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Royal Hampshire County Hospital | Winchester Cathedral
Winchester's Royal Hampshire County Hospital has, since 1736, been dedicated to serving and curing the sick people of Hampshire. Though easy not to notice as you drive by, as it is not one of Winchester's most historic buildings, it has seen the births of babies, cured children, and the lives of generations have been aided, diagnosed and saved by its quiet, unassuming presence.
Medicine in Winchester Before the Hospital
The first hospital in Winchester had been founded in 934 by Saint Brinstan. Other mediæval monasteries and churches went on to provide care and almshouses, most notably the Hospital of Saint Cross, founded in 1136. Yet the dissolution of the monasteries removed this level of care. The presence of Winchester College, founded in 1382, had also ensured a steady supply of learned medical men, many of whom set up practice in the city.
Winchester had the advantage of a good, pure water supply, filtered through the chalk of the South Downs. Yet by the 18th Century the city was crowded, and not only with the general population associated with a small city. There were also cathedral staff, the college, a large army garrison and the county gaol. Additionally, several prisoners of war were crammed into the half-finished royal palace.
The overcrowded population relied on wells that often became contaminated, and between 1665 and 1667, Winchester was badly affected by the plague. This resulted in the foundation of the Charitable Society of Natives1 and Citizens, a charity dedicated to the apprenticing of Wintonian orphans whose parents had died of the plague. A similar Society of Aliens, dedicated to the help of residents not born in Winchester, was later founded. An obelisk to these charities was made in 1758, and is now a Grade II* Listed Building.
By the 18th Century, caring for the sick and disabled was the legal responsibility of local parishes, yet though the poor ill were cared for, they were rarely aided by trained medical men, instead relying on medicines from licensed apothecaries.
The Founding of the Hospital
The founder of the hospital was Doctor Alured Clarke, who had been born in 1696 and first came to Hampshire in May 1723. Two of his uncles, Charles and William Trimnell, had powerful positions in Winchester's Cathedral, being Bishop and Dean respectively. They used their influence to appoint him Canon of Chilbolton. Sadly Charles died soon after in late 1723 and William died in 1729.
Thirteen years after his arrival in Winchester, Clarke began vigorously campaigning to raise funds to found an infirmary in Winchester. He needed the support of local influential people, the Bishop and Cathedral staff, the College and especially Hampshire's Members of Parliament. A key ally was Bishop Benjamin Hoadly, who had been appointed Bishop of Winchester in 1734 and whose son Doctor Benjamin Hoadly was a Fellow of the Royal College of Physicians. With his family's medical connections, Bishop Hoadly enthusiastically supported the proposed hospital, becoming the first person to subscribe money for the cause. He used his influence to encourage Hampshire's high society, from the Members of Parliament and then everyone who considered themselves to be anyone, to follow suit. From the start the hospital was to be a County Hospital rather than simply a Winchester hospital, as without supporters from all across the county of Hampshire, the hospital would not have been possible.
The hospital would be a practical method of promoting Godliness, tackle illness and reduce the amount spent by parishes on poor relief. Only the seriously ill would be treated in the hospital; those able to work were expected to do so. Sickness was believed to be the result of un-Christian living, so all patients were to be given books on religious instruction. One favourite tract distributed to patients was The Whole Duty of Man Laid Down in a Plain and Familiar Way, for the Use of All, but Especially the Meanest Reader, first published in 1657. This was considered especially suitable, including as it did 'A Thanksgiving for Recovery', 'Directions for the Time of Sickness' and 'A Prayer for a Sick Person'.
Colebrook Street Hospital
With the support of the Bishop, enough funds to make Clarke's vision real were soon collected, with King George II himself donating £200 in 1737. All who had subscribed at least a guinea to the hospital were allowed a vote, a committee of 14 men was chosen to decide the hospital's rules, and Clarke was appointed Chairman. The first Meeting of the Governors of the Public Infirmary at Winchester was held on 23 August, 1736. It was decided that the hospital was to be called 'The County Hospital for Sick and Lame at Winchester' and the official opening was to take place following a sermon at Winchester Cathedral on 18 October, 1736, St Luke's Day.
