Hospitals
A hospital ward showing sick patients being tended to by medical staff, after a quote from the Bible (Matt. 25.36). Line engraving by C. Galle. Wellcome Collection. Source: Wellcome Collection.
‘I was sick, and you visited me’. This quotation from Matthew 25 verse 36, points to one over-arching motivation for hospital development in Western Europe in the early modern period: Christian charity. Whether reformed or members of the Counter Reformation churches, early modern Christians considered the development of hospitals as a moral good. General hospitals were not, of course, new institutions, but, as Grell and Cunningham note, from the mid-fifteenth century onwards a re-organization and centralization process had been taking place in Catholic bastions of the south of Europe: Italy, France and Spain.[1] With the arrival of syphilis in the last decade of the fifteenth century, hospitals for incurables had sprung into being.[2] In post Tridentine southern Europe religious orders such as the Capuchins and Ursulines identified other target groups and founded hospitals, orphanages and other institutions to cater for them.[3]
Following the Reformation a similar process may be witnessed in the Protestant north where hospital provision formed just one aspect of a wider response to poor relief.[4] Medical care was not limited to hospitals – the sick poor might be treated at home, aided by poor relief which was organised by the local parish. The parish might pay other parishioners to undertake nursing duties, or pay for the services of surgeons and physicians. As Grell and Cunningham note, some physicians in seventeenth-century Amsterdam provided their services for free in some parts of the city.[5] Practices might vary across reformed countries, and some countries might emphasise some aspects of poor relief over others, but the drive towards provision of poor relief and with it a reorganization of hospitals was clear.[6] The religious motivation was obvious to all: the Reformation and Counter Reformation medical battle was not only for the bodies of hospital patients – it was for their souls as well.[7]
John Stow, A Survey of Cities of London and Westminster (London, 1720), i, plate opposite p. 189: image of St Thomas’s Hospital, London.
The Reformation in England witnessed a major transformation in healthcare. Slack notes that prior to the English Reformation there had been almost thirty hospitals in London.[8] Some, such as the Savoy Hospital, had been remodelled as recently as 1505, during the reign of Henry VII (1457–1509), king of England and lord of Ireland, along the model of Santa Maria Nuova in Florence.[9] Henry VIII’s dissolution of the monasteries therefore not only had a major impact on the monastic staff who ran the hospitals but also on the poor who were reliant on them. Rushton and Sigle-Rushton argue that the disruption was profound – indeed that its true impact has been underestimated due to the problematic returns of the 1535 Valor Ecclesiasticus.[10] The Valor was a church tax assessment devised by Thomas Cromwell, earl of Essex (b. in or before 1485, d. 1540), in his drive to dissolve monasteries. Rushton and Sigle-Rushton suggest that agents reporting to Cromwell, aware of his aim, sought to underplay the charitable records of the monasteries and the amounts set aside for charitable initiatives including hospitals.[11]
Certainly the public were not happy with the dissolution of their hospitals and due to public demand five hospitals were reinstated in London during the reigns of Henry VIII (1491–1547), king of England and Ireland, and his son Edward VI (1537–53), king of England and Ireland.[12] As Slack suggests, one influence on this process were the foreign communities in London, members of the Dutch and Walloon reformed churches who introduced new ways of dealing with the sick urban poor.[13] The Edwardian reforms introduced during the reign of Edward VI were heavily influenced by the young king’s desire to be a reformed king, and, as Grell and Cunningham note, high ranking members of Elizabeth I’s government took an active role in reforming poor relief.[14]
The five hospitals in London were as follows: St Barthomew’s Hospital was for the sick, Christ’s Hospital was for orphans, Bethlehem Hospital for the mentally ill, the Bridewell was for the ‘idle poor’, and St Thomas’s Hospital was for the old.[15] The last of these, St Thomas’s Hospital, became a political bone of contention during the reign of the later Stuarts. Charles II (1630–85), king of England, Scotland, and Ireland, eager to counteract Whig bastions, focused on the London hospitals, and in particular St Thomas’s Hospital, a few years before his death in 1685. As Rose notes, the early years of the 1680s had witnessed a powerplay between Whigs and Tories for control in London and St Thomas’s, led as it was by a noted opponent of the king, was considered ripe for reform.[16] By 1683 the plans were in place to take over control of any Whig dominated London hospital and St Thomas’s, with its pronounced Whig sympathies, was the principal target when a royal Commission for Hospitals was formed in 1683. This Commission duly purged the London hospital boards of any Whig elements and replaced them with Tories. St Thomas’s Hospital continued to be in the line of political fire during the reigns of James II and VII (1633–1701), king of England, Scotland, and Ireland, and William III and II (1650–1702), king of England, Scotland, and Ireland, until the accession, as governor, of Sir Robert Clayton (1629–1707), in February 1692.[17] A politician and banker, Clayton would play a major role in a rebuilding programme at St Thomas’s Hospital in the period 1693 to 1709.
