The Construction of Hospitals for the Insane


* Chapters 1 - 10

Chapter I
Chapter II
Chapter III
Chapter IV
Chapter V
Chapter VI
Chapter VII
Chapter VIII
Chapter IX
Chapter X

* Chapters 11 - 20

Chapter XI
Chapter XII
Chapter XIII
Chapter XIV
Chapter XV
Chapter XVI
Chapter XVII
Chapter XVIII
Chapter XIX
Chapter XX

* Chapters 21 - 30

Chapter XXI
Chapter XXII
Chapter XXIII
Chapter XXIV
Chapter XXV
Chapter XXVI
Chapter XXVII
Chapter XXVIII
Chapter XXIX
Chapter XXX

* Chapters 31 - 40

Chapter XXXI
Chapter XXXII
Chapter XXXIII
Chapter XXXIV
Chapter XXXV
Chapter XXXVI
Chapter XXXVII
Chapter XXXIX
Chapter XL

* Chapters 41 - 50

Chapter XLI
Chapter XLII
Chapter XLIII
Chapter XLIV
Chapter XLV
Chapter XLVI
Chapter XLVII
Chapter XLVIII
Chapter XLIX
Chapter L

* Chapters 51 - 60

Chapter LI
Chapter LII
Chapter LIII
Chapter LIV
Chapter LV
Chapter LVI
Chapter LVII
Chapter LVIII
Chapter LIX
Chapter LX

More to come...


THE frontispiece, Plate I, represents the elveation of a hospital for two hundred and fifty patients, being the plan adopted in 1856, for the Department for Males, of the Pennsylvania Hospital for the Insane at Philadelphia, when it was decided to increase its accommodations by the erection of a new hospital, and to provide for the separation of the sexes. This building gives ample accommodations for the specified number of patients, for the officers of the institution, and for all persons employed about the establishment. Such a building is calculated for one or both sexes, but this was planned specially for a single sex, as there was a hospital of similar size and general character, and for the same number of patients of the other sex already on the premises; and the plan was regarded as equally well calculated for a State or corporate institution. This particular form of building was adopted, mainly because the tract of land on which it was to be placed, did not admit of the extent of structure required for the linear plan, originally proposed in the first edition of this book.

The building consists of a basement and two principal stories in every part, except the extreme portions, intended for the more excited class of patients, which are of only one story. The ventilating shafts terminate on the projecting portions of the wings and in the central dome. The first range of wings on either side of the centre building, is separated from it by a fireproof space ten feet wide, with movable glass sashes on each side of the passage way, and the same arrangement is made where the next range comes in contact with the first. This gives all the space that is required for light and the free circulation of air between the different wards, and yet keeps up the proper proximity and all desirable facilities for passing from one part of the hospital to another, without exposure or loss of time, or unnecessary labor. This arrangement, as already said, will be seen to give eight distinct wards for each sex, exclusive of some additional provision for very noisy or violent patients at the extreme end of each one-story building, or for sixteen classes if only one sex is treated in the building.

Plate II is the ground plan of the building shown in the frontispiece, and is opposite to it. It will be seen that the second section of the wings passes off at right angles from the first, and that the more excited class of patients are accommodated in one-story structures with rooms only on one side of the corridors, and that these are connected with spacious yards, open in front, from which there is a fine view of the adjacent grounds. Between these yards, are the dining-room and workshop. This one-story building on each side is intended to accommodate four distinct classes of the more excited patients, exclusive of the six rooms on the small cross halls, making two more classes for those who are specially violent, noisy, and destructive. This arrangement permits what is so very important in all wards containing excited patients—their division into very small companies—the mingling of the large numbers of this class being very subversive of good order, and often detrimental to individual patients, especially when the cases are recent.

The first stone of this hospital was laid on the 7th of July, 1856, and it was opened for the reception of patients on the 27th of October, 1859. It is situated on the western side, and in full view of the building previously in use, at a distance in a right line of 648 yards, and in the midst of fifty acres of pleasure grounds and gardens, the whole of which are surrounded by a substantial stone wall, of an average height of ten and a half feet, the top of which is covered with flagging. The gate of entrance is on an avenue 100 feet wide.

The hospital faces the west, and consists of a centre building, with wings running north and south, making a front of 512 feet; of other wings, connected with each of those just referred to, running east a distance of 167 feet, all three stories high, and these last having at their extreme ends communications with extensive one-storied buildings. All the exterior walls are of stone, stuccoed, and those of the interior are of brick.

