History of Hospitals:Medicineand surgery date back to the beginning of civilization because diseasespreceded humans on earth. Early medicaltreatment was alwaysidentifed with religious services and ceremonies. Priests were also physicians or medicine men, ministering to spirits, mind and body, Priestsdoctorswere part of the ruling class with great political in!uences and the templehospital was also a meeting place.Medicine as an organized entity frst appeared "### years ago in the ancient region of $outhwest %sia known as Mesopotamia. &etween the 'igris andEuphrates rivers, which have their origin in %sia Minor and merge to !ow into the Persian (ulf.'he frst recorded doctor)s prescription came from $umer in ancient &abylon under the rule of the dynasty of *ammurabi +,-./0,1/1&23. *ummurabi)scode of law provides the frst record of the regulation of doctors 4practice, as well as the regulation of their fees. 'he Mesopotamian civilization madepolitical, educational, and medical contributions to the later development of the Egyptian, *ebrew, Persian and even 5ndian cultures.Indian Hospitals: *istorical records show that e6cient hospitals were constructed in 5ndia by 1## &2. 7uring the splendid reign of 8ing %soka +.-90.9.&23, 5ndianhospitalsstartedtolooklikemodernhospitals. 'heyfollowedprinciplesofsanitationandcesareansectionswereperformedwithcloseattention to techni:ue in order to save both mother and child. Physicians were appointed ;one for every ten villages0to serve the health care needs of thepopulations and regional hospitals for the infrm and destitute were built by &uddha.

Ownership models%sseenintheearliersection, dinlike, most other sectors, for0 proft organizations constituted a minority of frms supplying hospitalcare in the >nited $tates and in all developedcountries. 5n the >$, such hospitals constitute only ,?@ of all nonfederal short term general hospitals in ,AA1+%merican *ospital %ssociation ,AA/3. &ycontrast, ?A percent of hospitals were private nonproft and the rest were operated by government, primarily local governments or special governmentauthorities. %nother stylized fact is that growth of for proft hospitals market share has been moderate .%lthough for proft chains have grown bothnumerically and in in!uence since they frst appeared in the late ,A1#)s,the share of small independent for proft hospitals has declined.% recent study in 5ndia indicates that healthcare is delivered by a multitude of public and private providers. 'he government infrastructure is large in bothrural and urban 5ndia. 5n rural areas, the government has a vast base of primary healthcare centers, community health centers and sub centers. 'hepublic infrastructureinurban 5ndiaconsists of tertiary medicalcolleges,districtandtalukhospitals andurban health posts.'heprivate healthcaredelivery sector consists of a large number of private practitioners, for proft hospitals and nursing homes and charitable institution. 'he average size of such hospitals is less than .. beds0much lower than developed countries.'he purpose of for proft, investor owned hospitals was primarily to increase the value of invested capital. Prior research fnds that for proft hospitals tendto locate in more proftable areas and are smaller than nonproft hospitals. Bor proft hospitals obtain fewer donations and are not taC subsidized and sorely primarily on patient fees. 2hurch hospitals are owned and governed by religious organizationsD they were originally organized to provide services forchurch members, to restrict procedures that are contrary to religious beliefs and to permit patients to follow the tenets of the religion for last rites andother ceremonies. 'hese hospitals rely on both patient fees and donations. (overnment hospitals are owned and governed by governments, $tate or2entral. 'hese hospitals rely on subsidies and grants for part of their operations and perform more charity than other hospitals. &ecause these hospitalsare taCsupported, government agencies are likely to monitor operations and have the authority to increase or decrease funding through budgeting processes.=ther nonproft hospitals are privately owned and usually community hospitals or physician group hospitals. Physician in!uence tends to be stronger inthese hospitals. 'hese hospitals rely also on patient fees and public donation. Eon proft frms may earn profts. 5n fact, many, including hospitals, do. Father nonproft frms are precluded from distributing profts to persons whoeCercise control over the frm. %lthough such frms can pay reasonable compensation to suppliers of inputs, resulting earnings cannot be distributed. $uchearnings must be retained and used by the frm. &ecause of the non distribution constraint, nonproft frms have no owners, that is, persons who controland share residual earnings.