The inter war period saw a marked change in the demands placed upon health care providers as public expectations rose and medical science and practice improved. The need for service improvement was felt particularly strongly in the hospital sector where providers sought modern institutions to satisfy the demands of doctors, patients, scientists and medical schools as well as their funders. These trends were especially noticeable in the Anglo-American world, Germany and France with the 1930s seeing some impressive new projects undertaken, notably in Strasbourg and at Columbia University. Moreover, design was increasingly driven by US influences which promoted the idea of building up to increase efficiency, light and space.
Conditions in the old hospitals of Lille c.1950.
It was in this climate that the City of Lille embarked upon its ambitious plans for a major hospital complex. From 1925 the city council had been under the leadership of the socialist mayor, Roger Salengro (1890-1936) whose vision included both improved living and working conditions and the need for a city worthy of its citizens. In 1929 he pushed through a plan of ‘grand works’ to ‘edify’ Lille, especially improving the ‘salubrity’ and health of the city by the transformation of the city sewers, water supply and hospital provision. The planned Cité Hospitalière would replace the existing out-dated buildings with an entirely new complex unifying all of the services of Les Hospice de Lille (the hospital administration), together with a new model maternity unit, an anti-cancer centre, a tuberculosis sanatorium and a medical school. Condemned by the right-wing press as an indication of ‘socialist megalomania’ and as overly ambitious in the prevailing economic climate, the project almost collapsed when the plans for the complex were unveiled in December 1932.
Hôpital St Sauver, lille in the 1920s
Designed by Paul Nelson, an American born but Paris resident architect and ‘following modern conceptions’, it took the current thinking on hospital design to a new level. Nelson’s idea was to build high, with two central blocks each of twenty-five floors, prompting a sceptical press to note that:
This method of construction offers, say the specialists, a number of advantages for the running of hospitals.
It allows saving to be made in general expenses and a rationalisation in both therapeutics and medical teaching.
A press representation of Nelson’s plan
Undoubtedly, such modernist ideas were spreading in France, with the new Beaujon hospital under construction at Clichy – to a design by the French architects Walter and Martine – adopting many innovative principles. But Nelson’s plan was even more physically and aesthetically radical. Of ‘très vastes’ proportions covering over 40 hectares, one tower would be the Hospice, erected in the form of a cross, the other a ‘block hospital’ in the shape of an open book containing all of the medical services and the faculty of medicine. There would, in addition, be an eight storey private hospital with maternity and surgical facilities; a 200 bed convalescent home; a school of nursing; various scientific and administrative buildings and a leisure centre with swimming pool.
The proposal prompted a flood of hostile comment from the local press who focused on the appearance and cost of the project to support a sustained anti-American and anti-socialist attack. Sympathetic commentators noted that, as an American Nelson could ‘not do otherwise than envisage a sky-scraper (gratte-ciel)’ while harsher critics contended his design was ‘totally without aesthetic qualities’ and indeed ‘was perfectly ugly’. Moreover, the right wing papers attacked the payment of 250,000 francs to ‘l’architecte americain’ for the model and it was claimed the likely cost of executing his grand design would be between 250 and 400 million francs (up to £20m). Indeed the government – who had promised to meet some of the cost – had to step in to cap the price at a maximum 200 million FF.
Nelson’s controversial model unveiled in December 1932
By early January 1933 the virulently anti-socialist Depeche had rallied opposition from the Federation of Architects of the Nord, who penned an open letter to protest against the choice of a foreign architect. Depeche was right behind the profession attacking both the appointment of a foreigner but also ‘the quality of the product: artistic horror, crazy idea’ and concluding that it would end in a ‘shell of grandeur’ accompanied by ‘an astronomical bill’.
There had undoubtedly been a lack of transparency in the way Nelson had been commissioned to produce his treatment for the complex and faced with both media and state opposition to the project Lille city council abandoned his plan and launched a competition amongst French professionals. Although the Nelson project was now presented as an opening shot which ‘had for its object, above all, the giving of general ideas’ this was a significant climb down for Salengro as the decision on the final shape of the Cité Hospitalière would now rest with a more conservative jury made up of professionals, state officials and doyens of university departments. Yet the proposal they chose, though not as radical as that of Nelson, was still a significant design. The competition winner, also by Walter and Martine, extended some of the principles of their work at Beaujon to create a work recognised as pioneering both in its structure and in the ambition it showed to unify hospital services on a single site.
The Cité Hospitalière de Lille as it looked when it opened in 1953
So why did the Nelson hospital of the future fail? It failed, in the main, because it gave too many targets for the right to aim at. Certainly Lille needed improved hospital services, but these could have been provided by a more modest scheme, focused on a combination of extensions at existing institutions and some new building on green field sites. The failure to take this route in the cash strapped 1930s, and fuelled by the suspicion the socialist authority wanted a grand project not an economical extension, allowed the conservative press to castigate the plans of Salengro as socialist megalomania.
More important, however, was the issue of national interest. Papers like Croix du Nord were quick to pour scorn on Lille’s ambition to compete with Strasbourg or cities in Germany and America by building a grandiose ‘foreign’ gratte-ciel. But this was nothing to their hostility to the appointment of an American as the chief architect, Depeche claiming they learned of Nelson’s contract from an American newspaper when ‘for a construction of such importance, it would seem to us that there should have been a competition and with a preference given to a French architect’ not least because the project would be financed entirely by municipal and state funds. In the increasingly nationalist and protectionist world of the early 1930s it was easy to claim that the appointment of Nelson was unpatriotic and his ideas at odds with the cultural and aesthetic values of the French. Yet ultimately Lille did create a radical and monumental hospital complex which merged French taste with American ideas.
This piece is based on records held in the Archives départmentales du Nord and Lille Archives Municipales.