Financial pressure. Admittance quotas. Affordable patients
Victorian Bournemouth (72) analyses aspects of the Sanatorium’s admittance policies during the town’s second period. In concept, the institution had aimed to provide care to people unable to pay. It operated under such financial strain, however, that managers appear to have admitted patients who could contribute to their care, thereby altering its social mission.
Victorian Bournemouth (72): Cost of ambition
Hostage to fortune
Constant fund-raising had brought the Sanatorium from concept to building, but it never seems to have had a solid capital base. The admirable social strategy of dedicating the hospital to poor people thus did not have an effective financial counterpart. Already, in its first winter, the superintendent advertised for paying convalescents to choose the Sanatorium over private venues. The next year, thoughts had turned to placing the Sanatorium ‘in an almost self-supporting position’. This consisted of reserving some rooms for paying patients while increasing the room count to maintain the number of non-paying convalescents. The resort’s influencers and decision makers could not allow the hospital’s bankruptcy or removal elsewhere. Already, it formed an important part of the town’s reputation and, hence, commercial appeal. In this sense, therefore, the institution had made the town a hostage to fortune. For the short term, therefore, charity funding had to continue.
In 1860, the Sanatorium’s board of governors met, chaired by the Reverend A. M. Bennett. The financial position had improved, but still required subsidy from trustees of a ‘special fund’. Nevertheless, the meeting decided that ‘fresh vigour will be infused into the affairs of the institution’. To do so, they created a management committee and a subcommittee for finance. This appeared to lead to a two-level pricing structure, which charged ‘educated’ professionals ‘with limited incomes’ three times more than an ‘artisan labourer’. This may have helped, but by 1865 the Reverend Bennett announced fund-raising plans to attach a chapel to the Sanatorium. Patient queues also led to building more rooms. The enormous new load brought by these ambitions drew private support as well as the Queen’s donation of £100. Nevertheless, by 1871, a detailed letter appeared in the press portraying the Sanatorium as a financial victim of its own success.
Victorian Bournemouth (72): patients
At their 1860 board meeting, governors heard that, since 1855, the Sanatorium had admitted 252 patients, although 46 had arrived in the last six months. According to the 1870 AGM, patient numbers had risen to 151 in the previous year. Another reference reported 42 patients inside with 55 on the waiting list. These figures match the statement made in 1860 that a patient stayed for around four months. According to the 1861 census, the Sanatorium had 21 patients on that night, whereas ten years later, its list numbered 34. Thus, the official figures reported in the press fit with the situation found in the census listings to some extent. A report for 1871 referred to a plan to increase the bed count from 42 to 62. The Sanatorium, therefore, experienced success both in increasing its patient capacity and in the extent to which it had to manage a waiting list.
Evidence suggests that the Sanatorium admittance staff applied various quotas. At a fundamental level, given its targeting towards people too poor to afford proper care, staff would have applied social classification to potential patients. The occupations listed by the census cover labouring and middling people, but nobody living on unearned incomes. Both census listings showed an equal intake across genders. Although their ages averaged around twenty-five, patients included children, teenagers, young adults, and people in middle-life. Quotas seemed to have extended to geography. Press reports emphasised the Sanatorium’s national position. In 1870, patients from twenty counties attended. Origin and contemporary location need not have matched at the time of medical need. Nevertheless, birthplace data in the census corresponds to this claim. Hence, the Sanatorium appeared to have remained close to its intended purpose of restriction by social type, but that aside, patients of a wide variety gained admission.
Victorian Bournemouth (72): more on social profiles
Artisans and middling people
The occupations listed in each census provide insights for patients’ social profiles. Although servants featured amongst the women, apart from a butler only one male had this occupation. Furthermore, only a single labourer and a hawker belong to the unskilled social levels. This may relate to inabilities to afford initial medical consultation or perhaps the closed nature of some rural communities. For the most part, the males had artisan occupations, but also included soldiers and a policeman. The latter and one soldier had reached the rank of sergeant, having received promotion. Thus, the Sanatorium did not at this stage appear to admit patients from the poorest social levels. Hence, the quota system, may have included social profiling, based perhaps on the apparent need for patients to contribute towards their treatment. The Sanatorium’s uncertain financial foundations, therefore, may have tilted it away from patients at the poorest levels.
Sometimes, patient identification permits further analysis of their fathers’ occupations. This applies to only to a few of the 1861 patients, but about half of those in 1871. Most of the traceable fathers seemed to have worked as artisans or retailers, several achieving apparent success. Emily Bull’s father kept a grocery, but also served as alderman. Ebenezer West’s father, a London bookbinder, employed 80+ people, several of his identified bindings surviving today. William Brittain, a bank clerk, grew up the son of a master draper, employing nineteen people. Maria Hyde’s father, a plumber and glazier, served as parish clerk, also collecting rates. Only a handful of unskilled paternal jobs occurred: two farm workers, a labourer, a gardener, and a servant. Just one had the status of pauper. Thus, it seems, that as suggested by each census, the Sanatorium admitted patients from artisan or even middling households, but not lower.
Hence, while it may have launched with the intention of admitting patients incapable of paying for their treatment, the Sanatorium’s low capital base may have diluted this objective. Social analysis of patients listed by the census in 1861 and 1871 suggests that the majority came from backgrounds able to contribute towards payment. Financial reality, therefore, tempered social enthusiasm.