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 […]
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.
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.
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.
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.
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.
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.
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.
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.
This leafy residential development near St Albans, within sight of the M25, has been established on the site of Napsbury Hospital, incorporating many of the former hospital buildings. Re-named Napsbury Park, the development took place largely between 2002 and 2008.
The asylum was designed by Rowland Plumbe in 1900 to serve the county of Middlesex. Following the Local Government Act of 1889 and the formation of the London County Council, the former Middlesex County Asylums at Hanwell and Colney Hatch were taken over by the LCC, while the former Surrey County Asylum in Wandsworth (Springfield Hospital) was transferred to Middlesex. The need for a new institution was soon recognized and in 1898 the estate of Napsbury Manor Farm was acquired. In the same year the architect Rowland Plumbe and the Medical Superintendent of Springfield Hospital, Dr Gardiner-Hill, visited asylums in Scotland where a new type of asylum plan was evolving, inspired by the continental colony system.
Plumbe’s design that he presented to the County’s Asylums Committee introduced elements from the Scottish system, such as the separate hospital section and detached villas, as well as a typical English-style échelon-plan main complex. In part this was a necessary compromise, as English asylums tended to be considerably larger than their Scottish counterparts and so detached colony-sytle buildings for all patients were uneconomic – Napsbury was designed for 1,152 patients.
The foundation stone was laid on 26 February 1901; the building contractors were Charles Wall Ltd of Chelsea, a firm with considerable experience in hospital construction. An arrangement was made with the Midland Railway Company to provide a station on the Company’s line, to the north west. A branch line was constructed from there directly to the heart of the main asylum complex, with sidings near the boiler house for bringing in coal.
William Goldring was commissioned to design the landscape setting, having earlier been brought in to take over the landscape design for Kesteven Asylum (later Rauceby Hospital) near Sleaford. The OS map below shows the network of curved paths amongst trees and shrubs laid out around the main complex.
Each ward block had its own garden area in front, and picturesque circular shelters were provided, as focal points and providing somewhere to sit.
As well as garden grounds, there was a cricket pitch with pavilion on the south side of the main complex.
On 3 June 1905 the new asylum opened. The main complex provided accommodation for 650 patients, its dog-leg échelon plan allowing for a higher proportion of female patients to males. Patient ward blocks, designed as far as possible in the style of large detached villas, were linked by single-storey corridors, and each block was allocated to a different class of patient depending on their diagnosis. In the terminology of the time these were: sick, infirm, epileptic, chronic, chronic refractory and working patients.
Each ward block comprised day rooms, dormitories and single rooms for the patients in addition to attendants’ rooms. These were floored with pitch pine coated with ‘Ronuk’ polish. Doulton and Company’s faience open fires, supplemented by hot-water radiators, provided the heating, and the sanitary annexes, containing the baths, wash basins and WCs, were separated from the main patient areas by cross ventilated corridors in the usual manner.
The ward blocks each had a fire escape and goods lift and were designed so that any outbreak of fire could not spread to the adjacent blocks. As part of this fire-proof construction, the main stairs were of cement concrete with York stone treads.
A large common dining hall was situated at the centre, dividing the male and female sides of the complex. To the north of the dining hall was the kitchen, kitchen offices and stores. On the male side were the boiler house, workshops and water tower. The laundry was on the female side.
On the north, counterbalancing the dining hall, was the administration block. This imposing gabled building of two storeys had a squat square tower over the main hall and a stubby porte-cochère before the main entrance. It contained the committee rooms, offices and quarters for the assistant medical officers.
The separate hospital for admissions and cases requiring observation and medical treatment was situated to the east of the main asylum complex and was completely detached from it and independent, except for a subway carrying steam pipes. It had its own water supply, laundry, kitchen, dining and recreation hall.
The administration block was on the north side, in a similar style with a multi-gabled façade and mullion and transomed windows. It was of two storeys and attic with a central entrance leading to the main entrance hall and fernery. In addition to office accommodation, it also contained rooms for photography, a museum and research laboratory. The hospital provided 250 beds in single-storey ward blocks. Convalescent and nursing cases occupied the blocks on the south side, the sick and infirm those to the east and west.
Dotted about the park were five detached villas, these were originally designed to accommodate working patients, convalescent patients soon to be discharged and private patients (‘paying guests and artisans’). Each could house fifty or fifty-two patients, sleeping in small dormitories, with sitting rooms and dining rooms.
There was also a small isolation hospital, on the edge of the site near the railway line, with its own separate services. It was extended in the 1920s and 30s. Other ancillary buildings included a post-mortem department, medical officer’s house, staff housing, chapel and farm buildings.
Only a few years after the hospital opened Rowland Plumbe was asked to prepare plans for additions and alterations – accommodation was needed for another 600 patients and improvements had to be made to the drainage.
During the First World War the hospital was taken over by the Army. By 1915 the Army had realised that it needed considerably more accommodation for those suffering from ‘war strain’, and entered into negotiations with Middlesex County for the use of parts of its asylums at Wandsworth and Napsbury. The acute hospital at Napsbury and two of the villas (for convalescents) were transferred to the Army in 1916. Napsbury War Hospital provided 350 beds and was allocated to the severest cases. In May of the same year, the remainder of Napsbury Hospital was also handed over to the Army for general medical and surgical cases, with 1,600 beds for soldiers invalided home from the front.
The largest addition to the site after the First World War was a new nurses’ home built to the south of the main complex and west of the cricket ground.
By the early 1920s one of the detached villas, that nearest the hospital section, had been taken over as a nurses’ home.
When we visited the site in 1992 as part of the RCHME Hospitals Survey it was still a hospital for those suffering from mental illnesses. The staff were very welcoming, allowing us to go over the site and photograph the outsides of the buildings, although one person was disturbed by the sight of the camera (the phrase ‘tupenny-ha’penny photographer’ was thrown in our direction).
The hospital closed in 1998, although a small psychiatric unit remained on site until around 2002. The grounds were designated by English Heritage as a Grade II historic park in 2001, recognizing the importance of this rare survival of a public landscape designed by William Goldring. The hospital buildings were listed, also Grade II, in 1998. Crest Nicholson acquired the site in about 2002. Around 545 residences have been created in a mix of apartments in the converted buildings alongside new detached and terraced houses the masterplan and detailed designs were drawn up by Design Group 3 architects. Much has been demolished – all the service buildings at the core of the main asylum complex, apart from the water tower, the ward blocks of the hospital section and some of the villas, but the footprint has been retained – paths or roads replacing the distinctive corridor that linked together the ward blocks. The new buildings have been designed to match the old in the use of warm orange-red brick, and in style they take their cue from Rowland Plumbe’s buildings. Generally it is one of the better examples of the re-use of a former asylum complex.
The Builder, 31 August 1901, p.198; 17 June 1905, pp.651-2; 1 Feb. 1908, p.127: Building News, 2 June 1905, p.780: Hertford Library, H362.11, brochure for the opening of Middlesex County Asylum: PP XXVIII.381 c.899, 1920, History of the Asylum War Hospitals in England and Wales
Storthes Hall was the fourth, and last, pauper lunatic asylum for the West Riding of Yorkshire. The first section, designed as an acute hospital, opened in June 1904. This was similar to the earlier acute block added to the Wakefield asylum in 1899. Only the gate lodge and the administration block of this section now survive, the remainder of the buildings providing the footprint for Huddersfield University’s student village that now occupies the site. The larger section to the south-west (pictured above), has also been demolished with just the administration block remaining in a ruinous state.
