From Locks to Perforated Blocks

Shifting mentalities in disease control and architecture

從枷鎖到通花磚:疾病管理與現代建築

Charles Lai 黎雋維

本文透過勾劃香港西方醫療發展的歷史,探討疾病控制與城市空間及醫療建築設計的關係。開埠初期,為了控制性病傳播,性病醫院成為妓女的困鎖空間 ;及後香港熱的流行啟發了建築物的迴廊和高樓底設計;十九世紀末的的鼠疫引致太平山街給直接夷平;二十世紀初頒布的《醫務衛生及建築條例》更明確以衛生原因管制建築物之間的距離。作者更以五十年代由西營盤國家醫院改建成的贊育醫院和西營盤分科診所為例,指出當年的醫療建築的佈局、區間以及通風的設計別具心思,有效以低廉及科學化的方法防止疾病的傳播,值得今日的建築參考。


Since the mid-eighteenth centuries, advances in maritime technology have fostered intercontinental exchanges between Europe, Asia, and America. In addition to accelerating global trade, these exchanges also spread many types of diseases previously unknown or rarely seen in Europe. In the era before modern bacteriology knowledge had developed, European military medical officers believed that many of these diseases arose from hot, humid tropical climates, over-crowded environments and poor ventilation.1 Of course, it was later understood that many of these diseases were the result of many other causes, including nutritional deficiencies caused by a lack of fresh vegetables and fruits in diets. Nonetheless, the clinical relationship between environment and health was not completely speculative.


The management of diseases arising from long-haul sailing formed the cornerstone of Western healthcare deployed in colonies such as Hong Kong. Sailors were often at sea for weeks or months. Their occasional breaks on shore were often beset by debauchery and overindulgence. The sickness resulting from this pattern of life was a particular burden for the navies.

Therefore, some of the first Western hospitals in Hong Kong were military infirmaries established specially for seafarers and ‘Lock Hospitals’ where sexually transmitted diseases were treated. Prostitutes who contracted sexually transmitted diseases would be locked up in these facilities to prevent them from continuing to work.


A major problem that plagued European colonial troops were the various tropical diseases they found themselves exposed to. The colonists believed that the sources of these diseases were the unhygienic environment and cultural backwardness found in tropical areas. This biased view, tainted with imperialism, moulded the city’s spatial planning and architecture in the colonial era. In 1842, the outbreak of a plague that was named ‘Hong Kong Fever’ caused the death of many European dwellers. With medical professionals still unaware of the theory and study of bacterial pathogenesis, the colonial authorities concluded that poor ventilation in barracks had caused the soldiers to overheat and develop fever symptoms in hot weather.2 These ideas led to the development of some specific architectural features, including the use of cloisters and high ceilings, in barracks, official residences and hospital buildings in colonial times. Thus the stylistic features of colonial architecture were not only for keeping the houses cool but also to ensure the survival of their inhabitants.


At the same time, to escape Hong Kong’s hot and humid environment, Europeans in Hong Kong began moving to the cooler and airier Mid-Levels district; while the Chinese community was moved to the Tai Ping Shan Street area. The overcrowded living conditions of the Chinese quarter provided a ‘favourable’ environment for the outbreak of the Hong Kong Plague of 1894. This disease was believed to have originated in Yunnan, arriving in Hong Kong via Guangzhou. The Hong Kong government dealt with the plague with an iron hand. Apart from quarantining patients and punishing those who refused to receive treatment (many Chinese at that time were sceptical of the merits of Western medicine), the government also demolished many buildings in the Tai Ping Shan Street area, hoping that by lowering its population density the spread of the plague could be controlled. The cleared area is where Blake Garden is now located.


In 1903, the government, heeding Sir Edwin Chadwick’s advice, introduced the first ‘Public Health and Buildings Ordinance’ in Hong Kong. The ordinance opened a new chapter for building control, prohibiting back-to-back buildings and stipulated the use of back alleys. It is worth noting that the original intention of these building control regulations was public health concerns, not building safety.3 Such efforts and policies aimed at maintaining public hygiene played a key role in shaping the built environment of Hong Kong’s early years as a colony.


