Department of english language and literature

5. Conclusion

My intention has been to make a tidy outline of the development of medical care provided in Great Britain, especially in England since the seventeenth century. I have intended to depict the most important events from history which referred to medicine, such as the discovery of blood circulation and penicillin; the way people were treated by doctors; descriptions of hospitals; the establishment of the NHS.

I have mentioned some physicians from Great Britain who are well-known even in the twenty first century. It is not possible to mention every important person from history who has partaken in the development of medicine and medical care in Great Britain. There are so many people who have made various contributions to the development of medical care in Great Britain, many of whom very little is known about. My choice of who to depict as the most important medical practitioners in the history of Great Britain forms an important part of this work.

Since my thesis is an outline of the development of medical care in the Great Britain, there are many possibilities of further research. It is possible to develop each chapter or even each subchapter in detail. I find specially the remedies and the practitioners in the seventeenth and eighteenth centuries very interesting. Naturally, it would be much better to obtain necessary information right in England; there is undoubtedly easier availability to the books dealing with the topic and there is the opportunity to visit museums which are devoted to medicine and its history. Further research might be based on the comparison of British and Czech medical care in the past and also in the present including the most significant Czech physicians.

6. Summary

The diploma thesis depicts the development of medical care in Britain since the 17^th century until the present.

The first chapter, Medical Care in Britain before 1946 deals with, among other things, descriptions of various treatments pursued in each century starting with the 17^th century until the beginning of the twentieth. Moreover, significant physicians or scientists, who contributed discoveries to the development of medicine, have been mentioned along with the century in which they lived.

The second chapter, The National Health Service, is about the creation of the NHS, its structure and how it functions nowadays, and also with the problems it has had to cope with.

The last chapter, The Medical Profession, deals with doctors and nurses. The subchapter about doctors depicts the profession mainly from a historical point of view because the present profession of Doctor is described as a part of the chapter The National Health Service. The remainder of the chapter describes the profession of nurses from a historical point of view, including two famous British nurses who have influenced medical care and nursing in Great Britain, as well as elsewhere. The subchapter, Nurses and the Present outlines very briefly the current nursing profession in Britain only for the purpose of contrast to the history of the profession.

7. Resumé

Diplomová práce zachycuje vývoj zdravotní péče v Británii od sedmnáctého století až doposud.

První kapitola - Zdravotní péče v Británii před rokem 1946 - se zabývá, kromě jiného, popisem různých léčebných postupů prováděných v jednotlivých stoletích, začínající od století sedmnáctého až po začátek století dvacátého. V jednotlivých stoletích jsou zmíněni i významní lékaři a vědci, kteří svými objevy přispěli k rozvoji medicíny.

Druhá kapitola - The National Health Service - je o stvoření, struktuře a fungování NHS v současné době a o problémech s kterými se musí potýkat.

Poslední kapitola - Zdravotní profese - pojednává o lékařích a zdravotních

sestrách. Podkapitola o lékařích zachycuje profesi zvláště z historického hlediska, neboť problematika současného lékařského povolání je popsána jako součást kapitoly The National Health Service. Další část kapitoly popisuje profesi zdravotních sester z historického pohledu, včetně dvou slavných britských zdravotních sester, které ovlivnily zdravotní péči a ošetřovatelství nejen ve Velké Británii. Podkapitola - Zdravotní sestry a současnost - nastiňuje velmi stručně současnou ošetřovatelskou profesi v Británii pouze jako kontrast k historii této profese.

