Fort Pitt (Upper Hospital) 1858.
This Hospital consists of 4 blocks of wards, arranged in two lines, running from north-east to south-west. The blocks are 18 feet apart from each other, and the space between them in the middle is occupied by buildings, so that the whole Hospital has the form of the letter H. On either side of the middle line of the buildings is a small rectangular court, not yet open, but built across on the north-east side by structures connected with the Hospital, and on the south-west side by a wall. The space between the blocks of wards, instead of being left open for the thorough ventilation, is thus converted into two closed courts. The court, on the north-east side, is occupied by lavatories, births, water-closets, and covered passages, leaving only a small square yard in the centre. The south-west court contains in its centre a large cesspool, which had not been emptied within the memory of any one in the Hospital. At one end of this court are the water-closets, which are drained into this cesspool, and at the other end are some very offensive open privies.
The Hospital occupied high ground within the lines of Fort Pitt, on an area of about 3 acres. The ditches are deep, and there are no drainage outlets from the interior of the fort, so that all the filth and drainage of the establishment, except what is carted away at distant intervals from the privies, is allowed to percolate into the chalk.
The wards are arranged in pavilions, or blocks joined end to end, and have windows along the two opposite sides.
There are 8 wards, each 59 feet long, and 22 feet 9 inches broad; they are of different heights, 4 being 13 feet 8 inches high, and four 12 feet 8 inches high.
One ward is 23 feet 6 inches long, 19 feet 3 inches wide, and 12 feet 8 inches high. One ward is 34 feet 2 inches long, 24 feet 2 inches broad, and 9 feet 9inches high; and two wards are each 14 feet 10 inches by 13 feet 9, and 12 feet 8 inches high. These two latter wards are only occupied in cases of emergency, and are used for patients requiring separation.
The 8 larger wards have each 9 windows, the sills of these windows are 5 feet 2 inches from the ground, and the windows open at the top only.
The two smaller wards have, one 5 and the other 2 windows, opening at the top and bottom. The windows are some 7 some 8 feet high. Each of the larger wards has a fireplace at either end, and the smaller wards hove one fireplace each.
In each of the eight larger wards are 27 beds, 25 for sick, and 2 for orderlies, arranged on opposite sides of the wards, between and under the windows. The beds are only 20 inches apart, and 9 feet 1 inch from foot to foot, and the cubic space per bed in the four loftier wards is 678 feet, while in the other four wards it is 629 cubic feet.
The two smaller wards accommodate, one, 9, the other, 16 sick, with a cubic space per bed, varying from 503 to 636 feet.
The following table shows the present ward accommodation at Fort Pitt Hospital, in comparison with what it would be, at 1,200 cubic feet per bed:-
| Wards | Present Number of Beds. | Number of Beds at 1200 cubic feet each. | Deficiency of Bed space. |
| 2, 3, 6, 7 | 108 | 60 | 48 |
| 10, 11, 14, 15 | 108 | 56 | 52 |
| 12 | 9 | 5 | 4 |
| 5 | 16 | 7 | 9 |
| Total 10 | 241 | 128 | 113 |
Ventilation may be effected by open windows and fireplaces, and there are besides, ventilating openings in the ceiling of ach ward, covered by plates with a few round holes bored in them, communication with the external air by hollow beams above the ceiling. In four wards there are twelve of these openings in the ceilings. In other four wards there are four each, and in each of the two smaller wards there are three each.
The Hospital is lit by gas.
There is one lavatory with slate tables and moveable zinc basins; there are wooden gratings on the floor, and the room is well lighted. This lavatory can be reached from any part of the Hospital under cover, but the distance from the more remote wards is too great. The structure of the lavatory is likewise much behind that of lavatories in more improved hospitals.
There are three fixed enamelled baths with hot and cold water laid on. There are two coppers, each capable of heating water for seven baths. There is also a shower-bath. These bath arrangements are much better than those in any other military Hospital we have yet examined.
The laundry is used for washing personal linen, flannels, and table-cloths, and for such purposes it appears to be sufficient.
The kitchen has not sufficient means for cooking hospital diets. There are boilers for boiling, stewing, and preparing hot water for tea; there is also an oven and an ordinary kitchen range, but a proper roasting apparatus is required.
