The Architecture of Health

The Architecture of Health: Hospital Design and the Construction of Dignity
by Michael P. Murphy with Jeffrey Mansfield and MASS Design Group
Cooper Hewitt, November 2021

Hardcover | 7-1/4 x 10 inches | 256 pages | 250 illustrations | English | ISBN: 9781942303312 | $45.00


The Architecture of Health is a story about the design and life of hospitals—about how they are born and evolve, about the forces that give them shape, and the shifts that conspire to render them inadequate.

Reading architecture through the history of hospitals offers a tool for unlocking the elemental principles of architecture and the intractable laws of human and social conditions that architecture serves in each of our lives. This book encounters brilliant and visionary designers who were hospital architects but also systems designers, driven by the aim of social change. They faced the contradictions of health care in their time and found innovative ways to solve for specific medical dilemmas. Designers and professionals such as Filarete, Lluís Domènech i Montaner, Albert Schweitzer, Gordon Friesen, E. Todd Wheeler and Eberhard Zeidler are studied here, while the medical spaces of more widely known architects such as Isambard Brunel, Aalvar Aalto, Le Corbusier, Louis Kahn and Paul Rudolph also help inform this history. All these characters were polymaths and provocateurs, but none quite summarizes this history more succinctly than Florence Nightingale, who, in laying out her guidelines for ward design in 1859, shows how the design of a medical facility can influence an entire political and social order.

The Architecture of Health charts historical epidemics alongside modern and contemporary architectural transformations in service of medicine, health and habitation, exploring how infrastructure facilitates healing and architecture’s greater role in constructing our societies.

Michael Murphy, is the Founding Principal and Executive Director of MASS Design Group, an architecture and design collective that leverages buildings, as well as the design and construction process, to become catalysts for economic growth, social change, and justice. Jeffrey Mansfield is a design director at MASS Design Group, a John W. Kluge Fellow at the Library of Congress, and a Disability Futures Fellow with the Ford Foundation, whose work explores the relationships between architecture, landscape, and power.


Buy from AbeBooks Buy from Amazon Buy from Buy via IndieBound


Today is the opening of Design and Healing: Creative Responses to Epidemics, an exhibition at Cooper-Hewitt, Smithsonian Design Museum curated by MASS Design Group and Cooper Hewitt. Presenting "architectural case studies and historical narratives alongside creative design responses to COVID-19," the exhibition is timely and relevant, especially as the world finds itself in a fourth (or is it fifth?) wave of the pandemic, one that is almost guaranteed to keep growing as the omicron variant spreads globally. The exhibition, which I got a sneak peek of yesterday, is accompanied by a book written by Michael Murphy of MASS Design Group, whose first project was a hospital and is one of the few architects I've seen profiled on 60 Minutes. While the exhibition takes a broad design look at health in general and COVID-19 in particular — masks, social distancing markers, medical equipment, furniture, hospitals — The Architecture of Health focuses on the last: hospitals.

Although a book such as Beatriz Colomina's excellent X-Ray Architecture examines the relationship between architecture and medicine, which book would one read to gain a comprehensive understanding of the design of hospitals? Murphy admits to a dearth of attention on the typology early in his book, though some of the sidebar citations in the book's eight chapters reveal at least a couple of them focused on hospitals: The Hospital: A Social and Architectural History by John D. Thompson and Grace Goldin (Yale University Press, 1975) and Jeanne Kisacky's Rise of the Modern Hospital: An Architectural History of Health and Healing, 1870–1940 (University of Pittsburgh Press, 2017). But those titles are outdated and academic, respectively, making the book Murphy wrote with Jeffrey Mansfield and MASS Design Group a welcome addition to scholarship on the subject. It is an accessible history to the design of hospitals while also being, I agree, a way of "reading architecture through the history of hospitals," as the book description attests.

Following a prologue on the innovative and much-missed Prentice Women's Hospital by Bertrand Goldberg, the book's eight chapters provide a chronological history of hospital architecture, from the Italian Renaissance to twentieth century America. Readers learn about Isambard Kingdom Brunel, Florence Nightingale, E. Todd Wheeler, Eberhard Zeidler, and others who influenced the design of hospitals, as well as the lexicon of plans (panopticon, pavilion, block, mat, labyrinth, etc.) accompanying the evolution of hospitals. But "evolution," at least in the linear sense of the word, might be the wrong choice of words here, for Murphy argues that the trajectory of hospital architecture, with its reliance on mechanical ventilation and provision of windowless spaces, has taken us in the wrong direction. The ideal — or something approaching such a thing — might be found in one of MASS's own projects: Butaro District Hospital in Rwanda, which was completed in 2011 but is more closely aligned to a nineteenth century Nightingale ward or the century-old Santa Creu i Sant Pau Hospital in Barcelona, with their narrow footprints and natural ventilation, than many of today's modern hospitals. 

Murphy ends the book with an epilogue on Butaro Hospital, explaining how a personal situation led him to reach out to Dr. Paul Farmer, who would typically build hospitals in places like Rwanda without the input of architects; together they would realize the project that has been much lauded and led MASS to design other medical facilities in and beyond Rwanda. Natural ventilation is key in the ten-year-old Butaro Hospital. COVID-19 has hammered home how natural ventilation is important everywhere, not just in places like Rwanda where installing and maintaining expensive mechanical equipment is prohibitive. And here is where The Architecture of Health, with lessons gleaned from the 1800s as well as the recent past, attempts to shift the design of hospitals from a linear trajectory to a circular one. Butaro certainly doesn't look like a Nightingale ward, but it embodies the earlier precedent's most important principles, balancing them with contemporary and contextual concerns to "construct dignity," in MASS's parlance. "Architecture can be sculptural, beautiful, cultural, and inspiring," Murphy writes, "but also inessential and a luxury. In a hospital, however, architecture is essential. It impacts our rights as individuals." He's clearly speaking about hospitals, but by the end of the book readers might think the statements about the importance of architecture and rights to it should apply to all typologies and all people, not just hospitals and patients.