A national clinical center for chronic disease research · Clinical Center of the National lns+1tutes of He.alth . A national clinical center for . T. J.Ui. RECOG~-UlON Of chronic

Clinical Center of the National lns+1tutes of Health

A national clinical cente r for

T JUi RECOG~-UlON Of chronic di$shycases as a majol public health

problem has emphasized the need for a coonlinatd research proshygram in long term illnesses These are no the greatest causes of dibullabHity and death in our popushylation With advanc-es ln the prevention and treattnent 9( comshyuiubull)icable disease and with the increasing nwnber or aged pcrgons -an1ong V_hom lthronic disease is most prevalent-vbulle are conmiddotfrontcd vith an urgent need for more knowledge in the prevention and control of chronic illn~scs

The National Institutes oC Health the research arm ofmiddot the Public Health Service Federal Security Agency conducts laboratory reshybullearch in narly all fields of medshyical science Its cliriical ~enter now under COJlStruction wj]J provide not only necesary additional Jaborashytoty facilities but will Iuirtish clinical (acilllies fo~ tb lational Cancer Institute National Heart l11$titute National Institute of Mental Health E xperimental Bishyology and lIedicin Institute Mishycrobiological Institute and lational Institute of Dental Research as well Thus the clinical ltntet will be a broad stltgtp toward conquershying cbronic diseases in the UnHcd States

General medical facilities in the clinical center will providemiddot for the nvestigation and treatment oI certain patients from everyvherc in the nation aJiecteltl rith cancer he~ut disc~sc metabolic diseases 1ntntal diseases and infectious and tropical diseases The Research b acilities Planning Committee of th1gt Iational Ihstitutes of Health responsibl for the deyelopmenl of the building progfam now is conshyducting a series o special studies which include planning for ( l) lltychiatric care and research ( 2)

D~ z1awr Is director of the lt1inlcenta1 ei1~shyt~r Karloml InsEH1t~ n~ Healtb PubhcshyHealttt Se1ce Federal S11~ndty A~ency ind h-lr Tho)S~U ~s middotc htepound 01 tbe hospitalampOClirgtni Pobllc BuildiDYs Ailtinis1r(IJJ01 GenefJ ScrvjcCS Ad1ntnattmiddotatton

chronic disease research JACK MASUR MD ANO N P THOMPSON AIA

faltJities or metabolic studies (3) scientific libraries (4) design of chemical fume hoods in faboratory planning in aix conditioned buildshyings ( ~) devclopmfnt of centralshyized services (glassvrare Vashing cage cleaning photography and pactcriological media preparashytion) (6) breeding and care of experimental acixnals (7) enshyvironmental sanitation (air condishytioning lighting safety features equipm~nt for food preparation and food servioe)

Authoriwtion by the United States Congles for the exp~nsion of tle facili t ies for IDtramural reshysearch programs of the National Institutes of Health providtd Ior the acquisHion of an additionltll 213 ac1middotes of lahd adjacent to the prsshycnt 90-acre ~ile at Jlethesda 11d a comlnunity which is about sevfto miles north of Washington DC

1n the bisic plannibg the Pubshylic Health Service and the Public Btilldings Administration sought to design a ~aboraory-Jiospital buildshying Vhicli degould provide tice as much spacti tor resParch labQ1middotashytories a~ for direct care oC patientsmiddot

THE CLINICAL cnfer will be a 14-sfory structure combining hopital arid re etch facilitiM AmiddotrtiSts perspe~ivet s~ow ~e south view ~fop) ancl ffie natfhern oxpo~urct

afford p rogtdmity of sclentiljc inshyvestigaWrs and clinicians for free interlthange of ideas and knovlshyedge localize thebasic science and clinical research labotalo1ies and nursing units for one disease c~tc gory on each middot ftoor for a coordishynatea team approach

Thc most desired ckllents were utility and flexibility to meet tlie ever-dhangirig requirements of laboratory research patient care a11d admini~trative praclices

The clinical center will be an air conditioned building (lcsigned in approximately the shape of a Lorr-tlne cross The central stein utilizes a modified two-conidor or three-function plan locating all

Reprinted from HOSPITALS Journ(1 qf flt~ Atetican Homiddotsmiddotpital Anoci41ion

NoVetnBbullr 11149

PLANS fqr the NaitionoI lnrlit11te~ of HeeIth inclvdff not -only the n9 ~liniisI ~c11ht ( tig1) but o 9ra11p o( $~rvicQ nncl ovl(iliory builclin9s slttgtWlI at the upper IE-ft ExistiAg buitdi11(Js ~enter foreground tltlfff deii911~d -s the middotn11cleui of middota J~rg94cole progNm

patients~ rooins on the south ~jd~ 1 Routi11e underground storM vaults for tlie 11ursing scrvicc units in middotthe laboratorfs com hustilgtle ccnteigt and all cliniCal i1-1vestigashy 2 PhyMcil A guiding conidoration in tlie

rncdilinc miiJLi9n l~boTatoric middoton thE- north s~dEt plan ha) btien th~ location of servshylchabilitzi1ion 46 modules

The head houbulle ibull Jla)ked by six ice functi~s uth a$ po~middote1middot and3 Scientificvings co1ltaining the bosic science utilimiddottie l)tOLagegt muintennnc~libr~ry

laboratories shegtps ond laundly ouid the4 S1rgical _1rchitccturnl piltern pl~~m~iJll sUitc onP-h~Ili tenth ~linical center builltllng Thibull arshy

Jlh1Umiddot cc-ntrallt1pound pbulltmgel and middotfrcigttt cl~vaior 1middotangernent mflkcs posjbl~ the amptenthankmiddot reritrtlizalion o ltttain maxhnwn utilizttion of the more

