THE AMERICAN HOSPITAL OF THE TWENTIETH CENTURY isSSSJ^ffS^vssSJs^M EDWARD F. STEVENS, ArcMtet Columbia ^nibersfitp intf)eCitj»ofi^eiD|9crfe ituoUege of S^tv^imm anb ^urgeonjf S^tUvmtt %ihvavp Digitized by the Internet Archive in 2010 with funding from Open Knowledge Commons http://www.archive.org/details/americanhospitaOOstev THE AMERICAN HOSPITAL OF THE TWENTIETH CENTURY A treatise on the development of medical institutions, both in Europe and in America, since the beginning of the present century. By EDWARD F. STEVENS, Architect Member of American Institute of Architects Member of Province of Quebec Association of Architects Member of American Hospital Association ILLUSTRATED NEW YORK Architectural Record Publishing Comipany 1918 ;.}> To Warren LeVerne Babcock, M. D., Su- perintendent of Grace Hospital, Detroit, Michigan, whose advice and encourage- ment decided the writer of this book to devote his entire practice to medical institutions, this book is respectfully dedi- cated. \i Irl 3*0 6 THE AMERICAN HOSPITAL OF THE TWENTIETH CENTURY FOREfFORD In visiting the liospitals of Europe, one finds on every hand splendid examples of hospital architecture. The administrators of these institutions take pride not only in laying before the foreign visitor for inspection the institution itself, but in providing him with carefully prepared plans and descriptions of the institution and its equipment. Everywhere one can obtain profusely illustrated books on the modern hospitals of the locality, books written and published by hospital admin- istrators, architects, and engineers. These books are most helpful to the native as well as to the foreigner. While visiting these foreign institutions, the writer has been asked repeatedly for the names of recent books on American hospitals. Such books are, alas, very few in number, and there are none commensurate with the rapid growth and development of the modern American hospital. It is in response to this demand that the writer has endeavored to collect plans and information concerning a few of the many good institutions recently finished or under construction, with the hope that interest in the publication of such works will grow and that this book will be only a forerunner of much more comprehensive treatises. It is not the writer's intention to criticise the plans of the institutions here shown, but to present them as various solutions of the great problems of housing and caring for the sick and to point out a few of the findings of his own experience in the planning of more than fourscore hospitals and institutions. The field is so broad that it is impossible more than to touch upon the various points. If frequent mention is made of hospitals in Europe, it is for the purpose of comparison, with the hope that the study and comparison may interest the reader, as it did the writer in collecting the data. The chapters on the Ward Unit, the Surgical Unit, the Medical Unit, and the Equipment are taken largely from papers by the writer which were read before the American Medical Association and the American Hospital Association. The chapters on Heating, Ventilation, Plumbing, and Landscape Work have been reviewed and suggestions given by prominent specialists in each line, for which advice the writer is much indebted. Edward F. Stevens. Boston, February, 1918. OD|»yn;fht M8 THE AiMERICAN HOSPITAL OF THE TWENTIETH CENTURY Chapter C ONTENTS I. In General Page 1 II. Administration Department 11 III. The Ward Unit 16 IV. The Surgical Unit . ". 57 V. The Medical Unit 67 VI. The Maternity Department 78 VII. The Children's Hospital 95 VIII. The Contagious Department 108 IX. The Psychopathic Department 119 X. The Tuberculosis Department 130 XI. ( Social Service Special Departments • Out-patient f Pathological & Roentgen-R ay ) XII. The Small Hospital ..... 155 XIII. The Xurses' Residence 175 XIV. The Kitchen and Laundry 185 XV. Heating, \"entilation. Plumbing 196 XVI. Details of Construction and Finish 208 XVII. Equipment . .... 217 XVIII. XIX. Landscape Architecture as Appli( War Hospitals .... ;d to Hos pitals 228 239 (general 3nbex Page Administration Department 11 American Hospitals 6 Artificial Lighting 58, 212 Barmbeck (Hamburg) Hospital 4 Barre (Vermont) Citj- Hospital 160 Baths, Limited Use of 18 Bed Space, Proportion to Utilities 18 Bispebjerg Hospital 5, 21 Boston Consumptives' Hospital 134 Bridgeport Hospital 66, 84, 101 Brigham Hospital, Peter Bent 6, 11, 22 Buildings, Character of 2 Cable Memorial Hospital. Benjamin Stickney 162 Chicago Lying-in Hospital 86 Children's Hospitals 95 Cincinnati General Hospital 26,65 Classification of Patients 17 Clothes Closets 208 Clothing, Care of 219 Comfort of Patients 17 Contagious Department 108 Creche or Nursery 80 Day Rooms 17 Deaconess Hospital, Concord, Mass.... 159 Delivery Rooms 80 Details of Construction 208 Disinfecting Room 223 Disturbing Noises 18 Drinking Fountains 207 East New York Dispensary 152 Equipment 217 Essentials in Ward Buildings 17 European Examples 4 European Influence 2 Floors, Quiet 211 Floor Alaterial 211 Ford Hospital, Henry 27 Forsyth Dental Clinic 96 Galloway Alemorial Hospital 32 German Hospital, Chicago 32 Grace Hospital, Detroit .....57, 62 Greenville (Me.) Hospital 162 Growth of Hospitals 1 Hamot Hospital 35 Hardware 209 Harper Hospital 27 Heating of Operating Rooms 198 Heating and Ventilating 196 Hospital Entrance 41 Illinois Central Hospital 36 Kingston Avenue Hospital 110 Kitchen and Laundry 185 Kitchen, Requirements of 185 Kitchen Utensils 188 Laboratories 139 Landscape Architecture 228 Lane Home, Harriet 97 Laundry and Disinfecting Plant 189 Lighting. Artificial 58, 212 Macon Hospital 33 Page Mansfield General Hospital 34 Mason Hospital 172 Massachusetts General Hospital 11 Massachusetts Homeopathic Hospital, Contagious Department 118 Massachusetts Psychiatric Hospital.... 126 Maternity Department 78 Mattresses 218 Mayo Clinic 145 Meadville City Hospital 82 Medical Baths 67 Medical Unit 67 Medicine Closets 208 Melrose Hospital 100, 162 Militarj- Hospital at D'lssy-les-Mouli- neaux 240 Munich Psj^chiatric Clinic 119 Munich-Schwabing Hospital 5, 21 Newton Hospital 81 Newton Hospital Grounds 229 New York City Hospital 65 Noises, Minimizing of 18 Nurses' Residence 175 Nurses' Signal 214 Nurses' Stations 215 Nurses' Work Room 60 Nursery 80 Ohio Valley General Hospital 11, 33, 65 Operating Room Walls 214 Operating Unit 57 Out-Patient Department 139 Pasteur Hospital 108 Pathological Department 139 Phipps Psychiatric Clinic 129 Plumbing 196 Pneumatic Chamber 77 Providence Citj^ Hospital 110 Psj'chopathic Department 119 Quiet Rooms 17 Quincy Hospital 62 Rhode Island General Hospital 65 Rigs Hospital 21 Roentgen-Ray Department 142 Royal Victoria Hospital, Ross Pavilion. . 