Margate’s Sea Bathing Hospital

Royal Sea Bathing Hospital, Margate. Photographed in 2017 © H. Richardson

Earlier this year I spent a wonderful weekend in Margate and was fortunate to be staying just around the corner from the former Sea Bathing Hospital. This was a building that I first visited in September 1991. Since then it has been transformed into a gated private housing development, with some very swanky newly built ‘beach huts’ overlooking the bay.

The new ‘beach huts’ at the former Royal Sea Bathing Hospital, Margate. Built in 2016 for the developers, Harriss Property Limited, to designs by Guy Hollaway Architects. Photographed in 2017 © H. Richardson

Back in the early 1990s the future of the hospital was uncertain. Remaining services were then scheduled to move to a new building on the Thanet District General Hospital site. Ten years later the buildings were in a sorry state. In 2001 a planning application was submitted to convert the historic core into luxury apartments.

Extract from the 25-inch OS map revised in 1936. Reproduced by permission of the National Library of Scotland

What makes the hospital so special is its long history – it claims to be the earliest specialist orthopaedic hospital in Britain if not the world, and was a pioneer in the use of open-air treatment for patients with non-pulmonary tuberculosis. Founded in 1791 by John Coakley Lettsom, the first building went up in 1793-6 to designs by the Reverend John Pridden. Lettsom was a Quaker physician who espoused the benefits of treating disease with sunshine, fresh air and sea bathing.

John Coakley Lettsom (1744-1815),  with his family in the garden of his house in Grove Hill, Camberwell, Surrey. Oil painting by an unknown English artist, c.1786. Wellcome Library

The idea that sea bathing had health benefits was not new. A Dr Wittie promoted sea bathing as a cure as early as 1660 in Scarborough. By the mid-eighteenth century sea bathing for health had become widely popular. The small fishing village of Brighthelmstone  grew into the resort of Brighton on the strength of the perceived healthiness of its especially salty sea as well as through the patronage of the future George IV. Just about any illness was claimed to be curable by the application of sea water – externally or internally, but glandular and respiratory complaints were thought to be particularly likely to benefit from such treatment.

Mermaids at Brighton by William Heath of c.1829 (public domain image via Wikimedia Commons)

John Coakley Lettsom firmly believed in the efficacy of sea air and sea bathing for the treatment of scrofula (also known as the king’s evil, this skin disease is caused by a form of tuberculosis). Lettsom’s idea to found an infirmary at Margate for the poor was given royal patronage almost from the start, so his intention in July 1791 to found the ‘Margate Infirmary for the Relief of the Poor whose Diseases require Sea-Bathing’ soon changed to the ‘Royal Sea Bathing Infirmary’.

This early print shows the main elevation as designed by Pridden and is dated 1793. Reproduced under Creative Commons Licence CC BY 4.0 via Wellcome Collection

Margate, on the north-east coast of Kent, offered sheltered conditions and a moderate climate. It was within easy reach of London by boat. The site was outside the town in Westbrook, a tiny hamlet that remained largely undeveloped until after the First World War. The new building was designed with access to fresh air in mind, with open arcades and verandas. Its clerical architect, the Reverend John Pridden, was an enthusiastic supporter of Lettsom. He was both an antiquary and an amateur architect – not an especially unusual combination of interests in Georgian Britain.

Floor plans and elevation of the infirmary by Darton & Harvey. Wellcome Collection Creative Commons Licence CC BY 4.0

His first design was drawn up as early as June 1791 for a hospital large enough for 92 patients. In the end this proved too ambitious and was simplified to provide for 30 patients. With the plans approved, building work began some time after May 1793 and it was ready by the spring of 1796. Though much altered, Pridden’s building survives at the heart of the present complex.

West façade of the infirmary. Photographed in September 1991 © H. Richardson

Pridden’s design prefigured open-air sanatoria of the early twentieth century, with wards opening out on to colonnades, or piazzas as he called them, so that beds could be pushed out into the open air. There were wards with nine or six beds on either side of a two-storey block containing offices and staff accommodation.

Detail from the OS Town Plan of 1874

The Royal Sea Bathing Infirmary was a charitable institution, funded by subscriptions and donations. Patients were admitted on the recommendation of the governors after examination by a medical board in London. Out-patients as well as in-patients were treated.

Sea Bathing Machine at Margate. Wellcome Collection Creative Commons Licence CC BY 4.0

The sea-bathing element of the treatment was administered under the supervision of bath nurses, who escorted patients down to the shore in the hospital’s own bathing machine in order for them to be fully immersed in the water. In addition to this stimulation, the fresh air and decent food provided were of great benefit.

View of the infirmary from the Nurses’ Home, photographed in 1991. This shows how close the sea is to the hospital. On the left can be glimpsed the flat roof of the 1880s extension

Until the 1850s the infirmary was only open during the summer. In 1853 indoor salt water baths were introduced. A horse-driven pump forced sea water up from the shore 30 ft below. This facility allowed the hospital to remain open all year round. By then the hospital had expanded, with a new single-storey wing added to the south in 1816 that increased the capacity to 90 beds. Another wing, this time of two storeys, had been added by about 1840 facing north. The extended infirmary was subsequently altered and further extended to give it a more coherent appearance with Greek Revival dressings. It was raised to two storeys throughout, and the west-facing entrance front given a tetrastyle Doric portico (the columns supposedly came for nearby Holland House). The portico was later moved to its present position on the south front.

The new wing added to the west of the hospital in the 1880s. Photographed in 2017 © H. Richardson

Wards for children were added in 1857-8. A large dining hall and a school were also added, connected to the main building by a covered way, and a house for the Governor. More substantial additions were made in the 1880s.

The view from the roof terrace, looking west over the bay towards Westbrook. Photographed in 1991 © H. Richardson

James Knowles Junior produced the designs for a long, single-storey building adjoining the old hospital to the west – hence the re-siting of the portico.

Detail of the ground plan from H. C. Burdett’s Hospitals and Asylums of the World, Portfolio of Plans, 1893, showing the southern end of the new wing.

Funds for the extension were donated by Sir Erasmus Wilson, a director of the hospital who had a house at Westgate just up the coast. He gave £30,000 to build more wards, a heated indoor swimming pool and a chapel. The statue in front of the main entrance is of Wilson, erected in his honour in 1896.

The south front of the former Sea Bathing Infirmary with statue of Sir Erasmus Wilson in the foreground. Photographed in 2017 © H. Richardson

A description of the new ward block noted:

The general wards, which are provided with hot and cold sea-water baths, are utilised largely for “dressing” the tubercular joints and glands, and for sleeping accommodation during unusually inclement weather. For the most part, however, the patients remain both by day and night on the verandah surrounding the “quadrangle”. In this position the patients while in their beds are able to enjoy the sea air both by day and night, while those who are able to move about secure exercise in the grounds and, in suitable cases, sea-bathing on the beach. [PP 1907, XXVII, 406-7]

The ward block also had a flat roof, creating a promenade, protected by an attractive balustrade of pinkish terracotta. To the south of the ward block was the swimming bath, supplied with fresh sea water by the horse pump which piped water to underground tanks.

The 1880s wing, looking towards the chapel. Photographed in 2017 © H. Richardson

More architecturally ornate is the Gothic chapel. Its tall nave and semi-circular apse is reminiscent of Gilbert Scott’s collegiate chapels.

The 1880s wing seen from the east, with the chapel to the left and the former swimming bath building. Photographed in 2017 © H. Richardson
The same part of the hospital – the chapel and swimming bath – in 1991.  © H. Richardson

The interior was given a complex decorative scheme. Stained-glass windows illustrated Christ healing the sick, the virtues, and medicinal plants, while a mural depicted the story of Naaman bathing in the River Jordan.

Chapel interior photographed in 1991

Other murals depicted saints, angels and the Tree of Knowledge. Part of the nave was kept free of seats to enable beds or wheelchairs to be brought in directly from the quadrangle verandah.

The east end of the chapel, with its apsidal end, designed by James Knowles Junior. Photographed in 2017 © H. Richardson

During the First World War the hospital treated British and Belgian servicemen with TB, as well as the wounded and those suffering from shell shock. A new wing, the King George V Wing, was built in 1919-20 to the west of the main complex, but this has now been demolished.

Later additions to the site, including, to the right, part of the George V Wing. Photographed in 1991 © H. Richardson

The last major addition to the site was the nurses’ home, on the corner of Canterbury and Westbrook Roads. Originally built in 1922, it was extended in 1935 from two storeys to four.

