Prinsengracht Hospital The Path of Memory

Research Report Graduation Studio Heritage & Design V.A.Piras (4322487) Technical University of Delft - Faculty of Architecture Chair of Heritage & Architecture TUTORS: Lidy Meijers Frank Kopmaan Index

8 Chapter One _ Introduction

9 1.1 Introduction 10 1.1 a Amsterdam & The 17th Century Expansion 12 1.1.b Problem Statement 16 1.2 Research Question 17 1.2.a Sub question 1.2.b Sub question 1.3 Methodology 18 1.3.a Aspects to be discovered 19 1.3.b Scheme of Work & Analysis

20 Chapter Two _ Systems of Health&Welfare

22 2.1 Europe 2.1.a Hospital & Nursing School 25 2.1.b Almshouses 26 2.2 In the Netherlands 27 2.2.a Buildings for Health (Amsterdam) 29 2.2 b Buildings for Welfare (Amsterdam) 31 2.3 Current Situation in systems of Health & Welfare 33 2.3.a Amsterdam 35 Chapter Three _ The Prinsengracht Hospital

37 3.1 The Canal Ring Area 40 3.2 The transformation process 52 3.3 Current Situation 54 3.4 Future Initiatives

55 Chapter Four _ Users Perception in the Hospital

56 4.1 Originally Usage - Comfort - Maintenance - Sustainability

58 4.2 Currently Usage - Comfort - Maintenance - Sustainability

60 Chapter Five _ Values of the Building

66 Chapter Six _ The Design for a Future Use

67 6.1 Introduction 6.2 Increase in life expectancy 68 6.3 Dementia & Alzheimer´s disease Outlines 69 6.4 Stages 71 6.5 Facts and Statistics

72 SECTION A _ DEMENTIA

73 PART 1_ Demented patient, caregiver and Health Services 1.1 Alzheimer´s ill and its relation with/ within Society 1.1.a Family and home care 74 1.1 b The Health Structures 75 1.2 Alzheimer´s ill and its relation with Architecture 76 1.3 Conclusions

77 PART 2_ Facing Reality 2.1 Common mistakes 2.2 Increase in problematics

78 SECTION B _ DESIGN PRINCIPLES

81 Chapter Seven _ Conclusions

83 Bibliography PREFACE

This research is the result of a graduation process, started February 2015 at the Technical University (TU) of Delft in the track of Heritage & Architecture. The mentioned specialization is set to constitute design projects for the existing built environment. The term “Heritage” ( features belonging to the culture of a particular society, such as traditions, languages or buildings, that were created in the past and still have historical importance ) is intended in a broad sense and on a wider screen from the mere building´s or complex´s monument status. Time becomes an essential member in both creation and defnition of the future project development and helps identify the value of the built heritage of the country.

The following report constitutes a complete record of the documents brought through from the research and analysis carried out on the atelier of Heritage & Design _ Amsterdam Design Studio during the academic period of 2015/16. The above-mentioned specialization deals with existing structures and their potential of adaptation in an over changing community and urban environment by setting a open design goal, which as to respond to a functional heritage. In detail, the building selected is the former Prinsengracht Hospital, part of the UNESCO World Heritage Area and inserted in the 17th century Canal Ring Area (Grachtengordel). To deal with a cultural and social heritage the understanding of the tangible and intangible elements is essential and mandatory for the constitution of a valuable intervention strategy, which will proactively tackle the needs of the users and display the potential of the preexistence. Due to this an investigative process as been carried out during the thematic research to highlight the necessities and possibilities of the building in relation to wider contexts, like the urban and district environments. Different scales and dimensions of analysis are the foundation to a knowledge acquired throughout the entire course of the survey.

Thank to this preliminary investigation, the project established keeps the infuence of the original treatment facility function but addressed new challenges faced by the current society. Subsequently, inspired by the raising life expectancy that we are observing, the diseases connected to it and based on the unique enclosed nature of the architectonical manufacture the proposal for a Dementia Village was formed.

- 6 - To improve the understanding of the complete mind method and design planning behind this report, the consecutive chapters will be - in an overview - described as it follows :

* Chapter 1 introduces the process of analysis, the questions that it brought forward and the method selected to fnd the answers to the designated queries.

* Chapter 2 spans from the motivations behind the systems of Health and Welfare to the architectonical forms that symbolized them in Europe and purposely in the Netherlands and in Amsterdam.

From this overview of the level of the City, the focus moves to the building itself, so in

* Chapter 3 the Prinsengracht Hospital is introduced; from its location to the process of modifcation that constitute it and with a fnal look of what the future holds for it in the range of initiatives.

* Chapter 4 expands the spectrum to the experience that users in time tested directly and indirectly in the complex, which helps outline the values of the building in * Chapter 5.

Then, the future design is presented and with it the designated project;

* Chapter 6, therefore, connects the past and the future in a plot where the necessities of the current society and the tangible and intangible values of the Prinsengracht Hospital are connected. This chapter is enriched by two sub-sections that give an overview frstly, on the illness and its implication in the case of architecture and space, and then of the design principles that this relation arises.

Lastly, * Chapter 7 nails down the result of the process of analysis, the discoveries and the data captured.

- 7 - Chapter One Introduction

- 8 - 1.1 _ Introduction

The Prinsengracht Hospital is a building complex set in between the Prinsengracht and the Keerkstraat in the middle of the designated UNESCO World Heritage Area. It exhibits a conglomerated of building blocks, all representative of a number of adaptations needed in time to endorse the increase number of users and their changing necessities.

The main buildings was constructed between 1857 and 1903 after the sketches of J.H. Leliman; from then on a number of modifcations and incremental improvements have taken place in a time lapse of 54 years and have altered the original volume to the level where it constitutes an unusual and dense composition in one of the most relevant areas of the city center of Amsterdam.

The edifce started its life as the location for the “Society for nursing”; at that time it was important to train nurses so that they were able to take care of the patients in their homes without extra assistance. During the 19th century, with the achievements in the feld of medical science, a lot of surgical procedures could not take place in private residences and therefore the necessity for hospital arise.

In the specifc case of the Prinsegnracht, at the beginning both functions (training and care) were maintained, but in time the initial academic purpose of the complex left space to the simple care, in the sense of hospitality and cure of ill people. With the events of the Second World War and the loss of monetary funds, the health-care system of Amsterdam was affected until the early Sixties, when it started gaining back its importance thanks to the economical boom. Despite this positive rise, hospitals set in the city center lost their usage and importance due to the migration of the majority of the inhabitants in the new peripheral districts newly designed. Same faith attended the Prinsengracht complex, that lost his care purpose and became useless.

The understanding of this specifc architectonic component and its value starts from the relation that it had/has with the city. Location and spatial conformation are the main factors to be defned, always in relation to the usage. Therefore, starting from the morphological composition of Amsterdam and the development that it underwent, it is easily understandable how the dimension of the hospital represents an unusual presence in the urban pattern.

- 9 - 1.1 a _ Amsterdam & The 17th Century Expansion

The origin of the city of Amsterdam lies in the 12th Century, when fshermen living on the banks of the Amstel river built a bridge across the waterway; the lower wooden structure of it served as a dam (currently where Dam Square is positioned), protecting the villages from frequent foating. this was the establishment of the frst natural harbor which quickly became an important trading-exchange point. The name Amsterdam derived from it as well; the settlement of the “dam in the river Amstel” - referred for the frst time in this term on a document dated October 27, 1275 -, in Dutch “Aemstelredamme”, quickly was summarized as we all know. During the Middle ages the old city center that we identify currently in the “Old Side” and “New Side” was found. This represents an area compact enough to be traverse easily on foot, in a time lapse of half an hour, a core separated by Damrak ( the path between Dam Square and the Central Station) and Rokin (the path between Dam Square and Muntplein), a trajectory used to form the fnal stretch of the Amstel River. With time Damrak and Rokin, which used to be canals became flled and paved. The next important step in the history of the city started with the Dutch Golden Age, a period where trade, art, history, military power and science of the Netherlands became the world´s most acclaimed.

The canal area - setting to the edifce - is a relevant example of the advanced level in mathematical and engineering knowledge achieved by Amsterdam in that period; at the same time, it showcases the high level gained on architectural practice and better known now-days as Dutch Classicism or Dutch Renaissance. The ground plan conformation of it - differently from previous city developments - does not follow the geography or the morphology of pre-existing landscape but was accomplished as a geometrical designated pattern between the long canals and orthogonal parcels of land. Similarly to other city expansions of the same period it was based on theoretical foundations on architectural design and urban planning that characterized both the Seventeenth and Eighteenth centuries and found their origin on earlier architectural treatises.

During the 17th Century, Amsterdam was a raising trading city, politically and - with no doubt - commercially active within the European panorama; this made the ruling bourgeois, merchants and patrician families eager to display its prestige. In this period conventions concerning dimension and modules, harmony, social and spatial hierarchies and composition are the base to the structure and design of the uprising

- 10 - city of Amsterdam; therefore UNESCO defned the urban growth site of that time (n. “Grachtengordel”) as a World Heritage Area because it represents an outstanding example of “ (..) the combined works of nature and man “ with an immense “ (..) universal value from the historical, aesthetic, ethnological or anthropological point of view”.

