As the site faces a new chapter, LHSA Manager Amy has been looking into the history of Astley Ainslie hospital...
Astley Ainslie Hospital was built on a site that has been
associated for centuries with the care of the sick. The Burgh Muir covered the
area bounded by Leven Street, Colinton Road and Myreside and the edge of
Craiglockhart on the West; Dalkeith Road to the East; The Borough/South Loch
(now the Meadows) on the North and the Jordan Burn to the South.
The Burgh Muir, then part of the ancient Forest of
Drumselch, was used as a hunting ground for many Scottish Kings. It was there
that whilst hunting deer that David I was separated from his retinue and
confronted by a fierce stag. Muttering a prayer for his safety, David saw that
a cross had appeared above the stag’s head and it fled into the forest, leaving
the King unharmed. David founded the monastery of the Holy Rude, Holyrood Abbey
in 1128, in thanks for his deliverance he also gave Edinburgh its Royal Charter
in 1143 and the Burgh Muir to the town as a gift.
During the period of the Black Death, the Edinburgh Town Council issued an edict stating that those infected with the disease were to be taken to a more secluded part of the City, then part of the Burgh Muir. People were quarantined there and very often died and were buried nearby. Small wooden huts, serving as makeshift hospitals for quarantine were erected to house the victims. Water from the springs around what was later to become Astley Ainslie Hospital, provided water to clean the clothes of the plague victims.
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| Artist's impression of St Roques Chapel, Edinburgh by Francis Grose (1731 - 1791). Courtesy of National Galleries of Scotland |
In c. 1507 a small chapel dedicated to St Roque (or Roch) was built on the Burgh Muir on a site now occupied by the Astley Ainslie grounds. The chapel was reputedly built with support from James IV; he did visit and made a donation. The chaplain appointed to the chapel also tended to the sick and dying. During the plague epidemics, Edinburgh Town Council appointed ‘Medical Officers of Health’, two of whose names are recorded as Dr James Henrysoun and Dr John Paulitus. The last outbreak of plague in Edinburgh was in 1645.
St Roque’s chapel fell into disuse after the
Reformation and was demolished in around 1749, vanishing completely by 1791. It
is believed that the chapel stood somewhere between the Children’s Unit and the
school. [The Astley Ainslie Community Trust website has more information on St
Roque’s Chapel and St Roque’s House, the latter purchased by the
Astley Ainslie Trustees to expand its activities in Occupational Therapy.]
Parts of the Burgh Muir were feued out as lots during the
reign of James IV. One of these was the 65 acres of the former Caanan estate.
I.
Famous medical residents
In the 19th Century, before the establishment of
the Astley Ainslie Hospital, the area was home to many of Edinburgh’s wealthier
residents – University professors, writers and medical men.
In 1842, Professor James Syme, Chair of Clinical Surgery at
Edinburgh Medical School bought the villa of Millbank. In addition to the Chair of Clinical Surgery, Syme also
became Junior Assistant Surgeon at the Royal Infirmary of Edinburgh. He held
these posts until 1848 when he was appointed Professor of Clinical Surgery at
University College London, but he returned to Edinburgh and was reinstated that
same year after finding that he was expected to also carry the Chair of
Systematic Surgery in London. In 1868 due to the adverse sanitary conditions in
the High School Yards site, he argued for the building of a new Royal
Infirmary. Joseph Lister, Surgeon and pioneer of antiseptic surgery,
trained under Syme and became a close friend and colleague, later marrying
Syme’s daughter, Agnes, in 1856. The wedding took place at the Syme family home
of Millbank.
The building known as Morelands was once the home of
Professor John Thomson (1765-1846). In 1804, the College of Surgeons of
Edinburgh established a professorship of surgery and Thomson was the first to
be appointed to this post. In 1806 he was appointed regius professor of
military surgery at the University of Edinburgh. Later in his career, in 1832, he became
professor of general pathology at the University of Edinburgh.
II.
Astley
Ainslie Hospital, founding and early years
In 1900, Mr David Ainslie of Costerton, Midlothian died
leaving instruction to his Trustees that the residue of his estate, after a
lapse of 15 years, was to be applied ‘to the purpose of erecting, endowing and
maintaining a hospital or institution to be called the Astley Ainslie
Institution, for the relief and behoof of the convalescents of the Royal
Infirmary of Edinburgh.’ Ainslie’s will stipulated that the bequest should
accrue interest for at least 10 years.
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| David Ainslie |
The outbreak of WW1 meant that the conditions of Ainslie’s will were not concluded until 1921, when the Court of Session in Edinburgh approved a Deed of Constitution and Trust, including provision for the prospective hospital to be established with a board of governors. It was originally known as Astley Ainslie Institution and the focus of the hospital was very much on convalescence – it was not aimed at those suffering from long-term or incurable conditions, but at those who would ultimately make a full and permanent recovery.
