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The excellent Victorian River Hospitals - Dartford Long Reach Smallpox Hospital ships.
The Long Reach Hospital Ships
Smallpox, known at least since the times of the ancient Egyptians, had been a greatly feared highly infectious disease which is estimated to have killed over 300 million people. Despite Edward Jenner’s initial rudimentary vaccination, derived from cowpox in May 1796, it remained a serious killer of the poor and rich alike. The vaccine, he discovered, was gradually refined and in England, compulsory vaccination against smallpox was first introduced in 1852, yet in the period 1857 to 1859, a serious smallpox outbreak killed 14,244 people. In the following two years from 1863 to 1865, a second, even worse, epidemic claimed 20,059 victims resulting in, during 1867, a more stringent compulsory vaccination law being passed. Those who were unwise enough to evade or ignore vaccination were, not only liable to die from the disease, but were prosecuted as a dangerous carrier to others. After an intensive four year campaign intended to vaccinate the entire population between the ages of 2 and 50, the Chief Medical Officer of England announced in May 1871 that they had managed to vaccinate 97.5% of the population. However, in the following year, 1872, England was unexpectedly swept with a mutated version of the smallpox virus, against which the current vaccine was ineffective. This caused a major epidemic which claimed the greatest total of 44,840 lives. Sadly, despite 1871-1880 being the peak period of compulsory vaccination, the death rate from smallpox had leapt from 28 to 46 per 100,000 head of population, until the vaccine was modified to deal with the alternative type of virus. Chillingly smallpox was simply spread by close contact with the sores or respiratory droplets of an infected person. Lack of hygiene in deprived areas meant that contaminated bedding or clothing could also spread the disease. A patient remained infectious until the last scab separated from the skin and with burial being the preferred method of disposal of a body rather than cremation which would have destroyed the virus, meant that the patient could infect others for some time even after death.
America was a little way behind until Benjamin Waterhouse (1754-1846), a Harvard professor of medicine, studied Edward Jenner’s work and performed the first U.S. vaccinations on his children. Having been snubbed by U.S. President John Adams, he wrote in 1800 to the current Vice President (and soon-to-be-President), Thomas Jefferson, who read his pamphlet, entitled “A prospect of exterminating the smallpox.” He went on to put much effort into encouraging a public vaccination programme.
The greater smallpox epidemic which began in England in 1881 placed an enormous strain on the medical facilities and casualties far exceeded the available number of suitable hospital beds in the South of England. To create more immediate isolated bed space the Metropolitan Asylums Board (MAB) acted quickly and chartered two obsolete wooden warships from the Admiralty to be used simultaneously. The Atlas, a 91-gun second rate warship built in 1860 but not completed and never fitted out for use at sea was to be used, initially, for acute male cases and the Endymion, a 21-gun Ister-class wooden screw frigate built in 1865, would become the 'administration block,' boiler house, kitchen and storeroom. The total cost of converting these two ships came to £11,000.
Originally MAB’s intention was to moor the ships at Halfway Reach, near Dagenham, but the Thames Conservancy, who was responsible for the river, were less than impressed and insisted that they be moored off Deptford Creek in Greenwich, near to the hospital ship Dreadnought (built in 1808, as HMS Caledonia an ex-Battle of Trafalgar 120 gun Caledonia-class ship of the line). She was renamed in 1856 and had been sited as a hospital ship for 19 years between 1856 to 1875 during which time she took a number of smallpox cases in 1871.
The first patients were admitted on board the newly refurbished 120-bed Atlas in July 1881. By the end of the serious epidemic in August 1882, almost 1000 smallpox patients had been treated on the ship, of which only 120 of the most serious cases had been impossible to save.
Due to not unreasonable public fears of the spread of infection to houses in the vicinity of isolation hospitals a Royal Commission was set up in 1882 to investigate and address the growing public fears. The final recommendation was that smallpox patients should be treated only in isolation hospitals sited along the banks of the Thames, or in hospital ships located on the river itself and that their convalescent hospitals should be sited in the rural countryside at some distance from densely populated urban areas. The Commission also recommended that a central road and river ambulance service should be established, to avoid the necessity of moving infectious patients on the normal health transport system, through towns and villages.
Following this report, the smallpox hospital ships Atlas and Endymion were moved in 1883 from Greenwich to newly established moorings at Long Reach, Dartford, which was some 17 miles from London Bridge and was a very isolated area with little in the way of surrounding housing or public roads.
It soon became obvious that demand still exceeded capacity and to increase the number of beds the iron paddle steamer Castalia joined the others to become the third hospital ship in 1884. A relatively new ship, built in 1874 by Thames Ironworks for the English Channel Steamship Co., she had been intended to run a first class cross channel passenger service between Dover and Calais. Controversially she was designed and built with an advanced catamaran style double-hull to stabilise the ship and reduce rolling with the intention of preventing sea-sickness. However, on trials, she had proved unsuitable for the highly unpredictable English Channel and was removed from service and moored in reserve at Galleons Reach on the Thames. The relieved owners sold her to MAB in 1883, which extensively refitted her as a hospital ship with 154 beds primarily for female patients. Both engines and paddle wheels were removed and the resulting huge space decked over. The lower deck was divided into five wards capable of treating 84 female patients. Five ward blocks for another 70 female patients were built on her upper deck, giving the Castalia the appearance of a floating row of houses. The blocks were placed obliquely so as to benefit from more light and a sophisticated forced air ventilation system was installed. This essential and innovative ventilation was achieved by two tall shafts from each ward fitted with "Boyle's" extractors. Wind blowing from any direction created an upwards draught in the shafts giving an average throughput of 1,200 cubic feet of fresh air a minute which replaced all the potentially infected air in the hospital nine times an hour. In case of a dead calm, a steam engine driven fan created an artificial draught through the shafts and whole ship.
The three ships were moored in a line, with the Endymion in the centre, anchored about 165 feet from the shore, but, at this stage, with no fixed land connection. They were close anchored and connected to each other by a complex gangway system which allowed for the rise and fall of the tide and for the pitching and swaying movement of the vessels themselves.
The Atlas contained the wards for male patients and even had a chapel on deck, which occasionally was used for overflow patients during epidemics. The ship could house up to 250 beds using the main, lower and orlop (orlop is the lowest deck of a ship usually used for access and equipment stowage) decks, with isolation wards on the upper deck. New admissions were delivered, by river ambulance, to the reception rooms on the orlop deck and then taken by a lift to the upper deck. Also on board were the dispensary and sleeping quarters for the medical staff. Conditions were very cramped; with the only windows being the former small gun ports, which were glazed, but the ceilings remained very low.
The Endymion had no wards but was fitted out as the administrative centre. There was a well equipped kitchen on the main deck where all the food for the patients and staff of the hospital ships was prepared. The mess rooms for the staff were on the deck below, as were the food and medical storerooms. Living quarters for the Matron, the steward, the male staff and some female staff were also on board. Before leaving the ships, all staff was required to bathe, wash their hair and change their clothes and shoes completely. All three of the ships were heated using steam generated by a large boiler in the hold of the Endymion and conducted to the other ships by flexible piping. Once on the specific ship steam was pumped through copper heat coils to warm the air passing through the fresh air inlets. Each ship also had its own stand-by boiler as a reserve in case of accident or breakdown. But these would not be used except in the case of dire emergency due to the ever present danger of fire, on wooden ships. In addition there were no fireplaces or open flame heating or cooking stoves on any of the ships for the same reason.
In order to maintain the ships isolation from the general public, a major decision had to be made whether the hospital ships should be supplied locally or centrally. By 1901, at the beginning of the last major smallpox outbreak, there were anomalies starting to arise, no doubt from the problems with central supply. For instance, originally fish came direct from Grimsby, well wrapped in ice, whereas by 1899 it was supplied from G Vinten, High Street, Dartford, as also did ice, used therapeutically. Milk, which was unrefrigerated, very often went bad in hot weather, came from Brockley, SE London, but some meat and vegetables came from D Bacon of Dartford. However it was the deliverymen of the main meat vendor, Reuben’s of Dartford, who were found guilty of being the cause of smallpox escaping from the isolation hospital. They, in collusion with the Long Reach gate porter, broke the rules disastrously, by being allowed to take their delivery carts up to the pier head based solely on their verbal assurance that they had been vaccinated. They had of course, by law, only been vaccinated in infancy, so their immunity had faded and was no longer effective. Thus, when a delivery man named Graham developed smallpox two to three weeks later which started an outbreak in the local town of Erith, just a few miles away, Dr Ricketts had to accept that Graham had been infected in the hospital compound. After this, photographs of delivery men who had been recently vaccinated and cleared for access were held at the gate lodge for the porters to use for identification purposes before allowing entry.
The transgression of the rules cost the gate porter his job and Reuben Message his meat contract. All was not lost to London traders as D Bacon continued to supply potatoes and a year later Message provided ice again, but only a negligible order
amounting to £67. This was admittedly nothing like a 1902 quarterly account of over £1000 to a replacement London meat firm. Many companies and workers fared very well from the smallpox epidemic but Reuben Message must have regretted the day he turned a blind eye to his men crossing the hospital threshold claiming false immunity.
Meat was required for beef tea, the main nutritional support for patients, and Dr Ricketts was very particular about its preparation. In 1894 he wrote "according to the dietary scale in force at the hospital till recently soup was allowed for sick patients and beef tea was not specified. A short time back I directed that beef tea prepared according to the recognised formula, should be substituted in the dietary scale for soup, and I pointed out that lean meat should be used instead of shin beef”. As an aside, the beef tea produced to his formula was absolutely delicious and offered a greater nutritional value than many were used to at home with prime beef a luxury.
The Long Reach Pier Buildings
In 1883, London's Metropolitan Asylums Board spent £1000 to buy land at Long Reach, on the banks of the Thames, for the purpose of building an additional hospital facility.
The Long Reach pier was built, immediately adjacent on the shore to; at last, provide a connection for the hospital ships and steamer ambulances directly to the few service buildings currently on land. Some of these shore based buildings provided sleeping accommodation, bathrooms and dressing rooms for the nurses and female attendants. The site also contained a large laundry for the tremendous amount of washing and ironing and general storerooms. A mortuary was built nearby, as well as stables for the horses that pulled the trams used to transfer convalescing patients to Darenth Camp, an hour's drive away. There were also gardens for cheery and perfumed flowers and vegetables and a recreation ground. In 1886 a shed was built to house the engines and dynamos needed for electric lighting to be connected to the ships. The Electric Lighting Act, 1882, permitted the setting up of supply systems by persons, companies and local authorities, and MAB installed electricity on the Atlas (following a fire on the Training Ship Goliath in 1875 ((Vanguard-class 80 gun ship of the line used as a pauper training ship for workhouse boys)) which had been caused by faulty oil lamps).
As mentioned the landing pier also provided the terminus for the MAB's new river ambulance service which transported patients along the Thames from the wharves in London, to and from the hospital ships and also the convalescent hospital at Gore Farm, four miles away.
In 1893 MAB had decided to build a far more substantial land-based smallpox hospital at Long Reach, but the project was delayed. Building work finally began in 1901, just as another smallpox epidemic swept through London.