This rebuilding programme was of particular interest to Dr Edward Worth (1676–1733) and his fellow Trustees of Dr Steevens’ Hospital. Indeed Worth had been commissioned in 1717 to find out more about St Thomas’s Hospital, for, like the projected Dr Steevens’ Hospital, it too was a hospital for the curable poor. This, coupled with its recent rebuilding programme, which had been privately funded, attracted the attention of the newly founded Trust of Dr Steevens’ Hospital which was, at that time, exploring methods by which they might bring Richard Steevens’ plan for a hospital for the poor to fruition. The colonnade and ward structure of St Thomas’s Hospital would later be replicated in Dr Steevens’ Hospital in Dublin.[18]
Thomas Wilson, An account of the foundation of the Royal Hospital of King Charles IId. near Dublin, for the relief and maintenance of antient and infirm officers and soldiers Serving in the Army of Ireland. Begun By His Grace James Duke of Ormonde, anno 1680, (at that time Lord Lieutenant of Ireland) and compleated by His Excellency Henry Earl of Clarendon, Lord Lieutenant of the same, in the Year, 1686 (Dublin, 1713), title page.
The Trustees of Dr Steevens’ Hospital had not one but two models to guide them in their foundation: St Thomas’s Hospital, London, and the Royal Hospital at Kilmainham. Worth possessed two editions of this tract on the foundation of the Royal Hospital and it is not hard to see why, for the book served as a project manual of how to build a hospital in Dublin in the later seventeenth century. Charles II was certainly not alone in his desire to build a military hospital: the seventeenth century had witnessed the creation of a military hospital at Vadstena in Sweden in 1638, the famous Invalides (the model for the Royal Hospital Kilmainham), had been begun in 1670 by Louis XIV (1638–1715), king of France, and of course Charles II was also busy with the building of the Royal Hospital at Chelsea. This drive for military hospitals was a reflection of the war-torn nature of early modern Europe, and the crowns’ need to provide for military veterans. The late seventeenth-century monarchs were as preoccupied as Henri IV (1553–1610), king of France, had been, when he attempted to reform the French hospital system by instituting a Chamber of Christian Charity in 1606 which would not only centralize smaller hospitals, but which he hoped, would enable him to fund hospital provision for veterans.[19]
Crucial to the staffing of all hospitals were nurses, usually female and usually unsung. In Wilson’s account of the foundation he mentions that there were thirteen nurses, each paid £6 and 10 shillings per annum – but this reference, in a listing of the annual payroll, is the sole reference to a crucial element of any hospital, and a comparison with others on the list demonstrates how badly paid they were.[20] And yet, it was rare for a hospital to be run without women. Women likewise worked as nurses in Elizabethan London’s five major hospitals (as well as places like workhouses and orphanages).[21] As Harkness notes, female nurses in these London hospitals came under both male and female supervision – the role of matron being the apex of the female medical profession at these hospitals.[22] The matron had many roles: she not only supervised the nursing staff but also, as in Germany, was responsible for provisions – and in the case of the London hospitals, admissions.[23] Nurses in her charge might not have earned as much as either the matron or the male medical staff but they were distinguished from carers in the community by their livery, which gave them a semi-official status.[24]
Harkness argues that the matron and nurses were not the only females employed in a medical capacity in London hospitals, drawing attention to the role of a few women as empirics – i.e. non-licensed medical practitioners responsible (in the case of the hospitals) for dispensing medicines.[25] Some, such as Mrs Cook at Christ’s Hospital, London, and Mother Edwyn at St Thomas’s Hospital, London, are recorded as being paid for surgical work.[26] Just how many did the same in private practice in the metropolis of sixteenth- and seventeenth-century London is difficult to say. Some might work alongside their husbands, be they surgeons or apothecaries, carrying on their practice after their husband’s death. Others might seek to work for licensed physicians, helping them with an overflow of patients.[27] They might not appear in lists of members of the College of Physicians, or the guild of the barber surgeons, but they existed in the community, sometimes beneath the official radar, sometimes in plain sight. As Harkness concludes:
‘These women were at the very heart of London’s medical world. They were not marginal, they were not laughable, and they were not expendable. Perhaps that is why so many male practitioners found them so very threatening’.[28]
Drawing of Dr Steevens’ Hospital by T. G. Wilson.
