It’s always interesting when reading about history to discover that “modern” isn’t always as fresh and squeaky new as we like to think. Although technology continues to change our environment massively, as human beings we still have the same emotions and aspirations our forebears experienced through all the millennia. I revisited this notion just recently, upon reading an excellent history of healthcare design called The Fourth Factor: A Historical Perspective on Architecture and Medicine by John Michael Currie, AIA, FRSH, of the architectural firm EwingCole.

The book was authored to honor last year’s 150th anniversary of the American Institute of Architects. It’s significant that a book on healthcare design was commissioned to observe that august occasion—apparently healthcare design really has arrived as an architectural specialty. In was only in 1946, after all, as Currie tells us, that the AIA membership rejected such recognition of healthcare design, although the editor of Architectural Record at the time noted, “It is a field not to be entered lightly, but soberly, imaginatively, solemnly, and in the fear of God.” Perhaps the arrival of the Academy of Architecture for Health a decade later put a cap on that statement.

Getting back to my original thought, though, the book shows why a “fourth factor” should be added to the famous quote by Hippocrates that the art of medicine “consists in three factors—the disease, the patient, and the physician.” The fourth factor, this book documents, is “place.”

Currie reviews healing places dating back to ancient Egypt and Greece. The book is replete with plans spanning all epochs since. It shows that, one way or another, attention has always been paid to environmental impacts on health. The classic plans displayed include the ancient courtyard plan, the medieval cruciform plan and the pavilion plan—the last being chiefly a 19th-century invention, reflecting the latest scientific findings on infectious disease, and positing open, airy, sunny spaces as healthfully preventative.

Another advance, by a physician named Thomas Story Kirkbride, revolutionized mental healthcare in the mid-19th century by breaking away from the typical shackles-and-chains modality toward prescribing gentle, natural, bucolic surroundings for the “asylums” of the day. Currie notes that Kirkbride’s environmental ideas were superseded by developing pharmaceutical “control” of patients during the early 20th century—but, judging by activity I’ve observed at our sister publication Behavioral Healthcare in recent years, Dr. Kirkbride’s design ideas might be making a comeback.

Personally I’m struck more by how healthcare design in general has swung toward a more humanized scale and attractiveness in recent years. Many of the hospitals from the era between Queen Victoria and Hill-Burton in the United States were and are heavy and monumental, no matter how “pavilion-ized” or otherwise healthful their environments. It’s only within the last few years—and the last few pages of The Fourth Factor—that we see the light, airy, colorful structures so typical of today and so readily observable in our publication.

So “modern” really does mean something. It’s just that the motivations behind it are as old as Man. HD



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