Glasgow Royal Infirmary, from the Wellcome Collection, CC BY 4.0

The old buildings of Glasgow Royal Infirmary have long since been demolished. It was there that Joseph Lister pioneered antiseptic surgery in the 1860s. But by then the original part of the infirmary designed by Robert Adam was seventy years old, and had been added to and extended many times.

In comparison with the other Scottish infirmaries which were in existence by the end of the eighteenth century, such as those at Aberdeen or Dumfries, Adam’s design for the Glasgow infirmary was far more ambitious and its impressive principal elevation was a dignified expression of civic pride. Its grandeur and the choice of architect suggest a degree of one-upmanship. However, Robert Adam was not the infirmary managers’ first choice and he was only brought in, almost by chance, following the death of the first appointed architect, William Blackburn. Blackburn had made his name in London when he won a competition to design a national prison in 1782. He became best known as a prison architect, but he was also surveyor to both St Thomas’s and Guy’s hospitals in London. Michael Port succinctly captures Blackburn’s character: ‘Corpulent in figure, medium in height, Presbyterian in religion, Blackburn was noted … for his candour and modesty’.[1] Blackburn was on his way to Glasgow to discuss a new goal there when he died suddenly at Preston, Lancashire. Many of his uncompleted works were taken over by his brother-in-law, William Hobson, but Hobson would not take on the infirmary commission. Fortuitously, Robert Adam was in Glasgow around this time overseeing the construction of the Trades House, in Glassford Street, and was conveniently placed to step into Blackburn’s shoes.

Main elevation of the Trades House, photographed in 2012, by Trades House of Glasgow

As Glasgow grew and found prosperity in the late eighteenth century, the need for an infirmary became pressing. There was the Town’s Hospital on the banks of the Clyde, but there may well have been a desire to have an infirmary closer to the University, the college buildings at this time were near to Cathedral. Amongst those who came together to found the hospital, two key figures were George Jardine, lecturer in Logic and Alexander Stevenson, Professor of Medicine at the university. Support also came from the city’s leading merchants, merchant and trade guilds, and the Faculty of Physicians and Surgeons. The first meeting of subscribers to the new institution was held in June 1787.

Robert Adam was requested to produce plans for the infirmary in November 1791, and more particularly to design it in such a way that it could be built in phases, just as his father had been instructed by the managers of the Royal Infirmary in Edinburgh in the 1730s.  His first designs were presented in October 1791, but were rejected as being too expensive at a cost of just over £8,725. Adam was asked to make the design plainer. This he succeeded in doing, reducing the cost to £7,185 10s, with the further option of having a rusticated or plain basement. As he offered the rusticated basement at no added cost, that was the version the managers chose. [2]

Glasgow Royal Infirmary, R. Chapman (1812) The picture of Glasgow or a Stranger’s Guide (2nd Ed.) Glasgow, facing p.105. Public Domain

By the end of December estimates were being advertised for the building tradesmen. In February 1792 the Infirmary received its Royal Charter, but in early March Robert Adam died, leaving his younger brother James to continue as architect to the Infirmary. The building contract was awarded to Morrison and Burns, on their estimate of £7,900 and the foundation stone was laid with full Masonic honours in May.

Detail of Fleming’s map of Glasgow of 1807 showing the original extent of the infirmary and its proximity to the cathedral. Note also the circular area in front of the infirmary, which was part of Adam’s original design. Reproduced by permission of the National Library of Scotland.

Death continued to shadow the new building as James Adam died in 1794, the year that the first patients were admitted: an ironic echo of Edinburgh’s Royal Infirmary, where William Adam had died in 1748, the year that his infirmary building was completed. When the Glasgow infirmary first opened, not all the wards were furnished, and the second report makes it clear that other parts of the hospital were not exactly finished. In 1796 money was spent on conducting water from the Monkland canal by lead pipes, making a reservoir and erecting cisterns. Hot and cold baths were installed, a high stone wall around the grounds behind the infirmary and laying out a kitchen garden there, as well as furnishing new wards, rooms for the physician, clerk and house surgeon.