36 Ruptured and Crippled, Hospital for.... 101 St. Georg Hospital 62 St. Luke's Hospital, Jacksonville. . .9, 27, 110 St. Luke's Hospital, New Bedford 84 St. Thomas Hospital 96 San Francisco Hospital 35 Scrub-up Sink 60 Sea View Hospital 132 Serving Kitchens 18, 187 Sick Children, Hospital for 96, 100. 115 Sick Children, Hospital for, — Nurses' Residence 183 Sink Room 223 Sites for Hospitals 1 Small Hospital, The 155 Social Service Work 150 Southern Pacific Hospital 75 Sterilizers 221 Page Sterilizing Room 60 Sunshine, Importance of 17 Surgical Unit 57 Talitha Cumi Maternity Home 81 Thomas Hospital, Josiah B. (Peabody, Mass.) 171 Toronto General Hospital 8 Tuberculosis Department 130 Twentieth Century Hospital, Ideal 4 U. S. Overseas Hospitals 247 Utility Room. 18 Utrecht Psychiatric Clinic 119 Vacuum Cleaners 215 Page Wall Decoration 213 Walls, Material for 214 War Hospitals 239 Ward, Size of 17 Wards, Roof 17 Ward Unit 16 Ward Units, European 20 Wesson Maternity Hospital 86 Willard Parker Hospital 110 Worcester City Hospital 101 X-Ray Department 142 Yonkers Homeopathic Hospital 86 Youngstown Hospital 30, 62 Sllusitrationsi Page Augusta General Hospital, Nurses' Resi- dence 183 Autopsy Tables 205, 206 Barmbeck III Hospital, General Plan... 4 Barre City Hospital. Exterior 161 Floor Plans 159, 160, 161 Operating Room IZ Base Hospital, Plan 246 Bath, Admitting 202 Bath. Baby 203 Beds, Adjustable 217, 218, 219 Bedside Tables 220 Beverly Hospital, Plan of Grounds 235 Bispebjerg Hospital. General Plan 5 Ward Unit 22 Boston Consumptives' Hospital 138 Bridgeport Hospital. Birdseye View^ 20 Major Operating Room 68 Operating Room 66 Plot Plan 19 Viev^ in Operating Department 67 Serving Kitchen 193 Bridgeport Hospital, Maternity Pavilion. First Floor Plan 36 Second and Third Floor Plans 2>1 Children's Ward 101 Creche 83 Day Room 102 Delivery Room 84 Exterior 36 Private Room 39 Ward 39 Bridgeport Hospital, Nurses' Residence. Exterior 177, 178 Nurse's Room 180 Plans 176 Study Room 178 Superintendent's Room 179 Bridgeport Flospital, Service Building.. 194 Brigham Hospital, Peter Bent. Airing Balcony 26 General Plan 7 General View 14 Interior of Wards 25 View in Pharmacy 13 View in Rotunda 13 Ward Floor Plans 24 Page Buffalo General Hospital, Private Pavi- lion. Operating Department 75 Typical Ward Plan 57 Cabinets, Built-in 67 Cable Memorial Hospital, Benjamin Stickney. Exterior 164 Plans 162, 163 Plan of Grounds 236 Canton Hospital School 199 Chart Cases 215 Chicago Lying-In Hospital, Plans 87, 88 Children's Hospital, Philadelphia. Out-Patient Department, Plans 147 Cincinnati General Hospital. Exterior of Wards 28 General Plan 8 Interior of Ward 27 Kitchen 190, 191 Ward Plan ' 26 Cincinnati General Hospital, Operating Building, Plans 70, 71 Cincinnati General Hospital, Receiving Building 16 Clothing Lockers 221 Deaconess Hospital, Concord, Mass., Plans 158 Details of Door Finish 209 Details of Linen Closet 211 Details of Window Finish 210 D'Issy-les-Moulineaux, War Hospital. General Plan 239 Plans 140-145 Diet Kitchen 225 Door Frames, Hospital 209 East New York Dispensary, Floor Plans 152, 153 Floor Trap 205 Fluoroscope (Upright) 147 Food Truck 224, 227 Footstools 220 Ford Hospital, Henry, Ward and Op- erating Plan 29 Forsyth Dental Clinic, Wall Decoration. 97 Galloway Memorial Hospital, Second Floor Plan 40 German Hospital, Chicago, Floor Plans.41, 42 Grace Hospital, Operating Department. 59 Greenville Hospital, Plans 165 Page Page Haniot 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 Heywood Hospital, Plan of Grounds. . . . 235 Rear View 44 Hospital Beds 217-219 X-Rav 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 11 Plans 132, 133 Quincy City Hospital. Operating Build- Kings Countv 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. Mason 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 Alassachusetts 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 Alaternity Beds 219 W'est 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 142 Floor Plans 167, 168 St. Luke's Hospital, Jacksonville. Militarv Hospital D'Issy-les-Mouli- Administration and Operating Depart- nea'ux 239,240,241,243 ments 69 Morse Hospital, Leonard, Nurses' Corridor and Public Wards 34 Home, Plans 182 Exterior of Private Ward }>2 Munich Psychiatric Clinic 120, 121 General Plan 9 Munich-Schwabing Hospital. Laundry, Plan 193 General Plan 6 Private Ward, Plans 31 Medical Treatment Department. Plan. Id Public Ward, Plan ZZ Pathological Department 139-141 Exterior of Public Ward 35 Ward Unit 23 St. Luke's Hospital, Isolation Building. Newton Hospital, Newton, Alass 230-233 Admitting Bath 202 New York City Hospital, Opei ating Exterior Ill Room 65 Plans 109 Page Private Room 112 Serving Kitchen 112 Three-Bed Ward 113 Ward Plan 31 St. Luke's Hospital, Jacksonville, Nurses' Residence. Exterior 181 Plans 180 St. Luke's Hospital, New Bedford, Maternity Department 85 St. Thomas Hospital, Children's Ward.. 96 Sea View Hospital. Dining Building 135 General Plan 134 Group Building 135, 136 Ward Unit Plans 137 Serving_ Kitchens 224, 225, 226 Sick Children, Hospital for. Exterior View 99 Floor Plan 100 Interior 116 Laundry 195 Nurses' Residence 175 Out-Patient Department 154 Pasteurizing Room 226 Sink Room 223 Special Door Hardware 212 Sterilizers, Box Type 222 Surgeons' Scrub-up Bowls 203, 205 Talitha Cumi Maternity Home. Plans 81 Plan of Grounds 234 Thomas Hospital, Josiah B. (Peabody, Mass.) 170, 171 Page U. S. Overseas Hospitals. Details of Construction 269-272 Details of Plumbing 273, 274 Elevations 266 General Plan 250 Plans of Units 252-265 Utrecht Psychiatric Clinic. Interiors 124 Plans 122, 123 Vent Ducts 197 Ventilating through Closet 198 Ventilation Roof 199 Virchow Hospital. General Plan 3 Kitchen 189 Surgical Ward Unit 21 View in Grounds 229 Water Bed 78 Wesson Maternity Hospital, Plans 89,90 Western Infirmary, Out-Patient Plan.. 148 Willard Parker Hospital, Plans 114 Williams Private Sanatorium. Operating Room 72 Plans 156, 157 Worcester City Hospital, Children's Building 106, 107 Yonkers Homeopathic Hospital. Exterior 93 Plans 91, 92 Youngstown Hospital. Operating Department 61 Ward Unit 35 Zander Room 79 THE AMERICAN HOSPITAL OF THE TWENTIETH CENTURY CHAPTER I. 3n 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 580,- 000 were patients. Even Avith this vast number, only aboutf "twelve per cent, of the sick people in this country who are ill enough to need a doctor are cared for in hospitals." The line of advance has been influenced not only by the medical men and the nurs- ing force, but by the social welfare worker, the hospital commission, the so- *Hospital Management, W. B. Saunders Co. tEditorial Modern Hospital, Vol. VIII, No. 1. ciety to suppress tuberculosis, and the public at large ; for the people are realiz- ing that the hospital is built to benefit humanity and not to aiTord a place in which to die. "All hope abandon ye who enter here" no longer is the appropriate inscription for the hospital gate. But this advance has been by gradual