Hull Royal Infirmary, United Kingdom (Winter 2016)
The General Infirmary at Leeds: 1771
“The best hospitals in the world are not those which merely use new knowledge, but those which create it.”
attributed to Sir George Pickering (1960)
Modern hospitals originated in fourth-century Byzantium. They succeed not because they housed the grandest, lavishly equipped buildings, but because of the excellence and dedication of their staff. Original research, inspiring clinical practices, and teaching often emerged from dilapidated buildings. University College London’s famous Anatomy Department and the Royal National Orthopaedic Hospital began in Nissen huts, prefabricated corrugated steel structures widely used during World War II.
The General Infirmary at Leeds (LGI) was one of a handful of independent, voluntary hospitals, relying on philanthropy. Between 1710 and 1740, London’s Guy’s and Westminster, the Edinburgh Royal Infirmary, and Cambridge’s Addenbrooke’s hospital opened. A temporary Leeds Infirmary was opened on 2 October 1767 “for the relief of the sick and hurt poor within this parish” in a private house of a Mr Andrew Wilson.
What prompted the creation of new hospitals? There were three main influences: the growing social conscience of the 18th century enlightenment, the needs of local surgeons — such as William Hey (1736–1819) in Leeds — for a hospital where they could operate, and the needs of wealthy factory and mill owners for an institution which could treat their sick and injured workmen to get them back to work quickly.1
In March I77I a new infirmary, built by John Carr in Infirmary Street (Fig 1), was opened for twenty -seven inpatients. Thirteen years later John Howard, the Quaker, prison and hospital reformer commented:
This is one of the best hospitals in the kingdom. In the wards, which are fifteen feet eight inches high, there is great attention to cleanliness … Many are here cured of compound fractures, who would lose their limbs in the unventilated and offensive wards of some other hospitals.
Because of the growth of the city during the Industrial Revolution and increasing numbers of patients, the Infirmary was extended between 1782 and 1792. This culminated in a new site on Great George Street in 1868, where it remains today (Fig 1). It employed the famous architect, George Gilbert Scott, R.A. Encouraged by his acclaimed London St. Pancras Station, Scott designed a similar pseudo–Gothic Infirmary. The central hall had a railway–station roof. Before constructing the plans, Scott with the Infirmary’s physician, Charles Chadwick, sought ideas from hospitals in Bruges, Brussels, and Paris. They adopted the pavilion plan commended by Florence Nightingale. It featured modern ventilation, plentiful baths, lavatories, and hydraulic hoists to assist the nurses.
The Prince of Wales (later Edward VII) opened the new hospital on 19 May, 1869. It cost £100,000 and quickly became fully functional. The founding physicians and surgeons all worked at the LGI.
| Leeds Infirmary Plaque, 1869.
From Leodis, a photographic archive of Leeds.
The adjacent Leeds School of Medicine in Thoresby Place was founded in 1831, one of ten provincial medical schools established between 1824 and 1834. It became the university’s Faculty of Medicine.
The Grade I listed Infirmary remains one of the Victorian icons of Leeds, but in the 20thcentury, it expanded with new wings in strangely divergent architectural styles. They included the Brotherton Wing 1940, Martin and Wellcome Wings in the 1960s, and the Clarendon Wing in 1983. The Jubilee Wing opened in 1998 — the 50th anniversary of the National Health Service.
The first apothecaries were unlicensed. Membership of the Royal College of Surgeons was instituted in 1800, and the Apothecaries Act of 1815 ordered the license examination.2Hospitals for the sick became centers of research and student training. Current politically correct, jargon–ridden appraisals of what is a good hospital3 would be unintelligible to these hospital founders. Until the mid 20th century many Leeds consultants hailed from local areas, carrying the characteristic Yorkshire grittiness and no–nonsense approach to patients, often blended with erudite learning acquired from training at other British and foreign medical schools. Their attitudes reflected profound humane vocation and tireless dedication with disregard for the rigid hours and structured methods which dog much of 21st century practice. Since most consultants had unsalaried honorary appointments, they earned their living in private practice. Consequently, high standards of care were achieved by market demands; the indifferent clinician would fail and his hospital position would be jeopardized.
When we explore the practices of doctors of past generations, we can only wonder that despite their primitive factual knowledge, their ideas and inventiveness were awe-inspiring. Several LGI doctors earned wide acclaim. William Hey F.R.S. (1736–1819) was a founder, later chief surgeon of LGI. Hey was an innovative anatomist and surgeon. His friend Joseph Priestley, described him as “the only person in Leeds who gave any attention to my experiments.” The blue plaque at Hey’s house in Albion Place records: “For 50 years Hey was in the front rank of British surgeons.” Sir Arthur Mayo–Robson (1853–1933) ranked “among the greatest surgeons of all time” according to Lord Moynihan (BMJ 1933:2:762). He established removal of loose cartilages in “internal derangement of the knee,” and he described two eponymous signs in pancreatitis.
The much-decorated Lord Berkeley Moynihan (1865 – 1936) was described as our most illustrious surgical son. In 1925, he became the first professor of clinical surgery in Leeds, and a fellow of the American College of Surgeons. He introduced surgical rubber gloves, and prized “caressing the tissues” rather than speed in surgery. In Diseases of the Stomach, written with Mayo Robson in 1901, he was the first to make duodenal ulcers widely known. Abdominal Operations (1905) was an indispensable text for two decades. Moynihan was twice President of the Royal College of Surgeons of England (RCSE): the first from outside London. He was made Baron in 1929, the only surgeon to receive that honour after Joseph Lister.
