ALVAAR ALTO: SAVOY RESTAURANT

ESPAÑOL

Alvar Aalto, a Finnish architect sometimes called the "father of modern architecture", is renowned for the quality of its
architecture, inserted within the Modernist Movement but full of warmth, superb handling of scale and the materials and
respect for the surrounding context . Among his best known works are the Academic Bookstore, the Finlandia Hall, the
Finnish Pavilion for the Paris Exposition of 1937 or the City Hall of Saynastalo .

Less known is, however, his works as interior and furniture designer. This post focuses precisely on the Savoy
Restaurant in Helsinki, which still retain some of his original designs.
 View from the old terrace, before being covered with glass, for obvious climatic reasons
( Helsinki is at latitude 60)

Opened in 1937, the Savoy is a luxury restaurant located at the top of the Industrial building, which was not designed
by Aalto.

It consists of two areas, one indoor area and the terrace overlooking the Esplanadi Park, one of the most important
public spaces of Helsinki. In addition, there are some exclusive banqueting cabinets.
 Lobby at the restaurant entrance.

Originally the restaurant interior was designed by Alvar Aalto and his wife Aino, in collaboration with textile artist Dora
Jung. The construction was carried out by Artek Oy.
Views and details of the living room
 View to the terrace

Esplanade Park View from the terrace.

Despite being a luxury restaurant, Aalto rejects the glitz and instead he choose simple , austere, minimalist style,
creating a warm and intimate atmosphere of elegant proportions. Among the designed elements are the club chairs by
Aino Aalto and the luminaires by Alvar Aalto.
 Detail of the luminaires

The restaurant also contains a display of the famous Savoy vase, designed in 1936, which consists of a hyperbolic
curve surface which folds sinuously along two similar curvatures of different radii.

The design, as Aalto was inspired by the Finnish Eskimos girls' breeches. In the words of Professor Jan Michl, "it
represents the qualities of the quintessential Finnish design: originality, openness and aesthetic sophistication."
The Savoy vases were placed on each table and allowed the flowers to be arranged in different ways.

Despite its name, the vases were not made exclusively for the restaurant, but were part of a collection for Karhula and
Iittala factory for the Paris International Exposition in 1937. In fact, the shape of the vase is similar to Aalto's Finnish
Pavilion built for that Expo.

Finland Pavilion, by Alvar Aalto. Paris Exposition, 1937

Since the first vases were made using wooden molds, their surfaces were slightly more textured than they are today. A
curious fact is that originally, after the glass hardened, the wooden mold was burned in order to release the vase.

Currently the Savoy vase rights have been acquired by the restaurant, and it is now called Aalto Vase.

Left: detail of the floor. Right: the restaurant was so expensive

that we could only afford to eat a dessert (it was such a treat!). In the background you can see the Aalto vase, still used on each table.

http://architecturalmoleskine.blogspot.com/2013/06/alvaar-alto-savoy-reastaurant.html
 http://paimiosanatorium.fi/

The Paimio Sanatorium (1928-1933) has been canonized as an internationally recognized

masterpiece of modern architecture, and it is often considered to be the breakthrough of Alvar
Aalto.
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preface
The subject of this popular-style article is connected to my doctoral thesis Architecture and technology: Alvar Aalto’s
Paimio Sanatorium for the Aalto University School of Arts, Design and Architecture, Department of Architecture.
Completed already in 2005, this article, however, is not a part of my thesis. We had drawn up a contract with the
Alvar Aalto Foundation for its publication in the Foundation’s monograph series. Because the publisher eventually
came to another conclusion, I made the decision to publish the updated research-based article myself.

Helsinki September 8, 2014, Marianna Heikinheimo

Download thesis

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Paimio Sanatorium
Introduction
In autumn 1928 the committee in charge of building Paimio Sanatorium (the Tuberculosis
Sanatorium of Southwest Finland), issued the following announcement: “Esteemed Architects are
invited to participate in a competition for drawing up the designs for said sanatorium with 184 sick
beds”.[1] Alvar Aalto won the open competition and the construction project began soon after the
result had been announced.

Architects Aino and Alvar Aalto, then a young couple, had developed very rapidly in their ideas
about architecture, and it is difficult to imagine that the rather modest Alajärvi Municipal Hospital
completed in 1928 was designed by the same practice as the winning entry for Paimio Sanatorium
in the following year. When the Aaltos[2] moved to Turku in 1927, they came into contact with a
group of important avant-garde architects. Turku and the international contacts it brought the Aaltos
had a strong influence on their ideas about the home, living and architecture. Their moving to a
new environment can also be seen as a spiritual journey into a world of new stimuli and
architectonic ideas. [3]
 The patients´ wing in the front, the
B-wing to the left and the balconies to the right. Photo Sami Heikinheimo, © ark-byroo.

The municipal hospital of Alajärvi. Photo the

archives of the Alajärvi municipality.
The task of designing Paimio Sanatorium offered the innovative young architects the opportunity to
try out their new ideas in practice. With its wings of different heights, its various gardens, courtyards
and sections, Paimio Sanatorium resembled a small town. The steel ribbon windows of the facade
and the mechanical motion of the scenic lift were features that underlined the overall feeling of
movement. The Aaltos’ architecture, using reinforced concrete, met the requirements for hygiene,
fresh air and sunlight generally placed on tuberculosis sanatoria. They saw the patients’ rooms as
minimal apartments, and this inspired them to develop suitable furniture, both movable and fixed,
for a small space. The simple design of articles for everyday use reflected the value placed by the
architects on the morphology of industrially manufactured articles. In the course of the Paimio
Sanatorium project, cooperation between Alvar Aalto and furniture manufacturer Otto Korhonen
deepened, leading to the creation of an autonomous process for patenting the technical innovations
relating to furniture.[4]

The common factor linking functionalist architecture and Taylorism (the Scientific Management
method developed by Frederick Winslow Taylor, a reformer who introduced rational work methods)
is the need to redefine problems and seek new solutions to them. These ideas are strongly
reflected in the architecture of Paimio Sanatorium. In fact, in terms of its challenges, the design of
the sanatorium can be compared to that of a factory.

In the industrial world of the early 20th century Taylorism can be seen as a process of profound
cultural change that affected all spheres of life. The engineers who specialised in re-organising
industrial production studied the functioning of a factory and analysed the work motions and the
time taken to perform the work, the tools used, and the work environment. The work itself was
divided into stages, and for each stage an optimal way of performing the work was defined. The
traditional ways of working were to be subjected to rational scrutiny.

With the demands for standardisation and efficient use of manpower, materials and workshops,
there arose a need to re-design the factory. The design of an industrial plant required knowledge of
production economy, rational plant design, new technical systems for buildings, and installation
technology – in practice, therefore, a profound and broad-based expertise.[5]

Architects became familiar with Taylorism mainly through the works and writings of Walter Gropius
and Le Corbusier. The demands of rationalism were part of the theoretical groundwork for
functionalism.[6] The architects were also interested in Frank B. Gilbreth’s visual motion studies,
which aimed to define work methods that were both efficient and energy-saving and to develop
appropriate tools for the work. The Aaltos also had to consider similar details when designing
Paimio Sanatorium.

