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 4:00 F! BATHS TERRACE WARD Fig. 8. GENERAL PLAN OF HERBERT BOSPITAL, WOOLWICH. 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. WARD WARD The basis or unit of hospital construction is the ward. The conditions which determine the size and form of a ward are the following: 1. The number of patients which it should contain. 2. The floor and cubic space allowed to each patient. 3. The arrangements for warming, light, ventilation, and nursing. 1. The number of patients in a ward will depend on the size of the hospital, and, occasionally, on the nature of the cases. A cottage hospital, for example, will necessarily consist of small wards, and even in large hospitals small wards are required for isolating very severe or special cases. With these exceptions, however, the number of patients in a ward must depend mainly upon the number which can be efficiently nursed at the smallest cost per head. Miss Nightingale, in the Report on Metropolitan Workhouses, fixes this number at 32. She says, a head nurse can efficiently supervise, a night nurse can carefully watch, 32 beds in one ward, whereas, with 32 beds in four wards, it is quite impossible." Throughout European hospitals the number varies from 24 to 32. 2. One of the most important questions attaching to hospital construction is the amount of floor and cubic space which should be allowed to each patient, and there is scarcely any question concerning which there has been so much discrepancy of opinion. Thus, Dr. Todd maintained that 500 cubic feet were sufficient; Dr. Burrows, 1000; the Army Sanitary Commission, 1200; and the Committee appointed to consider the cubic space of Metropolitan Workhouses, 850. The recommendations of this Committee further limited the cubic space allowance for dormitories to a minimum of 300 feet, and for wards containing infirm paupers to a minimum of 500 feet per head. There is no doubt, however, that, in consequence of the conflicting evidence on which the Committee had to base its recommendations, the difficulties of efficiently ventilating small spaces without draught were not sufficiently appreciated, but as reference has already been made with regard to this point, it need not be again discussed. Suffice it to say that General Morin, the greatest French authority on ventilation, to whom the disputed subject was submitted, gave it as his opinion that, even for paupers who are not ill, he considered it "necessary not to descend below 880 cubic feet of space, and besides this the condition must be imposed of renewing the air in the proportion of 1060 cubic feet per individual per hour." That the recommendations of the Committee have failed in securing purity of the air in workhouses, is shown in the reports on night-nursing which appeared in The Lancet in 1871. With regard to the Holborn Workhouse, for example, the report states that "there are upwards of 200 sick paupers here, of whom the great majority are unable to leave their beds. There are 240 deaths in the year, or an average of 5 per week. The wards are low, close almost to offensiveness, and overcrowded; although they may be an improvement on the style of thing which was in vogue twenty years ago, they nevertheless cut a sorry figure when compared with even the worst-built of our general hospitals." And again, with regard to the Marylebone Workhouse :"The amount of cubic space varies from 300 to 1200 feet. In some of the wards the beds absolutely touch, and there is scarcely room to thread one's way between the rows. The atmosphere in these wards is, as may readily be imagined, anything but nice. It is true, the inmates of them are comparatively healthy, but we should think that the arrangements are well calculated to rob them of what health they have." For ordinary hospital cases, it is now generally admitted that a cubic space of at least 1200 feet should be allowed per patient, and for cases of infectious disease, or for severe surgical cases, as much as 4000, and it may be doubted if this be sufficient at all times. On the superficial area per bed will depend the distance between the beds, the facilities for nursing, and the conveniences for ward administration. This, like the cubic space, has been variously estimated. Thus, in St. George's Hospital it is only 69 square feet; in St. Bartholomew's it is 79; in the Herbert Hospital, 99; in the Netley Hospital, 103; in Guy's, 138; and in the new St. Thomas's Hospital, 112. For all nursing purposes, Miss Nightingale maintains that at least 90 square feet should be allowed per bed, and this amount, according to Captain Galton, should be accepted as a minimum. Where medical schools are attached to hospitals, an extra allowance must be allotted for the requirements of clinical teaching. The space must also be greatly increased in fever or lying-in wards. The height of an average-sized ward should be 13 or 14 feet. 3. For providing sufficient light and for maintaining purity of the air, much depends on the width of the ward. Experience has shown that this should not be less than 24 feet, and not more than 30 or 35, In the new Leeds Hospital, it is 27 feet 6 inches; in the new St. Thomas's, 28 feet; and in the Herbert Hospital, 26. P The ventilation of each ward should be entirely independent of the others, and to effect this crossventilation by means of open windows, aided by Sheringham valves, extraction-flues, and ventilating fireplaces, is deemed to be the most efficient. In the summer months, when fires are not required, the windows should always be kept more or less open, except during rough blustering weather. When a window is allowed for each bed, which is sometimes the case, the wall-space between the windows should be six or eight inches wider than the bed. In the pavilion system, however, an allowance of one window for every two beds is generally considered sufficient, the beds being arranged in pairs between the windows, and separated from each other by a distance of at least three feet. The windows should reach from within two feet or two feet six inches from the floor to within one foot from the ceiling. The space between the end wall and the first window on either side of the ward should be four feet six inches, and the space between the adjacent windows, nine feet, the windows themselves being four feet six inches wide. An end window to a long ward adds greatly to its cheerfulness, and aids materially in the ventilation of the ward. The ordinary sash window, made to open at top and bottom, is perhaps preferable to any other kind. To economise heat, plate-glass should be used instead of ordinary glass. In addition to means of ventilation provided by windows, there should be a fresh-air inlet, furnished with a Sheringham valve, placed near the ceiling and between each window. When the fire-places are situated in the external walls, two or three fresh-air |