WORLD’S COLUMBIAN EXPOSITION, Chicago, Ills., iSgz-’gj. WAR DEPARTMENT EXHIBIT, MEDICAL DEPARTMENT UNITED STATES ARMY. No. 1. DKSCRIF’T'ION OF THE MODELS OF HOSPITALS. DIRECTION OF THE SURGEON-GENERAL, U. S. A. LOUIS A. LA GARDE, ASSISTANT SURGEON, U. S. A., IN CHARGE OF THE REPRESENTATION OF THE MEDICAL DEPARTMENT, U. S. A. CHICAGO, ILLS. i892-’93. WORLD’S COLUMBIAN EXPOSITION, Chicago, Ills., iSqz-’yj. WAR DEPARTMENT EXHIBIT. MEDICAL DEPARTMENT UNITED STATES ARMY. No. 1. DESCRIPTION OF THE MODELS OF HOSPITALS DIRECTION OF THE SURGEON-GENERAL, U. S. A. LOUIS A. LA GARDE, JN CHARGE OF THE REPRESENTATION OF THE MEDICAL DESARTMENT, U. S. A. ASSISTANT SURGEON, U. S. A., CHICAGO, ILLS. 1892-93. WORLD’S COLUMBIAN EXPOSITION, Chicago, Illinois, i892-’93. MEDICAL DEPARTMENT. UNITED STATES ARMY. Descriptions of Models of Hospitals. I.—Model of Bbick Regulation U. S. A. Hospital, foe 24 Beds. This model, which was constructed by Mr. Charles Seltman, of Wash- ington, D. C., is, including the base, 4 feet 7 inches long by 3 feet 2 inches wide, and was made on a scale of half an inch to the foot. It shows a quarter section of the building made in accordance with plans and specifications contained in appendix to Circular 10, War Depart- ment, S. G. 0., October 20, 1888. The hospital consists of a central administration building arranged with two wards as wings, and a separate building in the rear contain- ing kitchen, dining-room, isolation ward, and attendants’ quarters. Each ward will be 42 feet 1 inch long by 24 feet 4 inches wide inside, and 14 feet high in the clear from floor to ceiling. For very cold climates the height may be reduced to 12 feet. In all cases the ground floor must be raised at least 18 inches from the ground; and in warm climates and malarious regions it should be at least 3 feet above the ground. The administration building will be 42 feet 10 inches by 42 feet 6 inches, with cellar, two stories, and an attic. The first floor is divided into four rooms by two halls, one 7 feet 6 inches, the other 6 feet wide, running from front to rear and from ward to ward. The two front rooms are used, one for an office, the other for a dispensary; the rear rooms, one for waiting-room, the other for bath-room and water-closets. The second floor has a store-room and four attendants’ rooms. The rear building is 47 feet 6 inches by 21 feet, and consists of cellar and first and second floors. On the first floor is the dining-room, pan- try and kitchen; on the second floor, the isolation ward, bath-room, and attendant’s room. The administration and rear buildings are connected by a covered passage-way 6 feet wide, and the entire administration 4 building and its two wings are surrounded by a veranda 10 feet wide, except along the rear of the administration building, where the veranda is only 6 feet wide. All exterior walls of cellars and foundations of wards and adminis- tration buildings to be 21 inches thick. All exterior walls of wards to be hollow; 9-inch exterior shell, 2-inch air space, 4-inch inner shell and 1-inch plastering, making a total thickness of 16 inches; the air space to be made as nearly air-tight as possible. The steam-heating apparatus, located in the cellar of the rear build- ing, from which the heat is distributed through the rear building and under the floor of the covered passage-way to the main building, is one horizontal tubular steam boiler, 9 feet long, 36 inches in diameter, con- taining 30 tubes 2% inches in diameter and 9 feet long. The method of heating, as shown on the model, is by indirect radia- tion for the wards, and direct radiation for other rooms. The radiators are constructed of one-inch wrought-iron pipe. The indirect radiators are enclosed in galvanized-iron chambers. Each chamber is fitted with cast-iron doors, one above and one below the radiators. From these ra- diators flues of galvanized iron open into the wards, the heating cham- ber being supplied through galvanized-iron ducts, which are fitted with damper and rod for controlling the supply of cold air. The movement of air is effected by aspiration chimneys for the wards and by open fire- places and chimney flues for other rooms. The model shows the position of main flow and return pipes. These vary in size according to the size of the wards. All the exposed main and return pipes in the basement are covered with |-inch asbestos- lined hair felting with two thicknesses of heavy manila paper and 10- ounce canvas. An automatic self-acting air valve is placed on each in- direct radiator and at the foot of each return riser. All condensation from the heating apparatus is returned to the boiler by gravitation without the use of steam traps. 