Newcastle, like many growing industrial cities, faced somewhat of a crisis in the 18th century - industrial accidents and illness were rife in urban areas, and actions had to be taken to treat and care for those who fell sick. In this piece, retired journalist Ken Smith discusses the history of the building itself as well as the people and innovations inside it.
The year 1751 witnessed the foundation of the Newcastle Infirmary, situated at the top of Forth Banks, where the Centre for Life stands today.
The infirmary lasted for more than 150 years and during the second half of the 19th Century witnessed significant progress in the field of surgery. It can be regarded as the first Newcastle 'hospital' in the modern sense of the word. George Beatson, a surgeon who had worked with Joseph Lister, the pioneer of antiseptic technique, introduced the use of carbolic acid to the hospital to combat the infection of post-operative wounds. Combined with the introduction of chloroform as an anaesthetic, this development represented a great advance in reducing patient death rates and widening the range and number of operations.
The Newcastle Infirmary was set up in 1751 and its foundation was made possible by a subscription fund established as the result of a letter to a local newspaper. The anonymous letter, to the Newcastle Courant, was from a mysterious benefactor signing himself or herself 'B.K.'. His or her identity was never revealed. However, it was rumoured to be a young surgeon named Richard Lambert.
The letter drew attention to the numerous accidents that occurred in the factories and collieries of the region. The writer's call for a subscription fund to set up the hospital proved to be a resounding success. Supported by the Press, a committee was formed and soon donations were pouring in. Among the most prominent supporters of the scheme was Newcastle Corporation, which made a gift of the land at Forth Banks on which the Infirmary would be built and also contributed £100 towards the fund.
The scheme proceeded with great speed. The enthusiasm of its supporters led to the hospital being opened even before the new building was erected. A house was acquired in Gallowgate and it began to receive patients in May 1751. Soon afterwards, there was a need to accommodate more patients and this led to the hiring of rooms in neighbouring houses. It was not long, however, before building work on the Infirmary at Forth Banks was started. On 8 October 1753, the new hospital was opened to receive its first patients. The cost of construction and equipment amounted to £3,697. One of its first surgeons was Richard Lambert, the young man credited with writing the letter that had started the project. He had, it seems, been supported in this move by a number of friends.
Initially, 90 beds were provided and in the first year 167 inpatients and 178 outpatients were received. These admissions were by subscriber's letter. This meant that only patients recommended by people who had given money to fund the hospital could receive care and treatment. It should be stressed that at this period in history only the poor used hospitals. The wealthy or comfortably off were treated in their own homes.
As was to be expected, the infirmary admitted many patients injured in accidents, and surgery was a principal part of its work. In 1774, the governors of the institution decided to exclude fever patients from its wards. A number of other classes of patient were also refused admission.
Yet there was compassion in evidence. Early 19th Century Newcastle historian Eneas Mackenzie asserts: ‘Persons meeting with sudden accidents, or labouring under diseases requiring immediate help of surgery, are admitted, without recommendation at any hour of the day or night’ . All other patients were admitted by a recommendation letter and only on a Thursday.
Despite the recommendations, it seems the conduct of some patients in the 18th Century was not always beyond reproach. In his history of the Newcastle Infirmary, published in 1906, surgeon George Haliburton Hume declares that ‘disorderly, dirty and drunken’ habits among patients led to strong reprimands from the House Committee. On some occasions the names of those who misbehaved and their offences were posted up and read out in the wards.
There were occasional complaints from patients about the food and drink. Hume relates the story of an amusing episode in May 1754, when a complaint about the meat and beer was judged by the committee to be without foundation. The complaining patients were severely reprimanded and ordered to have toast and water for a week. It was a distinctly unsympathetic reaction, but the committee seems to have taken on board part of the complaint. They ordered that the quantity of malt in the beer should be increased. At this period a small brewery was situated within the hospital grounds.
A number of house visitors were appointed to keep an eye on proceedings and to report on any problems. The house visitors were in earlier years expected to attend the funerals of patients. These funerals would not have been elaborate affairs, as virtually all patients were drawn from the poorer sections of society.
The medical staff at first consisted of four physicians and two surgeons, but in 1760 two more surgeons were appointed, making numbers equal. During the second half of the 18th Century and early 19th Century, only a small number of nurses were employed and their pay was low.
