292663676

THE MUN IC IPAL HOSP ITALS OF COPENHAGEN

THE MUNICIPAL HOSPITALS OF COPENHAGEN BY K. M. NIELSEN HOSP1TALSDIRECTOR

COPENHAGEN E N G E L S E N & S C H R 0 D E R 1928

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T HE administration of the municipal hospitals in the metropolis ■is controlled by the Second Division of the Municipal Administration. A director — who is not a medical man — supervises the admi? nistration and finance of the hospitals. Everything within the individual hospital, hospital department or laboratory which concerns treatment of patients, nursing and laboratory work is in charge of the respective senior physician or surgeon*in*chief. The whole of the senior physicians and surgeons* in*chief, in conjunction with the Mayor and Alder* man of the Second Division of the Municipal Ad* ministration, the Director of the Public Health Ser* vice and the Director of the Hospitals, constitute a Hospital Board which meets at least once a year (in November) to discuss hospital questions in general and to examine the budget of same for the following year. The Mayor is chairman of the Board and convenes a meeting as often as he thinks fit. At the annual meeting in November the Board elects four senior physicians or surgeons who, in the following year, together with the Director of the Hospitals, constitute a standing committee assembling at least once per month and, in addition, as often as

a member makes a request to that effect to the Di* rector. The latter convenes and presides at the meetings; the proceedings are taken down in a minute*book which is signed by all members present. The standing committee gives its opinion as to all cases placed before it by the municipality. In addition, it can itself take up cases concerning a plurality of hospitals or any cases of special impor* tance to an individual hospital or hospital depart* ment, the chief physician or surgeon of which is convened by the committee to a discussion regarding the case under review. Moreover, all physicians or surgeons*in*chief can submit questions to the com* mittee for discussion. The opinion of the committee is taken regarding cases of general or fundamental importance to the hospital service. Whilst the activities of the Hospital Board and Committee are essentially of an advisory character, the actual carrying*out of the administrative autho* rity rests with the Director of the Hospitals, who, as mentioned above, is appointed by the Second Divi* sion of the Municipal Administration. The office of the Director — the Directorate of Hospitals — is the central administrative office of the hospitals, whilst the daily administration of each hospital is carried out by an inspector and the staff under him. In its capacity of central administration, the Di* rectorate does not as a rule participate in the more detailed daily management of the institutions under its control. The administrative duties are carried out by the respective inspectors, their situation ac*

cordingly being rather independent and highly responsible. However, all joint concerns and more important decisions of interest to the individual hospital as well as of fundamental importance to all hospitals are treated and, in the majority of cases, finally settled by the Directorate of Hospitals. In addition, the following specified duties rest with the Directorate: After a preliminary discussion regarding the budget of the individual hospitals with the inspector in question, the budget is worked out at each hospital and thereafter handed in to the Directorate, where it is critically examined and worked up with the budgets of the other hospitals to be submitted to the municipal authorities. Amendments to the budget are worked out in the Directorate, which submits them to the municipal authorities. Application for grants (and special grants) of importance are worked out for the muni* cipal authorities by the Directorate, which, in the case of minor grants, sanctions the defrayal of the expenses under review. The accounts of each hospital are handed in to the Directorate, which forwards them' to the municipal authorities. When commodities are put up for public tender, they come under the province of the Directorate, to which tenders must be sent, and the former submits the tenders to the municipal authorities for approval. The Directorate takes the final decision as re# gards the majority of commodities. Appointments (excepting servants who are en# gaged by each hospital) are controlled by the Direc#

torate; the appointments to superior medical offices must, however, be submitted to the Hospital Corns mittee. The distribution o f patients to the individual hospitals is carried out through the physicians di- rectly appointed by the Director of the Hospitals, the so-called »Visitatorer«. The payment for hospital treatment takes place at the office of the hospital in question according to the following rates: Paying Patients. Resident in common ward . . . 1kr. 20 oere per diem » » single ward ........ 12 » » » Nonresident in common ward 10 » » » » » single ward.. 18 » » » Foreigners in common ward.. 10 » » » » » single ward .... 18 » » » Children under 1 year, half of the above charges. For members o f sick-benefit clubs the hospitals receives 60 oere per diem — for a member’s child under 15, however, only 30 oere per diem — up to 91 days. After that period the patient is treated free of charge for 91 days, and the payment and gratis periods alternate until the sick-benefit aid expires, i. e., after 420 days. The patient then comes on to the Guardians’ account should he or she be unable to pay the ordinary charges. Several bequests have been given to the hospitals