The sanatorium as an institution

The planning of a tuberculosis sanatorium was a matter of national importance and urgency in
Finland. In the early decades of the 20th century there was no medication for pulmonary
tuberculosis, which posed a serious threat to public health. The disease was treated in specialised
institutions through rest, diet, exercise and surgery.[7] Patients were taught ways of making their
everyday lives easier and protecting themselves and those living with them from infection.
Treatment times were long and not very effective. With the Act on State Aid which came into force
in 1930, society took over financial responsibility for the building and maintenance of institutions for
the treatment of tuberculosis. The State began to subsidise public sanatorium projects by paying 75
per cent of the building costs, in addition to supporting their operation. The National Board of
Health supervised the projects receiving financial support. In the first half of the 1930s, 16 large
new public sanatoria were built in Finland.[8]
Paimio Sanatorium was commissioned by a special Building Committee set up for the building of a
tuberculosis sanatorium by the Municipal Federation of Southwest Finland, consisting of 52
municipalities. The committee consisted of lay members, three of them being Members of
Parliament, who were able to follow the progress of the Act on State Aid in Parliament.[9] The
construction project was timed so that it was eligible to apply for financial aid. The work started in
late spring 1930 and the sanatorium was inaugurated on June 18, 1933.

In addition to the main sanatorium building, the Aaltos’ architectural practice designed other
buildings that were completed at the same time. There were also older buildings, most of them farm
buildings, on the 327 hectare estate set up for the sanatorium. Paimio Sanatorium was built to take
286 patients. A total of about 70 people worked on the farm and at the hospital. All the daily
foodstuffs for both patients and staff were provided by the farm.

Tuberculosis was a much feared disease in the 1930s, and Paimio Sanatorium was an institution
where the patients were isolated. Its tall, white, 7-storey high outline was unlike anything that had
been seen before in the Finnish countryside. Despite people’s fear of the disease the project was
publicised from the beginning in a positive light, as there was seen to be a real need for a modern
tuberculosis hospital. The positive public image was influenced particularly by the recently enforced
Act on State Aid, but probably Alvar Aalto’s effective and extensive public relations efforts also
played a role in building the sanatorium’s image. He knew many influential people and through his
contacts was able to gain publicity not only for his own design work, but also for the whole project.

Since its completion Paimio Sanatorium has been in use as a hospital, and it has therefore not
been possible to completely avoid alterations. Protection of the building was first considered when
Alvar Aalto died in 1976. Aalto was such a highly regarded authority in Finland that the quality of
the changes made was not discussed in front of the maestro during his lifetime. The National Board
of Antiquities started the protection process with the Building Protection Act in 1990, as protection
on the level of regional and local master plans was not sufficient to ensure that the cultural-
historical values of the area would be preserved. In 1993 Paimio Sanatorium was protected under
the Building Protection Act. The protected buildings are the former sanatorium, the heating plant,
the garage facilities, the workers’ housing, the junior doctors’ terraced houses, the senior
physician’s residence, the funeral chapel and the area surrounding these buildings. In 2002 the
Ministry of Education applied for nomination of Paimio Sanatorium to the UNESCO World Heritage
List.

Sanatorium architecture
Competition
Although the Building Committee’s original intention was to organise a large invited competition for
the design of the institutional building, in which the architects invited to participate would be
experienced hospital designers, an open competition was organised. This was of vital importance
for new architects who were just setting out on their career. The jury for the competition consisted
of the chairman of the Building Committee, Bernhard Heikkilä, with architects Jussi Paatela and
Väinö Vähäkallio from the Finnish Association of Architects, Professor Akseli Koskimies of the
Association for the Control of Tuberculosis (now the Finnish Lung Health Association), and Doctors
Severi Savonen and Väinö Horelli. Väinö Vähäkallio was familiar with the development of
construction technology and the demands of rationalisation [10], while Jussi Paatela was a specialist
in hospital design.[11] He also served as an expert for the National Board of Health’s hospital
department during the building of Paimio Sanatorium. Doctors Severi Savonen and Väinö Horelli
acted both as representatives of the developer responsible for the building project and as experts
for the National Board of Health.

Invitation of the
architectural competition was published in November 1928. Arkkitehti No. 11 1928.

The programme for the architectural competition listed the buildings to be designed, the space
requirements for the functions to be located in the main building and instructions for the allocation
of space.[12] Four separate wards were planned, with a total of 184 beds. The individual rooms were
designed to accommodate two, three or four patients, with 25 cubic metres of space for each
patient. Each ward would also have two single rooms. The sanatorium would have offices and
examination rooms, rooms in each ward for the use of staff and of patients, and communal rooms
for the use of all patients. In addition, kitchens, rooms for the use of nursing and domestic staff,
communal spaces and equipment, an isolation ward with its own entrance for patients with
contagious diseases were also to be located in the main building. Further, the competition
programme specified as separate buildings a residence for the senior physician, housing for the
junior physicians and housekeeper, a maintenance building and a building for housing staff. The
farm buildings were not included in the competition brief.

The competition entries were placed in three classes by the jury: one entry in the lowest class,
eight in the middle class and four in the top class. Of the latter, three were awarded prizes. The jury
was unanimous as regards the winning entry, submitted under the pseudonym Piirretty ikkuna
(Drawn Window). The second prize was awarded to a team of three architects, Kaarlo Borg, Otto
Flodin and Paavo Hanstén for their entry, Valo (Light). The third prize went to Antero Pernaja and
Ragnar Ypyä for their entry, Ammon-Ra. The Awards Committee proposed purchasing Erik
Bryggmann’s entry, also placed in the top class, for its architectural merit, but the Building
Committee rejected the proposal.
The jury considered Alvar Aalto’s Drawn Window architectonically interesting, but somewhat
“restless and pretentious” as a whole. The room arrangement was considered pleasing and their
layout successful. However, the dimensioning of the building was criticised: the main stairway was
too narrow, the patients’ bathing facilities overestimated and the cubic volume of the building
insufficient. The jury favoured economy in the basic solutions, and felt that a wider frame would
reduce the external wall surface and thus the heating costs. [13]

The entries gaining second and third place, Valo and Ammon-Ra, were similar in their basic
concepts. The buildings had L-shaped floor plans within a orthogonal coordinate system, with the
wards leading off side corridors, located on different storeys in one wing, and an open sun deck
wing continuing from it. The entrances were at the articulation point of the L-shaped building. Both
entries had a large roof terrace. The jury criticised the placing of individual functions in the building
and the dimensioning of the spaces. Also criticised was the use of strip windows on the façade of
the Ammon-Ra entry, despite the fact that it was a load-bearing structure. All the prize-winning
entries had flat roofs.[14]

The winning entry, consisting of eleven sets of drawings, met the competition requirements as far
as the buildings were concerned. The three wings of the main building were laid out on a free-form
coordinate system. Two of the wings were four storeys high and one had three storeys. In the main
building all the wings had side corridors. Different types of activities were distributed among the
different wings. In the competition entry the wards’ sun balconies were a continuation of the patient
wing, but the idea of a roof terrace was only introduced as a proposal. Three sun decks for use in
summer were to be built on the terraced slope in front of the sun balcony wing. The heating plant
and garage space were in the basement of the maintenance wing.

The four wards located on different floors were identical. The isolation ward was situated below
them in the basement. Although the patients’ rooms were
intended to accommodate 1–4 patients, most of them had two occupants. The ward sister’s
accommodation, with a south-facing balcony, was midway along the row of patients’ rooms.

