College Student Reflects on Recent Academy Lecture

Today’s guest post is by Eliana Lanfranco, who is a rising sophomore studying at Georgetown University. She is majoring in medical anthropology and hopes to pursue a career in medicine in the future with the aim of returning to her home country to open a clinic. Eliana attended the Academy lecture with Project Rousseau, a non-profit organization, whose mission is to empower youth in communities with the greatest need to reach their full potential and pursue higher education. Project Rousseau takes a holistic approach to students’ educational problems delivering a variety of programs and strongly believes in the importance of exposing students to as many new experiences as possible, such as attending lectures at the New York Academy of Medicine!

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Eliana Lanfranco (center) with Project Rousseau Founder and President, Andrew Heinrich, and two younger Project Rousseau students.

On May 11, I attended “Facades and Fashions in Medical Architecture” at the New York Academy of Medicine.  This was my first time attending a lecture outside of my college classes, and I left with a different perspective on what lectures have to offer. The lecture did not contain slides filled with information I was required to know for a course, but rather an interactive, engaging talk filled with information I wanted to know. Through it, I learned about a new side of the history of medicine that I had never thought about before.

The lecture began with an overview of dispensaries, which were used primarily by the lower income groups in NYC (the wealthy had their own private doctors) in the 19th and early 20th centuries.  Many of the volunteers in these dispensaries were doctors from affluent backgrounds who had recently graduated and wanted to gain clinical experience to become established doctors. Later, when hospitals began to serve both the poor and rich, recent graduates preferred the hospitals over the dispensaries, since the former had the latest equipment, such as x-rays and anesthesia, which the doctors could learn about and use.  It is interesting to see how this trend has, to some extent, remained among medical students today, and which medical institutions attract which students. Today, it may be easier to find a volunteer spot in community clinics than in hospitals, and medical students can oftentimes be more exposed to the health issues that affect certain communities who use these facilities.

The lecture also highlighted the way in which hospitals were built to be relatable to the patients and how their architecture reflected medical beliefs at the time. Older hospitals were built with long, narrow wings, as it was believed that the flow of air and light eliminated germs. Their architecture also tried to be welcoming and non-imposing to people walking past them; for example, mental health institutes were built to have a countryside feeling instead of looking like enclosed plots of land. Later, many of the hospitals built during the New Deal time period also featured murals painted by local artists in their waiting rooms. These murals were sometimes twofold, as they featured “controlled medicine” or modern medicine, and “uncontrolled medicine” or folk forms of healing. They portrayed historical figures in medicine, such as Louis Pasteur, and minorities in the field of medicine. As a patient, I would have been thankful for these murals since they offer some distraction from the endless wait in the waiting room.

In contrast, modern hospitals have been built in big clusters, along with skyscrapers. Their rectangular shape makes them reliant on mechanical ventilation, and their towering height makes them overpowering to people walking by. However, many try to maintain their air of welcome by making the entrances wide to show that it is not an institution for a select few. I think that these small details are very important because even though the majority of patients may not consciously think about the architecture they’re entering, these features greatly affect how patients, especially those who are not used to having structured medical systems in their home countries, feel about entering the hospital. I lived in a rural part of the Dominican Republic and the tallest hospital I saw growing up was four floors high. When I moved to New York City, I was surprised at the height of the hospitals and, although I am no longer a child, I am often intimidated by the buildings. It is good to see that some hospitals have incorporated details into their architecture to retain the air of welcome for patients, although as I, and many others, still quiver as we enter hospitals, I wonder how successful this approach has truly been!

Prior to this lecture, I was unaware that so many buildings I walked by every day, and that just looked like apartments with no historical importance, were actually hospitals and medical institutions.  Although older medical institutions can give us an insight into older medical beliefs and practices when carefully inspected  and can help us shape future medical practices, many of the older medical institutions have survived only through repurposing to other uses, such as apartments or firehouses; few have maintained their original purpose. It would be great to see the older hospitals that have survived, continue their original purpose or become museums so that their medical history can be saved, as has been the case with some buildings in nearby Philadelphia and Boston. As a pre-med student, the thought of attending an architecture lecture was, at first glance a little strange, but now I realize how related medicine and architecture are. A doctor’s primary aim is to treat all those in need, but without the right architectural design many patients may be hesitant to enter towering, intimidating hospitals!

