The competition for the modernization of the Cognacq-Jay hospital was based on a complex programme. The generally unheeded tragic nature of everyday life in a hospital rarely has a decor other than standard architecture. The Cognacq-Jay hospital, whose aims include providing the best possible care for terminal patients, invited five architects - Architecture Studio, Chemetov + Huidobro, Dominique Perrault, Jean Nouvel and Toyo Ito - to design a hospital of enhanced quality. The winning scheme by Toyo Ito is being developed and construction is scheduled for 2003.*1

What did the architects find on site? A small hospital between Rue Blomet and Rue Eugene-Millon in the 15th arrondissement of Paris, two narrow streets of unbroken six-storey buildings. The hospital constitutes the only opening in these walls of facades: it consists of two-storey brick pavilions set at right angles to the streets, in a wild garden with tables and benches, a pond, a greenhouse, a chapel.
The shop-window dummy dressed as a liftboy in the lobby and the colourful fresco behind the reception desk give no hint that you are in a hospital; the same holds for the upholstered sofas, the piano, plants, photographs and paintings. One floor up, however, there are tiled corridors, doors left ajar, rooms with a bed. On a table is a book in which family members attest to their experiences. Besides other tasks, the hospital has been concentrating since 1978 on the palliative nursing of terminal cancer patients. About four hundred and fifty people are admitted each year. The director, J.-L. Fidel says, 'We never say "You are here to die". There are patients who recover, you never know how things will go.' The hospital's aspiration is to 'preserve the intellectual autonomy, the capacity to reflect, so that a patient can gradually become aware of the approaching end'. Other tasks include the treatment of post-operational lymphedemas and neurological impairment in AIDS patients. It is the hospital's wish to approach each patient as an individual.

A complex programme

What was asked of the architects? First, the modernizing and reorganizing of the hospital, dating from 1922 and standing on a site of 4980 square metres, that is to increase from 72 to 168 beds due to a fusion. With the addition of an orthopaedic service and a centre for autistic children, the hospital is to consist of three main departments. Technical services and parking space had to be accommodated in the basements.

Besides that there was also a demand for conservation: all the patients' rooms had to remain facing the garden, a garden which was to stay intact; the homely character of the existing low-rise was considered an asset. The nursing staff and voluntary workers have strong ties with the building, symbol of the characteristic ambience that they wish to preserve. So recreating this high-quality environment is part of the programme. A last request was the integration in the neighbourhood, that the facades should match the street contour, while a certain architectural sobriety needed to reflect the building's function. How did the architects translate both this programme - the encountered human reality - and the desire to uphold quality, into architectural forms?

Formal responses

In all five projects the grounds are enclosed ^y two parallel buildings. All the European architects draw a wing of communal rooms between them to produce the same H-shaped ground plan. Architecture Studio places an enormous glass sculpture right across the site and through the buildings, containing services and post-treatment rooms, Nouvel's 'bridge' set on pillars has the-same function, as does Perrault's broken, shifted wing. Chemetov + Huidobro take 'nous maintiendrons'*2 as their device; retaining one pavilion, they wrap an original facade in glass and turn the existing main building inside-out, so to speak.

Ito by contrast sites the public and communal spaces in two slender glass-fronted wings; along the inside of these he places three blocks of private rooms. The functions are differentiated from outside to inside, from public to private; the pavilions in the garden provide the required intimacy. Ito thus succeeds in keeping all the private rooms away from the street side; he is the only one to respect this essential aspect of the brief. The two parts, like separated pieces of a puzzle, are linked by a basement running below the grounds and containing common treatment and examination rooms. By ascribing different functions to buildings and giving them characteristic shapes or materials, Ito preserves legibility and the small-scale character: the glass skin facing the city differs distinctly from the timber cladding on the facades of the classical modernist blocks.

Urban interaction and spatial variety

That the requirement of urban integration can be treated as a formal game is demonstrated by Architecture Studio with their imitation of Parisian roofs, Chemetov with quotations of the old in the new, and Perrault by falling back on the classical 'hotel particulier'. Instead of historicizing, Nouvel and Ito rightly interpret urban integration as meaning active interaction - Nouvel places rooms on the street side and is therefore obliged to close his facades, but he allows the city generous vistas of the garden by raising his building on pillars. A roof terrace protected with glass walls allows patients to maintain some contact with the city. Ito structures the block of houses by screening off a green heart visible to the rest of the neighbourhood with semi-transparent 'filters' that ensure a (controllable) continuity between city and hospital, and between city and garden. Like Nouvel he places city-oriented walks along the top of these facades. The legally protected garden is split up by Chemetov + Huidebro into three parts, one of which is roofed. Architecture Studio places screen-printed trees on glass in the garden and real plants on the glazed facades, creating a courtyard with rooms opening onto it. Perrault too comes up with a dark little square which he imagines could be compensated by smothering the building with a monoculture of bamboo. Nouvel guarantees both continuity and light by projecting a 'glass bridge' over the garden with windows that can be opened in summer. In Ito's concept the park is much more than an obligatory chopped-up strip of green: the complex yet continuous garden winding around his pavilions is the principle uniting the freestanding buildings. Architecture and nature interlock as it were, something that is emphasized by having the three entrances pass through the garden. This garden is elaborated down to the smallest details, and in accordance with the best Japanese tradition, into five distinct themes: a wooded area for tranquillity and meditation, an open garden of water and grass, a patchwork area of hillocks, a childrens' playground and, atop the lowest pavilion, a garden with glasshouses. Ito's concern for sun and light even determines the height of the buildings. On the north side he projects five floors but on the south there are three at most, thus ensuring sunlight in the garden and in all the rooms with an east-west alignment. The basement too gets daylight from the steeply raked garden, a garden where it never gets dark - in the evening spotlights shine on trees and ponds, floodlights provide a sort of blue moonlight at night, and red lamps act as beacons.

