Case Study Paimio Sanatorium

Kapittel 10

Paimio Sanatorium

Alvar Aalto 1933

Paimio Southwest Finland

Students: Andrea Wolstad

Ingvild Kvikne Jan Trinh

Orthophoto over Paimio

The typology of this year’s course is the Hotel, where the overall studies are assessing large buildings in context. Today, the average hotel stands as a prominent institution providing the client with more than accommodation and meals, by being a place to dwell outside of one’s home. The history of the hotel as a typology can be read through its name, where the word “hospitality” is rooted in the Latin word “Host” or “Hospice”. The first hotels were therefore nothing more than minimal places to dwell- private homes opened to the public.

“I pretend I’m one of the royal family when I’m in a hotel and that the hotel belongs to me - it is a palace.”

As Martin Short writes, the hotel is a figure of our imagination. It’s a chameleon, eager to be whatever we need it to be for the brief moment of our stay, only limited by our willingness to pay. It’s a built paradox, where everyone is welcomed regardless of their background, making it therefore highly public. While at the same time, being a severely private establishment by locking the experience to one’s income by reducing it to one’s ability to pay. Giving little other than economy back to the field of the city. This makes us wonder, what is then a hotel in the modern sense and where is the connecting between the hotel and the sanatorium as an institution? To answer that question, this case will explore how medical practice conditions medical architecture, by viewing the historical context of the Paimio Sanatorium, augmenting therefore that understanding the Sanatorium as an architectural work, is to understand the social changes that occurred during its period, as it can be viewed as a prominent sign of its time.

In this chapter, we will present the Paimio Sanatorium by Alvar Aalto, a prize-winning proposal driven by his instrumental approach to architecture and health. Situated Southwest of Finland in the town of Paimio in a dense pine-tree covered area, elements such as fresh air, natural light, and space were considered important factors in the recovery process of the patients suffering from tuberculosis. The disease was seen as a consequence of the industrialized city with its poor living conditions, making the sanatorium a place for health that was only to be found outside of the dense city by turning away from it. The shift from a site-depended development where outer elements of the building were equally essential to the patients’ health and wellbeing, to the independence of site, marked the era of functionalism where elements such as light, air, and space were now reduced to measurable components inherent to the quality of the building. It was now believed that the building alone would function as a health-promoting environment, serving as a tool for recovery, justifying the architectural features and choices as a means for health.

Source: https://www.metalocus.es/en/news/alvar-aaltos-paimio-sanatorium-now-sale

Illustration showing the colour-scheme of the groundfloor

Source: https://divisare.com/projects/386217-alvar-aalto-fabrice-fouillet-paimio-sanatorium

Source top and bottom: https://www.finnishdesignshop.com/design-stories/architecture/alvar-aalto-and-the-colors-of-the-paimio-sanatorium

Source: https://divisare.com/projects/386217-alvar-aalto-fabrice-fouillet-paimio-sanatorium

Source: https://divisare.com/projects/386217-alvar-aalto-fabrice-fouillet-paimio-sanatorium

Model photo unfurnitured, showing the space.

Source : https://www.finnishdesignshop.com/design-stories/architecture/alvar-aalto-and-the-colors-of-the-paimio-sanatorium

Source top and bottom: https://www.finnishdesignshop.com/design-stories/architecture/alvar-aalto-and-the-colors-of-the-paimio-sanatorium

The death and life of great functionalistic buildings

The examination of the Paimio Sanatorium as an effect of techno-social change

In the article “The Humanizing of Architecture” Alvar Aalto wrote

“(…) The fundamental problem of architecture is not that of attaining formal perfection, but the task of creating an attractive environment with simple means in harmony with our biological needs” (Aalto, 1940)

In this essay, I will discuss the premises of this statement through examination of the Paimio Sanatorium, a building that, despite its independence of site, cannot be seen independently of its historical context. I will discuss how the building can be seen as a formalistic answer to the social currents of its time, hence serving as built evidence of governmental concern for its citizen’s needs by addressing the building as a political means. Before questioning the architectural qualities of the building, I will therefore illuminate the historical movements that contributed to its rising, by examining Alto’s approach to solving what he claims to be the fundamental problem of architecture, asking therefore whether the building answers its self-claimed task of creating a healing environment for its patients, or not. To examine the sanatorium as an architectural work is, therefore, to examine it as an effect of the techno-social changes occurring during the period, as they are interconnected entities conditioning each other.

