England Hospitals - International Institute

Early History
Most of the monastic hospices, a term which included lodging for travellers, housing the elderly and infirm, as well as tending the sick, were destroyed in the 1530s at the Reformation. There were a few exceptions which were re-founded under lay control, notably the Royal hospitals of St. Bartholomew’s (Bart’s), St. Thomas’s, Bridewell, and the Bethlehem/Bethlem (Bedlam) hospital for the insane, all in London. In 1551 a court decided that three hospitals (St. Thomas, Bridewell and Christ’s) should care for:


 * 300 fatherless children
 * 200 sore and sick persons
 * 350 poore men overburdened with Children
 * 400 aged persons
 * 650 decayed householders
 * 200 ydell vagabonde

Other mediaeval hospices were founded by private benefactors or charitable groups such as livery companies and guilds and there are early records of the people who contributed amongst the records of the appropriate institutions.

Infirmaries and hospitals were also founded in Tudor times, but the 18th century was the real age of hospital foundation with a commitment to science and philanthropy in the medical field. During this century the population almost doubled as a result of an increased birth rate and a very much reduced death rate due to improved medical services. Another factor in the cities was the decline in consumption of cheap gin.

The famous London teaching hospitals of Guy’s, St. George’s, Westminster, London and Middlesex were all founded between 1720 and 1745. Altogether 154 new hospitals and dispensaries opened between 1700 and 1825 by co-ordinated voluntary effort and subscription. Most of them were taken into the National Health Service after its inception in 1948. The foundation dates of the major hospitals and asylums are given by Richardson, and the history of the development of medicine in London by Beresford.

19th Century Hospitals
In 1802 in Reading, Berkshire a group of local doctors set up a dispensary to provide medicines and advice free of charge, which was dealing with over a thousand patients a year by 1848. By 1820 there were 60 dispensaries in England, but they had no facilities for overnight or long-term cases. Records are unlikely to have been kept.

Those who could afford to do so were treated at home by a visiting doctor who made his income from these wealthier patients, and donated his time ‘for the experience’ at the voluntary hospital. Nurses could be hired out privately by the hospital that trained them.

Improvements in hygiene and sanitation, and the developments in anaesthetics and antiseptics, made hospitals less fearful in the late 19th century. There were some private hospitals for which patients paid; perhaps they were somewhat cleaner, less crowded and more respectable than the regular sort.

Generally only the poor would be admitted to most early, voluntary hospitals (funded by voluntary contributions) as they were dirty, crowded and staffed by untrained nurses. The system for admission depended upon getting a letter of recommendation from one of the benefactors of the hospital, rather than from a doctor. This was particularly inefficient for urgent cases and eventually it changed so that the poor just presented themselves at the hospital. It was open 24 hours a day and patients queued up on wooden benches for their turn to be examined, treated or admitted.

Alan Jones in his work, The Taunton and Somerset Hospital (pre-NHS), wrote about conditions for entrance to the Taunton and Somerset voluntary hospital in the early 19th century. Letters from steward John White to his employer Lord Palmerston in March 1757, refer to the outbreak of smallpox in Romsey, Hampshire and the system of recommendations (Dewey 2003b):

Chart: Letters Regarding Hospital Recommendations

By the 1840s ether and chloroform were being used as anaesthetics, which eased the pain of operations, but did not deal with the frequent problem of infection of the wounds. In 1867 Lister proved that carbolic acid would destroy germs and eliminate septic infection, thus revolutionising surgery. Now hospitals could offer a real hope for cure, and not just be a charity for the sick poor, and from this time on the voluntary hospitals started to provide beds for paying patients. Many became significant research and teaching institutions where large numbers of patients with the same condition could be studied and cures effected.

During the Victorian era several specialist hospitals developed for those cases not taken by the voluntary, general hospitals. These included facilities for children, incurables, patients with chronic conditions, pregnant women, the mentally ill, and isolation hospitals for infectious diseases. By the 1860s there were 66 specialist hospitals in London alone.

It helps the genealogist to know that clean air and open spaces were favoured for the mentally ill and for infectious diseases, and these institutions may be some way outside the major cities where their ancestors came from.

The voluntary hospitals were mainly concentrated in larger towns and cities; another development, in small towns and rural areas was the cottage hospital, with 6-26 beds, catering for a local community’s needs. The first was erected in 1859 and by 1895 there were nearly 300. They were the first port of call for the sick or injured and many continue in use today, being absorbed into the National Health System after WWII.

