History of Popular Culture
Part II – Hotels, Hospitals, and the Architecture of Care
B.M. Scott
2 December 2025
Nineteenth‑century Americans did not experience “the city” only in the open air of the street. They encountered it as a network of interiors that filtered, reframed, and at times domesticated the risks of urban life. Among these interiors, few were more symbolically charged than the hotel and the hospital. Both offered shelter, service, and the promise of care. Likewise, both depended on the circulation of bodies and capital that the street made possible. Over the course of the nineteenth and early twentieth centuries, the boundaries between these two institutions became porous. Hotels promised health and restoration in addition to comfort. Hospitals borrowed design cues and service practices from the hospitality industry. New hybrid spaces—spa resorts and sanatoria—emerged that explicitly fused cure with retreat.
Many hospitals did not begin as purpose‑built medical complexes. They arose in converted mansions, boarding houses, and former inns. St. Elizabeth Hospital in Danville, Illinois, offers a clear example. In 1882, four Franciscan sisters arrived and converted an existing hotel into a small hospital that could serve the local population. The building was not designed as a clinical machine. It was a hospitality space reoriented toward healing. Patients did not enter an austere, anonymous institution. They crossed a threshold marked by familiar forms of welcome—foyers, parlors, dining rooms—now repurposed as wards, treatment rooms, and chapels. This reuse of hotel architecture did more than economize existing spatial architecture. It mapped the cultural association of convalescence onto the language of lodging. To be hospitalized in such a setting was to become, in a sense, a guest.
In certain respects, the Civil War accelerated the porosity between hospitality and care. North and South alike, many hotels were requisitioned as temporary hospitals or barracks to accommodate wounded soldiers and displaced civilians, as in the case of the Mansion House Hotel in Alexandria, Virginia. Indiana itself housed two of the five largest military hospitals in the conflict, and its central geographic position above Tennessee, Arkansas, and Mississippi made it a primary location for Union medical facilities. Well‑located hostelries offered ready infrastructure—private rooms, kitchens, dining halls, and central positions along key transport routes—that could be swiftly adapted for medical use. After the war, these experiences left a lasting imprint. Veterans and their families associated certain hotels and former inns with recovery and communal support, blurring the lines between spaces of lodging and spaces of healing even before the rise of dedicated sanatoria. Wartime necessity thus anticipated the postbellum symbiosis between hotel and hospital and helped normalize the idea that interiors built for comfort could be turned toward cure.
At the same time, hospitality venues absorbed medical aspirations. Hotel Mudlavia, near Attica, Indiana, was built around a natural spring that had been discovered in the nineteenth century. Opened in 1890, it advertised itself as a place where the mineral waters and mud baths could relieve rheumatism and a host of other ailments. Guests did not simply seek leisure. They came to be treated. The hotel offered rooms, meals, and social activities in the manner of a grand resort, yet its core promise was therapeutic. Here the logic of the spa and the hotel converged. The guest was a patient, and the patient a guest, moving through corridors that echoed the spatial language of luxury while submitting to regimes of bathing, rest, and dietary control that echoed the disciplinarity of the clinic.
The Indiana State Sanatorium, founded in 1908 as the state’s main tuberculosis hospital, represents a further stage in this evolution. Its designers placed it on a large rural tract, away from the dense city but connected to it by road and railway. The complex included a central administration building, residential wings, wide porches, etc. Patients were meant to spend long periods there in a quasi‑domestic environment oriented around fresh air, rest, and routine. The sanatorium was not a hotel in any ordinary sense, yet its architecture borrowed from hotel and resort models - viz., long verandas, vistas over landscaped grounds, communal dining, recreational spaces. The emphasis on comfort and environment reflected a conviction that cure depended as much on atmosphere as on intervention. Tuberculosis patients “took the cure” as if they were temporarily relocated residents in a specialized, medically supervised retreat.
Mudlavia and the Sanatorium form two poles of a continuum. Mudlavia was a commercial hospitality enterprise that claimed medical legitimacy through its waters and the rhetoric of cure. The Sanatorium was a state medical institution that adopted elements of resort design to make long‑term treatment bearable and to align public health with middle‑class ideals of rest in nature. Between them lies the converted hotel in Danville that became St. Elizabeth Hospital - an intermediate case where existing hospitality space was explicitly reconfigured in the service of organized, religiously inflected care. Across these examples, the line between hotel and hospital is not merely blurry. It is structurally interdependent.
This interdependence reflects broader currents in nineteenth‑century popular culture. The “grand hotel” emerged in this period as a symbol of modern mobility and aspiration. Urban hotels with imposing facades, spacious lobbies, and elaborate dining halls offered more than beds. They offered an experience of being temporarily placed within a world that was orderly, serviced, and elevated above the street. Hospitals and sanatoria drew on this symbolic economy. To persuade the sick and their families to accept institutional care, they needed to counter older associations of hospitals with desperation and death. By mimicking some of the spatial and service codes of grand hotels—wide staircases, verandas, landscaped grounds, attentive staff—they could present themselves as humane environments in which the patient’s dignity and comfort would be preserved.
