Nick Black

Author of The Honourable Doctor



One bright, chilly May morning in 1862, James Lambert Clapham walked down the gangway onto the quayside in Lyttleton, New Zealand.1 After over 100 days at sea, the relief at having arrived safely must have been tinged with sadness knowing he’d probably never see his homeland and relatives again.2 Many of the seven thousand emigrating from Britain that year were, like him, young and single. Each had their reason. What was it that drove him to leave the small Fenland village that had been home for most of his life and venture into the unknown?

James was born in 1840 in Wansford, a village five miles west of Peterborough. His father, William, was the local general practitioner (apothecary-surgeon). He’d taken over the practice in 1834 and, two years later, had married Sarah Crane. Their first child, Emily, was born in 1837, followed by James and then Frederick, in 1843. Life appeared to have worked out well for William. A thriving practice, growing family and living only ten miles from his parents and other relatives in Thorney where his father, to whom he’d been apprenticed, was in practice in partnership with William’s older brother, John.

Life for James was about to change. In 1844 his father,  still only 33, died. With no relatives to take over the practice, his mother had no choice but to sell it. At this point, the first puzzle in James’s life occurred. His mother moved 40 miles away, to Bedford,3 but only took his sister, Emily, and her servant with her. Why move to Bedford? Her parents and many of her thirteen siblings lived in Thorney, as did most of her deceased husband’s relatives.4 And why did she part from her two sons, still only seven and four years old?

Whatever her reasons, James was, in effect, orphaned. Fortunately, one of his aunts, Sarah’s sister Amelia, had recently married and set up home with her husband, John Buck,5 in the Doctor’s House. This large Elizabethan building on The Green in Thorney housed three related families. John and Amelia, who lived in the southern part, had plenty of space and, having married at the relatively advanced age of 35, may have considered it unlikely they would have children of her own.

The move must have been quite traumatic for James (and his brother Frederick), now parted from both parents. On the other hand, having seen little of his relatives while living in Wansford, he was now surrounded by family. In the northern part of the house lived his maternal grandparents, Wright and Mary Crane, while in the central part was his uncle John (his father’s brother), aunt Ellen and their three children. The eldest, Edward, was the same age as him so it’s likely they spent much time together.

Uncle John was now the sole doctor in Thorney, James’s grandfather having retired and, with his wife, moved to Eye, a nearby village. Just as the apothecary’s workshop at the back of the building had fascinated his uncle and his father when they were boys, so it captured James and Edward’s imagination. They’d spend time watching John’s apprentice compounding medicines, maybe asking if they could help. By 1855, having reached fifteen, the two boys were ready to start their apprenticeships.

It was common for general practitioners to take on and train their sons. Although it meant foregoing the apprentice’s fees, the loss for John was minimal and there was the attractive prospect of being able to hand on the practice one day to Edward. As for James, his uncle could see his nephew’s interest and desire to be a doctor, something he would have recognised in himself at that age. He’d also have known that his deceased brother, who he had been close to as a child, would have wanted his son to train to be a doctor. Out of a sense of duty, he took on James as a second apprentice, alongside Edward.

Over the next five years, Edward and James would have gained the practical knowledge and skills to be an apothecary and a surgeon. All that was needed to complete their training and qualify, was to attend a medical school in London. But in autumn 1860, it was only Edward who set off for a year in the capital. Why didn’t James go too? It’s possible, though unlikely, that he’d decided he no longer wanted to be a doctor. Few apprentices turned away from a medical career after completing five years training. Maybe no one would pay for him to be a pupil – not his mother,6 the Bucks, John Clapham or his maternal grandfather, Wright Crane. If this was the reason, why wouldn’t any of them? All could have afforded it.7

Curtailing his medical career at that stage is particularly poignant given his name. His father, William, had died before he’d have had the opportunity to explain to James the origin of his name. That responsibility passed to his uncle. At some point, John, will have told him about James Lambert, the cousin who had been apprenticed to his father, William senior. He’d have talked of how, for five years, James Lambert had lived with them in the Doctor’s House, becoming a much loved member of their family. Of how both he and his brother, William junior, were in awe of their cousin. To them he had been more like an elder brother. And he’d have told him of the extraordinary life James Lambert led in London, becoming one of the leading proponents of reform of the medical profession and the hospitals. Of how he had tried to help James Lambert in his hour of need. Painful though it must have been for John, he will have told him how unjustly both James Lambert and he himself had been treated by the medical establishment. How it had resulted in his imprisonment for six months and how the dreadful consequences had led to the untimely death of James Lambert, there in Thorney.8 John would have taken and shown him the sombre white marble plaque in the Abbey, a memorial to his namesake.

Given all that, it makes it even harder to believe that John wouldn’t have paid for his young nephew to complete his training. Whether abandoning medicine was his choice or not, James Lambert Clapham went to work for another uncle, John Crane, on his farm on Towers Fen, not far from Thorney. James was now twenty, old enough to see how limited his opportunities and prospects were. He’d have seen advertisements in the newspapers for assisted passages to various colonies, including New Zealand. The promises offered for enterprising men must have convinced him. So on a cold Tuesday morning in February 1862, he went to London and embarked on a ship. Did he leave, savouring the opportunities that life in a new country offered or saddened and resentful that his hopes of becoming a doctor had been dashed, feeling let down by those nearest to him?

Arriving in the port of Lyttleton in Christchurch,9 he’d have been hounded by agents looked to recruit new arrivals off the ships. All over South Island, employers were in need of labour. With some experience of farm work, James opted to take up the offer of a job on a farm in the northern part of the island. It was owned by Charles Wiesenhavern who had himself arrived from Lower Saxony some years before and established a sheep station near Nelson. Nothing is known of the few years he spent there nor his reason for choosing that option against all the other possibilities there would have been. Employed in menial, manual work on a remote farm wouldn’t have offered him much and the isolation would have provided few opportunities for finding a wife.

Around 1867 he moved to Feilding, a small town 20km north of Palmerston North on the North Island. He took a job as a clerk for Bartholomew Brothers, a firm manufacturing doors and sash windows. It probably paid better than a farm labourer’s wages and being in a town meant greater scope socially. The town and job must have suited him as he was to remain working and living there for 13 years. During that time, he met Maria Lane, eleven years younger than him and newly arrived from England (in 1873). They married in 1876 and that year their first child was born. Seven more were to follow over the next 16 years.

Despite the hard manual labour involved, his time on his uncle’s farm in Thorney and on the sheep station in Nelson must have stimulated an interest in farming. Maybe it was a desire to live in the country, surrounded by nature and animals. His interest in farming even led him to write to the local paper in Feilding about flax dressing machinery.10 Whatever the reason in 1890, James and Maria moved to Halcombe, 12 km away, to start farming. He was to remain a farmer the rest of his working life, later moving to Colyton.

Around this time, James dropped his first name in preference for Lambert. The surgical skills he’d learnt back in Thorney as an apprentice doctor were not forgotten. Although he’d never trained or qualified in veterinary medicine, he offered a service to local farmers which, by all accounts, was most welcome and valued. Maybe he harboured a long held frustration that he’d never had the opportunity to qualify as a doctor.

Whether James ever heard from his mother or sister Emily in England is not known. A relative, probably Lawrence Clapham, who’d succeeded his father as the doctor in Thorney in 1882, will have informed him of the death of his mother in 1902 (just as he was to in 1918 about Emily’s death).

After nearly 30 years farming, Lambert (James) retired and he and Maria left the land and, in 1919, moved to the local town, Palmerston North. The year before, like so many others, they’d suffered the loss of a son fighting in Europe. Harry Cautley Clapham, their youngest child. Of their seven other children, three lived locally, the others scattered across North Island.

Despite having eight children, Lambert (James) had felt no inclination to perpetuate the name, James Lambert. Having, as a child, never met his father’s cousin, there’s no reason for him to have felt any strong connection. All he’d ever known was a simple plaque in a church on the other side of the world. And that was a lifetime ago.

However, the name didn’t disappear with Lambert’s death in 1926.11 His eldest son, William John Ward Clapham, had, in 1907, named one of his children, Lambert William. That was probably in tribute to the boy’s grandfather rather than to an English doctor from the previous century.

Whether Lambert William ever learnt the origins of his unusual name is unknown but what is clear is that he was last faint vestige of James Lambert, either in New Zealand or England, until his death in Halcombe in 1979.



I’m indebted to Alison Whelan in Hamilton, and several other contributors to for supplying vital documents and information, and to Emma Burton for her usual forensic genealogical detective work.


