Life in the Victorian Hospital E-Book

Michelle Higgs

• Herausgeber: The History Press
• Kategorie: Fachliteratur
• Sprache: Englisch

Seitenzahl: 375

Veröffentlichungsjahr: 2017

Beschreibung

Throughout the Victorian period, life-threatening diseases were no respecter of class, affecting rich and poor alike. However, the medical treatment for such diseases differed significantly, depending on the class of patient. The wealthy received private medical treatment at home or, later, in a practitioner's consulting room. The middle classes might also pay for their treatment but, in addition, they could attend one of an increasing number of specialist hospitals. The working classes could get free treatment from charitable voluntary hospitals or dispensaries. For the abject poor who were receiving poor relief, their only option was to seek treatment at the workhouse infirmary. The experience of a patient going into hospital at this time was vastly different from that at the end. This was not just in terms of being attended by trained nurses or in the medical and surgical advances which had taken place. Different methods for treating diseases and the use of antiseptic and aseptic techniques to combat killer hospital infections led to a much higher standard of care than was previously available.

Leseprobe

First published 2009

The History Press

The Mill, Brimscombe Port

Stroud, Gloucestershire, GL5 2QG

www.thehistorypress.co.uk

Reprinted 2015

This ebook edition first published 2017

© Michelle Higgs, 2009

The right of Michelle Higgs to be identified as the Author of this work has been asserted in accordance with the Copyrights, Designs and Patents Act 1988.

This ebook is copyright material and must not be copied, reproduced, transferred, distributed, leased, licensed or publicly performed or used in any way except as specifically permitted in writing by the publishers, as allowed under the terms and conditions under which it was purchased or as strictly permitted by applicable copyright law. Any unauthorised distribution or use of this text may be a direct infringement of the author’s and publisher’s rights, and those responsible may be liable in law accordingly.

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Contents

Acknowledgements

Introduction

PART 1: THE DEVELOPMENT OF HOSPITALS

Chapter 1

The Hospitals of the Eighteenth Century

Chapter 2

General Voluntary and Endowed Hospitals

Chapter 3

Specialist Hospitals

Chapter 4

Dispensaries

Chapter 5

Children’s Hospitals

Chapter 6

Poor Law Infirmaries

Chapter 7

Hospitals for Infectious Diseases

Chapter 8

Cottage Hospitals

Chapter 9

Hospitals for Paying Patients

Chapter 10

Convalescent Homes

Chapter 11

Lunatic Asylums

PART 2: GOING TO HOSPITAL

Chapter 12

Getting Medical Treatment

Chapter 13

Admission Procedures to Hospital

Chapter 14

Out-patients

Chapter 15

In-patients

Chapter 16

Accidents and Emergencies

Chapter 17

Conditions in Hospital

Chapter 18

Treatment of Diseases

Chapter 19

Surgical Cases

Chapter 20

Medical Innovations

Chapter 21

Discharge from Hospital

PART 3: GOING INTO AN ASYLUM

Chapter 22

Admission to Asylums

Chapter 23

Pauper and Private Patients

Chapter 24

Mental Illnesses and their Causes

Chapter 25

Living Conditions in Asylums

Chapter 26

Treatment in Asylums

Chapter 27

Recovery

PART 4: MEDICAL STAFF

Chapter 28

Physicians and Surgeons

Chapter 29

Matrons

Chapter 30

Nurses

Notes

Bibliography

Acknowledgements

While writing this book, I received help and advice in locating information and illustrations from a number of different sources. I would like to express my gratitude to the following:

The staff of Birmingham Archives and Heritage Service; Glamorgan Record Office; Gloucestershire Archives; Great Ormond Street Hospital NHS Trust & Kingston University; Gwent NHS Trust; Gwent Record Office; Centre for Kentish Studies; Kent & Medway NHS & Social Care Partnership Trust; Lancashire Record Office; the University of Aberdeen Special Archives; Wiltshire and Swindon Archives; Alistair Tough of the NHS Greater Glasgow and Clyde Board Archives; Fiona Watson of the Northern Health Services Archives in Aberdeen; Alan Humphries of the Thackray Museum in Leeds; Dr Ian Paterson of the Northern General Hospital in Sheffield; Kevin Towers of the West London Mental Health NHS Trust; Dr Paul P. Davies; Paul Arnold; Gareth Edwards and Yvonne Goulding.

Special thanks are due to Dr Sue Hawkins of the Historic Hospital Records Project for her feedback and advice on the Children’s Hospitals chapter, to Ava Connelly for helping with my research in Glasgow and to Ellie Thomas for giving a nurse’s perspective on Victorian medical treatments.

I am extremely grateful to the K. Blundell Trust, administered by the Society of Authors, for providing me with a generous grant, without which I could not have undertaken research in Scotland and Wales.

I would also like to thank the following people who were so generous with their time and their research:

Benjamin Caine, Rina Callingham, Geoff Couling, Paula Couling, Wendy Fitzpatrick, Lisa Gregg, Caroline Haycock, Carl Higgs, Christopher J. Hogger, Lyn and Alan Howsam, David Rawdon, Jill Reeves, Stuart Reid, John Royle, Prue Stokes, Richard Waddy and Louise Williams.

