Clinical precision: An extension of a distinguished ear, nose and throat hospital department is both efficient and lyrical.

The Regional Hospital of Graz marks an important moment in Austrian social and architectural history. Built on a low plateau to the north of Graz between 1903 and 1912, it had an unprecedented 1940 beds and was organized by a new body, the Regional Building Authority. Architecturally it consisted of a series of four storey pavilions, Classical in spirit and designed by pupils of Otto Wagner. One of these pavilions had become occupied by Graz's internationally renowned Ear, Nose and Throat Unit, which struggled to maintain its high standards in the antiquated buildings, so a competition was held to renovate and extend the Wagnerschule pavilion. It was won by Ernst Giselbrecht.

The old building's Classical front stands on the crest of a steep slope, visible from across the valley and complete in its elegant symmetry. Obviously the extension would have to be put behind. There was also the problem that the old building was listed, yet it required repairs in its original craft technology and avoidance of major alterations. Giselbrecht therefore sought to place highly serviced treatment rooms and operating theatres in the new block, while leaving wards, offices and lecture theatres -- it is a teaching hospital -- in the old. He avoided attaching the extension directly, and consequent violence to the old building's back: instead he left a gap between the two, with glazed passages as connecting links. He did however need to add fire-stairs at the corners of the old building and he had to extend parts of the third floor facade. These additions were made in a modern vocabulary following the Wagnerian geometry.

The cliff in front of the old main facade always made a lateral approach necessary, and the centre of the whole hospital complex lies to the west, so it made sense to create new entrances facing that direction, while making separate provision for emergency arrivals by ambulance to the east. Wisely, Giselbrecht made no attempt to continue the symmetry of the Wagnerian conception, though he did respect the central axis of the old building by retaining it as main public link leading to the original main stair. A second link further east at ground and first floor levels has become the main route for doctors and nurses entering the new wing. The main entrance for the whole department is now in the gap between the two buildings, and while the public turn left into the new or right into the old, doctors continue straight on across a small open court to their own entrance behind. This court is the new heart and an important visual reference point while moving about the building, decorated with a geometric artwork in polished stone by the Czech sculptor Vaclav Fiala.

In section, the new block consists of three layers: a day-patient clinic and emergency service on the ground floor, three operating theatres and associated facilities on the first, and a service floor above. To the back and north-east, the twin bed-sized lifts make a service tower, bringing the new building to a complete stop while, at the entrance end, it remains open and ambiguous, with a projecting wing-like shade to the second floor roof terrace that signifies openness and welcome. The south-west side also has a fully glazed ground floor set back behind pilotis, indicating the location of the most public interface: the day-patient clinic. The glass walls allow views out from the waiting area, and there is even a covered terrace for sitting out. Linked visually at high level by clerestoreys, consulting rooms are contained by a shiny red partition including red doors, a striking gesture in an otherwise white and neutral building. Although red might mean fire or danger, and these are rooms where grim discov eries might be made, it does seem appropriate to cheer them up in this way: all white, the whole thing would have seemed too antiseptic.

Trained as a mechanical engineer, Giselbrecht is a stickler for detail and received a generous enough budget to use expensive materials - polished stone in the washrooms, for example. Every corner seems nicely made, every fitting well-integrated. Frameless glass and stove-enamelled panels make for slick elevations, and solar control is provided by a new variation on one of Giselbrecht's favourite themes: horizontal metal louvres, this time perforated for reduced light when closed.

The high level of specialist servicing is not made too obvious, and there is seamless continuity between the technology of the architecture and that of the medical equipment - all speaks of scientific efficiency. One of the technical advances most prized by the doctors and not immediately obvious in the architecture is the provision of electronic networks to allow operations and investigations to be filmed and recorded, for work up the nose and down the throat is only just visible to the surgeon, let alone to surrounding colleagues or students. Miniature TV cameras now allow all to be seen in detail, and operations are routinely recorded on video tape for teaching purposes and in case of future complications. Equally, a whole lecture theatre of students can see on large screen and hear an operation take place without crossing the threshold of sterility or risking getting in the way.

One slightly amusing detail is an obsessive provision of clocks, for in public life generally, they have disappeared in favour of personal watches, whose private time is now generally considered universal enough. But having hospital time displayed on every floor leaves room for no ambiguity: it spells teamwork and control in no uncertain terms. The architect told me that a leading consultant even objected to having a digital clock in the lecture room, asking for it to be replaced by one with a face: no less accurate of course, just a spatial representation, and one developed in accordance with a now outmoded technology.

These things are symbols of the prevailing ethos. Shown around by one of the younger consultants, I gained a strong impression of their pride in their new building and the expression it gives to the efficiency of their organization. For the manager of hospitals too, this was the best of the bunch. An updated version of machine-made modern, the architectural language shows the machine aesthetic fulfilled as it never could be in the 1 920s. In a vulnerable and life-threatening situation, one could feel grateful for such calm surroundings, for the reality and rigour of technical control and the latest and best equipment. Surely this is better than being palmed off with a stage-set offering a fourth-hand myth of domesticity.

* For earlier work see AR January 1994, October 1995, April 1996, April 1997.