Between Hospital and Home: English Convalescent Care from Nightingale to the National Health Service

“Between Hospital and Home: English Convalescent Care from Nightingale to the National Health Service” examines the history of convalescent homes in England since the nineteenth century. Starting around 1860, concerns about the salubrity of the urban environment, the risks of pauperism, the impact of industrial society on the body, and defects in hospital administration and design led to the founding of hundreds of institutions in country and seaside towns for the care of working-class convalescents. By the early twentieth century, these homes had become essential to the practice and organization of medicine, welfare, and charity, a position they maintained until the creation of the National Health Service. Convalescence was, and is, a liminal category, occupying the hazily defined space between illness and health. Using archival records from hospitals, charitable organizations, government bodies, and convalescent homes, along with medical literature, patient accounts, and popular media, I examine how philanthropic ideologies, geographic imaginaries, spatial arrangements, therapeutic practices, and material cultures shaped the meanings and experiences of convalescence. In contrast to the figure of the invalid, which carried cultural resonances of stasis and withdrawal, the figure of the convalescent was attractive to philanthropists and medical reformers because it offered the promise of reconciliation between economic progress and social dislocation, industrialization and individual health, and urban disruption and family stability. The history of convalescent homes makes an important contribution to historians’ understanding of the transformation of the hospital at the end of the nineteenth century. I demonstrate that convalescent homes freed up space within hospitals that was crucial to advancements in surgery and the use of new therapeutic technologies in hospital wards. Moreover, convalescent homes themselves represented new forms of therapeutic space. Such institutions functioned as technologies of place—as means to harness the therapeutic benefits of rural and seaside climatic hinterlands for the treatment of hospital patients. By providing healthy diets and adopting the architectural rhetoric, spatial arrangements, and decorative practices of middle-class and genteel houses, convalescent homes sought not only to create environments conducive to their patients’ recovery, but also to inculcate the habits of domesticity and the values of liberal citizenship