The former nurses’ home. Photographed in 2017 © H. Richardson
View of the chapel from the north-east. Photographed in 1991 © H. Richardson
Looking northwards out to sea along the roof terrace. Photographed in 1991 © H. Richardson
Looking east from the roof terrace. Photographed in 1991 © H. Richardson


Anon 1812. An Account of the Proceedings for establishing Sea-Water and other Baths, and an Infirmary, in the vicinity of London…
British Medical Journal (BMJ), 1898, ii, 1768
Cazin, Le Dr H 1885. De L’influence des Bains de Mer sur La Scrofule des Enfants
Colvin, H M 1978. A Biographical Dictionary of British   Architects 1600-1840
Gentleman’s Magazine, vol.LXVII (ii), Oct. 1797, 841; LXXXVI (i), Jan. 1816, 17
Honour, H 1953. ‘An Epic of Ruin-building’. In Country Life, 10 Dec. 1953
 Illustrated London News, 16 Sept. 1882, 298
Kent Record Office, Maidstone
Lettsom, J C 1801. Hints Designed to promote Benificence, Temperance & Medical Science (3 vols)
MacDougall, P 1984. ‘A Seabathing Infirmary’. In Bygone Kent, vol.5, No.9, Sept. 1984, 511-6
Metcalf, P 1980. James Knowles Victorian Editor and Architect
Nursing Times, 10 March 1977, 9-12
(PP) Parliamentary Papers 1907, XXVII. Annual Report of the Medical Officer of the Local Government Board
Royal Sea Bathing Hospital Archives
Strange, F G St Clair 1991. The History of the Royal Sea Bathing Hospital Margate 1791-1971
Whyman, J 1981. Aspects of Holidaymaking and Resort Development within the Isle of Thanet, with particular reference to Margate, circa 1736 to circa 1840 (vol.2)

see also:

Greenock’s lost hospitals

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Greenock in the mid-eighteenth century, depicted on Roy’s map of the Highlands. Reproduced by permission of the National Library of Scotland

The dark, austere tower block that is Inverclyde Hospital opened in 1979. It superseded the Greenock Royal Infirmary, Eye Infirmary, Gateside Hospital, Duncan Macpherson and Broadstone Jubilee Hospitals which were all disposed of by the local Health Board in 1982. It was built just to the north of Larkfield Hospital, and that too was later replaced by the present Larkfield Unit. Later the last of Greenock’s pre-war hospitals, the Rankin Memorial, also closed and has since been demolished. This post gives a brief account of Greenock’s past hospitals, mostly demolished but a couple still stand in other use. Information on the lunatic asylum, poorhouses, and hospitals nearby can be found on the Inverclyde page of this website. Grateful thanks must go to the McLean Museum and Inverclyde Archives for kindly allowing me to use images from their online collections website (which I highly recommend).

Inverclyde Royal Hospital, with the Larkfield Unit in front, photographed in 2007. © Copyright Thomas Nugent and licensed for reuse under this Creative Commons Licence

Though Inverclyde hospital is perhaps not the most heart-warming in terms of architectural delight, Greenock can nevertheless be proud of its historic hospitals and of the people who built, funded, staffed and administered them. The earliest of these now-lost hospitals was the Royal Infirmary in Inverkip Street.

Postcard of the infirmary, probably early 20th century. Reproduced by permission of the McLean Museum and Art Gallery, Inverclyde Council

A dispensary had been established for the sick poor in 1801, but an outbreak of fever in 1806, the source of which was thought to be the crew of a Russian prize-vessel brought into the harbour that year, demonstrated the limitations of the dispensary and the necessity for a hospital. Plans for establishing an infirmary were put in train in 1807, the foundation stone was laid in 1808, and the building opened on 14 June 1809 – the dispensary becoming part of the new infirmary. In most instances the first generation of voluntary hospitals built in Scottish towns were designed by local architects. Greenock was no exception, although John Aird,  who furnished the plans, was the local harbour engineer rather than an architect per se and it appears to be the only known building that he designed.

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Greenock, from John Wood’s plan of the town of 1825, showing the new streets laid out for development in grids around the old town. These were said to be ‘filling up with rapidity’ at the time of Wood’s survey, although neither Macfarlane’s map of 1842, or the first edition OS map of 1857, bear this out. Reproduced by permission of the National Library of Scotland.

The original infirmary was a good size for the time and the size of the town, providing 32 beds. Sir John Shaw Stewart, Lord of the Manor, gave the site, originally on the outskirts of the town, and the building costs amounted to around £1,815. It operated as a voluntary hospital funded by subscriptions, and was intended for cases of fever as well as general medical or surgical cases. Additional ground was given in 1815 to provide a larger airing ground or garden.

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Wood’s Map

The image above shows a detail of Wood’s map, the infirmary is marked by the letter ‘n’ and is towards the bottom left of the map. To its north ‘o’ marks the United Session Church and ‘p’  is the Greenock brewery. Further to the east ‘r’ marks the relief chapel and ‘s’ the tabernacle. On the right hand side are the bridewell –  ‘x’ and the Renfrewshire bank – ‘y’. At the top ‘c’ is the gaelic chapel. All this can be seen much more clearly on the National Library Maps collection site, which also has a link to the description of Greenock that accompanied Wood’s Atlas.

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Detail from Andrew Macfarlane’s map of Greenock of 1842. Reproduced by permission of the National Library of Scotland.
Extract from the OS Town Plan, 1857. The small building to the south was the wash house and dead house. Reproduced by permission of the National Library of Scotland

Outbreaks of fever (i.e. an infectious disease) remained common in this harbour town, and were often severe. In 1829 the hospital was stretched beyond its capacity during an epidemic, resulting in the erection of a temporary fever hospital and plans made to extend the building. Two wings were added in 1830. By the mid-1840s the capacity of the infirmary had been increased to around 100 beds. An extraordinary number for the building depicted in the 1857 OS map (above).

Late-nineteenth century lantern slide of Greenock Infirmary and Duncan Street cemetery. Reproduced by permission of the McLean Museum and Art Gallery, Inverclyde Council

Additions were made in 1847 (James Dempster architect), and in 1869 the infirmary was enlarged (James Salmon & Son, architect). Further additions in 1938-43 by W. J. B. Wright included a nurses’ home.

Extract from the 2nd-edition OS map, surveyed 1896. Reproduced by permission of the National Library of Scotland

One of the specialisms that developed at the infirmary was the treatment of diseases of the eye. In 1865 James Ferguson, merchant of Inverkip, had bequeathed £6,000 to provide an eye hospital but legal action ensued and it was not until 1879 that the trustees rented a consulting room in Greenock Infirmary and in the following year appointed an oculist. At last the Eye Infirmary was built in 1893 on Nelson Street.

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Extract from the 2nd-edition OS map, revised in 1912, showing the eye infirmary to the west of the County Court and prison. Reproduced by permission of the National Library of Scotland 

The Eye Infirmary was designed by James B. Stewart with funds donated by Mr Anderson Rodger, a Port Glasgow ship builder. It also catered for ear, nose and throat patients until 1921. It is a handsome building, and survives, latterly as the Ardgowan Hospice.

Opening ceremony of the Eye Infirmary on Nelson Street, Greenock on the 19th August 1893. Reproduced by permission of the McLean Museum and Art Gallery, Inverclyde Council
Atmospheric colour slide of the Eye Infirmary taken in 1971 by Eugene Jean Méhat (1920-2000). Reproduced by permission of the McLean Museum and Art Gallery, Inverclyde Council
 Ardgowan Hospice photographed in 2007 © Copyright Thomas Nugent and licensed for reuse under this Creative Commons Licence

Public Health legislation in the late nineteenth century eventually made the provision of municipal hospitals for infectious diseases compulsory. For Greenock this resulted in the erection of Gateside Hospital, otherwise known as the Greenock and District Combination Hospital for infectious diseases. Built well outside the town, it was designed by Alexander Cullen of Hamilton and opened in 1908.

Extract from the 2nd-edition OS map, revised 1912. Reproduced by permission of the National Library of Scotland

With the decline in need for hospitals for infectious diseases Gateside took on orthopaedic surgery, paediatric medicine and general medicine, before finally closing in 1979, superseded by Inverclyde Hospital.

Postcard of the combination hospital, Greenock. Possibly the most surprising hospital to find a postcard of, made even more bizarre with the MacGregor tartan and lucky heather. 
A photograph of the nurses with Miss Gay, Matron to the left of Dr Phillips, taking tea in front of the hospital. A poignant scene, given the year 1913. Reproduced by permission of the McLean Museum and Art Gallery, Inverclyde Council

The photograph above shows the matron Miss Margaret Russell Gay, seated to the left of Dr Phillips. She was matron at Gateside for over 25 years, having been appointed when the hospital first opened. From Greenock, she trained at Greenock Royal Infirmary, and before taking up her appointment at Gateside was matron at Largs hospital. She also spent time in America as a private nurse, and was in San Francisco during the 1906 earthquake. She died in 1941 aged about 70.

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Extract from the 2nd-edition OS map revised in 1938. Reproduced by permission of the National Library of Scotland.

A Children’s Convalescent Home was built c.1900 on the edge of the smart western suburb of Greenock, on the corner of South and Forsyth Streets. It was opened by Mrs Andrew Carnegie – who had gifted £500 towards the home – in October 1902. It was still running during the Second World War. The building survives, now as private housing.

