CHRISTA NIELSEN INDES 396 SPECIAL TOPICS IN INTERIOR DESIGN WINTER 2016 FINAL RESEARCH PAPER MODERNISM, ALVAR AALTO AND THE ARCHITECTURE OF HEALTHCARE The architectural history of health and the hospital runs deep in our culture. Decade after decade, its physical structure has changed in function, appearance, prominence and location–all dependent on cultural dynamics. With that said, there is a specific time period where the hospital became a key building and its relationship to architectural practices was particularly profound–during the modernist movement of the early twentieth century. The use of new technology to create high-functioning, efficient health facilities laid the groundwork for today’s modern hospital. In the following essay, I will attempt to outline a brief history of healthcare architecture before the twentieth century. I will then answer the question of how hospital architecture, specifically the sanatorium, in the early twentieth century was a reflection of, and response to, the Modernist movement. Through a series of case studies, I will explore how the ideals of the Modernist philosophy were expressed in the built environment of the “modern” sanatoriums built during the early to mid 1900’s. Finally, I will focus my analysis on Alvar Aalto’s masterpiece, the Paimio Sanatorium. I will show how the concepts developed in this building both embraced and went beyond the modernist aesthetic to lay the foundation for contemporary healthcare design. To truly understand how profoundly the modernist movement affected hospital architecture, it’s necessary to take a brief look at what came before. Early in history, the sick were cared for in their homes. Later, religious orders took responsibility for looking after the infirm within their churches or cathedrals. Eventually, in more affluent cities, hospitals were constructed by civic organizations. Many of these buildings were structured around large central courtyards with smaller secondary courtyards delineated by open wards (Figure 1).
FIGURE 1. HOSPITAL, 1789, SPAIN But what began as a noble, rational response to the growing needs of an exploding urban population was often overwhelmed by the realities of the situation. Many public hospitals became overrun, understaffed and unsanitary. Not surprisingly, it was only the poor, urban population that were treated in these large, open wards while physicians continued to make house calls to the upper class. During the age of Enlightenment, a re-evaluation of the hospital form was prompted by new treatment theories. Florence Nightingale wrote Notes on Hospitals in 1863 outlining her priorities for designing hospitals based on her observations while nursing in the Crimean war of 1854. According to her book, she argued that hospitals must be designed to divide the sick into separate areas, allow more space for patients as well as provide more ventilation and sunlight. Her principles were implemented in a new hospital typology, the pavilion plan. The Royal Herbert Hospital (Figure 2) in Woolwich London was the first building complex to incorporate a pavilion type of spatial arrangement. It opened in 1865 and was designed by Captain Douglas Galton who was a nephew of Nightingale’s.
FIGURE 2. ROYAL HERBERT HOSPITAL, 1865, LONDON The general plan of these pavilion style hospitals included a primary supply corridor for circulation of people and supplies with patient wards that extend off of this linear, central spine. The thin pavilion plan allowed light and fresh air to penetrate and created garden views between the building forms. This design emphasized function over form—an important step in the modernist direction. At the end of the nineteenth century and the beginning of twentieth, the hospital was beginning to take on some of the familiar aspects of the modern building: part hotel, part civic structure, part church; clean and comfortable. For the first time, the wealthy and the middle class were utilizing new medical machinery in the hospital setting instead of being treated at home. The pavilion plan design began to wane in favor of the mega-hospital and the disease specific, sanatorium. These new typologies reflected the modernist ideals: functionalism, hygiene, whiteness and transparency. According to Edwin Heathcote, “The nineteenth-century hospital was a secularized version of its monastic forebears, a civic landmark and a solid and symbolic reminder of social responsibility. In the next century it would become something apart from the city, a gleaming beacon of health.” (Jencks, C., & Heathcote, E., 2010)
To understand how these new hospital typologies reflected modernist architectural theories, a brief explanation of “Modernism” is required. The Modern Movement in architecture first emerged in the early twentieth century in response to sweeping changes in technology and society. A new world of industrialization and its accompanying machines had radically changed the fabric of daily life. Artists, philosophers and architects began looking at their environment through a new lens. They believed that their predecessors had failed society; that historical architectural theories and methods had been unable to deliver basic social needs. The modernists had a “strong sense of social responsibility in that architecture should raise the living conditions of the masses.” (Henket, 2002) They argued for a new architectural paradigm based on an emphasis of function over form, the exploration of new materials, the idea of progress, the rejection of historicism and a dedication to social morality. The modernists believed that architecture could heal a sick society. According to Le Corbusier, “On the day when contemporary society, at present so sick, has becomes properly aware that only architecture…Can provide the exact prescription for its ills, then the time will have come for the great machine to be put in motion.” (Corbusier, 1967)
FIGURE 3. AYRSHIRE CENTRAL HOSPITAL, 1935, WILLIAM REED, SCOTLAND Modernist principles had a profound affect on architecture beginning in the first half of the 20th century and hospital architecture was no exception. These revolutionary theories were reflected in new healthcare typologies devoted to the modern ideals of health and hygiene—the urban mega-hospital as well as
the rural sanatorium. To keep the scope of this paper manageable, I will be focusing my attention specifically on the latter. I believe the sanatoria built during this period offer the best examples of the modernist principles expressed in architecture of this time. Since the discovery of infection in the late 1800s, hygiene was placed at the center of hospital and healthcare design. Highly contagious illnesses like tuberculosis instigated the need for a new type of architecture to support more modern treatments. From the mid-nineteenth to the mid-twentieth century, specialist institutions such as sanatoria were designed specifically to cure infectious diseases based on the accepted theory that rest, fresh air and sunlight were the ideal methods of TB treatment. Architecturally speaking, this lead to the incorporation of cleanliness, adequate ventilation, outdoor terraces and an austere aesthetic as the key elements in the modernist’s sanatorium design. Furniture was lightweight and moveable; everything could be wheeled away to clean all the nooks and crannies. Many of these new buildings included features such as large windows and terraces that exposed patients to direct sunlight and the natural surroundings of the site.