The West Riding Asylums Committee decided to build their fourth pauper lunatic institution around 1897 and purchased Storthes Hall, together with a large part of the estate, from Thomas Norton in 1898. By January 1899 the county surveyor, Joseph Vickers Edwards, had visited the most recent asylums built in England and Scotland and presented a report to the Asylums Committee. The Commissioners in Lunacy advised that they would not approve an asylum designed on the village or colony principle, a type that was emerging as an ideal form for mental hospitals around this time. They agreed to sanction plans for the acute hospital provided that it was entirely separate from the general asylum complex. Originally this section was to have 200 beds (100 each of male and female patients), the general asylum was to accommodate 1,200 patients and be capable of enlargement. 
The acute hospital was symmetrically arranged with two blocks or wards on either side of the central administrative section, each for 50 patients, one for sick and infirm, the other for recent or acute cases. Flanking the hospital were two detached blocks, or ‘cottage homes’, designed to house 36 chronic, healthy patients each, who would form part of the labour force for the asylum.  To the south-west of the acute hospital was the central boiler house and laundry, with laundry residence, these sections were constructed in 1902-3 by John Radcliffe & Sons, Huddersfield (acute hospital) and William Nicholson & Sons, Leeds (laundry and boiler house).  The rest of the complex was commenced in 1904 once the acute hospital was completed, with Radcliffe & Sons as the building contractors.
Joseph Vickers Edwards, who designed the asylum, was the County Architect. He also designed High Royds Hospital, the third West Riding asylum, in 1885 (built in 1887-9), and the hospital blocks at Scalebor Park, which opened in 1902 as an asylum for paying patients. Edwards was born in Liverpool around 1852, and trained as a civil engineer. He had been the borough engineer for Burnley before he was appointed as the deputy surveyor and architect to the West Riding in the late 1870s under Bernard Hartley. As County Architect he initially had responsibility for roads and bridges as well as all the other local authority buildings. He designed a number of public and council buildings: additions to County Hall, the police headquarters at Wakefield, the teacher-training college at Bingley, and inebriates’ reformatory at Cattal. He was remembered as a genial man, popular with his staff and ‘moderately fond’ of sports – mostly cricket. 
Later additions to the site included: 1909 post-mortem room; 1915 isolation hospital; 1934 tenders for Assistant Medical Officers residence, W. H. Burton, architect; 1935 Clerk of Works house, extension to the nurses’ home also by Burton; 1939 Medical Superintendent’s house.
Storthes Hall itself, a private house to the north east of the hospital site, was used as an institution for the mentally handicapped, and was known as the Mansion Hospital. After it closed in 1991 it reverted to a private residence. In 2005 outline planning permission was granted for building a retirement community on the site of the former general asylum complex. An extension to the time limit was granted in 2012, considerable delays had ensued with arguments over the inclusion of affordable housing in the scheme. Revised plans were approved in 2016 which include converting the derelict admin block into a residential care home.
For more images of the asylum and details of its history see highroydshospital.com, the website for Storthes Hall Park student accommodation has photographs, mostly interiors, of the Huddersfield University’s student village. Historic England Archives holds a file on the hospital, ref: BF102003. Recent bird’s-eye aerial photography of the site can be seen on Bing.com/maps.
Huddersfield Chronicle, 12 Jan 1899, p.4
Huddersfield Chronicle, 5 July 1900, p.3: Building News, 21 July 1900, p.61
Leeds Mercury, 1o Oct 1901, p.2
Yorkshire Post and Leeds Intelligencer, 6 May 1913, p.7
For nearly twenty years now the faculty of Health and Applied Sciences of the University of the West of England has occupied the old Bristol Lunatic Asylum. The asylum, latterly Glenside Hospital, was wound down from 1993 when it merged with neighbouring Manor Park Hospital. New facilities for mental health patients were constructed on that side, and it was renamed Blackberry Hill Hospital. The University faculty was formed in 1996 when the existing faculty of Health and Community Studies merged with Avon and Gloucestershire College of Health and Swindon College of Health Studies.
The former hospital is one of the most attractive architecturally of the many county asylums built for paupers in the mid-nineteenth century. Its history has the added interest of its association with one of Britain’s greatest modern artists, Stanley Spencer, who worked as a medical orderly here during the First World War when the hospital was requisitioned by the War Office. During that time it was renamed Beaufort War Hospital. There is a museum on the site housed in the chapel.
Bristol Pauper Lunatic Asylum first opened in 1861. Patients had previously been sent to St Peter’s Hospital, the city workhouse that had been set up in a converted Jacobean house near St Peter’s church (see map below). By the 1850s this had become inadequate and there had been ‘certain distressing casualties’; one case at least had been the subject of an inconclusive investigation. There was much local hostility to the idea of building a county asylum, principally on the grounds of the increased burden on the rates. It was hoped that a swap might be organised with the workhouse at Stapleton, moving the pauper lunatics there and the ordinary paupers into St Peter’s, or of just converting some of the workhouse buildings into lunatic wards. But these plans were quashed by the Poor Law Commissioners who flatly refused to sanction the conversion of any part of the workhouse.
In the interim, legislation governing the provisions for pauper lunatics was tightened up, with an amendment to the Lunacy Act making it harder for counties and boroughs to avoid providing suitable accommodation. With no option but to construct a new asylum, a competition was held for the design. There were 27 entries, judged by the building committee with advice from Anthony Salvin. In March 1857 the best three were awarded prizes, the first premium went to Thomas Royce Lysaght of Bristol (£100), second were Medland & Maberly of London and Gloucester (£50), and third J. H. Hirst of Bristol (£25). Lysaght’s plans were preferred as they seemed to meet the requirements while remaining within the restricted budget, and the architect had experience of asylum construction, having been responsible for that at Cork. Mr Herapath¹ congratulated the committee for having chosen well. They had ‘taken care not to adopt the most beautiful plan, but had chosen one which was neat but not gaudy’. It was ‘quite sufficiently ornamental’. [Bristol Mercury, 21 March 1857, p.6]
Henry Crisp has sometimes been credited with the design of the original buildings (including by Historic England in the list description), but he only arrived on the scene later and it was Lysaght who got the job. Construction began in 1858 and after it was finished it was dubbed the Lunatic Pauper Palace on account of its architectural grandeur and the high cost of building (£27,500 for the building including lodge, stables, roads, planting, draining, boundary walls, supply of gas ‘etc’). The clerk of works was Mr Long, and the building contractors were J. & J. Foster, with Mr Yalland, mason; Mr Melsom, St James’s Barton, plasterer and painter; Mr Abbot, plumber; Mr Williams, glazier and Mr Harris, gas-fitter. [Bristol Mercury and Western Counties Advertiser, 20 Oct 1860,p.2]
The cost was not far removed from the half-a-dozen or so other asylums that were built around the same time; those in Cumberland and Northumberland, for the same number of patients, were estimated to cost £20,00 and £42,427 respectively. It was also considerably less than the figure being bandied about in the press some years earlier when it was reported that Lord Palmerston had ordered the authorities of Bristol to build a new lunatic asylum at an estimated cost of £45,000 (although the following year the figure reported was a more reasonable £20,000). [The Western Times, 11 Feb 1854]
It was designed in the fashionable Italianate style, the front ‘well broken up’ and forming ‘without superfluous ornament’ … ‘an exceedingly picturesque structure’, and built from Pennant stone that was mostly quarried on site, the quarries were then used for water storage beneath the kitchens. The asylum could accommodate 200 patients, with one-third in single rooms (a few of which were padded cells), the remainder in associated dormitories containing between six and eleven beds. In addition there were infirmary wards, providing a total of 22 beds. A measure of fire-proof construction was achieved through rolled iron floor joists filled in between with concrete, apart from in the offices and stores. Fire plugs for attaching hose pipes were provided at four points and the towers contained large reservoirs of water.
