England Hospitals (National Institute)

Early History
Most of the monastic hospices, a term which included lodging for travellers, housing the elderly and infirm, as well as tending the sick, were destroyed in the 1530s at the Reformation. There were a few exceptions which were re-founded under lay control, notably the Royal hospitals of St. Bartholomew’s (Bart’s), St. Thomas’s, Bridewell, and the Bethlehem/Bethlem (Bedlam) hospital for the insane, all in London. In 1551 a court decided that three hospitals (St. Thomas, Bridewell and Christ’s) should care for:


 * 300 fatherless children
 * 200 sore and sick persons
 * 350 poore men overburdened with Children
 * 400 aged persons
 * 650 decayed householders
 * 200 ydell vagabonde

Other mediaeval hospices were founded by private benefactors or charitable groups such as livery companies and guilds and there are early records of the people who contributed amongst the records of the appropriate institutions.

Infirmaries and hospitals were also founded in Tudor times, but the 18th century was the real age of hospital foundation with a commitment to science and philanthropy in the medical field. During this century the population almost doubled as a result of an increased birth rate and a very much reduced death rate due to improved medical services. Another factor in the cities was the decline in consumption of cheap gin.

The famous London teaching hospitals of Guy’s, St. George’s, Westminster, London and Middlesex were all founded between 1720 and 1745. Altogether 154 new hospitals and dispensaries opened between 1700 and 1825 by co-ordinated voluntary effort and subscription. Most of them were taken into the National Health Service after its inception in 1948. The foundation dates of the major hospitals and asylums are given by Richardson, and the history of the development of medicine in London by Beresford.

19th Century Hospitals
In 1802 in Reading, Berkshire a group of local doctors set up a dispensary to provide medicines and advice free of charge, which was dealing with over a thousand patients a year by 1848. By 1820 there were 60 dispensaries in England, but they had no facilities for overnight or long-term cases. Records are unlikely to have been kept. Those who could afford to do so were treated at home by a visiting doctor who made his income from these wealthier patients, and donated his time ‘for the experience’ at the voluntary hospital. Nurses could be hired out privately by the hospital that trained them. Improvements in hygiene and sanitation, and the developments in anaesthetics and antiseptics, made hospitals less fearful in the late 19th century. There were some private hospitals for which patients paid; perhaps they were somewhat cleaner, less crowded and more respectable than the regular sort.

Generally only the poor would be admitted to most early, voluntary hospitals (funded by voluntary contributions) as they were dirty, crowded and staffed by untrained nurses. The system for admission depended upon getting a letter of recommendation from one of the benefactors of the hospital, rather than from a doctor. This was particularly inefficient for urgent cases and eventually it changed so that the poor just presented themselves at the hospital. It was open 24 hours a day and patients queued up on wooden benches for their turn to be examined, treated or admitted. Alan Jones in his work, The Taunton &amp; Somerset Hospital (pre-NHS), wrote about conditions for entrance to the Taunton and Somerset voluntary hospital in the early 19th century. Letters from steward John White to his employer Lord Palmerston in March 1757, refer to the outbreak of smallpox in Romsey, Hampshire and the system of recommendations (Dewey 2003b):

Chart: Letters Regarding Hospital Recommendations

By the 1840s ether and chloroform were being used as anaesthetics, which eased the pain of operations, but did not deal with the frequent problem of infection of the wounds. In 1867 Lister proved that carbolic acid would destroy germs and eliminate septic infection, thus revolutionising surgery. Now hospitals could offer a real hope for cure, and not just be a charity for the sick poor, and from this time on the voluntary hospitals started to provide beds for paying patients. Many became significant research and teaching institutions where large numbers of patients with the same condition could be studied and cures effected.

During the Victorian era several specialist hospitals developed for those cases not taken by the voluntary, general hospitals. These included facilities for children, incurables, patients with chronic conditions, pregnant women, the mentally ill, and isolation hospitals for infectious diseases. By the 1860s there were 66 specialist hospitals in London alone. It helps the genealogist to know that clean air and open spaces were favoured for the mentally ill and for infectious diseases, and these institutions may be some way outside the major cities where their ancestors came from.

The voluntary hospitals were mainly concentrated in larger towns and cities; another development, in small towns and rural areas was the cottage hospital, with 6-26 beds, catering for a local community’s needs. The first was erected in 1859 and by 1895 there were nearly 300. They were the first port of call for the sick or injured and many continue in use today, being absorbed into the National Health System after WWII.

In the late 19th century working class people were encouraged to pay into subscription schemes to help maintain their hospital. Many gave a penny a week and then had a right to treatment rather than receiving it as charity. I recommend Lavinia Mitton’s well-illustrated guide, The Victorian Hospital, to Victorian hospitals to understand what the medical system was like for patients in the 19th century.

