The Story of the General Hospital
Adapted from the book by Professor Tony Mitchell
HOSPITALS BEFORE THE 18th CENTURY
IIn the 20th Century we take hospitals for granted. If we are seriously ill, need an operation or have an accident we expect to find a hospital nearby. We assume that skilled medical, nursing and other staff will be available to look after as and that safe and effective treatment of various kinds will be forthcoming. We forget that until recently none of these things was true.
Even by the 18th century, the only institutions caring for the sick in England were those that had developed from religious orders, such as St Thomas's and St Bartholomew's in London. These were places for general and spiritual care rather than for skilled management and cure. For example, in the 14th century St Bartholomew's Hospital took in "sick persons found in the streets of the city and all the wounded or injured who chose to apply for relief." The instruction for receiving a patient was that "having confessed his sins to the priest he shall be communicated religiously and afterwards be carried to bed and treated there as Our Lord according to the resources of the house." The patients were looked on as representing Christ and were referred to as "Our Lords the Sick."
Nottingham too had its hospitals, not so large or well endowed as St Thomas's, and so they eventually disappeared. One of them, the Hospital of St John, stood at the corner of Parliament Street and Glasshouse Street, where the central market was until it was moved to the Victoria Centre. From about 1602 until 1720 it was used by the Corporation as a workhouse, or "house of correction" as it was then called.
However, by the late 18th century, an awakening of social conscience led philanthropic individuals and groups to found hospitals with a special concern for the sick. By 1800, thirty-
THE FIRST 100 YEARS
In 1778 John Key, a member of a Nottingham banking family, died at his home at Fulford, York. In his will he set out to create two hospitals; one bequest enabled a County Hospital to be built at York, and the other bequest provided £500 for a County Hospital or Infirmary for Nottingham "provided that £1000 be raised by subscription within five years of my decease." At a public meeting in 1780, it was decided to take up the offer; site was chosen just outside the town near Derry Mount, where Charles 1 had raised his standard in 1642. This land had formed part of the Northern Bailey of the Royal Castle but had passed into possession of the Duke of Newcastle when the castle was razed to the ground and the Duke's town house was built on the site. The Duke gave 1 acre of his land and £300, the Corporation adding another acre. The cost of the proposed building was £3300 so a subscription list was raised. Ready support came not only from Nottingham but also from Derbyshire since that county did not have its own hospital until 1810. Prominent among the early subscribers were Sir Richard Arkwright and Sir Henry Cavendish. The latest subscriber was Peter Nightingale, of Lea in Derbyshire, great-
John Simpson was appointed as architect and by 1781 the organising committee felt confident that sufficient funds for the building would be forthcoming. On February 12, a procession led by the Mayor and Corporation strangled from the Town Hall to Derry Mount, to lay the foundation stone. Under the stone, they placed some coins and an inscribed plate (Figure 1). The latter came to light 100 years later when the Jubilee Wing was being built.
Figure 1 Plaque from Foundation Stone
In 1781, Derry Mount was an open space inside the old Town Wall which in the Middle Ages ran down Butt Dyke (now Park Row) to the main gate into Nottingham from the west at Chapel Bar. The smaller gate, to admit two riders, pierced the wall and is commemorated by the present name of Postern Street. The only building near Derry Mount watched the Duke of Newcastle's town house on the site of the former Castle. The Castle Park (now the Park estate) and open fields lay below the hills to the West and the North. This opens site (see front piece) explains the quaint title of the General Hospital, near Nottingham.
Building proceeded and by September 18, 1782, everything was ready; the two-
Figure 2 General Hospital 1782
The hospital provided forty-
Figure 3 Letter of recommendation
The population of Nottingham had grown apace and being confirmed within its mediaeval boundaries because of the strangling ring of common land, notorious Nottingham slums had grown up. Charity towards the poor (Figure 4) was the main spring of the hospital of which "the objects of it are such only as are in real Distress... for the poor, as much as we are apt to overlook them are a very necessary and useful part of the community, nor ought to be forgotten that to the sweat of their brows and to the labour of their hands it is owing that the rich enjoy the accommodation of ease and pleasure." The value of an institution such as the hospital was that "good effects are produced at a very small expense…distressed objects are taken care of in the infirmaries for a tenth part of what must be spent on them in their own habitations."