During the inter-war years Greenock’s hospital services increased greatly, but just before the end of the First World War, in 1917, Togo House was presented to the burgh of Greenock by Baillie Daniel Orr for use as a maternity hospital. This house was presumably on the site of present-day Togo Place, just off Dempster Road near the corner with Ann Street.  It only had space for six patients, but in 1925 plans were approved to build a single-storey extension that would provide a proper maternity ward with 18 beds, and turn the house itself over to office and administrative use.

It was during this period that a convalescent home was built in association with the Royal Infirmary at Larkfield. Designed by Abercrombie & Maitland, it opened on 21 December 1929. At the opening ceremony, a Birmingham-made ceremonial silver key in a gold-coloured casket was presented to Miss Maggie Donald Rankin. The casket and key are now in the McLean Museum and Inverclyde Archives. Miss Rankin and her brother, Mathew, were major benefactors of Greenock. Mathew Rankin was partner in the local firm Rankin and Blackmore, engineers.

Extract from the 2nd-edition OS map, revised in 1938. Reproduced by permission of the National Library of Scotland.

The home provided two, ten‑bed wards and eighteen private rooms. By 1943 it had become an auxiliary hospital treating all medical cases. It has considerable historic importance in terms of the development of hospital planning after the Second World War for having the first experimental ward designed by the Nuffield Provincial Hospitals Trust, built in 1951-6, and followed by one in Belfast at Musgrave Park built in 1956-9. The Trust began to develop a new type of ward unit in the early years after the war, looking abroad for inspiration where the old Nightingale style wards had made way for groups of patients’ rooms on one side of a corridor with ancillary facilities on the other – bathrooms, treatment rooms, sluice rooms etc. The Trust studied the daily routine of nurses and aimed to devise a new layout that would reduce the amount of walking for nurses, improve privacy for patients but not lose the necessary level of supervision of patients by the nursing staff. The ward unit that they came up with still provided a basic 32 beds (about the size of the largest Nightingale ward) but arranged with a combination of four-bed bays and single rooms on either side of a central corridor. (An illustration can be seen on the University of Cambridge School of Architecture website, and a plan is reproduced in Jonathan Hughes’ article in Medical History.)

Larkfield Hospital closed in 1979. That same year the new Inverclyde Royal Hospital was opened, built just to the north-west. The Larkfield unit for geriatric patients has since been built on the site.

Two more hospitals were built in Greenock in the later 1930s. The Ear, Nose & Throat Hospital in Eldon Street was built in 1937 by James Miller. It originally had accommodation for 20 beds and an out‑patients’ department. Eear nose and throat patients were initially taken into the Royal Infirmary and then moved out to the Eye Infirmary when it opened in 1894. In 1921 the old prison buildings in Nelson Street were acquired as a temporary measure until the new hospital was provided in Eldon Street. The Eldon Street hospital was demolished some time after 1990 and has been replaced by blocks of flats.

Housing has also been built on the site of the Rankin Memorial Hospital. This hospital opened on 17 August 1938 replacing the Togo House Maternity Hospital and the children’s hospital at Shaw Place (about the latter, I have found no information). Maggie Donald Rankin donated £41,000 to build and equip the new combined hospital.

Extract from the 2nd-edition OS map, revised in 1938. Reproduced by permission of the National Library of Scotland

The architect was James Watson Ritchie, for H.M. Office of Works. It was designed as a long low, two‑storey building in three sections with maternity to the west and children to the east of the central administration section. All the blocks were rough‑cast. There was accommodation for 28 women and 28 children, and the 13 1/2-acre site was laid out by Greenock Corporation Parks Department.

A ceremonial silver key, made by Hendry & Co. of Birmingham, England, was presented to Miss Rankin on the opening of the hospital by the Burgh of Greenock Corporation. Like the other key presented to her on the opening of Larkfield Hospital, it has been preserved in the McLean Museum and Inverclyde Archives.

Following transfer to the National Health Service in 1948 plans were drawn up for extensions and a nurses’ home, and a special baby-care unit designed in 1979 by Ross, Doak and Whitelaw.  The Rankin closed in 1994. (There was also a Rankine Memorial Hospital, established around 1901, in Yichang, China, named after Dr David Rankine, its founder. The nursing staff were deaconesses from the Church of Scotland.)

Sources: Greenock Royal Infirmary: Dictionary of Scottish Architects: The New Statistical Account of Scotland: Renfrew, Argyle… 1845, pp 474-6. Gateside Hospital: Common Services Agency, Glasgow, plans collection: Glasgow Herald, 29 Dec 1941, p.6. Greenock Eye Infirmary: F. Walker, South Clyde Estuary, Edinburgh, 1986. Togo House Maternity Hospital: Glasgow Herald, 20 May 1925, p.6. Ear, Nose & Throat Hospital: Architect & Building News, 1937. Rankin Memorial Hospital:  McLean Museum and Inverclyde ArchivesDictionary of Scottish ArchitectsThe Builder, 23 Jan 1948, p.125; 27 Feb 1948, p.264; 11 Jan 1952, p.101; 30 April 1934, p.786: The Scotsman, 18 Aug 1938, p.6: Aberdeen Journal, 2 May 1907, p.3 for the Chinese Rankin Memorial Hospital.

Book Review: The Hospitals of Skye

I was delighted to receive three booklets this week from an ongoing series produced by the History of Highland Hospitals project set up in 2008. The first to be published was The Hospitals of Skye in 2011. Written by Jim Leslie and his son Steve, this slim volume provides a detailed history of the seven hospitals known to have existed on the island: the Skye Poorhouse, Portree and Ross Memorial Hospitals in Portree; Gesto Hospital, Edinbane; Martin Memorial Hospital, Uig; Mackinnon Memorial Hospital, Broadford, and a tiny smallpox hospital at Stein.

Portree Community Hospital behind the cottages on the water front, photographed in 2010. ©Copyright John Allan and licensed for reuse under this Creative Commons Licence

The buildings have been thoroughly researched, there are plentiful illustrations and the text is fully referenced with end-notes and footnotes. The stories of the hospitals and the poorhouse are written engagingly with an emphasis on their social history. This is mostly concerned with the staff and founders of the hospitals, but there are also details of patient numbers, including the detail that Gesto Hospital, in 1912, was reported as being full, and amongst the patients was a Welsh tramp with a broken leg in the attic.

I have had an enjoyable weekend up-dating the entries on the Highlands page of this website, adding in new information and correcting a few errors that I had made. Portree hospital, pictured above, had been extended since I visited it in the 1980s. It was built in the 1960s, and had a wonderful almost Art Deco-style bowed entrance porch with a port-hole window, but this has been altered and its character lost (I don’t think portholes on the door make up for the loss). Otherwise it is an endearing building and an early example of an entirely new NHS hospital.


Gesto Hospital, Edinbane. Photographed in 2010. The boarded up building looking more dilapidated by the month. What a pity! © Copyright Carol Walker and licensed for reuse under this Creative Commons Licence

The Gesto Hospital closed in 2007 and has stood empty ever since. As Carol Walker comments on her photograph above – what a pity! I hadn’t realised that the harling was not original – the book contains a photograph of the building from the 1920s (it is also on the front cover of the book) showing the exposed masonry with its neat cherry-caulking. As to the Stein Smallpox Hospital, that was completely new to me – a prefabricated Speirs & Company building that was never actually used and was only in existence between 1905 and about 1919.


I love this photograph taken in 2009 by Mick Garratt with its Mediterranean colours. Former Gesto Hospital © Copyright Mick Garratt and licensed for reuse under this Creative Commons Licence

As the Leslies’ book was published five years ago there have been some further developments in the lives of these buildings. I was sorry to see that plans were passed last year by the Highland County Council to demolish the old poorhouse – built in 1859 and designed by William Joass, an architect about whom I should like to learn more. The poorhouse had never been heavily used, and was turned into a hostel for school children in the 1930s (the Margaret Carnegie Hostel).

The Combination Poorhouse, Portree. Extract from the 1st-edition OS map, surveyed in 1875. Reproduced by permission of the National Library of Scotland

The John Martin Hospital at Uig was a youth hostel in 2011, but was closed and sold off around 2013, while the Ross Memorial Hospital, which had been turned into an arts centre in the 1980s and had closed in 2007, has since been remodelled and extended to become the new West Highland College, opened in 2013 as part of the University of the Highlands and Islands.