The hospital, renamed Hampshire County Hospital, leased a 'lowercase t'-shaped mediæval building on Colebroke Street, formerly part of St Mary's Abbey and located neighbouring the Cathedral grounds, for 14 guineas a year. The building was 102 feet long, north to south and initially housed 60 beds. Plans show that the ground floor contained the Dispensary, Hot and Cold Bath2, Store Room, Board Room, Secretary's Office, private wards, the Physicians' room, kitchen, pantries, scullery, vaults, laundry, wash house, brewhouse and dead room ('a convenient place for receiving a dead body'). Wards, the surgery and nurses' and Matron's rooms were located above. The entrance to the hospital contained the words:
Despise thou not the chastening of the Almighty.
This text shows that the founding idea was that illness was caused by sinfulness. At least cleanliness was next to Godliness, as the hospital was washed daily. Although the hospital did not have a chapel, Communion was regularly held.
Rules and Regulations
From the start there were a number of strict rules that had to be obeyed by the patients, who were required to be faithful members of the Anglican Church:
- In-patients were not to remove themselves without permission.
- They were not to use bad language or behave indecently.
- They were not to play cards, dice or any other game.
- They had to attend prayers constantly.
- Smoking was completely forbidden.
- Male and female patients were not to mix under unauthorised circumstances.
- Patients had to clean and wash the wards before 7am, and wash and iron the linen.
- Patients who died were entitled to be buried in the neighbouring Cathedral graveyard, but though attendance at funerals was compulsory, patients were not allowed on the Cathedral's gravel paths.
Every Thursday the rules were read aloud in each ward. Patients received one warning, and if they broke the rules they would be dismissed and never readmitted.
Out-patients, the ill treated in their own homes and not admitted into the hospital, also had to obey rules. They had to be punctual for their appointments at the hospital - but never approach the hospital via the Cathedral's gravel path. This was not to be used by the Sick Poor. They also had to return all medicine bottles to the hospital, or face instant dismissal.
Nurses were also covered by the rules, and had to behave themselves with tenderness towards the patients. The hospital did not accept 'children under seven or crazy-headed people; they could disturb whole wards'. Similarly the hospital did not cover childbirth, but was intended to be a place where the virtuous ill and injured could convalesce and recover.
Impressively, records show that from the start the hospital cured a majority of their patients. They also show that even in the 1730s, hospital food was notorious. Most patients had a monotonous diet consisting of pints of broth, pints of milk pottage and pints of gruel, but the resident staff were well fed.
Forty Governors, who had greater powers than the medical men who they appointed and dismissed, controlled the hospital. The Governors met every three months at Quarterly Courts, with day-to-day administration done by the Management Committee, later known as the Weekly Board. The Weekly Board could engage 'Nurses and other common servants' and consisted of the Chairman, Treasurer, Deputy Treasurer and 12 other members appointed by the Governors. Qualification for membership of either was restricted to those who donated at least £5 per annum to the hospital.
The most important member of staff in the hospital was initially the Apothecary-Secretary, who commanded all administrative duties as well as being a member of the medical staff.
Though the newly created hospital desired the support of the locally respected, established medical profession, the more established and respected the doctors they approached, the less they wanted to have to deal with the poorest possible patients, especially as the hospital had rules forbidding the doctors from performing operations without the approval of the management committee. Any eminent, respected surgeon appointed was expected to provide their services for free, and have their medical opinion overruled by an ignorant committee who felt that experienced surgeons were in any case less important to a hospital than a chaplain.
Though Clarke had hoped that the medical staff would serve 'without fee or reward' it soon became apparent that the best-known surgeons had no interest in taking on extra work for no pay. Though the hospital soon boasted having two Physicians and two Surgeons on the books, for the first few years these were figureheads who allowed their names to be associated with the hospital to grant it respectability, on the understanding that they were not actually expected to do anything they chose not to.
In early 1742 Clarke resigned as Chairman of the Hospital and left Winchester, having been appointed Dean of Exeter, where he initiated the construction of Exeter Hospital. Clarke laid the foundation stone there in August 1741, but died on 31 May, 1742, six months before his second hospital opened.
