Developing Hygienic Urban Spaces

City Fabric and Hospital Heritage in Hong Kong’s Western District


Zhu Xu  徐翥 /  Weijen Wang  王維仁

作為港島最早華人居住的城市街區,太平山和西營盤至今仍然保留著許多建築與景觀史蹟,成為都市發展中遺留下來的城市歷史肌理 。這些建築肌理與城市空間,見證了香港早期市政建設中應對公共衛生的管制措施,以及滿足華人與歐洲居民健康和社會需求所作出的設施建設。這些留存的歷史建築與城市空間,包括醫院、公共浴室、病菌研究所、消毒站,大多數是香港醫學博物館所規劃的「太平山醫學史蹟徑」的一部分。本文通過解析太平山和西營盤地區醫學史蹟建築的變遷歷史,指出這些衛生與醫療設施在香港早期社會發展中的獨特地位,更闡明這些具有特色的遺址與建築肌理,在整體城市空間特色的形成過程所扮演的重要角色。

During early colonial times, Tai Ping Shan and Sai Ying Pun in Hong Kong Island’s Western District were among the few urban areas of Hong Kong reserved mainly for the city’s Chinese population. Many heritage buildings and relics remaining there today show early urban attempts to facilitate hygiene and control. These historical architecture and urban spaces, including the first Chinese Hospital, opened in 1872, public bathhouses, the Bacteriological Institute and the site of a disinfecting station and ambulance depot, all form part of the Tai Ping Shan section of a heritage trail promoted by the Hong Kong Museum of Medical Science. This article illustrates how these heritage sites relate to the development of the city patterns and urban spaces of early Hong Kong, not only to bring attention the significance of Hong Kong’s unique hygiene and medical heritage to its social history, but also to highlight how these heritages helped shape the character of the district’s urban fabric.

     Reviewing the early development of Western District, it is not difficult to understand the decision made for selecting the area between Tai Ping Shan and Sai Ying Pun as the prime hospital site for civil medical facilities. Long before the arrival of the British in the 1840s, Chinese settlements had existed along the nullahs and streams that ran down the northern slope of Victoria Peak to Tai Ping Shan. After Hong Kong became a British colony, this district was designated a Chinese quarter to house an influx immigrants and refugees. The hillside was leveled and parallel streets running southwest to northeast were laid down in accordance with the natural topography (fig 1).

     Sai Ying Pun district, originally used as a British military camp, was redeveloped a decade later in the 1850s, as an additional Chinese residential district. A street plan was drawn up with rectangular blocks laid along a grid, running north to south (Eastern Street, Centre Street and Western Street) and east to west (First, Second, Third and High Streets). An unplanned hilly area left between the two planned districts, near the major military camp and harbour front, became the ideal place for placing hospitals, both because of its location was away from the overcrowded Chinese neighbourhood with poor sanitation while still being close to its target community group (fig 2).

     Over time, five urban clusters then developed, each with its medical and hygiene concerns. . First, an urban section along the Queens Road, starting from Hospital Road, was selected for setting up early hospitals to control diseases. This was followed by the building of mental hospitals above High Street and the establishment of a common at the KGV Memorial Park. Third, along the west of Blake Garden, Chinese communities in Tai Ping Shan developed their own health facilities almost in parallel with the government hospital complex to the district’s west. Fourth, above Blake Garden, government facilities for plague control were later established. Fifth, the government and churches provided Western medical facilities for the Chinese community in both Tai Ping Shan and Sai Ying Pun(fig 3). Let us consider each of these developments in in more detail.

1 Starting from Hospital Road: Civil Medical Care for Public Health

Between Tai Ping Shan and Sai Ying Pun, in the area sandwiched by Hospital Road and Queen’s Road West, stands an important hospital site still occupied by a group of public and teaching hospitals today. A century and a half earlier, Lock Hospital and Government Civil Hospital, two of the city’s earliest governmental medical facilities, were established there to provide the civilian population with public health and hygiene services (fig 4).

     The first to be built was Lock Hospital in 1858 at a time when sexually transmitted diseases were a major public health concern due to the vibrant prostitution industry in Tai Ping Shan and Sai Ying Pun. The hospital was founded as the result of legislation aimed at lowering the incidence of venereal diseases. It began operations in rented accommodation used for the care of military personnel, seamen, and local prostitutes before moving into its own newly constructed premises in 1861.