The Commissioners in Lunacy published a report on the asylum in 1861 following an inspection of the buildings in October the previous year by two of the Commissioners, Robert Lutwidge (Lewis Carroll’s uncle) and Dr James Wilkes. The main building was located on the northern boundary of the site, the principal elevation facing south-east. It was approached from the lodge at Fishponds along an ornamentally planted avenue. All the ground to the south of the building, amounting to around 17 acres, was used as a vegetable garden. Patients largely occupied the apartments on the south side of the building, staff and services the north side. The latter included the porter’s room, reception room, visiting room, committee room, apartments and office for the clerk or steward, rooms for the engineer and stores. In the central block, which acted as a buffer between the male and female sides of the building, were staff apartments: on the ground floor those of the Assitant Medical Officer and the Matron, the Medical Superintendent’s residence occupied the first and second floors, and servants had bedrooms on the third floor.
The kitchens were on the ground floor and the dining-hall above – a lift being installed to take food from one to the other. There was a chapel within the main complex, capable of holding 150 patients, located adjacent to the dining hall which could seat the same number. The galleries for the patients were 12 feet wide, were heated by open fire-places, and were positioned to take advantage of the views over the surrounding landscape (‘commanding good views of the picturesque country round’). Window seats encouraged patients to sit and contemplate the scenery. There were also day rooms, larger rooms with two fire-places. Every ward had direct access to the airing grounds, which were ornamentally laid out, with walls low enough to allow patients to see over them.
Heating and ventilating for the ‘asylum portion’ was by Haden & Son of Trowbridge. The towers at the extreme ends of the building extracted foul air from the wards, which was then conveyed through the roofs in a pupose-built channel. The same firm supplied the kitchen equipment. On the female side was a ‘laundry ward and establishment’ consisting of a 10-bed ward for the more convalescent patients, a receiving-room for soiled linen, a wash-house, laundry, room for sorting clean linen, and nearby were drying machines and boilers. Corresponding with this on the male side were workshops, with a ‘workshop ward’, carpenter’s, shoemaker’s and tailor’s shops. The dead-house and postmortem room were also at this end, ‘being nearer the road for funerals’.
There were various phases of extensions to the asylum. It was first enlarged in 1875-7 when the wings to the west and east were added, then in 1882 a detached chapel was built, the original one being absorbed into the hall. The chapel was designed by a local architect, E. Henry Edwards in a ‘Norman Gothic’ style to seat 350 souls. The foundation stone was laid in September 1880, the building contractors were Forse and Ashley of Bristol. [Bristol Mercury & Daily Post, 25 Sept 1880, p.8]
Henry Crips and Oatley were the architects for the additions carried out in two phases between 1887-91. The first phase comprised four new wings, mortuary and workshops, for which the building contractor was A. Krauss of Russell Town, Bristol. The second phase comprised an ‘entirely new’ administration and residential block providing for the greatly enlarged asylum – it had expanded to from its original accommodation for 250 patients to an anticipated 1,000 patients. For this phase the general building contractor was A. J. Beaver of Bedminster, and R. Withycombe of Bristol was the clerk of works. Fire-proof floors were carried out by Dennett & Ingle of Whitehall.
It was at this period that the impressive clock tower was built, rising to 120 ft with clock faces on each side. These were supplied by Potts & Sons of Leeds, and were 8 ft in diameter with illuminated dials. Bells truck the quarters and the hours. A strictly time-tabled routine had obviously become a key feature of the running of the asylum. [Building News, 10 April 1891, p.500]
Further additions were carried out in 1888-90, and then again in 1897-1902. This time the Visiting Committee dispensed with the services of an architect and appointed H. R. Withycombe, the clerk of works who had served under Crisp and Oatley, to supply plans and supervise construction. (There seems to be some doubt as to whether Withycombe actually designed the buildings or if another architect was involved.)[Western Daily Press, 16 April 1902, p.7]
During the First World War the asylum was requisitioned as a military hospital for the war wounded and renamed Beaufort War Hospital; the existing patients were relocated to other asylums, but some returned in 1919 when the military handed the hospital back to the City. Cary Grant’s mother, Elsie Leach, is said to have been one of those readmitted after the war. Although officially now called Bristol Mental Hospital, it continued to be known as Bristol Asylum locally, well into the 1920s. In 1959 it changed its name again to Glenside Hospital. The conversion to the Glenside campus of the University of the West of England seems to have been a particularly happy one, preserving the old buildings and their setting.
¹ Mr Herapath, probably William Herapath, Professor of Chemistry (1796-1868), a magistrate and prominent Town Councillor.
Brislington House, together with its founder Dr Edward Long Fox, was one of the most influential asylums in the first half of the nineteenth century. It has much in common with the York Retreat. Fox was a Quaker, like the Tukes, and he held a similar belief in the restorative power of nature and the familiar comforts of a domestic environment. Brislington House originally comprised a row of separate houses, rather than the large rambling pile that survives today. It was designed to make the patients feel at home, rather than in an institution or a prison. This was, in a large part, possible by catering primarily for paying patients, and the well-to-do at that. In this manner it operated in a similar way to Ticehurst, Sussex and Laverstock House, Wiltshire, both lucrative private asylums.
Edward Long Fox is an intriguing individual, he had an extensive private practice as a physician in Bristol, rose to be a senior physician at Bristol Royal Infirmary, and was an astute businessman, amassing a considerable fortune. Before embarking on the Brislington House venture he had operated a private asylum at Cleve Hill. But he was also involved in radical politics, and had an active interest in some less mainstream aspects of medicine. He seems to have been widely admired, but not universally so, accused at times of quackery and worse. 
Fox bought the Brislington estate in 1799, and spent several years over the planning and construction of the asylum and the laying out of the grounds around it. Building work seems to have begun in 1804, and the first patients were admitted in 1806. Fox described the arrangements:
The patients of each sex are arranged under three classes. Each class inhabits a distinct house, detached from the other by an interval of eighteen feet, with a separate court for the exercise of the patients, wherever they please; the ground of which is elevated, so that they can view the surrounding country, while a border sloping towards the wall secures them from escape. 
Although Brislington House is well documented, and plans survive for the buildings, no architect seems to be mentioned anywhere, or even a builder.
In addition to this idyllic accommodation were less glamorous cells for the refractory patients. These can be seen on the plan above, at the foot of the walled gardens to the south of each house. It was in one of these that John Perceval (son of the former prime minister, Spencer Percival, assassinated in 1812) recorded spending a miserable period. Perceval noted that the cells were lit from above, and heated by flues in the wall rather than with open fires.
At either end of the row of houses were two small detached infirmaries. The use of separate houses to aid the classification of the patients may have been inspired by contemporary French asylums, notably La Salpêtrière in Paris where the different categories of patients were assigned to separate loges or detached blocks. However, the loges at La Salpêtrière, designed by François Viel c.1786, were all of one storey and the same design. At Brislington the houses were of two or three storeys and not identical.
The buildings were also interesting for their early use of fire-proof construction; a matter which was close to Fox’s heart. When the first county asylum was built at Nottingham in 1810, Fox was in correspondence with the Committee of Governors and warmly recommended the use of iron in construction which he considered ‘did not only serve to alleviate the dangers from fire, but also from lice and vermin’. 
Fox’s success was immediate and sustained. A mark of this is the erection on the estate of Lanesborough Cottage in 1816 for Lord Lanesborough, and of Swiss Cottage in 1819 for Lord Carysfoot. The Beeches was added in the 1820s and Heath House, the large villa to the north-west of the main asylum, was built around 1829 and was occupied by Edward Fox when he retired from the management of the asylum in that year. But the asylum remained a family business, his sons Francis and Charles, both also physicians, taking over its management. After their father’s death in 1835 they issued a brochure or booklet relating the history of the asylum and its present state. In 1850-1 they undertook a major remodelling of the buildings, joining them together as they are now, and building additions, including the chapel. Previously the laundry was converted into a chapel on a Sunday, and services regularly performed there. 
