The Hospitals Investigator 5

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

Hereford Workhouse

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

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

Workhouse Visitations

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

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

Cross-Ventilation

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

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

Bristowe & Holmes

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

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

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

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

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

More Baths

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

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

Suppliers of “Temporary” Hospitals

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

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

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

Atkinson Morley Hospital, now Wimbledon Hill Park

AMH print c1870

We visited the former Atkinson Morley Hospital in 1992 as part of the RCHME Hospitals Project. It was then still functioning as an acute hospital, specialising in brain surgery. The hospital closed in 2003 and remained empty and decaying for more than ten years. It is currently being converted into apartments by Berkeley Homes. It was designed as a convalescent home in conjunction with St George’s Hospital, Westminster, and was built in 1867 with generous funds left by Atkinson Morley, for the purpose of ‘receiving and maintaining and generally assisting the convalescent poor patients from St George’s Hospital’ in Westminster (Kelly, 1887). Atkinson Morley, the proprietor of the Burlington Hotel in Cork Street, Burlington Gardens, London, died in 1858 a wealthy man. He left a number of bequests to his relatives and friends and also for charitable purposes. These included the establishment of surgical scholarships at University College, a fund for the widows of tradesmen from St James’s parish in Westminster, and gifts of £1,000 each to Queen Charlotte’s Lying-in Hospital, the Lock Hospital, St Mary’s Hospital at Paddington, and the Royal Sea-Bathing Infirmary at Margate.

South side of the Atkinson Morley Hospital, photographed in November 1992 © H. Richardson

In the terms of Morley’s will, the residue of his property was to be allowed to accumulate for five years before being applied to the building of the hospital. The foundation stone was laid on 25 July 1867, and the hospital was opened on July 14 1869, the anniversary of Morley’s death. There was not the usual elaborate ceremony on the occasion, as the governors of St George’s Hospital, who acted as the trustees of Morley’s bequest, felt that it would be inappropriate to spend any of the new hospital’s funds on such an event. It is unclear which architect should be credited with the design of the hospital. Edward and John Kelly seem to have been acting as architects to the hospital from 1866-7 and John Crawley took over in 1867-70.

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Second Edition OS Map 1899 (Reproduced by permission of the National Library of Scotland )

The hospital was built on Copse Hill, on a site which sloped gently to the south. Built of stock brick, with black and white brick string courses and white brick window heads, it was of two storeys and basement and was designed on a T-shaped plan.

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Floor plan of Atkinson Morley Convalescent Home from H. C. Burdett’s Hospital and Asylums of the World, 1893. This shows the basement plan of the north block (at the bottom of the plan) which, because of the sloping site, was the ground floor of the main south block (at the top of the plan)
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This shows the ground/first floor plan. The wards are of the Nightingale type, although later convalescent homes often departed from the pavilion plan for something more homely, as the patients were no longer ill, and many were ambulant, and so pleasant grounds were also an important feature.
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The first/second floor plan.

The main entrance and administration offices were on the north side, linked to the patients’ wing by the kitchens in the basement and the chapel above. The patients’ wing, which formed the cross-bar of the T, had a long south elevation. The basement here was in fact at ground level, due to the slope of the ground.

Entrance to the Atkinson Morley, photographed in November 1992. © H. Richardson

A portico, since removed, sheltered the main entrance which led into a square hall with the committee room on one side and a sitting-room for the resident medical officer on the other. Two corridors extended to the south, on either side of the chapel, which gave access to the patients’ wing, with the men’s accommodation on the east side and the women’s on the west. The chapel rose up through two storeys and was lit by arched windows with geometrically patterned glazing. There was a gallery at the south end, the altar being placed at the north end. The kitchen in the basement had nothing above it so that it could be provided with a large sky-light. Directly below the chapel were the stores, larders and scullery.

Atkinson Morley Hospital, Wimbledon, photographed in 2010 (© Copyright Richard Rogerson and licensed for reuse under this Creative Commons Licence

The central room on the south front, with a canted bay window, was Matron’s sitting room. To either side of this was a linen room and the Matron’s bedroom. On the exterior these central three bays were slightly advanced and rose up to an additional storey with a steep pitched roof ornamented by decorative iron brattishing. To either side of this central section were four bays standing slightly advanced from the outer wings. On the ground floor this area was occupied by children’s wards, and in the single bay between this and the outer ward wings, there was a small ward containing one bed. Below the children’s wards were dining-rooms for the patients, and in the centre a dining-room and day-room for the nurses. On the first floor there were staff bedrooms over the children’s wards and the bay-windowed room was a spare bedroom.

The outer wings, lit by five tall and narrow windows on each long side, contained wards on the ground and first floors and large day-rooms in the raised basement. The wards were furnished with between 15 and 22 beds and had a fireplace or stove in the centre. The sanitary towers were on the north side, as were the stairs.

The hospital was modernized, probably under the direction of Adams, Holden and Pearson, in 1931 (Allibone, F, Catalogue of Adams, Holden and Pearson drawings, RIBA). In the early 1940s the hospital began to take head injury cases to relieve the accommodation at St George’s. After its transfer to the NHS in 1948 it developed further as an acute hospital. The buildings suffered from the usual rag bag of additions, largely obscuring the original south elevation.

Architects John Thompson & Partners (JTP) were appointed by Berkeley Homes (Urban Renaissance) to work on the redevelopment of the Atkinson Morley Hospital in Wimbledon, London.  Part of the site is designated Metropolitan Open Land.  The site was previously owned by Laguna Quays until April 2010 when it was purchased by Berkeley Homes.

former Royal Infirmary of Edinburgh, now Quartermile

The present Royal Infirmary of Edinburgh was built in 1996-2002 as a PFI project, to designs by Keppie Design of Glasgow on a large green-field site south-east of the city, close to the A7 at Little France, by Craigmillar Castle, in a large area of open countryside. If you follow the A7 northwards, and cross over the A701, you reach its predecessor on the north side of the Meadows, fronting Lauriston Place.

