Chester Royal Infirmary 1756-1956

"This brochure is published by The Chester and Distrtict Hospital Management Committee to mark the bi-centenial of the Chester Royal Infirmary and it is hoped that it will be read and cherished by the many friends of the Hospital." "Prepared from materials and records available at The Royal Infirmary by Mrs Enid M Mumford, M.A. to whom the Management Committee express thanks" 1956.

CONTENTS
Early Days, 1756—1856
Administration
The Second HundredYears, 1856—1956
Finance
The First Doctors
The Development of Nursing
The Patient
Medicine and Surgery
The Hospital Today (actually of course, in 1956)
Go to main History Index Page

Early Days.

Fabric.
Chester Infirmary arose out of the great charitable spirit and newly awakened social conscience that gave impetus to the voluntary hospital movement of the eighteenth century. Its foundation was made possible by a bequest of £300 left in 1753 by Dr. William Stratford.a well known local ecclesiast, for the establishment of a public hospital in the City of Chester. This legacy inspired the City fathers to start a campaign for additional funds and two years later, in 1755, they issued an appeal for money and set out a proposal for the establishment of a general  infirmary in the belief that ‘the establishment of this infirmary will not only be a private, but a public advantage, as it will be the means of supplying the diseased poor with advice, medicines, and every necessary of cure, which the ordinary parochial charities do not sufficiently provide for.

In 1761 the Infirmary was completed. In plan it was a large quadrangular building of four stories with an open court in the centre. The basement provided cellar accommodation, the ground floor offices and the first and second stories the wards. There were four of these, two on a floor, each running the whole length of the bnilding and with sufficient space for two rows of twelve beds. Adjoining the wards were the nurses’ rooms, staircases and chapel.

Although this design had the advantage of simplicity it proved to be defective in many  respects. Patients could only be classified according to sex; the absence of small wards made it  impossible to separate patients with one type of disease from those with another or the dying from the convalescent. Far from patients being cured through hospital care, infection spread rapidly, erysypelas and gangrene were common, and disease that should have responded readily to treatment often proved fatal.

 The medical officers and patients had to suffer these extremely trying conditions for almost seventy years. Between 1823 and 1829, however, a number of subscribers led by one of the honorary physicians and governors of the Infirmary, Dr. George Cumming, made determined efforts to secure improvement. In 1829 a building committee was appointed to consider alterations that would improve the design of the hospital and, after much argument and the submission of a number of conflicting plans by the architect, the medical officers and Dr.Cuniming himself, agreement was finally reached and in 1830 the sum of £3,250 was spent on  alterations and additions.

The basement was now divided up into laboratories, store rooms, domestic offices and a  number of small rooms intended for the care of patients suffering from hysteria, epilepsy, smallpox or in delirium, whom it was advisable to keep isolated from the rest. The ground floor was still retained as office accommodation, board room, library, etc., but a suite of rooms was set aside as a dispensary and a number of baths were installed for the use of patients. On  the first and second floors the long wards were divided into two and new rooms and bathrooms for nurses were built around the central courtyard. These must have effectively blocked off a great deal of light and air that .had previously reached the wards but despite this the hospital  governors were well pleased with their improvements and expressed it as their opinion that ‘the  Chester Infirmary is now confessedly one of the most improved institutions, as to plan, in the country.’

 The new dispensary, in particular, was a very valuable addition to the hospital’s services. Patients treated here were divided into two classes: ordinary patiehts who attended personally and home patients who were looked after by a ‘Visiting Surgeon.’ The dispensary thus saved  expense by enabling non-surgical cases to be treated at home and at the same time was welcomed by those patients who preferred domestic comforts to the wards of a hospital.

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Administration.

Although the design of the hospital was greatly improved between its foundation in 1756 and its centenary in 1856, administration proved more resistant to reform and disputes amongst the governors were common occurrences during these early years.

Under the Statutes of the Chester Infirmary published in 1763, the administration of the hospital was placed entirely in the hands of the governors. These were exceedingly numerous. In addition to the honorary physicians and surgeons any person subscribing two guineas a year was entitled to be a governor during the time he subscribed and any donor of twenty guineas or more became a governor for life. Governors had a number of duties and privileges. The Infirmary Statutes laid down that general meetings of the governors should be ‘held at three stated times in the year, viz., on the second day of Chester May races, the second day of Chester Summer Assizes, and the last Tuesday in January.’ Special general meetings should be held at  convenient times for the election of salaried and honorary staff. In addition there should be a weekly board of governors who would meet ‘to regulate all matters relating to the admission and discharge of patients, enquire into the behaviour of officers and servants, examine and pass  accounts, order payments, prepare matters for the general board, and transact such affairs as shall be committed to them by the General Board.’

The governors, therefore, wielded enormous power in the affairs of the hospital and, in view of the ease with which any person could become a governor, it would appear that right from the start the system laid itself open to muddled thinking and political machinations. The early hospital records provide many examples of, as one governor put it, the ‘unhappy spirit which has not only blasted, but still threatens to blast the higher destinies of our infirmary.’ To cite but one example out of many, the election of staff was always a bone of contention. This was done by the governing body as a whole who~ either attended in person or voted by proxy.

Lobbying and canvassing were common and the records note a number of sharp practices such as the deliberate miscounting of votes and the sending of fictitibus letters to governors in the hope of preventing them from voting. This election procedure meant that not only were responsible medical posts allocated by people with no medical knowledge whatsoever, but these posts were frequently given to the ‘local boy ‘ rather than to the most suitable candidate. Many criticisms were also directed at the system of weekly boards for it was felt that the governors  who attended these varied so greatly from week to week and, because of their numerical strength could be so easily mustered in support of particular schemes, that unity of policy and action was virtually impossible.

Besides their administrative responsibilities the governors had the privilege of recommending patients for admission to the infirmary. The 1763 Statutes stated that ‘no person shall be admitted a patient but by recommendation of a subscriber, benefactor, physician or surgeon attending the infirmary unless in cases which admit of no delay. A subscriber of two guineas a year or a donor of twenty guineas could recommend annually one in-patient or two out-patients and subscribers and donors of larger amounts were permitted to recommend a greater number of patients in proportion to their contribution. The only patients not eligible for admission were expectant mothers, children under seven, people with infectious diseases, inoperable cancers or those unlikely to recover.

