the district the use of the hospital for deserving cases under his care. The model cottage hospital should not have more than six beds, and must be under the management of one medical man as director, the other medical men in the district holding office as honorary medical officers. The annual cost of the establishment is defrayed chiefly by voluntary contributions, and partly by the weekly payments of the patients. These weekly payments, as already stated, are regulated by the means of the patient, and vary from 2s. 6d., when the Union has to help, to 5s. or 8s., when the patient has been earning fair wages, or belongs to a club. All fees allowed by the Union for accidents or operations are paid to the Union medical officer, in the same way as if he had attended the patient at his own home. Every subscriber, no matter what the amount of his subscription, should have equal privileges in recommending cases, and will generally be able to state what amount the patient whom he recommends can afford to contribute weekly. Cases of accident and emergency are admitted without order, but otherwise a recommendation from a subscriber must be procured, and this should in all instances be accompanied by a certificate from one of the medical staff, to the effect that the case is one deserving and fit for admission. Only those are admitted who cannot be efficiently treated at their own homes, while cases of infectious or incurable disease are excluded.

Experience has proved that in rural districts a cottage hospital of six beds will suffice for a population of 6000. The initial outlay will of course depend on whether a cottage which has already been built can be procured, and if so, what alterations will be necessary

to convert it into a hospital. If the hospital has to be built, the amount required may be estimated at £500, or about £90 per bed. In converting a cottage, which has already been occupied, into a hospital, the walls should be thoroughly cleaned, scraped, and afterwards replastered and washed with caustic lime. Attention must also be paid to the sanitary surroundings of the building.

The cost of furnishing a cottage hospital for six beds will amount to about £100, and the necessary surgical instruments to about £50. The maintenance per patient weekly costs from 8s. to 10s., so that the hospital, when once started and properly furnished, will require for its support an annual income of at least £120, about £25 or £30 of which will be subscribed by patients.

Although the architectural arrangements may admit of many variations, the plan best suited for a cottage hospital of six beds should provide for a nurse's room, a three-bedded male ward, a two-bedded female ward, a single-bedded ward, which can be used as an operation-room, a kitchen, which may also be used as a dayward, a scullery, and a small mortuary. All the rooms should, if possible, be on the ground-floor, so that good roof ventilation and ample cubic space may be secured. Part of the roof should overhang, so as to form a sort of verandah for the use of patients. It need scarcely be added that a tasteful arrangement of flowers and shrubs in the space immediately surrounding the hospital will add greatly to its cheerfulness.

The nursing, cooking, and cleaning, can generally be efficiently attended to by one woman. As the duties are therefore of a somewhat more arduous nature than those of a nurse in a general hospital, they cannot be

discharged by lady-nurses or sisters. Indeed, it is found that a homely woman from the neighbourhood, trained at the hospital or elsewhere, gets on much better with the patients than the professed trained nurse. She should be able to read and write well, and must be steady, honest, attentive, and cleanly.

If a cesspool is used for the receptacle of excreta, it should be at a safe distance from the building, and constructed as described in the Chapter on Dwellings. Where no water is laid on, the dry-earth system is found to answer very well. (See Handy Book of Cottage Hospitals by Dr. Sweete.)

SECTION III.-HOSPITALS FOR CASES OF

INFECTIOUS DISEASE.

By the 37th section of the Sanitary Act, 1866, power is given to the sanitary authorities of any town or district to provide, for the use of the inhabitants, hospitals or temporary places for the reception of the sick;" and when such provision has been made, any justice may order the removal to the hospital of any person suffering from a dangerous infectious disease who is without proper lodging, or lodged in a room containing more than one family, or is on board ship.

In a Memorandum of the Privy Council printed in the Appendix to the First Report of the Local Government Board, it is recommended, as a condition of the first importance, that the accommodation for isolating cases of infectious disease shall be ready beforehand, and further that it shall be sufficient for the treatment of different infectious diseases separately. The amount of accommodation required will of course vary for

different places. As regards villages, for example, it is recommended that "each village ought to have the means of accommodating instantly, or at a few hours' notice, say four cases of infectious disease, in at least two separate rooms, without requiring their removal to a distance. A decent four-room or six-room cottage, at the disposal of the authority, would answer the purpose. Or permanent arrangement might be made beforehand with trustworthy cottage-holders not having children, to receive and nurse, in case of need, patients requiring such accommodation. Two small adjacent villages (if under the same sanitary authority) might often be regarded as one."

If further accommodation be at any time required, neighbouring cottages should be hired, or tents or huts may be erected on adjacent ground.

For towns of any importance the hospital provision ought to consist of a permanent building containing at least four wards in two separated pairs, each pair to receive patients of both sexes suffering from one contagious disease. The building should be larger than the average necessities of the place require, so that temporary extensions may be wanted less frequently when infectious disease has become epidemic. In case, however, such temporary extensions should be required at any time, the administrative offices ought to be made somewhat in excess of the wants of the permanent wards, and sufficient free space should be reserved around the building.

The minimum floor-space recommended is 144 square feet, and the minimum cubic space 2000 feet. The arrangements for ventilation, heating, removal of excreta, disinfection, and the maintenance of the strictest

cleanliness, ought to be of the most approved description.

Temporary extension of the accommodation may be provided in the summer and autumn by tents, and in the winter and spring by wooden huts. The tents recommended are, the regulation bell-tent of the War Department, 513 cubic feet space, and the regulation hospital marquee of 3000 cubic feet space. The former should not contain more than one patient, nor the latter more than three. The ground on which they are pitched should be kept dry by means of trenches around and between them; the floors should be boarded; the approaches paved or boarded; and the tents themselves should be everywhere distant from each other at least a diameter and a half. All slops and refuse matter should be carefully removed.

With regard to huts, "dryness of site is, as in the case of tents, of the first importance. Each hut should be trenched round. Its floor should be raised a foot or a foot and a half from the earth, so as to permit the free under-passage of air; but care must be taken to prevent the lodgment of moisture or impurities beneath the floor. A distance not less than three times the height of a hut should intervene between any two huts, and each hut should be so placed as not to interfere with free circulation of air round other huts. In huts, as in permanent buildings, for the treatment of infectious diseases, not less than 2000 feet cubic space, with 144 square feet of floor, should be given to each patient, The ventilation of huts, also, is of equal importance with that of permanent hospital buildings. It is best secured by the combination of side-windows with roofopening, the latter protected from rain, and running the