Humanity is undergoing similar doubts and unknowns in the treatment of coronavirus, just as tuberculosis has been for centuries. Here's how architecture provided answers!
The Covid-19 pandemic, or coronavirus, which results in severe pulmonary disease, has forced us to address hospital architecture. More specifically, the architecture of the pulmonary, ie. tuberculosis dispensaries, which have been built as a special facility for more than five decades around the world, for a disease that was very contagious and deadly in the mid-20th century.
Then it took decades to find a cure, a the only solace for the treatment of the sick was provided by architecture which, through the development of research into this insidious disease, gradually improved its field of activity. Hospitals and spas have been designed over time solely for needs treatment of tuberculosis which implied their specific shape, structure and spatial orientation. In our country, these researches arrived only after the Second World War, when the construction of tuberculosis dispensaries throughout Socialist Yugoslavia started to accelerate.
Tuberculosis is a highly contagious disease (it is still not uprooted in our state, with Serbia at the top of Europe in terms of numbers), which annually takes over two million lives, making it the second deadliest disease behind AIDS.
The construction of health resorts in the mountainous regions and near the thermal spas with architecture characterized by large terraces began.
Its origins are as old as human civilization (over 17,000 years), but isolated as a special disease and named in the first half of the 19th century. From then on, her treatment began, conditionally speaking, because it was not in fact a cure but only a cure, and in most cases just a delay in the death. Doctors already determined that lung disease, including tuberculosis, mitigate by exposure to fresh air and sunshine, and accordingly began to treat the diseased.
The construction of health resorts in the mountainous regions and in the vicinity of thermal spas with the specific architecture of these dispensaries, which characterized large terraces, on which patients' beds were drawn so that they would be exposed to the sun for most of the day.
Despite this type of treatment, tuberculosis took a great deal of life. According to statistics from the interwar period, just before the discovery of the drug, tuberculosis in the case of France killed an estimated 10,000 lives annually, while the total number of infected people was over 700,000. The situation in the Kingdom of SHS / Yugoslavia was no better, with tuberculosis accounting for almost the same number of lives as malaria. Despite this, the state did not have a specific strategy to combat this disease, because it was then a disease of the “poor and hungry”, whose health care was no more important than internal and external political and economic problems.
Architecture of interwar dispensaries in Europe
Since medical research from previous decades had established the only possible way of treating tuberculosis, architects designed specialized therapies accordingly. They reach the most advanced level of the moment modern architecture (international style and ar deco) is beginning to be recognized as the most suitable because of its functionality and practicality of construction.
Specialized dispensaries are starting to emerge across Europe, most notably in the isolated mountain regions of France and Germany, as well as in many spa resorts of Czechoslovakia. The common features of all these complexes were complete insulation of buildings, large striped windows for better sunshine and breathability and a characteristic large terrace, on which patients spent most of the sunny days.
In the design of such specialized buildings, the Czechoslovak architects were especially emphasized Jaromir Krajcar, with the Mahnak dispensary in the town of Trepčianske Teplice (1930-1932) and Bohuslav Fuks, with a Morava dispensary in Tatranska Lomnica (1930-1931).
Paimio: The most famous solution
Of course, the most famous and best architectural solution of a tuberculosis dispensary of the interwar, but also later periods, belongs to the one near the Finnish town of Paimio (1929 – 1933), the work of an architect Alvara Alta. The building of this spa has a very unusual plan of foundation, ie. several arms / tracts, each with separate function. Therefore, each of the functions also requires a specific orientation towards a particular side of the world, so they are accordingly patient rooms facing east and south-east to be most sunny.
The best architectural solution for a tuberculosis dispensary was given by architect Alvar Alto.
The building also has large striped windows, due to the room's ventilation, as well as several types of terraces, from ordinary for occasional stay, to spacious, specialized for the placement of beds with patients. There were newspapers in the building vertical communication systems, from stairs of various uses to specially designed hospital lifts. The architecture is in the spirit of international modernity, with an expression of expressionism, simple lines and elegant form, which can be compared with the aesthetics of a luxury hotel.
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The situation in the Kingdom of SHS / Yugoslavia regarding tuberculosis dispensaries was more than tragic. Belgrade, as the capital itself, did not have a specialized hospital for the treatment of tuberculosis patients, but they were treated exclusively at specialized clinics within general hospitals, that is, where they would be diagnosed and the most severe cases would lie. The first tuberculosis dispensary was given to Belgrade only in 1935 on the personal initiative and commitment of the then mayor Vlade Ilić. It is not known for sure what this facility, which was damaged during World War II, was soon and completely removed, and was located near today's City Institute for Pulmonary Diseases and Tuberculosis.
