The Architecture and Landscape of Health

A Historical Perspective on Therapeutic Places 1790-1940

Julie Collins

• Publisher: Routledge
• Year: 2020
• Print ISBN: 9781138625372
• eBook ISBN: 9780429862342
• Edition: 1
• Topic: Architecture
• Subtopic: Architecture General

The Architecture and Landscape of Health explores buildings and landscapes that were designed to treat or prevent disease in the era before pharmaceuticals and biomedicine emerged as first line treatments. Written from an architectural perspective, it examines the historical relationship between health and place through the emergence of dedicated therapeutic building types from the late eighteenth to the early twentieth century, a time when the environment was viewed as integral to the health of both the individual and the population.

This book provides an overview of ideas surrounding health and place and their impact on architecture and designed landscapes. Different therapeutic buildings and places are examined, including public parks, asylums, sanatoria, leprosaria, quarantine stations, public baths and healthy homes. Each chapter outlines the medical context, common therapies, a history of buildings designed in response to these, and an examination of how such places were perceived to have functioned. Illustrated using geographically and temporally diverse examples, the book includes designs drawn from locations across the world including Europe, the Americas, Africa, Australia and Asia.

The Architecture and Landscape of Health identifies and examines moments in the conversation between health and design, and is a timely look back on the resultant buildings and places, offering insights which could inform the design of therapeutic places of the future. An ideal read for researchers, academics and upper-level postgraduate students interested in architecture, and architectural history, particularly relating to healthcare design and medical history.

1 Introduction

Aboriginal and Torres Strait Islander readers are advised that this publication contains images and voices of people who have died.

The Architecture and Landscape of Health explores buildings and landscapes that were designed to treat or prevent disease in the era before pharmaceuticals and biomedicine emerged as first line treatments. Written from an architectural perspective, it examines the historical relationship between health and place through the emergence of dedicated therapeutic building types from the late Enlightenment to the early bacteriological era – a time when the environment was seen as integral to the health of both the individual and the population. In doing so, this book shifts its gaze from archetypical hospitals, to buildings and landscapes that have historically received less attention but which were none the less designed and built for the public good.

During the period which stretched from the late eighteenth to the early twentieth century, buildings and landscapes were seen as instruments, of both disease prevention and therapy, and as such, architects often designed health-related buildings in close consultation with medical professionals. The book identifies and examines moments in the conversation that transpired between health and architecture. In doing so it affords insight into the ways in which architects and medical practitioners collaborated to design therapeutic and preventative environments.

The Architecture and Landscape of Health begins with an overview of ideas surrounding health and place and their impact on architecture. Chapters then examine a range of therapeutic places and building types: public parks, baths, asylums, sanatoria, leprosaria, quarantine stations and homes. Each chapter outlines a health-related need or medical problem, common treatments of the time, buildings and places designed in response, and an examination of how these environments were designed to function with respect to health; each illustrated using geographically and temporally diverse examples.

By the mid-twentieth century, however, many of the profiled building types were being made redundant by shifts in knowledge, attitudes, and emerging biomedical and pharmaceutical approaches to treatment. With renewed interest, though, in the role of the environment and designed places for health and wellbeing, this book provides not only a meditation on the historic buildings and landscapes during a period when place was seen as a vital component of the prescription for health and wellbeing, it also provides a lens that may inform the design of the therapeutic places of the future.

A bridge between architecture and health

Siegfried Giedion in his work Mechanization takes Command wrote “There is no lack of work tracing the broad political, economic, or sociological trends of our time. Specialized researches into the various fields are also available. But few bridges have been thrown between them” (Giedion 1970: 3). The Architecture and Landscape of Health aims to do this, by tracing the impact of understandings and developments in health and medicine on the design of buildings and places. In doing so it brings a range of specialist medical buildings and health related places together into one volume. While many publications have dealt with a single type (e.g. parks or sanatoria) or a case study (e.g. Bethlem Asylum), this book aims to bring several types together in order to establish patterns they may have in common, both built and socio-cultural. In order to achieve this, narratives from medical sources associated with the architectural development of the buildings have been examined. In doing so, it is hoped that The Architecture and Landscape of Health will provide a useful text for both those who wish to gain an overview of the impact of architecture in the history of medicine and health sciences, as well as those interested in the designs of specific building types.

Too often, architect designed buildings have been assessed from an aesthetic or stylistic perspective without a full understanding of the rationale behind the designs. However, it can be seen in the buildings designed for health, that the foundations of their planning, aesthetics, services, and materials were commonly related to understandings of medical theories and treatments common at the time of conception. Concurrently, roles played by the community, the public, doctors, medical texts and journals, have been infrequently considered in architectural writings which prioritise stylistic or architectonic theories as the guiding principle behind built expression. This book aims to explain for an architectural audience the health-related rationales behind buildings in a clear and understandable manner.

Frequently architectural histories take a reductionist standpoint on explorations of individual buildings, ignoring the context and landscapes in which they are embedded and co-form. An aim of The Architecture and Landscape of Health is to examine buildings in their landscapes, since it has become evident that the surrounding environment is critical to understanding the intentions behind, and functions of, the buildings investigated. Another of the book’s key aims is to use examples from across the world that demonstrate local interpretations of the building types examined, including lesser known buildings.

