In the 20th Century we take hospitals for granted. If we are seriously ill, need
an operation or have an accident we expect to find a hospital nearby. We assume
that skilled medical, nursing and other staff will be available to look after as
and that safe and effective treatment of various kinds will be forthcoming. We forget
that until recently none of these things was true.
Even by the 18th century, the only institutions caring for the sick in England were
those that had developed from religious orders, such as St Thomas's and St Bartholomew's
in London. These were places for general and spiritual care rather than for skilled
management and cure. For example, in the 14th century St Bartholomew's Hospital
took in "sick persons found in the streets of the city and all the wounded or injured
who chose to apply for relief." The instruction for receiving a patient was that
"having confessed his sins to the priest he shall be communicated religiously and
afterwards be carried to bed and treated there as Our Lord according to the resources
of the house." The patients were looked on as representing Christ and were referred
to as "Our Lords the Sick."
Nottingham too had its hospitals, not so large or well endowed as St Thomas's, and
so they eventually disappeared. One of them, the Hospital of St John, stood at the
corner of Parliament Street and Glasshouse Street, where the central market was until
it was moved to the Victoria Centre. From about 1602 until 1720 it was used by the
Corporation as a workhouse, or "house of correction" as it was then called.
However, by the late 18th century, an awakening of social conscience led philanthropic
individuals and groups to found hospitals with a special concern for the sick. By
1800, thirty-eight been created in England and in this booklet we describe the story
of one of them, the General Hospital Nottingham, together with the associated hospitals
which grew up near to it.
THE FIRST 100 YEARS
In 1778 John Key, a member of a Nottingham banking family, died at his home at Fulford,
York. In his will he set out to create two hospitals; one bequest enabled a County
Hospital to be built at York, and the other bequest provided £500 for a County Hospital
or Infirmary for Nottingham "provided that £1000 be raised by subscription within
five years of my decease." At a public meeting in 1780, it was decided to take up
the offer; site was chosen just outside the town near Derry Mount, where Charles
1 had raised his standard in 1642. This land had formed part of the Northern Bailey
of the Royal Castle but had passed into possession of the Duke of Newcastle when
the castle was razed to the ground and the Duke's town house was built on the site.
The Duke gave 1 acre of his land and £300, the Corporation adding another acre.
The cost of the proposed building was £3300 so a subscription list was raised. Ready
support came not only from Nottingham but also from Derbyshire since that county
did not have its own hospital until 1810. Prominent among the early subscribers
were Sir Richard Arkwright and Hon. Henry Cavendish. The latest subscriber was Peter
Nightingale, of Lea in Derbyshire, great-uncle of Florence.
John Simpson was appointed as architect and by 1781 the organising committee felt
confident that sufficient funds for the building would be forthcoming. On February
12, a procession led by the Mayor and Corporation strangled from the Town Hall to
Derry Mount, to lay the foundation stone. Under the stone, they placed some coins
and an inscribed plate. The latter came to light 100 years later when the Jubilee
Wing was being built.
In 1781, Derry Mount was an open space inside the old Town Wall which in the Middle
Ages ran down Butt Dyke (now Park Row) to the main gate into Nottingham from the
west at Chapel Bar. The smaller gate, to admit two riders, pierced the wall and
is commemorated by the present name of Postern Street. The only building near Derry
Mount watched the Duke of Newcastle's town house on the site of the former Castle.
The Castle Park (now the Park estate) and open fields lay below the hills to the
West and the North. This open site explains the quaint title of the General Hospital,
Building proceeded and by September 18, 1782, everything was ready; the two-storey
building was complete and ready for its first patients but first there had to be
a grand opening. This time the Mayoral procession walked from the hospital to St
Mary's Church. Tickets had been sold at 2/6d her head for the church service "to
prevent the common people from coming from the country and the common people of the
town from leaving their work and crowding the church doors to get in." The day ended
with a gargantuan dinner at Thurland Hall and a concert and ball at the Assembly
The hospital provided forty four beds but stringent controls were exercise over there
would-be occupants. No one with "smallpox, itch or other infectious distempers and
none who are disordered in the senses were to be admitted. No patient can be admitted
(except in cases of accidents) without a recommendatory letters signed by a subscriber",
and recommendations were in proportion to subscriptions given. For one hundred pounds
down or five guineas annually a subscriber could recommend " six in-and twenty outpatients
annually but shall not held more than two at any time in the house." However, subscribers
her duties as well as rights and "in the case of death the person who recommended
the deceased must either remove the corpse or defray the expenses."
