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BOOKS Buildings facing an uncertain future English Hospitals 1660-1948: A Survey of their Architecture and Design Edited by Harriet Richardson. RCHME, 1998. 232pp. £35

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This is a fascinating, timely and important book - impelled by the closure of hospitals up and down the country as reforms in health care have been implemented. Between 1991 and 1994, rchme staff surveyed over 2000 hospitals, of various shapes, sizes and purposes, throughout England. So large a thematic survey is a welcome return to the sort of complete coverage associated with the rchme at its best, rather than the sampling tactics of other recent work.

Hospitals considered date from the late seventeenth-century until shortly before the creation of the nhs. They range from small cottage hospitals - established to service rural areas, and given the clothing of domestic architecture - to vast, complex and forbidding asylums in sylvan settings, now all but gone as we (supposedly) 'care in the community'.

Once, access to hospitals was the preserve of the wealthy until, as with housing provision and public health, the appearance of ever more frightening illnesses - plague, smallpox, cholera, tb - accentuated the need for wholesale solutions.

Of the 350 hospitals from the survey that this book treats as representative, some are now gone, others partly demolished, and an increasing number are finding a new lease of life thanks to residential conversion. The fate of others still hangs in the balance, their sheer scale and poor record of maintenance inhibiting new uses. Yet many hospitals and sanatoria, stripped of their institutional camouflage, can pass muster as a country estate or health hydro - the accent shifting to prevention rather than cure.

Now residents of the magnificent, newly converted Holloway Sanatorium can find themselves swimming in the former dining room, or weight-training in the chapel. With the melancholy air that comes from being left behind, the chapels of demolished hospitals often survive, supplying a bogus history to a new housing or retail development. Hospital chapels, such as that at Mount Vernon (an accomplished essay in the English Freestyle), together with board rooms, often received the most elaborate architectural decoration, while elsewhere glazed brick, tile, terrazzo and easily scrubbed surfaces were demanded to combat disease. The authors consider not merely the design and layout of hospitals but the impact of new medical theories, legislative changes and technological advances to provide a well-rounded and, of course, wonderfully illustrated study.

As hospital design became a specialisation of the architect during the nineteenth century, leaders in the field emerged - Adams, Holden and Pearson; Burnet, Tait and Lorne in our own century. Think of the Belgrave Children's Hospital, the Midhurst Sanatorium, or the Royal Masonic. But there may be little to distinguish the exterior of the average hospital from, say, a headquarters office or a hotel. Indeed, George Gilbert Scott's design for the St Pancras Hotel may be as beholden to his Leeds General Infirmary as his ill-fated Foreign Office design.

Yet despite their ubiquity, hospitals are under a continuing threat, as the authors say: 'An entire building type is beginning to disappear from the landscape.' This book is an indispensable guide to that building type; one which has had to contain more raw emotion than any other.

Julian Holder is an architectural historian

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