outcome of the fatal typhus epidemic which committed such ravages at the close of the eighteenth century, and the first was opened at Chester. Liverpool, Manchester, Norwich, Hull, Dublin, London, and other towns soon followed; and at the same time the necessity of establishing fever wards in the old hospitals was acknowledged, and in a great many cases acted upon. There are yet, however, numerous institutions with no means of isolating infectious cases. It is scarcely two years ago when smallpox broke out in a provincial infirmary; the authorities turned out all those who were able to leave, with the effect of introducing the disease into the neighbouring villages!! Hospital Construction generally.-We have learned much in hospital construction since the "Report of the Commission on the Sanitary State of the Army in 1857," which embodied the general principles of improved hospital construction. The theory of erection of a good sanitary building is perfect, but the practice in carrying out the details leaves yet much to be desired. The brain can often conceive what the hand has not the skill to accomplish. As they are charitable institutions, suggested, built, and endowed by charity, the first axiom is, economy of construction. All unnecessary embellishments, architectural adornments, corridors, passages, rooms, are to be avoided. A hospital should contain nothing more than wards for sick, and rooms for attendants and ward requirements. The foundation of a hospital plan is the ward, all else is merely subsidiary. And this subsidiary accommodation should be no longer in superficial area than is absolutely wanted; more than this is unnecessary expenditure, and adds an element of mischief to the building. The separation of fever from general cases would appear one of those first principles of an obvious character that are at once accepted by the human mind; yet even to the present time there are many who oppose the plan, the chief objection in their opinion being that the poison of the fever being more concentrated, there is a greater mortality among the patients themselves, and the nurses and attendants are likely to catch the disease. The first of these objections is purely theoretical, and is disproved by facts; for instance, Murchison shows that one person took typhus (in 1862) for every five typhus patients admitted into the general hospitals, but only one for every sixty-seven admitted into the London Feversible in practice to keep the buildings required Hospital; and that one person died out of every fourteen admitted into the former, but only one for every 326 admitted into the latter. In large towns it is seldom difficult to obtain a staff of nurses whose age is such that it does not predispose them to fever, or who have previously had an attack. Statistics show that persons of forty years of age are not very liable to typhoid, while persons under thirty pass through typhus better than those over that age. It is therefore well in a typhoid ward to employ elderly or middle-aged people, in a typhus, younger persons. Typhoid is, however, treated daily in general hospitals without evidence of injury, the principal contagion residing in the dejecta. The exhalations from the breath and skin do not appear to travel far or have great virulence, and the dejecta can be easily disinfected. Cases of fever should, however, never be mixed up with the other patients, but have separate wards. Typhus in a general hospital is one of the most dangerous diseases, and is so likely to spread, that it should never, where possible, be admitted. It is not easy to prevent the importation of one or two cases in epidemics, as the diagnosis, until the fever is developed, is not always easy; still reasonable care can always be exerted. For obvious reasons, the out-patients' department should have no connection with the hospital so called. The same remark applies to kitchens, stores, boiler-rooms, cellars, dustbins, and the like, also to physicians' and surgeons' rooms, and dispensary. It is quite pos for patients and their attendants just as much by themselves as if they were miles away from the subsidiary accommodation, and yet to place the whole of this latter in perfectly convenient localities. It is a grave error and no saving of cost to place them altogether within the hospital. The whole structure is complicated by this arrangement, and the sanitary condition of the building is endangered. Small country hospitals may to some extent form an exception to this rule, but even in them there should be no communicating atmosphere between the wards and the subsidiary accommodation.-("Principles of Hospital Construction," by SUTHERLAND and GALTON, Lancet, 1874.) One of the first things is to ensure a healthy site. There may be some difficulty in towns to obtain an unexceptionable one, since hospitals are most useful in an unhealthy, overcrowded locality; but this, of all sites, is the worst, and instead of putting the hospital in such a population centre, it is best to establish it where there is most facility of communication. The soil should be, if possible, a selfdraining, gravelly soil; but if a damp, clayey, impermeable soil must be built upon, then it should be prepared thoroughly by draining. A gentle elevation, cæteris paribus, is best, but no hospital or habitation of any kind should be built with the ground rising directly in front or behind. This obstructs ventilation, and the high ground drains directly into the low. The surroundings of a hospital are of the first importance. If narrow courts, filthy alleys and passages, cluster on all sides, every wind must bring deteriorated air. If there are smoky manufactories, or other insanitary conditions, in the vicinity, the patients must suffer. of patients, so much the better. The French hospitals in this respect have a manifest advantage over ours. For instance, the St. Antoine, St. Louis, and the Necker are surrounded by large and beautifully laid-out gardens, a pleasant resort for convalescents. "The requirements as to site are thus dryness, healthiness of surroundings, and facility of external movement of the atmosphere."