When the hospital opened, it was obvious that the building on Colebrook Street3 was too small to hold the entire county's poorly poor. A policy of discharging patients for any infraction of the rules or simply for their condition not improving after six months was introduced, in a vain attempt to cope with the increasing numbers.
Fortunately a fortune was inherited by the hospital from millionaire Richard Taunton, twice mayor of Southampton, cousin of noted Southampton hymn writer Isaac Watts and an enterprising wine-merchant and privateer. When he died in February 1752, his fortune was distributed among Southampton charities dedicated to educating the poor. He also left the Hampshire County Hospital an oil portrait of him and almost £5,000. The picture was rediscovered in an apple-loft after the Great War, but the money was far more appreciated and was soon spent on purchasing and adapting Clobury House, a 17th Century mansion. By 1759 the new building was complete; it was the first hospital to be fitted with underfloor ventilators to encourage the circulation of fresh air. Fresh air was very much a hot topic of the time, as the spread of Methodism under John Wesley, a practising doctor, had also distributed ideals emphasising the importance of fresh air and hygiene as it was believed that effluvium or bad smells spread disease.
The hospital also had its own well constructed, ensuring an independent water supply filtered from the chalk of the South Downs. The new building was described in the 1773 History of Winchester with the words:
This magnificent edifice was opened for patients at Michaelmas 1759, the front of which is 224 feet long, and is ascended by a noble flight of steps. It contains six wards and is furnished with every other convenient office; besides an extensive green on the east side of the building, wherein the patients are at proper times to receive the benefit of the air.
The hospital struggled initially with a smallpox epidemic, not helped by the increasing number of soldiers and militia in the area, and outpatients who were unpunctual in attending appointments. One of the hospital's greatest expenses was obtaining enough coal to keep the hospital warm, but other drains on resources included wooden legs for patients whose limbs had been amputated.
In 1772 the hospital rewrote and published its rulebook, known as the Statues and Constitutions, with a highly detailed list of the duties of the hospital servants, such as the never-ending list of tasks for the poor put-upon Porter. Patients now had to sign a form on entering the hospital, promising:
to obey all the House Rules, and if I refuse to comply with the rules or leave the Hospital without the consent of my Physician, I promise to pay the Matron, for all the Provisions and Medicines I shall have had during my stay in the House.
At this time the reputation of the hospital staff increased greatly, with the appointment of dedicated, professional members of medical staff turning the hospital into a top teaching centre. This notably included Charles Lyford, whom author Jane Austen snobbishly dismissed as a 'mere country surgeon'. He served the hospital as Apothecary and Surgeon from 1768 to 1805. Charles Mayo, also thrice Mayor of Winchester, was appointed in 1814 and served as a highly skilled amputating surgeon until 1874. Following the 1751 Murder Act, surgeons could legally 'anatomise' or dissect the bodies of executed murderers. As Winchester had a Crown Court, a constant supply of cadavers allowed the surgeons at the hospital to practise and demonstrate techniques to their pupils, ensuring the surgical staff had finely honed skills.
In 1825 the staff consisted of three Physicians, two Extraordinary and Consulting Surgeons, three Surgeons, an Apothecary, the Matron and nurses for 60 inpatients and 300 outpatients. The hospital also gained an extensive medical library in 1827, when it began campaigning for funds to expand, as even the larger premises were too small for the number of patients. This appeal stated that patients 'are impelled to be in crowded wards, inhaling the effluvia of discharging wounds', with convalescing patients staying in the same rooms as the seriously ill, and numerous patients turned away because of the lack of room. Most damaging of all, the hospital did not have a chapel. This dramatic account soon raised enough funds to expand the existing building, construct a new one and purchase a neighbouring building, creating new wards and a chapel, and taking the total number of beds to 112.
Another fundraiser was the addition of a small museum. For a modest fee the public could view the dissected bodies of murderers, plaster casts of their hideously powerful muscles and casts of their heads, purporting to show phrenological causes for their criminal behaviour.
