Herefordshire’s Historic Hospitals

Over the last year I have been revising the pages on this website that cover the hospitals in England. I am aware that some of the county pages have little more than a list of sites. Herefordshire was one that had very little information about any of the buildings, but it has now been revised with maps, brief histories and illustrations. This post gives a quick summary of the historic hospitals of Herefordshire and the present status of those buildings.

Hereford General Hospital from the Annual Report for 1927, from the Wellcome Collection

Hereford General was the first hospital in the modern sense to be established in the county. It was founded in 1776 and occupied adapted premises in Eign Street. Its success warranted a permanent structure for which a site was given by Lord Oxford (Edward Harley, the third Earl of Oxford and Mortimer, who was MP for Leominster and Droitwich). Building work began in 1781 to designs attributed to William Parker and was completed in 1783.

Former Herefordshire General Hospital, photographed in 2013  © Stephen Richards from Geograph

The original building survives at the heart of the site, comprising the central nine bays with advanced pedimented centre. It has been much extended and altered, upwards and outwards, including the entrance porch that was added in 1887 at the same time as the Victoria Wing. By the middle of the twentieth century the site was heavily built over, apart from the open ground immediately in front of the original range overlooking the River Wye. A good sense of way in which the hospital evolved can be gained from a short film made in 2002, as the hospital faced closure, which gives the viewer a guided tour both outside and in (see Hereford Focus on YouTube).

Victoria Ward, Hereford General Hospital, from the Annual Report for 1928, from the Wellcome Collection

Hereford General remained the main acute hospital for the county throughout the nineteenth century and into the twentieth. The main alternative was Hereford Union Workhouse, which would have had some accommodation for sick paupers from when it was first built in 1836-7. New infirmary wings were built on the site in 1876 and in the early 1900s, but the main transformation came after the Local Government Act of 1929 which saw many former workhouses transformed into municipal hospitals. For Hereford this resulted in its development into the present Hereford County Hospital, initially with a new hospital range begun just before the Second World War. Shortly after the war broke a series of hutted ward blocks were built on the site as part of the Emergency Medical Scheme to provide for the anticipated large numbers of casualties.

Hereford County Hospital. Part of the former workhouse buildings remaining on the site, photographed in 2008 © Jonathan Billinger from Geograph

Hereford also had a number of specialist hospitals. The Victoria Eye and Ear Hospital opened in 1889, a handsome Tudor style building designed by the local architect E. H. Lingen Barker. Hereford Town Council also provided for infectious diseases with hospitals at Tupsley while the wider county was served by a sanatorium for tuberculosis near Ameley in a converted house (Nieuport Sanatorium). Provision for maternity cases was increasing in the 1940s, as hospital births began to be more common than home births. The County Hospital had a maternity department that was being extended at the end of the war, and there was a small public maternity ward at the General as well as a few private beds. There were also a few maternity beds at all but Ledbury of the former workhouses, while for private paying patients there was a maternity home in Hereford with four beds.

Former Victoria Eye Hospital, now converted to housing. Photographed in the early 1990s © L. Holmstadt

There was also the county mental hospital, St Mary’s, at Burghill, first opened in 1871 and a ‘mentally deficiency’ institution at Holme Lacy House that opened in the 1930s. In the rest of the county there were a few workhouses, cottage hospitals and small rural isolation hospitals that were established in the nineteenth century.

Holme Lacy House, photographed in 2005, © David Dixon, from Geograph

Most of the pre-war hospitals in the Herefordshire are no longer in the NHS estate. Some have been demolished, others adapted to new uses. When the NHS came into being in 1948 the hospitals in Herefordshire came under the Birmingham Regional Hospital Board, which also covered Worcestershire, Warwickshire, Staffordshire and Shropshire. This administrative structure remained in place until the NHS reorganisation of 1974.

Postcard of the former St Mary’s Hospital, probably from around 1900-10, when it was still known as ‘the asylum’.

Initially the Regional Board was responsible for around 220 hospitals with a total of about 42,000 beds. These were grouped into management units based on function and geographical location. Herefordshire Hospital Management Committee oversaw eighteen hospitals. These were: the General and County Hospitals and the Victoria Eye Hospital in Hereford; St Mary’s Mental Hospital, Tupsley Hospital for infectious diseases and Tupsley Smallpox Hospital; Holme Lacy Hospital for ‘mental defectives’; the cottage hospitals at Ledbury, Leominster, Ross-on-Wye, and Kington; Stretton Sugwas Hospital, near Credenhill; Nieuport Sanatorium; the former workhouses at Ross-on-Wye (Dean Hill Hospital), Bromyard, Leominster (Old Priory Hospital),and Kington (Kingswood Hall). Leominster and Kington were owned by Hereford County Council but the NHS had rights to accommodation under the 1948 National Assistance Act. Nieuport Sanatorium closed in 1951 and the Tupsley smallpox hospital was used as a store. Another smallpox hospital near Bromyard was transferred to the NHS but not used, it was sold in 1952.

Nieuport House was used as a TB sanatorium by Herefordshire County Council in the 1930s. Photographed in 2007 © Philip Halling, from Geograph

There are now four NHS hospitals in Herefordshire: Herefordshire County Hospital (the main complex built in 1999-2001, W. S. Atkins Healthcare, with other blocks from 1950s-80s and fragments of the 1830s workhouse), and three community hospitals at Leominster (1899, partly rebuilt 1991), Ross-on-Wye (1995-7 incorporating part of the former workhouse) and Bromyard (1989, Abbey Hanson Rowe Partnership). Mental Health services also operate two in-patient units in Hereford: the Stonebow Unit is on the County Hospital site and is a purpose-built facility erected in 1985 that was recently upgraded, and Oak House in Barton Road, a residential rehabilitation unit in a converted house.

