It can be argued that healing spaces have existed since 800 to 500 BC (Heathcote and Jencks, 2010, pp56). Considering this, both an understanding and recording of what is integral to hospitals, as healing environments, is lacking. Architecture critic, Charles Jencks, writes of a loss of tradition once historically evident in the ‘seamless continuity between health and architecture’ which he claims is ‘verified by picking up the standard textbook on hospital building today; it shows little record of past interplay between culture and health’ (Heathcote and Jencks, 2010, pp16).
A H I S T O R I C A L P R O G R E S S I O N
OF H O S P I T A L A R C H I T E C T U R E
T A K E M E T O
Early civilisation hospitals were a ‘fusion of religion and healing’ (Haggard and Hosking, 1999, Foreword pp1), and it can be assumed that their reliance on religious faith as a tool for healing was due to the absence of scientific capabilities that emerged since the discovery of infection (Heathcote and Jencks, 2010, pp71). The first health institution, surfacing a ‘hybrid of healing and culture’ (Heathcote and Jencks, 2010 pp18), was Epidaurus, a temple dedicated to God of healing, Asclepius (Sternberg, 2009, pp220). Adopting a holistic approach (Heathcote and Jencks, 2010, pp56), and offering powerful views of nature, Epidaurus signifies humankind once largely relied on the environment to help mind, body and spirit assist healing (Prasad, 2014).
A N C I E N T G R E E C E
M E D I E V A L H O S P I T A L
A landmark in early medieval healthcare architecture is the Hotel Dieu, Paris (651 AD), translating to Hostel of God (Science Museum, N/A). It is questionable whether the healing temples were a source of architectural inspiration, however similarities arise in the primarily religious orientation and multi-function healthcare approach (Heathcote and Jencks, 2010, pp57). The hospital is adjacent to the Notre-Dame Cathedral (Vallois, 2003), likely acting as precedent for city centre hospitals. After a fire in 1817, it began to ‘shed its reputation as a disease trap’ and its revised design adopted a central courtyard and spaces with vaulted ceilings (Vallois, 2003). It can be questioned whether its gradual closure of its medical facilities is due to its diminishing architectural suitability, or as a result of changing societal needs of the modern hospital.
1 2 T H C E N T U R Y [ I S L A M I C ]
‘The intellectuals of Islam’ (Heathcote and Jencks, 2010, pp57) were the first to develop the Ancient Greeks medicinal discoveries. Inspiring hospitals like the Nur Al-din Bimaristan, Syria (1154); operating over several centuries and being a medical school and hospital (Demeter, 2014), it is ‘closer to anything we have today than anything that came for centuries after’ (Heathcote and Jencks, 2010, pp57) regarding healing architecture. Bimaristans locations prioritised hill or riverside plots (Al-Ghazal, 2007, pp3), suggesting Islamic architects understood the health benefits of natural ventilation; as supported by the design of wards with windows facing the street (Tabbaa, 2003, pp106).
1 4 T H C E N T U R Y + R E N A I S S A N C E
A pivotal moment in hospital architecture surfaced by the 14th Century. An increasing number of hospitals were under the instruction of the city rather than the church. It can be questioned whether this initiated the collapse of the influential relationship of religion, culture and hospitals, distancing from the charitable, spiritual institutions they had been for centuries.
The Renaissance's ‘first major building was a hospital’ (Heathcote and Jencks, 2010, pp59). The Ospedale degli Innocenti (1419), Florence, designed by Brunelleschi (Prasad, 2014), was an orphanage. Similarly to other institutions at the time, a generous donation was made after the decision to ‘deliberately select the civic guild instead of a church or religious order’ (Hornik, 2007, pp65). A design based upon Brunelleschi’s influence of ‘Classical Roman, Italian Romanesque and late Gothic architecture’ (Istgalilei, 2009), the calculated geometric structure and presence of the loggia provides a medium of shelter and enclosure.
1 8 T H C E N T U R Y
At the end of the 18th Century hospitals began to develop the role they have within society today: decreasing their association with the Church, simultaneous to their increasing demand (Nickl and Nickl-Weller, 2007, Foreword pp1). German hospitals initiated the pavilion style, spanning a larger land surface area with the composition of separate buildings (Nickl and Nickl-Weller, 2007, Foreword pp2). Unintentionally, this revised layout proved to be healthier; isolating patients by illness and reducing spread of infection (Nickl and Nickl-Weller, 2007, Foreword pp2).
1 9 T H C E N T U R Y H O S P I T A L S
The various 19th Century approaches to hospitals were influenced greatly by the industrial revolution. With a significant rise in factory buildings, the UK became notorious for poor living and working conditions: the detrimental effect this had on citizens health increased the number of hospitals built (Heathcote and Jencks, 2010, pp67). ‘Hospitals became a feared presence, evidence of decay and death’ (Heathcote and Jencks, 2010, pp67) and debatably, this instigated the stigma hospitals often have today.
Infamous nurse, Florence Nightingale impacted 19th Century hospital architecture; advocating her belief that conditions of the built environment is central to healing, her writings informed that natural light and fresh air are vital in hospitals (Prasad, 2014). The value of her teachings was certified in her influence over the re-location and design of St Thomas’ Hospital, London (Godfrey and Roberts, 1951, pp79). Comprised of individual buildings with river views: three of the classical buildings remain operating today (Godfrey and Roberts, 1951, pp80), highlighting its success. Later in the 19th Century a scientific paper informing that sunlight destroys bacteria was released to the Royal Society in London (Sternberg, 2009, pp4). Consequently the emergence of large windows and skylights (Sternberg, 2009, pp4) exploiting maximum levels of sunlight, began to direct hospital architecture into an era of hygiene.
M O D E R N I S M [ 2 0 T H C E N T U R Y ]
Arguably the most respected 20th Century hospital is Alvar Aalto’s Paimio Sanatorium, Finland, 1933 (Heathcote and Jencks, 2010, pp74). Its south facing wards and pine forest views were supposedly inspired by the 19th Century focus on the benefits of sunlight and natural ventilation (Sternberg, 2009, pp5). Despite its widespread admiration, the post WWII continuance of ‘the hygienic, puritanical language of international modernism’ becoming ‘the universal language of hospital architecture’ (Heathcote and Jencks, 2010, pp77) has since received criticism. The functional nature signature to modernism becoming the designated hospital design has been described as ‘a vehicle to express mankind’s faith in technology as a cure for all ills’ (Heathcote and Jencks, 2010, pp77). The gradual realisation of hospitals being too solely focused on homing technological advancements and consequently ‘leaving man behind’ (Heathcote and Jencks, 2010, pp80), began with the late 20th Century associations between neuroscience and architecture.
FIG 10
FIG 11 HOSPITAL COURTYARD
FIG 12 CORRIDOR WITH VAULTED CEILING
FIG 13 LEADING TO COURTYARD
FIG 14 CENTRAL POOL COURTYARD LEADING TO FOUR CORNER PATIENT ROOMS
FIG 15 NUR AL-DIN BIMARISTAN PLAN
FIG 16
FIG 17 ORPHANAGE DECORATIVE MURALS TO FACADE
FIG 18
FIG 19
FIG 20 HOSPITAL RELOCATION OVERLOOKING RIVER
FIG 21 AERIAL PHOTOGRAPH AND ORIGINAL SITE PLAN
HAYLEY MARCROFT
INTERIOR ARCHITECTURE | NTU
N0495471