After 20 years of service the condition of the ships was deteriorating badly and despite continuous maintenance work they were now in quite poor condition and were proving increasingly costly to keep in service. Their wooden construction and fittings made them dangerous, being prone to fire despite being lit by electricity, and were vulnerable to weather hazards and thick fogs that tended to envelope the open bleak Thames, as well as collisions with other careless ships (in 1898 the Castalia was hit by SS Barrowmore, an immigrant ship). It was additionally difficult to restrain wretched delirious smallpox patients from throwing themselves overboard to end their suffering and terrible irritation. As the victim numbers grew it became apparent that it was also impossible to further increase the number of patients the ships could accommodate.
The smallpox ships eventually became redundant in 1903 when Joyce Green and the other River Hospitals began to open. During their lifetime the ships had held over 300 patients at a time; therefore a massive fivefold increase in capacity was expected for smallpox patients (although a major epidemic never occurred again in London). It was a tribute to the forward thinking of the authorities that the ships had given two decades of sterling service and accommodated over 20,000 smallpox victims with an unexpectedly low death rate.
The deserted ships rose and fell at their anchors, shrouded in mist, the only sound being the creaking of their timbers and ropes and the slap of the water against their hulls. They were ignominiously auctioned off for scrap in 1904 at The Bull Hotel - Dartford. The Atlas realized £3,725, the Endymion £3,200 and the Castalia £1,120. It is assumed they were broken up and fittings sold off, but there is no record of their actual fate, particularly bearing in mind their previous use and how the scrap was disinfected.
Despite the usual lack of money the whole project had been well planned and managed but extraordinarily MAB decided to scrap the electricity generating plant rather than use it for Joyce Green Hospital which remained lit by gas until 1926 when electric lighting was installed at a cost of £10,500.
To recap in 1881 the Royal Commission recommended that fever hospitals should be freed from the constraints of the Poor Law, whilst smallpox patients should be transferred to a less urban site at Dartford, Kent. From 1883 therefore smallpox patients were transported by the River Ambulance Service to hospital ships moored at Long Reach, near Dartford as described above. Only paupers were admitted to MAB institutions until the Public Health (London) Act, 1891, made fever hospitals free to all.
To recap, early in the 20th century smallpox hospitals were built on land near the moorings and the ships were scrapped. These land hospitals were known collectively as the 'River Hospitals' and comprised Long Reach, Orchard and the largest and most substantial being Joyce Green Hospital.
River Ambulance Service
Following publication in 1882 of the Royal Commission report on smallpox and fever hospitals, the Metropolitan Asylums Board (MAB) established a River Ambulance Service so that patients could be transported from central London to its smallpox hospital ships moored at Long Reach. (A Land Ambulance Service had been established in 1881 but there were fears that infection along the route through towns and villages, could occur.) Unruly small children had a nasty tendency to run alongside the hospital wagons chanting abuse at the poor victims inside.
In 1883 work began on the construction of specially equipped wharves at Rotherhithe, Blackwall and Fulham, to which each suspected patient would be brought before being taken onto the fast ambulance steamers to Dartford. Each wharf would be equipped with an examination room, an isolation ward for patients too ill to immediately undergo a boat journey, and a ward where cases of suspected smallpox or other infectious disease would be held awaiting confirmation.
Before the wharves could be completed, another smallpox epidemic began in 1884, at a time when there was only one ambulance steamer the 105ft Red Cross available, which had been specially built for MAB. The wards were in the fore cabin, divided by a bulkhead into two equal parts; each had 8 beds for acute adult patients. The after cabin was used for mild cases that were capable of travelling in a sitting position. The Red Cross was brought into service in February, using the Potter's Ferry Wharf until the nearby North Wharf was completed.
The 132ft Albert Victor had been purchased, in May, from the liquidated London Steamboat Co., for £3,150 (she was later sold in 1931 for £92 10s). She was specially converted and fitted out with hospital facilities, with 16-bedded wards fore and aft, but was eventually mainly used to return recovering patients to London.
A second dedicated ambulance steamer, the 132ft Maltese Cross, constructed for MAB after the Red Cross and to an improved design (following the experience gained with the Red Cross), came into service at the end of October, 1884. She had two wards, fore and aft, each containing 16 beds for serious adult patients.
A 73ft steam launch, the Marguerite, was also acquired in 1884. She was not fitted as a river ambulance but instead used for transporting visitors and the ships' staff, however she was sold in 1889 as unsuitable for service.
In March 1885, a local resident, Miss Willis, died suddenly after dancing with a porter from the Hospital ships at a ball in Erith. Her cause of death was diagnosed by a local doctor as 'malignant smallpox' (she had died of haemorrhage within three hours of onset). However, initially this was contested by the ships' physician, who also asserted that the crew followed a strict protocol of precautionary measures when leaving their duties. The diagnosis was never confirmed but, following this incident, MAB introduced a policy that the ships would receive supplies through the River Ambulance Service rather than be purchased locally or sent by rail.
Between 1884 and 1887 over 11,000 acutely ill smallpox patients had been transferred to the Long Reach ships by river ambulance, while 10,328 patients had been brought back.
Year Patients using the River Ambulance Service
The fast paddle steamer river ambulances were often out of commission. Collisions between them (their protruding paddles and boxes were particularly vulnerable) and the wharves and other careless vessels were frequent. On 31st December 1888 the steamship SS River Derwent of Glasgow, after having previously sunk a vessel just below the Blackwall Reach, fouled the hulk SS Benmore and the Maltese Cross secured alongside, slightly damaging the latter. The forward mooring bitts (pair of posts for fastening mooring cables) were torn away and the after bitts damaged.
In 1892 there was another smallpox epidemic. By this time MAB also owned the Swallow, a steam pinnace. The 143ft Geneva Cross, a new purpose-built ambulance steamer built in 1894, necessitated the replacement of the hulk Benmore by constructing mooring dolphins. At her stern the Geneva Cross had an upper cabin with two compartments for 16 acute patients and a lower cabin with two compartment for 36 patients. Visitors could travel in an isolated suitably equipped fore-cabin.
In November 1896 a new ambulance steam pinnace, the much smaller 65ft White Cross, built by Edwin Clark replaced the Swallow. The venerable Red Cross was sold in 1897 for £450 and the money put towards the cost of the White Cross.
By 1898 the River Ambulance Service had three ambulance steamboats in service - the Maltese Cross, the Albert Victor and the Geneva Cross - and the ambulance steam launch, the White Cross. In that year the Service carried 955 passengers (compared with 1293 in 1897); these comprised 6 patients (69 in 1897), 5 recovered patients (55 in 1897) and 944 visitors, staff and workmen (1159 in 1897).
During the next smallpox epidemic of 1901, MAB made plans to build a pair of permanent land-based smallpox hospitals. Two temporary hospitals - the Long Reach Hospital (with 300 beds) and the Orchard Hospital (800 beds) - were built during this time and opened at the beginning of 1902. In the same year another vessel, the Red Cross II, had been bought from the London and South Western Railway. Originally named the Solent, she had been built as a 300-seat passenger vessel but was skilfully converted to hold 68 beds. Also in 1902 a further paddle steamer the Conversator was acquired but little is known of her service history or disposal date.
The hospital ships remained in use until the Joyce Green Hospital (with 940 beds) was completed in 1903. The River Ambulance Service continued, with patients disembarking at Long Reach pier, then being transported by horse-drawn ambulance (later horse-drawn tram cars running on a dedicated 4 ft. gauge tramway) to hospital, using, in places, a glass covered tramway to protect the patients.
During 1925-1926 the running costs of the River Ambulance Service were £7,547.
The attrition rate of the river ambulances had increased and collisions between the steamers and wharves was an increasingly frequent reason for the boats to come out of commission for extensive repairs. The protruding paddle boxes were particularly vulnerable, as can be gauged from a study of the Engineer Surveyor's Report Book, reproduced below.
'The barge Ely collided with the Maltese Cross doing damage to the paddle box,' 'Repair work to 0wharf frontage, and Red Cross taken to Long Reach and moored.' 'Tug Lizard (Built 1882 by Finch & Co., 59grt, 1888 Sold to Thames Conservancy Board, London. 1929 thereafter renamed Sunfly. Scrapped 1939.) collided with White Cross' and 6 months later 'White Cross returned to duty after repair of damage on 15th May'
The river ambulances reached the end of their sterling career when on 24th July 1930 a cargo steamer collided with the Lower Dolphin at South Wharf where the Albert Victor was moored. This sounded the death knell for these feisty little steamboats and from now on all patients, still coming at over 200 a month increasingly went, using motor ambulances, by road. In the last 6 months of their working life the steamers had transported over 2,500 patients to and from Long Reach - an impressive finale.
However, it wasn’t until 3 years later that the LCC finally finished it all. The Engineer Surveyor's last report is dated 10 March 1933. 'The steamer Geneva Cross left South Wharf on the 21st February, the Maltese Cross on the 28th February and the Red Cross on the 6th March for mooring at Erith, preparatory to disposal, after being disinfected and certified as such by the Port Sanitary Authority. All of these ships were sold for scrap to Russia.
The first two proceeded under their own steam.' It was suggested that up until the final voyage they may have been used to ferry patients, staff and general stores between North Wharf Blackwall and South Wharf Rotherhithe, for lack of a better way of crossing the River.
What remained of the River Ambulance service came to a complete end in 1940 when South Wharf, still in use as a smallpox collecting point, was destroyed in a Blitz raid by German firebombs.
Smallpox epidemics in London
1870 - 1872
1876 - 1878
1881 - 1882
1884 - 1885
1893 - 1894
1901 - 1902
Long Reach Isolation Hospital.
As mentioned it was built by the Metropolitan Asylums Board at the end of 1901 to provide temporary extra accommodation during one of the smallpox epidemics. It used land adjoining the shore base of hospital ships Atlas, Endymion, and Castalia which, by this time, were constantly full. It was designed by A & C Harston. Up to 300 patients were to be accommodated in a long row of detached single-storey ward pavilions built rather inexpensively of wood on an iron structure. Patients came by river using the Metropolitan Board's river ambulance service which terminated at the Long Reach pier. A tramway had been constructed in 1897 to transfer patients between the pier and various hospitals using horse-drawn tram-cars. It was worked as an auxiliary hospital to the ships with Dr Ricketts as Medical Superintendent (who became an expert on the disease and wrote the definitive textbook 'Diagnosis of Smallpox', published in 1908) and with the expert services of Matron Wacher and Steward Moule. As a preventative all nursing and domestic staff were vaccinated against smallpox every 2-3 years and were only allowed to wear their uniform through the duration of their stay on hospital grounds. Each time they left the hospital gates they had to bathe, wash their hair and change their clothes completely. The River Ambulance Service ferried patients, staff and visitors to and from the ships and the Long Reach pier and were scrupulously cleaned and disinfected between trips.