The population of Nottingham had grown apace and being confirmed within its mediaeval
boundaries because of the strangling ring of common land, notorious Nottingham slums
had grown up. Charity towards the poor was the main spring of the hospital of which
"the objects of it are such only as are in real Distress... for the poor, as much
as we are apt to overlook them are a very necessary and useful part of the community,
nor ought to be forgotten that to the sweat of their brows and to the labour of their
hands it is owing that the rich enjoy the accommodation of ease and pleasure." The
value of an institution such as the hospital was that "good effects are produced
at a very small expense…distressed objects are taken care of in the infirmaries for
a tenth part of what must be spent on them in their own habitations."
To get into hospital the "object of distress" had to present himself at the hospital
on Tuesday with a letter of recommendation. After examination by the physicians
and surgeons, he was then questioned by the Weekly Board to ensure that he was "a
proper object of charity." Apprentices and domestic servants could only be admitted
if their employers paid six shillings per week and persons who were not "object to
charity, but could not afford a grand operation" could also pay six shillings per
week to be admitted.
Patients were allowed "no provisions, liquors or medicines from anyone outside the
house, nor give any money or gratuity whatever to nurses or servants." Games were
forbidden and there was to be "no cursing, swearing or abusive language or rude or
indecent behaviour." Smoking was allowed by permission of the physicians and surgeons.
Patients had to be up at 7 a.m. and in bed by 8 p.m. in winter and 9 p.m. in summer;
they were then locked in by the Matron. Breaking the rules could lead to instant
discharge, the patient thereby being debarred from future admissions. Inmates were
expected to work in that "such patients as are able shall assist in nursing other
patients, washing, ironing and cleaning." The hospital got its water from a well,
though it was only in 1813 that a steam engine was installed because it was "not
thought proper for the patients to be employed in pumping."
The idea that nurses needed skill and training did not gain acceptance until the
mid 18th century, so when the hospital opened, the nursing staff were seen as housekeepers.
By 1834 the hospital owed only 4 tablespoons, 4 dessert spoons and 6 teaspoons and
the Matron had to "hold herself responsible for their safety." In 1854 she was instructed
to appoint one of the nurses to search the female visitors of patients to ensure
that nothing undesirable was being bought in. The early Matrons were paid £12 per
annum plus 3 guineas for tea, and the only qualities required of them and their nurses
were that they should be moral, of good health, be able to write and keep accounts,
be orderly and clean, and be able to deal with household economy. The Matron locked
in the patients at night, and thereafter they were attended by “Watchers" recruited
from the town women for sixpence per night. Supervision of the staff was delegated
to "House Visitors" appointed by the Board. They visited the wards once-a-day, the
nurses withdrew, and the patients were asked "if the servants had done their job."
In 1831 A Matron was sacked because the patients had not been washed every fortnight.
The visitors then viewed "meat, provisions and malt liquor" to ensure that the patients
were receiving their allowance of 14 ounces of bread and 2½ pints of beer per day
and 4 pounds of meat per week.
