D
Short’s book highlights a developing and sophisticated art and science of ventilating buildings through the 19th and earlier-20th centuries, including the design of ingeniously ventilated hospitals. Of particular interest were those built to the designs of John Shaw Billings, including the first Johns Hopkins Hospital in the US city of Baltimore (1873-1889).
‘We spent three years digitally modelling Billings’ final designs,’ says Short. ‘We put pathogens* in the airstreams, modelled for someone with tuberculosis (TB) coughing in the wards and we found the ventilation systems in the room would have kept other patients safe from harm.
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* pathogens: microorganisms that can cause disease
E
‘We discovered that 19th-century hospital wards could generate up to 24 air changes an hour – that’s similar to the performance of a modern-day, computer-controlled operating theatre. We believe you could build wards based on these principles now.
Single rooms are not appropriate for all patients. Communal wards appropriate for certain patients – older people with dementia, for example – would work just as well in today’s hospitals, at a fraction of the energy cost.’
Professor Short contends the mindset and skill-sets behind these designs have been completely lost, lamenting the disappearance of expertly designed theatres, opera houses, and other buildings where up to half the volume of the building was given over to ensuring everyone got fresh air.
F
Much of the ingenuity present in 19th-century hospital and building design was driven by a panicked public clamouring for buildings that could protect against what was thought to be the lethal threat of miasmas – toxic air that spread disease. Miasmas were feared as the principal agents of disease and epidemics for centuries, and were used to explain the spread of infection from the Middle Ages right through to the cholera outbreaks in London and Paris during the 1850s. Foul air, rather than germs, was believed to be the main driver of ‘hospital fever’, leading to disease and frequent death. The prosperous steered clear of hospitals.
While miasma theory has been long since disproved, Short has for the last 30 years advocated a return to some of the building design principles produced in its wake.