^m&i .-.•*» "TO ■+ American Hospitals.................... 6 Mason Hospital.............• ••........ l/~ Artificial Lighting....................58, 212 Massachusetts General Hospital........ n Barmbeck (Hamburg) Hospital......... 4 .Massachusetts Homeopathic Hospital, Barre (Vermont) City Hospital........ 160 Contagious Department ....... "« Baths, Limited Use of................. 18 Massachusetts Psychiatric Hospital.... 126 Bed Space, Proportion to Utilities..... 18 Maternity Department................. /o Bispebjerg Hospital....................5, 21 Mattresses ............................. fj° Boston Consumptives' Hospital........ 134 -Mayo Clinic.......................... - Bridgeport Hospital..............66,84.101 Meadville City Hospital................ ^ Brigham Hospital, Peter Bent......6.11,22 Medical Baths.......................... "' Buildings, Character of................. 2 Medical Unit........................... °' ,- , , ,«■ • i tt •*. i d • Medicine Closets.....................•• f"° Cable Memorial Hospital, Benjamin Melrose Hospital....................100,162 Stickney ..... .............. 162 Mim Hospital at DTssy-les-Mouli- Chicago Lying-in Hospital.............. 86 neaUx 240 Children's Hospitals ........... 95 M id; psyc'hiatr'ic' Clinic.'.'.' '..''. '......•• 119 Cincinnati General Hospital..........26, 65 Munich-Schwabing Hospital...........5, 21 Classification of Patients............... 17 x- . u„^;t,i 81 n, ., n, , oflo N ewton Hospital....................... oi Cothes Closets ....................... 208 Xewton Hospital Grounds.............. 229 Clothing, Care of ..................... 219 Xew York City Hospital................ 65 Comfort of Patients.. ................ 17 , ; Minimizing of.................. 18 Contagious Department................ 108 x , Residence...................... 175 Creche or Nursery...................... 80 -,- , c- „ . ?14 J Aurses Signal.......................... -1-+ Day Rooms..............•............... 17 \Urses' Stations........................ 215 Deaconess Hospital, Concord, Mass.... 159 Nurses' Work Room................... 60 Delivery Rooms........................ 80 Nurserv ................................ 80 Details of Construction................ 208 Ohio Valley General Hospital......11,33,65 Disinfecting Room...................... 223 Operating Room Walls................. 214 Disturbing Noises...................... 18 Operating Unit......................... 57 Drinking Fountains.................... 207 Out-Patient Department............... 139 East New York Dispensary............ 152 Pasteur Hospital....................... 108 Equipment ............................. 217 Pathological Department.........:.-•••■ 1-59 Essentials in Ward Buildings........... 17 Phipps Psychiatric Clinic............... 129 European Examples.................... 4 Plumbing .............................. 196 European Influence..................... 2 Pneumatic Chamber.................... 77 Floors, Quiet........................... 211 Providence City Hospital............... 110 Floor Material.......................... 211 Psychopathic Department.............. 119 Ford Hospital, Henry.................. 27 Quiet Rooms............................ 17 Forsyth Dental Clinic.................. 96 Quincy Hospital........................ 62 Galloway Memorial Hospital........... 32 Rhode Island General Hospital......... 65 German Hospital, Chicago.............. 32 Rigs Hospital........................... 21 Grace Hospital, Detroit...............57, 62 Roentgen-Ray Department............. 142 Greenville (Me.) Hospital.............. 162 Royal Victoria Hospital, Ross Pavilion .. 36 Growth of Hospitals.................... 1 Ruptured and Crippled, Hospital for.... 101 Hamot Hospital........................ 35 St. Georg Hospital...................... 62 Hardware .............................. 209 St. Luke's Hospital, Jacksonville. . .9, 27, 110 Harper Hospital........................ 27 St. Luke's Hospital, New Bedford...... 84 Heating of Operating Rooms........... 198 St. Thomas Hospital................... 96 Heating and Ventilating................ 196 San Francisco Hospital.................. 35 Hospital Entrance...................... 41 Scrub-up Sink.......................... 60 Illinois Central Hospital................ 36 Sea View Hospital...................... 132 Kingston Avenue Hospital............. 110 Serving Kitchens.....................18,187 Kitchen and Laundry................... 185 Sick Children, Hospital for......96, 100! 115 Kitchen, Requirements of............... 185 Sick Children, Hospital for,—Nurses' Kitchen Utensils........................ 188 Residence ............................ 183 Laboratories ........................... 139 Sink Room............................223 Landscape Architecture................ 228 Sites for Hospitals................... 1 Lane Home, Harriet.................... 97 Small Hospital, The................... 155 Laundry and Disinfecting Plant........ 189 Social Service Work................ ' 150 Lighting, Artificial...................58,212 Southern Pacific Hospital.............. 75 Macon Hospital........................ 33 Sterilizers ................... 221 Page Page Sterilizing Room........................ 60 Wall Decoration........................ 213 Sunshine, Importance of................ 17 Walls, Material for..................... 214 Surgical Unit........................... 57 War Hospitals.......................... 239 Talitha Cumi Maternity Home.......... 81 Ward, Size of........................... 17 Thomas Hospital, Josiah B. (Peabody, Wards, Roof.................. 17 Mass.) ................................ 171 Ward Unit.............................. 16 Toronto General Hospital.............. 8 Ward Units, European.................. 20 Tuberculosis Department.............. 130 Wesson Maternity Hospital............ 86 Twentieth Century Hospital, Ideal..... 4 Willard Parker Hospital................ 110 U. S. Overseas Hospitals............... 247 Worcester City Hospital................ 101 Utility Room............................ 18 N-Ray Department...................... 142 Utrecht Psychiatric Clinic.............. 119 Yonkers Homeopathic Hospital.'....... 86 Vacuum Cleaners....................... 215 Youngstown Hospital.................30, 62 illustrations Page Page Augusta General Hospital, Nurses' Resi- Buffalo General Hospital, Private Pavi- dence............................... 183 Hon. Autopsy Tables......................205, 206 Operating Department................ 75 Barmbeck III Hospital, General Plan. .. 4 Typical Ward Plan.................... 57 Barre City Hospital. Cabinets, Built-in....................... 67 Exterior............................. 161 Cable Memorial Hospital, Benjamin Floor Plans...................159, 160, 161 Stickney. Operating Room...................... 73 Exterior............................. 164 Base Hospital, Plan..................... 246 Plans .............................162, 163 Bath, Admitting......................... 202 Plan of Grounds...................... 236 Bath. Baby............................. 203 Canton Hospital School................. 199' Beds, Adjustable................217, 218, 219 Chart Cases............................. 215 Bedside Tables........................ . 220 Chicago Lying-in Hospital, Plans.....87, 88 Beverly Hospital, Plan of Grounds..... 235 Children's Hospital, Philadelphia. Bispebjerg Hospital. Out-Patient Department, Plans....... 147 General Plan.......................... 5 Cincinnati General Hospital. Ward Unit............................ 21 Exterior of Wards.................... 28 Boston Consumptives' Hospital......... 138 General Plan.......................... 8 Bridgeport Hospital. Interior of Ward...................... 27 Birdseye View........................ 20 Kitchen ...........................190, 191 Major Operating Room............... 68 Ward Plan........................... 26 Operating Room...................... 66 Cincinnati General Hospital, Operating Plot Plan............................. 19 Building, Plans....................70,71 View in Operating Department....... 67 Cincinnati General Hospital, Receiving Serving Kitchen...................... 193 Building............................ 16 Bridgeport Hospital, Maternity Pavilion. Clothing Lockers....................... 221 First Floor Plan...................... 36 Deaconess Hospital, Concord, Mass., Second and Third Floor Plans........ 37 Plans ............................... 158 Children's Ward...................... 101 Details of Door Finish.................. 209 Creche ............................... 83 Details of Linen Closet................. 211 Day Room............................ 102 Details of Window Finish.............. 210 Delivery Room....................... 84 D'Issy-les-Moulineaux, War Hospital. Exterior ............................. 36 General Plan......................... 239 Private Room......................... 39 Plans ..............................140-145 Ward................................. 39 Diet Kitchen............................ 225 Bridgeport Hospital, Nurses' Residence. Door Frames, Hospital................. 209 Exterior-..........................177, 178 East New York Dispensary, Floor Nurse's Room......................... 180 Plans ...........................152, 153 Plans................................. 176 Floor Trap.............................. 205 Study Room.......................... 178 Fluoroscope (Upright).................. 147 Superintendent's Room............... 179 Food Truck.........................214,227 Bridgeport Hospital, Service Building. . 194 Footstools ............................. 220 Brigham Hospital, Peter Bent. Ford Hospital, Henry, Ward and Op- Airing Balcony....................... 26 erating Plan........................ 29 General Plan.......................... 7 Forsyth Dental Clinic, Wall Decoration. 97 General View......................... 14 Galloway Memorial Hospital, Second Interior of Wards.................... 25 Floor Plan.......................... 40 View in Pharmacy.................... 13 German Hospital, Chicago, Floor Plans.41, 42 View in Rotunda...................... 13 Grace Hospital, Operating Department. 59 Ward Floor Plans.................... 24 Greenville Hospital, Plans.............. 165 Page Page Hamot Hospital. New York City Out-Patient Depart- Operating Plan....................... 74 ment ............................148, 149 Private Ward, Exterior............... 47 Ohio Valley General Hospital. Private Ward, Plan................... 47 Airing Balcony........................ 43 Harper Hospital, Ward Plans........... 30 Fourth Floor Plan.................... 63 Heating. General View......................... 15 Details of Vent Flue.................. 197 First Floor............................ 15 Direct-Indirect Radiators............ 196 Ground Floor Plan..................._. 43 Temperature of Patients' Rooms..... 197 Isolation Department.............115, 116 Haynes Nurses' Home, J. Manchester Kitchen .............................. 192 (Augusta General Hospital)........ 183 Operating Room...................... 64 Hey wood Hospital, Plan of Grounds.... 235 Rear View............................ 44 Hospital Beds.......................217-219 X-Ray Department................... 79 Hospital Help's Building................ 184 Pasteur Hospital, Ward Plan........... 108 Illinois Central Hospital, Floor Plans.50, 51 Pasteurizing Room..................... 226 Jacksonville Tuberculosis Hospital, Pneumatic Chamber.................... 77 Plans ...........................132, 133 Quincy City Hospital, Operating Build- Kings County Hospital, Help's Build- ing. ing ................................. 184 First Floor Plan...................... 62 Kingston Avenue Hospital.............. 114 Operating Room...................... 200 Kitchen Cabinet........................ 211 Scrub-up Sink......................... 200 Lighting Fixtures...................212,213 View in Operating Room............. 63 Linen Cabinets......................... 211 Radiators .............................. 196 Macon Hospital. Revolving Airing Balcony.............. 131 First Floor Plan...................... 45 Rhode Island General Hospital, Operat- Out-Patient Department.............. 151 ing Department..................... 64 Private Pavilion...................... 46 Rigs Hospital. Roof Plan............................. 44 View in Kitchen...................... 186 Mansfield General Hospital, First and Ward Unit............................ 22 Second Floor Plans...............48, 49 Rockefeller War Hospital. M ason Hospital. Construction ......................... 268 Exterior.............................. 174 Interior of Ward..................... 268 Plans .............................172, 173 Royal Victoria Hospital, General Plan. 52 Massachusetts General Hospital. Royal Victoria Hospital, Ross Pavilion. Administration Building.............. 12 Distant View.................Frontispiece Basement Plan........................ 13 Entrance Lobby...................... 56 Operating Department............... 58 Entrance to Grounds................. 238 Original Building..................... 11 Fifth Floor Plan...................... 54 Zander Room......................... 79 Front View........................... 55 Massachusetts Homeopathic Hospital, Ground Floor......................... 53 Isolation Building, Floor Plans..... 117 Kitchen .............................. 192 Massachusetts Psychiatric Hospital. Operating Room Heating............. 200 Exterior ............................. 125 Serving Kitchen.............. 193 Floor Plans........................126-128 Typical Floor.......... 53 Maternity Beds......................... 219 West Side............................. 54 Mayo Clinic, Floor Plans...........143-146 Ruptured and Crippled, Hospital for', Meadville City Hospital, Maternity De- Floor Plans.................103, 104^ 105 partment ........................... 82 -San Francisco Hospital. Medicine Closet....................206,210 Maternity Department............... 86 Melrose Hospital. Medical Department................. 80 Children's Ward...................... 106 Typical Ward Unit............. 49 Exterior.............................. 169 St. George Hospital. General Plan......................... 166 Operating Department........... 60 Interior .............................. 170 Pathological Department...... ..... 14? Floor Plans.......................167, 168 St. Luke's Hospital, Jacksonville. Military Hospital D'Issy-les-Mouli- Administration and Operating- Denart neaux,..................239,240,241.243 ments ............. ...... .. P 69 Morse Hospital, Leonard, Nurses' Corridor and Public Wards.'. ". 34 Home, Plans........................ 182 Exterior of Private Ward.!.. 3? Munich Psychiatric Clinic...........120, 121 General Plan............... n Munich-Schwabing Hospital. Laundry, Plan............ ' 193 General Plan.......................... 6 Private" Ward, Plans!!.... '. ' 31 Medical Treatment Department, Plan. 76 Public Ward, Plan....... 33 Pathological Department..........139-141 Exterior of Public Ward...... 35 Ward Unit.............. 23 St. Luke's Hospital, Isolation BuYlding. Newton Hospital, Newton, Mass.....230-233 Admitting Bath........... 202 New York City Hospital, Opeiating Exterior... ' -.V, Room .............................. 65 Plans..........■■■■........'.'..'........ J09 Page Page Private Room.......................... 112 U. S. Overseas Hospitals. Serving Kitchen...................... 112 Details of Construction............269-272 Three-Bed Ward..................... 113 Details of Plumbing...............273, 274 Ward Plan........................... 31 Elevations ........................... 266 St. Luke's Hospital, Jacksonville, General Plan.......................... 250 Nurses' Residence. Plans of Units.....................252-265 Exterior ............................. 181 Utrecht Psvchiatric Clinic. Plans................................. 180 Interiors ............................. 124 St. Luke's Hospital, New Bedford, Plans .............................122,123 Maternity Department............. 85 Vent Ducts 197 St. Thomas Hospital, Children's Ward.. 96 Ventilating through Closet!.'!!!!!!!!!!! 198 Se^.\ie\Ho,sPltaL „ Ventilation Roof....................... 199 Dining Building....................... 135 Virchow Hospital. GeneralPlan...................... 134 General Plan.......................... 3 Group Building....................135,136 Kitchen 189 Ward Unit Plans.............•;•••-• Ul Surgical Ward' Unit.'!!!!!!!!!!!!!!!!! 21 Serving.^tchens..._............224, 225, 226 View in Grounds...................... 229 Sick Children. Hospital for. „. T1 , -n Vv+or;nr v,^,„ nn Water Bed.............................. 78 tLxtenor View........................ 99 w ^T , ■, n ■, , ,->, on nn Floor Plan 100 Wesson Maternity Hospital, Plans... .89, 90 100 Interior .............................. 116 Laundry.............................. 195 Western Infirmary, Out-Patient Plan.. 148 Willard Parker Hospital, Plans........ 114 Nur*sesV Residence!!!:!:!!:::'.'.:'.;;!!! 175 WAlliamts. Pri^ate Sanatorium. Out-Patient Department.............. 154 Operating Room................... 72 Pasteurizing Room................... 226 ,J lans. ' ' ' • r-V ■•■■•■•• ■ ■ • ■ • ■ ■••••■ • n?' 1S/ Sink Room............................. 223 WorDces1tJr Clty HosPltab Children s Special Door Hardware................. 212 Building ........................106, 107 Sterilizers, Box Type................... 222 Yonkers Homeopathic Hospital. Surgeons'Scrub-up Bowls...........203,205 Exterior ............................. 93 Talitha Cumi Maternity Home. Plans ............•................91, 92 Plans gj \ oungstown Hospital. Plan of Grounds. ..................... 234 Operating Department................ 61 Thomas Hospital, Josiah B. (Peabody, Ward Unit............................ 3S Mass.) ..........................170, 171 Zander Room........................... 79 THE AMERICAN HOSPITAL OF THE TWENTIETH CENTURY CHAPTER I. 3fn (general Historical. It would be vastly inter- esting to trace the evolution of hospital building and equipment from the crude structures of ancient times designed to house the sick, to the comprehensive hos- pital of today, and to show how architec- ture and equipment have advanced stride for stride with medical and surgical prog- ress ; but in these days of vivid and in- sistent research and accomplishment there is no time for comparative specula- tion or historical review. All our ener- gies are needed to keep pace with the newly devised methods which are con- stantly being put in practice and to fa- cilitate these achievements by proper housing and equipment. Hospital build- ing, since the beginning of the twentieth century, has increased enormously. In 1911 Dr. Charles P. Emerson* stated the number of hospitals in the United States to be 2,547; and the data available in 1914 gave the total number as 7,000, housing 1,000,000 persons, of whom 5°ILtt iir\KCH\Hl Houst lNSP£CT°*_ MCHITtCT FIG. 3. GENERAL PLAN, BISPEBJERG HOSPITAL, COPENHAGEN, DENMARK. M. Nyrop, Architect. In the Barmbeck, coupled with the medical center, is the patients' entertain- ment hall, which is used also for a church. On the surgical side, three of the pavilions are connected by corridors, while the fourth is isolated. All other buildings throughout the group are isolated. The Bispcbjerg Hospital of Copen- hagen (Fig. 3), designed by Professor Martin Nyrop, is located on slightly ris- ing ground. The site is ideal, containing fifty-one acres. The hospital consists of clinics as well as for hospital patients. The grounds are laid out with special care for the comfort of the patients, with arbors, benches, and fountains. One of the most modern and complete hospitals in Germany is Munich-Schwa- bing (Fig. 4). In this building Archi- tect Richard Schachner has embodied the best of German planning and coupled with it the most valuable of American ideas. While he has separate pavilions, he also has everywhere connecting corri- dors above ground, except to the con- 6 THE AMERICAN HOSPITAL 1. Main building. 2. Chapel. 3. Sisters' building. 4. Administration building and apothecary. 5. Benzine building. 6. Operation building. 7. Main bath. 8. Kitchen. 9. Male out-patients' building. 10. Female out-patients' building. FIG. 4. GENERAL PLAN 11, 13, Male patients' buildings. 12, 14. Female patients' buildings. 15. Disinfecting building and laun dry. 16. Garden and workshop. 17. Machinery building. 18. Animal experiment building. 19. Pathological building. 20. Segregation building. 3( 21. Contagion building. 31 22. Skin and sex disease building. MUNTCH-SCHWABING HOSPITAL Richard Schauchner, Architect. Mental disease building. Children's building. Gynecological building. Janitors' quarters. Director's residence. Public lavatory. Main administration building and residence Coal house. Building for help of electric plant. MUNICH, GERMANY. tagious and special treatment buildings, and between these there are underground passageways. The administration is in the center, flanked by the chapel and the nurses' resi- dence on one side and by the office and the home for the staff on the other. The surgical group has for its center the op- erating building; and the medical unit, a splendid bath-house. This bath-house is considered the finest in Europe connected with a general hospital, and will be de- scribed in another chapter. American Hospitals. The Peter Bent Brigham Hospital (Fig. 5), created by the bequest of six million dollars from the man for whom it is named, was opened in 1913. In the year 1907 a com- petition was held by the Trustees, seven architects being invited to submit plans, which resulted in the selection of Cod- man & Despradelle. Perhaps no hospital in America has had more study and thought put into it than has this institu- tion, and the plan is worthy of much study. Under the guidance of the super- intendent, Dr. H. B. Howard, the archi- tects and engineers have developed a comprehensive plan which gives the patient every advantage of open air, sun- light, and quick and quiet service. In planning for the Cincinnati General Hospital (Fig. 6), the City was wise in the selection of a site which would give OF THE TWENTIETH CENTURY PETES BHrr--EHlO«^^SPlTAlL/ CO&MAM AIOJJESPJiA2HV3^OTrBCr5 \ JUKACCN STREET ,9, rW,\ Vi " ^ THE AMERICAN HOSPITAL e, d e. /i A V E./1 V E. B U k ri El T A V E /i KJ E CINCINNATI GENERAL HOSPITAL. GENERAL PLAN. sufficient room for growth. It was also wise in its appointment of Dr. Christian R. Holmes as medical adviser, since the time and thought he has given to this in- stitution, after studying foreign and American hospitals, has made it one of the leading hospitals of the world. Dr. Holmes was ably assisted by the archi- tects, Samuel Hannaford & Son. The trustees of the Henry Ford Hos- pital, Detroit, were farseeing in the se- lection of their site. The results of care- ful study of the European hospitals are noticeable in their plans, made by Archi- tect William B. Stratton. The plans of the Toronto General Hos- pital, Toronto, Canada, were developed through a term of years, and show much OF THE TWENTIETH CENTURY FIG. 7. ST. LL'KE'S HOSPITAL, JACKSONVILLE, FLA. PLAN OF THE GROUP. careful study. This hospital exhibits the influence of the English institutions, particularly in the surgical units, where each unit is placed under the charge of one surgeon, who has his own operating rooms. This makes of every unit a com- plete hospital. The detached buildings of many of the European hospitals seem ideal for the climate for which they are built; but in America, especially in the rugged climate of the northern part, protection must be given the patient in going from building to building, and connecting corridors, at least, are generally provided. In the mild climate of Florida, however, at St. Luke's Hospital (Fig. 7), Jacksonville, it has been possible to build detached pavilions with open corridor connection. The group will consist of fourteen buildings, eight of which are finished and occupied. The administration building is in the center, with the ward and treat- ment buildings to the south. There are six or eight of these ward and treatment buildings, only two being now built. The domestic building, containing kitchen and dining-rooms, is directly behind the administration, while the power house and laundry are still farther back. The nurses' residence occupies a position cor- responding to that of the private ward. 10 THE AMERICAN HOSPITAL Two buildings for the care of infectious diseases are also provided. The administration building contains not only the offices of the institution, but also the accident department, the admitting department, and. in the second story, a thoroughly equipped operating department and medical treat- ment rooms. The ward unit is planned to eliminate, as much as possible, the general noise of the hospital, and to give an abundance of open-air balconies. The private ward unit has a large open-air ward on the second floor. The isolation building is so planned that patients can be treated individually, after the manner of the Pasteur Hospital at Paris. (See description in Chapter VIII.) OF THE TWENTIETH CENTURY 11 CHAPTER II. ADMINISTRATION DEPARTMENT. FIG. 8. MASSACHUSETTS GENERAL HOSPITAL. (From an old wood cut.) Whether it is a large institution or a hospital of twenty beds there must be headquarters for the administrator or di- rector. This department may vary from a single room to a vast building with ad- mitting rooms, waiting rooms and staff rooms. From careful observation, it would seem desirable to have the administrative unit the center through which all patients (except stretcher cases) and all their friends shall pass, and where the general business of the institution shall be con- ducted. The entrance to this department should be carefully studied from the psychologi- cal standpoint, with reference to the ef- fect on the would-be patient. It should be so plainly indicative of its purpose that there can be no hesitation as to where to go first for further direction. The in- formation desk must be plainly in evi- dence and at this desk should be every facility for answering questions. Vaiting space should be provided for visitors who may come in numbers be- fore the visiting hour. There should be offices of the superintendent, admitting officer, bookkeeper, and superintendent of nurses; the staff and board room, and the medical library. The sleeping and sitting rooms of the house