V International Seminar on the History of Hospital Architecture

Hospital Heritage and Healing Landscapes

September 6 to 8, 2023

Anatomical Amphiteatre of the Faculty of Medicine of the University of Coimbra (Campus I) > Call for Papers until February 28th

Radio Pavilion Dr. Mário Neves © Mário Novais (1899-1967).
Undated photograph. Produced during the activity of Estúdio Mário Novais: 1925-1985 [CFT003.62558]
Photograph from the Art Library - Calouste Gulbenkian Foundation

 

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Call for papers

The submission of articles for the six thematic sessions is open to all participants of the V International Seminar on the History of Hospital Architecture (V SIHAH).


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Dates:

15_12_2022 to 28_02_2023: Call for papers

03_15_2023 to 04_15_2023: Selection of articles and return to proponents

15_04_2023 to 30_05_2023: Early bird registration

15_04_2023 to 30_06_2023: Limit for revision of accepted articles

01_06_2023 to 15_07_2023: Late bird registration
 

The modern project of protected life, which assumes a passive body, individually constructed in the opposition between disease and health, is centred on the elimination of disease with the use of the hospital as a fundamental device in biomedical knowledge and intervention. However, health is permanently being reinvented from its social, ecological and political dimensions, and the medicalization of life centred on the individual expands to spaces composed of less static and more complex visions problematized by (re)emerging challenges such as the recent case of the Covid-19 pandemic.
From a biomedical point of view, maintaining a healthy state is centred on an individual's relationship with biomedicine and daily practices associated with preventive medicine and the promotion of health, avoiding periods of hospital stays aiming to cure illnesses. We know today that physical activity, sea bathing, cold/hot energy drinks, swimming or going to the gym are part of individual health experiences, but they also fit into the social and collective construction of health. Shelter, “comfort temperature”, or the interior-exterior continuity of a transparent building, freed from the constraints of the wall and the ceiling, reflect changes in viewpoints arising from economic logic and health governance. They co-exist and go hand in hand with reinvention of biomedicine and public health in view of their challenges in different parts of the world. The transition from curative medicine to preventive medicine reflects a “Copernican revolution” in terms of looking at the body: from healing a sick body to needing therapies to maintain a healthy body, in a permanent effort and attention to the slightest signs or symptoms of degeneration, pain or changes in shape or texture.

Economic and governance logic in health continues to coexist and follow the reinvention of health in the challenges it faces. However, the pandemic has again caused problems in hospitals due to the resurgence of infection, something that seemed to disappear in hospitals due to the remote control of infections. This change is also felt from the point of view of hospital buildings in the growing importance of specialized outpatient services in hospital centres and in the location and access to new diagnostic means. It is reinforced by new imaging centres, or in the great increase in outpatient treatments and surgeries with the consequent minimum length of stay in a hospital environment. This profoundly alters the old notion of the hospital as a place of long stays, of spaces for wards centred on services, or spaces of panoptic surveillance. The study and reporting of these transformations, both of the facilities and of the city, has been the object of work of historians of architecture, medicine and planning. Today, the role of the hospital in the construction of modernity is recognized not only as a facility that, due to its rationality, enables the fight against disease, but also because of a clear architectural image that conveys values of transparency, hygiene of mirrored surfaces, spatial continuity and cross ventilation, which both influenced and were influenced by the modern movement in architecture. This modernity of the facilities is conveyed by its promoters, sometimes doctors interested in hospital constructions, but also by architects and other participants in their elaboration. The interpretation of hospital facilities, in so many cases, involves the observation of photographic albums produced, documenting the final building or a study excursion, the notes at the side of the project drawings on functional or constructive issues, and the exchanges of correspondence. Tracing the design process also informs us about the old aspiration of a fluid, flexible space, adaptable to the permanent changes in organization that the complex hospital building always entails. This spatial flexibility, as opposed to the rigid functional determination so characteristic of the hospital building, is now more necessary, considering the indispensable sustainability of the facilities and the great potential for creating responses to the challenges that healthcare faces today.