5 Diagnool ic hwpiial and lJgtlt1ralo ly ervicc dcshy (-1middotay expensive type of middotconLruchon or va1middotuncnts instnllation of dumbshy dcponmiddotl1nnt oite-holt siXth fabortory-and patfont ca1middote funcshywaiter prleltUllatk lube bull)Siems and tloor centrol tions locatio11 of auxiliOTbull servhe buildshy s~nr The major service buildlt)g~ ate

6 middotRadiotiqu Eight-SLl1y ings connEtcteltl Uy ah middotundelground middotconnected wilh the dinilt-al center ~ini

tunnel vcrc determined br im-shy by nine-foot twmd for utility1 ~eut~l

purtant conl)id~lmiddotatio11s of yerticoJ linrs and an ~ltlJltHmiddotenL njl1e-fuots~rvices 3fl rnodules and hegtrizegtntal traffic flow for (1) -a Gcncr-nl lUnnttl for iransportotion of supshyunity with dive1middotsity (2) ffoxishy patha1uay bull 3U rnutlul~8 p t iCs and refU$~ tgtXClusive ofmiddot o bility in the usemiddot of spac anct (3) 2 t 4 in sidewalk for pedestrians

There also are space WJocations effieincy o opc1middotatiltgtn ind conmiddot Tho mthmiddot p tbullojecl ibull acheduled lor outpatient and ~dmini$trativc

Vltnjcncc fol middotpersonn~l or completion in Tulymiddot JU52 dttpartments and ccnumiddotul services

1o guide initinl prograu1 planshy CLINICAL FACILITIES middot ning the provisiouaJ allocaticgtn of

The bed capacity of tle clinical center will be 509 and the number lvfony of the middotSLa~da1middotd ratiobull middotfor

b~d co1nplen1cnts and l~botatory of lescarch lahoaiory module general hol)pital design -ere nee

rrodul~s (12 ft x 20 ft) follows (12 ft x 20 fl) approximtely essadly modiiicc bcGausc the calemiddotB~ds Labx NHlional Jn$titutc Lgtt J000 exclusivr of inodules asshy eories or di~ase to be admitted

middotMental Hc1lth 150 21~ sigQed to xmiddotoutine diagn9stic u1d to the clinicnl cCntcr involve long 1ationi1 Cao( ef treatment facilities aDd an~illary term illnesl)1 inciuding ps-ychlatric

Institut middotmiddotmiddot- J2S 270 serbullhes and infectious and tropic~ I llii~aishyNation~l l-f~Hfmiddot1 shy In additipn tomiddottllc clinicil cent~r ltk The primary prupose ltgtf thIrictitul+l bullbullbullbullbullbullbullbull 100 246 Expcrirncotiil B iology th~ pr~sent conl)truction program cen1ef mureovcr is for scieritililtgt

and DIeampci11e of tfgtc National Institutes of Health iJ1~estiAation ai ell ai treatment Institute in~luctes the Collowing auxiliary In ddition 10 all of tho rcsommiddot~es (Jh~Lubc)Iit service building Temporary rashy and cqJipmnt or a modm gen shydi~~middotHReH) 1~ 160

dioactiv facilitiebull building (now Etral hospitalmiddot~ nn insti1uiion pound01middot tlurJIi~r1hiolllgfralmiddot Iustitute middot under construction)~ utility builifshy careof cuonic disease should inshy(Infectious nnd iilg (now under- conbulllruction) clude accommodations for Sj)ecial ~middotopilt~l middot cti~s~s) middot JO 88 power plant shops laundry and emphasis ot1 ancillary s~nicCs

lt)ther inajo1middot assignments middotof storag~ building anim al br~ding bulluch a medical and psychiatric space_for general servic~ functions builtline and animal feed building soci a I vmiddoto~k public l1tNtlth nursi~g include grou11lt1 mainteJance building and physical medicin and rhabiHashy

ti_on dlvCrsional anltl recr~tional the rapy and religious mmistcy filr all faiths The chapel an impoimiddotshytant feature oI the center has a revolving interchangabk altar which vii 11 provide religious servshyices Ior all faiths

Patients facilities The patientsbull rooms and nu)Sing sevices of the center are arranged to provide mixiinum comfort to the sick iind 1AOrkirig convenience to the nursshying staff The planners have had to consider the probability that the ratiosof Jed-bound semiambulashytory and ambuligt-toty patients will vary g-eatly depending on the stages ol t-ertain diseases undCr study at dHfcrent periods

the typical nursing unit on the east half and west half of the main s11m is in close physical relationshyship fa the clinical investigation area Qn thmiddoto north side In each nursing unit there are 13 two-bed rooins on the south side) with serbullmiddotshyice units in the middle lOW of rooms With exception of the floor serving piintry-- v1hich accommoshydates both n u1middot$ing units on each floo~ the middle row nursing servshyice rooms hr~ identical in bClth east and west nu rsing units

The middotservice rooms for every nursing unit of 26 paticntoinclude

A Patients dining room with a

a tot) eapacltt oC rn patients B Treatment rooms including

sbullnall laboratory bench for on-theshyspot simple laboratory tests

C Small office for use by charge nurse dietitian or social Orker

D Nursing station (with sepshyarate 1ncdication rootn) including pneumatic lubemiddot ~tation and single p3nel board for nurses call ligh ts soft audiblc doctoramp call sys tbullm pre-~gnal fire alarm chhnes and signal light and dumbwaiter signal light

E Utility room F blo~rcr room G Linen room (for special truck

with shelves) if Passage t -0 clinical research

laboratories I Nurses) rest room J Sfrctche r and wheel chair

room K Jani~ors closet and gear

room J Tmiddotash chute M Linen chute (with adjacent

mechnniCal wa15hing 1nachi n~ tomiddot1middot badly soiled lillen)

