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Special Articles

OUTPATIENTS AT GREAT ORMOND

STREET

THE spirit of a hospital, whether good or bad, is aptto be enduring. An engraving of a ward in The Hospitalfor Sick Children, Great Ormond Street, published inthe Illustrated Times of 1858, shows a genial replica ofthe Victorian nursery-high fireguards, scattered toys,go-cart, big tea-table, cosy nurses and all. At first

glance the new outpatient department-functional,austere, and impersonal-seems to have lost the humantouch of those early days ; but in fact the same spiritof friendly consideration for the children and theirmothers underlies the whole design.

WAITING SPACE

Mothers of sick children are likely to be anxious andpreoccupied : they are in no state to follow complexdirections or find their way through a labyrinth of passagesto an almoner or a laboratory. Moreover, in additionto the sick child, they may be hampered by others whocould not be left at home. The new outpatient depart-ment, which went into action on July 19, is therefore

compact, housing on the spot all the people the motherand child may need to see. Though the site availablewas small, it has been used with great ingenuity. Theold waiting-hall-vast, noisy, flanked by consulting-rooms, and rich in bottlenecks-provided a good exampleof what to avoid. In the new building patients arewelcomed by a receptionist who directs all newcomersto a small office for registration before they join themain flow. " Flow " is perhaps too strong a word,suggesting a surging tide. In fact-the flow, thoughsteady, is small, for this hospital runs an efficient

appointments system. So well does this work thatthe average time for a patient to spend in the out-patient department, from arrival to departure, is 55minutes.The new department is on two floors : surgical patients

go up a few stairs to the surgical suites, medical patientsdown a few stairs to the medical suites. The waiting-rooms-one on each floor-are light and quiet ; and a

good deal of ingenuity has gone to making them so.

The windows, placed high along the walls, are slopedto catch all the light of the sky ; and the shining walls

are painted cream. The terrazzo floors too are cream,and the terrazzo extends (round a curve, not a sharpangle) on to the walls and upwards for about a foot.The floor rises slightly towards the middle, and aluminiumfaucets, set an inch or two above floor level, can beopened to flush it. Water fans out from them, coveringthe whole floor to a depth of about 1/2 in., and drainingtowards the walls ; these are encircled by shallow gutterswhich carry it off to drains. Men in rubber boots, withsqueegees (" floor hygienists " is the name given themin this age of resounding titles), can clean in a fewminutes a floor which would engage a team of scrubbingwomen in drudgery all morning. (No doubt the scrubbing

Fig. 2-Windows of the consulting-rooms.

women could wear the boots and use the squeegeesequally well, but it seems to be a rule, not only inhospitals but in other large public buildings, that themoment a labour-saving device is installed the jobceases to be a woman’s work.) There is nothing newin principle in this method of cleaning floors : Herculesused it very successfully in the Augean stable. Theremarkable thing is that it has not been more widelyadopted before this, if only as an economy measure.The wet floors dry fast, for these rooms are warmed

by heating panels embedded in the terrazzo ; and thusanother ancient principle, the Roman hypocaust, comesinto its own again. The same floors and the same methods

of cleaning and warming them, are foundthroughout the building. The waiting-rooms besides being comfortably warmare air-conditioned. The chairs, welldesigned to the human form, are not setin bleak rows but can be grouped at willby the waiting families. They are rust-less and light to move, being made ofcast aluminium, and their feet, clad inrubber socks, make no sound on thehard floor ; moreover, they can bestacked. The ceilings are sound-absorbingto a degree which subdues even loudconversation to a temperate murmur.All furnishings-tables, cabinets, trolleys,and the like-clear the floor sufficientlyfor a squeegee to pass under them ; and

they too are made of aluminium.

THE CLINICAL ROOMS

Wide communicating corridors openfrom the waiting-halls. One of thesecontains administrative rooms, the nurse’soffice, the weighing-room, and the like.The other is flanked by consulting-rooms.Two members of the consulting staff, oneFig. I-A consultant’s room.

