Cameronlogan 2010

International Travel as Medical Research: Architecture and the Modern Hospital
Author(s): Cameron Logan and Julie Willis

Source: Health and History, Vol. 12, No. 2 (2010), pp. 116-133
Published by: Australian and New Zealand Society of the History of Medicine, Inc
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International Travel as Medical Research:
Architecture and the Modern Hospital
Cameron Logan
Julie Willis
The design and development of the modern hospital in

Australia had a profound impact on medical practice
and research at a variety of levels. Between the late
1920s and the 1950s hospital architects, administrators,
and politicians travelled widely in order to review
the latest international developments in the hospital
field. They were motivated by Australia’s geographic
isolation and a growing concern with how to govern
the population at the level of physical health. While
not ‘medical research’ in the conventional sense of the
term, this travel was a powerful generator of medical
thinking in Australia and has left a rich archival legacy.
This paper draws on that archive to demonstrate the
ways in which architectural research and international
networks of hospital specialists profoundly shaped the
provision of medical infrastructure in Australia.
The connection between health and architecture has been long

established, with medical and architectural professions both aware
of the importance of appropriate building in the mitigation of ill-
health. At different times debates about the significance of salubrious
environments for questions of the public health have been so
prominent that the ambits of the professions have stretched to
encompass aspects of each other. Indeed this overlap has variously
been the source of competition and fruitful collaboration, an indicator
of evolving professional pride and status as well as of shared areas
of concern.1
In Great Britain in the 1870s and 1880s doctors helped to
transform the architectural and building professions. They did this
by emphasising the sanitary flaws in ordinary dwellings and by
taking a systematic view of buildings. In some cases they not only
pointed to systematic problems with drainage and ventilation, which
in their view were the basis of many eradicable health problems, but
they even designed new buildings to conform to sanitary principles
116 Health & History, 2010. 12/2

Architecture and the Modern Hospital 117
by eliminating ‘bad air’ and unhealthy waste. Underlying the
doctors’ critique of the British built environment was the belief that
architectural and building practices in the period lacked scientific
principles and a systematic approach to the problems of health.2
This stinging rebuke to the architectural profession in the
nineteenth century helped motivate an effort to make architecture
healthy. The second half of the nineteenth century saw unprecedented
attention to questions of adequate plumbing and ventilation, not only
in housing but also for schools, factories, and offices. Such efforts
would naturally reach their zenith in the design of hospitals, where
the containment of illness was the special problem. The advent of
pavilion planning in the late eighteenth century, and its universal
acceptance in the nineteenth—due in no small part to the influence
of Florence Nightingale—pointed to the role architecture might play
in the abatement of ill-health. The pavilion plan, or Nightingale ward
system as it is became known, called for long open wards separated
from other hospital buildings or connected only at one end. Ideally
such arrangements provided for a generous envelope of space around
each individual bed with the aim of ameliorating the harmful effect
of miasma through isolation and the circulation of fresh air.3
But while the pavilion plan was a fundamentally spatial idea that
deeply influenced hospital layouts and organisation, it was not an
idea that demanded great architectural expertise. In fact it was the
period from about the 1880s until World War II that saw the most
sustained period of professional architectural concentration on the
problem of the hospital. This period not only saw the emergence
of the modern hospital as an institution of knowledge, integrally
connected to university teaching and research, but also a total
reconfiguration of the physical form of the hospital. By World War
II the block hospital or monoblock, arranged vertically rather than
horizontally, was almost universally regarded as the most efficient
solution for large hospitals engaged in acute care, teaching, and
research—the hallmarks of leading medical institutions. Architects
were central to this transformation. Leading hospital architects not
only encouraged shifts in thinking about planning and design, but
also became influential advocates for hospital modernisation and
experts on the myriad technical and organisational challenges facing
twentieth-century hospitals.4
By the turn of the century, a handful of architects had emerged as
specialist hospital designers and, as such, they were at the vanguard
of efforts to create architecture that would play an active role in
118 CAMERON LOGAN & JULIE WILLIS
facilitating best medical practice. Leading architectural practitioners