Finally, I would like to thank my husband Carl for his unstinting support, and my family and friends for their encouragement during the writing of this book.

Illustrations

Every effort has been made to trace copyright holders of images included in this book. The publishers would be grateful for further information concerning any image for which we have been unable to trace a copyright holder.

Introduction

The era of the Victorian hospital was one of cash-strapped institutions, deadly hospital infections, surgical advances and medical discoveries. Through it all, life-threatening diseases were no respecter of class, affecting rich and poor alike.

However, the medical treatment for such diseases differed significantly, depending on the patient’s social class. The wealthy still received private medical treatment at home or, later in the nineteenth century, in a practitioner’s consulting room. The middle classes might pay for their treatment but could also frequent one of an increasing number of specialist hospitals. The working classes who were just above the poverty line could get free treatment from charitable general hospitals or dispensaries. For the abject poor who were receiving poor relief, their only option was to seek treatment at the workhouse infirmary.

Whatever medical treatment was received, it made a difference if:

… the sick person was male or female; young or old; confronted with minor, serious, shameful, or life-threatening illness … was rich or poor; trusted his doctor or not; was in a hospital, outpatient department, doctor’s surgery or at home; was educated or not; was seeing the neighbourhood practitioner or a high-powered specialist; was in the hands of a ‘good’ doctor or not.1

During the Victorian period, there was a huge growth in the number and type of hospitals to cater for the increasing population. A bewildering array of medical facilities were available including voluntary hospitals, poor law infirmaries, specialist and children’s hospitals, hospitals for infectious diseases, dispensaries, cottage hospitals, convalescent homes and lunatic asylums. However, at first there was no real advantage to going into a Victorian hospital for treatment as they offered ‘little beyond the domiciliary capabilities of a physician or surgeon’.2

A patient entering hospital for treatment at the end of Queen Victoria’s reign would have experienced a much higher standard of care than was available at the beginning. Increased medical knowledge and surgical skills led to more accurate diagnoses and targeted treatment, addressing the causes of disease, rather then just the symptoms. A better understanding of the transmission of deadly hospital diseases such as erysipelas, pyaemia and hospital gangrene, along with antiseptic and aseptic techniques, dramatically cut mortality rates in hospital. Scientific innovations such as anaesthetics and artery clamps increased the range of operations surgeons could safely and successfully perform. Above all, it could be argued that better training of nurses, with whom patients had the most contact, significantly improved the care a patient could expect in hospital.

Aberdeen Royal Infirmary. (Private collection)

Chapter 1

The Hospitals of the Eighteenth Century

Until the eighteenth century, there were no medical hospitals in Britain outside London.1 This was largely because the great majority of religious hospitals, which were established by the end of the fourteenth century, were closed after the dissolution of the monasteries. There had been 500 such institutions in England alone.2

Before 1720, London’s only hospitals were St Bartholomew’s and St Thomas’s, founded in 1123 and c.1215 respectively, and re-established as secular facilities, plus Bethlem, England’s only lunatic asylum. Eighteenth-century Britain saw a gradual founding of general hospitals across the country, established for the deserving poor on a secular basis and funded by charity.

Five more hospitals were opened in London: the Westminster (1720), Guy’s (1724), St George’s (1733), The London (1740) and The Middlesex (1745). By the beginning of the nineteenth century, London’s hospitals treated over 20,000 patients a year.3

Many Scottish hospitals also had eighteenth-century origins. Edinburgh’s Royal Infirmary was set up in 1729 with Aberdeen establishing its own infirmary ten years later. In the last quarter of the eighteenth century other Scottish cities followed their example, including Dumfries (1776), Glasgow (1794) and Dundee (1798).

In England, most major cities established hospitals between 1730 and 1800, including Winchester and Bristol (1736), York (1740), Exeter (1741), Bath (1742), Northampton (1743), Manchester (1752), Birmingham (1779) and Sheffield (1792).4 By 1800, ‘every sizeable town’ had a hospital.5

It was not until the early nineteenth century that general hospitals were established in Wales, which is perhaps indicative of the smaller size of eighteenth-century Welsh towns and their propensity for the use of dispensaries. Although it was a relatively small town, Carmarthen had a dispensary as early as 1807.6 Swansea’s Infirmary was founded in 1814 followed by Cardiff in 1837, Aberystwyth in 1838 and Carmarthen in 1846. The infirmaries in Swansea, Cardiff and Aberystwyth developed from dispensaries founded in 1808, 1822 and 1821 respectively.

