ROYAL INFIRMARY
OF EDINBURGH
The Infirmary
The Royal Infirmary of Edinburgh was founded in 1729. This was part of a wider movement which took place across Britain during the 1700s, in which 42 voluntary hospitals were established in England and Scotland by groups of charitable individuals, sometimes with the active support of local authorities.
The voluntary element of these institutions relates to the fact that they were funded, in large part, by voluntary donations from individuals, parishes and corporations, with additional revenue often supplied from other sources, such as church collections, charity theatre performances and bequests.
Definition:
There is no real difference between a hospital and an infirmary. The word ‘hospital’, prior to 1700, was used in a lot of different ways and a city hospital was often more akin to an almshouse, workhouse or boarding school than a hospital in the twenty first century sense. But in the 1700s whether a new inpatient medical facility was given the title ‘hospital’ or ‘infirmary’ was fairly arbitrary and often depended on whether a town or city already had an institution called a ‘hospital’ in it (in which case, to avoid confusion, the title ‘infirmary’ was usually used).
Finances
The Royal College of Physicians of Edinburgh was instrumental in the infirmary’s foundation – by establishing a public appeal for funds which was advertised in the press and approaching individuals and bodies such as the General Assembly of the Church of Scotland to solicit donations.
While the infirmary accepted donations, it was not run on the same subscription model which English infirmaries adopted, where patients had to apply to donors for recommendations, and as a result only patients recommended by financial backers of the infirmary were admitted. The subscription model was only adopted in Edinburgh in 1796.
Unusually, the Edinburgh infirmary had fee-paying wards alongside its wards for the poor. These were designated for servants, soldiers and sailors. Funds were also generated by the sale of attendance tickets to medical students attached to the University of Edinburgh. But without a subscription model of financing, the Edinburgh infirmary was unusually reliant on its financial investments, including slave plantations. In the mid-1700s Dr Archibald Kerr (who was not a Fellow of the Royal College of Physicians of Edinburgh) left an estate in Jamaica to the infirmary. This estate included 25 enslaved people. The infirmary then leased these premises to various individuals over the following decades.
Patient admissions
As a result of the subscription model, most of the people on the management board of English infirmaries were usually donors, while key management positions on the Edinburgh infirmary’s board were held by physicians. Freedom from control by lay management enabled the Edinburgh infirmary to admit individuals who were usually excluded from English infirmaries for moralistic reasons, including venereal patients and unmarried pregnant women.
Patients were only admitted to the Edinburgh infirmary on recommendation by an individual connected with the infirmary. This was standard practice in infirmaries during this period. This meant that while, in theory, the infirmary was open to the sick poor - they needed to be well connected, or employed by, people of high status. As a result, the patients of the infirmary were disproportionately working-age men, with much lower rates of children, women and the elderly.
In addition, the focus by infirmaries, including the Edinburgh infirmary, on the importance of a rapid turnover of patients left those with long-term conditions largely excluded from infirmary care.
