Brislington House, now Long Fox Manor, Georgian Bristol’s exclusive private madhouse

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Brislington House, engraving after S. C. Jones, c.1865.  Wellcome Library, London. Reproduced under Creative Commons Attribution only licence CC BY 4.0 

Brislington House, together with its founder Dr Edward Long Fox, was one of the most influential asylums in the first half of the nineteenth century. It has much in common with the York Retreat. Fox was a Quaker, like the Tukes, and he held a similar belief in the restorative power of nature and the familiar comforts of a domestic environment. Brislington House originally comprised a row of separate houses, rather than the large rambling pile that survives today. It was designed to make the patients feel at home, rather than in an institution or a prison. This was, in a large part, possible by catering primarily for paying patients, and the well-to-do at that. In this manner it operated in a similar way to Ticehurst, Sussex and Laverstock House, Wiltshire, both lucrative private asylums.

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Brislington House, now Long Fox Manor, private flats, photographed in October 1992

Edward Long Fox is an intriguing individual, he had an extensive private practice as a physician in Bristol, rose to be a senior physician at Bristol Royal Infirmary, and was an astute businessman, amassing a considerable fortune. Before embarking on the Brislington House venture he had operated a private asylum at Cleve Hill. But he was also involved in radical politics, and had an active interest in some less mainstream aspects of medicine. He seems to have been widely admired, but not universally so, accused at times of quackery and worse. [1]

Fox bought the Brislington estate in 1799, and spent several years over the planning and construction of the asylum and the laying out of the grounds around it. Building work seems to have begun in 1804, and the first patients were admitted in 1806. Fox described the arrangements:

The patients of each sex are arranged under three classes. Each class inhabits a distinct house, detached from the other by an interval of eighteen feet, with a separate court for the exercise of the patients, wherever they please; the ground of which is elevated, so that they can view the surrounding country, while a border sloping towards the wall secures them from escape. [2]

Although Brislington House is well documented, and plans survive for the buildings, no architect seems to be mentioned anywhere, or even a builder.

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Ground plan of Brislington House Asylum, probably published around 1809. (public domain image)

In addition to this idyllic accommodation were less glamorous cells for the refractory patients. These can be seen on the plan above, at the foot of the walled gardens to the south of each house. It was in one of these that John Perceval (son of the former prime minister, Spencer Percival, assassinated in 1812) recorded spending a miserable period. Perceval noted that the cells were lit from above, and heated by flues in the wall rather than with open fires.

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Garden front, from  Francis Charles Fox, History and present state of Brislington house, 1836 Wellcome Library, London. Reproduced under Creative Commons Attribution only licence CC BY 4.0 

At either end of the row of houses were two small detached infirmaries. The use of separate houses to aid the classification of the patients may have been inspired by contemporary French asylums, notably La Salpêtrière in Paris where the different categories of patients were assigned to separate loges or detached blocks. However, the loges at La Salpêtrière, designed by François Viel c.1786, were all of one storey and the same design. At Brislington the houses were of two or three storeys and not identical.

The buildings were also interesting for their early use of fire-proof construction; a matter which was close to Fox’s heart. When the first county asylum was built at Nottingham in 1810, Fox was in correspondence with the Committee of Governors and warmly recommended the use of iron in construction which he considered ‘did not only serve to alleviate the dangers from fire, but also from lice and vermin’. [3]

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Extract from the 6-inch OS map, revised in 1901-2. Reproduced by permission of the National Library of Scotland

Fox’s success was immediate and sustained. A mark of this is the erection on the estate of Lanesborough Cottage in 1816 for Lord Lanesborough, and of Swiss Cottage in 1819 for Lord Carysfoot. The Beeches was added in the 1820s and Heath House, the large villa to the north-west of the main asylum, was built around 1829 and was occupied by Edward Fox when he retired from the management of the asylum in that year. But the asylum remained a family business, his sons Francis and Charles, both also physicians, taking over its management. After their father’s death in 1835 they issued a brochure or booklet relating the history of the asylum and its present state. In 1850-1 they undertook a major remodelling of the buildings, joining them together as they are now, and building additions, including the chapel. Previously the laundry was converted into a chapel on a Sunday, and services regularly performed there. [4]

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The chapel, Brislington House, photographed in 1992

The main building was oriented on a north-east to south-west axis, with the entrance front facing north-west, so the garden front had the sunnier south-east aspect. Both long elevations still have a rather disjointed appearance, presumably reflecting their former separation. The building is rendered with stone dressings in an Italianate palazzo style.

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Main building north-west elevation, photographed in October 1992

The garden front is more informal, the central seven bays are flanked by full-height bows, rather resembling angle turrets, with three windows at first and second floor levels.

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South-east elevation of the main range, 1992

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South-east elevation, photographed in October 1992

Across the north end the chapel and recreation hall were built. The chapel has a Greek cross plan and follows the classical style of the rest of the asylum. Inside the box pews were still in situ in 1992 and a fine wood-carved reredos with gothic (or possibly gothick) details, some good light fittings and a painted timber compartmental ceiling. There was also a small gallery over the entrance.

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Brislington House chapel, October 1992

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The chapel in 2013. Photograph by Rodw, from wikimedia commons, licence CC BY-SA 3.0

Brislington House chapel window

Detail of chapel window, the rendering was quite decayed in places in 1992, it has since been repaired and painted.

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Memorial window in the chapel, from St Luke’s Church, Brislington. 

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Detail of the chapel ceiling. Slightly squiffy. October 1992.

The recreation hall, which was added in 1866, has a deceptively austere exterior – doubly so in the early 1990s when it was faced in rather grimy render. The interior was contrastingly lavish with a small platform at the west end, the walls panelled with bolection moulding and ornamented by anthemions and lyres, and broad pilasters with paterae decorating the frieze. The coved ceiling has bands of greek key pattern and, in the corners of the central flat section, decorative plasterwork scrolls. Similar neo-Classical inspired plaster ornamentation appears over the doors at the west end. The iron pendant lamps are equally ornate.

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Recreation Hall, photographed in October 1992

Brislington House remained in the ownership of the fox family until 1947 when it was purchased by the Governors of the United Bristol Hospitals and was used as a nurses’ home.

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Brislington House, undated photograph, perhaps from the time of the sale by the Health Authority in 1984. Image from flickr reproduced under creative commons license CC BY 2.0

In 1948 it passed to the National Health Service and was put on the market by the South Western Regional health Authority in September 1984. It was then run as a private nursing home for some years before it was sold again and turned into private flats in 2001 and renamed Long Fox Manor.

The landscaped grounds and their importance as a part of the therapy for patients at Brislington House have been researched and written about by Sarah Rutherford (see studymore) and Clare Hickman, see her article on ‘The Picturesque at Brislington House, Bristol…’ in Garden History, vol.33, No.1 Summer, 2005, pp. 47-60.

References

  1. Leonard Smith ‘A gentleman’s mad-doctor in Georgian England: Edward Long Fox and Brislington House’ in History of Psychiatry 2008, 19 (2), pp 163-184
  2. The reference that I had for this was from Fox’s evidence to the Parliamentary Select Committee on the state of Criminal and Pauper Lunatics in England and Wales of 1807. I cannot now find any such evidence from Fox to this Committee. Sarah Rutherford gives a reference to Fox giving evidence to the 1815 committee, but I can’t find that either. The quote is not from his evidence given in the late 1820s, nor does it match the report on the asylum in the 1815 committee, where the evidence was given by Edward Wakefield for Brislington House. Happy to be enlightened.
  3. Nottinghamshire Record Office, SO/40 1/50/4/1
  4. PP Report of the Committee on Madhouses in England, 11 July 1815, evidence of Edward Wakefield p.21

 

The Retreat, York

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The Retreat, Heslington Road, York, photographed in 2009 © Copyright Gordon Hatton and licensed for reuse under this Creative Commons Licence

More has perhaps been written about The Retreat since its foundation in the late-eighteenth century than almost any other psychiatric hospital in Britain. Alongside Bethlem it is probably the best known. The post here merely aims to provide a brief overview, principally of the buildings. The bare bones of its history are simply told. It was founded by the Society of Friends, and more particularly by William Tuke, as a lunatic asylum for fellow Quakers. The chief spur to its foundation was to provide an alternative to the York asylum, about which some serious questions were being raised regarding the treatment of patients there, particularly of the poorest class, and the conditions in which they were kept.

While the motive for the foundation may have derived from the Society’s spiritual beliefs, the groundwork was entirely practical. Recent works on asylum management and design were read, the new St Luke’s Hospital in London was visited and physicians consulted. But the choice of architect was less straight forward. In the 1790s there were still few purpose-built asylums in Britain, and the architectural profession was very much in its infancy. There were no particular specialists in institutional buildings, such jobs often went to the county surveyor. The top man locally, John Carr, might have been too expensive for the Society, but he had also been the architect of the York Asylum, and not only did the Society object to the management of that asylum, but it was also stylistically at variance with the Society’s preference for unostentatious buildings.