A site was acquired on the south side of the city,
consisting of several mansion houses and their grounds: Millbank, Southbank,
Canaan House and Canaan Park. (Morelands and St Roques House and their grounds
were added later.) Thirty-one acres of the Caanan estate was purchased by the
Board of Governors in 1921.
As shown on this extract from Robert Kirkwood’s map of 1817
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| Courtesy of National Library of Scotland |
As well as the houses and gardens, a nine-hole ladies’ golf course was included in the purchase. The trees, planting and stone boundary walls were to be kept in situ as they were. Of the original villas, Canaan House (The Administrative Block), Canaan Park, St Roque and Morelands survive today.
In 1923 an experimental unit of 34 beds was opened by Lady Susan Gilmour in Caanan Park. From the outset, the emphasis was on light and clean air, inspired by the example of Continental sanatoria. The Institution's location on the outskirts of the city allowed patients to benefit from the quiet and from fresh, air. An article from the Nursing Times in around 1926 described the entrance hall of Canaan Park House as having a piano and that it was ‘bright with pots of growing chrysanthemums”. The interior colour scheme was generally ivory white and green – colours chosen for their calming and restful qualities.
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Caanan Park Pavilion
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| Mary Mears |
By 1930, 120 beds were available. It was agreed that the existing Infirmary Convalescent House at Corstorphine would be used mainly for patients requiring a short convalescent period before returning to normal life. The Astley Ainslie would provide for those requiring longer care and supervision to fit them for a normal life; it might also occasionally take in infirmary patients who needed to be built up for surgery; it would not be used for patients with a chronic disability or debility due to old age, where a return to normal health would not be expected.
IV.
The hospital starts to grow
The East and West Pavilions were opened in
1929. These purpose-built single storey wards used a 'butterfly plan' with
extensive verandahs to three sides for 45 female and male patients,
respectively. These were very spacious and
airy. The same year, the first medical superintendent, Lt-Colonel John
Cunningham, was appointed. Cunningham came from a very well-respected
scientific family. He was the eldest son of Professor Daniel John Cunningham,
who was a demonstrator in Anatomy at Edinburgh University, 1876-1882, and
Professor of Anatomy at the Royal College of Surgeons of Ireland, 1882, at
Dublin University, 1883-1903, and at Edinburgh University, 1903-1909. He
carried out original research in human and comparative anatomy as well as in
the wider field of anthropology including giantism and right-handedness and
left-brainedness.
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| John Cunningham |
John Cunningham was educated at the Loretto School, Epsom College, Trinity College, Dublin and Edinburgh University, and entered the Indian medical service in 1905. He worked in various laboratories, saw service on the Indian North-west Frontier during the First World War and became Director of the King Institute, Madras, 1919-1926, and of the Pasteur Institute, Kasauli, 1926-1929. He was also the Organising Secretary of the Seventh Congress of the Far Eastern Association of Tropical Medicine held at Calcutta in 1927. On his return to Scotland, Cunningham became the first Medical Superintendent of the Astley Ainslie Institution, a post he held until 1948.
In 1930, he was elected as a Fellow of the Royal Society of
Edinburgh. On retirement from Astley Ainslie, he became Chairman of the Board
of Management for Astley Ainslie, Edenhall and associated hospitals. In 1954,
he became an Hon. Fellow, World Federation of Occupational Therapists.
The Scientific Unit, opened in 1930, with laboratory,
X-ray, artificial sunlight installation (very important in Scotland!),
gymnasium, dispensary and dental room. The
nurses’ home was completed in 1930, a two-storey and attic, H-plan building,
built on the site of South Bank House. (original house was demolished)
From the outset, the focus of the Astley Ainslie was on
rehabilitation and rest, ensuring that patients were only allowed home when
they were fit enough to do so and it was clear, even in a pre-NHS Scotland,
that general hospitals did not have capacity. Newspaper coverage of the time
very much echoes the pressures currently experienced by the NHS today:
"...pressure on existing hospital
accommodation means patients can't be kept for more than 2-3
weeks...insufficient to build up patient's health... without fear of
relapse...result is that in many cases, particularly among working women, the
daily task is resumed before the patient is fit for it."
Scotsman, 1930
"The great pressure on the beds in our
general hospitals, as is evidenced by their heavy waiting lists, is...
contributed to by this class of case... the "ins and outs."
[readmissions]
Scotsman, 1930
V.