The floor serving pantry in the cast nursingunit is 17 ft x 34 ft It is furnished with consid~rable mecllanical equipmmt for rapid assembly of food trays from elecshytric heated [aad carts (sent rom mam kitchen via spltgtcill elevator)

and prompt delivery to 52 patients Each pantry also inclt1des a ga1middotshybage grinder disposal unit pre rinse double sink and two-tank mecllanical dishwasher

Corridors middotare eight feet wide with 4 ft 6 in We dado flush with plaster and five-inch terrazzo base There is a metal handrail (i6 inches high) on both sides of themiddot corridormiddot for the cohvenience of setni-ambulato_rmiddoty patients Reshycessed tlte hose and extinguishe1middot caliinets are located at 100-fool inteivals and are identifiable from a distance by a light coloredmiddot tile marker in tJ1e floor

The corrjdor ceilings sus pended height 9 ft 6 in) a1middote treated willl prefabricated acoustic t ile Dlwnination is furnished by hanging metal indirect Incanshydescen t ligllt Hxtwes in the patient areas Drinking_ fountains with centrally supplied chiUed water are located iri each OUJ-sing unit and ctt wing crosiings

Typical patient s room The typical patients room is17 ft x 11 ft 6 in designed to accommodate two beds Corutruction details in clude an aluminum frame window 4 ft 6 in x 5 ft asphalt tile floor plaster walls painted in pastel shades tershyraz1o base plastebullmiddot ceiling and steel doors four feet wide

-- ~~shy -

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FLpoundll18llrf i9mbltt~d with ltuletlolal layout will make ~the clinical eenter ldeaI for rasmiddotamparct llt11boratories Space will be middotallotted according to the rcqulremenft of eaih rescet~h group Equipmenf and fulnishings wiU be sfandar(lj~d for efficiency and econigtMy

The room is air conditioned It contains a lavatory wash basin with mirror and two small lockers for clothes Cubicle curtains and outlets for centralized oxygen and vacuum electricity telephone rashydio public -address and nurses call are available for each bed A conshyduit for the future installation of central television reception has been provided Indirect illuminashytion will be furnished by a standshying lamp with inverted bulb bowl

Tliere is no overhead lighting fixshyture although a concealed outlet has been built into the ceiling for future use if necessary A night light is situated on the far wall 18 inches from the floor An improved reading lamp for attachment to the wall or head bedpost now is being designed

Inasmuch as many patients will be ambulatory or semi-ambulashytory at different periods of study and treatment a variety of beds

PATIENTS rooms in the center will accommod 11te two beds 11nd include to ilet facilities as well as locker space for clothes Each room will be air co11ditioned and equipped with oxyshygen vacuum teleshyphone radio public add ress and nurse call outlets A conmiddot duit for the future installation of cenmiddot tral television recepmiddot tion aho will be av11ilable

will be available for each ftoor Moreover several types of highly mobile beds for easy transportashytion of bed-bound patients will be given pilot study during the eohshy

struction of the clinical centeti The width of the qoors of bedrOQms and clinical reseaxch Iiboratories and elevator entrances are die~ by the greater-than-normal traffic involving beds stretchers and scishyentific appruatus in a teseatch institution

Adjacent to ~acb patients room will be a bathroom containing a bathtub and showerbead toilet_ bedpan washing hose and storage rack A metal Jull-up bar abcl emergency nurses cltUl bell are provided beside the toilet seat for the semi-ambulatory patient A safety bar is to be provlded on the wall over the bathtub The exhaust ventilation duct for the bedroom is in the ceiling of the bathroom

UTILITY ROOMS

The utility rooms centrally loshycated in the middle row of service rooms in each nursing unit are 16 ft x 17 ft with separate in and out doors No attempt has been made to achieve so-called separashymiddottion between clean and dirty areas It is believed that the siZe of t1ie room and the location of equipshyment will encourage separation bett~r than subdivision by various types of physical barriers There are no bedpan washing facilities in the utility rooms since bedpans are cleansed and stored in the toilets adjacent to the patients roolllS Ice cubes for chilled drihks are supplied to the nursing staff in the fiQor pantry rather than in the utilshyity room

METABOLIC KITCHE S

On the west nursing units of the seventh eighth and ninth floors t_here are metabolic kitchens for the preparation of special diets in nutrition studies (see page 55) Another type o_f metabolic kitchen designed for the north side labshyoratory area of the clinical center by Dr Russell Wilder and bis asshysociates at the Mayo Clinic is being considered also These special food service units provide for the most meticulous preparation of care- fully analyzed food stuffs beyond the degree of accuracy which usushy

ally can be handled in the special diet kitchens of hospitals

INFECTIOUS DISEASE UNIT

The basic floor plan has been modified in one nursing Unit of the eleventh floor for the care of infecshytious disease patients (see page 56) Each of the 13 rooms is a selfshysufficient unit which insures maxshyimum protection and efficiency and thus permits the concurrent invesshytigation and treatment of several types of communicable diseases The length of the typical bedroom has been reduced from 17 feet to 15 ft l in The patients lavatory has been recessed in the bathroom and a shower substituted for the tub

Personnel in contaminated gowns masks and caps are to be restricted to the bedrooms thus reducing the possibility of contamshyination of corridors This plan pershymits free use of the corridor for normal traffic A recessed area in each patients room fitted with a foot control lavatory facilitates aseptic techniques by providing hand washing facilities and essenshytial supplies (clean gowns masks and caps) in a clean area immeshydiately adjacent to the source of contamination

NEUROPSYCHIATRIC SERVICE

The integration of patient care clinical investigation and basic scishyence research in neuropsychiatry with other disease categories is a significant feature of the compreshyhensive program of the National Institutes of Health The 150 beds and 215 laboratory modules asshysigned to the intramural program of the National IDstitute of Mental Health represent the greatest allobull cation of space among the six inshystitutes within the new clinical center

