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A HISTORY OF 
THE LONDON HOSPITAL 





.lOHN HAlUilSOX. SUUGKON, 
IIUNDKR OF Till'. LONDON HOSl'ITAL 



'a history of 

THE LOroOI^ HOSPITAL 



BY 

E. W. MOERIS 

■ I \ 

SECRETARY OF THE LONDON HOSPITAL 



ILLUSTRATED 



SECOND EDITION clI^-^^ 






LONDON 
EDWAED ARNOLD 

1910 

[All rights reserved] 



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PREFACE 

A Preface is often an excuse. If an excuse is neces- 
sary for writing this book, I have none to offer except 
that my love for the old place led me to spend a good 
deal of time in reading up the minutes of its life, and I 
then felt that it was a pity that there should be no more 
accessible history of the Hospital than is obtainable 
from these voluminous minutes. 

But I must also take the opportunity of a Preface 
for saying that I am alone responsible for every word 
here written. From the fact that I have been com- 
pelled, in writing of the Hospital, to refer to my Chiefs, 
it was impossible that — beyond obtaining leave to 
write this History — I could consult anybody about 
what I should say or how I should say it. I am 
anxious to make this as clear as possible. I alone am 
responsible for any sin of omission and of commission. 

I wish to express my thanks to three of my fellow- 
workers at "The London " for their invaluable help — 
Mr. Arthur G. Elliott, Mr. Walter Richardson, and 



vi PREFACE 

Miss Ethel Willis. In the hunting up of faded and 
dusty records, and in classifying and preparing my 
own rough notes, these helpers have, I am afraid 
burned more midnight oil than they have chosen to 
tell me of. I should hke those who may honour me 
by reading this little book to know of my indebted- 
ness to my three friends. 

E. W. M. 

London Hospital. 



PREFACE 

TO THE SECOND EDITION 

In response to the request of many friends, a 
chronology has been added to this Edition. I 
am indebted to many readers for pointing out 
certain errors and omissions, which have been 
corrected. 

E. W. M. 



vu 



CONTENTS 



CHAPTER I 

PAOE 

A GLANCE AT THE LONDON HOSPITAL TO-DAY - - - 1 

CHAPTER n 

THE SICK POOR AT THE TIME OF THE HOSPITAL'S FOUNDATION 25 

CHAPTER III 

MEDICINE AND SURGERY AT THE TIME OF THE ;' HOSPITAL'S 

FOUNDATION - - - - - - 37 

CHAPTER IV 

EARLY DAYS. PRESCOTT STREET - - - - 47 

CHAPTER V 

THE NEW SITE, WHITECHAPEL - - - - 73 

CHAPTER VI 

SOME CURIOUS POINTS IN HOSPITAL MANAGEMENT - - 96 

CHAPTER VII 

QUARTERLY COURTS OF GOVERNORS — HISTORY OP THE JEWISH 

WARDS ---.-.- 114 

CHAPTER VIII 

RELATIONS BETWEEN HOUSE COMMITTEE AND STAFF - - 136 

ix 



X CONTENTS 

CHAPTER IX 

PAGE 

BREAK OF DAY ------- 155 



CHAPTER X 

SUNDRY mCIDENTS AND EVENTS 

CHAPTER XI 

THE MEDICAL SCHOOL 



172 



186 



CHAPTER XII 

THE NTTRSING OF THE SICK POOR .... 204 

CHAPTER XIII 

THE LAST TWENTY YEARS - . - . - 215 

CHAPTER XIV 

THE ADMINISTRATION OF A MOD?.RN HOSPITAL - - 235 

CHAPTER XV 

THE FUTURE OF VOLUNTARY HOSPITALS ... 269 

CONCLUSION ...--.- 286 

CHRONOLOGY ------- 293 

INDEX -------- 315 



LIST OF ILLUSTRATIONS 



JOHN H.iBEISON, STJEGEON 

HOSPITAL ----- 
THE WAirrNG-HALL, OUT-PATIENT DEPARTMENT 

THE FINSEN LIGHT ROOM 



rOTJNDER OF THE LONDON 

Frontispiece 
- facin:i page 10 

u 

20 
66 



IN ONE OF THE CHILDREN'S SURGICAL WARDS 
patients' ADMISSION TICKET, 1747 

Hogarth's original design fob back of ad- 
mission TICKET ----- 
THE LONDON HOSPITAL IN 1759 
WILLIAM BLIZARD, F.R.S. - 

A MODERN OPERATING THEATRE 
THE LONDON HOSPITAL FROM THE BACK 
THE PRESENT MEDICAL SCHOOL 
THE LIBRARY IN THE MEDICAL COLLEGE 
ONE OF THE NURSES' SITTING-ROOMS, NURSES' HOME 
THE HON. SYDNEY HOLLAND, CHAIRMAN 
THE BOARD-ROOM ----- 
BALCONY OF MARIE CELESTE MATERNITY DEPARTMENT 
LABOUR-ROOM OF MARIE CELESTE MATERNITY 
DEPARTMENT ..... 

THE LONDON HOSPITAL FROM WHITECHAPEL ROAD - 
A SUMMER DAY IN THE GROUNDS - 



66 
80 
146 
162 
182 
188 
202 
210 
224 
224 
230 

230 
234 
268 



XI 



PLAXS OF THE LONDON HOSPITAL 



PAGE 



Plan- I.— March 26, 1752 86 

Plax 11.-1759 89 

Plan III.— 1840 91 

Plan IV.— 1886 93 

Plan V. — Modern Times - - - - - 95 



Xll 



A HISTORY OF THE LONDON 
HOSPITAL 

CHAPTER I 

A GLANCE AT THE LONDON HOSPITAL TO-DAY 

Probably until recent years the London Hospital was 
little more than a name to most people who dwelt 
north, or south, or west of the City. They had heard 
that there existed a huge hospital somewhere in the 
East End, but its address, Whitechapel, was not an 
attractive one. The very name of Whitechapel con- 
jured up in the mind thoughts of dangerous slums, of 
foreigners of the lowest tjrpe wandering from the 
adjacent docks, of pickpockets, of highway robbery 
with violence, of murders, and of all kinds of crime. 

Recently the Hospital has become better known to 
the dweller in the West End. He has found that 
Whitechapel is a place quite easily reached, that he has 
to pass through no slums to get there ; nor, as he comes 
eastward from the Bank, is he likely to see anything 
which will shock him. On the contrary, he will see 
much to arouse his interest and curiosity. 

But to the dweller east of Aldgate Pump the London 
Hospital is to-day a landmark as familiar — probably 

1 



2 THE LONDON HOSPITAL 

more so — than is Westminster Abbey or the Marble 
Arch to the West End inhabitant. He has passed the 
long ugly building (and whatever boasts " The London" 
may make, it has never boasted of being good-looking) 
which faces the Whitechapel Road on his way to and 
from his work for years. It is the end of the penny bus- 
fare from the Bank. He invariably glances up, as he 
passes, at the long lines of windows, with a never- 
ending curiosity as to what is going on inside. He 
knows which are the windows of the great operating 
theatres. He is sure to take notice if they are lighted 
up or not ; if they are, he will probably mention the 
fact when he gets home, for he looks upon these 
operating theatres as the very battle-ground between 
life and death. His father did this before him, his 
grandfather before that. 

But the resident within a one-mile radius of the 
Hospital — an area which contains a greater population 
to-day than the whole of London contained when the 
Hospital was founded — by no means regards the 
Hospital simply as a landmark. It enters into his 
life, and is part of it. He has never seen those great 
front-gates closed, and he never will. Hardly a house 
within that area but at some time or other has 
lent a patient to the Hospital, to be coaxed back 
to health and happiness ; not a family but has had 
father or mother, brother or sister or child, lying 
within its walls. These people do not simply notice 
the Hospital : they love it. They understand and 
appreciate its work. And the love these poor people 
bear is often mingled with a tenderness most touching ; 
for there, in spite of all that skill and care could do, 



THE HOSPITAL TO-DAY 3 

some loved child or parent passed away. In more 
than one instance a few flowers are sent year by year 
to the ward on that sad anniversary. There is no more 
pathetic proof of this feeling than the way in which 
hundreds and thousands of the poorest of London's 
poor will, from year's end to year's end, give a penny 
a week of their earnings for the help of " the 'Ors- 
pital." 

A visit to-day is well worth making, and visitors 
may be assured of a welcome ; and before turning to 
the ancient history of the Hospital, it may be of 
interest to foUow such a visitor round the building. 
Having done this, the steady growth of to-day's 
splendid institution from its very small beginning may 
be better appreciated. 

On leaving Whitechapel Station, which is on the 
District Railway, and exactly opposite the Hospital, 
one enters the main gates and walks up the slope to 
the main entrance. The visitor may be surprised to 
notice that his arrival at the main entrance is expected. 
The main entrance and the main gates are in tele- 
phonic communication, so that when a " case " enters 
the main gates, porters with stretchers are in readiness 
to receive it at the main entrance, to convey it to the 
Receiving-room. The saving of time is all-important 
on such occasions. It is to be hoped that the visitor 
will not make his first entrance to the Hospital as a 
" case," but his convenience may be served by the 
system in vogue, and he will not be kept long waiting 
for a guide. 

He will enter first of all the main hall, and on his 
right is the Receiving-room. This is the great 

1—2 



4 THE LONDON HOSPITAL 

sieve of the Hospital, through which every patient 
must pass before he can be reheved, either as an in- 
or out-patient. It is never closed througliout the 
twenty-four hours, and the seven officers in charge 
work here in turns day and night. Their duty (they 
are all senior and highly qualified men) is to find out, 
not all that may be the matter with each patient, 
but whether the case is a slight one, a serious one, or 
one which comes between these two extremes, and 
they must decide what is to become of it. One of 
three things will happen to the patient, depending on 
whether his injury or illness is slight, more serious, or 
very serious. If a slight injury or illness, the patient 
will be given advice and one supply of medicine or 
dressing, and sent away. Such cases number seven or 
eight hundred a day. If more serious, and the patient 
requires watching and longer treatment, he will be 
transferred to the Out-patient Department. If it is 
a matter of life or death, he is taken into the wards 
at once. 

It is interesting to watch these men at work for a 
few minutes. Half a dozen cases are being examined 
one after the other quickly ; they are all trivial com- 
plaints, perhaps — trivial to the Hospital, but not 
trivial to the man, and may interfere with his work — 
cut fingers, slight sprains, sore throats, a tooth abscess, 
and so on. The seventh case to a layman appears to 
be no worse than the others, but some symptom has 
necessitated a more thorough examination ; some 
sound in heart or lung has called the special attention 
of the officer, and he asks : " How long have you had 
this ? Why did you not come before ?" Instructions 



THE HOSPITAL TO-DAY 5 

are given for such a patient to attend in the Out-patient 
Department of the Hospital, in order that he may be 
thoroughly examined by one or other of the specialists 
who visit every afternoon, and a course of treatment 
decided on. It may be that by weekly advice and 
weekly medicine the wage-earner is enabled to keep 
at work through the dreaded winter months. 

The next case may be more serious still : arrange- 
ments must be made for the patient's immediate 
admission to a bed. The list, showing at that par- 
ticular minute where the empty beds are, is consulted, 
and the house physician or house surgeon on " full 
duty " sent for. Even while this is being arranged 
there is a stir at the door ; a Pickford's van has driven 
up the slope, and into a private room has been carried 
a figure on a stretcher. These very serious accidents 
— •" smash-ups " — are not brought into the main 
Receiving-room, but into a separate room, to avoid 
alarming the other patients. The officer we have been 
watching immediately leaves the less urgent cases and 
passes into the room to examine this serious one. It 
is a case, perhaps, from the docks — a man has fallen 
down a ship's hold ; or it is a " run-over," or the result 
of some explosion, or an attempt at suicide. On one 
occasion a fully-laden bus dashed up to the main 
entrance at a gallop. The front passenger on top had 
attempted suicide by cutting his throat, and the driver, 
with great presence of mind, had driven full speed 
through the back streets from the Commercial Road 
to the Hospital, to the great astonishment of the in- 
side passengers, who did not know what had happened 
outside. The patient, a Swede, was pulseless on 



6 THE LONDON HOSPITAL. 

admission, but was immediately attended to in the 
Receiving-room, and ultimately recovered, un- 
doubtedly saved by the prompt action of the driver. 
A serious accident arrives at the Hospital's doors 
almost every five minutes. I shall never forget one 
scene in this Receiving-room. A man came rushing 
in, carrying in his arms a little girl ; he carried 
her by the waist, and had evidently been running. 
Her head and her legs were hanging limp, and I thought 
she was dead. Her fair hair was like that of a little 
friend of mine, and it was this that first drew my 
attention to her. I went up. " Run over ?" I asked. 
" No ; she has swallowed something, and it has choked 
her." The little mite had quite lost consciousness. 
Receiving-room Officer, Dr. A., ran up. "You'll 
' trachey,' I suppose?" I said. "I should like to 
watch you, if I may." But Dr. A. was a gentleman 
and a sportsman, and could " pass the ball." " Dr. B. 
happens to be here," he said ; " he is quicker than I 
am." In twenty seconds Dr. B., who was not on duty, 
had slipped off his coat. Everybody did something. 
The Sister was ready with swabs. The tracheotomy 
set of instruments was at hand. The little limp body 
was slid along on the table until the head lolled back 
over the end and the throat was tight. In ten seconds 
the knife had passed into the windpipe and the trache- 
otomy tube slipped in. Then came the delightful 
sound of the air whistling through the tube into the 
lungs. " Jolly smart," said Dr. A. "I congratulate 
you ; that was fine," I said. But Dr. B. was the 
coolest man on the house at the time — just washed 
his hands, put on his coat, and strolled off to lunch. 



THE HOSPITAL TO-DAY 7 

" Pretty near thing " was all he was heard to say. 
Within five minutes of coming in the child was in 
warm blankets in bed. The actual obstruction, a 
collar-stud, was removed later. The child did well, 
and is alive now. 

Work exactly like this will be going on in the Re- 
ceiving-room throughout the twenty-four hours from 
January 1 to December 31. 

The examination of the patients here has to be 
carried out with great despatch ; on an average not 
more than thirty seconds can be given to each. It is 
astonishing how expert the officers become, and how 
rarely their diagnosis is set aside when the more 
thorough examination is made later. Time was when 
a Receiving-room Officer would enter the room and 
call out : "All with coughs stand up " ; " Now all with 
stomach-ache stand up"; but that day is long since 
passed. It might be thought that the work would 
become monotonous, but if an officer has the saving 
grace of humour, he will not be dull, and wiU have great 
opportunities of studying human nature. A dear old 
soul — an old woman — enters ; obviously she has never 
been in a Hospital before. After glancing nervously 
round the crowded room, she appeals anxiously to the 
Sister-in-Charge, to know, " Where do yer sit for 
tumours ?" Then a man enters who has evidently 
just emerged from a strenuous street row, and eye and 
cheek are cut and damaged. " Been fighting ?" says 
the Receiving-room Officer. " Yass !" " Traid you've 
had the worst of it," says the sympathetic officer. 
" Garn !" says the patient, " the other bloke will be 
here in a minute ; they're bringing him along in a cart." 



8 THE LONDON HOSPITAL 

Here, too, happened what has long since become an 
old story, and has got into Punch. A woman entered 
with a badly bitten cheek. " A dog, I suppose ?" said 
the Sister. " No," said the woman ; " another lidy !" 
Another patient calls to ask if it is advisable for her 
to eat vegetables, as she has been told that she has 
got " haricot " veins in the legs ! A woman enters 
with a black eye, and tells the officer that her husband 
had done it. " Does he often treat you like this ?" 
asks the officer sympathetically. " No, sir ; that's the 
curious thing about it. He's been more like a pal 
to me than a husband." 

As a rule patients are extremely grateful for any 
advice and attention given. Recently a coster entered 
to have a cut stitched, and whispered as he left : 
" Doctor, where can I leave yer a couple of nice fine 
'addicks. I've got a barrer outside, and I shan't 
miss 'em." Tipping is not allowed at "The London," 
however. Other patients take everything as a right, 
and are apparently under the impression that the 
Hospital is supported by the rates ; and only recently 
one of them addressed the tired and harassed doctor : 
" It's the likes o' me that keeps the likes o' you, and 
if it wasn't for us being ill, where would you be ?" 
Needless to say, the Receiving-room Officers are un- 
paid, the only return being the experience the}^ gain. 

The poor in the East End believe that the Hospital 
can do anything to help them. A Receiving-room 
Officer was confidentially asked to " take baby into 
the Hospital for a week, 'cos we're moving, and 
mother's busy." Many patients, either through visits 
paid to other Hospitals or from previous visits to this 



THE HOSPITAL TO-DAY 9 

particular one, get very knowing and important about 
their own ailments. Such patients are a perpetual 
embarrassment to the Receiving-room Officer. It is 
certainly surprising to hear a tattered tramp say that 
he has " a severe pain in the region of the pancreas," 
or that " my heart drops a beat." 

Many patients begin their report on themselves to 
the officer by the remark, " I am an inward case." 
This is evidently intended to put the doctor on his 
mettle. One of the commonest of cases which come 
up to the Receiving-room is that of the young child 
emaciated and collapsed from wrong feeding. The 
doctor naturally inquires what the child is being fed 
on, and we get the oft-quoted and constantly-made 
reply, " Why, just the same as we 'as ourselves," 
which in the East End invariably includes beer, pickles, 
and tea. 

Home pets, dogs and cats, are often brought up 
to the Receiving-room for treatment, and are never 
turned away. I remember a coster bringing in a 
dog which he had just seen run over — a dog he had 
never seen before. He considered it a perfectly natural 
thing to bring it into the Hospital, which, to his mind, 
kept its gates open for the relief of all suffering. 

The visitor may now pass to another part of the 
Hospital, the Out-patient Department already referred 
to, and which is a hundred yards from the main building. 
Every case he sees here has come through the Receiving- 
room, as I have already explained. The patients in 
this Out-patient Department are too ill to send away 
with one treatment only in the Receiving-room, and 
yet not sufficiently ill, at their first visit at any rate, 



10 THE LONDON HOSPITAL 

to be admitted as in-patients, for into the wards only 
the very worst cases can go. It is not the question of 
urgency alone, but of com'parative urgency, which has 
to be considered, and therefore there is always a list 
of several hundred cases waiting to be written for as 
soon as room can be found. 

Every patient who enters the Out-patient Hall 
must pass the Inquiry Officer, v/hose duty it is to dis- 
cover that the patient is a proper person to receive 
free medical relief. Satisfactory repUes must be given 
to such questions as, "How much are you earning ? 
How many are dependent on you ? Are you in regular 
work ? What is your rent ?" and so on. This is 
necessary for the protection of the private practitioner, 
and for fairness to the subscribers to the Hospital. 
Obviously a patient might be a suitable Hospital case 
if suffering from one disease, but unsuitable if suffering 
from another. And therefore the Receiving - room 
Officer, in sending the case to the Out-patient Depart- 
ment, always states on the patient's card what he 
considers to be the diagnosis. The Inquiry Officer 
might " pass " the case for phthisis, but refuse it for 
some trivial ailment. 

It may be easily imagined that the greatest tact and 
sympathy are required on the part of the Inquiry Officer. 
The dress of the patient is no guide, for many a poverty- 
stricken girl wdll actually hire clothes for the day 
so as to come to the Hospital respectable. 

After passing this officer, the patient waits in the 
Main Hall until called into one of the many rooms to 
see the surgeon or physician ; and after seeing the 
doctor, and having received advice and treatment. 







7. 



THE HOSPITAL TO-DAY 11 

the patient may be referred to one of the Lady Al- 
moners. 

A few words concerning the work of these ladies 
may be necessary. The day has gone by when a Hospital 
can exist all alone as a unit of charity. Its forces 
are wasted if it overlaps with other charities, or does 
not sufficiently avail itself of their help. The Hospital 
must be a link in a chain. The Lady Almoners link 
up the Hospital's work with that of other charities. 
These ladies are trained by the Lady Almoners' 
Association, and are in touch with various organiza- 
tions which may be of assistance to the Hospital in 
its work — Emigration Societies, Labour Bureaux, 
Sick-room Aid Societies, Societies for Prevention of 
Cruelty to Children, Convalescent Homes, Associations 
for the Prevention of Phthisis, Apprenticeship Societies, 
and so on. When a case comes before a physician — 
such a case, for instance, as that of some poor girl who 
spends her time in a garret stitching buttonholes or 
blouses (" The Song of the Shirt " may still be heard), 
and who turns out to be suffering from incipient phthisis 
— the physician would naturally order all sorts of extra 
diet — meat, cream, and milk, more fresh air, and all 
the expensive extras a phthisical patient requires. 
Having done so — and he might just as well have ordered 
champagne — and given his advice, his strict duty as 
a Hospital physician ends. He is not in a position to 
see that his advice is followed, and if it is not, aU his 
care is wasted. He sends, therefore, such a case to 
the Lady Almoner, who, by her training, can make 
arrangements for the patient to be provided with the 
extra food, gets her away to a Convalescent Home or 



12 THE LONDON HOSPITAL 

Sanatorium, and communicates with the Sick-room 
Aid Society and Health Visitors, or the Jubilee Nursing 
Association, who instruct the family in order that the 
disease may not spread. As a matter of fact, before 
the days of Lady Almoners many a physician helped 
his patients by dipping into his own pocket. How 
often have I heard one of them say : " You do not 
want medicine ; you want a steak. Go and get it." 
Kind as this was, no permanent good was gained. 
A man must have food every day, not only when he 
meets a generous sympathizer. 

The Out-patient Department contains sub-depart- 
ments, where specialists attend to treat every disease 
that flesh is heir to — of the throat, ears, eyes, skin, 
teeth — as well as the departments for general surgery 
and medicine. It also contains the now famous 
Finsen Light Department, which was inaugurated by 
the Queen, the President of the Hospital, who presented 
the first lamp, and really introduced into England the 
cure of lupus by this light. Lupus is a disease which 
attacks the skin, usually in exposed parts, and is due 
to the tubercle baciUus — the same bacillus which, 
when it attacks the lungs, produces ordinary pulmonary 
consumption. 

Finsen found that by focussing intensely powerful 
light on the part by means of lenses — Finsen at first 
used sunlight — the bacillus to which the disease was 
due was destroyed. Two of the members of the staff 
and two Sisters from the London Hospital went to 
Copenhagen to study the details of the treatment 
under Finsen himself. On their return the Light 
Department was opened, and the tradition of what 



THE HOSPITAL TO-DAY 13 

they learned has been faithfully handed on from 

Sister to Sister. When it was known that a cure had 

been discovered for this fearful disease, poor people 

from all parts of the world appealed to the Hospital, 

begging for treatment. They came from New Zealand 

and South Africa, Canada and South America, as well 

as from every county in the British Isles. One would 

hardly have believed that the disease was so common. 

But those who suffered usually, by reason of the fearful 

disfigurement, kept themselves hidden away. Now 

hope, long since abandoned, led them to creep out 

of their hiding-places. The department was on one 

day a seething crowd of sufferers. There were cheap 

excursions from aU parts of England for the final 

Football Cup-tie at the Crystal Palace, and these poor 

people in hundreds had availed themselves of this 

cheap trip to come up and be cured. How bitterly 

disappointed they were I can never forget. Within 

a month or two of the opening of the department, the 

lamps were booked forward for two years, and no more 

patients could be treated. Oh, that awful time, when 

every post brought letters begging " that my child 

may be treated before too late," all of which letters 

had to be answered in the same dreadful way. Some 

of these letters haunt one still. Speaking of this 

department, I remember a man walking into the 

Secretary's office. His face was fearfully disfigured — 

so much so that it was difficult to look on him and not 

show the horror one felt, and that is the first duty that 

everyone who walks in a Hospital must learn. He 

was a Boer, and spoke broken English. He had come 

all the way from Johannesburg to the London Hospital 



14 THE LONDON HOSPITAL 

to be cured. He had been saving every penny for 
three years ; his friends had helped him a Httle, too, 
and he had partly worked his passage. He had 
landed at the docks with seven shillings left, and 
walked to the Hospital. He was in a state of great 
excitement naturally. At last he had reached the 
place where they could make his flesh become " as 
the flesh of a little child." He was examined. Two 
minutes were sufficient. It was not lupus at all. 
The lamps were powerless. It was another awful 
disease. That day he was admitted to Whitechapel 
Infirmary. I saw him some weeks after, and I am 
convinced that even then it had not clearly entered 
his mind that he could not have been helped by " The 
London." 

Close by are the Electrical and Rontgen Ray Depart- 
ments. These departments are always of interest to 
the lay visitor. In some of the rooms X-ray treatment 
is given for ringworm, rodent ulcer, and malignant 
tumour ; in another room is the apparatus necessary 
for taking radiographs. Round the walls are prints of 
some of the more curious of the cases which have been 
radiographed— chiefly of articles swallowed by chil- 
dren : pins, penknife blades, nails, watch-keys, safety- 
pins, little tin soldiers, etc., and in one case a toy 
bicycle. There is also an interesting photograph of a 
bullet lodged in a burglar's neck. It was fired by his 
" pal " because he refused to " shell out " half the 
proceeds. 

It will be noticed that some of the operators in the 
X-Ray Department have terribly damaged hands. 
The danger of the X rays was not known until two or 



THE HOSPITAL TO-DAY 15 

three years after their discovery ; then all those who 
were in the habit of working with them complained 
that they were beginning to suffer from an extremely 
painful form of skin inflammation. The original workers 
all have damaged hands ; joint after joint has had to be 
amputated, and nothing so far has been found which 
has had any effect in curing the malady. Modern 
workers run no risk. When the danger of long-con- 
tinued exposure to X rays became known, a means of 
lessening — indeed, of removing — the danger was soon 
discovered. A glass which contains in its composition 
a certain percentage of lead, added when the glass is 
in a molten state, entirely prevents the passage of the 
raj^s, and the screens which the visitor notices around 
each X-ray tube are made of this lead-glass. At 
" The London " a further precaution is taken : it is im- 
possible for the operator even to switch on the current 
for the X-ray tube except from the inside of a cabinet 
which is lead-lined. 

The " Tyrnauer Baths," for the treatment of rheu- 
matism by hot air, are situated in the Out-patient 
Building, and are worth a visit. They are the inven- 
tion of Dr. Tyrnauer, of Carlsbad, who kindly came 
over and saw them properly installed. There are eight 
separate baths, cleverly adapted to apply great heat to 
the various parts of the body — legs, arms, hands, back, 
neck. The heat is dry, and therefore patients are able 
to bear a very high temperature — far higher than that 
of boihng water. Hundreds of patients have been 
relieved from the pain of rheumatism and rheumatoid 
arthritis by these baths since they were given to the 
Hospital by Princess Hatzfeldt at the beginning of 



16 THE LONDON HOSPITAL 

1909. Rheumatism is the curse of the East End 
poor. 

The Pharmacy must also be seen. It is a medicine 
manufactory rather than a chemist's shop. The de- 
partment is fully equipped with machinery for making 
lozenges, tabloids, pills, ointments, tinctures, spirits, 
ice, and mineral waters, thereby saving expense and 
insuring purity and accuracy. Here is made a certain 
magical cough lozenge which is used to the amount of 
three tons a year. I have heard that they have been 
seen on certain hawkers' barrows in Middlesex Street 
on a Sunday being sold at four a penny. But that is 
nonsense. Patients to whom they are given would not 
part with them at any price. 

At the eight windows of the Dispensary stand long 
lines of patients, like the queue outside a theatre pit 
entrance, waiting for their medicines, after having paid 
their visit to the physician or surgeon. 

Every patient who can afford it pays threepence 
towards the cost of his week's medicine. Children are 
exempt, so are those who are unemployed or very poor, 
and also those sent up to the Hospital by an outside 
private practitioner for a consultant's opinion. The 
threepence does not pay for the medicine received. I 
have known a patient tc ta-ke away twenty-three shil- 
lings' worth of drugs for threepence. There is no 
cutting down of the cost of medicine at the Hospital ; 
no prescription is tampered with in any way in the 
Dispensary ; what is ordered is given, whatever the 
cost. The ignorance of the poor as to the nature of 
medicine may be noted. Patients may sometimes be 
seen exchanging sips from each other's bottles. The 



THE HOSPITAL TO-DAY 17 

idea seems to be that medicine which has done a 
patient good is good medicine — a sort of charm — and 
will do every patient good who is privileged to share it. 
Before leaving the Out-patient Department, a visit 
must be made to the Department for Cripples — the 
Orthopaedic. In no part of the Hospital is more im- 
portant work done than here, although quite unob- 
trusively. Crippled children are transformed into able- 
bodied men and women. Thousands of children are 
treated here annually, for " The London " has a name 
for this work, and children are brought from all parts 
of the country. There ought not to be any cripples, 
and if there were some powerful organization to relieve 
crippled children in the very early days there would be 
none, or, at any rate, none who could not be rendered 
fit to earn a Hving. The children are always brought 
too late. 

Having visited the more important parts of the Out- 
patient Department, where a quarter of a million new 
patients are seen and treated annually, the visitor wiD 
be taken to some of the wards and to other depart- 
ments. It woidd be impossible to visit all the wards, 
but those visited may be taken as types of the rest. 
The walls of many of them are covered with glass tiles, 
and all have a strikingly cheerful appearance : they are 
gay with flowers, and laughter is heard more often 
than groans. Some of the wards are allotted to 
surgical cases, some to medical, others to children under 
seven years of age, and some to lying-in cases. It is a 
mistake to think that a visit to a hospital ward is a sad 
experience. The majority of the patients are getting 
well, and are fuU of hope. 

2 



18 THE LONDON HOSPITAL 

At " The London," and at every good hospital, no 
patient is simply a case ; it is always remembered 
that " the case " is also a man or a woman or a child. 
One of the wisest physicians the Hospital ever had was 
going through the wards with his class, and was 
questioning one of the students about a case — 
What did he think was the matter ? What should 
be the treatment and the diet ? The student 
answered correctly as to the complaint, and 
gave the strictly theoretical treatment, which was 
a severe one. The physician approved. " Yes, 
that is quite right for the case, but for the man 
I think we will prescribe a little ale with his lunch 
and a pipe in the garden in a wheel-chair every 
afternoon." 

About the poverty of most of the cases there can be 
no doubt whatever. The incident has often been told 
of the starving little child admitted to one of the 
children's wards, and on being given a cup of warm 
milk, according to custom, asked that pathetic ques- 
tion, " How far down may 1 drink, please. Sister ?" A 
cup of milk had to go far at home. The poverty at 
home can be easily guessed, too, by the remark a Httle 
toddler of eight was heard to make to his mother one 
visiting-day : " Don't let Willie wear out my trousers 
while I'm in here." 

In going round the wards nothing is more touching 
than the kindly hes which are constantly told, by the 
wife, for instance, on visiting her sick husband. It is 
quite obvious that the husband's cure is being delayed 
by his anxiety as to what was going on at home — Were 
they starving ? Was the rent being paid ? W^ere the 



THE HOSPITAL TO-DAY 19 

children well ? Judging from the replies of these poor 
women, the entrance of the husband into the Hospital 
is the sign for the entrance of a fairy godmother into 
the patient's home. Nothing is more astonishing than 
the love which the poor bear towards each other, deep 
and strong, in spite of bad language and sometimes of 
unkind behaviour. Sir Frederick Treves told me of a 
poor woman who was brought into the Receiving- 
room, shockingly burnt. She reported that her hus- 
band in a passion of temper had thrown a lighted 
paraffin lamp at her, and then a second. Obviously 
she could not live more than an hour, and she was at 
once removed to one of Sir Frederick's beds, and a 
magistrate sent for to take her dying depositions. 
The magistrate arrived and sat by her bedside, but the 
patient did not speak. The surgeon, knowing that time 
was short, urged her to say what she had aheady said 
to him. At last the patient struggled up, cried, " Why, 
/ told yer : it was a pure accident," and fell back dead. 
It was not what she had told him, however, but it was 
a splendid lie ! 

The kindly encouragement which one patient who 
has been in for some time will give to a newcomer is 
sometimes amusing. A boy had been in for some time 
with stricture of the oesophagus, brought on by swal- 
lowing in mistake some caustic potash. One of the 
surgeons saw him daily, and had to keep the oesophagus 
open by passing sounds. When the patient had been 
in for some months, another boy was admitted with 
precisely the same trouble, though from some other 
cause. The first patient immediately took upon him- 
self to comfort the newcomer. " You'U be ail right in 

2—2 



20 THE LONDON HOSPITAL 

'ere," he said, " Mi'. will be your surgeon ; he 

looks after me and the King !" 

The Children's Wards are always cheerful, especially 
the Surgical Wards, and the comments of the children, 
used all their lives to the squalor of a Whitechapel 
home, are often entertaining. " What are them ?" 
said one of the children. " Snowdrops," said the Sister. 
" Well, they're a bit droopified, ain't they ?" Another 
little mite who had been listening to Sister's description 
of heaven remarked plainly " that she did not want to 
go to heaven, sitting on the marble in her little nightie 
a-blowin' a trumpet." To dance round a piano-organ 
was a higher heaven to her. 

Many of the cases in these Children's Surgical Wards 
are accidents from the neighbourhood, and due to the 
life the poor have to live. If the mother has to leave 
home all day charing, it is not surprising that the 
children hnd their way to the Hospital, and they come 
in hundreds — run over, scalded, burnt, fallen from 
windows. One little child came to the Receiving- 
room and said she felt ill and " did not want to die 
in mother's bed !" 

The most pathetic patients in the Children's Wards 
are the hip-disease cases. There they lie flat on their 
backs, week in, week out, and it seems that these little 
hip children never murmur. Everyone has noticed 
this. After months in Hospital, they are sent to some 
Convalescent Home, and eventually return to their 
homes well — it is to be feared merely to relapse within 
six months as the result of ignorance, poverty, and dirt. 
It would be so much more encouraging coaxing these 
children back to home and health if the homes were 




■Jl 

o 



.0 



h-l 

a 

'A 

a 



/5 

O 



THE HOSPITAL TO-DAY 21 

but worth the going back to and life for them worth 
the living. Children are splendid patients. 

The visitor would perhaps now be shown the Opera- 
ting Theatres. There are twelve of these for in- 
patients and four for out-patients. They are perfectly 
equipped, and are one of the finest suites of theatres 
in England. 

The methods adopted to carry out the principles of 
aseptic surgery will be more fully described in a later 
chapter. The Anaesthetic Rooms are distinct from the 
theatres, so that no patient may see the theatre. 
Recently (since writing this the tale has been published) 
a little patient — a boy of ten — in one of these Anaes- 
thetic Rooms, just as he was about to be anaesthetized, 
was found to be clutching something in his list. This 
turned out to be a brass button from the tunic of his 
father, who was a soldier, and the little chap had grasped 
this talisman to give him courage in his ordeal. The 
poor little chap died, however, but bravely. 

Then the Kitchens might be visited, where from 
1,000 to 1,200 dinners are cooked daily. The methods 
adopted to deliver these dinners hot and punctual to 
the minute over a building which covers eight acres 
would probably interest the visitor. 

Then the Jewish Wards would be shown, and a visitor 
could not but be struck at the very minute arrange- 
ments made in order to observe the rites of the Jewish 
people. These wards have, of course, their separate 
kitchens and separate food-supplies. The Mazuza on 
the lintel of the doors should be noticed. 

The " Marie Celeste " Lying-in Wards would be 
shown. These wards are endowed by the liberality of 



22 THE LONDON HOSPITAL 

Mr. James Hora, a Vice-President of the Hospital, in 
memory of his wife. The good done in this depart- 
ment for the very poor mothers within a mile radius 
of the Hospital can hardly be overestimated. The 
London Hospital Maternity Nurses may be seen in 
every lane and alley at every hour of the day or night. 
Their uniform passes them safely in the small hours 
of the morning in slums where a policeman would 
hardly venture alone in daytime. There has never 
been an instance of a nurse receiving the slightest insult, 
although her work lies in a district marked black on 
Mr. Charles Booth's Map of London. 

Every mother confined in the Hospital or in the 
district attended by our Maternity Nurses is provided 
with what is known as a " Derby Bundle," owing to 
the Dowager Countess of Derby's generous gift. These 
bundles contain warm clothing of the most useful 
kind. 

The clergy and various charitable associations assist 
the Hospital in making inquiries as to the recipients 
of this part of the Hospital charity, and every care is 
taken that the charity is not abused. 

This department is one of the registered training 
centres for the examination of the Central Midwives 
Board, and forty-eight nurses are trained every year to 
become midwives. 

Then the visitor would be taken to the Nurses' 
Homes, with accommodation for over 700 nurses. 
The homes contain Lecture Halls for teaching anatomy, 
physiolog}^ and sick-room cookery ; there are also 
beautifully fitted recreation-rooms — sitting, reading, 
and writing. Adjoining one of the Homes is the 



THE HOSPITAL TO-DAY 23 

Nurses' Garden (usually known as the " Garden of 
Eden "). The last Nurses' Home erected is called the 
" Liickes Home." On entering, the following inscrip- 
tion will be noticed : 

THE EVA LtJCKES NURSES' HOME, 
OPENED 1905. 

" By the unanimous vote of the House Committee 
it was resolved to associate the name of the Matron 
with this ' Home,' and therebj^ to commemorate her 
loyal and devoted service to the London Hospital, and 
to the improvement of Nursing. This vote was passed 
in the hope that Miss Eva Liickes' name and work may 
be gratefully remembered, and in the belief that the 
high standard which she has established will ever 
remain as a tradition and example to the Nursing Staff 
of the London Hospital." 

Then the Isolation Block would be pointed out, with 
wards for infectious cases — measles, diphtheria, ery- 
sipelas, scarlet fever, etc. 

The Laundry, too, might be visited, with machinery 
and staff sufficient to wash 10,000 " pieces " daily. 

Then a call would be made at the Medical School, 
and here the Lecture Theatres, Demonstration Rooms, 
Museums, and Laboratories would be shown. 

When the visitor has finished his round he will 
probably be tired. He will have walked some miles, 
and will have been astounded at the enormous amount 
of work carried out in such an institution in the course 
of a single day. He will be astonished at the smooth- 
ness and quietness with which the whole work goes on. 
Every man has his post, and is at his post ; every man 
knows his duty, and does it. 



24 THE LONDON HOSPITAL 

The work would, indeed, be overwhelming were it not 
tliat it is the growth of years. 

Everything which the visitor has seen to-day, and 
which will be referred to in more detail later, is the 
result of a little meeting of seven men which took place 
in the bar-parlour of the Feathers Tavern, Cheapside, 
in the evening of September 23, 1740, " when," as the 
old minute quaintly words it, "a motion was made — 
whether with the sum already subscribed (100 guineas) 
it would be proper to begin the said Charity. And 
unanimously agreed it was." A hundred guineas ! — 
tliat sum would to-day " run " the HosjDital from 
breakfast to dinner time ! 

But that was a groat gathering in the Feathers 
Tavern, Cheapside. 



CHAPTER II 

THE SICK POOR AT THE TIME OF THE HOSPITAL'S 

FOUNDATION 

The names of those who attended this important meet- 
ing at the Feathers Tavern on September 23, 1740, 
should be recorded. They were Mr. John Snee, senr., 
Mr. Sclater, Mr. Fotherley Baker, Mr. G. Potter, Mr. 
John Harrison, Mr. Josiah Cole, and Mr. Shute Adams. 
Evidently there had been previous meetings, for at 
this one " Mr. Harrison delivered in the lease of the 
house taken for the intended Infirmary, which was 
approved." They met again on that day week in the 
same place. At this meeting a man and a woman 
were engaged to look after the house for £20 a year 
between them. Mr. John Harrison and Mr. Potter 
were commissioned to provide furniture " for the 
doctor's, surgeon's, apothecary's, managers', and 
patients' rooms for a sum not exceeding £15, and that 
the Treasurer do pay the bills for the same." The 
treasurer, doctor, surgeon, and apothecary had not 
yet been appointed, however. Another meeting was 
held in the following week, this time at the Baptist 
Head Tavern in Aldermanbury. Seven persons were 
again present, three of whom were candidates for the 
post of surgeon, physician, and apothecary respectively. 

2.5 



26 THE LONDON HOSPITAL 

Mr. Fotherley Baker was chosen first treasurer, Mr. 
John Harrison the first surgeon, Dr. Andree first 
physician, and Mr. Josiah Cole first apothecar3^ 

The house taken was in Feather stone Street, " near 
the Dog Bar, for £16 per annum, with liberty to quit 
the same at six months' notice." It was decided to 
open this " the intended Infirmary " on the first 
Monday in November, 1740. 

The newly elected apothecary was asked to draw up 
a list of his wants in " medicines, plaisters, and oint- 
ments," and he was to refer such a list to those sub- 
scribers " who were of the physical profession." Two 
thousand letters were to be printed " on a half -quarto 
paper on the cheapest terms "; these were to publish 
abroad the news of the birth of this charity. Then 
there came the first check — furniture had been bought, 
the house taken, the staff appointed, and the Infirmary 
was to open in a fortnight, but the treasurer reported 
financial difficulties — " there be only one shilHng in 
the Bank." 

While the treasurer is settling his difficulties with 
the committee and staff, we may seize the opportunity 
of making some inquiry into the condition of the sick 
poor in London at the time the charity was founded. 

Up to this time there existed in London but two 
great hospitals — St. Bartholomew's and St. Thomas's ; 
these had existed for over 500 years. 

But within a few years all the following hospitals 
were founded : the Westminster, in 1720 ; Guy's, in 
1724 ; St. George's, in 1733 ; " The London," in 1740 ; 
Middlesex, in 1745 ; Queen Charlotte's, in 1752 ; and 
manj^ others. 



THE SICK POOR IN EARLY DAYS 27 

Why, after 500 years of apparent neglect, this 
sudden awakening to the needs of the sick poor ? 

Was there some sudden advance in medicine and 
surgery in the benefits of which the rich considered the 
poor should have their share ? Was there some great 
wave of public philanthropy ? Was it a time of great 
sickness and of great poverty ? Or were the hospitals 
founded for reasons which must be described as selfish ? 
Were the sick poor herded together because it was better 
for the sick poor, or because it was much better for the 
non-sick rich ? 

Perhaps a reference to the history of the two royal 
and ancient hospitals already mentioned may help us. 

St. Bartholomew's was founded by Rahere in 1123. 
Raliere is usually believed to have been the jester of 
Henry I., the Conqueror's son. Mr. Wheatley says 
that there is no authority for this, although Rahere 
was known to have been a frequenter of the Palace and 
Court. 

Every schoolboy remembers that Henry I. was the 
gentleman who never smiled again after the death of 
his only son by drowning. Such an inflexible deter- 
mination to see nothing funny in Rahere's jests, 
whether he was the official jester or unofficial one, 
seems to have had a depressing effect upon the humor- 
ist. He gave up the follies of his career, became 
pious, and made a pilgrimage to Rome. Here he 
appears to have been seized with some severe illness. 
His past life, which must have been a wicked one, as 
well as a merry, rose up before him, and impressed him 
profoundly ; in his extremity he made a vow that if 
health were given him and he were allowed to return 



28 THE LONDON HOSPITAL 

to his native land, " he would make an hospital in 
recreation of poor men, and to them so there gathered 
necessaries minister after his power." 

Rahere returned to London, and his old master the 
King gave him a site in the Smoothfields — now Smith - 
field — in the western suburbs of the City. The actua I 
place was a marsh at the time, and had to be drained. 
Rahere collected the money to build the priory and 
hospital, and became the first prior. He died after 
having been a prior for over twentj^ years. 

Mr. Wheatley points out that the hospital was from 
the first a hospital for the sick, and not a mere alms- 
house. 

The hospital, no doubt, had times of good and evil 
fortune until the time of the Reformation, and the 
dissolution of the religious houses under Henry VIII. 
This, so far as St. Bartholomew's was concerned, came 
as a terrible blow to the citizens of London. To quote 
from Sir Henry Burdett's " Hospitals and Asylums of 
the World " : 

" The poor were deprived of the charitable relief 
which had been bequeathed to them by the piety 
of former ages. This was specially the case in 
London, where the indigent had to be supported by 
the private charity of the citizens, who were not only 
called upon to relieve their own poor, but many others, 
still more wretched, who, tempted by its great reputa- 
tion for wealth, flocked into the City. By the dissolu- 
tion of the Religious Houses, not only was much 
misery caused, but disorder and confusion were in- 
creased to such an extent that the administration of 
justice, sanguinary as it was in those days, could not 
entirely subdue them. The poverty and misery in 



THE SICK POOR IN EARLY DAYS 29 

the City of London at length reached such a height 
that in 1538 the Mayor and Commonalty of the City of 
London prayed that they might from henceforth have 
' the order, rule, government, and disposition of the 
hospitals or spitals — commonly called St. Mary's 
Spital (Bethlem), St. Bartholomew's Spital, St. 
Thomas's Spital — and the New Abbey at Tower Hill, 
with the rents and revenues appertaining to the same, 
for the annual relief of the poor, needy, and sick per- 
sons.' Nor did the Worshipful Body, in any of their 
supplications, attempt to conceal from the King the 
real state of the poor in the City of London, for they 
reminded him that the three great spitals named were 
' fownded of good devocon by auncyent fathers, and 
endowed \v^ great possessions and rents, onely for the 
relyeff comforte and ayde of the poore and indygent 
people not beyng hable to help theymselffs, and not 
to the maynten'nce of preestes chanons and monks 
carnally lyvyng as they of late have doon, nothyng 
regardyng the myserable people lyeing in the streete, 
offendyng every clene person passyng by the way w' 
theyre fylthye and nastye savors : Wherefore it may 
please yor mercyfuU goodness, ever enclyned to pytie 
and compassyon for the relyef of Crystes very images, 
creatyed to hys owne symlytude, to order and estab- 
lyshe by graunte or otherwise, by yor most vertuous 
and sage dyscrecon that the Mayre and hys brethren 
of yor C3rtye of London or suche other as shall stande 
w* yor most gracyous favor shaU and may from hens- 
furtli have the order rule dysposicon and governance 
of all the sayd hospy tails and abbey.' 

" The prayer of the Corporation was granted, and 
the above-named hospitals were placed under their 
management, but six years elapsed before any direct 
system of administration was organized. The fir^t 
spital handed over to the civic authorities was that of 



30 THE LONDON HOSPITAL 

St. Bartholomew's, which was for ever to be styled 
' The House of the Poor in West Smithfield in the 
suburbs of the City of London, of King Henry the 
Eighth's foundation,' in order, as Stow states, that 
' there might be comfort to the prisoners, visitation 
to the sick, food to the hungry, drink to the 
thirsty, clothes to the sick, and sepulture to the 
dead.' " 

St. Thomas's was founded in the reign of William 
Rufus by a woman, "pious, robust, and unmarried," 
who amassed a fortune by running a ferry across the 
Thames near the site of the present London Bridge. 
With this she built and endowed a convent and hospital 
near her residence in Southwark. She was canon- 
ized under the title of St. Mary Overie (Mary over 
river). 

This hospital, like St. Bartholomew's, had varying 
fortunes, and also, like St. Bartholomew's, it fell, in 
1538, into the hands of Henry VIII. A charter was 
not given until 1553, in the reign of Edward VI., 
and it was dedicated to St. Thomas the Apostle. It 
had previously been dedicated to St. Thomas a 
Becket. 

These two hospitals, it would seem, although 
originally founded as an act of piety, were re-founded 
in the time of Hem-y VIII. and Edward VI., not 
entirely as an act of piety, but rather for the conveni- 
ence of the healthy citizens. To have diseased and 
often infectious mendicants lying, and often dying, on 
their doorsteps was a nuisance ; Dives objected to 
Lazarus : " the myserable people lyeing in the streete, 
offendyng every clene person passyng by the way w* 



THE SICK POOR IN EARLY DAYS 



31 



theyre fylthye and nasty e savors." And selfishness 
may have been a reason for the foundation of the group 
of hospitals in the middle of the eighteenth century. 
But I think there were other reasons. 

Was there any special amount of sickness and poverty 
about this time or before ? In attempting to answer 
this question, I must acknowledge my great indebted- 
ness to Dr. Charles Creighton, from whose exhaustive 
and deeply interesting work, " The History of Epi- 
demics in Great Britain," I quote freely. 

The Eastern bubonic plague entered Britain in 1348, 
and was known as the Black Death. It appeared 
from time to time (in the fifteenth, sixteenth, and 
seventeenth centuries, several times in each) for the 
long period of 300 years. There are no trustworthy 
statistics of the earlier plague epidemics, but of those 
of 1603, 1625, and 1665, Dr. Creighton gives the follow- 
ing particulars for London : 



Year. 


Estimated 
Population. 


Total 
Deaths. 

42,940 
63,001 
97,306 


Plague 
Deatlis. 


Highest 
Jlortality 
in a Week. 


Worst Week. 


1603 
1625 
1665* 


250,000 
320,000 
460,000 


33,347 
41,313 
68,596 


3,385 
5,205 
8,297 


Aug. 25 to Sept. 1 
August 11 to 18 
Sept. 12 to 19 



Dr. Creighton discusses at great length the reasons 
for this long-continued survival of this disease in 
Britain, while other exotic infections — e.g., Asiatic 
cholera — have not become domesticated. He beHeved 
that the virus of the plague had its habitation in the 
soil, and that it depended for its continuance upon 
* The year of the Plague of London. 



32 THE LONDON HOSPITAL 

the decomposition of human bodies. If he is correct, 
he says, 

" then it is easy to understand that the immense 
mortaHties caused by each epidemic would preserve 
the seeds of the disease ... in the soil. Buried plague- 
bodies would be the most obvious sources of future 
plagues." 

Be this as it may, one cannot help feeling that 
this regular appearance of plague in London must 
have had a terrifying effect upon the citizens, cul- 
minating in absolute horror in the year of " the 
Plague." And for many years after 1665 — indeed, 
right up to the time of the foundation of the 
London Infirmary, as the Hospital was first caUed 
— isolated cases of plague occurred which kept 
this terror alive ; and an epidemic of plague in 
Marseilles created a panic in Western Europe 
(Wheatley). 

But the bubonic plague was not the only epidemic 
which harassed the inhabitants of London. Creighton 
has shown that scarcity and want due to a run of bad 
harvests were always followed, or nearly always, by 
an epidemic of some kind. For instance, the opening 
years of the eighteenth century were j^ears of abundant 
harvests ; then in 1708 came the excessively severe 
winter — " one of the three memorable winters of the 
eighteenth century." This was foUowed by a deficient 
crop in 1709, and the price of wheat rose from 27s. 3d. 
per quarter at Lady Day, 1708, to 81s. 9d. at Lady 
day, 1710. Then began an epidemic of fever — the 
dreaded typhus. In 1710 the deaths from fever 



THE SICK POOR IN EARLY DAYS 33 

reached the highest total since 1694. Creighton 
says : 

" The tremors, offensive sweats, and offensive breath 
are distinctive of a form of typhus that became common 
towards the middle of the century, and was called 
putrid /ever." 

Epidemics of typhus, and smallpox too, continued 
to come periodically, and, to quote again from " Epi- 
demics in Britain " : 

" The eighteenth century, even the most prosperous 
part of it, from the accession of George I. to the begin- 
ning of the Industrial Revolution in the last quarter 
of it, was none the less a most unwholesome period in 
the history of England. The health of London ivas 
never worse than in those years, and the vital statistics 
of some other towns, such as Norwich, are Httle more 
satisfactory. This was the time which gave us the 
saying that God made the country, and man m.ade the 
town." 

Now we have come to the time and year when the 
seven men we have spoken of sat talking in the bar 
parlour of the Feathers Tavern. 

"The harvest of 1739 had been an abundant one, 
and the export of grain had been large. At Lady Day 
the price of wheat had been 31s. 6d. per quarter, and it 
rose 10s. before Lady Day, 1740. An extremely severe 
winter had intervened, another of the three memorable 
winters of the eighteenth century. The autumn- 
sown wheat was destroyed by the prolonged and in- 
tense frost, and the price at Michaelmas, 1740, rose to 
56s. per quarter, the exportation being at the same time 
prohibited, but not until every available bushel had 

3 



34 THE LONDON HOSPITAL 

been sold to the foreigners. The long cold of the 
winter of 1739-40 had produced much distress and 
want in London, Norwich, Edinburgh, and other 
towns. In London the mortality for 1740 rose to a 
very high figure — 30,811 — of which 4,003 deaths were 
from fever and 2,725 from smallpox. In mid-winter, 
1739-40, coals rose to £3 10s. per chaldron, owing to 
the navigation of the Thames being closed by ice ; the 
streets were impassable by snow, there was a ' frost- 
fair ' on the Thames, and in other respects a repetition 
of the events preceding the London typhus of 1685-86. 
The Gentleman'' s Magazine of January, 1740, tells in 
verse how the poor were ' unable to sustain oppressive 
want and hunger's urgent pain,' and reproaches the 
rich — ' colder their hearts than snow, and harder than 
the frost '; while in its prose columns it announces that 
' the hearts of the rich have been opened in considera- 
tion of the hard fate of the poor.' 

" The great epidemic of fever in 1741-42 was the 
climax of a series of years in London all marked by 
high fever mortalities. If there had not been some- 
tliing peculiarly favourable to contagious fever in the 
then state of the capital, it is not likely that a temporary 
distress caused by a hard winter and a deficient harvest 
following should have had such effects. This was 
the time when the population is supposed to have stood 
still or even declined in London. 

" Drunkenness was so prevalent that the College of 
Physicians, on January 19, 1726, made a representa- 
tion on it to the House of Commons through Dr. 
Freind, one of their Eellows and member for Launceston : 
" ' We have with concern observed for some years 
past the fatal effects of the frequent use of several 
sorts of distilled spirituous liquor upon great numbers 
of both sexes, rendering them diseased, not fit for busi- 
ness, poor, a burthen to themselves and neighbours, 



THE SICK POOR IN EARLY DAYS 35 

and too often the cause of weak, feeble, and distem- 
pered children, who must be, instead of an advantage 
and strength, a charge to their country.' 

" ' This state of things,' said the College, ' doth every 
year increase.' Fielding guessed that a hundred 
thousand in London lived upon drink alone ; six gallons 
per head of the population per annum is an estimate 
for this period, against one gallon at present. 

" The mean annual deaths ivere never higher in London, 
not even in plague times over a series of years, the 
fever deaths keeping pace with the mortality from all 
causes, and, in the great epidemic of typhus in 1741, 
making about a fourth part of the whole. The populace 
lived in a bad atmosphere, physical and moral." 

We may take it, then, that there was special poverty 
and special distress ; and here is one of the causes. 
Arbuthnot said, in 1733, " that the very first considera- 
tion in building of cities is to make them open, airy, 
and well perflated," on which Creighton comments as 
follows : 

" In the growth of London from a medieval walled 
city of some forty or sixty thousand inhabitants to 
the ' great wen ' of Cobbett's time, these considerations 
had been little attended to so far as concerned the 
quarters of the populace. The Liberties of the City 
and the out-parishes were covered with aggregates of 
houses all on the same plan, or rather want of plan. In 
the medieval period the extramural population built 
rude shelters against the town walls, or in the fosse, if 
it were dry, or along the side of the ditch. The same 
process of squatting at length extended farther afield, 
with more regular building along the sides of the high- 
ways leading from the gates. . . . The out-parishes 
were covered with houses and tenements of aU kinds, 

3—2 



36 THE LONDON HOSPITAL 

to which access was got by an endless maze of narrow 
passages or alleys ; regular streets were few in them, 
and it would appear from the account given by John 
Stow in 1598 of the parish of Whitechapel that even 
the old country highway, one of the great roads into 
Essex and the Eastern Counties, had been ' pestered.' " 

And Creighton says later : 

" But that which helped most of all to make a foul 
atmosphere in which the contagion of fever could 
thrive was the window-tax. It is hardly possible that 
those who devised it can have foreseen how detri- 
mental it would be to the public health ; it took nearly 
a century to realize the simple truth that it was in 
effect a tax upon light and air." 

It was high time some properly equipped organization 
was created to meet and fight this army of distress, 
disease, and death ! 

And what of the medical profession at this time ? 



CHAPTER III 

medicine and surgery at the time of the 
hospital's foundation 

At the time of Rahere the clergy were the doctors, and 
the healing art in England remained in their hands for 
some centuries after Rahere's day — at any rate so far 
as medicine v/as concerned. By an edict of 1163 the 
clergy were forbidden to perform operations which in- 
volved the shedding of blood. Surgery, therefore, passed 
out of their hands — into the hands of the barbers ! 