The main building was oriented on a north-east to south-west axis, with the entrance front facing north-west, so the garden front had the sunnier south-east aspect. Both long elevations still have a rather disjointed appearance, presumably reflecting their former separation. The building is rendered with stone dressings in an Italianate palazzo style.
The garden front is more informal, the central seven bays are flanked by full-height bows, rather resembling angle turrets, with three windows at first and second floor levels.
Across the north end the chapel and recreation hall were built. The chapel has a Greek cross plan and follows the classical style of the rest of the asylum. Inside the box pews were still in situ in 1992 and a fine wood-carved reredos with gothic (or possibly gothick) details, some good light fittings and a painted timber compartmental ceiling. There was also a small gallery over the entrance.
The recreation hall, which was added in 1866, has a deceptively austere exterior – doubly so in the early 1990s when it was faced in rather grimy render. The interior was contrastingly lavish with a small platform at the west end, the walls panelled with bolection moulding and ornamented by anthemions and lyres, and broad pilasters with paterae decorating the frieze. The coved ceiling has bands of greek key pattern and, in the corners of the central flat section, decorative plasterwork scrolls. Similar neo-Classical inspired plaster ornamentation appears over the doors at the west end. The iron pendant lamps are equally ornate.
Brislington House remained in the ownership of the fox family until 1947 when it was purchased by the Governors of the United Bristol Hospitals and was used as a nurses’ home.
In 1948 it passed to the National Health Service and was put on the market by the South Western Regional health Authority in September 1984. It was then run as a private nursing home for some years before it was sold again and turned into private flats in 2001 and renamed Long Fox Manor.
The landscaped grounds and their importance as a part of the therapy for patients at Brislington House have been researched and written about by Sarah Rutherford (see studymore) and Clare Hickman, see her article on ‘The Picturesque at Brislington House, Bristol…’ in Garden History, vol.33, No.1 Summer, 2005, pp. 47-60.
Leonard Smith ‘A gentleman’s mad-doctor in Georgian England: Edward Long Fox and Brislington House’ in History of Psychiatry 2008, 19 (2), pp 163-184
The reference that I had for this was from Fox’s evidence to the Parliamentary Select Committee on the state of Criminal and Pauper Lunatics in England and Wales of 1807. I cannot now find any such evidence from Fox to this Committee. Sarah Rutherford gives a reference to Fox giving evidence to the 1815 committee, but I can’t find that either. The quote is not from his evidence given in the late 1820s, nor does it match the report on the asylum in the 1815 committee, where the evidence was given by Edward Wakefield for Brislington House. Happy to be enlightened.
Nottinghamshire Record Office, SO/40 1/50/4/1
PP Report of the Committee on Madhouses in England, 11 July 1815, evidence of Edward Wakefield p.21
More has perhaps been written about The Retreat since its foundation in the late-eighteenth century than almost any other psychiatric hospital in Britain. Alongside Bethlem it is probably the best known. The post here merely aims to provide a brief overview, principally of the buildings. The bare bones of its history are simply told. It was founded by the Society of Friends, and more particularly by William Tuke, as a lunatic asylum for fellow Quakers. The chief spur to its foundation was to provide an alternative to the York asylum, about which some serious questions were being raised regarding the treatment of patients there, particularly of the poorest class, and the conditions in which they were kept.
While the motive for the foundation may have derived from the Society’s spiritual beliefs, the groundwork was entirely practical. Recent works on asylum management and design were read, the new St Luke’s Hospital in London was visited and physicians consulted. But the choice of architect was less straight forward. In the 1790s there were still few purpose-built asylums in Britain, and the architectural profession was very much in its infancy. There were no particular specialists in institutional buildings, such jobs often went to the county surveyor. The top man locally, John Carr, might have been too expensive for the Society, but he had also been the architect of the York Asylum, and not only did the Society object to the management of that asylum, but it was also stylistically at variance with the Society’s preference for unostentatious buildings.
And so they looked to one of their own faith, John Bevans, sometime carpenter and architect of London. He had never built a lunatic asylum before, and confessed that asylum planning ‘was a subject that never occupied my thoughts’, prior to his appointment.  However, there is some evidence that he was the designer of the Quaker Workhouse in Clerkenwell, completed in 1786, so not altogether irrelevant experience.  Along with William Tuke he visited and was impressed by St Luke’s Hospital in London, and aspects of the plan were adopted for The Retreat, albeit on a reduced scale. The wings were two instead of three storeys, flat ceilings substituted for arches, and there was a central stair rather than separate stairs in each wing. William Tuke and his son had also sketched out early plans as guidance, but as Bevans remained in London, a local architect, Peter Atkinson, was brought in to manage the construction, and draw up plans and elevations following Bevans’ directions. 
Before the plans could be finalised, money had to be raised and a site found. William Tuke, his son Henry and Lindley Murray raised funds by subscription from Friends throughout England and the site was acquired in 1793. When The Retreat opened in 1796 it comprised a central three-storeyed block with a recessed two-storeyed wing to the west. In the following year a corresponding wing was built to the east. The buildings were of plain brick with slate roofs.
Twenty-one years after the foundation of the asylum had been first considered, William Tuke’s grandson, Samuel, published a description of The Retreat. He related that the idea had been to establish ‘a retired Habitation, with necessary advice, attendance, &c. for the Members of our Society, …who may be in a state of Lunacy, or so deranged in mind (not Idiots) as to require such provision.’ 
From the outset the setting and the grounds were as important as the building itself. The founders wanted a site large enough to furnish a few acres of pasture land for cows and for gardens where the patients might take exercise. The financing was arranged on the established model of a voluntary hospital, whereby voluntary subscriptions were made towards the cost of running and maintaining the institution. Those subscribing over a certain amount could nominate poor patients on the lowest rates of admission, and could attend the governing committee meetings. 
The central block contained the main entrance, and, on the ground floor, the kitchen, a dairy, pantry and larder on the north side, and a parlour and dining-room on the south side, as well as the principal stair. A corridor, eight feet wide, ran along the east-west axis of the whole building and the patients’ accommodation in the wings comprised single bed rooms, pump room, closets and day rooms placed either side of the corridor. As at earlier asylums, including St Luke’s and Bedlam in London, the patients’ single rooms were lit by a small window, placed high up in the wall.
The Retreat was opened on 11 May 1796 and the first three patients were admitted in June. A local physician was appointed to attend the patients.  The entrance retains its original pedimented doorcase but most of the windows have been refitted with modern sashes. The original sashes, of which only a few remained by 1992, were of iron with iron glazing bars; in order to give security without the appearance of bars one sash filled the whole height of the window but was only glazed in the lower part, and a second, moving, sash had glazing bars which, in the closed position, came exactly behind those of the first.
The Retreat became the most influential asylum of its time, not so much in terms of its design, but in the treatment and care of the patients it admitted. Although the roles of William and his son Henry Tuke should not be underplayed, it was William’s grandson, Samuel, who was largely responsible for the wide sphere of influence of the hospital through his systematic study of lunacy and his publications, notably the Description of the Retreat of 1813. It was at his father’s request that Samuel began writing ‘a history and general account of the Retreat’ in 1811, but it was on his own initiative that he turned this into an opportunity for himself to read as many authors as he could come accross on the subject of insanity. He also read William Stark and Robert Reid’s accounts of the planning and design of the asylums at Glasgow and Edinburgh, both of whom had visited the Retreat. In 1812 he visited St Luke’s in London to discuss the ‘humane system’ with Thomas Dunston, the superintendent there, but was neither impressed by Dunston nor the asylum, which he considered was too prison-like in appearance.