Some hospitals were founded by individual benefactors, the most famous example being Thomas Guy and Guy’s Hospital in London. In Elgin, Scotland, Dr Gray’s Hospital was founded and endowed by Dr Alexander Gray, a surgeon for the East India Company, who amassed ‘a considerable personal fortune’ during the time he spent working in Bengal.7 Other hospitals, such as the Royal Devon and Exeter, were established by ‘local groups of concerned citizens’.8

Unlike the earlier hospices and religious-based hospitals, these new hospitals were not built for paupers. They were founded to serve the ‘industrious poor, and, in particular, the urban poor’.9 The managers of the Glamorgan and Monmouthshire Infirmary, later known as the Cardiff Royal Infirmary, clarified exactly who the hospital was meant to treat. The objective of the institution was ‘to afford medical relief to the labouring classes and mechanics, who, while in the enjoyment of health and strength, are enabled to maintain themselves and families in decency and comfort, but who, when suffering from disease or accident, become objects of real concern and sympathy’.10

The exact type of ‘industrious poor’ each hospital aimed to treat depended on the area in which it was situated. For example, the London, founded in 1740, was set up to help ‘in particular, the manufacturers and merchant seamen together with their families’.11 With the city’s close association with the slave trade, it is unsurprising that Bristol’s General Hospital, set up in 1737, was founded to treat those engaged in this industry ‘using part of the personal fortune of one man actively involved in it, John Elbridge, a Quaker and collector of customs’.12 The clientele of Liverpool’s first hospital, founded in 1749, was inextricably linked with trade in the city’s port.

Gray’s Hospital, Elgin (postmarked 1908).

In common with general hospitals, the first specialist hospitals had their foundation in the eighteenth century. London’s charitable Lock Hospital, which catered exclusively for venereal cases, opened in 1746. Venereal disease had been previously thought of as a just punishment for sins, and it has been argued that the opening of hospitals like the Lock was ‘a sign of a changing climate of opinion’.13 The founders of hospitals for sufferers of venereal disease were taking the Enlightenment view that ‘relief of suffering was the duty of humanity’.14

Despite this more charitable point of view, it could be difficult to secure funding for a hospital treating venereal diseases. Glasgow’s Lock Hospital, founded in 1805, could not generate enough income from its subscribers and ‘needed grants from the parish authorities to keep it open’.15 In Edinburgh, subscribers were even less forthcoming and the city’s Lock Hospital, established in 1835, had to close after just twelve years.16

London’s first lying-in or maternity hospitals were opened in the mid-eighteenth century.17 They included the British (1749), the City (1750), the General (1752) and the Westminster (1765).18 Glasgow’s Lying-in Hospital, opened in 1792, was connected with the university.19 These maternity hospitals guaranteed much-needed bed-rest to impoverished women and allowed unmarried mothers ‘to deliver their illegitimate babies with no questions asked’.20

Lying-in hospitals were to fall victim to high death rates of mothers and babies from puerperal fever, but, for the medical profession, they provided an environment where ‘students could practise obstetric skills’.21

Eighteenth-century hospitals provided medical treatment, food, shelter and time for convalescence. They treated accidents and emergencies and restricted themselves to ‘routine complaints likely to respond to rest and treatment’ such as winter bronchitis or ulcerated legs.22 Those with infectious diseases were usually excluded from the general hospitals because they could not be cured, and admitting them would only lead to further outbreaks of disease. The exception was in Scotland, where the voluntary general hospitals vigorously adhered to the principle of accepting all cases which needed medical treatment, with separate wards for fever and smallpox patients.

In the eighteenth and early nineteenth centuries, ‘there were no medical procedures exclusive to hospitals: you could be operated upon on the kitchen table, and you gave birth at home’.23

Chapter 2

General Voluntary and Endowed Hospitals

At the beginning of Queen Victoria’s reign, there were two kinds of general hospital available to the industrious poor: voluntary and endowed. It is unlikely that patients would have perceived any difference between the two, which related to the funding of each type of hospital.

The vast majority of Victorian general hospitals were voluntary, funded by charity. It was always a challenge to meet the running costs, in terms of food, drugs, dressings, medical sundries and wages, not to mention the maintenance of the buildings.

The administrators of every voluntary hospital faced the same daily challenge: that of balancing the books. They had to generate their income from a number of different sources including regular subscriptions, church collections, bequests from wills, ad hoc donations from individuals and businesses, and the staging of charitable events.

Endowed hospitals such as Guy’s and Dr Gray’s were funded with large legacies which, if invested wisely, provided a regular source of income for the hospital. With the increase in population and demand for medical services, by the last quarter of the nineteenth century, most endowed hospitals had to supplement their investment income from other sources, for instance by opening wards for paying patients. Until then, these favoured few hospitals had the luxury of being able to pick and choose the cases they treated, without being bound to recommendations from subscribers.

Subscriptions and subscribers

Voluntary general hospitals throughout Britain operated the subscription system which provided funds for the hospital and dictated who could receive medical treatment. Under this system, wealthy members of the local community paid an annual sum, which entitled them to recommend a set number of in- or out-patients to the hospital per year. The precise number which could be recommended depended on the value of the subscription, and a sliding scale was published in hospitals’ annual reports.

Subscriptions varied across the country. For instance, at Birmingham’s General Hospital, annual subscriptions started at 10s 6d, which entitled subscribers to recommend three out-patients only. The scale had nine levels with the top subscription of £5 5s 0d entitling subscribers to recommend two in-patients and six out-patients every year.1 At the Royal South Hants Infirmary in Southampton, subscribers could recommend ‘one in-patient or three out-patients per year for each guinea subscribed’.2

At many hospitals, if the annual subscription was sufficiently high, usually one guinea or more, this entitled the subscriber to become a governor of the hospital for one year. Subscribers could also pay a single sum to become a life governor of the hospital. At the South Hants Infirmary, the cost was £21.3

Recommendations by subscribers were sometimes known as ‘letters’, ‘tickets’ or in Scotland, a ‘line’. Although subscriptions were a vital source of income, they were only ever sufficient to subsidise the cost of care for patients.

