Heritage hospitals

In his foreword Lord Farringdon, the commission's chair, explains that this survey was a response to the threat that much of England's vast stock of largely 19th-century hospitals is beginning to disappear as a result of the inevitable process of closure and redevelopment. His point is nicely confirmed by the book's coffee-table dust-jacket photograph, in glorious technicolour, of the Royal Holloway Sanatorium, now redeveloped as a private residential complex.

However, this is certainly not a coffee-table book but a very serious, cherishable work of reference. Its scope may be too ambitious, covering as it does 288 years - the passage from medieval to modern England - during which thousands of buildings were designed and erected in response to growing and changing needs in human health. Orme and Webster's book on the English hospital, 1070-1570, covers the preceding history well, so the opening date for this book seems right - the record shows little of post-medieval architectural interest until the end of the 17th century. Thereafter, things happened at a relentlessly accelerating pace with no obvious punctuation until the second world war.

Not only is the amount of history overwhelming, but so is the wide range of hospital types. Hospitals are much more diverse than textile mills or country houses - typical subjects of previous RCHME surveys. After the opening historical outline, distinct types are surveyed in separate chapters - general hospitals, cottage hospitals, workhouse infirmaries, hospitals for infectious diseases, mental hospitals and, finally, convalescent homes and hospitals.

One notes without dismay that teaching hospitals do not warrant separate consideration (though they will post-1948). On the other hand, although the commission refers to and illustrates hospitals in Paris and the Crimea there is no mention at all of the Royal Victoria Hospital in Belfast, whose original design was of such architectural importance, and only scant reference to hospitals in Scotland and Wales, these being outside England and the commission's remit.

This is one of the difficulties of such a broad subject. Ostensibly the book is about the architecture of hospitals, but architects only specialise by choice or happenstance: we still know of and respond to what is happening on the wider architectural stage, which has no geographical borders. The authors of the stylistic comments in this survey appear to assume that readers will be fully informed of their relevance in the history of architecture.

Nevertheless, I would not be without this fine book. Almost every chapter contains material about our legacy of healthcare buildings, properly placed in their contemporary social, legislative and medical settings. It is educative as well as quite fascinating.

This survey represents a priceless stock of recorded documentary, graphic and photographic information. With the 50th anniversary of the NHS, we will doubtless be given new, less-scrupulous accounts of the more recent and spectacular period of hospital design and building, ended so brutally by the 1991 NHS 'reforms'. And now that we have to accommodate healthcare in buildings made to the design of speculative development consortia under the private finance initiative, we may surely come to value not just the hospital architecture that is still standing, but also our historic tradition of making architecture that responds to and respects our healthcare needs.

Peter Scher

Independent architect and consultant, and visiting research fellow at the faculty of art and design, Manchester Metropolitan University.