It was not good for medicine that it should be left 
in the hands of the monks. The Church wished to 
maintain " a superstitious atmosphere by its own 
system of miraculous healing," and there could be no 
growth in true knowledge in such an atmosphere. 
Writing in " System of Medicine," Dr. Payne says, 
although speaking of an earlier date : 

" The Church, while it condemned the Oriental magic, 
without doubting its power, as being of Satanic origin, 
maintained a superstitious atmosphere by its own 
system of miraculous healing. For the impious 
charms and magical rites of the heathen were substi- 
tuted invocations of saints, pilgrimages to sacred 
shrines, and the like. To put trust in these methods 
was held to be more pious as well as more efficacious 
than to have recourse to secular medicine. Miraculous 
cures happened every day." 

37 



38 THE LONDON HOSPITAL 

In the same article he points out that there was one 
branch of the ancient medicine which never entirely 
died out — the knowledge of medicinal herbs : 

" Among the late Latin medical writings we find 
herbals. . . . These books were the manuals of the 
Benedictine monks, who, while cherishing some re- 
mains of the old medical lore, were never without a 
herb garden to provide their simple remedies, which 
were ever at the service of the poor. The herbal 
medicine steadily held its ground, and was one of the 
foundations on which this low reconstruction of medical 
science was based." 

Chaucer's description of the doctor was a fairly 
accurate description for some hundreds of years after 
the " Tales " were written : 

" With us ther was a Doctour of Phisik, 
In all this world ne was ther noon hym Hk, 
To speke of phisik and surgerye ; 
For he was grounded ia astronomye. 
He kepte his jjacient a ful greet deel 
In houres, by his magyk natureel. 
Wei koude he fortunen the ascendent 
Of his ymages for his pat ient. 
He knew the cause of everich maladye, 
Were it of hoot or cold, or moyste or drye, 
And where they engendred and of what humour ; 
He was a verray parfit practisour. 
The cause y-knowe and of his harm the roote, 
Anon he yaf the sike man his boote. 
Ful redy hadde he liis apothecaries 
To sende him drogges and his letuaries, 
For ech of hem made oother for to wynne. 
***** 
Of his diete mesurable was he, 
For it was of no superfluitee, 
But of gi'eet norissyng and digestible. 
His studie was but Utel on the Bible." 



TREATMENT IN EARLY DAYS 39 

" There was little advance until the beginning of the 
seventeenth century. The doctor was influenced, not 
by reason and research, but by superstition and theory ; 
not by facts observed, but by an appeal to authority 
and dogma. 

" The method of advancing knowledge was by dia- 
lectical reasoning. And whatever may have been the 
case in philosophy, there can be no doubt that in 
physical science and medicine the syllogism was not 
only an ineffectual instrument, but actually a hindrance 
to progress," 

A remedy blessed by the patronage of royalty was 
deemed to be most efficacious. Henry VIII. devised 
plasters and decoctions. Here are some : 

" The Kinges Majesties owne piastre, a black piastre 
devised by the Kinges Hieghness, a piastre devised by 
the Kinges Majestie at Grenewich and made at West- 
minstre to take awaye inflammacions and cease payne 
and heale excoriations, a decoccioun devised by the 
Kinges Majestie, a cataplasme made ungtment-lyke 
of the Kinges Majesties devise made at Westminster " 
(Wheatley). 

Charles I. treated 10,000 patients for "glands of neck" 
by the royal touch, and Charles II., although somewhat 
sceptical, continued to " treat " patients in this way. 

Dr. Creighton notices that, although during the 
various epidemics which from time to time swept the 
country the doctors made more or less desultory notes 
on the cases, all interest appeared to cease when the 
epidemic was over. Nothing seems to have been 
learned by experience ; scientific search for causes from 
observed effects was lacking. 

But in the beginning of the seventeenth century 



40 THE LONDON HOSPITAL 

some notable advances were made. Harvey discovered 
the circulation of the blood in 162L Francis Bacon 
lived, and " his influence on the progress of medicine, 
though indirect, was considerable." 

Gradually the spirit of investigation and inquiry was 
spreading ; superstition was dying out. 

The greatest physician of the seventeenth century 
was Sj'denham, and his method of studying disease 
illustrates weU the change which was coming — indeed, 
had come, since the days of Henry's wonderful 
plasters. He held that — 

" First, diseases are objects of natural history which 
have to be studied by observation alone, without trying 
to ascertain their remote causes and without framing 
hypotheses. The description of a disease must be 
complete, including all its features, mere narrations of 
individual cases being insiiificient and unimportant. 
Diseases have their own natural laws, their own course, 
their times and seasons. In acute diseases there is a 
rise or climax and a spontaneous decline. Secondly, 
Nature is the true healer of disease ; the physician has 
to imitate her processes of cure, to aid them if they 
appear weak, and to moderate them if they are too 
violent. A disease is, in fact, an effort of Nature to 
expel the morbific matter. In therapeutics experience 
is the only test of what is right. Whatever does good 
is best." 

But as yet there was no regular clinical teaching in 
England, although medical schools and organized 
medical study had sprung up on the Continent. 

In the eighteenth century, from the middle of which 
the London Hospital dates, and which has been called 
" the century of enlightenment," the most important 



TREATMENT IN EARLY DAYS 41 

factors of advance were the organization of medical 
teaching all over Europe, the rise of morbid anatomy 
to the position of a science, and the elucidation of a 
number of special diseases due to these improvements 
(Payne). And we shall see that soon after the Hos- 
pital's foundation a medical school attached to the 
Hospital was inaugurated, now one of the oldest in 
London, and the first in which a complete course of 
medical education was established. 

It has been pointed out that, when the clergy were 
forbidden to perform operations which necessitated 
bloodshed, the barbers became the surgeons. So early 
as 1310 barbers were appointed " to keep strict watch 
at the City gates so that no lepers should enter the 
city," although one would have thought that this was 
more the duty of the physician than the barber. 

If it can be said that the monks fostered superstition, 
the behef in miracles, voices, appearances, incubation 
(or temple sleeping), for the good of the Church and the 
benefit of their own Order in particular, it must also 
be said that the barbers worked on the credulity of the 
public, not for the good of the Church, but entirely for 
the good of their own pockets. The textbooks of the 
masters took less care to teach the disciples how to cure 
the patient than to teach them how to extract fees. 

Arderne, one of the first writers on English surgery, 
teaches his pupils " to beware of scarse askings," states 
what he should charge " a worth}^ man and a great," 
and also " a lesse man." The fees he suggests are 
preposterous. Concerning him Mr. Wheatley writes : 

" He counsels doctors to be careful in estimating the 
length of time of a cure — in fact, to suggest double 



42 THE LONDON HOSPITAL 

the time they expect. If the patient wonders at the 
rapidity of cure, and asks, ' Why that he putte hym so 
long a tyme of curyng, sithe that he helyd hym by the 
halfe ? Answere he, that it was for that the pacient 
was stonyherted and sufEred wele sharpe thingis, and 
that he was of gode complexion, and hadde able fleshe 
to hale, and feyne he other causes pleasable to the 
pacient for pacientez of syche wordez are proude and 
dehted.' Arderne's instructions for the guidance of 
doctors are very sensible, and they help to form us 
a correct estimate of the manners of the public who 
were patients." 

Dr. Poore, after giving an analysis of the surgeon's 
work, writes : 

" It is evident that John of Arderne was a con- 
summate man of the world, and knew all the tricks of 
his trade. His fees seem to have been enormous, and, 
indeed, he is only one of many examples among our 
early professional forerunners who made very large 
professional incomes." 

I am indebted for the following notes on the 
barber-surgeons to an article in the London Hos- 
pital Gazette of May, 1894, by Mr. Jonathan 
Hutchinson. 

The red lamp now seen over the doctor's door was 
originally a bottle of blood, but in the fourteenth cen- 
tury the custom of putting blood in the window was 
forbidden, and the barber " who was so bold or so hardy 
as to put blood in his window was fined two shillings." 
A Guild of Barbers was founded in 1308. A Guild of 
Surgeons also existed from very early times in London ; 
they appear to have been a very select and exclusive 



TREATMENT IN EARLY DAYS 43 

body, superior to the common barbers — consultants, 
perhaps. Mr. D'Arcy Power says : 

" The Guild of Surgeons was always a small body, 
probably never more than twenty in number, and 
sometimes dwindling to less than a dozen." 

The Guild of Barbers and the Guild of Surgeons were 
constantly quarrelling. The barbers were jealous 
because certain of the surgeons, aldermen of the 
Surgeon's Guild, were sworn before the Lord Mayor, as 
master surgeons, that 

" they would well and faithfully serve the people, in 
undertaking their cures, would take reasonably from 
them, would faithfully follow their calling, and would 
present to the said Mayor and Aldermen the defaults 
of others undertaking cures, so often as should be 
necessary ; and that they would be ready at all times, 
when they should be warned, to attend the maimed or 
wounded, and other persons ; and would give truthful 
information to the officers of the city aforesaid, as to 
such maimed, wounded and others, whether they be 
in peril of death or not. And also to do all things 
touching their calling." 

On which Mr. D'Arcy Power comments : 

" It is certain that they took so wide a view of their 
duties as to harass the members of the Barbers' Guild 
who meddled with surgery. Thus in 1410 certain 
' good and honest folk, barbers of the city, appeared 
by their counsel in the private chamber of the aldermen 
and sheriffs, and demanded that they should for ever 
peaceably enjoy their privileges, without scrutiny of 
any person of other craft or trade than barbers, and this 
neither in shaving, cupping, bleeding, nor any other 



44 THE LONDON HOSPITAL 

thing in any way pertaining to barbery, or to such 
practice of surgery as is now used, or in future to be 
used, within the craft of the said barbers.' " 

The rival guilds combined in 1493, or, rather, " en- 
tered into a composition " (the composition recognizing 
the independence of the two fellowships) which lasted 
until 1745. 

In 1745 the surgeons seceded and formed the 
Surgeons' Company, which came to an end in 1796. 
In 1800 the Royal College of Surgeons was estab- 
lished. 

The old surgeon-barbers had very little legitimate 
opportunity of becoming skilled anatomists, or of 
teaching anatomy to their apprentices. They were 
provided with four bodies annually of those who had 
been executed. The beadle of the company used to 
attend public executions and select suitable subjects, 
the hangman being entitled to the clothes. The beadle 
was frequently attacked by the mob. 

''In 1740 a remarkable event occurred. A criminal 
named Duell had been hung at Tyburn, and his body 
duly removed for dissection. He had not been five 
minutes on the table when, to the consternation of 
everyone present, he showed signs of returning to life. 
He was bled, and other restoratives applied, with the 
result that after some hours he could be safely wrapped 
in a blanket and removed to Newgate, being subse- 
quently transported for life " (Mr. Jonathan Hutchin- 
son). 

Surely this may have been one of the topics discussed 
by our friends in the Feathers Tavern on that Sep- 
tember evening in 1740. 



TREATMENT IN EARLY DAYS 45 

The laws relating to the apprentices of the barber- 
surgeons were strange and interesting. 

" No barber or surgeon was to teach any but his 
apprentice, and no decrepit, diseased, or deformed 
apprentice was to be retained. . . . The apprentice 
corresponded to the modern medical student ; he was 
not allowed to wear a beard of more than fifteen days' 
growth under a penalty of half a mark, to be paid by 
the master. . . . Attendance at the four public dis- 
sections was compulsory, but the enforcement of the 
order must have been difficult. One Hugh Ward was 
summoned before the Court for his absence from 
lectures ; he then used opprobrious language and defied 
the Court, and was committed to the Compter ; but 
when the officer attempted to seize Mr. Ward, he 
' drewe his knife and swore he would sheathe it in his 
guttes and soe he made his escape from the officer.' " 

It is easy for us in 1910 to indulge in a cheap sneer at 
these worthies of the past groping about in the dark. 
After all, it is by their groping that we are in the light, 
or, at any rate, can see signs of the dawn. Perhaps 
some hospital official writing a hundred years hence 
will smile that we should have thought we were in the 
light. We hope he will judge us as we try to judge 
these men of long ago. We forgive their ignorance ; 
we admire their patience. What little material they 
had ! Chemistry, as understood to-day, was as yet 
unborn ; even oxygen had not been discovered. Cell 
structure was unknown. The presence of micro- 
organisms was unsuspected. The microscope as an 
agent for detecting disease was undiscovered. The 
functions of most of the organs was understood but 
partially, or wholly misunderstood. The need of anti- 



46 THE LONDON HOSPITAL 

septics was not appreciated ; indeed, the need of 
ordinary cleanliness was hardly considered of moment. 
The investigations of the modern pathologists were not 
dreamed of. Anaesthetics were unknown. Even the 
homely stethoscope was not used until 1815. 

The physician to-day enters the ward and proceeds 
to examine a case newly admitted — an obscure case. 
Behind him stand the physiologist, the bacteriologist, 
the chemist, the anaesthetist, the pathologist, the 
psychologist, and still others. 

Let us remember that Dr. Andree walked into his 
wards alone. 



CHAPTER IV 

EARLY DAYS. PRESCOTT STREET 

Let us return to the little company of men and their 
embarrassed treasurer whom we left wondering how 
the " intended Infirmary " was to be opened with only 
" one shilling in the Bank." They talked long, but 
as little good was to be done in this difficulty by talking, 
and as the Infirmary was not to be opened for a fort- 
night yet, they left it to Mr. Harrison to consider 
what should be done, and to report at the next meeting ; 
and then they immediately set to work to draw up 
some rules for the management of the new Charity. 
Their difficulty and their determination "to do the 
thing that's nearest " has been repeated a thousand 
times since in the history of the old place. Hopeless 
times have followed each other over and over again, and 
hopeful times have followed these, and the hopeless have 
always been turned into hopeful by the strong action 
and bright, unquenchable cheeriness of one man, and 
" The London " is what it is to-day because of the line 
of these men, apostolic successors to "John Harrison, 
Surgeon." One is reminded of the well-known Lines : 

" One who never turned his back, but marched breast-forward. 
Never doubted clouds would break, 

Never dreamed though right were worsted, wrong would triumph. 
Held, we fall to rise, are baffled to fight better, 
Sleep to wake." 

47 



48 THE LONDON HOSPITAL 

" John Harrison, Surgeon " (that is how he is gene- 
rally referred to in the old, faded minutes) would have 
been very much surprised to hear such words applied 
to him. There was nothing sentimental about him. 
He simply marched into the next little meeting of his 
friends, this time at the Black Swan Tavern, Bartholo- 
mew Lane, and said that he had managed to get ten 
guineas, and that he had called on the Duke of Rich- 
mond, made him interested in the movement, and 
obtained from him a promise to become an annual 
subscriber. 

The little house in Featherstone Street was opened 
as the " London Infirmary " on November 3, 1740. 
It was agreed that the Staff — the physician, surgeon, 
and apothecary — should attend the house daily from 
eight to ten on summer mornings, and from nine to 
eleven in winter. No medical man was resident, nor 
were nurses considered necessary. The man and wife 
who had been engaged were evidently thought com- 
petent to carry out all that was necessary between the 
visits of the Staff. 

Mr. Cole, the apothecary, agreed to attend on one 
afternoon a week " for the practice of midwifery and 
the distempers incident thereto." 

Subscribers agreed to meet at one of the taverns 
every Tuesday week at 7 p.m. to discuss details of 
administration, and all subscribers could attend these 
meetings. From among the subscribers a committee 
was chosen to meet at the Infirmary itself every 
Thursday in the morning, " to inspect and examine 
into the management of it." This weekly committee 
of the subscribers seems to have been the origin of 



EARLY DAYS. PRESCOTT STREET 49 

the present weekly meetings of the House Committee. A 
Mr. Josso was elected the first chairman at one of these 
weekly inspection meetings. He must have had some 
glimmerings as to the honour of the post he held, the 
first of a long list of fine chairmen, because " Mr Josso 
paid for one bottle of wine on his being chosen Chair- 
man of the Committee," a custom no longer existing. 
It ma}' be noted that the elected Staff were themselves 
subscribers to the Charity, and served on the committee. 

I have not been able to discover what was the 
number of beds for patients in this house. There 
could not have been many, however, as it will be 
remembered that the rent was only £16 a year. 

By January, 1741, the Infirmary had got well to 
work. Week by week a list of subscribers, all of five 
guineas, was read out. These subscribers were called 
managers or governors. 

A secretary, Mr. Richard Neil, was chosen. I am 
not impressed with the business abiHty of Mr. Neil. 
He never discovered, for instance, that a new year 
had begun before April or May had arrived, and this 
error in the date occurs in the minutes continually 
during the time he was secretary. The committee 
found him lax, too, or they would never have passed 
a minute to the effect that he must write up his minutes 
after a meeting " before he left the room " — necessary, 
perhaps, as the meetings always took place in a tavern. 
But what could the committee hope for ? They paid 
him ten guineas a year, and this is what he was ex- 
pected to do for his ten guineas : 

'" To reside near the Infirmary ; to write all letters to 
noblemen and others ; to attend all courts and com- 

4 



bo THE LONDON HOSPITAL 

mittees ; to attend the House Visitors twice a week 
from 11 to 1, and not to be absent without leave 
from the Chairman ; to collect subscriptions ; to keep 
a register of patients' names ; to keep the accounts ; 
to make out all summons ; and to perform all other 
work usually performed by secretaries." 

No wonder he applied for (and obtained) a " rise " 
to £25 per annum. Three years after his salary was 
raised to £40, " on condition that he act as Attorney 
or SoHcitor to the Charity in all such business in law or 
equity as this Charity may require." At last he came 
to a sad end so far as the Hospital was concerned. 
He embezzled £400 of the Charity's money. There 
must have been some strange and endearing quaUty 
about this happy-go-lucky, though hard-working, 
under-paid secretary, because " nine gentlemen guaran- 
teed to replace the £400 within two years, with interest, 
out of compassion for the unfortunate secretary, his 
wife and children, and the Court unmiimously decided 
that he continue secretary." His disgrace, however, 
overwhelmed him, and he insisted upon resigning. 

Everything was managed with the greatest care and 
economy. Evidently every penny was counted ; for 
instance, it " was agreed that a sum not exceeding 
£3 2s. lid. be spent for converting the wash-house 
into a kitchen " — not three guineas, be it observed, but 
one penny less. 

An account was now opened with Mr. Thomas 
Miners, banker, of Lombard Street. 

Within three months of opening the house in 
Featherstone Street the work had so increased that it 
became necessary to consider a change of abode, and 



EARLY DAYS. PRESCOTT STREET 51 

the treasurer was asked to make inquiries. He re- 
ported that he had found a house a httle east of Aid- 
gate, which appeared to be suitable. It was in Pres- 
cott Street, Goodman's Fields. The street still bears 
the same name, and is a turning out of Leman Street, 
to the left before one comes to the railway arch. 
The treasurer was asked to send his servant to call on 
all subscribers to collect outstanding subscriptions 
before " so extraordinary an expense " could be 
undertaken as a change of abode. The servant must 
have had a pleasant manner ; at any rate, he managed 
to collect the necessary subscriptions, and the house 
in Prescott Street was taken on a three years' lease at 
£25 per annum, " in the name of Mr. John Harrison, 
Surgeon." The move was made in May, 1741, the first 
house having been occupied for five months. 

The materia medic a of that time were limited. A 
few drugs only were in use — roots, leaves, and barks — 
but to have bought up an apothecary's shop, lock, 
stock, and barrel, for the benefit of the new Infirmary, 
for £14 10s., " according to the inventory delivered," 
speaks well for the business ability of the governors. 
Perhaps " Mr. Harris in Aylott Street in Goodman's 
Fields," who sold the shop, let his charms, nostrums, 
and formulae go at sale prices. The day was near 
when they would indeed be a drug on the market. 

Soon after the opening, in 1742, was made the first 
organized appeal for public help, which is interesting 
as showing what the founders wished to be the aim of 
the Charity. It was agreed — 

" That papers be printed with the following preamble 
on a half-sheet — viz. : ' There being an infirmary set 

4—2 



52 THE LONDON HOSPITAL 

on foot by subscriptions in Goodman's Fields for 
charitably relieving poor manufacturers, sailors in the 
merchant service, their wives and children, with medi- 
cine and advice in case of sickness or accident — for 
the assistance and promoting of so laudable a design, 
we do subscribe the sumes opposite our respective 
names.' " 

During this year (1742) a rule was made that certain 
diseases which were considered " unclean " should 
*' not be taken under the care of the Infirmary." It 
was agreed, however, that such cases might be treated, 
but not admitted. The interesting point about this is, 
that the arrangement may be considered to be the origin 
of the modern Out-patient Department. Of course, 
in time, all kinds of cases came to be treated as out- 
patients, and what led up to this will be seen later. 

A committee was now appointed from among the 
governors (subscribers of £5 5s.) to draw up a set of 
rules for the Infirmary. This committee communi- 
cated with St. George's Hospital, which had been 
founded seven years earlier, and had safely passed 
the critical period of infancy, and from the governors of 
that charity they received much assistance. They 
recommended the appointment of a " Grand or House 
Committee " of twelve subscribers of five guineas 
(governors) for directing and transacting all affairs 
relating to the Infirmary. This committee was to be 
elected by all the governors at a " Court " every three 
months, and was to sit weekly, electing its chairman 
at its first meeting. The recommendations were 
carried out, and the committee invariably met at a 
tavern ; and " the Crown Tavern, behind the Royal 



EARLY DAYS. PREvSCOTT STREET 53 

Exchange, and the Angel and Crown Tavern, White- 
chapel Bars," appear to have been the favourite 
houses. The House Committee soon made a rule of 
appointing two of their members to be, in turn, 
" House Visitors." 

The meetings always took place at seven in the 
evening, and it was wisely resolved that no business be 
done after 10.30. The meetings at these taverns seem 
to have been lacking somewhat in dignity. Once, 
after sitting too long, and possibly patronizing the 
house too well, a noble resolve was made not to hold 
these meetings at taverns any more, " it being repre- 
sented that it was improper." 

A kind offer, made by the Master of the Haber- 
dashers' Company, to lend a room in Haberdashers' Hall 
to the governors for their meetings was accepted, and 
for many years all the meetings of the governors were 
held at Haberdashers' Hall. 

As illustrating a fact which has often been noticed 
and urged as one of the greatest boons in the voluntary 
hospital system — viz., the long-continued and heredi- 
tary interest of well-known families with one or other 
hospital — it may be noted that on one of these com- 
mittees which sat within a year of the Charity's founda- 
tion (1741) there was a Mr. John Buxton, and from 
that day to this the committee has rarely been without 
a Buxton. Mr. Thomas Powell Buxton, who died in 
the year 1908, was chairman from 1857 to 1867, and 
treasurer from 1868 to 1878. His son, Mr. John Henrv 
Buxton, has worked for the Hospital with as much zeal 
as did his father. He was chairman from 1877 to 
1884, and treasurer from 1884 to 1903. A son of 



54 THE LONDON HOSPITAL 

JVIr, John Henry Buxton now serves on the House 
Committee. 

Many other names, household words in the 
Hospital 100 or 150 years ago, are still found on 
the committee to-day, or are connected wdth the 
Hospital in other ways — the Charringtons, the Han- 
burys, the Paulins, the Barclays, the Wigrams, and 
others. 

One of the first things which the first committee did 
was to introduce a book in which to insert names of 
donors of gifts in kind, and such a book stands on the 
table to-day at every Board Meeting. One looks up 
the first entry in the hope that some beautiful and 
romantic gift might have been entered, a worthy fore- 
runner to the hundreds of gifts which have been made 
to the Hospital later ; the entry, however, is an un- 
fortunate one : " Mr. Gascoigne presented a water- 
butt " — a useful gift, doubtless, but not romantic. 

Certain of the governors recommended the appoint- 
ment of all sorts of subcommittees — of accounts, of 
drugs, of contracts, etc. The House Committee was 
jealous of its honour, and would have none of them : 

" It is the opinion of this Committee that the weekly 
Board of this Infirmary is capable of transacting all the 
current business of auditing accounts, admitting and 
dismissing patients, and doing all the business usually 
done by Committees in other hospitals, without ap- 
pointing any other Committees or any part of the same." 

And they certainly seem to have given the most 
minute attention to details. Nothing escaped their 
notice ; for instance : " Agreed that 2s. 6d. be paid for 
a cap and strap to the pestle "; " Agreed that the 



EARLY DAYS. PRESCOTT STREET 55 

messenger bespeak 2 dozen candles "; " Agreed that 
an ink standish be bought for the dispensary." And 
everything was to be paid for within a week of purchase ; 
no running accounts were allowed. 

An interesting note occurs in the minutes about this 
time (May, 1741). It has already been stated that 
there were no medical schools attached to the hospitals 
in London. A man became a surgeon by being appren- 
ticed to a surgeon. Mr. Harrison asked that one of his 
apprentices might be allowed to study at the Hospital. 

" Mr. Harrison, the surgeon to this Infirmary, de- 
siring to enter Mr. Godfrey Webb as a pupil of surgery 
within the said Infirmary for the space of one year, it 
was ordered that the said Mr. Godfrey Webb be so 
entered on the books for one year from this day, and 
that if he be constantly attendant on the practice of 
this Infirmary, he shall have a certificate signifying this 
attendance, and for what space of time, from the weekly 
Committee of this Infirmary." 

In November, Mr. Cole, the apothecary, retired, and 
this same Mr. Godfrey Webb, who had only entered the 
previous May, was appointed apothecary in his place. 
Bearing in mind what could have been the extent of 
Mr. Webb's experience after only six months in the 
Hospital, one cannot but feel that it was hardly fair 
to place such important duties on his young shoulders. 
He was not to practise out of the house — the com- 
mittee were kinder to the outside public than to their 
own patients — he was to keep a proper stock of medi- 
cines in the dispensary (probably the pharmacopoeia 
was not large) ; he was to keep accurate account of his 
drugs ; he was to give full instructions to patients as 



56 THE LONDON HOSPITAL 

to their medicine ; he was" not to " lye abroad " nor 
be out after ten at night ; he was to bring no wife or 
child into the house ; he was to take no pupil. For all 
of which he was to receive £30 a year, 

" with a room, coal, and candles, and shall be permitted 
to have his food drest at the Infirmary, but shall board 
himself, furnish his room, and provide his own washing." 

About this time it was felt by the committee that 
some person should be engaged to look after the 
patients other than the man and his wife who were 
the caretakers of the house. It was beginning to dawn 
on the governors that patients needed nursing as well 
as the attention of the physician, surgeon, and apothe- 
cary. When one considers, however, the type of 
woman they chose for this important work, one is filled 
with curiosity as to what they expected such a woman 
to do. I believe as a class they did much more harm 
than good, certainly for the first fifty years, and the 
great Blizard's strong denunciation of them, years after 
the time we are now speaking of, cannot but make one 
feel that they were a hindrance to the surgeon rather 
than a blessing. 

The first nurse ever appointed at the London 
Hospital was called " Squire," simply " Squire." She 
is not even honoured with " Mrs. " or " Miss." She 
certainly was not " Miss," for nurses then were in- 
variably broken-down and drunken old widows. 
" Squire " was paid 5s. a week, and lived out ! The 
committee also engaged a night nurse at a rather lower 
salary — 3s. 6d. per week. The night nurses were 
acknowledged at the time to be of even a lower grade 



EARLY DAYS. PRESCOTT STREET 57 

than the nurses. They were called " watches," and, if 
good, might hope to work up to the position of " nurse " 
some day. It was strange that the least experienced 
woman was on duty at a time when help could least 
easily be obtained. The first minute referring to this 
honourable society of topers — they were confessed to 
be inclined " to drink," at a time when everyone 
drank — was as follows : 

" Squire was reported to have taken money from 
patients ; she was not dismissed, however, as it was not 
in the rules that she should not do so. She promised 
not to do so again." 

From this date (1742) there is hardly a meeting of the 
committee but some nurse or watch was dismissed 
for drunkenness, although they were repeatedly for- 
given. The type of woman thought good enough may 
be inferred from the fact that the head nurse, who was 
called matron, was the wife of the hall-door porter ! 

" It was agreed that the matron and the messenger 
be allowed their diet from this day at the rate of a 2d. 
loaf per day, and double the quantity of cheese or 
butter allowed to patients." 

The matron's salary was £15 per annum. It is 
evident that the type of woman engaged was not above 
extorting various gifts from patients whom they were 
nursing, and who were completely at their mercy. A 
system of blackmail existed. The committee found 
that a nurse had refused to bring the most ordinary 
necessities to patients without promise of a " tip." 

The first matron (Mrs. Ehzabeth Gilbert) was paid 
6d. a day by the committee for each patient, with 



58 THE LONDON HOSPITAL 

which she was to provide food. It was found that she 
had practically starved the patients, and the little she 
had supplied them with had been given at the expense 
of local tradesmen, with whom she had run up accounts 
and then decamped. After this the committee decided 
to do their own catering, and asked for tenders. 

It was decided in 1743 to make the nurses and 
watches resident, and their salaries were £6 per annum 
for a nurse and £4 for a watch. This salary could 
even then hardly be expected to attract superior 
women, physically, mentally, or morally. Sarah 
Spencer was engaged, but Sarah Spencer was discharged 
Avithin a week because she was found to be " lame in 
her arm." Two others saw no harm in petitioning the 
committee, " praying for some cordials." The com- 
mittee discharged one of them, as she was under the 
influence of cordials when she appeared before them. 
They forgave the other, however, " on her submission." 
I think the committee were beginning to be doubtful 
whether nurses and watches were a success, because 
they advertised " for a sober, grave person who is 
capable of acting as a nurse." One of the ladies en- 
gaged as the result of this advertisement was very soon 
dismissed, for reasons that are not fully explained, 
although hinted at, and to have described herself as 
either " sober " or " grave " could, under the distress- 
ing circumstances, hardly have been strictly accurate. 
The committee raised the salary to £7 for nurses and 
£5 for watches as an attraction, but there was no 
improvement. Perhaps the accommodation was not 
good, for the House Visitors report " that the nurses 
receive their friends in the room in which the watches 



EARLY DAYS. PRESCOTT STREET 59 

sleep, to the disturbance of their rest," and it was 
ordered that in the future nurses " should receive their 
acquaintances in the kitchen !" What could the 
committee expect ? They certainly got what they 
deserved. 

I shall speak of the birth and growth of the profession 
of sick-nursing in another chapter. 

Mr. Harrison, partly from ill health and partly be- 
cause of the increasing amount of work in the Infirmary, 
asked in 1743 that he might have an assistant for 
iielping in the work. This was quite a different thing 
from the appointment of an assistant-surgeon to the 
Infirmary. Nowadays a surgeon who is appointed on 
the staff is called assistant-surgeon for seven years, and 
afterwards a surgeon. But Mr. Harrison wanted per- 
mission for someone to assist him in his work and obey 
his orders. The request was granted, and such a man 
was appointed for one year. Evidently the experiment 
was satisfactory in every way, for next year the 
committee recommended the permanent appointment 
of an assistant-surgeon " upon the same foot as they 
are at St. Bartholomew's." 

It is interesting to note that Harrison, who knew 
nothing about micro-organisms or of sepsis, found that 
the result of his operations varied under different 
conditions, and it is significant that he should have had 
observation enough to urge the committee to remove 
all paper from the waUs of his wards, and have the 
walls varnished instead, " so that they can be washed 
down." We line the walls of our operating theatres 
to-day with glass tiles for that very reason. 

His zeal aroused jealousy, and his detractors reported 



60 THE LONDON HOSPITAL 

to the committee that he was full of fads, incompetent, 
neglectful, and unkind to his patients. The charge 
was even brought that he was dishonest, and appro- 
priated medicine from the dispensary for his own use. 
A subcommittee was appointed to look into this, and 
here is its report : 

" We find Mr. Harrison attends every day from 
about 11 to 1, except in summer-time, when he is 
out of town ; he used to get the apothecary to see his 
accidental cases, but some misunderstanding having 
lately arisen between them, Mr. Harrison has directed 
your beadle to send for him on any emergency ; failing 
Mr. Harrison, to go for the assistant-surgeon ; failing 
him, for the surgeon-extraordinary ; failing him, for 
any surgeon who -is a Governor. If all of these were out 
of the way, then such accidental patients have been 
dressed by Mr. Harrison's pupils. With regard to the 
complaint as to William Burridge, a patient, it was 
reported to the subcommittee that this patient was 
brought in as an accident, being a compound fracture 
of the leg ; that he was brought in at 3 p.m., and is 
stated not to have been seen till next morning ; the 
leg was then so swelled that it could not be set ; that 
no surgeon had attended him, or was sent for, pupils 
taking such care of him as they could, or thought proper, 
and that he was so much neglected that his groans 
disturbed the patient in the next bed. Your Com- 
mittee, on examination of these statements, found the 
facts to be as follows : The patient was brought in 
at 3 ; Mr. Harrison was out of town ; Mr. Wood (a 
pupil), who had served almost a year in the Hospital, 
besides a previous apprenticeship to a surgeon, v/ent 
to Mr. Jones, surgeon-extraordinary, who was not at 
home ; then to a governor who was a surgeon, and he 
was out of town too ; so Mr. Wood undertook the 



EARLY DAYS. PRESCOTT STREET 61 

patient himself, with the assistance of the other pupils, 
as he apprehended himself capable of it, and accord- 
ingly set his leg. Mr. Harrison saw the case next day 
and approved ; the patient did well for ten days, at 
the end of which he complained of his bowells and of a 
shivering, and that upon opening some abscesses which 
were found gathering in his leg, the discharge was so 
great that he lost his appetite and sank under it. The 
warmth of the weather was supposed to contribute 
not a little. Mr. Harrison had ordered him fish, 
chicken, or anything else he could eat, and large nose- 
gays to prevent his being affected by the stench of his 
leg, and that the man was thankful, and particularly 
so on the day of his death." 

We need not go into other complaints, although they 
are interesting reading enough. It is sufficient to quote 
that 

" ]Mr. Harrison, the surgeon-in-ordinary, hath acquitted 
himself to the satisfaction of this Court in point of 
practice and attendance on the patient, and hath dis- 
charged his duty in every respect." 

Nothing, however, could affect Harrison's popularity 
as a teacher, and every week or two he asked the 
committee's permission to introduce another and 
another pupil to the Infirmary for a year. They came 
from all parts of the country ; one, I noticed, was a 
Mr. Geoffrey Lang of Newton Abbot, in Devonshire. 
He was more popular as a teacher than was Dr. Andree 
the physician. 

Each pupil had to come before the committee and 
receive a printed charge, which was as follows : 

" Sir, you are recommended by our Physician (or 
Surgeon) to be entered on our books as a pupil under 



62 THE LONDON HOSPITAL 

him for one year. At the same time as we receive you 
as such I am to acquaint you that humanity to the 
patients and a conformity with the laws of this Charity, 
and a decent behaviour, is what the Governors expect 
from you, and which will intittle (sic) you to our 
friendship, and a certificate from the Board of your 
attendance and good conduct when your term shall be 
expired." 

The spiritual welfare of the patients was not neg- 
lected. The Rev. Matthew Audley, from the year 
of the Infirmary's foundation, had volunteered his 
services. He had read prayers twice a week, and had 
preached a sermon every fortnight, which the com- 
mittee always attended. He did not conduct services 
on Sundays, however, as he had his own church to 
attend to. For his kindly work, which was not 
noticed, apparently, for a long time, he was presented 
by the Court with — a surplice. Later he was made 
an honorary life governor, but it was many years 
before the Court gave him " an annual present of 
Thirty Guineas." The Bishop of Oxford was much 
exercised that there was no service on Sundays, and 
repeatedly wrote to the committee about it. The 
committee replied that they could not see their way 
to spend anything but on the health of the patients. 

They distinguished, evidently, between " an annual 
present " and a fixed salary to a chaplain. At last, 
however, on account of the frequent appeals of the 
Bishop of Oxford, persisted in during several years, 
Mr. Audley was appointed Chaplain to the Infirmary 
at £100 a year, and had to give his whole time to his 
duties, which, of course, included preaching on Sundays. 



EARLY DAYS. PRESCOTT STREET 63 

He gave up a good living to do so, but the Hospital 
work was near his heart. He held the post until his 
death in 1790, a noble and self-sacrificing record of 
fifty years. He was a quiet, unobtrusive man. In 
looking up the records for this little history I have 
become very familiar with his name ; it appears week 
by week in the faded, musty old minute-books, and 
when his name dropped out I felt I had lost an old 
friend. How many despairing and despondent suf- 
ferers did this good old man encourage and cheer during 
his fifty years of faithful service ! There is never 
reference to him but shows that he was loved and 
respected by all — a silent saint. 

There were many other silent workers in those early 
days of the Infirmary. One loves to picture them. 
Who was Mr. William Myre ? He certainly added a 
brick or two in the building of the great palace of 
healing we see to-day, for the committee passed a 
minute saying that " the success and happiness of this 
establishment is owing in a great measure to the in- 
defatigable zeal and industry of Mr. Myre," and asked 
him to accept a life governorship, " it being the only 
means we have of acknowledging the many services he 
has done." And there were others, too, too poor, per- 
haps, to give large donations, but who gave what labour 
they could. For instance, a Mi-. Meares, who was 
poor, but would make trusses for the patients gratui- 
tously, and who, so the minute says, " treated all 
patients sent to him in a compassionate and tender 
manner." The love which men had for the place was 
wonderful ; for instance. Sir James Lowther, a mem- 
ber of the committee who, lying ill — he had a leg 



64 THE LONDON HOSPITAL 

amputated — received a deputation of sympathy from 
the committee, and sent a message to the committee 
in reply " that he wished the greatest prosperity to 
this Charity, and that living or dying he would never 
tire of showing his regard to it." 

I cannot imagine that those dignified old merchants 
and bankers who considered their " friendship " suffi- 
cient reward for good conduct could have had a sense 
of humour, and yet there are symptoms of it in the 
minutes, as when a benefactor sent twelve bound books 
to the committee entitled " The Knowledge and 
Practice of Christianity Made Easy to the Meanest 
Capacities. " There were at the time twelve members 
of the committee, but they evidently did not think 
themselves of the " meanest capacity," so they ordered 
a copy to be chained in each ward " for the benefit of 
the miserable objects," 

When the Infirmary had been one year in its new 
home in Prescott Street its vigorous growth necessitated 
enlargement. As a baby it had soon outgrown its 
cradle, now as an infant its cot proved too confined 
for its rapidly increasing vigour. It had made a fine 
circle of friends. Every Bishop in England was on its 
subscription Kst, and every honoured name we know 
in contemporary history. Mr. Harrison, as usual, was 
the one who urged immediate extension. His sym- 
pathies were moved towards those unfortunate out- 
casts M'hom the governors decided ought not to be 
treated, and it was he who led the way in preaching 
that the duty of the Hospital was to ask three ques- 
tions of its patients — " Are you poor ?" " Are you ill ?" 
" Can we help you ?" and that it was not part of the 



EARLY DAYS. PRESCOTT STREET 65 

Hospital's duty to ask a fourth question — " Are you 
moral ?" So an extra house was taken and opened — a 
house always spoken of as the " Lock," a name which 
seems to be derived from " Loke," a house for lepers in 
Southwark. 

When the Infirmary had been opened one year a 
report of its work was published. One hundred and 
twenty-seven in-patients had been treated, of whom 
105 were said to have been cured, 12 were incurable, 
and there had been 10 deaths, a death-rate of 8 per 
cent. The total income for the year was £298 14s. 6d., 
and the expenditure £206 5s. 6d. The following are 
some of the items of the expenditure : 

Furniture, £29 5s. 4d. ; candles, £1 3s. 4d. ; firing, 
£11 8s. ; house-rent and taxes, £19 10s. ; salaries and 
wages, £27 15s. 5d. ; provisions, £27 lis. 6d. ; dispen- 
sary, £63 3s. Id. ; turnery, £1 3s. 5d. ; repairs, £15 Os. 3d. ; 
stationery, £9 15s. lid. ; and soap, 10s. 6d. 

Soap 10s. 6d. ! And yet a death-rate of only 8 per 
cent. The figures do not seem to commend the gospel 
of cleanliness. 

One cannot resist comparing these figures with those 
in the report of the London Hospital for 1908, although 
it almost seems " bad form " to boast of ourselves when 
talking of the pioneer work of these men. 

The in-patients treated numbered 14,781 ; the death- 
rate was 10*17 per cent. ; the total income was 
£149,735; the total expenditure was £111,799; and 
on the altar of cleanliness were placed the following 
gifts : Expenses of laundry, £6,100 ; cleaning and 
chandlery, £1,356 ; water, £296 ; and annual cleaning 
{i.e., spring cleaning), £2,924. 

5 



66 THE LONDON HOSPITAL 

The " abuse of hospitals," of which one hears so 
much to-day, is nothing new, evidently, for in 1744 
we find : 

" Relief is administered to persons capable of paying 
for their cure, under the specious pretence and cloak 
of poverty, and your Committee think it a duty in- 
cumbent upon them, as immediate trustees of this 
Charity, to seek a remedy for this growing evil." 

As patients were only treated on the recommenda- 
tion of a subscriber, a letter was sent to all subscribers 
begging them to take particular care to recommend 
only proper cases. The habit of subscribers sending 
cases up from the country for in-patient treatment, 
without first ascertaining that a bed was vacant, was 
as great a difficulty then as now : 

" Diverse persons from town and country having 
been sent by the Governors of this Charity to be ad- 
mitted as In-patients at a time when the house was 
full, which must be attended with charge to the patients 
for their conveyance, this [i.e., advertisement] to 
desire every gentleman who may have In-patients to 
recommend that thej^ would inform themselves of the 
steward or matron if there be room, that they may not 
meet with disappointment ; should there be no room 
in the house, patients will be treated as out-patients 
until there is a vacancy." 

And this last seems to have been the chief use of the 
Out-patient Department and the chief cause of its 
growth. It was for patients waiting for a bed. There 
is still a " waiting-list " to-day which numbers nearly 
500 names. I see that the committee were sometimes 
at expense in sending patients back to the country 
when sent up in this way. 



L O N D O N-l ,\ !•' I K M A R Y, 

Dr. H I B B i*N S, Phyjhian. 

IFedmfdayi^ 1\rid Fridays. 
The PATIENTS, tcJ* attend at Eleven o'Clock, 
(^/fj^^' : 4 /*y Patient's Niime. 

ThtP»TiiNTS, bting admitted wifiout any F.ipence. arc required :o be con- 
Ibnt in their Atwildance i and, when cured, to acknowledge the Beocfiu they 
hnve received at Chitpil, and at the next WVi.'jr Cc-Mitre. 

Patients not complying htrcwitji will nc\er be r.dniittcd again ^ but thofe 
who attend their Cure, and return Tlunk-., will receive a Ccrti.icitc tkcitof, 
which »u <; ! ::c them to tiOjttP.cUef lr«u thii Cuakity. 

/A/, , .y y/' ^ Chairman. 



^.' 



PATIENT S ADMISSION TICKET, 1747 




HOGARTH'S OPaGINAL DESIGN FOP BACK OF ADMISSION TICKET 



EARLY DAYS. PRESCOTT STREET 67 

The Hospital authorities soon learned the value of 
advertisement. All patients had to return thanks for 
their cure before the committee, and the governors 
were much hurt because some neglected to do so — 
" whereby the Charity appears less extensive in its 
good effects than it actually is." On the admission- 
card of each patient was the following, and the 
steward was to draw each patient's attention to the 
rule at the time of his admission : 

" The patients, being admitted without any ex- 
pense [this was not quite true ; each patient was 
charged one shilling " for the use of utensils "], are 
required to be constant in their attendance, and, when 
cured, to acknowledge the benefits they have received 
at chapel and at the next weekly committee. Patients 
not complying herewith will never be admitted again ; 
but those who attend their cure and return thanks will 
receive a certificate thereof, which will entitle them to 
future relief from this Charity." 

And when a patient had returned thanks " in the 
chapel and before the Committee," there was still more 
to be done ; a card was given him to give to the offici- 
ating clergyman of his own parish church, to be read 
out in the " Thanksgiving " on the Sunday following 
the patient's discharge : 

" A person having lately received great mercies from 
Almighty God by a cure at the London Hospital, 
desires to return humble and hearty thanks for the 
same." 

This custom made the Hospital well known, and 
the idea, not having been patented, is offered without 
fee or reward to all whom it may concern. 

5—2 



68 THE LONDON HOSPITAL 

In-patients who were convalescent were allowed to 
leave the Hospital during the day if they wished, re- 
turning to sleep at night. Patients with such leave 
constantly disappeared ; the sights they saw in hospital 
were evidently too much for them. The horrors of 
a hospital before the days of anaesthetics can easily be 
imagined. Such runaway patients had their names 
entered in a " black list," and were forbidden all further 
treatment. One, however, was forgiven, and the reason 
is curious : " On confessing his error, and it appearing 
he had lately lost a leg in the service of his country, 
he was pardoned." 

Smallpox was, of course, much commoner then than 
now, and much trouble was caused by these smallpox 
patients attending the Hospital and mixing with other 
patients. 

" Your Committee being informed that among the 
objects recommended to this Charity [patients were 
always spoken of as " objects " or " miserable objects "] 
many appear to have the smallpox, which being con- 
tagious, they cannot, according to the rules of the 
house, be received, and such patients being thereby 
exposed to great danger, it was moved that apphcation 
be made to the smallpox hospital to know on what 
terms they would receive these objects ; and Mr. Harri- 
son having, at the request of your Committee, waited 
on Sir Samuel Gower, the Treasurer of that Charity, 
reported that they had agreed to receive such poor 
under that complaint as shall be recommended by this 
Charity. It was decided, therefore, to subscribe ten 
guineas in the names of Dr. Andree and Mr. Harrison." 
(From the quarterly report of the House Committee 
to the General Court.) 



EARLY DAYS. PRESCOTT STREET 69 

I find about this time the first dietary scale referred 
to. Breakfast always consisted of " milk pottige " or 
" water gruel " only ; for dinner, boiled meat (always 
boiled) was given on alternate days, and boiled or 
baked pudding alone on alternate days ; for supper 
there was broth or " milk pottige." There was no 
selection of diets which could be used according to the 
patient's disease ; it was to be this or nothing — " it 
was agreed that no other diet be expected or allowed 
on any account whatever." 

The Infirmary now consisted of the original house 
and the one added known as the Lock. On account 
of the rapid increase in the work, it was proposed to 
take three more houses adjoining, in Prescott Street. 
After due consideration, this was done ; the extra 
houses were taken on a twenty-one years' lease at 
£15 a year each ; £300 was spent in alterations, one of 
which was that " the shed at the bottom of the garden 
be fitted up as a place for out-patients to wait in, so 
that they may be protected from the inclemency of the 
weather." Hitherto they had waited in the garden or 
street. 

One of the five houses soon came to be known as 
" The Jews' House " (1745), but there is no reference 
in the minutes to any special accommodation or diet 
prepared for them as yet. In the alterations there 
was little regard to hygiene, and the drainage was of 
the simplest. " As the frequent filling and emptying 
of the cesspool is a great expense, it is decided to let it 
drain into the other cesspool under the arbour.''^ A 
neighbour complained that the overflow from the 
Hospital's cesspool ran over his garden, as his ground 



70 THE LONDON HOSPITAL 

lay lower than that of the Hospital. The committee 
ended his complaint, but not the cause of it, by taking 
his garden at 40s. per annum. It was decided to build 
a dead-house (a room for post-mortems was built over 
this next year), a place for drying herbs, and a cold 
bath. A cold bath ! There was accommodation for 
sixty-eight patients besides the servants. 

Nothing was more noticeable in these years than the 
absolute disregard of all cleanliness, and one wonders 
how wounds healed at all. One pair of sheets only was 
allowed to each bed. How often could they have been 
washed, for beds were never empty ? To make a 
patient sleep in sheets in which his predecessor had 
died seems too horrible, but I am afraid it is true. 
The committee did seem to have some slight qualms 
about this ; at all events, the more fastidious of them 
expressed some slight fear lest beds in which patients 
died " might have retained part of the indignity of 
their distemper." 

An increase of the medical or surgical staff of this 
Hospital, or any hospital, nowadays is a matter of the 
most serious deliberation. The Staff is not paid, but 
the honour of belonging to the staff of a great hospital 
is so great that it is most jealously guarded. Certainly 
such an honour is not to be had for the asking. It is 
usually the result of many years of hard and gratuitous 
work for the Hospital. It does not seem to have been 
so in the days of which I am writing ; for instance : 

" The Chairman reported to the Committee that 
Dr. Cunningham had offered to attend as Physician 
Extraordinar}^ to this Infirmary, which, being moved 
and seconded, it was resolved that Dr. Cunningham be 



EARLY DAYS. PRESCOTT STREET 71 

desired to attend as Physician Extraordinary, and the 
thanks of the Court were returned to him for favouring 
the Hospital with his advice and attendance." 

Dr. James Hibbins, about the same time, also offered 
his services as Physician Extraordinary. Apparently 
Dr. James Hibbins was not quite up to the standard, 
for he was elected Assistant Physician. 

Dr. Cunningham died three years after (1749), and 
by this time the post of Physician to the London 
Infirmary appears to have come to be considered a 
desirable honour, for there were many candidates. At 
the Court to elect a successor 363 governors were 
present. Dr. John Sylvester headed the poll with 
242 votes, the other votes being distributed amongst 
the other candidates. He was called upon to make 
a speech, but his feeUngs at his success appear to have 
been too much for him, and all he was able to say, in 
returning thanks for his election, with reference to his 
future work, was " that he hoped to be able to acquaint 
the apothecary with a remedy for killing bugs," which 
shows, at any rate, that Dr. Sylvester was a very 
practical man. 

One of the committee's greatest worries was with the 
coroner, who constantly refused bodies to be buried 
" without sitting on them." As the committee had 
to pay his fee, which was thirteen shiUings, they very 
naturally objected to so much of this " sitting." For 
instance, the committee reported to the Court of 
Governors : 

" Your Committee having received into the Infir- 
mary a Swiss soldier who had been dangerously 
wounded, were afterwards informed of his death, and 



72 THE LONDON HOSPITAL 

that the Parish refused to bury him without the 
Coroner's warrant ; the Steward apphed to Mr. King 
[the Coroner] for that purpose, who refused to sit upon 
the body without his fee, notwithstanding there were 
no assets ; whereupon the Corps becoming obnoxious, 
the Committee wrote him the following letter : ' Sir, 
the Governors of this Charity have ordered me to 
acquaint you that they were in hopes you would have 
granted an order for the burial of a Swiss soldier (who 
is become a prodigious nuisance) without putting them 
to any expense, as they have nothing but the benefac- 
tions of charitable people, but they still hope you will 
be so good as to send it by the bearer, who has orders 
to satisfy you if you are not inclined to save this 
Charity that expense.' But he still refusing his 
warrant, the steward, pursuant with their letter, paid 
him his demand of 13s." 

The five houses in Prescott Street by 1746 were 
costing so much in upkeep and repairs (they were very 
old houses) that the committee began seriously to 
consider whether it would not be better to buy a site 
somewhere in a convenient neighbourhood, and build an 
infirmary of their own. This project will be con- 
sidered in the next chapter. 



CHAPTER V 

THE NEW SITE, WHITECHAPEL 

Soon after the foundation of the Infirmary in 1740 
there was instituted the custom of having an annual 
festival. 

At this festival a sermon was preached at one of the 
City churches in the morning, and then the whole con- 
gregation marched in procession to the Hall of one of 
the City companies or to one of the taverns, and dined. 
At the dinner the praises of the Infirmary were sung 
and donations collected. 

At many hospitals this custom of an annual festival 
still survives, although the sermon is dispensed with ; 
but it has ceased to be an annual function at the 
London Hospital for many years. 

In early days, however, the annual festival of the 
London Hospital was a very great event, and everybody 
who was anybody attended, from Royalty downwards. 
As some of these festivals had an important bearing 
on the Hospital's career, it may be of interest to 
describe the function in more detail. 

The " annual festival " was instituted in 1742 at 
the suggestion of " Mr. Harrison, Surgeon," and the 
arrangements made by him for the first festival were 
but very slightly altered after. The President of the 

73 



74 THE LONDON HOSPITAL 

Infirmar}^ (who at this time was the Duke of Richmond 
and Lennox) was asked to fix a date suitable for him to 
attend. Then one of the Bishops was appHed to, and 
asked to preach the annual sermon on the appointed 
day. On going through the records, one notices that 
the Hospital has been beholden to every Bishopric in 
England. The sermon was usually preached at Bow 
Church, in Cheapside. The first preacher was Dr. 
Maddock, then Bishop of St. Asaph, and afterwards 
Bishop of Worcester. 

After the sermon the whole company formed up in 
procession, and marched through the City amid 
pealing of church bells to the place chosen for dinner. 
The Halls of the Mercers', the Haberdashers', and the 
Drapers' Companies were favourite places, and so was 
the London Tavern. The procession itself was quite 
an imposing one, and, if it did no more, served to 
remind the City of the Hospital's existence. The 
procession was drawn up by the City Marshal, and 
included, in groups, the President and Vice-Presidents 
of the Hospital, the House Committee, the Physicians 
and Surgeons, the Lay StalBP (including the Hospital 
beadles, who were always presented with new uniforms 
for the festival), and the guests. A band accompanied 
them, and as one of the items of expenditure at these 
festivals was invariably " 72 yards of Garter blue ribbon 
from Mrs. Davenport in Whitechapel for favours and 
two dozen white wands for the Committee," the pro- 
cession must have given a gay and festive appearance 
to the City. In order, however, that there should be 
no undue levity on the part of City urchins, it marched 
under the protection of a large body of City Constables. 



THE NEW SITE, WHITECHAPEL 75 

The outburst of bell-ringing was not quite so spon- 
taneous, I fear, as the onlookers thought, or why do 
we find in an old notebook belonging to the Secretary, 
" For the bells of St. Botolph's, to commence at 10.30, 
two guineas ; for St. Michael's bells, as the procession 
passes, one guinea," and so on ? 

The dinner itself was always the gift of the " festival 
stewards " of the year. It was an expensive honour 
for them, and usually cost each of them from twenty to 
twenty-five guineas. The diners paid for their tickets, 
and this was a clear profit to the Hospital, as the 
stewards had provided the dinner. 

The ponderous meal began at five o'clock, but the 
stewards " were not expected to pay for wines drunk 
after midnight." Up to midnight, however, all were 
welcome and were expected to drink heartily, and it is 
recorded that " the Stewards decided to cover the 
tables with Port Wines ; that Madeira and Sherry be 
distributed discretionally, but Claret be only at the 
upper table." Strong beer was provided ad lihituin. 
Two " careful persons " were to be procured " to take 
care of the wine, one in the dinner-room to receive it, 
and one at the door to prevent its being carried away." 
This precaution was probably necessary, because the 
guests brought their own servants to wait on them, 
and these were provided with a dinner and one pint of 
wine each. At the later festivals this custom was 
put an end to on account of the expense to the 
stewards, who themselves found servants to do the 
waiting. It had been found that many persons joined 
the procession on its march through the City, and got 
into the dinner on the plea of being somebody's servant. 



76 THE LONDON HOSPITAL 

Musicians were usually engaged, and were allowed 
a dinner and a bottle of wine each. The " publick 
professional singers " were not always present, how- 
ever, the stewards sometimes deciding to be " satisfied 
with the volunteer songs of the company at large." 
Can one imagine it ? The Bishop who had preached 
the sermon, the Princes of Royal blood at the upper 
table, Members of Parliament and leaders in the army 
(I see both Pitt's and Wellington's name among the 
guests), sitting at a dinner which lasted from five 
until twelve, and " satisfied with the volunteer songs 
of the company at large " ! And what toasts ! No 
less than sixteen toasts are found on the list for one of 
these dinners. They included, after the Loyal Toasts, 
among others : 

Prosperity to the London Infirmary. 

Health to the Bishops of England. 

Health to the Nobility of England. 

Health of the Lord Mayor. 

Health of the House Committee of the London 

Infirmary. 
Health of the Stewards for providing this excellent 

entertainment. 
Prosperity to the City of London. 
Success to aU other Charitable Institutions. 
Prosperity to Trade and Navigation. 

No wonder the stewards had to " cover the tables 
with port wines " ! From the very first a separate 
table was provided " for gentlemen of the Hebrew 
Nation," the food being cooked by a Hebrew cook. 

At the first dinner £36 14s. 6d. was collected ; at 



THE NEW SITE, WHITECHAPEL 77 

the second, £82 ; and these collections grew year by 
year until they amounted to thousands of pounds. 
At the record Festival Dinner of 1856 £26,000 was 
promised and given. 