It was important to encourage subscribers to renew their subscriptions each year. In their Annual Report for 1848, the managers of the Cardiff Royal Infirmary addressed their subscribers directly: ‘Your Medical Officers by your means go among people whom you may never see, and into houses which you may never enter, to alleviate the amount of human misery, of which you can have no experience.’4

This address was designed to tug at the subscribers’ hearts (and their purse strings), but it also clearly demonstrates the wide gulf in social class between the subscribers and the patients.

Grenoside Hospital Parade in aid of Sheffield hospitals, 1908. (Courtesy of Grenoside & District Local History Group)

A receipt for a subscription of £1 1s paid by Mrs McMurdo to the Dumfries & Galloway Infirmary, 11 December 1877.

Fund-raising

In the Victorian period, it was always easier to raise funds for ‘children and young adults than old people, for acute disease rather than chronic, for the ‘worthy’ poor than the residuum, for physical than mental disorders’.5

The role of the hospital treasurer was vital in ensuring that funds kept coming in. His work was ‘part accountant and part publicist’.6 A good treasurer could increase his hospital’s income by emphasising the numbers of patients successfully treated and cured in the local press and in annual reports. By the same token, a fraudulent collector could prove disastrous to a hospital’s annual income if he disappeared with the collection.

The Royal South Hants Infirmary is an example of a typical Victorian voluntary hospital. In 1855, the hospital’s total income was £2,473. This was broken down into various sources of income: ‘36 per cent (£883 8s 6d) came from subscriptions; 25 per cent (£613 14s 11d) from donations and approximately 30 per cent (£742) from investment income. The remainder was made up of legacies, payments by patients and employers, and by the sale of slops from the hospital kitchen.’7 As a comparison, the ‘hotel’ costs of the hospital, which included the provision of beds, linen and food to patients, ‘were never less than 53 per cent of total expenditure annually’.8 In 1858, these costs amounted to over £1,345.9

Bequests

Bequests were an important source of income to hospitals, often left by grateful former patients or generous benefactors. Thomas Darbey, described as a gentleman of Sedgley in Staffordshire, died in 1863 aged sixty-three. The son of a shoemaker, he had become wealthy during his lifetime and was a proprietor of land and houses. He had no family and left numerous bequests to charities including the sum of £300 to the South Staffordshire General Hospital and Dispensary at Wolverhampton. The money was for ‘the charitable uses of the said Hospital’. A condition of the bequest was that Thomas Darbey’s executors should have ‘the privilege of recommending the same number of in or out patients to the said Hospital as a subscriber or donor of the above amount or value may have’.

As a wealthy gentleman, it is highly unlikely that Thomas Darbey ever had treatment at the South Staffordshire General Hospital and Dispensary himself, but it is quite possible that he was treated in his own home by a consultant working at the hospital. He died of ‘Malignant disease of Bladder and Prostate’, also known as prostate cancer.10

Charitable events

Once the general hospitals were established in their local communities, they became a focus for fund-raising through charitable events. These were often annual affairs, such as summer fêtes, music festivals and galas, prompting much civic pride. The success of such events depended largely upon the calibre of the committees which organised them and, in the second half of the nineteenth century, ladies’ committees sprang up across the country to galvanise support for their local hospitals.

In Birmingham, the musical festivals in support of the city’s General Hospital became famous in their own right. The first concert was started in 1768 and ‘had become a triennial event by 1784’.11

‘The Great Lawn and Tent, Chelsea Hospital.’ (The Illustrated London News, 20 June 1846)

At The Hospital for Sick Children in Great Ormond Street, the Annual Festival Dinner was a vital component of the institution’s annual fund-raising efforts. With eminent speakers such as Charles Dickens, Oscar Wilde and members of the Royal Family, this one event ‘could raise almost half the Hospital’s total income’.12

Other forms of income

Church collections were a significant form of income for many hospitals, especially in Scotland. In 1867, the Aberdeen Royal Infirmary received a total of £954 1s 1d from church collections, with various amounts from the Established Church, the Free Church, the Episcopal Churches and the United Presbyterian and other churches. In the same year, the hospital received just £85 from subscriptions and £84 in donations from public bodies and works.13

Like the hospitals in ports at Bristol, Liverpool and London, Southampton’s Royal South Hants Infirmary provided hospital and accident facilities for both passengers and crew members of the numerous ships which docked there. It is no coincidence that ‘P&O was a “Life Governor” of the RSH and paid £21 each year through its agent, Captain Engledue, who was also appointed Vice-President of the Infirmary’.14 The company also made donations to the hospital and regularly took collections on board its ships for the hospital’s benefit.

The endowing of hospital beds, either for a fixed term or in perpetuity, was particularly effective for raising funds for children’s hospitals. From 1868, The Hospital for Sick Children in Great Ormond Street introduced a scheme under which wealthy benefactors could sponsor individual beds, ‘following an example set by the children’s magazine Aunt Judy’.15

Sometimes a hospital building itself could be a source of income. Bristol’s General Hospital, established in 1832, quickly outgrew its first premises and a new building was erected between 1856 and 1857, which included an out-patient department for 300 patients. The new building itself provided an income for the hospital because the basement was designed as ‘warehousing for the nearby harbour’.16

Gifts in kind, not just money, were frequently received from members of the local community. This might include clothing, linen, books and magazines, toys or specific medical equipment.