The hospital continued to be funded by donations, handled by the Governors and Weekly Board, from patrons and parishes, much of which was from Hampshire's Poor Houses and Poor Law Unions, other charitable Friendly Societies and old money from the upper strata of society. Although women were allowed to donate money to the hospital, they were not allowed to stand for the Weekly Committee or to be a Governor.
Census records show that in 1841, 111 people were resident in the hospital, including the Apothecary, Matron, eight nurses, two porters, two pupils, one dispenser and their patients. In 1851 there were 101 residents, including the House-Surgeon, Matron, two Chemists' Assistants, Porter, six day nurses, five night nurses and 81 patients.
In 1839 Mayo exposed the Governors' shocking plan to introduce a cost-cutting rule to exclude from the hospital's care all sufferers of sexually transmitted venereal diseases in The Lancet. Only patients who brought with them a marriage certificate and certificate of high moral character signed by their Anglican parish priest would otherwise have been treated.
Water Water Everywhere, and Not a Drop to Drink
In 1835 it was discovered that cholera was caused by contaminated water supplies. The Central Board of Health was established in 1848, but it was up to local government to create their own drainage system. Despite campaigns from the Cathedral and college, Winchester did not yet have its own sewerage system, with by far the most waste in Winchester being created by the crowded hospital, whose waste water system was a cesspit.
The Sanitary Conditions of the Hants County Hospital was published in 1861, severely criticising the lack of decent sewers in the hospital site and describing the hospital as 'tainted by putrid sewage to an extent which cannot be computed'. The author concluded that Winchester needed to have a sewer constructed and the hospital rebuilt on a new site, or a devastating epidemic was inevitable.
This was not a solo view. In 1859 Florence Nightingale, heroic nurse of the Crimean War, had written Notes on Hospitals. She also investigated an outbreak of erisyphilas in the Hospital that took place in 1860-1. Despite suffering a severe debilitating illness, she continued her constant campaign from her bedside. Finally in September 1861 the Governors accepted her recommendations for the construction of a new hospital. A new site was found on Romsey Road, opposite the new County Gaol4, which had opened in October 1849. New funds had to be raised for this plan to proceed, and as Osborne House on the Isle of Wight was considered to be local to Winchester, Queen Victoria donated £200 for the hospital.
Royal on Romsey Road
The Committee trust that it will please God to make the Royal Hampshire County Hospital a blessed means of extending to the sick and afflicted the benefits of medical staff and science, and while the physical necessities of those, who in a long succession of years resort to its Wards are relieved, that their spiritual wants will ever be remembered and supplied.
The new land was purchased in April 1863, and the architect chosen to build the new hospital was William Butterfield. Butterfield was an enthusiastic and thorough man, who toured many of the country's newest hospitals for inspiration. The doctors wanted the new building to contain a museum, a library, numerous small wards rather than a small number of large wards, a central bathroom, day rooms and a balcony for convalescence. Florence Nightingale rigorously checked all of Butterfield's suggestions, and despite informing him 'I think you may justly congratulate yourself on having planned a model hospital', she did have some reservations. She felt that small wards automatically resulted in neglected, unsupervised patients, and that any patient well enough to be able to use a Day Room was well enough to be sent home, although her main objection was the presence of wards dedicated to sufferers from venereal disease located in the main building.
Following her objections the Day Rooms were eliminated, only three wards were to be constructed and venereal patients were to be housed in a special 'distant' building5.
Work on constructing the new hospital took five long years, but the new building kept the Foundation Stone of the Parchment Street hospital, giving the impression that the hospital building is older than it actually is. The new hospital site was also located outside the municipal boundary on the top of downland to the west of Winchester on the road leading towards Romsey. Unlike the densely populated city centre, the area was empty except for the new prison opposite and to the east lay the Diocesan Training College and St James' Churchyard, Winchester's Roman Catholic cemetery. As the hospital was built at the top of the down, the site was a climb up from the river valley below, and also sloped considerably to the south. The site had cost £2,225 to buy, the main building cost £25,000 to build and the chapel £1,430. The main hospital building had a central 255 feet long block and two wings. There were waiting rooms, Dispensary, Library and consultation rooms beneath the main entrance's ground level, and the offices, board room, kitchen, three small wards for special cases, and the operating theatre, with the apartments for the House Surgeon and Matron, and nurses and servants' rooms were above.
