Nightingale’s Notes on Hospitals: The Realities of Implementing New Hospital Layouts in the Nineteenth Century

 

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Figure 1: ‘Plan of St. Bartholomew’s hospital, London, 1893’, in H. C. Burdett, Hospitals and asylums of the world, (London: J & A. Churchill, 1891-1893), Portfolio of Plans, pages unknown, WX100 1891-B95h Vol. 1, The Wellcome Collection, The Wellcome Library, London, online access: https://wellcomecollection.org/works/mpc5fukx?query=st+barts+hospital+plan

 

Owing to relatively good health, the extent of my hospital visits begin and end at the phlebotomy department. Often quick visits, there is no time to study my environment. Yet the layout of hospitals sparked debate in the nineteenth century, so much so that during the latter half of the century, hospital environments changed dramatically. Reflecting on her life as a nurse, Florence Nightingale argued that the ‘wise and humane management of the patient is the best safeguard against infection.[1] In her book Notes on Hospitals, published in 1863, Nightingale applied this theory to hospital construction and layout, calling for all hospitals to provide fresh air, light, ample space and the subdivision of patients into wards and pavilions – this would prevent the spread of disease in hospitals.[2] Yet this perfect image of the hospital was not carried forward completely by planners. Very few hospitals followed all of Nightingale’s recommendations; the realities of existing hospital buildings and their functions meant that most, but not all, of Nightingales’ recommendations were implemented in every hospital.

 

Most hospitals adopted pavilion style wards, in which beds were positioned in long, low ceilings wards, with ample windows to allow for good air circulation. The 1893 plans of Kings College and St Bartholomew’s hospitals show pavilion wards containing no more than 32 beds, just as Nightingale proposed.[3]  Windows were also placed above every bed, giving direct access to fresh air and sunlight. Both hospitals also ensured that each ward was paired with both a scullery and a nurses room, in order to ensure good patient care both day and night.[4] Interestingly, both Kings and St Bartholomew’s were built before Notes on Hospitals was published. Similarly, the 1865 plans of East Sussex and St Leonards hospital show circular ward rooms each with 12 beds and ample light.[5] As the hospital did not move from its site in White Rock Road, Hastings until 1911, the wards could not emulate the traditional pavilion style. The adaptation of established hospitals therefore highlights the flexibility of Nightingale’s recommendations; pavilion wards with good ventilation and around the clock care could be provided in most hospitals.

 

Other recommendations were harder to follow. Operating theatres were very rarely placed between wards, but more towards the back of the hospital. This is the case with both Kings College and St Bartholemew’s.[6] It could be argued that the two hospitals status’ as teaching hospitals had an impact on operating theatre placement; the operations were performed close to student labs and teaching facilities. In contrast, the operating theatre at Swansea General Hospital was placed directly between the wards.[7] This placement is further evidence to suggest that Nightingale’s recommendations were adapted to suit existing hospital buildings; a hospital’s function, whether it provide teaching facilities or simply healthcare, had an impact on the placement of facilities.

 

Rather than being seen as rigid recommendations, Nightingale’s guidelines were adapted to a hospital’s individual needs. Notes on Hospitals became a vital nineteenth century tool that influenced every British hospital to some degree; the realities of hospital layout and functions dictated to what extent.

 

*All images used under the Creative Commons License (CC BY 4.0), taken from the Wellcome Collection’s free online image library.

 

References:

[1] F. Nightingale, Notes on Nursing: What it is and what it is not, (Philadelphia: J.B.Lippricott Company, 1992), p. 20.

[2] F. Nightingale, Notes on Hospitals, (London: Longman, Green, Longman, Roberts and Green, 1863), p. 26.

[3] ‘Plan of St Bartholomew’s hospital London, 1893’ and ‘Plan of Kings’ College London hospital, 1893’, in H. C. Burdett, Hospitals and asylums of the world, (London: J & A. Churchill, 1891-1893), Portfolio of Plans, pages unknown, WX100 1891-B95h Vol. 1, The Wellcome Collection, The Wellcome Library, London.

[4] Ibid.

[5] ‘Plan of E. Sussex, Hasting and St. Leonard’s Hospital’, in H.C. Burdett, Hospitals and asylums of the world, Portfolio of Plans, page unknown.

[6] ‘Plan of St Bartholomew’s hospital London, 1893’ and ‘Plan of Kings’ College London hospital, 1893’, in H.C. Burdett, Hospitals and asylums of the world, Portfolio of Plans, page unknown.

[7] ‘Building plan of Swansea Hospital, 1893’, in H.C. Burdett, Hospitals and asylums of the world, Portfolio of Plans, page unknown.

Review: ‘The Butchering Art’ by Lindsey Fitzharris

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Uk front cover of The Butchering Art – taken from amazon.co.uk

‘The Butchering Art: Joseph Lister’s Quest to Transform the Grisly World of Victorian Medicine’ by Lindsey Fitzharris was an odd book to place so highly on my Christmas list. Nonetheless, Santa delivered and my days between Christmas and New Year were spent entirely in 19th century hospitals, operating theatres and lecture halls. Focusing on Dr Joseph Lister and his implementation of surgical and hospital sanitation against the backdrop of ingrained, grisly practices, Fitzharris’ debut brilliantly captures the influence of Lister’s research and his long journey towards its acceptance amongst his medical peers.

Unlike some academic studies, The Butchering Art successfully captures the everyday reader with its story-like prose, whilst still satisfying the medical historian’s want of in-depth analysis of Lister’s experiments and surgical career. Yet the sheer gory nature of the operations performed and wounds inflicted upon 19th century patients added an extra layer to the story. I think both amateur and professional medical historians can agree, there is no such thing as too much gore – a opinion which Fitzharris seems to agree with!

Lister received significant opposition to his development of antiseptics, mainly due to its precise nature, and the inability of fellow surgeons to implement antiseptic procedures properly. Instead of solely focusing on Lister’s scientific work, Fitzharris has made the wise decision to contextualise Lister’s work within the framework of the 19th century medical profession, and society itself. Without the accompanying remarks on medical school status, the life of everyday men and women, and contemporary medical practices, Lister’s discoveries could have been in danger of looking irrelevant – just as they did to his medical contemporaries.

I would certainly recommend The Butchering Art to anyone interested in Joseph Lister, the introduction of antiseptic into hospitals, and indeed 19th century medical advancements and medical professionals. Medical history students should take particular note of this monograph, due to its brilliant context and engaging account of a important medical figure; The Butchering Art is a fascinating introduction to 19th century medicine.