  1. His obituary states he travelled on the SS Zealandia from London arriving 24 May, though his name is not on the passenger list. At that time, arrivals of immigrants from the UK were equally spread between Lyttleton (Christchurch), Auckland and Dunedin.
  2. His younger brother, Frederick (b 1843), also emigrated, settling in Blenheim. Descendents of both men believe they travelled from England together but no documentary evidence has yet been found to confirm this.
  3. In 1851, lived at 3 Tavistock Street, St Paul, Bedford.
  4. Sarah Crane’s mother, Sarah Jenkins, had been born in St Neots (15 miles from Bedford) so its possible that some members of the Jenkins family were living in Bedford.
  5. John Buck was an agent for the Norwich Union Fire and Life Insurance Company.
  6. Sarah (Crane) Clapham had moved back to Peterborough. In 1861 she lived at 1 Albion Terrace, Fletton, described as a ‘landed proprietor’ (ie income from owned property) which might suggest she was reasonably well-off. Frederick had rejoined her from Thorney.
  7. William Clapham senior, James’s paternal grandfather who had trained James Lambert and sons John and William, had died thirteen years earlier in 1847.
  8. The full story appears in: Nick Black, The Honourable Doctor. Grosvenor House Publishing, 2022.
  9. Further evidence that Lyttleton was his port of entry is an unclaimed letter to him that was recorded in March 1863 awaiting him in Christchurch Post Office.
  10. Lambert Clapham. New fax (sic) dresser (letter). Feilding Star, 26 March 1889:10 (3);2.
  11. (James) Lambert Clapham died on 17 November 1860 only five months after his wife, Maria died (3 June 1860). They were buried in Terrace End Cemetery, Palmerston North.

An Essex Childhood

Belchamp St Pauls  1806

‘Scaredy-cat, scaredy-cat. James is a scaredy-cat,’ the three of them chanted as they splashed about in the pond behind the church. James stood on the bank ignoring their taunts.

‘Come on in,’ shouted Tom, his older brother. ‘It’s not deep.’

Despite the sweltering heat tempting him, James knew he shouldn’t. Mama had told them it was dangerous, that they could drown.

‘No, we’re not allowed,’ he replied, before wandering off to find some shade.

Nearby was a vast, dilapidated wooden barn. What remained of the large doors lay on the ground, overgrown with cow parsley and ragged Robin. Sitting inside, on an old beam, he watched swallows and pigeons fly in and out. Occasionally, a butterfly mistakenly flew in, from feeding on the briar roses around the entrance. Through the holes in the roof, beams of sunlight shone down. They were just like the ones in the pictures he’d seen at Sunday school, that God sent down from heaven. He wondered if these came from heaven.

He picked up a stick and scratched his name in the dry earth floor. Papa had told him how, if he learnt his letters, he’d be able to read tales about kings and queens, knights and dragons, and adventures in faraway lands. He couldn’t understand why other children weren’t interested in reading. Even Tom would rather play outside, climbing trees and building dens.

Mama had said, ‘If you can read, there’s all sorts of things you’ll be able to do when you’re older,’ but he wasn’t sure what those things were.

At the sound of his brother calling, he jumped up and scrubbed his writing out with his foot before Tom appeared.

‘Thought I’d find you here. Time to go.’

On their way back to the village green, they passed Reverend Staveley, heading up the hill to the church to prepare for evensong.

‘Hello boys, been up to no good I expect,’ he called out.

He was always so cheerful. Other men just ignored them or were grumpy and told them to clear off. When they reached the village green, James was glad that Tom’s friends left. James liked it best when it was just the two of them. When other boys were around, Tom paid him less attention.

At home, his mother was sitting in the sunshine, sewing. She was so different from Papa. Round and cuddly. When he was smaller, James had loved sitting on her lap but since his sister arrived two years ago, he rarely got the chance.

‘There you are,’ said Mama, looking up from under the wide brim of her bonnet. Her smile soon turned to a look of concern. ‘Tom, what’ve you been up to? You been in the pond again? What have I told you?’

Tom muttered something and disappeared indoors.

‘James, go and wash your hands. I want you to go and get a loaf.’ She fumbled in the pocket of her smock and handed him a coin.

As he sauntered back across the green, clutching the warm loaf, he saw his father coming down the road, back from work. He didn’t understand what Papa did but knew he had to go to other villages and a town called Clare. He was something called an Excise Officer and he’d had to pass special tests to get the job. That was why he wore a special coat and a peaked hat with a gold badge.  Papa said it was to show he was working for the King and that people had to do what he said.


The cool of the house was a welcome relief. At dinner, they sat in their usual places, Papa at the head of the table and Harriet in a high-chair beside Mama. As ever, his father sat erect, never leaning on the table. James had heard other boys say they were scared of his father because he had dark hair, wore black clothes and always looked cross. What they didn’t know was how kind he was. Papa bowed his head and said grace.

There was rabbit pie, cheese, pickles and the bread James had collected. As a treat, there were strawberries which Mama had grown in their garden. His parents had once told him how they’d both grown up on farms but Papa had to leave his home because it was his older brother who’d inherit it. That’s why he’d had to find something else to do.

‘Where have you been today, love?’ Mama asked, as she did every day. James loved hearing about the places Papa went, picturing them.

‘Over at Ridgewell. Something at the dairy didn’t seem right. Turned out that they’ve been making cheese and selling it locally. Dairyman thought, as it was just for villagers, it didn’t have to be taxed.’

‘Was he angry?’

‘Not too pleased. They’ve got a new baby and he’s struggling to pay the rent. I said I’d overlook the past as long as he started collecting it.’

‘That was good of you.’

‘Hmm. Trouble is, he says if he charges more, no one will buy them.’

As Mama gave everyone some more pie, James could see his father was gazing across the room at nothing in particular. He did that when he was thinking.

‘So many people are struggling,’ said Papa. ‘We’ve got that scoundrel Napoleon to thank. Sooner this war is over the better.’

James knew that Napoleon was a bad man and he was French and that last year someone called Nelson, who was on our side, had beaten him in a big battle at sea.

As Mama stood up she suddenly stopped.

‘Oh, I nearly forgot. Got a letter from brother William. He and Sarah have had another baby. A girl. Emma.’

She turned to Tom and James. ‘That’s another cousin for you.’

James wasn’t sure what a cousin was. Some children at Sunday school were cousins. It seemed to be like a brother or sister who didn’t live with you.

‘Right, I’m putting Harriet to bed. You boys clear away the dishes so your father can read his paper.’

Every Wednesday, one of James’s jobs was to go to the village shop and collect the Bury & Norwich Post, which arrived on the mail coach from Sudbury. Papa settled down in his usual chair, lit his pipe, and opened the paper. After a while James heard him tutting.

‘Another horse been stolen over at Belchamp Water.’

‘Oh dear,’ said Mama, who’d settled herself down in the other armchair. ‘You must be so desperate to do such a thing.’

Papa put down the paper. ‘Still not an excuse to break the law. If they need help, there’s the Overseers. That’s what we pay our rates for.’

‘I suppose so,’ said Mama. She turned to Tom and James. ‘Right, you two. Time for bed.’

‘But it’s still light,’ complained Tom. ‘Can’t I go out for a bit?’

‘Do as your mother says,’ said Papa. ‘Plenty of time to be outside tomorrow.’

James was already on his way up. On summer evenings, with the window open, he loved lying in bed listening to the world outside. The blackbirds in the garden, men outside the Half Moon breaking into song, and the rumbling of wagons returning from the fields laden with corn. The last thing he heard before falling asleep was the church bell, drifting over the fields in the warm evening air.


James was always up early so as to spend time alone with his father. He’d run alongside him to the stable behind the house where he’d watch his father saddle his horse.

‘Where are you going?’ James asked.

‘Foxearth. Got to check on the miller.’


Papa stopped for a moment and looked down at James. ‘If he isn’t paying his taxes, the King and the government won’t get their money.’

James thought for a while. ‘Why doesn’t the government do that?’

His father smiled at him. ‘Well, I work for the government. It’s my job to get the money for them.’

He ruffled James’s hair before mounting his horse. ‘Come on Scrump. Busy day for us.’

James watched him until he turned at the end of the lane and passed out of sight, still trying to understand what Papa did and why.

It was another hot, sultry day. James spent the morning looking after Harriet while Mama was busy washing sheets. He liked playing with her, trying to make her laugh and teaching her words. After lunch, as he and Tom were taking some freshly baked cakes to Mrs Talbot and Miss Walford, who lived in the alms-houses across the green, Tom’s friends appeared, heading up to the ponds.

‘Tom. You coming?’

‘All right,’ he hollered.

‘You go,’ James said, ’I don’t want to.’

He liked being by himself. He wanted to visit the wood behind their house. A couple of days earlier he’d seen an ants’ nest he wanted to investigate. He sat on a patch of grass and watched the long lines of ants coming and going. He wondered how they knew what to do. Did they talk to each other? He laid sticks and stones across their path to see if they went over or round, or turned back. He shaded them from the sun to see if that changed what they did. Then, when he dug a trench across their route, he was amazed to see them build a bridge across it. How did they do that? Was one giving orders? He was mystified.

