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the rapid supply of food at all times. There is more difficulty in doing this than at first appears, as the central kitchen cannot supply everything; and yet there must be no cooking in the wards, or even near them, as the time of the attendants should be occupied in other ways. Probably the best arrangement is to have hot closets close to the wards, where the food sent from the kitchen can be kept warm, and ready for use at all hours of the day and night.
2. The Supply of Water.—Hot and cold water must be supplied everywhere, and baths of all kinds should be available. The supply of water for all purposes should be 40 to 50 gallons per head daily.
3. The Supply of Drugs and Apparatus.— The chief point is to economize the time of attendants, and to enable drugs and apparatus to be procured without delay when needed.
4. The Nursing and Attendance, including the Supply of Clean Linen, etc.The time and labor of the attendants should be expended, as far as possible, in nursing, and not in other duties. Every contrivance to save labor and cleaning should therefore be employed. Lifts, shafts, tramways, and speaking-tubes to economize time; wards arranged so as to allow the attendants a view of every patient; wards not too large nor too small, for Miss Nightingale has conclusively shown that wards of from 20 to 32 beds are best suited for economy of service.
5. Means of Open-air Erercise for Patients.—This ought properly to be considered as medical treatment. As soon as a patient can get out of his ward into the open air he should do so; therefore, open verandas on the sunny sides of the wards, and sheltered gardens, are most important. For the same reason hospitals of one story are st,' as the patients easily get out; if of two stories, the stairs should be shallow.
6. In addition to all these, the supply of air medicated with gases, or fine powders, or various amounts of watery vapor, is a mode of treatment which is sure to become more common in certain diseases, and special wards will have to be provided for these remedies.
The parts of a military hospital are:
Patients' Rooms, Wards, and Day-rooms, if possible ; the wards of two sizes,-large, i.e., from 20 to 32 beds, and small, for one or two patients. It is desirable to have the small wards not close to the large ones, but at some little distance. Attached to the wards are attendants' rooms, scullery, bath and ablution rooms, small store-room, urinal, closets (one seat to every eight men).
Operating-room-Dead-house-Administration.-Surgeons' rooms ; casebook and instrument room ; offices and officers' room.
Pharmacy.-Dispensary; store-room ; dispenser's room.
· The late Dr. Parkes wrote :-“I had never properly estimated the importance of patients getting into the air, and the desirability of one-storied buildings for this purpose, till I served at Renkioi, in Turkey, during the Crimean war. The hospital was composed of one-storied wooden houses connected by an open corridor. As soon as a man could crawl he always got into the corridor or between the houses, and the good effects were manifest. Some of the medical officers had their patients' beds carried out into the corridor when the men could not walk. In the winter greatcoats were provided for the men to put on, and they were then encouraged to go into the corridor."
? Hospital space is to be provided for 10 per cent. of the force. Lately, since the health of the army bas been so much improved on home service, it has been proposed to reduce it to 7 per cent., but it would appear desirable always to have a large hospital space for emergencies and for war. For the duties of administrative medical officers with regard to hospitals, see the Medical Regulations, 1878.
Culinary.-Store-room; wine and beer room ; larder and meat room ; kitchen ; room for arranging diets ; scullery ; cook's room.
Washing.–Washhouse ; dirty linen store ; baking and fumigating room; cleaning room for mattresses.
Steward's Department.—Offices, furniture, linen, utensil, and pack stores ; rooms for cleaning.
FIG. 73.-Detail of present Ward, Lavatory, Closets, and Urinal, as used in Military Hospitals
(from Miss Nightingale's book).
The amount for storage room is, for an hospital of 100 sick-
= 250 square feet. Clothing store = 100
Foul linen store = 120
= 200 Provision store 100
(In military hospitals.) Fig. 73 shows the arrangement of closets and lavatory in a military hospital.
The two following plans show the arrangement of the Lariboisière Hospital in Paris,' which circumstances have made the type of the socalled block or pavilion plan; and of the Herbert Hospital, which is the best military hospital in this country, or perhaps anywhere.
