The Hospitals Investigator issue 7, circulated in November 1992, included an update on the memoranda concerning the provision of isolation hospitals produced by the Ministry of Health in the 1920s, a preliminary look at school sanatoria – specifically those built for boarding schools, considers the question of lifts in hospitals and finally provides some references for hospitals built just prior to the outbreak of the Second World War as part of the Emergency Medical Scheme. EMS hospitals and hutted annexes added to existing sites often remained in use for decades, despite having been considered as temporary buildings. The availability of materials affected their construction, and they vary from timber to brick. At the former workhouse in Amersham, which by the 1930s had become St Mary’s Hospital, a small annexe of these huts was built. By the early 1960s one of these was in use as a maternity ward, serving the local area – and that was where I was born.
Memoranda on Isolation Hospitals (again): Cubicle Isolation Blocks
In our third number we dealt at length with the memoranda on isolation hospitals issued by the Local Government Board. In 1924 a further edition was published, by which time the LGB had become the Ministry of Health. The main change in 1924 was that the facing-both-ways plan (Plan B in the 1902-21 editions) had been omitted, leaving only the former plans C and D, which became B and C respectively, without any alteration. The overall site plan (Plan A) was amended in line with this, and had only simple pavilion outlines. Space for a future boiler house had been added behind the administration block, perhaps indicating a change in technology, from stoves to central heating, in small hospitals.
Plan C is described as an Observation (Cubicle) Block, intended for single cases of diseases other than smallpox, mixed or doubtful infection. One nurse may, provided rigid precautions are taken, attend to more than one patient. The Department is prepared to accept wards as small as 12ft by 10ft. An air space of 1,872 cubic ft is said to be permissible in cases of diseases other than smallpox, if the 12 linear feet of wall space and 144 sq ft of floor space are provided, but in smallpox hospitals 2,000 cubic ft per bed are required.
This basic and small-scale isolation ward works on the cubicle principle, it was published in the early 1920s as a model plan in the Cambridge Public Health series.
Interestingly, the sentences saying that unnecessary duplication of small hospitals in an area is to be avoided, have been tightened up to increase the emphasis.
The types of wards suggested were thus reduced by 1924 to two only, the pavilion and cubicle blocks. Thus ‘official’ isolation hospital ward planning had begun with the simple huts of 1876, then gone through a phase of great diversity and finally settled down with two basic and simple types. This was still the position in 1947 when E. and O. E. published the final edition of their useful book Planning: the architect’s handbook. The same two basic types are given, along with a fanciful plan with hexagonal cubicles that was actually built at Tolworth.
This block was destroyed during the Second World War. A similar design was adopted in the two cubicle blocks added to the Mogden Isolation Hospital (later South Middlesex Hospital), Twickenham, in 1937. They were unoccupied and due for demolition by the early 1990s.
Robert Taylor noted that having attended a working-class day school in the Black Country, he felt that his knowledge of public schools was minimal: ‘Innocently we assumed that a school sanatorium was a glorified sick-bay, although we should have suspected something when we discovered that the sanatorium at Uppingham School had more beds than any other hospital in the county. It seems that this simple and obvious sick-bay interpretation is wrong, and that we were forgetting our own childhood illnesses. Jeremy Taylor ignores school sanatoria, thus presenting a challenge. In the meantime, here is a theory to set discussion or argument rolling.’
‘At present sanatoria dating from before 1864 are unknown to us. The earliest seems to be that at Harrow School, built in 1864 to designs by C. F. Hayward, and resembling a cottage hospital with square ward-rooms lit on one or two sides; it held 16 beds for a school of 500 pupils. It supplemented but did not entirely replace the earlier system of sick rooms at each house at school. Despite the unspecialized nature of the very domestic plan it had, apparently in common with all other school sanatoria, built in the last quarter of the 19th century, the primary function of the instant isolation of infectious diseases.’
Perspective view, with First and Ground floor plans of Harrow School Sanatorium published in The Builder, 23 Jan 1869, pp.66-7
‘Boys could not be sent home but had to be treated institutionally, hence there was a generous provision of beds in relation to the number of pupils. Any other accident or illness could also be treated in the same building, but the planning was determined by the treatment of infectious diseases. At Harrow it seems that the sick bays of the houses had been unsuccessful for the treatment of infectious diseases, and after the building of the new sanatorium they remained in use for other ailments.
