The War Demonstration Hospital Its Plan and Construction New York Thei Rockefeller lastitute for Medical Research 1917 A WX 140 oR<>8?» 1*17 554108O0R NLH 05EftQ15a 3 »ti. i nun or mcdicim V |X y Wxl/oiX, ./An XV iri\./ in X The War Demonstration Hospital Its Plan and Construction N e w York The Rockefeller Institute for Medical Research 1917 z-x ■&t>r\ Inn MM tef: 1 KM t£W S&* 'Hit | kv. . St*1* I g a; -» -S ARMED FORCES MEDICAL LIBRARY — WASHINGTON, D.^ The War Demonstration Hospital OF THE ROCKEFELLER INSTITUTE FOR MEDICAL RESEARCH The object of this pamphlet is to give a few essential facts about the plan and con- struction of a temporary hospital which has been built upon the model of a recent base hospital actually in use on the Western Front. When the Rockefeller Institute decided to establish a small hospital service for the treatment of infected wounds by the methods worked out by Dr. Alexis Carrel and Dr. H. D. Dakin, and to demonstrate to American surgeons who may be enrolled for service abroad the technique of this method, it was thought worth while at the same time to set up a demonstration service in pavilions which would imitate war conditions, and test the feasibility of a unit portable military hospital designed by Mr. Charles Butler of New York, who has made a thorough study, under the French War Depart- ment, of the military hospital units developed in France and England. THE planning of barracks, can- tonments and base hospitals is one of the problems of the hour. It is the purpose of the Institute to make a contribution to the solution of this problem by illustrating one system. Critical inspection will be welcomed. The Institute will be glad to supply more detailed information when- ever possible. Base hospitals are seldom moved in toto, and the fact that a particular kind of construction can be knocked down and put up in a certain number of hours is not the most important consideration. The shifting demands imposed upon base hos- pitals by changing seasons and war plans result, however, in changes of particular units. For this reason the flexibility of the knock-down construction is an advan- tage; it is also an advantage because it simplifies orders, specifications and labor and transportation calculations. Shack construction would be cheaper than portable construction and would un- doubtedly be expedient under many con- ditions. But knock-down construction is in wide use on the Western Front and such forms of construction will require consideration. Experience of three years on the Western Front has demonstrated that improvisation and flimsy construction does not pay in base hospitals; tentage is no longer used. Heating, ventilating, and such kitchen, laundry and sanitary con- veniences as enable the staff to give patients the equivalent of the care which they would receive in a reasonably equipped modern hospital are worth 5 ] T 11 !•: W v u D i■: \i o \ s ta \ tion Hosimt a l while, for they result in shortening the period of disahilit \, reducing the recupera- live interval and returning men to duty more rapidly and in greater numbers. The \alue of a trained soldier is so great that money intelligently invested in his care is money saved. The War Demonstration Hospital of the Bockefeller Institute is a double- walled construction with a double roof. It is thus well protected both against heat and cold. The manner of supplying steam heat will vary according to local conditions. The plan of the temporary hospital at the Bockefeller Institute was made 1>\ Mr. Charles Butler, a Mew York archi- tect, who has for a year and a half studied French and British hospital con- struction in France; he collaborated with the French War Department in designing hospitals. Mr. Butler adopted the unit building system patented by the Hum- phreys Company of London. This sys- tem has been used at the Etaples Base Hospital and in other places. i\ umerous slight structural changes, made necessary by American building conditions, have been devised by Messrs. Marc Eidlitz & Son. contractors. Mr. Butler's plan places the wards north and south with the service room at the north end and a terrace at the south end of each ward. North of the wards are such services as mess, kitchen and laun- dry : south of the wards are the adminis- tration, receiving and operating buildings. If the shape of the available lot had been different, this last group would probably not be south of the wards. It need not and had usually better not occupy the southern side of the plan. Patients are entered at the Reception Building, passed directly to the Operating Building and thence