such as Englishman Henry Saxon Snell, Birmingham-based Henman
& Cooper and North American Edward F. Stevens took a much more
systematic approach to hospital design and construction than had
been conventional, initiating an effort that would see the hospital
recognised as an important piece of healing equipment. One of the
ways they did this was by travelling extensively and consulting with
physicians, hospital boards, and nursing experts who were working at
medically advanced institutions in places such as Baltimore, Boston,
and Berlin. Stevens went so far as to attend, as an observer, as many
medical procedures and surgeries as he could, so to understand every
aspect of the spatial needs of the hospitals he would design.5
By the interwar decades this specialist commitment to
understanding the functioning of the hospital, and the systematic
principles involved in designing a piece of healing equipment, were
sufficiently developed to suggest that architects were in some respects
taking on the role of medical researcher. In Australia, between 1930
and 1950, architects became the leading experts in the procurement of
hospitals, shaping decisions about the appropriate scope, technological
servicing, and efficient organisation of new hospital facilities.
By the late 1920s, there had been such rapid change in the treatment
of disease, including such new treatments as X-ray and radiotherapy,
and in the knowledge of infection that those who sought to create
modern hospitals, including doctors, administrators, and architects,
required extensive and detailed knowledge of the latest research and
development in spatial, medical, and therapeutic practice. Such was
the complexity of the modern hospital that it spawned an extensive
international network of hospital experts that represented a major
collaboration between the medical and architectural professions. The
architectural ambition that informed this effort was not confined to
the creation of salubrious spaces for diagnosis, surgery, and medical
treatment, though these were significant considerations. Specialist
hospital architects believed that architectural design might underpin
the very efficacy of hospital treatment and of health efforts more
broadly.
The international hospital network

The design of the modern hospital was a very particular and quite
daunting task. By the 1920s it had become a highly complex entity.
In addition to the specialist equipment and servicing involved in
industrially-scaled kitchens and laundries, surgical areas, nurses’
stations, and ward areas, there was a proliferation of new modes of
diagnosis and treatment which involved planning challenges and new
medical technologies. There was an ongoing debate about the need to
plan spaces for both hydro and helio-therapy, and rapid developments
in autoclaves, X-ray, and deep therapy. The appropriate model on
which to base the design of surgical spaces was another issue to
consider and one that involved new options and ideas in this period.6
Added to this was the complicated politics involved in leading
hospital boards, the medical profession, and political leaders towards
an acceptance of new ideas and rising standards in the hospital field.
To the ordinary architectural practice, the design of a hospital was
likely to be a one-off project, the firm having few experiences or
nearby precedents (at a suitable standard of medical advancement)
on which to draw. To raise hospital standards through the improved
design of new facilities meant architects and others needed access to
the experience and example of others. It is thus not surprising that
architects deliberately set out to acquire such knowledge in any way
they could and that, over time, certain firms chose to specialise in the
field of hospital design.7
American specialist hospital architect Edward Stevens was at
the centre of a burgeoning American network of hospital specialists,
including doctors, administrators, and architects. Stevens’ travel—
research trips to Europe in 1907 and 1911, during which he toured
key medical facilities—became an important tool in his practice.8
But it wasn’t simply that he had visited many different hospitals
that made his influence so important; rather, it was that he sought
to understand, first-hand, the various medical and organisational
practices contained within the hospital and to educate others about
these through publication, such as his book The American Hospital
of the Twentieth Century (three editions: 1918; 1921; 1928). A
key focus of the network was the American Hospital Association
(AHA), which was formed in 1906, from its earlier incarnation as
the Association of Hospital Superintendents of the United States
and Canada (begun 1899).9 The AHA, like other similar groups that
would follow, was primarily concerned with the modernisation and
efficient operation of the hospital, which included Taylorist ideas
of scientific management. Architects quickly came to play a central
role. In his 1918 book Stevens suggested that,
Hospital planning demands the same careful thought that is the

foundation of any modern, successful business enterprise ... In the
factory the saving of time in any of the processes adds to the annual
product, and in the hospital, likewise, careful scientific nursing,
freedom from disturbing elements and everything that can help early
convalescence, add to the efficiency of the institution.10
In 1913 the AHA launched The Modern Hospital, which quickly

became the leading publication dedicated to the design and
management of hospitals. It contained everything from suggested
menus for ‘diet kitchens’ and graphic discussions of medical
procedures to organisational charts and equipment reviews. It also
regularly published articles on new hospital facilities, including
photographs and plans. All of these aspects—from the organisational
to the built form—were seen as integral to furthering knowledge,
understanding, and facilitation of the best in modern medical practice.
During the early decades of the twentieth century the desirability of
creating wider networks for hospital design and management was
also recognised in Europe. In France, Germany, and Switzerland,
there was arguably a greater emphasis than in the United States on
the hospital building as an instrument of healing, seen especially in
sanatoria, which were the most overtly modern hospitals constructed
in the 1920s and 1930s.11 During the interwar decades the importance
of sharing knowledge and advances within the hospital field was
firmly established as priority on both sides of the Atlantic. It is
perhaps no surprise then that an international hospital network
soon emerged, realised in the form of the International Hospitals
Association (IHA).12 Like the AHA, the IHA understood its role as a
key facilitator of communication and ideas about the modernisation
of the hospital, establishing its own journal, Nosokomeion (from the
late Greek, meaning hospital or hospice), begun in 1930. It was a
truly international forum as reflected in the make-up of its editorial
board, and for the most part it transcended national boundaries and
rising tensions in Europe during the decade of its publication, 1930–
39.13
The importance of these networks to Australians was evident
by their engagement with and contribution to them. Individuals and
institutions subscribed to the journals The Modern Hospital and
Nosokomeion and contributed articles and toured facilities with letters
of introduction from key players in the IHA and/or AHA. Australian
architect and burgeoning hospital specialist, Leighton Irwin, later
to design Melbourne’s Prince Henry’s Hospital, the Royal Hobart
Hospital (1938–40), and Sydney’s Rachel Forster Memorial Hospital
(1936–41), was a member of the Nosokomeion editorial board in
the early 1930s; Arthur Stephenson was a member of the journal’s
building committee in the late 1930s; and (John) Howard Cumpston,
the head of Australia’s new Commonwealth Department of Health,
was an occasional contributor to the journal.14
1926: A watershed year for Australian hospitals

