MODERN
HOSPITALS
THE AMERICAN ARCHITECT
NEW YORK
vl
^C€^n4- ^ ^c^r/}J
tmf. DE CALJF. LIBRARY, 1:98 /
J
il-
\
MODERN
HOSPITALS
A Series of Authoritative Articles on Planning
Details and Equipment, As Exemplified
By the Best Practice In This
Country and Europe
By
EDWARD F. STEVENS, A.A.I.A.
EDWARD PEAHCE ("ASEV. A.A.I.A.
(LAREXC E W. WILLIAMS, Heating and Ventilating Engineer
D. D. KIMHALL. Heating and ^"entilnfing Engineer
E. II. UOSTOC K
M. E. .McCALM()INn\ R.N., Fonner Superintendent of ( ivil Hospital, .Manila. I'. I.
.\XI) OlIIKIis
7V) Winch Is Added More Than 125 Full Page and Text Illiisfnifioti.'
of RecnitJy Consiriicfed Hospitals. Their .Irchitectural
and Technical Ecjnipment
THE AMERICAN ARCHITECT
Xo. .-,(1 rXlO.X SC^lAUE, XEU NOKK
?7
Pre j ace
/'/' (.V (/'(/// ///(■ itilciilion <>f<'J)('riii</ to (irchilicl.s anil tlio.sc con-
cerned with the .siijierinfciidcnfc of ho.s/iifdi.s atid the rare of
the .sieh\ .wwr measure of assistance that this Imn/: has been
jire/Hin'd. Its le.rt rejle<-ts the latest leord in each dc/iarlincnt
treated, and the statements set forth niaij he tahen as hiiscd on the
best practice. The illnstrations are a diverse collection of irrll
dcsiljued hospitals in their dijfercnt special or iieneral fields, that
have been recently erected, udiile the names of their de.sii/ners irill
be .sufficient proof that theirarchitectnnd treatment is of a character
that irill afford valuable suyyestioiis to ecerijoue entjuijed in tlie
field of hospital enn.ff ruction. While a portion of the te.vt and
dludrations liave found precious pnhlic<ition in tfie pages of
The AmeHICAX AlWHirEvr. mucfi of the muteriid presented
in this boofi lias neeer heretofore lieen pulilisheil . Its collection.
ni boof,- form presents a irorh enci/clopedic in character and
recommends it as a volume for ready reference. ,
C'op.vri«lit, \QU. by
'PuK American Architkct
Nkw York
\m\^\£
3 C=l □
MODERN HOSPITALS
AlUl.Nl. I(.\l,( ONV AT HKMCIILY HOSPITAL. BK\ KHLV. MASS.
DETAILS AND EQUIPMENT OF HOSPITALS*
Bi/ EDWAUI) F. STEVENS, A.A.I.A.
HAVE road over the re-
ports of the hist tliree
years, as well as the re-
ports of otlier papers on
hos|)ital phiiininj;' and
coiistruction whicli liave
heeii given, and 1 find
that the field has l)een
j)retty well covered from
every }ioint. It may he
that the writer of one ])aper lias insisted
that no ward shonld he larjier than six heds,
while another states that a twenty-hed
ward is the hest to administer; that one
♦Resume of ;ui aiiilress enlilled "Dcliiils iiiul K<|iiipriU'tit of
the Ilospifal." Delivered liy >[r. Kilwanl V. Stevens. A.A.I.A.,
Before the .\ineriean Hos[)ital .Vssooiatioii at its Thirtet>iitli
.\ninial Confereiue. hehl in New York. SeptenilxT 19, 1911.
Bein^ a Report of the Hospital Construction Committee.
thinks file utilities should he placed in a
corner toilet tower wliilc another helieves
these utilities shdiild l)e placed in a lo.ss
prominent position. In stndvinj; tlie.se
prohlems of hospital plamiiiii,^ with iiianv
siiperintendents in all parts of the worhj.
I am led to the l)elief that what mav be
j)erfect and complete in Xorthern Canada
wonld he siin|)ly ridiculous in Florida;
that which would l)e complete in (Termanv
would lie lackiiii,^ in detail in .Vmerica; and
I believe that the planniiiii- of the hospital
is unlike the |)lanniiii; of any other huilding
for it must be ileveloped for the climate
and the environment in which it is to be
built, and no rules can be laid down which
would apply equally well to all parts of
the countrv.
MODERN HOSPITA1.S
INTERIOR DOOR FINISH
So I shall not discuss at this time the
construction and phmning of an hospital,
but shall take for my subject the "Details
and Equipment of the Hospital" — com-
paring the American with the European
work, and. in taking this branch of the
subject, I will not be trespassing so much
on the field already covered l)y my prede-
cessors.
I think it was our own Dr. Emerson
who said, in a paper presented a few years
ago: "An hospital building is a piece of
medical aj)paratus for use in the treatment
of patients." If that is true about the hos-
pital building, is it not more true about
the interior details, the equipment and fur-
nishing of the hospital.''
By presenting some of the things which
I have been able to photograph myself,
or to secure from other sources, it will give
you some idea of the way other hospital
AIRING MALCONY. LTKKCHr. II(>I,1,AM)
AMBULANCE ENTRANCE, BROCKTON HOSPITAL,
BROCKTON, MASS.
men in other countries, as well as this,
have solved some of their problems.
Construction
The interior finish and details of an hos-
pital are of considerable importance when
the economic and hygienic side is consid-
ered, whether finish is to project witli edges
and moiddings to catch dust or to have a
smooth surface. In the modern German
hospitals one rarely sees any projecting
member, and I am speaking now of the
portion of the hospital set apart for the
care of the patients.
The door jamb may be of iron or wood,
l)ut it is sure to be of the simplest detail.
The iron jamb is (piite likely to be contin-
ued through the wall and around the open-
ing in tiles as is well illustrated in the
private hospital of the "Merchant" in
MOD !•: i{ \ II OS ri r A r,s
M.\TKI{MI^ WAUI), IJ'l'HW IIT
Vienna, or in tlie plain fini.sJi at St.
(ireorg's in Ilanihnrg.
Bnt wliiio this finish aI)()V(' tlio flooi' in
the rorciyn hospitals is \vell-ni<ih |»('rl'('(t,
the j()inin<;' of tlie door jamh to the floor
in iHNirly everv hospital which I visited in
Europe is, to my nund, verv had, as it
leaves an untidy anj;le impossible to dean.
If this door jand) is cut away and the ltas(>
earried llirouj;h as is shown in the illustra-
tion, whicli was taken in (Iraee Hospital
at Detroit, it is almost impossihle for any
dirt to eolleet. This base and jamb is set
before plastering, so that every part of the
finish is smooth with the wall. This same
character of finish should also be applied
to the windows. The American door man-
ufacturers certaiidy make better and more
sanitary doors than in any country I have
visited. The one-|)anel or no-panel "slal)""
doors now beino- used in the modern .\meri-
can hospitals are to be preferred to those
used abroad. The hardware is a small
item but should always be selected for its
suitability. The an^le door knob or handle.
as .seen in the (icrnian hospitals, has many
advanianc's over the frlass knob. Invisible
liin<;('s, bo.\ed strikers and non-projectinfi
haniware can be used to advantage.
'i"he ever prcMMit (|uesti()n, "AVliat is the
besj floor.'"' is often met with antl i^ hard
to answer, '{"his (|neslioti I a^ked of llie
leadiiii;- architects and hospital men in
Knrope and the almost universal prefer-
ence seemed to be fur lile. ,i light grev peb-
ble linish vitreous tile; llic next favorite
lor a hard or dense floor was terraz/.o.
while one would see evervwhere on the
Continenl llie Battleship linoleum. This,
cemented as it was to the constructi(jn and
laid against a tile base, made a very hy-
gienic, noiseless floor. One wouhl liardl\
HKVOlA l\(i liAl.coN^, I I'liii irr
SOrAUICM, CORKY HILL IIO.si'ITAL, HIJOOKLINK.
ever see wood used for floors, while lino-
leum Avas used not oidy for floors but for
table tops, stair treads, .screens and even for
door panels. In my own practice I have
found that linoleum is the best all-around
ward or private room floor becau.se of its
noiseless and .sanitary (jualities.
The exterior details of th(> hospital are
important but should be made subservient
to and expressive of the plan and to fulfill
the mission of the hospital. The entrance
should be dignified and express its use as
far as |)ossil)le.
The pnnailing idea of surgeons and phv-
sicians that the patients should be in the
open air as nuich as po.ssible makes it
necessary for us to design airing balconies
and roof wards. The hospital at Utrecht,
in Holland, has many excellent features.
3
MODERN HOSPITALS
(iKNKKAl, WAIJD AT BKVKRLY HOSPITAI,. l!KVi;i!l.V.
MASS.
one of them being the extensive airing
balconies. These airing balconies are used
very extensively wherever they are provided.
The roof wards are used extensively in this
country. Provision should be made in
these roof wards for diet kitchen and toilets
the same as for regular wards so that the
patients could l)e cared for night and day
if necessary. The airing balcony, however,
cannot always l)e in the sun and the clever
director of the T'trecht Hospital has had a
M Al ,K W A I! 1 ), 1 1 i;V\V( )( )1) IIOSPITAI.. ( ; ARDN KM, M ASS.
revolving l)alcony built, wliicii follows the
sun or can l)c placed to shield the pallcul
from the wind.
The .solarium is, of course, useful as a
day room, but unless well vciitiialcd is apt
to get very "stuifv." It can be made at-
tractive with j)alms and flowers.
Whv not make the whole ward a solari-
um, as was done at the Beverly llospilal.'
The windows made large, extending low
enough .so that the patient could look
out while Iviu": in bed, and hioh enoujrh to
.secure the maxunum ol sindight. In the
European hospitals, ca.sement windows are
used, as well as transoms, but one hardly
ever .sees the unsanitary roll shades. The
wa.shable linen curtains are u.sed and make
the ward much more homelike.
Artificial lighting for the general ilhimi-
(;i,.vzi'.i) Diviui.vc; PAUTirioxs, isolating di;-
I'AHTMENT, JOHNS HOPKINS HOSPITAI.
nation of the ward, using a reflecting light,
is much less trying to the patient
Note in the illustration of the Ileywood
hospital that the ward is flooded with sun-
shine, as each bed is near a window.
In the (lerman and Holland maternity
hospitals, the babies are always kept in
the same room with the mothers and the
draping of the bassinets is sometimes (|uite
grotes([ue. This hospital at I treclit was
()1HI.|{\M'|()\ WAIil). Cllll.DltKNS ItllLDIXC;.
.lOllNS HOPKINS IIOSPITAI,
M () I) i; w \ II OS n r A i,s
7
•'Wt'';
■p^sacaa:..
lir.ATi;!) I'OOl) W \(.()N. A.MSri;i!l)AM IIO^I'IIAI.
one of tlic Ix'st i'(|ui|)|)('(l tli.il we s;iw. ( Ndic
here a<>iiiii tlie reHectcd lii;lit.)
In the illustration of the interior of Johns
IIo|)kins Hospital, it will he noted thai Mr.
IJntler lias used the glazed dividing |)artitions
for the rooms in tlie isolating department,
similar to that seen in the I'asleni' at Paris.
The ob.servation ward of this institntion
has the unique feature of having in the
same room children infected witii different
diseases, for observation purposes, dividing
the cases only by a glass ])artition some
eight or nine feet high. Scrub-up bowls
occur along the outsitle wall. 'I'here is a
free circulation of air everywhere and why
is this not a simple solution of a small con-
tagious hospital? Perhaps the cubicals like
the Pasteur, where one room is absolutely
cut off from another, would be a little safer;
but 1 believe that for the small contagious
hospital, there is no necessity for separate
buildings for the difl'erent diseases; for with
proper isolation of the buildings and pre-
caulinri In' ev«'r\one \isiling, and the ob-
ser\ancc of lli<- la\ss of antisepsis, these
casc> ^l|ollll| be as safcK' cared for without
danger fiotM cross infection as in separate
Itiiililings.
Of course, all utensils, china, and <-verv-
Ihitig about ilie patients should be stcrili/.cd.
and ill lliisway there should be no necessity
for keeping the china of flic difl'crcnf cases
separali'.
( )ii I lie ( 'dill liiciil (]iir sccs \-cr\' ivw tuirses
bed-side calls cillirr bclU or otherwise.
'I'he |)aticnt iiiiisl wail iiiilil tlir nurse
makes her rounds. In an .Vnicric.in hos-
[)ital, ho\\c\fr, nurses" calls from tlie pa-
tient's Ix'd seem a necessity. I cannot
recommend too strongly the doing away
with the nois\ clamor of the ordinary call-
iiiir svstem for IIk- iiursc and doctor. 1
ori.KAriXCi Itl ll.DING. ST. GKORGS. IIAMHIRG
STKRILIZINC; ROOM. BKTWKKN ASKFl'IC AND CLK.\N
ROOMS SI'. GKORGS, HAMBURG
think the liell system should be relegated
to the shop and factory where noise is ex-
pected, as noise i)egets noise, and no matter
how numv "Silence'' signs there are, if the
electric call bell is rung whenever a patient
wants to turn in bed, there will be other
noises to drown the .sound of the bell.
With the simple devices of electric light
calls now on the market, the working of
which is simpler than the electric bell it-
self, 1 think the system should be .so
arranged that the patient after once pre.s.s-
ing liic Ituttoii could iu)t cancel the call,
and. at the same time the nurse should
onlv have to go to the patient and not to
the wall behind the bed to cancel it. A
svstem of this nature has just been installed
in the Grace Hospital at Detroit. A simi-
MODERN HOSPITALS
OPERATING ROOM, DRESDEN HOSPITAL. SINGLE LARGE REFLECTORS ARE USED IN ALWY ROOMS
liLFIJXTKD LKilir. ITRECIIT
lar system for calling the internes was also
installed; the signals are set from the main
office and bv difierent colors and positions of
electric hnlhs the different doctors are sig-
nalled to answer. They go to the nearest
honse 'phone and call the office for instruc-
tions, then the call is cancelled.
The conveying oi food from kitchen to
patients is a very important item in hos-
pital economics. In the great Steinhof at
Vienna, where .S,()()() patients are scattered
over 3.50 acres of land, the food is carried
in electric cars and in an incredihly short
time is in the various serving rooms. In
the smaller hos|)itals, push cars are used.
At I trecht, this was a heated car, while
in some of the (ierman hospitals the two-
wheel cart with caus hung upon the high
rails were used. While the siuiple open car-
rier is sufficient for short distances, I be-
lieve that a food carrier made on the prin-
ciple of the Hreless cooker should be used
for long distance transportation.
The cfpiipment of the sink room is grow-
ing in importance with every new hos-
6
MODKIJX IIOSPITAI.S
■ ADDITION TO-
•GRACC-ZIOiPlTAL-
•DETROIT- MICHIOAM-
EOWA».0-r-.3TEVeN5 AE.CHITtCr
&OSTOA<- -A1AJ5 ACH USCTT5-
pital. Less is made of this room in the
European hospitals than our own. The
sink room becomes the work room,
the Uil)oratorv, tlie repository for all dirty
ward work. In this room there should be
the sterilizers for stools and bed jians;
these with the automatie lifts make the
work of absolute cleanliness nnich easier.
also the ward incinerator (and this I coii-
sider almost a necessity in the modern hos-
pital) ; and the sinks, the blanket warmers,
the bed-pan warmers, the mops and brooms
for cleaninj); are all essential. This room
should have large doors and above all
things should be well ventilated, lighted
and heated.
OpER.VTING BriLDIXG
It was a very noticeable feature tliat even
in the large (jcrman hospitals there were
but few operating rooms as comparcfl
with the numl)er of j)atients. Even in the
great ^ irchow there were but four. In
the St. Georg Hospital there are I)ut two —
a clean and a septic. In the clean opernt-
hm room the walls on two sides and ceiliiii:
are of glass and double, with spaces be-
tween for heating of these rooms. The
sterilizing room is placed between the
septic ;iiid clean I'ooins
entering from the clean
anfl from the corrirlf>r,
there being windows, how-
ever, into both rooin>, and
at those windows ai'c the
inst rn men t '^t(•^il izers,
w hich (-Jill |j(- i-c;i(-Im-(| with-
out lca\ing III*' Dpcratiiig
rooms. The aiijc-tliclic
room a bo joins. 'J'he ar-
tificial lighting is a<-com-
plislu'd b\' means of three
domc-sha|)ei| ceiling fi.v-
tures with numerous high
candle-power lamps.
In other (iermati hf)s-
pitals single large reflec-
tors were used in the op-
erating room.
I have used the type of
fixture shown in the ilins-
tratioii with good .success.
This shows a crane swing-
ing to the centre of an
eighteen-foot room; this
fi.xture at the Beverly Hospital has the ad-
vantage of being swung back out of the
way and leaves no dust-retaining surfaces
above the operating table, and can be raised
or lowered at will.
We, in onr investigations al)roa<l. found
that the reflected light from a high power
arc lamp in an adjoining room. >hining
through an opening in the wall and re-
flected from one mirror to another and
thence to the seat of operation, was very
successful.
I believe the day of the large amphi-
.V.-iaTll- U1'1.1;A11.\u UtKJ.M.^r. L.L01;(-. ^.;lA.^liiLKG
.MODERN HOSPITALS
OPERATING ROOM, SHOWING CRANE. BEVERLY HOSPITAL. BEVERLY. MASS.
theatre for major operatioiLs is past and
the .smaller room.s with movable oliserva-
tion .stands, where the student or observer
can get near the patient, should take its
place. 'I'he view of the Douglas Operat-
ing TJuilding at Brockton shows a room
wliicli I l)elieve is the most compact and
servic-eable I have ever seen on this con-
tinent or the (»ther.
No hospital nowadays is (piitc complete
without its i{oentgcn or .c-Ray room and
apparatus. The styles and sizes of the
ap|)aratus and character of the work done
varies with the institution. 'I'hc Uocntgcn
Institute, as this department is called in
the (icrman hospitals, is made nnich of
occupving in tiic case of St. (Jeorgs the
entire second st(»ry of the operating build-
ing.
Bath House
Occu|)ying a position of c(|nal im|)ort-
ance with the operating department in the
(ierman hospitals is the bath hou.se, this
building occupying the same relative posi-
tion on the medical side that the operating
buildiu"' does on the suroical. In this
building are located the various baths as
will be seen by the plan, with its electric,
steam, sand, douc-he, brine, CO2 (carbon
di(»\'i(le), hydro-electric, etc.
I thoroughly believe that in America we
should do more for the medical side of our
statt" in the way of sj)ecial rooms and equip-
luent for baths, muscular develo{)ment and
exercise of various forms. It is not un-
conunon on the Continent to .see a well-
e(|uipped gymnasium and mechanical mas-
sagi' room in an hospital.
'i'he method of sterilizing and tempering
the air in the St. (ieorg operating room was
most interesting. In the section shown
through the major operating room you will
notice that the outer sash is double and air
is conducted entirely around this hollow
space warming in winter and cooling in
snnuner, the Hoor. the walls and the ceil-
MOD K l{ \ ll<)> 1' I r A I.S
irifj. Additional lical in winter is seemed
from direct radiators heliind thin nickel
jilales in the walls as shown ni | ili< ilo<^fa | )li .
OI'Kl! VI'INc; liOOM. ItltOCKTON IIOSIMIAI,,
lil!()( KION. MASS
l)ul all()\viii<;' no air Ironi tlii> >onrcc to
enter the rooms. 'I'lic air for the operatiiij.^-
rooms is first hrontiht into a clean cliandx'r
where it is passed tliron^li ground coke,
thence over heated coils in winter and ice in
summer, fliron^li into the fan where it is
driven tlironi'li a filterini' snhstance of
fine sand and yravel and tlience taken to
the operating- rooms |)raclically free from
all bacteria. The ceilino- vents in the
operating rooms are closed and there is a
\-KAV UOO.M, ST. GEOKGS. IIAMIUIU;
sufficient pressure outward so that the
openiiiji; of any door would not admit
any foul air. 'This may have heen carried
to a refinement heyond what would l)e
necessary to follow, I)ut it certainly seemed
a well developed plan.
II I ■ 1 1 \'.
While it i- not ni\ iiilcntiDn to '^i) into
he sul)|e(t of he;itiii;^ ami \eritilation of
lospilaU. ;i- that i> loo hroarl a sulijcct
o take n|j heic at thi> time, still I want
o present a lew simph- way- which have
lecn called to m\ attention.
W the l''ranz .lo-ef hos|)ital at \ ieniia
the eoniliinalion shown in the ilhi>trafion
I'ltivvn; itoo.M wash hasin. (iUAci; iiosimiai..
DrrUOIT. MICH.
is used. This .section seems s(>If-e\plana-
tory; either the air comes from dnct> helow
— passing; over the radiators, or, liy man-
ipulatini;' the valves, the air of the room is
circulated. I noticed that in the (ieneral
Hosiiilal at \'icnna a svstem of "direct-
OUiFXT-IXDIRECT RADI.Vno.N". QIINCY HOSPITAL.
QITNTV. M.\SS.
MODERN HOSPITALS
indirect" heating was adopted for nearly
all the rooms and corridors, introducing the
fresh air from outside at the top of the
direct radiator, de{)ending on the natural
tendency for cold air to drop. Let me say
that I am for simple forms of heating and
ventilation for hospitals, for who wants to
breathe air at a certain even temjjerature
all day.- The patient in bed, covered
ft
PLAN OF BATH HOUSE, ST. GEORGS, HAMBUR<.
with blankets, does not need the tempera-
ture at seventy degrees or seventy-five de-
grees and is not comfortable with it. My
old professor of ventilatit)n used to say the
ideal temperature was that of a beautiful
June day in a pine forest in New England;
l)Ut this would not be at just sixty-five
degrees or sixty-eight degrees for the twelve
hours, as it would l)e varied with the move-
ment of the air. A system should be used
which would be as near "fool-proof" as
[)ossible and not de|iendant on mechanical
means altogether.