The composition of the Grachtengordel showcased new examples of town planning and a constructive typology that modifed permanently the pattern of the city. Due to the rapid economic development and the related population growth a number of canals were constituted: the Singel, the Herengracht, the Keizergracht and the Prinsengracht. The land between the canals was divided in plots, whose dimension was determined by municipal “Keuren” (n. “laws”) with a frontage of thirty feet and depth of two hundred; each canal has evidence of architectonical hierarchy following the combination or not of plots t create density; along the Herengracht mansions and double houses (two plots) can be found and decrease exponentially in narrower houses and businesses - like in the Prinsengracht -. Due to the affordability of the land plots, throughout the Canal Ring area a variety of perspectives and dimensions of building blocks create an over-changing and dynamic perception of the area.

The Amsterdam canal area (UNESCO World Heritage Site)

- 11 - 1.1 b _ Problem Statement

The Prinsengracht Hospital has undergone many changes and additions since its frst establishment. This modifcations have affected both the building in itself and the relationship that it ties with the surrounding edifces, the district and the urban pattern. Those relations rise a number of challenges for the redevelopment of the building on a variety of levels.

Generally, the ensemble recalls the courtyard typology used in healing and welfare designs due to the inner garden, but some parts do not seem to fulfll a specifc ideology. The original typology has been affected by the modifcations and that leaves a number of unclear spaces and connections.

Exterior

The additions, especially the latest ones, have affected the facades outlook, the geometric organization and the alignment of the parts. In particular on the Prinsengracht the 1950s extension of the representative main side façade totally rejects a stylistic uniformity to pursue its own presence on the canal: materials, window frames, heights and tones defer - even if sometimes just slightly - throughout this side. The only clear element seems to be the original entrance, now positioned at the far right of the building. The façade facing the garden seems to lack logic: style, position and material of the architectonical elements are totally unrelated features. The façade on Kerkstraat instead, is perfectly integrated in the general appearance of the street thanks to the dimension and detailing typical of the small narrow plots of the warehouses.

Facade conjunction - Prinsengracht

- 12 - Flimsy height - Prinsengracht

The monumental entrance - Prinsengracht

Facade Outlook - Kerkstraat 122-126

- 13 - Flimsy Windows - Prinsengracht (facing the garden)

Interior

On the other hand, the level of the interior highlights the fault and mistakes pursued during the modifcations and adaptations of the building in time. The space is defned by a number of dark hallways and unexpected changes of level within the same routes create disorientation in the paths and confusion in the experience of the space. Materials are highly defning and outdated; valuable building elements clash constantly with functional additions, unused at the moment; the integration of low ceilings to hide the technological systems has affected the views and outside perception by cutting the window frames to the eye spectrum. The visual connections within the inner garden - strong point of the complex and typical element of the area (green belt internal system) - are compromised and tarnished by the addition of walls and volumes inside and outside the original structure. In the sphere of instinctive perception, from the inside the building feels dull and unclear, overloaded with an absurd number of information and experiences which are unable to shine through clearly. The users get lost and the valuable parts of the complex pass unnoticed.

- 14 - Dark hallways - Lack of daylight and narrow spaces and height.

Intense height changes between foors.

Modifed window views.

- 15 - 1.2 _ Research Question

The subject of this research can be synthetized in this research question:

“ What are the architectural aspects that qualify buildings meant for Health & Welfare in time and which, in the Prinsengracht hospital can be qualifed as unique and valuable for a future employment? ”

The historical process of the building shows which are the elements that defned the “courtyard” typology, used in the majority of cases as the architectural form for care facilities and residences.

If we look at the urban districts composition of the center of Amsterdam edifces with similar uses (meant to host hill patients or elderly people) can be found, especially set in the same area of the study case: the Grachtengordel. Thanks to the broader spectrum of those buildings in mind an easier understanding of the Prinsengracht Hospital and is potential is available. An important thing to keep in mind is that not always the subject of aesthetic, well-being and health - strictly related to the users - is kept as the main focus in this complexes during modifcations. Sometimes, due to major economical or social infuences, the edifce is adapted in an uneven form which does not take care of the aim, requirements and ambition of the initial design and therefore creates a confict.

In the case of the Prinsengracht Hospital the modifcations in time struggled to maintain an healthy environment and decreased the chances of it being functional for other health related usages on the longer run. The edifce, thought to constitute an healing environment, has evolved its characteristic and typology to an undefned level due to a number of unrelated modifcations over time derived from the demands of different societies.

Health and welfare complexes are usually subjected to the era in which they are set and the social organization of that period. The lack of adaptability in the structure leads in the majority of cases to minimum exploit of the spaces. So the research will try to clarify to which limit an healthy environment can be kept as valuable asset for society in different eras and what are the elements in that specifc typology that can be requalifed and/or modifed without changing the functionality and quality of it.

- 16 - 1.2 a _ Sub question

What are the typologies that represent Health & Care centers in Europe and in the Netherlands?

1.2 b _ Sub question

What is the aim of this combined system and what is the current approach to Academic Medical Centers?

1.3 _ Methodology

The aim of this research is to defne, describe and illustrate the main adaptations of the Prinsengracht Hospital in relation to the core, social-sanitary motives hidden behind the design decision. The result should fnd what are the valuable tangible and intangible qualities of the building in order to accomplish a valuable design.

To do so four main categories are used to organize and order the fndings and observations; each concept works on a dual scale of investigation: architectural and technological.

1. USAGE :

It includes all the adaptations caused by the change in use, which had to be re- qualifed to support a certain utilization and its related demands.

2. COMFORT :

Those adaptations meant to provide a pleasurable ease, well-being and contentment. Majorly all the inner interventions that focus on making the built environment more comfortable while improving general health and safety conditions.

- 17 - 3. MAINTENANCE :

The range of study here includes all the alterations thought to reduce the demand of maintenance and improve the capability of being sustainable. Often replacing some element make the overall more durable, sometimes it defeats the general functionality of the complex.

4. SUSTAINABILITY :

This last category consists of the adjustments, whose goal is improving the capacity of the building to live without effecting on the long run the environment.

1.3.a Aspects to be discovered

The relation that the building ties with the city and, in particular, its function are the main actors in this research. The motivation behind this building was initially welfare and well being, strickly related to a population fairly rich and needy of some sort of home care. The frst function was a nursing school, just partially a clininc space; in time, the needs of the society shifted, the level of wealth in it decreased following the industrial period and beggining of the 20th century and the building had to modify himself to a newer mixed usage and, from then on, to a hospital. This last one is a typical form of health service and shows how this building has not been constantly monothematic but kept a number of felds into his comformation.

Therefore, the systems of Health and Welfare can be useful to delineate a number of future possibilities for the new design of the Prinsengracht Hospital. Due to the fact that those systems are constituted on the necessities of the current society in which they are set and thought in strickt relation to the users, the aim of this research is to fnalize a number of criteria that could be valued as relevent in those typilogies no matter the time changes; at the same time, which of those criteria can be fnd in the Prinsengracht hospital has to precisated.

All discoveries then will be related with our society needs to fnalized a direction of use and will be the main foundation of the design. Every criteria will be transformed into an architectonical feature based on the social needs of the users selected.

- 18 - 1.3.b Scheme of Work & Analysis

Health&Welfare Determinate the tangible and intangible values of the building upon P the analysis of the city and its heritage. 1. CITY of AMSTERDAM

Draw a possible usage upon the P 2 undertsanding of the history of the . PR building and its potential. IN S E N

G R

A

C P H Defne the intervantion 3

T . necessary and explicate

FUTURE

all the design aims.

H

DESIGN

O

Preliminary Design.

S

P

I

T

A

P

L

4

.

Narrow down the elements

useful to the reconstruction of

the identity of the building in

relation to the new design.

P

CURRENT 5 . SOCIETY Finalized Design.

Users Necessities

- 19 - Chapter Two Health&Welfare

- 20 -

This chapter will briefy try to narrow down the various typologies of Health and Welfare system both in the broader frame of Europe then in the minor one of the Netherlands and Amsterdam.

- 21 - 2.1 _ Europe

As history of design in the sphere of health and care shows, the composition of spaces in relation to a creation of an health environment requires a specifc attention to the sequence and volumetric extension of the individual and compacted units. At the same time the intangible feeling of space has to be investigated to achieve a valuable design. An overlook on the historical development of health buildings demonstrates how the investigation on the ideal environment for different symptoms has increasingly arise in the in the architectural feld with the acquisition of knowledge that different illnesses require varied approaches.

In European culture the range of health and welfare buildings comprehends all the shelters for the sick and aged. Those, depending on their date of establishment come in a variety of shapes and sizes, from monastic infrmaries, to almshouses throughout sanatoriums and military hospitals; the cases are numerous and vary on the necessity of the society at the period of establishment. Medical history is characterized by long periods of steady fow and drastic changes (major discoveries and revolutions) that, in a sort of repeating pattern, characterize the way hospitals work.

2.1 a _ Hospitals & Nursing School

Hospitals are buildings used for the care and cure of ill and injured people and are a typology existing from decades, always changing and defning itself during time. Even if examples of hospitals can be found from the ancient Greece on, the real beginning of the typology can be set during the 15th century. One of the most famous examples of that period, designed after the Renaissance principles is the Ospedale Maggiore in Milan of Filarete (1456); it is a symmetrical block with a large central courtyard and four smaller ones on the sides. This building was meant to refect the separation between classes with its symmetric organization.