The wings each contained two large wards on the ground floor capable of holding 18 patients, two wards on the first floor, and a ward on the second floor in the west wing, with the chapel located in the east wing. It was designed to house 108 inpatients and even contained a lift. The hospital was equipped with large windows and, despite Florence Nightingale's reservations, enjoyed balconies. The hospital also had an area to grow fruit and vegetables.
In June 1868 the first part of the hospital, the Barter Memorial Chapel, opened. Queen Victoria granted the title of 'Royal', finally allowing the hospital users equal social status with patients in its southern neighbour, the Isle of Wight, who had enjoyed attending the Royal Isle of Wight County Hospital since 18496. On 5 August the first patients were admitted to the new building. The former hospital in Parchment Street was sold by auction in October 1868, and was bought for 3,000 guineas by a local building firm, who developed the area into two rows of town houses.
The nurses were all trained at the Florence Nightingale School for Nurses at St Thomas' Hospital, Stoke Newington, which maintained the hospital's high reputation. This reputation was internationally recognised; in 1874 following the Franco-Prussian War and siege of Paris, nurses from Winchester were requested to set up an English Hospital in the French capital.
The hospital had moved from Parchment Street to escape from the problems associated with sewerage. Winchester's first sewer opened in 1866, a pumping station was built in Garnier Road in 1874 and this began to resolve the city's waste water problems. Yet as the Royal Hampshire County Hospital was outside the city boundary, the City Council refused to connect the new hospital to Winchester's sewers until 1897. The hospital continued to develop, with the opening of a Fever Cottage in a separate building in 1882 and in 1886 a nurses' dormitory block was built.
The 20th Century
Life at the hospital continued into the 20th Century, with some disruption caused as a result of the Great War. Many experienced members of staff went to serve near the front lines, and the War Office began making decisions about the running of the previously independent hospital. Although Hampshire had military hospitals, notably Netley and Queen Alexandra, military patients were sent to the hospital, and as a consequence, smoking in the male wards was allowed for the first time. The hospital also received record numbers of volunteers from the local community. Members of the Volunteer Aid Detachment of the Red Cross Society under the command of their Resident Commandant, Lady Portal, became an increasingly familiar presence.
Three temporary huts were built to house 150 military patients on the hospital's lawn: the Burrell Hut, given by Miss Burrell of Fairthorne Manor, Bluebell Hut and Blighty Hut. Following the war, the hospital gained valuable X-Ray apparatus from an American military hospital that had been erected temporarily nearby. A new house in West End Terrace was donated to the hospital to provide nurses with accommodation. The need for staff accommodation would continue as the hospital expanded and required more residential staff.
In 1919 the hospital opened its first maternity department, named the Florence Portal ward. Located on the south of the building, it had six beds. Yet by 1921, the Royal Hampshire County Hospital's bank warned the hospital that, as their overdraft had gone beyond its limit, if it did not do something to rectify their finances, then wards would have to shut. The hospital had still relied on donations and money raised from private patients, yet this changed. In Winchester a Contributory Scheme was introduced, where every workman who contributed 6d a week could receive free treatment for himself and his family, otherwise heavier fees could be incurred should the facilities be required.
The Hospital's nurses continued to enjoy a highly esteemed reputation; the Matron, Miss Emily Carpenter Turner, had formed the first syllabus for the General Nursing Council, and a Preliminary Training School for Nurses was set up in Winchester in 1918. In 1928, the first female Chairman was elected: Nina, Countess of Northbrook.
The Second World War
On the outbreak of the Second World War, five temporary huts were erected in the hospital grounds. The hospital naturally suffered staff shortages, with keen, if inexperienced, volunteers taking their place. The basement storeroom was converted into an air-raid shelter and other preparations for likely emergency cases made. As King Alfred's College was closed for the duration, its beds and bedding were purchased to increase the hospital's capacity to 331 patients. A Gas Decontamination Centre was converted out of the hospital's garage.
