The following dissertation examines the history of general hospitals in modern, central and western Canada. It follows extensive case studies of the Toronto, Winnipeg, Calgary, and Vancouver general hospitals. The last few decades have seen an expanded interest in hospitals by Canadian medical historians, but the overall literature is thin. Further, many of the extant histories focus on a particular constituent: the medical profession, administrators, or architects. In this dissertation I argue that these general hospitals were contested spaces, and that their organization and layout reflected negotiation between several parties. A further important vector is the role hospitals played in the social life of their communities. As these general hospitals grew, and began treating middle-class patients, they also required large sums of money from the public purse. Administrators had to account for the shape and use of medical space to the general public that helped finance it, as they did to the doctors who worked there. During the period 1880-1945 general hospitals moved from the periphery of medical care to the centre, but not without substantial growing pains. These institutions routinely lacked funds and space, and remained in operation as much through the efforts of medical professionals as by concerned citizens. After the Second World War the Federal Government shifted from a standoffish institution to one ready to release funds and administrative energies towards new ideals of social welfare. Funding increased dramatically for the building of new hospitals, and legislative developments such as Medicare transformed the social and political relationship between hospitals and patients. / Thesis / Doctor of Philosophy (PhD) / This dissertation began with the question: why do our general hospitals look the way that they do? It goes on to examine the ways in which multiple actors, including many non-medical ones such as local citizens, city councils, architects, and patients, interfaced with administrators and doctors to establish and build general hospitals in four Canadian cities. The core argument is that these were contested spaces, which reflected the communities in which they existed.

A partir da análise dos conceitos de sustentabilidade, de arquitetura hospitalar, de conforto e qualidade, é constatada a importância da preocupação que projetos hospitalares devam ter, desde o início, com os recursos naturais e a sua adequação ao meio ambiente. Através de uma Avaliação Pós-Ocupação do Hospital Universitário de Londrina é verificado que os principais problemas detectados pelos usuários - problemas esses responsáveis pela sua insatisfação na avaliação dos ambientes - são aqueles que estão diretamente relacionados ao projeto e a sua inadequação ao local. É proposto um instrumento de avaliação, um guia que pode ser utilizado por arquitetos durante a elaboração de projetos hospitalares, na avaliação de projetos prontos e de edifícios construídos e em uso, capaz de verificar o comprometimento do projeto sob os aspectos ambientais, de conforto e qualidade, funcionais, construtivos e estéticos. / Starting from the analysis of the sustainability concepts, of hospitals’ architecture, of comfort and quality, it is verified the importance of the concern that hospitals’ projects should have, since the beginning, with the natural resources and its adaptation to the environment. Through a Post Occupancy Evaluation of the Hospital Universitário de Londrina it is verified that the main problems detected by the users - problems responsible for the unsatisfactory evaluation of the spaces - are those that are directly related to the project and its inadequacy to the place. It is proposed an evaluation instrument, a guide that can be used by architects during the elaboration of hospitals’ projects, in the evaluation of ready projects and of built buildings and in use, that can verifies the compromising of the project under the environmental aspects, of comfort and quality, functional, constructive and aesthetic.

A partir da análise dos conceitos de sustentabilidade, de arquitetura hospitalar, de conforto e qualidade, é constatada a importância da preocupação que projetos hospitalares devam ter, desde o início, com os recursos naturais e a sua adequação ao meio ambiente. Através de uma Avaliação Pós-Ocupação do Hospital Universitário de Londrina é verificado que os principais problemas detectados pelos usuários - problemas esses responsáveis pela sua insatisfação na avaliação dos ambientes - são aqueles que estão diretamente relacionados ao projeto e a sua inadequação ao local. É proposto um instrumento de avaliação, um guia que pode ser utilizado por arquitetos durante a elaboração de projetos hospitalares, na avaliação de projetos prontos e de edifícios construídos e em uso, capaz de verificar o comprometimento do projeto sob os aspectos ambientais, de conforto e qualidade, funcionais, construtivos e estéticos. / Starting from the analysis of the sustainability concepts, of hospitals’ architecture, of comfort and quality, it is verified the importance of the concern that hospitals’ projects should have, since the beginning, with the natural resources and its adaptation to the environment. Through a Post Occupancy Evaluation of the Hospital Universitário de Londrina it is verified that the main problems detected by the users - problems responsible for the unsatisfactory evaluation of the spaces - are those that are directly related to the project and its inadequacy to the place. It is proposed an evaluation instrument, a guide that can be used by architects during the elaboration of hospitals’ projects, in the evaluation of ready projects and of built buildings and in use, that can verifies the compromising of the project under the environmental aspects, of comfort and quality, functional, constructive and aesthetic.