On its publication, Tuke’s Description… was thrust to the fore in the subsequent controversy involving the York Asylum, and its physician, Dr Best, who took great and public exception to Tuke’s well considered work. If Best had hoped to blight the prospects of this rival asylum in York, he was doubly disappointed. Not only did he attract much publicity to the Retreat but to his own institution which was very soon exposed as corrupt in administration and inhumane in its treatment of the poorest inmates.
Neither Samuel Tuke nor John Bevans considered that the plan of the Retreat was a perfect model. Tuke considered that ‘an inferior plan well executed, may be more beneficial than a better system, under neglected managements’.  Tuke was also critical of the airing courts on the south side of the building which were bounded by eight foot high walls. Although the natural slope of the ground preserved a reasonable view of the surrounding countryside, Tuke nevertheless felt that the courts were too small and that they must appear uninviting to patients where ‘the boundary of his excursion is always before his eye; which must have a gloomy effect on the already depressed mind’. Another defect of the plan which Tuke noted in his Description… was the arrangement of patients’ rooms on either side of the corridors, or galleries: ‘for, though a large portion of light is admitted, by the window at each extremity of the building, yet, the galleries on the ground floor, at least, are rather gloomy’. 
The treatment of the patients set the Retreat apart from its contemporaries, in particular the larger London asylums. Whilst the system of ‘moral management’ developed there did not necessarily have direct expression in the design of the building, it did have an effect and elements of building reflect the greater understanding of the needs of those afflicted with mental illness. The Tukes, and the early staff of the Retreat, rejected the widely held belief that lunatics were insensible to the usual comforts of the sane, such as warmth or an appreciation of their surroundings. At both Bedlam and St Lukes the windows in the patients’ cells were unglazed, as it was considered that lunatics were insensible to cold, and the ventilation helped to disipate the stench of soiled straw which formed the patients’ bedding. In response to their more enlightened views Bevans devised the iron-framed windows for the Retreat and the fires and stoves were provided with safety guards to protect the patients. Similar thought was given to the furnishings – curtains were designed specially without any element that could be misused by a patient to harm himself or others.
The Retreat quickly became a success and additional accommodation was soon required. The first addition of the west wing, part of the original design, was made almost as soon as the first phase of construction had been completed in 1796. In 1799 a building was added for male patients and a separate airing ground provided. This was the five-bay wing added at the south-east corner. It was appropriated to the more violent patients. Later, in 1803, a corresponding wing was added to the south-west corner for female patients. Further accommodation was still required and in 1810 a house near Walmgate Bar was acquired for £1,200. This house was, for a time, known as ‘the Appendage’. It was sold in 1823 to the Yorkshire Quarterly Meeting as a boys’ school. Another house was acquired in 1816 on Garrow Hill.
An annexe to the south, known as ‘the Lodge’ was built in 1816-17, rebuilt on a larger scale in 1875. In about 1827 the south-east wing was extended eastwards and two new wings had been added on the north corners replacing the stable block on the east and the brew house and bake house on the west. There was also an octagonal gate lodge on Heslington Road.
Expansion continued in the second half of the nineteenth century, beginning with an appeal for building funds launched in 1852, resulting in another new wing in 1854. Further additions were made in 1858-60. Villas were acquired in 1879 (Belle Vue) and built in 1880 (East Villa) while from the 1890s the now ageing buildings were remodelled by Walter Brierley, and a new recreation room constructed in 1906. 
A nurses’ home was built in 1899, but a newer and larger one was built in the 1920s following a limited competition for the design. This was won by Chapman & Jenkinson of Sheffield. Bedrooms for fifty nurses were provided on the first and second floors, and a kitchen, dining-hall and sitting-rooms occupied the ground floor. It was constructed of local grey bricks with hand-made red brick and some stone dressings, and Westmorland slates for the roof. The contractors were William Birch & Sons of York and work was completed by 1929. 
The Retreat continues to provide specialist mental health care, occupying its original site and most of its original buildings, a testament to the success of the original founders and the validity of their ideals. (see theretreatyork.org.uk)
A. Digby, Madness, Morality and Medicine. A Study of the York Retreat, 1796-1914, 1984, p.18
Survey of London vol.46 South and EastClerkenwell, pp.341-2
Anne-Marie Akehurst ‘The York Retreat A Vernacular of Equality’, pp 81-4, in Peter Guillery, ed Built from Below British Architecture and the Vernacular, 2011
Samuel Tuke, Description of the Retreat, an institution near York for Insane Persons of the Society of Friends, 1813, p.26
Samuel Tuke, Description of the Retreat, an institution near York for Insane Persons of the Society of Friends, 1813, p.29
Samuel Tuke, Description of the Retreat, an institution near York for Insane Persons of the Society of Friends, 1813, p.46
Samuel Tuke, Description of the Retreat, an institution near York for Insane Persons of the Society of Friends, 1813, p.47-9
Samuel Tuke, Description of the Retreat, an institution near York for Insane Persons of the Society of Friends, 1813, p. 106
The Builder, 12 Feb. 1926, p.276; 26 April 1929, pp 764-76
This is far from comprehensive, but just a few key texts or books/articles that I have read and found interesting.
Anne-Marie Akehurst ‘The York Retreat A Vernacular of Equality’, pp 81-4, in Peter Guillery, ed Built from Below British Architecture and the Vernacular, 2011 Anne Digby, Madness, Morality and Medicine. A Study of the York Retreat, 1985 Barry Edginton, ‘The Design of Moral Architecture at the York Retreat’ in Journal of Design History, 2003 vol.16 (2) pp.103-117 H. C. Hunt, A Retired Habitation, A History of The Retreat, York, 1932 R. Hunter and I. Macalpine, Description of the Retreat… 1964 Samuel Tuke, Description of the Retreat, an institution near York for Insane Persons of the Society of Friends, 1813
Holloway Sanatorium was in a parlous state when we visited it in about 1992 as part of the RCHME Hospitals Project. Although the process of decay was sad to see, the stunning interior decoration was still impressive. In 1997-8 the main rooms in the building were restored, the artwork re-instated and the site developed as a gated residential estate, rebranded Virginia Park.
The sanatorium was founded by Thomas Holloway, of Holloway’s Pills and Ointment fame, for the mentally afflicted of the middle classes. Its architect was W. H. Crossland, who won a competition for the design in 1872. The foundation stone was laid by Holloway’s wife Jane in 1873. Although it was described as nearly finished in 1877, it was another seven years before the first patients were admitted in 1884, and the official opening ceremony did not take place until 15 June 1885. By then Thomas Holloway was dead, the project having been completed under the direction of his brother-in-law, George Martin Holloway.
‘All exuberance of ornament and expensive detail is avoided’ was the claim, but the building itself rather belies that statement. 
The sanatorium was intended for the middle classes only, with a particular view to accommodating professional men who were thought likely benefit from a year’s residence in a quiet rural neighbourhood.  This was incidentally the type of patient most likely to be able to afford the highest rate of fees for such a stay. A year was the maximum length of stay permitted. Certain conditions were excluded, including those deemed incurable, so no hopeless cases or, in the language of the time, epileptic, paralytic, and uncleanly subjects were all inadmissible. 
Holloway thoroughly researched asylum planning and the treatment of the mentally ill before announcing a competition for the design. He was said to have visited asylums at home and abroad, and consulted numerous architects and the members of the medical profession.
