378 
NATORE 
2d. TOersFo 
It has been experimentally shown that ward-air moves 
most readily when care is taken to combine as far as 
possible the following requirements :—Ist, To let the 
prevailing outer air currents strike the szdes of the wards; 
2nd, To provide that the sun shall shine on the opposite 
sides of the wards every day he shines: 3rd, To have 
windows on opposite sides of the wards, with the beds 
arranged between them. A proper use of these opposite 
windows is the sxe gua nox of ward ventilation and of 
ward healthiness. But, in cold variable climates, provision 
has to be made for graduating the ventilation and for 
warming a portion of the air. 
The subsidiary means which have been found to answer 
in practice are foul air shafts, fresh air inlets close to the 
ceiling, and warm air stoves—of a peculiar construction 
described in detail—so contrived that, while the ward is 
heated by radiant heat, the air warmed is not ward air 
but fresh air. 
The cubic space per patient is determined primarily by 
the superficial area per bed, which, in its turn, is deter- 
mined by the area required for efficient nursing. From 
go to Ioo square feet per bed is sufficient, except in 
hospitals where there are medical schools. The cubic 
space per bed hence depends on the height of the ward. 
There is but one test of ventilation and that is fresh- 
ness of the ward air. No quantity test is of any avail, 
hence ventilation, that is, the proper use of the means of 
ventilation, is an essential part of ward administration. 
No man or woman who has not a sensitive nose and who 
has not also a perfect horror of bad smells or closeness, 
should ever take office in a hospital. 
The central point in hospital construction is the ward 
itself and the following figure shows the usual arrangement 
of the ward and its offices, in the new class of hospitals. 
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FIG. 1, 
On one side of the entrance is placed a nurses’ room ; 
on the other side of the entrance is placed a small scullery. 
In the ward itself the beds are arranged two and two 
along the wall spaces between the windows, with a bed at 
each corner. At the further end of the ward is a large 
end window. On one side of this window there is a build- 
ing, thrown out from the corner, in which are placed the 
water-closets. The other building, at the opposite corner, 
contains the lavatory and bath-room. 
The next figure shows the simplest arrangement of 
these ward units in a regimental hospital. Such a building 
can be constructed on one or two floors. The administra- 
tive portion, together with two or four small wards for 
special cases, occupies the centre of the block and the 
kitchen is detached. The larger wards project at either 
end. (A, fig. 2.) 
A very important question, raised by Mr. Galton, is 
the manner in which hospital accommodation should be 
provided for recurring epidemics, fevers, cholera and the 
like. He shows that the cheapest and most effectual 
provision consists of temporary huts, a result which we 
commend to those who consider that large, costly, per- 
manent fever hospitals are necessary for London. 
Vith this general statement of the principles we must 
refer our readers to the address itself for the numerous 
points of detail which require to be attended to for secur- 
ing due care and prompt attendance on the sick. They 
are all in strict accordance with scientific requirements 
and, if intelligently applied, wiil save many valuable 
lives. 
We-wish we could say as much of some portions of the 
Fic, 2. 
discussion which followed the address. We allude to the 
obtrusion of the “germ” disease hypothesis into the hospital 
question. This theory, it is true, met with little coun- 
tenance from the meeting ; but there it was. In one sense 
its introduction was useful as showing what the final 
results of such a doctrine are. Of discase itself we know 
little scientifically as yet; nevertheless, it has become 
a fashion of late to supplement lack of knowledge by 
assuming that certain diseases are separate specific ex- 
istences like animal or vegetable species, each springing 
from a “germ” or seed introduced from without; hence 
in the discussion it was averred that the supposed de- 
structive influence of carbolic acid on these “ germs” can 
be made to supply the place of fresh air in hospital wards, 
and, as a consequence, that the danger has to be en- 
countered, not in foul air but in disease “ germs.” 
There may be disease “germs” for anything we know ; 
but, until their existence is proved physically and until it 
is shown that there are germs with different distinctive 
specific characters, each of which germs can be shown to 
produce always the same group of symptoms in the human 
body, which symptoms can arise from no other cause ; we 
can in no sense recognise the existence of disease germs. 
In scientific questions of this kind, “de zon apparentibus 
et de non existentibus eadem est ratio.” 
To neglect the ventilation and other sanitary arrange- 
ments of hospitals for a mere theory, would be to undo all 
that has been done in hospital improvements in Europe, 
with the inevitable result of destroying life. 
Mr. Galton concludes his paper with some pertinent 
remarks on the cost of useless ornament in hospitals, 
which we commend to the consideration of hospital 
architects. Hospital resources are limited, patients are 
many—too-many we should say. 
Miss Nightingale begins her admirable “ Notes on Hos- 