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Main entrance from Lauriston Place, taken in 1999 © Diane King, from the Public Monuments and Sculpture Association collection, RCAHMS
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Architectural perspective showing the north elevation of the infirmary fronting Lauriston Place, from RCAHMS

At the end of May 2004 The Scotsman reported that demolition work had begun on the old Edinburgh Royal Infirmary complex in Lauriston Place to make way for the £400m development. Contractors moved on to the site earlier that week to begin knocking down the Florence Nightingale nurse home, the boiler house and the dermatology ward (known as The Skins). The original developer was Southside Capital, which bought the site from Lothian University Hospitals Trust in 2001, and comprised a consortium with the Bank of Scotland, Taylor Woodrow and the Kilmartin Property Group. Planning permission was granted in December 2003, ‘after a battle with heritage watchdogs’, which included formal objections by Historic Scotland.  By 2009 the development was being undertaken by a joint venture of Gladedale Capital and the Bank of Scotland.

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This aerial photograph was taken in 2007 and shows the empty space where the Simpson Memorial Maternity pavilion and the nurses home formerly stood on the right, from RCAHMS

Quartermile is a mixed development, combining residential and commercial premises over the 19-acre site. The design team was headed by Foster + Partners as the masterplanners and Architects working with Richard Murphy Architects; Hurd Rolland Architects; CDA – Architects and EDAW – Landscape Architects.

Edinburgh Royal Infirmary in the snow, from the Meadows in the late 1980s. (photograph © Harriet Richardson)

After years of adapting itself to the needs of modern medicine, and having enjoyed decades of Crown immunity which enabled additions to be made to the buildings without deference to the usual planning procedures, the Infirmary was a bit of a mess. All these accretions have been cleared away and the ranks of ward pavilions are as imposing and uncluttered as the day they were first completed. But much more than just the clutter of late twentieth century lift towers and sundry infill buildings have been removed, other casualties include the listed Simpson’s Memorial Maternity Pavilion, the Queen Mary Nursing Home and the George Watson’s wing of the Surgical Hospital.

The same view, pretty much, taken in April 2015. (Photograph © Harriet Richardson)

Walking round the site in April this year (2015), there are positive aspects to the works that have been done. Clearing away the accretions around the ward pavilions allows them to be appreciated, with open balconies once more, where residents can sit out and take the air, and communal gardens laid out between the pavilions. The unity of style of the new glass curtain-walled buildings acts as a foil or counter-balance to the stone-built Victorian hospital blocks, retaining the Simpson Pavilion might have interrupted Foster’s flow, but as it was on the edge of the site it could have provided an impressive termination, and provided a gentler transition between the new development and the tenements beyond.

Perhaps the most surprising loss is the eighteenth-century William Adam school building, George Watson’s Hospital, that had been retained by Bryce and about which he had designed his large infirmary complex.

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Plans and elevation of George Watson’s Hospital, William Adam, from RCAHMS

It was not demolished without comment or protest. Even after the protests had failed to keep the building on the site, James Simpson made a plea for the building to be taken down stone by stone so that it might be rebuilt at some distant time.

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The heart of the site today, a cavernous view between grey-glass curtain walls to the back end of the old infirmary admin block, with the clock tower rising beyond. (photograph © Harriet Richardson)

The OS map of 1882 shows what was then the recently completed Royal Infirmary on that site designed by David Bryce and built between 1870 and 1879.

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Extract from 2nd Edition OS Map reproduced by permission of National Library of Scotland

It was one of the first in Scotland to adopt the pavilion plan, widely adopted for new hospital buildings from the 1860s. Though it was pipped to the post by the Western Infirmary in Glasgow by John Burnet senior, designed in 1867 and built in 1871-4, Edinburgh’s infirmary was far bigger. The Western Infirmary in Glasgow was hampered by a lack of funds, which both delayed building work and reduced the scale of the project, so that it could only provide 150 beds at first. The new Royal Infirmary in Edinburgh had 600 beds, placed in eight 3-storey ward pavilions, with one large ward per floor.

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This aerial perspective of the infirmary, from RCAHMS,  makes an interesting comparison with the map of 1882 as it makes the hospital look as if it is almost in the middle of the countryside. It is apparently surrounded on all sides by green space, which of course was not actually the case.
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This early photograph from across the Meadows, with its artfully posed sheep, similarly evokes the image of the hospital set in a rural idyl, from RCAHMS

At the heart of the new hospital, Bryce incorporated a part of William Adam’s school building, George Watson’s Hospital, built in 1738 the same year that the previous royal infirmary building was begun to Adam’s designs. It is easily identified on the ground plan below at the centre, being the range that is slightly askew in relation to the alignment of the rest of the buildings. It was adapted to house some of the administrative offices and the hospital chapel. To its north and south the ward pavilions were disported, linked by single-storey corridors, with surgical wards to the north facing Lauriston Place, and the medical section on the south side. What the pavilion plan enabled were the primary requirements of separation and classification. Each ward was a self-contained unit, its occupants having no connection with any other ward, and thus hopefully preventing the spread of infection.

L0011802 Plan of Royal Infirmary, Edinburgh, 1893.
Plan of Royal Infirmary, Edinburgh, Wellcome Library, London (L0011802). Engraving from H. C. Burdett, Hospitals and asylums of the world, 1893

The ward itself featured windows placed opposite each other to promote the all important cross-ventilation, there were single rooms at the corridor end, which could be fitted up for a patient, the supervising nurse, a ward kitchen and sluice room.

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This photograph shows the interior of one of the top-floor wards, taken during the First World War, c.1917, from RCAHMS

The turrets at the opposite end were to contain water-closets and a bath. These sanitary towers evolved over the second half of the nineteenth century to become ever more separate from the ward itself, with the introduction of a small lobby, again, cross-ventilated, between ward and water-closet. Often a balcony was strung between the towers, offering a small space to sit out for ambulant patients.

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One of the southern, medical ward pavilions photographed in 2015 after conversion to private flats. (photograph © Harriet Richardson)

Each pavilion could serve a different classification of patient. As mentioned, here Bryce located the surgical cases to the northern pavilions and the medical cases to the south, further classification allowed men and women to be separated, but the possibilities were endless. It was this adaptability of the plan which made it ubiquitous for almost all types of hospital for decades: in hospitals for infectious diseases the separation was made more complete between the pavilions by omitting the connecting corridors.

