Friday, November 03, 2006


For most of the 18th and 19th centuries hospitals were the resort solely of the poor; the better off were treated in their own homes. There is no evidence that hospital treatment improved the health of the patients!

St Thomas’s Hospital had been refounded in Southwark in 1551 on a former monastic foundation. In 1693 the governors decided to rebuild and the rebuilding was completed in 1709. Over 250 patients could be accommodated in wards each containing 12 to 29 beds. The finest room in the hospital was the governors’ hall where gold-lettered wall tablets recorded the names of subscribers.

Some of the earliest of the new general hospitals were foundation charities paid for by wealthy philanthropists. The physician John Radcliffe (d. 1714) of Oxford left a bequest for both the extension of St Bartholomew’s in London and the erection of the Radcliffe Infirmary in his home town. Another physician John Addenbrooke (d. 1719) of Cambridge He left a modest fortune ‘to hire, fit-up, purchase or erect a building fit for a small physicall hospital for poor people’—an intention only disclosed in his will. Though the master and fellows of St Catharine's were given responsibility as trustees, the will was only implemented with the aid of subscriptions and an Act of Parliament. The hospital was not completed until October 1766.

Guy’s Hospital was chartered by Act of Parliament following the will of Thomas Guy (d. 1724). He profited greatly from well-timed investments in South Sea stock and the hospital was founded from the bulk of his fortune of £200,000. It was intended for 400 sick persons deemed to be incurable for treatment elsewhere and took in 2,000 patients per annum. A ward for incurable lunatics was also established.

But Guy’s was not typical. The other general hospitals established at this time were subscription. They were entirely dependant on gifts and legacies and there were administered by governors appointed by the subscribers.
1720: Westminster; this was largely due to the initiative of Henry Hoare, banker of Stourhead.
1733: St George’s
1740: London (by 1785, 7,000 patients a year)
1745: Middlesex

With very few exceptions the management and administration of provincial hospitals were entirely in the hands of all male subscribers of 2 guineas per annum and benefactors of £20, otherwise known as governors, each of whom had the right to recommend patients and to have a vote in the management of affairs. Women made up to 10-20% of annual hospital contributors and up to 25% of weekly ones, but they had to exercise their privileges by proxy.

The potential for undue influence by the elites was circumscribed by the use of ballots during contested elections and second by the rule that the accounts had to be opened to any subscriber. Persons whose subscriptions were not paid up were excluded from privileges.

The enthusiasm of the medical profession aroused fears that infirmaries were being used to carry out experiments on the poor. But the main benefit for physicians lay in the fact that they were permitted and expected to have paying pupils of their own in attendance.

The London hospitals carried out an increasingly specialized range of treatments:
1749: British Lying-in Hospital in Long Acre
1750: City of London Lying-in Hospital
1752: General Lying-in Hospital (later Queen Charlotte’s)

1746: two smallpox hospitals were founded.
1746: the Lock Hospital for venereal diseases: patients received moral instruction as well as medical care. It was closely associated with Lady Huntingdon’s Connexion. Her preacher, Martin Madam, was her chaplain until his public advocacy of polygamy in 1780 compelled him to resign. His assistant was Thomas Haweis, who was the executor of Lady Huntingdon’s will.

1751: St Luke’s Hospital for the Insane was established partly because the waiting lists for Bedlam were so long, partly because Bedlam’s constitution did not did not allow subscribers to share in its government. Public viewing at Bedlam finally stopped in 1770 at considerable financial loss to the foundation. The most successful ‘mad doctor’ at St Luke’s was the highly respected William Battie.
1763: Newcastle asylum
1776: Manchester
1777: York
In 1796 the Quaker William Tuke founded The Retreat in York, a model of human care of the mentally ill.

Provincial case study: The Bristol Infirmary
The first voluntary general hospital in the provinces was the Winchester County Hospital admitted its first patient in 1736. This was followed by the Bristol Infirmary. In 1736, 78 people signed a memorandum promising subscriptions of from two to six guineas annually. The subscribers alone were to have the power to recommend one inpatient and two outpatients at a time for admission to the hospital. An initial £1,500 was provided by John Elbridge, the Controller of Customs. The Imfirmary’s motto was ‘Charity Universal’. The first patients, 17 men and 17 women, were admitted in December 1737. The opening of the Infirmary was celebrated by a church service at St James attended by the Mayor and Corporation, the medical staff and the trustees (the subscribers).

In 1788 plans for the enlargement of the Infirmary began.

28 June 1788: Felix Farley’s Bristol Journal:
‘The foundation Stone of the Centre Building of our new Infirmary was laid on Tuesday last when William Turner, Esq of Belmont, Somerset [now Tyntesfield], nobly presented one thousand pounds to the Treasurer towards completing the benevolent design. - May the opulent of our city and neighbourhood speedily follow so humane and liberal an example! and thereby prevent the capital stock of this excellent charity from being diminished, which otherwise must be the case before the building can be completed ... the increased size of the Hospital will require a great increase of income to support it, and the annual subscriptions for that purpose being extremely precarious, its permanent fund should be as inviolate as possible. ...’
25 Oct: FFBJ: ‘Last week died in College Green, Miss Turner, sister of Wm Turner, Exq of Belmont, near Wraxal, Somerset, - who, we have good authority to say, has left a very handsome legacy to our Infirmary’.