Construction and Design Manual

Books made by Architects

Hospitals and Health Centres

Construction and Design Manual

Lavishly illustrated and showcasing detailed descriptions of

more than 130 hospital buildings, this handbook focuses
on the interrelationship between the functional and technical aspects of the hospital structure and its aesthetically
pleasing, hotel-like healthcare facilities.
This two-volume publication contains ten specialist contributions on key issues in the current debate on the hospital
of the future. Architectural history and typological classifications make this 700-page+ textbook an indispensable reference work for everyone with an interest in hospital architecture, whether students, architects or hospital directors.
>Structured by function
>Large format photos
>Scale drawings and plans
>Coloured function diagrams

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Friedrich-Schiller-University Clinic Jena

Helios Clinic Berlin-Buch

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Essays written by Chistian Lunger, Christoph Schirmer,

Daniel Gutmann, Hartmut Nickel, Wolf Dirk Rauh,
Joachim Staudt, Linus Hofrichter, Lekshmy Parameswaran,
Peter Pawlik, Philipp Meuser, Jeroen Raijmakers und
Franz Labryga (scientific advisor)

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Hospitals and Health Centres

Construction and Design Manual

Philipp Meuser, born in 1969, architect and journalist. Has his

own architects office in Berlin. Studied architecture in Berlinand
history and theory of architecture in Zurich. Numerous publications
on healthcare, urban planning, architecture and the history of architecture in the Soviet Union.

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Philipp Meuser (Ed.)

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225 280mm, 720 pages

over 700 images

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TMK Architekten Ingenieure

3 Waiting area
4 Patient room
5 View into two patient rooms
6 Patient room
7 Atrium

8 Atrium
9 Entrance hall
10 Main entrance at night
11 View into restaurant
12 Restaurant

Longitudinal sections

Ground floor

Photos: Kim Oliver Gottschalk

Photos: Linus Lintner

171

138

139

From House for the Sick to Hospital

Klinikum Berlin-Buch, aerial view,

architect: Ludwig Hoffmann
(18991906)

13 quoted in: Ludwig Hoffmann: Die Wiederentdeckung eines Architekten. Ausstellungskatalog

(source: Landesarchiv). Berlin 1986
14 Wolff, Horst-Peter et al.: Zur Geschichte der
Krankenanstalten in Berlin-Buch. Berlin 1996
15 quoted in: ibid.
16 Reinhard, Hans J. und Schche, Wolfgang:
Ludwig Hoffmann in Berlin. Die Wiederentdeckung eines Architekten. Berlin 1996
17 Lampugnani, Vittorio Magnago: Moderne,
Lebensreform, Stadt und Grn. Urbanistische
Experimente in Berlin 1900 1914. In: Scheer,
Thorsten et al. (ed.): Stadt der Architektur.
Architektur der Stadt. Berlin 1900 2000.
Berlin 2000

TheOut-PatientDepartment

Klinikum Berlin-Buch, elevation and ground plan

Klinikum Berlin-Buch, administration building

Krankenhaus Maulbronn, terraces

Krankenhaus Maulbronn, design variants A and B (realised),

architect: Richard Dcker (1930 1932)

St.Joseph-Krankenhaus,Berlin,Medicaladministrationwithout-patientandin-patientcorridor,
architects:PlanungsringDr.Jchser+Pawlik(1982)