steps, — an improved ward unit here ; better methods of service there ; building up thus by experimental work and research a standard to meet the needs as they ap- pear, and with the ever-increasing feel- ing that the welfare of the patient is of more importance than the zeal for sci- ence. Hospital Sites. Before taking up the subject of the planning of the hospital itself, we must consider the very impor- tant subject of the site. Attractive loca- tions for public buildings or even for resi- dences are rarely suitable for hospitals. The improvement of the patient, w^hich is the fundamental purpose of the insti- tution, depends in large measure on its situation and environment — the contour of the land, the surrounding country, the aspect, the accessibility for friends of the patient and for visiting physicians, re- moteness from disturbing influences, a site of sufficient size to insure privacy, are all contributory elements for the process of recovery. A southern exposure is always desir- able, with the land sloping toward the THE AMERICAN HOSPITAL south. If in the country, it is still more advantageous if the north is protected by evergreen trees. ' Enough land should be provided to al- low for growth. In building even the first portion, the future should be con- sidered and the plans for the develop- ment of the entire institution studied and worked out so that the structures may be grouped to the best advantage. What- ever portion is built, it should be done with reference to the completed whole. Oftentimes the central or administration building is all that can be managed in the beginning, and in this must be disposed temporarily all the departments. If the site is in the city, the same care in selection should be exercised. Smoke from adjoining chimneys, noise from nearby railroads, and proximity to a noisy thoroughfare or factory are men- aces to be considered. The suggestions for treating the grounds of an institution will be taken up in the chapter on Landscape Archi- tecture. Buildings. The building or buildings should be simple in style and designed to make a pleasing impression upon the pa- tients with the entrance speaking a wel- come. The motto suggested for the Virchow, in Berlin, might well be placed over the entrance of many another hos- pital — "While treating the disease, do not forget to treat the man." Hospital planning demands the same careful thought that is the foundation of any modern successful business enter- prise. It is essential in the shoe factory, the paper mill, or the business establish- ment to so plan that the raw materials may be assembled and the finished prod- uct delivered with the fewest possible in- tervening motions. In the hospital the patient, the food and the treat- ment may be termed the raw material. AA''hatever conduces to recovery, the con- valescent being the finished product, is of business importance in the hospital. The care, the comfort, the convenience and the food, together with the treatment, are the processes of manufacture. The hospital planner must seek to eliminate here all lost motion or unnecessary work. In the factorv the savin? of time in anv of the processes adds to the annual prod- uct, and in the hospital, likewise, care- ful scientific nursing, freedom from dis- turbing elements and everything that can help early convalescence, add to the ef- ficiency of the institution. With the de- mands for accommodations that are made- in these days, any factors that w^ill in- crease the percentage of hospital capacity will be truly valuable. Location is here most important, an environment that will be an uplift to the patient; an outlook that while distant from industries may still remind the patient that he is a part of the world's Hfe and activity, sunlight and ventilation and the modern fresh air balcony ; these items and many others are factors toward increased hospital capa- city. Internal disturbances should be avoided by planning the noisy rooms at a distance from the wards and there arc many important relations of the utilities to be considered, a single example of which may be the illumination in such a Influence of European Hospitals. The good influence of European hospitals is shown in many of our modern American institutions. While we would not con- sider duplicating any one European in- stitution, we do receive from them valu- able suggestions for the solution of many a perplexing hospital problem. The gen- eral relation of one department to another, the method of preparing and serving food, the housing and treatment of patients, the orientation and environ- ment, and the proportion of sunlight and shadow are some of the things upon which we may receive enlightenment. The hospital which would be perfect and which would fulfill the climatic condi- tions of southern France, however, would be entirely unsuitable in our northern states. If we can put the European hospital on our dissecting table and remove the part we cannot use, we will still have a pretty good portion of the body left. By this metaphor I do not assume that hospital architecture is a dead subject — far from it. It is ver\' much alive. Only last week our medical co-worker asked to have provision made for a patient in a warm, closed room, with hot baths ; yes- terday, the same patient was to be kept OF THE TWENTIETH CENTURY FIG. 1. GENERAL PLAN, RUDOLPH VIRCHOW HOSPITAL. in the open air ; today, ice baths are pre- the ideal ward unit ; in another, a service scribed; and we must study the cHnics building of peculiar fitness; and in still very closely to find out what will be another, the perfect floor (although the wanted tomorrow, for the hospital archi- ideal hospital floor does not seem to have tect must meet the latest demand. been discovered yet). One institution In one foreign institution we may find Avill have an ideal operating or medical THE AMERICAN HOSPITAL department, while in others the architects will have solved new problems in detail and equipment. The twentieth century hospital, whether built in Spain, Russia, or the United States, has one common condi- tion in its program — that is, to give the patient the best chance for recovery. If a more thorough study of sanitation, ventilation, nursing, disturbing elements, orientation, and environment, one or all, will help us to design buildings that hasten convalescence and produce the de- sired results, then that information must out grounds and parks, with their walks and drives, become the ideal place for convalescents. One of the rules of these parks is that on every third day they are for the sole use of the patients, every third day for the sole use of the staff, and every third day for the sole use of the nurses. The surgical group, on the left of the main axis, is connected with the operal;- ing building, while the medical group has the bath-house occupying the same strategic position. The isolation