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 SMALL-POX HOSPITAL.
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DESCRIPTION OF PLATES.
                             PLATE I.
  Fig. 1. Front elevation.
  Fig. 2. Plan of main floor, with an arrangement of five or seven beds for each
ward.
  Fig. 3. Plan of basement. 
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PLATE  II.
  Fig. 1.  Rear elevation.
  Fig. 2.  Plan of attic room.
  Fig. 3.  Section (diagram) of a Galton fire-place (with blower applied), and chim-
ney, (from Putnam's, " The open fire-place in all Ages.")
  A.  Duct for entrance of fresh air.
  P.  Iron pipe, leading from the throat of the grate to the flue above.
  C.  Ceiling.
  F.  Space behind grate, where, .and at the sides of the grate, and around the iron
pipe, the air in its ascent is heated.
  R.  Register or opening, just beneath the  ceiling, through which the heated air
enters the ward. 
SMALL-POX HOSPITALS.*
    The construction and equipment of  hospitals is the province of a
  branch of sanitary science, and of this branch I have selected a por-
  tion; viz., that of small, or as they are now commonly termed, cottage
  hospitals, having special reference in the treatment of the subject, to
  the use of these small hospitals as small-pox hospitals or pest-houses,
  or, avoiding  those old-fashioned and apparently objectionable names,
  and adopting a recently recommended euphemism, hospitals for  the
  the treatment of contagious  and infectious diseases.
    The  origin and growth  of small hospitals  are  exceptions to  the
  general rule  of the development of the great from the small, for  the
  large hospitals came first and have existed for many centuries, whereas
  small or cottage hospitals are the  product of the last  three or four
  decades.
    The great  hospitals sprang from the church, and were  at first and
  for a long time afterward devoted  to the  care of the old and  helpless,
  as we would  now  say, asylums, and  were, some of them, at least,  de-
  voted to the care  of sick and  wounded in comparatively modern times.
  Some of  those enormous establishments still  exist, being found  in
  Rome, Naples and other cities of Italy.
   The year 1859 saw in England,  at Cranleigh, the birth of the first
 cottage hospital, a lapse of fifteen  centuries since St. Jerome used the
 word " nosocomian " for an institution which must have then existed.
   I will not waste the valuable time of the society by attempting  to
 describe the various forms of  cottage hospital which have been erect-
 ed in Great Britain and  America ;  nor is it deemed necessar}r to  dwell
 upon the important items of site, material, etc.  A few remarks may,
 however, be permitted on the advantages  of  small hospitals, and more
 especially of that variety of them peculiarly devoted to the treatment
 of contagious  and  infectious diseases.
  The general advantages of small hospitals, beside the great one  of
being comparatively, if not entirely, free from the vice of hospitalism,

  *From a paper read before the State Medical Society at its annual meeting January 25, 1882, by
R. J. Farquharson,  M. D. 
8
so graphically and eloquently 'described by Sir J. Y. Simpson, are the
following:
  Affording as  they  do a home-like refuge  for the poor, in cases of
sickness and accident, they are not  regarded with  that  superstitious
dread, amounting almost to horror,  with which all  great hospitals are
generally invested by the imagination of their intended inmates.
  Persons treated in a well-conducted small hospital are  actually sur-
rounded with more  comforts, more care and more cleanliness than are
to be  found in the homes  of most people, for it is a lamentable fact
that most private dwellings, even those of the better class, abound in
unsanitary surroundings.  But it is when a small hospital is used as
a pest-house, i.  e., for the seclusion of those sick  with infeetious or
contagious disorders, that its great excellence becomes apparent.
   If every person over the age of one month was  properly protected
by vaccination,  as they should be in every civilized  community, and as
they  would be in  the  Utopian  city of Hygeia, there would not be a
particle of use or necessity m isolating a single case of small-pox; how-
ever this place might be advantageous in regard to  scarlatina, measles,
diphtheria, and perhaps other diseases.
   Unfortunately, however, there are in all communities in this coun-
try a number of unprotected,  or improperly protected  persons for
whose safety isolation of small-pox cases is necessary.
