NOTTINGHAM GENERAL HOSPITAL

IIn 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

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 Sir 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 (Figure 1).  The latter came to light 100 years later when the Jubilee Wing was being built.

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 letter signed by a subscriber” (Figure 3), 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 (Figure 4) 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.

It is Lighting was by whale oil lanterns and candles until 1839 when gas was installed (Figure 5).  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 thankful Received.

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 1893.

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 (Figure 19) 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 (see back cover) 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.

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