Medical     The first medical facilities in New York tended to be specialty facilities, such a “lying-in” maternity hospitals or insane asylums. By the late 19th century, general medical facilities were being established that were starting to provide comprehensive care to the public. The modern hospital in the 20th century frequently developed into a huge facility with extensive patient care available in the main campus. Recently, these huge facilities have begun to decentralize into an array of ambulatory facilities and a core medical facility, where length of stay is reduced as far as possible. Advances in medical technology have made many operations that previously required hospitalization into ambulatory procedures, while the main hospital facility is increasingly reserved for intensive care. Macrae-Gibson Architects have been involved in both of these developments. At the same time, the firm has attempted to go beyond the merely utilitarian aesthetic that is all too prevalent and to provide a metaphorical dimension in its hospital design.