Scientific Paragon to Hospital Mall: The Evolving Design of the Hospital, 1885-1994 Author(s): David Charles Sloane Source: Journal of Architectural Education (1984-), Vol. 48, No. 2 (Nov., 1994), pp. 82-98 Published by: Wiley on behalf of the Association of Collegiate Schools of Architecture, Inc. Stable URL: http://www.jstor.org/stable/1425315 . Accessed: 04/06/2013 00:08 Your use of the JSTOR archive indicates your acceptance of the Terms & Conditions of Use, available at . http://www.jstor.org/page/info/about/policies/terms.jsp . JSTOR is a not-for-profit service that helps scholars, researchers, and students discover, use, and build upon a wide range of content in a trusted digital archive. We use information technology and tools to increase productivity and facilitate new forms of scholarship. For more information about JSTOR, please contact [email protected]. Wiley and Association of Collegiate Schools of Architecture, Inc. are collaborating with JSTOR to digitize, preserve and extend access to Journal of Architectural Education (1984-). http://www.jstor.org This content downloaded from 128.125.150.250 on Tue, 4 Jun 2013 00:08:16 AM All use subject to JSTOR Terms and Conditions ScientificParagon to Hospital Mall: The EvolvingDesign of the Hospital, 1885-1994 DAVIDCHARLES SLOANE, PHD, UniversityofSouthern California Since 1885, the hospital has evolved from a logical and organizational success-the welcoming, waiting rooms more inviting, public charity to a scientific paragon. A growing of the world's health facilities more into chorus of criticism, though, attacks its imperson- centerpiece greatest reintegrated fully daily ality and inhospitality,especially in the emerging caresystem. urbanlife, and patients(or even better,cli- competitive health market which emphasizes The hospital went through a re- ents) treatedmore as guestsor consumers. ambulatorycare. Hospital administratorshave markable transformation The of these responded by asking designers to re-create the physical during implications changes hospital into a more welcoming and accessible its ascensionfrom a place of public charity are quite complexand not yet totallyclear. place. A popular method of achieving comfort to one of practicalnecessity. The asylums The earlyhospital was sociallyconstructed and familiarityhas been to adapt elements of the and of the nine- around a in shopping mall to the hospital and even to public hospitals early paternalistic relationship consider merging mall and hospital. This teenth century had declaredtheir mission which the care-givermaintained an inordi- adaptation raises importantconcerns about the through their architecture.Emulating the nate amount of controlover the patient.In evolution of attitudes toward illness and death, of the were the scientific the private and public spaces, and the mall as a public buildings period, they hospital, care-giver's modern design standard. This article highlights placesof confinementand patronizingcare powerwas reinforcedby the magicalquali- one unusual implication,the possibility that the situatedin buildingsdesigned to evoke the ties of the medicine practiced, profes- mall, viewed as a reason for the diminishmentof and of the donors sionalized and and public space, might be a means of opening to the generosity public spirit relationships, spaces public one of society's most closed institutions-- and benefactors. While the well-off and routines that minimized a person's indi- the hospital. middlingAmericans continued their prac- viduality and limited the patient'scontrol tice of receivingmedical treatmentsin the over the courseof the illness.In both older home, physicians argued that the new, permutations of the hospital, efficiency The EvolvingHospital more sophisticatedprocedures were more and order were virtues that under-girded effectivein special,monitored places. They the system of care. The beautiful new As RECENTLYAS 1900, MOSTAMERICANS RE- re-createdthe hospitalas a placewhere pa- rooms and "guest relations"could repre- ceived their health care at home or in the tients could be isolatedwithout losing the sent a significantre-creation of the institu- doctor'soffice, not in a hospital.Even with comforts and atmosphere of home. tion or a facade behind which little has the advent of antiseptic procedures and Quickly, though, these earlyhospitals were changed in the relationship of patient to technologicaladvances such as X rays,the institutionalized and sterilized. By doctor or institution to client. Using the hospital only graduallyovercame its repu- midcentury, the hospital had been trans- world'sfinest architectsto design new hos- tation as a place of death for the poor. The formed into the familiar efficient, bland, pitals may leave city skylines with attrac- hospital