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4 Middle-class medicine It is well known that Englishmen are in the main opposed to any and every new system with which they are not familiar. Probably to this influence is due the fact, that, with a few exceptions, pay wards are as unknown in this country as the pay hospitals themselves. 1 Sir Henry Burdett

in Payment and philanthropy in British healthcare, 1918–48

This book examines the payment systems operating in British hospitals before the National Health Service (NHS). An overview of the British situation is given, locating the hospitals within both the domestic social and political context, before taking a wider international view. The book sets up the city of Bristol as a case study to explore the operation and meaning of hospital payments on the ground. The foundation of Bristol's historic wealth, and consequent philanthropic dynamism, was trade. The historic prominence of philanthropic associations in Bristol was acknowledged in a Ministry of Health report on the city in the 1930s. The distinctions in payment served to reinforce the differential class relations at the core of philanthropy. The act of payment heightens and diminishes the significance of 1948 as a watershed in the history of British healthcare. The book places the hospitals firmly within the local networks of care, charity and public services, shaped by the economics and politics of a wealthy southern city. It reflects the distinction drawn between and separation of working-class and middle-class patients as a defining characteristic of the system that emerged over the early twentieth century. The rhetorical and political strategies adopted by advocates of private provision were based on the premise that middle-class patients needed to be brought in to a revised notion of the sick poor. The book examines why the voluntary sector and wider mixed economies of healthcare, welfare and public services should be so well developed in Bristol.

training courses, actors in both the medical and sporting spheres were still able to identify some practices as novel or innovative, others as old-fashioned or traditional, and yet more as scientific or mere quackery. What this chapter will go on to show is that both philosophical and physiological theories constrained and informed the construction of sports medicine; these ideas were part of the shared values and liberal education of a generation of middle-class men who, as doctors or amateur athletes, contributed to an understanding of the athletic body in the early

in A history of British sports medicine

leisure activities including swimming and sea bathing. For many middle-class consumers water ceased to be an element that required significant amounts of time and effort to collect – and was accordingly used sparingly – and became a plentiful commodity delivered directly into domestic settings on a commercial basis.3 By the end of the nineteenth century luxurious bathrooms attest to changing hygienic routines among the better off. Initiatives were also launched to ameliorate sanitary conditions for the poorer classes with the promotion of personal cleanliness seen as an

in Healing with water

This book demonstrates the continuities and the changes in wartime nursing during the one hundred years, from 1854 to 1953. It examines the work that nurses of many differing nations undertook during the Crimean War, the Boer War, the Spanish Civil War, both World Wars and the Korean War. The influence that Florence Nightingale had on Southern women providing nursing care to Confederate soldiers during the American Civil War, and the work of the flight nurses, are detailed. The book also examines the challenges faced by nurses caring for the thousands of soldiers suffering from typhoid epidemics, and those at the Norwegian Mobile Army Surgical Hospital (NORMASH). The decades following the Crimean War witnessed a burgeoning of personal narratives relating accounts of nurses who ministered to combatants in the Franco-Prussian and Anglo-Zulu wars. In considering the work of First World War military nurses, the book explores the dangerous military and political worlds in which nurses negotiated their practice. The book argues that the air evacuation system which had originated during the Second World War was an exciting nursing innovation for the service of the Royal Australian Air Force (RAAF). At the beginning of the Second Anglo-Boer War, there were three distinct groups of female nurses: the Army Nursing Reserve; civilian nurses; and volunteers, many of whom came under the auspices of the Red Cross. The humanitarian work of trained and volunteer nurses after the liberation of Bergen-Belsen in 1945, and their clinical wisdom enabled many of the victims to rehabilitate.

Interpreting ‘patented’ aids to the deaf in Victorian Britain

find them some little thing that they may put into their ears, that will make them hear everything, without anybody finding out what is the matter with them.’ Harriet Martineau, ‘Letter to the Deaf ’, Tait’s Edinburgh Magazine, April 1834 Hearing assistive devices were a more or less visible feature of middle-​class and aristocratic life throughout the nineteenth century. Since up to one-​sixth of the population has historically been affected by hearing loss at some stage of their lives, the ubiquity (and therefore effective mundanity) of hearing aids seems easily

in Rethinking modern prostheses in Anglo-American commodity cultures, 1820–1939
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charity, even as these underwent significant changes over the early twentieth century. The previous two chapters examined the arrival in the hospital of patient payments and the almoner, contributory schemes and the middle-class patient, and how they became commonplace in the interwar years. It is typically assumed that these changes undermined or even ended philanthropy as the organising principle of the voluntary hospitals. 1 Yet, as we have already seen

in Payment and philanthropy in British healthcare, 1918–48
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fellow’. 4 Meanwhile, the surgeon was ‘interested’ in George, who was ‘so obviously middle class. And he guessed he must have been pretty low’ for his doctor to have sent him there. As a poor patient of middle-class character, the surgeon knew ‘Anderson would get the same skill – if not the same nursing – for nothing.’ He explained the medical details ‘to the students who, recognising Anderson as one of their own class, felt slightly

in Payment and philanthropy in British healthcare, 1918–48

class and occupation, June 1918 –​ June 1919. (Source: weekly reports of the registrar general, 1918–​19, using the class and occupation categories in the reports, where Class 1 is the professional and independent class, Class 2 the middle class, Class 3 the artisan class and petty shopkeepers and Class 4 the general service class.) 0 7 70 S tacking the coffins 100 Deaths per thousand living 90 80 70 60 50 40 30 20 10 0 8 June 1918 28 June 1919 Intervals in weeks from 8 June 1918 to 28 June 1919 Class 1 Class 2 Class 3 Class 4 Figure  10  Death rate in

in Stacking the coffins
The impact of the campaign for professional status on nurses’ health, 1890–1914

headlines in the Pall Mall Gazette, designed to shock its readership and discredit The London Hospital.10 Registration’s supporters and opponents did agree on the need to attract more middle-­class recruits as a way of raising nursing’s status.11 It was, therefore, the special attributes and vulnerabilities of middle-­class women that framed discourses about the organisation of nursing and nurses’ health. Citing nurses’ health gave credibility to the necessity for improvements to working and living conditions. It was also used to limit change by suggesting that middle-­class

in Who cared for the carers?