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Holland
is relatively a new country: two third of the country is reclaimed
land. Not only the country is relatively new but also our hospitals. If we want to discuss what to do with the future hospital heritage, we have to look into what kind of hospitals we have and what kind of buildings they are. · 1880-1940 What's a hospital? If we want to compare hospitals in different countries we have to define the term hospital. In my opinion a hospital is a place where people go to be treated by doctors and nurses. It's not, like the so called hospitals in the 16th and 17th century, a big place for the poor to stay and wait for their death. According to this definition, hospitals came into existence about 1880 when nursing had become a profession and when the aseptic operations and X-ray equipment made it necessary to treat all patients (rich and poor) in hospitals. The first school for nurses was started by Vincent de Paul and Louise Legras-de Marillac in 1633 in Paris. The nurses founded the religious order of Soers de la Charité. In Holland the first catholic hospital was founded in 1826 in Breda. In 1839 the Soers de la Charité founded a hospital in Amsterdam. The protestant version, the Deaconesses, was founded in Kaisers-werth, Germany by Theodor Fliedner, a vicar. The Deaconesses started in 1844 their first hospital in Holland in Utrecht, followed by a hospital in The Hague in 1865. Florence Nightingale worked in 1850 at the hospital in Kaisers-werth. Her influence on nursing and hospitals in England is clear. The influence of the 3 different backgrounds is still recognizable in the wards: in Germany the doors of the patient rooms are closed; in England the nurses want to see all their patients from the nursing station. The interest in the medical profession and the ideas about hospitals spread all over Europe. The old big hospitals were replaced by new hospitals. The Coolsingel hospital in Rotterdam in 1851 was almost a copy of the Diakonissen Anstalt Bethanien of 1847 in Berlin which had a corridor structure. The others were pavilion hospitals: Academisch Ziekenhuis in Utrecht (1866), Academisch Ziekenhuis in Groningen (1903), Wilhelmina Gasthuis in Amsterdam (1906) and Academisch Ziekenhuis in Leiden (1920). The pavilion hospitals are replaced by new hospitals on the same spot or made into pricey apartments. Because the care in the large (teaching) hospitals was free for poor people, the richer people did not go to these hospitals. Catholic orders had started their own small hospitals for the catholic people. In protestant villages the local doctors started their own hospitals with 16 to 20 beds. Germany, where still a lot of private clinics are, was considered to be the main example. Between 1920 and 1940 the number of beds in hospitals in Holland doubled, but no new hospitals were founded. The small cottage hospitals consisted of just one building and are now either pulled down or converted into houses. · 1945-1965 The Second World War changed a lot in Holland. Bismarck had invented a health insurance for all German workers. In 1941 everyone in Holland who earned less than average, had to be insured. This is still the case. During the Second World War a lot of buildings had been demolished. For instance Rotterdam (and the Coolsingel hospital) was bombed flat in May 1940 by the Germans. After the war there was a shortage of material, manpower and money. Until 1965 there was a law that forbid to build anything without permission of the government. This made that hospitals had to get permission of the Ministry of Health to build. The Ministry of Health saw to it that hospitals were spread over the country. Hospitals were considered necessary places to cure patients. Religion was not considered by the government. The study Making Better Health Available to All of I. Rosenfield and S. Breines in the USA (1947) put forward different hospital structures which were like Hôpital Beaujon in Paris (1935) characterised by blocks. In the period 1955-1965 most Dutch hospitals were built like that. The hospitals consisted of a building for wards (single corridor), a treatment building with operating theatres and the main entrance and a building for out-patients. Since doctors saw at least their none state insured out-patient still at home, the out-patient area was not so large. The X-ray department had still a clinical and an out-patient side. This is still seen in Belgium. Next to the hospitals were living quarters for nurses; not only because young nurses had to live protected, but also because there was a shortage of houses. In this period just a few hospitals were built. Most of them were replaced because they merged with other hospitals in the neighbourhood. · 1966-1982 Economically it went well with Holland. There was still a shortage of staff. Therefore the teaching (pavilion) hospitals were complaining about the inefficiency of being spread over so many buildings. In 1966 the government, who owned the teaching hospitals, decided to start a programme of renewing the teaching hospitals. They made one programme of requirements for 5 new teaching hospitals. The hospitals were opened between 1984 and 2000. In the programme of requirement the hospital was seen as a machine and the patient as a product on which had to be worked. Patients who were not treatable did not need a doctor and should not be in a hospital. Separate nursing homes were founded and in 1968 a law was passed for financing nursing homes by a special obligated insurance. After 1965 permission was no longer needed to build in Holland. A lot of hospitals wanted to have new housing and wanted to enlarge themselves. New buildings attracted staff and patients. Because such a lot of money was involved in all these plans, the Ministry of Health passed a law that the hospitals still had to get permission of the Government to build. If there is a lot of construction going on, the insurance premium has to go up. If the health insurance premium goes up, the government will be forced to lower the taxes. For this reason the system of permits for hospital buildings still exists. At the end of the sixties, people believed in machines and functionalism. Hospitals became air-conditioned places, structured as a Breitfuss: outpatients on the ground floor (doctors saw all their out-patients in the hospital), treatment area on the first floor and a block of wards (double corridor) on top. First the wards were one straight block with a double corridor. At the end of this period the wards got a carousel structure (Ziekenzorg in Enschede (1981)) like the wards of St. Thomas Hospital in London. Problematic was that the materials used in this period were of low quality. The structure of the buildings is such that you cannot use them easily for other purposes. Up 'till now we have stripped some of those buildings completely. We have also pulled some down. The economy slowed down. Hospitals were still making lots of plans for new buildings. There were so many plans that the Ministry of Health decided that all plans had to be rejudged again. Only a few were allowed to carry on. |