The first patients arrived in February 1902. In 1910, it was decided that Long Reach would be kept in reserve for smallpox and the other local River Hospitals would be used for fevers, infectious illnesses and convalescence. In 1928, despite the cases of smallpox waning, the hospital was extensively rebuilt as a permanent smallpox hospital. It was transferred from Metropolitan Asylums Board to London County Council and later to the NHS. As previously mentioned in the severe weather of 1953 the River Thames flooded, breaking its banks and Long Reach Hospital was submerged to depths, in places, of up to 6 feet. The Gate Porter was the only member of staff on duty and he waded and swam to the Joyce Green Hospital building. Three weeks later the water had finally been pumped out of Long Reach Hospital, the boiler cleaned and restarted and work began on its renovation.
In 1954 the Hospital had 222 beds reserved for smallpox but by the 1960's the hospitals capacity had contracted to just 50 beds kept on standby but was capable of being completely reopened within two hours. The decision was made for sufficient staff to be kept on permanent reserve, each receiving a small regular payment. They worked a 14-hour shift, being re-vaccinated whenever a smallpox patient was admitted (staff to patient ratio was 14:1). By 1973 just 30 standby beds were retained and during this period it was opened only once for the last patient ever to be treated at Long Reach. The patient, a laboratory technician employed at the London School of Hygiene & Tropical Medicine, was suspected of having meningitis and had initially been admitted to an open ward at St Mary's Hospital in Harrow Road. Two visitors to the ward, Mr and Mrs Thomas Hurley, contracted smallpox and subsequently tragically died. The old isolation buildings, beds, fittings and furnishings were deliberately destroyed by controlled fire in 1977 to make sure that no trace of infection could remain. The fire cleansed site was then taken over by Thames Water for improved flood defences to be built. Arrangements were made for the Cray Valley Hospital to deal temporarily with future smallpox cases.
End of the hospital ships
Historically the hospital ships continued in use until 1903 when the new permanent Joyce Green smallpox hospital was opened on an adjacent site. Two temporary hospitals, the Long Reach Hospital and the Orchard Hospital had also been opened on nearby sites during a serious smallpox outbreak in 1901-2. As mentioned above the three ships were auctioned off and it was a condition of sale that the vessels had to be removed within two months, after which a rental of £25 per week would be charged.
With the decline in smallpox cases, it was decided that the service needed consideration and reorganising in 1910. The decision was that Long Reach Hospital, close to the river, was to be kept permanently in reserve for smallpox cases, while its sister hospitals would be used for patients with other notifiable infectious diseases and for convalescence. Originally quickly and cheaply built with just a two-year planned life expectancy, the deteriorating Orchard Hospital desperately needed repairs, but these had been delayed because of the absence of Dr. Ricketts, who had been on sick leave for a year.
Dr. Ricketts finally recovered and returned in the autumn of 1912 and immediately demanded changes to the plans made in his absence. However, no action was taken and the outbreak of The Great War delayed any possibility of major improvements. Despite his return to health, in 1914 Dr A.F. Cameron replaced Dr Ricketts (who later died of TB in 1918).
Dr Cameron revived the plans for redevelopment of the Hospital and during 1928-1929 the original wood and metal framed huts were replaced by seven brick built permanent ward blocks, an isolation block, a dispensary, kitchens, storerooms and dormitory blocks for the nurses and domestic staff. The Hospital was equipped with facilities for 250 beds and electric light finally replaced gas, with the redundant gas pipes acting as conduits for the electricity cables. (The engines and dynamos, which had provided electric lighting for the hospital ships had, rather short sightedly, been scrapped along with the ships in 1902). The redevelopment was completed just in time for an outbreak of variola minor, (a milder form of smallpox), which occurred between 1929 and 1932 (this was to be London's final smallpox epidemic).
The River Ambulance Service ceased in 1930 when the LCC took over control of the Hospital and finally used road ambulances. The Long Reach pier was finally demolished in 1936.
Long Reach Hospital
Today much of the marshy ground around the original Hospital site has reverted to nature and is a wild and overgrown mix of scrub and now used for motocross practise areas.
To recap the running costs in its latter years:
Year Cost Number of patients admitted to Long Reach Hospital
1954-1955 £23,531 0
1955-1956 £7,833 0
1956-1957 £7,840 0
1957-1958 £8,988 6
1958-1959 £9,903 0
1959-1960 £8,524 0
1960-1961 £17,338 2
1961-1962 £24,442 11
1962-1963 £19,156 4
1963-1964 £28,078 4
The last case of smallpox in England was in 1978, when Mrs Janet Parker, a medical photographer working in the Anatomy Department of the University of Birmingham Medical School, was infected by the virus which had travelled in air currents up along a service duct from the smallpox laboratory below. Mrs Parker was the last person to die of smallpox.
The last reported case elsewhere in the world was Ali Maow Maalin, a cook at a hospital in Merca, Somalia, in 1977. He had the milder form and survived. The World Health Organisation declared smallpox to be totally eradicated in 1979 and millions of lives were no longer at risk.
Joyce Green Hospital during the period 1919-1939
Joyce Green Hospital
In the spring of 1902 another temporary smallpox hospital, the Orchard, opened to the south of Long Reach and in the following year, the large permanent Joyce Green Hospital became operational. The group of isolation hospitals became known collectively as the River Hospitals. A tramway (initially horse-drawn) linked them all to Long Reach pier (The tramway continued in use until 1936.) for delivery of the infected patients, linen, stores etc.(This is described more fully later).
During the period mentioned Joyce Green experienced mixed fortunes, on four occasions it stood empty, twice it accommodated fever victims and in June 1918 the hospital took in 1,140 Russian refugees and also acted as EMS Hospital (Emergency War Hospital) for many of the wounded during The Great War.
The disadvantaged Russian refugees from Europe had come into contact with many homeless civilian stragglers from the Great War and were suspected of picking up infectious disease or being smallpox carriers and were admitted on 7th & 8th July 1918. Examinations and re-vaccinations were carried out and two cases of smallpox found. Other infectious diseases found were chiefly among the children: rubella 20, chicken pox 18, scarlet fever 4, and other diseases 47. One patient died from influenza. The refugee’s period of quarantine expired on 25th July and their dispersal to unspecified places commenced.
The hospital required substantial help to cope with this number of patients and they obtained the services of a company of German prisoners-of-war from the Dartford War Hospital (the Lower Southern Hospital in peacetime).
When the refugees recovered and left, they presented Dr Cameron with a silver epergne (table centrepiece) to show their gratitude. He wrote in his weekly report to the MAB ' It was unfortunate that I was quite unaware of their intentions. Otherwise I should have taken steps to divert their intentions into a more suitable channel in the form of something in which the staff generally might have shared'.
The immediate post-Great War years were dominated by the catastrophic worldwide flu epidemic, which killed millions and also various fevers notably scarlet and diphtheria which, hit the deprived adults and many of their children hard. Mortality from these diseases was heavy but the public’s mind was still absorbed with the horrors and incredible death toll which affected most households due to the absolute carnage of the Great War. There was not a family in the British Empire that did not know of or suffered loss due to the war death-toll or the later decimation caused by flu.
A consequence of the extreme infectious nature of the diseases was the high infection rate suffered by those who nursed the sick. To illustrate the severity of the situation in 1921 the Medical Superintendent Dr A F Cameron, reported that 30 nurses and nursing assistants had contracted scarlet fever and 3 suffered diphtheria. By modern standards, this degree of exposure would be considered unacceptable, but this was the price that had to be paid for nursing some 900 cases of scarlet fever and 150 cases of diphtheria in days before antibiotics and powerful antiseptics.
The death of seven patients in one month seems quite small when compared with the 25% death rate of severe smallpox, but in the mild form (Variola Minor) seen in the epidemic a decade later the death rate was much lower being only 1%.
In these days prior to antibiotics there was little that could be done for viral infections and fevers apart from isolation and nursing. It took the patients out of circulation but how effective these measures were in helping to halt the epidemics is not clear. The patients, mostly children, would have been previously infectious at home with coughs and sneezes long before it was identified and they reached the care of the hospital. Once there, isolation was probably longer than necessary, but in the late 19th and early 20th century caution was the wisest and possibly only course of action.
Due to the massive number of clothing changes required for the nursing staff, the clothing stocks, in 1927, amounted to 2,805 pinafores, 2,767 chemises and 5,004 flannel vests. The stock check showed a deficit of 182 garments which had been spirited away and were probably being put to good use in the poor homes of SE London!
A limited range of antiseptics were available, but specific antibiotics did not exist at this time. They used tried and proven essential oils and herbs, but whilst often partially effective, none of these were specific remedies. In 1924, it was importantly established that bacteria (streptococci) was the causal agents in scarlet fever. The hunt was on for an effective way of killing it but penicillin was still many years away.
In 1926 Dr Cameron and his assistant Dr H M Pereria described the state of the art thus - 'The throat in scarlet fever and diphtheria was syringed with the strongest disinfectant solution possible to use. Insufflation of sulphur was employed and the diphtheritic membrane forcibly removed. The skin was anointed with antiseptic oil in order to bind down the flakes of desquamation and kill the infection that they contained.'
Routine bacterial test facilities were not available until many years later so it was not possible to know if streptococci bacteria covered the skin or not. Whatever the reason, effective antiseptics, good nursing, loss of virulence by the streptococci or a mix of all three, resulted in the epidemic dying down and by 1923 the hospital was empty again.
The next time Joyce Green was filled with disease it was smallpox the disease for which it had been built originally. This time, though, it was the milder type (variola minor) and the mortality rate was thankfully less than 1%. It enabled Dr Cameron's assistant Dr J P Marsden to report on the epidemic in depth, during which he investigated and analysed the 13,500 cases seen between 1928 and 1931.
This established his status as one of the top smallpox experts in the country with the River Hospitals being the main treatment centre for the disease in England. After 1931 Joyce Green was never again used for smallpox with Long Reach being reserved specifically for this purpose. Joyce Green lay empty until the end of the 1930s when its desperately needed facilities were again pressed into service to deal with the injuries and deprivations of World War 2 in 1939.
No one could have guessed from reading the Medical Superintendents (MS) reports that 1930 heralded in a new era, for in that year the London County Council (LCC) took over from the MAB. The most obvious change was the prompt closure of the River Ambulance Service. It had been struggling for a long time, under used, with inadequate cost-cutting maintenance and consequent difficulty in attracting suitable crew.
Then, as Long Reach was being rebuilt, smallpox again broke out. The managers found a suitable Captain and crew to take over the steamers and the service resumed. By this time patients were being sent to Joyce Green at the rate of 500 per month, which was more than the steamers had capacity for. This was no doubt a good test of the alternative 'land ambulances' that were soon to become the future standard method of transport.
Joyce Green, in 1939, was made into an EMS (Emergency Medical Service) hospital and for the first time became a general hospital rather than a smallpox or infectious disease centre. It retained the services of the Medical Superintendent, Dr Mitman and other medical staff but now included a Military Registrar and his R.A.M.C. detachment.
The hospital accommodation was increased from 986 to 1,900. B Block was converted to deal with sick staff, and a decontamination hut for the treatment of potential gassed cases was prepared in the old mortuary of the Orchard hospital. Staff accommodation was also improved and increased and the committee rooms, sitting rooms and all other available space were changed into dormitories for the staff and resident R.A.M.C.(Royal Army Medical Corp.) detachment.