WHEEL STRPrrCHERS, (iTRECHT
10
STOCK KETTLES L\ KITCHEX OF ST. GEORG'S HOS-
PITAL, HAMBURG
Plumbing
There is perhaps nothing more impor-
tant in the equipment of an hospital than
tlie plumbing, for through the pipes go
all the filth and product of disease and
it is most important that this plumbing
work be done well and that all pipes and
fixtures on the room side of the trap at
least be get-at-able for cleaning not onlv
the outside, but the inside as well, that
r ■ p
C3
DD
CZZ)
FnschluftUansI
ASEPTIC OPERATING ROOM, SI'. GEORG'S. HAMBURG
enough space around the fixtures should be
allowed tor cleaning and the simplest form
of brackets and su|)port>i used.
The bath tub for the patient should, I
think, be constructed as to allow the pos-
sibility of filling it in the shortest possible
time. 'I'lie large inlet itlea like the ocean
steamship tul)s ;i|)peals to me. The over-flow
M()1)KI{\ IIOSI'IIALS
(if there must Ik: one) .sliould be sueli that
it can 1)6 easily cleaned; if the trap is set
above the floor the watiT line is within easy
reach of the hand and the |)ii)es can all be
cleaned inside. This tub should be set
high — making it easy t"or the inirse to assist
if necessary in the bath. With the "bug-a-
boo" of sewer gas exploded, there is no
reason why the private room, at least,
should not have a wash basin. In a type 1
have used in the (irace Hosj)ital, the bowl
and even the shelf and towel rack are away
from the wall.
The simpler form of surgeons' scrul)-U|)
sinks appeals to me, doing away with the
c(miplicateil foot and knee valve which has
come into popularity within the last ten
years and having the simpler elbow valves
for the non-hand-touching valve is only
wanted after the surgeon has done his
scrubbing-up. A page from the catalogue
of a (jcrinan in.>trunifnt maker show.-, the
develo|)ment of the elbow valves and the
simple brackets and supports. The sur-
geon can turn on the water lo the desired
tem|)erature, scrub his ten or fifteen min-
utes, then with a push of the elbow or
shoulder the water is shut off.
I have referred in;iii\ liiiic> to the St.
(ieorg Hospital at Ibimiinrg. I have done
this for two reasons: first, that tlic ;iv;iil-
ablc material was better, and scroinl. tli;il
the St. (Jeorg embodies the gn-afcr nunilxi'
of new and *'u|)-lo-dale" ideas that 1 Found
in m\ visits to over thirty-five lios|)itals
in Europe.
I desire to make acknowledgment to the
architect, the man whose study and knowl-
edge of the hospital problems has devel-
o|)ed some of the finest things in this line
in Germany, and, I believe, in the world,
liaurat Dr. K. I{iippel.
MODERN PRACTICE IX HOSPITAL HEATING AND
VENTILATION*
«// CI-.\RENCE W. WILLIAM.S
N this article it is the
purpose of the writer to
describe, in general, vari-
ous tyi^es of heating .sys-
tems which have been
adopted in modern hos-
j)ital practice and where
they slioiUd or should not
be u.sed. Only such sys-
tems as are applicable
to the larger institutions will be considered,
as those in the snudler class of buildings
depend more upon the resources of the
in.stitution than uj)on their capability of
economical o[)eration.
It is unfortunate that the economical
side of the selection and design of heating
and ventilating apparatus has not been
given greater thought and study; but it is
the prevalent idea that so long as it is pos-
sible to use the exhaust steam from an en-
gine in a heating system, further economy
IS impossible and if that condition is fuj-
*An address deliveivil iM'furc llu- N:iliiMi;il IIn-|Ml:il
.\s.socialioii.
tilled, then tiie only thing that renuuns is
to in.stall the system that costs the least,
regardless of the operating cost.
Considering first the compact or .single
block hospital, the system generallv in-
stalled is that using low-pressure .steam
through the building. In this tvpe of
heating, exhaust steam is w^vd with a
l)ack pressure on the engines, varving ac-
cording to the merits of design. The de-
ficiency in the exhaust .steam is supple-
mented by live steam, delivered through a
pressure-reducing valve. We have learned
by experience that for this type of building
such a system, if well designed, with mains
of ample size so pro})t)rtioned as to provide
a perfect circulation with one pound pres-
sure and to heat the entire building in the
very coldest weather with not more than
five pounds [n-essure, gives good results
with a smaller initial cost than any other
type of heating s\stem. There is tlie same
fault with this as with every other steam
system— namely, that of heat regulation,
which is practically impossible exc-ept bv
11
MODERN HOSPITALS
the addition of a temperature control.
This, as it rehites to fuel economy, will l)e
considered later.
Where there is more than one main hos-
pital Ijuildino- and the buildings are widely
separatefl, the low-jjressure steam system
is not so well adapted to these conditions
if true economy and first cost he consid-
SERVICE BUILDING, STAMFORD HOSPITAL, STAM-
FORD, CONN.
ME.SSRS. GEORGE D. POST * SONS, ARCHITEnS
ered. for, if it is desired to keej) the hack
pressure on the enoines within rcasonahlc
limits, the heatinj;- nuiins must he very laroe.
On the other hand, if the mains are not
properly |)ro])ortioned for load friction and
condensation losses, or if made too small,
then the back pressure on the engine is in-
crea.sed, with a consequent reduction in
power and incTcase in steam consumption.
There are many types of vacuum sys-
tems — .so many that it is hard even for
heating engineers to keep informed. — and
of the.se there are but two types whicli are
in general use. One type docs nothing but
remove the air from the radiators tlirougli a
.system of air pipes, they in turn being con-
nected to a vacuum |)um|) or an injector.
Its advantages consist of the removal of
air from the radiators, thus increasing their
efficiency, the reduction in size of tlic pi|)ing
and the reduction of fin' back pressure on
the engines becau.se of llic vacuiini in llic
air line .system. In a wcll-dcsigncd low-
pressure steam plant the addition of such a
.sy.stem is really unneces.sary, according lo
the writer's opinion, especi;illy if the auto-
matic air valves are comicctcd to air lines
which are connected together and discharge
into a convenient receptacle in the basement,
thus doing away with unpleasant odors
and discharge of steam and water from leaky
air valves. In justice to this .system, how-
ever, there is no doubt that it works well,
gives satisfaction, and could be installed
in many heating })lants with profit to the
in.stitution and comfort to the occn])ants.
The other type is that in which vacuum
valves are placed on the return or conden-
sation ends of the radiators or coils, the
bottom of risers, and wherever it is neces-
sary to drain the supply mains; and the.se
valves are connected to the return mains
which, in turn are connected to the vacuum
pump. This pump handles all the water
of condensation in the system and places a
vacuum on the whole, thereby making it
especially adapted to large in.stallations
where otherwi.se there would be unduly
large mains. This system is of value in the
remodelling of old steam heating plants,
where, through improper design or growth
by piecemeal, the |)iping is too small, thus
necessitating the u.se of hve steam at a high
pressure to force a circulatioiL Tnder such
conditions it can make a good showing in
economy and justifies its use. Large claims
for economy arc made for this ty|)e of sys-
tem l)ccausc of the vacuum, but while un-
doubtedly, in Ihcoiy. il ought to be more
economical than low-pressure steanu in
practice leaky vaciunn valves often nullify
all the advantages claimed for it. This
type of .system is found to be of greatest
value in large installations where .steam is
neces.sary for other uses and where, there-
^.r**^''^.
I
l^
tsl
roWLI! I'LANT, STAMFORD IIOSIMTAL. STAMFOKj),
CONN.
MP»8RS. GEORGE B. POST A SONS, ARCHITECTS
12
m()|)i;k\ II ()> i'i ta i.s
Idle, llic one set of rii;iiris cjin serve .'ill
purposes. Tlie l;i>l t'c.iliire ii.'is oricii liccii
tlie (iecidiiiii,' poiiil in I'mnoi' of wliollv sleaiii
sysleius o\-ei' oilier l\|)es iiiid lijis l>eeri iii;i(le
imieli of eiilii-el\ loo imicli. in llie wiilei'^
opinion.
Anollier svslern wliieli is in i^cnerjil use
in many hirifv hospilais is the liol l)!asl or
so-called IMennni sxsleni. 'I'liis consisls of
a series of fans or Mowei's rorein<;' healed
air through duels of hriek or oalvani/e<l
iron inio Ihe wards and oilier |)arls of liie
i)nildiiij;s, the aii' heiny' healed 1»\ coils
placed alongside Ihe Mower, oi- l>y radia-
tion at the base of Ihe heal flues. This sys-
tem has many advantages and has heen
more oenerally adopted for lar^e instilu-
tional work than perha|)s anv other, thoiii;ii
the cost of mainlcnanee is, no donhl, Ihe
o'reatesl. 'I'he ad\anlai;'es of this .system
are the concenlralion of Ihe healiiiii' a|)pai-
atus at one point, Ihe elimination of all
steam |>ipini;- lhroui;houl Ihe l)uildin<is, and
the ventilation or air changes oiven. Phe
disadvantaj^es are the cost of operation.
tlu> power required to drive the fans, and
that, if the air is re-circulated (as is some-
times done to save expense), it then Inis no
advantag-e.s over any direct system, Kiil an
additional drawhack of the extra co>t of
operating Ihe fan day and night in very cold
weather.
In nearly all hospital hnildings where
ventilation is actually re<|uii-ed Ihe method
now adopted In the most progressive engi-
ueei's is to Iuinc the ventilation svstem en-
tirely free from iieating; that is, in tiie rooms
and wards is placed sufficient direct radia-
tion to take care of the heat losses through
windows and exposed walls and a certain
amount of aii' leakage, flu^ air for venlila-
tion being delivered into the rooms as
tem|)ered air at about seventy degrees and
in such quantity as is recpiired l»y the nnni-
l)er of occupants and the pnrposi> for which
the room is used, liy this method the tem-
perature of the room can he regulated to
any degree desired, and on pleasant days,
when windows or doors may he opened,
the fan introducing teni])ere(l air for venti-
lation can he stopp(>d and cost of oj>eration
saved, while snfliciiMit heat will he main-
tained hy the direct radiation to k<'cp the
huilding comfortahle.
Another tyjie of heating which has re-
cently lieen iiitr-odiH'cd 1)\ a large inaiiufac-
Inring concern in .\c\\ 'SOrk State is that
w liicli inserts lino of >lcanj pipc> in the con-
>lrnction under Ihe doors and lliiis warms
the luonis In healing the flo(»rs oid\. This
is (piile a daring depariun- from any of the
so-called "totecl and tried"" svslenis, and
the writer doe-, not agree that it could he
>iiccess|'nlly used in modern hospital prac-
tice. Il may apply lo such buildings as
factories, wheic the occupant^ are on the
floors for only a few hours a da\, but I do
not think a nurse or attendant coiiM work
oil ^ikIi a flnor the lioiirs re(|uirc<l of lliem
in most of our ho^pitah. The liiiih tem-
perature lo which the llo(n> must be heated
ill order lo maintain an even temperature
in expox'd rooms docs not warrant the
recommendation of this svstem for hospital
praclic<\ and it will udt. therefore, further
lie discussed.
.\ lyp<' of lu'ating system that is gaining
nincli favor in large iiislitiitioiis as its ad-
vantages are licconiing better known is
the hot-water healing by t'orced circulation.
Hy this is meant a system of hot water heat-
ing in which a circniation is iniluced by
means of a pump placed in the circuit of
the mains, (he water beino- heatc(| \>\ cither
exhaust or liv<' steam or by both. The ad-
vantages of this system are economv in
steam coiisnm[)t ioii, ea.se of control. Ihe
maintenance of a constant temperature in
the wards, and the al)ility to run Ihe mains
an\ where, regardless of the grades, there-
by making possible the location of the power
house at a desirable |>oiut. which is often
iiol possible with a wholly steam sy.stem
unless pumps or other devices are installed
to return the water of condensation to the
boilers or expensive pipe tunnels are built.
Some of the disadvantages of this system
are that it is necessary to have an independ-
eiil steam system, as .steam is re(|uired for
other purposes in nearly all hospital build-
ings: that it re(|nires a greater amount of
radiation than a steam sy.stem and a con-
se(|uent greater cost of installation: that il
rt-iiuires greater engineering ability or
knowledge of design; and that it nuist be
installed in a more careful and better man-
ner than the usual type of steam systems.
One of the great advantages and one that
should not be o\'ei'looke<l, is the abilitv to
control the temperature in the buildings
13
MODERN HOSPITALS
bv controlling the temperature of the water
and the flow at the power liouse, besides
the individual control of the radiators or
coils. That this means much will be con-
ceded when we consider the great varia-
tion in temperatures to which we wlio live
in the east are subjected. In the New
England States, for example, the tempera-
ture varies during the heating season from
zero to fifty degrees, and even more. As
sufficient radiation must be installed to heat
the rooms to seventy degrees in zero weather,
and as the average temjjerature for the heat-
ing season in New England is a])j)roxi-
matelv thirty-five degrees, with a steam
system of 100 per cent, more steam is used
for heating than is actually required. If
projier attention could l)e given and the
radiation shut off when the temperature
gets above seventy degrees, this would not
occur, but, unfortunately, this is not pos-
sible where there are a great many radia-
tors or coils and, besides it is much easier
to open a window and let the surplus heat
escape. In some of the better class of
hospital buildings, thermostatic valves are
installed on the heat sources, which regu-
late the temperature of the building In'
control of the supply of steam to the
radiation. Such devices are not only an ex-
pense to install. l)ut are often found troul)le-
some to maintain. Their installation the
writer would recommend only to the better
class of buildings and large wards and clinics
where hrst cost is not to be considered.
It may be claimed that it is possil)le to ol)-
tain a degree of regulation with steam by
varying the pressure, but, even so, the best
that can be obtained by such a method
is by the use of high pressure steam direct
from the boilers, which is not good practice.
A hot water system is especially adapted
to the heating of many widely separated
buildings. Where ventilation or rapid air
changes are required, fans supplying fresli
air or exhausting vitiated air are driven bv
electric motors. "^IMie hot water for all
domestic purpo.ses, also for tlie heating
system, is heated at the central plant and all
apparatus centralized in the power house.
In sutiiiniMg up the ditt'erent systems
above described, as applicable to modern
hospital practice, many, no doubt, will
ask the (luestion, "Which is the best of
the several recommended.^" You will
agree with me, I think, when I say that it
is seldom, if ever, that a patient is admitted
to our hospitals and treated by our physi-
cians or surgeons without a very care-
ful study or diagnosis of the case. The
treatment that would apply to one j)robably
would not apply to another. Just so in the
question of modern heating and ventilat-
ing systems. A study of all conditions
must be made and if a competent and re-
liable engineer be consulted, he will value
his reputation as much as the physician
and siu'geon. and will design a system
best adapted to the needs and locality of
the institution.
A recent design for a large system of
hospital heating and ventilating in the
Dominion of Canada where extreme tem-
j)eratures had to be considered might be
referred to. After months of very careful
study a combination system was adopted;
namely, a forced hot water system for all
direct heating and a steam system for all
tempering coils. Practically every room
in the group of a dozen or more build-
ings is to be warmed by direct radiation.
Tempered air will be introduced to all large
wards and operating rooms and such other
rooms as require rapid air changes. The
ventilation will l)e entirely independent of
the heating system and will be largely by
exhaust fans on the roofs controlled by elec-
tric motors.
The writer thoroughly l)elieves in natural
ventilation as far as possible. There are
but very few days during the heating season
that the well-trained nurse will not have
the windows partly oj)en to admit the health-
giving fresh air just as it is provided by
the Creator. At such times, the direct hot
water heat will probably care for the tem-
j)erature of the rooms and the tempered air
will not be recjuired. Therefore, the fans
introducing this air can be shut down and
the ex])ense of operation saved.
I have often found entire systems where
the wards were wholly dependent upon the
introduction of air by fans or under pres-
sure, where, owing to the great ex|)ense of
operation, the same are not used or only
partly .so, and, therefore, no air is admitted
to the rooms if doors and windows are closed,
except what enters by wall or window
leakage. In designing the I'lenum cham-
bers and ducl.s, in this instance, they are so
14
\l()l)Kir\ II OSI' J I A I.S
arraiif^t'd as lo iiiltodiicc cdiisLhiIK Iciii
pered air l>\ i;ra\il\, simnld die I'aris lie
dosed; also. Ilic syslcin of vciilNalioii will
!)(• ()|)<'ii upon the same f^cncral plan li\ IIh'
iiitrodiiclioii of a.spiraliii<f coils citlicr in llic
flues dieinselves or at Hie point of assend)l\
on the roof. In tliis way. 1 maintain llial
while we shall Ke aMe conslanilv lo care fur
our room tempei'atnres \>\ dir'ccl ladiation,
we shall also liave a natural j,n-avity ven-
tihdinji' system that will "-ive us from two lo
tliree changes ot' air [)er hour, even lhoni;li
tiie exluiust tans l)e closed down, 'riiere arc
manv interestiufj; |)hases of this condiina-
lion liol water and ^Icam i\ .^leni thai 1
^lioulil like \cr\ mmh lo discuss if the time
pcrmittcfi. I will oidy add. Iiowever. that
as far as 1 have liecri aiilc lo learn, tliis is the
first conihiuation hot \\alcr and steam .sys-
tem of this nature applied lo iio^pital pra<--
tice and. no donlil, will In- watched with a
f^reat ileal of inlercsl. I lliorou<,dily l»e-
lie\'e lli;il foi- ;i larj^ely scaltcicd iii-litution
located Ml a lold section ol llic cdimlrs.
what i^ now licmn |il;iiiiic(| inr llii~ iiimlci-n
hospital will pro\c the simplest, most eco-
nomii-al .ind -atisfactoiA of all systems,
in U-.C in niodrrii ] iraclicc.
w \i;ii i\ >i la.n Ai. lu ii.DiNc. \i \i, \i: \ iai.i s Mi:\i()i;i \i. m )-i'i r\i,
MKssiis. i;ni.i;\ .^ « r< Ks. Mii ill TKcrs
15
THE BARNARD SKIN AND CANCER HOSPITAL
MAURAX & RUSSELL, ARCHITECTS
HIS l)uilding is Hreproof
throughout with an ex-
terior of I)riek and terra-
eotta. while the interior
is uniformly of reinforced
(• o n (• r e t e construction
^ . with a finish on all walls
I j and ceilings, cohunns.
'-- -^ etc., of Acme hard |)las-
ter, painted with impervi-
ous enamel i)aint. While the floors through-
out, together with the leases, are of carholith
without joints of
any sort, it is
hardly necessary
to say that all
modern hospital
require ments
were observed,
such as rounding
of all interior and
extericn- angles,
including the car-
bolith base, with
particular provis-
ion on all com-
municating doors
against tlie neccs-
sity ot openmg hy
hand and the
similar provision
against hand op-
eration in the
p 1 um l)in g fix-
tures. Nothing
has been omitted
looking to a thor-
oughly a s e p t i c
construction f o !■
the particular
needs of this kind of a hospital.
The uni(|iie features to which we woul<l
call particular attention arc: There arc-
two gateways to the hospital, the main
entrance for the admission of doctors, staff,
nurses and the public and the clinic entrance,
which also serves a.s the cntiauce for pa-
tients. No access is had fioin tlic entrance
for supplies in the rear or through the special
MKZZA.NLNK AM) l!(K)l' I'lAN
exit provided for the removal of the ca-
davers.
Briefly, the course of a tyj)ical case
ap|)lying at the ho.spital is as follows: —
Through the clinic entrance viu the exami-
nation rooms the ai)|)licant is taken directly
to the hydrotherapy which is directly under
the clinic and absolutely shut off from the
hospital ]iro]>er. After thorough l)athing
and cleaTisiny;, the clothes havin"' been
removetl to the sterilizer in the l)oiler room,
the patient is taken in hospital garb to one
of the rooms on
the main floor in
the wing to the
north sijecihcally
reserved for ob-
noxious c a s e s .
This isolated sec-
tion is, in fact, a
hos])ital by itself
in so far as com-
munication, food,
.service, pluml)ing
a n d ventilating
are concerned.
As objectionable
.sym})toms a r e
ameliorated, the
|)rogress is to one
of the j)rivate
rooms on one of
the upper floors
and as improve-
ment continues,
eventually to the
ward.
It will i)c noted
that till' (ih.'io/iifc
shutting off of
means of
one floor from another
enclosed clcvatoi' shaft
by
anc
ic
tlie enclosure
of the stairway in a metal and |)olished
wire glass enclosure, gives as thorough sep-
aration as would separate l>nildings with
connecting links.
The laboralorv facilities are unusually
coniniodious and eom|)lcte. as this hospital
devotes an uiuisual amount of attention to
16
\l () I) !•; K .\ ll()>l' I I A I.S
the slii(I\ ;is well .is llic .iiiicliDiMlidii n\'
llic (liscjiscs Irciilcil.
Tlic ()|KM';il iiiu,' rooms li;i\c lln' iiiiii|iic
I'ejiliirc of |)('riiiilliiii; IIh' sIikIciiIs |o oIi-
sci'vc ()|)ci';i I loiis IVoiii ;i (diiiiiioilioiis riic/-
/.iiiiiiic (looi- w lllioiil III!' il.-iii^cf of iiil'ci-lioii.
wliicli is oiijinlcd a^jiiiisl li\ inrjuis of ;i
phite "iliiss screen.
'riie whole efl'eel ;iii(l resiill in ihc Use
ol' tlie h(>s|)it;il (hiriiii;' Ihe hisl six inonllis
is of ;i ln'in'hl, .illijielivc iiiid ihoroii^hly
seieiilihe iirraii^eiiiciil eoNciiiii;' Ihc |);ii-
lieiihir needs of .-i skin and c;iin'cr hos-
pital.
T
TlIK MODKRX IIOHI'II \l,
UK staienieiit has heen made that Ihc
Ijuildinj;' of hospitals is a |)i'aclieal
expression of man's .sen.se of res|)onsi-
bilitv for the physical well-lteiiii;' of his fellow
creatures. If we accept this (h-iinilion,
the work .shonld command our sympa-
thies, as well as our most |)rofound sludy.
