Mike Royden's Local History Pages


The Roots of the New Liverpool Women’s Hospital:

Early care of women in the first half of the 19th century

M.W.Royden (B.A.Hons., Cert. Ed.)

A Lecture given at the Liverpool Medical History Society/Historic Society of Lancashire & Cheshire Conference:

Wives and Whores in 19th Century Liverpool

Liverpool University, Centre for Continuing Education, Saturday 4 April 1998.
(A journal convering the full conference is due for publication Autumn 1999)

In 1792 Erskine, on looking down upon Liverpool for the first time from a local vantage point, had exclaimed that the Port was '...fit to be a proud capital for any empire in the world...' and had '...started up like an enchanted palace, even in the memory of living men.'(1) This was a fair comment regarding the mercantile nature of Liverpool, but the town certainly could not be held up as a model in most other aspects of civilisation. Only a small minority of men had benefited from the great wealth of the port, the majority eking out an existence in sordid conditions and miserable degradation. An American loyalist exile, Samuel Curwen, on visiting Liverpool in 1780 wrote that,

'...the streets were long, narrow, crooked and dirty...We scarcely saw a well dressed person...The whole complexion of the place was nautical and so infinitely below all our expectations that nought but the thoughts of the few hours we had to pass here rendered it tolerable...'(2)

In 1795 it was calculated that every seventh house was open for the sale of liquor, supplied by the large breweries of the locality, and rum was imported in large quantities from the West Indies.(3) The streets were frequently scenes of drunkenness, fighting, riots and press-gangs. Local politics were constantly anarchical and corrupt. William Moss, in his Medical Survey of Liverpool published in 1784, gave a doctor's perspective;

'The situation of the town as it affects the health of the inhabitants has many natural advantages...the west side of the town becomes freely exposed to the fresh and unpolluted air of the sea...The town is kept regularly purified, ventilated and freed from the lodgment and accumulation of vapours, and effluvia of various kinds which by retention, become highly deleterious and unfavourable to mankind. The strong gusts of wind which come from the western quarter so frequently throughout the year are most singularly effacious in these respects...’(4)

Although culturally and artistically, Liverpool was still what Ramsay Muir termed a 'Philistine town',(5) the period saw the increased attempts by enthusiastic, intelligent men to improve the conditions of all members of society. Most of the credit for this can undoubtedly be centred on the radical liberal factions who, with their frequently unpopular politics, tended to be looked upon with scorn and suspicion by fellow citizens. Vigorous advocates of political and social reform, their opposition to the slave trade for example, on which the ports' wealth and prosperity was largely based, frequently earned a hostile reception from the mercantile ranks. Such men were a product of the 'Age of Enlightenment', a period of phenomenal growth of the arts and of scientific knowledge. In Liverpool as in many other provincial towns, hospitals, dispensaries, medical schools and societies came from the enthusiasm and spirit of such individuals. It was a period where doctors began to rise from 'quack' or apothecary status - and barber-surgeons too - to one of respected university educated level. The rapid growth and expansion of towns of the industrial revolution would present doctors with hitherto unknown challenges and in a thriving seaport such as Liverpool with its background of social extremes, average life expectancy was only twenty four years.

The change in quality of Liverpool doctors during the mid 18th century was certainly affected by the establishment of the Infirmary which provided a focus where physicians and surgeons could work together exchanging ideas instead of remaining in competition as individuals. In 1749 the building was ready to accommodate 100 patients, although there was still much to be desired regarding its universal treatment of the sick. Barred were those who could pay for their own medicines, as were those who could not provide a reference from a Trustee (except in cases of casualty). So too were the ‘incurable, children under seven, lunatics, sufferers of small-pox or women big with child'.

The Infirmary had been sponsored by a group of 'Clergy, Physicians, Surgeons, Merchants and Tradesmen, with some neighbouring gentlemen'. and was erected entirely on charitable subscription. The principles on which it was founded would set the pattern for numerous institutions which were to follow. Alongside the Infirmary in 1752 was erected the Seamen's Hospital for seamen and their families. Every mariner of the port had paid a compulsory contribution of 6d a month towards its support. (Both buildings stood on the site now occupied by St. George’s Hall). In 1778, the Liverpool Dispensary was established in North John Street which provided medical advice and medicine for the poor, and was supported by voluntary subscriptions from the majority of the established surgeons or physicians in the town. Yet, despite such positive steps made in a Port increasingly influenced by its diverse cultural influx, it was, by the end of the 18th century, a town of much pauperism, appalling housing conditions and frequent violence.

