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Who received treatment at Dorset County Hospital in the 1850s?
Who were the patients treated at Dorset County Hospital in the mid-nineteenth century? How did they access their treatment? And what were the results? These questions are addressed in my article which has recently appeared in The Proceedings of the Dorset Natural History and Archaeological Society (volume 139).
The Proceedings, which covers social history as well as archaeology and natural history, is available from Dorset County Museum. If you would like a copy, please email membership@dorsetcountymuseum.org for further information.
The article is based on an analysis of the hospital’s admissions registers for the 1850s (the earliest complete decade for which the registers have survived) and compares the hospital’s patients with the general population in Dorset, using data from the 1851 census. The article also looks at how DCH compared with similar hospitals in the south west.
Patient numbers
During the 1850s there were 3,227 in-patient admissions and 3,730 admissions to the out-patients’ department. To gain access to treatment, the majority of patients needed a recommendation from one of the hospital’s subscribers. The exceptions were the 14% of in-patient who were admitted as accident or emergency cases, when the normal admissions procedures were waived. In addition, the hospital provided minor one-off treatments – such as teeth extractions – to 6,417 ‘casual’ patients, who also accessed treatment without recommendations. The majority of in-patient admissions were surgical rather than medical. The reverse was true for out-patients. Surgical cases required specialist equipment and recovery time on the ward. The medically sick could be prescribed drugs to take at home. In any case, the hospital’s rules prevented individuals with infectious medical conditions from being admitted as in-patients.
Subscribers
The vast majority of subscribers who sponsored patients’ treatment were private individuals, including many of the county’s clergy (they accounted for 28% of all initial recommendations made by individual subscribers). In some parts of the county subscribers were thin on the ground. Dorchester was well served with 8.2 subscribers per 1000 people, but four of the more distant areas had fewer than 1 subscriber per 1000. The local poor law unions also acted as subscribers and recommended patients for treatment. In the 1850s, they initiated in-patient treatment 214 times. Many individual subscribers were also involved in administering the poor law system. In 1851, for instance, 18 of Dorchester’s poor law guardians were also hospital subscribers. Dorset’s poor law unions also sent patients to Salisbury Infirmary, Bath General Hospital and the county hospital at Winchester.
Elective patient admissions by sex and age group, Dorset County Hospital, 1850-59, compared to the 1851 census
Age and sex
Access to elective in-patient care was targeted at older adolescents and younger adults, reflecting their economic utility. The hospital’s admissions policy barred young children and expectant mothers from in-patient care. From the age of 30 access to in- and out-patient care declined for both sexes, but less dramatically so for males. Greater value was attached to men’s labour; if a man was unable to work his whole family could become destitute. It is no coincidence that the subscribers most keenly aware of this – the poor law unions – sent twice as many men for treatment as women (141 males compared to 73 females). Females aged 60 and over were significantly under-represented among patients. Males accounted for nine out of ten urgent admissions.
Occupations
Labourers formed the predominant male occupation among patients just as it was in the general population of the county. One in five Dorset males were agricultural labourers, with men continuing to labour well into old age. Relative to their numbers in the census, there is also a fair representation of tradesmen (such as bakers, butchers, and blacksmiths) among male patients, although more prosperous tradesmen were more likely to be subscribers than patients. Farmers represented the fourth largest male occupational group in the census but, because of their incomes, they were noticeably absent among the patients. As confirmed by reports of coroners’ inquests, carters were disproportionately prone to accidents: of the 59 admitted as in-patients during the 1850s, 26 were as a direct result of an accident. Fifty-one ploughboys were admitted as in-patients in the 1850s, ranging in age from 8 to 18 years; 24 were injured in accidents.
It is likely that both the census and the hospital’s admissions records under-recorded female employment. They were often described by the hospital as someone’s wife or daughter, rather than being recorded as having an occupation of their own. As we would expect, a large proportion of the wives – over 60% – were married to labourers. The majority of female patients with a recorded occupation were domestic servants or they made or washed clothes. This broadly conforms to the incidence of these occupations in the census, except that females working in button- and glove-making were underrepresented as out-patients. These jobs were very localised, in only a few parts of the county at some distance from the hospital, making out-patient attendance impractical. Over a thousand women in the census were described as annuitants. Very few were admitted because their income was too high. There were few male or female paupers among the patients because they were excluded by the hospital’s admissions policy.