   What great assistance in stamping out small-pox and  kindred dis-
eases the complete  isolation afforded by a small hospital lends, is shown
by the following  quotations :
  No sane person  doubts that the provision of adequate hospital  accommodation
for such cases is, in the end, by far the cheapest and most effectual course for the
local authorities to adopt.  Experience abundantly proves this.
   Dr. Buchanan has shown the value of this ready-made provision for infectious
cases by recording the results of establishing a small-pox hospital at  Cheltenham
with fourteen beds.
   During six months of the year 1875, small-pox was brought into Cheltenham, no
less than six times, from Gloucester, Birmingham, Liverpool and elsewhere.  Seven
persons ill of the  imported  disease we're taken without delay to the hospital, and,
except one individual  (who was also removed to the hospital), nobody in the  town
caught the disease from these centers of contagion.
   Dr. Wilson says:—At Hastings  small-pox epidemics have been  twice stamped
out. At Bristol, on many occasions, epidemics from various infectious diseases have
been averted, and probably one of typhus in 1877.
   At Newcastle on-Tyne typhoid fever (once epidemic) has several times been com-
pletely stopped. 
9
   At Leet, in Staffordshire, no case of small-pox occurred after removing the first
 to the hospital.
   At Coventry small-pox has been stopped twice, and scarlet fever on many occa-
 sions. At Ipswich, in 1877, small-pox was'imported into the borough no less than
 twenty (20) separate times without once getting  a foothold.—Burdett,  Cottage
 Hospitals, 2nd ed., Phila., 1881, pp. 265 et seq.

   All this evidence comes from England, but had we such carefully
 prepared statistics of small hospitals in America, which  unfortunately
 is not the case, there is little or no doubt but that it might be dupli-
 cated here.
   Another and a great advantage of a  ready-made small hospital for
 contagious diseases, is on the score of  economy, and from experience,
 I am fully satisfied that no outlay of public money will yield a greater
 return in the long run.  As an illustration, I may be allowed to quote
 the following brief chapter of my personal experience.
   In 1873, the  city  of Davenport  and Scott county were without a
 proper hospital for infectious and contagious diseases; upon the  out-
 break of the cholera, the  usual senseless panic  occurred, and though
 the epidemic only lasted a very short time, over $2,000 of public money
 was expended (the most of it wasted), an amount, as will be seen fur-
 ther on,  almost sufficient to build  the efficient hospital  now in exist-
 ence.
   This brings me now to  the proper subject of this paper, which is to
 demonstrate  by example how a small hospital, especially adapted to
 the  treatment of small-pox, cholera, scarlet fever, measles, diphtheria,
 or any other  contagious or infectious disease (and which may be, and
 is, used for other purposes), may be erected upon a safe and  suitable
 site, and  for a comparatively small sum of money.
   The use of the word  safe, in reference  to the situation of the hos-
 pital, does not refer, as it might seem at first sight, to the isolation of
 the building,  for, in my opinion, a very slight separation from other
 houses is necessary, but to the protection of the hospital from destruc-
 tion by fire; for, strange to say, pest-houses,  although isolated from
 all other buildings, and not in any way peculiarly exposed to the ac
 tion of the elements, are of all others,  in my experience, the most
liable to destruction by fire.  The neighbors, not near ones, of almost
every building used  as a  pest-house, think  it no crime to apply the
torch of  the  incendiary to the humble structure.
   This had been the constant experience in Scott county, each suc-
NATIONAL LIBRARY  OF MEDICINE
      BETHESDA  14, MD. 
10
ceeding year bringing its quota  of detached  cases of small-pox, the
advent of each creating the ever-recurring panic, with its search for a
new pest-house, and the inevitable big bill of expenditure for nurse-
hire, provisions, transportation, etc., amounting in some cases to hun-
dreds of  dollars.
   Tired of this state of  affairs, the supervisors of Scott county and the
Mayor and council of the city of Davenport, entered into a contract
with the Mother Superior of the  Sisters of Mercy, at Mercy Hospital,
for the care and treatment of all such cases of small-pox, and other
contagious diseases, as might in the future be admitted into that hos-
pital.  The agreement in brief, striking some  details, was as follows;
viz.,
   Lease of ground for twenty-one years; city and county may  renew
the lease, or may remove the building, having twenty days to do so.