Midwifery

It is within such a context that the roots for the Liverpool Maternity Hospital are to be found. With a history reaching back just on two centuries, it can claim to be one of the oldest local hospitals in the country. Such roots lie in the foundation of the 'Ladies Charity' in 1796, whose objects were to afford medical and other assistance in childbirth "to reputable married women or widows resident in this town," in their own homes.

However, up to the mid-sixteenth century it was universal practice throughout Europe that women were attended in confinement only by those of the same sex. Attitudes began to change due mainly to the work of Ambroise Paré (6) with the result that the medical profession began to give the practice of midwifery a much higher profile. But it was not until the eighteenth century before greater advances began to be made, notably in 1726 when a professorship in obstetrics was founded in Edinburgh. Despite the acceptance by wealthier classes of the principle that the medical profession could give assistance to those in childbirth, public opinion was still, at first, largely prejudiced against the building of 'lying-in' hospitals for the poorer classes. The following advertisement reflects the problems faced by both medical men and their patients in Liverpool during the mid eighteenth century. (7)

' THE LIVERPOOL CHRONICLE AND MARINE GAZETTEER'

" A Lying-in Hospital in this town being what many charitably disposed persons have desired, and thought very necessary; and as such a design if put into execution must require a considerable time before it can be completed, the following Proposal is made, as an attempt to relieve the most pitiable part-of the Lying-in Poor in the mean time.

As many unfortunate poor Women and their Infants, suffer greatly thro' the insufficiency of their Midwives in Difficult Cases, and as the Expense of calling in a Man- Midwife at such times often presents the Indigent from having proper assistance; and as there is a proper place of reception for all sick Poor already provided in town free of charges, but none for this particular purpose, which deserves at least equal consideration; and as almost every person is engaged at this Juncture in contributing, each according to his particular talent, towards the distresses of the Poor, I judged my endeavours for this end, might not be unacceptable; I therefore hereby inform the Public, that I am ready to attend and assist to the best of my power Gratis, all such married Women, living within the limits of this town, whose Cases in Labour are Difficult or Dangerous, so that the Midwife is at a loss, or unable alone to perform her Office, provided they are not able to pay.

But considering that some persons may, from the tenor of this Advertisement, insinuate that the design may not proceed from any motive of compassion, but only for my own Improvement, to try experiments, or to practice upon the abovementioned objects of Pity, it may not be amiss as to obviate these objections (as I have practised but a short time in this town) by further observing to the Public, that I have studied and practiced Midwifry in two of the chief Schools for that Art in Europe; of the truth of which any person may be satisfied, by only calling at my house, where they may see it certified under the hands of Doctor Smellie, teacher of Midwifry in London and of Mons Levret, Censor of the academy of Surgery, professor of Midwifry in Paris'

M.TURNER

Atherton Street,
Liverpool
May 2nd 1757

N.B. 'Tis hoped that the Gentlewomen who practice the Midwifry in town, will not look upon any thing here mention'd as designed to prejudice or undervalue them; the design being only to give them assistance when 'tis wanted, which I judge may be offered to them in the manner here proposed, without any Impeachment of their abilities, by those who may be allowed to have had better Opportunities of acquiring skill in the Profession, than the Practitioners of their Sex usually have’.


Matthew Turner practised as a surgeon in John Street (now North John Street). Thirty-nine years had elapsed since Matthew Turner's generous proposal regarding free obstetric care for the poor without further provision, before the foundation of a charitable obstetric organisation in the town in 1796. No doubt a direct catalyst in this development was the widespread poverty associated with the Napoleonic Wars - although as we have seen, institutions founded on charity had become a product of the enlightened times.

The first building to be utilised by the Ladies Charity was at 13 School Lane, from where the suffering were to be alleviated,

1. By gifts of clothing, food, soap or money.
2. By loans of temporary requisites, such as changes of bed linen.
3. By the provision of the attendance of a midwife, and, if necessary, of a doctor. (8)

Three medical officers were appointed and the subscriptions given by the ladies of Liverpool rose from £256 in 1797 to £385 in 1800. The town was to be divided into four administrative districts, each with its resident midwife working for the Charity. Each of these districts would also have an accoucheur. At the end of its first year, 126 maternity cases had been attended to by the Charity. William Moss was an accoucheur for the first five years of the Charity's existence, and at the end of his first year he reported;