Building The Knick: New Hospitals of the Turn of the Century

By Paul Theerman, Associate Director, Library and Center for the History of Medicine and Public Health

“In mid-nineteenth-century America it was well understood that, aside from an occasional emergency, none but the truly indigent would voluntarily enter a hospital . . . . By the First World War all this had changed. Respectable Americans were beginning to find their way into hospitals—especially, but not exclusively, for surgery. . . . The hospital was being integrated into medical care as it already had been into medical education and the structuring of elite careers. Hospital budgets, physicians’ practice patterns, attitudes towards science, charity, and the prerogatives of class . . . interacted to transform the early twentieth-century hospital.”1

These factors—budgets, physicians, science, charity, and class—are all themes of The Knick, which focuses first on the hospital as a backdrop, then as an institution, and finally as a building. Part of the narrative arc in season two is the decision to build a new Knickerbocker Hospital uptown. This fictional plot point is in line with historical developments at the turn of the century.

For example, in the first decade of the 20th century, the new Mount Sinai Hospital could stand in for the uptown Knickerbocker. Founded in 1852 in west Midtown, Mount Sinai Hospital moved in 1872 to the East 60s, and then to its current location on Fifth Avenue at 100th Street in 1904, on the Upper East Side abutting Harlem. The city’s population moved north, and the hospital moved to follow the people, taking advantage of new buildings to advance hospital architecture generally. Under the guidance of one of America’s premier hospital administrators and builders, Dr. S. S. Goldwater, Mount Sinai developed state-of-the-art buildings to support modern, advanced medical care.2

Postcard showing Mount Sinai Hospital, 1910.

Postcard showing Mount Sinai Hospital, 1910.

Mount Sinai Hospital is only one example of a great wave of hospital building at the turn of the century, not only in the United States, but also in Western Europe. The change can be seen through books and journal articles promoting and hoping to guide the process. At one end of the scale in hospital building was Alfred Worcester’s Small Hospitals: Establishment and Maintenance (1894, 1905, 1909), which included Suggestions for Hospital Architecture, with Plans for a Small Hospital, by William Atkinson. Worcester had no compunction about calling this “The New Hospital Movement,” and linking it to professional nursing and surgical advances. The detailed hospital plans in this book provided for an institution of about 50 beds, with possible expansion to about 75.3

The other end of the scale can be seen in The Planning of a Modern Hospital, by Dr. Christian R. Holmes, chairman of the Board of Hospital Commissioners of Cincinnati, Ohio. In an address given at Teachers’ College of Columbia University in 1911 and published in 1917, Holmes discussed the new large urban hospital.4 He promoted the virtue of hospital architecture as a separate study and competency, giving three reasons: “Hospital construction differs from every other kind of building,” due to the ever-changing and progressive nature of medicine and sanitation, and thus requires “unusual care and foresight”; often “the men placed in charge . . . have not the slightest knowledge of the needs of a hospital”; and “the architect is often selected for reasons other than his knowledge.” Holmes supplied a typology of hospitals—pavilion, block, corridor, and composite—and then went into detail on planning a patient ward, including lighting, heating, ventilation, and bed placement and spacing, and including a room for clinical teaching.

Mount Sinai ward unit design. Figure 21 in The Planning of a Modern Hospital.

Mount Sinai ward unit design. Figure 21 in The Planning of a Modern Hospital.

In addition to general wards, he also provided specific modifications for patients with contagious diseases; neurological conditions, including alcoholism; and venereal and dermatological diseases. He included operating theaters—a major reason for seeking a hospital at the time, and an important source of income. And he went into the specifications for all the supporting structures: kitchens, dining halls, and dormitories for staff, laundry, power plants, and of course, administration. Holmes illustrated his book with 74 photographs, elevations, and plans of large, well-known hospitals from around the United States and Western Europe. Given his background, many illustrations showed the Cincinnati General Hospital, completed in 1915, but he also included classic institutions such as the Rudolph Virchow Hospital, Berlin (completed 1906), New Royal Infirmary, Manchester (completed 1908), the Johns Hopkins Hospital, Baltimore (completed 1889), the Mount Sinai Hospital, New York (completed 1904), and Hôpital Boucicaut, Paris (completed 1897).5

Hospital Boucicaut. Figure 29 in The Planning of a Modern Hospital.

Hopital Boucicaut. Figure 29 in The Planning of a Modern Hospital.

The Knick touches on issues of its time as well as of ours. The New Hospital Movement was in ascendancy more than a hundred years ago, when the show is set. But who can deny that our own time has witnessed a new hospital movement, characterized by consolidation and closures, as institutions and their buildings adapt to the new financial, social, and medical worlds of the 21st century.

