Hospitals

Supplementary criteria for the assessment of hospitals and workhouses

Work has recently been carried out by the Designed Landscapes team to research and identify lesser-known types of historic designed landscape: those associated with historic hospitals and workhouses. Such work is invaluable in helping to set the national context in which these sites are placed when considered for addition to the Register. As a result, the supplementary criteria below have been drawn up for these landscapes, many of which are under significant threat, and were endorsed by English Heritage's Historic Parks and Gardens Advisory Panel on 5th June 2001.

There are nine main criteria for inclusion on the Register of Parks and Gardens of special historic interest in England. They are intended to offer a flexible framework within which a detailed understanding of the subject is required in order for an informed judgement to be made. Of these main criteria, five are based on date bands, the remainder covering other areas of interest including sites which were influential on the design of other sites, or representative of a style of layout or the work of a designer of national importance, sites with strong group value, those with an association with significant persons or historic events, etc. Supplementary criteria have been provided so far for three areas: cemeteries, town squares and those sites registered for their historic associations. These are intended to aid the assessment of individual sites for addition to the Register where there are further issues to be considered than are covered by the main criteria.

Introduction
The late C18 and the C19 saw the development of a variety of purpose-built hospitals which included former lunatic asylums, epileptic and mental deficiency colonies, tuberculosis sanatoria and large scale isolation hospitals. Many of these were built with large and integral grounds, which were often modified when extra facilities and buildings were required. The NHS, during its late C20 and early C21 estate rationalisation, has followed a policy of disposing of several types of such purpose-built historic hospitals. The inevitable change of use has put the future of such sites at risk.

Workhouses can also be included in this category, as being of similar structure to county asylums, with confined airing courts for the inmates and kitchen gardens/farmland for them to work on. Many of these landscapes have been largely degraded when converted to hospitals or, when they lie in urban areas, have been built over. It seems that only a few retain anything like their original landscapes.

Threats to hospital landscapes
With the closure of hospitals, the future of the often extensive grounds automatically comes into question, even where buildings are to be retained. During their use as hospitals such sites are usually initially within one ownership (i.e. NHS or Health Trust), but following closure their subsequent sale usually results in divided ownership. These landscapes are frequently seen as opportunities for intensive new residential development. As a consequence many historic hospital landscapes have been partly or wholly developed in an intensive manner, much reducing or eliminating their historic interest, and so the number of complete landscapes is rapidly decreasing. Many currently complete hospital landscapes, too, are destined to be severely degraded or lost completely.

Requirement for additional criteria
In the context of the Register, when assessing the historic interest of hospital landscapes, a supplementary set of criteria has been developed to augment the basic assessment framework. These prompt that for this type of landscape integral functional elements should be seen to be of interest as part of the landscape. Such elements relate mainly to the medical theory of the day, and although while there for practical reasons, they were often given an ornamental form.

The additional guidelines also consider the issue of condition, i.e. the completeness of the whole extent of the site, together with the remaining features within the site. The majority of examples of this type of site have lost historic fabric either in terms of the extent of the original area laid out and/ or the detailed features within the site. There are few hospital landscapes which have remained since their construction entirely unmodified in terms of hospital-related insertions, but such insertions are not necessarily detrimental to the landscape as a whole.

Factors relevant to the assessment of hospital landscapes
In the context of the Register of Parks and Gardens there are several key factors on which a hospital site may be assessed, in addition to the standard criteria:

• The significance of the landscape in medical history, it being for example an influential or early example of a particular method of treatment.
• The site may be one of the last remaining examples of a particular type of hospital landscape, albeit not especially significant in medical history.
• Good historic documentation relating to the laying out of the site and its subsequent therapeutic use. By substantially enhancing the knowledge of a site's place in medical and landscape design history, a good archive can enhance a site's historic interest.
• The extent of the hospital building remaining. Once the principal building has been lost, extensive development usually occurs across the site, particularly in the core. It is thus unlikely that a site would be registerable if it had lost its main building, although if the footprint of the building alone was developed and the landscape essentially left untouched this would not preclude the addition of such a site to the Register.
• The condition of a site, that is, encompassing the historic extent of the site and the historic features. The condition of these sites is often relatively poor, with, for example, features having been lost to erosion and poor maintenance, or with particular areas lost to development. The criteria which identify other types of site as in too poor condition to be added to the Register are thus not applied as rigorously to hospital sites. In terms of condition, the remaining core of a hospital site may be particularly important, with the accompanying outer land being of lesser interest. Most early asylums have lost much of the detail of the original landscape layout, and so the remains of the core of such a site would be important. For example an asylum built before 1845 which retains the key structural detail of its airing courts (including fences, ha-has, path system, shelters, etc) and pleasure grounds may be of sufficient historic interest to merit inclusion on the Register even where its peripheral park/farmland has been lost.

Additional general criteria for hospitals
The following guidelines offer general supplementary guidance for the assessment of historic hospital landscapes for inclusion on the Register. These are related to the condition of hospital sites, which are frequently degraded by neglect or by building development to a greater degree than other types of similar sites of the same period.
The guidelines prompt that hospital landscapes likely to be of sufficient historic interest to merit registration include, as well as those which are of special historic interest in terms of landscape design, are those which meet one or more of the following criteria:

a)	A medical context of particular note is reflected in the landscape layout, such as a pioneering or representative example of a landscape feature or features associated with a particular type of hospital site. The assessment should be made in the context of the individual landmark dates in the development of the particular type of hospital in question.
b)	Where the outer areas of a site are no longer intact, the core of a site is sufficiently intact to show the original design, and is of particular importance in design and/or medical terms;
c)	The historic documentation of a site provides a good knowledge of the site's importance in medical and landscape design history.

As an example of how these criteria can be applied to a specific type of hospital, asylums have been used below. The former asylums are the largest group, in terms of number and area, of large-scale landscapes laid out for hospital use.

ASYLUM SITES
The development of the asylum
Bethlem in London having been rebuilt in the 1670s, it was not until the C18 that a few further purpose-built asylums were erected. These comprised 9 relatively small, charitably-funded asylums: Bethel, Norwich (1712); St Luke's, London (1751); Newcastle (1765); Manchester (1766); York (1777); Leicester (1794); The Retreat, York (1796); Liverpool (1797); Hereford (1798). Of these, the York Retreat was a catalyst for future asylums to be built following 'moral treatment' principles, resulting in more humanitarian regimes and the use of the designed grounds as patient facilities. A number of privately run asylums were also opened, but few of these were purpose-built, instead mainly occupying former urban or country houses.

The Lunatics Act of 1808 permitted county justices to build rate-funded pauper asylums, and led to the establishment of over a dozen purpose-built county asylums, together with several further charitable asylums. In 1845 the Lunacy Act made it compulsory for counties to make provision for their pauper lunatics, resulting in a further 50 or so asylums being built from scratch in the 35 years to 1880. The Commissioners in Lunacy produced Suggestions and Instructions ... for authorities and architects involved in erecting new asylums, dictating the structure of the buildings and to some extent the layout of the grounds. In the 34 years between 1880 and World War I (following which the asylum building boom decreased significantly), a further 50 or so asylums were built, largely to a design known as the echelon, together with a number of the newly-established type of idiot (later known as mental deficiency) and epileptic colonies. Extensions were continuously being made to existing sites. Up to 1939 a total of probably 150 purpose-built public, charitably funded and private asylums and related hospital sites (including so-called idiot and imbecile training establishments, mental deficiency colonies and epileptic colonies) were constructed.

Asylum landscape features
The asylums, when purpose-built, were usually deliberately placed in a rural setting for the benefit of the patients, the grounds being laid out in the style of a modified traditional country house estate. Extensive areas were provided for therapeutic use by the patients, and also for their recreation and that of the staff. The main modification to the country house estate style of layout was the addition of so-called airing courts, which were intended to provide a confined, ornamented area for patient exercise adjacent to the patient accommodation within the asylum building. These courts were largely opened up and their boundary features (including enclosure walls, iron fences, gates and ha-has) lost in the mid-C20 when patients were allowed more freedom of access to the grounds. However, associated path systems and shelters often remain intact.