The planning of the second through the fifth floors provides accommodations for psychiatricpashytients ranging from the seriously disturbed to those with minor emotional disorders This wide range is necessary because the proshyposed research program covers all psychiatric and neurologic condishytions

The patients facilities provided for the National Institute of Mental Health differ from the typical nursshy

ing area previously described as follows

1 The second third and fourth floor units accommodate an avershyage of 16 patients instead of 26 The fifth floor conforms to the typshyical plan The capacity of the bedshyrooms ranges from one to six pashytients Four special security rooms for distwmiddotbed patients are on the third floor These are provided with a special light signal and intercommunicating systems for ntrrsing personnel in case of emershygency

2 There is additional day room space with removmiddotable partitions for flexibility

3 Doctors office suite is proshyvided with examining room oneshyway mirror screens and recording apparatus

4 A substation for admitting procedures is provided

5 A hydrotherapy room with continuous flow bath is planned

6 Safety glass and brackets for installation of safety screens are to be used on all windows except the fifth floor

7 Outlets in all patient rooms will permit microphone hook-up to central recording equipment

8 A separate key system has been provided

There also is one room for local occupational therapy activities as in the nursing units of other instishytutes

A REVOLVING interchangeable altar has been designed for the chapel at the center This will provide religious services for all fa iths and will contribute to the well-being of patients The altar here is arranged for non-sectarian services

The physical relationships of the hospital and laboratory units for neuropsychiatry offer opportunishyties for conducting multiple reshysearch projects with wide variashytions in content and techniques The proximity of the patiehts acshycommodations and Tesearch staff to the othei- categorical services in the clinical center promise close collaboration among staff members in ( 1) applying the disciplines of the biological sciences to neuroshypsychiatric research and (2) emshyphasizing the emotional aspects of organic illness in cancer cardiac metabolic infectious and tropical and dental diseases

SURGICAL SUITE

The surgical suite will occupy the west half of the tenth floor of the central stem The 84~foot width of the head house afforded an inshyteresting opportunity for the layshyout of the suTgical facilities The supporting concrete columns howshyever were limiting factors in room design in some areas

There are eight operating rooms two endoscopy rooms one plaster room and one electroencephaloshygraphic recording room The avershyage operating room is about 18 ft x 20 ft There are no visitors bleachers Scrub-up rooms are adshyjacent to each operating room Space has been assigned for a censhytral television projection control

[ABO RATORIES

-- ~ - ~ _L_ shyCORRIDOR -r- _ - _ I _ --

14 FUTURE

room but rapii rlcvdltgtpmcnts in this field have mad it difficult to ~nticipate its ultintc requireshyments

bull1bullhc vcmiddotntHation electrical v1irshying aild middotequipment middotstanltlards f()r movable cquipmCQt and speciiicashytions pound9r condutlivlt1 telmiddotimiddotazzo noors conform to the recomm~dations recentcy issued by the Commitshytee 01 Explo~ions in Hospital Opshyeruting looms of the Public Buildshyings Altlmmiltigttration

In an att~mpt ta eliminate the maze o~ rlreS ant suetion linc1 which usually clutter the flour

lIFTH FLOOR PLAN

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arolmicro)d ~hc opcratingmiddottablc a $tain lbullsbull bullteel monitor box 12 inx 18 in (vrlth the baic six imiddotnchcJ above the floor) is to b~ built immedishyately to thegt left of middotthe ancstheshymiddottists tabl in each operating room lhiC widcr1l-0or conduit io the monitor will carry tlilre electric lines (safety plugs)) two valt-uum lines one sou~1dmiddot systenl line and one bl_ink for ~lctntuai hook-up fof television or various typci of sCie~tific r~cording devices

Each operating room has an aclshyjnhlinp ancsthrsin room tpproxshyimately 8 rt x io rt equipped with

central suction cn1crg~ncy tignal to the officebull of the chief anestheshytist and surgical supcrvior and a wall b1middotacket bullpoUighl (for fin1 check on the prep area)

The recovery room is about 40 ft x 9 ft with sliding doors to the conirlor It is cquippcltl with ccnshyumiddota1 oxygen and suetion supply and mi emergency intercommwlicating system tltgtmiddot the office of the surgical supervisor There is un adjaltent utility room and auxiliary blood Uank The surgi~al suite also conshytains the olloting

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10 Botbull coutir19II Ore-sScg rocn 12 RmiddotIGords aW ftlOJlltof 13 Ve1tl~illt1 14 Office 15 l ab storo9c Iamp SfofilQf 17 Scrwice ein01Jor 18 NbullJts~middot ~ 100Cfl

JrJc101middot p lunE desiened lhro~ combined d ons ot tile Federal $ecurmiddotl1) bullgcncy Public H calb S en snd thf Eedera Vltdtc Agetlcy lubllc1ccr Buil1lngs AdnUolStra-tfon

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LABORATORIES

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to the central ster ilization and supshyply room and pharmacy

2 A setUp room with complete sterilizer facilities as an alternate to central supply ~ervict

3 Nurses work room and stltr ile supply storage

4 Locker rooms 5 Offices for sutgical supervisor

chief bullurgeon and cbie anestheti~t 6- Dictation room for surgeons

and clerical-stenographic room 7 Stretcher alcove and general

utility room The nearby vrings provide libshy

eral laborntory facilities for immeshy

diate tissu sections and other lil shygcnt diagnostic procedures

The main corridors and lead-off corridors aimiddote all eight feet -ide with acoustic- tile ceilings and reshycesseltt fluorescent lights

OUTPATIENT DEPARTMENT

The outpatient departmenf will srve follow- up patients special investigative projectlt 1or ambulashytory patients and the employees hetlth service It halt been difficult lo project the anticipated patient visi t load An area of nppro~imateshyJy 14 700 net square feet in the