Raphael Tuck & Sons postcard, showing the Royal Infirmary to the left of the cathedral.

The end result did not lack the flair that one would expect from Adam. The Scots Magazine in 1809 described it as magnificent, and grandly, if not entirely accurately, claimed that ‘Its front has some resemblance to the Hôtel des Invalides in Paris’. The main façade was symmetrical with a broad, central entrance bay which was slightly advanced with canted returns. Above the entrance a typical Adam-style arched tripartite window was set within a pediment carried on coupled columns.  A dome was placed at the centre, with its drum ornamented with carved swags. The only other infirmary to come near to this in richness was Gillespie Graham’s Grays Hospital in Elgin of 1815.

Detail of Adam’s façade, photographed in 1910. Wellcome Collection CC BY 4.0

The internal arrangements of the infirmary were not dissimilar to William Adam’s Edinburgh infirmary, though in Glasgow the building was one single range rather than the U-shaped plan in Edinburgh. On the ground floor were single cells for ‘lunatics’, and on the upper floors the wards took up the full width of the building and had opposing windows. There were separate stairs to access the wards at each end of the block, allowing for a seemly segregation of male and female patients, as well as separate access for the operating theatre, which, like Edinburgh’s was at the top of the building under the dome with ample seating for students. The 1809 Scots Magazine account was by Dr Joseph Frank who had been shown round the hospital in 1803. He noted that there were eight wards or sick rooms, two on each floor, ‘besides one underground’. The wards had twelve beds in each, standing ‘two and two in the spaces between the windows, quite close to each other’.

Ground plan of the infirmary in 1832, the original building to the left, with the wing added in 1814-15, is to the left, and the fever block to the right. Reproduced from M. S. Buchanan,  The History of Glasgow Royal Infirmary…, 1832.

The entrance led into a handsome porch, but he was less impressed by the rooms in the basement, the kitchen (disgustingly dirty), pantry (in bad order), laboratory (so narrow that there was scarcely room to turn around in it),  apothecary’s shop (small and dark) and the warm and cold baths (the cold bath small and damp). For patients who were too weak to be able to use these baths, there were tin-plate bath tubs, which could be brought to their bedside. These had ‘the appearance of a shoe’. Quite how the the patients managed to get in or out of these contraptions puzzled the writer.

One of the Glasgow infirmary’s  first physicians, Robert Cleghorn, called attention to the superior quality of the sanitary facilities, with water-closets even on the upper floor, and the use of iron bedsteads, rather than the wooden cubicles at Edinburgh. Up-to-date literature on hospitals was influential in the design, including the work of Jacques Tenon who had made a tour of hospitals and prisons in England in the 1780s for the Académie des Sciences in Paris. The report and plans produced by the Académie in 1788 had been supplied to Adam by Cleghorn himself. There are at least superficial parallels between the ward pavilions in the Académie’s plan for the Hotel Dieu in Paris and Adam’s upper-floor plans. In both the end bay contain stairs and ancillary rooms, and project forward from the central part of the range.

The operating theatre under the dome was the piece de resistance. The early historian of the infirmary, Dr Buchanan, writing in the 1830s, waxed lyrical on the beauty of the space:

The centre area is about 42 feet in circumference, and rising in a circular form all around this surgical, and clinical arena, may be remarked five ranges of high-backed steep benches, for the accommodation of at least 200 individuals. The whole of this splendid and commodious operating theatre is crowned by the large central dome … whose vertical lattices, descending to a considerable depth, thus throw the light to great advantage on the table of the operator. This beautiful termination to the edifice, which rises to the height of about 35 feet above the floor of the operation room is supported on twelve chaste pillars of the Ionic order, and by this means, as in the construction of all the other parts of the building, convenience, simplicity, and elegance, are seen mutually to harmonise and assist each other.