group occupies a portion of the extensive Allgene nes Krankenhaus Hamburfl Sarmbeck Z^^^^Ws;:^ FIG. 2. BARMBECK HOSPITAL, HAMBURG. GENERAL PLAN. be obtained ; and, if necessary, we should be willing to circle the globe for it. Some European Hospitals. A few ex- amples of European hospitals will show some of the features which have inter- ested the writer in his study of the sub- ject. Perhaps the most familiar of the mod- ern hospitals is the Mrchow (Fig. 1) at Berlin. This was built by Architect Ludwig Hoffmann in 1907, and is of the pure pavilion plan. It has a capacity of two thousand beds. With the exception of two ward units connected with the surgical or operating buildings and the administrative group, the buildings are all isolated and are of one story so far as the patients are concerned. Owing to the ease with which the patients can be taken from the buildings, the beautifullv laid- grounds on the south, and the service buildings on the north. The ward pavilions, of which there are twenty practically alike, consist of two twenty-bed wards, with service at the center and at the ends, and with room for attendants in the second story of the central portion. The floors of the wards are elevated but a few feet above the ground, giving a ready entrance for the patients and for the food, both of which are carried over- ground. The new Bannbeck III, City Hospital at Hamburg (Fig. 2), built by Baurat F. Ruppel, consists of forty-four build- ings, and wall house fifteen hundred patients. In this plan Ruppel has varied somewhat from his usual method, in plac- ing the center of the medical unit — the OF THE TWENTIETH CEXTURY bath-house — on the axis of his plan. In the St. Georg, the Eppendorf, the Mr- chow, and other large German hospitals the bath-house is placed on the medical side, balancing the operating building as the center of the surgical side. forty-six buildings, two or three stories high. These buildings, while isolated above ground, are all connected by wide, well-lighted, underground corridors. The bath-house, while far removed from the medical buildings, serves for out patient ■f L O T 4^ L A N I-Tl SKf~ WfrfccJ' TJBr-IW Ok.-o-'\='' & i^vcrj^n K?-EZriJ<^i>Ti«K A ADMIMliTtfcTlcK (5?H.YCLIKIC B hUJ> EiecToi:, C 5;^Thi D.G.K \nctt. t.K. XuRJti r- hJSttMl.\KC n*U^t &*It^.?'-tI_ M Ownx. A*i fHv?L-&icxi. lnsTfiurt L STWttS eWnASMOK M Orriafcii O Kirc«£« P fcoiLtt. C-nKCMlHE he^Jft G 1>UN E>tf R- (K5?I.CT»2_ AlCHITtCr FIG. 3. GENERAL PLAN, BISPEBJERG HOSPITAL, COPEXHAGEX, DENMARK. M. Xyrop, 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 Bispehjerg Hospital of Copen- hagen TFig. 3j, designed by Professor Martin Xyrop, 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-Schzi'a- hing (Tig. 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. \A'hile he has separate pavilions, he also has everywhere connecting corri- dors above ground, except to the con- THE AMERICAN HOSPITAi- 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' buildin: FIG. 4. 11, 13, Male patients' buildings. 23. 12, 14. Female patients' buildings. 24. 15. Disinfecting building and laun- 25. dry. 26. 16. Garden and workshop. 27. 17. Machinery building. 28. 18. Animal experiment building. 29. 19. Pathological building. 20. Segregation building. 30. 21. Contagion building. 31. 22. Skin and sex disease building. GENERAL PLAN, MUNICH-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 THE AMERICAN HOSPITAL E D E. /) A V E./1 U E. PowEE.s.Ljv/iDa.Y B'Lbi; er \j iL n L r A V E /I v; e: CIN'CIXXATI 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. LUKE'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, w^hile 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 TWEXTIETH CEXTURY CHAPTER II. 11 ADMINISTRATION DEPARTMENT. FIG. 8 MA'^SACIH '^EIT'^ OENPRM HOSPIIAI (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. Waiting 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. 8), did not have an administration building until 1916; so that, wnth 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 comes 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 fFig. 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, simpHfies 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 Inionnation office 3 Stairs to public toilet for men 4 Waiting room for patients to be ad- mitted 6, 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 tsf 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 FLoOR 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 futxire 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 35 Dressing room for men employees 36 -Emergency- ward office 37 Entrance for ambulatory patients 38 Central clothing room 39 Elevator. r '° ■ i r h^. I ' r^ 1 ^ nnor A m^^fS^tOk t^J L. i W^. I. Lli (r^^ 'U \\^\ fc FIG. 11. MASSACHUSETTS GENERAL HOSPITAL. MOSELEY MEMORIAL (ADMINISTRATION) BUILDING. Coolidge & Shattuck, Architects. and isolation rooms are on the ground jfloor (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. VIEW IN ROTUNDA. FIG. 14. PETER BENT BRIGHAM HOSPITAL. VIEW OF PHARMACY. 14 THE AMERICAN HOSPITAL OF THE TWENTIETH CENTURY 15 ,. II |i l! ^ If «. * fs ?( «i t it*' ■ ■ ■ *; .-4 2 .'■3 3 FIG. 15. GENERAL VIEW, OHIO VALLEY GENERAL HOSPITAL, WHEELING, W. VA. Edward F. Stevens, Architect. First ruooE. Puah 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. AA'e 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 — hozv 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- r '^ AMEULANCt -POE-CH fLOOTJ. Plan NfW GENER-AL- H0.5PITAL CINCINNATI " OHIO jAMUtL H*NNflfOeD ic JONi — AU.CH1T£CTJ CiNCJNNATi — 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 dift'erent 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, eij'jh- teen patients should be in one room, and some think that these should be sub- divided for a better segregation. In zvards, 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 httle 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 w^ard 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 day room for private rooms affords a sitting room w-here 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 necessary 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. AVhere 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 CEXTURY 19 A U. tit 3 rOTUHC- ; GRANT JTT^ELT n r PLOT PLAN. BR[DGEPORT-IiO-5PITAL Bridgeport— -Conn LDWARP E.5TiVtN3-AR.CMiTCCT 5o_>TOM Ma. 5^ 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, witli 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 \^I, on "Maternity Depart- ment." j 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 europeax ward uxits. and the American ward units will serve It will be noticed that in the Bannheck k^ _ ^*- S B 'TV .V 'W'^r v^# *:.>^ • .'