In the centre of Stevenage, just next to the central library with its adjoining Health Centre, stands this gem of an early NHS building. However, the building is now under threat of demolition as part of the current Stevenage Development Board’s plans to make ‘Stevenage Even Better’. (Surely a potential sequel to WIA?) There has been an outpouring of dismay at this decision on Twitter. Is it too late to hope that this building might be preserved? So many of the early NHS hospital buildings have been demolished, this is becoming an increasingly rare survivor.
It was built in advance of the new District General Hospital, the new Lister Hospital. Well in advance as it turned out, as the outpatients clinic was built in 1959-61 while the residents of the New Town had to wait another ten years or so for the opening of the Lister Hospital.
Stevenage Development Corporation reached an agreement with the North-West Metropolitan Regional Hospitals Board in about 1957 for them to build a casualty and outpatients’ clinic on a site to the south of the main shopping core of the New Town. The site formed part of the area reserved for Hertfordshire County Council, offering the opportunity of forming a close link between the clinic and the local authority’s health centre. The County Council agreed to give up part of the land to the Hospital Board in recognition of the need for hospital services in the town, which were provided by the hospitals at Hitchin. These were the former workhouse (renamed the Lister Hospital during the Second World War) and the North Hertfordshire and South Bedfordshire Hospital, the town’s long-established former voluntary hospital. Both of these hospitals had been acquired by the State on the appointed day in June 1948 when the National Health Service was inaugurated.
Plans were approved for the clinic in about 1958 at which time it was anticipated that work would begin on site the following summer. The commission was put out to Peter Dunham, Widdup and Harrison, architects based in Luton, a firm that had some experience with hospital design in Northern Ireland, but also designed some elegant private houses, laboratories and factories. It was not unusual for the NHS to place design work with private firms, especially for larger schemes. Most of the Regional Boards had architects departments, but some were small, and initially under-staffed for the large amount and range of work with which they were faced.
Peter Dunham was born in Luton and had trained at the Bartlett School of Architecture. He had started in private practice in 1933, and served in the Royal Engineers during the war, where he met MacFarlane Widdup. Widdup, a Yorkshireman who had trained in Leeds, was two years older than Dunham. According to the Architectural Review of 1953 he spent his spare time ‘cutting down trees too near his new house, admiring other people’s vintage cars and making amateur films of the kind no-one else understands’. As for the third partner of the team, Michael Harrison was a fellow Lutonian and Bartlett student, who had spent three years in local government before joining Dunham and Widdup in 1949.
Stevenage Development Corporation welcomed the development of the clinic but lamented that instead of building even the first stage of a new general hospital all that the Regional Hospitals Board were able to do were some improvements to the existing Lister and North Herts Hospitals at Hitchin. In their Annual Report published in 1959, the Corporation noted their hopes that the Stevenage Hospital would be given high priority when the country’s economic circumstances permitted new hospital building. The growing population of the area was making it more difficult for the Hitchin hospitals to meet the demands made on them. When the new clinic opened it functioned as an annexe of the old Lister Hospital at Hitchin and provided a full range of consultative and specialist clinics staffed from both the Lister and the North Herts. Since that time it has continued to have an outpatient function within the NHS, and latterly was known as the Danestrete Centre.
The most distinctive feature of the building is the gymnasium with its decorative quilted finish to the external walls. On the north side the lozenges of aggregate chips are pinned together by blue tiles bearing the coat of arms of Joseph Lister. This alluded to the Lister Hospital, which had been so-named as Lister had attended the Quaker school at Hitchin as a child.
This part of the building was specially designed as an independent reinforced concrete frame structure, to isolate it from the rooms beneath, in order to ‘avoid interference by the activities of this department’.
The remainder of the construction is of brickwork with concrete floors and timber roofs. The ceilings of the corridors and the public spaces, such as the waiting room, were lined with sound absorbent boarding for quietness. Particular efforts were made to provide a ‘homely building’ offering a ‘friendly welcome to the patients’. Accordingly materials and decorations in the waiting areas were carefully chosen to create the desired atmosphere, and a modern touch was provided by a large abstract mural at the entrance, giving a ‘strong and gay splash of colour’.
The clinic was centrally heated, and apart from its gymnasium, provided a series of consultant and examination rooms, treatment rooms, dental and E.N.T. departments, and small pathological department, x-ray, and pharmacy. The original proposal to include a casualty section was not carried out, and emergency services continued to be dealt with at the old Lister Hospital in Hitchin. The total cost of the building was £95,610.
References: Stevenage Development Corporation, 11th Annual Report, 1 April 1957 to 31 March 1958 and 12th Annual Report, 1 April 1958 to 31 March 1959: Architectural Review, 1 Nov. 1953, p.282: The Hospital, March 1962, pp.147-51.
Queen’s Lodge and the Mary Bamber Convalescent Centre
With so many suffering from Long Covid, the idea of a period of convalescence after an illness has become relevant again. We had become used to a quick recovery, to being sent home from hospital as soon as we can manage the stairs, and all is functioning as it should. But in the not-so-distant past a period of convalescence was to be expected.
Convalescent homes were once numerous in Britain, particularly in coastal resorts. A period of convalescence by the sea or in the countryside was an important part of the recovery process. In the nineteenth century, charitable voluntary hospitals found that patients discharged after surgery or an illness often had to be re-admitted soon afterwards, having relapsed through not being able to convalesce at home. Wage-earners returned to work too soon, while wives and mothers went back to the heavy work in the home and taking care of their children. Sometimes neither the home nor the family’s income were adequate for someone in need of rest, nourishing food and fresh air. From the mid-nineteenth century increasing numbers of voluntary hospitals started to establish convalescent homes, where their patients could be moved, thus freeing up beds in the main hospital. Early convalescent homes tended to look very much like the parent hospital. The former Atkinson Morley Hospital in South London is a prime example.
In the later nineteenth century, convalescent homes developed to provide more home-like settings, with rooms where the patients could sit or dine, and gardens in which to sit out. Private homes were also set up for those who could afford to pay. Some were little more than boarding houses, with next-to-no medical attendance. Others, like the Rustington Convalescent Home in West Sussex were purpose built and offered a high degree of home comfort. The Rustington was built in 1897 to designs by Frederick Wheeler. It was founded and endowed by Sir Henry Harben, Chairman of the Prudential Assurance Society. It was particularly luxurious, charging a ‘moderate’ fee for accommodation, mostly in single rooms but with some twin and a few with four beds. After Sir Henry’s death the home was entrusted to the Worshipful Company of Carpenters of London.
Alongside these individual bequests, some homes were established through contributory schemes, where workers contributed a part of their wages towards health care – effectively a form of health insurance. These schemes were important for more than funding a patient’s convalescence. Penny-in-the-pound schemes typically levied a portion of the workers’ wages: one penny per pound, or two to three pence weekly. After the First World war such schemes expanded, becoming vital as a reliable source of income for voluntary hospitals that were facing rising costs. The contributions to the hospitals were exchanged for the right of members to treatment, without recourse to means testing. Some schemes were linked to just one hospital, others to multiple hospitals in a given area. The latter type were more common in large cities, and were operated as independent organisations to which local businesses paid their workers’ contributions. The Merseyside Hospitals Council was one of these, formed in Liverpool in the late 1920s.
