In this blog, medical student Isabel Raynaud reflects on the history of healthcare design and considers some of its lessons for the present day.
The corridor stretched ahead of me – long, airless, devoid of natural light. The décor, reminiscent of a more hopeful time, now seemed eerie. The brightly coloured footprints on the floor and cartoon characters capering across the walls, intended to be jolly, struck an uncanny and sinister chord. Initially, it was unclear why, but looking closer, details came into view, justifying my unease. The tarpaulin membranes sealing once open doorways, the abundance of increasingly urgent warning signs and the layered mustiness of stale air and disinfectant collided jarringly with the garish decal-littered walls. This ward, once so bright, was now a much darker, more ominous space…
This is my recollection of a fleeting moment, earlier this year, when I was taken up to a Covid ward in a central London hospital. This ward, designed for paediatric patients, had recently undergone an urgent transformation to accommodate a different clientele – adult Covid patients. I found my experience of the ward alarming, even as a medical student who has spent plenty of time in similar environments. I could only imagine how patients, vulnerable in their sickness and distance from the familiarities of home, might be made to feel by these surroundings.
This brief and surreal glimpse into an environment of such stark contrasts brought home the core principle of my BSc dissertation, a medical history study that I wrote last year as part of an intercalated degree for medical students. My dissertation found that spaces, consciously and unconsciously, convey meanings, sometimes with deep visceral effects on their inhabitants. I explored the design of two twentieth-century British sanatoria – the Brompton Sanatorium, Frimley and the Papworth Village Settlement, Cambridge – investigating how they reflected the social views and intentions of their designers and considering the impacts this may have had on their patients. By reviewing archive material, architectural plans and the publications of their medical directors, I was able to address broader contemporary medical issues: segregation, institutionalisation and authority.
The sanatoria I studied each had a design ethos aimed to address the societal complications posed by tuberculosis in the poor. They both took influence from the open-air movement, aiming to remove patients from the bustle and squalor of industrial cities to bucolic, green and – critically – remote environments. Both of them utilised work as the basis of their therapy, with Frimley using its medical authority to oblige its patients to dig gravel and Papworth initiating a scheme where recovered tuberculosis patients lived and worked in a modern industrialised village. The differences in design are critical. Frimley’s design was an anachronism, taking influence from asylum architecture. It had an imposing edifice, full of meaning to incoming patients, putting them in their place by taking them out of place. Papworth, conversely, emphasised its egalitarian values through its design as a fully independent working village. It still removed patients from healthy society, but it also allowed them to escape the prejudice of the outside world and flourish, despite their diagnosis. In their designs, the medical directors positioned themselves at opposing ends of a spectrum in terms of their response to the danger posed by their patients. Frimley prioritised aspects of protection of the public and Papworth protecting the patients themselves.
Through my spatial analysis, I disentangled how these principles influenced design, considering the impacts on the patients within. Just as my visit to the Covid ward left a deep impression, patients at Frimley and Papworth would have experienced conscious and unconscious responses to their surroundings. The lack of patient voice represented in primary sources makes it hard to know the full extent of these effects, but with the evidence growing surrounding the psychological and wellbeing consequences of spaces, it isn’t challenging to empathise and imagine, either the impacts of authoritarian Frimley or community-based Papworth. These spaces are now crumbling relics, consigned to history – their texture, sounds and smells lost forever. But using the evidence that remains, we can start to piece together a sense of these spaces.
Research is increasingly trying to develop an evidence base for modern healthcare facilities. Reflecting on past design can inform new design – we should be thinking about the meanings represented in the architecture and layout of modern healthcare spaces. Do patients feel supported and equal to their doctors? Or have modern hospitals inherited problems of the past, making patients feel displaced, distressed and dissatisfied? Empowering patients is a key priority in modern healthcare and, as a medical student, I’d like to think we’ve got our own priorities straight today.
Isabel Raynaud is a fifth year medical student at Imperial College with a BSc in Medical Humanities. She has an interest in the history of institutional spaces in healthcare, focussing her dissertation on a spatial analysis of twentieth-century sanatoria. She hopes to remain engaged in architectural projects, recently being involved in an interview project engaging with designers of mental healthcare spaces.
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