2.—Model of the Regulation U. S. A. Post Hospital of 24 Beds This model was constructed by Mr. Charles Seltman, of Washington, D. C., on a scale of half an inch to the foot. It is, including the base, 7 feet 2 inches long by 4 feet 5 inches wide, and has been built in exact accordance with the plans and specifications contained in Circular No. 10, War Department, Surgeon-General’s Office, October 20, 1877 (rendered authoritative by General Orders No. 98, Headquarters of the Army, Adjutant-General’s Office, Washington, October 20, 1877), from which the following description has been taken ; Front Elevation. DRAWING OF THE MODEL OP THE REGULATION U. S. A. POST HOSPITAL OP 24 BEDS. PLATE A. YeTwnzicv 10'xiride. YeTanzLcv B'xvule. YevaruLcv 8 'xirixle. VeTorvcUv 10' xaicLe. APPROVED PLAN FOR A REGULATION POST HOSPITAL OF 24 BEDS OR 12 BEDS. FIRST-STORY PLAN. PLATE B. APPROVED PLAN FOR A REGULATION POST HOSPITAL OF 24 BEDS OR 12 BEDS. SECOND-STORY PLAN. PLATE C. 8 1.—Approved Plan for a Regulation Post Hospital for 24 Beds. “ This hospital consists of a central administration building and two wards arranged as wings. “The wing for each ward will be 45 feet 8 inches long by 25 feet 4 inches wide and 15 feet high in the clear from floor to ceiling. For very cold climates the height may be reduced to 12 feet, in which case the length will be increased to 50 feet. “Attached to each ward, and at the outer end and behind, will be a room for earth closets, as shown in the plans. “ The administration building will be 36 feet 4 inches front by 40 feet 4 inches deep, and two stories high, with a back building 43 feet 8 inches by 15 feet 4 inches. Each story of this building will be 13 feet high from floor to ceiling. “A veranda 10 feet wide will surround the hospital, as shown in plans. “In hot climates the wards will be detached from main building, re- maining connected with it by the veranda only, which will thus entirely surround the ward. (The ward on the left hand side of model has been so detached. See drawing, Plate A.) The back building will be sep- arated in like manner. “ The plan of the first floor, the designations and dimensions of rooms, and the positions of doors, chimneys, windows, and beds are shown on Plate B, the plan and dimensions of the second floor on Plate C. (For front elevation of building see Plate A.) All of the exterior walls will be rough boarded, with inch boarding, well nailed, on which will be laid a covering of tar paper or felt. A cistern out of dressed stuff, dovetailed and strongly put together with lead, will be put over ceiling, when directed, 5 by 5 by 2 feet deep, supplied by a pump in sunk cis- tern through a pipe. The roofs of verandas will be trimmed with best roofing tin. A2oby 8 inch galvanized-iron ventilating pips, for ventilation of ward, running between joists, open under floor of veranda, having 2 regulating registers at ends of pipe. On the centre of this pipe, on the upper surface, should be an opening 20 inches square corresponding with a similar opening in the floor of the ward, over which a jacketed stove may be placed. “In all cases the ground floor must be raised at least 18 inches from the ground. On the Gulf coast and in Arizona the wards will not be ceiled and will have ridge ventilation their whole length. (The left- hand ward in the model has been thus constructed.) “ At all posts where continuous artificial heat is required for three months in the year, the walls will be ceiled and have boxed openings 9 carried from the centre of the ceiling to the ridge for summer ventila- tion. There will be two of these openings, each 10 feet long by 2|- feet wide, and 10 feet apart, each fitted below with lattice work and above with movable shutters. (The right-hand ward in the model has been so constructed.) A ventilating shaft 6 inches square will be placed in each earth-closet room, and the lamp or gas burner of this room should be directly beneath this shaft.” 