In all references to the Charity in the minutes up 
to the year 1747 it is called the " London Infirmary." 
After that date it is " The London Hospital." The 
reason for the change was some remarks made in the 
after-dinner speech of the Duke of Richmond at the 
Festival Dinner of 1748 : 

" The Duke was pleased publickly to drink to the 
success of this Charity under the title of the London 
Hospital, being pleased to declare that from the great 
encouragement now given it, and the extensiveness 
of its benefits to the poor, it deserved that appolation " 
{sic). 

The sermon preached by the Bishop of Worcester 
seems to have been particularly eloquent and successful 
in raising funds. During the three months following 
his appeal no less a sum than £650 was received in new 
subscriptions, traceable to the wide circulation of the 
Bishop's sermon. Copies had been sent to the Lords 
of the Admiralty, Lord Mayor and Court of Aldermen, 
the Trinity Masters, the Lieutenant of the Tower 
Hamlets, and to all the hospitals which had been 
founded about the same time. The success of the 
Bishop's sermon seems to have been due to its plain 
common sense ; there was nothing emotional or 
Utopian about it. It urged strongly that in view of 
the decrepit condition and costly upkeep of the five 
houses in Prescott Street, it was the clear duty of the 
governors to found a special fund, with the object of 



78 THE LONDON HOSPITAL 

buying a site and building a hospital of their own. 
He gave emphasis to his remarks by himself in- 
augurating the fund by sending " a draught on his 
goldsmith for £20." The governors were filled with 
enthusiasm at the Bishop's suggestion, and the follow- 
ing letter was circulated to all the nobility throughout 
the country : 

" The Lord Bishop of Worcester, out of his great 
regard to this Infirmary, has opened a subscription 
for raising a fund to erect a new building by the time 
the leases of the present premises shall expire, which 
will then be too old and ruinous to continue in longer. 
But tliis building will not be attempted until a sum 
sufficient be given for that purpose ; and in the mean- 
time the money accruing will be laid out at interest, 
and none be applied but for the particular use for 
which it was directed." 

The fund increased rapidly, and all donations were 
carefully invested. Three trustees were appointed, 
and within a year the Capital Fund had reached to 
over £5,000. (It was also called the Building Fund, 
the Benefaction Fund, the Bishop of Worcester's 

Fund.) 

Within two years there is the following report from 
the House Committee to the Quarterly Court : 

" Your Committee, having had it represented to 
them, and having considered that the design of the 
Bishop of Worcester's sermon was to inculcate the 
necessity of providing early for a building to the use 
of this Charity, and as the expenses attending the 
tenements at present occupied for that purpose leave 
no room to doubt they will be incapable of further use 



THE NEW SITE, WHITECHAPEL 79 

at or before the expiration of the present lease, 
apprehend we cannot too early secure a proper piece 
of ground for the same. And the more so as there are 
at this time convenient places for that purpose to be 
had, which may not offer should there be any delay. 
And as there is money enough vested in Trustees for 
that particular end, which being purchased, a proper 
plan and estimate of such intended building may be 
layed before this Court for their approbation, to be 
then engraved on a copper plate and copies thereof 
dispersed amongst the Governors of this Charity, and 
others inclinable to promote it, and at the same time 
convince the world that there is nothing ostentatious, 
sumptuous, or unnecessary intended . . . wliich, we 
conceive, will greatly tend to hasten the execution and 
completion of the same. To which purpose it is 
further humbly submitted that certain gentlemen be 
appointed to take upon them to examine into and 
procure such piece of land in the cheapest and best 
manner they can by a full authority from this Court, 
as a purchase of this kind will require great manage- 
ment, secrecy, and expedition." 

A subcommittee was at once formed to look for a 
suitable site, and in reading the various reports of this 
subcommittee one sees by how small a chance the 
London Hospital is where it is to-day. A site in Lower 
East Smithfield was examined and reported on, and 
disregarded because it was thought to be too small. 
A site on the north side of Whitechapel Road, " a 
httle to the eastward of Whitechapel Church," was also 
considered. Then negotiations were entered into with 
regard to a piece of land " situated near that part of 
Tower Hill commonly known as the Ditch Side," but 
these, too, fell through. Sites were advertised for, 



80 THE LONDON HOSPITAL 

inspected, reported on, and declined during a period of 
six months. In June, 1748, Mr. Robert Mainwaring, 
an architect and member of the committee, was asked 
to look for a suitable piece of ground, and he reported 
" that the only thing he had met with suitable for the 
occasion is situated near Whitechapel Road, commonly- 
known by the description of the Mount Field and 
Whitechapel Mount." Mr. Mainwaring further dis- 
covered that the premises were now possessed by 
Mr. Samuel Worrall, " a bilder," under a lease from 
the City for sixty-one years from midsummer, 1740, 
Tliis lease would expire, therefore, in 1801. Mr. 
Worrall paid to the City a yearly rent of £26. The 
City, so Mr. Mainwaring reported, were not the 
freeholders, but had the same on lease from Lady 
Wentworth for 500 years, of which he believed 
about 440 were yet to come. He had interviewed 
Mr. Worrall, who would be willing to assign his 
interest therein for £750, he having at this time 
(1748) fifty-three years to come in his lease from 
the city. 

Mr. Mainwaring's report was not favoured by the 
committee. There were strong objections to the site. 
What was the good of a hospital standing out in the 
fields all by itself ? How could patients be expected 
to come to so lonely a spot ? Was it fair to ask the 
physicians and surgeons to come, especially at night, 
for Whitechapel Road was one of the great roads out 
of London, the main artery to the Eastern Counties, 
and was infested by highwaymen, footpads, and riff- 
raff of all kinds, ready to rob unprotected wayfarers 
coming in to or leaving London ? Moreover, the com- 




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THE NEW SITE, WHITECHAPEL 81 

mittee thought Mr. Worrall's price unreasonable 
altogether. Mr. Mainwaring's suggestion for a site 
was not approved, and the committee continued their 
search for another six months. At Christmas Mr. 
Worrall offered to sell his interest in the piece of land 
at Whitechapel Mount for £500 (instead of £750), but 
" this was unanimously rejected as unreasonable." 

A year after this — viz., September, 1750 — the com- 
mittee were still advertising and still unsuccessful. 

At last, 1751, the committee, in despair, again 
opened negotiations with Mr. Worrall, and were in- 
clined to take his piece of land. They could find no 
other at all suitable. The chief attraction was the 
fact that this site had land behind it right to the 
river, which was offered to the committee, and which 
was likely to become of value as a building estate. 
After much delay we find the following : 

" The Committee recommend that Mr. Samuel 
Worrall be given £800 for his term of the piece of 
ground and improvements thereon which he holds of 
the City of London, situate at and near the White- 
chapel Mount, subject to the rent of £26 a year paid 
by him to the City for the same, provided that the 
City should, after the expiration of the term granted 
to Mr. Worrall, grant to this Charity the remainder 
of their term in the said premises." 

The Court agreed that this was the best that could 
be done, and it was arranged that a deputation from the 
Hospital should attend the Committee of City Lands 
to lay the proposal before them, which was done. The 
deputation was well and kindly received, and the Com- 
mittee of City Lands promised to put the matter before 

6 



82 THE LONDON HOSPITAL 

the Court of Aldermen and Common Counsel, urging 
that the request of the Hospital authorities be granted : 
Within a month is the following minute : 

" The Court of the Lord Mayor, Aldermen, and 
Common Counsel concur with their Committee of City 
Lands to grant to this Charity their reversionary term 
of the premises which lye eastward of Whitechapel 
Mount, after the expiration of Mr. Worrall's term 
therein, subject to the rent of £15 a year for the same." 

The governors had to contract " that the site should 
be used for the building of an Infirmary, and not for any 
other purpose," and it was one of the conditions in the 
lease — and this seems to have been overlooked — " that 
the arms of the City be set up on all future Buildings." 

The City's reversionary term was granted to lessees 
" wliich are named and accepted, as no agreement 
could be made with the President and other Governors 
of this Charity, not being incorporated." 

The names of the lessees are given, and among them, 
of course, is " Mr. John Harrison, Surgeon." It may 
be noted in passing that the inconvenience caused in 
this transaction on account of the Charity not being 
incorporated drew Mr. Harrison's attention to the 
necessity of a charter. 

So to-day the greater part of the ground on which 
the Hospital is built is leased from the City. It is 
that portion, consisting of the whole frontage, extend- 
ing from Turner Street on the west to East Mount 
Street on the east, and back to about a line drawn 
between these streets running through Queen Alex- 
andra's statue. The lease ends, it may interest readers 
to know, on September 26 in the year 2166. What 



THE NEW SITE, WHITECHAPEL 83 

will the Hospital do then ? The City will not be able 
to renew the lease, because the City's lease from Lady 
Wentworth ends five years later. Our successors will 
have to note that it is in the lease that, when the 
property returns to the City, " the bolts and locks 
are to be in good order." 

The governors, having now obtained the site, lost 
no time in getting to work on the building. A new 
Building Committee was appointed, on which, by-the- 
by, sat the Archbishop of Canterbury. 

Very definite instructions were given to this Building 
Committee by the Court, No contract exceeding £100 
was to be entered into unless at least thirteen of the 
Building Committee were present ; no plan for the 
new building was to be accepted until laid before a 
Greneral Court, nor was any expenditure exceeding £500 
to be incurred without the permission of the Court, 
which the committee were empowered to summon at any 
time. No business at all was to be undertaken by the 
Building Committee unless seven members were present. 

The Building Committee were fortunate in being 
able to let the houses in Prescott Street for the un- 
expired part of the lease, through Mr. Mainwaring, 
who was now appointed Surveyor to the Hospital. 

On September 25, 1751, the Building Committee 
reported as follows : 

" That after having unanimously resolved that a 
building ought to be erected for the use of this Charity, 
they had desired Boulton Mainwaring, Esq., your 
Surveyor, to prepare a plan or plans of a building 
for the reception of patients, with proper offices, who 
accordingly laid before your Committee at their last 

6—2 



84 THE LONDON HOSPITAL 

meeting five several plans, two of which, one for the 
reception of 396 patients, and the other for the recep- 
tion of 366 patients, each with proper offices, were 
approved of ; and Mr. Mainwaring was desired to 
make some calculation what the expense of erecting 
each plan might amount to. Who accordingly at the 
next meeting informed your Committee. But they 
being of opinion that the expense was more than the 
Charity ought in its present circumstance to engage 
in with prudence, and that a building without orna- 
ments, not so large, and to contain accommodation 
for a smaller number of patients, might be sufficient 
for the present, desired Mr. Mainwaring to prepare a 
plan as near as he could conformable as to convenience 
and elevation with that for the reception of 396 patients, 
but not so large, and which should be capable of further 
extension and enlargement if at any future time there 
should be occasion for it, and to give a calculation of 
the expense. The said gentleman was also desired 
to take the opinion of your physicians and surgeons, 
and to make the rooms no higher than they should think 
necessary for the health of the patients." 

After submitting several plans, one was at last 
accepted both by the Committee and the Court. It 
provided accommodation for 350 beds. Nearly all 
the wards had a south aspect (the wards were in the 
main building, facing south — i.e., over the present 
quadrangle ; the wards in the present wings face almost 
due east and west). The wards would be well away 
from the dust " of one of the most frequented roads," 
and sheltered from the cold winds ; the building would 
be continuous, so that " the physician, surgeon, and 
apothecary might at all times attend the patients in 
all parts of it without danger, to which they might be 



THE NEW SITE, WHITECHAPEL 85 

exposed by their attendance in different detached 
parts, as proposed by the former plan "; the front was 
to be parallel with the highroad, " with an area of 
above 20 feet between for the coaches and chariots of 
the Governors." An engraving of this approved plan 
was to be prepared and circulated amongst the 
governors and to all guests at the ensuing feast. 
It was decided that the building was to be erected 
" under the immediate care and supervision of Mr. 
Mainwaring. " He was asked to examine the site as to its 
suitability for building. He did so, and reported that it 
would be necessary to go down 18 feet for a foundation. 
The method adopted for the erection of a large 
building in those days strikes us as peculiar. Now 
an architect would be asked to prepare a set of plans ; 
specifications would be drawn up, and tenders invited, 
and one contractor would erect the whole building. 
This was not how they arranged matters then. In- 
quiries were first made as to what amount there was 
in the Building Fund available. It was agreed that 
there was sufficient to dig the foundations and raise 
the sheU of the building to the first floor. An adver- 
tisement was inserted asking bricklayers to tender 
for their work, carpenters for theirs, and later, 
plumbers, masons, and painters. Each tradesman 
was to be paid for his own work, and all to 
work under the direction of the Hospital surveyor. 
The Building Committee were empowered to draw 
from the Building Fund, " but care must be taken that 
the contracts do not exceed the whole of the money 
appropriated for the building." When the money was 
spent, the building was to be stopped until more funds 



mfmmmwl^^ )' ^ ||| ^m)^»->!^^irm ■. 













"A 



THE NEW SITE, WHITECHAPEL 87 

were raised. At last, as the Building Committee 
reported, " the foundation of the Hospital began on 
the 11th day of June, 1752, being His Majesties acces- 
sion to the throne." (That is, of course, the anniversary 
of it.) The foundation-stone was laid by Sir Peter 
Warren, Bart., K.B., Admiral of the Fleet, on Octo- 
ber 15, 1752. The building was finished in 1759. 
The long time taken in building was due to the re- 
peated stoppage of the work from lack of funds. The 
general funds of the Hospital were never drawn upon, 
and more than once the treasurer advanced money 
out of his own pocket to pay the workmen, because 
no money was left in the Building Fund — on one occa- 
sion as much as £350. He never charged interest. 

When the Hospital opened its doors to patients, 
which it did in September, 1757 — two years before the 
building was finished — it consisted simply of the 
central block facing Whitechapel Road. The long 
corridor as seen from the main entrance, east and 
west, shows the length of the original building. The 
foundations of the east and west wings were laid (half 
their present length — i.e., as far as to the present 
lobbies between the wards), but the wings were not 
erected for more than ten years after. The Alexandra 
Wing, where the Committee-room is, and the Grocers' 
Wing, where Yarrow Ward is, are quite modern. 

When the Hospital opened it had accommodation for 
161 beds. The approved plan showed 350 beds, but the 
wings had not been built on account of lack of funds. It 
has now nearly 1,000 beds. The additions from 1759 to 
the present time are shown on the accompanying four 
plans. 



PLAN II.— 1759. 

This is from Maiawaring's original plan. At this date the two 
short wings shown were not built, but their foundations were laid. 
They were not built until ten to twelve years after completion of 
the main building. The small building on the left was the 
Post-mortem -room and Store-rooms. It will be noticed that 
Turner Street was not made, and that the Momit came right up to 
the Hospital boimdary. Although shown in the plan, as a matter 
of fact the New Road did not open into Whitechapel Road until 
1761, and the small section of the Hospital estate necessary to make 
this opening was purchased by the Trustees of the New Road for 
£50. Oxford Street was not made. The Hospital stood in fields, 
and in a map of this district, sHghtly before this date, New Road is 
shown as a footpath leading from Whitechapel Road to the river. 
The plan shows that part of the Hospital grounds which are leased 
from the City of London. The building attached to the Hospital 
on the right is the shed for the " Chariots of the Governors." 



88 



PLAN III.— 1840. 

It will be noticed that the east and west wings have now been 
extended to the present length. On the east side there is now a 
Medical School, with Post-mortem-room, and rooms for the Patho- 
logists. Note also that that part of the gromid now known as " The 
Field " was the burial-ground for patients who died in the Hospital. 
This space was let out for grazing sheep until a comparatively recent 
date. Turner Street has now been made, and the Hospital estate 
behind has been mapped out into streets and blocks of buildings. 
At this time the water was pumped up from the Hospital's own wells 
by means of a horse-pump. 



90 



I " I I I I Mi l 



ioo 




PLAN IV.— 1886. 

It will be noticed that the Medical College has been removed to 
its present site in the south-west corner of the grounds. The 
Alexandra Wing has been built. The Grocers' Wing has been built, 
and at the end of the east wing the first of the three present Nurses' 
Homes has been built ; the Chaplain's house also, and workshops. 



92 



PLAN v.— MODERN TIMES. 

The second and third Nurses' Homes have been built, and the 
main entrance of the Hospital added. There was no porch at the 
main entrance until 1897. The Isolation block has been erected. 
The College has been considerably enlarged. The Out-patient De- 
partment has been built. The Grocers' Wing has been entirely 
changed, and near this wing has been built one of the finest Patho- 
logical Departments in England. A laundry has been built, and 
extensive workshops. The alterations are considerably more than 
can be shown on a plan, as nearly the whole of the Hospital has been 
raised one floor, in some parts two floors, and there is hardly one 
part of the vast building which has not been altered and improved 
to perfect it for doing its work. These alterations, with the neces- 
sary equipment, have cost no less than £500,000. 



U 



CHAPTER VI 

SOME CURIOUS POINTS IN HOSPITAL MANAGEMENT 

When the Hospital was founded, everyone who sub- 
scribed five guineas a year, whether lady or gentleman, 
was a " governor " or " manager " so long as he con- 
tinued to subscribe, and in 1743 it was agreed that 
donors of thirty guineas became life governors. All 
governors were concerned in the management and the 
affairs of the Charity. As the number of governors 
increased, it became impossible to conduct the business 
of the Hospital on such lines. Meetings attended 
sometimes by as many as 500 governors were not 
likely to do much to further the interests of the 
Charity, and consequently this cumbersome form of 
management was discarded quite early in the Hospital's 
history. It was decided instead to elect from among 
the governors certain representatives who should meet 
every week, and who should report once a quarter to 
the full Court of Governors on all that had been done 
during the preceding weeks, and receive the Court's 
approval. With some not very important modifica- 
tion, the Hospital is to-day managed in this 
way. 
At first the House Committee consisted of thirteen 

96 



CURIOUS POINTS IN MANAGEMENT 97 

members ; there are now thirty. For many years the 
House Committee was elected quarterly by the Court ; 
now it is elected annually by the Court which sits in 
December. 

It is not easy to imagine what it could have been like 
to manage a hospital in those days (1740-1800). No 
telegraph, no telephone, no railways ! The secretary 
was to summon the committee for 10 a.m., and 
business was to commence at 11. All who were not 
there when the clock struck eleven had to put a 
shilling into the poor-box. The decision that all 
committeemen should pay this line was solemnly 
passed every three months. So these dear old gentle- 
men used to turn up at ten, and, apparently, gossip 
until eleven. There was time to gossip then. There 
was always time, too, to be courteous, and one finds 
many instances of this throughout the minutes. 
Letters sent to unimportant people on unimportant 
matters receive long and careful consideration as to 
the wording. Telegram letters were not used. I am 
sorry, however, to find the following minute : 

" Resolved that this Committee for the future do 
adjourn to the Angel and Crown Tavern, Whitechapel, 
at 4 o'clock, for the better transacting the business 
of the Infirmary." 

And they had begun business at 11 a.m. ! The 
secretary and the beadle were also to adjourn with 
them. That the secretary should attend one can 
understand. But why the beadle ? Dare one suggest 
that the beadle assisted some of these worthy gentle- 
men home after they had wearied themselves — over- 
wearied themselves — in transacting the business of 

7 



98 THE LONDON HOSPITAl. 

the Infirmary ? Perhaps it is not surprising that the 
following occurs a few months after : 

" Resolved that all business to be done by this 
Committee wheyi held by adjournment to any other 'place 
be read over the next Committee Day for confirma- 
tion." 

They had time, too, to pay compliments. One 
sometimes wishes there was time for more resolutions 
to be passed now, such as the following. A similar 
graceful acknowledgment of service rendered is to be 
found at the end of every report of the House Com- 
mittee to the Quarterly Court : 

" Your Committee have now laid before you the 
principal transactions and occurrences of this Quarter, 
and hope the steps they have taken for promoting the 
Charity will meet with your consent and approbation. 
But they cannot on this occasion omit expressing with 
the utmost pleasure and satisfaction how wonderfully 
the hand of Providence has showed itself in setting on 
foot, increasing, and establishing in so short a time a 
work of such pubHck benefit and utility. It is true 
several gentlemen have distinguished their extra- 
ordinary zeal in this good cause by using their interest 
for the increase of its supporters, and that with so 
much success that it is hoped, besides the private 
satisfaction it must give them, their names and ser- 
vices will always be most gratefully remembered, and 
that it will be an incitement to others to foUow their 
laudable example with equal prosperity and advan- 
tage. A further but necessary duty of this Com- 
mittee is to acknowledge the constancy of ]Mr. Peck, 
our Chairman, in the execution of that office, who has 
during six months past never failed in the most 



CURIOUS POINTS IN MANAGEMENT 99 

punctual attendance, not only on Committee days, 
but whenever any affair of importance was directed 
by the Committee, by whose ability and application 
several disorders and inconveniences have been either 
prevented or removed, and some of the most desirable 
advantages obtained. We therefore unanimously join 
in recommending to the Court that he may have their 
publick thanks, as he has unfeignedly those of this 
whole Committee." 

The minutes do not say what were the special 
services rendered by these excellent men, but that does 
not belittle them at all. ]\linutes may tell of " de- 
sirable advantages obtained "; they do not always 
draw attention to " disorders and inconveniences pre- 
vented." Perhaps they were somewhat more easily 
pleased than we are. For instance, in a previous 
chapter reference was made to a neighbour who, when 
the Infirmary was still in Prescott Street (1745), com- 
plained that the overflow from the Infirmary cesspool 
ran over his garden, which was lower. This was 
certainly no small fault, and one can imagine how 
an epidemic of typhoid would run riot under such 
conditions. At the very Court before which the 
complaint of this fastidious neighbour was brought, 
the committee concluded its report in the following 
words : 

" The Committee congratulate the Court with joy 
that the Infirmary is now established on such a basis, 
and governed by such laws and regulations, as not 
to admit of any imiovations.^' 

It would be a bold House Committee who could pass 
such a minute to-day ! 

7—2 



100 THE LONDON HOSPITAL 

In 1786 the committee was in a state of panic on 
account of funds, and, as usual with people in panic, 
they did some very strange and unwise things. They 
actually made a rule that the annual expenditure was 
not to exceed £2,500. I have heard of somewhat 
similar rules being made to-day in hospital manage- 
ment. Of course, the principle is a perfectly right 
one, that you must make expenditure suit income, 
and the principle may be applied in every walk of life. 
But in an institution like a hospital the rule cannot be 
invariably adhered to. Is a hospital to stand doing 
nothing when an epidemic chooses to arrive at the end 
of a hospital's financial year, and it had spent the sum 
allotted ? Is a hospital to let some scourge like cancer 
or consumption continue to slay its thousands, after 
the discovery of a remedy, because the hospital had 
spent its cash in hand when the discovery was made ? 
Is all research to stop on a certain day in October 
because funds are not in hand to carry on the work 
to December ? Can a hospital discharge a skilled staff 
one day and re-engage it another ? These dear old 
men had not yet discovered — how could they ? — that 
whereas usually expenditure must follow income, in 
a voluntary hospital income foUows efficiency. So 
they passed a solemn resolution that " the first object 
of the Hospital is the stability of it." There appears 
to have been no one present to tell them that " the 
first object of the Hospital is the usefulness of it." 
The stability of a useless hospital is of no account 
whatever. So a great many weak and foolish rules 
were made which deserved to bring the Charity into 
ridicule. One of such foolish rules was that not more 



CURIOUS POINTS IN MANAGEMENT 101 

than twenty in-patients were to be treated in any 
week. So the twenty-first was to be turned away, not 
because the patient was in less need, but because he 
was the twenty-first. The Hospital now admits about 
270 new in-patients a week. But the growth in its 
usefulness was never stimulated by such policy as this 
of 1786. John Harrison strongly opposed such a 
policy, and after a time these dark and hopeless days 
passed. They have returned from time to time, but 
the light has followed, and there has always been a 
man who has " greatly dared " to show the way. 

It was in this year (1786) that the House Committee 
was first elected for the year, instead of for the three 
months, as hitherto. At the same time the number 
of members was increased to thirty. 

The House Committee from the first appointed two 
of its members to be House Visitors for a fort- 
night at a time. These House Visitors were instructed 
by their orders to make the following inquiries : 

First, whether any of the patients or servants have 
been guilty of cursing, swearing, drinking, abusive 
language, or any other disorderly behaviour ? 

Secondly, whether the patients have been duly 
attended by the physicians and surgeons, apothecary, 
matron, nurses, watches, and other servants ? 

Thirdly, whether the provisions have been duly 
distributed ? 

Fourthly, whether any ojEfence hath been committed 
against the rules of the Hospital ? 

I have come across an old book in which the House 
Visitors used to report, and perhaps some of these 
reports may be interesting enough to quote, and they 



102 THE LONDON HOSPITAL 

will certainly give some idea of the way the work was 
carried on. 

" 1768, February 28th. — Visied the patientes of this 
house & had complaints of James Dye, this day whent 
out with out Live & of is Bad Beaver in the ward 
cauled Geo ward. I tasted the Bear & Fund it very 
ordney. — Jno Cobb. 



55 



John Cobb's spelling was imperfect, but his meaning 
is clear. Did he write Ms report immediately after 
tasting the " smoU bear " ? 



a 



1768, May I9th. — Visited the house. No com- 
plaints from ye patients. In old John's ward nurse 
complained that William Crookshanks behaved very 
bad and swore and cursed ; he whent out yesterday 
without leave and is not returned. — James Pepwell. 
P.S. — A part of the ditch behind the hospital is fell in, 
which ought to be put to rights." 

The ditch referred to was an open sewer ! 

" 1769, January '2nd. — No complaints, only there 
was but 17 patients at chapel to-day. The nurses 
complain of the minister coming late. Last night 
Sarah Trigg was delivered of a boy she being admitted 
under the care of Dr. Leeds by the complaint of 
obstructions. — William Twedale." 

Mr. Twedale makes this note because of the rule 
that pregnant women were not to be admitted to the 
Hospital. 

" 1769, Thursday evening, 7 o'clock. — 'Visited the 
house. Found ye nurses and patients agreeable except 
in Sarah's ward. Elizabeth Hutton's behaveour, a 
bad woman and no thanks to your charity. Please 



CURIOUS POINTS IN MANAGEMENT 103 

to call her to acct for ye Benefitt of ye charity. Great 
complaints against ye mutton and with great reason 
for I saw it myself and thought it very indifferent 
and the deception in ye legs of mutton was repeated. 
Complaint against one patient in Richmond's ward, 
John Patten, who had leave to go out yesterday, and 
half a guinea from a brother patient to buy him two 
shirts but has not yet returned. — J. W. Batson." 

The habit of patients to run away before treatment 
has been referred to. It was the duty of the apothecary 
to give leave of absence to patients. Mr. Batson, who 
made the above report, we know well. To this day, 
as a result of the " Batson gift," certain account-books 
must be brought before the committee for inspection 
every April and October. 

And I recognize Mr. Jno. Cobb again. His spelling 
has not improved, and I am afraid it was an injustice 
to have suggested that his orthography was due to 
his conscientious care that the patients' " smoU bear " 
was of proper quality. 

"1770, Feb. 26^^.— Vissited the House & had 
Greate Complaintes in ould Jno' Ward met [meat ?] 
being bad, & the a Loueces very smoU as they say. 
had sad complant of the Pepell [pupil ?] for St. Jno's 
Ward. One George Nesbitt in old George's Ward 
Got Drunk on Sunday and abused the Nurse and 
swear. Cursed, and used much abuseful Language. 
Complaints against Sophia Preston for abusing the 
Nurse & saying she gives Better Vituals to her dog. 
Order her out of the House Directly. Sophia preston 
is in Mary Ward. The nurses in New George acquaint 
me that they have had no water for several days 
past, pump being as they say out of repair. Ashes 



104 THE LONDON HOSPITAL 

has not been cleared away this 2 months which the 
Cooks sa}^ blov/s in at the windows the top of the 
dust hill being raided above the levle of the windows. 
The beadle told me that the surplis of the minister is 
stowle a wav. Please take it in consideration. Had 
complentes of smoll Bear but I find it mended when 
tasted it. — Jno Cobb, (the surplis is found)." 

A very good morning's work. I think somebody 
must have teased Mr. Cobb about his spelling, for 
from now on his reports, always practical, are " writ 
fair " by the secretary, and then follows the big 
sprawling signature, " Jno. Cobb." 

The shortage of Avater and the stoppage of sinks 
were sometimes reported for six or seven consecutive 
weeks before anyone thought of doing anything. No 
wonder that one visitor reported, " The house very 
offensive, so much so that I could not Bare the smell " ! 
One of the visitors certainly felt that a little more 
cleanliness would be better for the patients, for he 
wrote : 



a 



1789. — I make an observation that there are no 
towels allowed in any of the v/omen's wards, nor 
soap for the hands, etc., of any of the patients." — 
J. Howard." 

I do not think the secretary in 1782 could have been 
very popular, or why did the Rev. Dr. Mayo write — 

" Visited all the wards, heard no complaints. 194 
patients. The Apothecary and his assistant, the 
steward, and tlie matron were in the house, but the 
secretary, that son of , was at the Gun. — Her- 
bert Mayo" ? 



CURIOUS POINTS IN MANAGEMENT 105 

Two of the committee for several years focussed 
their attention on the number of people who attended 
Divine service in the Hospital. The two gentlemen 
were the Rev. Dr. Mayo and a Mr. Thomas Blunt. 
This is the sort of thing which is written over and 
over again : 

" 1790, Dec. 12. — Attended divine service. The 
chaplain gave a very suitable good discourse. Present 
— the steward, apothecary, 4 nurses, and 35 patients. 
All behaved very well and were very attentive." 

" Visited the house in which were 156 patients, 
15 of whom attended chapel. Heard of no complaint 
except some of the patients who were weU enough to 
attend chapel went with great reluctance. — Thomas 
Blunt. P.S. — It appears from Matron, for good 
reasons, there was no service in the chapel this day. 
Of course the number mentioned by the nurses is not 
true." 

The nurses' reference, therefore, to the " reluctance " 
of the patients seems to have been " merely corrobora- 
tive detail, intended to give artistic verisimilitude to 
a bald and unconvincing narrative." 

In 1782 the acting-chaplain was a Rev. Mr. Churchill, 
Mr, Audley being away on sick-leave. Mr. Churchill 
resented so much reference to his department. The 
trouble began through a note in the Visitors' Book by 
Ml-. Thomas Blunt : 

" 1782, Oct. 28^^.— The chaplain did not attend this 
morning. Watch of Sarah's Ward, notwithstanding 
no prayers were read in the chapel, said that five of 
her patients certainly attended chapel and heard 
prayers read. Would wish her reprimanded by the 
Committee for this. — Thomas Blunt." 



106 THE LONDON HOSPITAL 

To this Mr. Churchill replied in the Visitors' Book 
as follows : 

" It has been asserted that prayers of the chapel 
were omitted on Monday last, and the omission 
imputed to the non-attendance of the clergyman. The 
assertion is true, but the imputation is false. I was 
at the hospital on that day, and waited some time, 
but no person could be found to ring the bell or open 
the chapel. — W. Churchill." 

Then Mr. Blunt, also in the Visitors' Book : 

" Mr. Churchill is requested, when he makes minutes 
in future in the Visiting Book to be a little more 
decent in his expressions and imputes. What was 
inserted in that book of the 28th October against him 
was owing, as it appears from his own account, to a 
wrong information of those of whom B. inquired. 
Had Mr. Churchill done as is the duty of the chaplain, 
he would have waited more than 10 minutes before he 
departed the hospital, and then have made his com- 
plaint in writing in order that the committee might 
have been able to judge on whom the neglect lay. — 
Thomas Blunt." 

Mr. Churchill has the last word : 

" I esteem myself much obliged to Mr. Blunt for his 
kind information relative to the impropriety of my 
language, and shall certainly pay such attention to it 
as it deserves — i.e., I shaU not again be guilty of the 
like impropriety of language (as he thinks it) unless 
Mr. Blunt is guilty of the like impropriety of behaviour. 
If in future Mr. Blunt will take a little time to con- 
sider before he acts or writes, perhaps his conduct, as 
well as his orthography, will be less exceptionable." 



CURIOUS POINTS IN MANAGEMENT 107 

This was a knock-down blow for Mr. Blunt, and the 
committee, like a modern editor, decided " that this 
correspondence must now cease." 

Notliing irritated the committee more than that 
" the miserable objects " in the Hospital should show 
any reluctance at the treatment meted out to them. 
Any patient who was so absurd as to shirk an opera- 
tion (and without an anaesthetic, be it remembered) 
was bundled out promptly in disgrace. Liptrap, who 
in 1785 was instrumental, with the great surgeon 
Blizard, in founding the Medical School, reported to 
the committee : 

" In Gloucester Ward is WiUiam Shaw, a boy whose 
disorder appears to be more of idiotism than anything 
else, as he will not take his medicine, and a blister 
which was put on his head he immediately pulled ofE. 
He also disturbs the patients in the ward by singing ; 
therefore, in my opinion, a very improper object for 
this charity." 

So the child was discharged because he very naturally 
objected to a blister on his head. 

Some of the most interesting reports are those from 
gentlemen of " the physical profession." They were 
evidently proud of the term, and in their reports tried 
to impress the committee with their overwhelming 
wisdom. For instance : 

" 1785, April 1 5th. — Passing through some of the 
wards, I found several of the nurses and patients 
complaining of the bad quality of the milk ; this led 
me to examine particularly into the origin of the 
complaints, how far it was, or was not, to be considered 
as valid — i.e., founded on absolute fact. The Officers 



108 THE LONDON HOSPITAL 

{i.e., the matron, house pupils, etc.) informed me that 
from Tuesday last to this day they had seen none but 
what was sour. The cook and some of the nurses 
asserted that it was in that state when received, and 
this assertion was confirmed by the declaration of all 
the patients. By entering into the composition of 
porridge, etc., milk constitutes an essential part, and, 
to some who are on that diet, the principal article, of 
their nourishment. If, then, by the addition even of 
a considerable quantity of water, it does not possess 
those qualities wliicli milk in its natural state ought to 
be possessed of (which I have great reason to believe 
particularly in this house alwa3^s to be the case), our 
end in giving it as a Nutrient Substance is perfectly 
defeated. But if at the time it be brought in it has 
already acquired acidity, so far from being followed by 
salutery, its internal exhibition or external application 
must be attended with hurtful effects to the patients. 
And inasmuch as they are made to pay for what 
(can be clearly proved) they do not receive, to the 
Governors also of the Hospital, so far with respect to 
quality. I have also some reason to think that if 
inquiries were properly directed, it would be found that 
more of this (if I may be allowed the expression) 
Degenerated Milk is paid for than is actually received, 
and more received than there is occasion for. — Thomas 
Thomas." 

In considering the administration of the Hospital a 
hundred years ago, the rules for the admission of 
patients seem particularly strange. Governors had the 
right of having one patient in the Hospital at a time. 
The treasurer and chairman of the House Committee 
had power to order the admission of "serious accidents 
or extraordinary disorders." The Staff had no power 
whatever to admit cases ; indeed, there were special 



CURIOUS POINTS IN MANAGEMENT 109 

regulations prohibiting them from doing so, as we shall 
see. And then, too, as has previously been stated, 
patients were only admitted on one day in the week — 
the day on which the committee sat. Each patient 
came before the committee with his recommendation 
from a governor, and the committee decided whether 
he should be admitted or not ; and no case was con- 
sidered unless the recommendation was delivered in 
before eleven. 

Every time the committee sat the physicians and 
surgeons came before them with a long string of 
" miserable objects," and the Staff represented that 
these miserable objects had been cured by them (I 
counted a list of seventy -five introduced by one member 
of the staff on one committee day — a good week's 
work, and no small advertisement to the surgeon con- 
cerned). And all these poor objects were asked then 
and there to contribute to the poor-box kept in the 
committee-room for the purpose. No patient was 
allowed under any consideration to remain in the 
house longer than two months, except cases of 
" fracture." In 1756 a hst of diseases was put up, 
and patients suffering from these were not to be 
admitted. The " prohibition list " included " ulcerated 
cases," women with child, children under seven (except 
for amputation or " cutting for stone "), patients 
suffering from fits, smallpox cases, cases of itch, dis- 
tempers, consumptives, asthmatical cases, infectious 
cases, and all " disordered in their senses." 

Patients were not allowed to leave the building 
except by permission of the apothecary ; they were 
not to swear or curse in the wards, nor to play any 



110 THE LONDON HOSPITAL 

kind of game, especially games of chance ; nor were 
they to " smoak " in the wards. And the men were 
not allowed in the women's wards, nor the women in 
the men's, except " by leave." 

Pewter medals were made, the size of a crown 
piece, with the words " London Hospital " round the 
edge, the name of the ward in the centre, and a number 
corresponding to the number of the bed. All in- 
patients had to wear these medals " fixed to their 
clows," so that they might be readily distinguished. 
This custom was eventually given up because the 
medals were lost by the hundred. It appears that the 
patients stole them as mementoes of their visit (1790). 

When a patient was about to be discharged from the 
Hospital, a printed notice to the following effect was 
given to him : 

" Thro' the charitable assistance of the Governors 
of this hospital, you have in your late afflictions, with- 
out any expence, been provided vntli comfortable 
lodging and proper advice. By the blessing of Almighty 
God on their humane endeavours, you are now so 
much recovered that you will shortly be discharged. 
The Governors, in return, expect and require notliing 
from you but that you attend devoutly in the Chapel 
of the Hospital on Monday next at 10 o'clock in the 
forenoon, and also in your Parish Church or other 
usual place of worship on the Sunday after you are 
discharged, publickly to return your thanks to Almighty 
God for His great goodness to you. You will have a 
paper given you to be conveyed to the minister for 
that purpose. That you appear to return thanks 
before the Committee on Tuesday morning next at 
11 o'clock, and that, if admitted by a recommenda- 



CURIOUS POINTS IN MANAGEMENT 111 

tion, you by no means omit to show your gratitude, 
and give notice of the opportunity for some other 
distressed person to be relieved, by delivering the letter 
of thanks, which will be given you, to the Governor 
who recommended you. Should you fail in these, 
remember that you Avill show yourselves ungrateful 
both to God and Man, and wholly unworthy of the 
blessings and benefits which you have received, and 
you will be deservedly precluded from any future 
relief at this hospital. They hope and trust that 
during the hours of affliction and sickness your minds 
have been employed in religious meditation ; that the 
good advice and instruction which you have received 
will be seriously attended to ; that you will henceforth 
endeavour to live in the fear of God, who alone can 
protect you from disease and accidents and evils, and 
preserve to you that health to which you are now 
by His blessing restored." 

This paper, strange though it may seem now, was 
given to every patient from 1793 until comparatively 
modern times. 

About this date the Staff made serious complaint to 
the committee that the Out-patient Department was 
in a very unsatisfactory condition. The patients were 
said to be very irregular in their attendance, thereby 
wasting the time of the doctors and the medicine of 
the governors ; that a great many of the patients seen 
could afford to pay, and were absolutely defrauding 
the Charity ; that in this department patients were 
often cured, but refused to return thanks, " and this 
procedure lessens the credit of the Hospital." The 
committee agreed that there had been great abuse of 
the Charity. This was partly through ignorance, the 
public not understanding what were the aims and 



112 THE LONDON HOSPITAL 

intentions of the Charity. In its infant state medicine 
and advice had been given to all who asked in the 
Out-patient Department. This would now be stopped. 
Governors should have, as hitherto, the right of 
recommending in-patients. Subscribers of less than 
five guineas should have the right of recommending 
out-patients, and no out-patient, except accidents, 
would be seen except by such recommendation, which 
would remain in force for two months. 

Even these rules did not sufificiently reduce the num- 
bers of the out-patients, and it was at last decided that 
not more than twenty new out-patients per week 
could be treated, and all subscribers were told of the 
new rule. Up to 1785 new out-patients were seen on 
one day a week only, the same day as in-patients were 
admitted, but in 1786 it was decided that out-patients 
might apply any working day. 

Up to 1788 there was no division of patients into 
medical and surgical wards ; all were nursed in all 
wards. In this year one of the physicians, Dr. Hamil- 
ton, proposed that the surgeon's and the physicians' 
patients should be in separate wards. The proposal 
was strongly opposed by the surgeons, and the Court 
refused to adopt Dr. Hamilton's proposal. Indeed, 
there seems to have been a very hazy notion as to what 
were the distmctive duties of physician and surgeon. 
The Sta£E quarrelled about it, and referred the matter 
to the House Committee, who appointed a subcom- 
mittee to consider and report. This subcommittee 
reported in due course as follows : 

" In obedience to your order of reference, we pro- 
ceeded to inquire into the practice of physick and 



CURIOUS POINTS IN MANAGEMENT 113 

surgery in the House, and after mature deliberation 
thereon, and a full hearing of the several parties con- 
cerned, we humbly propose the following rules as a 
proper plan for regulating the said practice and pre- 
venting all difference between the physicians and 
surgeons for the future. In the forming of which rules 
we have had the good of the poor patients and the 
improvement of the Charity principally in view. 
First, that the surgeon have liberty to order internals 
for his own patients in all cases merely chirurgical, 
with this restriction — that upon the appearance of 
apprehension of danger, he do apply to one or more 
of the physicians. Secondly, that all cutaneous 
eruptions which do not require external a^jplications 
or operations shall fall under the care of the physicians. 
Thirdly, that the physicians and surgeons do regularly 
go round the house together every Thursday at eleven 
in the forenoon to consult in such cases belonging to 
them respectively as may require it ; after which such 
of the out-patients as likewise require their mutual 
assistance or advice shall be called in for their opinion." 

It would seem, therefore, that it was generally felt 
that the surgeon was to attend to external ailments, 
and the physician to internal ! 



8 



CHAPTER VII 

QUARTERLY COURTS OF GOVERNORS — HISTORY OF 
THE JEWISH WARDS 

A VERY pleasant feature, repeated^ seen in looking 
back through the old. minutes, is the jealous way in 
which the honour of the Institution was guarded. To 
the committee no trouble was too great in investigating 
and refuting any breath of slander. Complaints made 
by the public as to the treatment of a patient, some- 
times quite trivial, received an amount of attention 
quite out of proportion to their importance. Fre- 
quently a deputation waited on the person concerned to 
lay the whole case before him, a subcommittee having 
previously sat to make inquiries. The following report 
to the Quarterly Court in 1744 is a good instance of this : 

" Your Committee being informed that Mrs. Holden, 
a good benefactress to this Infirmary, was pleased to 
express some uneasiness relating to the usage of the 
patients belonging to the same, and that in particular 
an unhappy person whose leg was broke, and brought 
into the said Infirmary, was neglected for three days 
without any attendance given him, which coming to the 
knowledge of your Committee, M'ho were then sitting at 
the Infirmary, they immediately made inquiry if any 
such treatment had ever been given to any poor patient 

114 



QUARTERLY COURTS OF GOVERNORS 115 

then or at any time before, and upon the strictest 
examination of the affair could find no ground what- 
ever for such complaint. Your Committee thought 
proper to depute some Grentlemen then present to 
wait on Mi's. Holden, to know how she came by the 
said information, and to express their great concern 
for such report, as likewise the ill consequences that 
might attend the Charity, not only in disobliging her 
in particular, but likemse all the other kind and charit- 
able Benefactors to the said Infirmary. Accordingly, 
John Peck, Esq., Chairman, Sir John De Lange, and 
William Myre, Esq., waited on the abovesaid lady, 
who, upon their acquainting her with the purport 
of troubling her with such a visit, exprest a very great 
concern in giving them that trouble. However, she 
did say that such a report had been made to her, 
but so far from giving her any uneasiness, she had 
never thought of it since, nor could she then anyways 
recollect from whom, or how, she heard it. The 
aforesaid Gentlemen then took the liberty of explaining 
to her the nature of the management of the said In- 
firmary, which would now be tedious to insert here, 
but after having heard them, she said that she was 
fully convinced of the falsity of such report, and was 
pleased to say from what they had related to her she 
wished every Charity of the sort was as well conducted, 
and that Gentlemen who would give so much of their 
time as those of the Infirmary did ought to have the 
thanks of all who were well disposed for supporting so 
good a work; and upon them taking leave of her, wished 
them all success in their undertaking, and if anything 
of that nature should ever happen, as she had reason 
to hope never would, that for the future she would 
endeavour all that in her lay to satisfy any person 
who should attempt to put so uncharitable a construc- 
tion on the management of the Infirmary, and that 

8—2 



116 THE LONDON HOSPITAL 

this she was the better able to do from her being so 
well acquainted and satisfied with the nature of the 
care and pains that was taken therein." 

The committee must have wasted much time and 
energy in investigating complaints which were quite 
trivial or entirely imaginary, for a rule was at last 
made (1765) that patients who made any complaint after 
they left the Hospital, and had not done so before they 
left, would have their names entered in the Black Book. 
This meant refusal to help such patient ever afterwards. 

It was doubtless due to the same anxiety that no 
word should ever be spoken against the fair name of 
the Charity that it was decided in 1750 "That no 
chaplain, physician, surgeon, or other officer or servant 
of this Charity who shall hereafter be elected shall act 
as a governor of this Charity during his continuance 
in office "; also that " no tradesman or artificer serving 
this Charity shall be of any committee." 

The meetings of the Quarterly Court were by no 
means invariably meetings of dull formality. The 
governors seem to have had strong feelings on all 
subjects, and did not hesitate to express themselves 
forcibly, although always politely. 

The quorum for the Court was fifteen, as it is now ; 
but frequently the attendances reached some hundreds, 
especially when some election was to take place. 
The reports of the House Committee were read and 
re-read paragraph by paragraph, criticized, modified, 
referred back, but rarely unanimously adopted ; nor 
did the House Committee on its first meeting after 
a Court hesitate to state what it thought of the Court's 
proceedings. For instance, at a Court in 1807 a Dr. 



QUARTERLY COURTS OF GOVERNORS 117 

Buxton was elected a physician to the Hospital by a 
narrow majority, his success being due to a decision 
of the Court earlier in the proceedings of the day that 
minors had no right to vote. This infuriated the 
House Committee, who had recommended another 
candidate, and especially as some of the members of 
the House Committee had made their children governors 
on purpose to insure the success of their candidate. 
They protested at the Court itself — " we do hereby 
protest against the election of this day " — on account 
of what they considered the unfairness of the voting. 
They did more. At their first meeting they passed the 
following resolution : 

" The House Committee, deeply impressed with a 
sense of the evil consequences that may result from a 
law that would deprive a considerable part of the 
governors of those rights and privileges they have 
hitherto exercised, and which have been repeatedly 
confirmed by the custom of the Hospital (and this 
Committee cannot but be mindful of the great benefits 
which have arisen, and they have good reason to hope 
will continue to the Hospital from old attachments, 
which, commencing in youth, gather in strength as 
they advance in age), resolved unanimously that the 
resolution of the Court of the 9th June denying the 
right of governors under age to vote at an election 
of a physician, not having been specified in the summons 
for holding such Court, was an act illegal in itself and 
mischievous in its tendency, and ought to be rescinded ; 
it is further resolved that the above resolution be 
inserted in the Times and ' Public Ledger.' " 

The strong protest of the committee had an effect 
upon the Court, for at the next sitting the resolution 



118 THE LONDON HOSPITAL 

as to the illegality of minors voting was rescinded. 
The harm had been done, however. Dr. Buxton had 
been elected — the only man I have ever found on the 
London Hospital Staff of whom I am ashamed. He 
came on to the staff by a trick, and when he resigned in 
1822 the Court, in accepting his resignation, passed 
the following resolution : 

" The Court cannot refrain from noticing a report 
that he has been negotiating to resign his situation as 
physician to the Hospital for a pecuniary consideration, 
and this Court is anxious to give Dr. Buxton an 
opportunity to exculpate himself from an imputation 
which it considers highly discreditable to his profession, 
and destructive of the best interests of this valuable 
Institution." 

Dr. Buxton did not reply, and the Court minutes 
never refer to the matter again. His name seems to 
have been his only good asset. But I must not omit 
to say that he was in no way connected with the family 
of Buxtons who have done so much for the Hospital. 

Voting at the Quarterly Courts was by ballot, and 
very definite rules were laid down as to the mode of 
procedure. When, for instance, a member of the Staff 
was to be elected, the names of all candidates were 
printed on slips of paper, the chairman received the 
ballot-papers in a glass, the secretary checked off 
each governor who dropped in a ballot-paper, the 
governor signed his paper, and if it was found he had 
dropped in two, both were cancelled. As many 
" fyles " were provided as there were candidates ; 
the chairman drew out the papers and stuck them on 
the corresponding " fyle " ; a governor acted as 



QUARTERLY COURTS OF GOVERNORS 119 

champion to each candidate, attending to his " fyle " 
and checking his votes. The ballot always opened at 
eleven and closed at two. 

Peers of the realm and ladies were allowed to vote 
by proxy, but the vote was invalid unless the proxy 
was signed by the principal. 

As appointments on to the Staff became more valuable 
it paid candidates to make governors (at five guineas 
each) who should attend the Court and vote. The 
governors, however, tried to put an end to this practice 
by not allowing anyone to vote whose subscription 
had not been paid seven days before the election took 
place. This seven days was extended in 1790 to one 
year. The following report of the House Committee 
on the subject may be of interest : 

" The Committee conceive they caimot close their 
report more consistently with the proper dignity and 
real design of the Hospital than by their decided and 
unanimous proposal to the General Court to extend 
still further the approved principles of their late 
experimental motion made to prevent part of the in- 
convenience of admitting annual governors in con- 
templation of an election, some of them on the actual 
day of election and during the progress of the ballot, 
by which motion it was resolved ' that no annual 
governor shall vote at any election who has not been 
a governor seven days.' The Committee perceive with 
concern the disadvantage of admitting new voters 
even wdth this cautionary resolution, since the Charity 
has seldom retained, these casual contributors beyond 
the period of their subscriptions, while it has lost 
through this influx of voters some able and ancient 
governors who had for a series of years been the 
tried friends of the House, and whose personal services 



120 THE LONDON HOSPITAL 

and prompt supplies would infinitely have out- 
weighed any advantage that has arisen from those 
temporary and transient aids. The Committee therefore, 
wishing to see the Institution elevated and honoured, 
to raise its revenue and exalt its rank, as well as to 
evince respect for constant benefactors and cordial 
friends, which alone can merit or maintain the con- 
tinuance of their friendship and of their bounty, do 
respectfully recommend and earnestly exhort the 
General Court to carry their experimental decree into 
a positive decision, that no annual governor or governors 
admitted from this date shall vote at any election 
who has not been a governor or governess one year, 
the election day inclusive ; but that perpetual governors 
shall possess the privilege of voting from the instant 
of their admission as a just discrimination between 
those who are attached to the Charity for life, and such 
on whose connection no confident reliance can be placed 
beyond the duration of a single year. This immediate 
transfer to Life Governors of the right of voting is 
also sanctioned by the example of the Royal Hospitals 
of the City of London." 

The above resolution was carried unanimously by 
the Court. 

A good illustration of the necessity of such legisla- 
tion and of the energy with which an election was 
conducted was shown on the election of Dr. Little to 
the Staff in 1839. I am indebted to an article in the 
London Hospital Gazette of February, 1895, for the 
following account of this contest : A vacancy had 
occurred by the death of a Dr. Davies. The House 
Committee recommended, according to custom, four 
candidates to the Court, each of whom was eligible 
to fill the vacancy. Two of these retired before the 



QUARTERLY COURTS OF GOVERNORS 121 

day of election, leaving Dr. Little and Dr. Fox to 
contest the appointment. Each of these employed 
a host of canvassers, who visited the governors daily, 
and worried them to support their candidate. Each 
candidate had committees meeting at his house, and 
some of the methods adopted by these committees 
to further the cause of their friend are worthy of a 
Parliamentary election a hundred years ago. 

Dr. Fox's committee saw nothing very dishonest in 
publishing by advertisement in the public press a 
series of resolutions said to have been passed at a 
meeting of the governors in Dr. Fox's favour. 

Dr. Little's committee retaliated by also publishing 
in the press a statement that not only were the state- 
ments made as to his rival's adoption by the governors 
fictitious, but no meeting whatever had taken place ; and 
this statement of Dr. Little's committee was actually 
signed by four vice-presidents and eighteen members 
of the House Committee, including the chairman. 

Dr. Fox objected to this interference as being 
" dictatorial, oppressive, and unjust." 

Dr. Little's committee announced that on the day 
of the election they would sit at the London Tavern, 
" where carriages are in readiness for the convenience 
of Dr. Little's friends." Dr. Fox's committee made 
similar arrangements at a house in BilHter Street. 

On the day before the election the following anony- 
mous letter was circulated : 

" The Committee of Dr. Little, in again thanking 
you for the very kind manner in which you have 
tendered him your support, viewing with regret the 
circumstances of their canvass, even at this late period 



122 THE LONDON HOSPITAL 

have reluctantly determined not to proceed to the poll, 
as they are of opinion this step will be most conducive 
to his future prospects, and tend to make friends 
where a vexatious opposition might create enemies. 
They therefore respectfully release you from your 
attendance at the Hospital to-morrow on his behalf. 

" 10, FiNSBURY Square, 
'' July 2nd, 1839." 

The trick was detected in time. Of course, Dr. 
Little had no intention of resigning from the contest. 
Handbills were distributed on the day of election by 
Dr. Little's committee, denouncing such a scandalous 
letter. 

No doubt it was the Englishman's sense of fair play, 
so shamefully outraged, which helped to make Dr. 
Little's return the triumphant one it was. 

After the election there was a good deal of bad 
feeling, Dr. Fox stating that his defeat was due to 
" crushing family influences." 

The election cost Dr. Little over £500, and no less 
than thirteen people became life governors, paying 
thirty guineas each in order to be allowed to vote. 

Dotted throughout the minutes one comes across 
report after report on " Economy." 

The modern craze for economy in hospital manage- 
ment IS no new thing, although a good deal more public 
attention has been drawn to it than formerly. The 
public to-day have got hold of a catch phrase — 
" the cost per bed " — of hospitals. I have known 
many instances of supporters withdrawing their sub- 
scription from one hospital because its " cost per 
bed " was more than that of another, to which, I 



QUARTERLY COURTS OF GOVERNORS 123 

presume, the subscription was transferred. This 
figure, "the cost per bed," is obtained by dividing the 
hospital's expenditure by the number of beds in 
occupation, and the hospital's management stands 
condemned or commended according to the amount 
of the quotient. If all the hospitals were doing the 
same kind of work, there might be reason in such a 
comparison. But they are not, and many questions 
need to be asked and answered before the figure is of 
the slightest value in comparing one hospital with 
another. To do so without asking such questions is 
as reasonable as to compare the cost per day of two 
ships, which have nothing in common except that 
they both float on the sea. The difference in the work 
of hospitals is as great as the difference in the work 
of a battleship, a private yacht, a Cunarder, and a 
cattle-ship. 

These oft-repeated reports on " Economy " are 
interesting, however, from the fact that they give 
many a peep into the work of the time. 

In 1748 such a report tells us that the cost per day 
of a patient was 6|d. — 

" wliich your committee apprehend to be very 
reasonable, and they do not think it possible to make 
any reduction unless it shall be thought proper to 
discontinue the gratuity of 2 guineas per annum to 
the banker's clerk." 

The committee also suggested that an appeal might 
be made against the window tax, the Hospital being 
assessed at £5 lis. for window lights. It is gratify- 
ing to note that the appeal was successful. In the 
report of an "economy committee" in 1754 I note 



124 THE LONDON HOSPITAL 

that the cost per bed in that year was £12 per annum. 
(In 1767 it had grown to £17 15s., and in 1822 to 
£26 9s. 4d. It is now about £90 per annum.) The 
people to-day who spend so much time in doing " cost 
per bed " sums would surely have admired the 
Hospital's work in 1754. No better illustration could 
be given of the danger of the modern worship of all 
that is cheap. One has nothing but admiration for 
those who use every endeavour to get efficient work 
performed at as little expenditure as possible, but 
there must be no " trimming " of one's idea of what is 
efficient. To-day a hospital bed costs nearly eight 
times as much as it did in 1754. It is doing eighty 
times the good. In 1754 the Hospital's duty was to 
cure John Smith of a disease. In 1910 its duty is to 
destroy disease, to stamp it out, so that every John 
Smith who lives need never enter the walls of any 
hospital. The modern hospital says : 

" We have had a patient with a certain disease ; 
we have found what has caused it ; that patient need 
not have had it ; no man, woman, or child henceforth 
need have it. And this, cost what it may, is to be done, 
in order that no one need suffer from it." 

And so, one after the other, diseases are disappear- 
ing. Smallpox, tjrphus, hospital gangrene, diphtheria, 
malaria, Malta fever, consumption, are all going. 
All " germ " diseases are going. Length of life is 
extending. As many people died at forty in the 
reign of Elizabeth as now live to seventy. 

