Health and Architecture

The History of Spaces of Healing and Care in the Pre-Modern Era

Mohammad Gharipour, Mohammad Gharipour

• Publisher: Bloomsbury Visual Arts
• Year: 2021
• ISBN:
  9781350217393
• Edition: 1
• Topic: Architecture
• Subtopic: History of Architecture

Health and Architecture offers a uniquely global overview of the healthcare facility in the pre-modern era, engaging in a cross-cultural analysis of the architectural response to medical developments and the formation of specialized hospitals as an independent building typology. Whether constructed as part of Chinese palaces in the 15th century or the religious complexes in 16th century Ottoman Istanbul, the healthcare facility throughout history is a built environment intended to promote healing and caring. The essays in this volume address how the relationships between architectural forms associated with healthcare and other buildings in the pre-modern era, such as bathhouses, almshouses, schools and places of worship, reflect changing attitudes towards healing. They explore the impact of medical advances on the design of hospitals across various times and geographies, and examine the historic construction processes and the stylistic connections between places of care and other building types, and their development in urban context. Deploying new methodological, interdisciplinary and comparative approaches to the analysis of healthcare facilities, Health and Architecture demonstrates how the spaces of healthcare themselves offer some of the most powerful and practical articulations of therapy.

CHAPTER 1

PLACES OF CARE AND HEALING

CONTEXT, DESIGN, AND DEVELOPMENT IN HISTORY

Mohammad Gharipour

The word “heal” is derived from an Anglo-Saxon word “haelon,” which means wholeness. As this root indicates, healing involves a holistic process that requires attention to a patient’s physical, biological state as well as to his or her psychological one, which entails spiritual, mental, emotional, and social needs. In various historical contexts, places of healing have provided therapy to those in physical and mental distress. For the historian, they provide a window into the notions of health, science, and medicine as conceived by various civilizations. Whether housed in monasteries in medieval Europe, appended to Chinese palaces in fifteenth-century Beijing, or designed to sooth their patients with elegant fountains and birdsong in sixteenth-century Ottoman Istanbul, healthcare spaces provide some of the most beautiful architectural expressions of therapy—and reflect the vast, and ceaselessly changing, array of attitudes toward healing that have existed across time. As the majority of research on healthcare facilities has focused on the nineteenth century onwards, healthcare design in the pre-modern era represents fertile ground for new inquiry.

As this book aims to accomplish, an interdisciplinary study of the design of places of care across culture and time would shed light on the multitudinous perceptions and approaches to healing and health that have existed in a range of historical and geographic environments. Hospitals have long reflected the cultural attitudes of their day, as well as the predominant scientific theories and political dynamics in their broader environments. There is much about this wider context that can be teased out from hospital architecture, such as considering how medical developments affect building design and hospitals’ interior spaces, or how the hospital building’s style might overlap and connect with other typologies, to name a few avenues of study. While the spatial practices of healthcare architecture should be viewed in the context of urbanization and urban design, it is equally important to articulate the internal and external changes of architecture that concern cultural and medical configurations.

Primarily, this book asks: what distinguishes pre-modern hospitals from their modern counterparts, and how has evolution in building design occurred historically? While the difference between pre-modern and modern hospitals is somewhat vague and, of course, dependent on geography, a number of distinctive features characterize the era of modern healthcare. These include the shift from caring for patients as a religious, charitable act to active medicalization; the revival of environmental perspectives on disease and health; the rise of public health institutions and policies; emphasis on preventive care; and greater monitoring of patients and medical staff. These transformations have not only changed the design and construction of hospitals in both rural and urban communities but have also produced a design practice that takes into account the measurable physiological and psychological effects of an environment on the people exposed to it.¹

This introductory chapter limns the chronological development of places of care across different geographies to demonstrate the tension evolving between practitioners acting within a worldview shaped by spiritual ritual and understanding of the body and those who adopt an emerging vocabulary of scientific diagnosis and treatment. While it could not possibly substitute for a comprehensive study of hospital history—already covered more masterfully by several extant publications²—the purpose of this chapter is to provide a historical summary, highlight some crucial points on the design of places of healing in various forms, and prepare the reader for the contents of this volume.

Ancient Times

Our knowledge of places of care in ancient civilizations, including the Egyptians, Mesopotamians, Persians, Greeks, and Romans, is limited, although the few historical accounts and artifacts that do exist can help us understand their context, design, and evolution. Medical organizations in ancient Egypt were guided by political states. The strict hierarchical organization of medical practice could have affected the use and design of spaces dedicated to the healing of various populations. In ancient Egypt, special institutions known as “The Houses of Life” trained healers and physicians and compiled medical texts.³ Although physicians were said to have treated the sick in their own homes, tombs were used for more intensive surgeries and difficult procedures.⁴ In the tomb of Ankh-Mahor, known as The Tomb of the Physician at Saqqara, a burial ground in ancient Egypt, wall paintings represent two men undergoing a medical procedure variously explained as a massage or surgery. The Greek historian Herodotus wrote extensively of his observations of Egyptian medical practice after he visited the country around 440 BCE.⁵ Nevertheless, there is not much information on how the design of these spaces would have looked in ancient Egypt.

