Reference and contact details: GB
Title: Hospitals and related institutions in the Manchester area
Dates of Creation: -2002
Reference: Former reference: MMC/J
Extent: 1635 items
Name of Creator:
The history of hospitals in Manchester is also important to the history of hospitals in general; Manchester, partly as a result of its part in the industrial revolution, was one of the earliest centres of provincial medical education and its hospitals saw a number of medical 'firsts'. The particular medical issues which developed in this early industrial town gave the hospitals in Manchester unique experience which would put them at the forefront of scientific developments.
In 1752 the first hospital in Manchester was founded; named the Manchester Infirmary, it is now known as Manchester Royal Infirmary (MRI). The Infirmary was a voluntary hospital, or infirmaries as they were commonly known, were set up for the benefit of the poor. By the early 20th century, Manchester had rapidly grown into a large city with a correspondingly large number of hospitals. There were large Poor Law hospitals, a number of provident dispensaries, and voluntary hospitals of all descriptions. In the nineteenth century, with the establishment of a new Poor Law system of welfare relief, Poor Law Hospitals (which were attached to workhouses) were set up to treat the destitute. The Poor Law hospitals, which treated the huge majority of patients, were governed locally and attempts were made to coordinate hospital provision for different types of patients across Manchester and Salford, especially after the reorganisation of the Unions in 1915. From the 1870s, provident dispensaries were set up, paid for by subscriptions from usually working class patients. The provident dispensaries aimed to coordinate provision across the region, but in competition with the Poor Law and voluntary hospitals they never became universal.
Voluntary hospitals, of which there were many, were essentially independent of the local government and of each other. Some served a need which was not addressed elsewhere, other duplicated services. Some changed in response to changing needs and survived, many failed to raise sufficient funds and closed. However, despite this heterogeneity, Manchester was at the forefront of coordinated hospital provision.
After the First World War, hospital treatment became the norm for all classes of society, though private patients were usually accommodated in separate wards. Voluntary hospitals became increasingly influenced by health authorities. Many were dependent on payments made by local authorities to fulfil statutory responsibilities (for example, fever cases sent to Monsall Fever Hospital). An increasing number of patients resulted in pressure on beds and transfer of patients between hospitals. A controversial case of a patient who died while being moved from St Mary's Hospital led to greater coordination of the public and voluntary sector. Ambulances took accident victims to the nearest hospital, irrespective of the status of the patient. Gradually the distinctions between hospitals became less visible, though differences remained. Some voluntary hospitals were defensive of their status, but many worked closely with local authorities. The Local Government Act of 1929 provided for the establishment of committees linking voluntary and public hospitals to improve hospital coordination. Few local authorities acted as quickly as Manchester; the Manchester Joint Hospitals Advisory Board met for the first time in October 1935. Manchester had shown its progressive nature, making considerable advances in hospital coordination before the second world war. Recognising the likelihood of mass civilian casualties, hospital accommodation was planned in advance. This experience of a planned national system, involving public and voluntary hospitals, was a stepping stone to the National Health Service. It showed the benefits of coordination, including possibilities for greater specialisation, and also showed up gaps in provision.
With the advent of the National Health Service in 1948, free hospital treatment was available to everybody, and hospital services could be managed centrally for the first time. National Health Insurance, which was in many ways the forerunner of the NHS, had only covered tuberculosis hospitals. There was some opposition to the NHS, especially from the small voluntary hospitals, but most hospitals in Manchester became part of the new service. Cheadle Royal Hospital was the most significant exception, becoming a private hospital. The development of coordinated efficient services meant the merger of some hospitals, although few hospitals were closed. The University teaching hospitals, which included Withington Hospital (South Manchester University Hospital), had a different status. Subsequent reorganisation of the NHS in the 1970s and 1980s led to the closure of many small hospitals. The creation of trusts in 1991 saw the merger of the hospitals on the Oxford Road site into the Central Manchester Healthcare Trust and the merger of the old voluntary Salford Royal Hospital with the previously local authority Hope Hospital.
