Cranked krankenhaus.

Hospitals are often health machines for anonymous processing of the sick. Here, the architects set out to make a hospital as a series of places, which respects the needs of individuals without impairing medical efficiency.

It is a tribute to the effectiveness of the Gothic Revival in England that the popular idea and image of 'church' is still so bound up with the Gothic, but when we think of 'hospital' it is not nineteenth century examples that come to mind but rather the modernist image epitomised in Aalto's Paimio and Duiker's Zonnestraal. The desire for sunlight and air that reached its ideal fulfilment in tuberculosis sanatoria was driven by the knowledge that the only way to kill the bacillus before the development of antibiotics was exposure to ultra-violet rays. But there was also a powerful symbolic component: the purity of early Modernist forms seemed perfectly to fit the hygienic hospital programme. Not only must germs be eliminated, the place has to be seen to be clean, and although a black surface may be as germ-free as a white one, whiteness makes cleanliness more visible. Also, as Mary Douglas established in her seminal book Purity and Danger, dirt in everyday life is not so much germs as matter out of place, and what is regarded as 'in place' depends on the classification system in force.(1)

The hospital deals with those whose bodies are threatened by alien organisms, and the surgery taking place within it often involves an invasion of the body boundary which in any other context would count as assault. Visible control is needed to reassure, so the hospital is generally, to use another of Douglas's terms, 'high-grid'.(2) That is to say it is organised in a very disciplined way, with everyone in uniform, a well- defined staff hierarchy, and strict ordering of time and space. Faith in the powers of science and technology is reinforced by a show of technical equipment, and the imagery spills over into the normal furniture, reinforcing the daily ritual with its functionalist style and hard materials.

This image belongs more to the '40s and '50s than to the present day. Since then two changes have taken place in quite opposite directions. First, because of its increasingly complex servicing requirements and the labyrinthine bureaucratic procedures developed to produce it, the hospital has been taken over almost more than any other public building type by the kind of quantitative functionalism first advocated by Hannes Meyer.(3) So many are the rules and regulations, so strict the budget, and so forceful the standard design templates imposed at the start, that there is little room for consideration of the whole - some would say little room for architecture. The project is also often so large, the design and construction time so long, that both programme and design personnel change many times. The result is often a huge confusing monster much compromised along the way, never foreseen as a whole by anyone, unloved and unlovable.

The second change is more recent and reflects the theme-park nature of post-modernism. As life-expectancy has improved and medicine has become more sophisticated, the spartan purity of earlier hospitals has given way to images of home and hotel, especially in the growing area of small private clinics, which need to sell themselves by conveying an air of luxury in contrast with the state system. But how far can the pseudo-homeliness go before it critically undermines the necessary sense of reassurance provided by the modernist hospital? State hospitals are still there, and in emergencies they are still the only destination.

Bruck is a small town in Styria on the river Mur, about 30 miles north of Graz. The regional hospital has been there for a century, but the inadequacy of the old buildings in the town centre was felt already in the 1950s. In 1965 a competition was held for a new 500-bed hospital on the suburban site finally occupied by the new hospital, but costs were reckoned to be too high, and instead of building anew, further extensions were made to the old hospital. Pressure on space mounted, and by the mid 1980s had again become untenable, so in 1987 a second competition was launched, and won by Domenig's office. The design was developed and built, and the building has been in use since early 1994.

The image of the new regional hospital is poised provocatively somewhere between the spartan Modernist hospital and the international hotel. It is more the former on the outside, but quite deliberately more the latter within, if not enough to dull the impression of brisk efficiency. It is a relatively large institution with 335 beds and seven operating theatres, for, as with hospitals everywhere, economy of scale requires bringing together expensive diagnostic and life-saving specialist facilities in one place. It has casualty and intensive care departments, a dialysis unit and many other specialist areas. With its own power station, its own shops, and even its own chapel, it has become almost a city in itself, and the beautiful location on a hill at the edge of the town affords it tranquillity, clean air, and good views.

At first glance, the project model with its curves and angles seems wilful and surprising for such a serious programme, but the finished building generates quite the opposite impression, and study of the plans reveals a skilful organisational strategy. There are essentially two linear wings of building (positive) which generate an important contained space (negative) between them. Facing south is a serpentine wing of wards 240 metres long, its curves responding to the contours of the landscape, and folding around at the east end to enclose the entrance before ending in the servicing area and power plant. The curves allow varied views and orientations to the rooms, and prevent corridors becoming oppressively long. They also reduce the apparent scale of the building.