staff and in- ternes can be located in this department building. In the smaller hospital, the laboratories and Roentgen-ray, the autopsy and lec- ture rooms, and at times the kitchen de- partment work out most satis- factorily in this unit. To show that a hospital can be successfully run without a so- called administration building, it will be noted that the Massachu- setts General Hospital, one of the oldest in the country, built by Bulfinch in 1821 (Fig. S), did not have an administration building until 1916; so that, with the hundred years in which to study the needs, it is not surpris- ing that the plan is well-nigh per- fect (Figs. 9, 10). To the entering visitor, the broad marble information counter at once in- vites confidence; and with the ample waiting-room in the center and the vari- ous offices of the institution around the perimeter, one is not apt to lose his way. The plan is self-evident. The casualty entrance from the same court conies into the basement (Fig. 1), where there are minor operating and treatment rooms. In the upper stories are the rooms of the staff. At the Peter Bent Brigham Hospital (Fig. 5), the problem is worked out on a more palatial scale. In the great rotunda (Fig. 13), the circular informa- tion deck in the center is evidently the center of information. The offices of the superintendent and his assistants, and that of the superintendent of nurses, as well as the admitting and examining rooms, are grouped around the rotunda. In the basement are located the Roent- een-ray department and the pharmacy. The central location of this building, con- necting as it does the approach to all de- partments of the institution, simplifies the problem of surveillance. At the Ohio Valley General Hospital (Fig. 15), which is a block-type, self- contained building, the ground and first stories are set aside for administration and domestic purposes. The main and ambulance entrances, the laboratories and treatment room, the out-patients' 12 THE AMERICAN HOSPITAL PLAN OF FIRST FLOOR 1 Main entrance to Hospital 2 Information office 3. Stairs to public toilet for men 4 Waiting room for patients to be ad- mitted 5, 6, 7, 8, 9, 10 Telephone booths 11 Admitting Physician's office 12 Outside corridor to yard 13 Record Clerks' office 14 Corridor to Main Hospital 15 Cashier's office 16 Elevator 17 Bookkeeper's vault 18 Bookkeeper's office 19 Office of First Assistant Resident Physician 20 Office of Resident Physician 21- Trustees' room 22 Private toilet 23 Cleaners' closet 24 Clerks' office 25 Office of Superintendent of Nurses 26 Office of Assistant Superintendents of Nurses 27 Office of Assistant Resident Physicians 28 Telephone switchboard room 29, 30 Reception rooms 31 Office of Assistant Resident Physician 32 Parcel room 33 Main waiting room for visitors 34 Stairs to public toilet for women FIG. 9. MASSACHUSETTS GENERAL HOSPITAL. PLAN OF FIRST FLOOR, ADMINISTRATION BUILDING. Coolidge & Shattuck, Architects. FIG. 10. MASSACHUSETTS GENERAL HOSPITAL. EXTERIOR, ADMINISTRATION BUILDING. Coolidge & Shattuck, Architects. OF THE TWENTIETH CENTURY 13 PLAN OF BASEMENT FLuOR 1 Corridor to ambulance entrance 2 Isolation room 3 Dark room 4, 5, 6, 7,11,12 Operating and examining rooms 8 Air chamber - 9 Splint room 10 Covered incline to possible future buildings 13 Ward service room 14, 15 Male and female emergency wards 16 Ward kitchen 17 Linen room 18 Blanket-warming room 19 Sterilizing room 20 Instrument room and medicine closet 21 Storage vault 22 Disinfecting room 23 Staff dressing room 24 Tunnel under Fruit St., to Nurses' Home 25 Women employees' rest room 26 Women employees' dressing room 27 Patients* toilet (women) 28 Apparatus room 29 Public toilet for women 30 Storage 31 Public toilet for men 32 Cleaners' closet 33 Patients' toilet (men) 34 Emergency-ward bathroom 36 Dressing room for men employees 36 ^Emergency-ward office 87 Entrance for ambulatory patients 38 Central clothing room 39 Elevator. FIG. 11. MASSACHUSETTS GENERAL HOSPITAL. MOSELEY MEMORIAL (ADMINISTRATION) BUILDING. Coolidge & Shattuck, Architects. and isolation rooms are on the ground floor (Fig. 53), while the main adminis- trative offices, the internes' quarters, the kitchen and dining rooms are on the first floor (Fig. 17). This concentrates all of the non-profit-bearing portion of the building near the ground and the less in- teresting outlook. FIG. 13. PETER BENT BRIGHAM HOSPITAL. FIG. 14. PETER BENT BRIGHAM HOSPITAL. VIEW IN ROTUNDA. VIEW OF PHARMACY. n x c H > FIG. 12. GENERAL VIEW, PETER BENT BRIGHAM HOSPITAL, BOSTON. Codman & Despradelle, Architects. OF THE TWENTIETH CENTURY 15 FIG. IS. GENERAL VIEW, OHIO VALLEY GENERAL HOSPITAL, WHEELING, W. VA. Edward F. Stevens, Architect. F1R.5T FLOOR. PLAN FIG. 17. PLAN OF FIRST FLOOR, OHIO VALLEY GENERAL HOSPITAL, WHEELING, W. VA. Edward F. Stevens. Architect. 16 THE AMERICAN HOSPITAL CHAPTER III. THE WARD UNIT. The subject of the ward unit has been discussed by so many able writers on hospital planning that one hesitates to say more on the topic; still, the ward unit is really the keynote of the hospital, since it is here that the patient for whom the institution is built, lives, eats, sleeps, and spends his weary hours of conval- esence. We should, therefore, never cease to study the best methods of filling those hours with as much comfort as possible; how to serve him with palatable food; how to provide him with fresh air and sunshine; and how to guard him from undue noise and from the excite- ment caused by the workings of the hos- pital. The planning of the ward unit, whether in a hospital of one hundred or one thousand beds, presents the same problem—how best to care for the patient. After more or less careful study of hospital buildings in Europe and America, after consultation with many of the leading hospital authorities, and after living in the hospital and seeing the operation and treatment, it appears to the writer that there are certain fundament- T Ambulance. _Por.ch Mew General. Hospital Cincinnati -— Ohio •3AMUIL HANNfiTOILD U Jonj — AR.CHIT£.CTJ Cincinnati — Ohio FIG. 18. OF THE TWENTIETH CENTURY 17 als which every ward unit should pos- sess—i.e., every ward unit of a general hospital where the surgical, the usual medical, and special cases are treated, or where the general run of cases are cared for. These essentials of planning can be classed under two heads: (a) Comfort of Patients. The com- fort and care of the patients are in- variably the first things to be consid- ered. Around this center—the pa- tient—we build our institution. If the supplying of more light, better air, and freedom from disturbing noises will add to the comfort and hasten the con- valescence of the patient, then these things must be provided. (b) Accessibility of Service. The utility rooms should be so near and so well equipped that the patient need not be called upon to wait for service. At the same time, these service rooms should be so planned that the necessary noises therefrom will not be a menace to speedy convalescence. The ward unit should be planned for the particular class of disease which is to be treated in it. The conditions which govern the treatment of acute surgical patients are different from those govern- ing chronic medical cases. The ambula- tory tuberculosis patient needs different accommodations from the patient suffer- ing with the same disease in an advanced form ; the child from the adult; the con- tagious from the psychopathic case. There are a few essentials applicable to all classes of cases. Whatever the case (with a possible exception of eye cases), the ward or bed of the patient should be so placed that it is possible to have sunshine in the room and near the bed some part of the day. All necessary inside doors and all doors or windows giving access to porches should be de- signed wide enough for the patient to be moved in his bed without any change and without any discomfort or inconvenience, to any part of the building, porches, or roof. As to the number of beds to be placed in a ward, authorities differ very much and local demands vary widely. The best authorities abroad believe that not more than sixteen, or. at the most, eigh- teen patients should be in one room, and some think that these should be sub- divided for a better segregation. In wards, every patient should have, when all windows and doors are closed, at least one thousand cubic feet of air. If we consider the height of the ceiling twelve feet, each patient should have not less than eighty-three square feet of floor space—one hundred is better. The height of the ceiling may depend upon the character of the disease being treated, but any height above twelve feet is un- necessary and is of little use in the puri- fication of the air, since the breathing line is about three feet from the floor. On the other hand, for appearance's sake, a ward of more than ten beds should not be less than ten feet in height. Where wards are of any considerable size, there should be provided nearby one or more "quiet" rooms for delirious or dying patients. Every patient should have at least semi- privacy and some place in which to hide the "household gods" which he may have brought with him. Many of our modern hospitals, for economy's sake, have a flat roof; and some of them use this roof to a limited extent for the care and treatment of patients. These flat roofs should be used not only as an observatory but, if partly covered for protection from storms and intense heat and partly open to the direct rays of the sun, a patient may be given open-air treatment. The regular ward service of toilet, sink room, serving kitchen, and linen and supply room should be provided here. In Europe the day room or conval- escent room is considered by the Govern- ment so important that every hospital is compelled to provide one for each ward or group of private rooms, allowing a little over nine square feet for each patient, thus making the area of the day room about one-tenth that of the ward or group of private rooms. In some institu- tions this room is used for a dining-room. The day room for wards allows a separa- tion of the convalescing patient and the really sick patient, to the advantage of each. The (lav room for private rooms affords a sitting room where the patients 18 THE AMERICAN HOSPITAL can receive their friends, gossip one with another, and get away from the mon- otony of their own rooms. Every ward unit, or section of private rooms, should have a serving kitchen of sufficient size, so placed so as allow quick service of palatable food. The common faults of serving kitchens are that they are too small, and that the arrangement of the equipment is inconvenient. Such rooms should be carefully planned around the equipment, instead of the equipment being adapted to the room after the build- ing is done. The things most used should be located so as to be most accessible; and the things which are needed together should be adjacent, in order to save time and confusion. There should be facili- ties for keeping food either hot or cold; for cooking small diets; for laying trays for patients, and for washing the china. (See Chapter XVII, on "Equipment.") It is always necessary to have a sep- arate utility room for the emptying, ster- ilizing, and storage of bed pans and urin- als, and such service. The soiled clothes' container may be placed here, unless a clothes' chute is used. Here, also, should be the gas stove for the making of poul- tices, the sterilizer for boiling instru- ments, the ice-crusher for ice caps, the small ice storage box, the blanket warmer, etc. A local incinerator is some- times found valuable for destroying ward waste, and can be placed in this room. The utility room and the serving kitchen, on account of their constant use, should have the walls tiled to at least four feet in height, and should be located so as to minimize annoyance from noises. Baths. With acute cases little use is made of the bath tub, so that in a gen- eral surgical or medical ward only a lim- ited number is needed, perhaps one to fifteen or twenty patients. In tubercular wards, simple bathing facilities should be provided, both tub and shower, since bathing usually forms a part of the treatment. For departments where patients need assistance in taking their baths, the tub should be set high above the floor. In children's wards where the bath is always given by a nurse, the high, shal- low slab or tub, with spray, should be used. For the ward entrance bath, a shallow tub where the spray can be used has been found desirable. (See Chapter XV, on "Plumbing.") The necessarv toilets must be pro- vided. A small laboratory is a great con- venience. For surgical wards, a properly equipped surgical dressing room is al- most a necessity; it saves much dirt and many odors in the ward, and adds to the comfort of other patients. Where there are many private patients, there should be a small room with sink where cut flowers can be taken at night and rearranged in the morning; this pre- vents the clutter which one finds in the bath or sink room on morning rounds. For the convenience of doctors and at- tendants, lavatories should be placed in every room or in the corridors adjoining. Drinking fountains, preferably of the "bubbling" type, add to the comfort of both patient and nurse. From a careful investigation of mod- ern ward units for the care of general cases—of eighteen to twenty-four beds per floor—it has been found that an av- erage of twenty-five per cent of the area of a floor is needed for staircases, ele- vators, and utilities, and twenty-five per cent for corridors, leaving fifty per cent for patients. Circumstances will, of course, change this proportion. In con- tagious wards the proportion for utilities will be greater, while in those for in- cipient tuberculosis it will be less. There is nothing more disturbing to a sick patient than street noises, the ring- ing of electric bells, the clatter of dishes, clicking of doors, hum of conversation, the flushing of plumbing, etc. He wants quiet and grumbles if it is denied. The minimizing of hospital noises is one of the architect's problems. It cannot be accomplished by putting legends on the wall, warning the visitor, doctor, or nurse to "keep silence." It must be done by planning. With modern fireproof con- struction, hard-plaster finish, lack of draperies, and necessary elimination of architectural detail the very walls become sounding boards, which " transmit and magnify noises throughout the building. OF THE TWENTIETH CENTURY \9 FUTUK.C. ; tact :£xTeLadicjn n r PLOT PLAN. BR ID G E PO RT- H (X5PITA L Bridgeport--Conn tDWARP Z."STl\-tm- ARCHITECT BOJTON----------MAS! FIG. 19. Hospitals should be so planned that noises are confined, as far as possible to the localities in which they origin- ate. Much elevator and staircase noise can be avoided if these are enclosed in one shaft, away from wards or private rooms, with a wide landing in front, shut off from main corridor by a door. In a well-planned private house, the kitchen is never connected with the liv- ing rooms nor directly even with the din- ing-room ; yet in modern hospitals we sometimes find the serving kitchen next to or directly opposite a patient's room or ward, with the clatter of dishes dis- turbing him many times a day. This is also quite true with other utility rooms such as sink room or public toilets. If these utilities can be segregated, placed at the end, the center, or even around the corner of the ward building, there will be much greater freedom from these dis- turbing noises. In maternity departments, the nursery, the delivery room, and the labor room should be as far as possible from patients' rooms, and should be isolated by at least two intermediate doors. (See Chapter VI, on "Maternity Depart- ment.") The operating department should be well removed from all others, preferably on a separate floor or in a separate pavilion. Floors which minimize the noise, either of cork or linoleum, should be used in the sick rooms; and noiseless hardware and door checks to prevent slamming, etc., should be considered in the construction of the building. Outside noises, such as street cars, railroads, traffic on the pavement, manu- facturing plants in the vicinity, etc., can 20 THE AMERICAN HOSPITAL be avoided only by proper location. This to illustrate some of the important should receive serious consideration. points. A few examples of both the European European ward units. and the American ward units will serve It will be noticed that in the Barmbcck < H O o K £ Si •" '1 *" Q > fc, fa O - OF THE TWENTIETH CENTURY 21 the largest ward is sixteen beds (Fig. 2) ; that from each ward is a licgehalle or airing balcony; that each ward has its tageraum or day room; that the serving kitchen, sink rooms, and toilets are re- moved from the vicinity of the patients' rooms; and that each ward unit has a laboratory and a surgical dressing room. This ward building proper is two stories in height, with room on the third floor for a few nurses for quick call. The operating building of this hospital of fifteen hundred beds has but two op- erating rooms, so that many of the minor surgical procedures are done in the surgi- cal dressing rooms which are in each unit. The Barmbeck unit is an unusually good and complete one. The Rigs Hospital ward unit (Fig. 21) has much to commend it as worthy of study, for it is in many ways unique. The staircase, elevator, and other noisy equipment are kept at the extreme ends, away from the portion of the building occupied by patients. The serving kitchen, bath and sink rooms are on a cross corridor; the surgical dressing rooms and toilets are at the opposite end of the building. An isolation room and nurses' room are placed in the center. The ward itself, containing twenty-six beds, is divided into eight sections, each section containing three or four beds. A dividing screen affords privacy to the patients and still allows free access to all parts of the room for the atten- dants. The screens, only six feet high and raised one foot from the floor, afford the same ventilation as an open ward. Bowls for surgeons' use and medicine closets are placed in each ward. This is doubtless one of the best de- veloped ward units in Europe. In the Bispcbjcrg Hospital (Fig. 23), the ward unit is interesting, sixteen beds being the largest ward. The entire de- sign of the group is simple and dignified, and rather different from the stereotyped styles one sees throughout Germany. Professor Nyrop has taken advantage of the natural contour of the land in the use of terraces, steps, and landscape effects. The details of the various equipment were very carefully devised. In the Munich-Schwabing (Fig. 24) 22 THE AMERICAN HOSPITAL FIG. 21. PLAN OF WARD UNIT—RIGS HOSPITAL, COPENHAGEN, DENMARK. unit the largest ward is twelve beds. All wards face the south and have oppor- tunities for wheeling patients into the balconies and into the gardens. The bal- conies are spacious and comfortable with attractive boxes of flowers decorating them in summer. The service rooms are to the north, also the laboratory and dressing rooms. The day room is to the south, central with the unit. FIG. 23. BISPEBJERG HOSPITAL, WARD UNIT. M. Nyrop, Architect. The admitting department for each ward unit is very complete. The patient comes into room No. 11; his clothes are removed and put into a container of linen which is hung on a truck; he next goes to room No. 12, where he is bathed; to No. 13, where he is given hospital clothes; passes to No. 8, where final examination is made and history completed, and thence to his bed. The elevator at this part of the building is for the convenience of the second-story patients. AMERICAN WARD UNITS. The European hospitals are built and supported very largely by the govern- ments. In this country, we have a very different condition. Many of our hos- pitals are private corporations, and it is generally a question of accommodating the largest number of patients for the smallest amount of money. Our archi- tects, therefore, are often forced to econ- omize in every way, until the wards in many cases have become almost barracks for the mere housing of people, and the attendants are obliged to put up with the scantiest accommodations. Some of our newer hospitals are ris- ing in scale. Instead of making a num- ber of rooms and leaving it to the admin- istrator to find out later what he can put into these rooms, they are allowing their architects to provide some of the more essential rooms, such as the sink room, a serving kitchen of sufficient size, a surg- ical dressing room, laboratory, etc.; and are letting him design and plan the equip- ment at the time he makes the drawings for the building. The care and thought put upon the working out of the plan of the Peter Bent Brigham Hospital (Figs. 25-27), makes it worthy of attention. The first floor of the ward unit con- tains two large wards, one of eight and the other of fourteen beds. A cross cor- ridor _ separates the two wards. Two isolation rooms, with diet kitchen, duty room, baths and toilets, are grouped to- gether on the side of the corridor op- posite the main ward. There are, also, a laboratory and a consultation room on this floor. The staircase and elevator lead direct- ly from the main corridor at the extreme north end of the building. In the second story there is one large ward of twelve beds, two isolation rooms, duty and toilet rooms. Ample airing bal- conies or terraces on both floors provide outdoor space for all the patients of this unit. =o=^)=o Q=0=Cc€nQ^ cOzQXZXXO 0=Q=CfQ=Cp 0-0---0-00-X Pavilion fur innerlich Kranke, Medizinische Abteilung A. Grundriss des Erdgeschosses. 1. Kmnlo nzimmer. la. Lsolierzimmer. 2. Waschraum. 3. Krankenbader. 4. Warterzimmer. 5. Gerateraum. 6. Dauerbad. 7. Lagerraum. 8. Gerateraum I-akalienentleerung. 10. Krankenaborte. 11. Auskleideraum. 12. Aufnahmebad. 13. Ankleideraum. 14. Tagraum. 15 Stationszimmer. 16 bpulkuct 17 Laboratonum 18 Lntersuchungszimmer. 19. Tonncraum. 20. Schwesternabort. 21. Personalabort. 22. Luftzufuhrungshausehen. 23. \ erbindungsgang O H X W FIG 24. PLAN OF WARD UNIT, MUNICH-SCHWABING HOSPITAL, MUNICH. Richard Schaehner, Architect, 24 THE AMERICAN HOSPITAL Typical Pavilion KAIL V.J T Y_¥ f£LT FIGS. 25, 26 AND 27. FLOOR PLANS, WARD UNIT, PETER BENT BRIGHAM HOSPITAL, BOSTON. Codman & Despradelle, Architects. OF THE TWENTIETH CENTURY 25 FIG. 28. INTERIOR PAVILION "C," PETER BENT BRIGHAM HOSPITAL, BOSTON, MASS. Codman & Despradelle, Architects. FIG. 29. INTERIOR OF WARD, PAVILION "C," PETER BENT BRIGHAM HOSPITAL, BOSTON, MASS. Codman & Despradelle, Architects. 26 THE AMERICAN HOSPITAL FIG. 30. AIRING BALCONY, PAVILION "C," PETER BENT BRIGHAM HOSPITAL. BOSTON, MASS. Codman & Despradelle, Architects. The portion of the building containing the octagonal ward (Fig. 28) is but one story in height, and has monitor win- dows. The main ward, second story (Fig. 29), is also top-lighted. On the third floor (Fig. 27), there is an open-air ward, with the necessary duty room, toilet, and isolation rooms. This can also be used for contagious cases which may develop in the hospital. The Cincinnati General Hospital shows the influence of European examples. Dr. Holmes has given much thought to the perfecting of this ward unit (Figs. 31- 34). In this ward unit the nurses' station, while not directly in the main ward, is in such a position that it commands a view of all the ward beds, as well as the doors of the private rooms. The patients' toilet is entered through a fresh-air cut-off, after the manner of New General hospital Cincink.-ti — Ohio JAJWtL H*MWwoaDfi.Jo«> — ARC* FIG. 31. WARD UNIT PLAN-NEW GENERAL HOSPITAL, CINCINNATI, OHIO. Samuel Hannaford & Sons, Architects. OF THE TWENTIETH CENTURY 27 ^j|p '$» FIG. 32. INTERIOR OF ONE OF THE WARD BUILDINGS-NEW GENERAL HOSPITAL, CINCINNATI, OHIO. Samuel Hannaford & Sons, Architects. the best-planned English hospitals. The sink room is entered either through the nurses' work room or directly from the corridor. There are additional toilet facilities connected with the solarium, thus minimizing the work of nurses or attendants. The utilities, baths, and toilets are grouped together. The entrance to the serving kitchen is near the main stair and elevator corridor. A commodious dining room is provided for those patients who are able to be about. In the Henry Ford Hospital (Fig. 35), the ward unit provides for sixteen beds in the general ward, one two-bed ward and two single rooms. The patients' toilet is entered indirectly from the ward through a fresh air passage. There are also additional toilets, entered from the solarium or day room. In the six-story building recently erected for the Harper Hospital (Figs. 36 and 37), Detroit, an innovation has been introduced into the construction by making eight-foot set-backs in the walls of the main pavilion at the fourth floor so that the first three stories provide for pri- vate rooms on either side of a wide cor- ridor. The upper three stories provide for a ward on each of proper width for administration. This allows for two large airing balconies on the fourth floor, over the roof of the third-story private rooms. In this plan, also, the utilities are grouped in the center, with a fresh afr cut-off between them and the main twenty-two-bed ward. At the end of the large wards toilet rooms are provided, in addition to the general toilet rooms from the main corridor. For every story there are surgical dressing rooms, and on the private room floors a special room for cut flowers is introduced. The seventh story consists of a large roof ward, with diet kitchen and other utilities. In the St. Luke's Hospital, Jackson- ville, Fla., it was planned to have several public ward units (Fig. 40), accommo- dating thirty-six patients in each build- ing, the largest ward containing but six beds. The entrance is from the open-air corridor at the east, and the utility rooms THE AMERICAN HOSPITAL FIG 33. WARD BUILDINGS "C" AND "B"-NEW GENERAL HOSPITAL Samuel Hannaford & Sons, Architects. CINCINNATI, OHIO. FIG. 34. REAR VIEW. WARD BUILDINGS "J" AND "K"-XE\V GENERAL HOSPITAL CINCINNATI, OHIO. Samuel Hannaford & Sons, Architects. OF THE TWENTIETH CENTURY 29 T1E.3T FLGDE PLAN • PCIVATE"PATIENT-BUILDING - HENDY'fOPD' HOSPITAL DETROIT- MICH 1. Operating Room. 2. Sterilizing Room. 3. Operating Amphitheater. 4. Nurses' Work Room. S. Emergency Operating Room. 6. Passage. 7. Doctors' Wash Room. 8. Anesthetizing Room. 9. Dark Operating Room. 10. Utility Room. 11. Emergency Receiving Room. 12. Laboratory. 