The Evolution of Hospital Architecture from the Beginning to the Present Day: Koç University Hospital
One of the oldest jobs is healing people, saving them from their pain, illnesses, so one of the earliest architectural forms arose as a space for healing people which we call a hospital. Ancient civilization thought that pain, illnesses are due to the bad spirit or punishment of gods, so the healing job was done by religious people or elderly leader in ancient time and this type of healing process did not require any kind of special building. However, some civilizations such as the Greeks and Romans tried to heal people not just via prayer or spiritual power, but also via some herbal syrups and animals. Therefore, the need for special enclosed areas for the healing process appeared. Medicine has changed from century to century and we have evidence-based medicine nowadays. Until this time, medicine has witnessed several theories about illnesses and their cures, and every theory about the healing process comes with its own unique need for space or structural elements which leads to the experimentation of hospital architecture. Therefore, the architecture of a hospital has mainly changed from time to time to meet the requirements of the healing process. "The connection between health and architecture has been long established, with medical and architectural professions both aware of the importance of appropriate building in the mitigation of ill health." (Cameron Logan, 2010) Thus, it can be concluded that hospital architecture is based on its function which arises from the accepted healing process of the era while using the local architectural elements of the era as an example of eclecticism.
In this paper, I am planning to begin with how the Greek Hospital, Asklepion, arose and how they used the space for medical purposes. Then, I will continue with Ottoman's Hospitals and how the Ottoman Empire applied the healing process and how this influenced the use of space and form of the hospital. I will finish my paper by discussing the architecture of Koç University Hospital as a contemporary example of the hospital in Istanbul.
Asklepion was one of the first examples of the hospital architectural form in Anatolia. Asklepion has great significance in emerging hospital typology because before Greek medicine, illnesses were cured without the need for a specific place. After Greeks began to apply a three-step healing process which includes sleep, fitness, and snake bite to cure diseases, there was a necessity for buildings which could provide suitable areas for these procedures. (Kuskonmaz, 2016) For example, the sleeping room of Asklepion was preferably larger than other rooms and had more enclosed areas to make patients sleep easily, while fitness areas in Asklepion were more dynamic and open. Even though Asklepion’s architecture varies from one example to another, it is important to see the use of columns is common among them. When Greeks created Asklepion, they also used architectural elements of classical Greek architecture to create new spaces for new functions as seen in the figure. Thus, Asklepion was not just a building with naos and columns, it was the first functional unit of hospital typology which arose from the need for a structure for a specific purpose.
In the Ottoman Era, medicine showed enormous improvement in the healing process of mental diseases which was followed by changes in hospital architecture in the Ottoman Empire. Ottoman doctors tried to cure mentally retarded people via music and water sounds in the hospital. Using music and water sounds are some of the techniques that we are using even today. Because of the change in healing techniques, hospital architecture evolved in a way that it could provide these functions. Therefore, we began to see a more integrated hospital in a way that it integrated both with the sound of the city and nature. While the hospital was evolving, it also used architectural elements from Islamic traditions. For example, the use of fountains in the Darusifa, Ottoman Hospital, is one of the examples of deriving architectural elements from Islamic architecture to use for new functions. In the Ottoman Era, the first hospital was constructed in 1399 and it was called Yildirim Darusifasi. After that, many were constructed on several sides of the Empire and one thing common among them was compartmentalization. (Öztürk & Şaylıgil, 2015) Because Islamic medicine had a great amount of information about eyes and some surgery techniques, Islamic doctors began to operate surgery and use different techniques to heal diseases. Therefore, a need for compartmentalization arose in Ottoman Hospitals, and we can see one of the first examples of functional compartmentalization in the Ottoman period. Compartmentalization is needed because of the need for different functions in a single building with the development of knowledge about medicine. Moreover, training and research were done in these buildings which are called Madrasah. It is fair to say that the Madrasah of the Ottoman Empire is today’s school of medicine, so the idea of using hospital buildings as training and research centers comes from the Madrasah of the Ottomans. (Öztürk & Şaylıgil, 2015) Thus, the compartmentalization of hospital buildings also led to the emergence of new functions such as training and research.
After World War II, hospitals and medicine changed drastically. New achievements in science led to the emergence of evidence-based medicine so that bacteria, parasites, surgery, imaging technologies, and much more are known. With the devastating effects of the World Wars and changes in medical knowledge, hospitals were transformed into new forms. "The various currents in post-Second World War hospital architecture have shared one central aim: to ‘normalize' the healthcare environment." Architects aimed that new hospitals look like office blocks, shopping malls, and zoned campuses with a distinctly local feel. (Peters & Adams, 2017) With the effect of modernization and the use of steel and reinforced concrete, new hospitals were constructed as giant buildings with several compartments. Obviously, steel and improving construction techniques enable architects to cover the hospital with glass which allows the passage of light into the hospital. Light has been seen as a healer or related to good spirits even in ancient times, and no one can deny the positive effects of light on the mood of a human. Because the mood of a patient is very crucial for fighting against disease and the resistance of the body, it cannot be thought that hospitals can be constructed in a way that light cannot pass inside them nowadays. Therefore, mall-type hospitals have increased rapidly after the mid-1950s due to the need for compartmentalization and the use of light for normalization. "One advantage that hospitals of this period had over retail malls was their use of daylight and views as a wayfinding strategy and partner to medical treatment. Whereas in malls, disorientation can lead to spontaneous shopping, getting lost in hospitals can be problematic." (Peters & Adams, 2017) Even though the emergence of the mall-type hospital is a great achievement and transformation in the architecture of hospitals, it exists with the problem of getting lost in the hospital. Now, hospitals are not only buildings where the treatment process is applied, but they are also places that make a patient more enthusiastic and better about the future and their health. Because of these architectural changes, people have begun to see hospitals as normal as a shopping mall.