‘So far during fieldwork we have seen two types of sanatorium (apart from Harrow), both suitable for infectious diseases, but differently planned, and these differences have a chronological significance. It will be valuable if it can be discovered whether this distinction has real meaning. The two late-19th century sanatoria, at Sherborne and Warwick, consist of two separate two-storey blocks linked only by an open corridor, one containing the wards and the other the ‘administration’ and at least in the case of Sherborne a third ward as well. These wards are thus surrounded and isolated by fresh air in the approved manner, and are also designed in accordance with contemporary principles. At Sherborne Keith Young was chosen instead of the usual retained architect because of his special knowledge of hospital building. There were 22 beds for a school of 270 pupils. We have yet to see the sanatorium at the Asylum for Fatherless Children at Reedham, where three wards on each of two storeys gave isolation for three diseases for both boys and girls, presumably one sex on each storey. Again the declared aim of the sanatorium was to treat infectious diseases first, and any other diseases as they arose.’
Sherborne School sanatorium
‘The second type of school sanatorium was seen at Oundle and built about 1930. It is a two-storey cubicle block added to one side of an older house that became the administration department. The 16 cubicles all opened Southward onto balconies. Again this is in accordance with current planning ideas, but it is far more flexible than the larger wards of Sherborne and Warwick, and so more suitable to the mixed use of a school sanatorium as suggested above.’
We have often marveled at the steep staircases in hospitals, and wondered whether female wards were often placed on the first floor because ladies were easier than gentlemen to carry upstairs. Lifts seem to be almost impossible to date, and some documentary evidence may help understand how patients were moved.
At the Northampton Infirmary patients were carried from 1793 until 1872 when two hand-operated lifts were installed in the wells of the two main staircases. These remained hand-cranked until 1911 when they were converted to electricity. Two lifts were installed in the two staircases at the North Devon Infirmary at Barnstaple in 1872 and 1873, but we do not know how they were operated.
Dates for events like Otis’ experiments to demonstrate the safety of his ratchet mechanism in 1854, and its first installation in a public lift in 1857, and the first successful electric lifts developed in 1889, are well-published, but the process of installing lifts in hospitals is not yet clear. Most seem to be inserted in the generous wells of already existing large staircases, the dreadful blind towers of the modern lift shaft being a phenomenon of the second half of the 20th century rather than earlier.
Emergency Medical Scheme Hospitals
The Builder carried brief notices of Government and Military contracts, sometimes hopelessly brief and uninformative. Emergency Hospitals were reported until 13 October 1939, when the lists of H.M.O.W. contracts were discontinued because they were regarded as being of potential use to the enemy.
Stoke Mandeville Hospital was originally built as part of the Emergency Medical Scheme, many of the hutted ward blocks remained in use in the early 21st century, but have since been demolished, the area where they stood has been developed for housing.
This OS Map from 1955 shows the easily recognisable layout of the blocks. The small group of buildings at the south-west corner were a pre-existing municipal isolation hospital. Reproduced by permission of the National Library of Scotland
This OS map from the 1930s shows the isolation hospital and the future site of the EMS hospital. Reproduced by permission of the National Library of Scotland
The Emergency Hospital buildings that were recorded up to that date are as follows.
21 July 1939
4 August 1939, p.222
Mount Vernon Hospital, Hammersmith
Hemington Infectious Hospital, Middlesborough
11 August 1939, p.250
Highwood Hospital, Brentwood
Furse Hospital, Hillingdon
Windosr Public Assistance Institution
St Mary’s Hospital, Amersham
25 August 1939, p.347
Farnborough Hospital, Kent
1 September 1939, p.385
Evesham Public Assistance Institution
Black Notley Sanatorium
Pinewood Sanatorium, Woking
Middleton in Wharfedale
Chester le Street
8 September 1939, p.419
Three Counties Hospital
Boleys Park Mental Hospital
Preston Hall Hospital, Kent
George VI Sanatorium
Scotton Banks Sanatorium
15 September 1939
St Andrews PAI, Billericay
West Malling Institution
Botleys Park (West Surrey Waterworks)
22 September 1939, p.483
Warranford Hospital, Guildford
29 September 1939, p.513
6 October 1939, p.541
Langho Epileptic Colony
The Builder published plans of two Emergency Medical Service hospitals, one said to be in the Home Counties and the other in the Midlands. The precise locations were concealed as a matter of national security, but the areas given prove to be grossly misleading. Both hospitals can now be identified. The hospital said to be in the Midlands (Builder, 9 October 1942, p.306) is readily identifiable by its amazing plan as Stoke Mandeville Hospital. Not only does the plan show the hospital as built, but in the 1990s most of it survived. The Home Counties Hospital (Builder, 24 April 1942, p.359) turned out to be the Churchill Hospital in Oxford, which again survived largely intact into the 1990s.