partially adorned with round towers and high roofs, are

vaguely reminiscent of East Prussian castle Romanticism.
The houses form an enclosed space with a garden on the
inside in an open horseshoe arrangement with ample
green inner courtyards, giving an impression of quiet and
comfort. This Fourth Irrenanstalt was built literally at the
beginning of the First World War and never used for its
original purpose; it first served as a military hospital and
was primarily used as a childrens hospital after the war. A
Berlin city spokesman enthusiastically announced in 1917
that our municipal military hospital in Buch is a model institution in every sense of the word. He further enthused:
The military hospital is not only an ornament for Berlin,
but a classic example of Germanys perfect humanitarian
and sanitary installations in this war. 14
For the Hospital Buch-Ost, originally a home for the aged
built in 1908 (before the Fourth Irrenanstalt), Hoffmann
compensated for the building mass of 21 houses on the
relatively small area of barely ten hectares with a countryhouse style with garret roofs. The Berliner Tageblatt printed the following on 19 June 1909 about The City of the
Elderly: This home does not look at all like a hospital or
even a sick-house. The twenty pretty houses which make
up this city have bright walls and high, red brick roofs; they
are separated from each other by areas of green lawn and
yellow gravel walkways. Door openings and aligned walls
lend the whole a unified and organic appearance. And in
the background a tower overlooks the cheerful bustle of
roofs, round and thick, like an old watchtower.15 In order
to arrange the buildings in a square around the garden
adorned with fountains, thereby flanking a representative
central axis, Hoffmann was able to develop the construction of the Fourth Irrenanstalt in a much more expansive
way, on an area of 41.2 hectares with 32 buildings. A decisive factor in terms of municipal building regulation was
that Ludwig Hoffmann oriented himself on the influences
of social reform apartment-building originating in the private apartment-building societies, both in his architecture
and his conception of space.

These influences had led to the following development: at

the time, dense block structures were broken up from within in favour of large, green inner courtyards and communal buildings; at times, the space-forming quality of house
and street were negated and turned inwards. Examples
are Albert Gessners social reform rental apartments, Paul
Geldners and Andreas Voigts Goethepark, Paul Mebess
apartment group on Horstweg in Berlin-Charlottenburg,
his residential street in Berlin-Steglitz and the facilities for
companies like those on the Berliner Hohenzollerndamm
built to Max Welschs designs. All these buildings were constructed during the first decade of the twentieth century
with the philosophy of making inner city living conditions
healthier. They represent the first phase in this direction
from which, from a historical perspective, it was only a
small step to the abandonment of the traditional blockedge building in favour of the city built in the middle of a
landscape, as the urban architectural strategies of the new
architecture or new objectivity have made clear as a direct consequence of the Garden Cities Movement. Ludwig
Hoffmann was also influenced by the social reform movement of the turn of the century, declaring light, sunshine
and nature not to be the sole preserve of the elite, but the
basic existential needs of all, in the context of social health.
Hoffmanns rehabilitation communes were seen from the
perspective of the reformers as the first garden cities.
However, in their eyes they remained only a half-hearted
step, because the healing places, in which the patients only
stayed for a limited period of time, did not lead to a change
in their circumstances but offered only temporary respite.
Hoffmann was therefore perceived by the aforementioned
reform architects as an architect between historicism and
modernism.16 Life-style reform ultimately means breaking out of the swamp of morally circumscribed and patronising Wilhelmine culture into a contrasting design of
naturalness feeding oneself from ones own soil, knowing
that ones body is in harmony with creation and living accordingly: Economically self-supporting and culturally autonomous. 17 The life reform movement, Germanys first

mass socio-cultural protest and ecology movement were

that societys reaction to the rapid industrialisation which
had radically changed its cities and landscapes. Life reform
meant more in those days in Germany than it did later, e. g.
between the 1960s and 1980s, in the Federal Republic of
Germany. Life reform, above all, meant getting away from
the customary living conditions: flight from the bourgeoisie and flight from the city became one. 18
The architecture of the New Objectivity was the artistic
expression of this communal movement towards sunshine, air, naturalness and freedom. In 1920 the influential architect for new building in southern Germany,
Richard Dcker (1894 1968), formulated the evolutionary leap thought to have been undertaken by Homo
sapiens as follows: People of today and of the future
are self-determining, healthy and free, life-affirming and
without rules.19

