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. lessness and ignorance will falsify the results of the best architects and physicians. Care 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 flooring at short intervals, so as more readily to admit the Meat. The pit for the stove was covered over by a pent roof, a few steps leading down to the fireplace. A movable valve in the flue provided a ready means of regulating the temperature, and even of diverting the heat from one tent to the one adjoining, for which purpose branch flues were arranged from some of them. "Among the many advantages of this mode of heating was the circumstance that after a time the soil under the tent became heated as well as the interior itself; a steady and constant movement of air in the interior was, moreover, kept up; and even in the depth of winter, with an external temperature of 25° F., that of the interior could be retained easily at 55° F. if necessary.”—(Lessons on Hygiène and Surgery from the Franco-Prussian War, by C. A. GORDON.) In the American war some of the hospitals contained from 2000 to 2800 beds-in fact, they were much too large. The numbers under the same roof should be as small as possible. Hammond states that in his experience the best size for a ward or tent was that which would accommodate fifty men: length of ward, 175 feet; width, 25 feet; height, 14 feet; superficial area per man, 87 feet; cubic space per man, 1200 feet; ridge ventilation by an opening 10 inches wide running the whole length of the roof. In the Austrian campaign of 1859, the method of distribution over a large tract of country, and in many small hospitals frequently entirely removed from military control, notwithstanding the disadvantage of badly arranged transport and want of care en route, was attended by most satisfactory results, not only as regards the health of the sick but the behaviour of the soldiers. The distribution spread no epidemic among the civil population, but, on the contrary, epidemics among the soldiers were arrested by it. Hospital Ships.-Ships have the one great advantage of isolation, but they are difficult to ventilate, the space is cramped, and there are other disadvantages. They are, however, extremely useful in certain cases, especially in warfare. One of the best hospital ships ever constructed was the Victor Emmanuel, sent out to the Ashantee war. A short account of this vessel will give an actual example of what a hospital ship ought to be. "H.M.S. Victor Emmanuel is a wooden screw steamship of the old class, of 5157 tons, and carried originally seventy-nine guns. She was launched at Pembroke dockyard in September 1855, under the name of the Repulse; but having been, shortly after the close of the Crimean war, visited and admired by the Emperor Victor Emmanuel, she was ordered henceforth to bear the name of that monarch." She was converted into a hospital ship in 1873. As now constituted, she is a flushed-deck ship with poop added, and has below what may be called a service deck, a main, gun (or lower), and orlop deck. The water-supply is stored in large tanks amidship. Three of these reservoirs contain salt water for flushing closets; three fresh water, for washing and bathing purposes; and two are fitted with Crease's filters, for drinking and cooking purposes only. From these tanks, by an elaborate system of pipes, all parts of the ship are supplied, so that anywhere, at any moment, salt, fresh, or filtered water may be obtained. The hospital deck is 230 feet long; width, 52 feet; height from deck to beam 6 feet 2 inches, and from deck to deck nearly 7 feet. Ventilation and light are ensured by sixty-six ports, fitted with sashes and jalousies. The hatchways and two large stern ports also assist ventilation; while six cowled tubes, projecting higher than the bulwarks, and trimmed head to wind, act as downcasts. The upcast ventilation is provided for by long slits in the deck, covered with wooden hoods (resembling in some respects the ridge ventilation in hospital tents). These hoods are arranged so that they may be raised or depressed to any extent. There are numerous orifices leading into goose-neck pipes along the top-sides of the deck above, which also assist. The engine room hatchway is completely separated by glazed bulkheads, so that no heat or smell can find its way from that source into the hospital deck. There are cabins on each side of the stern for the use of sick officers. The latrines are on the upper deck, opening towards the bows just abreast of the smoke-funnel. There are also closets fitted with patent disinfecting apparatuses in different parts of the ship. They are arranged in three sets-viz., two sets aft, two at the bows, and two opposite the engine hatchway. The hospital accommodates 140 patients, occupying cots arranged in three rows fore and aft, and made so as to "rock" and "lock." The cots are also provided with mosquitocurtains rendered uninflammable by tungstate of soda, and light canvas screens are provided. There is a large outside platform, protected by wire fencing, on each side of the hospital deck, on which the patients can have the benefit of fresh air either in beds or chairs. There are excellent arrangements in the lavatories, numerous baths, and a laundry fitted with Bradford's washing apparatus, an arrangement by which the foul linen can be hoisted up from below. The ship has a spacious cooking-galley, ice-making machines, dispensary, lifts, pumps, &c., and the whole painted white, in order to show any dirt. The arrangements were so admirable that it was expected to be a great success, and it fully realised all anticipations, except a few minor defects easily remedied. Here, then, we have a model of a hospital ship-effectual arrangements for plenty of water, for cooking food, the disinfection of excreta, the ventilation of the ship throughout, the comfort and amusement of the sick, and as much cubic space as can well be obtained in a vessel.