This last, although not least valuable, of the public charities which adorn the town, was long in contemplation, but was only effected in 1796. Its intention is the relief of poor married women, in childbed, at their own homes; a mode that proves to have many advantages over a public hospital. Proper assistants, male and female, are appointed; as also a matron, to provide every necessary of food, etc., that may be wanted; by which means the poor and their offspring are rescued from the injuries arising from improper treatment, and are restored and preserved, with comfort to themselves, to that society from which many, in this trying situation, have been severed by ignorance and want. The charity is very properly under the patronage of ladies, with a lady patroness at their head; and the accounts necessarily conducted by a committee of gentlemen . It is supported by annual subscriptions, and by other gratuitous benefactions and contributions; and its various comforts have already been sensibly felt. (9)

After its second year's work in 1798, the Charity compared itself with other charitable institutions,

...admirable as they all are there is not perhaps any of them which with such a minute supply tends more to diminish wretchedness and to preserve the human species than this institution...'

The annual report revealed that the expenditure of the Charity had amounted to £340 while 483 married women had been attended to. The troubled times and uncertain future were also alluded to when the Charity declared,

'it is a universal duty to supply the unavoidable waste of protracted warfare by guarding with no common care the Buds and Blossoms of our future strength.'

In its early years the Ladies Charity had a remarkably fine record. About one third of the total average births in Liverpool came under its supervision and the death rate was remarkably low - somewhere in the region of 0.1%. Most of these were due to disease or circumstances which would have proved fatal despite medical care. (10)

Date Labours Deaths Cause
1799 621 1 No external cause
1803 996 1 Natural and regular causes of indisposition
1811 1515 2 From causes which no human hand could have prevented
1812 992 1 as above
1813 905 2 as above
1815 1072 1 In the last stage of consumption

Table 1: Causes of death among cases dealt with by the Ladies' Charity, 1799-1815

Thomas H. Bickerton, Opthalmic Surgeon and local medical historian, suggested that it was the general good health of country bred wives of the new labourers coming to the port from Ireland and Scotland that largely explained the low maternal mortality.

Despite such statistics Obstetrics was still in a rather backward state during this period. In 1801 it was remarked,

‘...very much still remains to be done for the perfection of this branch...not by the speculative and presuming who are misleading us; but by men of industrious attention and research, capable of reducing into order the observations they will have many opportunities of making and of converting them to practical use and advantage’. (12)

British medical schools remained slow to include midwifery, despite advances being made on the continent, and it would be another forty years before the type of men Denham was hoping for began to emerge. In 1840 James Simpson, for example, was appointed Professor of Midwifery in Edinburgh, yet, there was still much to be done, as Ramsbotham's remark in 1841 bears testament,

'This branch of physic indeed has struggled against far greater difficulties than have beset the general practice of medicine and surgery; for both ignorance and prejudice have lent their aid towards retarding its advancements...it has to contend with the natural blindness that females themselves must entertain against admitting a person of the opposite sex seen to undertake the duties under the trying time of labour; and on the other hand with the erroneous belief that parturition, being a natural action, would be accomplished in women with equal facility and safety as in the brute creation. (13)

Small improvements had been made in the intervening years, although methods were still primitive. Caesarean section, for example - which was usually performed as a last resort after gross mismanagement of labour - was still an imperfect and highly dangerous technique. Denman's researches across the country could reveal no survival of the mother, while Ramsbotham recorded three survivals out of thirty such operations. Other practices were so entrenched in tradition that it was very difficult to change attitudes. Blood letting was still popular practice well into the nineteenth century. In fact, during the early years of the century it was even believed that serious bleeding from a vein should be controlled by reducing the blood volume further by puncturing an artery. Richard Kay, who was a surgeon in Chorley, published a case of rupture of the pregnant uterus in the Liverpool Medical Gazette in 1833. (14) He described his 'gastrotomy' (the contemporary term for abdominal exploration) where he extracted the infant and closed the wound. He then proceeded to twice bleed his patient until she lost consciousness. After the loss of twenty ounces of blood, his patient, not surprisingly, died.

Obstetric practice in Liverpool during the early years of the Ladies’ Charity has been somewhat illuminated by the existence of two unique documents in the possession of the Liverpool Medical Institution Library. The first was compiled by Henry Park (1745-1831), who, although primarily a surgeon, also practiced medicine and obstetrics. His Book of Genesis lists all the births he attended wherein he also recorded the names and addresses of all the mothers he delivered, the sex of each child and a brief clinical note. Although he did not record mortality of the mother or infant, it is occasionally inferred by mention of 'crotchet case' (extraction of a dead foetus by a crude instrument), and other complications which must have resulted in infant or maternal death. Such figures can be rather misleading as he tended to practice in more affluent areas, although there is no record of his fees.