By 1838 this admission system was becoming unworkable. The governing body had greatly increased in size and governors were permitted an almost unlimited number of recommendations.As a result income would not balance expenditure and the Infirmary was rapidly running into debt. A committee appointed to put matters right drastically curtailed the number of recommendations allowed each governor. This restriction caused much dissatisfaction and concern in the City where it was felt that the sick poor would no longer get the medical attention they had received in the past. Letters were received from the ‘Guardians of the Poor’ and other charitable bodies begging the governors to return to the old system. The governors remained firm but did make a concession to public opinion by permitting the Weekly Board to admit additional in-patients if their sponsors would pay one shilling per day for their treatment and maintenance. Thus Chester Infirmary was one of the first hospitals to apply the self-supporting principle to its administration.
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Finance.

The whole question of hospital finance in these early years is an interesting one. The governors naturally provided a large part of the Infirmary’s income, but money came also from a number of other sources. Besides the annual subscriptions. benefac~ions and donations there were legacies, share dividends and contributions from patients. In addition a number of  private charities raised money for the hospital. An annual ball held at the Albion Hotel, Chester, contributed from £80 to £100 while it was not unusual for local clergy to preach sermons  in aid of the hospital funds. The Chester townspeople were proud of their hospital and ready to respond to appeals for its support, and, although often in difficulty in these early years, the hospital seldom found itself seriously hampered by lack of funds.

By 1856 the Infirmary was out of debt and had achieved a favourable balance of £152 - 7s - ld., mainly due to the centenary fund of that year; but efforts were being made to increase the annual subscriptions so that the ‘certain’ income might be raised. Unfortunately, these efforts were not successful, chiefly, it was thought, because the Crimean War had increased taxation so much. However, in The Annual Report of the centenary year 1855/56 the auditors express the hope that now that the country has peace and the prospect of prosperity subscriptions  will increase so that the Infirmary may continue to be ‘under the blessing of an ever merciful Providence, of great utility in alleviating human suffering, and restoring the diseased to health,  amongst the poor within the range of its influence.’
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The Second Hundred Years. 1856-1956

Fabric.

 The first event of historical interest after the centenary was the purchase, in 1859, of five acres of land from the ecclesiastical commissioners. This land, the ‘Infirmary field,’ adjoined  the hospital on the north side and the governors hoped by ‘keeping it for sanitary and recreative purposes’ to preserve an area of open ground around the Infirmary. Here was a great improvement to the outdoor amenities of the hospital. Unfortunately the same improvement was not to be found within the walls for the conlition of the Infirmary building was rapidly deteriorating.  Because of the hospital’s age the wards and corridors were dirty, dilapidated and alive with vermin. In 1865 a committee of inquiry warned the governors, ‘the present deplorable s.tate of the wards has the effect of deterring patients from seeking admission to them or remaining there when admitted . . . . the chairs, old benches and cupboards, more or less dilapidated  give a comfortless and distressing appearance to the rooms . . . . tire floors and skirting boards have become partly decayed and infested with vermin which it is impossible to remove except by a process of fumigation . . . .‘ This fumigation, together with the repainting of the hospital and other improvements such as the installation of ‘Staffordshire White Baths’ in place of the existing lead ones, cost the governors £1,630, a sum they could ill afford. From a hygienic  point of view it was money well spent, however, for the Chairman of the Board was able to  inform the 1866 Annual General Meeting that the alterations had ‘cleaned it entirely from those parasitic insects which attach themselves to the human frame and are found not only in the beds  of the Infirmary but on the waIls . . . . The institution will now bear examination and comparison with others of its class.’
 

In 1865 an extension of the Infirmary’s medical services was made possible through a legacy of £500 left by Mrs. Henry Wood to provide a hospital for smallpox and other infectious  diseases. At this time there was urgent need of such a hospital. The Infirmary would not accept smallpox cases as there was no way of isolating this type of patient and any unfortunate person contracting the disease was promptly despatched to the Chester Workhouse.

 The Board of Management chose a site on the east side of the Infirmary and plans were  obtained for the erection of a building to provide accommodation for twenty-four patients. Two other charitably inclined ladies, Mrs. William Ball and Mrs. James Dixon, hearing of the project, relieved the governors from much of their financial worry by donating £500 and £1,000 respectively and a public appeal brought in the balance required to meet the builder’s estimate  of £2,595.

Work began in 1867, the plans showing a two storey building with wards on the ground floor  and day and nurses’ rooms upstairs. While the first bricks were being laid, however, the  governors received a deputation of angry local residents vigorously opposing the scheme on the grounds that it was prejudicial to the health of the neighbourhood and likely to depreciate the value of house property. They threatened that if the hospital was built local residents would withdraw their financial support from the Infirmary. The governors were aghast at this attack but refused to be intimidated. They assured the deputation that there would be no risk of contagious diseases being spread throughout the neighbourhood and continued with the project  in the face of local opposition. Unfortunately the hospital was not finished in time to provide accommodation during the serious cholera epidemic that struck Chester in 1867 but this outbreak did bring about a rapid change in public opinion and an appreciation of the need for a fever hospital.

In May 1868 the new hospital was completed and immediately proved of great value. In 1869. 115 fever patients were admitted to its wards, over half of these being cases of typhus, but only one death occurred. As the House Surgeon pointed out in his annual report to the  governors, the mortality rate had never been so low and the policy of Yemoving fever victims to the new hospital was undoubtedly paying dividends. The smallpox hospital was in use until 1899 when Chester Corporation opened an isolation hospital at Sealand. In 1902 it was converted  for use as a nurses’ home.