When he got home, and Mama asked him what he’d been up to, he thought it best to say nothing about the ants. She might think it odd and not let him go there again.

‘Just playing down by the wood,’ he said.


Every evening, when Papa got home, James fed Scrump. He liked the feel of her warm, wet mouth on his hand when he gave her a carrot. It was almost as good as when Mrs Chamberlain, who lived next door, let him collect eggs from her hens. He loved crawling into the hen coop and finding the newly laid eggs in the warm straw.

One evening, as they sat having dinner, James noticed that Mama and Papa weren’t saying much. At one point, he saw his mother looking at him before quickly switching her gaze to his father. When they’d finished eating, Papa carefully folded his napkin and put his hands on the table.

‘Boys, Mama and I have some news.’ He looked from one to the other but lingered on James. ‘I’ve got a new job which means we’ll be moving to live somewhere else.’

‘Papa has been so good,’ added Mama, smiling, ‘they’re giving him a more important job.’

‘But we live here,’ said James.

‘We do but we’re going to a new place, a town called Harwich,’ said Papa.

James stared at his father for a while. ‘What about Scrump? Will she come with us?’

‘No, this is her home,’ said Mama. ‘Someone will look after her.’

‘Is it far away?’ asked Tom.

‘Yes. It’s by the sea. There’s a harbour and lots of ships.’

James sat silently, staring at the table. He didn’t want anything to change. He liked everything just as it was.

Harwich 1809

‘When can we go home?’ he asked his mother, as she was putting him to bed.

‘What do you mean? This is our home.’

‘I don’t like it here. I liked it in the country.’

Here, in the town, he rarely ventured out, unlike Tom who, three years ago, had immediately made friends and spent most days messing around by the harbour.

Also, Papa was much busier, usually going off before daybreak. When James asked him why, he’d explained how the chandler couldn’t start work until he’d unlocked the man’s tools. ‘Then I’ve got to open up the malt-house,’ he’d added.

Unlike in Belchamp, James could see his father often worried about his work. One morning, James couldn’t understand why his father seemed reluctant to set out on his visirs. He hardly ate any breakfast and was pacing around, endlessly checking his bags to make sure he had all his equipment.

‘What’s going on?’ asked Mama. ‘Shouldn’t you be on your way?’

‘Aye, just going,’ he replied.

James could see how concerned his mother was. ‘Where you off to?’

‘Tannery over in Dover Court. I reckon they’ve been selling unstamped leather.’ He paused and looked at her. ‘Trouble is, I can’t prove it.’

‘Well, what will you do?’

‘Keep visiting and note the hides they’re handling. Least I can make life difficult for them.’

‘Do be careful, love,’ said Mama.

‘I will. They’re not dangerous. Bit of abuse, name-calling. That’s all.’

‘It’s not right. You’re just doing your job.’

‘Don’t worry,’ he sighed. ‘Being unpopular is just part of the job,’

James watched his father pull on his special coat. He was glad it was so bulky, disguising how thin he was, making him look stronger.


‘James. How about a walk by the sea this morning?’

‘What?’ asked James. ‘All of us?’

‘No. Just you and me.’ She turned to Tom. ‘You’ll look after Harriet, won’t you?’

In the past, Tom would have moaned about having to stay home but not anymore. Recently, he’d stopped going out, even when his friends came to get him. James was puzzled but hadn’t asked him why.

Still wondering why they were going, the two of them set off, hand-in-hand. They headed through town, towards the high lighthouse. From first seeing it, James had marvelled at how it didn’t fall over during winter storms. They carried on towards the smaller, low lighthouse on the shore. The sea both excited and scared James. He’d heard Papa talking about a boat called the Bugg which had capsized and a hundred people had drowned. Some nights he lay in bed imagining what it would be like to drown.

To their left, waves crashed on the shingle, whilst from inland, he could hear the sound of stonemasons working on the new fort. They were gradually leaving the shore behind as the land rose towards a promontory. At the top, they looked out over the sea. Where the sun shone through gaps in the clouds, patches of sea sparkled. Ships were dotted across the ocean, small fishing boats near the shore, large steamers with plumes of black smoke further out. Above them, gulls were circling, bothered that people were near their nests. Mama knelt down and put her arm round his shoulders, sheltering him from the breeze.

‘Isn’t it wonderful?’ said Mama. ‘We didn’t have a view like this in the country, did we?’

James looked at her and nodded. He so wanted to make her happy.

‘Come on now,’ she said, standing up and taking his hand. ‘Best we were getting back to the others.’


When they got home, Harriet was playing by herself in front of the stove.

‘Where’s Tom?’ asked Mama.

Harriet pointed upstairs. His mother hurried up, soon reappearing and making a hot drink.

‘Is Tom all right?’ asked James.

‘Yes, he just felt cold and shivery so went to bed. Here, take him this and make sure he drinks it.’

James climbed the stairs slowly, taking care not to spill it. Tom was in bed, looking pale and sad. James crouched down beside him.

‘Mama said you must drink it. Are you all right?’

Tom propped himself up but said little. He took the mug and drank. James had never seen his brother like this before. He coughed a bit before dropping back and pulling the blanket up to his neck.

Back in the kitchen, it took James some time to pluck up the courage to ask, ‘Is Tom going to be all right?’

‘Yes, love,’ she said wiping her floury hands on her apron and coming over to cuddle him. ‘It’s just a bit of a fever. He needs to rest.’

That evening Tom didn’t come down for dinner. Papa took him up some food but when he brought the tray down later, James could see his brother hadn’t eaten much. Over the next few days, Tom stayed upstairs. Although his fever had gone, James could see his brother wasn’t well. He spent much of the time dozing. When he was awake, James sat with him looking out of their bedroom window, watching the fishing boats in the harbour and listened to the women on the quay, chatting as they filleted fish.


It was a couple of weeks before Tom came downstairs. Mama made him sit in the yard in the sun. James so wanted to believe he’d soon be well but he looked so thin and wan, and was coughing a lot.

James tried to distract him by talking about Belchamp, reminding him of the people they’d known and the things they’d got up to. They joked about Reverend Staveley and his boring sermons, the funny voice Mrs Pannel had when she sang hymns, and the Morris dancers who covered their faces with soot and had bells on their clothes.

It was several weeks before Tom was more like his old self, though James could see he still wasn’t eating much. At least, the gloom that had descended on the house started to lift. Then, at dinner one evening, Mama told them she had some good news.

‘You’re going to have a new brother or sister,’ she announced.

James didn’t understand where babies came from. He remembered when Harriet was born, he and Tom had been sent to neighbours for the day and when they came home, Mama showed them their new sister. He’d never asked how it had happened. But now he was eight he wanted to understand.

James still worried about Tom. At night, he lay listening to him struggling to breath. It frightened him. At Sunday school, they’d been told you had to pray for people who weren’t well. So secretly, at night, he prayed to Jesus to make Tom better, even though he couldn’t see how it could work.


The four of them were sitting at dinner one evening, Tom having gone to bed early.

‘James, you’re always asking me about what I do,’ said his father. ‘Would you like to come and see for yourself?’

‘What about Tom?’ asked James.

‘Oh, he’ll be all right,’ said Mama. ‘We’ll keep him company, won’t we Harriet?’

James hardly slept that night, excited about the day ahead. In the morning, he was downstairs and ready before it was even light.

‘We’re going to the Customs House first,’ said Papa, as they set off. ‘That’s where they check all the cargo coming in on the boats to stop smuggling. There’s an Excise Officer wants to see me.’

Stone steps led up to the front door. Inside, the hallway was packed with men, all talking loudly. The air was smoky and, despite his father protecting him, he kept getting jostled. They all seemed pleased to see his father, greeting him and shaking his hand. After a few minutes his father found the person he was looking for and the three of them withdrew to an adjoining room.

‘You heard about John Walford, over at Colchester?’ the man asked.

‘No. What happened?’

‘Beaten up by some tea traders.’

‘What! Why?’

‘Discovered a hidden consignment. They threatened him that if he didn’t overlook it, he’d regret it. Offered him five pounds to forget he’d seen it. He refused, said he’d confiscate the lot. Well, that evening he was set upon on his way home. The surgeon said he was lucky to be alive.’

James could see that his father had gone quite pale. ‘What’s happened to the men who did it?’

‘They haven’t found who it was. The traders hired some thugs.’

‘It’s happening more and more,’ said his father, shaking is head. ‘We need more protection.’

‘Ha! It’ll never happen. We’re on our own. Makes me think maybe best to take the pay off. We could be rich men!’

‘Never. I’d rather resign. If we do that, there’d be no law and order.’

‘Well, I don’t know how much longer I can keep doing this. My wife worries herself into a state.’ The man took out a large white hanky and mopped his brow.