LIBRA RY ___ ________ _FUTURE LABORATORIES

CORRIDOR

---~ -- shyLIBRARY---shyFUTURE LA 80RATORI H

west hall of the main door and the adjacent three wings has been asshysigned Co ambulatory patients scr~ces

Flel(ibility in the reallocation err space in future years is acbieved through the use of demountaole metal partitions T hr e is a sepshyltgtIate entrance to the outpatient department The wai ting rooms have been d~entralized and office space has been asigned for the staff of the socia1 -scrvi~ nutriti9n health edu cation and rehabilitashytion dcpartm~tlt Special faciliti~ Ior the observation of children at

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Engineering Data Ld 300 lb~ Si9ftol fghh it ours s-totio-111 1lu~e dumb4il ctt opotbullf~d via cenitrlttf f4f ioA tin e optrtd viamp clt1ll and seftd

lll~11motlc 1111gtbull bull1ilont Co1ufit1t runnin~ Vacuum fypt incorpo1atin9 twin fube and ilidbullpeAdcrit linebull 51 subdotioni Carrier COfltolnbullr 14 In hy 275 in

Fire pfotciJon iiritproltgtlt Mtttriel1 throu9llouf Sprinllori l~undry chut lnd laundry colshylection roonu f rbullll ehutK d~9e of eoUclishytodu Fjre olerm Ybulltbullm i11eludinq cliime ~nd light d9nolJ eit nuritbull sfafion Fir~ dttet loo unit thcrraodbullt lor paeushyafic lubt) 1ybulltm is 4n l~4~ Wbulllc~nbullec potl bullyrlent firo qJ

Clod sydeom Elechicbullt Miul t impuls~ type cenfret controlmiddot

fo1JScent~eoftg OCltliffl ry$ftm Copaclly of 22 1wt~pbullrs operating imulbull taneously Vlt1c11ulI inleh at SO H interval in all corrdou

fmefge11cr qcclrlcol power system r_ Ugh ting of 1tJ co1ridon and e-Xitt amiddotnd (2t orbullrbulltlng roombull fqr ctr-nf fo (Itiive o tvltfofl end (2 ) Ure albullrrn ytem and (3) cbullnlrlt1I Olly9e-n system alarm

Typteamiddot loborofo r hfodulc 12 h by 20 ft Floor G~1tprool bullsphalt tile Porliffon1 MflbullI dbullmountaW inclvdi19 -weinscot for eJof-Ot wbullll Cbullilia-g U1ti1tincd conclttt Might 11 ft 6 i 111 Ooou 3 fl plut I in panel dffl Wiftdowt Alumhwm 4 ft 6 ira by S ft lightin4jj Ftvort1ctni dive~t- +)ftlt ltn middot die rllvmlfl itio at bench top Au+atl lc titbull dtbullction syriem

Air coflcll1of1i119 Birildln9 complotoly tir conditioned Heetshyiag a11d ~oohr19 to1Wt 1 equipme1f locaicd in powt r pl6nt1 steam hot atbullt and cllillbull d Wi r lill ilS run via tunne-1 +o clinshyical lt~n+r Hi9tl prtUUttl air duel mLgtlhod of oir co11dlHonlnltJ used lhroughout e c~pl in micJlo row nursin9 1orvict rooms of cbullnhol aftm which 11~bull low proi-5Utbull ducts Encloibulld vd1tdow air conditiohing unit ttmpt1 httttd (01 co-oJ~dJ air ftorn hiQh pttHut-t duch by hot Cgtt chille-d wa ~r teond1ry c0t1s io uoih labot-fo rUi fllcl Mdroorai frnded wifh 2-5 freJi bullir c1bullbullgc1 per how No rccirud~dioP of IPftf eollditioMd oir ViCldc lilOiti e 1roiri wcondoty oir from ro-Ofll and p10shyduet 10 to tZ tit hirncwers ~r hour Pa ftentsbull rocm1 ~itipped with ~e~-fric th~nnoit1f conkob Lbotafories ~1 Pp-1d with pritumbulllic thermosh1f coriirqfa

$1BO Pt r cubio foot (estiMale-dJ S11bshytnieturt t d UPt Ntruclurf confJect it1middot diaal e eolfmiddot ill be wilhi thi middot 9finate

E-PfUlllJJllllllflllllllUl lll UJIUIUllJllJIUlllHIUllJllfl

plampy hampvc hcen lnstalled for the Notional Institut40fMn t41Health

DIACONOSTIC XmiddotRAY

The diOlllOgtllk x -riy dpartmcnl will oceupy lhc ~st halt of the eighth flltgtOr W1 ~ of ab-Oul 14shy0011 square rect Herc too the 84shyfool width or tlgte majn tern of the huildinl( offers an unusual opporshyluuily to UlilJ1e a two-~orridor plan he central ru~ uf rooW8 has bn d~igned (Or dark rooms rlcshyvclopini( nnd drying melaquohanical equipme1ll vi~vl11g roltnns (vet tilm vkwing depar1mntal staff reading and dicluling 1middotoom ~nd hospi1aJ ctoff nuxiliary viewing rooms) ~urrerll mm 1111ng and clerical stcnol(raphic room The pneumatic W~ gtItem will convey small gtC-rAy fthru to all parts of the buildinir Liberul prOvtgtlOCl halt ~en made for office for the fullshytime stafi and Cur ~varate waili1ig rooms for Sitrc1chcr case~ mnbushylatury inpaliotllbull lllld outpatients

The dcpnrtmcnt is planned for an estimatlld load or l~O cases Pel day wi th due consideration for th more time-oorlbullllming types ormiddotexshyaminatlons in clinlcnl earch proshygroms For exampl ihe cardioshyvascular Utllt lncludE provl~ion for ani(ioca rdiuArapb y cardiac calheterizaliorl and elec11middotokymogshyTaphy

