Although in quite small hospitals the general principles of disconnection and the arrangement of the wards apply just as they do in large ones, yet in some cases there is greater opportunity, and in others there is less ; and, in fact, a small hospital on a very open country site is naturally so well placed with regard to air space that considerable liberties may be taken with impunity. When dealing with infectious diseases, however, it is impossible to be too cautious, and it is now generally held that more successful treatment results in small than in big hospitals, if the utmost advantage is taken of the opportunity to allow fresh air to play round every individual block, and to keep the wards as small as possible.

An example of this is illustrated in Plate III., which shows a little fever hospital erected at Linslade, near Leighton Buzzard, from the designs of Mr. T. H. Bishop, A.R.I.B.A. The general arrangement can be observed upon the block plan, from which it will be seen that there are four small detached houses or blocks with no communication between them other than gravel paths and electric-bell wires, everything having to be carried, between the blocks, absolutely through the open air in all weathers, not even covered ways being provided. There is a nurses' house in the front, replacing the administrative block of a larger hospital ; then behind that, to the north-west, are two infectious diseases blocks, one reserved for diphtheria cases and the other for scarlet fever, and beyond these again, reached by a path which passes directly through from back to front, there is a small laundry and mortuary block.

The nurses' house is planned in rather a special manner. There is a doctor's room in the front, with windows both at back and front so as to secure through ventilation, and this room is separately entered, so that the doctor need not come into contact with the servants. The kitchen is so arranged that the food intended for the patients is carried out through a back door to an open covered passage, and passed from there into a small covered servery, whence it is fetched by the ward nurses, who, during duty hours, do not enter the house, although they live in it when off duty.

There is always one nurse on duty in each ward block, and for her use there is provided a dressing-room and bathroom at the end of the block, to enable her to change her clothes both on entering and leaving.

She enters through the dressing-room entrance, then passes into the bathroom and assumes her nurse's clothes, passing out through the external door of the bathroom to her duty; and the process is reversed when she comes out, except that on that occasion she takes a medicated bath as a matter of course before assuming her ordinary clothes. There is no direct communication between these rooms and the ward, and she thus has to traverse a short distance in the open air on each occasion.

The two blocks are very similarly planned, upon the principles already laid down, except that, as the hospital is small, the wards are narrow and contain only one row of beds, while there is a verandah right along the whole of the south-east front. The roof to this is broken through wherever windows occur, to enable these to be carried up to ceiling level without obstruction to either light or air, and the entrance hall is lighted by a window above the verandah roof, as well as by two windows beneath it on either side of the doorway. All linen after use is thrown out through one of the windows of the disconnection passage between the ward and the sanitary block into a dirty-linen basket, and is taken thence to the disinfector, while the clean linen is brought back to the central hall and stored in the cupboards until needed, just outside the nurse's room. This is placed centrally in each of the blocks, with inspection windows opening into the wards, of which that for scarlet fever patients is made with short transepts in order to economise by reducing the spans, and the opportunity is taken of placing doors there which open directly upon the verandah. An objection to this form of ward might well be raised, in larger hospitals, that there were corners which were not under observation by the nurses, but the space so hidden from the nurse's room is insignificant in a small ward, and the beds at least are always visible. The bathroom in connection with the ward can hardly be properly called a room, as it is only 4 feet wide. It is, in fact, nothing more than a recess into which a bath can be wheeled for filling and discharge, and in which it is stored, as in every case it would be taken into the ward for actual use.

As in the whole hospital there are only twelve beds, the laundry block is naturally quite a small thing. There is one room for the steam disinfector, so that the clothes can be passed through it from end to end, and thence to the laundry, which also consists of a single room only. The mortuary, too, is quite a small room, and necessarily well ventilated, while an ambulance-room is also provided, just large enough to take a small vehicle for the conveyance of patients. This has somewhat thick walls, as the water tank which supplies the whole of the place is built over it.

Small And Special Hospitals 55

Fig. 29.

Ground Floor

Ground Floor.

Plan

First Floor

First Floor.

Plan.

Fig. 30.

The cottage hospital at Woburn, designed by Mr. H. P. Adams, F.R.I.B.A., for the Duke of Bedford (see Fig. 29) is a very perfect example of a small hospital for a country place, intended for other than infectious cases. There is not such perfect disconnection, perhaps, as in the Linslade hospital, nor is it necessary under these circumstances, but everything is about as perfect as it well could be in accordance with modern accepted ideas. There is, on a small scale, the same departmenting that would be found in a large hospital. The central block in the front is devoted to a matron's room and a staff dining-room, and at the back to a nurse's room and an operating-room, the latter being carried up two storeys and partially top lighted, with its window on the north side. To right and left of this block a transverse corridor passes direct to the wards, this corridor having a large window at one side forming quite sufficient disconnection when the cases are of an ordinary type, the side opposite the window being taken up by a dispensary, a dayroom, and two single-bed wards. The main wards contain five beds each, one being intended for men and the other for women, and they are so planned as to be pleasing in appearance, with large bay windows on the south side and a conservatory opening out of each, opposite the entrance from the corridor, while they are almost surrounded by verandahs. There is a small inspection window between the single-bed ward and the main ward, so that the nurse in charge could inspect both, whichever room she might happen to be in. The sanitary blocks, it will be seen, open out of the corridor and not out of the ward, and are properly disconnected. By this arrangement they never cut off any direct sunlight at any time of the day, for they are on the north side.