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[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 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)roahining 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/ey 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 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 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\ 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\ 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 wouler. 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 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 driidortalile 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 lilaltliy 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 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- 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 titiilating-, 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, anatients; 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 ac<>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 isc 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 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-contaening 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 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 ^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 essar\ 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;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 fusinIM; 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' diniiil. 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 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. 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 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 iiicliiorlanl |)arl mc\('r\ cdiicalional licaltli campaign. I'^oi' linndreds ol' vcais ccrlain siiperslilioiis and fears lia\e kepi orrict '/■\T.r>TfccLti 7 carter. Vi, I'KOI'lc \l, IKKlM lAI. liall\c liiiii^e> lii^lilU c|o~c(| al lii;^lit. to which I'acl iiia\ he lar;^el\ a 1 1 lihiited llio wide pre\alcncc oi' liil)ei'ciilo-.i^ in tin* IMiili|)pine^ and in other similar tropical count lies. The capacil\ lor employee- may he ciilariicd l)\ pulling a -ecoiid -loi'V over the k lichen pavilion, hill Mil-- i> iiol dcsir- ahle as the kilclicii proper >hoiild he two stories III lieiiihl. lo make il hearahle diiriii;^ llie hollc-l season. A heller a rra Ii;^cnielil wolllil he lo hiiild a lliircl me,\pen>l\i' hiiildini;' which coiild he utilized I'oi- a laundry, tool house, disiiifcctiii;: plant, mrinerator, ele.. and w liicli could al- >o mchitle accom- modatioii.s for any .servants not pro- \ided fill" ill the main hiiildiii:^-. 'i'hi- ho-pital in the dime n>ion s sh(i\\ii was planueil a > a remi( irced c( m- crclc >l ructure, esti- mated lo cost ( with a lai'Ljc proportion. Ihouiih not all of its e(|uipmenl) .SHO.- (tdd. Labor con- ditions, etc.. vary lo such an extent that it is impossil)le to make a more ac- curate estimate ap- pl lea hie to other sect lolls. 1 1 a larger sum is available and greater capacity de- sired, the plan is easily expanded by aS value of the ari'aiiueineiit is evident. So coneentrated is this featui'e that the inini- inuin amount of hihor from a small stati' will take eare of a large number of patients. AS A TUBKRCULOSIS HOSPITAL A tro|)ieal hospital for general purposes and a tuliereulosis hospital foi' a tenipei-ate region have two great points in conunon. Heating of the wards does not have to l)e consideied and plenty of air is the chief concern. l'\)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. 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. 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 lN 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\[* ^ ■ 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.-=^ 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.\;--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., Kital. ('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 <'™ 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