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Elevation drawing of 1872 showing the southern medical ward pavilions connected by an arcaded link corridor, from RCAHMS

Despite the apparent vastness of the new Infirmary it was not long before additions and alterations were necessary. Sydney Mitchell & Wilson added a nurses’ home in 1890, the laundry in 1896, and the Diamond Jubilee Pavilion in 1897. In 1900 they designed two new pavilions for ear, nose and throat and ophthalmic patients.

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Drawing of 1896 for additions to the infirmary, this was the Jubilee pavilion and has been retained. It sits alongside the southern ward pavilions on the west side, from RCAHMS
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Photograph from RCAHMS.

 The photograph above is of Sydney Mitchell’s Nurses Home of 1890, fondly known as the Red Home. A courtyard plan, offered an internal garden where the nursing staff could escape for some peace and quiet. It was originally intended to retain this handsome building, but the developers were given permission to demolish. It was argued that the building did not make a positive contribution to the local townscape, as its design, scale and form were out of keeping with neighbouring buildings, including the retained listed buildings. It was also considered to be ‘not a particularly good example of a building by Sydney Mitchell’, the neighbouring Ear, Nose and Throat pavilion being thought ‘a much better example’. More credibly it was claimed that it was not commercially viable to convert it. Demolition was permitted on the grounds that what would replace it would be of high quality and create a local public space at the heart of the site. 

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This is what replaced the Red Home, photographed in February 2015. ( ‘Lines’ by Byronv2 is licensed under CC-BY-NC 2.0)

The major addition of the twentieth century was the Simpson Memorial Maternity Pavilion constructed in 1935 to designs by Thomas W. Turnbull, with James Miller acting as consultant. An imposing steel framed building faced with concrete, as was the Florence Nightingale Nurses’ Home which was built at the same time. The Pavilion was officially opened on 1 March 1939.

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The Simpson Memorial Maternity pavilion, photographed around 1940, viewed from the Meadows. Classically elegant, and a sad loss, from RCAHMS
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The monumental nurses’ home built to the rear of the maternity wing, photographed around the time that building work was completed in 1939, from RCAHMS

The Simpson Memorial had its origins in the Edinburgh Lying‑in Hospital which opened in Park Place in November 1793. This was financed by Professor Hamilton and then by his son, James, until his death in 1839. It moved in 1843 and occupied five further sites before becoming the Edinburgh Royal Maternity and Simpson Memorial Hospital, in commemoration of the achievements in obstetrics of Sir James Young Simpson who died in 1870. The resultant building, designed by D. Macgibbon & T. Ross, opened in May 1879 and later became the School of Radiology, at No.79 Lauriston Place. The first ante‑natal clinic in Britain was opened there in 1915 as a result of the work of James Haig Ferguson. After the First World War buildings in Lauriston Park and Graham Street were acquired to try to combat overcrowding but this was not satisfactorily overcome until the new Pavilion was provided in the 1930s.

Repton Park, formerly Claybury Hospital

Claybury Mental hospital, or London County Lunatic Asylum, Ilfor
Aerial view of Claybury, undated. (posted on flickr by Jeroen Komen and licensed under CC BY-SA 2.0)

Repton Park at Woodford Bridge in Essex is a large housing estate that has been created on the site of the former Claybury Hospital, using many of the former hospital buildings and keeping the new buildings to a minimum, so as to retain the open southern aspect and the original south elevation of the main hospital complex. (The aerial photograph above shows the western half as it appears in 2015 on Bing.com) The hospital closed in 1997 and it was originally intended to build much denser housing on the site.

Claybury Hospital was recorded as part of the RCHME’s Hospitals project and was visited in August 1991 by three of the project team (myself included) together with our photographer, Derek Kendall, and a student who worked with us over the summer.

Claybury was built as the fourth County Pauper Lunatic Asylum for Middlesex. It was designed on an échelon plan by G. T. Hine in 1888 and built in 1889-93. The site included the modest country house, Claybury Hall, of c.1790, which was retained and extended for private patients. It was an extensive complex of largely two- and three-storey asylum buildings linked by single-storey enclosed corridors, constructed of red brick with terracotta ornament, dominated by the central water tower.

This view of Claybury Hall was photographed by Lil Shepherd in September 2010 and is licensed under  CC BY 2.0 There is a painting of the house in the Government Art Collection  painted c.1800 by Abraham Pether

A competition was held for the design in 1887 and Hine was selected from among seven specially invited architects. A notable and prolific designer of asylums, he had been responsible for planning the borough asylum for his native Nottingham (1877). It was following his success in the Claybury competition that Hine moved to London and subsequently was appointed consulting architect to the Commissioners in Lunacy for England. [The Builder, 5 May 1916, 331]

L0023315 Claybury Asylum, ground floor plan
Claybury Asylum, ground floor plan from H. C. Burdett, Hospitals and asylums of the world, 1891 image ref: L0023315

In 1888 the plans for the Asylum were approved by the Lunacy Commissioners and in June 1890 the memorial stone was laid over the principal entrance of the administration block by Lord Rosebery, the first Chairman of the London County Council (LCC). The asylum was formally opened on 17 June 1893.

L0023316 Claybury Asylum, first floor plan.
Claybury Asylum, first-floor plan from H. C. Burdett, Hospitals and asylums of the world, 1891 image ref: L0023316 

Whilst Claybury had been begun as the fourth County Pauper Lunatic Asylum for Middlesex, it was opened as the 5th LCC Pauper Lunatic Asylum, following the Local Government Act of 1888 and the inauguration of the LCC. The LCC took over Hanwell, Colney Hatch and Banstead Asylums from Middlesex, and Cane Hill from Surrey. In June 1889 the Asylums committee was authorised to provide a fifth asylum for London by completing Claybury and a new building contract was drawn up in the following October. The building contractor under the LCC was E. Gabbutt of Liverpool. George Wise, who had been appointed Clerk of Works by the Middlesex Justices, was retained, as was Hine. A tramway was constructed to link up with the Great Eastern Railway for transporting building materials. In 1891 Hine was obliged to modify his plans following a decision to install electric lighting. This involved providing three additional boilers.