Medical training and a unified profession did not develop until the mid-19th century,
so at the opening of the hospital two types of practitioner worked there. There
were 3 physicians and 4 surgeons who were elected and gave their services to the
hospital (hence the title of "honorary physician" etc). They visited the hospital
when they could spare the time from their practices serving more prosperous fee-paying
clients. The day-to-day responsibility for the patients lay with the second type
of doctor, the resident apothecary. He was appointed and was expected to administer
the vigorous physical forms of treatments which were all that could be offered (bleeding,
purging, cupping, leeching, blistering and emesis). He kept an herb garden "for
aromatic herbs for the baths and to distil and for sundry herbs for the house" but
with the exception of a few powerful remedies (such as digitalis, atropine and morphia)
the rest of the herbs which he was expected to store in his dispensary were ineffective.
He was also expected to show male patients how to give other male patients enemas,
and to act as storekeeper.
The physicians could only use their unaided senses, since no stethoscopes or chemical
tests were available. Diabetes could only be diagnosed by tasting their urine. In
1819 patient with “thirst and loss of flesh was observed to pass half a gallon of
urine each night, the urine being of saccharin taste." The surgeons had no anaesthetics,
so operations were uncommon. Nevertheless the early members of staff made notable
contributions to knowledge and practice -- Attenburrow for example introduced smallpox
vaccination to Nottingham in 1800.
Lighting was by whale oil lanterns and candles until 1839 when gas was installed.
An important member of the staff with the porter. As well as "pounding the herbs
in the great mortar" his job was to look after the hospital livestock. Near the
herb garden was stable for the horse and the style for the hospital pigs. The latter
posed problems; one ward was "very offensive arising from the maiden and the piggeries
placed below the windows." What could not be grown or raised was obtained from benefactors
and in 1782 an appeal was made for linen and; "being often in great want of linen,
and rags, and large quantities of which are constantly used by the surgeons, if any
well disposed persons will send old linen it will be thankfully Received.
EXPANSION AND DEVELOPMENT
The first of many extensions was made in 1787, increasing the beds available to 64.
At this time infectious diseases such as typhoid, typhus, tuberculosis and cholera
were rife, so in 1802 a special Fever Ward was built. The microbial cause of these
diseases have not yet been revealed; “miasmas" or bad smells were thought to be responsible.
Although the idea of isolation had not yet developed, the new fever wards were built
away from the main building and have subsequently been adapted to form the present
University and Gover Ford wards. Mentally ill patients were debarred from admission;
the "lunatic, lost to himself and his friends and his dearest relations, degraded
and sunk below the very lowest order of animate beings" had nowhere to go. However,
in 1812 a separate hospital, the Lunatic Asylum, was opened at Sneinton. This was
succeeded in later years by Mapperley and Saxondale Hospitals. In 1828 two "lock
wards" for venereal disease were opened at the General Hospital. The name derived
from "les locques" of the rags with which the sufferers cocooned themselves.
By 1835 the hospital was bursting at the seams; cholera epidemics and more accidents
from mechanised industry were taking their toll. The town's population has increased
from 15,000 in 1780 to 40,000 so to increase the capacity of the building, Bromley
Ward was created; the physicians’ and surgeons’ rooms, library and day rooms were
requisitioned to form the Bazaar Wards. At this time, too, the role of outpatient
and aftercare which beginning to be recognized; in 1831 a dispensary was opened in
a house in Hockley and in 1843 it was moved to its present premises in Broad Street.
In the 1850s three important developments occurred; first, the addition by Thomas
Chambers Hine of an extra floor to the original building bringing the bed complement
to 136; second, the completion of a report by Francis Sibson, Resident Surgeon Apothecary,
which recommended that properly trained nurses should be recruited; the nurses should
be freed from domestic duties such a sweeping and carrying coal and "a superintendent
nurse be obtained from the Institute of Nursing Sisters in London at a salary of
£30 per year." The third and most important development was the introduction of
anaesthesia which permitted modern surgery to begin.
