While hunting for Doecker portable hospital buildings I came across its American counterpart, including an illustrated catalogue advertising their wares published in or after 1888. Founded by William M. Ducker of Brooklyn, New York, U.S.A. who had patented his invention, the Ducker Portable House company had offices in New York and London. The catalogue showed a variety of uses for their buildings, ranging from the utilitarian hospital hut to more elaborate garden buildings. Ease of transportation was also emphasised.
Here one of their portable buildings is neatly packed onto a horse-drawn wagon. While below the image shows the mode of transporting a Ducker building in mountainous countries. The buildings were ‘light, durable, well ventilated, warm in winter, cool in summer, healthful and cheap’. From reading the description of the buildings they seem to be almost indistinguishable from the Danish Doecker system, the components being wooden frames, hinged together, and covered with a special waterproof fibre. The same claims are made for both that they could be assembled without skilled labour.
This example was said to be at Wellington Barracks in London. Another was erected in Blackpool; Henry Welsh, the local Medical Officer of Health, noted in August 1888 that the recently erected building ‘gives great satisfaction, and answers its purposes admirably’. The cost of this model was given as $600. The German War Department bought one, and they had been adopted by the United States Naval and Marine Hospital Service, and several Departments of Charities and Correction. In 1885 the Red Cross Society had organised an exhibition in Antwerp of portable hospitals at which the Ducker buildings (and Doecker prefabs) had been shown. Ducker’s was awarded a special medal by the Empress of Germany and, so it was claimed, garnered the ‘warmest encomiums from civil and military surgeons, engineers, architects and philanthropists from all parts of the civilised world’. Wards are suitably Spartan, the interior here measured 18 x 34 ft.
The Department of Public Charities and Correction, Randall’s Island Hospital erected a Ducker house. Of the many pest houses, generally for smallpox cases, erected in America, it seems likely that if they were not actually Ducker houses, they were of a similar design, as is suggested by an early photograph of a pest house put up at Storm Lake, Iowa, photographed in 1899 (see University of Iowa libraries)
Temporary buildings were widely used at large construction sites to house migrant workers. Above is an administrative building, suitable for ‘Contractors and Construction Companies’ or for a private residence. It comprised a main building 16 x 30 ft and a separate kitchen and store-room connected by a covered passage. The workforce would be accommodated in huts such as this one.
This is its interior, with simple iron bunk beads, it put me in mind of the description of the bunk house in Of Mice and Men. These huts were bigger than the hospital buildings, at 30 x 30 ft, and cost just over twice as much at $1,250.
Versatility was key to healthy sales figures, so the catalogue demonstrates a variety of different uses for the Ducker portable building. Sports pavilions were an obvious use; above an athletic and bicycle hall, others illustrated were a racing stable, a boat house and a bowling alley. A photographer’s studio could be constructed for just $375, or a billiard room for $400 (billiard table not included). ‘The attention of hotel men is called to the fact that for annexes to hotels, to be used for sleeping apartments during the rush of midsummer, these building just exactly answer the purpose’.
For the domestic market there was a range of summer cottages (above), lawn pavilions (below) and camping houses. The Norton Camp House could have been yours for $150 (and upward), measuring a cosy 9 x 12 feet and weighing 450 pounds. It could accommodate four people, and opened out on all sides. Camping was not necessarily a leisure pursuit, and this camp hut was also touted for cattle ranchmen, miners, prospectors, surveyors and contractors.
If you were on vacation, however, you might have considered a bathing house. ‘The portability of these buildings make them simply invaluable… At the end of the season they can be taken down and stored until the opening of another season. They can be constructed in any form or style desired and can be made to comfortably accommodate more people than any other building known’.
The Lawn pavilions were the most decorative, being intended for ornament as well as usefulness, aimed at owners of large summer residences. ‘They are constructed in decidedly artistic style.’ ‘and will be found useful and delightful for ladies’ sewing, reading and painting rooms, children’s play rooms, tea and lunch rooms, tennis purposes, and sleeping rooms as well if required’ If you didn’t run to summer residence with large grounds in need of a lawn pavilion, then don’t worry, you could have an entire summer cottage or camping cottage. The latter pretty much the same as the hospital huts, but the former comprised the most ornate in the Ducker range.