The modernisation of Australian hospitals began in earnest in 1926.
Before that time doctors and designers relied heavily on British
authority and examples to inform the designs of new hospital buildings.
The hospital discourse in Australia closely mirrored conventions
and practices in Britain and was shaped by the conservative British
Medical Association (BMA). By the middle of the 1920s, however,
the assumption that the Australian state chapters of the BMA
were sufficiently expert in the field of hospital development and
organisation could no longer be taken for granted.15
The catalyst for change came in the form of Malcolm
MacEachern, associate director of the American College of Surgeons
and expert hospital consultant who had been invited to Australia to
review the state hospital systems of New South Wales and Victoria
through 1925–26. In Victoria, MacEachern’s visit, under the auspices
of Stanley Argyle, the then minister for Health and later state
premier, signalled a considerable interest in revitalising the state’s
hospitals. MacEachern was quickly convinced of the need for such
renewal. After several days inspecting hospitals around the state he
noted in his diary that ‘there is no person in this whole state with
any great knowledge of hospital construction, organisation or the
numerous aspects of such importance in good hospital management
and service.’16 While MacEachern couched the recommendations in
his final report in very moderate language he suggested a number
of reforms. Amongst the most significant was his encouragement of
the adoption of methods of standardisation across the state. Perhaps
most importantly for architecture he strongly urged hospitals and
governments to find ways to foster specialist expertise in hospital
planning, construction, and administration.17
MacEachern’s visit was thus the direct motivation for a number
of Australians to travel to gather knowledge and experience of
hospitals and other health facilities overseas. In March-April 1926, a
conference instigated by the state government to examine the future
of hospital and medical school development in Victoria was held,
no doubt prompted by the discussions held during MacEachern’s
visit. Professor Richard Berry, the University of Melbourne’s dean

of Medicine, then travelled extensively at the invitation of the
Rockefeller Foundation through Australasia, the United States,
Canada, and the United Kingdom in 1927 examining hospital and
medical education facilities.18
It was not just medicos travelling to gain information as the
result of MacEachern’s visit; others, too, saw the benefit of gaining
knowledge overseas. Within months of MacEachern’s discussions
concerning hospital construction, held at the end of January 1926,
representatives from Melbourne architecture firms were touring
North America to gain hospital expertise. The leaders of sizeable
Melbourne architectural firms, Stephenson & Meldrum and A & K
Henderson, set off on extensive fact-finding trips across the United
States in June and July (respectively) that year. It would set in train
a pattern of gaining both contacts and knowledge that Stephenson
& Meldrum, who subsequently became hospital specialists with a
formidable international reputation, would repeat multiple times.
Arthur Stephenson himself took an even longer trip in 1932–33,
encompassing the US and Europe, taking another four major
international trips between 1937 and 1958. He argued publicly that
Australians must take advantage of international knowledge and
best practice in advancing their medical institutions: ‘The whole
world is open to us to study the facilities they provide for service
in their institutions ...We should build from world standard rather
than flounder away in ignorance at the expense of our institutions.’19
He backed this belief by sending other members of the office (D.K.
Turner and J.D. Lobb) to undertake similar missions to those he had
undertaken and encouraged prospective clients to do likewise. Both
Arthur Baillieu, president of the Committee of the Royal Melbourne
Hospital, and Colonel Fanning the hospital’s secretary-manager
undertook such trips in 1936 as plans were drawn up for the hospital’s
new facility at Parkville. With introductions from Stephenson they
made contacts with leading hospital experts and viewed up-to-
date facilities. Other architects and public servants also travelled
internationally to look at hospitals in this period, among them the
NSW government architect Cobden Parkes and influential Victorian
architect and town planner Frank Heath. But it was the influence of
Stephenson that helped establish such trips as an essential part of
the preparation for commissioning, designing, and procuring new
hospitals in Australia.20
Travels and travails

