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MOUNT VERNON HOSPITAL FOR CON-

SUMPTION, NORTHWOOD.

THE country branch of the Mount Vernon Hospital forConsumption has now been in actual working order forsome months and about 60 patients are constantly undertreatment. We therefore willingly availed ourselves of anopportunity of visiting the sanatorium and of inspecting thevarious buildings of which it is composed. The sanatorium

was designed by Mr. Frederick Wheeler, F.R.I.B.A., and issituated upon an estate of 104 acres near Batchworth Heath,Middlesex, a distance of some 16 miles from London. The

site is 375 feet above sea level, the soil being sand and graveloverlying chalk. The hospital is built on a southern slopeand provides for the treatment of 114 patients (57 male and57 female) and consists of eight separate buildings whichare connected by means of covered ways. We reproduce aplan (Fig. 1) which shows the relative positions of the

component parts of the sanatorium. The provision of suchcovered ways is highly commendable, for there are numerousobjections to having the kitchens, laundry, nurses’ apart-ments, and so on, entirely cut off from the wings in whichthe wards for the patients are contained.The largest and most important of the buildings is

Block A (Fig. 1) which may be termed the hospitalproper. It consists of a central block of three storeys,having a central tower, with the wards arranged in extendedwings on either side. This building has a south aspect andits length is 500 feet, the wings being placed at a slightangle. In the central portion of this block is situated theprincipal staircase. The ground floor comprises two con-sulting rooms, the dispensary staff dining room, and the

private apartments of the resident medical officer andmatron. Upon the first floor are the library and two readingrooms (for men and women respectively). The library is

rightly not accessible to the patients but the books are passedthrough hatchwavs into the reading rooms. On the upperfloor of this central block accommodation is provided for thehospital servants who each occupy a separate bedroom. Onthe north side of each wing and running throughout itsentire length is a well-lighted and ventilated main corridor,nine feet wide, paved with marble terrazzo and having a greenbrick dado, presenting a very pleasing appearance. Openingfrom this corridor there are on the ground floor in each wingthree large wards for ten beds each and three wards oontain-ing single beds. The wards have a cubic space of not lessthan 1400 feet per bed. They are lighted by large Frenchcasement windows which open, in the case of the groundfloor wards, on to a broad terrace extending along the wholesouth front of the hospital. Similar windows in the wardsabove open on to a balcony which also extends along thewhole south front and is set back several feet in order not tointerfere with the light and circulation of air on the terracebelow. These ward windows are fitted with latticed rollerblinds which form a good protection against wind and rain.Further ventilation is provided by means of hopper-hangwindows placed high up on the corridor side of the wards.Abundant access of fresh air is thus afforded. The walls ofall the wards are treated with distemper above dadoes whichare finished with Ripolin paint and the angles are, ofcourse, everywhere rounded. An excellent plan of heatinghas been designed by placing in the centre of eachward a specially arranged Teale stove with double fire-places. We were informed that this method answers

admirably.In addition to the wards already described there are four

isolation wards situated in spurs connected with the maincorridors by cross-ventilated passages. They can be entirelyshut off from the main wings and have separate externalentrances. In connexion with each are provided a nurse’skitchen and lavatory. This arrangement is most completeand will be found valuable in cases of unexpected develop-ments in the way of infectious diseases or complicationsnecessitating the isolation of patients. In having wardscontaining several beds this sanatorium differs from most ofthe more modern buildings in which each patient has aseparate bedroom. We were favourably impressed with theappearance of the wards. The space allotted is ample

and if a patient is confined to bed the sense of companion-ship, owing to other patients being in the same room, hascertainly something to commend the large-ward system.From a purely theoretical point of view separate bedroomsare to be preferred, and it will be interesting in future yearsto ascertain whether the use of separate rooms as opposed towards yields the more favourable statistics.

