CHAPTER XXXIII.

THE PRINCIPLES OF CONSTRUCTION OF ISOLATION HOSPITALS.

(408) Infectious Hospitals.

A LARGE amount of experience, both as regards the construction and administration of infectious hospitals, has been acquired during the last thirty years, and the results of this experience are easily accessible, thanks to the reports of Dr. Bristowe and Mr. Holmes in 1863, to the inquiry of Dr. Thorne Thorne in 1881, and to the work of the Asylums Board.

In this chapter the chief material used is Dr. Thorne Thorne's very able summary :

The first principle to be laid down is the absolute necessity of buildings set apart for small-pox, scarlet and other infectious fevers. A sanitary authority, not providing facilities for isolation, has failed to fulfil one of the great purposes for which it was instituted.

The second principle is that the construction of such hospitals, is best carried out with deliberation in non-epidemic times, experience having demonstrated that those which have been hastily run up to meet sudden emergency, have provided accommodation. of a most indifferent kind, have failed to meet the permanent wants of a district, and the cost has been in relation to usefulness large.

The third principle is that small-pox hospitals should be at least a mile from inhabited dwellings.

(409) Site.

It is seldom that there is a free untrammelled choice of site, but the considerations most weighty are (1) moderate elevation; (2)

ample and pure water supply; (3) facilities for drainage; and (4) a dry healthy soil. The authorities generally also agree that it is desirable the opposite side windows of the ward pavilions should face respectively east by south and west by north.

(410) Hospital Construction.

Hospitals for infectious diseases are composed of (1) an administrative block; (2) wards; (3) outbuildings, such as wash-house, disinfecting chamber, mortuary.

(1) Administrative Block.—This should always be constructed in excess of the requirements of the permanent wall buildings—it is by far the most important block. It would indeed be practical in rural districts to rely wholly upon a good permanent administrative block and four small permanent wards, extending the accommodation as required by means of tents or huts. The general construction of the administrative block should of course follow the rules and regulations governing the erection of modern dwelling houses generally; it is, however, more important than even in the above to shut out the ground air by means of concrete or asphalt. Most of the administrative blocks have consisted of only one story, but considering that nurses have to take some part of their rest in the day, it is preferable to have two stories; sleeping rooms on the first floor being more quiet. The smallest administrative blocks contain the following:-kitchen; scullery; pantry, or larder; medical officer's room and dispensary combined; bedrooms; one or more water-closets. The larger administrative blocks contain provision for the accommodation of a resident medical officer, a mess room for the nurses and staff, bathrooms, &c. The administrative blocks should be some little distance from the ward buildings, communicating with them by means of a covered way-this covered way is best open at the sides.

(411) The Wards.

The permanent wards should be constructed of brick or stone; at Weymouth concrete has been used advantageously. Corrugated iron hospitals lined with matchwood and wooden huts have all been failures as regards temperature and comfort.

"At Nottingham, where the two layers of wood forming the walls are six inches apart, the interspace being filled with sawdust,

it was on one occasion found impossible even when large fires were maintained night and day to raise the temperature near some of the beds beyond 32° F. In the Alcester rural district, where there is a very similar building, the temperature was found in the winter of 1880-81, and under the same conditions, to fall to 38° F."

If attempts be made to remedy these inherent defects then the initial cost is brought up to that of stone or brick buildings, while the maintenance is greater and the durability less.

The wards usually consist of a single story, but there may be reasons, such as limited area of site, to prefer two stories rather than encroach upon the airing ground.

There must be ample space for the whole of the wards and buildings, the number of patients per acre should not be more than twenty. The floor space per patient should be 144 square feet as a minimum, the cubic space at least 2,000 cubic feet, the window surface should be in the proportion of 1 square foot to about every 70 cubic feet. Excessive window surface is to be avoided.

Dr. Angus Smith, F.R.S., made some careful experiments as to the ventilation of the Children's Hospital at Pendlebury, which has window surface in the proportion of 1 square foot for every 35 cubic feet, but it was found that owing to this extent of window surface the ward air could not be kept pure and at the same time equably warm.