Stonebow Unit photographed in 2008, © Jonathan Billinger, from Geograph

Herefordshire in 1945 was still an essentially rural county with no large centres of population. The advent of the NHS was seen as an opportunity to rationalise services, including centralisation, continuing a process that had begun before the war. In order to inform the strategic planning of the hospital service, the Board drew on the Hospital Survey of the West Midlands Area published in 1945 by the Ministry of Health. The Survey did not cover the mental health service which was considered as an essentially separate service with its own legislative basis and at the time there were uncertainties about how it might be integrated within a broader national health service, or even if it should be included at all.

Former Ledbury Cottage Hospital, converted to apartments in 2009. Photographed in 2016 © John M. from Geograph

The future of cottage hospitals was particularly threatened by the wider policy for modernisation, centralisation and rationalisation. The Hospital Survey of 1945 noted that Ross-on-Wye cottage hospital had 16 beds, plus ‘a few beds in huts in the garden’, Leominster had 13 beds, Ledbury 12 and Kington just 10 beds. There had also been a cottage hospital at Bromyard, but financial difficulties had led to its closure during the First World War. The others lasted longer. Ross-on-Wye Cottage Hospital was replaced by the new community hospital built on the site of the old workhouse. It was demolished after closure in 1997 and replaced by retirement flats. The original Leominster Cottage Hospital partly survives, absorbed by the present community hospital. Its ward block was demolished to make way for the new hospital building which opened in 1991. Ledbury Cottage Hospital was converted to mixed residential and business use in 2009, having closed in 2002. The Victoria Cottage Hospital at Kington is now Kington Youth Hostel.

Former Bromyard Hospital, now Enderby House, photographed in 2021 © J. Thomas, from Geograph

The Hospital Survey also noted that five former workhouses in Herefordshire had chronic sick wards: Leominster, Ross, Kington, Ledbury and Bromyard. Leominster workhouse, like Kington Cottage Hospital, has become a youth hostel (the workhouse had incorporated some fifteenth-century priory buildings). Ross-on-Wye union workhouse developed into Dean Hill Hospital for geriatrics and mental health unit, and had 157 beds by the mid-1960s. The workhouse buildings have partly been demolished to make way for the present community hospital. Kington and Ledbury Workhouses were not transferred to the NHS. Kington has been demolished and Ledbury partly demolished, but some of the workhouse ranges were converted into housing. Bromyard Workhouse has also been turned into flats, not with great sensitivity.

The former Medical Superintendent’s House of St Mary’s Hospital, photographed in 2011  © Philip Pankhurst from Geograph 

The largest hospital in the county was St Mary’s, built as the City and County Asylum. It closed in 1994 and in 1998 most of the hospital buildings were ‘stupidly demolished’ (according to the Pevsner Architectural Guide) to make way for a large housing development. The entrance building (St Mary’s House) remains along with sections of the ward wings which were converted to flats.

More information on Herefordshire’s hospitals can be found on the Herefordshire page. There is also more on the workhouses on the workhouses.org site. Archival records relating to the hospitals are mostly at Herefordshire Archive and Records Centre, and I would also recommend the Herefordshire Through Time website, which has a section on hospitals. Historic England Archive has the hospital reports and building files that were put together for the national survey of hospitals carried out in the early 1990s on which I worked (though not on Herefordshire). The files may contain photographs of buildings that were standing then but have since been demolished.

Hertfordshire Hospitals Survey Revisited

Hertfordshire was one of the counties covered by the London team of the national hospitals survey, carried out in the early 1990s by the Royal Commission on the Historic Monuments of England. The London team comprised myself and Colin Thom (now Director of the Survey of London). At that time we only investigated hospitals built prior to the inauguration of the NHS in 1948 – so major post-war hospitals, such as those at Welwyn and Stevenage, were excluded.

Welwyn Garden City’s early post-war general hospital was demolished in 2017. Photograph from in February 2017 © Gerry Gerardo, on Geograph

Fieldwork for the survey was carried out in 1991-3. There was not enough time to visit every single site, and some were considered in greater detail than others. The selection had as much to do with ease of access as it did with the historic significance of the buildings. This meant that some ‘important’ sites were either missed out or only briefly dealt with. I am puzzled now as to why some weren’t visited. In Hertfordshire we seem not to have managed to get to Welwyn, Royston or Hitchin, and also didn’t photograph Letchworth Hospital. The rest we visited on various dates between May 1992 and June 1993, while also covering the rest of the South East (Greater London, Essex, Kent, East and West Sussex, and Surrey) as well as Avon, Staffordshire, Shropshire and parts of the West Midlands, added late on to help out the York-based team. We covered a lot of ground, so perhaps I shouldn’t be too surprised that I’m struggling to remember visiting some of them.

For each site a building file was created, and these can be consulted in Historic England’s Archive based in Swindon. (The reference numbers for the files can be found on each of the county pages of the gazetteer after the name of the hospital following the grid reference.) These files vary in content, but generally have a report, photographs and maps.

Follow the link to the Hertfordshire page of this website for more details of individual sites.

What does Pevsner say?

