A journey through the origins and history of hospital architecture

Today we tell you about the historical trajectory of hospital architecture. At ENERO Arquitectura, this type of architecture is the pillar of our services. That is why we have decided to document its beginnings.

If you are interested in learning about our architectural projects, you can review our hospital architecture projects on our website.

Historical tour of hospital architecture: Part 1

A journey through the history of hospital architecture reveals not only the typological evolution of hospital architecture, but also the social transcendence that these spaces have had in different cultures and from different points of view. Although at times they have been linked to spirituality and at others they have been closer to science, there is no doubt about their role in the evolution and transformation of our societies.

We will see how hospital infrastructure has been articulated in different parts of the world and what features have been common to all of them, as well as their main differences. In many cases they were linked to sociological issues, such as demographic explosions, or even political ones, such as the strategic will of the Catholic Monarchs. The architectural project of a hospital reflects the feelings of an era.

Hospital architecture in Egypt and Greece

In this first part, we start in Egypt and its religious approach to these proto-hospitals and then arrive at the most paradigmatic Renaissance examples, such as by Filarete, an important figure in the history of architecture.

In Egypt, in 3000 BC, there were buildings dedicated to the care of the sick. Although they were associated with religion, and therefore not linked to the development of medicine as we know it today, they were relevant. In fact, it is believed that one of the temples used for such purposes, called the Temple of Sais, named for the goddess Neith, housed the first gynaecological school near Alexandria. Thanks to the numerous surviving papyri on medicine, such as the London Medical Papyrus, it has been possible to gather important data, such as the existence of the first important female physicians, Merith Ptah and Pesehet.

In ancient Greece, temples also housed certain medical practices, like in the Asklepion on the island of Kos, which is dedicated to Asclepius, the god of medicine. The building was constructed of two levels and was surrounded by a stoa.

Hospital typologies begin to be differentiated in Byzantium, 4th century:

• Xenodochium (hostel) for pilgrims.
• Gerocomium (geriatric) for the elderly

Nosocomium (hospital) for sick people

• Orphanotropium (orphanage) for children
• Xenodochium pestiferorum (leprosarium) for plague sufferers.

Some examples of this typological diversity are: the abbey Monte Cassino, Italy (529), the Xenodochium in Merida (6th century) and the Hospital of the Holy Spirit in Rome (8th century).

Fotografía de Jorge Fernández Salas en Unsplash

Islamic world

We find valuable examples of hospital architecture from the 8th century in the Islamic world, where medicine gained great importance from a scientific point of view.

These early hospitals were called Bimaristan, which comes from the Persian bimâr, sick, y istan, place, house or asylum. They were secular places with different specialities. They integrated new care concepts, such as music, beauty, visitors and areas for medical students. In Spain there were many examples of these hospitals. In Cordoba, for example, up to 50 hospitals were built in the Islamic period.

Hospital architecture after the 7th century

The great change in the history of hospital architecture arrived in Europe between the 7th and 12th centuries. The concept of the hospital, as we know it today, began to emerge from religion. Its appearance coincides with a demographic explosion in the first half of the 12th century. Then, the concentration of poverty increased in the first cities and the need to care for the sick arose, the origin of today’s hospital.

The concept of care and charity of certain religious orders was a determining factor in the emergence of the first hospitals (Franciscans, Benedictines and Dominicans). Nuns and female servants were responsible for the centres. The few doctors who worked there did so as a charitable act. The scientific aspect of medicine was set aside, and treatments were based on providing rest, warmth, hygiene and food (no medicines were provided).

The furnishings were very simple, usually just a lamp and a bed. Carpets and curtains were rare. The abbey of Saint Gall in Switzerland (7th c.) illustrates the self-sufficiency model of Benedictine monasteries. This abbey includes buildings such as the infirmary, the botanical garden and the blood-letting room (perhaps a prototype of the surgical room).

Other examples from this period are the abbey of Cluny (10th c.) and the Hôtel-Dieu hospital in Paris (7th c.) which is still in use today.

11th and 13th centuries

During the 11th and 13th centuries, hospitals were more focused on the care of the helpless than the sick. The architecture was very closed with rectangular pavilions in the shape of a nave. Men and women were separated. Hospitals varied in size and accommodated people for long stays. The chapel was an important part of the complex, as it was the finishing touch in the naves.

Renaissance

After the Black Death ravaged Europe in the Middle Ages, the Renaissance began, and some important changes came about because of Italian hospitals.

The demographic concentration in cities like Florence, Venice, Milan, and Genoa led to the proliferation of hospital centres at the time. In Florence between the years 1000 and 1500, 58 hospitals were built, with about 1 bed per 40 inhabitants. The centres acquired a new status and became the wealthiest institutions in the city. The size of the hospitals grew considerably, as in the case of Santa Maria Nuova with almost 300 beds.

The architecture of these buildings was based on a cruciform plan and the altar was present and visible from every bed, probably the origin of today’s observation control. The cloister began to be used by the sick, whereas previously it had only been used by the monks. This was the first step towards hospitals being separated from monasteries and becoming places exclusively for the treatment of the sick.

Evolution of hospital architecture: Variety of types of hospitals

During the Renaissance, different types of hospitals coexisted, not only those of religious orders, but for the poor, guilds, orphans, pilgrims, etc. Their staff began to specialise as directors, administrators, clergy, gardeners, doctors and nurses.

One of the most important hospitals of the Renaissance is Santa Maria della Scala in (9th c.) and Santa Maria Nuova in Florence (13th c.).

In the Hospital of the Holy Spirit in Rome (16th c.) we can also see a type of floor plan based on a cross with the rooms on both sides of each arm and the cloisters between them.

Filarete, a great Renaissance theorist and architect, refined the hospital model, bringing together the characteristics of the Ospedale Maggiore of Milan (1456). The project retains two large crosses, and the altar disappears from the centre. Each arm had a speciality and was connected to the exterior through the cloisters. The church now emerged as a building outside the hospital. The religious part began to be separated from the healthcare part. This hospital was the origin of the 16th century hospital layouts in Spain, which drew from Renaissance sources through great Italian architects and were promoted by the Catholic Monarchs. Enrique de Egas, and on occasion, Alonso de Covarrubias built several of them:

• Santa Cruz de Toledo (16th c.)
• The Royal Hospital of Granada (16th c.)
• Royal Hospital of Santiago de Compostela (16th c.).

Extracted from a lecture given by Francisco Ortega, Director General of Enero Arquitectura.