But let us return to some of the decisions of the 
various "economy committees." 

Some of their recommendations were thoroughly 



QUAKTERLY COURTS OF GOVERNORS 125 

good and sound. It was wise, for instance, to insist 
that complete inventories of the Hospital's " furniture, 
utensils, dispensary equipment, sheets, and linen " 
should be taken periodically ; that all purchasing was 
to be by public tender ; that " tips " to servants were 
to be abolished ; that an efficient system of book- 
keeping should be inaugurated. All these recom- 
mendations were carried out before the year 1800, and 
most of them are in force to this day. 

These dry economy reports always commenced 
with a pompous exordium and expression of pious 
opinion. For instance, in 1792 : 

" Attention to economy is essential whether we reflect 
on the effect of example as influencing the class of 
people admitted into this Hospital or refer it to the 
enhanced price of provisions and increased expendi- 
ture. A public charity, not very affluent in its revenue 
and resources, is under more immediate obligation to 
attend closely to economy, not only as dispensing public 
contributions seriously devoted to the rehef of misery, 
but as every deviation from strict frugality abridges 
the power of doing good, and excludes many afflicted 
petitioners, who, in agony and indigence, throng about 
the gates with unavaiUng entreaties for that healing 
aid which cannot on the present scale of expense be 
afforded them, etc." 

One of such reports was by no means complimentary 
to the House Committee and its management. The 
committee appointed had " attentively compared 
the expenditure of the London Hospital with that of 
other similar establishments, and they grieved to report 
an apparent extravagance highly reprehensible." 
They recommended that an expert, thoroughly con- 



126 THE LONDON HOSPITAL 

versant with the management of such establishments, 
be engaged to look into the whole matter and advise 
the committee as to economy. This was in 1807. 
So a Rev. Mr. Rudge was engaged to act as superin- 
tendent for one year. The experiment was eminently 
satisfactory. The minutes speak of greater comfort 
to the patients, greater cleanliness, and greater 
economy. When Mr. Rudge retired, in 1809, to attend 
a small living in the country, the committee voted 
him £650 as " a thank-offering for the zeal, talents, and 
exertion he has so constantly and successfully prac- 
tised." We hear no more of Mr. Rudge, but doubtless 
his influence is felt to this day. When he left, the 
committee decided to make the appointment of super- 
intendent a permanent one, and so advertised for 
" a man between the age of thirty and forty, single, 
and of an active and firm mind." 

In 1818 this appointment, then known as that of 
House Governor, was merged with the duties of 
Chaplain in the person of the Rev. William Valentine. 
He was paid £250 a year, with board and residence. 

One of the chief features of the Hospital to-day is 
the accommodation given to those of the Jewish faith. 
There are four wards exclusively reserved for Jews, 
in which all the religious rites of these people are very 
carefully observed. Separate contracts a,re entered 
into for Kosher meat. A separate kitchen is provided, 
which is under the charge of a Jewish cook. There 
is a Jewish mortuary for the dead. Every con- 
venience is given for the observation of the great re- 
ligious festivals — the Feast of the Passover, of Taber- 
nacles, and for the rite of Circumcision. The ordinary 



HISTORY OF THE JEWISH WARDS 127 

visiting-day at the Hospital, when friends are enabled 
to see patients, is Sunday. For Jews it is Saturday, 
their Sabbath. One of the rules of the Hospital is 
that out-patients who can afford to do so should pay 
3d. per week towards the cost of medicines or dressings. 
About haK the patients who attend pay this small 
charge towards the expense of their cure. To the 
strict Jew the carrying of money on the Sabbath is 
forbidden. In order that there may be no suffering 
on the part of Jews, who would refuse to attend the 
Hospital on their Sabbath with such a rule in force, 
certain members of the House Committee have guaran- 
teed to pay the 3d. for any Jews who conscientiously 
object to carry money on the Sabbath. 

A district near where the Hospital is situated has 
been a dwelling-place for Jews for more than a hundred 
years. In 1747 their numbers were so great that they 
had thoughts of founding a hospital of their own, for 
we find a deputation visited the committee of the 
Hospital, led by a Dr. Castro Samento, " to desire the 
favour of being informed of the scheme upon which this 
Charity was first founded, the Jews having decided to 
found an Infirmary for their poor." The steward was 
directed to give all information possible. The infor- 
mation was given, evidently, for three months after 
we find that — 

" Joseph Salvador thanked the Committee in the 
name of the Elders and Body of the Portuguese Jews 
for the assistance rendered by the Officers of the 
London Infirmary." 

The scheme appears to have fallen through, for in 
1756 arrangements were made for the treatment of 



128 THE LONDON HOSPITAL 

Jews in the Hospital. There were no special wards for 
them, nor was special food provided ; but there is a 
minute which says : " Jews are to be allowed 2|d. a 
day in lieu of meat and broth, but to receive bread 
and beer, like the other patients." 

The Jews are not referred to again in the minutes for 
forty years, when the Medical Staff of the Hospital 
reported to the committee that the 2hd. per day was 
insufficient for Jewish patients to provide themselves 
with meat. The allowance was therefore increased to 
4d. a day. This was not to be paid, however, unless 
the patient was on a meat diet ; patients who were on 
milk or fever diet were not to receive the grant. If 
patients' diets were changed then as often as they are 
now, the steward must have found his time fully 
occupied in keeping accounts of these small payments. 
In 1816 there was a conference between " Gentlemen 
of the Hebrew Nation " and the committee, to con- 
sider what further accommodation could be afforded, 
and the result of the conference was that the com- 
mittee " entirely relinquishes all idea of a separate ward 
or wards." 

Nothing is heard of the subject until 1837, when 
a very influential deputation of Hebrew gentlemen 
attended the committee and read the following com- 
munication : 

" The Committee, for the more effectual relief 
of the sick poor of the Jewish community re- 
quiring medical aid in and about London, are very 
desirous of having a ward in the London Hospital 
appropriated exclusively for persons of their Faith, to 
be divided into two compartments, being for males 



HISTORY OF THE JEWISH WARDS 129 

and females, the former to be attended by a Jew nurse, 
the latter by a Jewess nurse, as also a separate kitchen 
under the care of a Jewess cook, and the meat to be 
supplied by a Jewish butcher ; by which means the 
Jewish in-patients would, on their sick- and often 
on their death-beds, receive that consolation and 
peace of mind which would prove most consonant 
with their religious feelings. They are also desirous 
of having out-patients to the Hospital for such poor 
whose cases do not require their becoming in-patients. 
The Committee have been informed that the average 
number of Jewish patients in the different wards of 
the London Hospital have been about forty for some 
time, to whom the Hospital kindly allows 9d. per day 
each in lieu of diet.* The Committee are aware that 
their present request would be attended with extra 
expense to the Hospital, and therefore purpose to make 
an annual payment as some compensation for the 
required boon, or would recommend their body to pay 
immediately (as much as their funds will allow) a sum 
of money in lieu of an annual payment. The deputa- 
tion of the Committee now in attendance leave the 
amount of compensation in either case to the known 
liberality and generosity of the Governors of the London 
Hospital, and they only regret that their present means 
are such as to obUge them to use every economy in 
the distribution of them. But, as the Governors of the 
London Hospital are aware that the Jews have been 
liberal donors to their excellent Charity, the Committee 
think they are warranted in beheving that, should the 
present request be granted, the generosity hitherto 
displayed by the more opulent of their brethren will 
be considerably augmented, not alone by them, but 
by every member of the Jewish community." 

* There is no reference in the minutes of this change 
from 4d. 

9 



130 THE LONDON HOSPITAL 

A special committee was appointed to consider this 
communication. This special committee reported in 
three months as follows : 

" With every possible desire to meet the wishes ex- 
pressed by the gentlemen of the Hebrew nation for 
peculiar accommodation for patients within the walls 
of the Hospital, the committee is of opinion that the 
present means of the Hospital do not afford the power 
of granting the request ; but the committee will be 
ready to resume consideration of the subject whenever 
the funds of the Hospital will enable them to extend 
the building." 

In 1840 a Building Committee was appointed to con- 
sider the extension of the east wing, " including a 
ward for Hebrew patients." 

In 1842 this Building Committee reported (the east 
wing having been built) : 

" Having had under consideration the arrangement 
for the Hebrew patients as formerly proposed by the 
Surveyor, we are unanimously of opinion that it would 
be more for the interest of the Hospital, as well as for 
the comfort of the Hebrew patients themselves, and 
more convenient for the medical officers and servants 
of the Hospital, to appropriate Sophia Front Wards for 
the female Hebrews, and Talbot Front Wards for the 
male Hebrews." 

Mr. Ellis, " on behalf of the Gentlemen of the 
Hebrew nation, approved of this arrangement." The 
Jews had separate wards in the Hospital from this 
date until 1853. 

In the latter year the House Committee complained 

" of the great inconvenience resulting to the Hospital 
from the practice of keeping an entire ward exclusively 



HISTORY OF THE JEWISH WARDS 131 

for male Hebrew patients, whether there were appli- 
cants for the beds in such ward or not, and suggested 
that no injury could accrue to Hebrew patients if, 
upon application for admission, they were placed in 
one allotted portion of certain wards, the other beds 
in such wards being given up for Christian patients, 
when not required by the Hebrews, and vice 
versa^ 

As to this, the representatives of the Jews, through 
a Mr. Helbert, replied, in a broad-minded spirit, " that 
it was by no means their wish that beds should be 
kept empty to the detriment of patients requiring 
them." 

The arrangement was adopted, and the wards 
hitherto used for Jews exclusively were now used for 
Christians as weU, when necessary. 

The plan did not succeed, however, and within a 
year — i.e., in 1854 — the Jews again approached the 
committee by deputation, asking for the allotment of 
separate wards instead of only distinct portions of 
certain wards. The committee replied that it was 
impossible to accede to the request. The refusal was 
considered by the Jewish Vestry to be unfair, as the 
wards had once been opened, and the following letter 
was sent to the governors of the Hospital : 

" That this Vestry, having heard with great regret that 
the wards at the London Hospital, agreed to be set apart 
for Jewish patients, have been opened for the admission 
of patients of other religious denominations, this Vestry 
request that Mr. Ellis and the other Jewish members 
will represent to the committee of the London Hospital 
that the admission of such patients is contrary to the 
spirit of the arrangement between the Committee of 

9—2 



132 THE LONDON HOSPITAL 

the London Hospital and the Jewish Community, and 
earnestly hope that they will use their best influence 
with a view to prevent its recurrence." 

The House Committee sent the following letter in 
reply to this resolution of the Jewish Vestry : 

" To the Secretary of the Great Synagogue. 

" Sir, 

" Mr. J. H. Helbert having handed to the House 
Committee the copy of a resolution passed at a meeting 
of the Vestry of the Great Synagogue held on the 
19th instant, I am instructed to inform you that such 
resolution has received the fullest consideration. In 
pursuing your inquiries, the following facts have been 
made evident to the House Committee — viz. : that 
since 1842, the year when the Hebrew wards were 
established, the number of in-patients generally has 
very much increased ; that the several changes in the 
appropriation of the wards have been adopted under 
circumstances of pressing necessity ; that every pre- 
caution is taken to render those portions of wards 
allotted to Hebrew patients as distinct as possible 
from the other parts of such ward ; and that very great 
benefit has resulted to the general body of patients 
from the present arrangement. With reference, how- 
ever, to these several views of the question, or to their 
own desire to meet the wishes of the Jewish Community, 
the Committee have reluctantly to confess that, with 
the limited accommodation afforded by the present 
building, surrounded as it is by a rapidly increasing 
population, it is impossible to allot separate wards to 
Hebrew patients — a conclusion at which the Com- 
mittee have arrived not without very sincere regret. 
The utmost, therefore, wliich the Committee can now 
do is to express their determination, in the event of 



HISTORY OF THE JEWISH WARDS 133 

an enlargement of the Hospital being effected, which, 
for the present, has been placed in abeyance, to give 
the fullest consideration of the subject of providing 
suitable separate accommodation for the patients of 
the Hebrew persuasion." 

The Vestry replied : 

" The difficulty in which the Hospital has been 
placed with reference to this subject having been ex- 
plained, it is suggested that a screen, reaching nearly 
to the ceiling, with a door, might be provided, mov- 
able, so as to make that portion occupied by Jews 
quite distinct and separate, which would meet the 
exigencies of the case." 

This plan was temporarily adopted. This, too, did 
not prove a satisfactory arrangement, and in 1856 the 
question was again raised. Mr. Sebag attended 

" with the Hebrew Trust Deed and other documents, 
which were read, and from which it appeared that in 
the year 1842 certain Trustees had been appointed to 
apply the funds of a Society, now extinct, for the 
relief of Sick Poor of the Hebrew Persuasion in aid 
of the funds of the London Hospital, so long as certain 
conditions involving separate accommodation, etc., for 
Hebrew patients should be adhered to. The minutes 
of the House and Building Committees were then also 
examined, from which it appeared that no legal engage- 
ment to adhere to the conditions of the above-named 
Trust Deed had ever been entered into by the Governors, 
the Hebrew wards, kitchen, and other accommodation 
having been provided solely under certain recommen- 
dations from the House and Building Committees." 

This was quibbling, I think, on the part of the Com- 
mittee, or else they had not all the facts before them. 



134 THE LONDON HOSPITAL 

The following extract from the old minutes, dated 
April 21, 1842, of the " Institution for the Rehef of the 
Distressed Sick of the Jewish Persuasion," seems to 
show that there tvas an agreement : 

" Mr. S. H. Ellis attended on behalf of the Committee 
of the London Hospital, and officially announced to 
the meeting that four wards in that Institution were 
now completed and ready for the admission of Jewish 
patients on the amiiversary — the 28th instant — and 
that the same wards would be named on that day by 
His Royal Highness the Duke of Cambridge as follows : 
Two male wards — the one Goldsmid and the other 
De Rothschild ; and the female wards — one Hannah, 
in compliment to the Baroness de Rothschild, and 
the other Esther ; and that, further, one Hebrew 
nurse was already engaged, and that other arrange- 
ments were in progress for the Jewish patients, with 
due regard to their religious habits ; whereupon the 
following resolutions were moved and unanimously 
adopted : Resolved, ' that in consideration of the 
Governors of the London Hospital having appropriated 
four separate wards for the sole use and admission of 
male and female patients of the Jewish faith, and 
undertaking to provide Hebrew nurses and cooks, that 
the provisions and comfort of the Jewish poor may be 
provided for according to their custom, it is resolved 
by this Committee that the interest arising from 
£700 in the Reduced 3J per cent, standing in the 
names of Trustees and £500 in the hands of the 
Great Synagogue Trust be transferred in the names 
of Trustees, and that the interest arising therefrom be 
paid half-yearly by the Treasurer of this Society to 
the Treasurer of the London Hospital for the time 
being, so long as the said wards are appropriated for 
the reception of the Jewish patients.' " 



HISTORY OF THE JEWISH WARDS 135 

As the Hospital had been receiving the''^ income 
derived from this trust since 1842, one cannot see 
what right the committee had to say the governors 
had not entered into any agreement. The income 
from the Hebrew Trust, now known as the Rothschild 
Fund, is still paid to the Hospital. 

At last wards were reopened exclusively for Jewish 
patients about 1860. Later they were situated in the 
Alexander Wing, soon after its opening in 1866 until 
1904. The four splendid new wards for Jews, situated 
in the west wing of the Hospital, were opened in 1904. 
The late Mr. Edward L. Raphael contributed the mag- 
nificent sum of £20,000 towards their endowment, and 
his son, Mr. Louis Raphael, a present member of the 
House Committee, has contributed generously to their 
equipment. 



CHAPTER VIII 

relations between house committee and staff 
William Blizard 

The relations between the Lay Committee and the 
Medical and Surgical Staff were not always so cordial 
as, fortunately, they now are. Many of these dis- 
agreements between committee and Staff arose out of 
differences between the members of the Staff them- 
selves, who called in the assistance of the committee 
to decide their quarrels. Whichever side the com- 
mittee took, trouble arose, and one or other section 
of the Staff was offended. It seems to us strange 
nowadays that the Lay Committee should take upon 
themselves the duty of acting as judges between the 
surgeons and physicians in purely professional matters. 
The quarrel between the surgeons and physicians as 
to what each might do has been referred to already. 
This particular trouble must be mentioned again, 
however, as it led to further disagreement. 

In 1750 the physicians passed a resolution that 
" the surgeons be not permitted to prescribe to patients 
under their care any internals except purgatives." 
The surgeons objected. The dispute was laid before 
the House Committee, who " maturely considered the 

136 



HOUSE COMMITTEE AND STAPF 137 

arguments on both sides," and gave their decision in 
favour of the surgeons. 

The physicians then sent a private report to the 
President, the Duke of Richmond, complaining " of 
the method of practice of physick and surgery at the 
Hospital, and of other irregularities." It was bad 
enough to send in their private report of the dispute, 
which had been considered by the House Committee, 
but it was worse to drag in " the other irregularities," 
whatever they may have been. 

The committee got to hear of this memorial, and 
demanded a copy of it from the physicians, who 
refused to give it. Application was then made to the 
President himself, who ignored the letter. Therefore 
a subcommittee was appointed to " investigate the 
behaviour of the Hospital Staff," which was done very 
thoroughly, and reported on, certainly without fear or 
favour. 

The subcommittee reported that the physicians 
attended on two days a week each only, 

" and they surmised that this might be prejudicial to 
patients' interests, particularly in fevers, when the 
necessity of altering a prescription frequently occurred, 
were it not that they found that each physician, after 
visiting his own beds, visited others, if his attention 
was required, and they altered each other's prescrip- 
tions ; and this was often done by the apothecary, 
whose skill and acquaintance with the method of prac- 
tice of the several physicians sufficiently qualified him 
for that post." 

Those must have been fine times for a patient, when 
any physician who passed his bed, not to mention the 



138 THE LONDON HOSPITAL 

apothecary, had the right to pour a little more physic 
into him ! One can appreciate the heartiness with 
which he returned thanks " to Almighty God and the 
House Committee " when he got out of the place safe 
and sound. 

The subcommittee referred incidentally in their 
report to the complaint which had been made con- 
cerning the treatment of one Michael Bourdon, " a 
patient of Dr. Sylvester's." He was a lad of fifteen, 
who "had a shortness of breath owing to a dropsy." 
A swelling was noticed in his cheek, and the phj^sician 
stated that he had asked the surgeon to look at it, but 
he had neglected to do so, and the patient subsequently 
died. The subcommittee, having given the matter 
their attention, soon settled that the death of the 
patient was not due to any neglect upon the part of 
the surgeon, but that " the patient died of a fever, 
shortness of breath, and a broken constitution." With 
such an omniscient committee one wonders what need 
there could have been for coroner, surgeon, physician, 
chaplain, or apothecary. 

With reference to the action of the physicians in 
sending a memorial to the Duke of Richmond, the 
committee reported as follows : 

" We also took into consideration the action of 
your physicians in presenting a memorial to His Grace 
the late Duke of Richmond, President of the Hospital, 
and the physicians, being called in, did acknowledge 
that some expressions of heat had passed from them 
in their memorial, which they were sorry for, and they 
engaged to submit themselves in future to the direc- 
tions of the House Committee. This acknowledg- 
ment was deemed as sufficient satisfaction in the 



HOUSE COIVIMITTEE AND STAFF 139 

opinion of your committee, who recommended to the 
physicians a particular caution against making any 
complaints whatsoever for the future relating to the 
Hospital, except first to the House Committee." 

The subcommittee closed their lengthy report by 
a long list of rules as to the general management of 
the institution and as to the behaviour of the members 
of the Staff, medical and lay. 

Every member of the lay Staff had to appear before 
committee every three months, to hear his standing 
orders read over to him, and to be questioned as to 
whether he had kept them the preceding quarter. 
Among these rules was one to the effect that the 
apothecary and the " dresser for the week " were to go 
round the hospital every morning and examine every 
patient. It would seem that the apothecary played 
into the hands of the physicians, and the dresser 
championed the cause of the surgeons, for it is stated : 

" In case of any dispute which shall at any time 
arise under whose care a patient ought to be, the 
same shall be determined at the next meeting of the 
House Committee." 

Until the year 1768 no medical qualification or 
degree was demanded of gentlemen who were candi- 
dates for appointments on the Staff. In this year a 
Dr. Samuel Leeds was appointed, and was asked to sit 
for his examination before the College of Physicians 
before the next Quarterly Court, and it was at the same 
time decided — 

" That no person be in future admitted a candidate 
for the office of physician until he has been examined 
by the College of Physicians in London, has their 



140 THE LONDON HOSPITAL 

approbation, and has been admitted by them to 
practice." 

Dr. Leeds failed to pass his examination, and re- 
signed, although an extension of time was allowed him. 

In 1784 there were two candidates for a vacancy 
caused by the death of Dr. Thomas Dickson ; they 
were Dr. John Whitehead and Dr. John Cooke. 
Each had to show his certificate from the College of 
Physicians before he was allowed to be a candidate. 
This election was interesting for another reason : 586 
votes were recorded, as follows : 

Dr. Whitehead 293 

Dr. Cooke 292 

One vote was disqualified. A protest was lodged 
immediately that the voting was unfair, and a court of 
inquiry was held, which reported " that in the opinion 
of this court. Dr. John Cooke had a majoritj^ of legal 
votes, and is duly elected physician." The illegality of 
the election was in connection with some of the proxies. 
The great distress throughout the country at the 
beginning of the nineteenth century is reflected from 
time to time through the minutes. In 1800 the Staff 
approached the committee as to the urgent need of 
opening more beds, if only temporarily, " during the 
present winter, so peculiarly distressing to the invalid 
poor on some obvious and afflicting reasons." But 
the committee were at their wits' end to keep the beds 
open which were already in use, on account of the great 
increase in the cost of all provisions and other neces- 
saries, and they not only had to refuse the request of 
the Staff, but were driven to make more stringent 
rules than ever to lessen the expenditure. The use of 



HOUSE COMMITTEE AND STAFF 141 

foreign wines was forbidden. Spirits and porter 
could only be used for the most urgent cases, on the 
special request in writing of the surgeon in charge. 
On certain days every week no meat was to be 
served to patients on any account whatever, and 
these meatless days were known as " banyan days." 
So great was the pressure on the beds that 
two patients were put into each at times, and the 
" matron complained that the blankets were so small 
that they would scarce cover one patient." The 
committee decided to go round the wards every week 
" and discharge all patients who appear to be in the 
Hospital for reason of maintenance rather than for the 
cure of disease." The committee, out of their own 
pockets, made grants to patients when leaving the 
Hospital, on account of the fearful distress. The 
purchase of pewter plates, spoons, and porringers 
was forbidden ; wooden vessels only were used. 
Soldiers were to pay 4d. a day while in Hospital, as 
" a contribution towards their cure." The Overseers 
of the poor of Whitechapel were urged to do their 
duty more efficiently, and the Hospital authorities 
refused to treat patients who should rightly be 
cared for by these Overseers. Help was refused, 
for instance, " to all such as ask alms in the streets," 
and if such had to be admitted for urgent medical 
reasons, the Overseers were to be charged 4d. a day, 
like the soldiers, for the cost of the patient's keep. No 
bread was to be given to any patient until he had 
eaten up what had been given him on the previous day. 
The charge of 4d. a day for parish patients was soon 
increased to 6d., and the Overseers had to deposit 



142 THE LONDON HOSPITAL 

one guinea on the admission of such patient. But 
patients of the French nation " are to be paid for at 
the rate of 2s. per day, as arranged with ChevaHer 
Sequier, the French Consul." Convalescent patients 
were to be set to work in order to relieve the wages bill. 
The apothecary's laboratory was a favourite place 
for the employment of such convalescents, and one 
cannot wonder at the repeated complaints of the Staff 
that the medicines were unsatisfactory, and that cases 
of poisoning are reported from time to time throughout 
the minutes. 

Not often does one come across any definite reference 
to current events in the records, but occasionally such 
reference is found. In 1748 there was a thanksgiving 
service for the deliverance of the country from great 
peril, and at this time there was a Guildhall subscrip- 
tion " for the sufferers in the late rebeUion." The 
Hospital received £100 of this appeal, "as it had 
reheved so many objects who were sufferers in the late 
Rebellion." This, I presume, referred to the march 
of the Young Pretender into England as far as Derby, 
and his final defeat at Culloden. Then, in 1798, the 
Hospital received £100 " from the fund raised for the 
benefit of the sufferers in the action of July 1st " (the 
Battle of the Nile). 

In 1810 the following letter was received by the 
committee : 

" Gentlemen, 

" It being found necessary to assemble a body 
of troops round the Metropolis, amongst whom a 
number of sick are to be expected, we request you will 
be pleased to inform us whether under this emergency 
such men can be received into the London Hospital, 



HOUSE COMMITTEE AND STAFF 143 

and to what extent accommodation can be provided. 
Should you accede to this proposal, we beg you to say 
if it be your desire that the sick shall be under the 
sole care of the Medical Gentlemen of the Hospital, or if 
INIiMtary Medical Officers shall be ordered to attend them. 
" We have the honour to be, 
" John Weir, 
" Theodore Gordon, 

" Army Medical Board Office." 

The following reply was sent : 

" Sir, 

" This moment your letter of the 10th inst. has 
been delivered to me, and I have the pleasure to inform 
you that there is room in the London Hospital for 100 to 
150 men. Unfortunately, there are no beds, but if His 
Majesty's Government will undertake to provide them, 
and to make also a provision for the men, I will undertake 
that they will be cheerfully received and placed under 
the care of the Medical Gentlemen attached to the 
Hospital, who, with that liberal sentiment for which 
they have always been distinguished, have undertaken 
to give them every possible attention and assistance. 
I have the honour to be, etc., 

" QuARLES Harris, 
" Chairman of House Committee,''^ 

" 41, Crutched Friars, 
''April nth, 1810." 

The offer was accepted. The Government agreed to 
supply the beds and all else that was needed, with 
servants and attendants, and to pay lOd. a day for 
each man admitted. The wards were prepared. 
Nothing came of it, however. No sick soldiers were 
admitted. This massing of troops had to do with Lord 
Chatham's expedition to attack the French in Holland. 



144 THE LONDON HOSPITAL 

Neither is there often reference in the minutes to 
the prevailing diseases of the time. When such refer- 
ence is made it is usually on account of the disease 
having reached the magnitude of an epidemic, and 
cholera is often referred to in this way. The following 
reference to hj^drophobia, dated October, 1808, is 
interesting : 

" The physicians and surgeons respectfully represent 
to the House Committee of the London Hospital that 
there have been received into the Hospital within the 
last three months several cases of hydrophobia ; that 
many instances of the same dreadful and fatal disorder 
witiiin a short period have come to their knowledge ; 
that several persons and animals have very lately been 
bitten by dogs unquestionably mad ; and that in their 
opinion it is highly necessary that these facts should 
be stated to persons in high authority, in order that 
proper measures may be taken for the public safety." 

A copy of the above, which was signed by William 
Blizard, surgeon, and others, was sent to the Lord 
Mayor, and was inserted in the morning and evening 
papers. 

Many reports which had to do with the public wel- 
fare were received from time to time by the com- 
mittee from this same William Blizard on cleanhness, 
on drainage, on fresh air. Some more detailed refer- 
ence to this wonderful man and surgeon is necessar}'-, 
and I am indebted to a memoir published by William 
Cooke for most of the following information. 

William Blizard was born at Barnes Elms, in Surrey, 
in 1743. His father, William Blizard, was an auctioneer, 
and had five children, of whom the future surgeon was 



WILLIAM BLIZARD 145 

the youngest but one. His early education was 
neglected, but in later life he made up for the loss 
by doing all in his power to educate himself and to 
improve his general knowledge. He became proficient 
in the reading of Latin, and undoubtedly was a great 
botanist and a great chemist. 

At an early age he was apprenticed to a surgeon and 
apothecary at Mortlake, a Mr. Besley. He afterwards 
came to London and became the assistant of a surgeon 
practising in Crutched Friars. While practising as 
a surgeon, he was studying under ]\Ir. Henry Thompson, 
one of the surgeons of the London Hospital, and a man 
of considerable talent and eminence in his day. On 
the death of Thompson in 1780, Blizard was elected 
surgeon in his stead. He performed all the operations 
at the Hospital for many years, his two colleagues, 
Mr. Grindall and IVIr. Neale, leaving this duty entirely 
to him. He always took the deepest interest in sys- 
tematic medical education, and when quite young 
connected himself with a Dr. Maclaurin, a well-known 
teacher of anatomy, in giving lectures on surgery at 
a small house in Thames Street, and afterwards in 
Mark Lane. His greatest honour in this respect 
was that he founded, in 1785, the first regular medical 
school connected with a great Hospital — viz., that 
connected with the London Hospital. The House 
Committee gave the ground ; the building was erected 
at an expense of some thousands of pounds, chiefly 
supplied by himself, at a time when he could ill afford 
it. The foundation of the Medical School will be 
referred to in another chapter. 

It is of interest to note in passing that at first 

10 



146 THE LONDON HOSPITAL 

Blizard's anxiety to teach in the Hospital met with 
no favour from the committee. He was not allowed 
to teach on cases in the Hospital, and although he 
was permitted to use a room for his lectures, he had, 
at first, to bring his cases with him. He seems to have 
considered the opening of the school on October 27, 
1785, as the great event of his Ufe. He wrote an ode 
on the occasion " expressive of humane and correct 
sentiment." Here is a quotation from this ode : 

" Hail the retxim of this auspicious day ! 
Now let the grateful, gen'rous heart record, 
In heartfelt strains, how Providence befriends 
This seat of commerce and benevolence ! 
In this fam'd city dweUs such social love 
As smiles alone in chmes of hberty. 
The genial pa.tronage of every art 
That tends to soften the rough paths of Ufe 
Bids the wide dome with lofty columns rise, 
Fann'd with refreshing air, and ev'ry charm 
Which the lax nerve and di'ooping frame can ask : 
She, kinder still, bids industry prevail, 
Without whose aid aU other aids are vain : 
Sacred to her be this auspicious day !" 

The ode was set to music by Dr. Samuel Arnold, 
and was performed at the London Tavern, a house 
which for 150 years has been strangely connected 
with the history of the Hospital. About this time 
Blizard received an invitation from Guy's Hospital 
to occupy the Chair in Chemistry, which he dechned. 

"As a practitioner he was discriminating and 
decided in forming his opinions, energetic and skilful 
in the apphcation of his means, and studious of as 
much simphcity as possible. . . . The last year he 
operated in public was in the year 1827, at which time 
he was eighty-four years of age. It was the removal 




WILLIAM BLIZARD, F.E.S. 

President of the Royal College of Surgeons, and for fifty-three years Surgeon to 

the London Hospital 



WILLIAM BLIZARD 147 

of a thigh, and the stump healed perfectly in a fort- 
night. As an operator he was remarkably cool and 
determined, never losing his presence of mind. His 
hand never trembled, and it is said to have been as 
steady the last year as at any period of his life. It 
was highly to the honour of Blizard that when called 
into scenes of suffering or to the infliction of pain in 
operative surgery he was never insensible to the 
sympathy and kindness of the man, when he had to 
exercise the cool intrepidity of the surgeon. He had 
often the satisfaction to notice how the kind and 
sympathizing word appeared to mitigate anguish and 
to inspire with fresh courage under the required 
incision ; and the gratitude subsequently felt for the 
kindness of the manner was sometimes more prominent, 
in the acknowledgments of the patients, than for the 
dexterity and success of the operation." 

Blizard was a bad lecturer, but an excellent teacher. 
Cooke says of him : 

" He was most happy and appeared to greatest 
advantage in the wards of the Hospital ; his clinical 
remarks and his oral instructions were much valued. . . . 
The aptness and vivacity of his remarks, and his ready 
tact in directing the attention of students to the 
leading points in the case under his care, rendered his 
visits at all times instructive." 

The great surgeon John Abernethy says of him (in 
1814) : 

" My warmest thanks are due to him for the interest 
he excited in my mind towards those studies, and for 
the excellent advice he gave me to direct me in the 
attainment of knowledge. ' Let your search after 
truth,' he would say, ' be eager and constant. Be 

10—2 



148 THE LONDON HOSPITAL 

wary of admitting propositions as facts before you have 
submitted them to the strictest examination. If, 
after this, you beheve them to be true, never disregard 
or forget one of them. Should you perceive truths to 
be important, make them the motives of action, let 
them serve as springs to your conduct. Many persons 
acknowledge truth with apathy ; they assent to it, but 
it produces no further effect on their minds. Truths, 
however, are of importance in proportion as they admit 
of inferences which ought to have an influence on our 
conduct, and if we neglect to draw those inferences 
or act in conformity to them, we fail in essential 
duties.' " 

Abernethy says of him further : 

" He contrived by various means to excite a degree 
of enthusiasm in the minds of his pupils. He displayed 
to us the beau-ideal of the medical character — I cannot 
readily tell you how splendid and brilliant he made 
it appear — and then he cautioned us never to tarnish 
its lustre by anything that wore even the semblance of 
dishonour. He caused the sentiment of the philan- 
thropic Chremes of Terence to be inscribed on the 
walls of the Hospital surgery, that students should 
have constantly before them an admonition to humanity 
drawn from a reflection of their own wants : ' Homo 
sum ; humani nihil a me alienum puto ' " (I am a man ; 
and all calamities that touch mankind come home to 
me. — G. Colman). 

That line from Terence has been the motto of the 
Hospital ever since. 

I must apologize for digressing for a moment. The 
mention of the Hospital motto reminds me of an amusing 
incident. A much harassed and very weary Receiving- 
room Officer was reported for being rude to a man 



WILLIAM BLIZARD 149 

in the Receiving-room. He acknowledged that he 
had been rather " short," but the patient had ex- 
asperated liim beyond aU endurance ; among other 
things, had insisted on being thoroughly examined 
at 3 a.m. for some trivial complaint which he had had 
for a week, but had not found it convenient to attend 
to before. 

The officer was reminded that to keep his temper 
at aU times was part of his medical training — that he 
must be polite to all sorts and conditions of men. 
V/hat was the Hospital motto ? It was rightly 
quoted, but in asking for the English equivalent, I was 
told : "As I'm a man, I don't beUeve an alien's a 
human being !" 

Blizard's exertions w^ere not limited to the founda- 
tion of a great teacliing school nor to his routine 
Hospital duties. He loved the Hospital with his whole 
heart, he was jealous of its honour, and his energies 
were unceasingly devoted to the extension of its sphere 
of usefulness. His own interests were repeatedly 
sacrificed to promote this object. He induced most 
of his wealthy patients to become governors. At a 
period when its funds were greatly depressed, he made 
innumerable applications for support and assistance, 
and spared neither means nor labour in urging its 
claim upon public attention. He once said his 
connection with the London Hospital was the pride 
of his life. 

He received the honour of knighthood in the year 
1803. 

" During several years he was in the habit of con- 
tributing extensively from his own pocket, to relieve 



150 THE LONDON HOSPITAL 

the pressing necessities of patients, who, on leaving the 
Hospital, still perhaps but convalescent, or in a lame 
or incurable condition, penniless, houseless, and not 
unf requently without friends,were exposed to wretched- 
ness exceeding that of their condition before they were 
admitted. These were objects of great commiseration 
to him, and it was to relieve such distress that 
he founded the Samaritan Society in the year 
179L" 

Now known as the " Marie Celeste " Samaritan 
Society, on account of the munificent gift of Mr. James 
Hora, in memory of his wife Marie Celeste Hora, this 
Society still administers such relief to the patients of 
the London Hospital as does not fall under the actual 
work of the Hospital, by sending convalescent patients 
to sea or country ; by assisting patients to provide 
themselves with surgical appliances in accordance 
with the recommendation of the surgeon ; by supplying 
the poorer patients with clothing, if necessary, when 
leaving the hospital ; or by making small monetary 
grants to patients who may be in urgent need of 
assistance. 

One cannot imagine how the usefulness of the 
Hospital could be maintained without such a charity. 
Last year (1909) over 2,000 cases were sent to con- 
valescent homes on their discharge from hospital ; 
3,500 surgical appliances were supplied (artificial limbs, 
expensive splints for hip-disease, etc.) ; monetary 
grants were made to seventy-four patients, cliiefly 
with a view to save the home while the husband or 
father was a patient in the Hospital, the result of an 
accident, etc. The Queen herself has generously con- 



WILLIAM BLIZARD 151 

tributed to its funds to help poor patients to bear the 
expense of travelling up to attend the Finsen Light 
Department. 

Such work was exactly what Blizard had in view 
when he founded this most useful society. In doing 
so he made an appeal to the public, from which the 
following may be quoted as showing what he desired 
should be the aim of the society, and, incidentally, 
the kind of man BUzard himself was : 

" To learn all the varieties of wretchedness, to 
remove it, or to soften its pangs, the ear must be un- 
weariedly inclined to tales of woe, the hand must be 
ever ready to succour, and the heart and understanding 
to advise, to comfort, and to guide. In the lustre 
of public charities, misery, of a nature not immediately 
to attract the eye, often remains unnoticed. The 
greatest exertions of art and the most diligent care are 
extended to poor, sick, and hurt fellow-creatures. 
But skill and tenderness will hardly avail against disease 
whilst the mind is continually depressed by reflection 
upon a hopeless prospect in life, or upon the condition 
of a family pining with grief or want." 

Soon after Blizard's appointment to the Staff of the 
London Hospital he was made Professor of Anatomy 
to the old Corporation of Surgeons, and he was chiefly 
instrumental in obtaining a charter for the new college. 
He was one of the two first appointed professors to 
the chartered institution, now designated the Royal 
College of Surgeons, and he twice served the office of 
President, an honour which has fallen to other 
" Londoners " since. Blizard was the founder of the 
Anatomical Society, a Fellow of the Antiquarian 



152 THE LONDON HOSPITAL 

Society, a Fellow of the Royal Society, a Fellow of 
the Royal Society of Edinburgh, the founder of the 
Horticultural Society, and one of its first Fellows, 
and was one of the founders of the London Insti- 
tution. 

He was tall in person, with features strongly 
marked, a man of strong emotions, and " prone to 
jocularity." 

" Allusion has been made to his high sense of pro- 
fessional honour. Abhorrence of quackery in any form 
was a leading feature in his character. He could not 
endure to have kept secret any remedy adapted to 
the relief of human sufferings, nor bear with the 
self - commendation, or the detracting innuendo, 
designed to place another practitioner in a false light, 
or to subvert his interests. Everything which mili- 
tated against pure integrity and unsophisticated 
courteousness incurred his marked disapprobation." 

He was a man of strong religious feeling, and every- 
thing that had to do with the betterment of mankind 
was of interest to him. Sunday-schools, infant schools, 
the reclamation of the fallen, the reform of the prison 
system — all appealed to him as they did to his great 
friend John Howard, the philanthropist. He enter- 
tained great respect for the clergy, and was always 
ready to befriend them, knowing many to be poor 
and well deserving of kind consideration. He 
was a man of Cathohc spirit, and as readily gave 
his counsel to a suffering minister of any other 
religious persuasion as to one belonging to his own 
Church. 

Many anecdotes cling to a personality so marked. 



WILLIAM BLIZAED 153 

Cooke, in the memoir from which I have quoted, tells 
the following : 

" Many years ago, when the vicinity of London was 
greatly infested by footpads, BLizard was travelling 
alone on the Essex Road, and his carriage was stopped 
by three men. Having placed a pistol against the 
breast of one of them, it missed fire ; he therefore gave 
up his watch and purse. Afterwards recollecting that 
the watch, though not of much value, had been given 
him by an esteemed friend, he asked for it back again. 
The man to whom he had given it up replied : " There, 
my honest fellow, take your watch," at the same time 
returning it. The man had been under Blizard at 
the London Hospital, and had recognized him." 

At this time it was dangerous to travel in the vicinity 
of London at night unarmed. There is a reference 
in the minutes of a complaint from Blizard that, 
coming to the Hospital during the night to see a patient 
on whom he had been operating during the previous 
day, he was kept waiting at the outer gate of the 
Hospital for some time, to his great inconvenience and 
danger. The gates were always locked at night, and 
a " watcher " from one of the wards went to the 
gate every hour or two to see if anyone were there. 
After Bhzard's complaint a bell was hung at the gate. 
Blizard always carried a weapon when he visited the 
Hospital. 

" One night," says Cooke, " on leaving the 
Court of Examiners at the College, he missed his 
favourite hanger, which had more than once served 
him as a weapon of defence in early life. His servant 
was unable to give any account of it, which induced 
Blizard to exclaim with some energy : ' It must be 



154 THE LONDON HOSPITAL 

found, for with it I am in fear of no one, not even of 
the devil himself.' A member of the Court who was 
by remarked : ' If that is the case, he had better have 
it put in his coffin with him." 

Sir William Blizard died on August 28, 1835, at 
the age of ninety-two, and was buried in a vault under 
Brixton Church. 



CHAPTER IX 

BREAK OF DAY 

Mention has been made of William Blizard's friend- 
ship for John Howard. This great reformer paid a 
visit of inspection to the Hospital in 1788, which is 
thus referred to in the minutes : 

" Your Committee beg leave to acquaint the Court 
that John Howard, Esq., a Governor of the Charity, 
who has visited all, or at least the greatest part of, the 
hospitals in Europe, did, in the month of September 
last, visit this house three separate times. He sug- 
gested to Mr. Blizard, who accompanied him in one of 
his visitations, many useful observations with regard 
to rendering such Asylum of the afflicted sweet and 
salutary, and upon principles, too, ye most economical. 
Your Committee, anxious for the welfare of the Charity, 
and wishing to profit by the experience of one whose life 
has been spent hitherto in such benevolent exertions, 
have adopted some of his useful regulations, which will 
be laid before you in a subsequent report." 

John Howard's visit led to many improvements 

in ventilation, cleanliness, and the prevention of the 

accumulation of refuse and rubbish. The following 

letter was sent to him : 

155 



156 THE LONDON HOSPITAL 

" Sir, 

" The Committee of the London Hospital, duly 
sensible of the value of your endeavour to make 
hospitals answer the end of their establishment, return 
you their sincere thanks for your attention to the 
Charity under their special care, and particularly for 
your representations for its improvement. They are 
now executing everything in their power which you 
have suggested as necessary to be done, and they 
trust that this proof of their sincerity in their work of 
charity will secure them your future regard and 
communications, to which they will always pay the 
greatest deference. It is their earnest wish to see the 
Hospital and its government merit your entire appro- 
bation, and your good word with the discerning and 
humane part of mankind. They then shall not 
despair of that support of which they stand greatly 
in need, not only as affording them means of doing 
what is judged proper, but also as encouraging and 
giving energy to their undertakings." 

Many of these recommendations of Howard show 
how far advanced he was of his day. He condemned 
the raising of dust in the wards, dust being somehow 
or other the conveyer of disease ; he advocated cross 
ventilation ; bedding was to be laid in the sun " on 
the grass newly mown " as often and as long as possible ; 
the flock from the mattresses was to be washed in 
water, dried in the sun, and then baked. The last 
words of Howard's report are important, and as true 
in hospital management to-day as they were in 
1788. 

" All these several articles, however seemingly 
insignificant considered individually, are, nevertheless, 



BREAK OF DAY 157 

the important constituent parts which compose the chief 
amount of the sum of welfare which arises from public 
charities to the numberless objects of human sympathy." 

We who to-day enjoy the merciful benefits of aseptic 
surgery, which is nothing but cleanliness raised to a 
science, cannot but be interested in the work of these 
pioneers. They noticed and recorded the facts. 
Lister, who was to explain the facts, was not yet born. 
For instance, a year before Howard's visit, the Physical 
Committee reported : 

" Your Committee are of opinion that as the recovery 
of the patients greatly depends on a free circulation 
of fresh air, that the present disposition of the beds is 
improper by causing a stagnation of noxious efHuvia, 
and in consequence thereof, often producing putrid 
diseases, the frequent effects of confined air." 

And two years before Howard's visit, namely in 
1786, William Blizard, speaking for the surgeons, 
wrote to the committee as follows : 

" In the discharge of our duties as surgeons we have 
for a long time past, and particularly of late, observed 
with great concern that many of our patients who 
had met with accidents — particularly compound frac- 
tures when the broken bone has pierced the outer skin, 
or those who had undergone certain operations, par- 
ticularly that for rupture — have lost their lives through 
being placed in wards in which were persons ill of fevers, 
and that men have been principally the sufferers from 
this cause, being more frequently the subjects of the 
above accidents and operations, and breathing a more 
impure air from a less degree of cleanliness than women." 

At this time medical and surgical cases were all 
nursed together, so he goes on to ask for a small ward 



158 THE LONDON HOSPITAL 

of ten beds in which these cases could be nursed apart 
from the general cases in the main wards, and, in- 
cidentally, he asks that more efficient nursing may be 
provided, complaining that 

" Lately an infirm old woman, nearly seventy 
years of age, had the care of two persons who had 
been cut for the stone, and who required constant 
attention both night and day." 

In order that lay-readers may appreciate the impor- 
tance of the struggle which was beginning, it may be 
of interest to give some particulars here of the precau- 
tions which are taken in modern surgery. There 
was a long period between Blizard's and Lister's day, 
during which there was Kttle or no advance. It has 
been stated that the experienced surgeon of fifty years 
ago was possessed of an operative skill and a know- 
ledge of anatomy that the modern surgeon can hardly 
hope to surpass. However that may be, the results 
obtained by the surgeon of that time, as shown by the 
following statement of facts, are quite appalling to us 
nowadays : " The idea of a wound was inseparable 
from that of fever " ; " the healing of a wound without 
inflammation was not known, and wound fever seemed 
to be the normal reaction of the injured organism." 
Pirogoff, a most experienced surgeon, actually wrote 
a treatise on " Luck in Surgery," in which, after long 
years of surgical practice, he expressed his opinion that 
the influence of the skill of the surgeon was as 
nothing as compared to that of chance in determining 
the success of an operation, and he goes on to state 
that the scourges of suppuration, hospital gangrene, 
erysipelas, and tetanus, dogged the steps of the surgeon 



BREAK OF DAY 159 

and frustrated his efforts. At the private hospital — 
nursing-home we should call it — of a well-known 
surgeon at Munich " 80 per cent, of all wounds 
were attacked by hospital gangrene, and erysipelas 
was so common that its occurrence was considered 
normal." " The mortality after compound fracture 
amounted to 40 per cent." Moreover, wounds which 
did eventually heal took so long to do so that patients 
were kept in hospital as many weeks as they are now 
kept days. Now all this is changed. We now know 
that the cause of wound infection is due to the entrance 
of minute organisms into the wound, which, growing 
there and multiplying, produce each its own toxin. 
The aim of modern surgery is to prevent these organisms 
from so entering. 

By what means may these micro-organisms gain 
access to a wound, and how may they be prevented ? 
In the first place, can a wound be infected by contact 
with the air ? To answer this question innumerable 
experiments have been performed, and the answer is : 
" No, a wound cannot be infected by the air unless the 
air contains particles of dust." It was firmly believed 
that contact with the air did infect the wound long 
after Lister's discovery — indeed. Lister himself believed 
it — and his custom of performing an operation with a 
spray of carbolic in the vicinity was intended to 
destroy the myriads of organisms which he believed 
to be floating around. We still possess in the Hospital, 
curios now, several of these old Lister's sprays. This 
beHef in contamination by the germs in the air died 
hard. When several patients in a ward were attacked 
by erysipelas or hospital gangrene, the air of the ward 



160 THE LONDON HOSPITAL 

was blamed, and it was customary to perform all 
operations with as small an incision as possible, in 
order to admit as little air into the wound as possible. 
Now we are accustomed to see incisions freely made 
several inches in length, and wounds are exposed to the 
air in the theatre sometimes for as long as three hours. 
The method by which the number of micro-organisms 
in the air may be counted is a very simple one theoreti- 
cally. A bottle of known capacity is filled with 
sterilized water ; the water is slowly drawn off from 
a tap at the bottom ; an equal volume of air, obviously, 
is drawn in through the neck of the bottle ; the entering 
air is made to pass across the surface of, or through, 
" culture media." These culture media are fluids 
or jellies (broths, meat extracts, gelatine solutions, 
etc.), in which germs will freely grow, if present, just 
as seeds will grow in potting mould in a greenhouse. 
The culture media are themselves rendered sterile 
by heat before the experiment, and proper precautions 
taken that they may not be infected by anything else 
than by the micro-organisms which may be in the air 
as it passes into the bottle. The tubes containing the 
culture media are then removed and placed in an 
incubator, and under such conditions each retained 
microbe grows into a colony, which may be seen even by 
the naked eye, and the colonies may be counted. 
Thus we are in a position to say that the air in such a 
place contains a hundred, or a thousand, or twenty 
thousand micro-organisms per cubic yard or metre, 
according to the size of the bottle. Moreover, the 
colour, shape, and method of growth of the colonies 
give much information even to the naked eye as to 



BREAK OF DAY 161 

the identity of the germs present. Simple as the 
experiment may appear, it has to be performed with 
infinite care if the results are to be reHed upon. Having 
devised a plan for counting the germs in the air, it 
became easy to apply the test in various ways. It 
was soon found that — 

1. The air was richer in germs in cities than in the 
countrv. 

2. In dry weather germs are more numerous in the 
air than in wet Aveather. 

3. They are more numerous when wind is blowing 
than in a calm. 

4. Far out at sea the air contains no germs at all. 

5. The air at the summit of the Alps, above the snow- 
line, is free. 

6. On the sea-shore wind blowing off the land is 
germ-laden ; that blowing in from the sea is germ- 
free. 

AH these experiments seemed to point to one con- 
clusion — namely, that air which was free from dust 
was free from germs, and that air which contained 
suspended dust contained germs. This theory was 
therefore put to the test by a very noted set of experi- 
ments, by which it was found — 

7. That the air examined in the middle of the city 
of BerHn contained about 1,000 germs in each cubic 
yard, while the air in the drains underneath Berlin 
was entirely free. 

It is now understood that these micro-organisms 
require warmth, moisture, and also some substance 
on which to feed and grow. These conditions do 
not exist in the air. When germs are found in the 

11 



162 THE LONDON HOSPITAL 

air their presence there is temporary and accidental, 
and may be accounted for by the fact of their food 
material having dried up, and their subsequent dis- 
persal by the process of sweeping or dusting, or by the 
wind ; but they will settle as soon as they are alloAved, 
and leave the air free again. Germs do not fly about 
of themselves ; they will never leave a damp surface 
to pass into the air, for the air is not in the least 
congenial to them as a dwelling-place. 

Long before Lord Lister explained the reason why, 
the old surgeons considered dust to be a carrier of 
disease and infection : Blizard believed this to be the 
case. More than one surgeon had insisted that no 
one should enter his theatre for some hours before an 
operation was to be performed, but it never struck him 
that his own finger-tips and his instruments were the 
most important carriers of infection. 

Now that the reason of wound infection is known, 
every endeavour is made to prevent the access of micro- 
organisms to the wound. At the London Hospital, 
and at all great hospitals, tliis sterilization of all 
material used is in the hands of experts. Every corner 
in the theatres is rounded, to make cleaning easy. 
All water-pipes and shelves are carried on brackets 
away from the walls for the same reason. Air coming 
into the theatres is warmed and strained through fine 
gauze, and the water used is boiled and cooled again 
out of contact with the air (no harmful micro-organisms 
can resist five minutes in boiling water). Instruments 
are boiled and not touched again by anyone except the 
surgeon himself ; dressings are sterilized by heat from 
steam under high pressure in boxes of copper, which 



BREAK OF DAY 163 

are sealed down after sterilization, and the seal not 
broken until the time of the operation. The patient's 
skin, in the vicinity of the incision, is also rendered 
sterile by means of ether and various antiseptics, in 
order that no germs may be washed into the wound. 
The surgeon's own hands are cleaned by long scrubbing 
and by antiseptics. Sometimes the cleaning of the 
surgeon's hands will take longer than the operation 
itseK. There are many materials used — such as sponges 
and catgut — which cannot be steriHzed by heat, the 
most efficient method. Sponges, which are used in 
thousands, are never allowed in the theatres at " The 
London " until they have been washed by hand in at 
least fifty changes of water, to remove all grit and sand, 
and have then been allowed to stand for not less than 
seven weeks in strong solution (5 per cent.) of carbolic 
acid. All these precautions being taken, wounds 
heal with a regularity that is almost monotonous. 
The average residence in hospital of a surgical in-patient 
has been lowered since Bhzard's day from sixty days 
to nineteen, so that each bed is taking nineteen patients 
each year instead of six. As there are nearly 1,000 beds 
at " The London," the gift to the country from this 
voluntary charity in returning the wage-earner to his 
family is not an insignificant one. 

But to return to the old records. In reading through 
the minutes, I find no less than six references in the 
Hospital's history to fearful epidemics of cholera. 
The close neighbourhood of the river and docks may 
partly account for this. In 1832 cholera was raging 
at Newcastle, and the committee of " The London " 
sent one of its physicians, Dr. Cobb, to Newcastle to 

11-2 



164 THE LONDON HOSPITAL 

thoroughly investigate the cause and treatment of 
the disease — 

" In order that the Committee may be prepared to 
make the best arrangements and provide the most 
efficient remedies in the event of the appearance of 
this most fearful disease within the London Hospital, 
or in the densely peopled district in which it is 
situated." 

At this time Sir William Blizard presented the 
committee with a paper on the subject of cholera, 

" which contained suggestions so valuable in reference 
to the duty of the directors of a public institution 
at this crisis that the Committee ordered that it be 
printed and published." 

Two hundred and fifty copies of Dr. Cobb's report 
were also printed and circulated. He was given fifty 
guineas for his expenses. Fifty of the surrounding 
parishes were communicated with — from London 
Bridge to East Ham — and warned not to send any cases 
of cholera from their district to the Hospital, as all 
the beds available for such patients were in use for 
cases occurring in the Hospital itself. Every patient 
arriving at the Hospital had to be examined by one 
of the Staff or the apothecary to make sure that he 
was not suffering from cholera. In spite of the warning 
sent to the parishes, patients came to the Hospital 
suffering from the fearful disease, and all the parishes 
were again written to, the committee asking where 
they were to send the patients, since the Hospital 
was fuU. Eventually each parish arranged for the 
treatment of cholera in its own workhouse, and the 



BREAK OF BAY 165 

Hospital referred a patient to the workhouse of his 
parish. One cannot help wondering how this was 
arranged. It is difficult to imagine a conversation 
with a man dying from cholera to ascertain what parish 
he came from, and it is still more difficult to understand 
how he was sent through the public streets without 
spreading the disease. Quite likely this was one source 
of infection. 

In 1848 there was another cholera epidemic. This 
time the committee were bolder, and decided to meet 
it more efficientl}^ Special arrangements were made 
for the reception and treatment of all patients who 
might come to the Hospital. The secretary was in- 
structed to use his discretion, and open one ward after 
another for cholera, and the committee was to be 
summoned at twenty-four hours' notice, should the 
secretary require further advice. The apothecary 
seems to have been the most influential and important 
person during this epidemic, for the Court passed a 
special vote of thanks to " our Apothecary, Mr. Burch, 
for his very zealous exertions, and for his unfailing 
attendance during the period." That is all I can find 
of Mr. Burch, but it is " honourable mention." But 
all the Staff, lay and medical, were heroic in their 
exertions. When this epidemic had lasted a year, 
the Medical Staff were worn out, and begged 

" that when the number of cholera cases admitted to the 
Hospital reached one-tenth of the total beds, no more 
should be admitted, on account of the insufficiency of 
Medical Aid." 

Cholera was raging again in 1853 and 1854, and 
here I note that a nurse — her name is not men- 



166 THE LONDON HOSPITAL 

tioned — is thanked by the Court " for her great 
service." 

But the most awful visitation of all was in 1866. 
Canon the Rev. Thomas Scott was chaplain of the 
Hospital at the time, and he has very kindly given me 
the following description of this epidemic : 

" The Cholera in the London Hospital, 1866. 

" It was on Friday, July 13th, that the first case of 
Asiatic cholera was brought to the London Hospital. 
I was Chaplain at the time, and earlier on the same 
day had been drawing up a Form of Service for the 
opening of the Alexandra Wing. 

" I lost no time in writing to Mrs. Gladstone (whose 
husband had only just ceased to be Chancellor of the 
Exchequer) to warn her not to continue her usual 
visits to the patients, as it was very unlikely that the 
present case of cholera would be the only one. I had 
an answer by return of post saying that, though she 
knew that her visits could be of no direct advantage, 
she thought that her presence might help to cheer the 
nurses, and, as a fact, she was in the Cholera Ward the 
very next day, and was a very frequent visitor during 
the whole outbreak. 