As the years passed the Infirmary medical officers came to realise that it was not enough merely to treat a patient’s disease but that he also needed specialised care and attention during his convalescence. In 1877 they proposed that a sanatorium should be established at Parkgate for the care of convalescent men. The governors appealed for funds and in 1882 the home was formally opened by the Duke and Duchess of Westminster. It proved such a success that in 1883 an adjoining house and garden were purchased for the use of women and children.

The Parkgate convalescent home flourished and provided a much needed service until 1914 when it was handed over to the Army authorities for use as a Red Cross Hospital. In 1919 it was re-opened but by this time it had grown decayed and unattractive and in 1923 it was regretfully closed down after more than forty years’ service. The Parkgate Convalescent Fund was founded out of the proceeds of the sale of the convalescent home and to this day the income from this fund is used to pay for convalescent home treatment for needy patients from the  Royal Infirmary.

The end of the nineteenth century saw an important addition to the Infirmary itself with the building of the Humberston Wing in 1892. Colonel Humberston, a Chairman of the Board of Management for twenty-five years, had left the hospital a legacy of £500 and the governors  used this as the nucleus of a fund in his memory; £2,000 was collected and the Humberston Wing still stands as a reminder of one of the Infirmary’s devoted servants.

The beginning of the twentieth century brought further improvements. In 1903 the Outpatient Department was enlarged, and a new operating theatre built thanks to the generosity of Mrs. R. Tidswell who gave the hospital £600 in memory of her husband. The original operating theatre appears primitive in the extreme when compared with our modern surgical palaces of stainless steel and gleaming tiles. Its furniture consisted of an old wooden operating table, a wooden instrument cupboard and one small basin with a single tap of cold water. The floor, also of wood, must have absorbed countless bacteria during the 149 years of its existence.

Now electric light and hot and cold water were installed. A modern operating table and apparatus took the place of the outdated equipment and a bay window was built in the wall over the Infirmary porch.

The governors were blissfully unaware that their new operating theatre would prove to be  the last bit of patching they were to make to the original Infirmary building. They had tried hard to improve the structure and design of the hospital and realised its limitations but there were never sufficient funds available for ambitious schemes of rebuilding. In 1909, however, to their consternation they found that the Infirmary was being subjected to strong criticism from a well known outside hospital authority. The gentldman responsible for this rude shock was Sir Henry Burdett, Editor of ‘The Hospital,’ who paid a visit to Chester Infirmary in the course a private survey of the hospitals of the United Kingdom. Sir Henry arrived unannounced  and unexpected, toured the hospital without making his presence known to the Secretary or Board and terminated his visit by placing a note in the visitors’ book to the effect that, in his opinion, as the hospital was more than 150 years old an effort should be made to provide a new  hospital more up to the standard of modern requirements.

 The Board of Management, believing Sir Henry meant them to build an entirely new  hospital and realising that this would cost at least £60,000 wrote urgently asking him to repeat his visit and make his suggestions round the board room table. Sir Henry replied through an article in ‘The Hospital,’ pointing out that if the present building was renovated and an additional wing built at a cost of about £25,000 the Infirmary would be satisfactory. The Board were greatly relieved at his more practical suggestion and felt that the time was now ripe for a  hospital appeal.

In 1911 a meeting of the governors held at the chester Town Hall resolved to extend and renovate the Infirmary as a memorial to King Edward VII and an appeal was launched for  £30,000. By the end of 1912 more that £31,000 had been contributed, £12,500 alone being a gift from Mr. Albert Wood of Conway, a name memorable in the history of the hospital. The  architect’s plan showed almost a new hospital. There was to be a new ‘Albert Wood’ wing; a new nurses’ home, and a new out-patients’ department; while the old building was to be reconstructed and used as an administrative block.

In 1914 King George V and Queen Mary visited Chester and officially opened the ‘Albert Wood Wing,’ the King announcing that it was his Royal pleasure that the hospital should, in  future, be known as the ‘Chester Royal Infirmary.’

War broke out and the building programme was held up but by 1915 most of the new wards were in use aad in 1917 the work was finally completed. Many donations were made to the hospital in memory of relatives who fell in battle. The ophthalmic wards were completed  and a new operating theatre opened in memory of Lieutenant William Gladstone. Squire of Hawardcn, and two wards were endowed in memory of Harry Urmson Hayes and Captain Francis Rigby. Other bequests were made by Mrs. lames Taylor, who provided a new operating  theatre in memory of her husband, one of the Infirmary’s honorary surgeons, and by Mr. George Barbour, Mr. F. Farrimond and Mr. B. Boden, who gave their names to three of the hospital’s new wards. Between 1917 and 1922 it was possible to make special provision for the  treatment of venereal diseases, to form orthopaedic, x-ray and pathology departments and to open a new children’s ward and almoner’s department. In 1923 the Humberston Wing was enlarged and reconstructed.
 

In 1938 it was proposed to extend the existing buildings and erect further new departments. The Board hoped to build a new out-patient and casualty department, to extend the nurses' home, to build additional ward blocks and to reconstruct the existing administrative accommodation. Then came the second world war and the work was never started. ~ The much needed out-patient department did not materialise and the staff were compelled to continue their work in grossly overcrowded and depressing conditions. Now, in 1956, the construction of the new  out-patient department is to be the largest building scheme undertaken by the Management Committee since its formation, and should prove a worthy memorial to the cgntinued efforts  for the well being and improvement of the hospital.
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Administration.

In 1921 the home visiting service provided by the dispensary was reluctantly closed down. The demands of this service had been a source of worry to the Board for some considerable  time. Patients requiring home medical attention increased year by year and the hospital finances did not grow proportionately. By the 1920’s the need for this type of service had”dhninished: National Insurance was ~in operatiOn and sick benefit schemes were widespread and the Board therefore felt that these new societies should bear the load that the Infirmary had carried for so  many years. So ended a service that the older people of Chester still remember with gratitude and admiration.