IVrhaps there is no class of linildini;s that
demands .so thorough an nn(h'rstandini^.
on the part of the architect, of the various
uses to which the ditfen-ut rooms and de-
partments of a l)uilding- are lo he put. ,is
does that to which iios|)ilals heloug-. In
oi'der to design and e(pii|) a hospital huild-
ing in a nianner that will render it of great-
est value to the counnunity in which i! is
erected, an architect must eond)ine uilh
the ability of an artistic designer, a knowl-
ed<>'e not oulv of sanitation, heatini;-, ven-
tilation and the various structural reiiun-e-
ments of the average building, but al.so a
considerable degree of familiarity with the
nraetiee of meilicine and surgery. lie must
by reading and study keep al>i-east wilh Ihc
progress made in the care and trt-almeni
of the sick and di.sea.sed, as well as that
made in Ihe science of building.
The im|)ortance of a full understanding
of the essentials in hos|)ital design is real-
ized when we consider that if an error occurs
due to an imperfect knowledge of acoustics
the architect of a tlieatre or hall lias ,il
wor.st .sim|il\ failed to secure for his c|i(>nl
the maxinuini of satisfaction in oper.ilion
and hence revenue obtainal)le from his
investment. The same might be said in
the ease of failure to provide ade(|uale
lacililics for th*' siieeessfnl operation of a
<onimercial building. Moicover, these rle-
lects would lie oluious and jirobablv read-
ily remcflicd. bul in Ihe r'ase of an improp-
<'ily \cnliialed Jiospital or one not j)ro\ ided
\\ilh projjcr jind adcijn.ale .sanitary ecjuif)-
nienl, Ihe lack while perhaps unappareni
woidd ne\ filhelcss endanger if it did not
• ■aiisc Ihc p(i-ilive sacrifice of hiim.-in life.
In \ iew Iherclore of Ihe complex nature
which cliaiacteri/.es hospital planning, and
Ihc sciidUs r<'sulls wIikIi mmi-I in ;i njeasiire
.il least follow any failure to full\- realize
and amply pi'ovide for the \arious re(|uire-
menls, il would seem lo be a ilutv which
the incmliei's of the profession owe humaii-
ily to thoroughly acfpiaint tliemselves with
Ihe probIem.s presented, .■in<l the .soliition.s
already furnished before atlcmpting to meet
the needs of any j)aiticular situaticju.
\'\(i iM ('i.i;\\i\(, SvsTKMs \ Di;«ii{AHi,K
I"'l..VlL Kl, 1\ -MuDl.liN 11(J.->I'ITAL.S
Till-", |)r<'\ailing idea now among the
leading hospital authorities is that
every hospital of fifty beds or over,
w here power is a\ ailable, .should l)e j)rovided
with a vacuum cleaning plant. The original
piping call l)e very sim|)ly done and .should
have a snfhcient number of outlets to make
the work easily aeeomplislie(| by the attend-
ants. Kaeli outlet should i)e valved so that
the ap|)lying of Ihc hose wduld lie done
with as lillli' noise as possiiile so as to avoid
disturbing the patients when this work i.s
going on.
The chief advantage of the vacuum
cleaning system is that all dust and dirt
arc taken diieclly to the receiver without
disturliing or distriiinting the particles of
dust or bai-teria. which are always a menace
where the floor is swept in the ordinary wav.
For that reason, the portable vacuum
cleaner, which exhausts into the air of
the room, should lie avoided in hospital
rooms unless this exhaust is conducteti into
Ihe open air by a .second flexible |)ipe.
The refuse from the cleaner should. <»f
course. Ih> luirned and not liberated into
Ihc open .lir. ("are should be taken lo
procure as noiseless a |)lant as possible
for tlie hosjiital l)uildiiigs. -£'. F. Stevens
r
^r O D E R X H O S P IT A I. S
The New Gexkkal Hosphal, ri\<'iNN'ATi,
Ohio
M
3lessrs. >anuie
Hannaforil & Sons, Architects
THE typical ward building illustrated has
its long axis directly north and south.
The basement has ceiling 10 feet high
the rooms are from two to four feet out of
ground accortling to the slope of the land.
Above the basement are the three stories
or ward units and over the double corridor
portion or "head-house" of the building is
a fourth floor containing a smaller ward
and accessory room from which is reached
an o|3en roof garden, 100 feet long. This
roof garden is surrounded by a jjarapet
about nine feet high, pierced by screened,
low-set windows. The basement of all the
buildings are connected at the north end l)y
well-lighted basement corridors, the average
being ten feet high by ten feet wide.
The ward units as shown in the plan of
the first floor present the following features:
To the right of the door, entering the
central corridor from the ])orch is a s|)ace
comnuinicating with the doors and ele-
vator. This is the "Fresh-Air Cut Off"
and measures seven by nineteen feet. This
|)revents the air from the basement and
from the otlier stories entering into direct
communication witli the ward. The fresh
air enters from the door or transom and is
exhausted through the ventilating shaft
near the elevator. 'I'he "Fresh-Air Cut
Oft"" also permits the complete isolation
of the first floor from those above. The
central corridor is eight feet wide and sixty-
seven feet long and is lighted by large glass
panel doors and transoms at lioth ends.
A sanitary driid<ing foiuitain is j)!aced in
the corridor near the visitors' bench. The
serving room or diet kitchen is thirteen by
fifteen; the food coming from the central
kitchen enters this room through the pas.s-
door and is here divided and, if necessary,
reheated. Tiie dining-room for convales-
cent patients, fourteen feet nine inches by
fifteen feet nine inches, can also be used
as a day-room should the overcrowding of
the ward demand the use of the ward solar-
ium for Ix-dridden patients. The bathroom
is nine feet six inches by fifteen feet nine
inches. There is a .shower on the male side
only, experience having shown that women
will not willingly take shower baths. This
bathroom has both |>ortalile and stationai'V
tubs. In the children's room, the tubs are
omitted and showers, slai)s and sprays
take their place. In order that the nurses
may attend to tlieir duties in the sink room
and yet have all the convalescent patients
under observation, wlut are al)le to use the
bath room, a plate glass four by sixteen has
been placed in the partition l)et\veen the
bath and sink room. The siidv room has
the custonutry e(juipment for sterilizing,
etc. Leading from the sink room is the
nurses' work-room, which is eight feet l)y
six feet nine inches. This room .serves the
double purpo.se of a "Fresh-Air Cut Off"
between the ward and sink rooms. The
work-room is connected with the ward by
an open arch, so that the nurse can, even if
at work, see the flash signal at her desk at
the entrance of the corridor. On the left
of the corridor and beginning at the main
entrance from the ])orch, a room for treat-
ment and class-room purpo.ses, twelve feet
six inches by fifteen feet, has been planned.
The door leading to this room is extra wide,
so as to permit the ])atients being trans-
ferred to this room in their beds when it is
necessary.
Hos])ital practice in this country and
abroad has demonstrated the neces.sity for
more small rooms in connection with the
large wards, where special cases mostly of
an obnoxious type can be taken. F'or this
reason there have been ])laced in these pa-
vilions one two-bed and three single-bed
rooms. In order that the various kinds of
service may have rooms of adecjuate size
for treatment and lecture rooms adapted
to their special needs, it has been so planned
that the partition l)etween the treatment
room and the two-bed ward, which is eleven
feet by sixteen feet nine inches, can l)e
moved, thus enlarging the lecture and treat-
ment room and reducing the doul)le room
to a one-bed room, ^^he doors, leading into
each of the small rooms, will iiave a peep-
hole covered with a movable metal plate,
.so that the nurses passing down the hall
can inspect tlie I'oom without disturbing
the patient.
'^rhe architects believe that it woidd be
extremely wise now to plan liberally enough
to provide for future development and
therefore additional small rooms have been
planned for carrying out new methiKis of
18
MOD K K \ II OS P I r.\ I,S
trealiiiciil tli.'il inc mii'c Io (Ic\c|(i|) hi IIic
futur(>. Tlic inside incjisurciiiciils of llic
wan! arc iiiiK-ty in tliirtv In lliiticcii led.
It contains twenty-Fonr Weds, i^ivin^ W^H
scuiarc I'cot of floor space and \AUi cnl)ic
feet ot air' space for' eacli Ix-d. Macli l)cd
^l.•lnd^ hctwccn two window-, which extend
III liie ceilin;^^ 'Ihe heating- is \>y means
of ImiI walci- |)i|)c^ and liy indirect niethofj.
I'hc olhcr details of the waid Imilding may
Ik' I'cadiiy delcfnn'ned IVom tli<- [il.-ni-> that
arc pnlilishcd herewith.
STAMFORD HOSPITAL, STAMI'OKD, COW.
MESSRS. GEORGE I!. POST A SONS. ARCHITECTS
SOME ESSENTIALS OF HOSPITAL HEATING
AND VENTILATION
Bn I). D. KIMBALL
V is noteworthy that the
many years of hospital
construction in this coun-
try have entirely failed
to produce an accepted
standard or method of
hospital heating and ven-
tilation. This is not so
strange as it may seem
if consideration he given
to the almost infinite variety of physical
conditions and needs of hospital patients
and of the nature of the buiUlings and tlieir
surroundings. Manifestly a method of
treatment for a hospital for the ruptured
and crippled who, in a general sense are
not ill, is not suitable for a hospital for
contagious diseases or for a surgical ward.
Nor is the method suitable for a hos})ital
in the open country adaptable to a hospital
built within city limits, particularly if
the city in question be one with an atmo-
sphere like that of Pittsburgh.
There is still a wide difference of opin-
ion as to the merits of artificial ventilation
as applied to hospitals. A ])rominent hos-
pital expert recently made the statement
that there was no such thing as a ventilat-
ing system for hospitals, that clinical rec-
ords in one of tlie largest hospitals of New
York City proved that the l)est results were
olitained in the wards in whicli no artificial
ventilating system was used, free use being
made of the windows. The statement was
also made that the air was "roasted"
in passing through the heaters to a tem-
j)erature of 400 degrees, the absurdity of
which statcTiient ])ecomes apparent when
it is recalled that the temperature of the
steam used for heating rarely exceeds Ho
19
MODERN HOSPITALS
degrees, while to reach a temperature of
400 degrees a steam pressure of over ;>00
pounds per square inch would be recjuired.
Investigation led the writer to the conclu-
sion that the o])inion expressed was based
upon an experience with an antiquated,
inefficient and insufficient system of ven-
tilation. The windows, in some cases,
were not only shut at all times, but screwed
fast or locked, the key in the latter case,
l)eing in the hands of the Superintendent.
Recently a hospital building has been
built without a system of artificial ventila-
tion, entire dependence for ventilation be-
ing placed upon the windows. An unfor-
tunate experience may safely be predicted
for this building.
It is granted that luider many conditions
no better ventilation may be had than nat-
ural ventilation through |)roperly construct-
ed windows, a fact too little appreciated
bv many designing heating and ventilat-
ino- enguieers
But there are many condi-
tions within the wards under which it is
(lesiral)le to close the windows, many days
when inclement weather makes
openino- of the windows un
desirable or impossible, and
many more days when, be-
cause of the direction of the
wind, absence thereof, or be-
cause of a sultry atmosphere,
no ventilation may be had
through the windows.
Artificial ventilation, as an
adjunct to natural ventilation,
is an absolute necessity if the
best results arc desired, as
is well evidenced by the in-
creased mimbers of cures am
lessened time required for
recovery in ventilated hospitals.
Actual exam-
[)les or proofs of
the value of
hospital venti-
I a t i () II are
coni|)ai'al i v e ly
rare because of
the difficulty of
obtaining lil<c
conditions
lor
c o tri p a r i s on,
lime element,
SKCOM) AND IIIIKI) Fl.OOliS, ADM INISIUA'IION IUTII.I)
ING, STAMI'Oiil) IIOSI'ITAI., STAMI'Olil), CONN.
etc., but in school and commercial circles
illustrations are aljiuidaiit.
In no place is thorough ventilation so
truly a requisite as in hospitals. Shocks
due to accidents or a collapse sometimes
attending siu'gical operations reduce the
vitality and render the patient unusually
suscej)tible to improper surroundings. The
vital resistance is diminished, or in some
cases a|)parently lost, by disease, making
necessary the most helpful of surrounding
conditions. The patient is acutely sus-
ceptible to the effect of imj)roper hygienic
surroundings. Pure air, proper medicine,
the best of food and skilled attendants are
of equal importance.
The reports of the Boston City Hospital
show that improved general sanitary condi-
tions in that institution changed the death
rate from forty-four per cent, to thirteen per
cent. In the general wards of the same
hospital the sanitary improvements effected
changed the death rate from twenty-three
to six per cent., or nearly in the same ratio
as in the surgical wards.
At the S. R. Smith Infirmary
at Staten Island a comparison
was made in two wards of
tlie same nature containing the
same class of patients, in which
case it was found that in the
ward without ventilation an
average of sixteen days was
required to effect a cure, while
in the ventilated ward the
average was ten days. This
also means a greater work
with the same equipment.
In the Dublin Lying-in Hos-
pital the death rate under old
conditions reached 50 per cent,
of those born, while for an
e (] u a I period
with imjiroved
sanitary con-
ditions, includ-
ing vcniilation,
drainage, light-
ing and disin-
fection, t h c
death rate fell
to five per cent,
("criaiii it is
tiiat the hospilal
^0
M Ol) K K N II OS !■ riA I.S
pulicMit wilii liis wcakciu'd vilalil) sliuuld he
provided with the best possible siirromidiiii;
coiidilioiis. l*A('r\' possiMe care is exer-
cised in sciecliiij;' llie palieiit's food and
drink. Inasmuch as llic ainoiml of aii-
a normally lu>altliy person hrealhes is ;5.0()()
limes hy volume and Iwenty-live times liy
weiii'ht, the drv iood eaten, should iiol llic
<;reatest |)ossil)le care he exei'cised m pro-
viding suilahle air lor hreathing.^
It is probable that in the past
loo little consideralion has been
given to the conditioning o
the air provided by the venti-
lating system, v.r., the regida-
tion of its dust content, tem-
perature and humidity, factors
now regarded as ((uite as im-
portant as air (piautity.
A certain New York hospital
board was led to condemn arti-
licial ventilation because of the
results with the system used
in their large downtown branch.
Investigation disclosed that the
air intake of the ventilating
s y s t e m w a s
through an area
at the sidewalk
level on one of
the busiest tho-
roughfares in the
city, no means of
tiltering the air
were provi<led,
humidifica I ion
was absohilcly
nealected, n o I'MiST
system of tem-
perature regula-
tion was installed, and the size of the duels
and location of registers indicated that the
volume of air had been too small, its tem-
perature too high and its diffusion nil. The
heating ap])aratus was crowded into a space
altogether too small, thus permitting of no
additions or improvements. And be it noted
that cram])ed sjiaces and failures of venti-
lating systems are intimately related. A
cloud of dangerous dust reached the rooms
with the operation of the sy.stem rather than
a stream of revivifying air. Small wonder,
therefore, that the system was condemned. It
is unfortunate, however, that such samples
of artificial ventilating systems should be
II.OOH, AD.MINISTRAIION HUILDIXG
IIOSPITAI., STA-UKOIil), COXX.
'|ii'|lc(| a^ <ili|cclii)ji> lo the iii.^tallation of
modern and cllicient .systems.
'I'lic first esseidial of hospital vciililation
is ample provision for natural vcntilaticjii,
Ihal is. pl(iil\ of window ojjenings with
properly arranged windows. An arrange-
iiicnl of the windows frecjueiitly advo-
<alc(i by li()s|iil,d (experts is the casement
window opening out in halves, half of the
w iiidow to be thrown out lo catch
the wind depending upon direc-
tion thereof, a lop light or
transom swinging in, being
placed above for night u.se,
all of which is good, but the
use of this requires constant
attention on the part of the
nurses. Of itself il is not a
ventilating system. A substi-
tute for the above window is
the ordinary doiible-hung win-
dow with a plate glass .shield
at the bottom of the window
inside, tipping in at an angle to
defied llie air upward when
.sash of the win-
dow is raised.
Open air bal-
c o n i e s m a y
hardly be con-
sidered as a [)art
of, or es.sential
to, a ventilating
system. t)ut they
are don lit less
e.ssentia! In the
equipment of
a modern hospi-
tal, some experts
maintainingthat
)f llie floor area of
STAMI OKI)
lea si
lifl\
_)('!■ cent. II
a hosjtital should be out of doors.
(^uile as importani as this [provision for
naluial ventilation is the provision of a
system for the ])ositive supply of fresh air
when the natural supply must be .shut nf\'
or is not dependal)le. This may take the
form of a fan system, and usually should
for a large i)uilding or a building within a
city, or it may consist of a gravity system
in the ca.se of a small building, the latter
lacking the advantages of ])ositiveness and
the difficulty of applying filters or satis-
factory humidifying devices thereto.
Essential to the full success of either the
■21
MODERN HOSPITALS
AU.MlNlSTK.VnON' AND WARD BUILDINGS, S IWMFOilD HOSPITAL. STAMFORD, CONN.
MESSR.S. nEOR(;F; n. P0.ST * .sons, .VRCHITEfTS
natural (window) or artificial ventilating
system is a system for exhausting the viti-
ated or foul air. This, too, may take the
form of either a gravity or fan system, the
latter .system being prefer-
able because of its positive-
n e s s and independence
of varying weather conditions.
The amount of air which
.should be su])plied and ex-
hau.sted by a hospital ventilat-
ing system varies with the
nature of the patients or dis-
eases treated, from sixty feet
per minute per occupant in
general medical wards to
100 feet in siu-gical wards
;i n d wards
ministering to
severe cases,
and lf]() to 1.50
feet in operat-
ing rooms and
in wards for
contagious di.s-
eases, the aim
in the latter
case being not
alone to give
the i)atient the
maximum o f
lOURTII FLOOR, ADMINISTRATION BUILDING (OPER.VriNG
PLANT; STAMFORD HOSPITAL, STAMFORD, CONN.
help but to protect those not inoculated.
In the case of wards heated entirely
by indirect heat the quantity of air sup-
plied should, in any case, be so great that the
temperature thereof need not
exceed 120 degrees at any time.
Special and separate sys-
tems of fan ventilation by the
exhaust fan method should be
provided for the laundry, kitch-
en and machinery rooms. Also
another separate system of ex-
haust fan ventilation should be
provided for all toilets, baths,
slo|>sink closets, mop closets,
disinfecting, refuse rooms, and
similar apartments. It is
especially im-
portant that
this be made
a separate sys-
tem of ducts
with its own
fan and motor.
It will thus be
a snudler sy.s-
t e m w h i c h
should be kept
ruimingtwenty-
four hours a
day and 365
22
MOD !•; i{ \ II ()- r I r A i.-^
days a ycjir, wlicrcas in Uiil lew cases arc
llic main cxliausl fans (t|)cralc(l dniin^j, llic
siiMuiicr, alllH)n^■ll il is l'rc(|iicnlly (lcsiral)lc
tlial llu'v slioiiM lie. 'I'lie pi'opcr rale of air
cliaiiii'cs in llie lOdins connected to liiis
s|)ecial swsteni will \ary IVoin Iwelve to
twenty |)cr hour.
A general rnle t'oi' air sn|)|»ly and e\-
lianst is to snppK air lo all rooms inio
which patients may enler, and
also to the corridors, and to
e.xhaiist the vitiated air from
such rooms, ti'om all the s|)ecial
rooms referred to aliove, aiu
from auv other rooms wlucli,
l)ecauseof their special use, would
make ventilation desirable.
Reference has heen niad(
above to the condition of the
air, a subject upon which too
much emphasis cannot be lai(
It should be free from dus
for dust may not oidy carry
disease germs
but il is a .seri-
ous irritant, and
if it reaches the
respiratory .sys-
tems of the pa-
tients it may in-
f 1 ic t i n j u ry
therein, and
render the pa-
tient liable to
further disease
because of its
physical a n d
germicidal pro-
[)erties. Also, it
i s believed b y
some scientists
that the dust contains nuich vewtable matter
from which, when comiiiir into conlaci with
I • • •
heatnig surfaces at a high tem|)erature. there
nniy be distilled harmful gases. I'rouble
from these sources may be obviated by re-
moving the dust from the air u.sed for
ventilation by means of filters.
It is most desirable that the air intake
.should be high, as high as the roof line if
possible. Actual te.sts by Dr. (irahani
Rogers, of the New York De|)artment of
Labor, demonstrated that there is but alxuit
one-seventh to one-tenth as nuich dust
fiftv feet above the street as at one foot
FIRST .VXD SKCOM) I'l.OOUS.
UOSIMI .\l„ SIA
abo\(' IIh; sidewalk. lb- aUo foutiil that
there was a Iessene(l proportion of oxidizable
mailer and of carbon ijioxidc in the air at
Ihe greater height.
Itegardless of the location of the air in-
take all air entering the hospital through Ihe
\'etililatitig s\stcni should be passed through
air filters. 'I'licsc nia\ lie of the cloth
t\|H'. although much of the cloth used for
I his purpose is either too coarse
or loo fine, insufficiently strong,
or' full of sizing which in damp
weather clogs the (Openings in
the cloth. Frequently these cloth
screens or the frames therefor
are so loo.sely jnit t<jgether that
he filter lo.ses its value as such.
.\ better apparatus for air
filtratioti is the air washer,
which is more thorough and,
with a reasonable amount of
altenlion, is easib kept in (jrder.
matter of dust suggests
the importance
of' pi'ojiei- eon-
sfi-ucfion of air
cluunbers and
air |)assages.
\\\ sides thereof
should be fln-
i.shed perfectly
smooth and
should be as ac-
cessiljle as pos-
sible, that the
interior surfaces
may be occasion-
ally cleaned, and
that they m a v
not become cul-
ture tubes for the
propagation of germs. To this end sheet
metal Hues are desirable, but where ma-
sonry chambers, ducts or flues are used thev
.should be finished perfectly smooth.
It is desirable also that air chandlers
should be .subjected to as much davlight
as possible, especially sunlight, because of
the germicidal properties thereof.