Following Operation Dynamo (Dunkirk evacuation), on 1st June 1940, Joyce Green was sent more than 160 Dunkirk service casualties, including 24 French nationals and 4 Zouaves (French regiment from Algeria or Tunisia). The contingent of 130 British came from over fifty different units of the BEF, the largest individual number being five of the 1st Suffolk's. One of the more unusual cases was a farrier from the 6th Cavalry Regt. who was suffering from severe varicose veins.
In an attempt to make greater space available, dispersal began on 8th June when the Royal Navy patients went to their own dedicated naval hospitals and a lightly wounded batch of twenty-nine; (four of them French) went to the Three Counties Hospital Ordsley, Bedfordshire.
A second larger wave of French, making fifty-two in all came on the 8th June. Among them were ten crew from the Jaguar, a French Charcal class destroyer sunk off Dunkirk on 23rd May by German E-Boats. Records confirm that they were transported from Dover in Green Line ambulances (hastily converted from Green Line Bus Company coaches). The French came from some 20 units including crews of various vessels. At least 12 were from the Dunkirk garrison.
As commonly happened seven Frenchmen carved a memento of their stay at Joyce Green into the bricks on unit 11A. They were:
Jerome Caidout Gunshot wound transferred 7.10.40 Eaton Hall, Chester
Eugene Garsi Gunshot wound…..transferred 7.10.40 Red Cross Hospital
Emile Olivier…….Gunshot wound……..transferred 7.10.40 Red Cross Hospital
Yves Paillard…….Gunshot wound………transferred 7.10.40 Red Cross Hospital
Louis Perrin……..Fracture, left arm…….transferred 4.11.40 Liverpool
Louis Defoin…….From Maidstone 27.6.40….further transfer 4.11.40 Liverpool
Marcel Gille(t)… fracture…….further transfer.4.11.40 Liverpool
The three for Liverpool went to Broad Green Orthopaedic Hospital along with three others. Eaton Hall was an officer training centre on the Duke of Westminster's estate.
On the 22nd June 1940 the Ministry of Health issued a directive that Joyce Green among other hospitals 'must be ready to receive patients from coastal and certain inland hospitals in Kent which are being evacuated as a precautionary step in the face of threatened enemy action. Nurses will accompany the patients and residential accommodation will be required for them. Date, time, numbers and travel would be advised later'. On the 5th September 1940, British Intelligence warned that information had come to light of an invasion threat for the 15th. They had planned for the total number of evacuated patients but not accounted for the number of nurses as had been previously considered.
Joyce Green played an important role in these evacuations. On the 5th August, 24 servicemen arrived from the County Hospital Chatham, it being in the evacuation zone which extended up the Thames estuary to Rochester. However the proximity of the Royal Navy Dockyard, Short aircraft factory and heavy engineering works which attracted heavy bombing raids in the area may have been an added factor. Three days later a further 44 came from the Kent and East Sussex Hospital ,in Tunbridge Wells, some with gunshot wounds and some with various medical conditions.
The invasion scare of the 5th brought no patients from the Kent coast evacuation as it was the height of the Blitz and Joyce Green was the destination of convoys of ambulances carrying injured civilians from London. In fact it was from the County Hospital the main convoys came (what became West Hill Hospital Dartford town centre), with 113 patients, after West Hill had received a direct hit in a bombing raid. This was one of the worst incidents of all in Dartford and occurred during the early hours of 5th September 1940 when a high explosive bomb demolished two women's wards at the County Hospital, West Hill, killing two nurses and twenty-two patients. Sister Mary Gantry, one of the hospital staff, earned the respect and praise of everybody in Dartford. Without regard for her own safety, she crawled in and out of the burning wreckage with a bowl of hypodermic syringes giving injections of morphine to the badly injured trapped women. Twice she was lowered into the smouldering wreckage head-first. To acknowledge her bravery a hospital ward, at West Hill hospital was named Marion A2 after her, but this tribute is sadly now lost when that hospital was also finally demolished.
On the 31st December 1940, the Medical Superintendent Dr Mitman reported that there were 924 civilians, 169 military, the latter mostly skin cases in a 'special dermatological unit' serving the whole of the South Eastern Region and sector X of the London area. This was situated in ward block 8.
From 1st January 1944 to 30th September 1944, the Netherlands Military Hospital was based at Joyce Green (but the last patient did not leave until the end of 1945). During the nine months the unit was at Joyce Green it treated 10,054 patients. As payment the Ministry of Health submitted to the Netherlands Ministry of War a bill for £4,310. This was calculated on the basis of 9 shillings (45p) per patient per day. When the unit closed Dr Mitman accepted full responsibility for the Dutch patients still remaining in the hospital and one assumes this is perhaps why the Dutch Authorities awarded him the Oranje Nassau medal.
The patients' library at Joyce Green was a benefit of the war. It was stocked and staffed by the British Red Cross Society. By 1945 there were nearly 3,000 books, which, until they were badly worn and ready for discard, were not made available for TB and skin patients, due to the risk of cross infection. The Red Cross Voluntary Service was replaced by a paid librarian after the war and has continued to expand into the excellent service provided today.
For those of you who mistakenly believe that the enemy did not deliberately bomb soft undefended civilian hospitals, in 1945, Dr Mitman estimated that up to May 1941 there had been 26 bombing incidents involving 64 HE bombs, 3 oil bombs, and about 200 incendiary bombs, the latter doing much damage to the wooden hutted Long Reach and Orchard Hospitals.
Luckily for the majority the only fatality had been a member of the bomb disposal squad, who sadly I have not been able to identify, except for the fact that a female bomb disposal member was killed around that time. However not a single ward or other building escaped entirely and many were repeatedly damaged. At the end of 1945 almost all blackout and gas-curtains had been removed but the blast walls were still present, offering some protection to the staff and patients from the indiscriminate bombing.
In 1945 staff and patients celebrated VE and VJ days. Patients were allowed to take tea with their relatives which were an unheard of privilege! The special fare included for patients was tinned cakes (from New Zealand), ice cream, minerals, beer and cigarettes. For children there were two new soft toys and sweets (also a gift from New Zealand). Staff did not qualify for the tinned cake or the beer although they did get the free cigarettes. To mark the end of the war visiting days were increased from just Wednesdays to Wednesday and Sunday from 1430 to 1530hrs.
Dr Mitman's reign as Medical Superintendent ended in 1948 with the introduction of the National Health Service (NHS) but he continued his career as Physician with a special interest in fevers.
1948-2000 Introduction of the NHS
The new NHS brought a number of changes in the running of the River Hospitals. For the first time they became general hospitals for the people of Dartford and with a locally run Management Committee.
The Dartford Hospital Management Committee took over the running of the hospitals from the London County Council. The Chairman was Mr William Parry. He had been an ideal candidate for the post as he was a local man with extensive experience in hospital administration, having been Assistant Clerk to the Metropolitan Asylums Board and then Principle Clerk of the Special Hospital's Division of the London County Council.
The Vice-Chairman was Mrs Flora Welch and the committee made up of doctors and members of the public. The first meeting was recorded by Mr Parry (the secretary Mr Durrant was not appointed until the second meeting) and he kept detailed accounts of all the meetings including any press cuttings about the hospitals (these are now in the archive collection at The Centre for Kentish Studies, Maidstone). The Committee was also responsible for the following hospitals:
Riseley Maternity Hospital
Back to the primary River Hospitals (Joyce Green, Long Reach and the Orchard)
The Orchard Hospital
The Orchard Hospital was built as an 800 bedded temporary hospital in 1901/2, along with Long Reach to cope with the smallpox epidemic at the time. The number of beds available on the ships was proving insufficient and the vessels condition was deteriorating rapidly, coupled with the fact that no one wanted a smallpox hospital in their town! The Metropolitan Asylum Board (MAB) already owned the land and patients were easily transported from London by the existing River Ambulances. The cost of building the hospital was £135,359.
The Orchard was frugally furnished with surplus furniture and equipment from Gore Farm Hospital and opened with Dr Rundles as temporary Medical Superintendent (MS); he was also to cover for Dr Ricketts (MS of the ships and Long Reach) during Annual Leave. Matron was Miss E M Bann from the Brook Hospital who served a dual function as she was to return to the Brook when she wasn't needed at the Orchard.
When Joyce Green Hospital opened in 1903, the combined bed total of Long Reach, The Orchard and Joyce Green meant that there were, at last, an adequate number of beds available for smallpox and so the Hospital Ships, which were now in poor condition, were, as described previously, sold for scrapping.
After 1910 Long Reach was kept permanently in reserve for smallpox. However, it was apparent that in years of low incidence of smallpox there was a corresponding high incidence of scarlet fever, so the requirement for isolation facilities continued to exist. The Orchard and Joyce Green hospitals, therefore, were designated as fever hospitals when there were small numbers of smallpox patients. With Joyce Green the hospital of choice the Orchard, with its large capacity, spent the majority of its time closed and was only opened for major epidemics.
The Orchard Hospital and the Australian Army 1916 - 1919
The Orchard hospital fulfilled a major function when it was turned over to dealing with the military casualties during the Great War. It became the Dartford Australian Auxiliary Hospital on the 9th October 1916, under the command of Lieutenant-Col. H Arthur Powell. In a newsletter written by the soldiers, their arrival at The Orchard was described like this: "There was nothing particularly inviting about the trip from the railway station to the gates. The country looked dark and bleak, nothing that could suggest a happy hunting ground after nature's bounteous gifts, yet those weary travellers hailed it at last as their haven of rest. A word and a glance were all that passed during the dreary march from the station to the Hospital “(a distance of about two miles). At first sight the Hospital had an unattractive and deserted appearance. Nevertheless, those weary travellers hailed it with a sigh of relief. All that could be seen was the long drab rows of timber and iron buildings, weather-beaten, unpainted, unkempt, and the prospect of having this for a future home for a probable indefinite period was quite uninviting. The place was pretty near deserted and the few staff that had to be there looked very downhearted. The occasional ward building had lights showing, likened to a welcoming star in an otherwise sea of darkness. However here was to be the safe home for many a fine brave Australian lad to be nursed back to life and health again following his return from the hellish battlefields of France and Flanders. Here, in the company of his Australian comrades and the care of the Australian nursing sisterhood, using the science of Australian and British medical and surgical expertise he could learn to smile and re-join society once again.
Over the following years to 1919 considerable improvements, by the Australian forces were made to the hospital. The most notable was to the grounds and vegetable gardens, cookhouse, headquarters and the addition of a desperately needed operating theatre. There was an efficient boiler house supplying steam to drive the engine to supply heat for the laundry to dry clothes and to provide hot water and heating for all the wards. The lighting was still provided by gas, with each ward having a liberal number of gas mantles. (As a child the fragile mantles were known in our family, as a threepenny poke, as that’s what it cost to replace them.)
As improvements to the hospital were made, its capacity increased from 1,000 to 1,200. This change meant additional staff was required and on the recommendation of Lieut. Col. B M Sutherland, 110 Women's Army Auxiliary Corps members found work.
