Rise of the Hospital: 1700-1900
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Rise of the Hospital: Rise of the Hospital: 1700-19001700-1900
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Islamic Medical InstitutionsIslamic Medical Institutions
HospitalsHospitals
More medically oriented than their western More medically oriented than their western counterpartscounterparts
Developed a teaching function sooner, as wellDeveloped a teaching function sooner, as well
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Types of HospitalsTypes of Hospitals
Poor law hospitalsPoor law hospitals
Royal hospitals (London only)Royal hospitals (London only) Endowed by Henry VIIIEndowed by Henry VIII
Voluntary hospitalsVoluntary hospitals First emerged in 18First emerged in 18thth century century
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Voluntary General HospitalsVoluntary General Hospitals
Also intended to care for the poorAlso intended to care for the poor
Depended on donations Depended on donations
11stst established in London in 1720 established in London in 1720 (Westminster)(Westminster)
Last – St. Mary’s (1851)Last – St. Mary’s (1851)
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Donors provided with incentives to donateDonors provided with incentives to donate
Given admitting privileges to hospitalGiven admitting privileges to hospital
Could sponsor specific patientsCould sponsor specific patients
Only sponsored patients admittedOnly sponsored patients admitted
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Hospitals controlled by the donorsHospitals controlled by the donors
Only “deserving” poor admittedOnly “deserving” poor admitted
““Undeserving” poor went to poor law hospitalsUndeserving” poor went to poor law hospitals
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Patients selected on the basis of:Patients selected on the basis of: Moral behaviourMoral behaviour UtilitarianismUtilitarianism
Preferred to admit adult males who were Preferred to admit adult males who were gainfully employedgainfully employed
Utilitarian principles influenced much of Utilitarian principles influenced much of charitable work in the 19charitable work in the 19 thth century century
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Jeremy Bentham (1748-1832)Jeremy Bentham (1748-1832) John Stuart Mill (1806-1873)John Stuart Mill (1806-1873)
An action is right only if it produces the most An action is right only if it produces the most benefitbenefit
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Voluntary hospitals competed with a wide Voluntary hospitals competed with a wide range of other charitiesrange of other charities
Needed to appeal to self-interest of donorsNeeded to appeal to self-interest of donors Enabled them to create institutions in their Enabled them to create institutions in their
own imageown image Reflected their moral anxietiesReflected their moral anxieties
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Specialist Voluntary Specialist Voluntary HospitalsHospitals
1. Lock Hospitals1. Lock Hospitals
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Admitted women suffering from VDAdmitted women suffering from VD
Reflected British middle class anxieties about Reflected British middle class anxieties about prostitutes & working class womenprostitutes & working class women
Purpose was to morally reform prostitutesPurpose was to morally reform prostitutes
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Linda Mahood. Linda Mahood. The Magdalenes: Prostitution The Magdalenes: Prostitution in the Nineteenth Centuryin the Nineteenth Century
Judith Walkowitz. Judith Walkowitz. Prostitution in Victorian Prostitution in Victorian Society: Women, Class and the StateSociety: Women, Class and the State
New approaches to old problems often signal New approaches to old problems often signal shifts in social beliefsshifts in social beliefs
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Sentimental view of prostitution in early 19Sentimental view of prostitution in early 19 thth centurycentury
Victim of seductionVictim of seduction In need of protectionIn need of protection Admission to magdalene homesAdmission to magdalene homes Served 2 purposesServed 2 purposes
Controlled sexual behaviourControlled sexual behaviour Controlled vocational behaviourControlled vocational behaviour
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Change in social attitudes at mid 19Change in social attitudes at mid 19 thth century century Prostitutes endangered morality of middle Prostitutes endangered morality of middle
class menclass men Creation of new systems to deal with themCreation of new systems to deal with them
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Glasgow systemGlasgow system Interlocking system of repressionInterlocking system of repression
Communicable diseases actsCommunicable diseases acts Magdalene homesMagdalene homes Lock hospitalsLock hospitals
Police could arrest any woman suspected of Police could arrest any woman suspected of prostitutionprostitution
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Subjected to medical examinationSubjected to medical examination If infected, to Lock hospitalIf infected, to Lock hospital If not, to magdalene homeIf not, to magdalene home
Controversy over use of speculumControversy over use of speculum
Resistance to CD acts by feministsResistance to CD acts by feminists
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2. Lying-in Hospitals2. Lying-in Hospitals
Provided limited maternity services to working Provided limited maternity services to working class womenclass women
Contributed to medicalization of childbirthContributed to medicalization of childbirth
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3. Infectious (fever, isolation) 3. Infectious (fever, isolation) hospitalshospitals Less popularLess popular
Less financial support from donorsLess financial support from donors
No one wanted them in their neighbourhoodNo one wanted them in their neighbourhood
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Case example of Winnipeg & founding of the Case example of Winnipeg & founding of the Municipal HospitalsMunicipal Hospitals
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Hospital ArchitectureHospital Architecture
In early years, any building would doIn early years, any building would do
Gradual emphasis on the role that architecture Gradual emphasis on the role that architecture played in:played in: Health of patientsHealth of patients Moral development of patientsMoral development of patients
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NightingaleNightingale
Development of Development of pavilion hospitalspavilion hospitals
St. Thomas Hospital, c. St. Thomas Hospital, c. 18701870
Design of Nightingale Design of Nightingale wardswards
2500 cu. ft. air/hr2500 cu. ft. air/hr Width 30 ft.Width 30 ft. Beds on exterior wallsBeds on exterior walls
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Debates about hospital locationDebates about hospital location
Nightingale favoured suburban or rural Nightingale favoured suburban or rural locationslocations
Controversy re: re-location of St. Thomas Controversy re: re-location of St. Thomas HospitalHospital
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Adams & Theodore. “Designing for ‘the little Adams & Theodore. “Designing for ‘the little convalescents’: Children’s Hospitals in convalescents’: Children’s Hospitals in Toronto & Montreal.” Toronto & Montreal.” Canadian Bulletin for Canadian Bulletin for the History of Medicinethe History of Medicine
Surroundings of hospital were completely at Surroundings of hospital were completely at odds with normal living conditions of working odds with normal living conditions of working class children & parentsclass children & parents
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Designed to meet two conflicting sets of needsDesigned to meet two conflicting sets of needs
Domestic ideals of middle class female Domestic ideals of middle class female supporterssupporters
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Scientific aspirations of organized medicineScientific aspirations of organized medicine
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Hospitals as Social SystemsHospitals as Social Systems
Types of patientsTypes of patients SexSex OccupationsOccupations Financial circumstancesFinancial circumstances
Type of careType of care
Length of stayLength of stay
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Therapeutic regimesTherapeutic regimes
Hospital routinesHospital routines
Moralizing strategiesMoralizing strategies
Patients’ resistancePatients’ resistance
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StaffingStaffing NursesNurses Medical staffMedical staff Medical studentsMedical students
Impact on mortalityImpact on mortality
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Crisis & ChangeCrisis & Change
Significant turmoil in voluntary hospitals in Significant turmoil in voluntary hospitals in late 19late 19thth century century
Erosion of absolute authority of hospital Erosion of absolute authority of hospital governorsgovernors
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FinancialFinancial Linkages with other charitiesLinkages with other charities Working class contributionsWorking class contributions Advent of the paying patientAdvent of the paying patient
Power struggles between governors & medical Power struggles between governors & medical professionprofession