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THE FREEMASONS HOSPITAL

ON Wednesday of this week the King opened thenew Freemasons Hospital at Ravenscourt Park,Hammersmith. The Brotherhood have long desireda larger and better hospital than the one in Fulham-road, but the late war postponed any realisation oftheir hopes. At the same time, if the new hospitalhad been built even five years ago it could not havecome 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 thehelp of nature in the process. Thus the design iscalculated to give the maximum amount of light, air,and cleanliness. All the roofs are flat; the window-spaces are enormous, in the modern plan of massesof horizontal rectangular panes. One of the most

striking features of the building is a number of greatprojecting semi-circular sun balconies. The landingsare lighted by shafts of glass running sheer from groundto roof. The buildings are surrounded by lawns andbeds of flowers, and the site, although only aboutfive miles from Harley-street, is almost rural, forRavenscourt Park gives it an open outlook on twosides, and the upper windows look out to the opencountry of Hounslow Heath and the Surrey hills.The hospital consists of four blocks built in cubical

masses of red brick. The main entrance is on the eastside, opposite the park, in the administration block,which is T-shaped with the head of the T parallel withthe road. Opening off the large main hall, with itsdedication stone, are passages leading to the numerousoffices, dining-rooms for typists and doctors, waiting-rooms and cloak-rooms necessary in the running of thehospital. On the first floor are the resident doctors’bedrooms and sitting-rooms, the reception-room, and theboard-room, with two roofed terraces. Above are theflats of the matron and assistant matron, and highest ofall 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-bedwards. 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, sothat 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 front of the Administration Block.

audible signal. Each ward has a fitted basin and tubularsteel furniture. Each group of wards has a sluice-room,with a cascade sink for bottles and an automatic washingcabinet for bed-pans, and each floor of each wing has itsown kitchen fitted with hot cupboards, milk boiler, and

One of the sun porches of the ward block.

gas stove, where simple meals can be prepared and wheremost of the food arrives by lift for distribution. A sisteris in charge of each floor and sits in a room open to thecorridor, containing the medicine and poison cupboards,and the switch which adjusts the strength of the broad-casting.The children’s wards are on the third floor, with wide

4P - -- - -1 I- - I --’ - I- - - -root terraces, and the kItcheneand food stores are on thetop floor, where they can

neither be heard nor smelt.Special kitchens are devotedto kosher food for Jewishpatients and to the pre-paration of special diets. Thenurses have comfortablerooms for their use on dutyand in their short intervalsof leisure, but at present

. they have to walk over fromthe nurses’ home in Fulham-road. One of the chief needsof the hospital is its ownnurses’ home, and this willshortly be supplied. Theward block has a system oflight signalling by which anymember of the staff can besummoned to the telephone.From the back of the ward

block a passage opens intothe small annexe block, whichcontains the boiler rooms andthe ambulance reception hall,and behind that again isthe electrical and surgicalblock. The ground floor of

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this block is filled with the staff dining-rooms, kitchens,and pantries ; on the first floor are the radiological andphysiotherapy departments, and on the second the

operating theatres. The radiological department has notyet been fitted up, but it will have the largest installationof 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 ofelectric bath, apparatus for light treatment, and a

gymnasium for remedial exercises. These two depart-ments 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 betweenthe two groups are a plaster-cast theatre and an X raytheatre. The surgeon undresses in a cloakroom withfitted basins and shower-bath, puts on a sterile change ofclothing and walks into the anteroom where he scrubs upand finds his gown, mask, and gloves, and where hisinstruments are ready prepared for him; he walksthrough to the operating theatre and meets the patient,who has come from the anaesthetic room. After work heleaves his iheatre-dress in the anteroom and goes backto his own dressing-room. This floor contains specialtheatres for ear, nose, and throat work, eye work, dentistryand the like, and rooms for surgeons and staff. Thesterilisers are fed from the central boilers, and are of the

enclosed type, which has not been seen much in thiscountry but which is very comfortable in use. Before

they are opened a tap is turned and the chest is floodedwith cold water to condense the steam and cool theinstruments to handling temperature.The whole building is almost fireproof, but is equipped

with elaborate fire-fighting appliances. Fire-alarm buttonsare placed at suitable points and show a red light andsound a buzzer in the quarters of all responsible officials,though no alarm is given to the patients. The hoses areof small size, capable of being handled by women, andtwo chemical extinguishers are kept in each hose cupboard.The steam supply for the whole hospital is generated atone point. The boilers are oil-fired, and the hospital isheated by vapour, circulated by means of vacuum pumps.There are 14 electric passenger lifts, including two specialbed-lifts, with self-levelling devices at every floor. Aunique feature is an emergency button which, if a liftstops between floors through electrical failure, will allowit to be moved to the next floor. In addition there arelifts for food, supplies, soiled linen, soiled dressings, andX ray photographs.