by means of which patients can be treated — free or at low rates — should they fulfil the special terms attached to these bequests. The 60 oere and the 1 kr. 20 oere charges cover respectively only about 4 to 5 and about 10 per cent of the cost of maintenance. The municipal grants*in* aid to the Hospital Service, including St. Hans Hospi* tal but not those hospitals or hospital departments controlled by the Guardians, at present amount to 14 million kroner per year. In addition to the hospitals proper, the manage* ment of the municipal convalescent and nursing homes is also controlled by the Directorate of Hospi* tals. Finally, the Directorate controls the Municipal Nursing in Homes. The work of the Directorate of Hospitals con* sists, therefore, in dealing with general questions affecting the institutions controlled. Its work is as* sisted partly by the presence of the Directorate in the individual institutions and partly by means of the reports made — at least weekly — by the heads of institutions in the Directorate. Finally, the Directo* rate convenes the heads of institutions to meetings when a mutual discussion of a question is held to be desirable, e. g. before the yearly budgets are prepared. The hospitals and institutions the administration of which is centralised in the Director are the fol* lowing: 1. The Kommune Hospital .......... 1,022 beds 2. The Oeresunds Hospital ........ 539 » 3. The Blegdams Hospital .......... 499 » 4. The Rudolph Berghs Hospital 176 »

5. The Boscrup Sanatorium ............ 6. The Sundby Hospital ................. 7. The Balders Hospital .................. 8. The Bispebjasrg Hospital........ 9. The Children’s Hospital at Fuglebakken ............................ Convalescent Home »Skjoldborg« ............................. 11. Idle Nursing Home »Gyvel? holm« ......................................... 12. The Inebriate and Convales* cent Home »Faarupgaard«.. 13. The Convalescent Home »Fre* derikVilhelm Hegels Minde« 14. The Municipal Nursing in Homes.................................... 15. The St. Hans Hospital at Ross 10. The

152beds

362*)»

79 »

700 »

122 » ------------- 3,651

34 »

28 »

32

»

35

»

129

kilde (hospital for insane) ..................... 1,753

Total number of beds.. . . 5,533

In the table below a general view of the attem dance at hospitals during the period from 1890 to 1925 is given; the table embraces only the hospitals under headings from 1 to 9 in the above list. In the case of the Kommune Hospital, however, the beds used by the municipality in private hospitals and clinics are included.

*) At present the hospital aceommodates 127 beds, but it is being extended. When the work — presumably in 1930 — is finished the hospital will dispose of 362 beds. As to further particulars here on vide item 6, the Sundby Hospital.

Annuul number of hospital sick«days per head in the metropolis.

Total number of cases.

Total number of sick«days.

Daily average occupation.

Number of siek*days per patient,

Total population.

Year.

26 29 30 35 35 35 33

1890 14,314 375,514 1,028 315,000 1895 14,192 412,078 1,129 336,000 1900 17,082 520,173 1,425 358,000

1.19 1.19 1.45 1.81 2.08 1.95 2.04

1905 22,118 767,166 2,101

425,000

1910 27,195 940,980 2,578 453,000

1915 27,051

969,135 2,647

498,000

1920 35,004 1, 148,688 3,145 562,000 1925 35,208 1,165,968 3,208 587,500

33

1.98

A more detailed account of the individual institu? tions is given below.

1. KOMMUNE HOSPITAL. The hospital, which was opened in the year 1863, is built on the corridor system. In its present form the hospital contains 1,022 beds distributed between the following departments: First Department, surgical ..................... 140 beds Second » * medical . ...... 140 » Third » medical .................... 135 » Fourth » skin and venereal diseases..................... 130 »*) Fifth » surgical .................... 140 » Sixth » mental and nervous diseases .................... 230 » *) As the impatient treatment of venereal cases gradually decreased, the numher of beds in this department was reduced, and during the last ten years the reduction amounts to not less than 130 beds.

Department for ear, throat and nose diseases .................................................... Department ophthalmic diseases............. Private wards open to all departments ..

