are difficult to supervise, and are a temptation to patients to spend too much time indoors; it being now generally admitted that patients when indoors should be as much as possible in their own rooms, which can be thoroughly ventilated, and where talking and forbidden amusements are not indulged in. There are also too many mouldings, decorations, curtains and other dust-traps about the building. The water-closets are not detached from the main building, and the ordinary baths are poor, except for the douche, etc., which are much used, and which are situated in the basement under the staff-rooms, and here the bathing is done under medical supervision and the taps are placed outside the rooms. The dining-room, the one really important sitting-room in a sanatorium, though a fine room, is not well placed, having only north and east aspect. The patients' rooms are 13 ft. to 14 ft. high, which is quite unnecessary and even inconvenient, 8 ft. 6 in. to 9 ft. having been found in practice to be quite an efficient and convenient height. But to take the chief objection to this plan last, the patients' rooms are placed on both sides of corridors, and it has become an axiom that patients' rooms should only be placed on one (and that, of course, the south) side of a corridor; in other words, that your patients' block must only be one room thick. This has been realized in Germany now as well as in England, as you will see in the plans of more recent German buildings which I shall show immediately.

Let me first show Hohenhonnef. This closely resembles the Falkenstein plan, but is, I think, an improvement on it, as it should be, having been built sixteen years later. The wings here are shorter, so that the centre is not so shut off from the sun. The dining-room with east and west aspects and the complete blow through is better; and on the upper or patients' floor the central portion is only one room thick, and the water-closets are partially isolated. But we get the same excessive number of sitting-rooms and the same number of stories. In both these sanatoria, which are for paying patients, there are bedrooms for visitors and friends of patients, and these, together with the number of reception-rooms, lead one to suppose that the life more nearly approaches to that in a large hotel than would be allowed at Nordrach, and certainly the general aspect of Falkenstein, when I saw it three years ago, was very different to that of the newer and stricter English sanatoria.

Ruppertshain. This sanatorium for the poorer classes, built about six miles from Falkenstein in 1895, is, as regards

plan and arrangement, a great improvement on the former. The building was originally planned to accommodate men in the west and women in the east wing, and was so being used when I visited it; but a new sanatorium for women was then being built close by, and the whole of the old building was to be given up to men. The arc form is distinctly good, although the thickening of the ends seems a mistake and overshadows the rooms next to them. Here you will notice that the room and corridor plan has been adopted, so that by the use of fanlights over doors an excellent blow through may be obtained. You will notice that a diningroom and a day-room are the only sitting-rooms provided, but that there are ample open-air galleries. The basement contains, beside the day-rooms, douche-room, stores, cellars, heating chambers, etc.

On the first and second floors the dining-rooms occupy the centre, one being for men, the other for women, and there are small pantries off them—a certain amount of the light housework being done by patients, both men and women. The bedrooms are arranged for one, three and five beds respectively, but at the time of my visit they were being used for larger numbers than these. This dormitory arrangement can only be tolerated on the ground of expense, and possibly in the case of very poor patients who, Dr. Walker tells me, do not always appreciate the luxury of a single room. But anyone who has slept for many nights in the next room even to a coughing consumptive patient will realize how essential separate rooms are.

Here the sanitary arrangements are fairly isolated, and for the most part good, except for the earth-closets, which are of a strange and wondrous pattern-that is to say, they are on the soil-pipe plan-this pipe being a 9-in. glazed stoneware one, and as it bends and twists, and is jointed to connect to the closet below, the result may be imagined, and I could well believe the doctor when he assured me that they must shortly be abolished and water-closets put in.

The two small buildings on the extreme west of the plan are objectionable, being pig-styes, and comfortably placed between the open-air gallery and the scullery. In spite of these objections the buildings are well laid out and built, and as there is no ornament, and reasonable precautions are taken to avoid the lodgment of dust, they struck me as in every way better than those at the parent institution, Falkenstein.

Alland. This sanatorium, which was opened in 1897, is thirty miles from Vienna, and at present accommodates 118 patients, but the grounds, farm, laundry, lighting, laboratory and other blocks are sufficiently large for a sanatorium for 300, and new patients' blocks will shortly be built to bring the number to this total. This sanatorium is particularly interesting to us in England at this moment, as in its present size and completeness it closely approaches the King's scheme. It is intended for patients of the poorer classes, the charges being about 30s. per week for first and 12s. per week for second class patients.

You will see by a glance at the ground-floor plan that the patients are accommodated in dormitories as at Ruppertshain, but here each dormitory accommodates eight patients, except for six small rooms to accommodate two each. The layout of this main patients' block is fairly good as a whole. The sanitary blocks are not, of course, sufficiently isolated for English ideas. But the chief fault lies, to my mind, in the size of the dormitories, and the fact that each acts as a passage-room for at least one other. As at Ruppertshain, the washing is done in the lavatories and not in the bedrooms, excepting in the case of patients confined in bed, and, where dormitories are used, this is the best arrangement; though where separate rooms are provided it is very vexed question as to whether washing and bathing should be done in the rooms or not. At Nordrach, where great stress is placed upon bathing, each room is provided with a shower bath, and in other sanatoria a fixed lavatory is placed in each room. The disadvantages in having wash and supply pipes in rooms are so obvious that I think it is better to have all washing and bathing done in separate rooms, allowing wash-stands and baths, which may be connected only to the first class of patients and to those too ill to walk to the bath-rooms.