Ospedale Maggiore (Milano - Italy, 1456) by Antonio Averulino (Filarete)

- 22 - Regardless, just in the 1830s general design principles started to be utilized. During the nineteenth century, the majority of hospitals recorded occupied private residences. Specifc medical functions tended to be contained within a single block, although parts such as the kitchen and isolation wards were gradually removed to separate buildings. None of the hospitals of this type function as a place for medical science and research; the progress was steady but it was not happening inside of this structures. The most popular system was the “pavilion plan”, which resulted ideal for ventilation and lighting during the years were the “Miasmic” theory (disease were thought to pass through air rather like a cloud) was still prevailing.

A raising awareness on the importance of heating and ventilation meant a more detailed design of the rooms, windows and the green areas. In this period, hospitals meant places for recovery of poor ill people while rich ones were taking care home by private nurses; therefore at the same time, another important edifce in this years is the Nursing School. The Second half of the 19th century saw a radical improvement in the medical feld with the discovery that infections were passed by direct contact with the ill patients and the decision of constitute a series of specialized facilities based on different diseases. The design of hospitals changed radically and the majority of the nurses school were integrated with the medical facility itself. Spatially, the different areas are connected by corridors and in between courtyards are always positioned.

The majority of hospitals presents an enclosed typology with rooms facing the inner courtyards and a representative façade with offces and other utilities spaces behind it. At the beginning of the 20th century, the pavilion plan is supersede by the block hospital, a more compact typology that avoided distance between facilities and improved effciency of the complex and its users (direct/indirect), like a gear.

Ospedale S.Giovanni Calibita (Rome - Italy, 1575)

- 23 - After the Second World War the community requested a reconstruction of society; segregation was seen as one of the causes of the confict and to avoid the same path a systematical method, based on rational and scientifc principles became the tools to a renewed society. Light, air and space became words of slogan for the new constructions for health and welfare; nature, therefore, requalifes itself as a fundamental element of this spaces, that does not present itself as a inner courtyard but a overall landscape which improved the quality of the rooms. Mostly, starting from the central core (entrance) a series of hallways constitute the spine of this complexes and different usage rooms are set on the sides in relation to the orientation. A renewed attention is applied to the patient and the spaces are defned in minute detail, from the geometry of the space to the detail of the door handle. An example is the Sanatorium of Paimio (Finland) were particular attention was given to the use of color and materials, dimensions and relations, to make sure that the users conditions could be improved.

Sanatorium (Paimio - Finland, 1932) by Alvar Aalto

Project for an Hospital (Venice - Italy, 1964) by Le Corbusier

- 24 - 2.1 b_ Almshouses

ALMHOUSE noun, plural “Almshouses” (ahmz-hou-ziz) Chiefy British

“a house endowed by private charity for the reception and support of the aged or infrm poor.”

Almshouses are charitable housing complexes provided to enable people (typically elderly people unable to work and earn enough to pay rent) to permit them to live in a particular community. They are often targeted at the poor, at those who lost previous employments or their widows and are generally maintained by a charity or the trustees of a bequest. Almshouses have been built since the 10th century and throughout up to the present day, starting in England and gradually imposing in other countries worldwide. Other relevant examples in Europe can be found in Belgium and the Netherlands.

The example of England is majorly medieval; those were established with the aim of benefting the soul of the founder of their family, and for this reason they usually incorporate a chapel. As a result, most were regarded as charities and were dissolved during the Reformation, under the act of 1547.

There is an important delineation between almshouses and other forms of sheltered housing because in this typology residents have no security of tenure, being solely dependent upon the goodwill of the administering trustees. One of the oldest and still existing ones is St. Cross in Winchester (England) - beginning of the 12th century - that worked both as a hospital and as an almshouse for noble people.

Ewelme Hospital (Oxfordshire - England, 1871)

- 25 - 2.2 _ In the Netherlands

The historical hospitals in Amsterdam present usually two typologies: the monastery or the pavilion. The frst one has a number of edifces (chapel, canteen, rooms) organized around a courtyard. An example can be found in the original plan of the Binnengasthuisterrein, which was readapted from an original nunnery. The second it is organized around a central core of services with an hall and creates the connection with a number of secondary blocks, were usually rooms are organized; garden is usually at he back of the complex. As understandable the latter is way more schematic and defned but does not relate outside and inside as an overall space like the monastery. In both the organization is thought accurately and the movements are partially thought and precisely defned throughout the volumes.

In the case of the Almshouses (Hofjes), as representative buildings for welfare, there is always a precise number of recurring architectural aspects; the majority is composed by a number of dwellings organized around a courtyard or a garden with an entrance defned through a passage or a covered alley. The movements throughout the complex usually are defned with detailing and organization of the core courtyard and see the presence of a main path that surrounds the dwellings and gives access to them. The green is an important feature of this typology because gives defnition and improves the general condition of living of the users.

Like the majority of the houses in the Grachtengordel, the inner garden has a value that overtakes the spatial organization of the houses and rooms; therefore the outside space and its distinction in comparison to the interiors of the complex is a fundamental element to defne the typology. The users in this case were treated as equal and therefore the space results intact and repetitive in dimension and organization in the majority of cases. Most of the hofjes for elderly or single people (generally women) were built in the Jordaan - built during the Third Expansion in the 17th century - and in Weteringbuurt/Noortse Bos (Fourth Expansion) due to the lower property costs. Some were established along the canals within the Canal Ring and still lay there nowdays. Some are scarcely visible as such from the main façade such as Claes Reiniershofjes (“Liefde is´t fondament”), Keizersgracht 332-346, Zon´s hofje (“Het Nieuwe hofje”), Prinsengracht 159-171 (“Nieuwe Suykerhofje”) and Prinsengracht 385-393.

- 26 - 2.2 a _ Buildings for Health (Amsterdam)

Wilhelmina Gasthuis

The Wilhelmina Hospital (WG) is a former hospital in Amsterdam. It was established on May 28, 1891 when Queen Wilhelmina offcially inaugurated the site positioning the foundation stone. It was meant to be an hospital in a park setting and it was close to the former infrmary and the Buitengasthuis, located outside the city walls, south west of the canal.

Through time the hospital was built during the development of the Oud West. In 1925 the entire character of the complex was changed due to the implementation of the activities in that site; new pavilions were erected where various clinics were housed. The WG was for decades a teaching hospital at the University of Amsterdam, along with the older and more central Binnengasthuis. Both hospitals were merged in the 1980s and moved to the fnal AMC in Holendrecht (Amsterdam Southeast). Since 1981 the WG was moved, partially, to a new site.

Inner gardens (Wilhelmina Gasthuis, 1893)

Entrance (Wilhelmina Hospital, 2003)

- 27 - Binnengasthuisterrein

The Binnengasthuisterrein was as well a former hospital in the middle of the city, in the medieval part. It was established in the 16th century as the new nunnery on the Amstel and followed the curve that the river made here. It is an enclosed, majorly inward-looking group of buildings and gardens, which stands alone surrounded by urban structures. it was originally a monastery complex, which, at the end of the 19th century and beginning of the 20th century, was transformed into a city hospital and, in the 1980s was altered once again to become part of the university of Amsterdam (UVA).

Aerial view (Binnengasthuisterrein, 2004)

Sketch original plan (Binnengasthuisterrein)

- 28 - 2.2 b _ Buildings for Welfare (Amsterdam)

In the Netherlands almshouses were positioned around a central courtyard and created the typology of the Hofjes. Usually it was built in a U-shape with a yard or a garden as core of the complex and a gated entrance. The typology existed since the Middle Ages and provided housing for elderly people (mostly women). They were privately funded and served as a form of social security; the majority was built around the centuries XV and XVIII thanks to the help of the church as an institution or to the economical support of rich people.

Usually is for poor classes, elderly people or sick ones. They take the form of gated communities formed by small dwellings clustered around a central courtyard or garden (originally often used to dry the washing, now usually a shared garden). As a rule, they are concealed behind other buildings in a street or alley and can only be entered from the street through a door or getaway. The name or coat of arms of the founder is sometimes displayed above the entrance. Most of them permit access to tourist, who have to respect silence and privacy of the residents. The majority of them are still in use.

There are three kinds of traditional Hofjes based on the time of the construction and usage:

1 _ Beguinages (Begijnhofjes) Founded from the 12th to the 14th century for women who wanted to live in religious community primarily to look after the sick. The women - called “beguins” - were not nuns.

2 _ Charity Hofjes or Almshouses (Liefdadigheidshofjes) Primarily founded in the 17th and 18th century and were built around a square courtyard. The founder was almost always a rich person who offered free housing to poor older women.

3 _ Hofjes for the lower working class (Arbeidershofjes) Built in the 19th century behind large city houses, could be entered through a gate positioned between two city houses. Those were rented out to lower working class people at high prices, since making a proft was very important. In the 1970s many of these hofjes disappeared due to the city renovation.

- 29 - To be eligible to live in one of this facilities four criteria had to be met, nameable as it follows:

SEX: almost all hofjes were founded for women, as they could be relied on to keep a household running.

RELIGION: many were founded for people of the same faith or by church communities.

AGE: from the 17th century a minimum age was often used; ffty years was common.

SOCIAL-ECONOMIC BACKGROUND: they were targeted for poorer people.

Sketch original organization Begijhofje (Amsterdam - NL, 1346)

Sint Andrienshofje (Amsterdam - NL, 1616)

- 30 - 2.3 _ Current situation in systems of Health & Welfare

Right now most health care takes places outside the hospitals, for most people they have come to symbolized the health care system. The fact that our society worldwide shows an inconsistency economically and technologically when it comes to health and care refects in a variety of systems. A “hospital” may have only a handful of beds, a staff with only basic skills and no infrastructure – even no electricity or running water in some parts of the former Soviet Union. Or it may have hundreds of beds, a highly trained staff and sophisticated equipment, operating theatres and laboratories in a Northern European country.