The best known architectural guide to the buildings of Britain is the series begun by Nikolaus Pevsner after the Second World War. The Pevsner guides are generally the first place to look for information about the historic buildings throughout the UK. The original Pevsner guide to Hertfordshire was published in 1953, with an extensive revision published in 1977 (revised by Bridget Cherry). A further revised guide with new material edited by James Bettley was published by Yale University Press in 2019. I have relied heavily on this for updates to the condition of the various hospitals that we visited back in the 1990s. However, hospitals, especially former hospitals, are not easy to find in the guides and often receive only cursory mentions, if any at all. It is not a reflection of their historic significance as public buildings, but rather their relatively lowly architectural status, as they were seldom designed by ‘top’ architects, many are more interesting for their plans than their outward appearance, and where there have been many additions and alterations they can seem muddled and incoherent.

Original central administration block of West Herts Hospital, Hemel Hempstead, from the 1870s rebuilding of the infirmary. Photographed in 2018 © Dormskirk CC BY-SA 3.0

In its introductory overview, the guide notes that the first purpose-built hospitals appeared around the same time as the first workhouses built after the Poor Law Amendment Act of 1834. The West Herts Infirmary at Hemel Hempstead was built in 1831-2 followed swiftly by Hertford’s County Hospital in 1832-3 to designs by Thomas Smith. In 1840 Hitchin Infirmary was built designed by Thomas Bellamy. The last two have since been replaced, and only the core of their original buildings has been retained. Bellamy’s Hitchin Infirmary is now Bellamy House – the remainder of the site now occupied by a Waitrose supermarket. Hertford County Hospital has been replaced by a new building constructed alongside in 2003-4 (architects Murphy Phillips) leaving the old building rather marooned. West Herts is a typical multi-phase hospital, with much of its built heritage remaining in use, including the early Cheere House of 1831 and Coe and Robinson’s 1875-7 pavilion-plan infirmary (see photo above).

Former Watford Union Workhouse from Vicarage Road, photographed in May 1992. The former workhouse building became part of Watford District General Hospital © Harriet Blakeman

As well as general hospitals, there was a private asylum at Much Hadham established around 1803 (principally of architectural interest to the Guide because it occupied The Palace), and a crop of workhouses. Of the latter, there are partial survivals at Buntingford (1836-7 by W. T. Nash); St Albans (1836-7 by John Griffin); Ware (1839-40 by Brown & Henman) and more substantially at Watford (1836-7 by T. L. Evans) where the workhouse developed into the general hospital.

Architectural aerial perspective view of proposed asylum, Leavesden, from The Builder

During the Victorian and Edwardian eras Hertfordshire attracted children’s homes and mental hospitals, including the Metropolitan Asylums Board’s ‘Imbeciles’ Asylum’, later Leavesden Hospital, at Abbots Langley designed by John Giles & Biven and built in 1868-70. This asylum was the twin of Caterham Hospital which served the south of the Metropolitan area.

View looking up the central spine of the hospital with the ends of the ward pavilions to the left, water tower on right. All of the buildings in the photograph were demolished as part of the redevelopment of the site. © Harriet Blakeman

Of Leavesden Hospital only the former administration block, chapel and recreation hall have been retained, converted to the residential Leavesden Court – a gated development – with new housing built to the north and west on the site of the former ward pavilions and parkland to the east.

Setting aside children’s homes, the Guide also notes Holman & Goodrham’s TB sanatorium built for the National Children’s Home built in 1909-10 (survives as the King’s School); Rowland Plumbe’s Napsbury Hospital built in 1901-5 (partially demolished, parts converted to housing); and G. T. Hine’s Hill End Asylum of 1895-9 (largely demolished). The only ‘local hospitals’ during this period mentioned in the Pevsner Guide are the cottage hospital at Watford of 1885 designed by C. P. Ayres (still extant) and the Sisters Hospital at St Albans designed by Morton M. Glover of 1893 (later extensions demolished, original main buildings converted to housing).

One of the former ward blocks of Hill End Hospital, photographed in May 1992. Only the chapel and the southernmost blocks were retained when the site was redeveloped for housing. © Harriet Blakeman

In the 1920s Royston Hospital was built to designs by Barry Parker (still an NHS hospital, but much extended). Then in the 1930s the large new mental hospital at Shenley was built, designed by W. T. Curtis (mostly demolished), and ‘a rather utilitarian general hospital’ at Welwyn designed by H. G. Cherry (still an NHS hospital with a newer block built to the south).

Part of the former Shenley Hospital, photographed in May 1992, now demolished, © Harriet Blakeman. Only the chapel, medical superintendent’s house and one small accommodation block were retained
The chapel at Shenley Hospital, photographed in May 1992 © Harriet Blakeman

There is no mention in the introduction of the post-war hospitals, and the Lister at Stevenage is quickly covered by two sentences that provide the date (1966-72), the architect (E. A. C. Maunder of the North West Metropolitan Regional Hospital Board) and summary of its appearance (A central Block of nine storeys, a symmetrical elevation with projecting balconies, surrounded by extensive lower buildings.) Before too long, I hope to produce a separate post on the Lister and the other post-war hospitals in Hertfordshire.

Hertfordshire Hospitals in the 2020s

Hospital services in the 21st Century have become significantly more complex since the early years of the NHS. The NHS currently has thirteen hospitals in the county (not including those that were formerly in Hertfordshire which now lie within Greater London – such as in Barnet). There have been at least 44 hospitals in Hertfordshire in the past, not including a few small local authority hospitals for infectious diseases. The decline in the number of hospitals reflects increasing centralisation of services and changing practices in medical care and treatment. Of the 44 that feature in the Hertfordshire gazetteer page, only five are still NHS hospitals; 15 have been converted to housing or other use, including partial demolition; and 24 have been either entirely or largely demolished. The scale of demolition is larger than even that figure suggests, as it includes some of the largest hospital complexes in the county.