In the B wing above the second-floor reading room and library were living quarters with spacious
loggias. The dining room and a common room, the hub of social life in the sanatorium, were also
located in B wing. The canopy over the entrance was rounded at one end, but otherwise
rectangular. Aalto’s proposal visualised a water tank to be built around the heating plant chimney,
accessed by a glass-walled spiral staircase.[15]

The load-bearing column and slab construction was already fully worked out at the competition
stage. The lines of columns in the patient wing were behind the south-facing facade, inside the
corridor walls. The vertical pipe risers were also to be inside the corridor walls, as finally
implemented. The projecting sun balconies were closed at one side and open at the other. The
load-bearing beams were designed to taper towards the outer edge.

In the competition entry, the main building was to have a flat roof and roof terraces. According to
the report, a wooden roof truss and a sharply-pitched tiled roof was too complex a solution for the
basic structure of the main building, but might be acceptable in a smaller building. Aalto’s tactics
were evidently to keep options for the roof open, fearing that the jury would favour more traditional
roof shapes.

At the competition stage, the junior physicians’ terraced building was to be built in the same
direction as the B wing, with its long side parallel to the entrance axis. The long facade of the staff
building was also to face south. The morgue was to be north of the maintenance wing near the
main building. The senior physician’s house was to be situated farther from the main building.
While the competition was still in progress, Alvar Aalto received a letter from the National Board of
Health dated January 2, 1929, expressing an opinion on the draft design for the Tuberculosis
Sanatorium of Southwest Finland, in other words the as yet unfinished competition entry. [16] The
letter, which is still in the Aalto archives, bears the name “Horelli” pencilled in, in brackets. This
suggests that Aalto knew about Väinö Horelli’s statement, and therefore at the competition phase
he already knew the medical expert’s opinion on certain critical issues. As the criticism of Aalto’s
entry received at the beginning of January differs in content from the assessment of his final
competition entry, it can be surmised that his plan developed considerably during January 1929. [17]
It remains a mystery to what extent the medical expert’s opinion finally influenced Aalto’s work and
the course of events during the competition: Did Aalto gain an advantage over the other
competitors, or did the situation put him I an awkward position?

The design commission

The architect’s assignment included the main drawings, cost calculations and specification of
works, supervision of the construction work and interior design, excluding the houses and
apartments meant for private use. The developer was responsible for contracting out the work.
Aalto as leading expert was able to influence the choice of contractors and subcontractors.

In addition to Alvar Aalto and Aino Marsio-Aalto, the Norwegians Erling Bjertnäs and Harald
Wildhagen, as well as Finnish architects Lauri Sipilä and Lars Wiklund, participated in the design.[18]
Concrete engineer Emil Henriksson’s engineering office carried out the strength calculations for the
reinforced concrete structures of the main building as a sub-consultant for the architectural
practice.[19] Various engineering offices and subcontractors drew up the specialised technical plans,
mainly at the implementation phase. The planning and building were started in 1929. The design
process went on until 1932, and the project was completed in 1933. Detail design and construction
went on simultaneously.

In his work the architect had to consider the changes to the competition entry proposed by the
experts. The main drawings and cost calculations were supposed to be ready by December 1,
1929. The design contract was extremely stringent. For example, as a condition for accepting the
drawings or for the granting of State aid, it included a clause whereby the architect was obliged,
without separate remuneration, to draw up new drawings should the National Board of Health
propose changes.[20]

Aalto presented the final drawings to the Building Committee according to schedule, in December
1929. The committee was satisfied and stated that Aalto had in the main taken the required
changes into consideration.[21] The scale of the Paimio Sanatorium project changed significantly the
following spring, when the City of Turku decided to participate. As a result, the number of patient
beds was increased from 184 to 286, but the wish expressed by the City of Turku that the number
of staff be increased accordingly was turned down. The medical experts considered the planned
number of staff to be sufficient, despite the greater number of patients. [22] The change in the building
plan meant adding two extra floors to the patients’ wing. Aalto presented the drawings for the
extended sanatorium to the Building Committee in April 1930, after which he had the task of
sending an application for approval of the drawings by the National Board of Health.[23]

Division of functions

Floor plan
The floor plan for Paimio Sanatorium attracted attention as it was asymmetrical and non-rectilinear,
but at the same time was based on a controlled system of coordinates. The sun balconies joined
the A wing at an angle of 20˚, running parallel to the B wing; in other words the A and B wings were
at an angle of 20˚ to each other. This can be seen from the entrance forecourt as a false
perspective. The circulation area connecting the A and B wings was at right angles in relation to the
A wing, while the C wing joined the B wing at an angle of 45˚.

Different functions were placed in different wings, which was the standard practice in tuberculosis
sanatoria.[24] Aalto was also familiar with the grouping and separation of functions indirectly, through
the concept of rationalisation as proposed in the Scientific Management programme. Special
requirements regarding light and sunshine only affected spaces where it was important for
treatment and it was necessary to ensure that light could penetrate sufficiently into the building
frame. The sun balconies the large halls, the dining room and the work room in the B wing faced
directly south. The halls were higher on the south than on the north side. This ensured that the
sunlight could penetrate into the northern corners of the space as exemplified in the sectional
drawing. The windows of the patients’ pavilion faced south-southeast towards the morning sun. To
regulate the light entering the patients’ rooms, wooden Venetian blinds were fixed outside the
windows. The windows on the south-facing B wing facade were furnished with canvas sun
awnings. Aalto accepted the medical experts’ opinion that patients needed shade as well as
sunlight.[25] The operating theatre was separated from the four-storey volume of the building in a
low, semi-circular structure on the northern side of the B wing. The theatre received natural light
from above and from the side, thus meeting the orthodox requirements for its function. [26]

The corridor of the patients´ wing in 2008. There are ventilation tubes and a lowered ceiling. Photo Sami Heikinheimo, © ark-byroo.
The patients’ rooms formed a row along the almost 100-metre long corridor.[27] At the western end
of the corridor, outside the actual ward area, were the apartments for the ward sisters. These six
small apartments had their own lift and stairs. At the eastern end of the patients’ wing each ward’s
sun balconies formed their own separate units adjoining the patient wing. On the sixth floor there
was a sun deck for 120 patients meant for the use of all wards.

The top floor

balcony and its curved canopy. Photo Soile Tirilä, National Board of Antiquities.

The ward’s work rooms were strategically placed near the middle of the corridor, so that traffic
along the corridor was easily supervised. The office was separated from the corridor by glass walls.

The six wards, one above the other, were almost identical, but separate units. According to
Taylorism, problems would be solved in separate production units without disturbing the functions
of the whole plant. In Paimio Sanatorium men and women were in separate wards, [28] the weaker
patients on the lower floors.

The building was entered from a foyer connecting the A and B wings. This route was used by the
patients and some of the staff. The main entry was covered with a free-form canopy, which was an
eye-catching feature of the inner courtyard. The front steps were partly outside and partly inside the
building with the door on the intermediate landing. For carrying stretchers into the building the
staircase was impractical but evidently this was not regarded as a disadvantage as the patients
selected for the sanatorium were fit enough for rehabilitation and reasonably mobile. [29]

The work stations of the administrative and nursing staff were all near the main foyer. The
administrative department also had its own entry. The communal spaces for the use of patients
were on the upper floors of B wing, as were also the staff common rooms and living quarters. B
wing was the most versatile part of the building in terms of functions. Local people from Paimio also
visited the sanatorium to consult doctors as the municipal GP’s post had been discontinued when
the sanatorium was built, and junior physicians could also take private patients. [30]

The dining hall in 2008. Photo Sami Heikinheimo, © ark-byroo.