sent straight to the wards. The Laboratory Building is larger than neces- sary because of the demonstration work planned at this hospital. Three dormi- tories and an isolation pavilion art1 placed where they do not interfere with the main plan of the services and are at convenient distances from the wards. The accompanying illustrations show two or three aspects of the layout and illustrate the maimer and rapidity with which the double panels of the Hum- phreys' system can be erected, and also illustrate such important features as the ventilation in the wards, which permits beds to be placed without reference to window location. A. working drawing illustrates the manner of locking the demountable sections. On the basis of this experiment, it is probable that such hospitals could be erected and equipped by union labor to which New York wage rates as of August, 1917, apply for approximately $800 per bed for a 500-bed installation, plus $100 per bed for an adequate power plant. In other parts of the country not governed by New York prices the cost should be appreciably less, much less if soldier labor were employed. In a small demonstration hospital having a capacity of at most sixty-six beds, a steam kitchen, laundry, etc., would not ordinarily be installed, but in view of the special object of this undertaking these have been included for the Rockefeller unit. The War Demonstration Hospital :ove«EDS»Li.e«y (c ® s: □ n ® © D1 CLOSE D*r«£> HEATED C © UET—3-E ® *F @ © TT Services placed north \ of wards connecting ilh service ends of !1A wards Closed CJalleky Reception ami> Pischarge 0 y ®_Jnf ru: Service connection to )the north, opening on to southern terraces Administrative and operative installations placed between entrance and wards East 64™ Street [ T ] T ii t: W \ i\ D t: m o n st n \t i o a Hospi t \ l Steam Laundries Economical It is interesting to note in this connec- tion, that the French army medical authorities consider that steam laundries and kitchens are economical for any num- ber of beds over 300. As the base hos- pital of to-day tends towards a capacity of 1,000 I teds rather than 500, it may safely be assumed that it will always need high and low pressure steam and electricity from its own or existing plants. Water Supply and Sewage The problem of water supply and sew- age disposal, always a vital one in hospital work, is of course simplified by the loca- tion in the midst of the city. If no cit\ system is available, a Waring or similar disposal system is used ordinarily; many are being installed on the front. II SITE AND ARRANGEMENT OF BUILDINGS The site available for the hospital was an L-shaped lot, the vertical leg 460 feet long and 170 feet wide, running north and south along Avenue A; and the horizontal, 60 feet wide b\ 320 feet long, running east along Sixl>-fourth Street. The arrangement of the buildings was planned to save every unnecessary move for the patients, and at the same time serve every convenience of the surgeons and nurses. An arriving patient goes directly to the Receiving Pavilion, then to the Operating Rooms just back of it, and then to the ward adjoining. [ Entrance on Avenue A The main entrance on \venue \. just below Sixty -fourth Street, leads into the \mbulance Court. Immediately on the left is the visitors' entrance to the Admin- istration Building, which runs north along \\enue \ and at its north end is connected with the Laboratory building, which also runs north and south. East of the Administration Building, forming the north side of the court, is the Reception and Discharge Building, in front of which the ambulances draw up to discharge the patients. On the south side of the court along Sixty-fourth Street are the Orderlies' Barracks, and east of this, in the L. are the Nurses' Building, running east along Sixty-fourth Street, and the Maids' Building, running north and south. The east side of the Ambulance Court is closed by the Isolation Building. To the north of the Reception Building and parallel to it, and connected to it. by a closed corridor, is the Operating Building. The character of the property across the street made it necessary to put such buildings as these along the Sixty-fourth or southern front, where the wards might more normally have been located. Closed corridors are provided only where patients have to pass from one building to another; otherwise the corri- dors connecting the pavilions are roofed but open at two sides. Location of the Wards The two wards are placed between the east corridor and the Laboratory Build- ing, connected to a transverse corridor at ] T HEW A H D E M 0 A S