13. Doctors' Phone. 14. Doctors' Offices. 15. Rear Entrance. 16. Doctors' Locker Room. 17. Toilet Room. 18. Waiting Room. 19. Accounting Room. 20. Phone Exchange. 21. Office. 22. Private Room. 23. Bath. 24. Alcove. 25. Linen. 26. Utility. 27. Diet Kitchen. 28. Dressing Room. 29. Head Nurse. 30. Doctors' Phone. 30 THE AMERICAN HOSPITAL FIG. 36. HARPER HOSPITAL, HUDSON MEMORIAL, DETROIT, MICH. Malcomson & Higginbotham, Architects, Detroit, Mich. Edward F. Stevens, Consulting Architect, Boston, Mass. are grouped around this entrance, with the doors to sink room, serving kitchen, nurses' toilet, and elevator opening from the cross corridor, minimizing the noises from these disturbing elements. Two large airing balconies are provided on each floor. In the private pavilion of the same hos- pital (Fig. 38) a similar arrangement is secured so far as the utilities are con- cerned. The units are smaller, a three- bed ward being the largest, most of the space is utilized for single rooms. In this plan, the open-air ward is introduced on the second floor, being connected with the main corridor and served from the main utility rooms. Both this building and the public ward unit are but two stories in height. In the Youngstown Hospital at Youngstown, Ohio, the ward unit (Figs. 42 and 43) is not unlike some of the others described, providing for a central location of the utilities, with sufficient isolation for the rooms and wards to min- imize the effect of noises upon the patients. The first floor of this pavilion is used only for ward patients; and the second, third, and fourth floors for private pa- J w ^J_-J^r^aiJl■ Jl'pJLiDLlDD. DDDDD UDD □ 'iDQDD ,DDDDD Floor ?lan FIG. 37. HARPER HOSPITAL. HUDSON MEMORIAL. OF THE TWENTIETH CENTURY 31 tients. On the north there is a day room (Fig. 44), and is described under the on each floor, and a large roof ward on chapters on maternity and children's hos- tile fifth floor, pitals. (See also Figs. 45-49.) The ward unit used in the maternity This unit, designed on the Rigs Hos- and children's department of the Bridge- pital ward plan, affords a better division port Hospital at Bridgeport, Conn., is of patients than almost any other plan of one which will apply to any general ward the same area. It is arranged in groups 32 THE AMERICAN HOSPITAL FIG. 39. VTEW OF PRIVATE WARD BUILDING ST. LUKE'S HOSPITAL, JACKSONVILLE, FLA. Ei'ward F. Stevens, Architect; Mellen C. Greeley, Associate Architect. of four beds, allowing one large window for each group. The division between the groups is made by a permanent screen, upon which are placed the con- nections for the nurses' calls and the electric lights. The utilities and quiet room are planned for the most efficient service. The Galloway Memorial Hospital a! Nashville, Tenn. (Fig. 50), consists of a group of three buildings, the first one to be erected being in the center, and is composed of an operating pavilion, char- ity ward pavilion, and private ward pavilion. In the operating pavilion the basement floor is to be used for administrative pur- poses and to the rear an ambulance porch shelters patients being received. The second floor consists of the operating de- partment, together with dressing rooms, sterilizing, anaesthetic and recovery rooms, and all other modern arrange- ments necessary to a thoroughly equipped operating department. The third floor is similarly fitted for a charity operating department, and is furnished in every particular with the same conveniences and advantages that the pay service will afford. Ward D is for charity patients only. The basement floors are used for con- sultation, emergency beds and a free dis- pensary. The second and third floors hold one hundred charity beds, con- veniently arranged, with one to twelve beds per room. The roof garden, to which the patients have access for fresh air and sunshine, is reached by an ele- vator. In Ward B, the basement floor for the present will furnish space for kitchen, dining-rooms and domestic service. The second and third stories contain thirty- two rooms for pay service ; and the fourth floor, in the form of a roof garden, fur- nishes outing space, sunshine and fresh air for the patients below and can be reached by means of an elevator from the wards. In the German Hospital in Chicago (Figs. 51 and 52), which is of the L- shape plan, the architects have designed the private and public wards in different OF THE TWENTIETH CENTURY 33 sections of each floor, giving an excellent chance for segregation and treatment of diseases. In the public ward portion, six- bed wards are the largest. The placing of the elevator and staircase in a sep- arate space, and grouping about these the utility rooms, must tend to minimize dis- turbance from the noises. Each floor is provided with two suites, with bath and toilet connecting, so arranged, however, that the waterclosets and bowls are sep- arated from the tub, making it possible to use the suites as private rooms. The maternity and operating departments are on the fourth floor, with proper shut-offs and segregation of the noisy portions of the maternity department. The Ohio Valley General Hospital (Fig. 53) was built on one of the many hills of West Virginia, which made it necessary to utilize the various grades of the streets surrounding the site. An al- most precipitous cliff at the north deter- mined the outline of the north wing. The hospital is a block type, self-con- tained institution. It is planned to care for all departments of a general hos- pital—out-patient, accident, surgical, medical, maternity, children's, con- tagious—as well as for the segregation of colored patients. It is also provided with heating, lighting, and refrigerating plants, as well as a distilling plant for distilling all the drinking water and that used in connection with the surgical de- partments. In planning this institution, it was de- cided to have no wards larger than eight beds, as a better segregation of cases could be obtained than by using large wards. This being a general hospital, both private and charity cases are cared for. Provision is made on every floor for airing balconies (Fig. 54) so that all patients can be wheeled into the open when desired. A large roof ward is pro- vided on the upper story. The combining of the contagious de- partment (Fig. 158) with the general hospital within the same walls is prac- ticed here without any serious complica- tions or cross infections. The Macon Hospital (Fig. 55) like many another institution throughout the United States, found that its work was deficient on account of lack of better facilities for the care of the sick; addi- tional land was secured in two different directions and the development of the in- stitution has been attempted. The old buildings, A, B, and C, have been re- modelled and put into working condition. The ward unit in Building B has been rearranged on the "Rigs" type, provid- ing for sixteen beds, with quiet roomr 34 THE AMERICAN HOSPITAL **» FIG. 41. ST. LUKE'S HOSPITAL, JACKSONVILLE. CORRIDOR AND PUBLIC WARD UNIT. and utilities, while the old children's ward has been made into a modern serv- ing kitchen. The old staircases and gen- eral partitions in A, B, and C have been largely retained, but the utilities have been enlarged. Pavilions D, E, and F are new. Pavilion D is practically for private pa- tients and consists of private rooms and the general utilities. Pavilion F is de- signed for colored patients, who in southern sections, of course, must be segregated from the white patients. The service building, E, contains the kitchen, dining-room, laundry, power plant, and garage, and is located centrally with respect to the whole group. The ground floor of the pavilion for negroes, F, is devoted to an out-patient department, which will be described in another chapter. The third floor of Pavilion D consists of children's and operating departments, which are described in their proper places. The roof ward (Fig. 56) is pro- vided with ample facilities for out-door treatment, and is connected directly with the serving kitchen, elevator, and stair- case. The Mansfield General Hospital, at Mansfield, O., (Fig. 57) is another ex- ample of the self-contained type, with all departments in one building. In this hos- pital the attempt has been made to segre- gate, so far as possible, the divisions of male, female, children's and maternity; and with the T-shape plan which is here adopted this was found to be a compara- tively easy problem to solve. A central serving kitchen serves all of the three dif- ferent departments on each floor. A sep- arate sink and toilet room, however, is provided in each unit. The nurses' sta- tion is located in the center, from which point it is possible to observe the three wings of the building. The main offices are located on the first floor; and a small out-patient department, a medical treat- ment, Roentgen-ray department, the heat- ing plant and the kitchen plant are located on the ground floor. The contour of the site selected allows for good lighting in all departments. On the second floor (Fig. 58) are located the maternity department and private rooms and suites; and shut off and isolated from the rest of the building is the operating department. The maternity delivery room is placed within the operating section, making it possible to utilize the sterilizing room, the doctors' waiting-room, and the other OF THE TWENTIETH CENTURY 35 FIG. 42. YOUNGSTOWN HOSPITAL, TOD WING. FIG 43. YOUNGSTOWN HOSPITAL, TOD WING. TYPICAL FLOOR PLAN. equipment of the operating department in connection with the obsetetrical work. The recent addition to the Hamot Hos- pital, at Erie, Penn., consists of a seven- story fireproof building (Fig. 60) which is devoted largely to private rooms and surgical department of the hospital. This pavilion is designed as the first unit of an entirely new Hamot Hospital, but is com- plete in itself. In this ward unit, all the utilities are grouped at one end of the building; the stair hall and elevator are shut off from the main corridor; the sink room and serving kitchen are at the ex- treme end of the building. A large solarium and airing balcony are on the southwest end of the building on each floor. Fig. 59 shows a typical floor. In the San Francisco Hospital (Fig. 61), the ward unit has some interesting features. The main ward, while rather larger than some authorities would naturally permit, is well-lighted and ven- tilated. The architect has introduced into this ward unit the old English toilet tower which, while having excellent hygienic reasons for its existence, has a tendency to darken more of the main ward than if the toilet were placed at either end of the long ward. While the toilet tower up to within a few years was used very generally in all English hos- pitals, some of the best English authori- ties today are not advocating it. The utilities of this ward unit are ex- cellently arranged. The splendid day 36 THE AMERICAN HOSPITAL room for patients, away from the ward unit itself, is most attractive. Each unit has its own surgical dressing room and its own laboratory, as well as the quiet rooms and necessary toilets. In the Illinois Central R. R. Hospital, Chicago, the ward unit is somewhat un- usual, as there are no large wards. The greatest number of beds in any ward is four, while the majority of the rooms are for individual patients. Like some of the other hospitals de- scribed, the basement and first floor are devoted to administration and medical treatment, and there are no patients' rooms below the second floor. The en- trance lobby is large and generous, giv- ing the would-be patient the idea of hos- pitality. On the first floor (Fig. 62), besides the general office, reception rooms, etc., are located the laboratory, the hydro- therapeutic, Zander room, and X-ray room, together with rest room, toilets, etc., for the medical treatment depart- ment. On this floor is also located a small out-patient department, with wait- ing and treatment rooms; also rooms for the internes and chief surgeon. The kitchen, scullery, diet kitchen, dis- infecting room, mortuary, etc., are lo- cated in the basement. The ward utilities are sufficiently iso- lated from the public corridor. The ele- vator and staircase-hall are placed in a separate tower. On the third floor (Fig. 63) is located the operating suite, consisting of three operating rooms, nurses' work room, sterilizing room, anaesthetizing room, utility room, and surgeons' locker room, the surgeons' scrub-up being placed at the end of the main operating corridor. Built-in cabinets, blanket warmers, etc., make this a most complete unit. The heating plant and laundry are in an entirely separate building. The demand for a private ward unit in Canada's great hospital, the Royal Vic- toria, in Montreal, has been so great that one of her most generous-hearted sons has provided the means for building a FIG. 44. PLAN OF FIRST FLOOR—MATERNITY BUILDING, BRIDGEPORT (CONN.) HOSPITAL. Edward F. Stevens, Architect. OF THE TWENTIETH CENTURY 37 HC OF .Second Fum Plan —#- Maternity pavilion Bridgeport Hospital Bridgeport Conn EDWAfi-D f. JTEVENj AtCHITtCT bOJTON----------Masj FIG. 45. PLAN OF SECOND FLOOR-MATERNITY BUILDING, BRIDGEPORT (CONN.) HOSPITAL. Edward F. Stevens, Architect. :tLVING WKlTCHEH i «* I O LOOf loof.imib- 6.oor Thi^d Floo^ Plan Maternity Pavilion Bridgeport Hospital Bridgeport Conn E.DWA6-D F .STEVEN,} AJXrUTECT BOSTON FIG. 46. ROOF WARD-MATERNITY BUILDING, BRIDGEPORT (CONN.) HOSPITAL. Edward F. Stevens, Architect. 38 THE AMERICAN HOSPITAL OF THE TWENTIETH CENTURY 39 FIG. 43. MATERNITY WARD-ERIDGEPORT (CONN.) HOSPITAL. Edward F. Stevens, Architect. FIG 49. PRIVATE ROOM-MATERNITY BUILDING, BRIDGEPORT (CONN.) HOSPITAL. Edward F. Stevens, Architect. 40 THE AMERICAN HOSPITAL _j 9- d O o -J' b z. o 0 H is a W < t/i > < - .S ►J "3 < « O -3 * i >H B < W OF THE TWENTIETH CENTURY 41 complete and thoroughly equipped pri- vate-patient pavilion for this institution. The general plan (Fig. (A) shows the location in connection with the existing hospital. It has been necessary to plan with precipitous grades, and the ap- proach to this pavilion from the main hospital is over a bridge from the second story of the original building; thence through the tunnel into the mountain; thence, by means of elevators and stair- cases, to the various floors of the new pavilion. While every institution should have its entrance speak "Welcome" to the coming guest, it is doubly important in a build- ing of this kind that much care be de- voted to making an entrance commen- surate with the object for which the building is erected. The severe hygienic detail which it is desirable to use where surgery and surgical dressings are under 42 THE AMERICAN HOSPITAL way can be abandoned here and the aesthetic side considered. While the ques- tion of hygiene should never be lost sight of in any hospital department, the hos- pital architect should not be a slave to this fancy, but should be able to couple good hygiene with good design. The medical department of this build- ing is as complete as that of any of its kind in America, for the authorities of the hospital realized that the physician should have greater op- portunities for his work than are pro- vided in the majority of medical institu- tions. The surgical department is most com- plete. The system of lighting is entirely indirect, no lighting fixture being in the operating room, but all concealed behind the glazed ceiling. Entirely new models of sterilizers were designed for this building. Distilled OF THE TWENTIETH CENTURY 43 jc.le '«m..'.«..t- Gr-ound Floor. Plan FIG. S3. OHIO VALLEY GENERAL HOSPITAL. GROUND FLOOR PLAN. FIG. 54. AIRING BALCONY, FIRST, SECOND AND THIRD FLOORS, OHIO VALLEY GENERAL HOSPITAL WHEELING, W. VA. Edward F. Stevens. Architect. 44 THE AMERICAN HOSPITAL FIG. 54A. OHIO VALLEY GENERAL HOSPITAL. VIEW FROM REAR, SHOWING AIRING BALCONIES. E-OOF Wakp Compo/ition Root" Pavilion P" fovHTn fi-oofc c Hoof -Plan FIG. 56. MACON HOSPITAL. PRIVATE PAVILION. ROOF PLAN. OF THE TWENTIETH CENTURY L z_ " ytcoND ftooii Plan FIG. 55A. MACON HOSPITAL. PRIVATE PAVILION. FIG. 55B. MACON HOSPITAL. PRIVATE PAVILION. 24 OF THE TWENTIETH CENTURY 47 FIG. 59. HAMOT HOSPITAL, ERIE, PENN. FIG. 60. 48 THE AMERICAN HOSPITAL MANSflLLD &LNLCAL HOSPITAL MANsntLLD Ohio VtWod teDoiKcj-AicitrrecT- Maj^ticlo-Omu) EDWAtD T: JrcvUs ~Co*soum$ AtctfiTtcT- Bojtox-M»« FIG. 57. water for drinking purposes is provided on all floors. A series of balconies from private rooms is arranged on all sides of the building, making it possible for the patients to have their own private balconies, just as they have their own baths and toilets. Additional airing bal- conies for every floor are provided. Much of the equipment for Rontgen ray department was especially designed for this building. OF THE TWENTIETH CENTURY 49 FIG. 58. MANSFIELD GENERAL HOSPITAL, MANSFIELD, O. SECOND FLOOR PLAN. FIG. 61. SAN FRANCISCO HOSPITAL. TYPICAL WARD UNIT. 1 Solarium. 2. Laboratory. 3. Dining Room. 4. Diet Kitchen. 5 Dressing Room. 6. Toilet. 7. Ward. 8. Two-Bed Ward. 9. Toilet. 10. Two-Bed Ward. > FIG. 62. THE CENTRAL HOSPITAL. FIRST FLOOR PLAN. Richard E. Schmidt, Garden & Martin, Architects, Chicago, 111. LOOt 01 IO«tL HOWt ^ o H X W w H w H a n H G TDIBt UOOti PUN FIG. 63. THE CENTRAL HOSPITAL. Richard E. Schmidt, Garden & Martin, Architects, Chicago, 111. 52 THE AMERICAN HOSPITAL FIG. 64. GENERAL PLAN. OF THE TWENTIETH CENTURY 53 FIG. 65. GROUND FLOOR PLAN AND PLAN OF TYPICAL FLOOR—ROSS PAVILION, ROYAL VICTORIA HOSPITAL, MONTREAL, CANADA. Stevens & Lee and Kenneth G. Rea, Architects. FIG. 66. TYPICAL FLOOR-ROYAL VICTORIA HOSPITAL, ROSS PAVILION. 54 THE AMERICAN HOSPITAL FIG. 67. ROYAL VICTORIA HOSPITAL. ROSS PAVILION. FIG. 67B. WEST SIDE OF ROYAL VICTORIA HOSPITAL, MONTREAL, CANADA. Stevens & Lee and Kenneth G. Rea, Architects. OF THE TWENTIETH CENTURY 55 :; •iibtrv\/'' FIG. 91. HAMOT HOSPITAL, ERIE, PENN. OPERATING DEPARTMENT. Edward F. Stevens and C. Paxton Cady, Associated Architects. OF THE TWENTIETH CENTURY 75 foutTH fLoot Plan PtivATt Pavilion foR THE BUffALO GENERAL ttOJPITAL BUffALO NEW YOEK FIG. 92. NEW OPERATING DEPARTMENT. in which case the chamber is put under pressure instead of suction. The water bed (Fig. 102) is used for the relief of many troubles and is con- sidered one of the indispensable pieces of equipment. At the St. George the writer saw one poor fellow in the water bed, which he had occupied for months, eating, sleeping and reading, who could not have lived under other conditions. One will see this water-bed, or full- length tub with adjustable hammock, in many wards in Europe. In one hospital that the writer visited each medical ward had its water-bed, and in other wards each bed was provided with pipes from the wall, for cold water circulation in place of ice caps. The sand bath (Fig. 103), where the patient is packed in sterile sand at the proper temperature, is found in almost every large European hospital. There are few hospitals in the world, however, which have a more complete mechano-therapy equipment than the Massachusetts General Hospital, Bos- ton, with its splendid Zander room (Fig. 104). But even here the service is largely that of the surgical side. Today nearly every hospital, large or small, has its Roentgen or X-ray outfit. (See Chapter XI.) In many a more or less complete hydro-therapeutic depart- ment is provided. In discussion with various medical specialists, they have acknowledged the value of equipment and recommend it where possible, especially the full-length continuous bath or water-bed, the hydro- therapy and baking. In designing a new hospital there should be set apart certain rooms to be reserved for medical treat- ment rooms, for within a very short time the medical men will demand more equip- ment. In the St. Luke's Hospital (Fig. 84) at Jacksonville about one-half of the sec- ond story of the administration building is set apart for medical treatment. This portion is not equipped, but is ready whenever the demand comes and the funds necessary to equip and maintain it are obtained. In the Ohio Valley General Hospital the same is true (Fig. 16). In the Ross Private Pavilion of the Royal Victoria Hospital (Fig. 65) a large section is set apart and equipped for medical treatment, consisting of a small psychopathic department, Roent- gen-ray department, hydro-therapy, elec- tric Nauheim, and continuous baths, rest, and massage rooms. The Southern Pacific and the San Francisco County (Fig. 106) Hospitals, both at San Francisco, not only have very complete medical equipment but are us- ing it constantly with the best results. The help given by scientific treatment to the so-called chronic invalids in some of the medical departments of the newer hospitals is referred to as little short of miraculous. Preventive medicine and treatment are much discussed. Why should not the medical treatment or bath-house depart- ment, with its many treatment and rest rooms, soon be as important a factor in our hospitals as our operating depart- ment is today ? 76 THE AMERICAN HOSPITAL 1. Roentgen therapeutics. 2. Physicians' room. 3. Dark room. 4. Light shaft. 5. Photograph laboratory. 6. Roentgen room. 7. Undressing room. 8. Waiting room. 9. Attendants' room. 10. Elevator. 11. Social room. 12. Ante-room. 13. Segregated room. 14. Light bath. IS. Wash room. 16. Toilet. 17. Rest room. 18. Pneumatic room. 19. Examination room. 20. Physicians' room. 21. Ante-room. 12. Douche room. 23. Hot air bath. 24. Warm air bath. 25. Vapor room. 26. Fango mud bath. 27. Mud bath. 28. Heat bath. 29. Four-cell bath. 30. Electric water bath. 31. Gas bath. 32. Salt water bath. 33. Sand bath. 34. Sand room. 35. Sulphur bath. 36. Female attendants' room. 37. Therapeutic gymnastics. 38. Massage room. 39. Rest room. 40. Hallway. FIG. 100. GROUND FLOOR PLAN, MEDICAL TREATMENT BUILDING, MUNICH-SCHWABING HOSPITAL, MUNICH, GERMANY. Richard Schachner, Architect. OF THE TWENTIETH CENTURY 77 PNEUMATIC CHAMBER PLAN. FIG. 101. PNEUMATIC CHAMBER SECTION. 78 THE AMERICAN HOSPITAL CHAPTER VI. ®f)e iWaternttp department There is a growing call for maternity service in nearly every hospital, whether it be large or small. This has made it necessary to establish an obstetrical de- partment, either by setting apart a sec- tion of some .building, calling into requisition an existing dwelling near the institution, or erecting a new building or group of buildings for this one service. Most obstetricians declare that the ma- ternity service should be classed as surgi- cal, since the area of open wound is greater than in almost any other clean surgery, and hence is subject to greater danger of infection from outside. Cer- tainly modern asepsis plays its part in this department, and many a mother owes her health and perhaps her life to the modern methods of care. FIG. 102. WATER BED. That such cases can be more carefully treated in the hospital than in the home no one will gainsay; but to do this to the best advantage the hospital must be espe- cially planned for the work. Study is necessary toward minimizing the noises of preparing and serving food, provision should be made for privacy or semi- privacy in the wards, and preparation made for emergency conditions. There are four distinct departments to be considered in planning for obstetrical cases: 1. The waiting department. 2. The delivery or confinement rooms. 3. The puerperal or after-confinement rooms. 4. The creche or nursery. Waiting Department. With private patients, as a general thing, the patient goes to the hospital but a day or two be- fore or even on the day of delivery, and occupies at once the room or bed that FIG. 103. SAND BATH. will be hers during her recovery. In hospitals where charity patients predom- inate the patients frequently enter from OF THE TWENTIETH CENTURY 79 " m'iLj!:. £■■ FIG. 104. MASSACHUSETTS GENERAL HOSPITAL. ZANDER ROOM. FIG. 105. OHIO VALLEY GENERAL HOSPITAL. ROENTGEN-RAY DEPARTMENT. 80 THE AMERICAN HOSPITAL 5an Franoisco Hospital. FIG. 106. MEDICAL TREATMENT DEPARTMENT. 1. Mechanical apparatus. 2. Plunge bath. 3. Pump room. 4. Toilet. 5. Irrigation room. 6. Douche room. 7. Steam room. 8. Toilet. 9. Dressing rooms. 10. Lounge room. 11. Hall. 12. Store room. 13. Toilet. 14. Closet. 15. Office. one to three months before confinement. Such women assist about the hospital work and in a measure repay for their care when sick. Where such a practice prevails separate wards or dormitories must be provided. In charity homes for unfortunate girls the situation is the same, and in many the waiting depart- ments are larger than the hospital proper. The location of this department in the hospital group should have most careful study for two reasons : 1st—Because, owing to the crying of the infants, it can well be called the most noisy of all of the depart- ments ; and 2nd—-Because, owing to the pos- sible danger of infection from out- side sources, it should be as far re- moved as possible from the other buildings, and should not be used as a passageway to any other buildings. Delivery Rooms. The delivery rooms, with their sterilizing rooms, labor rooms, doctors' waiting room, etc., should be cut off from the rest of the department by doors. This department should be treated in its details like an operating suite. The delivery rooms should be large, well lighted, and well ventilated; should in fact be operating rooms with all the careful finish and detail, and should be equipped both for day and for night work. Either a special sterilizing room should be provided, or sterilizers for water, utensils and instruments must be placed in the delivery room. There should be at least one scrub-up sink in or near each delivery room. In hospitals where mixed cases are taken it is considered wise to provide separate delivery rooms for the different classes. Patients' Rooms. If open wards are used, it is well to have them small; or, if the ward is large, subdivided by fixed screens. A certain number of private rooms should be provided, and perhaps a few suites with baths. The finish and detail, toilets, sinks, baths, etc., should be similar to those of the surgical wards of the hospital. Airing balconies should be provided as in the medical and surgical wards, or solaria can be added if found desirable. There should be opportunity for the isolating of the occasional cases which may be infected. A simple suite of two rooms and a bath, which will serve as a general utility room, should be arranged on a separate corridor entered from the main corridor, and with an outside en- trance as well, if possible. This arrange- ment will give opportunity for such iso- lation but will not prevent the use of these rooms for regular work. The rooms should be treated and equipped the same as isolation wards for con- tagious cases. Creche or Nursery. The nursery should be light, well-ventilated, cheerful and warm, and well away from the mothers. There should be not only space for a separate bassinet for each baby, but a separate room for bathing and dress- ing. A balcony should connect with this room, so that the babies may be easily OF THE TWENTIETH CENTURY 81 kept out of doors in suitable weather. Linen closet, blanket warmer, linen dryer, etc., should be planned. If the department is large a creche may be pro- vided for ward babies and another for those belonging to private patients. A few concrete examples will serve to illustrate. In the Newton Hospital (Fig. 403), Xewton, Mass., the maternity serv- ice is cared for in a building recently On the third floor are the delivery rooms for ward and for private patients, with sterilizing room between. A nurses' duty room, guests' rooms, isolating room, toilets and storeroom complete this floor. The Talitha Cumi Maternity (Fig. 408) Jamaica Plain, Mass., is an institution for unfortunate girls. The waiting depart- ment is larger than the hospital proper, and is arranged as an industrial home. ICey A Airing Balcony .!