This arrangement gives provisions for the accommodation of sixteen distinct classes of male patients in this building, as the same number of classes of females are providd for in that previously in use. Each one of these sixteen wards has, besides the corridors for promenading and the chambers of the patients and attendants, a parlor, a dining-room, a bath-room, a water-closet, a sink-room, a wash-room, a drying-closet, a storeroom for brushes and buckets, a clothes-room, a dumb-waiter, a dust-flue, and a stairway by which persons can pass out of doors or to the centre building, as may be desired, without communication with the other wards; and each room in the building, almost without an exception, has a flue, communicating with the fresh-air duct from the fan, for warm or cool air, according to the season, and with the main ventilating trunks which terminate in the various ventilators on the roof of the building.

The centre building is 115 by 73 feet. It has a handsome Doric portico of granite, in front, and is surmounted by a dome of good proportions, in which is placed the iron tanks from which the whole building is supplied with water. The lantern on the dome is 119 feet from the pavement, and from it there is a beautiful panoramic view of the fertile and highly improved surrounding country, the Delaware and Schuylkill rivers, and the city of Philadelphia, with its many prominent objects of interest. In the basement or first story of the centre building is the main kitchen, 42 by 24 feet, in which are improved arrangements for cooking: a scullery, 24 by 11; two storerooms, each about 20 by 22 feet; a trunk-room, 24 by 12 feet; a general clothes-room, a bread-room, a dining-room for the officers, another for the domestics, a lodging-room for the seamstress, another for the supervisor of the basement, a stairway to the main story, a dumb-waiter leading from the kitchen to the cellar, and another to the upper rooms of the centre building. The cellars under the centre building, bsides containing the hot air-chambers for that division of the house, have three distinct rooms for storage, which are ventilated by means of flues leading out through the roof of the house. In front of the basement story, and under the steps and adjoining roadway, are the vaults for coal for the kitchen and bake-room, and the ice-house, the latter being ventilated, like the cellars, and carts are unloaded into both, through openings in the blue stone flagging, which forms the roadway upon the arches below it. Adjoining the ice-house is a small apartment, with stone shelves for keeping food cool in summer; and alongside of the coal-vault is a space for the offal from the kitchen. There is also a small kitchen near the scullery, intended for the superintendent's family, or for making dishes for the sick, whenever it is required for either of these purposes. In one of the storerooms is a dark apartment, and in another the tanks for the oxygen and hydrogen gases for the dissolving apparatus used at the evening entertainments.

On the second or principal story is the lecture-room, 42 by 24 feet, in the lecturer's table of which, water, steam, and gas, for experimental purposes, have been introduced. It also contains commodious cases for apparatus, a black board running on a track behind the cases, and a smooth surface, 24 by 18 feet, at its eastern end, on which the dissolving views are shown. On the opposite side of the main corridor is a reception room for visitors, and a room for visits to patients by their friends, each being 24 by 23 feet. There are also on this floor two small rooms for more private visits, the medical office, 24 by 14 feet, with a small storeroom, containing a sink, etc., adjoining; the lodging-room for the assistant physician having charge of the medical office, which is also that of the steward, 24 by 20 feet; a manager's room, 24 by 19 feet, which is also the principal physician's private office; a parlor, 24 by 19 feet, for the use of the officers of the house; and a fireproof room, 11 by 9 feet, in connection with the general business office. In the third story front are four fine rooms, each 24 by 21 feet; a corridor, 42 by 16 feet, shut off from the adjoining portion by a ground-glass partition, a bath-room, water-closet, and clothes-closets, for the use of the family of the superintending physician. There are also on this floor, chambers for the steward and matron, for the senior assistant physician, three others that may be used as deemed expedient, and a room, 24 by 11 feet, lighted from the roof, and intended for a general storeroom for the bedding and other dry goods not actually in use.

The main corridors of the centre building, running east and west are sixteen feet wide; those running north and south, in which are the stairways, lighted from the roof, are twelve feet wide.

The height of the ceiling of the basement story in the centre building and of all parts of the wings and one-storied buildings, except the upper story of the wings, which is one foot more, is twelve feet. The ceilings in the second or principal, and in the third story of the center, are eighteen feet high.

