Hospitals

by

Joy Knoblauch, Sara Honarmand Ebrahimi

• LAST REVIEWED: 23 March 2023
• LAST MODIFIED: 23 March 2023
• DOI: 10.1093/obo/9780190922467-0085

Introduction

As a building and as an institution, each hospital reflects the values and priorities of the society in which it resides. As a place of healing, the design responds to theories of faith, medicine, and technology. As a resource-intensive instrument, each contemporary hospital responds to funding structures, whether publicly funded, charitably funded, operating as a business, or some mix of all three. From their origins within religious institutions to contemporary flagships of innovative technology, hospitals have changed a lot, and many different types of hospitals continue to exist in the present. Religious ties remain strong, and the distance between a small country hospital and an urban university medical center is measurable in much more than miles. It should be acknowledged that the idea of a building “typology” is always already flawed, being itself a problematic notion with roots in colonial and racial ordering systems based in quasi-scientific thinking. So while it should not be taken as essential, the cultural symbol of “the hospital” does still achieve prominence in many eras, providing a window into the life and death of a society. In the twentieth and twenty-first centuries, these buildings and institutions retain an innocence and association with faith in technology that often cloaks deeper, more complex, and deadlier truths. Peeling back that cloak may not be easy for those with a weak stomach (quite literally, in that many stories and images bring pain, sickness, and death to mind), yet the study of hospitals has much to offer scholars of architecture, culture, technology, religion, risk, and the limits of human bodies. There are two broad sets of literature on hospital architecture. The first includes those written by architects, physicians, religious administrators, nurses, and patients. These works provide practical guidance, sometimes offer a historical overview, and often include insightful comments about bodily experiences in space that may be overlooked in literature on other buildings. Curtains, drains, and the sounds of wheels along various flooring materials become worthy of attention and commentary because of the chronic and somewhat involuntary occupation of the buildings, as well as the need to worry about transmission of diseases, which can require the management of each small gesture. The human occupation and the social element are no less crucial in these often insular institutions where close physical work with high stakes happens across race, class, and gender lines. The spaces are undeniably physical, emotional, and authoritarian. The patients, families, and staff in a hospital confront boredom and crisis, again and again. In particular, the field of hospital administration reveals important discussions about space, cleaning, and the many instruments devised by 20th-century humans to manipulate bodies into position for surgery, bathing, or mobility. The second set includes literature that provides historical analysis of hospital architecture. Appearing initially in the 1980s, this topic is now becoming a serious preoccupation of architectural history. Working from drawings and photographs, this literature shows that hospital history is not only medical, cultural, political, and religious, but also architectural. The focus has predominantly been on hospitals built in Europe and North America over the last forty years, but there are signs that this is now changing.

General Overviews

There are several substantial histories of hospitals, including Rosenberg 1995, Granshaw and Porter 1989, and Risse 1999. These books are helpful for understanding policy, medicine, and social history. In particular, by locating medieval, early-modern, and modern hospitals in their social, cultural, and medical contexts. Risse’s book shifted the historiography of hospital history. But these works do not examine the architecture and design of hospitals. In parallel to this scholarship, Goodall and Richardson 1998 and Stevenson 2000 discuss English (and British) hospital architecture, while Thompson and Goldin 1975 provides one of the earliest histories of hospital architecture that discuss European and North American hospitals. We can learn from these books how the architecture and design of hospitals have changed since antiquity. The latter also attempts to provide a social history. They demonstrate that hospital history is not only cultural, social, and medical but also architectural history, a point that Henderson, et al. 2007 highlights while also inviting comparison among hospitals across time and place, showing that there are no neat chronologies in hospital history.

• Goodall, Ian, and Harriet Richardson, eds. English Hospitals, 1660–1948: A Survey of Their Architecture and Design. Swindon, UK: Royal Commission on the Historical Monuments of England, 1998.

  An edited collection of essays on English hospitals, including mental hospitals, convalescent hospitals, and military hospitals, informed by a survey conducted by the Royal Commission on the Historical Monuments of England.

• Granshaw, Lindsay, and Roy Porter. The Hospital in History. London and New York: Routledge, 1989.

  Examines medieval English hospitals, the voluntary local infirmary movement in Georgian England, the history of children’s hospitals, and the cancer hospitals and illustrates the evolving institutional structure and functions of the hospitals, hospitals’ relationship with the wider community as well as patients’ experience of institutional culture.

• Harrison, Mark, Margaret Jones, and Helen Sweet, eds. From Western Medicine to Global Medicine: The Hospital beyond the West. Hyderabad, India: Orient Blackswan, 2009.

  Traces the history of hospitals in different non-Western countries, including Iran, Japan, Cameroon, Manchuria, the Ottoman Empire, and India, addressing diverse questions, such as the role of hospitals in spreading Western medicine.

• Henderson, John, Peregrine Horden, and Alessandro Pastore, eds. The Impact of Hospitals, 300–2000. Bern, Switzerland: Peter Lang, 2007.

  Covers a span of nearly 1,700 years and examines various topics, including the role of hospitals in shaping urban mortality, their position in the public sphere, their architecture in the second half of the twentieth century, and the treatment of tuberculosis in Britain and Germany, among others. The geographical focus of the book is Europe; only one chapter looks beyond the European context.

• Risse, Guenter B. Mending Bodies, Saving Souls: A History of Hospitals. New York: Oxford University Press, 1999.

  Covering from ancient Greece through the AIDS epidemic, Risse presents one of the broadest histories of hospitals though primarily European and North American examples. While the book’s focus is not on architecture, it provides basic information about architecture in some chapters.

• Rosenberg, Charles E. The Care of Strangers: The Rise of America’s Hospital System. Baltimore: Johns Hopkins University Press, 1995.

  Focusing on the period between the US Civil War and 1920, it discusses how hospitals became central to modern medicine, medical education, and science and turned into primary sites for treating severe illnesses and managing death.

• Speziale, Fabrizio, ed. Hospitals in Iran and India, 1500-1950s. Leiden, The Netherlands: Brill, 2012.

  Examines hospitals in the post-medieval Indo-Iranian world, including state, missionary, and Indigenous hospitals, and shows ambivalent and contrasting views of hospitals and their role in the society.

• Stevenson, Christine. Medicine and Magnificence: British Hospital and Asylum Architecture, 1660–1815. New Haven, CT: Yale University Press, 2000.

  Examines all major hospitals built in England and Scotland during the “golden age” in hospital construction. Stevenson discusses the architecture of these buildings—their style and typology—while exploring what they meant to their commissioners, designers, and users.

• Thompson, John D., and Grace Goldin. The Hospital: A Social and Architectural History. New Haven, CT: Yale University Press, 1975.

  One of the earliest book-length histories of hospital architecture. It is a historical survey of hospital design from antiquity until the twentieth century, discussing European and North American examples. It is a useful book but, as it was published in 1975, it requires revisiting.