The aim of this international seminar is to bring studies of the history of the hospital to the present day and projecting the future, through its specific relationship with health spaces, whether they are a “Maggie’s Centre” or a “third-generation” health centre. The urban placement of hospitals or health facilities, in their proximity to neighbourhood facilities, inserts this daily proximity of the facility into the network of activities and leisure and health spaces, such as the swimming pool or the gym. A strong recent trend towards the deinstitutionalization of some hospital facilities, such psychiatric hospitals or maternity wards, calls into question the fate and necessary conservation of hospital assets. It also allows other forms of conservation and critical reuse of its monoliths, deconstructing the power strategies that gave rise to it.
Debating new urban health spaces – spaces for physical exercise and mental health such as the urban park, the green corridor, the bike path, but also relaxation spaces such as the spa, the viewpoint on the dune walkway, the mountain trail, in short, mental health spaces and devices – thus allows a different framework for the study of old facilities. It expands the field of observation of historical devices for combating disease through the study of their location, the design of outdoor spaces and programmes that are not confined to functional prescriptions, leading to the V International Seminar on the History of Hospital Architecture the Landscapes of Healing in Hospital Heritage.

This seminar is organized in six broad themes, corresponding to an equal number of sessions:

1. The hospital and images of modernity
Hospitals are images of the constant metamorphosis of their architecture, their actors and their designers, just as they are in their materiality and function. They are, therefore, images of change, not only in time and space, but objects of controversy, of proximity or reluctance, or even foci of insecurity or health. These conditions mean that its image behaves not only as a reflection of contemporaneity, but as “indices” of modernity, of response to hygienic concepts, of design for safety or of specificity for the disease. Perhaps considered as healing machines – a controversial concept in itself – they will tend to plasticize their human aspect, of architecture for their users and viewers, namely for their patients. As heritage, they are also plundered and victims of their own image: seeing them as machines, they are quickly replaced and emptied of function, taking with them the images of the body and health to a silent tomb.
Can hospitals have a simplistic or linear reading? Certainly not. This session uses images of hospitals (from the construction of their own image over time), as a propaganda image or, even, how it is represented in its own history. It also has the objective of “seeing” the hospital as a social and political mirror and as an architectural design in the present and in light of its historical evidence, appealing to the current discussion of the hospital in its design and in its programmatic and architectural understanding.

2. Social dimensions in hospital construction: programmes and actors
Throughout history, the need for health care has led to the development of hospital and assistance models derived from social programmes and public policies that, in conjunction with the prescriptions of medicine and hygiene, form guidelines that impact on the planning, design, construction and operation of hospitals. In this context, it is important to emphasize the participation of promoters and actors in the process of designing hospital spaces. The daily habitability of the hospital also requires particular characteristics for medical-architectural programmes; experiences that can raise the levels of quality of care, and improve medical practices. Understanding the complexity of these relationships and uses, which define the needs and ways of caring for patients in hospitals, can contribute to consolidating practices that lead to better projects and an improved image of these models and, therefore, contribute to the diversity and affirmation of medical and architectural evolution. In this context, scientific advances and technological innovations can be incorporated that affect spatiality and form and generate healthy environments.
This session, crossing the contribution of social sciences, architecture and urbanism in the study of the history of hospital facilities, opens new interpretations to the study of facilities by recognizing the role of the various actors involved in it.

3. Reuse of hospital architecture and sustainability
In recent decades, studies on hospitals have gained prominence in research carried out in Latin America and Europe, whether from the point of view of their history, heritage condition, typology, technology or their reconversion. In the years when the world faced one of its worst pandemics, we have seen how much we still depend on hospitals and how necessary it is to study them, historically and contemporaneously. It is necessary to rethink their spaces, their placement in the city, their permanence, their values and ways to make their use more sustainable.
This session seeks the contribution of researchers who reflect on the function and functionality of the hospital, its use and reuse, its sustainability and flexibility, its programme and its typology, whether pavilion, single block or megastructure. Such typologies reflect forms and models of hospital construction over the centuries, but also proposals that can serve for contemporary projects. Their characteristics translate into important, still current elements for configuring and reconfiguring health spaces, such as the adoption of structures, modulations, dimensions and technical solutions; the use of materials and constructive elements; as well as the study of flows and accesses, among others, that deserve the attention of designers, but, above all, of researchers.