As cases of bubonic plague gradually subsided, replaced by tuberculosis as the biggest threat to public health. In response, the government placed more emphasis on promoting personal hygiene and expanding the public health system. Clinics and hospitals were renovated or established to cope with increasing demand, and unlike earlier hospital designs, these new facilities were often designed with modern, sometimes avant-garde features. The use of such contemporary architectural languages was simply a response to the popular architectural trends of the time, but also to suggest ideas of neatness and hygiene through their appearance.


The Government Civic Hospital in Sai Ying Pun, originally built in 1879, was redesigned in phases in the 1950s to include Tsan Yuk Hospital, designed by Eric Cumine and completed in 1955, and Sai Ying Pun Jockey Club Polyclinic, built in 1960. Designed by Leigh & Orange Architects, the Polyclinic used an arch-shaped form to follow local topography. Its windows and air-conditioning racks created a neat, grid-like pattern on the façade. Behind the uniformity of the facade, the interior of the building could be flexibly adapted to different spatial needs and functions.


In addition to a general out-patient clinic, the Polyclinic also housed specialised outpatient clinics that handled patients transferred from other hospitals on Hong Kong Island. To reduce the risk of disease transmission, a dedicated waiting area was created for tuberculosis and chest patients. The area was directly connected with X-ray examination rooms through exterior staircases and dedicated passages that prevented contact between tuberculosis patients and other patients.


The Tuberculosis & Chest section of the hospital also had its own entrance and exit to further prevent cross-infection. The public passages including corridors and staircases were built with perforated walls with hexagonal honeycomb tiles. These air holes let in sunlight and boost air ventilation so bacteria would not be trapped in confined spaces. These layout and ventilation designs formed a low-cost but effective first line of defence against disease. Built in an era when resources were sparse, these health-conscious architectural designs were part of the shield for public health. Strangely, in today’s resource-abundant Hong Kong, architecture seems to have abandoned such simple principles. When facing a pandemic, the architecture of today’s city finds itself not only defenceless, but with designs and densities that often appear to accelerate the spread of disease. As this year’s Covid-19 outbreak has reminded us, illness can still be hugely destructive and disruptive. So it may be time for architectural professionals to rethink how design can serve to protect people against the spread of infectious diseases.

Conclusion
Adopting biophilic and salutogenic designs in hospitals and other public infrastructure may involve additional spending and recurrent costs. But such investment is worthwhile as it can help the elderly maintain their health and prolong the period in which they can live independently, in turn reducing demand for chronic medical care. Schemes such as the Pier Improvement Programme, which is upgrading over a hundred public piers to include barrier-free access, will enable the elderly, even those with walking difficulties, to visit natural areas in Hong Kong’s outlying islands that they could not previously enjoy, so improving their quality of life. Such public works not only benefit Hong Kong residents, they can also help relieve the long-term strain on medical services. Keeping the elderly in good health cannot be achieved only by having more hospitals. It also requires effort to take care of their physical, mental, social, and spiritual well-being. Good architectural design that improves accessibility and liveability is an important tool to realising these goals.

 

Charles Lai is an architect registered in the UK and an architectural historian. His works explore the history of modern architecture in East and Southeast Asia, the material culture and history of Shanghai plaster, and the conservation of historical built heritages.
黎雋維為英國註冊建築師及建築歷史學者。主要研究範圍包括東亞及香港現代建築歷史、上海批盪的文化和歷史、以及歷史建築保育和改造設計。

1 Chakrabarti, Pratik, Medicine and Empire: 1600-1960, Basingstoke, Palgrave Macmillan, 2014.
2 Cowell, Christopher, ‘The Hong Kong Fever of 1843: Collective Trauma and the Reconfiguring of Colonial Space’, Modern Asian Studies, 47, No. 2 (2013), pp 329-64.
3 馬冠堯 [Ma Koon-yiu]. 戰後到回歸前香港結構工程規範發展的探討, MA Thesis. University of Hong Kong, 2006. 

Fig.1 Sai Ying Pun Jockey Club Polyclinic
The arch-shaped massing forms an urban wall that embraces the curvature of the Queen’s Road West (Credit: author)

Fig.2 Sai Ying Pun Jockey Club Polyclinic
The grid of the facade with rhythmic subdivisions and stretcher bond tile pattern (Credit: author)