T R A TION H 0 S P I T A L "*$ June 8—One week after work was commenced. Note arrangement of foundation posts and sills their north or service ends and free at their south ends. To the north of the transverse corridor and looking out on the service court are the Mess Hall for nurses, orderlies and maids, and the Recreation Building for convalescent patients. On the east side of this court is the Kitchen and on the north the Laundry, while the Stores Building occupies the northern portion of the west side, balancing the Recreation Building. The service entrance from Avenue A is between these two buildings. The grouping of Kitchen and Laundry in close proximity to the Mess Hall and ward buildings reduces to the minimum the labor required for the constant trans- port of food and clean and soiled linen. The frequency of this transport as con- trasted with the infrequent trips of patients between the Reception and Operating Buildings and the wards was the determining factor in this arrange- ment. Ease of Communication Essential In all war hospitals, ease of communi- cation between buildings is essential, as all transport must be by wheeled vehicles, food cars, stretchers, soiled linen cars. etc. Every war hospital will be short- handed at active times, and the difficulty T 11 I; W A R D K M 0 N S T R A T I 0 N II () S P I T A L June 11 —Note building in centre of group. All wall panels set during erection, but roof and floor panels are not yet in place Trusses, posts and floor girders lying in place ready for erection of Reception Building near south end of lot of operating must be reduced to the mini- mum ; hence the uniting of all buildings by slatted walks and the elimination of steps, differences of grade being taken up by inclines. The ward buildings should be well sep- arated from the quarters reserved for nurses, maids and orderlies, so that when the latter are off duly they may be able to make a reasonable amount of noise with- out disturbing the patients. Had it been possible to do so, it would have been preferable, for this reason, to place the Isolation Building rather further from the orderlies' quarters. The grouping of buildings has been assigned just as they would be at a field hospital. The walk-ways are an absolute necessity in the sea of mud in which one lives at the front, even if it is imprac- ticable to cover them. Ill DETAIL PLANS OF THE BUILDINGS The Administration Building contains the general waiting room for visitors, with the telephone exchange, a coat and toilet room for visitors, and offices for clerks, 10 T II E \\ A R D E M O \ S T R A T ION 11 0 S P I T \ L June H — Reception Building completed. Kurscs' Home in process of erection Roof /Hinds slacked just beyond building, ready to be dropped into place executive officer, superintendent of nurses, maintained for demonstration and in- surgeon on duty and chief surgeon. si ruction. The Laboratory Pavilion Adjoining this the Laboratory Building contains a demonstration and lecture room, Record Officer's room, coat room and storage, the pharmacy with its wait- ing room for orderlies, and the chemical and bacteriological laboratories. Labor- atories are supplied with water and gas and with electricity for both light and power. As has already been said, this building is arranged to meet the peculiar requirements of a hospital which is to be The Receiving Pavilion The Receiving and Discharging Pavilion is in its present development a product of the war. All wounded must be cleaned before being admitted to the wards. It has been found convenient to associate the storage of patients' effects and the discharging service1 with the admitting service. The Receiving Room into which the ambu- lances discharge is in the center, with the washing room adjacent, where the 11 T 11 E \\ A R D E M O N S T H A T I 0 N HOSPI T A L >$3?&V 4m* S^J mm *X , ■ ■ 1 [tl: ■■*•?■ u "^k r". i' ™ ws^^^^ Ll . ?-£, Ju/y ;?J— /l Completed Ward patients' pedigrees are taken, where they are undressed, washed and put into hospital clothes. Soiled clothing is transported in bags on wheeled frames to the laundry building for disinfection and washing; it is then returned to the storage room at the right end of the Receiving Building. Dis- charged patients return to this building, where their records have been kept. secure their valuables and clothing, dress in the small room adjoining the office, and turn in their hospital clothes. The surgeon on duty in the Receiving Building has a small office. He keeps first aid supplies there, in case they are needed to replace a dressing. He ex- amines all arriving patients and