Photographed in 2012 while under construction. The new Broadford Health Centre. This £1.3 million development nearing completion next to the Dr MacKinnon Memorial Hospital in Broadford will replace the nearby building currently used by Broadford Medical Practice. The new facility will serve people living in Broadford, Strath and north Sleat. © Copyright John Allan and licensed for reuse under this Creative Commons Licence

There are currently two community hospitals on Skye, at Portree and Broadford (the Mackinnon Memorial). A new health centre was built next to the Mackinnon Memorial Hospital in 2012 by the NHS Highlands Estates Department. I rather like the health centre. It reminds me of a boat-house or perhaps even a smoke-house, though that might not have been what the architects were aiming for. In 2014 plans were announced to build a new community hospital on the island at Broadford with a reduction in services at Portree, sparking a ‘Save Portree Hospital’ campaign (there is to be a protest march on 20 June, if you feel like joining in). It seems likely that the Portree hospital building will be replaced. I hope that it will not share the same fate as the former poorhouse.

J. C. Leslie and S. J. Leslie, History of Highland Hospitals The Hospitals of Skye, 2011, Old Manse Books, Avoch, Scotland ISBN 978-0-9569002-0-3 £5

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Building Bedlam again – taking a leap forward to Monks Orchard

Entrance gates to Bethlem Hospital, 1896 from The Queen’s London : a Pictorial and Descriptive Record of the Streets, Buildings, Parks and Scenery of the Great Metropolis (Public domain, from Wikimedia Commons)

Bethlem Hospital remained in St George’s Fields, Southwark from 1815 to 1930. In that time numerous additions and alterations were made to the building, but the area around had also developed and changed almost beyond recognition. In the early nineteenth century it was airy and open, with few houses and market gardens in the immediate vicinity. It was on the other side of the river from the densely built-up urban centres of Westminster and the City, and on the outskirts of Southwark itself. But it did not remain a rural or even suburban idyll for long, as industrialisation and the population expansion of the capital brought waves of building activity.

Greenwood’s map of c.1830 showing the area around Bethlem Hospital

Greenwood’s map of London of 1830 captures the moment before this expansion, half a century later and Bethlem hospital had been engulfed. Population density increased as the century wore on, with the usual pattern of housing intended for single families increasingly occupied by two or three.

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Booth’s Poverty Map. Printed Map Descriptive of London Poverty 1898-1899. Sheet 9. Inner Southern District. Reproduced courtesy of LSE Library

Booth’s poverty map of London of the late 1890s showed that although those living in the immediate surroundings of the hospital were classed as fairly comfortable, on the other side of the Lambeth Road were pockets of the lowest class, the vicious and semi-criminal, amongst housing that was almost entirely occupied by the poor, or very poor.

Broadmoor Asylum for Criminal Lunatics, from The Illustrated London News, 1867

Other changes had occurred during the century or so that Bethlem was at St George’s Fields. Legislation had been introduced to encourage the establishment of lunatic asylums for paupers early in the nineteenth century (the Lunacy Acts of 1808 and 1815), and this reduced the need for Bethlem to cater for the poorer class of patient. The County Asylums Act of 1845 made the establishment of pauper asylums compulsory, and this, coupled with a new regime headed by Dr W. Charles Hood, the first resident medical officer, saw a shift towards caring for a higher class of patient. This was consolidated after the opening in 1863 of Broadmoor for criminal lunatics, removing another class of patient formerly accommodated at Bethlem. Improvements to the accommodation were made, the comforts of home introduced and a convalescent home built at Witley (1866-9, designed by Sydney Smirke). [1]

V0013739 The Hospital of Bethlem [Bedlam], St. George's Fields, Lambe Credit: Wellcome Library, London. Wellcome Images The Hospital of Bethlem [Bedlam], St. George's Fields, Lambeth: the men's ward of the infirmary. Wood engraving by F. Vizetelly, 1860. 1860 By: Frederick VizetellyPublished: - Copyrighted work available under Creative Commons Attribution only licence CC BY 4.0
The men’s ward of the infirmary at Bethlem Hospital, 1860 by Frederick Vizetelly, reproduced under Creative Commons Attribution only licence CC BY 4.0 from Wellcome Library, London

So by the early twentieth century the type of patient at Bethlem had changed, and the locality had become more densely urban, but more importantly than either of these in prompting a move to a new site was the old-fashioned design of the building and the constant demands and cost of maintaining the ageing fabric of the asylum.

V0013741 The Hospital of Bethlem [Bedlam], St. George's Fields, Lambe Credit: Wellcome Library, London. Wellcome Images The Hospital of Bethlem [Bedlam], St. George's Fields, Lambeth: the female workroom. Wood engraving probably by F. Vizetelly after F. Palmer, 1860. 1860 By: F. Palmerafter: Frederick VizetellyPublished: - Copyrighted work available under Creative Commons Attribution only licence CC BY 4.0
Female workroom, Bethlem Hospital. Wood engraving probably by F. Vizetelly after F. Palmer, 1860. Wellcome Library, London. Reproduced under Creative Commons Attribution only licence CC BY 4.0 

Asylum design had moved on since 1815, and a century later the ideal form for a mental hospital was considered to be the colony plan or villa system, comprising detached buildings set in landscaped grounds. Colony plan asylums were developed in Germany from the late 1870s but had their origins in the Gheel Colony in Belgium. Gheel had traditionally originated in medieval times as a place of pilgrimage to the shrine of St Dymphne which had gained a reputation for curing the insane. Pilgrims were boarded in the village and gradually it developed into a mental colony. In the nineteenth century the Belgian government placed its administration under the control of a Commissioner and Board of Governors. [2]

Screen Shot 2016-02-20 at 15.41.44
Plan of Altscherbitz Asylum, Germany, from Sibbald’s Plans of Modern Asylums for the Insane Poor, 1897

One of the most influential of the later colonies, was the Alt Scherbitz (now Altscherbitz) village asylum near Leipzig, established in 1876 for 960 patients. Its layout was published by John Sibbald, a Commissioner in Lunacy for Scotland, in 1897 in his Plans of Modern Asylums for the Insane Poor. At Altscherbitz, the site was naturally divided in two by the high road between Halle and Leipzig and this separation was used to divide the medical and non-medical sections. Gender informed the first level of classification, with the women’s houses to the west together with the kitchen and laundry, and the men to the east where a brick works provided manual labour.

The ground plan of Brislington House, near Bristol, a private asylum established by Dr Fox. The patients occupied detached houses arranged as a terrace. The plan dates from 1806. Reproduced from Wikimedia Commons.

This colony plan was welcomed as it seemed to offer a solution to new ideas about how the patients’ environment promoted recovery or cure. It aimed to provide recognizably domestic surroundings, emulating the home environment rather than reminding the patient that they were in an institution. There were earlier precedents for this, but in small private asylums such as Brislington House near Bristol, built in 1806.

View over to Craighouse, the colony built in 1889-94 as part of the Royal Edinburgh Asylum. Craighouse in the middle distance, ‘Morningside and Craighouse’ by Pascal Blachier, taken in 2007, imaged licensed under CC BY 2.0

The first time the colony plan was attempted on a large scale and at a public institution was at Craighouse, built as an annexe to the Royal Edinburgh Asylum in 1889-94, although this was for paying patients. It was designed by Sydney Mitchell in close collaboration with Thomas Clouston, the asylum’s Medical Superintendent, to give architectural form to his ideas on the cure of mental illness. The buildings revived something of the palatial aspect that had largely disappeared from asylum architecture since Hooke’s Bethlem. Clouston wanted variety, in the colours of the building materials, in the architectural details, of size and of scale. Believing that patients associated phases of their illnesses with their surroundings, he particularly wanted to be able to move convalescent patients to a new environment.

Rutherford House, designed by Sydney Mitchell in 1899 and completed in 1904 as a detached infirmary or admissions hospital for paupers. The year after it opened, Sydney Mitchell went to Germany to see asylums there. Photographed in 1993, © RCAHMS

Poorer patients got their taste of the colony system a little bit later at the Crichton Royal in Dumfries, where detached houses were added in the grounds during the early 1900s. Sydney Mitchell, was the architect, and he, along with a deputation from the asylum’s Board of Management, had set out in 1897 to visit Altscherbitz and similar asylums at Biesdorp and Lichtenberg near Berlin. Such missions became increasingly common. In 1899 a deputation of the Aberdeen District Lunacy Board made a tour of continental asylums before commissioning a design for their new district asylum on the Altscherbitz model.

The former Bangour Asylum, photographed in the late 1980s. The church was added later, though always intended as the focal point of the colony.

Further colony plan asylums were built in Scotland at Bangour, which opened in 1906 serving Edinburgh, where a competition was held for the design which specified Altscerhbitz as the model, and Dykebar at Paisley which opened in 1909. Bangour is particularly significant for Bethlem: its architect, Hippolyte J. Blanc, had as one of his assistants working on the asylum plans, John Manuel, who later worked with Charles E. Elcock, architect of the new Bethlem Hospital. [3]

Rydinghurst House of 1908 at the former Epileptic Colony in Chalfont St Peter, Buckinghamshire, now the Epilepsy Society, photographed in 2011 © Copyright Nigel Cox and licensed for reuse under this Creative Commons Licence

In England colonies were built around the same time, but not as yet for general mental hospitals. Instead they were deemed appropriate in the first instance for epileptic colonies. In 1884 the National Society for the Employment of Epileptics established a home at Chalfont St Peter in Buckinghamshire. It began with just one villa, a temporary iron structure, to which further villas were gradually added.

a hospital474
Leybourne Grange Colony, Kent County Council, W. H. Robinson architect, built about 1935 for the so-called mentally deficient.

