426 HISTORY OF MEDICINE Postgrad Med J: first published as 10.1136/pgmj.2003.017350 on 14 July 2004. Downloaded from Caring for ‘‘incurables’’: the 150th anniversary of the Royal Hospital for Neuro-Disability, Putney G C Cook ............................................................................................................................... Postgrad Med J 2004;80:426–430. doi: 10.1136/pgmj.2003.017673 The Royal Hospital for Incurables (RHI), now known as the care of these unfortunate individuals. This fact had been made clear in Household Words in 1850. Royal Hospital for Neuro-Disability and situated on West This weekly journal, with Charles Dickens Hill, Putney, was founded by Andrew Reed DD exactly 150 (1812–70) as its editor, considered: years ago. The RHI was thus the pioneer in modern times of long stay institutions for the sick and dying. It became one ‘‘It is an extraordinary fact that among of the great Victorian charities, and remained independent innumerable medical charities with which this country abounds, there is not one for the help of the National Health Service, which was introduced in of those who of all others [that is, the 1948. Originally the long stay patients suffered from a ‘‘incurables’’] most require succour …’’. multiplicity of diseases; in recent years chronic neurological disease has dominated the scenario. This institution has It is probable that Dickens was merely reflect- ing (as he often did) the popular opinion of the also become a major centre for genetic and trauma- time. In any event, Dickens took a keen interest associated neurological damage, and rehabilitation. in Reed’s initiative and presided at the first two ........................................................................... charity dinners, the prime object of which was to raise much needed funds for this unique venture. It seems possible that Reed had based his riginally founded as the Royal Hospital for underlying philosophy on that of John Howard 1–5 Incurables (RHI) in 1854 the name of (1726?–90),6 the great 18th century philanthro- Othis institution was changed in 1917 to the pist. Royal Hospital and Home for Incurables (RHHI), Obviously, siting of the new charity was and in 1919 a Royal Charter was at last granted. important. Reed had already founded the Recently, the name was again changed to the Asylum for Fatherless Children at Coulsdon, Royal Hospital and Home, Putney (1982) and to Surrey (see above), and it seemed appropriate the Royal Hospital for Neuro-Disability (1995). to establish the RHI in that locality, which being well away from London (the ‘‘great wen’’) was http://pmj.bmj.com/ THE ORIGIN AND THE SITE relatively free of miasmas. An old workhouse at The RHI was the fifth and last of the charities Carshalton (north of Epsom) provided the first founded by one of the great 19th century (temporary) home of the RHI. Although it served philanthropists, Andrew Reed (1787–1862),26 a to get the hospital established, it was inadequate non-conformist minister who obtained an hon- on many counts, not least its very limited space, orary doctorate in divinity in the USA (fig 1). which precluded expansion. After three years His four preceding charities were: therefore, the Board of Management decided on September 26, 2021 by guest. Protected copyright. that a more commodious venue was required, N The London Orphan Asylum, 1813. and the RHI was moved to Putney House N The Infant Orphan Asylum, 1827. (now demolished) in Richmond (now Upper N The Asylum for Fatherless Children (the Richmond) Road. Shortly afterwards an annexe Reedham Orphanage), 1843. had to be found for the expanding patient N The Asylum for Idiots, 1847. numbers. Reed, together with some members of the All, except the ‘‘Asylum for Idiots’’, remain Board of Management, remained strongly in extant. favour of a site at Coulsdon for the definitive The situation regarding incurables, or long stay building. He, and his supporters, invited the patients, in 1854 was that if poor they were ....................... views of several leading authorities on hospital cared for at the workhouse infirmary.78 If they design—including Florence Nightingale (1820– Correspondence to: were not paupers, they were not eligible for long 1910)—an enthusiast for the ‘‘pavilion’’ plan,9 Professor Gordon C Cook, term accommodation in either the local hospi- Fellowship of Postgraduate and still regarded by the public as the heroine Medicine, 12 Chandos tals, or the great voluntary general hospitals (the ‘‘Lady with the Lamp’’) of the Crimean War Street, London W1G 9DR, of London—for example, St Thomas’s, Guy’s, St (1853–56), which the bulk of the population had UK Bartholomew’s, and the (Royal) London. Those not wanted, and which had in fact decimated the were primarily curative institutions, and as laid British Army. However, a significant proportion Submitted down in their charters they could not, and would 1 December 2003 Accepted not, admit incurables. 