Building Bedlam – Bethlem Royal Hospital’s early incarnations

From City fringe to St George’s Fields

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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Anonymous etching of the Royal Exchange from the British Museum

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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Imperial War Museum, photographed January 2014

References

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

The Hospitals Investigator 6

October 1992 brought forth the sixth newsletter from the Cambridge team of the RCHME Hospitals Project. It included short pieces on mortuaries and asylum farms, and accounts of the Victoria Cottage Hospital, Wimborne, Dorset, with thoughts on holiday closures of hospitals. There is also a note on Sleaford’s isolation hospital, a portable hospital with what sounds like a camper van for the nurse. Extra curricular activities at hospitals were discovered too, with money making schemes in a Yorkshire madhouse and an unofficial B&B at Addenbrooke’s Hospital in Cambridge.

Victoria Cottage Hospital, Wimborne

This unremarkable little Dorset hospital has a history written in 1955 by someone hiding behind the initials G. H. W. From this booklet we can extract several amusing bits of hospital history.

 

First must come the sanitation. In 1887 when the hospital was built there was one earth closet for the patients. This came to light in 1907 when water was installed along with an extra closet. The operating theatre was another horror for it doubled as the bathroom from 1887 until 1904 when a new operating room was built. Even this new theatre did not have an electric light until 1934. Provision of a separate operating theatre did not end the dual use of the bathroom, however. Until 1927 it housed the telephone. In that year the telephone was moved to the matron’s office.

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Extract from the 1901 OS map. The cottage hospital is to the north-west of the town, almost on a level with the union workhouse, which is to the north-east. Reproduced by permission of the National Library of Scotland

Until 1924 the hospital closed completely for about a moth every year, for cleaning and repairs. During this time the staff took holidays, and the patients were dismissed. Some were sent to the small 18th-century workhouse in Wimborne, for in 1922 the Guardians sent the hospital a bill for care of patients. We have met this sort of annual closing and cleansing elsewhere, but it seems poorly documented. In 1946 the Passmore Edwards Hospital at Liskeard closed for a moth because that was the only way in which the staff could take a holiday; our source does not say whether this was a regular event. The Royal National Sanatorium at Bournemouth closed in winter, allegedly because the hospital was only intended to provide a summer break for consumptives (and thus for their carers as well). At Northampton the General Infirmary managed cleaning and repairs by simply closing one ward at a time, but as this was a large hospital part-closing was easier than in a small hospital like Wimborne.

Finally, on a frivolous note, when the townsmen were discussing whether to commemorate Victoria’s jubilee by building a hospital or by some other means, one suggestion was ‘erecting a statue of Queen Victoria with a clock on top’. Just how this was to be arranged is not explained.

Sleaford Hospital

The Sleaford Rural District Council bought an isolation hospital in 1901 for the sum of £127. It was ‘an ingenious contrivance’ of numbered wooden sections that could be put together in a few hours, measured 20 feet by 12 feet and could hold up to four patients. A van on wheels provided both accommodation for a nurse and the necessary cooking arrangements. There was also a portable steam disinfector that was reported to be too heavy to be portable. This magnificent hospital was stored at the Sleaford Workhouse, and was erected for the very first time for the benefit of an inquisitive Local Government Board inspector in 1905. It is not known whether it was ever used after that. [The inspector’s report is in Parliamentary Papers, 1907 XXVI, 200-201.]

The East Stow Rural District Council in Suffolk had a ‘small portable hospital’ for smallpox cases in 1913, and presumably this was also a sectional wooden building. [PP 1914 XXXVII, 746] In 1913 Bournemouth Corporation had lent the neighbouring Rural District Council a Doecker Hut for use as an extra hospital ward during an outbreak of enteric fever at Ringwood, another portable structure. [PP 1894 XL, 565 and see Doecker Portable Hospitals]

At least these buildings were of wood. Shortly before 1890 the Gainsborough Rural Council bought a hospital marquee for patients and a bell tent for the nurses. They were aired from time to time, but appear not to have been used. [PP 1894 XL, 565] Perhaps even these tents were better than the converted dog-kennels at Bishop Auckland in 1895. [PP 1896 XXXVII, 704]

Mortuaries

In the course of research for the project a file copy turned up of a Government questionnaire headed ‘Isolation Hospital Accommodation’, and filled in for the Southampton Smallpox Hospital. The printer’s rubric shows that it dates from 1926 and that some 10,000 copies were printed. The answers, together with a crude plan from another source, make a description of this vanished hospital possible, but there is little of interest until the question ‘is there a mortuary at the hospital?’ The answer is simply ‘Cubicles in Observation Hut used for this purpose’. The observation hut was a small building with two single-bed wards and a duty room If one cubicle was occupied by a patient, the psychological effect of comings and goings in the other cubicle can hardly have been good. Perhaps the real significance of this arrangement is that the observation wards of isolation hospitals were probably rarely used, and that there never was a living patient to be disturbed by the arrival and departure of a dead one. It also helps to suggest ways in which hospitals without mortuaries might have functioned.

