When hospitals have to be built in crowded cities and upon comparatively small pieces of land, a good deal of skill is necessary in order to obtain the accommodation in compliance, to as great an extent as possible, with the rules already discussed. Considerations of aspect, important as they are, have to give way before the greater consideration of an ample supply of air to the wards ; and these, instead of being ranged far apart with wide spaces between them, and themselves of only one or two storeys in height, have to be piled up on top of one another, more or less obstructing light and air to all parts of the building. Obstruction of some sort being unavoidable, it is consequently essential that the wards should have the first consideration, and the administrative offices and kitchens are consequently placed as a general rule on the lower floors, the kitchens often extending over the whole area, and being to a considerable extent top lighted and flat roofed, while just the ward portions are carried up.

Under these conditions, varying as they do in every case, it is hardly possible to develop a definite type, and all that can be done here satisfactorily is to give a few examples, differing from one another in point of surrounding circumstances as much as may be. In Fig. 21 is illustrated the Italian Hospital built in Queen Square, Bloomsbury, from the design of Mr. T. W. Cutler, F.R.I.B.A., on a narrow corner site, having the main entrance necessarily upon the short frontage. As in most such cases, the planning was controlled more by the wards than by the ground floor, the principal wards occurring upon the narrow frontage and extending over the whole width. It is thus, perhaps, desirable to consider the first-floor plan before that of the ground floor, and here, in the principal position, we find the men's ward so contrived. The normal arrangement of opposite windows, and windows between the beds, has been possible except in two places, where windows are replaced by doors, the only departure from the customary arrangement being the placing of fireplaces at the two ends of the ward, and the omission of the sunning balcony, for which there was no room ; while the usual sanitary annexe has been obtained at the back, in such a position as to obstruct the passage of air to a comparatively small extent. The duty-room, too, is separated from the ward by an area for light, but it is sufficiently near for most practical purposes, and has a window which overlooks two of the ward windows, thus securing a certain amount of supervision. There are the usual disconnection passages, and access is obtained by means of a semicircular staircase and a lift in the well hole, besides a small service lift at the side. In addition to this ward in the front, there are others at the back of the building, which could, had it been thought desirable, have been thrown into one, though, owing to the class of patients which had to be provided for, it was thought better to cut up the space into four single wards and a ward of four beds.

The second floor is also devoted to ward purposes, being mainly intended for the use of women ; but the large ward in the front is in this case replaced by a ward for eight beds, and two small ones, one containing two beds and the other a single bed. Disconnection is obtained as on the floor below, and so is communication with the other floors. The back portion is somewhat curiously planned, with two special wards of equal size, one containing two beds for adults, and the other four beds for children, both having glazed partitions so that they can be overlooked from the corridor ; while there is an isolation ward at the extreme end, cut off by a long disconnecting passage having a current of air passing through it. Above this back portion there is a flat roof for exercise, which could be used by convalescents or by such patients as could be carried up there on stretchers, though unfortunately the passenger lift does not go up so far, for on the third floor the space occupied below by the semicircular staircase is taken up by a small chapel.

The front portion of the building is, on the third floor, divided into a series of rooms for the nurses, including a dormitory, dining-room, sitting-room, infirmary, and sewing-room. The infirmary contains only a single bed, and is evidently intended for use during temporary indisposition only.

From all these floors there is a dust shoot to an area in the basement, it being intended to heat the building to a large extent by ordinary open fires.

Turning now to the ground floor, it will be found that the space under the men's ward is given up to a good entrance and hall, out of which board-room, secretary's office, and surgeon's room are reached, as well as a small porter's office and porter's bedroom. Access from the entrance to the passengers' lift and main staircase is quite easy, past both the porter's office and the surgeon's room, the same method of departmenting being followed here as in the Bedford County Asylum, the secretary's office being near the board-room, and neither being necessarily passed by any patients. The operating-room is obtained underneath the duty-rooms, but it is larger than these, and so obtains top lighting. Its door is immediately opposite the passenger lift, so that there need be no delay in carrying patients to their wards, though unfortunately space is so restricted that no anaesthetic or preparation-room is provided. A small accident ward, however, occurs on this floor, placed in the quietest position which could have been found, behind the operating-room, from which it could be easily reached. There is also access at this point to an out-patients' department, which, though small, is perfectly complete, with separate entrance and exit and a very large waiting-room, and with registrar's office and consulting-rooms both for surgeons and physicians, with the necessary surgeon's dressing-room and physician's dispensary.