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CHAPTER XXIV.

ACCOMMODATION FOR THE SICK.

Departments of Hospital Establishments.-Conveyances for the Sick-Ambulances.-Two kinds of Ambulance necessary.-Disinfection of Ambulances.-Hospitals. Reception of Sick.-Hospital Wards.— Size and Accommodation in Wards.-Warming, Ventilating, Lighting, and Decoration of Wards.-Ward Offices.-Pavilion Hospitals.-Cottage Hospitals. — Epidemic Hospitals.-Intercepting Hospitals.—Floating Hospitals.-Lying-in Hospitals.-Refuges for Persons exposed to Infection.—Quarantine and Sanitary Inspection of Shipping.

THE duty of providing accommodation for the sick is vested in the sanitary authorities of the district.

Hospital establishments must be considered to consist of three principal departments

1st. That for bringing the patient to and admitting him into the hospital.

2nd. That for his proper accommodation in the hospital during the treatment of his disease.

3rd. That for his accommodation after treatment and during convalescence.

Conveyances for the Sick.-The conveyance of the sick to hospital is one of the most important duties which a sanitary authority has to perform. Every sanitary district should be provided with a sufficient number of properly constructed ambulances for the conveyance of the sick; these should be placed in easily accessible positions, and should be quickly available at all hours, otherwise the public will at once lose confidence in their management, and make use of other vehicles for the removal of the sick. Every facility and encouragement should be given for the use of these ambulances. No charge should be made, and the most scrupulous care should be exercised by the persons in charge of them. It would be out of place to

describe minutely a particular form of conveyance, but one thing must be positively stated, that none of the ordinary private or public vehicles are suitably constructed for the purpose, and few of them can even be modified so as to make comfortable or efficient ambulances. Nothing is to be more deprecated than the system so commonly pursued at present of using (either modified or unmodified) old worn out cabs or carriages. The conditions necessary for an ambulance are, that the patient can be conveyed from his own bed to the ambulance in a recumbent position, and without change of position-in other words, the couch of the ambulance should be capable of being brought to the patient's bedside, then replaced in the ambulance, and on arrival at the hospital carried at once to the hospital bedside. The patient should be easily accessible when in the ambulance, and the vehicle should be lightly and efficiently springed, so as to avoid any shaking.

Every sanitary authority should maintain two sets of ambulances, one for persons suffering from contagious diseases, the other for ordinary cases. The ambulance used for contagious diseases should be disinfected after each time it is used, so that it may not be a means of spreading diseases.

HOSPITALS.

Hospitals are of various kinds, according to the various conditions to be fulfilled, but the general principles of construction may be the same for all. The main points to be carried out in an hospital are to combine, as far as possible, the conditions of economy of administration with sufficient provision for attendance, cleanliness, ventilation, water supply, and medical attendance. The site of a hospital must depend, to a great extent, upon the locality for which the institution is intended. It should be built as far as possible from other dwellings, on a pervious soil, sufficiently high to afford proper drainage, and plenty of sunshine, and a plenti

ful and pure water supply. It is generally considered that a hospital of 80 or 100 beds should stand on at least one acre of ground, but this should not satisfy the managers if a larger space can be obtained.

a special receptionIf the case be a bad bed in this reception

Reception of Patient.-There should be room for the patients in every hospital. one, the patient should be placed in his room. The patient's own clothes should be taken off in the reception-room, and be disinfected if necessary, and conveyed to a proper store. The patient's own clothes should never be permitted to be taken into the wards. The patient should be washed and made tidy if possible in this reception-room, which should be provided with a bath and other means for cleansing dirty patients.