3.—Model of the Lincoln Hospital, Washington, D. C This is a block model, on the scale of 30 feet to the inch, and repre- sents the arrangements of the wards and other buildings of this hospi- tal, of which the following description was furnished by Surgeon J. C. McKee, IT. S. A., who was for a long time in charge: Lincoln Hospital, Washington, D. C., is located about a mile east of the Capitol building. Its site is a gently-undulating, uncultivated plain, without shade-trees. East and south of the hospital, the plain declines toward the Eastern Branch of the Potomac, which is about half a mile distant. The soil is a light, sandy loam, rest- ing on a deep stratum of gravel. The hospital covers an area of thirty acres of ground, and consists of twenty detached pavilion wards, arranged “en echelon” in the shape of the letter V, the apex of which looks westwardly. The administra- tion building is at the apex of the Y. The buildings for kitchen, dining-rooms, etc., are in the space between the two sides of the letter. The whole is surrounded by a picket-fence, five feet high, between which and the wards is a wide road for ambulances. (See Figure 1.) The Wards are pavilion barracks, built of rough boards, white-washed, with roofs of boards covered with tarred paper; they are 20 in number, 10 on each wing. Each ward is 187 feet by 24, 16 feet to the eaves and 20 to the ridge, at which there is the usual ridge-ventilation the whole length of the ward. They are plastered on the inside for about 8 feet above the floor. At the west end of each are 4 rooms, occupying 15 feet in length. These are used for clothing, baths, nurses, and sinks. Each ward contains 34 windows and 4 doors, one at each end and two in the middle, opposite each other. Four ventilating gratings, at regular distances in the floor of the ward, communicate by wooden flues under the floor with the air outside, thus giving a full supply of fresh air whenever the weather requires the doors and win- dows to be closed. With 62 patients, there are 72 square feet of floor and 1447 cubic feet of air-space for each. Thirty-one beds are arranged on each side, with a chair and bed-side table between each pair. An avenue of 11 feet is left between the two rows of beds. The wards are lighted at night by kerosene lamps, and heated by stoves in winter. On the inner side of the two wings of the hospital, and running the whole length of each, is a raised covered walk or corridor, on which is laid a railway track 2 feet wide and 2156 feet long. Box-cars convey the food from the main and extra kitchens to each ward. The Administration building, at the apex of the triangle, is 184 by 38 feet, 22 feet to the ridge and 16 to the eaves. A hall, 8 feet wide, runs the entire length of the first floor. On the left side of the hall are the following rooms: office of surgeon in charge, 14 by 14; office of military assistant, 11 by 14 (employs two clerks) ; principal office, 56 by 14 (employs fourteen clerks); printing office, 19 by 14 (em- ploys two men); quartermaster’s store-room for clothing, etc., 44 by 14 (employs two clerks) ; wardmaster’s room, 13)- by 14 ; bath-room, 4f by 14 ; post-office, 7by 14 (employs a postmaster and assistant). On the other side of the hall, and on the right of the entrance door, are the office of the officer of the day, 15 by 14 ; office of the officer of the guard, 11 by 14 (four clerks) ; office of surgical records, 11 by 14 (one clerk); private office of surgeon in charge, 12J by 14; office of medical in- spector, 11 by 14 ; linen-room, 66 by 14; all washed clothing and bed-linen is sent 10 from the laundry to this room, and thence distributed to the different wardmasters; one clerk and four women are employed here, the latter