With a shortage of hospital beds in Australia in the 1920s but limited
funds with which to provide them, Arthur Stephenson had recognised
hospital design as a promising field of specialisation in architecture.
Stephenson took out a personal bank loan to finance his first trip,
taking a number of months to visit nearly sixty-five hospitals across
the United States, looking at their costs, equipment, and advances
in planning and design. Under the influence of specialists such as
Stevens, the design of hospitals in the United States had become
almost a professional discipline in itself, as had the servicing and
running of hospitals. Stephenson perceived these advances as a
revolution in hospital conception and development.21
Stephenson also understood that the architect was responsible
for combining the needs of the medical practitioners with those of
hospital administrators—with their eye on efficiency and costs—
into a workable solution, and thus held a pivotal role in procuring
hospitals.
The expertise gathered on his trip was transferred into two
medium-sized hospital commissions on his return: the Frankston
Orthopaedic Hospital (1929) and the Jessie McPherson Wing of the
Queen Victoria Hospital (1930) and enabled Stephenson to gain a
third substantial hospital commission, St.Vincent’s Hospital in the
inner Melbourne suburb of Fitzroy (1933). This group of hospitals
signified the coming of the modern hospital to Australia. Like the
American hospitals that Stephenson had seen, the innovative aspect
of these new Australian hospitals was their planning and organisation
(that is, their systematic aspects), rather than what they looked like
(the more aesthetic dimension of design). In particular they indicate a
strong movement towards the centralisation of services. Traditionally
hospitals were conceived as a collection of wards, with nurses
overseeing them and servicing them somewhat independently. For
Stephenson the watchword was ‘integration’ in this period, meaning
integration of the various branches of medical expertise into a
system of hospital care and the integration of the different elements
of the hospital building, considered as a system, into an efficient
configuration. This meant centralised kitchen and laundry services,
as opposed to separate service at the ward level; new therapeutic
facilities, such as hydroptherapy that would be available to all the
patients that required it; and new technical servicing so that oxygen
could be delivered direct to surgical areas from a central supply, heat
piped from a central boiler, and electrical signal systems and personal
radio connected to each bedside.22

These innovations all came together in the building completed for
St. Vincent’s. While it did not look that much different to the Jessie
McPherson wing at the Queen Victoria Hospital, its specifications
and block type made it, or so the firm claimed, ‘a showcase for the
future’.23 More than the building itself, it was the research trip that
Stephenson took in 1932–33, a trip directly inspired and partially
funded by the St. Vincent’s commission that laid the foundation for
hospital design in Australia over the next two decades.
Like his trip to America in 1927, Stephenson’s motivation for
travelling overseas in 1932 was based on his desire to research the
latest in hospital planning, equipment, and design, this time with the
specific goal of informing the St Vincent’s Hospital project. His trip
included North America, Britain, and Europe and he saw hundreds
of hospitals and made painstaking enquiries and carefully detailed
notes. His queries were generally concerned with equipment,
running procedures, and costs, but he also interviewed many hospital
staff, both administrative and medical, to understand new medical
procedures and changing administrative processes. He found little
new in America beyond his 1927 trip that impressed him, except in
equipment developments. Similarly in Britain, he found little that was
useful, although he remained faithfully optimistic that developments
there would be forthcoming. It was in Europe that Arthur Stephenson
saw the most interesting developments.
Stephenson was so impressed by his trip that he wrote up his
observations in an article titled ‘A Tramp Abroad in the Hospital
Field’, which was published in five parts in the respected American
journal The Modern Hospital. The article describes Stephenson’s
journey through Italy, Switzerland, Austria, Poland, Germany,
USSR, Sweden, Denmark, France, The Netherlands, Finland, and
other European destinations. Stephenson described that ‘in the
planning of hospital departments revolutionary developments have
taken place. Some of these are due to the advances of science, such
as deep therapy and the use of radium, but the greatest development
has been in the direction of obtaining more light and air for the
patients’.24 Stephenson had particular praise for a number of German
hospitals and the now-famous Paimio Sanatorium, in Finland, then
under construction. Stephenson described Richard Döcker’s small
Waiblingen Hospital (1928), near Stuttgart, as ‘a terrace type hospital
... that allows patients to be wheeled through the great sliding window
sashes of their rooms on to the open terraces.’ While conceding that
this was an expensive way to build a hospital he also noted that it
was ‘an extremely attractive way to build and if it can be proved that
patients generally benefit by such treatment, then we may well study
such plans’ (See Image 1).25
Image 1: Waiblingen Krankenhaus, near Stuttgart, Germany. Architect:

Richard Döcker 1926–28. Photograph: Richard Docker, 1928. (Source:
Sigfried Giedion, Befreites Wohnen: 85 Bilder, [Zurich: Orell Füssli Verlag,
1929])
Stephenson’s approach to his research trips was to be thorough and

systematic. He used the contacts he made along the way to open new
doors for him and met as many involved in designing and working
in hospitals as possible. He travelled, mostly, with his secretary in
tow, which allowed him to write copious letters to equipment and
hardware suppliers to obtain catalogues and specifications. Where
he could, he obtained copies of plans of other hospitals as well as
statistics, to further understand the requirements of a modern hospital.
Well-known for his personal style, Stephenson no doubt charmed his
way through hundreds of institutions and many of the connections
he established would last for decades to come: one German supplier
forwarded him copies of Hitler’s speeches; and the hammer and
sickle badge he received from his foray into Russia in 1932 is still
held in his papers at the National Library of Australia. As a result
of his travels, his firm began to build an extensive library of trade
and medical literature, which would be the foundation of a research-
based approach they would employ for decades to come.26

Although the 1932–33 journey had ostensibly been as a research
trip for St Vincent’s Hospital, it turned out to be a turning point in
Stephenson’s career as a whole. He incorporated a number of technical
innovations at St. Vincent’s, such as the provision of reticulated (or
piped) services ‘to the wall’ where needed. It also was the first time in
Australia that a hospital was designed to accommodate ward patients
according to the so called ‘Rigs ward’, first used at Rigshospital
in Copenhagen in 1909–10 and adopted by Stevens for his North
American work in the 1920s. In essence, the Rigs ward was a cubicle
arrangement in which a 16 or 24 bed ward is broken down into smaller
units of four or six beds each (Image 2). This provided greater patient
privacy without reducing nursing efficiency or the capacity to deliver
services direct to the patient bedside. These innovations would be
harbingers of a more stridently progressive approach to hospital
architecture overall. 27
Image 2: Ward at St. Vincent’s Hospital, Melbourne, showing ‘Rigs’

arrangement. Architects: Stephenson & Meldrum, 1930–1934. (Photograph:
Commercial Photographic. Source: La Trobe Picture Collection, State
Library of Victoria)
While the transformative effects of Stephenson’s 1932–33
travels were not obvious on the exterior of St. Vincent’s Hospital, the
impact on subsequent Stephenson & Meldrum hospital projects was
dramatic and evident at every level of design. From this point on the
buildings themselves were to be utilised more actively in the healing
process and this would become visible in the architectural design.
Thenceforth the inclusion of solaria and balconies to aid the provision
of sunlight and fresh air to patients became a characteristic feature of
hospitals designed by Stephenson & Meldrum (renamed Stephenson
& Turner after 1938). Gloucester House at Sydney’s Royal Prince
Alfred Hospital (1936) and both the Mercy (1934) and Freemasons
(1936) Hospitals in Melbourne were all designed in the early to mid-
1930s and maximised the opportunities for exposing patients to fresh
air and sunlight (see Image 3). Even more important was his growing
awareness of the need to plan hospitals in such a way that enabled
rapid communication between interdependent medical departments,
promote efficient nursing and record keeping, and enhance standards
of hygiene in operating theatres and pathology labs (see Image 4).
Image 3: Gloucester House, Royal Prince Alfred Hospital Sydney. Architects:

Stephenson & Meldrum, 1936. (Photograph: Cameron Logan.)
Image 4: Plans of Ground Floor and Third Floor, Mercy Hospital, East
Melbourne. Architects: Stephenson & Meldrum, 1934. (Source: State
Library of Victoria).
Surgery was one area that generated substantial architectural research
and innovation during the first half of the twentieth century and
Stephenson utilised his extensive engagement with the international
hospital network to stay abreast of important developments. At the
King George V Hospital for Mothers and Babies in Sydney (1939–
41), Stephenson designed an extraordinary hemispherical operating
theatre based on a prototype created by Jean Walter for the Cité
Hospitalier at Lille in France (1934–36). In these operating theatres,
shown in Image 5, a stainless steel vault covered the whole ceiling. Its
purpose was the reflection of a high-powered projection light, which
had to be water-cooled and so sat outside the room. The vault also
had apertures cut into them to enable students to observe operations
and the surgeon’s explanations were amplified in those outside
observation areas.28 The motivation of course was to provide strong,
even light that would not be subject to the vagaries of weather or the
time of day. Students were kept from the actual operating theatre
so as to minimise the risk of infection but could still observe the
procedures conducted there. In this instance the transfer of expertise
based on travel and the international hospital network was very
explicit and Stephenson acknowledged it as such. In many other areas
Stephenson, Leighton Irwin, Cobden Parkes, and other architects and
hospital administrators incorporated ideas and practices into their
hospital design with less of a specific source. Nevertheless in most
cases they were derived from an international precedent, primarily
one that they had come into contact with on a research trip.
The knowledge Stephenson and a small group of Australian experts
in the field of hospital design gained from overseas travel underpinned
their expertise in the field of hospital planning and equipment and led
to their domination of hospital projects in Australia until about 1960.
In the case of Stephenson there were dozens. In addition to those
we have already cited there were: Bethesda Hospital, Melbourne
(1936); King George V Pathological Block at the Royal Women’s
Hospital, Melbourne (1939); United Dental Hospital, Sydney (1940);
the Royal Melbourne Hospital (1942); and the Yaralla Military
Hospital (1942)—and that only includes those underway prior to
1945 in major metropolitan centres. These hospitals have long been
recognised as the foundation for Australian functionalist modernism,
but more importantly they thoroughly modernised hospital-based
medicine in Australia.29 Moreover that expertise, developed and
honed in the medical environment in Australia, became a source of
authority internationally.
Image 5: Hemispherical Operating Theatre, King George V Hospital.

Architects: Stephenson & Turner, 1939–41. (Source: Royal Prince Alfred
Hospital Museum and Archives.)
The sharing of information in hospital design and operation was

also seen as enormously powerful by the Australians in this field.
From 1937 the Charities Board of Victoria published The Hospital
Magazine. At the same time the Charities Board also established a
hospital information bureau to make available technical information,
architectural plans, and specialist advice in the hospital field that
might be needed by architects and hospital boards embarking on the
design and construction of a new hospital facility. It reflected the
expertise gathered by individual firms such Stephenson & Meldrum.
After World War II health care and the debates surrounding its
provision became national in scope. In response leading figures,
especially Arthur Stephenson and leading Sydney surgeon Herbert
Schlink, supported the establishment of the journal The Australian
Modern Hospital, which emulated its American predecessor The
Modern Hospital.
The combination of published and first-hand knowledge of the
latest in hospital-related developments, be they about the therapeutic
equipment to be housed within the hospital, new medical procedures,
new operational efficiencies, or more prosaic construction, sanitation,
communication, or servicing innovations, became a kind of medical
research in itself, which was key to the rebuilding and revolutionising
of Australia’s hospitals between 1930 and 1950.
University of Melbourne
1. On the establishment of monopolies of professional expertise and the competition