Figure 4 Charity box front entrance hall of hospital
To get into hospital the "object of distress" had to present himself at the hospital on Tuesday with a letter of recommendation. After examination by the physicians and surgeons, he was then questioned by the Weekly Board to ensure that he was "a proper object of charity." Apprentices and domestic servants could only be admitted if their employers paid six shillings per week and persons who were not "object to charity, but could not afford a grand operation" could also pay six shillings per week to be admitted.
Patients were allowed "no provisions, liquors or medicines from anyone outside the house, nor give any money or gratuity whatever to nurses or servants." Games were forbidden and there was to be "no cursing, swearing or abusive language or rude or indecent behaviour." Smoking was allowed by permission of the physicians and surgeons. Patients had to be up at 7 a.m. and in bed by 8 p.m. in winter and 9 p.m. in summer; they were then locked in by the Matron. Breaking the rules could lead to instant discharge, the patient thereby being debarred from future admissions. Inmates were expected to work in that "such patients as are able shall assist in nursing other patients, washing, ironing and cleaning." The hospital got its water from a well, though it was only in 1813 that a steam engine was installed because it was "not thought proper for the patients to be employed in pumping."
The idea that nurses needed skill and training did not gain acceptance until the mid 18th century, so when the hospital opened, the nursing staff were seen as housekeepers. By 1834 the hospital owed only 4 tablespoons, 4 dessert spoons and 6 teaspoons and the Matron had to "hold herself responsible for their safety." In 1854 she was instructed to appoint one of the nurses to search the female visitors of patients to ensure that nothing undesirable was being bought in. The early Matrons were paid £12 per annum plus 3 guineas for tea, and the only qualities required of them and their nurses were that they should be moral, of good health, be able to write and keep accounts, be orderly and clean, and be able to deal with household economy. The Matron locked in the patients at night, and thereafter they were attended by “Watchers" recruited from the town women for sixpence per night. Supervision of the staff was delegated to "House Visitors" appointed by the Board. They visited the wards once-
Medical training and a unified profession did not develop until the mid-
The physicians could only use their unaided senses, since no stethoscopes or chemical tests were available. Diabetes could only be diagnosed by tasting their urine. In 1819 patient with “thirst and loss of flesh was observed to pass half a gallon of urine each night, the urine being of saccharin taste." The surgeons had no anaesthetics, so operations were uncommon. Nevertheless the early members of staff made notable contributions to knowledge and practice -
It is Lighting was by whale oil lanterns and candles until 1839 when gas was installed (Figure 5). An important member of the staff with the porter. As well as "pounding the herbs in the great mortar" his job was to look after the hospital livestock. Near the herb garden was stable for the horse and the style for the hospital pigs. The latter posed problems; one ward was "very offensive arising from the maiden and the piggeries placed below the windows." What could not be grown or raised was obtained from benefactors and in 1782 an appeal was made for linen and; "being often in great want of linen, and rags, and large quantities of which are constantly used by the surgeons, if any well disposed persons will send old linen it will be thankful Received.
Figure 5 Portland Ward in 1890
EXPANSION AND DEVELOPMENT
The first of many extensions was made in 1787, increasing the beds available to 64. At this time infectious diseases such as typhoid, typhus, tuberculosis and cholera were rife, so in 1802 a special Fever Ward was built. The microbial cause of these diseases have not yet been revealed; “miasmas" or bad smells were thought to be responsible. Although the idea of isolation had not yet developed, the new fever wards were built away from the main building and have subsequently been adapted to form the present University and Gover Ford wards. Mentally ill patients were debarred from admission; the "lunatic, lost to himself and his friends and his dearest relations, degraded and sunk below the very lowest order of animate beings" had nowhere to go. However, in 1812 a separate hospital, the Lunatic Asylum, was opened at Sneinton. This was succeeded in later years by Mapperley and Saxondale Hospitals. In 1828 two "lock wards" for venereal disease were opened at the General Hospital. The name derived from "les locques" of the rags with which the sufferers cocooned themselves.
