This view was taken by the meeting, who after a long discussion passed the following resolution :
“ That special legislation for the control of the construction of block-dwellings for the industrial classes in cities is requisite.”
It is to be hoped that steps will be taken to bring this resolution before the notice of the Government, as it is the only way in which the problem can be satisfactorily solved.
On the fourth day of the Congress, the architectural section turned its attention to Hospitals and Asylums.
Three papers were devoted to hospitals. Doctor Thorne-Thorne of the Medical Department of the Local Government Board dealt with the question of Isolation Hospitals. He said that isolation hospitals should be of such an extent as to enable sanitary authorities to deal with two infectious diseases at the same time for both sexes. The site should be large enough to accommodate twenty beds per acre without counting the space necessary for recreation. A zone of not less than 40 of unoccupied space should surround the hospital. Each patient should have at least 2,000 cubic feet of air, and should be allowed not less than 12 of lineal wall-space, nor 144 square feet of floor-space. The laundry should be distant not less than 40 and should be isolated. Hospitals of this nature should be made as attractive as possible as it was difficult to carry out the compulsory clauses, or to force people to go to a hospital.
The Rev. C. E. Few, Vicar of Seal, read a somewhat impractical paper in which he advocated the construction of temporary local Isolation Hospitals as opposed to central hospitals.
The most useful paper came from Mr. Keith D. Young, F. R. I. B. A., who described a hospital which he had recently built at Leamington. The buildings accommodate 22 persons, one to every 2,000 of population, and consist of four detached blocks (1) the administration block (2) the isolation block (3) the ward block (4) the laundry block.
The administrative block is two stories high, the remainder being one story. The general rooms are on the ground-floor. These include sitting-room for matrons and nurses, room for medical officers, linen-room and the usual offices. On the upper floor are the bedrooms and a bath-room.
The isolation block is in duplicate, half for each sex and is divided into equal parts by a central wall. Each half contains a large ward for three beds, two small wards for one bed each, nurse’s duty-room, five water-closets and slop-sink. The rooms communicate by an open veranda. The wards are 12 high with an allowance of 216 square feet of floor-space and 2,592 cubic feet per bed. One square foot of window-surface is provided for every 65 of cubic-space.
The ward-block has allotted 156 of floor-space and 2,082 of cubicspace to each bed, and 1 of window-surface to every 60 of cubic space. The building is entered at the centre from an open porch in which are two doors, one giving access to the entrance-lobby the other being an outer door to the bath-room. “ The object of the latter is to enable a patient, on being discharged, to leave the building directly from the bath-room. The bath-room thus becomes a discharging-room ; not, perhaps,” said Mr. Young, “ an ideally perfect arrangement, but certainly a better one than if the patient had to enter the ward after his final bath.” Between the wards is the nurses’ duty-room.
The windows of the wards form the principal means of ventilation. Thev are divided into two parts by a transom, which is fixed about 1 6 down from the head of the frame. Below the transom are ordinary double-hung sashes, provided with a deep bottom rail and a sill-board which permits of the lower sash being raised and a current of air admitted in a vertical direction between the two sashes, at the same time preventing free access of air at the sill-level. Above the transom is a “ hopper-light,” hung on hinges at the bottom to fall inwards and provided with glazed cheeks at the side to prevent down draughts. The wards are artificially ventilated in addition to the window-ventilation, and an opening is made at the floorlevel behind each bed.
The walls of the ward are lined to a height of 5 with tinted glazed bricks, above which they are plastered and distempered. The floors are laid with 3 yellow deal, ploughed and tongued. The vertical angles of the walls, the horizontal angles at the junction of floors and walls, and walls and ceilings are all rounded, as also are all the angles of door-panels and windows.
The cost of the hospital, including land, buildings and furniture was about £9,350. To meet this outlay loans were obtained from the Loan Commissioners, at 3£ per cent, repayable in thirty years. The interest and repayment of principal amounts to an annual sum of £630, which is met by a rate equal to 7-16 of a penny in the pound.
I have given this paper more in detail than the others, not so much as describing a particular hospital, as evidently the most recent opinions as to the construction in detail of a small hospital of this nature.
There were two papers read on Asylums, the first by Dr. Richard Greene, F. R. C. P., Ed., Medical Superintendent Berrywood Asylum, Northampton, and the second by Mr. O. F. Hine, F. R.
