ABSTRACT
In examining the development of the general hospital in England and France since the mid-eighteenth century, this chapter suggests that, apart from any purpose they may have had in curing the sick, hospitals also served more fundamental social functions. For the eighteenth and much of the nineteenth century, hospitals were dominated by lay authorities. Under this control, they were used to complement the system of poor relief, and were instrumental in introducing a new social morality, now often called the ‘work ethic’, which attached great importance to self-help and stigmatized the receipt of charity. In the nineteenth century, as medicine developed into an organized and socially powerful profession, doctors started to make use of hospitals to advance their professional prestige and social standing. With their greater influence, the design and management of hospitals began increasingly to incorporate specifically medical ideas, besides the moral principles they had embodied formerly. In more recent times, despite attempts to introduce more lay control, doctors continue to have great authority over the utilization of hospital buildings, although their general management is in the hands of bureaucrats. It is the purpose of this chapter to trace these developments and show how they gave rise to radical changes in the design of hospital buildings.
