On Victorian Hospitals
May. 21st, 2009 11:03 am![[personal profile]](https://www.dreamwidth.org/img/silk/identity/user.png){kind=small}
elaby*is dweeb*
In my efforts to contribute to![[livejournal.com profile]](https://www.dreamwidth.org/img/external/lj-community.gif)
watsons_woes, a community where the rules necessitate that Watson either gets beaten up or falls ill or is in other ways woeful, I've come across a block in my research. I love to do research so very much that I sometimes end up spending more time trying to find out what treatment the Victorians would have prescribed for intestinal inflammation than actually writing the fic that involves such disorders. But one question came up time and time again when doing research and planning fics: at what point would a couple of middle class gentlemen such as Holmes and Watson go to the hospital rather than be treated by a physician in their home?
My early research seemed to say that hospitals were for the poor – people who had nowhere else to go – and that was that. Anyone who could afford it had a doctor come to them when they got sick. But this information came from the time ranging between the 1840's and 1870's, not the late 1880's through early 1900's when our stories usually take place. I also ran into a lack of information about what would happen if someone, say, got hit by a cab, or fell down the stairs and broke their arm, or got the snot beaten out of them by criminals in a dark alley, or had scaffolding collapse on them. Would injuries like these be taken care of by a nearby physician, fetched from his consulting rooms, or would the injured person be taken to a hospital? I've endeavored to answer this question as best I can from primary sources and modern accounts of the period. I took entirely from www.victorianlondon.org (which is a remarkable resource - all the content is from books and magazines and articles published in the Victorian era). I've included anything that mentioned the financial state of the patients, or medical school, on account of this being Watson research, you know.
Chronological order is our friend!
From 1844
Concerning a "consumption hospital":
"Of these, about three-fourths occur in males, of whom a large proportion are working-men unable to provide for themselves and families - systematically excluded from our general hospitals, and uniting in their own persons every conceivable claim to sympathy and assistance."
General hospitals, then, excluded the poorest populations? A book I have, Victorian London by Liza Picard, says "Hospitals were supposed to be for the sick poor, but some governors [the people who run and donate funds to the hospitals] used 'their' hospitals as free nursing-homes for their own servants; no enquiry was ever made as to the patient's means. The Royal Free Hospital, originally in Hatton Gardens, had been founded in 1828 as a protest against the power of 'governor's letters'. The London, out at Mile End, had never used them. For a hopeful patient, the trick was to know which was which." There's a lot of mention of "letters of recommendation" that people apparently had to have in order to be seen at a hospital.
Greenwich Hospital - "The principal features of this splendid British palace for poverty, are the chapel, and painted hall [...] How could he ever suspect that all this splendour of columns and cupolas is destined to shelter a couple of thousand of poor, decrepid sailors!"
I found a lot of articles about hospitals for specific people, professions, and diseases. Most of them, especially early articles, specified that these hospitals were for the poor.
Guy's Hospital - "At the anatomical and surgical theatres here, the lectures are accessible only to students, on terms always advertised in the public newspapers; but to witness any of the great surgical operations here performed, a ticket from one of the principals of the establishment will alone admit."
Teaching hospitals! I included this for Watson research (and I have an original character who's a medical student in this era).
From 1850
"In one year (1849) the committee relieved upwards of 9000 necessitous persons, of whom although many were recommended by subscribers, much the greater part were admitted without any other recommendation than the sympathy which their necessities and sufferings excited."
So it appears that hospitals were for sick poor people as late as 1865. They had to be recommended by "subscribers," who I think were people who donated money on an ongoing basis (judging by women's magazines that encouraged single donations if you couldn't afford to subscribe).
St. Bart's (where Watson did his... residency? I assume, since he got his degree from the University of London, that St. Bart's was where he got experience toward the degree) - Founded in 1102 for "omnes pauperes infirmos" and refounded in 1423 "towards the relief and succour and help of the poor, aged, sick, low, and impotent people" of London. So far, in what I've read, this is the most focused on being a teaching hospital: "In 1835, the Anatomical Museum was considerably enlarged, a new Medical Theatre was built, and Museums of Materia Medica and Botany were founded; and at the same time, the Library was removed to the present building [...] In 1843, the Governors founded a Collegiate Establishment, to afford the Pupils the moral advantages, together with the comfort and convenience, of a residence with the walls of the Hospital..."