■- -l^-l OF THE TWENTIETH CENTURY 21 'OO / V y ao ;t=^A^ ^ ^ p -fa o < the largest ward is sixteen beds ( Fig. 2) ; that from each ward is a liegehalle or airing balcony ; that each ward has its tageranrfyi 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 f 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 afifords 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 Bispehjerg 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 dififerent 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 efifects. The details of the various equipment were very carefully devised. In the Miinich-Sclrivahiug (Fig. 24) 22 THE AMERICAN HOSPITAL FIG. 21. PLAX OF WARD UNIT— RIGS HOSPITAL, COPEXHAGEX, DEXMARK. 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 h5SPITAL, WARD UXIT. M. Xyrop, Architect. The admitting department for each ward unit is very complete. The patient comes into room Xo. 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. AMERICAX' WARD UX'ITS. 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 monev. 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, the}- are allowing their architects to provide some of the more essential rooms, such as the sink room, a ser^'ing 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- Iv 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. OF THE TWENTIETH CENTURY 23 ! i 24 THE AMERICAN HOSPITAL Typical Pavilion 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 FIG. 31. WARD UNIT PLAN-NEW GENERAL HOSPITAL, CINCINNATI, OHIO. Samuel Hannaford & Sons, Architects. OF THE TWENTIETH CENTURY 27 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 ?>?) , 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 air 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 Avard 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 28 THE AMERICAX HOSPITAL ?^IiC^- "^"'^^i iUMJlifll in FIG 33. WARD BUILDINGS -C" AND "B- — XEW GENERAL HOSPITAL, CINCINNATI, OHIO. Samuel Hannaford & Sons, Architects. FIG. 34. REAR VIEW, WARD BUILDINl,.- J AND -K'-NEW GENERAL HOSPITAL, CINCINNATI, OHIO. Samuel Hannaford & Sons, Architects. OF THE TWENTIETH CENTURY 29 F12.5T TLODE. PLAN • PEIVATE-PATIENT'&UILDINQ ' HENRY- rOED' HOSPITAL- PETEOIT- MICH 1. Operating Room. 2. Sterilizing Room. 3. Operating Amphitlieater. 4. Nurses' Work Room. 5. 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 Harplr Hojpttal MALCOMJON ($c HlGGINBOTHAn Architlctj R.OIT Michigan. LDWARD F JTLVE.NJ 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 suflicient 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- nDDDDD DDDnDD ,DDDDD %^\ 4Q, £ A i FIG. 37. HARPER HOSPITAL. HUDSON MEMORIAL. OF THE TWENTIETH CENTURY 31 o. -I tients. On the north there is a day room on each floor, and a large roof ward on the fifth floor. The ward unit used in the maternity and children's department of the Bridge- port Hospital at Bridgeport, Conn., is one which will apply to any general ward ( Fig. 44), and is described under the chapters on maternity and children's hos- pitals. (See also Figs. 45-49.) This unit, designed on the Rigs Hos- pital ward plan, aft'ords a better division of patients than almost any other plan of the same area. It is arranged in groups 32 THE AMERICAN HOSPITAL FIG. 39. VIEW OF PRIVATE WARD BUILDIKG-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 Gallozvay 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 dift'erent 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 rooms 34 THE AMERICAN HOSPITAL il»r FIG. 41. ST. LUKE'S HOSPITAL, JACKSOXVILLE. 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 TFig. 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. YOUNGSTOWX 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 ofif from the main corridor ; the sink room and serving kitchen are at the ex- treme end of the building. A large solarium and airing balcon}^ 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 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, Maternity Pavilion Bridge POR.T Hospital Bfudgepoiu Conn C.DWftE.DF.5TEVEN:5 AR.CH1TCCT Bottom MAii FIG. 44. PLAN OF FIRST FLOOR— MATERNITY BUILDING, BRIDGEPORT (CONN.) HOSPITAL. Edward F. Stevens, Architect. 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 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 OF THE TWENTIETH CENTURY 37 5.C or 3EC0ND fLOOt PLAN iCALE - '■' ■' '■' W V V •■'«'• if rEEt E N.— '-O "'-^ Maternity pavilion Bridgeport Hospital Brjdgeport Conn EDV/At.D f. JtEVENJ At-CHITCCT Boston MA5j FIG. 45. PLAN OF SECOND FLOOR— MATERNITY BUILDING, BRIDGEPORT (CONN.) HOSPITAL. Edward F. Stevens, Architect. MATERNITY PAVILION Bridgeport HoiPiTAL Bridgeport Conn EDV/ftft-D f .iTEVENi AtLCniTECT BojTON Haw FIG. 46. ROOF WARD— MATERNITY BUILDING, BRIDGEPORT (CONN.) HOSPITAL. Edward F. Stevens, Architect. 38 THE AMERICAN HOSPITAL 3 s p „ M . f-i -a S I <; 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 AMERICAX HOSPITAL d a"D n c| ponnn no liif O o t_ o z o Li < ^ O < OF THE TWENTIETH CENTURY 4i complete and thoroughly equipped pri- vate-patient pavilion for this institution. The general plan (Fig. 64) 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 Edwab-d F .Stevens ARCHITECT Boston «ass. ' ■■ ■ ' ■ ■» ■ > GE.OUND Floor. Plan FIG. 53. OHIO VALLEY GENERAL HOSPITAL. GROT-XT; VJ/^nR PLAX. FIG. 54. AIRING BALCONY, FIRST, SECOXD AXD THIRD FLOORS, OHIO VALLEY GENERAL HOSPITAL WHEELING, W. VA. Edward F. Stevens,. Architect. 44 THE AMERICAN HOSPITAL OTIrlifHijii iiiiji £ II1IIII1I iH FIG. 54A. OHIO VALLEY GENERAL HOSPITAL. M:EW FROM REAR, SHOWING AIRING BALCONIES. FIG. 56. MACON HOSPITAL. PRR'ATE PAVILION. ROOF PLAN. OF THE TWENTIETH CENTURY 45 T Z t E T MACON CITY tiO/PITAL MACON QtouqiA CCWftU) f /Ttvtn/ AlCnlTECT AlUAWHK ilAJl ^//OCJATEO AtCHITCCT FIG. 55. FIRST FLOOR PLAN. 46 THE AMERICAN HOSPITAL FIG. SSA. MACON HOSPITAL. PRIVATE PAVILION. -Pavilion "P" FIG. SSB. MACON HOSPITAL. PRIVATE PAVILION. OF THE TWENTIETH CENTURY 47 FIG. 59. HAMOT HOSPITAL, ERIE, PENN. FIG. 60. 48 THE AMERICAN HOSPITAL MANsriLLp Ge:nl!?al Hospital MANsntLD Ohio VtCfioli £tDDI'i(^-AECHrrtCT- MA^iMCLD-OHlO CDWAEOt-rTtVENJ-CortJOLTIIiq AtCtllTtCT- BDJTa>l-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. 