Book Review: The Fourth Factor: A Historical Perspective on Architecture and Medicine

Abstract

The Fourth Factor: A Historical Perspective on Architecture and Medicine, by John Michael Currie, Washington, DC: AIA Press, 2007, 192 pages, $39.99. ISBN: 1571650180The Fourth Factor is a fascinating book with a less than obvious point to make. Its author, John Michael Currie, takes the position that, for as long as the art of medicine has existed, there has been an aspect of its practice that has subtly influenced the whole process-that of setting or place. Hippocrates of Kos, the ancient Greek physician whose oath is still taken by many graduating physicians the world over, talked of three factors constituting the art of medicine: the disease, the patient, and the physician. Currie proposes that the environment in which the healing arts are exercised is the fourth factor. While this premise is perhaps naturally understood by the architect, it dawned only slowly on me, a practicing physician, that the author is obviously right. Where (and when) one practices greatly influences the outcome of care.Currie has immersed himself in the history of medicine and seems to comprehend the procession of ideas that have influenced it. As much history book as the story of medicine's relationship to architecture, this tidy volume weaves together the story of human thought, demonstrating the influence of ideas, beliefs, and even politics on the gradual evolution of medical care and architecture as they have advanced from the earliest times. Currie suggests that those who design and work in the places where the ill are cared for should understand the foundations on which they stand.Beginning at the beginning, The Fourth Factor explores ancient Egyptian, Greek, and Roman practices and forms. Replete with excellent drawings and photographs, the book offers examples of structures and sites where the sick came for care. We are introduced to practitioners, builders, and buildings. Examples of temple sites, to which those stricken with disease traveled great distances for care, are amply illustrated alongside a text that explains the gradual transition from superstition to more rational care. We meet Aesculapius and Galen and see where and in what settings they practiced.Successive chapters explore the development of hospitals for the care (and isolation) of the sick and other unfortunates. We explore care in various parts of the world and see how ideas spread, or failed to spread, from one region to another in the early Middle Ages. …