The Architecture of Isolation

May 2, 2020 / Harriet Richardson / 2 Comments

Recently I wrote a short post on this topic for the Society of Architectural Historians of Great Britain for their website. This is a slightly revised and extended version of that piece.

Interior view of NHS Nightingale, London. Photographed on 27 March 2020 by No.10 Reproduced under Creative Commons License CC BY-NC-ND 2.0

The conversion of exhibition centres to temporary hospitals in our major cities mimics earlier measures to cope with hospitals overwhelmed by cases of infectious disease. Though nothing on quite that scale, as far as I am aware. The last major pandemic that occurred in Britain, the ‘flu that ran rife after the First World War, completely overwhelmed the systems in place to deal with infectious diseases which included a nationwide network of isolation hospitals. These hospitals had been built in response to a series of earlier epidemics, which had given rise to a sequence of Public Health Acts, variously aimed at improving environmental health, preventing the spread of disease, and containment when disease did occur.

Old leper Hospital of St. Bartholomew, Oxford. Wellcome Collection. Attribution 4.0 International (CC BY 4.0)

Some of the earliest hospitals were provided for the purpose of isolating those with infectious diseases. Colonies for lepers were established on the outskirts of settlements from the late 11th century to the early 13th. When the Black Death arrived in England in 1348 land was set aside for cemeteries in which to bury plague victims. Later epidemics led to the establishment of Pest Houses – these were mostly isolated dwellings for those who could not be isolated in their own homes. By the 17th century these were commonly administered by the local parish, a nurse would be employed to occupy the house and care for patients sent there.

The Bills of Mortality from 1664. Reproduced from Paul K. BibliOdyssey Bogspot

In London, the course of the Great Plague was documented by those who lived through it, most notably Samuel Pepys and John Evelyn. Statistics which charted the rise and fall of epidemics began in the late 16th Century with the Bills of Mortality, printed and published weekly giving the numbers and causes of deaths. Isolation remained the main way of dealing with contagion.

Aerial photograph of the Lazaretto Vecchio, from Chris 73 Reproduced under Creative Commons License CC BY-SA 3.0

Ports were the vulnerable points for introducing infectious disease – and most had some form of quarantine station. Lazarettos, or Lazar house, close to a harbour or on an island were more often permanent and purpose built. The Venetians were perhaps the most efficient at setting up a network of lazarettos to protect their trade interests throughout their territories. The Lazzaretto Vecchio on Santa Maria di Nazareth, an island in the Venetian Lagoon, was established in the early 15th century for both plague victims and as a leper colony. These hospitals were maintained and continued to serve their original purpose for centuries.

The Fortress of Clissa, from Les bords de L’Adriatique et le Monténégro, Charles Yriate 1878

In 1757 when Robert Adam journeyed to Spalatro (modern day Split, then a Venetian territory) to explore and record the Roman antiquities of Dalmatia, he was initially put up at the governor’s residence in the lazaretto by the harbour. He recorded how traders bringing goods from Bosnia and the neighbouring parts of Turkey were escorted by soldiers from the Fortress of Clissa (now Klis) to Spalatro to prevent them from ‘Scattering or Mixing with the People’ until their goods had been purified in the magazines of the Lazaretto and the traders themselves spent time in quarantine there. [National Records of Scotland, Clerk of Penicuik Papers, GD18/4953.]

Edward Jenner vaccinating patients against smallpox. Wellcome Collection. Attribution 4.0 International (CC BY 4.0)

Although various remedies were experimented with to treat disease, medicine was first used successfully in the realm of prevention, with inoculation and vaccination against smallpox. Inoculation was introduced to England in the 1720s from Turkey, and vaccination discovered by Edward Jenner at the end of the century. Despite the success of the vaccine, public uptake was not sufficient to prevent further epidemics. The first purpose-built smallpox hospital in England was in Cold Bath Fields, Clerkenwell, built around 1753. At that time three such hospitals were in existence in London: one in Islington was for those convalescing from the disease, one in Shoreditch was for those who had smallpox although they had been inoculated, and so had a milder form of the disease, while that in Clerkenwell was for the severest cases – those who had never been inoculated.

View of the Coldbath Fields smallpox hospital in 1823, by which time it had been replaced by a new hospital in St Pancras. The redundant hospital was subsequently used as a distillery. Reproduced from the Survey of London, volume 47 original in Islington Local History Centre

As the onus on action was placed at local level, and legislation advised on measures that could be taken, rather than dictating what must be done, responses to epidemics varied across the country and often took too long to be truly effective. With inadequate existing hospital accommodation, outbreaks of smallpox and cholera saw houses, factories and barracks commandeered. In Aberdeen a disused match factory was turned into a temporary hospital by the City Corporation after an outbreak of smallpox in the early 1870s. In most cases once the outbreak subsided the temporary hospitals closed and any plans to build permanent isolation hospitals were abandoned. But at Aberdeen a permanent hospital was begun in 1874, designed by the City Architect, William Smith II, and unusually constructed of concrete. This was chosen on the principle that the wards could be hosed down and disinfected after use. Even the floors were of concrete. Later, timber floors and panelling were inserted to soften the rather prison-like interiors.

View of one of the ward blocks at the City Hospital, as altered and enlarged to designs by John Rust in the 1890s https://canmore.org.uk/file/image/1374923

Detail of a plan of the City of Aberdeen from the Post Office Directory of 1879, showing the ‘Epidemic Hospital’ on the outskirts of the city. Reproduced by permission of the National Library of Scotland

Until about the 1860s there was no consensus regarding ideal hospital design. Of the few purpose-built fever hospitals erected in the 18th and early 19th centuries, some had small wards arranged on either side of a corridor with the idea that smaller groups of patients limited the risk of cross-infection, others large open wards with twenty or more beds. The presence of such a hospital – often optimistically dubbed a ‘house of recovery’ – on one’s doorstep was understandably unpopular. When one was set up in a house off Gray’s Inn Lane the neighbours threatened legal action to have it closed. It decamped northwards, and eventually became the London Fever Hospital, designed by Charles Fowler and built in 1848-9 on Liverpool Road, Islington. Here a mix of small, large and back-to-back wards seems evidence of a lack of confidence in any one system.

Coloured engraving of the main front of the London Fever Hospital. Reproduced from the Wellcome Collection https://wellcomecollection.org/works/pspzgh6a

Plan from The Builder, 12 August 1848, p.391

General hospitals also took in infectious cases, sometimes against their own regulations, but needs must. The London Hospital and University College Hospital both set aside wards for contagious cases in the 1830s and 40s. Other hospitals built separate fever blocks, one of the largest was at the Royal Infirmary in Glasgow, built in 1828-9

The west front of the Fever block, probably photographed around 1910. From the Wellcome Collection CC-BY-4.0.

The Poor Law Amendment Act of 1834, and its counterparts in Ireland of 1838 and Scotland of 1845, not only saw a network of workhouse built across Britain but also of associated infirmaries and fever blocks. A small single-storey fever hospital was built as early as 1836 at Stow-on-the Wold workhouse in Gloucestershire.

The first cholera epidemic in Britain erupted in 1831 and claimed around 22,000 lives. Yet there was scant progress in providing hospitals for its victims. A Cholera Prevention Act of 1832 had little effect. The worst epidemic came in 1848-9, in which about 50,000 lost their lives in England and Wales. This was particularly devastating, coming just a decade after a smallpox epidemic that claimed the lives of around 42,000. Legislation continued to encourage the provision of isolation hospitals, but hospitals were expensive to build, and raising the money from local rates to pay for them as unpopular. In the midst of each succeeding epidemic local authorities accepted that available hospitals accommodation was disastrously inadequate, but had seldom gone farther than proposing to take action before the epidemic subsided and the initiative was lost. The cholera epidemic of 1866 for example prompted the erection of only a few hospitals although the provisions of the Sanitary Act of 1866 gave town councils and local boards of health the power to provide either temporary or permanent hospitals and justices of the peace the power to remove patients to them.

Aerial photograph of the Brook Fever Hospital, Shooter’s Hill, London built by the Metropolitan Asylums Board and opened in 1896. Wellcome Collection. Attribution 4.0 International (CC BY 4.0

In London the Metropolitan Poor Law Amendment Act of 1867 resulted, eventually, in a comprehensive network of fever hospitals around London, linked by an efficient horse-ambulance service. Public fear remained strong. The building of a large smallpox hospital in Hampstead was considerably delayed by local opposition. Most isolation hospitals were built well away from the denser urban areas, and floating hospitals served by river ambulance operated from wharves at Fulham, Blackwall and Rotherhithe.

Outside London, from the 1870s the construction of isolation hospitals was overseen by the Local Government Board, and following the 1875 Public Health Act loans were made available to build them. Low cost solutions widely adopted were the purchase of a tent that could be put up and used in emergencies, or the erection of temporary, pre-fabricated hospitals. Hospital huts of timber and corrugated iron were supplied by various companies: Humphreys of Knightsbridge; Boulton and Paul of Norwich; Speirs and Company of Glasgow being three of the largest and most enduring. The corrugated iron block near Hempsted, to the south-west of Gloucester, may have been supplied by Humphreys – Gloucester was listed as one of the places supplied by the firm. A smallpox epidemic in 1874-5 had raised talk of erecting a temporary iron hospital. An even worse epidemic struck the city in 1895-6. Dr Sidney Coupland prepared a lengthy report, attempting to assess why this epidemic had been so much worse than the previous one, and to what extent re-vaccination had contributed to its rather abrupt cessation. Some of his observations strike a chord today: ‘It is possible that the hope was entertained that by an attempt to isolate every case as it arose the epidemic might be checked, but this attempt only resulted in filling the hospital beyond its capacity and over-burdening a too-restricted staff.’

Hempsted Smallpox Hospital, Gloucester, photographed by H.C.F. in 1896 Wellcome Collection. Attribution 4.0 International (CC BY 4.0)

Where permanent buildings were erected, they were usually based on standard plans drawn up by the Local Government Board and issued between 1876 and 1924 in a series of memoranda. The model plans adopted the pavilion principles of planning, validated by Florence Nightingale, with open wards, windows placed opposite each other to create cross-ventilation, and W.C.s placed away from the ward, separated from it by a cross-ventilated lobby at the very least. These were intentionally draughty places. Currents of air were drawn through the wards through open windows, ventilation grilles and ducts. Drainage too, became increasingly important to keep infected waste out of the water supply. The new isolation hospital for Hemel Hempstead, built in 1914-15 at Bennet’s End, is a typical example. It was designed by John Saxon Snell and Stanley M. Spoor and comprised two single-storey ward blocks, an observation block, a service building housing the laundry, with steam disinfector, mortuary, and ambulance garage, and an administration block with nurses’ accommodation. The wards were intended for the most prevalent diseases at that time, diphtheria and scarlet fever, with the observation block for the undiagnosed.