The Hospital Saturday Fund

Organised workmen’s collections to support local hospitals began in Birmingham in 1846 when an Artisans’ Fund was founded by Mr S. Bradley to benefit the Queen’s Hospital in Birmingham. The hospital treated a large number of workplace accidents and in the following year local workers contributed almost £1,000 to its funds.17 From the 1850s, there were similar schemes in place in other towns, the largest of which supported the Glasgow and North Stafford infirmaries. During the 1870s, the Artisans’ Fund at the Queen’s Hospital was developed into the Hospital Saturday Fund, ‘led by influential inhabitants, including one of the hospital’s surgeons, Sampson Gamgee’.18

The Hospital Saturday Fund was a formal organisation controlled by workers elected from the workshops. It encouraged workers to contribute a small weekly sum of money and was so named because Saturday was usually the day when the week’s wages were paid.

In 1874, £258 was raised in street collections and £5,000 in workshops. By 1890, the respective sums had increased to £5,096 and £15,237. The funds were distributed according to ‘the work, economy and efficiency of the different institutions’.19

The Queen’s Hospital in Birmingham quickly benefited from the Fund, the first evidence of this being an additional wing opened in 1873. As a direct result of the Fund, by 1875 the governors were able to make the hospital a free institution so that patients did not need letters of recommendation from subscribers to be treated.20

Critics of the scheme included the British Medical Journal, which believed the Hospital Saturday Fund’s penny-a-week scheme was ‘a dangerous precedent’ arguing that it ‘will be essentially provident and will establish a moral if not a legal claim’ to treatment.21 It has been argued that the worker who contributed a penny a week to the Hospital Saturday Fund assumed ‘that this entitled him and his family to use its facilities and so increased demand’.22

A Memorial Cot at the Queen’s Hospital for Children (n.d.).

The Hospital Sunday Fund

Operating at the other end of the social scale, the Hospital Sunday Fund was aimed at raising money from the middle classes. It began in the 1850s and was organised through co-ordinated collections at church services. By 1873, a central organisation had been set up to ‘stimulate the raising of money and rationalise its distribution’. In its first year, it collected £27,000; by 1889 the annual sum collected had increased to £41,700.23 The Council of the Hospital Sunday Fund distributed the money according to the ‘needs and merits’ of each institution.24

In 1897, the Prince of Wales’ Hospital Fund for London was set up, which was a development of the original Hospital Sunday Fund. After Edward became King, it became the King Edward’s Hospital Fund. This fund ‘successfully capitalised on the popularity of royalty and spearheaded centralised charitable giving in London for half a century’.25

Voluntary general hospitals after 1860

By the mid-1860s, there were two free hospital services: the charitable voluntary hospitals and the poor law infirmaries funded from rates. It was said that the public was ‘lavishing princely munificence on the splendid institutions which ostensibly supply the national hospital requirements’ but ‘ignored the real hospitals of the land’.26

Voluntary hospitals originally carried ‘the stigma of charity’,27 but after 1860 demand for their services increased dramatically. This was largely because hospitals began to offer treatments ‘beyond the scope of GP or informal care’.28

In exchange for such sophisticated treatment, the Victorian hospital became the place where ‘disease could be displayed to students on what became standard ward rounds: being charity cases, the patients could not complain’.29 The morgue also provided valuable material for research and the training of students.30 Under the terms of the 1832 Anatomy Act, medical students were allowed to use dead paupers for dissection purposes. It has been argued that the passing of this Act ‘made the poor less willing to receive treatment in hospitals, for fear they would be experimented on and dissected’.31

However, the main reason for passing the Act was to curtail the actions of so-called ‘bodysnatchers’ or grave-robbers, who stole corpses from newly dug graves to meet the demand by medical schools for anatomical specimens to study and dissect. This practice was carried out in Edinburgh and London, but not in Aberdeen or Glasgow.32 Matters came to a head in 1818 when Burke and Hare turned to murder as a way of increasing the number of corpses they supplied to Edinburgh University.33

‘Hospital Saturday.’ (The Illustrated London News, 22 July 1893)

The voluntary hospitals were supported by charity and staffed by ‘unpaid and able, and often fashionable, part-time consultants’ while the poor law infirmaries were maintained out of the rates and staffed by paid full-time doctors ‘of no particular standing’.34 The voluntary hospitals could legally transfer their patients, usually chronic cases, to poor law infirmaries which had to take paupers. This they did increasingly from the 1880s, especially in London, retaining the interesting cases and getting rid of ‘those they did not want [in order] to make room for the next batch of accidents and acute sick’.35