" In ten days' time we had had sixty-seven cholera 
cases, and by the 30th of the month two hundred and 
thirty, and one hundred and ten deaths, which, by 
the 2nd of August, numbered one hundred and fifty. 

" The Alexandra Wing was to have been opened 
about the same time by a member of the Royal Family, 
but it was opened by King Cholera. 

"On the 3rd of August there appeared in the Times 
a letter from Mrs. Gladstone asking for help towards 
opening a Home for Children who had been left orphans 



BREAK OF DAY 167 

by both their parents dying in the Hospital of this 
terrible disease. How liberally her appeal was answered 
may be realized by the fact that my wife and I sat up 
tlie next night till twelve o'clock acknowledging the 
donations which had already been sent in, and for days 
afterwards we could only keep pace with the task by 
the help of various friends. 

" It was at Clapton that Mrs. Gladstone opened the 
Home, which she kept open for several years, till the 
inmates were old enough to leave it to earn their living. 
It was not then closed, however, but was continued 
as a Convalescent Home for general patients. It is 
now known as Mrs. Gladstone's Home for Convales- 
cents. It has been removed from Clapton to Mit- 
cham. 

" But Mrs. Gladstone was not alone in this good 
work. Rather later in the outbreak, Miss Marsh 
(whose name is well known for her charities and her 
writings) became a welcomed visitor in the wards, 
and a letter from her to the Papers brought a liberal 
response, which was the means of establishing a second 
Convalescent Home at Kemp Town, Brighton, which, 
like the other, is still doing useful work. At the time 
it was arranged that men should be sent to the one 
and women to the other ; and if I remember right, the 
Authorities at Brighton did not welcome our arrival ! 
I recall this the more clearly because Mrs. Scott and 
I had the chief share in arranging the fitting up of the 
Home ! 

" But I have said nothing of the work which fell to 
the Chaplain during the terrible time of the outbreak — 
about three months in all. 

" It was a remarkable instance of the way in which 
the Divine promise may be fulfilled — ' As thy day so 
shall thy strength be ' — that all nervous fear of infection, 
which up to that time had been one of my many 



168 THE LONDON HOSPITAL 

weak points, was entirely removed. I was well aware 
of my danger, but all nervous fear was absent ; and 
though constantly in the wards, and, so far as it was 
possible, ministering to the spiritual wants of the 
patients, I kept my health the whole time. 

" Terrible was the scene, for the agonies of the 
sufferers were often very great. Death not un- 
frequently followed the attack in a very short time. 
As an instance of this, one of our laundry-women came 
to her work at seven o'clock one morning, to all appear- 
ance in good health, but was dead by the middle of the 
day. And I saw two little children lying dead in the 
same bed (where they had been placed for want of 
more accommodation), the second having died before 
there had been time to remove the first. I had 
to watch my opportunity for speaking with the 
sufferers, or for offering a prayer, because it was only 
now and then that they were free enough from pain, 
or in a state of sufficient consciousness, to listen to 
or understand what I might say. 

" I was not left to minister to the sufferers alone, 
for, besides the excellent City Missionary who was 
attached to the Hospital, several clergymen from the 
neighbourhood, and even from the country, volunteered 
their help. 

" The mortality was so great that Pickford's vans 
came early every morning to take away the dead. On 
one morning there were forty, and it became a serious 
difficulty to get coffins made fast enough. 

" But it cannot be necessary to Avrite more, for I 
have written enough to recall to my own mind, and to 
give some notion to anyone who may read it, of a ver}'^ 
terrible and solemn time, but of a time full of mercy 
from Our Father in Heaven, and of sympathy and 
help from numberless friends known and unknown." 

"T. S." 



BREAK OF DAY 169 

The mortality in this year rose from 10 per cent., 
at which it had been for many years, and has been 
nearly ever since, to 37 per cent., of all the patients 
admitted. 

The London Hospital, from its close proximity to 
the docks, has always had a share in quelling epidemics 
of cholera in London. Before me as I write is a letter 
dated September, 1909, from the Metropolitan Asylums 
Board, asking permission to send any urgent case 
arriving at the docks to the Hospital by ambulance 
at once. Permission was at once given, of course, 
and necessar}^ arrangements made for such admission. 

I cannot resist setting down some further reminis- 
cences of Canon Scott : 

" When I first came to the London Hospital as 
Chaplain in 1860, it was not much more than half its 
present size. The Grocers' Wing had not yet been 
built, and 400 In-patients were as many as could 
possibly be accommodated at one time. 

" Mr. Fowell Buxton was Chairman. 

" It was a great change from Brighton, where I had 
been a curate for some years, though in a parish of at 
least as poor people as in Whitechapel. 

" If I remember right, Mr. Adams, Mr. Curling, and 
Mr. Hutchinson were Senior Surgeons, and Dr. Eraser, 
Dr. Davies, and Dr. Andrew Clark (he was not then 
Sir Andrew) were Senior Physicians. It was in the 
early days of anaesthetics, and they were not always 
made use of, one of the older surgeons going so far as 
to say that he ' hked a good honest scream ' ! The 
prejudice against anaesthetics was general, and lasted 
for some time. 

" There was a chapel on the first floor, with an 
organ-galler}^ and a lady organist (Miss Bell), and a 



170 THE LONDON HOSPITAL 

choir of boys. A much larger proportion of the patients 
were able to attend than can now venture to St. 
Philip's, and my congregation must have resembled, 
as I used to think, the multitude of impotent folk at 
the Pool of Bethesda. On Wednesday and Saturday 
mornings, which were the usual days for convalescents 
to leave the Hospital, they attended a short Thanks- 
giving Service and shook hands with the Chaplain. 
For years afterwards I used to be stopped in the street 
by former patients, and to have a bit of chat about the 
Hospital. 

" Almost every morning and evening were spent by 
me in the wards. In the morning, when dressers and 
nurses were about, I went from bed to bed, and had 
an advantage over what I have often had since, in 
there being no back-door at which the man I wanted 
to see could slip out when he saw the parson coming. 
It was my own fault if I did not make friends with him, 
and I hope I did not often fail to do so. To propose 
finding him an interesting book from the shelves was 
often a first step towards getting on friendly terms, 
and the beginning of more serious intercourse. In a 
good many instances, when a patient's answer to my 
offer to find him a book had been, ' Worse luck, I can't 
read,' I was able to persuade him that his time in the 
Hospital gave him such a chance of learning as he 
might never have again. And by other more literary 
patients undertaking to teach him, such a man has 
often left the Hospital an accomplished reader. 

" In the evening the wards were much more free, 
and I could generally speak or read from the desk 
between each two divisions, and thus be heard by a 
good many at once. Besides this, I was always liable 
to be called to special cases. And thus, in one way or 
another, my time was pretty fully occupied, and very 
happily to myself. 



BREAK OF DAY 171 

" Tlie Chaplain's work was made pleasanter, and the 
patients were cheered, by the frequent afternoon visits 
of a number of ladies, including Mrs. Gladstone (the 
wife of the Rt. Hon. W. E. Gladstone) and her friend 
Miss Smith, the Hon. Mss Lyttelton, Miss Pole-Carew, 
Lady Robartes, and perhaps others whose names I 
do not remember, their visits often ending with 
afternoon tea in the Chaplain's room. During the 
cholera outbreak Miss Marsh was also a frequent 
visitor. 

" There had been for many years a Special Service 
in the Chapel on some week-day afternoons in the 
summer, at which a well-known clergyman was 
preacher, and which was attended by members of the 
Committee and friends of the Hospital. The last 
preacher whom I happen to remember was Dean 
Goulbourn. 

" One meeting of the Committee at which I was 
present, and one only, I will mention. It was when 
the building of the West Wing was contemplated, and 
the Chairman suggested that it was now time to con- 
sider how much they themselves proposed to give. 
Two gentlemen were sitting next each other, and one 
of them asked the other how much he meant to give. 
To this the reply was, ' I will give the same as you,' 
'WeU,' said the other, ' I'U give £5,000.' 'And I'll 
give the same,' was the reply. As much as £23,000 
was promised round the table, if I remember correctly." 



CHAPTER X 

SUNDRY mCIDENTS AND EVENTS 

Canon Scott in his reminiscences referred to the 
administration of anaesthetics, and their unpopularity 
at first with some of the Surgical StafiF. 

The references, or rather the scarcity of them, to 
anaesthetics in the minutes is a good illustration of 
a fact which is often noticeable in reading the Hospital's 
records — namely, the frequent lack of appreciation of 
that which was important and fundamental, and, on 
the other hand, the great amount of attention given 
to what has since been proved to have been but trivial 
and transitory. 

The introduction of anaesthetics is undoubtedly one 
of the two most important factors contributing to the 
advance of surgery, the other being the introduction 
of antiseptics. The great abdominal operations were 
impossible when patients had to be strapped to the 
table, or held down by volunteers, while the surgeon 
did his awful work. The patient's inabihty to bear 
unlimited pain, and the surgeon's inabihty to inflict 
unlimited pain — for, strange as it may appear, some 
of the surgeons shrank from this part of their work, 
and would never perform any large operation — entirely 
prevented advancement in surgery beyond a certain 

172 



INCIDENTS AND EVENTS 173 

point. There are still ghastly relics in the Hospital 
of these terrible days : the great wooden operating- 
table with its straps ; the bell which was sounded 
before an operation to call assistants to hold down the 
patient — a bell whose dreadful clank could be heard 
by every shivering patient in the building, including 
the patient, often a little child ; a bell with a voice 
loud enough and harsh enough to make all Whitechapel 
shudder ; and then there are the instruments used by 
the iron-nerved, although tender-hearted, Blizard 
himself. 

It is undoubtedly true, also, that the honourable 
profession of sick-nursing by tender, good, refined 
women could never have developed but for the intro- 
duction of anaesthetics. Few women could have faced 
those shambles. 

And yet there is no reference of any sort in the 
minutes to these merciful drugs for many years after 
Simpson's discovery, and then not in wonder and 
thankfulness because of the new era which was dawn- 
ing, but because of a petty quarrel between committee 
and Staff as to whose duty it was to administer the 
anaesthetic. The Staff wrote to the committee to 
say that it was not the duty of members of the Staff, 
nor of house-surgeons, to give anaesthetics, and that 
the apothecary ought to be made responsible. The 
committee would not agree to this, and said that the 
apothecary's duties were sufficiently onerous already, 
as they certainly were. The committee insisted that 
it was the duty of the house-surgeons to administer 
chloroform, and further, that it was the duty of the 
Staff to teach the house-surgeons to administer it 



174 THE LONDON HOSPITAL 

properly. The Staff were no doubt offended, and some 
of the surgeons continued for years after to operate 
without an anaesthetic. 

The apothecary's was the most thankless appoint- 
ment in the Hospital. There was no end to his duties, 
and every advance in any department added to them ; 
and, for all, he was badly paid and badly treated. 

He slept " on a settee-bed placed in the physicians' 
parlour." He was allowed to increase his slender 
stipend by taking an apprentice ; but even his appren- 
tice was bound by humiliating rules like his master, 
for although he were permitted " to follow the box 
and attend all chyrurgical operations, he was not 
allowed to bleed patients nor to apply dressings." 

This " following of the box " referred to the custom 
of the surgeons having a box of instruments carried 
before them as they went round the wards, with which 
they used to perform lesser operations then and there. 
Instruments so used would be put back into the box, 
to be used again, possibly, on some other patient ! 
Sometimes the apothecary very mildly protested, but 
he belonged to a dying race, and was easily cowed into 
submission. For instance, " The apothecary was 
severely reprimanded because he objected to carry 
water for the hot bath " ; and " the apothecary's 
assistant was reprimanded in that he considered it as 
not part of Ms duty to carry dead bodies." 

In an advertisement for one of these gentlemen in 
1821 we find that he was expected " to have attended 
lectures in anatomy, physic, chemistry, and midwifery l 
he was to produce a certificate of his moral character, 
and was to be careful to attend chapel daily." And 



INCIDENTS AND EVENTS 175 

yet with such qualifications this officer was responsible 
for all sorts of petty and insignificant duties. He was 
to see that patients' heads were clean and their feet 
and legs washed before they were admitted into the 
wards. He w^as instructed to procure twelve flannel 
garments in which in-coming patients were to be clothed 
while he examined their clothes for vermin. In 1828 
still further duties were placed upon him. He " was 
to report to the Committee weekly on the conduct of 
the nurses towards the patients, and was to superintend 
the warming and ventilation of the house." Among 
his many duties and accomplishments, his knowledge 
of drugs seems to have been considered the least 
important, and yet some of these old apothecaries 
were excellent druggists. Quackery, however, appealed 
most to the committee, evidently, for 

" Mr. Seal of Blackwall having offered to supply this 
Charity with an approved remedy for the ague, it is 
the sense of the Committee that he should be admitted 
a Governor." 

One of the greatest difficulties which the poor 
apothecary had to meet was to keep a supply of lint ; 
he had to engage a woman to scrape lint, and she was 
expected to produce three-quarters of a pound of lint a 
week. So important a person was a lint-scraper that she 
was paid more than a nurse, and was engaged by the 
quarter, not by the week. One quarter's salary was 
always held back, and was confiscated if she failed 
to supply the allotted amount per week. In 1837 the 
Staff complained that the apothecary had made three 
serious mistakes in one day in making up his medicines, 
and that it was important that a " Chemist and 



176 THE LONDON HOSPITAL 

Druggist " be engaged, as " being more likely to 
be skilled in the making of medicines than an 
apothecary." 

In 1854 the committee, on the request of the Staff, 
abolished the title of apothecary altogether, and he 
was henceforth known as resident medical officer, 
because, as the Staff said, 

" The said officer is, in reality, not an apothecary, 
but a Medical Practitioner, whose chief and most impor- 
tant duty consists in prescribing for the patients, in 
the absence of the physicians." 

The question of lighting the Hospital with gas was 
first raised in 1822, when a subcommittee was appointed 
" to look into this new invention." Hitherto candles 
had been used, and very precious they were, and their 
consumption was carefully checked. The Family 
(the resident staff, steward, apothecary, and matron 
were always spoken of as " The Family ") were allowed 
seven candles (seven to the pound) each in winter, 
and five in summer ; seven candles per week were 
allowed to each ward, and " no extra allowance of 
candles at any time of the year except those required 
for operations by the order of the surgeons." Imagine 
a surgical operation by candle light ! Now an 
operating theatre at night is as light as day, and the 
surgeon has the further assistance of a multitude of 
extra lights — head-lights, hand-lights, bull's-eyes, and 
various electric devices for illuminating internal 
organs. 

The subcommittee appointed to consider the question 
of lighting by gas invoked the assistance of the medical 
Staff. 



INCIDENTS AND EVENTS 177 

The StafE did not object to the lighting of the corridors 
by gas, but would have none of it in the wards. 

After considering the subject for a year, the sub- 
committee recommended the adoption of twenty gas- 
burners for the whole Hospital. This was not ex- 
travagance — ^it included one burner for the entrance- 
hall, one for the theatre, one for the kitchen, and one 
for the dispensary. The cost was 40s. per 1,000 cubic 
feet. Gas was not introduced into the wards for many 
years after. 

Soon after the introduction of gas the committee 
received a deputation from the inhabitants of Wliite- 
chapel, asking that the great clock over the main 
entrance of the Hospital might be lighted at night. 
The request was at first refused, but was afterwards 
granted on the inhabitants contributing £30, which 
they had collected, towards the expense. 

It may be of interest to mention that this clock 
was the gift of the workmen of John Elhcot, F.R.S., 
the great clock-maker, in 1757. John Ellicot was a 
great friend and supporter of the Hospital from very 
early days ; he was Chairman of the House Committee 
in 1757. He presented a clock of his own make for the 
Committee-room, and the House Committee time their 
sittings by the same clock to-day. 

John Ellicot was a great personal friend of Benjamin 
Franklin, and Benjamin Franklin, who was Post- 
master of New York, when he came to this country, 
was introduced to the Hospital by John Ellicot, and 
ever after took the deepest interest in it. We have 
a letter framed in the Committee-room from Franklin 
to Ellicot. 

12 



178 THE LONDON HOSPITAL 

In 1823 a very serious disagreement between com- 
mittee and Staff occurred, and echoes of this storm 
were heard for twenty years. 

It has already been explained that patients were 
admitted to the Hospital on the recommendation of 
one of the governors, and patients were admitted once 
a week only — viz., on Tuesday — and discharged once 
a week only also. Both on admission and discharge 
patients had to appear before the committee. The 
only cases on whose behalf exception was made were 
those of sudden accident. At the end of the year 1822 
the committee discovered that nearly 300 cases had 
been admitted ?y^YAo^<i recommendations from governors, 
and that the Staff were making use of the Hospital 
as a sort of private nursing-home for cases in which they 
were interested. A special meeting of the governors 
was called to consider the matter. As a result the 
following resolution was passed at a large Court : 

" That no person shall be admitted a patient into 
the Hospital without a recommendation from a 
Governor, nor on any day except the weekly day of 
meeting of the House Committee, cases arising from 
accident only excepted, and such excepted cases only 
on the authority of a surgeon of the Hospital, notice 
being given by him to the Secretary in the usual 
manner of every such occurrence, and a ticket in such 
case to be filled up by the clerk superscribed with red 
ink ' extra case from accident,' and affixed to the bed 
of the patient." 

The rule was extended, and cases of sudden illness 
might be admitted in this irregular way. For many 
years after this, every patient who was not admitted 



INCIDENTS AND EVENTS 179 

by the committee in the usual way was distinguished 
by a card printed in red, " Extra case, essential for 
the preservation of life," and the officer in charge had 
to fill up the following form and present it at the next 
meeting of committee : 

" By virtue of the discretionary power in me reposed 
by the Governors of the London Hospital, I hereby 
certify that A. B. is afflicted with . . . and that . . . 
admission is essential to the preservation of life. 

"(Signed) . . . ." 

The House Committee in 1839 refused to take such 
a certificate from assistant surgeons and assistant 
physicians, insisting that such discretionary power was 
vested in the full Staff alone. 

The following resolution was passed by the Court 
every two or three years from 1803 onwards : 

" Resolved, that the right of admitting patients into 
this Hospital is vested solely in the Grovernors thereof, 
through the medium of the House Committee." 

Not until recent times, in 1896, did the governors 
choose a more honourable way. Then they gave up 
their letters of recommendation, threw open the doors 
of the Hospital, and made " the right of admission " 
depend upon poverty and sickness alone. 

There were those who foretold disaster to the 
Hospital when the change was made. " Who," they 
asked, " would pay to be a Governor of a Hospital 
where Governors had no rights 1" 

The disaster has not come, for there still are found 
men and women who are charitable for Charity's sake, 

12—2 



180 THE LONDON HOSPITAL 

and love to support a great almshouse whose gates 
stand open always. To the few who objected answer 
was made that they ought not to complain because, 
whereas formerly they could only recommend that 
number of patients corresponding with the number 
of the letters, now they would be able to recommend 
as many as they liked. But what about abuse ? 
The Hospital has very complete organization to check 
abuse, but had it not, the abuse would be far less 
than in the old " letter " days. Now every case is 
treated on its merits. The Hospital had ceased to be 
a huge sick-club which received pay for services ren- 
dered. It has become a charity, and its work is a gift 
to the people, and every patient within its walls is a 
guest. How long this may last it is impossible to say. 
The outlook is not cheering. What will England be 
when there are no gifts between friend and friend, but 
only rights demanded and paid ? 

The Charter of the Hospital w^as obtained on 
December 9, 1759. The question of obtaining a charter 
was first raised by the energetic Harrison in 1742, but 
it fell through. In 1756 the matter was again brought 
forward in a report of the House Committee to the 
Quarterly Court. The committee drew attention to 
the great inconvenience of not being an incorporate 
body. The Hospital could not sue or defend an action, 
could not recover a disputed legacy, could not purchase 
lands. A committee was appointed to consider the 
matter, and meetings were held at the Pontack Tavern, 
Abchurch Lane. A draft was drawn up and sub- 
mitted to the Court and approved. The Duke of 
Devonshire, then President of the Hospital, appealed 



INCIDENTS AND EVENTS 181 

to His Majesty, George II., who consented to grant 
a charter. The draft 

" was delivered to the Right Honble. William Pitt, Esq., 
one of His Majesty's principal Secretaries of State, who 
promised to lay the same before His Majesty." 

This was done. The King, on the advice of the 
Attorney-General, approved, and the Charter was 
granted. The Charter cost the Hospital £398. The most 
important provisions of the Charter are : 

A benefaction of 30 guineas entitled to the privileges 
of governor for life, and an annual subscription of 
5 guineas for the period during which such subscription 
was continued. 

The Corporation was empowered to purchase lands 
to the yearly value of £4,000, to sue in courts of law, 
to use a Common Seal. 

Quarterly Courts were to be holden, at which alone 
the Common Seal might be used, and at which bye- 
laws were to be framed. 

Special General Courts might be called for election 
of officers. 

General Courts were to elect committees. 

Elections were to be by ballot. 

Noblemen, members of Parliament, and ladies, being 
governors, might vote by proxy. 

Fifteen governors were to constitute a General Court, 
whether Quarterly or Special. 

Accounts were to be audited quarterl}'-. 

The meaning of any expression in the Charter being 
disputed, the construction most beneficial to the 
Hospital was to be adopted. 

It has been pointed out that when the Hospital was 
first erected on its present site, it stood alone, and was 



182 THE LONDON HOSPITAL 

surrounded by fields which extended at the back almost 
to the river. 

The committee, as they were able to afford it, bought 
up this land bit by bit. The first to be so bought was 
a farm, which stood immediately behind the Hospital, 
for £1,442. This was in 1754. In 1772 a second farm 
was bought for £2,800. The size of these farms is 
not given in the minutes, but they were certainly very 
extensive, for they were relet, in portions, to various 
tenants, and the sum of these portions makes a very 
large area. There is nothing interesting to the general 
reader in these agreements and leases except that in 
a good many cases light is thrown on the kind of district 
Whitechapel was at the time : " Mrs. Mary Webb 
offers £13 a year for 2 acres of the field known as ' Ten 
Acres ' " ; the same lady also offered £8 a year for a 
piece of land near the new road leading from White- 
chapel Road to the Turnpike, for the purpose of a 
Tenter Ground. " Mr. Perry takes the several par- 
celles of land situated on the East Side of the New 
Road, with the dwelling-house, barnes, cow-houses, 
and aU other buildings " ; "a bill is to be put up at 
Mile End Turnpike making known the desire of the 
Governors to let the Red Lion Farm, with several 
pieces of meadow land." 

In 1787 the committee decided that aU this pasture- 
land around the Hospital should be let on building 
lease. Before tliis was done the directors of the London 
Dock Company wished to purchase the whole of the 
estate of the Hospital. The governors refused, as they 
did not consider " that the Act for making the Docks 
at Wapping warranted the Dock Company in making 






^ 




■aiSig^ 



INCIDENTS AND EVENTS 183 

a compulsory purchase," and application was made to 
various members of Parliament, asking them to watch 
the interests of the Hospital. 

In 1802 there was an Act " for making and main- 
taining a road from the West India Docks in the Isle 
of Dogs to Whitechapel," and the trustees of the 
Commercial Road purchased from the Hospital a 
piece of land for this road. 

In 1807 the leases on the estate for ninety-nine years 
were sold by auction, and the whole estate mapped out. 
The Commercial Road Trust complained that the 
arrangement of the roads on the Hospital's estate 
enabled persons to evade the turnpike on their road, 
but the committee replied that the Trust must make 
their own arrangements about that, as the Hospital 
could not be expected to lay out its estate to suit the 
Trust's turnpike. 

In 1822 BUzard persuaded the Court to pass a 
resolution that the open space immediately at the 
back of the Hospital, the part now known as " The 
Field " and " The Garden of Eden," should not be 
built on, this " being of the utmost importance to the 
health of thousands of patients in succession." 

This piece of ground between the CoUege and the 
Nurses' Home has been turned to many uses. It was 
once larger than it is now, and included "The Garden 
of Eden " and the site of the Isolation Block, there 
being no Oxford Street between. It was let out until 
comparatively recent years for grazing sheep. It was 
once the kitchen garden of the Hospital, and it was for 
many years the burial-ground for patients who died in 
the Hospital. There are several references in the 



184 THE LONDON HOSPITAL 

records of cases of body-snatching from this burial- 
ground, in two instances the culprits being found to 
be porters of the Hospital itself, who had exhumed 
bodies at night in order to sell them to the students for 
dissecting. 

For many years the offices of chaplain and secretary 
were filled by one and the same person, as has been 
said, and this secretary-chaplain conducted hundreds 
of burial services on this ground, at which all patients 
who were able were bound to be present. 

The London Hospital, like many other of the 
hospitals in London, is heavily rated. In the year 
1908 more than £1,400 was paid in rates. That a 
voluntary hospital should be rated at all is an ex- 
tremely unfair thing, considering that all its work, 
freely given, tends to enable the poor to keep off the 
rates, and to remain working members of society. 

So long ago as in 1763 the churchwardens of the 
parish of Whitechapel threatened to distrain for rates 
if the Hospital would not pay. The committee of 
that day treated the threat with scorn, and replied 
that "this Charity will stand a lawsuit with them." 
But the churchwardens did not bring an action, and 
for nearly a hundred years we hear no more of these 
churchwardens. 

In 1853 the Whitechapel Improvements Bill was 
before Parliament, and the solicitor of the Hospital 
reported that in ail probability the Hospital would 
become rateable under the provisions of that Bill. 
Therefore the governors who had previously supported 
the measure immediately withdrew their support. 
The evil day was postponed until 1866, when the 



INCIDENTS AND EVENTS 185 

Hospital first had to pay rates, in spite of a petition 
to Parliament, " for special exemption from Parochial 
Rating or for a continuance of that exemption which 
the Hospital has hitherto enjoyed." From that day 
onwards the rates have steadily increased year by year. 
Some parts of the Hospital are exempt. 

That a charitable institution should have to pay 
legacy duty also seems hard lines. Legacies form 
a very important part of a hospital's income. In 
going through the records some very strange legacies 
have fallen to the Hospital. One of the strangest 
was " the plantation called ' Spring,' in the Parish of 
Hanover, in the Island of Jamaica, which contains by 
estimation 110 acres, and all the slaves thereon^ This 
property paid a profit to the Hospital for thirty years, 
and then ceased to yield any profit, " because of the 
unjust attempt in operation upon the slave popula- 
tion." How strange that the Hospital should have 
been partly supported for many years by the labour 
of slaves ! Stranger still that John Howard, " the 
philanthropist," should have been one of the trustees 
of tliis estate, and saw nothing incongruous in holding 
such a position. 



CHAPTER XI 

THE MEDICAL SCHOOL 

The Medical School attached to the London Hospital 
was founded in 1783, chiefly by the exertions of Sir 
William Blizard. 

Before that time the members of the Staff attended 
the meetings of the House Committee week by week, 
and asked permission that one or other of their own 
private pupils or apprentices might be allowed to 
" walk " the Hospital for the sake of experience. The 
length of time during which a pupil " walked " was at 
first one year, but later, as the number of pupils who 
were allowed about the Hospital was limited by the 
committee, and on account of the popularity of the 
Hospital, the requests of the Staff to be allowed to take 
pupils became more and more frequent, and the length 
of time was cut down. Within ten years of the 
foundation, Harrison was taking pupils for eight 
months, and a little later Blizard himself, who was 
said to have made more by his pupils than by his 
practice, took pupils for six months. 

Every pupil was introduced to the House Committee 
with great solemnity and form, and received the 
" charge " from the chairman which has been set down 
in a previous chapter. 

186 



THE MEDICAL SCHOOL 187 

This loose system very soon led the authorities into 
all sorts of trouble, as may very easily be imagined. A 
pupil would take no orders from any member of the 
Staff except the particular one to whom he was appren- 
ticed. The Hospital was broken up into factions and 
parties, not working for the good of the Charity as a 
whole, but only for the benefit of his party, against 
every other part}^ There were Harrison's men, and 
Andree's men, and Grindall's men, and Neale's men. 
The strong feeling running between these groups of 
pupils aggravated quarrels and jealousies between 
the members of the Staff. 

The medical pupil of a hundred years ago was not the 
gentleman he is now. That Bob Sawyer was a picture 
from real life is abundantly proved by the minutes of 
this Hospital. Many of his misdeeds cannot be written 
here. He frequently appeared before the committee 
to be expelled, and to be forbidden entrance to the 
Hospital for ever. He was frequently " disguised in 
liquor," was insolent to everyone but his own chief, 
held all lay authority in great contempt, was often 
cruel to the patients (but there were many honourable 
exceptions to this last), and was generally as insuffer- 
able a cad as can be imagined. 

And there existed no sort of educational facilities : 
no lectures, no demonstrations, no teaching, clinical 
or otherwise, no system of any kind. The pupil just 
lounged about the Hospital, doing nothing in particular, 
and was a nuisance rather than a help. His delight 
was to invite friends of his own, who had nothing to 
do with medicine, and to take them round the Hospital 
to " see the show." The " show " consisted of all the 



188 THE LONDON HOSPITAL 

horrors he could find, and the fearful butchery of the 
operating theatre was his 'piece de resistance. The enter- 
tainment ended with a drinking carousal in the Pupils' - 
room, and he did not hesitate to put his friends up for 
the night in the ward beds if they were too intoxicated 
to go home. 

Sometimes these friends whom the pupils invited 
into the Hospital did more than see the sights ; they 
actually interfered in the treatment of patients. The 
committee objected, and passed a resolution " that no 
young gentleman who is not an apprentice to one of 
the Surgeons be suffered to dress any patient, or dis- 
pense any medicine in the surgery." 

Although the School was not founded until 1783, 
the very lax state of affairs just referred to was put 
an end to twenty years earlier. The committee in- 
sisted that the pupils of any member of the Staff were 
under the authority of the whole Staff when such pupil 
was at the Hospital, and, further, that all fees from 
pupils which were paid for Hospital practice were to 
be equally divided between all members of the Staff. 
The pupils were to be pupils of the Hospital, not of 
individuals, although the Staff took all fees. 

A little incident in 1769 shows the sort of respect 
these gentlemen had for all authority. It was found 
that the pupils were borrowing Hospital instruments 
to use on cases outside. A notice was put up accord- 
ingly by the committee in the Pupils' -room forbidding 
the practice. The notice was promptly torn down. 
A second notice was put up. This also was torn down. 
The pupils w^ere at last summoned before the com- 
mittee, and the chairman censured them severely. 



THE MEDICAL SCHOOL 189 

One of the pupils then began to discuss the question 
with the chairman, and was grossl}^ impertinent. The 
chairman, Mr. Robert Salmon, however, was a strong 
man, and the pupil " caught a Tartar." The hall- 
porter was called in, and told " that Joseph Gibbs 
was to be removed from the Hospital within haK an 
hour, and never admitted again under any pretence 
whatever." There was no more trouble during the 
tenure of office of that chairman, but, strange to say, 
the incident was repeated with other pupils and another 
committee exactly seventy years after. On this occa- 
sion two pupils were expelled, and all the rest informed 
that " the Committee had a determination to make 
a severe example of anyone who might be convicted 
of such conduct in future." The committee also decided 
that no pupil was to be found in the House after 5 p.m. 
In 1783 the following petition was received from the 
physicians and surgeons of the Hospital : 

" We beg leave to state to the Chairman and Com- 
mittee of the London Hospital that we are of opinion 
that teaching the several branches of physic and sur- 
gery by lectures at this Hospital would prove to the 
interest and credit of the Institution. That at present 
there are many obstacles in the way of such an under- 
taking for want of room and conveniences. That by 
estimation, the expense of a proper building would not 
exceed the sum of £600, and therefore we request of 
the Committee — That the said sum may be raised by 
subscriptions for the above application, and that such 
persons as shall subscribe 30 guineas or upwards may 
be deemed Governors for Life." 

The Court of Governors gave permission to the 
physicians and surgeons to build a lecture theatre at 



190 THE LONDON HOSPITAL 

the east end of the Hospital, near where the Patho- 
logical Institute now is, and a subcommittee was formed 
to collect subscriptions for this new theatre. A 
separate account was to be opened at the bankers', 
however, and the Court would not agree that sub- 
scriptions to this fund entitled the donor to be a 
governor of the Hospital. 

Blizard issued an appeal in pamphlet form — " An 
Address to the Friends of the London Hospital and of 
Medical Learning " — on this occasion, from which the 
following may be quoted as being true to-day, when we 
find it so difficult to get money for the endowment of 
our Medical School : 

" As all those advantages and that superiority 
which distinguish one nation from another have 
arisen either directly or ultimately from their know- 
ledge of the sciences or their skill in the arts, so the 
comparative reputation of nations, and the consequent 
advantages of such reputation, will be in proportion 
to the degree of perfection in which they possess the 
arts and sciences. . . . But, amongst the various 
arts, those which contribute most to the good of man- 
kind should claim our first attention. The importance 
of the arts of Physic and Surgery, from that degree in 
which they may be made to contribute to the good and 
happiness of mankind, is universally acknowledged. 
The cultivation and advancement of these, therefore, 
are objects highly deserving of the consideration of 
good and wise men in every country. . . . But 
however great may be the importance of these arts, 
and however strong the desire of the humane to pro- 
mote their cultivation and improvement, yet if proper 
and effectual methods be not adopted for the educa- 
tion of young persons who are to practise them, thej^ 



THE MEDICAL SCHOOL 191 

may, with the generality of practitioners, be in a very 
imperfect state, and even prove pernicious and destruc- 
tive, instead of useful and salutary. It unfortunately 
happens with respect to the Art of Medicine that it 
is not with it as with many other arts ; as, for example, 
those of the painter and of the pleader at the Bar, 
where the spectator or hearer can judge of the abilities 
of the performer. On the contrary, in Medicine, no 
bystander who is not skilled in the art is capable of 
drawing any tolerable certain conclusion as to the 
comparative merit of the most skilful and knowing 
and the most unskilful and ignorant practitioner. 
But whilst we wish to promote the cultivation of 
Physic and Surgery, and make provision that practi- 
tioners in them msiy not be ignorant and unskilful, 
we should certainly endeavour to promote and facilitate 
the means of attaining the qualifications which are 
necessary to such as intend to practise these arts. 
A skill in the practice of Physic or Surgery cannot be 
acquired without an attendance at an hospital. But 
that degree of skill which can be acquired from an 
attendance on hospital practice, without a proper 
knowledge of principles, as it is the result of mere 
imitation, must be comparatively very small. It is 
necessary, therefore, that principles be studied. But 
the principles of Medicine and Surgery cannot be taught 
but by means of lectures publicly read. The ex- 
perience of learned men from the beginning of science 
to the present time has proved this to be the only true 
and effectual method of instruction. By means of 
these the several discoveries that have been made 
respecting any art or science are properly brought 
together and preserved, and new ones continually 
added, which otherwise might in time be lost and for- 
gotten. But lectures on the principles and practice 
of Physic and Surgery cannot, consistently with the 



192 THE LONDON HOSPITAL 

advantage of the student respecting his improvement, 
be properly given in any other place than the hospital 
which he attends. . . . These are some of the reasons 
from whence it has been judged proper that Lectures 
should be read at the London Hospital, the situation 
of which, as being remote from places of dissipation, 
is uncommonly well calculated for a medical school. 
But there are additional reasons which relate more 
immediately to the Hospital itself. The Governors of 
an Hospital depending upon public favour should be 
able to make every possible plea of public utility, and 
should employ every rational means of promoting 
its interest among all ranks of people. If Public 
Lectures on the various branches of Medicine are 
delivered at the Hospital, its reputation will be raised, 
its fame extended, and it will become an object more 
generally noticed. But, farther, the giving of public 
lectures at the Hospital will conduce to the good of 
the patients and the interest of the Charity, for the 
great number of gentlemen who will receive their 
education at the Hospital, and who from that circum- 
stance will have formed an attachment to it, may be 
a means of greatly promoting its interest. This effect 
has already been experienced from gentlemen formerly 
educated at the Hospital. But hitherto the conveni- 
ences for the teaching of the several branches of 
Medicine were wanted. The Physicians and Surgeons 
therefore made application for and have obtained 
leave of the Governors to erect by subscription a 
Theatre for that purpose. By this means a valuable 
building will be added to the property of the Hospital 
without the smallest expense or detriment of any 
kind being incurred by the Charity. ... It is already 
in great forwardness, and it is intended that the 
Theatre shall be opened some time in September, with 
orations from some of the Physicians and Surgeons." 



THE MEDICAL SCHOOL 193 

Exactly two years before this, however, Mr. Blizard 
had obtained permission from the committee to dehver 
two courses of lectures on Anatomy and Surgery. 
He had to undertake not to use any patient of this 
Hospital in these demonstrations. 

Blizard's appeal was successful, and, with the help 
of liberal gifts from himself, the theatre was built, 
and regular courses of lectures commenced. 

The School was started, and grew, but we have very 
little reference to it in the minutes for fifty years. 
There appear to have been great dissensions amongst 
members of the Staff as to who had the right to lecture 
in the theatre, and the House Committee appointed 
a special committee to investigate the whole matter. 
This special committee reported (in 1834) as follows : 

" In furtherance of the objects delegated to them, 
your Committee have instituted a diligent inquiry 
into the nature of the tenure under which the buildings 
at the East End of the Hospital, at present occupied 
as a museum, theatre, dissecting-room, and chemical 
laboratory, are held, and from careful investigation, 
and by examination of witnesses, the following facts 
appear to be satisfactorily established. 

, That at a General Court held February 5, 1783, 
permission was granted, on application by memorial 
from the Physicians and Surgeons, for the erection by 
subscription of an Anatomical Theatre ; that under the 
authority of the said Court, and under the superin- 
tendence of a Committee appointed at a subsequent 
Court of March 5, 1783, the buildings were accordingly 
erected on ground belonging to the Hospital ; that the 
precise amount of subscriptions cannot now be cor- 
rectly ascertained, but it appears from the evidence of 

13 



194 THE LONDON HOSPITAL 

Sir William Blizard, then one of the surgeons, that, the 
amount proving inadequate, the deficiency was sup- 
plied by himself and his friends ; that for a long 
period after its erection the School remained in the 
possession of Sir William Blizard, and it has since 
passed through various hands, without any express 
permission from the Governors, into those of the 
present managers, consisting of a portion of the 
Medical Officers of the Hospital, who officiate as lec- 
turers, possession having always been retained by suf- 
ferance only. The scanty information afforded by the 
Hospital records in relation to the School has caused 
considerable difficulty, but your Committee feel per- 
fectly warranted, from what they do afford, in now 
repeating their conviction that the whole of the build- 
ings are the undoubted property of the Corporation, 
the fixtures and fittings, with the contents of the 
museum, belonging to the Lecturers. 

" Under the next head of inquiry — namely, the 
dissensions reported to have existed among the Medical 
Officers — your Committee have found that from time 
to time, for a considerable number of years past, 
dissensions and jealousies have unfortunately pre- 
vailed, which to a great extent appear to have 
originated in the possession of the Theatre by a 
portion of the Medical Officers only. Your Committee 
are therefore of opinion that such cause of disunion 
should be henceforward removed by placing the 
management of the School equally in the hands of 
all the Medical Officers of the Hospital. In order to 
accomplish this object, two plans are proposed by your 
Committee : 

" Either, 1st, that the present possessors of the 
Theatre should continue to hold it, admitting hence- 
forward the other Medical Officers, on the latter paying 
a certain proportion of the capital or expense, to be 



THE MEDICAL SCHOOL 195 

determined accordingly as they may be more or less 
interested in the profits of lectures ; or — 

" 2nd, that the Governors should acquire by pur- 
chase such interests in the theatre and museum as 
have been declared in this report to be private 
property. 

" Your Committee found much difficulty in decidedly 
recommending either of these plans, and therefore they 
submit them to the consideration of the Court of 
Governors. In any case, your Committee recom- 
mend that the management of the Medical School 
should be entirely in the hands of all the Medical 
Officers, who should constitute a Medical Board for 
that purpose. All regulations which originate with 
such Medical Board should be submitted to the House 
Committee for their approval, to enable them to see 
that such regulations do not interfere with the due 
discharge of Hospital duties. 

" Your Committee further report their opinion 
that some improvements may be made in the Medical 
Department of the Hospital by the observance of 
certain orders ; that the certificates of the attendance 
and competency of Pupils shall be issued under the 
authority of the I\Iedical Board ; and that the delivery 
of lectures be prohibited during the time in which the 
attendance of pupils is required on their Hospital 
duties. 

" Your Committee, in conclusion, beg leave further 
to state in unqualified terms that, deeply regretting 
that any expressions should have been used during 
the heat of discussion tending to reflect upon the 
professional character of the Medical Staff of this 
Hospital, nothing whatever has transpired in the 
course of this lengthy inquiry to impeach their liigh 
character for latent humanity and attention to the 
duties they have undertaken to perform." 

13—2 



196 THE LONDON HOSPITAL 

Nothing was settled, however. After all the trouble 
taken by the subcommittee, the Court simply resolved 
" that this report do lie on the table," and there is no 
further reference to it. 

The beginning of the custom of having a resident 
staff of house-physicians and house-surgeons seems 
to have been in the decision that two of the pupils 
should be resident, and so always ready " to attend 
accidents and extraordinary cases." These men were 
not " qualified," and had little in common with modern 
resident officers. They were in office for one week only, 
and received the following charge from the Chairman 
of the House Committee : 

" You are, agreeably to the Standing Orders, recom- 
mended by Mr. , one of the Surgeons of this 

Hospital, as Gentlemen competent to discharge the 
respective duties of Senior and Junior House Pupils 
for the ensuing week. The Committee consider this 
recommendation as an assurance that you are qualified 
for the fulfilment of the several important duties thus 
confided to your care ; they accordingly admit you to 
the exercise of these duties, trusting that, by devoting 
your best attention to the comfort and relief of the 
patients, and showing due respect to every authority 
and regulation constituted for the preservation of good 
order within the Establishment, you will evince a 
becoming regard to the interests and reputation of the 
Hospital, and to your own character as destined to an 
honourable profession. On your thus realizing these 
expectations of the Committee, you will secure to 
yourselves their approbation, with that of the 
Covernors of the Hospital ; but if otherwise, the 
Committee have determined that the privilege of 
residence shall in future be withheld." 



THE MEDICAL SCHOOL 197 

By 1837 the Medical School seems to have been 
fairly started. 

It is interesting to note that in 1845 there were 
two kinds of pupils — dressing pupils and visiting 
pupils. The dressing pupils, who corresponded to 
the modern students, were limited in number ; 
no surgeon could introduce more than six. Visiting 
pupils could enter the wards, operating theatre, 
and Out - patient Department, but " were not 
permitted to dress nor direct for any patient in the 
Hospital." 

The House Committee claimed the right to recom- 
mend three students annually to be appointed, without 
fee or reward, to attend daily in the Out-patient 
Department. If they served with satisfaction, they 
were to receive, also gratuitously, the appointment of 
dressing pupil for one year. In 1849 this arrange- 
ment caused great annoyance to the Staff, who wrote 
by one of their number to the committee as 
follows : 

" Gentlemen, 

" The regulation respecting which I have already 
addressed the Committee, and which my colleagues and 
myself desire to have altered, is that contained in the 
Standing Orders for Pupils, by which the Surgeons 
are required to forego their fees for three students 
when entering upon their studies in the Wards of the 
Hospital, in consideration of their diligent attendance 
as Dressers to the Out-patients for one year. The 
Surgeons beg to state that they consider the fees 
received from Students as afEorded for the instructions 
which they impart, and they regard these fees as an 
indirect though inadequate means of remuneration for 



198 THE LONDON HOSPITAL 

the services which they render to the Hospital. They 
are of opinion that no part of these means should be 
withheld from them for the payment of duties in the 
Out-patient Department, which they cannot be ex- 
pected themselves to discharge. The Surgeons beg, 
therefore, to suggest that, if the appointment of 
Dressers to the Out-patients be continued, with the 
present condition of the Dressers receiving gratuitous 
dresserships to the In-patients, the expense of the 
arrangement be no more expected to fall on the 
Surgeons, but be defrayed by the Governors. The 
collateral advantages to the Hospital School of gratui- 
tous dresserships which induced your former surgeons 
to consent to these appointments are now materially 
diminished by the regulations of the Royal College of 
Surgeons, and they are consequently, as respects the 
attractions of the School, of little value, and improperly 
curtail the remuneration of the Surgeons. Had the 
collateral advantages continued, the Surgeons would 
have been unwilling to interfere with the existing 
regulations, but under altered circumstances they 
consider themselves fully justified in requesting a 
different arrangement. 

"(Signed) T. B. Curling." 

The committee, having maturely considered the 
statements made before them in the above letter, 
unanimously resolved that it was inexpedient to make 
any alteration in the regulations. 

In 1851 the Hospital Staff approached the com- 
mittee, asking the committee to sanction the payment 
of a grant to the Medical College out of the Hospital 
funds. The letter making this request is of sufficient 
importance to be quoted : 



THE MEDICAL SCHOOL 199 

" To the Secretary of the London Hospital. 

" Sir, 

" I have been requested to submit to the House 
Committee a table showing the amount and nature of 
the support and assistance afforded to the Medical 
Schools in London by the Authorities and Governors 
of the Hospitals to which they are attached. The 
information was obtained and the Table constructed 
by one of the Lecturers of the Westminster Hospital 
School. It shows the great disadvantages under 
which the Lecturers of the London Hospital Medical 
School labour in competing with the other hospital 
Medical Schools in the Metropolis, from having to bear 
entirely the heavy expenses connected with the 
business of Medical Instruction. The grounds upon 
which the Governors of the other Hospitals have 
either borne the whole expenses of the Medical Schools, 
or afforded them large assistance, are understood to be 
the advantages derived by the Hospitals, not only from 
the educating and training of Gentlemen in order to 
qualify them for undertaking the higher and more 
responsible duties of the Medical Staff, but from the 
great and important services rendered gratuitously by 
well-instructed Pupils in the capacities of House 
Surgeons and Dressers, which services, without the 
adjuncts of Medical Schools, could be obtained only 
by a heavy outlay of the Hospital Funds. The 
Medical Officers entertain a confident hope that a fair 
and liberal consideration of the circumstances here 
represented will induce the House Committee to recom- 
mend that assistance be granted for the maintenance 
of the Medical School, in some degree commensurate 
with the advantages derived by the Hospital from the 
Association and the value of the services rendered by 
the Pupils. The Committee " need scarcely be re- 



200 THE LONDON HOSPITAL 

minded that, in consequence of the great amount of 
patients admitted into the London Hospital — an 
amount exceeding that of the In-patients of any other 
hospital in London, with the exception of St. Bar- 
tholomew's — of the large proportion of Surgical cases 
and Accidents, and of the immense number of Out- 
patients, the duties required of the Dressers are very- 
onerous, and equal to, if not greater than, those per- 
formed at any similar Institution. The Medical 
Officers, in making this application, have no intention 
at the present time of calling the attention of the 
House Committee to the subject comprised in the last 
column of the Table — namely, " Honoraria received 
by Medical Officers of Hospitals"; but as the services 
of the Medical Officers of the London Hospital are not 
acknowledged in this way, they trust that will be 
regarded as an additional reason for the Medical School 
receiving the support and countenance of the Governors. 

" T. B. Curling, 
''Hon. Sec. to Medical School.^* 

The committee did not send a favourable reply. 
After giving the matter due consideration, they did 
not consider they were justified in passing any pe- 
cuniary vote. 

That decision has long since been reversed. It is 
now understood that the interests of the Hospital and 
the Medical School are one. A good medical school 
stimulates the hospital to good work. A hospital 
doing good work attracts students to its school. With- 
out students it would be impossible to secure men of 
the same standing for the Staff, and the patients would 
thereby be great losers. The Hospital from 1880 
until the recent Commission upon " Hospitals and 



THE MEDICAL SCHOOL 201 

Medical Schools " in 1905 made an annual grant (it 
had made an occasional grant before) to the School for 
services directly rendered by the School to the Hospital. 
For instance, the Medical School has to supply the 
London Hospital annually, and without salary, with 
14 Receiving-room Officers, 8 Resident Accoucheurs, 
10 House-Physicians, 14 House-Surgeons, 8 Emergency 
Officers, 40 In-patient Clinical Clerks every three 
months, and 30 In-patient Dressers every three 
months, besides Out-patient Clerks and Dressers, 
Maternity Assistants, Post-mortem Clerks, and many 
others. But for the School the Hospital would have 
to pay for the services of these gentlemen. Their 
medical education at the College is closely associated 
with their work at the Hospital. It is of considerable 
interest that, when the Commission decided that no 
grants were in future to be made from the general 
funds of a hospital to a medical school, many sub- 
scribers, and those who best understood the value 
of this School to this Hospital, wished that in future 
their subscriptions should be given to the School, and 
not to the general funds of the Hospital at all, if the 
House" Committee so wished. They well understood 
that they were supporting the Hospital most usefully 
in insuring continued success of the School. 

In 1853 the Medical College was erected on its present 
site. The old building, with which Blizard had so 
much to do, had long since been inadequate. 

Since the erection of the new building in 1853 it 
has been enlarged on four occasions, and is to-day one 
of the finest schools in the kingdom for affording 
medical education. 



202 THE LONDON HOSPITAL 

There are the following departments under the 
control of specialists : 

1. Biology. — Laboratory, museum, and class-rooms 
for general and University students. 

2. Chemistry and Physics. — A lecture-theatre and 
laboratories for general students. University students, 
and students of public health. 

3. Materia Medica and Pharmacy. — A pharma- 
ceutical laboratory, and a museum containing all the 
substances described in the Pharmacopoeia, and plates 
of officinal plants. 

4. Anatomy. — Dissecting - room, class - rooms, and 
lecture-theatre, fully equipped for teaching anatomy 
to University or general students, and for research. 

5. Physiology. — Class-rooms and laboratories for 
general, chemical, and experimental phj'-siology ; rooms 
for special research ; and a lecture-theatre, supplied 
with electric light and power, and with an epidiascope 
for lantern demonstrations. 

6. Bacteriology. — Laboratories and class-rooms for 
routine instruction and for research. Annexed to the 
department is a laboratory for the investigation of the 
treatment of certain diseases by inoculation. 

7. Operative Surgery. — A special department in which 
students are taught opeiative surgery. Special classes 
are also held for those preparing for the higher examina- 
tion, officers in His Majesty's service, and others. 

8. Public Health. — Laboratories, lecture- and demon- 
stration - rooms, and museum, fully equipped for 
students proceeding for the Diploma in Public Health. 

By the generosity of the late Rev. S. A. Thompson 
Yates, the laboratories have been furnished with all 



v 



THE MEDICAL SCHOOL 203 

the latest and most approved apparatus, and with 
electric hght and power. 

The library, which serves also for an examination- 
hall, is well provided with the most modern medical 
and surgical works, and with a large collection of 
ancient authors. New works of interest to students 
are being constantly added to the collection. 

The Medical College is managed by the College Board, 
which has been presided over for many yea,YS by Mr. 
Douro Hoare, and Mr. Munro Scott has filled the 
important position of warden of the Medical College 
for thirty years with conspicuous success. 

An endowment fund has been established, and last 
jea,v a sum of £20,000 was received (from a donor who 
wishes to remain anonymous) for the advancement of 
medical research. 



CHAPTER XII 

THE NURSING OF THE SICK POOR 

As far as the records of this Hospital are concerned, 
we have seen that the type of woman employed as a 
nurse or watch at the beginning of the Hospital's 
career was of the lowest. She was usually an old 
woman who, on account of her age, and very often on 
account of her habits, was worse than useless to the 
community. 

Her wages were of the smallest, and her livelihood was 
eked out by gratuities from the committee, tips from 
the Staff, and fines from the patients. If her wages 
were small, her number of hours on duty was certainly 
not. 

In 1756, when she was honoured by having Standing 
Orders, she was expected to come on duty at 6 a.m., 
and was to continue on duty until her supper-time at 
10 p.m. She might then consider herself free, but had 
to be in bed by 11. 

When referred to in the minutes, she is classed with 
" beadles, porters, and other inferior servants." Her 
duties, according to the Standing Orders referred to, 
were, amongst other things, " to make the beds of the 
officers and servants, to clean the rooms, passages, 
and stairs, and the Court- and Committee-rooms." 

204 



THE NURSING OF THE SICK POOR 205 

It was not until 1820 that the committee thought 
it advisable that nurses should be able to read and 
write (two were discharged in 1822 because they 
could not read and write, " which was contrary 
to the bye-laws "). This law had to be relaxed, 
however, in 1829, on account of the difficulty of 
obtaining nurses. Only head-nurses were expected 
to have this qualification. Nurses who were not able 
to read and write were not to administer medicines 
except on emergency. 

Sir Henry Burdett, writing on " Nursing Systems," 
and speaking of these days, says : 

" The only points to be settled on engaging a nurse 
were that she was not Irish and not a confirmed 
drunkard. ' We always engage them without a char- 
acter,' wrote a doctor, ' as no respectable person would 
undertake so disagreeable an office.' Every vice was 
rampant among these women, and their aid to the 
dying was to remove pillows and bedclothes, and so 
hasten the end." 

The training of women for the honourable profession 
of sick-nursing was unknown before 1840. 

It would be doing a wrong to the memory of many 
faithful women if it were thought that every woman 
who nursed in the London Hospital before 1840 was 
of the type described above. There were brilliant 
exceptions. There were " born nurses " then, as now, 
whose names occur in the minutes from time to time 
with honourable mention. " Annie Broadbent was 
well qualified for her situation, which no one could fill 
with more credit to herself or advantage to the 
Hospital "; " Susan Jewell was very attentive, par- 



206 THE LONDON HOSPITAL 

ticularly with respect to administering medicine ;" 
" Ann Maddy was very attentive, highly respectable 
in her character and conduct, and is very humanely 
disposed ;" " Sarah Lowe was a very good servant, 
kept her ward particularly neat, and her patients in 
good order ;" " Catherine WilHs was exceedingly kind 
and attentive to her patients, of a good character and 
of an obliging disposition." All honour to these un- 
known women who used their only talent well. They 
showed a true womanliness and tenderness in times 
when their duties were considered degrading, and when 
their surroundings were abhorrent — born nurses, but 
untrained. 

Now the pendulum has swung in the other direction. 
The danger is in thinking that training alone will make 
a nurse. It will not. It can only perfect the inborn 
nursing instinct. It can only make the woman more 
useful, but it cannot make the woman. A nurse must 
be a true, pure, seK-sacrificing, cheerful woman. That 
comes first, middle, and last. That is her power. 
Her training directs her power into waj^s of increased 
usefulness, but it does not create her power. Her 
certificate will tell you about the one ; a sick child 
could tell you most about the other. 

On September 2, 1840, appears the following 
minute : 

" The Committee met on special summons to con- 
sider a communication from a deputation of the 
Provisional Board of Management of a projected 
society for the establishment of Protestant Sisters of 
Charity, especially with the view to improve the class 
of women employed in nursing the sick, requesting 



THE NURSING OF THE SICK POOR 207 

the Committee to admit two or three respectable 
women to be trained under the superintendence of the 
Matron. Resolved that the application be complied 
with, under a definite understanding that it shall in 
no manner be permitted to interfere with the discipline 
or arrangements of the Hospital." 

Mrs. Elizabeth Fry was the moving spirit and 
founder of the society, a deputation from which at- 
tended the Hospital. The minutes do not say who 
was on the deputation, although it is more than 
probable Mrs. Fry was present. 

The excellent services rendered to the Hospital by 
these Nursing Sisters is referred to years after — namely, 
during the cholera epidemic of 1866 : 

" Resolved, that a letter be addressed to the Lady 
Superior of All Saints' Home, Margaret Street, Caven- 
dish Square, conveying the best thanks of the Com- 
mittee for the very efficient services of the Sisters who 
attended nightly in the cholera wards of this Hospital 
during the period of greatest pressure, and assuring 
her that their kind attention to the wants of the 
patients and their responsible supervision of the Night 
Nurses were of great value to the Charity, and have 
been higiily appreciated by the House Committee." 

The Hospital, however, as yet showed no disposi- 
tion to train its own nurses for their work. 

In 1847 serious illness in the nursing staff is re- 
corded. A committee was appointed to investigate the 
cause of this general breaking-doAvn in health. They 
reported that 

" The general disorder of the health of the nurses is 
brought on from excessive fatigue, induced by having 



208 THE LONDON HOSPITAL 

to perform both Day and Night Duty, with but a short 
and hurried interval of rest between those periods of 
attendance in the wards." 