This example seems to be giving a stylistic nod towards a Chinese pagoda or an Indian bungalow. As I am heading to Fife in Scotland later in the summer, I was particularly tickled to read the testimonial on the back cover of the catalogue which was furnished by one George C. Cheape, of Wellfield house, Strathmiglo in Fife, master of the Linlithgow and Stirlingshire hounds. ‘No country house should be without one’ he wrote: ‘It was put up in one day by the village joiner and my gamekeeper.’ He continued to effuse about the merits of the building: ‘In wet weather the children quite live in it, and play all day. I have gymnastic apparatus put up in it, swings, etc; the consequence is a quiet house, whilst the children are enjoying healthy exercise and games to their heart’s content, where they disturb no one, and their tea-parties in the Ducker House are enjoyed by all.’ Cheape was a Captain in the 11th Hussars, Justice of the Peace and Deputy Lieutenant of Fife. He was also widely travelled, had served in India, and had visited America on three occasions, having business interests in Texas, Colorado, Arizona and California. While in America he also travelled to Canada and Mexico, and worked to promote the interests of the International Company of Mexico, of which he was a shareholder. Sources: The catalogue for Ducker Portable House Co. can be found online from archive.org, information on George Cheape was from the census, marriage records, passenger lists etc and there is a brief biography in David Pinera Ramirez, American and English Influence on the Early Development of Ensenada, Baja California, Mexico, 1995 pp.99-100
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 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.’
‘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.’
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.’
Old postcard with aerial photograph of Herrison Hospital, posted on flickr by Alwyn Ladell and licensed under CC BY-NC-ND 2.0Originally 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’.
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
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 [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 subject of pine trees formed a digression in the second issue of the Hospitals Investigator, and it put me in mind of earlier research that I had done in Scotland where Sanatoria were set amongst pines so that the patients might benefit from terabinthine vapours. Nordrach-on-Dee was one such, later Glen O’Dee Hospital, near Banchory.
The former Glen O’Dee Hospital
Forests, Woods and Trees in relation to Hygiene was published in 1919, by Augustine Henry. Here he discussed the latest research into the effects of pine trees in a chapter on ‘Forests as sites for Sanatoria’. Even Pliny, it seems, considered that ‘forests, particularly those which abound in pitch and balsam, are most beneficial to consumptives or to those who do not gather strength after a long illness; and are of more value than a voyage to Egypt’.
In New York patients with tuberculosis were sent to the Adirondack Forest, where they might benefit from the pure and invigorating air. In England the earliest experiments with fresh-air treatment for consumption were made in 1840 by Dr George Boddington, at Sutton Coldfield in Warwickshire and in Ireland by Dr Henry MacCormac of Belfast in 1856. Dr Walther systematised and popularised open-air treatment in the Black Forest with his Nordrach Colonie Sanatorium, which was hugely influential in Britain. Treatment in an alpine sanatorium in Switzerland was beyond the financial reach of most invalids, but pine woods could easily be planted, and already existed in abundance, allowing this form of treatment to be widely replicated.
I particularly like this dramatic architectural perspective of the West Wales Sanatorium, at Llanybydder, Carmarthenshire, with its fringe of pine trees on the hillside behind. It was designed by E. V. Collier and treated women and children. As built in about 1906, without the side wings, it didn’t look quite so romantic, and the regime within the hospital was equally grim. In 1923 complaints were made that sick girls were made to go out into the surrounding pine forest to saw trees while kneeling in the snow. [ref: Linda Bryder, Below the Magic Mountain quoted in the New Scientist 14 July 1988 p.63] The Pevsner Guide for Carmarthenshire and Ceredigion published in 2006 describes the building as ‘originally a cheerful Neo-Georgian with red-tiled roofs and green shutters, now very decayed’.
