The Strange History of Medical Architecture: From Concrete Giants to Courtyards of Calm
Medical architecture has never been just about walls and roofs. From the towering Soviet hospitals of the Cold War to the light-filled sanatoriums of Finland and the garden-filled courtyards of Renaissance Europe, hospital design has long reflected our hopes, fears, and beliefs about care. This article traces some of the most unusual chapters in healthcare design history and shows how their lessons continue to shape the hospitals of today.
Categories:
Date Posted:
July 7, 2025
The Strange History of Medical Architecture: From Concrete Giants to Courtyards of Calm
The history of hospital design and medical architecture reveals a fascinating mix of science, culture and creativity. Hospitals have always been more than places of treatment. They reflect how societies understand health, healing and the role of space in care. Across centuries, these buildings have taken many forms – bold, strange, beautiful and sometimes deeply flawed. Some changed the course of healthcare. Others became examples of what to avoid.
In this piece, we explore some of the most unusual and influential moments in the history of hospital design, examining what worked, what failed and how past ideas continue to shape the hospitals we build today.
Concrete Power: Soviet Hospitals and the Weight of Ideology
During the Cold War, architecture in the Soviet Union was more than practical. It was political. Hospitals were built to look unshakable, often rising as enormous brutalist blocks carved from raw concrete. These buildings were designed to project power, not patient comfort.
One of the most infamous examples is the Khovrino Hospital in Moscow. Construction began in 1980 with the goal of creating a state-of-the-art centre for infectious diseases. The design resembled a five-pointed star, which locals quickly nicknamed “The Umbrella”. Despite years of work, the hospital was never completed. It sat abandoned for decades and eventually became a magnet for urban explorers and conspiracy theories.
Khovrino’s failure wasn’t just about delays or bureaucracy. It revealed a fundamental problem in the way the building had been conceived. These designs focused on scale and function, but they ignored the emotional and psychological needs of patients. Endless corridors, little natural light and a cold atmosphere made care feel impersonal at best and punishing at worst.
Today, architects see this as a cautionary tale. Healthcare spaces need to support the patients recovery, not just the hospitals operations.
The Quiet Genius of Finnish Design
While the Soviets built monuments to showcase power and control, Finland pursued healing through calm and comfort. In the 1930s, architect Alvar Aalto created the Paimio Sanatorium for tuberculosis patients. His goal was simple but revolutionary. He wanted the building itself to be part of the treatment.
Every detail in the sanatorium was crafted to support rest and wellbeing. Patient rooms were tilted to catch morning sunlight. Ceilings were painted soft green to ease the eyes. Even the sinks were designed to reduce splashing sounds so that patients could sleep more easily.
The Paimio Sanatorium was not grand in size or budget, but it was elegant in thought. Aalto showed the world that hospitals do not need to feel clinical or cold. They can feel human. His ideas continue to influence designers today, especially in settings where care depends as much on emotional support as on medical intervention.
“People heal better in places that offer beauty, nature and peace”
Gardens, Light and the Renaissance Vision of Care
Long before hospitals had ventilators or blood tests, Renaissance architects were already thinking about the relationship between environment and healing. In places like Florence, the goal was not just to treat illness. It was to restore the person.
One standout is the Ospedale degli Innocenti, which opened in 1419 and was designed by Filippo Brunelleschi. Built as a home and care facility for abandoned children, it featured open-air corridors, precise proportions and a focus on symmetry and light. Everything was intended to feel ordered, peaceful and generous.
Many Renaissance hospitals also included gardens planted with herbs, flowers and fruit trees. These were not merely decorative. They were believed to offer therapeutic value, easing the mind and supporting physical recovery.
Although the science of the time was limited, the designers understood something that remains true today: people heal better in places that offer beauty, nature and peace. In recent years, this idea has made a comeback under the name “biophilic design”. It turns out the Renaissance may have been onto something.
“Until then, many hospitals followed a centralised model.”
Keeping Germs in Check: The Pavilion Plan
By the 19th century, breakthroughs in microbiology had changed everything. Scientists had begun to understand that infections spread through the air and by contact, not just through poor sanitation or bad smells. This shift in knowledge called for a complete rethink of how hospitals were designed.
Until then, many hospitals followed a centralised model. Patients were often treated together in large, crowded buildings with little ventilation and few barriers between illnesses. Once germ theory took hold, this kind of layout was no longer acceptable. Architects and health officials began advocating for a new solution known as the Pavilion Plan.