> Nursea Hoomj C. NuB.Jli .Sitting HooM p PRivATt Wards E. -Store. CLOitT F BR.OOM CuOitT Wards C 4tqre Closet I?, Clothing Room t Linen F Toilet Cr 'ElLftNKET WARM K B"Room Closet 1 Delivery room j steriliz/no •• K. Diet Kitchen 1- EUEYATOK M Poctors Room Hospital Pavilion Talitha Cumi Maternity Home. Jamaica Tlain Mass. Edward f JtevsnS Architect Boston Mass FIG. 112. erected in memory of the founders of the institution. This building is connected with the main group by an underground passage, and on the first floor by an open corridor. The public ward is on the first floor, together with four private rooms. There are baby rooms, diet kitchen, toilets, linen and medicine closets. The second floor is devoted to private rooms. The creche is on the south, with its own airing balcony. In this building are the offices of the in- stitution, the kitchen, and dining-rooms. The hospital proper is connected with the waiting department by a closed corridor, On the first floor of the hospital build- ing (Fig. Ill) is a six-bed ward, three private rooms, and an isolating suite so arranged that the doors leading into the corridor can be closed and the suite reached from the service staircase and from out-of-doors. There are toilets, bath, linen room, diet kitchen, and creche 82 THE AMERICAN HOSPITAL on this floor. An airing balcony and a solarium afford outdoor facilities. The second floor (Fig. 112) is similar, except that the delivery rooms replace the isolating suite. There are two deliv- ery rooms connected by the sterilizing room, and a doctors' room across the hall. The delivery rooms are cut off from the patients' part of the hospital by double doors. Meadville Hospital, Meadville, Penn., has a separate pavilion for the maternity service (Fig. 113). This pavilion is at the extreme end of a group of buildings. It is two stories in height, with elevator. There is but one public ward, the re- mainder of the patients being in private rooms. On the first floor is an isolation suite and a nurses' office. The delivery room, sterilizing room, doctors' room, •MM'^ENITy- PAV1LIOH •MEADVILLE-CITY- M05PITAL- •MEADVILLE' PENN- •EDWARD F-5TeveM5 ARCHITECT •BOSTON • MASS- FIG. 113. o H X M H FIG. 114. CRECHE-MATERNITY BUILDING, BRIDGEPORT (CONN.) HOSPITAL. Edward F. Stevens, Architect. 84 THE AMERICAN HOSPITAL FIG. 115. MATERNITY OPERATING ROOM—BRIDGEPORT (CONN.) HOSPITAL. Edward F. Stevens, Architect. etc., are on the second floor. Each floor has a creche, which contains an unusual feature, a fireplace. There are the usual airing balconies and a solarium. In the maternity department of the Bridgeport Hospital (Figs. 44 and 45) the ward unit is somewhat different from that of any of the other hospitals men- tioned in this chapter. In the main six- teen-bed ward the principle adopted in the Rigs Hospital is introduced—that is, there are four groups of four beds each, and these groups are divided by station- ary glazed screens six feet in height, giving the semi-isolation needed in these rooms. The creche (Fig. 114), as well as the serving-kitchen and sink-room, is at a distance from the ward and private-room patients. In this plan an admitting unit is pro- vided, in which the careful examination and bathing of patients are conducted. Adjoining this admitting unit is the isola- tion unit, in which any suspicious case can be kept for observation. This isola- tion department is connected with the serving kitchen of the children's depart- ment by a slide. Directly under the slide is the dish sterilizer, the cover of which is controlled from both sides of the parti- tion, so that the infected china can be returned through the dish sterilizer. The children's ward unit in this build- ing is similar to the maternity ward unit, except that the screens are of clear glass, permitting the nurse on duty to have close observation of all the children and still affording the necessary isolation. The maternity department of the Ohio Valley General Hospital (Fig. 77) is sit- uated at the end of one of the wings and consists of wards and private rooms, two delivery rooms, a creche, and waiting room. Cases needing isolation are taken to the isolating department in the same building. At the 57. Luke's Hospital (Figs. 116 and 117), New Bedford, this service is taken care of in a separate building, with a nearly ideal arrangement of rooms and service. OF THE TWENTIETH CENTURY 85 r_. 6 BCD WAKP 8 &LD WAfkDC ^ " 1 ' Hi Ralcony'i -l^_l FIG. 116. ST. LUKE'S HOSPITAL, NEW BEDFORD. MATERNITY DEPARTMENT. Edward F. Stevens, Architect. • ss j » ti rHj^lXil FIG. 117. ST. LUKE'S HOSPITAL, NEW BEDFORD. MATERNITY DEPARTMENT. Edward F. Stevens, Architect. 86 THE AMERICAN HOSPITAL Placed at the extreme end of the group and adjoining the ambulance entrance of the operating department, the admitting service is simple. The staff sitting-room at this point makes a special waiting- room unnecessary. There is, however, a husbands' waiting-room provided for the anxious fathers-to-be. The admitting room, with entrance bath, adjoins the delivery corridor. There are three delivery rooms for the three services—public, semi-private, and pri- vate. The public wards, two of eight beds each, accommodate the only patients on the first floor, except the occasional iso- lated case, access for which is from a sep- arate corridor. These ward beds are separated into groups of four by screens, upon which are located the nurses' calls and bedside lights. The Chicago Lying-in Hospital (Figs. 120 and 121) is planned on the broad, generous basis of the comfort of the pa- tient, the isolation of sound, and the con- venience of management. The nurses' station, located as it is at the crossing of the corridor at the elevator entrance, makes possible the easy surveillance of the entire floor. The nursery and service rooms are placed with regard to care and easy service. On the sixth floor (Fig. 121) are lo- cated the operating section, the birth and labor rooms, so placed as to allow the utmost flexibility of service and at the same time the utmost privacy when pri- vacy is required. The sterilizing and nurses' room is cen- trally located. There is a waiting room for the husband and expectant father. The Wesson Maternity Hospital (Figs. 122-125) consists of three fireproof buildings and is a complete hospital unit. The plans of the patients' pavilion, nurses' home, and power plant, show the general relation of one department to the others. The maternity department of the Yon- kcrs Homeopathic Hospital at Yonkers, N. Y. (Figs. 126-130), is a self-contained building of fireproof construction. It is used for clean surgical cases as well as for obstetrical service, and contains the administration offices and the superin- tendent's living apartments. For smaller units in private hospitals see plans of Macon Hospital (Fig. 55a), Melrose Hospital (Fig. 252), and San Francisco Hospital (Fig. 118). FIG. 118. SAN FRANCISCO HOSPITAL. MATERNITY WARD. Newton J. Tharp, Architect. 1. Patients' waiting room. 2. Doctors' dressing room. 3. Isolation room No. 1. 4. Isolation room No. 2. 5. Diet kietchen. 6. Delivery room. 7. Nursery. 8. Toilet. 9. Ward. 10. Nursery. 11. First stage room. 12. Toilet. 13. Nurses' Supplies. 14. Laboratory. o H X M W H i—i W H n w H a FIG. 120. CHICAGO LYING-IN HOSPITAL. THIRD FLOOR PLAN. Richard E. Schmidt, Garden & Martin, Architects. M 2 n > X o en > FIG. 121. CHICAGO LYING-IN HOSPITAL. SIXTH FLOOR PLAN. Richard E. Schmidt, Garden & Martin, Architects. OF THE TWENTIETH CENTURY 89 C O B. E. I D O B- FIG. 122. WESSON MATERNITY HOSPITAL, SPRINGFIELD, MASS. FIRST FLOOR PLAN. Kendall, Taylor & Stevens, Architects. MatEnnY Eanucw FIG. 123. WESSON MATERNITY HOSPITAL. SPRINGFIELD, MASS. SECOND FLOOR PLAN. Kendall, Taylor & Stevens, Architects. THE AMERICAN HOSPITAL HuaswffcML MAUOTryBMUOH FIG. 124. WESSON MATERNITY HOSPITAL, SPRINGFIELD, MASS. THIRD FLOOR PLAN. Kendall, Taylor & Stevens, Architects. KUWWffDMii MATLEBrryEwiuoH FIG. 125. WESSON MATERNITY HOSPITAL, SPRINGFIELD, MASS FOURTH FLOOR PLAN. Kendall, Taylor & Stevens, Architects. OF THE TWENTIETH CENTURY 91 f|R5T fLOOR Second Floor. FIGS. 126 AND 127. FLOOR PLANS-YONKERS HOMEOPATHIC HOSPITAL, YONKERS, N. Y. Kendall, Taylor & Stevens, Architects. 92 THE AMERICAN HOSPITAL FIGS. 128 AND 129. FLOOR PLANS-YONKERS HOMEOPATHIC HOSPITAL, YONKERS, N. Y. Kendall, Taylor & Stevens, Architects. OF THE TWENTIETH CENTURY 93 iMHife KMM?'| %•'•■»%.■ v i£fX- «*•*»>••«-•• rU^ o ■» I! c y S s ^ si sH. K^ si c 94 THE AMERICAN HOSPITAL "A LITTLE CHILD SHALL LEAD THEM." OF THE TWENTIETH CENTURY 95 CHAPTER VII. Cfnibren's hospitals! In planning for a children's hospital or a children's department of a general hospital we have new conditions that do not exist in any of the other depart- ments, for we are dealing with sus- picious cases where the only logical treat- ment is to consider every case as having been exposed to some contagious dis- ease and to provide proper isolation for the study of every patient. To that end the admitting department should have a sufficient number of subdivisions so that each case may be temporarily isolated until a careful diagnosis can be made. During the usual period of incubation the children should be placed in an ob- servation ward, with the beds so sep- arated by screens, or otherwise, as to prevent the contact of one patient with another. These screens may be made of glass, or glazed cubicles can be provided that will give segregation and the neces- sary isolation. Where a children's department is placed in a general hospital, be the de- partment ever so small, it should be sep- arated from that portion of the hospital occupied by adults, which should be as- sured freedom from the noises coming from the children's ward and safety from the danger of infection. The necessity of providing private rooms is not so great in the children's hospital as in the adults', for it is found that children are much happier if they can be with others, as their attention is taken from themselves and they are likely to forget their own discomfort in seeing the discomfort of others. Even in the general wards, however, outside of the observation ward, a certain segre- gation or grouping is desirable. A glass screen partition between every three or four beds gives a sufficient amount of separation, but it is not desirable to have wards larger than from sixteen to twenty beds. As with the adult, every ward unit should be supplied with one or two quiet rooms for the very sick. These rooms can be glazed so that the nurse from the corridor may watch the patient without the necessity of entering the room. One of the essentials in a children's ward unit is the day room or play room, for in this the little convalescents are freer to romp as much as their infirmi- ties will allow and to gather what com- fort the>r can from the toys furnished them. The floor covering of this room should be some warm material—linoleum or cork carpet, for instance, or even cork tile. The serving kitchen and sink room should be very little different from those provided for the adult ward units. The toilet and bath facilities, however, should be entirely different. The waterclosets should be low and easily accessible. For bathing, the shallow tub or slab tub af- fords the most convenient method of washing children. Without undue ef- fort on the part of the attending nurse the children can be washed in clean run- ning water through a spray attached to a rubber hose. The temperature of the water can be controlled either by a con- trol device or by a large storage tank placed directly above the bathing slab. By using this method the patient is never washed in dirty or poisoned water, as is the case in bathing in a filled tub. (See Chapter XV, "Plumbing.") In this bath- ing room should be placed a cabinet for the toilet articles of each individual child. This should be divided into compart- ments and should contain the usual mug, tooth brush, comb, and hair brush. A simple device to hold the toilet arti- cles of the children, devised by Mr. Bar- tine, Superintendent of the Ruptured and Crippled Children's Hospital in New York, may be hung on the end of each bed. This contains not only the toilet 96 THE AMERICAN HOSPITAL articles, but the towel also. Of course this necessitates the taking of these arti- cles to the toilet room when they are to be used. The prevalence of contagious diseases in a children's hospital is so much greater than in the hospital of the adult that ft is desirable to have a section of the hos- pital planned and set apart for the care of such diseases. This department should be treated the same as the con- tagious hospital—that is, there should be a certain number of cubicles or rooms where each individual bed is screened, and the same care maintained in the treat- ment of cases as in the contagious hos- pital. Here the orthopedic service is, as a general thing, greater than in the hos- pital for adults, and it is decided econo- my, if the hospital is large, to have a de- partment for the manufacture of cor- rective apparatus, as is well illustrated in the Hospital for Sick Children in Toronto and in the Ruptured and Crip- pled Children's Hospital in New York, which will be mentioned later in this chapter. The requirements for operating rooms and surgical dressing rooms do not differ from those described in the chapter on the ward unit. The question of color and decoration is one which requires careful study. The children can sometimes be quieted more easilv by pictures on the walls than in anV ' other way. Simple illustrations from Mother (loose, stenciled at a con- venient height for the children to look at, is one way of providing for this. One of the most attractive wards which the writer has ever seen was in the children's department of the St. Thomas Hospital in London (Fig. 132). Here the walls were lined the entire height with tiles depicting interesting incidents in child life. The admitting room of the Forsyth Dental Clinic (Figs. 133 and 134) in Boston is another good example of cer- amic decoration. A few examples of children's hospitals and departments will serve to illustrate some of the points which are mentioned. In the children's clinic of the Dussel- dorf Hospital, at the entrance is a small hospital isolation department of four beds, for the observation of doubtful cases. The ground floor is for the ac- commodation of infants and has an in- teresting incubator department consisting of six cells or tiny rooms, each for t\\o cots. The lower portion is constructed of marble and the upper of two layers of glass, with elaborate apparatus for con- trolling the temperature, humidity and ventilation of each cell from the corridor. The utensils are contained in glazed com- partments at the head of each bed. The FIG. 132. ST. THOMAS' HOSPITAL, LONDON. CHILDREN'S WARD. OF THE TWENTIETH CENTURY 97 FIG. 133. FORSYTH DENTAL INFIRMARY, BOSTON. CERAMIC FRIEZE IN WAITING ROOM. Edward P. Graham, Architect. first floor of the clinic contains the wards for the older children. The Harriet Lane Home for Invalid Children (Fig. 135 and Fig. 136) (the children's department of the Johns Hopkins Hospital), planned by Mr. Charles Butler of New York (in col- laboration with Wyatt & Nolting of Balti- more), to whom the writer is indebted for the data, is worked out most care- fully to provide for proper observation and segregation. This plan consists of the main building, with three small ward units. The patient enters through the main admitting room, with the examin- ing rooms adjoining. Suspicious cases FIG. 134. FORSYTH DENTAL INFIRMARY, BOSTON. CERAMIC FRIEZE IN WAITING ROOM. 98 THE AMERICAN HOSPITAL ■* * CORRIDOR TO HOJPITAi. First • floor ■ plan FIG 135. HARRIET LANE HOME FOR INVALID CHILDREN. Wyatt & Nolting, Butler & Rodman, Associated Architects. OF THE TWENTIETH CENTURY 99 FIG. 136. JOHNS HOPKINS HOSPITAL. HARRIET LANE HOME FOR INVALID CHILDREN. Wyatt & Nolting, Butler & Rodman, Associated Architects. FIG 138. IIOSPITAL FOR SICK CHILDREN, TORONTO, CANADA. ISOLATION PAVILION. Stevens & Lee, Architects, 100 THE AMERICAN HOSPITAL are admitted through what is termed the infectious waiting-room, and one of the three wards provided is for observation purposes. In this, each bed is screened from its neighbor by a close glass and metal screen. Each of these ward units contains a duty room, sink room, bath room, isolation room, and a serving kitchen with nurses' dining-room adjoin- ing. Perhaps no children's hospital in this part of the world is doing greater work than The Hospital for Sick Children, at Toronto, which administers more to poor children than to the children of the rich, both in the outdoor and in the indoor de- partments, as well as in the summer Lakeside Home. The isolation building (Figs. 137 and 138) of this group is planned particular- ly for the care of an epidemic and for small children. It is designed on the principle of the Pasteur Hospital in Paris, and will be described in detail in the chapter on contagious hospitals. It provides for absolute isolation of sus- pected cases, or contagious cases as they develop. A separate entrance, separate elevator, and a separate corps of nurses are provided for this section of the hos- pital. This hospital carries on a very large out-patient clinic. (See plan Out Patient Department, Fig. 229). The original hospital has been remodeled, airing bal- conies and day rooms added, and the wards opened up and brought into the sunlight. One department of this hospital which probably no other hospital of its size has is the complete plant for the pasteuriza- tion and modification of all milk not only for the hospital but for a very large out- patient distribution. This department has the most modern, up-to-date equip- ment. Two or three examples of children's departments in general hospitals will illustrate some of the points suggested in the preceding paragraphs. In a small hospital in Melrose, Mass. (Fig. 253), the children's department, al- though very small, is separated from the main corridor by two glazed doors. The ward (Fig. 144) is connected with a OF THE TWENTIETH CENTURY 101 _ 8 1 I i i 1 '}■'■ f4~£ ! , ., -■• :M ■^K-:iki:h.. ■■■■ ;■■* is:..:-- '] i! 1 " ; FIG. 139. CHILDREN'S WARD—MATERNITY BUILDING, BRIDGEPORT (CONN.) HOSPITAL. Edward F. Stevens, Architect. large outside airing balcony and is pro- vided with special children's toilet, and a small isolation room with glazed walls for better observation is provided. In the children's department of the Bridgeport Hospital (Fig. 139) eighteen children are cared for in the main ward. This ward is sub-divided by glazed screens into groups of four or five beds each, the glazed screens permitting per- fect supervision. A small isolation room is provided for one or two more patients. A large, well-lighted day room (Fig. 140), ample airing balcony, and complete service rooms, including serving kitchen, sink room, surgical dressing room, bath- ing room, and toilets, are provided. The simple decoration on the walls of the main children's ward, depicting mountain scenery, and a large memorial window add to the color effect of this department. Adjoining the children's department is a small infectious department, consisting of two isolation rooms and an isolation toilet. This isolation department, while adjoining the children's department, can be entirelv shut off and served from a cross corridor connecting with the ad- mitting department. Another good example of a children's ward building is shown in the plans of the children's pavilion of the Worcester City Hospital (Fig. 145, 146). The wards, the private rooms, and the utilities are grouped around a central rotunda in such a way that surveillance is easily kept of every portion of the floor. Here the natural system of ventilation is used— i.e. ventilating the entire wards from the center of the ceiling, which slopes at an angle of at least thirty degrees. This construction is well hidden in the exterior treatment. In the plans for the Hospital for Rup- tured and Crippled (Figs. 141-143), New York City, a most comprehensive scheme is carried out. This service is largely for children and the planning is simple and straightforward as the outpatient sec- tion, consisting of thoroughly equipped rooms and departments, is entered on the left of the center while a corresponding entrance on the right enters the execu- tive department. In the basement are the kitchen, the 102 THE AMERICAN' HOSPITAL OF THE TWENTIETH CENTURY 103 .ST «" J T«.U Ti u i£^V;CL CKJV •PLAN OF ■ FIR.5T- FLOOR- HOSPITAL- FOFL-THL-rU.LIE.F- Oi ■ TH L ■ FLV P TV FLLD- AND- C FU PPL L D tOWL AND J AW Y i r FIG. 141. laundry, the heating plant, the brace shop, and storage for supplies. On the first floor are the out-patient department and the administration de- partment. The second floor contains the living quarters for the superintendent, staff, housekeeper, and graduate nurses. On the third floor are the wards for girls and female adults, together with dining-rooms for patients. The fifth floor plan is similar, except that the operating department is here located. The fifth floor contains the class and school rooms and the large assembly halls for the children, while on the sixth are the great out-of-door wards and so- lariums. The color scheme throughout is most pleasing and is most artistically carried out. 0264 104 THE AMERICAN HOSPITAL EAJT 4J" i T M I T L A i T i T f> t L T PLAN OF FOVK.TH FLOOI^ HOSPITAL- FOiC-THL-PvLLI LF-OF -THL-Px-VP TV fUD AND-C.PvlPPLLD t»- a icht; FIG. 142. OF THE TWENTIETH CENTURY 105 5 t *. t ■ r 1 OP EH R.AT AR.T OF HC A.00 M L A i T 42" 5 T R. t C T PLAN OF FIFTH FLOOR.- HOSPI TAL- FOFV--THL FULILF OF - TH L • ICV P IV PUD-AND CPJPPLLD ICfU- _t,.i,i.jJra-.i. rou. MojHrii. »«.cht: FIG. 113. 106 THE AMERICAN HOSPITAL FIG. 144. MELROSE HOSPITAL. CHILDREN'S WARD. FIG. 146. WORCESTER CITY HOSPITAL, CHILDREN'S BUILDING. EXTERIOR. Fuller & Delano, Architects. OF THE TWENTIETH CENTURY 107 a _. ^7 i ■■-»■-'-•■ 1 "1 i ' ■■'. '■' '■' '*' '« ^ ''I • • • -:; ■• -l-Min FIG. 145. WORCESTER CITV HOSPITAL, CHILDREXS BUTPDIXG. FLOOR PLAN. Fuller & Delano, Architects. 108 THE AMERICAN HOSPITAL CHAPTER VIII. &fje Contagious; department In all the large general hospitals of Europe, departments for the care of in- fectious diseases are provided and gen- erally consist of separate, detached buildings, being complete units and di- vided into small wards with complete service rooms and equipment. Among those which are particularly interesting technically are those at Eppendorf, Vir- chow, West End Berlin, and Lindenberg- Cologne. But perhaps no hospital in Europe has carried the newer principles of infection to a higher development than the Pasteur Hospital in Paris. When in 1907 I visited the Pasteur Hospital for the first time and saw cases of scarlet fever, measles, diphtheria, sleeping sickness, and other communic- able diseases side by side in one build- ing, within plain view of the nurse and visitor and separated from each other only by plate glass partitions, I was very much surprised. My training had been that to care safely for contagious cases one must, at least, have separate depart- ment, if not separate buildings. What was my greater surprise to find that while these various diseases were in the same building and being cared for by the same nurse, the record of the five years pre- ceding mv visit, with a service of nearly five thousand cases, showed the cross or internal infection to be only two to the thousand! Friends are allowed to visit the pa- tients, communicating with them from the open balcony provided for the pur- pose. This balcony extends in front of all rooms. In an interview with Dr. Louis Mar- tin, the Director of the Pasteur, and from his book,* "Hygiene Hospitaliere," the writer gathered the following facts: (a) The service is divided into two sections—that for the very ill patients and that for convalescents. Between these two sections are the service rooms (Fig. 150) and fresh air pas- sages, so that the patient must pass through an area of fresh air in being transferred from one department to another. (b) In caring for all cases, the nurse wears a special gown for each room or cubicle, never removing the gown from the room except for cleansing. (c) After handling the patient or anything which the patient has touched, *"Hygiene Hospitaliere," J. B. Bailliere et Fils; Paris, 1917. UJ^I" TmTm Tr4" F £|j]LjlTI!IT][;£- FIG. 150. PASTEUR HOSPITAL, PARIS. FLOOR PLAN. OF THE TWENTIETH CENTURY 109 FIG. 151. FLOOR PLANS—WHITE ISOLATION BUILDING, ST. LUKE'S HOSPITAL, JACKSONVILLE, FLA. Edward F. Stevens, Architect; Mellen C. Greeley, Associate Architect. 