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The architects are Sir John Burnet, Tait and Lorne,and the total cost of the hospital has been about335,000. The chairman of the medical advisorycommittee is Sir D’Arcy Power.

PUBLIC HEALTH SERVICES

Malnutrition in ChildrenTHE early reports for 1932, reviewed in this column

on June 17th, gave an impression that " malnutritionin school-children is not common, but its comparativerarity must be due to the many active measurestaken to combat it." Those that have reached ussince then bring out the fact that school medicalofficers of different localities see very different aspectsof this problem.Some of them, perhaps -the majority, do not think

it necessary to comment at all on unemploymentand its effect on children ; nor do they record anyspecial measures for supplementing diets. Othershave evidently given careful consideration to the

situation, but do not lay much emphasis on damageresulting from pure poverty. Thus Dr. A. W.Forrest states that subnormal nutrition is not an

important, nor very common, defect among Leytonschool-children. ;‘ For the most part, these casesare due to a temporary derangement of health,a hereditary factor, unsuitable dietary, or in a fewcases insufficient food," Dr. J. A. M. Clark reportsthat in Walsall there is as yet little evidence thatmalnutrition exists to any extent. The problemto-day, he says, is no new one ; it is a problem notso much of insufficient as of improper food.A third and large group of reports mention increases

in feeding at schools and express more or lesssatisfaction with the results. The following are

examples :-,EDINBURGH (Dr. John Guy).-Measurements of height

and weight continue to, show a general upward trend andthe diminution in children with bad nutrition is alsonoteworthy. 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 thefree food roll. Under the milk scheme 5025 childrengot a daily ration, on payment, of Grade A (T.T.) milk,and 342 got free milk because, despite free meals, theystill seemed to be too poorly fed to profit by the educationoffered. (A recent inquiry into the physical conditionof 77 Edinburgh families revealed no cases in whichthere was undernourishment because of lack of means ;see THE LANCET, July 8th, p. 98.)NUNEATON (Dr. P. G. Horsburgh).—There is no pro.vision of milk under the Education Act (Sections 82-b5),

but the education committee have a scheme for supplyingmilk during school hours to those who need it. This hasdone much good and is of great benefit to the selectedchildren.EDMONTON (Dr. H. W. Harding).-Unemployment is

marked in the district and is reflected in the amount ofmilk granted by the maternity and child welfare com-mittee and the number of free meals to necessitous childrenunder the arrangements made by the education com-mittee. With regard to the former, the restriction madeduring 1931 was still in force-namely, that milk shouldbe given to mothers only who are in regular attendanceat the welfare centres. The number of free meals toschool-children was over 56,000 in 1931 and nearly 113,000in 1932.KETTERING (Dr. C. B. Hogg).-Only two definite cases of

malnutrition were found during the year. This smallnumber, notwithstanding the increased amount of -’ unem-ployment, 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 hasarranged for the provision of free milk (fresh and dried),or milk at half cost, to necessitous cases in which the familyincome 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. " Whetheror not this is due to the milk in school’ schemes cannotdefinitely be assessed. I think it is, but whatever the causethe result is one which we are glad to record; as showingthat the nutrition of the school-children in Warrington isnot suffering in these times of economic stress."LANCASHIRE (Dr. J. J. Butterworth).-The percentage

of children showing malnutrition at the routine inspectionswas 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 rollof the elementary schools. The selection for free meals ismade on an economic basis in accordance with a scalefixed in 1929. During the year it was found necessaryto allocate a further sum of JE5000 in the estimates forthe cost of free meals, and the expenditure under this.heading is now at the rate of 25,000 per annum. "Itis quite evident that the expenditure of this money hasbeen of considerable value in keeping down the percentageof malnutrition to the low figures ascertained for this andthe previous year, if the routine groups may be regardedas a fair sample of the whole." " It would appear thatthe health of the elementary school-children has notbeen adversely affected to any noticeable extent by thisdepression."