Going Viral

In early January, the Chinese Government recognized that Wuhan had become the epicentre of the COVID-19 epidemic. It responded to this public health crisis with a well publicized effort to construct, in ten days, two massive hospitals for a total of 2,500 patients, using prefabricated modular rooms. The purpose of the project was threefold: to isolate those infected with the virus, to provide opportunities for treatment, and to convince a skeptical world that the government was on top of the situation.

Watching the effort to provide the citizens of Wuhan with instant hospitals brought to mind a large-format, handsomely illustrated catalogue that was published 125 years ago by the Danish-German firm Christoph & Unmack. I had discovered a copy of Transportabeles Baracken-Lazareth für 200 Kranke (Portable Hut Hospital for 200 Patients) in the Berlin State Library while researching the history of the barrack-hut. The catalogue presented a Red Cross-approved, prefabricated, demountable emergency hospital, for use in war or during epidemics, in four coloured lithographs captioned in German, French, English, Russian, Danish, and Ottoman-Turkish. The pictures gave the potential purchaser—most likely a national Red Cross organization, a public health department, or the medical service of a national army—an opportunity to immediately assess and comprehend the hutted hospital as a tool that might do some good in the world.

A sick ward for 20 patients (in summer) and 17 patients (in winter). The winter capacity was smaller because of the need to accommodate two stoves. The folding field beds were produced by the Karl Schulz company in Berlin, and were standard issue in Prussian Army hospitals. Courtesy Berlin State Library and Robert Jan van Pelt

The origin of Christoph & Unmack’s hutted hospital went back to the American Civil War (1861-65), when groups of women volunteers, inspired by the example of Florence Nightingale in the Crimean War (1853-56), pushed for the creation of a system of comprehensive care of the wounded. Surgeon-General William A. Hammond and Philadelphia architect John McArthur, Jr. conceived of standardized military hospitals to be assembled out of identical wooden barrack-huts (or “pavilions”) made from dimensional lumber, each holding sixty patients. In short order, the Union built 202 such hospitals with 136,894 beds.

Before the Civil War, army hospitals had been many times more lethal than the battlefield because of the prevalence of typhus, typhoid, cholera and dysentery. In Hammond’s hutted hospitals, army surgeons were able to control the spread of infectious diseases, reducing the mortality of admitted patients to eight percent—with the majority of those dying from battle wounds.

While war raged in America, delegates of sixteen “civilized powers” reached an agreement to create an international network of relief organizations coordinated by the International Committee of the Red Cross (ICRC). The Red Cross made a first public presentation of its aims and tools at the Universal Exhibition in Paris in 1867, where it included models of Hammond’s hospitals and its pavilions.

In 1885, the ICRC initiated a high-profile design competition for a lightweight standard hut for twelve patients to be produced as a kit: to be rapidly assembled by unskilled labour, and to function either as a stand-alone unit or as part of a larger emergency hospital. German Empress and Prussian Queen Augusta—who was a great admirer and friend of Nightingale, and who had been instrumental in creating many women-run relief organizations—sponsored the competition. Contestants were encouraged to submit a full-size prototype, to be exhibited at the International Exposition in Antwerp that year.

A single Doecker Hut contains an operation room, pharmacy and hospital management office. The prefabricated, portable hospitals were developed in 1885, and used around the world, including in the First World War. In America, they were marketed for managing epidemics in the wake of the 1892 typhus fever outbreak in New York. Courtesy Berlin State Library and Robert Jan van Pelt

Danish furniture makers Christian Ferdinand Christoph and Christian Rudolf Unmack submitted two prototypes of a hybrid between a tent and a hut developed by Captain (ret.) Johan Gerhard Clemens Døcker. The filttelt (felt-tent) consisted of rectangular frames that were covered with lightweight, waterproof, easily disinfected sheets of felt, pressed on a base of canvas and impregnated with linseed-oil. The assembly could be clipped together by a system of rabbeting, screw fastenings, and clamps. The two submissions were supported by a thorough engineering report on the thermal behavior of the felt-tents during earlier trials at a Danish military base. Both shelters earned a gold medal.

