In 1748, after James Lind left active naval service as a surgeon, he retired to Edinburgh. That year he graduated MD, became licensed to practice medicine, and was elected a Fellow of the Royal College of Physicians of Edinburgh. Lind published his celebrated Treatise of the Scurvy in 1753 (Lind 1753; Tröhler 2003a), and became Treasurer of the College in 1757. It was the following year that Lind accepted an invitation to become Chief Physician at the recently inaugurated, but only partially built, Royal Hospital Haslar. In a letter sent that year (1758) to Sir Alexander Dick, a friend who was President of the Royal College of Physicians Edinburgh, Lind referred to Haslar hospital as ‘an immense pile of building’ which would ‘certainly be the largest hospital in Europe when finished…’(Roddis 1950, p 128).
The year after his appointment to Haslar, Lind is reputed to have advised Sir Edward Hawke, who was commanding the Fleet blockading the French port of Brest, of the importance of fresh vegetables and fruit, as indicated in his Treatise of the Scurvy (Lloyd and Coulter 1961, p 115-116; Roddis 1950, p 64). While at Haslar, Lind published three more books – An essay on the most effectual means of preserving the health of seamen, in the Royal Navy (Lind 1762; Tröhler 2003b); Two papers on fevers and infection (Lind 1763; Tröhler 2003c); An essay on diseases incidental to Europeans in hot climates (Lind 1771; Tröhler 2003b). He remained Chief Physician for 25 years, and was succeeded by his son John in 1783. James Lind died in 1794 (Wickenden 2011), and two years later, when the First Lord of the Admiralty visited Haslar and asked to see a case of scurvy, not one could be found (Roddis 1950, p 68; Trotter 1797, p 420-421).
Haslar’s story begins in 1745, when John Montagu, 4th Earl of Sandwich, in partnership with the Admiralty, submitted plans to King George II for a hospital. Haslar was to be one of three proposed hospitals to provide care for sailors of the Royal Fleet. The hospital was designed by Theodore Jacobsen, FRS, and reflected his design of the Foundling Hospital in London. It was constructed with bricks made of local clay mixed with Portland Stone, under the direction of James Home, a surveyor, and John Turner, a Master Carpenter from Portsmouth Dockyard.
Although no record of a formal opening can be traced, the hospital is believed to have been opened on the 12 October 1753. By 1753, with the hospital only partially built, the situation concerning the care of sick and wounded sailors in the Portsmouth and Gosport area had become desperate. Having heard of the new building, desperate patients were already living in the builders’ accommodation (huts) in the grounds of Haslar. The Admiralty directed the first hundred patients to be admitted into the first stage of the hospital.
The original hospital plans included a chapel within the main hospital, which was to have been sited in the fourth side of the quadrangular building. Due to over-expenditure, this part of the hospital was never built. St. Luke’s Church was eventually built facing the quadrangle. Construction of the main hospital building eventually stopped in 1762.
Responsibility for the day to day running of the hospital lay with Mr Richard Porter, the Surgeon and Agent (a physician who was paid by the Admiralty to review and care for sailors of the Fleet for a stipend from the Admiralty) for Gosport, who had had to cope with almost insurmountable problems (Birbeck 2010a, p 54). However, a letter from Vice Admiral Boscawen dated 12 April 1755 drew attention to the inadequacies of the administration of the hospital, and laid the blame squarely on the shoulders of Porter:
The hospital at Haslar is so ill conducted that it little answers the design of it…The Agent is also the Surgeon, his profits by the 6/8d (33p) (a per capita payment) are above £2000 per annum and the office of agent alone is sufficient employment for him. (letter quoted in Birbeck 2010a, p 54)
The income of £2000 was very high for those days. The Admiral’s comments were endorsed by a Mr Ward, contractor for all the stores in the hospital, from bedding to biscuits. He observed that:
….at present there is drunkenness and all sorts of licentiousness committed by the people there, many of which are very far from being proper objects for a hospital.” (letter quoted in Birbeck 2010a, p 54)
The Hospital Commissioners acted promptly. They dispatched Sir Edward Hawke to investigate, who confirmed that the accusations were correct. On arrival at the hospital he found the gate porter missing from his post, and chaos reigning in the hospital.