Ihnnidily has been icferred to as one of
the essentials of good ventilation. Rela-
tive humidity and temjierature are most
intimately associated. It is true that a
tenijieratiu'e of sixty oi- sixty-five degrees
with a relative humidity of fifty or si.xty
WAKi) lirn.Di.NCi. sr\Mi <i
Ml'OlU), ( OXN.
lil)
is
MODERN HOSPITALS
i •^jiiiMJ y^'"^:
'Jo.':-\o.ou^ Waco. ^TATinDco MojP'TAl.
per cent, is more comfortable and health-
ful than a tenij)erature of seventy or seventy-
five degrees with a relative humidity of
twenty j^er cent., the latter condition be-
ing frequently observed in our homes,
schools and hos])itals during the winter.
This dry atmosphere is trying to the eyes,
nasal passages and skin, it produces ner-
vousness and sleeplessness, and because of
the evajooration of moisture from the liody,
which rapidly absorbs heat, it causes a
feeling of cold desjiite the high tem]:)era-
ture. In marked contrast is a reas()nal)ly
humid atmosphere of the lower tempera-
ture, say fifty to sixty per cent, and sixty
to sixty-five degrees, in which freedom is
had from the above annoyances and rest-
fulness prevails.
It is not true, however, that the tempera-
ture may be lowered and the humidity
raised with a resulting saving in fuel, for
it takes vastly more fuel to evaporate into
the air the amount of water retpiired to
raise the humidity than is saved in the five,
or even ten, degrees less to which the air is
heated. In determining the capacity of
the boiler and in considering the fuel con-
sumption allowance nuist be made for
humidification. Inasmuch, however, as it
means the difference between healthful
and trying surroundings, between bright
cheeks and eyes or sallow cheeks ami (hill
eyes, between wide-awake minds or dull
minds, and even between preservation or
destruction of furniture, it is urged that
humidification is well worth its cost. Doubt-
less within five years, or ten at the most,
a hospital or school without provision for
himiidification will be regarded as ineffici-
ently equijiped.
The moisture for humidification may
be introduced into the air-su])])ly system
by means of steam jets blowing directly
into the air, by means of vaporizing pans
containing steam coils, or by means of
the air washer to which reference has al-
ready been made.
The first method has many objections,
the second serves but the single piupose
of humidification and is not so well adaj^ted
for large installations, while the third meth-
od serves the double purpose of humidifica-
tion and air filtration, and in the most
convenient manner, especially for large
installations. Nor is the cost of the air
washer greatly in excess of that of a really
well constructed cloth air filter. Its man-
ipulation is easier and ex|)ense of upkeep
little dift'erent. Discrimination should be
exercised in selecting the ty[)e and make of
air washer, as not all of tiieni are entirely
successful.
The relativ<' humidity may be aulomatic-
ally regulated by means of the humidostat
in nuicii the same manner as temperature is
auloniatically regulated.
We are much less a|)t to sullVr willingly
from a temperature too low than from a
U
MODERN llOSIMIAIvS
tem[)eruture loo lii^li, Iml ;is a matter ol'
fact an exccssivt'ly lii<rh tt'in[)oratiire, es-
pecially if accompanied hy ;i lii<i;li liuiiiidity,
may cause a rise in bodily tcuipcraturc
and even serious functional disturbances.
Iiuisnuich as sufficient radiation must Ik-
|)rovided for the coldest hut most iid'ic-
quent day of the year it is not stranj^e
that the complaint is frequently, and usually
un justifiahly, made of too nnich radiation.
Manual control is almost inijxtssihlc of
success aiifl an automatic temperature regu-
latintr system therefore hecomcs an essen-
tial part of a complete hospital heatmg
and ventilating .system, and it is an eco-
nomical device as well.
The subject of direct versus indirect heat
for hospitals is much discus.sed. The direct
radiators have the advantage of making
possible the quicker and less expensive
warming up of the rooms upon the closing
of the windows and of giving the patients
a place to warm feet or hands at such times,
the absence of which in rooms without
su|)plcm(;ntcd with a fresh air supjjly and
foul air exhaust by means of the ventilat-
ing system, and if they can be so placed
as iu)t to be too clo.se to patients, their
presence is usually regarded as desirable,
bill in such cases .several small radiators
g<'iicrally distributed are [)rcfcrable to a less
ruimber of large radiators which concen-
Italc llic heat. The radiators should be
plain and .smooth and should be su[)[)orled
t'lom the walls without legs with a space of
two inches back of them .so that they may
be kept clean as well as the wall and floor
areas in the vicinity.
Concealed piping for the heating .sy.stem
is regai'ded as preferable in that it lessens
available places for the deposit of dust.
Some consideration is being given by
the medical fraternity to the subject of
artilicial cooling of hospital wards. In view
of the results of recent investigations as
to the effect of excessive temperature and
humidity it is rea.sonable to expect that
much good may be accomplished in severe
WARD FLOOR, COiVrAGIOUS WARD HUILDI.XG, STA.MIOUI) HOSPITAL. ST.\MFORD, CONN".
direct radiators, is often criticized by doc-
tors.
The amoiuit of direct radiation used in
rooms occupied by patients may well be
hmited to an amount sufficient to counter-
balance the heat losses through wall and
glass areas. It should not be used in
operating and similar rooms. If am]ily
cases by lessening the temperature and
humidity within the wards in hot weather,
lliere is little available data, however,
as to the clinical value of .such an arrange-
ment. A combiiuition of a mechanical
refrigerating system with an indirect heat-
ing and ventilating .sy.stem for cooling pur-
poses is quite possible.
25
MODERN HOSPITALS
Reca]>itiilating-, the essential features of a
hospital veiitihitiug system may lie said to be:
Ample natural or window ventilation.
Supplementary thereto an ample supf)ly
of fresh air at a low temperature to all
rooms used by patients.
System of exhausting the vitiated air
from all such rooms.
S])ecial exliaust fan systems for toilets,
baths, slop sink and mop closets, etc.
Separate exhaust fan systems for laun-
dry, kitchens, machinery rooms, etc.
The operating rooms may well be sep-
arately treated.
Air intake shoidd be located as high as
pt)ssible.
x\ll air suj)plied to the hospital should be
freed from dust by means of filters, pref-
erably of the washer type.
Air chambers and ducts shoidd be fin-
ished smooth, and so far as possible be
subjected to light.
Humidification is desirable, and even
essential.
Temperature regulation is desirable and
a source of economy.
Direct radiation, of a limited amount
is regarded as desirable.
HOSPITAL LIGHTING
/,'// K. 11. HOSl'OCK
is. of course, rather trite
and commonplace to say
that here is a subject
to which, considering its
importance, the architect
has not given sufficient
study, and yet if it is of
the next greatest iin])ort-
ance to sanitation in hos-
pital building as it should
lank, then il is about the most neglected
sul)ject; for the light problems of a hospital
are rather peculiar, and caimot be met by
the usual methods of simply providing
enough windows or lighting outlets.
It is the unusual hos|>ital that is located
where it ni.n obtain full and unrestricted
light; rallici'. of nc(('s>ity. ai'e they in such
location^ in url)an districts where light is
cut off by surrounding buildings, l)y smoke
or dust, and sometimes forfeited to avoid
publicity. Every lios|)ilal, of necessity,
carries lighting problems of its own.
Ill hospital lighting one great help, of
course, is that it is the wise custom to keep
all interiors finished in while eiiainel, al-
most altogether, thus giving alxmt the best
reflecting surface, and. while undoubtedly
this has come to >tay, if architects had be-
fore them the n-adiiigs of ligjit efKciency of
rooms finished in white and in other colors,
they would be glad of the greater efficiency
shown as proving their wisdom.
Daylight lighting of hospitals is probably
just now in a transitory period, inasmuch
as, for the feeling of safety gained by its
use, wire glass is being used as a means of
fire protection. In hospitals in cities, prob-
alily before long, building codes will re-
quire its use, and in grouped or connected
Imildings it surely must l)e adopted, and if
such a possibility is admitted to exist,
then we had lietter plan to meet it.
One is apt to think of wire glass as the
grade usually used in hreproofing ware-
houses, etc., forgetting that polished wire
glass as clear as ])late except for the mesh
of the wire is j)rocurable. and, if he knows
of the latter, judges its price as being as
high as when first introduced a tew years
ago. It is, however, very inuch lower in
price recently, and can lie used to great
advantage in gla/ing.
It would seem that, in the case of a wing
with windows on three faces, that ordinary
rough wire glass would give all the desired
light and fire protection at the least cost.
When rooms can only receive light from
one e\|)osure, however, or if overshadowed
by buildings across the street to the exclus-
ion of light, we nuist find a means to utilize
all the available light Hu\ and resort to
polished wire or prismatic wire glass.
I'risiii glass and wire glass are of course
known to architects generally, itut possibly
it is not known to all that a combination
26
MODERN HOS I'l I A I.S
of them prismatif wire glass has re-
cently hecii riiarkclcd.
For use in locations facing streets or
light wells tlic niatMitaclnrcrs make prism
glass with (lill'crcnl angles calcniated lo
turn light into WniMings at approximately h
right angle, ami hy rererence to their data
the glass with correct angle lo suit any sit-
uation may he procured, and a double sash
window, the uj)[)er sash glazed with the
proper prismatic wire glass, and the lower
with polished wire, would seem appro-
priate, if cost permits.
It has become the custom of recent years
to equip each hos[)ital with a sun parlor.
The.se usually are built upon the roof .so
as to catch all possible sun and light, and
built with an insulating space sufficiently
supplied with heat between the outer and
inner glass, and are well [)lanncd for tlieir
purf)o.se, but it occurs to the writer that ad-
vantage is not taken of an opjjortunity
here in using the therapeutic (pialities of
light.
For instance, certain green and blue-
toned lights are depressing in effect, and, on
the contrary, some amber and rose tone
lights are cheering. Now, in the treatment
of certain forms of melancholia or those
where low spirits retard convalescence, a
corner of the sun parlor glazed wifli light
amber (champagne) tinted glass would be
of great value it would .seem, iji bringing
back brighter spirits.
The sash could l)e made to (it the inner
casing and movable, .so that they could
replace the clear glass at will, or even be
changed for other glas.ses having known
therapeutic values for the sunlight to l>ring
out.
Wherever a hospital is fortunate enough
to possess detached operating rooms, or
rooms with .skylights, advantage should be
taken of this fact to jjrocure light by having
a dome constructed, not of ground glass
as has been frequently done, but l)y a dome
of the new diffusive glas.ses in sheet form.
In the question of artificial light the first
inquiry is what .shall be the medium, and
it .seems, too, that there can be only one
answer, as electricity so nearly fills all our
requirements. The question rather seems
to be, is it worth while to use combination
fixtures or pipe for gas at all f
It will, of course, be admitted that great
danger ensues upon the use f)f gas in ward^
and operating looiu'^, first from the use of
light fabrics and lints. jukI ;iU(, from the
(langci's that slight leakages uilglil have
upon weak ami susceptible patient^.
(ias is, of course, inq)ossiblc where sid-
phuric ether is handled largely, an<l in the
days when chloroform was of more fre-
(|uent use doctors rememlier \i\i(ll\ Ihe
acrid odor of burning chlorofoi-m vapors.
No electric plant, however, is infalliiile,
and, as a matter of insurance again.st its
failure, perhaps the majoritv of architects
will think it wise to have the buildings fitted
for gas, and provide the neces.sarv gas out-
lets to tide over such a possibilitv.
\\hafcver fixtures may be provided should
be of the simplest ty|)e, with no more or-
namentation f)r angles to calcji dust than
can be avoided, utterly plain spinnings
and tubing, if they can be used with an
enamel finish that may be washed if nec-
es.sary, without harm, are best.
The lights provided for halU. stairways
and corridors should be as far as j)ossible
ceilinj'' dishes, this beinii- the form easiest
kept clean, and the glass bowl, if to be used
with a ground or acid finisli to soften light,
.sliould be specified "ground or finished on
the inside."
Wall brackets should be avoided if pos-
sible. They are harder to kee|) clean and
.sanitary, and there are known in.stances
of patients turning on gas outlets and lea\-
ing tliem undiscovered for a long period.
The color values of light in relation to
hospital work deserve a few words, for the
nur.se or surgeon must of necessity decide
sometimes as to what is healthy or unhealthy
tissue by its color, so that if its color value
is cluingetl very much from that of its dav-
light color they may be a little at fault.
Tlie yellow color of the carbon filament
lam|), sometimes intensified by long use, can
surely be improved on by the use of the
tungsten filament, and, while we have con-
sidered other sources, we are inclined to ad-
vocate the more general use of the tungsten
lamp as being the most practical white
light that we can use. having in mind also
its low cost per candlepower-hour.
The lighting of the hospital wards is one
point on which it is hard to come to a de-
cision, as there are so many factors to be
considered: the color, the amount, the
MODERN HOSPITALS
localizing, the mobility of units, all seem
to pull against each other.
The first thought arising probably is that
s(mie one of the concealed lighting schemes
would be of great value, but after considering
it in connection with other features, we fear
it does not ap])ly. Even if it were only a mat-
ter of enough light, the strain upon the eye
FIG. 1
of a patient who must for many hours keep
the tension of the eye muscles set, by reason
of the absence of restful variations of light,
would cause its al)andonment. Small can-
dlepower units are often needed as night
lights, and again high-powered lights are
needed for some attentions that must be
given and a plug and cord necessitating
two nurses' care is surely a disadvantage.
If a high-j)owered lani]) is used under
these conditions its light may annoy other
patients luiduly, and again it seems wise to
arrange units that can be brought in use
at any bed where needed as quickly as
possible.
As a matter of general ward night light-
ing, the iustalliiig of two or three ceiling
clusters with ground dishes is pr()b;il)ly
as o'ood as <-aii be done.
But for general purposes, after studying
all ciiuditions, perhaps a fixture built from
the suggestion in the accompanying iliustni-
tion might act as a guide.
If the "tongs" feature were not thought
feasible, this might be replaced by telescopic
tubes.
It is designed to Ciirry an eiglit-c-andle-
povvei' carbon and a foi'ty-caiidlepowci'
tungsten light, and for ordinary use to lit
into recess in wall as if it were a stationary
sconce, and used with the eight-candle-
power lamp as a night light or nurses'
aitl for general purpo.ses.
When for examination or attention a good
light is required, the light which would be
installed over every bed is pulled out to any
position where it will stay without atten-
tion, being tight-riveted in every joint
of the extension tongs and the swivel joint
with which it is fastened to the studding;
the rider weight is used to keep wiring al-
ways in order. The shade used could be
built doul)le as shown in cut, and if light
is to be used any length of time, the upper
part be slid out to serve as a screen to keep
hght from annoying other ]>atients; the
shades would be of light sheet metal with
white enamel finish, therein' acting as re-
flectors and when pushed back into wall
as sconce being in touch with wall finish
and almo.st unnoticeal)le.
AVhile not really in topic, it would seem
best to provide a push socket outlet below
this in wall for use if electrically oj)erated
instruments may be used.
In operating rooms care must be taken to
proviile enough light in all ])ortions of
room so that nurses may never be at a loss
in reading laltels. etc.. but the question of
proper lighting for the operator is a matter
of graver discussion.
riie usual procedure has been to |)rovide
a cluster of carbon filament lam|)s of sup-
po.sedly sufhcient power at a height of
about twenty-four inches above the level
of operating table. The candlepower us-
ually installed was from 120 to '-200, and
yet, while this would seem to be ample,
surgeons are continually complaining as
to light, and either require nurses to hold a
portable light close to the ])oinf of operation
or wearing a head lamj) with a reflector to
hei|) them.
One mistake has been that, the light liav-
iu"' usually l)een from a relatively small
area, whenever the hand of the surgeon was
Interposed of necessity l)etw(>en the area
of light source and the |)oint of o|)eration,
a shadow was cast that was inconvenient.
Perhaps this (piestiou could best be
solved by the use of a circular or rather
hexagonal fixture built up of say six three-
foot units of reflecting trough as shown,
canying lamps of forty-candlepower tung-
28
Moi)Ki{\ Fiosrri A I.S
sten tv|H; lillcd willi ii llulcd jrlass rcllcctor
desio^iu'd ;it angles to throw all the light
within a circle of two I'eel, dianiclci' at the
height of an opei'ating taMe. 'I'liis lixtnrc
m^^
. >l I H
I
I ; 1 1 . " 1 1 r ;
i''i(;. o
niiglit be hung at height completely out
of way of surgeons, and yet throw easily
two or three times the light availaMe imder
present systems upon the work, and if
diameter of circle be kept at about six feet
the surgeon cannot create a shadf)W that
will tr(»nl)le him.
'I'iie color of iiglit has also been considered
ill recommending timgsten lamps; the
slow-starling lights niight at times waste
vahiahic seconds, and the tid>e lights might
indeed by the breaking of a unit cause
lioidilc; whereas the breaking of a fila-
ment lanif) or two would in a circle of such
lights be no great incfjtivenience.
Jn the matter of the liirhtin"; of clinical
amphitheatres as attac-hed to most hosf)itals
we thiidv a fixture f)f this ty[)e desirable,
also, except that it had j)rol)at)ly be better
suspended by chain so as to give as few
lines as possible to obstruct vision.
CONTAGIOUS GROUP OF THE PROVIDENCE CITY
HOSPITAL
MESSRS. MARTIN & HALL, ARCHITECTS
[IIS particular hospital is
uiH(|ue in construction
and in its administration
because it is probably the
first hospital to be estab-
lished in this country
where contagious diseases
are treated on the theory
of contact infection,
which means, when defined, tliat such
diseases are not carried by the air but by
something or somebody coming in contact
with patients suffering from a disease and
transmitting it to the healthy individual.
Heretofore contagious diseases have
usually Ijeen combated on the theory that
diseases are carried by the air and it is
only very recently that physicians and
hospitals have begun to adopt the theories
of Pasteur on the subject of contact infec-
tion. He estal)lished a ward in Paris, in
which a varietv of diseases were treated in
the same building, under dehnite rules and
requirements as to care on the part of
nurses and others coming in contact with
tlie patients, and secured definite results.
Eighteen montJis of practice of these theories
in the Providence City Hospital has indi-
cated that they are soiuid.
The following extract from the report of
Dr. Dennet L. Richardson. Superintendent.
clearly explains the method employed in
securing the very best results from the
building as designed and planned.
"The opening year of the hos])ital has
presented numy problems. It has not been
easy to bring together efficient help (for
many of the employees had never had anv
previous hospital experience), and establish
a routine based on the principles and prac-
tices of other hospitals and adapt them to
our own needs. We have had to make
changes and expect to make more to im-
j)r()ve the service. The peculiar problems
relate to the method by which we have
started out to handle contagious di.seases.
It is based on the theory of contact infec-
tion, which, defined, means that these dis-
eases are not carried by the air but by
something or .somebody which has come
in contact by touch with a j)atient suffering
from one disease and transferred it to the
healthy individual. As a working basis,
contact infection is made to include po.s-
sible infection by coughing upon anything
or anyone at short range. While perhaps
this is the fir.st time this practice has been
employed in this country, it has been suc-
cessful in certain hospitals in England,
France and (Jermany.
In tlie treatment of all the contagious
diseases contact infection is avoided bv
29
MODERN HOSPITALS
1
' 1 i
B 1
^^^^
1
1 f
■■;:j
11 3 n 3
GENERAL VIEW OF GROIT, PROVIDENCE CITY HOSPITAL, PROVIDENCE, R. I.
strict ase]).sis, and air infection has been
disregarded. Nurses, orderlies, maids and
all the help are carefully instructed, first,
how to protect themselves, and, secondly,
how to avoid transmitting infection from one
ward to another, or from one patient to
another. The following set of rules is
given to everyone:
"Keep finger, pencils, pens, labels and
everything out of your mouth.
"Keej) and use your own drinking glass.
"Do not kiss a patient.
"Wash hands often and always before
eating.
"Keep (Mit of doors as much as possible
and always sleep with your window open.
"Do not touch face or head after handling
a patient until hands are washed.
"Do not allow patient to cough or sneeze
in yovu' face.
"Do not eat anything that patient may
wish to give you.
"If taking a drink or lunch 1)6 sure and
u.se the nurses' dishes.
"Put on gown or change uniform when
going into the ward.
"On leaving ward always wash hands.
"Always remember that infectious dis-
eases are carri<'d by contact and not by air
infection."
The nurses all occupy the same dormi-
torv and eat in the same dining-room.
When ready for (bily they go to a dressing-
room where they put on a ward unifornL
Each nurse is provided with two lockers,
one for her ward clothes and the other for
the imil'orm worn when off duty. On
leaving the ward she changes again, wa.shes
her face and hands and dries them on an
individual towel.
The ward maids live with the other fe-
male help and eat in the help's dining-
I'oom. They observe the same rules as
do the nurses, with the exception of wearing
a long gown instead of removing the outer
garments.
The resident physicians, when making
their visits, wear white suits and put on a
gown in each separate ward. This is not
always done unless they are likely to exam-
ine patients. No caps are worn. Great
care is taken in washing their hands.
Soiled clothing is thrown down a chute
and falls into canvas bags which are regularly
collected. One man is delegated to take
the clothing to the laundry, where it is put
directly into the ordinary washers and
washed in boiling water from forty to
sixty minutes. The man wears a gown
and washes his hands thoroughly after
handliuti- the infected clothing. The clean
clothing is delivered to the wards in bundles
tied up in cloth.
'J'he iuiml»cr of dishes which must pass
between the main kitchen and the ward
kitchen has been reduced to a minimum,
but such as do are carefully boiled. All
garbage is burned.
I believe that the most fertile source of
infection is the patient himself. It is very
important to nuike a correct entrance
diagnosis, tt) rule out mixed infections and
if tlicrc is any doubt, to isolate tlie case until
a decision is reached. New patients are
taken to tlic a<hiiitting room in each ward,
ulici'c tlicv arc carefully exauiincd, the
30
M()F)F;I{\ IIOSI'IIALS
history and physiciairs cxaiiiiiialioti care-
fully r(>c<>r(l('(l and llicn arc sent eillier
to fielention rooms, oiundcd |)\' ;i i-cd cjipd
if necessary, or sent lo tiie isolation ward.