110 THE AMERICAN HOSPITAL the nurse washes her hands thoroughly. (d) All utensils are disinfected by boiling or otherwise. This is Dr. Martin's description of the rooms: "The partitions of the room are glazed to facilitate surveillance and to render isolation less irksome to the patient, for through the glass parti- tions the patient remains in contact with the world outside, which is a great comfort to him. "The patient in his room ought to be sheltered from all cross infection, whether it be from the hospital or from outside. Everything which enters the room shall be sterile, or at least freed from all noxious germs. All that leaves his room must also be sterilized." In other words, the laws of antisepsis and aseptic surgical technique must be observed. On these principles many of our newer American hospitals for contagious dis- eases are now being built. The theory is that none, or comparatively few, of the communicable diseases is transmitted other than by contact, and the best authorities agree that true air-borne in- fection is very rare. We should then plan our hospital for communicable diseases: 1st—So that the nurse or doctor, after contact with the patient, can have ample and immediate opportunity to scrub the hands. 2nd—So that sterilizers can be pro- vided for sterilizing every article that goes to the patient or is taken from tlie patient. 3rd—So that provision can be made for the removal and destruction of waste, either by local incinerators or properly protected receptacles to con- vey to the general destroyer. Then there must be the careful observ- ance of strictly surgical technique—i.e., as in the surgical case the area around the open wound is clean, unless infected by contact with some unsterile instru- ment, or unclean hands, so the area around the infected patient is clean un- less polluted by touch or contact from the patient or some one or something which the patient has touched. Perhaps no man in this country has given more thought and study to this subject than has Dr. Chas. V. Chapin,* the Providence, R. L. Health Commis- sioner, ably assisted by Dr. D. L. Rich- ardson, Superintendent of the Provi- dence City Hospital. Here theory is supplemented by actual practice, with wonderfully satisfactory results. In this hospital one will see in rooms adjoining one another, cases of scarlet fever, diphtheria, erysipelas, and measles, with the same physicians and the same nurses administering to all, the latter eating in the same dining-room, living in the same nurses' home with nurses of other departments of the hos- pital. As the service becomes larger or the diagnosis of the cases surer, then the grouping of the various diseases in dif- ferent buildings becomes an economy, but the technique is never relaxed. One of the best planned isolation pavilions in this country is that recently built by the Department of Health of the City of New York at the Willard Parker Hospital, and used for a measles build- ing (Fig. 156). Here on the ground floor one finds the best form of cubicle system. In addition to the special sink, lights, etc., each cubicle has a small well- ventilated toilet room entered from the room, containing a watercloset, making it unnecessary for the patient to leave the isolating room until he is convalescent or discharged. The admitting pavilion (Fig. 157) of the Kingston Avenue Hospital of the De- partment of Health, City of New York, is well planned, providing for separate service and entrance from the outside, if necessary, to every room on the ground floor. This, too, has separate toilets for each cubicle or room. The contagious department of the St, Luke's Hospital, Jacksonville, Florida, consists of separate pavilions for white and colored (See general plan, Fig. 7). The plan is an adaptation of that of the Pasteur Hospital of Paris (Fig. 150) and does away with all the cumbersome and elaborate arrangements of the old school (Fig. 151). All classes of con- *"Sources and Modes of Infection." i OF THE TWENTIETH CENTURY 111 FIG. 152. VIEW OF WHITE ISOLATION BUILDING, ST. LUKE'S HOSPITAL, JACKSONVILLE FLA Edward F. Stevens, Architect; Mellen C. Greeley, Associate Architect. cagious diseases, with the exception of smallpox, which is still cared for at a distance from other people, largely on account of popular prejudice, are treated in one building. There are single rooms for fresh cases and wards for convales- cents. The rooms are cubicles, with glass partitions for ease of observation, each cubicle being a separate entity, com- plete in itself. Correct technique, the so- called "aseptic nursing," prevents the spread of infection, but facilities must be provided for carrying it out. The central portion of the building is the administrative department, being occupied by the admitting and discharge rooms and the various utilities, with the office of the nurse in charge. An open air cut-off separates this from the part occupied by patients. Each room or ward is furnished with a scrub-up sink, with elbow faucets, so that after any service for the patient the physician and the nurse scrub and disin- fect their hands before leaving the room. They also wear gowns while caring for the patient, leaving them on hooks in- side the door before they depart. The equipment consists of utensil ster- ilizers, which can be opened by the foot; elbow handles for the faucets over slop sinks; dish sterilizers large enough to take a tray and its dishes; garbage in- cinerators which may be opened by el- bow; liquid soap dispensers with pedal action; lever door handles which can be opened by elbow or upper arm; and everywhere scrub-up sinks with elbow handles. By means of these carefully worked out details the nurse is enabled to care for a patient, dispose of all waste material, and accomplish the disinfec- tion of all utensils and appliances used in the process, without touching anything else. At the close of each procedure she sterilizes her hands and removes her in- fected gown, becoming clean again, to start upon the same round with another patient. When a patient is admitted, he is * 112 THE AMERICAN HOSPITAL FIG. 153. ST. LUKE'S HOSPITAL, JACKSONVILLE. ISOLATION BUILDING. VIEW IN SINGLE ROOM. •^JLse '■"^PPii :: FIG. 154. ST. LUKE'S HOSPITAL, JACKSONVILLE. ISOLATION DEPARTMENT. VIEW IN SERVING KITCHEN. OF THE TWENTIETH CENTURY 113 bathed on the shallow tub-slab with a spray, so he gets what is practically a shower bath or champoo in running water. He is then placed in a single room. When convalescent, he is trans- ferred to the small ward where there may be other patients recovering from the same disease. This ward is treated as a unit, but the aseptic technique is still carried out. A portable tub (Fig. 153), similar in principle to the one in the admitting room but made of wood covered with copper for lightness, set on a wheeled stretcher frame of the same height as the beds, is also provided. This may be taken to any room, the patient transferred to it, and bathed with a spray attached to the faucet at the scrub-up sink. A floor drain in each room receives the waste water from the tub. The tub is disin- fected after each using. When the patient has recovered and is to be discharged, he is taken through the open air corridor to the discharge room, given a cleansing and disinfecting bath, and passed into the dressing room, where he receives his own uninfected clothing. From this room he departs without coming into contact with other persons or parts of the buildings. (See also Figs. 153 and 154.) Hospital finish of the simplest and strictest sort has been carried out in these pavilions and everything made so as to be easily cleaned. The furniture is ex- tremely simple, the rooms having no more than a bed, a comfortable chair, and a table, besides the all-important sink or lavatory. These sinks were made special, being provided with an integral drain-board upon which to place hand brushes and other appliances. The convalescent wards have toilets directly off them, and each has its own screened-in porch. FIG. 155. ST. LUKE'S HOSPITAL, JACKSONVILLE. ISOLATION DEPARTMENT. THREE-BED WARD. 114 THE AMERICAN HOSPITAL -----•— —H — -*-- FIG. 156. WILLARD PARKER HOSPITAL, NEW YORK. MEASLES PAVILION. All floors are of cement, painted. Washable rugs are provided for the rooms of the convalescents. Visitors are not allowed in the build- ing, but there is a narrow balcony run- ning in front of every room, like the Pasteur, so that parents and friends may come to the patient's window, see and talk with him, and know how he is get- ting on. This one provision probably does as much as any one thing to estab- lish confidence in a contagious hospital. Though there is considered to be no adequate reason why the nurses caring for contagious cases may not mingle with other nurses, it has been deemed wisest, -41iftl=gal ■JtCONDn.0rA.»LMJ • FIG. 157. KINGSTON AVENUE HOSPITAL, BROOKLYN. ISOLATION PAVILION. OF THE TWENTIETH CENTURY 115 vCA i, E. fcfcj m.% m ■ wT Fifth Floor. Plan EDWAB.O F 3TEVEN4 Architect Bojton «».u FIG. 158. PLAN OF FIFTH FLOOR, OHIO VALLEY GENERAL HOSPITAL, WHEELING, W. VA. Edward F. Stevens, Architect. at the present time, to house them in the isolation pavilion. The second floor, therefore, provides single rooms for six nurses, with bath, etc., these rooms being fully as commodious as those at the nurses' residence. This floor has a sep- arate entrance, through one of the open air corridors. The pavilion provided for white per- sons has rooms for patients on two floors, one accommodating twenty and one eleven patients. Only the first floor is used at the present time, the ground floor being finished but without equip- ment until such time as it may be needed. The pavilion provided for colored per- sons accommodates eleven patients. It is an exact counterpart of the adminis- tration portion and one wing of the white pavilion. If the theory of isolation and the tech- nique of care is correct, then infectious diseases can be safely cared for in the general hospital. This is now being car- ried out in the Ohio Valley General Hos- pital. While this department (Fig. 158) is in the main building, it is nevertheless isolated by a fresh air cut-off from the other rooms on this floor. Separate serv- ing kitchen and sink room are provided as well as every facility for cleansing the person of the patient, for the work of the nurse, and all utilities. The nurse, after thoroughly cleansing her hands and changing the department gown, mingles freely with the other nurses of the hos- pital. The isolation unit (Figs. 137, 138, 160) of the Hospital for Sick Children, Toron- to, Canada, has been developed on the Pasteur principle, or much like the Isola- tion Department of St. Luke's Hospital at Jacksonville, with air cut-offs between the acute, the service, and the convales- cent departments. Each cubicle is pro- vided with the sink described in the Jacksonville Isolation. Food is delivered in the open corridor through a window to the serving kitchen. Under this win- 116 THE AMERICAN HOSPITAL H- iv the ward units. OF THE TWENTIETH CENTURY 119 CHAPTER IX. Wje JJsspcfjopatfjtc department of tfje (general hospital Since the beginning of this century, no greater development has been made in any branch of hospital housing and treat- ment than in the psychopathic and neurological departments. Only a few years ago the person who was adjudged insane was committed to an asylum; and if resistance were offered he was placed in irons and half starved. The mild cases were herded with the vio- lent—yes, "herded" is a good name for it—and they were treated more as beasts of the field than as human beings whose course of thought was diverted through some slight lesion. The scientific study of the disturbed patient has shown that in most cases the modern or humane treatment is productive of the greatest success; and psychopathic hospitals, either as independent institutions or as departments of a general hospital, are be- ing considered everywhere. The psycho- pathic hospital then becomes a clearing- house for the study and segregation of cases. In this department more than in any other in the hospital is it essential to con- sider the environment of the patient; the interior must be restful; there must be nothing in color or design to excite the patient; the surroundings must be home- line, with as little of the institutional ap- pearance as possible. Great care should be used, however, to avoid giving any opportunity for the patient to inflict per- sonal injury, by providing non-projecting hardware; turned-down door handles; flush transom bars; lighting fixtures out of reach, with no projections; small lights of plate glass in windows, which never open enough to admit the body of a person ; special plumbing fixtures, firm- ly secured; and cabinets for telephones and service built into and not projecting from the wall. One of the earliest institutions to rec- ognize the more scientific care of the mild cases was the "Psychiatrischc Klinik" at Munich. The treatment is humane. No force is used with the pa- tients. If they are inclined to be unruly, they are persuaded to enter the contin- uous bath ; if they offer resistance, a mild hypodermic is given, and when they re- cover from this the continuous bath keeps them quiet. So the bath has become a great factor in the maintenance of peace and quiet in what was once called the "mad house." In this "Klinik" (Figs. 170 and 171) one hundred and fifty patients are cared for, divided into first, second, and third classes, according to the service and ac- commodation. Every class is provided with special visiting-day rooms wherein patients may receive their friends. Those in the first class have private rooms. For this accommodation, with services of nurse and doctor, they pay eleven marks ($2.75) per day. Every attempt is made to make the apartments homelike, and no visible form of restraint is noticed. The second class patients have less luxurious accommodations but have com- fortable living rooms and sleeping quar- ters, for which they pay six and one-half marks ($1.63) per day. The third class patients occupy wards at three marks ($.75) per day. The wards are neat and well kept, and toilets are provided in every ward unit. The details of construction are most carefully worked out. The door frames are of iron, with no projection; all door handles are turned down, affording no ay to cause injury; all cabinets are of steel, placed flush with the wall; the tele- phones are enclosed in cabinets, and sig- nal is given by a red light, no bells being- used. In the new Psychiatric Clinic of the State University of Utrecht, Holland (Figs. 172-176), Professor Heilbronner has worked out some excellent ideas. Zr1i!: 11 ■A" ■■■ «■> ■■ kmk mnm aaJ /'l •>--.- I KUCMJ , -:'■ tfl-J-JT <00 5 « .-31 Jl & ^ NUSSRRUM - 5THR55E. FIG. 170. PSYCHIATRISCHE KLINIK, MUNICH. GROUND FLOOR. n > X c > r OF THE TWENTIETH CENTURY 121 122 THE AMERICAN HOSPITAL FIG. 172. PSYCHIATRISCH-NEUROLOGISCHE KLINIK. UTRECHT. GROUND FLOOR. One hundred patients are accommo- dated and all are placed on the first floor, which is divided into six sections—three for women and three for men—and clas- sified according to condition. The offices, laboratories, etc., are lo- cated on the second and third floors of the main building. While this is strictly a pavilion type of hospital, all sections are connected by a common corridor, adjoining which is the working or domestic side of the institu- tion, the kitchens, dining-room, together with lecture rooms, etc. Each one of the patients' sections is supplied with the necessary utensils and equipment; each has an examining room, so arranged with curtains that it can be changed into OF THE TWENTIETH CENTURY 123 1 124 THE AMERICAN HOSPITAL FIG. 175. PSYCHIATRISCH-NEUROLOGISCHE KLINIK. CORNER OF WARD. a dark room; also a linen room, store room, sink room, tea kitchen, bath rooms. day room, and airing balcony. The bath rooms are centrally located and can be reached readily from the wards or single rooms. For the con- venience of the wards, a corner water- closet is provided, so screened as not to be objectionable, at the same time keep- ing the patients under the surveillance of the attendant. ■fct^ir1. " f | ^HMafiBl jpr^lp'n ' ™jl WT: '«W u 1 iff ' 1 'jgj 1 1 ■■ i- i ... i$y HE >Mt&.< .mm. ii- FIG. 176. PSYCHIATRISCH-NEUROLOGISCHE KLINIK. DAY ROOM. OF THE TWENTIETH CENTURY 125 126 THE AMERICAN HOSPITAL There are no large wards in any sec- tion, six beds at most. In the neurological section, where less surveillance is needed, the rooms are sep- arated by single doors; while in the psychiatric sections the wards are divided by large sliding doors, making it easier for the night watch. In the psychiatric sections, three baths to every thirteen beds are provided. The control for these baths is behind locked cabinet doors, and if the temperature of the water varies beyond certain limits an electric alarm summons an attendant. In each psychiatric section is provided an isolation room with rounded corners, fastened-down toilet, protected lights, and protected double doors with an ob- servation window. The windows are made of swinging sash, divided by heavy reinforced sash and glazed with heavy plate glass. The floors are covered with linoleum. The administration offices, the labora- tories, and the sleeping quarters for the attendants are on the second and third stories. A large photographic gallery is ar- ranged for cinematography, and has special lights arranged for night photog- raphy. These two examples will show some- thing of the development of the psycho- pathic hospital in Europe; but there every large hospital has its own psycho- pathic department, large or small, as the needs and development dictate. In this country the Massachusetts Psychopathic Hospital, in Boston, was one of the first clinics of the kind. In 1911 the State of [Massachusetts ap- propriated the sum of six hundred thousand dollars, to be expended in the building of a new psychopathic hospital in the City of Boston. The site selected was in what has come to be known as the "hospital district" of Boston, located in close proximity to the Harvard Medi- cal School, the Peter Bent Brigham Hos- pital, the Infants', the Children's, the Good Samaritan, the New England Deaconess, the Robert Brigham, the Channing, the Huntington and other hospitals. The work was intrusted to Henry H. Kendall, architect, under the direction of FIG. 178. BASEMENT PLAX—PSYCHOPATHIC HOSPITAL, BOSTOX. Kendall, Taylor & Co., Architects. OF THE TWENTIETH CENTURY 127 ffp SECOND FLOOR. PLAN FIG. 181 ornctjus eni. MAIN ENTRANCE, OUTPATIENT^' INT'. FIR.iT FLOOR. PLAN FIG. 179. PSYCHOPATHIC HOSPITAL, BOSTOX. Kendall, Taylor & Co., Architects. 128 THE AMERICAN HOSPITAL ii ^ i FOURTH FLOOR. PLAN FIG. 182. THIO FLOOR- PLAN* FIG. 181. PSYCHOPATHIC HOSPITAL, BOSTON. Kendall, Taylor & Co., Architects. OF THE TWENTIETH CENTURY 129 Dr. Owen Copp, executive officer of the State Board of Insanity. The development of this institution in Massachusetts has given the State a mag- nificent psychopathic building which forms the clearing-house, as it were, for the larger insane institutions throughout the state. The building is E-shaped, a plan giv- ing the greatest number of rooms ex- posed to the best light and air. It is four stories in height and will accommodate one hundred and ten patients. The pa- tients are generally admitted at the am- bulance entrance on the first floor, lead- ing from the side street. On the first floor (Fig. 179) there are two admitting units, one for each sex, divided by a general corridor. These units consist of two admitting wards of five beds each, general treatment rooms, baths, isolation rooms, etc. Connected with this section are the operating and emergency department and the offices for the admitting officers. The remainder of the first floor is occupied by offices and quarters of administration, matron, and staff, and the general receiving depart- ment, containing waiting-room, examin- ing rooms, rooms for social service workers, etc. What might be termed the patients' building is separated from the main building by a short connecting corridor containing the elevator and staircase. The wards for the men are placed on the second floor and those for the women on the third floor (Fig. 181). Each has a section for disturbed cases, divided into separate rooms for each patient. As in the foreign hospitals previously described, the continuous bath is used largely in the treatments. Each ward unit has its own serving kitchen, and bath and toilet unit. A large out-door day-room on the roof (Fig. 182) affords opportunity for exer- cise and recreation, and as this institution overlooks the splendid park system of the city the patients have much outside of themselves to occupy their minds. The Phipps Clinic, a well-studied psychopathic department of the Johns Hopkins Hospital, shows much care and thought, not only in the planning but in the aesthetic side of hospital architecture. The restricted area made it cecessary for the architect to carry the building five stories above the basement in order to provide for the needs of the department. For description, the writer is indebted to Adolph Meyer, M. D.* There is an out-patients' department, with waiting room, which also is used in part for occupation classes, social work- ers, and examining rooms. In the hospital division there is an ad- mission ward, with provision for excited cases, as well as a semi-quiet ward, a quiet ward, and a private quiet ward. A number of well-arranged, exclusively private suites and rooms are provided. The administrative portion is princi- pally on the north, consisting of offices for administration, laboratory and staff quarters. The medical treatment department consists of hydrotherapy and mechano- therapy. The top floor is reserved for the large recreation hall and roof gardens, charm- ingly designed and colored. The ward unit consists of an eight-bed ward. *"The Modern Hospital," Vol. I, No. 2. 130 THE AMERICAN HOSPITAL CHAPTER X. {Kuberculossig department The care of patients afflicted with pul- monary tuberculosis demands special study for the problem is totally different, from almost every point of view, from that of the treatment of the general pa- tient, whether surgical, medical, or con- tagious, in the number of gradations of patients and the different care required for each grade. If we are to plan for the care of tuber- culosis patients on the grounds of the general hospital, then a portion of the site should be selected remote from the other patients' buildings, but with equal regard to sunlight and protection from the cold winds. If, as is more likely to be the case, the tuberculosis hospital or sanatorium is to be isolated and an in- stitution by itself, and a site is selected remote from water, sewerage, and other municipal service, then the problems are increased many fold, and the natural contour, the nature of the land, and the meteorological conditions must be care- fully studied. If planning for "all comers," it will be necessary to plan on about fifty per cent of the patients being of the ambulatory class, who are able to be up and about and to do light work. Plans must be made for ground room for exercise and recreation, buildings for light industrial work, buildings for dining and enter- tainment rooms, facilities in ether wards for carrying on the various activities of life under hygienic and supervised con- ditions, the main aim being to have the maximum amount of sunshine, fresh air, and absolute ventilation. The area of land must not be restricted and it should have level stretches about the buildings. The outlook and general environment are almost as important as sunlight and ventilation—e.g., an other- wise beautiful site might lose much of the therapeutic value if a cemetery were in the immediate foreground, or if sit- uated near noisy manufacturing plants or of smoking chimneys. The average incipient patient soon wearies of his enforced confinement; and unless the natural attractions are consid- ered he becomes discontented and leaves, so that the sanatorium may be without patients. In providing service for tuberculosis cases they may be roughly divided into three general groups: 1st—Those in the last stages, in many instances dying patients; 2nd—The ambulatory cases, with in- cipient or even moderately advanced cases, incapable of regular work yet enjoying a reasonable degree of health; 3rd—The out-patient who, while needing treatment through the day, may return to his home at night under proper supervision. For the treatment of the first class, wards or private rooms not unlike other medical wards or private rooms should be provided. Proper care must be exercised for the protection of the nurse and the preven- tion of the spread of disease. For the comfort of the patients the wards should not be too large; if sub- divided by permanent screens they may become less depressing. Everything possible should be done to brighten the ward, and there should be provided a wealth of sunshine and plenty of out-of- door balconies. As the death rate in these wards will naturally be greater than in any other part of the institution, the method of re- moving the body from the building so as to attract the least attention should be studied. If the morgue can be at some little distance from the wards, with an underground connection, much mental suffering will be avoided. For the ambulatory case the problem OF THE TWENTIETH CENTURY 131 is very different. Here there are patients with the disease in an incipient or mildly advanced stage, who are up and dressed, and active to a certain degree, but for whom there must be provided proper sleeping quarters, with due regard to the out-of-door treatment recommended for this class. There must also be dress- ing and bath rooms which can be warmed in cold weather, recreation rooms for stormy weather, recreation parks for pleasant weather, and light em- ployment for certain hours. Every am- bulatory patient should have a cupboard, locker, or closet, which will be large enough to be entered and to contain his personal belongings. This cupboard should be well lighted, well ventilated, and well heated; for to the lonely man away from family and friends this may be the only place which he may call his very own. Such a cupboard should not be less than three by four feet in size, and should contain a seat, shelves, mir- ror, and any other conveniences which experience may dictate. The toilets should be of sufficient size to accommodate the patients of the par- ticular unit which they serve, and should be reasonably near the sleeping quarters. The general room or day room should be light and cheerful, as it is the living- room of the family or the unit which it serves. The sleeping quarters can be in wards, with beds on either side, with plenty of windows to open, or of the "tent" or "shack" form, open toward the south, with beds to the north. The modifica- tion of the shack has become perhaps the most popular form for the housing of in- cipients, for with this type the bed of the patient can be