The junior physicians and ward sisters regularly had meals with the patients in the large dining
room, which was designed to be multi-functional. From a room on the second floor films could be
projected onto the wall of the dining room, and as the chairs and tables were stackable, the room
could be also cleared for social functions. In addition, the white leather-covered sliding door of the
dining room could be opened directly onto the patients’ communal lounge. As the wards had none
of the dayrooms typical in sanatoria, the lounge was no doubt actively used.

The maintenance building and the B wing were joined by a tunnel-like corridor where the food was
also served into dishes stored in practical wheeled cupboards. In the kitchens, the areas where
food was cooked were separated by glass partitions. The ingredients were prepared on the floor
below. The basement in C wing housed a laundry and on the upper floors the living quarters for
kitchen staff.

Housing

The staff and their families lived on the premises of the Paimio Sanatorium, and different forms of
housing were an important feature of the entire sanatorium area. In practice it was expected that
the doctors and female nursing staff would live on the grounds of the sanatorium. Likewise it was
recommended that the female domestic staff and male technical staff should live near the
sanatorium. This made staff supervision easier, and they would also be more committed to the
work if they were offered housing.[31]

In the 1920s–1930s a detached house was usually built for the senior physician in the hospital
grounds. For junior physicians a terraced house with 3-4 rooms and a kitchen was considered
suitable. Housing for female nursing staff was also given attention as they often lived on the
hospital premises for most of their working lives.[32]

The size and comfort of the dwellings reflected the social hierarchy within the community. The
senior physician of Paimio Sanatorium lived in a two-storey detached villa-type house with a floor
area of 250 square metres and surrounded by a garden, situated 150 metres from the main
building. The family had three bedrooms at their disposal as well as a large reception room, two
toilets, a bathroom and a dressing room. The kitchen was equipped with a refrigerator. There was a
servant’s room and toilet with a separate entrance. The senior physician’s house even
had separate plumbing, so that his family would not be affected by any bacteria spread by water.
The house also had its own sauna in the garden. Of the sanatorium staff, the head physician was
the only one who had a say in the planning of his own living quarters.[33]

The terraced house for the junior physicians’ and the housekeepers’ families was a partly two-
storey and partly single-storey, chain-like building that bordered on the sanatorium’s entrance
forecourt. The area of the houses was 120 square metres per dwelling and each had three
bedrooms, a toilet and a bathroom. There was a room and toilet for a servant adjoining the kitchen.
Doctors and the housekeeper were assumed to have families, and the housing was thus designed
accordingly.

There were two types of accommodation for workers. On the ground floor of the building there were
four family apartments of 45 square metres with a living room, two bedrooms, a kitchenette and a
toilet. On the upper floor there were 8 single-room apartments of 16 square metres each, furnished
with a wash basin only. The rooms were built along an open gallery, at the end of which there were
two toilets for residents’ use. The upper storey apartments were probably for male workers with no
families, such as drivers and heating plant workers.[34]

The size and furnishing of the housing were more modest the further down the occupant was in the
sanatorium hierarchy. The lowest level was the quarters for female staff on the second floor of the
C wing in the main building. Aalto compared the living quarters to a hotel, and in the drawings this
part was called the “service and kitchen staff hotel”. The designation hotel is controversial, as
generally a hotel implies temporary habitation. On the other hand, the name can be seen as an
attempt to make the modest form of housing seem more luxurious, and give the impression of
efficiency. Even a small hotel room usually has toilet and washing facilities, in the same way as a
ship’s cabin. Both a hotel room and a ship’s cabin can be compared to the minimum apartment
which had probably inspired the architect.

Indoor and outdoor space

The relationship between indoor and outdoor spaces plays an important role at Paimio Sanatorium,
as in most of Aalto’s architecture. Between the wings of the main building a number of different
courtyards and gardens were built, forming a part of the functional complex.

The entrance courtyard opening to the west of the sanatorium, bordered on three sides by the main
building, and on the western side by the junior physicians’ terraced houses. The road curving in
front of the main door was dimensioned to allow a vehicle to turn. People were brought by bus from
Paimio station right to the sanatorium door. In the centre of the courtyard there was a parking area
decorated with flowers. From the stair landings, the patients’ corridors, the dining room and the
library there was a good view of this central stage. A Swedish manual of hospital building from the
1930s urged that the main entrance be separated from the outpatient and staff entrances. The
entrances should also be located so that traffic would not disturb infirm patients. [35] Aalto’s plan was
completely different: In his view it was important to see and to be seen. From the patients’ corridor
you could see the main entrance, which was also the route used by patients going to the outpatient
department. Aalto’s sanatorium entrance was like the steps up to a 19th century theatre: a social
stage.

In the garden to the south of the patients’ wing five circular ponds were built, bordered by flower
beds and joined by sandy paths. The bright, sheltered garden, freely bordering on the forest, was
meant for the patients to walk in. From their rooms and sun balconies patients could watch life in
the courtyards and gardens, and by walking outside they could express their existence, for
example, they communicate their improved state of health, to others.

The entrance forecourt and garden were visible to all, but one could also see from outside into the
sanatorium. The open building with its large window panes gave those outside an insight into life
inside the sanatorium.[36] At night and in winter the patients’ corridors with their strong colours and
bright lighting made the sanatorium glow like a lamp in the dark.

Mechanical motion
Paimio Sanatorium was in many ways an extremely modern hospital building. The multi-storey
hospital was based on the idea of greater efficiency and shorter distances. Movement between
floors was by staircases, lifts and shafts.

Three passenger lifts, two combined passenger and goods lifts and one lift for conveying sputum
spittoons, were installed in the sanatorium.[37] The patients’ soiled linen was dropped from a shaft in
the ward to the basement, where the laundry was situated. The clean washing was taken by lift
back to the ward.

Efficient lifts played an important role in the new rationalist and functionalist architecture. In 1914, in
his manifesto on futuristic architecture, the architect Antonio Sant’Elia extolled buildings that were
like machines and encouraged his colleagues to place lifts where they could be seen, on the
facades of buildings, like “serpents of steel and glass”:

“We must invent and rebuild the Futurist city like an immense and tumultuous shipyard, agile,
mobile and dynamic in every detail; and the Futurist house must be like a gigantic machine. The
lifts must no longer be hidden away like tapeworms in the niches of stairwells; the stairwells
themselves, rendered useless, must be abolished, and the lifts must scale the lengths of the
façades like serpents of steel and glass.”[38]

The scenic lift at Paimio Sanatorium can be seen as a romantic idealisation of the building as a
machine. The lift was housed between two glazed steel-framed walls. The movement of the
plywood lift car and the mechanism with its wheels were visible through the glass as one
approached the sanatorium. The high, narrow glazed shaft in the facade accentuated the scale of
the building, and gave expression to a longing for the hectic bustle of metropolitan life, which never
stopped, even at night.
Air
Fresh air and abundant natural light were two of the central themes in rationalist building and
architecture. Alvar Aalto gave considerable thought to ventilation and air, in many different
contexts:

“Among the biological requirements of human life are air, light and sun. Air cannot be equated to
room size or number of rooms. It is a factor in its own right. We can certainly build a dwelling with a
large volume of air without it affecting the economical use of floor area or playing any role in
determining room heights. It is a question of ventilation.”[39]

A natural gravity ventilation system was installed in Paimio Sanatorium., The importance of clean
air and ventilation for health was emphasised in the early decades of the 20 th century, especially in
medical publications. As the patients’ wing was ventilated all year round, the indoor spaces of the
building were not as warm in winter as they were designed to be. There was an exhaust outlet in
the corridor-side wall of the patients’ rooms. These were equipped with valves and the exhaust air
was conveyed by separate shafts to the roof ridge.[40] The height of the building resulted in an air
pressure difference between the lower and upper floors, which allowed the gravity system to
operate efficiently. On the roof there were separate ventilation outlets for each group of shafts. In
rooms where gases accumulated the exhaust air outlets were provided with electrically operated
valves.