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St Luke’s Hospital, print, London, England, 1785, from the Wellcome Library,  Wellcome Images licensed under the Creative Commons Attribution 4.0 International

And so they looked to one of their own faith, John Bevans, sometime carpenter and architect of London. He had never built a lunatic asylum before, and confessed that asylum planning ‘was a subject that never occupied my thoughts’, prior to his appointment. [1] However, there is some evidence that he was the designer of the Quaker Workhouse in Clerkenwell, completed in 1786, so not altogether irrelevant experience. [2]  Along with William Tuke he visited and was impressed by St Luke’s Hospital in London, and aspects of the plan were adopted for The Retreat, albeit on a reduced scale. The wings were two instead of three storeys, flat ceilings substituted for arches, and there was a central stair rather than separate stairs in each wing.  William Tuke and his son had also sketched out early plans as guidance, but as Bevans remained in London, a local architect, Peter Atkinson, was brought in to manage the construction, and draw up plans and elevations following Bevans’ directions. [3]

Before the plans could be finalised, money had to be raised and a site found. William Tuke, his son Henry and Lindley Murray raised funds by subscription from Friends throughout England and the site was acquired in 1793. When The Retreat opened in 1796 it comprised a central three-storeyed block with a recessed two-storeyed wing to the west. In the following year a corresponding wing was built to the east. The buildings were of plain brick with slate roofs.

L0048416 Description of the RetreatA view of the North Front of the Retreat near York, from Samuel Tuke’s Description of the Retreat, 1813. Wellcome Library, London. Reproduced  under Creative Commons Attribution only licence CC BY 4.0 

Twenty-one years after the foundation of the asylum had been first considered, William Tuke’s grandson, Samuel,  published a description of The Retreat. He related that the idea had been to establish  ‘a retired Habitation, with necessary advice, attendance, &c. for the Members of our Society, …who may be in a state of Lunacy, or so deranged in mind (not Idiots) as to require such provision.’ [4]

From the outset the setting and the grounds were as important as the building itself. The founders wanted a site large enough to furnish a few acres of pasture land for cows and for gardens where the patients might take exercise. The financing was arranged on the established model of a voluntary hospital, whereby voluntary subscriptions were made towards the cost of running and maintaining the institution. Those subscribing over a certain amount could nominate poor patients on the lowest rates of admission, and could attend the governing committee meetings. [5]

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Extract from the 6-inch OS Map, published in 1853. Reproduced by permission of the National Library of Scotland.

The central block contained the main entrance, and, on the ground floor, the kitchen, a dairy, pantry and larder on the north side, and a parlour and dining-room on the south side, as well as the principal stair. A corridor, eight feet wide, ran along the east-west axis of the whole building and the patients’ accommodation in the wings comprised single bed rooms, pump room, closets and day rooms placed either side of the corridor. As at earlier asylums, including St Luke’s and Bedlam in London, the patients’ single rooms were lit by a small window, placed high up in the wall.

L0048417 Description of the Retreat Credit: Wellcome Library, London. Wellcome Images images@wellcome.ac.uk http://wellcomeimages.org Ground plan of the Retreat near York. 1813 Description of the Retreat, an institution near York, for insane persons of the Society of Friends : Samuel Tuke Published: 1813. Copyrighted work available under Creative Commons Attribution only licence CC BY 4.0 http://creativecommons.org/licenses/by/4.0/Ground plan of the Retreat near York, from Samuel Tuke’s Description of the Retreat, 1813. Wellcome Library, London. Reproduced  under Creative Commons Attribution only licence CC BY 4.0

The Retreat was opened on 11 May 1796 and the first three patients were admitted in June. A local physician was appointed to attend the patients. [6]  The entrance retains its original pedimented doorcase but most of the windows have been refitted with modern sashes. The original sashes, of which only a few remained by 1992, were of iron with iron glazing bars; in order to give security without the appearance of bars one sash filled the whole height of the window but was only glazed in the lower part, and a second, moving, sash had glazing bars which, in the closed position, came exactly behind those of the first.

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Upper-floor plan of The Retreat, from Samuel Tuke’s Description of the Retreat, 1813. Wellcome Library, London. Reproduced  under Creative Commons Attribution only licence CC BY 4.0

The Retreat became the most influential asylum of its time, not so much in terms of its design, but in the treatment and care of the patients it admitted. Although the roles of William and his son Henry Tuke should not be underplayed, it was William’s grandson, Samuel, who was largely responsible for the wide sphere of influence of the hospital through his systematic study of lunacy and his publications, notably the Description of the Retreat of 1813. It was at his father’s request that Samuel began writing ‘a history and general account of the Retreat’ in 1811, but it was on his own initiative that he turned this into an opportunity for himself to read as many authors as he could come accross on the subject of insanity. He also read William Stark and Robert Reid’s accounts of the planning and design of the asylums at Glasgow and Edinburgh, both of whom had visited the Retreat. In 1812 he visited St Luke’s in London to discuss the ‘humane system’ with Thomas Dunston, the superintendent there, but was neither impressed by Dunston nor the asylum, which he considered was too prison-like in appearance.

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One of the original-style of sash window at The Retreat, designed to look like a domestic sash window but modified to create ‘hidden’ iron bars to prevent patients from escaping.

On its publication, Tuke’s Description… was thrust to the fore in the subsequent controversy involving the York Asylum, and its physician, Dr Best, who took great and public exception to Tuke’s well considered work. If Best had hoped to blight the prospects of this rival asylum in York, he was doubly disappointed. Not only did he attract much publicity to the Retreat but to his own institution which was very soon exposed as corrupt in administration and inhumane in its treatment of the poorest inmates.

Neither Samuel Tuke nor John Bevans considered that the plan of the Retreat was a perfect model. Tuke considered that ‘an inferior plan well executed, may be more beneficial than a better system, under neglected managements’. [7]  Tuke was also critical of the airing courts on the south side of the building which were bounded by eight foot high walls. Although the natural slope of the ground preserved a reasonable view of the surrounding countryside, Tuke nevertheless felt that the courts were too small and that they must appear uninviting to patients where ‘the boundary of his excursion is always before his eye; which must have a gloomy effect on the already depressed mind’. Another defect of the plan which Tuke noted in his Description… was the arrangement of patients’ rooms on either side of the corridors, or galleries: ‘for, though a large portion of light is admitted, by the window at each extremity of the building, yet, the galleries on the ground floor, at least, are rather gloomy’. [8]

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Detail from a survey of The Retreat of 1828 by Watson and Pritchett.  This shows the walled airing yards on the south side of the building that Samuel Tuke criticised.  (Public Domain image)

The treatment of the patients set the Retreat apart from its contemporaries, in particular the larger London asylums. Whilst the system of ‘moral management’ developed there did not necessarily have direct expression in the design of the building, it did have an effect and elements of building reflect the greater understanding of the needs of those afflicted with mental illness. The Tukes, and the early staff of the Retreat, rejected the widely held belief that lunatics were insensible to the usual comforts of the sane, such as warmth or an appreciation of their surroundings. At both Bedlam and St Lukes the windows in the patients’ cells were unglazed, as it was considered that lunatics were insensible to cold, and the ventilation helped to disipate the stench of soiled straw which formed the patients’ bedding. In response to their more enlightened views Bevans devised the iron-framed windows for the Retreat and the fires and stoves were provided with safety guards to protect the patients. Similar thought was given to the furnishings – curtains were designed specially without any element that could be misused by a patient to harm himself or others.

The Retreat quickly became a success and additional accommodation was soon required. The first addition of the west wing, part of the original design, was made almost as soon as the first phase of construction had been completed in 1796. In 1799 a building was added for male patients and a separate airing ground provided. This was the five-bay wing added at the south-east corner. It was appropriated to the more violent patients. Later, in 1803, a corresponding wing was added to the south-west corner for female patients. Further accommodation was still required and in 1810 a house near Walmgate Bar was acquired for £1,200. This house was, for a time, known as ‘the Appendage’. It was sold in 1823 to the Yorkshire Quarterly Meeting as a boys’ school. Another house was acquired in 1816 on Garrow Hill.

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Extract from the 6-inch OS map, revised in 1929, showing how The Retreat had been extended and added to, and also the encroaching suburbs of York. Reproduced by permission of the National Library of Scotland.

An annexe to the south, known as ‘the Lodge’ was built in 1816-17, rebuilt on a larger scale in 1875. In about 1827 the south-east wing was extended eastwards and two new wings had been added on the north corners replacing the stable block on the east and the brew house and bake house on the west. There was also an octagonal gate lodge on Heslington Road.

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The Lodge, added to the south side of The Retreat, 1875. Photographed in 1993.

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Detail showing the central part of The Lodge with its elegant iron and glass veranda. Photographed in 1993

Expansion continued in the second half of the nineteenth century, beginning with an appeal for building funds launched in 1852, resulting in another new wing in 1854. Further additions were made in 1858-60. Villas were acquired in 1879 (Belle Vue) and built in 1880 (East Villa) while from the 1890s the now ageing buildings were remodelled by Walter Brierley, and a new recreation room constructed in 1906. [9]

The North-West wing of The Retreat.  Begun in 1827, remodelled in the 1890s. Photographed in 1993.