I. B. A. The papers, however, travelled so much over the same ground, that I propose to combine them and simply describe what these gentlemen considered an ideal arrangement for an asylum, without reiterating their individual opinions, except in certain in stances*
The site, then, for an ideal asylum should be on high ground, on a gravel soil, if possible. If the building has to stand on clay, careful
and thorough subsoil drainage should be carried out. Dr. Greene asserted that the insane are more liable to tubercle than the general population, and that it had been proved that subsoil drainage lessens the mortality from consumption. A gentle slope- facing the south was the right position for an asylum.
The block system was quoted as being almost invariably followed in the construction of asylums of 500 beds and upwards. These blocks could be arranged in five chief ways :
1. Placed on either side of a straight corridor of communication.
2. Arranged en echelon on either side of a corridor, bent in the centre, with the administrative block at the junction, the whole being in shape somewhat like a broad arrow.
3. Attached to the free sides of corridors arranged in the form of the letter H.
4. Arranged in rectangular form, the important blocks facing due south, the other blocks facing east and west, and the administrative block only facing north.
5. Arranged on the outer edge of a corridor in the horse-shoe form. Another form of recent adoption in America was mentioned.
This comprised a number of entirely detached blocks, placed more or less distant from the central or main building, practically forming a number of villas, wherein the segregation of patients could be easily effected.
The main principle of arrangement once determined, the chief care should be to arrange the wards in the best positions for aspect, light and air, and within easy reach of the administrative centre.
An asylum, it was agreed, should not exceed two stories in height, indeed, Dr. Greene felt convinced that a one-story building would really prove the most efficacious. It was pointed out that the accommodations in many of our public asylums exceeded 1,600, but this was considered excessive and 800 was cited as the maximum accommodation that should be allotted to a single asylum. In all ordinary asylums space should be provided for the following :
(1) Sick and infirm, including a small ward for newly-admitted patients.
(2) Acute or refractory cases. (3) Epileptics.
(4) Quiet and working patients.
The infirmary wards generally accommodate one-fourth the total number of patients, exceeding by one-third the superficial area and cubic contents of wards occupied by healthier patients. The wards generally should be constructed similarly to hospital wards.
Next to the infirmaries should come either the ward for acute cases or that for epileptics. In a small asylum the latter must be on the ground-floor, and the former over, but in any case, epileptics should be housed day and night, on the ground-floor. Their wards should be bright and roomy, the day-rooms rectangular, without breaks or obstructions, behind which the patient might get lost sight of while in a fit. There is little use in sub-dividing these rooms as these patients are generally quiet, and in their healthier moments are more rational and appreciative of surrounding advantages than other classes of patients. The dormitory should be large enough to hold fully five-sixths of the patients in the ward, the remainder sleeping in single rooms, which, unlike other wards, should open out of the dormitory.
The ward for acute cases should be made sound-proof, to prevent the disturbance of patients in rooms above or below. This ward is best broken up by dividing the day-rooms into several smallt-i ooms by partitions partially glazed, to permit of efficient control. The single rooms accommodating one-third of the whole number oi patients should open out of the day-rooms.
The wards for quiet or working patients should be very simple and consist of large day-rooms, with associated dormitories of proportionate size on the upper floor.
There is much diversity of opinion as to the number of separate single rooms in an asylum. Generally with numerous moderate-sized dormitories, one single room to every five patients should suffice, distributed as follows:
Acute and refractory cases, one room to three patients. Epileptics, one to five or six. Infirm, one to six or seven. Quiet working, one to ten.
On the construction of the doors, the authorities differed. Doctor Greene thought that the upper panels of the doors should be of strong plate-glass and the lower panels of open ironwork, fitted in some cases with light wooden shutters, while Mr. Hine objected to inspection holes or shutters as suggestive of espionage, except in epileptic wards where a narrow panel must be left open to permit an attendant to hear a patient in a fit. He preferred a silent lock in general cases, actuated by the handle.
In the construction of wards and staircases, careful thought should be given to fire and means of protection and escape provided. The stairs should be of ample width and easy of ascent.
The administrative block should be centrally situated, and should comprise
(1) A large hall for recreation.
(2) Kitchen, with sculleries, larder, etc. (3) A general or steward s store. (4) The laundry buildings.
(5) Committee-rooms, waiting-rooms, etc.
The superintendent’s house, generally incorporated with the administrative block should, Mr. Hine thought, be entirely detached.
