SECTION II
CONSTRUCTION AND IMPROVEMENT
CHAPTER IV
CONSTRUCTION PLANS FOR TEMPORARY HOSPITALS
BLOCK PLANS
Figure 13 (p. 58) shows various groupings of hospital buildings. The key inserted in this figure explains symbolically and by letters the use for which the building was designed. Block plan(A) is that of the Letterman General Hospital as that hospital was at the beginning of our participation in the war.1That this plan influenced the design of the early hospitals, built at the National Army and National Guard camps, is demonstrated when comparison is made between (A) and (B). Block plan (B) was used for the 32 hospitals of the National Army and National Guard camps, and for several other hospitals of approximately the same size (1,000 beds) built soon afterward.2The block plan next evolved (C) was for the hospital at Camp Abraham Eustis, Va.3This hospital was designed when the scarcity of materials was beginning to be acutely felt. The street construction was minimized by using only one street with a side arm and a loop; all kitchens, utility, and supply buildings were placed on the street; and storehouses (O)were built parallel to the street, one being placed well forward on a main corridor to enhance its accessibility. Another point of difference between (C) and (B) was the location of the isolation and psychiatric wards (M-1) and (R-3) on the main corridors in the hospitals constructed on plan (C). The block plan next developed was for a smaller hospital where more fire-resisting materials were to be used. The Camp Bragg hospital, in North Carolina, was of this type (D).4In so far as the layout only is concerned, (D) differed from (C) mainly in the corridor connection. In the type of hospital represented by (D), the connecting corridors passed through the center of the ward building on both floors and were constructed to permit isolation from the adjacent buildings. Opening the corridor doors and closing the ward doors freed the passage from end to end. This block plan did not permit of great extension because of the eccentric location of the general mess hall and kitchen. Block plan (E) was that for the hospital at Camp Mills, Long Island.5 Upon the promulgation of the approved military program to place 3,360,000 men in France by June 30, 1919, and meanwhile maintain an average of 1,400,000 men in the camps of the United States,6 it was necessary to take careful stock of the available doctors, nurses, other hospital attendants, materials, and labor. This affected the problem of the care of the sick, whether in camp hospitals or general hospitals, and, very materially, requests for new hospital construction, which, from that time on, had to be so planned that the
58
maximum number of patients could be cared for by the minimum number of personnel. It resulted in the construction, at large hospitals, of large wards; in the general use of two-story buildings, more fire-resisting materials, consoli
FIG. 13.-Types of block plans for hospitals
dated kitchens and mess halls, the use of cafeteria systems and smaller mess halls. These changes in hospital construction influenced both interior arrangements and the block plan, but were effected only at Camp Knox, Ky., Camp
59
Jackson, S. C., and Camp Mills, Long Island, which were designed to be made the largestcamps.7 In a measure, also, the plan for the hospital at Camp Bragg, N. C., was influenced.8 Here, however, the hospital was smaller and the large ward was less adaptable to a small hospital. The plans of the hospitals of these two classes of camps were prepared, at about the same time, in the fall of 1918.
INDIVIDUALBUILDINGS
The more commonly used hospital buildings have been divided into classes according to the purposes for which they were utilized. The following classification indicates the purposes of the more important buildings:
Class I. For general administration and the operation of the hospital:
1. Administration building.
2. Receiving building.
3.Hospital exchange.
4. Guardhouse.
5. Chapel.
Class II. For general care and treatment:
1. Ward buildings.
(a) General wards-
Common wards.
Officers` wards.
Nurses` wards.
(b) Tuberculosis wards-
Infirmary.
Semi-infirmary.
Ambulatory.
(c) Psychiatric ward.
(d) Isolation ward.
(e) Ward barrack.
(f) Prison ward.
Class III. For special care and treatment:
1. Surgical buildings.
2. Head surgical buildings.
3. Laboratory buildings.
4. Physical reconstruction buildings-
(a) Curative shops.
(b) School buildings.
(c) Physiotherapy buildings.
Class IV. For food, housing, and supplies:
1. Kitchen and mess buildings for patients.
2. Kitchen and mess buildings for personnel.
3. Quarters for all personnel.
4. Storehouses.
Class V. For utilities and physical operation:
1. Power house.
2. Shops.
3. Laundry.
4.Garage.
5. Fire station.
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CLASS I. GENERAL ADMINISTRATIVE AND OPERATIVE BUILDINGS
For the reception and discharge of patients and the general administration of the hospital, certain offices were required. A condensed list of the elements involved follows:
Reception and discharge:
Receiving room.
Clerks.
Undressing room.
Linen room.
Observation rooms.
Small laboratory.
Patients` effects storage.
Disinfector rooms.
Clothing issue room.
Dressing room.
Discharging room.
General administration:
Commanding officer.
Adjutant.
Waiting room.
Clerks.
Registrar.
Post office.
Information and telephone.
Chaplain.
Visitors` room.
Toilet.
Receiving buildings.-The first type (plan J in Figure 14) was built for the National Army and National Guard hospitals.9 It was necessary, later, both to enlarge and to redesign the administration and receiving buildings at all camps and cantonments in the United States, because of general additions to the hospitals.9 In the receiving building greater floor area was provided, together with more adequate isolation space for observation and examination.
A combined receiving and administration building is shown in Figure 17 (B-9)10 (p. 63). This building had the advantage of being larger and of possessing separate facilities for the admission of the contagious or those suspected of having communicable diseases. It permitted the discharge of general administrative duties, as well as the reception of the sick, and afforded opportunity for close contact between the hospital management and the troops in camp. It placed the dispensary where it was in easy contact with the hospital and where it was most accessible to the camp. The receiving building was the accepted point of contact with the members of the command to whom it was familiar. The dispensary, in the same building, was convenient for prescription work arising out of this contact. The entrance and hall farthest to the right on plan (B-9) was designed for the admission of suspects, and provision was made to keep these suspects separated from all other patients during examination and observation.10 Through the central entrance, and the space to the rear of it, the ordinary cases were admitted, and to the left were provisions for the routine discharge of patients.
For the reception of large numbers, another type of building, J-3 in Figure 14, was designed, and was erected at General Hospital No. 41, Fox Hills, Staten Island, N. Y.,11 which was planned for a debarkation hospital.
Another type of combined receiving and administrative building (B-13) is illustrated in Figure 18 (p.64).
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62
FIG. 15.-Administration building, base hospital
FIG. 16.-Receiving building, base hospital
63
64
CLASS II. GENERAL CARE AND TREATMENT BUILDINGS
This class included the various ward units. By ward units is meant the sum total of the facilities in one ward building used in the care of the sick, including the ward room, where the beds were located, and the auxiliary rooms for utilities, office, linen, and serving.
