As the field hospital NHS Nightingale opens at the ExCeL centre in London, Marie Allitt considers a wartime precedent for temporary spaces of caregiving.
As I write, temporary hospitals are being hastily erected across the world to handle the casualties of Covid-19. These spaces are labelled ‘field hospitals’ despite the fact that we are not at war or in military conditions, illustrating how far martial language is already embedded in how we approach crisis. The blur between the civilian and military is taking hold, so it seems a fitting time to consider the historical precedent for temporary hospitals in wartime, and how such hospitals are not always swiftly erected tents and huts, but also the conversion of existing buildings, sometimes generating strange visual and symbolic disparities.
Throughout the First World War, temporary hospitals were needed across Europe, especially in evacuation zones, such as northern France. In August 1914, voluntary aid detachment (VAD) nurse Adelaide Walker was assigned to a Base Hospital in Versailles. It was in fact the Trianon Palace Hotel, and had just been frantically adapted into a working hospital:
The rooms…were full of terribly wounded men, dying of gas gangrene and tetanus…It was a curious sight – almost unbelievable – the brightly lighted hall, scarlet carpeted stairs (there had been no time to remove the carpets), stretcher after stretcher being carried in with wounded men caked in mud and blood…Beautiful bedrooms were filled with hospital beds, all occupied.
Walker briefly admits the jarring juxtaposition of the hotel-turned-hospital, illustrating the disruption to the site, and disturbance in its existence. It is a ‘curious sight’ to see the contrast between luxury, beauty with pain and broken bodies. This may be a brief interlude in its life as a glamorous holiday destination for the rich and influential, but the hotel can never really forget its status as a hospital.
By October, Walker was posted to the No.13 Stationary Hospital in Boulogne-Sur-Mer, where sugar sheds and warehouses at the Gare Maritime became the hospital. It was another strange sight: the sheds in the process of becoming wards, with wounded soldiers lying on straw, but ‘a miraculous change soon took place; reinforcements of nurses began to arrive, and the sheds took on the appearance of a well ordered hospital.’ A new spatial identity was immediately applied to this space: it not only functioned as a hospital, but looked like one too. It became a hospital. But there remained a contrast between its prior use, the goods it housed, and its new state, offering shelter and care to wounded soldiers.
The hotel and sugar sheds are just two examples of unusual spaces converted into hospitals during the conflict: other sites included schools, churches, chateaux, casinos, and racecourses. Once made a hospital, the character of that space must and does change, in often surreal and juxtaposing ways. I offer several examples of temporary hospitals, paying particular attention to the varied sites that, although temporary, are irrevocably marked by the contrast between its pre- and post-war identities. One doctor at the time observed how ‘the normal life of the state has been turned upside down’, and the buildings altered their ‘sphere of usefulness.’ Not only had ordinary life been changed and suspended, so too had the identities of those buildings-turned-hospitals. There is a divergence between what the building once was, what it reverts back to, and what it was as a hospital. The space is changed, and its story rewritten.
Responding to the need for volunteers, Mary Borden was assigned to nurse at ‘the dilapidated casino of Malo-les-Bains’, Dunkirk, which ‘had been turned into a makeshift typhoid hospital of 250 beds.’ Despite its dilapidation, the contrast between the luxury of the casino and the broken bodies persisted: ‘The sick lay helpless under the great tarnished chandeliers of the gaming rooms, the rows of dingy beds were reflected to infinity in the vast gilded mirrors.’ There is something uncanny, almost grotesque, in the image of wounded bodies reflected in the glass under the crystal chandeliers. The wounded are made into spectacles ‘reflected to infinity,’ across time and space, an echoing revulsion made more forceful by contrast with the worldly pleasures of the casino.