The Merseyside Hospitals Council secured the agreement of 23 voluntary medical institutions in the area to co-operate with their penny-in-the-pound contributory scheme that secured free vouchers for workers and their dependents that would be recognised by the participating hospitals. By November 1928 the scheme had 134,000 contributors, and though only founded in 1927-8 its income already stood at £52,000. The vast majority of that was distributed to the local hospitals (88.7%), the remainder paid for the administration of the scheme (7.8%) and ancillary services. These last included ambulances. In July 1929 Liverpool’s Guild of Undergraduates gifted a cream and red ambulance to the Merseyside Hospitals’ Council for the use of the contributors’ fund. Local companies that participated in the scheme included the Birkenhead shipyard, Cammell Laird, with 6,000 workers contributing. The local newspaper, the Liverpool Echo reported that for the first time in their history many of the Merseyside voluntary hospitals were working free from the anxiety of financial embarrassment due to the success of the penny in the pound fund. It assured an annual income, helping with their working expenses and, the Echo hoped, would in time enable them to ‘enlarge their accommodation, purchase new equipment and replenish their stocks generally.’ [Liverpool Echo, 6 Nov. 1928; 13 Feb 1929, p.7; 11 July 1929.]
In 1929 the Royal Infirmary of Liverpool received the largest sum from the fund (£3,540), with the Royal Southern Hospital, the David Lewis Northern Hospital and Birkenhead General Hospital each also receiving over £2,000. Smaller institutions received comparably smaller sums: £25 each for the Heart Hospital and the Netherfield Road Dispensaries, and just £1 to the Neston Cottage Hospital. [Liverpool Echo, 13 Feb 1929, p.7.]
The Fund also established its own convalescent homes. In 1946 Queens Lodge, a large house on the edge of Colwyn Bay, was purchased at auction for £15,200. This late-nineteenth century house was built for a Warrington wire manufacturer and was subsequently the home of Lord Colwyn. The architect of Queen’s Lodge is not know for certain, but it has been attributed to William Owen. RCAHMW gives some information on the site.[Edward Hubbard, The Buildings of Wales: Clwyd, p. 140.] The Merseyside Hospitals Council converted the house into a convalescent home for men, and it was officially opened in May 1947 by the Chairman of the Council, W. Sutclliffe Rhodes. The previous year the Council had opened its first home at Windermere, which was for women, and were planning to establish a third home at Ulverston for boys.[Liverpool Echo, 17 May 1947, p..3]
Merseyside Hospitals Council continued to provide for convalescents after the establishment of the National Health Service in 1948. In 1949 the Council purchased another large house near Queen’s Lodge: Plas Euryn, on Tan-y-Bryn Road, Rhos-on-Sea. This was the former home of the late Sir Harold and Lady Elverston, and stood in about three and a half acres laid out as lawns, shrubbery, flower and vegetable gardens. It had latterly been in use as a private hotel. After conversion, it was opened in May 1950 by the managing director of Littlewoods, John Moores, and was named the Mary Bamber Home, in memory of a former chairman of the Council’s convalescent and after-care committee from 1934 until her death in 1938. Mrs Bamber had been one of the first to urge the council to establish its own comprehensive convalescent service. Mary Bamber’s daughter, Elizabeth M. Braddock, had followed her example, becoming an MP and later also became chairman of the Council’s convalescent committee. Elizabeth Braddock also attended the opening ceremony of the new home, which provided accommodation for 38 women. This was the fifth home owned and run by the Council, two for women, one for men, one for boys and one for the elderly (this last at Southport). [North Wales Weekly News, 11 May 1950.]
In 1964 Queen’s Lodge was renamed after John Braddock, a former chairman of the Hospital Council, who had died the previous year. Then in 1965 the Council decided to close their two homes for women at Brock Hall, Windermere and the Mary Bamber Home at Rhos-on-Sea, and consolidate their operations at the Queen’s Lodge site by building a new home for women there. The new home took the name ‘Mary Bamber Home’ and was designed to provide 60 beds in one or two-bedroomed units. It was to be ‘the last word in comfort and elegance’. The Council’s officers planned to show the plans of the new home to the Health Minister, Kenneth Robinson, when he visited Liverpool for the annual conference of the Association of Voluntary Hospital Contributors, being held at Southport. [Liverpool Echo and Evening Express, 23 Oct. 1965.]
Although the home was not owned by the National Health Service it was officially opened by Kenneth Robinson, in May 1968. The home had cost around £130,000. Building work had been completed in December 1967 and the first patients admitted the following February. The home provided 12 single and 24 double bedrooms, with built-in wardrobes, dressing tables and wash-hand basins. The patients’ bedrooms were on the ground, first and second floors, each floor having an ironing and drying room. On the lower ground floor were staff bedrooms, a staff rest room, and the patients’ recreation room. The most striking feature of the home was the semi-circular lounge, looking out on to the lawns. It was furnished with easy chairs and window seats, ‘sumptuously’ carpeted. There was also a dining room, a writing room, and a roof terrace from which views of the sea and the grounds could be enjoyed.
The convalescent home closed in 2008, and was purchased for redevelopment in about 2018.
The other day I was searching through boxes of old photographs and came across a bundle of colour negatives which turned out to be photographs that I had taken of the Royal Alexandra back in 1988. It would have been great to have had them when I wrote the blog post on the former Royal Alexandra Infirmary, Paisley back in December 2016, but better late than never! I would be the first to admit that the photos are for the most part pretty terrible, and scanning the negatives may not have improved them. However, I thought it would be worth sharing them in a new post.
The Royal Alexandra Infirmary was built between about 1894 and 1902, to designs by the architect T. G. Abercrombie. Above is a detail of the ends of two of the ward blocks with their semi-circular sun balconies. The square tower to the right housed the WCs and wash-hand basins. These ‘sanitary towers’ were typical adjuncts to the ends of Victorian hospital ward pavilions. Often there were a pair of towers with a simple balcony strung between them – as at St Thomas’s Hospital in London or the Royal Infirmary of Edinburgh’s Lauriston Place buildings (now the Quartermile development).
The photographs above and below show the main east front the infirmary. You can just glimpse the balconies of two more ward pavilions behind on the top photograph, and on the right the circular ward tower. This main range has been converted into private flats, and re-named Alexandra Gate. Back in 1988 the hospital had not long closed. It was replaced by the new Royal Alexandra Hospital, off Craw Road to the south west. That was built roughly on the sites of the former Riccartsbar Hospital and the Craw Road Annexe.
Circular wards are very rare in Britain. There was a brief fashion for them around the turn of the 19th to the 20th centuries. I think the only other one built in Scotland was in Kirkcaldy at the old cottage hospital there – long since demolished. I have an old postcard that shows the hospital which you can find on the Fife page of this site. At the apex of the roof of the ward tower is a lantern or cupola that was part of the ventilation system. They feature along the ridge of the ward pavilions and atop the sanitary towers. It is not uncommon to find this kind of decorative treatment of a functional element, such as the ventilation system, in hospital architecture of the Victorian and Edwardian eras.
I barely remember visiting the site – let alone having managed to get access to the interior, but here are two snaps of the interior of the circular ward. Rather gloomy I’m afraid, but hopefully you get an impression of what it was like.
You can see the rails from which the bed curtains would have been hung. That will have been a post-war addition. Originally the beds would not have had individual curtains. The idea of providing patients with privacy became much more important after the foundation of the National Health Service, when free hospital treatment became available to everyone. Previously charitable hospitals, or voluntary hospitals, such as the Royal Alexandra were designed to provide free treatment for the poor. Wealthy patients were either treated at home, in a private nursing home or a paying patients wing of a voluntary hospital. By the 1920s and 1930s different standards of hospital accommodation for the poor and the well off were common, sometimes even in the same institution.
