Bethlehem Hospital

“ Bartholomew's hospital, the total in the three will be 10,617: add to these, the number cured in the hospitals at Hyde-park corner and Westminster, the London Infirmary, the Middlesex, Small-pox, Bethlehem, and other hospitals in London, and they will amount to 15,000 at least. Add to this number the patients cured in the hospitals at Winchester, Bath, Bristol, Newcastle, Shrewsbury, Northampton, Liverpool, and the two hospitals at Exeter; I think there are fourteen of them out of London in different counties ”

“ And that the same is a false pretence to colour their wandering and begging, and to deceive the people, to the dishonour of the government of that Hospital." [74]
I will now pass on to the close of the chapter of this the first Bethlem Hospital, with the remark in passing that Charles I. confirmed the charter of Henry VIII. in [67] 1638, [75] and will direct attention to the year 1674, when the old premises having become totally unfit for the care—to say nothing of the treatment—of the inmates, it was decided to build another hospital. ”

“ Bethelham Hospital, or Bedlam, was founded in the year 1713, for the reception of lunatics; for its endowment, the founder settled by will, all her estates on a body of trustees, who were to have the management of the house forever. As many poor lunatics are kept here gratis, as the funds will allow—the inhabitants of the city having the first claim; after which the trustees have the power of selecting proper objects from any part of the county; they may also admit others, while there is room, whose friends will agree to pay the moderate allowance of four shillings and sixpence per week. ”

“ The current system of large hospitals is abandoned, as being equivalent to 'warehousing diseases on the largest possible scale;' while special hospitals are deemed unnecessary—'as if the different organs could walk out of the body and present themselves for separate treatment.' Each hospital has an ambulance ready to be sent out to bring any injured persons to the institution; the ambulance drives straight into the hospital, where a bed of the same height on silent wheels receives the patient, and conveys him or her to a ward. ”

“ When a patient is cured, he is called before a Committee of the Governors and Physicians, who examine him, and being found fit to be discharged, the Physician gives a certificate to that purpose, and then the steward of the house takes care to have him delivered to his friends.
The hospitals of Bethlem and Bridewell being made one corporation, they have the same President, Treasurer, Governors, Clerk, Physician, Surgeon, and Apothecary; yet each hospital has its proper steward and inferior officers, and a particular committee is chosen out of the Governors for each. ”

“ The Bloomingdale Asylum for the Insane, is a branch of the New York Hospital. It is situated on One-hundred-and-seventeenth street, between Tenth and Eleventh avenues. It is one of the most complete establishments in the world, and is admirably conducted.
Bellevue Hospital, on the East River, at the foot of Twenty-sixth street, is one of the largest in the city. It will accommodate 1200 patients, and is conducted by the Commissioners of Charities and Corrections. There is no charge for treatment and attendance, everything being free. ”

“ Through the courtesy of one of the largest Boston hospitals, a clinic is held weekly in its Out-Patient Department. The hospital is in no way responsible for the clinic, simply lending the room in which the clinics are held. ”

“ A dozen doctors, with each his smattering of patients, can learn and teach but little while they work apart: whereas a regular system of inquiry and record, in action where the sick are brought in in battalions, is the best possible agency. Not only are these objects lost when surgeons are allowed to make the great hospital a mere receptacle for a cluster of small and desultory hospitals, but the advantages of a broad study of diseases and their treatment are lost. ”

“ Thomas' Hospitals, now in process of construction at the Surrey Side of the Thames, in Lambeth, opposite the Houses of Parliament, will combine a number of hospitals for Special Diseases, and will accommodate about 2,000 patients, with as many beds, and will have an income of £50,000 a year, or more.
It is impossible to think of any disease, complaint, deformity, or injury to any member or organ of the body, which has not its special hospital or institution for relief or cure, in the English metropolis. ”