A ward block built at the Hemel Hempstead Infectious Diseases Hospital at Bennet’s End, based on the model plans issued by the Local Government Board. LGB model plan B, 1900 and 1902-21 versions. The Bennet’s End ward has elements of both. Ward block photographed in May 1992 as part of the RCHME Hospitals survey. © H. Richardson

LGB model plans from Local Government Board On the Provision of Isolation Hospital Accommodation by Local Authorities August 1900, and reissued in 1902.

Research interest in bacteriology from the late 19th century saw the rise of laboratories, in Glasgow a laboratory was set up to deal with the bacteriology of epidemics. This research helped the medical officers of health to control epidemics through isolation, supervision of carriers and contacts, tracing the source of infection and the pathways by which it spread. The present test, trace and track strategy has its roots in this late-Victorian public health policy. Then as now it was widely recognised as the most effective means of controlling epidemics. One historical method of interrupting the spread of disease was to provide a ‘reception house’ to take families who had been in contact with infected persons, such as that opened on Baird Street in Glasgow in 1906.

Baird Street Reception House, from the 1906 Medical Officer of Health for Glasgow’s Annual Report.

Ground and First-Floor plans of the Reception House.

Progress in medical knowledge was reflected in hospital design. A better understanding of the transmission of diseases and the discovery of bacteria were factors behind the development of the cubicle isolation block. This first appeared in the early twentieth century. One was built at Walthamstow which consisted of rows of single rooms reached from an external veranda. This allowed patients suffering from different diseases, or who were yet to be diagnosed, to occupy one building. Glazed partitions between the rooms allowed nursing staff to supervise the patients, as well as allowing patients to see each other. By about 1940 almost every isolation hospital in the country had at least one cubicle block. At Twickenham the former South West Middlesex Hospital was originally built in 1898 to designs by W. J. Ancell comprising four ward blocks and the usual service buildings. Two cubicle isolation blocks were added in 1937 as part of a major extension of the hospital. Following the Local Government Act of 1929, provision for infectious diseases passed from the myriad of small local urban and rural sanitary authorities to county and borough councils, this also led to many of the smaller hospitals being replaced by larger more centralised hospitals.

Cubicle isolation block built at the South West Middlesex Hospital, exterior and interior views. Photographed in November 1991 © H. Richardson

Wide-ranging public health measures to improve living conditions were the first effective weapons in lessening the impact of infectious diseases. Improved housing, sanitation, and street cleaning, regulation of lodging houses and factories, testing for food adulteration, were all vital preventive measures. Local Medical officers of health had a wide network of resources from laboratory research to morbidity and mortality statistics, to help them control epidemics through isolation, supervision of carriers and contacts, tracing the source of infection and the pathways by which it spread, and interrupting these by whatever means were available. Vaccines, inoculations, and effective treatments, for the most part, came after the Second World War. Since then we have been in a period of epidemiological transition, shifting from an age of receding pandemics and into an age of degenerative and so-called man-made diseases (those associated with lifestyle, such as heart disease, or lung cancer from smoking).

Infectious diseases were not wiped out, but could be treated within a general hospital. Post-war general hospital design included a higher proportion of single rooms in ward units to allow patients to be isolated for a variety of reasons, cross-infection being one of them. An experimental ward unit built at Hairmyres Hospital, East Kilbride, in the 1960s, was used to study ways of reducing cross-infection, but one of its findings was that human error remained a major culprit. Medical, nursing and domestic procedures could be one source, but also misuse of the engineering services. They found ventilation diffusors and exhaust grilles blocked up by the medical staff.

Photographs of the interior of NHS Nightingale show the huge open warehouse being fitted up with cubicles – here to facilitate laying on all the necessary services for each patient rather than isolating one from another. A dedicated hospital for infectious diseases is an old solution, but it is still a valid one, provided the infrastructure, the equipment and staffing are also in place – along with the necessary training in how to operate the appliances and services. As history shows, to tackle epidemics of infectious disease isolation hospitals need to be backed up by systems of quarantine, testing, tracing and tracking.

William Goldring and Asylums — The Gardens Trust

April 25, 2020 / Harriet Richardson / Leave a comment

This blog post on asylum landscape design was posted recently on the Gardens Trust site. I sympathise on the difficulties of researching the gardens and grounds of hospitals, it can be very difficult to find much information in the surviving documentary sources. Old maps provide evidence of how diverse and complex these designed landscapes were.

At the end of last year I wrote about the work of William Goldring, a prolific landscape and garden designer who died in 1919. Apart from his private commissions and work on public parks he was also involved in the design of landscapes that have been generally overlooked by garden and landscape historians: those of […]

via William Goldring and Asylums — The Gardens Trust

The Hospitals on Islay

June 2, 2019November 26, 2020 / Harriet Richardson / 5 Comments

Islay Hospital, Bowmore. View of the ward block and main entrance from the west. Photographed in May 2019, © H. Richardson

There have been three hospitals on Islay: a poor law institution that provided medical care for paupers and in the early decades of the National Health Service became the island’s general hospital; an infectious diseases hospital, established in the 1890s, and provided with a permanent small building in 1904; and the present Islay Hospital built in 1963-6, pictured above.

Screen Shot 2016-03-03 at 21.23.29

Extract from the 1st-edition OS map, surveyed in 1878, reproduced by permission of the National Library of Scotland

The earliest of these was the poorhouse, built in 1864-5 on the outskirts of Bowmore on land owned by Charles Morrison. The local Parochial Board decided to get their plans from an Edinburgh architect with experience in such buildings, J. C. Walker. As can been seen from the map above, the building comprised an H-shaped complex. The main north wing was of two storeys, the rest single-storey. (For a photograph of the poorhouse see the Islay History blogspot)

Gartnatra Hospital, from an old photograph on display at the Columba Centre.

To comply with the Public Health Acts the local authority had to provide accommodation for cases of infectious disease and so a fever hospital was established at Gartnatra, to the east of Bowmore. Although the building pictured above was built in 1904, there had been a hospital hereabouts since at least the mid-1890s. The local Medical Officer for Health, Dr Ross, reported on an outbreak of measles in 1895, the patient being removed to the hospital. However, as there was no nurse employed by the local authority to attend the hospital, the patient’s mother went to nurse her daughter. Dr Ross had no authority to confine the mother to the hospital, and she went in to the village on many occasions. In a short time the disease spread rapidly throughout Bowmore.

The former fever hospital, now the Columba Centre. Photographed in May 2019, © H. Richardson

The situation was finally remedied with the erection of a new building for which the plans were approved by the Local Government Board for Scotland in 1902. To cover the cost of construction a loan of £1,100 was secured from the Public Works Loan Board. The building is dated 1904, and the Local Government Board sanctioned it for occupation in February 1905. It was built by James MacFayden. The building survives, though the interior has been completely refurbished and a large extension built to the rear. It is now in use as a cultural centre.

The former Gartnatra Hospital, viewed from the east. The old hospital is the gabled block on the left, with the short bay attached (the former sanitary annexe). The rest has been added to form the new cultural centre and cafe. Photographed in May 2019, © H. Richardson

With the establishment of the National Health Service in 1948 the administration of Gartnatra Hospital and the poorhouse, latterly known as Gortanvogie House, passed to the Campbeltown and District Hospitals Board of Management, under the Western Regional Hospital Board (WRHB). Under the terms of the National Health Service Act responsibility for the elderly remained with local authorities, so the presence of elderly as well as the sick at Gortanvogie posed problems. In the opinion of the Board of Management, although Gortanvogie left much to be desired, the conditions were probably better than most of the patients enjoyed at home.

Photograph taken in 1955 outside Gortanvogie Hospital. The Matron, Miss C. E. M. Morrison, is seated on the left, and behind her in uniform is the hospital sister, Agnes Watson Miligan. A colleague is pictured seated to the right, and a young patient standing behind. (Reproduced by kind permission of L. Tudball. © L. Tudball.)

Given the list of improvements that the Matron had requested, this makes for a depressing view of those conditions. She had asked, without success, for: electric light – the Hydro Electric Board’s supply reached the front door, but the building was not wired; hot water on the ground floor; a bathroom directly off each main ward on the ground floor; a linen cupboard; wooden or other suitable flooring instead of stone floors; a brick side screen with steel windows along the outside of a covered way between the front and back of the building to stop the inmates from passing through the staff dining-room; essential repairs to the structure of walls and ceilings, and re-slating a large part of the roof. Neglect of building maintenance during the war, common throughout Britain, had left many of the inner walls damp and rotten, with plaster having fallen from many of the ceilings.

Extract from the 2nd-edition OS map, surveyed in 1897, reproduced by permission of the National Library of Scotland

Gartnatra, on the other hand, was described as well-built with no serious trace of damp except in two W.C.s at the back on either side which were below a flat part of the roof where the rain water had forced a way in during stormy weather.

‘The site of Gartnatra is bleak and exposed to the prevailing westerly wind coming off the bay; there is nothing “cosy” about the building, but Matron remarked that the islanders are used to hearing the wind roar about their houses. Our visit was on a day of cold rain. A shelter belt of trees would obviously be desirable, but we were told that owing to the wind and the salt spray from the sea, there would be little chance of trees growing.’

The former Gartnatra hospital, now the Columba Centre, viewed from the south-east. Photographed in May 2019, © H. Richardson

When the question of modernising the hospital facilities was under discussion, a small team from the mainland visited Islay in May 1952 that included Mr Guthrie, the Regional Hospital Board Architect, Dr Guy, the Medical Officer of Health, and representatives of Argyllshire County Council. The Secretary of the Board of Management for Campbeltown & District Hospitals favoured an extension to Gartnatra but the local doctors argued for a new hospital on a more convenient and sheltered site. Funding was the main problem, but the Department of Health were conscious that spending money on upgrading inferior accommodation was not the best long-term policy.