References

1. Charles Rosenberg, The Care of Strangers: The Rise of America’s Hospital System (New York: Basic Books, Inc., 1987), p. 237. See also Guenter B. Risse, Mending Bodies, Saving Souls: A History of Hospitals (New York and Oxford, Oxford University Press, 1999).

2. “Two Hospitals, Two Presidents,” chapter 9 of The First Hundred Years of the Mount Sinai Hospital of the City of New York, 1852–1952, by Joseph Hirsh and Beka Doherty (New York: Random House, 1952).

3. Alfred Worcester’s Small Hospitals: Establishment and Maintenance, with William Atkinson, Suggestions for Hospital Architecture, with Plans for a Small Hospital (New York: John Wiley and Sons, 1909), pp. 1, 3, 114.

4. Christian R. Holmes, The Planning of a Modern Hospital (Detroit: The National Hospital Record Publishing Company, [1917]).

5. Holmes, The Planning of a Modern Hospital, pp. 3–13, and figures 1, 22–24, 27, and 33–74, which refer to the Cincinnati General Hospital, and figures 2, 7, 16, 21, 29, 30, and 31, which refer to the other hospitals mentioned.

How Air Conditioning Changed the NICU

By Johanna Goldberg, Information Services Librarian

We’ve entered the season of hot, humid, frizzy-headed misery outside and freezing temperatures from blasting office air conditioners inside. Which got me to thinking: What impact did air conditioning have on medicine?

Constantin P. Yaglou. From the Harvard School of Public Health 1955 yearbook.

Constantin P. Yaglou. From the Harvard School of Public Health 1955 yearbook.

One man did impressive work on this front. Constantin P. Yaglou (1897–1960) was not a physician, but a professor of industrial hygiene at Harvard’s School of Public Health. Born in Constantinople, he came to the United States in 1920 and earned a master’s degree from Cornell. He joined the Research Laboratory of the American Society of Heating and Ventilating Engineers in 1921, where he spent five years studying the influence of humidity, temperature, and air circulation on working and resting adults. In 1925, he joined the department of industrial hygiene at Harvard.1

His cross-disciplinary collaboration with Harvard Medical School’s pediatrics department, notably Dr. Kenneth Blackfan, proved innovative. Assisted by nurse Katherine MacKenzie Wyman, they published “The premature infant: A study of the effects of atmospheric conditions on growth and on development” in the American Journal of Diseases of Children in 1933.

The air conditioning unit in a nursery for premature infants. In “The premature infant: A study of the effects of atmospheric conditions on growth and on development,” American Journal of Diseases of Children, 1933, 46(5).

The air conditioning unit in a nursery for premature infants. In “The premature infant: A study of the effects of atmospheric conditions on growth and on development,” American Journal of Diseases of Children, 1933, 46(5).

They studied the effects of Harvard’s newly air conditioned nursery from 1926–1929, and compared their measurements to those from pre-air conditioned 1923–1925. (From 1926–1929, they controlled for variables like diet and dress.) They found that premature infants were less able to stabilize their body temperatures than infants born at term. Even among premature infants, ability to regulate temperature changed depending on birth weight. They determined the ideal temperature for premature newborns to be 75-100 degrees Fahrenheit with 65% humidity.2 These influential findings lay a foundation for the development and use of temperature-controlled incubators.3

Yaglou published a figure neatly summarizing the study’s major results in JAMA in 1938:

A summary of the results of the premature infant study. In "Hospital air conditioning," JAMA 1938, 110(24).

A summary of the results of the premature infant study. In “Hospital air conditioning,” JAMA, 1938, 110(24).

This figure comes from Yaglou’s broad-reaching “Hospital Air Conditioning,” which brought together studies on air conditioning’s effects in the operating room, recovery wards, premature nurseries (summarizing his prior work, as in the figure above), fever cabinets, allergen-free rooms, and oxygen chambers.4

According to the article, not only did air-conditioned operating rooms help those involved in surgery feel more comfortable, it also reduced “the risk of explosion of certain anesthetic gases.”4 In the post-operative recovery rooms, air conditioning reduced the risk of heat stroke and improved the body’s ability to recuperate, though Yaglou did not recommend a particularly cool temperature. “With a relative humidity of about 55 per cent,” he wrote, “a temperature of about 80 will probably prove acceptable.”