‘I must be getting along,’ Papa said. ‘Got things to show this one,’ looking down at James. ‘I think he’s heard quite enough of our problems for one day.’

Outside on the quay, nets were being laid out in preparation for that night’s fishing. The previous night’s catch had all been boxed and was being loaded onto the smacks, bound for London. James had learnt the names from the women who sorted them – cod, haddock, whiting, coalfish. The ones he always hoped to see were halibut and skate, like birds of the sea with their huge wings.

As they stood watching the boxes being winched aboard, James looked up at his father. ‘What’s London like?’

His father looked into the distance as he spoke. ‘It’s hard to imagine until you’ve been. It’s very large, just seems to go on forever. The streets are dirty and noisy and full of people. Lots of horses and coaches and carts.’ He looked down at James. ‘I didn’t like it much. I prefer it here.’

James thought for a while. ‘I’d like to go to London one day.’

His father smiled. ‘Well, you may.’

They spent the day visiting workshops around the town. Making their way home along King’s Quay Street, Papa stopped and pointed out a building with an ornate inscription above the door.

‘That’s the grammar school.’

‘Who goes to it?’ asked James.

‘Boys, once they’re eight.’ After a pause Papa asked, ‘Would you like to?’

‘I don’t know. What happens there?’

‘It’s a bit like Sunday school but you go every day and they teach you things like writing, sums and,’ he said pointing at the Latin inscription, ‘how to read that.’

James didn’t know what to say.

‘We can talk about it later,’ said his father.


When they got back, James could see his mother had been crying. Harriet, who was sitting on the floor playing, looked up at James.

‘What’s happened?’ Papa asked.

‘Tom’s taken a turn for the worse. I can barely rouse him and he won’t drink.’

‘I’ll go and see him,’ said Papa. James went to go upstairs with him but his father took him gently by the shoulders. ‘Stay here with Mama.’

When Papa returned he could see the same look of concern as his mother had.

‘He’s burning hot so I opened the window. I’ll go and get the apothecary.’

The apothecary’s shop was nearby so it wasn’t long before his father arrived back accompanied by Doctor Amos. They went upstairs for what seemed, to James, like  ages. He so wanted to go and see Tom. Eventually they reappeared.

‘Mrs Lambert, I was just saying to your husband, I could bleed Thomas but best we wait till his fever has dropped. It needs to come out. This should help.’

He handed her a small package. ‘A spoonful in a cup of boiling water. He should have it every two hours.’

‘Will he be all right, Doctor?’ asked Mama.

‘When the fever settles, come and get me and I’ll bleed him.’

James froze. Why hadn’t the doctor said Tom was going to be all right? Why hadn’t Mama insisted on an answer?

‘Can I go and see him?’ James asked.

He climbed the stairs not sure what he would find. Tom lay sleeping, his head propped up on pillows. He looked so thin. The cool air blowing in through the open window, smelt of fish. Maybe that caused tom’s fever, thought James. He knelt down.

‘Tom. Tom.’

Tom opened his eyes slowly and tried to smile.

‘Hello James,’ he whispered.

‘The doctor’s given Mama some medicine to make you better.’

Tom just smiled but said nothing.

‘It’ll probably taste horrible like that magic drink we made with pond water and flowers,’ said James.

Trying to laugh brought on a bout of coughing which exhausted him. James waited until his breathing was calm again before creeping away.

That night, Mama put James in with Harriet. He lay awake thinking of Tom. At times, try as he might, he couldn’t stop himself crying. He could hear the rain on the shutters and, before dawn, the sound of the Darby Bell, calling men to their work at the navy yard. It was still dark when he got up and went downstairs. He found his father sitting at the table, unshaven and looking pale and tired.

‘Hello son. Up early…like me.’

‘How’s Tom?’ asked James.

‘Still got a fever but he’s taking his medicine. He’s very weak.’

The two of them sat in silence. Outside, James could hear fisherman returning from their night’s toil, tying up at the quayside. The sound of rain water dripping from the gutter onto the metal bath in the yard marked out time. James sat fiddling with a toy of Harriet’s he’d found on the floor. He looked over at his father, who was staring into space.

‘Papa,’ he gulped, walking over to him, ‘I don’t want him to die.’

He leant against his father, who put his arm round him. ‘None of us do, James.’

James looked up into his father’s face. ‘He’s my only friend.’

He could see tears running down Papa’s cheeks. He’d never seen his father cry before. Papa was so strong and sensible, always knowing what to do. As James looked at him, he knew there was no hope.

When his mother appeared, his father just gazed at her, unable to speak.

‘Come on now you two,’ she said, putting some plates and spoons on the table. ‘How about some breakfast?’

How could she bustle around preparing breakfast as if nothing was happening upstairs? He dried his eyes and got up to help her. The three of them sat at the table in silence, drinking tea. Eventually, Mama spoke.

‘At eight, I’m getting the doctor.’ She looked at his father. ‘Love, you should be on your rounds.’

While his mother was out, fetching the doctor, James crept back upstairs to see Tom. He tried rousing him, but couldn’t wake him, so he just stroked his brow. He’d never touched his brother before, apart from when they’d once rolled around pretending to wrestle. He couldn’t stop himself bursting into tears. That was how Mama and Doctor Amos found him a few minutes later.

‘Come on now,’ said his mother, helping him up off the floor. He threw his arms around her, buried his face in her skirt and howled. His mother knelt down and took him in her arms.


James hadn’t been to a funeral before. He sat holding his mother’s hand, unable to join in the hymns. When he looked up he could see his father was crying, which made him even sadder. Since Tom died, his father had said little, shuffling out to work each day and returning just before dinner. Papa no longer polished his shoes every night, something he’d always insisted was vital if he was to earn respect. It was Mama who kept them all going.

As he stood by the grave watching Tom’s coffin being lowered into the ground, he remembered the day he and Tom had secretly peered into the coffin workshop at Belchamp, wondering if they’d see any ghosts.

Later, sitting round the dinner table, James kept looking at the empty place where Tom had always sat. Lying in bed that night, he turned to the wall, unable to look at the empty bed on the other side of the room. When Mama came and put her arm round him, he wanted to disappear into the warmth and comfort of her body.

‘James, it’s dreadful now but I promise, it’ll get better in time. We’ve all got to be strong and help each other. Tom will always be with us, even if he isn’t here.’

She stroked his hair and kissed him goodnight.

Over the next few days, James couldn’t understand how his mother was able to carry on doing normal things. She took him and Harriet with her to the market, where people told her how sorry they were. They also wanted to know when she was due. James wasn’t sure what that meant. It seemed to be something to do with the new baby because they looked at her tummy as they asked.

It was a few weeks later that Mama told James and Harriet that the new baby would be coming soon. Three days later, Mama didn’t appear at breakfast and Mrs Donald, who lived nearby, arrived with a large bag. She went upstairs and Papa told James to look after Harriet in the backyard. They spent the day trying to ignore the cries coming from the room above. Papa tried to reassure him that Mama was fine but it didn’t sound like it. It was late afternoon when Mrs Donald emerged, bustling about in the kitchen. As she headed out the door she turned to James.

‘Well, you’ve got a lovely new brother to look after.’

That evening Papa came downstairs cradling their new brother in his arms. ‘James, come and say hello to Billy.’ Papa put the baby in his arms. ‘He’s so lucky to have a brother like you.’


Never a day went by that James didn’t think of Tom. Sometimes, when he was in the street he was sure he’d spotted Tom and would be about to call out, before realising his mistake. It made it seem as though Tom was still around and it was only a matter of time until they met up.

One evening, shortly before Christmas, Papa reminded him of the grammar school they’d seen.

‘Mr Chapman at the town hall told me a place is coming up in January. The Mayor and Aldermen are asking if you’d like it.’

‘You’d meet lots of other boy’s your age,’ added Mama, ‘and you’d learn all sorts of things. Its very kind of the Mayor to offer you a place. They only take one or two boys each year.’

James wasn’t sure he wanted to be with other boys. He liked being by himself. But he could tell that his parents wanted him to go.

He nodded. ‘When would I start?’

Harwich 1812

With the bell in St Nicholas Chapel already chiming nine, James ran, determined not to be late for school. He got there just in time for the roll call.

His initial worries about going to school had vanished within days. Over the past two years, he’d learnt so much from Reverend Price, the school-master. He felt so lucky to have a place. Other boys longed for the end of lessons so they could dash off to play, but not him.

He couldn’t wait to get home and tell his mother what he’d learnt. Although she always showed an interest, he could see she wasn’t really listening, distracted by cooking and nursing his new brother, Henry.

Although he loved going to school, part of him longed for the carefree days he’d enjoyed in Belchamp when there seemed to be nothing to worry about. He could see that it wasn’t just the loss of Tom that was upsetting his parents. His father was always troubled by his work. One evening, with the little ones upstairs asleep, James was hunched under a candle making notes from a book when he overheard his parents talking in the kitchen.