One operuinir room wi1hin the x-ray dcpaTtme11t i equipped for cystoscopic examinations another operating room Ibull plampnn~d for venshytriculogrnl)hy Space also has been a llocampted ampt the la1e1middotal-mobullt porshytion next W tht viring laburatories (or anitMI raltliographic studiebull

Extensive storage spac for xshyry Jilrru1 has lgtee11 a llooaied in one suti-ba~cment winf

With 01e Eltxcepliou oI one x-ray apparatubull ndjocent to the autopy room a photolluorographic uni l i11 the outpatient department and small dental unit au diagn0gttic radiologiC11 equipment is centralshyibulleJ iu lhe d1ag1100lic gtlt-ray deshypartment Elcctllcal outlets formltgtshybile x-rHy lpparatus are provide in all nurR1ng unit1 mod in one surgic~l suile u)lttraling room

PHYSICAL MEDICINE

Physical fhorapy T he physical the rapy d lvibull lon ilf the department of physical mbullufoine occupies the

tifth tioor of nnc wing an areltJ of about 5 700 net bullqu1middot feet P roshyvibullion Lbull mnde tor oIJ therapy modshyalities (includ1ni 41Clricity lighl heal anrl water) co1middot1-cctive ltgtcrshycises physiciangt office ~C6 and cxaminatinn TOOtnA witing rooms~ linen rounut loCkttt1gt wlltl toilets lhc hydrothcrnpy section nlso in cluds two sunkbulln 1Jalh$ approxshyimate ly 11 ft x 4 ti CCJuipped with a walr agitation dbullvice and thermshyobull1atic contlOIbull 1o~ the treatment of rheuHHttism tind Vtli-OUS lypes of mubullcle PbullrnlyRc$ T wo t-picol Jalgtoratory modulbullbull are included for rc~careh In 1hc effects of physical ai11lt Thegte will conshytain special equipment such a plethys1uo1raph gtpirometer vishytal tal)ampcity appllln1ubull ltelf-recordshying lhermocoupl arnl dnnamoshymctcr

On the roof above 1h division of physical Ulerapy will be an en shyclosed undcck for h~l ioth1apy

On the ~econct lhi1middotd and fourth floor nursin1t wiiu tu be occupied by neurltgtpsychiatrlc pigtticnts there will be two rooms ~pproximat1y 12 Il x 17 11 for cltgtnthrnou flow b~1hs for disturb~d patients Occupation~ thbullrdpy The oocushy

pational therapy division of 1he department of physical medicine occupies one wing floor approxshyimately 5100 net square c1 in the Slllile wing and Immediately bcshynctlth the physical Uravy service Metal demo11n1ahle partitiongt will permit th size o rooms to ~ ad shyjusted Ior vsri()Uli forms of u-cc-ushypational therupy

Jn additinn some d~ltent1~1izashy

tion of occup~lilltQI therapy is posshysilJle 1hrough assignment oI one room in 1nost 111l$ling unit~ in the central stem for troup work by lhe visiting occupatiofla l 1hcrapi~t

RADIATION WING

The activities of lb radiation wing will r~p1-esonl one of the most important Patts of lbe cfutical censhyter progra1n lwlcarch will be wnshyduclcd to cxlltnd tbltt kJJOWledge of the biologic eiiectbull ot Ionizing rldshyiationbull I t nlsu will expa11d tlgte usefulness of radllllion therlPY (external nbull well internal) ampnd improve tb~ U$EI Of 1middotamp(1ionctivc isoshytopes as dlngnostlc toltgtls (eg the use of tramp()ampfS1

in 1nc tobolic inshyvestigations)

degmiddot

0 1 1 I Ill I 4+1illjj u 1gampil I ii I ii I I II middotbull D

L) ~~ftiiil___

I I ml[]O_gQ i I shy-JV

middot-middot

1 Shelvu nec1111~ j Tabf~ I lvlk food cut Ii Shd JC$ 20 Cofkie rnilshymiddot Plo111ts Covet c~ampr IS Patfffk trav cart 21 Pl~tt d~

IL 8owldhli dispeMlaquo 16 Refrigudor 22 Tablbull II Skk 17 Tabki 23 Tolttst~ 12 Tuy diJperuir 18 Cqp-pot dhpo11cr l Rctri9er1for

KITCHENS d be loeatampcI on floors two to five bull ocI seven to 13 indvsive and wil provide ~pace or tite most mode~ft of eqolprnenf Thls plan mows thamp large worliag areas and amPe stOJage sp-ace ptovidampd for ho1neleepin9 S11ppfies utensils and dish dispe-n~rs

there is urgent need for more fundamonlal radiobiologic research with high energy radiations by teams of investigators I()prcltentshying many scieniific specialties such as physies- biochemistry physiol ogy patholo~y and genetics MorcshyObuller -there appeal to be mariy promising avenues of clinical re search in high energy radiations which may yield better results in radiotherapy

One entire wing extending three stories under the ground and fi~e stories abomiddotc ground has been built Ior the investigation and diagnostic and therapeutic applimiddot cation of ionizing radiations rhc eight floors provide an area of 3~-000 square feet of vorking space poundxtraordinary precautions must be exercised in the use of radiations in the multimillion volt range and in tile handling of all radioactive substances espetjaJly in ho-pitals lrbr this reason the design and eon struction of this portion of the clinical center has raised many dinC1llties and complicated probshylems o sbieldi11g vegttilating plumbing laboratory equipmen t and tloor surfaces

All available data have been apshyplied to insure lhe greatest posshysible safety for personnel ond pashyticn1s Many items such as dishes clothing cags and instrnments cannot bt- serviced through central facilities and m ust be handled ill the radiation wing Cleating unshyavoidable duplication of equipment ~use ot the hazards involved As in all radiation installations the rigid enforcement of safety regulationbull win be the responsishybility oI specially trained health personnel assigned to duty on each floor

