The Cottage Hospital Movement in England & Wales 1850–1914
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The Cottage Hospital Movement in England & Wales 1850–1914: Origins, Growth and Contribution to the Healthcare of the Poor Keith Atkins This thesis is submitted in partial fulfilment of the requirements of Kingston University for the posthumous award of the degree of PhD. December 2018 Abstract This thesis makes a significant contribution to the understanding of healthcare provision for the poor in the second half of the 19th century in England and Wales. It explores the origins behind a new type of hospital which began to emerge in the mid-nineteenth century, the cottage hospital, and attempts to fill a gap in the historiography of the rise of the hospital in the nineteenth century. It compares six cottage hospitals, three based in villages and three based in towns, and reveals marked differences (especially in comparative analyses of admissions by gender) as well as similarities. It highlights the impact of industrialisation and mechanisation on workers revealing work place accidents as the most frequent cause of admission for men. The thesis uses the writings of the founder, and his supporters, of what became known as the Cottage Hospital Movement, studying contemporary arguments, for and against, such an enterprise. It provides in depth insight into the role of the church and philanthropy and the importance of local community in the success of the hospitals, but most importantly highlights the role of the medical men as prime movers. It also exposes how local medical men were not only able to improve their standing in their local communities, but were able to improve their own knowledge and practice through the presence of the hospital. As Steven Cherry has shown, many of these hospitals survived and continue in the NHS today still offering local, in the community care. Now, as then, they are in the firing line of the ongoing debate between the desirability of small/local/familiar institutions versus the specialist/ technical but distant ‘super hospitals’. This thesis adds significantly to the historical cannon of nineteenth century medical care for the working poor, and the databases created as part of this research offer future historians the opportunity to explore the subject further. Dr Sue Hawkins, First Supervisor, 22 March 2019 Table of Contents List of Tables Figures etc ii Preface First Supervisor’s Introduction v Chapter 1 The Beginning of the Cottage Hospital 1 Movement in England and Wales, 1850 – 1870 Chapter 2 The Cottage Hospital Movement: 49 Consolidation, Expansion and Growth, 1871 – 1914 Chapter 3 Governance and Financial Management of 85 Cottage Hospitals Chapter 4 The Patients 127 Appendix 1 Database Technical Specifications 177 Appendix 2 Analysis of Cottage Hospitals by County and 179 Decade, 1860-1900 Appendix 3 Biographies 181 Appendix 4 Geographical and Chronological Dispersion 185 Maps Appendix 5 Research Methodology 191 Bibliography 207 i List of Charts, Tables and Figures Page No. Charts 1.1 Cottage hospitals opened each year between 1859 40 and 1870 2.1 No. of new cottage hospitals opened annually 55 between 1871 and 1880 2.2 Cottage Hospitals opened between 1881 and 1890 69 App 2.1 Growth of the Cottage Hospital Movement by Region, 180 1836-1940 Figures 1.1 Cranleigh Village Hospital, c1866 6 1.2 Plan of the Cranleigh Village Hospital 17 2.1 Chorley Dispensary and Cottage Hospital 73 3.1 Causes of admission, Lydney Cottage Hospital, 1904 96 3.2 Gifts given to Cranleigh Village Hospital,1887-88 98 4.1 Cranleigh Village Hospital Diet Tables 154 4.2 Diet Table for Bourton 155 Tables 3.1 Income and expenditure, Braintree & Bocking 109 Cottage Hospital 4.1 Occupation and financial status, Cranleigh Village 132 Hospital, 1860-64 4.2 Sponsorship at Cranleigh Village Hospital, 1860-1864 134 4.3 Admissions by gender, three rural cottage hospitals, 137 1875-94 4.4 Adult male admissions by disease, three rural cottage 138 hospitals, 1875-94 4.5 Adult female admissions by disease,three rural 143 cottage hospitals, 1875-94 4.6 Length of hospital stay, female patients, three rural 148 hospitals, 1875-94 4.7 Child admissions by disease, three rural cottage 149 hospitals, 1875-94 4.8 Admissions by gender/age, three town-centred 160 cottage hospitals, 1886-1907 4.9 Occupations of Chorley patients 1893-1904 161 4.10 Occupations of Lydney patients, 1897-1904 162 ii Tables continued … 4.11 Occupations of Braintree patients 1886-1907 163 4.12 Male admissions by disease at three town-based 165 cottage hospitals, 1886-1907 4.13 Female admissions by disease at three town-based 167 cottage hospitals, 1886-1907 4.14 Accident admissions to six cottage hospitals by 168 gender 4.15 Child admissions, both genders, by disease, at two 169 town-centred cottage hospitals, 1886-1907 App 5.1 1871 census