‘I’m so worried, love,’ Mama was saying. ‘You’re not getting enough sleep. Up and out before first light and out again late at night.’

‘I’ve no choice.’ His father sounded so weary. ‘The chandler insists on starting early and finishing late. If I don’t go and check and lock up his tools, he could be defrauding the government.’

‘He never used to work that late.’

‘It’s his way of getting back at me. Ever since I warned him I’d close him down, he’s claimed he works till eleven. Course he doesn’t. From the smell of him, more likely he’s at The Three Cups.’

‘Dear, dear,’ said Mama. ‘He shouldn’t be allowed to get away with it,’

‘I know but I can’t stop him. It’s part of the job.’

It upset James that his father was being treated like that when he should be respected. After all, he thought, he’s an officer of the King and the government.


Despite his long working days, his father always found time to read the weekly newspaper. He wondered why, given what he read upset him so much, he persisted. One evening he was particularly incensed, flinging down the paper in a way James had never seen him do before.

‘It’s unacceptable. Government’s got to put a stop to it.’

His mother, startled, looked up from her knitting. ‘Goodness. What’s the matter?’

‘More trouble in the countryside. Can you believe it? Farm labourers been rioting.’ He ran a hand through his hair. ‘If they’ve got a grievance, they should make their demands peacefully. Rioting won’t help bring down the price of bread.’

‘Can’t imagine those we knew in Belchamp rioting,’ said Mama.

‘Don’t be too sure. There are dangerous people about spreading dissent. Heard about some new paper produced by someone called Cobbett. Very popular I’m told. Wants more people to have the vote.’ He shook his head. ‘Next thing, what happened in France will happen here.’

‘Don’t look so worried James,’ said his mother. ‘We’re not like the French. That’s why we’re fighting them.’


Spring and summer were the coldest anyone could remember. People only ventured out if they had to. That didn’t bother James who had become absorbed in a book he’d borrowed from Reverend Price, about fossils and stones. His interest increased when he learnt that lots of fossils had been found nearby, at Beacon Cliff.

As soon as they had all sat down for dinner one evening, James asked his father if they could visit Beacon Cliff on Sunday, after church.

‘Why on earth do you want to do that?’

‘That’s where you find fossils. Some are thousands of years old.’

Sunday couldn’t come fast enough. He and his father walked along the shingle beach to the base of the cliff where, his father sat on a boulder, while James searched. He wasn’t too sure what he was looking for. He didn’t find any fossils but he collected three pieces of black rock and one bit that was quite bright and shone when he washed it in seawater.

‘Come on,’ called Papa. ‘Time we were going. Let’s go back via Dover Court beach.’

As they rounded the headland James saw there were wooden buildings, right by the shingle. Lots of people were gathered there, some of them in the sea.

‘What are they doing? Why are there carts in the sea?’

‘Bathing. The carts take people out so they can step down into the sea.’

James frowned. ‘Are you serious? Why would they do that?’

‘Doctors think that it makes people better.’

James was intrigued. He was wondering if it might have saved Tom. ‘Does it?’

His father smiled. ‘Who knows? Those people must believe it does, seeing as how they’re paying for it. Some even come up from London.’

‘But how can the sea make people better?’

‘No idea. Don’t suppose it does them any harm, though you’d think they might catch cold.’ He pointed at the buildings. ‘There’s heated seawater in there and, I’m told, a machine that throws seawater on people.’

James stared at his father. ‘You’re making that up.’

‘It’s true. Come on, best we were getting back.’


For the rest of the summer, whenever the rain stopped and the wind dropped, James went to the cliff after school. It was better than waiting for his present on Christmas Day, not knowing what, if anything he might find. The shore was always deserted, apart from the gulls circling overhead. It took several visits before he started spotting fossils. His first was a Cochlea terrestris. That evening, at dinner, he couldn’t stop talking about his find.

His collection of stones and fossils grew so large Reverend Price encouraged him to bring them in to show the other boys. On the day before his presentation, James laid them out on a table, labelled them, and covered them with some cloth. He was so excited about revealing his finds to the other boys.

The following morning, with all his class gathered round, his joy turned to horror when, on removing the cloth he saw the labels had been moved around. Holding back tears and determined not to show his disappointment, he said nothing but just started collecting up everything, putting them in his bag. Some of the boys were laughing.

‘Quiet now,’ said Reverend Price. ‘All go back to your desks. Who did this?’

There was silence. ‘Come on. Who messed up Lambert’s display?’

He turned to James. ‘I’m sorry that someone thought it funny to do this. Would you lay them out again later, so we can see them?’

James was seething. ‘I don’t want to, sir.’

At the end of classes, Reverend Price asked him to stay.

‘Lambert. Whoever did that was stupid and unkind. But sometimes things like this happen. We have to learn how to deal with it.’

‘But it’s not fair, sir,’ said James.

‘You’re right. But you mustn’t let people who behave badly upset you. We can’t let them succeed, can we?’

‘I suppose not.’

‘You must stand up to them. Now, off you go home, and I want you to bring your collection back next week. I’m sure they’ll be no trouble.’

The following week James presented his fossils and pieces of jet, amber, pyrites. He kept for last a geode. As he broke it open, with a hammer,  revealing shining crystals inside, there were cries of astonishment and wonder. His audience couldn’t believe he’d found it just lying on the beach. As he walked home he could see how you had to persevere and not be cowed by people.


James couldn’t believe it. A whole book about the Beacon Cliff fossils.

‘Stumbled upon it clearing out a cupboard,’ said Reverend Price. ‘Looks like a schoolmaster must have shared your interest, Lambert.’

James spent hours studying it, learning how people had been hunting at the cliff for two hundred years. He learnt of the giant turtles that had been discovered and, even more extraordinary, an early ancestor of the horse which they’d named Hydracotherium.

What intrigued him most was how, in the past, people had used rocks for treating diseases – something called Osteocolla, for mending broken bones, and ludus paracelsi, for bladder stones. He couldn’t understand how rocks could do that.

‘Papa, do you think rocks really make people better?’

His father smiled. ‘I don’t know. I don’t suppose it would say so if it wasn’t true.’

James was turning over a stone in his hands. ‘Is everything in books true?’

‘Ha! Depends on the writer, I suppose. Can’t believe everything written.’

‘So how do you know if it’s true?’

‘That’s the tricky bit. I suppose you want to know if there’s any evidence.’ His father sat back and thought for a while. ‘It’s bit like my work. I can’t just decide someone is breaking the law. I have to measure things, record facts and dates. That way I can prove it.’

That summer, all James could think about was fossil hunting. Now he knew what to look for, he found more and more. Whenever he did, his first thought was to show it to Tom. He’d immediately tell himself off for being so stupid.


One morning his little brother, Billy, was unwell. His father was about to go to the apothecary when he asked James if he’d like to go with him.

The streets were already busy with ship-builders heading to the navy yard and fisherman making their way home after a night at sea. James had passed the apothecary shop many times, sometimes stopping to peer in through the window. Some of the boys at school said the apothecary was a magician and could put spells on you.

It was dark inside and the air was heavy with the smell of spices. He looked around at the shelves, on which stood dozens of white jars, each one with a Latin name. James started reading: extractum stramonium, folia sennae, carum carvi. He understood some of them from his Latin lessons.

Doctor Amos appeared from the back of the shop. He nodded slowly as James’s father answered his questions about Billy. Returning to the room at the back, James could hear him giving instructions. James crept over to the doorway and peered in, trying not to be seen. Suddenly, the spices made him sneeze.

The doctor looked up from his bench. ‘Want to come and watch?’

James edged forward. The benches were covered in large stone bowls, each one with what looked like a wooden cudgel. There was a boy, a few years older than him, climbing up to the higher shelves to get down various jars. Doctor Amos carefully measured out the contents into one of the bowls. Then the boy started mixing and crushing the material.

‘Come closer if you want,’ said the apothecary.

Once he’d finished, the boy tipped the mixture into a funnel of paper.

‘There now,’ said the apothecary, handing it to James. ‘You get your mama to give Billy a pinch of that with hot water every couple of hours.’

James didn’t want to leave. He was entranced by the jars and pots, each containing exotic plants and minerals and goodness knows what else. He wanted to discover more, to understand the mysteries that lay in the shop. And he wanted to ask him if he used rocks.

He struggled all day at school to concentrate as he kept thinking about what he’d seen that morning. When he got home, Mama was sitting with Billy on her lap.

‘How is he?’ James asked.

‘Much better. The medicine’s done the trick.’

‘Mama, the apothecary’s shop was wonderful. It’s full of extraordinary things. Herbs and chemicals and plants from all over the world.’

‘Oh yes, I’ve been in there,’ laughed his mother. ‘So you enjoyed your visit?’

‘There’s so much to see. The apothecary must be very clever. It all looks so complicated.’

