#2 Horton Asylum
Horton Asylum Epsom Cluster #2
- Opened: 1902
- Closed: 1997
- Architect: George Thomas Hine
- Original authority: London County Council
- Original capacity: approximately 2,000 patients
- Original accommodation: 900 men and 1,100 women
- Original name: Horton Asylum
- Later names: Horton Mental Hospital; Horton Hospital
- Wartime use: Horton (County of London) War Hospital during the First World War; emergency/war hospital during the Second World War
- Epsom Cluster: No. 2 – the second hospital of the Cluster to open
- Architectural plan: Compact arrow plan, closely based upon Hine’s earlier Bexley asylum
An asylum built on an enormous scale
When Horton Asylum opened in 1902, it marked a very different stage in the development of the Epsom Cluster.
The Manor, which had opened three years earlier, had provided a rapid and supposedly temporary answer to London’s shortage of asylum accommodation. Horton was the purpose-built institution that was intended to follow it.
Designed by George Thomas Hine, one of the leading asylum architects of the period, Horton was the seventh London County Council asylum and the second hospital to open on the vast Horton estate at Epsom.
Its scale reflected the problem confronting the London County Council.
Horton was designed to accommodate around 2,000 patients – approximately 900 men and 1,100 women – effectively creating a small self-contained community on the outskirts of Epsom.
George Thomas Hine’s design
Hine designed Horton using what became known as a compact arrow plan.
The arrangement was closely related to his design for Bexley Asylum in Kent. Instead of placing patients within one enormous institutional block, wards extended from connecting corridors, producing the distinctive pattern visible on historical plans of the hospital.
But an asylum of 2,000 people required far more than wards.
Horton was provided with the infrastructure necessary to sustain a population comparable with that of a small town. Historical accounts record a boiler house and electricity-generating plant together with a chapel and industrial buildings among the facilities constructed for the hospital.
The wider Epsom Cluster also developed shared infrastructure and extensive working farmland.
For patients and staff, Horton therefore became not simply a collection of wards but an extensive institutional community.
Work and daily life
Work formed an important part of asylum life.
The hospital had workshops and other facilities where patients could undertake practical work, while the extensive estate offered opportunities for agricultural labour.
This reflected the prevailing asylum system of the period, in which employment was regarded both as occupation for patients and as a means by which these very large institutions could perform some of the work necessary for their own operation.
For decades, thousands of patients and staff would live and work within this environment.
Then, just thirteen years after Horton opened, its purpose changed completely.
From asylum to war hospital
On 9 February 1915, a decision was taken to convert Horton Asylum into a military hospital for casualties of the First World War.
That required the removal of its existing patients.
Between 12 March and 8 April 1915, some 2,143 mental health patients were transferred to other London County Council institutions, placing additional pressure on hospitals elsewhere.
Horton came under military control on 9 April.
Its medical superintendent, Dr John Robert Lord, remained in charge, but now served as a Lieutenant-Colonel in the Royal Army Medical Corps.
The former asylum was transformed into a military hospital with capacity for 2,532 beds.
Its first 72 wounded servicemen arrived on 20 May 1915.
More than 44,000 servicemen treated
What followed was one of the most extraordinary chapters in Horton’s history.
During its First World War service, Horton admitted 44,613 servicemen.
They came from across the British Empire and from different theatres of war, with the hospital treating general and acute cases as well as developing specialist work.
Contemporary medical reporting described Horton as a centre for eye cases and for ear, nose and throat patients, in addition to its general hospital work.
Among those who arrived were survivors of one of the war’s maritime disasters.
On the night of 17 November 1915, Horton received survivors from the hospital ship Anglia, which had struck a mine and sunk in the English Channel.
Dr Lord later recorded that 112 soldiers and two sailors from the Anglia were admitted, together with a cabin boy from the Lusitania, a collier involved in the rescue effort.
Remembering their arrival, Lord wrote:
“The night of 17th November, 1915, will never be forgotten.”
Many of the men were suffering both from wounds and the effects of immersion in the sea.
It was one night within four years during which a hospital built for London’s psychiatric patients became responsible for casualties returning from war.
The men who did not return home
Not every serviceman treated at Horton survived.
Of the 44,613 servicemen admitted during Horton’s First World War service, 351 died.
Those who died were not normally buried in Horton Cemetery alongside patients from the Epsom Cluster. A military burial area was made available at Epsom Cemetery in Ashley Road, where 94 of the servicemen who died at Horton War Hospital were buried. Others were buried elsewhere.
There are, however, two remarkable exceptions within Horton Cemetery itself. At least two servicemen are buried within Horton Cemetery who are also recognised by the Commonwealth War Graves Commission.
