Epsom Hospital Cluster

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Edvard Munch's The Scream
Edvard Munch's The Scream

This document covers the general development of the five mental hospitals that made up the Epsom Hospital Cluster. If you are looking for more specific information or want hospital records please see the following research guides: You may also like to see our Horton Cemetery and the Horton Cemetery Burial Registers pages.

Part 1 - General Background

In 1807, when the population of England and Wales was 9,690,000, there were 2,248 people classed as insane; by 1909 the population was 35 million and the number of insane 128,200. Put another way, in 1807 there was one insane person for every four thousand of population and in 1907 the number had risen to more than 14 for every four thousand!

The London County Council (LCC) was formed in 1888 and part of its responsibilities was the care of the mentally ill. From the start it was clear that their current asylums could not cope with the demand for beds. If they didn't build new asylums they would have to continue shipping new patients to other parts of the country to be looked after in commercial establishments at two to three times the cost of an in-house solution. A major expansion was needed.

By the late 1880s mental health treatment had moved away from just tying up the insane out of sight of society; by then few were left half-starved to wallow in their own excretions on straw-strewn floors in unheated and poorly ventilated rooms. The relevant LCC committee wanted the sick to benefit from peace and quiet in airy grounds away from the hustle and bustle of the Capital. Of course, the cost of building and running establishments had to be taken into account so they decided to buy parcels of cheap farmland located outside, but within easy reach of, their area. Savings could also be made if the asylums could share common facilities, such as sewerage, and were of a functional, efficient and hygienic design. By making use of patient labour the asylums could become almost self-sufficient in food and give some of the patients occupational therapy. Patient labour continued until the 1960s.

Plan of the Horton Estate July 1890
Plan of the Horton Estate July 1890 (shortly before the estate was purchased by the LCC)
Click image to enlarge but please do not copy
Image courtesy of Epsom and Ewell Local and Family History Centre ©2014

In 1896 the LCC bought a rundown estate called Horton Manor from Sir Thomas Buxton for £35,900 (say about £35m at 2012 prices). The Estate was 15 miles from the centre of London, covered 1060 acres of land and had a Mansion House, offices, gardens and grounds, woods, four farms together with land set aside for arable and pasture. The original plan was to build six large hospitals, each to hold two thousand patients. These twelve thousand inmates plus many hundreds of nursing, auxiliary, domestic and maintenance staff totalled more than the whole population of the local town of Epsom which in 1896 only had about nine thousand residents. Someone has rightly said that this was health care on an industrial scale. Over the next 30 years only 5 hospitals were built but the estate still became the world's largest cluster of hospitals for the mentally ill. Initially the hospitals were used as follows:
  • Horton Hospital catered for all stages of nervous and mental disorder.
  • Long Grove Hospital catered for all stages of nervous and mental disorder.
  • Manor Hospital mainly catered for people with learning difficulties and aimed at providing them with life skills. From 1948 the hospital concentrated on the training and behaviour modification of disturbed adolescents and young adults and gained an international reputation in the field of industrial and behaviour therapy.
  • St Ebba's initially catered for epileptics and children. From 1918 to January 1927 the institution served as a war hospital and treatment centre for ex-servicemen suffering from neurasthenia (a set of psychological and physical symptoms caused by injury or neurosis). On return to normal duties the hospital's villa wards were well suited to handling voluntary patients who needed short term treatment (up to two years) without the usual stigma of a long stay in an old fashioned mental institution. After the Second World War it also cared for adolescents in a special unit. From 1962 it became a hospital for people with learning difficulties.
  • West Park Hospital catered for all stages of nervous and mental disorder.

A group of patients from the Horton Asylum in Epsom c1907
Image Source Topical Press Agency/www.gettyimages.co.uk

The hospital cluster needed all the usual utilities and infrastructure that a new small town required and over time on-site facilities were to include:
  • A number of separate villas used by parole inmates (as halfway houses for recovered/recovering patients)
  • Acute hospital block (for inmates with acute surgical and medical needs)
  • An un-consecrated burial ground (Horton Cemetery)
  • Bakeries
  • Cafeterias
  • Central Boiler House (1960)
  • Central Station for the supply of water, gas and electricity
  • Chapels
  • Cobblers' Workshop
  • Convalescence blocks
  • Engineers' Offices
  • Farms
  • Isolation Hospital
  • Kitchen Stores
  • Kitchens
  • Laboratory
  • Laundries
  • Main Stores
  • Maintenance Workshops
  • Market gardens
  • Mortuary
  • Needlework Workshops
  • Occupational Rooms
  • Pharmacy
  • Recreation Halls / Theatre
  • Recreational Rooms
  • Sanatoria
  • Shops
  • Staff accommodation (both in blocks and separate villas)
  • Staff Rooms
  • Tailoring Workshops
  • Treatment Rooms
  • Upholsterers' Workshops
  • Visiting Rooms

The cobblers workshop in Horton
The cobblers' workshop in Horton. Date not known
Image courtesy of Eric Hill ©2014

Clean water was supplied from a 400-foot borehole (steel-lined to stop contamination) within the grounds, pumped via a Central Station built for water, gas and electricity supply. A sewerage system was installed and linked to the public system. Although gas was also laid on, the main heating was from coal-fired boiler houses. The 1930s saw the direct current electrical generators in the Central Station dismantled and all the hospitals in the cluster connected to the alternating current of the National Grid. In 1960 a Central Boiler House was opened on the site of the old Central Station to supply high-pressure steam to all the hospitals for heating.