Former Harperbury Hospital, photographed in May 1992 © Harriet Blakeman

It has been depressing to discover the extent of destruction of former hospital buildings, a great many of them only having been demolished in the last ten to twenty years. A great deal more should and could have been retained, particularly of the large former mental hospitals such as Shenley, Harperbury and Hill End.

Former St Pancras Industrial Schools that became part of Abbots Langley Hospital, photographed in the early 1990s, now demolished. © Harriet Blakeman

Leavesden Hospital, as mentioned above, has largely been demolished to make way for housing. The hospital also had an annexe to the south. This had formerly been the St Pancras Schools, together with detached hospital and babies home. It had an Emergency Medical Scheme spider block built at the start of the Second World War on vacant ground behind the buildings which became Abbots Langley Hospital when transferred to the NHS in 1948. These emergency hutted buildings were intended to be temporary, and it is perhaps more surprising that they lasted into the 1990s than that few of them are left in the 2020s.

The wartime extension of EMS hutted ward blocks at Abbots Langley Hospital, photographed in the early 1990s, now demolished. © Harriet Blakeman

I have always had a few favourite hospitals – ones that were particularly attractive or interesting. In Hertfordshire, Shenley was one – at least in part because of its lovely grounds. The hospital was laid on the Porters Park estate, along with the mature landscape around the mansion house.

Porters Park mansion was adapted for convalescent patients at Shenley Hospital. © Harriet Blakeman

Porters Park has a complicated history having been substantially rebuilt or remodelled on more than one occasion. Its present appearance is largely due to the rebuilding of 1902 for C. F. Raphael by the architect C. F. Harold Cooper. The house and estate were transformed into Shenley Mental Hospital in the 1930s. The map below show the extent of the hospital in the 1950s. It was designed on a colony plan, whereby all the patients’ accommodation and treatment blocks were detached, and arranged in the manner of a village, with central service buildings and chapel.

Shenley Hospital on the OS map surveyed in the 1950s CC-BY (NLS)

The map below shows the modern housing development on the site. The existing buildings are shaded orange. The map is overlaid on the 1950s OS map above – and the grey shapes of the hospital blocks can just be seen behind. Only the PW – place of worship – and the small block to its south are from the hospital era.

Overlay map of Shenley showing the new housing development on the former hospital site. OS map of the 1950s and OS Opendata CC-BY (NLS)

Napsbury was another favourite – here too the landscape setting was particularly good, but the architect for this large asylum, Rowland Plumbe, was allowed to bring his characteristic style to the buildings, which were more decorative than Hine’s more pedestrian Hill End. The picturesque qualities of Napsbury no doubt made its adaptation appealing for the developers of the site, and it is now at the heart of Napsbury Park – a residential development near St Albans largely constructed between 2002 and 2008 (see blog post on Napsbury here).

One of the detached villas at Napsbury Hospital, photographed in the 1990s. Sadly, this villa was demolished © Harriet Blakeman

If I had to name a top three of Hertfordshire hospitals, Napsbury would probably be at number one, with Shenley at number two. At number three I would put Bennett’s End – and I was particularly saddened to see that this one has been demolished. It was the perfect small local authority isolation hospital, built in accordance with the Local Government Board’s model plans.

Aerial perspective of Bennett’s End Hospital published in 1914, the hospital looked remarkably similar to this when we visited in the 1990s.
Bennett’s End Hospital, administration block © Harriet Blakeman

There were a few other losses that I am particularly saddened by. Potters Bar Hospital was a charming low-rise late 1930s Deco-ish building that has been replaced by a Tesco supermarket. A new Community Hospital was built on Barnet Road.

Potters Bar and District Hospital, Mutton Lane, built c.1938, closed 1995 © Harriet Blakeman

I was also shocked to find that I had missed Welwyn Garden City’s Queen Elizabeth II Hospital, demolished in 2017 after the new QEII was built on the adjacent site. The original QEII opened in 1963 and was one of the first new general hospitals to be completed by the NHS. There is a little more information on the Hertfordshire page.

Model of the Welwyn-Hatfield new hospital, published 1958 by the North-West Metropolitan Regional Hospital Board

It has been a sobering exercise, revisiting the survey of Hertfordshire’s hospitals. Far more has gone than I had anticipated. We knew at the time that the NHS was winding down the majority of the large former mental hospitals in England. There had also been an increase in hospital-building during the 1980s with many ‘nucleus’ district general hospitals being built. Together this contributed to a great many hospital closures and redundant buildings. Replacing the older pre-war hospitals had been an early ambition of the new NHS in 1948, but it has taken most of the second half of the twentieth century to come close to that ambition.

The Hospitals Investigator 5

August 1992 saw the production of newsletter number five from the RCHME Cambridge office. There are snippets here about sanitary facilities – water closets and baths – and and more on temporary buildings. There are also useful indexes to information in the Parliamentary Papers, with reports on English provincial workhouse infirmaries by Edward Smith from 1867, and the enormously useful survey of hospitals in the United Kingdom carried out by Bristowe and Holmes in 1863.

Hereford Workhouse

In 1866 an inspector from the Poor Law Board visited the Hereford Union Workhouse in order to report on the infirmary. He found that the building was being greatly enlarged, and that two new wards were being built over the dining room. There was only one water closet on each side of the main building, at first floor level, but there were some other water closets in the yards that contained water aden were flushed twice or three times a week. The dry wording leaves one in doubt about the presence of water in the closets on the first floor. The rest hardly bears thinking about.