The letters for the plans or buildings represent the symbols used by the Surgeon General`s Office,12designating roughly the purpose of the building: A, block plans; B, administration buildings; C, officers` wards; D, officers` quarters; E, nurses` quarters and wards; F, laboratory, X ray, head surgery, etc.; G, general surgical buildings; H, hospital exchange, garage, shops, etc.; I, all kitchen and mess buildings; J and K, receiving buildings; L, wards (common and tuberculosis); M, isolation wards, and N, psychiatric wards. Numerals following these letters indicate subsequent variations and new designs;13 numerals above100 further indicating a tile construction. As an example: B represents the earliest frame administration building;M-3, the third variation or newer design of frame isolation ward; and F-102, the second variation or newer design of a tile laboratory.
In ward designing, four classes of patients were provided for:12 General, tuberculous, contagious, and mental. For the general cases, two variations from general designs were made: One to provide for officer patients and the other, a minor modification of the general ward unit, for prisoner patients.14
Although several types and variations of general ward units were constructed during the war period, by far the largest number of sick were treated in but two types of wards:15 The one-story single ward (K-1) and its derivative, the double ward (L-1) and its final form (K-20); and the two-story ward barracks (K-5).
The other general ward units differed from these types in minor details with two exceptions: The ward building known as (K-105)16, a two-story
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adaptation of the one-story single ward (K-1); and a special and distinctly different type of building(K-58).17
The following tabulation shows the total bed capacity of the different types of wards constructed throughout the country:15
|
Building plan |
Description |
Number of buildings |
Number of beds |
Percentage of all bed construction |
|
K-1 |
I-story ward |
491 |
16,694 |
14 |
|
L-1 |
Double ward and lavatory |
89 |
6,408 |
5 |
|
K-20 |
1-story ward |
97 |
3,104 |
2? |
|
|
Total |
677 |
26,206 |
21? |
|
K-5 |
2-story ward barrack |
395 |
25,280 |
21 |
|
K-105 |
2-story ward |
13 |
1,053 |
1 |
|
|
Total |
408 |
26,333 |
22 |
|
K-34 |
2-story wing ward |
57 |
8,174 |
7 |
|
K-58 and 5-117 |
2-story pavilion ward |
6 |
432 |
? |
|
Other types |
New construction |
--- |
36,249 |
32 |
|
|
Extemporized wards in leased buildings |
--- |
20,218 |
17 |
|
|
Grand total |
--- |
117,612 |
100 |
The K-1 type of the one-story ward was designed in the early summer of 1917, and was built at all the National Army and National Guardcamps.18 The plan K-1, and its final form K-20,were also used in the construction of most of
the other camp hospitals and the general hospitals previous to the fall of 1918.15 The K-20 type of one-storyward19 was a revised form of K-1 and included in its design various changes made in plan K-1, from time to time, as experi-
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ence dictated and as conditions demanded. The double ward L-1 was evolved by combining, for purposes of economy, the toilet facilities of two K-1 wards.20 This type was discontinued after the completion of the hospitals at National Army and National Guard camps in the early fall of 1917.13 These constituted the one-story pavilion types of wards.
The first of the two-story type wards, known as a K-5 ward-barrack, was designed in the early part of December, 1917, and was erected at many of the hospitals21 to provide for a very considerable increase in the capacity of the hospitals at the camps which became necessary at that time. The two-story type was selected in order to concentrate the required number of beds in as small an area as possible, thus obtaining economy in first cost and facilitating
administration. Then, too, in many of the hospitals already built the area available for expansion, immediately adjoining the hospital, was limited. When making the increase in bed capacity it was necessary also to increase the housing capacity for the correspondingly augmented enlisted personnel. In order to secure further economy in cost and more rapid erection of the buildings, it was decided to make but one design which could serve both purposes and to use this type of building insufficient numbers to provide increased bed capacity and, at the same time, increased housing for personnel. This building had decided advantages in its flexibility, since it could be used either as a ward for the ambulatory patients or as a barrack.
The two-story ward building of the K-105 type was designed to meet the special conditions which arose at United States Army General Hospital No. 2,
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Fort McHenry, Md.,22 where, during its erection, a large number of the K-5 buildings were being constructed. It was found that the existing one-story wards were not sufficient in capacity to provide the number of beds desired at that place, so it was determined to substitute, for some of the K-5 buildings, a number of two-story buildings suitable for acute cases. This K-105 building followed the general design of the one-story ward building K-1; but the second story was arranged for convalescents; and the diet kitchen, the ward office, and one quiet room were omitted.16
During July, 1918, it became necessary to design several large camp hospitals of about 2,500 beds each, and to make an extensive enlargement of one of the existing camp hospitals where the available space was limited.23 It was
found in the case of the new camps that the one-story ward (K-20), if built in sufficient numbers to give the required bed capacity, would cover an immense area, thus making the first cost excessive. It would also either jeopardize administration or demand more personnel than could be supplied. These conditions again led to the use of two-story buildings and to the further necessity for concentrating the beds into even a smaller area than was possible by the use of a K-5 ward barrack. From these requirements the K-34 type of two-story ward developed and was called the Knox type,24 because it was first designed and built at Camp Knox, Ky.
Just previous to the signing of the armistice a two-story ward building (K-58 in Figure 22) was in course of design, intended for use in hospitals not exceeding 1,000 beds.17 When, due to the ending of the war, it was no longer necessary to build large camps, one of them, Camp Bragg, N. C., was so reduced in size as
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to make a small hospital of only 400 beds necessary, instead of the 2,500 beds previously contemplated. TheK-58 was used at that place and at a few others where hospitals of small capacity were needed.15
The designs of the isolation and psychiatric ward units were not greatly changed from the original plan, except when it was necessary to conform with changes in the general ward units. Figure 23 shows the original one-story isolation wards (M and M-1) constructed as part of the early hospitals,25 and
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Figure 24 shows the two-story ward unit (M-3) used with the Camp Knox type of two-story ward,26 and the latest design of isolation ward (M-6)27 corresponding with the general ward unit (K-58). Figure 25 exhibits the plan of the original one-story type of psychiatric ward (R-2);28 and the later, two-story type(R-4),29 corresponding with the two-story general ward unit (K-34).
Some of all of the following facilities constituted the various ward units:30
FOR GENERAL CASES
(a) General ward units-
I. Bed facilities 1. Ward proper.
II. Toilet facilities for-
(a) Bed patients 2. Utility room.
(b) Ambulant patients 3. Toilet room.
III. Recreation facilities 4. Day room.
IV. Service-
(a) Feeding 5. Serving kitchen.
(b) Supply 6. Linen room.
(c) Cleaning rooms7.Slop sink closet.
V. Administration-
(a) Officers` administrative work 8. Ward office.
(b) Nurses` administrative work 9. Nurses` office.
(c) Convenience for nurses 10. Nurses` retiring room and toilet.
VI. Special facilities for-
(a) Care of acutely sick or moribund 11. Quiet rooms.
(b) Minor medical and surgical treatment.12. Treatment rooms.
(c) Minor chemical and bacteriological work. 13. Ward laboratory.