If according to these principles a ward for four patients be designed, the floor might be 24 feet square, and 14 high, which will give 2,000 cubic feet per bed and 144 square feet of floor space per bed, the windows 4 in number may be 3 x 5 feet, giving 1 square foot to every 88 cubic feet. The windows should serve the purpose of both lighting and ventilation, hence the double hung sliding sash window is the best type. The position of the windows should be opposite each other, one being in the centre of each side wall, the others near the angles beyond each end bed. The walls should be lined with Parian cement or glazed bricks, so that they can be readily washed and disinfected. All architraves, cornices and ledges where dust could collect must be avoided.

(412) Ventilation.

However efficient windows of the class mentioned may be as ventilators, in all cases Tobin's tubes should also be placed at the

angles of the walls; and experience has shown that in order to change quickly and completely the air of the wards at least twice daily, openings must be made at the floor level-these openings should be capable of being closed by a sliding door-two will be enough on opposite sides, but they should be of considerable length, 4 feet by 6 inches.

The superior results of mechanical ventilation in the case of schools has been referred to at page 85, and the same remarks apply to hospitals.

(413) Warming.

A small ward like the one suggested may be warmed by an open fire-place-Green's grate is a good one for the purpose, the grate may be at either end. A larger ward would probably have to be heated by pipes or by centrally placed stoves.

(414) Closets.

A closet should be placed at the end of the ward, a small lobby having cross ventilation being interposed. If a water-closet be used it should be provided with an automatic disinfecting apparatus discharging either 90 per cent. phenol into the pan, or a 2 per cent. solution of corrosive sublimate.' It would be still better if the dry system were adopted for the excreta, using sawdust which has been saturated with petroleum and burning it in a special crematory furnace.

(415) Sinks-Drainage.

The ward must have a sink to throw slops down, and this necessitates a drain. No evil is recorded to have resulted from connecting fever hospitals with the public sewer system, but if there are no sewers available the ward and other buildings can drain into impervious cesspits of proper construction, the drainage of course being trapped, and provided with ventilating shaft and disconnecting chamber. In some places where the local conditions are favourable sub-soil irrigation has been successfully employed.

1 Dissolved by the aid of ammonium chloride.

(416) Furniture.

The four bedsteads must be of iron, and have wire-coil or wirespring mattresses-so as to form a bedstead and mattress in one, and then horse-hair beds placed upon them; the latter easily admit of disinfection in a hot-air apparatus, and the wire-coil mattresses can be washed and cleaned in situ. There may be a few rugs on the floor, or pieces of carpet, for these are easily cleaned and freed from infection.

A laundry is an essential part of the hospital, and should form an annex to the administrative block.

(417) Disposal of the Dead.

The bodies of patients dying of small-pox as well as those dying of typhus, it is certain are highly infectious; but there is not an equal amount of evidence as to infection from scarlet fever; nevertheless it is safest to treat the corpse in all cases as likely to be injurious to the living, save in the presence of strong disinfectants. Cotton wool steeped in a 5 per cent. alcoholic solution of corrosive sublimate should be packed carefully into the mouth, the nostrils, ears, and other apertures of the body, the whole surface of the body should then be sponged with a saturated aqueous solution of the same salt, and finally packed in sawdust mixed with sanitas powder. In this way a fairly perfect disinfectant combined with concealment of foul odours is attained.

The mortuary proper, that is the space within which the bodies themselves are placed, should be well ventilated. For this purpose there should be oblong openings close to the floor covered with wire gauze, and swing windows also protected by gauze to prevent the entrance of flies, and by blinds to shade off direct sunlight.

(418) The Local Government Board Hospital Plans.

Plans have been issued by the medical department of the Local Government Board,1 as a guide to local authorities in the construction of hospitals. The first plan is that of the smallest hospital, simply consisting of a cottage-like building to hold two patients 1 Seventeenth Annual Report (Supplement), p. 199.