
All drinking water is filtered, and in the summer months boiled. 
The rooms and wards of the main building have open fireplaces, but 
these being inadequate, stoves are employed. 
The staff consists of a surgeon and a passed assistant surgeon. The 
employes are the apothecary, watchman, two cooks, a gardener, and 
four coolies. Two of the coolies do the cleaning and act as nurses; 
the other two are laborers. They have detached quarters. - The 
watchman acts also as night nurse, and the cooks also set the tables. 
The gardener is also a carpenter and gatekeeper. The apothecary, 
in addition to usual duties, superintends nurses and issues stores. 
The daily average of patients last year was 10. The patients come 
entirely from the fleet, and many of the diseases originate on the 
coast of China. Venereal troubles, of course, play their part, 
diarrhceal and malarial disorders are not uncommon, and smallpox is 
an occasional visitor. 
Yokohama itself furnishes a certain number of cases, as the vessels 
of the navy pass much of the year there, to escape the debilitating 
summer of the south. This city, frequently spoken of as a desirable 
sanitarium, has a delightful climate, though July and August have a 
mean temperature of 80 degrees F. with a minimum of 70 degrees F. 
January, the coldest month, has a mean of 38 degrees and a minimum 
of 30 degrees. The dew-point in January is 30, and in July and 
August is 70. The annual rainfall is 50 inches. The prevailing 
winds in May, June and July are southeast, and during the rest of 
the year northeast. The main portion of the city is intersected by 
numerous canals, and has northwest of it many rice fields which are 
frequently flooded. Malarial disorders are therefore common, but 
on the bluff this influence is not noticeable. 
Variola is present all the time, and occasionally becomes epidemic, 
beginning among the native population. Rubeola, frequently attack- 
ing adults, is also occasionally epidemic. There is also a disease 
among the natives known as kakke, and considered identical with 
beri-beri. 
Closing Remarks. 
The subject is far from a conclusion. England, France and the 
United States are only three of the many nations who send their sons 
upon the sea as warriors. Austria, Brazil, China, Germany, Italy, 
Russia, Spain, Turkey and others, represented by 2000 ships of war 290 
GATEWOOD. 
with 200,000 men, have established naval hospitals well worthy of 
study. These institutions furnish a part of the histories of these 
countries and offer to him who seeks, much of interest and profit. 
Yet they cannot be considered here, as an apology is due for the 
many pages already written. This apology is found in the little 
attention these important hospitals have received from the various 
writers on that subject. 
Discussion. 
The Chairman.—The Section is very greatly obliged to Dr. 
Gatewood for this paper, which is valuable from an historical point 
of view, and for permanent consultation when published. The paper 
is accompanied with plans of a number of French, English, and 
American naval hospitals; and it would be very desirable if this 
could be completed for other nations, as Dr. Gatewood suggests, 
because, so far as I know, there is no treatise or article upon naval 
hospitals which is complete. GROUND PLAN OF NAVAL HOSPITAL AARM0UTH-310 BEDS, 
PLATE I. 
exclusive of Sick OfficersAccommodation 
A Enframe archway. 
B Oardeti. 
C Open arched corridor. one storvtm/h,surminduuf dte aartim 
D Rooms for sich officers. 
E Steward s stores. 
F Qrnpet 
G Fust flt/or,operating theatre,groundPoor, bdlt tud room 
H Committee momjnngery, £-c 
11 \,Sr: Ward?, /h beds ea ch, 
K Pa/idled room. 
L Hath roo ms, washhouse .d-c. 
MM Sculleries. 
N N Worses rooms. 
00 WtUeivlosetd. Royhl Nrvhl Hospitkl, Yokohrmr. 
PLATE II. 
P M. S. 8. Co.’s 
Coal Wharf. 
KEY TO PLATE II. 
Scale of 40 yarda to ono Inch. 
1, 2, 3, 6. General Wards. 
7. Gun-room and Engineer’s Ward (rooms). 
8. Warrant Officers’ Ward (rooms). 
9. Non-commissioned Officers’ Ward 
(rooms). 
1 1. Contagious Ward. 
12. Ward-room Officers’ Ward (rooms). 
13. Mortuary. 
14. Latrine. 
15. Fire-engine House. 
16. Quarters for Natives. 
17. General Cook and Bath House. 
18. Nurses’ Quarters, Clothing Store, Coal 
Store and Larder. 
19. Steward’s Quarters and Bedding Store. 
20. Dispensary, Survey Room, and Provision 
Store. 
21. 22. Senior Medical Officer’s House. 
23. Second Medical Officer’s House. 
25. Servants’ Quarters, Kitchen, Stores, etc., 
for Medical Officers. 
33. Contagious Ward. 
K. Kitchen, Disinfecting Rooms, etc. j4 . JYCrdicctf C/inrc. 
j9 jSiuytcal CKnic. 
