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St Mary's

St Mary's: The History of a London Teaching Hospital

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    St Mary's
    Book Description:

    Surveying the role of medical science in transforming the hospital, she traces the appearance of research on the curriculum vitae of ambitious clinicians in the 1850s, the appointment of salaried scientists in the 1880s, the emergence of full-time clinical researchers in the early 1900s, and their gradually increasing influence over the teaching hospital. Carrying the analysis to the present day, she shows St Mary's growing participation in a developing medical public sphere that includes medical societies, a medical press, and granting agencies such as the Medical Research Council.

    eISBN: 978-0-7735-7086-3
    Subjects: Education

Table of Contents

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  1. Front Matter
    (pp. i-vi)
  2. Table of Contents
    (pp. vii-viii)
  3. Figures and Charts
    (pp. ix-x)
  4. Foreword
    (pp. xi-xiv)
    Sir Roger Bannister

    THERE COULD BE no more appropriate time for this book to be written. It tackles the broad canvas of the evolution of over 150 years of St Mary’s Hospital and Medical School. The story starts unpromisingly with the poverty-stricken navvies working on the Paddington canal and railway site in the 1850s, living up to ten in a room near reservoirs described by the medical officer as an “enormous wen.” The book ends as the new Imperial School of Medicine arises, phoenix-like, from merging the existing medical schools in West London, of which St Mary’s was the first. The Imperial College...

  5. Acknowledgments
    (pp. xv-xvi)
  6. Introduction
    (pp. xvii-xxii)

    ST MARY’S HOSPITAL began to admit patients and students in 1851, almost the same day that, across Hyde Park, the Crystal Palace opened its doors to visitors. The inhabitants of Paddington were probably no less fiercely proud of their hospital than they were of Britain’s pre-eminence in the Great Exhibition, for both accomplishments spoke to a high-Victorian faith in the value of material progress through the growth of knowledge and in man’s essential humanity to man.¹ St Mary’s was not the first of the great London voluntary hospitals: in fact, it was at the tail end of a movement. Close...

  7. Foundations

    • 1 The Cornerstone: Paddington
      (pp. 3-32)

      FROM THE BEGINNING, St Mary’s was slightly out of step. London’s general hospitals were mostly built in two waves, one associated with medieval Christian piety and the other with “Georgian philanthropy” among the enlightened patricians and bourgeoisie. The first to be founded on voluntary subscriptions was the Westminster Hospital in 1720.¹ By the mid-nineteenth century, voluntary hospitals were becoming unfashionable, and St Mary’s, in a suburb which in 1851 was characterized by social relations still reflecting eighteenth-century paternalism as much as nineteenth-century industrialism, was the last of the great London voluntary hospitals to open.

      For centuries Paddington had been a...

    • 2 Becoming a Consultant: The Founding Staff and Their Activities
      (pp. 33-64)

      ARRANGEMENTS ON BEHALF of the sick poor in Paddington were determined as much by social pressures as by medical ones. The foregoing chapter emphasized the civic purposes of St Mary’s Hospital, as conceived by the lay governors, with only glancing references to the practice of medicine on the wards. This chapter surveys mid-nineteenth-century hospital medicine as a system in its own right, viewed from the perspective of its practitioners: the consultants. A complex interplay of social, epistemological, and technical factors went into the making of mid-century medicine as a pattern of knowledge and practice. By treating the founding staff of...

    • 3 The School
      (pp. 65-86)

      BY 1850 SCHOOLS were cropping up at hospitals across London, actively encouraged by hospital governors. Schools provided prestige, cheap labour on the wards and an income from fees. Lane’s school had prospered, and Mary’s might do the same. The founding governors proclaimed, a “Hospital without a School is sadly crippled in the noble work which it is founded to accomplish.”

      Elsewhere, some still opposed letting students onto wards. At the same time as St Mary’s was being planned, a governor at the Leicester Infirmary objected to proposals to permit students there, saying he “did not like to acknowledge any object...

  8. From the Late Victorian Period to the First World War

    • 4 The Changing Hospital 1
      (pp. 89-118)

      ST MARY’S HOSPITAL changed a great deal in the late nineteenth and early twentieth centuries. For a start, it looked different, thanks to the addition of two new wings, Stanford and Clarence. Finally the governors had frontage on a major street; no longer would cab drivers look puzzled when directed to St Mary’s Hospital. Randolph Churchill, MP for South Paddington, had advised the governors to become “more get-at-able,” and at last they were. A spacious new casualty department was opened in 1912. Nurses wore uniforms. Governors were now elected to a closed board of management. Some of the changes were...

    • 5 Almroth Wright and Pathology
      (pp. 119-144)

      IN THE BEGINNING pathology was the humblest department at St Mary’s. The work was salaried, always a sign of low status, usually done by a young man waiting for an opening on the consulting staff. His duties included mounting specimens for the museum, performing post-mortems, and giving practical instruction to the students. The department was chronically understaffed, and unmounted specimens often piled up.

      By contrast, at the outbreak of World War I pathology was St Mary’s most celebrated department. From the unprepossessing material available to him at one of the smallest teaching hospitals in London, Almroth Wright built up an...

    • 6 The School, 1900—1920: Coping with Science
      (pp. 145-168)

      BY THE 1890s the school’s future seemed assured. Its student intake exceeded all but the endowed schools and even University College and King’s College. Yet within a decade it was facing its most serious troubles to date and for the first (but not the last) time, had to contemplate the possibility of extinction. Student intake and income declined both absolutely and relative to expenditure. As the ancillary disciplines - anatomy, physiology, pathology, and pathological chemistry - became increasingly laboratory based, they caused a crisis in medicine. The costs of salaried workers and laboratories became prohibitive for the smaller medical schools....