The introduction of anaesthesia meant that surgeons were less reluctant to operate
but wound infection became almost universal. The bacterial origin of wound sepsis
was not understood. By 1872 the board considered that the fabric of the building
had become so impregnated with a disease-causing “miasma" that the only remedy was
to build anew on a different site. The Norfolk and Norwich Hospital did this, but
in Nottingham and the influence of Pasteur and of Lister prevailed before the plans
for a new building were ready. It was recognized that bacteria caused sepsis and
bacteria could be killed by chemicals. Initially however, only the walls, floor
and who were treated with "anti-septic" and the surgeons still "operated while attired
in their old overcoats which were often used for many months and even longer without
being cleaned... the more marked and the stained the coat the greater the lustre
at which accrued to the wearer."
A reoccurring theme in all voluntary hospitals, and the reason for their eventual
absorption into the state health service in 1948, was financial anxiety. The tasks
expected of them were limitless, whereas their income depended entirely on the philanthropy
of the rich and the energy and persuasiveness of the not-so-rich in extricating small
amounts of money from their colleagues. A warning note had been sounded in the first
annual report in 1783, for "altho all economy has been attended to, yet the expense
will exceed what was at first expected. There is still a necessity for the well
wishes of this establishment to persevere steadily in its support, not only by a
continuation of their present subscriptions, but also by exerting their utmost endeavours
to obtain additional contributions from those who for want of proper applications
have never yet lent their assistance to so good a work." The 1948 concept that hospitals
should be run by a compulsory levy, rather by voluntary subscriptions was not, of
course, a new one. In 1813 an institution whose functions differed little from the
General Hospital was in operation on a site bounded by Mansfield Road and York Street.
St Mary's workhouse provided care for poor parishioners and did so from a parish
rate. This development was of course the forerunner of the "municipal" system of
hospitals like the City Hospital, which was built and run by the local authority,
in contrast to the "voluntary" hospitals maintained by gifts and subscriptions.
By 1875, the anxiety was about accidents and how to get the money to look after the
victims. They were not necessarily "distressed objects" and yet they occupied "so
large a portion of the beds that it is with great difficulty that any ordinary surgical
or medical case can gain admittance -- there are rarely now above 2 or 3 beds for
the Weekly Board to fill up and there are generally from 10 to 15 applicants most
of them week after week to be sent away." The Board of the day saw that “the most
crying want of the hospital is a new wing for accidents." They took a courageous
decision to go ahead "because the risk of debt was less evil than risk of life."
The new wing, located on the Park Row frontage, was opened in 1879 enabling the
enlarged hospital to house about 120 patients. By 1881 the financial anxieties had
turned into realities; the income for the year was £6,695 whereas expenditure was
£7,300. To this deficit had to be added the debt on the building fund of £853 11s.
A national event can often be harnessed to local objectives, and Nottingham chose
to mark the Diamond Jubilee of Queen Victoria in 1897 by building a substantial extension
to the hospital. Alfred Waterhouse, the architect for the Prudential building in
King/Queen Street, was asked to present to design for this Jubilee Wing. He visited
various new hospitals and was very impressed by the circular wards which had been
opened in Liverpool, so in 1899 the foundations for the three circular Jubilee wards
were dug. Revealing the plaque placed there in 1781 and several caves and tunnels.
It was not the first time that such passages had been uncovered; in 1818, during
the construction of Lenton Road, an "ancient guardhouse" was found "with an apartment
about 60 feet square, hewn out of solid rock with a pillar in the centre and initials
and dates cut in the walls from 1570 to 1640." A "subterranean passage leading to
the Postern Gate" was also uncovered, while in 1899 a workman broke through into
an underground passage which James Shipman explored. He found "a remarkable series
of underground passages, two ancient ditches and a cave or vault with a flight of
steps cut in the rock leading down to it." The ditches were very extensive, one
being 320 feet long and located at a depth of 28 feet, while the other was 106 feet
long and may have been used to convey water from the old town ditch when it functioned
as a reservoir. Unfortunately none of these passages or cave rooms was properly
recorded, and we cannot tell whether they were linked to the Royal Castle before
its destruction in 1651.