 Throughout the country as a whole it was now becoming evident that a more co-ordinated  hospital service was an urgent necessity. The 1929 Local Government Act brought the first  move towards this by giving the counties and county boroughs greater powers to provide hospital accommodation, and in Chester representatives of the Chester CorporatiOn, the Royal Infirmary and the Chester Maternity Hospital met together to survey the local hospital services with a view to their co-ordination. Ten years later,. iii 1939, Lord Nuffield offered one million. £1 shares in Morris Motors to finance a scheme for regionalising hospitals throughout the country.

During the second world war little further could be done, but 1945 brought with it both the termination of hostilities and the election of a Labour Government with Mr. Aneurin Bevan as Minister of Health. In 1948 the National Health Service as we know it today came into being Regional Hospital Boards were appointed and these, in turn, delegated part of their authority to Hospital Management Committees whose function it was to look after the day to day administration of groups of hospitals. The Chester Royal Infirmary came under the jurisdiction of the Chester and District Hospital Management Committee. The governors welcomed the  health service as the solution to tbeir by now overwhelming financial problems but in their Annual Report for 1948 they expressed the hope that ‘the outcome will be a plan for a  co-ordinated and well distributed hospital service, retaining the individuality and the best traditions of the voluntary hospitals.’
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Finance.

An organisation that was to play a large part in the 7lnfirmary affairs, both from a financial and administrative point of view, appeared on the scene about this time. This was the Working Men’s Hospital Saturday Association, a group of working men who contributed one penny a week towards the Infirmary funds. Although th’e relationship between the Association and the Board of Management was at times a stormy one, by 1872 the members had contributed well over £1,000 and also secured for themselves a number of seats on the Board. This was a healthy  innovation from the Infirmary’s point of view as, for the first time, men who had been or were likely to be patients in the public wards had a say in bow the hospital should be run. The Association worked zealously to raise funds and, in addition to their weekly subscriptions,  organised an ar~nual cycle parade, a masquerade ball and a football charity cup match.
 

In 1915 a second association of great financial assistance to the Infirmary came into being with the founding of the Chester Royal Infirmary Linen League. This was organised by a  number of public ~pirited ladies who not only equipped the hospital beds with sheets and blankets but also, through their subscriptions, kept the hospital cupboards stocked with linen.

By 1921 the Infirmary was desperately in need of money and the ladies of Chester once  again came to the rescue by forming the Ladies’ District Association. Members made stalwart efforts to increase the hospital’s number of annual subscribers and, by means of district collectors,  to obtain donations and small subscriptions. This association, together with the Linen League, worked magnificently in the hospital’s cause.

1931 brought no easing of the financial situation and it was at last reluctantly decided that the patients themselves must bear part of the cost of their treatment. Each patient was now  required to pay for his maintenance according to a scale laid down by the Board of Management. Members of organisations such as the Working Men’s Saturday Association, later called the Deeside Hospital Council, and other benefit schemes were exempt from this charge as were patients without the means to pay. This scheme meant the end of the old system of patient recommendation, although subscribers were still privileged to introduce to the hospital any person they felt to be in need of its service.
 

In 1937 some of the heavy financial responsibility for the hospital’s solvency was removed from the shoulders of the governors by making the Infirmary into a Limited Company but it was  not until the National Health Act of 1948 and the ending of the voluntary hospital system that the Infirmary was at last relieved of its monetary problems. By this time ~~o1untary contributions had become entirely inadequate for the upkeep of a modem hospital and state support was the only feasible solution.
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The First Doctors.

 The first medical staff at the Infirmary consisted of four honorary physicians and surgeons and a paid ‘House Apothecary.’ The 1763 statutes did not specify any medical qualifications  but physicians and Surgeons were required to ‘attend in their turns at the Infirmary every Tuesday at eleven of the clock to examine those who shall be recommended for patients.’ They must also ‘meet at the Infirmary every Friday at eleven of the clock to visit their in-patients,  and to consult upon difficult cases’ and ‘visit their respective in-patients at other times, as they shall judge necessary         No amputation or other great operation was to be performed without a previous consultation of the physicians and surgeons.’

By 1816 the 1763 statutes had been amended and it was now required that physicians eligible for office should be fully qualified and medical graduates of Oxford, Cambridge, Dublin, Edinburgh or Glasgow. As yet no formal qualifications were laid down for surgeons for it was still common practise to learn surgery by serving an apprenticeship. However, Chester Infirmary required that the ‘House Surgeon and Apothecary,’ as he was now called, must ‘bring testimonials of moral conduct, of having served five years to .a surgeon or surgeon and apothecary or three years to some public hospital, and of having attended at least one course of lectures on anatomy, surgery, the practice of physic and pharmaceutic chemistry.’

Dr. Cumming who figures so much in the hospital records of the l820’s sets out in detail the duties of an efficient and conscientious Chester Infirmary House Surgeon. These were —
7-0 a.m. Rise. Receive nurses’ reports.
8-0 a.m. Breakfast.
9-0 a.m.—1 1-0 a.m. Visit patients—’ being at the rate of two minutes of time, upon an average, for each patient.’
11-0  a.m. — 1-0 p.m. Accompany the physicians and surgeons on their rounds, superintend dressings, etc.
1-0 p.m~—3-0 p.m.     Attend in the shop or laboratory to assist in the composition of medicines.
3-0 p.m.—4 p.m. Exercise.
4-0 p.m.—5 p.m. Dinner.
5-0 p.m.—7-0 p.m Draw up sketches of all cases admitted, for the consideration of the physicians and surgeons.
7-0 p.m.—9-0 p.m. Visit patients.
9-0 p.m.—11 p.m. Supper, followed by professional reading.

For this marathon day’s work the House Surgeon was paid £60. a year. Although it seems unlikely that the House Surgeons did in fact keep to Dr. Cumming’s exhaustive time table, by 1838 the Infirmary was getting frequent complaints and resignations from House Surgeons on the grounds of too little money and too much work. The Board of Management therefore raised the House Surgeon’s salary to £80 a year and once again revised the rules relating to the medical staff. The new rules stated that the House SurgeOn~ was to be considered as resident superintendent of the institution and must now be a member of one of the Royal Colleges of Surgeons — London, Edinburgh or Dublin. By this time an apprenticeship scheme had been introduced which may have relieved the House Surgeon of some of his less responsible duties. Each apprentice paid the Infirmary 300 guineas and in return he was ‘entitled to see the medical and surgical practice of the Institution’; to be ‘instructed in his profession by the House Surgeon and provided with board and lodging in the establishment.’ The term of apprenticeship was five years.
 

