The cruciform structure of Renaissance hospitals was religiously inspired, but also had practical purposes. While this allowed all patients a view of the mass being celebrated, it also provided medical staff with a clear view of those in their care. It is uncertain whether this particular design first evolved at the Santa Maria Nuova hospital in Florence, but it soon proved very influential and reappeared in the designs of other hospitals in Italy in the 1400s, including those in Mantua (1451), Brescia (1447) and Cremona (1451).
Over the following centuries, the size of hospitals, especially in cities, greatly increased and often interfered with such innovative designs. This introduced problems of surveillance, but also of maintenance. In England in the 1700s, voluntary hospitals had begun to resemble large houses with three to four storeys. Patients were to be carefully screened on admission, in order to ensure only the respectable ‘deserving’ poor were treated.
In the latter half of the 1800s, more careful surveillance was also introduced to prevent the admission of any infectious cases. The layout of hospitals in general made this difficult. According to Florence Nightingale, the domestic design of hospitals resulted in too many rooms and corners which prevented the circulation of air and allowed dirt and dust to settle. Interestingly, her famous text, Notes on Hospitals (1859), also suggested hospital designers reduce the numbers of cupboards in which staff could hide from their superiors. Both staff and patients had come under the eye of hospital managers.
Though accessible public spaces, today’s hospitals continue to be places of heavy surveillance. They carry a great responsibility to their staffs, patients and the public. Security cameras now hang in most hospital wards, monitoring the activities of staff and patients. They also monitor the comings and going of visitors. The health functions of hospitals have also turned them into sites of information collection.
J Henderson, The Renaissance Hospital: Healing the Body and Healing the Soul (New Haven: Yale University Press, 2006)
C Stevenson, Medicine and Magnificence: British Hospital and Asylum Architecture, 1660-1815 (New Haven: Yale University Press, 2000)