A History of Britain's Hospitals and the Background to the Medical, Nursing and Allied Professions
Authors: Irvine Loudon
Journal: Journal of the Royal Society of Medicine (2006)

To attempt such an undertaking as a history of British hospitals from ancient times to the present requires, if it is to be successful, great skill in historical analysis and the ability to distinguish between the important and the trivial. What we have here, however, is a book packed with facts and dates mostly about the architecture, sites, and founders of hospitals, and little about the concepts and practice of hospital medicine. The emphasis is conspicuously on London and the home counties. London's general and special hospitals get about twice as much space as the much more numerous provincial hospitals. To a deeply disturbing extent, important facts rub shoulders with utter trivialities. A typical example is the Royal Hospital for Sick Children in Glasgow, founded in 1882. After writing at length about the troubles with funding and location, the authors tell us that this hospital had:


`... three wards, one on each floor, each painted with reproductions of Randolph Caldecott's illustrations of nursery rhymes. The lower parts of the walls were lined with green tiles with a narrow red border... There was also a mortuary where the floor was of marble mosaic and round the walls ran a dark grey wreath-patterned frieze with the words “Not dead but sleepeth”'.


Three pages are devoted to this kind of detail, but we are told nothing about the children who were admitted, the spectrum of disease seen at the hospital and the mortality rates, the treatments used, the work of the medical staff, and whether this hospital was integrated with other paediatric institutions. In a book where space is desperately needed for the important, such trivialities abound.

Conversely, some of the major events in Britain's hospitals are ignored. For instance, the authors tell us a lot about the various sites occupied by Queen Charlotte's (maternity) Hospital, including the opening in 1929 of a special unit containing a laboratory to study the treatment of puerperal fever. Yet there is no mention of the fact that in this very unit Leonard Colebrook carried out a series of clinical trials in the mid-1930s which showed the dramatic effect of the sulphonamides in curing puerperal fever—which was by far the most important discovery in the history of maternity hospitals. Nor is there anything about the Glasgow Maternity Hospital where, in 1888, an obstetrician, Murdoch Cameron, was the first surgeon anywhere in the Western World to show that Caesarean section could be carried out as a safe operation. Indeed, it was so famous at the time that Caesarean section became briefly known as the `Glasgow Operation'.

The book's greatest merit is the publication of over 200 illustrations; the large majority being illustrations of hospitals. Many of these are striking, yet even here there are oddities. On pages 318 and 319 there are two portraits facing each other. They are the only two portraits of hospital doctors in the book. The first is entitled `“A Great Surgeon” (Dr Bland Sutton)' and the second has the title `“Orthodoxy” (Sir William Henry Broadbent)'. There is nothing in the title or the text to say who they were, when they lived, or what they did. Searching elsewhere I found that `The Great Surgeon' is in fact Mr (not Dr, but later `Sir') Bland Sutton (1855-1936) who worked at the Chelsea Hospital for Women, and Sir William Henry Broadbent (1835-1907) was a physician at St Mary's Hospital in London. This may seem a trivial criticism, but it characterizes the eccentricity of the book as a whole. If the authors planned to include portraits why did they select only two; and why choose two such obscure figures when they could have chosen from such names as Hunter, Abernethy, Astley Cooper, Paget or Parkinson?

There are two or three chapters in which there is an attempt at historical analysis—notably chapter 12 on the evolution of the medical profession—but they are not successful. Where the authors venture into the history of apothecaries and general practitioners they go badly wrong; except for the chapter on cottage hospitals which is one of the best in the book. Far too much of the text resembles a collection of tit-bits taken from local histories such as:


`A porter had to be employed to carry the patients upstairs for their treatment. Another venture was the employment of midwives at 3s 6d a delivery to carry out domiciliary confinements, although several had to be sacked for fraud, conniving with the patients'.


That comes from the section on Charing Cross Hospital in the 1820s. Multiply this and the other trivial details by at least 100 and you will have a sense of the contents of the book as a whole.

This is a work which cries out for footnotes but there are none and the reader cannot check the origin of any of the contents. There is an index of illustrations, there is a short and unsatisfactory general index, and a relatively brief and decidedly eccentric bibliography. But you will not find a better collection of illustrations of British hospitals.