population, hospital admissions and 198 database records, three rural cottage hospitals, 1875- 189 App 5.2 No. of database records and years spanned for each 199 hospital App 5.3 List of fields contained in the Patient Admissions 201/202 Databases Maps Map 1 Cottage Hospitals founded in England & Wales,1850- 186 70 Map 2: Cottage Hospitals founded in England & Wales,1850- 187 80 Map 3: Cottage Hospitals founded in England & Wales, 188 1850-90 Map 4: Cottage Hospitals founded in England & Wales,1850- 189 1900 Map 5: Cottage Hospitals founded in England & Wales, 190 1850-1915 iii iv Preface This thesis was submitted for a posthumous award of PhD. Its author, Keith Atkins, sadly passed away, as he was entering his writing-up period. It is therefore incomplete. It was examined in its incomplete form (as presented here) by an external and internal examiner who both agreed that, despite being incomplete the thesis makes a significant contribution to our knowledge of early cottage hospitals in England and the individuals who were key to the development of the cottage hospital movement. They agreed that Keith’s work was ‘original … packed with detail … and showed clear evidence of thought and analysis’. As his supervisor, I have pulled Keith’s work together and tidied it up to present here, but all the work presented is Keith’s own. The only exception is this preface, which I have written, in an attempt to explain how far Keith had got and where there were areas which we had both agreed needed further refinement. I explain where these lacunae are in this Preface. In my opinion the thesis is 75-80% complete. The first three chapters required some minor editing (especially in relation to referencing), whilst the final chapter was still in draft format, requiring some more thought about the structure and the conclusions to be drawn from it. All archival research was complete. Some updating of secondary literature was required. Keith’s aim was to study an aspect of pre-NHS healthcare in England and Wales which has been neglected by medical historians to date, the cottage hospital movement of the mid-late nineteenth century. There has been a small number of articles on cottage hospitals which focus on specific geographic areas (particularly Steven Cherry’s study of cottage hospitals in East Anglia), but no attempt has been made to survey the Movement as whole, which in the second half of the 19th century brought affordable healthcare to the rural poor. Using records from his selected hospitals (annual reports and committee minutes), the writings of some of the main players in the Cottage Hospital Movement (including Henry Burdett), and the lively discourse on the subject in v Preface the contemporary medical press, Keith’s research provides detailed insight into the Cottage Hospital Movement. It sheds light on how and why the Movement flourished in the late 19th century, the individuals who were behind it and their motives. Further, as Keith has been able to locate and use patient records from a selection of hospitals, he has also been able to study the health challenges facing the rural poor (and a lesser extent, that of industrial workers in small towns) at a time when the rural economy was undergoing as dramatic a revolution as was seen in the towns and cities. When much historical focus in this period has been on challenges to public health in the urban populations, this research offers new insights into the health of the rural population. Keith took a quantitative approach to his research, collecting data on cottage hospitals from a wide array of sources and compiling databases from which he was able to plot the geographic development of the Cottage Hospital Movement, revealing an uneven development of hospitals around the country and enabling him to ponder on why this might be? In addition to a study of rural health (or ill-health) and to a lesser extent, that of the industrial workforce, Keith’s research also encompasses subjects such as the role of philanthropy and the Poor Law in rural healthcare, and the role of women in the provision of rural healthcare services. Primary research took place at archives around the country, in Keith’s search for information on cottage hospitals. He had two objectives in mind: firstly to create a comprehensive directory of cottage hospitals in England and Wales which could be used to study the development of these institutions; secondly to identify a number of hospitals with extant annual reports and patient records which could be used to study both the work of the cottage hospitals and the health of rural (and to a lesser extent, town-based) poor. As a result of this work, he identified six hospitals (three town-based and three rural) which form the basis of this thesis. They all had extant patient records with a long enough continuous and overlapping chronology to enable meaningful comparisons to made.