- Email: [email protected]
THE FREEMASONS HOSPITAL
151
THE FREEMASONS HOSPITAL
Wednesday of this week the King opened the Freemasons Hospital at Ravenscourt Park, Hammersmith. The Brotherhood have long desired a larger and better hospital than the one in Fulhamroad, but the late war postponed any realisation of their hopes. At the same time, if the new hospital had been built even five years ago it could not have come up to its present standard. The aim has been to make the building an expression of the need to cure the patients and also to enlist the help of nature in the process. Thus the design is calculated to give the maximum amount of light, air, and cleanliness. All the roofs are flat; the windowspaces are enormous, in the modern plan of masses of horizontal rectangular panes. One of the most striking features of the building is a number of great projecting semi-circular sun balconies. The landings are lighted by shafts of glass running sheer from ground to roof. The buildings are surrounded by lawns and beds of flowers, and the site, although only about five miles from Harley-street, is almost rural, for Ravenscourt Park gives it an open outlook on two sides, and the upper windows look out to the open country of Hounslow Heath and the Surrey hills. ON
audible signal. Each ward has a fitted basin and tubular steel furniture. Each group of wards has a sluice-room, with a cascade sink for bottles and an automatic washing cabinet for bed-pans, and each floor of each wing has its own kitchen fitted with hot cupboards, milk boiler, and
new
consists of four blocks built in cubical of red brick. The main entrance is on the east side, opposite the park, in the administration block, which is T-shaped with the head of the T parallel with the road. Opening off the large main hall, with its dedication stone, are passages leading to the numerous offices, dining-rooms for typists and doctors, waitingrooms and cloak-rooms necessary in the running of the hospital. On the first floor are the resident doctors’ bedrooms and sitting-rooms, the reception-room, and the board-room, with two roofed terraces. Above are the flats of the matron and assistant matron, and highest of all are the quarters of the cooks and food supervisor. The back of the administration block opens into the ward block, which is U-shaped and five floors high. This building contains 120 single-bed wards and 20 four-bed wards. These rooms are decorated in quiet green colours ; they are sound-proof and beautifully lighted ; each patient has his own bell-push, set in a rubber ball, so that he can keep it in bed, a plug for wireless head-phones, and a bed-light. The bell gives a visible as well as an The
hospital
masses
One of the
sun
porches of the ward block.
gas stove, where simple meals can be prepared and where most of the food arrives by lift for distribution. A sister is in charge of each floor and sits in a room open to the corridor, containing the medicine and poison cupboards, and the switch which
adjusts
casting. The children’s wards
are on
the
strength
the third 4P - -- - -1
root
of the broad-
wide floor, with - I- - - -
I- - I --’
terraces, and the kItchene and food stores are on the
The front of the Administration Block.