A nurses’ home was built in 1899, but a newer and larger one was built in the 1920s following a limited competition for the design. This was won by Chapman & Jenkinson of Sheffield. Bedrooms for fifty nurses were provided on the first and second floors, and a kitchen, dining-hall and sitting-rooms occupied the ground floor. It was constructed of local grey bricks with hand-made red brick and some stone dressings, and Westmorland slates for the roof. The contractors were William Birch & Sons of York and work was completed by 1929. [10]

The Retreat continues to provide specialist mental health care, occupying its original site and most of its original buildings, a testament to the success of the original founders and the validity of their ideals. (see theretreatyork.org.uk)

References

  1. A. Digby, Madness, Morality and Medicine. A Study of the York Retreat, 1796-1914, 1984, p.18
  2. Survey of London vol.46 South and East Clerkenwell, pp.341-2
  3. Anne-Marie Akehurst ‘The York Retreat A Vernacular of Equality’, pp 81-4, in Peter Guillery, ed Built from Below British Architecture and the Vernacular, 2011
  4. Samuel Tuke, Description of the Retreat, an institution near York for Insane Persons of the Society of Friends, 1813, p.26
  5. Samuel Tuke, Description of the Retreat, an institution near York for Insane Persons of the Society of Friends, 1813, p.29
  6. Samuel Tuke, Description of the Retreat, an institution near York for Insane Persons of the Society of Friends, 1813, p.46
  7. Samuel Tuke, Description of the Retreat, an institution near York for Insane Persons of the Society of Friends, 1813, p.47-9
  8. Samuel Tuke, Description of the Retreat, an institution near York for Insane Persons of the Society of Friends, 1813, p. 106
  9. VCH
  10. The Builder, 12 Feb. 1926, p.276; 26 April 1929, pp 764-76

Further Reading

This is far from comprehensive, but just a few key texts or books/articles that I have read and found interesting.

Anne-Marie Akehurst ‘The York Retreat A Vernacular of Equality’, pp 81-4, in Peter Guillery, ed Built from Below British Architecture and the Vernacular, 2011
Anne Digby, Madness, Morality and Medicine. A Study of the York Retreat, 1985
Barry Edginton, ‘The Design of Moral Architecture at the York Retreat’ in Journal of Design History, 2003 vol.16 (2) pp.103-117
H. C. Hunt, A Retired Habitation, A History of The Retreat, York, 1932
R. Hunter and I. Macalpine, Description of the Retreat… 1964
Samuel Tuke, Description of the Retreat, an institution near York for Insane Persons of the Society of Friends, 1813

Holloway Sanatorium – garish or gorgeous?

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Holloway Sanatorium was in a parlous state when we visited it in about 1992 as part of the RCHME Hospitals Project. Although the process of decay was sad to see, the stunning interior decoration was still impressive. In 1997-8 the main rooms in the building were restored, the artwork re-instated and the site developed as a gated residential estate, rebranded Virginia Park.

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Elevation of Holloway Sanatorium printed in The Graphic, 2 June 1877

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Recreation Hall, Holloway Sanatorium, W. H. Crossland architect, photographed c.1992 

The sanatorium was founded by Thomas Holloway, of Holloway’s Pills and Ointment fame, for the mentally afflicted of the middle classes. Its architect was W. H. Crossland, who won a competition for the design in 1872. The foundation stone was laid by Holloway’s wife Jane in 1873.  Although it was described as nearly finished in 1877, it was another seven years before the first patients were admitted in 1884, and the official opening ceremony did not take place until 15 June 1885. By then Thomas Holloway was dead, the project having been completed under the direction of his brother-in-law, George Martin Holloway.

a holloway 4‘All exuberance of ornament and expensive detail is avoided’ was the claim, but the building itself rather belies that statement. [1]

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The sanatorium was intended for the middle classes only, with a particular view to accommodating professional men who were thought likely benefit from a year’s residence in a quiet rural neighbourhood. [2] This was incidentally the type of patient most likely to be able to afford the highest rate of fees for such a stay. A year was the maximum length of stay permitted. Certain conditions were excluded, including those deemed incurable, so no hopeless cases or, in the language of the time, epileptic, paralytic, and uncleanly subjects were all inadmissible. [3]

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Holloway thoroughly researched asylum planning and the treatment of the mentally ill before announcing a competition for the design. He was said to have visited asylums at home and abroad, and consulted numerous architects and the members of the medical profession.

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Initially there was accommodation for 200 patients, divided into four classes, 1st, 2nd, sick and feeble, and excited. All day-rooms, dormitories and single rooms had a south and south-western aspect. Attendants’ rooms were placed between day-rooms and dormitories with a glass window or doors of communication that allowed them to keep the patients under observation.

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Some of the interior decoration, notably the ceiling of the recreation hall, was carried out by the Scottish architect and designer John Moyr Smith. The walls of the dining hall had frescoes after Watteau, variously reported as being executed in the National Art Training School at South Kensington under the direction of Edward Poynter or by James Imrie, though both statements may be correct.  When the sanatorium opened the medical press thought the wall decorations betrayed the influence of ‘Japanese artistic methods’. [4]

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Above is one of  the Watteau-inspired paintings in the dining-hall, painted on canvas rather than frescoed, with a pastoral scene of grazing sheep in the lunette over it.

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The richness of the interior for a mental hospital is perhaps rivalled only by Craighouse in Edinburgh, at least in Britain. Tellingly, Pugin was consulted by Holloway in the early stages of the project. As well as the huge recreation hall and dining-hall, according to one report the sanatorium was intended to have a billiards room, thirteen day rooms, and no less than four libraries for the use of the patients, ‘well stocked with readable books’ (always the best sort). [5]

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The decorative scheme certainly seems to give more than a nod to Pugin, with echoes of the Houses of Parliament, and at the time the sanatorium opened The Builder considered that its only equal in richness was the House of Lords. It fell foul of the next generation of architects – C. R. Ashbee commented that it was ‘very garish and ghastly, but appropriate’. [6]

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The hammer-beam roof of the recreation hall evokes Tudor splendour, modelled on examples such as the hall at the Middle Temple or Hampton Court Palace. Crossland had produced something similar for his Rochdale Town Hall.

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The central grand entrance and staircase were originally intended only to be used on special occasions. Every inch was covered with gilding or bright colour, apart from the parquet wood floor and the marble top of the staircase balustrade.

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In the early 1990s the portraits were the most badly decayed, and there were chunks of painted plaster lying on the floor. Depicting ‘distinguished persons’ the portraits were said to have been the work of Ernest Girardot and others. [7]

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The portrait above may be of Thomas Holloway himself, watching over the patients and staff. His portrait, and that of his wife, graced the interior, along with his coat of arms and family monograms, a constant reminder of the founder.

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References

  1. The Builder, 24 Aug 1872, p.665
  2. BMJ 20 June 1885, pp 1258-9
  3. The Graphic, 2 June 1877, p.521
  4. BMJ 20 June 1885, pp 1258-9: The Star, 18 June 1885, p. 4: British Architect, 26 June 1885, p.311
  5. Frome Times, 27 Nov 1878, p.3
  6. quoted in Anna Sheperd, Institutionalizing the Insane in Nineteenth Century England, 2015, p.24
  7. Illustrated London News, 5 Jan 1884, p.24

Toronto General Hospital

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A recent e-bay purchase has prompted this brief post. I was drawn to the attractive tinted postcard showing this monumental hospital complex, and tickled by the short statement the sender had written on the back:
‘This is all one hospital, grand don’t you think’.

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Former main building of Toronto General Hospital, now home to MaRS Discovery District. Photograph by Chjovans wikimedia commons  CC BY-SA 3.0

Much of the range fronting College Street survives, but was sold off by the hospital to the MaRS charitable trust around 2002. The impression from the postcard of gleaming white buildings turns out to be misleading, as they were built of a warm honey coloured brick with stone dressings. Perhaps the producer of the postcard, Valentine & Sons United Publishing Co. Ltd, was responding to contemporary comments on the choice of material – the brick came in for a good deal of criticism from ‘the man on the street’ while the buildings were going up. Valentine & Sons have corrected the error of the architect by painting the hospital white. [1]

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Toronto General Hospital c.1913. Courtesy of Toronto Public Library

The entire complex was designed by the Toronto architects Darling & Pearson, Frank Darling as executant architect. Darling had designed other hospitals, but was not the best-known hospital architect in Canada so the choice was not without controversy. However, from the time when the foundation stone was laid by Earl Grey, Governor General of Canada, on 11 April 1911 it took just two years to complete the buildings which opened in 1913.  The main range pictured above faced north on College Street with a frontage of around 620 feet, the administration block with its central domed tower was flanked by the medical and surgical sections (to the west and east respectively).

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Goad Fire Insurance plan from 1924, showing the extent of the hospital before expansion in the later 1920s. Reproduced by courtesy of Toronto City Archives

In all it was planned to accommodate nearly 700 patients. Three-storey ward pavilions extended southwards from the main range and had  24- and 16-bed wards on each floor as well as numerous smaller wards for different cases, at the south end were sun balconies or verandas. The separate blocks to the south included the square outpatients department and pathology department on the west side fronting University Avenue, and nurses’ home,  and obstetrics building on the west side.

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Toronto General Hospital medical ward pavilion to south of main range. From the James Salmon Collection, Fonds 1231, item 206. Reproduced by courtesy of City of Toronto Archives

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Toronto General Hospital,  Nurses’ Home. From the James Salmon Collection, Fonds 1231, item 205b. Reproduced by courtesy of City of Toronto Archives

Fonds 200, Series 372, Subseries 41 - Miscellaneous photographs

Toronto General Hospital view from the roof of Elizabeth Street School, across to the main building (right) with the Private Patients’ pavilion to the left. Reproduced courtesy of City of Toronto Archives. Fonds 200, Department of Public Works photographs

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The Private Patients’ Pavilion 1928-30. Courtesy of Toronto Public Library

A large and significant addition to the site was made in the late 1920s in the shape of the new pavilion for private patients. This giant T-plan building providing 321 private rooms, was erected on the south-east corner of the site. It was fitted up in the style of a well-appointed hotel, with soft furnishings unthinkable in a charity or municipal hospital. The aim was to attract patients whose fees would contribute not just to the pavilion but the entire hospital. [2]

References

  1. C. K. Clarke, A history of the Toronto General Hospital, 1913,  p.134
  2.  J.T.H. Connor, Doing Good: The Life of Toronto’s General Hospital, Toronto: University of Toronto Press, 2000, pp.212-3.