hospitals as institutions of municipal welfare delivery received an additional stimulus during the Weimar Republic
in the midst of a drive for social reform that placed almost
all social services under municipal control. During this process, the architecture of individual hospitals developed as
part of a public service. A new type of tall building came
into being with the so-called terrace hospitals. Our time
imperiously demands a hygienic life for all levels of human
society. The breaking out of the old block of the full, closed
building has taken place. Closed-off life within the building
has ceased; it presses out towards light and sunshine,
searching for connectedness with nature and landscape.
Other housing bodies and forms are coming into being
from this demand alone wrote Richard Dcker in 1929 of
the style of terrace buildings on which he had a marked
influence.19 In single-family houses, shared family houses
and rented apartments alike, Dcker applied terracing regardless of building style, e. g. in the style of acute-angled
rooms with bay-windows, both horizontal and vertical. He
also transferred this construction strategy to residential and
municipal buildings in order to do justice to the principles
of a healthy living. What is good for the healthy person can
only be cheap for the sick person; and thus Dcker set new
standards in southwest Germany with his terraced hospitals
in Waiblingen (1927 1928) and Maulbronn (1930 1932).20
Hospitals were now no longer built in the city but outside
it, in remote green areas according to the model of the
sanatoriums. Dcker knew that the medical profession supported him in his designs, for contemporary scientific investigations had revealed that infection could be greatly
limited by a good amount of sunshine radiation. The result
was hospitals with broad terraces in front of the patient
rooms, where the patients could lay in their beds like holiday-makers, contentedly enjoying the view of the idyllic
landscape. These were hospitals free of the typically cold,
stationary atmosphere, intended for a maximum of
120 patients and resembling a holiday hotel. The hospital
in Waiblingen is a single-wing, two-storey, elongated
building which contains all the rooms. In order to attain the

between out-patient and in-patient care. Only since the

last health reform has a certain change in thinking taken
placewhichisnowinfluencingplanning.Theformerlystrict
separationwasloosenedinfavourofaninterlockingofboth
typesofcare.Theessentialandpurposefulelementinthe
developmentofmodernout-patientdepartmentsisabove
allinterdisciplinarywork.Theconstantlyincreasingspecialisationofdoctorsinpastyearshascausedthepatientasa
wholeentitytobeoverlooked.Oftenapatientwouldlieon
acertainwardfordayswithoutacleardiagnosisbecause
departmentalthinkingdominatedinterdisciplinaryworkfor
the good of the patient. In order to understand the new
concepts,technicalmodesofbehaviourinthecourseofthe
processmustbeclarifiedtogetherwithbuildingstructures.
Suchprocessesareelementaryfortheplanning.
Thesubjectcanbevividlyillustratedbydescribingvarious
specificpatientcases.Inconnectionwiththecompetition
preparationsforthehospitalinMunichinthepartoftown
calledHarlaching,theTeamPlanbureaufromTbingendescribedthevariouscoursesofthepatientssimilarlytothe
followingaccount:5

016

Strahlentherapie
Unfallchirurgie

Section auditorium

170

Fall 2011

ISBN978-3-86922-134-2

Ground floor

Subscription price until January 31, 2012

EUR 98.00, regular price EUR 128.00

783869 221465

er

Stefan Ludes Architekten

Elevation

ISBN978-3-86922-146-5

First floor

Plans without scale

Auditorium

978-3-86922-146-5 (English)
978-3-86922-134-2 (German)

Halle
Luftraum
Aufwachraum

so

so

2 volumes in slipcase

be

be

4
4 Auditorium
5 Communal area in new link building
6 Auditorium
7 Auditorium, detail

From Scaled Building to the Brutalist Architecture

In Kaiser Wilhelms Germany, the natural healing properties
of air, sunshine and landscape were already considered parameters of a humane architecture; they were already architectonically applied in staggered and stacked buildings
and in those with terraces. This architectural form took the
place of pavilion hospitals for well-off tuberculosis patients;
the good healing results achieved by the terraced sanatoriums also subsequently came to influence the architecture
of general hospitals. A good example of this is the main
building of the Dsseldorfer Krankenanstalten built between 1903 and 1907, provided with broad verandas in
front of the patient rooms. But the ultimate departure from
the stuffiness of society and the absolutist ruling systems
of Europe only took place after the First World War. A naturalistic idea of society, conveyed by the idea of self-determination for the individual, began consistently to establish
itself in a new art free of limitations. This development was
not confined to Germany but occurred throughout Europe,
out of the period of the economic crisis and relatively late
during the second half of the 1920s. The building of
Volume I