top floor, where they can neither be heard nor smelt. Special kitchens are devoted to kosher food for Jewish patients and to the preparation of special diets. The nurses have comfortable rooms for their use on duty and in their short intervals of leisure, but at present . they have to walk over from the nurses’ home in Fulhamroad. One of the chief needs of the hospital is its own nurses’ home, and this will shortly be supplied. The ward block has a system of light signalling by which any member of the staff can be summoned to the telephone. From the back of the ward block a passage opens into the small annexe block, which contains the boiler rooms and the ambulance reception hall, and behind that again is the electrical and surgical block. The ground floor of
152 this block is filled with the staff dining-rooms, kitchens, and pantries ; on the first floor are the radiological and physiotherapy departments, and on the second the operating theatres. The radiological department has not yet been fitted up, but it will have the largest installation of the kind in the country. The generators will be capable of an output to the tubes of 5 amperes. The physiotherapy department is fitted with many kinds of electric bath, apparatus for light treatment, and a gymnasium for remedial exercises. These two departments are the only ones admitting out-patients. The surgical floor shows much ingenuity of design. There are two groups consisting of anaesthetic rooms, operating theatre, and sterilising rooms, and between the two groups are a plaster-cast theatre and an X ray theatre. The surgeon undresses in a cloakroom with fitted basins and shower-bath, puts on a sterile change of clothing and walks into the anteroom where he scrubs up and finds his gown, mask, and gloves, and where his instruments are ready prepared for him; he walks through to the operating theatre and meets the patient, who has come from the anaesthetic room. After work he leaves his iheatre-dress in the anteroom and goes back to his own dressing-room.This floor contains special theatres for ear, nose, and throat work, eye work, dentistry and the like, and rooms for surgeons and staff. The sterilisers are fed from the central boilers, and are of the
enclosed type, which has not been seen much in this country but which is very comfortable in use. Before they are opened a tap is turned and the chest is flooded with cold water to condense the steam and cool the instruments to handling temperature. The whole building is almost fireproof, but is equipped with elaborate fire-fighting appliances. Fire-alarm buttons are placed at suitable points and show a red light and sound a buzzer in the quarters of all responsible officials, though no alarm is given to the patients. The hoses are of small size, capable of being handled by women, and two chemical extinguishers are kept in each hose cupboard. The steam supply for the whole hospital is generated at one point. The boilers are oil-fired, and the hospital is heated by vapour, circulated by means of vacuum pumps. There are 14 electric passenger lifts, including two special bed-lifts, with self-levelling devices at every floor. A unique feature is an emergency button which, if a lift stops between floors through electrical failure, will allow it to be moved to the next floor. In addition there are lifts for food, supplies, soiled linen, soiled dressings, and X ray photographs. ’
The architects are Sir John Burnet, Tait and Lorne, and the total cost of the hospital has been about 335,000. The chairman of the medical advisory committee is Sir D’Arcy Power.
PUBLIC HEALTH SERVICES Malnutrition in Children THE early reports for 1932, reviewed in this column on June 17th, gave an impression that " malnutrition in school-children is not common, but its comparative rarity must be due to the many active measures taken to combat it." Those that have reached us since then bring out the fact that school medical officers of different localities see very different aspects of this problem. Some of them, perhaps -the majority, do not think it necessary to comment at all on unemployment and its effect on children ; nor do they record any special measures for supplementing diets. Others have evidently given careful consideration to the situation, but do not lay much emphasis on damage resulting from pure poverty. Thus Dr. A. W.
Forrest states that subnormal nutrition is not an nor very common, defect among Leyton
important,
school-children. ;‘ For the most part, these cases are due to a temporary derangement of health, a hereditary factor, unsuitable dietary, or in a few cases insufficient food," Dr. J. A. M. Clark reports that in Walsall there is as yet little evidence that malnutrition exists to any extent. The problem to-day, he says, is no new one ; it is a problem not so much of insufficient as of improper food. A third and large group of reports mention increases in feeding at schools and express more or less satisfaction with the results. The following are
examples
:-,
EDINBURGH (Dr. John Guy).-Measurements of height and weight continue to, show a general upward trend and the diminution in children with bad nutrition is also noteworthy. Last year the education committee supplied, during the session, 1,176,634 dinners to scholars. The daily number of children, at the close of the session, receiving the meal was 6221 of whom 4720 were on the free food roll. Under the milk scheme 5025 children got a daily ration, on payment, of Grade A (T.T.) milk, and 342 got free milk because, despite free meals, they still seemed to be too poorly fed to profit by the education offered. (A recent inquiry into the physical condition of 77 Edinburgh families revealed no cases in which there was undernourishment because of lack of means ; see THE LANCET, July 8th, p. 98.) is no pro. vision of milk under the Education Act (Sections 82-b5),
