Ontario, Canada (Summer 2014)
|Kingston General Hospital in 1858|
I live in an old city by North American standards. I love walking through the Victorian parts of town, which have limestone buildings and hidden courtyards. However, I never gave much thought to the historical significance of the Kingston General (KGH), the hospital I go into or cycle past on a daily basis.
My first inkling of Kingston General Hospital’s link with the past was when my father made his first trip to Kingston when I was an intern. He asked to go to KGH because the original building’s façade was reputedly based on the design of the Edinburgh Royal Infirmary, where he had trained in the 1950s. He looked at the “old entrance” and commented that it looked nothing at all like the Royal and suggested the architect must have been drunk when making the copy. This entrance dates back to the 1850s and like most nineteenth century hospitals is now surrounded by more modern buildings in a variety of architectural styles. Until I read the call for submissions for the Vesalius prize, I did not consider how important the hospital has been in the history of health care in Canada. My ignorance was notable given the efforts of Heritage Canada to educate me; including a large plaque immediately next to where I park my bicycle.
Kingston is a small city located on Lake Ontario. It is most famous for prisons (including historically significant Kingston Penitentiary) and Queen’s University, one of Canada’s oldest universities. It was for a short time the capital of a young Canada, and Kingston General played a role in this part of Canadian history. The main building at Kingston General dates back to 1833-1835 when it was built as a charitable hospital. KGH did not open as a public hospital until 1845 however, as it was the first home of the Canadian Parliament after the union of Upper and Lower Canada from 1841-1844.
At the time KGH opened, most care was provided at home and hospitals provided care for the destitute ill. Medical education was unregulated and the relationship of medical schools with hospitals was less defined. Well-off citizens did not view hospitals as desirable places to receive medical care. The development of new wings at KGH reflects the evolution of health care and society’s perceptions of the role of hospitals. The Watkins wing (1862) added more comfortable space for paying patients, isolation wards for smallpox, and a small space for teaching students in the new medical school. In 1890-91 the Nickle wing had wards for other infectious diseases, reflecting the growth of this field. There was also space for the new nursing school, indicative of the increasing role of nursing in hospitals. The Doran building (1894) provided more beds for maternity, gynecology, and pediatrics but incorporated new knowledge of isolation and infection control (lessons should have been learnt for the newer buildings in the late twentieth century where carpets were a haven for hospital-acquired infections requiring expensive renovations!). It is not apparent now but the Doran wing was designed in pavilion style, as was common in late nineteenth century hospitals, with an emphasis on light and ventilation. The Fenwick operating room highlights the growing profile of surgery and is the oldest operating theatre in Canada, albeit used now as a meeting room without amphitheatre seating for observers. The last addition to the old hospital was the Empire wing (1912-1914), with private and semi-private rooms to meet the expectations of paying patients.
KGH has been in operation longer than any other hospital in Canada, and the original areas were used for patient care when I started working. Only three hospitals in Canada are National Historic Sites; KGH received this status because it encapsulates the evolution of health care in Canada and the changing role of hospitals. Given recent attempts by governments and health professionals to move care out of hospitals and into the community, an understanding of the history of hospitals is interesting and instructive. Reading about the history of hospital design has made me realize that healthcare architecture reflects much more than just the architect’s design sensibilities. When I pass through the early buildings or attend administrative meetings, I now try to envision the original hospital filled with patients and health professionals. I also recognize that the layout and designs of new parts of KGH will appear antiquated in just a few decades.
Why highlight KGH when there are more famous institutions? It is easy to work in a building and not consider its context in the past and present. Buildings are a concrete example of changing societal standards and beliefs about health and care. Increasing my own knowledge of the history of the hospital has had an impact on my connection to the organization and provide context for understanding the constantly changing world of health care in the 21st century.
CHRISTOPHER FRANK, MD, FCFP, CCFP, is a family physician with additional training in care of the elderly and works as an associate professor in the Department of Medicine, Queen’s University. His clinical work is done at Kingston General Hospital and at an even older building, St Mary’s of the Lake Hospital. His focus is on geriatric rehabilitations and palliative care and he enjoys using humanities with medical trainees whenever possible.