The confguration of hospitals is driven largely by technology, and their other roles developed with little conscious thought. Emergency departments became a common, and frequently chaotic, entry point to the hospital, even though those passing through them often had very diverse needs and fnal destinations. * Structure are bigger and broader and therefore positioned outside living districts, usually occupying an entire block or a number of them. The courtyard typology is still kept as the main organizational system and green is reaching more and more importance in the design of this buildings. Visual connections, readability and remarkable experience of the space are the main requirements that current projects try to achieve. Same fundamentals are used for Welfare systems such as care houses for old people or living facilities for people with disabilities. Creating a valuable element in time, outside from all the stylistics restrictions becomes the aim in this feld and connects architecture with sociology and human rights.

The characteristics of this typology, can be relevant in a future design of the area, thanks to a series of elements of connection between those and the current hospital shape.

Health Clininc Ruukki (Kansantie - Finland, 2014) by Alt Architects + Karsikas

- 31 - Center for Visually Impaired (Mexico City, 2001) by Taller de Arquitectura Rocha

Alzheimer residence (Coueron - France, 2014) by Mabire Reich

CAP-CSM SARRIÁ (Barcellona - Spain, 2013) by Sulkin Marchissio

- 32 - 2.3 a _ Amsterdam

In the city of Amsterdam hospitals have been decentralized following the citizens spread from the center to the peripheries For what regards the systems of Welfare, many hofjes have been renovated and are often inhabited by young people. Currently inside the city center there are 47, more than in any other city in the Netherlands. New living or caring facilities for elderly or ill are positioned outside the original city limit, usually confned in vast green areas separated from the rest of the community. The one positioned in urban districts are usually smaller facilities, with glass facades to connect to the outside. Majority are enclosed, anonymous and not well organized.

De Hogeweyk (Weesp - NL, 2009) by Molenaar

Eltheto Housing and Healthcare Complex (Rijseen - NL, 2014) by 2by4-architects

- 33 - Jeroen Bosch Hospital (Dordrecht - NL, 2010) by EGM architecten

Rehabilitation Centre Groot Klimmendaal (NL, 2011) by Koen van Velsen

Institute Verbeeten (‘s-Hertogenbosch - NL, 2010 ) by EGM architecten

- 34 - Chapter Three Prinsengracht Hospital

- 35 -

This chapter will introduce the case study building; from its position in the city of Amsterdam to the process that it underwent to reach the current situation and the future plans for its usage.

- 36 - 3.1 _ The Canal Ring Area

The Prinsengracht hospital is a relevant feature of the canal ring area. The latter since 2010 is protected by UNESCO for its outstanding technological, urban and architectonic value. If we pin point on the area the historical buildings by typology the only one with a “health” function hat still remains untouched or underqualifed is the Prinsengracht Hospital. On the other hand there are numerous examples of complexes for welfare, or more precisely, hofjes; those constitute a defning element in the conformation of the area, especially in the second expansion of the Grachtengordel, where the density increases clearly. At the same time those have lost their original identity and are now majorly used as residences for young people.

“ The property consisting of the ´Seventeenth century canal ring area of Amsterdam within Singelgracht´, including on the west side of the river Amstel the canls Singel, Korte Prinsengracht, Herengracht, Keizersgracht and Prinsengracht, and the transverse canals Brouwersgracht, Blauwburgwal, Leliegracht and Reguliersgracht and to the east to the Amstel Nieuwe Herengracht, Nieuwe Keizergracht and Nieuwe Prinsengracht, was built in two phases of expansion (Third Expansion (1609/10-1620)), from the IJ to Leidsegracht, and the Fourth Expansion (1656-1668), from Leidsegracht to the Eastern Islands, Kattenburg, Wittenburg and Oostenburg, land developed in that period. ”

(Kingdom of the Netherlands _ 2009 NOMINATION DOCUMENT pg.29)

Aerial view (Amsterdam - NL, 2013)

- 37 - “ Of the 200-odd surviving hofjes in the Netherlands, 47 are in Amsterdam - more than in any other city. They were once 51. some lie along the canals of the “canal ring”. Most were built in the quarter known as the Jordaan, since land was cheaper there. As the Plantage district was not developed during the Fourth expansion, this was also a relatively cheap place to built, and several hofjes were found there. Today, these former almshouses retain little if any of their original function. Renovations generally lead to two of the tiny dwellings being combined to make one larger one, They are now primarily used as accommodation for students and other young people, as well as artists. ”

(Kingdom of the Netherlands _ 2009 NOMINATION DOCUMENT pg.270)

Map of the hofjes (Amsterdam - NL, 1653).

- 38 - The area of the Grachtegordel is renown to constitute a green belt in the middle of the city and its quality is protected by laws and regulations in force. This feature is a valuable element, both in the dimension of the city that in the dimension of the building itself and constitutes a quality to enhance in a future design for the Prinsengracht Hospital.

“ There are 27 areas with private gardens locate within the building blocks of the ´Seventeenth- century ring of canals´ which are known as ´regulated blocks´ (keurblokken), lying between the Herengracht and Keizergracht canals and the Keizersgracht canal and the Keerkstraat (see appendix, map “regulated blocks”).

Legal provisions frst issued in the seventeenth century prohibited any building without a permit in these regulated blocks, with the exception of a summerhouse. Seventeen of the regulated blocks are located at the back of the houses along the Herengracht canal between the Brouwersgracht canal and the Amstel; six are located on the even-numbered side of the Keizergracht canal between the Leidsegracht canal and the Amstel.

If a tree-felling permit is requested for exceptional trees or trees located in the gardens on the 27 regulated blocks (subject to a regulation passed in 1615), the procedure is more stringent than normal. The permit may be subjected to certain conditions, for example the obligation to plant a replacement tree. ”

(Kingdom of the Netherlands _ 2009 NOMINATION DOCUMENT pg.191)

Aerial view of the green streep (Amsterdam - NL, 2014).

- 39 - 3.2 _ The transformation process

The establishment of the former Prinsengracht hospital begins in the mid 19th century when a fre destroys a series of warehouses and canal houses and a new open plot is left available. The Verenijing, a collective which aimed to take care of people who could not afford it themselves took charge of the area and began the construction. The initial design was made by J.H. Leliman and was completed in 1857 as a school for nurses and a collective center for sick people unavailable to be taken care privately in their residences.

The building is precisely symmetrical, with a C shaped mass that surrounds a back garden and a monumental façade defnes its presence on the canal. Internally, the functions are precisely divided between the three different foors: children, patients and nurses. The collective spaces are set in the center of the complex and as a gathering core on the ground foor on the west wing the utility rooms are set. Not long before the frst establishment (1872) the hospital needed to accommodate a growing request and therefore was expanded throughout the west wing up until the Kerkstraat.

In 1902 the original block acquired a all new foor as well as other expansions on the Kerkstraat side. The number of beds was increased from 14 to 55 and therefore even the number of nurses hosted doubled. The organization between the users of the complex changed: not by levels but by block; for example the nurses were hosted of the Kerkstraat and the patients in the former Prinsengracht side block and the other expansions. Every healing room was facing the inner garden and orientated towards the sun for the majority of the day. A surgery room was added on the ground foor and in the west wing of the former edifce because medicine and surgery started to take more and more importance and they were being practiced more often during those years. Even if the extension changed the form of the building drastically, it kept almost the same C shape but with a different orientation which did not arm the garden but helped keeping the quality and importance of it as a green retreat in the middle of the city.

- 40 - The majority of the changes that the building underwent were related to the growing importance of the users and their needs. There is a totally different approach, that more and more tries to take distance from classicism and segregation and values the user and its necessities as primary.

1829 1857 1872

1882 1889 1890

1902 1923 1957

- 41 - The Prinsengracht hospital tried to keep up to move with the necessities of the growing community of the inner city and expanded with another block at the end of 1950s. Anyhow the reposition of the residences outside the historical center of Amsterdam diminished its use and importance and brought the complex to abandon. In the following lines a more detailed explanation of all the modifcations is given.

THE 1857 CONSTRUCTION

The building for the “Association of nursing” was designed by the architect J.H. Leliman. When it opened in 1857 it hosted fourteen patients, divided in three classes and a staff of twelve nursing sisters and fve students as full time residents. On the board of the association, dated April 1858, this report can be found:

“ Except from the cellars, one which is meant for sulfur and the other for baths, the building has three main foors and a huge attic. On the frst and bottom foor one fnds upon entering to judge side, except a doctor’s offce, the living and working quarters of the Director; a large garden located in the room, which serves as a companion room and dining room for the foster sisters (and anywhere in the home devotions, the lessons of nursing and board meetings are held); and rooms for children’s hospital. On the left, you see, except the janitor room, the living and sleeping quarters of the under-Director, one laundry room, one bathroom for the foster sisters and the kitchen, with a few side rooms. The second foor contains three classes; the larger and smaller for inclusion of the patient plus an ample and very neat party room with library and two bathrooms. The third foor is entirely intended for stay for the foster sisters. There is one distinct sick room and the sleeping quarters of the sisters are divided so that most, already older in order of time of accession, have a separate room. Two heating and ventilation devices, in different areas work and can be fred in the lower foor, bring even heat and fresh air through the building height, both in the rooms as in the corridors. Energy survival is entirely lit by gas and equipped due to water, and the smooth movement of the internal service is assured by internal stairs. At the rear edges of the building with two wings there is the garden out. The garden itself, which was just planted and for Amsterdam is quite large, gives with a large plant the pleasant opportunity to patients to refresh themselves in the open air without fatigue. ”

- 42 - The design of Leliman for the hospital was revolutionary because it was one of the frst modern hospitals in the Netherlands. The architecture is traditional and differs clearly from the earlier draft of Leliman for the “Arti et Amicitiae”.

