Finance, Philanthropy and the Hospital: Metropolitan Hospitals 1850-1898 KEIR WADDINGTON University College London Submitted for the Degree of Ph.D July 1995 ProQuest Number: 10055443 All rights reserved INFORMATION TO ALL USERS The quality of this reproduction is dependent upon the quality of the copy submitted. In the unlikely event that the author did not send a complete manuscript and there are missing pages, these will be noted. Also, if material had to be removed, a note will indicate the deletion. uest. ProQuest 10055443 Published by ProQuest LLC(2016). Copyright of the Dissertation is held by the Author. All rights reserved. This work is protected against unauthorized copying under Title 17, United States Code. Microform Edition © ProQuest LLC. ProQuest LLC 789 East Eisenhower Parkway P.O. Box 1346 Ann Arbor, Ml 48106-1346 Abstract Hospitals throughout the nineteenth century remained the one of the main channels for the Victorians’ voluntary zeal, but from the 1850s onwards tensions emerged as charity became ill-suited to meeting all the hospitals’ financial needs. An historiographical survey shows that metropolitan hospitals have been seen as an institution funded and administered through philanthropy, but these views are insufficient. By looking at seven hospitals in London between 1850 and 1898 a different view is suggested. Hospital governors were adept at manipulating philanthropic interests through their innovative fundraising tactics, playing on a wide range of motivations for benevolent action. Administrators used feelings from guilt to gratitude to promote support, suggesting that philanthropy and contributions cannot be constrained by any simple approach. Using the hospitals’ financial records, charitable contributions are placed in the overall context of funding in an institution that drew its income from a wide variety of sources. Over time these sources of funding changed their relative relation to one another in a process of financial diversification. Expenditure, expansion, the financial demands of different hospitals, local charitable resources, competition for funds, and popular perceptions of individual institutions all created pressures on finances that made diversification desirable. Financial diversification, however, took place in a context where the hospitals’ voluntary ethic was not affected. Hospitals experienced administrative expansions as they adopted more medical functions, but management remained on voluntary lines and administrators continued to be drawn from London’s wealthy business and social elite. Within this changing managerial structure doctors competed for authority and asserted their influence through a series of internal conflicts which often stressed the importance of medical science. A comparative investigation of the Whitechapel Union shows that a similar process of change occurred. Financial and administrative diversification was therefore more the consequence of institutional healthcare rather than a development limited to the voluntary hospitals. Contents List of Illustrations 4 List of Tables 6 Acknowledgements 8 Notes on Abbreviations 9 1. Introduction: To Prove a Need 10 Part I: Philanthropy and Funding 2. The Philanthropic Imperative 38 3. Paying for the Sick Poor 86 4. Diversification- an Explanation 138 Part II: Philanthropy and Control 5. Charity and Control: Lay Administration of the Hospital 176 6. Striving for Influence: Lay v. Medical Control 217 Part III: An Institutional Comparison 7. The Whitechapel Union 255 Part IV: 1897 and Beyond 8. State Aid Versus Voluntarism 308 9. Conclusion: 1897 and Beyond 334 Appendix: Financial Sources and Methodology 342 Bibliography 346 Illustrations Plates 1 Charity Sermon {Punch, 1868) Page 72 2 Charity Bazaar {Comhill Magazine, 1861) 74 3 Sunday Fund’s 1873 Collection {Punch, 1873) 95 4 Structure of Income Contributing to Assigned Revenue 267 5 Prince of Wales Hospital Fund Appeal Poster (1898) 320 6 Prince of Wales Hospital Fund Hospital Stamp (1897) 324 Figures 2.1 St.Bartholomew’s Hospital: Legacies Received 1850-1898 63 3.1 Sunday Fund’s Total Collections (1873-1895) 96 3.2 Sunday Fund Grants to University College London, Royal Chest Hospital and Guy’s (1873-1895) 97 3.3 Saturday Fund: Amount Distributed 101 3.4 University College London: Contributions from Funds 107 3.5 St.Bartholomew’s: Rental Income (1850-1898) 110 4.1 University College London: Income Against Expenditure 140 4.2 Royal Chest Hospital: Expenditure (1850-1898) 143 4.3 London Hospital: Expenditure (1850-1898) 143 4.4 Patient Admissions (1850-1895) 147 4.5 Royal Chest Hospital: Income Against Expenditure 150 4.6 German Hospital: Income Against Expenditure 151 4.7 Guy’s Hospital: Income Against Expenditure 166 5.1 St.Bartholomew’s: Patient Admissions 1870, 1898 207 5.2 Guy’s: Patient Admissions 1855, 1875, 1898 208 5.3 German Hospital: Patient Admissions 1855, 1875, 1893 212 5.4 London: Register of Operations (1852-1862) 214 7.1 Receipts-in-Aid: National Awards (1850-1897) Page 262 7.2 Whitechapel Union: Income (main) 1890-1895 265 7.3 Whitechapel Union: Income (other) 1890-1895 270 7.4 Whitechapel Union: Patient Admissions 1851, 1871, 1891 277 Maps 1 Distribution of Hospitals in London (1883) 160 2 Poverty in Whitechapel 280 Tables 1.1 Increase in London Hospital Treatment Page 25 3.1 Income from Direct Philanthropy by Institution (1892) 90 3.2 Income from Direct Philanthropy 92 3.3 Congregational Contributions to the Sunday Fund 99 3.4 Institutions Assisted by the Sunday and the Saturday Funds (1897) 104 3.5 Contributions of Benevolent Funds to Individual Hospitals 106 3.6 Income from Rent 113 3.7 Income from Investments 114 3.8 Income from the Sale of Invested Property 117 3.9 Income from Poor-law Patients 122 3.10 Patient Payment by Hospital Type (1897) 124 3.11 Guy’s: Inpatients’ Payments (1886-1898) 127 3.12 Income from Nursing 130 3.13Income from Loans 131 3.14 German Hospital: Income (1851-1895) 135 3.15 St.Bartholomew’s: Income (1863-1895) 136 3.16 Guy’s: Income (1853-1895) 136 4.1 Hospital for Sick Children: Expenditure 142 4.2 St.Bartholomew’s: Expenditure 142 4.3 Guy’s: Income from Landed Property (1875-1891) 167 5.1 Social Composition of Governors in West Bromich and Dudely (1867-1900) 197 5.2 Social Composition of Active Governors in London Hospitals (1850-1898) 197 5.3 Occupational Structure of German Community in London 210 7.1 Whitechapel Union’s Borrowing (1890-1898) 266 7.2 Persons Given Poor Relief in the Metropolis on Sample Days in January (1850-1900) 274 7.4 Residence of Whitechapel Infirmary Inmates (1894) Page 219 7.5 Whitechapel Union: Expenditure Increase 282 7.6 Occupational Background of Elected Guardians (1853-1873) 285 8.1 King’s Fund: Income (1897-1898) 323 Acknowledgments My research has been based on the archival sources of the eight medical institutions covered in this study and I would therefore like to thank the various archivists who have faithfully hunted down the records I have requested: Ms Gillian Furlong at University College Library; Geoffery Yeo, Andrew Griffen and Caroline Jones at the City & Hackney Health Authority Archive, St.Bartholomew’s; Nicholas Baldwin at Great Ormond Street Hospital, and Jonathan Evans at the Royal London Hospital. I am also grateful to the staff of the Greater London Records Office from whose archive at least half my primary sources have been drawn, as well as the staff of the Wellcome Institute for the History of Medicine Library, University of London Library, Institute of Education Library, University College Library, British Library and the Guildhall Library who have provided valuable help. My main debt lies with my supervisor. Professor Martin Daunton, who saved me from working on ‘social control’ and introduced me to the social history of medicine. His unerring questioning has helped guide my research. The same needs to be said of my second supervisor. Dr Ann Hardy, who provided useful assistance and encouragement on the medical side of my work and has faithfully read and commented on everything that I have produced. Gratitude is also owed to Abigail Beach, Amanda Berry, Steve Cherry, Anne Crowther, Martin Gorsky, Negley Harte,Colin Jones, Paul Johnson, Patrick O’Brien, Frank Prochaska, and Richard Weight, for their suggestions. Special gratitude is owed to Mark Allinson whose invaluable comments have been of much use and to Michelle Elvin for keeping me sane and reading with tolerance several first drafts. Any mistakes are of course my own. I wish to acknowledge the support of the British Academy, the Institute of Historical Research and Royal Historical Society, whose funding made my research possible. Abbreviations BMA British Medical Association BMJ British Medical Journal COS Charity Organisation Society FWA Family Welfare Association LCC London County Council LGB Local Government Board MAB Metropolitan Asylums Board NHS National Health Service PP Parliamentary Papers RC Royal Commission RCH Royal Chest Hospital SBH St.Bartholomew’s Hospital SC Select Committee UCH University College Hospital 1 Introduction: To Prove a Need 1. THE METROPOLITAN HOSPITAL SYSTEM The publication of the Tomlinson Report in 1992 was the ninth in a series of government sponsored investigations into the London hospitals/ Following closely behind a survey of primary healthcare by the King’s Fund and the government’s National Health Service (NHS) reforms, the Report generated public interest and a wave of panic among hospital administrators/ Over a century ago, in 1890, a Select Committee of the House of Lords was established to investigate similar concerns. The Committee sat for two years and addressed the structure, finance and nature of healthcare in London, concerns that the Tomlinson Report returned to. Where the Select Committee vacillated, only weakly recommending a modicum of central supervision and relocation, its twentieth-century counterpart called into question the very pattern of development, organisation of finance, and nature of healthcare in London.^ In the three years following the Report's publication the outpatients’ department at St.Bartholomew’s has been closed and the fate of Guy’s and St.Thomas’s remains undecided.