HOSPITALS. The aggregation of a large number of sick persons suffering from a variety of diseases, or recovering from surgical operations, in one common building, is a necessity of modern life, but is now recognised as being attended with risks and dangers from which the patient treated in his own home is to a large extent exempt. In former times, this crowding together of the sick in hospitals led to outbreaks of erysipelas, pyæmia, and hospital gangrene in the surgical wards, the contagion appearing to be conveyed from one patient to another through the air, or by means of the surgeon's hands or instruments when engaged in dressing wounds. The antiseptic treatment of wounds and injuries, and the greater care bestowed on the construction and management of hospitals have nearly eradicated these terrible diseases from modern hospital practice; but when from any cause the surgical wards of hospitals are overcrowded, and the cleanliness and frequent dressings of wounds cannot be attended to, these septic diseases are almost sure to make their appearance and cause frightful havoc. Those who witnessed the horrible sufferings and mortality occasioned by dirt and overcrowding in the hospitals for sick and wounded during the Russo-Turkish war can bear evidence to the truth of this statement. It has often been noticed that cases of open wounds, from injury or operation, recover far more rapidly when treated in the open air, or in huts and tents practically open to the air, than when confined in close buildings; and the same is true of cases of acute infectious disease. For such cases the breathing of pure air is a prophy lactic worth more than all the drugs in the pharmacopoeia. For the cases of organic disease of important viscera, which are treated in medical wards, the beneficial effects of pure air, though not equally striking, are not unimportant, although in these cases pure air and thorough ventilation must often be subordinated to considerations of warmth and moisture. The first principle, then, in hospital construction and management is bound up in an abundant supply of pure air to the patients. The putrescent organic effluvia from the skins and lungs of sick persons, which, if not more copious, are certainly more deleterious than those from healthy people, must be diluted with fresh air and rapidly carried away. For each patient in a medical ward, the superficial floor space should not be less than 100 square feet, and the cubic space 1000 cubic feet. The air should be changed at least three times in an hour, which would give 3000 cubic feet of fresh air per head per hour. In wards containing many patients suffering from phthisis, bronchitis, or pneumonia, with much purulent expectoration, a higher set of figures should be taken. For surgical wards and infectious disease hospitals the minimum floor space should be 140 square feet, and the minimum cubic space 1500 cubic feet per head, changed 3 or 4 times an hour. In the surgical wards, the effluvia from purulent or septic wounds are added to the exhalations from the lungs and skin, and require rapid dilution and removal. In the infectious wards, infective particles are wafted into the air from the skin and excretions, and must be destroyed by thorough oxidation as soon as formed. For general hospitals it is found that the most convenient number of patients that may be treated in one ward, is on an average 30, this being the number which one nurse can readily supervise. In an oblong ward (fig. 73) with 30 patients, each patient to have 100 square feet of floor space and 1000 cubic feet of air space, 3000 square feet of floor space will be required and 30,000 cubic feet of air space. The 3000 square feet of floor space will be available if the ward is 120 feet long and 25 feet wide. A A A FIG. 73.-Diagrams of Oblong and Circular Wards. A. Turret As there are 15 beds on each side of the ward, the longitudinal wall space for each bed will be 8 feet, and the distance between any 2 beds (themselves 3 feet wide and 6 feet long) will be 5 feet. The width of 25 feet is a convenient one, as it allows a passage 11 feet wide between the two rows of beds for the whole length of the ward, and permits of thorough cross-ventilation between the opposite windows, and the flooding of every part of the ward with daylight. To provide the 30,000 cubic feet of air space the ward must be 10 feet high. It would be better to have the height of the ward 12 feet, which would allow 1200 cubic feet of air space per patient. Any height above 13 feet is useless for purposes of ventilation, and should be discounted in calculating the cubic space per head. The circular ward system (fig. 73) has been much advocated. It has several advantages, such as the absence of corners for the accumulation of dust, the aspect facing all corners of the compass, by which the ward obtains sunlight at all seasons of the year and at every hour of the day, and the facility offered to nurses and attendants in passing from one bed to another. On the other hand if a circular ward is to accommodate the same number of patients as an oblong ward having an equal floor measurement and cubic contents, the beds of the patients, which are placed around the wall, must be very closely packed together, and the 8 feet of wall space per bed cannot by any possibility be attained. Thus, for a circular ward to have 3000 square feet of floor space, the diameter of the circle must be 61.8 feet. The circumference of the circle will be 194 feet. From this must be deducted the width of the entrances of two lobbies or passages, say 13 feet, which leaves 181 feet of wall space for 30 beds or about 6 feet per bed, at the head of the bed. The circumference of the smaller circle formed by the feet of the beds is 153 feet, which gives 5 feet per bed at their feet, or an average of 5'5 feet for each bed. This means far too close approximation of the beds, and the creation of an evil not encountered in the oblong wards. There is a large open space in the centre of the ward unoccupied, which is of little use to the patients crowded together at the circumference. It has been proposed to utilise this space for a nurse's room or for a central staircase; but both these plans would create obstruction to cross-ventilation and access of light, whilst the central staircase might act as a shaft for the passage of foul air from one ward to another. Where space will admit, the system of one-storied pavilions is far the best for all hospitals, and is especially suited for those intended for infectious diseases. The pavilions are connected with one another, and with the administrative blocks, by corridors which are, or may be, open to the air; and all risk of transference of foul air and effluvia from one ward to another is avoided. In large towns, a certain amount of crowding on a limited area is indispensable, and wards of two or more storeys in height must be built. Even in these, the system of disconnected pavilions should be aimed at, and the staircases require careful planning to prevent them acting as shafts for the passage of air from one ward to another. The external air space around the wards should be ample, and overshadowing by high buildings in the neighbourhood must be carefully avoided. Provision should be made for the entrance of warmed fresh air in winter; this may be effected by Galton's ventilating open fireplace, or by a ventilating stove or stoves placed in the centre of the ward. Hot-water pipes should also be placed in the ward, as they may be required during very cold weather, or for the treatment of cases where much warmth is desired. To secure the best kind of natural ventilation, the ward should have opposite windows reaching nearly to |