Architectural Set Medical Centers

About 50 properties nationwide that serve as part of the VA's Architectural Set, a thematic, multiple property nomination to the National Register. They share a common prototype floor plan, campus sitting/landscaping, and overall health care design strategy; the exterior facades differ regionally by architectural style.  In-Depth Information about the Set and the Veterans Bureau is below this list:

These medical centers form a set of hospitals in VA ownership which are a thematic group illustrative of a major concept in the delivery of health care, specifically to veterans. Hospitals in the set may be found in almost every state and include a wide variety of architectural styles or facades used with the same structural design for buildings intended to serve the same or similar functions.

The architects at the Treasury Department, which planned early veterans facilities for the Veterans Bureau, were transferred to the new Veterans Administration in 1930. From their early work at Treasury, the designers brought with them a prototype plan and health care delivery philosophy for a new generation of hospitals.

The 50 properties derived from this prototype, built in the 1920's, 30's and early 40's, are "The Architectural Set".  Campus-like sites were acquired on the outskirts of towns, and the primary building was usually sited on the most prominent hill with a front yard vista. The facades applied to a fairly fixed floor plan layout reflected architectural tastes or design traditions of the local host communities or regions.

Many popular ornamental revival styles were used such as: the Mediterranean Tuscan Villa Style, at Waco, Texas; French Colonial Revival at Alexandria, Louisiana; Spanish Colonial Revival at Amarillo, Texas, the Federal style at Murfreesboro, Tennessee; Southern Colonial Revival style at Biloxi, Mississippi; and, the Jacobethan style at Canandaigua, New York. At Marion, Illinois, in a region known as "Little Egypt", Egyptian Revival Style was used. In Bay Pines, Churrugueresque, an elaborate form of Spanish Colonial Revival, decorated the facade entrances.  At San Francisco, designers used the locally popular Art Deco style. But by far the most popular style used throughout the midwest and northeast was the Georgian Colonial Revival style. The site’s particular style was always carried through to the staff and director’s quarters, as well as engineering and support buildings.

Typical Elevation

Typical Floor Plan

In Depth Information: The Architectural Set and the Veterans Bureau

The Veterans Bureau was established by Executive Order in 1921. The first Director of the Bureau, appointed by President Harding was Charles R. Forbes, formerly Director of the War Risk Insurance Bureau. At the time the Veterans Bureau was established World War I veterans were receiving medical care and examinations for pensions or compensation and other health related benefits in a conglomeration of Public Health Service, military, contract, leased and Veterans Bureau (former military and Public Health Service) hospitals.

During his initial inspection tour of facilities Forbes was appalled at the "deplorable, absolutely deplorable" conditions in "many cantonments" which he characterized as "all fire hazards," and "wooden shacks."

A second immediate problem faced by Forbes, in his view, was the insistence of Dr. Charles E. Sawyer, President Harding's personal physician that all classes of Veterans Bureau patients, general medical and surgical, neuro-psychiatric, and tuberculosis, be housed together.

With the appropriation of acquisition and construction funds, the Bureau, under Forbes’ leadership, initiated the beginnings of a massive new construction program to replace the firetraps Forbes deplored. The construction provided for what would become prototype buildings for the categories of patients for whom Forbes felt segregation was appropriate.

The use of "standard" designs by the Veterans Bureau-Veterans Administration was not a new concept in government. But, the manner in which "standard" designs were used for the architectural set of hospitals was a new direction in the use of "standard" designs.

The military has used standard designs for barracks, quarters and other facilities at least since the last quarter of the 19th Century when scattered garrisons and frontier outposts were replaced by concentrations of troops into large, permanent posts, usually at railheads. There are variations in the use of standard designs. These appear to be based upon the availability of specified building materials and local preference rather than any high level policy decision on design variations.

In the Architectural Set of VA hospitals the stylistic variations were approved at the highest levels of the agency and therefore reflect a conscious design policy. The distribution of the various styles across the county reflects some organized concept of local history, local architectural preferences and an effort to "fit in" and appear as a part of the host community.

Since the beginning of the century a great advance has been made in the diagnosis and treatment of patients suffering with one or more of the many classifications of mental diseases. As a result of World 'War I the opportunity presented itself for a great amount of research and development. Throughout this period an attempt has been made by the Veterans Administration to have the physical arrangement of its hospitals afford the doctor every opportunity to further this work.

