Nightingale’s Hospital Plans in 3D: Eleven Plates from Notes on Hospitals (1863)

Abstract

In the third edition of Notes on Hospitals (1863) Florence Nightingale did not only describe what a hospital should be. She printed eleven engraved plans, two as examples of what not to build and nine as improved designs, and argued from them. This teaching module rebuilds every one of those plates as an interactive three-dimensional model. Each footprint is traced from the engraving, storeys and ward dimensions are taken from her text where she gives them, and everything else is marked as inferred. The reader can turn each building, lift the roof to look into a ward, switch on the movement of air, and lay the original 1863 plate under the model to check it. Read in sequence, the eleven plans show how the pavilion principle was reasoned out: from wards that share one atmosphere, to separate pavilions with windows on both sides, set apart by twice their height.

Keywords: Florence Nightingale, Notes on Hospitals, hospital design, pavilion plan, ward ventilation, history of hospitals, patient safety, teaching material

Open the interactive module: eleven rotating 3D hospital models with guided stops, cutaway wards with beds and fireplaces, blue and red arrows for fresh and ward air, and the original engravings beneath each building.
Nightingale’s Hospital Plans in 3D: Interactive Module →

Purpose and Reading Guide

The material is designed for students and teachers of health management, nursing and hospital planning, and for anyone who has read about the “Nightingale ward” without seeing the buildings behind the term. Each plan can be opened on its own. The guided stops beside each model quote or paraphrase what Nightingale wrote about that building.

1. The Eleven Plans

Defects in existing plans

• Plan I, Hôtel Dieu, Paris, before the fire of 1772. Her example of agglomeration: above 550 beds on a single floor in one connected suite of wards.
• Plan II, Royal Victoria Hospital, Netley. The corridor plan: one side of every ward covered by a corridor, small wards, beds ranged along the dead walls.

Improved hospital plans

• Plan III, Bucks Infirmary. A small double pavilion for 53 beds, offices below and wards above.
• Plan IV, Hôpital Lariboisière, Paris. 612 beds in six detached pavilions round a court. The block plan she calls excellent; the pavilions are too close for their three floors.
• Plan V, Vincennes Military Hospital. 637 beds in double pavilions on two sides of a square with the corners left open.
• Plan VI, the Herbert Hospital, Woolwich. 650 beds in seven pavilions on one corridor, two floors of wards, the administration detached. In her words, the finest hospital establishment in Europe.
• Plan VII, proposed General Military Hospital, Valetta. Six pavilions side by side on a cramped site, joined by open arcades.
• Plan VIII, Asylum for the Aged and Infirm, Malta. Eight detached pavilions in two squares for 1,000 people.
• Plan IX, Hospital for Incurables, Malta. Two long pavilions on the Herbert pattern, each with its own dining hall and day-room.

Convalescent and children’s hospitals

• Plan X, a convalescent hospital arranged as cottages. Four cottages for twenty people, with bedrooms in place of wards.
• Plan XI, Children’s Hospital, Lisbon. Two pavilions of 32-bed wards round a court, with the nursing staff housed over the staircase.

2. Method

Each plate was scaled with its own scale of feet where the engraving carries one. Five plates have no scale; for these the scale was estimated from the beds drawn in the wards, from the stated number of beds in a ward, or, at Lisbon, from the size of the court given in the text. The outline of every block was traced and raised to the number of storeys given by the plate or the text. Ward interiors follow the text: beds in two rows with heads to the wall, a window for every two beds at the Herbert Hospital, fireplaces on the centre line, nurse’s room and scullery at the corridor end, water-closets and baths at the free end.

What the sources do not give is inferred and listed for each plan under “Sources and assumptions” in the module: roof forms, window proportions, materials and colours, basement and storey heights, and the exact place of each bed. For Netley the number of storeys is not in the plate or the text and follows the building as constructed. The Hôtel Dieu is shown as a schematic block model only.

3. What the Models Show

One atmosphere or many. At the Hôtel Dieu and at Netley the air of one ward reaches the next: through open ward suites in the first, through the corridor that joins every ward door in the second. Nightingale’s judgement on the corridor plan is that the whole hospital becomes “a complicated ward”. In the pavilion plans each ward has its own windows on both long sides and touches the rest of the hospital only at one end.

Distance and height. Her rule is that pavilions should stand apart by twice their height. Measured on the plates, the Lariboisière pavilions are about 69 ft apart for three floors of wards, and those of the Herbert Hospital about 61 ft apart for two. Her criticism of the first and praise of the second can be read directly from those figures.

The ward as a unit. The large wards hold 28 to 36 beds. At the Herbert Hospital each is 26½ ft wide and 14 ft high, with 93 to 97 square feet of floor and 1,200 to 1,400 cubic feet of air per bed. At Lisbon the wards are 138 ft by 30 ft by 18 ft, which she expected to be the most magnificent in Europe.

Separating what the sick need from what they do not. Across the improved plans the administration, kitchen, laundry and sanitary rooms move out of the ward block: into a detached front, a basement corridor with lifts, towers at the free end of the ward, or separate blocks at the angles.

A plan is not enough. The Lariboisière is her warning. One of the best block plans in existence had one of the highest rates of mortality, because it was warmed and ventilated by artificial means and built a floor too high.

4. Limits

The models are teaching reconstructions and not architectural surveys. They show what Nightingale published and argued in 1863, which is not always what was finally built. Several of the plans were proposals at the time. Heights and elevations are the weakest part of the evidence, since nine of the eleven plates are ground plans only.

5. Discussion Questions

1. Nightingale judged a plan by how air moves through it. Which of her criteria would a hospital planner still accept today, and which rest on a theory of disease that has been abandoned?
2. The Lariboisière had an excellent plan and high mortality. What does this say about the relation between structure, process and outcome?
3. Compare the nurse’s line of sight in a Netley ward of nine beds and a Herbert ward of thirty-two. What is gained and what is lost in each?
4. Single rooms have replaced the open ward in many new hospitals. Which of the pavilion ward’s advantages have been kept, and which given up?

References

Nightingale, F. (1863). Notes on hospitals (3rd ed.). London: Longman, Green, Longman, Roberts, and Green. Plates reproduced from the Cornell University Library copy digitized by the Internet Archive.

Prepared by Prof. Dr. Mehmet Nurullah Kurutkan, Düzce University, Faculty of Business, Department of Health Management.