Power Station
The former Power Station, now a Fitness Centre;
note the use of indigenous yellow Horton Bricks
Image courtesy of Nick Winfield ©2014

The narrow local roads were not built for such an influx of people, quickly becoming overcrowded, and the increased traffic during the early building phase caused ceilings to fall down and cracks to develop in roads and house walls. Much to the disgust of local ratepayers a special 6d in the pound local rate (2.5%) was levied to help pay for road improvements.

Horton Lane Epsom, c,1900
Horton Lane, Epsom c.1900
Image courtesy of Surrey Libraries and is held in the
Epsom & Ewell Local And Family History Centre Collection

As a stopgap measure, whilst the infrastructure was installed and the first hospital built, the old manor house was renovated and turned into staff accommodation. A number of 'temporary' buildings were dotted around the original manor house to house seven hundred women with learning difficulties of the 'comparatively quiet and harmless class'. These 'temporary' buildings had wooden frames clad with corrugated iron sheets and were in constant use until pulled down in the 1950s. The 'temporary' buildings had an initial planned life of just 5 years but the final costs (£110,000 or about £105m at 2012 prices) turned out to be almost as high as permanent buildings so the Commissioners in Lunacy reluctantly licensed them for just 15 years. In the end they lasted over 50 years! The architect to the scheme was William C Clifford-Smith, who was the chief engineer to the Asylum Committee. In 1899 the Horton Manor Asylum, also just known as the Manor Asylum (Epsom) (Epsom Cluster No.1), started accepting its first patients into the 'temporary' buildings. By 1901 extra 'temporary' buildings were erected to house one hundred and ten male patients who were used as manual labour on the estate. The Manor site was expanded by 1907 by the addition of brick villas to provide 1000 more beds and became a 'Certified Institution for Mental Defectives'.

Horton Manor House July 1890
Horton Manor House July 1890
Image courtesy of Epsom and Ewell Local and Family History Centre

Composite 1930s OS Map showing Manor Hospital
Click on the map to see it full size
Composite 1930s OS Map showing Manor Hospital
Click on the map to see it full size

The new Horton Asylum (Epsom Cluster No.2) was built to an existing design by George Thomas Hine and was opened in March 1902 at a cost of £327,590.14s.4d (or about £264m at 2012 prices). The site lay on clay and, to avoid the buildings cracking up as the clay expanded and contracted depending on the dampness of the soil, deep excavations were needed to get to firm sub-soil. The extracted clay was turned into yellow bricks on site for use in the buildings. Hine's design was for a curved corridor with the wards on the outside and offices, the meeting hall, main stores, kitchens etc. on the inside of the curve. The idea was that staff could get to any part of the hospital quickly. Many parts of the buildings and corridors were made of glazed bricks to save the cost of plastering walls and to be easily kept clean and hygienic. Male patients were moved in to the new building as soon as the male wing was finished, female patients had to wait till their wing was completed: however, full capacity could not be reached until the sewerage system was fully operational. Of course, social custom demanded that male and female patients were segregated, with males in the wards on one arm of the curved central corridor and females on the other.

Postcard view of Horton Hospital
Postcard view of Horton Hospital, date not known
Image courtesy of Epsom and Ewell Local and Family History Centre

Composite 1930s OS Map showing Horton Hospital
Click on the map to see it full size
Composite 1930s OS Map showing Horton Hospital
Click on the map to see it full size

In 1904 the Ewell Epileptic Colony (Epsom Cluster No.3) was opened. It was built to a different design and consisted of a number of villas; the architect was William C Clifford Smith. Epileptics were often used as patient labour and, if working, were usually housed in single storey villas within the Colony. The cost for the first 325 beds in the Colony was £70,000 (or about £57m at 2012 prices), which reflected the extra costs of the villa design. It is not known when the Colony became known as Ewell Mental Hospital, then St Ebba's Hospital or just St Ebba's.

Postcard view of St Ebba's Hospital
St Ebba's Hospital, date not known
Image courtesy of Bourne Hall Museum

Composite 1930s OS Map showing St Ebba's Hospital
Click on the map to see it full size
Composite 1930s OS Map showing St Ebba's Hospital
Click on the map to see it full size

Although the modern thinking was rapidly moving away from huge asylums with barrack-like wards, the committee had little choice but to think big, due to rising demand for services and the rising costs of care. So Long Grove Asylum (Epsom Cluster No.4) was started in 1903 to the same basic design as Hine's Horton Asylum. However, it had slightly fewer wards as about 500 patients were housed in villas within the grounds. The hospital was named after a woodland area on the estate. Eleven thousand men were reportedly employed in building Long Grove. Nine hundred of the builders travelled daily on a 'workmen's special' from Waterloo to West Ewell, then walked the two and a half miles to the building site - their weekly fare was just 4s (20 pence). In an attempt to keep them out of the local pubs these 'workmen's special' builders were only paid on their return to West Ewell station.

Long Grove Hospital
Long Grove Hospital, date not known
Image courtesy of Bourne Hall Museum

Composite 1930s OS Map showing Long Grove Hospital
Click on the map to see it full size
Composite 1930s OS Map showing Long Grove Hospital
Click on the map to see it full size

Charles Wall Ltd laid the hospital foundations but the contract for the above-ground work was awarded to Foster & Dicksee Ltd on October 1904, with the understanding that the work was to be completed by the end of June 1907. Aware of the numerous transport problems the previous contractor had experienced moving building materials on the narrow local roads, the new builders applied for and were given a licence to lay a light railway. The route chosen for the single track meant crossing a bridle way and Hook Road, so complicated negotiations took place between London County, Epsom Rural District, Epsom Urban District and Ewell Parish Councils. The first locomotive was a 0-6-0 K Class saddle tank engine called Hollymoor built by Manning Wardle with the official date of completion given as 8 June 1905. It carted a load of bricks and cement from the sidings of the London South Western Railway at West Ewell to the building site where the material was off-loaded. A network of tramlines was then used to ferry the building supplies around the site. It was not long before Hollymoor was supplemented by an unamed 0-4-0 M4 saddle tank built by Peckett & Sons. Link to Railways Serving The Epsom Hospital Cluster.

