University College Hospital

“University College Hospital, London. Bird’s-eye view of scheme.” Builder 2 (1896).

Most typologies locate the emergence of the modern hospital in the nineteenth century and argue that by the 1890s, hospitals conformed to a distinct architectural type—the pavilion hospital—and were the desired place for surgical care and central to medical education and research (Risse; Henderson et al.). However, hospital buildings were not simply passive locations for treatment, training, or research; they were also important civic, social, and professional spaces. For many contemporaries, it was their medical, social and professional functions that made hospitals and “not our bridges, or railways” the “real glory and abiding distinction of our civilisation,” as Henry Burdett explained (3). The doyen of the voluntary hospital movement, Burdett made his claim during a resurgence in the building of large general hospitals; one member of the Royal Institute of British Architects dubbed the late-Victorian period “essentially the age of hospitals” (Builder, 1903). The rebuilding of University College Hospital (uch) between 1896 and 1906 was part of this renaissance but also embodied a new approach to hospital design and incorporated facilities “undreamt of a few generations back” (Poore 995).

Opened in 1834 and, like many voluntary hospitals, designed to provide clinical experience as an ancillary to a university medical education, uch quickly outgrew its existing building: a south wing was added in 1840, a north wing in 1846, and a new floor in 1867 as the original design was adapted. Rising patient demand, changes in surgery and nursing, and new technologies placed demands on treatment and teaching as uch struggled to keep pace. Outbreaks of infectious disease on the wards highlighted the hospital’s poor sanitation, and inadequate ventilation caused constant worry. Further enlargement was rejected in 1877, when it was decided that only complete rebuilding would solve the problems of space and sanitation.

Rebuilding uch was not a straightforward project, however. Discussion, planning, and fundraising took eighteen years, and the restricted site on Gower Street required a different approach, one that challenged existing models of hospital design. Just as the voluntary hospitals’ medical functions changed during the nineteenth century beyond the simple arrangements needed to dispense care to the sick poor, so too did their design. Historians have focused on how the pavilion hospital was a response to increasing concerns about the need for fresh air, cleanliness, and order, offering a model that melded form and function with notions of hygiene and efficiency. Characterized by long rectangular pavilions, greater segregation, and cross-ventilation, the pavilion hospital was presented as sanitary for patients and convenient for nurses. Although historians have seen the pavilion layout as coming to dominate health-care design by the 1870s (Richardson 7), they have overlooked how by the 1890s, the style was increasingly viewed as conservative by architects, who felt constrained by the “incubus and terrible tyranny of the pavilion system of construction” (“On the Construction of Hospitals” 102). The realities of many hospital sites imposed constraints that made a pavilion layout difficult to implement as architects struggled with the practicalities of light and ventilation. Cross-ventilation often required innovative solutions, as evidenced in the multi-storey circular wards of the infirmary at New End, Hampstead, which were subsequently adapted in Alfred Waterhouse’s design for the Liverpool Royal Infirmary (Taylor 30). Building vertically offered a further solution for restricted sites, although it was only following opportunities to “manipulate hospital building form while maintaining hygienic medical conditions” from the 1880s onward that such an approach became feasible (Taylor 32).

The design for the new uch by Alfred Waterhouse and his son Paul combined both approaches. Although not a specialist in hospital design, Waterhouse had a special interest in health-care work. Not only had he designed the new Liverpool Royal Infirmary (1887–90) but he had also been involved in major architectural competitions for new hospitals. While not a radical departure for his practice, uch was Waterhouse’s last major work.

Much of the architectural detail of Waterhouse’s design for uch derived from Classical and Northern Renaissance sources, which resonated...