By the early twentieth century the value of the ‘exhalations of turpentine etc’ from Scots Fir trees was being questioned, and instead it was as shelter belts that pine trees continued to play an important role at hospitals. In the second issue of Robert Taylor’s Hospitals Investigator he drew attention to these surviving shelter belts of pines around many of the sites that the Cambridge team visited. It also brought back memories of his own experience of being interned in an isolation hospital as a small child. I remember him telling us that parents were not allowed on the wards, so they would remain outside and could only see their children through the window. At one former isolation hospital he found a shelf under a window, provided so that a parent could kneel on it and see inside.
Here are Robert’s remarks on pine trees:
“In the very first day of fieldwork in Suffolk it was noticed that there was an association between hospitals and pine trees. Tuberculosis sanatoria, cottage hospitals and isolation hospitals all appear with shelter belts; indeed the site of one isolation hospital was completely inaccessible because of the fallen conifers and evergreens. The Beccles War Memorial Hospital appears from amps to have had new planting, and the surviving trees confirm this. Even the isolation hospital where one of us spent a month in 1944 has a belt of pines. It was obviously considered that a shelter belt of conifers afforded a perceptible improvement in the quality of the air. The reasoning behind this seems to smack of black magic and the symbiotic theory of disease, physicians had relatively few methods of cure, and little reliable theory with which to evaluate those methods. A belief in the specific effect of climate was harmless and must have appeared plausible. The first practical application of the theory was at the Royal Sea Bathing Infirmary at Margate in 1791, where consumptives were treated. Nothing more seems to have been done until 1854 when Brehmer believed that he could cure tuberculosis by living in high mountains, and opened an institution in Silesia. The general theory was given a more specific interpretation in 1862 when Dr. L. C. Lane of San Francisco considered that the fragrant smell from the resin of the Sierra Nevada pines was salutary: ‘in chronic pulmonary affections the breathing of such an atmosphere must be productive of a highly salutary influence’. At the same time many people thought that some leaves, particular pine and balsam, are disinfectants, and this idea still lingers with the toilet cleaner industry. In America patients were encouraged to take holidays in areas of differing air; in England that air was brought to the patient by means of sanitary plantations around the hospital, the resinous smell of the trees contribution to the recovery of those within the building. In some cases the hospitals are on such poor soil that birch and conifers are the only sensible trees to plant, as at Ipswich Sanatorium.”
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.
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:
The sick should be separated from the healthy. this is especially important with the poor, living in crowded and ill-ventilated conditions
The accommodation must be ready beforehand
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:
The hospital should be reasonably accessible
Each patient to have 2,000 cubic feet of ward space and not less than 400 square feet of floor space
Thoroughly good ventilation
Security against foul air entering the ward
Means of warming the wards in winter and keeping them cool in summer
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.
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.
Local Government Board model plan B, 1888-1892
Local Government Board model plan D, 1888
Plans B and D are of a completely new type of ward block, characterised by having the verandahs in front of the male and female wards facing opposite directions, and having the duty room recessed between two flanking wards. Plan B is a single range with all wards in line, while D has the larger end wards set at right-angles as cross-wings. Water closets and sinks are in detached blocks against the outer face of the verandahs. Plan B was included in the 1892 memorandum, but otherwise these distinctive plans were not published in the later editions.
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.
Local Government Board model plan C 1900-21 (top) and 1902-21 (below)
Local Government Board model plan C 1888-9
In 1902 and 1921 the plan was repeated along with an alternative arrangement, having two projecting single-bed wards flanking the duty room. In all of these later publications, the original plan letters were retained.
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:
is within quarter of a mile of a hospital of any kind, workhouse or population of 150 to 200 people (200 people after 1900)
is within half a mile of a population of 500 to 600 people (600 people after 1900)
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.
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.
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.