Composite 1930s OS Map showing the five Hospitals, Central Station  and the Horton Light Railway. Click image to enlarge
Composite 1930s OS Map showing the five Hospitals, Central Station and the Horton Light Railway
Click image to enlarge

Locals apparently referred to one of the locomotives as 'Puffing Billy' - this was assumed in the past to be 'Hollymoor', but it is possible it could have referred to the unnamed Peckett Tank as the existence of this second locomotive has only recently been ascertained. A runner was employed as a look out and sat in the front wagon when the train was being propelled from the back. This system went wrong when Mary Tobin was knocked down and killed by a trainload of 12 wagons being propelled by the engine. Against regulations the crossing gates had been left open and, being at the back, the engine driver could not see the front of the train. Neither could the 'runner', who was on the fifth wagon, due to the first four being covered over. The driver sounded the whistle but Mary was aged 64 and a bit deaf. The inquest found the builders guilty of 'sheer neglect'.

'Hollymoor' at the Exchange Sidings, c1905
'Hollymoor' at the Exchange Sidings, c1905
Image courtesy of Bourne Hall Museum

Despite this and another accident, caused by high winds blowing over a crane, which damaged one of the new buildings, the builders completed the building two months ahead of schedule. Hollymoor and the Peckett Tank were sold off and the LCC bought the railway line, subsequently purchasing another 0-4-0 Saddle Tank called 'Crossness'. The line was extended to take building supplies to a new building site - to be called the West Park Asylum (Epsom Cluster No.5) - and to ferry about fifteen thousand tons of coal to the Central Station each year. In 1935 'Crossness' was replaced by on 0-6-0 Saddle Tank called 'Hendon'. In March 1947 a 0-4-0 Saddle tank engine from Robert Stephenson & Hawthorns Ltd, called Sherwood, replaced Hendon but was not a great success. Trains ran on the line till January 1950 when it was closed, dismantled and sold off to Nigeria.

Work on West Park Asylum was halted because of the outbreak of the First World War when the Canadian Military took over the buildings that had been completed. It was not fully completed until 1921 and when it opened it was called West Park Hospital: it was built as a set of separate ward buildings behind and slightly to one side of the one in front in a sort of curved arrow head shape. The main services were in the middle of the arrow so, in plan view, it looks like Horton and Long Grove but without the curved main corridor. It comprised 45 wards for 2096 patients, on a total of 83.5 acres, of which 9 were taken up for the buildings and the associated one and a half miles of service tunnels. The wards were two storeys high, built using red brick with reinforced concrete floors between the two levels. The combined chimney and water tower stood 120 feet high (36.6m): it held 3 large water tanks and stood on an 18 foot (5.5m) solid base made of blue engineering bricks. The initial estimate of costs was £517,930 but, because of the interruption and wartime inflation, the final cost was £1,030,670 (or about £363m at 2012 prices). As a cost-saving measure softwood flooring was installed, rather than the hard wood floors used elsewhere on the cluster, but this was a false economy as it considerably increased the maintenance costs. The Right Honourable John Wheatley M.P., the Minister of Health, opened it on 20 June 1924. The scheme architect was William C Clifford-Smith. By 13 November 1925 1720 patients had been admitted, 1117 by transfer from other establishments and 603 by direct admission, and these patients were under the care of 6 doctors and the Medical Superintendent. Hollywood Lodge was part of the original Horton Estate and was converted for use by West Park Hospital.

Postcard view of West Park Hospital
Postcard view of West Park Hospital. Date not known.
Image courtesy of Bourne Hall Museum

Composite 1930s OS Map showing West Park Hospital
Click on the map to see it full size
Composite 1930s OS Map showing West Park Hospital
Click on the map to see it full size

Both Horton Asylum and Manor Asylum were taken over from 1915 to 1918 for use as military hospitals called Horton (County of London) War Hospital and Manor (County of London) War Hospital. With much overcrowding the existing patients were shoehorned into other establishments at short notice.

Postcard view of patients relaxing outside Horton (County of London) War Hospital
Postcard view of patients relaxing outside Horton (County of London) War Hospital. Date not known.
Image courtesy of Bourne Hall Museum

After the end of the First World War both hospitals reverted to treating the mentally ill but with new names - Horton Hospital and The Manor Certified Institution, the latter eventually becoming The Manor Hospital with (in 1960) one thousand two hundred beds.

The outbreak of the Second World War saw Horton taken over by the Military as Horton War Hospital. Again existing patients were crammed into other establishments at short notice - for example, Horton moved 400 patients to West Park in just 2 days! The hospital cluster needed all the trappings of war with air raid shelters, blackout regulations, extra fire drills and fire precautions such as extra sand and water buckets and the inevitable Stirrup pump. To cope with the patients from other hospitals some rooms and buildings changed function - for example,one of the West Park Sanatoria became a casualty station and another a ration store. One only has to think of the problems fitting gas masks to uncooperative patients whilst wearing a mask oneself to realise the extra burden the nursing staff had to cope with. Apart from having to cope with extra patients, the cluster also had to accommodate other departments - for example, the central pathology lab was transferred from the Maudsley Hospital in South London to a ward in West Park and parts of the central LCC Hospitals administration was also moved out of war-damaged London to the relative safety of Epsom. The cluster did not escape bomb damage and suffered from incendiaries as well as a high explosive bomb and even a flying bomb. It returned to its usual work in 1949 as Horton Hospital with about one thousand beds.