NUNEATON (Dr.P. G.Horsburgh).—There
but the education committee have a scheme for supplying milk during school hours to those who need it. This has done much good and is of great benefit to the selected
children. EDMONTON (Dr. H. W. Harding).-Unemployment is marked in the district and is reflected in the amount of milk granted by the maternity and child welfare committee and the number of free meals to necessitous children under the arrangements made by the education committee. With regard to the former, the restriction made during 1931 was still in force-namely, that milk should be given to mothers only who are in regular attendance at the welfare centres. The number of free meals to school-children was over 56,000 in 1931 and nearly 113,000 in 1932. KETTERING (Dr. C. B. Hogg).-Only two definite cases of malnutrition were found during the year. This small number, notwithstanding the increased amount of -’ unemployment, is no doubt due to the provision of, milk ii) school and meals at the school canteen centre. ’I BURY (Dr. G. Granville Buckley).—The corporation has arranged for the provision of free milk (fresh and dried), or milk at half cost, to necessitous cases in which the family income comes within the limits of a prescribed scale. During 1932 many more applications were received. WARRINGTON (Dr. G. W. N. Joseph).-No deterioration in the nutrition of the child has been observed. " Whether or not this is due to the milk in school’ schemes cannot definitely be assessed. I think it is, but whatever the cause the result is one which we are glad to record; as showing that the nutrition of the school-children in Warrington is not suffering in these times of economic stress." LANCASHIRE (Dr. J. J. Butterworth).-The percentage of children showing malnutrition at the routine inspections was 1-55 (compared with 2-16 in 1930 and 1-48 in 1931). The children in receipt of free meals or milk, cod-liver oil, &c., form about 7-75 per cent. of the children on the roll of the elementary schools. The selection for free meals is made on an economic basis in accordance with a scale fixed in 1929. During the year it was found necessary to allocate a further sum of JE5000 in the estimates for the cost of free meals, and the expenditure under this. heading is now atthe rate of 25,000 per annum. "It is quite evident that the expenditure of this money has been of considerable value in keeping down the percentage of malnutrition to the low figures ascertained for this and the previous year, if the routine groups may be regarded as a fair sample of the whole." " It would appear that the health of the elementary school-children has not been adversely affected to any noticeable extent by this
depression."
THE FREEMASONS HOSPITAL
Wednesday of this week the King opened the Freemasons Hospital at Ravenscourt Park, Hammersmith. The Brotherhood have long desired a larger and better hospital than the one in Fulhamroad, but the late war postponed any realisation of their hopes. At the same time, if the new hospital had been built even five years ago it could not have come up to its present standard. The aim has been to make the building an expression of the need to cure the patients and also to enlist the help of nature in the process. Thus the design is calculated to give the maximum amount of light, air, and cleanliness. All the roofs are flat; the windowspaces are enormous, in the modern plan of masses of horizontal rectangular panes. One of the most striking features of the building is a number of great projecting semi-circular sun balconies. The landings are lighted by shafts of glass running sheer from ground to roof. The buildings are surrounded by lawns and beds of flowers, and the site, although only about five miles from Harley-street, is almost rural, for Ravenscourt Park gives it an open outlook on two sides, and the upper windows look out to the open country of Hounslow Heath and the Surrey hills. ON
audible signal. Each ward has a fitted basin and tubular steel furniture. Each group of wards has a sluice-room, with a cascade sink for bottles and an automatic washing cabinet for bed-pans, and each floor of each wing has its own kitchen fitted with hot cupboards, milk boiler, and
new
consists of four blocks built in cubical of red brick. The main entrance is on the east side, opposite the park, in the administration block, which is T-shaped with the head of the T parallel with the road. Opening off the large main hall, with its dedication stone, are passages leading to the numerous offices, dining-rooms for typists and doctors, waitingrooms and cloak-rooms necessary in the running of the hospital. On the first floor are the resident doctors’ bedrooms and sitting-rooms, the reception-room, and the board-room, with two roofed terraces. Above are the flats of the matron and assistant matron, and highest of all are the quarters of the cooks and food supervisor. The back of the administration block opens into the ward block, which is U-shaped and five floors high. This building contains 120 single-bed wards and 20 four-bed wards. These rooms are decorated in quiet green colours ; they are sound-proof and beautifully lighted ; each patient has his own bell-push, set in a rubber ball, so that he can keep it in bed, a plug for wireless head-phones, and a bed-light. The bell gives a visible as well as an The
hospital
masses
One of the
sun
porches of the ward block.