deter- mines the order in which they are to be bathed and sent into the operating room or wards. The Operating Pavilion The Operating Pavilion is of especial interest in a war hospital. For this building, 105 feet in length, the wider type of unit, 28 feet wide with walls 10 feet high, has been adopted. The building lies east and west, so as to insure north light all along one side. Of the tw o entrances, one to the east is reserved for doctors, nurses and orderlies, 12] The War Demonstration Hospital ■"V. ■** J ^..::^ 1 BfelT^B »*©S^ ^^3»? wH| ■^hSHqES^l'^ ' AV^ «^ ^^:-^AV*-- AXA^ BUI . n**^#j^itft% ^^^--^^WiMil 1.,"."' "" f!ai*Fai Mi* Lt^ ^ ■lifimiii^'^r * - 77;e Completed Kitchen and the other for patients. Orderlies coming for their supply of sterile bandages for the wards do not pass beyond the vestibule at tin1 east entrance. At the east end is a large work room for nurses, and next to it a sterilizing room easily accessible from the Operating Room. Scrub-up basins are in the Operat- ing Room. The Etherizing Room, almost directly opposite the1 patients' entrance, gives access both to the Operating and Plaster Rooms, while the west end of the building is occupied by the X-Ray service1, with dark room, demonstration, and storage room. The Ward Pavilions The plan of the wards follows very closely that of an ordinary surgical hos- pital of peace times. Running north and south, the services are grouped at the north end, so as to allow the free entrance of the winter sun at the south end. This arrangement, while not a necessity in southern climates, is most desirable in a country like France, where every ray of sunlight is precious. \l the south end of the1 ward is a ter- race1, covered in summer by awnings. Patients' beds may be wheeled on to this even before they are convalescent. 13 T II E \\ \ \\ D E M O A S I R A T 1 () A 11 () S P I T \ L \t the1 northern or service1 end of the1 ward the Nurses' Office1 and linen room adjoins the1 ward on the west siele of the corridor. This room has glazed sash to permit the nurses to watch the ward and the Isolation Room. The Diet Kitchen, containing steam table with electric cooker, sink, refrigerator and divsser, adjoins the Isolation Room on the same1 siele of the1 corridor. \t the (>asl siele of the1 e'orrielejr next to the ward is the bedpan sink room; next are the patients' toilets and lava- tories, the1 sterilizing room, the1 bathroom and the1 housemaids' sink room, contain- ing the soiled clothes bags, brooms, mops, etc. As all dressings are made in the1 wards, no surgical dressing room is re- quires!. The bath tub is so placed in the bath room that a stretcher may be run into the room. On each side of the ward, two wall panels hinged at the bottom are arranged to swing out to permit of rapid exit from the building in case of fire. These openings also furnish additional ventila- tion in hot summer weath" to be hinged at lutttom. saving out, to give Jire exits and extra rentitation a-----r- --B a-~ fid n o : (XI [ J '£5 -----------IS Demonstration 5TDRAG Eof Pi<|rE3 OmwcRooIm MIRTH SIDK ----i os1. o-— --S ill ;-A— -« in ., Q K-----4 I I I ../ Ope.ratih& Room [ "l-_ 5teril\zih, 0 ZING- .,D. •1 -r-s----------** r Bandage | I^STRUME EF^EPARATI OH, £ l^*STROMENT CLEANING ND STORA.&E. a^----»■+—-—!~»-------a JatE>3T.. "^J t------------------- Ice ___ Ic.o ■SMEkVB* OVtR ■ , **! /Coax Room W L.-- --- . / >-t-»Ar ROOM A VESTIBULE locY A"D LAVATORy t^Jat *tog*llje«y FXticnt* AO NOTK:—Shower Ralh Compartment to be galvanized iron lined and to have lead-lined safe O I'I'R \Ti\e; PAVILION NOTE:—All partitions in this pavilion doubted, painted and carried to roof T H E \Y \ R D K M ONSTRMION H () S P I T \ L the public space from the kitchen proper. Food cars remain in the kitchen between meals, and pick up their loads at the pas- try table, tea and coffee urns and cooks' tables. Refrigeration is supplied to the storage boxes in the Kitchen Building by a portable ice machine of American manu- facture1 such as has already been put into operation in France1. The Laundry Pavilion The Laundry Building has two receiv- ing rooms, one for infected clothing, linen and bedding, which must pass through either the sterilizing washer or the steam and formaldehyde sterilizer, and the other for ordinary soiled linen. Mattresses and pillows after steriliza- tion are stored at the west end of the building, while the linen after drying and pressing is stored near the east end on tables and in bins. The mending room and small storage room are placed at the extremity of the building. The Stores Building at the northwest . corner of the property