Florence Nightingale began working on hospital reform even before she founded her famous school of nursing; hospitals were dangerous places for nurses as well as patients, and they urgently needed fundamental reform. She continued to work on safer hospital design, location, and materials to the end of her working life, advising on plans for children’s, general, military, and convalescent hospitals and workhouse infirmaries. Florence Nightingale and Hospital Reform, the final volume in the Collected Works of Florence Nightingale, includes her influential Notes on Hospitals, with its much-quoted musing on the need of a Hippocratic oath for hospitals—namely, that first they should do the sick no harm. Nightingale’s anonymous articles on hospital design are printed here also, as are later encyclopedia entries on hospitals. Correspondence with architects, engineers, doctors, philanthropists, local notables, and politicians is included. The results of these letters, some with detailed critiques of hospital plans, can be seen initially in the great British examples of the new “pavilion” design—at St. Thomas’, London (a civil hospital), at the Herbert Hospital (military), and later at many hospitals throughout the UK and internationally. Nightingale’s insistence on keeping good statistics to track rates of mortality and hospital stays, and on using them to compare hospitals, can be seen as good advice for today, given the new versions of “hospital-acquired infections” she combatted.

Buildings are essentially social and cultural products. They result from social needs and accommodate a variety of functions - economic. social. political. religious. Their size. appearance. location and form result not simply from physical factors such as mat­erials. climate or technology. nor from architects· designs. but from a society's ideas. its forms of economic and social organisation. and the beliefs and values which prevail at any one time. Society produces its buildings and the buildings help to maintain many of its social forms.