Volltext Seite (XML)
■upon those who arc actually inmates, but in their daily visits see and prescribe for large numbers of the sick who can come to the hospital for advice and for medicines. Lastly, so good an opportunity of studying disease is not to be neglected. Where some hundreds of sick are always col lected, there the students of sickness and how to cure it ought to be, and in fact are found. We have now the elements for understanding something of what the planner of a hospital has to provide for, and are prepared to classify the requirements into four groups, a division which will be a convenient one, and one that applies alike to the working and the buildings of the institution. We have them— First. The inmates, or in-patients, i.e., the sick who reside and are treated in the house. The rooms they live in are technically termed wards. Secondly. Wc have the administration. This embraces medical officers, dressers, sisters, nurses, attendants, and the parts of the building appropriated^ their use, and to cook ing, stores, business offices, &e. Thirdly. Out patients. Those who come to the hospital periodically for advice and medicine, and the portions of the building where they are received, seen, and supplied. Fourthly. The Medical School, i.e., students and professors, and their lecture rooms, library, museum, dissecting room, &c., &c. The medical school and the out-patients ’ department may one or other of them require in rare cases little provision; but through out I must be considered as treating of a hospital as it usually occurs. I shall have nothing to say here of hospitals for peculiar diseases, or children’s hospitals, or lunatic asylums, or convalescent hospitals, but shall confine myself to a general hospital for in and out patients, and having a medical school. The most important part of a hospital consists of the wards, the apartments where those patients who reside under the roof of the hospital are lodged. Virtually it may almost be assumed that all the patients are in beds while in the wards. This is not strictly the case, but still hospitals are so anxious to devote their resources to those who need them most, that by far, by very far, the larger number of in-patients are such as are too ill to be out of bed. Each patient has a separate bed, and as the same attendant can usually supply the wants of a good many sick if they are in one room, it Becomes an economy of attendance to place several beds in a ward. Practically it is found best to place from twenty to thirty beds in a ward; reserving, however, a few small wards where only two or three beds are receivable for special cases. The most important provision for the sick man which the architect can make in a hospital is a supply of plenty of fresh air. This is the one consideration to which all others ought to give way. The patient ought to have plenty of air in his ward, and that air ought to be constantly renewed. This, according to all authorities, will promote his recovery more than any one other thing you can supply; and, moreover, will prevent his injuring his fellow sufferers, or their injuring him. For there are, as you know, many diseases directly communicable by the atmosphere, and some of these have to be received into the wards of a general hospital, and others which, perhaps, would not be received if they existed or were traceable when patients apply, will break out when the patient is in the ward, and then must be dealt with as best they can. More than this, many surgical cases and diseases, if not all, cause the patient to taint and vitiate the air of the room where he is, more or less, and if a number of persons already in low health are brought together into an atmosphere where taint is allowed to remain, they will all suffer; their diseases will not leave them, and new ones will be added to what they already suffer from. The best authorities consider that each bed should have from 1,500 to 2,000 cubic feet of air space, and that the change of air, while, of course, not sufficiently rapid to create a draft or a breeze, should yet be sufficient to be felt as an air passing over the face and hands. There are more precautions to be observed still against vitiated air. The sick must not be so placed that the air to reach any bed must necessarily pass over any other, they must not only not be too many in one room, but there must not be too many wards under one roof, or too many stories of sick one above another, or too ready access from one ward to another, or else danger of harm will arise. Next to air, light and cheerfulness are conducive to health; and, in addition to these, the easy supervision of the beds, and easy access to each one, and to either side of the bed, and a clear passage way up and down each ward must be provided for. All these requirements are practically best met by wards that arc long in proportion to their width, arranged so that one of the long sides shall have an aspect exactly or nearly south, with a row of beds at each side, placed with their heads to the wall, and a row of windows on each side. A width of over 20 feet, and under 30, averaging 25 feet, is the most useful; over 30 feet the ventilation becomes sluggish. Beds ought to be about 8 feet apart from centre to centre, and the height of the ward ought to be at least 15 feet. No bed should come in front of a window. A window to each two beds is the usual allowance, and the windows ought to go as nearly as possible to the ceiling, and to come down low enough for patients in bed to be able to look out of them. The importance of fresh air is equally recognized by all authorities on hospitals ; the ' best way of supi ’ matter upon which English and continental autl The best known and most followed English authorities agree that the only reliable apparatus for ventilation is having win dows facing each other on the two sides of each ward, and keeping them almost constantly open. This is termed natural ventilation. For this purpose hospital windows may be sash windows in several heights ; often, however, they have in their height several casements, each hung at the bottom edge, and capable of opening back at the top, so that the incoming air shall be thrown upwards. These casements ought to be capa ble of being regulated with great nicety, and made to remain at whatever angle they are set. They should be glazed with thick plate glass to diminish the loss of heat that occurs at all window openings ; or, better still, double glass, with perforated zinc taking the place of some of the panes of glass. The walls of wards should be very thick and of solid material to retain heat. I would here caution against supposing, as I believe many do, that there is a magic in a long ward, with windows on each side of it, which will do good to all patients of every sort. There is in this apparatus the means of killing patients as well as curing them ; and I, for one, am far from believing that this is the only method which ought, in a climate like ours, to be adopted for changing the air of a ward. I have the authority of a physician, who has paid much atten tion to the subject, for saying that window ventilation, especially where not tempered by wire-gauze or perforated zinc, is often the cause of fatal or dangerous relapses. Patients suffering from kidney disease, bronchitis, or rheumatic fever, are certain to relapse if they get a chill—and from these open windows a chill is often contracted. A different and more tempered de gree of ventilation is therefore wanted where there are such pa tients. A greater degree of it is required where there are many surgical cases. Great care should, therefore, be taken that the window openings are judiciously placed and well screened; and 1 believe thoroughly that an appliance for keeping up a supply of fresh air, warmed and moistened, and for drawing off foul air, ought to form part of a hospital ward, and ought to be equal to keeping the wards thoroughly aired in frosty or stormy weather, at night, or at any other time, when windows cannot be safely open. This is something like heresy, but I believe it to be the truth, and I have good authority in the preparations now being made for supplying some such appa ratus at new St. Thomas’s Hospital. Indeed, hospital ventila tion may be said to be a subject still open to improvement and study, and not yet perhaps brought to the full perfection claimed by some for its most modern development. In the warming and artificial auxiliary ventilation of St. Thomas’s, Messrs. Haden were consulted, and the plans indi cate that in each ward there will be three open fire-places on the centre of the floor, with a vertical tubular flue from each passing up to the ceiling, having an outer air-tube round. This will serve to carry off some considerable part of the vitiated air beyond what goes up the flue with the smoke, which, in all open fire-places, is always a large amount; but, not content with this, the architect, Mr. Currey, has supplied four foul air extraction flues, which meet in the roofs, and near the outlet of jmg it is a horities differ.