Plans for extending Gartnatra were drawn up by the WRHB architects, only to be rejected by the Board of Management. With patient numbers dwindling to none, Gartnatra closed in April 1955. The following year the tide had turned towards using Gortanvogie as the hospital and turning Gartnatra over to the local authority as a home for the elderly, and in 1958 sketch plans were drawn up by the WRHB for a new hospital building on the Gortanvogie site. By May 1959 these plans seem to have evolved into something like their final form, encompassing the demolition of Gortanvogie and building in its place two separate buildings, a hospital and a home for the elderly. This was certainly the case by the following May, when some of the problems of shared staff and services were beginning to be discussed.

Islay Hospital, south-west corner of the main block, showing what was originally planned as the patients’ dining and sitting-room and on the left the end of the link corridor to the Eventide Home. © H. Richardson

By July 1960 detailed plans had been drawn up by the WRHB and submitted to the Department of Health. Forbes Murison, Chief Architect to the WHRB, had been building up a central staff of architects with some success, and did not want to have them sitting around doing nothing. The Islay job was one on which he was keen to let them cut their teeth. In 1960 Douglas Gordon McKellar Adam had joined as Principal Assistant, (he became Assistant Chief Architect in 1962).

Islay Hospital, general view from the entrance looking along the south side of the ward block, photographed in May 2019 © H. Richardson

In the hopes of gaining the necessary approbation from the Department of Health, the WRHB stressed that Gortanvogie was one of the few examples of an old poorhouse still used in the hospital service in the Western Region. It not only had 12 beds for the sick, but 8 for the old and infirm under the charge of the local authority. Despite the nature of its original purpose, the hospital had in recent times been fulfilling the functions of a cottage hospital by the admission of general and maternity patients. The fabric of the building was so poor as to make reconstruction unviable. Many of the floors were laid directly on the ground, and there was practically no sub-floor ventilation. The intention was to provide all the services of a general cottage hospital and make the island as independent of the air services as practicable. Argyll County Council wished to arrange for the provision of a 20-bedded Eventide Home as part of the scheme, and it was agreed that the one architect should design both, and that this should rest with the Regional Board’s architectural staff.

The entrance front of the Eventide Home, photographed in May 2019, © H. Richardson

The new hospital was also originally to provide 20 beds (an additional maternity bed was added later), as well as X-ray, casualty and treatment room, mortuary, boiler-house, kitchen etc, accommodation for the matron and six nurses – considered essential given the location on a ‘remote island’. From the start, the hospital was to be linked to the eventide home by a covered way, and the heating, hot water services and kitchen were to be shared. This raised the question of who should fund what. It also required authorisation from the Treasury as sharing facilities was not authorised by the National Health Service Act. Although combining a hospital with a home for the elderly went against government health policy, as well as introducing the complexity regarding shared funding, mixed institutions were thought to have a place in the more remote parts of the Scottish Islands and Highlands.

Plan of Islay Hospital, based on original dated January 1962, in the National Records of Scotland. © H. Richardson

At this point the estimated cost was £146,000. At the end of October the Department forwarded their comments on the plans. Within the Department of Health these were circulated to a team of advisers on the different elements of hospital design, function and administration, each of whom submitted comments, criticisms and suggested alterations. The list of criticisms was lengthy, ranging from concern over the position of the maternity unit below the staff residential quarters (as babies’ crying was liable to cause disturbance), to suggesting that the entrance to the visitors’ viewing room into the mortuary should be placed opposite the doctor’s room rather than in the main hall. Some rooms they thought too small, others too large.

Islay Hospital. This block was designed as the maternity wing with staff accommodation on the upper floor © H. Richardson

Treasury approval was granted in November 1960, and the following month the Department was able to give the Regional Board approval in principle to enable planning to proceed. In June 1961 the WRHB sent in revised plans, and raised the issue that the scheme would need to be carried out in two phases, the first phase being the provision of the hospital which could be done without demolishing the existing building, and the second phase being the eventide home following demolition. The revised plan for the eventide home had by then already been agreed to by the County Council, but one of the Department of Health’s architects, R. L. Hume (presumably Robert Leggat Hume, 1899-1980), also discussed the plan with the Regional Board, which seems to have resulted in further revisions.

Islay Hospital, main entrance © H. Richardson

Some of the criticisms revolved around room allocation, others around safety. The home was designed around a garden court with a pool in the centre – and so there were concerns that the old people might fall in. Hume discussed the plans with Mr Ellis (Kenneth Geoffrey Ellis), one of the Regional Board’s architects who confirmed that the points raised had been attended to, and that the pool was intended to be shallow with low shrubs or flowers planted around it to keep old people away from the edge. (The plans submitted to the Department were drawn by Ellis, and are dated January 1962.)

Islay Hospital, viewed from the south-east looking towards the maternity and staff quarters’ block. On the left is the rear of the entrance block, and the link range contained treatment rooms and the X-ray room. © H. Richardson

Although it had been hoped that building would start in the financial year 1961-2, the already complex bureaucracy was exacerbated by the apportionment of costs between the Department and the County Council. It was not until June 1962 that the Department sanctioned the preparation of final plans.

Islay Hospital, from the north-east with the ward block in the centre and the eventide home to the right of the picture © H. Richardson

Revised plans were submitted in April 1963, and circulated yet again to the Department’s professional advisers for comment. As comments trickled in they were relayed back to the Regional Board, but the Department was at pains to stress that they would not expect drastic alterations to the proposed layout at this stage. The main delaying factors were not difficult to identify: the amount of scrutiny that the project was given had led to ‘a good deal of adverse comment on the plans’; the architectural staff of the WRHB were under pressure to cope with the wider building programme; and the awareness of the shortage of capital funds had generated a reluctance to embark on a relatively expensive project for its size. Once the plans were agreed and the costing completed, work began towards the end of 1963.

Islay Hospital, north side, with wards and kitchen block. © H. Richardson

Caution over the estimates was well founded. Within the three years since the original probable costing of around £100,000, it had more than doubled to £236,816. The revised figure took into account the special prices that might be expected to be charged for building on Islay. But everyone involved was aware that costs might still creep up. The main difficulty was attracting a sufficient number of contractors even ‘reasonably interested’ in building on Islay, in order to avoided inflated prices.

The north-east corner of the Eventide Home, with the link corridor between it and the hospital, photographed in May 2019 © H. Richardson

The hospital was built first, then Gortanvogie House demolished and the home built on its site. In 1966 work on the hospital was completed. It had cost about £180,000, and provided 12 chronic sick beds, 6 beds for general medicine and 3 maternity beds.

Sources:

National Records of Scotland, HH101/1491: Dictionary of Scottish Architects

Charnwood Forest Convalescent Homes

February 3, 2019February 6, 2019 / Harriet Richardson / 6 Comments

As convalescent homes were not strictly speaking medical buildings, and most of the patients sent to convalescence were able to get up during the day, many were established in private houses which required little alteration to fit them to their purpose. If they proved popular and were well supported, they might be replaced by a purpose-built establishment. Location was important, somewhere where the patients could benefit from clean air away from the cities or towns where they were likely to have been living. Many general hospitals set up convalescent homes in the surrounding countryside or by the sea. Others were independent, but both types were run as charitable ventures, supported by donations, subscriptions and fund-raising events.

Old postcard of the Charnwood Forest Convalescent Home. © H. Martin

Charnwood Lodge, near Loughborough, is now a residential home for people with autism and complex behaviour run by Priory Adult Care, but it was originally built as a convalescent home. The foundation stone of was laid on 2 August 1893 by the Duchess of Rutland, and the home was designed by local Loughborough architect, George H. Barrowcliff. A convalescent home for Loughborough patients had first been established in rented rooms in a cottage at Woodhouse Eaves in 1875. Its success led to the opening of a second convalescent home in 1879, intended for Leicester patients. The two homes were merged in 1883 from which time they were officially known as Charnwood Forest Convalescent Homes.

Extract from the 25-inch OS map revised in 1901. Reproduced by permission of the National Library of Scotland

The new building, pictured in the postcard and marked on the map above, was described in the Nottingham Evening Post when the foundation stone was laid in 1893:

The building is situated on the west side of the Buck Hill road, in the heart of Charnwood Forest, being midway between Nanpantan and Woodhouse, … It is sheltered by the Outwoods from the east, by the rough rising rocks known as Easom’s Piece from the west, and by the rising ground at the rear on the north. This site, selected by the committee after most careful consideration, contains an area of four acres, a part of which is covered by a spinney, and it is proposed that the remainder shall be laid out as ornamental grounds. The building, which is of a domestic character, is being erected of the local forest stone, and faced with red sand faced bricks to the doors, windows and corners, and with a brick lining on the inner side, all the external walls to the main building being erected with a two-inch cavity between the stonework and the inner lining. On the front of the building a verandah 7ft 6in wide runs the entire length. This is partly covered with glass, so as not to diminish the light in the rooms. The building will consist of ground, first and second floors, with a spacious corridor running the entire length of each. The entrance hall is approached from the centre of the verandah, and will be available as a committee-room or for the patients to receive their friends, and is divided from the men’s and women’s corridors by swing doors. The remainder of the front consists of three sitting rooms … and a matron’s room 16ft by 13ft. The back portion of the main building ground floor consists of dining hall, … capable of seating 56 persons; sitting room, … china and store rooms. Main staircases at either end lead to the men’s and women’s bedrooms. At the rear are kitchen … scullery, larder, and other offices opening into large paved yard, at the side of which a coach-house is being erected. Suitable lavatory accommodation, lined with white glazed bricks, and isolated from the main buildings, is provided for both sexes at either end of the building. The ventilation and sanitary arrangements are as perfect as can be attained. … The house is designed for 45 patients, and for the entire separation of the sexes except when taking meals, when they will meet in the common dining hall. The sitting and bedrooms will be heated by open fire grates, and the corridors and dining hall by hot water. … The architect after careful consideration has selected the Brindle tile for the roofs from Mr J. Peake, Tunstall bricks for facings from Messrs Tucker and Son of Loughborough, the stone from Messrs. Brabble & Co. Farley Darley Dale quarry. The cost of the structure complete including purchase of land, water supply furnishing etc will be about £6, 000, and the contract is being carried out by Messrs W. Moss & Son of Loughborough, under the direction of the architect, Mr George H. Barrowcliff, of Loughborough.