The medical systems of the roughly contemporaneous ancient Mesopotamian cultures were not as intricate as the Egyptians’ medical sciences. Their medicinal culture depended upon magic and astrology for diagnosis and used magical and ritualistic therapeutics. Mesopotamians believed in keeping a clean spirit and body in order to prevent diseases and in purifying themselves before God. Yet, the rulers in ancient Mesopotamia promulgated surprisingly progressive regulations organizing the healthcare system. Adapting existing edicts, King Hammurabi of Babylon incorporated precepts of managed care into the Code of Hammurabi—a huge stone stele erected approximately in 1780 BCE. The code emphasized the following:

Rates set for general surgery, eye surgery, setting fractures, curing diseased muscles and other specific healthcare services; fees set according to a sliding scale based on ability to pay; owners to pay for healthcare for their slaves; objective outcome measurement standards to assure quality of care; outcome information management to include data collection and evaluation; consumer and patient’s rights to be publicized, explained and made known to all.⁶

The laws of the Code of Hammurabi, especially concerning the setting of fees and malpractice, informed not only Jewish and Islamic law but also were echoed in the modern health policy of the United States. Only a few hundred years before the disappearance of the Babylonians, the Greeks started developing a society in which health was seen as a holistic process, as they believed that the healthy mind existed in a healthy body. According to the historian C. F. Kleisiaris and her colleagues:

Three main categories were observed in the Hippocratic provision of care: health promotion, interventions on trauma care, and mental care and art therapy interventions. Health promotion included physical activity as an essential part of physical and mental health, and emphasized the importance of nutrition to improve performance in the Olympic Games. Interventions on trauma care included surgical practices developed by Hippocrates, mainly due to the frequent wars in ancient Greece. Mental care and art therapy interventions were in accordance with the first classification of mental disorders, which was proposed by Hippocrates. In this category music and drama were used as management tools in the treatment of illness and in the improvement of human behavior.⁷

The Greek tradition of healthcare originated in Asclepieion, a healing temple where the wealthy and famous orator Aelius Aristides was healed in 145 CE after dreaming that the Greek god of healing, Asclepius, had invited him to Asclepieion.⁸ From the evidence, it appears that Asclepieia (healing temples) were mostly constructed in valleys at favorable wooded locations and near natural springs, or near caves outside of towns.⁹ As reflected in the Hippocratic Oath, the Asclepieia based their medical practice on an inclusive approach predicated on “understanding the patient’s health, independence of mind, and the need for harmony between the individual, social and natural environment.”¹⁰

The design of the healing temple reflected the rituals performed within its walls. The sacred land or hieron in the Asclepieion was always marked by an enclosure, called a temenos, separating it from secular spaces by a wall or stones surrounding the whole complex. A roofed gate provided access and opportunities for prayer. The roofed gate must have been in proximity to water basins that allowed guests to purify themselves symbolically before stepping into a sacred area. The enclosure guarding the sacred land included a temple, an image, and an altar. A few of the enclosures were also built next to a grove, spring, or cave in the countryside.¹¹

In the Greek temples of healing, elected officials were to monitor the temple’s funds and administration, as well as other peripheral buildings. People visited these temples for various reasons, perhaps to petition the gods for the prevention of illness, to give thanks for their good health, or to seek a cure for whatever ailed them.¹² Visiting a temple for healing purposes required following certain preparatory rituals to ensure physical purity.¹³ Sacrifice was an integral part of temple culture in ancient Greece, and it usually took the form of animal killings followed by a ritual meal. Before the slaughter, purified visitors made preliminary offerings to the god by laying cheesecakes, honey, bread, roasted meats, and fruits upon an aperture before the god’s image. In many cases, after this ritual the supplicant would visit a healer, who would inquire into his or her condition, give instructions, and finally deliver a prognosis.¹⁴

Another important building for healing in ancient Greece was the abaton, a long and narrow building where patients slept and rested, with an open portico and oriented to the south. The supplicants lay on the ground, both inside the temple and outside, in the open air. The populous city of Epidauros, which was known for its healing features, had a huge hostel with about 180 rooms. The abaton in this city was located near a sacred well and next to a bathhouse facing east. As Epidauros grew, new temples were constructed in order to stage elaborate festivals, as well as new guest lodgings to accommodate the visitors.¹⁵

Following in the footsteps of the Greeks, the Roman Empire (753 BCE–476 CE) tried to promote public health through sanitation and hygiene not only in Rome but also in their colonies. Grasping the relationship between urban design and architecture on the one hand, and public health on the other, they commissioned i...