The Nurses’ Home was as grand as the hospital itself, with a rich array of decorative elements. It is Scottish Baronial in style, with turrets and crowstepped gables, although the tall chimneys, dormer windows and this broad arched entrance have some of the sinuous elegance that is typical of Glasgow’s late 19th and early 20th century buildings. This is particularly evident in the sculptural elements, such as the female head on the keystone over the entrance.
The Nurses’ Home is one of the survivors on the site, having been converted into flats. It is named after Peter Coats, who had paid for its construction. Coats was one of the brothers that owned the great thread manufacturing company in Paisley; Peter managed the company’s finances. The nurses’ home was built before the hospital itself, and was opened 1896. There is an inscription round the archway which reads ‘They brought unto him sick people and he healed them’, and the two shields are carved with the thistle and the rose. The hospital replaced an earlier infirmary in the town, located near Bridge Street by the river, which had originated with a dispensary for the poor in the late 18th century.
The two images above of nurses’ home show the transformation from abandoned and boarded up building to well-cared for flats. It is particularly good to see that the original small-paned glazing has been either kept or reproduced, and the tall chimneys preserved. .
The former entrance range to the infirmary has been converted for use as a nursery. It originally housed a dispensary and opened in 1902. The gate piers are very striking, the banded stonework picks up on the chunky banded pilasters flanking the gabled bays of the lodge. There is another fine stone gateway that used to lead in to the south of the infirmary site further down Neilston Road, that now gives pedestrian access to the flats that have been built there.
If you explore Google maps on street view for the old infirmary you can tour round most of the buildings, and really get a sense of how those that have not been converted into flats decayed between about 2011 and 2019, and obviously how much more ruinous it has become since the late 1980s.
Ugie Hospital was formerly the infectious diseases hospital for Peterhead. The foundation stone was laid by Provost Leash in June 1905 and the hospital opened in 1907. It was built on the standard plan with, at the centre, the two‑storey administration building of a very domestic character.
Most of the original buildings survive, though now linked together by later infill. The old hospital building is of pink Peterhead granite enlivened by bull‑faced quoins and dressings, in a simple Tudor-Gothic style with mullioned windows and steep gables. It was designed by the Burgh Surveyor, T. H. Scott. The construction cost £4,000 and was helped along with a bequest of £1,500. In 1920 Peterhead Town Council built a small TB annexe and further additions in 1922.
Before the Ugie Hospital was provided, a small hospital had been built in 1880. Prior to that, c.1865, a house at Roanheads had been used for a fever hospital, although it only provided two beds. (It may be that this was attached to the poorhouse, see the page for Aberdeenshire, Peterhead Parish Home.)
When I visited the site in October 2020, the hospital was closed and empty. Its future was being discussed in 2018-19, and it was subsequently declared surplus to requirements. In-patients were moved to Peterhead Community Hospital in November 2019. All remaining staff had been relocated out of the hospital by the end of last year.
Inverurie lies to the north-west of Aberdeen. A small hospital for infectious diseases was built in the town in the 1890s to serve the Garioch district. The site and plans were approved by the Local Government Board for Scotland in 1894-5, and the hospital opened in January 1897 (see map below). It had cost about £2,000.
The hospital was designed by Jenkins and Marr of Aberdeen, and comprised two separate sections in a single-storey and attic building. The smaller section contained two wards, which could be combined into one, with three beds each, and a small kitchen and lavatories. The larger section to the west had a large and a small ward, separated by folding doors, with seven and three beds respectively. The main kitchen, matron’s room, bathroom and staff bedrooms were also in this section of the building.
This hospital was replaced in the 1930s by a new and much larger hospital, for a time the old building was use as council offices. The Medical Officer of Health’s Report for 1936 noted that the original hospital had been recognised as structurally unsuitable for infectious cases for a long time, and that the County Council had decided to erect a new hospital near by with between 60 and 70 beds. A serious epidemic of scarlet fever and diphtheria had highlighted the shortage of beds in the county, and the need for an up-to-date hospital able to cope with diseases of epidemic proportions.
The site had been acquired and plans prepared in by the architect R. Leslie Rollo in consultation with the Medical Officer for Health. The plans were approved early in 1937. An article in The Scotsman headed ‘£50,000 Aberdeenshire Scheme’, records that the construction of the hospital was to be of cement blocks, which had been recommended to the architect as both brick and granite would be very much more expensive. However, when the tenders were submitted the cost came in at around £60,000, with another £13,000 needed for the land, furnishings, equipment and architects’ fees. A number of councillors objected to the high cost, arguing that it was a waste of public money. Various suggestions for economies were made, but the original plans seem to have been adhered to.
Hailed as the most ambitious hospital scheme that Aberdeenshire had ever financed, the hospital was finally completed in December 1940. It was intended primarily to serve the suburban districts of Aberdeen, Garioch, Turriff, Ellon and Huntly. Provision was made for 60 beds, 20 in a cubicle block of two storeys and 40 in two single‑storey pavilions. These ward blocks were arranged around a square with the nurses’ home on the fourth side opposite the cubicle block.
The single-storey ward pavilions were intended for scarlet fever and diphtheria cases and comprised wards of three and thirteen beds. The cubicle block could take doubtful cases or patients suffering from different diseases as each separate room or cubicle had just two beds (nine in all) – usually these had glazed partitions between them. The cubicle block had an operating theatre and treatment room attached.
There was also an administration block with kitchen, stores and dining‑rooms, located to the west of the wards and near the site entrance. This is a two-storey, T-plan building with large bow windows to the ground-floor rooms at either end of the main front, and a smart porch over the main entrance. The buildings were designed in the streamlined manner of the International Modern style, with wide bow windows, on the lines of Tait’s Hawkhead Hospital in Paisley.
The nurses’ home lies to the south of the wards, the main rooms enjoying a view south to a tennis court. Like the administration block, this has two bow windows to the outer ground-floor rooms, here leading out onto a terrace. There was accommodation for 46 staff, and training nurses had study room. Service buildings included a laundry and ambulance station, and boiler house to power the central heating system.
In 1958 Inverurie Hospital was adapted to maternity as well as general nursing cases. It had by then become part of the National Health Service and was part of the North Eastern Regional Hospital Board, based at Aberdeen. With the introduction of antibiotics the need for infectious diseases hospitals had greatly diminished, but there had been a rise in demand for maternity accommodation. An ageing population also created a shortage of beds for geriatric patients, and many of the smaller isolation hospitals became geriatric units. Inverurie was to provide 30 maternity beds, the rest for ordinary medical beds and some for the elderly.
Later developments at the site included a standard plan 30‑bed ward unit, which opened in 1982. Plans for a major redevelopment were made in the early 1990s, intended to provide a geriatric unit, day hospital and facilities for occupational therapy and physiotherapy. These eventually seem to have been abandoned. More recently a new ‘Integrated Health Care HUB’ has been built, and the 1980s building demolished. The hub was the first phase in a projected larger scheme. It occupies the site of the cubicle isolation block and was designed by Mackie Ramsay Taylor Architects. Their brief was to provide for General Medical Practice, including minor injuries, a Community Midwifery Unit, Dental Suite, and various out-patient clinics. Plans were finalised in about 2015.