Because of the size of VA neuro-psychiatric hospitals, it has been possible in most cases to design one or more buildings for the exclusive care of each type of patient thus permitting assignment of duties, recreation, etc., possible of accomplishment by each type of patient together with such specialized treatment as is required. As the treatment buildings are described, therefore, it will be understood that in a smaller hospital consolidation of two or more of these activities might with careful study be possible under one roof.

In lay terms neuro-psychiatric hospitals, based upon the bed levels established, required a certain number of "hospital" beds in relation to controlled access buildings, intermediate stage buildings and low security buildings. Medical and surgical patients required a mix of acute (serious condition) versus convalescent buildings, while the treatment of TB required more long term buildings and no security. These were supplemented by the appropriate administrative buildings, dining halls and other support facilities such as recreation halls, chapels, engineering shops, boiler plants and staff housing. The actual structure for each type of building, down to the floor plans for stairways and elevators was standardized. However the facade or exterior architectural treatment of each hospital ranged from minor variations based upon the Georgian Colonial theme to such wide variations as English Tudor, Spanish Renaissance or French Colonial.

While these prototypes were not used exclusively by the Veterans Bureau and its successor agency, the Veterans Administration, they were the dominant design concept used through the end of World War II.

While the original, standard interior plans of the Architectural Set of VA hospitals is the initial basis of it significance, only the exterior interpretation of that plan is presently significant. Since these medical centers were originally constructed (between the early 1920's and the immediate Post World War II period) the interiors have been renovated and remodeled repeatedly.

The hospital buildings originally had multiple-bed wards, large day rooms and porches. Health care concepts, life-safety codes for institutional occupancy and the standards of the Joint Committee on the Accreditation of Hospitals (JCAH) have undergone a constant evolution. As a result the interiors of these buildings have been altered frequently to meet each of these changing requirements. Rather than large wards, patient rooms are now most often a mix of 4 or 6 bed wards, 2 bed rooms and single bed rooms.

The changes in space criteria per bed in each of these configurations have meant porches were enclosed to provide additional space and prevent a loss of beds. As buildings have been air conditioned, it has been possible to enclose additional porches to provide additional space needs without the costs of new construction. As a result of these repeated changes to the interiors of the buildings the original fiber and significance of the interiors no longer exists.

It is not surprising that the use of standard designs for hospitals would continue for a quarter of a century. At the time the nation began to meet the need for veterans hospital facilities after World War I the construction of all federal buildings was under the jurisdiction of the Supervising Architect in the Department of the Treasury. The First Langley Bill had authorized construction of veterans hospitals by Treasury. Planning assistance came from the Armed Services and former members of the services. Construction for a number of hospitals was underway when the Veterans Bureau was created in 1921. Existing U.S. Public Health Service Veterans Hospitals were transferred to the new Bureau by one Executive Order, while a second directed the transfer of the First Langley Bill hospitals when completed.

The Second Langley Bill, passed after the creation of the Veterans Bureau gave the Bureau the direct authority to construct veterans hospitals. At this time key personnel associated with the planning of the First Langley Bill hospitals transferred to the new Bureau, forming the core of the Bureau's construction service.

The Veterans Bureau under Charles R. Forbes was plagued by the same reports of scandal, corruption and cronyism as the Harding Administration. Charges ranged from outright bribery and collusion in the selection of hospital sites to kickbacks for contracts, bootlegging of federally held liquor stocks and improper disposal of reputedly surplus medical supplies to veiled suggestions of personal improprieties on official travel.

Charles Forbes’ resignation from the Veterans Bureau on February 15, 1923, was followed almost immediately by a Congressional resolution for an investigation into the operations of the Bureau and the suicide March 16th of his hand-picked General Counsel, Charles F. Cramer. Following the Congressional investigation, Forbes was convicted for his role in the scandals that occurred under his administration, ending the blackest era of the VA history.

Forbes was replaced as Director of the Veterans Bureau by General Frank T. Hines, a World War I veteran of impeccable reputation. Hines remained as Director of the Veterans Bureau until the creation of the Veterans Administration in 1930 when he became the first Administrator of Veterans Affairs. He served in that capacity through the end of World War II when a new, and much larger body of veterans pressed for the replacement of the World War I cadre of leadership within the agency by representatives of "their" war. Hines was then replaced by "The G.I. General" Omar Bradley.