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:
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
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
On the Provision of Isolation hospital Accommodation by Local Authorities (September 1892)
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
On the provision of Isolation Hospital Accommodation by Local Authorities. (August 1900)
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
On the provision of Isolation Hospital Accommodation by Local Authorities. (1921)
In July 1991 Robert Taylor produced the second edition of The Hospitals Investigator, the newsletter he wrote and circulated to his five colleagues working on the RCHME survey of historic hospital buildings. Here he pondered Pest Houses, discussed deposited plans, and thought about (operating) theatres. In part 2b I will relay his discussion of ridge lanterns, sanatoria, and sewage works – we really knew how to enjoy ourselves.
Pest Houses
“Pest houses have been emerging from the Suffolk countryside at an alarming rate. The name indicates a house, usually an ordinary farm house, which was used by the local authority as an isolation hospital in the event of an outbreak of infectious disease, usually smallpox but in some early cases the plague as well. Details of the arrangements must have varied, but it seems that the tenant had an obligation to either nurse the victims or to move elsewhere for the duration of the sickness. The latter was perhaps the more common practice in the seventeenth century. The possibility of such an arrangement was taken for granted in the 1875 Public Health Act, although the Local Government Board did not like ad hoc hospitals very much and put pressure on local authorities to provide specialised buildings. A very few pest houses remained in use in the first years of this century.”
“So far the Cambridge office has seen only three surviving pest houses, at Halesworth, Framlingham and Bury St Edmunds. The first was a standard three-cell two-storey farmhouse of the late seventeenth century, and remained the centre of a working farm until the land was sold away recently. That at Framlinhgam was an early seventeenth century two-cell house with central stack, and similarly showed no sign of specialised planning. Although reputedly built in 1665, the Bury pesthouse displayed nothing earlier than the eighteenth century, and was a three-cell, single-storey house with internal stack. Other pest houses remain to be located at Eye, Nayland and Huntingdon, as well as a few less certain cases.”
I couldn’t find any photographs of these particular pest houses, though there will be photos taken by Robert and Kathryn in the relevant files in Historic England Archives. Here is a much smaller version in Hampshire at Odiham, where presumably, a small population did not require anything bigger.
The Patrick Stead Hospital continues to function as a community hospital, and was designed as a cottage hospital by Henry Hall. It opened in 1882.
Above is a postcard showing the hospital, and below an elevation and plans produced in The Builder in 1880. Originally it provided a dispensary, outpatients’ clinic and accident ward, all on the ground floor, with further wards above. Patrick Stead set up a maltings business in Halesworth, and bequeathed a generous £26,000 to establish the hospital. Deposited Plans
“Recently one of us was reading a letter written by an official of the Ministry of Health in 1926 when it suddenly became clear that the writer of the letter had in front of him a set of plans for an isolation hospital that had been sent to the Local Government Board in 1888 in connection with an application for sanction to raise a loan. Plans of isolation hospitals were deposited when an authority applied for permission to borrow money for hospital building, and also when the more responsible authorities voluntarily sought approval of their proposed hospital. The Local Government Board was replaced by the Ministry of Health, whose archive should contain these immeasurable riches, along with similar material for workhouses. Unfortunately most of the material dating from after about 1902 was lost in the blitz, and what survived that seems to have been mostly destroyed in a fire in Brighton. All that survives is at [the National Archives, at] Kew, hidden behind the catalogue code MH. The three main groups seem to be MH.12, MH.14 and MH.34.”
“MH.12 consists of Poor Law Union Papers, of which 16,741 bound volumes, arranged under Unions, survive from between 1834 and 1900… MH.14 is called Poor Law Union Plans, and there are 38 boxes of them dating from between 1861 and 1900. They have reference numbers linking them to MH.12… MH.34 is a register in 11 volumes of authorisations on workhouse expenditure between 1834 and 1902.”
Reading this today, it is a reminder of how much researchers now gain from online digitised archive catalogues, and perhaps a lesson not to grumble about them (as I frequently do) when we can’t find what we’re looking for, they crash, they change, or they assault ones aesthetic sensibilities.