in mending, etc. The medical store-room, 11 by 14, adjoins the dispensary, and is used for storing sup- plies. The dispensary, 25 by 14, usually employs four men ; the medicines for the whole hospital are compounded here, under the charge of a hospital steward. Lastly, the laboratory, which adjoins the dispensary, is 22 by 14 feet, used for pre- paring tinctures, ointments, plasters, etc. On the second floor of the administration building is the knapsack-room, 111 by 37 feet. The effects, accoutrements, etc., of the patients coming into the hospital are deposited in this room for safe keeping. It employs two men, who receive the articles deposited, issue tickets for the same, credit them to depositors, and deliver them when the patients leave. There are 2184 boxes, arranged in parallel rows, reaching from the floor to the ceiling. Adjoining the knapsack-room is the extra- duty men’s room, 50 by 37 feet, used as a sleeping-room by the men employed on extra duty, and a clerk’s room, 25 by 23 feet, used by the clerks of the principal office for the same purpose. Within the triangle formed by the two wings, and east of the administration building, is the Tank, resting upon a platform 25 feet high, and holding 12,000 gallons of water. It is supplied from a well under the engine-room, and the water forced into it by the engine, which drives the machinery of the laundry. This tank supplies each ward with water by means of pipes. There are four other wells in the enclosure, used for drinking, and culinary purposes. Twenty yards east of the tank is the Laundry, 61 by 24 feet. The building runs east and west, is two stories high, and has a platform for drying clothes on the roof. Seven men and twelve women are employed in its various departments. The wash- ing is done by steam-power, as is also the drying and ironing. The average wash is 5000 pieces daily—has been pushed to 7000. On the first floor of the laundry is the washing apparatus, consisting of a mangle, steam-boiler, revolving drum for wringing, rinsing-boxes, roller and ironing table; on the second floor is the steam drying-room, 36 by 12h feet. This is in addition to the drying arrangements on the roof. Separated by a partition from the laundry, on the first floor, is a sleeping- room for women, 22 by 24 feet; a kitchen for the same, by 17; a dining-room, 9J by 18. The engine is in a building adjoining the laundry on the east; it is of six-horse power, and employs one engineer and an assistant. It supplies power for the tank as well as for the laundry. The well which supplies the tank is 40 feet deep, with usually 4 feet of water; its diameter is 6 feet. The steam pump can raise 2000 gallons of water per hour. The building for Sisters' Quarters is 23 by 51 feet, with a wing 16 by 28, forming a letter “ L.” It is divided into chapel, sitting-room, kitchen, etc. Twenty-eight Sisters of Charity were on dirty, and I must bear evidence to their efficiency and superiority as nurses. The extra-diet kitchen is under the care of a sister, and one is detailed by the superior for each ward. They administer medicine, diet, and stimulants, are under the orders of the ward surgeon, and are responsible to him alone. They have been beloved and respected by the men. The Stewards' Quarters are 18 feet north of the engine-room, are two stories high —contain dining-room, kitchen, sleeping-rooms, etc. Five stewards generally oc- cupied this building. The Operating-room is 25 feet east of the engine-room. It is 17 feet square, and lighted by a skylight on the north side of the roof. A revolving table is in the centre of the room; also a cupboard for instruments, sponges, microscope, etc., with a sink in the northwest corner. The Examining-room adjoining it is 17 feet 7 inches square, and communicates by a door with the operating-room. The Extra-diet Kitchen is under the same roof with the general kitchen. It is 18 by 24 feet—has in it a Harrison’s European range, 8 feet front, 3 feet 6 inches deep. A room 18 by 12 feet adjoins on the south. This kitchen is under the supervision of a sister, who is generally assisted by from four to six men. The Main Kitchen is 77 by 24 feet. It contains a cooking-range, 28 feet 10 inches long and 3 feet 2 inches wide; also three of “Peters’ and Johnson’s bake- ovens or roasters,” two boilers for tea and coffee, each with a capacity of 120 gallons, five boilers or cauldrons for soup or hash (60 gallons each), and two for heating water, (one 60 gallons, the other 22 gallons). Full diet is prepared here for all the men in the hospital. ®"ig. I.