“It may seem a strange principle to enunciate as the very first requirement in a Hospital that it should do the sick no harm. It is quite necessary, nevertheless, to lay down such a principle, because the actual mortality in hospitals, especially in those of large crowded cities, is very much higher than any calculation founded on the mortality of the same class of diseases among patients treated out of hospital would lead us to expect. The knowledge of this fact first induced me to examine into the influence exercised by hospital construction on the duration and death-rate of cases received into the wards; and it led me to lay before the Social Science Association a paper reprinted with the present title. Since the publication of the first edition of that paper, great advances have been made in the adoption of sound principles of hospital construction; and there are already a number of examples of new hospitals realizing all, or nearly all, the conditions required for the successful treatment of the sick and maimed poor.”

Notes on Hospitals 3rd Edition (1863), Preface