Patient Care

Question 1

Religious -medieval

Answer 1

Almost all hospitals were religious institutes
Run by the church- buildings of monasteries with an infirmary e.g tintern Abbey
Varied in size from 12 to 225 (St Leonards, York, 1287)

Question 2

Medieval - leper hospitals

Answer 2

Leprosy epidemic 12-13th century, incurable and contagious

Built on Outskirts of towns, less mixing, lodging, food, no treatment

Question 3

Christian hospitals (middle ages)

Answer 3

Set up, paid for, run by church- poor and ill
Did not treat but made comfortable
Did not accept seriously ill and in need of care
Main purpose was to pray and attend religious services
Cared for and tried to save souls but did not attempt to cure
Spent much of the day praying and confessing sins

Question 4

Early modern changes

Answer 4

Henry VIII’s dissolution of the monasteries in the 1560s closed many hospitals
Church now ceased to support hospitals, charities had to take over
Some Area councils took over almshouses
In London they petitioned the crone to provide funds for hospitals

Question 5

Royal hospitals - early modern

Answer 5

5 major hospitals endowed in London by the crown some examples:
1547- st Mary Bethlehem- mentally insane
1553- christ’s hospital- provide for the poor
1553- bridewell hospital and prison- homeless children, disorderly poor

Question 6

Charities in early modern

Answer 6

Westminster hospital 1719 98 beds by 1757
Royal infirmary- Scotland, 1745-228 beds, 1000 outpatients by 1754
Foundling hospital 1739- children’s house for deserted children, 783 admitted out of 2523
Royal infirmary hospital 1752- eighty beds, 50 more by 1793, 3 physicians, 3 surgeons

Question 7

Almshouses- Middle Ages

Answer 7

Almshouses- for the elderly who needed long term care
Sheltered accommodation, nursing, no treatment, small, often a priest and 12 inmates
Widows with young children, pregnant women, poor, travellers

Question 8

19th century growth in number

Answer 8

1800- 3000 patients, 7619 in 1851
Specialists for maternity, orthopaedic, ENT
Cottage hospitals in rural areas, run by GPs

Question 9

Conditions 19th century

Answer 9

Cramped, stuffy wards, little cleaning, infection spread quickly
Untrained nurses- dirty, ignorant, drunk
Little training, nurses not a respected profession

Question 10

Nightingale Crimean war 19th century

Answer 10

1854-56, first war reported back to Britain
Nightingale took 38 nurses to Scutari on the Turkish coast
Patients washed, bedding changed regularly, patients separated depending on illness to prevent spread
After six months only 100/1700 still confined to bed, death rate fell from 42 per 100 to 2 per 100
Cadwaldr cleaned wounds and changed bandages but they didn’t get on

Question 11

Nightingale return (19th)

Answer 11

Raised 50k from public fund for Nightingale School of Nursing at St Thomas’ in 1860
Air, light, warmth, cleanliness, quiet, diets
Pavilion principle- 6 wards along a long corridor (good circulation

Question 12

Nightingale notes on nursing (19th)

Answer 12

1859- nurses can only go out of pairs and live in hospital
Keep a work diary, inspected monthly
Clean, change dressing

Question 13

Nightingale effect (19th)

Answer 13

1850- 0 trained nurses
1901- 68,000
1899- international council of nurses set up in London
Nursing recognised as a profession

Question 14

Mary seacole (19th century)

Answer 14

Born in Jamaica, her mother ran a medical centre for British soldiers
1855- Crimean war, opened “the British hospital”
Jaundice, diarrhoea, dysentery, frostbite
1957- autobiography the wonderful adventures of mrs seacole in many lands- raised awareness

Question 15

Examples of liberal reforms (20th century)

Answer 15

1906- Workmen’s Compensation Act and Education (Provision of Meals) Act (free school meals)
1908- old age pensions act (pensions for over 70s)
1909- Labour Exchanges Act (helped people get jobs and Houses and Town Planning Act (back-to-back houses illegal

Question 16

National insurance act 1911

Answer 16

Workers made weekly contributions to fund a sickness benefit and free medical care
Those entitled got free medical attention and 10 shillings a week for 26 weeks if absent from work
A second in 1913 meant it gave 7 shillings a week for 15 weeks for unemployment

Question 17

Beveridge report +first two parts (20th century)

Answer 17

1942- 600,000 copies sold, identified 5 “evils giants” for the government to tackle
Battle against want: national insurance act 1946, protected unemployed and pregnant
Battle against squalor:housing act 1949-financial aid to town/city rebuild
1946- new towns act, production of 14 new towns

Question 18

Last 2 battles (20th)

Answer 18

Battle against idleness and ignorance
1944 education act- free primary and secondary education
1947- school leaving raised to 15
1948- Employment and Training Act
Battle against disease:
1946 National Health Service Act

Question 19

NHS in 1946

Answer 19

Took 2 years to implement
Every British citizen had free medical treatment
Health centres- vaccinations, maternity care, ambulances, district nurses
Provide support from the cradle to the grave, raised money through taxes

Question 20

Opposition and impact of NHS (20th)

Answer 20

BMA survey January 1948- showed 90% of doctors would refuse
MP Aneurin Bevan would persuade opposition, 5th July 1948- 90% of doctors agreed
By October 1949: 187 million prescriptions, 8.5 million received free dental treatment

Question 21

Development of NHS

Answer 21

1952- charges for glasses, prescriptions and dental treatment
1990s- hospitals could become trusts and GPS fund holders
1998- NHS direct- 24hr advice on the phone
2002- primary care trusts, healthcare at a local level
2004- foundation trusts run by local managers, staff and the public