Counties

Counties

Prior to the foundation of Hospitals those in the population who could afford to pay chose to have a Doctor attend them in their own homes. Those who couldn’t afford assistance usually had to apply for charity. Much assistance was given by the Monks before the dissolution of the Monasteries. The Elizabethan poor laws introduced parochial relief for the sick and needy, being replaced by the Poor Law Unions of the 19^th century. Provision was also made for Children in Orphanages away from the large Poor Law Workhouses.

Voluntary Hospitals were introduced as charitable hospitals usually built by funds raised by local people or out of great benevolence. These hospitals were governed by a Committee and admission was by a letter of recommendation or subscription. This practice was later ceased and financial status was ascertained by the Doctor during the admission process. Those who could afford to pay something toward their treatment did so.

A large number of prospective patients were excluded from treatment within the Voluntary hospitals, including Vagabonds, Tramps, Incurable patients, Pregnant Women, Mentally sick (classified as Insane), Patients with Infectious Diseases, and those with Chronic Conditions.

Each hospital had it’s own pharmacy with a Dispenser, and indeed many hospitals owed its foundation to the Town’s Dispensary which grew in want and need. The Hospital would also provide it’s own laundry and kitchen facilities, and provide a Hospital Almoner to assist Patients with social requirements.

Subscription schemes for Workers commenced to assist Hospital finances, but as the cost of Medical care increased a number of charity events were held to help the struggling hospitals. Gala Days, Charity Balls and Concerts to raise money were held in addition to the Saturday and Sunday Hospital movements.

A number of small Cottage Hospitals were founded in rural areas to prevent local people having to travel far. The first of which was at Cranleigh in Surrey founded in 1859. A modest weekly fee was charged to maintain the small number of beds available.

In the larger Towns and Cities, Specialist Hospitals were founded to fill the gap formed by the Voluntary Hospital omissions. Eye Hospitals, Ear, Nose and Throat Hospitals, Cripples Hospitals, Hospitals for Women and Lying In (now called Maternity).

The Poor Law Infirmaries filled the greatest void for the poor, the destitute, the sick and the aged. The change in Nursing followed the lead of Florence Nightingale and slowly improved the level of care given in Hospitals and Infirmaries.

Infectious Disease cases were sometimes admitted to separate blocks within Workhouses or often separate hospitals were provided by the Local Authority under the control of the Medical Officer of Health. Sanatoriums were operated on the basis of separation.

The Mentally Ill were treated as paupers, vagabonds or criminals (often being sentenced to Gaols or Reformatories) prior to any legislation, but the County Asylums Act 1808 allowed for the erection of County Asylums which became compulsory in 1845. Although there were a small number of privately maintained Asylums, there began a large increase in the number of County Asylums.

From the Local Government Act 1930 many Poor Law Infirmaries became large Municipal Hospitals providing healthcare for the general public. The introduction of the National Health Service in 1948 brought free healthcare to the population. Specialist Hospitals were gradually integrated into the large general hospitals to provide specialist departments. Medical and Surgical advances introduced new treatments that saw the end of any need for Infectious Disease Hospitals, many of which were modernized to provide a different type of medicine and others demolished.

Mental Health Care changed significantly with the introduction of “Care in the Community” and the large County Asylum buildings are rapidly being replaced by small short term units.

Hospitals are now redefining their provision and locating all resources onto one large site. Large new General Hospitals provide modern facilities and treatments, and the decaying architecture of the Poor Law, Voluntary and Subscription Hospital era is rapidly disappearing.