To supply the hospitals with garden produce, five farms were established, each called after the hospital it was supporting. Patients worked the farms under the supervision of an experienced farm manager.

Horton Land Girls and some male colleagues
Horton Land Girls and some male colleagues c.1948
Image courtesy of Mrs N Pattison © 2014

From the start each Hospital had its own Medical Superintendent. Not a bad job as he (they were all male) was paid around 1000 guineas (£1050 or about £377k at 2012 values) a year plus free food, accommodation, coal and domestic help provided by inmates. By contrast, a matron in the early 1900s was only paid 90 guineas (£94.50 or about £34k at 2012 values) per year.

The closure of the hospitals was as a result of the care in the community policy of the 1990s:
  • Horton Hospital closed in 1997; provision for some 60 former patients was made in Horton Haven, but the rest of the site has been developed into 460 private homes, in a mixture of houses and flats, called 'Livingston Park'.
  • Long Grove Hospital closed in 1992 and by 2002 had become the 'Clarendon Park' housing development.
  • Manor Hospital made provision for some former patients in Ethel Bailey Close but the rest of the site has been developed into 340 private homes, in a mixture of houses and flats.
  • St Ebba's has been converted into a complex of old and new buildings housing about 60 patients. The rest of the site has been sold and developed into 280 private homes, in a mixture of houses and flats.
  • West Park Hospital closed down progressively from 2005.

Demolition of Napier and Nelson Wards, Long Grove Hospital. 1998
Demolition of Napier and Nelson Wards, Long Grove Hospital. 1998
Image courtesy of Epsom and Ewell Local and Family History Centre ©2014

Part 2 - The Patients

The Bad Old Days

Mental illnesses cover a very broad range of conditions and society's view on what constitutes mental illness has changed greatly. For example a single woman could be committed just for becoming pregnant in the Victorian era. Social attitudes played a big part in deciding which other 'conditions' could result in a person being sent to an asylum - to give you a broad idea of the range see the 1907 list used by Horton to categorize the cause of a patient's illness.

Everyone will know of 'Bedlam', the nickname for the Bethlem Royal Hospital: it is now a modern facility in the forefront of psychiatric treatment, but that was not always so and it once epitomised the appalling state of mental health 'treatment' (or, rather, incarceration/containment) up until the early part of the 19th century; change was very gradual but one catalyst for improvement was the mental illness of King George III.

The Interior of Bedlam from The Rake's Progress by William Hogarth, 1763.
The Interior of Bedlam from The Rake's Progress by William Hogarth, 1763.

Abuse of patients was rife and many were kept in physical restraints even when they were not violent. 'Treatment' often consisted of baths, which were thought to be calming, but these were not baths as we know them. There were very hot baths, very cold baths and baths into which a patient was unexpectedly pitched whilst standing on the cover.

Douche for the treatment of the insane, 1828
Douche for the treatment of the insane, 1828.
Image source: Wellcome Images L0001486.

Rotatory motion machine for treatment of the insane, 1828
Rotatory motion machine for treatment of the insane, 1828.
Image source: Wellcome Images L0001487

One famous inmate of the Bethlem Royal Hospital was the artist Richard Dadd; he trained at the Royal Academy and manifested signs of serious mental illness whilst in his twenties. At the time he was travelling up the Nile and his behaviour was initially attributed to sunstroke, but later diagnosed as paranoid schizophrenia. However, having returned home, his delusions worsened and, believing that his father was really the Devil, Richard stabbed him to death. He then fled to Paris, attempted to kill someone else with a razor en route, was arrested and sent to the Bethlem Hospital. The manner in which he was treated quite possibly had something to do with his class and/or his undoubted artistic talent, for he was allowed to paint and most of his best work was accomplished in institutions (he was later moved to Broadmoor Hospital, where he died from lung disease in 1886).
Caravanserai at Mylasa in Asia Minor by Richard Dadd, 1845 (painted in Bethlem Hospital)
Caravanserai at Mylasa in Asia Minor by Richard Dadd, 1845 (painted in Bethlem Hospital).
Image source: Wikimedia Commons.

The London County Council Mental Hospitals

The LCC mental hospitals had a centralised admissions policy and patients were assigned to whichever hospital had spare beds. The main exceptions were patients of the Jewish faith, who would be sent to the Colney Hatch (Friern) Mental Hospital, where arrangements were made to meet the needs of their faith. This centralised policy was still in place in the late 1940s.

Male patients being washed by hospital orderlies, Long Grove Asylum circa 1930?
Male patients being washed by hospital orderlies, Long Grove Asylum circa 1930?.
On first arrival at the hospitals the patients would be bathed to reduce
the risk of cross contaminations and to check for infestations.
Image source: Wellcome Images (WI no. L0015468)

From the start physical restraints were not in common use, although padded and semi-padded rooms were. On arrival inmates were given a bath and a medical examination. They were then given clean clothes to a uniform pattern, made in the needlework workshop, and slept on clean sheets, washed by fellow patients in the hospital laundry, on beds made in the upholstery workshop; they lived in dry and heated accommodation. Patients had good, but boring and simple, food prepared by fellow patients in the hospital kitchens with many of the raw ingredients coming from the hospital's own farms worked by fellow patients.

To many, who had been living on or below the poverty line in the appalling conditions of the London slums, the hospital life would have had some distinct advantages. However, life in the asylums must have been uneventful and tedious. You were physically isolated from family and friends and the stigma of a mental condition kept many apart from loved ones. It is not surprising that many patients quickly became institutionalized.