Koç University Hospital
One of the contemporary examples of hospital architecture in Istanbul is Koç University Hospital (KUH) which became operational in September 2014 as a research and training hospital. Its modern look and glass covering appear as a residence or mall-type hospital at first glance, however, it differs from others because this building is not functioning only as a hospital but also as a research and training center which indicates its roots in the Ottoman madrasah. In Istanbul, we have different architectural examples of University Hospitals, however, none of them is a single architectural unit. Other University Hospitals have generally preferred separate buildings and even architectural elements for different functions such as research, clinics, classrooms, etc. One of the greatest achievements which architects and designers of KUH have done is integrating and unifying the different functioning units into one structural building as seen in the figure. They literally melted different functioning and structural elements in the same pot and created this gigantic building "that spans over an area of 220,000 m2 including the school of medicine, the school of nursing, research laboratories, the Advanced Learning Center, and the general hospital." (KUH, 2017)
In this architectural structure, we can observe the compartmentalization which we saw in Darusifa. However, this compartmentalization is not static like in other hospitals or historical examples. I interviewed Birkan Kankatan, one of the architects of Koç University Hospital. As he stated, they as an architectural team tried to create an enclosed space that could serve several different functions, so they used a 9*9 axes system between two columns. It could fit one surgery operation room, or three cars park areas, or two different patient rooms, etc. between two axes. Because of this dynamic compartmentalization, it is predicted that the hospital will not need any expansion or new buildings for new functions in the future; it could change within the current structure. Therefore, it can be said that hospital architecture responds to the evolving medical science. Because science and medicine change significantly from year to year, hospital architecture has begun to gain more dynamic compartmentalization rather than a static one as we saw in the Ottoman period.
The use of light is also a second important aspect of the architecture of KUH. Even though the use of light in hospital architecture is a common feature after the World Wars, the way that light is used in KUH is extraordinary. The mall-like hospital aims to capture light, but also KUH has one more different element which ensures that light can go into the building even to the basement floor. KUH has two atriums and two inner gardens in it. As the architect stated, they wanted to use basement floors, and they created an inner garden full of glass covering which will ensure the natural light transmission to even basement floors. However, the hospital building is in a factory area which is not suitable for the idea of normalizing hospital architecture. Mr. Kankatan stated that they created a space that does not interact with the outside environment and ventilation is fully automatic and mechanical except for the inner gardens and atriums. Both Asklepion and Darusifa have natural integration within the structure, also natural ventilation in the hospital is seen as a normalizing factor after the World Wars. Thus, most of the new examples of hospitals have natural ventilation. "The local climate allows for natural ventilation in many of the building's interior public spaces, with fresh air delivered through the ends of its ‘branches' and through its vertical atriums." (Peters & Lyon, 2017) However, fresh air cannot distribute into the hospital through the vertical atriums of the KUH due to the location and inappropriate climate. Therefore, it can be concluded that the surrounding environment and climate have great effects on the architecture of the hospital, especially concerning ventilation.
Bibliography
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Cameron Logan, J. W. (2010). International Travel as Medical Research: Architecture and the Modern Hospital. Health and History, 12(2), 116-133. doi:10.5401/healthhist.12.2.0116
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KUH. (2017, December 2). Corporate - About Us. Retrieved from Koc University Hospital: http://kuh.ku.edu.tr/en/page/corporate/corporate-information/about-us
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Kuskonmaz, Ş. (2016). Bergama’da İki Bin Yıllık Bir Hastane ve Bir Hekim: Asklepion ve Galen. Konuralp Tıp Dergisi, 8(2). doi:http://www.dx.doi.org/10.18521/ktd.99317
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Öztürk, H., & Şaylıgil, Ö. (2015). From the Medicine in Ottoman Madrasahs to Faculty of Medicine. Konuralp Medical Journal, 7(3), 174-185.
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Peters, T., & Adams, A. (2017, March-April). Decoding Modern Hospitals: An Architectural History. Architectural Design, 87(2), 16. doi:10.1002/ad.2148
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Peters, T., & Lyon, C. (2017). Humanist Principles, Sustainable Design and Salutogenics: A New Form of Healthcare Architecture. Architectural Design, 87(2), 56. doi:10.1002/ad.2153