Between 1870 and 1940, medicine was transformed, as countless studies have chronicled. The hospital was a key site in that transformation, shifting from a place of charitable care to a modern technological machine for all patients. Yet we still know surprisingly little about the hospital as a building, and how changes it underwent reflected and influenced the shifts in medicine occurring within it. Drawing on examples from the eastern and midwestern United States, but especially from New York City, Jeanne Kisacky's book provides a detailed examination of alterations in design, engineering, and practices that illuminate how medicine became modern. Admirably, the book makes its over 170 illustrations integral to its analysis. Kisacky persuasively argues that the hospital is a valuable venue for exploring the larger medical debate surrounding environment and behavior. As she puts it, “Which creates health—the world we inhabit, or the actions taken within it” (p. 343)? The book oscillates persuasively between building and practice, with neither proving conclusive. Tragically, physicians felt by the 1970s that they had won the battle against nosocomial infections, only to almost immediately (and continuously since) have their hopes dashed. Kisacky provides a comprehensive description of the evolution of hospital architecture, beginning with the standardized ward pavilion designs. These early hospitals were designed to draw on nature as a curative force. Air and sunlight were viewed as elements of the therapeutic environment. As the transformation commences, Kisacky effectively illustrates the debates between and among architects and designers over ward designs, engineering solutions, and nursing stations, as they tried to improve staff efficiency, eliminate infections, and diminish mortality. With the acceptance of bacteriology, the adoption of aseptic and antiseptic procedures, and the advent of technological medicine (with x-rays as the pioneering example), hospital buildings changed. Architects and medical consultants diminished patient space to fit rapidly growing demands for technologies, laboratories, and education facilities—and they had to figure out the most efficient ways for staff, especially nurses, to maneuver through these spaces. Hospitals were repeatedly redesigned, yet were shaped by the debate between environment and practice. For example, Kisacky effectively describes how operating rooms evolved from open-air spaces with natural light to air-conditioned, hermetically sealed rooms with no windows. While the latter room type was typically more effective at limiting infections through a combination of environment and behavior, infections still occurred on a surprisingly regular basis. While the book is a bit redundant and overly exhaustive at times, Kisacky provides a treasure trove of information about the evolution of patient rooms and plumbing, and about operating rooms and nursing units, that illuminates how architecture and practice are no “duality” but, instead, together shape the hospital experience (p. 344). The book is useful not only for the detailed information on evolving hospital design but also for a well-reasoned discussion of critical issues in medical, architectural, social, and engineering histories. © The Author 2018. Published by Oxford University Press on behalf of the Organization of American Historians. All rights reserved. For permissions, please e-mail: firstname.lastname@example.org.
The Journal of American History – Oxford University Press
Published: Mar 1, 2018
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