50 THE AMERICAN HOSPITAL ^ M <; ^ bo Ph rt u « ■fl o u C-) hJ tn p-< t< dj H ■*-i t C) K J » FIG. 70. MASSACHUSETTS GENERAL HOSPITAL. OPERATING DEPARTMENT. If the operating department is in a separate building, there should be an ad- mitting room at the ambulance entrance, closely connected with the accident room which should have good north light. These rooms should not connect with anything except the corridor. This ac- cident room can also be used for septic cases. The day of the amphitheatre in the modern hospital, as an operating unit for teaching, seems to have gone. While the amphitheatre is used, of course, for teach- ing in clinics and lectures, the majority of surgeons have come to the conclusion that in order to gain an intimate knowl- edge of live tissue the student must be very close to the patient under operation, and smaller and more numerous classes are formed. The major operating room should have no plumbing or other attached fixtures, except perhaps a flushing floor drain and a sterile water outlet. A small electric instrument sterilizer may be thought de- sirable, but with the sterilizing room close at hand this is not necessary. The heating of the operating room should be sufficient for any desired tem- perature within reason. Fresh air should be introduced to make the room comfortable to work in. This can be ac- complished in various ways — by the plenum system, where the air is heated and blown in by fans ; by gravity, with screens to prevent air from being fouled by dust; and by direct-indirect, with proper air inlets carefully screened. There can be no objection to direct heat, provided the heating units are readily ac- cessible for cleaning, and provided fresh air can in some way be introduced. But the rooms used for operating, sterilizing, and anesthetizing must be well ventilated always. (See Chapter XV, "Heating and Ventilation.") The lighting of the operating room needs careful study, both for day and for night. For the day, large vertical windows and skylight, facing toward the north or as near north as possible, are best. By carrying the vertical window sufficiently high, practically the same results without skylights are ob- OF THE TWENTIETH CENTURY 59 FIG. 71. GRACE HOSPITAL, DETROIT. OPERATING DEPARTMENT. Edward F. Stevens, Architect. I • p L..A N • OF- T-tjiR.©. p'uoo Re- tained so far as light is concerned — e. g., Macon, Cable Memorial and Williams Hospitals. The glazing, in cold climates, should be double, or with a glass screen as at the Jefferson in Philadelphia, the Bridgeport at Bridgeport, the Royal Vic- toria at Montreal, etc. The skylight windows may have rolling shades be- tween the two panes of glass in case the light is too strong. There is much to be said in regard to artificial lighting. The crane light has been used successfully, having the ad- vantage of a direct and powerful light when needed and of being swung away easily when not wanted. (See Artificial Lighting under Chapter XIV. j Reflected light from a high power lan- tern outside the operating room, with fixed reflecting mirrors, has been used with much success. Trouble, however, has been experienced through the vibra- tion of the building, which changed the adjustment. Reflected lights from numerous fix- tures, either with direct reflectors or dif- fused from the ceiling, have been very successful. Daylight effect is very desirable in the operating room. There are different 60 THE AMERICAN HOSPITAL lamps and combinations with occasional improvements. The best of today ap- pears to be from high power nitrogen lamps above the ceiling diffused by inter- vening glass of proper quality. One can hardly name the best floor for an operating room. There are many good materials, such as non-absorbent marble, FIG. 72. ST. GEORG HOSPITAL. OPERATING UNIT. vitreous tile, terrazzo. and even cement if treated with a non-dusting prepara- tion. The zvalls of the operating room should either be lined with marble or tile, or finished in hard plaster and thoroughly enamelled. It must be possible to scrub thoroughly or spray with water or steam the entire surface of the walls and floor. To this end, a floor drain of proper con- struction should be supplied. (See Chapter XV, "Plumbing.") It has been found that a clear white tile on floor and w^alls is too glaring in the intense light of the operating rooms ; and gra}^ buff, and even green have been used with success. Gray Tennessee mar- ble is very satisfactory. Next in importance to the operating room is the sterilizing room. This need not be large, but should be specially ven- tilated ; all exhaust steam pipes should be extended into the open air ; and if a hood can be placed over the sterilizer, it should be done. It is advisable to place the water sterilizers or still at an eleva- tion, so that the sterile water may flow to each operating room and, by the use of reheaters, be heated by steam or elec- tricity. Such reheaters should be pro- vided with elbow control valve and the discharge nozzle protected from contact by a metal or glass hood. A proper re- ceptacle, like a porcelain sink, properly trapped, should be placed under the re- heater. The nurses' zvorkroom should be large enough for the corps of nurses needed, should be provided with tables for mak- ing up dressings, with sinks, slabs for cleaning instruments, special scrub-up bowls for the clean nurses, cabinets for sterile and unsterile dressings, etc. The small laboratory for quick diag- noses is considered a necessary part of the operating suite. It should be well provided with apparatus for making rapid microscopic examinations of tissue while the patient is still on the table. There should be a surgeons' room or rooms, of sufficient size, supplied with a locker for each surgeon, comfortable fur- niture, shower bath and toilet. The in- strument room may have a locker or com- partment for each surgeon's instruments. Anaesthetizing rooms, well ventilated, should be sufficiently screened from the operating corridor, yet near the operating rooms, and should have doors of ample width to admit a bed, with jambs and doors protected by metal. FIG. 73. ST. GEORG HOSPITAL. OPERATING UNIT SECTION. The scrub-up sinks should be either in the corridor or in an open alcove without doors near the operating room where there will be plenty of room for all to work without interference, and w'ith plent}' of shelf room for soap, brushes, etc. The details of finish and equipment, the plumbing and heating of the operat- OF THE TWENTIETH CENTURY 61 ^ O 0- (^ D D H o ^ It o 111 f^ tu O .-_; ^ o c^ u D D N ^ D ni E..r 1 V \ lU \ -^ V 1 ^ r^ ' \ [S-li J r^ J._^J\ [\ ■■IH 1 - u rfi;---^^ / ^ A >^ o .\/ "- Ll ^'"'";\ >^ in^H-J-^ 1 \A w." r O A d2 o o / ^ V ^ t^ ^> > ^ '^ 1 MM jl ; X [P^ 1^ - E /^ h O / -^ o 1^ 3: fc^ -->. X to L.