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Monday, September 9, 2013

The Architectural Design of Civil War Hospitals

From: vermonthistory.org


Sloan General Hospital [in Vermont] was a fully developed example of the pavilion principle of hospital design, which employed many small, connected buildings instead of a single massive structure. This approach to hospital design and construction derived from the work of Florence Nightingale, who exposed the poor conditions in British military hospitals during the Crimean War (1853–1856) and became an internationally renowned advocate for improved sanitation and care in hospitals.

Attributing poor recovery rates of injured soldiers to “bad air” and crowded conditions, she recommended treating patients in smaller wards, with improved ventilation. More windows would let in sunlight and air, provide light for reading, and offer views for enhancing good morale. The pavilion system proposed by Nightingale as an organizational principle for hospital construction and operation called for smaller treatment wards in detached buildings with centrally located administrative and support spaces. Pavilions could be arranged parallel to each other, or in line.

The U.S. military tested, refined, and revised the pavilion design as it erected large new hospitals in rapid succession throughout the eastern states. The hospital complexes functioned as discreet, self-contained
communities, providing for the physical and social needs of the hundreds of patients, medical personnel, and support staff who lived there.

Tents often supplemented the wooden buildings of a facility. The hospitals bore a resemblance to forts or prisons—often contained within a high fence, although most typically of a picket type that only symbolically
protected the complex from invasion or escape. Point Lookout (1862) in Maryland combined a prison and a hospital. The hospital there used the spoke-and-wheel plan, perhaps the first example of a design
that would later be used at Montpelier. The converted barracks buildings that became the wards at Smith
General Hospital in Brattleboro lacked sufficient windows for air and light. Barracks were typically constructed directly on the ground, exposed to damp and odors, termed by one observer as “unwholesome exhalation from the confined soil beneath.”

By contrast, the pavilion-style hospitals constructed by the U.S. Army consisted of one-story wards raised off the ground, with clear-span interiors open to the roof ridge. As the prescription for good air and lots of it became an essential part of medical treatment, the army began improving ventilation in the pavilion model. Florence Nightingale noted that a patient gave off three pints of moisture in each twenty-four-hour period.

Contemporary accounts of hospital facilities measured quality in terms of the cubic feet of fresh air available per patient bed. Early examples providing 500–600 cubic feet of air space per bed proved inadequate and “unhealthy,” and the goal moved toward 800, 1,000, and 1,200 cubic feet/bed. Using these criteria the army designed wards with an abundance of windows and placed two beds between adjacent windows so that each patient was next to one. Ridge ventilators penetrated the roofs to draw air through the wards. Some pavilion wards included shafts that in winter could be opened periodically to funnel air under the floor to an opening beneath a stove, where the air would be warmed as it entered the ward.

Separating ward buildings also became a concern. Closely spaced wards were thought to stifle good air circulation, and the distance between adjacent pavilions grew to forty feet and more. Similarly, wards
should be free of taller surrounding structures that could cut off breezes. Topographic elevation became a desirable specification for new hospital sites.

The army constructed its first ridge-vented hospital wards in Parkersburg, Virginia, with pavilions measuring 130 feet long by 25 feet wide by 14 feet to the eaves. That general size became a standard dimension for subsequent pavilion-style military hospitals, although length could vary considerably. In southern hospitals, the ventilators ran continuously along the roof ridge and remained open or, when necessary, could be covered by side shutters. This design proved impractical for colder climates, where only sections of the ridge were vented. Sloan General Hospital in Montpelier had only two small ridge vents per ward, which like little barn cupolas, vented moisture and encouraged air circulation.

The U.S. Sanitary Commission, founded in June 1861 to advocate for improved medical treatment of wounded and sick soldiers, promoted use of the pavilion principle and urged the construction of new hospital facilities. Two such hospitals in Washington, D.C., Judiciary Square and Mount Pleasant, were ready for occupancy by April 1862. For administrative convenience, the pavilion wards at these sites, which measured 84 feet by 28 feet by 12 feet, were laid out on both sides of and perpendicular to a central connecting corridor, staggered in alternating fashion along its length to promote air circulation. Critics were quick to point out two major flaws in the design as executed in these early experiments. By joining all the pavilions to a single enclosed corridor, the hospital interior and the “atmosphere” within it became one space, whereas the goal was to separate pavilions and thereby control the spread of airborne diseases. The second error was the placement of the water closets in the corridor, instead of at the free end of the pavilions. Later hospitals avoided both problems.

