Between Medical Care and ‘Social Death’: the Paimio Sanatorium
(2025) The Space of the Other. Architecture from Exclusion to Care in the Modern City — Location: Politecnico di Milano, Mantova (27.November.2025)
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- Since the 12th-century, epidemic diseases have been addressed through acts of exclusion: the sicks were expelled from the city and taken to ad hoc facilities – leprosaria and lazarettos. Expulsion continued to be practiced even at the beginning of the 20th-century, when medicine had already developed the first vaccines and other therapeutic solutions. The aim was to contain the spread of the epidemic at a time when medical measures were slow to be implemented. Drawing on archival material and Finnish-language primary sources, this article focuses on one of the most emblematic yet ambivalent examples of modernist health architecture: the Paimio Sanatorium (1929–33), designed by Aino Marsio-Aalto (1894–1949) and Alvar Aalto (1898–1976). Although studied from various perspectives, it has never been considered through the lens of exclusion or compared with earlier measures of distancing. Conceived as a “medical instrument” (Aalto, 1956) in close collaboration with physicians, Paimio embodied both the modernist ideal of healing through architecture and the exclusion inherent in the sanatorium system. Isolated from the city and largely self-sufficient (Aalto, Kalkas, Savonen, 1950; Anon., 1933) it functioned as a world apart – an “island” (Tuberkuloosiliitto, 1958) where exclusion and institutional autonomy were presented as prerequisites for recovery. As the notion of the “total institution” (Goffman, 1975) suggests, this “particular community” (Tuberkuloosiliitto, 1958) operated as a complete environment where all aspects of daily life were absorbed into a collective regimen and governed by strict rules. Sicks occupied the lowest rungs of the social and medical hierarchy (Aalto, 1933): excluded from decision-making, their admission was compulsory once diagnosis was confirmed. Though admission was open to all, hierarchies emerged, and some sicks gained a distinct status as “consuls” (Nenola, 1986), operating under their own rules and exercising delegated authority. The ‘family metaphor’ masked this disciplinary order (Nenola, 1986): while promising protection and recovery, it also imposed control by reproducing a regulated parallel to life outside, legitimizing authority and making discipline acceptable. The logic of exclusion, justified in the name of health, extends into the building: architecture there instituting near-omnipresent surveillance and undermining sicks’ autonomy. It thus operates as a disciplinary apparatus for conditioning the body, the figure of the “sick reduced to a horizontal position” (Aalto, 1978) and “in a state of pronounced weakness” (Aalto, 1940) shaping spatial proportions and guiding the design of furnishings and room typologies. Upon discharge, former patients carried the stigma of tuberculosis, facing suspicion, unemployment, and difficulties of reintegration. The sanatorium thus represented not only a space of physical treatment but also a threshold to ‘social death’, where the boundaries between the ‘sick’ and the ‘healthy’ remained blurred. Today Paimio – now a site of international heritage – embodies both the modernist faith in architecture as a therapeutic tool and the hidden violence of institutional segregation. This paper argues that confronting that ambivalence – and making the tension between care and exclusion the central analytic lens – is essential to understanding how architecture both heals and marginalizes. Acknowledging these contradictions can help design healthcare and urban spaces that combine clinical care with social reintegration.
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Ferrari, E. (2025, November 27). Between Medical Care and ‘Social Death’: the Paimio Sanatorium. The Space of the Other. Architecture from Exclusion to Care in the Modern City, Politecnico di Milano, Mantova. https://hdl.handle.net/2078.5/279204