28 beds

30 »

49 » Total number of beds.. . . 1,022 beds

The average floor space per bed is 7.7 sq. metres, the air space 33.9 cub. metres. The hospital covers an area of 7 hectares. In addition to the above-mentioned departments, the hospital includes a Rontgen department, a surgi­ cal, a medical, and a nerve out-patient department, bathing and massage establishment, and out-patient departments for skin and venereal diseases and for ear, throat and nose as well as ophthalmic diseases. Situated on the hospital site there are houses for permanent officials, including a special home for nurses. At the head of each of the eight departments is a senior physician or surgeon. Pursuant to the regulations of the Faculty of Medicine, the senior physicians and surgeons of the two medical and two surgical departments give bed­ side lectures to the medical students. Furthermore, the senior physician of the department for mental and nervous diseases is appointed by the university to give clinical instruction in, as well as theoretical lectures on psychiatria. At the Kommune Hospital, as in all the other hospitals controlled by the metropolitan municipality, the nursing is in the hands of nurses who have been trained in the hospitals themselves.

In each department two head nurses are in charge — respectively of male and female wards — each having, excluding the probationers, a staff of trained nurses, generally seven, at their disposal. A matron is in charge of the Nurses’ Home. Part of her work consists in appointing probationers, supervising their preliminary training and assigning them to the various departments for further training. The superintendence of the nursing service is as? signed to a committee controlling the nursing ser? vices at all the municipal hospitals with the exception of the Bispebjaerg Hospital and the Children’s Hospital at Fuglebakken, which are controlled by a special committee. The Nursing Committee of the Kommune Hospital consists of the Director of the Hospitals, who presides at meetings, a senior physician or surgeon elected by and among the senior physicians and surgeons, the Matron of the Nurses’ Home and two head nurses elected by and among the whole of the head nurses. 2. OERESUNDS HOSPITAL. This hospital, opened in 1878, was originally inten? ded to act as a quarantine hospital, but it was after? wards altered and considerably enlarged. The hospital is now divided into two departments, each in charge of a senior physician, viz.: a tubercu? losis department, the senior physician of which also has charge of a minor epidemic department, and a medical department with a special sub?department for tuberculosis. The total number of beds is 539, arranged as follows:

Medical department, including subsdeparts ment for tuberculosis............................. 300 beds Tuberculosis department............................. 217 » Epidemic department................................... 22 » 539 beds The average floor space is 7.88 sq. metres, and the average air space 29.44 cub. metres. The aggregate area of the hospital is about 6 hectares. 3. BLEGDAMS HOSPITAL. This hospital, opened in 1879, is for infectious diseases. The total number of beds is about 500, arranged in 14 bricksbuilt houses and in a number of temporary huts or tents. During epidemics the hospital has accommodated up to 600 patients. The average floor space is 8.5 sq. metres, and the average air space 30 cub. metres. The aggregate area is 7.7 hectares. The hospital constitutes one service in charge of a senior physician, who has three resident physicians at his disposal.

4. RUDOLPH BERGH’S HOSPITAL. In the years between 1886, when this hospital was opened to the public, and 1906, only registered pros

stitutes suffering from syphilis and other venereal diseases were treated here. Since 1906 — in which year the regulations for the supervision of prostitutes by the police were abolished by the Act of October 11th — the hospital has received patients suffering from skin and venereal diseases, acting as a relieving station for the Fourth Department of the Kommunc Hospital. The hospital contains one department for men and one for women, both in charge of the same senior physician, and' an outpatient department for skin and venereal diseases. The total number of beds is 176, and the average floor and air space per bed amount to respectively 5.67 sq. metres and 20.26 cub. metres. The aggregate area of the hospital is about 6,100 sq. metres. 5. BOSERUP SANATORIUM. The sanatorium, which is situated in the Boserup woods at Roskilde, about 38 km. from Copenhagen, was opened in 1901. It receives patients — preferenti? ally metropolitan — suffering from tuberculosis of the lungs (at an early stage of the disease). In 1906 the sanatorium was recognised by the State as »Folkesanatorium« (people’s sanatorium). Accordingly, courses of treatment for patients in less affluent circumstances are now subventioned by the State. The sanatorium consists of two buildings for patients, containing respectively a male and female

department, both in charge of the same senior physician. The total number of beds is 152, with an average floor and air space of respectively 6.99 sq. metres and 26.56 cub. metres per bed. The aggregate area of the sanatorium, chiefly consisting of woodland, is about 30 hectares. The Inspector of the neighbouring St. Hans Hospi* tal (lunatic asylum) has control of the daily admini* stration of the sanatorium. 6. SUNDBY HOSPITAL. The hospital was opened in 1902 and receives surgical cases. The hospital, constituting one service in charge of a senior surgeon, includes a Rdntgen department and a surgical outpatient department. The total number of beds is 127, with an average floor and air space of respectively 7.87 sq. metres and 27.61 cub. metres per bed. The aggregate area of the hospital is 2.8 hectares. The hospital is, however, at present subject to extension, and will, the extension finished, contain 362 beds distributed in 4 departments in the following way: a surgicaldepartment of 111 beds a medical » » 146 » a children’s » » 73 » an aural » » 32 » 362 beds