The wings on each side of the centre building are almost exactly alike, except that on the south side in front, in the basement immediately adjoining the centre, is the ironing-room, 28 by 11 feet, with a drying-closet attached, 11 by 11 feet, and in the rear, the small kitchen already referred to, and the lodging-rooms of the female domestics, giving them the great comfort and advantage of having their apartments near their work; while on the north side, in corresponding positions, are the bake-room, the baker's store and lodging-rooms, and the lodging-rooms of the hired men not employed in the wards. On this floor, on each side of the centre, is also a museum and reading-room, 42 by 14 feet, and accessible either from the grounds or from the inside of the building, two work-rooms for the patients, two lodging-rooms for persons employed in the work-rooms, a bath-room for the officers and another for the domestics, two water-closets, etc. The portion of the wing just described is shut off from the adjoining part (which constitutes the fifth or infirmary ward) by a thick ground glass partition; this ward having in it a large room, 29 by 24 feet, with a bath-tub and water-closet in a recess, another 24 by 14 feet, a third 23 by 11 feet, and five rooms 11 by 9 feet, a bath-room, drying-closet, and all the other conveniences already mentioned as forming a part of each ward. These apartments and arrangements, making the infirmary wards, are intended for patients who are particularly ill, and who require special quiet and seclusion, where they may be visited, if deemed expedient, by their friends, without annoyance to others, or interference with the discipline of the house.

Besides the fifth ward, just described, and which is on the first floor, there are on each side of the centre two other stories, each of which constitutes a ward, and with all the conveniences already referred to. The rooms are arranged on both sides of the corridors, which are twelve feet wide, and have their extreme ends mostly filled with glass; while wherever one wing joins another, or a wing joins the centre building, there is entirely across it an open space for light and air, eight feet wide, glazed with small sash from near the floor to the ceiling; and in the middle of each ward, on one side, is a similar open space. These spaces may be decorated with flowering plants, birds, small jets of water or other objects of interest, which, in excited wards, may be guarded by ornamental wire-work, or they may be used as sitting rooms for thepatients. Each story of the return wings makes a ward similar to those just described.

Passing from the return wings into the supervisor's office, the one-storied buildings are reached. Each of these has provision for twenty-six patients and six attendants, and every arrangement for their comfort. The rooms are here on one side of a corridor ten feet wide, and at the end of each of those running towards the east is a cross hall, in which are three rooms intended particularly for patients who from any cause may require special seclusion. One of the main halls may be used for dining, and the other as a sitting-room. Between the dining-halls of these two wards (the seventh and eighth), and made private by sliding doors, are four rooms intended for excited patients, who have special attendants. Opposite these last is a room 110 by 14 feet, with an arched ceiling 15 feet high, with skylights and windows out of reach, intended to be used in one part as a dining-room, and in the other as a kind of gymnasium or work-room, and accessible either from the adjacent garden and yards, or directly from the wards; and in the story below this—mainly under ground—is a room of the same size, in which are two fine bowling-alleys, with reading-tables, etc. Both these rooms may be well lighted with gas, and warmed by steam-pipes, so that they can be comfortably used in the evening as well as by day, and in all kinds of weather.

The arrangement of these one-storied buildings makes for each two very pleasant yards, in size 110 by 54 feet, surrounded by broad flagstone pavements, and having grass in the centre, with an open iron palisade in front, giving a distinct, though sufficiently distant view of two of the most travelled roads in the vicinity. This permits for each one-story building five classes of excited patients, exclusive of the three rooms at the extreme ends already referred to. There is also a yard, 343 by 72 feet, adjoining eah sixth ward, fitted up as the others, and planted with shade-trees. Brick pavements also surround the entire building, making, with those just referred to and those in front, a continuous dry walk of 6152 feet, exclusive of more than a mile of board walks, on the grounds.

The height of the ceilings throughout the building, and the size of the parlors and of all the rooms in the centre building, have already been given. The ordinary size of the patients' lodging-rooms is 9 by 11 feet, while there are others in each ward of a much larger size, some of which have communicating doors,and are intended for patients who desire a parlor as well as a chamber, or for those having special attendants. The parlors in the first and third wards are 33 by 24 feet, and in the second, fourth, and sixth they are 23 by 30 feet. The dining-rooms are generally 23 by 17 feet. The bath-rooms are mostly 9 by 11 feet. Sixteen rooms in each one-storied building have water-closets in them, firmly secured to the floor, and with a strong downward draught. The sides of doors and windows in patients' rooms are generally rounded, by being built of brick made expressly for the purpose, and smoothly plastered.