Patients who worked within the hospital often had extra food privileges, but those able but unwilling to work would have some privileges withdrawn. A typical patient's working day in 1907 might have gone something like this:
7.50 am      Breakfast
8.20 am Start Work
10.15 am Tea and snack break
12.50 pm Return to ward for lunch
1.50 pm Resume work
4.00 pm Tea Break
5.20 pm Return to ward for tea
For recreation there were weekly film shows and dances throughout the year and concert parties during the winter. Outdoor and sporting activities were also encouraged.

1908 Patient Food Rations

These issues are not to be made in full unless they are actually required. Issues less that the full quantities allowed by the scale must be approved by the Medical Superintendent

Breakfast (Every day for both sexes)
Tea or Coffee 1 pint (568ml)
Bread 6 ounces (170g) (males), 5 ounces (142g) (females)
Margarine ½ ounces (14g)

Tea (Every day for both sexes)
Tea 1 pint (568ml)
Bread 5 ounces (142g) (males), 4 ounces (113g) (females)
Margarine ½ ounces (14g)
Jam 1 ounces (28g)
Cake 3 ounces (85g) (cost not to exceed 1¾d per pound (453g) when made at the asylum)
Extra Bread 3 ounces (85g)

Males Females
Pork, Beef, Mutton or Bacon (roast or boiled) cooked meat, free from bone. 5 ounces (142g) 4 ounces (113g)
Meat Pies Allowance of uncooked bone free meat 5 ounces (142g) 5 ounces (142g)
Paste for pie crust 4 ounces (113g) 4 ounces (113g)
Potato Pies (separate formula)
Fish (baked, fried or boiled including bone) 12 ounces (340g) 10 ounces (283g)
Melted butter only to be served with boiled fish
Irish Stew, Scotch Broth or Pea Soup 12 ounces (340g) 10 ounces (283g)
Vegetables for all dinners (Except Irish Stew)
Potatoes unpeeled (2 ounces (57g) less when peeled) 9 ounces (255g) 7 ounces (198g)
Other vegetables including salad when in season 8 ounces (226g) 8 ounces (226g)
Potatoes only 13 ounces (387g) 11 ounces (312g)
Other vegetables only 13 ounces (387g) 11 ounces (312g)
Bread 4 ounces (113g) 3 ounces (85g)
With Irish Stew, Scotch Broth or Pea Soup 5 ounces (142g) 4 ounces (113g)


On four days a week a roast or boiled meat dinner is to be given. On the three remaining days the diet is to consist either of meat or potato pies, fish or Irish stew, broth or pea soup.

Puddings may be issued for dinner at the discretion of the Medical Superintendent on any day. The allowance of pudding shall be ½ lb (226g) or ½ pint (284ml) for each patient. The allowance of meat or potato pie or fish when pudding is issued shall be half the ordinary allowance, with the full allowance of potatoes and 4 oz (113g) of other vegetable for both sexes.

When pudding is issued with Irish Stew or Scotch broth both the quantities of stew and broth are to be halved. When pea soup is issued the full allowance is to be given, followed by a second course of pudding.

October 1908

This was very precise, wasn't it, although one cannot imagine that the busy kitchen staff spent too much time in weighing out exact portions.

During 1964 Horton Hospital alone used:
  • 22 tons (22,353kg) of jam and marmalade
  • 1040 sides of bacon
  • 44 tons (44,706kg) of sugar
  • 400,000 eggs
  • 528,000 pints (300,042 litres) of milk
  • 260 tons (264,172kg) of potatoes
  • 43,080 packets of biscuits
And the Horton Hospital Bakery produced:
  • Bread 256,008 lbs (116,123kg)
  • Bread Rolls 77,686
  • Cake 21,876 lbs (9,922kg)
  • Fancies 196,249.
The late forties and the fifties saw another change which, whilst small, must have made a big difference - patients were able to wear their own clothes or at least choose from a small range that would withstand washing in the hospital laundry. Under the 1948 National Assistance Act patients would qualify for a small amount of pocket money to be used for clothing and personal items like soap and razor blades. The hospital's administration would keep track of this money and when a patient needed clothing they would be given a letter that could be used in some of the local shops. The letter would give a maximum amount that a patient could spend and the shop would send the bill to the hospital for payment.

The LCC was responsible for the capital costs of building the hospitals in the Epsom Cluster but running costs were charged to the patient's usual local Board of Guardians. In 1925 West Park Hospital charged the Board of Guardians £1.8s.7d per week per patient (or about £69 at 2012 prices). In 1968 the cost per patient had risen to £12.9s.4d (or about £183 at 2012 prices), but this was about 13% less than the regional average of £14.3s.10d (or about £208 at 2012 prices). If a patient had moved from one area to another disputes could arise between different sets of Guardians as to who should pay and this could end up with a magistrate making an order of adjudication. Transfers on social or welfare grounds between hospitals were rare as they needed the agreement of two Boards of Guardians and two hospital administrations.

Death and Burial
The hospitals had to cope with many people needing care for the rest of their lives - for example, one of the patients admitted in 1902 to Horton Hospital died there thirty-seven years later in 1939. With so many long-stay patients it is inevitable that some died in one or other of the hospitals. If their relatives were unwilling to take responsibility for the disposal of their remains then they were buried in an un-consecrated burial ground called Horton Cemetery. We understand that some of the graves held three or four bodies. The cemetery was open between 1899 and 1955 and, although the head stones have subsequently been removed and no plan of burial plots exists, the surviving records, which cover the period 4 April 1902 to 29 March 1955, are held at the Surrey History Centre and some at the Greater London Records Office. The land was sold to developers in 1983 but the local council has so far resisted all development plans for this site. In 2004 a memorial was erected in Horton Lane near the roundabout with Hook Road.