weakened these perceptions as and impersonalplace. tive buildings, but will those buildings be much throughchanges in medicaltraining, The latesttransformation of the hos- exclusivelyused by people who can afford professionaldesires, and social attitudesas pital began in the 1970s, moving the insti- them? The transformation of the space throughprogress in medicalpractice. Phy- tution from surroundings of scientific raises serious questions about the actual, sicians, now assisted by a professionally sterility to welcoming domesticity. It has measurablechanges in the quality of care trained corps of nurses, made the hospital been propelledby a new competitivemar- and of the experienceof the people using a scientific laboratoryin which specialized ket for health care, the rapid increase in the facilities. responsesto specific illnesses replacedthe outpatient surgery and ambulatory care Conversely, the emulation of the general, limited treatments of the past. and slowly evolving attitudesabout illness mall may have subversiveimplications for The new scientific hospital incorporated and death. Hospitals began searchingfor medicaland community relationships.Al- improved technologies within a structure new ways to providesophisticated services though used to improve the marketability that emphasizedthe sterilityand efficiency without alienating an increasingly edu- of the hospital by making it more familiar of modernmedicine. Commentators,even cated clientele.In a quirkycontinuation of and welcoming, the new spacesmay break those with complaints about patient care past thinking about the need for a civic down barriersbetween the hospital and and hospital impersonality,trumpeted the image for the hospital, designers and ad- surroundingcommunity, barriers that have hospital as a symbol of Americantechno- ministrators began emulating the design reinforcedthe medicalprofessionals' posi- and organizationof the suburb'snew com- tion of powerwithin the society. By open- Journal ofArchitectural Education, pp. 82-98, munity center, the shopping mall. As a re- ing the hospital to new franchises,forging ? 1994 ACSA, Inc. sult, hospital entrances became more alliances between ambulatoryclinics and November1994 JAE48/2 82 This content downloaded from 128.125.150.250 on Tue, 4 Jun 2013 00:08:16 AM All use subject to JSTOR Terms and Conditions streets or other nonmedical establishments, and treating patient visitors as guests rather than intruders, the new spatial relations may revolutionize the experience in the hospital. Indeed, the hospital may serve as a counterpoint to the broader societal di- minishment of public space. The new hos- pital may become a renewed public space. A place of confinement filled with the iso- lated sick may become a community meet- ing place as a result of the attempts of designers and administrators to control the future of the institution. The Foundationsof the ScientificHospital Home health care was sensible before the twentieth century. The sick cared for in 1. Firsthospital in the UnitedStates: Pennsylvania Hospital, the home escaped the dangers of crowded, 1755. FromThomas G. Morton,The History of the Pennsylvania wretchedly maintained and poorly staffed Hospital,1751-1895 (Philadelphia:Times Printing House, 1897). Courtesyof NorrisMedical Library, History of Medicine public hospitals, almshouses, and poor- Collection,University of SouthernCalifornia. houses. Family, friends, and ministers of- ten could give care equal to that of the physician, who could offer little more than Hospital's design imitated that of the disease through medical treatment. The a generalized diagnosis, a relatively small Edinburgh Royal Infirmary, with a modi- large wards of the new civic institutions array of proven remedies, and the terrify- fied H plan facing south. New York Hos- bedded dozens of patients, who were easily ing last resort of surgery. Many times, care pital was barely completed when it was supervised by a small staff of undertrained by the nonprofessional might be less dan- completely gutted by fire, then rebuilt in nurses. Order on the ward was maintained gerous considering the heavy contempo- time for occupation by the British who by expelling patients who behaved inap- rary reliance on mercury and arsenic in used it as a barracks. Both of these hospi- propriately and limiting visits to one hour potions to combat a variety of diseases. tals, and virtually all of the nation's 178 a day.' The home was a more sanitary site for sur- hospitals constructed by 1873, were estab- As late as 1876, W. Gill Wylie could gery than the overused, lightly cleaned op- lished as private charitable concerns for the write, "Civilization has not reached that erating rooms in which mortality rates urban poor, approaching