It was likely that much of the time patients were left to nurse each other. Convalescents probably shared with the nurse the task of looking after the more seriously affected patients. As late as 1865, there were only 11 nurses employed. In 1868, there were 13. This was a ratio of one nurse to 13.4 occupied beds.A significant step forward in the training of nurses came in the late 1860s with the appointment of a nurse superintendent who could provide the necessary education. During the earliest years of the hospital the few nurses that were employed had been untrained.
As well as the scarcity of nursing staff, another drawback beset the institution. Throughout much of its life its wards suffered from overcrowding, and an excess of patients only added to the risk of infections spreading. In an attempt to solve this problem a westwards extension to the building was erected between 1801-1803. However, a continuing increase in the population, and therefore an increase in patients, meant the problem did not go away. The new wards were divided into small apartments in the belief that this would combat the spread of infection.
It was soon evident that the accommodation provided little relief from the overcrowding. In 1804, a report by the infirmary's House Committee told the governors that more beds were crowded into some of the apartments than they were intended to contain, and several instances had occurred when two patients had been put into one bed.
At this time the average length of stay by patients in the hospital was 54 days, an extremely long period by present-day standards. This contributed greatly to the overcrowding. The problem continued and in 1852 work began on a second extension to the hospital. This would add six new wards and provide an additional 144 beds. The extension was designed by renowned North-East architect John Dobson and completed by the end of 1854.
The antiseptic method and chloroform
The year 1858 witnessed a significant crisis for the hospital. Major outbreaks of sepsis – infection of wounds after surgery – struck the wards, old and new. These infections included erysipelas, a serious skin condition. Another sepsis scourge was pyaemia, which, as George Haliburton Hume states, ‘in former days had so often stepped in to mar the success of many a well planned operation’. This condition invaded the wards again. Pyaemia proved fatal before the introduction of antibiotics.
In addition, gangrene could also develop following operations and this led to amputations or death. The next three years were also badly affected by sepsis and further outbreaks continued to occur into the 1860s, reaching a high point in 1867. These infections were often simply known collectively as hospital disease.
However, within a decade the situation was to change. In 1874, a new senior house surgeon was appointed, George Beatson, who brought about a vast improvement. He had worked in Edinburgh with Joseph Lister, the pioneer of antiseptic technique. Beatson introduced Lister's methods into the hospital and there was an immediate improvement.
The use of carbolic acid, also known as phenol, was the major feature of Lister's method. Its aim was to kill the infecting microbes. Lister's first use of his technique occurred in Glasgow in 1865, when he successfully treated a boy aged 11 who had suffered a broken leg.
Surgeons were instructed to wash their hands in a weak solution of carbolic acid before performing operations. Surgical instruments were also immersed in a weak solution of the carbolic acid and carbolic was applied to wound dressings. In addition, the phenol was sprayed into the atmosphere surrounding the patient during operations. Newcastle University's Robinson Library has a carbolic spray container in its special collections. This spray device was made in Newcastle in the 1870s and almost certainly used at the infirmary. A report on the state of the infirmary for 1875 stated that there had not been a single case of sepsis during the year. Succeeding years proved that the introduction of Lister's antiseptic method by George Beatson was a major breakthrough. Carbolic acid, including the spray, was still being used at the infirmary in the period 1882-1886.
However, it was eventually realised that use of the carbolic spray was a serious eye, skin and respiratory irritant, putting staff and patients' health at risk. Due to these health problems this method was eventually abandoned. Lister himself dropped use of the spray in the late 1880s. He had come to the conclusion that germs in the air were less of a threat than such micro-organisms on dressings, surgical instruments and hands. Use of the spray had been dropped at the Newcastle Infirmary before 1893, although in the period 1893-1898 it seems the hospital was still using carbolic acid on wound dressings and surgical instruments.
Heat was a major feature of newer methods which were to succeed carbolic acid. The future lay in pressurised steam sterilisation of surgical instruments by autoclaving, rubber gloves and theatre gowns, together with masks and caps, thorough washing of the surgeon's hands and lower arms, and thorough cleaning and disinfecting of the operating theatre. These methods are often referred to collectively as aseptic technique. The aim of this technique is to create a situation where germs are absent.