During the Battle of Britain, two of Hampshire's cities, Southampton and Portsmouth, were among Britain's heaviest-bombed. In December 1940 Southampton's Royal South Hampshire Hospital was severely damaged, leading to the moving of 102 patients to Winchester, and in 1941 Portsmouth's hospital was destroyed, leading to their nurses moving to Winchester. Once again the hospital helped heal civilians and members of the armed forces alike.
Before D-Day in 1944 the hospital became a Transit Hospital, where the wounded from the Continent were to be sent. Another 100 medical staff were ordered to work there, who soon dealt with 2,300 war causalities. Recognition of this achievement came with a visit by the Queen and the Deputy Prime Minister, Clement Attlee. Through 1944, as well as the military personnel, the hospital treated 4,152 civilian patients, and a further 4,855 in 1945. This led to plans to extend the hospital, especially the maternity and Radiological departments. By the end of the war the staff consisted of two Consulting Physicians, two surgeons, an ENT Surgeon, Ophthalmic Surgeon, Obstetrician, X-Ray Medical Officer, Dental Surgeon, Clinical Pathologist, Anaesthetist and assistant, Orthopaedic Surgeon, Speech Therapist, Assistant Surgeon, seven Medical Officers, a Chaplain, a Free Church Chaplain and a Chief Pharmacist as well as nurses and admin staff.
National Health Service
In 1946 the National Health Service Act was passed, meaning that from 5 July, 1948, the Royal Hampshire County Hospital would be part of that glorious ideal providing free health care to all from the cradle to the grave, the National Health Service.
In 1954 a new canopy to shelter patients arriving in the front courtyard was constructed. The hospital now had 118 beds and a 15-bed maternity unit, although it was agreed that the hospital was too small. Debate raged about whether the now-unfashionable Victorian building should be demolished and the hospital rebuilt from the ground up, but the first major post-war priority was the construction of a Dining Room Block in 1959. In the end the original building, now called the Butterfield Wing after its architect, was adapted rather than removed or replaced.
In 1973 the Florence Portal House Maternity and Gynaecology block opened on the west of the hospital site close to Queen's Road. In 1979 the Education Centre and Library at the bottom of the hill was built, although this would be rebuilt in 2006. Houses in Queen's Road on the west of the hospital's grounds were purchased in the late 1970s and the Nightingale Nurses' Home demolished. In 1986 the Nightingale Wing, what is now the hospital's large, central hub and A&E Department, opened. Between the Nightingale Wing and the Butterfield Wing lies the Brinton Wing, which opened in 1992 and is connected to both by a long corridor also used as a gallery.
Into the 21st Century
The hospital continues to operate well in the 21st Century, and the site has expanded to become a small warren of wards and wings. One of the largest blocks is the Burrell Wing, which since opening in 2006 has been the hospital's treatment and diagnostic centre. The hospital also contains smaller buildings, dedicated to such things as Outpatients, Diabetes, Occupational Health, ENT and Audiology, Pathology, Orthodontics, Breast Screening and a nursery; however, some of these are housed in temporary buildings which the hospital aims to demolish and replace as funds become available.
Something that did not need to be replaced was the hospital's MRI Scanner room, although a serious fire had other ideas. In December 2011, a fire there spread to the adjoining area and resulted in the need for a new MRI room to be constructed. Although the fire did not affect the main building and was soon under control, the aftermath caused disruption throughout the hospital until early 2013.
In 2014, the canopy and three temporary buildings at the front of the hospital were demolished. This has allowed additional disabled parking, improved access to the main entrance as well as allowing the original Victorian building to be seen in its full splendour once again.
One of the hospital's compact site's most pressing issue for visitors is the lack of parking space, with only 200 public spaces available in the entire hospital grounds. This has become so desperate that the garden centre located across the road now regularly allows patients to park there on payment of a fee. The hospital is located at the summit of the hill from Winchester's city centre, which is a steep walk, although there is a bus stop outside the main entrance on the B3040 and the hospital is served by the Winchester Park and Ride scheme.
Today the original building on the site, the Butterfield Wing, is a Grade II Listed Building.