With grateful thanks to my former colleague at the Survey of London, Sarah Milne’s grandmother, Elsie Cartney, a former nurse, who very kindly gave me a copy of the excellent history of the Inverurie hospitals produced by many of the people who worked there and published in 2004.
Sources: Grampian Health Board Archives, minutes of county council health committee: A History of Inverurie Hospitals, 2004: Ian Shepherd, Aberdeenshire: Donside and Strathbogie – An Illustrated Architectural Guide, 2006: The Hospital, 3 April 1897, p.18: Medical Officer for Health for Aberdeenshire, Annual Report 1936; Scotsman, 30 Jan 1937, p.14; 30 Oct 1937, p.17: Aberdeen Weekly Journal, 23 Nov 1939, p.4: Aberdeen P&J, 11 Dec 1940: Scottish Hospitals Survey, Report for the North Eastern Region, 1946: Aberdeen Evening Express, 6 Nov 1958, p.9: Aberdeen P&J 8 Feb 1991, p.33
The conversion of exhibition centres to temporary hospitals in our major cities mimics earlier measures to cope with hospitals overwhelmed by cases of infectious disease. Though nothing on quite that scale, as far as I am aware. The last major pandemic that occurred in Britain, the ‘flu that ran rife after the First World War, completely overwhelmed the systems in place to deal with infectious diseases which included a nationwide network of isolation hospitals. These hospitals had been built in response to a series of earlier epidemics, which had given rise to a sequence of Public Health Acts, variously aimed at improving environmental health, preventing the spread of disease, and containment when disease did occur.
Some of the earliest hospitals were provided for the purpose of isolating those with infectious diseases. Colonies for lepers were established on the outskirts of settlements from the late 11th century to the early 13th. When the Black Death arrived in England in 1348 land was set aside for cemeteries in which to bury plague victims. Later epidemics led to the establishment of Pest Houses – these were mostly isolated dwellings for those who could not be isolated in their own homes. By the 17th century these were commonly administered by the local parish, a nurse would be employed to occupy the house and care for patients sent there.
In London, the course of the Great Plague was documented by those who lived through it, most notably Samuel Pepys and John Evelyn. Statistics which charted the rise and fall of epidemics began in the late 16th Century with the Bills of Mortality, printed and published weekly giving the numbers and causes of deaths. Isolation remained the main way of dealing with contagion.
Ports were the vulnerable points for introducing infectious disease – and most had some form of quarantine station. Lazarettos, or Lazar house, close to a harbour or on an island were more often permanent and purpose built. The Venetians were perhaps the most efficient at setting up a network of lazarettos to protect their trade interests throughout their territories. The Lazzaretto Vecchio on Santa Maria di Nazareth, an island in the Venetian Lagoon, was established in the early 15th century for both plague victims and as a leper colony. These hospitals were maintained and continued to serve their original purpose for centuries.
In 1757 when Robert Adam journeyed to Spalatro (modern day Split, then a Venetian territory) to explore and record the Roman antiquities of Dalmatia, he was initially put up at the governor’s residence in the lazaretto by the harbour. He recorded how traders bringing goods from Bosnia and the neighbouring parts of Turkey were escorted by soldiers from the Fortress of Clissa (now Klis) to Spalatro to prevent them from ‘Scattering or Mixing with the People’ until their goods had been purified in the magazines of the Lazaretto and the traders themselves spent time in quarantine there. [National Records of Scotland, Clerk of Penicuik Papers, GD18/4953.]
Although various remedies were experimented with to treat disease, medicine was first used successfully in the realm of prevention, with inoculation and vaccination against smallpox. Inoculation was introduced to England in the 1720s from Turkey, and vaccination discovered by Edward Jenner at the end of the century. Despite the success of the vaccine, public uptake was not sufficient to prevent further epidemics. The first purpose-built smallpox hospital in England was in Cold Bath Fields, Clerkenwell, built around 1753. At that time three such hospitals were in existence in London: one in Islington was for those convalescing from the disease, one in Shoreditch was for those who had smallpox although they had been inoculated, and so had a milder form of the disease, while that in Clerkenwell was for the severest cases – those who had never been inoculated.
As the onus on action was placed at local level, and legislation advised on measures that could be taken, rather than dictating what must be done, responses to epidemics varied across the country and often took too long to be truly effective. With inadequate existing hospital accommodation, outbreaks of smallpox and cholera saw houses, factories and barracks commandeered. In Aberdeen a disused match factory was turned into a temporary hospital by the City Corporation after an outbreak of smallpox in the early 1870s. In most cases once the outbreak subsided the temporary hospitals closed and any plans to build permanent isolation hospitals were abandoned. But at Aberdeen a permanent hospital was begun in 1874, designed by the City Architect, William Smith II, and unusually constructed of concrete. This was chosen on the principle that the wards could be hosed down and disinfected after use. Even the floors were of concrete. Later, timber floors and panelling were inserted to soften the rather prison-like interiors.
Until about the 1860s there was no consensus regarding ideal hospital design. Of the few purpose-built fever hospitals erected in the 18th and early 19th centuries, some had small wards arranged on either side of a corridor with the idea that smaller groups of patients limited the risk of cross-infection, others large open wards with twenty or more beds. The presence of such a hospital – often optimistically dubbed a ‘house of recovery’ – on one’s doorstep was understandably unpopular. When one was set up in a house off Gray’s Inn Lane the neighbours threatened legal action to have it closed. It decamped northwards, and eventually became the London Fever Hospital, designed by Charles Fowler and built in 1848-9 on Liverpool Road, Islington. Here a mix of small, large and back-to-back wards seems evidence of a lack of confidence in any one system.
General hospitals also took in infectious cases, sometimes against their own regulations, but needs must. The London Hospital and University College Hospital both set aside wards for contagious cases in the 1830s and 40s. Other hospitals built separate fever blocks, one of the largest was at the Royal Infirmary in Glasgow, built in 1828-9
The Poor Law Amendment Act of 1834, and its counterparts in Ireland of 1838 and Scotland of 1845, not only saw a network of workhouse built across Britain but also of associated infirmaries and fever blocks. A small single-storey fever hospital was built as early as 1836 at Stow-on-the Wold workhouse in Gloucestershire.
The first cholera epidemic in Britain erupted in 1831 and claimed around 22,000 lives. Yet there was scant progress in providing hospitals for its victims. A Cholera Prevention Act of 1832 had little effect. The worst epidemic came in 1848-9, in which about 50,000 lost their lives in England and Wales. This was particularly devastating, coming just a decade after a smallpox epidemic that claimed the lives of around 42,000. Legislation continued to encourage the provision of isolation hospitals, but hospitals were expensive to build, and raising the money from local rates to pay for them as unpopular. In the midst of each succeeding epidemic local authorities accepted that available hospitals accommodation was disastrously inadequate, but had seldom gone farther than proposing to take action before the epidemic subsided and the initiative was lost. The cholera epidemic of 1866 for example prompted the erection of only a few hospitals although the provisions of the Sanitary Act of 1866 gave town councils and local boards of health the power to provide either temporary or permanent hospitals and justices of the peace the power to remove patients to them.
In London the Metropolitan Poor Law Amendment Act of 1867 resulted, eventually, in a comprehensive network of fever hospitals around London, linked by an efficient horse-ambulance service. Public fear remained strong. The building of a large smallpox hospital in Hampstead was considerably delayed by local opposition. Most isolation hospitals were built well away from the denser urban areas, and floating hospitals served by river ambulance operated from wharves at Fulham, Blackwall and Rotherhithe.