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OS Map 1914 revision reproduced by permission of the National Library of Scotland

The site had been selected by the Middlesex Justices in 1886. It comprised the house and estate of Claybury Hall. The mansion of c.1790 was probably designed by Jesse Gibson (c.1748-1828), the District Surveyor of the eastern division of the City of London. [Essex Review, xxxvii, pp.99-108, cited in H. Colvin, Biographical Dictionary of British Architects, 1978] The house was a relatively modest two-storey building. The principal façade, facing south, was symmetrical with a central bow flanked by two outer bays, slightly advanced and contained beneath a shallow pediment. The bow at ground floor level was further defined by a semi-circular portico with coupled columns. The grounds extended to 269 acres and were landscaped by Repton. Burdett gave a description of the site, although at the time of writing the asylum buildings had not yet been completed.

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Claybury Hall in 1991 (photograph © Colin Thom)

‘Part of the land is charmingly wooded, affording shaded walks for the patients. No better site could be found for such a building, and although only 1½ miles from Woodford Station, and 6½ miles from Tower Hamlets, from which district it is expected most of the patients will be sent, the asylum will be perfectly secluded, and comprise in its own grounds all the beauties of an English rural district’. [H. C. Burdett Hospitals and Asylums of the World, 1893, vol.iv, p.345).

The asylum was placed on the summit of the hill rising to the north of the mansion house. The hill was levelled to provide a plateau of 12 acres giving a largely uniform ground-floor level from which some of the outer main corridors sloped to the outside blocks. Hine emphasized the importance of a flat site arguing that the additional cost was justified compared with ‘the perpetual inconvenience and extra cost of working a building filled with feeble, irresponsible patients, which has numerous steps on the ground-floor, up and down which food trolleys as well as patients have constantly to be conveyed’. [G.T. Hine ‘Asylums and Asylum Planning’ in Journal of the Royal Institute of British Architects, 23 Feb. 1901, p.16]

Claybury was designed on an échelon plan. This was a development from the pavilion-plan asylum which comprised a sequence of pavilions or blocks, each designated for a different class of patient. Each pavilion contained a combination of wards, single rooms and day rooms, together with provision for staff and sanitary arrangements. The pavilions were generally linked by single storey corridors, either enclosed or as covered ways. The échelon plan differed from the pavilion plan only in its general layout, which, as the term suggests, consisted of pavilions arranged in an arrow head or échelon formation. This allowed Hine to provide all the patient blocks with day-rooms that had a southern aspect and uninterrupted views.

At the heart of the asylum was the recreation hall. It was particularly finely ornamented, was 120 feet long, 60 feet wide, and 40 feet high, and was capable of seating 1,200 people. At one end there was a gallery supported on iron columns and at the other the stage, with an elaborate proscenium arch in Jacobethan style, topped by a bust of Shakespeare. The high quality of decoration in the hall was integral to the philosophy of asylum planning and design at this date, as The Builder noted:

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‘The modern treatment of lunacy demands also more provision for the embellishment of the asylum than is to be found in the barrack like interiors of our older institutions. Hence the interior of Claybury Asylum is almost palatial in its finishings, its pitch-pine joinery, marble and tile chimney pieces, and glazed brick dados, so much so that some of the visitors rather flippantly expressed a desire to become inmates. The recreation hall, for example, is lavishly decorated with an elliptical ceiling, richly ornamented with Jackson’s fibrous plaster work, while the walls are panelled in polished oak, and the floors are to be finished in a similar manner.’ [The Builder, 30 July 1892, p.88]

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The interior of the recreation hall in 1991 (photographs © Colin Thom)

It is notable, however, that the majority of the fine interior work was reserved for the more public areas, such as the recreation hall, the chapel and the administration block.

L0027370 Claybury Asylum, Woodford, Essex: a dormitory. Photograph by
This photograph of one of the dormitories was taken around 1893 and shows a spartan interior, with the beds closely spaced. Note the fireproof construction of the ceiling. Photograph by the London &County Photographic Co. (c)Wellcome Library, London. Wellcome Images ref: L0027370 

Above is one of a series of photographs from the Wellcome Library which look to have been taken when the asylum was newly completed. It shows a large dormitory of the type provided for chronic cases. Acute cases were housed in small wards with a large allowance of single rooms.

L0027373 Claybury Asylum, Woodford, Essex: a dining room (?). Photogr
Photograph by the London & County Photographic Co. (c) Wellcome Library, London. Wellcome Images ref: L0027373

This view of a dining hall, presumably for patients rather than staff, although it is not so easy to tell as some of the decorative elements, such as wallpaper, curtains, potted plants, pictures on the walls, a hearth rug and the bird cage might seem a little luxurious for a pauper institution. However, homeliness and comfortable surroundings were recognised as important factors in treating mental illness. There is an almost identical photograph in Historic England Archives collection taken in 1895 by Bedford Lemere.

L0027374 Claybury Asylum, Woodford, Essex: a social room (?). Photogr
Photograph by the London & County Photographic Co. (c)Wellcome Library, London. Wellcome Images ref: L0027374

The photograph above is labelled as showing a ‘social room’. Wallpaper, pictures, rugs, and potted plants are all in evidence again along with the piano, and the shawls draped over the backs of the chairs might suggest that the patients have just stood up and moved out of view. The ceiling has the same fireproof vaulting  seen in the previous photograph. It creates a slightly less institutional feel to the room than the exposed iron beams in the dining hall.

L0027372 Claybury Asylum, Woodford, Essex: a nurses' day-room (?). Ph
Photograph by the London & County Photographic Co. (c) Wellcome Library, London. Wellcome Images ref: L0027372

The caption for these two photographs (above and below) suggest they might have been a day rooms for the nurses. The one below looks more like a staff room perhaps, particularly with the stained glass in the end window.

L0027371 Claybury Asylum, Woodford, Essex: a nurses' day-room (?). Ph
Photograph by the London & County Photographic Co. (c) Wellcome Library, London. Wellcome Images ref: L0027371

The snap above was taken in 1991, and shows similar stained glass, with the coats or arms of the local borough councils. It was in the administration block, in the main stair window. This block also contained the board and committee rooms and offices for staff as well as sitting and bedrooms for three assistant medical officers. The corridors were floored with mosaic tiling, and a faience panel marked the entrance to the board room, which had oak-panelled walls and an enriched plaster ceiling. Amongst the collection of photographs at the Wellcome Library are views of the service areas, the laundry and kitchens etc. These blocks, to the north of the water tower, have all been demolished, along with the blocks for the attendants and nurses which originally flanked the recreation hall.