Perhaps Watson lived there, then, when he did his residency? I guess it depends on whether St. Bart's was affiliated with the University of London.
"This Hospital [St. Bart's] gives relief to all poor persons suffering from accident or diseases, either as in-patients or out-patients. [...] Accidents, or cases of urgent disease, may be brought without any letter of recommendation or other formality at all hours of the day or night to the Surgery, where there is a person in constant attendance, and the aid of the Resident Medical Officers can be instantly obtained. [...] The in-patients are visited daily by the Physicians and Surgeons; and during the summer session, four Clinical Lectures are delivered weekly. The out-patients are attended daily by the Assistant-Physicians and Assistant-Surgeons. Students can reside within the Hospital walls, subject to the rules of the Collegiate system, established under the direction of the Treasurer and a Committee of Governors of the Hospital. Some of the teachers and other gentlemen connected with the Hospital also receive Students to reside with them."
"St. Thomas's Hospital, an Hospital for sick and diseased poor persons..."
"University College Hospital was founded in 1833, for the relief of poor sick and maimed persons, and the delivery of poor married women..."
Mid-century, anyway, publications were still explicit that hospitals were for the sick poor.
From 1865
"The CANCER HOSPITAL, Fulham Road, Brompton, is specially for the treatment of the poor afflicted with cancer. It was first established, in 1851, in Cannon Row, Westminster, and was removed to its present site in 1860..."
Charing Cross Hospital - "Its objects are, for the reception of the more helpless and destitute, and for the relief of the sick poor at their own homes."
From 1870
"Hospital for Diseases of the Chest, Victoria-park.
[For] the complete restoration of those who, having left the hospital ward or the sick room, where medical skill has done its best for them, have yet to cross that shifty ground between convalescence and recovery [...] It is to convalescent homes like that established at Woodford by Mrs. Gladstone, that we must look for the completion of the work done in our hospitals for the sick. [...] It was during the time of the last cholera epidemic, and when the poor patients taken from the infected districts to the London Hospital were saved from death only to be sent back to their bare rooms, unable to obtain the food necessary to renew their strength, that this charitable lady first opened the pleasant house at Woodford with thirty beds."
Knowledge of convalescent hospitals is probably useful for fic as well :3
"...what a boon to these poor convalescents is the opportunity of removing, if only for a week or two, from the foul neighbourhoods where they would have been in imminent danger of a relapse [...] to hear the words of grateful thanks in these institutions, would be worth a journey to either; and a visit, if it did not lead to a yearly subscription, would at least be a convincing proof that a contribution would be so well bestowed, as to make it a matter of duty either to work or give on behalf of those who have a double hold upon our sympathies..."
Charity visits and contributions kept these institutions running, from what I can see, and kept middle and upper-class women feeling like they were helping the poor. From various oblique references, it seems that well-off women did a lot of this type of visiting.
From 1870
"...the Metropolitan Free Hospital in Devonshire-square, where no letter of recommendation is required for immediate gratuitous relief..."
"...and King's College Hospital, where in cases of emergency medical or surgical aid may be obtained at any hour."
From 1879
The Order of St. John of Jerusalem In England mentions the poor as this hospital's patrons: "Providing the means and opportunity for local training of nurses for the sick poor"; "The promotion of a more intimate acquaintance with the wants of the poor in time of sickness" etc. "The institution of the 'St. John Ambulance Association' for instruction in the preliminary treatment of the injured in peace and the wounded war. Although started little more than a year since, this movement has already attained very great success, and local centres and classes have been formed London and in many provincial towns. [...] A large number of the Metropolitan Police are now trained under the supervision of this useful institution."
I thought knowing about ambulances would be useful as well. The next one is the most useful, I think, since it dates from smack in the middle of Holmes and Watson's era.
From Edward Owen, Hyde Park, Select Narratives, Annual Event, etc, during twenty years' Police Service in Hyde Park, 1906
"ACCIDENTS from collisions with carriages, and from ridden horses bolting or stumbling, are frequent in the Season. [...] Should there he any personal injury, it must be attended to first. Medical aid must be procured, either by sending for a doctor or conveying the injured to hospital. The latter is the usual practice."
So by 1906, most of the time people injured in the street would be taken "to hospital."