Connected with the main corridor by means of cross-ventilated passages are the sanitary spurs which are

centrally placed on each floor and in each wing and aresuitably fitted up with all modern appliances. A nurse’ssitting room and kitchen are also provided near the samespurs. In addition to the staircases for patients lifts areprovided in each wing. Large winter gardens are placed atthe extreme end of each wing and can be entered both fromthe terrace and from the main corridor. Patients are thusable to obtain exercise in bad weather by walking along theterrace, sheltered by the balcony above, through the wintergardens, along the corridor and back to the terrace again.As there are no wind screens in the grounds this pro-menade is found very convenient when the patients areunable to use the grounds. On the first floor thereis in each wing a recreation room. A piano is placedin each, also a billiard table for the men and a bagatelletable for the women. These recreation rooms are dividedfrom the reading rooms by glazed screens. Advantage hasbeen taken of a fall in the land to construct a subway underthe main corridor ; the lifts in connexion with the patients’staircases descend to the level of this subway, at the end off

which, under the winter garden on the men’s side, are placedthe pathological and post-mortem rooms. The pathologicallaboratory is admirably fitted up and provided with

appliances for research work. Block B, in which is situatedthe principal entrance, is the administration building andresidence of the honorary physician-in-charge. The adminis-trative department is placed on the ground floor and com-prises a large entrance hall, board room, secretary’s office,and other necessary rooms. Block C is the patients’dining hall and provides accommodation for about 250

persons. The patients sit at small tables, an arrangementwhich has several advantages. The hall is well lighted andventilated but is placed rather too near the main block.The Langfield system of heating has been adopted and thereis also a specially designed double Teale stove placed in thecentre of the hall. The building is connected with thekitchen (Block E) by a special service corridor in additionto the main covered way. Block E, the kitchen building,is, in view of the anticipated future extension of thehospital, larger than is necessary for the present purposes.The cooking arrangements are well devised and thelarder and store accommodation are ample. The milk roomcontains a 35 gallon steriliser. The nurses’ home (Block D)is also arranged in accordance with modern ideas. Eachnurse has her own separate bedroom and the night nurses’rooms are shut off from the rest of the rooms, so as toinsure quiet during the day. Block F is the stable buildingwhere in addition to the usual requirements there is a motorgarage for three cars. Block G is a building of considerablesize, the laundry and electrical plant being housed therein.The laundry occupies the whole of the first floor of the

building and is on a more extensive scale than would benecessary for an institution of this size, for here is carriedon the washing not only of the sanatorium but also for theparent hospital at Hampstead. All the linen articles andthe like are, of course, disinfected before being washed. It tis not necessary for us to give a detailed description of themachinery and methods employed. Suffice it to say that allthe arrangements are everything that can be desired andcould scarcely be improved either in completeness or

efficiency. The hospital is lighted throughout by electricity,the current being supplied from an extensive plant in

duplicate, which is housed in the lower portion of Block G.There are three engines which are coupled to three shuntwound dynamos of the multipolar type. The battery is ofthe " Hart" type, of 116 cells, and having a capacity of 540ampere hours when discharged at 60 amperes. Connectedwith Block G is an incinerator wherein are cremated allthe house refuse and sputum of the hospital.The water-supply is obtained from an artesian well which

has been specially sunk. The pumping plant, which isplaced in Block H, is designed to lift 2500 gallons of waterper hour from the borehole, about 4500 feet deep, into areceiving tank immediately under the floor of the pump-houseand thenoe to the reservoir tanks in the main building, the

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laundry, and other tanks. The provision for assuring a con-stant supply of hard and soft water is very elaborate and nofear need be experienced of a failure in this department. Incase of a breakdown or temporary failure of electrical powerarrangements have been made to work the pumps by steampower, in which case they would be connected by means ofauxiliary shafting to the steam engines in Block G. The

water softening plant is of the "Stanhope" type and iscapable of treating 10,000 gallons per day. The only reagent

well suited to the purposes of the building. By a happyselection of materials a good colour scheme has beenobtained. As regards the general decorative effect the wallsare faced with Luton grey bricks, with a proportion of redbricks indiscriminately introduced. The covered ways, too,are artistically built. When patients have to reside for somemonths in an institution of this kind their surroundings mustnaturally have an effect upon them. If an austere style isadopted a feeling of depression is likely to be produced but

FIG. 2.