Occupational therapy
In the early 1930s, Canada was already renowned as a pioneer in the field of occupational therapy. John Cunningham invited Miss Amy DesBrisay of the Toronto General Hospital staff to work at Astley Ainslie to develop an occupational therapy department. In 1933, Mabel McRae arrived from Canada as the first permanent occupational therapist. By all accounts, Mabel was a force of nature – see ‘The Astley Ainslie, Mabel McRae, and the Canadian Connection’ by the Astley Ainslie Community Trust https://www.aact.scot/history-blog/the-astley-ainslie-mabel-mcrae-and-the-canadian-connection
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| The Occupational Therapy Unit, the first of its type in Scotland, opened in 1936 |
For adults, the east wing was dedicated to 'quiet' crafts, such as weaving, painting and basketry; the west wing for noisier activities such as carpentry, pottery and metal work. Patients confined to bed could enjoy rug making, painting, wood carving and leather work, needlework and knitting.
The importance of occupational therapy was thrown into
sharper focus following World War II. The Scotsman reported that John
Cunningham “drew attention to the impetus given to the rehabilitation of
disabled people because of the …. increased social consciousness in recent
years, and still more because of the urgent demands for manpower brought about
by the war”. He added that the “treatment may have a psychological, remedial or
educative aim. Whenever possible, it should be started while the patient is in
bed, to keep up muscle tone and to arouse interest in something outside the
illness” (13 November 1944).
Scotland’s first Occupational Therapy training course was
opened at the Astley Ainslie in 1937.
Dorothy Bramwell was one of the first four Occupational
Therapists trained at Astley Ainslie. In 1939, she left Edinburgh to attend her
sister’s wedding in Malta, only to be evacuated to Egypt when Italy entered the
war. She ended up spending the duration in Egypt, putting her training to
immediate use helping servicemen to recover from their injuries, shell-shock
and battle fatigue. In her obituary, it was reported that men who were, in some
cases, unresponsive to human contact reacted well to her therapeutic skills and
a flock of budgerigars which she took with her in the wards. During the war,
she was instrumental in developing the occupational therapy service across the
Middle East and was awarded an MBE in 1944.
On her return to Edinburgh, she found herself at the centre
of Astley Ainslie’s occupational therapy service – the Canadian OTs, who had
remained to support casualties during the war, returned to Canada and Dorothy
became both head of Occupational Therapy and the Director of the OT training
course – positions she held for 20 years.
For more about the history of occupational therapy, see our earlier post here: https://lhsa.blogspot.com/2014/11/occupational-therapy-history-behind.html
VI.
Military Service
During the Second World War Astley Ainslie was closed to convalescent patients and became a military hospital. In 1939, Astley Ainslie was taken over as part of the Emergency Hospital Service and military patients began to be admitted on 28th October 1939.
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| Wooden huts for military patients |
Small wooden huts were built in 1940 to provide more accommodation for the Military Hospital. The minutes of a meeting of January 1940 with the Department of Health for Scotland suggests that the transition to admitting military sick was quite fraught at times and that there was some concern expressed regarding the necessity of enforcing discipline amongst some of the military sick. The appointment of a Military Registrar to oversee the military sick seems to have been the subject of some friction with the Governors of Hospital.
Astley Ainslie Hospital was designated as a Casualty
Clearing Hospital for air raid casualties., but as there were fewer than
anticipated, it became a general military hospital.
Towards the end of Oct 1944, there was a suggestion to change the
name of Astley Ainslie from Institution to Hospital, to better reflect its nature
and function.
In 1946, St Roques House was acquired for the Hospital by
the Trustees. It had been the home of William Ivory, a member of the Botanical
Society of Edinburgh and responsible for many of the fantastic specimen plants
and trees in the gardens, including the giant redwoods. A little later, the
villa known as Morelands to the east of the site was added to the growing
hospital site.
VII.
Post war constructions and beyond
In 1948, Astley Ainslie
Hospital became part of the newly established National Health Service and
started to receive patients from other hospitals as well as from the Royal
Infirmary of Edinburgh.
During this period, the
hospital came under the administration of South Eastern Regional Hospital Board
and in 1954 it was linked under a single Board of Management with Edenhall
Hospital, Musselburgh. In 1974 it became part of the South Lothian District of
Lothian Health Board.
Tyne Lodge opened in 1955 as
the hospital’s first outpatient unit. The Tyne Lodge General Register of
Patient (LHB35/4/3) records individual patients' attendances at the
Rehabilitation Unit.
One unusual facility was
created in 1959 when the National Coal Board designed, presented and installed
a model coal face (inside a corrugated steel tunnel). It came complete with a
coal face with roadway, seams, a bogie and rails, representing the cramped
working conditions and atmosphere of a coal mine. The idea was to help injured
miners return to work; at the time it was estimated that one miner in four was
off each year through industrial injury. LHSA’s collection of National Coal
Board Medical Cards (GD46) is a valuable source that provides insight into the
numerous cases in which miners got injured or became physically disabled
between the 1940s and 1980s. Amongst the most recurrent injuries and
disabilities are slipped discs, punctured thumbs and big toes, strained backs
and knees, bruises on feet/hands/arms, pustules on the knees, cut
forearms/fingers, abrasion to fingers/legs/shoulder blade, jerked back/lumbar
area, chest pains, and burst fingers.