Shipstone Operating Theatre
General Hospital 1875
Broad Street Dispensary
Part of Staverley & Woods Map, 1816
Portland Ward, 1890
Charity Box Front Entrance Hall of Hospital
Letter of Recommendation
General Hospital 1782
Plaque From Foundation Stone
Jubilee Wing, 1901
The building was opened in 1900 and increased the capacity of the hospital to 210.
The gibbering was fitted with electric light and the Board began to replace the
gas lighting in all the other wards. The opening of the wing also coincided with
the ability of the medical staff to go beyond their and aided sensors in searching
for disease for in 1898 the hospital had been given an x-ray apparatus. In 1899,
the Honorary Dentist, Henry Blandy, who pioneered this new technique, examined 127
patients, and in 1900 a kidney stone was diagnosed using a 20 minute exposure. Thus
by the end of the century, despite its perpetual financial deficit the hospital had
continued to grow enormously, and to keep up with new techniques in the service of
a city population which now stood at 275,000.
THE 20th CENTURY
In the years of the 20th century the pattern of disease began to change. Tuberculosis
was rampant, so in 1911 several houses in the residential area between the hospital
and the Castle were brought by Sir Charles Seely, a local mine owner and benefactor,
and given to the hospital. These houses provided 24 beds for the care of tuberculosis
patients, and were used in conjunction with the Sherwood Forest Sanatorium, near
Rainworth. This had been created by Dr William Branwell Ransom, who gave his life
to the care of these patients, initially as well as figuratively, since he died of
Other infectious diseases became less common. The gradual abolition of pale closets
and earth privies began in Nottingham about 1912 and was completed by 1923. This
almost abolished enteric infections such as typhoid and cholera. From 1895 to 1900
the average yearly incidence of these diseases in Nottingham was 489 cases with 73
deaths, but from 1923 to 1928 the annual rates were 17 cases and 1 death. The Fever
Wards were no longer filled with enteric diseases, and in 1902 had been re-housed
in the old Children's Hospital on the east side of Postern Street, Sir Charles Seely
providing a bridge to connect them to the main hospital. The first bridge resembled
the Bridge of Sighs and was admired by everyone except its donor, who hardly pulled
down and replaced by the present structure.
Bridge to Fever Wards
With the outbreak of the war in 1914 temporary ward to accommodate the expected inflow
of casualties were built on the front lawn. The hospital also began to occupy adjacent
houses; the Thornton family house on the Ropewalk was given to the hospital while
Broxtowe House was bought for £547 and still serves the present hospital as a home
for its resident medical staff. During the war, the hospital developed one new method
of treatment (physiotherapy) but refused to provide outpatients facilities for venereal
disease. So these were developed by the Local Authority on Glasshouse Street. This
conflict between trying to integrate all specialties on one site, making it a truly
General Hospital, and allowing separate and isolated institutions to develop (creation
of a new Children’s Hospital in 1900 and of the new Women’s Hospital in 1919; the
development of the Sneinton Lunatic Asylum in 1812 and of the Sherwood Sanatorium
in 1901) will recur throughout this history. The 20th century move towards re-integration
is being accomplished by the opening of the University Hospital.
War huts on the lawn 1915
After the war the City and the County agreed to adopt a scheme to extend the General
Hospital as a memorial as a memorial to its dead, so a new Nurses Home was designed
by Evans, the hospital architect. The site fronted onto Lenton Road. In view of its
location it is not surprising that “considerable difficulties were met during the
execution of this work owing to the various old buildings on the site at different
levels and to several old wells and caves in the rock.” In fact the foundations of
the Outer Bailey walls built in 1252 were discovered and destroyed. The walls were
“about six feet thick of waterstone blocks bedded in clay, the outer faces being
dressed and pointed with hard white mortar.” The new Nurses Home was opened by the
Prince of Wales in 1923 and provided 130 rooms (Figure 14); in 1927 another storey
was added, with 40 rooms.