The second volume was kept by Dr. John McCulloch, who attended on average 210 deliveries each year between 1797 and 1820. In his Register of Births and Innoculations he recorded the name and address of the mother, the sex of the child and his fee. Much of his work was carried out, in stark contrast to Henry Park, amongst the poor in the worst of the slums. Occasionally he entered a comment, mentioning deliveries taking place 'in a yard', 'in an opening', or 'in a court' frequently without charge. A better class of patient would pay one or two guineas.

The surgeons of the Ladies' Charity in its earliest years resided in the centre of the small town which was in close proximity to the districts they were attached to. Nevertheless, problems were to be encountered once the bounds of the town were extended and in 1842, for instance, the suggested hire of a cab for the surgeon had to be refused on economical grounds, with the result that cases in Kirkdale Township could not be attended. It was not until 1874 that cab hire was allowed to the surgeons of the Charity.

By the time the Ladies' Charity amalgamated with the Lying-in Hospital in 1869, the seventy-three years of its separate existence had undoubtedly resulted in an improvement in the management of childbirth in the homes of the deserving poor.

AMALGAMATION: LADIES CHARITY AND LYING IN HOSPITAL (1869)

Lying-in Hospital

The first  obstetrical  and  gynaecological  hospital,  the  Lying-in Hospital and Dispensary for the  Diseases  of  Women and Children, was established at 31 Horatio  Street,  Scotland  Road,  in November 1841. However, it was soon apparent that  larger premises were necessary and the hospital was transferred to 21 Pembroke Place in October 1845. During the  first  four  years  of  the  hospitals  existence,  figures regarding the early work carried out show only one death in labour;

Date Labours Deaths
Jan 1842-Nov 9 1842 46 1
Nov 9 1842- Nov 9 1843 73 0
Nov 9 1843-Nov 9 1844 103 0
Extra 1 0
Nov 9 1844-Nov 9 1845 107 0
Extra 11 0
Total 341 1

Males 173: Fem.147: Twins - 2 cases: still births 18: operations 21 (15)

Table 2: Death rates, Lying-in Hospital, Jan 1842-Nov 1845

In  the  period  highlighted   above,   2,490  out-patients  received gynaecological treatment, of whom 1,216  were  cured and 316 relieved, while there were nine nurses and  midwives  in training. On the staff, at that time was the surgeon  Benjamin  Blower,  the  inventor of the slipper bed-pan.

The hospital was operated according to clearly set out rules;

(I) The Hospital shall be  open at  all hours  for the reception of poor married women about to be confined, in whom the expected difficulties of labour may  require  the  care and advantages which  the  hospital  offers,   or  whose  circumstances  are particularly needy.

(II) Admission to the  Labour Wards  shall be open to all such cases whether residents of the town or  not, by recommendation of a Subscriber, or on application  to  the Executive Committee or Visitors at the Hospital, at such  time as may be prescribed; but for the   Special  Wards   the  certificate  of  one of the Medical Officers will also be required.

(III)Every case recommended to  the  Labour  Wards shall, prior to admission, be visited by  the  Inspector.  No  patient can be received who  is  afflicted  with,  or  recovering  from, any complaint of an  infectious  or  contagious  nature,  or with insanity.

(IV)No Labour patients shall be  allowed  to remain longer than a  fortnight  in the Hospital,  unless  on  the recommendation of the medical Officers,  and  for  special  reasons:  or in the "Special" Wards  longer  than   one  month ,  unless  otherwise sanctioned by the Committee. (16)

Use of anaesthesia

In  December  1846,  news  reached   Liverpool  about  the  successful administration of ether during  an  operation  in  Boston, USA. Within days local surgeons were using the new technique, but it was not until November 25 1847 before J.Parke gave the first paper on anaesthesia at the  Liverpool  Medical  Institution   'On   the  Moral  propriety  of administering  ether  in  other   than   extraordinary  cases'.  This reflected the current  arguments  concerning  the  use of anaesthesia, particularly in obstetrics. He discussed  the  moral aspects and made much of the  opinion  that  insanity  might  be  induced  by  ether or chloroform (by this date chloroform was  also in use). Others feared infantile convulsions  if  chloroform  was  given  in  labour.

