Healthcare before Welfare States: 2nd International Workshop Charles University, Prague, 8-9 March 2018

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UPDATE! Professor George Weisz, McGill University will give the Plenary Lecture on Friday 9 March.

 

This workshop builds on an event held in Huddersfield in 2017. It aims to bring together scholars interested in how healthcare was organized and delivered and by whom in the half century preceding the establishment of extensive welfare provision in the aftermath of the Second World War. We welcome papers that focus on individual countries/regions, national comparisons or transnational processes. Healthcare is generously defined to include professional and semi-professional, civic, religious and community providers of services that sought to treat, cure, care for or prevent accidents, disease or illness in the period 1880-1960.

 

We are seeking 20 minute presentations addressing these themes. We are particularly interested in papers that explore:

 

Hospitals

Mental Health

Rural Medicine

General Practice

Professionalisation

Finance

Buildings and locations

State, voluntary, religious and private providers and their inter-relations.

 

One of the key themes of our University of Huddersfield funded project is healthcare in Central, East and South East Europe and we are particularly keen to receive proposals from scholars working in and on the countries of these regions.

 

Abstracts of up to 250 words addressing the workshop themes outlined above should be submitted to b.m.doyle@hud.ac.uk by 15 October 2017. As we aim to publish a selection of the papers in either an edited collection or journal special issue we are seeking original submissions not previously published elsewhere.

 

Thanks to support from the University of Huddersfield URF, the Economic History Society and other funders we will be able to offer support with travel and accommodation to those giving papers, with preference given to research students and Early Career Researchers.

 

Barry Doyle

Professor of Health History

Centre for Health Histories

University of Huddersfield

UK

 

Thanks to Professor Petr Svobodny and Charles University for the venue and support with the mounting of this workshop.

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What’s in a Name? What is a Hospital? Part 2

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Healthcare establishments have gone by many names with the meanings changing over time. Indeed hospital should be seen as a generic term rather than one that holds the specific meaning it has today. Certainly it was widely used, but its early meaning owed more to concepts of hospitality or hosting than cure. However, in the second half of the nineteenth century in Britain, North America and France it was increasingly associated with the treatment of acute patients with an intention to cure or ‘materially relieve’ by the use of medical knowledge, techniques and technologies.

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The new Hopital Edouard-Herriot in Lyon (c.1934) constructed to replace the Hotel-Dieu

Yet in the mid-eighteenth century, when many new general institutions were opened by British philanthropists, the word infirmary was commonly used, as with the General Infirmary at Leeds, the Royal Infirmary of Edinburgh or Bristol Royal Infirmary. Moreover, this was a tradition that continued into the nineteenth century, for example with Middlesbrough’s North Riding Infirmary opened in 1864. Yet the name was increasingly associated with a place for the non-acute patient, a trend speeded up with the development of the workhouse Poor Law Infirmary.

 

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Alexianer St. Hedwig Krankenhaus, opened in 1846

In a similar vein many of Europe’s sick were treated in places not called hospital. In France, for example, more patients were admitted to hospices than hôpitaux. Similar in heritage and function to the English poor law infirmary, the hospice cared for a wide range of patients unable to care for themselves. In the German speaking world the central health care institution was the krankenhaus or literally sick house with the word hospital rarely used. In the early twentieth century the word clinic was increasingly adopted. Originating in France, it was taken up enthusiastically by US institutions – most famously the Mayo Clinic – and returned to Europe where it was usually associated with a specific, but potentially self governing, specialist part of a hospital. In Lille the Regional Hospital Centre initially opened in 1953 grew by adding more and more clinics based on the original Calmette tuberculosis clinic.

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The First Mayo Clinic in Rochester, 1914. 

The nineteenth century also saw the rise of the sanatorium, an environment where care and cure were mixed. Predominantly associated with tuberculosis treatment and often located in remote spots with plenty of fresh air and sunlight, the sanatorium attempted to sit outside the conventions of institutional medicine. The word was also used for convalescent homes, especially for the worn out wealthy! In the British context the latter category of patients were also to be found in the obliquely named nursing homes. Here the suggestion is of care not cure, yet many of these places were run by leading physicians and surgeons who successfully treated a significant proportion of the middle and upper classes in often impressive surroundings.

 

However, the most interesting of the health care institutions to eschew the name hospital is the asylum. The word derives from place of refuge and was used widely in the nineteenth century for a range of caring institutions. However, it became most closely associated with the care and treatment of mental health conditions. It was in vogue from the early nineteenth century until the early-twentieth century when changes in treatment regimes brought these institutions more into line with the curative practices of the general hospital. Thus in the 1920s the Royal Edinburgh Asylum was renamed the Royal Edinburgh Hospital for Mental and Nervous Disorders, but in most cases the name asylum remained.

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Wakefield Pauper Lunatic Asylum, later renamed Stanley Royd Hospital

Thus, a sick person could end up in an institution for the delivery of medical care or cure that may or may not have been called a hospital. Out of the confusion of the eighteenth century different names came to represent different functions – hospital for the acute and the curative, infirmaries and hospices for the long term sick or frail, asylum for those with mental health conditions, sanatoria for long term recovery, especially from TB, nursing homes for the wealthy, and clinics for the latest therapies. Yet some of the old words have stuck, leaving us to wonder why Scotland’s newest hospital is an infirmary?

 

{It looks like this series may run and run – Like Purnell’s History of the Second World War!]

 

What is a Hospital: Part 1

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The New Queen Elizabeth Hospital, Birmingham, opened in 2010

The central concern of the project European Healthcare before Welfare States, and by definition this blog, is comparative history. Over the past ten years I have gradually extended my efforts to compare, from a range of English towns and cities through my work on England and France to the complex multinational range involved in this venture. As I have noted elsewhere, comparison is a difficult but rewarding task. One of the key difficulties is understanding and managing difference – difference in practice, in priorities, in constraints and even in nomenclature. It was a growing awareness of the differences bound up in the word ‘hospital’ that prompted these opening posts for the European Healthcare blog.

For most people the word hospital conjures up an image of a large, probably new, probably white, building filled with busy doctors and nurses and a plethora of high tech equipment (like the new Queen Elizabeth Hospital in Birmingham pictured above). The object of the hospital is to cure the patient as quickly as possible and the presence of long-stay patients with stubborn or incurable conditions is is seen as a disruption to the true purpose of the institution. But this monolithic vision is relatively recent, largely a product of the wave of hospital planning that swept the western world in the 1960s and reinforced by television’s penchant for the hospital soap. In historical terms ‘hospital’ is a complex and messy term applied to a multitudinous range of institutions with an equally diverse set of objectives of which cure was, for the most part, a bonus.

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In this series of posts I aim to explore the many ways in which we can understand the meaning of hospitals in the past. Indeed, a caveat is immediately necessary as I am primarily considering these institutions in the modern period – since around 1800 – and won’t touch on medieval and early modern uses of the word to describe locations of hospitality, refuge and care. Evidence will be drawn from my own research into medical care institutions in Great Britain, France, Czechoslovakia, Hungary and Poland and international attempts to bring together information on health institutions, including the League of Nations Health Organisation’s Yearbook 1924-30 and Nosokomeion, the Quarterly hospital review of the International Hospital Association that ran from 1930 to 1940.

Beaujon 1934

In the next post we will consider what factors might help to define an institution as a hospital – things like size, range of functions, facilities, patients, length of stay and even the name. The third offering will assess the purpose of the institution – curative or caring; general or specialist; patient profiles; free or compulsory. It will also reflect on the influence of religion, nation and empire, charity, and the role and power of doctors in determining what a hospital was or might be.