- Architecture and the Modern Hospital: Nosokomeion to Hygeia by Julie Willis, Philip Goad, and Cameron Logan
Hospital history, Architecture, Nursing, Geography, Design
The last twenty years has seen significant interest in the history of hospitals, especially in their growth, management, and financing. Rather less attention has been paid to what actually happened in these institutions, how they ran on a daily basis and how changing processes shaped the physical environment. There has certainly been discussion of form but the limited presence of the big names of the International style in the design of medical facilities has meant architectural historians have rarely discussed the hospital while medical historians have prioritized issues like cost and capacity over the aesthetics of the physical fabric. This work, co-authored by three prominent Australian architectural historians, seeks to relate the form of the hospital to developments in its functions. It sets out to challenge the conventional focus of architectural historians on iconic designers and designs, opting instead to chart the development of the hospital form through an exploration of seven key sites: the bed, the nurses station, the operating theatre, diagnostic therapies, laundries and kitchens, the modern hospital, and the idea of the hospital city. Its timescale is the era of high modernity, from the end of the nineteenth century to the 1960s, which the authors characterize as a period of transition from caring to healing. They employ architectural and medical sources, like the International Hospital Association's journal Nosokomeion, and the American Medical Association's mouthpiece, Hygeia, along with a range of important texts by architects and hospital managers. Through these sources they investigate the emerging transnational world of hospital design with its hotspots in North America, France, and central Europe, and track the evolution from institutions shaped by space, light, and fresh air to technologically controlled environments dominated by machinery, data, and the motor vehicle.
The first half of the book is more innovative than the second, encouraging us to think differently about the hospital. The chapter on the bed takes an item usually discussed in terms of numbers and capacity and considers it as the central object in the institution. It explores how changing ward size and shape altered the role of the bed while the demands of modern medicine required its technological improvement. Similarly, the changing location of nurses – both in terms of their workplace and living quarters – reveals the interest of designers and architects in this key group. Thus [End Page 227] the movement of the nurses' bedrooms from within the building to purpose built homes and from the center of the Nightingale Ward to a panoptical nursing station signaled their diminishing importance to the working of the institution. As new technologies came to dominate medical practice and take up more space, the nurse's caring role reduced and the internal design of institutions saw them increasingly marginalized. The way these new technologies shaped the inside and outside of hospitals is the subject of the next three chapters. New spaces for surgery are contrasted with those for subcutaneous investigation and therapy, both developments pointing to a need for innovation in services such as laundries, kitchens and data management. Although the increasing importance of surgery is recognized in hospital history, its impact on the physical shape of the institution has rarely been considered. Yet this was significant, and the authors highlight attempts to produce round operating theatres or aseptic viewing spaces for students. Similarly, the rise of X-ray, light treatment, and bacteriology put demands on space for both the treatments and associated record keeping. Interiors were re-modeled squeezing out non-essential services and creating a need for more mobile beds to be moved round the building via elevators, swing doors, and longer and wider corridors. New services were required, with kitchens, laundries and heating systems modernized and centralized away from the wards. As ideas about healthy environments changed so commitments to sunlight and fresh air gave way to the closed world of the aseptic hospital dominated by artificial light and air conditioning...