 John Birkbeck Nevins, the recently appointed  Medical Officer at Mill Road Workhouse Infirmary, was, on 22 February  1848,  the next to present a paper on the subject, speaking 'On  the present state of our knowledge of the use and effects of chloroform  and ether'. By this date there had been fatalities  in  the  use  of  chloroform  but  Nevins had not witnessed a death in the general use of anaesthesia in eighty cases of labour. He  did,  however,  draw  attention  to  numerous  hazards and complications. On 17 February, much  discussion had been prompted by the widely publicised  death  in  Newcastle  of  a  young girl, Hannah Greer, following a minor operation in  which chloroform was used. This case  raised  considerable  suspicion   regarding   the   safety  of chloroform.  (17) 

 Ovariotomy 

It is documented that there was a  ward for ovariotomies at the Lying-in Hospital as  early  as  1851, (18)   although  there  are no published reports on the  success  of  operations.  Patients  on  the wards were expected to pay  7s.  per  week  for  maintenance.  In  Liverpool, the pioneers of ovariotomy were  J.F.Grimsdale,  Consultant Surgeon to the Lying-in  Hospital,  Messrs  Long,  and   Nottingham.

 In  March  1861 Grimsdale invited Spencer Wells  to  Liverpool  where he performed his twenty-first ovariotomy. It is likely that the operation took place in the  patient's  home  where  Wells   was  assisted  by  Grimsdale  and Bickersteth, and by Hakes  who  administered chloroform. Grimsdale had his first successful case early in  1861  and  by  the end of 1863 had carried out six such operations  with  four recoveries, a record which compared favourably even  with  that  of  Wells.  At  one meeting when Grimsdale's achievements were  reported,  it  was  remarked  with some local pride that it was  no  longer  necessary  to send these cases to Manchester. This was reference to Charles  Gray  of that city who over many years had  obtained  results  comparable  with  Spencer Wells. (19)  Meanwhile, an outdoor obstetric department had been formed in December 1860 on the recommendation of the Medical Board.

 Nursing 

Improvements in the training of  nurses  in Liverpool were undoubtedly influenced by the work  of  Florence  Nightingale,  although there had been some attempt to train nurses at the Lying-in Hospital as early as 1841. A Nurses' Institution  opened  in  Soho  Street  about 1855, but greater strides were made in 1862 when, through the efforts of William Rathbone, the 'Liverpool  Training  School  and  Home  for Nurses' was founded, while in the same year the Royal Infirmary decided to build a nurses home. (20)  

 The new Myrtle Street Hospital (1861) 

The dispensary at the Lying-in  Hospital  opened  three days per week, each patient  being  required  to  pay  one  penny  when  medicine was provided. The number  of  patients,  however,  was  not  increasing in comparison with the population of the town, and in the autumn of 1853, the  Board  of  Governors  agreed   that  smaller  premises  would  be preferable. Finally, it was decided to build  a  completely new hospital in Myrtle Street. This was erected at a cost of £3,000 and contained thirty beds for in-patients and  was  officially  opened  by  the  Lord  Bishop of Chester in July, 1862. The site  in  Myrtle  Street had been chosen in preference to one near the old Hospital, although this meant a loss of an offer of £1,000; a £50  gift  was also withdrawn because unmarried women were refused admission.

It was becoming clear  that  there  was  an  increasing overlap in the facilities provided by the Ladies'  Charity  and the new Myrtle Street Lying-in Hospital and  agitation  began  to  encourage  a combining of resources.  In  February 1866,  the  Medical  Society  supported  its colleagues by passing the following resolution:

'That the Liverpool Medical Society considers it highly desirable that the Ladies' Charity and the Lying-in Hospital should be united into a single charity. The Secretary was requested to forward a copy to the Committee of each Institution.' (21)

Finally, the Committee of the  Lying-in  Hospital approached the Ladies’ Charity with a view  to  the  amalgamation  of  the  two bodies. After protracted negotiations, a formal assent was obtained in February 1869.

Amalgamation of the Ladies' Charity and the Lying-in Hospital (1869)

The first year of amalgamation  was  far  from easy. Accommodation was still unfinished and during the  first  twelve  months the work of the Ladies Charity was carried  on  in  the  old  premises in Duke Street, while modifications were taking place at  Myrtle Street, mainly in the out-door relief department. It  was  also  decided to erect additional wards for  in-patients,  plus  accommodation  for  the  House Surgeon. Secondly, although  233  patients  were  admitted  into  the  Lying-in Hospital during  the  year,  there  was  an  outbreak  of  fever which resulted in the closure of the hospital from 13th May until 18th June. Consequently, twenty-seven patients were confined  to their own homes, under the care of the  Institution,  and  eleven others, who failed to come into the hospital, received partial relief.