Arthur Fergusson McGill (1846 – 1890) “was perhaps the greatest genius in surgery I have ever known,” reported Moynihan, (Obituary, BMJ 1933:2:761.) He was the first surgeon to carry out a suprapubic prostatectomy in 1887, assisted by his student, Moynihan.
Joseph F. Dobson (1874–1934) also hailed from Leeds. He succeeded Moynihan as Professor of Surgery. He was twice Arris and Gale lecturer at the RCS; in 1907, his subject was the lymphatic system of the alimentary canal, and in 1920–21, kidney function in enlargement of the prostate gland. He became a pioneer genito-urinary surgeon, both a resourceful and brilliant teacher.4
Physicians too acquired fame and distinction. Sir James Crichton–Browne (1840–1938)5 of the closely linked West Riding Pauper Lunatic Asylum6 started one of the first British clinical teaching courses for Leeds students. In 1873-4, under Crichton – Browne, Sir David Ferrier’s (1843–1928) classical work on cerebral localisation established one of the most productive centers of brain research in the world:
… the modern study of disordered brain function in Britain has its origins in Wakefield, Yorkshire. This was where James Crichton–Browne turned the West Riding Pauper Lunatic Asylum into a research institute that attracted, amongst others: Sir David Ferrier and John Hughlings Jackson.7
Sir Thomas Clifford Allbutt FRS, (1836 – 1925) was Physician at the LGI. (1861- 1889). He invented the prototype short–stemmed thermometer. In 1892, he became Regius Professor of Physic at Cambridge, where he edited his System of Medicine, “the doctor’s bible.” He introduced Helmholtz’s ophthalmoscope to the wards.8 A classical scholar, he was author of Greek Medicine in Rome and other Historical Essays (1921). George Eliot drew her character of Lydgate in Middlemarch from Allbutt, whom she knew in his Yorkshire days.
More recently Leeds spawned Hugh Garland (1903 – 1967), a flamboyant, inspirational neurologist and teacher who gave the original account of diabetic amyotrophy; JT. Ingram (1899 – 1972) was the supreme dermatologist of his day; and Geoffrey Wooler (1911–2010), cardiac surgeon,9 in 1955 used one of the first heart-lung machines and invented an annuloplasty for mitral reflux (the “Woolerplasty”). John Cedric Goligher (1912-1998) was regarded worldwide as the pre-eminent colon and rectal master surgeon of his time.10 His Surgery of the Anus, Rectum and Colon flourished through five editions.
Collectively, Leeds medical men truly did “not merely use new knowledge, but created it.” Sir Christopher Booth cogently observed: “Provincial scientists and hospitals [such as the LGI] should not be dismissed as “mere provincials” for during the 18th century it was provincials who made some of the major contributions of their day.”11 Lind’s conquest of scurvy, Priestley’s discovery of oxygen, Withering’s digitalis, and Jenner’s smallpox vaccination, were all achievements of “provincials.”
During the 19th and 20th centuries, the General Infirmary at Leeds was a vibrant, progressive teaching hospital which boasted enquiring and gifted physicians and surgeons to establish its major role in British Medicine.
- Anning ST. The General Infirmary at Leeds, vol.i, The First Hundred Years, 1767–1869 Edinburgh and London, E. & S. Livingstone, 1963.
- Anning ST. The Apothecaries of The General Infirmary At Leeds. Med Hist. 1961; 5(3): 221–238.
- Mannion R, Davies HTO, Marshall MN. Cultural characteristics of “high” and “low” performing hospitals. Journal of Health Organization and Management 2005;19:431–439
- Royal College of Surgeons: Plarr’s Lives of the Fellows Online .http://livesonline.rcseng.ac.uk/biogs/E003981b.htm
- Pearce JMS. Sir James Crichton––Browne 1840–1938. J. Neurology, Neurosurgery & Psychiatry 2003;74:949
- Pearce J.M.S., ‘The West Riding Lunatic Asylum’, J. Neurology, Neurosurgery & Psychiatry, 2003;74:1141.
- Compston A. From the archives. (On the weight of the brain and its component parts in the insane. By J. Crichton–Browne, MD, FRSE. Brain 2007;130:599–601
- Pearce JMS. Sir Thomas Clifford Allbutt . J Neurol Neurosurg Psychiatry 2003; 74: 1443.
- The British Cardiovascular Society, 12 May, 2008.
- Campos FG, Nahas SC, Cecconello I. The life of John Cedric Goligher (1912-1998) revisited. J Med Biogr. 2014 Jun 26. pii: 0967772014532896. [Epub ahead of print]
- Booth CC. John Haygarth, FRS (1740–1827): A Physician of the Enlightenment, American Philosophical Society, 2005. p.1
MD, FRCP (London) is emeritus consultant neurologist in the Department of Neurology at the Hull Royal Infirmary, England. All correspondence to: 304 Beverley Road, Anlaby, East Yorkshire, HU10 7BG, England, or to my email address [jms[dot]pearce[at]me.com].