The Hospitals Investigator 5

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

Hereford Workhouse

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

954821_1d0dbd83

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

Workhouse Visitations

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

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

Cross-Ventilation

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

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

Bristowe & Holmes

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

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

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

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

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

More Baths

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

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

Suppliers of “Temporary” Hospitals

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

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

boultonpaul_bungalowad1933

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

The Hospitals Investigator 4

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

Baths

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

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

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

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

L0015468 Male patients being washed by hospital orderlies. Wellcome Library, London.

Fire Precautions in Asylums

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

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

 

geograph-4142138-by-Clint-MannTattingstone Hospital in 1990 © Copyright Clint Mann and licensed for reuse under this Creative Commons Licence Originally built as a House of Industry in 1766, and later extended as Samford Workhouse, it became St Mary’s Hospital in 1930, finally closing in 1991 and was converted into housing around 2001. see also  http://www.workhouses.org.uk/Samford/

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

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

VLUU L210 / Samsung L210

VLUU L210 / Samsung L210

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

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

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

6830047491_273bab4af1_o

 

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