(b) Prison ward units.-Contained the same facilities as in the general ward unit, with additional provisions for the possible restraint of the patients, and their isolation under restraint in case of complication with contagious disease.
(c) Officers` ward unit.-This unit had the same facilities as the general ward unit, with the beds in separate rooms or in wards of two or four beds each, instead of in wards of10 or more beds. Cooking and messing facilities were made part of the unit.
FOR CONTAGIOUS CASES
Isolation ward unit.-Had facilities especially arranged for the control of infectious diseases(sterilizing and disinfecting apparatus) in addition to the facilities of the general ward units.
FOR TUBERCULOSIS
Tuberculosis ward units.-Had the same facilities as in the general ward unit, but they were arranged in three types of ward, modified to give better ventilation, heating, and increased floorspace per bed.
FOR MENTAL CASES
Psychiatric ward unit.-This unit, also, had the same facilities as in the general ward unit, grouped in a special manner, with the addition of facilities for minor hydrotherapy(continuous baths).
GENERAL WARD UNITS
WARD PROPER
Dimensions of the wards were determined from a study of several factors, that is, the maximum number of beds per ward, the cubic space per bed, the floor area per bed, and the number of rows of beds, whether two or four.13 Structural conditions, influencing the size of the ward were the timber sizes available and a limit to the length of the building, that is, the placing of it on the ground so that all buildings could be located on any terrain, however rough.13
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The number of beds in each ward in new construction varied from a minimum of 14 to a maximum of 100.30Of all the beds provided in new construction, 44 percent were in wards of 14or 16 beds each, 44 percent in wards of 25 to 35 beds each, and 12 percent inwards of over 35 beds each.15
Wards first constructed were relatively small, containing from 15 to 30 beds each.30This was believed to be the ideal size. The best size of the ward unit or of the ward wing, from an administrative standpoint, was later found to be from 50 to 100 beds.31 The psychological effect of treating patients in large numbers, even as high as 100 in a ward, was determined to be negligible, since the patients had become accustomed to living "in a crowd." On the other hand, in the interests of economy in first cost and operation and of satisfactory administration, it was considered desirable to make the wards larger than these limits, thus concentrating a greater number of beds in a given area and minimizing required personnel. Structurally, the large wards were cheaper in first cost, partly because of the concentration of toilet, utility, and diet services effected, and partly because of the saving in partitioning. Another argument which favored their adoption was that the head house and wing type of building lent itself much more readily and economically to a large dividing unit. In a measure, also, connecting corridors were converted into active hospital space. The solution of the problem was reached by balancing the two sets of opposing factors, giving sufficient emphasis to the contagious factor, when the cases to be treated were from raw troops, as in the camps, and not quite so great emphasis when patients came from seasoned troops who had acquired some immunity, as, for instance, in cases returning from overseas.
It was the rule to provide not less than 800 cubic feet of air space per bed,31 and a minimum spacing between beds of three to three and a half feet.30 The floor area per bed, including the necessary aisle space, varied from 70 to 85 square feet.30 In computing air space, the excess of height from floor to ceiling above12 feet was disregarded.13
Beds were arranged in tworows,30 parallel to the long axis of the wards, except in the few wide wards which were built, where more than two rows were placed.30Two rows of beds were found to be the best arrangement;32 it permitted the making of sheet cubicles around each bed, which then had light and air directly from the outside. The three-row or four-row scheme was used in those wards which were 48 feet wide, as a matter of economy entirely, since this made it possible to put 100 beds in a ward without making the building excessivelylong.30
Having determined the factors most intimately concerning the patient, the actual dimensions of the ward were laid out, consideration being given to the sizes of timbers most readily available, the length of studs used for the standard 12 or 24 foot lengths, and the same for floor joists. These sizes determined the actual width and height ofwards,13 for example, in the one-story ward the width, out to out, was 24 feet-two lengths of joists-and the height was 11.3 feet, being the 12-foot length of studs. Similarly, in the large wards the out width was 48 feet and thestuds extended through the two stories, giving a story height of 11.2 feet.
It was found by experience in locating buildings on the various sites that a length of from 150 to 180 feet was the maximum permissible.33 Greater lengths
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usually involved excessive cost for excavation and grading, or building up of the foundations of one end of the building when placed on a sloping grade.
The windows were spaced so as to come between alternate beds;30 thus each bed had the advantage of a window, and the number of windows was not excessive. Since it was necessary to conserve to the utmost glass and other materials used for windows,34 the size of these was determined from the sizes of glass available, i. e., 10 by 15 inches, with six lights to each sash. As window sashes were not counterbalanced,35 this size was reasonably easy of operation; whereas the larger size-nine lights pers ash-would have been heavy without counterbalances. Because of the nation-wide shortage of hardware36 and resultant restrictions imposed by the War Industries Board,37 the counterbalance was not used. The window area in wards was about 12 percent of the floor
FIG. 26.-Interior of typical one-story ward of temporary construction
area,30 except in ward barracks, where the percentage approximated 19,30 due to the fact that wards were short and without a solarium at the end and that the four end windows contributed to increase in ratio. In the latest ward (K-58) the percentage was21,17 windows being placed between each bed, as the restriction on the use of glass had passed at the time this ward was designed.13
In addition to the slidings ash of windows, ventilation was arranged for by ridge ventilators.30 In the first designs a continuous louver ventilator was used,30 but this was found to be unsatisfactory, particularly in cold, windy weather, and was changed to a special type,19 as shown in Figure 19. It is interesting to note that the same conditions obtained in the Civil War hospitals.38 At first, ridge louver ventilators were used and later changed to a type which
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was almost the same design as the second type shown in Figure 19. Even this method of ventilation was not entirely satisfactory, one objection being that it caused a vast amount of dust to collect in the attic space. In later buildings, such as K-34 and K-58, commercial metal ventilators were used.17
Porches were added to all the wards12on the long side, and, although they eliminated the direct sunlight on one side of the ward, these porches were a great advantage in permitting the wheeling of beds into the open air with a minimum of travel, and in providing a space to be used for expansion in sudden emergency.
AUXILIARY ROOMS
The toilet and day rooms were placed immediately adjoining the wards;30 and the utility room was placed either adjoining the ward or near it, because of its continued use in the treatment of patients.30The remaining rooms were grouped as near the ward as possible, but, excepting the nurses` office, not directly adjoining.30 The nurses` office was placed immediately adjacent, usually; sometimes it consisted of a station in the ward itself, as in later designs.30 All the rooms were at the corridor end of the ward.
Utility rooms were designed large enough to permit the emptying and cleansing of bedpans and urinals, as well as their storage.21 In the early design it was found that these rooms were too small, and they were consequently increased in size in later designs.39In some cases an electrical outlet was added for attaching heating apparatus, and in a few cases utensil sterilizers were added, but this was not the general practice.40 The slop sink was of the flushing rim type, when available, and the fixture was supplied with hot and cold water with combination nozzle.