^\ c lia\c alic;i(|y found our is<jlafion
ward insnflicieni and have heen ohlif^ed
lo isolate some nnxed cases in the di[jh-
llieria and scarlet fever wards. To fnlfil
4.
Kuolll.
24.
Sewinjf Room.
32.
G.
Lavatorv.
25.
Chamber.
33.
7.
Batli.
26.
Nurses' Diiiintj Koorn.
34.
8.
Linen Clo-set.
27.
Servinij; Rooni.
35.
!).
( 'IdspI.
28.
Df^tors' Diiiiiip; IJooiii.
36.
13.
Corridor.
19.
Women's [^avatory.
37.
14.
Stair Hall.
30.
Men's Lavatory.
38.
'23.
'I^iiniiel.
31.
Doctors' Bath.
30.
FIRST FLOOR PL.\.\, .VD.MINlSTR.Vno.N' BUILDING
Internes Chamher.
Superintendent's Parlor.
Superintendent's Living R(M)m.
Superintendent's ( hamber.
Superintendent's Office.
Matron's Office.
Waiting Room.
Nurses' Sitting Room.
tU. .Matron's Sitting Room.
41. Matron's Chamljer.
42. Matron's Bath.
43. Nurses' I^aundrj'.
44. Servants' Dining Room.
4.5. Pharmacy.
4(). Trunk Room.
SECOND FLOOR PL.AN, .\DMINISTRA HON BUILDING
Even if the diagnosis .seems j)lain, all
patients are placed in detention rooms for
several davs, where they are meanwhile
treated as suspicions cases.
the same purpo>c of the harrier .system of
the Kiiuli^li. we lumg on the bed, or put
on tin- door, a red card on which is printed
"Sjiecial Case." Hands are washed before
31
MODERN HOSPITALS
and after handling the i^atient and a gown
is worn. Every such patient has his own
bed pan, urinal, thermometer, and all his
dishes are sterilized. Every patient has
cultures on the first two days of his hos-
pital residence, and one is taken in the ad-
mitting room before he comes in contact
with any other patient. If the cultures are
positive in any but the di])htheria wards,
the case is isolated. Soap and water alone
are used for cleaning hands, floors, walls
and furniture. Mattresses are sterilized
by steam. Rubber goods and glass ^oods
are treated with carbolic acid 1-20. Fumi-
gation is never done.
I wish now to speak of the results of the
treatment of cases in the isolation ward,
where are carried on the same precautions
as will be used constantly and can be kept
in the room as long as the patient occupies it.
Utensils, dishes and trays after being taken
from the room are put directly into a large
utensil sterilizer in the ward kitchen and
sterilized by steam and hot air before they
are washed. The ward kitchen is thus
kept uninfected, and the trays of food are
made up and taken directly to the different
rooms. All rubber goods, glassware, bed
pans and urinals are sterilized in 1-20
carbolic solution.
Only physicians and nurses are allowed
in these rooms. If they simply go in and
do not touch anything in the room no pre-
cautions are taken. If the patient, or any-
thing in the room is touched, the hands are
washed with soap in running water and
TlllIiL) FLOOR PLAN, ADMINISTRATION BUILDING (Ser Key <m Pmje SI)
as are practised on the red card cases,
but more effectively. On the first floor
of the isolation building are ten rooms,
five on each side of a common corridor.
The doors are opposite to each other, and
beside each and opening into the same room
is a full window, sf) that a luu-se may pass
along the corridor and note what is going
on in each room without entering the door.
Each is provided with running water,
controlled by levers, which are operated
by the forearm, to avoid contact by hands.
The furniture consists of a chair, a metal
bed, and bedside table, so constructed
that they can be easily and thoroughly
cleansed. The patient once |)laced in a
room is not allowed out of it unless taken
out of doors, and seated by himself. lie
is j)rovided with a thermometer, pus basin,
hand basin, ice bag and so forth, such things
dried on individual towels. If the patient
is handled much or examined, gowns which
hang in the rooms are put on. The care
of the hands is rigidly insisted on. Toys,
books, etc., are either sterilized or burned
after the patient goes home. On discharge
of a patient the bed and furnitine, floors,
door knobs, wash basin and walls AAithin
reach are washed with soap and water.
Dirty clothing is sent to the laundry. The
mattress is sterilized by steam. The room
is aired as long as possible until there is
another patient to occupy it.
The s(>con(l story of the isolation ward,
consisting of one, two and three-bedded
rooms, has l)een ])rovided with running
water, sterilizer, etc., such as the first story
is provided with. This was o})ened early
in Jajuiary, 1911. and we now have amj)le
facilities for isolating twenty-five cases.
S£
MODKliX HOSPITALS
l^licsc aseptic |)rlri(i[)l('.s are lahorioiis
and icMjuirc llioiiglit and great care. Most
of the credit and success of satisfactorily
treating cases in this way belongs to the
nursing force.
The doors are left wide open and the w ind
sweeps freely through the rooms in warm
weather, wlien tlie windows are opened also.
From the opening of the hosj)ital March
1st, to the close of the hospital vear Decem-
ber .'51st, there were treated in lliis ward
140 cases, representing 1!>(I diirerenl dis-
eases. These diseases were divided as
follows :
Scarlet Fever ' 38
Diphtheria IS
Measles SS
Chicken-pox (i
Whooj)ing Cough 29
Mumps 5
Positive Di])htheria Cultures 21
Coiiorrheal Vaginitis.
Rubella
Krysij)elas
.\on-conta<fi()Us Disea.ses.
7
2
1
25
Tola! 190
At all limes there have been varving
cond)inations of Ihe aliove diseases in the
ward al the same lime. When there are
only a lew cases of chicken-jiox, measles and
whooping c-ougli, they are jmt directly into
this ward anfl kept there until discharged,
because it saves on nursing force and it has
.seemed .safe to treat them there. One ca.se
of mea.sles and one case of chicken-pox have
developed among the 140 |)ersons treated
in this ward, although they are j)ractically
in the same ward, and nurses pass from one
to another, ob.serving the necessarv precau-
tions. No case of cross infection has arisen
in eight months.
33
HOSPITAI. lU ILI)1N(;, BKOOKLVX ( HILDREN'S AID SOCIETY SEASIDE HOME. ( OXEV ISEAXD. X. V.
MH. EDWARD PE.VRCE CASEY, ARrHITECT
SEASIDE HOSPITAL OF THE BROOKLYN CHILDREN'S AID
SOCIETY, SURF AVE., CONEY ISLAND, N. Y.
EDWAKI) I'KAIUE CA.SEV. ARCHITECT
HIS hospital is an exten-
sion of the former phuit
of the Society, eonsistino-
of a niiml)er of frame
Kuildinu's and cottages
froiitinfi,- upon the !)eacli,
and is intended primar-
ily in its phmnino- for tlie
(Iren during; tl
treatment of voung chil-
le su
nimer months.
The site is an entire hh)ck located hack
of the present group, and was, at the time
operations were l)e<i,un, in its primitive
condition of drifting sand dunes, ten or
twelve feet high, of tine white heach sand,
which afforded, of course, an excellent
foundation for the walls of the structure.
'i'he hospital c()mj)rises the main huild-
ing. some 'iOO feet in each dirc<tion, and
;i detached laundrv huilding in the rear.
In these two l)uildings are found |)rac-
tically all the elements of llic niodcru lios-
[)ital estal)iishiueiit ; wards and sc|)aralc
rooms for patients; the aduiinislralioii,
including c-cnlr.il reception room, willi ad-
jacent waiting room, doctor's oilice, licad
nurses oflice and drug nxjni, and in the
rear of these the general dining room,
nurses' dining room, kitchen. ])antrv and
store room. There is also an operating
room witli dependencies and equij)ment
in the way of various kinds of sterilizers,
etc. A milk laboratory wheret he milk for
infants is ])repared. bottled and svdj.se-
quently distril)uted to the various diet
kitchens is also centrally located. At either
extremity of the l)uilding, on both floors,
are grou|)s of dependencies, each consisting
of a diet kitchen, a general lavatory and.
bath, an irrigating room, fitted with sinks
and slat)s for the treatment of infants,
and a linen clo.set.
A small ])athological room is provided
\\itli facilities for reseai'cli in disease, as
well as a morgue i-oom in an isolated posi-
tion in the basement.
Acconunodations arc aifordcd for a total
of I'-iO childi-cn. including lliose for sixty
cliildicn accompanied by their mothers,
each of whom occupies a separate room.
These I'ooms have dooivs o|>ening upon
Ihe balconies, as well as u|ion Ihc interior
corridors, and are furnished witli beds
pro\idc(l with small cradles, swinging from
34
MOD K l{ \ II OS r I I' A f.S
davits ill llic I'liiil for the con v<'iiiciil ac-
commodation (if I lie child, 'riicrc arc lic-
sid<'s I'oiir small wards cMiilainini; ^cvcn
cribs cacli, and two larger \\ai(l> each uilli
sixteen crihs arranged in Iwu row^ dnwii llic
center of the wanl.
Ill tlic second storv of the rear win;; Ihc
mirses are <|iiartered in sixteen separate
rooms, while in the second slorv of the
laundr\ Imildin^' the xarions emplosees
ure (juarlercd in eleven rooms.
The open court of Ihe Knildini;' at the
front faces tiie south. The |)ro eciiii^' w iuji;.s
.^
.^1
ftt
.\CORNF.U OK KUONT COURT, IK )SI'irAI. HI II, DIM.,
liltOOKLVN ( llll-DMKNS All) S()(li;i\ Si;\SII)i:
IIOMK, CONKV ISLAND. N. V.
MK, KDWKHl) I'KAlill-: I'ASEV, AliCHITKCT
on either side of this court are occii|)ie(l
mainlv hv tlie small rooms and small wards
for tlie infant })atients and their motlieis.
The.se wing.s are entirely surrounded on
three sides with covered balconies on both
floors. Doors from the rooms open dir-
eetlv upon the balconies and atford ready
means for the ex|)e(litious ri'iuoxal of |)a-
tient.s for open air treatment.
The plan of the hospital has been ar-
ranged with a view to the provision of the
greatest amount of air and thorough circu-
lation.
Tlie main corridoi' running across tlu"
building at the front may be opene<l nj) in
the warm weather so as to make it \ irtiiallv
ail o])en air balcony, similar to those sui-
roimding the wings. Besides, all corridors
terminate in either window or door open-
ings in the outside walls, while short cross
corridors are providml in the wings, all a>
an additional indiicenieiil to Ihe inlerioi'
circulation.
The Hat r(n)f over the whole building.
1 W fW mmm
I.OOKl.NC A( liOSS MiONI' < Olli T, IIOSITI \l. lillLI)-
l\(;. li|{0()KI.^ \ ( IIILDRKN'S All) SOCIKTV SK.V-
SIDI IKiMK, CONKV ISLAND, N. V.
\II( I UUMill J-KAR( K fA.SKY, AKIIIITEtT
a])pi()ached as il is by the main staircase,
also affords opporlunily for open air treat-
iiicnl under fa\orable conditions of the
weather.
All openings arc filled with casement
sash or iloors, as the case may be, with
Iraiisoiii s;isli oNcrlicad in c\'cry instance,
Iherebx alfordiii:^ means of ulili/in<f the
* -
entire ai'ca of Ihc opening for the passage
of ail', or of niodif\ing il to an\ desired
aniounl.
T\\v space lielwcen ihe roof and the
ceiling of the second story affords a non-
conducting air protection against the heat
of summer, and Ihe cold of winter, and for
I.OOKINt. INK) IKONl (OlKl. lICisl'llAL lil ILD-
IN(;. MHOOKLVN ( IIILDKKNS .\ID SOCIETY
SK.VSIUK IIOMK, ( ONKY ISL.\XD, X. Y.
MR. F.nWAHn PEAROE r.\SEV. ARCHITECT
the purpose of renewing the air as it l)e-
coines liealed in snininer, numerous small
openings are j)laced in the walls under the
cornice. These openings are provided with
35
MODERN HOSPITALS
WING, COXTAIXIXG S:\IALL ROOMS AND ^YARDS.
HOSPITAL BUILDING, BROOKLYN CHILDRENS
AID SOCIETY SEASIDE HOME, CONEY ISLAND,
N. Y.
MR. EDWARD PEARC'E CASEY. ARCHITCT
movable louvres, which serve to prevent
the escape of such heat as this air may
contain durine; the cold weather.
The space under the floor of the hrst
story is also provided with louvred openings
to admit of a ]iroper regulation of the air
under the building.
A complete circulating .steam j)lant is
installed, which will allow oj^eration of
the hosj)ital throughout the entire year,
although this is not at present contemplated.
The boiler is located in a cellar under the
kitchen and is of cast iron sectional type.
The radiators are direct and are located
under the window o])enings in order, as
is usual, to counteract the natural cold
currents at these points.
A high ])ressure boiler is also provided
to furni.sh .steam for use in the ojjeration
of the laundry, as well as to provide steam
for sterilizers in the operating department
and in the milk laboratory, and also for
cooking a])paratus in the kitchen.
Electricity is cm])l()yed for all lighting,
as well as for operating the laundry ma-
chinery and for ironing.
Gas is introduced sini])ly to supply small
cookers in the did kitchens, and as an
auxiliary in the main kitchen, and to supply
stcriHzcrs in the operating rooms ;iiid doc-
tor's ollice.
The con.struction of this plant is inter-
esting ni;iinly as affording ;in exanipU' of
fireproof hospital construction at a re-
markably low co.st, as this amounted to
.sixteen cents j)er cid)ic foot, iiichidiiig
laundry machinery atid all a])paratus of a
fixed nature, excepting sterilizers.
The construction to the level of the first
floor is in gravel and Portland cement
concrete. The outer walls of the first
story balconies are sn])ported on concrete
arches between piers of the same material,
the arches being concealed below" the grade
line.
The cellar under the kitchen, which con-
tains the boilers, 'water heater and coal
storage, was placed with some difficulty
about four feet below the water level in
the fine shifting beach .sand. The cellar
bottom w^as made very heavy of concrete
mixed with waterproofing compound, and
heavily reinforced with the tension bars
near the top of the slab, in order to resist
the upward pressure of the ground water.
The outside walls, including the roof
])arapet walls, are constructed of heavy
interlockino- terra-cotta tiles, affordino- within
the wall sufficient inclosed air spaces to
insure a dry and non-conducting wall with-
out the u.se of furring on the interior surface.
The balcony piers and arches are con-
structed of brick.
All interior partitions are of terra-cotta
tile of various thicknes.ses.
The first floor, including the floor of
the balconies, is entirely of reinforced con-
crete, of beam and slab con.struction, while
the second floor, including the balconies,
is a combination of reinforced concrete
beams filled between with terra-cotta blocks.
This latter method of construction produces
a flat ceiling, without resorting to the ex-
MAIN rUAXSVEUSE. CORRIDOR, HOSIMIAL liUH.D-
IN(;, BKOOKIAN CHILDREN'S AID SOCIETY SEA-
Sn)E HOAH', ( OXEY ISLAND, N. Y
MU. I.I)«AI(D I'EARCE CASEV, ARCHITECT
3()
MODERN HOSPITALS
pense of fiiniiij^, and tlicrchy docs ;i\viiy
with llic minicroiis surriicfs and angles
produced l)y u l)cain cciliii';', which tend to
the coMeclion of (hist and coltwehs.
The stairs are likewise constniclcd of
reinforced concrete and are finislicd witli
shite treads, and otherwise witli tlie same
liard finish that is a|)|)Hed to the walls.
Trim is used only in the o|)cnin^s of
thin interior parti-
tions, and this is of
as .sim|)le and non-
(i u s t - collect inj;'
character as pos-
sible.
Tlie w i n d o w
openings are with-
out trim, with the
wall plaster round-
ed in to meet the
frame.s.
In fact, all
angles of the plast-
er work, both sali-
ent and re-entrant,
are rounded, as
well as the angles
between the floors
and the walls,
which are finished
with a Portland cement base made flush
with the finished wall surfaces.
By these means all surfaces and parts of
the interior are readily accessible to cleaning
processes, so essential in a hospital, and
also are less liable to accumulate dirt.
An interesting feature of the construc-
tion is the outside trim, comprising the
base course, water table, main cornice,
sills, caps and steps. It was intended to
form these in concrete, but in order to
avoid the imperfections inherent in mono-
lithic concrete formed in place, such as
flaws, holes and a general rough ap[)ear-
ance, it was decided to cast all this work
in separate pieces on the ground, when any
imperfect casting could be rejected. This
was done, and besides all exposed surfaces
of the blocks were finished on a rubbing bed
to make them more presentable. No at-
tempt was made to imitate any particular
variety of stone, but tlie result obtained
hilly as sat)
aj)peai'anic
.•icf()i-y, boll: in
.■i> ^urnc of the
while al tlie same
A( (>\ i;i!i;i) i!Ai.( oN'i. ni;si'iiAi. lu ii.dinci.hhook
lAX Cllll.DKENS AIL) bOC IICTV SKASIDK IIOMK,
CONEY ISLAND, N. Y.
MR. KDWAIil) PKARfE CASEY, AKCIIITF.CT
seems tii he
hanlncss and
varieties of limestone
lim(> the cost is very muc-h less.
This idea of finishing concrete in the
same obvious ways that stone is finished
is one that is seldom practis<'f|. but snrelv
one material is as (■:iit:\\,\r as the other uf
iicing thus rendered more presentable.
I'lie exterior
surfaces of the
terra cotta walls
;iimI of the brick
[tiers and arches
>urrouiiding the
balconies, and also
III' the concrete and
tcira cotta ceiling
<>i' the first story
balcony, are stuc-
coed in Porth'uid
cement mortar ap-
[ilied in two coats,
'ihe finishing
coat was done
with a rich mix-
ture of white Port-
land cement com-
bined with coarse
white sand, which
gave a very hard, but rough sand finish.
More or less difhculty was experienced
in getting the men to sufficiently impregnate
the walls with water, and otherwise to
keej) the stucco damj) until thoroughly set,
but damp weather was a great aid, ami
very little hair cracking is apparent.
Experiments were made with the fine
white beach sand, of which there was an un-
limited su])ply. but the result with an e<juallv
rich mixture was very unsatisfactory as
the cement did not properly set and the
stucco could be rul)bed oft' as powder.
The floor covering for the balconies, as
well as the main corridors, operating room
and milk laboratory, is made in granolitliic
pavement, with metal mesh im1)edded in
the foundation to prevent cracking, as
the customary joints between sections were
eliminated in order to secure the unbroken
surfaces so desirable in modern hospital
architectural practice.
37
THE ARTIFICIAL LIGHTING OF HOSPITALS
Abstract of a Paper read at the ('oni;re.s.s of the Royal Sanitar_v Institute at Belfast, by Mr. John Darcli
|XY one wlio has had in-
■siaht into tlie work of
modern hospitals coiihl
not do otherwise t h a n
feel the <jTeatesi athiiira-
tion for tlie sjjlen(hd ser-
vice and effective ecjiiip-
nient that characterize
those institutions; and
yet it must be said that, models of ele-
oance and hvoienic forethoneht as thev
are. their excellence is usually marred
liv the enoraftino- thereon of svstems of
artihcial liyhtino tliat would justify a repe-
tition of ]\Iiss Xiohtingale's trenchant o})ser-
vation that "the very first requirement
in a hospital is that it sliould do the sick no
harm."
Light (and in that term radiation both
visible and invisil)le must be included), like
any other form of ])ower, may become an
agent of destruction or a minister of health
and blessing precisely in accordance with
the wisdom shown in its apjjlication; and
it is the duty of the professional adviser, l)e
he architect or engineer, to understand all
that j)ertains thereto before he can pretend
to satisfactorily invest his buildings with
the instruments of such a force.
There are to be avoided, on the one hand,
the evils of glare, and ])articidarly that
which, in a ward patient, would enter the
lower part of the eye; the evils of excessive
brilliancy, of violent contrasts of light and
shade, and of the injiu'ious and troublesome
rays of heat and actinism; there is also to be
avoided the risk of eye strain consequent
upon insnflicicnt light or upon the effort
to see in the face of inisplaccd lights. On
the other band, I here is to be sought the
comfort of a soft and well-diffused light
so arranged that vision ma\' be both easy
and pleasant, which, after all. is the proper
object of lighting.
'J'lic \alue of illuminaliiin (Icjicnds no! on
the aniouiil of light llial is shed throughout
a room, but on that which is reflecled from
visible objects. An essenlial part, there-
fore, of any scheme of illumination is the
colorino- of walls and ceilintrs, the strenath
of which must be properly balanced with
the amoimt of light availal:)le. Dark colors
eat up the light, and are. therefore, wasteful.
^^ hite ceilings, cornices and friezes not
glossy, with jiale tinted walls and slightly
darker dados, will best serve the hospital
and its inmates.
Let us proceed to consider some prac-
tical methods of dealing with the subject,
and begin with
The Hospital Ward
The average ward unit — of. say, twenty
beds- -should be provided with two kinds
of illumination, viz. (1) general, and (2)
local.
\. The oeneral liohtiuii' need be no more
than enough to see clearly about the room,
say. ()..5 foot-candle.
No sources of liglit, nor any illuminated
surfaces exceeding 0.1 candle-])ower per
s(juare inch (14 candle-power per square
foot) sliould be exposed to the patients'
or nurses' eyes; whereas the intrinsic bril-
liancy of the
Gas mantle averages. . 30 c.p. per sq. in.
Acetylene flame. ..... . 40 " " " "
Electric carbon fila-
ment 400 •• " " "
Electric metallic fila-
ment 1,000 " " " "
Direct illumination, therefore, u.seful
enough in the lofty outi)atients' hall or
elsewhere, is quite unsuited to the hospital
ward.
Direct lighting lamps may, however,
be usi'd if pro\i(lcd with proper shades,
i)ut everylhing depends upon that word
"proper." (dass shades and all transpar-
encies are inadmissible, nor .should any
partial translucency exceed the above-
named limil of brightness, while any shade
thai is used should etfectually .screen the
eyes without materially darkening the room.
