The design evolution: How hospital architecture has changed since the 19th century

20170702060000, Zayani Bhatt
'Did You Know?' seeks to uncover a variety of stories from all facets of medicine and healthcare.
Until the late 19th century, patients went to hospitals because they could not afford a doctor’s house call, had no family to look after them, and no other place to go. They could stay in hospitals for months, with doctors visiting once a day and nurses providing food, bandages and clean bed sheets but no treatment as such.

More importantly, every single hospital room was bright, clean and airy – a stark difference from the environment from which most patients came. Every room had a window because the hospital building was not just a functional facility – it was a form of therapy itself.

It was believed that disease spread in dark, stagnant spaces where pungent, particulate-laden air existed because in the 18th century, epidemics such as the plague always started in overcrowded, improvised neighborhoods, rather than in wealthy, airy and open-spaced ones.

Corridors, linen closets and even ventilation ducts had windows. Often, large windows in operating rooms meant surgeons kept suffering from momentary blindness due to the sun’s glare.

Necessity is the mother of invention


All of this began to change in the early 20th century due to advances such as germ theory, and urban growth meant hospitals began to gain popularity among persons of all classes. Because of that, hospitals needed to be more efficient and increasingly about the medical procedures rather than the healthiness of the building itself.

Windows everywhere were no longer feasible as it meant buildings could be no more than two rooms wide, which led to long, narrow and rambling structures. They were also labour-intensive and expensive to build, heat, light and supply water to.

Now, hospital designers were looking at time and motion studies to determine layouts and locations – but they retained windows in inpatient rooms. This meant that nurses would have to walk almost eight to ten miles each day, through long wards, each housing only 20 patients.

In 1942, Charles Neergaard, a hospital design consultant, proposed that two nursing units (groups of patient rooms overseen by a single nurse) share the same windowless rooms and only patient rooms have windows. He also moved service rooms closer to patient rooms, drastically reducing how much nurses had to walk.

By the 1950’s, medics knew patient healthiness was possible regardless of building design thanks to antibiotics and antiseptic practices.

Additionally, many preferred being able to control room environments as required with air conditioning, central heating and electric lighting. By the 1960’s, windows disappeared from patient’s rooms, too.

By the 1960s, hospitals did not have windows – even in some patient rooms.
By the 1960s, hospitals did not have windows – even in some patient rooms.

A blend of both past and future requirements


Now, a main concern is the design of the Emergency Department (ED) in hospitals as it is here, where inefficient design can be the difference between life and death. Research conducted by a team of international researchers found, space was needed where doctors could privately communicate with each other about patients, on personal matters with each other and take refuge from stressful situations.

The solution, the team found, was in creating small spaces that allowed doctors to observe patients – but that were acoustically separated from patients. They would have standing desks for short conversations and booths for longer, private ones.

Today, the idea of a building facilitating recovery is being implemented in Maggie’s Centres, a collection of cancer support facilities around the world. They are often designed by world famous architects who make them inspiring and healing.

Laura Lee, chief executive at Maggie’s remarks that "there's just no question that when someone walks in, there's something about the architecture that you can see in people's body language. They quickly change from being tense and anxious. Their shoulders relax."

Many have landscaped gardens, serene views, acoustics that make for quieter wards and materials that limit infection. Having spoken with cancer patients about how to make the centers as comfortable as possible, they have used wooden handles instead of metal ones which can aggravate the hands of patients undergoing chemotherapy.

They have also placed eaves to protect photosensitive patients from UV light whilst ensure there is enough natural light to make the place feel warm and welcoming. As Alex de Rijke, co-founder of dRMM which designed a Maggie’s Centre explains, “this is much more about the relationship between psychology and design." MIMS

Read more:
How hospital design can make patients sicker
Am I in a hospital or in a hotel?
5-star hospitals in Singapore: Pampering patients
Reforming the US healthcare system based on Singapore's model

Sources:
http://www.smithsonianmag.com/history/when-fresh-air-went-out-fashion-hospitals-180963710/
http://www.architectureanddesign.com.au/news/hospital-design-a-specialisation-that-is-critical
http://edition.cnn.com/2017/06/19/design/healthcare-clinic-designs/index.html