Toilets were designed to give sufficient space for the needs of ambulatory patients. The number of water-closets was determined on a basis of 1 to each 15 or 20 beds.30 In all the early designs, stalls were provided, usually without doors, although in a few buildings doors were used.30 Later the stalls were omitted entirely, for purposes of cleanliness, better ventilation, easy inspection, and economy in construction and maintenance.39
Lavatories of the individual type were installed in the same ratio as that for water-closets.30 These lavatories were supplied with hot and cold water in the earlier designs,30but in the late design a wash tray was supplied, and so arranged as to permit washing under a running, tepid stream, thus enhancing cleanliness as well as permitting economy in first cost and maintenance. The number of washing positions at each tray was in the same ratio as for individual lavatories. Showers were provided in the ratio of 1 shower head to each 20 or 30 beds.30 In the early designs a separate stall was provided for each showerhead,41while in later designs all shower heads were in one stall.17They were supplied in some instances with hot water control,30 and in other, later instances, with tepid water, controlled as was water for the wash trays, by an automatic temperature regulator.30 Each shower head had a self-closing valve, operated by a pull chain. One tub with hot and cold water faucets was provided for each ward.30
Urinals were provided in the ratio of 1 to each 25 beds;30 the early ones were of wood, lined with galvanized iron, and later ones either an enameled iron, flushing type, or, later still, a vitreous-ware, steel type.
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In the early buildings a dental lavatory for cleansing the mouth and teeth was installed,41 but this was omitted when the wash trays for washing in running water were adopted.
Serving kitchens contained the usual equipment for serving food. Though the special diets were principally prepared in the main diet kitchen, a part of the general kitchen, and were carried to the ward serving kitchens to be distributed by trays from there to the patients, there was some preparation of minor special diets in the serving kitchens. It was in this room that the patients` dishes were washed and sorted. In the large wards (K-34) arrangements were made for serving patients through a window opening directly into the ward.42As a large proportion of the patients were ambulatory, but at the same time not quite able to go to the main mess, they were served in cafeteria style,43 and for this purpose the window proved very useful.
Slop sink closets were not at first provided the wards. They were found to be necessary, however, particularly to afford a place for the storage of brooms, mops, cleaners` pails, etc., and they were installed.44 They were equipped with necessary racks for utensils, and an ordinary slop sink.45
A ward office, especially for the use of the ward surgeon, was provided for each ward,30 except in Debarkation Hospital No. 3 and in some other converted buildings, where, there being several wards on a floor, the offices were combined at one point.46
A nurses` office, or station, was sometimes placed in an immediately adjoining room, as in the early wards,30 but, in later designs, a station was established in the ward itself. This station consisted of a desk, placed near the wall, with space for the nurses` records.
Quiet rooms were provided, usually to the extent of 10 percent of the beds in the ward.30 In the earlier wards one of the quiet rooms was frequently taken for treatment purposes, and in the later designs a special treatment room was provided.46
In the earlier construction no ward laboratories were provided;41 but later they were, for minor or routine laboratory procedures, at the ratio of 1 to each 200 beds.42 The scope of the work done in the hospital laboratory increased to such an extent that this measure was a necessity in practically every large camp.47
Some of the characteristics of the general wards commonly used during the war are shown as follows:
|
Design |
One-story |
Two-story | |||||
|
K-1 |
L-1 |
K-20 |
K-5 |
K-105 |
K-34 |
K-58 | |
|
Bed capacity of each ward |
32 |
34 |
28 |
14 |
38 |
100 |
16 |
|
Bed capacity of buildings |
34 |
72 |
32 |
64 |
77 |
220 |
72 |
|
Total bed capacity of all construction |
16,694 |
6,408 |
3,104 |
25,280 |
1,053 |
3,174 |
432 |
|
Number of rows of beds |
2 |
2 |
2 |
2 |
2 |
4 |
2 |
|
Clear height of story (feet) |
11.3 |
11.3 |
11.3 |
10.2 |
10.5 |
11.2 |
10.4 |
|
Floor area per bed (square feet) |
80 |
77 |
77 |
80 |
76 |
73 |
87 |
|
Air space per bed (cubic feet) |
900 |
870 |
870 |
800 |
800 |
810 |
880 |
|
Spacing of beds, center to center (feet) |
6.5 |
6.5 |
6.4 |
6.2 |
6.2 |
6.3 |
6.5 |
|
Window area percentage of floor area |
12 |
11 |
13 |
19 |
13 |
11 |
21 |
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TUBERCULOSIS WARDS
The infirmary, Figure 27,was used for the cases confined to bed.48 Here, provision was made for heating all parts of the building and, at the same time, for good ventilation and easy access to porches. In each hospital for the treatment of tuberculosis about one-third of the beds were placed in infirmaries.49 This ratio was satisfactory early in the war; but later, however, nearly two thirds of the patients, then remaining for treatment, required accommodation in the special ward.50
The K-107, ambulatory, or fresh air ward, Figure 28, was constructed with an inclosed and heated centralportion.51The ward proper was without heat and was open on one whole side, the front. The central portion contained the day room, lockers for clothing, a dressing room, toilet facilities, etc. The buildings faced the south; the open side of the ward proper being fitted sometimes with curtains of various designs, or with hanging frames covered with canvas swung into place from the top. None of these various arrangements for admitting the maximum of air and light and at the same time excluding rain, snow, and high winds, wassatisfactory.13Every known variety worthy of trial was used and no one found free from serious fault.
The semi-infirmary K-108 was a compromise between the infirmary and ambulatory ward.52 Though similar to the ambulatory ward, it was only moderately heated in the ward proper, was less open in front, and contained sometimes one, sometimes two, rows of beds.
CLASS III. SPECIAL CARE AND TREATMENT BUILDINGS
The laboratory.-Figure 29(F) shows the original type of laboratory built for the National Army and National Guard hospitals.53 The character of the addition which was later made to all of these laboratories is also shown. The mortuary (P), built when the hospitals were constructed, and the animal house (F-19) built later for all of these hospitals, were in the earlier days separate buildings, which, with the laboratory, made a total of three buildings for the laboratory service, including the X-ray. Later laboratory plans are shown in the same figure. In these later plans all the laboratory activities were included in one building, and the X-ray department was moved to the surgical building.13 This consolidation of the laboratory activities brought the autopsy work under easier and better operation, placed the animals close at hand, and reduced cost. The undesirability of housing animals in the same building occupied by persons, particularly in summer, was known; but the open passage on the first floor, separating the animals from the remainder of the building, minimized any objectionable features.