consists of a large open storeroom, one side of which is fur- nished with racks for small objects, and the other half left for heavy storage, for a small carpenter and paint shop, and a small office for the storekeeper. The Nurses'1 Pavilion The Nurses' Building contains a small sitting room with pantry and electric cooker, bedroom and bath for the super- intendent, twelve single and two double bedrooms for nurses. Bath tubs, toilets, slop sink and lavatories and a small linen [ and store closet complete their accom- modations. The Maids' Building The Maids' Building is similar, but with more double and le>ss single1 rooms. The Orderlies' Quarters are1 divided into a large dormitory and a lew rooms for sergeants, a sitting room and a room for cleaning equipment, boots, etc. IV CONSTRUCTION OF THE BUILDINGS With the1 exception of the Stores Build- ings, which is of ordinary shack construc- tion, all buildings are of portable house unit construction. Walls, floors and roofs are formed of wooden panels, except in the Operating, Kitchen and Laundry Buildings where concrete has been used. In the early days of the war such buildings were erected with a single thickness of material for walls, but it very shortly became apparent that the walls must be double with an air space between the outer and inner sheathing. At the same time the desirability of double roofs and floors was recognized. The French have found that even a double-walled tent is preferable to the single^walh'el building. The Humphreys System A study of the various types of con- struction led. as has been stated, to the adoption of the Humphreys system, a patent eel English type which has been ] The War Demonstration Hospital NOTE:—All partitions to run to height of watt plate RECEPTION PAVILION [ 17 1 Ne)TE:—Concrete floor in Receiving room, Washing room, clean linen, soiled clothes 44 T tit: \\ \ ii Demonstration Ho s i> i t \ l employed in the base hospitals of the1 British Red Cross and St. John's Guild at Etaples. south of Boulogne. The1 system has been very considerably modified at the suggestion of AKssrs. Marc Eiellitz cV Son, the contractors for this work, and AKssrs. Sloane & Me)lleT, who have built the panel sent ions, both concerns having suggesteel various im- provements, which make the systeMn fit more closely with American methods of construction. Under the plan (employed, the panels of walls, roofs and floors are all of the same dimensions, so that any panel may be substituted for any either. Light Steel Trusses Used Many "pe>rtahle systems'" which em- ploy in part the unit method, abandon it when it comes to roof trusses, which they space only every second or third panel. But in this case the trusses are made lighter and spaced one to enery seetion, so that the trussing is also on a strictly unit basis. This would of course be pos- sible were the trusses of wood, as the suc- cession of heavy wooden members would decidedly lower the apparent ceiling height. This problem is thus solved by the use of exereelingly light steel rods as trusses. The1 upper member is of 2 x 6 inch spruce with 1x2 inch strips nailed on either side to carry the roof panels. The struts are \]/2 x V/i x 5/8 inch steel angles, and the tie rods A inch round. The connection between post and rafter is formed by y% inch gusset plates set in a saw cut made in both members. The plate is drilled with five holes, two each [ for bolts through the rafter and the post and one for the bent end of the1 tie1 rod. Similar gusset plate\s form the1 connections between rafters at the ridge, the1 three gusset plates forming an efficient wind brace. These1 ste1*1! parts are all easily obtainable stock material. Transverse Girders Support Floor Likewise the flooring is supported by 2x6 inch transverse girders, placed five feet apart, corresponding to the posts and trusses, and boltenl to the posts. These girders are supported on the exterior sills and by two intermediary sills in the e-ase1 e>f the 22-fi)e)t building. Te> each girder, near the holtemi, a 1x2 inch strip is spikeel on either siele te> carry the floor panels. The exterior sills, 2x6 inches, laid flat, are supported on 1 x 1 inch posts carried about two feet below grade and resting on 12-inch square bases of two- inch planking. The intermediary sills are supported on similar posts, but with- out bases; the sharpened ends are driven about 18 inches into the earth. Before erection the girders are bolted firmly to the posts, so that truss, post and girder form a complete whole. The erec- tion thus becomes a relatively simple affair, and one in which it is difficult to go