At first the training given to these students was rudimentary in the extreme and Mr. Robert Roberts, one of Dr. Cumming’s surgical colleagues, was so persuaded of the need for improvement that he distributed a pamphlet amongst the governors containing suggestions for better and  more scientific teaching. One of his suggestions was the need for courses of Anatomical lectures, ‘the sole foundation of all medical and clinical knowledge.’ He emphasised that these lectures must be practical and include demonstration and dissection and it is interesting  to note here that the dissection of human cadavers was now legal. The macabre deeds of the resurrectionists and body snatchers, particularly Burke and Hare in Edinburgh who in 1827 murdered thirty persons in order to sell their bodies to the surgeons, had so incensed public opinion that in 1832 the Government had been forced to pass the Anatomy Act which permitted  unclaimed bodies to go to the medical schools.
 

By 1852 the medical staff of the Infirmary consisted of a House Surgeon, an Assistant House Surgeon or Visiting Surgeon, a Dispenser and six honorary Physicians and Surgeons. In 1853 the progressive step was taken of adding a Dental Surgeon to the medical complement.

1858 and the Medical Act brought about an alteration in the rules relating to House Surgeons. Now any registered medical practitioner could apply for the post and it was not restricted to members of the Royal College of Surgeons. Also the clause concerning moral  conduct was struck out as it was assumed that registration implied impeccable moral conduct. The moral conduct of prospective House Surgeons seems to have caused the Governors some concern prior to 1858 as it is recorded in the minutes that on one occasion the Mayor of Chester was deputed to visit Caernarvon for three days in order to check on the behaviour of one applicant who had a reputation for dissolute habits.

The Infirmary records for the first hundred years of its history contain the names of many of the early physicians and surgeons and it may be of interest to mention one or two here.Among this distinguished gathering is Dr. John Haygarth, Honorary Physician from 1757 to  1798, to whose memory the present children’s ward is dedicated. Dr. Haygarth had an important influence on the treatment of infectious diseases in this country. He was one of the first doctors  to use innoculation and a pioneer in the field of sanitation and scientific nursing. At Chester Infirmary he put into effect with much success his revoluntionary ideas on the need for isolating  infectious cases, which he called his ‘Rules of Safety.’ This was to become general practice  in hospitals throughout the country. Two devoted nurses of the time Lowry Thomas and Jane Bird are recorded in the hospital minutes as having given their lives in support of his teaching.

Dr. W. M. Thackery, 1798 to 1827, is another name worthy of mention. Cousin of the  novelist, he was greatly interested in medical education and it was through his generosity that the Infirmary library was founded. Dr. Thackery was also an assiduous planter of trees and  seven hundred and eighty acres of forest in Denbighshire and Flintshire are the fruits of his efforts.

Mr. Griffith Rowlands, was one of the most renowned of the early surgeons of the hospital. He came to Chester from Saint Bartholomew’s in 1785 and served at the Infirmary for forty-three years. During this time he had many interesting cases and was one of the few who took the  trouble to publish his results. He was a bold and dexterous operator and the operation that added mOst to his reputation was that of sawing the ends of the bone in a case of ununited fracture of the thigh. Typical of the surgeons of the time he was feared because of his sterness and irritability but be was also greatly respected by his pupils for he was always willing to teach, a characteristic few surgeons of the time possessed.

Dr. Cumming, l804—1863, has left abundant evidence of his unflagging efforts for the  improvement of the hospital. He was one of the most ardent of the nineteenth century reformers and his ideas were vividly and often vitriolically committed to paper for the benefit of posterity. He wrote at length on the faulty administration and bad design of the hospital and made many  suggestions as to ways of improving these and adding to the comfort of the patients. Although Dr. Cumming was frequently exasperated by the slow moving governors and complained posterity will hardly credit the fact that, for the last twenty-five years, every attempt  to improve the Infirmary has met with the most rigorous opposition from one quarter or another,’  most of his suggested reforms were eventually carried out to the great benefit of the hospital.
 

Dr. Edward Waters, who died in 1890, is another example of the medical pioneers of the  time. Besides holding advanced ideas on the training of nurses he did much to improve the status of his own profession. In 1887 an illuminated testimonial was given him by the Lancashire and Cheshire Branch of the British Medical Association in gratitude for his devoted work in the interests of the medical profession. It was largely through his efforts as Chairman of the ‘Medical Reform-Committee’ that doctors were able to secure direct representation on the General Medical Council, a privilege they did not enjoy until the Medical Bill of 1886.

These men are typical of the great medical reformers of the eighteenth and nineteenth centuries and Chester Infirmary owes much of its present day reputation to their example and devotion and the high standards of service for which they so vigorously campaigned.
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The Development of Nursing.

Nurses, in fact, were regarded merely as servants, and had to endure long hours and miserable pay. The 1763 Statutes of the Chester Infirmary, under the heading ‘Servants’ list the duties of nurses as follows: — ‘that the nurses clean their respective wards by seven in the morning, from the first of March to the first of October; and by eight in the morning from the first of October to the first of March. That the nurses and servants obey the Matron as their  mistress; that they behave with tenderness to the patients and with civility and respect to strangers.’ For this labour they were paid the princely sum of £4 a year. Chester Infirmary must have been reasonably fortunate in the nurses it employed for in 1840 the minutes state that ‘in consideration of the good conduct and temperate habits of the nurses that they each be presented at the end of the year with a sovereign as a reward.’ The Board of Management’s  idea of temperate habits may have been rather elastic however, for between June and August of that year the housekeeping records show that the nursing staff of six consumed 126 pints of porter.
 