His mother put Billy in one of the armchairs and busied herself with baby Henry for a while. James went on standing, lost in his thoughts. After a while, his mother stopped and, still bending over Henry, looked over at him.

‘Your uncle William’s an apothecary. Would you like to be an apothecary when you’re older?’

‘What?’ said James, ‘I’m not clever enough. I could never do that.’

His mother stopped what she was doing and straightened up. ‘James, you most certainly could.’


There is little recognition of the potential value of historical research for studying health services and for influencing health care policy. Responsibility for the lack of use of history in formulating policy lies both with policy makers and historians.

Policy makers have generally either shown little interest in historical evidence or rejected it. At least three reasons have been suggested by one historian (1). First, policy makers think that the information that historians contribute is not relevant, the more so the further back in time they study. Second, the fact that historians offer different interpretations of the same events undermines their credibility. This reaction contrasts apparently with policy makers’ views of epidemiologists or economists, who can also provide conflicting interpretations of data, but still some how have their contributions accepted. Third, policy makers find it difficult to admit that their cherished ‘innovative’ policy has been tried before (and maybe found wanting). The challenge facing historians in changing such views is not always helped by the other disciplines that contribute to health services research: the current assessment of university performance in HSR in the UK does not acknowledge history as a relevant contributor (2).

Meanwhile, historians have not always furthered their own cause. There has been a tendency to regard ‘applied history’ as “suspect and inferior” (3). Apprehension about being seen in this light by their colleagues has led historians to produce papers that are inaccessible and over elaborate for busy policy makers (1). Many historians have also been reluctant both to gain an understanding of contemporary policy issues and to learn how to address policy makers. The latter requires appreciation of their perspective, priorities and the competing pressures they face.

Discouraged by health care policy makers’ lack of interest in history or, at best, a highly selective use of historical evidence, historians have tended to feel unvalued and disadvantaged. Difficulty in getting published in leading health care journals is seen by historians as further evidence of exclusion (1). While such grievances might be on occasion be justified, others, such as qualitative sociologists, have faced similar difficulties and successfully overcome them. History is certainly not unique in having its output either ignored or used selectively by policy makers.

Despite such discouragement, some historians have tried to contribute to contemporary policy debates. One recent example looks at current attempts in England to incorporate staff and public representatives in the running of foundation trusts (semi-independent public hospitals), a policy that draws on a supposedly successful model from the first half of the 20th century in which representatives of contributors to social insurance schemes were involved in the governance of voluntary hospitals (4). However, the historical evidence shows that in reality the majority of contributors did not participate actively and that those who did had their views largely ignored. This suggests that current policies may end in disillusion unless considerable effort is made to encourage participation and clear ground rules for influencing hospital policy are established.

Instead of responding to emerging policies, history can also help set the policy agenda. By drawing on the past, present day policies can be challenged. At the very least, history can remind people that health services have been organised, managed and financed differently in the past and could be again. For example, a case can be made that the increasing difficulties faced in the running of large general hospitals – hospital-acquired infections, poor patient safety, patient dissatisfaction, low morale of staff – stem from the gradual usurpation of nurses’ control of the running of hospitals  over the past 50 years (5). Such research challenges a well-established  policy of medical and managerial domination of hospital management, and tries to set in motion a new debate. In doing so, it tries to shift attention from solely seeking superficial changes in behaviour (such as issuing guidance on hand-washing) to also considering the management arrangements which, it is suggested, underlie the weaknesses in hospital performance.

While history’s contribution complements those from other disciplines, it has an additional unique role. It can help policy makers understand the limitations they inevitably face and in doing so, can help them maintain realistic expectations. Carefully formulated policies to shape the future are always going to be limited by unpredictable events. History demonstrates that health services will be influenced by a multitude of forces, most of which lie outside the control of health care policy makers. The development of services in London illustrates some of these diverse factors: the arrival of refugees, such as French Huguenots in the late 17th century who introduced the concept of voluntarism; the introduction of horse-drawn trams in the 19th century, which required street-widening and thus the demolition and relocation of hospitals; the Napoleonic war, during which the supply of leeches was cut off causing a rise in health care costs which threatened the survival of some hospitals; the vocational commitment of religious nursing sisterhoods, whose high quality led, from 1856, to the governors of many hospitals contracting out their nursing services to such organisations; and the increasing numbers of single working people in rented accommodation from the late19th century, who had no family to care for them when they fell ill, stimulated the establishment of private hospitals (6). Policy makers who fail to appreciate the limitations of their powers risk becoming frustrated and disillusioned. History can help them realise the constraints they face and help them plan accordingly, a situation well-expressed by Antonio Gramsci (7) in the 1920s:

“man can affect his own development and that of his surroundings only so far as he has a clear view of what the possibilities of action open to him are. To do this he has to understand the historical situation in which he finds himself: and once he does this, then he can play an active part in modifying that situation.”

Historians are starting to recognise the need to change the way they operate if they are to exert greater influence on policy (1). Evidence that historians are starting to take on the challenge of influencing policy in the UK can be seen in the establishment of a website, History and Policy, which aims to make historians and their expertise more accessible to policy makers and the media (8). But there also needs to be greater understanding by historians of how to communicate with policy makers. As with other disciplines, skills in transferring knowledge from academia to practitioners and policy makers need to be developed. One possibility is to develop a cadre of historical knowledge brokers who understand and can span the boundary between the two worlds. What is clear is that the contribution that history can make to policy is too important to be neglected for want of better communication.


  1. Berridge V. History matters? History’s role in health policymaking.
  3. Tosh J. In defence of applied history: the History and Policy website.
  4. Gorsky M. Hospital governance and community involvement in Britain: evidence from before the National Health Service.
  5. Black N. Rise and demise of the hospital: a reappraisal of nursing. BMJ 2005; 331:1394-6
  6. Black N. Walking London’s Medical History. London: RSM Press, 2006.
  7. Gramsci A (trans Marks L). The Modern Prince and other writings. New York: International Publishers, 1968

This first appeared in Journal of Health Services Research & Policy 2007; 12(4), 194-6


Between 1877 and 1903 something extraordinary in the history of health services happened in a small north Kent town.

The number of hospital beds in Dartford increased a staggering 60-fold to reach almost 10,000, this in a local population of just over 20,000. The earlier history of the town offers no clues as to why this happened.

How did a small town, 15 miles from central London on the south side of the River Thames, acquire 11 hospitals and so many beds? And why did such a concentration of hospitals occur here rather than elsewhere?

To begin addressing these questions, clues may be found in the origins and history of Dartford.

History of Dartford

Dartford was established in Roman times, around the ford which carried Watling Street over the River Darent. (1) This was a key strategic route carrying troops and produce between London and Dover. With the fertile Darent valley to the south and river access to the Thames, Dartford was ideally placed to develop as a market town. (2)

In medieval times, Watling Street took on additional significance as the route for pilgrims visiting the shrine of Becket in Canterbury (from 1170) and William of Perth in Rochester (from 1201). While this stimulated religious orders to establish hospitals to care for sick and infirm pilgrims along the route, there was no particular concentration of such facilities in Dartford. The financial benefits that accrued from such religious tourism largely ended with the Reformation in the 1530s.

With the start of industrialisation in the 17th century, Dartford was well placed to benefit given its copious supply of fresh water from the River Darent, the potential to harness the power of the river with water-mills, and ready access to the Thames to import coal and timber and export manufactured goods. (3) This made it an ideal location for brewing (benefiting from nearby hop fields) and paper-making, both established by 1600. (4) Later, in the 18th century, came gunpowder manufacture and engineering. By then transport links with London had improved, with almost 100 stage-coaches a day, and this was further enhanced in 1849 with the first railway line, followed by two additional routes in 1866 and 1895. (5)

Until 1866 the only hospital beds in Dartford were those provided for local paupers in the Dartford Union Workhouse. In response to the requirements of the 1834 Poor Law Reform Act, a new workhouse had been built in 1836 to meet the needs of the recently established union of 21 parishes. Health care provision was limited to a paltry 20 beds in the ‘accident’ and lying-in wards.

So by 1866, Dartford was a thriving market town with good transport connections to London and diverse industries. In these and other regards Dartford did not differ significantly from other small towns around London and there were no indications as to what was to happen over the coming years.

City of London’s need for an ‘airy and healthy situation’ (1866)

Before 1800 there was little or no care provided for paupers deemed to be ‘lunatics’. Although the 1808 County Asylums Act encouraged local government to provide asylums to house the insane poor, who were otherwise incarcerated in prisons or workhouses, by 1845 only about 20 had been established throughout England & Wales. The 1853 Lunatic Asylum Act put further pressure on local government to review their provision. The concept of an asylum as place of refuge meant a large amount of land and a calm environment was needed, ideally in ‘an airy and healthy situation’. (6). Like other urban areas, the City of London Corporation sought a site some distance from the hurly burly of the city.