“One of the problems met in small hospitals is the identification of the jumble of buildings behind the main block. As in a mediaeval house the identification of the hall acts as a key to understanding, or at least knowing the rough layout of, the entire house, so one might expect that the operating theatre might stand out and give some help in finding a way through the maze. Unfortunately this does not always happen. Plenty of light was necessary, so a roof light is an important indicator. A large North-facing window is another but less reliable sign, and far too often the windows appear to be ordinary ones, the lower parts filled with obscured glass, as at Southwold. At Felixstowe the theatre has a semi-octagonal North end, like a sitting room, with ordinary-sized windows that are now blocked. The Beccles Hospital of 1924 has a magnificent but sadly un-photographable theatre with a North wall and roof of glass. Sometimes it is possible, if we are very tall or can manage to balance on tip-toe or on a convenient upturned bucket, to glimpse through the windows the white-tiled walls, or even the upper parts of lighting equipment.”
AYRSHIRE CENTRAL HOSPITAL, IRVINE Comparable to both Inverurie and Hawkhead Hospitals, though lacking the flair of Tait’s buildings at the latter, these three hospitals constitute a interesting and important group of local authority infectious diseases hospitals built in the international modern style, adopting bold cubic shapes and flat roofs.
Ayrshire Central Admin block, photographed in 1997 by RCAHMS
Ayrshire Central, designed in 1935 byWilliam Reid, the County Architect, has a strong impact with its brilliant white finish enhanced by good maintenance and sympathetic extensions. The hospital was built to replace the old, small infectious diseases hospitals scattered over the county, and to meet the local authority’s new responsibility for maternity cases. The site was split into two halves to cater for the different functions. The infectious diseases section opening in 1941, and the maternity section in 1944. The specialities within the hospital altered when cases of tuberculosis declined and hospital confinements increased. Eventually, the infectious section became a general area with the ward pavilions adapted to various new functions.
The nurses’ home, in a central position between the two sections of the hospital, was designed on a U-plan and is a particularly pleasing small-scale example of its type. It has an almost Italian feel with the arcaded ground floor. The glazing and contemporary fire escapes are particularly notable details. [Sources: Ayrshire and Arran Health Board, Souvenir Brochure of Opening, 1941, site plan: Architect & Building News, 18 June 1937, p.359]
Revisions:
By 1933 Ayrshire County Council were considering the provision of a 70-bed maternity hospital to take the place of Seafield Maternity Home in Ayr. Plans for the hospital were drawn up in the office of William Reid, the County Architect, but it seems to have been Robert Govan Lindsay who was responsible for the design. From 1921 he worked for Ayrshire Education Authority which was taken over by the County Council in 1929, here he gained a broad experience in designing municipal institutional buildings. The plans were approved and work commenced in 1935 comprising 250 beds for infectious diseases cases, 70 beds for maternity cases and 46 children’s cots. In June 1937 The Architect and Building News reported that Reid was the architect of ‘new quarters for certain staff members’, costing £11,000. Perhaps this was the Nurses’ Home, which differed somewhat in style from the other buildings on the site.
The hospital was nearing completion in 1938, but costs had risen dramatically, that and the outbreak of war sufficiently explain the slowness in completing this hospital. Despite the war, there was an official opening for the hospital in October 1941. The cost was given as £400,000 and the number of beds provided had been increased to 436. [Annual Reports, Department of Health for Scotland: Sunday Post, 19 Oct 1941]
Aerial photograph of the site taken in 2014 by RCAHMS. The original blocks are to the left of the picture. Bare ground can be seen marking the sites of demolished pavilions at the centre of the site.
Ayrshire Central Hospital continues to provide young disabled rehabilitation services, and has a number of assessment beds for Elderly Mental Health Services. In 2010-12 the grade B listed buildings on the site were refurbished and modernised, although one block, the original maternity section, has been demolished. A new General Outpatient Department and Rehabilitation Centre has been added to the site, and in 2014 work commenced on a new 206-bed, acute mental health and community hospital for NHS Ayrshire and Arran designed by Lawrence McPherson Associates. Balfour Beatty are the building contractors (they were awarded the contract after ‘a robust procurement process’).[ref 1] Opening is planned for 2016.