Outside London, from the 1870s the construction of isolation hospitals was overseen by the Local Government Board, and following the 1875 Public Health Act loans were made available to build them. Low cost solutions widely adopted were the purchase of a tent that could be put up and used in emergencies, or the erection of temporary, pre-fabricated hospitals. Hospital huts of timber and corrugated iron were supplied by various companies: Humphreys of Knightsbridge; Boulton and Paul of Norwich; Speirs and Company of Glasgow being three of the largest and most enduring. The corrugated iron block near Hempsted, to the south-west of Gloucester, may have been supplied by Humphreys – Gloucester was listed as one of the places supplied by the firm. A smallpox epidemic in 1874-5 had raised talk of erecting a temporary iron hospital. An even worse epidemic struck the city in 1895-6. Dr Sidney Coupland prepared a lengthy report, attempting to assess why this epidemic had been so much worse than the previous one, and to what extent re-vaccination had contributed to its rather abrupt cessation. Some of his observations strike a chord today: ‘It is possible that the hope was entertained that by an attempt to isolate every case as it arose the epidemic might be checked, but this attempt only resulted in filling the hospital beyond its capacity and over-burdening a too-restricted staff.’
Where permanent buildings were erected, they were usually based on standard plans drawn up by the Local Government Board and issued between 1876 and 1924 in a series of memoranda. The model plans adopted the pavilion principles of planning, validated by Florence Nightingale, with open wards, windows placed opposite each other to create cross-ventilation, and W.C.s placed away from the ward, separated from it by a cross-ventilated lobby at the very least. These were intentionally draughty places. Currents of air were drawn through the wards through open windows, ventilation grilles and ducts. Drainage too, became increasingly important to keep infected waste out of the water supply. The new isolation hospital for Hemel Hempstead, built in 1914-15 at Bennet’s End, is a typical example. It was designed by John Saxon Snell and Stanley M. Spoor and comprised two single-storey ward blocks, an observation block, a service building housing the laundry, with steam disinfector, mortuary, and ambulance garage, and an administration block with nurses’ accommodation. The wards were intended for the most prevalent diseases at that time, diphtheria and scarlet fever, with the observation block for the undiagnosed.
Research interest in bacteriology from the late 19th century saw the rise of laboratories, in Glasgow a laboratory was set up to deal with the bacteriology of epidemics. This research helped the medical officers of health to control epidemics through isolation, supervision of carriers and contacts, tracing the source of infection and the pathways by which it spread. The present test, trace and track strategy has its roots in this late-Victorian public health policy. Then as now it was widely recognised as the most effective means of controlling epidemics. One historical method of interrupting the spread of disease was to provide a ‘reception house’ to take families who had been in contact with infected persons, such as that opened on Baird Street in Glasgow in 1906.
Progress in medical knowledge was reflected in hospital design. A better understanding of the transmission of diseases and the discovery of bacteria were factors behind the development of the cubicle isolation block. This first appeared in the early twentieth century. One was built at Walthamstow which consisted of rows of single rooms reached from an external veranda. This allowed patients suffering from different diseases, or who were yet to be diagnosed, to occupy one building. Glazed partitions between the rooms allowed nursing staff to supervise the patients, as well as allowing patients to see each other. By about 1940 almost every isolation hospital in the country had at least one cubicle block. At Twickenham the former South West Middlesex Hospital was originally built in 1898 to designs by W. J. Ancell comprising four ward blocks and the usual service buildings. Two cubicle isolation blocks were added in 1937 as part of a major extension of the hospital. Following the Local Government Act of 1929, provision for infectious diseases passed from the myriad of small local urban and rural sanitary authorities to county and borough councils, this also led to many of the smaller hospitals being replaced by larger more centralised hospitals.
Wide-ranging public health measures to improve living conditions were the first effective weapons in lessening the impact of infectious diseases. Improved housing, sanitation, and street cleaning, regulation of lodging houses and factories, testing for food adulteration, were all vital preventive measures. Local Medical officers of health had a wide network of resources from laboratory research to morbidity and mortality statistics, to help them control epidemics through isolation, supervision of carriers and contacts, tracing the source of infection and the pathways by which it spread, and interrupting these by whatever means were available. Vaccines, inoculations, and effective treatments, for the most part, came after the Second World War. Since then we have been in a period of epidemiological transition, shifting from an age of receding pandemics and into an age of degenerative and so-called man-made diseases (those associated with lifestyle, such as heart disease, or lung cancer from smoking).
Infectious diseases were not wiped out, but could be treated within a general hospital. Post-war general hospital design included a higher proportion of single rooms in ward units to allow patients to be isolated for a variety of reasons, cross-infection being one of them. An experimental ward unit built at Hairmyres Hospital, East Kilbride, in the 1960s, was used to study ways of reducing cross-infection, but one of its findings was that human error remained a major culprit. Medical, nursing and domestic procedures could be one source, but also misuse of the engineering services. They found ventilation diffusors and exhaust grilles blocked up by the medical staff.
Photographs of the interior of NHS Nightingale show the huge open warehouse being fitted up with cubicles – here to facilitate laying on all the necessary services for each patient rather than isolating one from another. A dedicated hospital for infectious diseases is an old solution, but it is still a valid one, provided the infrastructure, the equipment and staffing are also in place – along with the necessary training in how to operate the appliances and services. As history shows, to tackle epidemics of infectious disease isolation hospitals need to be backed up by systems of quarantine, testing, tracing and tracking.
This blog post on asylum landscape design was posted recently on the Gardens Trust site. I sympathise on the difficulties of researching the gardens and grounds of hospitals, it can be very difficult to find much information in the surviving documentary sources. Old maps provide evidence of how diverse and complex these designed landscapes were.
At the end of last year I wrote about the work of William Goldring, a prolific landscape and garden designer who died in 1919. Apart from his private commissions and work on public parks he was also involved in the design of landscapes that have been generally overlooked by garden and landscape historians: those of […]
The Falkirk Ward was designed by the Department of Health for Scotland in the 1960s. It was an experimental ward, a prototype to be tested for its efficiency and flexibility. If successful, it was to be rolled out in the new district general hospitals planned to be built across Scotland as promised by the Hospital Plan of 1962. In the 1990s it was selected by DoCoMoMo as one of Scotland’s key 20th Century Modern architectural monuments. It was one of 60 post-war buildings which were deemed to be of particular significance in terms of their design or style.
The ward block was erected at the existing Falkirk and District Royal Infirmary. The Infirmary had been built in 1926-31 to replace an older cottage hospital and was officially opened by Prince George, later Duke of Kent, in January 1932. It had been designed in a sparse Neo‑Georgian style by the local architect, W. J. Gibson, with advice from Dr D. J. Mackintosh, Medical Superintendent of Glasgow’s Western Infirmary. Mackintosh was an inveterate giver of advice to hospital boards of management, and author of Construction Equipment and Management of a General Hospital published in 1916. The architect, William Gibson, had a family connection with the infirmary as his mother, Harriette Hicks Gibson, had been the main force behind the foundation of the original cottage hospital. His father, John Edward Gibson, was managing partner of the Camelon Ironworks in Falkirk.