    One year after the opening of Lock Hospital, the government relocated its civil hospital from Central to an old mission building in this district. Set up initially for civil servants and police staff, the hospital never gained popularity with the Chinese population because of both its high fees and a distrust of Western medical practices. In 1874, this building was wrecked in a typhoon. The hospital then moved to a poorly constructed two-storied bungalow in Hollywood Road before returning to Sai Ying Pun in 1879, when it took over the Lock Hospital for its own use. The Lock Hospital continued its work treating sexually transmitted diseases in buildings next to the Government Civil Hospital until that institution took over this work in 1893.

     By the end of the 19th century, the Government Civil Hospital had developed into a large complex occupying a significant portion of the open space at the opposite side of the Hospital Road. There stood buildings for residential quarters of medical staffs, and a maternity hospital which was subsequently turned into an isolation hospital for smallpox patients and then converted back into a maternity hospital after the smallpox patients had been moved out. In the 1920s, in order to improve public medical service, the government decided to replace the Government Civil Hospital with a much more spacious hospital in Pokfulam (later named the Queen Mary Hospital) that would serve all sectors of the Hong Kong community.

     Probably because the establishment of Queen Mary Hospital lessened the pressure on space for hospital in Sai Ying Pun, in 1936 it was decided to establish a park on this site to be named in memory of King George V. Due to the interruption of World War II, the opening of the park was postponed to 1954. The civil hospital there remains a hospital site with a building complex constructed in several stages, beginning with Tsan Yuk Hospital in 1955, followed by Sai Ying Pun Jockey Club Polyclinic in 1960 and Prince Philip Dental Clinic in 1980.

2  Junction of High Street and Eastern Street: Mental Hospitals and the Park

As madness was principally regarded as a public social problem in 19th-century Britain, there was a consensus that the government should establish institutions to house any ‘insane’ person deemed dangerous or a threat to public order. Initially, Hong Kong’s colonial government had no intention of running a public asylum of its own. Instead, most Europeans confirmed as mentally ill were confined in the Central Police Station gaol, with just a few admitted to the Government Civil Hospital.

     In 1875, the first institution for treating those with mental health problems opened in a poorly maintained building on Hollywood Road. After this building was torn down, the government decided in 1886 to erect a new asylum building to house European patients in Eastern Street, at that time a relatively remote area but close to other government medical institutions in Sai Ying Pun. In 1891, a two-storied asylum for Chinese patients opened in an adjacent building.

     The design of both buildings was similar to those of asylums in Britain, with facilities considered modern at the time. In 1929, the two asylums were merged to form the Victoria Mental Hospital.  To cope with increasing demand, part of the adjacent nurses quarters was converted into female mental disease wards in 1939. After Castle Peak Hospital for the treatment of psychiatric patients opened in 1961, patients were transferred there.. In 1972, the old Chinese Lunatic Asylum Building was converted into Hong Kong’s first methadone clinic. The Civil Hospital Nurses Quarters building lay vacant for more than 20 years before being renovated as the Sai Ying Pun Community Complex, retaining only the building’s magnificent historic façade.

               Between 1875 and 1961, while the two mental hospitals at the junction of High street and Eastern Street stood unchanged, the two early hospitals along Hospital Street on the other side of KGV Memorial Park were developed into a large-scale modern hospital complex. The district thus witnessed the development of a unique urban space that saw both the expansion of medical facilities for health and hygiene and measures aimed at controlling those deemed insane.

3 Along Tai Ping Shan Street: Temples and Hospitals for the Chinese Community

Tai Ping Shan, as the city’s earliest Chinese residential district, not surprisingly was where several early health and welfare related institutions were established to meet the medical and social needs of the Chinese population (fig 5).

     On the eastern side of the lower end of the Ladder Street, standing in a line facing Hollywood Road, three traditional Lingnan-style pitch-roofed structures formed a temple cluster. The three blocks – Man Mo Temple, Lit Shing Kung and Kung Sor – were built between 1847 and 1862 by local merchants as places for worshipping the Civil God and the Martial God and to house an important assembly hall where Chinese residents in Tai Ping Shan could discuss community affairs.

     In 1851, another smaller temple, Kwong Fuk I Tsz, was built at the corner of Tai Ping Shan Street and Pound Lane, next to where a public bath-house would be later built. Its purpose was to house the spirit-tablets for Chinese immigrants with no social support who died in Hong Kong. Later, it would be used by sick and homeless people as a refuge in which they could spend their last days.

     I Tsz was also used to store the commemorative tablets and coffins of mainlanders who died in Hong Kong until these could be transferred to the deceased’s hometown. The temple’s lack of medical facilities, dilapidated condition and unhygienic environment aroused the concern of the governor and Chinese community leaders, leading to the government agreeing to the opening of a herbal clinic for Chinese people and the donation of land to construct a Chinese hospital, in turn leading to the founding of Tung Wah Hospital.

