While the majority of hospitals built in the U.S. between the 1860s and 1880s followed (at least to some degree) the pavilion-plan model of separate low-rise structures popularized by Florence Nightingale, the U.S. General Hospital on Hilton Head Island in South Carolina in 1861 is a striking exception.
Built as part of the Union Army’s southern headquarters (which also included Fort Howell) the hospital was laid out as a hollow square comprised of large wards abutting each other, and little else. The reason for the closed courtyard plan is obscure. It was described as 400’ long on each side and holding 500 beds. The closed layout might have been considered efficient for delivery of goods and services, or perhaps a more defensible structure given that it was a southern beachhead for the Union Army.
The wards were surrounded on interior and exterior by an open colonnade, which was likely an adaptation to the hot humid climate, providing shade and facilitating air flow even during rainstorms. The colonnades also provided a sitting space for convalescents.
The wards were large, even for the time. In order to fit 500 beds into what were essentially 10 large wards, there were at least 50 beds per ward. The plan indicates partitions on one side of the structure, indicating there may have been a few smaller wards (which would have made the other wards even larger).
William Alexander Hammond, the 11th Surgeon General of the United States, considered it “the only really badly planned hospital which has been built for the army” because the closed arrangement compromised the “free circulation of air.”[i] It was, however, one of the hospital structures Frank Leslie’s Illustrated included in its Famous Leaders and Battle Scenes of the Civil War.[ii]
[i] (Hammond, William A. A Treatise on Hygiene. wih Special Reference to the Military Service., Philadelphia: J. B. Lippincott & Co., 1863, 313-314.
[ii] (1896, p. 309)
Plan from Hammond’s Treatise; Views from Leslie’s Illustrated.