The work done by the hospital was substantial and exemplary:
Admissions from 9th October 1916 - 31st December 1918 were 56,411.
Discharges from 10th October 1916 - 31st December 1918 were 55,527.
Remaining in the Hospital on 31st December 1918 were 884.
The Australian Red Cross took over the running of the Red Cross Store in April 1917. Every patient able to walk visited the store and gratefully collected various items to improve their comfort during their stay. For patients unable to walk the shop came to them once a week to hand out cigarettes and chocolate. Contrary to modern medical thinking every patient was issued with 30 cigarettes a week, which for the non-smokers became a kind of currency.
Many of the soldiers married Dartford girls. St Albans was the nearest church in St Albans Road DA1 1TF (01322 224052) and many of the weddings were held there. The hospital authorities, even now, still get enquiries from Australians looking into their family history.
Between the wars the Australian government presented the people of Dartford with a German Field Gun captured, in battle by the Australians. The plaque inscription read 'Presented to the people of Dartford by the Government of Australia in grateful appreciation of the kindness and hospitality extended to the Australian Soldiers of the 3rd Australian Auxiliary Hospital by the citizens of Dartford 1915-1919′. Unfortunately the gun was 'sent for scrap' during the Second World War when this type of metal was desperately needed.
Post Great War years
Following dealing with the terrible carnage of the Great War it was back to the occasional opening for epidemics of infectious scarlet fever whooping cough and diphtheria. Many hundreds of children from the poor areas of London were treated. A good deal of them travelled in the ambulance steamers, which must have been an interesting unique experience for them.
The Orchard remained mostly idle until 1939 when chronically sick patients were brought from the Midlands. After they had gone the British Army took over. The first to move in was an Officer Cadet Training Unit, who constructed an assault course and next a battalion of the Green Howards, finally a contingent of anti-tank gunners. Soon after D-Day these disappeared, almost certainly on their way to France. The night they actually left a V1 doodlebug slammed into the east of the buildings, which very quickly turning it into a blazing inferno, resulted in it being partly destroyed. Eventually it was completely demolished some years later; with the last few standing buildings being used as a pig farm supplying meat to the main Joyce Green Hospital.
Other River Hospitals:
The Orchard Hospital had been badly damaged by bombs in the war and was now due for demolition and the smaller Long Reach continued to be held in reserve for unexpected smallpox outbreaks.
In the 1920s hospitals decided to take a proactive approach to improve standards of nursing and medical knowledge and as with many other hospital groups Dartford trained their student nurses to a high standard. By 1948 the Dartford Group had established three separate training schools.
The school at West Hill was the first to be established in 1921, with the schools at Joyce Green and the Southern starting after the close of the Second World War in 1945. The three training schools were finally amalgamated in 1951 with a preliminary training school situated at the Southern.
At the time of the amalgamation the nurses from each hospital were identified by different uniforms so the decision was made for a Group uniform to be adopted for all grades: - Deputy Matron wore grey; Departmental Sisters wore bottle green; Ward Sisters wore royal blue; Junior Sisters and Staff Midwives wore pale blue; Student Nurses wore yellow; Assistant Nurses wore apple green and Male Nurses wore white.
For all nurses who passed their final examinations after the 5th July 1948, The Management Committee also authorised the issue of a proficiency badge, with an emblem of the Dartford Warbler (a rare protected small dark long-tailed bird found primarily in the Dartford area). The Dartford Warbler was also incorporated into a new Group Badge which had been designed by Dr Henderson, the Medical Superintendent at the Southern hospital.
In October 1953, Joyce Green became one of the six centres dedicated to the treatment of the much feared poliomyelitis in the South Eastern Hospital Region. A medical team was established and specialist training given to nurses.
The terrifying but effective iron lung used in the treatment of polio, in the UK, had been designed by Dr Robert Henderson who had become the Medical Superintendent at the Southern hospital. The United Kingdom's first iron lung was designed in 1933 by him in Aberdeen. In the USA Henderson had seen a demonstration of the Phillip Drinker and Shaw respirator in the early 1930s, and built a much improved and significantly cheaper device of his own design upon his return to Scotland. Four weeks after its construction, the Henderson respirator was used to save the life of a 10-year-old boy from New Deer, Aberdeenshire, who was suffering from poliomyelitis. Despite this success, Henderson was, in many peoples opinion, rather unnecessarily, reprimanded for secretly using hospital facilities and time to build the machine.
In 1959, it was decided to close the Southern Hospital which was now too big and deemed not suitable for modernisation, due primarily to its cheap wooden construction. However, currently available was the solidly brick built Joyce Green Hospital. Wards 9a and 9b were modernised, divided into sections, and painted in restful pastel colours. These were the prototype wards, resulting from research in the use of colour and design to stimulate relaxation and therefore aid healing and recovery. The other wards had the antiquated central stoves removed, a new modern kitchen, state of the art sterilising equipment and were freshly redecorated.
The patients and staff, together with any useful and modern medical equipment, were all duly transferred from the Southern, with the exception of the Medical Superintendent Dr Henderson, who retired, sadly disappointed that the Southern Hospital had been forced to close.
Many ideas were considered as an appropriate way of marking the amalgamation of the two hospitals and eventually it was decided that the building of a much needed recreational swimming pool at Joyce Green in order to help with physiotherapy and rebuilding muscles and stamina both marked the event and provided increased facilities. The League of Friends started off the swimming pool fund with £500, an additional £4,000 came from the King Edward's Hospital Fund. The enthusiastic staff raised the remainder, making a tremendous effort by organising collection boxes, jumble sales and market days and many other events. The pool opened on 27th May 1961. Mr Kekwich, Chairman of the Hospital Management Committee introduced Mr S C Harris OBE JP, who officially declared the pool open. The opening ceremony was followed by an amateur swimming contest.
In 1962 the National Plan for Hospitals was implemented. For Joyce Green this meant the installation of a long awaited lift to the wards and a covered corridor outside blocks 1-4.
On 20th April 1963 Sir Arthur Porritt, President of the Royal College of Surgeons opened the new Twin Operating Suite. Mr Watts the Consultant Surgeon invited Sir Arthur to perform a pseudo operation by cutting the ceremonial tape at the entrance to the theatre. He was advised that a suitable cutting instrument would be provided to which he jokingly responded that he hoped it would be sharper than those he was normally supplied!
In 1964 the library moved from block 15 to its new location in the old sewing room. The library was started during the Second World War by the Red Cross and Order of St Johns Jerusalem and was run by volunteers. After the War the large selection of books were made available to all civilian patients as well and was still run on a voluntary basis until 1948 when the NHS took over all health matters. After this the library was funded by the Hospital Management Committee for the benefit of the patients and properly staffed for the first time. In 1965 the Medical Reference Library was started to replace the books housed in the Doctors Quarters. In 1966 a Nursing Reference Library was started and these collections formed the basis for the comprehensive Medical Library available in Dartford today.
The Study Centre was also opened in 1965 and together with the library was funded from the Local Government Endowment Fund. The study centre was on the ground floor of the PTS home (later Home 6 where Staff Development was), near the Pathology Laboratory. It consisted of a lecture room, meeting room and dining hall. Dr Farrant was the mainstay behind the setting up of the centre, which is why the Education Centre at the new Darent Valley Hospital is called the Philip Farrant Centre.
In 1965 Student Nurses swapped their rather drab corn-coloured dresses for some brighter new uniforms in candy stripes with no cuff or collar.
Joyce Green was the first hospital in the KCC area to open, in January 1966, a cervical cytology unit and the first hospital in the country to open the now familiar "well woman" clinic.
In 1967 the new group pharmacy opened and the old pharmacy department was converted to provide the new accommodation facility for the porters until the final closure of Joyce Green.
In 1968 it was reported in the staff newsletter “The Auricle” that Mac (the gardener) and his famous gnomes had a nice new greenhouse opposite the mortuary where he could develop his plants and new varieties. New tennis courts were also laid where the car park was situated at the end of block 19 (Orchard House).
During March 1969 the new psychiatry unit is opened, with Blocks 18 and 19 joined at a cost of £77,000 and patients from Constance and Christopher wards, West Hill, were transferred there. There were 54 beds at the unit, 40 for women and 14 for men, a therapy room and dining room. The unit was designed for short-term problems and patients stayed for a maximum of 4-6 weeks. No alcohol or drug related problems were dealt with here. Blocks 18 and 19 later became Orchard House.
Going back to the original function of the hospitals, in order to restrict the potential infectious spread of smallpox, even after death, most victims were buried in the hospital cemetery. However, as the fears of smallpox receded concerns were raised in 1970, over the proximity of the public footpath which ran down the side of the Cemetery. It was suspected that smallpox had an indefinite life span outside the body and there was some, possibly irrational, fear that there was a possible risk of catching smallpox from walking closely to the mass graves, even after so many years. An extension of the cobbled path ran from Joyce Green Hospital to the cemetery forming part of Marsh Street on the northern side. The path was used to transport the dead for burial at the Cemetery and for visitors coming to pay their respects from Dartford and the surrounding area, via Joyce Green Lane. The cemetery contains 1029 bodies buried in a total of 292 graves. Many of these were mass graves (in epidemic years) containing up to 14 bodies which were buried in hessian sacks stuffed with straw and charcoal in order to absorb any infected bodily fluids. In many instances the wooden coffins were rather unwisely reused, rather than being incinerated. The cemetery is now cut off from the hospital site by the new by-pass road University Way and is now surrounded by new houses. One of the only gravestones left marks the final resting place of Clara Couchman, a nurse who contracted smallpox whilst nursing others. Records show that throughout the whole period of burials within Joyce Green approximately half the victims were children less than 14 years of age. The cemetery became extremely overgrown and rubbish strewn making it impossible for relatives to visit or even find the graves. A plan of the graves and cemetery register are held at the Library, Darent Valley Hospital. The Temple Hill Trust bought the land for a nominal sum (£1) and ran a competition in the local primary school to provide the Cemetery with its new name
The Enchanted Woodland
Nature has reclaimed what was taken and returned it to a peaceful place.
You can still see the yews that once formed neatly clipped hedges beside the formal pathways and the woodland is studded with trees and shrubs you would not expect to find in native woodland alongside the species that you would expect - hawthorn, alder, ash, limes and splendid horse chestnuts. The woodland also boasts laburnum, lilac and privet and, in the spring, is awash with violets and the familiar drumming of the great spotted woodpeckers as they search for insects among the tree bark and the high pitched cheeping of the smaller birds as they feed their new families.
In October 1970, work started on the new £60,000 Paediatric block 7. Changes to the wards meant that blocks 7-11 were to be medical wards and blocks 1-5 surgical, blocks 18-22 were planned to be geriatric and psychiatric. The new Mentally Handicapped Unit (later to be Orchard House) was also opened.
In May 1971 the Government produced a White Paper creating new Health Authorities to replace the Hospital Management Committees (HMC) set up in 1948. The question is would the Dartford HMC merge with the Darenth and Stone HMC which ran Stone House and Darenth Park?