“ Often, too, these diseases rose to the height of epidemic pestilences, so that patients, however extreme their need, dreaded the very name of hospital, and the most skilful surgeons distrusted their own craft. New hospitals or new wards were built, yet after a very short time the new became as pestiferous as the old; and even scrupulous care in ventilation and housemaids’ cleanliness failed to prevent the devastation. Surgery had enlarged its freedom, but only to find the weight of its new responsibilities more than it could bear. ”

“ If we close the ward to visitors ... we have never in all the years the hospital has been in existence done ... that! Public confidence is our greatest asset. Has been. What shall we do? The newspapers, the police, the reputation of the hospital, d’y’see?”
“Too well, sir.”
But the tension was wearing itself out in speech and Dr. MacArthur went on:
“The hysteria among the nursing and medical staffs was bad enough, God knows, but before today is over, we must face the hysteria manifesting itself among the menial staff. How can a hospital run without orderlies, electricians, cooks? ”

“ The disadvantages, inseparable from general hospitals, are such as can never be counterpoised by all the regularities of medicine and regimen. Nature and kind nursing save a much greater proportion in our plain way, at a smaller expence, and with less abuse. One branch only of hospital institution is wanting with us; that is, a general establishment for those laboring under difficult cases of chirurgery. The aids of this art are not equivocal. But an able chirurgeon cannot be had in every parish. ”

“ Another problem is the question of creating, in connection with General hospitals, wards where patients of this sort may receive at the beginning of their treatment, their preliminary examination, where they may be evacuated home with compensation or without compensation, or evacuated to a prolonged treatment hospital for further care.
It has sometimes been difficult to get enough men, trained personnel, to man these wards. ”

“ Such disadvantages might be entirely removed if parliament would decide to throw open every poor-law infirmary for clinical purposes, and to have connected with each such establishment a responsible visiting medical staff, consisting of the best qualified men to be found in the community which each hospital serves. The old prejudice against hospital treatment has disappeared, for the least intelligent members of the population now understand that, when a citizen is sick, there is no place so good as the wards of a well-administered hospital. ”

“ During its two years of work for the sick and wounded, no military hospital has succeeded in establishing a finer record. To see it is a wonderful experience. The hospital consists of 17 wards, with 578 beds, and is entirely staffed by women—surgeons, doctors, pathologists, oculists, dental surgeons, anæsthetists, dispensers, nurses, orderlies. The only men are the patients.
Sir Alfred Keogh, the Director-General of the Army Medical Service, said, when speaking of it: “The hospital is in every respect a military hospital, differing in no way from any other military hospital in the country. ”

“ Notwithstanding this, he has been perfectly frank in confessing how much is accomplished by the religious management of the hospitals, and even did not hesitate to declare that if hospitals for the poor particularly, are to be successfully managed, there must be a change in the view-point of those who take up the work of hospital nursing, and the attendants must come from better social classes than is at present the custom. ”

“ The chief nurses have stated that the care of the patients means only “more patients.” There is no special problem in dealing with them and under the above conditions, they accept the necessary discipline and restriction which are fundamental if hospital treatment is to succeed.
It would seem, therefore, that the problem, as has already been pointed out, exists chiefly in the U. S. Public Health Hospitals where the greater number of patients from the Veterans’ Bureau are receiving care and treatment. ”

“ It is a curious reflection that whilst in the present war the base hospital has been given, if anything, an undue importance, in the other war it has been practically neglected. Our great hospitals are almost entirely field hospitals, planted right in the middle of the battle, and there we keep our patients till such time as they are to all intents and purposes cured. A very few convalescent homes will admit cases which still require treatment, but only a very few. ”

“ Most people assume that the older generations did not know how to build good hospitals. They did as well as they could, but until the development of modern knowledge of hygiene and sanitation, as well as the demand made on hospital administration by modern surgery, hospitals could scarcely be expected to be anything but the sordid piles of buildings they usually were, thought proper if they but furnished a protection from the weather and sustenance for the sick poor. ”