Initially there was accommodation for 200 patients, divided into four classes, 1st, 2nd, sick and feeble, and excited. All day-rooms, dormitories and single rooms had a south and south-western aspect. Attendants’ rooms were placed between day-rooms and dormitories with a glass window or doors of communication that allowed them to keep the patients under observation.
Some of the interior decoration, notably the ceiling of the recreation hall, was carried out by the Scottish architect and designer John Moyr Smith. The walls of the dining hall had frescoes after Watteau, variously reported as being executed in the National Art Training School at South Kensington under the direction of Edward Poynter or by James Imrie, though both statements may be correct. When the sanatorium opened the medical press thought the wall decorations betrayed the influence of ‘Japanese artistic methods’. 
Above is one of the Watteau-inspired paintings in the dining-hall, painted on canvas rather than frescoed, with a pastoral scene of grazing sheep in the lunette over it.
The richness of the interior for a mental hospital is perhaps rivalled only by Craighouse in Edinburgh, at least in Britain. Tellingly, Pugin was consulted by Holloway in the early stages of the project. As well as the huge recreation hall and dining-hall, according to one report the sanatorium was intended to have a billiards room, thirteen day rooms, and no less than four libraries for the use of the patients, ‘well stocked with readable books’ (always the best sort). 
The decorative scheme certainly seems to give more than a nod to Pugin, with echoes of the Houses of Parliament, and at the time the sanatorium opened The Builder considered that its only equal in richness was the House of Lords. It fell foul of the next generation of architects – C. R. Ashbee commented that it was ‘very garish and ghastly, but appropriate’. 
The hammer-beam roof of the recreation hall evokes Tudor splendour, modelled on examples such as the hall at the Middle Temple or Hampton Court Palace. Crossland had produced something similar for his Rochdale Town Hall.
The central grand entrance and staircase were originally intended only to be used on special occasions. Every inch was covered with gilding or bright colour, apart from the parquet wood floor and the marble top of the staircase balustrade.
In the early 1990s the portraits were the most badly decayed, and there were chunks of painted plaster lying on the floor. Depicting ‘distinguished persons’ the portraits were said to have been the work of Ernest Girardot and others. 
The portrait above may be of Thomas Holloway himself, watching over the patients and staff. His portrait, and that of his wife, graced the interior, along with his coat of arms and family monograms, a constant reminder of the founder.
The Builder, 24 Aug 1872, p.665
BMJ 20 June 1885, pp 1258-9
The Graphic, 2 June 1877, p.521
BMJ 20 June 1885, pp 1258-9: The Star, 18 June 1885, p. 4: British Architect, 26 June 1885, p.311
Frome Times, 27 Nov 1878, p.3
quoted in Anna Sheperd, Institutionalizing the Insane in Nineteenth Century England, 2015, p.24
Bethlem Hospital remained in St George’s Fields, Southwark from 1815 to 1930. In that time numerous additions and alterations were made to the building, but the area around had also developed and changed almost beyond recognition. In the early nineteenth century it was airy and open, with few houses and market gardens in the immediate vicinity. It was on the other side of the river from the densely built-up urban centres of Westminster and the City, and on the outskirts of Southwark itself. But it did not remain a rural or even suburban idyll for long, as industrialisation and the population expansion of the capital brought waves of building activity.
Greenwood’s map of London of 1830 captures the moment before this expansion, half a century later and Bethlem hospital had been engulfed. Population density increased as the century wore on, with the usual pattern of housing intended for single families increasingly occupied by two or three.
Booth’s poverty map of London of the late 1890s showed that although those living in the immediate surroundings of the hospital were classed as fairly comfortable, on the other side of the Lambeth Road were pockets of the lowest class, the vicious and semi-criminal, amongst housing that was almost entirely occupied by the poor, or very poor.
Other changes had occurred during the century or so that Bethlem was at St George’s Fields. Legislation had been introduced to encourage the establishment of lunatic asylums for paupers early in the nineteenth century (the Lunacy Acts of 1808 and 1815), and this reduced the need for Bethlem to cater for the poorer class of patient. The County Asylums Act of 1845 made the establishment of pauper asylums compulsory, and this, coupled with a new regime headed by Dr W. Charles Hood, the first resident medical officer, saw a shift towards caring for a higher class of patient. This was consolidated after the opening in 1863 of Broadmoor for criminal lunatics, removing another class of patient formerly accommodated at Bethlem. Improvements to the accommodation were made, the comforts of home introduced and a convalescent home built at Witley (1866-9, designed by Sydney Smirke). 
So by the early twentieth century the type of patient at Bethlem had changed, and the locality had become more densely urban, but more importantly than either of these in prompting a move to a new site was the old-fashioned design of the building and the constant demands and cost of maintaining the ageing fabric of the asylum.
Asylum design had moved on since 1815, and a century later the ideal form for a mental hospital was considered to be the colony plan or villa system, comprising detached buildings set in landscaped grounds. Colony plan asylums were developed in Germany from the late 1870s but had their origins in the Gheel Colony in Belgium. Gheel had traditionally originated in medieval times as a place of pilgrimage to the shrine of St Dymphne which had gained a reputation for curing the insane. Pilgrims were boarded in the village and gradually it developed into a mental colony. In the nineteenth century the Belgian government placed its administration under the control of a Commissioner and Board of Governors. 
One of the most influential of the later colonies, was the Alt Scherbitz (now Altscherbitz) village asylum near Leipzig, established in 1876 for 960 patients. Its layout was published by John Sibbald, a Commissioner in Lunacy for Scotland, in 1897 in his Plans of Modern Asylums for the Insane Poor. At Altscherbitz, the site was naturally divided in two by the high road between Halle and Leipzig and this separation was used to divide the medical and non-medical sections. Gender informed the first level of classification, with the women’s houses to the west together with the kitchen and laundry, and the men to the east where a brick works provided manual labour.
This colony plan was welcomed as it seemed to offer a solution to new ideas about how the patients’ environment promoted recovery or cure. It aimed to provide recognizably domestic surroundings, emulating the home environment rather than reminding the patient that they were in an institution. There were earlier precedents for this, but in small private asylums such as Brislington House near Bristol, built in 1806.
The first time the colony plan was attempted on a large scale and at a public institution was at Craighouse, built as an annexe to the Royal Edinburgh Asylum in 1889-94, although this was for paying patients. It was designed by Sydney Mitchell in close collaboration with Thomas Clouston, the asylum’s Medical Superintendent, to give architectural form to his ideas on the cure of mental illness. The buildings revived something of the palatial aspect that had largely disappeared from asylum architecture since Hooke’s Bethlem. Clouston wanted variety, in the colours of the building materials, in the architectural details, of size and of scale. Believing that patients associated phases of their illnesses with their surroundings, he particularly wanted to be able to move convalescent patients to a new environment.
Poorer patients got their taste of the colony system a little bit later at the Crichton Royal in Dumfries, where detached houses were added in the grounds during the early 1900s. Sydney Mitchell, was the architect, and he, along with a deputation from the asylum’s Board of Management, had set out in 1897 to visit Altscherbitz and similar asylums at Biesdorp and Lichtenberg near Berlin. Such missions became increasingly common. In 1899 a deputation of the Aberdeen District Lunacy Board made a tour of continental asylums before commissioning a design for their new district asylum on the Altscherbitz model.
Further colony plan asylums were built in Scotland at Bangour, which opened in 1906 serving Edinburgh, where a competition was held for the design which specified Altscerhbitz as the model, and Dykebar at Paisley which opened in 1909. Bangour is particularly significant for Bethlem: its architect, Hippolyte J. Blanc, had as one of his assistants working on the asylum plans, John Manuel, who later worked with Charles E. Elcock, architect of the new Bethlem Hospital. 