—Ground Plan of Lincoln General Hospital, Washington, D. C. Scale, 200 feet to the inch. 1, Admin- istration building. 222 2, Wards. 33, Dining-rooms. 4, Kitchen. 5, Laundry. 6, Stewart’s quarters. 7, Sis- ters’ quarters. 8, Engine-house. 9, Meat-house. 10, Coal-house. 11, Commissary building. 12, Sutler. 13, Chapel. 14, Stable. 15, Freedmen’s quarters. 16, Guard-house. 17, Dead-house. 18, Barracks for guard. 19, 20, Officers’ quarters. 21, Covered way. 22, Tank. 12 On either side of the kitchen, opening from it north and south, are the Dining- rooms, each 146 by 24 feet, with three tables running the whole length of each, capable of seating in all 860 men. At the distal end of each room a door opens on a corridor and raised walk, so that the patients are protected from the weather in coming to their meals. Cars, with cans fitted in them, are run around the corridors to the several wards with the food for those unable to come to the dining-room. On the northwest corner of the kitchen is a room 30 feet long, 14 feet wide, and 10 feet high, used for washing dishes, roasting coffee, etc. From 40 to £0 men are usually employed in the various departments of the kitchen. Opposite the centre of the northern dining-room and distant to the west 30 feet, is the Fire-Engine and Hose-House, 26 by 20 feet—contains one fire-engine, three hose-carriages, carrying 1850 feet of hose, 34 ladders, 22 hooks, 278 axes, and 300 buckets. Thirteen feet south of the kitchen is the Meat-shop, 14£ by 23. In its centre is an ice-box, by 144, and 4 feet deep, lined with zinc. The allowance of ice per day is one pound for each man. East of the kitchen, and connected by a covered way, is the Commissary Building, which is two stories high ; the upper story is used to lodge attendants; the lower story, used for commissary store-room, is 82 by 234, and is under a commissary steward. In the northeastern corner is the liquor-room, 8| by 13, heavily planked and secured against marauders. All liquor is issued here on the orders of the ward surgeons. The vegetable room is in the northwestern corner, and is 9by 134. An office, 9by 15%, adjoins the liquor-room. The books and accounts are kept in this office. The store-room is provided with a counter 524 feet long, and gives employ- ment to one steward, one clerk, and two men. At the southern end is the bread- room, 141 by 23, which employs two men cutting bread for the tables. Adjoining, on the east, is the bakery, 14 by 23£. The oven is 10 by 16 feet. The Chapel is situated 63 feet east of the commissary bxiilding. It is a structure shaped like the letter “ T,” one story in height, with a cupola on top. The main building is 24 by 78 feet. The northern end is used during the week as a reading- room. The left wing, 18 by 26 feet, is used as a library ; it contains 3,000 volumes, contributed to the hospital from various sources. The right wing is the same size, and is used as a school for the freedmen employed in the hospital, who are in- structed by two female teachers. Twenty-four feet south of the chapel is the Sutler's Store, 24by 68. The Stables, 25 by 101, are 72 feet east of the suttler’s shop ; they contain 18 horses, 3 wagons, 3 ambulances, 3 carts, and 1 night-cart. Thirteen men are employed as hostlers, drivers, etc. One hundred and twenty-one feet northeast of the stables is the Guard- House, 15 by 47 and one story high. South of this are the Oil-Room and Freedmen's Quarters, 29 by 69 feet. The oil and lamp room is in the northern part. Kerosene oil was used in lighting the whole hospital, and all the lamps were filled and trimmed in this room. A corporal and two men were employed. Ninety-one feet southeast of the oil-room