Dialogue and design creativity in England 1850-1914

Cassell 240 pages pounds75

Let me recommend this book at once as excellently written and illustrated, based on thorough research, and of much more than historical interest to everyone - client, manager or designer - engaged in developing existing or new hospitals. Jeremy Taylor's authoritative and fascinating study of the professional milieu and its preoccupations takes the reader through the period during which the pavilion hospital was conceived, developed and, in towns and cities all over Britain, realised.

Up to the middle of the 19th century, large hospitals were few and far between, and the many small ones were unremarkable in design - having until then few specialised clinical or technical requirements to meet. The urban population explosion of the industrial revolution and the concomitant spread of poverty, sickness and contagion forced one community after another to raise funds and build hospitals. The poor were helpless, the better- off frightened.

By the late 1850s, in the face of this unprecedented situation, clients and their architects had to invent a new building type, and in doing so were responding to the powerful influences of the Sanitarian movement; the important material published in the Builder magazine under the editorship of George Godwin; and, above all, Florence Nightingale.

What makes this history fascinating is the open and serious debate among professionals about hospital design, illustrating the way ideas were continuously developing. It details the evolution of circular wards from the pavilion principles and, by the end of the 19th century, the invention, design and construction of hospitals using the plenum system of ventilation. This latter development was so radical and raised such important issues that it generated a series of key meetings at the Royal Institute of British Architects where leading doctors and architects presented, illustrated and discussed it. All this was published in full together with further lively contributions in correspondence in the institute's journal. It makes an absorbing story, the more so on account of its parallels with today's thinking and practice.

The development of ideas in hospital design continued after the end of the period covered, and has been exceptionally rapid within the NHS and internationally. It is salutary to realise, as we read this book, that we are not really any wiser than our forebears. Over 80 years before the publication of Roger Ulrich's much-quoted study showing that a view through a window may aid recovery from surgery, the architect ET Hall was convinced that 'prospect, sunlight, trees and gardens are all aids to recovery', while the architect George H Bibby considered that the monotony of the plenum-ventilated, windowless wards at the Royal Victoria Hospital, Belfast, 'cannot fail to affect the comfort and well-being of patients'.

Valuable as these reminders are, I feel that the author's very occasional flashes of hindsight are inapposite: for example, in inferring an up-to- date description of the hospital architect's task from William Alfred Pite's 1915 article; or in seeing elements of 'indeterminacy' in the 1899 plan of the Royal Victoria Hospital, Belfast; or in reading A Saxon Snell's argument against the fully air-conditioned hospital in 1904 as an early architectural plea for a low-energy, ecological approach, and in suggesting a parallel with the 1980 low-energy design for St Mary's Hospital, Isle of Wight.

However, these asides are quite unobtrusive in his thorough exposition of, to quote the book's subtitle, dialogue and design creativity. More noticeable is the neglect of the social context for hospital development. One is left pondering questions prompted by phrases such as '...buildings which may be of important effect on the health of thousands' and '...the unavoidable miseries of public wards' in his quotations from Builder editorials of 1879 and 1883. Were any of those involved in the dialogue and design ever admitted to a public hospital? Was the subject of all this high-powered debate solely about the use of 'funds contributed for the benefit of the poor?'

Many of the pavilion wards described in the book are still standing and even in use as wards, or they have been until quite recently, so that many interested readers will find out something of the origin of familiar buildings. This knowledge could inform their responses to what is taking place in hospital design today. In important ways we may envy our predecessors of the period covered. Open and public discussion at a serious professional level about healthcare building design is in the doldrums today and its coverage in major professional periodicals seems superficial, inadequate and sporadic by comparison.

Jeremy Taylor has related the history of a rich period in hospital design and of the architects who played the important parts, and his book should be widely read.


Independent architect, consultant and researcher in design for healthcare and visiting research fellow at Arts for Health, Manchester Metropolitan University.