Rise of the hospital 1700 1900
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Rise of the Hospital: 1700-1900. Islamic Medical Institutions. Hospitals More medically oriented than their western counterparts Developed a teaching function sooner, as well. Types of Hospitals. Poor law hospitals Royal hospitals (London only) Endowed by Henry VIII Voluntary hospitals

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Rise of the Hospital: 1700-1900

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Rise of the hospital 1700 1900

Rise of the Hospital: 1700-1900


Islamic medical institutions

Islamic Medical Institutions

  • Hospitals

  • More medically oriented than their western counterparts

  • Developed a teaching function sooner, as well


Types of hospitals

Types of Hospitals

  • Poor law hospitals

  • Royal hospitals (London only)

    • Endowed by Henry VIII

  • Voluntary hospitals

    • First emerged in 18th century


Voluntary general hospitals

Voluntary General Hospitals

  • Also intended to care for the poor

  • Depended on donations

  • 1st established in London in 1720 (Westminster)

  • Last – St. Mary’s (1851)


Rise of the hospital 1700 1900

  • Donors provided with incentives to donate

  • Given admitting privileges to hospital

  • Could sponsor specific patients

  • Only sponsored patients admitted


Rise of the hospital 1700 1900

  • Hospitals controlled by the donors

  • Only “deserving” poor admitted

  • “Undeserving” poor went to poor law hospitals


Rise of the hospital 1700 1900

  • Patients selected on the basis of:

    • Moral behaviour

    • Utilitarianism

  • Preferred to admit adult males who were gainfully employed

  • Utilitarian principles influenced much of charitable work in the 19th century


Rise of the hospital 1700 1900

  • Jeremy Bentham (1748-1832)

  • John Stuart Mill (1806-1873)

  • An action is right only if it produces the most benefit


Rise of the hospital 1700 1900

  • Voluntary hospitals competed with a wide range of other charities

  • Needed to appeal to self-interest of donors

  • Enabled them to create institutions in their own image

  • Reflected their moral anxieties


Specialist voluntary hospitals

Specialist Voluntary Hospitals

1. Lock Hospitals


Rise of the hospital 1700 1900

  • Admitted women suffering from VD

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

  • Purpose was to morally reform prostitutes


Rise of the hospital 1700 1900

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

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

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


Rise of the hospital 1700 1900

  • Sentimental view of prostitution in early 19th century

  • Victim of seduction

  • In need of protection

  • Admission to magdalene homes

  • Served 2 purposes

    • Controlled sexual behaviour

    • Controlled vocational behaviour


Rise of the hospital 1700 1900

  • Change in social attitudes at mid 19th century

  • Prostitutes endangered morality of middle class men

  • Creation of new systems to deal with them


Rise of the hospital 1700 1900

  • Glasgow system

  • Interlocking system of repression

    • Communicable diseases acts

    • Magdalene homes

    • Lock hospitals

  • Police could arrest any woman suspected of prostitution


Rise of the hospital 1700 1900

  • Subjected to medical examination

  • If infected, to Lock hospital

  • If not, to magdalene home

  • Controversy over use of speculum

  • Resistance to CD acts by feminists


2 lying in hospitals

2. Lying-in Hospitals

  • Provided limited maternity services to working class women

  • Contributed to medicalization of childbirth


3 infectious fever isolation hospitals

3. Infectious (fever, isolation) hospitals

  • Less popular

  • Less financial support from donors

  • No one wanted them in their neighbourhood


Rise of the hospital 1700 1900

  • Case example of Winnipeg & founding of the Municipal Hospitals


Hospital architecture

Hospital Architecture

  • In early years, any building would do

  • Gradual emphasis on the role that architecture played in:

    • Health of patients

    • Moral development of patients


Rise of the hospital 1700 1900

Nightingale

Development of pavilion hospitals

St. Thomas Hospital, c. 1870

Design of Nightingale wards

2500 cu. ft. air/hr

Width 30 ft.

Beds on exterior walls


Rise of the hospital 1700 1900

  • Debates about hospital location

  • Nightingale favoured suburban or rural locations

  • Controversy re: re-location of St. Thomas Hospital


Rise of the hospital 1700 1900

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

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


Rise of the hospital 1700 1900

  • Designed to meet two conflicting sets of needs

  • Domestic ideals of middle class female supporters


Rise of the hospital 1700 1900

  • Scientific aspirations of organized medicine


Hospitals as social systems

Hospitals as Social Systems

  • Types of patients

    • Sex

    • Occupations

    • Financial circumstances

  • Type of care

  • Length of stay


Rise of the hospital 1700 1900

  • Therapeutic regimes

  • Hospital routines

  • Moralizing strategies

  • Patients’ resistance


Rise of the hospital 1700 1900

  • Staffing

    • Nurses

    • Medical staff

    • Medical students

  • Impact on mortality


Crisis change

Crisis & Change

  • Significant turmoil in voluntary hospitals in late 19th century

  • Erosion of absolute authority of hospital governors


Rise of the hospital 1700 1900

  • Financial

    • Linkages with other charities

    • Working class contributions

    • Advent of the paying patient

  • Power struggles between governors & medical profession


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