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CXXIV.-MEDICAL AND SURGICAL HOSPITALS AND LUNATIC ASYLUMS.

Ir is perhaps, on the whole, a matter of congratulation that the London Hospitals are more eminent as schools of medicine and surgery than for their influence as social institutions. In Paris one-third of the deaths (9338 out of 28,294, in 1840) occur in the hospitals, but in London the proportion is only one in nineteen (2358 out of 46,281). The domestic feeling, or prejudice, if we like to call it so, of the English people is, generally speaking, believed to be adverse to that public association which is inevitable in an hospital. This is true to a great extent; but, on the other hand, it is also the limited capacity of the London hospitals which restricts the proportion of persons dying there to one in nineteen. In ten general hospitals there does not exist accommodation for more than three thousand persons at one time, and every "taking-in day" a large number of persons are unable to obtain admission.

There is scarcely a district of London which is without its hospital of one kind or another; but we shall first notice the three great hospitals, two of which are of ancient foundation, and are historically interesting. The most ancient of these is St. Bartholomew's Hospital. Rahere, the minstrel of King Henry I., not content with founding the priory of St. Bartholomew, annexed to it an hospital, about the year 1122, for the relief of poor and sick persons. Alfune, who, among other charitable works, built the church of St. Giles-without-Cripplegate, and was the first "hospitaller," used daily to beg for the relief of the poor under

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his care at the adjoining market and shambles of Smithfield. Four centuries after the foundation of the hospital, the mayor, aldermen, and commonalty of the city of London prayed the King to commit the order and governance of both this hospital and St. Thomas's to their hands. The hospital, however, was not transferred to the city until 1546, eight years later, during which period the Crown continued to enjoy its revenues, which at the dissolution were of the gross annual value of 3711., of which sum 2921. was from rents in London and the suburbs. In 1544 the hospital was newly incorporated, but its revenues were not re-granted; and it does not appear that the new constitution ever came into operation. At length, two years afterwards, in 1546, the king consented to re-found the hospital, for the reception of one hundred poor and sick persons, and to endow it with five hundred marks from its former possessions, on condition that the citizens raised yearly other five hundred marks for its support. This they agreed to do: but Stow says that the houses which formed the bulk of the property granted by the King were either in such a decayed state or leased out at such low rents, that great difficulty was experienced in obtaining the required income, and various expedients were adopted to raise this sum. In 1548 there were three surgeons, with salaries of 181. each, appointed to be in daily attendance on the sick; and in 1552 the expenditure, including the payment to the ministers of Christ's Church and St. Bartholomew's, and the diet of the one hundred poor at 2d. per day each, amounted to about 8567. per annum. In 1557 this hospital, with St. Thomas's, Christ's, Bridewell, and Bethlem, were united for purposes of administration, and their affairs were managed by one general board until 1782, when an act was passed under which, with the exception of Bridewell and Bethlem, each of them was placed on its present footing and under separate government.

The income of the hospital at present exceeds 30,000l. a-year. The bulk of the real estate is in London, and the London rents amount to 17,0117. a-year; landed estates in different parts of the country produce 61871.; dividends on stock in the funds, 52361.; rent-charges and annuities, 10871.; and the benefactions and legacies for ten years averaged 440l. a-year. The pecuniary donations and bequests to the hospital, received up to 1836, amounted to 236,0191., including 40,978. appropriated to building the four wings between 1729 and 1748.

St. Bartholomew's Hospital is situated on the south-east side of Smithfield Market. The principal entrance is through a large arch, ornamented with a statue of Henry VIII., and two figures representing Lameness and Sickness. The main buildings consist of four separate elevations of three stories in height, faced with stone, standing detached on the four sides of a quadrangle. They were completed from the produce of voluntary subscriptions raised between 1729 and 1760. On the first floor of the north wing there is a very handsome hall, 90 feet by 35, and 30 feet high, which is appropriated to general court meetings and the annual dinners of the governors. The grand staircase was painted gratuitously by Hogarth. The four several stories of the south wing contain fifteen wards, and the west wing contains fourteen wards. The wards in the east and west wings are 52 feet by 21; and their height varies from 10 to 15 feet. In the south wing the wards are 60 feet in length, and the heights are the same on each floor as in the east and west wings. To every ward an apartment for the sister in