Besides the actual Rontgen department and the surgical out-patient department the hospital will after the extension contain an out-patient department for ear diseases, a bathing and message establisment and a light-bath. To the extension, which is expected to he finished in 1930, the Municipality has granted 2 l/> million kroner. 7. BALDERS HOSPITAL. This hospital was opened in 1903 and receives patients suffering from general medical diseases. The hospital has a consultation room which is used for out-patient treatment of general medical and surgical cases. The hospital constitutes one service in charge of a senior physician. The total number of beds is 79, the average floor and air space being respectively 8.08 sq. metres and 25.67 cub. metres per bed. The aggregate area of the hospitals is 3,100 sq. metres. 8. BISPEBJ^ERG HOSPITAL. The Bispebjterg Hospital was erected pursuant to a resolution passed by the municipality on March 2nd, 1908, and the hospital was opened on September 19th, 1913. At present, the hospital has 700 available beds distributed between four departments, viz.: two surgical and two medical, the former in charge of two

oz

senior surgeons, the latter in charge of two senior physicians. The number of beds can be increased to 1,600 without it being necessary to enlarge either boiler* house, engine*room, kitchen, laundry or any of the other accessory buildings. The aggregate area of the hospital is about 21 hectares. The average floor and air space per bed amount respectively to 9.15 sq. metres and 39.08 cub. metres. The hospital is built on the pavilion system, but in such a manner that all the pavilions are connected by means of a network of subterranean passages in* tended for conveyance of patients and goods. The »central laundry«, situated in the laundry of the hospital, does the washing for all the municipal hospitals (excluding Boserup Sanatorium and St. Hans Hospital at Roskilde); here, about 23,000 articles are washed daily. The hospital includes a Rdntgen department, bathing and massage establishment and an out*patient department for surgical cases. 9. CHILDREN’S HOSPITAL AT FUGLE* BAKKEN. The buildings of the hospital, which were erected by means of private funds — »Fonden til Oprettelse af et homoopatisk Hospital« (The Fund for the Esta* blisment of a Homoeopathic Hospital) — was rented by the municipality in 1916, and in 1921 was purch* ased by same.

The hospital can accommodate 72 children up to the age of 7. The average floor and air space per bed are re? spectively 5.14 sq. metres and 19.5 cub. metres. The aggregate area of the hospital is 1.2 hectares. In 1925 a building with 50 beds calculated for children convalescents was erected in the premises of the hospital. The convalescence department is in charge of the senior physician of the Children’s Hospital. 10. CONVALESCENT HOME »SKJOLDBORG«. The Home, which is situated at Frederiksvaerk, about 67 km. from Copenhagen was opened in 1917 and can accommodate 34 women discharged as con? valescent from the municipal hospitals. The patients normally stay about four weeks. The daily management of the Home is in the hands of a matron, a trained nurse; the medical supervision is in charge of a local practitioner who normally attends the convalescents once a week. The administration of the Home is, in conformity with the other municipal convalescent and nursing homes, directly controlled by the Directorate of Hospitals. 11. NURSING HOME »GYVELHOLM«. The Home, situated at Holte, about 15 km. to the north of Copenhagen, was opened, in 1918 and can accommodate 28 adults (men) suffering from tubercu? losis of the lungs, (slow consumption) without fever