L0027368 Claybury Asylum, Woodford, Essex: a linen room. Photograph b
Photograph by the London & County Photographic Co. (c) Wellcome Library, London. Wellcome Images ref: L0027368

This shows the linen room, and below is the ironing room. The work was strictly segregated for men and women. At this date patients would have assisted with many of the duties involved in the daily running of the asylum.

Photograph by the London & County Photographic Co. (c) Wellcome Library, London. Wellcome Images ref: L0027377
L0027369 Claybury Asylum, Woodford, Essex: a kitchen. Photograph by t
Photograph by the London & County Photographic Co. (c) Wellcome Library, London. Wellcome Images ref: L0027369

While the women washed and ironed, the men worked in the kitchens. I think this might be my favourite of the photographs of the working side of the hospital. Except perhaps this last one. These must be some of the senior staff, I think, though they are not identified and look very young.

Photograph by the London & County Photographic Co. (c) Wellcome Library, London. Wellcome Images ref: L0027376

More information and modern photographs of the site can be found here http://thetimechamber.co.uk/beta/sites/asylums/london-county-asylum-claybury

The Hospitals Investigator 4

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

Baths

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

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

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

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

Fire Precautions in Asylums

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

A Letter from Cornwall

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

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

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

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

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

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

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

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

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

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

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

Huntin’ Shootin’ and Fishin’ at an upper-crust, prefab sanatorium

alderney manor sanatorium

In the third edition of Rufenacht Walters’ Sanatoria for Consumptives published in 1905 is an account of Alderney Manor Sanatorium and the photograph above of the patients’ accommodation. This type of simple prefabricated timber and corrugated iron structure were commonly used for small schools, hospitals and chapels (tin tabernacles), often intended as a temporary measure to get an establishment up and running quickly.

Alderney Manor Sanatorium, situated at Parkstone between Poole and Bournemouth in Dorset, was for private, paying patients.  Surrounded by pine woods and heather-covered heath, it was set up around Alderney Manor, the house itself used for administrative offices. Despite the proximity to Bournemouth the climate was described as being ‘less relaxing’ in the summer time. Which to me sounds as though it was wetter, colder and/or windier.

In the grounds a dining-hall, a bungalow and a number of sleeping huts or chalets were erected, all prefabricated, made of wood with corrugated iron roofs and outer walls, large windows on four sides and ventilation in the gable, heated by anthracite-burning stoves (Choubersky’s stoves). The sanatorium also boasted two ‘sun baths’ for ‘ladies and gentlemen respectively’, and ‘sun bathing machines for bed patients’.

For amusements patients were offered the type of gentle pursuits one might expect: croquet, and, given the location, sea-bathing (under medical supervision, naturally). There was also a bandstand for musical entertainments. More unusual activities offered included fishing on Lord Wimborne’s preserves, and rabbit shooting on the estate itself. In addition to all this: ‘a local land agent gives lessons by arrangement in the management of landed property’. Not something I have ever come across before.

I have no idea what a sun-bathing machine looks like, nor what shape the ‘sun baths’ took. However, I did find a picture on the web of a Choubersky stove, from, naturally enough, a ‘Stove Identification Gallery’ provided by Stovemica. Whether this is the same Choubersky that manufactured an early form of in-line skates I couldn’t say.

Jean_de_Paleologu,_Patin-bicyclette_-_Richard-Choubersky
(Jean de Paleologu [Public domain], via Wikimedia Commons)

The sanatorium was right next to the local authority infectious diseases hospital, now Alderney Hospital, specialising in mental health problems and learning disabilities. Alderney manor, which in earlier maps appears merely as Alderney Cottage, was demolished some time in the 1920s or 30s, and the area where it stood was built over for housing after the Second World War.

Pine Trees

The subject of pine trees formed a digression in the second issue of the Hospitals Investigator, and it put me in mind of earlier research that I had done in Scotland where Sanatoria were set amongst pines so that the patients might benefit from terabinthine vapours. Nordrach-on-Dee was one such, later Glen O’Dee Hospital, near Banchory.

The former Glen O’Dee Hospital

Forests, Woods and Trees in relation to Hygiene was published in 1919, by Augustine Henry. Here he discussed the latest research into the effects of pine trees in a chapter on ‘Forests as sites for Sanatoria’. Even Pliny, it seems, considered that ‘forests, particularly those which abound in pitch and balsam, are most beneficial to consumptives or to those who do not gather strength after a long illness; and are of more value than a voyage to Egypt’.

In New York patients with tuberculosis were sent to the Adirondack Forest, where they might benefit from the pure and invigorating air. In England the earliest experiments with fresh-air treatment for consumption were made in 1840 by Dr George Boddington, at Sutton Coldfield in Warwickshire and in Ireland by Dr Henry MacCormac of Belfast in 1856. Dr Walther systematised and popularised open-air treatment in the Black Forest with his Nordrach Colonie Sanatorium, which was hugely influential in Britain. Treatment in an alpine sanatorium in Switzerland was beyond the financial reach of most invalids, but pine woods could easily be planted, and already existed in abundance, allowing this form of treatment to be widely replicated.

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I particularly like this dramatic architectural perspective of the West Wales Sanatorium, at Llanybydder, Carmarthenshire, with its fringe of pine trees on the hillside behind. It was designed by E. V. Collier and treated women and children. As built in about 1906, without the side wings, it didn’t look quite so romantic, and the regime within the hospital was equally grim. In 1923 complaints were made that sick girls were made to go out into the surrounding pine forest to saw trees  while kneeling in the snow. [ref: Linda Bryder, Below the Magic Mountain quoted in the New Scientist 14 July 1988 p.63] The Pevsner Guide for Carmarthenshire and Ceredigion published in 2006 describes the building as ‘originally a cheerful Neo-Georgian with red-tiled roofs and green shutters, now very decayed’.

By the early twentieth century the value of the ‘exhalations of turpentine etc’ from Scots Fir trees was being questioned, and instead it was as shelter belts that pine trees continued to play an important role at hospitals. In the second issue of Robert Taylor’s Hospitals Investigator he drew attention to these surviving shelter belts of pines around many of the sites that the Cambridge team visited. It also brought back memories of his own experience of being interned in an isolation hospital as a small child. I remember him telling us that parents were not allowed on the wards, so they would remain outside and could only see their children through the window. At one former isolation hospital he found a shelf under a window, provided so that a parent could kneel on it and see inside.