By 1862 nurses were becoming extremely hard to obtain and the Infirmary was forced to offer higher rates of pay in order to attract more recruits. Upper nurses were now offered 5 /6d. a week or £14 6s. Od.  year and under nurses 4/6d. a week or £11 14s. Od. a year. At the same time an effort was made to encourage sobriety by paying them 20/ - a year beer money instead of the customary issue of beer or porter. The 1862 increase did not overcome the nursing  shortage, however, and in 1866 it was reported that in order to have a more efficient class of nurse the Board have deemed it expedient to raise the scale of wages to a standard more in conformity with that of other infirmaries. At the same time they think it right to state that considerable difficulty is experienced in meeting with persons competent to discharge  the duties of nurse in a satisfactory manner.’ This last statement was undeniably true for in one week of that year’two nurses were sent to prison for stealing patients’ clothes and other hospital property and a third nurse was discharged for ‘grossly indecent conduct.’

In 1867 the first mention of training appears in the Infirmary records. 1860 had seen the  opening of the first training school for nurses in this country. This was the ‘Nightingale School’ at St. Thomas’s Hospital, London, built in honour of Florence Nightingale. The  Governors of Chester Infirmary, fired by the example of St. Thomas’s were anxious to raise the standard of nursing in their own hospital and, in consequence, an advertisement was inserted  in the Chester and Liverpool newspapers inviting applications for two young women to be  trained as nurses. At the same time they tried to give their nurses additional status by providing  them with a uniform. It was decided that ‘the four bead nurses each have caps of the pattern produced by the Matron also two cotton dresses and a blue merino dress. That the four under nurses have each caps and two cotton dresses, the dresses and caps to be the property of the Institution.’

In 1873 the question of nurses’ training arose again, this time through Dr. Edward Waters. He suggested that the hospital should start its own Nurses’ Institute and that the governors should now make use of the old Blue Coat School for this purpose. Dr. Waters pointed out that ‘it was admitted on all bands that one of the great wants of the city and neighbourhood  was that of skilled nurses. We have Institutions where they are trained in Liverpool, London and Dublin and in many of our country towns, but such is the demand upon these institutions that where nurses are wanted 1 can say from my own experience that there is the greatest difficulty in obtaining them . . . . it is impossible in London or Liverpool to obtain the services of a trained nurse.’ Dr. Waters felt that a Nurses’ Institute would serve three most valuable functions. Firstly that of providing nurses for, those who could afford to pay for them and thus helping to augment the Infirmary income. Secondly, that of looking after the poor who could not pay and thirdly, that of improving the nursing in the Infirmary. The Board of Management  regretfully turned down this ambitious scheme because of the expense it would involve. But, although rejecting his proposal, the Board was very much in agreement with Dr. Waters’ remarks on the need for higher nursing standards, so much so that they resolved ‘that immediate steps be taken to train nurses in the Infirmary, and that advertisements be inserted in the newspapers for two persons of respectable character and good position to be trained under the medical officers and Matron. They specifically stated that ‘no menial work would be imposed  upon such nurses in training . . .‘ This last proviso was a big step forward for a large part of a nurse’s duties had always consisted of heavy domestic work.
 

In October 1873 the Board took the question of training further by designing a proper training scheme and accepting the principle that infirmary nurses should be used for private nursing. Among the conditions laid down in this scheme were the following innovations: —

1. Probationers shall be not less than 21 nor more than 35 years of age.
2. After 12 months they will be considered trained nurses and their wages will increase  from £14 to £20 a year.
3. At the end of three years the Board of Management will grant a certificate of qualification and faithful service.

In theory this new scheme should have meant a great improvement in the Infirmary’s  nursing, but in practice, it apparently did not, for in 1874 the honorary physicians presented a report which stated that the condition of the nursing department was very unsatisfactory. To remedy matters they suggested:-

1. That the fully qualified nurses be not less than six in number.
 2. That the duty of night nursing should be discharged by the regular nursing staff of the Institution in rotation.(In the past convalescent patients had looked after the sick during the night).
3. That no nurse or probationer should be appointed unless able to read and write and free from any mental or bodily defect.”

 The nurses themselves now began to react strongly against the barrage of criticism that had been directed against them. The Matron, aMiss Goodman, resigned as ‘ unable to cope with any more difficulties;’ and the nurses wrote to the governors complaining that ‘we are much hurt by letters that have appeared in the newspapers reflecting upon us.’ The Board hastily assured them that they were held in high esteem and, as a peace  offering, provided a supper party in their honour as part of the Christmas festivities.
 

In 1901 the Board of Management published the ‘Bye-Laws of the General Infirmary at Chester,’ new regulations concerned mainly with the medical and nursing staff. Even at this date  nurses were still paid little, required to work extremely long hours and subjected to strict discipline. The Bye-laws laid down that: — ‘the salary of each nurse shall commence at £20  per annum with an increase of £1 per annum up to £30. Each nurse shall be entitled to two hours off duty daily. Nurses shall retire to their rooms immediately after prayers at 10-0 p.m. All lights to be out by 11 p.m.’
 

Long Hours - A number of present day Chester Royal Infirmary Sisters can recall,  - in 1956 -  when they were probationers, rising at six and working in the wards from 7 a.m. to 9 p.m. with only two hours  break, then supper and bed at 10 p.m. Permitted off duty time was one half day a week, from 2 p.m. to 9 p.m. and one full day once a month.
 

Nursing is not again referred to in the Infirmary minutes until 1919 when there was a major  development. This was the Nurses’ Registration Act and the formation of a General Nurses Council to supervise the State Examination and registration of nurses which was to become compulsory in 1924. This meant that nursing was finally recognised as a job with professional status, requiring high qualifications and a long training. The Board of Management appointed a well qualified sister tutor to bring the nurses up to state examination standard and a system of training was evolved in co-operation with other hospitals in the area. At the same time they took steps to impeove the status and conditions of work of their nurses. Hours of work were  reduced, salaries were increased and much closer attention was paid to the nurses well being   and comfort than had been the case in the past. In 1922 Chester Royal was officially approved by the General Nursing Council as a training school for nurses. In addition to its own probationers, help was given to Oswestry Cottage Hospital, the Royal Alexandra Hospital, Rhyl, and  Denbighsbire Infirmary in their training schemes. The Haygarth Medal and two silver medals,  the Taylor medical and the Dobie medical were and are still available annually to the three best nurses.