brought practically into the open when desired. The south can be closed with swinging sash or cloth screens, or can be left entirely open. Nearly every tuberculosis hospital or sanatorium has its out-patient clinic, where the patient spends the day on the sunny lawn or broad terraces, receiving nourishing food and good advice for home living. For this work the principal equipment is steamer chairs, blankets, serving kitchens, and intelligent attend- ants. This educational and helpful work, followed up as it is by the social service work of the institutions, is accom- plishing important results in the stamp- ing out of the great white plague. In the large city and county institu- tions the industrial work of the institu- tion can be done largely by the patients, with a tailor shop for the mending of patients' clothing, a harness shop for all leather work, carpenter shop for the necessary repairing, sewing rooms for re- pairing the linen and the making up of new material. Light employment during certain hours can be made a profit to the institution and a help to the patient. Waiting on tables and the light janitor FIG. 190. REVOLVING AIRING BALCONY, AMSTERDAM HOSPITAL. work about the building can all be done by the patients. For the ambulatory class, dining- rooms must be provided, general assem- bly rooms for religious and secular services, recreation rooms, reading rooms, store and post-office, as well as general examining rooms, dental rooms, barber shops, etc. An operating department should be provided, for the presence of tubercular germs does not prevent appendicitis or other troubles. One item peculiar to the care of tuber- culosis is the provision for the destruc- tion of sputum cups, gauze and dressings which have come in contact with the patient. This can be a separate build- ing where the patient can deliver his sputum cup and receive a fresh one, and where there is a suitable incinerator for 132 THE AMERICAN HOSPITAL Pining Hoom ® H [0] D&E//1NG (O) Eoom •■— /ix £>tD Waud foe. Mem Open fot.cn ^ DAY E.OOM Nunvi/ Toilet Diet Kitchen LJ DKE//1NG Room "—1 Day Eoom /ix 5eo Wab-d Pot Women Open Porch 1= IE-5T F LOO 12. tl ■ ■ ■ ■ IM— i FIG. 191. CITY OF JACKSONVILLE PROPOSED TUBERCULOSIS UNIT. the absolute destruction of all waste ma- terial. Open air day shacks or shelters can be provided through the grounds at little extra expense. There are numerous pat- terns and they may even be made revolv- ing, like the one photographed by the writer in Amsterdam (Fig. 190), where the pavilion could be moved to shield the patient from sun or wind. Of the many good examples of tuber- culosis hospitals and sanatoriums, few- will be here shown, as this subject has been so carefully taken up by Dr. Thomas S. Carrington in his work on "Tuberculosis Hospital and Sanatorium Construction,"* to whom the writer is indebted for many helpful suggestions in his own practice. A simple solution of the tuberculosis ward for the general hospital which was designed for the Health Board of the City of Jacksonville, is here shown (Figs. 191, 192). This unit provides for a limited •Published by National Association for the Study and Prevention of Tuberculosis, 105 E. 22nd St., New York. number of both chronic and incipient cases, the administration, food, and laun- dry being taken care of in another build- ing. This unit is a part of the con- tagious department under the charge of the city. The City of New York, through its Department of Health, has established at Otisville, at an altitude of from eleven hundred to twelve hundred feet in the Shawangunk Mountains, a most complete sanatorium for the care of tuberculosis. Various types of construction and units were built from a single bed tent house to the more pretentious fireproof build- ing; but in practically every building the sleeping is out-of-doors. Dressing-rooms and day-room are provided, which are heated certain hours in the day. The Department of Charities also pro- vides in its hospital work for the care of tuberculosis, both in the general hospitals on Blackwells Island and in the Sea View Hospital on Staten Island. In the latter institution (Fig. 193) which, with the ad- ditions now being built, will provide for two thousand patients, the earlier group OF THE TWENTIETH CENTURY 133 yECO/HP PLOOli FIG. 192. CITY OF JACKSONVILLE PROPOSED TUBERCULOSIS UNIT. occupied in 1914 will be used to house the chronic or bed patients. The ambula- tory patients will occupy the twenty-one new pavilions. The institution will then be well balanced, accommodating an equal number of bed and ambulatory cases. The new out-door pavilions are being built in two groups, the one at the southwest to accommodate six hundred men, with "group" or executive build- ing, and the other at the northeast to ac- commodate four hundred women. Din- ing facilities for the men will be afforded by the new dining hall placed on the main axis of the original group, and served by the main kitchen. This building (Fig. 194) also is used for an entertainment and assembly hall for patients of both sexes. The women will be served in the present dining building. While the administration of the entire group will be from the main administra- tion building, the "group" building in the center of the male section will contain the offices of the medical examiner and matron. There are examining rooms, pharmacy and treatment rooms, baths for men, store, barber shop, dental treat- ment room, recreation rooms and library, as well as work rooms for various indus- tries, and a linen room where all linen for the group will be given out. The pavilion buildings, twenty-one in number, are to be practically identical (Figs. 198, 199). They are two stories in height, of fireproof material, divided into four sleeping apartments of twelve beds each, with each unit of two beds separated from the others by a dividing screen six feet high, but open on end and underneath to permit air circulation. These are not heated and are open to the south, with possible closing by the use of cloth screens on frames hinged at the top. For each two wards a day room is provided, connecting directly with the toilet section, beyond which is the locker room. Each patient is provided with a locker three by four feet, with short door and screened ceiling, allow- ing free circulation of air but prevent- ing interference from outside. Two of the units used at the Boston 134 THE AMERICAN HOSPITAL /LA VlCW HQAPITAL laTEN/ION /TATlN I/LAND - NEW YOKX Demrtment - Public Gmahitil/ EPWAll) f /TEVENJ - 3o/TON,A\AJ/l A//OCIATED B.tNWiCK.A/J'iNyyALL.t Tucker - Ntw yob.i\ J AnctiiTtcr/ -Pot New Malit female Pavilion/. ■&toup Building « Dining Hall- FIG. 193. Consumptives' Hospital at Mattapan will serve to illustrate the various units for different treatment of chronic and in- cipient cases. The ward building (Fig. 161) here shown is two stories in height. Each unit is divided in the center, and the main service rooms are placed be- tween the two fourteen-bed wards. Am- ple airing balcony space is provided, and the unit has proved easy of administra- tion. For the more active patients the one-story pavilions (Fig. 162) are used. This unit is similar to those used in other State and City hospitals, and has been fully described and classified by Dr. Carrington.* Larger locker space is provided for the patients, additional airing balcony for each bed, an emer- gency room, and a room for the nurse, as well as a large day room accessible to each division. The building is of wood, in simple, picturesque style. •Published by National Association for the Study and Prevention of Tuberculosis, 105 E. 22nd St., New York. OF THE TWENTIETH CENTURY 135 oooooo ooooooo poooo.o ooooooo o oooo ooooooo PINING E.OOM o oooo ooooooo oooooo ooooooo oooooo ooooooo MEW Cul £00M IflEri/ Coat MENy Cc *r fcOOM Men/ Com SoomI Pining Hall Building flE/T FXOOB. -PLAN ENLAE.GEMENT "/EAVltW HO/PLTAL VTATEN l/LANP ~ NtW YOfcK PtPAHTMtNT " PUBLIC CHACITI£/ f /TEVCNy — EWton, Ma^"| A//OCIATW GfcOUP 3UILD1NG BA/t«tNT Plan I ii ii ■ u ■ t—di T I I ENLARGEMENT *• JtAYltW HQ/WTAL 7TATEN l/LAND ~ NEW Yo&K DtPAtTMtNT « Public Chaotic/ tswAlD T. /TftVtN/ — to/ron, MtkS/\ A//OCIHTLD FIG. 195. 136 THE AMERICAN HOSPITAL BtcuATioN Boom QtODP Building fit/T Flook Plam tttl*y ToiLtT KmI tiLUAts toon ENLARGEMENT " Jtk VIEW ttO/OTAL /TATEN t/LAND -NEW YOBK Dt«\.]iTME.NT •► Public CrtAtiTin/ Edward f. jfTtvtn/ ~ Boston, Ma//1 A//ocmTfcO Ituwicit. Ay»lNWALI. . TuCKat~Ntw Yo»* J AfcCHITCCT/ FIG. 196. Gtoop, Building /Icond rLoot Plan. ENLAEQEMtNT «./EA VIEW HO/PITAL /TATEN l/LAND ~ NtW YOUK Department « Public CnAtiTlt/ t»V«>D f. ^TCWtHJ — Io/ton, AAA//1 A'/oo«T£,Di tm»ic«, I'liiww « Tu«t»~Ntw To.../ UoiTtlV FIG. 197. OF THE TWENTIETH CENTURY 137 Dmmm Women/ -Pavilion • ynS| TOILET mmmmni O PfcN Alt DORMITO&* jirrxl FIG. 198. ENLARGEMENT « ,/EAVlEW HO/PITAL /TATEN INLAND ~ NEW Yo&K. Department •• Public CHAtiTit-r t»w.«l> T^TCVtN^- -J»«.LL « Twill- NtW Yo.kJ AlcniTra. - Dmrnmrnmn OftU AlB D0EW.IT01Y 1 MtN/' Pavilion . FlIUT - f LOOC-PLWJ ENLARGEMENT " yLAVlEW HO/PITAL /TATEN L/LAND ~ NEW YORK. Duaitaaknt " Public Chabitiej- tDWABP f /TCVEN-f "- - Ba/TON ,AA.A//1 AZ-TOCIAT tD ReNw.cn.AjpiNw^LL . TucKta- Ntw YomJ Architect./ FIG. 199. 138 THE AMERICAN HOSPITAL LEGEAJD A WAR.DJ - B COR.RIDORJ C STORE. CLOjET D LININ CLOSET L BOWL ROOM F SERVING RM G BATH BOOM H UTINJIL E./A 1 TOILET ROOM J JTAIR.CA5E K. LOCKJR, RX L LABORATORY M PIAZZA N CORBIDOR- O TUNNEL V V£NT DUCTS FIG. 201. BOSTON CONSUMPTIVES' HOSPITAL, WARD BUILDING. Maginnis & Walsh, Architects. UdunnndLifld CZ LI GEND A ASSEMBLY ROOM B WA&D C LOCKER, COOM D TOILET E NUR.St'5 B.OOM F EMERGENCY R.OOM G PIAZZA pnmpjniTLi +-!■ *** ^.i FIG. 202. BOSTON CONSUMPTIVES' HOSPITAL, COTTAGE FLOOR PLAN. Maginnis & Walsh, Architects. OF THE TWENTIETH CENTURY 139 CHAPTER XL Special ©epartmente Under this section will be briefly men- tioned the following departments and a few examples given: Pathological and laboratory work, Roentgen-ray work. Out-patient scrz'icc. Social service work. The development of the laboratory work in the general hospital de- pends largely on the personnel of the staff, the proximity to established inde- pendent laboratories, and th: possibility of development within the institution. In the larger hospitals, separate build- ings away from the main group are de- voted entirely to laboratory purposes, where there are class rooms for teach- ing, autopsy rooms and morgue; and often the chapel is connected with this building. These, with the local labora- tories in the ward units and the operat- ing units, form a chain for diagnostic and research work. In the small hospital, however, of fifty beds or less, where the laboratory work is done by members of the staff, it is not necessary to provide extensively. Light basement rooms will generally serve for the purpose, the principal necessity be- ing light. 2'lkin£e/fe/mmet, 6 Av9»egrujng»6a/ite. 10 t)oc/iiih^ ** 'ThrzZmnwz, 5 CVTeI2*zn&x?e. 7 GAv-nfa'du/^en/iau. H (Sa^. K SacLe**oa£. FIG. 210. MUNICH-SCHWABING HOSPITAL. PATHOLOGICAL BUILDING. FIRST FLOOR PLAN. 140 THE AMERICAN HOSPITAL 1 SomLmga^/Ooz&ogszotjTn^ 3 fleoerusaum. 6 Aufctiff. -to les&zLmmec. & @a&£erLoJog. >• 4? 'WagercLum, --------f2-------------£*- 'flf-././oa. SECOND FLOOR PLAN %*t t r r t~r.f { P r FIG. 211. MUNICH-SCHWABING HOSPITAL. PATHOLOGICAL BUILDING For the larger research laboratories, space for the hygienic care of animals used in experimentation must be pro- vided, either on the roof of the building or even in a separate building; but if they must be kept on lower levels, the rooms should receive special ventilation. Every hospital, even of fifty beds or less, should have a room where autopsies can be performed, and suitable equip- ment for the same should be furnished. This room must be well ventilated, should have a flushing floor drain, sim- ple autopsy table, with sink and facili- ties for properly handling the body. Good day lighting is desirable but not necessary; but there must be an abun- dance of artificial light. FIG. 212. MUNICH-SCHWABING HOSPITAL. DISSECTING ROOM. OF THE TWENTIETH CENTURY 141 »ji4jIu~i UaP iUU1 *'i'»i K~!£45^ ?" FIG. 213. MUNICH-SCHWABING HOSPITAL. PATHOLOGICAL DEPARTMENT. ANIMAL BLDG. Richard Schachner, Architect. 142 THE AMERICAN HOSPITAL Pathologiaches Institut, I. Stocki. Pathologisches Institut, ErdgeschoB i. Pathologiaches Institut, Keller1. FIG. 214. ST. GEORG HOSPITAL. In the larger hospitals in Europe, the tion to plumbing and outfit. In this in- pathological department is under sep- stitution there is a separate building arate management. The plans of the (Fig. 213) for animals, with special op- Pathological Institute of the Munich- erating room perfectly equipped. Schwabing Hospital are here shown The pathological building at St. Georg (Figs 210 and 211) and are self-explan- is another carefully developed depart- atory. The detail and equipment are ex- ment, as the few illustrations will show cellent the dissecting room in particular (Figs. 214 and 215). (Fig. 212) showing most careful atten- The Roentgen-ray, in its divers uses, OF THE TWENTIETH CENTURY 143 FIG. 215. ST. GEORG HOSPITAL. TABLE. DISSECTION plays a most important part in the work of every hospital. Its use in diagnoses has become invaluable. While it is true that the best results can be obtained by only the expert roentgenologists, never- theless even the limited use of the X-ray in the small hospital is most helpful. The advance in the possibilities of uses to which the Roentgen-ray can be put is so rapid that no attempt will be made to show them now. We know, however, that the recurrent use of this powerful medium has caused serious burns and the destruction of live tissue so that the ODerators should have every possible protection. Lead screens afford this protection against both direct and reflected rays. It is more common now to provide control rooms heavily lined with lead at least one-eighth inch thick; r ]-LZB n T" M-'ALfr- *°» •■ ^° i: j ..^ . ■ T Vk ijt"* - Lli„. m FIG. 216. ' [LIU IIT'TT MAYO CLINIC, ROCHESTER, MINN. FIRST FLOOR PLAN. Ellerbe & Round, Architects. Consultation rooms. Room 107- Room 105 Room 106 Room 108 I Room 110 Room 103 J Room 109 C. H. Mayo, Consulta- tion. Room 111 Reception, W. J. and C. H. Mayo. Room 113 W. J. Mayo, Consulta- tion. Room 115] Room 117 Room 119 Room 121 Consultation rooms. Room 123' Room 148 -i Room 125 Room 150 Room 127 Room 162 Room 132 Room 134 Room 154 Room 156 ^Consultation rooms. Room 138 r Consul tation rooms. Room 158 Room 136 Room 160 Room 140 Room 152 J Room 144 Room 174 -] Room 146 Room 172 1 Room 135 Clinical. Room 170 ( Stenographers. Room 137 Clinical. Room 168 J Room 139 Clinical. Room Kl VTail distribution. Room 141 Hospita ass gnment. Room 175 Dictaphone. Room 164 Alphabetical index. Room 173 Dffice. Room 169 Account s. Room 177. Office telephone central 144 THE AMERICAN HOSPITAL and where vision is required, lead glass is used for the operator. A few precautions may be mentioned in providing for this department: In selecting Roentgen laboratory avoid cellar, particularly if it is damp; moisture causes trouble with the trans- former and high tension wiring. The room should be sufficiently high studded to allow overhead high tension system. The X-Ray transformer requires a special electric current supply. Do not rely on the word of a local electrician or power company. Special precaution should be taken that all electric light conduits in Roentgen room are properly grounded. Arrangements should be made for a perfect ground near position of X-Ray transformer. The room to be used for fluoroscopy should be so arranged that it can readily be made light proof. Special lead protection is necessary where the Coolidge tube is used for X-Ray therapy. The dark room, for developing and loading plates, should be located as near the Roentgen laboratory as possible. Hot water, as well as cold running water, in the dark room is desirable. FIG. 217. MAYO CLINIC. SECOND FLOOR PLAN. Ellerbe & Round, Architects. Room 271 Cystoscopic. Room 232 Clinical. Room 273 Private office, Braasch. Room 228 Clinical. Room 201 Cystoscopic. Room 226 Clinical, blood Room 203 Cystoscopic. tures, etc. Room 205 Refraction. Room 224 Clinical. Room 209 Eye. Room 222 Clinical. Room 209a Eye. Room 220 Clinical. Room 213 Eye. Room 259a X-ray indexing. Room 215 Nose and throat. Room 278 X-ray viewing. Room 221 Nose and throat. Room 249a X-ray storage. Room 227 Laboratory, bacterio- Room 249 Fluoroscopic. logical. Room 249a Fluoroscopic. Room 227a Laboratory, parasito- Room 248 Food preparation. logical. Room248a Exposure, X-ray. Room 250 Exposure, X-ray. Room 252 Exposure, X-ray. cul- Room 254 Exposure, X-ray. Room 258c Developing. Room 258b Developing. Room 264 Exposure. Room 268 Exposure. Room 270 Exposure. Room 274 Exposure. Room 275 Private office. Room J2b Toilet, men, special, public. Room J2b Toilet, women, special, public. OF THE TWENTIETH CENTURY 145 This department should be planned for at the beginning, not left to chance. The writer knows of no more exten- sive use for diagnoses than at the Mayo Clinic (Figs. 216, 217, 218, 219) at Rochester, Minn. Nearly half of the second floor of this large building is de- voted to this form of diagnosing. The space allotted to this work in the various plans shown may be noticed—- Ohio Valley General Hospital (Figs. 77 and 220), Youngstown Hospital (Fig. 74), Barre Hospital (Fig. 239), etc. Today nearly everv large hospital in the country has an out-patient and social service department, where more or less dispensary work is afforded people who are not enrolled as patients of the hos- pital, or more home care is provided. The problem of how best to serve this class without lessening the service to the in-patients is one needing much study. The location of the hospital in the community, the likelihood of casualties, and the nearness to other dispensaries have a bearing on the development of this department. Except, perhaps, in the large city communities, this dispensary or out-patient service can be rendered more effectively in connection with the general hospital; for the reason that many of the departments can be used in common, such as the drug room, the Roentgen-ray department, the hydro- and mechano-therapeutic departments, the heating plant, and, in emergencies, the service of members of the staff and nursing forces. The size and shape of this department must be governed by the needs and the available space. If the call is small, it may be placed safely in the basement of one or more of the hospital buildings, or on certain floors set apart for this pur- pose. FIG. 218. MAYO CLINIC. THIRD FLOOR PLAN. Ellerbe & Round, Architects. Room 377 Editorial. Room 303 Editorial. Room F3a Toilet staff men. Room 305 Pathological labora- tory. Room 309 Pathological labora- tory. Room 313 Stenographic. Room 315 Pathological labora- tory. Room 323 Pathological labora- tory. Room 325 Pathological labora- tory. Room 331 Chemical laboratory. Room 363 Reading. Room 320 Pathological labora- tory. Room 359 Artists' studio. Room 355 Coat room. Room 349 Assembly room. Room 366 Stock room. Room 375 Reading room. Room 369 Reprints. 146 THE AMERICAN HOSPITAL Mackintosh* says, "The out-patient department should be a one-storied building, quite apart from the hospital." Whether this department be in a sep- arate building of one story or multi- story, or connected with any other de- partment, there are certain practical principles which must be considered. The waiting-room should be large, well- lighted, and, above all, well ventilated and centrally located, with the seating space so arranged as to give perfect cir- culation and prevent congestion. The entrance should be large and well protected from storms. As many of the out-patients are children-in-arms, ade- quate provisions must be made for the perambulators and wheel chairs, at or near the street level. Where practicabk1, the exit should be "^'Construction, Equipment and Management of a General Hospital," by Donald Mackintosh, M.B. a separate door. Near this door can be located the laboratory and the pharmacy. Near the preliminary examination desk there should be isolation rooms, with a separate exit for any suspicious case or case of communicable disease. The arrangement and division of de- partments may depend on the respective service. The L-shaped building often affords a better division of departments than the rectangle, since the large waiting-room can be placed at the junction of the two wings, giving better supervision from the administrative center. Near the entrance should be the office of the department, the examining rooms, and the social service workers' office. In the small service, by the use of dif- ferent rooms at different hours and by a slight change in equipment, the treat- ment of the different diseases can be ac- ;A| «e Ix Room 401 Store room. Room 409-405 Pathological muse- um. Room 411 Pathological store room. Room 420 Drafting. FIG. 219. MAYO CLINIC. ATTIC. Ellerbe & Round, Architects. Room 413 Pathological prepara- tion. Room 422 Shop Room 469 X-ray store room. Room 466 X-ray machines. Room 464 X-ray dry plates. Room 460 Photographic store room. Room 458 Bromide room. Room 453a Developing. Room 468 Waiting room. Room 453 Photographic gallery. OF THE TWENTIETH CENTURY 147 FIG. 220-A. UPRIGHT FLUOROSCOPE. ^ VESTIBULE. M i~F-~ ;• -^= ; I--IH „ | -a.. j_ — L L_|_ —"'—~^~i—*—h* p RECORD V ■ -~ .""■'----' I W A t T « N G R 0 ^ M[ *_ . 1 T T T T T 4 ~r~ ^o^ sJ.W^ jMb FIG. 222. CHILDREN'S HOSPITAL, PHILADELPHIA. OUT-PATIENT DEI'AK I'M ENT. 148 THE AMERICAN HOSPITAL complished; in fact, splendid work can be done in a very small space. But the ideal out-patient department should have space and divisions for general medical clinic, children's clinic, surgical clinic, gynecology clinic, genito-urinary clinic, eye-ear-nose-and-throat clinic, and dent- al clinic ; and as the department grows, separate space should be provided for orthopedic, nervous and mental diseases. and for the treatment of tuberculosis, whooping cough, and vaginitis. Since the recent epidenv'c- of infan tile paralvsis, separate departments have been established for the after-care of such patients. The work of examination and treat- ment is facilitated if provision is made FIG. 221. WESTERN INFIRMARY. GLASGOW OUT-PATIENT DEPARTMENT. FIG. 223. PROPOSED OUT-PATIENT DEPARTMENT FOR NEW YORK CITY. FIRST FLOOR. Designed by S. S. Goldwater, M.D. OF THE TWENTIETH CENTURY 149 for patients to wait at or near the treat- ment rooms. In some cases, separate waiting-rooms or history corridors are provided where the assistants can take down the history and prepare the patient for examination or treatment. In providing for the clinics, the larger services such as the medical and chil- dren's services should be located on the entrance floor, in order to avoid conges- tion. The orthopedic, with the plaster work and brace shop, may well be lo- cated in the basement. As to the size of the treatment rooms, there may be a difference of opinion; one man may wish a large room with, per- haps, cloth screens dividing the patients, another, a small room opening from the general room of that service, where any conversation will not be overheard b\' the patients nearby. If the small room is used, the ventilation should be assured and positive. If the rooms are to be used for teaching purposes, they should be of larger size. In the surgical department, there should be the complete operating room with its adjuncts—the sterilizing and FIG. 224. OUT-PATIENT DEPARTMENT FOR NEW YORK CITY. SECOND FLOOR. Designed by S. S. Goldwater, M.D. Men'i Medical {"^SST'^Kh"0") Hl=>TOEY CoZZ\DOZ —T5T ^ FIG. 225. OUT-PATIENT DEPARTMENT FOR NEW YORK CITY. THIRD FLOOR. Designed by S. S. Goldwater, M.D. 150 THE AMERICAN HOSPITAL anaesthetic room; and as many of the minor operations are performed under anaesthetics. Recovery rooms should also be provided. Each clinical division should be made a complete working unit, with proper plumbing fixtures, cabinets, and supplies for disinfecting against contagion, and apparatus for sterilization of instru- ments, etc. The floors, the walls, the ceilings, and the furniture should be of a material readily scrubbed and of simple design. The waiting room, however, should not be void of artistic merit, for even with the out-patient, the environment should tend to benefit the mind as the treatment does the body. While the social service work in con- nection with hospitals and out-patient departments is a development of recent years, nevertheless it has become a most important and necessary adjunct. It is truly a twentieth-century development, starting in Boston in 1905 through Dr. Richard Cabot, who introduced the so- cial worker as a means of securing more accurate diagnosis and rendering more effective treatment. The social worker co-operates with the clinician. Together they take the his- tory, one examines the patient, the other "investigates the social cause of the ailment." The physician prescribes; the social worker "follows up" the homelife, sees that the instructions of the phy- sician are carried out, and encourages better home environment. It is obvious that if the instructions of the medical man in the clinic are not carried out, the time is wasted and the patient returns without benefit. The social service worker renders here invaluable service to the hospital, to the dispensary, and to the public. The subject of the out-patient and so- cial service departments has been so ably covered by Mr. Michael M. Davis, Jr.,* Dr. Andrew R. Warner, and Miss Ida M. Cannonf that it would be presumptu- ous in the writer to enlarge more on the subject. *"Dispensaries—Their Organization and Manage- ment" (in press). f'Social Work in Hospitals, Russell Sage Founda- tion." A few illustrations, however, may serve to show the planning of a few de- partments of this kind. A more complete out-patient depart- ment is hardly to be found than that of the Western Infirmary at Glasgow (Fig. 221). From the time the patient enters until he leaves, it is not necessary for him to cross his own path. He final- ly comes up in front of the dispensary and goes thence to the exit. At the entrance is the preliminary waiting-room for new patients, with its isolation and diagnosis room; then the large central waiting; the special treat- ment room for eye, ear, nose, and throat; for minor dressings; and the various surgical and medical clinic rooms, with dressing-rooms connected; each unit a teaching theatre, with circular benches for students, with the dispensary near the exit. A special students' entrance is pro- vided, with corridor above and exit pas- sage, connecting with each of the clinic rooms. The first building of the Children's Hospital, Philadelphia, to be built is that for out-patients. Entrance is through a large vestibule arranged for the storage of baby carriages. A record office fills a commanding position. The babies' dis- pensary, with examining rooms and a milk and duty room adjoining, occupies the central position in the rear of the record desk. The medical and surgical examining rooms use the rest of the first floor (Fig. 222). The plans show in the basement the detention room for suspected cases, a whooping-cough clinic having a separ- ate entrance. The X-ray, orthopedic, and plaster rooms are on this floor. The eye, ear, nose, and throat treatment and utility rooms are on the second floor; also the operating and recovery rooms. The third floor is occupied by the labora- tories. The plan of an ideal out-patient de- partment suggested by Dr. S. S. Gold- water in Mr. Henry C. Wright's* report on City Departments of New York, shows the working out of a three-story ♦Report of Committee on Inquiry into Hospitals and City Homes of New York City. Out -Patient Pepartment /CALt L Pavilion f Quoonp fLooa Plan _______a___________»«_ At ftET macon City ho/pital Macon Giohgia tPWAtO f yTEVtN/-AtCrtlTtCT-Bo/TON,MA// Al-t*ANPl» &LAIR- AV/OCIATE AfcCHlTtCT-MACON-G* O H M H H n M H C < FIG. 226. 