In the late 19th century working class people were encouraged to pay into subscription schemes to help maintain their hospital. Many gave a penny a week and then had a right to treatment rather than receiving it as charity. I recommend Lavinia Mitton’s well-illustrated guide, The Victorian Hospital, to Victorian hospitals to understand what the medical system was like for patients in the 19th century.

Poor Law Infirmaries
After the dissolution of the monasteries there was no public assistance for the sick until the Elizabethan Poor Law of 1601. Even then, there was no requirement for a parish to set up a hospital or provide medical services and most could not afford to do so. Gradually, as workhouses were built, many included an infirmary where untrained nurses, or other inmates, provided the care. Local doctors would grudgingly provide a service paid for by the Overseers of the Poor or Guardians of the Workhouse to supplement an insufficient private practice

Chart: Doctor’s Bill to Crayford, Kent Overseers of Poor 1832 Overseers Misc PA/103/16/2



Conditions in workhouse infirmaries were definitely worse than in the voluntary hospitals. But oftentimes there was no local poor infirmary or hospital and a parishioner could be sent to one of the larger city hospitals. Such a case is related by Davey, where a woman from the Kent countryside was sent to the Middlesex Hospital in London. He shows examples of both poor law and hospital records concerning payments for her for several years.

The Metropolitan Poor Act of 1867 required the provision of a separate infirmary building or separate accommodation within the workhouse for the sick. Thus hospitals which were founded during the 1870s and 1880s probably developed out of a workhouse infirmary. One was St. Andrew’s in Stepney, founded in 1871 (Springer) at a time when the only qualification needed by a nurse was that she could read the labels on the medicine bottles!

In the 1860s non-paupers were admitted to workhouse infirmaries, at first comprising about one-third of cases, and by 1911 these infirmaries provided four times the number of beds as did the voluntary sector. It is thus common to find your ancestor dying in the union infirmary even if they weren’t a pauper. Consult Penelope Christensen’s Parishes and Registration Districts in England and Wales (2001, Heritage Publications) to find out which poor law union your parish was in.

Workhouses were taken over by local authorities in 1929 and all the records transferred to them, thus they should be in the county archives. The workhouses continued to provide a home for those not taken into special facilities until 1949 when the last few closed. Workhouse infirmaries became municipal hospitals for the general public, but it became increasingly difficult for the voluntary subscriptions to cover the costs of rapidly advancing treatment methods.

Army and Navy Hospitals
Prior to the Crimean War (1854-56) there were only three military general hospitals in the UK—at Chatham, Cork and Dublin. Two more, Woolwich and Netley (near Southampton) were added afterwards. There were also two institutions for wounded and disabled soldiers which were not strictly medical establishments. These were the Royal Hospital at Chelsea, London, and the Royal Kilmainham Hospital in Dublin which received soldiers not according to ethnicity but by their place of discharge from the army. They had both in-pensioners and out-pensioners, the latter received an allowance but lived at home.

Children’s Hospitals
Great Ormond Street Hospital, founded in 1852 was the first children’s institution and by 1888 there were 37 more around Britain. They dealt mainly with acute and urgent cases.

Foundlings and Orphans
Destitute, abandoned and orphan children were the responsibility of civil parishes from the 16th to 19th centuries and the overseers of the poor apprenticed them to local, or not so local, householders. From the latter part of the 18th century such children were unloaded on factory owners in the Midlands and North and many suffered appalling conditions.

In 1741 Thomas Coram’s Foundling Hospital opened in London and the records show the support given by benefactors such as an organ from Handel, and a painting from Hogarth. Clark describes in detail the process of admission of the child, how it was identified, given a new name and assigned to a wet-nurse in the home counties, and how inspectors supervised them. Orphaned children of soldiers, and some children of deserted women were accepted after 1763, but after 1772 only real foundlings and exposed or deserted children were supposed to be admitted. Most of those admitted after 1801 were illegitimate. Camp describes how some children were eventually reclaimed by their parents and the records available for them. Infant mortality was high and parish records often indicate those from the Foundling Hospital, an example shown below.

From 1838 the Poor Law Guardians were responsible for orphanages and large numbers of voluntary orphanages were built during the 19th century to cope with the growing problem of destitute urban children.

Chart: Burials in Withyham, Sussex of Children from the Foundling Hospital

The work of Dr. Barnardo is the most well-known but there were hundreds of others, including many who sponsored child migrants to Canada and Australia. Cavell has written on internet sources for children’s homes and orphanages.

Isolation Hospitals
From the mid-19th century certain diseases had to be notified to the central authorities, and those with infectious diseases were isolated in special fever hospitals, including hospital ships used for this purpose. For example, hulks moored in the Thames were used as floating hospitals during the smallpox epidemics of 1871-2 and 1880-1, and Woodlock describes the records available for a little smallpox victim on the ship Atlas in the Thames off Dartford in 1892, with further discussion by Gallagher (2002).