Horton Memorial
Memorial Text
The Horton Memorial with close up of text.
Image courtesy of Peter Reed © 2008

Please see www.epsomandewellhistoryexplorer.org.uk/HortonCemetery.html for further information on Horton Cemetery.

Well-known patients
Hospitals in the Epsom Cluster have treated some well-known people, including:
The Treatments
Various treatment regimes have come and gone during the life of the hospitals in the Epsom Cluster. Individual treatment of illness was becoming common and, although patients were not tied up or routinely encased in straitjackets, some were put in clothes which restricted movement and they were in a custodial environment with escape-proof iron fencing, locked wards and gated zones. But the 'open door' approach was finding favour and as early as 1925 West Park could boast four open wards. Additionally 43 men were allowed out of the grounds on parole and 219 allowed to roam at will within the grounds. By 1928 there were 10 open wards. The wards were, initially at least, well-equipped and to high contemporary standards.

Until the law changed in 1931 the vast majority of admissions were made under magistrates' certificates and in practice this meant that these patients first had to come to the notice of the law, then attend court just to be sent to hospital for observation. Treatment was made more difficult and lengthy because of the delays caused by the legal process. On arrival at the hospitals patients were usually in the later stages of their illness, making many aggressive and uncooperative, and they were placed in padded rooms or locked side wards. After 1931 voluntary admission became possible so patients could often be persuaded to seek treatment earlier and consequently the admitting wards were calmer places. With voluntary admission and the introduction of day hospitals and community-based outpatient clinics, the number of patients compulsorily admitted dropped, in 1939 to 70% and by 1959 to less than 30%.

Medical cures mainly come through experimentation and many patients were inevitably put though treatments that would not be considered today. Many of the treatments were unpleasant and dangerous and often needed to be given without anaesthesia.

Starting in 1928 Dr. Manfred Sakel of Berlin used the newly discovered hormone insulin to reduce the anxiety, nervousness, tremors, vomiting and agitation of patients undergoing opiate withdrawal. With high doses of insulin the patients went into stupor after which they often became more co-operative, less argumentative and less aggressive. Sakel moved to Vienna and began using insulin therapy on patients with schizophrenia, then an untreatable illness, and reported that post-treatment the patients lost their psychotic thoughts. The patient was usually rapidly brought out of the coma by the injection of glucose. This procedure was called Insulin Coma Therapy (ICT). It is sometimes called insulin shock therapy, partly as the result of translation problems and partly because the patient was brought round or 'shocked' out of his coma by rapidly injecting the glucose.

Other chemically-induced shock treatments were tried, including Metrazol (a brand name for pentylenetetrazol), which instigated convulsions; many of these shock treatments were found less effective than ICT which, although up to 10% of patients died from it, was widely used and was regarded as 'the' treatment for schizophrenia until the 1950s, when randomised trials showed that it was not effective.

Around the same time as ICT was being used Electro Convulsive Therapy (ECT), sometimes known as electric shock treatment, was being tried out by the Italian neurologist Ugo Cerletti, who found that his obsessive and difficult mental patients thereby became meek and manageable. The therapy involves placing electrodes to the patient's head and passing an electrical current through the brain to cause a seizure. In the early days high voltage rates were used and the patient was not sedated. The treatment was given two or three times a week for up to ten weeks. Early remission rates varied from 30% to 80% of the patients treated. Four nurses had to hold down the patient as the current was applied but many patients still suffered fractures, pulled muscles, severe memory loss, and spontaneous seizures as a result. Unsurprisingly the treatment has always been controversial within psychiatric medicine, with many patients dreading the procedure, especially as it was used to punish or sedate difficult patients in some psychiatric hospitals: however, it had very much lower mortality rates than ICT. Following a full course of treatment the improvement in most patients was startling: unfortunately, for some patients the improvement was somewhat short-lived. Despite being controversial ECT did help many thousands of patients who were able to return home and resume their old life, going several months or even years before the next episode of their illness.

The Bergonic Chair, an early type of ECT apparatus
The Bergonic Chair, an early type of ECT apparatus, pictured here in the First World War era.
Image source: Wikimedia Commons.

The Department of Health reported that in the period January to March 2002:
  • there were 12,800 administrations of Electro-Convulsive Therapy (ECT) compared to 16,500 in January to March 1999
  • 2,300 patients received ECT treatment compared to 2,800 in 1999.
  • There were 700 male patients receiving treatment, compared with 1,600 female patients.
  • 47% of female patients and 45% of male patients receiving ECT treatment were aged 65 and over.
  • 73% of ECT patients were not formally detained under the Mental Health Act 1983.
  • Of the 600 patients formally detained while receiving ECT treatment, 60% did not consent to treatment. (Note: The 2007 Mental Health Act [effective 03 November 2008] meant that detained patients deemed to have the mental capacity to make an informed decision would have the right to refuse electro-convulsive therapy).
Newer research suggests that the use of ECT has subsequently declined from the figures shown above.

ECT can be highly effective in cases where 'talking' and 'chemical' therapies have failed, or the patient is likely to harm themselves or others, and a rapid improvement is desirable. It has been much modified over the years and is given at much lower voltages: the patient is sedated and given a muscle relaxant, making the whole process very much less traumatic and without many of the unwanted side effects. Following treatment patients are often put on medications to prolong the benefits of the ECT.