As a result of Hawke’s report, the Commissioners issued a series of orders in May 1755. They appointed a Mr Francis Jones as Agent, Richard Porter as First Surgeon only, and George Cuthbert as First Physician and Senior Administrator. Cuthbert’s salary was to be £200 per annum. Although Porter’s new salary is not recorded, it must be assumed that he took a substantial cut in income.
Dr Cuthbert administered the hospital with the help of a small council for a few years, but he was succeeded by James Lind in 1758. In the letter already cited Lind explains that:
[t]he hospital is under the direction of the Physician and Council – the latter consists of the Physician who presides[,] two master Surgeons, the Agent & Steward, & lately two new members are added to the Council viz Dr Welch Physician to Gorton [sic, for Forton] hospital (which receives the marines only about a mile distance from us) & the Surgeon of that hospital.
But this Council must act entirely on orders from the Board of Sick & hurt. (Roddis 1950, p 128)
Insufficient accommodation was the main problem over the subsequent hundred years. Although Haslar had been built to hold 1,500 patients, by 1755 one thousand eight hundred had to be accommodated, and there were repeated requests from the Commissioners for more beds to be found. On 31 March 1755 the Commission wrote to Dr Cuthbert, the senior Physician at Haslar: ‘You are hereby requested and directed to use all possible expedition in making provision for the reception of 200 additional patients in the hospital at Haslar’.
Even after two new wings had been completed in 1762, the shortage of beds was still acute and it became necessary to use old hulks as ‘hospital ships’ for temporary accommodation. Discharged pensioner sailors lived in the attics of the hospital, and staff and their families shared the main building. By 1790, there were 2,100 patients in the buildings, causing considerable overcrowding, as noted in a report by Admiral Barrington (Lloyd and Coulter 1961, p 213).
Patients or prisoners?
Although physicians in the early years of Haslar tried bring a semblance of order to this state of affairs, their efforts were doomed to failure. James Lind drew up a comprehensive list of rules and regulations for the efficient management of the hospital (Lloyd and Coulter 1961, p 219-226) but it is doubtful that these were ever used even as guidelines, let alone as rules to be obeyed.
One of the reasons originally given for the erection of the hospital was to stem the ‘evil of such pernicious consequences’of desertions (Tait 1906, p 10). The patients were largely men who had been press ganged into the Navy. As soon as they had recovered sufficiently to walk they wanted to disappear into obscurity. As a result, Haslar was more like a prison than a hospital. All doors on the ground floor were locked at night to prevent patients escaping, and a guard of soldiers was installed to patrol the perimeter wall and apprehend patients attempting to escape.
To make matters worse, drunkenness was rife among the hospital’s staff. Some female nurses, avoiding the hospital’s armed guards by using the hospital sewers at low tide, smuggled in rum in pig bladders suspended under their skirts. Staff were accused of stealing patient’s food (Tait 1906, p 139); patients of the ‘2nd new ward East’ petitioned the Admiralty by letter, claiming to be afraid to eat their rations in case they had been poisoned, and to have been threatened with knives by staff of the hospital (letter dated 17 December 1761, National Maritime Museum). A Nurse Brown was dismissed by the Hospital Executive for infecting a number of patients with ‘a foul disease’, and other nurses were dismissed for not keeping their rooms tidy (Governing Committee Report Book 1765).
When the Executive Captains of the Navy also began to complain to the Admiralty about the situation, something had to be done. The first of two major official investigations into the management of Haslar was initiated by the orders of the Privy Council, and inspections were made by Admiral Barrington in 1780, and by Admirals Caldwell and Gardiner in 1794. Eventually, on the 26 August 1795, a Naval Commanding Officer – Captain William Yeo – was appointed to take command of Haslar, assisted by two Lieutenants, and this arrangement lasted to the end of the 19th century.
Wars and explorations
During the early 19th century many Army casualties from the Peninsular Campaign (1809), the Battle of Waterloo (1815), and the Crimean War (1853-56) were admitted and treated at Haslar. Such was the reputation of the treatment then being given to the Army at Haslar that the hospital was held up by the Army authorities as a shining light to nursing. By the late 19th century, Navy pensioners were also being admitted, both for care and shelter. These included the Greenwich Pensioners, who in turn helped to care for the patients. In return for this service many of the hospital wards (named after famous Admirals) accommodated pensioners, who ended their days in relative comfort.