The brick façade is strongly divided horizontally by heavy water tables; the cornice adjacent to the roof is particularly heavy, remarkably of this is the pediment above the middle rising of the facade. The cornice in this point is bent in an unusual way but for the majority it simply extends horizontally, for this reasons there is a main frame used frequently: a meandering line placed under the cornice of the pediment. This meandering line comes from the Romanesque architecture and is ornate with or as a circular arc. These arches are found mainly in France; it is possible that Leliman has observed this detail during his study period. From this period gradually more and more elements of the Romanesque architecture are used back. The applied details point to a very free interpretation of classicism. The arched windows are of red and yellow bricks, this blending of colors will be used until the early 20th century. The windows have both the front and rear three traditional format with a then inventive system of blinds. Both designed as sliding windows.

The whole building stands on a stone plinth where openings with windows are made, providing light to the basement. The structure of the plans and the building line are as symmetrical as possible. The layout of the maps is functional and uncluttered; after entering through the entrance the central staircase and access to the garden was visible. The central garden design was the hospital symmetrical design. The compulsive symmetry is on the hallways of the ground and frst foor indicated by wooden frames. On the side wings arc-shaped frames are used. In this building Leliman searches for a personal style based on existing profles and stylistic elements.

Plan of the Nurse School (Amsterdam - NL, 1857) by J.H.Leliman

- 43 - Facade on Prinsengracht (Amsterdam - NL, 1857) by J.H.Leliman

THE EXPANSION 1870-1890

Thirteen years after the frst establishment the association started buying various houses on the Kerkstraat, right behind the main building. In this way the plot of the hospital could ft any future expansions. The lots acquired were from n. 110 to n. 128. The architect Gerlof Bartholomeus Salm made a number of designs for this side. Some examples can be:

Building in the Kerkstraat (Amsterdam - NL, 1903).

- 44 - (1872) Kerkstraat n. 124

This building hosts the main residences for the nurses and consisted consisted of a dining room, 24 little rooms and a kitchen, which was directly connected to the main building. Relevant feature: there was a “vacuum device” for infectious diseases. It was the frst design made by the architect, frst of a series. The three foors building with attic is simple and practical; the facade on the street is defned by horizontal division made by a stone water battle with detailed executed masonry below. Next to the roof structure there is a wooden strip with a number of stylistic details. The bottom level has round arched windows with sliding elements hidden behind the main façade; just the entrance door is placed in an hard stone framework.

Plan n. 124 (Amsterdam - NL, 1872) by G.B.Salm

Facade (Amsterdam - NL, 2015) taken by V.A.Piras.

- 45 - (1882) Kerkstraat n. 126

Ten years after the rebuilding of Kerkstraat 124, another design of Salm takes place: the extension and renovation of the street number 126. This is the narrowest of the buildings in this block; compared to the previous design is more richly ornamented. Always a three level building with attic presents a number of details in the brick work; between the door the windows is arranged in a horizontally framed masonry pattern. Stones are carried out in a yellow, black and red color. The attic hatch is in a stepped masonry frame recessed in the wall. Wooden sash windows have on the underside a stone sill. What is striking is that this property is accessible only through the garden of the hospital at the frst foor. Striking in the interior was the detailed wooden spiral staircase which divided the building into two with nurses rooms on both.

Plans and section n.126 (Amsterdam - NL, 1882) by G.B.Salm

Detail of the roof and windows (Amsterdam - NL, 1882) by G.B.Salm.

- 46 - (1889) Kerkstraat n. 122

The hospital kept growing so a new building was added; this time the architect is unknown. In it fve sister rooms are hosted with a dining room and a dressing room. In the basement there are the pantry, kitchen and workshop. Just like the n. 126 there is no access to this property through the street. In this way they could effectively monitor the sisters and visitors (and possible boyfriends) needed frst to past the doorman. The façade is similar to one of the adjacent building n. 124; both show the strip of the water table above the frst foor; also, the windows are placed in a recessed frame and on the ground foor are arched. The difference with the neighboring façade is that these are double windows and then the building is equipped with a fat roof, unlike the other sister houses, and in the middle the third foor is split in two by an outdoor area. This new building will be demolished again in 1902, presumably only retain a portion of the façade.

Plans n.122 (Amsterdam - NL, 1889).

Sections n. 122 (Amsterdam - NL, 1889).

- 47 - (1890) Prinsengracht n. 767

The lack of space has forced the hospital to expand. The warehouse Dionysius, purchased in 1877, in 1890 will be reworked as a new area of the hospital. On the ground and second foor a number of sister chambers. The frst foor provides accommodation for a number of third-class hospital rooms. This construction is accessible from the main building of the ‘union’. The new building on the Prinsengracht, whose architect is unknown, connected the facade to a large extent on the design of Leliman. The characteristic water tables are also present like the round arch windows, only the distance between these windows is less among themselves. What is different in the facade is the layout of the bottom foor. The left door provides access for the nurses, because the ground foor is higher you frst go up the stairs. The right side door opens into the courtyard, which is similar to the street level. Between the two doors there is a wider window and behind, the living room.

Plans Prinsengracht n.767 (Amsterdam - NL, 1890).

Facade with Prinsengracht n.767 (Amsterdam - NL, 2015) taken by V.A.Piras.

- 48 - THE RENOVATION OF 1902

In 1902 the building was transformed into an effective hospital and the new block on the left side was designed. The purpose of this renovation is to create a well functioning, transparent and regularly decorated building. Posthumus Meyjes sr. produced the design for the new building in three parts. A portion of the design from 1882 is also demolished. The courtyard of the hospital is magnifed considerably. The left side of the original symmetrical design of Leliman disappeared for a large part and for this came a new construction part in the place. Because of the conversion, the number of beds has increased from 14 to 55 and there may be 700 patients are treated, instead of 250 per year. The number of sisters has increased from 23 to 45.

The new wing connected the Keerkstraat side with two foors; the frst foor faces the garden with sick rooms with balconies; those are accessible through double, patio doors from inside the rooms. The new designed garden gives nearly a twice as large courtyard and the design responds to its presence and therefore the design is responsible for the existing courtyard. On the left side, a new stairway protrudes up to the third foor. This staircase is richly detailed with tiling and a wrought-iron balustrade and covered with a glass skylight. On Kerkstraat the façade of the n. 122 kept a lot of similarities with the previous one demolished.

Map of the changes (Amsterdam - NL, 1902) by P. Meijers.

- 49 - New Plans (Amsterdam - NL, 1902) by P. Meijers.

THE EXPANSION IN 1923

On the third foor of the main building on the Prinsengracht, the new surgery department were constructed to replace the old operating room on the ground foor. The new surgery department consisted of a large aseptic operating room with a separate laundry and sterilizing chamber, situated above the kitchen wing. The new septic operating room is higher than the existing buildings and on the façade with the large light window also extends considerably beyond the existing cornice. This part is clearly recognizable in the façade of the Prinsengracht Hospital; the operating room had a large roof and is also provided a washing chamber in which tools could be sterilized. In addition to the actual operation department, there is a room for the surgeons, a dressing room for the sisters, the elevator shaft, toilets and fnally a urological department, consisting of an examination room, treatment room and adjoining laundry and dressing room. As the plan shows on the other side of the third foor across from the surgery department there were nurses rooms. These two were divided, each with their own hallway and separated by a wall.

Plan of the expansion (Amsterdam - NL, 1923).

- 50 - THE EXTENSION OF 1957

On the Prinsengracht, at the end of the 1950s, two canal houses (Prinsengracht 763 and 765) left space to a modern extension. In the new building a maternity ward and X-ray therapy were included. The kitchens were originally housed also be moved here. This addition was intended for the disabled and a new transparent staircase was built at the rear. The four foors were designed by C. de Geus & J.B. Ingwersen architects.

The façade on the canal voluntarily does not join the historic streetscape; a large number of windows with exterior shutters was included. The windows in the plinth differ from the ones in the superstructure. The ground foor of the building formed a plinth, on which the three remaining foors were installed. The architecture is typical of the reconstruction period, a concrete skeleton with steel bands of windows and concrete parapets. The ground foor forms a plinth, fairly closed and executed in masonry, on which the three remaining foors were installed.

Plan (Amsterdam - NL, 1957) by C. de Geus and J.B.Ingwersen.

Picture of the work in progress (Amsterdam - NL, 1957).

- 51 - 3.3 _ Current Situation

The last organization of spaces before the dismiss of the hospital saw the treatment and surgery rooms on the Prinsengracht side while offces were positioned on the Kerkstraat. The connection block between the two was assign to the amenities (restaurant-bar-waiting rooms). The main entrance was kept on the canal façade and coincided with the original entrance to the block of 1857 and gave direct access to the administrative offces, positioned at the sides of the staircase.