Hydrotherapy was widely used in the early days, including the continuous warm bath treatment where the patient was kept in a warm bath at a constant temperature, day and night, for 2 to 14 days!

Many patients were treated like children and had to follow a very rigid system of discipline in an attempt to retrain them out of their thinking and feelings. Sleep Therapy was also used, where the patient was put to sleep for several days and, conversely, sleep deprivation therapy has been tried.

Patients with general paralysis of the insane (a result of late-stage syphilis) were given malaria by mosquito injection in the hope that raising the person's body temperature would kill off the causative agent (see The Mott Clinic).

Some surgical procedures were also tried including Leucotomy, dental extraction, colectomy and hysterectomy. Leucotomy (also known as Lobotomy) is the surgical cutting of nerve fibres in the frontal lobe of the brain and was developed by Egas Moniz in 1935 for the relief of severe agitation and obsessive-compulsive behaviour. It is now rarely performed.

Set of Watts-Freeman lobotomy instruments; box inscribed by Walter Freeman, circa 1950. WI no. L0026980
Set of Watts-Freeman lobotomy instruments; box inscribed by Walter Freeman, circa 1950.
Image source: Wellcome Images (WI no. L0026980)

Freud's psychological approach and the 'talking' therapies were also tried and often found successful but they needed clinicians' time to explore and analyse the patient's mental problems and develop a suitable treatment regime. However clinicians' time is limited and group therapy, where a trained facilitator leads a group of patients in exploring personal issues, became common.

Treatments really started to change in the mid-1950s with the introduction of an anti-psychotic drug called Thorazine (also known as chlorpromazine). Many new drugs quickly followed and it became possible to cut the length of time patients stayed in hospital. Patients started being treated in Day Hospitals and on an outpatient basis in the 1930s and this, combined with different methods of rehabilitation, meant that patient numbers started to drop.

Changing social views put more emphasis on protecting the rights of the patient and new clinical staff tended to be less hierarchical and controlling than their predecessors. Further advances in individual treatment regimes moved away from treating everyone with a particular condition in exactly the same way.

The Epsom Cluster, with the exception of the Ewell Colony, managed to discharge an increasing percentage of patients as either 'recovered' or 'relieved' and this rose to over a third by the mid-1920s. In 1957 there were 773 admissions to, and 652 discharges from, West Park Hospital and by 1967 the numbers had risen to 1543 admissions and 1388 discharges. We do not, however, have any figures on readmissions of discharged patients.

Some well-known psychiatrists worked at the Cluster hospitals (see, for example, The Long Grove Psychiatrists of 1911), although at times the quality of some subordinates could now seem suspect. The Second World War period was obviously a difficult time for hospitals in the Cluster to obtain trained medical staff and right up to the end advertisments were appearing for temporary male nursing staff who needed no previous experience. Later the hospitals asked for student nurses to train for a peacetime career. Also during the War, there were repeated advertisments for kitchen staff, including several for an assistant kitchen superintendent who, strangely enough, did require previous experience -- in the use of gas, steam and electrical cooking equipment, plus the ability to control subordinates.

Inevitably, in large institutions like these things go wrong and some staff are better than others, but the hospital authorities investigated any claims of the maltreatment of patients by staff and some staff were dismissed or moved or procedures changed. But most clinicians are very caring individuals and they really do want to help the patient - ideally to a complete recovery, but at least to alleviate the worst symptoms of the malady. We should not judge the actions of doctors and nurses taken decades ago just by the use of hindsight and modern thinking. We have to consider what their contemporaries thought. The hospitals in the Epsom Cluster were generally very well regarded as enlightened; they received good official reports and often set the standards used in many hospitals throughout the world.

It was not always the patients who succumbed to mental disorder. In 1931 Dr Johnston Campbell Ramsay, aged 31 and newly arrived on the staff of West Park Hospital, was suffering from gastric trouble; he showed his wife a glass of liquid and invited her to share it with him. She declined the offer and he drank it himself with fatal consequences. The liquid was prussic acid.

For a very interesting account of the experiences of a nurse at Long Grove, please see My Time at Long Grove Hospital.

Patient tragedies
Again, given the size of the hospitals and the number of patients that passed through them, one would expect some instances of violence and suicide and remarkably few major incidents seem to have been reported for the Cluster institutions. One awful tragedy was the case of Horton patient Bessie Annie Clapham, admitted when suffering from post-natal depression, whose husband Walter was convicted of fatally cutting her throat with a razor, although there was a possibility that Mrs Clapham had done the deed herself. The particular sadness of this case was that the husband was also suffering from depression over the plight of his wife. See TragicDeath.html for more information.

In 1912 American James Mitchell battered to death a fellow inmate of Long Grove using a broom; he was said to have delusions that he was the Apostle Peter and owned all the land. In 1908 Walter Bartram escaped from Long Grove, only to commit suicide by throwing himself in front of a train at Dagenham.

Karl Kramer was born c.1884 in either Austria or Germany, depending on which report you believe. According to the Evening Telegraph of 20 October 1911, Kramer had been a patient at Long Grove in 1909, his manner then being 'similar to his present demeanour'. His 'present demeanour', as he sat in the dock at Staffordshire County Magistrates Court, was described thus: 'The prisoner maintained an attitude of deep dejection. Crouched in the chair with his shoulders bent and his head sunk so far forward upon his chest that the lower part of his face was entirely hidden, he appeared to take no notice whatever of his surroundings. His eyes remained closed and he presented all the appearance of a man in a deep sleep.'… 'There was a painful scene when the charge was interpreted to Kramer. He was raised to his feet by the warders but made no attempt to stand up, having practically to be lifted up. He continued to hold his head low down on his chest, and his hands, twitching painfully, were clasped in front of him. He neither opened his eyes nor made the slightest response when the charge was read.' The doctors at Long Grove had regarded this state as a temporary phase of his condition (which might have been schizophrenia or severe depression) and, when he recovered from the stupor, they discharged him. On 2 October 1911 Kramer was in Kidsgrove, Staffordshire and apparently decided to burgle a house called Avenue Villa; the proceeds seem to have been around £45. Later that day eight year old Jennie Weir came home from school for her meal and found her mother, four year old sister and the family's maid beaten to death. Kramer was found insane and unfit to plead and was eventually sent to Broadmoor Hospital.