   Compensation :  Three ($3.00) dollars per day of twenty-four hours,
provided,  that when any patient shall be provided with medical attend-
ance by second party  (the Sisters), then the sum of  five ($5.00) dollars
per day [in addition to the said three  ($3.00) dollars] shall be paid for
said medical attendance.  That said five ($5.00) dollars additional shall
at no time be paid for more than two (2) patients at a time; but such
additional sum of------, not to exceed in any one case more than four
($4.00) dollars per day, shall cover all charges for medical attendance;
and in case there is one or more such patients in said hospital, then a
male nurse is to be furnished  by  the  first party (city and county), as
above stated.
   Bedding, etc., to be cleaned for future use, if  practicable, to be fur-
nished by the city.
   A joint appropriation of $2,500, by the supervisors of Scott county
and the Mayor and council of Davenport, was then made for the build-
ing and equipment of the said hospital.
   I drew the plans of the building needed, and these, after their ap-
proval by the Medical Board of Mercy Hospital, were followed in the
construction.
   A fine site was found, sufficiently near the main  hospital for con-
venience of attendance  and administration, and  for the protection of
the building  against  incendiarism; and sufficienty  remote to  afford
ample protection to all parties.   This site was  on the  declivity of a
hill, but near the summit, thus affording excellent drainage, both sur-
face and otherwise, and, as will be seen from the accompanying plates 
11
having  all  the  well-known advantages of a hill-side  barn.   After
making the excavation, it was tile-drained, and a drain of broken stone
put just outside of  the foundation wall, on three sides; this wall is of
stone (ashler), but the  division walls of the basement and the  chim-
neys are of  brick.
  The upper structure  is of  wood (frame, with tarred paper under the
weather-boards), and the whole building has a total length of 70 feet,
with a width of  20  feet in the wings and of 26 feet in the central por-
tion, this projecting six feet, thus affording a hall  or vestibule, which
contains the stairs ascending to the attic, and those descending to the
basement.   These are all inside measurements.
  The wings have  a height to the eaves, in front of 12 feet, in the
rear of  20 feet, and to the ridge (from the top of the basement wall),
of 20 feet;  the central part  has a height to the eaves  of 18 feet,  and
to the ridge of  29 feet (from  top of basement wall).  There are
twenty-four windows, fourteen of which have eight (8) 14x20 panes of
glass; eight (in the  basement) have eight (8) 14x14 panes, and the re-
maining two, those of  the attic, smaller ones.  The fourteen windows
of the main floor are all provided with weights and pullies, and, also,
with inside  shutters, which  are not painted, but varnished.
  The whole wood-work had two coats of paint, and the floors of the
wards and of the central room, after being oiled, had three coats of
paint.
  The ground floor, which is entered from the rear by a door one or two
steps  above  the ground, contains three rooms, two  end ones of  18x24
feet, and a central one of 20x24 feet;  the  two former are  not floored
or otherwise finished, but it  was intended, at some future time, to erect
a bin at the end of  one for the storage of  dry earth, to be used  in the
earth-closets, with which the wards are  provided; and, also, in a con-
venient corner, near one of  the chimneys, a chamber for the disinfec-
tion of  clothing by dry heat.
  The central room is intended for kitchen and laundry,  being sup-
plied with water  from  a cistern, a pump, a sink, cooking-stove and a*p-
pliances. It was floored over, but this was a mistake, the flooring should
have been of concrete, which laid  over  a  drained  surface makes the
best floor for such a room.
  In the lower corner of the hospital  lot, which is enclosed by a board
fence, a small privy is built,  over a vault provided  with an over-flow
pipe leading further down the hill, and  into  cultivated ground; into
this vault or cesspool all the waste water is led. 
12
  As there is no other water supply than that afforded by the cistern,
water-closets were out of the question; however, a very cheap and ef-
ficient  substitute was  found in the  Wakefield earth-closet, one of
which was placed in each ward.