Overall, of the 195 confinements in the Hospital, 89 were boys and 106 girls, 3 were cases of  twins,  and  7  were  still born. There were a number of deaths -  2  mothers  and  6  children.  There  were also 28 'special' cases admitted during  the  year,  and  5,903 cases received treatment in  the  Dispensary.  The  number  of  Midwives  and Nurses Štrained and certified was 36, while 150 Wet Nurses were registered. (22) In the Ladies' Charity, 1594 cases  were  relieved as against 1518 the preceding year. According to the Committee,  the staff of Midwives had been 'carefully revised' and  their  conduct  and efficiency 'strictly superintended'. Dr. Henry Imlach, (whose  son is the subject of another paper in this journal), decided to retire from the  office  of  Hon.Consultant Physician after several years valued service. It was also decided in 1869 to  abolish the system of free Vaccination at the Ladies’  Charity  due  to  the  increase  of  Public Vaccinators providing a similar service, also free, within the town.

In the early years of the  amalgamation previous rules and regulations laid down in the days of their separate existence were adhered to, but this was soon found to be  cumbersome and inappropriate. By the 1880's they had  been  streamlined  to  effect  the  management  of  a  joint hospital;

The objects of the Charity were:
(1)To provide poor married women of good character, and widows whose husbands have died during their pregnancy, with the assistance of trained Midwives during their confinements, and, when requisite, of Surgeon Accoucheurs, such assistance being rendered either in the Hospital or at their own houses;
(2)To provide relief to out-door patients; and
(3)To maintain a School of Midwifery for women, who are to be instructed by means of Lectures given by the Medical Officers and of practice with the Midwives of the Nurses of the Charity. (23)

Certain stipulations were made regarding who had a right to treatment. Only those patients resident in  one  of  the Charity's Districts at the time  of  confinement  would  qualify for out-door relief. However, this did not apply to  in-patients who would be accepted from outside the area.

'The Hospital shall be used for the reception of Patients in whom the expected difficulties of labour may require the care and advantages which it affords, or whose circumstances are peculiarly needy. It shall be open at all hours for the reception of patients' (24)

Furthermore, in a town where  its  people  were  all  too aware of the decimation caused by cholera, typhoid and  smallpox, no patient was to be admitted suffering from infectious or contagious disease. Nor would there be a welcome for the insane.

The Institution was put under  the  control  of a Board of Management, assisted by a  Ladies'  Committee.  The  Board  members,  which varied between five and fifteen gentlemen, also  had to be subscribers to the Charity and were elected by  other  Subscribers  at the Annual General Meeting. The Ladies Committee numbered between ten and thirty members, also elected at the  AGM.  Both  Committees  met  once  a month at the Hospital. One or more Visitors selected from the Ladies Committee were appointed for a months duration at a time  who made a thorough inspection of the Hospital once  a  week,  the  details  of  which  were  logged  in the 'Visitors  Book'.  The  Ladies'  Committee   were  also  empowered  to superintend all the domestic arrangements  of the hospital, select the Matron, Superintendent, Nurses  and  female  servants,  although their proceedings had  to  be  reported  to  the  Gentlemen's  Committee for confirmation. In July 1870 an obstetric clerk,  Robert  A. H. Wood was appointed and received free board and lodging. Six  months later he became the first house surgeon with a salary of £50 a year.

In June 1874  a  local  paper  published  a  comparative list of figures  on the amalgamation:(25)

Number of Patients During Five Years Before Amalgamation:

Year Labours Special Cases Ladies' Charity Dispensary
1864 160 32 1,197 2,043
1865 187 25 1,123 1,965
1866 199 21 1,084 2,355
1867 265 20 1,408 2,983
1868 220 35 1,518 3,222
TOTAL 1,031 133 6,330 12,568

Number of Patients During Five Years Before Amalgamation:

Year Labours Special Cases Ladies' Charity Dispensary
1869 199 29 1,594 2,043
1870 235 85 1,841 7,426
1871 155 113 1,777 7,496
1872 189 141 1,758 8,014
1873 150 99 1,584 8,190
TOTAL 928 467 8,554 37,029

Table 3: Number of Patients treated before and after amalgamation.

The most significant comparative  statistic,  however, is not apparent here. The out-break of fever  on  the wards increased worryingly after amalgamation. In April 1874,  for  example,  there  was an outbreak of puerperal sepsis in the Hospital and  in June, William Stewart Trench, Medical Officer of  Health,  was  asked  to  inspect  the Hospital. He reported to the Medical Board:

'I have no hints to offer as to the management and no suggestions to make in respect of structural arrangements for I consider the management most excellent, and I can find nothing wrong in drainage and nothing so objectionable in the construction of the wards as to require alteration.' (26)

At the same time the Board, with  one dissident, gave an opinion that there was no objection to having special  wards under the same roof as those for lying-in women, provided that  cases for ovariotomy were not admitted. After discussion, the Board expressed its desire to postpone the closing of the lying-in wards  until certain proposed reforms were tested with a view to  preventing  deaths from puerperal fever. Later, in an attempt to adopt  the  antiseptic  practices pioneered by Joseph Lister, a Lister steam spray was  purchased in 1879 for operations and dressings of special cases.