=wnership form and hospital behavior: 'he social welfare implications of for0proft versus nonproft ownership, and private versus public ownership, havebeen of interest to economists for decades. 5n stylized microeconomic models of organizations, theory predicts that the for proft organizational form ise6cient ,because of the high powered incentives that arise from the presence of a well defned residual claimant with legally enforceable property rights.Fesearchers eCploring the e m measured vertical under such beam, fan or light.DOOR OPENINGS: 5inimum dimensions of clear door openings of patients bedrooms 8 &*>>mm wide and ;&>>mm high. 4lear door opening to room that may be accessed by stretchers, wheeled bed stretchers, wheel chairs or handicapped persons should be '>>mm. /oors, e#cept those to spaces such as ducts (which are not sub9ect to constant patient or staff occupancy), shallnotswing into corridors in a manner that mightobstruct traffic flow or reduce the required corridor width.CORRIDORS: 4orridor widths in which there is frequent bed stretcher and trolley movement, e,g inpatients units, ?Ts, $4@s, % ;&>> to ;A>>mm. 4orridor widths where infrequent trolley or bed movement is e#pected 8 &)>>mm 4orridor width where no patient transportation is required and where corridor rooms are no longer than &;meters (such as offices) 8 &;>>mm. 5a9or inter departmental arterial corridors and public corridors 8 ;&>>mm.CEILING HEIGHTS: The minimum ceiling height in occupied areas shall be ;A>>mm, but consideration should be given to the size (Aesthetic consideration) and use of the room. ;+>>mmis 4onsidered a more appropriate ceiling height in wor areas. The minimum ceiling height in corridors, passages, recesses, etc. shall also be ;A>>mm. $n portions of remodeled e#isting facilities, the corridor ceiling height maybe reduced to ;;*>mm, but only over limited areas, e.g., where a mechanical duct passes over a corridor, a reduced ceiling height for no greater corridor length than =>>>mmis acceptable. $n areas where access is restricted, e.g., drining fountain recess etc., a minimum ceiling height of ;;*>mm is acceptable.RAMPS: 5ost commonprovisionmadeforwheelchairsisaramp. However,rampsaremostlydifficultto use,bothin mounting and indescending. Theyshouldbe nosteeperthan ) per cent (preferably B per cent) and unbroen lengths of ramp no longer than &>m. 2or a rise of only B*> mm, therefore, a good ramp would tae up a considerablearea. The use of a chair lift or of ordinary lifts is therefore often preferable to a ramp,although these suffer from the need for adequate maintenance, and problems arisewhen they brea down. PROVISION FOR THE HANDICAPPED:CORRIDORS "hould be at least + ft wide to allow enough room both for two%way traffic of persons using crutches or wheelchairs. Handrails of a bright color or material in bold contrast to the walls should be provided on corridor walls. "uch handrails are especially helpful to people with poor visionend to blind persons. 0rovision for blind people needs to be made in the design of signs, raised letters being preferable to 7raille, particularly in lifts.WIDTH AND DESIGN OF CORRIDORS AND DOORWAYS : The width of a corridor should not be less than '>> mm for a self%propelled wheelchair, or &.) m if two wheelchairs are liely to want to pass each other, no columns,radiators, drining fountains, telephone booths, pipes, or other pro9ections should protrude into public corridors. TURNING SPACE 5ost wheelchairs require a space &.A m square to turn around. 4rutch users often find ramps more of a problem than steps.$deally, all wheelchair ramps should be ad9acent to supplementary steps. AMBULANCE:TURNING THROUGH 90 DEGREES :DIMENSIONS FOR DIFFERENT VEHICLES,engthC*))*mm 1idthC ;>>>mm HeightC;*A>mm Dound clearanceC&'>mm Turning circleCB.*mETERNAL DIMENSIONS OF A CAR LIFT DIMENSIONS: ,ifts transport people ,medicines, laundry, meals and hospital beds between two floor in buildings in which care, e#amination or treatment areas are accommodatedon upper floor at least two lifts suitable for transporting beds must be provided. ?ne multipurpose lift should be provided for &>> beds, with a minimum of two forsmaller hospitals. $n addition there should be a minimum of two smaller lift for portable equipments, staff and visitor 4lear dimensions of the lift car! >.'>E&.;> m 4leardimensions of the shaft! &.;*#&.*> m 0assenger lifts should be within a reasonable waling distance from the furthest part of the floor areas served (+> m ma#imum) The location of goods and service lifts will depend on their function, but they should not open into passenger lift lobbies or public areas. 