Two kinds of smallpox isolation hospitals for private patients developed during the early 18th century. The first was for those who had caught the natural disease and whose family or employer could afford to send them to recover and prevent them from infecting others. The second was for those being prepared for inoculation and recovering from it, and could include servants of the well-heeled as well as the families themselves. The first voluntarily supported (i.e. free) smallpox hospital was the London Smallpox and Inoculation Hospital founded in 1746. And others were set up around the country, some charging a fee for inoculation.

Another kind of isolation hospital was the tuberculosis sanatorium.

Lying-in (Maternity) Hospitals
These were established in many towns during the 18th century, as an alternative to home births. Some run by religious groups or spinsters refused to accept unmarried women, or even married women for their first birth in case the child was conceived before marriage.

The British Lying-In Hospital, Endell Street, Holborn, London has five films of registers covering Particulars of Patients 1754-1868 and Births and Baptisms 1749-1814 which are on the IGI.

Chart: British Lying-in Hospital, Holborn Particulars of Patients 1776  #13277

I wonder if the father was butler to the 3rd Duke of Portland who was twice prime minister?

Chart: British Lying-in Hospital Register of Births and Baptisms 1791 RG8/64 The minister seemed to come round once a fortnight to christen the latest batch.

Gallagher (1999) has presented a detailed study of the Westminster Lying-In Hospital including pictures of the buildings, many names, and photocopies of an order for admission, anexamination certificate and an affidavit.

20th Century Hospitals
The coalition government of WWII placed hospitals under government control so they could be effectively managed for both civilian and returning forces casualties. Thus, my great grandfather, hospitalised in Greenwich in SE London, was sent to a Glasgow hospital to free up beds for injured servicemen shipped from Europe. This centralised system laid the foundation for the National Health Service brought in under the National Health Act of 1948 which provided free health service for everyone. At first, most NHS hospitals were former Victorian hospitals and workhouse infirmaries but replacements and modifications have been made, for example:


 * Former cottage hospitals have often been changed into extended care facilities.


 * Sanatoria for infectious diseases have not been necessary since the widespread use of antibiotics after WWII and have been changed to other uses.


 * Specialist hospitals have commonly been merged to form special departments in larger municipal and county hospitals.


 * Most of the large, remote mental asylums are redundant since community care and drug therapy now predominate.

Many old buildings were unable to be modified for modern usage and have been demolished or converted to other uses such as senior’s residences, housing, offices and a few are even hotels.

Lunatic Asylums
First a word about the meaning of term asylum which nowadays tends to mean a place of treatment for the mentally ill. This was not the case formerly when the word had its original meaning of a sanctuary or place of refuge. This might have been for criminals, debtors, or any afflicted or destitute persons. Thus not every institution termed an asylum was for the mentally ill.

The genealogist will encounter various terms to describe those with mental problems of one kind or another. It is impossible to really define these, they were not used consistently in the past, and some have different meanings today. A rough guide follows:


 * Feeble-minded—Senile dementia
 * Idiot—Congenital mental deficiency with no lucid periods. Natural fools from birth. Incapable of attending to own personal needs
 * Imbecile—Persons who have fallen in later life into a state of chronic dementia. Could perform some simple functions of self-help, whilst having only a limited grasp of ideas.
 * Lunatic = Insane = Mad (but see other meaning) In the 17th C it was used for a person who had lucid periods, thought to coincide with phases of the moon. Some were merely highly intelligent and/or eccentric in their behaviour. By 1845 the term was officially persons of unsound mind. In the 19th century censuses the term sometimes included idiots and imbeciles. Now we restrict these old terms to those having such mental unsoundness as interferes with civil rights or transactions.
 * Mad—Formerly a raging lunatic, but nowadays has connotation of being a wildly foolish person.
 * Melancholia—Clinical depression.
 * Mentally ill—A more modern term for having a temporary, usually treatable, disordered mind.
 * Mentally disabled—A more modern term for having a permanent insufficiency of mental power.

The last column on 19th century census returns (the so-called deaf-and-daft column) asked householders to classify their mentally infirm relatives as imbeciles, idiots or lunatics but the results are very untrustworthy.

Prior to the mid-18th century mental illness was not recognized as such and the sufferers were treated as criminals, paupers or vagrants. Most would have spent time in the workhouse, prison or wandering and constantly hounded by the authorities. In London, there was one ancient hospital which catered for them, St. Mary of Bethlehem or Bethlem, founded as a priory in 1247 and converted into an asylum in 1547. It was known colloquially as Bedlam, from whence derives the modern word for a cacophonous situation, and people were allowed to view the inmates as an entertainment!

