3 
we cannot have too much. Into the exact 
quantity required we will enter presently ; the 
question now is how to arrange our buildings 
bo at to command the greatest amount of pure 
air within and around them. One great 
essential consists in the constant movement of 
the air in mass. The motion of the air in any 
ward or room should not exceed feet per 
minute, but should never be much if anything 
below it. No stagnation must be permitted, 
and great errors have been in past times com- 
mitted by enclosing open courts with lofty 
ranges of buildings forming closed angles, 
quadrangles and narrow culs de sac. Figures 
1, 2, 3 in diagram represent existing hospitals 
of this character, all of which should be rejected 
as models of imitation. The simplest form of 
hospital construction is a straight line as in 
figure 4 on diagram (A), with window openings 
on both sides, the wards being the lengthways 
of the building, and the administration in the 
centre. The axis of the building should be so 
placed as to gain the full force of the prevailing 
breeze, that the wards may be constantly 
blown through. If the building be two stories 
in height (and no hospital should be more) 
this plan would accommodate 120 beds with 
economy and efficiency. Additional ward space 
may be obtained by adding short wings as in 
figure (5), but two staircases would then be 
required, care being taken, however, not to 
prolong the arms too much to aggravate the 
evils of the closed angles which the plan in- 
volves. A better arrangement, however, is to 
be found in figure (6), the wings being 
separated from the centre and connected with 
it on the lower floor only by a covered corridor. 
This plan is adopted frequently in 
France, but its great disadvantage con- 
sists in not easily admitting of extension. 
Taken as a whole, the plan which is now most 
in favor as combining in its arrangements the 
chief requisites of a hospital is that of figure 8 
on diagram B. The wards are divided into 
separate blocks, each block being, as it were, a 
distinct hospital by itself, and connected with 
the rest and with the administration by a cor- 
ridor enclosing garden and airing grounds. On 
this plan, or slight modifications of it, are built 
the hospitals at Bordeaux, Brussels, and 
Laviboisiere at Paris, and in our own country 
at Leeds, and the new St. Thomas’, 
now erecting, in London. In the Lari- 
boisiere the corridor is covered with a 
flat roof, forming a promenade or airing 
ground for ihe convalescents. This plan is 
known as that of the pavilion principle ; and 
taking into account the requirements of our 
climate, I look upon it as the one of all others 
we should best adopt — limiting, however, the 
blocks to one storey only in height, fir reasons 
which I will hereafter allude to. The axis of 
the whole system of wards should be so placed 
that they may receive the full benefit of the 
prevailing breeze, and their distance apart 
sufficiently great to admit of each receiving its 
full amount of fresh air as an independent 
building. The nature of the ground selected may 
sometimes prevent this plan being carried out, 
but I think its principle should be aimed at, as 
thoroughly combining the great requirements 
in hospital building — subdivision of the sick, 
free ventilation inside and around, and con- 
venience of access for administration. The 
ground plan settled, we have next to determine 
the wards, their size and character ; and hav- 
ing secured our fresh air, to turn it to the best 
account. The wards should be of such a size 
and so arranged that the head nurse can have 
all her patients under her eye at once, especially 
at night, whereby a great saving is effected in 
the nursing staff. One head nurse only to 
each ward is desirable ; therefore the number 
of patients must be such as fully to occupy 
her attention, but not more. Small wards on 
this account are expensive, and demand ad- 
ditional nurses. They are sometimes said to 
be preferable to larger ones, as giving 
greater privacy, and also increased facilities 
for ventilation. These, however, are fallacies, 
for there can be no privacy in a 
hospital beyond any two adjacent beds ; and as 
to ventilation, the multiplication of angles has 
not sufficiently been taken into account. In 
some experiments at Lariboisiere it was found 
that the amount of air circulating down the 
centre of a ward is two or three times greater 
than that near the sides and angles ; and it 
seems to be overlooked tbit the difficulty of 
ventilating a given cubic space occupied by 
sick, bears a direct ratio to the length of the 
corridors and to the number of cells or wards 
into which that space is divided. Figures A, 
b, c, d, on diagram B, are instances of wards 
which should be avoided. Another objection 
to small wards consists in the greater facility 
they afford to insubordination, — a small num- 
ber of 6 or 8 can more easily combine for mis- 
chief than agreater number. Natural ventilation 
is the only efficient means of restoring the sick, 
and the amount of fresh air required for ven- 
tilation has been hitherto much underrated, as 
it was supposed that the carbonic acid gas 
produced by respiration was the chief noxious 
gas to be carried off. The total “ amount of 
this gas produced by an adult in 24 hours is 
about 40,000 cubic inches, which in a ward or 
room containing 16 men would give 370 cubic 
feet per diem, allowing 8 hours for the night 
occupation of such a room when the doors and 
windows may be supposed to be shut, the pro- 
duct of carbonic acid would be 123 cubic feet, 
or 15£ cubic feet per hour, nearly. This 
large quantity if not speedily carried away 
would undoubtedly be injurious to health; 
but there are other gaseous poisons 
produced with the carbonic acid which 
have still greater power to injure 
health. Every adult exhales by the lungs and 
skin 48 ounces, or 3 pints, of water in ° . 