But the colony plan was most widely adopted for a new breed of asylum ushered in by the Mental Deficiency Act of 1913. A Royal Commission had been appointed in 1904 to look into the care of the feeble-minded. This at least spoke out against the sterilization of those deemed mentally deficient that was being advocated by the Eugenics Education Society, and it was this Commission which resulted, eventually, in the 1913 Act. Amongst other things, the Act sought to define mental deficiency which was considered to be present from birth and incurable, as opposed to mental illness which was usually contracted later in life and deemed curable. The Act legislated for the provision of accommodation, care and protection of the former group whose removal from undesirable surroundings was thought necessary ‘in their own interests and that of society’. The Board of Control, which replaced the Commissioners in Lunacy in 1914, recommended the colony system for these new institutions, as it allowed ‘better classification and training’ and ensured that the inmates were happier and more contented than in institutions of the barracks type.

Bethlem aerial perspective
Aerial perspective of Bethlem Royal Hospital showing proposed layout of the buildings, from commemorative booklet produced for the laying of the foundation stone.

It was a combination of these influences which lead to the adoption of a colony plan for the new Bethlem hospital at Monks Orchard. It was the first new mental hospital designed in England since the war. Elcock & Sutcliffe were appointed in February 1926 to work alongside the hospital surveyor, John Cheston. Charles Ernest Elcock was the key figure behind the design, which he hoped would ‘make a leap forward’. However, his plans still had to meet the approval of the Board of Control. While the Board was in favour of colonies, it disapproved of Modernism, thought flat roofs should be shunned, and was most comfortable with the blandest of Neo-Georgian styles.

Administration Block, Bethlem Royal Hospital, photographed in 2008

Unsurprisingly relations were often frosty between Elcock and the Board’s architect John Kirkland, and indeed Sir Frederick Willis, Chairman of the Board from 1921 to 1928. Willis criticized the ‘generous scale’ of the rooms, which he suggested were due to Elcock trying to balance the buildings, while Kirkland queried the necessity for Turkish Baths, and took a great deal of convincing over the flat roofs, which were only used on the peripheral buildings on the site. After much wrangling, the amended designs were approved and detailed drawings submitted in December 1928. [4]

Elcock Bethlem chapel from SW
Bethlem Hospital chapel, photographed in about 2008 (© H. Richardson)

It may have been the pressure of work involved in the Bethlem job that prompted Elcock to seek an assistant in 1928. He appointed Ralph Maynard Smith, a young man in his mid-twenties, who was as much an artist and a poet as an architect. Maynard Smith had studied at the Architectural Association, and spent a brief time working with the architect Michael Waterhouse immediately before joining Elcock & Sutcliffe. There undoubtedly were other assistants in Elcock’s office, making it difficult to know who did what in the design and planning process. A building at Bethlem where Smith’s influence may be felt is the chapel. It is a beguiling building, quite unlike the many hum-drum Gothic asylum chapels of earlier years. Its design was obviously considered a success as it was elaborated upon a few years later at Runwell Hospital in Essex, also by Elcock & Sutcliffe.

Bethlem chapel interior
Interior of Bethlem Hospital chapel, photographed around 2008 (© H. Richardson). It is all but identical to the interior of the chapel built for Runwell Hospital in Essex (below), although the exteriors were different, Runwell also had a tower – planned for the chapel at Bethlem but later omitted.
Interior of Runwell hospital chapel, probably photographed soon after the building was completed, from a collection of negatives at the hospital leant to the author.

Stylistically Bethlem presents something of a mix, from the conservative administration block, with its hipped roof and Neo-Georgian simplicity to the starkly modern boiler house and flat-roofed patients’ accommodation blocks and treatment unit. Elcock laid an emphasis on the setting to give attractiveness to the buildings with ‘pleasing roads, avenues, flower borders, etc’. [5]

Bethlem quiet unit perspective
Architectural perspective sketch of the quiet patients’ unit, unlike the Neo-Georgian administraton block, most of the patients’ villas had flat roofs, and if not strictly modernist, in this sketch, taken from a brochure produced by the hospital, there seems to be an echo of contemporary Dutch or German architecture

Elcock set new standards in the scale and type of accommodation he provided which included laboratories, hydrotherapy facilities, a lecture room for students, and a separate treatment and research block. The sexes were no longer strictly segregated either: male and female patients shared buildings, from the more severe ‘excited’ patients to convalescents. Elcock researched his subject thoroughly, touring the country to visit the best new buildings added to older hospitals, and consulting medical staff.

Bethlem treatment block perspective
Architectural perspective of the Treatment and Research Unit, Bethlem Royal Hospital brochure.

In the end the design was compromised both by the restrictions imposed by the Board of Control and the necessary cost-cutting in the face inflation in the years after the General Strike. But if it wasn’t quite the magnificent hospital originally proposed, it was certainly well-equipped and incorporated many innovative features. There were four main villas for patients, two for quiet cases, one for ‘excited’ patients, the fourth for convalescents. Nearly all the patients were accommodated in single rooms, in line with private general hospitals and in contrast to tendency towards dormitories in municipal mental hospitals. In addition to the patients villas there were the usual service buildings – kitchens, boiler house, stores etc, and the innovative Treatment and Research unit, which provided hydrotherapy, psychotherapy, dental and electrical treatment, pharmacy, and operating theatre. [6]

Today the core buildings are little altered, but many of the outlying buildings have had many alterations and newer buildings have been added to the site to meet the changing needs of mental health care. In recognition of the hospital’s historic importance there is a museum on the site, the Museum of the Mind, which opened in 2015.


  1. Survey of London, vol.25 St George the Martyr, Southwark and St Mary Newton, Ida Darlington ed. 1955, p.78 (online version at British History Online): Jonathan Andrews, Asa Briggs, Roy Porter, Penny Tucker and Keir Waddington, The History of Bethlem, Routledge, London and New York, 1997, pp.503ff
  2. H. Richardson ‘A Continental Solution to the Planning of Lunatic Asylums 1900-1940’ in J. Frew and D. Jones (eds) Scotland and Europe, Architecture and Design 1850-1940, 1991
  3. H. Richardson ‘Charles Ernest Elcock’ in Essays in Scots and English Architectural History, 2009, p.122
  4. Bethlem Royal Hospital Archives, Special Commitee Minutes, 1928 pp. 194, 196-7, 291
  5. Bethlem Royal Hospital Archives, Special Commitee Minutes, 1926-7, p.34
  6. Jonathan Andrews et al, History of Bethlem, p.566

Building Bedlam – Bethlem Royal Hospital’s early incarnations

From City fringe to St George’s Fields

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.

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]

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.

The 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 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
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]

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.

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: seen Credit: Wellcome Library, London. Wellcome Images The Hospital of Bethlem [Bedlam] at Moorfields, London: seen from the south, with 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. 1812-1814 By: John Thomas Smithafter: Robert HookePublished: 15 September 1814 Copyrighted work available 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]

Aske’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.

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 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
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]

Imperial War Museum, photographed January 2014


  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 Bethlem 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

Marvellous Maps – updating the Scottish Hospitals Survey

Probably the best source that I have been using for updating the Scottish Hospitals Survey is the National Library of Scotland’s map images. Maps are always key to charting the history and development of buildings, settlements and indeed the landscape. And the best thing of all is that the NLS is freely available to all. It is a wonderful resource.

Athole & Breadalbane Union Poorhouse (see Perth & Kinross). Extract from the 1st Edition OS Map, surveyed in 1863. Reproduced by permission of the National Library of Scotland

Many of the maps, and for me particularly the first edition Ordinance Survey maps and large scale town plans, are things of beauty as well as mines of information. Being so used to the grey tones of most nineteenth-century OS maps, the vibrant pinks and reds of the buildings, buff or ochre paths and roads, and the blues of river and sea, are also a joy.

Kelso dispensary, Roxburgh Street, founded in 1777 (see Borders).  Extract from the 1st edition OS map, surveyed in 1858. Reproduced by permission of the National Library of Scotland

For anyone interested in public buildings these maps are especially useful as they give ground plans, and often room uses as well.

Barony or Barnhill Poorhouse was completed in 1853, so this map was produced just a few years after it opened (see Glasgow). Extract from 1857 Town Plan of Glasgow, reproduced by permission of the National Library of Scotland
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Detail of the OS large-scale Town Plans, showing the central part of Barony Poorhouse.

