Light, air, and hygiene were not just aesthetic preoccupations of the early Modernists: They were the best treatment for tuberculosis at the time.
Since the widespread use of antibiotics to treat tuberculosis started in the 1950s, most people have forgotten about the disease that was, at one point, the deadliest illness in America. But go back two or three generations in your own family, and chances are, you’ll find at least one relative who was affected by tuberculosis, also known as consumption or “the white plague.”
Death rates from TB peaked in the early days of the Industrial Revolution, exacerbated by overcrowding, lack of sanitation, and poor nutrition. Between 1810 and 1815, the disease accounted for more than 25 percent of deaths in New York City. In 1900, it was still the country’s third most common cause of death.
Robert Koch discovered the tubercle bacillus in 1882. As germ theory became better understood, medical professionals knew that isolation was key to prevent the spread of tuberculosis. A person’s best hope for recovery was to live somewhere with plenty of fresh air, sunlight, rest, and nourishing food. The standard of care for TB was primarily environmental—and the design of sanatoria influenced Modernist architecture.
The sanatorium movement began in Europe in the mid-19th century, with resorts in Silesia (now Poland), Germany, and Switzerland. (Davos was once “the tuberculosis capital” of Europe.) Although they began as collections of cottages in mountainous locales, sanatoria evolved into purpose-designed buildings, intended to limit the spread of germs while providing key ingredients for recovery: dry, fresh air and sunshine.
The first tuberculosis sanatorium in the United States was founded by a doctor named Edward Livingston Trudeau—who had consumption himself—in the Adirondacks town of Saranac Lake, New York, in 1885. A key feature of the buildings in Trudeau’s center was a glass-enclosed deck known as a “cure porch.” Tubercular patients would spend much of their time resting on recliners on these porches, even under layers of blankets during the winter months.
The design and construction of specialized sanatoria coincided with the advent of Modernism. Architectural elements like flat roofs, terraces and balconies, and white- or light-painted rooms spread across Europe. Not unlike the sanatorium, the new architecture was intended to cure the perceived physical, nervous, and moral ailments brought on by crowded cities. Part of the appeal of flat roofs was the extra outdoor space they created, which could be used for sunbathing—then known as heliotherapy—and other healthful activities. In 1925, the Swiss architect Le Corbusier dreamed of a city where every citizen’s house was whitewashed and hygienic. “There are no more dirty, dark corners. Everything is shown as it is. Then comes inner cleanliness … .”
In their designs for workers’ housing, early Modernists in Europe such as Bruno Taut and Peter Behrens drew on sanatoria for inspiration. At the Weissenhof estate in Stuttgart, built for the Deutscher Werkbund exhibition of 1927, Behrens designed an apartment block that “was directly inspired by the model of the sanatorium and provided every tenant with an open-air south-facing terrace,” as Paul Overy wrote in his book Light, Air and Openness.
Modernism and the sanatorium converged in Alvar Aalto’s Paimio Sanatorium near Turku in southwestern Finland. Opened in 1932, the seven-story building had balconies at the end of each residential wing, so weaker patients didn’t have to go far to reach them. Patients who were more mobile took the sun and fresh air on the roof terrace.
Aalto designed more than the structure—he also designed interior spaces, furniture, and fixtures intended to assist the healing process. For example, custom sinks in Paimio minimized noise, so as not to disturb the patient’s roommate, and splash, to keep germs from spreading. Perhaps the best-known of all of Aalto’s furniture designs, the Paimio chair was made from bent birch plywood, which made it easy to clean, and was angled to ease the patient’s breathing. The chair influenced Charles and Ray Eames and remains in production today. “During the 1920s and 1930s, furniture originally manufactured for sanatoriums and hospitals became fashionable for domestic use among the more sophisticated of the European and American middle classes,” Overy wrote.
Peter MacKeith, dean of architecture at the University of Arkansas, says that while Paimio adheres to many formal principles of Modernism—by concentrating patient rooms in one wing and social spaces in another, for instance —it also adapts them in ways that are more approachable and responsive to the overall site, climate conditions, and patients’ needs.
“I think that’s where this dialogue between the formal principles of Modernism and the site-specific and human-centered design approaches makes the building very, very instructive, even now in contemporary thinking,” MacKeith said.
It was no accident that Paimio was built in the middle of the forest with vast amounts of outdoor balcony space, as well as oversized windows to allow patients to look outside year-round. Whether in the mountains, on a beach, or in the desert (Tucson, Arizona, was a popular cure spot), the natural environment surrounding the sanatorium was carefully considered. Remote sanatoria got patients away from the dirty, crowded cities, but also provided them with beneficial views of nature—another focus of Modernist architects.
Reuben Rainey, a professor emeritus of landscape architecture at the University of Virginia, points to Le Corbusier. “Sure, he had a flat roof [on many buildings]—but he also had a view of the pastoral landscapes,” Rainey said. “The landscape as a healing element is very, very important to the Modernists themselves, the whole idea of bringing the outdoors indoors.”
Fifty-two years after Paimio opened, some of the first empirical research was conducted on the effects of nature on physical healing. The environmental psychologist Roger Ulrich looked at hospital patients who had a room with a view of a leafy green landscape. Published in Science in 1984, his study found that when all other aspects of their care were equal, the patients with a window that looked out onto trees had fewer surgical complications, healed faster, and required significantly less pain medication than those whose window faced a brick wall. Visit many newer hospitals today and you’ll see instances of integrating nature into the healing process, whether it’s an atrium full of natural light or patient rooms overlooking a green space.
The overlap between Modernism and sanatorium design is one reason for the movement’s association with sterility—the Modernist obsession with hygiene was real. But this overlap also complicates the notion that Modernism was coldly indifferent to human concerns. Modernists like Alto and the Eameses appealed to the senses and paid close attention to the dimensions and comfort of the human body. Those qualities inspire architects working today.
“One of the very common criticisms of modern architecture ... is that it’s usually presented and understood as being derived from a very mechanistic approach. As opposed to an architecture that’s much more derived [from human] anatomy itself and all of the interrelated systems that we have,” MacKeith said. “I think that over time, there has been a rather gradual transformation away from the strictly mechanical approach ... to one that is human-centered and much more organic, perhaps.”