The first addition to the infirmary was a wing projecting north from the central bays, added in 1814-15. This provided a staff dining-room, accommodation for female servants, and additional wards for about 80 patients. Each ward had a nurse’s room and water-closet and communicated with the kitchen, apothecary’s shop, mortuary etc. in the main building. A detached block to the north-east of the main building designed as a fever hospital was built in 1828-9, designed by George Murray, architect.

View of the Royal Infirmary from the north west, with the fever hospital to the left. Reproduced from M. S. Buchanan,  The History of Glasgow Royal Infirmary…, 1832.

Dealing with outbreaks of infectious diseases in the rapidly expanding, and increasingly overcrowded city, was one of the main challenges for the infirmary managers. The addition of a separate fever hospital had been anticipated for some years, but funds had not been forthcoming. As the need became more acute, first rented accommodation was used and then a temporary ‘shed’ put up in the grounds. The original plans for the new block were to provide 220 beds at a cost of £2,900. But with rising building costs, these were scaled back to provide 120 beds. During later epidemics temporary accommodation had again to be found.

The west front of the Fever block, probably photographed around 1910. From the Wellcome Collection CC-BY-4.0

By about 1842 the detached fever hospital had been linked to the main infirmary by a further wing, shown on the OS map below. It contained a large clinical lecture room, waiting room, dispensary, inspection room and a pathological museum. David Hamilton designed a west extension built c.1839, but more research is needed to discover whether he also designed the block on the east side.

Extract from the OS large-scale Town Plans, 1857. This shows the extent of the infirmary prior to the addition of the surgical wing on the north side, which was built a little to the north of the wing shown on this map labelled ‘wards’. Reproduced by permission of the National Library of Scotland.

Around 1859 work began on the third major addition to the site: the Surgical Hospital. The additional accommodation had been under discussion for some ten to fifteen years, with opinions divided as to whether the original hospital should be further extended or a new one built in a less overcrowded part of the city. A major consideration in remaining on the spot was that a third of the infirmary’s patients came from the old city districts in the immediate vicinity, the remainder fairly evenly from the city suburbs and more distant parts of Scotland.

Typical floor plan of the new surgical hospital, from the Proceedings at the Opening of the New Surgical Hospital of the Glasgow Royal Infirmary…, Glasgow, 1861.

Plans for the new surgical wing were prepared by the architect William Clarke of  Clarke and Bell. It was completed in 1861, and formally opened in May. The contractors were Mr Brownlie, mason, Messrs Lamb & Rankin, wrights, Mr Dalron, plaster work, and Mr Moffat was the clerk of works. Designed in accordance with the ‘most approved modern theories of hospital architecture’, it was an early example in Scotland of the pavilion plan, with two ward wings placed in line on either side of a central block containing the main staircase. Nurses’ rooms, sculleries, side rooms, bath rooms, water closets, and a hoist for raising and lowering patients were all placed at the extremities of the wards, while the wards themselves had opposed windows – seven on each side – destined for 24 patients, but in the first instance fitted up for a more comfortable 16. The operating theatre was, as before, at the top of the building in the centre. It was arranged in a horse-shoe shape and had tiered seats for 214 persons.

Aerial Perspective of the Royal Infirmary, with the new surgical wing to the rear, and the fever hospital to the right, from the Proceedings at the Opening of the New Surgical Hospital of the Glasgow Royal Infirmary…, Glasgow, 1861.

Ventilation and heating were key concerns in the design of large public buildings in the Victorian era. Glasgow Royal Infirmary’s superintendent, Dr McGhie, published an article in the Glasgow Medical Journal in January 1861 on the site and construction of hospitals with particular reference to the Royal in which these themes were fully explored. The new Surgical Hospital was heated by open fires, two per ward placed back-to-back, roughly in the centre of the ward. Vitiated air was carried away through a shaft containing two smoke flues and one ventilating flue for each ward except the top floor which was ventilated by four circular openings in the ceiling. An experimental heating system was fitted in one of the wards which had a heated chamber at the back of the fires into which fresh air from outside was warmed before passing into the ward.