In England colonies were built around the same time, but not as yet for general mental hospitals. Instead they were deemed appropriate in the first instance for epileptic colonies. In 1884 the National Society for the Employment of Epileptics established a home at Chalfont St Peter in Buckinghamshire. It began with just one villa, a temporary iron structure, to which further villas were gradually added.
But the colony plan was most widely adopted for a new breed of asylum ushered in by the Mental Deficiency Act of 1913. A Royal Commission had been appointed in 1904 to look into the care of the feeble-minded. This at least spoke out against the sterilization of those deemed mentally deficient that was being advocated by the Eugenics Education Society, and it was this Commission which resulted, eventually, in the 1913 Act. Amongst other things, the Act sought to define mental deficiency which was considered to be present from birth and incurable, as opposed to mental illness which was usually contracted later in life and deemed curable. The Act legislated for the provision of accommodation, care and protection of the former group whose removal from undesirable surroundings was thought necessary ‘in their own interests and that of society’. The Board of Control, which replaced the Commissioners in Lunacy in 1914, recommended the colony system for these new institutions, as it allowed ‘better classification and training’ and ensured that the inmates were happier and more contented than in institutions of the barracks type.
It was a combination of these influences which lead to the adoption of a colony plan for the new Bethlem hospital at Monks Orchard. It was the first new mental hospital designed in England since the war. Elcock & Sutcliffe were appointed in February 1926 to work alongside the hospital surveyor, John Cheston. Charles Ernest Elcock was the key figure behind the design, which he hoped would ‘make a leap forward’. However, his plans still had to meet the approval of the Board of Control. While the Board was in favour of colonies, it disapproved of Modernism, thought flat roofs should be shunned, and was most comfortable with the blandest of Neo-Georgian styles.
Unsurprisingly relations were often frosty between Elcock and the Board’s architect John Kirkland, and indeed Sir Frederick Willis, Chairman of the Board from 1921 to 1928. Willis criticized the ‘generous scale’ of the rooms, which he suggested were due to Elcock trying to balance the buildings, while Kirkland queried the necessity for Turkish Baths, and took a great deal of convincing over the flat roofs, which were only used on the peripheral buildings on the site. After much wrangling, the amended designs were approved and detailed drawings submitted in December 1928. 
It may have been the pressure of work involved in the Bethlem job that prompted Elcock to seek an assistant in 1928. He appointed Ralph Maynard Smith, a young man in his mid-twenties, who was as much an artist and a poet as an architect. Maynard Smith had studied at the Architectural Association, and spent a brief time working with the architect Michael Waterhouse immediately before joining Elcock & Sutcliffe. There undoubtedly were other assistants in Elcock’s office, making it difficult to know who did what in the design and planning process. A building at Bethlem where Smith’s influence may be felt is the chapel. It is a beguiling building, quite unlike the many hum-drum Gothic asylum chapels of earlier years. Its design was obviously considered a success as it was elaborated upon a few years later at Runwell Hospital in Essex, also by Elcock & Sutcliffe.
Stylistically Bethlem presents something of a mix, from the conservative administration block, with its hipped roof and Neo-Georgian simplicity to the starkly modern boiler house and flat-roofed patients’ accommodation blocks and treatment unit. Elcock laid an emphasis on the setting to give attractiveness to the buildings with ‘pleasing roads, avenues, flower borders, etc’. 
Elcock set new standards in the scale and type of accommodation he provided which included laboratories, hydrotherapy facilities, a lecture room for students, and a separate treatment and research block. The sexes were no longer strictly segregated either: male and female patients shared buildings, from the more severe ‘excited’ patients to convalescents. Elcock researched his subject thoroughly, touring the country to visit the best new buildings added to older hospitals, and consulting medical staff.
In the end the design was compromised both by the restrictions imposed by the Board of Control and the necessary cost-cutting in the face inflation in the years after the General Strike. But if it wasn’t quite the magnificent hospital originally proposed, it was certainly well-equipped and incorporated many innovative features. There were four main villas for patients, two for quiet cases, one for ‘excited’ patients, the fourth for convalescents. Nearly all the patients were accommodated in single rooms, in line with private general hospitals and in contrast to tendency towards dormitories in municipal mental hospitals. In addition to the patients villas there were the usual service buildings – kitchens, boiler house, stores etc, and the innovative Treatment and Research unit, which provided hydrotherapy, psychotherapy, dental and electrical treatment, pharmacy, and operating theatre. 
Today the core buildings are little altered, but many of the outlying buildings have had many alterations and newer buildings have been added to the site to meet the changing needs of mental health care. In recognition of the hospital’s historic importance there is a museum on the site, the Museum of the Mind, which opened in 2015.
Survey of London, vol.25 St George the Martyr, Southwark and St Mary Newton, Ida Darlington ed. 1955, p.78 (online version at British History Online): Jonathan Andrews, Asa Briggs, Roy Porter, Penny Tucker and Keir Waddington, The History of Bethlem, Routledge, London and New York, 1997, pp.503ff
H. Richardson ‘A Continental Solution to the Planning of Lunatic Asylums 1900-1940’ in J. Frew and D. Jones (eds) Scotland and Europe, Architecture and Design 1850-1940, 1991
H. Richardson ‘Charles Ernest Elcock’ in Essays in Scots and English Architectural History, 2009, p.122
Bethlem Royal Hospital Archives, Special Commitee Minutes, 1928 pp. 194, 196-7, 291
Bethlem Royal Hospital Archives, Special Commitee Minutes, 1926-7, p.34
Visitors to the Imperial War Museum south London may easily be unaware that they are walking through the remains of a former mental hospital, in fact the former mental hospital that gave us the word Bedlam. Only the central block remains of this, the third home of that exceptional, long-lived institution that is now Royal Bethlem Hospital in the London borough of Bromley. 
The origins of Bethlem hospital were monastic, evolving from the priory of St Mary of Bethlehem. The copperplate map of London of the 1550s shows its original site at Bishopsgate near the large open ground of Moorfields.
By the early 1400s it was already specializing in the care of the insane. In time it came to be owned and governed by the City, which also acquired Christ’s Hospital ‘erected for the vertuous bringing up of the myserable youth’, St Thomas’s hospital ‘for the relevynge of the neadye and deseased’, and Bridewell for ‘thenfocinge of the lewde and naughtie sorte to labor and worke’. Bridewell and Bethlem were managed by a joint court of governors. 
By the 1670s Bethlem had very much outgrown its site, the governors declaring their hospital to be ‘very old weake and ruinous’ and too small for the ‘great number of lunatics as are therein at present’.  The new building erected in 1674-6 just round the corner from the original hospital could not have contrasted more strongly with the old. It was designed by Robert Hooke with sufficient accommodation for 120 patients.
The engraving above shows the north elevation, viewed across the green expanse of Moorfields, and peeking above the roof ridge a regiment of City church towers and spires (and what appears to be Wren’s monument to the Fire on the left). Here is a hospital in the guise of a palace – its grandeur and French Renaissance style prompted the suggestion that it had been modelled on the Tuileries, and the apocryphal story that Louise XIV was so offended by the similarity that he ordered ‘a plan of St James’s Palace to be taken for offices of a very inferior nature’. 
A grand architectural statement was the wish of the governors. It was a quite deliberate piece of self-advertisement, intended to to attract visitors and funds. The policy of opening their doors to visitors to view the inmates was already well established at the old site. At the time the intention was to raise awareness of the plight of the insane, to awaken the pity of the spectator, and prompt charitable and generous donations towards their care and treatment.