Ariel photograph of the Memorial Nurses Home
The ability of doctors to diagnose diseases had been extended by x-rays and was now
widened again by the advent of laboratory tests. The funds which had been collected
in memory of Dr William Branwell Ransom were devoted in 1925 to establishing pathological
laboratories in the Fever Wards, formerly the old Children's Hospital.
As the demand for beds grew, the hospital had to expand so in 1927 and new wing was
built on land given by the City between the Ropewalk and Park Row. Evans was again
the architect, and the new wing was opened by Princess Mary. It provided facilities
for diagnostic and therapeutic x-rays; physiotherapy; outpatients; ear, nose and
throat inpatients and dispensary. This enabled the old outpatients department in
the main building to be converted into a Casualty Department in 1929. At the same
time another ward was added to the top of the Jubilee Wing. 1931 saw the creation
of the purpose-built the Louis Pearson theatre suite, a far cry from the days when
the room served as a day room, chapel and operating theatre in turns.
By 1932, important new benefactors had appeared. William Goodacre Player built two
new wards for the physicians on the steep west face of the site overlooking the Park
Estate, so increasing the hospital bed capacity to 344. The following year his brother,
John Player, gave £25,000 to start a fund for a private wing. The principle of catering
for paying patients was nothing new, for we have seen; in 1785 the Board resolved
that such patients could be admitted at a cost of 6/-per week. The Freemasons added
£4600 to the Player donation and in 1938 the 43-bed Pay Bed Wing on the corner of
Park Row and the Ropewalk was opened.
When the Second World War began in 1939 the hospital was included in the Emergency
Medical Services and 75 extra beds were squeezed into the existing wards to deal
with the expected flood of casualties. The hospital lost most of its medical staff
to the Armed Forces, but retired staff were retained all recalled and senior medical
students were recruited. The nursing staff was on call at all times for air raids
and the arrival of convoys of injured troops. Although Nottingham was only bombed
on 11 occasions, nevertheless 179 people were killed as and 350 were injured.
Despite the war the hospital still found the energy and funds to go on growing. In
1941 a sizeable addition to the Nurses Home (Pearson House) was built on the Standard
Hill frontage almost on the site of the demolished St James Church and a covered
walk way leading from the Board Room to the Nurses Home following a £12,000 donation
from Sir Louis Pearson. In 1943 a second-floor was added to the Player medical block
overlooking Park Valley and University Ward was endowed from money raised by the
Nottingham University College Rags.
THE NATIONAL HEALTH SERVICE
We have seen that there were two systems of hospital care in Britain; "voluntary
hospitals" maintained by subscriptions and gifts, and "municipal hospitals" maintained
by Local Authorities from the rates. In Nottingham, the General Hospital exemplified
the first time, and the City Hospital, formerly the Bagthorpe Workhouse and Infirmary,
the second. The War had shown that two types of hospital could work closely together
to deliver a national hospital service. Moreover, many of the voluntary hospitals
were in a parlous financial state so when the political desire to create a health
service, free at the point of use, but supported by a compulsory levy, came into
fruition in 1948, all hospitals, voluntary and municipal were absorbed into the newly
created National Health Service.
To illustrate the magnitude of the financial burden which had been shouldered by
voluntary contributors over the year’s one only has to compare the expenditure in
1897 of £9,447 which enabled 158 inpatients to be dealt with at a cost of 19/6 per
week each, with the expenditure in 1947 when the General Hospital spent £231,814
to deal with 387 inpatients, each costing £9 3s 5d per week. Nationalisation relieved
the hospital of this burden, but it also removed to Government funds, its accumulated
free monies in the form of gifts, legacies and trusts. Established Teaching Hospitals,
such as those in Sheffield, Manchester and Oxford were however allowed to retain
In 1947 the last of the 165 annual processions and services was held and the Committee
said “On July the 5th next this hospital will be taken over by the Sheffield Regional
Board. Local patriotism will deplore its attachment to the University of another
town but we hope that with the coming of University status to Nottingham, amour propre
will no longer be offended.”
In 1869 a group met to found a hospital for sick and poor children. T. C. Hine’s
daughter bought a house at 3 Postern Street which she presented to the committee.