Those who could afford to do so committed relatives whose behaviour was an embarrassment to fashionable society to one of the numerous small private mad houses. They were profit-motivated and conditions in many were deplorable. Hawker has stated that none kept records identifying inmates, a discreteness required by their families. However from 1774, when they had to raise their standards to be licensed by the justices of the peace, records of the JPs and medical practitioners survive in county archives. These include admissions, discharges, deaths, the official visitors’ reports and minutes of meetings. Hawker reports on some examples in Dorset, Burt on Hampshire and Jenkins in more detail about treatments and records at the Somerset asylum. Adams reports on conditions prior to and during his 30-year career as a male lunatic nurse.

The County Asylums Act of 1808 encouraged the provision of a lunatic asylum in each county, and in 1854 this was made mandatory. Numbers of beds rose from 12,000 in 1850 to 100,000 in 1900 (Mitton), but harmless paupers were left in workhouses from the 1870s as it was cheaper; only the dangerously insane being sent to the county asylums. Commissioners in Lunacy were appointed in boards of ten for inspecting asylums. Other terms that will be encountered in the records are:


 * Commission of Lunacy which authorized an enquiry into a person’s sanity.
 * Visitor or Master in Lunacy was the officer investigating cases of alleged lunacy.
 * A single lunatic was one being cared for at home.
 * A chancery lunatic was a wealthy person who became insane and incapable of managing his own affairs and the Chancery Court protected his estate.
 * A criminal lunatic was a convicted criminal whose reason was impaired and was considered dangerous to society.

Most of the surviving patient records will be found in the county or local archives in sections on private madhouses, poor law records and county asylums, as well as in quarter sessions. Some institutions which continue as hospitals retain their records. Others, such as criminal cases involving the insane, poor law returns of insane inmates, naval lunatics, and chancery records concerning property of lunatics can be found at The National Archives (TNA). The registers of patient files from 1846-1960 are at TNA in MH94 and contain name and sex of the patient, institution, admission and discharge (or death) dates (Cleaver 2003). Chart: Bill and Receipt from Kent Lunatic Asylum to Crayford Parish 1833 - Overseers Misc PA/103/16/2

For further information consult TNA leaflets D104-105 for official acts, commissions and central records and Mitton’s The Victorian Hospital for information about lunatic hospitals. Faithfull gives the history of how lunacy was viewed, treatments and asylums, as well as how to find records of lunatics. She has separate sections on women, chancery, criminal and naval lunatics as well as famous mad doctors i.e. doctors specializing in treating lunatics; all this in one inexpensive booklet. The Wellcome Institute has a register of the location of most hospital records.

An application for a chancery inquisition concerning the supposed lunacy of a distant relative in 1859 is given below. These records are at TNA under C 211/32/24/116938. Chart: Application for Chancery Lunacy Inquisition for Rachel DASHWOOD 1859

Chart: Chancery Lunacy Inquisition for Rachel DASHWOOD 1859

Categories of Records
Phillips categorises records which may be available as:


 * Administrative, including estate records and finances, account books and minutes of meetings. People mentioned are the governors, tradesmen supplying the hospital, persons dealing with the hospital about property, employees (who usually lived in) and the occasional patient.
 * Medical records of three major types:


 * Admissions and Discharge Registers may be very sketchy in earlier times, for example just the names, arranged by ward and unindexed. However some, for both in-and out-patients can be most useful for the family historian. They can contain ages and addresses for patients, the dates of admission and discharge as well as the treatment given. Sometimes indexes have been prepared.
 * Death Registers which from the mid-18th century can include name, date admitted, date died, parish, if buried in the hospital or not. A century later there may, in addition, be the patient’s age, ward in the hospital, disease, civil state, occupation, address, name of friend or undertaker who removed the body. Do not expect them to be indexed but be joyful if they are!
 * Case Histories still exist back to the early 1800s, and occasionally earlier and may be indexed by patient and by disease. However, because of volume and expense many were culled after 25 years from the time they were last opened. They can show the complete case history, the treatment and the outcome, including any post-mortems, and were originally intended for student instruction. The usual 100-year closure rule for public records applies, although archivists have some discretionary ability.

Chart: Examples from Dr. John Symcotts Medical Case-Book 1642 De tuberculis rubris faciei [red pimples on the face]

For casualties and outpatients there may be no records left in the hospital archives and Phillips suggest that local newspapers are likely to give details of accidents.