Building Bedlam again – taking a leap forward to Monks Orchard

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Entrance gates to Bethlem Hospital, 1896 from The Queen’s London : a Pictorial and Descriptive Record of the Streets, Buildings, Parks and Scenery of the Great Metropolis (Public domain, from Wikimedia Commons)

Bethlem Hospital remained in St George’s Fields, Southwark from 1815 to 1930. In that time numerous additions and alterations were made to the building, but the area around had also developed and changed almost beyond recognition. In the early nineteenth century it was airy and open, with few houses and market gardens in the immediate vicinity. It was on the other side of the river from the densely built-up urban centres of Westminster and the City, and on the outskirts of Southwark itself. But it did not remain a rural or even suburban idyll for long, as industrialisation and the population expansion of the capital brought waves of building activity.

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Greenwood’s map of 1830 showing the area around Bethlem Hospital

Greenwood’s map of London of 1830 captures the moment before this expansion, half a century later and Bethlem hospital had been engulfed. Population density increased as the century wore on, with the usual pattern of housing intended for single families increasingly occupied by two or three.

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Booth’s Poverty Map. Printed Map Descriptive of London Poverty 1898-1899. Sheet 9. Inner Southern District. Reproduced courtesy of LSE Library

Booth’s poverty map of London of the late 1890s showed that although those living in the immediate surroundings of the hospital were classed as fairly comfortable, on the other side of the Lambeth Road were pockets of the lowest class, the vicious and semi-criminal, amongst housing that was almost entirely occupied by the poor, or very poor.

Asylum_for_Criminal_Lunatics,_BroadmoorBroadmoor Asylum for Criminal Lunatics, from The Illustrated London News, 1867

Other changes had occurred during the century or so that Bethlem was at St George’s Fields. Legislation had been introduced to encourage the establishment of lunatic asylums for paupers early in the nineteenth century (the Lunacy Acts of 1808 and 1815), and this reduced the need for Bethlem to cater for the poorer class of patient. The County Asylums Act of 1845 made the establishment of pauper asylums compulsory, and this, coupled with a new regime headed by Dr W. Charles Hood, the first resident medical officer, saw a shift towards caring for a higher class of patient. This was consolidated after the opening in 1863 of Broadmoor for criminal lunatics, removing another class of patient formerly accommodated at Bethlem. Improvements to the accommodation were made, the comforts of home introduced and a convalescent home built at Witley (1866-9, designed by Sydney Smirke). [1]

V0013739 The Hospital of Bethlem [Bedlam], St. George's Fields, Lambe Credit: Wellcome Library, London. Wellcome Images images@wellcome.ac.uk http://wellcomeimages.org The Hospital of Bethlem [Bedlam], St. George's Fields, Lambeth: the men's ward of the infirmary. Wood engraving by F. Vizetelly, 1860. 1860 By: Frederick VizetellyPublished: - Copyrighted work available under Creative Commons Attribution only licence CC BY 4.0 http://creativecommons.org/licenses/by/4.0/

The men’s ward of the infirmary at Bethlem Hospital, 1860 by Frederick Vizetelly, reproduced under Creative Commons Attribution only licence CC BY 4.0 from Wellcome Library, London

So by the early twentieth century the type of patient at Bethlem had changed, and the locality had become more densely urban, but more importantly than either of these in prompting a move to a new site was the old-fashioned design of the building and the constant demands and cost of maintaining the ageing fabric of the asylum.

V0013741 The Hospital of Bethlem [Bedlam], St. George's Fields, Lambe Credit: Wellcome Library, London. Wellcome Images images@wellcome.ac.uk http://wellcomeimages.org The Hospital of Bethlem [Bedlam], St. George's Fields, Lambeth: the female workroom. Wood engraving probably by F. Vizetelly after F. Palmer, 1860. 1860 By: F. Palmerafter: Frederick VizetellyPublished: - Copyrighted work available under Creative Commons Attribution only licence CC BY 4.0 http://creativecommons.org/licenses/by/4.0/

Female workroom, Bethlem Hospital. Wood engraving probably by F. Vizetelly after F. Palmer, 1860. Wellcome Library, London. Reproduced under Creative Commons Attribution only licence CC BY 4.0 

Asylum design had moved on since 1815, and a century later the ideal form for a mental hospital was considered to be the colony plan or villa system, comprising detached buildings set in landscaped grounds. Colony plan asylums were developed in Germany from the late 1870s but had their origins in the Gheel Colony in Belgium. Gheel had traditionally originated in medieval times as a place of pilgrimage to the shrine of St Dymphne which had gained a reputation for curing the insane. Pilgrims were boarded in the village and gradually it developed into a mental colony. In the nineteenth century the Belgian government placed its administration under the control of a Commissioner and Board of Governors. [2]

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Plan of Altscherbitz Asylum, Germany, from Sibbald’s Plans of Modern Asylums for the Insane Poor, 1897

One of the most influential of the later colonies, was the Alt Scherbitz (now Altscherbitz) village asylum near Leipzig, established in 1876 for 960 patients. Its layout was published by John Sibbald, a Commissioner in Lunacy for Scotland, in 1897 in his Plans of Modern Asylums for the Insane Poor. At Altscherbitz, the site was naturally divided in two by the high road between Halle and Leipzig and this separation was used to divide the medical and non-medical sections. Gender informed the first level of classification, with the women’s houses to the west together with the kitchen and laundry, and the men to the east where a brick works provided manual labour.

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The ground plan of Brislington House, near Bristol, a private asylum established by Dr Fox. The patients occupied detached houses arranged as a terrace. The plan dates from 1806. Reproduced from Wikimedia Commons.

This colony plan was welcomed as it seemed to offer a solution to new ideas about how the patients’ environment promoted recovery or cure. It aimed to provide recognizably domestic surroundings, emulating the home environment rather than reminding the patient that they were in an institution. There were earlier precedents for this, but in small private asylums such as Brislington House near Bristol, built in 1806.

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View over to Craighouse, the colony built in 1889-94 as part of the Royal Edinburgh Asylum. Craighouse in the middle distance, ‘Morningside and Craighouse’ by Pascal Blachier, taken in 2007, imaged licensed under CC BY 2.0

The first time the colony plan was attempted on a large scale and at a public institution was at Craighouse, built as an annexe to the Royal Edinburgh Asylum in 1889-94, although this was for paying patients. It was designed by Sydney Mitchell in close collaboration with Thomas Clouston, the asylum’s Medical Superintendent, to give architectural form to his ideas on the cure of mental illness. The buildings revived something of the palatial aspect that had largely disappeared from asylum architecture since Hooke’s Bethlem. Clouston wanted variety, in the colours of the building materials, in the architectural details, of size and of scale. Believing that patients associated phases of their illnesses with their surroundings, he particularly wanted to be able to move convalescent patients to a new environment.

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Rutherford House, designed by Sydney Mitchell in 1899 and completed in 1904 as a detached infirmary or admissions hospital for paupers. The year after it opened, Sydney Mitchell went to Germany to see asylums there. Photographed in 1993, © RCAHMS

Poorer patients got their taste of the colony system a little bit later at the Crichton Royal in Dumfries, where detached houses were added in the grounds during the early 1900s. Sydney Mitchell, was the architect, and he, along with a deputation from the asylum’s Board of Management, had set out in 1897 to visit Altscherbitz and similar asylums at Biesdorp and Lichtenberg near Berlin. Such missions became increasingly common. In 1899 a deputation of the Aberdeen District Lunacy Board made a tour of continental asylums before commissioning a design for their new district asylum on the Altscherbitz model.

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The former Bangour Asylum, photographed in the late 1980s. The church was added later, though always intended as the focal point of the colony.

Further colony plan asylums were built in Scotland at Bangour, which opened in 1906 serving Edinburgh, where a competition was held for the design which specified Altscerhbitz as the model, and Dykebar at Paisley which opened in 1909. Bangour is particularly significant for Bethlem: its architect, Hippolyte J. Blanc, had as one of his assistants working on the asylum plans, John Manuel, who later worked with Charles E. Elcock, architect of the new Bethlem Hospital. [3]

geograph-2315257-by-Nigel-Cox-2Rydinghurst House of 1908 at the former Epileptic Colony in Chalfont St Peter, Buckinghamshire, now the Epilepsy Society, photographed in 2011 © Copyright Nigel Cox and licensed for reuse under this Creative Commons Licence

In England colonies were built around the same time, but not as yet for general mental hospitals. Instead they were deemed appropriate in the first instance for epileptic colonies. In 1884 the National Society for the Employment of Epileptics established a home at Chalfont St Peter in Buckinghamshire. It began with just one villa, a temporary iron structure, to which further villas were gradually added.

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Leybourne Grange Colony, Kent County Council, W. H. Robinson architect, built about 1935 for the so-called mentally deficient. 