Funds were raised to add a nurses’ home in the late 1930s and a competition held for the design, limited to architects practising in Scotland. First prize went to the firm of Rowand Anderson, Paul & Partners, Stuart R. Matthew came second and a local firm, T. M. Copland & Blakey were placed third by the assessor, C. G. Soutar. [AJ, 22 Dec 1938, p.1013.] The outbreak of the Second World War resulted in the plans being postponed and eventually abandoned, instead nine Emergency Medical Scheme huts were built on the site (a further two were added later).
Falkirk Infirmary was one of eleven institutions in Scotland selected by the Department of Health for hutted annexes to provide for the anticipated air-raid casualties. The eleven sites comprised four local authority hospitals (Robroyston, and Mearnskirk, in Glasgow; Hairmyres, Lanarkshire; and Ashludie, Dundee) four voluntary hospitals (Astley Ainslie, Edinburgh; Victoria Infirmary Auxiliary Hospital, Busby, Glasgow; Falkirk Royal Infirmary; and Stirling Royal Infirmary), and three mental hospitals (Gartloch, Glasgow; Bangour, Edinburgh; and Larbert). The huts, measuring around 144ft by 24ft, were each to contain 36 beds, and were to be built and maintained by the Office of Works. [The Lancet, 22 April 1939, p.943.]
The executive architects of the Falkirk Ward who worked in conjunction with the Scottish Home and Health Department and Western Regional Hospital Board were Keppie Henderson and Partners. The design was drawn up by the Hospital Planning Group of the Scottish Home and Health Department, comprising two architects – John Ogilvie and Mr Bruce, Dr Hunter and Miss McNaught on the medical and work-study side, Mr Rendle for administrative expertise, and Mr. Wotherspoon, engineer. Plans were finalised in October 1962 and work began in the following year. The new unit was officially opened by Bruce Millan M.P., Under Secretary of State for Scotland, on 4 November 1966, although one of the wards was brought into use towards the end of 1965. Patients were moved into it from two overcrowded wards in the old hospital. One of the consultant surgeons, Mr R. G. Main, noted that the old hospital’s surgical unit (which the new block replaced) had 65 beds consisting of one male ward and one female ward, but they sometimes added in as many as ten extra beds in the middle of each ward in order to cope with the waiting list. He recalled how ‘A ward round could be likened to a stroll through Glasgow Central Station on Fair Saturday!’ [SHHD, Hospital Design in Use 4 The Falkirk Ward, Edinburgh, HMSO 1969, p.39.]
The Falkirk ward was developed in order to provide greater ‘privacy, amenity and better facilities for caring for patients and so set standards for National Health Service hospitals which might be generally acceptable for many years to come’. [The Hospital, Feb 1968, p.65.] It was an experiment in design incorporating several features which were being contemplated or proposed for new hospitals but had not yet been tried out in Britain. It was a complete departure from the standard Nightingale ward, and involved a move towards much smaller ward units. It was not considered viable to provide only single and double rooms which were by then current in American hospitals. This would have created too many operational and staffing difficulties and greatly increased the running costs. For these reasons a combination of four‑bed wards and single rooms was selected, with a ward floor of 60 beds, including twelve for intensive care.
In addition to the experimental ward block, a two-storey service building was constructed as part of a general scheme of reconstruction at the infirmary. This addition provided kitchen, staff dining-room, pharmacy and central stores, and was also completed in 1965. In that year work began to design a new out-patients’ department. This, too, was designed by members of the Hospital Planning Committee of the Scottish Home and Health Department. The team in this instance comprised one of the few female architects employed by the NHS in Scotland in the 1960s, M. Justin Blanco White, Dr Hunter and Miss McNaught were the medical advisers and Mr Rendle the administrative adviser.
The new out-patients’ department was intended to be a demonstration building embodying the principles behind the Department’s Planning Note (the guidelines which were to be followed throughout the country for new out-patient departments). It was part of the wider strategy of devising standard hospital departments. In the mid-1960s the Department thought that the advantages of standardisation of departments would be increased if a standardised system of building and the use of common structural components were adopted. The model plan of the Falkirk out-patients’ department was also designed to illustrate the recommendations for A&E departments, especially regarding standard rooms for both diagnosis and treatment of either new or returning patients ‘walking, in wheel chairs or on a trolley’. They were also trialling a short-stay ward and operating theatre shared between out-patients and A&E.
Design work on the out-patients’ department continued through 1966-9. In 1969, with the plans nearing completion, work began to clear the site for the new department. Construction began in 1970, and the department was completed in 1972, having cost £881,000. It was equipped and furnished ready for use the following year.
With the reorganisation of the National Health Service in 1974, the running of Falkirk and District Royal Infirmary passed from the Western Regional Hospitals Board to the newly established Forth Valley Health Board. One of the first schemes undertaken by the new Health Board was the upgrading of the war-time hospital huts, completed in 1976.
The next major development took place in the 1980s with the addition of the Windsor Unit. This project was approved in 1979 and was intended to provide 176 maternity and geriatric beds. Work began in April 1984, on the scheme estimated to cost £8.7m and was scheduled for completion in 1986. The three storey block was very much of its time, the design made effective use of contrasting colours and materials, with the rich brown brick threaded with orange-red brick stripes. Despite being of relatively recent date, the unit had been decommissioned by October 2010, after the opening of Forth Valley Hospital, and was subsequently demolished.
The cottage hospital at Buckhaven opened on 28 August 1909. It was designed by Alexander Tod of Kirkcaldy for Lady Eva Wemyss in memory of her husband, Randolph Gordon Erskine Wemyss, of Wemyss Castle. Randolph Wemyss had died in July 1908 aged just 50 after a long illness, but in his relatively short life he had made a considerable impact on the Wemyss estate, guided and inspired by his mother. He invested the profits from the coal mines on his land both to improve production – building a coaling dock at Methil, and a railway from there to Thornton – and also to improve the conditions of his tenants and workers. He was behind the development of the ‘New Town’ or ‘Garden Village’ of Denbeath, where he built over 200 cottage flats in 1904-5, and invested in the company that built a tramway from Kirkcaldy to Leven.
The housing built by Wemyss at Denbeath was remarkable in many ways. The design of the cottage flats was unusual. Arranged in terraces of two storeys, with one flat per floor, the L-shaped flats interlocked with their entrances alternately on the north and south sides. The upper-floor flats were accessed by external stairs. They were also unusually large, giving a larger square footage of floor area than was recommended by the 1919 Housing Act, and built on a low density at 10 houses per acre, yet the rents kept affordable. [see John Frew and David Adshead’s article, ‘”Model” Colliery Housing in Fife: Denbeath “Garden” Village 1904-8’ in Scottish Industrial History, X (1987) pp 45-59 for more on the housing.]
Designs for a cottage hospital to serve the new garden village may have been outlined around 1907 by Randolph Wemyss and Alexander Tod, the Wemyss Castle estate architect. However, they were seen through by Lady Eva Wemyss, with Tod, following her husband’s death. Lady Eva was Randolph’s second wife (he had been divorced from his first wife in 1898), and the daughter of William Henry Wellesley, 2nd Earl Cowley, a great nephew of the Duke of Wellington. Both Lady Eva and Alexander Tod were said to have visited ‘some of the principal hospitals in the country’ before settling on the design, which embodied the ‘best features found in all of them’. [Dundee Courier, 31 March 1909, p.6]
In March 1909 Lady Eva Wemyss laid the foundation stone, placing a sealed glass jar containing current coins and copies of the daily newspapers in a cavity on top of which the foundation stone was lowered into place. Building work proceeded rapidly, and at the end of August 1909 the hospital was officially opened by Lady Eva, the ceremony being presided over by Charles Carlow, the manager of the Fife Coal company. Carlow gifted the four-dial clock, which originally had Westminster chimes, and had the novel design of hands representing the miner’s pick and shovel.