7ed lifts shall be necessarily provided in the emergency areas. HOSPITAL DEPARTMENTS & ITSCIRCULATION:OUT PATIENT DEPARTMENT (OPD) : The ?0/ should be ideally located on the ground floor with separate entrance and adequate paring facilities. Deception area and waiting space should be immediately apparent and welcoming. Attention should be paid to circulation transversing department. There should be easy access to labs , pharmacy , and pathology lab. Treatment rooms for minor procedures and cast wor be easily accessible from main waiting spaces and consultation rooms. DESIGN CONSIDERATION FOR OPD The storage areas for wheel chairs and stretchers should be neatly alcove and easily accessible from main traffic line. (levators should be accessible to the lobby and especially important for cardiac and obestric patients who require immediate care. To improve the atmosphere, patients should be dispersed to sub waiting areas. There should be proper lin between the emergency services and outpatient department. There should be provision of public telephones , toilets , water , cafeteria RADIOLOG!: The department receives inpatients, outpatient, and casualties. $ts function is to photograph, process the film and provide facilities for its interpretation and storage. E DAF rooms are equipped with photograph machinery of considerable sophistication .the #%ray rooms need dar rooms nearby for the processing of the films and aroom for viewing. The location of the department should be convenient for trolley access from the wards and close to the outpatients department unless the accident and emergencydepartment has its own #%ray facilities, it is essential that there should be easy access to the #%ray department. The radiology department comprises of mri room, ultrasound room, changing room, sub waiting area, #ray general , radiography room , control room , change room ,film store , reporting room. "tructural shielding from radiation can be achieved by using lead inserts or with thic concrete walls . The thicness of walls constructed in concrete only should be =.>> m for treatment and e#amination rooms in the primary radiation area and &.*m for rooms in the secondary radiation area , according to the type of equipment. The huge weight of the equipment and the required structural radiation protection measures mae it necessary for radiotherapy departments to be located in basement or ground floor.WARDS:AREAS General ward ='+)sqft "emiprivate H delu#e )A=+sqft 0rivateHdelu#e )A=+sqft Cl"a# spa$" a#o%&' th" ("' Total area wards A*=+) sqft. A=I of the total floor4lear space around the bed7ed spaces H clinical support H two en% suites H circulation added $n between. GENERAL )ARD:LINEAR )ARD %=> beds supported by nurse woring room at end,sluices and wc at other. COURT!ARD PLAN sq.mts. The nursing unit comprises of !% 7ed control (within patient Ls reach, with nurse controller cut off feature) 4($,$.G .urses call micro%speaers. radio speaers (for private room only) H$GH ?. 1A,,( B> inches or higher) over bed light fi#tures(direct and in%direct) o#ygen outlet . ,?1 ?. 1A,,( appro# malty ;A inches> /ouble duple# receptacle (bed, o#ygen%tent ,portable #%ray heating pad etc.) remote recording instrument receptacles(temprature,pulse,respiratory) This nursing unit layout permits a close relationship between the patient bedrooms and the nursing station and other service areas. 76Op"#atio& Th"at#"I&st#%,"&ts -o# G"&"#al S%#+"#. / 0Mat"#&it.1 O(st"t#i$s2G.&a"$olo+.3The aim of the following list of instruments is to provide an e#haustive checlist of instrumentsthat may be required. $t is recognised that surgeons have preferences for types and number ofinstruments and this list need not be considered as restrictive.I&st#%,"&ts 4%a&tit. Si5"G"&"#al I&st#%,"&ts"ponge forceps (Dampley) A ;.*cmsTowel clips B &&cmsArtery forceps, straight B &Bcms(crile) curved B &BcmsArtery forceps (mosquito) straight B &=cmscurved B &=cms4urved artery forceps (5ayo or Melly) B ;>cms"traight artery forceps (spencerwells) B ;>cmsTissue forceps (Allis) A &*cms"tandard dissecting forceps toothed ; &A.*cmsnon%toothed ; &A.*cms,ong dissecting forceps (toothed) & ;*cms,ong dissecting forceps (non%toothed) & ;*cms"traight dissecting scissors (5ayo) ; &+cms4urved dissecting scissors (5ayo) & ;=cms/issecting scissors (5etzenbaum) & &)cms"in grafting (Humby6s) handle &"in grafting blades"titch scissors with blunt ends ; &*cmsAbdominal wall 4%shaped retractors (narrow, medium)Detractors (/eaver) medium, blade & ;*mmlarge blade & +*mm.eedle holders (5ayo) medium ; &*cmslarge ; &+.*cms"calpel handles .o.= (7ard 0arer) &;.o.A (7ard 0arer) &;.o.* (7ard 0arer) A