The home was formally opened by the Duke of Rutland in 1894, and in 1896 a lodge was added to accommodate the gardener who also acted as caretaker to the home while it was closed over the winter.

Detail of the postcard, showing a group of convalescents posing in front of the building.

Although the bedrooms of the men and women were separated in the home, they were able to mix at meal times. Patients were allowed to entertain visitors, and musical entertainments were sometimes put on. There is a suggestion that early on some of the convalescents may have enjoyed their stay rather too much. At the annual meeting of the management committee one of the members, a Mrs Edwin de Lisle, moved that the rules of the home be amended to exclude ‘persons of intemperate habits’. She thought patients ought to be prevented from getting more intoxicating liquors than was sometimes good for them.

Following the outbreak of the Boer War in 1899 the management committee offered the War Office the use of the home during the winter months for wounded soldiers, though whether the offer was taken up is not clear. Wounded soldiers were accommodated during the First World War, mostly transferred from larger war time hospitals – such as the 5th Northern Hospital at Leicester.

Extract from the 25-inch OS map revised in 1901. Reproduced by permission of the National Library of Scotland

In 1900 a new building was erected as a children’s convalescent home to replace the small house in Maplewell Road at Woodhouse Eaves. This was entirely funded by the Revd W. H. Cooper of Burleigh Hall, Loughborough, in memory of his wife and was named the Cooper Memorial home for children. It was built on Brand Hill, at the upper corner of Hunger Hill Wood, at Woodhouse Eaves, a well wooded site with fine views on the estate of Mrs Perry Herrick. The home, originally built to house 26 children, was designed by Barrowcliff and Allcock in conjunction with Alfred W. N. Burder. Moss & Sons of Loughborough were the building contractors, and the heating and ventilation were provided by Messenger & Co. Ltd. It provided two large day rooms, one a dining-room the other a play room, sitting rooms for the matron and nurses, and four wards upstairs for the children, one of which was arranged as an isolation ward with nurse’s bedroom attached. A brass memorial plaque was placed in the entrance hall commemorating the home’s benefactor and his late wife.

Both homes continued in use up until the 1950s, the independent charity continuing after the inception of the National Health Service. The Children’s home was sold to the Church of England Children’s Society in 1987, and two years later was converted into a home for the elderly. It is now called Charnwood House, and has been converted into private flats.

[Sources: Leicester Chronicle, 26 April 1884 p.6; 16 Oct 1897, p.11; 24 March 1900, p.11; 27 Oct 1900, p.6: Nottingham Evening Post, 2 Aug 1893, p.4; 14 July 1894, p.2: Nottinghamshire Guardian, 24 Dec 1898, p.3: Nottingham Journal, 2 Dec 1899, p.8: Melton Mowbray Mercury and Oakham and Uppingham News, 14 July 1910, p.8; 1 Oct 1914, p.5; 31 Dec 1914, p.5: Leicestershire, Leicester and Rutland Record Office, contract files for Messenger and Co. Ltd. : Childrenshomes.org.uk.]

Bristol Royal Infirmary

February 4, 2018 / Harriet Richardson / Leave a comment

‘A Perspective View and Plans of the Charitable Infirmary at Bristol as it now is with the addition of two intended wings’ 1742. Image reproduced under licence CC BY 4.0 from the Wellcome Collection

The old Royal Infirmary at Bristol was one of the first to be founded in England outside London. Subscriptions began to be made in November 1736 and the present site was acquired shortly afterwards. The first patients were admitted the following year. It was not until 1782 that the decision to provide a new, purpose-built infirmary was taken. Thomas Paty, a local architect, drew up the plans and building proceeded in three phases. The east wing was erected first between 1784 and 1786. The central block was put up in 1788-92 and the west wing added in 1806-10. It was a large and impressive building of three storeys and basement, to which an attic storey was added later.

Early photograph of the main front, probably early 20th century. From Paul Townsend flickr site. Reproduced under Creative Commons License CC BY-NC-SA 2.0

A chapel with a museum underneath was added in 1858, an unusual combination. In 1911-12 the King Edward VII wing was built to designs by H. Percy Adams and Charles Holden in a stylish, stripped classical style which looks forward to inter-war modernism. In 2017 the original part of the hospital was empty, boarded up and under threat of demolition.

The Royal Infirmary, Bristol, from the 2nd-edition OS 25-inch map revised in 1901. Reproduced by permission of the National Library of Scotland

In November 1736 a subscription was opened for erecting ‘an infirmary in the City of Bristol for the relief of such persons as should be judged proper objects of a Charity of that kind’. [1] A site in Maudlin Lane was acquired which contained various buildings, including tenements, a warehouse and some waste ground. The existing buildings were adapted and a ward built and furnished. Out-patients were admitted to the infirmary from June 1737 and the first in-patients were admitted at the formal opening in December of that year. Initially there were 34 patients, with an equal number of men and women. As one of the first hospitals to be founded in England outside London, the Bristol Infirmary has some claim to historic importance. It vies with Addenbrooke’s Hospital in Cambridge, founded in 1719 although not built until 1740, and Winchester Infirmary, established in 1736.

This view shows the south front of the infirmary as it appeared in 1765. Public Domain image.

Within a year or so of the infirmary’s opening, plans were made to extend the building by two new wings extending from the south front. The first wing, to the south east, was completed in 1740, the south-west wing had been added by 1750. As well as being able to take in more patients, the infirmary had two cellars – one let to a tenant, the other used for preserving meat – a cold bath, rooms for the apothecary and his apprentices, and in the garrets, along with linen rooms and staff bedrooms, were wards for patients being ‘cut for the stone’. A colonnade was formed along the south front for convalescent patients.

View of the new front, from Munro Smith’s History of The Bristol Royal Infirmary published in 1917. From the Wellcome Collection, CC BY 4.0

A few additions were made over the next decades, but by the 1780s conditions were poor. The infirmary was always overcrowded, wards were ill-ventilated and infectious diseases frequently claimed the lives of patients and staff. In 1782 it was at last decided that a new building would have to be provided. Some attempt was made to establish the new building on a new site but this was eventually rejected by the Building Committee. Plans were drawn up by Thomas Paty, a local architect, for a U-shaped hospital with the main entrance on the north side facing Marlborough Street. Work was carried on in three stages, one wing at a time. The first to be built was the East Wing, in 1784-6, followed by the central block in 1788-92 and the West Wing, completing the original scheme, was added in 1806-10. Financial difficulties had prompted the managers of the infirmary to build piecemeal, but circumstances were so straitened in 1811 that it was not possible to admit any patients to the newly completed wing. When it finally opened some three years later the infirmary provided a total of 180 beds.

The north front of Bristol Royal Infirmary, photographed in 1993 © H. Richardson

In 1858 plans were drawn up for the addition of a chapel and museum to the infirmary. The museum was to house a collection of specimens which had been presented to the infirmary by Richard Smith. The two were neatly accommodated in one building on the east side of the infirmary, the museum was at ground floor level and the chapel built over it. Work was completed and the building opened in 1860.

The chapel with its tall lancet windows with the museum on the floor below, photographed in 1993 © H. Richardson

The chapel abuts Whitson Street to the east. Constructed of rubble masonry with ashlar dressings, it is a simple five-bay rectangle without a break for chancel or transepts. The windows are lancets with cusped heads and plate tracery for the east end. The eaves course is ornamented by a corbel table. The interior is quite plain, but has a good stained glass window depicting Joshua and one of Saint Elizabeth.

Chapel interior, photographed in 1993 © H. Richardson

Various additions were made during the nineteenth century. An out-patients’ department was established which underwent many alterations over the century. In 1866 the west wing was extended and two new wards created. By the turn of the century a nurses’ home had been built on high ground to the west of the hospital on Terrell Street. The largest addition to the infirmary before the advent of the National Health Service was the King Edward VII Memorial Building, situated on the opposite side of Marlborough Street, erected in 1911-12. It was designed by H. Percy Adams and Charles Holden to provide new surgical wards and it was largely through the efforts of Sir George White, the president and Treasurer of the Infirmary since 1904, that it was carried out. White made his fortune working at the Stock Exchange before setting himself up in business. He developed the Bristol Tramways Company and established the Bristol Colonial Aeroplane Company in 1910. He worked hard to clear the infirmary from debt and raise sufficient funds to improve the accommodation.

Postcard showing the new wing, with the original hospital on the right © H. Martin

A competition was held in 1908 for an extension scheme which comprised the remodelling of the old infirmary building, adding a new ward pavilion with 75 beds, a new casualty and out-patients’ department, and an isolation building with 24 beds for sceptic and infectious cases. [Allibone, J. Adams, Holden Pearson catalogue of plans in RIBA] The competition was assessed by Edwin T. Hall, and twelve firms of architects were invited to take part, amongst whom were the foremost hospital architects of the day. Apart from H. Percy Adams they were: Thomas W. Aldwinckle, W. A. Pite, J. W. Simpson, A. Saxon Snell, Alfred Hessell Tiltman, Young & Hall, all based in London; Arthur Marshall from Nottingham; Everard, Son & Pick from Leicester; Henman & Cooper, from Birmingham; T. Worthington & Son, of Manchester and E. Kirby & Sons of Liverpool. [Building News, 31 July 1908, p. 168]

South front of the King Edward VII Memorial Wing, photographed in 1993 © H. Richardson

The site itself was awkward, being bisected by Marlborough Street which became Upper Maudlin Street at the corner with Lower Maudlin Street. The winning design by Adams and Holden comprised a large new out-patients’ block with a central waiting hall, situated nearly opposite the old infirmary building, and adjacent to it a ward pavilion, alongside which further extensions could be erected. Behind the ward pavilion was the isolation block. The plans submitted by A. H. Tiltman, which were also published at the time, are notable for comprising circular ward towers.

This detail of the postcard shows patients on the balconies at the ends of the ward wings.

Insufficient funds led to the plans being modified. It was also decided to delay the building of the new out-patients’ block until more money was available. The foundation stone was laid on 14 March 1911 and the new building formally opened by King George V and Queen Mary on 28 June 1912. The nurses’ home was extended at the same time, this pushed the total cost up to £137,000 and left the infirmary with a debt of over £12,000.