Ultimately, this book suggests a reappraisal of the historic buildings designed for health, both for the potential it may hold for understanding lost building types, as well as for solutions it may offer to our current day problems. Many historic health buildings are under threat from demolition or neglect, yet interest in them has been growing, particularly in the case of asylums and sanatoria which have recently garnered much interest as abandoned sites. With these now being recognised as culturally significant, the reuse of these types of buildings has led to an increased demand for information on their history. The Architecture and Landscape of Health suggests that a reappraisal of ideas from the past, by looking at how designers dealt with the treatment of disease and as well as illness prevention when cures were not available, could be valuable in opening up opportunities for health and wellbeing through the design of contemporary therapeutic architecture and landscapes.

“Therapeutic landscapes” and “curing machines”

This book explores ideas that have informed the design of places intended to improve the health of the population and highlights the importance that was assigned to place as an instrumental part of treatment. William Gesler’s (1993) concept of “therapeutic landscapes”, which is a now well-established approach to environmental history and analysis, has been used as one guiding framework to ground this book. Using the “therapeutic landscapes” concept as a method of analysing “natural and built, social and symbolic environments as they contribute to healing and wellbeing in places”, this book investigates the functioning and physical expression of purpose-designed buildings and landscapes in light of their perceived health benefits (Williams 2007: 1–2). It also explores the role medical and scientific knowledge played in the design of these buildings, with a focus on the impact of medical professionals, as both client and consultant for the architectural and landscape works.

Within the following chapters examples of places designed for health have been analysed to explore how health related ideas were achieved. Particular attention has been paid to the ways in which buildings were anticipated to perform, and the physical manifestation of these expectations within the buildings and their landscapes. Likewise, evidence of socio-economic, cultural and political factors has been used to contextualise and provide insights into the promulgation of ideas behind the construction of these places. In recognising architecture and landscape as cultural artefacts from which histories of disease, medical knowledge and practice can emerge, this book demonstrates how the study of places can provide insights into the changing conceptions of links between place and health (Adams, Schwartzman, and Theodore 2008).

The theoretical framework for this work additionally encompasses the notion that during the eighteenth century hospitals and healing environments were recast as places of “therapeutic action” and as “les machines à guérir” – “curing machine[s]” (Foucault 1980: 180) becoming “not simply the place of the cure, but also an instrument of the cure itself” (Elden 2003: 245). It has been proposed that “hospital architecture [is] a form of medical technology”, a proposition which has been extended to the analysis of the places to be examined in this book (Adams, Schwartzman, and Theodore 2008: 911). Indeed, furthering Giedion’s belief that, “[t]ools and objects are outgrowths of fundamental attitudes to the world”, architecture and landscape can be perceived to be outgrowths of ideas and attitudes as well (Giedion 1970: 3).

This book concurrently argues that many of the places examined functioned not only as instruments of therapy, but also of prevention. Moreover, based on the theory of place as instrument or “curing machines” – both therapeutic and preventative, the analysis in the book has taken the medical understandings of the time and used them as cues for architectural exploration. Some of these have been applicable across all building types, for example ventilation, segregation, hygiene, discipline, and education. While others were found to be specific to certain places, such as sleeping in the open air for pulmonary tuberculosis, and legislated isolation for leprosy.

The book aims to explain to those interested in architecture how the buildings were intended to work to improve the health of the users or inhabitants. In doing so it concedes that since the late twentieth century historians have explored the difficult histories of many of the places designed as health settings, debating whether they improved the lives of their inhabitants, or oppressed them. Thompson and Goldin (1975: 69) in their wide ranging overview of hospital designs remarked that, “Hospitals have a way of being conceived in glory, executed with ingenuity and humanity, then subjected in use to misuse and abuse, finally to be overcrowded and understaffed and always and forever plagued by insufficient funds”. In particular, asylums, sanatoria, quarantine stations and leprosaria have been singled out for censure; however, critiquing architecture through the judgment of what occurred within the walls can be problematic.

Within the realm of architectural history, it can be argued that to decode physical designs, such places need be examined within the context of the intentions of their founders and within the historical setting from which they emerged. Historian Barry Edington has explained that, with regards to asylums, while their history included cases of abuse, “these were not the wishes of the builders nor the intention of the building” (Edington 1997: 92). American historian Gerald Grob also noted the faults of these institutions, but seeing them within the social context of the intentions of their founders, he stated that it is useful to “separate intentions from subsequent developments” (Grob 1977: 39). These intentions can tell us much, with physicians and architects of the era in question strongly believing that buildings were one of the most efficacious tools at their disposal for the treatment of the many health conditions that they faced. That said, no matter how well intended, the treatment of individuals within these places often fell short of the ideal for a multitude of reasons; a facet that provides pause for thought in uncritically valorising these buildings and the thinking behind them.

