King's College London
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Nightingale and hospital design

Notes on hospitals

These pages from an early (1859) edition of Miss Nightingale’s Notes on hospitals shows how carefully the logic of what was amiss in contemporary hospital design, and how it might be remedied, was presented to the public, published by JW Parker and sons of West Strand, the publishers of Gray’s Anatomy, in 1858. Miss Nightingale’s pamphlet has endpapers of a lovely Titian red.

The defective designs of existing hospital wards are being discussed on the first two pages: one can see how back-to-back wards, or wards opening onto closed corridors, could prevent the free circulation of fresh air, and actually assist in the circulation of infection. Since the development of antibiotics in the twentieth century, hospital designs have reverted to this sort of architectural density, and many modern hospitals are so entirely enclosed that windows are fixed and ventilation depends entirely upon the artificial circulation of air. Since we seem only with great difficulty to control new ‘hospital diseases’ from resistant bacteria, and what was known in the nineteenth century as ‘Hospital Atmosphere’, there are good grounds to recognise that Miss Nightingale’s horror of such designs may well have been justified.

The second two pages show Miss Nightingale’s ideal view of pavilion plan wards, connected by open corridors, and the arrangement of beds and sewerage facilities. Later designs allowed the sanitary arrangements to occupy a separate sanitary tower attached by a ventilated lobby externally half-way along the ward, so as to ease the distance for patients and nurses to access toilet and washing facilities. The table on the left offers ideal dimensions.

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