A brief history of healthcare provision in London



The first specialist hospital of any kind to be established was the London Lock Hospital, which opened in 1786 and treated patients with venereal disease.  Such patients were excluded from voluntary general hospitals because they were deemed to have sinned.  Previously the leper hospitals (mostly closed because leprosy had disappeared from the population) and St Thomas's Hospital had cared for such patients.  Later the Middlesex Hospital and the Royal Free Hospital offered treatment for venereal disease, as did the new specialist skin hospitals.

As the 19th century progressed, specialist hospitals began to appear, some of which had started as dispensaries.  The earliest were in converted houses with a few beds, but eventually the successful ones moved to purpose-built premises.  Most were in London and specialisations covered most parts of the body - eyes, throat, nose, ear, skin, genitourinary system, gastrointestinal system, bones and joints (orthopaedic), and heart and lungs.  By 1869 there were 64 specialist hospitals in London.  Advanced in instrumentation for examination and treatment enabled surgical techniques to be developed.  Specialist hospitals found it difficult to survive competition from the teaching hospitals, which began to establish their own specialist departments.

Eye hospitals developed mainly because soldiers, who had acquired eye diseases while on service in Egypt and India, began to spread them to civilians.  The first such hospital began in 1805 as the London Dispensary for the Relief of the Poor Afflicted with Eye Disease; it is known today  as Moorfields Eye Hospital.

Hospitals for women began to appear in the 1840s.  By 1871 there were 12 in England, most built to the pavilion plan.  The Elizabeth Garrett Anderson Hospital in London is named after the first woman to qualify as a doctor in England.  Some were in effect general hospitals but only admitted women and young children (a few were staffed solely by women), while some specialized in gynaecological disease.  From the 1870s general hospitals began to set up gynaecological departments and, by the 1930s, the need for separate hospitals for women had declined.

Specialist general hospitals for children developed somewhat later.  The first to be built in England was the Hospital for Sick Children in Great Ormond Street in 1872.  By the late 1880s there were 38 children's hospitals in Britain.  The term 'paediatrics' was not widely used until the 1920s.  As with women's hospitals, specialist children's hospitals also declined.

Orthopaedic hospitals emerged in the early 20th century, mainly treating skeletal deformities, such as scoliosis (lateral curvature of the spine).  Treatment of tuberculosis of the spine, hip and other joints was painstakingly slow, involving immobilization with many months and even years of hospitalization.  Some hospitals had country branches where the patients could benefit from fresh air and sunshine, for example, the Royal National Orthopaedic Hospital at Stanmore in the 1920s.

The first hospital specializing in cancer care was the Royal Cancer Hospital, which opened in 1852 (it was later renamed the Royal Marsden Hospital).  Little could be offered in the way of treatment until the discovery of X-radiation and radium at the end of the 19th century.  Radical surgical treatment of tumours was also developed.  Chemotherapy came much later.

Hospitals for 'incurables' also appeared in the mid 19th century, many established in large houses, such as St Columba's Hospital.  These hospices offered the comfort of a domestic environment, with large day rooms and a garden.  A small private chapel was usually available.

The first purpose-built sanatorium for the treatment of pulmonary tuberculosis (TB) was the Brompton Hospital in 1854.  TB was one of the great killers of the 19th century, but was not identified as an infectious disease until 1865.  There was no cure: treatment consisted mainly of fresh air and bed rest.  By the end of the 19th century many private sanatoria had been established and it was not until the Public Health (Tuberculosis) Act, 1921, that local authorities began to build sanatoria in large numbers.  By this time X-ray diagnosis and surgical intervention (plombage) were commmonplace.  The first antibiotic against the disease - streptomycin - was not discovered until 1943.

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Barry G, Carruthers LA 2005  A History of Britain's Hospitals.  Sussex, Book Guild Publishing.

Black N 2006  Walking London's Medical History.  London, Royal Society of Medicine Press.

Smith M, Sakula A 1994  Hospital names. London, Royal Society of Medicine Press.
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