The Washington Sanitarium, a white, gable-roofed landmark close to the District line in Montgomery County, is facing demolition. And with it, say Takoma Park residents who oppose its demise, is going the spirit of cooperation that has existed for 75 years between the city and officials of the Seventh Day Adventist Church's Washington Adventist Hospital, which owns the adjoining and now empty sanitarium.

The residents' five-year-old efforts to prevent the sanitarium's demolition come together beginning today, when hospital lawyers are scheduled to argue for a demolition permit from the Montgomery County Department of Environmental Protection. The city and county historic commissions, two community organizations, the city government and numerous individuals have contested the permit. The City Council recently declared the entire hospital grounds a historic district, and the hospital sued the county in Circuit Court demanding that it issue the demolition permit immediately. The court is expected to take up the issue next month.

In some ways, the dispute is not unlike others that erupt in urban neighborhoods when history-minded citizens fight to save old buildings. But in other ways, the conflict is unique.

Despite all the bitterness displayed on both sides, there are no obvious good guys or bad guys. The 310-bed, nonprofit hospital has had its accreditation threatened if it doesn't either tear down or restore what accreditation officials call a structurally unsound fire hazard that is now unused. Restoration, hospital officials say, is prohibitively expensive--it would cost more than $5 million.

Yet Takoma Park residents can correctly say that the sanitarium has played a vital role in their history, giving them a common identity and their town a definition. City residents have been born there, and died there.

The hospital and the city grew up together, but in the last decade, they've grown apart. Takoma Park is the headquarters for the church's four million members worldwide; its health organization includes 79 other hospitals internationally, making it the world's largest Protestant hospital system.

But as the church's concerns were expanding beyond the town's two square miles, Takoma Park's 16,000 citizens were growing increasingly concerned about and active in local affairs, and sophisticated in stopping development they didn't want. As it became clear the hospital intended to tear down what the residents considered their most important landmark, they began to feel betrayed by their largest hometown business. Hospital administrators, on the other hand, felt the town was standing in the way of medical progress.

Unless millions of dollars suddenly become available, it is now only a question of when the sanitarium will come down, or how much of it, if any, will remain.

The question not so easily answered is, how long will it take for the wounds to heal?

High up on the banks of Sligo Creek, a meandering tributary of the Anacostia River, the Adventists built the sanitarium in 1907 -- a four-story health resort known for its wide sun porches and dormer windows of colored glass.

The town was then 14 years old. Benjamin F. Gilbert, the city's developer and first mayor, stood that summer on the steps of the "San," as it is affectionately called, to welcome the Adventists, who had moved their headquarters there from Battle Creek, Mich. He was delighted they shared his affinity for the pristine realm he had created and named with the Indian word Takoma, meaning "close to heaven," a place where the Adventists believed a Christian environment would flourish.

Congressmen and wealthy Washingtonians traveled out to Takoma Park to recuperate in the restful atmosphere of the sanitarium, spending the days in exercise classes, rowing on an artificial lake, soaking in swirling hydrotherapy tanks, eating meatless meals in a refined dining room. Nobel Prize-winning poet Juan Ramon Jimenez wrote some of his verse there, touched by the calming sunlight and the solace of the woods.

By 1940, hospital officials decided to build a new wing onto the front facing the creek, tear down the lower porches, and convert the sanitarium's back into a new front with a columned entrance.

Ten years later, a whole new building went up, a six-story brick building that marked a departure from the old, both in construction and in the emphasis on the institution's brand of health care. The Washington Adventist Hospital was now in a league of metropolitan hospitals, offering advanced surgery that evolved into radiation therapy and pulmonary medicine.

Hospital administrators had always been able to adapt the building to keep up with stricter safety standards -- adding a sprinkler system, installing doors on previously open stairways. But in 1976, the national Joint Commission on the Accreditation of Hospitals and the Maryland state fire marshal adopted newly revised fire codes, and the sanitarium's basic wooden structure was no longer acceptable. Hospital trustees got a temporary accreditation on the promise the sanitarium would be torn down.

