A pavilion hospital is a functional and spatial organization of hospitals that emerged in the 18th century and became widespread in the 19th century. The principle was to distribute different functional units or hospital services across several buildings, known as "pavilions". This layout, which promotes air renewal and circulation, also made it possible to isolate wards and diseases, thus addressing the hygienist concerns that arose from advances in medicine.
One of the earliest pavilion hospitals in England is the Royal Naval Hospital, Stonehouse, near Plymouth, built from 1758. In France, the first was the Hôpital de la Marine de Rochefort, opened in 1788.
This organizational model spread mainly during the 19th century—notably with the construction in Paris of Lariboisière Hospital, opened in 1854—and reached its culmination in Lyon with Hôpital Édouard-Herriot, built by Tony Garnier between 1911 and 1933. In the United States, pavilion hospitals were constructed in large numbers from the 1860s.
From the 1930s onward, a new model, the block hospital, became dominant.
Origins The pavilion system has military origins. In France, since the time of Sébastien Le Prestre de Vauban (1633–1707), garrison troops were housed in separate and isolated buildings, making it easier to contain fires caused by artillery during sieges.
In the 18th century, this arrangement appeared best suited to preventing contagious diseases according to the miasma theory. Unlike medieval hospitals that gathered patients in stagnant air, the aim was no longer to purify air through fires or fumigation, but to renew it through circulation. This "aerist" doctrine was based on controlling airflows to eliminate contagion.
United Kingdom In England, it was James Lind (1716–1794), an administrator of the Royal Navy, who recommended these principles, not only in naval hygiene but also in hospital hygiene:"What I have said concerning the bad air of ships must also apply to all hospitals in general; it is far better to have the sick camp under tents near the hospital than to let them infect one another; this is the only method of preventing the communication of their disease." (Essay on the Most Effectual Means of Preserving the Health of Seamen, Paris, 1758).Cited in .The first reference model implementing one of the basic principles (a hospital composed of units in separate and independent buildings) is the Royal Naval Hospital, Stonehouse, built between 1758 and 1764 near Plymouth., It reflects the model of the tent (military encampment) or the island (archipelago), which strongly influenced the imagination of physicians and architects of that time.
France In France, a major event was the fire that destroyed much of the Hôtel-Dieu de Paris on the night of 29–30 December 1772. This disaster sparked a nationwide debate lasting about fifteen years and led to the emergence of pavilion hospital planning. Around forty reconstruction projects were proposed, most based on aerist doctrine: buildings arranged in grids with enclosed courtyards or gardens, inspired by Hôpital Saint-Louis, or circular layouts such as the star-shaped design proposed by Antoine Petit (1722–1794).
The physicist Jean-Baptiste Le Roy (1720–1800) was among the first to propose isolated pavilion systems in 1777. His design included high and low ventilation openings to encourage upward air renewal, aiming to limit horizontal air movement "to prevent miasmas from passing from one bed to another." The debate was settled by a commission of the French Academy of Sciences between 1786 and 1788, following study trips across Europe. The Stonehouse hospital served as a reference model. A monumental circular project by Bernard Poyet (1742–1824) was rejected, but a revised plan aligned with the commission's recommendations was presented in Jacques Tenon's influential Mémoire sur les hôpitaux de Paris (1788). On the eve of the French Revolution, all large unified hospital designs were rejected in favor of fragmented "hospital in pieces" concepts.
This debate was ultimately settled by a commission of the French Academy of Sciences between 1786 and 1788, following study trips across Europe, during which the Stonehouse hospital was taken as the reference model. An initial project for a colossal circular hospital, proposed by Bernard Poyet (1742–1824), was rejected in 1786, but Poyet submitted another plan in line with the Academy's recommendations, presented in the famous memoir by Jacques Tenon (1724–1816), Mémoire sur les hôpitaux de Paris (1788).
On the eve of the French Revolution, all projects for a massive, spatially unified hospital were rejected as archaic or incompetent. Under the auspices of the Academy, physicians and architects embraced the idea of a "fragmented hospital", one that was uniform in concept yet divided into separate units.
Pavilion systems In France, the first pavilion hospital was the Hôpital de la Marine de Rochefort, rebuilt from 1781 and opened in 1788. Initially planned as a complex of ten buildings, six of which were to be separate from one another, it was reduced to eight buildings for budgetary reasons, with one building housing a surgical school and an anatomical amphitheater.
Tenon system The French Revolution interrupted the planned hospital program, and major construction works did not resume until after 1830. Thus, the reconstruction of the Hôtel-Dieu de Paris only began in 1867. Poyet's original 1788 project provided for two rows of seven buildings aligned on either side of a large central courtyard, forming a strictly symmetrical structure known as the "double comb" layout. This system, presented in the memoir of Jacques Tenon, was adopted as a basic principle—known as the "Tenon system"—throughout the 19th century in hospital construction and reconstruction.