Here are Robert’s remarks on pine trees:

“In the very first day of fieldwork in Suffolk it was noticed that there was an association between hospitals and pine trees. Tuberculosis sanatoria, cottage hospitals and isolation hospitals all appear with shelter belts; indeed the site of one isolation hospital was completely inaccessible because of the fallen conifers and evergreens. The Beccles War Memorial Hospital appears from amps to have had new planting, and the surviving trees confirm this. Even the isolation hospital where one of us spent a month in 1944 has a belt of pines. It was obviously considered that a shelter belt of conifers afforded a perceptible improvement in the quality of the air. The reasoning behind this seems to smack of black magic and the symbiotic theory of disease, physicians had relatively few methods of cure, and little reliable theory with which to evaluate those methods. A belief in the specific effect of climate was harmless and must have appeared plausible. The first practical application of the theory was at the Royal Sea Bathing Infirmary at Margate in 1791, where consumptives were treated. Nothing more seems to have been done until 1854 when Brehmer believed that he could cure tuberculosis by living in high mountains, and opened an institution in Silesia. The general theory was given a more specific interpretation in 1862 when Dr. L. C. Lane of San Francisco considered that the fragrant smell from the resin of the Sierra Nevada pines was salutary: ‘in chronic pulmonary affections the breathing of such an atmosphere must be productive of a highly salutary influence’. At the same time many people thought that some leaves, particular pine and balsam, are disinfectants, and this idea still lingers with the toilet cleaner industry. In America patients were encouraged to take holidays in areas of differing air; in England that air was brought to the patient by means of sanitary plantations around the hospital, the resinous smell of the trees contribution to the recovery of those within the building. In some cases the hospitals are on such poor soil that birch and conifers are the only sensible trees to plant, as at Ipswich Sanatorium.”

 

The Hospitals Investigator 3

Isolation Hospitals

Issue number three of the Hospitals Investigator was produced by Robert Taylor in April 1992 and was largely devoted to the subject of isolation hospitals, and more particularly the model plans published by the Local Government Board from 1888 onwards. Just about all local authority isolation hospitals built after that adopted these plans.

V0047600 Hanley, Stoke & Fenton Joint Infectious Diseases Hospital, S

This plan from the Wellcome Images collection of Bucknall Hospital  is a typical example. Colin and I visited the hospital in May 1993, when it was still functioning under the NHS specialising in care for the elderly – a not uncommon re-use of former infectious diseases hospitals. It closed in 2012, and plans for housing on the site were in the pipe line in 2014, retaining just two of the hospital buildings.

Bucknhall Hospital was originally the Hanley, Stoke and Fenton Joint Infectious Diseases Hospital and the first five blocks were built in 1885-6. G. W. Bradford drew up the plans. One of the five blocks was a temporary ward block that was later demolished. Additions were made to the site from 1898, mostly carried out by Elijah Jones, architect to the Joint Hospitals Board. In the 1920s two cubicle isolation blocks were added.  [see Historic England Archives file on the hospital ref NBR No.101124]

All the original blocks at Bucknall Hospital closely followed the model plans produced by the Local Government Board.  Robert’s summary of the Board’s instructions and different types of plans issued follows:

The Local Government Board issued several memoranda to local authorities on the subject of arrangements for infectious diseases. The Board had the duty of persuading local authorities to make suitable provision, preferably by means o  hospitals, but also gave or withheld sanction to raise loans for such purposes. This meant that plasm for proposed hospitals had to be approved by the Board if the building costs were to be raised by borrowing money The hospital plans contained in the Board’s memoranda were thereof important guides to local authorities wanting to building hospitals.

The first memorandum was issued in 1876 and was titled Memoranda for Local Arrangements relating to Infectious Disease; it related to hospitals and ambulances. It addresses itself to those authorities who have power to provide hospitals under section 131 of the Public Health Act of 1875, and begins by laying down several principles:

  1. The sick should be separated from the healthy. this is especially important with the poor, living in crowded and ill-ventilated conditions
  2. The accommodation must be ready beforehand
  3. Patients with different infectious diseases cannot be kept in the same ward.

Villages should be able to accommodate about four patients in two separate rooms at small notice, and the memorandum, and all editions up to and including 1893 then describes the type of arrangement associated with ‘pest houses’. Tents or huts could be used to extend this basic accommodation if needed, but tents are not mentioned after 1888.

Towns need more accommodation more frequently, and there is greater likelihood that more than one disease will have to be treated. Consequently the minimum provision is two pairs of rooms, the size depending on the size of the town. Permanent building should ideally provide for more than the average requirements of the town, and should have space around for the erection of tents.

Several basic points regarding hospital planning are made:

  1. The hospital should be reasonably accessible
  2. Each patient to have 2,000 cubic feet of ward space and not less than 400 square feet of floor space
  3. Thoroughly good ventilation
  4. Security against foul air entering the ward
  5. Means of warming the wards in winter and keeping them cool in summer
  6. Safe disposal of excrement

In an epidemic it may be necessary to extend the hospital, by means of huts or, in summer, tents. The tents may be bell tents or Army Hospital Tents, with paved approaches and boarded floors. Regulation bell tents are said to be 14 feet in diameter, and regulation hospitals marquees 29 feet by 14 feet. Huts should be raised eighteen inches above ground level, and spaced not less than three times wall height apart. they should have ventilators along the length of the ridge.

There are plans of two types of hut. The first is arranged on one or both sides of a covered walkway, and consists of a hut with bathroom and kitchen next to the walkway, and a lower sanitary annexe at the outer end. these are arranged on either side of an administrative building, and resemble Emergency Medical Scheme hutted hospitals. The second contains two wards and a central nurses’ room etc in one hut, and a sanitary annexe at each end, generally resembling later simple ward blocks. There is also a detached kitchen.

The second memorandum, the first of several to be titled On the Provision of Isolation Accommodation by Local Sanitary Authorities, was dated March 1888. Although it is only an edited version of the earlier document, it reflects the experience gained since the Public Health Act of 1875. The principal change is in the plans of hospitals Both of the original plates are abandoned in favour of three new plates with four plans – A to D.

