It was back in June 1992 that Colin Thom and I visited King Edward VII Hospital, as it then was, as part of the RCHME Hospitals Project. The project involved site visits to as many pre-1948 hospitals throughout England as we could identify and manage within the three years allotted for the project. For the most interesting of these sites we requested professional photography from the Commission’s pool of excellent photographers, and those are now a part of the Historic England archives. We also took colour slides and black-and-white snaps for ourselves. I have been scanning some of these and have posted some of the slides already, but thought I would share the black-and-white snaps here. They are only snaps, and of mixed quality, but I think they provide an interesting record of how the hospital looked 30 years ago.
Central range, south front of King Edward VII Hospital, June 1992
You can just spot someone sitting in the alcove on the far left. The gardens around the sanatorium were designed by the architects Adams & Holden and the planting plans were drawn up by Gertrude Jekyll. Jekyll produced some forty plans in about 1905, which detail the planting for the formal gardens, the areas just behind the main south block and between it and the chapel, and also the Medical Superintendent’s garden. The light and sandy soil lent itself to Mediterranean plants, and ‘in the case of the Sanatorium walls, the planting was carefully considered for colour effect, masses of plants of related or harmonious colouring being kept near together’.¹
West wing of the hospital, looking westwards towards the chapel garden.
A raised basement provided a terrace in front of the ground-floor rooms, while the balcony in front of the first-floor rooms created a degree of shelter, as do the deep eaves for the upper-floor rooms. Shutters allowed the inward-opening doors to be left open over-night, to ensure that there was still plentiful fresh air entering the rooms.
The chapel from the north, showing the eastern nave and the tower.
The sanatorium was largely surrounded by woodland, in particular pine woods. Pines, and the ‘terebinthine’ vapours they exuded were considered particularly beneficial to those suffering from tuberculosis.
View along the western nave of the chapel
The chapel was most unusual, being V-shaped in plan with twin naves, one for male the other for female patients, each focussed on the central chancel.
The plan of the chapel above marks the entrances (no.54); open cloisters (57); altar (58); vestry (59); organ space (60); pulpit (61); lectern (62), nave for men (63); nave for women (64); courtyard (65); store room (66) and the mortuary chapel (67). It was produced for the Tuberculosis Year Book, and reproduced in F. R. Walters, Sanatoria for the Tuberculous, 1913. The south side of the chapel was originally open, the arcade was only glazed during the 1950s.
Above is a view of the western nave of the chapel showing the south wall with its glazed arcade. Although the glazing was added in the 1950s, its elegant design is very pleasing, and adds rather than detracts from the architectural effect of the building. It is also an indication of the changes in the way that tuberculosis was treated, following the discovery and widespread use of antibiotics, and the rather slower uptake of the BCG vaccine, which finally lead to the decline in TB and the redundancy of the sanatoria.
Detail of the clerestory windows and, just visible, the plaster frieze above.
Above the clerestory windows in the chapel a deep frieze is just-about visible on the photograph above, featuring vine leaves and bunches of grapes. It is an Arts & Crafts detail, inspired by later seventeenth century plasterwork.
Western nave, looking north-east
Midhurst Sanatorium was one of the most architecturally ambitious, and expensively fitted out anywhere in Britain. It was designed to represent best-practice at the time, and provide a model for future sanatoria in this country, also encouraging the establishment of sanatoria in Britain to bring open-air treatment within the reach of a wider section of society.
The main corridor at the centre of the hospital lead directly from the main entrance on the north side to the gardens on the south.
In the centre of Stevenage, just next to the central library with its adjoining Health Centre, stands this gem of an early NHS building. However, the building is now under threat of demolition as part of the current Stevenage Development Board’s plans to make ‘Stevenage Even Better’. (Surely a potential sequel to WIA?) There has been an outpouring of dismay at this decision on Twitter. Is it too late to hope that this building might be preserved? So many of the early NHS hospital buildings have been demolished, this is becoming an increasingly rare survivor.
It was built in advance of the new District General Hospital, the new Lister Hospital. Well in advance as it turned out, as the outpatients clinic was built in 1959-61 while the residents of the New Town had to wait another ten years or so for the opening of the Lister Hospital.
The Lister Hospital. Photographed by Peter O’Connor in 2011, CC BY-SA 2.0
Stevenage Development Corporation reached an agreement with the North-West Metropolitan Regional Hospitals Board in about 1957 for them to build a casualty and outpatients’ clinic on a site to the south of the main shopping core of the New Town. The site formed part of the area reserved for Hertfordshire County Council, offering the opportunity of forming a close link between the clinic and the local authority’s health centre. The County Council agreed to give up part of the land to the Hospital Board in recognition of the need for hospital services in the town, which were provided by the hospitals at Hitchin. These were the former workhouse (renamed the Lister Hospital during the Second World War) and the North Hertfordshire and South Bedfordshire Hospital, the town’s long-established former voluntary hospital. Both of these hospitals had been acquired by the State on the appointed day in June 1948 when the National Health Service was inaugurated.