8. Appendices
Appendix 1
[Report...from the Poor Law Commissioners on an Inquiry into the Sanitary Conditions of the Labouring Population of Great Britain. London, 1842, pp. 369-372.]
After as careful an examination of the evidence collected as I have been enabled to make, I beg leave to recapitulate the chief conclusions which that evidence appears to me to establish.
First, as to the extent and operation of the evils which are the subject of this inquiry:--
That the various forms of epidemic, endemic, and other disease caused, or aggravated, or propagated chiefly amongst the labouring classes by atmospheric impurities produced by decomposing animal and vegetable substances, by damp and filth, and close and overcrowded dwellings prevail amongst the population in every part of the kingdom, whether dwelling in separate houses, in rural villages, in small towns, in the larger towns--as they have been found to prevail in the lowest districts of the metropolis.
That such disease, wherever its attacks are frequent, is always found in connexion with the physical circumstances above specified, and that where those circumstances are removed by drainage, proper cleansing, better ventilation, and other means of diminishing atmospheric impurity, the frequency and intensity of such disease is abated; and where the removal of the noxious agencies appears to be complete, such disease almost entirely disappears.
Contaminated London drinking water containing various micro-organisms, refuse, and the like.
The high prosperity in respect to employment and wages, and various and abundant food, have afforded to the labouring classes no exemptions from attacks of epidemic disease, which have been as frequent and as fatal in periods of commercial and manufacturing prosperity as in any others.
That the formation of all habits of cleanliness is obstructed by defective supplies of water.
That the annual loss of life from filth and bad ventilation are greater than the loss from death or wounds in any wars in which the country has been engaged in modern times.
That of the 43,000 cases of widowhood, and 112,000 cases of destitute orphanage relieved from the poor's rates in England and Wales alone, it appears that the greatest proportion of deaths of the heads of families occurred from the above specified and other removable causes; that their ages were under 45 years; that is to say, 13 years below the natural probabilities of life as shown by the experience of the whole population of Sweden.
That the public loss from the premature deaths of the heads of families is greater than can be represented by any enumeration of the pecuniary burdens consequent upon their sickness and death.

That, measuring the loss of working ability amongst large classes by the instances of gain, even from incomplete arrangements for the removal of noxious influences from places of work or from abodes, that this loss cannot be less than eight or ten years.

That the ravages of epidemics and other diseases do not diminish but tend to increase the pressure of population.
That in the districts where the mortality is greatest the births are not only sufficient to replace the numbers removed by death, but to add to the population.

That the younger population, bred up under noxious physical agencies, is inferior in physical organization and general health to a population preserved from the presence of such agencies.

That the population so exposed is less susceptible of moral influences, and the effects of education are more transient than with a healthy population.
That these adverse circumstances tend to produce an adult population short-lived, improvident, reckless, and intemperate, and with habitual avidity for sensual gratifications.
That these habits lead to the abandonment of all the conveniences and decencies of life, and especially lead to the overcrowding of their homes, which is destructive to the morality as well as the health of large classes of both sexes.
That defective town cleansing fosters habits of the most abject degradation and tends to the demoralization of large numbers of human beings, who subsist by means of what they find amidst the noxious filth accumulated in neglected streets and bye-places.
That the expenses of local public works are in general unequally and unfairly assessed, oppressively and uneconomically collected, by separate collections, wastefully expended in separate and inefficient operations by unskilled and practically irresponsible officers.
That the existing law for the protection of the public health and the constitutional machinery for reclaiming its execution, such as the Courts Leet, have fallen into desuetude, and are in the state indicated by the prevalence of the evils they were intended to prevent.
Secondly. As to the means by which the present sanitary condition of the labouring classes may be improved:--

The primary and most important measures, and at the same time the most practicable, and within the recognized province of public administration, are drainage, the removal of all refuse of habitations, streets, and roads, and the improvement of the supplies of water.

That the chief obstacles to the immediate removal of decomposing refuse of towns and habitations have been the expense and annoyance of the hand labour and cartage requisite for the purpose.
That this expense may be reduced to one-twentieth or to one-thirtieth, or rendered inconsiderable, by the use of water and self-acting means of removal by improved and cheaper sewers and drains.
That refuse when thus held in suspension in water may be most cheaply and innoxiously conveyed to any distance out of towns, and also in the best form for productive use, and that the loss and injury by the pollution of natural streams may be avoided.
That for all these purposes, as well as for domestic use, better supplies of water are absolutely necessary.
That for successful and economical drainage the adoption of geological areas as the basis of operations is requisite.

