The Architect and the Pavilion Hospital: Dialogue and Design Creativity in England, 1850-1914

The health of hospitals—a concern since the mid-eighteenth century—became a key issue in Victorian times. Indeed, as Taylor, an architect, points out, “healthy” institutions projected favorable images, thus attracting donations, patronage, and better caregiving staffs. Already in greater demand, hospitals in the 1850s quickly adopted the pavilion system, a French arrangement of hospital space popularized by reformers (with the help of Florence Nightingale) that became the defining orthodoxy for the next forty years throughout Europe and, eventually, America. This book chronicles in detail the evolution of pavilion hospitals in England during the Victorian and Edwardian eras from the point of view of British architects summoned to reorganize and build hospital space for prominent voluntary and municipal institutions. Unlike earlier times, the emphasis was on institutional ventilation, cleanliness, and new spatial requirements.

The book is organized into six sections, with the first three devoted to the professional image, training, and competence of Victorian architects. Taylor describes the dawn of a specialized architectural discipline dealing with the design of hospitals. Architects interested in this field engaged in extensive dialogues with hospital administrators, building and executive committees, and medical professionals, and they became famous consultants and advisors. Unlike their colleagues working on other building types, Taylor tells us, hospital architects were aware of their special responsibility: inadequate designs could foster disease and cause deaths. They needed to upgrade and constantly expand their expertise by studying hospital plans and facilities, checking and evaluating the defects in existing institutions. Finally, hospital architects either received a direct commission or were asked to submit their plans to a competition. A competitive approach (such as that employed for the Johns Hopkins Hospital in Baltimore) left more room for individuality—but planning committees, not always very knowledgeable, were often swamped by entries and frequently asked for revisions and reductions because of the estimated costs of the designs.

In the remaining sections of the book, Taylor discusses the upgrading of older hospitals and the gradual refinements of the pavilion design at the turn of the century. This period witnessed a series of new general hospitals, built in expanding smaller English industrial cities and commercial centers. Hospital architects faced tensions between creating an outside façade worthy of a veritable healing palace, a source of civic pride designed to attract more patrons, and interiors that would prevent hospitalism by complying with the demands of medical and surgical staffs for better ventilation and cleanliness. New pavilion buildings were planned, while older, historical ones were turned over for nonclinical use, especially as administrative and outpatient facilities. Such remodeling spurred innovation and challenged an architect’s creativity, often leading to unique local solutions. Wings in existing buildings were extended, corridor plans transformed into pavilion layouts. Wards were deprived of dust-catching curtains and carpets that had provided a homelike atmosphere. The new emphasis was on sunlight and fresh air. Old operating theaters were broken up into suites of surgical rooms with smaller viewing areas, their rounded walls lined with marble and the floors composed of mosaic tiles for easier cleaning. Adjunct hospital facilities sprouted everywhere, especially outpatient departments, nurses’ homes, and isolation wards, with separate entrances.

By the early 1900s, overloaded outpatient facilities included X-ray and physiotherapy departments, and specialized clinics opened for the treatment of eye, ear, and throat problems, skin diseases, and venereal disease. Separate homes for nurses, disconnected from the main hospital complex, reflected their new professionalization: no longer forced to sleep in the wards or in attic dormitories, the educated Nightingales needed to be properly housed in a healthy and relaxed domestic atmosphere, away from the potentially noxious ward atmosphere.

Pavilions, Taylor tells us, came under increased scrutiny in the early 1900s. Rapid urban growth diminished the availability of space to expand existing facilities. Pavilions were eventually stacked on top of each other, and some institutions began to resemble small skyscrapers. Moreover, the old design was labor...