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Extract from the 1934 OS map. Reproduced by permission of the National Library of Scotland

The smallpox hospital was at Millbrook Marsh, an inhospitable looking place even as late as the 1930s, surrounded by mud and marsh. It is interesting to see that development of the estuary was just beginning at this time, to the east is the King George V graving dock under construction. By the 1950s the hospital site had become a boat yard, re-using the existing buildings. A couple remained in the late 1960s, when the area to the north had become a sewage works, which eventually swallowed the remaining former hospital buildings.The huge Prince Charles Container Port was built over the mud flats and saltings.

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Extract from the 1897 OS map. Reproduced by permission of the National Library of Scotland

Southampton, in common with other ports, provided a number of isolation hospitals. As well as the smallpox hospital there was another isolation hospital at West Quay.

It is in the usual location, close to the water so that anyone arriving by ship suspected of having contracted an infectious disease could be taken directly to the hospital by boat. The site was later an Out-bathing and Disinfection Station for Infectious Diseases and later still used for a clinic and a mortuary. That was in the post-war era, and by then land reclamation had seen the site removed from the water’s edge. As far as I can make out, the Grand Harbour Hotel seems to occupy the site now.

Asylum Farms

Slowly it is becoming clear that asylum farms were unlike those in the world outside, at least in the South of England. Large barns for storing crops are absent from those seen so far, but piggeries are ubiquitous and any fragments of yards and single storey buildings appear to have been for cattle. Sometimes there are stables and cart sheds, but it is not certain that these were specifically for farm use. Indeed the buildings suggest that attention was concentrated on stock, especially pigs and cattle, and perhaps market gardening, where there was greater scope for farming as occupational therapy. At Digbys, Exeter, there is a tall building which had large opposed loading doors, one opening on to the yard, the other on to a lane outside the hospital grounds. The building is not large enough to hold much, and certainly is not suitable for storing a grain crop. It seems to have been intended for receiving bought-in material, presumably feedstuff for the pigs and cattle.

EPW024131Digby Hospital, formerly the Exeter Lunatic Asylum. The small farm complex is on the east near to the London & South Western Railway line. The buildings have been converted to housing as part of the re-development of the hospital and its site for housing.

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Extract from the 1st Edition OS Map published in 1889. Reproduced by permission of the National Library of Scotland

The advantages of concentration on livestock is that it would provide the asylum with pork, bacon, milk and beef, while a market garden would provide soft fruit and vegetables. All of these are labour-intensive occupations, providing maximum work throughout the year for the relatively large number of patients.

Secondary Employment

John Beal was the proprietor of a private madhouse at Nunkeeling in the Yorkshire Wolds. The financial success of this venture seems out of proportion to the small number of patients and the remoteness of its position. The truth emerged in 1823 when the excise men found 24 casks of tobacco, 25 of tea, and 264 of assorted spirits, mainly gin, concealed about the premises. Perhaps we should pay greater attention to such institutions, in the hope that more than just buildings survive.

Income

Those hospital administrators busy trying to generate income have all failed to exploit one obvious opportunity that was seen as long ago as 1770 by the Matron of Addenbrooke’s Hospital, Cambridge. The town has long had a shortage of short-term accommodation. The matron saw this and let beds to overnight visitors, presumably giving them breakfast as well. On discovering this the Governors dismissed her, partly because she was pocketing the income.

Doecker portable hospitals

In the Hospitals Investigator number 5 the following list of suppliers of temporary hospital buildings was given: Humphrey’s of Knightsbridge;  Boulton and Paul of Norwich; Portable Building Company of Manchester; Hygienic Constructions and Portable Buildings Ltd; Wire Wove Roofing Company of London; G. W. Beattie of Putney; and Kenman and Sons of Dublin. To this list should be added Spiers and Co. of Glasgow, prolific providers of isolation hospitals pretty much throughout Scotland.

V0015643 Boer War: a temporary hospital hut at Netley with four nurse

A Doecker hospital hut at Netley Hospital during the Boer War, from Wellcome Library, London. Wellcome Images http://wellcomeimages.org V0015643

The Hygienic Constructions and Portable Buildings Ltd were the agents for temporary buildings constructed on the Doecker system  invented by Captain Döcker (usually rendered Doecker in English) of the Royal Danish Army. Johann Gerhard Clemens Döcker (1828-1904) first patented his portable building system in 1880. (He filed patents in France and Germany in October 1880,  in Denmark and Austria-Hungary in 1881, in Norway, England, Spain, Belgium, and Italy in 1882;  in Russia, Sweden and Victoria in 1883; and in New Zealand and the United States in 1884.) The full text of the patent he submitted in the United States can be read online here http://www.google.com/patents/US308833.

Three sheets of drawings provided details of his system:

Doecker 1

Sheet 1 from Doecker’s USA patent 1884. [Source: United States Patent and Trademark Office, www.uspto.gov]

‘My improved portable and impermeable structure is composed of a series of light frames which may be made of wood or metal, and for general purposes such frames are polygonal in shape. Each frame a is covered with a sheet of impermeable material,  permanently connected therewith in any suitable manner, as by nailing, riveting, or gluing. Two such frames are permanently hinged together by means of any suitable form of hinge, and a pair of such frames constitute a panel.