At the same time, hotels borrowed from the hospital’s promise of restoration. Spa resorts advertised cures for exhaustion, neurasthenia, and the diffuse ailments of modern nervous life. The guest was implicitly sick, even if the diagnosis was vague. The hotel room became a kind of temporary ward; the dining room became a controlled nutritional regime; the grounds became a prescribed circuit of walks and baths. Popular culture thus reimagined leisure as therapy and therapy as a species of curated leisure. This symbiosis was not merely conceptual. It was anchored in brick, timber, and institutional practice in places like Mudlavia and the Indiana State Sanatorium.
The Midwest case studies demonstrate how deeply the hotel–hospital dynamic shaped regional institutions. In Danville, the conversion of a hotel into St. Elizabeth embedded medical care in a building already legible as a site of welcome. Around Attica, the wooded grounds of Mudlavia drew visitors locally and from across the country seeking both rest and remedy. Near Rockville, the Sanatorium’s hilltop complex reoriented the surrounding countryside around a new axis of health and institutional presence. Each site participated in the same cultural logic. They promised to remove the individual from the dangers and dirt of everyday urban life and to place them in an environment where architecture, service, and accessibility worked together on the body.
The symbiosis between hotel and hospital in these developments helps to explain certain enduring features of American popular culture. It illuminates why medical institutions often present themselves in hotel‑like terms, emphasizing amenities, private rooms, and "patient experience." It also clarifies why leisure marketing is so saturated with the language of wellness and renewal. Under industrial modernity and its aftermath, the street produced both physical wear and psychic strain. Popular culture responded by creating interiors that would both profit from and ostensibly repair that damage. The hotel and the hospital thus became two faces of this response - distinct in function yet linked by a shared architectural and symbolic grammar.
Questions for Reflection
The foregoing analysis has traced how hotels and hospitals, along with spa resorts and sanatoria, developed in mutual reference to one another. It has shown that these institutions do not simply coexist in the urban and regional landscape. Rather, they share architectural languages, promises of care and restoration, and a common reliance on the flows of people and capital that the street makes possible. The questions below invite reflection on how this symbiosis appears in your own experience of built environments, health care, and leisure.
- When you walk into a contemporary hospital or clinic, which features remind you most of hotels or resorts (for example lobbies, reception desks, private rooms, decor), and how do these features shape your expectations of care?
- Conversely, when you think of hotels, spas, or retreats you have visited, in what ways did they present themselves as places of cure or wellness rather than as spaces of simple accommodation?
- How do the histories of places like St. Elizabeth, Mudlavia, or the Indiana State Sanatorium change the way you interpret current marketing of wellness, patient experience, or healing environments?
- Looking at your own region, can you identify buildings or districts where the line between hospitality and healthcare feels particularly thin, and what does that suggest about how popular culture continues to imagine the relationship between comfort, profit, and cure.
Recommended Reading List
Bob Wright, Danville: A Pictorial History (3rd printing 2005)
David W. Gutzke, Hotel Life: A History of Hospitality and Public Life in
Britain and the United States, 1800–2000, 2016
Charles E. Rosenberg, “Inward Vision and Outward Glance: The Shaping of the
American Hospital, 1880–1914,” Bulletin of the History of Medicine, 1979.
Charles E. Rosenberg, The Care of Strangers: The Rise of America’s
Hospital System, 1987
Indiana State Sanatorium, Annual Reports, 1915-1923.
Janet Greenlees, When the Air Became Healthful: Spa Resorts and the
Medical Marketplace, 1850–1910, Social History of Medicine, 2003.
Nancy Tomes, The Therapeutic Landscape: Medical Geography in
Historical Perspective, Bulletin of the History of Medicine, 1998.
Paul Foley, The Rise and Fall of the Sanatorium: A History of Tuberculosis
Treatment in the United States, 2012
Rosemary Stevens, In Sickness and in Wealth: American Hospitals in the
Twentieth Century, Basic Books, 1989.
Through2Eyes. Out the Indiana Mud: Hotel Mudlavia, 2020.
Jack Moore Williams, History of Vermilion County,
Illinois (Topeka, 1930).
Janet F. Davidson, Spa and the City: Urban Resorts and the
Culture of Health, 2010
Michel Foucault, The Birth of the Clinic: An Archaeology of
Medical Perception, 1963
William H. Jordy, American Buildings and Their Architects, Volume 5:
The Impact of European Modernism in the Mid‑Twentieth Century, 1972
John H. Goffman, “Hotels, Hospitals, and the Modern Corridor: The
Architecture of Institutional Hospitality,” Journal of Architectural History, 2004