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short, consist of a certain number of perfectly The general axis of hospitals should run distinct hospitals connected together merely north and south, or, at all events, the axis of for facility of access. Such a hospital, there- the wards ; thus each side obtains the infore, must consist of a number of pavilions." fluence of the sun, which aids ventilation --(Op. cit.)

and prevents damp.

The next thing to be considered is the ward,

the hospital unit. It should be of sufficient T E RR A C E size to give 2000 cubic feet of air to each bed,

which, with good ventilation, ought to keep the air sweet.

The ward is best made long and narrow (narrow, i.e., in proportion to its length), with opposite windows, to admit of cross-ventilation (fig. 40). The height should be about 14 feet; the wall-space, per bed, 7 feet 4 inches; the width of the ward certainly not less than 24 feet. The length must depend upon the numi"

ber of beds. WARD

The great and essential point is the superficial space per bed. This at the Lariboisiere is 104 square feet, at the Vincennes it is 90 square feet, at the Herbert 96 square feet; so that it may be put down that it varies in the best - constructed hospitals from 90 to a 100 square feet. In this respect we have not

only to consider the amount for sanitary reUN

quirements, but also in the London schools I

a number of students are taught around each bed, and therefore such hospitals require

additional area. с о

D O R The following is a sketch of a ward, or rather

double pavilion, each half of which represents a ward unit; it embodies the following priu. ciples (fig. 40):

" The number of beds is divisible by four, by which the whole wall - space is utilised. Wherever it is not intended to introduce fire places in the outer walls, the same numerical relations should be observed; but of course such a proportion in the bed-spaces necessi. tates the introduction of artificial warming and ventilating arrangements; or, as in the case of the Herbert Hospital, the use of firegrates, of which there are two placed in the centre line of each ward. The wards have windows along opposite sides, with a bed in each corner, and two beds between every two windows along the wall. Each ward has likewise an end window to the open air, and it will be seen that the beds are protected by projections from direct currents entering by these end windows, which currents are thrown

down the centre space between the beds. (SCALE 50 FEET TO AN INCH,)

“The water-closets, ward sinks, baths, lava. tory basins, and urinals are placed in two pro

jections at the outer or free ends of the wards, Fig. 40.

having special ventilating arrangements for asIn small hospitals in the provinces, the suring that, from whatever direction the wind block system is probably as good as any other, blows, no effluvia can enter the wards (fig. 41). and the pavilion plan unnecessary (figs. 38 and

“For each ward is provided a small nurses 39).

room, with an inspection - window into the




0 5 10







ward, and a small scullery for washing up s shown in the plan, have been found in practea things and providing warm water, or tice sufficient in the Herbert Hospital, in planwarm food or drink for special cases.

ing which they were considered in connection “The relative dimensions of all these parts, with the entire arrangements. In the double

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wards shown in fig. 40 the two wards are | lighted and ventilated by several large lofty effectually cut off from each other by a 12- | windows. But the wards admit of other feet-wide corridor and a central hall carried methods of arrangement. They may be qp to the roof of the building, where it is placed singly or alternately, or in line.

“One advantage, indeed, of the pavilion hospitals are at the rate of one to each bed. structure is the facility with which it ac- Perhaps this is more than enough. As no commodates itself to the shape of the site." | window fits tight, they even, when closed, are -(Op. cit.)

natural ventilators. Too much glass is objec. tionable. In winter, it cools the air ; in sum. mer, a room with many windows may become like a conservatory in temperature. Plateglass is the best material, and the window

should swing open top and bottom. The walls B

are recommended to be coated with as dense and as impervious a cement as can be obtained. One of this kind, capable of being polished, has been tried in the Herbert Hospital. It

admits of being washed with soap and water. B


The floor is best constructed of oak, with close joints, polished with bees-wax. Such a floor is, however, very slippery, and weak patients may have many a fall. The best position for water-closets is a separate square block at the

end corners, with a passage and lobby leading Fig. 42.

to them, both having cross-ventilation by opThe accessories of the ward remain to be posite windows. All the pipes from the drains considered. It must be light, have floors and should be trapped, and where necessary fitted walls into which contagious fluids or particles with charcoal deodorisers. do not easily soak. The windows in some Single wards are undoubtedly best. When



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Fig. 44, superimposed one upon the other, there is dan- | the upper one. l'he Marquis de Pastoret, ger of foul air rising from one to the other. in his Report on the Hospitals (France) from The unhealthiness of top wards has often been 1804 to 1814, showed that there was always shown. For example, Hunter remarked that the greatest mortality in the upper wards of in two wards of exactly the same dimensions, the Hôtel Dieu, where they were superimbut the one over the other, and containing posed, but elsewhere equal. He truly reexactly the same number of sick under similar marked that attendance on the sick was more circumstances, the mortality was greatest in difficult in the high wards than in the lower floors, that the convalescents could not walk -as well as cottage hospitals, and hospitals out with the same facility, and that in case of for sanitary authorities. fire there would be great difficulty in saving Military Hospitals.-A stationary military life.