amongst professions see James A. Gillespie, The Price of Health: Australian Governments
and Medical Politics 1910–1960 (Cambridge: Cambridge University Press, 1991), 15–16;
Annmarie Adams, Architecture in the Family Way: Doctors, Houses and Women, 1870–1900
(Montreal: McGill-Queen’s University Press, 1996); Annemarie Adams, Medicine by Design:
The Architect and the Modern Hospital, 1893–1943 (Minneapolis: University of Minnesota
Press, 2008), 89–108.
2. Adams, Architecture in the Family Way, 36–72.
3. On the development of the pavilion plan see Anthony King, “Hospital Planning: Revised
Thoughts on the Origins of the Pavilion Principle in England”, Medical History 10, no.4 (1966);
John D. Thompson and Grace Goldin, The Hospital: A Social and Architectural History (New
Haven: Yale University Press, 1975), 118–203; Adrian Forty, “The Modern Hospital in England
and France: the Social and Medical Uses of Architecture”, Buildings and Society: Essays on
the Social Development of the Built Environment (Routledge: London, 1980); Jeanne Kisacky,
“Restructuring Isolation: Hospital Architecture, Medicine, and Disease Prevention”, Bulletin
of the History of Medicine 79 (2005): 1–49; and Cynthia Imogen Hammond, “Reforming
Architecture, Defending Empire: Florence Nightingale and the Pavilion Hospital”, in (Un)
Healthy Interiors: Contestations at the Intersection of Public Health and Private Space, edited
by Aran S. McKinnon and Jonathan D. Ablard (Carrollton, Ga.: University of West Georgia,
College of Arts and Sciences, 2005),1–24.
4. See Isabelle Gournay, “L’Architecture Hospitalo-Universitaire: Les Tournant des Années
20,” The Journal of Canadian Art History 13, no. 2 and 14, no. 1 (1990/1991): 26–43.
5. Henry Saxon Snell and Frederic J. Mouat, Hospital Construction and Management
(London: Churchill, 1883); Edward F. Stevens, The American Hospital of the Twentieth
Century (New York: Architectural Record, 1918); William Henman, “Royal Victoria Hospital
Belfast: Its Initiation, Design and Equipment”, Royal Institute of British Architects Journal 11
(1903–04), 11.
6. Discussion of each of these matters was extensive in the specialist trade literature in the
1910s, 1920s, and 1930s. Typical examples include Edward F. Stevens, “The Surgical Unit:
European and American Architecture Compared – Description of Equipment”, The Modern
Hospital 1, no.1 (1913): 18–21; Kenneth D.A. Allen, “An Important Role is Played by the
Hospital Roentgenologist”, The Modern Hospital 36, no.1 (1931): 52–6; J.S. Coulter and W.H.
Northway, “Fundamentals in Design for Physical Therapy”, The Modern Hospital 50, no.3
(1938): 62–5.
7. During the 1930s in particular various bureaus and clearing houses for information
about hospital design were established. The Swedish hospital architect, Hjalmar Cederström
initiated such a centre in Stockholm in 1935 and a similar idea was carried out in Victoria by
The Charities Board. See William Riley, “Swedish Research Bureau Proves Valuable”, The
Modern Hospital 46, no. 1 (1936), 80; “Our Information Bureau”, The Hospital Magazine 1,
no.4 (1937), 8.
8. Annmarie Adams, Medicine by Design: The Architect and the Modern Hospital, 1893–
1943 (Minneapolis & London: University of Minnesota Press, 2008), 94.
9. For a history of the development of the American Hospital Association, see Morris J
Vogel, “Managing medicine: Creating a Profession of Hospital Administration in the United
States, 1895–1915”, in The Hospital in History, edited by Lindsay Granshaw and Roy Porter
(London & New York: Routledge, 1989), 243–60.
10. Edward F. Stevens, The American Hospital of the Twentieth Century: A Treatise on the
Development of Medical Institutions, Both in Europe and in America, Since the Beginning of
the Present Century (New York: Architectural Record Publishing Company, 1918), 17.
11. Margaret Campbell, “What Tuberculosis did for Modernism: The Influence of a
Curative Environment on Modernist Design and Architecture”, Medical History 49, no.4
(2005): 463–88
12. The suggestion for such an international forum came in 1926, when the idea was raised
at a meeting of the German Expert Committee on Hospital Matters in Vienna. The Germans
hoped to persuade the Americans to host the first meeting of such a group and that wish was
granted when the AHA hosted the first International Hospitals Congress in Atlantic City in
1929. See “Comprehensive Program Marks International Congress”, The Modern Hospital
XXXIII, no. 1 (July 1929), 89, 91.
13. “Editorial”, Nosokomeion X, no. 1 (1939), 21.
14. On Irwin’s involvement see front matter of Nosokomeion II (1931); J.H.L. Cumpston,
“Hospital-System, Health and Welfare in Australia”, Nosokomeion III, no.1 (1932): 29–35.
15. On the diffusion of hospital planning and design ideas in the British Empire between
the 1860s and 1920s see Jiat-Hwee Chang, “Tropicalising Technologies of Environment and
Government: The Singapore General Hospital and the Circulation of the Pavilion Plan Hospital
in the British Empire, 1860–1930”, in Re-shaping Cities: How Global Mobility Transforms
Architecture and Urban Form, edited by Michael Guggenheim and Ola Söderström (Routledge:
London, 2009), 123–142. In the 1920s Australian state governments paid an increasing share
of the cost of running hospitals and so they gradually asserted their entitlement to administer
the systems and looked to progressive, managerial expertise as opposed to established medical
authority for leadership. Nevertheless, as Malcolm T. MacEachern’s personal correspondence
