7 ways Liverpool was key to improvements in health care



As the NHS turns 70, we look at how and why Liverpool was a catalyst for change when it came to public health and how it continues to make a difference in health care today.

Liverpool Infirmary
Infirmary, Liverpool (credit: Wellcome Library, London)

In the 19th century, Liverpool was the second largest port and commercial centre in the UK. It became a vibrant city attracting many people to its shores. But with the introduction of seafarers and immigrants came infections such as tuberculosis, typhus and cholera. With many thousands of Liverpool’s inhabitants crowded into airless cellars and small squalid rooms, these infections quickly spread among the poverty stricken. Further decline in conditions in the city followed the influx of Irish fleeing the Great Potato Famine. The absence of running water and sanitation created significant health problems and medical interventions became necessary when vulnerable people started dying in huge numbers.

Here are just some of Liverpool’s pioneering developments that contributed towards improving health care across the nation. The people behind the innovations strived to improve the lives of the sick and vulnerable often having to challenge the conventions of their day and risk ostracisation by the medical establishment.

Dr Duncan1. Improving sanitation and living conditions for the poor

If you’ve spent any time at Liverpool’s famous Blue Angel nightclub you might have noticed a blue plaque on the building – it states that the nightclub was the birthplace of William Henry Duncan. Dr Duncan was appointed the first Medical Officer of Health in the country in 1847. Able to see the relationship between the health of the poor and their unsanitary living conditions, he pioneered a programme of street cleaning, improved water supplies and sewer building that helped the city combat cholera and other diseases. Along with the commemorative building plaque, Duncan also has a pub named after him in the city, which is actually pretty fitting considering back then it was safer to drink beer than water.

2. Making waves in radiology

The first x-ray department in the country was established in Liverpool’s Royal Southern Hospital with the first x-ray of a patient taking place in 1895. Charles Thurston Holland was one of the key figures in establishing the specialty of radiology in Liverpool. In 1896 he was made the medical officer in charge of the radiology department at the hospital. Charles became known for extending the scope of radio-diagnosis and introduced the use of radio waves as treatment for lupus. He transferred to the Royal Liverpool Hospital some years later to work alongside Charles Woods, a technician who lost both his hands and forearms to radiation burns before dying from radiation-induced carcinoma of the nose and face.

3. Paving the way in orthopaedic surgery

Up until the late 1800s fractures and joint disease were treated crudely by general surgeons and often resulted in limb shortening, gross deformity or amputation. Hugh Owen Thomas changed all this by inventing splints, among many other medical innovations. Known as the Thomas Splints, they could be applied to a fractured femur to provide stability and prevent infection. He set up a workshop where a blacksmith and leather workers created the splints which came to revolutionise the management of bone and joint disease. Although he was not fully appreciated in his own lifetime, his nephew Robert Jones, an orthopaedic surgeon himself, applied his uncle’s splints during the First World War – reducing the mortality of compound fractures of the femur from 87% to less than 8%.

4. Improving the welfare of sick children

It was this same Robert Jones who also became known for his innovative ideas about the treatment of seriously ill and disabled children. He believed providing residential care in suitable environments could cure children suffering from disease – all that was required was good sanitation, a residential doctor, first-rate operating facilities and laboratories, and access to fresh air. Eventually he was able to achieve his goal and in 1909 enough funds had been raised to open the Liverpool County Hospital for Children in Heswall.

5. Instilling the importance of good food and clean homes

Decent food and an understanding of domesticity were the first steps needed to rectify social inequality and poverty – this was the belief of Fanny Louisa Calder. She set up the Liverpool School of Cookery in 1875, her aim being to improve the diets and lifestyles of the people of Liverpool by teaching them how to cook, clean and look after themselves. She played a significant role in establishing training for domestic science teachers in Liverpool and across the nation. She was an initiator of and most significant campaigner for the recognition and establishment of domestic science in education and she also helped bring about a revolution in attitudes to education to women’s roles in, and beyond the domestic sphere.

Marsh gym

Gymnasium at IM Marsh College of Physical Education, Sport and Dance.

6. Championing physical fitness and education

At just 18 years old, Irene Mabel Marsh was appointed Director of the Bootle Gymnasium and taught women’s fitness classes for the Liverpool YMCA. Becoming an expert in physiology, kinesiology, pathology and educational method, she set up her own college in 1900. The college established itself at the forefront of physical education and teacher training, the IM Marsh College of Physical Education, Sport and Dance would eventually become the site of LJMU’s IM Marsh campus.

Apart from more formal education courses, Marsh also provided recreational classes for Liverpool’s business women as well as working class women, adopting innovative models of fitness not widely accepted at the time. She also worked with disabled women including those who were blind, deaf or unable to speak. Her remedial and physiotherapy work in collaboration with renowned Liverpool orthopaedic surgeon Sir Robert Jones, helped develop new approaches to scoliosis and spinal curvature. She established a medical gymnasium for what were probably the first remedial classes in the country, working with injured soldiers and patients from a local hospital.

7. At the forefront of training for practitioners

Pharmacy labPharmaceutical education had been unregulated and was based on the apprenticeship system until the middle of the nineteenth century. In 1849 Liverpool was home to one of the first pharmacy schools in the UK, the other being based in London. These days, LJMU’s School of Pharmacy and Biomolecular Sciences has achieved the status of Royal Pharmaceutical Society Foundation Training School ensuring that students receive high-quality, relevant education and training. The School has close connections to Liverpool’s community and hospital pharmacies as well as organisations within pharmaceutical, chemical, biomedical and forensic sciences making it a sought after place to study these subject areas.

In 1862 the School and College of Nursing and Midwifery, the predecessor of the School of Nursing and Allied Health at LJMU, was set up in an attempt to address the lack of formal training of nurses. It’s hard to imagine now, but in those days nurses were considered non-essential to the running of a hospital. Times have certainly changed but there are new challenges to face. Now in its 25th year and recently awarded the Student Nursing Times Educator of the Year (Pre-registration), the School of Nursing and Allied Health is looking forward to providing the best nursing education possible while working alongside health organisations to find solutions to meet the evolving health and social care agenda.

Both Liverpool and LJMU continue to be at the cutting edge when it comes to meeting the needs of health and social care. Just take a look at our many areas of health research within LJMU, for example the Public Health Institute and the Institute for Health Research.

And when it comes to creating the next generation of practitioners, the University continues to offer high-quality health-related education across a number of our Schools. If you’re interested in finding out what you could study, search our courses.



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