Figure 6 Part of Staveley and Wood’s map 1816
By 1835 the hospital was bursting at the seams; cholera epidemics and more accidents from mechanised industry were taking their toll. The town's population has increased from 15,000 in 1780 to 40,000 so to increase the capacity of the building, Bromley Ward was created; the physicians’ and surgeons’ rooms, library and day rooms were requisitioned to form the Bazaar Wards. At this time, too, the role of outpatient and aftercare which beginning to be recognized; in 1831 a dispensary was opened in a house in Hockley and in 1843 it was moved to its present premises in Broad Street (Figure 7).
Figure 7 Broad Street Dispensary
In the 1850s three important developments occurred; first, the addition by T. C. Hine of an extra floor to the original building (Figure 8) bringing the bed complement to 136; second, the completion of a report by Francis Sibson, Resident Surgeon Apothecary, which recommended that properly trained nurses should be recruited; the nurses should be freed from domestic duties such a sweeping and carrying coal and "a superintendent nurse be obtained from the Institute of Nursing Sisters in London at a salary of £30 per year." The third and most important development was the introduction of anaesthesia which permitted modern surgery to begin.
Figure 8 General Hospital 1875
The introduction of anaesthesia meant that surgeons were less reluctant to operate (Figure 9) but wound infection became almost universal. The bacterial origin of wound sepsis was not understood. By 1872 the board considered that the fabric of the building had become so impregnated with a disease-
Figure 9 Shipstone Operating Theatre 1890
A reoccurring theme in all voluntary hospitals, and the reason for their eventual absorption into the state health service in 1948, was financial anxiety. The tasks expected of them were limitless, whereas their income depended entirely on the philanthropy of the rich and the energy and persuasiveness of the not-
By 1875, the anxiety was about accidents and how to get the money to look after the victims. They were not necessarily "distressed objects" and yet they occupied "so large a portion of the beds that it is with great difficulty that any ordinary surgical or medical case can gain admittance -
Figure 10 The new wing for accidents
A national event can often be harnessed to local objectives, and Nottingham chose to mark the Diamond Jubilee of Queen Victoria in 1897 by building a substantial extension to the hospital. Alfred Waterhouse, the architect for the Prudential building in King/Queen Street, was asked to present to design for this Jubilee Wing. He visited various new hospitals and was very impressed by the circular wards which had been opened in Liverpool, so in 1899 the foundations for the three circular Jubilee wards (Figure 11) were dug. Revealing the plaque placed there in 1781 and several caves and tunnels. It was not the first time that such passages had been uncovered; in 1818, during the construction of Lenton Road, an "ancient guardhouse" was found "with an apartment about 60 feet square, hewn out of solid rock with a pillar in the centre and initials and dates cut in the walls from 1570 to 1640." A "subterranean passage leading to the Postern Gate" was also uncovered, while in 1899 a workman broke through into an underground passage which James Shipman explored. He found "a remarkable series of underground passages, two ancient ditches and a cave or vault with a flight of steps cut in the rock leading down to it." The ditches were very extensive, one being 320 feet long and located at a depth of 28 feet, while the other was 106 feet long and may have been used to convey water from the old town ditch when it functioned as a reservoir. Unfortunately none of these passages or cave rooms was properly recorded, and we cannot tell whether they were linked to the Royal Castle before its destruction in 1651.
