Rise of the Hospital:

Islamic Medical Institutions Hospitals Hospitals More medically oriented than their western counterparts More medically oriented than their western counterparts Developed a teaching function sooner, as well Developed a teaching function sooner, as well

Types of Hospitals Poor law hospitals Poor law hospitals Royal hospitals (London only) Royal hospitals (London only) Endowed by Henry VIII Endowed by Henry VIII Voluntary hospitals Voluntary hospitals First emerged in 18 th century First emerged in 18 th century

Voluntary General Hospitals Also intended to care for the poor Also intended to care for the poor Depended on donations Depended on donations 1 st established in London in 1720 (Westminster) 1 st established in London in 1720 (Westminster) Last – St. Mary’s (1851) Last – St. Mary’s (1851)

Donors provided with incentives to donate Donors provided with incentives to donate Given admitting privileges to hospital Given admitting privileges to hospital Could sponsor specific patients Could sponsor specific patients Only sponsored patients admitted Only sponsored patients admitted

Hospitals controlled by the donors Hospitals controlled by the donors Only “deserving” poor admitted Only “deserving” poor admitted “Undeserving” poor went to poor law hospitals “Undeserving” poor went to poor law hospitals

Patients selected on the basis of: Patients selected on the basis of: Moral behaviour Moral behaviour Utilitarianism Utilitarianism Preferred to admit adult males who were gainfully employed Preferred to admit adult males who were gainfully employed Utilitarian principles influenced much of charitable work in the 19 th century Utilitarian principles influenced much of charitable work in the 19 th century

Jeremy Bentham ( ) Jeremy Bentham ( ) John Stuart Mill ( ) John Stuart Mill ( ) An action is right only if it produces the most benefit An action is right only if it produces the most benefit

Voluntary hospitals competed with a wide range of other charities Voluntary hospitals competed with a wide range of other charities Needed to appeal to self-interest of donors Needed to appeal to self-interest of donors Enabled them to create institutions in their own image Enabled them to create institutions in their own image Reflected their moral anxieties Reflected their moral anxieties

Specialist Voluntary Hospitals 1. Lock Hospitals

Admitted women suffering from VD Admitted women suffering from VD Reflected British middle class anxieties about prostitutes & working class women Reflected British middle class anxieties about prostitutes & working class women Purpose was to morally reform prostitutes Purpose was to morally reform prostitutes

Linda Mahood. The Magdalenes: Prostitution in the Nineteenth Century Linda Mahood. The Magdalenes: Prostitution in the Nineteenth Century Judith Walkowitz. Prostitution in Victorian Society: Women, Class and the State Judith Walkowitz. Prostitution in Victorian Society: Women, Class and the State New approaches to old problems often signal shifts in social beliefs New approaches to old problems often signal shifts in social beliefs

Sentimental view of prostitution in early 19 th century Sentimental view of prostitution in early 19 th century Victim of seduction Victim of seduction In need of protection In need of protection Admission to magdalene homes Admission to magdalene homes Served 2 purposes Served 2 purposes Controlled sexual behaviour Controlled sexual behaviour Controlled vocational behaviour Controlled vocational behaviour

Change in social attitudes at mid 19 th century Change in social attitudes at mid 19 th century Prostitutes endangered morality of middle class men Prostitutes endangered morality of middle class men Creation of new systems to deal with them Creation of new systems to deal with them

Glasgow system Glasgow system Interlocking system of repression Interlocking system of repression Communicable diseases acts Communicable diseases acts Magdalene homes Magdalene homes Lock hospitals Lock hospitals Police could arrest any woman suspected of prostitution Police could arrest any woman suspected of prostitution

Subjected to medical examination Subjected to medical examination If infected, to Lock hospital If infected, to Lock hospital If not, to magdalene home If not, to magdalene home Controversy over use of speculum Controversy over use of speculum Resistance to CD acts by feminists Resistance to CD acts by feminists

2. Lying-in Hospitals Provided limited maternity services to working class women Provided limited maternity services to working class women Contributed to medicalization of childbirth Contributed to medicalization of childbirth

3. Infectious (fever, isolation) hospitals Less popular Less popular Less financial support from donors Less financial support from donors No one wanted them in their neighbourhood No one wanted them in their neighbourhood

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

Hospital Architecture In early years, any building would do In early years, any building would do Gradual emphasis on the role that architecture played in: Gradual emphasis on the role that architecture played in: Health of patients Health of patients Moral development of patients Moral development of patients

Nightingale Nightingale Development of pavilion hospitals Development of pavilion hospitals St. Thomas Hospital, c St. Thomas Hospital, c Design of Nightingale wards Design of Nightingale wards 2500 cu. ft. air/hr 2500 cu. ft. air/hr Width 30 ft. Width 30 ft. Beds on exterior walls Beds on exterior walls

Debates about hospital location Debates about hospital location Nightingale favoured suburban or rural locations Nightingale favoured suburban or rural locations Controversy re: re-location of St. Thomas Hospital Controversy re: re-location of St. Thomas Hospital

Adams & Theodore. “Designing for ‘the little convalescents’: Children’s Hospitals in Toronto & Montreal.” Canadian Bulletin for the History of Medicine 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 Surroundings of hospital were completely at odds with normal living conditions of working class children & parents

Designed to meet two conflicting sets of needs Designed to meet two conflicting sets of needs Domestic ideals of middle class female supporters Domestic ideals of middle class female supporters

Scientific aspirations of organized medicine Scientific aspirations of organized medicine

Hospitals as Social Systems Types of patients Types of patients Sex Sex Occupations Occupations Financial circumstances Financial circumstances Type of care Type of care Length of stay Length of stay

Therapeutic regimes Therapeutic regimes Hospital routines Hospital routines Moralizing strategies Moralizing strategies Patients’ resistance Patients’ resistance

Staffing Staffing Nurses Nurses Medical staff Medical staff Medical students Medical students Impact on mortality Impact on mortality

Crisis & Change Significant turmoil in voluntary hospitals in late 19 th century Significant turmoil in voluntary hospitals in late 19 th century Erosion of absolute authority of hospital governors Erosion of absolute authority of hospital governors

Financial Financial Linkages with other charities Linkages with other charities Working class contributions Working class contributions Advent of the paying patient Advent of the paying patient Power struggles between governors & medical profession Power struggles between governors & medical profession