Opposite this ward wing is a shorter 160 metre long straight tract with three northward projections. This part contains all the treatment rooms (including those for outpatients). At the entrance end on the ground floor is the administration, and opposite at the west end the casualty department with its own drive for ambulances. The main block of five operating theatres is placed centrally on the first floor. Between the serpentine wing and the straight one is a toplit, street-like hall 16 metres wide; almost a courtyard glazed over. This is the heart of the complex and the distributor of circulation, with passages running off in all directions and upper galleries along its sides. It contains waiting spaces, a cafe, several shops and other public facilities, and greenhouse-like areas of planting. At its east end is the main entrance, and contained within it on the west the hospital chapel. Its south side looks onto an open court in the knee of the ward wing, and also out to the landscape.

For the casual visitor, the first great advantage of this hospital is its legibility. Too often, the personal dislocation from everyday life that results inevitably from being subjected to hospital routines is aggravated by a quite unnecessary architectural dislocation.

With such large and complex institutions, signs will never be dispensed with, but at Bruck at least one can retain a sense of direction, for the organisation is clear and everything relates directly back to the court-like central hall. The approach is also commendably clear, for the drive sweeps up into the entrance court enclosed by the serpentine wing, and as soon as the building has announced itself with big letters on the railings, the great stripy curved wall that slices off the west end of the surgery wing funnels visitors towards the entrance. This is the route for ambulances and cars to drop people off. But for those who need to spend more time, there is a car-park sited to the east. From here too, the entrance route is clear to find and even exciting as the view unfolds. A glass sided bridge gathers visitors and guides them up the slope between the end of the ward wing and the power-station, depositing them in the court in line with the entrance.

The sweep of the stripy curved wall to the right of the entrance sets up a diagonal shift that continues within the entrance hall, picked up in a second curved stripy wall half way along its left side. The hall opens spaciously; the porter's desk is set back discreetly to the left, allowing good visual coverage without forcing confrontation. The first main stair to the two storeys of wards above presents itself invitingly, running diagonally up to the left, while a second stair at a shallower angle picks up the remainder of upstairs traffic towards the end of the space in its south west corner. The general leftward shift allows the right side of the hall to be occupied increasingly by waiting spaces for outpatients, while shops and cafeteria on the left can look south to the enclosed court and the countryside beyond. The shops and chapel have their own architectural identities without challenging the consistency of the whole, and the space is lively and complex. Sunlight, reduced as necessary by retractable blinds above, is reflected off the deep perforated main trusses, and there are lowered ceilings over some waiting areas to bring the scale down and make them more particular.

There are some single rooms, but the accommodation is mostly wards of modest size with four beds. Patients enjoy magnificent views out over the surrounding landscape, and the large windows are protected from excessive sun by projecting visors which have a strong animating effect on the facades. Though artificially lit, the corridors are punctuated by nursing stations and other glazed rooms, while their turns and junctions make memorable landmarks in the progression through the building. The long straight corridor in the surgical wing is relieved at its ends with views out. Where planning allowed, there are airy open roof terraces.

The hospital seems a clean and efficient place, but also pleasant, clear and not imposing. Everything relates back to the great hall, its social heart, and despite the scale, one can soon find one's way around. The decision to make everything long and low rather than resorting to the eight or nine storey towers more usual for a hospital of this size - and present in all the winning designs of the earlier competition for this one - seems to have paid off. This hospital is not just a great machine but a place. That this is not an accident but the conscious goal of the Domenig office is clear from Domenig's text in the Festschrift produced for the hospital opening. He does not mince words: 'Excessive trust in over-specialised hospital planners led in recent decades to the situation where, when it came to the construction of health buildings, the maxims of technique, function, and economy took over, and for better or worse this spirit also took over the architecture. This development of typological hospitals led to the health-machine and to anonymous processing.

'In the last ten years, as a result of growing concern among the public and those responsible, the use of standard solutions and the suppression of architectonic possibilities in hospital design has been questioned, and the contradiction between pure technocracy and a real sense of health has been understood. Behind this change is a more general shift of consciousness which manifests itself in criticism of great uncontrollable structures, a search for more humane medical methods, and more respect for the individual'.(4)

The new hospital at Bruck seems refreshing because it is so optimistic, and shows that at the end of the twentieth century inspiring architecture can still be made out of this difficult building type.

1 Published by RKP, London 1966.

2 A technical term in relation to her grid-group theory, but also a telling metaphor for architects.

3 Meyer's manifesto Bauen, published at the Bauhaus in 1928, epitomises this attitude. He denies the claims of art and composition, lists materials and functions to be considered, and advocates that everything should be measured and calculated: 'we draw the function diagram for the father, the mother, the child' etc. It is reproduced in Ulrich Conrads, Programmes and Manifestos of 20th century Architecture, Lund Humphries London 1972.

4 Gunther Domenig, opening paragraphs of 'Beispiel fur ganzheitliches Denken', in Landes-krankenhaus Bruck an der Mur, published by Steiermarkische Krankenanstalten Gmbh, p16. My translation.