As the Health Service marks its 60th year, Echo Memories looks at hospital provision in the days before the NHS.

IN the July 2007 edition of Medical History, a journal of the Wellcome Trust, is an excellent research paper by Professor Barry Doyle, now of the University of Huddersfield, entitled Competition and Cooperation in Hospital Provision in Middlesbrough 1918 to 1948.

In it, he details the hospitals which were available to the people of Middlesbrough before the creation of the National Health Service, which marks its 60th birthday next week.

Much of what Prof Doyle discovered deserves a much wider audience and so, with his permission and slightly edited, constitutes part of this timely edition of Echo Memories.

To put his research into context, he outlines the decline of public health in the town from its earliest times.

"Middlesbrough was a creation of the 19th Century.

Established in the 1830s as a port for the export of South Durham coal, by the middle of the 1850s coal exports had declined, to be replaced by a booming iron industry based on the discovery of local ore deposits.

"Population growth in the course of the 19th Century was remarkable, and between 1841 and 1881, the population increased more than tenfold - so that by the early 20th Century the village of less than 50 in 1801 had become a town of 100,000 inhabitants.

"The demand for housing in the 19th Century led to rapidly declining standards, as courts and yards filled in the spaces behind the broad streets of the original plan. Such conditions encouraged the spread of contagious diseases, including cholera, typhoid, scarlet fever and tuberculosis.

"Yet health was also increasingly threatened by other aspects of the environment.

Damp was a major characteristic of the housing, exacerbated in many parts of the town by the tendency to flooding.

"Smoke from ironworks combined with heavily-hanging moist air to produce smog for half the year, which was believed to have contributed to the prevalence of the infectious Middlesbrough Pneumonia."

PROF Doyle also refers to countless dangerous working practices to which men, women and children were exposed and to the dangers of childbirth and childhood illness. Before 1948, people had to pay for medical care, although free treatment could sometimes be had at teaching and charity hospitals.

Health insurance, where it existed from the likes of Friendly Societies, was in its infancy although a big step forward came in 1911 with the passing of David Lloyd Georges National Insurance Act.

As a result, a small amount of money was deducted at source from some people's wages and to this were added contributions from their employers and the Government.

The accumulated payments were used in part to provide health care, but not always the drugs prescribed by the doctor, and not everyone was included in the scheme.

When the National Health Service, which had sprung from the Beveridge Report of 1942, began operation in 1948 under the wing of Health and Housing Minister Aneurin Bevan, Middlesbrough handed over to it nine hospitals which included, reports Doyle, "acute, chronic, maternity, infectious disease and mental health institutions, " but that "the buildings varied in quality, were dispersed across a wide geographical area, a number were too small and there were problems with staff skill levels and equipment."

Writing of hospital provision in the town at an earlier date, Prof Doyle explains that "by 1918, Middlesbrough had six hospitals: two voluntary institutions - North Ormesby Hospital of 1861 and the North Riding Infirmary of 1864 - the Poor Law Infirmary of 1878, which changed its name to Holgate in 1915, and its separate children's hospital and the two municipal hospitals for infectious diseases, one built in West Lane, in 1872, the other at Hemlington, in 1895.

"During the next 20 years, all of these hospitals were enlarged and upgraded while three new institutions were added - a municipal maternity hospital in 1920, a voluntary bequest general practitioners' hospital in 1926 and a tuberculosis sanatorium between 1932 and 1945.

"By 1935, Middlesbrough had about 600 general beds, as well as some 250 for infectious diseases, including various forms of tuberculosis provision, 80 for children and 50 for maternity.

"As with many larger county boroughs in 1918, this hospital provision was in the hands of the voluntary sector, the Poor Law and the borough council.

The voluntary sector was divided between three separate providers who competed for patients, prestige and, most importantly, funding."

The allocation of patients to hospital beds was something of a lottery. By the middle of the Thirties, the North Riding Infirmary and North Ormesby Hospital accepted mainly working class patients, and their families, from the 70,000 across Teesside who made contributions to the hospitals from their wages.

Carter Bequest, staffed by general practitioners, accepted mainly private patients. The workhouse, built in the 1870s, had a separate infirmary, with more than 100 beds for men, women and some maternity cases. There was no other hospital maternity provision in Middlesbrough until 1920.

By the early 20th Century, this workhouse hospital, the Poor Law Infirmary, had changed its name to the Holgate and grew into an effective general hospital with a separate children's hospital called Broomlands.

Over the years, various Middlesbrough hospitals have merged or been closed and others have taken their place.

North Ormesby Hospital started life off Corporation Road, in Dundas Mews, but became a purpose-built hospital in North Ormesby, in May 1861.

It closed 120 years later.

The North Riding Infirmary and Middlesbrough General are no more, their places taken by extensions to the 1,010-bed James Cook University Hospital, which opened in 1980.

It was built in the grounds of St Luke's Hospital, in Marton Road, which had been opened by the Mayor of Middlesbrough, in June 1898. It used to have its own firefighters and a shoemaker's workshop.

West Lane Hospital, opened in 1872 in a rural setting, was once known as the Fever Hospital, as its speciality was the treatment of smallpox, typhoid and scarlet fever. Its tuberculosis ward opened in 1912.

There were other isolation hospitals at Eston Jetty and Hemlington, which opened in 1905 and finally closed in 1989.

West Lane Hospital for Infectious Diseases, to use its full name, was built at a cost of £500 following a serious outbreak of smallpox in 1871.

To cope with about 500 sufferers across the area, temporary huts were put up in the grounds of the hospital.

Twenty years later, there were more than 750 incidents of scarlet fever, enteric fever and smallpox. Two years after that, the number of cases topped 800.

The situation became so serous that the chairman of the Tees Port Sanitary Authority, Alderman Sadler, conceived the idea of a temporary floating hospital on the Tees.

Shipbuilder Head Wrightson was commissioned to build such a ship to hold 30 beds. Called the Osprey, it cost £800 and was not destroyed until 1929.

Echo Memories would love to hear readers' memories of Middlesbrough's old hospitals and of any stays in isolation hospitals where such visitors as were allowed had to speak to.