gas stove, where simple meals can be prepared and where most of the food arrives by lift for distribution. A sister is in charge of each floor and sits in a room open to the corridor, containing the medicine and poison cupboards, and the switch which
adjusts
casting. The children’s wards
are on
the
strength
the third 4P - -- - -1
root
of the broad-
wide floor, with - I- - - -
I- - I --’
terraces, and the kItchene and food stores are on the
The front of the Administration Block.
top floor, where they can neither be heard nor smelt. Special kitchens are devoted to kosher food for Jewish patients and to the preparation of special diets. The nurses have comfortable rooms for their use on duty and in their short intervals of leisure, but at present . they have to walk over from the nurses’ home in Fulhamroad. One of the chief needs of the hospital is its own nurses’ home, and this will shortly be supplied. The ward block has a system of light signalling by which any member of the staff can be summoned to the telephone. From the back of the ward block a passage opens into the small annexe block, which contains the boiler rooms and the ambulance reception hall, and behind that again is the electrical and surgical block. The ground floor of
152 this block is filled with the staff dining-rooms, kitchens, and pantries ; on the first floor are the radiological and physiotherapy departments, and on the second the operating theatres. The radiological department has not yet been fitted up, but it will have the largest installation of the kind in the country. The generators will be capable of an output to the tubes of 5 amperes. The physiotherapy department is fitted with many kinds of electric bath, apparatus for light treatment, and a gymnasium for remedial exercises. These two departments are the only ones admitting out-patients. The surgical floor shows much ingenuity of design. There are two groups consisting of anaesthetic rooms, operating theatre, and sterilising rooms, and between the two groups are a plaster-cast theatre and an X ray theatre. The surgeon undresses in a cloakroom with fitted basins and shower-bath, puts on a sterile change of clothing and walks into the anteroom where he scrubs up and finds his gown, mask, and gloves, and where his instruments are ready prepared for him; he walks through to the operating theatre and meets the patient, who has come from the anaesthetic room. After work he leaves his iheatre-dress in the anteroom and goes back to his own dressing-room.This floor contains special theatres for ear, nose, and throat work, eye work, dentistry and the like, and rooms for surgeons and staff. The sterilisers are fed from the central boilers, and are of the
enclosed type, which has not been seen much in this country but which is very comfortable in use. Before they are opened a tap is turned and the chest is flooded with cold water to condense the steam and cool the instruments to handling temperature. The whole building is almost fireproof, but is equipped with elaborate fire-fighting appliances. Fire-alarm buttons are placed at suitable points and show a red light and sound a buzzer in the quarters of all responsible officials, though no alarm is given to the patients. The hoses are of small size, capable of being handled by women, and two chemical extinguishers are kept in each hose cupboard. The steam supply for the whole hospital is generated at one point. The boilers are oil-fired, and the hospital is heated by vapour, circulated by means of vacuum pumps. There are 14 electric passenger lifts, including two special bed-lifts, with self-levelling devices at every floor. A unique feature is an emergency button which, if a lift stops between floors through electrical failure, will allow it to be moved to the next floor. In addition there are lifts for food, supplies, soiled linen, soiled dressings, and X ray photographs. ’
The architects are Sir John Burnet, Tait and Lorne, and the total cost of the hospital has been about 335,000. The chairman of the medical advisory committee is Sir D’Arcy Power.