The dining and kitchen block are to the southeast of and rather lower than the patients' block, the ground floor being on a level with the basement of the latter, to which it is connected by a covered way. There are two basements to this block, used for cellars, servants' rooms, offices, etc. This dining-hall is a wellplaced room, and the cooking arrangements seem excellent.

Alland, like the projected King's sanatorium, has a fine laboratory block, with mortuary and dissecting-room, also a scientific library, and accommodation for one or two foreign medical men who may wish to visit the place for purposes of study; there are

also an electric light house, laundry and model farm. These are detached from the main building, and as they are similar to those which must be provided for any general hospital, I do not intend to describe them-the whole is very well and fully set out in the Alland Sanatorium Association's report, published in Vienna, which contains full plans, diagrams, etc.

Albertsberg. I have included this among my slides, for though I can tell you little about it, it seemed an interesting plan for an inexpensive poor patients' sanatorium, the cost having been but £125 per bed against £173 per bed at Ruppertshain and £240 at Alland. The dormitories here are for ten beds each, but there are said to be eight single-bedded rooms in the block behind the dining-room. This seems a mistake, for they must, unless the slope in the ground is very great, be somewhat cut off from light and air. Another very obvious fault is that the open-air galleries are too much sheltered between the blocks; but there seems an idea in the plan, and the use of the dining and sittingrooms as passages seems an expedient to which no real objection can be taken.

Before leaving these German sanatoria, let me add that they all, except the last, appear too high, having five floors. This, even though the stairs be made easy of go, places too great a strain upon consumptive patients.

Now, gentlemen, having shown you plans of several German buildings, only some of which I have seen, may I be permitted to show you the plan of a small English sanatorium which I know well-namely, that built for the East Anglian Sanatorium Company at Nayland, Suffolk, and of which Dr. Walker is the medical director. This building was originally intended for twenty-eight paying patients, but seven more rooms were fitted up in the roof during construction. You will see here that slightly radiating wings were adopted, and, I believe, the angle which these make with the centre has been found to be about right-that is to say, they afford a certain amount of shelter without shutting off the sidelight from the centre. Each wing contains six ordinary patients' bedrooms (10 ft. by 14 ft. by 8 ft. 6 in.) on each floor, and larger bay rooms at each end; those next the open-air galleries being given up to staff officers' rooms, so that control is always. kept over patients in the galleries and also over the corridors. Practically the whole width of the south wall is window from 2 ft. 6 in. sill-level to the ceilings. A corresponding light is put in right across the north wall of the room above 6 ft. high, and

again in the corridor opposite, so that a complete blow through can be obtained.

The sanitary blocks are placed centrally behind the patients' blocks, and a nurse's room at each end close to the secondary staircases. The administration block is at right angles to the main block, with a passage through to the dining-room, which is an almost detached room. The small passage connecting the administration block with the dining-room was originally planned as an open veranda, but after one or two southwesterly gales, which had an unfortunate knack of upsetting nurses' trays passing to patients' bedrooms, glass screens had to be fitted, which in really fine and settled weather can be removed. Now, if one short length of corridor open on one side proved itself inconvenient here, it seems to me that a cottage or villa block sanatorium could never be a success in English climate unless the blocks were connected by enclosed passages either above or below ground, or unless each block was provided with kitcheners and full equipment for serving meals, and either of these two expedients would be exceedingly extravagant, and I cannot see that there would be corresponding advantages.

But to return to the plan before us. Stretching eastwards from the dining-room come the kitchen and offices, with extra larders and stores in a basement under the east end of the block. Here an open corridor is provided, but there is a passageway through kitchen and pantry, which can be used in windy weather. There is no first floor over the dining-room and kitchen block. On the first floor over the administrative block a pathological-room, and sewing and linen-rooms. The front portion of the first floor is similar to the ground floor. On the top floor on the east side are patients' room, and on the west, nurses' and servants' rooms. You will notice that owing to the slope of the ground the administrative blocks are midway between the ground and first floor patients' room, so that the patients on either floor have only to go up or down one flight of steps to reach the dining-room.

I have chosen these plans from those available, almost haphazardly, I am afraid. Open-air sanatoria are being built all over Europe and North America. They are to be found in Africa, and I learn from the highest authority that Wei-Hai-Wei is considered a suitable position. In Switzerland, of course, are many of the best-known ones, though I do not think that these are constructed on the latest and most scientific methods, which I am endeavoring to describe to-night.