The industrial city – a breeding ground for change

In the early 19s, Berlin was among the most prominent metropolitans in the world. The city became the testing ground for new technological enhancements, where the electrical industry paved the wave for the growth of the city. Developments in water, electricity and transport systems created an

electronic shift that altered not only the working environment by putting pressure on efficiency and scientific management styles, but also the built environment. The infrastructure changed rapidly, and water, gas, and electrical cables were now running through the underground of the city. Despite the triumphs of electrification and increase in efficiency, the overcrowded living conditions caused by industrialization became a breeding ground for airborne diseases. (Weston, 1996)

Compared to other European cities, Berlin had grown at an enormous pace despite its late industrial movement. The capital’s population grew by 300% within 30 years as the population doubled between 1871 and 1910. (Eylers, 2014) Roughly 120,000 citizens were then living in cellars as shelters were overcrowded, and the humid conditions proved to have drastic consequences for the resident’s overall health. Long before the discovery of the actual cause of the airborne disease, Tuberculosis became widely associated with the industrialized city, consequently creating an image of the city as a pressure cooker one must flee to restore health. “Places of health” therefore became the opposite of the city, where openness, light, and air stood in contrast to its dense, unsanitary, and dark industrial environment. The industrial metropolis had given rise to a factory landscape of dwellings for workers, where the prior conditions became a breeding ground for bad health and illnesses. Architecture was one of the last fields of production that would become industrialized, where questions of decent dwellings and a satisfying environment arose in the wake of it. (Kasa, 2021) The reaction to social issues and health became the stepping stone for the sanatorium movement, later known as the Volksheilstätten movement, shedding light on instrumental problems that architecture as a

field became responsible for answering.

The Sanitarium movement – from private reservoir to public health

In 1854 Dr. Hermann Brehmer opened the first place for healing intentionally situated outside of the city in Silesia. His theory of “the immune place” was a clear reaction to the problem of the city as well as a foreshadowing of what the architecture as a field soon would be occupied with- namely integration of form with a social purpose. (Campbell, 2005)

His treatment center was ideally located with a south-facing veranda and a winter garden between the building and the outdoor area. The rooms were large with a humid-controlling system, though not designed to face any direction regarding the natural view of daylight. This was the task of the outer environment with its natural surroundings and clean cold air, making the site and its climate a precondition for the cure, covering more than 10 hectares of land.

Brehmer believed that proper rest in the fresh air would increase the patient resistance of the infected body and would therefore strengthen the body’s self-defense. (Eylers, 2014)

A disciplined routine with a proper diet, walks in the dry air, followed by proper rest became the standard treatment for tuberculosis, known as the sunbed-cure. Görbersdorf was the first institution outside the hospitals to bring public health on the agenda, though one can question its “publicness” as it were a private institution funded by its clients, only open to people of a certain range. Nevertheless, it stood as the first private and seemingly luxurious institution which in the following years would spring up in the Alps, bringing with it a belief in the natural healing of the body. It wasn’t until Dettweiler, a former student of Brehmer, opened the first sanatorium for the people in 1876 that the Volksheilstätte movement began, paving the

way for future sanatoria such as Alvar Aaltos Paimio Sanatorium in Southwest of Finland.

The movement disregarded the patients’ financial standings, making it the first public health care facility in the history of time. Creating a distinction between the health resorts that were serving a clientele who could afford a stay, to the Volksheilstätten, the sanatorium for the people. Moving away from the word Santias, meaning health, to the Latin verb Sano, meaning to heal, emphasizing, therefore, the need for treatment as a means for healing. The sanatorium movement aimed to demonstrate that the human body could be returned to health through the proper environment and care. This holistic view also became apparent in the field of planning, as the site grew equally, if not more important than the building per se, by turning away from the industrialized city. In 1899 the TB conference was not able to sustain evidence for this treatment, where only 1 /3 of the patients were cleared as “healthy. (Eylers, 2014) It’s important to note that there were no cure nor blood samples that would prove the patent as clinically healthy, therefore a discharged patient was likely to only be temporarily recovered before suffering a relapse. Despite the lack of evidence for the sanatoria site-specific treatment, the spotlight did not return to the city and its working environment, instead a shift became apparent where the former holistic approach was disregarded, and the Haus-Sanatorium were on the rise. One can speculate as to why this happened, and whether the movement became a political symbol for the German state by sending out a signal of support through funding the now public sanatoria without actually dealing with the health conditions of its citizens. After all, tuberculosis was now defined as a “Volksseuche” (Folkesyke in Norwegian)

a pandemic of the people, where primarily the working class was to suffer. Therefore, the Volksheilstätten would serve as built evidence of governmental concern for the needs of the working class, addressing it as a political means to restore confidence in the state and hopefully outweighing the socialistic undercurrents at the same time. (Eylers, 2014) The Sanatorium became a political symbol by being a secondary preventative measure, whereas the people demanded a primary one where the actual conditions of the city dwellings would be dealt with. The movement was therefore an implicit answer to the social injustice of the time, offering a temporary cure to the individual patient, by acknowledging the question, if the individual is ill doesn’t society suffer as well? This created a prominent shift from the site as a precondition to healing, to the building as a lead figure. What had originally been provided by the site with environmental therapy was now to be provided by the building itself through a universally applied approach. The object became the place for healing, where the building was to be designed to provide the answer through its functions, paving the way for the institutionalization of tuberculosis and the era of functionalism as we know it.