That appropriate scientific arrangements for public drainage would afford important facilities for private land-drainage, which is important for the health as well as sustenance of the labouring classes.

That the expense of public drainage, of supplies of water laid on in houses, and of means of improved cleansing would be a pecuniary gain, by diminishing the existing charges attendant on sickness and premature mortality.
That for the protection of the labouring classes and of the ratepayers against inefficiency and waste in all new structural arrangements for the protection of the public health, and to ensure public confidence that the expenditure will be beneficial, securities should be taken that all new local public works are devised and conducted by responsible officers qualified by the possession of the science and skill of civil engineers.
That the oppressiveness and injustice of levies for the whole immediate outlay on such works upon persons who have only short interests in the benefits may be avoided by care in spreading the expense over periods coincident with the benefits.
That by appropriate arrangements, 10 or 15 per cent. on the ordinary outlay for drainage might be saved, which on an estimate of the expense of the necessary structural alterations of one-third only of the existing tenements would be a saving of one million and a half sterling, besides the reduction of the future expenses of management.
That for the prevention of the disease occasioned by defective ventilation and other causes of impurity in places of work and other places where large numbers are assembled, and for the general promotion of the means necessary to prevent disease, that it would be good economy to appoint a district medical officer independent of private practice, and with the securities of special qualifications and responsibilities to initiate sanitary measures and reclaim the execution of the law.
That by the combinations of all these arrangements, it is probable that the full ensurable period of life indicated by the Swedish tables; that is, an increase of 13 years at least, may be extended to the whole of the labouring classes.
That the attainment of these and the other collateral advantages of reducing existing charges and expenditure are within the power of the legislature, and are dependent mainly on the securities taken for the application of practical science, skill, and economy in the direction of local public works.
And that the removal of noxious physical circumstances, and the promotion of civic, household, and personal cleanliness, are necessary to the improvement of the moral condition of the population; for that sound morality and refinement in manners and health are not long found co-existent with filthy habits amongst any class of the community.
“Chadwick's Report on Sanitary Conditions.” The Victorian Web. 11 October 2002. 12 December 2006

Appendix 2
Political leaders in the matters of health since the end of the nineteenth century
President of the Board of Health

• 
  Sir Benjamin Hall (October 14, 1854 - August 13, 1855)
  
• 
  Hon. William Cowper (August 13, 1855 - February 9, 1857)
  
• 
  William Monsell, 1st Baron Emly of Tervoe (February 9, 1857 - September 24, 1857)
  
• 
  Hon. William Cowper (September 24, 1857 - February 21, 1858)
  
• 
  Charles Adderley (March 8, 1858 - September 1, 1858)
  

Minister of Health

• 
  Christopher Addison (June 24, 1919 - April 1, 1921)
  
• 
  Alfred Mond (April 1, 1921 - October 19, 1922)
  
• 
  Sir Arthur Griffith-Boscawen (October 24, 1922 - March 7, 1923) (Defeated for election to the House of Commons)
  
• 
  Neville Chamberlain (March 7, 1923 - August 27, 1923)
  
• 
  Sir William Joynson-Hicks (August 27, 1923 - January 22, 1924)
  
• 
  John Wheatley (January 22, 1924 - November 3, 1924)
  
• 
  Neville Chamberlain (November 6, 1924 - June 4, 1929)
  
• 
  Arthur Greenwood (June 7, 1929 - August 24, 1931)
  
• 
  Neville Chamberlain (August 25, 1931 - November 5, 1931)
  
• 
  Sir Edward Hilton Young (November 5, 1931 - June 7, 1935)
  
• 
  Kingsley Wood (June 7, 1935 - May 16, 1938)
  