PUBLIC HEALTH SERVICES Malnutrition in Children THE early reports for 1932, reviewed in this column on June 17th, gave an impression that " malnutrition in school-children is not common, but its comparative rarity must be due to the many active measures taken to combat it." Those that have reached us since then bring out the fact that school medical officers of different localities see very different aspects of this problem. Some of them, perhaps -the majority, do not think it necessary to comment at all on unemployment and its effect on children ; nor do they record any special measures for supplementing diets. Others have evidently given careful consideration to the situation, but do not lay much emphasis on damage resulting from pure poverty. Thus Dr. A. W.
Forrest states that subnormal nutrition is not an nor very common, defect among Leyton
important,
school-children. ;‘ For the most part, these cases are due to a temporary derangement of health, a hereditary factor, unsuitable dietary, or in a few cases insufficient food," Dr. J. A. M. Clark reports that in Walsall there is as yet little evidence that malnutrition exists to any extent. The problem to-day, he says, is no new one ; it is a problem not so much of insufficient as of improper food. A third and large group of reports mention increases in feeding at schools and express more or less satisfaction with the results. The following are
examples
:-,
EDINBURGH (Dr. John Guy).-Measurements of height and weight continue to, show a general upward trend and the diminution in children with bad nutrition is also noteworthy. Last year the education committee supplied, during the session, 1,176,634 dinners to scholars. The daily number of children, at the close of the session, receiving the meal was 6221 of whom 4720 were on the free food roll. Under the milk scheme 5025 children got a daily ration, on payment, of Grade A (T.T.) milk, and 342 got free milk because, despite free meals, they still seemed to be too poorly fed to profit by the education offered. (A recent inquiry into the physical condition of 77 Edinburgh families revealed no cases in which there was undernourishment because of lack of means ; see THE LANCET, July 8th, p. 98.) is no pro. vision of milk under the Education Act (Sections 82-b5),
NUNEATON (Dr.P. G.Horsburgh).—There
but the education committee have a scheme for supplying milk during school hours to those who need it. This has done much good and is of great benefit to the selected
children. EDMONTON (Dr. H. W. Harding).-Unemployment is marked in the district and is reflected in the amount of milk granted by the maternity and child welfare committee and the number of free meals to necessitous children under the arrangements made by the education committee. With regard to the former, the restriction made during 1931 was still in force-namely, that milk should be given to mothers only who are in regular attendance at the welfare centres. The number of free meals to school-children was over 56,000 in 1931 and nearly 113,000 in 1932. KETTERING (Dr. C. B. Hogg).-Only two definite cases of malnutrition were found during the year. This small number, notwithstanding the increased amount of -’ unemployment, is no doubt due to the provision of, milk ii) school and meals at the school canteen centre. ’I BURY (Dr. G. Granville Buckley).—The corporation has arranged for the provision of free milk (fresh and dried), or milk at half cost, to necessitous cases in which the family income comes within the limits of a prescribed scale. During 1932 many more applications were received. WARRINGTON (Dr. G. W. N. Joseph).-No deterioration in the nutrition of the child has been observed. " Whether or not this is due to the milk in school’ schemes cannot definitely be assessed. I think it is, but whatever the cause the result is one which we are glad to record; as showing that the nutrition of the school-children in Warrington is not suffering in these times of economic stress." LANCASHIRE (Dr. J. J. Butterworth).-The percentage of children showing malnutrition at the routine inspections was 1-55 (compared with 2-16 in 1930 and 1-48 in 1931). The children in receipt of free meals or milk, cod-liver oil, &c., form about 7-75 per cent. of the children on the roll of the elementary schools. The selection for free meals is made on an economic basis in accordance with a scale fixed in 1929. During the year it was found necessary to allocate a further sum of JE5000 in the estimates for the cost of free meals, and the expenditure under this. heading is now atthe rate of 25,000 per annum. "It is quite evident that the expenditure of this money has been of considerable value in keeping down the percentage of malnutrition to the low figures ascertained for this and the previous year, if the routine groups may be regarded as a fair sample of the whole." " It would appear that the health of the elementary school-children has not been adversely affected to any noticeable extent by this
depression."