Doecker 2

Sheet 2 from Doecker’s USA patent of 1884. [Source: United States Patent and Trademark Office, www.uspto.gov]

‘The frames are hinged together so as to fold inwardly toward each other, so that their covering will not come in contact when folded. I prefer to cover the frames with strips of felt, which may be rendered water-proof either before or after being attached to the frames, and I prefer the latter method, especially when the felt is attached by means of nails or rivets, for the reason that the points of attachment will then be covered by the waterproofing substance applied, and produce water-proof joints, which would not be the case when the felt is applied after being rendered impermeable. This impermeability may be imparted to the felt by any one of the many waterproofing compositions or water and fire proofing compositions, or by means of oil-paints. I prefer to use felt, owing to its density and non-conductive properties, it being better adapted than any other material to shield the occupants of the structure both from heat and cold.’

Doecker 3

Sheet 3 of Doecker’s USA patent of 1884. [Source: United States Patent and Trademark Office, www.uspto.gov]

The term Doecker hospital was sometimes used generally for portable hospital buildings, whether or not they were in fact of Doecker construction. Doecker buildings were largely used on the continent, and in Britain were also used for elementary and open-air schools.  There were two types: strong or light. The strong type were intended asa a substitute for permanent brick or stone buildings, while the light were for temporary and/or portable buildings, which could be put up quickly and cheaply.

For both types the buildings were made in sections roughly 3ft x 3ft (a little less than a metre squared). These sections could be fastened together with iron hooks and studs, allowing for de-construction and re-erection on another site. The strong type comprised timber frames weather-boarded on the outer side and covered on the inside with a composition called ‘Doecker material’ – a non-inflammable, water- and acid-proof. These two layers provided a cavity that was filled with insulating material, though the walls were only 4 1/2 inches thick (about 11 cm). The roof was covered with a flexible and water-proof material (‘ruberoyd’).

The light construction had a lighter frame covered on both sides by Doecker material. The whole building was made in sections, and the packing formed the floor ‘thus saving weight, space, and freight in transit’. No foundations were required, the building sat on adjustable wooden feet. Constructed these light buildings measured 50ft x 16ft (15.24m x 4.8m) and could be erected in one day by unskilled labour. Their insulation properties were commended: ‘Portable hospitals of this construction were used by the German Red Cross Society during the cold of a Manchurian winter in the Russo-Japanese war, and they have also been used in the tropical heat of South-West Africa’.

V0015642 Boer War: the Doecker Hospital Huts at Netley with patients

An image from 1900 of Doecker hospital huts, Wellcome Library, London. Wellcome Images http://wellcomeimages.org V0015642

Doecker system hospital buildings, along with other prefabricated buildings, featured in H. Franklin Parson’s book Isolation Hospitals, originally published in 1914 and revised in 1922 by R. Bruce Low.

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This hospital pavilion, with is sun-catching angled wards, was a type provided by the Hygienic Constructions and Portable Buildings Ltd, Stockholm Road, South Bermondsey.

The 1922 second edition formed part of a series of books on public health and hygiene (the Cambridge Public Health series) designed to advise those working for the government and the medical profession. It addressed the way in which infectious diseases were contained and treated, and defended the government’s decision to spend a significant amount of money on isolation hospitals. Parsons and Low discussed the most advantageous designs and locations for these institutions, the containment of diseases such as small pox and tuberculosis, and the issues that arose around both the staffing of isolation hospitals and the changing provisions made for those patients affected by severe poverty.

 

 

 

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.

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.

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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. 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.

Screen Shot 2015-07-05 at 16.29.40 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.

Screen Shot 2015-07-05 at 17.08.02 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)

Screen Shot 2015-07-05 at 17.11.56 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.

Screen Shot 2015-07-05 at 17.15.05 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.

AMH original pillars This photograph, and the engraved view at the top of this post, are taken from the Atkinson Morley Hospital Lung website 

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.

1989224_cad14c44 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 (c)Diane King, from the Public Monuments and Sculpture Association collection, RCAHMS

canmore_image_SC00601346-2Architectural 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.

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

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The same view, pretty much, taken in April 2015. (Photograph (c) 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.

 

canmore_image_SC00597543-3Plans 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.

IMG_1968The 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 (c) 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.

canmore_image_DP00073937-2This 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 (c) 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

canmore_image_DP00028963-2Photograph from RCAHMS. This was 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. 

 

16647727005_c9e7ee7941_oThis 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.

canmore_image_SC01174629-2The 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.

 

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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 (c) 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:

‘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 (c) 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.

L0027377 Claybury Asylum, Woodford, Essex: an ironing room. Photograp
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.

L0027376 Claybury Asylum, Woodford, Essex: six members of staff, andPhotograph 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.’

 

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.’

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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.

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

LGB plan D 1888

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.

Flat_Holm_isolation_hospital_plan_April_1895

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 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

Local Government Board model plan C 1900-21 (top) and 1902-21 (below)

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.

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.LGB B 1900

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)