The Design of Cane Hill Hospital

Charles Henry Howell’s Cane Hill Hospital was architecturally unique, built to a new design which was markedly different to the standard specifications that had evolved over time. Cane Hill did share some common characteristics with the majority of other asylums,  such as centralised services, distinct gender segregation, and segregation between different types of patients, however it also had some unique characteristics, due in part to being a transitional design which was improved upon but not widely adopted.

The majority of mid nineteenth century asylums were built to a linear plan, with navigational spaces being shared with dormitories and dayrooms.  At the foot of each ward was a corridor running the length of the hospital, and persons who had no business in the ward would need to walk through it to get to another. This caused obvious problems, transportation of patients, disruption and privacy being a few of them.

Charles Henry Howell’s first two Asylums were Brookwood in Woking, and  Fairmile in Berkshire. Each hospital was built to a linear plan, yet both needed extensions throughout their existence as the population in local towns grew with industrialisation. Howell’s design for Cane Hill made maximum use of the limited space available at the top of Cane Hill, ensuring that it wouldn’t need extending beyond the planned extensions delivered 6 years after opening. Indeed, there was little scope to extend further, meaning Howell had to ensure the design was absolutely suitable. His experience of building at Fairmile and Brookwood (Surrey’s first county asylum) taught him to fully maximise space available to accommodate the maximum number of patients. Cane Hill could not be realistically extended further than originally planned, and if room had been found for further accommodation, the workload on the hemmed in laundry and kitchens would have been overwhelming.

Radial designs had been popular in the latter half of the nineteenth century, appearing at St Lawrence’s in Bodmin (1820) and Exe Vale, Exeter (1845). These were based on a prison design which allowed disturbances to be heard by staff in the central block, enabling them to be attended to quickly. The wards received less light and air in sections towards the central block, and it was eventually considered an inhumane design for a place of treatment and betterment of the mentally ill. It is worth bearing in mind that when these hospitals were built, there was little concept of cure and long-term incarceration was very much the order of the day.

The Pavilion was the next significant design. The wards came from a central corridor, but they did not intersect. Patients were afforded relative peace from other wards, but the operations proved difficult because corridors were busy and certain parts of the hospital were not close to the services they needed to be near. Florence Nightingale made recommendations that had led to these designs, but while they may have proved suitable for short-term medical patients, they were not suitable for accommodating long-term residential mental health patients. The partially detached style of these hospitals alleviated some of the issues with the Radial and Corridor plans, but did not fully address them.

Howell’s design for Cane Hill combined both of these plans, the hospital was based around two curved corridors, one serving wards for male patients, another for female. Each category of patient could be separated from the others, yet all still had readily available access to the services they required. Howell imported the design for a ward for epileptics from Fairmile, laid out infirmaries in a manner which enabled patients to move to dayroom with relative ease, and provided refractory patients with accommodation with multiple single rooms.

As was conventional, the Laundry was based on the female side, and the engineering department and workshops on the male. The Main Hall and the Chapel were equally easy to get to from each side, being situated at the very centre of the hospital. The Female side was significantly larger than the male, yet this is not remarkable because there were more female patients admitted as a result of the policies of the time.

Despite Cane Hill’s seemingly good design ideas, ward blocks still suffered from a loss of light towards the corridors, and the design was not repeated elsewhere, despite in 1877 the plans being sent to the Pennsylvanian authorities when they sought advice on the best design in the UK.

What Cane Hill’s design did offer was versatility. It was easily extended in 1888, with 4 further 3 story blocks added at the rear of the hospital as had been planned by Howell. Should a ward not be required any more, it was easily sealed, unlike an Echelon or Corridor plan. From a practical perspective, this made its complete closure easier than other hospitals as parts o the hospital that were not longer required could be sealed off.

With the Compact Arrow plan, the wards did not intersect the corridors, yet many buildings were readily accessible from each other. The wards were usually built to very similar designs, unlike Cane Hill’s. The Compact Arrow design is distinct from a corridor plan as the corridors do not intersect the wards, and distinct from a pavilion because every ward is south facing.

This map below clearly articulates where the corridors were at Cane Hill (red). The Male and Female sides were identical in this respect; excluding the 1888 additions (Within the green boundary.) Inside the central rectangular corridors were the chapel, kitchens, Main Hall and stores. Each ward is distinctive from the others by its placement, defining each as a pavilion. As they radiate around the central services, and each ward is a pavilion separate from the corridor, this design is thus called a Radiating Pavilion.

Cane Hill had 49 different wards, built in 8 different styles. This allowed it to serve a wide range of patient types, from epileptic to acute, chronic, refractory, short term; drug addicted, infirm, and violent. The variety between the ward types made Cane Hill a unique design.

Other architects including GT Hine[1], and William C Clifford Smith[2] designed their asylums to be aesthetically pleasing, yet Cane Hill appears repressive, utilitarian and functional, similar to a prison. Bunched up buildings prevent appropriate levels of light entering the wards, and the unique ‘radiating pavilion’ design meant that doctors had to re-enter the corridor network to access the next ward, except in a few instances, such as between A and B blocks, and between H,J, and K blocks.

The Government had to authorise each set of plans for design and cost. This was partially due to the amount of public funds spent on these institutions within a relatively short space of time, and also the stigma attached towards the mentally ill, which meant that locals resented their rates being spent on the insane. At Severalls, Colchester, the preferred plan was rejected, as it was not the cheapest of the 22 tenders made. Architectural embellishments were frowned upon, and buildings had to be cost effective.

As designs developed, the principles that Cane Hill was built on were used in the Echelon designs, of wide and compact arrow, established and popularised by GT Hine.

In 1893, just 10 years after Cane Hill was opened, The county of Essex opened its flagship asylum at Claybury, on the edge of North London. This was the first Echelon, or ‘Compact Arrow’ design and was so successful it was adapted and replicated across the country until the 1930s when the villa plan became more popular.

[1]Architect of, Claybury Netherne, Hellingly, Long Grove, Park Prewett

[2]Architect of Manor, West Park, St Ebbas, Maudsley