Hospitals 1860–1910: Dynamics of growth

Few medical institutions changed as radically as hospitals did in the 19th century. Many of the hospitals around 1800 would more remind modern observers of old age pension homes or asylums. However, from this time onwards they gradually developed into institutions where the whole setup increasingly had the treatment and even the cure of diseases as their main objective. At the same time hospitalisation periods grew shorter; the patient should not remain but recover when admitted to a hospital.

This process was by no means homogeneous. While some hospitals retained their pre-modern structure till the early 20th century, it was in particular in newly founded institutions, often to be found in the rapidly growing urban settlements of the period, that the modern hospital features had their early appearances.

Minuro Yasumoto’s study* Yasumoto M. Medical care for industrial accidents in a late 19th century British voluntary hospital – Self help, patronage, or contributory insurance? Michael 2006;3:135–56. provides insight into a half century of history for one of those new institutions, the North Ormesby Hospital in Middlesbrough, which was founded in an industrial North Yorkshire town in 1859 as a voluntary hospital. Here, a fine set of records has survived and provides detailed insights into this historical process. North Ormesby Hospital was clearly intended to be a place for treatment. Its activities reflected the exposure of health hazards that an industrial town of the time offered its inhabitants: Fractures, bruises, burns etc. made up for most of the cases treated.

The archive material that Yasumoto was able to consult, also sheds light on the moral and financial economy of the hospital. While Christian charity provided the moral backbone, the financial basis was made available by local workers, usually in the form of individual monthly subscriptions. As Yasumoto puts it, the institutional structure «consisted of the co-existence of the so-called ‘mixed economy’ of medical service provision with a charitable principle on the one hand, and a sort of contributory quasiinsurance arrangement, supported by both industrial and labour concerns on the other hand». Local industries, however, sufficed with encouraging their workers to make subscriptions and usually refrained from making any financial contributions of their own. As a result, North Ormesby Hospital was effectively funded by local workers.

This peculiar structure of a local institution pushed forward by local interest groups, could serve to remind us about an important aspect of the history of the so-called welfare state: While the administration of welfare and public health was taken over by the state in most Western societies of the 20th century, the state played only a minor, if any, role at the outset of the development of modern welfare and public health some places, e.g. on the British Isles. Many of the innovations that the 19th century saw in this field should better be understood as a result of bottom up initiatives from local movements in the society.