HISTORY AND EVOLUTION

In order to achieve this, various architectural methods should be incorporated in the design making process beforehand. These strategies help in stimulating the senses of the human body. The physiological effect that are caused through architecture helps reducing the amount of stress that creates this uneasy, unpleasant atmosphere in the hospital. Including scenic views, open spaces, natural elements like trees gardens, landscape and use of natural materials like stone cladding to the walls etc. are a few of the ways a space can be converted from having a negative to a positive impact.

Analyzing the current scenario of healthcare industry in India, it was noticed that the holistic needs of patients was generally not being fulfilled in the healthcare facilities but the most prominent part was that even the patients that are at a very vulnerable situation do not receive the mental and emotional help they require the most.

The geriatric patients are one of the most venerable user groups today in healthcare. The most saddening part about this situation is that geriatric medicine is not a separately recognized part of healthcare study or degree in India. Hence the normal physicians treat the elderly population when in actuality there should be designated doctors with a geriatric degree practicing in a geriatric hospital treating the senior citizens physically mentally and emotionally.

Along with the drawback in the healthcare system the old people are most commonly observed to have immense mental issues hence it becomes all the more important to introduce geriatric facilities that provide mental, social, emotional and physical needs to the elderly patients which can be provided architecturally.

Figure 8: 5 senses of the body Source : https://www.dreamstime.com/five-sensesicon-set-vector-isolated-illustration-humanperception-taste-touch-hearing-smell-visionsensory-organs-brain-image186680798

Figure 9 : Mental health in elderly Source: https://preventionlane.org/mental-healtholder-adults

A study of the evolution of healthcare is required to comprehend when and how healthcare, in terms of holistic treatment, began to fail and to attain a better understanding of the current healthcare practices and requirements.

A) Healthcare architecture through the ages around the world:

i) The Sanctuary of Asklepios at Epidaurus

In ancient Greece and Rome, an Asklepion was a healing temple, sacred to the Greek God of medicine Asklepios. The Sanctuary at Epidaurus hospital facilities is an eminent example of a Hellenic architectural ensemble of the 4th century BCE. It is the earliest organized sanatorium.

Archaeological evidence provides proof that Asklepieia offered in antiquity what we nowadays call holistic health care. Each activity that took place at Epidaurus was designed to harmonize the mind, body, and soul.

The theatre of Epidaurus was where visitors could attend performances and escape from their debilitating problems. After having attained a calm and mentally relaxed state, they were led to the main therapeutic space, the Abaton; further was followed by the main healing phase, known as enkoi-mesis.

During sleep in the Enkoimeterion, the patient allowed himself to dream of the God, who would visit him and offer the healing treatment that was needed. The sanctuary with its peaceful natural surroundings invited people to explore the forces of nature and those within themselves. Thus, it is the ultimate example of holistic care.

Figure 10: The sanctuary of asklepios at epidaurus Source: https://www.gutenberg.org/files/61612/61612-h/61612-h.htm

ii) The Church and Spiritual healing

Early in history, the sick were cared for in their homes. As the Roman Empire turned to Christianity, the Church's role in looking after the infirm within their churches. After 400 AD, the Catholic Church became the most powerful provider of health care, and monastic orders were the caretakers for the sick. The monarchs of the 6th century reinforced this role with emperors that a hospital should be attached to every cathedral that was built in the empire.

Religious institutions continued to provide most of the healthcare to the poor in large, open wards housing multiple patients which continued to expand and became the standard for the public hospitals for hundreds of years. Often the wards were configured so the sick could see the altar to assist with their recovery.

The cross-shaped plan achieved this goal with the altar in the middle and multiple wards radiating from it. The plan is similar to many hospitals today, with the nurse's station instead of the altar at the center. The Church emphasized in the healing power of prayer and encouraged spiritual interventions as treatment procedures.

Figure 11: The church and spiritual healing Source: https://upload.wikimedia.org/wikipedia/commons/5/58/Rahn_Kloster_Sanct_Gallen_nach_Lasius.jpg

iii) The Pavilion system and nightingale wards

In the late 1700's a re-evaluation of the hospital form was prompted by the new recognition of clean air and hygienic conditions as agents of health, especially in hospital environments.

Florence Nightingale was a very influential figure in nursing following the Crimean war in 1854. Her approach towards a healing environment for patients not only looked at the physical surroundings but also at the social welfare of her patients. She focused on providing patients with access to natural light, air, landscape, attention to diet, as well as a clean, sanitary environment.

The pavilion plan allowed light and fresh air to penetrate and created garden views between the building crenellations. This design emphasized function over form.

Due to its large horizontal spread and the imminent crunch of space in cities, the typology died out. It was one of the best conceived ideas of healthcare architecture.

Figure 12: Pavilion system and nightingale ward plan Source: https://issuu.com/manushisheth/docs/thesis_volume

iv) Hospital as a Machine

In the hospital boom following World War II, Florence Nightingale's Original concept of hospitals was replaced by hospitals that prioritized efficiency over human comfort and healing.

A typical hospital configuration became a deep span, multi- floor block. Building technology aided in this transformation with a new ability to create long-span structures, mechanically ventilated interior spaces, and movement of people vertically with elevators. Through time, with the progression of diagnostic and treatment facilities, this platform has gotten bigger and taller, limiting access to the aspects of natural air, light, and view. Designers and builders maximized the machine-like efficiency of hospitals without evaluating how these changes in form related to human health, stress, and comfort.

The hospitals no longer functioned as "healing centers”. They were taken over by equipment and machinery. With everything from ventilation to circulation mechanized, the only scope for architectural intervention remained in the design of smooth functionality to support the mechanics and the aesthetics. Thus, the huge chunks of mass or rather the platform and podium transformed into decorated blocks of buildings from the outside as well as inside.

Figure 13: Schematic site plan, King Edward Memorial Hospital, Mumbai -Town within a hospital Source: https://issuu.com/manushisheth/docs/thesis_volume

B) Historical background of healthcare and its transformation in India:

Although this concept has started coming back to the lime light in the recent years, it actually dates back to a thousands of years ago, having its roots deep into the Indian culture that seemed to have been faded with time.

i) Healthcare during the Vedic times in India

The history of healthcare in India can be traced to the Vedic times (5000 BCE), Atharvaveda, one of the four Vedas, is considered to have developed into Ayurveda, a traditional Indian form of holistic medicine. Ayurveda worked on the principal of, the combination of certain characteristics that comprise one’s constitution (doshas) is derived from a person’s physical, mental and emotional composition.

Ayurveda applies the Thridhosha theory of disease. Thridhosha describes three dhoshas, or biological elements, which are linked to a patient’s health: Vata (wind), Pitta (gall) Kapha (mucus). Disease is explained as a disturbance in the equilibrium of the three dhoshas, a concept similar to the theory put forward by Greek medicine.

Figure 14: Three doshas in Ayurveda Source: https://www.healthbenefitstimes.com/the-threedoshas -in-ayurveda-vata-pitta-kapha/

ii) Transition from Traditional to Modern Medicine

Historical records show that efficient hospitals were constructed in India by 600 BC. During the splendid reign of King Asoka (273-232 BC), Indian hospitals started to look like modern hospitals.

During the Mughal rule in King Akbar's period the Unani medicine system spread all the way through the greater part of India. During his period, there were a good number of government hospitals, as well as private clinics run by many physicians.

In the 17th century, the modern system of medicine in India was introduced by the British emperors and the Christian missionaries in South India.