• 
  Walter Elliot (May 16, 1938 - May 13, 1940)
  
• 
  Malcolm MacDonald (May 13, 1940 - February 8, 1941)
  
• 
  Ernest Brown (February 8, 1941 - November 11, 1943)
  
• 
  Henry Willink (November 11, 1943 - July 26, 1945)
  
• 
  Aneurin Bevan (August 3, 1945 - January 17, 1951)
  
• 
  Hilary Marquand (January 17, 1951 - October 26, 1951)
  
• 
  Harry Crookshank (October 30, 1951 - May 7, 1952)
  
• 
  Iain Macleod (May 7, 1952 - December 20, 1955)
  
• 
  Robin Turton (December 20, 1955 - January 16, 1957)
  
• 
  Dennis Vosper (January 16, 1957 - September 17, 1957)
  
• 
  Derek Walker-Smith (September 17, 1957 - July 27, 1960)
  
• 
  Enoch Powell (July 27, 1960 - October 20, 1963)
  
• 
  Anthony Barber (October 20, 1963 - October 16, 1964)
  
• 
  Kenneth Robinson (October 18, 1964 - November 1, 1968)
  

Secretary of State for Social Services

• 
  Richard Crossman (November 1, 1968 - June 19, 1970)
  
• 
  Keith Joseph (June 20, 1970 - March 4, 1974)
  
• 
  Barbara Castle (March 5, 1974 - April 8, 1976)
  
• 
  David Ennals (April 8, 1976 - May 4, 1979)
  
• 
  Patrick Jenkin (May 5, 1979 - September 14, 1981)
  
• 
  Norman Fowler (September 14, 1981 - June 13, 1987)
  
• 
  John Moore (June 13, 1987 - July 25, 1988)
  

Secretary of State for Health

• 
  Kenneth Clarke (July 25, 1988 - November 2, 1990) – Conservative Party
  
• 
  William Waldegrave (November 2, 1990 - April 10, 1992) Conservative Party
  
• 
  Virginia Bottomley (April 10, 1992 - July 5, 1995) Conservative Party
  
• 
  Stephen Dorrell (July 5, 1995 - May 2, 1997) Conservative Party
  
• 
  Frank Dobson (May 3, 1997 - October 11, 1999) Labour Party
  
• 
  Alan Milburn (October 11, 1999 - June 13, 2003)- Resigned, Labour Party
  
• 
  John Reid (June 13, 2003 - May 6, 2005) – Labour Party
  
• 
  Patricia Hewitt (May 6, 2005 - ) Labour Party
  

“Secretary of State for Health.” Wikipedia: The Free Encyclopedia. 6 February 2007. 27 February 2007

Appendix 3

SHAs
Current (population) New (Population)
North East 2,545,073:

01 Northumberland, Tyne and Wear 1,396,374

02 County Durham and Tees Valley 1,148,699
North West 6,827,170:

03 Cumbria and Lancashire 1,929,653

04 Cheshire and Merseyside 2,358,474

05 Greater Manchester 2,539,043

Yorkshire and The Humber 5,038,849:

06 North and East Yorkshire and Northern

Lincolnshire 1,652,387

07 West Yorkshire 2,108,028

08 South Yorkshire 1,278,434
East Midlands 4,279,707:

09 Trent 2,687,496

10 Leicestershire, Northamptonshire and Rutland 1,592,211
West Midlands 5,334,006:

11 Birmingham and the Black Country 2,274,964

12 Shropshire and Staffordshire 1,499,568

13 West Midlands South 1,559,474

East of England 5,491,293:

14 Norfolk, Suffolk and Cambridgeshire 2,238,151

15 Essex 1,635,605

16 Bedfordshire and Hertfordshire 1,617,537

London 7,428,590:

17 North Central London 1,227,957

18 North East London 1,531,427

19 North West London 1,834,066

20 South East London 1,514,122

21 South West London 1,321,018

South East Coast 4,187,941:

22 Surrey and Sussex 2,577,631

23 Kent and Medway 1,610,310
South Central 3,922,301:

24 Thames Valley 2,120,859

25 Hampshire and Isle of Wight 1,801,442
South West 5,038,200:

26 Avon, Gloucestershire and Wiltshire 2,206,246

27 Dorset and Somerset 1,212,892

28 South West Peninsula 1,619,062

“Strategic Health Authorities Configurations.” Department of Health.