Hooke’s selection as architect was a logical one. He had been City Surveyor since 1666 and was at that time supervising the rebuilding Bridewell, Bethlem’s sister institution, after the fire. There were no other hospitals for the insane in Britain at the time, or indeed many hospitals of any kind. The very term ‘hospital’ had not yet become so exclusively the property of a medical establishment and was still being used with its broader meaning of a place of hospitality – and ‘infirmary’ might more usually be expected to be applied to a place for the sick. The plan for Bethlem called for a building that could house a large number of individuals, who might at times be disturbed or violent. This introduced the need for containment or confinement. To modern eyes the plan seems most closely allied to that of prisons, and in particular the model prisons of the nineteenth century.
Although Hooke presented two ground plots and a model of his intended asylum to the governors before building work began, no plan has ever come to light. However, there are sufficient descriptions of the interior for key elements to be deduced. The central pavilion, with the main entrance, contained a hall, ornamented by tablets bearing the names of the hospital’s benefactors linked together by carved cherubs’ heads. Off the hall were the steward’s office and a room for the chief physician and apothecary where new admissions were examined and from which patients were discharged. To the rear of the hall the principal staircase rose to the committee room, probably the grandest internal space decorated with an ornamental plaster ceiling. This central block also gave access to the patients’ accommodation which was contained within the wings on either side. These were of two storeys over a raised basement, with the inmates on the raised ground and first floors where the plan comprised a row of single cells, lit by small high windows on the south side of the building, off a long gallery, lit by larger windows. In the basement were the kitchen, laundry and stores.
The plan by Hooke is remarkable. It seems to be the first time that such an arrangement was devised, there being no obvious precedent in this country. This was also the first charitable building to be erected in London since the Reformation. In fact the first entirely new charitable foundation since the Savoy Hospital of 1505-17. It was one of the first public buildings completed after the Great Fire, pipped at the post by the rebuilt Royal Exchange designed by Edward Jarman and Wren’s Custom House, both of which were completed in 1671. 
Although there may not have been any lunatic asylums in Britain to provide a model, there were other buildings where large numbers were housed under one roof. Schools, almshouses, prisons, and even royal palaces. Including palaces in this selection is not a mere frivolous reference to the Tuileries. The galleries at Bethlem may well have their origins in the long gallery and cloister walks of the great Tudor houses and palaces, where they were intended to serve the same function of a place for exercise, particularly in bad weather. Bridewell was built as a palace, to which a long gallery was added in the early sixteenth century. It was only turned into a workhouse some decades later.
The galleries at Bethlem also served as corridors of communication, and were open to visitors. Hogarth’s final scene of the Rake’s Progress is set in Bethlem and shows one of the new men’s wards added at the east end of the asylum in 1725. This gives a glimpse of the cell/gallery arrangement, here the gallery is occupied by several patients, apart form Hogarth’s hero Tom Rakewell, and just two female visitors clinging to each other and keeping close to the wall in the background. It should be noted, however, that this wing, which was intended for incurable patients, had cells on both sides of the gallery. One of the key features of Hooke’s layout was therefore lost, that of creating a ‘permeable’ structure, with the cell doors opposite the gallery windows allowing light and air to pierce the building.
It may seem strange that the galleries were placed on the north rather than the sunnier and warmer south side of the building. This was no error, cool temperatures and even light were considered beneficial to a disturbed mind, having a ‘sedative power’. Some went so far as to argue that the insane were in fact insensible to cold, though at Bethlem, at least, there is evidence that measures were introduced to keep the patients warm.
Two views published in 1814 show the north side of the hospital. They demonstrate how severe this elevation was in comparison to the front, with these small, high windows that lit the cells, as well as its proximity to the boundary and the road.
Christine Stevenson has pointed out the similarities between Hooke’s design for Bethlem with that of his nearby Aske’s Hospital an almshouse for the haberdashers’ Company designed in 1692. 
Like Bethlem the building is single pile, which, as Roger North noted later, was particularly suitable for a college or hospital, to be divided into cells, and chambers independent of each other. In asylum architecture this pattern of patient accommodation in single cells off a gallery remained set for almost two centuries, although it was some time before anything on a comparable scale was built in Britain. In fact, not until St Luke’s Hospital was built in 1750. And so, when Bethlem took the decision to move to a new location, the plan of the new hospital pretty much followed that of the old.
A competition had been held to design the new building in 1810, judged by James Lewis, the hospital’s surveyor, George Dance the younger and S P Cockerell. Although Lewis’s pupil, William Lochner was awarded the first prize of £300, it was Lewis who was given the task of drawing up the final plans and elevations based on the three winning entries. (the second pirze was awarded to J. A. and G. S. Repton and the third to John Dotchen)
The opening of the new asylum coincided with the publication of a Select Committee Report on Madhouses in England in which it was immediately censured. There was a long list of complaints from its excessive expense to the gloominess of some of the rooms, particularly those at the front overshadowed by the ‘immense portico’.
The classification of the patients was deemed inadequate due to an absence of separate staircases to each of the galleries. There were complaints about the lack of glass in the patients’ sleeping rooms (a complaint no doubt shared by the patients, whose misery was increased by the fact that the system of warming the asylum by steam was installed only in the basement). This absence of glazing was no oversight, but a deliberate omission to ensure the ventilation of the cells and, as the governors claimed, obviate ‘the disagreeable effluvias peculiar to all madhouses’. A year later, however, the windows were glazed. The Report also disapproved of the way in which the front windows were closed up, preventing the patients from looking out of them. 
The new Bethlem was neither so very different nor so very much worse than most other asylums built both before and after. It had a central administration block from which sprouted the patients’ wings, most of which followed the ‘cells on one side gallery on the other’ arrangement. Also repeating the earlier arrangement of having the galleries on the north side of the building. At either end of the building, again repeating the arrangement of the old building after the early eighteenth-century additions, there were cells on both sides of a central corridor. A chapel was provided under the shallow dome; sniffily referred to as a ‘species of pumpkin-shaped cupola’ by the Government in 1812 when it was proposed to put a semaphore on top, as an early warning system in the event of an attack from France. The dome was rebuilt in 1844-6 as part of general additions and alterations carried out to designs by Sydney Smirke.
When Bethlem moved for the fourth time to Monks Orchard the freehold of the old site was bought by Viscount Rothermere in 1930 and vested in the LCC for the formation of a public open space named in memory of his mother, Gerladine Mary Harmsworth. Much of the hospital was demolished but the remainder was leased to the Commissioners of Works to house the Imperial War Museum. It opened to the public in 1936, was closed during the Second World War during which time it received bomb damage in 1940, 1941 and 1944. An account of its history was published in volume 25 of the Survey of London, published in 1955 less than ten years after the museum had reopened. The volume was edited by Ida Darlington, and it is perhaps her words which end the account thus: ‘It is perhaps appropriate that a building occupied for so many years by men and women of unsound mind should now be used to house exhibits of that major insanity of our own time, war.’ 
The main source used here is the definitive history by Jonathan Andrews, Asa Briggs, Roy Porter, Penny Tucker and Keir Waddington, The History of Bethlem, Routledge, London and New York, 1997
The History of Bethlem, p.76, quote from Christ’s Hospital minute books
ibid, p.248 quote from Bethlem Court of Governors Minutes
Thomas Bowen, An Historical Account of the Rise, Progress and Present State of Bethlem Hospital, London, 1783 p. 5n, see also Christine Stevenson’s article (below) p.256
Christine Stevenson ‘Robert Hooke’s Bethlem’ in Journal of the Society of Architectural Historians, vol.55, no.3 (1996), p.257
Christine Stevenson ‘Robert Hooke’s Bethlem’ in Journal of the Society of Architectural Historians, vol.55 no.3 (1996), pp.254-275
Survey of London, vol.25 St George the Martyr, Southwark and St Mary Newton, Ida Darlington ed. 1955, pp 78 (online version at British History Online)