In 1977, they won approval from the county board of appeals to tear down the building and move patients into what were then proposed additional levels to be built onto the hospital's new wing. Two residents argued unsuccessfully at the hearing against the demolition.

In 1978, the hospital fought off an effort to have the sanitarium added to the county's register of historic sites, arguing that it could no longer be used for patient care, was too costly to heat, too big for conversion to offices and stood in the way of future construction. The county planning board decided hospital needs outweighed historical value, according to hearing records.

The city government, long run by officials supported by Adventist leaders, had never opposed the hospital's expansion. But by 1978, things were changing: More and more young professionals were moving into Takoma Park, and they were interested in preserving its old-fashioned charm.

In 1980, running on a movement to give citizens more local control, Sammie A. Abbott was elected Takoma Park mayor after a voter turnout more than three times larger than the turnouts of 1976 and earlier. To Abbott and others, the sanitarium became a symbol of the power struggle between the old guard and the new.

Last year, the hospital asked the city to sponsor $4 million in municipal bonds needed to finish building the two new floors. The mayor and City Council used the opportunity to get a promise in writing from Herbert Z. Shiroma, the hospital president, that, "at present the hospital has no plan to either abandon or demolish the sanitarium building."

Historic Takoma, a local preservation group, hired an architect for $1,300 and presented the hospital trustees with a plan that would save the sanitarium's columned facade, leaving room to build doctors' offices in a separate building behind it. But the board didn't approve. The site where the sanitarium stands is the only place on the hospital's 16 acres where a future patient-care building could join the 1950 and 1972 wings.

Last fall, the hospital accreditation commission informed Washington Adventist Hospital it would not be accredited in 1982 unless the sanitarium was either torn down or restored. In February, the trustees voted to proceed with the demolition.

"I felt they were making a mistake," said Ronald J. Wylie, a former trustee now gathering signatures to save the sanitarium. "I felt they weren't taking into consideration the affection and support this community has given the hospital."

Eight-year trustee Dr. Naor Stoehr said outsiders don't understand what a difficult choice he and the other trustees had to make. "As a doctor involved emotionally, denominationally and professionally, I had to anguish that there was no way to save it, that we had to give it up. Then to have [the citizens criticize] us -- I feel betrayed."

City officials and residents were alarmed when the hospital went to the town of Riverdale seeking $24 million worth of municipal bonds. Sponsoring bonds was Takoma Park's only bargaining tool over the tax-exempt hospital.

Hospital Vice President Gerald M. Northam said at the time that the hospital was only seeking to refinance a debt that was coming due, and didn't want Takoma Park to attach conditions to it. He said the financing contained nothing the city contested.

But when the bonds were issued, it became clear that some of the money was to go toward the sanitarium's demolition. Northam said he considered that part of the refinancing. Another thing upset residents: The hospital had agreed to transfer $17,000 to Riverdale through its sister hospital, Leland Memorial in Riverdale, according to Charley Eldridge, former president of Washington Adventist Hospital and now administrator at Leland Memorial.

As it stands, the sanitarium's fate will be decided somewhere in a battery of hearings. Following today's hearing, the Maryland-National Capital Park and Planning Commission will hold a hearing tomorrow to decide whether it should recommend that the sanitarium be placed on the county's master plan of historic places. That designation wouldn't keep hospital officials from tearing the sanitarium down, commission officials say, but would slow the process by requiring more hearings concerning alternatives to demolition.

The Circuit Court takes up the hospital's appeal Dec. 2.

If there is to be healing, city leaders say the hospital must adhere to the way Takoma Park residents expect things to be done. They believe the hospital should have been more candid from the beginning.

"This dispute goes beyond four columns and a pediment," said Mayor Abbott. "It's a question of frankness, or lack thereof."