Figure 11 Jubilee Wing
The building was opened in 1900 and increased the capacity of the hospital to 210. The gibbering was fitted with electric light and the Board began to replace the gas lighting in all the other wards. The opening of the wing also coincided with the ability of the medical staff to go beyond their and aided sensors in searching for disease for in 1898 the hospital had been given an x-
THE 20th CENTURY
In the years of the 20th century the pattern of disease began to change. Tuberculosis was rampant, so in 1911 several houses in the residential area between the hospital and the Castle were brought by Sir Charles Seely, a local mine owner and benefactor, and given to the hospital. These houses provided 24 beds for the care of tuberculosis patients, and were used in conjunction with the Sherwood Forest Sanatorium, near Rainworth. This had been created by Dr William Branwell Ransom, who gave his life to the care of these patients, initially as well as figuratively, since he died of tuberculosis.
Other infectious diseases became less common. The gradual abolition of pale closets and earth privies began in Nottingham about 1912 and was completed by 1923. This almost abolished enteric infections such as typhoid and cholera. From 1895 to 1900 the average yearly incidence of these diseases in Nottingham was 489 cases with 73 deaths, but from 1923 to 1928 the annual rates were 17 cases and 1 death. The Fever Wards were no longer filled with enteric diseases, and in 1902 had been re-
Figure 12 Bridge to fever wards
With the outbreak of the war in 1914 temporary ward to accommodate the expected inflow of casualties were built on the front lawn (figure 13). The hospital also began to occupy adjacent houses; the Thornton family house on the Ropewalk was given to the hospital while Broxtowe House was bought for £547 and still serves the present hospital as a home for its resident medical staff. During the war, the hospital developed one new method of treatment (physiotherapy) but refused to provide outpatients facilities for venereal disease. So these were developed by the Local Authority on Glasshouse Street. This conflict between trying to integrate all specialties on one site, making it a truly General Hospital, and allowing separate and isolated institutions to develop (creation of a new Children’s Hospital in 1900 and of the new Women’s Hospital in 1919; the development of the Sneinton Lunatic Asylum in 1812 and of the Sherwood Sanatorium in 1901) will recur throughout this history. The 20th century move towards re-
Figure 13 War huts on the lawn 1915
After the war the City and the County agreed to adopt a scheme to extend the General Hospital as a memorial as a memorial to its dead, so a new Nurses Home was designed by Evans, the hospital architect. The site fronted onto Lenton Road. In view of its location it is not surprising that “considerable difficulties were met during the execution of this work owing to the various old buildings on the site at different levels and to several old wells and caves in the rock.” In fact the foundations of the Outer Bailey walls built in 1252 were discovered and destroyed. The walls were “about six feet thick of waterstone blocks bedded in clay, the outer faces being dressed and pointed with hard white mortar.” The new Nurses Home was opened by the Prince of Wales in 1923 and provided 130 rooms (Figure 14); in 1927 another storey was added, with 40 rooms.
Figure 14 Ariel photograph of the Memorial Nurses Home
The ability of doctors to diagnose diseases had been extended by x-
As the demand for beds grew, the hospital had to expand so in 1927 and new wing was built on land given by the City between the Ropewalk and Park Row. Evans was again the architect, and the new wing was opened by Princess Mary. It provided facilities for diagnostic and therapeutic x-
By 1932, important new benefactors had appeared. William Goodacre Player built two new wards for the physicians on the steep west face of the site overlooking the Park Estate, so increasing the hospital bed capacity to 344. The following year his brother, John Player, gave £25,000 to start a fund for a private wing. The principle of catering for paying patients was nothing new, for we have seen; in 1785 the Board resolved that such patients could be admitted at a cost of 6/-
When the Second World War began in 1939 the hospital was included in the Emergency Medical Services and 75 extra beds were squeezed into the existing wards to deal with the expected flood of casualties. The hospital lost most of its medical staff to the Armed Forces, but retired staff were retained all recalled and senior medical students were recruited. The nursing staff was on call at all times for air raids and the arrival of convoys of injured troops. Although Nottingham was only bombed on 11 occasions, nevertheless 179 people were killed as and 350 were injured.