Photograph of the surgical wing and the adjoining fever block, from Lister and the Lister ward in the Royal Infirmary of Glasgow : a centenary contribution, published in 1927, from Wellcome Images

Another innovation in the surgical wing was the provision of a day room on each floor for the benefit of convalescent patients. With three windows facing northwards, each day room was equipped with tables, books and ‘other means of amusement’. David Smith, the chairman of the building committee, pushed for this inclusion, arguing that recovery was facilitated by removing the patients from ‘moribund patients in the same ward’. [3]  Convalescents could also benefit from the pleasure ground laid out to the north of the new building. An acre in extent it was laid out in three terraces from a design by Mr Clarke of the Botanic Gardens. A verandah was built at the upper end of the ground, 150ft by 10ft for shade and shelter.

Extract from the OS Town Plan of Glasgow, 1892-4. Reproduced by permission of the National Library of Scotland.

In 1887-8 a nurses’ home was built to designs by J. Baird and J. Thomson.The contractors were Alex. Muir & Sons, masons; Anderson & Henderson, wrights; Wm Davie, slater; Brown & Young, plumbers and Alex. Brown, plasterwork. The new home was markedly more comfortable than the previous accommodation, and was aimed at attracting a ‘superior class of nurses’. Situated well away from the main infirmary complex, this four storey building had views to the south over the Necropolis and the Cathedral, but was linked to the surgical wing by a covered way some 180ft long and 15ft wide with an arched roof of glass and heating so that it could double as an amenity for convalescent patients.

The Home itself had 85 nurses’ bedrooms, rooms for the superintendents, bathrooms, and a large recreation room. There was a box room to stow the nurses belongings, a wide and airy staircase ‘almost elegantly finished’. Heating was primarily by hot-water pipes, with fireplaces only in the superintendents’ rooms, and ventilation was by Tobin’s tubes. At the back of the building a tennis court was laid out: the infirmary’s Superintendent, Dr Thomas, believed strongly in the game of tennis as a ‘health-giving exercise’.[4]

Extract from the 25-inch OS map of Glasgow, surveyed in 1892-3. Reproduced by permission of the National Library of Scotland.

As the nineteenth century drew to a close, the condition of the older infirmary buildings became an increasing source of concern. There was a general consensus that the oldest blocks needed to be replaced, but much disagreement as to whether the infirmary should be rebuilt on a new site – as had the Edinburgh Royal Infirmary in the 1870s – or on its existing site. Queen Victoria’s jubilee in 1897 prompted the Lord Provost of Glasgow to launch a campaign to rebuild the infirmary to commemorate the Queen’s long reign. Those in favour of remaining on the the original site won the day, and over the next seventeen years the new infirmary was constructed. The map above shows the site as it was before reconstruction, the two below are from 1910, part way through the rebuilding, and 1933, when it had been completed.

Extract from the 25-inch OS map of Glasgow, surveyed in 1910. Reproduced by permission of the National Library of Scotland.

Extract from the 25-inch OS map of Glasgow, surveyed in 1933. Reproduced by permission of the National Library of Scotland.

Notes & Sources:

1. quoted from Michael Port’s entry on William Blackburn in the Oxford Dictionary of National Biography, accessed online.
2. Robert Adam’s plans an elevations for the infirmary are held by the Sir John Soane Museum
3. Glasgow Herald, 22 May 1861, p.4
4. Glasgow Herald, 30 Aug 1888, p.8

Christine Stevenson Medicine and Magnificence, British Hospital and Asylum Architecture 1660-1815, Yale University Press, 2000: Buildings of Scotland, Glasgow, 1990, p.146‑7: The Builder, 29 Dec. 1900, p.592; 18 May 1907, p.604‑6: Scots Magazine, 1 May 1809, pp 333-4: Paisley Herald and Renfrewshire Advertiser, 25 May 1861, p.2