"The late Attorney-General, Sir Robert Finlay, when Q.C., had a nasty fall from his horse one morning in the Row. [...] [H]e had struck his head in the fall, and was rendered unconscious. I happened to be on duty at Hyde Park Corner as he was being brought along on the ambulance by Mr. Hall, the Apsley Gate-keeper. I assisted in getting him into St. George's Hospital, where he was placed on a couch, and soon attended by a doctor."
The Attorney-General certainly would not have been considered one of the poor, and he was taken by ambulance to the hospital. Finlay became the Attorney-General in 1900, and I can only imagine "when Q.C." means when he was Queen's Counsel, which he became in 1882. He was elected Liberal Member of Parliament in 1885, but I'm not sure whether that would take away his title of Q.C., so let's just say that this accident took place between 1882 and 1900. It's good enough for our purposes anyway, since this time spans the height of Holmes and Watson's cases.
"I am glad to say, after a short time, Sir Robert was able to leave the hospital and proceed home, not much the worse."
I’m not sure how long "a short time" is, but people must have gone home after being examined if they were able.
"...his horse stumbled and slipped forward, pitching the Major clean out of the saddle on to his head, inflicting a terrible wound. Death, I should say, must have been instantaneous, but he was conveyed with all possible speed on the ambulance (one happened to be stationed near the Marble Arch) to St. George's Hospital, and the House Surgeon was soon in attendance, but he stated him to be dead. Then came the question-Who was the gentleman? -for a gentleman he certainly was from his appearance, and evidently of good birth."
They eventually found him to be "Major Macdonald, of the Highlanders." I can't seem to find what year he died, though.
St. George's Hospital was at Hyde Park Corner, so anybody having horsy mishaps in Hyde Park (or almost drowning in the Serpentine) would be taken there.
Conclusion: Hospitals were established for the sick and injured poor, and the sick poor seem to be the most numerous patrons. Middle and upper class people generally had a physician come to their house (or went round to them) if they were sick. Anybody, regardless of class, would be more likely to be taken to a hospital if injured in an accident than taken to a doctor (in 1902, after all, Holmes was taken Charing Cross Hospital in ILLU before he insisted on being brought home, but in DYIN there was only talk of bringing a doctor to Holmes).
I welcome corrections of any sort or further information if anyone has it :) Incidentally, I'm off work today :3 Just a random vacation day because I was starting to go twitchy. Let the Brett/Burke marathon commence!
In my efforts to contribute to
watsons_woes, a community where the rules necessitate that Watson either gets beaten up or falls ill or is in other ways woeful, I've come across a block in my research. I love to do research so very much that I sometimes end up spending more time trying to find out what treatment the Victorians would have prescribed for intestinal inflammation than actually writing the fic that involves such disorders. But one question came up time and time again when doing research and planning fics: at what point would a couple of middle class gentlemen such as Holmes and Watson go to the hospital rather than be treated by a physician in their home?My early research seemed to say that hospitals were for the poor – people who had nowhere else to go – and that was that. Anyone who could afford it had a doctor come to them when they got sick. But this information came from the time ranging between the 1840's and 1870's, not the late 1880's through early 1900's when our stories usually take place. I also ran into a lack of information about what would happen if someone, say, got hit by a cab, or fell down the stairs and broke their arm, or got the snot beaten out of them by criminals in a dark alley, or had scaffolding collapse on them. Would injuries like these be taken care of by a nearby physician, fetched from his consulting rooms, or would the injured person be taken to a hospital? I've endeavored to answer this question as best I can from primary sources and modern accounts of the period. I took entirely from www.victorianlondon.org (which is a remarkable resource - all the content is from books and magazines and articles published in the Victorian era). I've included anything that mentioned the financial state of the patients, or medical school, on account of this being Watson research, you know.
Chronological order is our friend!
From 1844
Concerning a "consumption hospital":
"Of these, about three-fourths occur in males, of whom a large proportion are working-men unable to provide for themselves and families - systematically excluded from our general hospitals, and uniting in their own persons every conceivable claim to sympathy and assistance."
General hospitals, then, excluded the poorest populations? A book I have, Victorian London by Liza Picard, says "Hospitals were supposed to be for the sick poor, but some governors [the people who run and donate funds to the hospitals] used 'their' hospitals as free nursing-homes for their own servants; no enquiry was ever made as to the patient's means. The Royal Free Hospital, originally in Hatton Gardens, had been founded in 1828 as a protest against the power of 'governor's letters'. The London, out at Mile End, had never used them. For a hopeful patient, the trick was to know which was which." There's a lot of mention of "letters of recommendation" that people apparently had to have in order to be seen at a hospital.
