This post looks at the early history of the Astley Ainslie Hospital and the development of a more scientific approach to convalescence in the early twentieth century.

The Astley Ainslie Hospital is the main rehabilitation hospital in the NHS Lothian region. There are buildings of various dates, from the early 19th century to the early 21st century on the large site in the Grange area of Edinburgh. The hospital was established for convalescent patients from the Royal Infirmary of Edinburgh by a generous bequest from David Ainslie. The site comprising four large villas and a golf course was acquired in 1921, and the architect John Jerdan commissioned to adapt one of the villas – Canaan Park – as the first phase of turning the new hospital. The house became the main administration department with a new wing added to the south for 34 female patients under the charge of Dr (Isabella) Mary Mears, the resident medical officer.

The first patients were admitted in 1923, and three years later the Nursing Times provided a description of the new institution along with a photograph of the recently built ward unit (see above). The article noted the beautiful grounds, with fine view to the Braid Hills, and that the new ward unit was ideally suited to its purpose of a ‘convalescent retreat’. Although the Astley Ainslie was intended for patients from the Royal Infirmary it was independently run, with its own body of governors, as intended by its benefactor, David Ainslie. It was on his instruction that the hospital was named after John Astley-Ainslie, David Ainslie’s nephew who had died at the young aged of 26. It was also intended that the institution should be for cases that required longer care than was provided at the Infirmary’s existing convalescent home at Corstorphine (see the Edinburgh page for more details).

The Nursing Times described the entrance hall of Canaan Park House as having a piano and that it was ‘bright with pots of growing chrysanthemums’. The colour scheme generally was white and green – colours chosen for their calming and restful qualities. No operations were to be conducted at the hospital, but post-operative treatment, such as changing dressings, was one of the potential nursing duties. Initially the patients were generally surgical, tuberculosis or adolescent heart cases. The wards were ‘big, bright, airy places built on the horseshoe plan’, the balcony and veranda were accessed from large French windows, and had five beds on each, with a further twelve within the ward. Some patients slept out on the balcony or veranda in winter and summer. As well as the two wards, the patients had the use of a dining-room that also served as a recreation room.

The ample grounds at the Astley Ainslie allowed out-door recreation including bowls, croquet and clock golf. Patients could also undertake gardening in the vegetable garden. Indoors there was a well-stocked library, while concerts, lectures and entertainments were organised regularly.

Flowers, fruit and vegetables were supplied from the gardens, and the original gardeners to the large houses were retained with a view to preserving the ‘old-world appearance’ of the grounds. An ample supply of fresh produce was a vital part of providing patients with a nutritious diet, with a stress on milk, butter, eggs, green vegetables and fruit. A considerable part of the estate was laid out as a kitchen and fruit garden in order to maintain a constant supply. The best diet for convalescents was an ongoing subject of study. Early experiments at the Astley Ainslie in trying to encourage patients to consume plenty of green vegetables, especially when raw – such as lettuce and tomatoes – was too much of a novelty for some, being ‘often neither appreciated nor eaten without persuasion’.[J. Cunningham, Edinburgh Medical Journal, 1931 v.38 (9), p.146.]

The beneficial effects of nature, of fresh air, sunlight and pleasant grounds, had long been recognised as an important part of the therapeutic treatment of convalescent patients and before the development of effective drugs to treat tuberculosis had been shown to slow the progress of that disease in some patients. Sanatoria were designed with sun-trapping angled plans – a butterfly, or half-butterfly plan – with verandas in front onto which beds could be wheeled. This was the form adopted for the new blocks built in the hospital grounds, but even in the first ward extension to Canaan Park House a sun-trap was created where ‘screen-enclosed, sun bathing takes place in summer’ and a wooden shelter was built where patients could sit out and enjoy ‘the wintry sunshine, each clad in a big coat and wrapped about with a warm fleecy blanket’.

Two neighbouring villas were acquired in the 1920s to extend the site: Morelands and St Roque House. In the second half of this decade the first two new hospital blocks and a nurses’ home were constructed. For the design of the new buildings the governors turned to the architects Auldjo Jamieson and Arnott, who had taken over the practice of Sydney Mitchell and Wilson, architects of many hospital buildings including extensions to the Royal Infirmary. The grandly named and wealthy Ernest Arthur Oliphant Auldjo Jamieson (1880-1937) had worked in Mitchell and Wilson’s office early in his career before setting up on his own account around 1909-10, but soon after the two practices were merged and James Alexander Arnott (1871-1950) joined as a partner.

The 1920s hospital blocks (now the East and West Pavilions) were single-storey, butterfly-plan buildings built on the site of the ladies’ golf course (see maps above and below). The slope of the site gave uninterrupted views of Blackford Hill to the south.