  In the attic is a room of 18x20 feet, separated from the head of the
stairs by a landing.   There is here sufficient lodging room for two or
three attendants. On the main floor is the main room,  reached by a
small flight of steps from the ground level in front, through a hall or
vestibule 6x20 feet.   This room needs no particular description, being
furnished with a table and a few chairs, and may be used as a dining,
sitting or convalescent room.
  Coming now to the essential  part of the structure, we have  two
wards of 18x24x10 feet; each ward has a door leading  from  the cen-
tral room, and five windows, with one so  situated that either five or
seven beds (see  Plate I, Fig. 2), may be conveniently arranged.  This
would seem at first sight to limit the maximum capacity  of  the hos-
pital to fourteen beds, but when we treat of the peculiar  mode of ven-
tilation used, it will be readily seen that at any emergency this num-
ber of  beds may be safely increased.
  The  walls of  the wards, after having been plastered and  hard-fin-
ished in the usual manner, were  tinted of a  delicate shade  of color,
pleasant to the eye.
  Before applying the last coat, I made  a most  diligent  search for
something to produce an impervious  and glass-like surface, visiting
several newly built hospitals for the purpose, but in vain.  The best
that can be done with such walls is to frequently  scrape and white-
wash them; but I am satisfied that  the proper wall, especially  for a
small-pox ward, is one with a surface impervious as glass, which should
be kept constantly moistened with a dilute solution of glycerine, thus
catching all germs, debris,epithelial scales, pus corpuscles, indeed all solid
particles, and preventing their rebound into the air-space of the room; at
intervals, the crop  of contagious particles thus gathered  might be
wiped off with sponges and  destroyed.
  The  wards are heated by Galton fire-places  or grates, one of which is
placed  at the rear end of each ward, in the division wall.  Now, these
fire-places will not heat the incoming air more than 30° or 40° Fahren-
heit, and are, therefore, in very cold weather, to be supplemented by
stoves, holes and thimbles for the pipes of which  are placed in the
chimneys;  but for eight months of the year  the heat afforded by the
Galton grates would  be sufficient. 
13
  Now, I may here pause to remark, one of the great beauties of this
system of ventilation, which is that, no matter how  close, on  a cold
winter night, the nurse may make every crack or crevice, where fresh
air might enter, as is their wont,  or how red-hot he may make  the
stove, the proper ventilation of the ward will proceed as long as any
fire is kept up in the grate, which the  attendant is  always likely  to
have for his own greater comfort, and the increased convenience  of
boiling water, making tea and other drinks over an open  fire.   Find-
ing (in 1876) no Galton fire-places were to be had in this country; I pro-
cured two made in Cincinnati, which answered the purpose very well; I
may here remark, in passing, that Galton grates and an excellent Amer-
can modification of them may  now be  had in New  York.   These
grates are built into the chimney (see Plate n, Fig. 3)—this is a very
delicate job and requires an expert in the  building  of fire-places and
chimneys—and are of iron,  but have a lining of  fire-clay.  From  the
throat of this grate an iron pipe  (see Plate n, Fig. 2  p.) rises some
ten (10)  feet,  (just  above the  ceiling  C),  terminating in  a flue,
which runs the remainder of the  chimney, and should  terminate in a
cap (but does not in the present instance).
  The air, admitted from the outside at the base of structure A, is
warmed by contact with the heated sides and back F of the grate, then
after being still further heated by surrounding the iron pipe in its ascent,
is delivered into the ward from a lowered  opening or register R, placed
just beneath the ceiling C.  The end rooms of the ground floor being
vacant and unused, the air is taken  at present from them, but in case
of their occupation, it would be necessary to lead a  pipe  outside  (see
Plate n, Fig. 3 a).
  I have purposely left the subject  of  ventilation to the last, as the
most important, the most essential  feature, the sine qua non of good
hospital construction.