Tracing the role of nurses in Dr Steevens’ Hospital is challenging – history so often concentrates on leading physicians and surgeons rather than the nursing staff. One woman whose role in Dr Steevens’ Hospital is incontrovertible is the redoubtable Grizel Steevens (c. 1654–1747), the sister of Richard Steevens (c. 1654–1710), after whom the hospital is named. The decision of Richard Steevens to bequeath money for the foundation of a hospital in early eighteenth-century Dublin was a timely one for, unlike in England, the crown had not sought to re-found the medieval hospitals of Dublin which had been dissolved at the time of the Reformation in the mid sixteenth century. Dublin had therefore been without a general hospital since the dissolution of the medieval hospitals of St John the Baptist, the Steyne, St Stephen and a small early sixteenth hospital in Kevin Street.[29] True the Royal Hospital at Kilmainham had been founded in the 1680s by Charles II, but, as we have seen, it was envisaged as a retirement home for soldiers, not a general hospital.[30]
The need for a hospital for the poor had long been acknowledged. Indeed, it had been trenchantly articulated by Sir William Petty (1623–87), one of the founders of the Dublin Philosophical Society, in 1676 when he bemoaned the lack of hospital provision, as much for the patients as for the teaching it gave to prospective doctors.[31] However, there was no state support for such a venture in view and by the first decade of the early eighteenth century it was becoming clear that benefactions from private individuals, rather than public funding, might hold the key to unlocking health care provision in Dublin.[32] Richard Steevens’ decision in 1710 to leave money for the foundation of a hospital for the poor of Dublin was an important one not only because it led to the foundation of the hospital which bears his name but also because it encouraged others to attempt similar schemes. As James Kelly points out, Dr Steevens’ Hospital, though it was the first of its kind to be planned in Dublin, was one of three voluntary hospitals by 1734.[33] In 1718 six Dublin surgeons (probably influenced by the Steevens’ plan), came together to open a hospital on Cook Street to care for the ‘maim’d and wound’d poor’.[34] This hospital, called the Charitable Infirmary, was joined in 1733 by the opening of Dr Steevens’ Hospital for ‘the curable poor’ and in 1734 by Mercer’s Hospital, whose focus was on the mentally and dangerously ill.[35] By 1757 five more would be added: the hospitals for Incurables (1744), the Lying-in Hospital (1745), the Meath (1753), the Lock Hospital (1755) and St Patrick’s (1757).[36] All these hospitals had two things in common: they were led by dynamic medical professionals and were funded by private charity. It was not until the nineteenth century that state subvention of the voluntary hospital system was introduced in Ireland on a regular basis.[37]
Text: Dr Elizabethanne Boran, Librarian of the Edward Worth Library, Dublin.
Sources
Boran, Elizabethanne, ‘The Building of Dr Steevens’ Hospital, Dublin, 1710–33’, Eighteenth-Century Ireland, 37, no. 1 (2022), 1–31.
Coakley, Davis, Medicine in Trinity College Dublin (Dublin, 2014).
Geary, Laurence M., Medicine and charity in Ireland, 1718–1851 (Dublin, 2004).
Granshaw, Lindsay and Roy Porter (eds), The Hospital in History (London and New York, 1990).
Grell, Ole Peter, and Andrew Cunningham (eds), Health care and poor relief in Protestant Europe 1500–1700, Studies in the Social History of Medicine (London and New York, 1997).
Grell, Ole Peter, Andrew Cunningham, and Jon Arrizabalaga (eds), Health care and poor relief in Counter-Reformation Europe (London and New York, 2014).
Harkness, Deborah E., ‘A View from the Streets: Women and Medical Work in Elizabethan London’, Bulletin of the History of Medicine, 82, no. 1 (2008), 52–85.
Hickey, Daniel, ‘Sixteenth-Century Hospital Reform: Henri IV and the Chamber of Christian Charity’, Renaissance and Reformation, 17, no. 4 (1993), 5–15.
