Two centuries of caring for the sick

Glasgow Royal Infirmary University NHS Trust, #19.95 (pp 296)

THE story of the Royal Infirmary, far more than that of any other

hospital, is part of the story of Glasgow. Founded at a time of

re-awakening philanthropic instincts, this ''house of refuge and

consolation for the poor'' assumed an increasingly important role as the

city became afflicted by the physical and social ills accompanying rapid

industrialisation. In the post-industrial age, too, its catchment area

has had more than its share of deprivation. Even after the opening of

district health centres many East-enders preferred to make their way to

the Royal's emergency department.

What emerges strikingly from this book is the broadly based nature of

the support for the institution that began life 200 years ago this week.

Tobacco Lords and and business leaders, including David Dale, were

prominent among its backers, but there was a wider civic involvement

from the start. The early board of management included representatives

not only of the town council, Glasgow University, and the Faculty of

Physicians and Surgeons but also of trade organisations such as the

Journeymen Printers.

Though the infirmary, as a voluntary hospital, was funded by private

subscription, the net was spread widely -- contributions from factory

employees became an important source of funding. Even so the voluntary

principle proved inadequate in the face of Glasgow's appalling epidemics

and from 1818 fever patients were admitted on the basis of need.

The spur was fear as much as philanthropy -- typhus, an infirmary

report noted, was always ready to break out from the crowded alleys and

''contaminate the whole town'' -- but the effect was to make the

infirmary what the book describes as ''a chief source of public health

provision for the city of Glasgow in one of the most trying times in its

history.'' It has to be remembered that Glasgow did not acquire a

medical officer of health and a permanent municipal fever hospital until

the 1860s.

The infirmary's influence was not always benign. To preserve its

medical monopoly it opposed, for example, the establishment of a

children's hospital. This aspect of its history is not discussed in the

book, which nevertheless does justice to the infirmary's extraordinary

record of conflict. Lister clashed with the board of management; the

formidable Rebecca Strong, the infirmary's most famous matron, battled

on behalf of her nursing staff. The university and the Faculty of

Physicians and Surgeons contended for the control of clinical teaching.

More recently, the hospital authorities were at odds first with the

Western Regional Hospital Board, who shilly-shallied over the

infirmary's development plan, and, after the 1974 NHS reforms, with the

Greater Glasgow Health Board.

The GGHB emerges badly from this account. It ''did not seem to grasp

the urgency of the situation'' when the Royal pleaded for the upgrading

of the emergency services, and on another occasion would not provide a

''clear statement of board strategy, or even tactics.''

When the GGHB faced cutbacks under the Scottish health revenue

equalisation scheme ''there was no consultation, but, instead,

integration between the Royal and Stobhill and other hospitals was

summarily cut short at the end of 1989, paving the way, it was hoped,

for self-governing hospital trusts.

As the book notes, the Royal assumed trust status with misgivings

about the concept of rationalising services on the basis of cost rather

than need. An anonymous and somewhat anodyne postscript entitled ''Trust

in the Future'' speaks of ''opportunities'' as well as ''challenges''

but cannot remove the impression that trust status, with its emphasis on

market values, means, not only an erosion of basic NHS principles but

also a sad narrowing of the humanitarian ideals on which the infirmary

was founded.

This is a more comprehensive and systematic history than earlier

accounts (though specialists may regret that the footnotes stop short of

the end of the book). It includes some lively anecdotal material, is

excellently illustrated, and should be of interest to everyone who wants

to know more about the infirmary's special relationship with the city.