PLATE ill. 
J 'Iasi of /ju-xYC/iia'Ji/ . 
. A cvuct LHojjyvta,lj 
JtocJv^brt. 
ttfxrxj oflFCr-si jiory. 
Gwfce- l^sStory. PLATE IV. 
JVooucU IfojjJvtcoL, JauZcxw. 
•Basement. 
KEY TO PLATE IV. 
1. Bureau of Pharmacy. 
2. Office of Apothecary-in-Chief. 
3. Laboratory. 
4. Mortuary Chapel. 
5. Anatomical Lecture Room. 
6. Chemical Room. 
7. Dissecting Room. 
8. Mineralogical Room. 
9. Botanical Room. 
10. Garden. 
1 1. Chemical Lecture Room. 
12. Dead Room. 
13. Professor of Anatomy. 
14. Cuisine. 
15. Linen Room. 
16. Surgeon on Duty. 
17 ■ Baths. 
t8. Laboratory. 
19. Grand Pharmacy. 
20. Court. 
21. Court of Sisters of Charity. 
22 Lecture Room on Practice of Medicine. 
23. Professors’ Cabinet. 
24. Control. 
25. Office of Entries. 
26 Entrance. 
27. Guard Room. 
28. Sentries' Room. 
29. Office of Director. 
30. Council Room. 
31. 32, 33, 34. Rooms for arranging Linen. 
35. Sleeping Room of Attendants. PLATE V 
*JYctVOtl Hoppiftcub,TxxaZ&rv 
2’^jStoiy. 
Cot&rt. 
1. Museum. 
2. Basins for Leachers. 
3. Lecture Room for Chemistry. 
4. Anatomical Collections. 
5. Ward. 
6. Water-closets. 
7. Ward. 
8. Ward. 
9. Ward. 
10. Water-closets. 
1 1. Storeroom Pharmaceutical Utensils. 
12. Room for Confinement of Patients. 
13. Officers’ Room. 
14. Court. 
15. Ward, Medical Clinic. 
16. Large Court. 
KEY TO PLATE V. 
17. Ward. 
18. Court for Sisters of Mercy. 
19. Pharmacy for the Sisters. 
20. Chamber for the Sisters. 
21. Gallery. 
22. Office. 
23. Salle-a-Manger. 
24. Room for Pupils. 
25. 26. Superior Officer’s Room, 
27, 28. Cabinet. 
29. Cabinet of Natural History. 
30. Library. 
31. Ward. 
32. Chapel of the Sisters. 
33. Room for the Sisters. 
34. Superintendence. PLATE, rs 
PLATE VI. 
. JVcovoc O JHrOSpisfaa>b 
a.e 
Jj re-fi J'rctrLcv. 
/n. e n ct.cTe/. PLATE VII. 
{Kcmika£ mMdkmtesx)e<- 
Jar Jin Jokuiijue^. G&er&ourj. 
JT 01 Lvef ?wjnhx£ v\axxkaXaaaa<Zs. 
PLATE VIII. PLATE IX. 
U.S.N.Hospital 
AT 
Portsmouth N.H. 
2D FLOOR PLATE X. 
U.S.Hospital. CHELSEA. 
2D Floor. PLATE XI. 
USN. Hospital,— Brooklyn. 
2,D Floor. PLATE XII. 
US.N. Hospital, 
AT 
fhilad^ 
— 151 Floor.— PLATE XIII. 
U. S. Nrvhl Hospitrl, Washington. 
—2d Floor. 
3Vor"t (a PLATE XIV. 
U.S.N. Hospital, 
Norfolk. 
— 2® Floor — PLATE XV. 
U.S.N.Hospital 
AT 
Mare Island Cal. 
2™ FLOOR PLATE XVI. 
Plhn of the U. s. Nrvhl Hospithl rnd Grounds 
YOKOHSMH, JRPHN. 
Fig. i. Mound 20 ft. high, covered with trees, 
and former site of a Japanese temple and 
tombs. 
2. Flagstaff. 3. Vault. 4. Tennis Court. 
5. Carpenter. 6. Laborer. 7. Watchman. 
8. Cooks. 9. Officers. 10. Store Room. 
11. Carpenter Shop. 12. Coolies’ Quarters. 
13. Assistant Surgeon’s Dining-room. 
14. Parlor. 15. Ass’t Surgeon’s Bedroom. 
16 Pantry. 17 Light Room. 
18. Surgeon’s Office. 19. Officers’ Room. 
20. Dispensary. 21,22 Apothecary’s Quarters. 
23. Cell. 24. Men’s Smoking Room. 
25. Men's Diningroom. 26. Lavatory. 
28. Ward. 29. Porter’s Lodge. 
27,27. Servants. 30. Main entrance to Hospital.