The modern, indeed, quite recent, innovation of having private nursing homes attached to hospitals has to a very large extent done away with or encroached upon the profits of and openings for private nursing homes. It is still possible to make a living out of them, but it is more difficult than it used to be.

The Choice of a Neighbourhood

Before deciding to start one, it is advisable to try to obtain the interest of one or more doctors, and their promise that they will send patients. It is the general rule of West End doctors and specialists to have a special home or homes to which they send their patients, and this practice means, of course, a certain more or less definite income for the owner of the home.

In every case the matron should be a' fully trained nurse, as it is in her hands that the responsibility of the home and the lives of the patients rest. The matron is generally present at operations, and the nurses work under her control.

The first question to be settled is the locality of the home, and this depends entirely on the doctors whose support has been promised. They generally prefer the home to be as close as possible to their own residence ; for instance, if patients have been promised by Kensington doctors, it will be necessary for the house to be somewhere in the Kensington district. But for choice, and if one is fortunate enough to have the patronage of West End doctors, Harley Street and its environs is by far the best locality, and will command the highest fees.

In choosing the house, due regard should be paid to the convenience of reaching it by rail or 'bus. No side streets or out-of-the-way places are suitable ; a good address and a good thoroughfare are always important points with well-off patients.

No woman is advised to start, however, unless she has enough capital in hand not only to furnish the home, and to equip the theatre, but also to pay her expenses until patients come. Even with the support of two or three doctors, one may have to wait many months for patients, and, meanwhile, expenses are being incurred. The capital required depends on the size of the home.

Sanitary Arrangements

Good drains and perfect sanitary arrangements are of primary importance in a nursing home. Doctors are rarely content with the former tenant's certificate, and so the whole place should be thoroughly examined, not only by the London County Council inspector, but also by a private sanitary inspector. The latter will charge a fee of from two guineas upwards, but, as a rule, he is more difficult to satisfy in details, and insists upon more elaborate and careful arrangements being made than the London County Council man. Most doctors like to have the double certificate.

The landlord must understand that the house is required for a nursing home, and give his consent to its being used as such, otherwise he may afterwards intervene and stop the proceedings.

As the major part of the house will be required for bedrooms, all the rooms should be light and airy, though not necessarily large. Difficult or high stairs should be avoided, unless there is a lift which could be used for patients, and that is very unusual in ordinary private houses. All the rooms will have to be freshly painted and " done up," so that there can be no danger of "germs." The walls are seldom - if ever - papered, for the same reason. Most doctors prefer to have them distempered, as in cases of infectious illness they can be washed down.

Furniture And Decorations

Pale, soft colours, restful for the eyes of the sick, should be chosen, and it is a good idea to have the same colour scheme carried throughout the room; the screen, curtains, easy chair, and even the bed coverlet can be in harmony.

When one comes to discuss the furniture of a nursing home, the question is more difficult, because so much depends on the kind of patient expected. Rest-cure cases, for instance, should have a more luxurious room - sometimes two rooms - than operation cases, where the most rigid antiseptic precautions must be taken.

In these latter cases, carpets are never used - linoleum is substituted, with rugs for the bedside and the fireplace. The rooms of operation cases are furnished as plainly and lightly as possible, and everything is washable. White furniture is the best, and wardrobes, as a rule, are not allowed at all, the patients' trunks and clothes being kept in a special room. Single spring beds, of a comfortable height for bending over, a table for the patient's bedside, the necessary toilet articles, a couple of chairs, a screen, and perhaps a combination dressing-table will be, generally speaking, all that is required for an operation case's room.

The Operating Theatre

If there is no operating theatre - though, in high-class homes there should be one - a large white deal table of not less than six feet, on which the necessary mackintoshes and blankets are laid, will serve the purpose, and will have to be carried about from room to room as it is required. A well-known and successful home in the West End district used only for its many operations a wooden movable table. But this practice is not to be recommended, and gives a great deal of extra work.

When there is an operating theatre, all the articles required for operations will be kept there, and in an adjoining room or in the theatre itself there will be cupboards and receptacles for keeping dressings. The fitting-up of the theatre would have to be carried out by a qualified nurse.

The most modern hospital theatres are all in white, with tiled floors and walls, and though this may be impossible in a private nursing home, it is indispensable that everything in the theatre should be antiseptic and washable.

Hospitals always have an adjoining room where the anaesthetic is administered before the patient is taken into the theatre, but the only general rule which can be laid down is that the patients must be saved from every possible cause of nervousness. A tactful nurse has a very powerful influence before and after an operation, and nothing is more important in a nursing home than to choose not only competent, but tactful and pleasant nurses. Many people arrive so overcome by sheer fright that they stand in the way of their own recovery unless the nurse can soothe them. Young girls and children especially need infinite tact and patience 1 shown them when they are sent to a home for operations. There is usually homesickness, shyness, and often terror for the nurse to combat and overcome, for a patient who is constantly fretting does not get well.