I have never been sure about how to interpret the mapping of gardens, some seem too generic to be completely accurate representations, although the general layouts, or features such as embankments, paths, ditches etc. are more likely to be as existing. If anyone knows more, please do enlighten me. Looking at the detail of Barony Poorhouse above, the arrangement in the airing yard with diagonal paths leading up to a viewing area with seats seems too unusual not to be an accurate depiction of an actual feature.

The former Crichton Royal Asylum (see Dumfries & Galloway). Extract from the 1st edition OS map, surveyed in 1856. Reproduced by permission of the National Library of Scotland

The Crichton Royal  – what at first site might look like elaborately laid out formal gardens around the cruciform building are in fact the earthworks of the different airing grounds.

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Detail of the former Crichton Royal Asylum. Extract from the 1st edition OS map, surveyed in 1856. Reproduced by permission of the National Library of Scotland

Zooming in it becomes clearer. The airing grounds were walled enclosures, to prevent escape, but in order to allow the patients to see over the confining walls the ground within was built up to form a flat-topped mound. Bowling greens are shown close by the Crichton Royal and the Royal Edinburgh Asylum (below).

Royal Edinburgh Asylum (see Edinburgh). Extract from the large-scale town plans, sheet 50, surveyed in 1852. Reproduced by permission of the National Library of Scotland

Comparing different editions of the maps show how an institution was added to and changed. Between 1852 (above) and 1876 (below) wings were added to the main asylum building to the west, extending into the walled airing grounds.

Royal Edinburgh Asylum. Extract from the OS Large-scale Town Plans 1876. Reproduced by permission of the National Library of Scotland

The grounds of the East Division of the Royal Edinburgh Asylum not only have a bowling green, but what appears to be an orchard with paths crossing it, a formal flower bed (on the west side), shelter belts of mixed trees, and, on the east side, a cruciform feature which, on zooming in, is marked as a bower.

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Detail of the 1852 map, showing the Bower in the asylum grounds, with a cage marked at the centre where the paths cross. 

The cage presumably was an aviary. Caged birds were recommended for lunatic asylum patients in the mid-nineteenth century, along with potted plants and pictures, to provide objects of interest and an air of domesticity.

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Perth poorhouse (see Perth & Kinross), later Rosslyn House, council offices. From the OS large-scale town plans, 1860. Reproduced by permission of the National Library of Scotland

Perth poorhouse can be seen in splendid isolation, the wrong side of the railway tracks and very much on the outskirts of the city. The map was produced in 1860, the year after the poorhouse was built.

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Perth Poorhouse, detail. OS large-scale town plans, 1860. Reproduced by permission of the National Library of Scotland

The National Library of Scotland site allows you to zoom right in. The plan of the poorhouse above shows the room uses, positions of doors, windows and stairs. It shows the divisions within the poorhouse – women on one side and men on the other – and the separation of the aged and children from the able-bodied adults. You can also see that the managers had grander rooms, placed either side of the main entrance, which had bay windows (the Board Room and the Governor’s Office).

Finally, a note for anyone not of a Scottish persuasion. The NLS has maps of Northern Ireland, Wales, and, dare I say it, even England.

King Edward VII Estate: Midhurst Sanatorium

Following on from the post featuring Midhurst Sanatorium chapel, I wanted to look at the main Sanatorium building. It is one of the most important former sanatoria in England and one of the most attractive. Latterly the King Edward VII Hospital, it closed in 2006 and remained empty for some years after. The sanatorium building and chapel were listed Grade II* and the gardens registered, conferring a degree of protection for these important buildings and imposing restrictions on the re-use and redevelopment of the site. Nevertheless, by 2012 the condition of the buildings had deteriorated and the chapel was placed on the Heritage at Risk register. In 2015 work began on the redevelopment of the site, turning it into a luxury estate, by the developers City and Country.

A rather scratchy slide from June 1992 of the King Edward VII Hospital, as it then was.

As the name of the hospital implies, the origins of this sanatorium were closely linked with Edward VII. Having decided to fund the erection of a sanatorium in England for patients suffering from tuberculosis, in 1901, the year that he acceded to the throne, the king appointed an advisory committee comprising some of the leading medical men of the day to ensure that it should be of the most up-to-date design. There were six men on the committee: Sir William Broadbent Bt KCVO; Sir Richard Douglas Powell Bt KCVO; Sir Francis Laking KCVO; Sir Felix Semon; Sir Hermann Weber; and Dr C. Theodore Williams. In February 1902 the committee announced in the medical press of Europe and America that a competition was to be held for an essay and plans for the erection of the sanatorium. There was no restriction as to the nationality of the entrants, and they might be either from medical men or jointly from a medic and an architect (but not just from architects). The sanatorium was to provide for 100 patients, equally divided between the sexes, of which 88 beds were to be for the ‘necessitous classes’ the remaining 12 set aside for the well-to-do. All the accommodation was to be comfortable, with a single room for each patient, though with ‘superior arrangements’ being made for the wealthy patients. The building was to have the latest sanitary fittings and have facilities for scientific research. Entries were to be anonymous, but have a motto to distinguish them. The king was to provide £800 in prize money, awarding £500 for the best entry, then £200 and £100 for second and third place.

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Arthur Latham deposited this bound edition of his prize-winning entry in the library of the Royal College of Physicians. It has been digitised by the internet archive

There were 180 entries, and the winners were announced in August 1902. The top prize went to Dr Arthur Latham of London and William West, architect, also from London (motto – ‘Give him air, he’ll straight be well’). Second prize went to Dr F. J. Wethered with Messrs Law and Allen, architects, also all from London (motto – ‘If preventable, why not prevented?’), and third prize to Dr E. C. Morland with Mr G. Morland, architect, both of Croydon (motto – ‘Vis Medicatrix naturae’, roughly ‘the healing power of nature’, a motto associated with the nature cure movement).  On the architectural side, these were not well-known names. There were four honourable mentions, amongst whom were some better-known architects: Dr P. S. Hichens of Northampton submitted his essay in association with the architect Robert Weir Schultz, and Dr Jane Walker with Smith & Brewer. The only non-English entrant that featured in this list was the celebrated Dr Karl Turban of Davos whose architect was J. Gros. The final honourable mention went to Dr J. P. Wills of Bexhill, with Mr Wills, architect, London.

In the mean time the site had been chosen, at Midhurst in Sussex (now West Sussex). But the commission to design the new sanatorium did not go to Latham’s little-known architect William West, but to H. Percy Adams, presumably considered a safer pair of hands as he was already a well-experienced hospital architect. Since 1898 Charles Holden had been in Adams’ practice, and the final design for Midhurst Sanatorium bears the hallmarks of Holden’s characteristic style.

Aerial perspective of the ‘King’s Sanatorium’ as designed by H. Percy Adams and Charles Holden in 1902, published in Academy Architecture, 1903

To assist them in drawing up the design Adams and Holden had the benefit of Latham and West’s essay and plans, but they also visited sanatoria in Germany and Switzerland – Edward VII had been particularly impressed by the sanatorium at Falkenstein in Germany. The aerial perspective above shows the arrangement of the building. The patients were to occupy the shallow-V-shaped range to the right, which faced south, behind which was a U-plan administration block. These two ranges were linked by a central corridor. The admin block contained suites of offices, the committee room and service rooms, as well as an operating theatre, X-ray and casualty rooms, laboratories, a medical library, and the patients’ dining hall.

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Plan from Latham and West’s essay. Their preferred scheme was to provide separate blocks for the wealthy and necessitous patients, this plan being the block for the more wealthy patients. 
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This was Latham & West’s alternative plan, which housed the wealthy and necessitous in one building. Both plans have elements in common with the designs drawn up by Adams & Holden.

Edward VII retained his interest in the progress of the sanatorium, laying the foundation stone on 3 November 1903. Delays in construction, in part over the water supply, caused the king some vexation, but it was finally opened on 13 June 1906.

The main front of the sanatorium, photographed in June 1992

The patients’ wing to the south was symmetrically arranged with a taller central block of three storeys. The ground floor breaks forward, its flat roof providing a terrace for the rooms on the first floor. Within were two spacious recreation rooms on the ground floor, one either side of the central corridor which marked the division of the sexes (males on the west, females on the east side). There were also hydro-therapy rooms flanking the garden entrance. Each patient had a separate room, as the original competition rules had required.

Midhurst Screenshot
Photograph of the sanatorium taken c.1950. (Image kindly supplied by W. Parker.)

The rooms faced south and opened on to a terrace or balcony. Bathrooms and WCs were provided in sanitary towers to the north of the patients’ corridor that ran along the back of their rooms and at the far ends of the building. The wealthier or higher class patients had slightly larger rooms with private balconies situated in the central range, while the lower-class patients occupied the wings.

Detail of the central gabled bay, June 1992
One of the stone alcoves on the south front, which provided a secluded shelter

The furnishings and fittings combined hygienic and aesthetic requirements. Washable wallpaper was used in the patients’ bedrooms, an early use of this new product in England, and the floors were of wood blocks. Moulmein teak was used for the staircases which was less susceptible to fire than other, coarser grained wood. The dining-hall and kitchen walls were lined with Doulton’s Carrara tiles.