Threats to asylum landscapes
Few of the asylum landscapes of the eighteenth century have survived in anything like their original form, the sites having been located on what were at the time the outskirts of towns and many having subsequently been developed in various ways. The most notable exception is The Retreat, York, which is still a thriving psychiatric hospital. The landscapes of the earliest of the county asylums, built following the Lunatics Act (1808), have also been greatly altered or swept away, few of these surviving in their original form. However, the remoteness of most asylums built from the mid-nineteenth century onwards, together with their continued use for psychiatric treatment until the later C20, usually ensured that the associated estates remained largely intact until now, with the insertion of further hospital buildings as required. The advent of the NHS Care in the Community and estate rationalisation policies of the late C20 has since resulted in an almost universal closure policy for these hospitals, leading to their sale and redevelopment.

Specific factors for asylum landscape assessment

The following dates specifically relate to the significant dates in the development of asylums and thus the historic interest of their landscapes. These dates can be used to assist in the assessment of such sites for addition to the Register:

• 1700-1808 - The rise of the earliest charitably funded and private asylums. Very few of the contemporary landscapes of such purpose-built asylums survive in recognisable form.
• 1809-1845 - The rise of the prototype county asylums following the permissive Lunatics Act of 1808. The zenith of charitable and private asylums. Few of the contemporary landscapes of such asylums survive unmodified in recognisable form.
• 1846-1880 - The initial wave of the mainstream county asylums following the Lunacy Acts of 1845 compelling county magistrates to provide accommodation for their lunatics. Until the later C20 most of these landscapes survived largely in their original form, but many have since suffered severe degradation.
• 1881-1914 - The final wave of mainstream county asylums, the buildings planned usually to the echelon layout. The emergence of epileptic and mental deficiency colonies. Until the later C20 most of these landscapes survived in their original form, but many have since suffered severe degradation.
• 1914-1939 - The very last county asylums completed and the main construction phase of epileptic and mental deficiency colonies. Until the later C20 most of these landscapes survived in their original form, but many have since suffered severe degradation.

Specific criteria for asylum sites
The criteria which arise from these dates include

a)	Asylum or related landscapes laid out before 1845 where at least a proportion of the original layout is still in evidence, reflecting the key elements of the original design.
b)	Asylum or related landscapes laid out between 1845 and 1914 of which the key elements survive intact or relatively intact.
c)	Asylum or related landscapes laid out after 1914 but over 30 years ago, which remain intact or relatively intact.

S Rutherford
Acting Head of Register, Designed Landscapes Team, English Heritage

19th June 2001

At present there are 11 purpose-built hospital sites on the Register, all at grade II:

Royal Naval Hospital, Haslar, Gosport, built 1745-62 as the first hospital for Royal Naval sailors
Brislington House, Bristol, the earliest purpose-built private asylum, 1804-06, and influential on the structure of later county asylums.
Cheadle Royal, Manchester, built 1847-49 as a private asylum for the middle and upper classes
Broadmoor, Berkshire, built 1860-63 as the state criminal lunatic asylum
Fairmile, Oxfordshire, built 1868-70 as the pauper asylum for Berkshire
Rauceby, Lincs, built 1899-1902 as the pauper asylum for the county of Lincolnshire
High Royds, West Yorkshire, built 1884-88 as the pauper asylum for the West Riding of Yorkshire
Graylingwell, Chichester, West Sussex, built 1895-97 as the pauper asylum for West Sussex
Napsbury, Herts, built 1902-04 as the pauper asylum for the county of Middlesex
King Edward VII Hospital, Sussex, built 1905-08 as a private tuberculosis sanatorium for the middle classes
St Mary's Stannington, Northumberland, built 1910-14 as the pauper asylum for Gateshead