The career architects and engineers of the Bureau's construction service were never involved in any way in the Forbes scandals. Many of them remained with the Bureau and the new VA through the end of General Hines tenure, continuing to construct veterans hospitals according to the plans and care concepts they had originally developed in the early 1920's.

But the era of Charles Forbes left two legacies still a major part of the VA health care delivery program: an abiding concern for the safety of VA patients from fire and other life threatening dangers and separate facilities designed for the specific needs of general medical and surgical or neuropsychiatric patients. Thanks to VA research the need for separate TB facilities was obviated through drug therapy during the 1950's.

The irony of Charles Forbes’ legacy to the VA is this--all buildings constructed from the plans developed during his brief tenure as Director of the Veterans Bureau are attractive multi-building campuses featuring impressive facades and long wings--so long that they exceeded later fire safety standards for the hospitals. Each structure was modified with new stair towers or internal sprinklers.

The original appearance for each hospital location was a campus arrangement of buildings. The design for each campus was based upon the size and topography of the individual parcel of property and the number of the various structures required to meet the bed numbers and distribution for the individual hospital complex.

The selection of sites for veterans hospitals during this period was based upon a number of factors. The most important included:

• Demographics - The nationwide distribution of eligible veterans in need of care and the type of care needed compared to the availability of existing beds.

• Type of Facility - General siting policy at this time called for the location of neuro-psychiatric and TB hospitals (long term care facilities) on large tracts of land away from major urban centers. General medical and surgical hospitals (acute care facilities) were to be located in or near major urban centers on less extensive parcels of land.

• Availability of Federal Lands - The transfer of existing federal lands between agencies and the transfer of facilities with structures suitable for or adaptable to medical care use avoided acquisition and some construction costs. The transfer of military posts, slated for abandonment in the post World War I period, retained a federal presence in the areas and avoided the otherwise severe economic impacts on the local communities.

• Local Initiatives - Local communities, state governments and citizens' organizations supported requests for the location of a veterans hospital in a specific location with offers to donate land, funds, existing facilities or facilities under construction.

• Political Sensitivity - As with other federal agencies, the Bureau did, on occasion, select a specific site within the home states or home communities of prominent political leaders.

Other factors which determined the selection of specific land parcels included the suitability of the land for construction, a healthful environment and/or climate, the availability of water and utilities and proximity to regularly scheduled public transportation.

Neuro-psychiatric Building Types

Main Hospital Building - A main administrative and clinical building usually four or five stories including about 200 hospital beds each. Additional capacity is provided in two story ward buildings of 100 to 200 beds each.   The main building provides the medical and surgical center for the hospital.   It includes medical administrative space, operating suite, receiving ward and clinics.  Basically the Main Building is a combination of the neuro-psychiatric features necessary for the treatment, protection and safety of patients and all of the facilities for a general medical hospital.

Acute Building - Designed for the care and treatment of patients disturbed to such an extent that they require intensive treatment or that they may be dangerous to themselves or others.  The purpose was two fold; to provide specialized treatment and to keep these patients segregated from the less seriously ill.

Infirmary Building - Designated for patients suffering from physical deterioration was well as np disabilities and capable of doing little or nothing toward their own care.  Composed of mostly bedridden patients requiring close supervision and constant care, these facilities included dining rooms and kitchens within the building.

Continued Treatment Building - Housing for able-bodied patients with chronic conditions or a degree of recovery for which restriction and observation are still required.  Patients in this category took meals in the main dining hall building and participated in the occupational therapy program.

Parole Building - Patients housed in this type of facility were sufficiently recovered physically and mentally to care for themselves with nominal supervision.  Parole patients not only took meals in the Dining Hall Building but had access to the Recreation Building.

Dining Hall Building - The dining hall contained not only dining rooms but kitchens, facilities for refrigeration, food preparation and storage for subsistence supplies.

Recreation Building - The recreation usually contained a lounge for cards, billiards and other games, an auditorium and library.

Residential & Quarters Buildings - The residential and quarters buildings included a single family dwelling for the Director (then called the Manager), two duplex units for key staff and their families and the appropriate number of nonhousekeeping or dormitory living units for nurses and attendants.

Utility Group - Composed of the boiler house, laundry, storehouse, garage, shops, firehouse (if applicable) and farm buildings.

Connecting Corridors - The use of connecting corridors between buildings served two functions; patient control and the movement of patients and staff throughout the complex in adverse weather.

Send inquiries about this page to kathleen.schamel2@va.gov.