The combination of central heating and gravity ventilation is highly dependent on season and wind
conditions. It is more efficient the greater the difference between indoor and outside temperatures,
and thus the system works best in winter.[41]

Standardisation
Standardisation was one of the pillars of Taylor’s Scientific Management method:

“The standard method of doing anything is simply the best method that can be devised at the time
the standard is drawn. Improvements in standards are wanted whenever and wherever they are
found (…) a proposed change in a standard must be scrutinized as carefully as the standard was
scrutinized prior to its adoption; and further that this work be done by experts as competent to do it
as were those who originally framed the standard (…) Standardization practised in this way is a
constant invitation to experimentation and improvement.”[42]

The idea of standardisation was so important to Aalto that he had included the requirement for
standard drawings in the design contract for Paimio Sanatorium.[43] He had evidently taken the idea
of human biological needs as standard requirements from Le Corbusier. In the years 1929–32
Aalto designed a number of objects that he designated as “standard”, most of them connected with
the Paimio Sanatorium project.[44] For example, the furnishing of the patients’ rooms inspired the
architect to design standards for the wardrobe, glass shelf, wash basin, spittoons and windows.

According to the view of the Finnish Standardisation Board, the standardisation of the house
building sector could be divided into standardisation of parts of buildings and of complete buildings.
The standardisation of building parts was further classified as standardisation of form and
dimensions, or of quality.[45] Aalto’s interest in the subject also concerned the use of materials in the
Paimio Sanatorium building parts. Functionalist architects considered reinforced concrete to be a
material that was modern, of uniform quality and scientifically developed.
Reinforced concrete

The structural concept chosen for the main building of Paimio Sanatorium was based on Le
Corbusier’s flexible system. The load-bearing frame of the main building consisted of reinforced
concrete columns with a slab resting on top. The rows of load-bearing columns were partly inside
the building envelope and at some places in line with the external wall. Where the slab extends out
from the building in the form of a cantilever, the walls above and below the windows form narrow
concrete beams directly connected to the floor slab.

The intermediate floor slabs consisted of two leaves. The upper leaf was cast onto a bed of coke
cinder filling on top of the lower slab. The partition walls were built on the beam and separated from
the load-bearing structure, thus creating a floor and partition wall system that was sound-insulating.
Part of the beam system served to carry air exhaust ducts, and at these points the walls were made
of concrete slabs.[46] The roofs of the main building were flat, and the double-slab attic floor served
as the roof. Unlike the other spaces, the open sun decks and balconies were made of one slab. In
this case the load-bearing structure was a beam carrying a slab or simply a cantilevered slab.

In the patients’ wing, the room division, load-bearing structure and ductwork conceived by Aalto
work together in unison. The inspection hatches of the vertical pipe shaft in the corridor wall
opened onto the corridor. This arrangement later restricted changes to the sanatorium’s plumbing,
as the shafts were not big enough to accommodate both sewage and grey water pipes.

The sun balcony section owes its robust construction to Emil Henriksson, a specialist in concrete
engineering, commissioned in 1930 by the Aaltos’ practice to carry out the concrete strength
calculations.[47] The load-bearing row of columns in the completed building gives balance to the
structure, which is cantilevered in two directions. The beams taper towards the outer edge of the
cantilever. A thin reinforced concrete envelope cast in-situ was used in the solid, seven-storey high
rear wall to protect the tensioned steel rods. The sophisticated structure was a unique example of
engineering skill that satisfied the architect’s need to find a means of expression suited to the
challenges of the task.

The concrete structure of the main building was built by the company owned by a Turku contractor,
Master Builder Arvi Ahti, in 1930.[48] According to the contract, the architect’s drawings and building
specifications took precedence over the construction drawings and strength calculations. The
structures shown in the architectural drawings were not to be altered. The strength calculations and
the casting work proceeded simultaneously. The concrete casting of the framework began with the
boiler room in June. The concrete wall of the sun balcony section had reached plinth height by the
end of July.[49] The concrete frames of the main building’s various wings were built between July
and October. The strength calculations for the topmost beams of the B wing, which carried the
intermediate floor between the dining room and the library, were not drawn up until November. The
major part of the work was carried out in cold, rainy weather in the autumn of 1930. The final
inspection of the structural framework was attended by both Aalto and Ahti, in a very positive
atmosphere. According to the minutes, the contracted work had been executed with care and was
of high quality, to the complete satisfaction of the client. Against expectations, the developer had
been forced to commission drilling work on the bedrock at the site, and as a result had been forced
to postpone contracting work to a less favourable time of year than planned. The contractor
expressed special thanks that the detailed drawings and reinforced concrete calculations had
always been delivered on schedule, and that all the work phases had been agreed on in good
time.[50]
The construction of the sun balcony wing posed unprecedented challenges, and its execution
depended on mutual trust and collaboration between two men. Ahti was Emil Henriksson’s brother-
in-law and a member of the board of Ahti’s company. Henriksson was also Aalto’s oldest partner in
cooperation. His collaboration with Alvar Aalto started with the projects for the South-western
Finland Agricultural Cooperative Building and the local newspaper Turun Sanomat’s building in
Turku. Aalto presented the tenders to the Building Committee in such a way that Ahti’s tender was
accepted, even though it was not the cheapest. The Building Committee had already authorised the
executive committee to sign the contract with another company. [51] In June after Ahti had submitted
his tender the Building Committee and Aalto again negotiated with Ahti, who then lowered his price.
This move did not, however, convince the executive committee, who considered that the new
proposal required no further action, and they continued to negotiate with the company that had
been chosen first. At this stage Aalto evidently found an omission in the tender, which he used to
his own advantage. The chosen contractor had not included in the calculations the concrete casting
work on the rear wall of the sun balconies as specified in Aalto’s final drawings. As no unanimous
agreement could be reached the Building Committee called a halt to the contract negotiations and
decided to approach Ahti, who reduced his tender to the same price as the first company had
offered and was given the job.[52]

Even though the case took on somewhat farcical dimensions, it says something about Aalto’s
ability to handle situations to his own advantage. Aalto, Ahti and Henriksson benefited from the
mutual support, and Aalto was able to implement his bold plans with the help of trusted partners.

The Stockholm Exhibition of 1930

Sven Markelius was Aalto’s Swedish colleague and friend, who opened the doors to Europe for
him. Markelius had been given the task of planning the hospital section of the 1930 Stockholm
Exhibition. His expert team consisted of doctors and an engineer whose special field was heating,
ventilation and sanitation.[53] The timing of the Stockholm Exhibition was perfect as regards the
planning of Paimio Sanatorium. During the exhibition, in summer 1930, the master drawings for the
sanatorium had just been completed and the design process was progressing to detailed drawings.
The hospital section provided Aalto with a concrete model on which to base his design of the
patients’ rooms in Paimio Sanatorium.

