'Undying spirits' : religion, medicine and institutional care of the dying 1878-1938.

This thesis focuses upon the emergence of a new phenomenon in the late nineteenth century: institutional provision for the 'respectable poor' medically certified as 'dying'. For the first time this group was identified as having special medical, nursing and spiritual needs which could only be provided by trained staff through an institutional medium. Through a comparative study of three institutions founded in London - St Joseph's Hospice, the Hostel of God and St Luke's House - this study aims firstly, to understand why homes for the dying were set up during this period; secondly, to explore their foundation and development up to 1938; and thirdly, to situate them within the broader context of late nineteenth and early twentieth-century Britain. It argues that the homes were essentially a response to three perceived deficiencies in care for the dying 'respectable' poor which became apparent to certain groups and individuals at this time: a paucity of medical provision, inadequacies in domiciliary care and a lack of spiritual ministration. As religious and philanthropic institutions, the homes were very much influenced by wider developments in these areas, particularly moral attitudes towards the poor and the Churches' concern to counter what were seen as widespread working class religious indifference. The different denominational basis of each home (Catholic, Anglo-Catholic and Methodist) was important in determining perceptions of death and dying and how patients' deathbed experiences were portrayed, while their varying management structures had profound implications for subsequent development. In particular the homes provide an insight into the tensions that can arise when modernising influences encounter strong prevailing traditions. An increasingly modernising and secularising medical and social climate posed considerable challenge to institutions set up with the primary objective of caring for patients' souls and the homes responded to it in different ways.