Private Peter McMahon, who died on 1 December 1918, and Private Henry Walter James, who died on 7 February 1941, are buried in unmarked graves within the cemetery. Both men died at Long Grove Hospital rather than Horton Hospital.
Why these two servicemen were buried at Horton Cemetery instead of receiving military burials elsewhere remains unknown.
Private McMahon died on 1 December 1916. Private James, who served in the Pioneer Corps, died on 7 February 1941. The Commonwealth War Graves Commission recognises both men as war dead and records their burial at Horton Cemetery.
Because their graves within Horton Cemetery are unmarked, both men are commemorated by special Commonwealth War Graves Commission memorial headstones in the CWGC plot at Epsom Cemetery in Ashley Road, whilst their remains are buried within Horton Cemetery.
Their presence at Horton is also acknowledged by the Horton Memorial, which stands outside the cemetery and commemorates the thousands buried within. Its inscription specifically remembers “the servicemen of two World Wars who are buried here.”
The circumstances that placed Peter McMahon and Henry Walter James among the thousands buried at Horton may remain a mystery, but their presence is significant. Amid a cemetery overwhelmingly associated with patients of the Epsom Cluster lie two officially recognised Commonwealth war dead – one from each World War.
Horton becomes a mental hospital again
The war hospital finally closed on 17 October 1919.
Returning Horton to its former purpose could not happen immediately. The first mental health patients were readmitted in February 1920.
Dr Lord remained as medical superintendent, continuing in the post until his death in 1931.
His experiences during the war were preserved in an unusually detailed contemporary record. In 1920 he published the 264-page The Story of the Horton (County of London) War Hospital: Epsom, documenting the hospital’s wartime organisation and work.
The institution subsequently became known as Horton Mental Hospital.
But the inter-war years brought another important chapter in Horton’s medical history.
Malaria as a treatment for syphilis
During the 1920s Horton became involved in pioneering work on the treatment of general paralysis of the insane, or GPI.
GPI was a devastating consequence of untreated syphilis and, before effective treatment became available, was a significant cause of admission to mental hospitals.
An unusual treatment had emerged from the work of Austrian psychiatrist Julius Wagner-Jauregg: deliberately infecting a patient with malaria to produce high fevers.
At Horton, the Mott Clinic became associated with the development of malarial treatment for GPI from 1924.
The treatment belongs to a very different medical era, before antibiotics provided an effective treatment for syphilis. Nevertheless, Horton’s work in this field became an important part of the hospital’s medical history.
War returns to Horton
Twenty years after the end of its first period as a military hospital, Horton was once again required for wartime medicine.
At the outbreak of the Second World War in 1939, the hospital became part of the government’s Emergency Hospital Service.
Once again, existing psychiatric patients had to be moved elsewhere.
The scale and speed of the evacuation was considerable. Historical accounts record that 400 Horton patients were transferred to West Park in just two days, while others went to Long Grove, Caterham and institutions further afield.
Horton Emergency Hospital was organised to receive both military and civilian casualties.
The early months were comparatively quiet. That changed following the evacuation of Dunkirk in 1940, when casualties began arriving.
For the second time within a generation, buildings designed as a psychiatric asylum had been transformed to deal with the consequences of a European war.
Horton and the NHS
After the Second World War Horton returned once more to psychiatric care.
The creation of the National Health Service in 1948 brought another fundamental change: responsibility for the hospital passed from the London County Council system into the NHS.
The enormous Victorian and Edwardian asylum system was itself beginning to change.
During the decades that followed, attitudes towards psychiatric treatment increasingly moved away from the model of large, isolated institutions accommodating patients for long periods.
Horton continued operating as a psychiatric hospital, but the world for which it had originally been designed was gradually disappearing.
The end of Horton Hospital
Horton Hospital finally closed in 1997, 95 years after the asylum had opened.
Much of the site was subsequently redeveloped for housing, although a number of original hospital buildings were retained and converted.
The result is that parts of Hine’s enormous institution can still be recognised within the modern development, even though their purpose has completely changed.
Horton’s story, however, extends far beyond its surviving architecture.
For almost a century it accommodated psychiatric patients, doctors, nurses and other staff. Twice it was transformed by world war. Tens of thousands of wounded servicemen passed through its wards during the First World War alone, while its doctors later participated in significant developments in psychiatric medicine.
And behind the institutional history are the individual lives.
Patients who died within the Epsom Cluster could be buried at Horton Cemetery, often far from the London communities from which they had originally come.
Today, those graves provide another record of the human population behind the statistics – the individuals whose lives were spent, sometimes for many years, within institutions such as Horton Asylum.
The buildings had names, numbers and capacities.
The cemetery reminds us that the people within them had names too.