The date is March 31, 1997. We were calling Diddy ‘Puff Daddy’, Princess Diana was still with us, and Bill Clinton was starting his second term as US President. And on that day, Bullfrog’s classic simulation game Theme Hospital was released. In this column we’ll be recalling what made this game great, and whether it continues to shine after 15 years.

Theme Hospital is a simulation game with heart. Instead of being a dry, straight-faced micro-management game; you overlook a bustling hospital that deals with patients that suffer from rather peculiar diseases. Bullfrog’s classic black humor permeates throughout the game. Your GP might diagnose a patient with Slack Tongue – no problem, they trot off to the Slack Tongue Clinic for a date with the ‘Slicer’, a machine that wouldn’t look out of place in a medieval torture chamber. A quick turn of the handle; job done.

Meanwhile, you have to deal with epidemics, emergencies, and sickness waves. Your handymen will help you deal with the latter, of course, but only when their wages are in line with their peers’. Crazy diseases, grumpy staff and pompous hospital inspectors all need to be dealt with, or your carefully planned hospital will soon descend into chaos.

First time round

I first remember playing Theme Hospital in 1998. I was 6, but I’d seen my older brother having a go and figured it looked fun. We bought a second disk a few years later after the old one broke, and I remember reaching the end of the game at least once. After that, I’d tried installing the game again a couple of times, but without XP, Vista or Windows 7 compatibility I hadn’t had any success.

What memories did I have of Theme Hospital, a game that I’d last played about ten years ago? Extremely positive ones. I remembered the ridiculous but somehow endearing soundtrack, the incessant orders blasting out of the tannoy system (that you gradually became conditioned to), and, above all, the huge amount of fun that a relatively simple game provided for me. It was the game that I enjoyed most in my pre-teen years.

Original rating: 9 out of 10

Compatibility issues

Installing the game on Windows 7 is a little tricky. Inserting the CD that I’d bought in about 2001 gave me an error message, but a quick Google search provided a workaround that involved copying the files across to my desktop. The next problem was running the game flawlessly, without crashes or freezes; a problem I am yet to completely solve. Meddling with compatibility modes and other options brought variable results. Further, the results did not appear consistent each time I ran Theme Hospital under the same settings.

By right-clicking on WINMAIN, then going to properties, you can alter these settings. Try out different compatibility modes (98, ME, XP SP1-2 all worked for me on occasions). You can also have the game run in 256 colors, run in 640 x 480 resolution, and so on. It might take a few attempts to find the most stable settings for your OS and computer.

Sometimes on start-up the colours went crazy, but once I was into the game proper, they settled down. They might revert back to bright pink, blue and yellow whilst your playing, but if you switch to the bank manager or another screen that hides your normal game window, it should turn back to normal when you return.

Even with these tweaks, Theme Hospital does still crash frequently on my PC – usually every 10-25 minutes. If this happened with a more recent game, the long start-up time might deter me from continuing to play it after a crash. Theme Hospital, however, starts so quickly that you’re able to begin playing again within 20 seconds.

The return

Theme Hospital remains incredibly fun to play. As soon as a I started with the first level, it all came flooding back. Reception, check, GP’s office, check, pharmacy, check. I remembered I had to place fire extinguishers to keep the V.I.P. visitors happy, and plants to keep the patients happy. I knew I needed an army of identical handymen to keep the machines maintained and the hospital spotless. Even though it had been so many years since I’d last played, it might as well have been a day ago. The first few levels were entertaining but easy – I knew the best way of laying out the hospital, how to keep my staff happy, and all those other little tricks I’d picked up before.

With the introduction of epidemics in the fourth or fifth level, plus the sheer numbers of patients that you have to deal with, Theme Hospital began to get a little trickier. An ill-timed earthquake took out three of my rooms, and I even managed to lose a level. The increased challenge made it even more fun, with the numerous crashes barely denting my enthusiasm.

Theme Hospital may be close to the perfect simulation game, but I couldn’t help notice a few flaws that stopped it reaching perfection. First, the micro-management gets a little tedious – specifically when repairing machines. As the levels progress, you’ll need more and more machines (the Inflator, the Cast Remover, an Operating Table etc.), and as they deteriorate with use, you have to order handymen to repair them frequently. This is not a problem at the beginning of the game, but it soon starts to consume too much playing time when you get to later levels. Second, epidemics are equally tedious. The hefty fines attached to them easily become a burden upon your hospital’s finances, and I couldn’t help but feel irritated every time the tannoy shouted “Epidemic alert, stand by!” in nervous tones. Epidemics just aren’t fun to deal with.

Still, the rest of the game is so much fun that these issues barely matter. Take Harry Potter and the Prisoner of Azkaban, for example. It was my favourite Harry Potter film despite the awfulness of that one scene. You know the one – “HE WAS THEIR FRIEND!”. The rest of the film was so excellent that it almost seems unfair to mark it down because of it. The same applies to Theme Hospital. Even after fifteen years, its gameplay is among the best we’ve seen from any simulation game. Coupled with its dark comedic tone and hypnotic soundtrack, I’m not sure if I’d rather be playing anything else.

New rating: 8.5 out of 10.

What about a sequel?

If Theme Hospital was remade today, I would be very impressed if it could retain any of the charm of the 1997 game. Bullfrog Productions were long ago gobbled up by EA, and I’m not the only one to doubt them based upon their recent actions. We might see shiny new graphics so that our 30 handymen wouldn’t look like clones, or extra rooms offered as downloadable content. Maybe we’d get to use the classic doctor skin if we pre-ordered? None of these things would be right.

An indie games company might handle a Theme Hospital sequel with a little more finesse. The focus should remain on fun, addictive and challenging gameplay rather than graphics or revenue generation. Perhaps it could be done right. I doubt, however, that many Theme Hospital fans would welcome a sequel. The game is too precious for too many people; small alterations to gameplay would cause riots across Reddit, Twitter and 4chan. In an age where we are always wanting more and we always want it now, let’s take a step back and ask whether a sequel is really necessary.

I want to play!

If you’ve still got an old disk and are feeling adventurous, you can try messing around with the settings as I did above in order to play. GOG have Theme Hospital available for download, but you might need to run it through DOSBox for it to work correctly. Lastly, an open-source clone, compatible with recent versions of Windows, is being developed, but this requires a copy of the original to play.

Theme Hospital: still a must-play.

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