^n n O i pi ^ < -s c^ -Si o P > O ii 62 THE AMERICAN HOSPITAL ing suite ^vili be taken up in later chap- ters. The operating department of the St. Georg Hospital (Fig. 72) at Hamburg is one of the most carefully worked out, so far as hygienic detail is concerned. Strict attention is given to the heating and ventilation (Fig. 7Z) ; the air is washed and filtered before entering the room, and the direct heating units are en- tirely outside the v/alls. The equipment is most carefully designed. The accident department, on the ground floor, gives access for ambulance patients ; the elevator reaching the first floor level. On the ground floor are the receiving and waiting rooms, the two accident rooms, laboratories, morgue and store rooms. On the first floor are the operating rooms, with two anesthetizing rooms, which are placed in the center of the building, with skylights, and are entered either from the main corridor or from o ■ — - « Ifc QUINCY CITY HOSPITAL. OPERATING BUILDING. Edward F. Stevens, Architect. R.ICE.PAVIHOM In the operating department of Grace Hospital, Detroit (Fig. 71), there are three rooms for clean surgery, besides the septic, surgical dressing, and plaster rooms. The surgeons' locker and dress- ing rooms are outside the clean portion of the department. Here the room for scrubbing up is not connected with the locker room. There is a large sterilizing room and a larger room for the nurses' work of preparation ; also an instrument room where each surgeon has his own compartment in the instrument case, etc. The operating building of the Youngs- town Hospital (Fig. 74), Youngstown, O., is two stories in height, and is divided into two sections — the accident and the operating proper. the operating corridor. This makes it unnecessary for the patient to enter the operating corridor until anesthetized. The three clean operating rooms open from a ten-foot corridor, in which are the surgeons' scrub-up bowls, so placed that six men may scrub at once. A sep- tic operating room is provided, a large sterilizing room, a large work room for nurses, instrument room and a small laboratory. Sterile water is brought from a cen- tral apparatus to each operating and ac- cident room, and there heated locally by electricity. The Qiiincy City Hospital (Figs. 75 and 76), Quincy, Mass., is a small in- stitution with a capacity for fifty beds. OF THE TWENTIETH CENTURY 63 NO. 1(>. QUINCY CITY HOSPITAL. VIEW IN OPERATING ROOM, SHOWING GLASS SLIDE OVER INSTRUMENT STERILIZER. foucTH Floor. Plan AE.CH1TECT' BoiTON MaJS- FIG. n. PLAN OF FOURTH FLOOR, OHIO VALLEY GENERAL HOSPITAL, WHEELING. W. VA Edward F. Stevens, Architect. 64 THE AMERICAN HOSPITAL FIG. 78. OPERATING ROOM— OHIO VALLEY GENERAL HOSPITAL, WHEELING, W. VA. Edward F. Stevens, Architect. FIG. 19. RHODE ISLAND HOSPITAL. OPERATING SECTION. OF THE TWENTIETH CENTURY 65 but its operating department is in a sepa- rate building. In this, all the essentials have been provided. The accident and Roentgen-ray rooms and surgeons' room are removed from the clean corridor. At the Ohio Valley General Hospital (Fig. 77), one wing of the fifth floor is set apart for the operating department, with one septic and two clean operating rooms. The scrub-up basins are placed in the center of an open cross corridor, accessible from all sides. Sterilizing room, nurses' work room, surgeons' and anesthetizing rooms are placed conven- iently for service. Distilled water from a supply tank in the tower furnishes sterile water for the operating, accident, maternity, and laboratory departments. The operating pavilion of the Cincin- nati General Hospital (Figs. 86 and 87) is most complete, each operating unit having its own anaesthetic room adjoin- ing and recovery room close at hand. The necessary nurses' work rooms, dressing, instrument, and laboratory rooms are provided. The lecture amphitheatre, while in the same building, is not directly connected, but is reached through the lower level and approached by two elevators and staircases. It is quite common, in modernizing an old hospital, for the provision for the operating department to be somewhat limited; and it is not an unusual thing for the attic story, which has been used as kitchen or servants' quarters, to be turned over to the architect to make into a modern operating department. Two or three examples of this may be helpful. In the Rhode Island General Hospital fFig. 79) at Providence, an unused up- per story was utilized, providing five good operating rooms, and all the con- veniences of a modern surgical unit. In the New York City Hospital (Fig. 80), Blackwell's Island, the dome of the old building, formerly used as a kitchen, was so reconstructed as to meet the needs of the surgeons. The struc- ture of the roof trusses made the plan- ning more difficult, and the spaces which T^Z LO/£tJ|(0] OJ foool □ 2.00M inOn r LOCKEt- EOOM D 1 orrr ^ ^ WojiK Room Eoom li 1 Cuo/ET BPee/zing Room FIG. 80. NEW YORK CITY HOSPITAL, BLACKWELL'S ISLAND. Charles B. Meyers, New York, and Edward F. Stevens, Boston, Architects. ^ THE AAIERICAN HOSPITAL -H■^ K. Ji. I D /ECOND fLOOR, PLAN O 6 -I& ■'^ FIG. 81. BRIDGEPORT HOSPITAL. OPERATING DEPARTMENT. Edward F. Stevens, Architect. would in an ordinary case be used as op- erating rooms were very conveniently turned into nurses' and students' locker rooms, and entrance to students' gallery (in no sense an amphitheatre). Sky- lighting of all rooms was practically necessary. Four operating rooms are provided, only two of which could have the north exposure. Here again dis- tilled water is made at an elevation, and conducted to the various rooms. At the Bridgeport Hospital (Figs. 81 and 82) the case was slightly different. An old operating theatre, with a small addition, was turned into three modern operating rooms, with sterilizing, instru- ment and work rooms. Entrance for students to the major operating room was secured by a gallery from the main corridor. Built-in cabinets (Fig. 83), distilled water reheaters, and specially designed equipment make this a very complete department. OF THE TWENTIETH CENTURY 67 CHAPTER V. ®|)e JHebical ®nit The fact is recognized more and more every year that many diseases and ail- ments which have hitherto been consid- ered surgical cases or which have been neglected altogether can be treated with- out surgery and with little medicine. The medical treatment or bath department, as it is called in European countries, is gradually being introduced into the gen- eral hospital plan. Today a careful stu- The hospital boards in this country have given little thought to this depart- ment, but in the larger European hospi- tals one will find the medical units with such sections as Mechano-therapy. Hot air baths. Warm air baths. Steam baths. Light baths. FIG. 83. BRIDGEPORT HOSPITAL. OPERATING SECTION SHOWING BUILT-IX CASES. dent of hospital architecture will not dare to plan for a complete layout without providing facilities for some medical treatment, if it is nothing more than a few electric-light bakers. We should not give to the surgeon and the obstetrician all the best rooms of our hospitals, but should provide space for the present and for the future for internal medicine and therapeutics. Electric baths. Gas baths. Radium baths. Sand baths. Sulphur baths. Mud or peat baths. Sun baths. Inhaling and pneumatic chambers. Roentgen-ray, with all its ramifications. To the student of hospital architecture the question naturally arises : If these 68 THE AMERICAX HOSPITAL FIG. 82. MAJOR OPERATIXG ROOM— BRIDGEPORT (COXX.J HOSPITAL. Edward F. Stevens, Architect. methods of treatment are essential for the well-being of the poor and indigent across the sea, why should we not prac- tice them, or some of them at least, in our institutions? The hydro-electric bath, the carbon di- oxide bath, the plunge, and those previ- ously