A History of Britain's Hospitals and the Background to the Medical, Nursing and Allied Professions

Healthcare professionals will have varying degrees of recollection of the health service of the past, depending on their age, experience, and memory, and whether or not they are wearing rose tinted spectacles. Yet although we may remark on how many aspects of the NHS have changed in the past few decades, few of us know much about the British health service of centuries past.

Figure 1.

Book Guild, £18.50, pp 415 ISBN 1 85776 905 8 www.bookguild.co.uk

Rating: ★★★⋆

Dr G Barry, a retired honorary consultant at London's St Thomas' Hospital, and Lesley Carruthers, a medical researcher, have set out to change that. Starting in the first century ad—the earliest time for which records are available—they meticulously work through the birth and development of medical and nursing services and hospitals, incorporating topics such as the earliest monastic hospitals and lazar houses; the growth of London's hospitals; workhouses; specialist services for women, children, and the mentally ill; and the origins of the NHS and modern private sector.

The book skilfully mingles historical detail with fascinating and astonishing nuggets. For example, Westminster Infirmary, established in 1049, allowed its elderly monk patients two baths a year, and, in contrast with centuries to come, a female doctor was part of the team. So religious were the earliest hospitals that prayers were repeated up to 200 times day and night.

In the 12th and 13th centuries, many hospitals refused patients in need of special care, and confined themselves to the short term sick who were likely to recover. Private providers offering services in the contemporary NHS have sometimes faced allegations of similar activities. Similarly, there were reports of tensions between hospital managers and doctors as early as the 1700s, with doctors viewing the governors as suffocating and inefficient, and the governors regarding the doctors as their inferiors.

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St Bartholomew's Hospital in 1720. The hospital's first physician was hung, drawn and quartered

Most people are aware that Florence Nightingale dramatically improved standards of hygiene in hospitals, and there is a full account of her career here. But there are also reminders of the advances instituted by Semmelweiss in Vienna in the mid-1800s regarding handwashing, and James Lister's discovery of antisepsis with carbolic acid in Glasgow in 1867, both of which dramatically reduced mortality from infection. Hospital managers who have turned a blind eye to inadequate contracted out cleaning services in the modern NHS may be embarrassed to read that the benefits of stringent hygienic standards were recognised as early as the 12th century, with the Hotel-Dieu hospital in Paris getting through 1300 brooms a year in its daily sweeping of the wards, and the nurses washing each patient's face and hands daily.

There are also plenty of salacious and hilarious snippets. In the 1400s, for example, the matron of St Thomas' was arrested three times for drunken behaviour, while in 1535 an inspection of the same establishment found the “conduct of the master filthy and indecent” in that he kept a concubine and was stealthily selling the church riches while reporting them stolen. When physicians appeared around 1566, surgeons were rated as tradesmen and were only allowed to prescribe under the physicians' guidance. But it wasn't all good news for the new profession—the first physician at Barts was rewarded for his loyal 20 years of service by being hung, drawn, and quartered.

We may have difficulty recruiting nurses today, but how much more difficult it must have been in the 15th century, when pay was £1 a year with a daily food and beer allowance, and nurses were forbidden to leave the hospital after 7 pm in winter or 9 pm in summer, and sacked if they had the audacity to become engaged or get married. Similarly, junior doctors moaning about hours today may have heard finger-wagging tales from their consultants of one in two rotas, but the account of the first junior house officers in the NHS, who worked night and day and were only allowed a weekend off between posts, will silence both.

In their accounts of the birth of the NHS and its development the authors nobly maintain objectivity and relate political moves in a matter of fact manner. Yet, beyond the sobering facts, there is also room for cautious optimism as the goodwill of health service staff shines through.

I have a few minor quibbles. For example, I would prefer offensive terminology from the past to be in inverted commas or prefaced with “so called,” but the authors refer without qualification to bastards and lunatics. Also they mention Addison giving his name to the disease of the pancreas that he discovered, which is confusing, since most of us know Addison's disease as a condition of the adrenals. But these are tiny discrepancies in an otherwise eloquent, lively, and distinguished text.