Design & Healing: Hospital Typologies

A history of the hospital provides us with a conceptual framework in which to imagine future hospitals, and perhaps, reimagine assumptions about architecture itself.

Each historical era created its own unique hospital type that responded to the practice of health care and medicine in that period. An analysis of these hospital types reveals how their designers conceptualized care and the role architecture could play in delivering it.

Basilica Hotel DieuCooper Hewitt, Smithsonian Design Museum

The Basilica (c. 900–1800)

In antiquity, the basilica was a large, open public meeting hall used to transact business or host large audiences. As Christianity rose in status, the pagan temples of the Roman Empire fell out of favor, and basilicas were adopted as religious buildings.

Basilica Monastery of ClunyCooper Hewitt, Smithsonian Design Museum

During the Middle Ages, they were used as churches and cathedrals. As a growing number of people sought care and refuge, the basilica and the hospital merged in the monasteries of St. Gall, Switzerland (c. 747), and Cluny, France (c. 910).

Cross WardCooper Hewitt, Smithsonian Design Museum

Cross Ward (c. 1400–1700)

The cross-ward hospital emerged during the Renaissance as a solution for ward expansion. Previously, the typical expansion strategy was to lengthen the wards (width being limited by the vaulting methods of the time).

...but this had the disadvantage of positioning some patients—those at the end of the ward—too far from the altar to hear Mass.

The cross-ward hospital solved this problem by creating four open wards at ninety degrees to each other with an altar at the center, thus quadrupling the hospital’s capacity without compromising any patient’s access to prayer.

Panoptic Central Kansas Health ArchitectureCooper Hewitt, Smithsonian Design Museum

Panoptic (c. 1800–1900, 1960–70)

In panoptic hospitals, influenced by Jeremy Bentham’s eighteenth-century panopticon prison design, ward configurations maximize sight-lines from nurses’ stations to patient beds.

Panoptic HospitalCooper Hewitt, Smithsonian Design Museum

Due to the enhanced level of surveillance it enabled, the radial design was adopted in several asylums, military hospitals, and prisons, including the Glasgow Lunatic Asylum (c. 1814) and the Eastern State Penitentiary in Pennsylvania (c. 1829).

Manor Pennsylvania HospitalCooper Hewitt, Smithsonian Design Museum

Manor (c. 1600–1800)

Manor houses were generally classical in style, with an exacting symmetry that lent itself to a gender-segregated ward plan. 

Manor Bethlehem Royal Hospital DrawingsCooper Hewitt, Smithsonian Design Museum

The manor was exported beyond Britain: Philadelphia’s Pennsylvania Hospital, the first hospital in what would become the United States, was completed in 1755 with male and female patients each allocated a wing and administration offices and an apothecary located in the center.

Barracks Baragwanath HospitalCooper Hewitt, Smithsonian Design Museum

Field Hospital / Barracks (c. 1800–)

Quick to deploy and easy to assemble and expand, the barracks hospital is often used when a new facility is urgently needed, as in times of war or natural disaster. 

Selimiye BarracksCooper Hewitt, Smithsonian Design Museum

Like the temporary soldiers’ lodgings they evolved from, these hospitals are frequently conceived as kits of parts and prefabricated off-site or constructed with simple, cheap, and readily available materials.

Pavilion Moses Taylor CornellCooper Hewitt, Smithsonian Design Museum

Pavilion (c. 1800–1900)

The pavilion plan called for open wards of limited length and width, naturally ventilated with windows along the long walls with doors along the short walls, and joined to a circulation spine that connected the wards and provided storage and service space.

Pavilion John Hopkins ABourkeCooper Hewitt, Smithsonian Design Museum

The pavilion plan, popularized by Florence Nightingale in her 1859 book Notes on Hospitals, called for open wards of limited length and width, joined to a circulation spine that connected the wards.

Early Modern Bar Paimio AaltoFoundCooper Hewitt, Smithsonian Design Museum

Bar (c. 1900–40)

In the early 20th century, improvements in sanitary practices and the invention of new medical technology drew middle- and upper-class patients to the hospital for the first time. The result was an amalgam of old open wards for the poor and new private rooms for the wealthy.

This era also saw the rise of more complex planning strategies to improve efficiency and supervision and accommodate an expanding technical apparatus and increasing medical specialization.

Early Modern Bar Old Main Hospital Bentley, From the collection of: Cooper Hewitt, Smithsonian Design Museum
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Early Modern Bar Paimio AaltoFound, From the collection of: Cooper Hewitt, Smithsonian Design Museum
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The resulting architecture type, the bar hospital, was an amalgam of old open wards for the poor and new private rooms for the wealthy, all with attention to optimal lighting, ventilation, and airflow. 

Block Bellevue HospitalCooper Hewitt, Smithsonian Design Museum

Block (c. 1950– )

The block was the dominant hospital style of the mid-twentieth century. It was born in the era of “machine medicine,” amid the proliferation of new health care technologies and the growing cultural perception of medicine as an almost miraculous science.

Block Bellevue Hospital PlanCooper Hewitt, Smithsonian Design Museum

The block hospital is characterized by a minimal modernist style, specialized zones for different services, a monolithic form, and reliance on long-span structural systems.

Utopian Hospital TypeCooper Hewitt, Smithsonian Design Museum

Utopian (c. 1960–70)

In the mid-twentieth century, the block type was ubiquitous. There were, however, a few exceptions, and these can accurately be characterized as utopian. Utopian designs had little in common beyond an aspiration to defy the logic of the block (at least superficially). Most historical examples in the United States come from E. Todd Wheeler, a partner at health care giant Perkins and Will from 1936 to 1972.

Utopian Tent HospitalCooper Hewitt, Smithsonian Design Museum

Wheeler presented a number of radical concepts for hospitals of the future, attempting to address the biggest challenges in hospital design at the time: controlling the environment (in underwater and tent hospital designs) and facilitating flexibility and expansion. Other sketches incorporate cultural tropes such as drive-in theaters and atria.

19 McMasterCooper Hewitt, Smithsonian Design Museum

Mega-Hospital (c. 1960–80)

The mega-hospital arose as a response to the ever-increasing needs of the medical machine and the public sector. These megastructures decentered form in favor of the function and demands of a system, and were intended to change and resist obsolescence.

Tufts Interstitial Space VerderberCooper Hewitt, Smithsonian Design Museum

An interstitial hospital is a form of mega-hospital that is characterized by alternating spaces: one floor for the undefined and evolving, and the next for the controlled and precise. 

Mat Hospital Design LayoutCooper Hewitt, Smithsonian Design Museum

Mat (c. 1960–90)

Mat buildings became popular across sectors in the late 1950s and early 1960s owing to the work of the architecture group Team X, particularly Alison Smithson, Peter Smithson, and Aldo van Eyck.

GSCCooper Hewitt, Smithsonian Design Museum

Labyrinth (c. 1960– )

Some designers in the late mid-twentieth century sought to harness the labyrinth to fight the sense of institutionalization that health care settings perpetuated. They introduced labyrinthine elements to create an experience of discovery and delight.

Credits: Story

Typologies: A Taxonomy of Type is from The Architecture of Health: Hospital Design and the Constriction of Dignity by Michael P. Murphy Jr. with Jeffrey Mansfield and MASS Design Group (2021, Cooper Hewitt) Story author: Alyssa Perales

Credits: All media
The story featured may in some cases have been created by an independent third party and may not always represent the views of the institutions, listed below, who have supplied the content.
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