By the end of the nineteenth century, the challenge of funding general voluntary hospitals was far greater, given the increase in the number of patients treated, the burgeoning staff on roll and the accommodation needed to house them, plus the maintenance and expansion of most hospitals. In 1898, the drugs, dressings and medical sundries at The London cost £10,252 and ‘the various dressings alone, the wools, lint, gauze etc., cost …£3,500’.36 The Annual Dispensary Account gives some insight into the sundries used at the London, which must have been similar in other large, city hospitals: ‘Carbolic acid, 4,600 lbs; glycerine, 2,856 lbs; olive oil, 200 gallons; strapping, 15,608 yards; tow [a type of disposable dressing], 95 cwt. 74 lbs; absorbent cotton wool, 10,533 lbs; Blaud’s pills [iron tablets],672 lbs; lemons, oranges etc. 7,800.’ Anaesthetics included ‘ether, 189 lbs; chloroform, 292 lbs’ plus cocaine.37

Bed provision

Between 1861 and 1911, the provision of hospital beds almost tripled38 but voluntary hospitals failed to meet the demands of a growing population. In 1861 in England and Wales, there were 230 voluntary hospitals offering 14,800 beds. However, 5,200 of these beds were in London hospitals and one eighth of the total number was provided by specialist institutions. This represents a combined figure of 0.7 beds per 1,000 population.39 At the same time, there were 50,000 beds in poor law institutions.

In Scotland in 1891, there were 6,000 beds in voluntary hospitals, 4,500 in poor law institutions and just 1,500 in public health institutions. Twenty years later, this had increased to 10,500 voluntary beds, 6,900 poor law beds and 7,900 beds in public health institutions.40 In Glasgow, the provision of beds in voluntary hospitals was half that provided in Edinburgh at 1.6 and 3.1 beds per 1,000 population respectively. By comparison, the average beds per 1,000 population in the English provinces was only 1.06.41

Patients could be turned away from a hospital simply because all the beds were full, or worse, if a dire financial situation had forced the hospital to close certain wards. The London served one and a half million people in the East End and was the largest hospital in Britain and ‘with a single exception, the largest in Europe’.42 By the end of Queen Victoria’s reign, it had 776 beds, 300 nurses and ‘a great medical staff’, treating almost 200,000 patients per year. Even with so many beds, The London still had to turn people away. One doctor commented: ‘If we had two thousand beds, we could fill them all and keep them full. We are constantly obliged to patch up and send home cases that ought to come in, but which we cannot receive for want of room’.43

Hospital design

The most common Victorian hospital design was the corridor plan with numerous wards leading off a central corridor. City hospitals built to this plan included the Westminster, Bath, Hull, Manchester and many others.44 Some other hospitals including the Middlesex, St George’s, Reading and Leicester were built with a ‘H-shaped’ interior corridor.45

In the 1860s, only a few hospitals were built on the favoured pavilion plan, including St Bartholomew’s and the London Fever Hospital. Some smaller hospitals were designed with one ‘pavilion’, including the Charing Cross Hospital and the Ipswich Hospital.46 The new Gothic-style Leeds Infirmary, built in 1864–68 to replace an earlier hospital, was ‘one of the largest early pavilion-plan hospitals’ with accommodation for 296 patients.47

Florence Nightingale was an outspoken advocate of pavilion wards, which had windows on both sides for cross-ventilation, and allowed for easier ‘surveillance of patients by the nursing staff’.48 This lack of patient privacy in favour of nursing sightlines is ‘an appropriate reminder that patients mostly came from lower classes’.49 In her book Notes on Hospitals, Miss Nightingale argued that the essentials for the ‘health of hospitals’ were ‘fresh air, light, ample space and subdivision into separate buildings’.50 This sub-division was required to prevent dirty air from transmitting from one ward to another. It was believed that large quantities of air were beneficial to health so ‘patients were constantly exposed to continuing draughts of … chilly and dirty air’.51

When it was re-built in 1868–71 opposite the Houses of Parliament, St Thomas’s Hospital in London, which was home to the Nightingale School for training nurses, was ‘by far the largest pavilion-plan general hospital, providing beds for 600 patients’.52 There were six adjacent ward pavilions and ‘a ventilated lobby separated [each] ward from the sanitary facilities to prevent smells, which were believed to harbour disease, from entering the ward’.53

Chapter 3

Specialist Hospitals

In addition to the general hospitals, patients could also seek treatment in the growing number of specialist hospitals. As many of these institutions made a charge for their services, they had a different clientele from voluntary hospitals. The fees charged were less than those of elite medical practitioners and they were ‘free of the stigma of charity’ which blighted the voluntary general hospitals.1 For this reason, they became particularly popular with the middle classes.

The specialist institutions ‘partly created their own demand’.2 They included fever and maternity hospitals as well as those for the ear, nose and throat, the chest, skin diseases and mental illnesses. Most specialist hospitals met needs ‘which the patient could recognise for himself’.3 This was because the names of the hospitals described the diseases they treated, for example, St Mark’s in London was originally called the ‘Benevolent Dispensary for the Relief of the Poor Afflicted with Fistula, Piles and other Diseases of the Rectum and Lower Intestines’.4 Like St Mark’s, many of the new specialist hospitals began as out-patient dispensaries before developing in-patient facilities.5

By 1860, London had at least sixty-six specialist hospitals and dispensaries including the Royal Hospital for Diseases of the Chest (1814), the Brompton Hospital (for tuberculosis, 1841), the Royal Marsden Hospital (for cancer, 1851), the Hospital for Sick Children, Great Ormond Street (1852), and the National Hospital (for nervous diseases, 1860).6

‘The Alexandra Hospital for Children with Hip Disease: The Schachnar Ward – The Morning Round.’ (The Graphic, 11 October 1890)

‘The Hospital for Consumption and Diseases of the Chest at Brompton.’ (The Illustrated London News, 24 June 1865)

In Glasgow and Edinburgh in the same period, the following specialist hospitals were founded: Glasgow Eye Infirmary (1824), Edinburgh Eye, Ear, Nose and Throat Hospital (1834) and the Edinburgh Hospital for Sick Children (1860). Glasgow’s Royal Hospital for Sick Children did not open until 1883.