They recommended that a sufficient number of nurses 
be engaged, especially for night duty. Consequently, 
fourteen women were engaged to act as night nurses. 
They were not resident, but came in every evening. 
They were paid weekly, at the rate of Is. 6d. per night. 
And this was but sixty years ago ! About this time 
there is a note which says that only the older nurses 
were allowed to go into the men's wards, and that 
nurses were paid £2 a year more for nursing men than 
women. But within the next ten years the great 
change was to burst on the world, owing to the work 
and example of Miss Florence Nightingale. 

In 1863 the governors agreed to the principle of 
pensioning nurses who had long been in the service of 
the Hospital. No pension could be given until after 
twenty years' service, and the maximum for nurses 
was 12s. a week, and for assistant nurses 7s. 

In 1865 the committee received a memorial from the 
nursing staff, craving to be allowed one week's holiday 
in the year. This very unusual request was postponed 
for a year, but was eventually granted. 

In 1866 is found the first sign that the authorities 
thought it would be a good thing to train our own nurses : 

" Resolved, that a system of training Assistant 
Nurses be adopted in the Hospital, in accordance with 
the terms of a report from the Matron " (Mrs. Nelson). 

The following is part of this report : 

" The difficulty of procuring qualified Assistant 
Nurses has been long brought to your notice, but it is 



THE NURSING OF THE SICK POOR 209 

only now that I am in a position to submit for your 
approval a plan which has been for some time under 
the consideration of the House Governor and myseK, 
and which plan, when fully carried out, will, I firmly 
beheve, obviate this pressing inconvenience. I would 
suggest that we should have a small training establish- 
ment for our own purposes in the Hospital, to consist 
of from four to six probationary assistant nurses. 
These women, after two months' training, would, if 
required, be sufficiently qualified to be placed in wards 
under the Head Nurses, but, of course, they would 
become more valuable as they became more experi- 
enced. It is proposed to put these extra assistant 
nurses on the same footing as regards pay and allow- 
ances as the other assistant nurses, with this difference : 
that they shaU not have dresses supplied to them until 
they are appointed to wards, and that they shall not 
be entitled to gratuities until they have been six 
months in a ward, or twelve months in the service of 
the Hospital." 

It is strange that the committee should have been 
so slow in deciding that it was advisable to train 
nurses for the Hospital's own work, when it was con- 
stantly receiving requests, and granting them, from 
aU sorts of outside charitable organizations for per- 
mission to send women to the Hospital to be trained. 

In 1874 a new wing was added to the Hospital 
(the Grocers' Wing), and when the plans for this wing 
were being considered, the Court decided 

" that in carrying out the proposed extension of the 
Hospital the House Committee be empowered to in- 
clude, either in the same or in a separate building, 
arrangements for a training-home for nurses, for the 
special benefit and service of the London Hospital." 

14 



210 THE LONDON HOSPITAL 

Very few nurses could be accommodated in this 
wing, however, and in a small part of what subsequently 
became the first Nurses' Home. The greater number 
were accommodated in houses in the district. In 
1875 there was a serious outbreak of typhoid in some 
of these outlying homes, and several nurses were 
attacked, two with fatal results. 

Although the committee referred to a " training- 
home " for nurses in 1874, there was no proper and 
systematic training until 1880, when courses of lec- 
tures on nursing subjects were commenced by the 
present Matron, Miss Liickes, and, at her instigation, 
by members of the Medical and Surgical Staff. 

In 1895 a preliminary training-school was opened 
at Tredegar House. The advantages of such a pre- 
liminary training-home cannot easily be overestimated. 
Here probationers attend for seven weeks before 
entering the Hospital wards, and are tauglit all that is 
possible of routine work apart from the embarrassing 
surroundings of a great hospital. Here are given 
lectures on anatomy, physiology, bandaging, and sick- 
room cookery. One of the advantages of such an 
institution is that probationers are taught the 
necessity of discipline, punctuality, system, and 
accurate observation. 

For the benefit of those who may contemplate 
entering the nursing profession, some particulars of 
the conditions of a nurse's life in the London Hospital 
to-day may be of interest. 

Having been accepted as a candidate suitable for 
training (all particulars as to age limits, etc., can be 
obtained by applying to the Matron, and there is 




o 
M 

CO 

03 

Z 

a 

o 






CO 

D 

a 
a 

O 
H 
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THE NURSING OF THE SICK POOR 211 

always room for suitable candidates), the pupil pro- 
bationer would be sent to Tredegar House for her seven 
weeks' preliminary training. Parties of twenty-eight 
such candidates are received at a time. She would 
then come to the Hospital itself, and after a month's 
trial, if satisfactory, would sign an agreement to 
remain in the service of the Hospital for four years 
— that is, for two years of training, and for a 
further two years after obtaining her certificate. 
This last two years compensates the Hospital for 
expenses incurred in giving the training, free of all 
cost, to the probationer, and for paying her while she 
is being trained. 

From the day she enters the Hospital the proba- 
tioner is provided with a separate bedroom, and 
excellent sitting and reading rooms. The domestic 
arrangements generally are exceedingly comfort- 
able. 

The hours of duty are so arranged as to give all 
nurses and probationers three hours o£E duty daily, 
always by daylight. Nurses (a probationer becomes 
a " nurse " on the completion of her two years' train- 
ing), as well as three hours daily, have a half -day off 
duty every week, and every fourth Sunday. They 
are allowed to have the half-day of that week on the 
Saturday preceding the Sunday off duty, so that they 
may spend the night away from the Hospital, should 
they desire to do so. Probationers have their daily 
three hours, and also a whole day off duty every 
fortnight. 

In addition to the lectures given to pupU probationers 
at Tredegar House, three courses of lectures are given 

14—2 



212 THE LONDON HOSPITAL 

at the Hospital annually — on the General Details of 
Nursing, by the Matron ; on Elementary Anatomy 
and Surgical Nursing, by one of the surgeons ; and on 
Elementary Physiology and Medical Nursing, by one 
of the physicians. After each course of lectures an 
examination is held, and at the end of the first year's 
training the probationer sits for the annual examina- 
tion. 

As I have said, no fees are charged for training. 
On the contrary, a salary is paid from the first. A 
probationer is paid £12 the first year, and £20 the 
second. A nurse is paid £24, increasing by £1 per 
annum to £27. Sisters are paid £30 the first year, 
£35 the second year, £40 the third year, as a maximum. 
Nurses who are sent out to nurse private cases — that 
is, those who are appointed to the private staff — are 
paid £30 the first year, £35 the second, £40 the third, 
and £45 the fourth, as a maximum. 

A certain amount of uniform is provided to all 
members of the Sta3, and, of course, full board, with 
an allowance of 2s. 6d. per week for washing. 

In order to encourage the best nurses to remain on 
the Staff, an addition of £5 to her salary is made to every 
nurse after six years from the date of her entrance 
as a probationer ; a second increase of £5 per annum 
is given after the completion of her twelfth year ; and 
after the expiration of eighteen years' service, at a 
minimum age of forty-five, all members of the Nursing 
Staff are eligible for pensions, the pension being full 
pay for life. 

The training of the nurses at the London Hospital 
to-day is on lines laid down by one of the 



THE NURSING OF THE SICK POOR 213 

Hospital's best-known governors, Miss Florence 
Nightingale, who has always taken the keenest 
interest in the work of the Hospital, and in the 
nursing especially. 

Miss Nightingale was made a life governor in 1856, 
when she was still carrying out her nursing work at 
Scutari. On acquainting her with the wish of the 
House Committee to make her an honorary life 
governor, the secretary received the following letter 
from her : 

"Scutari, Barrack Hospital, 
"■March 20th, 1856. 

" Sir, 

' ' I beg to acknowledge the receipt of your letter 
of March 5th, and to request that you will be kind 
enough to convey my best thanks to the Governors 
of the London Hospital for the honour they have done 
me in entering my name on the list of Governors of 
that Institution. 

"It is an honour especially gratifying to me, since 
the objects of the Hospital are those which have been 
the strongest interests of my life. And to receive 
such a tribute of sympathy in these interests of cordial 
feeling from an Institution which commands the 
respect and admiration of all who have witnessed the 
manner in which it is conducted is a peculiar satisfac- 
tion, which I appreciate most highly and heartily. If 
I live to return to England, when this work in which 
I am engaged shall be at an end, I shall have great 
pleasure in receiving from the Governors of the London 
Hospital the documents mentioned in your letter, and 
in hearing whatever they may have the kindness to 
say to me concerning that Hospital. 

" Florence Nightingale." 



214 THE LONDON HOSPITAL 

No living woman has done more for the betterment 
of the conditions under which nurses work, the shorten- 
ing of their hours, the lengthening of their holidays, 
the improvement in the domestic arrangements, than 
Miss Liickes, the present Matron, and she has been 
encouraged in this work by our present chairman, who 
has made the improvement of the conditions of nursing 
one of his main objects in devoting his life to hospital 
work. 



CHAPTER XIII 

THE LAST TWENTY YEARS 

That more has been done in the great task of fighting 
disease in the last twenty years of the Hospital's life 
than in all the years since its foundation wiU be con- 
ceded by those acquainted with the work. And yet 
such a statement is not true altogether. It is more 
accurate to say that the result of the work of the last 
hundred years is shown in the last twenty. The 
blossom and fruit which we see and admire are only 
proofs that the root was quietly doing its work under- 
ground in the dreary winter days. 

Twenty years ago every hospital in London was 
beginning to see that it needed weapons in its combat 
with sickness the lack of which it had never felt before. 
Up to that time a hospital was essentially a collection 
of large rooms in which patients could be put to bed, 
kept warm, and well fed. Surgery rarely interfered, 
except in cases of accident. The cure of the patient 
was left to " Nature." How Nature assisted was not 
clearly understood. The treatment was negative, not 
active. 

From twenty years ago onwards great discoveries 

have been made almost every year, and there is 

occasion in a great hospital for the discoveries in all 

branches of science to find application — physiology 

215 



216 THE LONDON HOSPITAL 

and anatomy, chemistry and biology, bacteriology, 
pathology and histology. Discoveries have been 
made in all of these which are of use in the healing of 
sick folk, and in destroying the causes of disease. 
Consequently, every hospital, efficient as may have been 
its work hitherto, according to the light it had, suddenly 
found itself out of date, inefficient, and incomplete. 

Until twenty years ago the deliberations of the 
committee were chiefly concerned with routine ques- 
tions of discipline and standing orders ; of purchase 
and storage of coals, and meat, and bread, and bedding ; 
of appointments and resignations ; of income and 
expenditure. These questions still occupy, and must 
always occupy, much of the committee's attention. 
But now to these were added long and anxious con- 
siderations as to the possibility of introducing some 
new and hitherto unknown system of attacking some 
loathsome and hitherto unconquered disease. And 
it was not simply a question of deciding on the pur- 
chase of tliis or that apparatus, or the enlargement of 
this or that room. One single step forward on the part 
of one investigator would lead to a greatly increased 
permanent expenditure. For instance, Lister makes 
the discovery that wounds are infected by micro- 
organisms which enter at the time of operation ; that 
these micro-organisms produce suppuration, which may 
end in death ; therefore, their entry is to be prevented. 
What has followed ? The whole system of surgical 
operation was immediately changed. Before his day 
a simple well-lighted room, a wooden table, and a dirty 
old coat for the surgeon to wear for his dirty work, 
sufficed. Now the operating theatres must have 



THE LAST TWENTY YEARS 217 

mosaic floors, tiled walls, and rounded corners ; all 
theatre furniture must be enamelled and rounded. 
Hot and cold water must be supplied in unlimited 
quantities, and there must be conveniences for washing 
in running water, and all the water must be sterilized 
first. This is done by boiling, and then cooling out of 
contact with the air, and the coal bill is thus affected. 
The life of the instruments is shortened from years to 
months, because each instrument has to be boiled 
before use. The instrument sterihzers are always 
boiling in both theatres and wards, and so the gas 
bill is increased. No one may enter a theatre unless 
wearing a sterile calico smock. Some hundreds of 
these smocks are used in the theatres every week, 
and so the washing bill goes up. Dressings have all 
to be subjected to the action of steam under pressure, 
and for this expensive steam sterilizers must be pro- 
vided. Highly trained assistants must be engaged, 
who are alive to the danger which may lurk in a piece 
of inefficiently sterilized catgut or sponge. Large 
numbers of unskilled assistants must also be employed 
for keeping the theatres clean. 

Now, the above illustrates what has happened in 
nearly every department. The first simple discovery 
has led to enormous expenditure, which becomes a 
fixed and permanent expenditure. Is it worth it ? 
Yes, it is. The Hospital has doubled the number of 
patients it passes through each of its beds each year, 
because of the shortening of the time of " average 
residence " by half. In other words, recoveries are 
more rapid. But that is not all. Patients recover 
who previously would not have recovered at all. The 



218 THE LONDON HOSPITAL 

enormous advances in abdominal surgery have made 
recovery possible in cases which were once considered 
hopeless. 

Now, all these things began to force themselves upon 
a committee, already perplexed, about twenty years 
ago. The committee was already perplexed because 
it had been gradually driven to the conclusion that 
the work of the Hospital had outgrown the resources 
of the Hospital. Every ward was overcrowded ; the 
little underground Out-patient Department was full 
all day and every day. Mr. John Hampton Hale, one 
of the most devoted chairmen the Hospital ever had, 
was elected to the chair in 1893, and it is said of him, 
and I believe truly, that he never missed, except during 
his holiday, being at the Hospital for some hours of 
every day. Never did a distressed ship depend more 
on the judgment and skill of the captain than did 
the Hospital at that time depend upon its chairman. 
When Mr. Hale took office the time had come when 
something had to be done if the work was to go on at 
all, even in the old non-scientific method. Before he 
retired the new era had come, and the difficulties had 
increased a hundredfold. 

Up to now the Medical and Surgical Staff had been 
capable of teaching nearly all that a medical student 
ought to know. No better proof of the changes which 
were taking place can be given than the altered opinion 
of the Staff on this point, and the following extract 
from the Quarterly Report of the House Committee 
may be quoted : 

" During the last quarter the Medical Council asked 
the House Committee to receive a deputation of the 



THE LAST TWENTY YEARS 219 

whole Medical Staff, to discuss the present and future 
of the Medical School. The House Committee readily 
acceded, and at the interview it was pointed out very 
forcibly by the Medical Staff that it was absolutely 
necessary to strengthen certain of the teaching de- 
partments ; that so much was now required of teachers 
that it was no longer possible for a man to be a Pro- 
fessor of Science and do his teaching fairly towards 
the students, and also to be in practice as a physician 
or surgeon ; and that it has become necessary, if the 
Medical School was to maintain its high position, to 
support and adequately pay professors of physiology, 
bacteriology, biology, practical anatomy, and of 
chemistry." 

That report shows quite well what was going on. 
The healing forces were taking to themselves allies, 
and room had to be found in the old camp for the 
increased army. 

This sudden advance in medicine and surgery was 
reflected everywhere throughout the Hospital. There 
was a general awakening and a desire to do better. 
Disease was to be fought, not suffered. Overcrowding 
had been referred to years before, but only as an incon- 
venience, as a man might complain that his orchard 
was too small. Now it was more than that ; it was 
preventing good work from being conscientiously per- 
formed, when there was so much to be done. Every- 
where was greater keenness. So we note all sorts of 
minor and apparently discormected improvements. 
Modern bedsteads were supplied throughout the 
Hospital, which gave greater facilities for good nursing ; 
hair and spring mattresses were substituted for the 
old flock ones ; feather pillows were introduced. The 



220 THE LONDON HOSPITAL 

conditions of the nursing service were improved, and 
the quality of the training of probationers changed 
for the better. It was in the chairmanship of Mr. Hale 
that Tredegar House was opened (1895) as a pre- 
liminary training-school for nurses, and also it was 
from about this time that nurses were enabled to take 
a course of sick-room cookery. Much greater atten- 
tion was given to cleanliness, and now commenced the 
practice, still in vogue, of scrubbing the Hospital 
corridors, staircases, waiting-rooms, and Out-patient 
Department during every night between the hours of 
11 p.m. and 5 a.m. The Lords' Commission on the 
Metropolitan Hospitals awakened a keener interest 
in the work of these great charities, and the committees 
of them all strove to increase their efficiency. 

In 1896 is the first reference to the treatment of 
disease by serum, diphtheria, and tetanus being the 
diseases first attacked. 

This treatment has so revolutionized the treatment 
of certain diseases, diphtheria especially, that some 
fuller reference to it may be of interest to lay readers. 
The principle on which the treatment rests is this : 
that when a micro-organism grows, it first produces 
a substance which is poisonous. The symptoms shown 
by man after the invasion of these micro-organisms 
are due to the action of these " toxins " which have been 
produced, and which affect nerves, kidneys, liver, 
stomach, or other organs. After a certain time a 
substance is produced by the man which is antagonistic 
to the further action of the toxin, and eventually 
neutralizes it. This substance is called antitoxin. 
Each kind of organism produces its own special toxin 



THE LAST TWENTY YEARS 221 

and antitoxin. In the case of a person suffering from 
a disease due to the presence of one kind or another of 
these minute bodies, the recover}^ or the death of the 
patient depends largely upon his capacity for " holding 
out " until sufficient antitoxin has been produced to 
neutralize those toxins which are causing the disease. 
If a horse be inoculated with the diphtheria bacillus, 
he shows symptoms of the disease, and recovers, and 
in his recovery antitoxins have been produced in his 
blood. The animal is again inoculated with the 
disease, and again and again, until it is not possible 
to give the animal the disease at all, because the pro- 
tective antitoxins have been so developed as to be able 
to resist entirely any diphtheria baciUus with which 
he may be inoculated. When this condition has been 
arrived at, blood is drawn from a vein in the neck with 
a suitable vessel, and allowed to stand until clotting 
takes place ; the clear, yellowish serum is drawn off, 
and sterilized by being passed through a special filter. 
This serum, when injected into a child suffering from 
diphtheria, gives to the child the resisting power or 
immunity gained by the horse. By this, the now 
recognized treatment, the mortality in infant diph- 
theria in London was reduced from 59 per cent, in 
1888 to 11 per cent, in 1901. It should be stated that 
every horse used for the production of antitoxin serum 
is first of all tested by means of tuberculin and mallein, to 
insure his own freedom from tuberculosis and glanders. 
But to return to the Hospital. In 1894 the StaS 
asked that the Hospital should be lighted by elec- 
tricity. The old gas-burners were antiquated, and the 
surgeons urged that in the theatre especially (there 



222 THE LONDON HOSPITAL 

was only one) more efficient lighting was absolutely 
essential. The question was carefully considered, but 
the committee came to the conclusion that the expense 
was prohibitive. Two years later, however, incan- 
descent gas-burners were established throughout the 
Hospital instead. 

Electricity was now becoming an important agent 
in the treatment of disease, and again, in 1894, the 
Stafi attended the committee, asking for the provision 
and equipment of an electrical department. This was 
granted after careful consideration. A temporary 
building was built and equipped, and in the following 
year (1895) the first Medical Officer in charge of the 
Electrical Department was appointed. This, like 
every other new department, has grown enormously, 
and now engages the whole time of six assistants. 

At this date, also, is the first reference in the minutes 
to the Rontgen rays, and still another department 
had to be founded for the application of these rays. 
Once their uses were known, no hospital could afford 
to neglect so useful and important an aid in diagnosis 
and treatment. Now the Rontgen rays are in use at 
the Hospital from morning to night. Every fracture 
is examined on admission by their aid, and again 
examined after the bones have been put into position 
for imiting. X rays are in constant use, too, as has 
already been stated, to discover the whereabouts of 
the odds and ends wliich Whitechapel children, like 
little ostriches, delight to swallow — buttons, pins, 
coins, etc. They are largely used now, too, in the 
treatment of certain diseases — cancer, ringworm, and 
certain forms of lupus. 



THE LAST TWENTY YEARS 223 

In December, 1896, the Honourable Sydney Holland 
was elected chairman, on the resignation of Mr. Hale. 
IVIr. Hale had been chairman through the most 
strenuous years which the Hospital had known since its 
foundation. Everything was " pressing," and at every 
meeting of the committee some new development had 
to be considered. When he retired from the chair, the 
Court passed the following resolution : 

" On the occasion of the retirement of Mr. John 
Hampton Hale from the position of Chairman of the 
House Committee, which he has occupied since Decem- 
ber, 1892, it was unanimously resolved to place on 
record the very high appreciation of the splendid 
services rendered by Mr. Hale to this great Charity. 
The Committee acknowledged with deep gratitude the 
untiring zeal with which Mr. Hale has given himself 
up to the many interests of the Hospital, the absolute 
self-sacrifice with which he has devoted his valuable 
time to the Institution, and the able manner in which 
he has mastered all the many difficult details con- 
nected therewith." 

On looking through the records of the work, week 
by week, during Mr. Hale's term of office, one cannot 
but feel that the praise given in the passage quoted 
was thoroughly deserved. 

To the outside public Mr. Sydney Holland is best 
known as the " Prince of Beggars." That such a man 
should take up the responsibility of the chairmanship 
at such a time was a piece of great good fortune to the 
Hospital. Money was sadly wanted, and here was the 
man with a great power of interesting sympathetic 
people in what he himself was so keenly interested in. 



224 THE LONDON HOSPITAL 

To those who work within the walls of the Hospital 
Mr. Holland is known as a man of untiring energy, of 
broad views and high ideals, and of great kindness of 
heart. His appeals hit hard, and cannot be resisted. 
That is because he has himself been hit hard. The 
suffering poor appeal to him, and he appeals to the 
charitable. When he asks for help, it may be safely 
assumed that he has done his own share in helping 
first, and a great deal more than his share. His 
pocket and his time have been at the service of the 
Hospital since he was elected chairman in 1896. He 
is chairman now in 1910, and works as hard to-day as 
he did tliirteen years ago. On the desk before me as I 
write is a note of things Mr. Holland wants to know, 
and to know soon : Was that operation on So-and-so 
successful ? Is anyone doing anything for that man's 
wife while he is in Hospital ? Cannot we help that 
poor woman more ? Why has Mr. A. cancelled his 
subscription ? The Budget ! " Absurd ; give me his 
address." Are we not using too many chickens, and 
would not rabbits, which are cheaper, do as well in 
some case ? Are the dinners served hot in Row^sell 
Ward, which is a long way from the kitchens ? Are 
the residents' meals properly cooked and served ? 
and so on. All at " The London " work hard, but no 
one so hard as the chairman. 

From the first he devoted a great deal of his energy 
to improve the conditions under which the nurses 
worked. The hours on duty were shortened, the time 
off duty by daylight increased ; the holidays were 
extended, the salaries raised, and the accommodation 
enormously improved. A sick-room was provided 




THE HON. SYDNKV HuLLAND, CHAIRMAN 




THK lJ0Ai;U-KUOM 



THE LAST TWENTY YEARS 225 

for the nurses, with the advantages of a hospital ward, 
and the privacy and cosiness of home. For thirteen 
years he has championed the cause of nurses, not only 
here, but everywhere. 

Again and again the Staff attended the committee, 
urging the necessity of one improvement after another. 
They again appealed for the electric lighting of the 
Hospital. A fund was started. The work was com- 
menced, and was, after some five years — for the com- 
mittee had to feel their way — completed. It cost 
£15,000. 

Then the necessity of a photographic department 
was urged. It was started, and its work, too, has 
increased beyond all expectation. Very full and 
careful notes are kept here, as at all good hospitals, 
of every case treated — of the family history, of the onset 
of the illness, of its progress every day, and of its 
termination. These notes are classified and bound, 
and form one of the most useful medical and surgical 
reference libraries in the world. Should the patient 
die and a post-mortem examination be held, the 
notes of this examination are included with the 
notes formerly taken. With the notes are also 
bound photographs taken at different stages of 
the illness, if such a record may be useful, so that 
the appearance of the patient, or some part of 
the patient, may be compared before and after 
treatment. 

In 1897 affairs had reached a stage which made the 
most sanguine despair. Never was money so wanted 
since the Hospital began. There was none. Even 
ordinary upkeep could not be met. It was the dark- 

15 



226 THE LONDON HOSPITAL 

ness before the dawn, however, but at the time it was 
not known that dawn was breaking. Since then (it 
is only twelve years ago) the Hospital has been entirely 
rebuilt. Every department is up to date, and new 
departments, then unlieard of, have been founded and 
have grown. The scheme cost nearly half a million 
to carry out, and Mr. Holland may well be a proud 
man as he stands in the quadrangle to-day, with this 
great temple of healing towering around him, as nearly 
perfect as such a place can be, from the huge boilers 
throbbing in the basement to the kitchens on the 
roof. 

In looking through back records it seems that tliis 
huge scheme originated in a correspondence between 
the Prince of Wales' Hospital Fund — now King 
Edward's Hospital Fund — and the House Committee. 
The Prince of Wales' Fund wrote asking what improve- 
ments it was considered necessary to carry out in order 
to render the London Hospital up to date and efficient. 
A reply was sent giving a list of such requirements, 
pointing out that the necessity had long been recognized, 
but lack of funds made it impossible to carry out 
improvements so obviously necessary. In a reply 
from the Prince of Wales' Fund, dated December 29, 
1897 — a document of historic interest to us — it was 
stated that if the Hospital would spend £100,000 of its 
capital, the Fund promised to pay an annual subscrip- 
tion of £5,000. This has been paid ever since. The 
Staff were immediately acquainted with this good 
news, and were asked to appoint members to sit 
on a joint committee with members of the House 
Committee to form a Building Committee. The 



THE LAST TWENTY YEARS 227 

Building Committee was asked to conteider the 
following : 

1. Additional accommodation for about 100 nurses. 

2. Another Operating Theatre. 

3. Better accommodation for the Resident Staff. 

4. An Isolation Block for infectious cases. 

5. New Ophthalmic Wards. 

6. Seclusion, Padded, and Twenty-four-Hour Rooms. 

7. New Children's Wards. 

8. A new Out-patient Building. 

The above were the " terms of reference " to the 
Building Committee. That was what it was proposed 
should be done. It has all been done — much more 
than that. In the deliberations of the Building Com- 
mittee it was soon decided that during the alterations 
not a bed must be closed. That also was accom- 
plished. It must be noted, however, that this decision 
greatly increased the cost of the work. No part of 
the Hospital could be handed over to the builders 
until accommodation had been found for the patients 
elsewhere. Every single ward in the Hospital without 
exception, and every passage and every room, have 
been altered. The difficulty of carrying on the routine 
Hospital work with gangs of workmen all over the place 
cannot be imagined, and can never be forgotten by 
those who had to put up with it. Corridors were 
constantly being blocked, necessitating a journey to 
another floor to get to different parts of the Hospital. 
Night shifts had frequently to be undertaken in order 
to get some important part clear as soon as possible. 
In one case screws, instead of nails, had to be used to 
put down the floor of a new ward, at an increased cost 

15—2 



228 THE LONDON HOSPITAL 

of £40, simply for the comfort of the patients who occu- 
pied the ward below. Hammering had to be stopped 
every day in some part or another while a physician or 
surgeon went his rounds. The whole of the work was 
stopped on the East Wing one day for the sake of one 
patient, to whom sleep was a matter of life and death. 
Large temporary wards were built in the garden to 
accommodate the patients as they were turned out of 
each ward in turn. If there is one thing connected with 
this old place of which I am proud more than another, 
it is the fact that tliis vast rebuilding was done without 
closing a single bed. 

When the improvements had once fairly started, one 
munificent donor after another came forward with some 
splendid gift. We shall never forget those days. 
Surely some good angel watched over the Hospital 
at that time, and moved the hearts of men to great 
effort. 

To begin Avith, one donor offered £25,000 towards 
the cost of the new Out-patient Building. The gift 
was offered on two conditions : first, that the letter 
system should be abolished, and, secondly, that every 
out-patient who could afford it should be asked to pay 
some small trifle towards the cost of his medicine 
(3d.). And here I may add that this same generous 
man has since given £20,000 for the endowment of 
Research at the Medical College. After due considera- 
tion the committee decided to accept the gift with the 
conditions. This splendid department was opened by 
the King, accompanied by the Queen, our President, on 
June 11, 1903. It has been described in an earlier 
chapter. His Majesty's words at the opening cere- 



THE LAST TWENTY YEARS 229 

mony have filled the heart of every Londoner with 
pride : 

" It gives myself and Queen Alexandra great pleasure 
to be here to-day, and to open this building. 

"It is a satisfaction to me to see such a great ad- 
vance in hospital construction and policy ; and I am 
glad to think that the out-patients in this Hospital 
will be treated with greater care and attention than has 
been possible in your old building. 

" I am unable to thank by name the generous donor 
who has given £25,000 to this building, but it must be 
a pleasure to him to see his gift so well bestowed ; and 
I am specially glad to learn that the benefits of the 
London Hospital are open to everyone who is poor and 
ill, without having previously to obtain a letter from 
some subscriber. 

" I note also with satisfaction the help the Hospital 
has received from the great employers in the neigh- 
bourhood, and, looking at the report, I notice as a 
matter of interest that your Treasurer, Mr. John Henry 
Buxton, succeeds his father as Treasurer, and has also 
a son on the Committee. I note also the very generous 
help the Hospital has received, especially from the Lord 
Mayor and several great societies. 

*' You have rightly alluded to the interesting fact 
that the Duke of Cambridge has presided over this 
Hospital for fifty years. We are all delighted to see 
him here to-day, and trust he may long be spared to 
continue his duties as President. 

" I well remember the visit of Queen Victoria, my 
beloved mother, and I know of the great interest she 
took in this Hospital. 

" Speaking for Queen Alexandra, I can say that she 
is very much pleased with the way this Hospital has 
carried out the trust she imposed on it, and it is the 



•230 THE LONDON HOSPITAL 

greatest satisfaction to me that she has been able to 
introduce into this country from her own country the 
invention of her distinguished countryman, Dr. Finsen, 
for the treatment of hipus, which has already produced 
such satisfactory results. 

" We shall have great satisfaction in inspecting the 
building, and before declaring it open I wish to record 
my deep feeling of gratitude to this Hospital, which 
at the time of my severe illness provided me with so 
distinguished a surgeon as Sir Frederick Treves, with 
an anaesthetist in Dr. Hewitt, and with two such nurses, 
Nurse Haines and Nurse Tarr, whose unceasing atten- 
tion I cannot sufficiently praise. 

" I declare this building open ; and may God's 
blessing rest on all who come to it for aid, and on all 
who work in it." 

Before the Out-patient Building was finished, another 
great gift was received. The late Mr. B. W. Levy, in 
going round the wards once, was much affected by the 
mental distress which patients suffered who had to 
undergo operation. There was only one theatre ; 
there were 400 surgical beds. Patients, therefore, had 
to wait some days before it came to be their turn to be 
taken to the theatre, and often after being " prepared 
for operation " the case got crowded out — previous 
cases had taken longer than was expected, or an emer- 
gency case had to be taken at once — so the unfortunate 
patient was taken back to the ward unoperated on, 
and had to go through the dreadful time of preparation 
again. It was this that so moved Mr. Levy, and he 
gave at once five great theatres at a cost of £13,000, 
on condition that these theatres should be open for 
all time to all nationalities and all creeds, and that his 




BALCONY OF MARIE CELESTE MATERNITY DEPARTMENT 




LABOUR-ROOM OF MARIE CELESTE MATERNITY DEPARTMENT 



THE LAST TWENTY YEARS 231 

name should not in his lifetime be mentioned in con- 
nection with them. 

Once again the Staff came to the committee, this time 
to urge the necessity for the provision of a separate 
building for the nursing and care of cases which were 
infectious, or which, although not infectious to healthy- 
individuals, might be infectious to open wounds. The 
committee appreciated the necessity, but were again 
met with the dilficulty of expense. Again help arrived 
from an unexpected quarter. Mr. J. A. Fielden, at 
that time a stranger to the Hospital, came forward, 
bought the site, paid for the building, and furnished 
it throughout. It contains about sixty beds. We 
also owe to him many of the balconies outside the 
wards — an incalculable boon to patients. 

It had long been the intention of the committee to 
improve, to rebuild if possible, the wards reserved for 
Jewish patients, when sufficient funds were forth- 
coming. In 1899 came a gift of £10,000, afterwards 
increased to £20,000, from the late Mr. Edward Louis 
Raphael (for the endowment of these wards when 
built), whose son, Mr. Louis Raphael, then joined the 
committee. 

One of the most touching gifts was one of £10,000, 
which was received about this time from Mr. James 
Hora, for the endowment of the Marie Celeste Wards, 
in memory of his wife, Marie Celeste Hora. 

As has been stated, these wards are lying-in wards, 
and admit women from a radius of one mile of the 
Hospital. Hardly could a more beautiful method have 
been found for perpetuating the name and memory 
of anyone. The wards are to be called Marie Celeste 



232 THE LONDON HOSPITAL 

Wards " as long as the Hospital shall exist," and as 
long as the Hospital shall exist that name will be 
associated in the minds of hundreds of poor women with 
memories of tender care and loving help. 

And there is yet another of these great and special 
gifts to record. The executors of the late Baroness 
Julia de Stern gave £60,000 for the erection and en- 
dowment of a Convalescent Home for patients from the 
London Hospital at Felixstowe. This Home is of in- 
calculable value to the Hospital. We are enabled to 
send patients who are not sufficiently convalescent to 
go to ordinary convalescent homes — patients with 
wounds not yet completely healed, and who require 
very special nursing. It is reallj^ a country branch of 
the Hospital, and is managed on the same principles 
as the mother Hospital itself. 

I need not enter in further detail into these magnifi- 
cent gifts which the Hospital received about this period, 
each given for some definite object. 

In 1894 Sir Andrew Clark, one of the Hospital's most 
noted physicians, died, and a large sum of money was 
collected in order to erect some suitable monument to 
his memory. It was considered fitting that such a 
monument should be set up in the Hospital in which 
he had worked so long. After considerable discussion 
it was eventually decided to build a Pathological 
Department. This has been done. The building con- 
tains a post-mortem room, in which, if necessary, six 
post-mortem examinations can be carried out at the 
same time ; it also contains laboratories for the carrying 
out of research, and is equipped with everything neces- 
sary for investigations in this direction. It cost 



THE LAST TWENTY YEARS 233 

£10,000. The work here has been largely assisted by 
the generosity of Lord Northcliffe and the Right Hon. 
Sir Hudson Kearley, Bart. 

In 1899 our Queen, then Princess of Wales, during 
one of the many visits she has paid to the Hospital, 
urged the adoption of the new treatment for lupus 
which had been discovered by her countryman, Dr. 
Finsen of Copenhagen. Two of the physicians — one 
was the late Sir Stephen Mackenzie — at once went to 
Copenhagen to study the system under Finsen. The 
authorities sent two Sisters for the same purpose. As a 
result the committee decided to instal the light cure. 
The Queen herself gave the first lamps, and has ever 
taken the kindest interest in the department and in 
the sufferers from this awful disease. The Queen's 
lamps are in use to this day. It is a very costly depart- 
ment to run. Since its foundation an endowment fund 
has been formed, to which Lord Northcliffe gave the 
sum of £10,000, and for which Mr. Percy Tarbutt col- 
lected nearly £8,000. 

A Bacteriological Laboratory has been established, 
and an Opsonic Department opened, and later, an 
Inoculation Department. 

A Statistical Department has been added to the 
already existing Registrars' Quarters. 

In 1903 Mr. John Henry Buxton resigned the post 
of Treasurer, and Lord Stanley (now Lord Derby) was 
unanimously elected Treasurer. He is the Treasurer 
to-day, and has taken, ever since his election, the 
keenest interest in the Hospital's welfare, and has 
used his great influence to further its interests. 

In 1904 our Queen graciously accepted the position 



234 THE LONDON HOSPITAL 

of President, vacant by the death of H.R.H. the Duke of 
Cambridge, who had been President for fifty-four years. 

At the conclusion of the rebuilding, the committee, 
the Staff, and other friends of the Hospital, set up in 
the quadrangle a statue of the beloved President and 
friend of the Hospital, Her Majesty the Queen. 

The Hospital has been honoured many times by her 
visits, and those of other members of the Royal Family. 

That Great Lady has been the good angel which has 
watched over " The London," and it is " The Lon- 
don's " honour to do her pleasure, and watch over her 
poor in the East End. 




o 






H 

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O 

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CHAPTER XIV 

THE ADMINISTRATION OF A MODERN HOSPITAL 

Every secretary of a large hospital is constantly 
receiving letters asking for information on certain points 
of administration and management. Such letters 
arrive daily, and they come from every part of the 
globe, and especially from India and the Colonies. 
In one week letters asking such questions have come 
from Bagdad, from Calcutta, from Hongkong, from 
Auckland, and from Sydney. The questions asked refer 
to the nursing arrangements, the power and duties 
of the StafE, to the advisability or otherwise of paying 
wards, to the system of buying, storing, and distribu- 
tion, to the dietary, and so on. 

It may be of some advantage, therefore, to some 
who may be interested enough to read this little 
book, if I set down the chief points in the administra- 
tion of the London Hospital to-day. They are more 
or less the same at all large hospitals. Much that 
I shall state in this chapter has been touched upon in 
preceding chapters, but it may be a convenience if 
the various points are again mentioned in their order. 

Within the last few years much deeper interest than 
heretofore has been taken in the treatment of the 
sick poor, and the voluntary hospitals have recently 

235 



236 THE LONDON HOSPITAL 

occupied public attention as to their management and 
administration. The public are, as a rule, well dis- 
posed towards hospitals, and support them magnifi- 
cently. Nevertheless, the feeling exists that the 
hospitals are somewhat extravagantly managed. 
Officials have been charged with showing a lack of 
ordinary business methods, and it has been said that 
money, so generously subscribed, has not always been 
spent to the best advantage. 

Perhaps, on the whole, these criticisms have done 
good, in spite of the obvious danger of the hospital 
boards being influenced thereby into thinking that 
cheapness in itself was meritorious. 

How do those who charge the hospitals with ex- 
travagance come to the conclusion that a hospital is 
expensively managed ? In only one way — namely, 
by comparing the cost of one hospital with that of 
another. The total ordinary expenditure per annum 
of a hospital is taken, and this sum is divided by the 
number of beds occupied. A quotient is arrived at, 
and this is called " the cost per bed " of that particular 
hospital. Then the cost per bed of various hospitals 
is compared. That which has the lowest is taken 
to be right, and those who have higher are condemned 
more or less vigorously for " expensive management." 

Now, this " cost per bed " comparison is misleading 
to those who do not thoroughly understand hospital 
work, as I have previously tried to show. True, 
the low figure may be due to good management, but 
it does not in the least follow that it is so, and it 
certainly does not necessarily follow that the high 
cost per bed points to extravagance. 



MODERN ADMINISTRATION 237 

The comparison is wrong for this reason, that the 
word " hospital," being a word of wide appHcation, 
is used for institutions which are not doing the same 
kind of work, and are not intended to do the same 
kind of work, and so are not fit subjects for 
comparison. 

Moreover, to the question " What is efficient manage- 
ment ?" many answers may be given. There is no 
standard of efficiency, and those who know most about 
hospital work will be the last to attempt to fix a 
standard. These know, better than the public, that 
medical science is progressing so rapidly that what is 
" efficient " to-day may be culpably " inefficient " 
to-morrow. 

To illustrate. Until within the last few years all 
hospitals treated the terrible disease of lupus by the 
rough method of surgical scraping. As this was then 
the only means available for treating this disease, all 
hospitals were, to the best of their knowledge, efficient. 
Then Finsen came and worked, and pubhshed to the 
world the discovery of the light cure. Those hospitals 
which were governed by keen and progressive boards 
at once fitted up a Finsen Light Department. Such 
a department would immediately and materially 
raise the "cost per bed." Were they guilty of ex- 
travagance, or had they merely done their duty in a 
broadminded spirit ? This is only one instance, many 
of which might be given. By this instance may be 
seen the danger referred to above — namely, that the 
pubHc may press so urgently for a low " cost per bed " 
that progress in medical science may be hindered, unless 
a board is strong enough to be willing to sacrifice a 



238 THE LONDON HOSPITAL 

certain amount of popularity for what they feel to 
be right. 

It is necessary to draw attention to the very varied 
work which hospitals are doing. It is all good work, 
but it is not all equally costly work. 

For instance, one hospital is satisfied to receive certain 
patients who are sick, to heal them if possible, and 
finally to return them to the community well or 
relieved. This is a most commendable aim, and it is 
a sj)lendid work. But it is not very costly work, and 
it must be noted that such a hospital is enabled to do 
it as cheaply as it does because other hospitals have 
expended much in investigation and research. All 
big hospitals have now their Finsen lamps, but it was 
a few pioneer hospitals which bore the chief expense 
in finding out what were the best lamps to use. 

But some other hospitals have a somewhat loftier 
aim, and take a broader view of their duties than those 
just referred to. They are not content with simply 
returning their patients cured or relieved. They not 
only attempt to cure the disease from which the patient 
is suffering, but their wish is to investigate that 
disease, to trace it to its cause, to discover what favours 
it, what destroys it. The aim of these hospitals is 
higher ; so, of necessity, is their " cost per bed." One 
hospital is attempting to destroy the disease in the 
patient ; the other is doing this, and is also trying to 
eradicate the disease from the community altogether, 
to stamp it out of existence, just as tubercular disease 
of all kinds is being stamped out by those hospitals 
which are energetic enough and independent enough 
to establish an Opsonic Department. These hospitals 



MODERN ADMINISTRATION 239 

must have their Bacteriological Laboratories, Clinical 
Laboratories, Pathological Laboratories, Physiological 
Laboratories, Sterilizing Rooms, etc. All these 
adjuncts to Research require a large staff and 
expensive material. It will be one of these hospitals 
which will give to the world one of these days the 
discovery of the cause of cancer. 

And here I may draw attention to a statement 
which is often made — namely, that the work of the 
cheap hospital must be as good as that of an expensive 
hospital, because the " death-rate " of both is the same. 
Now, it is a curious fact that the death-rate at most 
hospitals is about one in ten of the patients admitted, 
but perhaps, from what has been said above, it will 
be seen that the death-rate is not the only test or 
measure of a hospital's work. The condition of the 
90 per cent, who do not die would perhaps be a better 
test, if taken, say, five years after they left the hospital. 
I will go further and say that the hundreds of happy 
people who never have to go to a hospital at all may 
actually owe their good fortune in this respect to the 
good work which these hospitals are doing in discovering 
and spreading the principles of hygiene. 

Further, the comparison between the various hospi- 
tals by the " cost per bed " method is misleading, in 
that some of them are much more than houses for the 
cure of sick people, more than establishments for the 
investigation of disease. They are also schools whereat 
the future physicians and surgeons of this country are 
being trained for their hfe-work. It may be said that 
to train medical men is no part of a hospital's work. But 
where else can they be trained if not at the hospitals ? 



240 THE LONDON HOSPITAL 

It is true that those hospitals which have schools 
attached are more costly than those without, although 
the increase in expenditure is not wholly due to the 
presence of the students, but largely to the energetic 
policy of the board which has attracted the students. 

There is yet one other reason which has made it 
misleading to compare the cost of the hospitals in the 
way mentioned. This is, that there is no standard 
as to the degree of " brotherliness " with which the 
sick and injured poor should be treated. Hospital 
boards have different views on this matter. Some, 
perhaps — one hopes they are few — would regard the 
sick poor man as little more than a damaged machine, 
to be mended as cheaply and as quickly as possible. 
Such a board, if it carried out its views logically, would 
dispense with the services of a chaplain. Change of 
diet would be considered unnecessary, flowers in 
the wards an extravagance. Expenses of cleaning, 
of lighting, of nursing, would be reduced to a minimum. 
There may be other hospital boards who go to the 
opposite extreme, and may treat patients in a way 
wliich, coming from the homes some of them do, may 
not be entirely appreciated. Somewhere between 
these extremes is the right line to take, and the 
King's Fund, in comparing the expenditure of the 
most important London hospitals in all their depart- 
ments, has been of service to the various boards in 
their attempt to decide where this line should be 
drawn. 

But while it may not be advantageous for the public 
to compare one hospital with another, the comparison 
by a hospital's officials of that hospital's expenditure 



MODERN ADMINISTRATION 241 

at different times is one of the most important duties 
of those officials who are anxious to prevent waste. 

There are two things to be borne in mind in 
controlling expenditure : Firstly, the method of buying 
must be sound — to insure this is not very difficult ; 
secondly, the methods adopted to prevent waste must 
be sound — the devising and carrying out of these 
methods is extremelj^ difficult. 

The whole secret of hospital economy lies in a keen 
appreciation of the importance of these two points. 

I will deal with the question of general administra- 
tion first, and of buying and the prevention of waste 
when each department is considered. 

As to general administration : The Hospital is the 
property of the governors. A governor is a subscriber 
who gives 5 guineas a year, and he is a governor as 
long as he continues to pay his £5 5s. a year. A life 
governor is a donor of 30 guineas. Courts of governors 
are held quarterly, and at these Courts the whole 
of the administration of the Hospital is decided. At 
the Courts all appointments to the Medical and Surgical 
Staff are made, and also the more important lay 
appointments. At the Courts, too, resignations are 
received. 

The Courts are responsible for all standing orders, 
and none of the Hospital's capital may be touched 
but by their permission and authority. Should the 
Charity be incorporated, the Court sanctions the use 
of the Corporation Seal to all documents. 

At the last Court of the year — the December Court — 
is chosen the House Committee for the following year. 
The House Committee consists of thirty governors. 

16 



242 THE LONDON HOSPITAL 

They sit weekly, and at their first sitting after their 
election in December choose their own chairman for 
the year. The whole Medical and Surgical Staff, 
too, are re-elected every year at the December 
Court. 

It is the duty of the secretary to bring before the 
House Committee at their weekly meeting all that has 
transpired during the week which it is of importance 
the committee should know. The ideal secretary — 
I have never met my ideal — must use considerable 
judgment in what he brings before committee. He 
must be able to recognize what are the most important 
things. He must draw attention to the principles 
involved in a certain course of action, and where such 
and such a course may lead to. He must be abso- 
lutely fair in reporting facts. A shrug of the shoulders 
may damn a man. He must have no personal Ukes 
and dislikes. That is the ideal secretary. The ideal 
chairman is a man who is so enthusiastic in hospital 
work that he inspires all those with whom he comes 
into contact with the same zeal. A man for whom 
it is a delight to work, a man who leads, not 
drives. 

The Weekly Committee reports to the Quarterlj?- 
Court all that has transpired during the last three 
months. The Court approves or refers back for further 
consideration. 

If the hospital is a small one — say of 250 beds — 
the House Committee can keep all departments under 
its direct management. If a large hospital — say of 
700 to 900 beds — it is wiser for the House Committee 
to appoint from among its members certain sub- 



MODERN ADMINISTRATION 243 

committees which will give more detailed attention 
to the different departments and report to the House 
Committee. Thus at the London Hospital we have : 

The Nursing Committee. 

The Steward's Committee. 

The Estate Committee. ' 

The Surveyor's Committee. 

The Dispensary Committee. 

The Theatres Committee. 

The Out-patient Committee. 

The Accounts Committee. 

The Finance Committee. 

The Hospital is divided into certain departments, 
each having its head. Each head of a department 
reports to the secretary anything in his department 
which is not routine. He would also report to his own 
subcommittee, who would deliberate. The minute- 
books of the subcommittee are delivered to the secre- 
tary, who brings them before the House Committee. 
The danger of this system is that the subcommittees 
work as units, and their work may clash with or overlap 
the work of another subcommittee. It is the duty of 
the secretary, who has a bird's-eye view of all, to guard 
against this, before the matters come before the House 
Committee, if possible. 

Some reference should now be made to the depart- 
ments and their heads. 

MATEON'S DEPARTMENT. 

The Matron is head of the Nursing Department, 
and is over all female servants — scrubbers, ward-maids, 
Jjousemaids, and laundry-maids. At the London 

16—2 



244 THE LONDON HOSPITAL 

Hospital the number of nurses, including those engaged 
on the Private Staff, is, at the time of writing, 780. 
The responsibihty of engaging such a staff and of 
maintaining its efficiency is enormous. The London 
Hospital is fortunate in having the services for nearly 
thirty years of a lady known throughout the Hospital 
world for her marvellous powers of organization, and 
her lofty ideas as to the attributes of a true nurse. 
Miss Liickes, an old friend of Miss Florence Nightingale, 
has for all these years worked quietly and patiently, 
and unselfishly, for the betterment of nursing and the 
betterment of nurses. I see in the minutes, from week 
to week since her appointment, suggestion after sug- 
gestion for improvement. Every suggestion that was 
ever carried out by the committee has been a con- 
spicuous success, and not one single one has ever been 
rescinded, hardly even modified. 

The Matron sees personally every candidate who 
wishes to enter the Hospital as a probationer. If, after 
medical examination, such a candidate is approved, 
a date is fixed for her to commence her course of seven 
weeks' preliminary training at Tredegar House. Here 
she is taught Sick-room Cookery, Bandaging, Ambu- 
lance Work, and Elementary Hygiene. Then she comes 
into the Hospital itself for a trial month. If approved, 
she signs a four years' agreement to serve the Hospital. 
For the first two years she is a probationer under 
training. If suitable, she receives, at the end of two 
years, her certificate, and, after a month's holiday, 
commences her last two years as a fuUy trained nurse. 
This is to repay the Hospital for the expense of training 
her. She receives salary from the day she takes up 



MODERN ADMINISTRATION 245 

her Hospital duties — namely, £12 for the first year, 
£20 for the second, £25 for the third, and £26 for the 
fourth. If she becomes a Sister in charge of a ward, 
she receives from £30 to £40 ; if she serves on the 
Private Staff, she receives from £30 to £45, and more 
under certain conditions. In order to encourage long 
service, she is given an increase of £5 after six years, 
and another increase of £5 after twelve years. She 
is well treated as to holidays. 

If she stays eighteen years, she is eligible for a full- 
pay pension for life. [j 

The training does not merely consist of her spending 
two years lolling about the Hospital, learning what- 
ever chance may bring in her way. Every day of the 
two years is most carefully planned out, so that she 
may get a share of male nursing and female nursing, 
of surgical nursing and medical nursing, of adult 
nursing and of children's nursing, of day nursing and 
of mght nursing. Definite courses of lectures are 
given and times for study classes allowed. Examina- 
tions follow the courses of lectures on medical nursing, 
surgical nursing, general nursing, physiology, and 
anatomy. The examinations are carried out by an 
examiner from outside, who has no connection with 
the Hospital. 

A separate bedroom is provided for each nurse, 
and there are spacious sitting- and writing-rooms, 
and an excellent library. 

In the summer, thanks to the kindness of the 
Tilbury Steam Lighterage Company, nurses who are 
off duty are taken several times a week on one of the 
company's tugs for trips to the mouth of ,the river. 



246 THE LONDON HOSPITAL 

These water-picnics are always looked forward to and 
enjoyed. 

With regard to the expenditure in cleaning, and the 
number of scrubbers engaged, it must depend upon the 
Hospital's " standard of cleanliness," and upon the 
traffic in the corridors and wards. If the Staff visit 
in the morning, which is not the rule in London, the 
cleaning can be done in the afternoon. If the Staff 
visit in the afternoon, the cleaning in some hospitals 
has to be done at night ; it cannot be done in the 
morning, because the wards and corridors are then 
crowded by students, and by porters with their troUies, 
distributing stores. Night cleaning is more expensive, 
both because a charwoman working at night must be 
paid a higher wage than a day woman, and also 
because it is necessary to employ artificial light. The 
scrubbers should be under supervision of a Sister or 
Housekeeper, who would give cut to each her supply 
of soap, soda, etc. This Sister would obtain her 
supply from the stores, as the ward Sisters do. The 
cost of cleaning, when once the standard has been 
fixed, can be checked and kept stationary. As a 
hospital is the meeting-place of all the sick and dirty 
people of the neighbourhood, I would advise that the 
standard of cleanliness should be a very high one, 
certainly much higher than is usually adopted for an 
ordinary dwelling-house. 

Under the charge of the Matron, too, is the laundry. 
Here is treated by efficient machinery all the Hospital 
washing, amounting to 60,000 " pieces " per week. 
The laundry is one of the best equipped in London, 
and we have been often complimented by managers 



MODERN ADMINISTRATION 247 

of commercial laundries who have visited it. The 
comfort of the seventy-five employes is carefully con- 
sidered. They are paid good wages, and are given 
good food, and their surroundings as to hght and 
ventilation delight the heart of the Government in- 
spector. It pays a large hospital of, say, 500 beds 
to have its own laundry. Where careful accounts 
have been kept, it was found that 60,000 pieces a week 
could be washed at a cost of about £100, which includes 
the cost of depreciation of machinery and interest on 
the building. The account for a week may be of 
interest : 

Salaries and wages per week 

Food (dinners, luncheons, milk) 

Materials : Yellow soap, 240 lb. ; washing- 
powder, 640 lb. ; soda, 7 cwt. ; starch, 
110 lb. ; borax, lOJ lb. ; blue, 3 lb 
turpentine, 1 gallon ; disinfectants 

Electric light and power . . 

Coal for boilers 

Water 

Interest on outlay and depreciation, say — 



The Matron is responsible for the buying of bedding 
and sheeting, uniforms, towels, hnen, etc. The ex- 
penses under the heading of bedding are largel}'' 
affected, not only by the number of beds occupied, but 
also by the number of patients the Hospital puts through 
each of its beds per annum. This number varies at 
different hospitals from twelve to twenty, and is cer- 
tainly a point to be borne in mind when the " cost per 
bed " is discussed. The expenditure in hnen and bed- 
ding is also affected by what one may call the " standard 



£ 


s. 


d. 


.. 40 


9 


11 


.. 13 


13 


6 


g- 






h, 






.. 12 


12 


lOJ 


.. 4 


5 


2 


.. 21 


7 


6 


1 


15 


6 


5 








99 


4 


74 





248 THE LONDON HOSPITAL 

of cleanliness " which the hospital adopts. Tliis is 
by no means the same at all hospitals. I have seen 
sheets in use at one hospital which would not be 
tolerated at another. The following is a fair allowance 
of bedding for each bed at a general hospital : Eight 
sheets, four draw-sheets, 4 blankets, 6 pillow-cases, 
two feather pillows, two counterpanes. It is, of course, 
important that an exact inventory of the bedding of 
each ward and room should be taken periodically — 
say once in six months. 

STEWARD'S DEPARTMENT. 

The steward is responsible for the engagement and 
good behaviour of the porters. He, too, has to do 
with the buying of meat, milk, bread, flour, and house 
coal (but not steam coal), fish, poultry, grocery, and 
provisions ; stationery, hardware, and crockery. The 
following notes on the system of buying may be of 
interest : 

Meat. — Tliis, like all other provisions, is bought by 
tender. Tenders are issued every six months. Firms 
wishing to compete should be approved by the 
Steward's Committee before being allowed to do so. 
It is quite sufficient to allow four or five firms of good 
standing to compete. Open contracts cause waste of 
time in correspondence and in examination of samples. 
The meat most suitable for a hospital is — 

{a) For Patients. — Best American refrigerated beef : 
thick flanli, rounds, middle ribs, shins and lean beef 
for beef-tea, kidney suet. Best New Zealand mutton : 
legs and mutton-chops. 



MODERN ADMINISTRATION 249 

(b) For Officers, Nurses, and Servants. — As for 
patients, but with the addition of fresh pork, fresh veal, 
New Zealand lamb. 

The tender forms must state that the meat is to be 
delivered as required every morning early, and should 
include the usual terms to be signed by the contractor 
— namely, that the buyer may cancel the agreement 
if the goods are unsatisfactory, and may purchase 
elsewhere, charging the contractor with the cost. The 
delivery each day must, of course, be checked by the 
steward or storekeeper as to weight and quality. It 
may be pointed out in passing that a stone of butcher's 
meat weighs 8 pounds, not 14. 

Fish. — This, too, is bought by tender. The fish 
most suitable for hospital use are plaice, fresh haddock, 
turbot, brill, and lemon sole. The tender form should 
state that the fish is to be delivered daily as required ; 
that heads, tails, roe, and offal are to be removed, and 
the fish is to be cleaned ready for cooking. The same 
penalty for unsatisfactory delivery must be imposed 
as for meat, and this applies to all contracts for pro- 
visions. 

Poultry. — Chickens are the only poultr}^ used in 
the hospital. The tender should specify that the 
fowls should weigh about 2 pounds each when trussed 
and ready for cooking. Hospitals which cater for 
Jewish patients will have to make a second contract 
for meat and poultry — i.e., for Kosher meat and Kosher 
fowls. These are more expensive than the ordinary. 