hospital is constructed on the same principles Esquirol had previously called public atten- as the civil, but the exigencies of warfare retion to the incontestable advantage in build-quire either camps or light buildings, which ings of the kind, of ground-floors in the chest can rapidly be put up in the rear of an army, affections of old men. Still, ground is so dear and as rapidly removed. The late war has in large towns that a two-storied building is enforced the lessons taught long ago--viz., in many cases a necessity, nor with proper that all buildings, churches, hotels, &c., are arrangements should it have any ill-effect. to be avoided as hospitals. The sick and More than two stories high, although practi- wounded do far better in tents, wooden huts, cally often difficult to avoid, is to be looked and other light buildings constructed at the upon with disfavour, but mechanical arrange time. ments—such as lifts, &c.-partially obviate During the siege of Paris we learn that the objections.

almost every kind of building was utilised as The arrangement of the different units, the a hospital, and as a consequence pyæmia and separate pavilions, is a matter which may be gangrene prevailed to a frightful extent. dealt with in various ways, and greatly de- Our own war hospitals are divided intopends upon the particular site. They may be 1. Regimental, which are small hospitals placed parallel to each other, or end to end. for the purpose of treating men when first Figs. 42, 43, and 44 will show the different reported sick, and slight cases. systems employed in the best hospitals.

2. Division Hospitals. These are in charge There are one or two points that are appli- of a staff surgeon, and are for the wounded. cable to all-viz., that the pavilions should 3. The Field General Hospital, where all have po structure between them, and they the wounded that can be transported from the should be connected simply by a low corridor. front to the rear are placed. It is best open-mere open arches supported In rear of these, again, there is some more by pillars. The administration should be en permanent building, sometimes constructed of tirely separate from the pavilions, and there iron at home, and then sent out in pieces, should be a separate building for the nurses so as to be quickly put up. to sleep in. It is a great stroke of policy for The Germans follow a similar plan. Their the managers of a hospital to keep the nurses war hospitals are in three classes, called rein the best possible health; by so doing they spectively Feld, Kriegs, and Reserve Latharin, ensure efficiency.

and the wounded are successively transferred A very original plan of hospital construc- from the one to the other, and then when tion has been proposed by Mr. Greenway of well enough transported into the interior. Plymouth. There is a double row of glass The great established principle in war hoscompartments along the centre of the ward, pitals is that they should be either tents or and separated from the side walls by a corridor. wooden huts, with ridge ventilation, and that The glass compartment is so ventilated that as soon as possible the wounded, if able to the vitiated air is effectually removed. Ex- bear the journey, should be transported far perience will show whether thus putting our away from the seat of operations. sickly plants under glass shades will answer Dr. Parkes, summing up the hygiène of field better than the usual plan. The cost per bed hospitals, considers that they should consist is £150.

of tents of good size, well ventilated, and with To the general and daily management of a flaps, by which they can, if desired, be conhospital is often due its good or its bad results. verted into awnings; the tent floor to be Careful sanitary supervision will make a covered with clean, and, if possible, dried earth badly-constructed hospital healthy. Care- or charcoal, and to be then covered with a lessness and ignorance will falsify the results waterproof cloth or boarded. The boards of the best architects and physicians.

should be removed frequently and the earth The immediate disinfection of all contagious cleaned, in order to prevent the accumulation excreta, the hourly watching of ventilation, of offensive rubbish. In the war of the Ameriexcessive cleanliness, the prompt removal of can Secession, as well as in the Franco-Prussian the dead, order, discipline, sobriety, and in- war, the Americantent-ambulance, constructed telligent quiet management,- these are the of field tents, 14 feet long, 15 feet broad, and things that render a hospital efficient. 15 feet high to the ridge-pole, was much used,

The general hospitals having been considered, and appeared to answer well. “Three such there remain those special structures peculiar tents joined end to end formed one long pavilion to warfare-viz., military and naval hospitals capable of accommodating eighteen wounded

men without crowding (figs. 45 and 46). ! means of an opening in the roof alternately The flooring consisted of planks placed upon on opposite sides of the united tents. The cross-supports, and raised about 3 inches from cloth itself was, moreover, permeable to air, the soil. In each division or separate small although not to wet; and it deserves to be tent were six camp iron beds — the very stated that the whole expenses of installation, ones that had been employed in the American including heating apparatus and flooring, were war—and free ventilation was ensured by under 130 francs per bed.

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“The system of warming was efficient, sim- , end. An ordinary stove was built into the ple, and economical. A trench of about 40 latter, the flue of which extended along the centimetres broad and deep was made in the trench under the floor, and rose at the farther ground, extending from one end to the other end in the form of a chimney. Along its of the tent; a pit of about 1 millimetre 50 course it was carefully built in by brick and centimetres in dimensions excavated at one mortar, a grated opening being left in the

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