In the wake of the competition, the Prussian War Ministry adopted the award-winning hut as the main type for its military hospitals, but insisted on an increase in size so that it could hold twenty patients in summer, and seventeen or eighteen in winter (when two or three beds had to give way to stoves). Twenty was the number of patients a single nurse could handle. The materials for two such huts were to fit in a standard railway freight car. The orders from Berlin came with an important condition: the manufacture of the huts was to take place in Prussia. Christoph contacted a cousin who owned a machine factory some 200 kilometres southeast of Berlin. The result was a new facility for producing the portable hospitals—now known as Doecker Huts—that quickly became the largest manufacturer of prefabricated huts in the world.

In 1892, a typhus fever epidemic erupted in New York. It was traced back to a ship that had arrived a few weeks earlier; all passengers that could be located—some 1,200—were quarantined in canvas tents. A year later, the Federal Government passed the National Quarantine Act, which gave it broad powers to detain ships and passengers.

Frederick W. Elsner, the American sales representative of Christoph & Unmack, saw a big market. He began a public campaign in which he discredited canvas tents as incubators of disease, while praising Doecker Huts as “germ-proof, fire-proof, and capable of disinfection, ad infinitum, by chemicals.” He sketched a perfectly managed emergency response using the Christoph & Unmack product. “If an epidemic breaks out anywhere on the American continent, all you have to do is to wire to headquarters for one, two, or more hospitals, which on arrival are unpacked and erected at once. Fill them with patients as required, and when your epidemic is stifled, take them down again, disinfect and repack them, and return to headquarters.” In Germany, the manufacturers of the Doecker Hut produced the beautifully illustrated catalogue to support the sales pitch—with its doll-house-like representations that reduced the imagined terrors of a ward full of deadly sick people to manageable proportions.

A hospital complex for 200 patients. A line of ten Doecker Huts serves as the sick wards, while four Doecker Huts provide an operation facility, a pharmacy, a laundry, a kitchen, and quarters for medical personnel. In the foreground is the steam disinfection unit. Courtesy Berlin State Library and Robert Jan van Pelt

Ultimately, few Doecker Huts were sold in the United States. But elsewhere in the world, thousands of Doecker Huts did remarkable humanitarian service—including in the Russo-Japanese War (1904-05) and the First World War (1914-18), and in the aftermath of natural disasters such as the Messina earthquake (1908). As advertised, most of them were reused on multiple occasions.

Today, only one Doecker Hut survives: constructed in 1911 as a single-hut hospital to serve the Pallars Jussà hydroelectric power station in the Spanish Pyrenees, its felt-panel-wall technology quickly failed in the mountain climate. The hut was abandoned—it was modified and used as a shed by people in the area—and forgotten until its rediscovery a few years ago by architect Sígrid Remacha Acebrón.

Today, the beautiful plates published in 1895 and the disintegrating ruin in the Pyrenees bear material witness to a lofty idea about the life-saving potential of prefabricated emergency hospitals.

Robert Jan van Pelt is a professor at the University of Waterloo School of Architecture. He is the Chief Curator of the international traveling exhibition Auschwitz. Not Far Away. Not Long Ago.

 

Bibliography

“Cholera at our Gates,” The Insurance Economist, vol. 15, no. 107 (September 1892), 15.

“Conditions of the Prize Offered by the Empress of Germany,” The British Medical Journal, vol. 1 for 1885 (1885), 459–60.

Elsner, Frederick William, “Portable Hospitals for Use in the Field and in Epidemics,” The Annals of Hygiene: A Journal of Health, vol. 9 (1894), 687-95.

Langebeck, Bernhard von, Alwin von Coler, Friedrich Werner, Die transportable Lazareth-Baracke, 2nd edition (Berlin: Hirschwald, 1890).

Longmore, Thomas, “Report on the Competitive Exhibition of Movable Hut-hospitals at Antwerp in September 1885, Together with a Descriptive Account of the Pattern to which the Principal Prize was Awarded,” Army Medical Department Report for the Year 1884 (London: Eyre and Spottiswoode, 1886), 360-64.

Menger, Henry, Transportabeles Baracken-Lazareth für 200 Kranke (Niesky O/L: Christop & Unmack, 1895)

Woodward, Joseph Janvier, “Hospital Organization and Construction,” in United States, Surgeon General’s Office, Reports on the Extent and Nature of the Materials Available for the Preparation of a Medical and Surgical History of The Rebellion (Philadelphia: Lippincott & Co., 1865), 152-166.

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