and of such relatively benign character that the patient is able to attend to himself, does not need constant nursing or medical attendance and at the same time has retained a certain amount of working capacity but where a lasting cure cannot be expected. Normally the sojourn extends over several years. The daily management of the Home is controlled by a manageress who is a trained nurse; the medical supervision is arranged as at »Skjoldborg«. 12. INEBRIATE AND CONVALESCENT HOME »FAARUPGAARD«. The Home is situated at Jelling, in the vicinity of Veile in Jutland, and can accommodate 32 male ine* briates (alcoholists) as well as male convalescents discharged from the metropolitan municipal hospitals. The period of sojourn for inebriates is from 6 to 18 months; for convalescents, four weeks. As far as possible the inebriates are employed in carrying out agricultural work on the farm attached to the Home. The daily management of the Home is controlled by a superintendent, whose wife, having passed a course in nursing, supervises the domestic concerns. The medical attendance is arranged as at »Skjold* borg«. CONVALESCENT HOME »FREDERIK VILHELM HEGELS MINDE«. The Home, situated in Fredensborg, about 43 km. from Copenhagen, was taken over by the munici? 13.

pality of the metropolis in 1922. An enlargement has been effected, and the Home can now accommodate 35 female convalescents discharged from the metro* politan municipal hospitals. The daily management and medical supervision are arranged as at »Skjoldborg«.

14. MUNICIPAL NURSING IN HOMES. In 1916, the municipal nursing in homes was in* troduced experimentally (with six nurses); it has since been extended and established. Thus the present appointments are as follows: one matron, 26 hospital? trained nurses, excluding probationers. The nurses are distributed over the metropolis, which is divided into six districts. The nursing in homes, which is gratuitous, is in* tended for panebpatients and the like who, without this aid, would be obliged to seek hospital treatment, or for those who, owing to lack of accomodation, cannot be admitted into any hospital, as also for such patients who can be discharged from the hospitals on the asumption that expert nursing is guaranteed in the home.

15. ST. HANS HOSPITAL. St. Hans Hospital is a hospital for the insane in* tended for residents in the metropolis suffering from insanity. In 1816, the hospital, originally situated in

the metropolis itself, was removed to a large country estate at Roskilde (ca. 33 km. from Copenhagen), the buildings of which formed the first framework of the hospital. Of these buildings only one still exists. During the hundred years and more which have elapsed since the removal, the hospital has grown to be the largest hospital for the insane in Scandinavia. The aggregate area is about 47 hectares. The hospital buildings are grouped into a male hospital, comprising 739 beds, and a female hospital, comprising 1,014 beds; total number of beds: 1,753. The medical supervision of each hospital is vested in a senior physician, assisted by a staff of house? surgeons. The hospitals are under a common administration; likewise they have electricity works, laundry, etc., in common. The Director of the Hospitals, the two physicians? in?chief and the inspector constitute a board which meets to discuss the affairs of the hospitals. In connection with the above information con? cerning the institutions controlled by the Directorate of the Metropolitan Hospital Service, it must also be mentioned that the Hospital Service has established connections with some few private clinics and hospi? tals, so that a number of beds in these are filled through the afore?mentioned »Visitatorer« specially appointed physicians at the Kommune Hospital. Among these private institutions I will mention only the largest, viz.: Dronning Louises Boernehospi? tal (Queen Louise’s Hospital for Children), which *

was opened in 1879 and, later, in 1910, enlarged, so that it now can accommodate 150 children suffering from medical and surgical diseases. The municipality of the metropolis subsidises the hospital. Below, a short summary is given of the individual hospitals or hospital departments affiliated to the foundations of the Board of Guardians, the admini? stration of which is controlled by the Third Division of the Municipal Administration. »Almindelig Hospital« (General Hospital), which is an institution for old men and women of the metro? polis in need of permanent relief — excluding people receiving Aldersrente (old?age pension) — as well as for younger incurables or cripples, includes a hospital department comprising about 300 beds. The hospital department receives patients from the other departments of the foundation, as also patients admitted from the town or transferred from other municipal hospitals. »Arbejdsanstalten (Workhouse) Sundholm«, com? prising partly a workhouse for able?bodied persons who can do a small amount of work temporarily un? able to support themselves, partly a compulsory workhouse for persons on whom penalties are im? posed for begging, vagrancy, etc., includes a sick? department of about 100 beds intended for the in? mates of the workhouse. »De Gamles By« (the old peoples’ town), which is an old?age home for persons to whom an old?age pension has been granted, has a sick department com? prising about 300 beds intended for old?age pen?

sioners who have been granted residence in »De Gamles By« or who are transferred from other municipal hospitals. Finally, the Third Division of the Municipal Ad? ministration controls a nursing home for indigent tuberculous patients (at late stages).' The Home com? prises ca. 80 beds.