Greenwich Hospital - "The principal features of this splendid British palace for poverty, are the chapel, and painted hall [...] How could he ever suspect that all this splendour of columns and cupolas is destined to shelter a couple of thousand of poor, decrepid sailors!"
I found a lot of articles about hospitals for specific people, professions, and diseases. Most of them, especially early articles, specified that these hospitals were for the poor.
Guy's Hospital - "At the anatomical and surgical theatres here, the lectures are accessible only to students, on terms always advertised in the public newspapers; but to witness any of the great surgical operations here performed, a ticket from one of the principals of the establishment will alone admit."
Teaching hospitals! I included this for Watson research (and I have an original character who's a medical student in this era).
From 1850
"In one year (1849) the committee relieved upwards of 9000 necessitous persons, of whom although many were recommended by subscribers, much the greater part were admitted without any other recommendation than the sympathy which their necessities and sufferings excited."
So it appears that hospitals were for sick poor people as late as 1865. They had to be recommended by "subscribers," who I think were people who donated money on an ongoing basis (judging by women's magazines that encouraged single donations if you couldn't afford to subscribe).
St. Bart's (where Watson did his... residency? I assume, since he got his degree from the University of London, that St. Bart's was where he got experience toward the degree) - Founded in 1102 for "omnes pauperes infirmos" and refounded in 1423 "towards the relief and succour and help of the poor, aged, sick, low, and impotent people" of London. So far, in what I've read, this is the most focused on being a teaching hospital: "In 1835, the Anatomical Museum was considerably enlarged, a new Medical Theatre was built, and Museums of Materia Medica and Botany were founded; and at the same time, the Library was removed to the present building [...] In 1843, the Governors founded a Collegiate Establishment, to afford the Pupils the moral advantages, together with the comfort and convenience, of a residence with the walls of the Hospital..."
Perhaps Watson lived there, then, when he did his residency? I guess it depends on whether St. Bart's was affiliated with the University of London.
"This Hospital [St. Bart's] gives relief to all poor persons suffering from accident or diseases, either as in-patients or out-patients. [...] Accidents, or cases of urgent disease, may be brought without any letter of recommendation or other formality at all hours of the day or night to the Surgery, where there is a person in constant attendance, and the aid of the Resident Medical Officers can be instantly obtained. [...] The in-patients are visited daily by the Physicians and Surgeons; and during the summer session, four Clinical Lectures are delivered weekly. The out-patients are attended daily by the Assistant-Physicians and Assistant-Surgeons. Students can reside within the Hospital walls, subject to the rules of the Collegiate system, established under the direction of the Treasurer and a Committee of Governors of the Hospital. Some of the teachers and other gentlemen connected with the Hospital also receive Students to reside with them."
"St. Thomas's Hospital, an Hospital for sick and diseased poor persons..."
"University College Hospital was founded in 1833, for the relief of poor sick and maimed persons, and the delivery of poor married women..."
Mid-century, anyway, publications were still explicit that hospitals were for the sick poor.
From 1865
"The CANCER HOSPITAL, Fulham Road, Brompton, is specially for the treatment of the poor afflicted with cancer. It was first established, in 1851, in Cannon Row, Westminster, and was removed to its present site in 1860..."
Charing Cross Hospital - "Its objects are, for the reception of the more helpless and destitute, and for the relief of the sick poor at their own homes."
From 1870
"Hospital for Diseases of the Chest, Victoria-park.
[For] the complete restoration of those who, having left the hospital ward or the sick room, where medical skill has done its best for them, have yet to cross that shifty ground between convalescence and recovery [...] It is to convalescent homes like that established at Woodford by Mrs. Gladstone, that we must look for the completion of the work done in our hospitals for the sick. [...] It was during the time of the last cholera epidemic, and when the poor patients taken from the infected districts to the London Hospital were saved from death only to be sent back to their bare rooms, unable to obtain the food necessary to renew their strength, that this charitable lady first opened the pleasant house at Woodford with thirty beds."