  9. The Interwar Period

    • Colour Plates
      (pp. None)
    • 7 The Changing Hospital 2
      (pp. 171-201)

      DURING THE FIRST half of the twentieth century the London voluntary hospitals lurched from crisis to crisis. From the early 1890s they were so short of funds that there was serious thought of a bailout by the state. At St Mary’s, sixty beds stood vacant in the new Clarence Wing for want of funds to administer them. War, then depression continued to threaten the voluntary system. Subscriptions and donations formed an ever-diminishing proportion of hospital revenues, requiring hospitals to cast about for other sources of income.¹

      At St Mary’s in 1900 subscriptions and donations made up 35 per cent of...

    • 8 Pathology between the Wars: Wright and Fleming
      (pp. 202-226)

      DURING THE 1920s and 1930s at St Mary’s, Sir Almroth Wright and Charles Wilson, Lord Moran, dominated the scene. They were two very different characters, forced into a shotgun wedding. During the 1920s and 1930s, as the two pushed the school and the Inoculation Department closer together institutionally, they veered away from medicine proper in their outlooks, one towards physiology and philosophy and the other towards politics and sports. Both men were institution-builders: during the late 1920s and early 1930s, they managed to get hold of considerable sums of money and rebuilt their respective institutions in a large shared building...

    • 9 Moran’s Mary’s
      (pp. 227-262)

      IN FORMAL STRUCTURE and in philosophical outlook, the medical school and the Inoculation Department moved closer together during the interwar period. They did so physically as well. During the 1920s, Charles Wilson, the future Lord Moran, took a leaf from Almroth Wright’s book and began to market the medical school to prominent businessmen and public figures as anavant gardephilanthropic cause. He raised enough to build a new school on a separate site alongside the hospital. When it became evident that Moran’s grandiose plans had actually borne fruit, Wright casually passed the hat around his sponsors and built the...

  10. The Rise of Science

    • 10 The Rise of Clinical Science
      (pp. 265-296)

      MEDICINE CHANGED A great deal in postwar Britain. The NHS was one engine of change, scientific advance was another, and demography yet another. Thanks to the labours of public health doctors and nurses, a rise in the standard of living, and a decline in overcrowding, people began to live longer. The fatal infectious diseases of childhood were all but wiped out, and those remaining were much less severe. Tuberculosis seemed to be beaten by better working and living conditions and by antibiotics. Although new diseases and antibiotic-resistant strains of old diseases appeared, their death tolls remained below those of the...

    • 11 The School Scientized
      (pp. 297-325)

      THE SECOND WORLD war marked a turning point in British science. As historian Dominique Pestre remarks, it was a “scientific and technological war” that “mobilized and trained a large number of scientists, engineers, and technicians, and has never ended.”¹ Until the war, government funding for science was fairly small.² After the war, science commanded a new influence in Whitehall, and its investment in scientific education and research increased. The Medical Research Council, for example, received less than £150,000 per annum until the mid-1930s, and only rose above £200,000 towards the end of the Second World War. Those MRC funds increased...

    • 12 Teachers and Students
      (pp. 326-356)

      THE GROWTH OF the sciences in English medical schools was justified primarily by their contribution to teaching. As the University of London inspectors engagingly remarked in 1950, researchers made good teachers because “students benefit by the livelier attitude of mind of the teacher.”¹ The development of scientific research exercised a growing influence over teaching as science and its corollaries, including the increase in state funding, introduced a new seriousness and a new sense of public accountability into the student culture.

      As the scientific departments of the medical school grew in size and in number, the encroachment of science upon the...

  11. St Mary’s at the Century’s End

    • 13 The Changed Hospital 1: The Big Picture
      (pp. 359-386)

      AFTER 1948 ST MARY’S exercised dominion over a sprawling fiefdom of “constituent” hospitals spread across West London and itself owed fealty to the Ministry of Health, which paid the bills. The money was good at first, though not quite as good as the governors had hoped. In subsequent years the government became less liberal and demanded proof of value for money. The state and the medical profession engaged in a long dialogue about the purpose and efficiency of the NHS, with hospitals at the centre of the dispute. This chapter shows how the hospital authorities learned to integrate these local...

    • 14 Science and Strategy: The Merger with Imperial College
      (pp. 387-422)

      FOR GOOD OR EVIL, London’s medical landscape was being kneaded like dough.¹ We have seen that there were pressures to concentrate and rationalize medical care in London. There were equally strong pressures to do the same for medical education. Twelve schools were too many. There were equally good and far cheaper facilities elsewhere. London still trained one-third of British medical students, and because most graduates either emigrated or practised within a few miles of their school, other regions remained chronically underserviced.

      The problem of London medical education had niggled during the 1950s and ’6os, leading the government to appoint a...

    • 15 The Changed Hospital 2: Hospital Culture
      (pp. 423-452)

      THROUGHOUT THE TWENTIETH century, doctors and politicians wrestled for control of the clinical encounter. Once medicine had begun to advance a creditable claim to explanatory power and therapeutical efficacy, ratcheting up successes, and once the middle classes began to demand admission to hospitals, the state began to take an interest in the equitable distribution of this resource. The result was an enormous improvement in the quality and quantity of medical care provided to the English population. But some of the qualities that the best, most privileged doctors could offer their patients - personal interest, constant care, state-of-the-art remedies - could...

  12. Abbreviations
    (pp. 453-454)
  13. Notes
    (pp. 455-502)
  14. Index
    (pp. 503-519)