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

 

Picture1
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.

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