954821_1d0dbd83
Fred Bulmer Building, County Hospital, Hereford, originally the Hereford Union Workhouse, built in 1834, it has been refurbished with the help of a legacy from a member of the cider-making dynasty.It is now a day hospital, which performs assessment and rehabilitation services. Photographed in 2008 © Copyright Jonathan Billinger and licensed for reuse under this Creative Commons Licence

Workhouse Visitations

The previous insalubrious snippet came from the Report (to the Poor Law Board) of Dr Edward Smith, 15 April 1867, on 48 Provincial Workhouse Infirmaries. It is published in Parliamentary Papers 1867-8 LX, pp 325 onwards. In these reports Dr Smith examined critically the provision for the sick, and gave a table for each workhouse examined, listing for each ward the dimensions, position of windows, number of beds and fireplaces, and present function. The only plan published is a block plan of Birmingham workhouse. {This was being demolished at the time the newsletter was written, in the summer of 1992.} One of the things that emerges from this report is that by 1866 rooms in workhouses were often used in a very different way from what was originally intended. Using the pagination of the original report rather than the imposed pagination of volume LX, the 48 workhouses are as follows:

Alderbury (p.26); Amesbury (28); Atcham (30); Barton on Irwell (32); Bath (35); Bedminster (37); Biggleswade (39); Birkenhead (41); Birmingham (43); Blandford (51); Bosmere (53); Chelmsford (60); Cheltenham (63); Chesterton (65); Dartford (67); Derby (70); Devonport (73); Dudley (75); Eccleshall Bierlow (82); Edmonton (85); Fareham (87); Grantham (89); Hatfield (91); Hereford (95); Ipswich (97); Keynsham (101); Leeds (102); Leicester (106); Lincoln (108); Liverpool (111); Loughborough (115); Manchester (118); Norwich (122); Nottingham (125); Portsea Island (129); St Neots (136); Sheffield (138); Stockport (142); Totnes (144); Wimborne (148); Wirrall (149); Wolverhampton (151); Worcester (154)

Cross-Ventilation

The Portsea Island Union Workhouse Infirmary at Portsmouth was built in 1842 and extended in 1860 by an additional storey. {This later became St Mary’s General Hospital} Unfortunately we did not manage to get inside this derelict building, but we do know something of its internal arrangement. The wards on all three floors were on the South side of the range, and there was a corridor along the North side. The wards had windows on the external wall and also into the corridor (part of alterations of 1860), thereby providing cross-ventilation of an indirect kind; the corridor also had windows on the external wall. The internal windows had shutters, but we are not sure of the details. The Poor Law Board inspector in 1866 was not over-critical of this arrangement, for cross-ventilaiton was still a new hobby-horse for hospital reformers. A comparable arrangement of parallel wards with a common wall pierced by windows appears at the London Fever Hospital of 1848 and in the new Halford Wing of the Devon and Exeter Hospital built in 1854.

The acceptability of this internal ventilation provides a background to the roughly contemporary alterations at the Military Hospital at Devonport. This hospital was built as a series of pavilions in 1797, each floor of each pavilion consisting of two wards side by side separated by a corridor containing a staircase. The hospital was criticised in the 1861 report on military hospitals, and was subsequently altered. The stairs were removed and windows inserted in the walls between the corridor and the wards. Presumably there are a few other hospitals with wards ventilated through corridors, but they are unlikely to date from after the 1860s.

Bristowe & Holmes

Appendix 15 of the 6th Report of the Medical Officer of the Privy Council for 1863 is titled Report by Dr John Syer Bristowe and Mr Timothy Holmes on the Hospitals of the United Kingdom. This report records the reactions of the authors to visits paid by one or both of them to what they believed to be all of the major hospitals in the Kingdom; it has a supplement of brief critical descriptions of 81 hospitals in England, and some sort of plan is published for 25 of them. The Report is Parliamentary Papers 1864 vol. XXVIII; Bristowe and Holmes’ appendix begins on p.467 as renumbered for the Blue Books (463 of the original pagination), and the supplement begins on p.575  (571 original pagination). The following list uses the titles for the descriptions of the hospitals, and the amended pagination. English hospitals were divided into metropolitan, provincial and rural; Scotland and Ireland were dealt with on pages 692 to 726.

ENGLAND
Metropolitan Hospitals
575 St Bartholomew’s Hospital, plan of block C
577 The Charing Cross Hospital, plan of front range
579 St George’s Hospital, plan of 1st floor
582 Guy’s Hospital
585 King’s College Hospital, plan of 1st floor
589 London Hospital
591 St Mary’s Hospital, plan of ground floor
594 Middlesex Hospital
596 St Thomas’s Hospital, plans of North Wing and first floor
599 University College Hospital
600 Westminster Hospital, plan of second floor
602 Royal Free Hospital

English Provincial Hospitals
605 Birmingham General Hospital
607 Birmingham Queen’s Hospital
608 Bristol General Hospital, plan of second floor
610 Bristol Royal Infirmary, plan of 1st floor
611 Hull General Infirmary
613 Leeds General Infirmary, plan of G floor
616 Liverpool Southern Hospital
619 Liverpool Northern Hospital
621 Manchester Royal Infirmary, plan of 1st floor
623 Newcastle Royal Infirmary
624 Sheffield Infirmary, plan of attic storey