Part 3 - Photos

Manor Hospital

Manor Admin Block
Manor as a War Hospital
Manor Ward Buildings
Manor Ward Buildings
Manor Hospital
Images courtesy of Bourne Hall Museum

Great War Wounded  in the Manor Hospital Grounds 1916
Great War Wounded in the Manor Hospital Grounds 1916
Images courtesy of G Porter and held in the
Epsom & Ewell Local And Family History Centre Collection

Manor Hospital Football Team 1938-9
Manor Hospital Football Team 1938-9
Manor Hospital Hockey Team 1930
Manor Hospital Hockey Team 1930
Manor Hospital Staff Christmas Party c.1932
Manor Hospital Staff Christmas Party c.1932
Images courtesy of G Porter and held in the
Epsom & Ewell Local And Family History Centre Collection

Horton Hospital

Horton Lane c1900
Horton Drive
Horton Administration Block
Horton Hospital
Images courtesy of Bourne Hall Museum

Horton Hospital Fire Drill c.1910
Horton Hospital Fire Drill c.1910
Image Courtesy of Mr Piner

Horton Hospital Fire Brigade c.1913
Horton Hospital Fire Brigade c.1913
Percy Walker Hepworth is shown seated in the first seat on the left.
Read more about Percy in our War Memorials section.
Image Courtesy of Mr Piner

A corridor in Horton Hospital 19 June 1991
A corridor in Horton Hospital 19 June 1991
Image courtesy of John R Rifkin www.jrrifkinphoto.co.uk © 2014
Please contact John if you wish would like a copy or want to use this image.

Long Grove Hospital

Long Grove Lodge
Long Grove Nurses Quarters
Longrove Hospital
Images courtesy of Bourne Hall Museum

A ward in Long Grove Hospital 19 June 1991
A ward in Long Grove Hospital 19 June 1991
Image courtesy of John R Rifkin www.jrrifkinphoto.co.uk © 2014
Please contact John if you wish would like a copy or want to use this image.

A dining room in Long Grove 19 June 1991
A dining room in Long Grove 19 June 1991
Image courtesy of John R Rifkin www.jrrifkinphoto.co.uk © 2014
Please contact John if you wish would like a copy or want to use this image.

St Ebba's Hospital

Ewell Epileptic Colony (Later renamed St Ebba's Hospital)
Ewell Epileptic Colony (Later renamed St Ebba's Hospital)
Ewell Epileptic Colony Entrance (Later renamed St Ebba's Hospital)
St Ebba's Hospital (Formerly Ewell Epileptic Colony)
Images courtesy of Bourne Hall Museum

West Park Hospital

Staff Training West Park Hospital
Staff Training West Park Hospital
The Visiting Room West Park Hospital
The Visiting Room West Park Hospital
Some of the wards West Park Hospital
Some of the wards West Park Hospital
Images courtesy of Bourne Hall Museum

One of the long corridors in West Park Hospital 19 June 1991
One of the long corridors in West Park Hospital 19 June 1991
Image courtesy of John R Rifkin www.jrrifkinphoto.co.uk © 2014
Please contact John if you wish would like a copy or want to use this image.

A ward in West Park Hospital 19 June 1991
A ward in West Park Hospital 19 June 1991
Image courtesy of John R Rifkin www.jrrifkinphoto.co.uk © 2014
Please contact John if you wish would like a copy or want to use this image.

Literacy Class at West Park Hospital
Literacy Class at West Park Hospital
Image courtesy Epsom & Ewell Local And Family History Centre Collection

Main Sources
  • Asylum, Hospital, Haven - A history of Horton Hospital by Ruth Valentine ISBN 0 95283006 0 4 published by the Riverside Mental Health Trust
  • The Colonisation of Epsom - The building of the Epsom Cluster by the London County Council in its historical context. A paper by DA Cochrane for the Planning Division, South West Thames Regional Health Authority
  • West Park Hospital - The First Sixty Years by Bryan C T Johnson F.H.A. published by the West Park Hospital Management Committee
  • West Park History - an undated internal memo of Mid Surrey Health Authority
  • Andrew Roberts' The asylums index website (now defunct)
  • Pete Cracknell's County Asylums website (now defunct)
  • Gordon K Tozer and Steve M's UK asylums website (now defunct)
  • Simon Cornwell's Urbex website
  • The Industrial Railway Society website
Original research and text by Peter Reed with some additions
to the sections concerning 'The Patients' by Linda Jackson © March 2014

Some extracts from the official reports on the early years of Horton Hospital can be read here Horton - Down the Years Note: This is a .pdf file so you may need to download Adobe Reader (available free from Adobe).

Links to pages on this website:
Horton Cemetery
Horton Cemetery Burial Registers
Horton Hospital Chaplin Rev Hockly

External Links (open in a new window)
Lost Hospitals of London
County Asylums
Index of English and Welsh Lunatic Asylums and Mental Hospitals
Industrial Railway Society
Exploring Surreys Past
Surrey History Centre
Hospital Records Database (Find out which archive holds which records)