LGB A 1888 to 92

Local Government Board model plan A, 1888

Plan A is a small building for four patients, with two-storeyed nurses’ accommodation flanked by two single-storey wards reached independently by a verandah. There is a detached laundry and mortuary. The same plan was also published in the 1892 memorandum, but not thereafter.

LGB B 1888 to 92
Local Government Board model plan B, 1888-1892

Local Government Board model plan D, 1888

Plans B and D are of a completely new type of ward block, characterised by having the verandahs in front of the male and female wards facing opposite directions, and having the duty room recessed between two flanking wards. Plan B is a single range with all wards in line, while D has the larger end wards set at right-angles as cross-wings. Water closets and sinks are in detached blocks against the outer face of the verandahs. Plan B was included in the 1892 memorandum, but otherwise these distinctive plans were not published in the later editions.

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An example of  ‘Plan C’: Plan, elevations and section of proposed Cholera Hospital for the Couty Borough of Cardiff, Flat Holm Island, drawn up by the Borough Engineer M. Harpur. It appears to be stamped 1905, or perhaps 1906. Posted by J W Smith (Flat Holm Project Archives) licensed under CC BY 3.0 

Plan C is of a rectangular block with two wards separated by an entrance lobby and a projecting duty room. At the outer ends of the wards are small projections with water closet and sink. This basic plan was repeated in all subsequent memoranda. In 1900 it is described as the most advantageous and convenient plan, and it is suggested that one ward could be larger than the other so that children could be included with women.

LGB plan c 1888 to 9
Local Government Board model plan C 1900-21 (top) and 1902-21 (below)

Local Government Board model plan C 1888-9

In 1902 and 1921 the plan was repeated along with an alternative arrangement, having two projecting single-bed wards flanking the duty room. In all of these later publications, the original plan letters were retained.

LGB C 1900 to 21

To the requirements of 2,000 cubic feet of air space and 144 square feet of floor space are added 12 linear feet of wall space for each bed, and also the necessity for a space of 40 feet between wards and hospital boundary. In 1892 a height of 6 feet 6 inches is given as the minimum height of the boundary fence, which should be a wall or close fence. In a note added in 1902 a hedge between barbed wire fencing is regarded as acceptable in ‘unfrequented situations’.

The special recommendations regarding isolation of smallpox hospitals first appears in the 1895 re-issue of the 1892 memorandum. Smallpox hospitals are forbidden where the site:

  1. is within quarter of a mile of a hospital of any kind, workhouse or population of 150 to 200 people (200 people after 1900)
  2. is within half a mile of a population of 500 to 600 people (600 people after 1900)
V0031473 Gloucester smallpox epidemic, 1896: a ward in the Hempsted Credit: Wellcome Library, London. Wellcome Images images@wellcome.ac.uk http://wellcomeimages.org Gloucester smallpox epidemic, 1896: a ward in the Hempsted isolation hospital. Photograph by H.C.F., 1896. 1896 By: nameNegatives of the Gloucester smallpox epidemic, Published: 1896. Copyrighted work available under Creative Commons Attribution only licence CC BY 4.0 http://creativecommons.org/licenses/by/4.0/
Gloucester smallpox epidemic, 1896: a ward in the Hempsted Isolation Hospital.  Wellcome Library, London. Wellcome Images

An enlarged edition of the memorandum was published in 1900 and reprinted with minor changes in 1902, 1908 and 1921. It is emphasised that the hospital should be in readiness beforehand, and that it is for the protection of the pubic at large rather than the benefit of individuals, so that restrictive charges should not be imposed. The combination of authorities in sparsely populated districts is encouraged, provided that patients do not have to travel long distances. A proportion of one bed to each thousand inhabitants is mentioned as a rough but unreliable guide to size of hospital.

Although a site plan had been published in 1892 showing the three principal buildings and the 40 foot cordon around them, they were not defined and described until 1900. They are ward block, administration block and out-offices. A new site plan is published, appearing as plan A from 1900 onwards. Wooden and iron buildings are poorly insulated and difficult to maintain, and so unsuitable; the Board does not sanction loans for them.

LGB B 1900

The administration block should contain no patients, but accommodate the matron, nurses and servants, and have a single-storey kitchen. It may be an existing house, and should control the entrance to the hospital. It should also be larger than at first required. Ward blocks should be single-storey unless unavoidable, in which case each storey should have a separate entrance from the open air. Two types are described as being suitable for small hospitals; large hospitals may need other types. Plan C has been discussed above; a note added in 1902 says that the space in the centre over the duty room is sometimes used as a day room for convalescent patients.

Local Government Board model plan B 1900

Plan B is a new plan that underwent several changes. It is called Isolation Block on the site plan, and is described as useful under a variety of circumstances, such as keeping complicated cases under observation, for paying patients, and for extra diseases. The plan of 1900 is of a rectangular block with a recessed duty room between two small wards; there is a continuous verandah across one side, with a single detached toilet block opposite the duty room. An internal lobby protects the door of each ward.

LGB B 1902 to 21
Local Government Board model plan B 1902-21

In 1902 this plan is modified significantly. The duty room is made to project slightly, and the internal lobbies removed from the wards. More important, the toilet block is divided into two separate blocks, with an enclosed lobby linking them to the ward doors, and also separating the two end sections of the verandah. The sink room is only accessible from in front of the duty room.

LGB D 1908 to 21
Local Government Board model plan D 1908-21

A third plan D, was added in 1908 and repeated in 1921. It is called an observation block, and is said to be for single cases of a disease, or for mixed or doubtful cases. The lower provision of 1,400 cubic feet of air is justified on the grounds of efficient ventilation and the separation of individual patients. It consists of a rectangular block with two single-bed wards on each side of a central duty room. A glazed partition separates the pairs of wards. All rooms are reached from a continuous verandah, on the outer side of which is a single block containing water closet, sink and portable bath.

The space for each bed is repeated, wight he additional restriction that in calculating the 2,000 cubic feet any space above 13 feet from the floor should be ignored. One square foot of window to every 70 cubic feet of ward is regarded as suitable.

The out-offices as defined as laundry, disinfecting chamber, mortuary, and ambulance shed; boiler house and engine house are only needed in large hospitals. A discharging block is said to be provided in some hospitals.