For more on Tyne Lodge and the
National Coal Board service, see: https://lhsa.blogspot.com/2025/03/disability-livelihood-and-employment-3.html
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| The Home Unit |
The Home Unit was opened in 1960. An article in the Scotsman at the time articulated very neatly the ethos of Astley Ainslie as a place of rest and recuperation; the new home unit was focussed on “caring about the patient, rather than just for the patient.” The unit provided a modern approach to rehabilitation and was kitted out with an assessment room, bedsitting room, bathroom and kitchen and equipped with gadgets and furniture to support disabled housewives/patients to reorientate prior to returning home. Staff also conducted home visits to arrange suitable equipment, and any structural alterations were requested via the Council (as they are now). During its first year more than 162 patients had been supported through the Home Unit and its facilities.
The Charles Bell Pavilion was
built in 1965 originally as the Children's Centre. It was constructed at a cost
of £238,000 and was designed to treat children from 18 months to 15 years. It
was the first of its kind in Scotland, providing physiotherapy, occupational
therapy and speech therapy, where needed. Children were able to attend school,
including taking standard examinations, whilst they were at the hospital as
there had been a school on site since 1957.
The Scottish Driving
Assessment Service (SDAS), like the Home Unit, enabled patients to adjust to life
with a disability or after illness or injury.
Established in 1983, the service was one of the first of its kind in the
UK and has continued to be a vital resource for those seeking to drive safely
again.
The service was initiated by
Dr John Hunter, who aimed to raise funds for the establishment of a driving
assessment service during the International Year of Disabled People in
1981.
The first patient was helped by the service in August 1983, and by the end of the first two years, sufficient evidence was gathered to present a paper at an International Conference and apply for ongoing funding as a ‘New Development in Healthcare’. The service has grown since then, providing assessments and advice on driving fitness for individuals with various medical conditions and disabilities, ensuring that those with a disability can continue to drive safely and independently.
VIII.
SMART Centre
The South-east Mobility and
Rehabilitation Technology (SMART) Centre opened in 2007, continuing the work
and legacy of pioneers like David Gow and David Simpson, Director of
Rehabilitation Engineering Services (RES), using engineering and technology to
support patients’ rehabilitation. SMART Services was the result of the
integration of two groups of services that were formerly on two separate sites:
RES and the Mobility Centre.
In 1969, RES was renamed the
Bio-Engineering Centre. As well as their pioneering work in creating externally
powered prostheses, the team also began to create externally powered disability
aids, such as feeding aids which helped disabled people eat independently. Dr
David Simpson was the first ever Director of the Centre.
In 1988, the Lothian Health
Board was given oversight of the Bioengineering Centre by the Scottish Home and
Health Department. That same year, they created an umbrella organisation called
Rehabilitation Engineering Services for the Lothian Area (RELSA). The
Bioengineering Centre continued to be based in the Princess Margaret Rose
Hospital, but this restructuring linked the Bioengineering, Prosthetics and
Mobility departments together under one organisation. It was later renamed
Rehabilitation Engineering Services (RES) dropping the Lothian Area remit to
represent the restructuring of NHS Trusts and reflect fact that they catered to
the needs of disabled people throughout the UK and even internationally.
The Bioengineering Centre was
moved from the Princess Margaret Rose Hospital to the Eastern General Hospital
in 2002, when the PMR closed. However, the Eastern General Hospital was also
scheduled for closure. The Bioengineering Centre and the Prosthetics Services
were the last services operating on the Eastern General site before it closed altogether.
In December 2006, the
Bioengineering and Prosthetics Services moved to the Southeast Mobility and
Rehabilitation Technology (SMART) Centre, a new purpose-built rehabilitation
medicine building at Astley Ainslie Hospital, where it has remained ever since.
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| Gait analysis software used in the SMART Centre in the 2010s |
The SMART Services currently provides wheelchairs and special seating services; prosthetics and orthotics services; environmental controls services (the adaptation of light switches, doors and electrical equipment for disabled people; a custom design service (designing unique equipment depending on an individual patient's requirements) and gait analysis services.
Patients based in Edinburgh
can still be assessed for a blue badge independent mobility assessment at the
SMART Centre, as well as undertake a Driving Assessment (a service that has operated
at Astley Ainslie since 1983) to learn how to drive again after being injured
or discuss vehicle modifications to support their disability.
You can find out more about the work of David Gow and bio-engineering in Edinburgh here:
https://lhsa.blogspot.com/2020/02/this-is-getting-out-of-hand.html
https://lhsa.blogspot.com/2025/04/bioengineering-in-edinburgh.html
https://prezi.com/p/foat604uumlm/bioengineering-in-edinburgh/