Despite the war the hospital still found the energy and funds to go on growing. In 1941 a sizeable addition to the Nurses Home (Pearson House) was built on the Standard Hill frontage almost on the site of the demolished St James Church. In 1943 a second-
THE NATIONAL HEALTH SERVICE
We have seen that there were two systems of hospital care in Britain; "voluntary hospitals" maintained by subscriptions and gifts, and "municipal hospitals" maintained by Local Authorities from the rates. In Nottingham, the General Hospital exemplified the first time, and the City Hospital, formerly the Bagthorpe Workhouse and Infirmary, the second. The War had shown that two types of hospital could work closely together to deliver a national hospital service. Moreover, many of the voluntary hospitals were in a parlous financial state so when the political desire to create a health service, free at the point of use, but supported by a compulsory levy, came into fruition in 1948, all hospitals, voluntary and municipal were absorbed into the newly created National Health Service.
To illustrate the magnitude of the financial burden which had been shouldered by voluntary contributors over the year’s one only has to compare the expenditure in 1897 of £9,447 which enabled 158 inpatients to be dealt with at a cost of 19/6 per week each, with the expenditure in 1947 when the General Hospital spent £231,814 to deal with 387 inpatients, each costing £9 3s 5d per week. Nationalisation relieved the hospital of this burden, but it also removed to Government funds, its accumulated free monies in the form of gifts, legacies and trusts. Established Teaching Hospitals, such as those in Sheffield, Manchester and Oxford were however allowed to retain their monies.
In 1947 the last of the 165 annual processions and services was held and the Committee said “On July the 5th next this hospital will be taken over by the Sheffield Regional Board. Local patriotism will deplore its attachment to the University of another town but we hope that with the coming of University status to Nottingham, amour propre will no longer be offended.”
In 1869 a group met to found a hospital for sick and poor children. T. C. Hine’s daughter bought a house at 3 Postern Street which she presented to the committee. The original nursing staff were recruited from the Sisters of St Lucy, service building became known as "St Lucy's Home" or Telford Place, but its official title was the Free Hospital for Sick Children. The entrance gateway to the hospital, parts of which are still in use in other capacities, was bought by T. C. Hine from Alfreton Church when it was undergoing Victorian restoration in the 1870s. In 1876 and new wing was added (Figure 15) followed in 1878 by an isolation block, the gift of the Jacoby family in memory of their daughter. Even so the hospital was still too small, so in 1899 they gratefully accepted the offer by Thomas Birkin of Forest House on Chestnut Grove, near St Andrews Church. At that time, skilled nursing staff was the most crucial factor in providing good care of the children. Taking the Children's Hospital away from the General Hospital posed no problems since staff who specialised in the care of children did not interchange with the staff of the adult-
The General Hospital set 12 beds aside for Women's diseases in 1875 but in 1893 a separate Women's Hospital was created in two splendid Georgian houses near St Nicholas Church (29-
As early as 1859 a Nottingham Eye Dispensary had been established on Park Row, it then moved to a house in St James Street and finally in 1912 a purpose-
Figure 15 The Old Children's Hospital, Postern Street
Figure 16 The Old Women's Hospital, Castle Gate
Figure 17 Nottingham Eye Hospital, Ropewalk
NOTTINGHAM'S MEDICAL SCHOOLS
When the General Hospital began, apothecaries, physicians and surgeons might have had formal training at various universities and colleges, or they might have served as apprentices or pupils, or alternatively they might have been entirely self-
The apothecaries were the first group to put their house in order. In 1815 an Act laid down that no one could call himself an apothecary without undergoing a formal apprenticeship and passing examinations. The General Hospital played its part in providing proper training. The Resident Apothecary had to apprentices, who had to be "versed in the elements of grammar and the Latin language." They paid a premium of 300 guineas for their five-
The physicians and surgeons of the early hospital also had pupils (Figure 18). They had to be over 18 and could then "see the practice of the Physicians and Surgeons of the Hospital for three years on a payment of a fee of 20 guineas." There was organised teaching and "provided six pupils shall enter... the medical officers will fix stated days and hours of attendance at the hospital which they will keep to so far as may be compatible with private professional arrangements."