makes clear the challenge to the BMA had to be managed with great care. See Malcolm T.
MacEachern, Diary of Australian Travels, December 21, 1925, Box 2, Malcolm T. MacEachern
Manuscript and Memorabilia Collection, American Hospital Association Resource Center
Library, Chicago.
16. Malcolm T. MacEachern, Diary of Australian Travels, December 17, 1925, Box
2, Malcolm T. MacEachern Manuscript and Memorabilia Collection, American Hospital
Association Resource Center Library, Chicago.
17. MacEachern’s itinerary, noted in his report, included a ‘General conference on Hospital
Construction’ on 29 January 1926, which is the most likely venue at which the architects made
contact. MacEachern also gave public lectures to large audiences: an audience of 5000 at one
event; and 2000 at his farewell address, the latter also broadcast on radio to an estimated
audience of 50,000. See Malcolm T. MacEachern, Report on the Hospital System of the State
of Victoria (Melbourne: 1926), 7–9.
18. R.J.A. Berry, Report on the Hospital-Medical School Problems of the State of Victoria
(Melbourne: H.J. Green, Government Printer, 1928–29).
19. Arthur Stephenson, “Hospitals and their Equipment”, Architecture (Jan 1934), 20.
20. Arthur Stephenson, “Stephenson-Turner: A Record of the Years 1920–1955”, c.1955,
in MS 2235/4 Papers of Arthur George Stephenson, National Library of Australia, 44; Leighton
Irwin, “The Trend of Design as Shown in Modern Architecture”, Royal Victorian Institute of
Architects (RVIA) Journal18 (July 1930): 65–74; Kingsley A. Henderson, “A Visit to the Great
Los Angeles Hospital”, The Hospital Magazine (May 1937): 22–3; D.K. Turner, “Trend of
Modern Hospitals: Elimination or Amalgamation of Special Hospitals and Treatment of All
Types of Disease in One Centre: Impressions of an Architects Tour”, The Hospital Magazine
(November 1937): 13–14; D.K. Turner, “Birmingham’s New Medical Centre: One of England’s
Largest Schemes”, The Hospital Magazine (April 1938): 30–2; J.D. Lobb, “Impressions of
Hospitals Abroad: Planning and Equipment the Most Complex Problem”, The Hospital
Magazine (January 1939): 14–16; Arthur Baillieu, “Modern Hospital and Faculty Combined:
How the New Institution at Lille Was Planned”, The Hospital Magazine (May 1937): 9–11.
21. J. Shaw, Sir Arthur Stephenson: Australian Architect (North Sydney: Stephenson &
Turner Sydney/Hong Kong Group, 1987), 26, 89.
22. “Stephenson-Turner: A Record of the Years 1920–1955”, c.1955, in MS 2235/4 Papers
of Sir Arthur Stephenson, National Library of Australia, 44.
23. J. Shaw, Sir Arthur Stephenson, 92.
24. Arthur Stephenson, “A Tramp Abroad in the Hospital Field, Part I – Holland, France,
Switzerland”, The Modern Hospital (May 1933): 55–6; the remaining parts appeared as
follows: “Part II – Italy and Austria”, The Modern Hospital (August 1933): 49–54; “Part III –
Germany”, The Modern Hospital (December 1933): 75–80; “Part IV – Germany”, The Modern
Hospital (August 1934): 61–5; “Part V – Germany”, The Modern Hospital (September 1934):
81–5; “Part VI – Germany”, The Modern Hospital (January 1935): 74–8.
25. Arthur Stephenson, “A Tramp Abroad in the Hospital Field: Part III”, 77.
26. Papers of Sir Arthur Stephenson, MS 2072, Box 2, National Library of Australia,
Canberra.
27. This model was taken up quite widely at this time and took on different characteristics
in different places but the central concept of cubicle areas remained in place. See Thompson
and Goldin, The Hospital, 215–16.
28. On Walter’s system see B. Franco Moretti, Ospedali (Milan: Ulrico Hoepli, 1951), 80.
29. Robin Boyd, Victorian Modern: One Hundred and Eleven Years of Modern Architecture in
Victoria, Australia (Melbourne: Architectural Students’ Society of the Royal Victorian Institute
of Architects, 1947): 18–19; J.M. Freeland, Architecture in Australia: A History (Melbourne:
Cheshire, 1968), 253; Donald Leslie Johnson, Australian Architecture 1901–1951: Sources
of Modernism (Sydney: Sydney University Press, 1980), 138; Julie Willis, “The Health of
Modernism”, in Australian Modern: The Architecture of Stephenson and Turner, edited by
Philip Goad, Rowan Wilken, and Julie Willis (Carlton, Victoria: Miegunyah Press, 2004),
9–30.

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International Travel as Medical Research: Architecture and the Modern Hospital

Author(s): Cameron Logan and Julie Willis

The design and development of the modern hospital in

The connection between health and architecture has been long

116 Health & History, 2010. 12/2

facilitating best medical practice. Leading architectural practitioners

The international hospital network

Hospital planning demands the same careful thought that is the

In 1913 the AHA launched The Modern Hospital, which quickly

1926: A watershed year for Australian hospitals

visit. Professor Richard Berry, the University of Melbourne’s dean

Travels and travails

radio connected to each bedside.22

Image 1: Waiblingen Krankenhaus, near Stuttgart, Germany. Architect:

Stephenson’s approach to his research trips was to be thorough and

based approach they would employ for decades to come.26

Image 2: Ward at St. Vincent’s Hospital, Melbourne, showing ‘Rigs’

Image 3: Gloucester House, Royal Prince Alfred Hospital Sydney. Architects:

Image 5: Hemispherical Operating Theatre, King George V Hospital.

The sharing of information in hospital design and operation was

1. On the establishment of monopolies of professional expertise and the competition

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