Paimio Sanatorium- An instrumental approach to health

Already in 1899, over 35 Sanatoria were dedicated to the treatment of Tuberculosis, some of them were large institutions such as Beelitz Heilstätten, others were small houses privately run. Natural elements such as green areas, air, and light were now reduced to measurable entities and understood as elements named “the conditions of nature”. (Overy, 2007) It was now believed that the building itself was sufficient enough to provide a proper healing environment that would be

more measurable and predictable through the right design by abandoning the idea of a site, turning the sanatorium into an ideal project which demonstrated the principles of functionalism by treating the building as an architectural experimentation. (Weston, 1996) One of these projects, treating the building as a stage for architectural experimentation, were the Sanatorium of Alvar Aalto.

Situated Southwest of Finland, the initial design for the Paimio Sanatorium began in 1928 whereas the building was first completed in 1933. Initially, the federation of municipalities announced a competition for the design of the sanatorium, where the Paimio was one of the pending deliveries. Even though the practice had shifted from the need of a sitespecific situation to a practice in favor of the building as a primary provider for recovery, the Paimio was placed on uninhabited pine-forest heathland, giving much freedom for the design process, still believing that the outer elements such as sunlight and fresh air would benefit the patients’ health. (Jokinen, et al., 2014) Aalto’s initial statement of the overall design showed careful consideration to details and a focus on the built environment’s role in the recovery of the patients, even though a large part of his ideas for the first draft were not approved, such as the L-Window, the outdoor “summer-rooms” and even the size of the rooms. (Heikinheimo, 2018) Despite the rejection, these elements still served as an important steppingstone for the final project, where the functionalistic style can clearly be read through the architectural framework of his delivery. One of these elements was the “Motto” delivered during the first draft, which was an L-shaped window going all the way down to the floor as to provide the right amount of light during the day.

The overall structure can be read as separate entities, where different wings were positioned for different functions regarding sunlight and view. The patient’s room and sun-terrace were in the A-wing- south of the building, which was connected through an entrance section before moving into the B-wing where the former social space, consolation office, and treatment room took place. The last C-wing was connected to laundry facilities, storage rooms, and a kitchen for the staff. (Jokinen, et al., 2014) The building accommodated 286 patients, with its first admitted one in 1933. Aalto believed that recovery through interaction with the built environment was possible if it served to ease the senses. He claimed that the former healthcare facilities were wrongfully designed for the healthy “vertical” patient in mind, and not for the sick “horizontal” one. This type of design-orientated vision can be viewed throughout the entire logic of the building, all the way from the circulation routes within the space, the glass in the exterior lobby, the south and southeast orientated wings, to the colorschemes and interior of the patient’s room. The layout of the rooms clearly illustrates an underlying curiosity for the role of architecture as a catalyst for shaping social processes, where one can speculate on whether his design facilitated greater individual freedom or not. This essay will therefore primarily focus on wing A regarding the patient’s room in continuing of the discussion.

The devil is in the details

The rooms were designed by emphasizing the patient’s viewpoint where correct lighting, color scheme, and acoustics were devised to provide the right environment for recovery by not irritating the senses. Despite its few square meters, the space available increases through design features such as multi-functional

artifacts (bedside lamps) along with objects what would carefully overlap spatially (bedside table) enabling an increase in the experience of spaciousness despite its few square meters. Every element was put in careful consideration to its position in the holistic puzzle, such as the window layout, doorknob, the chair, darkening of the colors, which replicated throughout the entire structure to create spaces that would accommodate the patients every mood. A particularly important element was the health window, originally designed as a double-glazed L-shaped structure with permanent ventilation through the glass panes. Based on medical advice, the former steel window changed into a hybrid wood and metal window with an integrating heating and ventilation system. (Heikinheimo, 2018) After advising that the windows should not reach the floor level for hygienic reasons, Aalto made the alteration of curving the floor upwardly, allowing for the preservation of essential features while still fulfilling hygienic standards. Visually it still looked as if the window reached the floor, but the curvature still enabled a great amount of light to reach the room without too much glare. The health window stands therefore as a prominent symbol of how medical practice conditions medical architecture, making it an important element in the holistic approach that shaped the architectural features of the room. Features such as walls covered with sound-absorbing cellulose, color differentiation between roof and floor and soundless washbasins, showcased how every piece of furniture was carefully designed to create a calm atmosphere, to promote the patient’s recovery. Even the ventilation of the room was handled with the patient’s care in mind, where a draught-free room climate was made possible by the ceilingmounted radiant heating system. (Eylers, 2017)

This installation was of course done via the wall hatch on the corridor, as to not disturb the patients. As the section of the room illustrates, the full structural system of reinforced concrete allowed for sunlight to flood the building frame, reaching even the further corners within the room. So where is the devil in these glorious details? What is there to criticize in the great life of the functionalistic building?

