Change and continuity in the cottage hospitals c. 1859-1948: the experience in East Anglia.

In studies of health care provision prior to the establishment of the NHS the development and contribution of cottage hospitals has been neglected. Because they largely emulated the voluntary general hospitals erected in most major towns by the mid nineteenth century, cottage hospitals have been seen as providers of a basic service in the smaller towns and rural areas, or as "auxiliary hospitals".' While the former description implies a longer term, if minor, tradition, the latter conjures up images of an institution pressed into service, like the wooden hutted accommodation added to the voluntary hospitals in World War I or the ex-poor law infirmaries used to accommodate post-operative cases in World War II. In fact, the proponents of cottage hospitals presented a powerful case, reflected in a wave of hospital building in the last four decades of the nineteenth century. At the time this was well publicized, but the twentieth century record is much less detailed.2 A new study by Dr Emrys-Roberts focuses upon the cottage hospitals and restates the case for such local facilities whether as cottage hospital, GP hospital or community hospital.3 It emphasizes continuity, for more than half of the original institutions have the same or a similar role today.4 Some have been lost, but others have grown into district hospitals and F. B. Smith has suggested that these "shed much of their homeliness and became miniature general hospitals, embryos of what most of them are now."5 In examining the role of cottage hospitals this article considers their establishment and characteristics before providing a more detailed analysis of those in East Anglia,