But even with the benefits of air conditioning discussed in the article, it was difficult to employ at a large scale in the late 1930s. Yaglou concluded, “High cost precludes cooling the entire hospital, but the needs of the average hospital may be satisfactorily fulfilled by the use of built-in room coolers in certain sections of the hospital and a few portable units which can be wheeled from ward to ward when needed.”4

In addition to his work in medical settings, Yaglou also performed military research on extreme climates like the Yukon, the tropics, and the Arizona desert, “working with volunteers to determine the limits of human endurance under severe heat, cold and humidity.”5 Perhaps it should come as no surprise that the UK Antarctic Place-names Committee christened Yaglou Point in his honor in 1965.6

References

1. Whittenberger JL, Fair GM. Constantin Prodromos Yaglou. Arch Environ Heal An Int J. 1961;2(2):93–94. doi:10.1080/00039896.1961.10662820.

2. Blackfan KD, Yaglou CP, Wyman KM. The premature infant: A study of the effects of atmospheric conditions on growth and on development. Am J Dis Child. 1933;46(5):1175–1236. doi:10.1001/archpedi.1933.01960060001001.

3. Rutter TL. Comfort zone. Harvard Public Heal Rev. 1997:29.

4. Yaglou CP. Hospital air conditioning. J Am Med Assoc. 1938;110(24):2003–2009. doi:10.1001/jama.1938.62790240003010.

5. Constantin Yaglou, Harvard Professor. New York Times. http://query.nytimes.com/gst/abstract.html?res=9A06E6DF123DE333A25757C0A9609C946191D6CF. Published June 4, 1960. Accessed July 21, 2015.

6. Yaglou Point, Antarctica – Geographical Names, map, geographic coordinates. Available at: http://www.geographic.org/geographic_names/antname.php?uni=16847&fid=antgeo_126. Accessed July 21, 2015.

Visiting Ellis Island’s Hospital Complex

On June 7, our Friends of the Rare Book Room and ARCHIVE Global: Architecture for Health enjoyed a private visit to the hospital zone on Ellis Island. The private support group Save Ellis Island offers hardhat tours of the hospital complex, which is adjacent to the main reception center operated by the National Park Service. More than 30 people took the ferry from Battery Park across New York Harbor to Ellis Island to learn more about the site and its importance to the history of public health in New York City. Some stayed on for lunch afterward at historic Fraunces Tavern.

Our Save Ellis Island tour guide gives safety instructions before the group enters the hospital zone.

Our Save Ellis Island tour guide gives safety instructions before the group enters the hospital zone.

On the south side of the island, and out of use since 1954, the hospital complex housed would-be immigrants who were not permitted to immediately enter the country. All steerage passengers were inspected—usually for only a few seconds, given their great numbers—and some 1 to 2% were detained for health reasons. Completed in 1909, the 750-bed hospital included wards for infectious diseases, kitchens, massive laundry facilities, an autopsy room, and recreation spaces for patients and staff alike.

The autopsy room.

The autopsy room.

Even in its semi-derelict condition, the complex is one of the few remaining “pavilion” style hospitals in the country. Pavilion hospitals were first built in France in the 18th century, and were enthusiastically endorsed by reformers such as Florence Nightingale in the 19th century. The design emphasized the need for ventilation, with wards built to promote sanitary conditions, provide light, and maximize the circulation of air. Pavilion hospital design fell out of use in the 20th century.

Caged verandas allowed patients access to fresh air while controlling their movement around the complex.

Caged verandas allowed patients access to fresh air while controlling their movement around the complex.

The Ellis Island site, already abandoned and crumbling, was further damaged during hurricane Sandy, and Save Ellis Island is working to stabilize the buildings, while preserving the sometimes eerie atmosphere of the site, now partially overgrown with vegetation. For more information about the complex, and the Save Ellis Island project to bring it back into public view, see: http://www.saveellisisland.org/history/hospital-complex

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Wall with a tide mark showing the level of water during Hurricane Sandy.

We are increasingly offering our Friends group exclusive events such as this visit. If you are interested in becoming a Friend, find out more here. Friends who missed out on this sold-out event should e-mail culturalevents@nyam.org to express their interest in another tour at a later date.

It’s All in the Details

By Arlene Shaner, Acting Curator and Reference Librarian for Historical Collections

"Male Ward E" at Hahnemann Hospital, from the Hospital's May 1901 Report.

“Male Ward E” at Hahnemann Hospital, from the hospital’s May 1901 report. Click to enlarge.

Advertising for The Knick, the HBO Cinemax series that begins tonight, is everywhere right now. The show, which centers on the world of a fictional New York hospital, The Knickerbocker, right at the turn of the 20th century, has been in our sights here in the NYAM Library for months.