17 August 2006 <http://www.dh.gov.uk/assetRoot/04/13/37/44/04133744.pdf>

Appendix 4
Duties of the Staff Nurses

ST GEORGE’S HOSPITAL

London, SW1

Duties of the Staff Nurses

 1.     Staff nurses should manage their work methodically and keep their Wards neat, clean and in good order. They should pay constant attention to the warmth, freshness and ventilation and study the welfare and comfort of their patients in every respect. Every effort should be made to keep the Wards as quiet as possible.

 2.     The senior Staff Nurse on duty shall deputise for the Ward Sister in her absence, and at such times shall report to the Sister who is ‘on call’ for her Ward (or in their absence to the Assistant Matron’s Office) the admission of any patient who is seriously ill and on any occasion when there is cause for anxiety.

 3.     Staff Nurses should give a kindly welcome to new patients immediately on their arrival in the Ward, treating them with gentleness and consideration and making them and their friends feel assured from the first that they will be tenderly cared for.

 4.     The admission of new patients should be carefully supervised, particular attention being given to observing the condition of the pressure areas. Any abrasion of the skin, however slight, must be reported immediately to the Sister in charge. Staff Nurses shall also see that proper care is taken of the clothing and valuables of patients admitted to their Wards.

 5.     Staff Nurses shall be responsible for looking after relatives and friends visiting the Wards, and shall see that those waiting for long periods in the Hospital receive food and refreshment.

 6.     An important part of their duties is to assist the Ward Sisters in the training of Student Nurses, teaching them to be accurate, careful and observant, and thorough in every detail.

 7.     They shall see that all new Student Nurses coming to the Ward understand the clinical work allocated to them and are carefully instructed in all procedures practised in the Ward.

 8.     They shall study the rules laid down for the care and checking of Dangerous Drugs, and see that these are properly observed.

 9.   They shall be responsible to the Sister in charge of the Ward or Department for the care of the following: Linen, Instruments, Surgical equipment including surgical stock, Crockery and cutlery. A weekly inventory should be taken and any losses reported immediately to the Sister in Charge. It is recommended that instruments and cutlery in regular use be checked every day.

 10. It is a strict rule of the Hospital that nothing may be borrowed from one Ward or Department for another without a written request signed by the Sister or Staff Nurse in charge. At night the request should be made to the Night Sister. This rules also applies to Dangerous Drugs.

 11. Staff Nurses should supervise the work of the Ward Maids and Orderlies, instructing new members of the staff in their duties and helping them to feel that they are essential members of the Ward team. They shall see that the Domestic Staff are punctual in arriving and leaving the Ward, and shall teach them to be quiet and thorough in their work and to avoid waste.

 12.Constant attention should be paid to every method by which economy may be effected, particularly with regard to food, surgical dressings, lotions, stationery and cleaning materials. Good management in this respect can save the Hospital considerable expense.

 13. Any accident affecting either a patient or a member of the Nursing or Domestic Staff on duty in a Ward or Department shall be reported immediately to the Sister in Charge and a written statement made by the member of the Staff involved or witnessing the accident.

 14. Staff Nurses should be thoroughly conversant with all the rules made for the prevention of infection in the Hospital and should see that these are conscientiously and carefully carried out.

 15. Nursing Procedures practised in the Hospital shall be those laid down in the Nursing Procedure Book, a copy of which shall be available in every Ward and Department.

Muriel B. Powell, Matron, 13 December 1951

(Rivett, 1998)