Education - 1956 - In the last six years the training programme and the residential and recreational facilities provided for nurses have been immeasurably improved. Today there is a pre-training school which accepts seventeen year olds and helps them to become used to the hospital atmosphere  before they commence their training proper. The course for the S.R.N. certificate starts with three months in the preliminary training school, then, equipped with a knowledge of elementary nursing, the student nurse is permitted to go into the hospital wards where she spends three months in each. For six weeks in every year she is sent back to school and, during this time, she receives special lectures and coaching to equip her for the hospital and state examinations. Since 1950 ward training has been given in both the Royal Infirmary and the City Hospital as  the former now speciãlises in surgical and the latter in medical cases.
 

Pay - 1956 - In contrast with the £4 a year of 1763, a student nurse of today receives £240—£265 (less £113 for board and lodging), the staff nurse £385—£485 (less £143) and the sister £450—575 (less £143). Hours of work are now 48 a week for day nurses and a 96 ‘hour fortnight for those on night duty. The rigid discipline of the past has been replaced by a sympathetic Understanding  of the need for leisure and recreation and in consequence rules are reduced to a minimum Much thought has been given to the comfort of the nurses in their nurses’ home. This was remodernised in 1955 and today there is central heating, comfortable bedrooms, radios, television and attractive accommodation for entertaining, visitors. Opportunities for a full social life are  numerous, whereas little over twenty years ago they were practically non-existent and the nurse was forced to dedicate her life entirely to the hospital even if this was not her natural inclination.
 

 Nurses who have trained at Chester Royal Infirmary look back on their days there with affection and nostalgia. This is most evident in the success of their flourishing.’ Nurses League which was formed in 1947 ‘ to keep all nurses in touch with their training school and to promote fellowship between past and present members of the nursing staff.’ Once a year former Infirmary  nurses meet together to renew their acquaintance with the hospital and talk over old times and in this way the traditions of the past are handed down from one generation to another and, in  some cases, from mother to daughter for a number of these ex-nurses now meet their own student daughters at the re-union.

The history of Chester Royal Infirmary shows clearly how nursing today has developed from a poorly paid, unwanted job to a highly skilled and desirable profession. The modern nurse enjoys a high status in the community and interesting and rewarding work, and the development of nursing at the Infirmary is one very good example of how enlightened managenent and high ideals have brought about this transformation.
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The Patient.

The lot of a hospital patient at this time was not a happy one. Anaesthetics were unknown until 1842. Hospital fever was rife and hospitals tended to spread infection rather than cure it. In addition to this risk of infection and the pain they had to endure through lack of anaesthesia  patients with weak nerves had a further discomfort at Chester Infirmary for the hospital was in close proximity to the’city gaol and after each assize it was possible to hear the hubbub and  commotion associated with the execution of condemned prisoners. However, despite these  physical and mental tribulations, patients do appear to have received the best medical. and  surgica1 attention available at the time, supplied by humane and devoted men who dedicated  their lives to the..service of the Infirmary.

Although, by our modern standards, many things were neglected in the eighteenth century  hospital food was not one of these and, from the earliest days, the patients’ diet at Chester Infirmary appears to have been plentiful and good. In 1828 the honorary medical officers decided that the meals then provided were too heavy for sick people, consisting of too many ‘huge masses of coarse food,’ and in consequence a new diet table was prepared. Typical menus  were as follows: -

• Breakfast:  Tea or coffee.
• Dinner:     Roast beef with stoved potatoes.
• Supper:     Rice milk or gruel.
• Breakfast:  Milk or milk gruel.
• Dinner:     Boiled beef with mashed potatoes.
• Supper:     Tea, broth or gruel.

Chester Infirmary patients seem to have been well served by the hospital governors for even in the early days thought was given to their comfort. In the 1830 improvements, day rooms were built for the convalescent patients and the psychological benefits of coal fires were combined with the warming properties of central heating.
 

Gifts to the patients were numerous, both from the Board of Management and individual governors: warm dresses were purchased for tbe convalescent patients and in 1867 the Matron was allowed to spend 10/- in buying spelling books and copy books for the use of the patients. This, surely, must be one of the earliest records of a hospital providing an educational service. In 1881 the Dean of Chester proposed that the governors should start a Samaritan Fund giving needy patients some financial assistance when they were discharged from the hospital and this fund is still in existence today. Another fund that was to do a great deal of good was the Yerburgh Fund started in 1895 by Mr. and Mrs. Yerburgh to help incurables. These patients because of the nature of their diseases, could not receive a great deal of help from the Infirmary and the fund was able to provide them with some of the necessities of life which they might otherwise have lacked. This fund too continues to provide help for patients discharged from the Royal Infirmary.
 

By the end of the nineteenth century this humane approach on the part of the governing body, together with the greatly improved nursing services, had changed the Infirmary from a place which was looked on with aversion by the sick, who would only enter it when desperate, to a popular and universally approved institution.

 In 1920 the first Lady Almoner was appointed, but although this was a big step forward from the point of view of the patient’s welfare, the hospital records suggest that, at first, her chief functions were to see that all patiepts were registered and to try to obtain voluntary  payments from patients and their friends. Now, in contrast, she is an indispensable part of the hospital social services for the emphasis of her work is directed entirely towards the welfare of the patients and the solution of their personal problems and she is no longer made into a collector of dues or a records clerk.

Today Chester Royal Infirmary is the kind of hospital any sick person would be happy to  enter. Everything possible is done to make the patients’ stay agreeable and cheerful from both a physical and mental point of view.

There is a flourishing library service run by the Chester City Council and the Women’s Voluntary Service; all beds have radio headphones, and television sets are to be found in both  the children’s ward and the orthopaedic ward. One very novel and progressive idea is a portable telephone which can be plugged in at the patient’s bedside enabling him to ring up his friends  and relatives at home.

