Reviews Book

Medicine and Magnificence: British Hospital and Asylum Architecture 1660-1815

BMJ 2001; 322 doi: (Published 24 March 2001) Cite this as: BMJ 2001;322:741
  1. Jeremy Hugh Baron, honorary professorial lecturer
  1. Mount Sinai School of Medicine, New York, USA

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    Christine Stevenson

    Yale University Press, £30, pp 312

    ISBN 0 300 08536 2

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    There were more than a thousand medieval English hospitals, almost all modest. From the middle of the 15th century, rulers in western Europe commissioned great new hospitals for their own and their cities' glory, as well as deeds of charity that might secure them and their families life everlasting. Their motives included piety, prestige, and pleasure. Our renaissance ruler Henry VII based his vast 100-patient Savoy hospital on these motives and Italian models. He ensured there were Tudor roses on the gowns of the staff and on the Tudor coloured counterpanes of the beds; the roof and stained glass windows were also of royal quality.


    Large, arched windows illuminated the galleries at St Luke's asylum, London, built 1782-87


    The Plymouth naval hospital of 1757, probably the prototype for the Hotel-Dieu in Paris

    Offering ample precedents, Christine Stevenson focuses on 1660-1815 for her splendid book on the “high” architecture of British hospitals. She concentrates on two Vitruvian principles, commodity and firmness, with little consideration of the third, delight, my specific interest of art in hospitals. Thus she describes how in 1456 the duke of Milan sent his ambassador to Florence, and his architect to Siena, for details of staffing, finances, and layout. I would have added that the duke also learnt that in Siena the sick, poor, and pilgrims would find “pulchros muros” (beautiful walls), so that he instructed Filarete to make his Ospedale Maggiore beautiful as well as functional.

    Stevenson begins with the major attitude of philanthropists in her centuries—that the poor should indeed receive health care, but they were to be segregated from the rich, and there should be no lavishness. My own favourite relevant quotation is from J E Smith in 1793: “Hospitals should not be made too comfortable as the poor would … then be too fond of having recourse to them.” However, in the 15th century, before Stevenson's period, hospitals such as Beaune and Toledo were built with magnificence for both the wards for the poor and private rooms for the rich, because the latter, and their friends and visitors, would be inspired towards charitable activity by the sumptuous embellishment. This is the principle that today successfully drives the Mayo Clinic in the United States, whose grandeur and visible costliness guarantees high quality medical care to prospective patients, as well as large donations from them and their families.

    Stevenson skilfully explores the philosophy, politics, and theology of building new hospitals. She starts with the monarchical glories of Bedlam, Chelsea, and Greenwich, and she cites Peter the Great advising William III to hand over Whitehall to the sailors and keep Greenwich for himself. She then describes the battle of the styles between Baroque, Palladian, and astylar (no columns) designs for the great voluntary hospitals in Britain. Their Protestant charity was based on societal duty, and building committee members had no expectation of immortality. Hospitals in Calvinist Scotland were denied any useless “ornament,” and I have no record of any works of art in those hospitals until the last 30 years.

    All the major British hospitals and asylums of the period have been analysed with contemporary views and plans, rarely solid blocks but mostly courtyard, H or U shape. Stevenson traces the separate pavilion hospital with what we call Nightingale wards (in which I worked until I retired) from the planned rebuilding of the Hotel-Dieu in Paris after its destruction by fire in 1782 to the enlightened international collaboration at the end of the 18th century. The prototype was probably the Plymouth naval hospital of 1757, much admired by foreign expert visitors.

    Most BMJ readers have worked in hospitals (some still pre-1815) and would be enlightened by this excellent monograph.

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