The first hospitals in England were voluntary hospitals, and Manchester was no exception. They were charitable establishments staffed by unpaid doctors and funded by subscribers who nominated (or 'recommended') poor patients. In the early years, voluntary hospitals were often called infirmaries, as 'hospital' was a more general term for charities offering accommodation. Voluntary hospitals were extremely varied; they included general infirmaries, dispensaries, specialist hospitals and colonies. Most specialist hospitals, particularly in Manchester, were founded as voluntary hospitals. Voluntary hospitals were established for a variety of reasons, some were founded to address a particular problem, others were set up as a result of an individual doctor wishing to develop a specialty. This often resulted in an overlap of services and many hospitals did not survive.
To be admitted for treatment at a voluntary hospital, a patient would need a nomination from a subscriber who would attest to the need of the patient for medical care and their inability to pay for it. Patients had to be so poor that they could not pay for treatment privately, but not so destitute that they were covered by the Poor Law. Sometimes the subscriber would also judge whether the patient was 'deserving' of the charity. It could be difficult to gain admission, patients often had to seek out a subscriber willing to nominate them. Most infirmaries excluded infectious diseases, children and midwifery cases. These would usually have been dealt with by dispensaries as home-patients, or by specialist hospitals. The system of recommendations gradually died out, triggered at first by dispensaries and some specialist hospitals, and by the 1900s, the decision to accept or reject patients lay in the hands of medical staff [hospital work funds, charitable donations/contributory schemes - those contributing would not have to pay for treatment). Voluntary hospitals admitted patients in three categories; in-patients were treated in the hospital, home-patients (or domiciliary patients) were treated at their homes and out-patients attended for treatment. Many hospitals began with few in-patients, as beds required higher capital expenditure for larger buildings. However, the home-patient service was unpopular with the medical staff as most patients lived in insanitary conditions. At Manchester Infirmary in particular, doctors were reluctant to work in insalubrious areas of the town where they were exposed to disease and crime. As medical education gained importance in Manchester, many hospitals supported clinical training by expanding capacity for in-patients. Home visits later became unusual, except for maternity cases. Voluntary dispensaries differed from the infirmaries in that they did not admit in-patients instead concentrating on out-patients. It was usual for dispensaries to be established by radical doctors independently of infirmaries, but in Manchester, whose politics tended to be radical, the Dispensary formed part of the Infirmary. Some independent dispensaries were formed, in particular in areas outside the geographical remit of the Manchester Infirmary. By the end of the nineteenth century, most voluntary dispensaries had closed or become out-patients departments of hospitals.
Voluntary hospitals were usually governed by a Board of Trustees, consisting of people who had given significant subscriptions. There was often also a Medical Board which included the honorary medical staff of the hospital. There was often conflict of opinion between the Board of Trustees and medical staff, especially relating to appointments. The Boards of voluntary hospitals were usually not publicly accountable. However, voluntary hospitals tended to have good reputations, as this was crucial to raise subscriptions. The surgeons and physicians of voluntary hospitals provided their services voluntarily. These doctors, often referred to as the honorary medical staff, gained most of their income from private practice. However, philanthropy was only one of the reasons doctors took positions in voluntary hospitals. An honorary position could gain a doctor valuable experience and reputation - election to the staff of Manchester Infirmary usually resulted in successful private practice. Doctors often saw employment at a dispensary or smaller hospital as a stepping stone to employment at Manchester Infirmary. The appointment of medical staff was usually decided by elections, controlled by the trustees. At Manchester Infirmary, these elections were often closely fought and sometimes controversial; medical experience was not necessarily the deciding factor. However, qualifications at one of the Royal Colleges was a requirement for honorary staff at most voluntary hospitals. They were in charge of the medical care of patients, but were later supported by paid junior medical staff. Honorary staff often received payments from medical pupils. The teaching staff of independent medical schools often used appointments at dispensaries or the smaller specialist hospitals to provide clinical training.
