Review: Health and Architecture: The History of Spaces of Healing and Care in the Pre-modern Era

This volume is a product of the recent scholarly interest in the architecture of early modern hospitals—charitable institutions dedicated to the poor that were the main component of welfare systems. Attention to the social history of the poor, public charitable systems, and their relation to state building emerged in the 1960s as part of a widespread interest in cultural history and flourished during the 1970s. Authors such as Brian Pullan (Rich and Poor in Renaissance Venice, 1971), Michel Mollat (The Poor in the Middle Ages, 1978), and, a few years later, Bronislaw Geremek (Poverty: A History, 1989) produced landmark works in the history of poverty in early modern Europe.¹

Calls to examine the architecture that housed such charitable systems, in addition to their sociopolitical and cultural aspects, arose in the same years. In an essay published in 1973 on the cruciform hospitals that appeared in Northern Italy around 1450, Philip Foster observed that the study of early modern architecture had traditionally focused on churches and palaces because of the nineteenth-century emphasis on religious sentiment and domesticity.² It was time, he argued, to turn scholarly attention to the architecture of hospitals, which were among the most prominent examples of public architecture. His call has only recently started bearing fruit. Edited by Mohammad Gharipour, Health and Architecture is an important contribution to what is slowly emerging as a subfield of study. The editor has commendably sought to provide an overview of developments in hospital architecture across various continents, and the result is a collection of essays that should prove useful to both newcomers to the topic and scholars familiar with the hospital architecture of some regions.

The chapter by Richard Piran McClary, for instance, examines three hospitals built in the twelfth and thirteenth centuries—in Damascus, Cairo, and Anatolian Sivas—to explain terminology, reconstruct the form and function of hospitals, and examine their links to palatial architecture and medical advances in the period. Among other things, essays such as these facilitate the comparison with contemporary developments in neighboring Western Europe, revealing that while architectural schemes differed, both the social function and the phases of development were similar. The historiographic significance of such comparisons is that they aid in debunking the still-persistent myth that the emergence of charitable institutions was an outcome of either Christian or Islamic religious piety—depending on the allegiance of those professing the myth.

As is often the case in edited volumes, some essays are more insightful than others. An example of the former is the chapter by Nina Macaraig, “Healing by Design: An Experiential Approach to Early Modern Ottoman Hospital Architecture,” which is both at the center of the volume’s declared intention—to investigate the relation between hospital design and medical understanding—and among the essays with the most clearly articulated historiographic aim. Macaraig does not intend to show how “advanced” treatment was in such institutions, a tired trope, but to view them “within the context of three burgeoning fields in Middle Eastern and Ottoman history: the history of the senses . . . , the history of emotions, and the history of the environment” (281).

An equally fresh approach is found in Maggie Bell’s examination of a famous cycle of Renaissance frescoes painted in the hospital of Siena, a medieval institution. Her essay “Health as Harmony: The Pellegrinaio Cycle of Santa Maria della Scala in Siena” explores the possibility that the architectural spaces depicted in the frescoes were meant to amend the perception of the actual architecture, increasing its healing properties.

While not all of the seventeen chapters offer new materials or credible insights, together they form a volume that covers a wide range of topics. The coordination of so many authors cannot have been easy, and the editor took on an ambitious task. Given the breadth of the enterprise, it is perhaps understandable that the organization of the volume is in some cases perplexing.

The book is divided into four sections, each containing four chapters; Gharipour provides an introductory chapter. The editor, however, seems to have been more concerned with preserving that numerical consistency than anything else. Two of the sections, for example, have overlapping titles and contents. Parts III and IV are respectively titled “Typologies: Places of Health in History” and “Architecture: Designing Spaces of Healing.” Both sections, in other words, are about architectural types of hospitals.

A section that is marred by a more substantial historiographic issue is the first, which is titled, with some repetition, “Religiosity: Healthcare in Religious Context.” Before the scientific approach to medical care, faith in healing rested largely on divine intervention. Across cultures and continents, places of healing before modern times all had strong religious components. Dedicating one section to hospitals with such components—which were shared by all institutions—inevitably gives rise to organizational difficulties. The useful contribution by Susan L. Burns, which examines the relationship between Buddhism and the architectural schemes of leprosy hostels in Japan, is a case in point. Included in the third section, on architectural type, this chapter is just as pertinent to the section on religious context.

The editor intentionally avoided a more traditional organization by geographic region and opted for a thematic approach instead. Such an approach can give rise to rich comparisons, provided the themes are carefully constructed. However, readers encounter three chapters on hospitals built in Portugal and the Portuguese colony of Mozambique in three different sections of the book. These essays by Danielle Abdon, Eugénia Rodrigues, and Joana Balsa de Pinho, if grouped together, would have amounted to an investigation into a region that was prolific in hospital construction yet is still relatively marginal in architectural studies—and would have enabled the comparison of institutions built in the motherland versus the colonies. As it is, the reader encounters the three essays by happenstance, while wading through seventeen chapters on widely differing subjects.

Also dispersed across several sections are four essays on early hospitals in the United States and Australia: Ann-Marie Akehurst’s on Quaker asylums, Julie Willis’s on early Australian hospitals, Jhennifer A. Amundson’s on the first maternity hospitals in the United States, and Stuart W. Leslie’s on the transformation of Johns Hopkins Hospital in Baltimore, part of the first research university in the United States, into a modern medical center. Grouping these essays together could have given rise to insights into the establishment of the earliest hospitals built in regions colonized by Anglophone settlers, who shared a common cultural background but provided different responses to the needs of new institutions built in colonized lands. Together, the essays on Portuguese, American, and Australian institutions would have constituted a remarkable examination of colonial developments in hospital architecture.

Other than an organization of topics that is at times confusing and misses scholarly opportunities, the weakest element of the volume is the introductory essay by Guenter B. Risse, which follows a similarly titled one written by the editor, creating some redundancy. Risse is the author of Mending Bodies, Saving Souls (1999), an important work that explicates the social and cultural significance of early modern hospitals, and his participation seems intended to add scholarly ballast to Gharipour’s volume.³ Risse’s evident lack of familiarity with architectural history, however, an obstacle he bravely strives to overcome in attempting to link social purpose to architectural form, achieves the opposite effect. Architectural historians reading his essay will wonder why he was assigned (and why he accepted) such a task. The selection of Risse is perhaps an expression of the newness of the field and the difficulty in identifying experts.

A matter that is not imputable to the editor is the quality of the images. Small, of modest resolution, and exclusively in black and white, they detract from the purpose of the volume—the exploration of the relationship between healing and architectural form. Nonetheless, the publication of the volume in paperback, a more affordable and accessible option, shortly after the hardback edition is laudable.

Such points of criticism should not make us lose sight of the fact that this is an ambitious book that required considerable effort from a single editor. The volume grants a view into an array of cultural, political, and medical contexts that witnessed the establishment of monumental hospitals before modernity. It is a volume that should not be missing from any academic library, or from the libraries of historians interested in the design of public architecture before the modern era.