“ That special legislation for the control of the construction of block-dwellings for the industrial classes in cities is requisite.”
It is to be hoped that steps will be taken to bring this resolution before the notice of the Government, as it is the only way in which the problem can be satisfactorily solved.
On the fourth day of the Congress, the architectural section turned its attention to Hospitals and Asylums.
Three papers were devoted to hospitals. Doctor Thorne-Thorne of the Medical Department of the Local Government Board dealt with the question of Isolation Hospitals. He said that isolation hospitals should be of such an extent as to enable sanitary authorities to deal with two infectious diseases at the same time for both sexes. The site should be large enough to accommodate twenty beds per acre without counting the space necessary for recreation. A zone of not less than 40 of unoccupied space should surround the hospital. Each patient should have at least 2,000 cubic feet of air, and should be allowed not less than 12 of lineal wall-space, nor 144 square feet of floor-space. The laundry should be distant not less than 40 and should be isolated. Hospitals of this nature should be made as attractive as possible as it was difficult to carry out the compulsory clauses, or to force people to go to a hospital.
The Rev. C. E. Few, Vicar of Seal, read a somewhat impractical paper in which he advocated the construction of temporary local Isolation Hospitals as opposed to central hospitals.
The most useful paper came from Mr. Keith D. Young, F. R. I. B. A., who described a hospital which he had recently built at Leamington. The buildings accommodate 22 persons, one to every 2,000 of population, and consist of four detached blocks (1) the administration block (2) the isolation block (3) the ward block (4) the laundry block.
The administrative block is two stories high, the remainder being one story. The general rooms are on the ground-floor. These include sitting-room for matrons and nurses, room for medical officers, linen-room and the usual offices. On the upper floor are the bedrooms and a bath-room.
The isolation block is in duplicate, half for each sex and is divided into equal parts by a central wall. Each half contains a large ward for three beds, two small wards for one bed each, nurse’s duty-room, five water-closets and slop-sink. The rooms communicate by an open veranda. The wards are 12 high with an allowance of 216 square feet of floor-space and 2,592 cubic feet per bed. One square foot of window-surface is provided for every 65 of cubic-space.
The ward-block has allotted 156 of floor-space and 2,082 of cubicspace to each bed, and 1 of window-surface to every 60 of cubic space. The building is entered at the centre from an open porch in which are two doors, one giving access to the entrance-lobby the other being an outer door to the bath-room. “ The object of the latter is to enable a patient, on being discharged, to leave the building directly from the bath-room. The bath-room thus becomes a discharging-room ; not, perhaps,” said Mr. Young, “ an ideally perfect arrangement, but certainly a better one than if the patient had to enter the ward after his final bath.” Between the wards is the nurses’ duty-room.
The windows of the wards form the principal means of ventilation. Thev are divided into two parts by a transom, which is fixed about 1 6 down from the head of the frame. Below the transom are ordinary double-hung sashes, provided with a deep bottom rail and a sill-board which permits of the lower sash being raised and a current of air admitted in a vertical direction between the two sashes, at the same time preventing free access of air at the sill-level. Above the transom is a “ hopper-light,” hung on hinges at the bottom to fall inwards and provided with glazed cheeks at the side to prevent down draughts. The wards are artificially ventilated in addition to the window-ventilation, and an opening is made at the floorlevel behind each bed.
The walls of the ward are lined to a height of 5 with tinted glazed bricks, above which they are plastered and distempered. The floors are laid with 3 yellow deal, ploughed and tongued. The vertical angles of the walls, the horizontal angles at the junction of floors and walls, and walls and ceilings are all rounded, as also are all the angles of door-panels and windows.
The cost of the hospital, including land, buildings and furniture was about £9,350. To meet this outlay loans were obtained from the Loan Commissioners, at 3£ per cent, repayable in thirty years. The interest and repayment of principal amounts to an annual sum of £630, which is met by a rate equal to 7-16 of a penny in the pound.
I have given this paper more in detail than the others, not so much as describing a particular hospital, as evidently the most recent opinions as to the construction in detail of a small hospital of this nature.
There were two papers read on Asylums, the first by Dr. Richard Greene, F. R. C. P., Ed., Medical Superintendent Berrywood Asylum, Northampton, and the second by Mr. O. F. Hine, F. R.
