In the architect Thomas Worthington’s Chorlton Union Hospital (1864-6), we saw in this city the first application of the ‘pavilion’ system to a workhouse hospital. Sent to each board of guardians in the country, its would become a national model for workhouse hospital design. The ‘pavilion’ system had been vigorously promoted by Florence Nightingale in her Notes on Hospitals (1858). Her enthusiasm for his plan is reflected in five letters we have from her to Worthington (English MS 1154), covering both the hospital’s design and her efforts to see it replicated elsewhere.
In 1862, Worthington was appointed by the guardians of the Chorlton Poor Law Union to design a new hospital for the district, to be sited next to their new workhouse in Withington, Manchester. The Union’s existing hospital wings, erected less than a decade earlier, were now dangerously overcrowded. The Lancashire cotton famine and trade depression had caused a surge in claims for relief, and there was great concern at the potential for infectious diseases to spread among the ‘inmates’.
In the first of her letters to Worthington in July 1865, Nightingale noted:
“I am deeply interested in Workhouse Hospitals, and I am sure that it is a question which will come very much before the public next year [1866], in relation to London Workhouses.”
The ‘pavilion’ system
Worthington’s plan for the new hospital was to be based on the ‘pavilion’ system. Originating in France in the 18th Century, it aimed to curb the spread of cross-infection through separation and isolation, with parallel blocks widely separated by open courts or gardens. These courts would also maximise the amount of fresh air, ventilation and light in each ward. As Worthington noted:
“The great feature of this principle is the entire detachment of the several blocks of buildings appropriated to different classes of disease, and the perfect isolation of each ward, in such a manner as to prevent the communication to other parts of the hospital of infected air existing in one or more wards.”
The pioneer of this system in England was John Robertson, surgeon at the Manchester Lying-in Hospital, and a man whom Worthington knew through their membership of the Manchester Statistical Society.
Nightingale was a great campaigner for its widespread adoption. The attraction of Worthington’s plan to her was not its innovation (construction began on ‘pavilion’ hospitals at Blackburn Infirmary and Marine Barracks, Woolwich in 1858), but its cost. The ‘pavilion’ system had been criticised as being too expensive: to Nightingale’s evident delight, Worthington’s plan was both compliant and affordable.
“If you succeed in completing the buildings for anything like the money with due regard to the simple sanitary arrangements of so great a building, you will have inaugurated a new era in building. And we shall hasten to imitate you; for you will have set up a model for the whole country.”
A New Model of Workhouse Hospital
That this plan was for a workhouse hospital only increased Nightingale’s interest:
“And, in these days when so much attention, wise and unwise, is being directed to Workhouse Infirmaries (and so little is being really done) the world’s gratitude is due to those who have solved a problem in a way which must be a model to the country.
“…For the good and cheap must prevail over the dear and bad, tho’ it is by no means certain that the good and dear will.”
The hospital opened in 1864, providing 480 beds on five, three storey ward blocks. His design allowed each of the hospital’s ‘inmates’ an “air space of 1350 cubic feet or thereabouts… more than double the minimum space required by the Poor Law Board”. The Chorlton Union Hospital also introduced a new system of nursing, using trained nurses under superintendent sisters.
Publication of Worthington’s plans
Worthington had already published two reports on the question of housing in the Manchester Statistical Society’s Transactions; in 1867 he presented a paper to them on the Chorlton Union Hospital, sending copies to a grateful Nightingale.
“It is of the greatest use to us, as giving details of the best and cheapest hospital that has yet been built. …If I had 20 copies I could place them well- abroad and at home.
“… [the charge] Made to me against Pavilion hospitals is: the construction is too expensive. To which I answer: look at the Chorlton Union Hospital.”
In her next letter, Nightingale informs Worthington she has sent copies of his plan across the world, and how she intends to use his example in future editions of her Notes on Hospitals.
The final letter we have from Nightingale concerns her questions about Worthington’s design for the Prestwich Poor Law Union’s new workhouse, on which work began in 1868, and the Woolton Convalescent Home in Liverpool.
Worthington would go on to design seven other hospitals, as well as many of Manchester’s finest buildings: Memorial Hall (1866), Albert Memorial (1867) and City Police Courts (1873); yet it was the Chorlton Union Hospital that was his most influential work, inaugurating a new standard in workhouse hospital design.
I don’t know how either participant in this correspondence would feel if they knew that when she died in what was then Withington Hospital in 1953 my grandmother had used up nearly all her remaining energy trying to get discharged to die at home and not in the Workhouse, in whose shadow she had lived since she arrived in Moss Side as a child in the 1870s. It hadn’t changed much since Worthington’s drawings and the images you supply. The memory of Edwin Chadwick outlived both of them.
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