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Gateways to death

Florence Nightingale assessing a ward at the military hospital in Scutari.

Florence Nightingale assessing a ward at the military hospital in Scutari.

Credits:Wellcome Library, London.

In the 1700s hospitals were regarded as places where people went to die. Some even suggested that hospitals positively did harm. Very often patients died from infectious diseases, conditions they did not have at the time of admission. The dangers were confirmed by the high rates of mortality at the Hotel Dieu in Paris, where 1 in 5 patients died.

As a result, some critics of institutional medicine suggested that the hospital not only did no good, but that it positively did harm. During John Howard’s tour of European hospitals in the 1770s and 1780s, he found many which deserved such harsh criticism. Florence Nightingale similarly criticised hospitals a century later. According to Nightingale, hospitals were ‘to do the sick no harm’. At the time Nightingale was writing, however, it was already recognised that much of this criticism was based on a poor understanding, or even a misuse, of statistics.

Not all hospitals were as bad as the Hotel Dieu. Mortality at most English provincial hospitals rarely exceeded 10%. The highest death rates were associated with children’s hospitals, where fevers were common. The lowest were associated with skin and venereal hospitals, where many chronic cases came for treatment, but rarely died. Voluntary hospitals also appeared safer than workhouse infirmaries, which were large and often overcrowded. Regionally, hospitals in London and other European capitals recorded the highest death rates. This is hardly surprising, as these institutions took only the most serious cases.

More recently, fears of entering hospital have again been articulated by the public following an increase in MRSA and other superbug infections. In particular, patients are fearful of contracting hospital infections that cannot be treated with antibiotics. As a result, hospitals are once again being described by some as ‘gateways to death’.


Related links

Techniques and Technologies:


J Woodward, To Do The Sick No Harm: A Study of the British Voluntary Hospital System to 1875 (London: Routledge & Keegan Paul, 1974)


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