VICTORIAN HOSPITALS: THE OUT-PATIENTS' DEPARTMENT

In the UK, we often take the NHS for granted. Everyone, regardless of background or income, can receive medical or surgical treatment if they need it without having to worry about whether they can afford it.

Imagine, then, how different it was if you lived in Victorian England. Back then, it was your social class which determined the type of healthcare you could get. The wealthy upper classes paid for private medical treatment at home or, later in the nineteenth century, in a practitioner’s consulting room. The middle classes might also pay for their treatment, perhaps at one of the increasing number of specialist hospitals, or through a general practitioner or dispensing chemist.  

'Awaiting Their Turn: In the Out-Patients' Department at St Bartholomew's Hospital drawn by Frank Craig (The Graphic, 3 August 1907)

Workers earning a regular and sufficient income could make weekly contributions to a ‘sick club’ or other providential scheme, but the benefits rarely extended to their wives or families. The working classes who were just above the poverty line were eligible for free treatment from charitable general hospitals or dispensaries.  The abject poor who were receiving poor relief were refused admission to these hospitals and their only option was to seek treatment at the workhouse infirmary.

The out-patients' department of a Victorian general hospital was very like today's accident and emergency departments where most cases could be treated and sent home. More serious cases were admitted as in-patients. 

'Notes at a London Hospital: Saturday Night’ (The Graphic, 27 December 1879)

When a reporter for Living London (1900) visited one of these out-patients' departments, he described the waiting room: "The pale consumptive jostles a sturdy labourer whose bandaged head furnishes an illustration of the momentum of falling bodies; patients with rasping coughs and panting breath; patients on crutches; patients in splints, with limbs swathed in bandages; men and women, old and young, strong and feeble, are here mingled into an indiscriminate assembly." 

Inside one of the consulting rooms, round the sides were "a number of electric lamps fitted with bull's-eyes. At one of these a clinical assistant is examining, with the aid of a reflector fastened to his forehead, a patient's throat, while at another a student is exploring an obstructed ear." In the medical department "stethoscopes abound and coughs prevail; in the surgical, bandages, dressings and antiseptics are in evidence". In the eye department, the air was "filled with a droning sound of "E, T, B, D, L, N" as the patients read aloud the letters of the test types through the trial glasses, and students, working out 'refractions', are seen in dark closets, throwing from their ophthalmoscopes bright, dancing spots of light on to the eyes of their patients." 

'Extracting a Metal Fragment at the Ophthalmic Hospital’ (Supplement to The Sphere, 16 November 1901)

Those who had been seen by a doctor emerged from the consulting room with a prescription card which they took to the dispensary. Unlike today, bottles were not supplied free of charge so patients brought their own jars as receptacles for their medicine, or bought one from an itinerant bottle-seller outside the hospital. As well as medicines, out-patients could be prescribed surgical appliances such as crutches, artificial eyes or limbs, spectacles or a truss for supporting a hernia (a common complaint amongst labourers).  

'Notes at a London Hospital: La Queue at the Dispensary' (The Graphic, 27 December 1879)

Victorian general hospitals were staffed with highly dedicated and skilled doctors, surgeons and nurses, but they were overstretched and had to work within the constraints of a limited budget. While there is a clear parallel with today's hospitals, large numbers of the Victorian population, particularly women and children, frequently went without medical treatment simply because they weren't entitled to it and couldn't afford it. Thankfully, those days are long gone and today's NHS is a more fair and just system of healthcare.