Ruminations on healthcare architecture
Allium Giganteum in the Boston Garden in June — a biomimetic reminder of the more pervasive Severe Acute Respiratory Syndrome Coronavirus 2
The checklist before leaving the house for a walk on a fine day in Coronavirus time consists of a hat to protect my bald head from the sun; dark glasses to protect my eyes from the sun; and a mask to protect others from my airborne particles. Proceeding along the banks of the Charles River shoulder to shoulder with my infectious-biome partner, we head east to the Charlestown Navy Yard and the Spaulding Rehabilitation Hospital for an 8-mile constitutional, there and back.
Spaulding was in the news at the time of the Boston Marathon bombing in 2013. The new building was completed and open for business on April 27th, just 12 days after the incident, and immediately put to the test. This fortuitous arrival of a state-of-the-art rehabilitation hospital at a time of crisis was perfect material for docudrama.
Designed by Perkins + Will, architects in Chicago, the Spaulding Rehabilitation Hospital is certified as a LEED Gold high performance building, recognized for its resilient features anticipating sea level rise. It is additionally, an exemplar of fresh air and natural light as central to the design of a healing environment. Every public space — meeting rooms, the gymnasia, the therapeutic pool, the cafeteria — has operable windows, there are roof gardens accessible on three levels, and a therapeutic garden at grade.
A patient can sit up in bed and take in magnificent views of Boston Harbor, looking southeast to a sunrise over the ocean, southwest to the towers of the Financial district and the waterfront. On the other side of the building, another patient can take in the distant, silent movie of traffic gliding in and out of town over the Tobin bridge, spanning the Little Mystic Channel and the river traffic below. Sunsets are a daily bonus. Views of nature, as the studies of Roger Ulrich and others have shown, greatly improve the rate of inpatient recovery.
The incorporation of nature and the natural environment is an essential part of the design strategy for this metal clad building that embraces a high-tech contemporary aesthetic. In this respect Spaulding evokes the spirit of Modernism, with roots going back well over a century. London’s Peabody Housing of the 1860’s and the housing of Red Vienna in the 1920’s reflect the reforming zeal for fresh air and sunlight (as well as baths, kindergartens and clinics) that was to be introduced into the lives of the urban poor. In 1923 (Towards a New Architecture) Le Corbusier elevated this public health imperative to the level of design manifesto in his paean to “soleil, espace, verdure”, breathlessly reminding his readers of the centrality of nature in the pursuit of modernity.
Closer to its programmatic purpose however there are two early twentieth century health buildings that clearly established the lineage to which Spaulding is a noble successor.
Alvar Aalto’s Paimio Tuberculosis Sanatorium of 1929–33 was inspired by the artistic and humanistic ideals of modernism as much as the more reductionist functionalism of that movement. Informed by his own recent experience of being hospitalized, Aalto conceived the hospital as a place for healing, for “a person in the weakest possible condition.” This ambition is reflected at every scale of the patient environment: from the parti of the building sited in a pine forest, oriented for maximum exposure to sunlight and for natural views, to the design of windows, mechanical systems, surface finishes, door hardware and furniture. The central staircase is not only flooded with light, but the wall surfaces are painted a vibrant canary yellow to invoke the healing power of the sun — even on a gloomy Finnish day. Window openings are designed not only for view, but as double windows, they are operable with staggered openings from outer to inner leaf to provide fresh air to the room while protecting the patient from the turbulence of outside breezes. With similar intent the ceiling is formed to create a downward current of air to encourage interior circulation.
London’s Finsbury Health Center was designed by Berthold Lubetkin in 1935, opening in 1938. The purpose of the building, radical at the time, was to provide the impoverished residents of a disease-ridden inner city borough with a clinic that would not only attend to their medical needs but would also actively promote what we would now recognize as a health and wellness program. The progressive public agency recognized that to achieve their goals they would not only have to engage the most advanced practitioners in primary care but that the building itself should reflect healthy living, freed from the soupy gloom and dampness of working class housing at that time.
On a site cleared of the most insalubrious blocks of housing, the new clinic was set in a park, a panoramic glass brick entrance foyer facing southwest, set back from the street. Offices and upper level corridors are lined with custom designed cast bronze pivot windows, to permit views and natural light and, with a fixed transom light positioned alternately high and low, natural ventilation channeled at ceiling- and person-level. As with Paimio, so the Finsbury Health Center has been designed from siting to the smallest architectural detail with health and wellness in mind. These features are charmingly summarized in the cartoons of the young Gordon Cullen, displayed in the foyer to inform the public as to what constitutes a healthy architecture. Perhaps the greatest honor paid to the building is that it was seen as a prototype for the post-war clinics that would form the bedrock of Britain’s National Health Service.
Eighty years on, the Paimio Sanatorium and the Finsbury Health Center are still in service and still valid in their guiding principles for a healthy healthcare architecture today, evidenced by the principles of views, natural light and ventilation embodied in the Spaulding Rehabilitation Hospital.
Hubert Murray, June 2nd 2020