But the colony plan was most widely adopted for a new breed of asylum ushered in by the Mental Deficiency Act of 1913. A Royal Commission had been appointed in 1904 to look into the care of the feeble-minded. This at least spoke out against the sterilization of those deemed mentally deficient that was being advocated by the Eugenics Education Society, and it was this Commission which resulted, eventually, in the 1913 Act. Amongst other things, the Act sought to define mental deficiency which was considered to be present from birth and incurable, as opposed to mental illness which was usually contracted later in life and deemed curable. The Act legislated for the provision of accommodation, care and protection of the former group whose removal from undesirable surroundings was thought necessary ‘in their own interests and that of society’. The Board of Control, which replaced the Commissioners in Lunacy in 1914, recommended the colony system for these new institutions, as it allowed ‘better classification and training’ and ensured that the inmates were happier and more contented than in institutions of the barracks type.

Bethlem aerial perspective

Aerial perspective of Bethlem Royal Hospital showing proposed layout of the buildings, from commemorative booklet produced for the laying of the foundation stone.

It was a combination of these influences which lead to the adoption of a colony plan for the new Bethlem hospital at Monks Orchard. It was the first new mental hospital designed in England since the war. Elcock & Sutcliffe were appointed in February 1926 to work alongside the hospital surveyor, John Cheston. Charles Ernest Elcock was the key figure behind the design, which he hoped would ‘make a leap forward’. However, his plans still had to meet the approval of the Board of Control. While the Board was in favour of colonies, it disapproved of Modernism, thought flat roofs should be shunned, and was most comfortable with the blandest of Neo-Georgian styles.

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Administration Block, Bethlem Royal Hospital, photographed in 2008

Unsurprisingly relations were often frosty between Elcock and the Board’s architect John Kirkland, and indeed Sir Frederick Willis, Chairman of the Board from 1921 to 1928. Willis criticized the ‘generous scale’ of the rooms, which he suggested were due to Elcock trying to balance the buildings, while Kirkland queried the necessity for Turkish Baths, and took a great deal of convincing over the flat roofs, which were only used on the peripheral buildings on the site. After much wrangling, the amended designs were approved and detailed drawings submitted in December 1928. [4]

Elcock Bethlem chapel from SW

Bethlem Hospital chapel, photographed in about 2008 (© H. Richardson)

It may have been the pressure of work involved in the Bethlem job that prompted Elcock to seek an assistant in 1928. He appointed Ralph Maynard Smith, a young man in his mid-twenties, who was as much an artist and a poet as an architect. Maynard Smith had studied at the Architectural Association, and spent a brief time working with the architect Michael Waterhouse immediately before joining Elcock & Sutcliffe. There undoubtedly were other assistants in Elcock’s office, making it difficult to know who did what in the design and planning process. A building at Bethlem where Smith’s influence may be felt is the chapel. It is a beguiling building, quite unlike the many hum-drum Gothic asylum chapels of earlier years. Its design was obviously considered a success as it was elaborated upon a few years later at Runwell Hospital in Essex, also by Elcock & Sutcliffe.

Bethlem chapel interior

Interior of Bethlem Hospital chapel, photographed around 2008 (© H. Richardson). It is all but identical to the interior of the chapel built for Runwell Hospital in Essex (below), although the exteriors were different, Runwell also had a tower – planned for the chapel at Bethlem but later omitted.

Interior of Runwell hospital chapel, probably photographed soon after the building was completed, from a collection of negatives at the hospital leant to the author.

Stylistically Bethlem presents something of a mix, from the conservative administration block, with its hipped roof and Neo-Georgian simplicity to the starkly modern boiler house and flat-roofed patients’ accommodation blocks and treatment unit. Elcock laid an emphasis on the setting to give attractiveness to the buildings with ‘pleasing roads, avenues, flower borders, etc’. [5]

Bethlem quiet unit perspective

Architectural perspective sketch of the quiet patients’ unit, unlike the Neo-Georgian administraton block, most of the patients’ villas had flat roofs, and if not strictly modernist, in this sketch, taken from a brochure produced by the hospital, there seems to be an echo of contemporary Dutch or German architecture

Elcock set new standards in the scale and type of accommodation he provided which included laboratories, hydrotherapy facilities, a lecture room for students, and a separate treatment and research block. The sexes were no longer strictly segregated either: male and female patients shared buildings, from the more severe ‘excited’ patients to convalescents. Elcock researched his subject thoroughly, touring the country to visit the best new buildings added to older hospitals, and consulting medical staff.

Bethlem treatment block perspective

Architectural perspective of the Treatment and Research Unit, Bethlem Royal Hospital brochure.

In the end the design was compromised both by the restrictions imposed by the Board of Control and the necessary cost-cutting in the face inflation in the years after the General Strike. But if it wasn’t quite the magnificent hospital originally proposed, it was certainly well-equipped and incorporated many innovative features. There were four main villas for patients, two for quiet cases, one for ‘excited’ patients, the fourth for convalescents. Nearly all the patients were accommodated in single rooms, in line with private general hospitals and in contrast to tendency towards dormitories in municipal mental hospitals. In addition to the patients villas there were the usual service buildings – kitchens, boiler house, stores etc, and the innovative Treatment and Research unit, which provided hydrotherapy, psychotherapy, dental and electrical treatment, pharmacy, and operating theatre. [6]

Today the core buildings are little altered, but many of the outlying buildings have had many alterations and newer buildings have been added to the site to meet the changing needs of mental health care. In recognition of the hospital’s historic importance there is a museum on the site, the Museum of the Mind, which opened in 2015.

References

  1. Survey of London, vol.25 St George the Martyr, Southwark and St Mary Newton, Ida Darlington ed. 1955, p.78 (online version at British History Online): Jonathan Andrews, Asa Briggs, Roy Porter, Penny Tucker and Keir Waddington, The History of Bethlem, Routledge, London and New York, 1997, pp.503ff
  2. H. Richardson ‘A Continental Solution to the Planning of Lunatic Asylums 1900-1940’ in J. Frew and D. Jones (eds) Scotland and Europe, Architecture and Design 1850-1940, 1991
  3. H. Richardson ‘Charles Ernest Elcock’ in Essays in Scots and English Architectural History, 2009, p.122
  4. Bethlem Royal Hospital Archives, Special Commitee Minutes, 1928 pp. 194, 196-7, 291
  5. Bethlem Royal Hospital Archives, Special Commitee Minutes, 1926-7, p.34
  6. Jonathan Andrews et al, History of Bethlem, p.566

Building Bedlam – Bethlem Royal Hospital’s early incarnations

From City fringe to St George’s Fields

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The dome of the Imperial War Museum, formerly Bethlem Hospital, photographed in January 2014

Visitors to the Imperial War Museum south London may easily be unaware that they are walking through the remains of a former mental hospital, in fact the former mental hospital that gave us the word Bedlam. Only the central block remains of this, the third home of that exceptional, long-lived institution that is now Royal Bethlem Hospital in the London borough of Bromley. [1]

The origins of Bethlem hospital were monastic, evolving from the priory of St Mary of Bethlehem. The copperplate map of London of the 1550s shows its original site at Bishopsgate near the large open ground of Moorfields.

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The Moorfields section of the Copperplate map of London, 1559, Museum of London. Public Domain

By the early 1400s it was already specializing in the care of the insane. In time it came to be owned and governed by the City, which also acquired Christ’s Hospital ‘erected for the vertuous bringing up of the myserable youth’, St Thomas’s hospital ‘for the relevynge of the neadye and deseased’, and Bridewell for ‘thenfocinge of the lewde and naughtie sorte to labor and worke’. Bridewell and Bethlem were managed by a joint court of governors. [2]

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Plan of Bethlem hospital reproduced in Daniel Hack Tuke, Chapters in the History of the Insane in the British Isles (London, 1882) Project Gutenberg Ebook Edition

By the 1670s Bethlem had very much outgrown its site, the governors declaring their hospital to be ‘very old weake and ruinous’ and too small for the ‘great number of lunatics as are therein at present’. [3] The new building erected in 1674-6 just round the corner from the original hospital could not have contrasted more strongly with the old. It was designed by Robert Hooke with sufficient accommodation for 120 patients.

V0013179 The Hospital of Bethlem [Bedlam] at Moorfields, London: seenThe Hospital of Bethlem (Bedlam) at Moorfields, London: seen from the north, with people walking in the foreground. Engraving by H. Fletcher, c. 1750  Wellcome Library, London

The engraving above shows the north elevation, viewed across the green expanse of Moorfields, and peeking above the roof ridge a regiment of City church towers and spires (and what appears to be Wren’s monument to the Fire on the left). Here is a hospital in the guise of a palace – its grandeur and French Renaissance style prompted the suggestion that it had been modelled on the Tuileries, and the apocryphal story that Louise XIV was so offended by the similarity that he ordered ‘a plan of St James’s Palace to be taken for offices of a very inferior nature’. [4]

V0013176 The Hospital of Bethlem [Bedlam] at Moorfields, London: seen

The Hospital of Bethlem (Bedlam) at Moorfields, London, showing the additional wings at either end of the building. Coloured engraving by T. Bowles after J. Maurer. Wellcome Library, London. CC BY 4.0

A grand architectural statement was the wish of the governors. It was a quite deliberate piece of self-advertisement, intended to to attract visitors and funds. The policy of opening their doors to visitors to view the inmates was already well established at the old site. At the time the intention was to raise awareness of the plight of the insane, to awaken the pity of the spectator, and prompt charitable and generous donations towards their care and treatment.