The purpose of the Stockholm Exhibition’s hospital section was to try out bold new solutions
instead of the traditional ones, and to give manufacturers the opportunity to present their furniture
and equipment designed for hospital use. The exhibition featured an operating theatre and a
nursing ward. The ward was located on the top floor of the two-storey exhibition building. Intended
to indicate future trends, the ward was of the “terrace hospital” type where the sun balcony was
built in front of the patient’s room. Markelius pointed out that this concept was specifically suited for
low buildings. The nursing ward comprised the patients’ dayroom, a kitchenette, two patients’
rooms with a bathroom between them, all built along a corridor. Markelius himself stressed that
locating the toilet and washroom facilities on the sunny side of the building could be considered
wasteful use of space, an unnecessary luxury, as their function did not require sunlight. Usually
hospital wards had a bathroom. According to Markelius this solution made the staff’s work easier,
improved hygiene and contributed to the patients’ comfort and wellbeing. A hospital should be
comfortable in his view.[54]

One of the patients’ rooms in the exhibition was designed for four, the other for two occupants. The
small patients’ rooms embodied a new line of thinking about treatment. Daylight entered the room
through two ribbon windows. The lower one was a sliding window that could be opened, with a
striped awning outside. Both strip windows were fitted with textile curtains. The aim was to
maximise the amount of light entering the room without making the window area too large. The
bedside tables, the small chairs at the head of the beds and the adjustable reclining chairs were all
light, made of steel tube. The beds and reclining chairs had castors so that they were easy to
move. The room lighting was a hygienic opal globe lamp. Fresh air came into the room through
vents mounted above the panel radiators, which were fixed below the windows. The wash basins
were in the bathroom with the toilet and two wardrobes.[55]

Hygiene and interior decoration

In the 1930s, hygiene was emphasised in rational hospital building as an important element in
patients’ recovery. In the design of Paimio Sanatorium, too, hygiene was a significant factor, both in
the floor plan and in the interiors of the patients’ rooms, but in addition, the interior design solutions
were guided by rationalism and the idea of the patient’s room as a minimal dwelling.

The model of the patient’s room as a minimal dwelling was repeated in hospitals countless times in
an identical form. The National Board of Health had laid down the floor area and volume of the
room, but the challenge for the architect was to design an environment where it was possible to
rest, dress, wash one’s hands, cough up sputum and work at a table within this strictly dimensioned
space. The room was like a stage where two people, previously unknown to each other, were to
play out their lives. Aalto solved the problem by using light, movable furniture, shapes that allowed
movement and activity, hygienic materials, an integrated heating system, non-glare lighting and a
soothing colour scheme. Hygiene was a principle that ran through the entire design process. Dust
accumulation was prevented by using furniture that could be wiped clean, glass lamp shades,
panel radiators fixed to the walls and encased radiant heaters on the ceilings.

The museum
room. Photo Soile Tirilä, National Board of Antiquities.
When arriving at the sanatorium the patients left their outdoor shoes in the entrance lobby and their
outdoor clothes in the ward cloakroom. The wardrobes in the patients’ rooms were for storing
indoor clothing. Aalto’s design for a standard wardrobe made of moulded plywood was well suited
to meet the requirements of rational use of space. Its curved contours facilitated movement in a
small space. The wardrobe was designed to be mass-produced, but despite later efforts of the
furniture manufacturer to sell it, the wardrobe was never used in other hospitals.

The walls have rounded shapes in the lobby. Photo Sami Heikinheimo, © ark-byroo.

Aalto also designed the wash basin for the patients’ rooms, as making it in Finland proved cheaper
than using a foreign-made standard product. Aalto also justified his choice to the Building
Committee by arguing that a domestically manufactured product was needed in
Finland.[57] Washing one’s hands was a basic ritual of good hygiene and the basin was a symbol of
this. The repeated study of an activity and its re-organisation was in line with Taylor’s doctrines of
standardisation. The wash basin designed by Aalto was of a special type, and its structure made it
possible to be used with as little noise as possible.[58] The grounds given in the Architect journal met
the requirement of the Scientific Management method for a good, noise-free environment. In
Paimio Sanatorium every patient had their own wash basin, which at that time was a hygienic
solution, even a luxury. This example shows how the reasons Aalto gave for his design solutions
could vary depending on the audience.
The ”noiseless” water basins were designed by Alvar Aalto. Photo Soile Tirilä, National Board of Antiquities.

Three different types of lighting were used in the patients’ rooms. A globe lamp designed especially
for Paimio Sanatorium provided indirect, overall lighting reflected from the ceiling. Above the wash
basins there was a conical incandescent lamp without a shade attached to the wall by a metal
bracket. The reading lamps in the room could be attached to the bed head or placed on the
bedside table. The lamps for the sanatorium were manufactured by Paavo Tynell’s Taito Oy
factory. Some of the lamps used were standard types made by the factory, while others were
designed by Aalto. Tynell was also involved in designing the lamps. [59]
Only one night lamp per room was purchased to the hospital. Photo Soile Tirilä, National Board of Antiquities.

The metamorphosis undergone by the windows of the patient rooms between the competition stage
and the implementation stage is one of the most revealing stories about how the details of the
sanatorium design developed. The pseudonym used for the entry “Drawn Window” was shown in a
vignette in all the plans as a steel window frame with three parts, the left- hand one reaching down
to the floor. In the upper part of the window was a so-called “health window” or a specially hinged
window providing ventilation. Under the window there was a cast-iron column radiator. The window
was an extremely important feature of a building, and it was required by decree to provide a
detailed plan of the window when applying for State aid.[60] Aalto described the window as it was
actually implemented in an article published in 1932 in the Byggmästaren journal as follows:

“Double glazed windows in wood with L-shaped frames, with permanent ventilation through glass
panes with vertical openings”.[61]

The window described was in fact technically a very traditional wooden window, the outer frame of
which was reinforced with steel profile. Aalto turned his ideological defeat into a rhetorical victory
when he described the project in the journal Arkkitehti:

”The windows are double V-iron framed wooden windows. In the position for ventilating, they
resemble a “health window” in the vertical position”.[62]

The heating pipes ran inside a round concrete bench under the window, which stored and radiated
heat. The floor surface was easy-to-clean linoleum and the walls could be washed when
necessary. One of the patient room walls was papered for reasons of acoustics with Enso
wallpaper, which was advertised as eliminating harsh echo. [63] The soothing colour scheme of the
rooms, in shades of green, brown and white, was part of the comprehensive plan.

The patient rooms had no toilets, which were in three groups at both ends and in the middle of the
corridor. The actual washrooms, separate bathrooms for men and for women were in the basement
of the B wing. The staff sauna was in the same area, but had its own entrance. The A wing
basement housed the room where spittoons were disinfected, and there was also a separate two-
compartment lift for transporting them. This detail further underlined the importance of hygiene in
treatment.

Life span of the sanatorium

Paimio Sanatorium was designed and built for one strictly defined use. In the first half of the 20th
century it was a model institution of its kind, where the focused nature of the treatment and the
doctors’ confidence in the work methods of the institution were more evident than in any other form
of health care at the time.[63] By the early 1970s, with developments in medication, tuberculosis
sanatoria were no longer needed in Finland. The use of sanatorium buildings has changed, and
this is especially evident in the main building of Paimio Sanatorium. Aalto’s practice was
responsible for planning the major alterations from the mid-1950s right up to the year 1994, when
the practice was closed on the death of Aalto’s second wife, Elissa Aalto. Alvar Aalto himself was
no longer interested in planning the alterations, but handed them over to younger architects.

