Hospital planning: revised thoughts on the origin of the pavilion principle in England.

OF the many domestic reforms hastened by the Crimean War, the rethinking of hospital design was one which most concerned the mid-Victorian architect. The deplorable state of military hospitals revealed by the Report of the Commission appointed to inquire into the Regulations affecting the Sanitary Condition of the Army, the Organization of Military Hospitals and the Treatment of the Sick and Wounded, 1858,1 stimulated the discussion of civil hospital reform2 which was already active in the mid-1850s. The change which took place from the early to the late nineteenth century, from conditions 'where cross-infection was a constant menace' to those 'where hospitals [were] ofpositive benefit to a substantial number of patients'3 occurred largely in the years following this report; improved medical knowledge, nursing reforms, increased attention to sanitation, and better planning and administration, combined to ensure that Florence Nightingale's maxim-'The first requirement in a hospital is that it should do the sick no harm'4-was far less relevant in 1890 than it had been fifty years before. Prior to 1861, there had been a considerable variety of different architectural designs for hospitals in this country, 'but in the 1870s and 1880s, the vast majority of new hospitals and rebuilt hospitals conformed to one basic plan-a series of separate pavilions placed parallel to one another'.5 The 'pavilion system', as conceived by its advocates, consisted preferably of single storey, or failing this, two-storey ward blocks, usually placed at right angles to a linking corridor which might either be straight or enclosing a large central square; the pavilions were widely separated, usually by lawns or gardens. In the wards, complete cross-ventilation was achieved by opposite rows of tall, narrow windows reaching from floor to ceiling. Natural ventilation, from doors, windows and fireplace was the rule. This uniformity of design among late Victorian hospitals, with its emphasis on spaciousness and natural ventilation, was the logical outcome of the general acceptance of the aerial conduction of disease, or, as it was known to contemporaries, the miasmic or pythogenic theory. The popularity of the pavilion system, expensive in terms of site value, building costs, administration, and maintenance, lasted well into this century. Moreover, with the rapid expansion of hospital facilities between 1861 and 1891, the twentieth 1 Parliamentary Reports and Papers, 1857-8, xviii (1). 2 B. Duncum, 'The Development of Hospital Design and Planning', in F. N. L. POYNTER (ed), 'The Evolution ofHospitals in Britain', London, Pitman Medical Publishing Co., 1964, p. 214. 3 B. ABEL-SM1TH, 'The Hospitals', London, Heinemann, 1964, pp.1-2. 4 FLORENCE NIGHTINGALE, Notes on Hospitals, 3rd ed., London, 1863, p. iii, Quoted in ABELSMITH, op. cit., p. 1. S ABEL-SMITH, op. cit., p. 154. Ibid., see also R. WMD, The Design andEquipment ofHospitals, London, Bailliere, 1949, p. 7.