The hospital of the nation. The story of spa medicine and the Mineral Water Hospital of Bath

ROGER ROLLS, with photographs by CLIVE QUINNELL, The hospital of the nation. The story ofspa medicine and the Mineral Water Hospital ofBath, Bath, Bird Publications, 1988, 4to, pp. x, 181, illus., £18.50. In a relatively slim text-but one quite sumptuously illustrated, with both old prints and modern photographs-Roger Rolls has attempted to unite at least three separate and substantial books: an account of spa medicine, a survey of the rise and fall of Bath as Britain's premier spa resort, and a history of the Mineral Water Hospital in the city. It is, indeed, a tall order. The result is never less than an immensely pleasurable read, but some aspects break more scholarly ground than others. The most meaty sections of Roll's book deal with the Mineral Water Hospital, founded in 1738 as part of the wave of foundations of charitable provincial hospitals, yet an institution with a difference. In that its rationale was the presence of the Bath waters, it was recognized that only patients with particular conditions should be admitted; thus, as a specialist hospital, it should admit patients from all over the country. (Rolls shows that the southern counties, not surprisingly, contributed some 80 per cent of the patients in the Georgian era.) Rolls offers a lucid and original account, derived from archival sources, of the progress of the Bath hospital, giving due weight to medical and nursing staff, to building programmes, and to the finances. In doing so he picks up an intriguing problem. Case notes and annual statistics gave a profile, clear from early on, of the kinds of conditions which apparently responded best to the water treatment. Yet, despite these leads, the hospital did not become a site for continuing medical research, into paralysis, arthritis, rheumatism, etc. Even the Devonshire colic, so often relieved by treatment at the Hospital, was not actually investigated by the staff. Intriguing questions are raised here as to the relationship between specialist hospitals and clinical research, which it would require analysis of other institutions to resolve. Certainly it appears that in the Victorian era the Hospital conservatively accepted its role as an agency of therapy rather than as an organ of investigation. The history of Bath, and the city's role as "hospital to the nation", are dealt with more skimpily, though Rolls offers enjoyable discussions of the leading Bath physicians of the Georgian and Regency periods. A full prosopography of Bath medical practitioners-coupled with an account of their medical politics and the economics of practice-is still needed: let us hope that Dr Rolls will pursue his researches in these fields.