Residence
Not surprisingly patients from the three Dorchester parishes and from nearby Fordington form a significant proportion of the intake. Because of the level of poverty in Fordington, it is over-represented. The largest occupational group from Fordington were labourers whereas the largest from St. Peter’s were servants, working in the houses of its better-off residents. Life for the poor in Fordington meant dangerous work and hazardous living conditions. Over 60% of in-patient admissions from Fordington were accident cases or medical emergencies. Overall, Fordington accounted for 28% of all urgent admissions to the hospital during the 1850s. Looking at the ten most frequently recorded places of residence and the distances of those places from the hospital, it is clear that the catchment area for out-patient admissions was far more limited than that for in-patients. For out-patients, the furthest in the “top ten” was just under seven miles away; for in-patients it was nearly 16½ miles away.
Treatment outcomes
Just over 43% of in-patients and out-patients were cured. A slightly greater proportion of in-patients than out-patients were relieved. These figures must be treated with caution. The terms cured and relieved embraced considerable latitude. Around 11% of DCH’s in-patients were transferred to the out-patients’ department to complete their treatment. Patients who were deemed incurable were discharged. Some sought treatment elsewhere; others had already been to one of the other hospitals in the south west and attended DCH as a last resort. It may not have been unusual for the poor to use different healthcare providers – the county hospital, infirmaries in neighbouring counties, and local poor law services – but until many more hospital and poor law records become accessible we will not fully understand how the poor used the range of institutions available.
Patient attitudes
We have very few first-hand accounts from early hospital patients, but even without direct testimony we can, to some extent, discern attitudes from behaviours. Patients were not without agency. They exercised choice and they had a voice. At DCH some voted with their feet. A small number (6) absconded; a significantly larger number (179) were discharged “at their own request” – either because they disliked the regime, or they felt well enough to go home, or they needed to return to wage-earning or caring for dependents. It seems likely that many left because they refused treatment. Just ten patients were expelled for misconduct during the 1850s. Complaints about hospital food and the attitude of the nurses were – and still are – commonplace in many hospitals, however there were just two recorded complaints against the nurses in the 1850s. Perhaps complaints against nurses were infrequent because they delivered little hands-on care. Wage records reveal the hospital only employed four permanent nurses at any one time, with one or two casual night nurses. Patients were required to care for themselves and each other, including cleaning the ward, fetching meals, and feeding those unable to feed themselves. While conditions at the hospital were not agreeable to everyone, there was growing demand for hospital places and repeat admissions were not uncommon. There are examples of individuals leaving grateful bequests to the hospital many years after treatment.
Conclusions
In drawing conclusions from my analysis, we need to avoid imposing modern day expectations and attitudes. We are familiar with the idea of comprehensive, universally-accessible healthcare. But voluntary hospitals did not aim to be either comprehensive or universal. Their intention was to assist the working poor with a limited range of surgical and medical needs. DCH broadly met this aim by limiting access and targeting resources, but that meant excluding many potential patients, including the very young and the elderly, particularly older women. Those who were socially and/or geographically marginalised were also excluded. The friendless, without the patronage of a subscriber, were unlikely to gain access. Would-be patients living in distant parts of the county also found it harder to secure a recommendation, and out-patients in particular were deterred by the need to travel.
Posted 26 July 2019
Ne
w poor law data highlight the everyday illnesses of Dorset’s working poor
Today lists of able-bodied workers paid poor relief by the Blandford Poor Law Union for the years 1858-61 have been added to the site (those for 1853-57 were published last year). These entries – now totalling 1,742 – shed light on the kind of illnesses poor workers and their families experienced in their daily lives. The data, sorted alphabetically, can be accessed here.
Most recipients were men and these payments were usually because of their own or their families’ illnesses. Occasionally relief was given for funeral expenses or transport costs to hospital, and there are a few orders for the individual to enter the workhouse. These lists began to appear in the poor law guardians’ minutes in December 1853. The form of relief – whether in cash or in kind – is rarely recorded in the original records.
One thousand entries state the nature of the medical condition giving rise to the relief. These include rheumatism (13%), influenza (10%), abscesses (5%) and hernias (4%). Agricultural labourers, working in the wet and the cold, were particularly prone to rheumatism, and many hernias were caused by hard manual labour in the fields. Blandford Union issued trusses to hernia sufferers: over time these rotted and the springs rusted, and the wearer normally needed a new one every few years. Joseph Andrews of Pimperne received a truss three times from 1856 to 1861, and on two other occasions he received unspecified relief for ‘rupture’ – that may also have been in the form of a new truss. Likewise John Ford, also of Pimperne, received a new truss four times from 1854 to 1859.