Midhurst aerial scr
Postcard with aerial view of the sanatorium. (Image kindly supplied by W. Parker.)

A formal garden was designed for the area to the south of the main building by the horticulturalist Gertrude Jekyll. Her layout, of gardens built on terraces on several levels, with buttressed stone walls separating one level from another, follows closely the scheme indicated by Adams in his perspective drawing. Lawns and flower beds were laid out on the terraces, and various shrubs, flowers and aromatic herbs were planted, many supplied personally by Jekyll. She also designed small gardens to fill the spaces between the administration block and the patients’ wings, again following closely Adams’ original designs. The work was carried out under Jekyll’s direction by two gardeners aided by some of the patients.

A. Latham The Prize Essay on the erection of a sanatorium for tuberculosis… 1903
Academy Architecture, 1903, ii, pp.116-9
F. Allibone, typescript notes to collection of drawings by Adams, Holden & Pearson in RIBA Drawings Collection
The Builder, 23 May 1903, pp.531-2; 22 April 1905, pp.440; 23 June 1906, p.707
Building News, 27 May 1904, p.761
Kelly’s Directory of Sussex 1934, 1934, p.243
S. E. Large, King Edward VII Hospital Midhurst 1901-1986, 1986
I. Nairn & N. Pevsner, The Buildings of England: Sussex, 1965

see also urbexer’s exploration of the site from 2012 on 28dayslater

Dry January? Head for a Hydro! A brief look at Victorian hydropathic establishments in Scotland

After the feasting and convivial drinking over Christmas and the New Year, a dry January has become increasingly common. The adverse effects of alcohol on our health are widely known and understood today, as are the benefits of keeping well hydrated, preferably by drinking plenty of water. These twin truths go a long way to explain why hydropathic establishments and spas have survived long after other institutions offering specialist treatments have either disappeared or remain rare.  Sea-bathing, anti-vivisection, galvanic, and mesmeric hospitals all had their promoters and supporters from the eighteenth into the twentieth centuries, though widely condemned by the medical profession. But a water cure, particularly if it was balanced with exercise in country air and abstinence from alcohol, did few any harm and benefitted many.

Shandon Hydro library of congress
Shandon Hydro, Helensburgh, image from National Library of Congress. West Shandon House, built in 1851, was altered and greatly extended by Peddie & Kinnear in the 1870s to turn it into a fairy tale castle of a hydropathic establishment.

Spas and Hydropathic establishments are generally set in attractive locations, occupying imposing buildings, and have not been neglected by historians. Health tourism has been studied both from an architectural and historical perspective in recent years. [1] Hydros had their heyday in Scotland in the later nineteenth century, the Shandon Hydro at Helensburgh and the Dunblane Hydro were both built to designs by Peddie & Kinnear in the 1870s. By that time they had become popular as health resorts and were often closely linked to the temperance movement. They attracted the healthy as well as the invalid, and water treatments began to subside in importance. Unsurprisingly, in terms of architectural planning later hydros were little different from hotels, only the treatment rooms set them apart.

Dunblane Hydro, designed by Peddie & Kinnear 1875. Image from National Library of Congress 

The water cure had been introduced into Britain from the Continent in the mid-nineteenth century, as a separate medical strand from taking the waters at a Spa. For the water cure primarily concerned water as an external treatment, with baths, douches and other inventive ways of applying water to the body. Hydropathy was big business in England and Wales before it gained much ground in Scotland. The first hydropathic establishments north of the border were small, located at Rothesay, Dunoon and Aberdeen. [2]

L0010944 Graefenberg: Hydropathic Establishment of Vincent Priessnitz Credit: Wellcome Library, London. Wellcome Images Graefenberg: Hydropathic Establishment of Vincent Priessnitz, circa 1839 Life of Vincent Priessnitz Metcalfe, R. Published: 1898 Copyrighted work available under Creative Commons Attribution only licence CC BY 4.0
Graefenberg, Hydropathic Establishment of Vincent Priessnitz, from the Wellcome  Library reproduced under under Creative Commons Attribution only licence CC BY 4.0

At Rothesay the hydro was set up in 1843 by Dr William Paterson who had visited Vincent Priessnitz, the founder of the water cure movement, at Graefenberg. Paterson’s hydropathic establishment occupied Glenburn House, overlooking Rothesay Bay on the Isle of Bute. The house was converted to provide accommodation for just ‘a few invalids’. [2] Unlike Priessnitz, Paterson combined the ‘judicious use of medicine’ alongside cold water in his treatments. The hydro was successful and underwent a number of additions before it was rebuilt in the 1890s following a fire. [3]

Glenburn hydropathic Rothesay
Glenburn Hydro, Rothesay from Wilson’s Guide to Rothesay and the Isle of Bute, 1848

The short-lived hydro at Dunoon was established in 1846 by another Scottish doctor who had been directly inspired by Priesstnitz, Dr Rowland East. It too was in a converted house, which was situated near the recently built Kirn Pier, on the banks of the Clyde. Here water treatment was combined with a regime of sea-water bathing.  The third hydro, opened at Aberdeen in 1850, was perhaps the most influential, but it was begun not by a doctor but a churchman, the Reverend Alexander Munro. Munro belonged to the Evangelical Union, and his interest in hydropathy was very much a product of his faith, providing scope for ministering to both the physical and spiritual needs of his flock. [4]

Extract from the 1st edition OS map, surveyed in 1867, showing the Aberdeen hydro at Loch-head, (just west of the Royal Lunatic Asylum). Reproduced by permission of the National Library of Scotland. Alexander Munro moved the hydro here in 1853 from Angusfield, where he had begun his hydropathic establishment in 1850.  [5]

Munro’s Aberdeen hydro proved sufficiently successful to warrant additions to the house at Loch-head. He built a new wing ‘of three storeys, two of these having fine oriel windows’. The new wing contained a dining room, drawing room and recreation room in addition to further bedrooms. Later he added a Turkish bath, in moorish style. In 1864 Munro left for the new Cluny Hills Hydro and his position at Loch-head was filled by Dr Meikle, for whom it proved a stepping stone to founding a new purpose-built hydro at Crieff.

Bridge of Allan Hydro, National Library of Congress

The Allan Water Hydropathic establishment was built in 1861-4 to designs by a lesser Glasgow architect James Hamilton, and was an early work in his career. Soon after he was commissioned to design the West of Scotland Seaside Home at Dunoon (later remodelled as the Dunoon Hydro), the Glasgow Hydropathic and Turkish Bath, and possibly designed extensions to the Glenburn Hydro, Rothesay. James, his son John and grandson Arthur were all closely associated with Rothesay and designed a number of villas thereabouts.

Strathearn Hydro, Crieff.  Library of Congress

The Hydro at Crieff is possibly the best known Scottish hydro, and one of the few to survive as a hotel to this day. It was first opened as the Strathearn Hydro in 1868, built for the not inconsiderable sum of £30,000 and founded by Dr Thomas Henry Meikle, on the back of the success of the Loch-head hydro at Aberdeen. The original building was designed by Robert Ewan, an architect and engineer who was commissioned in 1866 while still working as an assistant architect to J. Russell Mackenzie in Aberdeen. The early success of the establishment is attested by the almost immediate need to extend the accommodation, first with attic bedrooms in 1872, then in 1875 the dining and drawing rooms were extended. Further substantial additions were made in 1888 and 1894, and a winter garden was added in 1903-5. Ewan and his architect sons, Robert and Charles, were retained for these additional works. They were not foremost amongst Scottish architects, and the hydro is not the finest piece of architectural design, but it has distinct charm and a lively roofline of turrets and gables.

The Winter Garden from Strathearn Hydro’s souvenir brochure produced in the 1950s.

During the Second World War the Strathearn Hydro at Crieff was requisitioned by the army, it partially re-opened in 1949 and after refurbishment a souvenir brochure was produced to entice new visitors and encourage former guests to return. It advertised various sports: golf, tennis and croquet out of doors, billiards and a swimming-pool in doors. It also boasted 58 separate ‘lock-up’ compartments for motor cars. The medical side had not been entirely abandoned, there was a physiotherapy department, which it was hoped would prove increasingly helpful in the treatment of rheumatism ‘and in the restoration of function’. [6]  It remained dry, though, until the 1970s, when the management finally applied for a table licence. [2]

[1]  Phyllis Hembry, British Spas from 1815 to the Present… 1997: J.Bradley, M. Dupree, and A. Durie ‘Taking the Water-Cure: The Hydropathic Movement in Scotland, 1840-1940’ in Business and Economic History, vol.26 no.2, Winter 1997 pp.426-37: James Bradley ‘Medicine on the margins? Hydropathy and orthodoxy in Britain, 1840-60’ in Waltraud Ernst ed, Plural Medicine, Tradition and Modernity 1800-2000, Routledge, 2002: Allan Brodie, Travel and Tourism in Britain, 1700 – 1914, 2014: Eric Zeulow, A History of Modern Tourism, 2015.
[2] Alastair J. Durie, Water is Best The Hydros and Health Tourism in Scotland 1840-1940, 2006
[3] John Wilson, Wilson’s Guide to Rothesay and the Isle of Bute, 1848: Richard Metcalfe, The rise and progress of hydropathy in England and Scotland, 1906, p.157
[4] Alastair J. Durie ‘”The drugs, the blister and the lancet are all laid aside” Hydropathy and medical orthodoxy in Scotland, 1840-1900’ in Repositioning Victorian Sciences: Shifting Centres in 19th century… D. Clifford, E. Wadge, A. Warwick, M. Willis eds, 2006
[5] ‘Aberdeen in Byegone Days’, Aberdeen Journal, 30 Sept 1909, p.2
[6] Strathearn Hydropathic Crieff, souvenir brochure printed by David Philips, Crieff, n.d. but describes the hydro as being 90 years old.