152 THE AMERICAN HOSPITAL out-patient department on a restricted The treatment rooms, however, are not citv site with buildings adjacent. The divided. A complete operating depart- plans (Figs. 223, 224, 225) show the ment is here provided, which will serve, possibilities of such a site and the plac- to a certain extent, for minor operations ing of the rooms and corridors to con- for the colored patient, the wards for serve light, assure circulation, and afford whom are on the second and third stories ease in the handling of patients. of this building. The small out-patient department The dispensary building for the East (Fig. 226) of the Macon Hospital, New York Hospital, for the time being, where the problem of serving the col- will serve for dispensary and hospital. ored as well as the white must be met, As shown by Figs. 227 and 22S, a por- shows the possibilities of even a small tion of the ground floor and all of the unit. second will be used for out-patient ser- The waiting-rooms for both white and vice. Worked out on the "L" plan, with colored are supervised from one desk. the waiting-room at the junction of the OF THE TWENTIETH CENTURY 153 two wings and with the administration and examining rooms, the social service office, the pharmacy, and the laboratory in central locations, the problem of car- ing for the patients should be simple. The X-ray and hydro departments are on the ground floor. While the in-patient work of the Hos- pital for Sick Children, at Toronto (Fig. 229), and the work at the Lakeside Home is tremendous, the out-patient work and the milk dispensary work are even greater. The entire ground and first floors of the new contagious wing and a large portion of the first floor of the old building are used for the out-patient work. The main waiting-room connects at the left with the pharmacy; the labor- atories at the rear with the hospital and pasteurizing plant and at the right with the various departments including med- ical, surgical, eye, ear and throat, ortho- pedic, etc., while in the basement is a large measles clinic, and the brace and mechanical shops for making of appar- atus. a £^f3 First Floor. Plan ..... U-t-J.-t-J THF. HOSPITAL foe .3ICK. CHILDR.EN TORONTO i-revENa&LcE — ARCHiTe ts - TotONTO-- FIG. 229. OF THE TWENTIETH CENTURY 155 CHAPTER XII. Che Entail feospttal The development of the small hospital is largely American. While the village or small hospital may have started in England, as stated by Taylor,* the greater development has been in this country. One can find hundreds of well-planned hospitals of fifty to one hundred beds; but for the smaller private hospitals, one is more likely to find the adaptation of some dwelling, doing good service but handicapped at every turn for lack of conveniences for economical and efficient work. Every hospital must have its begin- ning; few indeed can start with a com- plete equipment; so the remodelled house should be looked upon as the step- ping stone to something more complete. It generally happens that before the house has been fitted for hospital pur- poses, enough money is expended to go far toward building a suitable, up-to-date institution. Even then there will be waste and unavailable room, which must be heated and taken care of. The finish which is attractive and necessary for a residence becomes almost a menace in a hospital. The staircases and halls are generally narrow, the rooms are not properly ventilated, the toilets are badly arranged, and the floor materials are not suitable. In other words, an undue amount of energy must be expended in the housekeeping for such a building, and this will detract, in all probability, from the care of the patient. The same standards of number and size of utilities are not applicable to a fifteen-bed that would be suitable for a fifty-bed establishment, for it would be all utilities, with no room for patients. In the small hospital there is not the need for the separation and segregation of utilities; one room may serve for toilet, sink and bath; food may be taken directly from the kitchen to the patient; •Brickbuilder, January, 1904. the operating room may serve for both surgical and maternity work. Even in the small hospital the life of the patients should be safeguarded; and the construction, the egress, the careful consideration of the patient are just as important as in a large plant. Fireproof construction may not be absolutely nec- essary but is always desirable, and is generally an economy in the end. It is possible, however, to meet mod- ern requirements in the small village hospital and at moderate expense, and the examples following will show the solu- tion here of several problems. However small, each institution must be balanced for its special location and purpose. In Dr. Williams' Private Sanatorium, Macon, Ga. (Figs. 236 and 237), the problem was to provide for the care of both medical and surgical cases, for offices, and for an out-patient department for colored people. The contour of the land gave the advantage of being able to place kitchen, dining-room, and store rooms in the base- ment and still get proper light. The first floor is occupied by offices, re- ception room, out-patients' clinic, ambu- lance entrance, and rooms, service and airing balcony for six patients. The am- bulance entrance room and clinic oppo- site are made sufficiently large so that minor dressings may be done here, or even a slight operation in a septic case which one would not wish to take to the main operating room. The elevator and stairway to the second floor are near this entrance. Though small, the operating depart- ment on the second floor is complete. There is the operating room, surgeons' scrub-up room, anaesthetizing room, and sterilizing room, with complete equip- ment. This department is in a wing on the north side of the building and is en- tirely shut off from the rest of the hos- pital. 156 THE AMERICAN HOSPITAL r'F^ 111 < • i iUi AIRING BALCONY 1 nnTTT ■ \li\\\Lm n m PLAN OF FIRST FLOOR.' ENTRANCE PORCH % FIG. 236. WILLIAMS' PRIVATE SANATORIUM, MACON, GA. Edward F. Stevens, Architect. OF THE TWENTIETH CENTURY 157 JUL AIRING BALCONY =ac^r PRIVATE Ro°M C0RRIO0R. JL PRIVATE. Ro°M PRIVATE R°°M. PRIVATE Room. CORRIDOR. "-^ PRIVATE R«"M. FTV^TVWV^J Y- C doctor/'rVi sir; DD PRIVATE R'M PRIVATE R'M. PLAN OF-SECOND- FLOOR/ PRIVATE RM. 3 BED WARD. Ro°r. eoinnw covckco. FIG. 237. WILLIAMS' PRIVATE SANATORIUM, MACON, GA. 158 THE AMERICAN HOSPITAL 1 L-[ |x| FIG. 238. DEACONESS HOSPITAL, CONCORD, MASS. Edward F. Stevens, Architect. OF THE TWENTIETH CENTURY 159 On the main floor with the operating room are eight private rooms and a three- bed ward; also the necessary utility rooms. All rooms occupied by patients are located on the south and west. An airing balcony of sufficient size to ac- commodate all patients is placed on each story, on the southeast side of the build- ing. The nurses are accommodated in a separate building nearby. This is a complete hospital of seven- teen beds, which cost less than twenty- five thousand dollars, with all modern details, ready for furnishing. A unique problem presented itself in planning the little hospital for the Nezu England Deaconess Association, in Con- cord, Mass. (Fig. 23S). Only ten or twelve beds were wanted, hut sufficient accommodation was demanded of the kitchen for summer tent work, and an additional private ward which was added two years later. The site is almost ideal, being on a slight eminence, with a level plateau stretching to the south, pine trees at the back, and an extended view of river and hills. The first floor of the original or north building constituted the hospital. The front is north, and, therefore, is taken up with the combination reception room and office, and with the utilities. In the eastern extension, shut off from the main hospital, is the operating suite, consist- ing of operating room, sterilizing room, anaesthetizing room, and surgeons' scrub-up room. The south and west sides are devoted to the rooms of pa- tients. An airing balcony extends the entire width of the south front, and ev- ery ward and private room opens direct- lv upon the balconv. There is an incline from the balcony to the ground so that patients may be wheeled down; easy service to the tent wards is thus secured. There were two private rooms, now used as reception rooms, a two-bed ward, a three-bed ward, and a four-bed ward. The basement is devoted to domestic purposes, with kitchen, nurses' dining- room, storage for supplies, heating plant, and a small hand laundry. The second story, in the gambrel roof, provides sleeping accommodations for the superintendent, four nurses, and three servants, all in single rooms, with a pleasant sitting-room at the west. As high pressure steam or gas was not available here, electricity was employed for the diet kitchen and for sterilizing. The original hospital building is fire- riJ^T?tCC*.l>LA.N- FIG. 239. BARRE (VERMONT) CITV HOSPITAL. Edward F. Stevens, Architect. 160 THE AMERICAN HOSPITAL incoNDtLoPB. Plan ■TtTIEJ? TTODIL VlfVi - FIGS. 240 AND 241. FLOOR PLANS—BARRE (VERMONT) CITY HOSPITAL. Edward F. Stevens, Architect. proof and cost, ready for occupancy, less than twenty thousand dollars. The small private pavilion, accommo- dating eight private patients, relieves the original building and affords room for the increasing demand. The second story of the new wing, also fireproof, occupied temporarily by nurses, is so constructed that with slight altera- tions the private service can be increased to sixteen beds. A small city hospital, wherz the ground is more or less restricted, certainly should consider only fireproof structure. The Barre (Vt.) City Hospital (Figs. 239-243) is another solution of the small hospital problem. Located on one of the hills overlooking the city and taking ad- vantage of the southeasterly slope for sunlight and air, the simple brick build- ing with its broad brick porch bids wel- come to the visitor or patient. On the entrance level or ground floor are located the administration, the heat- ing and kitchen departments, as well as the Roentgen-ray and laboratory depart- ments ; and, with the easterly side wholly above ground, light and air are not sacri- ficed. The grade permits entrance to the first floor on the westerly side, where the am- bulance door is located. With all the general offices and utili- ties placed on the ground floor, the first and second floors are left free for the care of patients. In planning this hospital no large wards were provided, for it was felt that a better segregation could be obtained with smaller wards. On the first floor were located four three-bed wards, seven single wards, and a small maternity de- partment, entirely isolated, with delivery room, creche, and bathing department. The second floor is almost wholly de- voted to private patients and consists of OF THE TWENTIETH CENTURY 161 DNJJJX CITY HOSPITAL- tDWMLD r^TtVUO-------AtCtllTECT — OtLCXirtD fLOOlL Pl.aH- FIG. 242. BARRE (VERMONT) CITY HOSPITAL. Edward F. Stevens, Architect. one four-bed children's ward and nine private wards. A complete operating de- partment is also provided on this floor, composed of two operating rooms, an- aesthetic room, nurses' work room, ster- ilizing room and surgeons' locker rooms, all shut off from the patients' quarters and planned for the most efficient service. On each floor ample serving kitchens, sink rooms, bath and toilet rooms, linen storage closets, medicine closets, and nurses' stations are provided. Large airing balconies at the south af- ford opportunities for patients to be wheeled into the open air. All doors are wide enough for beds, and all beds are provided with trucks, while the elevator connects all floors. Perhaps the most interesting feature FIG. 243. VIEW OF EXTERIOR—BARRE (VERMONT) CITY HOSPITAL Edward F. Stevens, Architect. 162 THE AMERICAN HOSPITAL I Oil L . 3TOKt3 I 3T0U3 HOJPiTai. OTOREO ■ ■ • I UnUCAVATtO I DAir.nii«T Tlooe Plad Scale. - IHMflU FIG. 244. BENJAMIN STICKNEY CABLE MEMORIAL HOSPITAL. of this thirty-two-bed hospital is the ex- tensive roof ward, equipped with all the conveniences and accessories of indoor wards and commanding a wonderful view over the city and the adjoining hills. The materials of construction are common brick, granite and terra cotta, with floor construction of iron and con- crete ; the interior walls of hollow tile; the finished flooring is of terrazzo, ce- ment, and linoleum; the finish is simple, the windows wide, and the coloring of the inside cheerful and attractive. The equipment is simple, but fulfills every requirement of modern science. Differing from the last example, where the grounds were more or less restricted, the Benjamin Stickney Cable Memorial Hospital (Figs. 244-247) in Ipswich, Mass., is erected in the center of a ten- acre lot. (See Chapter XVIII on land- scape architecture.) The ample space around the building, coupled with the natural beauty of the site, gives the archi- tect more than usual opportunities for placing the rooms to the best advantage. The building faces the north, or toward the town proper, but practically all the rooms for patients are on the south, over- looking the beautiful valleys and hills in that direction. The building, of fireproof materials, is designed in the early Georgian style so common in the old New England towns. It accommodates twenty patients on the first floor, and the second floor is also available for use of patients. The ground floor contains the kitchen, dining-rooms, X-ray, morgue, heating, and storage rooms; for the present, the second story is set apart for nurses and for a small isolation department. To give assurance of security, a low brick wall is built around the patients' court, upon which three airing balconies open. These airing balconies, projecting to the east and west, cut off the cold winds from the north and east. The plan is simple: one enters through the memorial entrance, which is finished in Colonial detail, passes up two steps to the main corridor and thence into the private patients' day room, or out into the patients' court. On the east end of the building is located the men's ward, the operating department, and the ambulance entrance; on the west, the women's and maternity wards; on the northeast, the children's" ward; on the south are four private rooms; and on the north the utilities. The small Greenville Hospital (Figs. 24S and 249) at Greenville, Me., built to meet the needs of the lumber industries of the vicinity, at the figure, approx- imately, of twenty-five thousand dollars, is, perhaps, as complete as any hospital of a like cost. It is somewhat unduly expensive, but was built in the season of 1916-1917 when all materials were at a maximum. The problem on the Melrose Hospital (Figs; 250-257) at Melrose, Mass., was to build a fifty- to sixty-bed hospital on a noisy street corner, with trolley lines on two streets. OF THE TWENTIETH CENTURY 163 TiE5T Floor. Plan Scale, uamu FIGS. 245 AND 246. BENJAMIN STICKNEY CABLE MEMORIAL HOSPITAL, IPSWICH, MASS. Edward F. Stevens, Architect. 164 THE AMERICAN HOSPITAL The buildings were set well back from the street, the operating portion only be- ing near the street, the buildings being so planned as to bring the patients away from the noisy corner. There are three buildings in this group. In the basement of the administration building are the Roentgen-ray and laboratory departments, the pharmacy, store rooms, autopsy and lecture rooms, and rooms for male help. On the first floor are all of the administrative offices, the superintendent's suite, and the oper- ating department. The second floor, however, is devoted to the care of patients—1st, in private rooms and suites; and 2d, in the ma- ternity department, which consists of a OF THE TWENTIETH CENTURY 165 FIR.JT fLOOR. Ran THE QK.EENV1LLE QHlENVILLL HOJPITAL MAINE. FIG. 248. three-bed ward, a delivery room, creche, and wash room—all isolated from the other portions of the hospital. One serving kitchen serves all patients in this building. The ward pavilion is joined to the ad- ministration building by a well-lighted corridor. On the first floor are the three main wards—men's, women's and chil- dren's—and five private rooms, and on the second floor are ten private rooms, with the usual service. All of the wards and private rooms on the first floor open directly onto air- ing balconies, which are so separated that the patients on one balcony are not visible to those on another. On the second story a large roof ward has been provided for the treatment of pneumonia cases, as well as for use by ambulatory cases. The heating plant and laundry are housed in a separate building, which also affords sleeping accommodations for fe- male servants. The nurses are pro- vided for in an adjoining estate. THCtt Bed Ward oom. AmiNt, bALCONT TheecBed Wie.o 5e.com>- fLOOR Plan THE GREENVILLE HOJPITAL QR.EENVILLE MAINE FIG. 249. 166 THE AMERICAN HOSPITAL r Plot Plan [Aelcoae hojutal IAELJLO.SE '----' MA56 L&WMLbF iTEXlNJ AO-CHITtCT tOiTON JCA.LE. - M»ii Lebanon yrkLET FIG. 250. OF THE TWENTIETH CENTURY 167 Administration Building melrose ~ ' h0.5jmtal IAEL+10.5E ~ MA^3 EDV/Att) T jTeVEUi ARCHITECT FIG. 251. Pavilion MELfc-OJE ~ HOJUTAL MELfcOJE - A\A^5 EDWAfcD r .5TEVEN-S AtCHITtCT JOJTOH '------- Mass FIC5T FlOO*. 1>LAN FIG. 253. 168 THE AMERICAN HOSPITAL hi fe.OOM 10 JLOOW 9 ----IT C.OOM II ^ Night \m Nufcitl *? COfcfclDOft. ILooja ii I- -T bATtt R.OOW HOOA\ 8 FEMALE. . LET <¥ lU)OA\ 7 ^ R.OOA\ 7 1* ° I M H.OOM 6 Hoof Administration Building FIEL4LOJE - HOSPITAL KfLROviE ~ MA 3.3. £l)WA Pla.n of riR5T.rL.ooc T • • * r^*"' r"—7 FIG. 258. OF THE TWENTIETH CENTURY 171 The problem of the Josiah B. Thomas Hospital (Figs. 258-260) at Peabody, Mass., was different. The land sloped to the north, making that exposure the important one to study. The operat- ing room window was made the archi- •THlv- JG3LAH- 5 ° TrlOMA> H03PITAL; PL ABODY". T^YA^SACrK J3 ETT6. tectural feature. Otherwise the build- ing is a simple treatment of the small hospital problem. A very complete out- patient department was secured under the surgical end of the building. As in the case of Dr. Williams' Sana- •n EN DALL TAYLOR. &OTEVEN.S EDWARD' FiTtVENi- ARCHI'Tl.CT.5- B05T0N Pla/i. of imt X) FTT T ILoovi /tcoND.£ Ti-neo Plooe, Plan/ FIG. 263. "FR E.OOM r--i 2oom The Ma/on Ho/pi tal Cla&k/buhg - Wt/T Virginia tp^vACP f" rTtVtN/ - AecMlTftCT So/ton- M*jv fou^TH tlooc Plan Tut Ma/on Ho/pi tal CLA2.K/3UHG -Wt/T VlBClNIA tPWAUD r /"TtVtN/- - A^cnlTCCT FIG. 264. 174 THE AMERICAN HOSPITAL FIG. 265. OF THE TWENTIETH CENTURY 175 CHAPTER XIII. &i)e Jjurses' &e£ibence Perhaps next in importance to the care of the patient is the care of the nurse, for to do her best and give com- fort and help to the sick a nurse must conserve her own health and strength. When off duty she must be able to go out of the environment of the sick room, out of the sound of suffering, out of the smell of iodiform, and in fact out of the hospital atmosphere. Any hospital of considerable size should have its nurses' residence. This should be a separate building, not too remote from the hospital, but far enough away so that the noises of an entertain- ment, a dancing party or a romp will not disturb the patients. The more attractive and homelike this building can be made and the more alluring it can be made to the young wo- man who is taking up nursing, the bet- ter will be the class of women who will come to it and, in the end, the better will be the care that the patient will receive. No matter how small the appropriation for a nurses' home, one should plan for nothing but single rooms. The nurse's work on duty is most exacting, and every 19 43 Z><2 - _i i__________Ii--------- 11 22 I' X !i " ____II_____IL_ - • -> i-----1 r - Ji____iL 25 ±L_. -ir Di 24 V 30 2D | 26 j! 27 1 17 V 1 29 g pi 28 16 o so f *> k> m ^ %g_yr 3CAL.E- FIG. 270. HOSPITAL FOR SICK CHILDREN. NURSES' RESIDENCE. GROUND FLOOR. 50VTM nodtw FIG. 271. HOSPITAL FOR SICK CHILDREN. NURSES' RESIDENCE. FIRST FLOOR. 176 OF THE TWENTIETH CENTURY Nurses Rlsidlnce Bridgeport Hospital Bridgeport Conn t DWA£D f ,5TtV£N.5 ARXHITLCT Ejojto'n. flRST fLOOR PLAN FIG. 273. OF THE TWENTIETH CENTURY 177 178 THE AMERICAN HOSPITAL FIG. 276. BRIDGEPORT HOSPITAL. NURSES' RESIDENCE. VIEW FROM REAR. 1 ■ t-fak. 1 ^^.....'♦*♦ .- -G? ©e$<01 ©©«©© ■?■ FIG. 277. BRIDGEPORT HOSPITAL. NURSES' RESIDENCE. STUDY ROOM. OF THE TWENTIETH CENTURY 179 FIG. 278. BRIDGEPORT HOSPITAL. NURSES' RESIDENCE. OF NURSES. ROOM OF SUPERINTENDENT nurse, whether pupil or graduate, should have her own separate room. It need not be large, only enough for a single bed, closet, dresser, and study desk. These can be fitted into an area 8'-6" by 12'-0". The closet should be large and, if possible, lighted by a window. An adjustable electric drop light can be made to serve both for study and toilet light. This is the minimum amount of light, and of course can be increased to any extent. The living room should be homelike and refined. It should have fireplace, settle seats, and cozy corners. There should be a number of reception rooms where the nurses may meet their friends, and a sitting or study room on each floor. There should be a small tea kitchen with gas stove and other conveniences, where the nurses may prepare an occa- sional "spread" for the refreshments of an evening party. A large trunk room is necessary, with easily accessible racks for trunks. A petty laundry, equipped with set tubs and ironing boards, should be provided in the basement. Class rooms for demonstration and class work should be planned for in a well-lighted section of the building. These class rooms should be well equip- ped for demonstration in all kinds of hospital technique. In the smaller hospitals, a portion of the nurses' residence is sometimes set apart for the housing of servants. The same general conditions should exist for servants as for nurses, but some of the refinements need not be furnished, al- though a separate room for each indi- vidual should be provided. Of course, where the size of the institution warrants, there should be a separate home. The same conditions apply to internes' and orderlies' quarters. The internes, so THE AMERICAN HOSPITAL i-TG. 279. BRIDGEPORT HOSPITAL. NURSES' RESIDENCE. TVPICAL NURSE'S ROOM. rm-rm FIG. 280. ST. LUKE'S HOSPITAL, JACKSONVILLE. NURSES' RESIDENCE. FLOOR PLANS. OF THE TWENTIETH CENTURY 181 *4» ^.„^*'- -'. . v -'- "V - *& FIG. 281. ST. LUKE'S HOSPITAL, JACKSONVILLE, FLORIDA. NURSES' RESIDENCE. FIG. 282. ST. LUKE'S HOSPITAL, JACKSONVILLE. NURSES' RESIDENCE. VIEW JN SLEEPING PORCH. 182 THE AMERICAN HOSPITAL LECTURE RODM ntD c * : CD Q? 0 CO R R l DOR. RECEfTIOri HALL n c-........ D Ii l<- CLOS TTTJn' DCD rajah g-§purL«mt|iciwiTi 3ui;t.| □ D □ | eJatmI/x VERAriPA r- FIR5T FLOOR PLAI1 r • i—^=^«------if J\T THE. HUR3E3 HOME LLOHARD MORSE HCLWAL NATICK. KEflOALL CD WARD MAS5ACHU5eTT6. ?'"""" architect FIG. 283. who are college men accustomed to re- finement, should have comfortable quar- ters, sufficiently removed from the pa- tients not to disturb or be disturbed. There must be ample toilet facilities on each floor—one tub and one water- closet for each five or six nurses, one wash basin to every four. There should be both shower and tub baths. If pos- sible, bowls with hot and cold water should be placed in every room. There should be a slop sink and broom closet on each floor. Space should be set aside for nurses on night duty, preferably in the upper story, away from the noise. These rooms should be on a separate corridor. An infirmary for sick nurses, fitted as a hospital unit, should be provided in every large home. There should be a piazza and balconies wherever space and money will permit, preferably on the sunny side. If the roof be flat, arrangement should be made to use it for outdoor sleeping as well as for recreation. In the larger homes for nurses, it may be desirable to provide a separate kit- AI THE. nuR5L5 home. LraiARD Morse, tlosnTM. KATIOK. SECOND FLOOR FLAM "ITASSACm/SE/r TS. 'architects FIG. 284. OF THE TWENTIETH CENTURY 183 FIRST FLOOR PLAN S. - - -:---r T 7 sciVLt • or rcE.T. J. MANCHESTER, HAYNES HOMEFORNt'RSES. Augusts. City Hospital,. Adcusta.. Mt KENDM-L.TAYLORi5TEVEN5 . tDVURD f 5KVEN5 FIG. 285. chen and dining-room in the building. In small institutions it is more economi- cal to place the nurses' dining-room near the main hospital kitchen. Dr. Donald Mackintosh,* in writing on hospital construction, places the nurses' residence of Hospital for Sick Children (Figs. 270-272), as the best example of convenience, and the plans are reproduced here. It is certainly a model home, with its great reception hall, dining-rooms and kitchen, its swimming pool and gymna- sium, its sitting and study rooms, etc. ■""'Construction, Equipment and Management of a General Hospital." Published by Wm. Hodge & Co., Glasgow. The nurses' residence at the Bridge- port (Conn.) Hospital (Fig. 19), plan- ned on the L-shape with provision for future extension completing the U-form, is built on the adjoining lot to the hos- pital. Reception rooms adjoin the entrance, and the social and lecture rooms are connected. The suite of the superin- tendent of nurses is at the northwest corner, and consists of two small rooms and bath. There is a study room on each floor. A small infirmary of four rooms is provided for the care of the sick nurse. The roof garden is sufficient- ly large for all to sleep in the open. 5ECOND FLOOR PLAN 5CALL OI J.MANCHESTE1\ HAYNES HOME FOR NURSES. Augusta City Hospital. Augusta.. Me.. KEHO&LL.T.' fLOR & STtVEni : EDU4RD f STEVE N5: FIG. 286. 