The relevance of these data to Dorset County Hospital is that they further our understanding of the medical histories of the hospital’s patients. For instance, Charles Giles, an agricultural labourer in his fifties, originally from Tarrant Hinton, received poor relief from the union twice in 1856 because he had pyrosis (usually known as heartburn – a painful, burning feeling in the chest caused by stomach acid flowing back into the oesophagus). In between those two payments he was admitted as an in-patient to Dorset County Hospital with dyspepsia (indigestion). He remained in the hospital for less than a month. Later that year he was admitted again as a medical in-patient, this time to Salisbury Infirmary. The reason for his admission is not recorded but it is likely it was related to his digestive problems. He remained an in-patient for two months and then was made an out-patient at Salisbury for a further three months. The burning sensations he experienced were, of course, symptoms rather than the underlying disease. He died in 1858 of ‘schirrhus of the pylorus’ – a cancerous growth in his digestive system.
Some individuals were frequent recipients of relief: for instance Charles Skivington (or Skyvington) from Charlton Marshall received relief 23 times from 1854 to 1861, for his illnesses or those of his family. He personally suffered from lumbago, influenza (numerous times), an abscess on his finger, stomach ‘affection’, rheumatism, and a back injury. Overall there are only seven entries relating to consumption and only one cholera case. The vast majority of the relief was given to men like Skivington, an otherwise able-bodied worker, who suffered a series of what historian Tim Davies has termed ‘mundane maladies’.
The poor relief lists can be found in the minutes of the Blandford Union Poor Law Guardians, which are held at the Dorset History Centre (opens in a new window). The volumes for 1853-61 are referenced BG/BF/A/1/7, BG/BF/A/1/8 and BG/BF/A/1/9.
Posted 16 February 2019
Update on this site and related activity
This site has been dormant for a while because of a serious family illness. However material is still being transcribed and I hope to publish a transcript of the 1861 in-patient admissions register in the next week or so. I also have material on poor law relief paid to the poor on account of illness which I have begun to publish. These transcripts are based on poor law guardians’ minutes, mainly for the 1850s. You can access these Poor Relief Indexes on the Poverty in Dorset page. More names will be added to the indexes in due course.
Also a 7000-word article about the hospital and its patients in the 1850s is due to be published in the Proceedings of the Dorset Natural History and Archaeological Society sometime in the first half of this year.
My related site – the Dorset Death Certificate Index (www.dorsetdci.com) – now has free transcripts of over 880 death certificates for people whose deaths were registered in Dorset from 1837 onwards.
Please follow the Twitter account @HistoryDCH for updates.
Dorset Death Certificate Index now live
www.dorsetdci.com
The new website with death certificate details has gone live and already there are 279 records. The period covered is 1837 to 1875 – slightly extended from what was originally intended. The coverage might be extended further once the supply of donated death certificates has been exhausted.
My interest is the 1850s – tying the death certificates in with hospital records and poor law records – to look at the illnesses that people lived with, not just the ones they died of. So, for instance, Jane Applin, a farmer’s wife from Fontmell, did not die until 1861 – but the death certificate tells us she was living with acute bronchitis for 15 years.
Dorset DCI is free to use and each entry contains all the information you find on a death certificate apart from the name of the registrar and the date of registration. The entries are arranged in alphabetical order and there is also a search function. This allows you to search for people (such as relatives) who registered the deaths. If you donate a scanned death certificate to the site, I will not give copies to anyone else, but the information on the certificate will be transcribed and published.
The more entries we have, the more useful this site will be to everyone, so please help by emailing scans of your death certificates to either mail@dorsetdci.com or dorsetdead@aol.com. All donations will be acknowledged so if you haven’t heard from me, please get back in touch.
Bring out your dead!
Please donate scans of your death certificates
As an extension to this website I am doing a project on illnesses and causes of death in Dorset in the 19th century. For this I need copies of death certificates of people who died in Dorset from 1837 to 1870. Details from all donated death certificates will be put on a separate website as a free resource for everyone to share. I will publicise the website address here when it is launched.
To help this project, please email scans of your death certificates to: dorsetdead@aol.com
Posted 25 March 2018
The History of Dorset County Hospital 