The plan is of the standard central administration block flanked by ward blocks favoured at the time but it is dressed up with baronial details. Described as picturesque in the contemporary accounts in the local newspapers, the building has undoubted charm. Originally the harling was yellow, or ochre coloured rather than white. There are circular stair turrets and corbelled bartizans at the angles of the wards. The somewhat eccentric entrance has a Doric portico fronting a circular tower, topped with a conical roof sporting the gabled clock faces.
To the rear were the kitchen and laundry, with the ‘latest appliances for mechanical ironing of linen’, and at the east end of the site a small chapel and mortuary. Originally there were wrought-iron gates ‘of mediaeval design, with side railings of wrought iron’ – now long disappeared’
The hospital was designed as a surgical hospital – accidents in the coal mines were not infrequent – and contained two main wards with six or seven beds in each, an emergency ward with two beds, operating theatre, X-ray room, doctor’s room, as well as accommodation for the matron and nurses and the usual stores and offices. Three ‘up-to-date’ bathrooms were installed, including, an ‘electric bath’. It was to be lit by electricity, and heated by hot-water pipes and open fires.
Some of the original plans have were deposited in the National Monuments Record of Scotland (now part of Historic Environment Scotland), including a design for the entrance hall floor. It features the Wemyss family crest of a swan at the centre.
The grounds were laid out and planted with flowers and shrubs by the head gardener of Wemyss Castle, Charles Simpson. Originally the front of the hospital looked directly out over the Forth, but housing has since been built opposite. Along with the view, the hospital has lost a few of its original features – weather vanes formerly topped the turrets, a swan in the centre, a working miner with lamp and tools and a ship and colliery winding engine on the side turrets. On the whole, though, the building is little altered, except internally largely the result of a sizeable addition to the west built in the 1960s as a geriatric unit added by the South East Regional Hospital Board in the face of a pressing need for additional beds for the elderly in Fife.
An extension of the hospital was first mooted late in 1954. At that stage it was hoped to add an out-patient and physiotherapy department. At much the same time the South East Regional Hospital Board had been considering its strategy for hospital provision for the ageing population, specifically in Fife. Early in 1955 sketch plans were drawn up, at this stage for a 44-bed unit with some physiotherapy and out-patient accommodation. Little progress having been made, in January 1957 the Regional Board appointed Dr Robert Rankine to develop and take charge of a hospital geriatric service for the county. He produced a report in April endorsing the proposals to expand the Randolph Wemyss hospital. At this stage, however, there was no prospect of funds being available for such a building before 1960. In February 1959 the Regional Board approved the acquisition of additional land to the west of the hospital for a new building and the construction of a 60-bed geriatric unit, with limited facilities for physiotherapy, at an estimated cost of £120,000. [Fife Archives, H/EF/1/10-11, East Fife Hospital Board of Management Minutes.]
The new unit was built in 1962-3 and officially opened early in 1964. The architect in charge was Iain D. Haig, one of the team in the Regional Board’s architects department headed by John Holt. Although in marked contrast to the original hospital, its stylish design and respectful distance from the older building ensures that each can be equally appreciated. (Personally, I think they are both very handsome – in different ways.) Rather like the slightly earlier Phase One buildings at the Victoria Hospital, Kirkcaldy, the geriatric unit blends modernism, in its construction and the concrete fins that form the building’s most distinctive feature, with elements of traditional Scottish vernacular building traditions, in the use of random-rubble stone as a facing on the ground storey.
The new range was designed with a reinforced concrete frame, aluminium sliding sash windows (since replaced), a central spine beam supporting floors and roof, and close-centred perimeter columns of precast concrete designed as projecting fins to create ‘sun baffles’ for the ward areas. Wards were on the upper two floors, designed on an adaptation of the Nuffield type with the bed bays on one side of a service corridor, and ancillary rooms, plus single-bed rooms, on the other.
Each of the two ward floors accommodated thirty patients arranged in two nursing units per floor of sixteen and fourteen beds, with four 6-bed bays, one 3-bed bay and three single rooms. Nurses stations were in the service corridor area placed centrally between the 6-bed bays and with the single rooms close by. Glazed screens divided the bed bays to maintain a clear view for the nursing staff. A day room was placed at the centre, between the two 6-bed bays, and a passageway ran along the south-west side beside the windows, fitted with a handrail to assist ambulant patients to exercise, out of the way of the main circulation corridor on the other side of the wards. Perhaps in an echo of the original entrance hall floor, there was a patterned vinyl-tile floor, supplied by Nairn’s of Kirkcaldy in the new wing. The original colour scheme throughout was grey and white, with accents of stronger colour. [The Hospital, May 1965, pp.229-30]
In 2008 the hospital was re-opened by Nicola Sturgeon after modernisation. It currently operates as a community hospital run by NHS Fife, with various out-patient clinics, and the geriatric unit (now the Wellesley Unit) providing in-patient palliative and continuing care.
Victoria Hospital, Kirkcaldy, and Queen Margaret’s Hospital, Dunfermline, are the two main hospitals in Fife, serving the eastern and western halves of this large county. They both comprise buildings that mark significant periods in the history of post-war hospital architecture, and the Victoria has some of the earliest surviving NHS buildings in Scotland. The site is now dominated by a large, 500-bed ward block built in 2009-12 by Balfour Beatty to designs by Building Design Partnership.
As yet little studied, I have recently been looking into the development of the hospital during the 1950s and 60s, delving into the Department of Health for Scotland files, and the records of the East Fife Hospitals Board of Management. But the story begins long before the National Health Service, and at least one remnant survives of the earliest phase of this hospital.
Although not the most architecturally exciting of buildings, at the heart of the modest brick-built building pictured above is an 1890s ward block, part of the original burgh fever hospital. This was built as a scarlet fever ward. There was a larger ward block to its west that was intended for typhoid patients in one half of the building, and diphtheria patients in the other. Between these two was an administration block which also housed some staff accommodation, and there was a laundry and disinfector, mortuary, and gate lodge on the site. Plans for the hospital had been drawn up by the Glasgow architects, Campbell Douglas & Morrison in 1897 to provide accommodation for 33 patients in all.
The fever hospital was extended in 1908, with a sanatorium pavilion for tuberculosis patients (on the site of the present hospice, and possibly partly incorporated in the present building). Further additions were made in 1930 with another sanatorium building and a cubicle isolation block. By the 1940s the hospital had 124 beds, but by then the buildings were not considered up to modern standards. In the run up to the establishment of the National Health Service the plan was to use nearby Cameron Hospital for infectious diseases, and to convert the Victoria into accommodation for the aged and infirm. Cameron Hospital had been considerably extended in the 1930s, its relatively modern buildings and large open site offered the potential to develop a new general hospital there.
Difficulties over the acquisition of the additional land required adjacent to Cameron Hospital caused considerable delays. This, together with the time consuming bureaucracy of the new health service, followed by drastic cuts in central funding for new building, lead eventually to the abandonment of the Cameron Hospital scheme in about 1958. In the mean time, a new surgical ward block and other additions had been planned at the Victoria Hospital, with a view to addressing the serious shortage of beds across Fife generally. Work on this extension was nearing completion when the Cameron plan was given up, and the decision taken to build a second, larger block at Kirkcaldy. The 1950s extension therefore became known as phase one, the 1960s development phase two. The contrast in style and planning between these two phases indicates how post-war hospital architecture was developing apace at this time. Both phases are rare survivals of a key moment, demonstrating the evolution of modernist architecture as well as of hospital planning.