The opening of the King Edward VII Memorial Wing. Image from Paul Townsend’s Flickr site, reproduced under Creative Commons CC BY-NC-SA 2.0

Following the outbreak of the First World War, just two years after the new wing opened, the Memorial Building was handed over to the military authorities and, along with Southmead Hospital, it became known as the Second Southern General War Hospital (C. Bruce Perry, The Bristol Royal Infirmary 1904-1974, 1980, p.27).

Postcard showing the interior of King George’s Ward, probably in the King Edward VII Memorial wing. Image from Paul Townsend’s Flickr site, reproduced under Creative Commons CC BY-NC-SA 2.0

Lack of money continued to darken the administration of the infirmary. After the War costs continued to rise and income diminish. In 1921 over one hundred beds were closed at the infirmary through a shortage of funds and two years later a shortage of nurses caused beds to remain unusable. The managers laid the blame for this deficiency in nursing staff to the inadequate nurses’ home. They were able to go some way to rectifying this by using a generous gift from Henry Herbert Wills to extend the existing home. This opened in 1925, the work having been carried out by the architect Sir George Oatley.

Extract from the 25-inch OS map, revised in 1913. Reproduced by permission of the National Library of Scotland

Further additions were carried out between the Wars. The isolation block was built in 1924, an x-ray department and dental department were added in 1925, and a massage department established in 1926. Henry Hill had been appointed as the infirmary’s clerk of works in 1906 and he drew up plans for two staff accommodation blocks which were completed in 1930 and 1931. During the Second World War the infirmary was lucky to escape serious damage from bombing. Only the mortuary was destroyed. After the war, greatly in debt, the infirmary was transferred to the National Health Service.

References

Minutes of Bristol Royal Infirmary, quoted in C. Saunders, The United Bristol Hospitals, 1965, p. 11

Margate’s Sea Bathing Hospital

December 27, 2017December 27, 2017 / Harriet Richardson / 23 Comments

Royal Sea Bathing Hospital, Margate. Photographed in 2017 © H. Richardson

Earlier this year I spent a wonderful weekend in Margate and was fortunate to be staying just around the corner from the former Sea Bathing Hospital. This was a building that I first visited in September 1991. Since then it has been transformed into a gated private housing development, with some very swanky newly built ‘beach huts’ overlooking the bay.

The new ‘beach huts’ at the former Royal Sea Bathing Hospital, Margate. Built in 2016 for the developers, Harriss Property Limited, to designs by Guy Hollaway Architects. Photographed in 2017 © H. Richardson

Back in the early 1990s the future of the hospital was uncertain. Remaining services were then scheduled to move to a new building on the Thanet District General Hospital site. Ten years later the buildings were in a sorry state. In 2001 a planning application was submitted to convert the historic core into luxury apartments.

Extract from the 25-inch OS map revised in 1936. Reproduced by permission of the National Library of Scotland

What makes the hospital so special is its long history – it claims to be the earliest specialist orthopaedic hospital in Britain if not the world, and was a pioneer in the use of open-air treatment for patients with non-pulmonary tuberculosis. Founded in 1791 by John Coakley Lettsom, the first building went up in 1793-6 to designs by the Reverend John Pridden. Lettsom was a Quaker physician who espoused the benefits of treating disease with sunshine, fresh air and sea bathing.

John Coakley Lettsom (1744-1815), with his family in the garden of his house in Grove Hill, Camberwell, Surrey. Oil painting by an unknown English artist, c.1786. Wellcome Library

The idea that sea bathing had health benefits was not new. A Dr Wittie promoted sea bathing as a cure as early as 1660 in Scarborough. By the mid-eighteenth century sea bathing for health had become widely popular. The small fishing village of Brighthelmstone grew into the resort of Brighton on the strength of the perceived healthiness of its especially salty sea as well as through the patronage of the future George IV. Just about any illness was claimed to be curable by the application of sea water – externally or internally, but glandular and respiratory complaints were thought to be particularly likely to benefit from such treatment.

Mermaids at Brighton by William Heath of c.1829 (public domain image via Wikimedia Commons)

John Coakley Lettsom firmly believed in the efficacy of sea air and sea bathing for the treatment of scrofula (also known as the king’s evil, this skin disease is caused by a form of tuberculosis). Lettsom’s idea to found an infirmary at Margate for the poor was given royal patronage almost from the start, so his intention in July 1791 to found the ‘Margate Infirmary for the Relief of the Poor whose Diseases require Sea-Bathing’ soon changed to the ‘Royal Sea Bathing Infirmary’.

This early print shows the main elevation as designed by Pridden and is dated 1793. Reproduced under Creative Commons Licence CC BY 4.0 via Wellcome Collection

Margate, on the north-east coast of Kent, offered sheltered conditions and a moderate climate. It was within easy reach of London by boat. The site was outside the town in Westbrook, a tiny hamlet that remained largely undeveloped until after the First World War. The new building was designed with access to fresh air in mind, with open arcades and verandas. Its clerical architect, the Reverend John Pridden, was an enthusiastic supporter of Lettsom. He was both an antiquary and an amateur architect – not an especially unusual combination of interests in Georgian Britain.

Floor plans and elevation of the infirmary by Darton & Harvey. Wellcome Collection Creative Commons Licence CC BY 4.0

His first design was drawn up as early as June 1791 for a hospital large enough for 92 patients. In the end this proved too ambitious and was simplified to provide for 30 patients. With the plans approved, building work began some time after May 1793 and it was ready by the spring of 1796. Though much altered, Pridden’s building survives at the heart of the present complex.

West façade of the infirmary. Photographed in September 1991 © H. Richardson

Pridden’s design prefigured open-air sanatoria of the early twentieth century, with wards opening out on to colonnades, or piazzas as he called them, so that beds could be pushed out into the open air. There were wards with nine or six beds on either side of a two-storey block containing offices and staff accommodation.

Detail from the OS Town Plan of 1874

The Royal Sea Bathing Infirmary was a charitable institution, funded by subscriptions and donations. Patients were admitted on the recommendation of the governors after examination by a medical board in London. Out-patients as well as in-patients were treated.

Sea Bathing Machine at Margate. Wellcome Collection Creative Commons Licence CC BY 4.0

The sea-bathing element of the treatment was administered under the supervision of bath nurses, who escorted patients down to the shore in the hospital’s own bathing machine in order for them to be fully immersed in the water. In addition to this stimulation, the fresh air and decent food provided were of great benefit.

View of the infirmary from the Nurses’ Home, photographed in 1991. This shows how close the sea is to the hospital. On the left can be glimpsed the flat roof of the 1880s extension.

Until the 1850s the infirmary was only open during the summer. In 1853 indoor salt water baths were introduced. A horse-driven pump forced sea water up from the shore 30 ft below. This facility allowed the hospital to remain open all year round. By then the hospital had expanded, with a new single-storey wing added to the south in 1816 that increased the capacity to 90 beds. Another wing, this time of two storeys, had been added by about 1840 facing north. The extended infirmary was subsequently altered and further extended to give it a more coherent appearance with Greek Revival dressings. It was raised to two storeys throughout, and the west-facing entrance front given a tetrastyle Doric portico (the columns supposedly came for nearby Holland House). The portico was later moved to its present position on the south front.

The new wing added to the west of the hospital in the 1880s. Photographed in 2017 © H. Richardson

Wards for children were added in 1857-8. A large dining hall and a school were also added, connected to the main building by a covered way, and a house for the Governor. More substantial additions were made in the 1880s.

The view from the roof terrace, looking west over the bay towards Westbrook. Photographed in 1991 © H. Richardson

James Knowles Junior produced the designs for a long, single-storey building adjoining the old hospital to the west – hence the re-siting of the portico.

Detail of the ground plan from H. C. Burdett’s Hospitals and Asylums of the World, Portfolio of Plans, 1893, showing the southern end of the new wing.

Funds for the extension were donated by Sir Erasmus Wilson, a director of the hospital who had a house at Westgate just up the coast. He gave £30,000 to build more wards, a heated indoor swimming pool and a chapel. The statue in front of the main entrance is of Wilson, erected in his honour in 1896.

The south front of the former Sea Bathing Infirmary with statue of Sir Erasmus Wilson in the foreground. Photographed in 2017 © H. Richardson

A description of the new ward block noted:

The general wards, which are provided with hot and cold sea-water baths, are utilised largely for “dressing” the tubercular joints and glands, and for sleeping accommodation during unusually inclement weather. For the most part, however, the patients remain both by day and night on the verandah surrounding the “quadrangle”. In this position the patients while in their beds are able to enjoy the sea air both by day and night, while those who are able to move about secure exercise in the grounds and, in suitable cases, sea-bathing on the beach. [PP 1907, XXVII, 406-7]

The ward block also had a flat roof, creating a promenade, protected by an attractive balustrade of pinkish terracotta. To the south of the ward block was the swimming bath, supplied with fresh sea water by the horse pump which piped water to underground tanks.

The 1880s wing, looking towards the chapel. Photographed in 2017 © H. Richardson

More architecturally ornate is the Gothic chapel. Its tall nave and semi-circular apse is reminiscent of Gilbert Scott’s collegiate chapels.

The 1880s wing seen from the east, with the chapel to the left and the former swimming bath building. Photographed in 2017 © H. Richardson

The same part of the hospital – the chapel and swimming bath – in 1991. © H. Richardson

The interior was given a complex decorative scheme. Stained-glass windows illustrated Christ healing the sick, the virtues, and medicinal plants, while a mural depicted the story of Naaman bathing in the River Jordan.

Chapel interior photographed in 1991

Other murals depicted saints, angels and the Tree of Knowledge. Part of the nave was kept free of seats to enable beds or wheelchairs to be brought in directly from the quadrangle verandah.

The east end of the chapel, with its apsidal end, designed by James Knowles Junior. Photographed in 2017 © H. Richardson

During the First World War the hospital treated British and Belgian servicemen with TB, as well as the wounded and those suffering from shell shock. A new wing, the King George V Wing, was built in 1919-20 to the west of the main complex, but this has now been demolished.

Later additions to the site, including, to the right, part of the George V Wing. Photographed in 1991 © H. Richardson

The last major addition to the site was the nurses’ home, on the corner of Canterbury and Westbrook Roads. Originally built in 1922, it was extended in 1935 from two storeys to four.