Lunatic at Large: an escaped patient from Ayr District Asylum

The former Ayr District Asylum, now Ailsa Hospital photographed in 2008. The building to the left is one of the villas built in 1899 © Copyright Mary and Angus Hogg and licensed for reuse under this Creative Commons Licence

‘Lunatic at Large’  was the sensational headline in the Glasgow Herald, at the end of November in 1871 of a sad story about a woman in her 30s who had escaped from the Ayrshire District Asylum at Glengall, just south of Ayr (now Ailsa Hospital). She was named as Christina Morton or Reid. Her story made the headlines because it was linked to the disappearance of two young children, a girl of about five or six years of age and a boy of just two and a half, who had been sent by their mother to fetch milk from the dairy, a few doors from their house in Mill Street, around seven o’clock in the evening. When after an hour they had failed to return the mother first searched for them at her neighbours’ houses and then raised the alarm. A diligent search was made, even of the river Ayr which ran past the foot of the gardens in Mill Street, but no trace of the children could be found. All the inhabitants of Mill Street ‘were running in search of them in all directions’. While the search was underway the police received a report that a female patient had escaped from the District Asylum that afternoon. And so the story unfolded:

Near midnight…

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It is a pitiful tale. Ayr District Asylum had only been opened for a couple of years in 1871. Evidently she was returned to the asylum, as she is listed as a patient there in the 1881 census.

Glasgow Herald, 30 Nov 1871 p.4
Scotland Census 1881

Hospitals for Incurables: the former Longmore Hospital, Edinburgh

Historic Scotland Offices in the former Longmore Hospital which closed in 1991 ©Copyright kim traynor and licensed for reuse under this Creative Commons Licence

Separate hospitals for incurables began to be established in Britain in the mid-nineteenth century and were welcomed by some, condemned by others. Andrew Reed, who founded the hospital for incurables in Putney in 1854 (which eventually became the Royal Hospital for Neuro-disability) firmly believed in the need to offer relief to such unfortunates, and had a few years earlier founded Royal Earlswood Asylum, for those with incurable mental disorders. While the Poor Law provided care for those who had been rendered destitute by their chronic illness, there was little provision for those above the poverty line, whose physical or mental condition was often made worse by their living conditions. Cancer, tuberculosis, rheumatism, paralysis, deformity and spinal disease or injury, were chief amongst the illnesses that were unwelcome in general hospitals because of the length of time a patient suffering from chronic disease occupied a place on the ward. The Middlesex Hospital in London was rare in having a cancer ward, established in 1792.

The first specialist cancer hospital in Britain was in London, opening in 1852 in a converted house in Fulham Road. Its founder was William Marsden, and his Free Cancer Hospital became known as the Royal Marsden in 1954. Other early cancer hospitals were established in Leeds (around 1858), Liverpool (1862) and Manchester (1871), although these did not just treat cancer. The first specialist cancer hospital in Scotland opened in 1890 in Glasgow (later the Beatson Memorial Hospital). The discovery of X-rays, radioactivity and radium in the late nineteenth century introduced new treatments and radical surgery.

By the late nineteenth century hospitals for incurables had become an established type.  Henry Burdett, the great chronicler of hospital planning and design in this period,  provided advice on what form such hospitals should take, reproducing plans of the Jaffray Hospital in Birmingham by way of an exemplar. This was a distinct hospital plan type, more analogous to a convalescent home where patients similarly might not be confined to bed all day. Day-rooms, sitting-rooms, libraries and smoking-rooms, with easy access to the open air, whether a balcony, verandah or garden, were considered desirable in hospitals for incurables. Wide corridors to accommodate wheelchairs, and a lift to access upper floors helped patients get about, and, Burdett urged, there should be  ‘an absence of everything which will tend to promote waste of energy of every kind’

In Scotland the first hospital for incurables was founded in Aberdeen in 1857, opening in a private house in Morningfield the following year. In 1874 the Scottish National Institution for the Relief of Incurables was established and this lead to a number of hospitals being founded. That in Edinburgh first opened in 1875 with accommodation for 22 patients, the Edinburgh Association for Incurables having purchased a house for the purpose at 3 Salisbury Place which was enlarged and altered at a cost of £3,265 142d, plus another £300 or so for furniture and fittings. Within a year of its opening, the management committee was already hoping to add separate wards for cancer cases.

Town Plans 1877
Extract from the OS Large Scale Town Plans, 1877. Reproduced by permission of the National Library of Scotland. The Longmore Hospital is the building on the north side of Salisbury Place set furthest back from the road, with two rear wings. 

The inadequacy of the original house lead to the acquisition of adjoining properties and rebuilding on the site. The patients were evacuated to a house in Fisher Row until the new hospital was completed at the end of 1880. Most of the cost was met by the trustees of J. A. Longmore, and the name of the hospital changed to honour this generosity.

Efforts to expand continued, Nos 6 and 7 Salisbury Place were purchased and fitted up for patients in 1886.

A visit from the Lord High Commissioner from RCAHMS

The Lord High Commissioner made more than one visit to the hospital, so it is hard to date the photograph. In May 1890 he paid a long visit with Lady Tweeddale, and in June 1894 The Lancet reported that the Lord High Commissioner and the Marchioness of Breadalbane had paid their ‘usual visits to the various hospitals in Edinburgh’ on which occasion the Marchioness opened a bazaar at the Longmore.

In 1891 plans for enlarging the hospital were approved which involved pulling down the old east wing of the building. This was to make way for a ‘more suitable wing’ which was intended to provide accommodation for 34 additional patients, with two 14-bed wards, nurses’ rooms, lavatories, kitchens, but no mention of where the other six patients were to be fitted in.

Women’s ward from the ‘old East wing, now demolished’, from RCAHMS

The OS map below from 1893 shows how much the hospital had evolved in the relatively short time since it first opened.

large town plans 1893
Extract from the OS Large Scale Town Plans, 1893. Reproduced by permission of the National Library of Scotland.

Princess May and the Duke of York opened the new East Wing in 1891.

Princess May Ward. From RCAHMS

The west wing was added in 1899, along with a new laundry, kitchen, chapel and mortuary, and electric lighting was installed. The new wing, of two storeys over a basement, was attached to the main building by a ‘wide corridor of iron and glass’. The ground floor was set apart for phthisical (TB) patients, the upper floor for cancer.

The map below from 1905 shows this later phase of the development.

1905 revised OS
Extract from the 2nd edition OS map, revised 1905. Reproduced by permission of the National Library of Scotland. 

A series of photographs of the interior of the hospital has been preserved in the National Monuments Record of Scotland, and provide a glimpse of what life was like there for patients and staff. The photographs seem to have been taken in the 1890s as a record of the new additions to the hospital, though as we have seen, they include at least one photograph of older parts of the hospital prior to demolition.

Interior of a ward for female cancer patients. The cancer wards along with the TB wards were probably in the 1899 addition which comprised a two-storey and basement wing connected to the main building by a broad glazed corridor. From RCAHMS
And its counterpart for male cancer patients. From RCAHMS
Interior of a ward for male TB patients, from RCAHMS
A private ward, from RCAHMS
It is particularly poignant to see children in hospital, but even more so in a hospital for incurables. From RCAHMS
Not all patients were confined to bed, here is a ‘recreation room’ for male patients. From RCAHMS
Probationer Nurses’ drawing room. From RCAHMS
The main hospital kitchen, rebuilt in 1899. From RCAHMS
A ward kitchen. From RCAHMS

References: H. C. Burdett, Hospitals and Asylums of the World, vol.3, 1893, pp.303-5: The Lancet, 4 July 1891, p.47; 6 Feb 1892, p.336, 9 June 1894, p.1476; 14 Jan 1899, pp.125-6: Edinburgh Evening News, 4 Feb 1876; 11 Nov 1880; 15 June 1886, p.2

see also: Lothian Health Services Archive blogspot and Building up our Health pp. 92-3