Stevenage Outpatient Centre when new, reproduced from The Hospital, March 1962. General view showing the gymnasium on the left.
Plans were approved for the clinic in about 1958 at which time it was anticipated that work would begin on site the following summer. The commission was put out to Peter Dunham, Widdup and Harrison, architects based in Luton, a firm that had some experience with hospital design in Northern Ireland, but also designed some elegant private houses, laboratories and factories. It was not unusual for the NHS to place design work with private firms, especially for larger schemes. Most of the Regional Boards had architects departments, but some were small, and initially under-staffed for the large amount and range of work with which they were faced.
Peter Dunham was born in Luton and had trained at the Bartlett School of Architecture. He had started in private practice in 1933, and served in the Royal Engineers during the war, where he met MacFarlane Widdup. Widdup, a Yorkshireman who had trained in Leeds, was two years older than Dunham. According to the Architectural Review of 1953 he spent his spare time ‘cutting down trees too near his new house, admiring other people’s vintage cars and making amateur films of the kind no-one else understands’. As for the third partner of the team, Michael Harrison was a fellow Lutonian and Bartlett student, who had spent three years in local government before joining Dunham and Widdup in 1949.
Stevenage Development Corporation welcomed the development of the clinic but lamented that instead of building even the first stage of a new general hospital all that the Regional Hospitals Board were able to do were some improvements to the existing Lister and North Herts Hospitals at Hitchin. In their Annual Report published in 1959, the Corporation noted their hopes that the Stevenage Hospital would be given high priority when the country’s economic circumstances permitted new hospital building. The growing population of the area was making it more difficult for the Hitchin hospitals to meet the demands made on them. When the new clinic opened it functioned as an annexe of the old Lister Hospital at Hitchin and provided a full range of consultative and specialist clinics staffed from both the Lister and the North Herts. Since that time it has continued to have an outpatient function within the NHS, and latterly was known as the Danestrete Centre.
The most distinctive feature of the building is the gymnasium with its decorative quilted finish to the external walls. On the north side the lozenges of aggregate chips are pinned together by blue tiles bearing the coat of arms of Joseph Lister. This alluded to the Lister Hospital, which had been so-named as Lister had attended the Quaker school at Hitchin as a child.
This part of the building was specially designed as an independent reinforced concrete frame structure, to isolate it from the rooms beneath, in order to ‘avoid interference by the activities of this department’.
The gymnasium in the physiotherapy department of the clinic. From The Hospital, March 1962, p.151
The remainder of the construction is of brickwork with concrete floors and timber roofs. The ceilings of the corridors and the public spaces, such as the waiting room, were lined with sound absorbent boarding for quietness. Particular efforts were made to provide a ‘homely building’ offering a ‘friendly welcome to the patients’. Accordingly materials and decorations in the waiting areas were carefully chosen to create the desired atmosphere, and a modern touch was provided by a large abstract mural at the entrance, giving a ‘strong and gay splash of colour’.
Interior view published in 1962, showing the waiting area, with natural wood finishes, patterned lino tiles.From The Hospital, March 1962.
The clinic was centrally heated, and apart from its gymnasium, provided a series of consultant and examination rooms, treatment rooms, dental and E.N.T. departments, and small pathological department, x-ray, and pharmacy. The original proposal to include a casualty section was not carried out, and emergency services continued to be dealt with at the old Lister Hospital in Hitchin. The total cost of the building was £95,610.
Ground Floor Plan of the Outpatients Clinic, from The Hospital, March 1962.
Upper Floor Plans of the Outpatients Clinic, from The Hospital, March 1962
References: Stevenage Development Corporation, 11th Annual Report, 1 April 1957 to 31 March 1958 and 12th Annual Report, 1 April 1958 to 31 March 1959: Architectural Review, 1 Nov. 1953, p.282: The Hospital, March 1962, pp.147-51.
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.
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.]
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.
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.
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 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.
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.’
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.
LGB model plans from Local Government Board On the Provision of Isolation Hospital Accommodation by Local AuthoritiesAugust 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.
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.
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 […]
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.
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 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. In the photograph below, 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.
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.
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.’
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.
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).
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 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.
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.
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.
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.)
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.
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.
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 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
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.
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.]
‘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.
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 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.
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.
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]
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
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.
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.
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.
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.
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 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 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.
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.
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.
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)
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 […]
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.
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 2nd 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.
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, 3rd 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.
Historic Hospitals 
