There was an acute demand for sanatoria in Finland, as tuberculosis was the coun-
try’s most pressing national health issue of the time.^36 Eradicating tuberculosis became
a national endeavour in the first few decades of the 20th century. The disease was not
confined to urban areas but spread in rural areas to a similar degree. Preventive meas-
ures played a major role in this effort. Population-wide screening was introduced in the
1930s with the aid of portable x-ray equipment.^37 Local authorities assumed increasing
responsibility for the care of tuberculosis patients from the 1910s onwards, and in the
1920s a whole movement for the prevention of the disease emerged. Collaboration
between municipalities became an established practice with the 1929 Act on State Aid
for tuberculosis hospitals and the 1932 Amendment to the Municipalities Act regard-
ing Municipal Federations.^38 Eight new, large hospitals were built in Finland, adding
2,500 new hospital beds for tuberculosis patients. The daily care routine included rest,
fresh air and a healthy diet, which often helped alleviate the symptoms of the disease.^39
Aalto won the design commission for Southwestern Finland Tuberculosis Sanato-
rium, known as Paimio Sanatorium through an open architectural competition held
between 1928 and 1929. When he won the competition in January 1929, the young
architect was faced with an unprecedented task. His previous experience in hospital
design was modest^40 and, through his then uncompleted projects, he was only starting to
learn how to manage a large-scale project.^41 The Building Board steering the sanatorium
project was strongly committed to go through with the work for three reasons. Firstly,
the state considered lung tuberculosis the greatest threat to public health;^42 secondly, the
Parliament legislated financing with the new Act on state aid to hospitals for tuberculo-
sis passed in May 1929;^43 and thirdly the Building Board considered Aalto’s architectural
solution convincing^44. Aalto and his architectural practice started work on the design in
1929, and the construction work started in 1930. The design work continued into 1932
and the Building Board completed the construction work in 1933. Aalto wanted to
incorporate his Modernist ideas into the work. He found himself having to convince the
other stakeholders of the feasibility of his ideas in order to win the mandate to execute
36 The tuberculosis mortality rate was close to two per thousand incidents in Finland during the 1930s. Forsius 2000b.
37 Forsius 2000a.
38 Forsius 2000b.
39 The medical treatments used in Finland in the inter-war period included the pneumothorax and plombage tech-
nique, which means inserting air or an inert substance such as oil into the pleural space, collapsing the lung to
allow it to rest and heal. Other methods included thoracoplasty and phrenic nerve crush. See e.g. Forsius 2000a.
40 In 1924, Aalto had designed a log-framed, classicist hospital building with four patient rooms, a special ward, an
operating theatre, a nurses’ room and an office, built in a remote village of Alajärvi in southern Ostrobothnia. The
hospital was altered during its construction as per instructions of the master builder Eeli Ojala, whose opinion
Aalto dutifully respected. Schildt 1995, 67; Aalto also participated in the invited competition for the Central Finland
tuberculosis sanatorium in 1927 without success. Raija Heinonen studied Aalto’s hospital designs from 1927–1931.
Heinonen 1986, p. 235.
41 The Southwest Finland Agricultural Cooperative Building project took place in 1927–1929, the Turun Sanomat News-
paper Building in 1928–1930 and the Defense Corps Building in Jyväskylä in 1926–1929. Heporauta 1999, pp. 10–25.
42 Tuberculosis mortality rate in Finland in the late 1920s and early 1930s was approximately two in one thousand.
New cases were detected at the rate of two to three in one thousand, and the number of registered cases was
eight to nine in one thousand with four to six in one thousand placed in hospital care. Forsius 2000b.
43 Valtionapua koskeva laki 269/1929 ja asetus 207/1929. (Act No. 269/1929 and Decree No. 270/1929 on the State Aid).
44 The jury considered Aalto’s proposal architecturally interesting and the disposition of functions generally success-
ful. Some measurements were, however, criticised. Anon, 1929b, pp. 42–46.