An initial estimate of £50 000 (equivalent to £5m in 2007, using GDP deflator) met with strong opposition from those who would have to pay. Meetings and petitions led to demands for the cheaper option of continuing to rely on the charity of the Royal Bethlehem Hospital (‘Bedlam’) and purchasing accommodation for the insane from neighbouring workhouses. The latter view was supported by Poor Law Unions who claimed that the transfer of patients would be clinically inappropriate, though their real concern was the prospect of losing income from the City of London. Despite such opposition, legal advice led the Corporation to start a search for affordable land which took only three months to identify Stone House, a 33 acre hilltop site one mile from the centre of Dartford. It was purchased for £3550 and construction cost about £40 000. Before building commenced, a well had to be sunk to confirm an adequate supply would be available, a task successfully carried out for £247.

The City of London Lunatic Asylum opened in 1866. (7) In addition to wards, it included administration offices, staff accommodation, workshops, a bake-house, a coach-house and steam engines to generate electricity. Over the following three decades it expanded so that by 1903 it accommodated 540 patients, had its own isolation ward, an impressive chapel with separate entrances for men and women, and a neighbouring 200 acre farm. (8) Responding to the decline in the population of the City of London, the asylum had successfully marketed its services to private patients who, by 1900, made up half the inmates.

Progressive home for London’s ‘imbecile’ children (1878-81)

Twelve years were to pass before another hospital was established in Dartford. And again, it was to meet the needs of London. Recognition of the inadequacies of locally provided workhouses and the need for better health care for inmates had led in 1867 to the creation of the Metropolitan Asylums Board (MAB). For the first time, London-wide planning and management of hospitals was possible, albeit limited to patients with fevers, smallpox and ‘imbeciles’. (9) This was to have a significant impact on Dartford.

In 1870 the Board created two large asylums for ‘imbeciles’, one in Hertfordshire and one in Surrey. However, there was increasing concern that accommodating children with adults missed the opportunity to educate rather than just contain them. A facility exclusively for children was established in 1873 in London. Meanwhile the search for a site to build both a home for children and an third adult asylum got underway which resulted in the purchase of 109 acres of land at Darenth owned by the Bishop of Rochester. (10) When it opened in 1878,  the Darenth School & Asylum for Imbeciles accommodated 580 children and included schoolrooms, workshops for industrial training, kitchens, laundries, a chapel and a cemetery. (11) Alongside it, the adult asylum accommodated 1000 patients. However, just before the asylum was scheduled to open, the Metropolitan Asylums Board faced a more pressing need which would result in yet more bed provision in Dartford.

Desperate measures to cope with London smallpox epidemics (1881-90)

Despite the introduction of smallpox vaccination in London in the early 19th century, epidemics still occurred and when they did the London Smallpox Hospital, a 100 bedded voluntary hospital located in Highgate, was unable to cope. On assuming statutory responsibility for managing services for smallpox in 1867, the Metropolitan Asylums Board decided to construct new fever and smallpox hospitals at  geographically dispersed locations across London. All proposed sites met with local opposition and, together with concerns about cost, this meant that by the time of the 1871 epidemic only two facilities had been established (Homerton and Stockwell). This meant that only a third of cases could be admitted. The Board’s plans continued to be frustrated with only two additional hospitals being constructed (Deptford, Fulham) over the following decade. Not surprisingly, the next epidemic in 1880-1 overwhelmed the MAB’s resources again.

In desperation, the Board decided on two radical solutions that would circumvent political obstacles. First they acquired two old wooden ships, converted them to accommodate acute smallpox cases and moored them at Greenwich, and second they  established a temporary tented camp on land they already owned in the grounds of Darenth Asylum. In May 1881 London’s first systematic transport service for hospital patients started ferrying convalescent smallpox victims from London, in hired four-in-hand horsed vehicles. However, during the winter of 1881-2 the tents proved inadequate against the cold so the recently completed adult asylum for imbeciles was temporarily requisitioned.

With the passing of the epidemic, the Board returned to considering its long term arrangements. The relative ease in establishing facilities on the hospital ships and at Darenth, compared with the opposition and intransigence experienced across London, offered a new option. In 1884, the ships, together with a third one, were moved and moored at Long Reach, the stretch of the Thames nearest to Dartford. There were few local residents to complain. And with the need to vacate the Darenth Asylum site, the adjacent Gore Farm was purchased and 300 beds were set up in tents to relieve pressure on the hospital ships. During the 1884-5 epidemic, 10 000 patients made the four mile journey across Dartford to Gore Farm Convalescent Hospital. These arrangements were consolidated when the tents were replaced in 1857 with huts accommodating 850 patients (the Lower Hospital) and in 1890 with brick buildings housing an additional 964 patients (the Upper Hospital).

Starting to meet local needs (1887-94)

By 1887 the establishment of hospitals to meet the needs of Londoners had not been matched by any improvement in provision for local people. Despite the population having more than doubled (from under 5000 to about 11 000) since the opening of the Dartford Union Workhouse fifty years earlier, the only inpatient care available remained the handful of beds for workhouse inmates plus the occasional referral to St Thomas’s or Guy’s Hospital. While funds had been found to build a new chapel in 1878, it wasn’t until 1887 that  an infirmary block was constructed. The addition of a second block in 1897 increased the number of beds to 140. But these were only for those who were so poor they had no other option than to enter the workhouse.

However, the Dartford Poor Law Union, together with the local Rural Sanitary Authority, one of 572 established in England & Wales in 1875, was responsible for the public health not only of paupers but of the whole population. At the time the sanitarians’ view of miasma as the cause of infectious diseases was giving way to acceptance of the germ theory. Together the two authorities established a hospital just to the north-west of the City of London Asylum. Bow Arrow Hospital, with 88 beds, opened in 1893 to isolate those believed to be suffering from an infectious disease.

As regards other diseases, although the size and wealth of the local population was insufficient to establish a voluntary general hospital, it was sufficient to support a cottage hospital. Despite this, Dartford lagged behind other towns in east Kent which had already established such institutions: Deal 1863; Betteshanger 1873; Margate 1876; Faversham 1887; Herne Bay 1892. The principal instigator of the cottage hospital in Dartford was Silas Burroughs who, with Henry Wellcome, had taken over the former Phoenix Paper Mills in 1889 as their factory to produce medicinal ‘tabloids’. Burroughs provided a third of the £3100 cost of the hospital, the rest coming from a myriad of local subscribers. At his suggestion, it was named Livingstone Cottage Hospital after the Christian explorer, David Livingstone, who had died in 1873. Appropriately it was opened by Henry Stanley.

Like all voluntary hospitals, its services were principally for the ‘deserving’ working class, with admission to the 18 beds requiring a subscriber’s letter of recommendation. More affluent people would either travel to London to seek care from private physicians and surgeons or make use of the one physician and four surgeons resident in Dartford. (12)

London‘s need for a refuge…again (1898)

With the passing of another Lunacy Act in 1890, responsibility for mental health care passed to the recently created county councils. Although the preceding 40 years had seen a trebling in the number of asylums in England & Wales to 66 (including the City of London Asylum) (6), the newly formed London County Council decided they required more than the four (plus one being planned) they had inherited. That all five were located to the north and west of London must have influenced the search for two more sites.

Advertisements in 1891 for a site led to numerous offers but the only one considered suitable was Baldwyn’s, an estate on the edge of Dartford Heath. (13) It was purchased in 1894 for £24 500 was purchased and, four years later, the Heath Asylum opened. (14) By then the earlier belief in the prospect of curing patients had given way to containment and custodial care, and the creation of small communities had been replaced by the construction of large institutions. The Heath Asylum was not unusual in having accommodation for over 2000. Although no physical restraints were used, the airing courts had six foot high railings, the wards were locked and the huge chapel held separate services for men and women.


Finally, a permanent solution for smallpox epidemics (1901-3)

While the hospital ships moored at Long Reach since 1884 had coped reasonably with minor epidemics, by the 1890s the MAB recognised the potential inadequacy of only 350 beds. While they coped with the 4500 cases in the 1893-5 epidemic, there were concerns about the ability to handle a major epidemic.

In anticipation of moving on shore, in 1894 the Board sought to buy 340 acres adjacent to the landing pier. Faced with Dartford residents’ concern about the increased risk of infection that might result, the local council only agreed to the purchase on the understanding that any local smallpox victims could share the benefits of the facilities being provided for Londoners. However, this did little to reduce the increasing tension between the hospital and the town.