astray. After the end truss has been set up and temporarily braced in position the first wall panel is slipped into place, then the second truss and the second wall panel, while the roof and floor panels follow close behind. The wall panels give the exact spacing to the posts and are fas- tened to them by a system of bolts. ] T it t: \v \ r Demonstration Hospital j _____rl___[l. v-r •Section through Roof 5s \ \ ] ■ , - . . i t" % 1 1 STRUCTURAL DETAILS The post itself is a composite member, formed of a 2 x I inch dressed stud with a 134 x 5 inch outside, and a 1 x 5 inch inside dressed cover strip, both ploughed out to make a tight joint with the post. The ends of the panels are shoved into the mortise formed by the post and its strips, and bolts are then run through the cover strips from out to in, holding the panels firmly to the posts and preventing the opening up of joints. How Roof Panels Are Supported The roof panels are supported on strips spiked to the rafters. It was, however, necessary to devise a method of holding the panels rigidly in place, and the scheme adopted consists of a 34 inch stool tie rod extending from one truss to the next, with nuts serowcel up tight so as to prevent the trusses from spreading and thus letting the panel drop. In the case of the single thick roof used in kitchen and laundry, the adjoining panels are held together by bolts passing through the intervening rafter, a simpler method, but one that is not feasible when the roofs are double, as they should be in all inhabited buildings. The panels themselves are built up as follows: The wall panel, five feet wide, is framed of 2 x 2 inch stuff, three uprights with four cross braces in all. The outer side is sheathed with 7 s inch siding over building paper, while the inside sheathing is % inch 19 T H E \\ \ R D t: m o n s tongued and grooved ceiling running vertically. The roof panels, divided into two sections for easy handling, are1 framed in a similar manner te> the wall sections. The floor sections, each 5 feet by 7 feet 1 inches, in the 22-foot builelings are framed with 2x3 inch timber and have two thicknesses of building paper as have the w alls and roofs. A sloping water table, notched out for the posts, serves as a guide and support dur- ing erection, and later the space below the water table is sheathed down to the grade. The partitions are alse> of unit construc- tion; in general I hew are of 7.8 inch tongued and grooved sheathing with beveled battens at top, bottom and middle. The partition rests on a grooved beveled base and receives a grooved cap. beveled on top in the ease of the partitions w hich are not carried to the ceiling. The height of partitions in general is the same as that of the walls, either 8 or 10 feet, but w here partitions must be carried to the roof additional units are provided, set on top of the partition cap. The fit- ting in of these upper sections of parti- tions, running up to the under side of the roof, is an unsatisfactory detail of the system of construction. Rooms Open Lp to Roof On the other hand, the reduction of height permitted by the fact that the roof is double and that all rooms extend up to the roof is a source of economy when compared with the height required where rooms are ceiled over at the height of the eaves. If the ward buildings were ceiled across [ r RATION II OS V IT \L at the height of the e'avevs, it would be1 noevssary to raise the walls from 8 feet to a height of over 10 feot in order te> seeiuv the same cubic fevl of air. There would then 1)0 a corresponding increase1 of the total height of the1 building, and of the material to be paid for and transported, and with rathe1!' levss salisfaeleiry ven- tilation. Ordinary metal ventilators are1 pro- vided at the ridge in the open wards, over toilet rooms, etc., and continuous moni- tor v(Mifilale>rs in the kitchen and laundry. * * * Two advantage's which this construc- tion possesses and which are probably worth emphasizing are- the stoeil trusses and the type1 of windows with lower sash lixeel and upper sash hinged at the bottom to swing in, provided in the case of the wards with cheek pieces to prevent draughts. This arrangement makes the spacing of beds entirely independent of the win- elows, a feature not to be disdained in a war hospital, where at the moment of an attack the number of beds per ward may be increased twenty-five or thirty per cent. * * * The unit employed in this system is five feet in length, either eight or ten feet in height, the windows in the ten- foot units having three sashes instead of two. The standard w idths of this system are 16, 