During July 1971, a £50,000 Post-Graduate Centre was built at Joyce Green, which meant that Dartford would be a focal point for medical further education and training. The centre would keep doctors and health professionals abreast of the latest medical research and discoveries. It was built around block 12 and included tutorial rooms, lecture hall, dining room and kitchen, with a later library added.
On the 8th November 1971, Princess Anne flew into Joyce Green by helicopter. She was met by the Lord Lieutenant of Kent, Lord Cornwallis then driven to West Hill Hospital to open the new sorely needed A&E department serving a large proportion of the surrounding area.
In October 1973, far from earth shattering news, but the new laundrette opened. This provided a far more civilised facility from the days when the nurses had to wash their 'smalls' in a Belfast sink in the recreation hall!
In April 1973 B block was converted to take the patients from the grim looking Denton Isolation Hospital at Gravesend (right on the banks of the river Thames), it took seaman, entering the country, who had fallen ill (particularly those with infectious diseases) aboard ship. These infected patients were removed by the Port of London Health Authority, their symptoms being either reported by the ship or identified during the PLHA routine ship inspections. They had dedicated three approx. 100ft launches, Howard Deighton, Alfred Robertson, Alfred Roach (just 53ft) or Frederick Whittingham which were suitably fitted out. These launches operated from the hulk Hygeia (built in 1914 as an Admiralty lighter) moored at Gravesend or from Woolwich. Denton was closed in October 1974 and remained empty until demolition in 1990, in the meantime a favourite haunt for ghost hunters and urban explorers.
Due to the dire political situation in January 1974, and the ensuing fuel crisis, savings needed to be made in the amounts of heating oil purchased and electricity consumed. Measures taken re the heating oil savings were satisfactory but not so the electricity. To help improve the situation, the offices were banned from using electric lighting on Thursdays, Fridays and Saturdays. Candles could be obtained from the main stores, but due to the lack of light in the dark evenings and candles being a fire risk and therefore not a good idea, the library had to close at 1600hrs. This was a step back almost into the Victorian era.
Soft toilet rolls are introduced to staff and patients in July 1974. Complaints are made by the Group Domestic Manager that the number of toilet rolls issued suddenly increased 10 fold and accuses staff of pinching them. They are warned to stop or face going back to hard paper again. The staff was furious and pointed out that the level of usage of the hard rolls was always artificially low due to their roughness and discomfort caused, therefore many patients and staff preferring to use their own tissues!
Joyce Green Hospital Radio started in 1976. During the relatively short history of Joyce Green Hospital Radio, many remember that the strangest things happened. Some remember the aeroplane that crash-landed near the now defunct Joyce Green airfield in the middle of a broadcast, or the numerous encounters with horses and other farm animals, that occasionally wandered into the studio from neighbouring farms. This cheery and welcome service for patients ran until the hospital closure and its volunteers now provide music and chat for patients at the new Darent Valley Hospital.
Despite continued maintenance and improvements in the 1980's rumours began to circulate of the building of a new general hospital. Different sites were looked at again and again, but Darenth seemed the popular choice, due to its proximity to the motorway, although no-one seemed to want to make a final decision. There were serious issues to consider and overcome. Availability of the land was a problem but more importantly the proposed capacity of the new Darenth hospital was nowhere near adequate to replace the closed hospitals in Dartford and the surrounding area.
At Joyce Green a support scheme for newly discharged elderly patients was set up in 1984. It is only the 3rd of its kind in the country and aimed at helping the elderly during the first 72 hours after discharge, which is considered a vulnerable and dangerous period for this age group.
The old St James Hospital (Gravesend) built in 1847 is finally closed in 1985 and the patients are transferred to Joyce Green to the newly refurbished J Block which is renamed St James House.
February 1986, the “bed bureau” is created in a pilot scheme. It is hoped to eliminate the time consuming search for beds by the GPs. The basis of the pilot scheme was successful as the bed bureau is still in operation today, by many hospital authorities.
February 1987, and amid the AIDS scare the Dartford and Gravesham Health Authority employ their first full time HIV/AIDS health advisor. Harry Smith's greatest stated ambition when interviewed for the local paper was to be made redundant, but regrettably, of course, he is still employed. Huge advances have been made in the care and treatment of AIDS but as yet, of course, there is still no cure.
In September 1989, £250,000 is spent on improvements to wards 13A, 11A, 11B, 5A, the twin operating theatre and endoscopy suite. At the end of October a further £100,000 was spent enlarging rooms in the doctor’s accommodation block and upgrading junior doctor’s rooms.
A local mother started the Scanner Appeal in April 1990 after the tragic death of her son. The Jamie Styles Memorial Fund topped £20,000 after two months. It needed to raise the £600,000 for the MRI scanner and £100,000 a year to run it for the first three years. By September 1991 Mrs Styles had raised £16,000 through her own efforts. Health Chiefs took over the appeal and needed to raise the remaining £1.2 million. The target was reached in September 1994 and the official opening took place in April 1995.
A massive blaze broke out and the laundry building was burnt down in August 1991 causing over two million pounds worth of damage. The fire spread to the nearby boiler room and 38 elderly patients were quickly evacuated from their ward as fire threatened to engulf them. The hospital lost half of their linen supplies. The blaze was later found to have been caused by arsonists.
In October 1991 ward 13A is upgraded. It was changed to a 16-bed ward with six beds in isolation rooms for infectious diseases to replace the beds in G1. The new ward was called the Mary Gantry ward after the West Hill midwife, who, after a bomb landed on ward A1 during WW2, crawled amongst the rubble administering Morphine to trapped patients. This incident was described more fully elsewhere in this article.
St James House (opened originally to take the patients from St James Hospital, Gravesend) closed in February 1992. It was deemed unsuitable for the elderly patient's and they were transferred to Wombwell Hall Nursing Home, Gravesend (.previously a large private house and grounds belonging to the Colyer-Fergusson family).
July 1992 and Joyce Green’s Day Care Unit opens. The unit consists of 11 trolleys, a surgical suite, and an endoscopy suite. The patients are treated under general or local anaesthetic and go home the same day.
The Ear, Nose and Throat Services are moved to Medway Maritime Hospital in August 1995, due to West Kent Health Authority changes. Clinics are still held locally but all patients have to travel to Medway for their operations.
Dartford and Gravesham NHS Trust in December 1995 was the first Trust in the country to provide its staff with access to a workshop developed by Action for Dysphasic Adults (ADA) called 'Communicate'. The course trains staff how to deal with people with communication difficulties caused by strokes, Alzheimer's, prion protein diseases and other similar illnesses.
The casualty unit is moved to Joyce Green July in 1996, into a new purpose-built building despite the new hospital being only a few years away from opening. This is due to demands from the Royal College of Anaesthetists (backed by other Royal Colleges), as they are unhappy about seriously ill patients being moved from the old A&E at West Hill to general wards at Joyce Green.
With the new hospital fast approaching completion, the staff and management of the hospital formed committees. Representatives from wards and departments attended regular 'briefings' so news could filter to all staff and question and queries that staff had could be answered.
The new wards need names and a competition was launched by the Trust for the staff to win a prize of one week’s annual leave. The Trust Board considered the shortlist (Local Towns and Villages, Botanical, Hospital History, Wild Flowers) which resulted in a clear favourite - trees. It was decided that the tree names would reflect those much loved in the grounds of Joyce Green.
Next a name for the new hospital itself was needed. It was around the time of the death of Princess Diana and the overwhelming public response was to name the new hospital in memory of her. This had proved to be very difficult as royal protocols prevented a Royal name being agreed to until quite near to the actual opening date. The time delay was not acceptable as the hospital needed to start familiarising the public with the opening of the hospital using leaflets and posters, liaising with ambulance services and modifying road signs and markings. So the staff and public were asked for suggestions. The Trust received over 100 suggestions and a small committee was formed to shortlist these to 8-10 names.
After all the toing and froing, it was decided that the staff should choose the final name and an official polling day was set. Official ballot boxes were put around the hospital and the staff was given one vote and a ballot paper each. The name Darenth Valley was, by far, the most popular choice and duly announced. Unfortunately, as is often with these things, a few influential members of public felt the name was incorrect and it was arbitrarily changed, illogically, to Darent Valley despite being in Darenth Wood Road! This was a disappointing blow to all the staff at the hospitals who had voted, as the name was one of the few important things that all the staff had been able to contribute to.
The final days of Joyce Green
An essential moving plan was formulated. A 60-day moving period was agreed and designed to be flexible and ready to start as soon as the building work at new hospital was completed. Its primary concern was to enable the smooth transfer of all the patients, wards and departments gradually. Plans were formulated, boxes and crates made ready and the packing of the whole hospital began. Historical mementoes were recorded and where possible, removed for safe storage. These included the War Memorial, plaques, medals, photographs, and pictures. The hospital had 97 years of history to preserve.
The physical moving started at the end of July 2000. The famous removal company Pickfords carried it out with a team of 35 removal staff and 6 large pantechnicons. They moved 25,000 crates and 4.66 miles of medical and other records.
The new Darent Valley hospital opened on 11th September, 2000 and whilst more modern, with up to date equipment and surroundings, proved, as feared, sadly too small from the outset to meet the needs of the ever increasing population of the surrounding towns. There was no more money available in the NHS kitty and this situation prevails today.
Returning to the early days in 1910, it was decided, at the time, that Long Reach would be kept permanently in reserve for smallpox and the other River Hospitals (Orchard and Joyce Green) would be used for fevers and convalescence. The need to carry out repairs to Long Reach, was now paramount as it had originally been built as a temporary structure with just a two year life expectancy. Many of the delays in repairs were due to Dr Rickets absence, who had been on sick leave for a year. When he returned in the autumn 1912, he demanded changes to the plans made in his absence. His proposed changes must have been extensive as nothing was done before 1914 and the outbreak of The Great War put paid to anything complex or expensive for the duration of hostilities.
In 1928 Long Reach was rebuilt as a permanent smallpox hospital, which coincided with an outbreak of variola minor, the milder version of smallpox.
As mentioned previously on the 1st February 1953 the Thames flooded and by 1400hrs Long Reach Hospital was submerged to a depth of 6 feet. The water swept in the North Gate at Joyce Green, a distance of half a mile from the river. The Gate Porter was the only member of staff on duty at Long Reach and he waded and swam to Joyce Green. During the afternoon of 2nd February the water flooded the adjacent firework factory (Joseph Wells) and a chemical reaction caused a fire and three large explosions which shattered 500 panes of glass at Joyce Green.
The last of the water was pumped out of Long Reach over the period of the 18th-22nd February and the clean-up began. The boilers were overhauled and finally restarted on the 2nd March, which helped dry out the buildings.
By the 1960’s Long Reach had 50 beds on standby and was capable of being reopened in two hours should a case be diagnosed. The nursing staff was on permanent standby and received a small salary in return. They moved in for 14 days at a time and all their clothing was destroyed when they left. The calculation of staff to patient ratio was set at 14:1.
In 1961 it was calculated that it cost £340 per week, £18,000 per year to maintain Long Reach in its present state. By 1973 with smallpox at an all-time low it was decided that just 30 beds were adequate to be kept on standby.