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Fig. 3-Corridor outside consulting-rooms, showing cubicles whenchildren are undressed.

on each side of the corridor, can be in session at the sametime ; and the live assistants of each can also be at workin the ten smaller consulting-rooms which line the corridor.Each consulting-room contains a table, chairs for

doctor, mother, and child, an examining-couch with amovable light above it, a basin, a long X-ray viewing-screen (on which successive radiographs can be com-pared), and a telephone. The consultants’ rooms have,in addition, chairs for students and a blackboard (fig. 1).The telephones are connected with a secretarial room.After seeing a patient the consultant dictates a letterto the family doctor into the telephone, and this isrecorded by dictaphone at the other end. There steno-

graphers-undisturbed by demands to " come and take

a letter "-rapidly transcribe the messages as they comethrough. Contrary to usual custom, the consulting-roomsare placed in the central well, and the almoners, clerks,and secretaries have the peripheral rooms, with a viewof the outside world. By a clever device (fig. 2) everyconsulting-room has studio-lighting from the north, andall are air-conditioned.

THE PATIENT And HIS MOTHER

When a mother has had the child weighed by the sisterand has received all the necessary papers she is calledinto the hive where the doctors are at work. Chairsare set out in the wide corridor where she may sit andwait her turn. Outside each consulting-room door is alittle terrazzo cubicle containing a chair and a shelf

(fig. 3). When her turn comes the mother undressesher child in the cubicle, leaving his clothes on the shelf.A signal

‘’ X ext patient," flashing on above the consulting-room door, tells her when to go in ; and just inside thedoor she finds a table on which she is asked to placeher handbag and any other possessions she did not careto leave outside. Thus with hands free she is able to

bring the child to the doctor, sit down, and give herentire attention to the matter in hand.

When she leaves the consulting-room she may needto see the almoner ; or she may need to go to the

laboratory so that a specimen may be taken from thechild ; or she may need advice on mothercraft ; or shemay need to go to the orthoptic or the audiometry room.All these services are close at hand and easily found.The almoner has her office in the same corridor as thedoctors, and the mothercraft department is at its end.The laboratory, the orthoptic room, and the audiometryroom are in the other arm of the corridor in which shehad the child weighed. On the surgical floor she willfind the surgical instrument maker there, as well.The mothercraft department, consisting of a series of

terrazzo cubicles and an aseptic-looking store, does notat first sight seem to match its name : but friendly is asfriendly does. This department is in the charge of asister who knows all about her subject, and has a giftfor passing it on. In the privacy of a cubicle a mothercan demonstrate her methods of feeding her baby andbe helped to improve it, or she can give a detailedaccount of her difficulties and receive friendly and

reassuring advice. Test meals can also be preparedwith equipment provided in the department, and themother can be taught by practical demonstration howto avoid errors. When she finally leaves the departmentthe mother goes to the dispensary, at ground-floor level,for any medicines her child needs, and leaves by way ofthe appointments office, making a new appointment(if necessary) as she goes.

This new department, planned with such kindly regardfor the anxieties, needs, and home commitments ofmothers, is but a beginning. It is hoped in time toprovide outpatient operating-theatres and theatres forclinical treatment, as well as an up-to-date records

department, reception-department, and dispensary ; and

plans for these are now under consideration by the

Ministry of Health. Drawing its patients from everycorner of the world, let alone these islands, GreatOrmond Street deserves good quarters. Meanwhile ithas what matters even more-good people to run it anda good spirit.

ROYAL COLLEGE OF OBSTETRICIANS

AND GYNÆCOLOGISTS

AT the silver jubilee dinner held in London on July 14the toast of The College was proposed by the LORDCHANCELLOR (Lord Simonds), newly admitted a fellowin recognition of the part he played twenty-five yearsago in advancing the college’s plea for incorporation.How long the gestation and how difficult the birth, hesaid ; but how farseeing had been those men who sawthat this neglected study should have its own college;and how remarkable its growth. Housed at first in theManchester consulting-room of Sir William Fletcher Shaw,and then in its present modest dwelling, its influence hadspread widely ; and alone of the Royal Colleges it had

regional councils in Commonwealth countries as well asfellows in almost every land acknowledging allegianceto the Crown. Now the infant was breaking out of itsswaddling-clothes and would soon be housed in a statelymansion in Regent’s Park. He could not doubt the

response to the college’s appeal for support, for the claimwas pre-eminent-the claim of the mother and herchild.

In his reply, Mr. ARTHUR GrEMMELL, the president, saidthat many of the advances in medicine and surgery havesprung from the two world wars ; but the college haddifferent origins. It came into being through a quickenedrealisation of the tragedy and waste in the homes of thepeople through the high mortality of childbearing andthe ill health that so often followed. The founders wereconvinced that the remedy lay in longer and better

training of obstetricians and in higher standards. In its