Rosa Monteserín Nadal, MD, PhD
Primary Health Care Centre, Eap Sardenya, Barcelona, Spain
|Hospital de la Santa Creu i Sant Pau|
The Hospital de la Santa Creu i Sant Pau in Barcelona is the oldest hospital in Spain. It was founded in 1401, after a pest plague and famine caused six medieval hospitals in Barcelona to merge and form the Hospital de la Santa Creu. This functioned until the 1930s, and in its medieval heyday was considered to be one of the best in Europe. It remains one of the city’s most characteristic civilian Gothic buildings, and in 1931 was declared a national historic-artistic monument.
As was common during the Middle Ages, its basic function was to help the patient to eat and drink, relieve pain and infection. It treated the sick and those with mental disorders. It even took care of orphans, raising and training them, after which the boys entered apprentice guilds and the girls received a dowry from the hospital if they married.
The hospital became a center of educational and scientific activity, leading in 1760 to the creation of the Royal College of Surgeons for training barbers as surgeons and develop surgery as a major specialty. In 1801 the Catalan Medicine School was created and almost all the great Catalan doctors were trained there. It was also in one of its laboratories that Ramón y Cajal developed his theory of the neuron for which he received the Nobel Prize for Medicine in 1906. As the city grew and medicine advanced the Raval neighbourhood become obsolete and too small, and the old hospital needed to be relocated. It closed its doors in 1930. One of its last patients was the famous architect Gaudí, seriously injured in a tram accident and dying in the hospital in 1926. Thanks to the administrators of the hospital and the legacy of Pau Gil, a banker, work began on a new hospital, The Hospital de Sant Pau i la Santa Creu. "Sant Pau" was added to the old name of "la Santa Creu" to honour the wishes of its benefactor. The architect Lluis Domenech i Montaner was commissioned to design the new hospital; building began in 1902 and was completed by his son Pere Domenech i Roure in 1930, following delays because of a lack of financial resources. The Hospital de la Santa Creu i Sant Pau was officially opened by King Alfonso XIII in 1930.
Before executing the project, the architect travelled throughout Europe to review trends in hospital construction. The hospital was to provide all services, and to conform to hygienists’ ideas he designed the streets, gardens, buildings, the water supply, a church, and even a convent. It was a medical complex based on the garden-city model, with its own urban layout, and comprised an administration department, a library, a modernist-style church, and a series of twenty-seven isolated pavilions, each different from the other and only sixteen modernist, divided into medical specialities and linked to the others by two kilometres of underground passages.
The architect believed that sunlight and fresh air were of vital importance to patients and doctors. The main entrance was oriented north-south, forty-five degrees from the Eixample district, believed to have been so designed by the architect because he wanted the wind from the sea to ventilate the hospital and prevent diseases. Separate areas were provided for men and women patients. On the left side were the pavilions of the women, named after saints or virgins, and on the right the pavilions of men, named after saints. At the main entrance there was a door on the left wing for women and one on the right wing for men.
Each infirmary pavilion consisted of a broad elongated ward with a circular day room in which patients not confined to bed could be with their families. An area of 145 sq. meters was assigned for each patient, including the landscape grounds, which at the time far surpassed that of the best European hospitals. The architect wanted to integrate nature into his architecture complex by designing two gardens per pavilion. These gardens played more than a purely decorative role in that plants and trees were to purify the air by fixing bacteria, dust, and toxics gases. He believed that if the patients were to recover they needed colour, fresh air, and a pleasant environment.
All the buildings were of made of redbrick. The gable roofs were covered with semi-cylindrical Spanish monochrome clay tiles of various colours. The pavilions had many decorative panels, millions of pieces of mosaic, ceramics with bright yellows, reds and greens captivating creativity, and a wealth of quiet spaces. The adoption of flora and fauna as ornamental elements, both in ceramics and sculpture, had connotations other than purely decorative, in that they maintained the common denominators of regeneration and healing, positive over negative, and life over death.
The lighting, ventilation, and decoration of the rooms made the Hospital de la Santa Creu i Sant Pau a new model that pioneered the importance of open space and sunlight in the treatment of patients. It remains one of the most significant works of Catalán Modernism, as well as the architect's masterpiece, catalogued by UNESCO in 1978 it as a historic monument and declared World Heritage in 1997 for its singular architectural and artistic beauty.
The hospital was the first in Spain to have its own school of nursing, to promulgate an institutional charter of patient rights (1976), and to launch a customer care service (1979). It was the first hospital in Spain to offer bone marrow (1976) and heart transplants (1984). During the Spanish Civil War, when many casualties were taken to the hospital, the surgeon Josep Trueta was appointed head of the Department of Traumatology and it was here that the new “closed method” treatment for war wounds began to be widely used, with great success.
At the beginning of the current century, the need for expansion of the hospital again became evident, as structural deterioration of buildings showed that the modernist group did not meet the necessary conditions to maintain quality of care. So began the complex process of relocating its facilities for the second time, and transferring the medical activity to a new building made it possible to start rehabilitating the modernist pavilions, linked to a new project named Sant Pau Art Nouveau Site. This was transformed into a research centre accommodating benchmark international organisations in healthcare, sustainability and education. At present, seven entities are housed on this campus of knowledge (the United Nations University, the Casa Asia, the Global Water Operator’s Partnerships Alliance, the World Health Organisation, the European Forest Institute, the UN-Habitat City Resilience Programme and the Global University Network for innovation) and the Historical Archive of the Hospital de la Santa Creu i Sant Pau, one the most important of its kind in the word today.
The new hospital was inaugurated in 2009 at the far north-east end of the traditional modernist complex. It was designed as a building in a shape resembling a hand, consisting of a main central block from which four wings for hospitalisation extend like fingers. It now has a highly specialized staff and recognized teaching and research capacity in addition to its high technological equipment. It has over 35,000 admissions each year and more than 145,000 emergencies. Each year some 350,000 people are seen as outpatients and the day hospital attends to over 75,000 users. There are 136 day hospital points, 644 beds, and 21 surgical rooms. Teaching and training programs include the Faculty of Medicine Teaching Unit, the University School of Nursing, and participation in the State Residency Programmes to train specialists and provide continuing education. A Sant Pau Biomedical Research Institute (IIB Sant Pau) was established in 2009 to promote of basic clinical, epidemiological and sanitary service research aiming to improve the population health. Thus the Hospital de la Santa Creu i Sant Pau now spans over six centuries of history, art, and medicine.
- Arxiu Històric Sant Pau. http://santpaubarcelona.org/ca/arxiu-historic.
ROSA MONTESERIN NADAL, MD, PhD, is a family physician. Her clinical work is in the Primary Health Care Centre, eap Sardenya, in Barcelona. She is research associated in the Biomedical Research Institute Sant Pau (IIB-Sant Pau) and in the Health and Ageing Foundation of Autonomous University, Barcelona, Spain.