Knowledge of convalescent hospitals is probably useful for fic as well :3
"...what a boon to these poor convalescents is the opportunity of removing, if only for a week or two, from the foul neighbourhoods where they would have been in imminent danger of a relapse [...] to hear the words of grateful thanks in these institutions, would be worth a journey to either; and a visit, if it did not lead to a yearly subscription, would at least be a convincing proof that a contribution would be so well bestowed, as to make it a matter of duty either to work or give on behalf of those who have a double hold upon our sympathies..."
Charity visits and contributions kept these institutions running, from what I can see, and kept middle and upper-class women feeling like they were helping the poor. From various oblique references, it seems that well-off women did a lot of this type of visiting.
From 1870
"...the Metropolitan Free Hospital in Devonshire-square, where no letter of recommendation is required for immediate gratuitous relief..."
"...and King's College Hospital, where in cases of emergency medical or surgical aid may be obtained at any hour."
From 1879
The Order of St. John of Jerusalem In England mentions the poor as this hospital's patrons: "Providing the means and opportunity for local training of nurses for the sick poor"; "The promotion of a more intimate acquaintance with the wants of the poor in time of sickness" etc. "The institution of the 'St. John Ambulance Association' for instruction in the preliminary treatment of the injured in peace and the wounded war. Although started little more than a year since, this movement has already attained very great success, and local centres and classes have been formed London and in many provincial towns. [...] A large number of the Metropolitan Police are now trained under the supervision of this useful institution."
I thought knowing about ambulances would be useful as well. The next one is the most useful, I think, since it dates from smack in the middle of Holmes and Watson's era.
From Edward Owen, Hyde Park, Select Narratives, Annual Event, etc, during twenty years' Police Service in Hyde Park, 1906
"ACCIDENTS from collisions with carriages, and from ridden horses bolting or stumbling, are frequent in the Season. [...] Should there he any personal injury, it must be attended to first. Medical aid must be procured, either by sending for a doctor or conveying the injured to hospital. The latter is the usual practice."
So by 1906, most of the time people injured in the street would be taken "to hospital."
"The late Attorney-General, Sir Robert Finlay, when Q.C., had a nasty fall from his horse one morning in the Row. [...] [H]e had struck his head in the fall, and was rendered unconscious. I happened to be on duty at Hyde Park Corner as he was being brought along on the ambulance by Mr. Hall, the Apsley Gate-keeper. I assisted in getting him into St. George's Hospital, where he was placed on a couch, and soon attended by a doctor."
The Attorney-General certainly would not have been considered one of the poor, and he was taken by ambulance to the hospital. Finlay became the Attorney-General in 1900, and I can only imagine "when Q.C." means when he was Queen's Counsel, which he became in 1882. He was elected Liberal Member of Parliament in 1885, but I'm not sure whether that would take away his title of Q.C., so let's just say that this accident took place between 1882 and 1900. It's good enough for our purposes anyway, since this time spans the height of Holmes and Watson's cases.
"I am glad to say, after a short time, Sir Robert was able to leave the hospital and proceed home, not much the worse."
I’m not sure how long "a short time" is, but people must have gone home after being examined if they were able.
"...his horse stumbled and slipped forward, pitching the Major clean out of the saddle on to his head, inflicting a terrible wound. Death, I should say, must have been instantaneous, but he was conveyed with all possible speed on the ambulance (one happened to be stationed near the Marble Arch) to St. George's Hospital, and the House Surgeon was soon in attendance, but he stated him to be dead. Then came the question-Who was the gentleman? -for a gentleman he certainly was from his appearance, and evidently of good birth."
They eventually found him to be "Major Macdonald, of the Highlanders." I can't seem to find what year he died, though.
St. George's Hospital was at Hyde Park Corner, so anybody having horsy mishaps in Hyde Park (or almost drowning in the Serpentine) would be taken there.
Conclusion: Hospitals were established for the sick and injured poor, and the sick poor seem to be the most numerous patrons. Middle and upper class people generally had a physician come to their house (or went round to them) if they were sick. Anybody, regardless of class, would be more likely to be taken to a hospital if injured in an accident than taken to a doctor (in 1902, after all, Holmes was taken Charing Cross Hospital in ILLU before he insisted on being brought home, but in DYIN there was only talk of bringing a doctor to Holmes).
I welcome corrections of any sort or further information if anyone has it :) Incidentally, I'm off work today :3 Just a random vacation day because I was starting to go twitchy. Let the Brett/Burke marathon commence!