attendance is annexed. In the roof of each wing is a tank for water, containing from 1800 to 2000 gallons, supplied by a steam-engine; and a continual supply from the New River Company is carried all through the hospital by force pumps. Besides the quadrangle, the area of the hospital comprises buildings, almost as extensive, for the residences of the different officers, &c. There is also the church of St. Bartholomew the Less, rebuilt about sixteen years ago, at a cost of 60351. out of the hospital funds. At the back of the western wing is a range of buildings containing the Lecture-Room for Materia Medica, the Medical Theatre, Pathological Theatre, Chemical Theatre, the Anatomical Museum, DissectingRooms, rooms for lecturers, professors, and curators, pupils' room and library, laboratory, apothecary's shop, surgeon's and physician's rooms. The treasurer's house and garden, the burial-ground of the church, and the vicarage-house, occupy the space north-east of the western wing; and between it and the southwestern gateway are houses for the steward, the matron, and the apothecary.

St. Thomas's Hospital was originally a religious establishment, founded by Richard, prior of Bermondsey, in 1213. In 1538 its possessions were valued at 2667.; and in the following year they were surrendered to the King. Before the middle of the century the suppressed hospital was purchased by the City of London; and a charter from the crown having been obtained in 1551, and the building repaired and adapted for the reception of poor, lame, and diseased people, it was opened for their admission in November, 1552. For some time the funds of the hospital were insufficient; and in 1562 the lands late belonging to the Savoy Hospital, and some other property, which had been granted to the three hospitals united, were granted for the sole use of St. Thomas's, with a view, perhaps, of equalising the revenues of the several hospitals. Notwithstanding this assistance, in 1564 the treasurer was obliged to advance 100l., and in 1569 a sum of 50%. was obtained by pawning a lease; but it soon afterwards emerged from its difficulties. The rents of property in London and the suburbs at present realise 13,9627. a-year; the rental of estates in the country 99501.; and the dividends on stock 6711. From 1693, to 1836 the pecuniary gifts to the hospital amounted to 184,3781. The gross annual income applicable to the general purposes of the institution is nearly 26,000l.

St. Thomas's Hospital is situated in the borough of Southwark, not far from the foot of London Bridge. It consists of several courts or squares, in two of which are statues; one, in brass, of Edward VI. by Scheemakers, and the other one, of stone, of Sir Robert Clayton, Lord Mayor in 1680. A large part of the hospital buildings was rebuilt in 1693, and additions were made to them in 1732. A new north wing was completed in 1836, at a cost of 18,000l.; the south wing in 1842; and it is intended to rebuild the centre on an adopted plan, when the whole building will present a very imposing appearance. The site of the new north wing and a portion of ground north of the old north wing were purchased of the City for 40,850., which was at the rate of 54,8657. per acre! The Museum, Anatomical Theatre, Demonstrating Theatre, Lecturing Theatre, DissectingRoom, and other appropriate offices attached, cost 84437., and are built on a site formerly covered by slaughter-houses, brothels, and miserable tenements. The Museum and Dissecting-Room are 45 feet by 25; the Lecturing Theatre is circular and 30 feet in diameter. The Museum contains about 6000 prepara

tions. The parish church of St. Thomas stands within the area of the hospital, besides which there is a chapel. The whole parish is the property of the hospital. There are nineteen wards, three of which are 107 feet by 28, and vary in height from 12 feet to 14 feet. They are well ventilated, kept at a uniform and agreeable temperature by two fires, and in cold weather by hot-water apparatus, and are generally quite free from offensive smells.

The founder of Guy's Hospital was neither minstrel nor priest, and though claimed by booksellers as one of their body, his property was acquired by stockjobbing rather than by literature. At any rate he was a man of great benevolence, and had long been a munificent supporter of St. Thomas's Hospital when he determined himself to be the founder of a new hospital. At the age of seventysix he commenced the erection of the present building, on which during his lifetime he spent nearly 19,000l. He died on the 27th of December, 1724, and on the 24th of January following sixty patients were received into the hospital. In 1732 the sum of 220,134/. 2s. 74d. was carried to the account of his executors, as the residue of Mr. Guy's estate. This magnificent bequest has been laid out at different times in the purchase of real estates in the counties of Essex, Hereford, and Lincoln. The hospital has also been benefited by the enormous bequest of Mr. Hunt, who in 1829 left it a sum amounting to 186,6757., besides other property which made the total amount 196,115., on condition of enlarging the hospital and providing one hundred additional beds. This legacy has also been invested in estates. The other benefactions received from the foundation of the hospital to the present time amount to about 10,000l. The gross income is now above 30,000l. a-year, and about 21,000l. a-year is directly applicable to the purposes of the charity. The rental of the hospital estates is 24,7321. a-year, of which 22981. is derived from the Southwark estates, and the dividends from funded property average about 4600l. a-year.

