The ward is best placed with its axis running north and south, the entrance corridor lying at the north end of the block, and the south end being devoted to a verandah on to which patients can be wheeled on sunny days to take advantage of the fresh air and sunlight. This is flanked on one side by a tower containing the bathrooms, and on the other by a similar tower with the W.C.'s, slop sinks, etc., both of these being disconnected by the usual cross current of ventilation. A small ventilated cupboard is provided in the sinkroom for keeping bedpans prior to inspection of their contents by the medical staff. The bath, it will be noticed, stands in the middle of the room, so that the nurses can get round it, and very frequently it is upon wheels, so that it can be taken when necessary to the patient's bedside after having been filled. It is thus necessarily made of some light material, preferably of enamelled copper. When it is fixed, however, there is a preference for making it of glazed stoneware.

Bedford County Hospital

Bedford County Hospital.

Hospitals On Open Sites Part 3 30

Fig. 17.

It will be noticed that the ward kitchen has a small window from which the ward can be overlooked by the nurses, while the dayroom, which has a bay window for the sake of sunshine, is also under supervision by means of windows from the corridor. Of course, it will be understood that no cooking is actually done in this kitchen, which is used only for keeping food warm and for washing up the ward crockery, which is never allowed to go outside the block. The little larder here, too, is not intended in any way to take the place of the general larders. It is more for the temporary storage of such things as jellies, milk, and beef-tea, especially in order to keep them cool during hot summer days. Its window consequently faces north.

Fig. 18 illustrates the Royal Naval Hospital at Chatham, designed by Mr. J. C. T. Murray, F.R.I.B.A., which is in its main idea similar to the hospital at Bedford, for both are good examples of a general scheme which is now rarely departed from. It is, however, worth illustrating, to show how the generally accepted plan has to be varied in order to meet special circumstances. There is here no need for an outpatients' block, as in-patients only would be treated. Almost all the nursing is done by men, but this does not call for any great alterations in the plan. The main entrance occurs, as is usual, through a central corridor, passing first through an administration block, and leading subsequently to a kitchen block from which the great transverse connecting corridor diverges on either side. The ward blocks are again at right angles to this, but are found on both sides of it, particularly at its extreme ends, while special small blocks occur as recreation-rooms, and others as small special wards for ophthalmic patients and for the warrant officers, the latter when in hospital each having a separate room. The south portion of the site is covered in this way, and devoted to a general hospital, which is surrounded by a carriage way, beyond which again and in direct line with the entrance corridor is found a large block devoted to the engines and dynamos, and to a washhouse. Behind this block, and well screened, is the principal mortuary, which in detail is divided into several parts, one being devoted to post-mortems, and another having a viewing room for use at inquests. The north-west corner of the site is given up to an infectious division, separated from the general hospital by a neutral zone covered with trees, its kitchen, its entrance, and its exit alone being accessible from the main hospital.

Fig. 18. Royal Naval Hospital Chat Ham

Fig. 18. Royal Naval Hospital Chat Ham.

Fig. 19. John Ct.Murray Fri Ba Architect

Fig. 19. John Ct.Murray Fri-Ba Architect.

This is shown in greater detail in Fig. 19, where the kitchen appears as an entirely detached block, connected with the wards only by a long covered way, which the kitchen servants never enter, the food being served through a hatchway on to tables in the waiting-room, whence it is fetched away by the nursing staff. The surgeons' quarters are located alongside the covered way, so that they also are disconnected. The entrance is in the centre, through a small detached block containing waiting-rooms, and a few small observation wards for single patients, where any cases can be retained about which there is doubt until the disease fully develops. A central covered way passes from this block through a staircase block, by means of which, on the upper floors, the two central wards are reached by bridges. In this way the central wards are coupled on the upper floor, whereas they are detached on the ground floor where the outer wards are coupled.

Fig. 20.Di5infect1ng Station. Blackshaw Road. Tooting S.W.

Fig. 20.Di5infect1ng Station. Blackshaw Road. Tooting S.W.

Between each of these pairs of blocks there are single-bed wards, while the general wards contain eight beds each, and are planned very similarly to the wards of the Bedford Hospital, with the exception that there is no end verandah and only a single sanitary block to each ward. It may here be mentioned that, in the general portion of the hospital, the beds are not so greatly separated as they are at Bedford, but are placed in pairs along the wards.

A special provision has to be made at Chatham for officers, who have a separate block devoted to them in the infectious division. As a rule officers are not treated in the general hospital, as, except in cases of accident, they go home when taken ill, but of course when they are suffering from anything infectious they are removed at once to the hospital, and there they have to be kept distinct from the men. As far as possible they would be given single-bed wards, but not necessarily so. The great object in an infectious hospital is to have ample air space and plenty of sunshine, and this is obtained. There is a covered way along the south side of the officers' block, where patients could be taken out in good weather.

The nursing sisters are provided with a special little block of their own, quite distinct from anything else, while in another part of the ground, close to the other mortuary, occurs the infected mortuary, again with visitors' room and viewing-room.

Every hospital of any size is equipped with a complete laundry with a special arrangement for disinfection of the clothing. The disinfecting station belonging to the Wandsworth Borough Council at Tooting, shown in Fig. 20, and designed by Mr. H. J. Marten, A.M.Inst.C.E., is an example of the sort of thing, although the washhouse is not here so complete in its detail as it would be in the case of a hospital. A borough installation of this sort is primarily intended for disinfection, and washing is comparatively rarely necessary. Into such a building are taken all the clothes, bed hangings, and everything else of a portable nature, other than actual furniture, from the rooms in which a case of infectious disease has occurred. The goods are brought in closed vans, entering what is here known as the infected van-shed, containing an office for record. The van is here emptied, and the goods are passed into the infected chamber, whence they are transferred either to the steam disinfectors or to the formalin chamber according to their nature, all goods which will not be damaged by steam being steam treated. After remaining in these chambers for a sufficient period of time, the farther door is opened and the goods are taken out into the disinfected chamber, and, as a rule, passed direct to the van in which they are taken home, though in some cases they have to go first through the washhouse and the steam-drying or airing chamber. Only rough washing is attempted, as there is no obligation upon the borough council to properly get up linen, etc., and as a result there are no ironing or sorting rooms. It will be seen that the attendants on the two sides do not come into contact with one another, and that those who manage the infected clothing have to pass through a bathroom and to change their clothes on their way in and out.

This bathroom arrangement is also found in infectious diseases hospitals at the patients' exit, which generally contains waiting-rooms for the patients' friends on the outer side. Each patient is taken in turn to a dressing-room, undressed, then given a medicated bath to secure thorough disinfection, and afterwards carried, as a rule wrapped in blankets, across an open passage to another dressing-room, where the ordinary clothes brought by the friends are put on.

Hospitals On Open Sites Part 3 34Hospitals On Open Sites Part 3 35

Fig. 21.

thomas.W cutler architect