Our English heritage

English Hospitals 1660-1948 - A Survey of Their Architecture and Design. The Royal Commission on the Historical Monuments of England. Edited by Harriet Richardson. L35 excl P&P. ISBN 1 873592 29 9.

The 2000 hospitals documented by the RCHM here give a timely overview of the building stock that was inherited 50 years ago on the formation on the NHS. In addition to the main categories (general hospitals, workhouse infirmaries, infectious diseases hospitals and mental hospitals) there are chapters on cottage hospitals, those for the Armed Forces, specialist hospitals and convalescent establishments. The book succeeds as a fascinating mine of social history, as well as reflecting trends in medical science and in architectural taste and practice.

In the Middle Ages `hospitals' cared for travellers and the aged as well as the sick. After the dissolution of these monastic foundations, St Mary of Bethlehem ("Bedlam"), St Bartholomew's, and St Thomas' were for some time the only true hospitals in the country, although ad hoc provisions were made for victims of plague and other infectious diseases. St Thomas' was rebuilt between 1693 and 1709 - two to three storeys around courtyards Nucleus hospitals are not new in this respect. It was followed in the mid 18th century by Gibbs' rebuilding at Bart's. Military and Naval hospitals were among the finest buildings of the period. The NHS deserves a similar pride to that given to the Armed Forces in the 1900s, but its buildings have seldom given evidence of this.

The Metropolitan Asylums Board of 1867 resulted in England's first planned state hospitals; these fever and mental hospitals, together with the workhouse infirmaries, which had been of increasing importance throughout the l9th Century, formed about two thirds of the buildings of the infant NHS. Medical issues often drove design. Ideas on cross-ventilation led to the pavilion plan, as advocated by Florence Nightingale. Developments in anaesthetics and radiology steadily increased the proportion of a hospital's buildings devoted to diagnostic and treatment functions. Changing ideas about mental illness influenced the asylums, but `economies of scale' all too often overruled medical advice, and led to 2000-bed monsters.

This book gives ammunition for the eternal debate on "Can hospitals be architecture?" Gibbs designed the fine buildings at Bart's (between 1730 and 1768); these, with their Hogarth murals, are one of London's least known treasures, and a natural precursor of the modern `Art in Hospitals' movement. Other eminent architects who designed hospitals include John Wood (the Mineral Water Hospital, Bath), John Carr (York Lunatic Asylum, now Bootham Park Hospital), Gilbert Scott (Leeds General Infirmary), Waterhouse (University College Hospital), Norman Shaw (Cookridge and Queen Elizabeth's Hospital, Banstead), and Voysey, whose delightful Winsford cottage hospital at Beaworthy, Devon, is surprisingly not even mentioned.

JL Pearson was brought in to design the sumptuous neo-- Gothic chapel at Middlesex Hospital. Firms such as Adams, Holden and Pearson became notable as hospital specialists, and their Belgrave Children's Hospital at Lambeth is a good example of their early Arts and Crafts style. Notable work by Burnet, Tait and Lorne includes the Masonic hospital at Hammersmith and St Dunstan's convalescent home for blind exservicemen at Rottingdean. Frederick Wheeler is a little-- known Arts and Crafts architect, but the 1902 chapel at Mount Vernon - now well converted into a library and conference centre - is a remarkable building, with Art Nouveau influences. Many of the buildings in the book were the work of local architects and builders.

Some of the finest buildings, such as the Royal Holloway (Psychiatric) Sanatorium by WH Crossland and St Thomas' Hospital by Henry Currey are by otherwise little-- known architects. The surviving Thames-side pavilions at St Thomas' are probably the best-known and loved examples of hospital architecture in England, though their happy dialogue with the Houses of Parliament across the river was rudely shattered by the towers erected later at St Thomas'. If ever there was a case for replication of lost buildings, that was the one; Howard Goodman's alternative proposal for a linear Greenwich-type block for diagnostic and treatment functions is one of the lost opportunities of the NHS era.

Many practical considerations affected design. Fire safety was why Gibbs used separate blocks at Bart's, and why iron construction was increasingly used in the 19th century. Debates about cross-ventilation radically influenced later19th century hospitals - see also Jeremy Taylor's "The Architect and the Pavilion Hospital" (Leicester University Press, 1997). The effect of ideas on hygiene and ventilation could well be the subject of another book.

This admirable work is well-- researched and readable. A slight criticism is that it is not always stated which buildings survive, and what their present use is. A companion volume is warranted, to give examples of buildings still giving good service for hospital or other functions, and to identify endangered buildings. The changes stemming from the closure of the asylums (and of an increasing number of general hospitals) is of comparable to the dissolution of the monasteries.

Information on the National Monuments Record (NMR) archive is available on tel 01793 414600. The book is available from the NMR Centre, Kemble Drive, Swindon SN2 2GZ.

Review by Tony Noakes. health facilities planner. and formerly an architect at the Department of Health.

COMPETITION

We have three copies of this handsome 222-page hardback volume to give away to readers of Hospital Development, courtesy of the Royal Commission on the Historical Monuments of England. All you have to do to enter is answer the following question: What year was St. Bartholomew's refounded, following the Dissolution of the Monasteries? The three closest answers win, and the closing date is 1 Septmeber. Entries to "Book Competition," Hospital Development, Wilmington Publishing, Wilmington House, Church Hill, Wilmington, Dartford, Kent DA2 7EF.

Copyright Wilmington Publishing Ltd. Aug 1998
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