The former nurses’ home. Photographed in 2017 © H. Richardson

View of the chapel from the north-east. Photographed in 1991 © H. Richardson

Looking northwards out to sea along the roof terrace. Photographed in 1991 © H. Richardson

Looking east from the roof terrace. Photographed in 1991 © H. Richardson

Sources

Anon 1812. An Account of the Proceedings for establishing Sea-Water and other Baths, and an Infirmary, in the vicinity of London…
British Medical Journal (BMJ), 1898, ii, 1768
Cazin, Le Dr H 1885. De L’influence des Bains de Mer sur La Scrofule des Enfants
Colvin, H M 1978. A Biographical Dictionary of British Architects 1600-1840
Gentleman’s Magazine, vol.LXVII (ii), Oct. 1797, 841; LXXXVI (i), Jan. 1816, 17
Honour, H 1953. ‘An Epic of Ruin-building’. In Country Life, 10 Dec. 1953
Illustrated London News, 16 Sept. 1882, 298
Kent Record Office, Maidstone
Lettsom, J C 1801. Hints Designed to promote Benificence, Temperance & Medical Science (3 vols)
MacDougall, P 1984. ‘A Seabathing Infirmary’. In Bygone Kent, vol.5, No.9, Sept. 1984, 511-6
Metcalf, P 1980. James Knowles Victorian Editor and Architect
Nursing Times, 10 March 1977, 9-12
(PP) Parliamentary Papers 1907, XXVII. Annual Report of the Medical Officer of the Local Government Board
Royal Sea Bathing Hospital Archives
Strange, F G St Clair 1991. The History of the Royal Sea Bathing Hospital Margate 1791-1971
Whyman, J 1981. Aspects of Holidaymaking and Resort Development within the Isle of Thanet, with particular reference to Margate, circa 1736 to circa 1840 (vol.2)

see also: http://www.telegraph.co.uk/news/uknews/12202268/Luxury-beach-huts-go-on-sale-in-Margate.html

https://guyhollaway.co.uk/news/margate-beach-houses-completed/

Two London hospitals – St Stephen’s and the Chelsea Westminster

October 19, 2017 / Harriet Richardson / 1 Comment

I’m starting this week’s post with a few pictures by our new best friend Bill Figg who sometimes strayed as far north as the Fulham Road Although this view is about 25 years years old I still remember St Stephen’s Hospital pretty well. I went there several times, including one memorable occasion not […]

via Two hospitals — The Library Time Machine

Hospitals Investigator 11 revised

May 6, 2017May 7, 2017 / Harriet Richardson / Leave a comment

In February 1993, Robert Taylor from the Cambridge team of the RCHME Hospitals Project, produced his eleventh newsletter. Here are snippets on prefabricated hospitals by Humphreys, early prison infirmaries, provision of accommodation for tuberculosis in workhouses, the Metropolitan Asylums Board, Portal Frames and Wimborne Cottage Hospital (with a few digressions from me).

More Humphreys’ Hospitals

Another advertisement for Humphreys’ Iron Hospitals lists places where hospitals have been provided, but this time of 1895. All but three of the hospitals are also on the list published in 1915. As Humprheys provided buildings for the Metropolitan Asylums Board, is there any chance that they made the iron buildings of about 1894 at Colney Hatch asylum that burnt with such dramatic effect in 1903?

The three mentioned on the earlier list but not on the later one were: New Calverley, Romney, and Nottingham. ‘London’ is also listed. There are 102 places listed altogether.

Howard and Prisons

That a shortened version of John Howard’s The State of the Prisons should have been considered a sufficient work of literature to be added to the Everyman Library in 1929 is almost as amazing as the record of cruelty and discomfort contained within the book. The Everyman edition is taken from the third edition of Howard’s book, published in 1784.

Gateway to the County Gaol at Southwark, from Survey of London vol.25

By 1784 few prisons had an infirmary. The impression gained from skipping through Howard is that there were normally two rooms, one for each sex, but that these rooms were commonly on an upper storey and that they were not very large. At the Manchester County Bridewell, built in 1774, there were two rooms 14ft by 12ft. The Chelmsford County Gaol, completed in about 1778, had only one room, described by Howard as ‘close’ and therefore not used. The two rooms at the recently built Southwark County Gaol were also described as close, with only one small window each, and they too appear to have been little used because of this unsuitability. Whether the infirmaries were on the upper floor to get superior ventilation above the noisome cells is not clear; it could be that they were less convenient and so devoted to a less important function.

Howard himself considered that dryness and ventilation should be the principal factors. Howard also paid attention to the extent to which building were lime-washed. This he regarded in keeping with contemporary theory, as the one remedy for both infectious diseases and ‘bugs’ (vermin). Lime-washing as often as twice a year would kill disease and infestation. Many years later, in 1832, lime-washing houses was often tried as a precaution against cholera.

The fourth edition of Howard’s book published in 1792 was illustrated, and included a model plan and elevations.

Howard listed the most important features of an infirmary or sick ward in a prison as:
1. It should be in an airy part of the court
2. It should be detached from the rest of the gaol
3. It should be raised on arcades
4. The centre of the ward floor should have a grating for ventilation, 12 to 14 inches square
5. Perhaps there should be hand ventiltors

Some of these features can be seen in his model plan for a county gaol published in the 1792 edition of the State of Prisons.

TB in the Workhouse

By the beginning of 1904 some 27 English Poor Law Unions admitted to having adapted wards in their workhouse for consumptive patients, so that they could be separated from the rest of the occupants. Until then consumptives were mixed indiscriminately with the rest of the inmates, and remained so mixed at other workhouses for some time. Just how little work this involved will only emerge from further investigation, but my suspicion is that a French window and a balcony was probably a generous amount of alteration. At that time, open-air treatment for tuberculosis at Sheffield Royal Infirmary consisted simply of leaving half of the windows in the ward permanently open, and it seems that many or most unions took the same approach.

The unions are as follows:
Chester – two rooms in the hospital block
Plymouth – wards (unidentified)
South Shields – 1 ward
Portsmouth – 2-storey south-facing wards adapted by insertion of French windows and balconies. Electric fans were installed but little used.
Southampton –wards (unidentified)
Bishops Stortford – 1 ward in infirmary
Medway –wards
Blackburn –men have 2^nd storey of infirmary, women to have new wards then building
Prescot –ward for 20 men
Camberwell –infirmary wards
City of London –south block of infirmary
Fulham -2 infirmary wards
Hampstead – south facing wards
Kensington – 2 wards adapted
St Mary Islington –top floor of infirmary
Wandsworth –iron buildings at Tooting annex
Atcham –top ward of infirmary for 20 men
Axbridge -4 dayrooms and 4 bedrooms
Bath –two 10-bed wards adapted, windows altered, shelters and dining-room built
Frome –wards built
Stoke – 2 wards with balconies
Richmond (Surrey) -2 wards
Brighton – 3-bed ward and balcony for men; women under consideration
Stourbridge –wards with end verandas adapted
Ecclesall – wards
Sheffield –small 20-bed block being adapted

Source: L. A. Weatherley, ‘Boards of Guardians and the Crusade against Consumption’ in Tuberculosis, 3, 1904-6, p.66

Photograph showing the roof garden c.1915 with revolving shelters, probably for convalescents rather than Tb patients. From the RAMC Muniment Collection in the care of the Wellcome Library. Reproduced under Creative Commons licence CC BY 4.0

(The mention of shelters at Bath put me in mind of this photograph of the King George V military hospital, for more on this hospital see the excellent Lost Hospitals of London website.)

Nurseries

A brief paragraph in Paul Davies’ book The Old Royal Surrey County Hospital tells us that ‘the Metropolitan Asylums Board designated King George V Hospital, Godalming, and two other of their hospitals as ‘plant propagation centres’. This is a change of use that does not appear in any of the directories, and suggests that the M. A. B. operated a very successful cover-up. Presumably they also ran a very successful and profitable business, far more profitable than curing Londoners of their physical and mental ills.

Portal Frames

Robert Taylor succinctly described the portal frame as ‘a modern version of a jointed cruck’ but was struggling to date this type of construction until stumbling over an article in The Builder from the 1940s.

Cruck Framed Barn on Aldford Village Green photographed in 2014. This thatched, oak cruck framed barn was built in 2013 in a joint project between the Eaton Estate and Chester Renaissance. The purpose was to keep heritage skills alive by using modern and old-style building materials and methods. The barn is used as a public shelter and has a brick barbecue built into the chimney. © Copyright Jeff Buck and licensed for reuse under this Creative Commons Licence

The Ministry of Works and Planning carried out experiments between 1939 and 1942 to design a cheap, quickly erected hut that was largely prefabricated, infinitely adaptable, and durable. By 1942 they had developed the M.O.W.P. Standard Hut with reinforced concrete jointed crucks (two bracketed posts bolted to a pair of rafters, for the benefit of readers who are not members of the Vernacular Architecture Group) as its main feature. The trusses at each end were different, having two posts carrying a tie-beam with a wooden frame above to which corrugated asbestos was nailed. The corner posts are of a distinctive shape, with a quarter-round hollow. The trusses are usually at 6-foot centres, and the building is just under 20 feet wide overall. Wall panels and roof covering are whatever is available.

These huts crop up on every type of hospital site, usually as ancillary buildings such as laboratories, if indeed any function can be ascribed to them. At Ipswich workhouse they were used to create an H-shaped addition to the infirmary with operating theatre in the central range. It seems therefore that they are unlikely to be earlier than 1942. How late this design, with concave corner posts, remained in use is not known.

This answers an old question, where the name portal frame came from. The minister of Works and Planning from 1942 to 1944 was Sir Wyndham Portal, 3^rd baronet, created a baronet in 1935 and viscount in 1945. Like an earlier minister of transport he gave his name to something he did not invent, but unlike Mr Hore-Belisha’s beacon the invention took place before he became minister.

Whilst the idea that the Ministry of Works named its design after their minister, Sir Wyndham Portal, it has been gently pointed out to me that the term ‘portal frame’ was in use long before 1942. Indeed, a very quick search on the British Newspaper Archive provides evidence of its use in 1902. An article from Engineering News reported on a novel suspension bridge constructed in Freiburg, Switzerland, designed by the Swiss engineer M. Grimaud. The bridge was supported on a timber portal frame. (Source: the article was covered in the Irish News & Belfast Morning News, 4 Oct 1902, p.6)

Operations

In 1892 the committee of Wimborne Cottage Hospital in Dorset discussed the propriety of treating pauper patients. One of the doctors said that they should not be admitted because the workhouse infirmary was better equipped to deal with operations.

