The Architecture of the Hospital: A Study of Spatial Organization and Medical Knowledge

The paper opens with a review of recent developments in the sociology of spatial organization and after an examination of the ontological and epistemological assumptions which are embedded within current theorizations of space a number of arguments are advanced concerning the inter-relationships which hold between forms of knowledge, social practice and physical design. Using architectural plans, these arguments are then developed with reference to the study of the spatial organization of hospital wards in three contexts; the care and treatment of children, the containment of madness in the pre-1845 period and the management of psychiatric patients 1973-1982. The paper concludes that schemes of spatial organization are best understood in relation to the discursive practices -of which they form a part rather than as decontextualised and reified social facts which exhibit their own 'logic'. I SOCIOLOGIES OF SPACE The study of the social organization of space has figured prominently in much twentieth century social science literature, and the sociological account opened by Durkheim and Mauss in 1903 has been meticulously augmented throughout the twentieth century by a wide range of work from both European and North American scholars. In fact, and in marsy ways, it is an account which has given rise to an entire sub-discipline within the wider compass of sociology itself; namely that of urban sociology. The emphasis upon urbanism has, however, meant that the overwhelming bulk of the work has been written within the framework of modern geography, rather than of, say, Durkheimian sociology. Consequently, the primary focus of attention has been on the spatial relationships which exist between b.uildings, settlements, land holdings and the like upon landscapes The British Journal of Sociology Volume XXXIX Number I This content downloaded from 207.46.13.147 on Fri, 20 May 2016 07:26:10 UTC All use subject to http://about.jstor.org/terms The architecture of the hospital 87 in the widest sense of that term. Indeed, even within the most recent writings on spatial structures, such as those of Gregory and Urry (1985), (which claim to radically reconstitute the sociology of space), and Smith (1984), geography remains indelibly imprinted upon sociology's manifesto. Yet there is a case to be made for a sociology of space rather than a sociological geography and that case has also been recently represented; especially in the work of such writers as King (1980), Hillier and Hanson (1984) and, to a lesser extent, Giddens (1984, 1985). In this newly conceived sociology of space it is the internal structure of buildings as much as the settlement of landscape which provide the foci of attention, and it is inter-mural rather than extra-mural surfaces which constitute the planes on which sociology inscribes its analysis. It is just such a sociology of space which I wish to follow through in this paper, and I wish to do so by concentrating upon the architecture of the hospital. Hospital architecture is, of course, capable of many and varied forms of expression, and so in order to underline the several arguments which are contained in this paper I intend to concentrate on a few specific examples of architectural design as it appears in the hospital ward. My first examples will be drawn from paediatric wards and my later examples from what might be called 'asylum' architecture. The latter examples are especially interesting because, unlike the children's wards, they are drawn from a range of hospitals which in different ages have been known by a variety of names, and the revisions of nomenclature are undoubtedly correlated with revisions of design. Indeed, it could be argued that their changing architectural forms help in many ways to define the objects of therapy which were, or are, to be found within their walls and it is a point which I hope to elaborate upon in my discussion of two specific stages of such architecture viz the Asylum during the 1807-1845 period and the Psychiatric Unit 1973-1982. But before I actually turn to an examination of such architecture I would like to outline some sociological principles which can be applied to the study of spatial structures. Without doubt, some of the most fascinating developments in the sociology of space emanated from work carried out by the Durkheimians during the first few decades of the present century, and it is that work which offers the most fruitful starting point for any sociological consideration of spatial relationships. Durkheim and Mauss (1963), for example, in a sociologized version of Kantianism argued that space and time were ultimately forms of social categorization and, more importantly, that such categorizations expressed, 'under different aspects the very societies within which they were elaborated' (1963:66). Classificatory schemes were therefore modelled upon forms of social organization and human cognitive processes were assumed to have a social base (Durkheim 1915). The genius ofthe Durkheimians, This content downloaded from 207.46.13.147 on Fri, 20 May 2016 07:26:10 UTC All use subject to http://about.jstor.org/terms