The entrance to Guy's Hospital is in St. Thomas's Street, by an iron gate opening into a square, in the centre of which is a statue, in brass, of Mr. Guy, by Scheemakers, the pedestal on which it stands bearing on one side an inscription recording Mr. Guy's benevolence, and on the other sides are relievos of Mr. Guy's arms, Christ healing the Impotent, and the Good Samaritan. The main building consists of a centre and two wings, containing residences for the Treasurer, Chaplain, Steward, Apothecary, Butler, Porter, and the "Dressers ;' a chapel, in which there is a statue, by Bacon, of Mr. Guy; the "taking-in" and examination rooms, surgery, and waiting-rooms for out-patients, apothecary's shop, medical store-room, laboratories, medical and operating theatres, the electrical room (containing apparatus necessary for electrical and galvanic operations), a room for post mortem examinations, and several wards for patients. Behind this is the Lunatic House, which is peculiar to this hospital. The number of lunatics is twenty-four, the number provided for by Mr. Guy having been twenty. They have a tolerably spacious airing-ground in the rear of the building appropriated to their use, and a garden for their recreation adjoins it. The south side of the hospital ground comprises a mass of buildings, some of which are sick wards; and here are also the museum, theatre, and dissecting-room, and the museum of comparative anatomy, the residences of servants of the hospital, and various offices and store-rooms. The anatomical theatre and the larger theatre

in the main building afford accommodation for about 300 persons. The operating theatre is of smaller size. At the eastern extremity of the area, bounded on the north by St. Thomas's Street, is the Botanic Garden, which is occasionally used by the students, but its chief value consists in the improved ventilation which it secures to the whole establishment. The wards are all spacious and airy, and are warmed by means of stoves.

The constitution of the London Hospitals is not uniform, though in all of them the ruling body consists of the governors; but the powers of the various officers to whom the immediate management and superintendence of the hospital is entrusted are exercised under less control in some cases than in others. Since 1792 there have been two classes of governors at St. Bartholomew's, the chartered or corporation governors and the donation governors.

At St. Thomas's there are three kinds of governors. The corporation of London is represented by the lord mayor and aldermen and twelve common councilmen, as at St. Bartholomew's; and they do not derive their authority from the other governors, but from the charter of the hospital and the Act of 1782. The special governors consist almost entirely of retired officers, and the executors of benefactors are occasionally appointed. This class of governors is not required to contribute towards the funds of the Hospital, and it is this only which distinguishes them from donation governors. It has invariably been the practice to admit as donation governors any person willing to pay 50l. who can procure governors to propose and second them.

The government of Guy's Hospital was settled by the founder. The number of governors must be at least fifty and not exceed sixty, with a committee of twenty-one, to whom the immediate management of its affairs is entrusted, and of this number one-third retire annually. The governors are chosen from a list presented at a general court by the president and treasurer, and no division has ever taken place on their admission: no donation is required, and the appointment is for life.

The next important department of the hospitals consists of the medical and surgical establishment, including the "sisters" and nurses. At St. Bartholomew's there are three principal physicians and three assistant physicians, three principal surgeons and three assistant surgeons, who are appointed by the General Court: they do not reside in the hospital, but there are in addition three house-surgeons and an apothecary, for whom apartments are provided. One or other of the physicians and surgeons visits the hospital every day in the week, and one physician and surgeon attends the almoners in rotation on the weekly admission-days for the purpose of examining patients. The physicians receive a salary of 1057., but their principal emolument is derived from the fees paid by the pupils attending the medical practice of the hospital, which are fifteen guineas for eighteen months and thirty guineas for the perpetual right. These pupils, two or three of whom are in constant attendance on each principal physician, prescribe simple remedies in his absence. The physicians have also the opportunity of becoming lecturers to the students attending the hospital school. The salary of the assistant physicians is 100%. per annum, but they are not allowed to take pupils, though they may become lecturers to the medical classes. The stipend of the principal surgeons is 40%., besides a gratuity of 301. each voted to them by

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