Sanatorium life in the early years

In 1933 the sanatorium had a staff of 63, with additional replacements during holidays. [64] In the
main building there were three men’s wards, three women’s wards and a special ward in the
basement for seriously ill patients. The patients ranged in age from 8 to 57 years old. The daily
routine was strictly disciplined, including washing, three sessions on the sun balcony and several
meals. Every morning the male patients who were fit for work took part in clearing the forest area,
while the women patients mainly occupied themselves with the bed linen and knitting. Patients who
were not feverish regularly participated in cleaning, washing serving meals. The sanatorium library
played an important role in the psychological side of the treatment. A course in book keeping in
1934 initiated the programme of studies, which became established with the founding of a national
sanatorium college in 1941. The purpose of the studies was to maintain mental alertness and give
the patients an opportunity to find new employment.[65] Smoking, card-playing and alcohol were
prohibited, and patients were not allowed to miss sun balcony sessions or leave the sanatorium
grounds. Any violations of the rules were followed by a warning, and if the violation was repeated
the patient was expelled from the sanatorium.[66]

The senior physician did rounds of the wards and sun balconies weekly. The patients were known
to him, as he had made the decisions on admitting patients on the basis of referrals by local
doctors. The junior physicians were responsible for treatment, did daily rounds of the wards, did call
duty and ate with the patients. Both patients and doctors were X-rayed frequently. In serious cases,
surgical intervention was performed.[67]

The building was well suited for its function, and at first few alterations were needed. However, the
first repairs were made soon after the building was completed: the cantilevered reinforced concrete
canopy of the sun balconies turned out to be inadequate for protecting the balconies from wind,
and therefore impractical. In 1934 the canopies were extended by adding a steel tube construction
with corrugated Eternit roofing to provide shelter for the patients.

Naturally Paimio Sanatorium was influenced by World War II. The sanatorium buildings and
facilities were handed over to the Finnish Defence Forces in autumn 1939, and the patients were
evacuated. On Christmas Eve 1939 soldiers were admitted as patients.[68] During the Finnish Winter
War, civilians, soldiers and refugees from Karelia were treated in the hospital. The number of
patient beds was increased. In summer 1941 with the onset of the Continuation War Paimio
Sanatorium was once again evacuated. At first it was converted into a surgical hospital, and from
spring 1942 on it focused on the treatment of tuberculosis patients again. In the following years, the
majority of patients were soldiers. In the years 1945–46 a ward for treating the war disabled was
opened in Paimio Sanatorium.

The traces of hard wear left by the war years are visible in the building. Four sheds, later
demolished, were built in the grounds.[69] The sanatorium buildings could not be repaired until the
end of the 1940s, when good-quality paint ingredients once again became available.

In 1946 the 8-hour work day was first applied in the sanatorium.[70] The number of workers
increased, and housing had to be built for them. The drawings for the new residential building were
commissioned from a Turku architect, Lauri Sipilä, who had been involved in designing the
sanatorium as a member of Aalto’s practice the early 1930s. The two-storey, rendered building with
its pitched roof, called Mäntylä, was completed in 1949. Later, in the years 1961–62, a new, chain-
like residential building christened Kyykartano (Viper Manor) was built for nurses and doctors.

New operating theatre wing

The new operating theatre wing was designed by Olli Penttilä, who had worked in Aalto’s practice,
along with his assistant, student of architecture Heikki Tarkka.[71] At the eastern end of the B wing
an extension was also designed for the library and reception hall, but it was never realised.
However, in connection with the building of the operating theatre wing in 1956–58 alterations were
made to the interior of the main foyer and entrance. A vestibule was built in the foyer as well as a
mail desk and telephone switching centre. At the main entrance the stairs were altered and the
main door lowered. A high free-standing radiator, a fixed, semicircular shoe rack and the original
circular phone booth were all removed from the interior, and the original undulating line of the foyer
wall was lost when the wall of the administrative department was straightened. Outside the main
building the original semi-cylindrical operating theatre was mostly hidden inside the new two-storey
building.

A new reception desk was built in the late 1950s, when the operating wing was extended. Photo Sami Heikinheimo, © ark-byroo.

The ward sun balconies were no longer necessary and were converted for indoor use in the 1960s.
The new space was used to house auxiliary facilities. The new steel-framed curtain wall was
recessed from the surface of the original railings. At the end gable, a small balcony was left
provided with fire escape stairs. Heikki Tarkka, an architect who worked in Aalto’s practice, drew up
the conversion drawings. According to Tarkka, Aalto approved the plan in its main outline. [72] The
unique reinforced concrete construction of the sun balcony wing was now concealed behind the
new facade. For fire safety reasons, the staircases, foyer and corridors were compartmentalised.
New doors were installed and the glass windows of the steel doors were changed. When the lifts in
the main foyer were renewed, the glazed shaft wall was replaced, so that the machinery was no
longer visible.
The general hospital
The name Paimio Sanatorium was changed to Paimio Hospital in 1971. The interior spaces of the
sanatorium were converted for use as a general hospital in three stages, in the years 1974–79.
During the conversion work, the hospital continued to function without interruption. [73]

The changes affected the patient wing, where the partitions and all the surface materials were
removed. The interiors were completely renewed. Some of the original furniture ended up in the
hospital storehouse, some is still in use in other departments of the hospital, and some was
auctioned off. The doors of the patient rooms were widened to allow the wheeled patient beds to be
moved around in the rooms and out of them. The patient wing corridor had originally been too
narrow for movable beds. The ceiling-mounted radiant heaters were removed and replaced with
conventional radiators under the windows. The specially designed wash basins were replaced with
new models. The concrete benches in the patients’ rooms were removed and the wall straightened
right down to floor level.

With the mechanisation of the ventilation system, the original natural system was replaced by a
centralised one. The horizontal layout of the new system called for radical changes to the patient
corridors. The lights, equipped with spiral reflectors and protected by glass cupolas were replaced
by fluorescent tubes on the ceiling, which was lowered. The long steel ribbon windows were
retained but the glazing and architraves were renewed. The window opening devices were
removed, and with them one of the interesting architectural details was also lost. As the steel
window jambs and frames were kept, the appearance of the facade remained unchanged. The
original long, easily cleanable panel radiators fixed to the walls of the patient corridors were
replaced with flat radiators detached from the wall to avoid heat loss. In the energy-saving frenzy of
the 1970s, the original radiators may even have been considered a faulty design feature, since
heating of the external wall led to considerable heat loss. All the small alterations completely
changed the character of the patient corridors. The ventilation pipes with their casings and the new
ventilation machine rooms destroyed the architectural character of the sun balconies. The wired
glass partitions were also removed.

In 1970, as the space needed for administrative functions continued to grow, the kitchen staff’s
living quarters in C wing were converted for the use of financial administration. Some of the staff
were already living outside the hospital area. The connecting passage between the B and C
buildings was heightened to two storeys. The kitchen was overhauled and meals were taken in the
patients’ own rooms. The dining room was reserved for staff only, and a self-service line was
introduced. The new ventilation system was also evident in the horizontal ductwork between the
dining room and the common room, which visually divided the space originally meant to form an
entity.