The original nursing staff were recruited from the Sisters of St Lucy, service building
became known as "St Lucy's Home" or Telford Place, but its official title was the
Free Hospital for Sick Children. The entrance gateway to the hospital, parts of
which are still in use in other capacities, was bought by T. C. Hine from Alfreton
Church when it was undergoing Victorian restoration in the 1870s. In 1876 and new
wing was added followed in 1878 by an isolation block, the gift of the Jacoby family
in memory of their daughter. Even so the hospital was still too small, so in 1899
they gratefully accepted the offer by Thomas Birkin of Forest House on Chestnut Grove,
near St Andrews Church. At that time, skilled nursing staff was the most crucial
factor in providing good care of the children. Taking the Children's Hospital away
from the General Hospital posed no problems since staff who specialised in the care
of children did not interchange with the staff of the adult-illness General Hospital.
The 20th-century development of expensive techniques such as x-rays, pathological
tests, isotope scans and computerised tomography made it necessary to decide whether
it was economic feasible to duplicate such facilities, or to take children to larger,
general hospitals, where these resources could be centralised. This dilemma, unforeseen
in 1900, was resolved in 1978 when the Children's Hospital closed and its occupants
became the first inpatients of the University Hospital.
The General Hospital set 12 beds aside for Women's diseases in 1875 but in 1893 a
separate Women's Hospital was created in two splendid Georgian houses near St Nicholas
Church (29-31 Castlegate) In 1919, the Women's Hospital moved to purpose-built premises
on Peel Street.
As early as 1859 a Nottingham Eye Dispensary had been established on Park Row, it
then moved to a house in St James Street and finally in 1912 a purpose-built Eye
Hospital was created on the Ropewalk.
The Old Children's Hospital, Postern Street
The Old Women's Hospital, Castlegate
Nottingham Eye Hospital, Ropewalk
NOTTINGHAM'S MEDICAL SCHOOLS
When the General Hospital began, apothecaries, physicians and surgeons might have
had formal training at various universities and colleges, or they might have served
as apprentices or pupils, or alternatively they might have been entirely self-styled
and self-taught, with no recognizable training whatsoever. Before 1858 at least
a third of those practising medicine had received no formal training.
The apothecaries were the first group to put their house in order. In 1815 an Act
laid down that no one could call himself an apothecary without undergoing a formal
apprenticeship and passing examinations. The General Hospital played its part in
providing proper training. The Resident Apothecary had to apprentices, who had to
be "versed in the elements of grammar and the Latin language." They paid a premium
of 300 guineas for their five-year training but they were also expected to carry
out many of the duties delegated to the apothecary. The apprentices were not always
diligent in the discharge of these duties so in 1837 the hospital appointed a dispenser
to deal with herbs and drugs. His duties gradually began to diverge from those of
the medical staff and herald the beginning of pharmacists.
The physicians and surgeons of the early hospital also had pupils (Figure 18). They
had to be over 18 and could then "see the practice of the Physicians and Surgeons
of the Hospital for three years on a payment of a fee of 20 guineas." There was
organised teaching and "provided six pupils shall enter... the medical officers will
fix stated days and hours of attendance at the hospital which they will keep to so
far as may be compatible with private professional arrangements."
By the early 19th century it was recognized that attendance as a pupil could not
ensure an adequate knowledge of the body structure or function, or of diseases and
their management. Cities with general hospitals therefore began to set up medical
schools to bring students together for lectures and practical instruction. In Manchester,
Sheffield, Birmingham and Leeds these schools survived while in Nottingham, Hull,
York, Exeter and Bath they did not. The formation of the Nottingham Medical School
was reported in 1833. Lectures were held at Bromley House, and later at rooms in
St James Street. The stamina of the teachers and pupils must have been considerable;
on Wednesdays and Saturdays they started the day with a surgery lecture at 7 a.m.
and finished at 8 p.m. with a midwifery lecture. The school did not survive beyond
1835. In 1858 all medical practice was regularised by a Medical Act which laid down
strict regulations for the training and examination of doctors. By the time the
only surviving schools were those in the very large cities.