Long before the episodes of any historical drama are ready to air, a tremendous amount of research goes into making sure that the settings, costumes, and stories display a level of historical accuracy that will make the show believable. It is part of our mission as a library devoted to the history of medicine to help the show’s researchers discover where the information they need can be found. We don’t do our jobs alone, though, and colleagues at many other area institutions such as the Archives and Special Collections at the Health Sciences Library at Columbia University, the Museum of the City of New York and the Mount Sinai Archives, to name just a few, offered plenty of assistance as well.

There are lots of resources in our collections that Knick researchers explored while the show was under development. A particularly rich source for images and descriptions of hospitals in 1900, the year in which the show begins, are the annual reports produced by medical institutions here in the city. Illustrations of operating theaters, like this one from the Presbyterian Hospital, help designers build accurate sets in which the drama can unfold.

Presbyterian Hospital's operating theater, an image from its 1901 annual report. Click to enlarge.

Presbyterian Hospital’s operating theater, an image from its 1901 annual report. Click to enlarge.

In some instances, written descriptions help answer questions that come up when the photographs themselves don’t provide enough information. The Hahnemann Hospital operating room in the picture below is quite distinctive in appearance, but the actual descriptions of the rooms from the Hospital Souvenir offer lots of extra details: room dimensions; lists of equipment along with information about what everything is made from and where it sits in the space itself; and explanations of how the different rooms are physically connected to each other or separated from other spaces.

A Hahnemann Hospital operating room, from its May 1906 report. Click to enlarge.

A Hahnemann Hospital operating room, from its May 1906 report. Click to enlarge.

Descriptions of Hahnemann Hospital rooms, from the hospital's 1900 Souvenir.

Descriptions of Hahnemann Hospital rooms, from the hospital’s 1900 Souvenir. Click to enlarge.

A group of nurses from the May 1901 Hahnemann Hospital report.

A group of nurses from the May 1901 Hahnemann Hospital report. Click to enlarge

Some of the photographs also show us how doctors and nurses dressed. The nurses with their long white pinafores and puffy hats certainly look more dated than the surgeons in their doctors’ whites. And if you look back at the 1901 image of the operating theater from the beginning of this post, you’ll note that even though the doctors are performing surgery that no one is wearing a mask or gloves. In the Hahnemann Hospital operating room image from 1906, only a few people have gloves on.

We’ll be posting more about early 20th century medical practice on all of our social media platforms as The Knick gets underway, so be sure to follow us on Twitter and Facebook. And check our blog on Monday to learn more about the medical history behind The Knick.

Item of the Month: Boston City Hospital, Christmas 1912

By Rebecca Pou, Archivist

BostonCityHospitalWardG

Click to enlarge.

A slim volume from our collections provides a glimpse of the holiday festivities at a public American hospital more than 100 years ago. In Boston City Hospital, Christmas 1912 we find eight photographs documenting the hospital’s holiday adornments and celebrations. The stark black and white photos of vaulted ceilings and nearly empty rooms don’t paint the cheeriest picture of the holidays, but clearly the staff put a great deal of effort into the celebrations.

These are pictures of the spaces more than the people in them. We see patients in their beds and the kitchen staff waiting for their holiday meal, but the people seem almost incidental. Some of the shots focus on the feasts on the table and the Christmas tree, while others capture the entire ward with garlands hanging from the ceiling and wreaths on the walls. These images are striking in part because the hospital’s large, communal wards look so different from patient settings in hospitals today.

BostonCityHospitalWardO

In A History of the Boston City Hospital from its Foundation until 1904, we find out a bit more about Christmas at the hospital. “Christmas trees lighted by electric bulbs” and decorated with gifts for every patient spruced up the convalescent wards.1 If you look closely at the Christmas tree above, there appear to be several small dolls in its branches.

Boston City Hospital opened in 1864. From February 1, 1912, through January 31, 1913, the hospital treated almost 13,000 people with an average of 550 residents per day. About one third of the patients were natives of Massachusetts, but patients born in 61 other countries spent time in the hospital over the course of the year. The largest number of those came from Ireland, but the annual report lists patients born in Syria (25), Barbados (5), the Fiji Islands (1), and New Zealand (2), as well as many other locations.2 The hospital merged with the Boston University Medical Center in 1996, forming the Boston Medical Center.3

Click through the gallery below for the rest of the photos from Boston City Hospital, Christmas 1912.

References

1. A History of the Boston City Hospital from its Foundation until 1904. Boston: Municipal Printing Office, 1906.

2. Forty-ninth Annual Report of the Boston City Hospital, 1912-1913. Boston: City of Boston Printing Department, 1913.

3. History. Boston University, School of Medicine, Department of Medicine. Retrieved December 17, 2013. http://www.bumc.bu.edu/medicine/dom-introduction/history/