Hospital Wards.-The unit of a hospital is the ward, and having determined the arrangements necessary for a single ward, the question of their combination into a hospital is a simple one. The maximal number of patients to be accommodated in a ward is chiefly determined by the number which can be efficiently supervised by one head-nurse, as it is impossible that one nurse can supervise patients in different wards at the same time. The number of cases capable of being supervised by one head-nurse is from 25 to 30, according to the nature of the cases.1 A ward should, therefore, be constructed for the accommodation of not more than 30 beds. The size of the ward must be regulated by the superficial and cubic space required for each patient. The width of the ward should be from 25 to 30 feet, its height from 12 to 14 feet, its length to be determined by the number of patients to be accommodated. Each bed should have a space of 7 feet along the wall, and

there should be

There should be

10 feet between the opposite rows of beds. at least 90 superficial and 1,000 cubic feet of space for each bed in ordinary wards, and this space should be doubled for the

1 Nightingale's Notes on Hospitals and Nursing.

treatment of contagious diseases, operation, or lying-in cases. In other wards for diseases belonging to the zymotic or erysipelatous groups, the wards should either be double the size (which would be inconvenient), or but half the number of patients should be placed in the ward. A hospital ward should have windows upon both sides, and if possible at one end there should be a window for each bed and placed between them; it should open top and bottom; the top should reach nearly to the ceiling, and the bottom within two feet of the floor, so that the patients will be able to look out; it should be glazed with thick plate glass, so as to avoid sudden changes of temperature, and prevent loss of heat; there should be one square foot of window surface for each fifty feet of cubic space. The walls and ceiling of the ward should be covered with impervious cement or glazed tiles, and if these are not obtainable they should be painted and varnished so as to be capable of being easily washed. The floors and woodwork should be of wood, as impervious as possible, and polished the floor with wax-capable of being cleaned by rubbing with a damp cloth. Polished pine will be found best for doors, windows, and door casements, and oak or parqueterie work for the floor.

Warming. This is best accomplished by open grates, their advantage consisting in cheerfulness and better means of ventilation. Hospital wards should be as far as possible kept at a constant temperature, registering thermometers to be placed in each ward under lock and key, for the information of the superintendent. Hot-water pipes or stoves are sometimes employed for warming hospitals, but are inferior to properly distributed open fireplaces. In large hospitals, however, stoves or hot-water pipes may be used with great advantage in warming halls, passages, etc.

Ventilation.-Two systems of ventilation are spoken of— namely, natural ventilation by windows, doors, and chimneys, and artificial ventilation by ventilating shafts, fire places, or gas lights. Each is good in its own place, and should be

combined, as in this climate ventilation by open windows is frequently unbearable. Each patient should have 3,000 cubic feet of fresh air per hour. If ventilating shafts are used, there should be an opening of one square inch for each 50 cubic feet of ward space in upper floors, 1 for 55 in the next or middle floor, and 1 for 60 in lower floors, for exit of impure air. For the admission of air there should be one square inch for every 100 cubic feet of ward space.1

Lighting. There should be plenty of daylight; this will be provided if the windows are distributed as recommended above. At night the wards may be lighted by gas, lamps, or candles, according to circumstances.

Where gas or lamps are used, great care should be taken to carry off the products of combustion. There are many forms of gas fittings by which all products of combustion are conveyed out of the room, and these fittings have the great advantage of assisting ventilation.

Decoration.-Although ornamentation of wards is not a necessity, yet it is a great advantage; it should not be accomplished by ornamental plaster or woodwork, which only impedes ventilation and collects dirt, but by means of plants, flowers, and pictures. Such ornaments add much to the cheerfulness of the wards, thereby promoting the recovery of the patients.2

Ward Offices.-Each ward should have attached to it nurses' rooms, a water-closet, bath-room, and scullery, together with proper drainage for slops, etc. Each ward should have a constant and unlimited supply of hot and cold water by day and night.

Pavilion Hospitals.-If the above form of ward be adopted, the hospital must be constructed on the pavilion principle, which is, that each ward, or block of wards, is completely isolated from the rest of the hospital, and connected therewith only by corridors, which, in our opinion, should be

1 Galton On Hospital Construction.

2 Acland On Hospital Decoration.