Water is derived from a deep well. The water is hard, but otherwise good. It is raised by an antiquated pumping apparatus driven by a horse, apt to get out of order, and, when this happens, water has to be brought up from Brompton, two miles distant, in water-carts, in which case twenty carts-full are daily required for the consumption of the Hospital.
As already stated, Fort Pitt is not sewered. It has only surface drains.
The provision stores are inconveniently situated, and one of them is so dark as to require gas-light in the day-time.
There is a good pack store.
The bedding store is in a damp casemate.
The Dispensary is small, and situated close to a cesspool, the contents of which have saturated its walls.
There is no hospital accommodation for soldiers’ families.
There is no day room for convalescents.
The thing most to be commended in Fort Pitt Hospital is the plan of block construction, with the windows on both sides, but except in the adoption of this, the only admissible plan of hospital construction, the buildings are not well adapted for hospital purposes.
The wards are rather too low, the blocks too close together, the painting defective, the beds too crowded; the water-closets are not well situated; there are several large cesspools and offensive privies close to the sick wards.
The additions to the building have been made without any apparent consideration as to what was likely to be their effect on the health of the building. There is a very offensive privy close to the kitchen. The kitchen arrangements are defective, as are also those of the lavatories.
Several of these defects are more or less counterbalanced by the high exposed situation of the Hospital, which renders the building more healthy than it would otherwise be.
The following measures appear to us to be necessary for improving Fort Pitt Upper Hospital.
1. Diminution of overcrowding, by setting apart 1,200 cubic feet to each patient. This can be done in wards 2, 3, 6, 7, by reducing the number of beds from 27 to 15; and in doing this, care should be taken that no bed is placed under a window.
In wards 10, 11, 14, 15, the number will have to be reduced from 27 to 14 in each ward.
In ward No. 12, the beds will have to be reduced from 9 to 5.
In ward No. 5, the numbers must be reduced from 16 to 7.
The total available accommodation in this Hospital will contain 128 sick and no more, and to do this the orderlies must be removed out of the wards. It is as contrary to sound principles of administration and discipline as it is certainly contrary to the principles of humanity, that orderlies should sleep among the sick. They should never enter the wards for any other purpose than the performance of their duties, and to enable this arrangement to be carried out, separate accommodation must be provided for them both for sleeping and for taking meals.
2. If the proposed reduction of numbers be carried out, these wards may very well be ventilated both by day and night by the windows; and if the air is ever impure, the blame must be attached to the person charged with the ventilation.
3. The next most important improvement required is sewering the whole of the buildings within Fort Pitt.
For this purpose suitable iron pipes might be carried across the ditches, and made to open into sewers, conducted down the slope of the hill to the Medway.
4. As soon as the sewerage is completed, all cesspools and open privies must be abolished, and proper water-closets, or water latrines, for the officers of the establishment constructed in more suitable situations. Within the hospital precincts water-closets only should be permitted.
5. The present water-closets are situated in the very centre of the buildings, among the sick wards. It would be very desirable to remove them, and to construct new water-closets, with urinals and lavatories, and a bath room at the far end of each ward. This would enable to existing lavatories, baths and covered ways to be removed, so as to increase the circulation of air in tone of the courts. In fact, all superfluous buildings, or walls interfering with the circulation of air between the blocks, should be removed.
6. Lavatories should be constructed of slabs of slate, with white earthenware basins sunk in them, and water laid on, as in the Hospital of the Scots Fusilier Guards.
7. The kitchen to be provided with a proper cooking range, and the boilers for making tea, to be provided with taps to draw off the water. Tea in future not to be boiled, but infused in large teapots.
8. Improved pumping machinery to be provided for the water supply of the Hospital.
9. Provision and bedding stores to be improved.
10. A day room for convalescents, and proper rooms for orderlies to be provided.
11. The wood work of all the wards to be painted, and the walls and ceilings frequently limewashed.
12. There should be a suitable room set apart in each Division for the Medical Officers.
These improvements, which are necessary for health and efficiency, could only be carried out at considerable cost, and after all, the Hospital itself, as has been shown, would only accommodate 128 sick. It might be extended to make the accommodation more commensurate with the requirements; but the question arises, whether considering the local position of Fort Pitt, it is worth while to do so; or whether, on the whole, it would not be better to build a more suitable Hospital on a more convenient site, and deal with the present Hospital merely as a subsidiary establishment. If it is to be continued these improvements ought to be carried into effect without delay.
