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In small hospitals in the provinces, the block system is probably as good as any other, and the pavilion plan unnecessary (figs. 38 and 39).

The general axis of hospitals should run north and south, or, at all events, the axis of the wards; thus each side obtains the influence of the sun, which aids ventilation and prevents damp.

The next thing to be considered is the ward, the hospital unit. It should be of sufficient 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 num ber of beds.

The great and essential point is the superficial space per bed. This at the Lariboisière 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 requirements, but also in the London schools a number of students are taught around each bed, and therefore such hospitals require additional area.

The following is a sketch of a ward, or rather double pavilion, each half of which represents a ward unit; it embodies the following principles (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 fireplaces in the outer walls, the same numerical relations should be observed; but of course such a proportion in the bed-spaces necessitates 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.

"The water-closets, ward sinks, baths, lavatory basins, and urinals are placed in two projections at the outer or free ends of the wards, having special ventilating arrangements for assuring that, from whatever direction the wind blows, no effluvia can enter the wards (fig. 41).

"For each ward is provided a small nurses' room, with an inspection - window into the

wards shown in fig. 40 the two wards are | lighted and ventilated by several large lofty

effectually cut off from each other by a 12feet-wide corridor and a central hall carried up to the roof of the building, where it is

windows. But the wards admit of other methods of arrangement. They may be placed singly or alternately, or in line.

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ward, and a small scullery for washing up tea things and providing warm water, or warm food or drink for special cases.

shown in the plan, have been found in practice sufficient in the Herbert Hospital, in planing which they were considered in connection

"The relative dimensions of all these parts, with the entire arrangements. In the double

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hospitals are at the rate of one to each bed. Perhaps this is more than enough. As no window fits tight, they even, when closed, are natural ventilators. Too much glass is objectionable. In winter, it cools the air; in summer, 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 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. 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 to them, both having cross-ventilation by opposite windows. All the pipes from the drains should be trapped, and where necessary fitted with charcoal deodorisers.

Single wards are undoubtedly best. When

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superimposed one upon the other, there is dan- | the upper one.
ger of foul air rising from one to the other.
The unhealthiness of top wards has often been
shown. For example, Hunter remarked that
in two wards of exactly the same dimensions,
but the one over the other, and containing
exactly the same number of sick under similar
circumstances, the mortality was greatest in

The Marquis de Pastoret, in his Report on the Hospitals (France) from 1804 to 1814, showed that there was always the greatest mortality in the upper wards of the Hôtel Dieu, where they were superimposed, but elsewhere equal. He truly remarked that attendance on the sick was more difficult in the high wards than in the lower

floors, that the convalescents could not walk out with the same facility, and that in case of fire there would be great difficulty in saving life.

Esquirol had previously called public attention to the incontestable advantage in buildings of the kind, of ground-floors in the chest affections of old men. Still, ground is so dear in large towns that a two-storied building is in many cases a necessity, nor with proper arrangements should it have any ill effect. More than two stories high, although practically often difficult to avoid, is to be looked upon with disfavour, but mechanical arrangements-such as lifts, &c.-partially obviate the objections.

The arrangement of the different units, the separate pavilions, is a matter which may be dealt with in various ways, and greatly depends upon the particular site. They may be placed parallel to each other, or end to end. Figs. 42, 43, and 44 will show the different systems employed in the best hospitals.

There are one or two points that are applicable to all-viz., that the pavilions should have no structure between them, and they should be connected simply by a low corridor. It is best open-mere open arches supported by pillars. The administration should be entirely separate from the pavilions, and there should be a separate building for the nurses to sleep in. It is a great stroke of policy for the managers of a hospital to keep the nurses in the best possible health; by so doing they ensure efficiency.

A very original plan of hospital construction has been proposed by Mr. Greenway of Plymouth. There is a double row of glass compartments along the centre of the ward, and separated from the side walls by a corridor. The glass compartment is so ventilated that the vitiated air is effectually removed. Experience will show whether thus putting our sickly plants under glass shades will answer better than the usual plan. The cost per bed is £150.

To the general and daily management of a hospital is often due its good or its bad results. Careful sanitary supervision will make a badly-constructed hospital healthy. Carelessness and ignorance will falsify the results of the best architects and physicians.

The immediate disinfection of all contagious excreta, the hourly watching of ventilation, excessive cleanliness, the prompt removal of the dead, order, discipline, sobriety, and intelligent quiet management,-these are the things that render a hospital efficient.

The general hospitals having been considered, there remain those special structures peculiar to warfare-viz., military and naval hospitals

-as well as cottage hospitals, and hospitals for sanitary authorities.

Military Hospitals.-A stationary military hospital is constructed on the same principles as the civil, but the exigencies of warfare require either camps or light buildings, which can rapidly be put up in the rear of an army, and as rapidly removed. The late war has enforced the lessons taught long ago-viz., that all buildings, churches, hotels, &c., are to be avoided as hospitals. The sick and wounded do far better in tents, wooden huts, and other light buildings constructed at the time.

During the siege of Paris we learn that almost every kind of building was utilised as a hospital, and as a consequence pyæmia and gangrene prevailed to a frightful extent.

Our own war hospitals are divided into1. Regimental, which are small hospitals for the purpose of treating men when first reported sick, and slight cases.

2. Division Hospitals. These are in charge of a staff surgeon, and are for the wounded.

3. The Field General Hospital, where all the wounded that can be transported from the front to the rear are placed.

In rear of these, again, there is some more permanent building, sometimes constructed of iron at home, and then sent out in pieces, so as to be quickly put up.

The Germans follow a similar plan. Their war hospitals are in three classes, called respectively Feld, Kriegs, and Reserve Latharin, and the wounded are successively transferred from the one to the other, and then when well enough transported into the interior. The great established principle in war hospitals is that they should be either tents or wooden huts, with ridge ventilation, and that as soon as possible the wounded, if able to bear the journey, should be transported far away from the seat of operations.

Dr. Parkes, summing up the hygiène of field hospitals, considers that they should consist of tents of good size, well ventilated, and with flaps, by which they can, if desired, be converted into awnings; the tent floor to be covered with clean, and, if possible, dried earth or charcoal, and to be then covered with a waterproof cloth or boarded. The boards should be removed frequently and the earth cleaned, in order to prevent the accumulation of offensive rubbish. In the war of the American Secession, as well as in the Franco-Prussian war, the American tent-ambulance, constructed of field tents, 14 feet long, 15 feet broad, and 15 feet high to the ridge-pole, was much used, and appeared to answer well. "Three such tents joined end to end formed one long pavilion capable of accommodating eighteen wounded

"The system of warming was efficient, sim- | end. An ordinary stove was built into the ple, and economical. A trench of about 40 centimetres broad and deep was made in the ground, extending from one end to the other of the tent; a pit of about 1 millimetre 50 centimetres in dimensions excavated at one

latter, the flue of which extended along the trench under the floor, and rose at the farther end in the form of a chimney. Along its course it was carefully built in by brick and mortar, a grated opening being left in the

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