18 ibid.
19 quoted in: Mehlau-Wiebking, Friederike: Richard
Dcker. Ein Architekt im Aufbruch zur Moderne.
Braunschweig 1989
20 see Vogler, Paul and Gustav Hassenpflug (ed.):
Handbuch fr den Neuen Krankenhausbau.
Munich Berlin 1951

5 Moreinformationonthecompetitionunder
www.teamplan.de.

017

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necessary.Forthecontinuingdiagnosis,theareasoffunctionaldiagnosis,endoscopyandx-raysshouldbeclosely
connectedtotheadmissionsarea.Ifpatientscomewitha
doctorsreferraloutsideworkinghours,theyareguideddirectlytotheinterdisciplinaryemergencydepartmentand
givenaspecialisedmedicalexamination.Furtherdiagnostic measures are carried out in the adjoining functional
areasifnecessary(e.g.x-ray).
The administrative admission and the processing of the
patients paperwork takes place, in this case, in the
interdisciplinary emergency department. According to
the diagnosis and type of patient (ambulatory, partially
stationary,pre-stationary,stationary)thepatientiseither
discharged to go home, attended to again or admitted
on an in-patient basis. If an in-patient stay is probable,
the patient is usually temporarily transferred to the admissionscaredepartmentforfinalclarification.Evenifa
short-termobservationisnecessaryandthepatientcan
go home again immediately afterwards, staying in the
admissions care department has a purpose. The installationofsuchaunitcanreplaceanImmediateCareUnit
(IMC)inasmallhospital;thepurposefulcompletionwith
The Course of a Patient with a Diagnosis
day-clinic functions, such as chemo-out-patients or outThepatient,capableofwalking,entersthroughthemain patientsurgery,canguaranteeaneasingoftheworkload
entrance where he immediately recognises an informa- insuchaunit.Personneldevotethemselvestosuchpurtionordirectionarea.Bedriddenpatientsreachthehospi- posefulsynergies.Ifahospitalstayisnecessary,thepatalthroughthedrivewayforthebedridden.Thefirststa- tientistransferredtothemedicalcentrethatcorresponds
tionisimportantanddecisiveforthepatientsorientation, totheirdiagnosis.
regardlessofwhetherheorshecomeswithorwithouta
doctors referral. He or she must be received by a com- The Course of a Patient without a Diagnosis
petentmedicalpost.Thecentraladmissionsareaandthe The following section describes the normal course of a
interdisciplinaryemergencydepartmentareideallysuited patient,ofnormalappearanceandcapableofwalking,
forthis.Duringregularworkinghoursandwithadoctors with unclear symptoms and diagnosis. The first priority
orders,thepatientsfirststopisthemainofficeofthecen- with this patient is to establish the diagnosis as rapidly
traladmissionsarea.Thepatientsdataarehereentered as possible. This is especially important when bearing
intothecomputerandtherebyadministrativelyadmitted. theDRGinmind.Duringregularworkinghoursandwith
In the examination rooms near the central admissions a doctors referral, the patient must go to the main ofarea, the patient is given a thorough specialist medical fice of the central admissions area, where his data are
examination; further examinations can be carried out if immediatelyfedintothecomputer.Thepatientisgiven

InterdisciplinarycentraladmissionsunitinKrankenhausSt.Marienwrth,BadKreuznach,
architects:sanderhofrichterarchitekten(2005),groundplan

InterdisciplinarycentraladmissionsunitinStadtklinikFrankenthal,
architects:sanderhofrichterarchitekten(2005),floorplan,secondstorey
VolumeI

783869 221342

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