By 1900 the concern of the MAB as to the adequacy of the hospital ships included not only their capacity but also the cost of maintenance, risk of fire and collisions with other shipping, and the safety of patients given that delirious patients sometimes jumped overboard. However, plans to build a permanent new hospital had to be deferred as the MAB was faced with the threat of a new smallpox epidemic. Instead, two temporary hospitals were constructed in 1901-2 consisting of single-storey wooden buildings: Long Reach Hospital which housed 324 patients and Orchard Hospital which accommodated 800. In the event the scale of the epidemic did not require the use of the latter. (14)

Concerns among the citizens of Dartford inevitably increased during the epidemic when convalescent patients were regularly transferred through the town from the river hospitals to Gore Farm Hospital. In practice the greater danger was posed by local tradesmen ignoring the requirement to have been successfully vaccinated before making deliveries to the hospitals. This did not diminish local opponents of the hospitals from voicing their concerns.

With the demise of the 1901-2 epidemic, the MAB resurrected their plans to build a permanent new smallpox hospital. (14) The state-of-the-art Joyce Green Hospital, with 986 beds, opened in 1903 replacing the ships (which were sold) as the centre-piece of the Board’s complex of smallpox hospitals in Dartford. Patients arriving at the landing pier by river ambulance from London would be transferred to the river hospitals by unique horse-drawn ambulances on tramways. Those who had campaigned long and hard for adequate hospital services to cope with smallpox epidemics could take satisfaction from their achievements. Ironically the services were never put to the test as no further major epidemics were to occur. But the opening of Joyce Green Hospital had brought the number of hospital beds in Dartford to almost 10 000.

Hospitals’ fortunes and fates (1904-2009)

The vast number of beds in Dartford at the start of the 20th century was maintained until the 1960s. Along the way, all eleven hospitals were incorporated in the NHS in 1948, some having served key roles as part of the Emergency Medical Service during the Second World War. Today only one, Livingstone Cottage Hospital, birth place of Mick Jagger and Keith Richard, is still in use with most of the others having been demolished.

The demise of smallpox led to the redesignation of the three river hospitals and Gore Farm Convalescent Hospital (renamed the Southern Hospital in 1908) for fever patients. Despite their supposed temporary status, Orchard Hospital survived until 1940 when it was destroyed by fire bombs and Long Reach Hospital was rebuilt in 1929, survived the bombs and the 1953 inundation before being abandoned and demolished in 1975. Joyce Green Hospital fared better, being reinvented as one of three sites providing  general hospital services for the area in 1948, a role it fulfilled until 2000 when services transferred to the new Darent Valley Hospital. One of the other two sites was the Southern Hospital (Upper) which contributed until 1959 when its services had to be transferred to Joyce Green Hospital as it lay in the path of the new A2 road. Part of the Southern Hospital (Lower) also had to be demolished, though the rest survived until 1985 as a mental hospital.

The third component of general hospital provision in the NHS was West Hill Hospital, formerly the Dartford Union Workhouse. Although the original 1836 building was converted for commercial uses in 1986, the rest of the site continued to provide hospital services until 2000, since when it has been demolished.

The stories of the three asylums is typical of all such institutions. Having been incorporated in the NHS in 1948, a gradual closure programme was initiated in 1960s as hospital care gave way to community care. Darenth Park Hospital (its fifth and final name) closed in 1988 and was demolished in 1995; Bexley Hospital (as Heath Asylum had become) closed in the 1990s and was almost entirely demolished; and Stone House Hospital (formerly, City of London Asylum) closed in 2005 but survives and awaits conversion.



In 1866 there was nothing in the history of Dartford to suggest it would become a ‘hospital town’. So why, by 1903, were there 11 hospitals with almost 10 000 beds? Meeting the needs of local people contributed little, with only 2.6% of the beds for their use. Two factors probably contributed: local geography favoured the location of the asylums while the absence of effective opposition facilitated the development of the isolation hospitals.

First, geography. Asylums, by their very nature as havens of refuge, were located outside cities in rural hinterlands. London was typical in being ringed by large, self-sufficient institutions. While Dartford was not unique in hosting an asylum, the presence of three made it unusual. The attraction of the area may have been the availability of elevated sites above the flood plains of the Thames (City of London Asylum at 35 metres; Darenth Asylum at 70 metres; Heath Asylum at 40 metres). Other favourable features were plentiful water supplies (via wells), good drainage and the absence of public rights of way. Unfortunately the way the sites were identified by London bodies remains a mystery. The City of London’s Lunatic Asylum Committee decided on Stone House in a matter of weeks, apparently without recourse to advertising or considering any other sites. In contrast, while the MAB visited and inspected several sites that were offered in response to advertisements before selecting Darenth and London County Council inspected numerous sites over two years before announcing that Baldwyn’s on Dartford Heath was the only suitable site, the basis of their decisions was not made public.

Second, the lack of effective opposition. The establishment of what was to become London’s principal isolation facilities owes much to the MAB’s pursuit of policies that sought to avoid opposition. This was combined with an unplanned, incremental approach. The initial opportunism of the temporary use of land at the Darenth Asylum (already owned by the MAB) to house convalescent smallpox cases in 1881 led to the purchase of the adjacent Gore Farm to provide a permanent site for a tented hospital for convalescent smallpox patients. It then made sense for the hospital ships (for acute cases) to be moved from Greenwich to Dartford in 1884, so as to minimise the distance for transferring convalescent patients. Initially avoiding the construction of a smallpox hospital cleverly minimised the fears and hence the opposition of local residents. But by then the die was cast and permanent buildings followed, first at Gore Farm in 1887 and 1890, and then in 1901 acute cases started to come ashore with the building of the three river hospitals. This was policy development by incrementalism rather than the realisation of any grand plan.

While there was no effective opposition, the establishment both of asylums and smallpox hospitals was challenged at times. The first opposition to the smallpox hospitals was in 1883 when a local landowner, Mr Fleet, unsuccessfully tried to prevent the MAB purchasing Gore Farm. Later there were concerns about convalescent patients being transported across Dartford from the hospital ships to Gore Farm Hospital. Predictably, any case of smallpox contracted in Dartford was ascribed to the presence of the hospitals and, regardless of strict control over contacts (all suppliers and workers had to be vaccinated), some people would not be reassured. Such fears were fuelled when local people became infected, such as in 1901 when workmen building Joyce Green Hospital spread smallpox to Dartford residents. Attitudes to ‘lunacy’ also gave rise to opposition to asylums. For example, when London County Council wanted to rename Heath Asylum after the nearby village of Bexley, the local council felt it was ” a grave injustice to the district and if persistent, will cause serious loss to all property owners”. (13)

While it is difficult to explain why Dartford became a ‘hospital town’, there is no doubting the economic benefits it enjoyed. There may not have been much local benefit from land sales (given the owners were often not local) but the construction of the hospitals provided plenty of local employment. These were large building contracts: Heath Asylum cost £400k (£34m in 2008 using the RPI); Joyce Green Hospital cost £319k (£26m). And once built, there were even greater employment opportunities, though not through clinical posts. There were few doctors (for example the City of London Asylum employed 3, Heath Asylum 7) and although there were large numbers of nurses or attendants needed (City of London Asylum employed 67; Heath Asylum 283; Gore Farm Hospital 158), these were mostly filled by trained staff from London. In addition, the smallpox hospitals employed mainly temporary staff during epidemics, achieved by importing staff from other MAB institutions and hiring private nurses from London.

Where local people gained most was in non-clinical roles. Some of these were to meet patients’ needs: food (cooks, kitchen maids, bakers), clothing (seamstresses, tailors, shoemakers, laundresses), heating (stokers), porters and cleaners. But asylums also needed staff to provide training or occupational therapy such as mattress makers, basket makers, bookbinders. And given their size, these large institutions employed their own maintenance staff: bricklayers, masons, plumbers, painters, glazers, carpenters. And to achieve self-sufficiency, hospital farms (at all three asylums, Gore Farm Hospital and the river hospitals) required farmers, carters and cowmen, and those with their own gas-works and bore-holes needed yet additional specialised staff. There were also economic benefits for local tradesmen and suppliers. While some hospitals achieved self-sufficiency in food supplies, others remained major customers for local suppliers. Overall, the eight Dartford hospitals serving London provided hundreds of jobs for local people.


As so often with health services, developments reflect ad hoc, chance events rather than carefully formulated strategies. The staggering increase in hospital beds in Dartford in the late 19th century is just an exceptional example of the way health services develop. Although politicians and planners devise visions and comprehensive plans to meet the health care needs of populations, these are rarely enacted. Instead, services develop in a more piecemeal way reflecting the many forces and interests at work in any complex industrial or post-industrial society. The events in Dartford serve to illustrate this. No one set out in 1866 to increase the bed provision 60-fold in this small, unassuming town. Yet that it was happened. And as such, it offers a graphic illustration of the vagaries of health care planning and a caution to those who would try and impose order on such a complex system as health care, however well-intentioned and justified their aims may be.


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This first appeared in the Journal of the Royal Society of Medicine 2009: 102: 521–529. DOI 10.1258/jrsm.2009.090349