The southern aspect of the Northwood Sanatorium.

used is lime and the plant includes its own motive gear, themixing being effected continuously by power taken from awater wheel driven by the water entering the apparatus.A complete system for the protection of the buildings from

fire has been installed and by means of call bells and tele-phones communication can be effected between the medicalstaff, matron, wards, and various administrative departments.The style adopted in designing the sanatorium (Fig. 2)

is a free treatment of Georgian, simple in character and

in designing this sanatorium Mr. Wheeler has adopted astyle of decoration which can only have a beneficial influenceon the inmates. Architecturally the winter gardens addmuch to the interest of the south front, while affording con-siderable shelter to the terrace. The terrace i paved withred tiles and bounded on the south side by a dwarf wall andpiers having simple moulded stone caps. Fligt ts of stepsopposite the entrances lead down to the level of the grounds.The chapel is situated within easy distance from the main

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building. It is simple in its architectural treatment, Gothic Iin its lines, and is satisfactorily ventilated. The drainage ofthe whole building has been carried out according to the mostapproved principles of sanitation and is connected with themain system of the district.One of the essential points in sanatorium treatment is that

due opportunities for systematic exercise should be affordedto the patients. The grounds of the Northwood institutionhave been well laid out for the purpose. The walks for themale and female patients have been kept entirely distinct.This is not always easy to do, but experience has shown thatit is by no means an unimportant detail. Another im-

portant matter is that suitable employment must be foundfor the patients, otherwise a few months’ enforced idlenesshas a demoralising effect on them. We noticed that someof the patients were occupied in gardening and doubtlessthis is one of the best forms of work for a tuberculousindividual to undertake. The grounds of a sanatorium con-stantly require attention and it is better that these dutiesshould be done by the patients rather than that help shouldbe procured from outside. The committee of the MountVernon Hospital may be congratulated on the possession ofa sanatorium which fulfils all the requirements for theeffectual treatment of pulmonary tuberculosis. It will alsoserve a second important duty-namely, to instruct the

patients how to conduct their lives when they return totheir occupations, both as regards themselves and in pre-venting the communication of the disease to others.

THE ARMY MEDICAL REPORT FOR 1903.

CONCLUDING NOTICE.1AT the close of our first notice there remained a few points

which had still to be touched upon. We have already calledattention to the prevalence of enteric fever among Britishtroops serving in India in connexion with the increasedamount of susceptible material arriving in the command inthe large drafts and reliefs coming from home and SouthAfrica. Before dismissing this subject altogether it mayperhaps be well to add that the special predisposition of theyoung soldier to contract enteric fever during his first yearof service in India has been noted in every report of theArmy Medical Department since 1872.The increase in the number of men of the most susceptible age will

account for an increase in the actual number of admissions and themore the cases the greater the probability of further infection; thiswas brought to notice in the report, for the year 1902 and is still furtherborne out by the reports for 1903. In 1901 there was a great diminu-tion in the number of men of the susceptible age and a retention inthis country of mature and seasoned soldiers and time-expired men;this was during war pressure and consequently the prevalence ofenteric fever was much reduced.

We notice that there were only 12 admissions with twodeaths from plague in 1903, against four admissions and onedeath in the previous year. Considering the terrible pre-valence of that disease among the native Indian populationthis says much for the prompt judgment and care with whichprophylactic measures were adopted and enforced in the caseof the troops.Malarial fevers formed, as usual in India, a main source of

sickness and inefficiency in 1903. It is noteworthy that ofrecent years there has been no recurrence of any greatcholera epidemic, about which we used to hear so much fromtime to time in the past, but the disease was neverthelesssomewhat more prevalent and fatal in 1903 than in 1902.

Returning, however, to that section of the report whichdeals with the United Kingdom the reader will find at pages30 and 31 some remarks, together with a table, showing thehealth statistics according to arms of the service ; that is tosay, the table gives the admissions, deaths, number of meninvalided, and number constantly sick from each arm of theservice, with the ratios per 1000 of strength. It will be seenthat the Foot Guards do not occupy a favourable position in1903 in respect of admission, invaliding, and constant

inefficiency rates as compared with other arms of the servicefor they head the list. As regards the rate of mortality theFoot Guards, while showing the lowest death-rate in 1903,took the second highest place in this respect in the previousyear-the regimental depots being in the unenviable posi-tion of first. In the Household Cavalry, on the other hand,the different rates are relatively low and contrast very favour-ably with those of the Foot Guards.