A third butterfly-plan pavilion was built on the site of Millbank House which was acquired by the governors around 1930. At the same time a new main entrance to the site was created on Grange Loan with its fine wrought-iron gates made by Thomas Hadden in his characteristic Arts & Crafts style of flowing natural forms (see photographs at the top of the post and below). The gates were hung between square sentry pavilions with pyramidal roofs and over-sized circular window.

The nurses’ home was completed in 1930, a two-storey and attic, H-plan building, built on the site of South Bank House, just west of the former golf course. Plans of the home had been drawn up by 1925 when they were published in the Architects’ Journal. It followed the conventions of the time, with single bed-rooms for 45 nurses and shared bathrooms and toilets on the upper floors, and communal recreation rooms on the ground floor.

Just north of the nurses’ home a central kitchen block was built, now the Blackford Pavilion and still functioning as a kitchen and canteen. It also houses NHS Lothian’s health promotion Resource Centre. A covered corridor connects the centre to the nurses’ home.

A scientific block was amongst the early buildings at the Astley Ainslie, reflecting the governors’ decision that the institution should act as a centre for investigating the problems connected with convalescence and the greater prominence of rehabilitation in the years after the First World War. The large numbers of military personnel who became disabled in action led to developments in prosthetics and a range of treatments or therapies. The scientific block was designed in more formal style than the ward pavilions, its south front featuring an arcade of Grecian Doric columns within which the main entrance sits behind a pair of columns set in Antis. It housed a gymnasium for physiotherapy (at the time termed ‘massage’ and remedial exercises – a reminder of physiotherapy’s origins in ‘Swedish Gymnastics’). It also had an electric department with x-ray equipment, rooms for ultra-violet radiation and electric therapeutics, a dentist’s room, dispensary and research laboratory. Heliotherapy was an important part of convalescent treatment, but the unreliability of the weather soon led to the addition of an artificial sunlight lamp.

In April 1929 Lieutenant-Colonel John Cunningham was appointed as the Medical Superintendent of the Institution. He delivered a number of papers about the new science of convalescence to the Edinburgh Medical Society that were subsequently published in the Society’s journal. In a paper of 1931 he noted that the organised study of convalescence and the methods of dealing with it were of recent growth, and that there were few publications on the subject. Historically the main ingredients of successful convalescence were ‘moderation in exercise, peace of mind, tranquil sleep, and proper hygiene’. [Cunningham, ‘The Convalescent State’, Edinburgh Medical Journal, 1931, vol.38 (9), p.137.] However, until at least the mid-19th century, convalescence had been available only to the rich – ‘the poor man had no time to be sick, and still less were facilities for recovery provided for him’. [Idem. p.138.]

The earliest convalescent hospital founded in Britain was probably the Metropolitan Convalescent Institution, founded in 1841 and later moving to purpose-built accommodation at Walton-on-Thames (later named Ellesmere Hospital, see the Surrey page for more details). The type of convalescent home that developed concentrated on cases that were already well on the way to recovery. Most were unable to take patients who required active medical attention.

The Health Insurance Acts improved access to basic convalescence to the working classes (see Convalescing in Colwyn Bay for more details). There had long been an economic advantage to giving the work force a proper opportunity to convalescence – both from an employers’ point of view and for hospitals. Apart from freeing beds in an acute hospital by transferring convalescents to a different setting, the relative cost per bed of a convalescent home was significantly less than for an acute hospital.

During the First World War convalescent establishments were provided as well as hospitals for the military. This spurred advances in the study and treatment of convalescence, as well as bolstering the arguments for separate convalescent institutions that were specially designed and equipped for the purpose. Classification of convalescent patients was developed to outline the different requirements of particular groups, such as cardiac, orthopaedic or psychiatric.

By the 1920s America was forging ahead in refining the treatment of convalescents. The main sources of information were publication by John Bryant in the 1920s, and the example of the Burke Foundation near New York. The Burke Foundation had 300 beds and dealt with many cases previously excluded from convalescent homes, such as chronic illness and physical disabilities. Occupation and recreation as aids to recovery played an important role. There are cross-overs here with therapies in psychiatric hospitals of the time and particularly in institutions for those with learning disabilities, but the benefits of encouraging some form of occupation for convalescent patients had been recommended by many, including Florence Nightingale. Occupational therapy developed during the First World War, when it was shown to have positive effects on mental wellbeing (or in the language of the time, ‘mental tone and preventing moral deterioration).

One of the pioneering advocates of occupational therapy in Britain was Sir Robert Jones, who noted the lesson learnt during the First World War of the psychological and physical value of work. Workshops for wounded soldiers filled the hours when they weren’t undergoing treatment, usefully distracting their minds. The Canadian war hospitals were some of the first to place ‘Occupational therapy’ on an organised basis, while some of the earliest training schools for occupational therapists were established in Canada and the United States. The Astley Ainslie was one of the first to establish a school of Occupational Therapy in Scotland.

In a future post I will look at some of the later developments at the hospital.