2008-06-05 The state of the art in Victorian hospital design

This book was inspired when the author was touring classical remains in the Dardanelles. Close to the archaeological excavations of Troy, is the site of Renkioi Hospital; built in 1855 to care for the sick and wounded evacuated from the Crimea.
The medical history of the Crimean War can be divided into two phases. Firstly,the initial assault was characterised by administrative chaos, hospital overcrowding, rampant infectious disease and high mortality: in the second phase, Sebastopol was besieged and captured; there was more order, fewer hospital admissions and a substantially reduced mortality. It was during this latter period that Renkioi Hospital was built and deployed.
The hospital design was sketched out in just a few days by the great Victorian engineer Isambard Kingdom Brunel. The wooden components were made in the UK, shipped to the construction site and erected in less than six months. The hospital, which was originally intended to house 3,000 patients, incorporated state-of-the-art sanitation and ventilation together with a railway to transport newly-arrived patients from the ships to the wards. Brunel gave attention to every detail in the plans and even included printed instruction sheets for the revolutionary flushing water closet; a convenience which was unfamiliar to many of the intended users.
Lessons learned by Florence Nightingale at the military hospital in Scutari influenced the design and administration of Renkioi. The disposition of the wooden huts employed Nightingale's "pavilion" arrangement and Alexis Soyer, the celebrity chef, advised on the cooking stoves and dietary provisions.
Renkioi had a civilian administration and was led by a doctor. This arrangement proved to be superior to that of contemporary military hospitals headed by a commander in the field but was not popular with the military establishment.
The need for hospital beds declined while Renkioi was being built and consequently the facilities were never fully exploited nor were the well-qualified staff stretched. The absence of military red tape permitted a somewhat relaxed and elegant lifestyle with staff dressing for lunch and enjoying long walks and picnics. Extra-curricula activities included archaeological excavation, botanical and ethnological study and metrology.
Renkioi was staffed by many gifted people; most notable was the Medical Superintendent, Edmund Parkes, who became a pioneer of military and public health. Other Renkioi alumni were surgeons Thomas Spencer Wells (of artery forceps fame) and Holmes Coote (successor to Sir James Paget at Bart's). William Eassie, the engineer who supervised the hospital's erection, contributed to classical archaeological research in Turkey and together with Spencer Wells founded the Victorian cremation movement.
Dr Silver's book will appeal to the general medical reader as well as the historian. It is illustrated with some remarkable early photographs.