It has been estimated that the remains of some 13,000 sailors and soldiers who died at the hospital between 1753-1859, or whose bodies had been brought there, were buried in the hospital grounds (Birbeck 2010b). They include 114 sailors from the Russian Fleet, which was impounded in Portsmouth in 1808-9 (Birbeck and Goetz 2011). Since 2005, teams of archeologists and forensic analysts have explored the Paddock burial areas at Haslar. One skeleton had coins over the eye sockets (to pay the boatman for crossing the river Styx), one of only three examples found in the UK. One of the coins was a Slavery Abolition token minted in 1794 for a limited period in the local area. The coin showed the head of a negro and bore the inscription ‘Am I not a Man and a Brother?’
During the 19th and early 20th centuries, many physicians set out from Haslar as members of expeditions, not only pushing forward the frontiers of medicine but also those of global exploration. The most famous of these was Sir John Richardson, Inspector of Hospitals and Fleets at Haslar from 1838 to 1855. He undertook two expeditions in support of Sir John Franklin in search of the Northwest Passage. At the age of 62, and at the request of Lady Franklin, he was involved in the search for Franklin and his crew. Richardson became a renowned naturalist, and played a part in establishing collections of animals, birds, and books at Haslar. [The museum was destroyed by enemy action in October 1941, with the total loss of the collection. The Library survived, and the books are now held in the Historic Collections Library in the Institute of Naval Medicine at Alverstoke]. Richardson was consulted by Florence Nightingale on the running of military hospitals (Richardson 1916), and he met and corresponded with Charles Darwin. It was under Richardson’s direction that Thomas Huxley left Haslar in 1846 as the surgeon on board HMS Rattlesnake in the southern hemisphere, where he studied marine life. Later, through his studies and support, Huxleybecame known as “Darwin’s Bulldog” because of his unwavering advocacy of Darwin’s theory of evolution.
In 1847, Captain Sir Edward Parry, the renowned arctic explorer, took command of Haslar. He had previously overseen the transition from sail to steam for the Royal Navy, but had made his name in polar exploration. Parry worked with Richardson to improve the care of patients at Haslar, especially those incarcerated in the hospital asylum. His departure from Haslar in 1852 was much lamented.
In 1854 William Balfour Baikie, a physician at Haslar, was appointed to the Niger expedition to explore the west coast of Africa. He was instrumental both in discovering a treatment for malaria and in the discovery of Nigeria (McConnaha 2007).
In 1909 Edward Atkinson, vaccinator at Haslar, became Captain Scott’s medical officer, and he was one of the survivors of Scott’s ill-fated South Pole expedition of 1912. Atkinson also survived the Battle of Gallipoli (Turkey) during the First World War, and was decorated for his life-saving actions.
Haslar remained a busy hospital during the many wars and campaigns of the 20th century and especially during the First and Second World Wars. During and after D-Day in 1944, both allied and enemy troops were treated at Haslar in great numbers. Royal Navy surgeons were joined by US Army surgeons in treating the wounded. Haslar continued to grow in professional and technological ability. In 1954, the word ‘Naval’ was formally included in the title of the hospital, only to be removed again in 1996 when Haslar became the core Tri-Service Hospital and the original title of ‘Royal Hospital’ was restored.
The beginning of the current century opened a new chapter in Haslar’s history. In 2001, in partnership with Portsmouth Hospitals National Health Service Trust, Haslar combined the best of medicine in the Naval Health Service with the best of military medicine. It was a sophisticated hospital with advanced medical technology, housed in a prestigious and splendidly-preserved historic Georgian building. However, in March 2007, the Ministry of Defence’s involvement in the hospital ended, and in July 2009, the Royal Hospital Haslar finally closed after 256 years of service and history.
The Haslar Heritage Group (www.haslarheritagegroup.co.uk), formed by former hospital staff and others, will help to ensure Haslar’s place in history is assured and that this magnificent Georgian building is not only preserved, but put to good use (Birbeck 2010b;Birbeck et al. 2010).
I am grateful to Jane Wickenden, Historic Collections Librarian at the Institute of Naval Medicine, for help in preparing this article.
This James Lind Library commentary has been republished in the Journal of the Royal Naval Medical Service 2012:98;36-38.
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