Bread and Flour. — The tender form should state 
that the bread shouM be of the best wheaten flour, 
well baked, and made into loaves weighing about 



250 THE LONDON HOSPITAL 

IJ pounds each. Long loaves, square in section, are 
the most economical. It must be perfectly cold before 
delivery. The flour should be the best wheaten and 
the best Vienna self-raising. Bread will, of course, be 
delivered daily. 

Grocery. — This form includes tenders for rice, 
tapioca, sago, arrowroot, sugar, pearl barley, coffee, 
cornflour, and aU other grocery requirements of the 
doctors, nurses, and patients. 

Vegetables. — Those used in Hospital are potatoes, 
carrots, onions, turnips, and greens. Tender forms 
should state that the vegetables must be clean and 
free from dirt, that the greens should have the stalks 
and outside leaves removed, and should be free from 
undue moisture. 

Milk. — The percentage of fat and the total solids 
must be specified in the tender. Mlk should be 
examined daily on delivery as to proper quantity, and 
daily as to percentage of fat. ]\Iicroscopic and chemical 
analysis should be conducted periodically. It should 
be delivered in sealed churns. The contractor should 
supply a list of the farms from which his milk is ob- 
tained. The medical officers of the districts where 
these farms are situated should be communicated with, 
telling them that the hospital is obtaining milk from 
that district, and asking that he would give special 
attention to the condition of the surroundings. 

Coal. — The colliery should be specified in the tender, 
and a certificate should be demanded from the colliery 
from time to time, stating that the coal is being duly 
supplied. The coal should be selected on the advice 
of a chemist, as the result of proper analysis conducted 



MODERN ADMINISTRATION 251 

with a view to obtain its calorific power, percentage of 
ash, etc. 

The prices for coal are affected by the hospital's 
storage capacity. Most hospitals unfortunately must 
have the coal delivered daily. 

Furniture, Hardware, Soap, etc. — These should 
be bought by haK-yearly contracts. Soap should be 
bought to sample. All samples of soap should be 
carefully examined for the percentage of water they 
contain. It wiU often be found that the cheapest 
is by no means the least costly. 

Stationery. — This should be bought by annual 
contract. Each department should provide the secre- 
tary, steward, or other official with a sample of each 
book and printed form used, and the numbers likely 
to be required. Stationery is stored by the steward, 
and given out to the departments once a week, on 
written orders being given. 

Now as to the methods adopted to prevent waste. 

That the prevention of waste is the more important 
part of the work of the officials will appear when it is 
noted that to buy well is useless if stores are frittered 
away by lax systems in the hospital itself. One must 
be continually checking a tendency towards extrava- 
gance, which will creep into the hospital, as it will into 
any institution in which some hundreds of people are 
at work, and when individual carelessness can be so 
easily overlooked. Luxuries become conveniences, 
and conveniences necessities. 

As to checking waste in provisions. A system 
which very much affects the expenditure in provisions 
should be mentioned first — namely, that most hospitals 



252 THE LONDON HOSPITAL 

have what is known as a diet table. This is a table 
of the various diets which are intended to meet the 
requirements of patients in different illnesses, and in 
different stages of their illness. These diets are 
revised by the Medical Staff periodically, about every 
five years, and it is most important that the steward 
should sit on these revising committees. Few medical 
men, few men of any profession, are familiar with the 
cost of food, and consequently the diets may be drawn 
up without regard to cost. On the advice of an expert, 
such as the steward ought to be, in the price of foods, 
the cost of a diet may often be lessened by some slight 
modification without in any way depreciating its value 
as a food. The difference of a penny in the cost of a 
diet per day will amount to some hundreds of pounds 
a year in our large hospitals, with their five or six hun- 
dred occupied beds. 

The following is a sample of a diet sheet : 

DIET TABLE. 

LONDON HOSPITAL. 

Milk Diet.— {a) Milk, 1 pint, (6) or 2 pints, (c) or 
3 pints, [d] or 4 pints.* 

Diet No. 1. — (a) Bread, 8 ozs. ; fried or boiled fish, 
10 ozs. ; milk, 1 pint ; pudding ; green vegetables at 
discretion. For supper soup, or ^ pint of milk, or 
cocoa, or porridge, or gruel. (6) is as (a), but with an 
extra pint of milk or one egg.'f 

Diet No. 2. — {a) Bread, 10 ozs. ; potatoes, 8 ozs. ; 
cooked meat, 4 ozs. ; milk, 1 pint ; pudding ; green 

* Milk costs about 9d. per gallon, 
t This diet costs about 4|d. 



MODERN ADMINISTRATION 253 

vegetables. For supper, as in Diet No. 1. (6) is as 
(a), but with an extra pint of milk or one egg.* 

Diet No. 3. — Bread, 12 ozs. ; potatoes, 8 ozs. ; meat, 
6 ozs. ; milk, 1 pint ; pudding ; green vegetables. For 
supper, as in Diet No. l.f 

Diet No. 4. — Bread, 10 ozs. ; potatoes, 8 ozs. ; meat, 
6 ozs. ; or fish, 10 ozs. ; cooked bacon, 4 ozs. ; milk, 
2 pints ; pudding ; green vegetables. (Jews are allowed 
two eggs instead of bacon.) For supper, as in Diet 
No. l.J 

Extras Allowed. — The following extras may be 
added to the diets if it is felt that the patient's con- 
dition requires them : Beef -tea or mutton-broth ; 
extra eggs or milk, chicken, rabbit, bacon, fruit, ale 
or stout, cream, beefsteak, mince, wines or spirits. 
All orders foi extras lapse on Wednesdays — diet 
day — and will not be served unless re-ordered by the 
doctor. Orders for wines and spirits must be renewed 

every three days. _ _ 

'^ "^ By Order. 

It will be noticed that at the end of the diet table 
is a list of extras which the Staff are allowed to order 
for cases wliich require some further feeding than is 
provided by the regular diets. This is the usual 
arrangement at most hospitals. It is these extras 
which are the source of much leakage unless carefully 
watched. It is so very natural for a kind-hearted 
resident doctor to put a poor patient on bacon or 
chicken, " because No. So-and-so has bacon or chicken." 
Moreover, in the rush of hospital work, it is likely to 
happen that a patient who is on an " extra " will 
continue to have it long after he really needs it — the 

* This diet costs about 4|d. f This diet costs about 5|d. 

X This diet costs about 8Jd. 



254 THE LONDON HOSPITAL 

result of oversight on the part of the doctor, who is 
not, as a rule, present in the wards during meal-times. 
Therefore the necessity for the rule that these extras 
should lapse automatically. The secretary or steward 
should visit the wards on diet day with a view to noting 
whether the rule has been complied with. My ex- 
perience is that doctors err, not from intention, but 
from pure oversight. It is only fair to explain to the 
Staff what is the value of each of the diets, and of the 
extras, and I have invariably found them most ready 
to co-operate in reducing unnecessary expenditure in 
tliis direction. 

Each ward should keep a diet-book, which should be 
written up every evening by the Sister in charge. 
This is a summary of the particulars as to diets on each 
of the patient's presciption papers hanging at the bed- 
head. These ward diet-books should be delivered to 
the steward every morning, and the requirements 
analyzed by him, and entered into a book known as 
the " steward's diet-book." Tliis book serves two 
purposes : it is the guide to the chef as to the amount 
of beef, mutton, chicken, vegetables, etc., which he 
is to cook and deliver to the wards (he is allowed 31 
to 37 per cent, loss on meat in cooking), also to the 
storekeeper as to the amount of bread, milk, beer, etc., 
which he is to serve out. From this book, too, the 
steward compiles his weekly diet returns. This should 
show at a glance the cost of each ward in diets and in 
diet extras. 

It is more economical for the dinners to be carved 
by expert carvers in the kitchen, and delivered to the 
wards in hot-water tins, than to send down joints to 



MODERN ADMINISTRATION 255 

be carved in the wards. They are then served on to 
the patients' plates from the hot - water tins in the 
ward itself. It is more economical for two reasons : 
First, the carving itself is performed with less waste 
than if performed by ward Sisters, who cannot be ex- 
pected to be expert carvers ; and secondly, the bones, 
if they have never entered the ward, can be used for 
making stock. Bones returned from a ward can only 
be thrown away. It is a mistake for nurses in the 
wards to give large slices of bread to patients ; it is 
generally left, and is then wasted. 

There are many provisions which must be supplied 
to the ward which are not included in the diets, such, for 
instance, as tea, cofiPee, butter, sugar, arrowroot, etc. 
These should be ordered by the ward Sisters from the 
storekeeper on slip-forms. These orders are filed, 
and once a week are entered by the steward into the 
" steward's provision book " ; and from this the 
weekly cost of each ward, of the residents' quarters, 
and of the nurses' home, and of the servants, can be 
obtained, for such provisions as are not included in the 
official " diets." 

THE ESTATE DEPARTMENT. 
The Estate Committee superintends the manage- 
ment of the hospital's estate, if it is lucky enough to 
have one. It superintends repairs, collection of rents, 
and recommends the granting of leases. 

THE SURVEYOR'S DEPARTMENT. 
The Surveyor is responsible for the structural 
repairs and additions to the hospital buildings. Under 
him are the engineers, electricians, blacksmiths, stokers, 



256 THE LONDON HOSPITAL 

and labourers. He buys the steam coal, and should 
do so under arrangements similar to those by which 
the house coal is bought. He should arrange for 
a weekly examination of meters, both gas and 
electric. 

The amount of coal consumed will largely depend 
upon the system of heating in vogue. If by hot-water 
pipes, it wiU be less than if by open fireplaces. Most 
hospitals are warmed by both systems — the wards by 
one, and the corridors by the other. The amount of 
coal consumed in the furnaces for the boilers must be 
carefully recorded day by day. No automatic stoker 
can be compared with a good man who knows liis 
work. The difference in the amount of coal used by 
a good and bad stoker is astonishing, and, as a rule, 
the very fact that the consumption is being carefully 
watched makes the bad stoker try to improve. As 
to that part of the hospital which is heated by fires, 
the amount of coal and coke conveyed to each ward 
must be noted and careful firing encouraged. 

THE DISPENSARY DEPAKTMENT. 

It is the duty of the chief dispenser to purchase 
drugs, chemicals, and dressings. He also is responsible 
for the engagement of dispensers, and for the proper 
supply of medicines to in- and out-patients. As to 
purchasing : 

Drugs, Dressings, Chemicals, Wines, and Spirits. 
— These should be bought by half-yearly contracts 
from approved firms by the Dispensary Committee, 
a committee composed of members of the weekly Board 
and of the Medical and Surgical Staff of the hospital. 



MODERN ADMINISTRATION 257 

Samples should be delivered a fortnight before the 
committee sits, to enable the chief dispenser to analyze 
or carefully examine them, that he may be in a position 
to advise the committee. Drugs and chemicals are 
much more subject to market variations than pro- 
visions, and the advice of the chief dispenser should 
be followed if he suggests the postponement of certain 
purchases. 

The chief dispenser's most important and difficult 
work is the checking of waste in the dispensary. 

Drugs and Chemicals. — Every hospital has its 
own pharmacopoeia — a book containing formulse of 
repeatedly ordered mixtures, pills, liniments, etc. It 
is intended to save the physician's time in prescribing. 
Instead of having to write out a long prescription for 
each patient, he simply orders the mixtures by the 
names they are known by in the Hospital Pharma- 
copoeia. The dispenser will understand and dispense 
accordingly. This book is analogous to the diet table 
in the Steward's Department, except that in this case 
the formulae run to some hundreds. 

These formulse, like the diet tables, are revised 
periodically, and it is the duty of the chief dispenser 
to be of service to the revising committee as to the 
cost of the formulse suggested, and also (and this is very 
important) as to the keeping properties of the mixtures 
— important, because most out-patients take away 
medicine for a week at each visit. Care in respect 
to both of these points will save the hospital some 
hundreds of pounds a year. 

I should like to say very emphatically that the more 
of its medicines a hospital makes, and the fewer it 

17 



258 THE LONDON HOSPITAL 

buys, the more it will save. It is cheaper for the 
hospital to buy crude roots, barks, leaves, and seeds, 
and with them make its own tinctures and infusions, 
ointments, lozenges, and tablets, than to buy out- 
side. 

Every dispenser knows the tendency of young 
doctors to try all sorts of advertised remedies. This 
tendency should be judiciously checked. If the 
doctor does not know the formula of some patent 
medicine he is ordering, he has no right to prescribe 
it. If he does know the formula, he should write it 
so that it may be dispensed in the ordinary way in the 
dispensary. As a matter of fact, he should be allowed 
to prescribe only — 

{a) Medicines described in the British Pharma- 
copoeia. 

(a) Medicines described in the special Pharma- 
copoeia of the Hospital. 

(c) Medicines described in a list, revised quarterly 
by the staff, of newly-discovered remedies. 

It may happen that certain commonly-used medi- 
cines rise at times to a fabulous price. The chief 
dispenser must report this, and it may be necessary for 
the Dispensary Committee, on his advice, to withdraw 
a drug or medicine from use on the plea of non possu- 
mus, until the price has fallen. Notice of such with- 
drawal should be sent to each member of the Staff at 
once. 

A cause of waste in the Out-patient Department is 
that patients sometimes have to attend for weeks, if 
not months, and gradually their prescription books 
accumulate quite a long list of various medicines. 



MODERN ADMINISTRATION 259 

Pills are ordered one week, liniment is added another, 
lotion another, then a gargle. The temptation of 
the young doctor, to avoid wading through pages 
of back prescriptions, is to put Rep. omnia (Repeat 
everything), and to let the dispenser do the search- 
ing, under the impression that the patient will say 
what he wants. The patient always wants omnia. 
Once having had a gargle, he will always want it. This 
custom must not be allowed. The rule should be 
insisted upon that the doctor must write down exactly 
what he wishes the patient to have at each visit, 
and dispensers must be authorized to refuse any 
other kind of order. 

Another possible leakage in the dispensary which 
must be guarded against is the tendency of dispensers 
to give too large a quantity to out-patients. The 
temptation is to give patients a few extra cough 
lozenges, a little extra hniment, because " the doctor 
said I might rub my arm as well as my leg, and take 
a lozenge whenever I liked." The dispenser knows 
quite well that he did not say so, but, to save long 
discussion, gives the extra. Dispensers must dispense 
exactly what is written, and no more. If the prescrip- 
tion says the lozenges ter die sumendi, he must count 
twenty-one, and no more. The trouble is that these 
tendencies grow, unless they are constantly checked ; 
and if, at a hospital where the out-patient attendances 
run into hundreds of thousands, every patient is 
given a little extra for the sake of peace, a £2,000 
drug account will jump to £3,000 for no apparent 
reason. 

With regard to the medicines sent to the wards for 

17—2 



260 THE LONDONi HOSPITAL 

in-patients, the very natural tendency of the dispensers 
is to send too large a quantity of each prescription 
ordered, specially if the prescription is somewhat 
difficult to dispense. In the wards patients are seen 
daily, and medicines are repeatedly changed. Small 
supplies, therefore, should be sent, or the waste in a 
large hospital through medicines being thrown down 
the sink will be enormous. 

There will be things required from the dispensary 
by the wards other than the patients' prescriptions — 
such, for instance, as stock bottles of various lotions, 
turpentine, stock ointments, glycerine, etc. These 
should be ordered by the Sister of each ward in an 
order-book day by day, and from these order-books the 
dispenser writes up his returns for the " dispensary 
sundries," supplied to each ward week by week. 

Dressings and Bandages. — It is not necessary to 
dwell with any detail upon the special pitfalls into 
which, with a mistaken notion of economy, a chief 
dispenser is likely to fall in buying dressings. Suffice 
it to say that in dressings, almost more than in any- 
things else, the lowest price is not the most economical. 
Bandages may be bought so cheaply, and be so common, 
that a dresser uses two or three instead of one, and they 
can be so flimsy as not to stand washing, and can 
therefore be used once only, whereas a good bandage 
can be washed and used two or three times. A cheap 
lint will run six or seven yards to the pound. One 
costing 50 per cent, more wiU run to double the length. 
Gauzes, bought in 100-yard lengths, are quoted at 
most alluring prices, but may be so light in weight 
that the dresser uses ten thicknesses instead of five. 



MODERN ADMINISTRATION 261 

Against all this sort of thing the wise dispenser will be 
very much on his guard at contract time. 

As to the Out-patient Department, not much in the 
form of dressings is used : lint, boric lint, and bandages 
are the most important items. It used to be the 
custom to keep a pile of lint on the dispensary counter 
already cut, and, whenever lint was ordered on a 
prescription a piece of this lint was given. The 
dispenser, with a long line of patients waiting at his 
window, had no time to make inquiries as to how 
much was likely to be required. To-day lint is kept 
ready cut as before, but in three sizes : (a) is a piece 
only a few inches square, (b) is larger, and (c) is the 
largest, and is about 18 inches square. The surgeon, 
on ordering lint for a patient he has examined, must 
state whether (a), (b), or (c) is to be given. This, of 
course, refers to dressings which the patient has to 
apply at home. 

As to bandages, it has already been shown that 
cheap, thin bandages are wasteful. But a cheaper 
bandage than is used in the wards can be used in the 
Out-patient Department, because out-patients can 
never be depended upon to wash their bandages, so 
they need not be of that fine quality which is necessary 
to withstand repeated washing. 

Coming to the in-patients, all dressings are ordered 
daily for each ward from the dispensary (in the same 
way as are all other ward requirements), and from these 
the dispenser prepares his weekly dressing summary. 

One word as to the Dispenser's Store - rooms. 
Everything delivered from the manufacturers must 
be entered in, although it must not be put away into 



262 THE LONDON HOSPITAL 

stock until examined and passed by the chief dispenser 
himself ; also nothing must be allowed to leave the 
stores unless a voucher is received. 

The dispenser should attempt to keep the cost of 
in-patients and of out-patients distinct. 

THE THEATRE DEPARTMENT. 

The Theatres Committee and the theatre supervisor 
are responsible for the management of the operating 
theatres, the purchase of instruments and appliances, 
the steriHzation of material used in operations, and the 
engagement of the Theatre Staff. 

Instruments. — Orders for instruments are sent at 
irregular intervals. As new instruments are constantly- 
being invented, requests from surgeons for these are 
made from time to time. If the instrument is below 
a certain value, the order is written in the surgeon's 
order-book, and this book and all other order-books 
are sent from the various departments every week to 
the secretary to be examined by him, and laid before 
the board. If the required instrument is of greater 
value than £5, the order must be initialled by four 
surgeons. This rule is intended to check the too 
ready ordering of every instrument that is put upon 
the market. The " life " of surgical instruments is 
much longer if they are carefully looked after, and it 
is wisest to make one man responsible for certain 
cabinets of instruments, of which an inventory must 
be taken periodically. It is surprising how few in- 
struments are lost, even in a very large hospital, by 
making the individual responsible. It is important 
to have the name of the hospital clearly stamped upon 



MODERN ADMINISTRATION 263 

each instrument, the chance of loss by theft being by 
this rule reduced to a minimum. Someone must be 
responsible for the instruments in the wards and in the 
Out-patient Department. It pays a large hospital 
to have a skilled instrument mechanic in its employ, 
responsible for all sharpening and minor repairs, and 
for the examination of all instruments after use in 
the theatres. He should overhaul all instruments 
allowed in the wards as stock, at least once a week, 
and see that they are kept thoroughly in order. By 
this means it is insured that no mishaps occur during 
an operation through a faulty instrument. 

Instruments are not purchased, as a rule, by tender. 
They are usually required suddenly and singly, and 
have often to be specially made. 

The responsibility of the theatre supervisor in super- 
intending the all-important work of the sterilization 
of material has been mentioned, and need not be again 
referred to. We have two assistants for each theatre, 
one senior and the other junior. The junior is re- 
sponsible for the rougher work — the cleaning. The 
senior is responsible for the instruments, " cleans up " 
before an operation, and acts as an assistant in passing 
proper instruments, threading needles, etc. 

THE OUT-PATIENT DEPARTMENT. 

The Out-patients Committee manages the very 
important part of a hospital's work — the Out-patient 
Department. The system of treating out-patients varies 
at different hospitals. At the London Hospital it is as 
follows, to summarize what has previously been said : 

There is first of all a sieve, called the "Receiving- 



264 THE LONDON HOSPITAL 

Room," through which every patient who enters the 
Hospital must pass. It is open night and day, and is 
under the charge of seven senior quahfied men, called 
"receiving-room officers." These men decide what is 
to be done with a patient. They have nothing to do 
with his social position. They may act in one of three 
ways, according to the urgency of the patient's 
condition. 

L A very minor ailment is given one treatment and 
sent away. They may not treat a case twice in the 
receiving-room for the same ailment. 

2. A more serious case is referred to the Out-patient 
Department for more thorough examination. Such 
a case would be referred to a physician or surgeon, or 
to one of the specialists who attend for diseases of the 
throat, ear, nose, eyes, skin, teeth. 

3. More serious cases are recommended for imme- 
diate admission. 

When patients in Group 2 arrive at the Out-patient 
Department, they have to pass the inquiry officer, 
and satisfy him that their relief by a charity is justifi- 
able. If passed, they see the medical officer to whom 
they have been recommended. They then pass the 
almoners, whose duties have already been described, 
and at last, on their way out, receive their medicine. 
A patient on his first visit is known as a " new case." 
Afterwards, as he comes up week by week, he is an 
" old case." Only new cases have to pass the inquiry 
officer and almoner. 

Men are always seen first, in order that they may get 
back to work. Women afterwards. 

Every patient who can afford it pays 3d. for a week's 



MODERN ADMINISTRATION 265 

supply of medicine. There are exceptions to this 
rule. Children do not have to pay. If advice only 
is given, there is also no charge. No patient who is 
out of work pays. No patient sent up by an outside 
practitioner pays. After all these deductions, it is 
found that about half the patients who attend pay 
3d. a week. The total value of these payments is 
about £2,000 a year, and enables the Hospital to treat 
more cases who cannot pay at all than it otherwise 
would. 

THE ACCOUNTS DEPARTMENT. 

The Accounts Committee sits quarterly, and ex- 
amines all accounts before payment. Each invoice 
must be initialled by the head of the department, 
to signify that the goods have been received, and that 
the price is correct. 

It must, of course, happen that many articles have 
to be purchased during a quarter which are not in- 
cluded in any contract, articles the demand for which 
is small, or the use for which was unforeseen. All 
such articles are entered week by week in the order- 
books, which are kept by the heads of departments. 
These books are dehvered to the secretary weekly, 
and are submitted to the House Committee. 



THE FINANCE DEPARTMENT. 

The Finance Committee advise on questions of 
investment, sale, and purchase of stock, loans on 
mortgage, etc., and generally report to the House 
Committee on the financial position of the Hospital. 



266 THE LONDON HOSPITAL 

THE MEDICAL AND SURGICAL STAFF, 

Something should be said as to the rules observed 
by the Medical and Surgical Staff. 

Each surgeon has a colleague — an assistant-surgeon. 

Each physician has an assistant-physician. 

Each physician or surgeon, after twenty years' service 
as such, retires, and his place is usually filled by the 
senior of the assistant-physicians or assistant-surgeons. 
Thereby a vacancy is created in the assistant staff, 
and all newly appointed officers come on to the 
assistant-staff first. 

The physicians and surgeons — the full staff — attend 
on three days a week. They do not see out-patients. 
They have the care of about sixty beds each. 

The assistant-physicians and assistant-surgeons — 
the assistant-staff — also attend on three days a week. 
They see out-patients on two of these days, and they 
have also twenty beds each for in-patients. If a 
member of the assistant-staff, while seeing out-patients, 
desires to admit a case, he admits into his own or his 
senior's beds. He may not pick out his cases. He 
is bound to admit in strict rotation, three cases to his 
senior and the next to himself. 

A physician and his assistant-physician are spoken 
of in hospital language as "a firm " ; and so is a 
surgeon and his assistant-surgeon. Each " firm " has 
a house-physician or a house-surgeon, as the case may 
be, who is resident in the Hospital, and who takes 
charge of his chief's cases in the intervals between the 
visits. Every house-physician and house-surgeon must 
see his cases twice daily. The visiting-staff are pledged 



MODERN ADMINISTRATION 267 

to see every case once a week, and as many times 
oftener as may be necessary. 

The " firms " are on " full duty " in rotation for 
half a week each. When members of a " firm " are 
on full duty (and the time comes round in about 
seventeen days), they must be in constant telephonic 
communication with the Hospital, and be ready to 
come at a moment's notice, night or day. The member 
of the staff on full duty would be always called in the 
case of a patient admitted directly to the beds from 
the recei\ang-room. They spend most of their time 
at the Hospital in their half -week on full duty. It 
is common for the surgeon or assistant - surgeon 
on full duty to be called to the Hospital two or 
three times during a night to operate on a case of 
emergency. 

The students act as clerks to the physicians, and 
have to make full notes of every case and of its family 
history. The students also act as dressers to the 
surgeons. They go round with the staff at each visit 
and receive instruction — how the physician or surgeon 
is led to his diagnosis, what is the treatment, and what 
is the prognosis. This bedside teaching comes after 
the student has spent two years at the Medical College 
attached to the Hospital, where he has received syste- 
matic instruction in chemistry, biology, anatomy, and 
physiology. As some 15,000 in-patients are treated 
annually and about 250,000 out-patients, the value of 
the London Hospital as a school of medicine can hardly 
be exaggerated. Every student will probably see 
there hundreds of cases such as he will only see in 
isolated instances when he goes into private practice 



268 THE LONDON HOSPITAL 

during the rest of his life. He will certainly not in 
private practice see a disease for the first time after 
spending five years at " The London." 

SECRETARY'S DEPARTMENT. 

In the secretary's office all accounts are kept, and 
these must be kept according to the system laid down 
by the King's Fund. The bills paid are analyzed, and 
the items classified under certain fixed headings. Thus 
the expense of each hospital, under the headings of 
provisions, dispensary, domestic, salaries, etc., can be 
compared. 

As a rule the secretary is responsible for the collec- 
tion of new subscriptions, but this is not so at " The 
London." 

In this chapter I have quoted largely from a paper 
written by me, at the invitation of the King's Fund 
to all hospital secretaries, on " The Management of a 
Voluntary Hospital." 




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CHAPTER XV 

THE FUTURE OF VOLUNTARY HOSPITALS* 

When we were young we were probably troubled by a 
mathematical master, full of curiosity, whose great 
quest in life was to know what would happen to a 
billiard-ball if it were acted upon by different forces at 
various angles at the same time. His question used 
to take this form : " If an object be acted upon by 
three forces of X, Y, and Z pounds respectively at angles 
of 25 degrees to each other, what will be the direction 
in wliich the object will move, and what will be its 
velocity ? " He usually added a few extras in the way of 
friction and so on, for those who were more advanced 
in solving these riddles. 

He illustrated his meaning by always talking of 
billiard-balls. A great deal of paper was used in 
working out these problems, and the answer seemed 
insignificant when compared with the amount of brain- 
power and ink used in arriving at it. Personally, when 
giving in the answer that the object would move with 
a velocity of so many feet per second along the diagonal 
of such and such a parallelogram, I was never quite 
sure in which direction along that diagonal it would 

* I have quoted freely from a paper read before Hospital 
Officer's Asssociation. 

269 



270 THE LONDON HOSPITAL 

travel — to me or from me. The answer, therefore, 
could have been of no real use. 

In trying to discover what is to be the future of 
voluntary hospitals, we must work out some such 
problem. The modern voluntary hospital is the object — 
the billiard-ball. The object appears to be acted upon 
by four forces. They are : 

1. The sick poor, who cannot afford the treatment 
they require to restore them to health necessary to 
make them useful members of the community. 

2. Generous people, who are willing to pay for such 
treatment for others. 

3. The medical men, who provide the skilled 
treatment. 

4. Medical students, who must use the hospitals as 
educational centres. 

These are, I think, the only forces of any importance 
which are acting upon the modern voluntary hospital. 
They are not all acting in parallel directions. That 
is to say, they are not all pushing in exactly the same 
direction, nor yet in exactly the opposite direction to 
one another ; they are acting at an angle to each other. 
Each influences the others. The direction in wliich the 
object will go depends upon the force of each, and upon 
the angles between them. It will not move in the 
same direction if any one of these forces be removed. 
That is the sum. And here is the first difficulty — that 
these four forces are changing so rapidly that they alter 
in direction and force almost while we are doing the sum. 

Our guide as to how they are changing is to look back 
and note how they have changed. 

First as to the sick poor. 



FUTURE OF VOLUNTARY HOSPITALS 271 

We have seen, while considering the foundation and 
early history of St. Bartholomew's Hospital, that those 
who received the charitable help of the Hospital were 
poor men and women who were of the very lowest 
type ; they were the outcasts, waifs and strays, 
tramps and vagabonds. When Henry VIII. seized 
St. Bartholomew's, the City merchants appealed to 
him to return it to the City, because they objected to 
this riffraff dying on their doorsteps. In the old 
inmates of our own Hospital there is the constant 
reference, half pitiful, half contemptuous, to the 
" miserable objects." This was characteristic of those 
old days — the wide gulf which existed between the 
nobles and the serfs, the rich merchants and the gutter- 
drabs. There were only two classes. The rich, who 
could pay ; and the destitute, who could not — the 
" miserable objects " of absolute charity. Now this 
gulf has been gradually bridged over. Fine social dis- 
tinctions have sprung up, and the growth of these social 
distinctions has reacted upon the system for the 
treatment of the sick. The class which the hospitals 
used to treat are now treated in our Poor Law In- 
firmaries. The hospitals now treat a class higher than 
was intended when they were founded. 

What do we often see in the sick poor to-day ? A 
person who by no means looks upon himseK as a 
" miserable object." He is probably a member of 
some Trade Union. He joins associations to resist 
the power of Capital. He is perhaps a Sociahst. He 
has his own Member of Parhament. He does not 
accept favours ; he claims rights. His tendency is to 
claim free healing, as he claims free education for his 



272 THE LONDON HOSPITAL 

children, and free Old Age Pensions. I am not 
speaking of individuals, but of some of the character- 
istics of the modern poor as a class. 

Further, the " sick poor " of our modern hospital is 
often a person who is not poor except to meet sickness. 
He cannot possibly afford the heavy expenses of modern 
methods of treatment, whether medical or surgical, so 
he has gradually drifted to the hospitals, where such 
skilled attention could be had for the asking. 

He came at first with some diffidence, but tliis is 
passing. He accepts the state of things as he finds it. 
The necessity of laying by for sickness, or of insuring 
against sickness, becomes less and less. He takes jree 
relief in sickness into consideration when making up 
his budget. In many cases he expects free attention 
for his wife during her confinement, although the event 
was long foreseen, and should have been provided for 
by thrifty saving. 

This class of sick poor is quite different from the 
class of individuals who take their blessings as a rigid. 
He has simply grown used to the existing state of 
things, and accepts them without any thought at all. 
He, too, is no " miserable object." 

For his existence the hospitals are themselves largely 
to blame. They have assisted to make liim what he is. 
They have said, " This struggling shopkeeper, this poor 
City clerk, cannot possibly afford the skilled attention, 
surgical and nursing, for the operation, say, for 
removal of appendix or for gastric ulcer ; we must 
help him." And they did right in helping liim. But 
were they right in doing much more than help him ? 
Was it wise to provide also free food, free medicine, 



FUTURE OF VOLUNTARY HOSPITALS 273 

free warmth, free light, free service, and afterwards 
probably a free holiday at the seaside in a convalescent 
home ? I do not wish to be misunderstood. I am 
not saying that all hospital patients are of these types. 
But hospitals should have modified their rules in 
assisting such people. They should have instituted 
some form of payment or part-payment. From the 
very position of the London Hospital there are prob- 
ably fewer of this kind than at many hospitals, for ' ' The 
London " stands in a district of poverty and squalor, 
and the distress which haunts the " casual." Of course, 
at every hospital there are hundreds of patients who 
have made a fine but losing fight before they asked for 
the hospital's help. Every hospital secretary will 
remember a case when he would have bitten his tongue 
out rather than have said what he did, not knowing all. 
As he gets older he takes longer before he decides to 
condemn. I should here like to quote a paragraph 
from a paper by Miss Marion Elliston on the poor of 
the East End. She is speaking of the casual labourer. 

" Follow the programme of the day as it is being 
spent now by hundreds. The man gets up about four, 
or possibly five, according to the distance of his first 
work-seeking destination. There may be some strain- 
ings of long-stewed tea left from last night, and possibly 
a crust of dry bread. Equally possibly there may be 
neither. He sets out with it, or without it, as may be. 
If you do not know, it is well to imagine as realistically 
as you can the taste of November air at five or six in 
the morning to an unfed man. Also the feeling inside 
which it quickly creates. He joins the waiting crowd 
outside the docks or labour-yard of his special calling. 
The ' call ' passes him and most of the others. They 

18 



274 THE LONDON HOSPITAL 

melt away to another yard, or some point where the 
road is ' up.' And on and on, from one labour-selling 
point to another. At last the man ceases to be con- 
scious of his hunger. His gait grows slower. But he 
slouches doggedly, gazedly on, half-stupefied with his 
emptiness of food and liis fulness of fog. Possibly he 
may happen on a cigarette-end in the gutter. A mate 
will supply the light. It eases the internal discomfort 
somehow. Still he goes on with that dull, dead, un- 
hoping tramp after a vague, indefinite 'Job.' That 
may continue all day, and many days in succession. 
Its only likely variation is that a mate in like plight, 
but not yet quite without a coin, may ofEer him ' a 
drink ! ' Blessed drink ! The penny paid for it buys so 
much — the ungrudged right to a corner of a bench ; 
the ungrudged right to the warmth of the bar-room 
fire ; a sense of satisfiedness ; and a dispelled taste of 
swallowed fog. You buy a great deal for a penny 
spent on beer if your feet have been carrying all your 
weight for hours and hours ! Some days those of us 
who love temperance, and long for it, will set to work 
seriously at making available at the same cost as much 
of comfort without intoxicants. But we have been 
too occupied with talking about ' doing away with 
drink ' to achieve it yet. 

"At last the day ends, and the man reaches home 
again. Then comes a crucial moment. Such a man 
reached home after such a day last week. A wife and 
several little ones were waiting for him to come. There 
was no food. There was no fire. He dropped from 
sheer exhaustion, and from sheer exhaustion cried as 
his little children were doing. It happened so often 
that there seemed to the mother nothing left to pawn 
but — the shoes the little girl was wearing. The boys' 
had gone before. And the ha'pence lent on the Httle 
girl's shoes secured a few lumps of coal and some bread 



FUTURE OF VOLUNTARY HOSPITALS 275 

to be divided between them. All the bedclothes, too, 
had gone. Nothing remained but two stuffed sacks. 
Then to-morrow began again to carry forward the 
work of deteriorating the man — of killing all the good 
within him. : .j 

" In another home the wife was watching for her 
husband to come home. She explained that he had 
been out all day yesterday — first up to Wliitechapel, 
and thence to Dartford and Ilford, home again to 
Plaistow, without a moutliful to eat. Weeping as 
she went on : ' And I hadn't a mouthful to give him 
then, so we went to bed, and this morning he went 
out again with nothing. I thought I must make sure 
of something for him this evening, so Tommy (the little 
boy) went up to Stratford Market and gathered up 
some of the cabbage-leaves dropped in the loading of 
the carts. The fire has burnt out, but I just managed 
to boil them ready while it lasted.' She showed me the 
plate of cold, wet-looking cabbage waiting to be a 
man's first meal in two days ! For herself — a neigh- 
bour had given her a cup of tea ; no, she hadn't had 
anything to eat ! And there was nothing left to pawn ; 
but it used to be the nice little four-roomed home of a 
boiler-engineer !" 

A large number — perhaps nearly all — of the patients 
who find their way to " The London " are just of this 
class. To help such is a dehght. It is the duty of the 
authorities to see that their charitable assistance goes 
to such, and not to the unworthy. 

But I do not think these legitimate cases should 
blind our eyes to the changes which have taken place 
in the character and the status of the sick poor as a 
class since our hospitals were founded. 

Now we come to the changes in the second force — 

18—2 



276 THE LONDON HOSPITAL 

the generous- minded donors, the financial supporters 
of the hospitals. 

This force is changing because of the changes which 
have taken place in the first — the sick poor. 

Most hospital secretaries will own that to keep up 
their subscription lists becomes a harder and ever 
harder struggle. 

The fact is that the old appeal to the pity of the 
public is of less avail than it used to be. I do not think 
people are less tender or sympathetic than they used to 
be, but their pity does not, as it used to do, run in the 
direction of hospitals. There is a suspicion that they 
treat cases with which the rich givers have no sympathy. 
Most secretaries have received letters from former 
subscribers withdrawing their support because of the 
unpleasant attitude taken up by " the working man." 
One of the most forcible letters I ever had of this kind 
was from the late Mr. Bischoffsheim, within a few weeks 
of his death, pointing out that the average working 
man was taking such keen interest in himself, with his 
Workmen's Compensation Acts, and so on, that it was 
hardly to be expected that his hated rival, the financier 
and capitahst, should longer subscribe to his well- 
being. He took so much that little was left to be given. 
Though Mr. Bischoffsheim wrote this, he never acted 
on it, because his generosity and kindness were un- 
bounded, as is that of Mrs. Bischoffsheim ; and only a 
short time before he wrote this letter he and she had 
distributed £100,000 amongst charities to celebrate 
their golden wedding. I only quote this as typical of 
a new line of thought amongst thinking men. 

Yes, the appeal to pity is losing power ; other appeals 



FUTURE OF VOLUNTARY HOSPITALS 277 

have to be made. We point out that the old institu- 
tions of the monastery order existed chiefly for the poor 
to die in, but now these modern hospitals exist to restore 
men to their work ; we point out what an asset to the 
nation a modern hospital is, when by modern methods 
the " average residence " comes down, and the wage- 
earner returns to his family, not in sixty days, but 
twenty. 

Our appeal falls flat when we are told that what 
probably happens is that the patient leaves the 
hospital a potential, if not actual, striker, and that 
many incomes of employers have fallen 25 per cent, 
on account of the uncertainty of labour. 

I cannot but foresee a gradual lessening in effective- 
ness of Force 2, because of the changes which are taking 
place in Force 1. 

Now we come to the third force — the Medical Staff. 

I note that for long after the foundation of the 
Hospital the staff sat on the committee. They were 
themselves most liberal subscribers to the charity, as 
liberal as any of the laymen, and they gave their 
services as medical men as well. I cannot see what 
they gained in the early days by being attached to the 
Hospital. There were no students. They were not 
allowed to teach such private students who might come 
with them in their visits on hospital cases. If they 
wished to lecture, they had to bring their patients as 
well as their students. They were forbidden entirely 
to admit cases in which they were personally interested 
into the beds. They had letters of recommendation 
exactly as had other Governors. 

Now all this is changed. A man, if he aims at con- 



278 THE LONDON HOSPITAL 

sultant practice, must be on the staff of some well- 
known hospital, anci the vacancies on the staff of any 
hospital could be filled ten times over if necessary. 
The piiblic have just discovered — and they think them- 
selves rather clever— that it pays a man well to be on 
the staff of a hospital. From a former state of 
adoration for the man who gave his services to the sick 
and suffering, they have gone to the other extreme, 
and fancy that every hospital doctor is very much 
" on the make." This view is as unworthy and untrue 
as extreme views always are. A man may not — he 
certainly does not — join the medical or surgical staff 
of a hospital for charitable reasons, but that is no reason 
that he should not be a most charitable man when he is 
on the staff. His work will push him in the direction 
of charity. We all know what a valuable asset to our 
voluntary hospitals is that noble es'prit which is so 
difficult to define, but which marks off the voluntary 
hospital so distinctly from the average Poor Law 
Infirmary. We all know the doctor or surgeon who 
works for the poor, and often the grumbling poor, with 
no regard for hours, and who makes many a voluntary 
journey to his hospital, far beyond his legal obligations, 
for reasons of pure sympathy and large-hearted 
humanitJ^ How often I have seen a member of our 
staff called down at midnight to see some case just 
brouglit in, and have noted that he came again volun- 
tarily at 3 a.m. or 5 a.m., just to make sure that no more 
could be done. He did not mention it next day. It 
only appeared in the night gate-porter's report : 
*' Mr. A. arrived at 12, left at 1." " Mr. A. arrived at 
3 a.m., left at 3.30." 



FUTURE OF VOLUNTARY HOSPITALS 279 

This valuable spirit in the voluntary hospitals is of 
such ethereal nature and delicate growth that one 
dreads to tamper with the present conditions of hospital 
life for fear ot killing it. 

Undoubtedly the " kudos " of being on the staff of a 
well-known hospital is immense. The opportunity of 
meeting students, the future general practitioners who 
A\'ill need to call in consultants, is of the greatest 
importance. The great benefit to the man himself, so 
far as his own experience is concerned, is obvious. 
The possibilities of his work, too, have changed for the 
better. He is now assisted in his researches by expert 
bacteriologists working in finely-equipped laboratories, 
and ready to prepare antitoxins for every infection. 
Another expert scientist works in the Chnical Labora- 
tory, and to him is handed over the duty, performed in 
a more or less rule-of-thumb method by the old phy- 
sicians, of examining urine, stomach contents, speci- 
mens of sputum, or of counting blood corpuscles. Many 
other specialists assist him. 

Obviously the conditions of the Medical Staff have 
changed. % 

We have considered three forces. Already we can 
see the direction that the billiard-ball is likely to move. 
All are benefiting by the hospital, the rich and the 
poor. The hospitals do infinitely more good than they 
did a hundred years ago, and infinitely more than their 
founders ever dreamt of. Dives and Lazarus are both 
benefited, although Dives may never enter its walls. 

There is one force more — the medical students. This 
is a comparatively new force. It has become one of 
great power and importance. It affects, as we have 



280 THE LONDON HOSPITAL 

seen, the third force— the Medical Staff— strongly. The 
presence of that most pertinacious critic, the medical 
student, is the cause of much of the high quality of the 
work in the hospitals. You must k7ioiv when you talk 
to a student ; you must not think. He wants to know 
all about causes, not simply about effects ; about the 
disease, not simply about its symptoms. His presence 
acts as the " fierce light " that beats on all the surgeon 
does. If we can rightly measure all these forces, we 
shall know whither the voluntary hospitals are moving. 

What is the ideal ? Let me try to describe an ideal 
hospital — a hospital where only those are treated who 
really and truly cannot afford to pay for such treatment 
themselves ; where all patients who can afford to pay 
something will do so, disdaining to accept the whole 
if they can pay in part — disdaining, at any rate, to 
accept the hospital's charity habitually, and to lean 
entirely on charity. Such men will, as a matter of 
course, join sick clubs and provident dispensaries, and 
the hospital will co-operate with these as consultants. 
Subscribers, knowing that their gifts are wisely and 
honourably dispensed, will be more willing to help. 
The nation, recognizing that the work is national, good 
for the country as well as for the individual, will be 
wilhng to help, but in such a way as not to emasculate 
the generous giver, be he milHonaire or working-man, 
and doing nothing to interfere with the hereditary 
characteristic and individuality of each hospital, nor 
to hamper in its help by red tape. And the Poor Law 
should co-operate. 

The present lack of sympathy between the Poor 
Law and the hospitals is as serious as it is foolish. 



FUTURE OF VOLUNTARY HOSPITALS 281 

Every hospital official knows how irritating are the 
difficulties when a patient has necessarily to be trans- 
ferred from the wards to a Poor Law infirmary. If an 
out-patient is sent to the infirmary, via the Relieving 
Officer, that patient is almost certain to turn up at 
the hospital again in the course of two or three days. 

The hospital's work in saving men and women from 
being a burden on the rates by giving them timely 
assistance is enormous. I asked one of our physicians 
to give me a list of cases which came under his care as 
the result of unhealthy surroundings or ignorance. 
Here it is : 

Rickets, infantile diarrhoea, scurvy, phthisis, anaemia, 
tubercular diseases of hip and other joints, chronic 
throat diseases, scabies, favus, impetigo, pedicuh, many 
skin diseases, many eye diseases, curvature of the spine, 
and some heart disease. 

All of these cases the hospital helps to keep at work, 
and it is not fair that the hospitals should be saddled 
with all the expense of these " long time " cases 
brought about by their unhealthy surroundings and 
conditions of work, without any help from the 
Guardians of the Poor, whose duty towards the poor 
the hospitals are helping to carry out. 

If the voluntary support goes on decreasing, there is 
nothing for it but the hospital to close bed by bed, and 
ward by ward. No one can exaggerate the magnitude 
of such a disaster. It would be far greater than that 
we should merely cease to admit sick persons suffering 
from this or that disease, great as that would be. It 
would mean that we should be ceasing to fight that 
disease as a disease. Hospitals are misused rather 



282 THE LONDON HOSPITAL 

than abused. There must be part-paying beds to 
stop this misuse. There must be some more efficient 
system to stop the abuse. We have been told at the 
London Hospital by the Charity Organization Society, 
which at our request investigated the matter, that we 
ought to spend at least £1,000 a year on almoners. 
How can we spend £1,000 a year on this ? It would 
keep twelve beds the whole year through, through each 
of which eighteen patients pass ; 216 poor people 
restored to health ! Somebody ought to pay it, per- 
haps, but the Hospital cannot afiford to. 

I think State aid will come ; I hope not State control. 
The State aid should be so rendered as not to free the 
supporters of the Hospital from their responsibility. 
It might be done by adding a percentage to the sub- 
scriptions, or by an annual grant dependent upon the 
quality of the work as reported on by a trained 
scientific Government Inspector. 

In London and large towns I should like to see the 
formation of a department or office to supervise in 
some new way the public health of the poor. This 
department should bring into line by authoritative 
powers the voluntary hospitals, which should still be 
voluntary, and the Poor Law Infirmaries, which should 
still be rate-supported, and, like the voluntary hospitals, 
eligible to receive State aid. 

By this department officers should be appointed as 
"■ public almoners," and these should act as almoners 
both to the hospitals and the Poor Law, and to such 
an officer all applications for charitable medical relief, 
other than accidents or sudden illness, should be made. 

These officers should be numerous, and their offices 



FUTURE OF VOLUNTARY HOSPITALS 283 

easily found. Their offices should carry a conspicuous 
and distinctive sign, such as a red cross. This officer 
should have the power, with certain modifications as to 
the sort of illness, of sending a patient direct to the 
infirmary, if he can pay nothing, or to the hospital if 
he can pay something, and yet cannot afford all that 
is needed to complete his cure. He could refuse to 
send the patient either to hospital or infirmary should 
he consider it a case to be treated by a private doctor. 
He should also be able to send a case to the parish 
doctor (or medical man of similar status). These 
parish doctors should be much increased in numbers, 
and be assisted by a State grant, and be independent 
of the Guardians. They should treat patients in the 
patients' own homes. Paying beds at the voluntary 
hospitals should be much increased, and could be under 
such conditions. They cannot now. The authorities 
could admit a better class of patients to those at a 
charge which would pay all expenses, and yet be far 
under the exorbitant charges of some of the present 
so-called Nursing Homes. 

The Governors of voluntary hospitals should have 
the right to admit "request " cases should they wish 
to — patients recommended by supporters of the 
charity. 

At the risk of being thought a sentimentalist, I feel 
strongly that the individuality of our hospitals is such 
an important feature in obtaining the best help and 
work that I think it should be maintained. Financially 
it is important, because, as I have already noticed, 
certain families attach themselves to a hospital, and 
support it generation after generation ; for instance, in 



284 THE LONDON HOSPITAL 

the case of the Buxtons and the London Hospital. 
Less important subscribers, too, take a special pride 
in the hospital of their choice ; they interest themselves 
in its history, and watch its career \vith affection. 
This advantage would be lost if all hospitals were forced 
into one mould by some central governing body. 
With the voluntary staff, this individuahty of the 
hospitals is of still more importance, and it would 
be lost were they all painted the same monotonous 

grey. 

Country hospitals should be dotted round and well 
outside all large towns. These should be fed by motor 
ambulances by all the town hospitals, and to these 
country hospitals all cases should be transferred as 
soon as possible. 

I am no believer in the theory that wounds are 
adversely affected by town air in these days of aseptic 
surgery. Wounds heal in towns just as well as any- 
where else in the majority of cases. Everyone knows, 
however, what an immense help it is to a patient if he 
can convalesce in a change of air. The after-effects of 
a serious illness are much reduced. 

The Out-patients' Departments of all hospitals should 
decrease. They should become more and more of con- 
sultative use, for specialists' work and for slight 
operation cases. The parish doctors, by the almoners' 
advice, should do most of the casualty work. 

Of course, these alterations would necessitate 
alteration in the present system of medical education. 
The student to-day gains more information of practical 
use, it is said, in the Out-patient Department, where 
small ailments are treated, than in any other part of 



FUTURE OF VOLUNTARY HOSPITALS 285 

the hospital. But such ailments must be treated 
somewhere, and there the student must go. 

These are the things I wish, and some of which I 
see ahead for our hospitals. By some such system the 
general poor will still be assisted, while the misuse of 
the hospitals by the thoughtless, and the abuse by the 
thriftless, would be, I think, prevented. 



CONCLUSION 

Whatever may be the future of " The London " and 
other voluntary hospitals, nothing can rob them of their 
glory for the work they have done. They got on with 
the work while others were discussing. England is 
a great deal richer for them. As for our own Hospital, 
readers who have been patient enough to read this 
little gossiping history to the end will, I think, pardon 
us in that we are proud of the fine, ugly old place. 
We are proud of its fighting power against disease and 
death. We are prouder still of a certain spirit that 
exists in it, and which pervades its workers — a spirit the 
existence of which, as I have said, is as easy to recognize 
as it is difficult to define, and which has been often re- 
ferred to in these notes. This spirit exists not only in 
" The London," it is in St. Bartholomew's, and St. 
Thomas's, and Guy's, and in all hospitals with a history. 
It has something to do with the voluntary system., for 
the spirit is not the spirit of " the hireling." It is 
somewhat akin to the affection of a schoolboy for his 
school, and an undergraduate for his college, though 
in a hospital this affection is intensified, because the 
workers are mature men and women, whose work brings 
them habitually face to face with the more earnest 
and solemn sides of life. 

286 



CONCLUSION 287 

The merriest houseman at dinner to-night will, if 
necessary, before the morning comes, run any risk 
imaginable to save a Whitechapel gutter-duck. He 
will not think of the risk, nor would any of his colleagues, 
A diphtheritic child may cough in his face as he 
examines it, but that will not in the least hinder him 
from continuing his examination. A filthy wound 
may poison him as he dresses it, but he will dress it ; 
and should he succumb, as has happened, through the 
absorption of the poison, another man would, as a 
matter of course, take on the duty, and another, and 
yet another, if necessary. These men would be 
amused, and probably a little disgusted, if such action 
were called heroic ; they would be the last to admit 
any heroism. The spirit of " The London " expects 
nothing less, and the matter rests there. There are 
no mottoes on their bedroom walls, nor does one notice 
uplifting platitudes in their speech, but " The London " 
has always obtained the service she demanded. 

Have you ever been round a great hospital in the 
night ? There is no glitter nor pomp. The students 
have all gone home. Everything is in dead earnest, 
and everyone who is up has something to do. Let 
us go now, and into the Receiving-room first. The 
room happens to be free from patients, but that peace 
will soon be broken. The " night-up " Receiving-room 
Officer is having a quiet smoke, and is wishing for the 
morning. A nurse comes down from one of the wards 
with a message. No. 7 Royal has been taken seriously 
worse, and can hardly live until the morning : can the 
relatives at Brixton be told ? Not easy to get a 
message through to a back-street in Brixton at two in 



288 THE LONDON HOSPITAL 

the morning. But long experience has taught the night- 
porter a wrinkle. The constable on point-duty outside 
is unofficially told all the facts. He strolls, or gets a 
comrade to do so, unofficially, to the nearest police- 
station. The particulars are unofficially telephoned 
to Brixton Police-station, and shortly a constable will 
be, unofficially, patrolling that little back-street, and 
will manage to let those relatives know that it would 
be wise to hurry to the Hospital. I hope I have not 
given away any of our good friends the police in 
stating this. I know they have no business to do us 
this favour. But many a husband has been in time 
to say good-bye to his wife or child through their 
unofficial kindness. 

We will leave the Receiving-room, and go over to 
the Isolation Block. This is the Diphtheria Ward. 
There are screens round a Uttle cot. That means 
failure. The Uttle one has passsed. There is the mother 
talking to night-nurse. She is not crying. She is 
talking calmly, and is holding a doll. She is leaving 
now ; she says she will come up in the morning. Nurse 
will tell us aU about it. Yes, it was the mother, and 
her Uttle girl has just died. She came in three days 
ago. A sweet little mite, with fair hair, and beautifuUy 
clean. Her mother earns 4s. a week stitching sliirt- 
buttons. This is her only child — aU she has in the world, 
in fact. The mother had always hoped some day to 
be able to buy her a doU, but had never been able. 
When the child was admitted, we gave her an old doll 
to play with, and she always cuddled it up. She died 
cuddling it. Yes, the mother was asking whether we 
could possibly spare her the doll now. 



CONCLUSION 289 

Let us go on. This is a medical ward for men. 
That young fellow near the door — he is only twenty-two 
— is on the " dangerous list." His name is at the gate, 
and friends may see him at any time, night or day. 
The old lady at the bedside is his mother ; she is sitting 
up with him. Sister is beckoning us. She explains 
that she is in a difficulty. That old woman sitting 
by her boy is separated from her husband. They 
have not seen each other nor spoken to each other for 
twenty years. They both love the boy, but they never 
meet. One visits the Hospital on Wednesdays, the 
other on Sundays. But the boy is much worse to-night, 
and Sister has let them both know. The mother has 
arrived iirst. See, the door is opening — a white-haired 
old man. It is half -past two — one wonders how he came. 
Sister says that is the father, so we will move on. 
Here is a child who is not asleep. Sister says that 
nothing is wrong. He is going to Pevensey to-morrow, 
to a little cottage provided by one of our surgeons 
for convalescent children. He is very excited, that's 
why he cannot sleep. He has never seen the sea. 
His ward-mate, aged nine, went a week ago ; he, too, 
had never seen the sea. It was a rough night when 
he arrived, and the sea was running high. In the 
morning it was a great calm. Tommie had gazed in 
amazement, and then said : " Now then, who's been 
and done that ?" We turn to leave the ward. Near 
the door we entered by we notice an old couple on 
opposite sides of a bed ; they are both looking into the 
face of a young feUow of twenty-two, who seems to 
be dying, and it needs no lamp to see that he is smiling. 
They are holding his hands, and each other's. 

19 



290 THE LONDON HOSPITAL 

This is the theatre floor. There are six theatres 
here. One is fully lighted up, you see. Something 
is going on. An assistant explains that the police 
brought the case in an hour ago ; he was picked up un- 
conscious near the docks. Found on examination by 
the Receiving-room officer — ^we thought he would not 
be smoking long — to have a serious abdominal wound, 
a stab undoubtedly. The " full duty surgeon " was 
sent for at once, and is now " doing his best." Seven 
men have been called up to assist, and each has his 
definite duty, and would be missed if he were not there. 

This is one of the obstetric wards. In that bed that 
is empty a woman died yesterday. She was only 
twenty-four. She had been in hospital a fortnight. 
Her husband was a young fellow about her own age, 
and he worshipped her and she him. Sister managed 
to get them properly married a week ago. The patient 
had asked that it might be so. When she died, her 
wedding-ring was her greatest treasure. Yes, they 
were together when she died. 

It is six o'clock now. You notice the Receiving- 
room has several patients waiting. Men have dropped 
in as they went to work. That man is one of our own 
gardeners ; he has been here thirty-four years, and has 
learned a few things. What is he doing in the Re- 
ceiving-room ? He is speaking to the officer, and 
explains that he is suffering from a " tired feeling " 
— it has only just gone six — and suggests that the 
officer would be doing a kind thing to a " brother 
officer, as it were," if he would just write a slip to say 
that " the gardener required rest " ; he could then take 
the paper to the Steward and all would be well. The 



CONCLUSION 291 

Receiving-room oflficer, who was not appointed yester- 
day, examined his " brother officer " carefully, and 
feels, on the whole, that light exercise is indicated 
rather than rest. What sort of light exercise ? " Oh, 
just roU the tennis lawn for one hour each day before 
breakfast." 

We will look in at the children before we end our 
round. This is a surgical children's ward — much more 
cheerful than the medical. The convalescent children, 
who are running about, are excellent nurses. Here is 
a committee of four, telling each other fairy-tales 
apparently. One is telling the others that when she 
goes to heaven she intends to have a tea-party. 
Florrie and little Dick and ]\Iinnie shall all be invited, 
and Jesus will pour. One hopes, as I heard a good 
man once say, that she may be spared from going to 
heaven for many a long day. 