By the early 19th century it was recognized that attendance as a pupil could not ensure an adequate knowledge of the body structure or function, or of diseases and their management. Cities with general hospitals therefore began to set up medical schools to bring students together for lectures and practical instruction. In Manchester, Sheffield, Birmingham and Leeds these schools survived while in Nottingham, Hull, York, Exeter and Bath they did not. The formation of the Nottingham Medical School was reported in 1833. Lectures were held at Bromley House, and later at rooms in St James Street. The stamina of the teachers and pupils must have been considerable; on Wednesdays and Saturdays they started the day with a surgery lecture at 7 a.m. and finished at 8 p.m. with a midwifery lecture. The school did not survive beyond 1835. In 1858 all medical practice was regularised by a Medical Act which laid down strict regulations for the training and examination of doctors. By the time the only surviving schools were those in the very large cities.
Medical schools required facilities which attracted attention; bodies were needed for dissection, and organised gang’s systematically raided churchyards to obtain them. In 1827, 30 bodies were stolen from St Mary's churchyard in Nottingham and were intercepted on their way to London; a legal way of obtaining bodies was from the scaffold. It 1815 a 19-
The first Medical School in Nottingham was soon forgotten but in 1931, Lord Moynihan opened the new Pearson operating theatre at the General Hospital and said "I should like to see you here with a medical school. You have an abundance of material, you have men quite fitted to rank with any other members of their profession in the great teaching hospitals in this country. I am sure there is room for you and I am sure if established, you will become a medical school of great distinction." Despite this encouragement, Nottingham had to wait for 33 years until in 1964 it was decided that the city should be the location for Britain's first new medical school since 1893.
THE NEW ERA
To remedy deficiencies in the existing Nottingham hospitals and to bring medical teachers into close proximity with the University, it was decided to build an integrated Hospital and Medical School to the east of Clifton Boulevard. After considerable initial delay in the acquisition of the site, building began in 1971 to create the 1400-
Her Majesty the Queen visited the building in July 1977 and named it "The Queen's Medical Centre." The first outpatients were treated in August 1978 and the first inpatients arrived in December 1978 when the Children's Hospital closed. The remaining facilities will be brought into use progressively from April 1979 onwards, and the building will be completely occupied by 1983. We have described separate developments which previously occurred for mental illness, for children, for women and for patients with eye disorders. Some elements of these specialities will be reunited in University Hospital, enabling it to be a truly general hospital.
The first students arrived in Nottingham in 1970. As the medical School building had not yet started, they were housed in newly built accommodation intended to be occupied later by the Department of Pharmacy. The first students were ready for clinical training in 1973, and because of the delay in building the new hospital; clinical teaching for the new school has been carried out in the existing Nottingham hospitals. To enable the General Hospital to extend its activities and except clinical students in 1973 many developments occurred.
To provide accommodation for the University Departments of Medicine and Surgery, an additional floor was built in 1968 on the Player Medical Wing. In 1969 residential blocks of doctors and nurses was built on the corner of Lenton Road and Park Valley and houses in the Park, Park Terrace and the Ropewalk were acquired for residences and for new departments. In 1971, to expand its outpatient facilities, the hospital adapted Thornton house, and a new library, teaching centre and car park was built on Postern Street in 1972.
In 1967 and major development began. Trent Wing (see back cover) was opened in 1972 and contains operating theatres, surgical wards and pathology laboratories, enabling the latter departments to move out of the Ransom Memorial building. Like other developments before it, Trent Wing was built on the hospital's front lawn. It conceals completely from the casual passer-
Figure 19, Queen's Medical Centre