As already stated, the entrance to the hospital is from an avenue 100 feet wide. The gatekeeper's lodge has two comfortable rooms on the north, while on the opposite side of the gateway is a pathological room, and another for tools used about the grounds. Brick paths on either side of the main roadway lead to the centre building, and the space in front, planted with evergreen and ornamental trees, and having a fountain in the central grass-plot, is 325 by 175 feet. From the front platform eight steps lead up to the vestibule, and seven steps inside of the building to the level of the principal floor. Visitors passing into the centre building may go out upon a pleasant balcony on its eastern side, and overlook the improvements in that direction, but they cannot pass through the grounds.

Ten steps descend from the roadway to the pavement around the basement, which, except immediately at the front of the centre, where it is surrounded by a wide area, with sodded banks, is everywhere above ground.

There is also a gate on Market Street, near the engine-house, used for bringing in coal or other heavy articles, and another on the eastern side of the grounds, for the use of the officers of the hospital only.

The engine-house, 71 feet from the nearest point of the hospital building, is a substantial stone structure, 70 by 64 feet, and two stories in height. The character of the ground is such that carts are driven into the second story to discharge the coal directly into the vaults below, and the level of the railroad in the cellar of the hospital brings it upon the second floor of the engine house.

The first story, on the level of the ground on its southern and eastern sides, has vaults capable of containing near 500 tons of coal. Adjoining these vaults is the boiler-room, 30 by 17 feet, opening into the engineer's work-room, in which are placed lathes, grindstones, pipe-cutting machines, etc., driven by the engines in the engine-room, which is 23 by 19 feet in size, and separated from the last by a glass partition; while further west, also separated by glazed windows and doors, is the fan-room and the tower for supplying fresh air to the main duct, which leads from it, through the entire building. The height of ceiling in this story is 17 feet, and it is arched over the engine-room and the engineer's work-room, so as to give a proper support to the stone floor of the room above. In the second story of this building, into which the railroad passes, is the wash-room, 27 by 24 feet; the room for assorting and folding clothes, 24 by 14 feet; the mangle-room, 43 by 8½ feet; the drying-closet, occupying a space 26 by 13 feet; a water-closet; and a large room over the coal-vaults and boilers, surrounded by movable blinds, and intended for drying clothes without the use of artificial heat, for making soap, etc.

The carpenter shop, 36 by 50 feet, is of frame, two stories high, and 45 feet from the engine-house, from which steam may be taken for warming it in the winter. It has two rooms below, and a single large one above.

The carriage-house and stables make a neat stone structure, 57 by 36 feet, and two stories high. It has accommodations for six horses and as many cows, and for the carriages required for the different purposes of the institution. The lower floor is of cement, brick, or blue stone. The piggery is in the yard in the rear of the stables, and there is a carriage-yard in front, both being surrounded by a stone wall, and supplied with hydrants and other conveniences.

The other arrangements correspond so nearly with what have been detailed as essentials in the preceding pages, that it does not seem necessary to give a description of most of them.

There is no fire used in any part of the hospital for heating, although provision for open fires has been made in all parlors and in many of the other large rooms, should such an arrangement ever be deemed desirable. The only fires kept up in the building are those in the kitchens, bake and ironing-rooms.

In the boiler-room at the engine-house there are three large tubular boilers. Each of these has a furnace 5 feet 3 inches wide by 5 feet 3 inches long, and 7 feet 4 inches high. The shell is 17 feet 8 inches long by 4 feet 6 inches in diameter, the combustion chamber is 4 feet long, and there are 98 tubes 2½ inches in diameter and 11 feet long. The total heating surface for each boiler is 744 square feet. The grate surface is 20¾ square feet. The escaping gases enter a common flue, and the draft can be regulated by a damper at the back end of each boiler, or the supply of air graduated by a register in the ash-pit door.