184 THE AMERICAN HOSPITAL T^iTa-ST TL0012 ~Pj_a/S ot*ax >/It" 1-d FIG. 287. PROPOSED HELP'S BITLDINC Edward F. Stevens, Architect. While all hospital buildings should be fireproof for the safety of the helpless patients, it is sometimes possible to give the maximum amount of convenience at a minimum cost by making this section of the institution non-fireproof. This was done in the nurses' residence of the St. Luke's Hospital (Fig. 280) at Jackson- ville. This was built at a very low cost, owing to its simple lines, being planned on a nine-foot unit system, so that all partitions and piping came in verticals, one above the other. All the necessary rooms were provided for the comfort and pleasure of the nurses, including a broad roof balcony for sleeping. The outer finish of this building is the same as the others of the group, which are fireproof. The plans for the nurses' residence of the Leonard Morse Hospital and of the Augusta (Ale.) City Hospital are here shown. One example of help's building on even more economical lines is that designed for Kings County Hospital (Figs 287- 289), New York City, Department of Charities. This is planned on an eight-foot unit basis and has all the necesary common rooms, toilets and staircases for a build- ing of this nature. Sixo/iti 5T Tftlkb TLoofe £uv« Scali. l/lx>%N FIG. 289. PROPOSED HELP'S BUILDING. Edward F. Stevens, Architect. OF THE TWENTIETH CENTURY 185 CHAPTER XIV. lUtcfjen anb Haunbrp The location and plan of the kitchen building, so-called, are most important factors in the success or failure of an institution. The kitchen, whether an isolated building or a department in a general building, should be so located that food—hot, palatable food—can be readily transported, with the least de- lay and the least amount of handling, from the place where it is cooked to the patient's tray or dining table. To do this, certain conditions must exist—■ (a) A central location, (b) Adequate means of transport- ing, (c) Serving kitchens of sufficient size and equipment to care for and distribute food properly. If occupying only a portion of the building, the kitchen should be on the ground floor or on the highest floor. Many of our best hospital superintend- ents contend that the kitchen should be on the upper level, while others agree that, owing to a greater facility for de- livery of supplies, the lower basement level is the more economical. With a refrigerating system and good elevator service, the upper level kitchen has cer- tain advantages, the chief being the free- dom from odors of cooking and the ex- clusion of tradesmen from the kitchen. On the other hand, the low level kitchen affords quicker delivery of supplies, quicker disposal of waste products, and, as the heavier demand is apt to be on the lower floors, quicker service to the greatest number of patients. The kitchen should not be too large or too small. If too large, time is wasted, owing to the distance traveled; if too small, it will be too crowded to secure the best results. In other words, the kitchen should be planned to meet the needs of the institution, not forgetting, however, its probable growth. The hospital kitchen should be plan- ned like a modern factory—that is, to re- ceive the raw material and to deliver the finished product (which is palatable food) with as few lost motions and de- lays as would be expected by a modern manufacturer in his factory. If there is any delay by the way, there is a loss in food value, and the patient has in con- sequence less of vital energy than with efficient service. The same thing applies not only to the patient but to the nurse, the attendant, the servant, and all along down the line. An underfed nurse or domestic cannot do her best, so that as a purely business proposition it pays to feed well everybody connected with the institution. In the kitchen, the building should be planned around the equipment. The ranges, which are perhaps the apparatus most constantly in use, should be placed in the most convenient place—generally in the center, where all sides are avail- able. For fuel, circumstances differ, and what is best in one part of the country may not be good in another. Gas, either natural or artificial, in the long run is not only the most economical but the most efficient. There is no dust, no dirt, no unsightly or unsanitary coal scuttle in the way. The modern blast burner ranges give the same quality of heat as the best coal range. Broilers or toasters are equally good in gas, and these should be placed on the same line and near the range. In the institutions in the west crude oil is used both for kitchens and for heating boilers. With electricity at a minimum cost much work can be done with that me- dium. Much of the cooking formerly done on the range can now be more efficient- ly done by steam. In the pressure steam cooker practically all vegetables can be prepared. This cooker should be of 186 THE AMERICAN HOSPITAL OF THE TWENTIETH CENTURY 187 sufficient size and of proper design to do the work easily. The steam stock kettles as made and used in Europe are much finer in work- manship and more attractive than those made in America. American manufac- turers have not sufficiently considered the hygienic construction of many of our hospital appurtenaces. For the cooking of cereals, the tilting kettles are the simplest in action, being easily manipulated and cleaned. All steam apparatus should be planned to withstand a pressure of at least sixty pounds per square inch. To that end, a reducing valve for the kitchen steam supply should be provided. The kitchen sinks should be planned for their special uses—deep sinks for pots and pans, and shallow sinks for smaller utensils. Vegetable sinks can be grouped together. A small sink in the cook's table often saves steps. The many labor-saving devices driven by the small motor, such as meat chop- pers, bread and cake mixers, ice-cream freezers and ice crushers, vegetable and fruit parers, make the work of preparing food vastly easier. Power dish-washers save much time and many dishes. Steam tables have become a necessity in keep- ing food palatable. All cabinets and racks should be open and easy to clean. Dish cabinets and dish warmers should be at a proper height from the floor to prevent extra muscular strain in removing the dishes. Every hospital of considerable size should have a room for the preparation of special diets. This room should be near but not a part of the kitchen. It must also be near the food lifts and the route of service. It is customary to use the diet kitchen for a teaching kitchen for the nurses in training; and where this is the case, cabinets, fitted for in- dividual service, are sometimes pro- vided. The serving kitchen has a place among the important rooms of a hos- pital, for in this room the trays for the food are prepared, and from it the food is distributed. If the serving kitchen is conveniently arranged, the food is more likely to be brought to the patient in the best condition. And what a difference even the looks of a tray makes to a deli- cate patient! How often one hears it said about a hospital, "The operating room technique is perfect; the nursing is all that can be desired ; but the food—and the service!" Good food, properly served, goes a long way toward offsetting deficiencies in other departments. The serving kitchen should be of suf- ficient size to do the work properly. In one of the earlier hospitals designed by the writer, the planning of which was directed largely by the building commit- tee, the desire on their part to make every inch available for patients made it neces- sary for the serving kitchen to be so re- duced in size that it has always been a great drawback to the best serving of meals. A little more space devoted to this room would have added greatly to the comfort of both nurse and patient. What are the essentials and what are the luxuries of a serving kitchen? The essentials are: ist, Proper Location—Remember that a ward serving kitchen is a very busy place three times a day. Many utensils must be handled, washed and put away; food trucks are going and coming; so that this room should be located remote- ly or in such a way that the sound from the room is cut off from the patients. This may be accomplished by having the serving kitchen entered from a side cor- ridor, as in the Melrose Hospital (Fig. 253) ; or through a vestibule, as at the Royal Victoria (Fig. 66) ; or by having it entirely apart, as at the Bridgeport Hospital (Fig. 45). 2nd, Room Enough to Lay Trays— There should be room enough, and the room should be so planned that no one will be crowded while preparing the meals. If the building is a multi-story building, special food lifts, large enough to carry a food car, should be provided, and space enough to bring the car into the room to discharge it. In moving the food from the kitchen it should be handled as little as possible. To that end, the food truck loaded in the kitchen should not be disturbed until it reaches the serving kitchen. This food 188 THE AMERICAN HOSPITAL truck can be taken on the serving ele- vator; or, better still, special food ele- vators may be provided, working auto- matically from the sending point on the kitchen level. These food trucks can be kept warm by electricity, hot water, or hot soapstone. The one shown in the illustration (Fig. 41) is heated by soapstone. 3rd, Keeping Food JVarm or Cold— The steam-table is almost indispensable for keeping food hot, and should be pro- vided with a gas plate and warming closet. Tray racks of sufficient capacity for holding all trays should be provided. These racks should be mounted on ball- bearing casters, so that if required the trays can be brought en masse to the ward door. The use of the portable hot table is growing in popularity. For some classes of patients this makes the most satisfactory method of serving. Refrigerators should be built or select- ed with care and, with due regard for hygiene, should be either porcelain or tile lined, and should have properly trapped drains. If there is a refrigerat- ing plant, by all means extend the pipes to these small serving-kitchen refriger- ators. 4th, Utensils and Their Cleaning— Among the luxuries of the serving kitchen might be counted special egg boilers, coffee percolators, individual services for private patients, special china and glass, hot plates and more at- tractive trays and linen. Where the dishes from patients with infectious diseases are cared for, the dish sterilizer is absolutely essential. The location and size of the sink is important. There should be an ample drainboard and the sink set high. The tendency of the plumber is to place the sink at his standard height, making everyone who uses it stoop, while plac- ing it a few inches higher would save many a backache. The material for the sink is largely a matter of fancy. Iron, porcelain and soapstone are used. A suitable receptacle should be pro- vided for the dishes and utensils after they are cleaned. The cabinet should be hygienic in its construction, easilv cleaned, with slanting top so that the dust may be seen and removed. It should contain drawers and cupboards enough to store the cutlery and silver needed in the section served by ward kitchen. In General—The room should be tiled to a height of four feet. If the ex- pense of this is prohibitive, place tiling at least back of all plumbing fixtures. The floors should be of a non-porous substance, like magnesite, terrazzo, or tile; if of tile, a gray or buff is much easier to care for than white. Dining Rooms. The dining-room for nurses (if in the same building with the kitchen) should be in a well-lighted por- tion of the building, and some attention should be paid to the decoration and ar- tificial illumination. A serving room, equipped with steam table and coffee urns, should be placed between kitchen and dining-room, if possible. FIG. 302. STATE HOSPITAL, KARLSRUHE. KITCHEN DETAIL. It has been found in many institutions that a dining-room or restaurant for friends of the patients is not only a source of satisfaction to the friends but also a profit to the hospital. The feeding of servants has been ac- complished in an economical wav in many institutions by establishing a 'self- serve system, where each person selects what suits him best, takes it to the table. and eats. This removes dissatisfaction on the part of the servants, facilitates the service, and reduces the number o± waiters. OF THE TWENTIETH CENTURY 189 FIG. 303. RUDOLPH-VIRCHOW HOSPITAL. VIEW IN KITCHEN. More attention is paid to the design and finish of the kitchens in many of the larger European hospitals than in this country. (Figs. 301, 302, 303.) Like the kitchen, the Laundry and Dis- infecting Plant should have an accessible location to which the soiled linen and articles of disinfecting can be easily brought and from which the fresh linen can be removed. The size and character of the building is, of course, governed by the requirements and size of the in- stitution. In planning the hospital laundry, the same care and thought should be used as in planning a factory; that is, to secure the greatest efficiency in the work, from the bringing in of the soiled linen to the delivery of the clean. From the sorting room to the linen room, an effort should be made to avoid lines of crossing and re-crossing; one process should fol- low the other until the work is completed. The washing or wet work should be kept separate from the ironing or dry work. If, as is quite, common now in hos- pitals, the soiled linen is bagged at the ward unit, then easy transportation should be provided for these bags, and a covered corridor above or below ground is quite desirable for this transporta- tion. In regard to the equipment of the laun- dry, much may be said, but whatever apparatus is used, the principle which has been set forth for the conservation of human energy should be brought into play in this department. For a single example take the sorting bins; if these be placed high enough so that it is not necessary to stoop every time a single article is handled and if these sorting bins are made with easy-rolling wheels, the transmission of the soiled linen will be secured with the least amount of fatigue on the part of the operators. The various items of machinery should be selected for the efficiency they will show. A washing machine capable of doing the work of three ordinary ma- chines and costing the price of two is an economy. The same is true with reference to the extractor, the mangle, the drying tumbler, etc. Electricity is rapidly taking the place of gas and steam in many of the laundry operations. The body ironer is being superseded by the steam press. 190 THE AMERICAN HOSPITAL FIG. 304. CINCINNATI GENERAL HOSPITAL. VIEW IN KITCHEN, SHOWING FOOD CARRIAGES. FIG. 305. KITCHEN BUILDING NEW GENERAL HOSPITAL, CINCINNATI, OHIO. Samuel Hannaford & Sons, Architects. N= <}> ^: .SUPERINTENDENT:] off icee.j »>k internes Dining Room C O R- R. I D z=r ]□ \ i I «J tflrrxTd >C|TC HEN 1 ECFtltlRAT n n ! i i i if1 \ u oB b_d u K.ITCH EN kitchen and dining Hall First Floor, plan Son ?--,--?-7i—If New General Hospital Cincinnati — Ohio Jami'EL HANNAF012D& ^ONJ ~ AR.CHITECTJ Cincinnati — Ohio FIG. 309. DliH \ / fEMALE JEE.VANTS \ , Male jERyANTj Pantry Dining Room Dining TJoom ju o H H H M H n M H VO 192 THE AMERICAN HOSPITAL FIG. 306. OHIO VALLEY GENERAL HOSPITAL. VIEW IN KITCHEN. FIG. 310. MAIN KITCHEN, ROSS PAVILION-ROYAL VICTORIA HOSPITAL. OF THE TWENTIETH CENTURY 193 FIG. 311. SERVING KITCHEN, ROSS PAVILION-ROYAL VKTORIA HOSPITAL. Toilet CC Locke, k Koom *H "E___l C^ LAUNDTLT £ ^ Kected cloVhing eece.ivin6 and [Delivering "Room1 Fir^t Floor. "pLArv. FIG. 314. ST. LUKE'S HOSPITAL, JACKSONVILLE-LAUNDRY BUILDING. 194 THE AMERICAN HOSPITAL care of in the soiled linen sorting room; then carried to the wash room where the wet-washing work is done; thence through the drying room, mangle and D ® TOIIET I ft. ON iKELF Q D&.Y H-OOfA l&ON :NG llOO/A 1A6U- MA.TTft.E.55 JTEtULIZElL II3TEWLIZ JlOOJA 1 Dft.YlkG J TuiA&Lfeft. PLAT VMOR.K I^ONEIL "IftSLE - Delivery = loot* AND OFFICE irEMLizihjc WaShe*. WA6HE.«_ (Ex)t^c(t^i WAJH JLOOM WAiHE^L WA6tt£k- JOILED - Linen Men Fil^t Flool Plan o________ 8_________* iCALE. ■ ■■■■■ ■=■=! JEtLVice Building &JUDGEPOW HOJPITAL-^IDGEJOUT CONN EfcWAil-b f. iTEVENi ■ Afc-CtHlTE-CT • fcOSTON MAS-S. FIG. 312. In a large hospital it is considered de- sirable to have the staff linen laundered in an entirely different department from the hospital linen. It is undoubtedly an economy to have the main linen room of the institution connected directly with the laundry, from which the freshly laundered articles as well as the new supplies can be given out. In this way, the linen, v. hether new or old, is under one supervision. A few illustrations will serve to show some of the points mentioned. In the laundry of the Bridgeport Hos- pital (Fig 312), the writer has attempted to work out the principles mentioned; that is, the soiled linen is the first taken linen room, into the main linen supply room. Provision for infected clothing, which is brought in through a separate entrance and introduced into the washing department of the laundry through a sterilizer or sterilizer washer, is here provided. In the small laundry of the St. Luke's Hospital at Jacksonville (Fig. 314), where care of both general patients and contagious cases is provided, the same provision is made for the infected linen— passing through a disinfector before reaching the laundry proper. Fig. 315 shows the interior of the laundry of Hospital for Sick Children, at Toronto. OF THE TWENTIETH CENTURY 195 FIG. 315. HOSPITAL FOR SICK CHILDREN, TORONTO LAUNDRY BUILDING. INTERIOR VIEW. 196 THE AMERICAN HOSPITAL CHAPTER XV. Seating, Ventilating anb plumbing The power plant, the center of the me- chanical end of the hospital, in many respects is not unlike the power plant for any institution or manufactory. An hospital plant, however, is unique in its demand for the production of steam in an economical way, the transmission of the steam into horsepower energy, either for generating electricity, furnish- ing high pressure steam for laundry, kitchen, or sterilizing room, inasmuch as steam—i. e. high pressure steam or its equivalent—is needed twenty-four hours a day and three hundred and sixty-five days in the year for sterilizing. There- fore there is little saving made, even in a small plant, by using low pressure heating and using gas or electricity for sterilizing. Using steam for sterilizing, cooking, The much discussed problem of how properly to heat and ventilate a hospital building has still many unsettled points, almost as many as the floor problem. It FIG. 320. DIRECT-INDIRECT RADIATOR, SHOW- ING REMOVABLE SHIELD. and laundry, it can be readily seen that the generating of electricity would show a marked economy, even in the small in- stitution, for in the heating months the exhaust steam from the engines would serve for heating the buildings, reducing the cost of current and heating to a minimum. It is not intended, however. in this book to discuss the power plant methods, but merely the portions of the plant affecting the health and comfort of the patient. Method °* heating general Ho/pital At Vienna FIG. 321. is still undecided whether it is best to conduct the air to the ground floor or basement, heat it there, send it through the building warmed, washed and humid- ified, and force it into the closed room under thermostatic control at a given temperature night and day, a system which necessitates for its perfect work- ing the closing of all doors and windows; or whether to heat the air by means of indirect radiators in the basement or pipe space and conduct it by its own ascentive force to the rooms or wards; or whether to use the simple system of putting the heating units in the room and intro- ducing outside air directly below or above the radiators; or whether by direct hot water, direct steam, or a combina- tion of various systems. One of the simplest methods and one adopted by the writer for securing fresh warmed air is a modification of the commercial direct-indirect radiator. OF THE TWENTIETH CENTURY 197 FIG. 322. HEATING CHART, SHOWING UNDE- SIRABLE CONDITION FOR SICK ROOM. (Fig. 320). A radiator (hospital type preferred) is set on brackets four inches above the floor ; air is introduced through the outside wall directly in line with the bottom of the radiator. A shield, hinged at the bottom to allow for cleaning and extending under the radiator joining the intake pipe, prevents direct cold air from entering the room; and a damper in the direct flue governs the amount of FIG. 323. DETAIL OF VENT FLUE AT FLOOR. air. At the new General Hospital at Vienna, out-door air is introduced di- rectly above the radiator, as shown in Fig. 321. Many medical men and hospital ex- perts agree that the patient in bed, ex- cept in special cases, should not have a high temperature in his room. They agree that Nature calls for changes in temperature—that the man in robust health demands them; that the patient who is building up his strength should not be denied them. A certain professor in a technical school used to say to his class that the ideal temperature is that of a.sunny June day in a New England pine forest. Such an ideal does not in- FIG. 324. DETAIL OF VENT FLUE ABOVE FLOOR. volve an even temperature of sixty-eight degrees for the entire day. Manufacturers of various apparatuses pride themselves on controlling the tem- perature of a room to a fraction of a degree, as shown by chart record (Fig. 322). This would not seem to be con- ducive to the best results, excepting under certain conditions. The breathed air in a ward or room should be in some way removed, and the means for ventilating so located as to insure a complete circulation of air. If the room is large, there should be vents at top and bottom, with dampers, so that the air can be drawn from either one or the other, by properly adjusting the damper. The vent ducts should start at the floor, and the floor material extended 198 THE AMERICAN HOSPITAL to the back of the flue (Fig. 323), or the bottom of the flue curved so that no dust shall remain in it. In no case should a register face be used to close the open- ing at the floor. However the air is introduced, the ex- haust should be placed so as to vent all parts of the room. If the air is intro- duced at or near the wind'oV, the ex- Cooe, FIG. 325. DETAIL OF VENT THROUGH CLOSET. haust should be near the door. The de- sirability of ventilating the clothes cup- boards as well as the room led the writer to adopt the method of placing the room vent in the ceiling of the cupboard, cut- ting the door thereto so as to leave an open space below, setting the cupboard shelf away from the wall, and in this way allowing a free circulation of air, ventilating the room and cupboard. (Fig-. 325.) K The natural "tepee" form of ventila- tion is used in a number of Massachu- setts institutions—that is, providing for heat units on the outer walls, either ra- diators or coils; making the side walls low, about seven feet, and sloping the ceiling at least thirty degrees to a moni- tor vent. The result is ideal heating and ventilation, but the difficulty of using this method in large units is the neces- sary waste space involved in the sloping ceiling and the monitor, although this has been carried out in the Children's Hospital in Boston, in the State Hos- pital School for Crippled Children at Canton, Mass. (Fig. 326), and in the children's ward of the Worcester City Hospital (Fig. 146). The use of hot water for general heat- ing and steam for special ventilating units gives satisfactory results. The hot water may be in coils of large pipes, eas- ily cleaned, or radiators of hospital type set away from the wall; but the common ornamental radiataor, set close to the wall, should never be used in the sick room, since every surface should be available to the brush or vacuum clean- ing pipe. The heating of the operating room at St. Georg's in Hamburg is one of the more elaborate systems. In the section shown (Fig. 72), it will be observed that the outer sash is double and the air conducted entirely around this hollow space, warming in winter and cooling in summer the floor, the walls, and the ceil- ings. In winter, additional heat is se- cured from direct radiators behind thin nickel plates shown in the walls, but al- lowing no air from this source to enter the room. The air for the operating rooms is brought first into a clean cham- ber where it is passed through ground coke, thence over heated coils in winter and over ice in summer, into the fan, where it is driven through a filter of fine sand and gravel, and taken thence to the operating rooms, practically free from all bacteria. The ceiling vents in the operating rooms are closed and there is sufficient pressure outward so that the opening of a door does not admit any foul air. A simpler method for the heating and supplying of fresh air for the operating room is by the use of a screen or false wall inside the operating window. The heating unit is placed between the screen and the outer window, introducing out- door air at the top (not the bottom) of OF THE TWENTIETH CENTURY 199 the radiator. The air from the room drawn under the screen mingles with the outdoor air, is heated, and passes out over the top of the screen, warming the room by this inflow and by direct radiation from the glass screen. Ad- ditional radiating surface may be placed above the ceiling lights. To prevent the entrance of any dust from outside, gauze removable screens may be placed in the openings at the top of the screen. A sec- tion through the operating rooms of the Ross Pavilion of the Royal Victoria Hospital (Fig. 327) will serve to show this method, and a reference to the illus- tration of operating rooms at the Bridge- port Hospital (Fig. 82) will show the effect from the room. FIG. 326. HOSPITAL SCHOOL AT CANTON, MASS. SHOWING ROOF VENTILATION. 200 THE AMERICAN HOSPITAL 4>LAW or OK.um