Liverpool Hospitals - A Preface

William Hogarth - 'She Expires, while the Doctors are Quarrelling', April 1732.

It is traditionally thought that the first hospitals in England emerged following the Norman conquest and Westminster Infirmary, established in 1049, allowed its elderly monk patients two baths a year, and, in contrast with centuries to come, a female doctor was part of the team. However, in 2010, radiocarbon analysis at the former leper hospital at St Mary Magdalen in Winchester suggests that there may have been a late Anglo-Saxon hospital on the site (960–1030). The beds in the earliest hospitals consisted of pallets of straw, but before the end of the twelfth century there were probably wooden bedsteads, usually large, as they had to accommodate two or more patients. London's oldest hospitals, both general hospitals founded by Augustinian monks in the twelfth and thirteenth centuries, were St Bartholomew's in West Smithfield, and St Thomas's in Southwark. In 1123, Rahere, a courtier of King Henry I, had established the Priory of St Bartholomew, and St Bartholomew's Hospital for the sick poor in Smithfield, London, following a pilgrimage to Rome. This hospital was one of the first to be established in Europe and had provision for teaching. Gradually, the hospital became independent of the religious order. So religious were the earliest hospitals that prayers were repeated up to 200 times day and night. The Priory of St Mary of Bethlehem was established in 1247, over a century after St Bartholomew’s Hospital was established, and would become the first hospital for the mentally ill in England, and was later known as Bedlam. 

Bedlam Asylum

 

Over seven hundred hospitals were founded in England between the Norman conquest and the middle of the sixteenth century although many of them were not really hospitals as we know them today. Their name indicated their primary function; it was derived from the Latin word 'hospitalis', meaning being concerned with 'hospites', or guests, and guests were any persons who needed shelter. This eventually developed into what we now understand as a hospital, with various monks and lay helpers providing the medical care for sick pilgrims and victims of the numerous plagues and chronic diseases that afflicted Medieval Western Europe. In the 12th and 13th centuries, many hospitals refused patients in need of special care, and confined themselves to the short term sick who were likely to recover. When physicians appeared around 1566, surgeons were rated as tradesmen and only allowed to prescribe under the physicians' guidance. In the 15th century, nurses' pay was £1 a year with a daily food and beer allowance, and they were forbidden to leave the hospital after 7 pm in winter or 9 pm in summer, and sacked if they had the audacity to become engaged or get married. The first junior house officers in the NHS, who worked night and day were only allowed a weekend off between posts. In the 1530s, following his dispute with the Pope, Henry VIII ordered the dissolution of all monasteries in England and Wales. This had a dramatic impact on patient care as the monasteries had been the main providers of medical care for many centuries. In some towns and cities, councils stepped in and took over the running of hospitals. There were reports of tensions between hospital managers and doctors as early as the 1700s, with doctors viewing the governors as suffocating and inefficient, and the governors regarding the doctors as their inferiors.​ 

Poor people waiting at a Hospital door early 19th Century

 

Some hospitals started life as workhouses, and the changeover from workhouse to hospital was a gradual one. Liverpool had a number of workhouses such as Toxteth Park, Mill Road and Belmont, run by Poor Law unions which were public bodies, to care for the destitute. Eighteenth-century medical care was limited by incorrect diagnoses and the limitations of the understanding of the body, and this was true both inside and outside hospitals. Surgery was rarely carried out due to the lack of anaesthesia and was primarily confined to amputations and lithotomies (removal of stones from the urinary bladder). Instead, what hospitals offered patients besides food and a bed were basic medicines and external cures. Slowly, hospitals began to change. Initially, they gave only basic care to the sick but over time, they began to attempt to treat illness and carry out simple surgery, e.g. removing gallstones and setting broken bones. Alongside these general infirmaries, a number of specialist hospitals were set up during the 19th century. These included the London Chest Hospital in 1814 and the Free Cancer Hospital (now the Royal Marsden) in 1851. Perhaps the most famous is Great Ormond Street Hospital for Children, founded in 1852. Isolation hospitals were also established in order to treat infectious diseases. For example, the Liverpool Fever Hospital was established in 1801 and the London Fever Hospital was established in 1802. In 1847 when Liverpool had a population of 250,000, 5,845 people died of 'Fever' and 2,589 died of 'Diarrhoea'. This was the highest mortality rate ever seen in Liverpool and Doctor William Henry Duncan, who was appointed Medical Officer of Health on the 1st of January 1847, the first person to hold the post in both the city and the country, requested an embargo on the landing of Irish immigrants in Liverpool, but this was not sanctioned by law. During the later part of the nineteenth century the level of medical care provided for workhouse inmates increased. The hospital wings of these workhouses increased in size and patients were admitted to the workhouse hospitals for treatment rather than being admitted as workhouse inmates. The workhouses often changed their name to 'institutions' after about 1913 to reflect this change in role and also because the name 'workhouse' carried a stigma. In 1930 the Poor Law unions were abolished and medical care for the poor became the responsibility of a local Public Assistance Committee. The workhouses officially became known as hospitals at this time or shortly thereafter, but the association with the workhouse remained, and some people would have been reluctant to ask for free care at these hospitals for this reason.

Prior to the setting up of the National Health Service in 1948, if you needed hospital treatment and were unable to pay for private treatment, your options were to try to obtain treatment either at a voluntary hospital or at a public hospital run by the local authorities. Nineteenth century Liverpool saw a number of new voluntary hospitals set up such as the David Lewis Northern Hospital and the Royal Southern Hospital. Voluntary hospitals were able to offer only limited free treatment; patients were expected to pay what they could afford or to reimburse expenses at a later date. In 1948 both the voluntary and public hospitals came into the ownership of the National Health Service and were put under the management of local hospital management committees under the Liverpool Regional Health Board. A reorganisation of the National Health Service in 1974 saw Liverpool hospitals come under district health authorities as part of the Liverpool Area Health Authority, in turn part of the Mersey Regional Health Authority. Between 1991 and 1995 Liverpool hospitals became independent NHS trusts.
Liverpool was the first place in Europe to have a horse drawn service. A house doctor or medical student would accompany the driver, equipped with drugs, splints, instruments and dressings. Previously patients would be taken to hospital in at best an ordinary cab, which often worsened their injuries. Voluntary hospitals in Liverpool had been in existence since the setting up of the Liverpool Infirmary (later the Liverpool Royal Infirmary) in 1749.

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