Discourse on method

Texts can be as significant as drawings or scale models. Whether it is the cynicism of Perrault, who bases the 'poetic architecture' and 'charm' of his proposal on the motto live comfortably as if at home', or the exclusively urbanistic and architectural arguments of Architecture Studio and Chemetov - these attitudes reappear in the projects. Ito begins with a simple description of this striking, emotionally charged place. What does that give him? Doubt: 'What does architecture have to offer people who are facing death? How to preserve the existing ambience?' These are problems whose solutions he seeks with an almost Cartesian orthodoxy of observation, asking questions, answering them point by point and verifying the answers. Language, as a means of analysing systems through investigation, can be decisive in architecture too. Ito's project consists of responding with form to precisely ! stated definitions of problems deriving from the programme -forms that are only assembled at a later stage. The clarity of the method is evident from the beauty of the project, in which everything is conceived on the basis of function, but where nothing is sacrificed to formal functionality. With such a dense programme, trying to find one all-embracing form or locally appropriate style can onjy result in unsatisfactory compromise. For architects inclined to minimalism like Perrault who are thoroughly familiar with the megalomania of high finance or political power, programmes - content and meaning of form - prove to be a side issue, a mentality whose manifesto is his Grande Bibliotheque. It is noticeable here how form is first sought and fleshed wt; only then are functions given a place.

The architect's role

Nouvel, who had already built an old people's home for the Cognacq-Jay foundation in Rueil-Malmaison, writes that in this situation architecture can produce 'minuscule positive emotions' but must otherwise remain invisible. In his project the individual rooms and the balconies, which can be closed off with aluminium shutters, almost constitute a common Parisian building of studio apartments. Based on individual comfort, but not attesting to a clear idea of the hospital, which is not recognizable as such. Nouvel, who expresses discretion often with transparency, rejects such a presence here. His ideal hospital is a warm, luminous building.

There is no beautiful play of light on metal but two cold glass walls in Ito's proposal. How does he see the architect's role? The creator of the Tower of Winds explained that the reality of Cognacq-Jay led him to a new working method. This project is not a critique of architecture as an art form, a position that has often determined his 'challenging' concepts in the past. No, in ftiis competition the very role of the artist was at stake, the question was 'how we architects see life, and how we can respond to this special situation of the sick and dying'.*3 Ito's response, then, is a lucid modern building that makes not the slightest concession to the style of a Parisian neighbourhood, does not becoming invisible, but does respect the programme a la lettre. Here, the architect, according to Ito, is someone who naturally doesn't expect to solve human problems but does hope to deal with the attendant architectural ones. A form of applied architecture that, like applied art, does not exclude beauty but achieves it by other routes. The fact that he allows sunlight in every room, designing it so that patients can see both the door and the garden from their pillow as well as receive Internet and TV on a vocally operated screen, gives a picture of the task Ito has taken on. Besides this demand for quality he has a gift for granting freedom - in the buildings one can always choose between lounges or dining rooms that are lively or peaceful, facing the city or the garden, long and narrow or wide and open. Ito proposes a new model for a hospital, one that frankly admits as much to its technical medical function as to its homely character and human dimensions. It is with good reason that in this process he combines the two fundamental forms of hospital architecture - the nineteenth-century system of pavilions, related to comfort and nature, and the twentieth-century building in the form of one block representing modern medicine and efficiency.

Architectural portrait

It so happens that Toyo Ito has responded to mourning once before, and beautifully too. White U (1976, Tokyo) is a horseshoe-shaped villa, designed for his elder sister and her two daughters who had just lost their husband and father. In close consultation with the future occupant, Ito created a continuous space around the themes of light and earth, sheltered from the world and with a central garden so that the members of the family could always see each other. It is easy to regard his project for Cognacq-Jay as a prolongation of White U: the scrupulous observation, the light, the garden, the transparency as well as the possibility of withdrawing into the pavilions. Pavilions that he calls 'houses' with good reason. Since Gaston Bachelard we know how important the form and image of the house are for organizing our memories, for our ability to dream there, to come to terms with events.*4

With the villa White U, Ito made an 'architectural portrait' of a family living with grief. Portraying presupposes observing, communicating, interpreting. Likewise, the characteristic features of the existing building of the Hopital Cognacq-Jay are accentuated or softened with a sharp eye; the essence is translated into a work representative of the model but also of the artist's style, the requirements of art. It is a project that does not want to be a critique of architecture, but does stand for the rejection of broad formal approaches and is a manifesto for working with precision from programmes that combine technical, human and affective factors. It is also a lesson, because Ito succeeds with compassion in creating a fitting form for an extremely sensitive content.

© Steven Wassenaar

*1. The schemes were shown in the IFA from 18 February to 14 May 2000.
*2. Unless stated otherwise, all quotations come from the catalogue Concours pour l'hôpital Cognacq-Jay, Paris (IFA) 2000.
*3. Interview with Toyo Ito by Frédéric Nantois in the IFA, 20 December 1999.
*4. Gaston Bachelard, La poétique de l'espace, 1957.