Head surgery buildings.-Two types of the original head surgery building are shown in Figure 30. The smaller type (F-6), for eye, ear, nose, throat, and dental work, was built at the smaller camp hospitals;54 and the larger type (F-1), for the same work but providing greater space, was built at the larger cantonment hospitals.55 In later plans the activities of the head surgery building were consolidated with the general surgery in a single, larger building.56
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The surgical building.-The original surgical building (G) for the National Army and National Guard hospitals, and the addition which was made later, are also shown in Figure 30. In the later plans an effort at consolidation was made; recovery and conference rooms were provided where possible, and additional fixed equipment installed. The consolidation referred to grouped
the X-ray, eye, ear, nose, throat, and dental work in the same building with the general surgery. This consolidation would not have been possible but for the use of more fire-resisting material permitting larger buildings. A combined surgical department for a 1,000-bed hospital is shown in Figure 31 (G-8), and for a 2,000-bed hospital in Figure 32 (G-12, p. 80). In general terms, under the con-
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80
solidation effected in these activities, two large buildings permitted the accomplishment of the work formerly done in five small ones.
All of the above surgical and laboratory activities for a small hospital were consolidated,57 late in the war period, in a single building (G-103, Figure 32). In addition, a dispensary was included, but no special provision was made in the building for the few animals required at such a small hospital.
Physical reconstruction buildings.-The special buildings for physical reconstruction comprised curative workshop buildings, school buildings, and physiotherapy buildings. Effort was made to house physical reconstruction activities in new buildings, constructed according to prepared plans.58Comparatively few of them were constructed. The majority of the general hospitals were
81
being installed in buildings already existing; and as the other activities of the hospital, such as surgery, laboratory, wards, etc., were being provided for by alteration in existing buildings, this specialty was finally provided for in the
same manner.59 The construction of new buildings for physical reconstruction was not authorized by the Secretary of War except in some of the early generalhospitals.60 Figure34 (S) (p. 82) shows an early plan for a physiotherapy building.
CLASS IV. FOR FOOD, HOUSING, SUPPLIES
Cooking and messing facilities.-The vital character of the cooking and messing facilities was appreciated from the beginning. The development of the designs for buildings for these purposes was, therefore, given the closest attention. The patients` mess in the early design included rooms for the storage, preparation, cooking, and serving of the food for patients only, there being decentralized kitchens and messes for officer patients, as well as for medical officers, nurses, and the detachment, Medical Department.61 In the later designs, and especially in smaller hospitals, the food was cooked for nearly the entire hospital in the general kitchen building. There were, however, separate mess halls for the groups for which cooking was separately done formerly.
The elements concerned in the preparation and serving of food, were: In the kitchen, storage, preparation of the food for cooking, and cooking; in the mess, direct service in the mess hall and food service to wards, and the scullery.
There were really three marked developmental designs for the general mess hall and kitchen. The first is represented by the plan designated by the letter I-1, the second, a transitional stage, by two plans, I-11 for a relatively small,62 and I-12 for a relatively large hospital;63 and the third, or latest type,
82
83
by I-34 for a 500-bed hospital64 and I-39, 1-42 or I-43, andO-12 for the three buildings, kitchen, mess and preparation building, respectively, for a hospital of 2,000 beds.65 The numbers of all three types constructed were as follows:66
|
Type |
Plan |
Number built |
|
Early type |
I |
49 |
|
Transitional type: |
|
|
|
Small size |
I-11 |
4 |
|
Large size |
I-12 |
5 |
|
Latest type: |
|
|
|
Small size |
I-34 |
4 |
|
Large size |
I-39 (kitchen) |
1 |
|
Do. |
I-42 (mess) |
1 |
|
Do. |
I-43 (mess) |
2 |
|
Do. |
O-12 (preparation building) |
1 |
Figure 35 shows the early type, I, constructed as a part of all of the large camp hospitals built during the first summer of the war, including all National Guard and National Army hospitals, as well as many others.67 When the capacity of the hospital became overtaxed, the refrigeration space, which was found to be inadequate, was generally increased.68 A third long table was added through the length of the mess hall; and often the food cart room was used for storage and office space, the food carts being kept in the corridors when not in use. Cement floorsa was laid in many kitchens to replace one of wood.69 With these exceptions, however, this building and its equipment withstood usage remarkably well. In construction there was little difference in these early kitchens from any of the other hospital buildings. The materials used were the same as those used in the wards; the length of the bay, the porches, the ridge ventilator, the sash size, all were built from the same detail sheet as that sent out for the wards. The plan shows the arrangement of the elements and their equipment.
Ambulatory patients, figured at about 60 percent of the total patients, were provided for in the mess hall by the system of serving them then in vogue in Army hospitals, called "setup service," i. e., dishes and food were placed upon the tables in preparation for the arrival of the patients; the patients arrived at a given hour, ate, and left the mess hall. Tables were then cleared by attendants and clean dishes placed for the next meal, or for the next sitting of the same meal, if, as was more frequently the case, there were more ambulatory patients than seats in the mess hall. Food for bed patients, figured at 40 percent, was cooked in the main kitchen and in the diet kitchen, under the supervision of the dietitian. Food was then placed in the food carts which were rolled to the several ward diet kitchens, whence it was served under the direction of the ward nurse.
In January, 1918, the first variation from the plan I was made, taking advantage of the experience gained from the many camp and cantonment hospitals that had by that time been in operation for several months.70 In a few steps there was developed the transitional type of general mess, represented by the plans (I-11 and I-12), for a small and a large hospital,respectively.71 The restriction to the 24-foot width wasdiscontinued.13 This was the inevitable
aCement floors had been intended primarily, but through some error wood floors were originally laid inmost camp hospitals.
84
85
FIG. 36.-Interior of a base hospital general kitchen
86
result of the decision to give up the E-shaped plan in favor of the rectangular building, which was more adaptable to an uneven terrain, and more economically constructed.13
A comparison of the perimeters and areas of plans I, I-11, and I-12 (Figs. 35, 38, and 39) is as follows:
|
Building |
Total exterior wall of mess and kitchen |
Area of mess and kitchen |
Floor area per foot of outside wall |
|
|
|
|
Square feet |
|
I |
1,190 |
12,500 |
10 |
|
I-11 |
430 |
6,840 |
15 |
|
I-12 |
790 |
16,400 |
21 |
The I-11 building was planned for the use of both patients and attendants, and it had a cafeteria arrangement. The set-up manner of feeding, an old custom in the Army, had become an unwieldy method of feeding a really large number of men. The cafeteria system was made effective to overcome the necessity of greatly increasing the seating capacity of the mess halls, or the alternative of having successive sittings for the same meal. When intelligently operated, it
had the following advantages: Hot food, faster service, less waste, operable with fewer mess hall attendants, greater flexibility-adaptability to sudden increase or decrease in the number to be fed-greater construction economy, economy in dishes, etc.
The large general mess and kitchen of the transitional type (I-12), capable of feeding 2,000 men, shows a rectangular kitchen 36 feet wide, directly attached to a mess hall, six 12-footbays wide, divided into two cafeteria units. The kitchen in construction was similar to I-11. The mess hall was a larger building consisting of a central nave of a 24-foot span with two 12-foot bays on either side. Close window spacing and a monitor provided sufficient light for this wider building. There was no ceiling over the main kitchen, scullery, and grocery storeroom.