In conclusion one can only say that the Hospital Management is always aware that its foremost responsibility is towards the patients and they are never forgotten in its deliberations. Patients at Chester Royal Infirmary receive expert medical attention, first class nursing and an almoning service to look after their welfare.
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Medicine and Surgery.

 The Infirmary is fortunate in still retaining its early medical and surgical records and it is  interesting to note the very long time most of the surgical patients were in hospital. For example in 1761:—

•  Joseph Thomas — Carious bones in foot ... ...  6 months.
• John Davies — Fractured leg   ... ...     ...  5 months.
• Ann Lawrence — Dislocated shoulder   ...  ...  5 months.

The medical complaints most frequently recorded in the 18th century were scrophulous, sore legs or ulcers on the legs, scorbutick or scurvy, dropsy, epilepsy, ague and sore eyes. Bleeding was a treatment frequently used and the weekly board book often deplores the extravagant use of leeches. For example, 9th April 1839, ‘the consumption of leeches being considered very great, ordered that the pupils under the direction of the medical officers be requested whenever possible, to make use of cupping instead.’ For some years yet the stethoscope was a novelty used more for show than diagnosis but cod liver oil was starting to be used by hospitals and in 1885 there is a note that the secretary ordered 30 gallons.

The medical and surgical advances that have been referred to in this chapter are only a few incomplete examples of the many developments that have taken place at Chester Royal Infirmary over the years. but they are typical results of the progressive spirit that exists in the hospital. The Management Committee and medical staff are always looking to the future however, and continually accelerating their rate of progress by means of more modernisation and the introduction of new therapeutic techniques.
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The Hospital Today. (1956)

It has been said that a hospital planned today will be out of date by the time that it is built; that may be an exaggeration, but it is no exaggeration to say that the Royal Infirmary, like many of the other great and ancient voluntary hospitals in the country is, by modern standards, wrongly sited and badly planned. When it was first built the objection to its site was its proximity to the local gaol. That defect has now gone, but in its place has conic the  consequences of the progress of civilization — the interminable noise of the trains which reverberates throughout the Infirmary day and night and the bad access and restricted parking space for motor traffic which visits and leaves the hospital in an ever increasing stream every day and all day.

The fact that it is badly planned by modem standards is by no means the fault of past governors but, conversely, is evidence of the determination of those governors to see that the  Royal Infirmary kept abreast of modern developments. It is safe to assume that when the extensions which were completed in 1917 were planned provision was made for all then known  requirements, but as new techniques and aids in the fight against disease became known the governors were to the forefront in seeing that they were provided for the Royal Infirmary. The use of radium and X-ray therapy and the introduction of orthoptics are two cases in point. Space had to be found for these new departments and the fact that they were provided without any  major extension says much for the ingenuity of the boards of management.

There must, however, be an end to the amount of improvisation that can be done and that point has now been reached. Accommodation in general is very restricted at the Royal Infirmary, and needs augmenting for several different purposes, but the most urgent need is and  has been for many years, a new Out-patient and Casualty department. It is, therefore, fitting that in this bi-centenary year of 1956 the stone of a new department will be laid in the Infirmary field, that same field which was purchased by the governors in 1859 to ‘preserve an area of open ground around the hospital which would not be built on.’ For nearly 100 years that proviso has been honoured but now it must be overridden and if those same governors were with us today it is fairly certain they would concur. The actual completed Outpatient's Department is shown here:-

The new department will bring under one roof all out-patient and casualty services, including such ancillary services as X-ray, Physiotherapy, Orthoptics, and Hearing Aids. It is estimated to cost £150,000 and will probably take three years to complete.

The Royal Infirmary, in company with all other hospitals, was taken over by the State in 1948 under the provisions of the National Health Service Act and with six other hospitals in the area came under the control of the newly formed No. XIII Chester and District Hospital  Management Committee, acting as agents for the Liverpool Regional Hospital Board. The Regional Board’s main initial task was to plan the hospital services for the region so that the best use could be made of existing resources, which resulted in some specialist services being centred at specific hospitals in the region. One was radiotherapy which meant that the radium held at the Royal Infirmary was transferred to the Radium Institute at Liverpool. Radiotherapy  clinics staffed by consultants from the Radium Institute are however still held at the Royal Infirmary.

Another far reaching change was the amalgamation of the Royal Infirmary with the Chester City Hospital to make one general hospital unit, recognised by the General Nursing Council as a training school for the training of nurses for the State Register. Out-patients and all surgical beds are concentrated at the Royal Infirmary and medical, paediatrics, chest, maternity and chronic sick beds at the City Hospital, and by interchanging between the two hospitals the  student nurse gets a thorough and complete training.

Statistics should not find their place in such a human document as this, but the minimum must be quoted to give some indication of the amount of work, now being carried out at the  Royal Infirmary: 40 consultative clinics covering all specialities and involving an annual attendance of some 125,000 are held weekly in the out-patient department; 4,518 patients were  admitted and 4,832 operations carried out during 1955. A staff of 380 of all categories and grades  work within its walls and the gross revenue expenditure for the last financial year was £210,000.

In 1893 Sir Henry Burdett, of whom reference has previously been made, wrote ‘anything more opposed to the best interests of the people than the substitution of state hospitals for the voluntary hospitals as they at present exist cannot be imagined        to set on foot an agitation for their abolition is to enter upon a course the end of which no man can see and is therefore one to be withstood to the death.’ These were brave, defiant words said at the end of the nineteenth century, but not even Burdett could have foreseen the great social revolution which the 20th century was to bring. The Royal Infirmary has lived through two turbulent generations and stands today, 200 years after the first patient entered its doors, a glowing testimony to our  forefathers whose endeavour and foresight established and maintained it. Its days as a noble voluntary medical charity are in the past; much has changed since the first patient was admitted, but the ideals which led to the Infirmary’s establishment—the relief of pain and suffering—have  not changed; they are there today in full measure and will remain so long as there is a Chester Royal Infirmary.