Medical schools required facilities which attracted attention; bodies were needed
for dissection, and organised gang’s systematically raided churchyards to obtain
them. In 1827, 30 bodies were stolen from St Mary's churchyard in Nottingham and
were intercepted on their way to London; a legal way of obtaining bodies was from
the scaffold. It 1815 a 19-year-old boy called Hemstock was hanged at the Shire
Hall. His body was "delivered for dissection at this infirmary" and because "there
is not a perfect skeleton at present belonging to the infirmary, there is the opportunity
afforded of acquiring one at about two thirds of the price now estimated." It was
therefore decided that "the bones of the said Hemstock be sent to London to be prepared
and jointed," and this skeleton was still in use at the General Hospital in 1900.
The first Medical School in Nottingham was soon forgotten but in 1931, Lord Moynihan
opened the new Pearson operating theatre at the General Hospital and said "I should
like to see you here with a medical school. You have an abundance of material, you
have men quite fitted to rank with any other members of their profession in the great
teaching hospitals in this country. I am sure there is room for you and I am sure
if established, you will become a medical school of great distinction." Despite
this encouragement, Nottingham had to wait for 33 years until in 1964 it was decided
that the city should be the location for Britain's first new medical school since
THE NEW ERA
To remedy deficiencies in the existing Nottingham hospitals and to bring medical
teachers into close proximity with the University, it was decided to build an integrated
Hospital and Medical School to the east of Clifton Boulevard. After considerable
initial delay in the acquisition of the site, building began in 1971 to create the
1400-bed University Hospital and the medical school with an annual intake of 160
students, the cost at today's prices being £70 million, equal to two Concorde airliners.
The architects are Building Design Partnership and the building has a centre core
housing communal facilities such as operating theatres, x-ray and pathology departments,
outpatient clinics and dining areas. Four towers stand at the corners of the core
block; one houses the Medical School and the others will house surgical specialities,
medical specialities and obstetrics and paediatrics respectively. Her Majesty the
Queen visited the building in July 1977 and named it "The Queen's Medical Centre."
The first outpatients were treated in August 1978 and the first inpatients arrived
in December 1978 when the Children's Hospital closed. The remaining facilities will
be brought into use progressively from April 1979 onwards, and the building will
be completely occupied by 1983. We have described separate developments which previously
occurred for mental illness, for children, for women and for patients with eye disorders.
Some elements of these specialities will be reunited in University Hospital, enabling
it to be a truly general hospital.
The first students arrived in Nottingham in 1970. As the medical School building
had not yet started, they were housed in newly built accommodation intended to be
occupied later by the Department of Pharmacy. The first students were ready for
clinical training in 1973, and because of the delay in building the new hospital;
clinical teaching for the new school has been carried out in the existing Nottingham
hospitals. To enable the General Hospital to extend its activities and except clinical
students in 1973 many developments occurred.
To provide accommodation for the University Departments of Medicine and Surgery,
an additional floor was built in 1968 on the Player Medical Wing. In 1969 residential
blocks of doctors and nurses was built on the corner of Lenton Road and Park Valley
and houses in the Park, Park Terrace and the Ropewalk were acquired for residences
and for new departments. In 1971, to expand its outpatient facilities, the hospital
adapted Thornton house, and a new library, teaching centre and car park was built
on Postern Street in 1972.
In 1967 and major development began. Trent Wing was opened in 1972 and contains
operating theatres, surgical wards and pathology laboratories, enabling the latter
departments to move out of the Ransom Memorial building. Like other developments
before it, Trent Wing was built on the hospital's front lawn. It conceals completely
from the casual passer-by the original 1781 building and its many extensions, but
nevertheless the old hospital is there, sharing in the provision of medical care
for its community as it is done for almost two centuries.