English Rural Hospitals
626 Barnstaple Infirmary
626 Bath United Hospital
628 Bedford Infirmary
629 Bradford Infirmary
630 Sussex County Hospital {Brighton}
632 Suffolk General Hospital at Bury St Edmunds, plan of ground floor of old hospital and new hospital
634 Addenbrooke’s Hospital at Cambridge, plan of ground floor
636 Kent and Canterbury Hospital, plan of ground floor
638 Cumberland Infirmary, Carlisle, plan of ground floor
640 St Bartholomew’s Hospital, Chatham, outline plan of ward
641 Cheltenham Hospital
642 Chester Infirmary
643 Chichester Infirmary
644 Essex and Colchester General Hospital
646 Derbyshire General Infirmary, plan of attic {first} floor, fever house
648 Devonport Hospital {Royal Albert}
649 Dover Hospital
649 Devon and Exeter Hospital
652 Gloucester Infirmary
653 Hereford Infirmary
655 Huddersfield Infirmary
656 Ipswich and East Suffolk Hospital
657 Lancaster House of Recovery
659 Leicester Infirmary and Fever House, plan of ground floor
661 Lincoln Hospital
662 West Kent General Hospital, Maidstone
663 Northampton Hospital
664 Norfolk and Norwich Hospital, ground floor plan
667 Nottingham General Hospital
669 Radcliffe Infirmary at Oxford, plan of ground floor
672 South Devon Hospital, Plymouth
674 Royal Portsmouth, Portsea and Gosport Hospital
675 Berkshire County Hospital at Reading, plan of 1st floor
677 Salisbury Infirmary
678 Salop Infirmary
680 Royal South Hants Infirmary, Southampton
681 Stafford General Infirmary
682 Taunton and Somerset Hospital
684 Whitehaven Hospital
685 Hants County Hospital, Winchester, plan of ground floor
688 South Staffordshire General Hospital, Wolverhampton
689 Worcester Infirmary, plan of ground floor
691 York County Hospital

Special Hospitals
726 Hospital for Sick Children in Great Ormond Street
728 Dreadnought Hospital Ship
729 Haslar hospital, block plan
731 Royal Victoria Hospital, Netley
731 Hospital for consumption and Diseases of the Chest {Brompton}
732 London Fever Hospital, plan of ground floor
737 Newcastle Fever Hospital
737 Small Pox Hospital {Highgate Hill}
739 York Road Lying-in Hospital {London}
740 Liverpool Lying-in Hospital
740 Margate Sea-Bathing Infirmary
741 Southport Convalescent Hospital

More Baths

The Hospitals Investigator No.4 drew attention to how many lunatics it was possible to get into one change of bath water. It now emerges that lunatics were not the only victims of this economy. At the Royal Berkshire Hospital at Reading in 1870 they managed to wash, if that is the correct word, at least eight patients in one change of water. The full number is not known, because it was only the eighth patient who complained. The reason appears to be that it took ten minutes to fill the bath and another ten minutes to empty it again, and the hospital porter did not have time to do this.

geograph-830153-by-Andrew-Smith
Royal Berkshire Hospital, Reading (© Copyright Andrew Smith and licensed for reuse under this Creative Commons Licence). Money spent on this fine stone front with its ionic portico and coat of arms in the pediment, may have lead to economies elsewhere, notably bath water.

Suppliers of “Temporary” Hospitals

Several firms are now known to have provided wood and iron hospital buildings, especially in the early years of he twentieth century, although their hospitals and chalets are hard to find or identify. So far the list includes the following:

Humphrey’s of Knightsbridge, (a catalogue of 1900 was located by the York office team). Several of their hospitals survive.
Boulton and Paul of Norwich, who were still in business (in 1992) selling garden shelters that are almost indistinguishable from sanatorium chalets. Early chalets have been found as far away as Plymouth. {The company was taken over in 1997}
Portable Building Company of Manchester, who provided a sanatorium for the Nottingham Association for the Prevention of Tuberculosis in about 1900.
Hygienic Constructions and Portable Buildings Ltd. who supplied the Homerton College Sanatorium in 1913. This weatherboarded building still (1992) stands.
Wire Wove Roofing Company of London made tuberculosis chalets.
G. W. Beattie of Putney advertised their New Venetian Shelter, for tuberculous patients, in 1913.
Kenman and Sons of Dublin, who sold tuberculosis chalets in 1913.

boultonpaul_bungalowad1933
Not a hospital, but a temporary building that reflected the popularity of open-air living, this is taken from the rather wonderful Broadland memories blog 

The Hospitals Investigator 4

Issue 4 of Robert Taylor’s Hospitals Investigator was circulated in July 1992 and in his editorial he wrote that the theme for this issue would be lunacy, in particular, baths and fire precautions. It concluded with a report on the Cambridge team’s trip to Cornwall and what they found there.

Baths

‘One of the many criminal economies practised in public institutions in the 19th century was the sparing use of bath water. At the Suffolk Asylum at Melton the male attendants used a single filling of the bath for five men, but on the opposite side of the same institution  the female attendants managed to make a single filling serve ten women. This amazing achievement gives a new and unexpected meaning to sexual discrimination. At some asylums things were managed differently, and they put two lunatics at a time into the same tub, thereby ensuring that all and an equal chanced to enjoy hot water. Oxford, however, held the record and regularly managed to bath three at a time, thereby beating Cambridge by a factor of three. We have yet to see the size of the Oxford baths.

Considering that the water was frequently delivered at such a high temperature that patients were in real danger of scalding themselves and the taps could only be controlled by the attendant, one wonders at the temperature of the bath water at Melton when the first woman got in, and when the tenth got out.’