  On this subject Dr. Elisha Harris says (Public  Health Reports, vol-
ume 1, page 114):

  At his side stand the masters in hygiene and surgery, and in the words of John
Simon, all unite in the statement that,  " So thoroughly does a hospital depend for
its usefulness on the capacity of its wards for the most exquisitely perfect ventila-
tion, that in all plans of hospital construction this is the one cardinal virtue to be
insisted on.  The ventilation must be such as shall leave  no corner unsearched by
its current." 
14
  Surgeon Billings, U. S. A., in his " Notes on Hospital Construction "
(Public Health Reports, volume 2, page 386,), says of  the Galton-fire-
place :

  If  carefully made and adjusted, such a fire-place (a double one) has been found
by experiment to satisfactorily heat a room of 48x25x12 feet, and to ventilate it at
the rate of 40,000 cubic feet of air per hour (i. e., to renew the air of such a room
every twenty minutes), the external temperature being at the freezing point.

  Another author says :
  The open fire-place (he is speaking of the common  open fire-place,  and his
remarks apply with double force to the Galton, which not only removes the foul,
but brings in fresh air,) sweeps the air of the room by removing 12,000  cubic feet
per hour (he is speaking of a small room), every portion of which is charged with
organic debris of  every kind, from the inert  particles of the floor, bedding and
clothes, to the epithelial scales, and pus corpuscles, the carriers, it may be, of actual
contagion.
  It is customary to speak of allowing 1,000 cubic feet of space to each patient, but
if the air is renewed as contaminated by respiration and transpiration, 300 cubic
feet per hour would  suffice.—Billings'1  Notes on Hospital  Construction, Public
Health Reports, vol. 2, p. 387.

  Our ward of  18x24x10 feet would give a cubic space of about 4,000
cubic feet (4,320), which, for five persons would give a cubic  space of
800 cubic feet of air, and a square surface of 86  square  feet  to each;
but, as will be seen below, the air would be renewed  five (5) times per
hour, or every twelve (12) minutes.
  Captain Galton's estimates are as follows :
Size of the room being.............................  6,357 cubic feet.
Air changed per hour..........................31,784 cubic feet#
Requiring sectional area of smoke-pipe...........  140 solid inches.
Requiring sectional area of cap-pipe..............   70 solid inches.
Requiring sectional area of fresh-air flue..........  400 solid inches.

  Now, if these elements are  preserved  in  the construction of the
ward (and they are, excepting  the chimney-cap), it would  give just
20,000 cubic feet of air renewed per hour, and the cubic contents being
4,000 cubic feet, would make five times per hour, or every twelve min-
ute, as stated.
  Ridge ventilation of the wards was not  attempted, and for  the fol-
lowing reasons :  In our climate it is  impracticable  in  winter; it  is
always under the control of  the nurse, who invariably closes it when 
15
most  needed, /. *»., at night; and, finally, in  summer it is not needed,
for the end and side  windows  would give ample  ventilation, if there
was any wind blowing, and, if the air was calm, a small  fire  burning
in the grate (with the air-duct closed) would soon renew the air.
  Not having the bills at hand, I cannot state exactly what each item
cost, but the total expenditure was $2,500.   This included the  whole
outlay for the building, painting, plastering, plumbing, the  purchase
of a cooking stove with the  necessary kitchen utensils (including a
large  boiler), tables, chairs, twelve iron bedsteads  with beds  and bed-
ding,  and, finally, the erection of two  lightning-rods made  of  three-
fourths-inch iron rods  welded together  (planted each in a small well
reaching to  the wet subsoil and filled with powdered coke) and  reach-
ing some distance above the top of each chimney.
  I have thus attempted to show how a small hospital in every way
adapted to the treatment of cases of small-pox, or of any other con-
tagious  or  infectious disease,  may be  constructed at a comparatively
small cost.
  This plan of a small  hospital is not  presented as a model or typical
one, but merely as a suggestion, in the hope that it may stimulate and
in some degree assist in the erection of some such  hospitals in various
quarters of  the State, where,  as every  one must admit, they  are very
greatly needed.
  The accompanying plates will  be soon published  in the small-pox
circular of the State Board of Health,  and can be procured by any one
on application. 
 
 
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