     Tung Wah Hospital began operation at Po Yan Street in 1872. It was the first hospital providing solely traditional Chinese medical care for the Chinese community. Apart from treating patients, the hospital also took over services previously provided by I Tsz and Man Mo Temple, such as the repatriation of refugees, free distribution of food and clothing, and the provision of free burial services. The hospital quickly became extremely popular and played an important role in handling the outbreaks of bubonic plague that hit Tai Ping Shan between 1894 and 1926. It launched its first Western medical services in 1896, opened two branches in Kowloon and Eastern district of Hong Kong Island, and eventually become what is now the biggest hospital charity group in Hong Kong.

4 Above Tai Ping Shan: Controlling the Plague

Unlike other high-density urban quarters in Western District and Sheung Wan, Tai Ping Shan has a large open space, Blake Garden, at its heart. It would be difficult now to imagine its earlier history as a place notorious for its densely populated tenements, contaminated water supply, open drains and deplorable sanitary conditions. When the plague broke out in 1894, half of all the cases came from this district. After the outbreak was controlled, many of its buildings were deemed unfit for human habitation and almost all of them were demolished in order to sanitise the neighbourhood (fig 6). The garden was the result of an urban redevelopment project carried out in 1903 that reserved a large portion of the site for a public park.

     Above Blake Garden, where Caine Street adjoins Ladder Street, stands the Hong Kong Museum of Medical Sciences and its adjacent Caine Lane Garden (fig 7) on what was once the site of the Pathological Institute and a disinfecting station, both constructed in response to the plague outbreaks. The disinfecting station, opened in 1902, used large steam disinfecting equipment to sterilise bedding, clothing and other personal effects from the homes of people diagnosed with plague or other infectious diseases. In 1906, the Pathological Institute started to provide facilities for monitoring the plague and other infectious diseases. Run by the government, it was Hong Kong’s first purpose-built public health and medical laboratory. The site was also home to an ambulance depot and staff quarters for the sanitary department staff who hand-pulled the carts which served as ambulances used to transfer patients to local hospitals.

     The complex continued to provide health protection services until the 1970s. Of the original buildings, the main building and staff quarters remain (fig 8). Declared a protected monument as one of the best examples of colonial Edwardian-style buildings in Hong Kong, they are now home to the Hong Kong Museum of Medical Science. The disinfecting station, ambulance depot and Pathological Institute’s laboratory animal house were demolished, and their former site incorporated into Caine Lane Garden.

5  Tai Ping Shan and Sai Ying Pun: Early Western Medical Care for the Chinese Community

On the periphery of Tai Ping Shan and Sai Ying Pun districts are scattered a group of non-governmental institutions and facilities built to promote Western medical public health and hygiene processes. Many of these buildings remain today and are still in use, albeit not serving their original functions.

     The first effort to make Western medicine available to Tai Ping Shan’s Chinese population occurred in 1881 when a group of concerned citizens opened the Nethersole Dispensary on the ground floor of the London Missionary Society Chapel. After the government resumption of Tai Ping Shan, the chapel was pulled down and its land became part of Blake Garden. Also in 1881, the society purchased a lot of land on Bonham Road, near Caine Lane Garden, for the relocation of its headquarters. Over time, this plot of land became home not only to the mission, but also several hospitals, including Nethersole Hospital in 1893 (fig 9), Alice Memorial Maternity Hospital in 1904 and Ho Miu Ling Hospital in 1906, all of which were later combined to form Alice Ho Miu Ling Nethersole Hospital in 1954. Although the site was sold after the hospital was later moved to Tai Po, the church still stands there.

     In Sai Ying Pun, several Chinese public dispensaries opened during the plague epidemics. A two-storied building was constructed in 1909 on Third Street to house the Western District Plague Hospital and the Chinese Public Dispensary. The dispensary provided Western medical care. Any patients confirmed by the dispensary doctor as having the plague were admitted to the hospital. The building is now used by the Conservancy Association as a heritage education centre. Next to the Chinese Public Dispensary on Western Street is the Old Tsan Yuk Hospital, now housing Western District Community Centre. Opened in 1922, the hospital was a maternity hospital built to meet demand for the Western midwifery services that had gradually gained acceptance by the Chinese community in the early 20th century.