(Op. cit.) The next consideration is the form of the building. The time when large hospitals Where possible, an open space in the were constructed of one huge block or great suburbs of a town should be selected. If rambling continuous building, like the Hôtel sufficient ground can be had for the exercise, Dieu of Paris, is probably for ever at an end. TERRACE WARD Fig. 38. WARD WARD The grand principle that appears to be definitely settled is isolated blocks, so arranged that the atmosphere of each block is also isolated. This is the true pavilion principle, and is effected in perfection in the Herbert Hospital; but certainly not in the new St. Thomas's, where there is a nominal, not a real isolation. In order to carry the principle out, it necessary that there should be two distinct divisions in the plan, one entirely for the sick, the other for administrative purposes. "This latter division might be so designed as to contain the dispensary and the out-patient department; but it would be far better, where funds admit of it, to separate the out-patient department entirely from the hospital and its administration. The design should, of course, provide for easy means of communication between the different blocks, but this can be, and ought to be, effected (as in the Herbert Hospital, figs. 38 and 39) in such a manner that the air-isolation of the different blocks shall be complete. The hospital proper in its turn should be divided into the required number of blocks, so that not more than a certain number of sick are placed under one roof; and these blocks or pavilions should be connected with each other in such a way that each pavilion should be as isolated from its neighbour as if it stood by itself. The hospital should, in The general axis of hospitals should run north and south, or, at all events, the axis of the wards; thus each side obtains the influence of the sun, which aids ventilation and prevents damp. The next thing to be considered is the ward, the hospital unit. It should be of sufficient size to give 2000 cubic feet of air to each bed, which, with good ventilation, ought to keep the air sweet. The ward is best made long and narrow (narrow, i.e., in proportion to its length), with opposite windows, to admit of cross-ventilation (fig. 40). The height should be about 14 feet; the wall-space, per bed, 7 feet 4 inches; the width of the ward certainly not less than 24 feet. The length must depend upon the number of beds. The great and essential point is the superficial space per bed. This at the Lariboisière is 104 square feet, at the Vincennes it is 90 square feet, at the Herbert 96 square feet; so that it may be put down that it varies in the best-constructed hospitals from 90 to a 100 square feet. In this respect we have not only to consider the amount for sanitary requirements, but also in the London schools a number of students are taught around each bed, and therefore such hospitals require additional area. The following is a sketch of a ward, or rather double pavilion, each half of which represents a ward unit; it embodies the following principles (fig. 40): "The number of beds is divisible by four, by which the whole wall-space is utilised. Wherever it is not intended to introduce fireplaces in the outer walls, the same numerical relations should be observed; but of course such a proportion in the bed-spaces necessitates the introduction of artificial warming and ventilating arrangements; or, as in the case of the Herbert Hospital, the use of firegrates, of which there are two placed in the centre line of each ward. The wards have windows along opposite sides, with a bed in each corner, and two beds between every two windows along the wall. Each ward has likewise an end window to the open air, and it will be seen that the beds are protected by projections from direct currents entering by these end windows, which currents are thrown down the centre space between the beds. "The water-closets, ward sinks, baths, lavatory basins, and urinals are placed in two projections at the outer or free ends of the wards, having special ventilating arrangements for assuring that, from whatever direction the wind blows, no effluvia can enter the wards (fig. 41). "For each ward is provided a small nurses' room, with an inspection - window into the wards shown in fig. 40 the two wards are lighted and ventilated by several large lofty effectually cut off from each other by a 12feet-wide corridor and a central hall carried up to the roof of the building, where it is windows. But the wards admit of other methods of arrangement. They may be placed singly or alternately, or in line. hospitals are at the rate of one to each bed. Perhaps this is more than enough. As no window fits tight, they even, when closed, are natural ventilators. Too much glass is objectionable. In winter, it cools the air; in summer, a room with many windows may become like a conservatory in temperature. Plateglass is the best material, and the window should swing open top and bottom. The walls are recommended to be coated with as dense and as impervious a cement as can be obtained. One of this kind, capable of being polished, has been tried in the Herbert Hospital. It admits of being washed with soap and water. The floor is best constructed of oak, with close joints, polished with bees-wax. Such a floor is, however, very slippery, and weak patients may have many a fall. The best position for water-closets is a separate square block at the end corners, with a passage and lobby leading to them, both having cross-ventilation by opposite windows. All the pipes from the drains should be trapped, and where necessary fitted with charcoal deodorisers. Single wards are undoubtedly best. When |