The hospital historian’s comment on this in 1948 was that as neither the cottage hospital or the workhouse infirmary had any equipment for operations, this probably meant that the workhouse had a bigger kitchen table. We should also remember that at this time the theatre doubled as a bathroom.

Mike Searle’s photograph above from Geograph.org.uk, is captioned with this brief account of the building’s history:

The hospital was built in 1887 to commemorate Queen Victoria’s Golden Jubilee. The land was owned by Sir John Hanham of Deans Court who leased it at a peppercorn rent on condition that the poor would be treated there. Many local people donated money towards the cost of the building including Sir Richard Glyn of the Gaunt’s estate who gave £700. It opened initially with only thirty beds, and was limited to accepting local parishioners only, but as it grew, this was extended to outlying villages. It came under the authority of the NHS in 1947 when it ceased to be a voluntary hospital.

Grantham Hospital

November 13, 2016November 14, 2016 / Harriet Richardson / Leave a comment

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The future of this fine old building is under threat. It has stood empty for many years and there are fears that it may be demolished, despite its important place in the local history of Grantham and in the wider history of hospital architecture in England.

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Postcard of the hospital c.1900

A day of public celebration, parade and partying accompanied the ceremony of laying the foundation stone of Grantham Hospital on 29 October 1874. The band of the Royal South Lincoln Militia lead a procession, followed by the architect and builder, local dignitaries, and interested parties, that marched from Grantham Guildhall to the site of the new hospital on the Manthorpe Road to the north of the town centre.

Countess Brownlow, who was closely associated with the project from its inception, conducted the actual ceremony, once she had listened to an address by the chairman of the building committee, a short service by the Vicar, and been presented with a silver trowel. A public luncheon was given at the Guildhall presided over by Earl Brownlow. Tickets for this event could be purchased for 2s 6d. Earl Brownlow and his wife donated funds towards the hospital and took an interest in the plans, and the Earl of Dysart gave £1,000 to the building fund. [Grantham Journal, 24 Oct 1874, p.4]

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Extract from the 25-inch OS map, surveyed in 1885. Reproduced by permission of the National Library of Scotland.

Extract from the 25-inch OS map, revised in 1903. Reproduced by permission of the National Library of Scotland. This shows extensions to the rear of the hospital and an additional block.

Grantham Cottage Hospital was designed by the London architect Richard Adolphus Came (1848-1919), who went on to lay out the development of Woodhall Spa in Lincolnshire where he later settled, designing many of its buildings. He appears in the 1901 census as the proprietor of the Royal Hydro Hotel there. Came freely adapted a basic pavilion plan to create a picturesque elevation. Unusually, the wards were T-shaped, an arrangement which was commended by the great champion of hospital architecture in the late 19th century, Henry C. Burdett. He thought the wards were novel, pleasing and noteworthy, presenting a cheerful and airy appearance ‘which fills the visitor with pleasure’.[H. C. Burdett, Cottage Hospitals, 2nd edition 1880 p.412]

Baroness Brownlow also officiated at the official opening on 5 January 1876. ‘As it now stands approaching completion, the building with its neatly arranged grounds, and trim Gothic porch, forms a somewhat picturesque object’, reported the Grantham Journal.

The hospital, which is Gothic in character, is constructed of local stone with Ancaster dressings, and consists of three distinct blocks of buildings. The main building, which faces the road … is composed of a central block of two stories, providing a waiting-room, entrance lobby, surgeons’ sitting-room and operating-room, kitchen, offices and store-rooms, &c. on the ground floor; convalescent and board rooms, and four bedrooms on the first floor; and two bedrooms and lumber room in attics. There are wings stretching right and left of this block, forming the wards for male and female patients, and containing seven beds each, together with nurses’ room, bathroom, and other offices. The Gothic timber porch, which certainly contributes much to the appearance of the building, has been erected at the expense of the Earl Brownlow. Some distance in the rear of the main building, the fever hospital has been erected, and will contain five beds, bathroom, nurses’ room, kitchen &c., the working of this department being kept entirely separate from the other part of the hospital. A convenient laundry is also provided, with the addition of washing and ironing rooms, drying closet, and other similar accommodation. [Grantham Journal, 8 Jan 1876, p.4]

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Grantham & Kesteven Hospital, photographed in 2010. Opened in 1874, the old buildings are now obsolete, superseded by new facilities and left decaying. © Copyright Richard Croft and licensed for reuse under this Creative Commons Licence

A major extension to Grantham Hospital was built in the mid-1930s to designs by the local architect F. J. Lenton, of Traylen & Lenton. The plans were approved by the British Hospitals Association, the Ministry of Health and the County Council. It was partly as a result of Kesteven County Council’s obligation to provide hospital accommodation that Grantham Hospital was extended, and the enlarged hospital was to take patients from the county as a whole. This raised the number of beds provided in the hospital from 33 to 76 initially. A new entrance was formed to the south of the original building. New ward blocks ‘of the latest verandah type’ were built for men, women and children. There was also separate provision for private patients, a new isolation block and operating theatre unit.

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Architectural perspective of the extensions to Grantham Hospital by F. J. Lenton, architect

Verandah wards with folding windows, usually occupying the length of one side, originated in Denmark, and were introduced to England by Charles Ernest Elcock at the County Hospital, Hertford. Beds were placed parallel to the the side walls in groups of four, separated by glass partitions, instead of the old pattern in Nightingale-style wards where the beds were placed in rows at right-angles to the side walls. Each ward had five groups of four beds and two separate observation wards. The south-facing children’s ward had a paved terrace in front of the folding windows to allow cots to be wheeled out into the open air.

Verandah wards were hailed as revolutionizing hospital planning by providing improved access to fresh air and sunshine, and the psychological effect of smaller groups of beds (‘cosy communities’). It is interesting to note that the local paper praised the hospital for its functional design. ‘Rigid economy’ was observed in order to be able to provide the most up-to-date equipment: ‘In past days Hospitals were so often designed for external effect first and foremost’… ‘present-day designers always have in mind that their building should not be monumental, but sufficient for the present, and of a type that can be readily altered or adapted to the possible requirements of the future. [Grantham Journal, 27 Jan 1934, p.5]

In the new hospital, the private wards occupied a separate unit to the west of the complex which had its own enclosed garden. It had six private wards, with bedrooms for special nurses and separate ward kitchens. A subterranean boiler house was constructed at the edge of the site to provide heating and hot-water, operating on the panel-heating system by low pressure hot water, accelerated by electric pumps. All pipework was concealed in the ceilings. This was supplemented in the wards either with conventional open coal fires or gas fires. The building contractors for the extension were Bernard Pumphrey Ltd of Gainsborough. [Grantham Journal, 22 Sept 1934, p.5]

Extract from the 6-inch OS map, revised in 1938. Reproduced by permission of the National Library of Scotland. This shows the extension to the south of the hospital.

The new buildings were completed early in March 1935, after which the old hospital was refurbished to provide accommodation for the nursing and domestic staffs. At the same time a maternity unit was created in the old south ward wing of and the old theatre converted into a special labour ward. These alterations brought the hospital’s capacity up to 100 beds. [Nottingham Evening Post, 24 March 1936.]

Further additions were made following transfer to the NHS, including a new maternity unit which opened in 1972. Grantham Hospital has retained huge local support, as witnessed by the demonstrations that took place earlier this year to protest against the drastic reduction of the opening hours of the A&E department.

Stone House Hospital, Dartford – now The Residence

October 9, 2016February 26, 2017 / Harriet Richardson / 13 Comments

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Former Stone House Hospital photographed in 2005. The main range of the former hospital is now known as The Residence. © Copyright Glyn Baker and licensed for reuse under this Creative Commons Licence

A short hop from the Bluewater shopping centre is the former Stone House Hospital, built in the 1860s as the City of London Pauper Lunatic Asylum. The hospital was closed in 2005, a process that had begun some years before, and the buildings remained empty and slowly deteriorating for around seven years before planning permission was given for the redevelopment of the site for housing.

Stone House Hospital, administration block, photographed in 1992.

The P. J. Livesey Group carried out the development. Listed building consent was granted in 2012 for the conversion of the main hospital range, the former superintendent’s house (the Hollies), coach-house and stable buildings to provide 93 dwellings and a private gym, change of use for the chapel to offices. Consent was also given for the demolition of the female infirmary, boiler house, laundry rooms, mortuary and associated buildings. A total of 260 residences were planned for the site.

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Stone House Hospital, near Dartford in Kent, built as the City of London Pauper Lunatic Asylum and opened in 1866. Extract from the 2nd-edition OS Map revised in 1895, reproduced by permission of the National Library of Scotland

The Corporation of London dragged its heels over building a pauper lunatic asylum. They acquired a site at Stone near Dartford in Kent in 1859 from C. White Esq of Barnsfield. Plans were commissioned from the City Clerk of Works, J. B. Bunning. Arguments rumbled on over how big the asylum should be, or if it were needed at all, but after a few revisions of the plans, work finally began in 1862. Progress was painfully slow. With work still far from complete, Horace Jones replaced Bunning as City Architect in 1864. Jones supervised the completion of the building which was officially opened on 16 April 1866.

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Engraved view of the City of London Asylum, 1866.

The year before the Visiting Committee reported that the furniture, bedding and general stores had, for the most part, been delivered. An arrangement had been made for the gas supply from Dartford, but the water supply was insufficient. The Committee recommended that patients should not be transferred to the new asylum until the spring, because of the ‘bleak and unsheltered situation of the asylum’. Committee members were also concerned that this bleakness also applied to the interior, where the walls were just ‘rough brickwork whitewashed from the ceiling to the floor’. They feared the contrast would make for an unpleasant change for the poor patients and called for walls to be painted or papered with a cheerful-coloured pattern.

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Former Chelsea Ward. Photograph reproduced by kind permission of Peter Aitkenhead.

