HH62/1/DUMFRI/51

Transcription

[Page] 50

such comparative rarity that temporary hospitals in the shape of
huts or tents will probably prove sufficient for their accommoda-
tion. But a permanent hospital, to be efficient, ought to be so con-
structed as to enable us to deal with at least two of the others
within its walls at the same time. To do so and to separate the
sexes four rooms or wards must be provided. Thus, in Moffat and
Langholm Hopitals there might be four wards with two beds each,
in Lockerbie four with two or three beds to each, and in Annan
four with three or four beds. Thornhill and Dumfries Districts call
for more careful consideration. For the former probably it will be
found that two hospitals may be required. If so, there ought to
be in each four wards, with two beds to a ward. In Dumfries, if
provision is to be made for the District alone, four wards, each con-
taining three beds, will probably suffice. If, however, the Burghs
combine with the District there ought to be accommodation for the
treatment of more than two fevers, which will necessitate probably
six or more wards, each of which might contain five beds. But in
addition to the wards there ought to be one or more smaller rooms
in which doubtful cases may be kept until their nature be ascer-
tained. If not required for patients they may be otherwise
utilised.
Such an hospital should be constructed of stone or brick.
The maintenance of a proper temperature has been found to be a
difficult matter in buildings of wood or iron, and in one instance a
somewhat substantially constructed hospital of wood had to be
closed during winter because it was believed that the deaths of
two patients had been brought about by the low temperature,
which it was found impossible to obviate. The internal walls
should be lime-washed and afterwards covered with a slightly
toned wash, or, if it be preferred, they may be constructed of
glazed bricks which can be easily kept clean. The ward space
should be such as to give each patient 144 square feet of floor and
2000 cubic feet of air. Ventilation should be carried out partly by
the windows and partly by air inlets and outlets. Tobin's tubes
and Boyle's ventilators have been found to give satisfaction in
small as well as in large hospitals. Heating may be done con-
veniently by open fires. The window surface must not be ex-
cessive, otherwise the air cannot be kept pure and equably warm.
One square foot to 70 or 80 cubic feet has been found to be a
suitable proportion. The furniture must be as simple as possible.
A table and one or two chairs to each ward of four beds may be

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sufficient. The bedsteads ought to be of iron. Carpets and cur-
tains are inadmissible. At least one moveable bath will be required,
and earth closets containing some disinfectant are preferable in the
country to water closets. Slops should be carried from a sink
outside the ward by a properly constructed drain to a well made
cesspool, disconnection and trapping being carefully attended to.
If the hospital is to be thoroughly equipped, it must have, in
addition to wards, an administrative building and certain out-
buildings. The administrative should contain kitchen, scullery,
pantry or larder, a dispensary, and bedrooms. In it the nurses or
caretaker should be housed, and it ought to be a building separate
from the wards but connected with them by a covered way. The
out-buildings will consist of a laundry, a mortuary, and a disin-
fecting chamber. A shed may also be required for the ambulance
or fever coach which must be provided for the removal of patients.
The site of the hospital should be at some distance from other
buildings; at least 40 feet ought to lie between its boundary fence
and the nearest. Its extent should be such as to admit of the
erection of huts or tents in the event of the permanent wards
being insufficient during an epidemic, or of Smallpox or Typhus
breaking out. It ought to be convenient of access, moderately
elevated, on a slope, and with a dry soil. There must be free cir-
culation of air and a good water supply. The most suitable aspect
in this county appears to be one facing the south-east. Lastly, a
close fence or wall about six feet in height ought to be placed
around it.

I have the honour to be,
SIR,
Your obedient servant,
J. MAXWELL ROSS.
DUMFRIES, July 30, 1891.