The volumetric composition of the space is generally well proportioned with the human dimensions and necessities, but lacks in the connection parts like stairs and hallways where the ratio is either too small or over scaled. Internally the building presents a series of spaces where the connection with the outside (canal side or garden) is enhanced to give a sense of calm and relaxation; at the same time, due to shifted heights throughout the complex and sides, there is no visual relation between the user of the garden and the users of the rooms.

The Prinsengracht hospital (Amsterdam - NL, 2015) by Google Maps.

(Amsterdam - NL, 2015) taken by V.A.Piras.

- 52 - Due to an exponential addition of volumes, the Prinsengracht hospital currently presents an illegible composition; spaces are hidden and deformed due to the integration of installations, hallways are dark and characterized but height differences and narrow angles deviating the perception and creating a decline of orientation for the visitor, like in a sort of labyrinth. In spite of those features, the different layers of implementation are not always easily readable while wondering on the inside whereas seems pretty clear -for the majority - from the inner outdoor spaces like the garden, the parking lot and the bike shelter. The facades facing this spaces indeed do not manifest any type of alignment or cohesion between the window frames and the height. This blundering boost suffered by the hospital minimizes the overall perception; what is kept alive in the block is just the monumentality and the quality of the garden for the system.

The garden is a characteristic design features of hospitals and buildings for health and welfare and even if, like the edifce, went under major changes is still the most important element of characterization in the complex. The architecture that surrounds it, should work in tandem with it but seems to lack a number of aspects necessary for reach the maximum level of usage, comfort, maintenance and sustainability.

(Amsterdam - NL, 2015) taken by V.A.Piras.

(Amsterdam - NL, 2015) taken by V.A.Piras.

- 53 - 3.4 _ Future Initiatives

In 2012 Manten and Lugthart Architects presented a rebuilding plan for the hospital keeping in mind the history and the function of it throughout time. The renovation plans were the next phase of the restructuring plan developed by the architectural frm. The specifc nature of the hospital had to be kept and the building had to be strengthened. This meant that the frst hospital in the design needed special attention to become a welcoming, warm, patient-oriented environment. Another great challenge was integrating the necessary modern technology in the building. The renovated units were located mainly on the ground foor. They remodeled the entrance area were patients could feel welcomed and be receiving in the feature departments, outpatient clinics and staff facilities. In addition, the fre safety of the complex with applicable standards has been modifed.

Impression (Amsterdam - NL, 2012) by Manten & Lugthart.

Plan (Amsterdam - NL, 2012) by Manten & Lugthart.

- 54 - Chapter Four Users Perception

- 55 - 4.1 _ Originally

USAGE : The complex for the majority of the time was meant to host a low number of patients. Spaces were dimensioned and thought carefully with an higher attention to the users and their necessities. Movement was natural and of easy understanding for the

COMFORT : Huge windows, spacious rooms, direct views and accesses to the garden, materialization of the rooms and detailing were some of the features which made the hospital more comfortable.

MAINTENANCE : Majority of the maintenance was given to the garden, which was organized and defned precisely to keep a variety of areas and features.

SUSTAINABILITY : The systems were basic and through time had to be improved in favor of an healthy air environment which was thought to prevent the transit of diseases. The ventilation was only natural and the large windows on both sides -thanks even to the presence of two wings - helped heating thanks to solar direct irradiation. Thick masonry walls helped keeping a stable temperature inside and irradiate the heath achieved throughout the day during the night.

Reading room (Amsterdam - NL, 1857 ).

- 56 - Garden (Amsterdam - NL, 1857 ).

Dining room (Amsterdam - NL, 1902 ).

Balconies (Amsterdam - NL, 1957 ).

- 57 - 4.2 _ Currently

USAGE: The complex had to be dismissed for two reasons: (1) the position, which was not favorable for emergency transports, and (2) the challenging composition of the space and the connections. Currently some rooms are being readapted to host momentarily the stay of students or no-proft associations.

COMFORT: The majority of the spaces have been compromised due to technical installations. The height is lowered, daylight with diffculties can fow inside the building and fresh air system aren´t working. The majority of the lighting is artifcial and dull, with neon bulbs going around hallways and rooms. The path inside the building is scatterbrain and interrupted by level differences. Perception and appreciation of the space is not present at the moment. The complex has lost the majority of is qualities.

MAINTENANCE: The complex is characterized by a number of controls units disposed in four different underground levels throughout the building. All the maintenance is electrical and fragmentary and necessitates of a huge dispend of money and work.

SUSTAINABILITY: As explained before, the different control units keep the building far away from being an effective and work-fowing system. The system right now are outdated and they obstruct between one another.

(Amsterdam - NL, 2015) taken by V.A.Piras.

- 58 - (Amsterdam - NL, 2015) taken by V.A.Piras.

(Amsterdam - NL, 2015) taken by V.A.Piras.

(Amsterdam - NL, 2015) taken by V.A.Piras.

- 59 - Chapter Five Values of the Building

- 60 -

This chapter will present the quality, tangible and intangible founded during the analysis of the hospital with a number of pictures.

- 61 - Garden facing the back of the Kerkstraat (Amsterdam - NL, 2015) taken by V.A.Piras.

Serra on the Prinsengracht (Amsterdam - NL, 2015) taken by V.A.Piras.

The previous balconies (Amsterdam - NL, 2015) taken by V.A.Piras.

- 62 - The balcony on the frst foor (Amsterdam - NL, 2015) taken by V.A.Piras.

Details (Amsterdam - NL, 2015) taken by V.A.Piras.

Stairs on Prinsengracht (Amsterdam - NL, 2015) taken by V.A.Piras.

- 63 - Big bright rooms (Amsterdam - NL, 2015) taken by V.A.Piras.

Big bright rooms (Amsterdam - NL, 2015) taken by V.A.Piras.

Attic space (Amsterdam - NL, 2015) taken by V.A.Piras.

- 64 - Through the analysis it came out that the complex has lost the welcoming and homie feeling due to a number of design mistakes or construction and installation decisions; those, even if sometimes needed to keep track of the booming medical research and innovation have compromised the space and its value for the users.

Changes of height; volumes too big that overshadow lower one; windows frames diminished in view; lastly solar achievement reductions, all these are just a few of the problems that can be found while wondering around the complex. Light and air, two of major elements of the health and welfare complexes are not appraise and make the edifce look dated and unusable.

Apart from it, the building unusually conformed around the canal area and full of valuable assets. Starting from the main façade facing the canal, we can fnd a number of rooms with outstanding views that convey the feeling of the city on the inside; the sensation of cohesion and connection with the urban scale is combined in those with a sense of protection and safety. The main entrance and both the facades are marvelous examples of monumentality and strong stylistic decisions. On the inside some parts present colorful details and a defne materialization that gives an edge to the complex and revitalize a bit the hospital from its austerity. The core of the complex, the garden, is a relaxing oasis in the middle of the city, unreadable from the outside but totally understandable from the inside, thanks even to a number of winter gardens and balconies that enhance it and connect inside and outside.

The feeling of this building and its historical value is intrinsic and can not be related to a specifc element or part of the building. The intangible value is not simply related to an architectonical form but to a more complex feeling that is innate; even so, the space can be a deciding factor on its perception now days. For this reason, the future design will take into account all the valuable feature of the building and, after they have been narrowed down and the more invasive and destructive changes have been located, decide in which way the complex will be able to work as a functional unit for heath and welfare.

- 65 - Chapter Six Design for Future Use

- 66 - 6.1 _ Introduction

The following pages will introduce the choosen theme of design and a specifc range of users. The original purpose was as health and welfare facility and throughout time it as shifted between the two edges in a steady fow; seen that the Prinsengracht hospital worked well as a care center and still gives a feeling of relax and privacy, the function should be kept connected with this innate capacity of the edifce. The problem is that the spaces are well dimensioned for living but they are not suitable to host technologic equipment, so the major possibilities are in creating a residential facility for people affected by diseases that affect some abilities but do not need a specifc medical treatment. In this range all the psicological phenomena can be held but in the next chapter a better understanding of which disease has been choosen to be hosted in this design and why will be given.

6.2 _ Increase in life expectancy

Reports in the last ten to ffteen years showed how, in our society, people are living increasingly longer; this represents on one side an achievement in both the medical and human feld for the worldwide community but at the same time highlights a bigger and signifcant challenge in the planning and organization of this longer lives.

The Global burden of Disease, a study conducted by the World Health Organization and the World Bank with the side support of the U.S. National Institute on Aging, predicts a signifcant increase in disability caused by an augment in age-related chronical diseases worldwide, such as Alzheimer or Parkinson. In a few decades the picture presented by this analysis introduces the loss of health and life from chronic diseases as a greater factor than the one from childhood diseases or accidents. (1)

+ The overall population is aging. For the frst time in history, people age 65 and over will outnumber children under age 5.

+ The number of oldest old is rising. People age 85 and over are now the fastest growing portion of many national populations.

(1) National Institute on Aging U.S. Department of State, Why population aging matters. A global perspective. (Washington,D.C.: Department of State Publication NO. 07-6134, March 2007)

- 67 - + Family structures are changing. As people live longer and have fewer children, family structures are transformed, leaving older people with fewer options for care.

+ New economic challenges are emerging. This increase in age will have a dramatic effect on social entitlement programs, labor supply, trade and savings and may require a new approach to society and economics to accommodate the changing world.