The architecture of post-war dispensaries in the SFR Yugoslavia
After World War II and the invention of antituberculous antibiotics, the treatment of this vicious disease became far easier. The national leadership of the FNR Yugoslavia recognizes that it has to learn from the mistakes of their political predecessors, and is soon conducting mass reviews across the country.
In addition to hospital and outpatient examinations, the state is making makeshift mobile ambulances, remodeling several dozen buses, which tour remote villages and townships with no lung disease specialist.
The next step was construction antituberculosis dispensaries, when, as early as the early 1950s, almost every urban area received one such treatment. Larger cities such as Belgrade, Zagreb and Sarajevo soon receive several such institutions, and their construction was entrusted to architects who specialize in this type of public buildings.
The architect with the greatest experience in hospital design, who taught the same subject at the Faculty of Architecture in Belgrade, was prof. Stanko Kliska. Architect Kliska begins her career in interwar Yugoslavia, designing hospitals in today's Croatia. Hospital u Sisak (1930), Hospital at Sušaku (with pulmonary dispensary, 1931) and Rebru Hospital at Zagreb (1934-1941), were his early capital achievements in the field of architecture of health facilities.
The architect with the greatest experience in hospital design, who taught the same subject at the Faculty of Architecture in Belgrade, was Stanko Kliska.
After World War II, architect Kliska moved to Belgrade, where she first got a place at the Design InstituteJugoprojekt“, Where he establishes a special bureau for designing healthcare facilities. Already then he is engaged in designing significant hospital complexes, including hospitals and pulmonary dispensaries.
Three years later, in 1950, he was employed by the Faculty of Architecture on the subject “Designing Healthcare Buildings“, Where he lectures until his death. He has published a number of scientific papers on the design of hospitals and other health facilities, which he publishes in professional and medical journals, which is far more important for the joint advancement of architectural and health research. He is the author of the book Hospital and the textbook Health Station and Health Center, which are still almost unmatched in the professional literature.
Milorad Pantovic and Mladenovac Hospital
An architect also taught the experiences of Stanko Kliska Milorad Pantović, which we know as the author of the complex Belgrade Fair. Milorad Pantovic was a pre-war staff at the Faculty of Architecture in Belgrade and an associate of the architect Le Corbizier. After the war, he became part-time professor at the faculty, but even then he continued his work, primarily in the design of public facilities, including health facilities and spas.
An exemplary architecture of antituberculosis dispensaries can be taken as an object built in Mladenovcu (1953), whose author is precisely the architect Pantović. The project is not only based on the experiences of local experts, such as the architect Kliska, but also the personal Pantovićs, while working in the project bureau of the Corbisia architect, in which health care facilities were certainly designed.
The building was moved out of town, on a hill above Mladenovac, surrounded by noise and always exposed to fresh air.
It can be said that the building of the Antituberculosis Dispensary in Mladenovac is a simple, typical object, similar to many that were designed throughout the FNR of Yugoslavia in those years, but as such it deserves attention for basic analysis. For starters, he is characterized functionality, the main feature of all objects designed by modernist architects. On the other hand, it contains all the conditions for designing a hospital where lung and tuberculosis patients are treated.
The building was moved out of town, on a hill above Mladenovac, surrounded by noise and always exposed to fresh air. The hospital rooms are oriented so that they are as sunny as possible during the day, and each of them has a spacious terrace intended for the day care of patients. The terraces are no longer as large as the inter-war dispensaries, since it was already established that lying down in the sun was not as effective as antibiotic therapy. As far as architecture is concerned, it is simple, without superfluous decoration, derived primarily from the function of the object itself.
After decades of tuberculosis treatment and prevention, hundreds of such facilities have been shut down. Many, being youthful, converted into general-type hospitals, others are simply abandoned, and although there are no inscriptions on them for a long time, they can be identified by their positions on the outskirts or outside cities and the many terraces on one or more facades, which each room had to own. Some private investors have considered buying these facilities and executing them change to hotels (the location, layout and orientation of the rooms are almost ideal for this purpose), but there is a problem of lack of confidence in the complete cleanliness of the space and the destruction of the remaining bacteria, which remain in such buildings even after disinfection (for these reasons, hospitals are being demolished and new ones built ). For these reasons, the fate of these objects is not well known.
Worth the experience
Tuberculosis may be a disease that is overcome by many (although the danger is still present), but it is not bad to evoke thinking about one such disease, which is similar to that of coronavirus, which also attacks and damages the lungs. On the other hand, humanity is undergoing similar doubts and unknowns in the treatment of this dangerous and for now deadly virus, just as tuberculosis has been for centuries. It is never known, perhaps these experiences will be of use to us and lead the experts on the path to certain answers.
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