Instead of placing all patients under one roof, this design separated them into individual wings or standalone buildings. Each pavilion focused on a specific disease or condition, reducing the risk of cross-infection. The buildings were spaced apart, often with gardens or walkways in between, which allowed fresh air to circulate and gave patients access to sunlight. These were not just aesthetic choices. They were part of a deliberate strategy to create healthier, more hygienic environments.
The Pavilion Plan also made hospitals easier to manage. Staff could isolate outbreaks quickly. Natural ventilation improved indoor air quality. Large windows and open courtyards encouraged airflow and brought in daylight, which was believed to have disinfecting properties. All of this helped prevent the spread of disease and improved recovery rates.
One of the most influential examples of this approach was Johns Hopkins Hospital in Baltimore, which opened in 1889. It brought together the latest scientific thinking and a carefully considered layout. The hospital’s separate pavilions, wide corridors and open spaces created a cleaner and more functional environment for both patients and staff. It became a model for hospitals around the world.
Although the Pavilion Plan gradually gave way to more centralized layouts in the 20th century, mostly due to cost and efficiency, its impact never truly faded. Many of its core ideas, like the importance of airflow, light and separation, remain relevant today.
In fact, recent global health crises have sparked renewed interest in these design principles. Architects are once again thinking about how to create flexible, responsive spaces that can adapt to outbreaks or surges in patient numbers. Modular units, decentralised care zones and controlled circulation paths all reflect the same core thinking that guided the Pavilion era.
The Pavilion Plan reminds us that architecture is not just about structure. It is about strategy. When designed with care and insight, a hospital building becomes part of the treatment itself.
“Asylums were no longer hidden away or built like fortresses.”
Asylums and the Architecture of Optimism
In the 1800s, a quiet revolution in mental health care began to take shape. Known as “moral therapy,” this approach challenged the harsh treatment methods of the past. It suggested that mental illness could be eased, and perhaps even cured, through kindness, routine and exposure to the natural world. In response, architects and physicians began building a new kind of institution—one designed not to confine, but to care.
The architecture reflected this shift in attitude. Asylums were no longer hidden away or built like fortresses. Instead, they featured wide hallways, large windows, decorative facades and landscaped grounds. These design choices were rooted in a simple but powerful idea: that beauty, order and peace could support recovery.
One of the most well-known examples is the Trans-Allegheny Lunatic Asylum in West Virginia. Built in the mid-19th century, it followed the principles of the Kirkbride Plan, a design philosophy developed by psychiatrist Thomas Story Kirkbride. His model called for long, symmetrical buildings with staggered wings to allow sunlight and air to flow freely through each ward. The Trans-Allegheny structure stretched more than 600 feet across and sat on spacious grounds filled with gardens and walking paths. It was meant to feel more like a campus than a prison.
In its early years, the asylum provided structured routines, work programs and recreational activities, all set in a carefully designed environment. The goal was to treat patients with dignity and to create a sense of normality.
But the optimism that drove this movement was difficult to sustain. As mental health awareness grew, so did the number of people admitted to asylums. Facilities became overcrowded. Funding failed to keep pace with demand. What began as a humane alternative to past abuses eventually collapsed under the weight of its own success. Many of these once-hopeful institutions fell into neglect, their grand architecture left to crumble.
Even so, the legacy of this period remains. It showed that the physical environment plays a significant role in emotional and psychological wellbeing. Space, light, access to nature and a sense of dignity all matter in mental healthcare.
Modern psychiatric hospitals have taken this to heart. While the settings have evolved and the treatment methods have changed, the core idea persists. Facilities today often aim for calm, welcoming environments that prioritize safety without feeling sterile. Soft colors, open spaces and natural light are used intentionally, creating spaces where people feel supported, not shut away.
The architecture of optimism may not have been perfect, but it planted a vital seed. It reminded us that care begins the moment someone walks through the door.
What Yesterday’s Hospitals Can Teach Us Today
Medical architecture is never just about walls and windows. It reflects the values of its time, whether those values lean toward control, compassion, science or serenity.
From the imposing bulk of Soviet designs to the sunlit gardens of Renaissance Italy, from the quiet innovations of Finland to the hygienic brilliance of the Pavilion Plan, each moment in history added something to the way we think about healing.
At Graceland Architects, we believe the best healthcare spaces are shaped by both progress and perspective. A hospital must operate with precision and meet complex demands, but it should also feel human. People heal faster in places that recognise their emotional and physical needs. Our goal is to design with intent—to enhance function while creating environments that support care. Because often, the smartest way to move forward is to start by understanding what has come before. That’s where real innovation begins.