Another important advance in the field of surgery was the introduction of chloroform as an anaesthetic. One of the pioneers in its use was Dr John Snow, who underwent his initial training in the Tyneside area. In 1832, Snow attended the first medical lectures to be held in Newcastle. These lectures were delivered to students in an auction room at Bell's Court, off Pilgrim Street, and eventually led to the foundation of Newcastle Medical School. Among the group of surgeons and physicians instructing the trainees was John Fife, who was twice mayor of Newcastle and was knighted in 1840. Fife's consulting rooms were in the Bell's Court building. During his subsequent medical career, Dr John Snow helped to demonstrate the efficacy of chloroform as an anaesthetic. He administered chloroform to Queen Victoria when she gave birth to Prince Leopold in 1853 and at the birth of Princess Beatrice in 1857.
Significantly, Dr Snow was the first to advance the theory, which of course proved to be correct, that cholera was a waterborne disease caused by pollution from cesspools, drains and sewage, and he wrote about ways of preventing this serious illness. Snow placed great emphasis on the provision of clean water, free from pollution. His theory of cholera transmission through water was a milestone in the early development of bacteriology. In 1854, Snow traced the source of a cholera outbreak in London's Soho to polluted water from a pump in Broad Street, helping to establish the truth of his theory. He persuaded the authorities to have the handle of the pump removed. His attention is likely to have been drawn to the question of cholera while he worked as a trainee during an outbreak of the disease on Tyneside in 1832, the same year in which he attended the pioneering Newcastle lectures at Bell's Court.
Chloroform, combined with antiseptic technique, greatly widened the range and number of operations that could be performed. The number soared from 297 in 1876 to 908 in 1884, a rise of over 200 per cent. Yet this increase worsened the overcrowding problem. Staff members were keen to see a new hospital built, but after discussions it was decided to build a temporary extension, which became known as the Ravensworth Wards. The building, completed in 1885, provided an extra 50 beds and brought the total number of beds to 270. Wealthy philanthropist Sir William Armstrong, later Lord Armstrong of Cragside, founder of Newcastle's Elswick Works and Shipyard, contributed £1,000 of the £2,260 needed to construct the extension. Sir William also paid for the provision of a new operating theatre on the ground floor.
Despite the progress made in accommodation, over the years the hospital had become surrounded by urban and industrial development. Further expansion was difficult on the restricted site. The steam railway was to prove another problem. The hospital was close to the lines running into and out of the Central Station. Noise from the engines was a constant nuisance. Smoke from the chimneys of the town and glass factories had also proved to be an annoyance. Adding to the limitations of the site was the presence of the adjacent cattle market.
The old infirmary had done much good work over more than 150 years, but by the 1890s many believed it was time for major change. The situation eventually led to the building of Newcastle's Royal Victoria Infirmary on part of the Castle Leazes, completed in 1906. The last patient to be transferred to the RVI left the old infirmary in September of that year. The RVI was officially opened by Edward VII, accompanied by his wife Alexandra.. A new era in the health provision of Newcastle had begun.
Ken Smith is a retired Newcastle journalist who has written, often with co-authors, a number of books on various aspects of North East history, including Caring Newcastle, The Great Northern Miners, Echoes of the North East Miners, The Great Walls of Newcastle, Swan Hunter – The Pride and the Tears, Turbinia, Down Elswick Slipways, From Walker to the World, Palmers of Jarrow, Lost Shipyards of the Tyne and Emperor of Industry – Lord Armstrong of Cragside. His co-authors have included Dick Keys, Ron French, Tom Yellowley, Ian Rae, Jim Cuthbert and Ken Smith's wife, Jean.
Sources consulted and Bibliography
DALE, G. and MILLER, F. J. W. 1984 Newcastle School of Medicine, 1834-1984. Sesquicentennial Scrapbook, Newcastle upon Tyne.
GREY TURNER, G. and ARNISON, W. D. 1934 The Newcastle upon Tyne School of Medicine, 1834-1934, Newcastle upon Tyne.
HUME, G. H. 1906 The History of Newcastle Infirmary, Newcastle upon Tyne.
HUME, W. E. 1951 The Infirmary, Newcastle upon Tyne, 1751-1951, Newcastle upon Tyne.
MACKENZIE, E. 1827 A Descriptive and Historical Account of the Town and County of Newcastle upon Tyne, including the Borough of Gateshead, Newcastle upon Tyne.