The I-12 plan should be compared with I. It was designed to meet similar requirements. Each of the two large elements, the kitchen and the mess, be-
87
came simple rectangles. The kitchen was designed to keep orderlies, mess hall attendants, and food carts out of the cooking and preparation rooms, all serving being done over a counter. Access from the mess service corridor to all of the various rooms was obtainable without passing through the kitchen proper. A continuous service platform, in the rear of the kitchen, gave access to all of the rooms. This platform was left uncovered to afford the maximum of daylight throughout the kitchen.
Directly abutting the kitchen building were the two cafeteria service rooms, each serving a unit similar to that of I-11.
During the summer of 1918, plans for the third and latest type of kitchen and mess were developed.72The smaller of the two representative buildings of this latest type, I-34 (Fig. 40),was designed for use either as the general mess and kitchen for a 500-bed hospital or as a mess and kitchen for the medical detachment of a very largehospital.73 It was really a sequel to I-11 with a double mess hall to make it more flexible in its usage. Because of the fire risk and the vital character of this service, buildings of this type were made of metal lath and stucco instead of the wood siding previously used; otherwise, the construction was similar. The washing room directly adjoined the cafeteria coun-
88
ters, thus eliminating the transportation of clean dishes, which had been found quite a burden in buildings I-11 and I-12. A monitor roof, over the serving and dish washing rooms, provided an extra amount of light and ventilation for that busy portion of the mess hall. All other sections of the building were provided with metal ridge ventilators.
The elements covered in the planning of the food preparing and mess buildings were storing, preparing, cooking, serving, eating, and dish washing. It was necessary to depart from the ideal, direct contact arrangement of
these elements in the feeding of large numbers of men in the military hospitals.74 Variations and departures have been shown in the different buildings already referred to. In the feeding of a still larger number, what were planned for and secured were: A kitchen separate from, though closely connected with, its storage and preparation facilities, and a dining room with its service and dish-washing arrangements in the portion proximal to the kitchen. This typical large general mess and kitchen consisted of three buildings: Preparation building (O-12), kitchen (I-39), and double mess hall (I-43) shown in Figure 41. This group was planned to take care of the patients and the Medical Department detachment for a hospital of 2,000 beds.
89
90
The buildings were of metal lath and plaster on wood-frame construction with a plaster-board lining, the joints plaster filled. The commissary stores building (O-12) was a simple building, 32 feet wide, with a cellar in which were a 5-ton refrigerating plant and storage rooms. The first floor was used for vegetable storage, a dairy, vegetable and meat refrigeration, and meat and vegetable preparation. An inclosed corridor connected it with the cooking building. The I-39 kitchen contained the cooking facilities for all regular and special diets. It was but slightly modified in construction from its predecessor, I-12, by the division of its width, 36 feet, into unequal bays, the center bay being 20 feet across in order that there might be a wide aisle for the cooking equipment. The kettles and ranges were located in a double, back-to-back line running lengthwise with the building, the ranges facing the foot cart corridor. It will be noticed that it was possible by this arrangement for the cooks` tables, opposite the ranges, to operate as a serving counter at mealtimes. The I-43 mess hall was five 12-foot bays wide, the center bay running the length as a monitor. It contained two cafeteria units with the dish-washing room adjoining the serving counters. This type of mess hall caused both patients from the wards and food from the kitchen to enter at the head of the mess hall. It effected a considerable saving of aisle travel and, while it entailed a crossing of the food line through the incoming patient line, this intermittent occurrence was not found to affect seriously the messingoperation.13 Near, and in constant communication with, the kitchen was the reserve counter of the cafeteria serving room. It provided a working counter for any final preparation, make-up, or dishing out. It also provided counter and shelf area on which reserve supplies of food and dishes could be stocked from the outside and kept there. In front of the reserve counter, and at a distance no greater than that required by two men working opposite one another at the two counters, was the serving counter. In all standard designs for serving counters an effort was made to use 30 feet as a minimum length and 35 whenever possible. In the middle of the length was placed the steam table with food containers varying in number, depending upon the number to be fed and the distance from the kitchen. These containers were adequately high to obviate excessive stooping of those constantly working over them. Justin front of the row of containers and on a level with the main serving counter was a display shelf on which the food servers placed the plates of hot food as rapidly as they could and from which the patient could help himself as he passed by. A tray slide, slightly lower than the serving counter and display shelf, ran the length; and just near enough to make passing possible was a rail of sufficient height to make it uninviting and undesirable as a seat.
In the operation and the detailed arrangement of the cafeteria, there was considerable variation due to the different needs of the hospitals and to the diverse ideas of the mess officer. Very broadly speaking, however, it was similar to the usual public cafeteria.
In the planning of a cafeteria mess hall three closely related factors were considered:13 The rate of serving, the average length of time a patient devoted to eating his meal, and the required seating capacity of the tables. It was found that the serving of 20men per minute was entirely practicable; a man would seldom stay more than 10, never more than 15 minutes at mess; and, by a computation from these two facts, that from 300 to 325 seats were sufficient to keep a single serving counter unit in smooth, continuous operation.13
91
To permit the simplification of the service, a great deal of the equipment was later made interchangeable.13 In the later designs for cafeterias in leased buildings, the containers that fitted into the steam tables were all of a uniform
size, 15 by 12 inches by 11 inches deep. It was found that four of these containers held sufficient dinner (the largest meal) for 160 men.13 The containers were partitioned and designated for use asfollows:13Container No. 1, undi-
92
vided, for soup; container No. 2, undivided, for potatoes; container No. 3, divided in center, one-half for meat and one-half for gravy; container No. 4, divided at third point, two-thirds for second vegetable, one-third for dessert. The same containers were used in the ward service food carts, and the same ward service food carts were used in the main mess hall in serving patients who were not quite active enough to serve themselves at a cafeteria. The food cart held the four containers set side to side and into an insulated box, making the dimensions of the cart 2 by 6 feet by3 feet high. A shelf, underneath the main box, was so placed to hold extra containers. Dish trucks, the necessity for which was minimized by having the cafeteria patients carry their own dishes to the dish-washing room, were built on a framework identical with that of the food carts. Thus the food distribution equipment was made simple, flexible, and interchangeable.
Simplification was also accomplished in the cooking and the cafeteria serving. Based on experience in temporary hospitals, the fixed equipment of the main kitchen, diet kitchen, and cafeteria was standardized, and a schedule of standard equipment was prepared by the Surgeon General`s Office and the Construction Division.75 This schedule had about 60 items of equipment and gave the steam, water, and electric connections required, the floor space occupied, and the number and size of each item appropriate for hospital messes ranging in capacity from 25 to 5,000.