It has been argued that ‘the professional disease of blocked promotion’7 helped to create a large number of Victorian specialist hospitals. Ambitious doctors could more easily ‘cultivate a reputation for special skill in treating one particular condition’.8

For example, Birmingham’s Orthopaedic Hospital was established in 1817 by George Freer, a ‘local surgeon with a national reputation’.9 Dispensing from a building in New Street, the hospital was originally called ‘The Institution for the Relief of Hernia, Club Feet, Spinal Diseases, and all Bodily Deformities’. It expanded, moving first to Great Charles Street and then, in 1855, to Newhall Street. The first cases ‘were not adult workers disabled by their industrial employments, but local children born with malformed limbs’.10 The hospital’s aim was to ‘transform disabled children into productive citizens’. It undertook very few operations until the last quarter of the nineteenth century because it was concentrating on children with softer bones, and there was no need to resort to surgery to treat them.11

Hospitals for incurables

In 1850, Household Words, edited by Charles Dickens, lamented the fact that there was no large hospital for incurables, ‘for the help of those who of all others most require succour, and who must die, and do die in thousands, neglected, unaided’.12 At the time, there were a few small charities for incurables across the country such as an asylum in Leith for a few females afflicted with incurable diseases, and there were a few places in general hospitals which took incurables such as the cancer ward of the Middlesex and ‘the ward for seven incurable patients in the Westminster’.13

Dickens quoted the case of a poor servant girl afflicted with ‘a disease to which the domestics of the middle classes, especially, are very liable – white swelling of the knee’. When she presented herself at a hospital, she was told that an operation would be ‘certain death’ and therefore she was incurable, and could not be admitted. With no relations to call on for help, the girl ‘[crawled] back to a miserable lodging, she lay helpless till her small savings were exhausted. Privations of the severest kind followed; and despite the assistance of some benevolent persons who learnt her condition when it was too late, she died a painful and wretched death’.14 Charles Dickens called this situation ‘a marvellous oversight of benevolence’.15

When Guy’s Hospital was reserved for the acute sick, there was just one hospital in London for chronic cases: the relatively small Royal Hospital for Incurables at Putney. Founded in 1854, it was funded by public subscription with accommodation ‘far from adequate to meet the needs of this type of patient’.16 Provision for incurables still remained inadequate and by 1890 it catered for just thirty-eight men and 180 women.17

Eye hospitals

At the beginning of the nineteenth century, the first eye hospitals were founded ‘partly because of the heavy incidence of trachoma in soldiers returning from the Napoleonic Wars’18 and partly because of the high concentration of eye ailments in most industrial regions.

The London Eye Dispensary, which became Moorfields, was opened in 1805. Between 1808 and 1832, nineteen more eye infirmaries were established in the provinces ‘by an English public that valued its sight above all other senses’.19 By 1866, there were six eye hospitals in London, although there were seven ophthalmic departments in the general hospitals.20 Birmingham’s Eye Hospital opened in 1823, catering for patients from the industrial working classes, particularly those who had been injured in the workshops of the various metal and glass trades.21

Women’s hospitals

In the 1840s, with the emergence of gynaecology as a precise science, specialist women’s hospitals started to appear in London and quickly spread to the provinces. The Jessop Hospital for Women in Sheffield, opened in 1864, was just one example. It was established specifically to ‘attend cases of midwifery and diseases particular to women’.22

Birmingham’s Women’s Hospital started off as a dispensary in 1871 but quickly provided four free and four paying beds for in-patients. It catered for women ‘suffering from diseases of the pelvic organs regardless of their social backgrounds’. Operations were carried out in three temporary wards or sheds in the garden next door to the hospital, which it was hoped would reduce the risk of infection.23

Although the first ovariotomies took place in the 1850s, it was not until the late 1860s and early 1870s that they became accepted as a standard surgical procedure. Between 1871 and 1877, the death rate for ovariotomies at Birmingham’s Women’s Hospital varied greatly between 30 per cent and 100 per cent.24 After moving to a larger hospital with twenty-one beds but still performing operations in wards in the garden, the surgeons, Lawson Tait and Thomas Savage, had reduced the death rate for ovariotomies from 20 per cent to 9 per cent by 1881. The hospital’s average death rate was also 9 per cent ‘despite the performance of more than 120 abdominal sections annually’. This death rate continued to decline, reaching 1.4 per cent in 1892.25

