The book hardly saves in its diagnosis of hospital architecture: “Its complications are widespread, its authorship complex, its forms jumbled, incoherent, inelegant and bipolar.” The results are often poor, facilities for the care of sick people are confusing, frightening or worse. Murphy wonders, âWhat made this place so indifferent to the human experience? Why the humiliation? Where is the design? “
A first overview in The architecture of health is insightful and consists mostly of plans with the occasional axonometry; it becomes clear that the appearance of these buildings in the longue durÃ©e is secondary. This design approach continues to require attention as it follows the practical requirements that explain hospital development. We are a long way from the basilica hospitals starting this list, but the early proximity to the altar reflected a more fundamental organizational relationship, that of patients to nurses, a requirement the logic of which is purely internal and often achieved with few windows or any coherent relationship with the exterior of a building.
Growing awareness of the importance of ventilation, with great merit to hospital reform pioneer Florence Nightingale, made the building envelope increasingly important. Isambard Brunel’s prefabricated field hospitals were an early confirmation of this insight in the Crimean War; the death rate at his Renikoi hospital was about three percent; those in a barracks hospital nearby were over Fourty Percent.
However, the age of operable windows would not last as machines took over. Reyner Banham makes an appearance, of course, with the authors drawing his early attention to the consequences of the Royal Victoria Hospital in Belfast, as the authors note, “the first to introduce forced ventilation as a means of controlling the indoor air environment and regulating its” heat and humidity. “
By rising the hermetically sealed box, hospitals were able to turn inward again, swell and rise in a way that natural ventilation would not have allowed. Albert Kahn’s assignment for Ann Arbor University Hospital (complete with two miles of corridors) jumps off the page as a symbol of this enlargement: âIt was a closed system in which patients moved from one service to another along an assembly line – a factory for healing. “
The few healthcare facilities that are in the design canon appear more often as outliers than as reproducible peaks. Alvar Aalto’s Paimio Sanitorium in Finland is wonderful, but inherently small and inflexible. Others responded to current requirements but were overtaken due to trends beyond their control. Bertrand Goldberg’s Prentice Women’s Hospital, which unfortunately passed away, was well thought out: âThe tip illustrates the elementary nurse-to-patient relationship; Downstairs is the control center for systems, operations and technology. âThe problem is that mechanical elements were not satisfied with this space and kept asking for more.
Efforts to articulate mechanical requirements are certainly fascinating: E. Todd Wheeler’s very visible ventilation in his St. Mary of Nazareth Hospital in Chicago or Louis Kahn’s Richards Laboratories in Chicago. His Salk Institute was a rare building that was effectively future proof, with half floors for mechanical elements that were more needed in construction.
Even if future change was seen as inevitable, it was difficult to say what it would be like. Eberhard Zeidler’s McMaster Health Center in Hamilton, Ontario was built as a series of replicable modules, a framework that worked but most of it didn’t. Labyrinths often arise. Who hasn’t done three left and two right to see that you are still two floors below the skybridge? The report occasionally shows heroes, but many villains, with Bellevue being a not entirely atypical avatar of âinstitutionalization and dehumanizationâ.
And the world always offers new challenges. The sealed environment that was de rigeur was suddenly proven to be flawed by the COVID-19 pandemic. The authors point to the Mount Sinai Hospital in New York City, which moved patients from newer wards to a building from the 1930s – because it still had operable windows.
The particularly thoughtful design by the MASS Design Group of the Butaro District Hospital in Rwanda, which offers ventilation, nature views and effective care, is a very welcome coda for the band and is becoming prominent in Shaping and healing. With a broader focus on open source design, the exhibition showcases innovative new buildings as well as other medical technologies, from a range of masks to an inexpensive cot for a cholera treatment center in Port-au-Prince to smart thermometers in the UK and negative pressure ventilators from Bangladesh, designed at a fraction of the cost of previous ventilators. Design, like disease, is a problem that can never be entirely overcome, but progress is always possible.
Design and Healing: Creative Responses to Epidemics is now available through February 20, 2023 in Cooper Hewitt’s Design Process Galleries.