Hooke’s selection as architect was a logical one. He had been City Surveyor since 1666 and was at that time supervising the rebuilding Bridewell, Bethlem’s sister institution, after the fire. There were no other hospitals for the insane in Britain at the time, or indeed many hospitals of any kind. The very term ‘hospital’ had not yet become so exclusively the property of a medical establishment and was still being used with its broader meaning of a place of hospitality – and ‘infirmary’ might more usually be expected to be applied to a place for the sick. The plan for Bethlem called for a building that could house a large number of individuals, who might at times be disturbed or violent. This introduced the need for containment or confinement. To modern eyes the plan seems most closely allied to that of prisons, and in particular the model prisons of the nineteenth century.

L0015088 Statues of "raving" and "melancholy" madness, each reclining Credit: Wellcome Library, London. Wellcome Images images@wellcome.ac.uk http://wellcomeimages.org Statues of "raving" and "melancholy" madness, each reclining on one half of a broken segmental pediment, formerly crowning the gates at Bethlem [Bedlam] Hospital. Engraving by C. Warren, 1808, after C. Cibber, 1680. Engraving 1808 By: Caius Gabriel Cibberafter: Charles Turner WarrenPublished: 10 December 1808 Copyrighted work available under Creative Commons Attribution only licence CC BY 4.0 http://creativecommons.org/licenses/by/4.0/

These statues, thought to depict  raving and melancholy madness crowned the entrance gates, they have been preserved and can be seen at the Museum of the Mind at the present Bethlem Royal Hospital.  Engraving by C. Warren, 1808, after C. Cibber, 1680. Wellcome Library, London. Reproduced under Creative Commons Attribution only licence CC BY 4.0 

Although Hooke presented two ground plots and a model of his intended asylum to the governors before building work began, no plan has ever come to light. However, there are sufficient descriptions of the interior for key elements to be deduced. The central pavilion, with the main entrance, contained a hall, ornamented by tablets bearing the names of the hospital’s benefactors linked together by carved cherubs’ heads. Off the hall were the steward’s office and a room for the chief physician and apothecary where new admissions were examined and from which patients were discharged. To the rear of the hall the principal staircase rose to the committee room, probably the grandest internal space decorated with an ornamental plaster ceiling. This central block also gave access to the patients’ accommodation which was contained within the wings on either side. These were of two storeys over a raised basement, with the inmates on the raised ground and first floors where the plan comprised a row of single cells, lit by small high windows on the south side of the building, off a long gallery, lit by larger windows. In the basement were the kitchen, laundry and stores.

The plan by Hooke is remarkable. It seems to be the first time that such an arrangement was devised, there being no obvious precedent in this country. This was also the first charitable building to be erected in London since the Reformation. In fact the first entirely new charitable foundation since the Savoy Hospital of 1505-17. It was one of the first public buildings completed after the Great Fire, pipped at the post by the rebuilt Royal Exchange designed by Edward Jarman and Wren’s Custom House, both of which were completed in 1671. [5]

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Anonymous etching of the Royal Exchange from the British Museum

Although there may not have been any lunatic asylums in Britain to provide a model, there were other buildings where large numbers were housed under one roof. Schools, almshouses, prisons, and even royal palaces. Including palaces in this selection is not a mere frivolous reference to the Tuileries. The galleries at Bethlem may well have their origins in the long gallery and cloister walks of the great Tudor houses and palaces, where they were intended to serve the same function of a place for exercise, particularly in bad weather. Bridewell was built as a palace, to which a long gallery was added in the early sixteenth century. It was only turned into a workhouse some decades later.

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The long gallery at Haddon Hall, Derbyshire, photographed in 2011 by Michael Beckwith. Galleries in Tudor houses provided exercise in wet weather, and are a possible model for the galleries in asylums. Image licensed under Creative Commons CC-BY 2.0

The galleries at Bethlem also served as corridors of communication, and were open to visitors. Hogarth’s final scene of the Rake’s Progress is set in Bethlem and shows one of the new men’s wards added at the east end of the asylum in 1725. This gives a glimpse of the cell/gallery arrangement, here the gallery is occupied by several patients, apart form Hogarth’s hero Tom Rakewell, and just two female visitors clinging to each other and keeping close to the wall in the background. It should be noted, however, that this wing, which was intended for incurable patients, had cells on both sides of the gallery. One of the key features of Hooke’s layout was therefore lost, that of creating a ‘permeable’ structure, with the cell doors opposite the gallery windows allowing light and air to pierce the building.

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William Hogarth’s Rake’s Progress, Wellcome Library, London An insane man (Tom Rakewell) sits on the floor manically grasping at his head, his lover (Sarah Young) cries at the spectacle whilst two attendants attach chains to his legs; they are surrounded by other lunatics at Bethlem hospital, London. Engraving by W. Hogarth, 1763, after earlier engraving by himself, 1735.  Copyrighted work available under Creative Commons Attribution only licence CC BY 4.0

It may seem strange that the galleries were placed on the north rather than the sunnier and warmer south side of the building. This was no error, cool temperatures and even light were considered beneficial to a disturbed mind, having a ‘sedative power’. Some went so far as to argue that the insane were in fact insensible to cold, though at Bethlem, at least, there is evidence that measures were introduced to keep the patients warm.

L0011828 The Hospital of Bethlem [Bedlam] at Moorfields, London: seen

The second of J. T. Smith’s 1814 views of Bethlem showing its humble back elevation. Wellcome Library, London. Reproduced under Creative Commons Attribution only licence CC BY 4.0 

Two views published in 1814 show the north side of the hospital. They demonstrate how severe this elevation was in comparison to the front, with these small, high windows that lit the cells, as well as its proximity to the boundary and the road.

L0015087 The Hospital of Bethlem [Bedlam] at Moorfields, London: seenBethlem Hospital from the south, showing the small high windows that lit the inmates’ cells. This view also shows part of London Wall in the foreground, and a muck-raker scraping at the cobblestones. Etching by J. T. Smith, 1814, after himself, June 1812. Wellcome Library, London. Reproduced under Creative Commons Attribution only licence CC BY 4.0 

Christine Stevenson has pointed out the similarities between Hooke’s design for Bethlem with that of his nearby Aske’s Hospital an almshouse for the haberdashers’ Company designed in 1692. [6]

V0013682 Aske's Hospital, Shoreditch, London: a bird's-eye view of thAske’s Hospital, Shoreditch, London: a bird’s-eye view of the facade. Engraving, 1720. Wellcome Library, London. Reproduced under Creative Commons Attribution only licence CC BY 4.0

Like Bethlem the building is single pile, which, as Roger North noted later, was particularly suitable for a college or hospital, to be divided into cells, and chambers independent of each other. In asylum architecture this pattern of patient accommodation in single cells off a gallery remained set for almost two centuries, although it was some time before anything on a comparable scale was built in Britain. In fact, not until St Luke’s Hospital was built in 1750. And so, when Bethlem took the decision to move to a new location, the plan of the new hospital pretty much followed that of the old.

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The Moorfields building around 1811, depicted in a state of decay. Etching after a drawing by G. Arnald for the Beauties of England and Wales. From the British Museum

A competition had been held to design the new building in 1810, judged by James Lewis, the hospital’s surveyor, George Dance the younger and S P Cockerell. Although Lewis’s pupil, William Lochner was awarded the first prize of £300, it was Lewis who was given the task of drawing up the final plans and elevations based on the three winning entries. (the second pirze was awarded to J. A. and G. S. Repton and the third to John Dotchen)

V0013727 The Hospital of Bethlem [Bedlam], St. George's Fields, Lambe

The new Bethlem Hospital in Southwark, engraving from Ackerman’s Repository 1817. Wellcome Library, London. Reproduced under Creative Commons Attribution only licence CC BY 4.0  

The opening of the new asylum coincided with the publication of a Select Committee Report on Madhouses in England in which it was immediately censured. There was a long list of complaints from its excessive expense to the gloominess of some of the rooms, particularly those at the front overshadowed by the ‘immense portico’.

V0013728 The Hospital of Bethlem [Bedlam], St. George's Fields, Lambe Credit: Wellcome Library, London. Wellcome Images images@wellcome.ac.uk http://wellcomeimages.org The Hospital of Bethlem [Bedlam], St. George's Fields, Lambeth: elevation and plan, with a scale and a key. Engraving by J. Le Keux, 1823, after P. Hardwick. 1823 By: Philip Hardwickafter: John Le Keux and James LewisPublished: 1 December 1823 Copyrighted work available under Creative Commons Attribution only licence CC BY 4.0 http://creativecommons.org/licenses/by/4.0/

Bethlem Hospital elevation and plan, 1823. Wellcome Library, London. Reproduced under Creative Commons Attribution only licence CC BY 4.0 

The classification of the patients was deemed inadequate due to an absence of separate staircases to each of the galleries. There were complaints about the lack of glass in the patients’ sleeping rooms (a complaint no doubt shared by the patients, whose misery was increased by the fact that the system of warming the asylum by steam was installed only in the basement). This absence of glazing was no oversight, but a deliberate omission to ensure the ventilation of the cells and, as the governors claimed, obviate ‘the disagreeable effluvias peculiar to all madhouses’. A year later, however, the windows were glazed. The Report also disapproved of the way in which the front windows were closed up, preventing the patients from looking out of them. [7]

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Extract from the 25-inch OS map surveyed in 1872. Reproduced by permission of the National Library of Scotland

The new Bethlem was neither so very different nor so very much worse than most other asylums built both before and after. It had a central administration block from which sprouted the patients’ wings, most of which followed the ‘cells on one side gallery on the other’ arrangement. Also repeating the earlier arrangement of having the galleries on the north side of the building. At either end of the building, again repeating the arrangement of the old building after the early eighteenth-century additions, there were cells on both sides of a central corridor. A chapel was provided under the shallow dome; sniffily referred to as a ‘species of pumpkin-shaped cupola’ by the Government in 1812 when it was proposed to put a semaphore on top, as an early warning system in the event of an attack from France. The dome was rebuilt in 1844-6 as part of general additions and alterations carried out to designs by Sydney Smirke.

