Hospital planning, like school planning, has tended of late years towards certain recognised types which are more and more rarely departed from. There are no such definite regulations as those upon school planning, yet the general conditions are just as perfectly understood, the ruling principle being that of perfect ventilation, and disconnection of the various parts, combined with ample air space in the wards. Perhaps the general system can be most easily followed by considering it in relation to Fig. 14, which illustrates the general arrangement of Bedford County Hospital, designed by Mr. H. Percy Adams, F.R.I.B.A. It will be seen that in the front of the site there are two great blocks, of which one is devoted entirely to outpatients, and is kept quite distinct from everything else connected with the hospital. The other great block at the front is devoted to administrative purposes, and is itself divided into two parts, the front portion containing offices, and the back containing the kitchens and stores. These two portions are connected only by narrow corridors, which, as will be seen presently when the detailed plans are considered, have windows on both sides, and are practically mere covered passages, so that the air blows through and entirely separates the offices from the kitchens. Somewhat similar, but not quite such perfect, disconnection occurs between the kitchen block and a long connecting corridor which passes from end to end of the site parallel with the front. This corridor again has windows on both sides, and in many hospitals even the windows are absent, and it is nothing more than a paved pathway with a light roof over it. Along the corridor tram lines are carried, on which trolleys can be wheeled for the conveyance of food, while the corridor is wide enough to enable patients to be carried with ease along it on hand ambulances. At one end of the connecting corridor is found the chapel, for use by the nursing staff and convalescents, while the wards branch off from it almost invariably at right angles. These are kept always at least as far apart as their height if space permits, the least distance allowable being generally considered to be 40 feet. Whenever it is possible these wards are made to run north and south, with their more distant end towards the south, so that the sunlight may enter at all hours of the day. Occasionally, however, the wards are paired, one occurring on the north and one on the south side of the connecting corridor in the same axial line, but this is not done unless the site is somewhat restricted, or unless it be desired to reduce the length of the connecting corridor, which is difficult of supervision and proper management if it be too long.

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Fig. 14.

It is generally considered that there should not be more staircases in an hospital than are absolutely necessary. If in a large hospital there be one to every ward-block, the natural result is that doctors and nurses chase one another round and round, however much they may desire to meet. On the other hand, it is not well that a connecting corridor should itself be many storeys in height, and very frequently it occurs only on the ground floor, and the separate staircases, with all their inconveniences, are preferred to multiplying the corridors. In infectious diseases' hospitals, and in fact in all cases where the cost is not prohibitive, it is best to build a hospital of one storey only, but this is an expensive thing to do, and the ward-blocks are frequently two or three and sometimes more storeys in height. In very large hospitals it is necessary that there should be an operating block on each floor, and often on each side of the administration block, one side being reserved for surgical and the other for medical cases, while further subdivision will keep the male wards on one floor and the female wards on another, or otherwise provide for efficient separation. It will be noticed that at Bedford, which is a comparatively small hospital, there is only one male block, one female block, and one children's block, while a single operating block suffices. It is essential to have at least one operating-room on the ground floor, and it should be on the north side and perferably top lighted, so that there may be plenty of light on the operating table. This position is selected also in order to serve accident cases at the earliest possible opportunity, while at Bedford it will be noticed that it is near enough to the out-patients' department for use in case of an emergency in connection with that block.

In a modern hospital lifts are absolute essentials, and should be large enough for the conveyance of a patient on a stretcher or bed, while subsidiary lifts are also useful for the food trolleys. Underneath the connecting corridor there is generally a subway for the conveyance of pipes and wires, and this is also often used in connection with the heating and ventilating appliances.

As a matter of detail, but one of some considerable importance, it may be noted that throughout the whole of an hospital there should be no sharp corners. All angles are rounded, even those between floors and walls and walls and ceilings, to say nothing of the panels of doors and the mouldings on window sashes. Everything has to be accessible to a duster, with no places in which dust may lodge, for absolutely spotless cleanliness combined with plenty of sunshine and fresh air are relied upon for the cure of disease to a much greater extend than medicine. It is also perfectly essential that there should be a thorough system of telephonic communication between the wards, the kitchens, the nurses' and matrons' rooms, and the surgeons' rooms, though there are few cases in which this has yet been worked out as thoroughly as it ought to be.

The various portions of this hospital may very well be considered separately in detail, as it is generally acknowledged to be a model for hospitals of moderate size. Fig. 15 consequently illustrates the administrative block. This is symmetrically planned, the entrance being in the centre of the front, through a vestibule, into a large entrance hall, with a fine staircase rising in front having a large staircase window. There is a waiting-room for visitors, and beyond it, entered from a transverse corridor, are the secretary's and chairman's rooms, as well as the staff dining-room with its service entrance from the kitchen corridor. On the other side of the vestibule is the porter's office, the door of which contains an inspection hatch, and the porter has also another door through to the house and the surgeon's examination-room, which can also be reached from the transverse corridor. At this end of the corridor there is a large room for consulting purposes, which contains also a museum and a medical library. It will also be seen that the porter has a bedroom close by, and that under his control is an ambulance which is kept underneath the staircase. Two corridors pass, one on either side of the staircase, into the kitchen department, each traversing the lobby.

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Fig. 15.

Bedford County Hospital

Bedford County Hospital.

Hospitals On Open Sites 27Hospitals On Open Sites 28

Fig. 16.