Medicine and Magnificence: British Hospital and Asylum Architecture, 1660-1815 (review)

Christine Stevenson's remarkably fine new book provides a detailed and original survey of British hospital and asylum architecture in the period between the Stuart Restoration and the defeat of Napoleon—a particularly fertile century and a half, punctuated by an explosion of new hospital and asylum foundations and some radical shifts in institutional design and purpose. Stevenson's analysis is greatly enriched by a plethora of beautifully reproduced engravings, photographs, and floor plans, with the visual materials well integrated into the narrative and quite rightly serving as a central source of evidence for the arguments she presents. Yale University Press has a very distinguished list in the history of art and architecture, and this volume is a handsome addition to that list, produced on high-quality paper in an oversized format that is a pleasure to read and examine.

Stevenson's narrative engages simultaneously at several different levels. She is concerned to understand these new buildings as their contemporaries understood them, but just as keen to examine them as examples of "high" architecture: "big, expensive, and permanent buildings whose pictures were made, and whose architects' names are mostly known" (p. 6). She is fascinated by the intrinsic architectural interest these structures possess, but just as interested in the contributions that an enlightened interrogation of these built forms can make to wider cultural and sociohistorical understanding. Bethlem, for instance, the archetypical Bedlam, moved in 1676 from its previous location in an old monastery to a palatial new establishment designed by Robert Hooke and built in a suitably liminal position on the uncompacted soil of the ditch outside the old London wall. Stevenson brilliantly explores a structure whose "influence on later asylum construction was enormous" (p. 9)—and almost wholly negative. Its grand architectural excesses—its Corinthian pilasters and its luxurious ornamentation, its external resemblance to a palace fit for the newly restored king—rapidly came to be seen as ostentatious and misplaced magnificence, highly improper for a hospital for madmen; and this "developing distaste" (p. 9) for such designs was soon reflected in the plainness and simplicity of a rival establishment, St. Luke's Hospital, which opened its doors in 1751.

Hospitals in these years were charities, and implicit in the debate over their architecture and ornamentation were assumptions about what was fit and proper in the construction and operation of such establishments, about what was needless and unwarranted luxury and what praiseworthy magnificence. Hospitals were, of course, of great value as commissions for the architects who designed them—not so much for the fees they received for their designs, which were often relatively slight (though offset somewhat by the sums they charged for supervising construction), but rather more for their use as advertisements, since the prominence of such buildings ensured that they were seen by many potential clients. And though erected largely at lay initiative, they constituted an important arena within which another profession operated, a social space where medical men plied their trade and built their careers, the whole constituting "a scheme," in the words of the cynical Tobias Smollett, "which had succeeded to a miracle, with many of the profession, who had raised themselves into notice, upon the carcases of the poor" (quoted on p. 106).

How did the vast new array of such structures come to be built? What sorts of buildings were designed, and what considerations entered into the determination of their architectural features? They were, after all, as Stevenson quotes the late Roy Porter as observing, "conspicuous monument[s] of prestigious charity, distinct from the tainting and compulsory housekeeping of the poor law system" (p. 111). In elegantly written central chapters, Stevenson explores these concerns, as well as the technical issues that came to the...