In March 1973 Long Reach was finally opened for just one patient. The call came at 0900hrs and the staff were re-vaccinated (this happened every time they were needed) and were ready to receive the patient by 1030hrs when smallpox was confirmed. This was a response in absolute record time but was the last patient ever to be treated at Long Reach.
Long reach was knocked down in 1974 to make way for much improved flood defences.
Orchard Hospital (infectious)
The Orchard Hospital was originally classed as a 'temporary' hospital with its timber-structured buildings being quickly erected within a 63 acre site in 1902. The hospital provided some 800 beds that were to be used in case of a widespread epidemic. As mentioned earlier in 1916 the Australian Military acquired the Orchard Hospital for the treatment of its Great War wounded, during its Australian occupation the Orchard was known as The Dartford Australian Auxiliary Hospital. Following the cessation of hostility's the Australians departed and the hospital was little used. On September 3rd 1939 the Orchard Hospitals became a prime asset again when the UK's Prime Minister of the time Neville Chamberlain announced that Britain was at war with Germany. Nazi German air raids were soon to follow deliberately targeting soft civilian humanitarian institutions and the Orchard hospital was badly fire bombed. After the war some of the remaining buildings were converted to agricultural use and the remainder demolished. Today as with the Joyce Green Hospital ruins, the Orchard site is now part of the Bridge housing development.
Internal transport system
The three River Hospital were each connected by a horse drawn tram system, patients who were transported from London via the ambulance steamers (Albert Victor & Geneva Cross etc.) arrived first at Long Reach Pier and then were conveyed to the wards by a horse drawn tram. From Long Reach Pier the furthest point possible of travel via the tram system would have been Joyce Green Hospitals South Gate, in all a total of 3.4 miles of track was laid. You will find fragments of Joyce Green's unique horse drawn tramway, built in 1897, still surviving. On the south side of the hospital grounds, the tram sheds, stables and haylofts still exist, while stone setts and short sections of old rail can be spotted in various locations. At its most extensive, the single-track tramway stretched for nearly three and a half miles, from Long Reach, reaching most hospital buildings. As well as ferrying patients, the tramway was used for a myriad of other transport duties, particularly when the smallpox epidemic precluded the use of outside vehicles entering the hospital grounds. Originally modern electric motive power was considered but Joyce Green only had gas for lighting and electricity was some decade or so away. Eventually, horses were replaced by petrol engine motor traction as a means of propulsion and in July 1914 a motor tractor was tested. It hauled two trams laden with 23 adults, the test was successful but due to the war the idea was dropped as no suitable vehicles could be spared and it reverted to horses again. In 1924/5 motor traction was again tried. A Talbot motor ambulance was used successfully and two more ordered. They had to travel slowly and the tram brakemen had to get off at corners and lean against the tram to help it round as unlike the horses it didn’t have the same sideways pull at corners. The tramway was finally closed in 1936 and in 1943 its iron rails were commandeered for smelting to help with the war effort.
Gore Farm Hospital (Renamed The Southern 1911 and finally The Marledon)
Gore Farm Hospital was also constructed in 1888-9 by the Metropolitan Asylums Board. It was situated in Darenth Woods Dartford and over the years sections of the establishment were renamed The Southern Hospital Upper and Lower, The Dartford War Hospital, US Base No 37, and finally the Mabledon, which closed in 1985.
Recap of Joyce Green, Gore Farm, Long Reach and Orchard Hospitals
Commissioned by the Metropolitan Asylums Board, building began for the new Joyce Green Hospital in 1901, opening on the 28th December, 1903. Together with the nearby Gore Farm Hospital, which had been used for recovering patients since 1890, the MAB would have nearly 4000 beds available for smallpox cases. However, in the autumn of 1901, just after construction of the Joyce Green had begun, London suffered a severe outbreak of variola. With the new hospital still under construction and unable to take in patients, two temporary specialist hospitals were erected in the vicinity:
The Long Reach, which opened in February 1902 with 300 beds, was located on a riverbank area immediately to the east of the Long Reach Pier buildings.
The Orchard, opened later in 1902 with 800 beds and was situated to the north-west of the Joyce Green site. At the south-east of the site were stables and a coach house.
The MAB was abolished in 1930 and its functions passed to the London County Council. By this time, road ambulances were carrying most of the sick and their visitors out to the hospitals and the river service was rarely used. Although some ships had been maintained in case of an epidemic, the service was closed in May 1930 and the pier was finally demolished in 1936.
Dartford's River Hospitals played their part with Parliament taking possession of The Orchard at Long Reach on 24th May 1915 to accommodate the increasing numbers of sick and wounded soldiers returning from the hell of the trenches in Belgium. 1915 also saw the old Gore Hospital, now known as the Southern, caring for Allies in their upper sections and injured German prisoners of war in the lower levels. The Upper Southern became home to many American soldiers, after their entry into the war on 2nd April 1917, eventually being handed over to the US Military in 1918 to treat their servicemen and the Orchard became exclusively occupied by Australians. In a bid to increase the Allies' morale local people arranged special entertainments and treats, welcoming the soldiers into their homes with some even finding suitable partners among the indigenous population. In June 1918, five months before the official end of WW1 on 11th November, Joyce Green housed 1140 refugees from Russia after they potentially came into contact with various infectious diseases including smallpox.
Joyce Green remained in operation but the Long Reach was downgraded to be maintained in a condition of instant readiness, with a skeleton staff at all times. In 1926 Joyce Green received electricity and the Long Reach buildings were replaced with permanent structures. With smallpox in decline the Long Reach Hospital was the only hospital treating any further smallpox cases that is until 1928 when a large outbreak of the far milder variola minor virus caused Joyce Green to be reactivated. This continued until 1934 with the majority of sufferers being unwisely previously unvaccinated children.
On the 1st September 1939 it was again called into service, as part of the Emergency Medical Scheme, to treat wounded allied soldiers, plucked from the devastation of Dunkirk during the early months of the start of World War II. No longer needed as an infectious disease centre it was upgraded to a general hospital with military emphasis and an increase of beds from 986 to over 1500 with specialist injuries units built, including three x-ray units. Towards the end of the war between 1944 and 1946, part of the site became a Dutch military hospital, treating their sick and injured.
Sadly, as mentioned during the war most of the wooden buildings that formed The Orchard Hospital were destroyed by fire; those that survived were converted to agricultural use. By 1945, at the close of the war, the total number of beds available had fallen to 428.
1922 saw a minor outbreak of smallpox centralised in the deprived Poplar area of London. The outbreak took the lives of 107 Joyce Green Hospital patients and of those at least two were transferred from the Poplar Institute Workhouse. James McNamara, an inmate, aged 73 who was recorded in the 1911 Census as being single and a labourer, and Ethel Clara Chapman, a nurse at the Poplar Institute.
In 1948 Joyce Green joined the newly inaugurated National Health Service, run by the South East Metropolitan Regional Hospital Board and Dartford Hospital Management Committee. Following a storm surge, described earlier, which nearly completely flooded the site on 31st January 1953 the hospital, became a training unit for fever nurses, to take advantage of the facilities that were already installed.
From 1974 Joyce Green was run by the South East Thames Regional Health Authority and the Dartford and Gravesham District Health Authority. Joyce Green covered accident and emergency, general surgery, orthopaedics, paediatrics, haematology, general medicine, care of the elderly and postgraduate medical training.
Due to the increase in industry and consequently traffic flow, in 1994 University Way, the new northern by-pass for Dartford was built, cutting the Joyce Green Hospital land in two and leaving a small portion of the cobbled path and the cemetery isolated on the southern side. University Way has since been renamed Bob Dunn Way in memory the MP for Dartford in 2004. Parts of the cobbled path remain on the northern side with the best kept portion to be seen on the southern side, from Cornwall Road to Joyce Green Lane - a small section of which is now under the ownership of the Temple Hill Trust.
Staff Accommodation from the beginning.
Accommodation for the staff on the hospital ships can never have been spacious, but they did have the convenience of modern electric light, which made it one of the first hospitals to benefit from it. Nurse White had the dubious honour of being the first nurse to be disciplined for not switching it off at “lights out”, having been enthralled with her book while reading in bed.
Modern lighting must have been of little consolation to the Assistant Medical Officers living in low ceiling, cramped cabins under a leaky poop deck of the Atlas. In 1901 Dr Ricketts complained several times and wrote: 'From time to time I have pointed out the leaky condition of the poop deck on Atlas, under which these quarters lie. Some two years ago the quarters became uninhabitable for that reason, and as a temporary remedy the poop deck was painted on its upper surface and was closed for the use of patients and staff for the purposes of recreation. A considerable improvement was effected, but from the nature of the case, such improvement looked only to be temporary and this summer the leakage has been worse than it has been for two years. The coat of paint on the deck is renewed from time to time. But it is beyond my power to say how long this remedy will serve its purpose. It is quite possible, for instance, that next winter it may again become unfit for use. The quarters I have referred to are not only in a bad condition, but are insufficient in themselves. There is only one common sitting room, which is low and ill ventilated. This has to serve for 3 Assistant Medical Officers and the offices are so inconvenient that some of the office work has to be done in that room. The quarters, therefore, are hardly suitable for the occupation of medical men.'
In 1895 he also complained to the MAB about female staff accommodation, which two years earlier could only provide 130 beds for 139 persons. This would suggest that a certain number of nurses and auxiliaries had to sleep two in a bed, but he does not say if they had to simultaneously share a bed. Perhaps they used the “hot bunk system”, so beloved of the navy, if some were on night duty.
By 1895 the beds had increased to 136, but so had the staff to over 140. Thus more and more nurses were coming ashore and quite a little colony was forming on land at Long Reach and the concept of total isolation in floating hulks was proving quite impractical. But attitudes were changing and by 1902, when Long Reach Hospital opened, and the ships closed, local opposition became muted. Dartford’s population accepted the existence of the smallpox hospitals and anyway, they were extremely good for local trade.
Orchard Hospital -Joyce Green Lane
The second 'River Hospital', the Orchard Hospital opened just south of the Long Reach Hospital in the spring of 1902 as another temporary hospital for smallpox patients. Built on 63 acres belonging to the Joyce Green estate, it had cost £135,359 and could provide 800 beds. By this time the smallpox epidemic, which had begun the previous year, was already subsiding.
The Hospitals construction was of iron framing and wood and was furnished with surplus furniture from the nearby Gore Farm Hospital in Dartford and gas lighting was used in all the wards. A temporary Medical Superintendent, Dr Rundles, was appointed, who would also provide cover for Dr. T.F. Ricketts, the Medical Superintendent of the smallpox ships and Long Reach Hospital.
In 1910, with the decline of smallpox outbreaks, the service was reorganised and it was felt that the Hospital best served the community as a fever hospital. It spent a great deal of its time closed, being opened only for epidemics of contagious diseases, mainly of scarlet fever, whooping cough and diphtheria.
After the war the Hospital remained mostly closed, opening occasionally for epidemics. In 1939, at the outbreak of WW2, it received chronically sick patients temporarily evacuated from the Midlands. The mortuary was prepared as a decontamination hut for potential gas victims, but, of course this horror did not occur. The wooden ward buildings were most vulnerable to incendiary bombs and in 1940 fears were confirmed when the east buildings were destroyed by these very weapons. The remaining damaged buildings were demolished and those still standing were used as a pig farm by Joyce Green Hospital, until they too were demolished.
