Changes in Hospitals

The care and treatment of patients in hospitals saw significant changes between the 18th and 19th centuries, particularly during the 1800s. Hospitals evolved from basic institutions where many patients died due to poor conditions to institutions that began to adopt more scientific and hygienic practices.

Hospitals in the Early 19th Century

In the early 19th century, hospitals were often dangerous places to be. Many patients who sought care in these establishments succumbed to diseases caused by the hospital’s unsanitary conditions. These poor conditions included:

• Few toilets and inadequate sewerage systems, leading to unsanitary environments.
• Overcrowded wards, where the lack of space and proper ventilation created an unhealthy atmosphere.
• Lack of cleanliness, which allowed infections to spread rapidly among patients.

Additionally, there were very few regulations governing hospitals, and hospitals were underfunded, which worsened the conditions. Nursing staff were often untrained, and many times unqualified women were criticised for their perceived lack of professionalism. Nurses were typically female and not always acknowledged for the important work they did, with some even facing accusations of being ‘drunk’ on the wards.

Florence Nightingale – A Revolution in Nursing

Florence Nightingale is one of the most well-known figures in the history of nursing, and her work in the 19th century significantly transformed the standards of hospital care.

Nightingale was trained as a nurse in Germany before taking up a position at a hospital in London. When the Crimean War broke out in 1853, she was asked by the British government to manage the care of wounded soldiers at the army hospital in Scutari (now in Turkey). Shocked by the conditions she encountered, Nightingale found that the hospital was incredibly dirty, with poor medical supplies and unsanitary practices that led to frequent infections. Many soldiers came in with wounds or injuries only to contract deadly diseases like typhus, cholera, typhoid, and dysentery during their stay in the hospital.

In response, Nightingale and her team of nurses worked tirelessly to improve the conditions at the hospital. Her measures included:

• Regular handwashing to prevent the spread of germs.
• Improving the sewerage system to manage waste and reduce contamination.
• Improving ventilation to ensure a flow of fresh air in the wards.

These efforts led to a dramatic drop in the hospital's death rate, from a staggering 40% to just 2%. The success of her work in Scutari earned her international recognition and laid the foundation for modern nursing practices.

The Influence of Florence Nightingale

After returning to Britain, Nightingale continued to influence the development of nursing and hospital care. She wrote two important books:

Notes on Nursing (1859) – This book became a guide for nurses and helped to raise the status of the profession.

Notes on Hospitals (1863) – Aimed at improving hospital design and management to reduce the risk of infection.

In 1860, she established the Nightingale School for Nurses in London, which was the first of its kind and trained nurses in the principles of hygiene, patient care, and disease prevention. Nightingale’s ideas were largely based on the belief that miasma, or "bad air," was the cause of disease. Therefore, she focused on improving cleanliness and reducing sources of bad air to prevent illness.

Mary Seacole – A Pioneering Figure in Care

While Nightingale is often the most famous name associated with nursing in the Crimean War, Mary Seacole was another important figure. Seacole, a Jamaican businesswoman and healer, had extensive experience caring for British soldiers and treating diseases like cholera.

Seacole volunteered to travel to Crimea to help with the war effort but was refused passage by several influential people, including Nightingale. Despite this, Seacole funded her own travel to Crimea and set up her own British Hotel, a rest and recovery hostel for British soldiers. She was affectionately called “Mother Seacole” by the soldiers for her care and compassion. Although Nightingale and Seacole did not work directly together, Seacole’s contributions to the war effort and her reputation as a skilled and caring nurse were undeniable.

Developments in Hospitals

Throughout the 19th century, hospitals gradually improved in terms of size, funding, and organisation. The rise of voluntary hospitals—institutions funded by charitable donations from the wealthy—saw an increase in smaller cottage hospitals being established to treat the poor. In these hospitals, doctors often worked for free, and patients sometimes paid into a fund to cover treatment costs.

However, for the very poor, there were still limited options. People from the most destitute backgrounds were assessed by authorities, and if deemed in need, they were admitted to workhouses. Workhouses began to include infirmaries after 1867, where the sick and elderly could be treated.

Fever hospitals were another important development. These hospitals were specifically set up to isolate and treat those suffering from infectious diseases such as smallpox and scarlet fever, preventing the spread of such illnesses to the general population.

Key Fact

Before the late 20th century, nurses were usually female, and the profession was largely dominated by women, although they were not always recognised for their vital contributions to healthcare.

Conclusion

The 19th century witnessed dramatic improvements in the care and treatment of patients in hospitals. Thanks to pioneers like Florence Nightingale and Mary Seacole, hospitals began to adopt better hygiene practices, improving patient survival rates and setting the stage for further developments in medical care. These changes marked the beginning of a shift towards more scientific and organised healthcare, eventually leading to the more sophisticated and specialised hospital systems we recognise today.