Changes in Health and Medicine c.1340 to the present day

Welsh Examples: Voluntary Hospitals

  • 1807: Denbigh General Dispensary and Asylum for the Recovery of Health opens.
  • 1833: Wrexham established a dispensary, followed by an infirmary in 1838.
  • 1837: The Glamorgan and Monmouth Infirmary and Dispensary in Cardiff.
  • Hospitals became centers for treating illness with herbal remedies, performing simple surgery, and dispensing medicine.
  • Treatment was usually free.

Welsh Examples: Specialist Hospitals

  • Stanley Sailors’ Hospital, Holyhead:
    • Opened in 1861 to treat sick sailors.
    • Paid for by William Owen Stanley of Penrhos.
    • Taken over by the NHS in 1948.
  • Royal Hamadryad Hospital, Cardiff:
    • Opened in 1866 to treat sick sailors.
    • Aimed to stop infectious diseases such as smallpox from entering the town.

The Professionalisation of Nursing

  • The quality of nursing in hospitals was generally poor due to a lack of training or medical knowledge.

Florence Nightingale

  • A pioneer in improving standards of patient care.
  • Crimean War (1854-1856):
    • Britain fought Russia.
    • Nightingale addressed the poor treatment of British soldiers in the military hospital at Scutari in the Crimea.
    • She borrowed money to travel there.
    • Conditions: Patients suffered from cholera and typhoid, housed in filthy wards.
    • Actions: Cleaned the wards, provided regular washing, clean clothes, and bedding.
    • Disease control: Patients separated according to illness.
    • Results: The death rate went from 42 in 100 to 2 in 100.
  • Reforms:
    • Returned to England in 1856 and campaigned to reform army medical services.
    • Advocated for purpose-built hospitals with trained nurses, clean floors, light, fresh air, and better food.
    • Published Notes on Nursing in 1859.
    • The Times newspaper’s Florence Nightingale fund raised £50,000.
  • Training schools:
    • In 1860, Nightingale used the funds to set up training schools for nurses at St Thomas’s Hospital and King’s College Hospital in London.
    • Training was based on her principles of patient care.
  • Hospital design:
    • New hospitals, like the Royal Liverpool Infirmary, were built to her ‘pavilion’ design from Notes on Hospitals (1863).
  • By 1900, nursing had become recognized as a profession.

Welsh Example: Elizabeth ‘Betsi’ Cadwaladr

  • In 1854, went to the Crimea to help nurse wounded soldiers.
  • Disagreed with Florence Nightingale and left Scutari for a hospital at Balaclava.
  • Worked long hours treating the wounded and nursing the sick.
  • Caught cholera and dysentery and had to leave the Crimea in 1855.

Industrial Period: c.1800s Medieval Patient Care

  • Monasteries:
    • The infirmary was a type of hospital ward for sick patients, separated from the rest of the monastery to stop infection spreading.

Welsh Examples: Cistercians

  • Built monasteries at Valle Crucis and Aberconwy in the north, Strata Florida in mid-Wales, and Tintern in the south.
  • Franciscans built friaries at Bangor, Brecon, Cardiff, Denbigh, and Rhuddlan.
  • Hospitals:
    • Run by monks and nuns because they offered ‘hospitality’ - shelter to travelers, the poor, and the elderly.
    • No doctors within these hospitals.
    • Monks prayed for the souls of the patients.
    • Nuns looked after the welfare of the patients with herbal remedies.

Welsh Example: The Knights of St John of the Order of Hospitallers

  • Built a hospital at Ysbyty Ifan to care for pilgrims.

Voluntary charities in the 16th century

  • Henry VIII ordered the dissolution of the monasteries in the 1530s, and most hospitals closed.
  • Some were taken on by voluntary charities or town councils took over.
  • London:
    • 5 major hospitals were endowed with royal funds to care for the sick and poor, e.g., St Bartholomew’s Hospital serving the poor of the area of West Smithfield and St Mary Bethlehem which looked after the mentally ill.

Endowed hospitals in the 18th century

  • Population growth increased demand for hospitals.
  • Wealthy industrialists paid for them, e.g., Thomas Guy, a wealthy printer and bookseller who financed the establishment of Guys Hospital in 1724.
  • New hospitals:
    • 11 new hospitals were founded in London and a further 46 across the country in the growing industrial towns and cities, including Westminster Hospital in London, Addenbrooke’s Hospital in Cambridge, and the Royal Infirmary Hospitals in Edinburgh and Manchester.
    • The Bluecoat Hospital in Chester opened in 1717.

Medieval and Early Modern Periods: c.1300s-1700s

  • Changes in Health and Medicine c.1340 to the present day (Unit 3)

Early 20th Century Reforms

  • Liberal governments of 1906–14 introduced welfare reforms designed to help people who fell into difficulty through sickness, old age, or unemployment.
  • The reforms included:
    • Medical inspection of school pupils (1907).
    • Free school meals (1906).
    • Old age pensions (1908).
  • National Insurance Act (1911):
    • Workers and employers made weekly contributions to give workers sickness benefit and free medical care from a doctor.
    • It did not cover families (wives and children), the unemployed, or the elderly.

The NHS (National Health Service)

  • The Beveridge Report of 1942 identified ‘disease’ as one of the ‘Five Evil Giants’ and suggested that there should be a free national health service.

Welsh Example: Tredegar and the NHS

  • Aneurin Bevan, Labour MP for Ebbw Vale, was appointed Minister of Health in 1945.
  • He argued that everybody had the right to medical treatment according to need – rich or poor.
  • Bevan was inspired by the system for looking after local workers he had seen in Tredegar in South Wales.
  • Opposition:
    • Bevan faced opposition to his National Health Service Act 1946 from:
      • The authorities that ran hospitals.
      • The British Medical Association (BMA) who complained that doctors would make less money.
    • He overcame this opposition.
  • From 28 July 1948, the NHS offered a range of services.
  • Demand for health care under the new NHS went well beyond original predictions.
    • In 1947, doctors issued 7 million prescriptions per month; by 1951 the figure was 19 million per month.
    • By 1949, 8.5 million people had received free dental treatment.
    • Poorer people now had free access to medical treatment which previously they could not afford.
  • The NHS has played an important part in prevention as well as cure; it has launched health campaigns to warn of the dangers of smoking, drinking alcohol, and the lack of a healthy diet.
  • Services provided by the NHS:
    • GP services, ambulances and Accident & Emergency Departments, hospital care (tests, treatment, operations), pharmacies, mental health services, social care (children, the disabled, the elderly), dentists, opticians.
  • Huge demand for prescriptions, glasses, and dental treatment led to the introduction of charges in the 1950s.
  • The NHS prolongs the lives of people, but older patients are more likely to need treatment.
  • New scanning techniques and drugs have also increased the cost of running the NHS.

Welsh Example: Free Prescriptions

  • The NHS has been charging for prescriptions since 1951.
  • In 1999, the Welsh Assembly took over control of the NHS in Wales.
  • In 2007, the Welsh Assembly changed this so that prescriptions are now free in Wales.

Modern Period: c.1900s-present day

  • Changes in Health and Medicine c.1340 to the present day (Unit 3)