We return to the secretary's quarters. This photo- 
graph in the secretary's office, you will notice, is signed 
by the Queen. She is the president, and is often in the 
Hospital. She sent that picture to one of the patients. 
His was a horrible case, and he was fearful to look on. 
But the Queen pitied him, and often spoke to him. 
He died here . . . 

I never go round the Hospital at night but I picture 
the shades of the great dead walking the long corridors 
and down the great wards. Blizard, with sympathetic 
and admiring eyes, may be found any night in one 
or other of the silent theatres, never weary of studying 
how to get " 98 per cent, of first intentions." Harrison, 
too, I have seen there often. Dr. Andree, the benevo- 
lent physician, may be found near the Clinical Labora- 

19—2 



292 THE LONDON HOSPITAL 

tory and in all the medical wards, and the temperature 
charts are a never-ending source of interest and delight 
to him. Batson, that stickler for columns and figures, 
and tables and averages, may be found in the Regis- 
trars' Room and in the Statistical Department, wearing 
an eternal smile, for his highest fhghts of fancy have 
been exceeded. 

And everywhere throughout the Hospital, wherever 
pain is and any trouble, you may surely meet the good 
and gracious Rev. Matthew Audley, who walked its 
corridors and visited its bedsides " during forty-nine 
years, carrying all kinds of consolation." 



CHRONOLOGY OF THE LONDON 
HOSPITAL 



1740. At a meeting of the Feathers Tavern, Cheapside, it was 
decided to " begin the Charity on One Hundred Guineas." 
House in Featherstone Street taken. Register of Patients 
commenced. Set of Rules drawn up. 

Mr. Fotherley Baker elected Treasurer. 
Dr. Andree elected first Physician. 
Mr. John Harrison elected first Surgeon. 
Mr. Josiah Cole elected first Apothecary. 

1741. Charles, Duke of Richmond and Lennox, elected first 
President. 

Mr. Thomas Boehm elected Treasurer. 

Mr. Richard Neale elected first Secretary. Banking Account 
opened with Mr. Frank IVIinors, Lombard Street. Treasurer 
and Chairman alone were authorized to admit patients between 
the sittings of the Committee. Patients were, as a rule, ad- 
mitted once a week by Committee only. The Lifirmary 
moved to Prescot Street, Goodman's Field, one house being 
taken at £25 per annum. First student entered, Mr. Godfrey 
Webb, an apprentice of Mr. Harrison. A woman to act as a 
nurse engaged at £14 per annum. Rev. Matthew Audley 
acted as Honorary Chaplain, and was made an Honorary 
Governor. Decided that Lady Subscribers of Five Guineas 
be made Governors, and might vote by proxy. Decided to 
hold a House Committee weekly, to be elected by the Governors 
quarterly. 

1742. Annual Festival first held. Mr. John Harrison raised ques- 
tion of a Charter. Second House taken in Prescot Street. 
Decided that all Peers might vote by proxy. 

Mrs. Elizabeth Gilbert elected Matron of one of the houses 
at Fifteen Guineas a year, and to provide her own diet. 

293 



294 THE LONDON HOSPITAL 

Mi"s. Ann Looker appointed Matron of original house, and 
discharged same year. 
Mr. Godfrey Webb elected Apothecary. 

1743. Funds started for affording a capital " in readiness for any 
extraordinary emergency." Committee of Accounts first 
formed, which still sits. Decided to appoint an Assistant 
Surgeon. 

Mrs. Elizabeth Broad elected Matron (died same year). 
Mrs. Joanna Martin elected Matron. 

Dr. John Coningham elected Physician Extraordinary, and 
desired to attend once a week. 
Mr. William Petty elected Surgeon Extraordinary. 

1744. Mr. Richard Chiswell elected Treasurer. Admission to be 
by Governor's letter only. Physicians and Surgeons only 
have power to admit patients who require immediate relief. A 
Lint Scraper engaged. The addition of three more houses in 
Prescot Street decided upon. Mr. Godfrey Webb resigned. 
Steward first appointed at £20 per annum. 

Mr. Henry Dodson elected Assistant Surgeon. 
Mr. Boon appointed Apothecary. 

1745. Mr. Joseph Hawthorpe chosen Treasurer. 

1746. Sir James Lowther, Bart., elected Vice-President. Mr. 
Peter DuCane elected Treasurer. Mrs. Elizabeth Gilbert 
(Matron) died. Mr. Boon (Apothecary) resigned. 

Mr. Thomas Shield elected Apothecary. 
Mr. Walter Jones elected Surgeon Extraordinary. 
Dr. James Hibbins elected Assistant Physician. 
Mary Gony elected Matron. 

1747. George Jennings elected Treasurer. Decided to look for a 
site for new hospital to be built. Influential Jews asked for 
information as to how to found a Charity similar to the London 
Hospital. 

1748. Various sites for new hospital examined and reported on. 
Dr. James Hibbins elected Physician. 

1749. Mr. Peter Muilman and Mr. Daniel Booth appointed Joint 
Treasurers. 

Dr. John Coningham died. 

Dr. John Sylvester elected Physician. 



CHRONOLOGY OF LONDON HOSPITAL 295 

1750. William, Dake of Devonshire elected President. 
Mr. Daniel Booth elected Treasurer. 
Mr. Richard Neale resigned Secretaryship. 
Mr. William Trotter elected Secretary. 
Mr. Richard Grindall elected Assistant Surgeon. 

1752. Lease of the premises at Whitechapel from the City drawn 
up. Foimdation Stone of new building laid by Sir Richard 
Warren, October 15. Mr. Henry Dodson died. 

Mr. Grindall appointed Surgeon. 

Mr. Gabriel Risoliere and Mr. Henry Thomson appointed 
Assistant Surgeons. (Mr. Henry Thomson was the teacher 
of the future great Surgeon, William Blizard. ) 

1753. Mr. Robert Grosvenor elected Treasurer. Sum of money 
left to the Hospital for the assistance of poor patients on their 
leaving the Hospital, Mr. John Harrison died. Mr. George 
Neale elected Surgeon. 

1754. Bishop of Oxford urged that there ought to be Divine 
Worship at the Hospital on the Lord's Day. Governors com- 
menced to purchase the Estate around the Hospital. Mr. 
John EUicot (the famous clockmaker) served on the Com- 
mittee. 

1755. Mr. John Dupre elected Treasurer. Rule made that no 
patient might remain in Hospital more than two months. In 
building of the Hospital, bricks were made from the clay found 
on the Estate. This was afterwards abandoned, as the clay 
was foimd unsuitable. 

1756. Chaplain appointed at £100 per annum, to live within a 
quarter of a mile of the Hospital. Rev. Matthew Audley, who 
had been hitherto Honorary Chaplain, became first Paid 
Chaplain. First notice of Jews being systematically treated 
in Hospital. They were allowed 2f d. a day in lieu of meat. 

1757. Mr. James Godin elected Treasurer. Out-Patients first seen 
at the new Hospital, Whitechapel Road. In-Patient first 
admitted September 17, 1757, before completion of building. 
New building opened with 161 beds. Charter of Incorpora- 
tion granted. Mr. John Ellicot designed a seal. 

1758. The land adjoining the Hospital known as the Mount was 
now used as a Burial Ground for patients who died in HospitaK. 



296 THE LONDON HOSPITAL 

1759. The main building of the Hospital completed (Wings not 
added for about ten years). The New River Water Company 
agreed to supply the Hospital with water for seven years at 
£15 per annum. 

Dr. Hibbins resigned. 

Dr. Thomas Dickson elected Physician. 

1761. Mr. Christopher Roberts elected Treasurer. 

1763. Mr. James Haughton Langston elected Treasurer. Benjamin 
Franklin, then Postmaster of New York, rendered great 
assistance to the Hosjiital with regard to a legacy. He was a 
friend of EUicot, the clockmaker. 

Mr. Gabriel Risoliere appointed a Surgeon, and died same 
year. 
Mrs. Mark Eckley appointed Matron of the Locke. 

1764. H.R.H. Edward, Duke of York, elected President. The 
Mount Burying-Ground was full. The Ground enlarged 
" quite down to the ditch." 

Dr. Andree and Dr. John Sylvester resigned. 
Dr. Edward Richardson and Dr. Thomas Dawson elected 
Physicians. 

1765. Dr. Edward Richardson died. 

Dr. Benjamin Alexander elected Physician. 

1766. Mr. Richard Warner elected Treasurer. 

1767. H.R.H. William Henry, Duke of Gloucester, elected Presi- 
dent. Accounts show " cost per bed at this time was £17 ISs. 
per annum." 

Mr. William Trotter (Secretary) died. 
Mr. John Cole appointed Secretary. 

1768. Dr. Alexander died. 

Dr. Samuel Leeds elected Physician. 

1769. Mr. John Leajiidge elected Treasurer. Mr. Robert Salmon 
elected Cliairman (previous to this Chairmen were only elected 
for three months). Committee decided that Physicians in 
future must hold a diploma of the College of Physicians. 

Mrs. Joanna Martin (Matron) died. 

Mrs. Elizabeth Paterson elected Matron. (At this time 
there were two Matrons, one of the general wards and one of 
the Locke Department.) 



CHRONOLOGY OF LONDON HOSPITAL 297 

1770. Mr. Jolm Cooke elected Chairman. 

Dr. Samuel Leeds and Dr. Dawson resigned. 

Dr. Thomas Healde and Dr. Maddocks elected Physicians. 

1771. Mr. John Coe elected Chairman. 

Mr. Mainwaring, who had been the Architect and Surveyor 
of the new buildings, retired. 

Mr. Hawkins appointed Surveyor. 

1772. Mr. Devereux Bowley elected Chairman. Iron bedsteads 
first used instead of wooden. Large portion of the present 
Estate at the back of Hospital bought at Public Auction. 

1773. Mr. William Loney elected Treasurer. 
Mr. Joseph Sheppard elected Chairman. 

1774. Mr. Timothy Mangles elected Chairman. 

1776. Mr. John Swayne elected Chairman. 

1777. Mr. John Cooke elected Treasurer. 

Mr. Flower Freeman elected Chairman. 

1778. Mr. John Baker elected Chairman. 

IVIrs. Elizabeth Eckley (Matron of the Locke) resigned. 
(Committee decided there should be only one Matron in future.) 

1779. Mr. Thomas Jordan elected Chairman. 

1780. Mr. John Spiller elected Treasurer. 
Mr. Samuel Hawkins elected Chairman. 

Court decided that Surgeons in future must be " Members 
of the Company of Surgeons in London." 

Mr. Edward Hawkins (Surveyor) died, and Mr. Jolin Robin- 
son appointed. 

Mr. Henry Thomson (Surgeon) resigned, and Mr. William 
Blizard elected. 

1781. Rev. Dr. Robert Markham elected Chairman. Mr. Blizard 
asked permission to deliver two courses of lectures on Anatomy 
and Surgery. He had to bring his own patients, and had to 
give an undertaking that none of his Pupils should come into 
the Wards. 

1782. Mr. Thomas Wellings elected Chairman. Surgeons' request 
for the building of a Theatre to give Lectures. Permission 
given, but the Staff were to bear the expenses of building this 
Theatre. Mr. John Cole (Secretary) resigned. 

Mr. Thomas Hodges elected Secretary. 



298 THE LONDON HOSPITAL 

1783. Mr. Joseph Sheppard elected Treasurer. 
]\Ir. James Rondeau elected Chairman. 

With regard to the permission given to the Staff to erect a 
proper building, for teaching, in the Hospital Grounds, the 
Staff now asked that Donors of Thirty Guineas to this Building 
might be Governors of the Hospital. The Committee would 
not agree. 

1784. Mr. Nathaniel Allen elected Chairman. 
Dr. Thomas DicLson died. 

Dr. John Cooke elected Physician. 

1785. Mr. Thomas Jordan elected Treasurer, and Mr. Samuel 
Davy Liptrap elected Chairman. Hard times. Committee 
decided to close six Wards. Matron was discharged. Apothe- 
cary's Assistant discharged. Chaplain's salary reduced. 
Many Nurses, servants, and others discharged. 

1786. The Rev. Dr. Mayo elected Chairman. 
Dr. James Maddocks died. 

Dr. Sir Paul Jodi-ell elected Physician. 

1787. Mr. William Manbey elected Chairman. 
Dr. Sir Paul Jodrell resigned. 

Dr. William Hamilton elected Physician. 

1788. Mr. Samuel Hawkins elected Treasurer. Mr. Timothy 
Curtis elected Chairman. 

John Howard visited the Hospital and suggested many im- 
provements, which were carried out. 

Mr. Thomas Hodges (Secretary) resigned. 
Rev. Mr. Buckham appointed Secretary. 

1789. Mr. Thomas Coxhead elected Chairman. ,. 
Dr. Thomas Healde died. 

Dr. Joseph Fox elected Physician. 
Mrs. Elizabeth Paterson (Matron) died. 
Mrs. Anne Guian elected Matron. 

1790. Mr. Joseph Hankey elected Chairman. Much of the land 
forming the Hospital Estate was now let on building lease. 
Rule made that no Governors could vote at election who had 
not been Governors one year. 

The Rev. Matthew Audley died, after being Chaplain forty- 
nine years. 

1791. Mr. Nathaniel Allen elected Treasurer. 
Mr. John Dan vers elected Chairman. 



CHRONOLOGY OF LONDON HOSPITAL 299 

1791. A thermometer was purchased. 

The Rev. Mr. Buckham, the Secretary, now made Chaplain 
as well. 

1792. Mr. John Bacon elected Chairman. 

1793. Mr. John Liptrap elected Chairman. i 

1794:. 'Mr. Timothy Curtis elected Treasurer. 

Mr. Henry Hinde Pelly elected Chairman. 

1795. Mr. Thomas AUen elected Chairman. The three Surgeons 
asked that three Assistants might te appointed, and the Com- 
mittee agreed. 

Mr. Thomas White, Mr. Thomas Blizard, and Mr. George 
Vaux appointed Assistant Surgeons. 

1796. Mr. Christopher Barton Metcalfe elected Chairman. 

1797. ]Mr. Joseph Hankey elected Treasurer. Mr. Rawson Aislabio 
elected Chairman. 

]\Ir. Richard Grindall and Mr. George Neale died. 

Mr. Thomas Blizard and Mr. Thomas White appointed Sur- 
geons. 

'Mr. George Vaux resigned. 

Mr. Richard Headington elected Assistant Surgeon. 

Mrs. Guian (Matron) resigned, and Mrs. Arabella Doune 
appointed. 

1799. ]Mr. WiUiam Leighton elected Chairihan. 
jVIr. Thomas White (Surgeon) resigned. 
Mr. Richard Headington elected Surgeon. 

1800. ]^Ir. John Liptrap elected Treasurer. 
Mr. Thomas Windle elected Chairman. 
Dr. Thomas Fox resigned. 

Dr. Algernon Frampton elected Physician. 

1801. Dr. David Peter Watts elected Chairman. 

The London Dock Company attempted to purchase by 
Parliamentary powers the whole of the Hospital Estate 
without success. 

1802. Mr. Charles Flower elected Chairman. 

The Rev. Mr. Buckham, who had been holding office of 
Secretary and Chaplain together, resigned Secretaryship, but 
continued to be Chaplain. 

Mr. John Jones elected Secretary. 



300 THE LONDON HOSPITAL 

1803. Colonel Matthew Smith elected Chairman. The Committee 
decided to oiDpose a Bill in Parliament for the formation of 
a canal from London Docks through the Hospital Estate to 
Paddington. 

1804. Mr. Rawson Aislabio elected Treasurer. 
Mr. Ralph Keddey elected Chairman. 
Mrs. Arabella Doune resigned Matronshij). 
Mrs. Le Blond elected Matron. 

1805. H.R.H. William Frederick, Duke of Gloucester, elected 
President. 

Mr. Thomas Browoi elected Chairman. 

The Kitchen Garden to be levelled and thro^vn into the 
Burial-Ground, which was again full. 

1806. Mr. Henry Hinde Pelly elected Treasurer. 
Mr. Harry Charrington elected Chairman. 

The City of London granted the Turner Street Opening so 
that the Hospital Estate at the back might communicate with 
Whitechapel Road. 

Mr. John Robinson (Surveyor) died. 

Mr. John Walters elected Surveyor. 

The Rev. Mr. Buckham died. 

The Rev. Andrew Hatt elected Chaplain. 

1807. Mr. Charles Hampden Turner elected Chairman. 
Dr. William Hamilton died. 

Dr. Cooke resigned. 

Dr. Isaac Buxton and Dr. Yellowly elected Physicians. 

1808. Jews to have 4d. a day each, with bread and beer in lieu of 
diet from Hospital. Chajjlain's clerk paid half a guinea a year 
for attending fimerals. 

1809. Mr. Thomas Windle elected Treasurer. £2,000 sent to the 
Hospital from India by old London Hospital Students then in 
practice in India. 

1810. Mr. Quarles Harris elected Chairman. 

1812. Sir Charles Flower, Bart., elected Treasurer. 
Mr. John Henry Pelly elected Chairman. 

1813. Mr. Thomas Coxhead Marsh elected Chairman. 
1815. Mr. Thomas Brown elected Treasurer. 



CHRONOLOGY OF LONDON HOSPITAL 301 

1816. Dr. John Cooke elected Chairman. Cost of water raised 
from £15 to £30 per annum. Site of present St. Philip's 
Church was purchased from the Hospital for Chapel-of-Ease 
to the Parish of Stepney. (This site was sold for £840. Less 
than half was bought again by the Hospital in 1899 for an 
Isolation Block at a cost of £4,166 10s.). Deputation from 
gentlemen of the Hebrew Nation asking for further accommo- 
dation for Jews. 

Mr. Thomas Blizard, Surgeon, resigned. 

Mr. John G. Andrews elected Surgeon. 

1818. Mr. Harry Charrington elected Treasurer. 

Rev. A. Hatt resigned post of Chaplain, and Rev. William 
Valentine appointed. (Chaplain's duties combined with those 
of House Governor.) 

Dr. John Yellowly resigned. 

Dr. Benjamin Robinson elected. 

Mr. H. Lang elected Solicitor. 

1819. Mr. Charles Hampden Turner elected Treasurer. 
Mr. Nicholas Charrington elected Chairman. 

1820. Feather beds purchased for particular cases. 

1821. Mr. W. B. Harkness elected Assistant Surgeon to Sir William 
Blizard. 

1822. Mr. John Henry Pelly elected Treasurer. 
Sir Jolm Hall elected Chairman. 

Committee appointed to consider the adoption of gas. De- 
cided not to appoint nurses who could not read nor write. 
Dr. Buxton had leave through ill-health, and left the Apothe- 
cary in charge of his patients. The Brewers Company pur- 
chased a piece of land at the back of the Hospital on which to 
erect the Brewers' Almshouses. (These were pulled do-mi in 
1901, and the Hospital Laundry was built on the site. The 
land was sold to the Brewers Company in 1822 for £452. It 
was bought from them in 1901 for £6,401 17s. 3d.). 

Dr. Buxton resigned. 

Dr. Archibald Billing elected. 

1823. Gas adopted in corridors, but not in wards. The Committee 
decided that a convalescent ward (one for each sex) would be 
an advantage. The Staff objected, however, and it was never 
instituted. 



302 THE LONDON HOSPITAL 

1825. Mr. Nicholas Charrington elected Treasurer. 
Mr. William Davis elected Chairman. 

1820. Mr. Robert Batson elected Chairman. 

1827. Mr. William Cotton elected Chairman. 

The House Committee desired an increase in the Medical and 
Surgical Staff (there were at this time three Physicians and 
three Surgeons). The Committee appointed three Assistant 
Physicians and three Assistant Surgeons. Assistant Physi- 
cians and Assistant Surgeons were to have the same qualifica- 
tion as Physicians and Surgeons. 

Decided that a senior pupil should reside in the Hospital for 
periods of not less than three successive months, to take 
superintendence in absence of the Surgeons. George Frederick 
Yoimg became a Life Governor. 

Dr. James Alexander Gordon, Dr. Frederick Cobb, and 
Dr. Thomas Davis elected Assistant Physicians. 

Mr. William Blizard Harkness, Mr. John Scott, and Mr. 
James Luke elected Assistant Surgeons. 

Mr. William B. Harkness died same year, and was succeeded 
by Mr. Thomas Jeremiah Armiger. 

1828. Mr. Quarles Harris elected Treasurer. 

Mr. Christopher Richardson elected Chairman. 
Dr. Benjamin Robinson died, and Dr. J. A. Gordon elected 
Physician. 

Dr. John Macbraire elected Assistant Physician. 

1829. Committee decided that all nurses must be able to read and 
write, but it was found impossible to get such. Decided, that 
only nurses who could read and write should administer medicine. 

1830. West Wing extended to double its original length (Mr. Mason, 
Surveyor). 

Mr. Jolm Jones (Secretary) died, and Mr. Joseph Cecil 
appointed Secretary. 

1831. Sir John Hall elected Treasurer. 

Mr. Richard C. Headington, Surgeon, ched. 

Mr. John Scott elected Surgeon, and Mr. Alfred Hamilton 
elected Assistant Surgeon. 

Air. Thomas Jeremiah Armiger resigned, and Mr. John Adams 
elected Assistant Surgeon. 



CHRONOLOGY OF LONDON HOSPITAL 303 

1832. Mr. Francis Kemble elected Chairman. , 
Dr. Cobb sent to Newcastle to investigate Cholera. 

Dr. John Macbraire resigned. 

Dr. Algernon Frampton, jun., elected Assistant Physician. 

1833. Sir William Blizard resigned. 
Jlr. James Luke elected Surgeon. 

Mrs. Le Blond (Matron) retired, and Mrs. Nelson elected. 

1834. Mr. William Davis elected Treasurer. 

Committee adopted Filtering System, and all water used in 
the Hospital was filtered. Committee decided that no Phy- 
sician or Surgeon could hold that position longer than twenty 
years. Inquiry by the Committee as to the origin of the School 
in 1783. 

]Mr. Thomas Blizard Curling elected Assistant Surgeon. 

1835. H.R.H. Adolphus Frederick, Duke of Cambridge, elected 
President. 

Mr. Robert Batson elected Treasurer. 

Mr. Philip Wilham Mure elected Chairman. 

Death of Sir William Blizard. 

1836. Mr. William Mitcalf elected Chairman. 

Mr. Joseph Cecil resigned Secretaryship, and Mr. W. B. 
Bathurst elected Secretary. 

1837. Mr. William Cotton elected Treasurer. 

What is now the " Garden of Eden " was let to the Brewers' 
Company for the use of the inmates of the Brewers' Alms- 
houses. Special communication from representative Jews 
asking that special Wards should be provided for Jews. The 
House Committee decided that it was impossible to grant the 
request. This decision was rescinded in 1842. 

1838. Mr. Robert Hanbury elected Chairman. 
Receiving-Room first instituted for the examination of 

accidents and extra cases. Nurse engaged for this Re- 
ceiving-Room at 14s. a week, without diet or lodging ; hours, 
7 a.m. to 11 p.m. 

1839. Dr. Davis appointed Physician, and died same year. 
Dr. Wilham John Little elected Assistant Physician. 

1840. Mr. Phihp William Mure elected Treasurer. 
Mr. Leonard Currie elected Chairman. 

East Wing extended. ,. ; 



304 THE LONDON HOSPITAL 

1841. Dr. Algernon Frampton, sen., resigned. 
Dr. Frederick Cobb elected Physician. 

Dr. Jonathan Pereira elected Assistant Physician. 

1842. Mr. William Mitcalf elected Treasurer. 

Mr. George Frederick Young elected Chairman (still living). 
Special Wards were appointed for Jews. 
Rev. T. Valentine resigned Chaplaincy, and Rev. James W. 
Saunders elected Chaplain. 

1844. Mr. Robert Hanbury elected Treasurer. 

Three House Surgeons appointed. Qualification by ex- 
amination was not essential ; they were simply senior stu- 
dents. 

Dr. Gordon resigned. 

Dr. Algernon Frampton, jun., elected Physician. 

1845. Mr. John Davis elected Chairman. 

Mr. John Scott (Surgeon) resigned. ; ,.; 

Mr. Alfred Hamilton elected Surgeon. _ ; 

Dr. Patrick Fraser elected Assistant Physician. ; 

Dr. Archibald Billing resigned. I 
Dr. William John Little elected Physician. 
Dr. Herbert Davis elected Assistant Physician. 

1846. Dr. A. Billing was requested to become a member of the 
House Committee. Decided that all Surgeons appointed to 
the Staff must be Fellows of the Royal College of Surgeons of 
England. 

Mr. W. B. Bathurst (Secretary) resigned. 

Mr. Wilham John Nixon appointed Secretary, and is still 
living in 1910. 

Mr. Gfeorge Critchett elected Assistant Surgeon. 

]Mr. Henry Martin Harvey elected Solicitor on retirement of 
Mr. Henry Lang. 

Mr. A. R. Mason elected Surveyor. 

Rev. Saunders resigned Chaplaincy, and Rev. T. Ward 
elected. 

1847. Sir Edward North Buxton, Bart., elected Chairman. 

1848. Mr. Leonard Currie elected Treasurer. 

1849. Mr. Charles Bradshaw Stutfield elected Chairman. 
Physicians requested that a microscope should be purchased 

for the Hospital. This was done, and entrusted to the care of 



CHRONOLOGY OF LONDON HOSPITAL 305 

the Apothecary. Decided that Assistant Surgeons should be 
required to have the same qualification as Surgeons — that is, 
they must be Fellows of the Royal College of Surgeons of 
England. 

Mr. Alfred Hamilton (Surgeon) resigned. 

Mr. Jolm Adams elected Surgeon. 

Mr. Nathaniel Ward appointed Assistant Surgeon. 

Mr. J. G. Andrews (Surgeon) died. 

Mr. Thomas B. Curling appointed Surgeon. 

IVIr. John Cawood Wordsworth appointed Assistant 

Surgeon. ^.,. 

1S50. H.R.H. George William, Duke of Cambridge,' K.G., elected 
President. 

1851. Gas in future to be charged by meter instead of by fixed 
charge per annum. 

Dr. Algernon Frampton, jun., resigned. 

Dr. Jonathan Pereira elected Physician. 

Dr. Nicholas Parker elected Assistant Physician. 

1852. Mr. John Davis elected Treasurer. 

Captain Richard Pelly, R.N., elected Chairman. 

Medical Staff considered that the Apothecary was a proper 
person to administer chloroform ; the Committee did not 
agree. 

Rev. T. Ward resigned Chaplaincy. 

Rev. Edward John Nixon appointed Chaplain. 

1853. The House Committee, wishing to put an end to the previous 
decision of appointing special wards for Jews, decided that 
only parts of Wards should be set apart for Jews. The Jews 
objected to this as not fulfilling the agreement previously 
made with them. 

Dr. Ramsbotham appointed first Obstetric Physician. 

Dr. Jonathan Pereira died. 

Dr. Patrick Fraser elected Physician. (It is interesting 
to note that Dr. Patrick Eraser's widow gave £5,000 
to the Hospital, and on her death, in 1909, left another 
£5,000.) 

Dr. James Miller elected Assistant Physician and died same 
year. 

Dr. Septimus Gibbon elected Assistant Physician. 

20 



306 THE LONDON HOSPITAL 

1854. Sir Edward North Buxton, Bart., elected Treasurer. 

The title of " Apothecary " was changed to " Resident 
Medical Of3ficer." Now Medical College on its present site 
opened. Outside Maternity Department started, and first 
Resident Accoucheur appointed. 

Dr. Frederick Cobb resigned. 

Dr. Herbert Davis elected Physician. 

Dr. Andrew Clark elected Assistant Physician (afterwards Sir 
Andrew Clark, Bart., Physician to Her Majesty Queen Victoria). 

1855. Mr. James Scott Smith elected Chairman. 

Staff ai^plied for appointment of Surgical Registrars. 

1856. ]Mr. Charles Bradshaw Stutfield elected Treasurer. 
Miss Florence Nightingale becams a Life Governor. 

Rev. Nixon resigned Chaplaincy, and Rev. John Morrison 
Snody elected Chaplain. 

1857. Captain Richard Wilson Pelly, R.N., elected Treasurer. 
Mr. Thomas Fowell Buxton elected Chairman. 

Decided that Assistant Surgeons must reside within a mile 
and a half of the Hospital. 

jVIr. Henry John Barrett appointed Dental Surgeon. 

1858. Court of Governors decided that a Fourth Assistant Surgeon 
be appointed, and Mr. P. Y. Gowlland was appointed Assistant 
Surgeon. 

Mr. Mason (Surveyor) resigned. 

Mr. Charles Barry appointed Surveyor. 

1859. Staff complained of the rule that Assistant Surgeons must 
live within a mile and a half of the Hospital. The Committee 
refused to alter the rule. 

Mr. John C. Wordsworth resigned in consequence. 

Mr. Jonathan Hutchinson (now Sir Jonathan Hutchinson) 
appointed Assistant Surgeon. 

Dr. Robert Barnos elected Assistant Obstetric Physician. 

Dr. Septimus Gibbons resigned. 

Dr. Jabez Spencer Ramskill elected Assistant Physician. 
Court decided to appoint fourth Assistant Physician, and Dr. 
John Langdon Down elected Assistant Physician. 

1860. Vaccination Department started. 

Rev. John Morrison Snody resigned Chaplaincy, and Rev. 
Thomas Scott (now Canon Scott) appointed. 
Mr. Nathaniel Ward, Surgeon, resigned. 
Mr. Charles Frederick Maunder elected Assistant Surgeon. 



CHRONOLOGY OF LONDON HOSPITAL 307 

1861. Mr. James Luke resigned the post of Surgeon, and was 
appointed Consulting Surgeon (the first time such an appoint- 
ment was made). 

Mr. George Critchett was elected Surgeon. 
Mr. Jolm Couper elected Assistant Surgeon. 

1862. ]\Ir. Tanqueray Willaume elected Solicitor. 
Mr. GowUand, Surgeon, resigned. 

Mr. Louis Stromeyer Little elected Assistant Surgeon. 

1863. Decided to pension all Nurses after twenty years' service — 
12s. a week. 

Mr. George Ci-itchett, Surgeon, resigned. 

Mr. Jonathan Hutchinson elected Surgeon. 

Mr. Walter Rivington elected Assistant Surgeon. 

Dr. William Jolm Little resigned. 

Dr. Ramsbotham resigned office of Obstetric Physician. 

Dr. Nicholas Parker elected Physician. 

Dr. Robert Barnes elected Obstetric Physician, and at his 
request an Assistant Obstetric Physician was not appointed 
in his place. 

Dr. Hughlings Jackson elected Assistant Physician. 

1864. Foundation of Alexandra Wing laid. 

1865. Dr. Robert Barnes resigned post of Obstetric Physician. 
Dr. Edward Head appointed Obstetric Physician. 

Dr. James Palfrey appointed Assistant Obstetric Phy- 
sician. 

1866. Alexandra Wing opened. Cholera year. 

Mr. W. J. Nixon appointed House Governor as well as 
Secretary. 

Dr. Nicholas Parker resigned. 

Dr. Andrew Clark elected Physician. 

Dr. Morell Mackenzie (afterwards Sir Morell) elected Assistant 
Physician. 

Dr. Patrick Fraser resigned. 

Dr. Jabez Spencer Ramskill appointed Physician. 

1867. The Governors sent a special petition to Parliament for 
special examination from parochial rates, " or for a continu- 
ance of that exemption which the Hospital has hitherto en- 
joyed." 

Dr. Henry Sutton elected Assistant Physician. 

20—2 



308 THE LONDON HOSPITAL 

Mrs. Jane Nelson resigned post of Matron after thirty-four 
years' service. Matrons in future were to be appointed by 
House Committee, and not by Quarterly Courts, 

Miss A. M. S\vift appointed Matron. 

1868. Mr. Thomas Fowell Buxton elected Treasurer. 

Sir Edmund Hay Currie elected Chairman (now Secretary of 
the Hospital Simday Fund). 

Committee decided to appoint a fifth Assistant Physician 
and fifth Assistant Surgeon. 

Mr. James E. Adams elected Assistant Surgeon. 

Dr. Samuel Fen wick elected Assistant Physician. 

Rev. T. A. Pm-dy elected Chaplain in place of Rev. Thomas 
Scott. 

1869. Medical College enlarged. Committee seriously considered 
question of making Out-Patients pay something towards 
expenses of their treatment. 

Mr. Jolin Adams resigned post of Surgeon, and was appointed 
Consulting Surgeon. 

Mr. C. F. Maunder elected Surgeon. 

Mr. Warren Tay elected Assista.nt Surgeon. 

Mr. Thomas Blizard Ciirluig x-esigned, and was elected Con- 
sulting Surgeon. 

Mr. Louis Stromeyer Little resigned post of Assistant Sur- 
geon. 

Mr. John Couper elected Surgeon. 

Mr. Jeremiah McCarthy and Mr. Henry A. Reeves appointed 
Assistant Surgeons. 

1870. Dr. John Langdon Down elected Physician, and Mr. Walter 
Rivington elected Surgeon. 

Dr. W. Bathurst Woodman elected Assistant Physician. 
Mr. Barry resigned post of Surveyor. 

1871. Mr. Archibald Hanbury elected Solicitor. Decided to pay 
the Assistant Staff who see Out-Patients an honorarium of 
£50 per aimum. 

1873. The Grocers' Company gave donation of £20,000 towards 
cost of New Wing to be called the Grocers' Wing. Decided, 
that in building the Grocers' Wmg arrangements be made for 
a Training Home for Nurses for the benefit of the London 
Hospital. 
Sir Morell JIackenzie elected Physician. 



CHRONOLOGY OF LONDON HOSPITAL 309 

1874. Dr. Herbert Davis resigned, and was elected Consulting 
Physician. 

Dr. Hughlings Jackson elected Physician. 

Dr. Stephen Mackenzie (afterwards Sir Stephen) elected 
Assistant Physician. 

Sir Morell Mackenzie resigned. 

Dr. Arthur Emost Sansom elected Assistant Physician. 

Decided to appoint Medical and Surgical Registrar at a 
salary of £100 per annum. 

Mr. Ashley W. Barrett appointed Surgeon Dentist, on the 
resignation of Mr. Henry John Barrett. 

1875. Dr. Edward Head resigned Obstetric Physicianship. 
Dr. James Palfrey elected Obstetric Physician. 

3Ir. A. Snelgrove appointed Secretary. 

Mr. Nixon (late Secretary) appointed House Governor only. 

1876. The Grocers' Wing opened. 

Dr. G. Ernest Herman elected Assistant Obstetric Phy- 
sician. 

Dr. Henry Sutton elected Physician (fifth Physician now 
for the first time). 

Dr. Charlewood Turner elected Assistant Physician. 

Mr. A. Gardiner Brown appointed Aural Surgeon. 

1877. Dr. Bathm'st Woodman elected Physician, and died same 
year. 

Dr. Thomas Barlow (now Sir Thomas Barlow, Bart., 
K.C.V.O., Physician to His Majesty the King) elected As- 
sistant Physician. 

Mr. John Adams, Surgeon, died. 

1878. The Right Hon. Lord Aldenham elected Treasurer. 
]\Ir. John Henry Buxton elected Chairman. 

The Committee urged the necessity of a sixth Assistant 
Physician. Dr. Gilbart Smith elected Assistant Physician. 
Death of Rev. T. A. Purdy. 

1879. The Rev. J. S. Whichelow elected Chaplain. 
Mr. C. F. Maunder, Surgeon, died. 

Mr. James E. Adams elected Surgeon. 

Mr. Frederick Treves (now Sir Frederick Treves, Bart.> 
G.C.V.O., C.B., Serjeant-Surgeon to His Majesty the King) 
appointed Assistant Surgeon. 



310 THE LONDON HOSPITAL 

Dr. Ramskill resigned, and was elected Consulting Phy- 
sician. 

Dr. Samuel Fenwick elected Physician. 

Dr. Francis Warner elected Assistant Physician. 

1880. Dr. Thomas Barlow resigned. 

Dr. Charles Henry Ralph elected Assistant Physician. 
Mr. Snelgrove resigned Secretaryship. 

Mr. Mimro Scott appointed Warden of the Medical College. 
Miss Swift, Matron, resigned ; and Miss Eva Luckes, the 
present Matron, appointed. 

1881. Mr. A. H. Haggard appointed Secretary. 
Mr. James Luke, Surgeon, died. 

1882. Mr. Jeremiah McCarthy appointed Surgeon. 

Mr. C. W. Mansell-MouUin elected Assistant Surgeon. 

Mr. Waren Tay elected Surgeon. 

Mr. Edward Woakes and Mr. Mark Ho veil appointed Aural 
Surgeons. 

Mr. A. G. Brown, x4ural Surgeon, died. 

Dr. James Palfrey died. 

Rev. J. S. Whichelow retired from Chaplaincy, and Rev. 
Algernon Grenfell elected. 

1883. Dr. G. Ernest Herman elected Obstetric Physician. 

Mr. Jonathan Hutchinson (now Sir Jonathan Hutchinson) 
retired from post of Surgeon, and was elected Consulting 
Surgeon. 

Mr. McCarthy elected Surgeon. 

Mr. E. Hurry Fenwick elected Assistant Surgeon. 

1884. Mr. John Henry Buxton elected Treasurer. 

Mr. Francis Culling Carr-Gomm elected Chairman. 
The Committee decided to improve the accommodation for 
Nurses and to build r, Nurses' Home. 

Mr. James E. Adams resigned post of Surgeon. 
Mr. Frederick Treves elected Surgeon. 
Mr. Frederick Eve appointed Assistant Surgeon. 
Mr. Rowland Plum be appointed Architect. 

1885. Dr. Arthur H. N. Lewers elected Assistant Obstetric Phy- 
sician. 

Rev. A. S. Grenfell resigned. 

Rev. A. Tristram Valentina elected Chaplain. 

Dr. Herbert Da vies died. 



CHRONOLOGY OF LONDON HOSPITAL 311 

1886. Sir Andrew Clark, Bart., resigned post of Physician, and was 
elected (Consulting Physician. 

Dr. Stephen Mackenzie (afterwards Sir Stephen) elected 
Physician. 

Dr. James Anderson elected Assistant Physician. 

Dr. F. W. Hewitt appointed Instructor in Anaesthetics. 

1887. Mr. Haggard resigned Secretaryship. 
Nurses' Home opened. 

Dr. C. H. Ralph elected Physician. 

1888. Mr. G. Q. Roberts appointed Secretary. 
Mr. Thomas Blizard Curling, Surgeon, died. 

1889. Rev. Valentine resigned. 

'Mi. John Couper resigned post of Surgeon, and was elected 
Consulting Surgeon. 

Mr. Mansell-Moullin appointed Surgeon. 

Mr. Jonathan Hutchinson, jun., appointed Assistant Siu'geon. 

1890. ;Mr. Edward Murray Ind elected Chairman. 

House of Lords Inquiry into management of Hospitals. 
The Rev. J. D. K. Mahomed elected Chaplain. 
Dr. Langdon Down resigned, and was made Consulting 
Physician. 
Mr. Walter Rivington elected Consulting Surgeon. 
Dr. Arthur Ernest Sansom elected Physician. 
Mr. E. Hurry Fenwick appointed Surgeon. 
Mr. T. H. Openshaw elected Assistant Surgeon. 
Dr. Percy Kidd elected Assistant Physician. 

1891. Dr. Henry Sutton died. 

Dr. F. Charlewood Turner elected Physician. 
Dr. F. J. Smith elected Assistant Physician. 

1892. The question seriously considered of having ladies on the 
House Committee. 

Mr. H. A. Reeves, Surgeon, resigned. 

3Ir. Henry Percy Dean elected Assistant Surgeon. 

Mr. Nixon (House Governor) resigned. 

Mr. G. Q. Roberts appointed House Governor. 

1893. Mr. John Hampton Hale elected Chairman. 
Dr. James Anderson died. 

Dr. W. J. Hadley elected Assistant Physician. 
Sir Andrew Clark, Bart., died. 



312 THE LONDON HOSPITAL 

1894. Second Nurses' Home built. 

Dr. Hughlings Jackson elected Consulting Physician. 

Dr. Gilbart Smith elected Physician. 

Dr. George Schorstein elected Assistant Physician. 

1896. The Hon. Sydney Holland elected Chairman. 

Mr. Ashley Barrett (Surgeon Dentist) appomted Consulting 
Dental Surgeon. 

Dr. C. H. Ralph elected Consulting Physician, and died same 
year. 

Dr. Bertrand Dawson elected Assistant Physician. 

Dr. Samuel Fenwick elected Consulting Physician. 

Dr. Francis Warner elected Physician. 

Dr. Henry Head elected Assistant Physician. 

Dr. Langdon Doiaii died. 

1897. The complete rebuilding of the Hospital commenced. 
Second Nurses' Home built. 

Dr. J. S. Ramskill died. 

Dr. Probyn-Williams elected Assistant Instructor in An- 
aesthetics. 
Mr. Walter Rivington, Surgeon, died. 

1893. £25,000 given by an anonymous donor for new Out-Paticnt 
building. Letters of admission abolished, and payment for 
medicine and bandages by Out-Patients commenced. 

Mr. Jeremiah McCarthy resigned, and was appointed Con- 
sulting Surgeon. 

Mr. Frederick S. Eve elected Surgeon. 

Mr. A. B. Roxburgh elected Assistant Surgeon. 

Mr. Frederick Treves (now Sir Frederick) was appointed 
Consulting Surgeon. 

Mr. Jonathan Hutchinson elected Surgeon. 

1899. Mr. Edward L. Raphael (the late) gave donation of £10,000 
for the endowment of the Jewish Wards. He also gave a 
similar amount in 1903. 

Mr. Percy Furnivall elected Assistant Surgeon. 
Di'. Charlewood Turner resigned. 
Dr. Percy Kidd elected Physician. 

1900. It was decided to have five Assistant Surgeons. 
Dr. Charlewood Turner died. 

Dr. Robert Hutchison elected Assistant Physician. 



CHRONOLOGY OF LONDON HOSPITAL 313 

1901. The Isolation Block built at a cost of £32,000. 

The Pathological Department built at a cost of £19,143. 
Dr. Frederick W. Hewitt appointed Consulting Ansesthetist. 
IVIr. Harold Barnard elected Assistant Surgeon. 
Dr. H. L. Lack appointed Surgeon in charge of the Throat 
Department, and Mr. Hunter Tod Assistant Surgeon. 
Dr. Pro byn -Williams elected Instructor in Ansesthetics. 
Mr. Edward Woakes, Aural Surgeon, resigned. 

1902. New Operating Theatre Floor and five Theatres built at cost 
of £13,000. His Majesty King Edward VII.'s serious illness 
and operation just before the day fixed for the Coronation. 
Sir Frederick Treves operated. Mr. Frederick Hewitt gave the 
anaesthetic, and Nurse Haines (one of the Hospital Nurses) 
was engaged. 

Mr. Waren Tay aj)point<3d Consulting Surgeon. 

Mr. A. B. Roxburgh appouited Ophthalmic Surgeon. 

Mr. T. H. Openshaw elected Surgeon. 

Dr. Sansom elected Consulting Physician. 

Dr. F. J. Smith elected Physician. 

Mr. H. M. Rigby elected Assistant Surgeon. 
. Dr. Lewis Smith elected Assistant Physician. 

Dr. J. H. Sequeira appointed Assistant Physician to the 
Skin Department. 

Mr. Mark HoveU appointed Consulting Aural Surgeon. 

Mr. Hunter Tod elected Surgeon to the Aural Department. 

Mr. James Sherren elected Assistant Surgeon. 

Dr. Samuel Fenwick died. 

1903. His Majesty the King and Her Majesty the Queen opened the 
Out-Patient Department. The site, building, and equipment 
cost £83,000. 

Mr. G. Q. Roberts resigned Secretaryship, to become Secre- 
tary to St. Thomas's Hospital. 

Mr. Ernest W. Morris elected Secretary. 

Dr. Sequeira appointed Skin Physician. 

Dr. Russell Andrews elected Assistant Obstetric Physician. 

Dr. Ernest Herman appointed Consulting Obstetric Phy- 
sician. 

Dr. Arthur Lewers elected Obstetric Physician. 

Sir Stephen Mackenzie resigned post of Physician to the 
Skin Department, Dr. Sequeira being appointed in his stead. 

Dr. Henry Head elected Physician. 



314 THE LONDON HOSPITAL 

Dr. Morton appointed Medical Officer in charge of tlie 
Electrical Department. 

Mr. Jolin Henry Buxton resigned Ti-easurership. 

1904. Her Majesty the Queen elected President. 

The Earl of Derby (then Lord Stanley) appointed Treasurer. 

Dr. Gilbert Smith died. 

Dr. W. J. Hadley elected Physician. 

Mr. W. T. Lister appointed Ophthalmic Surgeon. 

Dr. Cecil Wall elected Assistant Physician. 

Mr. James Hora endowed the " Marie Celeste " Wards. 

New Laimdry built at cost (with site) of £32,000. 

1905. The Eva Liickes' Nurses' Home built (the third Nurses' 
: Home), at cost of £47,000. 

Mr. Munro Scott, Warden of the Medical College, completed 
the twenty-fifth year of his Wardenship. 

Mr. Hugh Lett a.ppointed Assistant Surgeon. 

Sir Stephen Mackenzie appointed Consulting Physician. 

Dr. G. Schorstein elected Physician. 

Dr. Otto Grimbaum elected Assistant Physician. 

190G. Dr. Schorstein died, and Dr. Dawson was elected Physician. 

1907. Dr. Theodore Thompson elected Assistant Physician. 
Dr. Robert Barnes died. 

Dr. Sansom died. 

1908. Statue of Her Majesty Queen Alexandra erected in grounds. 
Mr. Russell Howard elected Assistant Surgeon. 

Mr. Harold Barnard, Surgeon, died. 

Dr. Philip Panton elected Clinical Pathologist. 

1909. Appointment of Lady Almoners. Anonymous gift of 
£20,000 for Medical Research. Opening of the Tyrnauer 
Baths. 

Mr. Mansell-Moullin appointed Consulting Surgeon. 
' Sir Stephen Mackenzie died. 
Mr. Henry Percy Dean appointed Surgeon. 
Mr. Richard Warren appointed Assistant Surgeon. 
Dr. Morton resigned. 

Dr. Gilbert Scott appointed in charge of the Radiographic 
Department. 

1910. Mr. E. Hurry Fenwick appomtcd Consulting Surgeon. 



INDEX 



AccomsTTS Department, 265 
Admission, rules of, 10, 67, 108-10, 

178-9 
Advertisement, old method of, 67 
Alexandra Wing, the, 87, 135, 166 
Almoners, 11-12, 264, 282 
Anaesthetics, discovery of, 172 

rooms for administering, 21 
Andrf'-e, Dr., 26, 46, 61, 291 ' 
Apothecary, ancient duties of, 

173-5 
Arderne, John of, 41-2 
Audley, Rev. Matthew, 62-3, 292 

Bacon, Francis, influence of, on 

medicine, 40 
Bacteriological Laboratory, 202, 

233, 239 
Baker, Mr. Fotherley, 26 
Baptist Head Tavern, meeting at, 

25 
Barbers, Guild of, 43, 44 
as surgeons, 37, 41 
imscrupulousness of, 41 
Bischoffsheim, Mr. and Mrs., 276 
Black Swan Tavern, meeting at, 

48 
Blizard, William, appeals for 
funds, 190-3 
birth and education of, 

144-5 
death of, 154 
knighthood of, 149 
Medical School founded 

by, 107, 145-6, 186 
ofiSces held by, 151-2 
personality of, 147-8, 151, 

152 
Samaritan Society 

founded by, 150 
separate wards advocated 

by, 157-8 
surgical skill, 147 



Building Fund, raised by Bishop 
of Worcester, 78 
plans for employment of, 
83-5 
Buxton, Mr. John, 53 

Mr. John Henry, 53, 229 
Mr. Thomas FoweU, 53, 169 

Charter, Hospital, first obtained, 

180-1 
Chaucer, quoted, 38 
Cholera, epidemics of, 163-8 
Clark, Sir Andrew, 232 
Cobb, Mr. John, 102, 103, 104 
Cole, Mr. Josiah, 26, 48, 55 
Convalescent Home at Felixstowe, 

232 
Creighton, Dr. Charles, 31, 39 
quoted, 32-6 

Departments : 

Electrical, 14, 222 

Estate, 255 

Finsen Light, 12, 151, 237 

Nursing, 243-8 

Opsonic, 238 

Orthopaedic, 17 

Oiit-patient, 4, 9, 12-17, 66, 
258, 261, 263-5, 284, etc. 

Photographic, 225 

Rontgen ray, 222 

Steward's, 248-52 

Surveyor's, 255-6 

Theatre, 262-3 
D?rby, Countess of, 22 
Diet table, 69, 252-3 
Dispensary, 16, 256-62 

Economy, reports on, 123-6 
Electricity, treatment by, 222 
Ellicot, John, F.R.S., 177 
EUiston, Miss Marion, quoted, 
273-5 



315 



316 



INDEX 



Endowment of Medical Research, 
203, 228 
of Finson Light Department, 
233 
Estate Department, 255 
Examinations, qualifying, started, 
139-40 

Feathers Tavern, the, meetings at, 

24, 25, 33, 44 
Featherstone Street, first site of 

" London Infirmary," 26, 48 
Festival, Annual, institution of, 73 
ceremonies of, described, 
74-7 
"Field," the, 183 
Fiolden, Mr. J. A., 231 
Financial administration, 24, 50, 
54 
committee for, 265 
criticism of, 236-7, 240-1 
economy in, 123-4 
mistakes in, 100 
reports in, 65 
Finsen Light, 12-13, 151, 230, 233, 

237 
Foundation of the Hospital in 

Whitechapel, 87 
Fry, Mrs. Elizabeth, 207 
Fmids, appeals for, 190-3, 224 
great lack of, in 1897, 225 
Prince of Wales's, 226 

" Garden of Eden," the, 23, 183 
Governors, methods of procedure, 
118-21 
quai-terly courts of, 98, 98, 

116, 189-90, 241-2 
subscribers knov»'n as, 49, 96 
Grocer's Wing, the, 87, 169, 209 

Haberdashers' Hall, meetings at. 

Do 

Hale, Mr. John Hampton, 218, 

220, 223 
Harrison, John, surgeon, annual 
festival instituted by, 
73 
assistant surgeon ap- 
pointed to, 59 
charter, raised question 

of, 180 
complaints against, 60-1 
Infirmary, advises exten- 
sion of. 64 



Harrison, John, progressive policy 
of, 101 
pupils of, 61, 186 
share of, in founding 
Hospital, 25, 26, 47, 
51,82 
Hatzfeldt, Princess, 15 
Herbs, use of, 38 
Hoare, Mr. Douro, 203 
Holland, Hon. Sydney, 223-4, 226 
Hora, Mr. James', 22, 150, 231 
House Committee, the, constitu- 
tion of, 241-2 
elections of, 97, 101 
meetings of, 98-9, 110-17, 
etc. 
House Visitors, appointment of, 101 

reports of, 102-6 
Howard, John, 152, 185 

reforms introduced by, 
155-7 
Hydrophobia, epidemic of, 144 
Hygiene, disregard of, 69-70 
reports on, 104 

Infectious cases, 23, 68, 164-5 
Infirmary, the London, becomes 
the " London Hospital," 
77 
extension of, 64, 69 
opening of, 26, 48 
Inoculation Department opened, 

233 
Isolation Block, 183, 227, 288 

Jewish Wards, the, 21, 126, 130-5. 

231 
" Jews' House," the, 69 
Josso, Mr., first chairman, 49 

King's Fimd, the, 240, 26 > 
Kitchens, the Hospital, 21 

Lease of London Hospital, 82-3 

Levy, Mr. B. W., 320 

Liptrap, Mr., joint founder of 

Medical School. 107 
Lister, Lord, 157, 158, 159, 162, 

216 
" Lock," the, 65 
Lowther, Sir James, 63 
Luckes, Miss Eva, 23, 210, 214, 

244 
Lupus disease, treatment of, 12-13, 

230, 233, 237 



INDEX 



317 



Mainwaring, Mr. Robert, 80, 83^.J 
Mario Celeste, Maternity Wards, 
21,22,231 
Samaritan Society loO 
Matron, the, duties of 243-5, 246-7 

type of, in 1742, 57-8 
Mazuza, the, in Jewish wards, 21 
Meares. Mr., 63 .„„ „f^o 

Medical School, the, 186-203 

departments of, 20--3 
endowment ot, ^y)6, --»' 
foundation of. 41. 14o, 

services of, to the Hos- 
pital, 200-1 

students of, 187-9, 197, 
267-8, 279-80 
Medical science, recent advance m, 
219 

state of, from sixteenth to 
eighteenth centuries, 
37-46, 51, etc. , 
study of. first organized, 

I\Iedical Staff, present duties ot, 

266-7, 277-8 
Motto, hospital, 148-9 
Myre, Mr. William, 63 

Neil, Mr. Richard, 49-50 
Nightingale, Miss Florence, 208, 

213, 244 
NorthcliSe, Lord, 23o 
Nurses, accommodation for, ZZ-o, 

in early days, 56-9, 204-6 
Liickes' Home for, 2^ 
present duties of, 211 
salary of. 212 
training-school for, /lu 

Onerating theatres, 21, 160, 162-3, 
%t2f6-17, 230, 262^3 
Opsonic Department, 233,-^8 
Orthopedic Department, 17 
Out.p.t,ent^D»partm.ot. Ua7, 

284, etc. 
abuse of, 111-12, ISO 
extension of, recent, ZZH^ 

30 
origin of, 52 

Pathological Laboratories, 232, 
239 



Payne, Dr., quoted, 3/ -8 
Pensions, hospital, 208 212, 24o 
Pharmacy Department, lb 
Photographic Department, ZZo 
Plague, epidemics of, 31-/ 
Poor Law Infirmaries, 271, Zlti, 

281, 282 
Potter, Mr. G., 25 , 

Prescott Street, site of hospital 

transferred to. 51 
Prince of Wales's Fund, 226-7 
Provisions, hospital, management 
of, 248-52 

Queen Alexandra, 150, 228-9, 233, 
234 291 
statue' of, 82, 233 

Raphael, Mr. Edward Louis, 135, 

231 
Mr. Louis, 135, 231 
Rates of London Hospital, 184 
Rebuilding, recent 227-8 
Receiving-room, the, cJ, o, i, -^y 

263-4, 287, 290 , ,. ir, 

Rontgen Ray Department, 14- io, 

222 
Rothschild Fund, 135 
Rudge, Rev. Mr., 126 



Sclater, Mr., 25 

Scott, Canon the Rev. T., quoted, 
166-8, 169-71 
Mr. Munro, 203 
Secretary, the, duties of, ^42, 

268 
Serum, treatment by, 220- 1 
Sisters, Nursing, 206, 207, 21J, 

246, 254, 260 
Snee, Mr. John, senr., 25 
Staff, the, advantages of bjmg on, 
279 
alterations on, 70-1 
duties of, former, 48 
election of, 241-2 
Medical, 266-7, 277-8 
quarrels among, 112, lJb-», 

173, 187 
Surgical, 286-7 
St Bartholomew's Hospital, 2b, Z/, 

28-30, 200, 271 
Stern, Baroness J. de, 161 
Steward, the, duties of, 248, 

952 
St-^Thomas's Hospital, 26, 30 



318 



INDEX 



students, medical. 187-9, 197, 

267-8. 279-80 
Surgery, barbers, practised by, 37, 
41 
pioneers of, 157 
precautions of modern, 159-60 
recent advance in, 219 
Surgeons, Company of, 44 
duties of, 266-7 
Guild of, 43 

Royal College of, established, 
44 
Surveyor, the, duties of, 256 
Sydenham, physician, 40 

Tredegar House, 210,'' 211, 220, 

244 
Treves, Sir Frederick, 19, 230 
Tyrnauer Baths, 15 



Voluntary hospitals, 270-285 
State aid for, 282 

Wards, appearance of, 17 
children's. 20 
Jewish, 21, 126, 130-5, 231 
Maternity, 21-2, 231 
separation of, advocated, 112, 
158 
Warren, Sir Peter, 87 
Webb, Mr. Godfrey, 55 
~\^1iitechapel Road, dangers of, 
80, 153 
district, 182 
original building in, 87 
Worcester, Bishop of, 77-8 
Worrall, Mr. Samuel, 80, 81, 82 

X rays, use of, 14, 222 



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