London County Council is formed
The county of London came into being as part of reforms to local goverment implemented in 1889. Formed from a large area of the County of Middlesex, as well as the parts of Surrey and Kent into which London was expanding, the intention had been to provide a unified administrative body for London with the exclusion of the City itself.
On its inception, the London County Council assumed responsibility for all three of Middlesex's existing asylums at Hanwell (St.Bernard's), Colney Hatch (Friern) and Banstead, as well as the planned Claybury asylum.
Surrey's recently constructed Cane Hill asylum was also included. As patients within the catchment also became the responsibility of the new council, the existing asylums were already full to overcrowding - a situation briefly rectified with the addition of Claybury and later Bexley asylums. At times of severe shortage, the Metropolitan asylums board Imbecile asylums took excess chronic patients as well as others boarded out to other county asylums.
In an attempt to provide a permanent solution to future needs, the large Horton Manor estate near Epsom was purchased and could accommodate a number of separate institutions. Once purchased a temporary asylum was immediately erected around the existing mansion buildings, with three other asylums gradually developed on park and estate farmland to keep accommodation in pace with the expansion of London itself. A separate colony for male epileptics was also built to the north.
Hospital on the hill
Aversos Compono Animos – ‘I bring relief to troubled minds’
Surrey's Third County Asylum Cane Hill opened in 1882. Designed by Charles Henry Howell, the Asylum was located in Coulsdon (today part of the London Borough of Croydon). By 1888 the hospital was extended to house 2,000 patients and was taken over by the recently formed London County Council.
Cane Hill represented the final say in "radiating ward asylums" - the pavilion blocks comprising the wards were linked to an internal horseshoe shaped corridor. The hospital was divided into female and male halves, the vertical symmetry being cut along its centre by the administration block, a chapel, a large recreation and dining hall, kitchens, stores and laundry.
Cane Hill was typical of its time, providing specialised wards for different categories of patients, with day rooms on the ground floor and dormitories and individual cells mostly on the second and third floors. Patient treatments varied (ECT and Hydrotherapy were both practised at the hospital), difficult patients were confined to cells, and those of a more clement disposition could walk the airing grounds.
Male patients were encouraged to farm the land and work in the carpenters and stores. Likewise female patients could also help with farm work, but were probably employed more extensively in the hospital's kitchens and laundry. Recreation was varied - from outdoor pursuits in the recreation fields such as cricket, tennis and swimming through to dances and theatraticals in the main hall. Howell's original plans also show a Billiard Room - although it isn't known if this was for the patients.
The hospital changed little up to the 20th century. A new nurses' home was built to the north of the site, supplementing the existing block to the back of the hospital complex. The boiler house was moved from the service road at the back of the hospital to a new, purpose built block house near the rear. But new medical breakthroughs, new ideas for the treatment of the mentally ill, and better drugs had lead to new ideas and thoughts on these institutions.
It was this new thinking that lead to the Care in the Community legislation in the early 1980s, which saw the large scale closure of practically all the Victorian and Edwardian asylums in the country. Cane Hill was not immune and the site slowly started to close down in the late 1980s with all the staff and patients leaving in the site 1991. The only exception was the medium secure unit that stood to the side of the main hospital, located in the former vicarage. The unit was managed by South London and Maudsley NHS Foundation Trust until 2008 when it closed. Patients were transferred to River House, the new medium secure unit at Bethlem Royal Hospital.
Howell's showcase and final large asylum remained empty and without use. With tangled planning considerations (some caused the hospital to be standing in the London Green Belt) the buildings stood for over 15 years, a battered testament to its robust Victorian construction. In 2008 work began to deconstruct the Cane Hill site, today all that remains are the Water Tower and Chapel both of which are listed.
Source: Simon Cornwell http://www.simoncornwell.com/urbex
Private patients welcome
In 1857, the hospital decided to no longer admit pauper patients who were now provided for in the asylums counties were obliged to build after 1845. Bethlem remained a charitable hospital but preference in future was to be given to the poor of the middle classes.
In 1882, the charity commissioners permitted, for the first time, the admission of a few paying patients. The numbers increased over time although there was a scale of graduated charges based on the ability to pay and free admission was never wholly abandoned.
The Lunacy Act
The Lunacy Act 1845 required counties to provide asylums and most of Britain's psychiatric hospitals were built over the next 25 years. Funding arrangements encouraged local parishes to move the parish poor into asylums, as these were funded by the county councils rather than the parishes.
In the mid-19th century there was more emphasis on opportunities for work and leisure as a means of facilitating recovery. For example, female patients helped around the house making beds, washing up, cleaning, sewing and working in the laundry. Male patients used capstans in the airing courts to pump water and were also employed in knitting, tailoring and mending clothes.
The ward environment became much more comfortable and was furnished with aviaries, pictures, flowers and books. Recreation and entertainment was provided, as were regular excursions for those well enough to leave the hospital grounds.
A new State Criminal Lunatic asylum was housed in two detached wings at the back of the main building. It was built and maintained at Government expense with the Home Office controlling admissions and discharges - often at odds with hospital advice. Increasingly unpopular with Bethlem's governors, these wings were always overcrowded and in 1863 were replaced by a new institution at Broadmoor in Berkshire.
During the course of the 19th century, a network of county lunatic asylums gradually formed in Britain, prompted in part by new mental healthcare legislation. Bethlem's response to this was to change its profile from that of a hospital for 'pauper lunatics' to one for the middle and skilled labouring classes.
St George's Fields
The new Bethlem Hospital was built and maintained at government expense with the Home Office controlling admissions and discharges - often at odds with hospital advice.
By 1815, the increasing patient numbers and the crumbling building on the Moorfields site meant that Bethlem Hospital moved again, this time to St George's Fields, Southwark. A larger number of smaller wards in the new building allowed for a better system of classification, so that quieter patients and convalescents could be separated from the more seriously disturbed. Following a parliamentary inquiry into the treatment of patients, blocks for the 'criminally insane' were built over 1815 to 1816.
Bethlem's impressive building at St George's Fields, which was subsequently taken over by the Imperial War Museum, boasted a chapel to accommodate 220 worshippers, well-kept lawns, a pigsty and stables. Social outings were introduced, with patients being escorted by nurses and attendants to Kew Gardens, the National Gallery, Brighton Pavilion and the Smithfield Cattle Show.
Bethlem changed further in response to the findings of inquiries into the hospital's management and treatment practices in both 1815 and 1851. The changes precipitated the appointment of a reforming medical superintendent, Dr W Charles Hood, and included the abolition of all forms of 'mechanical restraint' from Bethlem, and the promise of treatments underpinned by 'humane and enlightened principles'.
The Airy and Healthy Situation
The County Asylums Act 1808 gave permissive powers to the Justices of each county to build asylums, paid for by local rates, to replace the few psychiatric annexes to voluntary general hospitals. However, this development was very slow.
The Act advised Justices to 'fix upon an Airy and Healthy Situation, with a good supply of Water, and which may afford a Probability of constant Medical Assistance', and that asylum accommodation was to comprise 'dry and airy Cells for lunatics of every description'.