Lower ttoors are devoted to apshyparatus and Laboratories for cxtershyrgtal radiation The equipment ill include six standard 250 KV x-ray apparatuses for radiotherapy a 5~million electron volt syrgtchroshyton or induction a-ccelerator for the study of high energy x-ray and electron therapy lwo electrostatic generators of tv~o million electron voltbull for the development of new techniques with highly penetrating x-ray beams

There also will be a 12-million voll electlOstatic generator for exshyperimenfal research and tberipy

Cl bull ~ bull I F--- -----J--shy

I P~nh tray cart amp1 f~d cart l Gciddlt 4 Coifebull rikor S T~s~r i lefsi9etetor 7 Ctan dhli tacble a Soiled dish- t4bft t DJ1lw-bull~hin9 rnach111bull

fl 6ib49a ~rind$$ II Co4i11tampr i111k $nd csbineh

SERVICE kifdc1ts for floon fffO and +llt9e aramp futllisd Wiflt 111eciianKI equipment for rapid Sse11tbly l)f food fro Oishwahen and a garbage 9rfodqr Q9jt are provide-d

vith radlatlons such a~ neutrons pfolons deuterons and ~ectrons J1le machine wil) be especially valshyuabl~ because it is One of the 1vork horses oI the radiation laboratory and because vith it rigid contro1 of inmiddotauiation oonru lio11s are possible middotThis Van de Graaf accmiddotelerator is also extremely useful for produoshyir1g shortlbted radinisotopes for esshysential studies of the effect of radJonctivc materials on living thi11gi

The upper tloots of the wing are devoted to laboratmmiddoti~ and 22 bedshyrooms (for pitients temporarily 1ransfcrrcd from o ther 11wmiddotsing units) or in ternal ntdiation studshyies l1hcrc arc a lso separate facil ities for animlttl qualmiddotters Son1e special lahmmiddotatorics in the radiashytion wing art to bt- utilized Co1middot prtparation of tncdications conshytaining r adioisotopes and their su bseqUCll( cxt-raction1 puriftcatio11 and ch emical antillrsis from excreshyt ions or patients and animals and from nnimal tissues Similarly these facilities provide for physical measurement of radioactivity in s ubtanccs before administration and after excretiou

Itmiddot is the ~roup judgrnent of tl1e radiation sp~cialits a11d conultshyimts or the National Institutes oi Health Lhal al lhe p1middotesen l stage of know ledge the prudent application of most radioactive materials such as radioisotopes requires special facilities Jor igtatlents and should not be used in the general patient ireas of th( clinical ccntc1-

TYPICAl LABORATORY AJIEAS

The six wings and north side o lhe central stem afford laborashytpbully space twice that assigned for clinical care~ The erer-cllinging dlllllallds or resealmiddotch programs make iledbility t he paramount eunsideration in the planning co11shystructlon a11d management of lab oratories The individul roo1ns in the laboratory aras are readily iutercb~ngeal)le as anhnaJ rooms offices laboratory wilts for che1nshyistry physics anil bacteriology Jhc d~sigi1 of the clinical center Jaboratolie1 is Qll the morlulc (12 ft) principle A wide nmge of adaptability is thus possible through availability or grouped servic~ line outle1s ftt regular inshytervals in all 1tings uni -on the

leoo EJdJmiddot- 11 Cl OSU

G - shy _

(Obullo Imiddot I

D r-o I 2 I

I L _ J

bull TM

MElA8ClJC l(lftHE UNIT f

11J I ( ~

lllmiddot 1

- - Jj

ff~==k--=--= shyI

[)r ~--1

1D1I 12

D11 II

II r------ -r--~II ~ 11

TvVO type of mclabolic l1tchcn~ are he-in4 considered for tfie prciporation ol spc-iel dieh in nutrition $tvdies Or Russc lt middotw il der de5igned a 5_peciel vnit for tfie north side laboratory area (le9end at ri9ht)

I a~ngt 2 fvhgtf6 tiQifltibfe $1~mer ) Toblo 4 ftoten fQod ftfrlgerategtt 5 Retfriqordt or 6 CQtfee makcit 1 Tois~ar 8 T4b lc lti Pot tltIC~

10 Mhcr

rt ~~~~ i1~i0 ~middotiimiddot n Oi$igtwo1$hin9 malthlflc Ill G e1 rb-9e 9 rindD1 15 Cltgtunl9r qnd ciblnet U1 C4binah l7 Coc11ler ond c6blt1cfs

c colwtt and bose 2 Soil~d dlih fobla J Cl~on dhh toblc 4 GMbbullqo qrindbullr 5 OhhwltSshin9 mochfoc bull middot c biJliiot ltlnd b~$8 7 flr-Oom clo set 8 fable middot Cbi11ct ind b uoto Oet

IL Froten food rcftigcrator12 fable ll Rcfriqer~to1 14 Ci1bll)ct aid blt1e IS F)od llli)(ot 16 Bev~ril(lc mixer 11 Coblriel rid bltr$eshyI$ Co1ntc1 9 Cofte niakbullr 20 Toohr 21 Range 22 ftltSngi 23 Co11nt9r 24 fr)v slfd~ 25 Palie1tsbull ltbully earl

- - - = - -[~

0 oo oou

lOItll wall of Lhe head house mshy The uti lity service lines are in stallation of demountable parlishy modules 12 feet on CGntCgtrn The tions standa1middotuibullal ion of laboratory lrertical risc1S hilth run in Lhe benches furniture and cquipooemicro t outside will of the entire building and ajr condlti(Jning except the patients in-ea on Lh

south side 11f lhe main stem carry U1e ollO~Tlf every 12 feet 120shyWH volt tllrttamp pllase tou~ wire $0 tycle power hnt wawr cold water lahoratory drain vent compressed ~ir vacuum and illuminating gas Every 24 feet litt vertical risengtalso carry steam and every 48 foet disshytilled woter