V0013730 The Hospital of Bethlem [Bedlam], St. George's Fields, Lambe

Bethlem Hospital with Smirke’s new dome. Wellcome Library, London. Reproduced under Creative Commons Attribution only licence CC BY 4.0 

When Bethlem moved for the fourth time to Monks Orchard the freehold of the old site was bought by Viscount Rothermere in 1930 and vested in the LCC for the formation of a public open space named in memory of his mother, Gerladine Mary Harmsworth. Much of the hospital was demolished but the remainder was leased to the Commissioners of Works to house the Imperial War Museum. It opened to the public in 1936, was closed during the Second World War during which time it received bomb damage in 1940, 1941 and 1944. An account of its history was published in volume 25 of the Survey of London, published in 1955 less than ten years after the museum had reopened. The volume was edited by Ida Darlington, and it is perhaps her words which end the account thus: ‘It is perhaps appropriate that a building occupied for so many years by men and women of unsound mind should now be used to house exhibits of that major insanity of our own time, war.’ [8]

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Imperial War Museum, photographed January 2014

References

  1. The main source used here is the definitive history by Jonathan Andrews, Asa Briggs, Roy Porter, Penny Tucker and Keir Waddington, The History of Bethlem, Routledge, London and New York, 1997
  2. The History of Bethlem, p.76, quote from Christ’s Hospital minute books
  3. ibid, p.248 quote from Bethlem Court of Governors Minutes
  4. Thomas Bowen, An Historical Account of the Rise, Progress and Present State of Behtlem Hospital, London, 1783 p. 5n, see also Christine Stevenson’s article (below) p.256
  5. Christine Stevenson ‘Robert Hooke’s Bethlem’ in Journal of the Society of Architectural Historians, vol.55, no.3 (1996), p.257
  6. Christine Stevenson ‘Robert Hooke’s Bethlem’ in Journal of the Society of Architectural Historians, vol.55 no.3 (1996), pp.254-275
  7. Survey of London, vol.25 St George the Martyr, Southwark and St Mary Newton, Ida Darlington ed. 1955, pp 78 (online version at British History Online)
  8. ibid, p.80

Marvellous Maps – updating the Scottish Hospitals Survey

Probably the best source that I have been using for updating the Scottish Hospitals Survey is the National Library of Scotland’s map images. Maps are always key to charting the history and development of buildings, settlements and indeed the landscape. And the best thing of all is that the NLS is freely available to all. It is a wonderful resource.

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Athole & Breadalbane Union Poorhouse (see Perth & Kinross). Extract from the 1st Edition OS Map, surveyed in 1863. Reproduced by permission of the National Library of Scotland

Many of the maps, and for me particularly the first edition Ordinance Survey maps and large scale town plans, are things of beauty as well as mines of information. Being so used to the grey tones of most nineteenth-century OS maps, the vibrant pinks and reds of the buildings, buff or ochre paths and roads, and the blues of river and sea, are also a joy.

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Kelso dispensary, Roxburgh Street, founded in 1777 (see Borders).  Extract from the 1st edition OS map, surveyed in 1858. Reproduced by permission of the National Library of Scotland

For anyone interested in public buildings these maps are especially useful as they give ground plans, and often room uses as well.

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Barony or Barnhill Poorhouse was completed in 1853, so this map was produced just a few years after it opened (see Glasgow). Extract from 1857 Town Plan of Glasgow, reproduced by permission of the National Library of Scotland

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Detail of the OS large-scale Town Plans, showing the central part of Barony Poorhouse.

I have never been sure about how to interpret the mapping of gardens, some seem too generic to be completely accurate representations, although the general layouts, or features such as embankments, paths, ditches etc. are more likely to be as existing. If anyone knows more, please do enlighten me. Looking at the detail of Barony Poorhouse above, the arrangement in the airing yard with diagonal paths leading up to a viewing area with seats seems too unusual not to be an accurate depiction of an actual feature.

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The former Crichton Royal Asylum (see Dumfries & Galloway). Extract from the 1st edition OS map, surveyed in 1856. Reproduced by permission of the National Library of Scotland

The Crichton Royal  – what at first site might look like elaborately laid out formal gardens around the cruciform building are in fact the earthworks of the different airing grounds.

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Detail of the former Crichton Royal Asylum. Extract from the 1st edition OS map, surveyed in 1856. Reproduced by permission of the National Library of Scotland

Zooming in it becomes clearer. The airing grounds were walled enclosures, to prevent escape, but in order to allow the patients to see over the confining walls the ground within was built up to form a flat-topped mound. Bowling greens are shown close by the Crichton Royal and the Royal Edinburgh Asylum (below).

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Comparing different editions of the maps show how an institution was added to and changed. Between 1852 (above) and 1876 (below) wings were added to the main asylum building to the west, extending into the walled airing grounds.

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The grounds of the East Division of the Royal Edinburgh Asylum not only have a bowling green, but what appears to be an orchard with paths crossing it, a formal flower bed (on the west side), shelter belts of mixed trees, and, on the east side, a cruciform feature which, on zooming in, is marked as a bower.

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Detail of the 1852 map, showing the Bower in the asylum grounds, with a cage marked at the centre where the paths cross. 

The cage presumably was an aviary. Caged birds were recommended for lunatic asylum patients in the mid-nineteenth century, along with potted plants and pictures, to provide objects of interest and an air of domesticity.

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Perth poorhouse (see Perth & Kinross), later Rosslyn House, council offices. From the OS large-scale town plans, 1860. Reproduced by permission of the National Library of Scotland

Perth poorhouse can be seen in splendid isolation, the wrong side of the railway tracks and very much on the outskirts of the city. The map was produced in 1860, the year after the poorhouse was built.

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Perth Poorhouse, detail. OS large-scale town plans, 1860. Reproduced by permission of the National Library of Scotland

The National Library of Scotland site allows you to zoom right in. The plan of the poorhouse above shows the room uses, positions of doors, windows and stairs. It shows the divisions within the poorhouse – women on one side and men on the other – and the separation of the aged and children from the able-bodied adults. You can also see that the managers had grander rooms, placed either side of the main entrance, which had bay windows (the Board Room and the Governor’s Office).

Finally, a note for anyone not of a Scottish persuasion. The NLS has maps of Northern Ireland, Wales, and, dare I say it, even England.

King Edward VII Estate: Midhurst Sanatorium

Following on from the post featuring Midhurst Sanatorium chapel, I wanted to look at the main Sanatorium building. It is one of the most important former sanatoria in England and one of the most attractive. Latterly the King Edward VII Hospital, it closed in 2006 and remained empty for some years after. The sanatorium building and chapel were listed Grade II* and the gardens registered, conferring a degree of protection for these important buildings and imposing restrictions on the re-use and redevelopment of the site. Nevertheless, by 2012 the condition of the buildings had deteriorated and the chapel was placed on the Heritage at Risk register. In 2015 work began on the redevelopment of the site, turning it into a luxury estate, by the developers City and Country.

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A rather scratchy slide from June 1992 of the King Edward VII Hospital, as it then was.

As the name of the hospital implies, the origins of this sanatorium were closely linked with Edward VII. Having decided to fund the erection of a sanatorium in England for patients suffering from tuberculosis, in 1901, the year that he acceded to the throne, the king appointed an advisory committee comprising some of the leading medical men of the day to ensure that it should be of the most up-to-date design. There were six men on the committee: Sir William Broadbent Bt KCVO; Sir Richard Douglas Powell Bt KCVO; Sir Francis Laking KCVO; Sir Felix Semon; Sir Hermann Weber; and Dr C. Theodore Williams. In February 1902 the committee announced in the medical press of Europe and America that a competition was to be held for an essay and plans for the erection of the sanatorium. There was no restriction as to the nationality of the entrants, and they might be either from medical men or jointly from a medic and an architect (but not just from architects). The sanatorium was to provide for 100 patients, equally divided between the sexes, of which 88 beds were to be for the ‘necessitous classes’ the remaining 12 set aside for the well-to-do. All the accommodation was to be comfortable, with a single room for each patient, though with ‘superior arrangements’ being made for the wealthy patients. The building was to have the latest sanitary fittings and have facilities for scientific research. Entries were to be anonymous, but have a motto to distinguish them. The king was to provide £800 in prize money, awarding £500 for the best entry, then £200 and £100 for second and third place.

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Arthur Latham deposited this bound edition of his prize-winning entry in the library of the Royal College of Physicians. It has been digitised by the internet archive

There were 180 entries, and the winners were announced in August 1902. The top prize went to Dr Arthur Latham of London and William West, architect, also from London (motto – ‘Give him air, he’ll straight be well’). Second prize went to Dr F. J. Wethered with Messrs Law and Allen, architects, also all from London (motto – ‘If preventable, why not prevented?’), and third prize to Dr E. C. Morland with Mr G. Morland, architect, both of Croydon (motto – ‘Vis Medicatrix naturae’, roughly ‘the healing power of nature’, a motto associated with the nature cure movement).  On the architectural side, these were not well-known names. There were four honourable mentions, amongst whom were some better-known architects: Dr P. S. Hichens of Northampton submitted his essay in association with the architect Robert Weir Schultz, and Dr Jane Walker with Smith & Brewer. The only non-English entrant that featured in this list was the celebrated Dr Karl Turban of Davos whose architect was J. Gros. The final honourable mention went to Dr J. P. Wills of Bexhill, with Mr Wills, architect, London.