Voluntary hospitals were funded by charitable donations, legacies and subscriptions; subscriptions usually formed the largest proportion of income. Many subscribers were motivated by a philanthropic wish to alleviate distress and to restore the afflicted to respectability and independence. This motivation links the infirmaries of the eighteenth century to the earlier idea of hospitals as places of refuge. There was a wide variety of subscribers, some of whom gave large amounts of money. The value of the subscription often determined to the number of patients who could be nominated by a subscriber; at Manchester Infirmary, an annual subscription of two guineas purchased rights for two out-patients and one in-patient at any time. In Manchester the wealthy classes included considerable numbers of factory and warehouse owners, many of whom used hospital subscriptions to ensure that their workforce would be admitted. Although the different motivations behind giving to hospitals varied in significance, it was a popular form of charity as it was secular, generally non-political and accessible to the moderately wealthy.
Income from subscriptions was the basis for the voluntary hospital system but was not without its problems. Most hospitals struggled financially on a day-to-day basis and many were forced to close. This particularly affected hospitals in poor areas with more poor patients and fewer wealthy subscribers, and hospitals with less picturesque objectives - such as the Lock Hospital for the treatment of venereal diseases. Many specialist hospitals regularly had to change premises in response to changing financial situations. Financial instability made voluntary hospitals reluctant to treat people who were unlikely to recover quickly, as such cases would drain resources and have a negative impact on the reputation of the hospital. Nominations, and consequently subscriptions, gradually became less important. Dispensaries and hospitals began to accept accidents and emergencies without nominations and some later extended this for all admissions. Many voluntary hospitals ran appeals; a bazaar in 1875 raised the huge sum of AD24,000 for the Royal Children's Hospital. Funds set up by worker's groups, such as the Hospital Saturday Fund, became increasingly important to voluntary hospitals. Payments for cases treated on behalf of poor law boards and local authorities were often an important part of income, as increasingly were payments from patients themselves. Nevertheless, the income of voluntary hospitals remained erratic and the rising popularity of hospital treatment left hospitals unable to cope with demand for beds.
Between 1884 and 1908 most of the major voluntary hospitals in Manchester moved to a site on Oxford Road (where Central Manchester Healthcare Trust is today). This radically changed the face of hospital provision in Manchester, but was the result of a slow process. Since the mid nineteenth century, there had been pressure on Manchester Royal Infirmary to move from the grim environs of Piccadilly to an out-of-town site. The pressure mounted in 1870 when Owens College and the medical school merged in a new site in Rusholme (where the University campus is today). Many medical men wanted closer cooperation between the hospitals and the College, but conservative opinion held sway and the Infirmary remained in Piccadilly. In 1884 the Royal Eye Hospital was the first hospital to move to Oxford Road, where it cooperated closely with the College. When Sir Joseph Whitworth died in 1887, his legacy enabled land to be purchased for a hospital near Owens College and the Eye Hospital. However, this was not made use of until 1892 when the Cancer Pavilion and Home was founded (later Christie Hospital in Withington). In 1893 the Southern Hospital moved to the site, where it merged with St Mary's in 1903. MRI finally followed in 1908. Led by increasingly scientific professionals and backed by wealthy industrialists, this complex of hospitals working with the medical school became the centre of medicine in Manchester.
Voluntary hospitals in Manchester played a vital role in hospital provision during the two world wars, providing much needed beds and expertise. However, the interwar years proved financially difficult for voluntary hospitals, especially general hospitals. Hospital care was more popular than ever, but increasing state provision made it difficult for voluntary hospitals to make a case for charity. However, MRI and many specialist voluntary hospitals were still at the cutting edge of medical developments and employed the best staff. Although they were small compared to the local authority hospitals, voluntary hospitals were a crucial part of hospital provision. With the arrival of the National Health Service in 1948, most voluntary hospitals became part of the Service. Many merged with other hospitals and a small number were closed or became private hospitals.