FIGURE 4. JOSEF HOFFMANN’S PURKERSDORF SANATORIUM, 1904-1905, AUSTRIA
FIGURE 5. PURKERSDORF SANATORIUM INTERIOR Josef Hoffman’s radical design of the Purkersdorf Sanatorium (Figure 5 and 6) was one of the first healthcare buildings to be realized in the “modern” style. This simple, unadorned building was built with the elements of the functionalist aesthetic—plain white walls, unadorned columns, big mechanically operated windows and white tile interiors. The modernist clean lines and smooth surfaces were designed to soothe the neuroses of urban Vienna. Hoffmann's design helped to reinforce the perception among patients that their illness was being treated in a rational, fact-based manner. The hospital building did not just symbolize healthiness; it was, in itself, a tool for treatment of disease.
FIGURE 6. JAN DUIKER’S ZONNESTRAAL SANATORIUM, 1925-31, NETHERLANDS
FIGURE 7. ZONNESTRAAL SANATORIUM, INTERIOR
The functionalist language of the modernist era in hospital architecture can also be seen in the Zonnestraal Sanatorium designed by Jan Duiker. Built in the late 1920s, this building embodies the definition of the modernist aesthetic by the immense amount of repetitive elements, lack of historical design motifs, its use of simple geometry and the avoidance of superfluous decoration. Flat, horizontal roofs hover over the entirely glazed interiors. Everything about the structure’s design, from materials to spatial arrangements, supported the idea of high-tech efficiency and the building as “medical machine.” This brings me to my final case study of early Modernist healthcare design. During this era of the proto-high-tech health facility, there is no better example than the Paimio Sanatorium by Finnish architect, Alvar Aalto. But as much as Aalto’s design was rooted in the concepts of the modernist aesthetic and its embracement of functionalist ideals, I would argue that this building stands apart from others in this period. Aalto believed that mechanization and standardization were a part of democracy—these processes were able to give more to more people. He saw the benefits of technology while at the same time he acknowledged its possibility to enslave. Aalto reconciled this duality by looking for solutions in nature. He didn’t advocated for a return to nature but, instead, he looked to it as a guide to create harmony between man and technology. The Paimio was his first clear expression of this reconciliation. Part modernist, part regionalist, part humanist and part organic, Aalto’s hugely admired and influential sanatorium presents contemporary architecture with one of its clearest and most complex typologies.
FIGURE 8. ALVAR AALTO, ARCHITECT AND DESIGNER
Hugo Alvar Henrik Aalto was a Finnish architect and designer, as well as a sculptor and painter. His work spans from the 1920s to the 1970s—a lengthy career that is reflected in the broad range of styles his buildings embody. Ranging from Nordic Classicism in his early work, to a rational International Style Modernism during the 1930s to a more organic modernist style from the 1940s onwards, Aalto’s buildings are hugely admired and profoundly influential. It is during Aalto's "Functionalist Period” that he designed the Paimio Sanatorium.
FIGURE 9. ALVAR AALTO’S PAIMIO SANATORIUM, 1929-33, FINLAND The Paimio Sanatorium (Figure 10) lies in the forest near Turku in Finland. Opened in 1932, Aalto received the commission after submitting the winning entry in a 1929 design competition. This was a turning point in Aalto’s career. His early works followed the principles of Nordic Classicism, the predominant style at that time. In the late 1920s and early 1930s, he made a number of journeys to Europe during which he and his wife Aino Marsio, became familiar with Modernism and the International Style. By the late 20s, Aalto had adopted
the modernist principals of functionalism in his architectural designs. The influence of Corbusier’s idea of the building as a “machine for living” was profound.