Seen on a global spectrum the global aging is a quite relevant problem and raises the question on how to face all the challenges connected to it. If we take into account the incidence of noncommunicable diseases in society, in the lap of almost 30 years it will almost double, leaving a substantial number of users in our cities with special needs and necessities.

6.3 _ Dementia & Alzheimer´s disease outlines

The majority of the diseases related with the aging process cause usually mental and physical disabilities, without possibilities of intervention; while both cause and cure are still unknown, an understanding of the consequences and their incidence in life and society are important to achieve an effective intervention in the areas that interest the everyday system for those human being affected by it. (2)

This paragraph will try to give a better understanding of the disease itself.

Dementia is a brain illness that debilitates and damages gradually cognition and/ or behavior to a point where average daily life functions are impaired. The specifc term “Dementia” gathers together a heap of disease, frst on the line Alzheimer´s. Moreover - the later - represents the majority of the cases between the population aged 65 or over and therefore was chosen has the case study for the research, but due to the many common aspects between it and other types of dementia as the vascular, the Lewy body or the frontotemporal ones the outcomes of the research process could be relevant for the broader spectrum and therefore the two will not be further subdivided.

(2) Cindy D. Marshall Anne M. Lipton, The Common Sense Guide to Dementia for Clinicians and Caregivers (New York, NY: Springer Science+Business Media, 2013)

- 68 - In medical terminology the general defnition of dementia is the following:

“Dementia is a syndrome due to disease of the brain, usually of a chronic or progressive nature, in which there is a disturbance of multiple higher cortical functions, including memory, thinking, orientation, comprehension, calculation, learning capacity, language and judgment. Impairments of cognitive function are commonly accompanied and occasionally preceded by deterioration in emotional control, social behavior or motivation.”(3)

Shortly, it is “a group of symptoms caused by gradual death of brain cells. The loss of cognitive abilities that occurs with dementia leads to impairments in memory, reasoning, planning and behavior”. (4)

Other than this general characteristics there are plenty more connection points between the different types of dementia; they are relentless, irreversible and devastating as the person suddenly or gradually slips into a state of complete dependence.(5) Usually side disorders arise like aggression, sleep disorders, depression (etc.) that increase the diffculties for the person who suffers of it. This diseases contaminate a whole system and normally not just the direct ill is affected by it but many are infuenced more or less directly.

6.4 _ Stages

Multiple stages of dementia’s progression are distinguished. Each one is recognizable with a number of specifc symptoms, all waernings of a person’s cognitive decline. Usually, those are referred to as “early stage”, “middle stage” or “late-stage”, but in this paragraph the most commonly used staging scale called Global Deterioration Scale for Assessment of Primary Degenerative Dementia or “Reisberg Scale” will be used to introduce the seven exact stages recognized by the medical society. This scale is most relevant for people who have Alzheimer’s disease, since some other types of dementia do not always include memory loss. (6) Even so, there are however no defnite boundaries on the start or end of a stage in relation to the other or to time because it differs in every person.

(3) Dementia, Design and technology: Time to get Involved, 24. (4) Gale Encyclopedia of Medicine. S.v. “Dementia”. Retrieved October 8th 2015 from http://medical-dictionary.thefreedictionary.com/dementia (5) Uriel Cohen, Contemporary Environments for People with Dementia (Baltimore: Johns Hopkins University Press, 1993) (6) Cohen J., Contemporary Environments for People with Dementia - 69 - - 70 - 6.5 _ Facts and Statistics

Dementia was offcially accepted as a global health challenge in 2012 by the World Health Organisation and all countries were suggested to include it in public health planning. (7) Currently, due to the unknown origins and cures, dementia is one of the most feared diseases; a lot of ignorance surrounds this topic and this creates an enormous gap in the planning of both society and the urban and architectonical improvements that could be made for the illed. The fear of being diagnosed with dementia recently has overgrown the one of getting cancer (8) and much more effort needs to be done to fully understand and accept the complexity of dementias. It is predicted that by the year 2050 there will be 135 millions of people with one or another kind of dementia worldwide, while today, there are 44, 4 million people with known diagnosis of dementia. (9) Below the age 65 there is generally a very small chance of being diagnosed with dementia. (10) The majority of our generation should be prepared to the fact that most probably we will be directly or indirectly connected to this disease and that mst probably, we will know a few people who will need assistance. An example now days is given ba England, where the esteem of people helping an older relative, friend or neighbour in everyday activities has reached the 68%(11) and the amount is gradually growing. The majority of the people will eventually need to be moved to some type of care residences, which is a situation healthy people nowadays do not even want to talk about. The need for elderly living will therefore grow esponentially and so it is important to accept this societal change in the dimension of a natural development and try to fnd actual solutions.

(7) Chris Quince, “Demography - Alzheimer’s Society,” http://www.alzheimers.org.uk/site/scripts/docu- ments_info.php?documentID=412. (8) Ph.D. Mario Garrett, “Fear of Dementia,” online article, Psychology Today: Here to Help (2013), http:// www.psychologytoday.com/blog/iage/201305/fear-dementia. (9) Alzheimer’s Disease International, “Dementia Statistics/ Alzheimer’s Disease International,” http:// www.alz.co.uk/research/statistics. (10) Dr. Lorne Label, “Dementia Facts and Statistics,” http://www.disabled-world.com/health/aging/demen- tia/statistics.php. (11) Disabled Living Foundation, “Losing Independence Is a Bigger Ageing Worry Tan Dying,” http://www. dlf.org.uk/.

- 71 -

SECTION A DEMENTIA

- 72 - PART 1 Demented patient, caregiver and Health Services

1.1 _ Alzheimer´s ill and its relation with/within society

Dementia in general is a topic that our society tries to avoid as much as possible. The devastating irreversibility, together with relentless consequences such as memory loss, changes in behaviour, dependence on others, loss of cognitive functions and many others are considered to be a horrifying experience. The fact that this topic is still a tabù does not create a base for a good strategy on the longer run. The current facilities are not thought to give the right care to a person affected by those synthomps and so, people with dementia gradually become lost in space and time. With only basic abilities remaining such as basic notions of movement, instincts and occasional awakenings, it becomes harder and harder to perform everyday tasks as well as to remember way through a building.

1.1 a _ Family and home care

Taking care of a person with a disease as violent on the person - intended as a precise character and not simply as a person with feelings - as Alzheimer´s can be emotionally and physically demanding, especially in later stages of the disease, when a nonstop care is required. Demented people lose their indipendence and this affects directly their family members creating a stressful and frustrating situation. This is the reason why usually, talking about dementia, they say you see the person die twice, once in mind and then again in the body. Within the degeneration of the disease, many diffcult situations arise and there are many diffcult decisions to make. One of the most diffcult ones is to decide that the time has come to move the person to some kind of care institution. In most cases, as the disease progresses, it is unsustainable for the sake of both sides to continue with the homecare. Such decision is however not easy and it is often accompanied by mixed feelings of regrets, blame and failure. Family memebers are often confused, blaming themselves for not being able to care directly of their loved ones and for feeling relieved at the same time.

- 73 - Researches have shown evidence that people feels less frustrated after moving their loved ones into a place that feels homey and comforting; if we compare this facilities with an institutional care one, the sense of normality in a facility creates less regrets. The current trend in the Netherlands is to keep a person with dementia at home for as long as possible. That way, people remain in their own environment and it is economically more feasible. That said, people at home are kept sort of isolated from the rest of the society and lack social contact. At the same time, dangerous things are more higly possible in a private environment that keeps the average composition of a house (an examples can be the equiped kitchen).

On the other side, bein moved to a nursing home at the beginning of the illness gives the possibility to interact better with others. For those reasons, environments designed to host elderly people should be as normal and home like as possible to lower the shock as much as possible. If it is designed to provide suitable conditions for people in the late stage as well as for those who are still independent, vivid mixture can be created. Furthermore, if people in the early stage are encouraged and motivated to move in maybe with their families by their side there will be less stress on them. Spending a quality time together in a safe environment that offers privacy and richness of activities can often be the best therapy.

1.1 b _ The health structures

Care institutions differ signifcantly in sizes and organization but also in the general approach. Some of them are exclusively for people with dementia; some are a mix of senior housing care. Respecting the privacy and dignity of the users should be the main aim behind this buildings but the complexity and delicacy of this necessities is easily shown in existing facilities; it is complicate creating a suitable environment and in the majority of cases the overall feeling can seem rather negative. This complexes are not only buildings on thereselves but they depend on the staff which as to be trained to improve the points that are lacking in the architecture. They are without any doubts a key feature more than the building itself because they are not just a caregiver, but also a friend. They provide support at any time and very often they are the only company people have left. Unfortunately, with the extremely low amount of money they are paid and both physical as well as mental demands of the job, there are not enough of them. That means they are very busy each and every day, spending time on unnecessary activities. They are under lot of pressure and often stressed. With buildings being often large in scale and numbers of people, their working conditions are even more diffcult.

- 74 - 1.2 _ Alzheimer´s and its relation with Architecture

Being diagnosed with dementia currently means being excluded from the society, not only on a human level but directly in the sense of physically being moved to a special care facility and become dependent upon assistance of a third part. The majority of people ill with Alzheimer pass the rest of their days after their diagnosis living inn aseptic environments. The progression of dementia makes the sphere of interaction for the person shrinking and the spaces inside the facilities can become a sort of prison; for example, in the later stages the bedroom becomes the whole world for the patient and for this reason the importance of the composition and design of the direct environment is essential. Architecture becomes the frame of the whole life of a person, the back bone to a quality of day life.