Among civilian hospitals, the double-comb layout can be observed, or was once observed, in Hôpital Saint-André in Bordeaux (1826–1829); in the hospice of La Reconnaissance in Garches (1835–1843), now Raymond-Poincaré Hospital; in the former Beaujon Hospital (1835–1844) in Paris's 8th arrondissement; in the Hôtel-Dieu d'Orléans (1844); in the Hôtel-Dieu de Nantes (1863), considered one of the finest examples of the double-comb type, though destroyed by bombing in 1943; and in the Hôpital de la Conception in Marseille (1858–1863), demolished and rebuilt at the end of the 20th century.
Among military hospitals, examples include those in Bayonne (1834–1841), now the Lycée professionnel Paul-Bert, and in Vincennes (1855–1858), now the Hôpital d'instruction des armées Bégin in Saint-Mandé. Owing to the simplicity of its design, the Vincennes hospital was regarded by contemporaries as the "egg of Columbus" of hospital architecture: two three-story patient pavilions frame a garden, while a third, perpendicular building houses general services, forming an open U-shape that met ventilation requirements.
The most notable example of the double-comb type is the Lariboisière Hospital in Paris, inaugurated in 1854. It is strictly symmetrical, consisting of ten three-story wings—five on each side—arranged around a central courtyard focused on a chapel.
Tollet system
From the 1860s onward, the Tenon model came under criticism: single-story pavilions were advocated, with the ground floor separated from the upper level, and construction using plaster and iron, allowing buildings to remain cooler in summer and better heated in winter. In 1872, after the defeat of 1871, military engineer Casimir Tollet (1828–1899) promoted a system of small, single-story pavilions with false metal vaults fitted with ventilation chimneys. Examples of this system include the military hospital of Bourges (Baudens Hospital) and the hospital-hospice of Épernay (Auban-Moët Hospital).,Victor Auban-Moët (1832–1896), son-in-law of Victor Moët de Romont.
In the 1880s, Tollet was regarded by his contemporaries as one of the last defenders of "aerism" through the dispersion of miasmas, even described as an "ultra-Tenonian". He sought to impose his system everywhere, criticizing others that were similar but differed in detail (such as fully isolated small pavilions). He notably criticized German hospitals, including the civil and military hospital of Berlin, the hospital of Heidelberg, the military hospital of Königsberg, and the new hospital of Hamburg.
Florence Nightingale and the Franco-British debate In the 1860s, British observers noted that new hospitals had lower mortality rates than older ones, but that these rates tended to increase again over time. The famous nurse Florence Nightingale (1820–1919), founder of nursing as a scientific discipline, suggested demolishing and rebuilding hospitals every ten or twelve years, which was not economically feasible.
Nightingale advocated ward-pavilions (single-ward pavilions), which she considered the healthiest form of hospital structure within the framework of aerist theories. These pavilion wards were easier to clean and ventilate. During the reconstruction of St Thomas' Hospital in London (the medieval hospital having to make way for a new railway station), she proposed relocating it more than 15 miles away to a suburban area. This proposal was rejected, but she succeeded in securing pavilion wards and a nursing school for the new hospital built on the south bank of the River Thames..
Nightingale's principles inspired the design of the Lincoln Hospital in Washington, D.C., organized into 21 pavilions arranged in a V-shape around administrative and service buildings.. This temporary military hospital (1862–1865), used during the American Civil War, was located on part of what is now Lincoln Park (Washington, D.C.) and was demolished at the end of the war.
The pavilion system, particularly that of small pavilions, was criticized for requiring too much space, as each pavilion needed large open areas to ensure proper ventilation. Savings in construction costs were offset by the expense of acquiring and maintaining land (courtyards and gardens).
Hospital hygiene became a widely debated issue on both sides of the English Channel, with English and French publications responding to one another. According to Pierre-Louis Laget: "Emulation feeds on comparisons, mutual disparagement, claims of superiority or, conversely, envious views of the other." Each commentator tended to adopt from abroad only what supported their own arguments. For example, Armand Husson (1809–1874), director of public assistance in 1859, extensively cited Nightingale's Notes on Hospitals when she praised Lariboisière Hospital, while omitting the criticisms she also expressed.
Apogee and decline The pavilion system reached its peak even as its theoretical foundations (miasma theory and aerism) were being called into question. As noted, "the hospital architect of 1880 scarcely knew any longer where to guide his steps."
Changes in hygiene
According to miasmatic theory, infections or "wound fevers" were caused by the immediate air environment surrounding the patient; prevention relied on ventilation and avoiding overcrowding (the ratio of patients to room volume). Following empirical observations—interpreted through statistics—such as those of Ignaz Semmelweis (1818–1865), and the work of Louis Pasteur (1822–1895) and Joseph Lister (1827–1912), antiseptic and aseptic practices became increasingly established. Wound infection came to be seen as dependent on the surgeon: the cleanliness of their hands, the sterilization of instruments, and the asepsis of the surgical field. By the end of the 19th century, all surgeons wore gowns, masks, and gloves.