The German Hospital, 1988.

© Chris Dorley-Brown

By Lisa Rigg

Hospitals are the places where the community meets medicine. By studying hospitals and health centres in Hackney we aim to map a history of theses buildings. One aspect of the project is to explore how these institutions were initiated, changed and adapted with the emergence and expansion of modern medicine.

Despite the long history of the hospital this building typology features only occasionally in architectural histories, and has rarely won prestigious architecture awards. But these buildings tell us much about society and its values. Our aim is to understand why Hackney was the location and provision of so many innovative and radical healthcare institutions, and what this says about society and medical provision from the past up to the present day. Hackney, like many other densely populated and poor urban areas, has an important healthcare history that is largely dispersed and unknown to inhabitants.

In 1992, the Royal Commission of Historical Monuments in England undertook an important national architectural survey of hospital buildings, which was part published in English Hospitals 1660-1948: A Survey of their Architecture and Design (ed. H Richardson, 1998). Hackney Hospital, the German Hospital, St Leonard’s Hospital and the Mothers’ Hospital were among the 2,000 buildings surveyed.

By utilising various archives we have been able to research four institutions during the first phase of this project:

Hackney Hospital (1750-1995), formed from the infirmary at Homerton Workhouse and eventually closed when the functions were absorbed into the Homerton Hospital (part extant);

St Leonard’s Hospital (1872-present day), which grew out of the infirmary at the St Leonard Shoreditch Workhouse in the 18th century and became a general hospital between 1872 until 1984, when inpatient services were closed. It then developed as a centre for district services (extant).

The Mothers’ Hospital (1894-1986) – the Salvation Army's maternity hospital for unmarried women which became a general maternity hospital (part demolished, converted into flats);

John Scott Health Centre (1948 to present day) – situated on the LCC’s Woodberry Down Estate, this recently listed building was the first NHS health centre in the UK;

The types of institution to be found in the borough at the end of the 19th century and beginning of the 20th century, included general hospitals, workhouse infirmaries, specialist hospitals, hospitals for infectious diseases, hospices, mental hospitals, convalescent homes, asylums and health centres.

In 2011, we would like to expand this initial investigation, represented on this website, to include a further ten hospitals and healthcare buildings.

These institutions are:

The French Hospital (1865-1949) – founded in 1708, the hospital was a convalescent home for French Protestants that moved in 1865 into a chateau-inspired building in Hackney (extant, converted into a school);

Eastern Fever and Smallpox Hospital (1869-1982) – one of the earliest Metropolitan Asylum Board hospitals for infectious diseases (demolished).

St Joseph’s Hospice (1905 to present day) – one of the first hospices in the UK opened by the Irish Sisters of Charity (extant).

The Royal Infirmary for Diseases of the Chest (established 1863) – this institution was the first sanatorium for Consumption in Europe (demolished);

The Metropolitan Hospital (1836 to 1977) – this hospital in Kingsland Road was amongst the first ‘free’ hospitals in London, with one of the first Jewish wards in the country (extant);

The German Hospital (1845-1987) – established for the treatment of ‘all poor Germans’, who in the 19th century were the largest immigrant community in London. The hospital was noted for its unique nursing provision staffed by Protestant Deaconesses from the Keiserwerth Institute in Germany (extant, converted);

St John’s Hospital for Diseases of the Skin (established 1868), an early specialist hospital (demolished);

The Mother and Child Welfare Centre (1923 to 1991), which was one of the first purpose-built mother and baby centres in the UK, designed to look ‘homey rather than institutional’. Funded by the Carnegie Trust and the Department of Health this centre was a prototype building providing advice on breastfeeding, birth control, nutrituion during pregnancy and childcare. It also provided dental care for pregnant women (extant, converted into flats);

Queen Elizabeth Hospital for Children (1866-1998) in Tower Hamlets but on the border with Hackney, was founded by two Quaker sisters in the wake of a cholera epidemic. In 1888 it moved to new premises in Hackney Road, becoming known as the North-Eastern Hospital and Dispensary;

Homerton University Hospital (1986-present day). Designed by Yorke, Rosenberg, and Mardall this hospital, the first in over 70 years, was influenced by the idea of a ‘total healthcare delivery system’ developed in line with Professor McKeon’s concept of the ‘balanced teaching hospital’ – a large complex that replaced the separate hospitals for the acutely ill, mentally ill, and for those suffering from special diseases or conditions.

Why were the buildings built in the forms that they were? Were they places designed to be “efficient mechanisms for delivering treatments” or “places of healing”? Other major questions to be asked in this study would be why so many hospitals were built in Hackney – perhaps because on the edge (green-field sites) of the eastern inner area of London, which was important for health and isolation hospitals (fever and lunatics needed to be housed without near neighbours). Also what was the role of the ‘specialist’ hospital. Consultants were the first specialists in general hospitals, but up until the 1940s ‘specialism’ was resisted. Hackney has several examples of these types of hospitals dating from an earlier period, and also two of the four ‘foreign’ hospitals in London.

In looking at the development of the individual hospitals and health centres we will look at the role of architects, patrons, medics and patients in their design. Medics, as the ‘user’, have understandably had an important and central role in the design of these institutions, unlike in the development of many other building typologies where the ‘user’ has been marginalised in the design process. We would also look at how the patient may have influenced the design of these institutions; and whether views, gardens, outside spaces, and art were incorporated into the design as a way to improve medical outcomes and wellbeing. Also, many of Hackney’s hospitals were built in the 19th and early 20th century when current technologies, with their diagnostic and therapeutic capabilities, did not exist. Therefore, many of these institutions were designed to give patients the best chance of recovery, relying on the quality of the nursing care and the avoidance of cross infection. In these hospitals the nursing or ‘bedded’ areas would have dominated – orientated to maximise sunlight, fresh air and good ventilation, which was seen to aid recovery. The hospital ‘campus’ was often extensive, with landscaped grounds in which patients could convalesce. They were often self-sufficient worlds with engineering workshops, laundries and homes for staff. The project will look at the health concerns that would have influenced their design.

Once the project is completed it will seek to try and answer some of these questions and provide further accessible outcomes for the general public to enjoy.