“ If the case be a common one, you get so much familiarity with a phenomenon that it will be continually presenting itself. If a rare one, you have seen what you may seldom see again. There is every reason for taking the practice of the hospital exactly as you find it. It represents the diseases of the largest class of mankind—the poor; and, although in some of the details there may be a difference, upon the whole the forms of disease that are the commonest in hospitals are the commonest in the world at large ”

“ Severally make oath and say, that they had, on Wednesday, the 29th day of November instant, a long examination of the patient, James Tilley Matthews, at Bethlem Hospital, and that they took considerable pains in ascertaining the state of his mind, and that it is their positive and decided opinion, as the result of such examination, that the patient is in a most deranged state of intellect, and wholly unfit to be at large. ”

“ That has been one of the complaints on the part of T.B. workers not only in government but in civil institutions as well.
We still find relapses occurring after the patient has been discharged from the sanitarium or T.B. hospital. Men go into training, and in a short time undergo another course of treatment, and so on. The reason for that is that they have not been given the necessary physical rehabilitation while still in the sanitarium, while under institutional protection and medical supervision. ”

“ Most of the cases appearing for treatment in the wards of that institution are of the most advanced type, for the nature of the New York hospital system may be said in a general way to select for Bellevue the least hopeful patients coming from the least hopeful classes of society. ”

“ My Richmond friends never lost sight of me for one day during my service in that city. Nearly every day my little boy was sent for to play among happy children, far away from the impure atmosphere of the hospital, which was soon filled with patients suffering from almost every form of disease.
As the demand for more room became pressing, the three stories of the main building were successively utilized, as well as a large storage-room in the yard. The ground-floor contained the surgeons' and steward's offices, store-rooms, etc., while the second and third formed two immense sick-wards. ”

“ Among hospitals are the Italian, the Homœopathic, the National for the paralysed and epileptic, the Alexandra for children with hip disease, and the Hospital for sick children. The Foundling Hospital, Guilford Street, was founded by Thomas Coram in 1739. ”

“ The glorious halls and corridors, the massive marble pillars, the splendid marble staircases, indicate wealth, but the perfection of the sanitary and scientific arrangements tells of long years of anxious thought and study and research. So perfectly is this marvellous hospital built that, in the event of plague or cholera breaking out to such an extent as to infect the building, the whole of the inside of the hospital can be removed and another hospital will still be left standing as complete as the other. ”

“ If they were in a strait waistcoat they could not assist themselves the least in the world." When, in the following year, the head-keeper of Bethlem Hospital was asked, "Was it not the practice in old Bethlem—not in the late gallery, but in the gallery pulled down—for eight, ten, or more patients to be fastened to the tables, almost in a state of perfect nakedness?" ”

“ The company erected at a cost of more than $60,000 a thoroughly modern brick hospital of thirty-five bed capacity which furnishes absolutely free to its employees and their dependents every type of medical, surgical and obstetric 78 treatment. No charge is made for any hospital care, operating fees, or for medicines. ”

“ Private subscriptions of citizens maintain the work, which is carried on in three fine buildings of brick and stone on Chardon street, one of which is used as a [64] temporary home for destitute women and children. The Massachusetts General Hospital—which, save for the Pennsylvania Hospital, is the oldest in the country—the Boston City Hospital, the New England Hospital for Women and Children, and a number of other finely-organized institutions care efficiently for the city's sick and suffering. ”

“ The Pennsylvania Hospital was also a model, for it contained a department for the insane, the only one of the sort in America except the Virginia Lunatic Asylum at Williamsburg. Even there the treatment of these beings, whom a later instinct of humanity thought peculiarly worthy of care and lavish expenditure, was harsh enough,—strait-jackets, whip­pings, chains, and dark-rooms being a part of the pre­scribed treatment in every such hospital in the world but where no hospitals existed, as in New England, New York, and elsewhere, the treatment was apt to be far worse. ”