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The front elevation of the hospital showing the chapel in the foreground surmounted by a winged victory holding theblazing torch of St. Dunstan’s. Behind is the camp bounding the parking ground, the roof of the main entrancebeing just visible. The large projecting bays on the 2nd, 3rd, 4th and 5th floors form the western ends of thecentral corridors and admit a large amount of light and air.

ST. DUNSTAN’S WAR HOSPITAL

A YEAR- ago St. Dunstan’s completed a new con-valescent home on the South Downs near Rottingdean.The home has now been converted into a war hospitalfor eye casualties in the Navy, Army, Air Force, FireBrigade, and Police, and can accommodate nearly 200patients. Its commandant is Mr. R. C. Davenport,F.R.C.S., one of the surgeons to Moorfields, and, withits own staff supplemented by Moorfields nurses, itforms a complete specialised hospital unit.The hospital is ideally situated, perched high above

and within 200 yards of the main coastal road thatruns between Brighton and Rottingdean, whence it isapproached by a long and rather steep drive. The

lay-out is designed to provide the greatest possibleamount of light and fresh air, and anyone approachingthe hospital is immediately struck by the huge amountof window space. The uninitiated might ask what isthe point of so much light in a building intended forblind people; but the beneficial effects of light andfresh air are as important for the blind as the sighted,and blind people often retain some consciousness oflight, in which case the more light the better. Further,so long as St. Dunstan’s remains a war hospital, therewill be many casualties who will not be blind.The hospital faces west and is completely isolated,

there being no building within half a mile of it.It has an extensive and uninterrupted view over theEnglish Channel and is entirely surrounded by grassand arable land. It is composed of six stories andresembles an aeroplane in shape. The nose and fuse-lage are represented by a projecting block containingthe main entrance hall, and above that are long corri-dors between the wards, which run at right angles onsucceeding floors and form the wings of the plane.Behind the wards is a second projecting block, whichrepresents the body and tail of the plane. This partis occupied by the quarters for orderlies, maids, nurses,and senior staff on successive floors, and on the topfloor are the kitchens.

THE INTERNAL PLAN

In more detail, the ground floor is occupied by alarge entrance hall flanked by cloak-rooms and lava-tories and with lifts facing the entrance. Outside theentrance and on the same level there is a large openspace for parking cars. The first or main floor is

occupied by administrative offices, which face the sea;behind them a wide hall leads to the serving-room,and so on. At right angles to the hall are a largelounge and dining-room and rooms for instruction inbraille and typing. These latter rooms open on eachside on to a wide terrace with a roof but otherwise

open to the air, where the men can get exercise withoutleaving the home. On this floor, too, are rooms formedical and surgical examination and treatment,with a small temporary operating-theatre. Leadingoff the north side of one of the terraces has beenplaced the new operating-block provided by LordNuffield.

The central part of the second, third, and fourthstories is given up to wards. The second and thirdfloors each contain two wards of 21 beds, one on eachside of a central corridor. On the fourth floor theaccommodation is partly broken up into small wardsof 2 or 4 beds, which can be used, if necessary, forofficers. There are therefore 126 beds on these threefloors. On the fifth floor are rooms for instruction intrades. The sixth floor’is now used as a winter gardenbut can be converted into two wards, each holding 21more beds; and, if to this number are added 4 beds ina small sick bay on the second floor (which was pro-vided for the convalescent home) and the extra bedsthat could be placed in the big wards, there is a totalof nearly 200.One ward of 21 beds is kept ready for immediate

occupation by casualties. The other beds are largelyoccupied by St. Dunstan’s pensioners, of whom about80 are in residence. These men could all be evacuatedif the pressure on beds for war casualties became

urgent, and preparations for such an emergency havebeen made. If the hospital became filled with warcasualties a far larger surgical outfit would be neces-

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sary, and Lord Nuffield has given E7000 to pay for thenew operating-block which has been added to thebuilding. This is on the main floor and will be in fullworking order, supplied with every surgical require-ment, such as anaesthetic room, sterilising room, andX-ray rooms, in about two weeks. There are two new

operating-theatres, one planned for ophthalmic workand another for general surgery. Experience in the lastwar showed that a great deal of surgery other thanophthalmic was needed for many blinded men. Whenthis block is opened, the present theatre and adjoiningrooms will be used as a dispensary and outpatients’room, together with a room for minor surgicaltreatment.