But in December 1879, the Medical  Board reported that four deaths had occurred in the lying-in wards. The  outbreak  was traced to a patient who had come from a  house  where  a  malignant case of scarlatina had occurred. By March 1880  the  Board  had  recommended that a building should be erected to  which  cases  of  a  suspicious  nature could be removed at  once  and  so  prevent  danger  to  other  patients. Three conferences followed, after which it was decided to extend the present uilding by adding an isolation block.  The lying-in wards were closed in March 1881  and  the  special  wards  a  month  later. By November, although it was still felt unwise  to  re-open the maternity wards, it was decided that 'a  special  hospital  for  the treatment of diseases peculiar to women' was an urgent  necessity. It was proposed therefore that the hospital be reopened to  deal with such cases while maternity cases and the dispensary would operate externally. These frequent out-breaks of fever again raised  the  question  of treating maternity and gynaecological cases together.

Yet, it was also apparent  that  the  hospital  was not at all popular with those it was intended to serve.  This was clearly part of a wider problem and many called for the  erection of a completely new hospital operating under new rules  and  ethos.  Articles  in  the local press accused it of being 'an institution hopelessly outgrown by the times' referring to the  'structural  deficiencies  of  the institution', the 'high rate of mortality' and 'the unwillingness of women to enter the hospital at all - at least  the  class of women that the Ladies' Committee are willing to  accept'.   Regarding  the  Board,  the Liberal Review (27) commented,

'...they will take one class of patients (married women of respectable character), but that class will not come, at any rate in sufficient numbers to utilise the full accommodation of the place. Another class that would be glad to come (that is, unmarried women who are prima facie not of respectable character, though they may not be leading a positively vicious life - the class, in fact, received at the Workhouse) the ladies' committee will have nothing to do with....
...it seems an absurdity to keep open a Lying-in Hospital which, for whatever reason, is never fully occupied, even though as it stands it is totally inadequate for such a population as that of Liverpool. If the committee prefer to keep up the "respectability" of the establishment even at the expense of its usefulness to humanity we suppose they must go on demanding marriage certificates from candidates for admission, and enquiring rigidly into the character of those who present them; a very necessary precaution, by the way, for even marriage certificates are not invariably an absolute guarantee for perfect and unblemished respectability'. (28)

To be fair,  the  Committee  were  operating  under  rules  made  by a previous regime, nevertheless, such conservatism could be modified. It was clearly a attempt by local  pragmatists trying to free the fetters Šof a dated and dying  society,  still  upholding its Victorian values. Consequently, a pessimistic view  of  the  future  of the hospital was hardly a surprise;

'what has yet to be proved is that a new building, on the most approved model, and conducted by the highest medical skill, would be any more popular than the old one under the operation of the same rules.' (29)

In fact, marriage certificates had  to  show evidence of marriage nine months  prior  to  admittance,  while  the  necessary  means  testing entailed a visit to  the  husbands  place  of  work  to verify income. Frequently, patients would send  furniture  to  a neighbour's house on the impending visit of a charity officer to simulate poverty. It had  certainly  become  apparent  that  there  was  now  a powerful argument for the closure of the  hospital  - or at least the 'service' provided for ordinary maternity cases.  It  was  the contention of the profession that patients preferred to  be  treated in their own homes, no matter how humble or squalid, and  that the rate of mortality among the patients  so  treated  was  lower  than  even  at  the  Workhouse Hospital. It was  also  considerably  cheaper  to  attend to expectant mothers in their home. At  this  time  it  had been suggested that the medical staff wished to  turn  the  Lying-in  Hospital into a 'private obstetric school' but this was later denied, as all the doctors wished to see was  the  removal  of  an  expensive  and  cumbersome system of maternity treatment. The  doctors  did  admit  that  their plans would entail the closure of  the  hospital  to  ordinary maternity cases and perhaps its conversion into  a  special  hospital  for the diseases of women, although difficult maternity cases would still be treated. The situation was clearly unsatisfactory -  a committee who would only admit a class of woman who did not wish to attend, while another class who would  avail  themselves  of  the  privilege  were  barred  entry. Meanwhile, the medical staff  wished  to  change  the  function of the hospital completely. At the Hospital, the dispute continued  and a Committee of Inquiry was appointed, who found against the Hospital Board in that it recommended the urgent provision of a lying-in  hospital for maternity cases only. The death rate  was  of  clear  concern  for  the  committee.  It was strongly felt that the exceptional sickness at the hospital was due to the attempt to combine the two  fields.  There was other provision for gynaecological complaints within the city,  while the Lying-in was the only one of  its  kind.  The  meeting  adopted  the  findings  and the Gentlemen's Committee, who, to  their  credit,  had  opposed the move, duly resigned.

