Cottage Hospitals developed in the second half of the 19th century. They were made possible and successful by international developments in hospital treatment: the use of anaesthetics in surgery from 1845; higher standards of nursing care under the guidance of Florence Nightingale, particularly after the opening of the Nightingale Training School for nurses at St Thomas’s Hospital in 1860, and the work of Lister and Pasteur on germ theory and antiseptics, which reduced hospital infection.
Many of the issues which pre-occupied the early founders of Cottage Hospitals are part of the current debates about hospital treatment in the 21 st century. How far should a patient have to travel? What are the relative merits of competition and co-operation in medicine? How can costs of hospital treatment be kept down? To what extent does the physical environment of a patient affect recovery?
Short-lived precursors of the 19th-century Cottage Hospital can be found from as early as the c.1740s. An embryonic version was established by William Fellowes, a landowner, at Hawes Green, Shotesham, outside Norfolk. The building is now converted to a house and much altered.
Cranleigh Village Cottage Hospital – Albert Napper
Cranleigh village hospital in Surrey, founded in 1859 by a general practitioner Albert Napper has come to be known as the model of later Victorian Cottage or ‘Village’ hospitals, as they were sometimes called. Cranleigh was well-publicised and featured in detail in the three editions of a 19th-century book on cottage hospitals by Henry C Burdett. Burdett was an enthusiastic advocate, who did much to disseminate good information and advice, covering every detail from bedpans to drainage (always a high priority) record-keeping and exemplary layouts. Cranleigh had four patient beds and its conversion maintained a completely cottage-like appearance. In the next 20 years or so about another 148 hospitals were established, some in existing buildings and some purpose-built. About the same number were added between 1879-1900. Average bed numbers rose to roughly 15 beds per hospital (based on an analysis of about 60% of the total). By 1934 there were over 600 cottage hospitals providing 10,000 beds.
The popularity of the cottage hospital was related both to the perceived cheapness of treatment, relative to larger or specialist hospitals, and the advantages they brought to the status of General Practitioners in the 19th century.
Cottage Hospitals came in many different shapes and sizes and were funded and staffed in different ways. The internal design and furnishings were kept simple and functional. The external design of the buildings often reflected the varied architecture of the period, however, they all shared characteristics. They were small hospitals, funded by donations, collections and subscriptions, in order to provide health care for the sick poor in rural areas. Each hospital had its own local rules and regulations but they invariably excluded patients with infectious diseases and the insane. They avoided the need for the patient (or his/her visitors) to travel long distances to a general hospital in a town or city. Patients contributed to the cost of their treatment and keep, in line with contemporary views about the value of self-help, unless costs were covered by the parish. The encouragement of feelings of self-help and independence amongst the patients was at the heart of the system. Burdett insisted that
If ever these small hospitals become free to any large extent…they will prove a curse rather than a blessing to the labouring poor. This is one of the rocks ahead.
Cottage Hospitals were thought to be economical. In 1867 it was considered that a six-bed hospital could be set up in an existing cottage for as little as £350 and would be adequate to serve a rural population of 4,000-5,000. Cottage conversion also provided an architectural environment familiar to the patients and this was considered to improve their wellbeing. The system of converting cottages was rapidly supplemented by purpose-built hospitals, often funded by a single philanthropic local landowner, as at Winsford, but sometimes by subscription.
General Practitioners & Surgical Training
Cottage Hospitals also had advantages for local general practitioners. They were usually staffed by GPs, who could admit their own patients and who provided medical care on a rota system, supplemented by nursing staff. This provided a focus for GP co-operation, unusual at a time when the usual relationship was competing for patients. The provision of operating theatres allowed GPs to share costly surgical instruments and develop their surgical skills on the sick poor in relatively hygienic conditions, enhancing their expertise and reputation amongst their wealthy patients.
The lessons learnt day by day in the cottage hospital become in time of need of real value in the ancestral hall. Henry C Burdett
Complicated surgery was sometimes undertaken by a consulting surgeon, providing a welcome educational link between General Practice and the specialist surgeon from a general hospital.
West Country – Dispensary
The West Country was an early provider of Cottage Hospitals. Dispensaries set up to provide medicines at cost price and free advice for the sick poor sometimes developed into Cottage Hospitals. The dispensary at Wiveliscombe in Somerset was providing emergency beds as early as 1804 and there were examples of small early hospitals at Penzance in Cornwall and Teignmouth in Devon.
Burdett recorded twelve Cottage Hospitals in Devon by 1896:
Ashburton and Buckfastleigh
Ottery St Mary
No doubt there were more by 1900.