Arrangements for the comfort of patients in thewards are admirable. Generous space is allowed for eachpatient. There is a spacious locker for the patients’belongings on one side of each bed and a large

The main approach to the hospital showing the large park-ing ground and the chapel below. The actual entranceis hidden by the projection of the main building.

" compactum " for clothes on the other. Above eachbed is a grid which admits warm air, and each bed isprovided with wireless ear-phones. At one side of thebed is a rug securely fastened to the floor. Nearlyhalf the ivall space is occupied on both sides by win-dows which can be opened at will. No occupied wardis left unattended, and the orderly on duty is providedwith a room at the end of the ward, where he sleepsat night. When the beds are occupied by war casual-ties there will be nurses in constant attendance, andthe orderly’s room will probably be occupied by asister.From the point of view of a convalescent home for

the blind, the visitor will be impressed by the in-genuity and care that has been bestowed on the safety,convenience and comfort of the blinded inmates. Forinstance, in the entrance hall is an embossed model ofthe hospital and its interior accommodation, sufficientlylarge and detailed to enable the blind man, by runninghis fingers over the various parts and aided by simpleinstructions, to form an idea of how things are

planned and where things are. All the floors are

modelled on exactly the same plan, so that havingonce mastered the geography of one floor, he is masterof the whole. Everything is arranged on the " keepto the right " principle. Handrails guide him alongcorridors to doorways and staircases. When a dooris reached, he opens it by a long handle let into thedoor. He cannot get knocked by the door after he hasopened it because its return swing is carefullyretarded, nor can he bump into the sharp edge of the

door or get his fingers jammed, because the twohalves of the door are lined by rubber " Dunlopillo "

cushioning. On the staircase the handrail guides himto self-closing swing gates which open both ways andwarn him that he is on the edge of the stairs. Thesegates are in two halves, acting independently, so thatthe man cannot collide or interfere with anybody goingin the opposite direction. Still grasping the handrailon his right he arrives at the bottom or top of thestaircase, as the case may be, and then, projectingfrom the rail, he finds studs which tell him which floorhe has reached.

The dining-hall and lounges where the men

congregate and meet their friends are extremely com-fortable. Here come the " Good Companions," an

organisation of ladies who come each day to take menout for walks and help to amuse them. Whensummer comes there will be a tunnel under the mainroad to take the men to the cliff and thence to thebeach without any danger of being run over. In thewinter there are entertainments every evening in thelounge or the winter garden. In front of thebuilding, on a lower plane than the entrance hall, isthe chapel, where regular services are held. RomanCatholics use the small chapel on the fifth floor.

Precautions have been taken regarding fire andair-raids. There is a second relief staircase openingon to each floor, and on the landings are stirruppumps and buckets of water and sand. When thehospital’s siren sounds, everybody will take refugein a heavily protected shelter in the basement, fittedwith lavatories and other accessories in case of a

prolonged stay.

A YEAR OF MENTAL HEALTH

THE report of the Board of Control for 1938’ 1

records that the position in the mental hospitals at thebeginning of 1939 was better than the board hadfeared. The total number of patients on the civilregisters was 133,596. Accommodation was increasedby 2259 beds and the aggregate overcrowding wasreduced by 600 to 2993. The death-rate fell from7 per cent. to 6’47 per cent. and an increase in directadmissions of 545 was more than counterbalanced byan increase of 1628 in the discharges and departures.On the other hand, an aggregate deficiency of nearly3000 beds is serious and the diversion of buildinglabour to defence purposes has delayed new construc-tion. If the death-rate remains at its present lowlevel, overcrowding is likely to increase again duringthe next three years, and there is no immediate pros-pect of any substantial increase in bed accommodation.For the second year in succession the discharges anddeaths from the L.C.C. mental hospitals exceed theadmissions. While this is probably the result ofefforts to secure earlier treatment, the figures do notrepresent recoveries only, since a number of voluntarypatients have discharged themselves unrecovered.As the result of a questionnaire on treatment by

insulin, Cardiazol and Triazol, the board find that thesehave been used at 92 institutions. Of 3531 completedcases 81.4 per cent. received cardiazol, 13.5 per cent.insulin, and 5.1 per cent. the combined treatment.Remissions occurred in 30.9 per cent. sufficient toenable them to leave hospital after treatment; 19 percent. improved but not enough to leave hospital. Until

1. The twenty-fifth annual report of the Board of Control forthe year 1938. Part I. 1939. H.M. Stationery Office, YorkHouse, Kingsway, W.C.2. Pp. 80. 1s. 6d.