In the mean time the site had been chosen, at Midhurst in Sussex (now West Sussex). But the commission to design the new sanatorium did not go to Latham’s little-known architect William West, but to H. Percy Adams, presumably considered a safer pair of hands as he was already a well-experienced hospital architect. Since 1898 Charles Holden had been in Adams’ practice, and the final design for Midhurst Sanatorium bears the hallmarks of Holden’s characteristic style.

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Aerial perspective of the ‘King’s Sanatorium’ as designed by H. Percy Adams and Charles Holden in 1902, published in Academy Architecture, 1903

To assist them in drawing up the design Adams and Holden had the benefit of Latham and West’s essay and plans, but they also visited sanatoria in Germany and Switzerland – Edward VII had been particularly impressed by the sanatorium at Falkenstein in Germany. The aerial perspective above shows the arrangement of the building. The patients were to occupy the shallow-V-shaped range to the right, which faced south, behind which was a U-plan administration block. These two ranges were linked by a central corridor. The admin block contained suites of offices, the committee room and service rooms, as well as an operating theatre, X-ray and casualty rooms, laboratories, a medical library, and the patients’ dining hall.

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Plan from Latham and West’s essay. Their preferred scheme was to provide separate blocks for the wealthy and necessitous patients, this plan being the block for the more wealthy patients. 

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This was Latham & West’s alternative plan, which housed the wealthy and necessitous in one building. Both plans have elements in common with the designs drawn up by Adams & Holden.

Edward VII retained his interest in the progress of the sanatorium, laying the foundation stone on 3 November 1903. Delays in construction, in part over the water supply, caused the king some vexation, but it was finally opened on 13 June 1906.

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The main front of the sanatorium, photographed in June 1992

The patients’ wing to the south was symmetrically arranged with a taller central block of three storeys. The ground floor breaks forward, its flat roof providing a terrace for the rooms on the first floor. Within were two spacious recreation rooms on the ground floor, one either side of the central corridor which marked the division of the sexes (males on the west, females on the east side). There were also hydro-therapy rooms flanking the garden entrance. Each patient had a separate room, as the original competition rules had required.

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Photograph of the sanatorium taken c.1950. (Image kindly supplied by W. Parker.)

The rooms faced south and opened on to a terrace or balcony. Bathrooms and WCs were provided in sanitary towers to the north of the patients’ corridor that ran along the back of their rooms and at the far ends of the building. The wealthier or higher class patients had slightly larger rooms with private balconies situated in the central range, while the lower-class patients occupied the wings.

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Detail of the central gabled bay, June 1992

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One of the stone alcoves on the south front, which provided a secluded shelter

The furnishings and fittings combined hygienic and aesthetic requirements. Washable wallpaper was used in the patients’ bedrooms, an early use of this new product in England, and the floors were of wood blocks. Moulmein teak was used for the staircases which was less susceptible to fire than other, coarser grained wood. The dining-hall and kitchen walls were lined with Doulton’s Carrara tiles.

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Postcard with aerial view of the sanatorium. (Image kindly supplied by W. Parker.)

A formal garden was designed for the area to the south of the main building by the horticulturalist Gertrude Jekyll. Her layout, of gardens built on terraces on several levels, with buttressed stone walls separating one level from another, follows closely the scheme indicated by Adams in his perspective drawing. Lawns and flower beds were laid out on the terraces, and various shrubs, flowers and aromatic herbs were planted, many supplied personally by Jekyll. She also designed small gardens to fill the spaces between the administration block and the patients’ wings, again following closely Adams’ original designs. The work was carried out under Jekyll’s direction by two gardeners aided by some of the patients.

Sources
A. Latham The Prize Essay on the erection of a sanatorium for tuberculosis… 1903
Academy Architecture, 1903, ii, pp.116-9
F. Allibone, typescript notes to collection of drawings by Adams, Holden & Pearson in RIBA Drawings Collection
The Builder, 23 May 1903, pp.531-2; 22 April 1905, pp.440; 23 June 1906, p.707
Building News, 27 May 1904, p.761
Kelly’s Directory of Sussex 1934, 1934, p.243
S. E. Large, King Edward VII Hospital Midhurst 1901-1986, 1986
I. Nairn & N. Pevsner, The Buildings of England: Sussex, 1965

see also urbexer’s exploration of the site from 2012 on 28dayslater

Oldmill Military Hospital (now Woodend Hospital) Aberdeen

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Postcard of Woodend Hospital dating from the First World War when it had been taken over as a military hospital. The card shows a concert being given in front of the main entrance block.

Woodend Hospital in Aberdeen was constructed as a Poor Law Institution, designed by the local firm of Brown & Watt, it opened on 15 May 1907 and was one of the last poorhouses to be built in Scotland. During the First World War the institution was taken over as a Military Hospital (from 24th May 1915 to 1st June 1919). The postcard above shows a concert underway, there is no message written on the back to give a clue as to when exactly the concert took place. It may have been the one described in the Aberdeen Evening Express in September 1915 when the band and pipers of the Scots Guards visited Aberdeen. From 11am to 12 noon they entertained the wounded soldiers and a small party of ladies and gentlemen, there being about 500 persons present. The band arrived at the hospital in motor buses supplied by the Suburban Tramways Company, and on arrival set up near the front entrance in the quadrangle. Band and pipers played alternately, and there was a cornet solo of ‘The Rosary’ and from ‘Il Trovatore’  played from the veranda.

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Detail of the postcard, bottom right, showing some of the audience of the concert

One member of the audience was apparently more interested in the photographer than the concert. The local Aberdeen newspapers published during the First World War carry many mentions of Oldmill, most concern the numbers of wounded arriving by train in the city and thence out to the hospital. There were also appeals for wheeled chairs and books, and numerous accounts of entertainments and concerts laid on for the wounded men.

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A detail of the centre of the postcard showing the main entrance to Oldmill Hospital and the band performing in front

Zooming in on the centre of the postcard shows the band arranged in front of the main entrance, with patients and nurses looking on from open windows and the balconies. I don’t know whether the uniforms here are plausible as Scots Guards, they are perhaps too indistinct to be able to tell. The Gordon Highlanders also gave an open air concert, in September 1916.

Most of the concerts took place in the evening inside the large dining hall, some were small affairs with local folks performing a medley of songs, some were given by theatre companies. There were lectures (two on mountaineering), and in October 1915 a ‘talking machine entertainment’ comprising selections given on the Edison phonograph ‘greatly appreciated by all’. The Aberdeen Sailors’ Mission Choir gave the very first concert at Oldmill in July 1915, only weeks after the first patients arrived on 25 June. An ambulance train had arrived at Aberdeen Joint Station shortly after 4am with 100 wounded soldiers from the battlefields of France and Flanders, 83 of whom were transferred to Oldmill.

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Postcard of Oldmill Military Hospital, Aberdeen produced during the First World War

This is another postcard produced during the war – copies of it often surface on eBay. The institution was still relatively new when war was declared, and it was with reluctance that the parish council relinquished it to the military, but when the need for more hospital accommodation for the wounded became urgent the council yielded. Many of the poorhouse inmates were evacuated to Rosemount and Westfield schools, which had also been commandeered to take the war wounded, others were boarded out.

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Detail of the postcard, showing the bridge part way along the long entrance drive

The notice on the right gives the weight limit that the bridge could withstand at just over 3 tons. The map below shows the hospital complex in the 1920s, after it had been returned to the parochial authorities. The bridge pictured above crossed a roadway that provided access to two detached buildings in the grounds. I think these may have been the nurses’ home and the Governor’s house, but more research is needed to establish whether that is so or not. Although I am fairly confident that the left-hand building was the nurses’ home, a later map marks a tennis court next to it.

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Extract from the 2nd edition OS map, revised in 1924. Reproduced by permission of the National Library of Scotland

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Woodend Hospital photographed in 2014. © Copyright Bill Harrison and licensed for reuse under this Creative Commons Licence

The hospital continues in use by NHS Grampian though now its main entrance is on the North side from Eday Road. It is a handsome building, certainly a fine example of its type despite the parsimony of the parochial board. When the plans for the poorhouse were reported by the Aberdeen Daily Journal readers were assured that,

‘As the general view of the poorhouse to most people will be from the Skene Road, a few hundred yards away, it is not intended that any expense should be put upon fine masonry details, and the effect of a satisfactory composition will, therefore, be obtained by means of grouping of the various buildings and arranging them in such a fashion as to give a suitable yet dignified appearance to the whole.’ [Aberdeen Daily Journal, 22 Nov 1901, p.5]

Sources: Aberdeen Evening Express, 17 May 1915, p.5: Aberdeen Journal, 25 May 1915, p.4, 26 May 1915, p.4, 26 June 1915, p.2, 16 July 1915 p.6: Aberdeen Evening Express, 13 Sept 1915, 11 Oct 1915: Aberdeen Weekly Journal, 22 Sept 1916: site visited as part of the Scottish Hospitals Survey 1988-90