The problem of installing mess halls and kitchens in the leased buildings which were altered for hospital use was a very indefinite and variable one. Usually the feeding system was the fundamental factor of the entire assignment of space.75 Sometimes there already existed an adequate kitchen and mess hall, as in the cases of some of the institutions and hotels that were leased. At other times, there would be a fair-sized kitchen that needed only some additional equipment. Then again, there were absolutely no facilities in a building, and the possibilities of each floor, from the basement to the roof, demandedconsideration.76
Housing.-In our hospitals three classes of duty personnel were provided for: Officers, nurses, and enlisted men of the MedicalDepartment.77 However, before the war was over a half dozen other classes, male and female, had been added to the operating personnel of the larger hospitals. In the beginning this housing included some recreational facilities.78 Soon the American Red Cross took over the housing of the recreational facilities for the nurses,79 and the Young Men`s Christian Association, Knights of Columbus, Jewish Welfare Board, and others, provided facilities for recreation for the enlisted personnel.80The officers` quarters were frame buildings, like others in the hospital, provided with a kitchen and mess hall and one room for each officer.81 Each hospital had in addition a small staff officers` building of four rooms for the commanding officer and his staff.82 The nurses` quarters were similar to those for the officers, containing a kitchen and mess hall; but part of the nurses only were provided for in separate rooms and the remainder had dormitoryspace.83 The dormitory was unpopular and in later construction a room was provided for each nurse.84 The enlisted men of the Medical Department were provided for in simple barracks parallel to each other, each building having two or three small rooms for noncommissioned officers.78 The kitchen and mess hall occupied usually a separate building in the middle of the group.82 Where the hospital was small, a separate kitchen and mess building was not built.
93
FIG. 44.-Officers` dining room
94
FIG. 46.-Living room, nurses` quarters
FIG. 47.-Enlisted men`s quarters
95
FIG. 48.-Enlisted men`s mess hall
FIG. 49.-Typical Red Cross recreation house for nurses
96
FIG. 50.-Typical Red Cross convalescent house
FIG. 51.-Typical Young Men`s Christian Association hut
97
FIG 52.-Interior of Young Men`s Christian Association hut
FIG. 53.-Typical medical supply buildings
98
Supply buildings.-The supply buildings were simple storehouses with a few separate rooms.85 They contained appropriate shelving for the orderly handling of small articles, and counters and loading platforms required for reception and issue work for the hospital, or for both the hospital and the camp if necessary.
CLASS V. FOR UTILITIES AND PHYSICAL OPERATION
The following additional buildings were mainly used for utilities and the operation of thehospitals:77 Powerhouse, shop, laundry, garage, fire house, and
dry cleaning (rarely).Laundries were planned for the hospitals of National Army cantonments and National Guard camps.77 The buildings were constructed, but were notequipped;86 so the hospital laundry was done either by
99
civilian laundries or by that operated by the quartermaster of the camp.87 At Debarkation Hospital No. 2, Fox Hills, Staten Island, N. Y., a modification of the original laundry plan was used for the construction of alaundry;88 and later, after this hospital had been built, a still further modified plan was used for laundries constructed at some of the tuberculosis hospitals and at a few large general hospitals which were isolated.89 These utility buildings were
FIG. 56.-Garage and cars at a base hospital
not closely connected with the care of the sick and in none of them were there such distinct changes in plans as occurred in the wards, the mess buildings, and the surgical pavilion, where the mushroom growth of military activity led from one readjustment to another. The early type garage constructed was changed to a wider, more economical type of greater capacity.90
REFERENCES
(1) Block plan A. On file, Hospital Division, S. G. O.
(2) Block plan B. On file, Hospital Division, S.G. O.
(3) Block plan C. On file, Hospital Division, S. G. O.
(4) Block plan D. On file, Hospital Division, S. G. O.
(5) Block plan E. On file, Hospital Division, S. G. O.
(6) Letter from the Acting Surgeon General to the Chief of Staff, September 16, 1918. Subject: Hospital program. On file, Record Room, S. G.O., Correspondence File 632 (General).
(7)Construction plans, Camp Knox, Ky., Camp Jackson, S. C., and Camp Mills, Long Island. On file, Hospital Division, S. G. O.
(8) Letter from the Surgeon General to the Construction Division, War Department, September 5, 1918. Subject: Hospital construction, Camp Bragg, N.C. On file, Hospital Division, S.G. O. (Camp Bragg, N. C.)
(9) Plans of receiving buildings. On file, Hospital Division, S.G. O.
(10) Plan B-9.On file, Hospital Division, S. G. O.
(11) Plan J-3. On file, Hospital Division, S. G. O.
(12) Original plan for hospital construction. On file, Hospital Division, S. G.O.
(13) Statement from Maj. Lloyd Kramer, M. C., April 12, 1922, to the Surgeon General. Subject: Hospital construction. On file, Record Room, S. G.O., Correspondence File 632-1.
(14) Plan K-25. On file, Hospital Division, S. G.O.
(15) Based on construction reports. On file, Hospital Division, S. G. O. (under camp).
(16) Plan K-105. On file, Hospital Division, S. G. O.
(17) Plan K-58. On file, Hospital Division, S. G. O.
(18) Letter from the Surgeon General to the Quartermaster General, July 5, 1917. Subject: Cantonment hospitals. On file, Record Room, S. G. O., Correspondence File 176796 (Old Files).
100
(19) Plan K-20. On file, Hospital Division, S. G. O.
(20) Plan L-1. On file, Hospital Division, S. G.O.
(21) Letter from the Surgeon General to the Quartermaster General, December 26, 1917. Subject: Hospital increase at National Army and National Guard base hospitals. On file, Record Room, S. G.O., Correspondence File 632-11 (General).
(22) Construction plans, Fort McHenry, Md. On file, Hospital Division, S. G. O.
(23) Camp hospitals of about 2,500 beds each, designed. Plans on file, Hospital Division, S. G.O.
(24) Memo. from Lieut. Col. Floyd Kramer, M. C., to Brig. Gen. Robert E. Noble, M. D., August 26, 1918. Subject: Hospital construction. On file, Record Room, S.G.O., Correspondence File 632 (General).
(25) Plans M and M-1. On file, Hospital Division, S. G.O.
(26) Plans M-3. On file, Hospital Division, S. G. O.
(27) Plan M-6. On file, Hospital Division, S. G. O.
(28) Plan R-2. On file, Hospital Division, S. G.O.
(29) Plan R-4. On file, Hospital Division, S. G. O.
(30) Based on plans of various wards. On file, Hospital Division, S. G.O
(31) Report of the Chief of Construction Division, W. D., 1919, 59.
(32) Letter from the Committee on Army Hospital Plans to the Assistant Secretary of War. November 24, 1918. Subject: Report of study of plans for Army Hospitals. On file, Record Room, S. G.O., Correspondence File 600.13 (Plans and Specifications).
(33) Letter from Chief of Construction Division, W. D., to the Surgeon General, October 23, 1918. Subject: Length of hospital buildings. On file, Record Room, S. G. O., Correspondence File 632 (General).
(34) Letter from the officer in charge, cantonment construction, to the Surgeon General, December 13, 1917. Subject: Glass for sash. On file, Hospital Division, S. G. O.
(35) Shown on detail plans of buildings. On file, Hospital Division, S. G. O.