Poor Law Hospitals were provided by local Poor Law Unions to care for sick paupers. In areas like Manchester with widespread destitution, Poor Law Hospitals played an extremely important role in hospital provision. Poor Law hospitals began their history in workhouses. Most workhouses had a medical officer, and sometimes even a medical ward, but only in later years did the hospitals become identifiable institutions. Workhouse hospitals were staffed by paid resident medical officers in charge of patients, in contrast to the system of voluntary hospitals which were staffed by unpaid consultants. Poor Law hospitals took the vast bulk of patients and formed the first organised hospital system. The Poor Law Hospitals were usually general hospitals, but in later years the state provided for mentally ill and infectious patients in separate hospitals. While these hospitals were subject to changes brought about by national legislation, there were still local factors which affected the way in which they developed in Manchester.
Workhouses, especially since the 1834 Poor Law Act, were places of last resort for people incapable of earning a living or without family support. Many of these people were ill or frail, but on entering the workhouse became part of a system whose primary aim was to deter the able bodied from seeking aid. The Act however did suggest separation of the sick and old from the able-bodied. Even before the Act, Manchester Workhouse had a resident surgeon and separate wards for the sick. The Act led to the appointment of poor law medical officers, who were underpaid and often had huge workloads. However, the Poor Law had little effect on the work of the charities - who often saw a reduction in income because ratepayers were now paying money for care under the Poor Law.
Workhouse hospitals had large numbers of chronic cases who required long term care, a significant proportion of patients were elderly or psychiatric patients, there were few acute cases. This was in stark contrast to the voluntary hospitals who concentrated on acute cases and generally rejected patients with chronic diseases. However, the proportion of acute cases treated at workhouse infirmaries rose, and workhouse infirmaries grew substantially to provide the full range of hospital services. Increasing prosperity in the mid-nineteenth century led to a smaller proportion of able-bodied people in workhouses and a corresponding rise in classification and separation of inmates, such as children, lunatics and those with infectious diseases.
The large populations of the Unions in the Manchester area led to more rapid segregation and medicalisation than in smaller unions. In the 1850s, new workhouses were built for Manchester, Chorlton and Salford Unions. In both Manchester and Salford, the new workhouse was for the able bodied while the old workhouse buildings became the infirmary. By 1866 the Manchester Workhouse infirmary held 1,319 patients, and was perhaps the largest hospital in the country. A new workhouse in Withington was built for Chorlton Union in 1855, however, the infirmary soon proved to be inadequate. Overcrowding was a huge problem in workhouse infirmaries, and increased the risks from infection. Infirmaries were often the most significant part of the workhouse, and later took over whole workhouse complexes. This was a practical solution, but the hospitals often found their reputations tainted by association with the workhouse. The vast numbers of patients treated in workhouse infirmaries and the very limited resources tended to result in poor sanitary conditions and levels of care. There was an increasing emphasis on the provision of medical care, but this was accompanied by an increasing awareness of the inadequacy of this care.
Chorlton Union Hospital in Withington sought to address these problems. It was built in the 1860s on an out-of-town site to a design by the architect Thomas Worthington. The hospital was designed according to the pavilion system, with separated wards coming off a central corridor. This enabled good ventilation of wards and easy communication between wards and was seen as the best design of hospital to reduce infection. However, this style of hospital was seen as expensive, prohibitively so for workhouse hospitals. The Chorlton Union Hospital was the first Poor Law hospital to be built on this style, and Florence Nightingale congratulated Worthington on building 'the best and cheapest hospital... that has yet been built'. Chorlton became a national model for architecture and organisation of workhouse infirmaries. It was also significant for the development of nursing and nurse training in the hospital which was highly unusual for a Poor Law hospital.
