Living With Buildings review – prescriptions for healthier design

To the modern eye, the ceramic washbasins in the bedrooms of the Paimio Sanatorium in Finland have the look of a urinal, their steeply angled backs sloping down into to a teardrop bowl. The reason for the unusual shape is that, following a thorough series of tests, their designer, Alvar Aalto, concluded that a 45-degree angle to the back of the sink resulted in the quietest performance, so as best not to disturb fellow patients in the hospital’s twin rooms.

Alvar Aalto’s design for noiseless washbasins, 1932.

Good neighbours … Alvar Aalto’s design for noiseless washbasins, 1932. Photograph: Alvar Aalto Foundation

Such was the level of bespoke detail invested in what has come to be regarded as one of the most pioneering medical buildings of the 20th century, built in the middle of a pine forest in southwest Finland in 1933. Above the beds, the ceilings were painted a dark greyish green, a colour Aalto deemed to be the most peaceful, while the overhead lamps were fixed out of view to avoid glaring into the patients’ eyes. The tall windows, meanwhile, extended all the way to the floor, so patients could still enjoy views of the rolling treetops from their beds, while plywood armchairs were designed to support the sitter at the optimum angle for breathing. They proved so comfortable that they’re still in production today, in perhaps medical history’s only example of a tuberculosis-tackling tool elevated to a luxury designer item – yours for over £3,000.

The hallowed chair now sits atop a spotlit plinth in the Wellcome Collection’s gallery in Euston, alongside Aalto’s detailed sectional drawings showing how sunlight would penetrate deep into the building’s covered balconies, where patients would spend two hours a day soaking up the healing rays. The groundbreaking project is one of the highlights of Living With Buildings, an exhibition that explores the relationship of architecture and urban planning with human health since the 19th century to the present day, a topic so broad that it sometimes struggles to tell a clear story.

Those expecting a history of healthcare architecture and design – itself a rich enough subject for a whole show – will be disappointed. Instead, the exhibition casts a much broader net across the themes of Dickensian squalor, Victorian industrialists’ model towns, postwar planning and the fresh air and light movement, ending with a pair of models of Maggie’s cancer caring centres – the only contemporary exhibits in the show. There is plenty of fascinating material, but it’s an odd mix that sometimes feels like it wants to be more of an exhibition about housing and the ills of gentrification than a focused investigation into how architects have tackled health.

A 1942 poster by Abram Games contrasts the newly built Finsbury Health Centre with bomb sites where diseases fester.

A 1942 poster by Abram Games contrasts the newly built Finsbury Health Centre with bomb sites where diseases fester. Photograph: Wellcome Collection

Oliver Twist sets the tone for the opening section, where Dickens’ preface states: “Nothing effectual can be done for the poor in England, until their dwelling places are made decent and wholesome.” The book is displayed alongside Charles Booth’s poverty maps and Jack London’s descriptions of East End misery before we are introduced to bold Victorian planning initiatives focused on healthy living. Saltaire, the model village built by Yorkshire wool magnate Sir Titus Salt, made a great show of cleanliness, with a majestic washhouse and Turkish bath complex. “Indoor washing is most pernicious, and a fruitful source of disease, especially in the young,” wrote Saltaire’s doctor, Samuel Rhind. Not that many took notice: the baths proved unpopular and were converted into housing, before later being demolished. Residents of Bournville, the chocolate utopia of the Cadbury brothers, were similarly issued with a passport-sized booklet titled Suggested Rules of Health which, along with advising eating meat only once a day and avoiding intoxicating liquor, recommended sleeping in single beds for good health, as “double beds are now little used in civilised countries outside the United Kingdom”.

Then comes a postwar section, where the Balfron Tower in Poplar and the Pepys Estate in Deptford are held up as trailblazing examples of integrated council housing, the latter designed from the outset as a “cradle to grave” model of welfare state ideals, from its maternity and child welfare centre, to its ground-level homes and social club provided for elderly people. Those who don’t know the story will likely be able to predict the punchline: one of its towers was sold to Berkeley Homes in 2002, resulting in the loss of 144 council flats, while the rest of the estate was “regenerated”, losing many more council tenancies in the process. Tenants of the Balfron, meanwhile, have been removed while the brutalist beacon is stripped and polished, to be reborn as luxury flats. Grenfell Tower makes an appearance too, as does Hackney council’s former passion for festively dynamiting its own high-rise housing stock (one poster gleefully advertises a “demolition day out”), and some incongruous photos of Poundbury, before the exhibition veers back on topic.

Good cafe, with a nice view of the gym … the Bauhaus-approved Peckham Pioneer Centre.

Good cafe, with a nice view of the gym … the Bauhaus-approved Peckham Pioneer Centre. Photograph: Reproduced with permission of Pioneer Health Foundation

A gigantic doll’s house model of a hospital kitted out with all the latest 1930s mod-cons provides an illuminating window into pre-NHS fundraising techniques. Built to raise money for the King Edward’s Hospital Fund, the model toured the country demonstrating all the facilities that a modern hospital could offer, from terrifying x-ray contraptions to spine-chilling operating theatres and mechanical lifts. In a touch of regal philanthropy, Queen Mary donated her lace handkerchiefs to make the bedspreads.

Another brave experiment of the era comes in the form of the appropriately named Pioneer Health Centre in Peckham. Dreamt up by a pair of doctors who believed that medical practice was overly focused on curing disease, their centre provided local families with a gym, swimming pool, games room, library and nursery, with the aim of promoting a wholesome lifestyle. Designed by engineer Owen Williams, the light-flooded glass and steel complex was hailed by Bauhaus master Walter Gropius as Britain’s best new building in 1935. Berthold Lubetkin’s iconic Finsbury Health Centre features here too, its outstretched arms and broad curved front designed as a “megaphone for health”.

This optimistic 1930s klaxon call for a new epoch of heroic health-giving architecture is set into sharp relief by the deathly silence offered by what’s happened since. Namely, not much. The Maggie’s Centres, one by Frank Gehry in Dundee, another by Norman Foster in Manchester, are both warm, humanely crafted spaces, but hardly a solution to the wider problem of bleak PFI-funded hospital design. As if dodging these tougher issues altogether, the upstairs gallery has been devoted to a milled plywood shell structure by Rogers Stirk Harbour, a “prototype mobile health clinic” (which owes a debt to the Wikihouse project and every other plywood pop-up pavilion), selected after an open call. Perhaps it is accidentally prophetic: with ever more swingeing cuts to the NHS, these emergency plywood cabins may well be the future of healthcare.

Pop-up protection … the Global Clinic plywood concept by Rogers Stirk Harbour being assembled at the exhibition.

Pop-up protection … the Global Clinic plywood concept by Rogers Stirk Harbour being assembled at the exhibition. Photograph: Michael Bowles


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