Hoppen, K. T., Papers of the Dublin Philosophical Society 1683–1709, 2 vols (Dublin, 2008).
Kelly, James, ‘The Emergence of Scientific and Institutional Medical Practice in Ireland, 1650–1800’, in Malcolm, Elizabeth, and Greta Jones (eds), Medicine, Disease and the State in Ireland 1650–1940 (Cork, 1999), pp 21–39.
Kinzelbach, Annemarie, ‘Women and healthcare in early modern German towns’, Renaissance Studies, 28, no. 4 (2014), 619–38.
Leong, Elaine and Alisha Rankin, ‘Testing Drugs and Trying Cures’, Bulletin of the History of Medicine, 91, no. 2 (2017), 157–82.
O’Brien, Eoin, ‘The Charitable Infirmary in Jervis street: The First Voluntary Hospital in Great Britain and Ireland’, in O’Brien, Eoin (ed.), The Charitable Infirmary, Jervis Street 1718–1987 (Monkstown, Co. Dublin, 1987), pp 1–48.
Rose, Craig, ‘Politics and the London private hospitals, 1683–82’, in Granshaw, Lindsay and Roy Porter (eds), The Hospital in History (London and New York, 1990), pp 123–48.
Rushton, Neil S. and Wendy Sigle-Rushton, ‘Monastic poor relief in sixteenth-century England’, The Journal of Interdisciplinary History, 32, no. 2 (2001), 193–216.
Sonnelitter, Karen, Charity Movements in Eighteenth-Century Ireland: Philanthropy and Improvement (Woodbridge, Suffolk, 2016).
Stow, John, A Survey of Cities of London and Westminster (London, 1720).
Thompson, John D. and Grace Goldin, The Hospital: A Social and Architectural History (New Haven and London, 1975).
Wilson, Thomas An Account of the Foundation of the Royal Hospital of King Charles II near Dublin. For the Relief and Maintenance of Antient and Infirm Officers and Soldiers Serving in the Army of Ireland … (Dublin, 1713).
[1] Grell, Ole Peter and Andrew Cunningham, ‘The Counter-Reformation and welfare provision in southern Europe’, in Grell, Ole Peter, Andrew Cunningham, and Jon Arrizabalaga (eds), Health care and poor relief in Counter-Reformation Europe (London and New York, 2014), p. 5.
[2] Ibid.
[3] Ibid., pp 3–4.
[4] Grell, Ole Peter, and Andrew Cunningham, ‘The Reformation and changes in welfare provision in early modern Northern Europe’, in Grell, Ole Peter, and Andrew Cunningham (eds), Health care and poor relief in Protestant Europe 1500–1700, Studies in the Social History of Medicine (London and New York, 1997), p. 1.
[5] Ibid., p. 11.
[6] On this see Grell, Ole Peter, and Andrew Cunningham (eds), Health care and poor relief in Protestant Europe 1500–1700, Studies in the Social History of Medicine (London and New York, 1997).
[7] Grell, Ole Peter and Andrew Cunningham, ‘The Counter-Reformation and welfare provision in southern Europe’, p. 6.
[8] Slack, Paul, ‘Hospitals, workhouses and the relief of the poor in early modern London’, in Grell, Ole Peter, and Andrew Cunningham (eds), Health care and poor relief in Protestant Europe 1500–1700, Studies in the Social History of Medicine (London and New York, 1997), p. 229.
[9] Ibid., p. 230.
[10] Rushton, Neil S. and Wendy Sigle-Rushton, ‘Monastic poor relief in sixteenth-century England’, The Journal of Interdisciplinary History, 32, no. 2 (2001), 193–216.
[11] Ibid., 215.
[12] Harkness, Deborah E., ‘A View from the Streets: Women and Medical Work in Elizabethan London’, Bulletin of the History of Medicine, 82, no. 1 (2008), 72.
[13] On the situation in London see Slack, Paul, ‘Hospitals, workhouses and the relief of the poor in early modern London’, in Grell, Ole Peter, and Andrew Cunningham (eds), Health care and poor relief in Protestant Europe 1500–1700, Studies in the Social History of Medicine (London and New York, 1997), p. 231.
[14] Grell and Cunningham, ‘The Reformation and changes in welfare provision in early modern Northern Europe’, p.28.
[15] Slack, ‘Hospitals, workhouses and the relief of the poor in early modern London’, p. 231.