Poor Law Infirmaries
After the dissolution of the monasteries there was no public assistance for the sick until the Elizabethan Poor Law of 1601. Even then, there was no requirement for a parish to set up a hospital or provide medical services and most could not afford to do so. Gradually, as workhouses were built, many included an infirmary where untrained nurses, or other inmates, provided the care. Local doctors would grudgingly provide a service paid for by the Overseers of the Poor or Guardians of the Workhouse to supplement an insufficient private practice

Chart: Doctor’s Bill to Crayford, Kent Overseers of Poor 1832 Overseers Misc PA/103/16/2

[[Image:Doctor's Bill17N.jpg|center|Doctor's Bill17N.jp]

Conditions in workhouse infirmaries were definitely worse than in the voluntary hospitals. But oftentimes there was no local poor infirmary or hospital and a parishioner could be sent to one of the larger city hospitals. Such a case is related by Davey, where a woman from the Kent countryside was sent to the Middlesex Hospital in London. He shows examples of both poor law and hospital records concerning payments for her for several years.

The Metropolitan Poor Act of 1867 required the provision of a separate infirmary building or separate accommodation within the workhouse for the sick. Thus hospitals which were founded during the 1870s and 1880s probably developed out of a workhouse infirmary. One was St. Andrew’s in Stepney, founded in 1871 (Springer) at a time when the only qualification needed by a nurse was that she could read the labels on the medicine bottles!

In the 1860s non-paupers were admitted to workhouse infirmaries, at first comprising about one-third of cases, and by 1911 these infirmaries provided four times the number of beds as did the voluntary sector. It is thus common to find your ancestor dying in the union infirmary even if they weren’t a pauper. Consult Penelope Christensen’s Parishes and Registration Districts in England and Wales (2001, Heritage Publications) to find out which poor law union your parish was in.

Workhouses were taken over by local authorities in 1929 and all the records transferred to them, thus they should be in the county archives. The workhouses continued to provide a home for those not taken into special facilities until 1949 when the last few closed. Workhouse infirmaries became municipal hospitals for the general public, but it became increasingly difficult for the voluntary subscriptions to cover the costs of rapidly advancing treatment methods.

Army and Navy Hospitals
Prior to the Crimean War (1854-56) there were only three military general hospitals in the UK—at Chatham, Cork and Dublin. Two more, Woolwich and Netley (near Southampton) were added afterwards. There were also two institutions for wounded and disabled soldiers which were not strictly medical establishments. These were the Royal Hospital at Chelsea, London, and the Royal Kilmainham Hospital in Dublin which received soldiers not according to ethnicity but by their place of discharge from the army. They had both in-pensioners and out-pensioners, the latter received an allowance but lived at home.

Children’s Hospitals
Great Ormond Street Hospital, founded in 1852 was the first children’s institution and by 1888 there were 37 more around Britain. They dealt mainly with acute and urgent cases.

Foundlings and Orphans
Destitute, abandoned and orphan children were the responsibility of civil parishes from the 16th to 19th centuries and the overseers of the poor apprenticed them to local, or not so local, householders. From the latter part of the 18th century such children were unloaded on factory owners in the Midlands and North and many suffered appalling conditions.

In 1741 Thomas Coram’s Foundling Hospital opened in London and the records show the support given by benefactors such as an organ from Handel, and a painting from Hogarth. Clark describes in detail the process of admission of the child, how it was identified, given a new name and assigned to a wet-nurse in the home counties, and how inspectors supervised them. Orphaned children of soldiers, and some children of deserted women were accepted after 1763, but after 1772 only real foundlings and exposed or deserted children were supposed to be admitted. Most of those admitted after 1801 were illegitimate. Camp describes how some children were eventually reclaimed by their parents and the records available for them. Infant mortality was high and parish records often indicate those from the Foundling Hospital, an example shown below.

From 1838 the Poor Law Guardians were responsible for orphanages and large numbers of voluntary orphanages were built during the 19th century to cope with the growing problem of destitute urban children.

Chart: Burials in Withyham, Sussex of Children from the Foundling Hospital

The work of [http://www.barnardos.org.uk/what_we_do/who_we_are/history.htm Dr. Barnard is the most well-known but there were hundreds of others, including many who sponsored child migrants to [http://webarchive.nationalarchives.gov.uk/20130107105354/http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4006199 Canada and Australi. Cavell has written on internet sources for children’s homes and orphanages.

Isolation Hospitals
From the mid-19th century certain diseases had to be notified to the central authorities, and those with infectious diseases were isolated in special fever hospitals, including hospital ships used for this purpose. For example, hulks moored in the Thames were used as floating hospitals during the smallpox epidemics of 1871-2 and 1880-1, and Woodlock describes the records available for a little smallpox victim on the ship Atlas in the Thames off Dartford in 1892, with further discussion by Gallagher (2002).

Two kinds of smallpox isolation hospitals for private patients developed during the early 18th century. The first was for those who had caught the natural disease and whose family or employer could afford to send them to recover and prevent them from infecting others. The second was for those being prepared for inoculation and recovering from it, and could include servants of the well-heeled as well as the families themselves. The first voluntarily supported (i.e. free) smallpox hospital was the London Smallpox and Inoculation Hospital founded in 1746. And others were set up around the country, some charging a fee for inoculation.

Another kind of isolation hospital was the tuberculosis sanatorium.

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