The unease from the contrast between pain and crystal chandeliers is similarly experienced with the requisition of Brighton’s Royal Pavilion and Dome, in East Sussex, which became a military hospital for Indian soldiers from 1914 to 1916, and a hospital for Limbless Soldiers from 1916 to 1920. The Pavilion is distinctive for its Asian architectural and decorative influences; its external minarets and domes are complemented inside, by exotic designs and furniture with Japanese, Chinese, and Indian influences. A local newspaper observed at the time:
Never surely, were there more beautiful hospital wards, with their decorated walls and ceilings, their wonderful chandeliers, their broad sheen of mirrors. All the morning sun streams in at those long windows, which open direct on to the eastern lawn. […] There are some forty beds in the Banqueting Room and Music Room, and from fifteen to twenty in the others.
While the Pavilion Estate provided necessary space, the choice of venue remains visually, and to an extent ideologically, disconcerting. Figures 2 and 3 show the extreme contrast between the chandeliers and wounded men lying on beds. The Pavilion, former palace, and the Dome, a performance and entertainment venue, exemplify the unsettling juxtaposition of signs of decadence and signs of pain and injury. Precisely because of the building’s style and decoration, as well as royal legacy, the sight of soldiers occupying these spaces is particularly jarring, creating a tension between its different identities.
Each of these sites ‘took on the appearance of a well ordered hospital’, but it was more than this: they became hospitals in reality not just in appearance. This begs questions concerning what makes a hospital, a hospital: is it the label, the function, the appearance? Once a hospital, is that site not always a hospital of sorts?
This week the UK sees the opening of the NHS Nightingale at the ExCeL centre, London, likely the first of several temporary hospitals across the country. The story of the ExCeL centre site is already being rewritten: once host to trade shows and conventions, Comic Con and Crufts, Olympic and Paralympic events, it is now a hospital. It will harbour the individual patient stories of loss and survival, and witness acts of strength and struggle. That is a lot for a building to hold, and so its structure will bear a burden for some time.
Some of the sites taken over today and throughout the current crisis will go back to their previous existence as if nothing happened. Some people will forget. But for many, no matter the “temporariness”, the brief interlude of the site as a hospital will forever be a part of its story, and for the caregivers, the families, and the survivors, those spaces will never be the same again.
Looking back on her war experiences, and reflecting upon the changed relationship that she and her fellow caregivers have with the spaces of caregiving, E. C. Fox illustrates that it is difficult, often impossible, to return to them:
Very few among the many who worked there during the war would, I think, choose to return to that hotel to spend their summer holidays. To go back to the hotel would revive too vivid memories of suffering and tragedy in which the place was often steeped during the war: sleep might easily be troubled with dreams of ambulances rolling slowly but steadily all through the night to the hospital, each disgorging its load of wounded men.
Fox illustrates the common consequence for those involved in war; that they cannot return to the same places with a clean slate: while the memories and ghosts may sleep, they cannot be fully erased. The space, in this case the hotel-turned-hospital, can never be experienced as only a hotel again. The landscape of these places changed irrevocably: the layers of its identity, once altered and added to, are eternally connected to these events, which are not easily forgotten. Ironically, despite the label of ‘temporary’, there is a permanence to the demarcation of ‘hospital’. The scarlet carpet might conceal the blood, but the aura of the hospital is embedded into the fabric, and that space will always be, and will always have been, a hospital.
Dr Marie Allitt is Humanities and Healthcare Fellow at the University of Oxford. Marie completed her PhD in English Literature at the University of York in 2018, focusing on experiences and representations of spaces and senses in First World War medical caregiving narratives.
 Adelaide L. Walker, ‘Experiences At A Base Hospital in France, 1914-1915,’ Reminiscent Sketches (London: John Bale, Sons and Danielsson, 1922), 54.
 Walker, 56.
 James Robb Church, The Doctor’s Part (New York: D. Appleton and Company, 1918), 109.
 Mary Borden, Journey Down a Blind Alley (New York, London: Harper & Brothers, 1946), 8
 Borden, 8.
 Brighton Herald, 28 November, 1916.
 E. C. Fox, ‘An Officers’ Hospital in France During the War’, Reminiscent Sketches, 61.