[16] On this see Rose, Craig, ‘Politics and the London private hospitals, 1683–82’, in Granshaw, Lindsay and Roy Porter (eds), The Hospital in History (London and New York, 1990), pp 123–48.
[17] Ibid., p. 142.
[18] On the architecture of St Thomas’s see Thompson, John D. and Grace Goldin, The Hospital: A social and architectural history (New Haven and London, 1975), pp 83–87.
[19] Hickey, Daniel, ‘Sixteenth-Century Hospital Reform: Henri IV and the Chamber of Christian Charity’, Renaissance and Reformation, 17, no. 4 (1993), 5–15.
[20] Wilson, Thomas, An account of the foundation of the Royal Hospital of King Charles IId. near Dublin, for the relief and maintenance of antient and infirm officers and soldiers Serving in the Army of Ireland. Begun By His Grace James Duke of Ormonde, anno 1680, (at that time Lord Lieutenant of Ireland) and compleated by His Excellency Henry Earl of Clarendon, Lord Lieutenant of the same, in the Year, 1686 (Dublin, 1713), p. 133. Harkness, ‘A View from the Streets: Women and Medical Work in Elizabethan London’, 76, notes that payment of nursing staff in Elizabethan London was far below that of the surgeons and apothecaries on the staff of the five major hospitals.
[21] Harkness, ‘A View from the Streets: Women and Medical Work in Elizabethan London’, 71.
[22] Ibid., 73.
[23] Ibid., 74.
[24] Ibid., 76.
[25] Ibid., 78.
[26] Ibid., 78.
[27] Ibid., 80.
[28] Ibid., 84.
[29] Coakley, Davis, Medicine in Trinity College Dublin (Dublin, 2014), p. 51. There is a brief reference in a broadsheet dated 1682 to a hospital in Back Lane: [By the] Lo[rd Mayor] of the city of Dublin. Whereas great numbers of foreign beggars and idle vagrants of late have, and still do resort to this city from most parts of this kingdom, to the great scandal of the government of this city, and annoyance and prejudice of the inhabitants thereof … (Dublin, 1682). Eoin O’Brien suggests that this was a military hospital: O’Brien, Eoin, ‘The Charitable Infirmary in Jervis street: The First Voluntary Hospital in Great Britain and Ireland’, in O’Brien, Eoin (ed.), The Charitable Infirmary, Jervis Street 1718–1987 (Monkstown, Co. Dublin, 1987), p. 2.
[30] Wilson, Thomas An Account of the Foundation of the Royal Hospital of King Charles II near Dublin. For the Relief and Maintenance of Antient and Infirm Officers and Soldiers Serving in the Army of Ireland … (Dublin, 1713). The hospital was built for the Lord Lieutenant, James Butler, 1st Duke of Ormond (1610–88). On other military hospitals at the time see Geary, Laurence M., Medicine and charity in Ireland, 1718–1851 (Dublin, 2004), pp 13–4.
[31] Marquis of Landsdowne, The Petty Papers; Some unpublished Writings of Sir William Petty (A. M. Kelley, 1967), pp. 171–81. On the Dublin Philosophical Society see Hoppen, K. T., Papers of the Dublin Philosophical Society 1683–1709, 2 vols (Dublin, 2008).
[32] See Sonnelitter, Karen, Charity Movements in Eighteenth-Century Ireland: Philanthropy and Improvement (Woodbridge, Suffolk, 2016), on the rise of private philanthropy in eighteenth-century Ireland.
[33] Kelly, James, ‘The Emergence of Scientific and Institutional Medical Practice in Ireland, 1650–1800’, in Malcolm, Elizabeth, and Greta Jones (eds), Medicine, Disease and the State in Ireland 1650–1940 (Cork, 1999), pp 21–39.
[34] O’Brien, ‘The Charitable Infirmary in Jervis street’, p. 2.
[35] The present state of Doctor Steevens’s Hospital (Dublin, 1735) broadsheet; On Mercer’s Hospital in the eighteenth century see Sonnelitter, Charity Movements, pp 80–98.
[36] Sonnelitter, Charity Movements, p. 80. See also Geary, Medicine and charity in Ireland, 1718–1851, pp 13–39.
[37] Grants were provided to some voluntary hospitals throughout the eighteenth century, but these had irregularly: see Commons Jn. Ire. xiii, appendix, p. cxcv.