1 The first notice was published in THE LANCET of June 24th, 1905.p. 1740.

I Turning to the subject of recruiting for the army, the

report for 1903 is an elaborate compilation containing asusual a number of statistical tables and details. Thenumber of recruits inspected during the year was 69,553.Of these 22,382, or 321-80 per 1000, were rejected as

unfit and 47,171, or 678-20 per 1000, passed fit for theservice. 1022 of the latter were, however, subsequently dis-charged as unfit for service within three months of enlist-ment, thus making the total number of rejections equal to23,404, or a ratio of 336-49 per 1000.A comparison with the corresponding ratios of the previous

year (1902) shows an increase of 14’61 per 1000 in rejections.The various causes of rejection are classified and set forth intabular form at p. 43 of the report. Taken as a whole, theydisclose a very unsatisfactory state of affairs, for they point toa growing deterioration in the general physique of that por-tion, at any rate, of the population from which our armyis recruited. The subject is one of serious import and nevermore so than at the present time. Nor does itseem to usthat any Government has made an earnest attempt to getat the root of the matter. What has still to be recognisedgenerally is that we require an army which shall beexpansible at need by the cooperation of all classes athome and in the colonies. Can it be said that the Govern-ment has any really adequate grip of the situation ? The

antiquated and lingering dread of so-called "militarism"can only be regarded as an anachronism nowadays andin present circumstances. Allowing for any additionalcauses for rejection which have been introduced of late yearsand such as did not formerly exist, and for any increasedstringency on the part of medical examiners, can it be saidthat the War Office authorities have made the best use ofthe means at tiieir disposal for making an entrance into thearmy more attractive to the recruit ?

It is unfortunate that these army medical reports are

belated publications, for it naturally tends to rob them ofmuch present interest, but we suppose that for official reasonsthis is unavoidable. But we may say that, speaking generally,the report for 1903 is a more than usually good one.

ROYAL COLLEGE OF PHYSICIANS OFLONDON.

AN extraordinary Comitia was held on June 23rd, SirRICHARD DOUGLAS POWELL, Bart., K.C.V.O., the President,being in the chair.The following communications were received : 1. From the

secretary of the Royal College of Surgeons of England, report-ing certain proceedings of its Council on May llth. 2. Fromthe General Medical Council drawing the attention of theCollege to a list of rejections at recent competitions forcommissions in the Navy, the Army, and the Indian MedicalServices, indicating the licensing bodies from which therejected candidates obtained their qualifications. 3. Fromthe secretary of the Royal College of Physicians of Edinburghdenying that the College encourages the use of the titleof "doctor" by its licentiates, not being graduates inmedicine. 4. From the principal librarian of the NationalLibrary of Turin returning thanks for the books presented tothe library by the College in January last. 5. From theBoard of Education, forwarding papers, received throughthe Foreign Office, from the committee for organising a firstInternational Congress on Radiology and Ionisation to beheld at Liege on Sept. 12th to 14th next.The TREASUREH (Sir DYCE DUCKWORTH) exhibited to the

College certain relics of Dr. Edward Jenner which had beenpresented to the College by Sir Samuel Wilks. The thanks ofthe College were ordered to be communicated to the donor.A report was received from the College representative (Dr.

Norman Moore) on the General Medical Council on the pro-ceedings of the Conncil during its session in May last.A report, dated June 5th, from the committee of manage-

ment was received and adopted on the recognition of theMedical School at Cairo as a place of study for candidates forthe diplomas of the two Royal Colleges.A second report from the committee of management was

received and adopted recommending some additions to theregulations for the public health diploma.The REGISTRAR (Dr. E. LIVEING) moved that the following

by-law be enacted for the first time, viz. :-That Leonard Rogers, M.D.Lond., elected to the Fellowship on

April 27t.h, being resident in Calcutta. be admitted i?t absentid, anyby-law to the contrary notwithstanding.