(2.) That they should be maintained in sanitary repair, under strict regulations.

"By this scheme, and by persevering with the measures in force, a great improvement would in a few years take place in the ventilation of the houses in the crowded quarters; and we are confident that there would be a commensurate and material improvement in the health of those living in them."

But there is another question connected with displacement of the population which seriously affects the poorer classes in almost all our large towns. Many extensive undertakings, such as the construction of railways and new streets, while they act beneficially in making wide clearances in the crowded districts, only tend to increase the overcrowding in neighbouring parts. The families that are thus rendered homeless by the demolition of their dwellings seek the nearest shelter, rents are raised in consequence of the increased demand for accommodation, and such as cannot afford to expend more than they did previously must be contented with homes even less healthy than those which they have been compelled to leave. As a compensating measure, the running of working men's trains morning and evening, between the suburbs and the town stations, although it is a step in the right direction, does not by any means meet the difficulty. Larger measures are undoubtedly required, and the more thoughtful amongst sanitary reformers are agreed in maintaining that no parliamentary powers, permitting the demolition of numerous dwellings in populous districts, should be granted unless the companies or corporations applying for these powers provide commensurate and improved accommodation elsewhere, and within reasonable distances. It is true

that many of the displaced population might not choose. to remove to the new dwellings, but they should have the option. Tenants, at all events, would not be wanting, and that there would be no financial loss is clearly proved by the profits gained by private enterprise in building homes for the working-classes, although it must be admitted that numbers of such houses, as they are run up in the present day, can scarcely be pronounced habitable. Urban sanitary authorities have, however, full powers vested in them by the statutes to prevent the erection of dwellings that are unwholesome, and it is their duty to see that the accommodation and structural arrangements are in all cases satisfactory.

Concerning the duties of the medical officer of health with regard to overcrowding and places unfit for habitation, together with the sanitary enactments dealing with the same, see Chapter XIV. and Appendix I.

CHAPTER IX.

HOSPITALS.

IN large towns the position of every hospital must primarily depend on the distribution of the population, or part of the population, whose wants it is intended to relieve, and hence the choice with regard to site is often very limited. Apart, however, from this restriction, there are certain considerations which ought always to influence the selection of site. For example, the future hospital should be erected in as airy and open a space as can be obtained, preference being given either to the outskirts of towns or to their largest interior unoccupied spaces. According to the recommendations of the Chirurgical Society of Paris in 1864, a free area of not less than 540 superficial feet should be allowed for each patient. This would give an acre of ground for a hospital containing 80 beds. In this country, on the other hand, an acre for 100 patients has been held to be sufficient. Any defect in salubrity of site must be compensated by increased floor and cubic space.

No doubt, the most healthy site for a hospital is in the open country, with a dry and porous soil, and slightly raised above the plain to facilitate drainage. While shelter from the cold north-easterly winds is desirable, it is an error to build hospitals on the face of a steep slope, or in any situation where there is an impediment to a free circulation of the air. Clayey soil and un

drained marshy ground should be avoided, nor should houses or clumps of trees be in close proximity to the building.

For hospitals situated in the crowded localities of large towns, convalescent homes in the country, or at the sea-side, are now being provided, and with marked advantage to the patients.

The late discussions on hospitalism, though perhaps somewhat one-sided in giving such prominence to the test of surgical results, have fully established the great hygienic advantages which small cottage hospitals possess over the large palatial buildings that have hitherto found favour with the profession. It is further generally admitted that, when large hospitals are rendered necessary, they should approximate as much as possible to the sanitary conditions which can only be ensured by small detached buildings. The application of this principle has resulted in the construction of hospitals on the pavilion system-a system which accommodates itself to almost any site and to any number of patients.

SECTION I.-PAVILION HOSPITALS.

In this description of hospital, each pavilion may be regarded as a separate hospital, and the impurities of every single ward are cut off from the other wards. The pavilions are united by a corridor for administrative purposes and for convenience, but are so arranged that a free circulation of air can always take place between them. In its simplest form a pavilion would consist of a single ward, with the necessary additions for administration. More frequently, however, it consists of two wards, one above the other, and, in some instances, of

three wards, as in the Marine Hospital at Woolwich. Three-storeyed pavilions are objectionable, because their height necessitates a lofty corridor to unite them, and induces stagnation of the air. With two-storeyed pavilions, on the other hand, the corridor need only be

Fig. S.-GENERAL PLAN OF HERBERT HOSPITAL, WOOLWICH.
(From "Construction of Hospitals," by Douglas Galton.)

half the height of the pavilions. In large hospitals, such as the Herbert Hospital, the pavilions may be united in twos, end to end, with the corridor running between them, the staircase being, as it were, strung

Fig. 9. Sketch of the end of the southern Pavilions of Herbert Hospital,
showing the elevation of the corridor. (After GALTON.)

on to the corridor. The distance between the pavilions should be at least twice their height.