4. Health spaces in the city
Health has been a constant concern in state and professional interventions in urban space. Throughout the 19th century, social hygiene and sanitation guided modernization projects and implied new ways of planning the public space, as well as new models for hospital architecture. The formal typology of hospitals organized in pavilions, which initially followed Durand's 19th-century French model of connected pavilions, was rethought to serve different hospital programmes. The change in the logic of locating hospital buildings in cities due to the change at the end of the century from the miasmatic to the Pasteurian paradigm did not happen instantly, and the idea of the hospital as an exceptional enclave remains to this day as a guiding factor in design decisions. However, there is a diversity of smaller-scale health spaces, public and private, that have been created in a more integrated way in the built environment of the city, such as primary care centres, clinics, offices, or even places for physical exercise. Although there is a rich historical literature on the role of health in the planning of public space or hospital architecture, we know very little about these smaller-scale, sometimes more private health spaces in the city. The recent pandemic, however, returns us to the old questions of typology and logic of location, and to think of health spaces in the city from their potential as salutogenic places. This idea is radically opposed to the thought of spaces and urban exchanges as facilitators of the spread of diseases.
This session seeks the contribution of researchers on the achievement of salutogenesis in public spaces, aiming to encourage collective reflection on the future of health in cities and contribute to the creation of places for physical and psychological well-being.

5. Deinstitutionalization of nocosomal architectures
Deinstitutionalization favours preventive and outpatient medicine, and aims to reduce long periods of hospitalization. The challenges posed today to the architecture of hospital buildings are thus linked to the processes of deinstitutionalization in areas such as psychiatry and mental health, or maternal and child health care, based on health policies oriented towards the provision of care for primary health care and health promotion initiatives with community-based approaches. However, in areas such as infectious diseases, as the COVID-19 pandemic has shown us, deinstitutionalization depends on other variables, and finds solutions in broader and more inclusive proposals such as John Weeks' "hospitals of growth and change".
Based on experiences in Latin America and Europe, participants are invited to present about:
- the deinstitutionalization of hospital architectures combined with a critical reflection on biomedicine (centred on disease and cure) and care (based on expanded visions of health);
- the connections between the architecture of hospital buildings/health facilities and the growing guidelines of health policies for the provision of primary health care;
- the importance of health facilities and care systems and practices (biomedical and non-biomedical) that expand the clinical encounter and promote the creation of multiple places of care, thus renewing spaces for health and social mobilization in the territories where people live (central to the deinstitutionalization processes).

6. Healing landscapes
There was a time when a simple stay high in the mountains was a healing process, as was the case with treating pulmonary tuberculosis. The recourse in high mountains, in search of pure and dry air, led to the design of architectural galleries for the deposition of patients, at prescribed times, seeking a passive immersion in a healing environment through the architectural device. The spatial segregation of the rooms corresponded both to the necessary purity of the air and to the depaysement of the sick, freeing urban or industrial concentrations from active outbreaks of infection.
The recent Covid-19 pandemic has reminded us, at a worldwide level, of the mandatory spatial confinement of urban areas as a condition for controlling infection. This confinement, which at times assumed the radical impediment of leaving the house, apartment or accommodation, came to remind us of the indispensable need for a neighbourhood garden for a minimum of daily exercise, outdoor public space for walking the dog, green space for stretching one’s gaze and feeling the continuity of life despite the suspension imposed by the fight against the disease. Public health, the health of the inhabitants and the urban space oblige us to rethink the qualification of public space and its active role in the physical and psychological well-being of the inhabitants, but it also implies a different perception of the role of hospital facilities, considered in a dimension of health rehabilitation.
This session is dedicated to the role of landscapes, including urban landscapes and the city, in the conservation or active recovery of health, urgent as they are in rethinking a new role for hospitals.