     The one other type of urban facility with a major role in the hygiene history of Tai Ping Shan and Sai Ying Pun is the public bathhouse. Many Chinese tenement buildings in the early days of Tai Ping Shan and Sai Ying Pun lacked bathrooms and tap water. Tai Ping Shan’s first bath-house opened in 1904 at the corner of Pound Lane and Tai Ping Shan Street, while Sai Ying Pun’s first bath-house only followed in 1922, at Second Street. Hot water and bathing facilities were provided free of charge for both men and women. This rather late introduction of public facilities such as toilets and bath houses did much to improve personal and environmental hygiene for the Chinese community.

City Texture and Urban Memory

Planning and constructing Western District’s medical institutions in response to the growing public health and hygiene problems brought by sailors, solders and immigrants played a significant role in shaping Hong Kong’s current city fabric and urban space. When the government was seeking appropriate sites for the Civil Hospital and Lock Hospital in Tai Ping Shan and Sai Ying Pun, the hilly area between the two districts was identified as a convenient location. This decision influenced the subsequent development of the area into a prime public hospital location that was also home to public parks. Within the densely populated Chinese quarter, before the opening of the first Chinese Hospital, temples provided the only public spaces for the sick and the homeless. The parks followed as part of the city’s post-plague urban renewal scheme. Over time, these two substantial urban green areas, along with the various remaining historical buildings, became anchoring spaces moderating the relocation and redevelopment of medical institutions in the two districts. These parks offer the densely populated Tai Ping Shan and Sai Ying Pun districts high-quality greenery, and have become urban artifacts with their own distinct textures and memories.

Xu Zhu, Assistant Professor teaching courses on architectural history of China, Department of Architecture, University of Hong Kong;
Wang Weijen, Andrew KF Lee Professor in Architecture Design, Department of Architecture, University of Hong Kong

1 Chu, C., ‘Combating Nuisance: Sanitation, Regulation, and the Politics of Property in Colonial Hong Kong’, in Imperial Contagions: Medicine and the Cultures of Planning in Asia, 2013, pages 22-35.
2 Chadwick, O. ‘Document 1.c2: Hong Kong in 1882, A Description’, in Society: A Documentary History of Hong Kong, edited by D. Faure, 1997, pages 29-47.
3 Echenberg, M. ‘An Unexampled Calamity: Hong Kong: 1894’, in Plague Ports: The Global Urban Impact of Bubonic Plagues 1894-1901, 2007, pages 18-46.
4 ENSR Asia (HK) Ltd., West Island Line Environment Impact Assessment. Final Environmental Impact Assessment Report, 2008.
5 Ho, Chi-suk, The Silent Protector: A Short Centennial History of Hong Kong’s Bacteriological Institute, Hong Kong Museum of Medical Sciences Society, 2006.
6 Lim, Patricia, Discovering Hong Kong’s Cultural Heritage: Hong Kong and Kowloon, Hong Kong University Press, 2002.
7 Liu, Lai Fai, ‘Chinese temple and Chinese community in colonial Hong Kong: a case study of Man Mo Temple in Sheung Wan’, PhD dissertation, University of Hong Kong, 2013.
8 Spurrier, Pete, The Heritage Hiker’s Guide to Hong Kong, Form Asia, 2011.
9 Tieben, Hendrik, Woo Pui Leng and Yuet Tsang Chi, Urban Transformation of Sai Ying Pun, 1850-2007, exhibition catalogue, 2007.
10 The Taipingshan Medical Heritage Trail, Hong Kong Museum of Medical Sciences Society, 2011.
11 Wordie, Jason, Streets: Exploring Hong Kong Island, Hong Kong University Press, 2001.

Fig.1: 1 Hong Kong Island’s Western District, 1859 (Source: British National Archive)

Fig.2: Street pattern and medical heritage sites in Tai Ping Shan and Sai Ying Pun (Source: authors)

Fig.3: Hong Kong’s medical heritage and urban spaces of Tai Ping Shan and Sai Ying Pun (Source: authors)

Fig. 4 Civil medical institutions and mental hospitals between Tai Ping Shan and Sai Ying Pun (Source: authors)

Fig. 5 Facilities to control plague outbreak and institutions of western medical care to the Chinese community (Source: authors)

Fig. 6 Disinfecting duties in Tai Ping Shan district during plague outbreak (Source: Centre for Research in the Arts, Humanities and Social Sciences (CRASSH), The University of Cambridge)

Fig. 7 Facilities to control plague outbreak and institutions of Western medical care to the Chinese community (Source: authors)

Fig. 8 Main Building of the Pathological Institute, now the Hong Kong Museum of Medical Science (photo: Ian Tan)

Fig. 9 Maternity Wards in the Nethersole Hospital, 1920s (Source: The Taipingshan Medical Heritage Trail)