The newly appointed committee immediately decided to vacate the Myrtle Street building. Land was purchased  from  the Corporation situated on the corner of Brownlow Hill and Brownlow Street, where a new maternity hospital was erected on the new  isolation principle. The old site was sold to the Committee of the  Hospital  for Cancer and Diseases of the Skin in 1882  for  £5,000.  (The  Hospital  still  stands  there today adjacent to the Philharmonic Hall).

Whereas  the  future  of  the   maternity  hospital  was  now  secure, facilities for the 'diseases of women'  were now removed with no clear plans for reintroduction.

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How this development continues towards unification in the present Liverpool Women’s Hospital and the ways in which the various institutions were linked can be seen in the chart.(see pics for this article). The full and complex story of the care for women and babies in Liverpool can be found in ‘A History of Liverpool Maternity Hospital and the Women’s Hospital’ and ‘A History of Mill Road Hospital’ by Mike Royden.


Mike Royden (1999)


Footnotes


1. Ramsay Muir , A History of Liverpool , L'pool Univ. Press. (1907) p.243 (Sir Thomas Erskine was a jurist, M.P. and briefly Lord Chancellor in 1806. He was famous for his defence of several English radicals, especially Thomas Paine, who were charged with sedition and libel during the French Revolution).
2. ibid. pp.270-1.
3. Moss, W. The Liverpool Guide (1796) p.104. (facsimile reprint 1974 p.84-85).
4. Moss,W. A Familiar Medical Survey of Liverpool (1784)
5. Muir, op.cit. p.288.
6. Ambroise Paré(‚ (1510-90) was a French surgeon and regarded as one of the fathers of modern surgery. As barber-surgeon to the army, Paré‚ discarded the practice of treating wounds with boiling oil and hot irons in favour of cleansing, the use of ointments, and surgery to tie off major arteries.
7. Liverpool Chronicle and Marine Gazetteer , No.1 Friday, May 6, 1757. page 4.
8. Moss, W. Liverpool Guide op.cit. (1796) p.104.
9. ibid.
10. Liverpool Surgeon, Henry Park, who attended a great many local births, kept a record of his cases in his Book of Genesis (now held in the Liverpool Medical Institution Library). His death rate figures are comparable to those of the Ladies Charity; out of 3,900 cases covering the period 1769 to 1830, only a very small number were abnormal. (On December 29 1809 Park records his delivery of William Gladstone, the future Prime Minister).
11. Bickerton, T.H. , A Medical History of Liverpool, Liverpool, (1936)
12. Denman, T. An Introduction to the practice of Midwifery 3rd Ed. (1801), preface. Also cited in, Shepherd, J.A. A History of the Liverpool Medical Institution (1979 Liverpool p.61.
13. Ramsbotham, F.H., The Principles and Practice of Obstetric Medicine and Surgery London (1841).
14. Kay, R. 'A Case of Rupture of the Uterus in which Gastrotomy was performed' Liverpool Medical Gazette Vol.1, 26. (1833).
15. Bickerton, op.cit. p.219.
16. Although these rules are extracted from the Annual Report of 1869, it is likely that they probably applied to the Lying- in Hospital for a period prior to that date.
17. Shepherd, op.cit. p.127.
18. Bickerton, op.cit. p.219.
19. Shepherd, op.cit. p.128, also his footnotes p.288.
20. ibid. p.129
21. Bickerton , op.cit. p.218.
22. Annual Report of The Ladies' Charity and The Lying-in Hospital of Liverpool, 1869 (1870) 'Rules', p.8.
23. Annual Report of The Ladies' Charity and The Lying-in Hospital of Liverpool, 1885 (1886) 'Rules', p.14/15.
24. ibid.
25. Bickerton, p.219.
26. ibid.
27. 'Respectable or Useful? - Which is it to be?' The Liberal Review 22 April 1882 pp.9 & 10. Lp.R.O.
28. ibid.


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