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Rise of the Hospital: 1700-1900

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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  1. Rise of the Hospital: 1700-1900

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

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

  4. 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)

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

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

  7. 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

  8. Jeremy Bentham (1748-1832) • John Stuart Mill (1806-1873) • An action is right only if it produces the most benefit

  9. 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

  10. Specialist Voluntary Hospitals 1. Lock Hospitals

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

  12. 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

  13. 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

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

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

  16. 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

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

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

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

  20. 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

  21. 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

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

  23. 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

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

  25. Scientific aspirations of organized medicine

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

  27. Therapeutic regimes • Hospital routines • Moralizing strategies • Patients’ resistance

  28. Staffing • Nurses • Medical staff • Medical students • Impact on mortality

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

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

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