Apart from some derelict buildings, nothing remains. The approach road to the former Hospital off Joyce Green Lane is blocked by a large unsightly pile of rubble, with barbed wire fences behind, primarily to keep out itinerant traveller camps from setting up. It was possible to gain access to the rough unmade track further along the fencing but it is amazing how quickly nature regains its hold because where the Hospital once stood is now just scrub woodland.
September surprises us all, as flocks of birds choose this wetland area to assemble and darken the sky with wheeling patterns before their long flight south for the winter. Each weekend, just outside the remains of Joyce Green Hospital, model aeroplane enthusiasts use the wide open spaces of the marshes to fly their latest creations. Few may know that in 1911, the marshland was chosen by Vickers to test their now famous flying machines. In its day, the large biplane Vickers Vimy bomber was among the world's most sophisticated aircraft and was built here.
Not that flying would have been easy. During The Great War, Royal Flying Corps pilots were forced to understand the hazards of landing at the newly built Joyce Green Airfield which was situated by a river, three fever hospitals, a sewage works and a gunpowder factory! The airfield closed prematurely in 1919 although evidence of its existence remains apparent to this day and photographers still visit it, in an attempt to capture its wild and unkempt beauty.
Joyce Green's long history means some things remain a matter for speculation. The origin of the name, itself, is uncertain. Historians believe that the local surname 'Joce', dating from the l4th century, probably gave rise to today's 'Joyce'. 'Joyce' would almost certainly have farmed the local green pastures, an activity that persists widely in the area, to this day.
In 1894, London's MAB had purchased Marsh Street Farm, a smallholding that would prove particularly useful some 20 years or so later. Between the wars, the farm reached its heyday and Joyce Green Hospital was almost self-sufficient for a great deal of the year, with its 'home grown' supply of vegetables, meat, fruit, eggs and milk. The farm also produced not only enough hay to satisfy its own requirements for the horses on the tramway but sufficient to provide a useful source of extra income for the hospital too.
Southern Hospital-Gore Road,
Originally a convalescent smallpox and infectious diseases hospital - Later a general hospital.
The smallpox epidemic which began in 1881 placed a great strain on hospitals in London. To relieve pressure on available beds on its hospital ships moored at Long Reach, the Metropolitan Asylums Board (MAB) established a tented camp for convalescent smallpox patients at the back of one of its other institutions, the rather derogatorily named, The Darenth School for Imbecile Children, which was still in the process of being built but had almost been completed although still unoccupied.
Transferred from the smallpox ships four miles away, the first patients arrived in May to their tented accommodation. The incomplete Asylum provided kitchen and other facilities but by the autumn the weather became too cold for tents and the patients were moved indoors to the Asylum buildings.
In 1883 MAB purchased Gore Farm from a Mr Morton at the cost of £16,000. The 160 acre farm was located immediately to the south of the Asylum. An additional strip of land linking the farm to the roadway was bought for £125 from the Ecclesiastical Commissioners. In 1884 the temporary camp at Darenth Park transferred to the site. It consisted of 15 double tents (one tent inside another for insulation and weather protection) which could accommodate 300 patients, two marquees which were for the patients to use during the day (one for females and one for males) and ancillary tents for staff, stores, toilets, etc. More tents were added as more patients arrived. Two wooden huts were built, which later became infirmaries. Part of the Hospital grounds was cultivated, the land being fertilized by locally produced sewage from the nearby works.
Most patients remained at the camp for three weeks. Visitors were not allowed unless death was imminent, in which case a visit was permitted subject to suitable precautions. Patients were encouraged to write letters, in order to keep touch and these were disinfected before being posted, to avoid infection being spread into or via the mail service.
During the 1884-1885 epidemics all smallpox patients were treated initially on the hospital ships at Long Reach, with recovering patients being sent to Gore Farm. The existing smallpox hospitals remaining in London were converted to fever hospitals for other infectious diseases.
By 1886 MAB was being pressured to improve conditions for patients at the farm. Despite being advised that wooden huts were a fire hazard, difficult to ventilate heat and clean, eight temporary pavilions made from wood and iron were built in 1887 on the southern part of the farm. Each ward had 26 beds. A house for the Medical Superintendent was built to the southeast of the huts and an administration block and laundry to the north of them. This became the Gore Farm Lower Hospital. Many more pavilions were added later to the north of the site.
In 1890 permanent buildings were erected on the higher ground at the northeast of the farm. They comprised 20 two-storey ward blocks and 3 small isolation wards and a two-storey administration block with a kitchen and laundry to its rear. On each side of the kitchen block was a two-storey block for staff accommodation - the men on the east and the women on the west. A Nurses' Home was built on one side of the boiler room and a block for domestic staff on the other, both three-storeys high. A two-storey temporary hut was built specifically for night nurses. This site was known as the Gore Farm Upper Hospital and it had 1000 bed capacity.
At the time of the next smallpox epidemic the Upper Hospital was full of scarlet fever patients, so the Lower Hospital was extended to 850 beds. Twelve dormitories were built and the two recreation halls converted to wards of 40 beds each. It was a large project and the building workers were obliged to remain on the site and were not allowed to visit Dartford town because of the risk of spreading infection. Four policemen also resided on site to maintain law and order.
During The Great War the Lower Southern Hospital became the Dartford War Hospital with 1,200 beds, treating badly wounded German soldiers, many of whom died of terrible injuries or disease and were buried at Darenth Park (later 285 graves were exhumed by the German War Graves Commission and reburied at Cannock Chase, German Military Cemetery, in Staffordshire). Those who recovered were sent to a nearby Prisoner-of-War camp and were employed doing menial jobs and helping out on various local farms. In 1918 German POWs were sent to Joyce Green Hospital to help prepare accommodation for over 1000 Eastern European refugees suspected of being in contact with smallpox, as mentioned previously.
In 1918 the U.S. government took over the Upper Hospital for its sick and wounded servicemen and it became the United States Base Hospital No. 37. It was the largest American military hospital in England. The brick buildings were supplemented by metal framed wooden huts. The 20 ward structures each contained 100 beds, giving the Hospital some 2,000 beds. The army medical unit consisted of about 50 surgeons, 100 nurses and 200 enlisted men, most from the King's County Hospital in Brooklyn, New York. They sailed for England on the vessel SS Lapland on May 19th 1918. In October King George V and Queen Mary paid a visit to the Base Hospital, chatting to the wounded soldiers, whose experience of meeting royalty was limited. In the two hours spent there, the King had spoken to 83 soldiers from 22 different States of America.
When news of the Armistice was announced on 11th November, the German patients in the Dartford War Hospital and the Americans in the Base Hospital celebrated the iconic moment together.
On January 21, 1919, all remaining American patients were evacuated and the hospital was closed and returned to the British authorities. The unit sailed back to the USA from Brest, France, on the SS Olympic, February 18, 1919. It arrived in New York February 24, and was demobilized at Camp Upton, N.Y., March 5, 1919.
A total of 4,350 American soldiers (3,111 surgical and 1,239 medical cases) had been treated during its operational lifetime, of which 40 had died, mainly of pneumonia. The largest convoy received had been of 202 men, followed immediately by the second largest, of 160 influenza cases from an incoming transport (25 of whom sadly died).
On 20th May 1955 the Hospital Veterans returned and presented a plaque to the Southern Hospital, commemorating their stay and treatment. The plaque is currently stored at the Dartford Museum and read as follows:
TO COMMEMORATE THE OCCUPATION OF
THE SOUTHERN HOSPITAL, DARTFORD BY U.S. BASE HOSPITAL No. 37
COL. EDWIN HOWE FISKE, COMMANDING
AMERICAN EXPEDITIONARY FORCES
After the war the Southern Hospital was used for infectious diseases and for the many poor children from London in need of care and convalescence.
By 1921 the Upper Hospital had 922 beds and the Lower 610. By 1924 bed numbers had greatly reduced to 600 at the Upper site and 160 at the Lower.
In 1930 the LCC took over control of the Hospital; at this time the Upper Hospital had 777 beds and the Lower 767 and was used mainly for rehabilitation of infectious disease patients.
In 1938 the Royal Naval Hospital at Chatham was transferred to the Southern Hospital during the Munich crisis, along with some 300 naval personnel. At the outbreak of WW2 it became a Group 1 Emergency Medical Service Hospital, expected to deal with a large number of casualties. The Hospital facilities were upgraded and it became one of the largest general hospitals in England, with 1580 beds. It received more casualties, of various nationalities, from Dunkirk than any other hospital and, throughout the war, also received many civilian air-raid casualties from the Blitz in London.
After WW2 most of the original huts built in 1887 for the Lower Hospital were demolished (the remaining buildings, in good condition, later became the Mabledon Hospital ).
Southern Hospital-Gore Road,
Originally a convalescent smallpox and infectious diseases hospital - Later, converted to a general hospital.
During the 1884-1885 epidemics all smallpox patients were treated initially on the hospital ships at Long Reach, with recovering patients being sent to Gore Farm; while the smallpox hospitals in London became fever hospitals.
By 1903 the last of the 'River Hospitals', Joyce Green Hospital, opened and MAB decided that there were sufficient smallpox beds; Gore Farm would be used instead to provide treatment for convalescing fever and general patients from London. In 1908 it was renamed the Southern Convalescent Hospital; in 1911 it became simply the Southern Hospital.
In 1948 the Southern Hospital joined the NHS. It remained a general hospital until it closed in 1959, deemed too big and not suitable for modernization. Patients and staff were transferred to Joyce Green Hospital.
For many, one of the lasting memories of Joyce Green Hospital will be that of its excellent gardens. Between 1919 and 1935, the grounds at Joyce Green were planted extensively and the legacy of those plantings still survives. Vast numbers of trees, including sycamores, poplars and conifers, were complemented by a wide variety of shrubs and hedgerows. By the early 1920s, more exotic species had been introduced and many plants were cultivated and tended so well that other institutions came to Joyce Green to buy their own plants. A garden seat, in commemoration of Joyce Green's most celebrated gardener survives in the grounds and bears the inscription 'Henry Hopkins, gardener, 1913-1935 planted these grounds'. It was a simple monument to a man with great taste, foresight and vision.
For more than 100 years, the area known as Joyce Green has been witness to man’s extreme struggle against disease and injury, most of which will have probably been forgotten in another 100 years. The new Darent Valley replacement hospital will owe it all to those early paddle steamers battling against rough water and shrouded in fog, heaving with infectious patients, which once made their way down the River Thames into Long Reach, Joyce Green and the other illustrious river hospitals.
Copyright Peter Geekie 22/6/2016
- Smallpox - Almost totally eradicated but should we drop our guard ?
Smallpox although eradicated in the Western world has re-occured recently from Third World counties. It has also be suggested as a terrorist weapon but can be easily neutralised using a simple essential oil blend.
Victorian Smallpox Ships
Do you find these smallpox hospital ships a good things.
Smallpox hospital ship
© 2016 Peter Geekie