If bracket liohts be used for oeueral li<jht-
38
MOD I-: l{ \ II OS I' I I A l,S
WAHD IN IIOSPIIAL Bl'ILDING
THH i{c)( KKi i;i.i,i;n iNsrrn ri; iok mi:i)1(:al reskarch, m;\v \()iik
MKS.SHS. VOUK A SAWVKH. ARnilTKCTS
iii<;', ;i hair circle shade should l)e used so as
to ilhnuiuate the wall. 'I'he piactical result
of all this is a soft all-oNcr illuiniiialion
which is very pleasiuii'.
IIi<;h placed ceiling lio'hts will prove
ecjually successful with a carefully calcnlaled
shadiiii;'.
Indirect lii;htiiii;' liy means of the in-
verted electric arc is deservedly gaining
favor, hut although it would serve well in
many parts of a hospital. 1 could not recom-
mend it for the waid. as the ceiling would
he too dazzling for those who have to lie
on their hacks.
.\ happy effect may, however, he ohiained
from indirect lighting, with timgsteu or
other metallic filament lani|)s, place(l inside
a .shallow metal howl, white on the inside.
To ohtain the hest eH'ect they should he
hung as low as convenient, nor should the
lamp he set too low in the l)owl.
Excepting in the wintei', ai'tificial light-
ing is little needed in the ward, for hospital
economy favors very early hours, liul vonic
sort of sulxhunl lighting is ni"ci>ssar\ dur-
ing the night watch all the vear round.
\\ilh gas or acetylene a -mall hurncr,
shaded, on a hy-pa-- would do. In electric
lighting, several expedients hav(> heen adojit-
ed. hut a "^ candle-power shaded lam|) i-
Ihc most economical. An cxcclleiit arrange-
ment is indirect lighting from .in S candle-
power lamp in a small howl.
"■2. Local l.iijlil niij. The sisters' and
nurses" laMcs should each ha\'e a well-
shaded lamp, that i- adjustahle in height,
so that au\ dc-ired inten-itx ma\' he oh-
taiiied. A comfoital>le illumination for
reading is 4 foot-candles. I)ut Kl foot-candle.s
is not loo nmch foi' some pui'po-e--. .V ifood
form of shade is a dee|i cone of dark green
opal, with the lamp entircK" recessed. A
more cheerful form would he one with a
rose silk flounce with white lining, deep
enough to hide the lamp, and for cleanli-
ness the top should he of white opal gla.ss,
and the Houuce easily remo\al)le.
'i^he patiiMits" lights are hest placed one
at the head of each lied, hidden in a dark
green opal sluide and somewhat to the left,
3!)
MODERN HOSPITALS
so as not to radiate heat on the patient's
head and to avoid gloss in reading. An
ilhimination of fonr candle-feet should be
available. This lamp will be useful for
examination, and should illumine the pa-
tient's chart. Near this there should be a
plug for a hand or standard lamp.
Steadiness is an essential condition of
good sanitary illumination, for fluctuation
and flicker are not only very disturlnng,
but may amount to permanent injury.
This trouble may arise (a) from the glow-
lamp when used on an alternating current
whose frequencies are below, say, 35 per
second; (6) from an arc lamp when the
light varies in intensity and color, due to
imsuitable or impure carbons, or when it
"pumps," due to defective feed mechanism;
(c) from the gas mantle, due to an ill-
regulated air sup])ly, accumulated conden-
sation in pipes or the wind from the open
windows of the ward; and {d) from all
flame burners by the two last-mentioned
causes.
Gloss is frequently as troublesome as
bare lights, and yet the majority of hospital
wards have shiny ceilings. There should
be no difficulty in getting a dift'usive or
dead surface as sanitary as that of the ob-
jectionable gloss.
The Operating Theatre
The operating theatre needs good arti-
ficial light, and plenty of it, for there is a
large proportion of surgical work done
after dark. It should have a separate
general illumination with screened lamps
over the sinks and sterilizers. The ceilings
and walls should be completely reflective,
and are be.st lined with close-jointed white
glazed tiles, with a little relief in the form
of a j)ale green or grey dado.
The illumination of the operating table
is, of course, the leading consideration.
The light siiould a|)proximate to the color,
the perfect dift'usion and the high intensity
of broad davliglit; both the luiisance of
overhead heat and the s('|)tic risks of dust
collection .should be avoi(k'd, and the fittings
and glass employed shoiilil be pliiiti, smooth
and easily cleansable.
It is important that the lights should not
all be clustered together, forming deep
and troublesome .shadows, nor be situated
directly over the table to worry the surgeon
with the shadows of his own head and
hands, or that would necessitate the fre-
quent shifting of the tal)le. Yet these are
the arrangements most commonly met with.
Every hospital has its own pattern of
operating light (scarcely two are alike),
while many of them are very curiously con-
trived. The following may be taken as
typical of the more usual arrangements: —
1. One or more j^lain shade pendants
of the common type, sometimes with a dust-
raising counterweight and pulley.
2. A cluster of from two to twenty glow
lamps imder a large opal shade.
3. llectangular trough four feet long
with opal sides, full of lamps, and sometimes
with a sheet of opal glass underneath;
this gives an excellent light, but the heat
is intolerable.
4. A foiu- or six light electrolier, each
arm with a separate lamp and opal or
aluminum bell shades.
Either of the foregoing may depend from
the ceiling or from the end of long swing
brackets. Glow lamps should have metal-
lic filaments; tungsten is said to give the
whitest light. Gas burners are sometimes
attached.
At Charing Cross the drawback of con-
centration is well met by distributing the
light over the long arms of four brackets
and round the gallery front.
The London Hospital and that at Ryde
are fitted with operating light, consisting of
a fixed central 100 candle-power lamp
under an opal reflector, with four hinged
arms, each with a 60 candle-power Nernst
lani]) in a condenser tube projecting the
light to any desired spot.
Electric arc lamps are employed in
some continental theatres.
Direct lighting with ordinary arc lamps
is out of the question on account of the
unavoidable shadows; excepting, perhaps,
for general lighting, lint where there is a
large skylight a splendid direct illumina-
tion nuiy be ol)taincd from white flame arc
lamps, which have a remarkal)ly high effici-
ency, and throw most of their light down-
wards. Four of tliese ni;iy be suspended
over, but not too close to, the ceiling light,
which should be of clear fluted glass to
spread the light. They may be fixed, or
may move on rollers worked by cords in the
40
MODKIIN HOSPITALS
room. (Questions oF dust and tlic iiiliiisioii
of liurij) triiiiiiKTs arc lliiis (■limiiialcd.
Indirect arc liii,litiiiji,', particidarly wlicrc
there is no skyliji;lit, is eniiiieiitly suitaMc.
Four teii-anipere open airs, properly f)la<'ed
and reflecting;- directly a<;ainsl a wliitc
ceilin<;', would <;'ive a hrilliaiil illniiiinalidM,
with all the advantaii-cs of da\ litilit.
Professor Siedeutopl' has invented an iu-
<;enious arran<;einent I'or li<i;htin^' the opcrat-
ini; table by nieans of isolated beams of
light, which are not only ample bul ciilircly
avoid the dust (juestion.
There are two forms of it : —
1. The siu<>;Ie, in which a twenty-ampere
projector, or search light, is placed out-
side the theatre, and about seven feet six
inches high, from which a jiarallel beam of
light is (lirected through a hole to a small
mirror, thence to the table, or through a
second mirror to the table. 'I'liis beam is
controlled by an iris diaphragm and smoked
glass. It is best suited to tin; gynecological
and throat theatres. It is necessary to have
good general lighting.
"■2. The compound foriii i-. more .-.alii-
faclorv. .\ piojcctor lamp as before, but
of twenty-five to thirty amperes, directs the
light through an aperture to a thin metal
disc, on uiiicli arc placed small flistriliuting
mii'rors which di\Idc tin- main licam into
a munber of smaller ones, and which are
sc|)aratelv projected to receiving mirrors
placi'd arounii the room. These mirrors
reunite the light on the table in a many-
sided form, free from shadows.
Electric fuse wires have a knack of
'Agoing" at most inoppoi-tunc moments,
while a l)reakdown on the part of a ^up[)ly
conij)any is not unknown. It is, therefore,
essential to have a reserve for such an emer-
o-encv. The fusin<r trouble is more common
on branch circuits; one excellent precaution,
lliercfoic. will be found in wiring glow
WARD I.\ ISOLATION Dl 1I.I>IM;
THE HOCKEFELLER INSTITUTE FOR MEDIC.\L RESE.\RCn. NEW YORK
MESSRS. YORK & SAWTER, ABCHITEOTS
41
MODERN HOSPITALS
lamp fittinos from two separate main
branches, either of which failing, enough
light may l)e left to work bv.
To provide against failures on tlie main
there are two methods: —
1. A gas lamp witli an inverted mantle,
as at the West London Hospital, which
should he lit during o])erations.
2. An electric accumulator, from which
a small emergency lamp sliould he kept
alight during oj)erations. and in connection
with which it should be possible to immedi-
atelv switch on sufficient light from the
accumulator to comj)lete an oijeration. Sep-
arate lamj)s would l)e required for this
purpose unless it would be convenient to
have the voltage of the accumulator etpial
to that of the circuit.
Some hosjiitals keej) oil lamps ready to
hand.
Hand and standard electric lamjts of a
varietv of i)atterns are to l)e found in every
operating theatre.
Thk Dispens.\ry
is nsuallv the worst served of any depart-
ment. It is, in London, frecjuently to he
found in the basement or in some other
part of the building lacking daylight, while
the artificial illumination is commonly so
inade(|uate that it sometimes becomes a
difficulty and a worry to read the prescrip-
tions.
A properly shaded light yielding four
or five foot candles is recpiired to each man
on the dispensing benches. The shelves
should be illuminated with .screened lights
to facilitate visual acuity; in fact, no bare
lights should be visil)le. Lndoubtedly, the
inverted arc lamp with a white ceiling would
aft'ord the best ilhimination. while the run-
ning cost of it should com])are favorably
witli that of glow lamps.
Nothing is more jn-oductive of eye strain
than the effort to (leci]>her any kind of
graduated .scale, but with the faint lines
of a glass measure in the twilight of the
average dispensary held uj) to a patchwork
background of bottles the strain is increased.
It would save time and afford conffort if
small white screens were fitted u|), one in
front of each luan, adjusted to catch the
chief incident rays from a skylight or win-
dow at such an angle that they reflected
towards the dis])enser. The same screen
could be used under an artificial light or
in a permanently dark situation, or there
should be an illuminated panel of either
reflec-ted or transmitted light.
ST. VINCENT'S HOSPITAL, INDIANAPOLIS, IND.
MESSRS. D. A. BOnLP:X & .SOXS, .ARCIIITKC'TS
HIS building is h)cated in
the center of a large i)ark-
likc s(|uare, well relieved
with trees and shrui)bery,
overlooking Fall Creek
and its boulevards. It
is accessible from Four
^ides, being bounded i)y
the most proniiiuMit drives
of the city. The location
is ideal and lends itself admirably to the
((uiet and restful beauty so desirable as a
backuround for an institution of this char- I
acter.
The building is designeil lo be fir<'|>i'o(ir
and as sarntarx' as modern means of coii-
■struction will allow. The exterior is of dark
pres.sed brick, grarling from a heavy, som-
ber coloi' on the first floor to a lighter and
more livelv one above, the whole beino-
lelieved with a rather free u.sage of Indiana
limestone. The floor con.struction is of
reinforced concrete slabs bearing on out-
side and inside brick walls; these walls
I icing designed heavy enough to practic-
ally eliminate all noises from penetrating
into the rooms. Throughout the entire
liuililing, sanitary base, made flu.sh with
the plastering, is used, and all ceilings and
wall cornel's are coved. ANOod floors are
o lie used in the rooms and terrazzo floor.s
and wainscoting in the- colridnrs and ■oper-
ating suites. All doors are flush panel,
inlaid veneer doors, and the hardware, etc.,
is designed as simple as possible to avoid
even the smallest lodging for dust.
-42
MODERN IIOSITI A I.S
Sj)Cfiiil attciitioii li;is hccii p.iid lu llic
arriiiij^ciiu'iit of rooms. 'I'lic nuilliw est
wiiio- l)('Iiiir (Icsioiu'd entirely lor I lie per-
niiiiieiil aileiiduiils of llie iMsliliilion. 'The
haseiiient of lliis |)arl heini;' cold .slora^c
rooms; first door, kitelieii and serving
rooms; mfiin floor, Sisters' diniii<i' rooms
and comimitiity room; second floor. Sisters"
apartments; third floor, nurses' apartments.
TJie north or chapel \viii<j contains wards
for nervous |)atients on the lirsl floor,
administraiion offices on the main flooi',
and the chapel and j;aller\ on the Icxcl
of the second floor. The soiilh, \ve>l.
east and center wings are devoted to wards
and semi-|)rivate rooms on the first fioor
and private rooms on the main, second,
third and fourth floors. Fyiitirely over the
main building and completely isolated from
anv of the other parts of the building are
the operating rooms, with their necessary
etherizing, sterilizing, .r-ray and rest rooms.
This floor also contains laboratories for
analyses, crematory, scrub rooms and re.st
rooms for physicians and tuirses. There
are also emergency op(>rating suites scat-
tered throughout the buildings, which arc
dcsign<,"d just as completely a> tlio-.e on tjie
operating floor. 'Ihc roof garden extends
o\('r the entire building and affoi'ris a de-
lightfulK- <)uicl place for |)alients to enjoy
the fresh aii'.
The building is e(|uip[)cd with large
sterilizing >!ills. so that all the water, both
hoi and cold, irsed on Ihc operating flooi-
and such other places as arc deemed riec-
cssar^, is distilled. The buihling is auto-
maticalK anil nu'chanically heated and
ventilatecl. Kach room being e(|uipped witJi
large outlet flues fi-om \\hi<-h the foul air
is drawn, thu> chan<i'inii' the air liii ouiihout
the entire building every few nu'nutes.
y\1I of the plumbing fixtures are of the late.st
approved types of hospital lixlurcs and
throughout tJie operating suites foot and
knee action fixtures are to be used.
In con jimction with the hospital building
|)roper, a large power house and laundry is
being erected. 'I'his building is two stories
high and is divided into a boiler room,
in which three 1.30 iior.sepower Kitzgibbons
high-pressure boilers are installed; engine
room and laundry, including the necessary
washing I'ooni. drNcrs, ironini;- looms, etc.
HAYNES CONTAGIOUS BUILDING. BHKiHTON, MA.S.S.
ME.SSR.S. KKXDAI.I.. TAYLOR * .STKVKXS. .IRCIIITECTS
43
CO-OPERATION IN HOSPITAL PLANNING
By M. E. McCALMONT, R.N., Hospital Specialist and Consultant, Former Supt. Civil Hospital, Manila, P. I. Chief, Division of
Hospital Construction and Equipment, Bureau of Health, Philippine Islands.
iX this practical age the
ultimate test of every
proposition is, not so
much what does it cost;
is it the newest thing;
or what do the critics
and others think of it;
but how does it v/ork; is
it practical ; does it stand
for the essentials of effi-
ciency and economy of service?
And this is the working test to which our
modern hospital planning and construc-
tion must be submitted. The architects
are giving us smooth interiors and artistic
exteriors. Many of them are becoming
indeed expert on the subject of rounded
corners and angles, flush surfaces and a
general absence of projections, and yet
we feel that these institutions are not yet
all that might be desired.
That "the hospital is for the patient"
has become an axiom beyond dispute.
But no hospital is successfully constructed
for the l)enefit of the patient unless also
constructed for the comfort and conveni-
ence of the entire working ])ersonnel. No
patient is receiving fair play from a hospital
which has faulty working machinery; where
jars, breakdowns and confusion are liable
daily.
In view of this, the question is pertinent —
are our hospitals practical from a icorkincj
standpoint?
Who is to answer this, the architects,
trustees and doctors, or the superintendents,
and working staffs .-'
The arcliitcct may be an excellent judge
of the dural)ility of the latest flooriug, and
competent to |)ass upon all the technical
details of hospital construction and finish,
but can we expect him to know the details
of hospital management sullicienlly to cope
with its peculiar and practical needs. ^
The trustees or boards of managers may
be able to see that a hospital is clean and
quiet, and be able to recognize, in practice,
smoothly running hospital machinery, or
its opposite — but can they, from their casual
visits to the hospital, be in a position to
locate an inconvenience of arrangement
which may be the occasion of daily con-
fusion ?
The doctors, through visits to their pa-
tients, may know whether orders are being
carried out or not; whether j)atients are
improving; or whether they are satisfied
with their surroundings and treatment.
But if tlieir patients are uncomplaining,
can they know that a lack of improvement
may be due to sleepless nights caused by
noisy, banging doors; crying babies who
should always be in sound-proof rooms;
the too near proximity of utility rooms,
bath-rooms or diet kitchens.' Can they
know that their patients are getting cold
meals because a diet kitchen is not adapted
or planned for efficient service; that a com-
plaint of lack of attention may not be be-
cause there are not enough attendants, but
because very often hospital planning neces-
sitates an unwarranted expenditure of time
and eft'ort in the way of service.''
These persons, doctors, trustees and ar-
chitects, are obviously not in a position to
fully appreciate all the working needs of a
hospital for the simple reason that, usually,
they have never worked in one. Yet they
are the persons upon whom we must de-
pend for the planning of our hos])itals.
Where there has been co-operation good
results are generally noticeable, but very
seldom is a superintendent seriously con-
sulted in matters concerning which often
he or she alone knows. Yet this same
superintendent will be expected to find a
way out of the difficulty after the error is
committed and the building comj)leted.
Rarely, if ever, are the various heads of
de[)artments called in for an expression of
opinion concerning subjects upon which
they are sure to have practical, if not tech-
nical, knowledge.
Never has the writer known of hospital
plans being submitted to the student nurs-
inj: body for suaji'estion and discussion.
44
MOD I-: u \ II ()> r I r a ls
^'(■i ll is .•iliiiosi ccrljiiii siicli ;i in'occdiii-c
would (li'jiw loilli iii,iii\ cxccllcnl sii^jics-
lioiis. I ,'irii ciiiilidriil lli.'il fcwci' ilici
Uitcliciis with llicir iiicx il;dilc noise woniil
!((' phiccd iicxi Id llic wjirds. ;is is so (il'Icii
(lone, il nurses or sn|ierinlen(lenls were
eonsniled :dioMl llie iiri'an^'enienl . I iini
;ds(> snr(" tlie\' would ;isk lor ;i I'easoindile
nnmlier of sonnd-pi'oof isolalion rooms
willi pfoperly t;ii;inle(l windows. Tlieirs
is lln' |)erson;d responsihijih for delirious
patients, and such a i'e(|iiest would lia\c
io he lieeded. ^'et, lauienlahU , few of sueli
rooms exist I
Would it not he as well to ask a dielisi
what is to u'o into her diet kitchen, and plan
aeeordin<;l\ , rather than laliel a tonr-walh^l
room "diet kitchen" and attempt to jikne
the manifold necessities tliei'c after the
linildin^' is completed.' It would seem that
such lack of co-operation is larg-ely res|)on-
sihle for a not utiusual arran^^-nient of
"•as .stove and ice-l)ox side l)\ side, with a
necessary serving table or drain-hoard hir
the sink omitted altogether for want of
room. Who hut the ilietist would he
liahle to think of the convenience of ha\iug
her meat hlocks ])lace(l near the cold stoi-
au'e, and her kitchen so arran<i'ed that hiod
trucks might be expeditiously loaded w ithoul
distnrl)ing the jiersonnel or working nia< liin-
erv of the kitchen itself.-
(.'an not the pharmacist best tell u^ of
arraiigcnients which would facilitate his
work; of the most convenient relation of
sinks, working tables, tablet machines,
dispensing connters. etc., etc..-' Would it
not he better to allow him a voice in such
matters, rather than have them aihitrarily
ari'anged by persons wlio could not l)i' ex-
pected to have a woi'king knowledge of the
facts, and. incidentally, would never ha\c to
sutl'er from the inconvenience ami annov-
ance which follow a thoughtless arrange-
ment oi- choice of C(pii|)ment and facilities.-
11 a ^npeiiutendent of nurses wen* con-
^nltecj \\i the matter of a nui'-cs' home, is
II not prol)al]|e llial nii^lit nur-e-, would he
pro\idcd with ^onnd-pioof rooms located
in a section of the building farthest re-
moved from duiiui; rooms, lecture rooms,
halhs, elc..-
'I'lie docloi's alwa\-< lia\c ade(|nale dress-
uig rooms, lockei's. shower halh>. etc., in an
operating pa\iliou, while a similar pro-
\ision is seldom if excr made for nurse>.
\ f\ nur-c> nia\ he perspiring through two
or three opci'alions to the <loclor s one, and
woidd ha\c e\'en greater ap|)i-eeiation of a
pi'oper dressing room and showci' than he.
If the chief operating loom nui'^e were
asked for sutiiifstiou^ in the planninir of an
operating |)avilion. i> it not prol,>aljle that
she would ask that these things he proxided
for her stall' as well as for the doclors.-
.Vlso, would she not piotot ai:ainst having
her instrument cases placed in the sterilizing
room, as is so often done.- Would not her
supph I'ooni lie much more con\cnient
and acce.ssihic than ihe Usual Inst .spare
III lie iililr.rd wliK-h i> labelled "".supplies,"
and then left to it^ -ad and unsatisfac-tf)rv
fate.-
riie loregoing i'ri'or> and man\ .-imilar
ones are actually I'oimd in the plans of
some of oui" best hospitals. 1 he\ are not
necessary, and it is believed that a friendly
co-operation between arcliitects and head>
of hospitals and heads of the various dc-
|)aitmeuts of the lios|)itals would .see fewer
and fewer commilt<'(l. Such co-operation
would undouhtedly develop a most whole-
some esprit ^\r corp- among Jiospital t'us-
tees, ofhcials and employees. All \\ould
then he working for the completion of an
iirstitntion both beautiful and .serviceable:
iutelligent in detail; and adapted in its
everv re(|uirement to the great pni'pose of
efficiently earing for the world.s afflicted.