Times had changed and with new winds blowing, many changes were made in the Paimio Hospital.
The senior physician’s house was converted for use as a kindergarten, since the doctor no longer
wanted to live on the hospital grounds. The funeral chapel designed by Aalto, the Rose Cellar, went
out of use in 1978, and a new space was provided for this purpose in the hospital basement.
Accessibility also began to be an issue around that time, and a new entrance for wheelchair
patients was built between the B and C wings.

In 1987 Paimio Hospital became part of Turku University Central Hospital. Due to lack of space, all
administrative functions were moved away from the main building in the 1980s. When the new
heating plant was built, the old plant was converted to house the heat distribution system. The old
chimney was not longer needed, but the architectonic value of the water tank built around it was
recognised and they were repaired. A below-ground extension was built below the B and C wings
for toilet and washroom facilities. A staff entrance was built through the old coal yard. A bathing
facility was built in the B wing basement for treating patients suffering from rheumatic diseases.
Financial administration was moved from C wing to the workers’ residential building, and at the
same time the open entrance gallery was enclosed.

The early flat roofs built in Finland have generally caused technical problems due to the harsh
climate. In the Paimio Sanatorium area nearly all the roof structures have had to be repaired. With
the repairs the eave structures have been made thicker and details have been changed. This has
changed the overall appearance of the buildings. Some of the repair plans have been
commissioned from local engineering companies rather than architectural practices. Since 1994 the
Turku architects Laiho-Pulkkinen-Raunio have been responsible for the alteration and repair work
on various levels at Paimio Hospital.

Contradictions
A study of Paimio Sanatorium/Hospital brings up many contradictory themes of modernism, with
which the Aaltos became familiar in their years in Turku. At the same time the building project
reveals many different areas of cooperation between the Aaltos and other parties involved.

At the beginning of the 1930s, steel window frames were imported goods, but Finnish workshops
began to produce them in increasing quantities during the recession of the early 30s.[74] The Paimio
Sanatorium Building Committee made every effort to use domestically produced building materials
and local labour. Steel-framed windows were expensive, made-to-measure products in Finland and
they were manufactured from imported steel profiles.[75] Wooden-framed windows were cheaper
and worked better than the steel ones. The use of steel-framed windows on the entrance forecourt
side of Paimio Sanatorium, the most visible part, symbolised the romanticisation of machine
architecture.

Concrete standards for the technical properties of reinforced concrete were first published in
Finland in 1929.[76] Building with concrete was a new technology that required knowledge of both
the material and the work methods used in handling it. The formwork and casting still required a lot
of human labour, and the worksites had not yet been rationalised.[77] Thus, in the 1930s, the quality
of concrete structures varied a great deal.[78] The result was supposed to look mass-produced,
although the work was done manually. For example, the sand needed for the Paimio
Sanatorium was transported to the site by horse and cart.[79]
 The steel
windows were manufactured by the Crichton-Vulcan shipyard in Turku. Photo Soile Tirilä, National Board of Antiquities.

On the completion of Paimio Sanatorium, the standard furniture designed by Aalto and
manufactured and marketed by Otto Korhonen’s factory received a great deal of publicity. The
cooperation between Korhonen and Aalto had already begun before the sanatorium project. [80]
During the design process, the men together developed several innovations. For example, the
patent application for the furniture leg known as the L-leg was submitted to the patent authority in
Great Britain in 1933.[81] The flexible armchair made of moulded plywood, called the Paimio chair,
was used in furnishing the Paimio Sanatorium patient common room. The patent application for the
armchair was not submitted to the Finnish patent authorities until the year 1934, even though chairs
based on the innovation had already been marketed in 1932[82]. In the recession of the early 1930s
Paimio Sanatorium’s order was a financially significant one for the furniture and building factory. [83]
Korhonen’s factory served as Aalto’s furniture laboratory, and from Aalto’s point of view, the factory
was of decisive importance in the development of innovations. [84]

As regards lighting and furniture design Paimio Sanatorium can be linked with the concepts both of
mass production and of a complete work of art. Most of the furniture and lighting was designed for
this building. Much of it was never mass produced or used anywhere else. On the other hand,
Aalto’s purpose was to design articles specifically for industrial production. The fact that Aalto could
involve the partners he wanted to work with in the project meant that he could produce a complete
work of art.

The importance of light was emphasised in the architecture of the Paimio Sanatorium although the
care of tuberculosis was primarily based on hygiene. Light improved the patients’ vitality, and the
regulation of light was important for their psychological wellbeing. This was stressed both by the
physicians and by the architect. However, the maximisation of light was stressed more in the
architecture than in medical opinions on the importance of light in tuberculosis treatment. The
architect therefore played a key role in decisions regarding the design of the sanatorium.

The architecture of Paimio Sanatorium was appropriate for its purpose and in line with the
guidelines for building sanatoria, but at the same time the building was designed only for a specific
use. The possibility that it might be adapted for another use was not considered, and the need for
flexibility was not even discussed in the Building Committee. The architect designed the room
division, the load-bearing structure and the pipe shafts in the patient wing, all following the same
rhythm. The medical expert recommended a width of two metres for the corridors, but this was not
implemented. To move beds a wider corridor would have been needed, and the beds would have
to be mounted on castors. The Building Committee was aware throughout the duration of the
building project of the space required for beds and the need for lifts that could be used to convey
beds in the sanatorium. The matter had also been considered in summer 1928, when they visited
the Harjavalta Sanatorium designed by Jussi Paatela. [85] From today’s perspective it seems strange
that Aalto completely ignored such factors. One can also wonder how he interpreted the concepts
of free floor plan and multifunctional use of space according to functionalist ideology when
designing a building for only one purpose.

The architecture of Paimio Sanatorium can also be seen in the light of gender theory. For centuries
the exercise of power by physicians and architects had influenced decisions on hospital typology
and space structure.[86] In the Paimio Sanatorium project neither matrons not ward sisters were
asked for their opinions on the architectural design.[87] The male physicians in leading positions
acted as medical experts and it was they, together with the architects, who decided on the needs of
both patients and staff. The everyday environment organises, constructs and reshapes our
concepts of people’s social relationships and their place in the world. Space arrangements uphold,
create, support and also hinder various gender-based and gender-discriminating practices in the
use of space.[88] Aalto’s ideas about the minimal apartment did not affect the dimensioning of the
physicians residences, which had to be in keeping their occupant’s rank. Even though Aalto
supported gender equality in society, the residential architecture of Paimio Sanatorium reflected the
patriarchal hierarchy of the time and reinforced power structures that were based on gender.

The typology and the level of furnishing of the Paimio Sanatorium residential arrangements were
directly related to the status and sex of the employee. The man in the top position and his family
were allotted the most privacy and space and the best furnished residence. It was expected that
doctors would be family men, so they were allocated appropriate accommodation in the terraced
house. The most modest accommodation was reserved for the unmarried, female kitchen staff. The
hostel-type premises reserved for these workers, the so-called “hotel for servants and kitchen
staff”, showed them their place at the bottom of the social ladder. The patient was the hub of the
architectural rhetoric, regardless of gender or age.

Overall, the living arrangements at Paimio Sanatorium are a good example of how the everyday
environment helps to create gender-based practices as regards the use of space and produces
gender and social hierarchies. However, in the spatial organization of the sanatorium there is one
detail where architecture overrules this pattern of social hierarchy. This feature is the scenic lift,
which Aalto placed at the end of the patient wards, in the stairwell of the living quarters used by six
ward sisters. There was no real need for the lift, and it can be regarded as a small, but significant
detail reflecting the structural changes taking place in contemporary society.