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Hospitals are an important part of Finnish national heritage. As public buildings they represent the development of Finland from a Swedish province to the Great Duchy of Russia and finally to an independent country. The hospitals, designed by famous architects, are monuments of architecture but they also reflect the history of medicine. The types of hospital buildings have transformed in many ways during the history of hospital architecture. In the 1900s the pattern changed from pavilions to skyscrapers. This was made possible by the 19th century scientific advances, breakthroughs to understanding the causes of disease. However, they were not fully understood in their time and so they were translated into changes in hospital design in the 20th century. Pavilion hospitals were replaced by multi-storey block hospitals in which wards and services were concentrated together. This new type was created in the United States. In Europe the hospitals were not necessarily as high as in the United States. Nevertheless, they aimed at the idea of concentration. In Finland the end point of this development was the Helsinki University Central Hospital. This 15-storey hospital was built in 1956-1965, and designed by architects Reino Koivula and Jaakko Paatela. This new block-type system was also made possible by architectural progress. Metal was increasingly being used for the building framework, and the steel skeleton building was introduced in about 1900. This made it possible to build to a greater height. The tendency was toward skyscrapers. Also, Functionalism demanded concrete structure. In Finland the new building types for health and sports became the most important monuments of functionalist building. Alvar Aalto's Paimio Sanatorium (1933) is one of the most renowned examples, even internationally acknowledged. At Paimio, the load-bearing structure was a concrete pillar frame, with the exception of the open-air wards, which formed the largest monolithic concrete structure in Finland at the time. The functionalist demand for light, air and sun corresponded to contemporary ideas in medicine, particularly in the treatment of tuberculosis. On the basis of rational and hygienic demands Aalto designed an organised building that can be seen as a "healing machine". Although the major changes in the 20th century hospitals occurred because of the scientific progress, it can be argued that some of the changes within hospitals were due to other reasons. The hospitals of the last two centuries can also be seen as monuments of the transfer of power from the layman to the professional. Teaching and research have become a more and more important part of the modern hospital. Sometimes this has led to the fact that the patient is only seen as an example of his or her disease. Furthermore, medicine has become a specialized branch of science. Therefore, co-operation between specialists has become imperative, which makes it necessary for them all to be within easy reach of one another. Moreover, there was a wish for specialist hospitals to be built near each other. The Meilahti University Hospital area in Helsinki is a case in point. In this area special hospitals have been built close to each other during the last one hundred years. The Women's Clinic (1934) in Helsinki was the first hospital in this area and it was also the first hospital in Finland, where the maternity hospital and gynaecological ward were housed in the same building. Soon after this, the Children´s Clinic (1946) and the Children´s Castle (1948), an institution for the specialized care of children and a training school for children's nurses, were built close to the Women's Clinic in Meilahti hospital area. In the end, when speaking about the conservation and architecture of modern hospitals we are discussing a serious subject. The modern Finnish hospitals mentioned above are still in operation and new technology sets challenges to them. Therefore there are certain risks of too massive redevelopment. Plain modern architecture is known to be very sensitive to alteration. When original details are changed too drastically, the architectural value of building can disappear and we lose architectural monuments as well as a part of the history of public health. Sources: Birch-Lindgren, Gustaf, 1934. Svenska lasarettsbyggnader. Modern lasarettsbyggnadskonst i teori och praktik. Stock-holm; Birch-Lindgren, Gustaf, 1951. Modern hospital planning in Sweden and other countries. Stockholm; Forty, Adrian, 1984. "The modern hospital in England and France: the social and medical uses of architecture", Building and Society. Ed. Anthony D. King. Lon-don; Foucault, Michel, 1993 (1963). The Birth of the Clinic. An Archaeology of Medical Perception. London. Naissance dela Clinique. Paris 1963; Nikula, Riitta, 2000. "The Inter-War Period: the Architecture of the Young Republic", 20th-century architecture Finland; Pevsner, Nikolaus, 1979. A History of building types. London; Thomson, John D. - Goldin, Grace, 1975. The hospital: a social and architectural history. New Haven & London.
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