Preliminary plans for a 100-bed surgical unit at the Victoria site were on the drawing board of the architects’ department of the South East Regional Hospital Board in 1953. By October 1954 they had been broadly approved by the Department of Health and had been submitted to the East Fife Hospitals Board of Management based at Kirkcaldy for their consideration. John Holt, the Regional Board’s chief architect, attended meetings with the local Board of Management to explain the rationale behind the designs.
The footprint of the ward block adhered to pre-war pavilion planning in its arrangement, if not its internal layout, comprising a three-storey T-plan building divided into three ward wings with the main entrance hall and stair at their meeting point. A single storey range on the north side contained the main out-patients’ department, and another at north-west corner housed a chest clinic. The entire building is flat-roofed, steel framed, and faced in buff-coloured brick and glass curtain walling. The flat roof of the north-east wing had a solarium and roof garden, its reinforced concrete pergola remains a distinctive feature of the building. Roof terraces and solaria were more common in the interwar period, and even then roof gardens were a rare feature in a Scottish hospital.
Inside, clinics, offices and the children’s ward were on the ground floor, wards and accommodation for medical staff on the first floor, and further wards and twin operating theatres on the second floor. According to Holt, ward planning was based ‘on the continental practice’ of having wards sited on one side of a central corridor and ancillary rooms on the other. This was known as the Rigs model (referring to the Rigs Hospital, Copenhagen), and was also the basis of the Nuffield Provincial Hospitals Trust’s widely publicised experimental ward built at Greenock in the early 50s.
Unusually, the operating theatres faced south. This met with surprise from the Board of Management committee, as it was traditional for theatres to be on the north side to benefit from even northern light. Holt explained that the trend was now against providing large theatre windows, rendering their position unimportant, and the theatres here would be air-conditioned, combatting heat from direct sunlight and providing effective bacteriological control.
When work on the surgical block was nearing completion in 1959, it was discovered that the ward doorways were too narrow to allow beds to be wheeled through easily. The standard hospital bed, without mattress, sheets and blankets, was 36 inches wide, and the new ward doorways were fractionally under 40 inches wide. Various suggestions were made for easing the beds through the doorways, but widening them was dismissed as too costly. Metal strips were proposed to be added to the door frames to protect the woodwork, narrower beds were rejected, but narrower mattresses would be used. The matter was also to be ‘kept in mind’ when plans were drawn up for the phase two ward block.
Nurses’ Home, Hayfield House
The nurses’ home, now Hayfield House, has some more overtly modernist features: its upper floors resting on slender pilotis, originally with an open space in the centre. It was constructed in a novel way, using a method that until that time was only used on tall silos. The concrete frame of the building was constructed from shuttered concrete made using continuously sliding forms operated by hydraulic jacks. The timber forms were constructed in situ on the first floor, and given a slight batter to ensure that they were self-clearing. Work was carried out continuously for four days, with 54 men on the day shift and 51 on the night shift. This experimental construction method was recommended by the consultant engineers, Blyth and Blyth, because of the ground conditions. The presence of historic mine workings favoured a concrete frame, being lighter than steel, particularly for a building of this height. Nevertheless, the modernist aesthetic was tempered by the warm tones of the brick facing, pale blue tiles and random-rubble stonework at the entrance.
In 1958 the Department of Health approved a second extension at the Victoria Hospital. Trial borings had to be made on the site once more, to check for underground mine workings, but as soon as the site was deemed suitable detailed planning was begun in the hopes that building work might start in 1961. The architect in charge of phase two was Eric Dalgleish Davidson, who had taken over from Walter Scott on phase one when Scott had left to set up in private practice late in 1957.
A model of phase two was made in 1962, and plans had been finalised by November that year. The annual report of the Scottish Home and Health Department recorded that the second extension to the Victoria was in progress at the end of the year. Officially opened in 1967, phase two is in marked contrast to phase one in style and scale: high rise rather than low rise, uncompromisingly modernist, and adopting a deeper, double-corridor ward plan.
An eleven-storey tower sits atop a two-storey podium – in the matchbox-on-a-muffin manner, demonstrated clearly in the model pictured above. The extension housed twice the number of beds as phase one (240), three operating theatres, a new out-patients’ department, A&E, X-ray, sterile supply, physiotherapy and occupational therapy departments, as well as a conference hall, and libraries for patients and medical staff. Eight ward units, each with 30 beds, were located in the tower; the beds were mostly in four-bedded bays, supplemented by single rooms. Various labour-saving devices were introduced making the most of technical innovations.
In addition to the main ward tower, some of the phase one buildings were extended to meet the demands of the large increase in patients and staff. The kitchen and dining-room building was one that had to be enlarged, but the Board of Management’s hopes for greatly expanded staff recreation facilities (including a swimming pool) proved too expensive.
With the shift from Cameron Hospital to the Victoria as the new general hospital for East Fife, the central laboratory which had been established at Cameron was now in the wrong place. A new laboratory was therefore included in the phase two scheme. Different in style again from either phase one or the ward tower, this distinctly industrial-looking building occupies the north-east corner of the site. The laboratory is square in plan, arranged around an internal courtyard.
The phase two extension of the Victoria Hospital is particularly significant in Scottish hospital history because of the involvement of Eric Davidson in its design. Whilst it is difficult to ascribe a single designer to the phase two buildings, Davidson was the architect in charge. In 1960 he had been made Assistant Regional Architect to the South Eastern Regional Hospital Board and also Chairman of the Scottish Hospitals Study Group (1960-4). Following the re-organisation of the NHS in 1974 he became Assistant Director and Chief Architect of the Scottish Health Service Building Division (from 1974 until he retired in 1989). John Holt, likewise, is a key figure in the earlier decades of Scottish hospital design. As the chief architect to the Regional Board, he headed up a department that designed many remarkable buildings extending from hospitals in the Borders, across the Lothians and into Fife.
In the more recent additions to the Victoria Hospital, major architects or architectural firms are also present, with Building Design Partnership for the newest development (completed 2012) and Zaha Hadid for the Maggie’s Centre (2006). Each phase, from the 1890s onwards, encapsulates in built form the ideas, hopes and aspirations of the different times in which they were designed.
The view above looks south across the double-curved front of the new wing, with its paired entrances sheltered by distinctive, up-turned, curved canopies. The nearer entrance leads to the out-patients’ department and main wards, the farther entrance to the maternity wing. Just visible on the right is the corner of the diminutive Maggie’s Centre.
National Records of Scotland, Department of Health files: Fife Archives, East Fife Hospitals Board of Management, Minutes; Plans, DG/K/5/121: Department of Health for Scotland, Scottish Hospitals Survey, Report on the South-Eastern Region, 1946: PP, Scottish Home and Health Department, Annual Report for 1967, p.76: The Hospital, Jan. 1960 p.67; December 1960, pp 995-1004; Jan. 1961, p.54; July 1961, p.474; May 1962, pp 303-4; March 1964, p.163; Sept 1967, p.353: AJ, 22 Nov 1956, pp 746-7: Urban Realm, 24 Aug 2012.