The City Asylum was contemporary with various second county asylums: Dorset, Surrey, Staffordshire, and Cheshire, and a number of other city asylums, such as Norwich, Newcastle and Bristol. Its plan demonstrated the refinements that were being introduced to the established corridor plan, having broader corridors, large day rooms and dormitories and fewer single rooms.

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Stone House Hospital, former canteen. Photograph reproduced by kind permission of Peter Aitkenhead.

The asylum was extended many times following its completion, with new wings added in the 1870s, an isolation hospital in 1885 (the cottage hospital, now demolished), and extensive additions in the late 1890s.

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Extract from the 25-inch OS Map revised in 1931, reproduced by permission of the National Library of Scotland

A detached chapel (St Luke’s) was built to the north of the main hospital range in 1898-1901 to designs by Andrew Murray. The original chapel, which was at the heart of the main building above the dining-hall, was then converted into a recreation room ‘for concerts, dancing and theatrical amusements’. Whereas the site of the asylum had been described as bleak and unsheltered in the 1860s, it was now commended as being ‘notable
for its salubrity’, commanding a view of the Thames and a charming rural panorama.

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Stone House Hospital chapel, photographed in 1992.

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Stone House Hospital chapel, photographed in 1992.

East end of the chapel. Photograph reproduced by kind permission of Peter Aitkenhead.

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Stone House Hospital Chapel, west window. Photograph reproduced by kind permission of Peter Aitkenhead.

Sources and References:

The surviving archives of the hospital are in the London Metropolitan Archives – ref: CLA/001: Gravesend Reporter, North Kent and South Essex Advertiser, 31 March 1860 p.4 : London City Press, 16 Dec 1865 p.3: Illustrated Times, 31 March 1866, p.205: Lloyd’s Weekly Newspaper, 19 June 1898, p.1: Building Design, 23 July 2010, 4: Lost Hospitals of London: P. J. Livesey Group website: Parliamentary Papers, Reports of the Commissioners in Lunacy.

	Judith Newland on Margate’s Sea Bathing…
	Harriet Richardson on Inverclyde
	LLOYD BLAKE on Inverclyde
	fmackay on Dundee
	Valerie Bowkett on Ayrshire and Arran

Interior view of NHS Nightingale, London. Photographed on 27 March 2020 by No.10 Reproduced under Creative Commons License CC BY-NC-ND 2.0

Old leper Hospital of St. Bartholomew, Oxford. Wellcome Collection. Attribution 4.0 International (CC BY 4.0)

The Bills of Mortality from 1664. Reproduced from Paul K. BibliOdyssey Bogspot

Aerial photograph of the Lazaretto Vecchio, from Chris 73 Reproduced under Creative Commons License CC BY-SA 3.0

Edward Jenner vaccinating patients against smallpox. Wellcome Collection. Attribution 4.0 International (CC BY 4.0)

View of the Coldbath Fields smallpox hospital in 1823, by which time it had been replaced by a new hospital in St Pancras. The redundant hospital was subsequently used as a distillery. Reproduced from the Survey of London, volume 47 original in Islington Local History Centre

View of one of the ward blocks at the City Hospital, as altered and enlarged to designs by John Rust in the 1890s https://canmore.org.uk/file/image/1374923

Detail of a plan of the City of Aberdeen from the Post Office Directory of 1879, showing the ‘Epidemic Hospital’ on the outskirts of the city. Reproduced by permission of the National Library of Scotland

Coloured engraving of the main front of the London Fever Hospital. Reproduced from the Wellcome Collection https://wellcomecollection.org/works/pspzgh6a

Plan from The Builder, 12 August 1848, p.391

The west front of the Fever block, probably photographed around 1910. From the Wellcome Collection CC-BY-4.0.

Aerial photograph of the Brook Fever Hospital, Shooter’s Hill, London built by the Metropolitan Asylums Board and opened in 1896. Wellcome Collection. Attribution 4.0 International (CC BY 4.0

Hempsted Smallpox Hospital, Gloucester, photographed by H.C.F. in 1896 Wellcome Collection. Attribution 4.0 International (CC BY 4.0)

LGB model plans from Local Government Board On the Provision of Isolation Hospital Accommodation by Local Authorities August 1900, and reissued in 1902.

Baird Street Reception House, from the 1906 Medical Officer of Health for Glasgow’s Annual Report.

Ground and First-Floor plans of the Reception House.

Cubicle isolation block built at the South West Middlesex Hospital, exterior and interior views. Photographed in November 1991 © H. Richardson

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Islay Hospital, Bowmore. View of the ward block and main entrance from the west. Photographed in May 2019, © H. Richardson

Extract from the 1st-edition OS map, surveyed in 1878, reproduced by permission of the National Library of Scotland

Gartnatra Hospital, from an old photograph on display at the Columba Centre.

The former fever hospital, now the Columba Centre. Photographed in May 2019, © H. Richardson

The former Gartnatra Hospital, viewed from the east. The old hospital is the gabled block on the left, with the short bay attached (the former sanitary annexe). The rest has been added to form the new cultural centre and cafe. Photographed in May 2019, © H. Richardson

Extract from the 2nd-edition OS map, surveyed in 1897, reproduced by permission of the National Library of Scotland

The former Gartnatra hospital, now the Columba Centre, viewed from the south-east. Photographed in May 2019, © H. Richardson

Islay Hospital, south-west corner of the main block, showing what was originally planned as the patients’ dining and sitting-room and on the left the end of the link corridor to the Eventide Home. © H. Richardson

Islay Hospital, general view from the entrance looking along the south side of the ward block, photographed in May 2019 © H. Richardson

The entrance front of the Eventide Home, photographed in May 2019, © H. Richardson

Plan of Islay Hospital, based on original dated January 1962, in the National Records of Scotland. © H. Richardson

Islay Hospital. This block was designed as the maternity wing with staff accommodation on the upper floor © H. Richardson

Islay Hospital, main entrance © H. Richardson

Islay Hospital, viewed from the south-east looking towards the maternity and staff quarters’ block. On the left is the rear of the entrance block, and the link range contained treatment rooms and the X-ray room. © H. Richardson

Islay Hospital, from the north-east with the ward block in the centre and the eventide home to the right of the picture © H. Richardson

Islay Hospital, north side, with wards and kitchen block. © H. Richardson

The north-east corner of the Eventide Home, with the link corridor between it and the hospital, photographed in May 2019 © H. Richardson

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Old postcard of the Charnwood Forest Convalescent Home. © H. Martin

Extract from the 25-inch OS map revised in 1901. Reproduced by permission of the National Library of Scotland

Detail of the postcard, showing a group of convalescents posing in front of the building.

Extract from the 25-inch OS map revised in 1901. Reproduced by permission of the National Library of Scotland

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‘A Perspective View and Plans of the Charitable Infirmary at Bristol as it now is with the addition of two intended wings’ 1742. Image reproduced under licence CC BY 4.0 from the Wellcome Collection

Early photograph of the main front, probably early 20th century. From Paul Townsend flickr site. Reproduced under Creative Commons License CC BY-NC-SA 2.0

The Royal Infirmary, Bristol, from the 2nd-edition OS 25-inch map revised in 1901. Reproduced by permission of the National Library of Scotland

This view shows the south front of the infirmary as it appeared in 1765. Public Domain image.

View of the new front, from Munro Smith’s History of The Bristol Royal Infirmary published in 1917. From the Wellcome Collection, CC BY 4.0

The north front of Bristol Royal Infirmary, photographed in 1993 © H. Richardson

The chapel with its tall lancet windows with the museum on the floor below, photographed in 1993 © H. Richardson

Chapel interior, photographed in 1993 © H. Richardson

Postcard showing the new wing, with the original hospital on the right © H. Martin

South front of the King Edward VII Memorial Wing, photographed in 1993 © H. Richardson

This detail of the postcard shows patients on the balconies at the ends of the ward wings.

The opening of the King Edward VII Memorial Wing. Image from Paul Townsend’s Flickr site, reproduced under Creative Commons CC BY-NC-SA 2.0

Postcard showing the interior of King George’s Ward, probably in the King Edward VII Memorial wing. Image from Paul Townsend’s Flickr site, reproduced under Creative Commons CC BY-NC-SA 2.0

Extract from the 25-inch OS map, revised in 1913. Reproduced by permission of the National Library of Scotland

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Royal Sea Bathing Hospital, Margate. Photographed in 2017 © H. Richardson

The new ‘beach huts’ at the former Royal Sea Bathing Hospital, Margate. Built in 2016 for the developers, Harriss Property Limited, to designs by Guy Hollaway Architects. Photographed in 2017 © H. Richardson

Extract from the 25-inch OS map revised in 1936. Reproduced by permission of the National Library of Scotland

John Coakley Lettsom (1744-1815), with his family in the garden of his house in Grove Hill, Camberwell, Surrey. Oil painting by an unknown English artist, c.1786. Wellcome Library

Mermaids at Brighton by William Heath of c.1829 (public domain image via Wikimedia Commons)

This early print shows the main elevation as designed by Pridden and is dated 1793. Reproduced under Creative Commons Licence CC BY 4.0 via Wellcome Collection

Floor plans and elevation of the infirmary by Darton & Harvey. Wellcome Collection Creative Commons Licence CC BY 4.0

West façade of the infirmary. Photographed in September 1991 © H. Richardson

Detail from the OS Town Plan of 1874

Sea Bathing Machine at Margate. Wellcome Collection Creative Commons Licence CC BY 4.0

View of the infirmary from the Nurses’ Home, photographed in 1991. This shows how close the sea is to the hospital. On the left can be glimpsed the flat roof of the 1880s extension.

The new wing added to the west of the hospital in the 1880s. Photographed in 2017 © H. Richardson

The view from the roof terrace, looking west over the bay towards Westbrook. Photographed in 1991 © H. Richardson

Detail of the ground plan from H. C. Burdett’s Hospitals and Asylums of the World, Portfolio of Plans, 1893, showing the southern end of the new wing.

The south front of the former Sea Bathing Infirmary with statue of Sir Erasmus Wilson in the foreground. Photographed in 2017 © H. Richardson

The 1880s wing, looking towards the chapel. Photographed in 2017 © H. Richardson

The 1880s wing seen from the east, with the chapel to the left and the former swimming bath building. Photographed in 2017 © H. Richardson

The same part of the hospital – the chapel and swimming bath – in 1991. © H. Richardson