Rise of the Hospital: Rise of the Hospital: 1700-19001700-1900

Islamic Medical InstitutionsIslamic Medical Institutions

HospitalsHospitals

More medically oriented than their western More medically oriented than their western counterpartscounterparts

Developed a teaching function sooner, as wellDeveloped a teaching function sooner, as well

Types of HospitalsTypes of Hospitals

Poor law hospitalsPoor law hospitals

Royal hospitals (London only)Royal hospitals (London only) Endowed by Henry VIIIEndowed by Henry VIII

Voluntary hospitalsVoluntary hospitals First emerged in 18First emerged in 18thth century century

Voluntary General HospitalsVoluntary General Hospitals

Also intended to care for the poorAlso intended to care for the poor

Depended on donations Depended on donations

11stst established in London in 1720 established in London in 1720 (Westminster)(Westminster)

Last – St. Mary’s (1851)Last – St. Mary’s (1851)

Donors provided with incentives to donateDonors provided with incentives to donate

Given admitting privileges to hospitalGiven admitting privileges to hospital

Could sponsor specific patientsCould sponsor specific patients

Only sponsored patients admittedOnly sponsored patients admitted

Hospitals controlled by the donorsHospitals controlled by the donors

Only “deserving” poor admittedOnly “deserving” poor admitted

““Undeserving” poor went to poor law hospitalsUndeserving” poor went to poor law hospitals

Patients selected on the basis of:Patients selected on the basis of: Moral behaviourMoral behaviour UtilitarianismUtilitarianism

Preferred to admit adult males who were Preferred to admit adult males who were gainfully employedgainfully employed

Utilitarian principles influenced much of Utilitarian principles influenced much of charitable work in the 19charitable work in the 19 thth century century

Jeremy Bentham (1748-1832)Jeremy Bentham (1748-1832) John Stuart Mill (1806-1873)John Stuart Mill (1806-1873)

An action is right only if it produces the most An action is right only if it produces the most benefitbenefit

Voluntary hospitals competed with a wide Voluntary hospitals competed with a wide range of other charitiesrange of other charities

Needed to appeal to self-interest of donorsNeeded to appeal to self-interest of donors Enabled them to create institutions in their Enabled them to create institutions in their

own imageown image Reflected their moral anxietiesReflected their moral anxieties

Specialist Voluntary Specialist Voluntary HospitalsHospitals

1. Lock Hospitals1. Lock Hospitals

Admitted women suffering from VDAdmitted women suffering from VD

Reflected British middle class anxieties about Reflected British middle class anxieties about prostitutes & working class womenprostitutes & working class women

Purpose was to morally reform prostitutesPurpose was to morally reform prostitutes

Linda Mahood. Linda Mahood. The Magdalenes: Prostitution The Magdalenes: Prostitution in the Nineteenth Centuryin the Nineteenth Century

Judith Walkowitz. Judith Walkowitz. Prostitution in Victorian Prostitution in Victorian Society: Women, Class and the StateSociety: Women, Class and the State

New approaches to old problems often signal New approaches to old problems often signal shifts in social beliefsshifts in social beliefs

Sentimental view of prostitution in early 19Sentimental view of prostitution in early 19 thth centurycentury

Victim of seductionVictim of seduction In need of protectionIn need of protection Admission to magdalene homesAdmission to magdalene homes Served 2 purposesServed 2 purposes

Controlled sexual behaviourControlled sexual behaviour Controlled vocational behaviourControlled vocational behaviour

Change in social attitudes at mid 19Change in social attitudes at mid 19 thth century century Prostitutes endangered morality of middle Prostitutes endangered morality of middle

class menclass men Creation of new systems to deal with themCreation of new systems to deal with them

Glasgow systemGlasgow system Interlocking system of repressionInterlocking system of repression

Communicable diseases actsCommunicable diseases acts Magdalene homesMagdalene homes Lock hospitalsLock hospitals

Police could arrest any woman suspected of Police could arrest any woman suspected of prostitutionprostitution

Subjected to medical examinationSubjected to medical examination If infected, to Lock hospitalIf infected, to Lock hospital If not, to magdalene homeIf not, to magdalene home

Controversy over use of speculumControversy over use of speculum

Resistance to CD acts by feministsResistance to CD acts by feminists

2. Lying-in Hospitals2. Lying-in Hospitals

Provided limited maternity services to working Provided limited maternity services to working class womenclass women

Contributed to medicalization of childbirthContributed to medicalization of childbirth

3. Infectious (fever, isolation) 3. Infectious (fever, isolation) hospitalshospitals Less popularLess popular

Less financial support from donorsLess financial support from donors

No one wanted them in their neighbourhoodNo one wanted them in their neighbourhood

Case example of Winnipeg & founding of the Case example of Winnipeg & founding of the Municipal HospitalsMunicipal Hospitals

Hospital ArchitectureHospital Architecture

In early years, any building would doIn early years, any building would do

Gradual emphasis on the role that architecture Gradual emphasis on the role that architecture played in:played in: Health of patientsHealth of patients Moral development of patientsMoral development of patients

NightingaleNightingale

Development of Development of pavilion hospitalspavilion hospitals

St. Thomas Hospital, c. St. Thomas Hospital, c. 18701870

Design of Nightingale Design of Nightingale wardswards

2500 cu. ft. air/hr2500 cu. ft. air/hr Width 30 ft.Width 30 ft. Beds on exterior wallsBeds on exterior walls

Debates about hospital locationDebates about hospital location

Nightingale favoured suburban or rural Nightingale favoured suburban or rural locationslocations

Controversy re: re-location of St. Thomas Controversy re: re-location of St. Thomas HospitalHospital

Adams & Theodore. “Designing for ‘the little Adams & Theodore. “Designing for ‘the little convalescents’: Children’s Hospitals in convalescents’: Children’s Hospitals in Toronto & Montreal.” Toronto & Montreal.” Canadian Bulletin for Canadian Bulletin for the History of Medicinethe History of Medicine

Surroundings of hospital were completely at Surroundings of hospital were completely at odds with normal living conditions of working odds with normal living conditions of working class children & parentsclass children & parents

Designed to meet two conflicting sets of needsDesigned to meet two conflicting sets of needs

Domestic ideals of middle class female Domestic ideals of middle class female supporterssupporters

Scientific aspirations of organized medicineScientific aspirations of organized medicine

Hospitals as Social SystemsHospitals as Social Systems

Types of patientsTypes of patients SexSex OccupationsOccupations Financial circumstancesFinancial circumstances

Type of careType of care

Length of stayLength of stay

Therapeutic regimesTherapeutic regimes

Hospital routinesHospital routines

Moralizing strategiesMoralizing strategies

Patients’ resistancePatients’ resistance

StaffingStaffing NursesNurses Medical staffMedical staff Medical studentsMedical students

Impact on mortalityImpact on mortality

Crisis & ChangeCrisis & Change

Significant turmoil in voluntary hospitals in Significant turmoil in voluntary hospitals in late 19late 19thth century century

Erosion of absolute authority of hospital Erosion of absolute authority of hospital governorsgovernors

FinancialFinancial Linkages with other charitiesLinkages with other charities Working class contributionsWorking class contributions Advent of the paying patientAdvent of the paying patient

Power struggles between governors & medical Power struggles between governors & medical professionprofession