These boilers furnish steam for warming the entire hospital, for driving all the machinery, for pumping water, and for ventilation, washing, cooking, etc. They are so arranged that one or all may be used at pleasure, either for heating or driving the machinery. The steam is carried from them in a five-inch welded iron pipe, and after reaching the hospital building, it is distributed in eighty-three air-chambers, placed in its cellar, with direct flues leading from them to the apartments above. The gases from the boiler fires pass through an under-ground flue, four feet wide and six feet high, ascending 31 feet in its course, till it comes at a distance of 557 feet, to the foot of the main chimney, which rises 78 feet above the surface of the ground. The chimney is built double, the interior being round, formed of hard brick, without pargeting, six feet in diameter in the clear from bottom to top, the latter being formed of cast-iron, while the foundation is of pointed stone-work to a height of eleven feet, and the remainder of pressed brick. The under-ground flue alluded to, contains the main steampipe until it reaches the nearest point of the building, and also that portion of the branch steampipe which is carried to the north section of the hospital. This flue is immediately over the main culvert.

This chimeny is made the ventilating power for securing a strong downward draught of air through all the water-closets, urinals, sinks, and bath-tubs in the entire establishment, and for this reason it is placed in a central position on the eastern side of the building.

The coils for heating are composed of welded iron pipes, three-quarters or one inch in diameter, and are in two sections in all the air-chambers, so that one or both may be used, according to the severity of the weather.

In the engine room are two horizontal high-pressure steam-engines, of fine finish. They are exactly alike, each having a cylinder 10 inches in diameter, and a stroke of 24 inches. They are so arranged that either may be substituted for the other, and one may be made to do the work of both in case of emergency. Ordinarily one drives the fan, and is therefor a part of the ventilating apparatus, while the second drives all the other machinery. The fan, of the Washington pattern, is of cast-iron, its extreme diameter being 16 feet, and its greatest width 4 feet, receiving air on both sides, through openings 12 feet in diameter. It is driven directly from the shaft of the engine, and its revolutions vary from 30 to 60 per minute, according to the requirements of the house. The fresh air is received from a tower, 40 feet high, so that all surface exhalations are avoided, and is then forced through a duct, which at its commencement is 8½ by 10½ feet, into the extreme parts of the building. From the cold air-duct, openings lead into the different warm air-chambers, which in the one-storied buildings are covered with slate, but in all other parts of the hospital these chambers and air-ducts are arched with brick, laid with smooth joints. The warm air in nearly all cases is admitted near the floor, and the ventilators open near the ceiling, always in the interior walls. The only exception to this arrangement is in the one-storied buildings, where, in the patients' rooms, the warm air is admitted above, and the ventilators are taken off near the floor. All the ventilating flues terminate in the attic in close ducts, either of brick or wood, smoothly plastered, increasing in size about thirty per cent. more rapidly than the capacity of the flues entering them, and by which, through the different belvederes on the roof, they communicate with the external atmosphere. In the centre building the ventilation is through the main dome.

All the cooking is done in the central kitchen, which has in it a large range, with three fires and three ovens, a broiler, a rotary roaster, a double iron steamer capable of containing ninety gallons, a smaller one, iron outside and copper-tinned on the inside, that will hold forty-five gallons, and six tin steamers for vegetables, besides the vessels for making tea and coffee. The food prepared in this room is put into closed tin boxes, which are lowered by a dumb-waiter to the car standing on the track of the railroad, under the kitchen, and which passes thence to each end of the building and to the engine-house, and it is thus conveyed to the bottom of the various dumb-waiters, which lead directly to the different dining-rooms above, of which, as before remarked, there is one for each ward. Each dining-room has a steam-table, with carving dishes on it, and abundant provision for keeping meats and vegetables warm as long as may be desired. The dumb-waiters are all controlled by the person having charge of the railroad; they are moved by a crank and wheel, and wire-rope is substituted for that commonly used.

The railroad is an indispensable part of the arrangements for distributing food. By its use a meal may be delivered in all the ward dining-rooms (eight in number) on one side—the extreme ones being 580 feet distant—in ten minutes after leaving the kitchen, or with one car, in all sixteen, in twenty-five minutes. It also forms a very vonvenient mode of transporting articles from one section of the building to another, of carrying clothing to and from the laundry, and the space occupied by it also gives a protected passage-way from the centre building to the engine-house, barn, and workshop, which persons visiting their friends in the room set apart for the purpose between the sixth and seventh wards, can pass through without interference with the patients or their apartments above.

Originally furnished with very complete pumping appratus, the hospital now receives its supply of water from the city reservoir on George's Hill, and of gas for lighting the building from the city gas works.