I. B. A. The papers, however, travelled so much over the same ground, that I propose to combine them and simply describe what these gentlemen considered an ideal arrangement for an asylum, without reiterating their individual opinions, except in certain in stances*
The site, then, for an ideal asylum should be on high ground, on a gravel soil, if possible. If the building has to stand on clay, careful
and thorough subsoil drainage should be carried out. Dr. Greene asserted that the insane are more liable to tubercle than the general population, and that it had been proved that subsoil drainage lessens the mortality from consumption. A gentle slope- facing the south was the right position for an asylum.
The block system was quoted as being almost invariably followed in the construction of asylums of 500 beds and upwards. These blocks could be arranged in five chief ways :
1. Placed on either side of a straight corridor of communication.
2. Arranged en echelon on either side of a corridor, bent in the centre, with the administrative block at the junction, the whole being in shape somewhat like a broad arrow.
3. Attached to the free sides of corridors arranged in the form of the letter H.
4. Arranged in rectangular form, the important blocks facing due south, the other blocks facing east and west, and the administrative block only facing north.
5. Arranged on the outer edge of a corridor in the horse-shoe form. Another form of recent adoption in America was mentioned.
This comprised a number of entirely detached blocks, placed more or less distant from the central or main building, practically forming a number of villas, wherein the segregation of patients could be easily effected.
The main principle of arrangement once determined, the chief care should be to arrange the wards in the best positions for aspect, light and air, and within easy reach of the administrative centre.
An asylum, it was agreed, should not exceed two stories in height, indeed, Dr. Greene felt convinced that a one-story building would really prove the most efficacious. It was pointed out that the accommodations in many of our public asylums exceeded 1,600, but this was considered excessive and 800 was cited as the maximum accommodation that should be allotted to a single asylum. In all ordinary asylums space should be provided for the following :
(1) Sick and infirm, including a small ward for newly-admitted patients.
(2) Acute or refractory cases. (3) Epileptics.
(4) Quiet and working patients.
The infirmary wards generally accommodate one-fourth the total number of patients, exceeding by one-third the superficial area and cubic contents of wards occupied by healthier patients. The wards generally should be constructed similarly to hospital wards.
Next to the infirmaries should come either the ward for acute cases or that for epileptics. In a small asylum the latter must be on the ground-floor, and the former over, but in any case, epileptics should be housed day and night, on the ground-floor. Their wards should be bright and roomy, the day-rooms rectangular, without breaks or obstructions, behind which the patient might get lost sight of while in a fit. There is little use in sub-dividing these rooms as these patients are generally quiet, and in their healthier moments are more rational and appreciative of surrounding advantages than other classes of patients. The dormitory should be large enough to hold fully five-sixths of the patients in the ward, the remainder sleeping in single rooms, which, unlike other wards, should open out of the dormitory.
The ward for acute cases should be made sound-proof, to prevent the disturbance of patients in rooms above or below. This ward is best broken up by dividing the day-rooms into several smallt-i ooms by partitions partially glazed, to permit of efficient control. The single rooms accommodating one-third of the whole number oi patients should open out of the day-rooms.
The wards for quiet or working patients should be very simple and consist of large day-rooms, with associated dormitories of proportionate size on the upper floor.
There is much diversity of opinion as to the number of separate single rooms in an asylum. Generally with numerous moderate-sized dormitories, one single room to every five patients should suffice, distributed as follows:
Acute and refractory cases, one room to three patients. Epileptics, one to five or six. Infirm, one to six or seven. Quiet working, one to ten.
On the construction of the doors, the authorities differed. Doctor Greene thought that the upper panels of the doors should be of strong plate-glass and the lower panels of open ironwork, fitted in some cases with light wooden shutters, while Mr. Hine objected to inspection holes or shutters as suggestive of espionage, except in epileptic wards where a narrow panel must be left open to permit an attendant to hear a patient in a fit. He preferred a silent lock in general cases, actuated by the handle.
In the construction of wards and staircases, careful thought should be given to fire and means of protection and escape provided. The stairs should be of ample width and easy of ascent.
The administrative block should be centrally situated, and should comprise
(1) A large hall for recreation.
(2) Kitchen, with sculleries, larder, etc. (3) A general or steward s store. (4) The laundry buildings.
(5) Committee-rooms, waiting-rooms, etc.
The superintendent’s house, generally incorporated with the administrative block should, Mr. Hine thought, be entirely detached.