-(For further details, see Report on H.M.S. Victor Emmanuel, Lancet, 1873, and Lancet, April 18, 1874.) Dr. Parkes considers it would be a good plan in large expeditions to have a small ship converted entirely into a laundry, a proposal that deserves consideration; and he insists on the facilities for bathing and sea drenching, with regular fumigation and disinfection. Cottage Hospitals.-The same principle that has already been laid down as applied to separate tents in military field hospitals, to separate pavilions in large hospitals, is seen in cottage hospitals. These have now been established in nearly every county in England, and the results of treatment are so good that they are on the increase. The cottage-hospital system was originated by Mr. Napper of Cranleigh; it is especially applicable to rural districts. Its advantages are 1. Skilled nursing. 2. Special appliances-such as water beds, fracture apparatus, &c. (in fact, all the mechanical appliances necessary). 3. Isolation. 4. Home comforts. 5. Any medical man practising in the dis trict may have the use of them for a deserving | tal, it should be at the rate of one bed for patient. every 1000 of population. Three cottage hospitals, of six beds each, will serve effectually a rural population of 18,000. The cost is Hospitals for Infectious Diseases. It is important that every sanitary authority should act upon the 131st section of the Public Health Act, and provide a proper place for the treatment of infectious diseases. Every board of guardians should also have a detached contagious ward. "Every village ought to have the means of The patients themselves pay a certain sum weekly, according to their means, so that the cottage hospital is to some extent self-support-about £90 per bed. ing, although voluntary contributions are also necessary. Each subscriber, no matter what the amount of his subscription, should have equal privileges in recommending cases. Those of emergency and accident are at once admitted, in other cases a recommendation from a subscriber is necessary. All infectious cases as well as incurable diseases are excluded. There will be little difficulty either in con-accommodating instantly, or at a few hours' struction or in selecting a proper site. "In notice, say, four cases of infectious disease, in, most instances a couple of huts or cottages for at least, two separate rooms, without requireach sex, with two or three rooms each for ing their removal to a distance. A decent subdivision, nurses' rooms alongside the four-room or six-room cottage at the disposal wards, and detached kitchens, all connected of the authority would answer the purpose. by open verandahs, will answer every pur- Or permanent arrangement might be made pose.”—(GALTON and SUTHERLAND's Hospital beforehand with trustworthy cottage-holders, Construction.) not having children, to receive and nurse, in With regard to the size of a cottage hospi- case of need, patients requiring such accom A. administrative buildings (kitchen, stoves, offices, nurses' bedrooms, &c.); B, laundry, &c.; C, disinfection, dead-house, &c.; D, huts for ten patients each, with scullery and bathroom at end, and closet and sink at other end of each; E, open corridors. The dotted lines show direction for farther extension. The London vestries have generally erected temporary hospitals of corrugated iron lined with match-wood. In the Hampstead Smallpox Hospital there was an interval between the wood and iron which was filled with felt. Any local authority may provide for the use of the inhabitants of their district hospitals, or temporary places for the reception of the sick, and for that purpose may— Where any suitable hospital or place for the reception of the sick is provided within the district of a local authority, or within a convenient distance of such district, any person who is suffering from any dangerous infectious disorder, and is without proper lodging or accommodation, or lodged in a room occupied by more than one family, or is on board any ship or vessel, may, on a certificate signed by Themselves build such hospitals or places of a legally-qualified medical practitioner, and reception; or Contract for the use of any such hospital or part of a hospital or place of reception; or Enter into any agreement with any person having the management of any hospital, for the reception of the sick inhabitants of their district, on payment of such annual or other sum as may be agreed on. Two or more local authorities, having respectively power to provide separate hospitals, may combine in providing a common hospital. -(P. H., s. 131.) Any costs incurred by a local authority in maintaining in a hospital, or in a temporary place for the reception of the sick (whether or not belonging to such authority), a patient who is not a pauper, shall be deemed to be a debt due from such patient to the local authority, and may be recovered from him at any time within six months after his discharge from such hospital or place of reception, or from his estate in the event of his dying in such hospital or place.-(P. H., s. 132.) with the consent of the superintending body of such hospital or place, be removed, by order of any justice, to such hospital or place at the cost of the local authority; and any person so suffering, who is lodged in any common lodging-house, may, with the like consent and on a like certificate, be so removed by order of the local authority. An order under this section shall be addressed to such constable or officer of the local authority as the justice or local authority making the same may think expedient; and any person who wilfully disobeys or obstructs the execution of such order shall be liable to a penalty not exceeding ten pounds.-(P. H., s. 124.) Any local authority may make regulations (to be approved of by the Local Government Board) for removing to any hospital to which such authority are entitled to remove patients, and for keeping in such hospital so long as may be necessary, any persons brought within their district by any ship or boat who are in T |