While looking for an illustration of bathrooms in asylums, I searched through the Wellcome Images collection which has this photograph taken around 1930 of Long Grove Asylum, Epsom in Surrey. Shared bath water was no longer acceptable, and a modicum of privacy was afforded by the  fixed screens.

L0015468 Male patients being washe by hospital orderlies. Credit: Wellcome Library, London. Wellcome Images images@wellcome.ac.uk http://wellcomeimages.org Male patients being washed by hospital orderlies, Long Grove Asylum, Epsom. In the Royal College of Psychiatrists. circa 1930? Published: - Copyrighted work available under Creative Commons Attribution only licence CC BY 4.0 http://creativecommons.org/licenses/by/4.0/
L0015468 Male patients being washed by hospital orderlies. Wellcome Library, London.

Fire Precautions in Asylums

‘Methods of preventing the start and avoiding the spread of fire in hospitals have developed in stages, usually one set of ideas at a time.’

‘The first fire precautions in the 18th and 19th centuries were purely structural, along the same lines as the various contemporary local regulations and the London Building Acts. The aim was to make buildings unlikely to catch fire or to burn, in other words, fireproof construction. Most of these techniques had become standard best building practice by the beginning of the 18th century, and included such things as not having timbers let into chimneys. This particular concern can be seen in an obvious form at the workhouse at Tattingstone in Suffolk, where ceiling beams are skewed in order to miss the fireplaces. The use of masonry for walls, and slates or tiles for roof covering were standard from the beginning; timber frame and thatch are not used for purpose-built hospitals.’

Tattingstone Hospital in 1990 © Copyright Clint Mann and licensed for reuse under this Creative Commons LicenceOriginally built as a House of Industry in 1766, and later extended as Samford Workhouse, it became St Mary’s Hospital in 1930, finally closing in 1991 and was converted into housing around 2001. see also  http://www.workhouses.org.uk/Samford/

‘At a later date non-burning floor structures were used, called ‘fireproof’ and depending at first on the use of iron beams and shallow brick vaults. This system had the disadvantage that it relied on exposed iron girders, which were liable to buckle in a fire. Later in the 19th century, devices such as hollow bricks forming flat arches, sometimes strengthened by steel rods cased in concrete, were used to avoid this problem and produce a lighter structure. Perhaps the most common fireproofing device is the use of stone for staircase treads, almost invariably combined with iron balusters.’

‘Despite all of these precautions, fires broke out and even spread. Limiting the damage done by a fire was an important consideration, and it is interesting to learn that in asylum building in the middle of the century it was considered desirable to restrict patients to two storeys, for greater ease of escape or rescue in case of fire, as well as to reduce the amount of building that might be damaged. [The Builder, 27 Nov 1852 p.754] This is a contrast with the earlier practice at workhouses, where three-storey main ranges to accommodate the inmates were common. The Commissioners in Lunacy seem to have been particularly concerned by the fire at the Cambridgeshire Asylum  in 1872. No lives were lost, and damage was limited, but the general opinion was that the fire very nearly destroyed the whole asylum.’

VLUU L210 / Samsung L210
Central block of Fulbourn Hospital, originally Cambridgeshire County Asylum, and now reconstructed NHS offices. (Photograph by Tom Ellis taken in 2009 and licensed under CC BY-NC-ND 2.0)

‘The boilers and pumps were in the basement of the central block, and as the call for steam and hot water had increased, the size of the boilers had been increased, well beyond the capacity of both the basement and the flues. It seems that this situation was very common, and it was this that led to a new wave of precautions in asylums during the 1870s, particularly after 1875. In that year the reports of the Commissioners on their annual visits to asylums pay great attention to fire prevention, and include descriptions of a number of devices.’

‘The major new concern of this decade was with the provision of a sufficient quantity of water at high enough pressure to extinguish any fire that should break out. Water mains with hydrants were installed both inside and outside the buildings and examined during visitations, when the Commissioners hoped to see an efficient fire drill and a jet of water that toped the highest roofs of the asylum. The pressure was usually produced by a steam engine. A sufficient quantity of water to extinguish a fire was essential and the problem was underlined when the Commissioners visited Ipswich Asylum on the day when each week the water company did not supply water. Under such circumstances a large reserve supply was essential. Tanks at a high level, thereby providing a head of water without recourse to a steam engine that would take time to get going, were favoured. There was a water tower on each side of the establishment at Herrison, Dorset, in 1863.’

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Old postcard with aerial photograph of Herrison Hospital, posted on flickr by Alwyn Ladell and licensed under CC BY-NC-ND 2.0 Originally the Dorset County Asylum, near Charminster, it has now been converted into housing, with much additional new building on the site, and re-named Charlton Down.

‘A new concern with the structural side of fire prevention is shown in 1874 by the visit to the Leicester and Rutland Asylum of Captain Shaw of the Metropolitan Fire Brigade. He suggested a system of intersecting walls with iron doors to prevent the spread of fire. From the way in which the Commissioners in Lunacy reported this visit, one senses that they wished that more asylums would follow the same course and obtain professional advice. The extent to which this was done is not clear.’

There is a fascinating set of photographs of the asylum from the University of Leicester Archives and  the Record Office for Leicestershire, Leicester & Rutland which can been seen on the website expresseumpoetics.org.uk 

‘In the 1880s the major concern of the Commissioners in Lunacy was with the escape of patients from an asylum should it catch fire. Every ward had to have a second means of getting out, an alternative exit. As many rooms seem to have had only one entrance, this sometimes tested the ingenuity of those responsible. By 1885 the provision of external fire escape staircases was in full swing. The stairs had to be suitable for both infirm and deranged patients to use, and it is interesting to see how many still meet these requirements. It was necessary to have sufficient space a the top of the stair for patients to be prepared for the descent, and the stairs themselves had to be wide and easy. The time scale of this development is shown by the second Birmingham asylum at Rubery, opened in 1882 without fire escape staircases, which were provided in 1886.’