In the late 1930s, Jane Jacobs famously proclaimed that the problem of the city was treating it as a problem of simplicity instead of a problem of organized complexity, criticizing the instrumental approach in the field of planning. This claim was further elaborated by sitting Dr.Weaver when listing the three stages of development in the history of scientific thought.

The categories are described as (1) A problem of simplicity, (2) A problem of disorganized complexity, and (3) A problem of organized complexity. (Jacobs, 1992) The former referring to problems of simplicity, two-variable problems such as dropping a ball and calculating its force.

The second one relates to a more complicated system, where there are no longer only a few predictable parts, but a billion components in relation to one another. Such a complex system could be an airplane, seeing that even though it’s a complicated system, it still maintains certain analyzable properties which makes it measurable and predictable. This method of analysis application, classification, and collections were highly misapplied to the field of planning as well as the field of architecture, where complex systems such as the human perception and interaction with the built environment got reduced to average properties to fit a schematic framework of the architectural object. Treating it as a problem of simplicity rather than a problem of organized complexity. This criticism is clearly transferable to the

design choices of the Paimio, where hygienic standards were the drive for architectural preferences, by viewing the patient’s room as a set of elements that together formed a holistic whole. The main purpose behind the design choices were, as stated earlier, driven by a deep belief in the built environments’ ability to promote positive change. A belief one can assume stemmed from the historical and social currents of its time, where illnesses emerged as a spatial problem, coining therefor the belief that the built environment must also contain the solution through the design of space. It’s hard to tell whether the formalistic approach was beneficial to the patient’s health, or not, given the fact that the cure for tuberculosis were not found until 1943. With that being said, if one were to criticize the aspects of the building, it would be on the grounds of its paradoxical pursuing of recovery, dealing with a complex problem- helath, through a generalized approach, by reducing its complexity into seemingly measurable entities. The reduction process removes large parts of the reality by forcing it into average properties. Like a sponge that is drained for water, you are emptying it of its contents that constitutes its shape. By designing for the average man, the proclaimed individual freedom of the architectural work gets lost through its design for an ideal vision instead of a diverse reality. As Hoffmayer puts it,

“(…) What I oppose, is that one wants to push life processes into the kind of mathematics where there is something on each side of the equals sign. For it means that it says, on the right side “is nothing but that on the left side”, which is only true if one has peeled the creativity out of the system, hence beaten it to death.” (Hoffmeyer, 1993)

As we have seen in this essay, the historical currents during the period contributed to the rise of the Sanatorium-movement, creating a steppingstone for the later architectural work of Alvar Aalto as the independence of site grew stronger, promoting a profound belief in the qualities of the built environment. Understanding the sanatorium as an architectural work, is therefore to understand it as a prominent symbol of its time by viewing it as an effect of tecno-social changes. Regardless of its outcome it still serves as a sparkling example of the death and life of a great functionalistic building.

Modelphoto Modelphoto

Modelphoto

Referencelist

Aalto, A.(1940) The Humanizing of Architecture, The Technology Review, pp. 102-107.

Campbell, M.(2005) What Tuberculosis did for Modernism: The Influence of a Curative Enviorment on Modernist Design and Architecture. Medical History (49), pp. 463-488. doi: 10.1017/S0025727300009169

Eylers, E.(2014) Planning the Nation: the sanatorium movement in Germany. The Journal of Architecture, 23 October, pp. 667-692. doi: 10.1080/13602365.2014.966587

Eylers, E.(2017) Alvar Aalto and the problem of architectural research. Why Aalto?, 10 June, p. 14. Heikinheimo, M. (2018) Paimio Sanatorium under Construction. Arts MPDI, 2019(7), p. 19.

Hoffmeyer, J.( 1993) En snegl på vejen. first edn. København: Rosinante & Co.

Jacobs, J. (1992) The Kind of Problem a City is. In: The Death and Life of Great American Cities New York: Random House, pp. 431- 458.

Jokinen, D. T., Mikonranta, K. & Murula, K. H. (2014) alvar aalto ARCHITECT - Paimio Sanatorium 1929-1923. Volume 5 red. Helsinki: Alvar Aalto Foundation / Alvar Aalto Academy / Alvar Aalto Museum.

Kasa, E. 2021. The problem of art and Architecture, Aesthetic communication. Avalible at: https://ntnu.blackboard.com/ultra/courses/_28118_1/cl/outline (Accessed: 3. September 2021).

Overy, P.(2007) Light, Air and Openness- Modern Architecture between wars. first edn. London: Thames & Hudson.

Weston, R. (1996) Modernism. Illustrated edn. London: Phaidon Press.