An egtlthaust duct for a chemical Cume hood can be mude available in cucb l1ltIXl1atory module Tbe opera U011 of many cbe1pical fume hoods in an alr conditioned buildshying raJscs verbull complicaLed techshynical p1middotoblems in ventilation A special pilot study now is being cnnductecl by tho staff of the Reshysearch bull acUties Planning Comshymittee to determine =act specishyfiealions

The demuuntable partitions are in 3 rt 6 in pancls consisting of slabs of l wo layers of enameled sheet mNal ~epltgtroted by three jnehcs of ftreJ)l(JQf in~ulation mashyterial The partitions may have inshytltrlahorotory windows and escape paneU ~OlllC of th doors have a three-foot wide active leaf and a oue-Coot hinged panel whidgt orshydinarily is kept bolted

There will be no permanent inshystallation fOJ constant temperature rooms A demountable unit for -alk-in refrilerated ipace or inshycubator wlU bltgt utilned as a room middotithin a room o that it can be relOltat(d aA the uccasion arises in reasUgnment of ipace

Laboratory bffflcheamp furniture and equipment arc to be standardshyize() alt much as possible Thltgt deshytails of J~boratory bench design snkbull trough drnins and cup drains and drawNmiddot and cabinet uni)s now are belnjl studied by the s taff memshybers or thlt1 ln1itutes

The damptllils nf a typical Jaborishytor room are pteren ied in the sununary of architectural data on pagltgt ~2 It should be noted that the lahoratory windows are unishyform with thOlie in the hospital area lllc 4 ft G in x 5 ft window is deemed ample since most labshyoratory work lbull done with a1tificial illuminulion 11nd larger wi10dows ~uch att those nomiddot being deshybullil(ned for some research institushytions-may introduce lhe problem of glare rlt1qu1 ring larger shadebull Al the ln tcrbullegtetion of Che laborashytory Vings there are tvvo paisc-n-

I ----------middot I r-~i---- _

I I I I

~-J ~ -~ --- ----- ~middot middotj ~ ---- -----shy - -

bullbullbullI

r-middotmiddotmiddot I bull__

ltbull -middot ---shy -_ middotmiddotmiddot --~-rmiddotmiddotmiddotmiddot

v _______ ____ _) ---middot

PATIENTS wUh infcfi01$ diseases wlll OG(upy t l room to(h of which will be ltshy

self-sufficteit unii pro idfn9 fof 111~ximum cleanllnau bullhd vUoJ isolation ftiilitibullmiddot

r~ and two freight elevators The door openinl(bull or tbe freight service clevators a~ five feet wide and can be incre1 to bulleven et for the transportation of large equipment The laboratory area also bave pneumntic tube stations in the genshyeral system or the cenler

A fire rlctection system extends throughout all labltJratory areas Cor maximum bullafcty

One winamp of tbe e levenlh loor is equipped as an Instrument deshysign office and sm11U machine shop Jn thr hn~ement arcos tbere arc central cage washing glasswar washing media prcpu-ltion and phOlUS13PWC SClVice depar1ments The labnrnUgtrics also are serviced by the auxiliary group of buildshying oonnec1AXI by twmel fur renshytral incineration animal food and bedding onimal breeding and maintenance and fabrication shopbull

EXTENSIVE SERVICES

The clinica l center will admit for treatment palumts from all parts n the country who are sufshyfclinl Crum the Prliculac type of cancT hcan clibullMlaquogt mental dis-

Jrln1oJ ln V $A

ease m~tltgtbollc disrltgtsr or infecshytious or tropicgtl duwase under investigamplion by the vanous in~u tutcs The sole criterion for gtltshymission will be the appropriate confirmed dtal(n04is during the period 11c category 11 under study at the Natiorutl Institutes of Health Retcrals Iox admission arc to be mode by pdvute physicians hospitals and health agencies Upon dibullclugtrgc the patient will be reertmiddoted back to Ille physician or t o the ngcncy

Tt is hcllovbulld by the stalfs o the Notional Inbulltitutebull of Health that the integralion o fundamemal and clinical reoeorch with adshyvanced metholtls or diagnosis and trcarment v1]1 yield a high qualshyity or patient ca1e rt is hoP(l lbal the constant Intimate colfaborashylion runoni specialists ill many branchC1lt of mrdicine and scirnce ill result in ~n increae in the knowledge needed for grcatltr inshysighl into the t1euu11ent and preshyvention of chronic illncses

tCKHOWLEDGMF-NTS

The dkcctlgtrs lgtf the she nstishytutes aod othe1middot members of the Research Facilllicbull Planning Comshymittee weimiddote 1eiponsible for the major plonning dcci1ions of tbe clinical cen~r Tbe eJCecution of the dctoiloo planning tor thlt conshygttrnction or the ceotebull would not have been possible withou exshyroptional elinrtb of o1aff members Ji all branches ol the Public Health Service and Publlc Buildinlts Adshyministration

rile National JnsLilute of Health lIalcfully aclmowlcdges the active inroresl and helpfulneas of many consultants who htgtvc paiticipated in tMs project We also ure inshydebted to the staffs ol a large numshybPr o induslrl11l laboratocirs universities and hospltolbull throughshyout the country for the hospitality extended to our rcprc-Stntativ~

during visilbull in Ufe past two years In the study or tbe clinical

facilities we owe a special word ot thanks to Dr Basil C Maclean and JamN1 Edmund~ Dr A C Bachmeyeimiddot and Carl Erickson Dr Claude W Munger and Aaron Kiff Lenna F Cooper Murgarel GiUam and Dr Henry Knpl~n all of whom calelully JtiVlCwed Md criticized pluns nt vorlou~ phnRCS