17 December 2003 London, and in fact Britain lacked, in 1854, an Abbreviations: RHI, Royal Hospital for Incurables; RHHI, ....................... institution designed specifically for the long term Royal Hospital and Home for Incurables www.postgradmedj.com The Royal Hospital for Neuro-Disability 427 Postgrad Med J: first published as 10.1136/pgmj.2003.017350 on 14 July 2004. Downloaded from Figure 2 The RHI in 1905. The fac¸ade as seen from Putney West Hill is not the original Melrose Hall building, but the great extension of 1879– 81. Races in the Struggle for Life (published in 1859) by Charles Darwin (1809–82). Extensions to Melrose Hall Since Melrose Hall became the home of the RHI, a number of wings (extensions) have been added. The original house (which incorporates the main entrance hall today) was a Figure 1 The founder of the RHI, the Reverend Dr Andrew Reed (1787– 1862). The bust by J H Foley, RA, is now in the entrance hall of the Royal relatively small building. North (1864) and south (1868) Hospital for Neuro-Disability. wings were soon added, and the great extension (forming the main northern fac¸ade, facing West Hill) was built between 1879 and 1881. This brought with it a new bakery and dining of Reed’s Board considered the Coulsdon site unsatisfactory. room, kitchen, and offices. The Prince of Wales (later King Among their reasons were: Edward VII) (1841–1910) laid the foundation stone, and the opening ceremony was performed by the Duke of Connaught N ‘The situation [was] too high and exposed for several and Strathearn (1850–1942). classes of the patients … The Restell Wing was added in 1901 to the east of the great N The situation [was] unsheltered by trees, the surface of the extension. A few years later, in 1909, the widow of General ground [was] irregular … and Edward de Lancey Lowe (1820–80) (she had subsequently N The distance from London and Croydon [was] incon- remarried) left in her will a sum sufficient to enable the RHI http://pmj.bmj.com/ venient … to build the de Lancey Lowe room, which lies to the south of the great extension of 1879–81, and like the Assembly room, As a sequel, a number of the Board (including the serves as a multipurpose room in the hospital today. This chairman and Treasurer, Viscount Raynham (1801–76), and room was opened in 1909. Before the Assembly room was one of the vice Presidents, the third Marquess Townshend built, the lady inmates had used what today is the library, (1778–1855) resigned, and immediately founded the British and the male equivalents had the use of the north wing. Home for Incurables at Clapham (it is now situated at The original lifts in the great extension were worked by on September 26, 2021 by guest. Protected copyright. Streatham). All ideas of Coulsdon as an ultimate venue were hand; they were succeeded by hydraulic, and in 1909 electric thus abandoned, and a satisfactory site elsewhere was ones. In 1892, a new laundry had been added. In 1930, the urgently sought. dining rooms were extended outwards towards the road; the Eventually Melrose Hall, West Hill, Putney (fig 2) was men’s room was merged into that of the ladies. Recently settled upon. This had been built by John Rucker in 1796. A several newer extensions, in very different architectural former house, situated on this land which had been carved styles, have been added: Chatsworth (to the west of the out of the estate of the first Earl Spencer at Wimbledon Park main building) (1976), Alexandra (1980) and Drapers (1985) had been built by Lady Rivers and subsequently became the (to the east), and Goodman House (1997) to the south east. property of the seventh earl of Stormont (1727–96). The A notable addition to the hospital was the nurses’ home, grounds of Spencer’s estate had been landscaped by the situated in close proximity to Holy Trinity Church. Although leading exponents of the day—including Lancelot Capability it had been decided as early as 1919 to build a nurses’ home Brown (1716–83). Reed sadly (or possible fortunately) did (nurses had until then lived in the main hospital building), not live to see the removal of the RHI to Melrose Hall. He died this scheme was abandoned due to lack of funds, and instead in 1862, and the removal (the house had been bought by the two houses were rented in West Hill. The original scheme was RHI in 1863) took place in 1864–5. In the same year that the later resurrected, and the Duchess of York (subsequently the charity bought Melrose Hall from John Beaumont (1806–86), Queen, and then the Queen Mother) (1900–2002) opened the the Lord Bishop of Winchester (Samuel [‘‘Soapy Sam’’] nurses’ home in 1935. Wilberforce, 1805–73) consecrated the newly erected church Purchase of the Melrose Hall estate in 1863 brought with it of the Holy Trinity, which has throughout most of the last a farm (which was situated in the hospital grounds, close to 150 years been a close neighbour of the RHI.