Chapter Two Hospital typology and its influences Introduction Within the architectural landscape, the typology of hospitals has changed dramatically over the years (Verderber et al., 2000; Kisacky, 2005, 2013, 2019; Adams, 2008; Burpee, 2008; Tesler, 2018). Typically, these changes to the typology have been scientific and government-led. Contemporarily, the influence of architectural thinking has seen a rise of human-centred design. Architects are starting to design for greater and more diverse human needs beyond the physical, thus creating spaces that reduce mental stress. This chapter explores these influences that led to hospital design changes throughout American history. The influences discussed within the chapter originated in America and these ideas have been internationally adopted. Photographs of historical and modern hospitals are used throughout this chapter to illustrate the ideas explained. Throughout this chapter, it is evident there is a rise and fall of biophilia within architecture. As biophilic spaces beneficially impact the users’ mental state it is important that architects critically engage with, and challenge, the current way of think and lead a strong movement into human-led design.
2.1
Scientific influences
As early as the third millennium BC (Tesler, 2018, p. 1), religious orders looked after the infirmed in hospitals, while the sick were looked after in their homes (Kisacky, 2017) and this was the case until the nineteenth century (Tesler, 2018, p. 3). According to Nancy Tomes (1998) in the late 1700s, the transmission of disease was due to bad air ventilation – Miasma Theory. It was thought that by creating a clean and pure environment within the wards the mortality rate of patients would improve (Burpee, 2008, p. 1; Kisacky, 2013, p. 84). As a result, hospitals were designed around the patient, natural light and the most important factor maximising the fresh air flow through the building to reduce miasma – bad air that carried airborne disease (Kisacky, 2013, p. 86). In the early 1870s views on disease prevention were based on the worry of airborne diseases floating on dust – Germ Theory (Kisacky, 2013, p. 86). These views resulted in hygienic design (Burpee, 2008, p. 1) – a space that is easily disinfected (Kisacky, 2013, p. 90). Florence Nightingale (1820 – 1910), American founder of modern nursing (Burpee, 2008, p. 1), developed the pavilion hospital design that was centred around the masima and germ theories (Nightingale, 1863). The pavilion plan consisted of a centralised corridor with the wards (pavilions) running perpendicular to the corridor (Burpee, 2008, p. 1). Each pavilion housed 30 to 40 patients in one large single room (Adams, 2008, p.10) and became its own small hospital.
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