In 1915, the Poor Law Unions in Manchester were rearranged, and a number merged. This led to better hospital provision across the Unions, with two large general hospitals, Crumpsall service in the north and Chorlton the south, and Booth Hall hospital becoming a dedicated children's hospital. These were large, comparatively modern pavilion hospitals on good sites. They compared favourably to other authorities, and the hospitals were also eager to improve their reputation in comparison with voluntary hospitals. In Salford, Hope Hospital was also a relatively new pavilion hospital, but was built and run very cheaply. By the 1920s Hope was overcrowded and had poor facilities compared to the Manchester hospitals. After the 1929 Local Government Act, the Poor Law Hospitals were taken over by the Manchester and Salford Corporations. In Manchester, they were managed by the Manchester Public Health Committee. The hospitals continued without immediate radical change, but some private hospital wings were developed and the poor law hospitals began developing specialist treatment. However, local authority hospitals struggled to avoid association with their Poor Law past. When the National Health Service was formed in 1948, Local Authority hospitals formed the backbone of the service. They were still the largest hospitals, but often their experience in dealing with large numbers of chronic cases was not given as much recognition as the medical and surgical expertise of voluntary hospitals. The NHS saw a number of Local Authority hospitals merge with voluntary hospitals, such as Crumpsall with North Manchester Hospital. This pattern has continued with the formation of trusts in the 1990s which saw the merger of Hope Hospital with Salford Royal Hospital.
During the Victorian period, there was a major change in attitude regarding charity. It was increasingly thought that there was a growing dependence on medical charities and that charity encouraged such dependence. Many thought that charity should be replaced with a system which encouraged poor people to be self-reliant. This led to the creation of Provident Dispensaries; these were funded by poor people who became members of the dispensary and were thus entitled to receive treatment free or at a reduced rate. The role that provident dispensaries played in the provision of hospital services is not widely recognised.
Manchester and Salford District Provident Association was founded in 1833 to encourage the working class take responsibility for their health and enable them to pay for medical care, as there was seen to be a growing dependence on medical charities. However, it was not until the 1870s that this scheme was actually applied to dispensaries. There was some opposition to the idea from local practitioners and hospitals as it threatened to reduce their patient numbers. However, the provident scheme aimed to reduce dependence on and inappropriate use of medical charities and so gradually became accepted, if anything, the provident dispensaries were hampered by the provision of free care at voluntary dispensaries.
Manchester and Salford Provident Dispensaries Association was founded around 1873. It aimed to divide Manchester and Salford into districts and provide a provident dispensary in each district. People who could not afford medical fees, but were not cared for under the poor law, would pay to become a member of their local dispensary. Once they were a member they could receive medical care at the dispensary for little or no charge. The medical staff of the dispensaries were often paid from the member subscriptions. The Dispensaries Association also had agreements with many local voluntary hospitals who would accept provident patients when referred from the dispensaries. The provident dispensaries were not charities and this was stressed to the members, although some were supported by charitable donations. However, many dispensaries struggled financially as they tended to be joined by people in need of treatment, rather than by the healthy. In 1905 a Royal Commission reported on the Poor Law and the relief of distress, and a majority of the Commission recommended that the dispensary system be widely extended. However, a minority strongly opposed any extension of the system and as a consequence the National Health Insurance Act of 1911 did not make special mention of dispensaries. Provident Dispensaries continued to treat women and children, who were not covered by the insurance scheme, but the establishment of the National Health Service in 1948 made most dispensaries redundant.
Sub-group comprising material on hospitals in Manchester area, and administrative bodies co-ordinating the work of hospital services such as JHAB and MRHB. The material for each hospital varies greatly in quality and type. However, there are sets of annual reports (in some cases complete) for some hospitals, together with rulebooks, material relating to the history of the hospital, its staff, medical services and building, and ephemera relating to social events and activities. The bulk of the material dates from the pre-NHS, and is most prolific for the older and more central hospitals in Manchester. Unsurprisingly the collection for the Manchester Royal Infirmary is the most substantial, and collections for St Mary's Hospital, Salford Royal Hospital, the Royal Eye Hospital, Manchester Royal Children's Hospital, Pendlebury, Christie Hospital, the Manchester Hospital for Consumption and the Dental Hospital.
Arranged by individual hospital.
Divided into 69 sections
The official archives for the hospitals described in MMC/9 are in nearly all cases retained by the hospital in question or by a successor institution. Details of the archives of Manchester Hospital can be found in a slightly dated volume, Liz Coyne, Dennis Doyle, and John Pickstone, A guide to the records of health services in the Manchester region: Volume 1 Hospital services (UMIST 1981).