FIGURE 10. PAIMIO SANATORIUM FLOOR PLAN Paimio Sanatorium is, in many ways, an extremely modernist hospital building. This impressive structure embraced the ideas of function over form, openness, natural light, hygiene, technology and efficiency. It also had the typical emphasis on modern technology of the period. Movement between floors was by staircases, glass-walled lifts and shafts—modern machines to increase speed and decrease distance travelled between spaces. The spatial organization of the structure also reflects the modernist’s concept of rationalization by grouping and separating the hospitals different functions in different wings, hence the asymmetrical and non-rectilinear floor plan.
FIGURE 11. PATIENT ROOM AT PAIMIO SANATORIUM Standardization is one of the pillars of modernism and Aalto embraced in wholeheartedly. He designed a number of objects that he designated as “standard” for the patient’s rooms including the wardrobe, sinks, spittoons and windows (Figure 12). These were different “parts” working together to create a healing machine.
FIGURE 12. EXTERIOR OF PAIMIO SANATORIUM
In addition, like other functionalist architects of the day, Alvar Aalto used elements like ribbon windows and structural materials like concrete (Figure 13). Aalto used reinforced concrete because he considered it modern, of uniform quality and scientifically developed. In fact, the reinforced concrete structure of the main building was based on Le Corbusier’s flexible system. The Paimio Sanatorium’s connection to the functionalist principles of the International Style and Modernism has never been denied. But Aalto’s masterpiece displays a tendency to depart from pure functionalism and contains a design language all its own. As Edwin Heathcote explains, “Architects, when attempting to reconcile the cool clarity of modernism without resorting to technocratic coldness, still turn to Paimio for inspiration, and the high point of design it represents has arguably never been surpassed.” (Heathcote, 2010)
FIGURE 13. MAIN ENTRANCE TO PAIMIO SANATORIUM One of the ways Aalto’s buildings deviated from the sterility of pure modernism was his focus on designing environments that emulated nature. In
fact, all of his work revolved around a cohesive relationship with the natural world. You can see this in the design of the sanatorium. He combines rectilinear forms with more curvilinear, organic shapes like the front entrance. He also focused on creating a strong physical connection between the patient and the natural setting. He designed a large roof terrace that allowed patients to be taken, in their beds, outside for fresh air and views of the forest. He also planned winding paths on the hospital grounds and designed sun balconies on the end of each patient floor. His extensive use of glazing and thoughtful building orientation allowed for the use of natural daylight whenever possible.
FIGURE 14. STAIRWELL
FIGURE 15. DINING HALL Also, unlike the impersonal, sometimes cold, designs of his modernist contemporaries, Aalto had a very emotional response to his buildings and furniture designs and his intent was for users to feel the same. He believed that above all, the spaces that he created must provide for the client’s needs. His powerful use of color in the sanatorium reflected that belief. Ceilings in patient’s rooms were painted green to avoid glare. Bright yellows were used throughout the building in keeping with the theory that this color could produce “happier” moods. Reds and blues were used in more active spaces. The “white box” of modernism was re-tooled to create a more humanistic environment.
FIGURE 16. PAIMIO CHAIR, 1931-32 The Paimio Sanatorium was developed as a Gesamtkunstwerk—a total work of art. Together with his first wife Aino, he designed not just the building, but the entire interior details including the furniture, fixtures and fittings; everything from chairs to lamps to glassware. One of Aalto’s unique interpretations of high modernism can be seen in the design of one of these elements—his famous Paimio Chair. The chair was specifically designed for helping in the treatment of the sanatoriums patients. Used in the patient’s lounge, the angle of the back of this armchair was intended to help sitters breath more easily. Aalto gave his humanistic and regionalist reinterpretation of the chair’s modernist predecessors by choosing local materials and softening its form. Aalto used native birch for its natural feel and insulating properties and developed a more organic, sculptural form by bending the wood into scrolls at the top and bottom of the seat. These types of rich details that are neither rational nor purely ornamental, add an expressive and distinctly personal flare to his modernist forms.
CONCLUSION The Paimio Sanatorium and other healthcare facilities in the first half of the twentieth century represented a powerful shift in architectural theory that occurred worldwide. Modernism and its functionalist principles had taken hold and nowhere was this more widely embraced than in hospital architecture. An analytical approach to the function of buildings, a strictly rational use of (often new) materials, openness to structural innovation and the elimination of ornament were the new foundation of the architecture of health. But the high modernist principles seen in sanatoria of the early twentieth century are not the only influential ideas that laid the groundwork for contemporary hospital architecture. I would argue that it was Alvar Aalto’s synthesis of modern, organic and humanistic ideas that brought about another significant leap forward in modern design. His use of organic forms, natural materials and increasing freedom in the handling of space was a powerful contrast to the harsher and more industrial aesthetic of the time. More importantly, his design represented his intention to meet the physical and psychological needs of his “users”. Patient needs took priority over historical building styles or society’s demands for efficiency. It was this philosophy that directly correlates to today’s growing patient-centered design philosophies where technological function must include psychological factors as well. So, though the Paimio Sanatorium is rooted in the rationalism of the modernist approach, it is one of the earliest examples of healthcare architecture’s reintroduction of the patient, the human being, into the modernist’s “medical machine.”
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