The importance of providing for the extinguishment of accidental fires, makes it proper to state, that, as already mentioned, no fires are required in the building for warming it, and that gas is used for lighting. Wherever one wing comes in contact with another, or with the centre building, all the openings in the walls, which extend up through the slate roof, have iron doors in addition to the ordinary wooden ones, and which may be closed at pleasure. The floors of the kitchen and bake-room, in which alone fire is used, are of German flagstone laid on brick arches, and all the stairways in the wings are fireproof. It is intended that there should always be about 20,000 gallons of water in the tanks in the dome of the centre building, and 15,000 gallons per hour may be placed there by pumping-engines, which are still kept ready for use. A standpipe connected with this reservoir passes into every story and into every ward, in all of which it is intended to have a piece of hose constantly attached, so that by simply turning a stopcock, water may be put on a fire almst as soon as discovered. A steam-pipe also passes up into the attic of each wing, and as one of the large boilers is constantly fired up, steam may at any moment be let into the building by simply turning a valve in the cellar. Hose is also kept near the steam-pumps, so that it may be promptly attached, and water thrown on the barn, carpenter shop, engine-house, and contiguous parts of the hospital. A watchman is constantyl passing through the house at night, and by means of two watch-clocks, there is no difficulty in ascertaining, not only how often the wards are visited, but almost the moment of each visit, and of course the time taken in passing from one ward to another.

The clothing, bedding, etc., collected in the different wards, after being sent to the cellar, are conveyed from that point by the railroad to the room for assorting clothes in the engine-house, and hence into the large wash-room, where, besides the usual washing, rinsing, and blue tubs and the soap vat, are various washing-machines, in which six different kinds of clothes can be washed at the same time, and a centrifugal wringer, all of which are driven by one of the steam-engines. From the wringer the washed articles are taken to the drying-closet, in which, by means of the heat derived from the exhaust steam from the engines, passing through a large amount of cast-iron pipe, and of fresh air from the fan, they are in a very few minutes made ready for the mangle (also driven by steam power), or folded and taken by the railroad to the ironing-room near the centre building, to which they are raised by the dumb-waiter already referred to, or are sent directly to the principal clothes room, from which they are distributed by the same route, as they may be required in the wards. All the divisions of the washing-machines, and of the rinsing and washing tubs, have hot and cold water and steam introduced directly into them, and the water from them all is carried off under the stone floor of the room to one of the iron columns below, through which it passes into the culvert on the outside of the building.

The amount of money paid on account of this building and its varied fixtures and arrangements, was $355,000. Of this total sum, $20,276.28 were for the boundary wall and gate-house, $2241.46 for the carriage-house and stabling, $800 for the carpenter shop, $4456.03 for machinery of different kinds, $23,612.37 for heating and ventilating apparatus, $15,201.47 for grading for the building, planting, and improving the grounds, and $10,441.73 for furniture, the latter being in addition to what was taken from the other building.

Before closing this notice of the Pennsylvania Hospital for the Insane, it may not be uninteresting to state that the completion of this new building allows the institution to carry out, under very favorable circumstances, what has for many years past been gradually gaining favor with some of the most experienced medical officers of American hospitals for the insane—a provision for the treatment of male and female patients in entirely separate buildings.

It is scarecly necessary to say that this arrangement in no way interferes with the humanizing influence for men, of suitable associations between the sexes; but intimacies of this kind between patients ought always to be guarded against. It certainly will be agreeable and profitable to all, that these influences should be exercised by those who are of sound mind and discreet demeanor, rather than by those whose impaired intelligence or want of self-control has compelled them to claim the benefits resulting from residence in the hospital. So far as I am aware, there is not a single advantage in having the two sexes when insane, in the same building, and it requires little observation to know that there are many and often not trifling disadvantages; while their separation will not only render the classification more complete, but permit for both the removal of many restrictions that could not otherwise be dispensed with.

So satisfactory has this building proved, that now, after twenty year' use, this plan would be repeated in all its details, with only a few slight modifications, these being simpy raising the building one more step from the ground, using cement in all the cellar walls, putting in an additional water-closet for each ward, securing a more absolute subdivision of the excited patients, in the one-storied buildings, so as to have at least four classes on each side unavoidably, instead of as now, possibly, and putting bay windows throughout the building at the ends and in the middle of the different halls.

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