This plan for an ideal Emergency Hospital published by architect George F. Hammond in 1891, provides an interesting catalog of new and old requirements for acute hospital care.
Hammond described an effective emergency hospital as one “to which purely surgical cases demanding immediate attention can be quickly transported.” (p. 56) He imagined that if such small emergency hospitals were regularly spaced across a city, it would reduce accidental deaths by reducing the amount of time between injury and treatment. Limiting the patient population to surgical cases also provided a safer place of treatment. At the time, proximity of medical patients to surgical patients was still widely considered (and statistically proven to be) a dangerous source of post-wound contamination and cross-infection in general hospitals. According to Hammond, in a hospital devoted solely to emergency acute surgical care patients, “there would not be the unspoken fear on the part of the surgeons that their efforts were being counteracted by dangerous medical cases in adjoining or neighboring wards.
The 1890s were a period of great change in hospital design and Hammond was clearly a proponent of traditional low-rise, pavilion-ward layouts rather than the more experimental multi-story compact structures that antisepsis and asepsis (and tight city lots) had enabled. (p. 52). He preferred the low-rise structures because of the “decreased expense of constructing low buildings and the increased amount of sunlight gained in a given space thereby.“ The building thus has traditional design features such as large open wards with separate toilet rooms and open-air connecting corridors.
And yet, the building contained many aspects of cutting edge hospital design, mostly to facilitate changing medical practices:
- angled wards to maximize exposure of all walls to direct sunlight.
- Separate, individual private rooms for paying patients removed from the large wards
- A prominent and central well-ventilated operating room with a separate room for antiseptic procedural cleansing, and separate rooms for the post-surgical patient to come out of sedation and for preparation and delivery of anesthetics (on the basement floor)
- A disinfecting boiler to sterilize the exhaust air from the laundry and mortuary (both considered dangerous sources of disease germs)
- elevators for the transportation of non-ambulant patients between floors (even on a three-story building)
This mixture of the old and the new is a visible register of the slow transformation of hospital design from a traditional building that provided a healing environment (full of sunlight and fresh air) and a more modern building that housed high-stakes medical treatment (full of specialized treatment and procedural rooms).
page references to: George F. Hammond, A Treatise on Hospital and Asylum Construction, with Special Reference to Pavilion Wards, (Cleveland, OH: 1891)