The Herbert Hospital at Woolwich consists of four double and three single pavilions of two floors each, all raised on basements. There is a convalescents' day-room in the centre pavilion. The administration is in a separate block in front. The axis of the wards is a little to the east of north. There is a corridor in the basement, through which the food, medicines, coals, etc., are conveyed, and then, by a series of lifts, elevated to the wards. The terraces in the corridor afford easy means of open-air exercise for the
patients in the upper ward. The wards are warmed by two central open fire-places, with descending flues, round which are air-passages, so that the entering air is warmed. The floors are iron beams, filled in with concrete, and covered with oak boarding."
The usual shape of ward is oblong, the standard width 26 feet (in the army) to 30 feet (St. Thomas's, for instance), and the length being determined by the number of beds. Mr. John Marshall' has, however, advocated a system of circular wards, which he thinks have certain advantages,
1 The new Hôtel-Dieu is on the same general plan.
* The arrangement of the pavilions may be varied in many ways; for different forms of arrangement, see the works already cited. It has been thought unnecessary to take up space by inserting plans, which vary merely in detail.
3 On a Circular System of Hospital Wards, by John Marshall, F.R.S., etc. London, Smith & Elder, 1878.
and a similar plan has been actually carried out in the new hospital at Antwerp, which will probably be ready for occupation by the end of this year (1882).
Hospitals in the Tropics. The Barrack and Hospital Commission, in carrying out the plans of the Royal Indian Sanitary Commission, suggest for each sick man
Superficial area = 100 square feet, up to 120 in unhealthy districts. Cubical space = 1,500 feet, or, in unhealthy districts, 2,000 feet.
It is also directed that hospitals should consist of two divisions—1st, for sick ; and 2d, for convalescents. This latter division to hold 25 per cent. of the total hospital inmates.
sealog Foot Fig. 75. — Ground Plan of the Herbert Hospital, Woolwich (from Miss Nightingale's book). Each hospital is to be built in blocks, to consist of two floors, the sick and convalescents to sleep on the upper floors only; each block to hold only 20 to 24 beds.
The principles and details are, in fact, identical with those already ordered for the home stations.
Hospitals for Infectious Diseases. Fever and small-pox hospitals have been long established in many large English towns ; but within the last few years it has become usual for all towns of any size to put up some temporary hospitals during an outbreak of cholera, small-pox, relapsing fever, and typhus, and to remove persons ill with these diseases at once from their dwellings. In this way, if there is early discovery of the cases, the chances of spread of the disease are greatly lessened.
British Medical Journal, August 26, 1882, on p. 350 a ground plan is given ; see also London Medical Record, July 15, 1881, p. 296 ; and Charitable and Parochial Establishments, by Saxon Snell, F.R.I.B.A., for similar plans. Op. cit., p. 27.
3 That such hospitals may, however, be themselves centres of infection has been shown by the Report of the Hospitals Commission, 1882, which may be consulted for much valuable information.
The Medical Department of the Privy Council issued a Memorandum in 1872, pointing out that power is given under the 37th section of the Sanitary Act, 1866,' to the local board, improvement commissioners, town council, or vestry, to provide a hospitals or temporary places for the reception of the sick.” It is pointed out that villages should have the means of accommodating instantly four cases of infectious disease in at lcast two separate rooms, and it is considered that a good cottage would answer this purpose. In towns a permanent provision is advised to be made, and the following suggestions are made :-The situation to be convenient; ward cubic space, 2,000 feet per head ; ward floor-space per head, 144 square feet; good provision for ventilation ; precautions against entrance of foul air (as from privies or sinks); warming in winter to 60° Fahr. ; keeping cool in summer ; means of disposal of excrements and slops ; and for cleaning and disinfecting linen.
For temporary emergencies, tents (army hospital marquees) are recommended, or huts are advised. The huts are described at some length, and plans are given of the huts and of the arrangement. As these are very similar to those used by the army in war, reference is made to that section.
1 Memorandum on Hospital Accommodation to be given by Local Authorities (signed John Simon, July 8, 1872).
? Now under the 131st and following clauses of the Public Health Act of 1875.