Workers' health, workers' democracy: the Western miners' struggle, 1891–1925

Builder (23 Jan. 1864), the editor George Godwin was able to assert, "Never was change more complete than that which has occurred in hospital building since we initiated in these pages the movement against the defective plans in use, and showed the advantages of the pavilion system of arrangement now univerally adopted". This reflected the Builder's dedicated support for a reappraisal of hospital design, including the earlier publication of papers by the surgeon John Roberton-which, as discussed by Anthony King in Medical History, 1966, 10: 360-73, were later absorbed into Florence Nightingale's text. The practical and direct manner of her presentation still brings echoes of her impact on contemporaries-whether it be through such provocatively titled subsections as 'Construction of hospitals so as to prevent fresh external air'; her grimly humorous assessment of existing designs, as for instance new hospitals in India that met the required minimum volume/bed allowance of 1000 cu ft by providing a floor space for each patient of 24 sq ft by 42 ft high; or her uncluttered writing style as exemplified in the first attention-riveting (and much quoted) sentence of the Preface to Notes on hospitals. The books conflate ideas on a wide, and sometimes disjointed, range of topics: survey statistics; building defects; principles for new buildings; special design requirements (e.g., for convalescents, children, soldiers' wives, Indian military hospitals, a training school for midwives); systems of nursing and management. Plans, details and tables amplify all this. Both books reflect a desire to see information properly collected and presented (with the opportunity not missed to include an exemplar survey form for the recording of data). Some harsh statistics on variations of death rates by different types of hospital were used to emphasize practical building implications as she saw them. Although Florence Nightingale's opposition to contagionism was implacable, and, as Rosenberg points out, she was by the time of the 1871 volume drawing still further apart from the medical consensus on disease transmission, her desire to provide a rationale in design would have come as a welcome, unambiguous, and highly useable guide for architects. For the latter there were "principles of construction" that covered everything from site selection, size of pavilions, and ward planning, to windows, ventilation, furniture, drainage, or water supply. The many health care buildings subsequently influenced by these guidelines-in particular the pavilion hospitals and workhouse infirmaries-can still be seen as distinctive elements in the fabric …