At Baxter General Hospital in Burlington the army hastily constructed a row of seven (or nine—reports differ on the number) parallel pavilions to supplement the original brick building. An open porch connected
the pavilions at the end nearest the complex of administrative offices, kitchen, and dining facilities. Separated from each other by forty-eight feet of open space, the new pavilions had six-over-six sash windows every ten feet along their length and privies entirely detached from the wards.

Saterlee Hospital in Philadelphia opened a month after Baxter began operation, and utilized parallel open corridors facing a central elongated courtyard. The pavilion wards joined the outside face of the corridors. From that rectangular configuration, hospital layout progressed first to an elongated ellipse, and finally to an oblong or circular corridor with radiating pavilions.

In December 1862, Mower Hospital in Chestnut Hill, Pennsylvania, opened with fifty wards arranged on an elliptical plan. The Jefferson Hospital in Jeffersonville, Indiana, which opened in September 1863, featured a 2,000-foot long enclosed corridor encircling a central open area 600 feet in diameter. Designers also experimented with the “en echelon” plan. At Lincoln Hospital in Washington, D.C., the pavilions were arranged in the V-plan, with administrative buildings sited at the apex. To increase the freedom of air flow, enclosed corridors, which had become de facto dining halls and cut off air circulation at the ends of the pavilions, soon gave way to open, covered walkways.

By July 1864, the U.S. Army had refined hospital design to a series of specifications for sites and buildings. Although finished just before the army published its design pamphlet, Sloan General Hospital in Montpelier represented a model of good hospital design. Vermont’s Surgeon General, Samuel Thayer, Jr., selected the site, located about a mile east of the State House on a plateau of land that served formerly as a fairground. It possessed the desired qualities of altitude (650 feet above sea level, or by local measure, 85 feet above the Winooski River), access to fresh spring water, and access to the Central Vermont Railroad (which was owned by Governor Smith), for convenient transportation of wounded troops and supplies.
Built on the pavilion principle, with detached buildings for various purposes,

Sloan Hospital was arranged around an almost circular covered walkway. The wards, administrative offices, kitchen, and dining halls were attached at one end to the walkway. Other buildings, located outside the circle but within the fence marking the perimeter of the hospital grounds, included a chapel that could seat 300 to 400 people, morgue, laundry, Reserves Corps barracks, ice house, and a large elevated water tank measuring 22 feet in diameter and 13 feet high.

Sloan’s 496 beds were distributed among twelve wards, in pavilion buildings most of which were 108 feet long, 24 feet wide, and 12 feet high—somewhat shorter in length and height than the army’s final published
specifications of 187 feet by 24 feet by 14 feet. The dimensions made practical sense for Vermont according to the Vermont surgeon general, who, referring to a similar practice in the construction of wards at Baxter Hospital, noted that in the local market, lumber mills cut boards in twelve-foot lengths.

A twelve-foot height used one board, and a length of 108 feet required 9 boards. Each ward had approxi
mately forty beds arranged in two rows along the walls of the pavilion. Air space per bed measured 1,000 cubic feet. Pavilions stood elevated above grade, insulated with “double-floors” as a concession to Vermont’s cold climate. A wardmaster’s room and lavatory room were partitioned off at the free ends. Privies located behind each ward emptied into a wooden sewer pipe. The two-story administration building, officers’ quarters, and laundry also housed in the upper floors the staff who worked below. Although the Army specification for laundry buildings called for a flat roof with clotheslines, at Montpelier builders used the snow-shedding gable roof design. The morgue or “dead house” stood behind the chapel, out of sight of the wards.

Clapboards sheathed the exteriors of the buildings. Inside the walls were plastered and painted white. Store receipts from the time indicate that the hospital used large quantities of brown pigment, either as brown paint or mixed with white pigment to make tan.

Six-over-six sash windows were used throughout, except for some Gothic, pointed arch windows in the chapel. The eaves were simply detailed, without the cornice returns typical of Greek Revival design of the period.

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