Does it not seem woith the expeiiment.'
43
m
]\\g\\a\\n\\c
||D][n]0[c
110
A TROPICAL HOSPITAL ADAPTABLE FOR TUBERCULOSIS
/)'// M. K. McCALMONT, llo^pilal Specialist aii;l Consiillaiit
jX every tropical eouiitrv,
there are certain ])eculiar
and apparently in.sur-
niountai)le problems
w h i c h confront those
whose duty it is to pro-
vide hosj)ital care and
acconmuxhition for the
>i(k natives, foreio'ners
and government employ-
ees. Class distinctions and race prejudices
are encountered from the start and must
he handled delicately or the ensnin<>; fric-
tion will bring the working machinery
to a halt at most inopj>ortune times.
Probably every hospital built in a ti'0|)ical
country must needs be general in character
— that is, must lie I'eady to take care of
medical, snroical and obstetrical cases,
with ])rovision for isolation in case of an
unex])ected communicable affection, (ien-
crallv the officers, employees and nurses"
training school have to be accommodated
and suital)ly provided for. Sexes and races
have to be separated, making at the least
four distinct wards with well separated
toilets, lavatories, etc. To include these
manifold needs in one building and for a
niininnim amount of money is a ])robU'in
which has vexed iiian\ of those who have
cast thcii- lot in ti-oiiical countries to battle
with the numerous health and sanitary
problems to be found there.
The plan which is shown accompanying
this article is the result of exjjerience and
of a great deal of thought given to the subject
by the writer.
"Thorough ventilation" has been the slo-
gan, and has been accomplished by the
ward wings with three exposures and the
interior open court, which .should of course
be jjrovided with a constantly playing
fountain to cool the air in the heat of the
day. The chief value of the plan is its
adaptability and elasticity. The many di-
visions can be adapted to peculiar local
conditions found any place in the tropics,
while the general arrangement can he
retained though the structure be l)uilt in
varying cajiacities and according to vai-ying
appropriations.
The wards can be enlarged w ith increased
funds witliout disturbing the administrative
section.
Sexes and races are easily .separated.
The capacity of the hospital is practically
doublefl by removing the convalescents
to the upstair loofs where they should re-
(juire little oi- no nursing attention and
where they are out of tlie depressing at-
mosphere of the acutely sick.
Native traininii' schools foi' both voun^
1 1'' I ,rlr, •' I / . ■ , ■■ '( f
-^-1
.-lA
~::\
•'ro;;t IL^'.'.vnoN
I'lioi'K Ai. no^rriAi,
k;
M () I) i; I,* \ II () - !■ I r \ i,s
incii Mini WDiiicii ,ii<' Iiciiil;' sI.iiIciI hi ;iI
most ('vcr\ lii)|)i(;il cuiinlrN. Mic |)l;iii
sliowii |)i-()\i(lcs ii (loriiiilorv fur Im(||i.
It' tlic ti'iiiiiini^' school iiiclii<lcs oiils wumcii.
one (joriiiilorN iiuiy lie iis<-il for llic cxlr.-i
iiiiilc ;itt('ii(iiiiits, uliicli, ill siicli cvciil.
would !)(' ii('<-('ss;ir\ . \iiiscs. |)ii|iils, .md
(•iii|)lo\ CCS all li;i\'c sc|)aralc rools lor open
air sleeping', a in'aciicc wliicli is hciiij;- more
and iiioi'c encouraged, and wliicli in I'acl
|)la\s an im|>orlanl |)arl mc\('r\ cdiicalional
licaltli campaign. I'^oi' linndreds ol' vcais
ccrlain siiperslilioiis and fears lia\e kepi
orrict '/■\T.r>TfccLti 7 carter.
Vi,
I'KOI'lc \l, IKKlM lAI.
liall\c liiiii^e> lii^lilU c|o~c(| al lii;^lit. to
which I'acl iiia\ he lar;^el\ a 1 1 lihiited llio
wide pre\alcncc oi' liil)ei'ciilo-.i^ in tin*
IMiili|)pine^ and in other similar tropical
count lies.
The capacil\ lor employee- may he
ciilariicd l)\ pulling a -ecoiid -loi'V over
the k lichen pavilion, hill Mil-- i> iiol dcsir-
ahle as the kilclicii proper >hoiild he two
stories III lieiiihl. lo make il hearahle diiriii;^
llie hollc-l season. A heller a rra Ii;^cnielil
wolllil he lo hiiild a lliircl me,\pen>l\i'
hiiildini;' which coiild he utilized I'oi- a
laundry, tool house,
disiiifcctiii;: plant,
mrinerator, ele..
and w liicli could al-
>o mchitle accom-
modatioii.s for any
.servants not pro-
\ided fill" ill the
main hiiildiii:^-.
'i'hi- ho-pital in
the dime n>ion s
sh(i\\ii was planueil
a > a remi( irced c( m-
crclc >l ructure, esti-
mated lo cost ( with
a lai'Ljc proportion.
Ihouiih not all of
its e(|uipmenl) .SHO.-
(tdd. Labor con-
ditions, etc.. vary
lo such an extent
that it is impossil)le
to make a more ac-
curate estimate ap-
pl lea hie to other
sect lolls.
1 1 a larger sum
is available and
greater capacity de-
sired, the plan is
easily expanded by
a<lilinj^ an extra
room on each side
of till' central ad-
ministration section
and iucri'asinii' the
Icuutli and breadth
of the wards ac-
cordingly.
For convenienee
and economy ot" ad-
ministration the
ArODEU X ITOS 1' 1! A I>S
value of the ari'aiiueineiit is evident. So
coneentrated is this featui'e that the inini-
inuin amount of hihor from a small stati' will
take eare of a large number of patients.
AS A TUBKRCULOSIS HOSPITAL
A tro|)ieal hospital for general purposes
and a tuliereulosis hospital foi' a tenipei-ate
region have two great points in conunon.
Heating of the wards does not have to l)e
consideied and plenty of air is the chief
concern. l'\)r these two reasons atone,
the ])lan shown is very adaptable for cases
( crt;
snggestec
in cnaiigcs may he
though local needs
even ditl'erent modifiea-
ot tuliereulosis
made, as
may necessitate
tions. Airy wards, warm dressing rooms
and a maximum amount of sunlight are
demanded in the construction of a tubercu-
losis hospital. It does not seem possible
to get more suidight for all wards than by
the ai-rangement shown in the accompanv-
ing |)lans.
I he convalescents can be moved up-
stairs to the roofs, which may be covered
with awning or enclosed by glass. If a
larger hospital is de-
sired, a thiid story
can be added with
pi-actically t h e
same aii'angement
of wards and rooms,
or if |)rivate rooms
are more desirable
than wards the
wings could lie
broken up into pri-
vate rooms.
As a tuberculosis
lios|)ital, oidy the
administrative cen-
ter would require
heat ajid for such
a hos])ital in a cold
climate the central
coni't would ])i-ob-
ably lia\-e to lie
domed instead of
being left o])en. A
lar<ie ylass skvliyht
whicli could be
opened in summer
might be feasible
and desirabl(>.
Details of con-
structit)n of course
provide for roimded
corners and angles,
s niool li sni'faces,
and a general ab-
sence of projec-
tions. In addition
lo Ihc regular doors
I lie rooms ar(> pro-
wilh
\lilc<l
lie
so-
I Hoi'K \i, iiosi'rrAi,
ca 1 1 (Ml I la r- TOO III
doors which allow
ventilation dav and
48
M () I) i: ij \ II OS I' I I \ I, s
iiii;lil, \('l siilliricnt l\ -.ciccii llic \lc\\ I'oi'
ordiiiarv piiiposcs. Mvcrylliiii^' [lo^sililc in
tlic \\;i\' III' still i()?i;ir\' (M|iii|)riiciil Is luiill (ill
tlic (Iddi's, (ir HI (illicr \\(iril>. Mis|icn(lc(| IVuin
lIlC Willis.
'I lie |ii;ili l> cDMilJicliilcil to tlic lii)i|jil a I
wdi'M lur till' iiii('i|ii:ii('ri aiiioiiiit oi' air and
^llIlilL;■||| III all >ri-linn-. ami t'lir tlic ar-
raiiijciMciil wliicii ic|irc~ciit - iniiiiuiiiiii ser-
vice Willi ma \ nil II III II '^1 1 Its.
45)
MODERN HOSPITALS
PLATES
MODKKX IIOSl'IIALS
,r^
•4
mt
y.
y.
s^/
n^
I" 1
PLATE 1
M () I) K R.\ II OS I' I lA LS
THE NEW HKI.I.EVrE HOSPITAL. NEW YORK
MESSRS. Mr KIM, MF..\D * WHITE, ARCHITECTS
PLATE 2
MOD K l{ \ II OS I' I I A l,S
X
'^~'=^y>^i '. ' ' ''"v
'\y—'
u U
— i
U E Q.
Z
lJU DDiDU UD uu (^l5
-4-f-
f^""'" nn = DD DO DD m!;-tlj;
:^
i i
IS £
►J V
^
«
z
I'l.ATK 3
MODK UN II OS ITIA LS
FIRST FUXm 1'I.AN
ri:=;n
PLATE 4
MOD !■; K \ II OSI'I r.\ |,S
AT lilOlll ISOLATION m;ilJ)l\(; Al' I-OIIT IIOHI'MAI, lllJH.mNO
MEHSKH VOUK A HAWVl ]i. Aid illTKOTS
rN fKNTiiio r.AiioBATonv In n.]ir.\(;
MKSSU.S, HHRPI.KV, lUITAN A COIILIIm;!;. AliririTKCTS
TJIE 1KHKK1-'ELI,E11 IXSTITL TE F()|{ MEDICAE HESKAI{( 11. NKW VOKK
ri.AI'K .->
M () I) i: K \ II OS I' I r A Ls
THE ROCKEFELLER LNSTITUTE FOR
MEDICAL RESEARCH,
NEW YORK
M to[j is ii gciK-ral view sliuuing the three builtlinj;s
constitutint; tlie group. At left is the laboratory
iMiilding, of wliieli Messrs. .Sliepley, Rutan & Cool-
iiige were the architects. In tlie centre is the isola-
tion building, am! al tlie right the hospital building.
These two buildings were designed bv Messrs. York
iS: Sawyer, architects. .\t left is a picturesque view
of the hospital building, with a glimpse of the isola-
tion building. This view is taken from the Ejisl
River.
ri.AlK (i
MOD !•; K \ II OS I' I I' A l,S
n: 11 ' r ^ J
innnDOii
■cS-i. e^gmrrrx-onj icr: ji. i^ivje=
jt-JH-i- 1 r .L U U H. — PTTTm H U J f 1 J- A_ L
HOSPITAL BUILDIXO
THE ROCKEFELLER LNSTITUTE FOR .MKl>RAL Ri;sEAR( H, NEW YORK
MESSRS. YORK * SAWI ER ARCHITECTS
PLATE 7
M()l)i:i{\ II OS I'll' A LS
JtVENTH rLOOP^PLA.N
HOSPITAL nriLDi.vn
THE R()CKEFEI,I,KU IXSTriTTE I'OIJ MEDU Al, UKSEAIU 11. NEW YORK
MESSRS. YORK * SAWYER, .AJICHITECTS
I'LATK S
M () 1) i: H \ IIOS I' I TA l<S
HASEMF.NT KI.ODR IM.A.V IS(1I.VTI(>N uni.DINO
THE RO( KKFELLER INSTITUTE FOR MEDICAL RESEARCH, NEW YORK
MESSRS. YOKK A SAWYER, ARCHITECTS
PL.\TE it
MODKRX IIOSI'ITALS
NURSES' HOME. MKMOKIAI, IIOSl'ITAI.. MACAKA I'AI.ES. \. V,
MESSRS. GREEN 4 WICKS. ARCHITECTS
PLATE l»i
MOD K K N II osr I r.\ I,S
■Jlcoajd • rtooG • Plau-
FIRST FLOOR PUV-S"
NURSES' HOME, MEMORIAL HOSPITAL, MACiARA FALLS, N. Y.
lltaSRS. GRFE\ A \M< K-S, ARCHITECTS
PLATE U
M()i)i;u.\ ii()si'ir\[<s
01. niirr-
frcaMO rjoo» ^t*»
^=0
'^ST nrcf ft At
NURSES' IIO.MK, (iEXKUAT. H(\SPITAL, BUFI-AI.O N. Y.
MESSRS. OR££N 4 WICKS, ARCHITECTS
i'l.ATK \i
M Ol) K K N II OS r IT A I.S
y.
■r. m
I'LATK i:i
ALODKMr.X II ()- I' I r A 1,-
BASEMENT VU\S
CHILDREN'S HOSPriAI.. BIFFAI.O. N. V
NtESSRS. GREEN A WICKS. ARCHITECTS
PL.\TE U
.MODKIi X IIOSI'I'IALS
#'■#' ^ yv ^ /y^j'. ^
FIRST KIXKJR I'l.AN
CHILDREN'S HOSPITAL, BLU-AlA), N. V.
UESSBS. GREEN « WICKS, ABCHITECT8
PLATE 15
MO I)K I? \ n 0< I' ['|- A i,s
PLATE 16
M ODK l{ N IIOSI'I'I' A l,S
^
riuEm;^
U-,lJ| llllll \p
1
I'TT-n
<J-
c:;."j
1:3
CZ]
Lmm
-A
2J ^3 S'
si
a: » is
^ = n^^aligaa:;I-=3^aJ&ga(Jg^a
T-fP-
u
1:
CEIU.
i
TO
Hi
g
^ a
i^
ri.ATK 17
M () I) i; |{ .\ II OS I' I 'I' A l,S
y.
~ H .1
S2
2-
- V- fcj-j <
: •! 5 -- •
•4 i^ ♦ •« >* ^ ■
z
<
z
C
PLATE 18
MODK l{ .\ ll()>l'I I' A LS
I'l.V II. 19
\i () I) i; K \ II o-^ I' I r \ i.s
Tl
2:
c2
1..
10
2:
4
o2
1-
a;
i ■ &
:; 7 2 5
ills
.■'/ :i r^ .Tt
= B e a
■X, 7. -/. =
"-: 2 3 s
s
a . .
scu:-/ r^
. . . . > I
•ij «^ »c i.*; "^ t
2
<
c2 ^
u.
s;;§2
— .- J ,-
» » r. r-
_■ o *^
PLATE iO
MOD K i{ N ii o.^ri r A l>S
z
<
o
z
8
1^
o
m m
z
c2
O
o
o2
I
a
S
«=•
5 3;^
i t z
CO 0". o
ft- ac
t J g
2 i IP
t lo tt t- "T!
•' «~ t- c- X
o
iti 2 ^
•/, C s — 5-4
y.
z
<
H
2
uJ
y.
-^~if.= X
O
^ 5f-=2
HJ^wS
> ^ —• • —
I'LATE -21
MODKIJN HOSPITALS
X. ^
< I
y. ^
■f.
y.
I'LAIK ■-'%;
xM () I) K ir\ IIO< I' IT A LS
•J
O
c -
'A
-/J
<
PLATE 23
MODKKN 11 OSr IT A I>S
BARNARD SKIN AND CANCER HOSPITAL, ST. LOUIS, MO.
.VJESSBS. MAOIAN * RrSSF.LL. ARrHITECTS
PLATE ii
MOD K K X II OS I' I lA LS
BAKXAUl) SKIN AND CANCER HOSPITAL, ST. LOl IS, MO.
.MESSRS. M.\URAN * RUSSELL, .ARCHITECTS
PLATE 25
MOD K K .\ II OSITI A LS
SURGICAL BUILDING, NIAGARA FALLS .MEMORIAL HOSPITAL
llESSRS. GREEX 4 WICKS, .UlCHITECTS
I'LATE -^6
ATODK H \ II OS I' I 'I A LS
X =
X L- x
r. c
y 7.
'r- %
^ -
Z
X
I'LAIK
MODE UN IIOSIM'IALS
? ' 'w r . r' T i i ' .. i i ' .
F^" F F F F fif
IH
'If
1
*BW
P
P^
!whk1
,t. -,■"•' ■■■• :«!
FIRST rtOOR PIAH
^ii^'^_Sjil''"-^-&'__ --4— --. _i^
9^* t £j.
iSi^i^;;;:t!:tti«v:i4
ADMIXISTHATION- liril.niNG
iECOND nOOP PLAN
CINCINNATI (JEXEUAI, IIOSITPAL, CINCINNATI. O.
MtaSKS. SAMl Kl. IIAWAFORn A SONS, .mcHITECTS
ri.vn: -.'s
MODKKN IIOSI' I I A I.S
WAHI) II
CINCINN.Vl'l (iKNKIJAI. IIOSIMIAI
CINCINNATI, ().
^TM?.
,.[I3.vL-.-f^--ilrx
. ■ '^> - ta
ii.X.
g=cil
HasT riooa Pla/^
ISOLATION WARD KOK MILD FORMS OF CONTAGIOLS DISEASES
MESSRS. SAMUEL HANNAFORD 4 SONS
ARCHITECTS
MALE WARD FOR SKIN D1SE,\SES
PIATE 29
MODK UN llOSl'l'i'ALS
TVI'K AI. WAi(I) I)UII.DIN<;S
t -iVsJ? c=> C3 trj en C3 c:3 ca cr» c=>
dj tf V *~* t— f £3 i^V VSy t r " ^ » *T»
c
'^^
li,
r«.-Ai*i:fi7,rft'^tj«i*:i
T
D
ta^
Fffl
tU^ . Ic^ ^
;a.ST FLOOR. PLAN TYPICAL V/AR.D SUILD'.NG
fHE NE7/ GENERAL HOSPITAL CltlClMt'AT' -'^y-O
iAMUEL HANNAFOB.D AND jONS AR.CHITECT5
D
Q
B
a
KITCHEN AND SERVICE BUILDING
CINCINNATI GENERAL HOSPITAL, CINCINNATI. O.
MESSRS. SAMUEL HANXAFORD * SONS. ARCHITECTS
PLATE 3U
MOD K I{ \ IK) SIM I" A I.S
m
O
J
s
P ■<
PLATE 31
M()I)KI{\ IIOS I'l r A I>S
ST. MNCENT'S HOSPITAL, IXDIAXAPOLIS, IND.
MESSRS. D. .V. BOHLEX 4 SONS, -ARCHITECTS
PLATE Si
.M Oi) i; 1{ .\ 11 ()> I'l TA l,S
-.__. ^ ■^-*^-.
.pw A*4 ■O''- PoapTf -p_oo«-
> I
* mJ^^"*-'^ ♦
PI.ATK ;s:!
M () I) K l{ \ IIOS I'l I A I,S
PI.ATK :u
MOD I', R \ II OS I' I I' A LS
!^:.^-h
il----; ii-.-j(if..' t-.-i J--^ i--^ i
rRONT Ct.CVACnON
l_t-.Uj-.— I I - . L.-I. L- i - -l i'i. <.t- . - i i i .1 '.U -4--1 -II.J I L I I ': iTf
!.-i t - i
RCWJ CLCX^TIOK.
'2..s''~'~i7Sl~~~}.c~t^jSic^~~'I~-i'^'^Tc'~'^ Si' „■ X"""-
B f T:' :B- '"
C--1 .'.-i r:5 -ii i-.i
SIDE CLCVATION.
I Q QQQQ
i^ E-i i!-';
* j« -*--t " i4-« tt«a tj < > t »* t ^
nr^
nn
■^
SECTION N.lf-3.
m ;.=•-
=.--?E=!El
iKkspiTAi, mn.niNG
l?lt()()KI.^ N ( llll.l)l!F\'S AID S()( IK'I'>- SKASIDK HOME, COXEY ISf-AXD. \. V.
MH. I l>\\ M(l) PKAUCK ( ASKV. AUCIIITKIT
I'l.AlK :i.->
M ODKIIX II OSniA LS
iKjepiTAi, inii.Ki.vi;
iil!()<)M.^\ ( nil |)l!l,\^ All>
SOCIETY SEAS II i i: 1 1 ( ) M I ; ,
CO\E'\' ISI.WI) \.V.
MR. EDWAIU) I'EARCE CASEY,
Al!( IllTECT
PI.ATK 30
MOD K l{ ,\ II OSri lA LS
fiiR.-=<DC-~i
SccrioN THRouGtt Suction through: Section; through
PlAZZ>^ ArCHC.3 W>J.I..3 aNChCor PiA2.?A^. RCAJi CxTEMSION WALT-.
IIospil'M. i:l ir.liixc
lUiOOKI.IN ( llll,l)l!i;\S All) S()( IKTV SKASIDK llOMK, ( OM'A ISLAND. N. V,
Ml!. l.IIU Mill IM AKIK C.V.SKY. .AWHITKCT
I'LATIC 37
M () I) K |{ \ II OS I' I T A I, S
y.
-■ ^
ri.ATi-; 3s
M () I) i; K \ II OS r I r A i.s
^
In ^nVj'
i \ ' -■J
^W
liAKKMKNT A\l> I'lltfiT KI.DDK I'l.AN
EMEH(;EXrV IIOSPITAl.. HII FAI.O. N. V
MKSSKS. ghi;i;n" a wuks, ARrmTHi ts
1'I.ATK ;S!)
M () I) K l{ \ II OS I' I I A I, S
! i fei^ii:iira a 3S^t£j^& ± i
SECOND AND THIRD FLOOR PLANS
EMERGEXf V HOSPITAL, BUFFALO. \. Y
MESSRS. (iREE.V A WICKS, ARCHITECTS
PLATK 411
.M(Jj)i:il.\ IIOSITIA I.S
WOMEN'S MKDK Al. AM) SIIMMCAI. HI JI,l)I.\(i. 1{KAI)F()|{I ) IIOSIMIAI,. HltAI )l ( )l!l). I'A.
MicsNUs. (ini:i:\ a- wii ks. aik hit kits
MEN'S MEDICAL AM) SURGICAL BTILDLXG, BRADFORD HOSPITAL. BRADFORD, PA.