 * Medical and nursing administration and personnel records are dealt with in the course English: Occupations - Professions and Trades.
 * Other Sources


 * Subscription lists (those who donated money)
 * Files of newspaper cuttings about the hospital
 * Hospital annual reports and year books
 * Collections of photographs of hospital wards and operating theatres.
 * Records of associated facilities such as medical or nursing schools and convalescent homes.
 * Census Returns

Those residing overnight in any institution will be enumerated there in the census returns, so those missing from a family grouping may be found this way. Remember that superintendents of certain institutions such as mental asylums were permitted to enter only initials for the names of their patients. In electronic searches these can be found trying various combinations of the initial, initial and a period, and initial and a space; it will appear as the transcriber saw it on the original. Many useful examples of hospital records and repositories can be found in Susan Bourne and Andrew Chicken’s Records of the Medical Professions: A Practical Guide for the Family Historian, and in Peter Amsden’s The Medical Professions and Their Archives although the latter’s book is primarily about medical personnel.

Location of Records
In 1957 hospital records were declared public records and as such could be deposited in county record offices, however, in practice they are too huge for these offices to handle. Only a few hospitals maintain an archivist, notably St. Bartholomew’s, the Royal Bethlem (see Allderidge and Gale’s Records of the Royal Bethlem Hospital ), and Oxford Health Authority. St. Bartholomew’s (Bart’s) Hospital in London has one of the largest, oldest and complete accumulations of records in the England. It was founded in 1123 and some 2,000 mediaeval deeds are extant; the majority of its records start in the 1530s. Cecil Humphery-Smith recounts his experiences with the Bethlem records, including a note on a Sussex vicar who committed himself because of dementia caused by a surfeit of choirboys!

The Hospital Records Database is a joint project of the Wellcome Institute and the Public Record Office. The aim is to record details of all known surviving hospital records in the UK. So far there are over 2,800 hospitals with entries, mainly of records deposited in archives. Researchers can find information in this database on:


 * The administrative details of the hospitals and their status and type.
 * The location and covering dates of administrative and clinical records.
 * The existence of lists, catalogues or other finding aids.

There may be closure periods of up to 100 years for individual patient records, except via a doctor or social worker. It is always wise to contact the archivist of the relevant repository before you visit to find which records are open and whether you need an appointment. The Medical Archives and Manuscripts Survey (MAMS) complements the above-mentioned Hospitals Records database by extending it into general practice, local authority public health departments, personal papers of patients etc. The Wellcome Library website is in its early stage of development to provide a consolidated finding aid for a huge number of scattered medical records. Hilton provides further details.

LMA (London Metropolitan Archives) holds records of over 100 hospitals and institutions, such as St. Thomas’ Hospital and the Nightingale Training School, Guy’s Hospital, Hanwell and Colney Hatch asylums, Moorfields Eye Hospital and Queen Charlotte’s Maternity Hospital. Many are not located within even the present, wide London boundaries but all around the home counties. In 1992 Foster listed those presently held by LMA.

You can also write to the Hospital Administrator or Patients Service Manager of a specific hospital. However, few hospitals have the resources to do searches, but their attitude towards archival records is changing and more are depositing records or hiring their own professional archivists.

Finding Records in the FHLC
There seems to have been no systematic collection or filming of English hospital records by the GSU (Genealogical Society of Utah) yet. The category of medical records only contains one item in the Great Britain section, about the 19th century vaccination acts. The section on England produces four general books and medical records—19th century contains only a medical directory. Similarly, a search of the county sections produces very little; two items on Eastbourne hospitals under Sussex, and one in Rutland, for example. Some can be found under a subject search for hospitals, but the majority of medical and hospital records that are at the FHL will be found with a place-name / locality search. They might be under medical records,history, public records, cemeteries, church records or poorhouses! A few selected to show the variety available include:


 * A centenary history of Halstead Hospital [Essex] 1884-1984. (not yet filmed).
 * Children and adults in various hospitals, schools etc. 1884-1899; and a list of births 1872-1873 in Bow and Bromley [Middlesex] on.
 * Care and compassion: old prints and photographs of hospitals and nurses in Berkshire and Oxfordshire 1839-1930. (not yet filmed).
 * Bully’s Acre and Royal Hospital, Kilmainham [Dublin, Ireland - army] graveyards: history and inscriptions..
 * Bishop’s transcripts of the Royal Navy Chapel of Hasler Hospital, Alverstoke Parish [Hampshire] 1831-1882 on.
 * Baptisms at King’s College Hospital, Denmark Hill [London] 1887-1913 on.
 * At the crossroads: a history of Arclid Workhouse and Hospital [Cheshire] on.

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