Life in the Victorian Hospital

Michelle Higgs

• Publisher: The History Press
• Year: 2017
• Print ISBN:
  9780752448046
• eBook ISBN:
  9780750984768
• Topic: Medicine
• Subtopic: Modern British History

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.

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 recei...

Table of contents

• Cover
• Title
• Copyright
• Contents
• Acknowledgements
• Introduction
• Part 1: The Development of Hospitals
• Part 2: Going to Hospital
• Part 3: Going into an Asylum
• Part 4: Medical Staff
• Notes
• Bibliography