MESSRS. GREEN i'wiCKS,".*HCHITECTS
PI..VTr. 41
M()i)i;u.\ ii()>i'irALS
MA'I'KUMl'V lUII.DlN".. liKAl )l'()l!l ) I lOSl'IIAI.. IJIiAl )l()l!l ). PA.
MlvSS».S. (IUKKN .V WICKS. AKI EIITKCTS
if II
-^^K £^
u-ii ;. , ..
IXTKItlOIi, WOMKNS WAIil), l?l!ADl"(inil IIOSITIAI.. HHADFC )l!l). I'A.
MESSliS. GHI-.EX .\; W l( K.S. AUl 1IHK< T
I'LATi: 4-'
MODERN IIOSniA LS
»h^'"^
H"Lij ilfealJ r..:i
MATEHNITV HI Il,l)l.\<i, BRADFORD IIOSJ'I'IWI., RRADFORD, I'A
MESSRS. GREEN 4 WICKS, ARCHITECTS
FIRST FLOOR PUN
( ) 1' E R A T I X G Ij L I L D 1 N G
BRADFORD HOSPITAL.
BRADFORD, PA.
MESSRS. GREE.V 4 WICKS, ARCHITECTS
Pl..^ IE 43
MODERN IIOSI'llALS
rl.OT IM.AN
151iAI)K()l{l) IIOSPITAI,. IJKADFOHl), I'A.
MKSSHS. GREEX i \M( KS, AK( linK( T.S
FIRST FLOOR I'U^X
MEXS MEDK AL AND SURGICAL BUILDlNXi. BRADFORD HOSPITAL, BRADFORD, PA.
MF-SSRS. GREEN 4 WICKS, ARCHITECTS
PLATK 44
_^^K-
M()I)i:i{N II OS I' I 'I" A LS
=71
J
^15?™,..^
.StCO-ND TLOOE PLAAJ
M
ADMINISTRATION UlILDIXG, BRADFORD HOSPITAL, BRADFORD, PA.
MESSRS. GREEN & WICKS, ARCHITECTS
PLATE 45
MOD !•; |{ \ ll()^ I* I I A LS
k 'r-
^m'\ Tl^S^
'*^^a
3»»-
- --^.:?^
j^:-
j..^-*^>;--J-«S^^.V,
^ -
X.
PLATE 46
MC)T)KI{X HOSITIAI.S
_ y^.
PLATE il
MODE l{ N II OS I' I r A I.S
U
!
1
^
Cjz
<
w___ •]
G
■ ■ -.■'•''l
.^l
^1
c^mm^.A
(_'TO^' 1
it^y\^_j^ r
iir.orK PLAN
MLXKirAl. HOSPITAL FOR I'llE DlSI'ltK T Ul ( Oi.lMlUA
MESSRS. FR.VNK MILliS DAY A BROTHER. ARCHITECTS
PLATE 4S
MODKKX IIOSI'J'l'A LS
■ j£'*JF^«Wliii
* K^^^^H. '
c
R. 1.
■
■ via ^-
1
ffiHr I
y.
PLATE 49
M()i)Ki{\ iiosrri'ALs
--t:
M
■P:
1 r
!
1
3 ?n» j'.!!s 1./, . ..
<
s:
o
o
O
1-
y
H
Q
uu
X
h-
Qt:
O
u.
-li
<
H
o
X
T-l^'^
P
l:^::^
n < !
J
I'i.ATE 50
MOD K l{ \ II OS I' I TA LS
lli^
^!
Si
a —
>.' i.
S
I'L.VTK ,->l
M()l)i;i{N IIOSriTALS
ri.Aii; .v2
MODKItX IIOSI'I'I' A I,S
PLATE 53
MOD !•: I{ \ II OS I' I r A LS
AmmUTEfcTIOH EKMI-DINC
l{K\"KKI,V IIOSriTAI.. Hi;\i:i!I.^, MASS.
-Mli. KlIWAHt) I-, STKVK.N.S, AR( IIITKCT.
I'LATK .54
M()i)i:i{.\ JiosrriALs
ADHINDTEATION BUILBUO
BEVERLY HOSPITAL. HJ:\ ERL\, .ALVSS.
MR. EDWARD F. STEVKXS, ARt'HITECT.
PLATE 55
MOD K i: \ II OS I' I r \ [.s
PLATK .-M
:\IOI)K I{ \ II OS I' IT A I, s
■ ADOITIO^TO
•GRACE- /HOSPITAL
•DETROIT MICH leA N •
■tDWAeO F 5TCVeN6 AECHITtCr
BOSTOM AiASSACHu strrs
I n SI -7 BED WAED
C O ft- R- I t» O E-
I VVAR.O
fo RfcL P WAICO
DDD
-r BCD WAC o
*■>-■— ~" «i^
I
PLAN OF F I R-ST- r=LOOR-
KITCMCN
E-XTSNSIOH
r/CWICC YAR.D ■houJE
IfiirjiuiMU mr^i.L
C O K. R. I O O K^
STOtA&p- FOE PCY CJCOCECIE-""
P LAN • OF- BASEMENr FLOOe.
I'l.ATl-: 57
MOD !•: I! \ II ()> r I I \ i.s
eijev.;
DIET
KITCHEN
■ U I- J
J
BALCONY
^
PKIVATt Ch"
PRIVATE KM.
PRIVATE K.'m tj
lal I
Q
m a
■ ADDITIO/i TO •
•GRACE /105PITAL-
■DETROIT MICHI&AN-
• COWARD F STEVENS ARCHITECT
•fS05T0AI- /"^ASSACHUiETri-
Li
/lUtSES
UTILITY EoOM
PEIVATC EM
LTD
'^.r* womK U toilet p m
iC
PRIVATE
D'
I PeiVATfc UM
IK' 1
PRIVATE eM
C
o
(?.
e
1
D
o c
1
n
^^
■ n
■^
^
J
P (C 1 VA TEJ
^ FK-tVATE
^ FCtVATL- 1
^FEIVATf-
F-ClVATt
^
rtMVATl-
EM
"
EM
1
RM
CM
R,M
%Xth
o @
f-Mf—
1
^
' '
1—
H
^^^H ^1
■IB— -1
■■■ ■
imm I
■§■ 1
■ ■
^^
1
P L A N OP • 5E.CON Q FLOOR-
I F
I •
Pt O OF-
GrAtOfc* A4
r F
r • •
X
1 • *
SEE TEXl FilH IHIHD Fl.'lnH IM.W
y
•P LAH- O F- KOOP •
I'j.Ari-; 58
MOD K l{ \ II OS ri 'I' A l,S
tr
"y f-" rn rn rrt r" ^"^ i
-=*=«
llAKI'i;i! II OS I'll- A
DK'IM! orr. M 1( II
MKSMH.S. MAl.COMSO.N & I1I(.(;1M10T1I AM, AK( IMTKl TS.
MH. KDWAKD F. STKVEXS, COXSfl.TI.NC; Al<( IIITKCT.
I'l.ATK Ji)
M()I)KI{\ IIOSI'I'IALS
y
y. *=
— <
— 2
? t
r.
V.
PLATE (id
MOD K l{ \ II ()< I* I I \ l,S
r. A
<
X
i'l.ATK (il
.MODK K .\ II ()> I' I lA LS
y
I'LAIK KH
M ()i)K n \ ]]()> r IT A 1.
■aKt^a&'jj
■-mi^s^s^s£££-,-
STAIF, ASYLIM KOK TIIK CIIROXIC INSANE, WERNERSVILLE. PA.
.MESSRS. H.WKl.N, KKI.l.OGC: A fK.V.VE, .UiCHITECTS
PLATE oa
MODKHX IIOS ITI' A LS
|-^ f-i ' ^t
»
x
S5
X ^
.- ^
SG
.1 J- I I
CJI '. luj::li:j , icj .
II II
I I- : • -I I
II II
n
: ii
>■
PLATE 64
.M()J>Eli.\ IIOSITIALS
( OiNNECTING ARl ADK
STATE ASYLUM FOR THE CHRONIC INSANE, WERNERSVILLE, PA.
MESSRS. R.\XKIX. KELLOGG & rR.\XE. .ARCHITECTS
PLATE 65
ivi o I) !•; i{ \ iKx I- 1 r A I,
ff'v
PLATE 66
MOD K |{ \ II ()> r I I A I.S
MECONI) KLOOK IM.AN
THOMAS MEMOKIVI. KOSl'I'l" Al. KOK (ONSIAIPTIVES. MIXXEAPOLIS. MINX.
MESSRS. HEWITT \- BKOWX, AHCIIITErTS
PLATK 67
M()i)i;i{.\ ii()>rn Ai.s
/
y
y
y
f.
y
y I:
O <
> £
^ a
z
■2 3
X ?
X
X
PT.ATE 68
M()I)KI{\ IIOSIM'IALS
t:
1
[i.i
r"T.r"i
«--»
LUL J
/<
X <
X
•r
^'
I'l.Aii; (111
M()l)i;i;\ IIOSIMTAF.S
y.
y.
'A
y.
■f.
y.
z y 1
li_...
'A
y
y.
-^■,;V^tS-s ■^v,-"Vgil
ri.AlK 70
MOD K K \ II OS I' IT A I,
I'OGRAPHIC^X ?iAAP
i-JLj; 2_E
sANAtORlUM
COOL
AEc-D- Bb-\w -J- Drv I-*-
THE COOLEY FAUMS TrHEHClI^OSIS SAXATORIUiM. WARREXSVILLE. OHIO
MK. J. MILTOX DVER, ARCHITECT
PT.ATE 71
M () I) i: i{ \ II OS I' I r A Ls
r-f-tt
^mmm
t&SMi
o
(4
>
Z
-u
>
s
x
u
PLATE 72
M () I) K K \ II OSri'l A LS
lr---S^^.!t:cr;.;:nr,;.
rit/r rLooE. ?iA/t
ATIMIVISTOATION' lU'ILniNC
TlIK CO()l.l•;^ lAK.MS 1 IBKliC I I.OSIS SANA r01{H .M. W AHI!KNS\ ILl.i:. O.
\11(. .<. .\llI.Tf>\ DYKJl AKCHITECT
ri.AI'K 73
M <) I) !•; i: \ II o> 1' I r A i.s
i '^ z
I'l.M i; n
M () I) l-;i{ \ IIOS I' IT A LS
u
^
a:
<
^
^
n
-
rT
x;
^
—
>'.
^-
p
*-•
:.:
c
Vj
>
.J
'/)
""
■ir
H
O
8
J
S
d
S
en
>-
8
PLATE 75
modi: K N IIOSIM'I A LS
IMMAXArOIIS. INI).. CITY HOSIM I'AI.
MU. ADOI.l SI III.HKER, ARCHITECT
PLATE 76
MOD !•; I{ \ II OS I' I 'I' A LS
ff
\nMi.\bi L\i ins liMiDiM-
PLAN (ir nXit-MF-ST
ADNflNLSTUATIOS IMr.DI\'C..
n. vv iir HOT FtiKC
iNDiANAroi.is. iM).. ( ir\ ii()>rir.\i.
MK. ADOI.F SOHERKKU, AH( niTK( T
I'l.Ari-;
M () I) !•: li \ II ()- I' I i \ i,>
\i)MiMMi;\iii'\ iMiniM'
I'L V\ OF THrHI riiXK
IXDI WArol.IS. IM). ( IIV IIO-riTAL
\IH. ADDl.K S( llKliUKK. AKClllTtCT
ri.M'K 78
M () I) i: i{ \ ii()> ri r A i,s
'V/;0\L ^AKD
INDIA X.VrOLIS, IXD.. CITY HOSPITAL
.MK. ADOI.K sc tlKHUKK. AUI'IIITKIT
i'LAll-; 7!)
M () 1) i; |{ \ II OS I' I I A LS
■:
- J
-e-
nnt^:
i[l>_^^
ii
ii
PLATE 80
M () I) i; l{ \ II OS I' I I' A I.S
y. =
A
I'LAi'i: SI
modi; i: \ II ()> I* n \ I
o
g
L.
/f:::iipr- ''-dy
o
CD
<
2
k
, ■„ ' h-i I- I"
i ■
f.
. ..Ji
IT Alio 85
M () I) i: u \ II o^ I'l r A i,s
•- • 1-
J i—\
.. _ .^ J
^1
-4
f s
= 1. - T
■■r^
..J
^
n
if. .
■+. . J
V
bH
L_rj
J
1
.■L±±*
0^^^?5j
Z
Q
t
[■ ""'
;:3
cQ
O
z
b
1
^
&j
Ci.
O
1
^-
Is
•
I — -_J
tn- --^1'
,- ■ n
\\
I It
i:- tt "
V- -
1
H
I-
k
H i^
~\
.at
X
PLATE 83
M () I) K l{ \ II OS I' I I' A I.S
/• r.
y.
1
^m^'^x^^m
PLATK 84
INDEX
TKXT ARTICLES
MiinianI Skin ;i]i(l ('aiiicr I losjiihil, I'lic, Maiii'aii iS; I'laiiiiiiif;. ' 'o-i)|ii-rali<)ii Ijj ll(i>|jilal, 15v M. ]■'.. \]i('ul-
IJusscll, ArcliiU'cIs Mi iriorit, l{. N'.. Hospital Specialist anri ('oii.sultant,
('"iilafrioiis (Jn.iip of llic I'lox iilciu e Cily ll((s|iital. I'lirincr Sii|.cnMlc?i(li-?it <^"ivil ILispilal. Manila,
Messrs. Martin \- Hall. Aicliilcits M ■' '■ 'lii'''' Division of IIos|.itai forislniction
DHailsan.l l-:,|ui|n,rnl „r lles|,iiMls, liv K.Kvanl K. '""' '■■M"M'""-"I- ''urc .f Ilraitl,. I'hilippine
Sl,.v,.ns. 1 '"'^""'^ ■»+
llcatinfr and Vontilafion, Modern I'raeliee in Ilospi- Si. Nineenl's Hospital. Indianaj.olis. Ind.. Messrs. D.
tal, Rv Clarence W. Williams II A. Bolden & Sons, .Vrcliilerts U
lleatiif,' and X'cntilation. Some Essentials of Hospi-
tal, Hv !)• !)• Kind)all 1!»
Seaside llospit.il of lli<' Bronklwi rhildren's Aid
Soriely, Surf .\\<'nne. Coney Islaiiil. \. Y., K<lwar<!
I.i'ditiiig, Hospital, Bv ]•]. H. Bostock '.id n ' i • v i ■. i » •
'^ " ■ • I earce ( asey. .\rclntcci .H
I,ii^htinif of Hospitals, 'I'lic Artificial. .Vl)slra<l of a
I'aper Bead at llic Connress of the itoyal Sanilarv Tropical Hospital .Vdaplable for Tuberculosis, \. By
Institute at Belfast. By .lolni Darcli .'!H M ''■ McCalinont. Ho.sjMtal Speciali.st and Con-
Modern Hospital. The 17
sultant +(i
New General llos|>ital. ('incinnati. ( )liio. Messrs. N'aruum Cleam'tif; Systems a Desirable Feature in
Sanniel Han na ford 1*^: Sons. .Vrcliitects 18 M oiler n Hospitals 17
PLATES AND TEXT ILLUSTRATIONS
.\mslcnlam Hospital I'a^'c ."> Detroit (icncral Hospital. Detroit. Midi. Plates 46,47
Barnard Skin and Cam er Hospital. Si. I .on is. Mo Dresden Hospital Page (>
l'af,'c K; Kmcrf^cncy Hospital. Bufl'alo, \. V Plates 38. ;?9. 4(1
Plates ■i-i, -i:i, -ii. -i.'t (Jencral Hospital. Nurses" Home. Bnlf.-do. \. ^■.
Bellevue Hospital. Xew, New York Plates I. ^i. :{. 4 I'li'l*' '^
Beverly Hospital, Beverly. Mass Pages 1.4. S <'™<t' H.ispilal. D.troit. Mich Pages 7, !>
i'lalcs .-..!. .-.4. :,:,. .■)(! Plates .57. .58
Bradford Hospital, Bradford, Ba. Harper Hospital, Detroit. Mich Plate o9
Plates 41. t'.2. 4.'i. 44. 4.-) Haynes Contagious Building. Brighton, Mass... . I'age 43
Brocton Hospital. Broc ton. Ma.ss Pages 'i-0 Ileywosxl Hos|)ital. (iardner. Mass Page 4
Brooklyn Children's .Vid Society Seaside Home, Coney Indianapolis City Hospital. Iiulianapolis. Ind.
Island, \. Y.. Hospital i?nilding P.igcs ;!4, .'!.5, :?(>. ,'!? Plates TC. 7T. 7S. 7!». S(l. SI . S-J. S.'!. 84
Plates . ■!.■,.;!(!. ;i7 .lohns Hopkins Hospital I'.itrc i
Children's Hospital. Buffalo. \. Y Plates 1:!. I t. l.") Municipal Hospital for the District of ( ohimlna.
Cincinnati (ieueral Hospital. Cincinnati. Ohio Plates 48. 4!), .5(1, .51 , .55
Plates '>7.'^S.'.2!). ;i(l.:!l National Home for Disabled \dhinteer Soldiers. .lohn-
Cooley Farms Tuberculosis Sanalorium. Warrenville, son Citv. Tciui Plates 68, 69. 70
Ohio Plates 71. ~~i. ?.'!, 74. 7.5 Niagara Falls Memorial Hospital Page 15
Corey Hill Hospital. Brooklinc. Mass Page 3 Plates 1(1. lI.;J(i
S.)
MODERN HOSPITALS— INDEX
Providence City Hospital, Providence, R. I.
St. Vincenf.s Hospital, Indianapolis, Ind. Plates .SS, .'58..S4
Pages 30,31,32,33 Stainford Hospital, Stamford, Conn.
Plates 16,17,18,19,20,21
Qnincy Hos|)ital, Qnin( y. Mass P''g'' "
Plates 3,5,36,37
Rockefeller Institute for Medical Research, The, New
York Pages 39, 41
Plates 5, 6, 7. 8, '.)
.St. Georg's, Hamburg Pages .5, 7, 9. 10
P
Pages 12, 19, 20, 21, 22, 23, 24. 2.5
State Asylum for the Chronic Insane, Wernersville,
Pa Plates 60. 61, 62, 63, 64, 6j
Thomas Memorial Hospital for Consumptives. ]\Iin-
neapolis. Minn Plates 66, 67
Utrecht Hospital. Holland Pages 2, 3, 6, 10
INDEX TO ARCHITECTS
Bohlen, D. A., & Sons Plates 32, 33, 34
Casey, Edward Pearce Pages 34, 35, 36, 37
Plates 35, .36, 37
Day, Frank Miles, & Brother Plates 48, 49, 50, 51. .'52
Dyer, J. Milton Plates 71, 72, 73, 74. 75
Freedlander. J. H Plates 68. (19. 70
Green & AVicks Page 15
Plates 10. 11.12,13, 14, 15, 26, 3S, ,39, 40, 41,42, 43, 44, 45
Hannaford, Samuel. & Sons Plates 27. 28, 29, ,30, 31
Hewitt & Brown Plates 06. ()7
Kendall. Taylor & Stevens Page 43
McKim. Mead & White Plates 1.2,3,4
MalcouLson & Higginbotham Plate 59
Martin & Hall Pages 30, 31, 32, ,33
Plates 16,17,18,19,20,21
Mauran & Russell Page 16
Plates 22,23,24,25
Post, George B., & Sons.
Pages 12,19,20,21,22.23.24.25
Rankin, Kellogg & Crane Plates 60. 61, 62, 63, 64, 65
Scherrer, Adolf Plates 7(;, 77, 78. 79, 80, 81, 82, 83, 84
Shepley. Rutan & Coolidge Plates 5, 6
Stevens, Edward F Page 7
Plates 53. 54. 5o. 50. 57, 58, 59
Stratfon \- Baldwin Plates 46,47
York (St Sawyer Pages .39, 41
Plates 5,6, 7,8, 9
8(i
Modern
Hospital
Equipment
:^m:
results from the utilization of the world's most famous ideas.
The evolution has been constant and the progressiveness in
design makes it possible for us to guarantee the efficiency of
each apparatus.
The great advance which lias In-ous^ht hos|)ital e(|uipnient to the present stage is due to our
close co-operation with the profession, and the conscientious adherence to high principles.
Throughout the manufacture of our products, standards of workmanship and material have
been established which are exclusive to The Kny-Scheerer Co.'s goods. It is because of this
feature that ours are the matchless products. Tlicy are the products which are preeminent in
the medical mind and satisfy the discriminating.
The complete equipment of Hospitals is a specialty with us.
Our lines are the most extensive.
They comprise
Surgical Furniture and Surgical Instruments.
Sterilizing Apparatus
Disinfecting Apparatus
Physio-Therapeutic Apparatus
For Instruments, Dressings, Water, Utensils, Bed-Pans,
Dishes and Cutlery.
For Mattresses, Bedding. Clothing. Etc.
By Steam or Formaldehyde Gas.
Comprising the famous Zander mechanically operated
Exercises, Massage, Vibrators, Etc.
Electric Bakers of the Tyrnauer System for Gout, Rheumatism, Sciatica, Etc.
Electric Light Baths, X-Ray Apparatus, Hydro-Electric Baths.
Hydrotherapy Control Tables, Shower, Needle and Sitz Baths, Dent's
Constant Temperature Flowing Baths. Massage and
Shampoo Tables.
..j^
1 A ? .
'-¥
I \ FORMATION and specifications relating to any
Apparatus will be sent upon receipt of your request,
and at your command are the services of the most care-
fully organized corps of hospital specialists.
The Kny-Sheerer Co.
Alantifacturers of
Sursiical and Therapeutic Instruments
and .\pparatus.
404-4 1 West 27th St., New York
University of California
SOUTHERN REGIONAL LIBRARY FACILITY
Return this material to the library
from which it was borrowed.
■/: "O'^'^Pf; ^r, "'.*: 'C^ap-" rkz
D 00'
u