Birmingham’s Women’s Hospital was pioneering in helping to expand the roles of women in medicine locally. It was the first in the city to appoint a female practitioner with Louisa Atkins becoming house surgeon in 1872, succeeded by Mary Pechey in 1875. It was also the first in the city to appoint a female dispenser in 1872 ‘largely because this proved to be cheaper than appointing a man to the job’.26 Women were also present on the managerial board of the hospital, with a rule which stated that ‘half of the managing board’s 18 members be women’.27

Criticism of specialist hospitals

Although payments were encouraged in cottage hospitals which were controlled by general practitioners, similar payments were criticised in hospitals controlled by specialists. In the eyes of the general practitioners, such payments amounted to undercutting because there was no reason for a patient to pay for a non-specialist opinion from a general practitioner when he could pay the same price for a specialist opinion.28

Some specialist hospitals charged their out-patients 1s or 2s 6d for ‘advice’, a service which attracted ‘some better-off patients who would not have attended at a general hospital’.29 These included teachers, clerks and tradesmen who could not afford to pay a guinea for a private consultation with a physician or surgeon.

Children’s and women’s hospitals usually took payments from patients. For instance, the women’s hospital in London’s Soho Square charged sums ‘varying from half-a-guinea per week to three guineas per week’.30 It introduced a uniform charge of two guineas after 1877. Pay beds were also available at the London Fever Hospital.

Specialist hospitals were criticised by many doctors ‘as a matter of principle’31 while others resented the reduction in ‘teaching material’ and private practice. The governors of general hospitals were opposed to specialist hospitals because they lost out on charitable funds which would otherwise have been donated to them.

The British Medical Journal joined the debate in 1853 arguing that ‘Half the special hospitals [were] founded in the grossest self-seeking on the part of some individual … An energetic surgeon makes up his mind to step to fame and fortune by means of bricks and mortar.’32

By 1860, when it was proposed to set up a Hospital for Stone and Diseases of the Urinary Organs (St Peter’s Hospital), a protest movement was organised including ‘all the leading figures and representative bodies of medicine’.33 In 1863, The Lancet launched an attack on ‘this rampant evil of over-weening specialism’.34 It commented: ‘Next may come a Quinine Hospital, an Hospital for Treatment by Cod Liver Oil, by the Hypophosphates, or by the Excrement of Boa-Constrictors.’35

Many of the general hospitals amended their rules so that no member of medical staff could work in a specialist hospital. Walter John Coulson was a surgeon at St Mary’s Hospital and was also on the staff at the new St Peter’s Hospital. When given an ultimatum by the general hospital, he chose to leave St Mary’s.36 By 1889, only thirty-one out of an estimated 195 medical staff in London general hospitals ‘did not hold some office in a special hospital as well’.37

The smaller specialist hospitals such as St Mark’s and the Skin Hospital at Blackfriars appealed for subscriptions ‘without offering any rights to subscribers in return for their money’.38 Using this method of funding, the doctors retained the right to select the patients. Other specialist hospitals employed secretaries to raise funds while older specialist hospitals such as the Brompton Hospital for Diseases of the Chest still used the traditional methods of ‘selling life governorships with the right to give subscribers’ tickets for sums of thirty guineas or less’.39

Specialist departments in general hospitals

In response to the increasing number of specialist hospitals, many general hospitals, particularly in London, opened their own special departments. Guy’s had an ophthalmology department with in-patient and out-patient facilities by 1831, and departments for obstetrics and gynaecology by 1842. A skin disease clinic was started in 1851 and another for aural diseases in 1862.40

By 1869, St Bartholomew’s had a full ophthalmology department and by 1880, there were ‘special clinics for diseases of the throat and skin, and for orthopaedics, obstetrics and gynaecology’.41 The ophthalmic ward at St Thomas’ was opened in 1851. The London had departments for obstetrics in 1853, for ear, nose and throat in 1866 and for orthopaedic cases in 1875.

Chapter 4

Dispensaries

If a patient had been refused treatment at a voluntary hospital, he or she could always turn to the local dispensary. The first free dispensaries started in London and Scotland in the late eighteenth century. Between 1770 and 1850, they provided ‘a more important institutional form of healthcare for the urban poor’ than the voluntary hospital.1

Dispensaries might be founded by generous benefactors or instigated by concerned businessmen or those from the medical profession, such as the dispensary in Haverfordwest which was established by three physicians ‘for administering advice and medicines to the sick poor’.2

Provident dispensaries

The free charitable dispensaries were replaced from the middle of the nineteenth century by new provident dispensaries which operated on a subscription basis. Patients could take advantage of their services if they had made a regular weekly contribution to the scheme, usually a penny a week.3 They also provided cover for dependants. Provident dispensaries did not ordinarily provide for charity cases but those in receipt of poor relief could usually receive treatment by an arrangement with the guardians or relieving officers.4

The dispensary at Fir Vale Infirmary, Sheffield. (With permission of the Waddy family)

Scottish dispensaries

There were no provident dispensaries on the English model in Scotland, with Perth being one of the few cities to attempt to set up such a service. The Perth Dispensary had been founded in 1819 to ‘vaccinate, give medicine and obstetric care when necessary to the poor’5 with just over 300 patients treated annually up to 1832. However, the directors of the dispensary were concerned that ‘not all the patients were really deserving of this charity’.6