is the Dead-House, 15 by 40 feet. It is divided into two rooms—the northern one used in making post-mortem examinations, and the south- ern for plaster-casts, etc. Thirty-two feet south of this room is the Photographic Gallery, 16 by 24 feet. An operator is employed at SIOO per month, paid from the slush fund. Surgical cases, pathological specimens, etc., are taken; also likenesses of all men discharged on surgeon’s certificate of disability, as a guard against fraud. On the base line of the triangle are the Medical Officers' Quarters, 63 by 24 and two stories in height; also, in the same line, the quarters for the Veteran Reserve Corps, a building two stories high, with an outside entrance-stairway to the second floor. Ninety feet further back, 100 hospital tents are pitched, placed four end to end, on substantial frames, with floors raised from the ground and a door at each end of the frame. The sides of these tents were always easily raised, and gave the best of ventilation; hence I selected some of them as gangrene-wards, and, I think, with the very best results. In winter, each ward was heated by two stoves, with pipes running to a shaft in the centre. Each ward of four tents contained 20 beds. The length of the fence around the hospital is 1458 yards. The distance of the fence from the tents at the base of the triangle is 124 feet. Sinks were arranged around the whole line of fence. They had movable boxes, which were regularly emptied and limed. Policing was done by a gang of about 20 freedmen. The hospital could accommodate 1240 patients in the 20 barrack wards. Its total capacity in January, 13 1865, was 2575 beds, including those in tents and the branch barracks, a short dis- tance otf. This hospital was opened December 23, 1862, and closed August 22, 1865. Dur- ing this period the movements of patients were as follows : M.O 1 w t1 p. c o - 1 H3 o CJ S ffi § &3" & “ P W • Ox h-i CO M CO Sick CO CC I—‘ CO -3 s CO CO CO Wounded. H b oi 1 fcO CO 50 1 tO —3 Sick. Admitted. o I o c 1 q 1 -3 —3 Wounded. to 1 to H-* H-* 00 CC —3 I ZC CO CO 1 CO Total. j£ 1 I £ Returned froin furlough and de- | 1 ; 25 sertion. 26291 39 j26330 Aggregate. o I o o 1 o 00 1 bO Ci Returned to duty. w H 03 d t* Ha CO M I M § S Mustered out. O 1 f—1 cO 1 gc Sent to other general 1 gj i hospitals. £*■ I ; g j ■ g Furloughed. :j: I ; rXl ! Transferred to Vet- g j : fi ■ eran Reserve Corps. § 1 h« ! Discharged. S 1 I s co ; co Oi l • Cn Deserted. o? 1 Died of Disease. H-* 1 CO GO 2 j j Died of wounds. Deducting those sent to other general hospitals as cases not terminated, and con- sidering that the furloughed and deserted amounted to 6194, while only 4457 of these are reported as having returned, we shall have the following statistics for the terminated cases of white troops treated : Total to be accounted for, excluding those sent to other hospitals. 16,956; of whom 10,106 were returned to duty, 1989 mustered out of service at the close of the war, 1737 lost by failure to return from furlough and desertion, 1937 discharged for disability, 865 transferred to the Veteran Deserve Corps, and 322 died. s.—Hospital Tents. The field hospital of the moving army consists of one hospital tent for a dispensary tent; one hospital tent for a squad tent; one hospital tent for a mess tent; two hospital tents for the reception of the sick ; one common tent for a cook tent; one common tent for the medical officer ; one common tent for water-closet. The new field outfit for the Medical Department is displayed in the ward, mess, dispensary, and cook tents, for a detailed list of which see the standard supply table. i IG. 2. Ground Plan of Mower Hospital, Philadelphia, Pa. Scale, 195 feet to the Inch. 1111, Wards. 2, Reception-room, laundry, &c. In the building between this and 12 is the kitchen, &c. 3, Knapsack-room, band quarters &c 4, Store-rooms, &c. 5, Operating-room 6, Butcher’s shop 7, Guard-house. 8, Boilers, coal, &c. 9, Sutler. 10, Carpenter’s shop. 11, Chapel. 12. Administration building. 13, Ice-house. 14,15, Railroad depots. 10,17, Corridors. 18,18, L-sliaped buildings used as barracks, store-rooms, &c.