(36) Second Annual Report of the Council of National Defense for the Fiscal Year Ended June 30, 1918. Government Printing Office, Washington. Page 171.
(37) Letter from the War Industries Board, Council of National Defense, to the Secretary of War. April 8,1918. Subject: Proposed building of new hospitals by the War Department. On file, Record Room, S. G. O., Correspondence File 632 (General).
(38) Medical and Surgical History of the War of the Rebellion, part third, medical volume. Government Printing Office, Washington. Pages 934, 945, and 952.
(39) Plans K-34 and K-58. On file, Hospital Division, S. G.O.
(40) Memo, from Maj. C. W. Richardson, M. C., to Lieut. Col. E. P. Wolfe, M. C., December 17, 1917.Subject: Sterilizers. On file, Record Room, S. G. O., Correspondence File 414.4(Sterilizers).
(41) Plan K-l. On file, Hospital Division, S. G.O.
(42) Plan K-34. On file, Hospital Division, S. G.O.
(43) Report on Study of Mess Conditions in Base Hospitals, by Capt. E. L. Scott, S. C., April 29, 1918. On file, Record Room, S. G.O., 720.1 (Food).
(44) Shown on first plans of wards of base hospitals. On file, Hospital Division, S. G. O.
(45) Letter from the Surgeon General to the Quartermaster General. January 9, 1918. Subject: Slop sinks. On file, Record Room, S. G.O., 652 (General).
(46) Shown on plans K-34,K-58, K-117. On file, Hospital Division, S. G.O.
(47) Letter from Chief of the Construction Division to the Surgeon General. March 18, 1918. Subject: Construction of laboratory additions at National Army base hospitals. On file, Record Room, S. G. O., 632-1 (General).
(48) Plans K-103/1,K-103/2. On file, Hospital Division, S. G.O.
(49) Shown on block plan of General Hospital No. 8, Otisville, N. Y. On file, Hospital Division, S. G.O.
(50) Shown on plans of General Hospital No. 21, Denver, Colo. On file, Hospital Division, S. G.O.
(51) Plan K-107. On file, Hospital Division, S. G.O.
(52) Plan K-108. On file, Hospital Division, S. G.O.
(53) Plan F. On file, Hospital Division, S. G.O.
(54) Plan F-6. On file, Hospital Division, S. G.O.
(55) Plan F-1. On file, Hospital Division, S. G.O.
(56) Plan G-12. On file, Hospital Division, S. G.O.
101
(57) Plan G-103. On file, Hospital Division, S.G. O.
(58) Letter from the Surgeon General to the Construction Division, November 22, 1918. Subject: Buildings for physical reconstruction. On file, Record Room, S. G. O., 652 (General Hospitals) K.
(59) Letter from the Surgeon General to the Construction Division, December 21, 1918. Subject: Allotment of funds for alterations for physical reconstruction buildings. On file, Record Room, S.G. O., 632 (General).
(60) Letter from the Surgeon General to the Construction Division, November 22, 1918. Subject: Buildings for physical reconstruction. Indorsements thereon. On file, Hall of Records, Fort Myer, Va.(Cr. 652-B.).
(61) Plan I. On file, Hospital Division, S. G.O.
(62) Plan I-II. On file, Hospital Division, S. G. O.
(63) Plan I-12.On file, Hospital Division, S. G. O.
(64) Plan I-34.On file, Hospital Division, S. G. O.
(65) Plans I-39, I-42, 1-43, O-12. On file, Hospital Division, S. G. O.
(66) Based on reports of authorization and construction from various hospitals. On file, Hospital Division, S. G. O.
(67) Construction reports(name of camp). On file, Hospital Division, S.G. O.
(68) Letter from the Chief of Construction Division to the Surgeon General, September 6, 1918. Subject: Allotment for refrigeration at base hospitals. On file, Hospital Division, S. G.O. (National Army General File, Misc.).
(69) Letter from the Surgeon General to the Quartermaster General, October 11, 1917. Subject: Concrete or composition floors for hospital kitchens. On file, Record Room, S. G.O., 633.3.
(70) Weekly report of construction branch, S. G. O., for week ending January 11, 1918. On file, Record Room, S. G.O., Weekly Report File (Hospitals).
(71) Plans I-11, I-12. On file, Hospital Division, S. G. O.
(72) Weekly report of construction branch, S. G. O., for week ending May 16, 1918. On file, Record Room, S. G. O., Weekly Report File (Hospitals).
(73) Plan I-34.On file, Hospital Division, S. G. O.
(74) "Report on Mess Administration," By Maj. R. G. Hoskins, S. C., October 22, 1918. On file, Record Room, S. G. O. Food and Nutrition File (Hospital Needs).
(75) Schedule of kitchen equipment. On file, Hospital Division, S. G. O. (Kitchen Equipment).
(76) Shown in floor plans of all buildings leased and used as hospitals. On file, Hospital Division, S. G.O.
(77) Letter from the Surgeon General to the Quartermaster General, May 26, 1917. Subject: Estimate for base hospitals for cantonments. On file, Record Room, S. G.O., 176796 (Old Files).
(78) Shown on plans for hospital barracks and quarters. On file, Hospital Division, S. G.O.
(79) Letter from the Surgeon General to Director General, Military Relief, American National Red Cross, March22, 1918. Subject: Construction of recreation rooms for nurses` home at military hospitals. On file, Record Room, S. G. O., 632 (General). Letter from the Surgeon General to chairman, Operations Branch, General Staff, March 20, 1918. Subject: Rest rooms in camps, for Army nurses. On file, Record Room, S. G.O., 632 (General).
(80) G. O. No. 57, W. D., May 9, 1917; G. O. No. 82, W. D., July 5, 1917; G.O. No. 2, W. D., January 7,1918; G. O. No. 46, W. D., May 9, 1918; Bull. No. 55, W. D., October 7, 1918.
(81) Plans for officers` quarters at hospitals. On file, Hospital Division, S. G. O.
(82) Block plans of hospitals. On file, Hospital Division, S. G. O.
(83) Plans of nurses` quarters. On file, Hospital Division, S. G. O.
(84) Plans of nurses` quarters in late construction. On file, Hospital Division, S. G.O.
(85) Plans of supply buildings at hospitals. On file, Hospital Division, S. G.O.
(86) Letter from the Acting Quartermaster General to the Chief of Staff. February 28, 1918. Subject: Laundries. On file, Record Room, S. G.O., 633 (General).
(87) Second indorsement from the Surgeon General to The Adjutant General. March 7, 1918. Subject: Laundries. On file, Record Room, S. G.O., 633 (General).
(88) Plan of laundry at Debarkation Hospital No. 2, Fox Hills, N. Y. On file, Hospital Division, S. G.O.
(89) Plan Q-4. On file, Hospital Division, S. G.O.
(90) Plan of garage at hospitals. On file, Hospital Division, S. G.O.
RETURNTO TABLE OF CONTENTS
