|King James VI Hospital, Perth|
My daughter is currently suffering from inflammation of her throat and abdominal glands and something inside her that the intestine wraps around which is causing the stomach cramps as well as scorching temperature! Thankfully, kids Neurofen, clean water and Disney XD are speeding her recovery but it got me thinking more of healthcare, or lack of, in times gone by.
Disease and Filth
If you look enough into your family tree, you'll soon come across death and disease no matter what your families social standing was. Tuberculosis, typhus, smallpox and palsy were all considered diseases associated with filthy, cramped and poor conditions. It is certainly true that the growing urban centres of Glasgow, Dundee and Edinburgh in the early 19th Century were ideal conditions to spread disease and invariably did. With a poor water supply, little sewerage and a poor quality of life it is not difficult to understand how disease stalked the streets and apparently plucked the lives of the poor off at will. Perth, by comparison got off slightly lightly. The population increase of Perth in the 19th Century was lower than the national average (the population doubled as a pose to the British average of other towns and cities that quadrupled) and the city gained a clean water supply in 1829; by comparison, Glasgow's water supply was not fit for purpose until it was allowed to draw water from Loch Katrine in 1855 at the cost of £1.5 million. Certainly the water supply would have helped Perth during the cholera outbreak of 1832-33, which claimed 148 lives compared to the deadlier two outbreaks in Glasgow.
Occupational DangersConditions were not the only contributing factor, however. To compare Perth to Glasgow is a little disingenuous as the industries they supported were entirely different. Whereas Perth was concerned with Dye Works, Bleach Fields, Weaving and Agriculture - areas such as Glasgow and Stirling would attract many miners and heavy industry such as dock workers. For instance, a collier could expect to live, on average, 34 years as a pose to a factory worker who would enjoy over 51 years of hard work! Although hard work, a Factory did not present the same exposure to fumes, chocking dust and danger. Whilst the countryside might be a leaner, meaner existence as people battled the vagaries of poor and good harvests; the fact that populations were more widely spread meant rural populations self quarantined themselves in times of epidemic. This was a change from the 1600's when troop movements during the Civil War ensured the spread of plague throughout the country- as a local example, there is an account of a landowner appealing to have taxes lowered and to be exempt from military draft on his lands as the population of Methven (west of Perth) had been reduced to just 6 people who themselves continued to suffer from plague for a year (1645-1646).
Access to cures and treatment fell into three areas during the 19th Century. Poor Relief, Medical Schools or Doctors. If you were destitute, you could be cared for under Poor relief which, until legislation for health was passed in 1889, was administered on a Parish Church or Philanthropic basis. It was haphazard and subject to the same pressures of costs we see today; whilst now we are concerned with mixed sex wards, then the concern was the fact that those suffering skin diseases and respiratory infections all shared the same accommodation and toilet facilities! It was not at all uncommon for the healthcare of the poor to be little more than providing a place for them to die. As an example, removing tumours was often done in the patients own bed or on a table right up to the 1870's as there was not the funds for dedicated operating theatres!
Your next level of care was the medical schools that would take you into their care if you had a "line" from a subscriber to the establishment. These establishments were top class in terms of the equipment and staff but were supported by donations, wills and subscription so were only available to those who could pay- no such thing as free health care and certainly no NHS. Working life gave you an income but everything had it's price- much like the American system today. Interestingly, if you were an apprentice or servant you were not allowed access to these establishments as your employer was fully expected to cover the costs of your treatment so you certainly wouldn't want to annoy the boss! Similarly, you could not attend if you were pregnant or suffering an incurable disease. Funeral costs were not covered which were the concern of your sponsor and you only had 40 days to get better! Your sponsor had to really care for you or be pretty convinced you'd get better quickly!
Then, of course, as an affluent individual you could call on the doctor to attend to you or your family. Not so good, however, when you consider that in Glasgow there was 1 doctor per 20,000 head of population - by this time, Glasgow was home to just under a million souls! During the 1800's, Doctors were even divided on what caused infections with some believing it was caused by the atmosphere with others believing it was caused by filth and contact.
Motivation to Improve
It wasn't until Cholera hit Scotland and Britain as a whole that health improvement was taken seriously. Until this time, those with the power and money to improve conditions did not have the will to do so - disease was looked upon as a curse on the filthy, unclean and morally corrupt poor which could be kept at arms length. Cholera was different as it had no respect for class, money or standing. Everyone from factory workers to Prime Ministers were infected and the survival rate could be as bad as 50/50. Improvement of public health suddenly became important with investment in sewerage, public baths and healthcare - much of which we enjoy today is based upon. As the 19th Century came to a close, however, conditions had not massively improved with treatment conditions and availability in Scotland at best hit and miss or, at worse, completely missing!
But hey, at least it was now illegal to water down milk and whiskey with untreated water as was often the case! Really, it's a wonder anyone survived at all!
Care Now - Don't Drop the Ball!
So, after visiting the Doctor free of charges (my father pointed out that in his native Ireland, it costs in the region of €20 to even go to a doctors surgery!) my daughter is fine. I forget the latin but she has inflamed glands and a fan shaped organ that the intestine sits on is probably inflamed also which is giving her the stomach cramps. She should be fine by the end of the week. As an aside, she has to take weekly medication on the account of having no Thyroid gland (all the medical staff locally have heard of her, the little rarity that she is!) and we don't have to pay for her prescription, saving us a lot of money. As it is a congenital condition, she would not have to pay for it anyway but no prescriptions carry a charge any more in Scotland. Whilst this is an excellent ideal I am yet to meet a pharmacist or medical professional that believes it is a sustainable idea whilst they watch other parts of our National Health Service struggle to cope.
As history has shown us, it's extremely tricky to balance the needs of a varied population's health and the financial pressures that go with it. The nucleus of ideas in the 19th century that were built on to emerge as the NHS in the 20th Century should not be wasted as no-one would want to see a return to the conditions of our ancestors. Already the move is towards centralised, mass care. Perth Royal Infirmary can no longer care for children after 10pm at night, requiring them to be transported to Ninewells Hospital in Dundee and Perth is reduced to a midwife led birth unit with no specialist cover. With fuel costs on the rise and a contraction of service provision to major towns and cities, will we again see crowded population centres as the engine rooms of disease in the UK?