mentioned, are but a few of the ex- amples one will find in the general pub- lic hospitals of Europe. Reference is not made to the various sanatoriums one finds over all the world, but to the gen- eral hospitals for the care of the poor and indigent. Should we not, in Amer- ica, provide such equipment that the pa- tient suffering from arthritis, chronic rheumatism, or cellulitis, let us say, may have the proper mechanical, electrical. heat and massage treatment, or the wa- ter-bed for severe bodily burns or sores ? It is not necessary to have a five-thou- sand dollar, complete hydro-therapeutic outfit; but room can be secured in every hospital for a small equipment — an elec- tric baker, massage table, small vapor bath, etc. — and many simple home-made devices can be brought into use, if the medical student of today will only pre- pare himself to use them w^hen he comes to be on the hospital staff of the future. Heat is an important therapeutic agent, whether it is applied by warm air, steam, electric light, or natural sunlight; scientifically applied, it is a recognized medium for benefiting man's ills. If heat applied by the direct rays of an arc light has a higher therapeutic value than when applied by any other method, then this should be recognized and the equipment supplied. If the hot air bath will relieve pain when nothing else will, then this should be recognized. As the study of non-surgical methods for re- lieving suffering advances, hospitals should be prepared to provide the proper treatment. The airing balcony provides sunlight for the medical as well as for the sur- gical patient. The simplest, and many times the most potent agency, Sunlight, can easily be provided in every institu- tion. OF THE TWENTIETH CEXTURY 69 FIG. 84. FIRST AND SECOND FLOORS-ADMIXISTRATIOX BUILDING, ST. LUKE'S HOSPITAL. Edward F. Stevens, Architect; Mellen C. Greeley, Associate Architect. FIG. 85. ST. LUKE'S HOSPITAL, JACKSONVILLE. ADMINISTRATION AND OPERATING BUILDING. 70 THE AMERICAN HOSPITAL OF THE TWENTIETH CENTURY 71 o > < a g < w Ah o hj Ph o o a fa Q o w n THE AMERICAN HOSPITAL FIG. 88. J5R. WILLIAMS' PRIVATE SANATORIUM. VIEW IN OPERATING ROOM. To illustrate what some of the later European hospitals are doing in the line of medical equipment, a few examples are here shown. The Virchow, at Berlin (Fig. 1) de- votes even more room to the medical treatment department than to the sur- gical. At the Barmbeck (Fig. 2), Ruppel's latest hospital, at Hamburg, the bath- house is given the place of honor on the main axis, while the operating pavilion occupies a secondary position. The Bispebjerg (Fig. 3) at Copen- hagen, among the newest large Scandi- navian hospitals, has devoted a large space to this department, which is en- tered by semi-underground passages. In Munich-Schwabing (Fig. 4), one of Europe's best hospitals, one finds a most complete equipment. If we study this plan in detail. (Fig. 100) we find baths of every kind for the relief of suf- fering humanity. Commencing at the left are the Roentgen-ray department, the inhalation department, the rest rooms, pneumatic chamber, massage and mechano-tlierapy ; and in the center are arranged the various baths— the Fango or Italian volcanic earth bath, the mud or peat bath, sand baths where the sand is heated and applied to the patient, the CO- bath, the light bath, and the general hydro-therapeutic room with its spray baths of every description, its warm and cold plunge, and its wading bath. On the second story of this building is the great sun-bath, so arranged that if the sun is too warm the surface of the glass can be covered by a water curtain, thus reducing the temperature of the room. In this hospital the writer first saw the pneumatic chamber used for treat- ment (Fig. 101). A patient needing rari- fied air and sent to the hospital is placed in one of these rooms, surrounded by his books and papers ; pressure in the room is reduced to the prescription amount and he is getting the rarified air of the high mountains at home. Perhaps he may be ordered a greater atmospheric pressure, OF THE TWENTIETH CENTURY IZ FIG. 89. BARRE CITY HOSPITAL, BARRE, VT. VIEW IN MAJOR OPERATING ROOM. Edward F. Stevens, Architect. 74 THE AMERICAN HOSPITAL o - ^ -J 2 ^ OF THE TWENTIETH CENTURY 75 fousTH fLcce Plan Pkivatc Pavilion fojt TUt BurfALO GtNEEAL HOJPITAL BurfALO NtW YOKK 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 rehef 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 wdth pipes from the w^all, 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 XL) 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 Xauheim, and continuous baths, res!, 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. 13. Wash room. 2. Physicians' room. 16. Toilet. 3. Dark room. 17. Rest room. 4. Light shaft. 18. Pneumatic room. 5. Photograph laboratory. 19. Examination room 6. Roentgen room. 20. Physicians' room. '/. Undressing room. 21. Ante-room. 8. Waiting room. 12. Douche room. 9. Attendants' room. 23. Hot air bath. 10. Elevator. 2A. Warm air bath. 11. Social room. 25. Vapor room. 12. Ante-room. 26. Fango mud bath. 13. Segregated room. 27. Mud bath. 14. Light 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 n PNEUMATIC CHAMBER PLAN. FIG. 101. PNEUMATIC CHAMBER SECTION. 78 THE AMERICAN HOSPITAL CHAPTER VI. ZKjje iHaternitj» ©epattment 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 mto 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 fiii -- ^r^ ■%r^^ Ay_^ ' '1 ' 1 'BM ^ J^^ h ik Lji-^I -^ -"St^ ry[jk. JKg '"^^^^WS^ Sffipsiifj^^ggi^i:; . ^f ^.. .-■..-■^-■■""?«ti-'- l^^^^i HpH^^H^r!^.^ '■' 1 IjM ^^^ft^ w^ '^t'-^^^^^- -.^'""*-^ y.^^A watMms^. '^^^■^■B^fc^ .^H It jflM FIG. ICM. MASSACHUSETTS GENERAL HOSPITAL. ZANDER ROOM. FIG. 105. OHIO VALLEY GENERAL HOSPITAL. ROENTGEN- RAY DEPARTMENT. 80 THE AMERICAN HOSPITAL © (dI [^X^\ ^ ® Jg ® \@] WM 1, ^[BlBMTiniT San Franoiaco 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 deliver}' 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 th^ 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 thfs 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 Nezuton Hospital ( Fig. 403), Newton, 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 Cwni Maternity (Fig. 408 j 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. Key A Airing B<<^LCONr .!> NUR.SI.'6 "R-OOMi C. NuB-^r'V .SiTTiNC Room T> PmvATE. Wards E 0TOH.E. Cuo^tT" F BR-OOM CuOiE-T 6 T01)-tT H Ell.ANKE.Ti AND LiNI-N 1 LABORATOR-TT J NUR.SE5 Room Isolation .Suite. K. T o I l_ E. T L Patient " • M Diet Kitchcn N Elevator- O COVER-B-P POTtCrt P COR.R.1COR. And iOLAK.IUM H0.5PITA1- Pavilion Talitha Cumi Mateilnity Home Jamaica Plain Ma55, EUV^-AliD F. .5TE.VEN.5, AeCHITECT 'BoJTON MAi3. FIG. ni. I Ke-y A AiB-i^o Balcony Z) WAR.DS C <5T0RE. CLOiET D Clothing TLooKi E. Linen F To 1 l_ E T Cr 'B.Li^'NKET WA-EM H Btj-oom Closet 1 PELivEie.-j- -Rooin J 5TEB.lLlZ(N