‘References to fire escapes should, however, be interpreted carefully, for not all were fixed to the building. In 1888 Cornwall Asylum bought a fire escape and built a house to put it in; the two similar contraptions at the Norfolk asylum in 1896 were of wood. At Norfolk the Commissioners were more concerned with their inadequate number than with their material. The introduction of fire escapes at asylums continued into the present century. It seems that in workhouse infirmaries the similar provision of fire escapes was about a decade later than in asylums, only getting under way in the 1890s’.

L0012311 Middlesex County Lunatic Asylum, Colney Hatch, Southgate, Mi
Perspective view and ground-floor plan of Middlesex County Asylum, Colney Hatch, later Friern Hospital. Now converted into housing. From the Wellcome Library, London

‘The fire at Colney Hatch on 27 January 1903, when 51 patients lost their lives in a fire in temporary buildings of 1895, brought a new realisation of the problems associated with fire. Rescue had been hampered by smoke, and a new urgency was now given to the containment of smoke in large asylums, particularly on staircases. In that same year, smoke doors were called for at the heads of certain staircases at Knowle in Hampshire, and at the Buckinghamshire asylum the doors with bars that opened onto the staircase had to be made solid. Smoke doors had already appeared in some institutions, as at Northampton in 1901, but are rarely mentioned.’

‘Immediately after the Colney Hatch fire, the Commissioners in Lunacy enquired after other temporary buildings, and tried hard to have them removed. They continued to accept timber framed buildings clad in corrugated iron, particularly it seems when the interiors were plastered rather than clad in boarding.’

A Letter from Cornwall

‘Five days of fieldwork were allotted by the Cambridge Office to investigate … the hospitals of Cornwall… The first that we visited, Truro workhouse, introduced us to the intractable nature of granite and the most informed attempt at Grecian style so far. The granite was so hard and difficult to work that the mason could do no more than produce a blocky outline of what was wanted but the result was still striking.’

‘Much of the county is swept by high, wet, winds, so that most of the early settlements hide in hollows or the lee of hills for shelter. The windward side of a building is often slate-hung to give extra protection. Although rendering houses is not as common as in some other exposed communities, the fashion for rendered walls in the 1920s was welcomed here. The textures are not always interesting, and when the paint is not renewed the effect is usually sombre.’

‘Despite the winds, workhouse were built on hills just as everywhere else in England, although the thick jungle around some of them shows that they are on the sheltered side. Palm trees were an unexpected impediment to photography at Truro and elsewhere. The usual Cornish workhouse consists of three parallel ranges. First comes an entrance range, often single storey; then comes the House, sometimes with short cross-wings but always a linear building with a single-storey kitchen behind. Finally comes either a row of workshops with the infirmary in the middle, or just the infirmary in large workhouses. There is almost no variation on this pattern. Bodmin had a rectangular infirmary, but several including Truro and Redruth had a small U-shaped block usually with a lean-to on the workhouse side There were always two doorways, but the internal arrangements could not be discovered.’

For images of Liskeard Union Workhouse, built 1937-9 to designs by Scott & Moffatt, including a postcard from around 1915 see workhouses.org.uk 

‘Many workhouses also had a small isolation hospital placed close to the main building. Few are dated, including Falmouth of 1871, and that at Bodmin could be 1842. They have a standard arrangement of two wards flanking a central duty room or set of central rooms, and all are uniformly plain. Some may by chance respect the 40-foot cordon sanitaire that was required by at least 1892, but they probably all date from before about 1880. It is interesting to compare them with Suffolk, where the only isolation hospitals associated with workhouses respected the quarter-mile cordon required for smallpox hospitals, and none was recognised closer to the workhouse except at Semer.’

‘Apart from these workhouse examples, surviving isolation hospitals were prominently absent from the cornish landscape, and one of the two that we did manage to find was occupied by such a desperate character that we did not approach too closely. …’

‘The Cornish cottage hospitals were frankly disappointing, for they had been savagely treated by enlargements. A curiously high proportion had a main range and cross-wings type of plan, or appearance, for the plans did not always accord with the outside. Our greatest joy was to discover that the Falmouth hospital, built in 1894 and replaced by a new building on a new site in 1930, survived intact and unaltered…’

Images of Falmouth Hospital, designed by H. C. Rogers and built with funds from J. Passmore Edwards can be seen on the web site passmoreedwards.org.uk  

‘Two hospitals, at Redruth and St Austell, and been established with the needs of accident-prone miners in mind, but the buildings told us nothing about these needs.’

‘Cornwall has a large number of ports, and had a corresponding number of Port Sanitary Authorities in the late 19th century. In general they provided makeshift hospitals of no size, and only a fragment of the Falmouth hospital, which also served the local urban population, was discovered. Fowey, constituted in 1886, had a corrugated iron building with a duty room and four beds by 1899; it got its water from a nearby spring, and although last used about 1920 it was still being maintained in 1943.  The Truro hospital was near the centre of the town and has not survived. Perhaps because the provision in the county was so small the Truro workhouse was converted into a 110-bed isolation hospital in 1940, mainly for the benefit of evacuees. We did not notice any evidence of pest-houses to either explain or supplement this poor provision of isolation hospitals.’

See also: old photograph of Truro workhouse on Truro Uncovered website