During the period of time that this book covers, the language and terminology used to discuss people with health problems can often be seen to be derogatory and offensive. Variously the terms and phrases that were applied reflected the attitudes of the time, providing an insight not only the ways in which people and their illnesses were perceived, but also illuminating the places they inhabited and the treatments they received. Today these terms carry the weight of centuries of mistreatment and judgement. However, following historical convention, the language and terms of the time are used here.

Extensive use has been made of primary sources drawn from the archival collections held by architecture museums and archives around the world including surviving architectural plans, photographs, books and ephemera, as well as items from specialist medical collections and local history collections. Many of these collections have significant digitally accessible holdings which are enabling research to be carried out that would have in the past been prohibitively expensive and time consuming.

Time and type

George Rosen in his influential A History of Public Health defined the period of Industrialism and the Sanitary Movement as falling within the dates 1830 to 1875. This book seeks to extend its timespan further, looking back to encompass influences from the period of Enlightenment and Revolution (1750–1830), and forward into the Bacteriological Era (1875–1950) (Rosen 1958). With the advent of the Industrial Revolution, and colonial and urban expansion, the relationship between health and place became increasingly complex. The nineteenth century saw ideas around the relationship between an individual’s body and the surrounding environment more closely examined, with environmental reform and the sanitation movement focussed on improving living and working conditions. During this time many health-related buildings and landscapes were purpose-designed by architects in consultation with medical professionals, including public parks, public baths, quarantine stations, asylums, leprosaria, sanatoria and homes. Therapeutic buildings and their grounds record the role that the architecture played in treatments which involved among other mechanisms: isolation, social segregation, exposure to nature and fresh air, and recreation, occupation and exercise. These were years of significant innovation, with designs reflecting understandings of health, treatments for disease, technical improvements in engineering, planning and construction, as well as the transmission of ideas around the world.

Organisation of the book

The Architecture and Landscape of Health opens with an overview of health and place through history, covering salient points on the main period of the book, from the late-seventeenth century to the mid-twentieth century. Following this, chapters are arranged by architectural type with those covered including: public parks, public baths, quarantine stations, asylums, leprosaria, sanatoria and homes. A synopsis of each of the main chapters follows.

Chapter 2, “Place as prescription: health and the designed environment”, reviews historical notions of health and place, covering progress in thinking during the eighteenth and nineteenth centuries including: Enlightenment ideals, the Sanitary Movement, Germ Theory, and the recognition of the importance of place in the emergence and promotion of public health. It also touches on the progression of ideas into the twentieth century where the focus of doctors, architects, planners and engineers moved to scientific and hygienic conditions. This chapter furthermore surveys the health-related rationales for architects’ designs, exploring the common influences on the functional design and appearance of therapeutic buildings and landscapes.

Chapter 3, “Fresh air, reform and exercise: early public parks and the health of the people”, examines the development of public parks in the eighteenth and nineteenth centuries when social, industrial and economic changes in towns and cities began to substantively impact the public’s health. It was a time when social and sanitary reformers looked to open spaces as “urban lungs” to ameliorate pollution and become restorative environments for the working population. Parks were additionally viewed as didactic spaces where the lower classes could engage in socially acceptable recreation. Over time the parks movement gained momentum, supported by landscape designers, social reformers, architects and town planners. Ornamental gardens, walking and riding paths, statues, woods and plantations, playing fields, playgrounds, gymnasia and memorials were all components of public park landscapes.

Chapter 4, “Cures, cleanliness and recreation: public baths and wash-houses”, examines the complexes associated with public bathing, including hammam, hydropathic resorts, sea baths, public baths and wash-houses, and swimming pools. The association of health and healing with water has a long history, dating back to Ancient Greece and Rome and even further in Asia. By the eighteenth century, physicians were recommending “taking the waters” – both bathing and drinking – as a cure for many diseases and disorders, from gout to arthritis. With Sanitary Reform in the Victorian period, public baths were viewed less as health resorts solely for the wealthy, and more as facilities associated with cleanliness for lower classes, with laundry facilities, or wash-houses, increasingly provided.

Chapter 5, “Mirroring the spread of epidemics: quarantine stations and lazarettos”, explores how quarantine stations functioned to examine, quarantine, isolate, disinfect and treat travellers and cargo in order to contain infectious diseases such as plague, cholera and yellow fever. The earliest quarantine stations built in Europe in the fifteenth century were associated with maritime ports. Often located on islands or peninsulas, quarantine stations were places where people and goods were held in buildings on site for a mandated p...

Table of contents

• Cover
• Half Title
• Series Page
• Title Page
• Copyright Page
• Table of Contents
• List of figures
• Acknowledgements
• 1. Introduction
• 2. Place as prescription: health and the designed environment
• 3. Fresh air, reform and exercise: early public parks and the health of the people
• 4. Cures, cleanliness and recreation: public baths and wash-houses
• 5. Mirroring the spread of epidemics: quarantine stations and lazarettos
• 6. Moral treatment and non-restraint: asylums for the mentally ill
• 7. Isolating the individual: leprosaria and Hansen’s disease
• 8. The open-air treatment: tuberculosis sanatoria
• 9. Sunlight, space and surfaces: healthy homes
• 10. Ideas from the past
• Index