22 and 28 feet. Thus a building may be erected of either of these widths and in length any multiple of five feet, this five-foot unit being probably the most practical—the panels are small enough to be easily 20 ] The \yar D em o n str ation Hospital handled, and yet large enough to permit of an ample window or double doors in one panel. Admiral Sims is reported to have ordered buildings of this type of construction for the American naval base in England. The Heating, Lighting and Plumbing Steam is furnished by the power house of the Institute, the pipes being placed in the roof of the connecting corridors. Laundry and kitchen, operating and sterilizing rooms are similar in equipment to those of any modern hospital. The heating is by pipe coils, which were adopted in preference to radiators, as being less liable to breakage if it became necessary to transport and re-erect the hospital. The hot water supply for the various buildings is furnished by steam coil tanks, so placed that one tank sup- plies a group of three or four buildings, the length of runs being thereby much reduced. For a Field Hospital the plumbing sys- tem must perforce be simplified, as must the heating system. Probably the best method of heating is the employment of small low pressure boilers, each arranged to heat a group of three or four buildings. Stoves are objectionable from every point of view, dirty, dangerous and wasteful of coal, and in more and more hospitals are being replaced by steam heat. There should also be a high pres- sure boiler to care for sterilizing and per- haps also for cooking and washing in the case of a large Field Hospital. The plumbing is that of a permanent hospital, but with the suppression of all [ elaboration; the electric wiring is exposed throughout, the fixture's except in wards and operating building being merely bulbs with painted tin reflectors. Hospital Has Telephone System And Fire Protection The hospital has a complete inter- communicating telephone system and a fire-alarm system with watchman's clock. Hydrants and fire extinguishers are placed in convenient locations outside and within the building. If an ample water supply wore not available the fire-hydrant system might be replaced by an equipment of extin- guishers, including a small chemical engine. * * * Matters of construction and equipment have been described in order to bring out the1 fact that base hospitals are te)-elay being built and equipped to give the best of surgical e-are to patiemts who can be almost as comfortable as if they were in permanent hospitals. Some discomfort is unavoidable, but much progress has been made1 by Great Britain and France in the planning of base and field hospitals. The experience of three years of war has shown that many lives and limbs may be saved if proper hospitals are provided. It has also proved how much our losses will be increased if we try to get along w ith inadequate equipment. Neither side could continue the present war unless its hospitals could return a large percentage of patients to active service. A Modern Field Hospital \\ hile the Rockefeller War Demonstra- tion Hospital is a base hospital, a modern ] Tut: W \ \\ D t: m o n s i |{ \t I o n Hosphai, Mold hospital is composed of buildings of the same type, provided, of course, build- ings are used. Connecting corridors at a base hospital would naturally not be closed, and in most cases would not be covered, but the slat walk connecting all buildings by inclines and without slops should always be present. The portable ice machine installed in the temporary hospital is, as has been said, like those which are being shipped abroad for use in base hospitals. \vo for field hospitals would doubtless be distributed from a base rather than manufactured on the spot. The electric installation would of course bo the1 same1 for the Meld as for the base hospital, including \-Ray equipment. Time of Construction The enaction of the Rockefeller Hos- pital was commenced em June 1st, and the buildings completed ready for oevu- pancy by July 13th. This result was achieved in six weeks due to the intelli- gent handling of the work by the general contractors, and the hearty co-operation of each and every trade employed on the work. The record shows how quickly this form of construed ion can be handled. [ 22 ] ^ " a y y\ »,y ^ ^ X \ sS X ^ xv — •/ A \ / %/wy x ^X Trap ^% x ^ v v niX y ^■-^ ^iF^^Kn o>^> A:,:":A^ 9 >X *>x x, Xv** o^X ?N , X ^ x / *>X ✓ /x X s.^ & X, M^ % %, X \ T y X «r /% \y X *F VV yx x '•o-. v y y x xy y Hl^iy ^ ■r oA '"',■ % 4 % ,0<5 y %. fe^ ^ V v^s y ✓ % X ^ xV* v^ ,^ 4A X t9 , X ^ X 4?