Right now the majority of the care units present a recurring number of problems:

1. Corridors have no point orientation. There is no visual contact with the ending destination; this lack of stimulation in the connection of spaces creates confusion, discourage and demotivation.

2. Privacy is transformed into solitude. The rooms, enclosed and reduced to a minimum lead to solitude and negative effects that can lead to depression.

3. No privacy. Other cases present a lack in privacy because rooms are shared with a number of other users; beds are stacked one next to the other and dignity, individuality and therefore privacy are questioned. Even so, shared living maintains a positive aspect to some extends because it allows positive interaction and psychological support.

4. Confusing materialization. The treatment chosen for foorings and walls in current care facilities are usually shiny and colorful. Those are thought to be helpful in wayfnding (usually they are used to emphasize elements but instead the overall contrast is lowered with those) but instead it creates confusion and diffculties when moving around or reaching a specifc point in the complex.

5. Lack of nature. Usually facilities are standing alone complexes. Green is thought but due to the organization in foors, the access to the outside is isolated to the ground foor. In this way people are deprived of a priceless source of relaxation.

- 75 - 1.3 _ Conclusions

Spaces defne and regulate the majority of life progress; volumes, materials, light and shadows can defne perception of spaces as positive or negative and therefore affect the mood of the users and incise on their quality of life.

The examples given by care centers or elderly residences - as shown in the previous subchapters - usually lack a number of spatial elements necessary during the progression of the illness for the everyday life.

Elements that usually for us defne a good environment become essential for an Alzheimer patient; for example natural day light, private resting spaces, visual connections, defned materiality and green are just some of those.

Thanks to this quick overview on the illness and its implications we can conclude that, while the illness infuences life, at the same time, the later is what should defne architecture. As other systems of health and care, building for Alzheimer´s patients should be therefore constituted to enhance the perception of the space, so that the overall life and illness system can be improved.

- 76 - PART 2 Facing Reality

2.1 _ Common mistakes

Which should be the answer to the problem of assistance and care giving is one of the main problems that our society will be facing more and more in the future in relation to the increase in life expectancy and other sub factors. There is no healing for this kind of diseases so the only possibility is to put the person as the core of design and strategies. Taking care of a person as to valuate a constant change and mutation should be part of the designs for care centers.

2.2 _ Increase in problematics

As already discussed in the previous chapters, Alzheimer´s creates a number of problems for design and society. The rising number of problematics is related to the level of disinterst and closure that people have towards the illness and its understanding. Fear of the unknown restricts the possibility of action and therefore new approaches have to be taken to help improving even the perception of society. This digression on the main aspects of the disease highlighted a few problematics and their solution at the same time; the aspects that still need to be understood, corrected and in other cases just improved:

* Stimulation

* Safety

* Dignity

* Privacy

* Sense of Belongings

* Sensory stimulation

* Wayfnding

* Autonomy

- 77 -

SECTION B DESIGN PRINCIPLES

- 78 - READABILITY & FUNCTIONALITY

Spaces should be clearly understandable and noticeble; functions have to be comprehensive so that the user knows immediately how to behave. Basic spaces such as kitchen, dining area or a living room are inscribed deep in people’s memories and create a familiar environment but can be dangerous in the case of dementia. However, those rooms should be part of the design, in a more basic way but with still understandable features. Having control over the situation, even if slightly can be benefcial for people with dementia as well as their care givers or visitors. Enough storage space, short distances or clear overview are part of the necessities.

SUBTLE CLUES

Spaces should be differentiate; to do so a number of possibilities are possible: less obtrusive barriers than a physical wall such as changes of materials, colors, columns, ceiling heights or levels of light allow improved orientation inside and otuside the building. Creating various patterns of light enhances movements and triggers curiosity (one of the last things that a Alzheimer´s patient looses) and so does changing heights of ceilings. Transitioning from a lower space to a higher, brighter one is accompanied by curiosity and therefore it can help people initiate their journey.

TRANSITION

Creating transitions between different spaces and levels of privacy gives people the time to settle and adjust to the change. Small in-between spaces can link places with different functions, noise and activity levels. Such gradual fow between spaces is fundamental.

POSSIBILITY OF SEPARATION / ZONING

A people with this illness, more then everybody needs the possibility of choosing when to interact and when to be on his own. Privacy is an important element and has to be mantained in a facility like that to minimize the shock of losing the majority of the space indipendancy that the user used to have back to his own home.

NATURE

Nature is a good reference and helps position oneself in time and space. Provides unique source of relaxation and stimulation. Access to nature relieves and freshens up, it provides opportunities of wandering around, gardening as well as for meditation and contemplation.

- 79 - COMPACT DESIGN

Creating small autofunctional units within one bigger complex eliminates the necessities of remember directions. All the spaces should be at physical reach and visible throughout so that the users can react and decide following the instinct without having to memorize and being able fnd their way no matter what. Compact layouts with short distances are benefcial both to people with dementia as well as to their care givers. The design should present less corridors in favor of more open and readable pathways that create the possibility of wonder and appreciate the surroundings.

VISUAL CONTACT

Visual contact in a series of places around the building reduces the strees of searching for precise elements. Seeing the possibilities eliminates the cognitive, decision making process. The eye contact with a destination eliminates the need of seeking constant help and information. Opening spaces work better for visual connections and at the same time allow sounds and smells to spread. This way a number of cues are created for the person with dementia.

RECREATIONAL SPACES

Providing areas for daily activities is extremely important. Everyday activities are familiar to people and offer a chance to keep up with what they had been doing their whole life. Singing, reading, watering plants and many other activities that people can engage in give them a sense of responsibility and belongings. Moreover such activities provide natural source of many stimulation. They are both a therapy as well as part of a normal life. Through actions, sounds, smells and various tactile stimulation can be achieved. Creating spaces for these activities and their cues gives life to the building as well as to the people.

SENSORY STIMULATION

Usually is one of the few things left in people with dementia, because it is processed by a part of brain which remains intact the latest, sensations have the power to trigger memories and emotions till very long. For that reason, it is important that a building itself is a rich source of diverse sensory experiences ranging from materials and atmospheres to activities.

FLEXIBILITY

Space should be able to adapt to the detour of the illness in the same effective way.

- 80 - Chapter Seven Conclusions

- 81 - The Prinsengracht hospital is an outstanding building with a number of relevant features but, due to the uncontrolled additions to adapt it to changing needs, has lost track of the characteristic that an healthy environment should have.

Volumes have been compromised; spaces quality and perception has been damaged in various part of the complex; readability of the overall is diffcult and in some part completely not present.

What made the building valuable was the thought behind it and for a future approach that should be taken into account. Society is what infuences the Health and Welfare systems; their constant necessity and improvements are what sustains our society and should be taken into account with refnement.

As it was previously introduced our society is constantly aging and this creates new necessities in the system. As citizens we would like to be included in the life of our society and segregation like in the past is not a valuable option for us; the need is to be taken care in a facility or an environment where necessities of the user as a human being and of the user as a patient are achieved and met simultaneously.

A care facility, therefore should be a place able to host at the same time private spaces (for personal necessities) and social areas (for sharing time, energy and thoughts with other people) in a balanced way. Those, do not have to be taken however as opposite elements and therefore being constituted as standing alone, separate entities; sensitive transition as to be researched in the design.

The decision of transforming the complex into a residential community for people with dementia is based on those criteria. The enclosed character of the building is a good based because usually people affected by this illness cannot wander around freely in the city and a number of part, from the different facades to the internal block, could create the perfect communitarian effect. The garden forms one block already functional to the needs of this users. The missing link is on the strip backdropping the 1957 expansion until the Kerkstraat side, that have to be built and tought as an opposite part from the garden but workable in the sistem as an overall.

The aim is to create a city in the city. A communitarian environment for people with dementia to feel at home and interact even with people not affected by the disease through a differentiation of living units that count even the possibility of moving in with the relatives. The new block should become a sort of meeting area, a square where interaction is improved and opposes and requalifes the other side, the one with the garnden.

- 82 - Bibliography

Lynch, K. (1960). The Image of the city. Cambridge, Massachusetts: MIT Press.

Pallasma, J. Holl, S. & Perèz-Gomèz, A. (1994). Ques- tions of perception; Phenomenology in architecture. Tokio: A and U.

Philips, C. (1967). Grachtenboek. Amsterdam: Uitgeverij Minerva

Grosz, E. (2001). Architecture from the outside. Cam- bridge Massachusetts: MIT Press.

De Witt, S. Aben R. (1999). The enclosed garden.

Feddersen, E. Lüdtle, I. (2009). Living for the elderly: a design manual. Switzerland: Birkhaüser.

Marquardt, G Schmieg P. (2009). Dementia friendly architecture: environments that facilitate wayfnding in nursing homes. Am J. Alzheimers dis other demen 24, n.4.

Feddersen, E. (2014). Lost in space: architecture and dementia, ed. Lüdtke I. German National Library: Birkhaüser Verlag.

- 83 - Stanley B. Klein, Shaun Nichols. “Memory and the Sense of Personal Identity.” University of California, Universi- ty of Arizona.

Swaab, D. F. “Alzheimer’s Disease.” In We Are Our Brains: A Neurobiography of the Brain, from the Womb to Alzheimer’s”. (2014) United States: Spiegel & Grau.

Dijck, Malou van. “Feeling at Home.” (2014) Design Academy in Eindhoven: Studio Op Poten.

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