Bibliography: 

  1. Memoranda for Local Arrangements relating to Infectious Diseases (December 1876), published in the Annual Report of the Medical Officer of the Local Government Board, PP 1882 XXX pt2, 503-7
  2. On the Provision of Isolation Hospital Accommodation by Local Sanitary Authorities. (March 1888) published in the Annual Report of the Medical Officer of the Local Government Board, PP 1888 XLIX, 875-83
  3. On the Provision of Isolation hospital Accommodation by Local Authorities (September 1892)
  4. Memorandum on the Provision of Isolation hospital Accommodation by Local Authorities. (January 1895) published in the Annual Report of the Medical Officer of the Local Government Board, PP 1895 LI, 627-35
  5. On the provision of Isolation Hospital Accommodation by Local Authorities. (August 1900)
  6. On the provision of Isolation Hospital Accommodation by Local Authorities. (1902) published in the Annual Report of the Medical Officer of the Local Government Board, PP, 1912-13 XXXVI, 136-40
  7. On the provision of Isolation Hospital Accommodation by Local Authorities. (1921)

Marianbad

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I bought this postcard on ebay the other week, and ever since have been footling about on the internet trying to find out something of the buildings shown here. Marianbad, or Mariánské Lázně, is in the Czech Republic, and was a fashionable spa town in the late nineteenth century and early twentieth – frequented by Edward VII (who opened the town’s first golf course in 1905) and many of his relatives, as well as wealthy Americans.

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from The Washington Post, 18 August 1907, p.11
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Marianske Lazne CZ Anglican church, by Jim Linwood (Anglikansky Kostel), Marianske Lazne (Marienbad), Czech Republic. Licensed under CC BY 2.0 

Amongst the exuberant Rococo hotels and buildings where the health-giving waters could be taken,  there were numerous churches catering for the many visitors of different faiths. Amongst these an Anglican church was designed by William Burges and built in 1879. It was there that after the death of Edward VII a memorial was to be placed, designed by William Lethaby.

It is rather small. But recognisably British, and Burges. I haven’t discovered whether or not the memorial was made and is there. The church was founded by Lady Anna Scott in memory of her husband who died at Marinaded in 1867. The church is now a concert hall.

After the Second World War most of the native German inhabitants were forced to leave, under the terms of the Potsdam agreement. After 1989 many of the buildings were restored and it has once again become a popular tourist destination.  In its heyday it was visited by Goethe, Chopin, Wagner, and Thomas Edison, as well as Prince Friedrich of Saxony, Czar Nicholas II and Emperor Franz Joseph I.

The postcard identifies the buildings as the Sanatorium Kavkaz, (or Maison Balneaire) and seems to date from the 1950s or 60s. More research is required to find out about the architects, and landscape designers (the landscaping was an important aspect of the town) who worked here. Any information would be most gratefully received.

Moorhaven Village, Devon, (formerly Plymouth Borough Asylum)

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Moorhaven Hospital by Nick photographed in July 2012, detail of the water tower. Image is licensed under CC BY-NC-ND 2.0

Via twitter, an article caught my eye that appeared in The Telegraph on the former Plymouth Borough Asylum, latterly Moorhaven Hospital and now a housing estate called Moorhaven Village.

geograph-2023177-by-Martin-Bodman
Ugborough, Moorhaven Village, photographed in 2010 © Copyright Martin Bodman and licensed for reuse under this Creative Commons Licence

The hospital closed in 1992, ninety-nine years after it had first opened to receive patients. It was sold in 1994 and some four years 120 homes had been created from the old buildings. The project was praised by SAVE Britain’s Heritage as a model of property enterprise and preservation. Jonathan Mathys and Andrea Peacock carried out the development, having already converted a convent and an abbey. They were guided by different principles from most commercial building developers, aiming to save and restore the historic fabric and create desirable homes. The central range of the hospital was turned into terraced housing, and the water tower has become a detached house, with one room per floor, the bedrooms occupying the lower floors and the reception rooms the upper floors, making the most of the views.

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The former hospital, Moorhaven, Bittaford, photographed in 2010 © Copyright Ruth Sharville and licensed for reuse under this Creative Commons Licence

The conversion stands out amongst many former asylum site redevelopments where the original buildings have been less respectfully dealt with, if not entirely demolished. Somerset County Asylum, later Tone Vale Hospital, in Taunton, for example, was largely demolished to make way for the housing development there in 1995, while St Lawrence’s in Bodmin was pulled down in 2014.

geograph-1181275-by-Guy-Wareham
Moorhaven Village, photographed in 2009 © Copyright Guy Wareham and licensed for reuse under this Creative Commons Licence

A competition was held for the design in 1886, and it was the local firm of J. Hine and Odgers, placed third in the competition, that was given the commission (their design was the least costly). James Hine was the cousin of George Hine, one of the most prolific asylum designers in England.

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Above is the plan of the asylum published in 1890

Plymouth Borough Asylum was built in 1888-91, initially for 200 patients, later expanded to twice that number. It is a good example of a small echelon-plan asylum, where the patients’ accommodation was arranged in an arrow or echelon formation, here in a flattened form. The random rubble walls make it rather more attractive than some of the plain brick versions built around this time.

 In 1901 Hine and Odgers were recalled to design extensions including a new wing on the male side, commenced in 1903, a second storey on each side, an isolation hospital and an extension to the administrative section. The British Architect reported in June 1906 that recent additions and improvements had quite altered the appearance of the institution. This may have been because the additions were of brick rather than stone – constructed with hollow walls, Pinhoe bricks were used for the facings. Two wards were added to either side of the main block providing additional accommodation for 110 females and 90 males. Each ward contained associated dormitories, day rooms, single rooms, attendants rooms, store rooms ward scullery and larder with bathrooms, lavatory and sanitary arrangements separated from the main buildings by cross-ventilated lobbies.

Later alterations on the site included, in 1912, additions to the farm buildings, TB shelters in the early 1920s, a nurses home, designed by J. Wibberley in 1929, and an admission hospital c.1932, also by Wibberley. In 1936 two detached villas for convalescent patients were built and a house for the medical superintendent.

Sources and further reading: Historic England Archives, file NBR No. 100330: Bridget Franklyn ‘Monument to madness the rehabilitation of the Victorian Lunatic Asylum’ in the Journal of architectural Conservation Nov 2002, pp.24-39: http://www.moorhaven.org.uk/History/history.htm