Hospital Life in Enlightenment Scotland: care and teaching at the Royal Informary of Edinburgh
Cambridge University Press, 1986
This work offers the first complete account of institutional life in an eighteenth-century British hospital. Using a multitude of surviving documents, the author presents an intimate view of the experiences of the sick poor and their physicians at the Royal Infirmary of Edinburgh between 1750 and 1800. The first voluntary institution of its kind founded outside London, the Infirmary is examined within the contemporary context of the Scottish Enlightenment and the tenets of British philanthropy. From its inception, this hospital was a focal point for the convergence of charitable intentions, local civic pride, and the improvement of scientific medicine.
After briefly reviewing the Infirmary’s early developments, building projects, finances, and regulations, the story concentrates on the experiences of patients and staff. Both groups are followed from the admitting room to the various wards, from the teaching section to the operating theatre. Admission routines, history-taking, diagnoses, and treatment are all meticulously reconstructed with the help of registers, minutes of meetings, lecture notes, and nearly 100 individual clinical histories preserved in casebooks. The final chapter is devoted to clinical instruction of medical students and surgical apprentices who were flocking to the Edinburgh University for their training.
Histories of hospitals have traditionally failed to probe the nature, workings and meaning of institutional confinement. Such narratives downplay the fate of patients and their diseases while medical treatments are judged to be harmful. By contrast, Professor Risse delves deeply into the organizational aspects of the Edinburgh Infirmary and effectively demonstrates that through careful patient selection and the assistance of experienced practitioners, this eighteenth-century British hospital played an important role in the study and treatment of the sick poor who secured admission.
TABLE OF CONTENTS
1. The Sick Poor and Voluntary Hospitals
“Desirous of accommodations in the house”: the road to hospital admission
The origins of the British hospital movement
The Royal Infirmary of Edinburgh
2. Hospital Staff and the Admission of Patients
Who attends the sick? Infirmary professionals and their helpers
“The patient comes into our hands”: admissions process
3. Patients and their Diseases
Entering diagnoses in the General Register
The spectrum of diseases at the Infirmary, 1770-1800
Length of hospitalization
4. Hospital Care: State of the Medical Art
Principles of eighteenth-century therapeutics
The context of hospital Care
Therapeutic effects of hospitalization
The use of drugs
Effects of treatment
Discharge from the hospital
5. Clinical Instruction
Organization and enrollment
Students and clinical teaching
Clinical teaching and the patients
The didactic role of autopsies
The teaching of surgery and midwifery
Edinburgh and Europe contrasted
Eighteenth-century hospitals: for better or worse?
The “birth” of the clinic
The final blessing
Selected clinical cases
Drug usage at the Infirmary: the example of Dr. Andrew Duncan, Sr.
(by J. Worth Estes)