Although hospitals have been intended as a blessing and benefit to the poor, they have too often proved the reverse, on account of the ignorance on the part of their administrators of the true principles of health.—EncyclopÆdia Britannica.

One of the greatest blots upon hospital management of the present day is the abuse of alcoholic drinks. The immense amount of spirits needlessly, and often not harmlessly, given to the patients is a serious tax on the resources of the charities, and a fertile cause of dram-drinking in the people at large. As you pass along the wards and read the cards over the beds, indicating the diet and amount of drink ordered by the medical officers, it is startling to see how many sick or convalescent patients are ordered six ounces of whisky or brandy a day. Now six ounces represent three wineglassfuls of good average size, or say nearly two bottles a week. This is expensive, to say the least—of very questionable service in most cases to say nothing more. That the custom has its advantages in an hospital like the one we were describing is indisputable—to the medical staff. Where a system obtains by constant worrying and painful, or at least unpleasant physical examinations, it is of great assistance to doctors and nurses to have at hand an unfailing means of putting and keeping the patient in good humour and benevolent docility. Does he object to be “mauled about,” as he sometimes inelegantly calls his dose of “palpation and stethoscopy,” his equanimity is at once restored by the comfortable words of the doctor, “An ounce of brandy, sister!” Should he object to his treatment, and rebel against the hallowed customs of the place, considering he has a right to the orderly arrangement and general integrity of his own limbs, he is a lucky fellow if upon an early date his spirit card is not reduced, or even taken away altogether. You could not manage St. Bernard’s on its present lines without alcohol. The medical school would not have a chance with it. Let us follow, say, Thomas Smith from St. Giles to the hospital. He has inflammation of the lungs, is very weak and ill, has been badly fed and cannot in his own home obtain proper care and nursing. His clergyman kindly gives him a letter for the hospital. He is advised to be at the out-patient department at one o’clock. To make sure, the poor fellow’s cab is there by half-past twelve; the great waiting-hall is already filling. The physician of the day arrives a little after two. About three, if he is lucky, Smith’s turn will come. He is not sorry. It was weary waiting, sitting upright on a hard bench in a great noisy, draughty room, with many distressing and painful sights around him; and when the kind, gently speaking physician tells his wife to strip him to the waist, he begins to think he is going to be cured straight off by some of the superabundant medical force surrounding him.

There are many interesting clinical features in Tom Smith’s case, and the doctor lectures long and learnedly to the score of good-natured, athletic young gentlemen whom he has just been informed are “sucking doctors.” They have all come provided with stethoscopes, and after the examining physician has thoroughly thumped, pummelled, and “auscultated” poor Smith’s chest, back and front, as many of the aforesaid young men who are invited, or who can be induced to interest themselves, “have their go” at the patient, and are very kindly and patiently shown precisely where the mischief is, and what is the exact stage of its progress; but all this could not be got through without an ounce or two of brandy in a drop of water, in a measure glass that stands handy. And everybody having quite done, with many remarks, such as, “You see the point I was driving at, Mr. Dobbs?” or, “You are quite convinced my theory of pneumonia is correct, Mr. Murphy?” poor, shivering, sick and faint Tom Smith is sent up to the wards to bed, under the care of an entirely fresh physician, physician’s assistant, clinical clerks, and students of the in patient department.

None of those men who have spent so much time over the case, will probably ever see it again. Smith’s cards, papers, and books having all been duly made out, signed and registered, he is conducted, say, to Magdalen ward, where he is put to bed and made comfortable. If he has brought any tea and sugar with him, he can have a cup; but these things are luxuries not provided by the charity.

When the staff has dined, the house physicians and surgeons, accompanied by their clinical clerks, dressers, and nurses, go their rounds. All the fresh cases that have come in during the day have to be examined. All that Tom Smith has undergone in the out-patient department goes for nothing, and the process is now still more carefully repeated. A minutely exact record of the “physical signs” is made; all that drumming of the fingers on the poor tender chest, that long stethoscoping at the panting lungs, whose every movement causes acute distress, has to be undergone; the heart sounds are scrupulously noted; its size and the line of demarcation of the liver and other organs recorded, not by the qualified doctor temporarily in charge of the case alone, but, by his kind permission, his assistant clerks also, for their education, verify all the recorded facts for themselves. “An ounce of brandy, sister!” and the man suppresses his growing discontent. His night temperature is recorded on the card above his bed, and now, if so disposed, he may say his prayers and compose himself to sleep. At six in the morning he will have to get his breakfast, for work in a hospital must begin early, or the wards will not be scrubbed and tidied up by ten o’clock, when the doctors go their morning rounds.

If the gentlemen who examined him overnight have been duly interested in their cases, they will have read them up from the approved text-books; and it will be strange if that reading has not raised questions and points that will necessitate a fresh examination. So the man gets another ounce of brandy, and another knocking about. At three in the afternoon the head physician—a fashionable West-End speciality man for diseases of the chest—goes his rounds, followed by a crowd of students. He makes himself responsible for each of the cases in the beds allotted to him, and naturally wants to know all about them, especially if any of them are likely to make good subjects for elaborate clinical demonstration. So with tenderest grace and the most honied phrases, with every courtly apology to the patient for disturbing him, the great man proceeds secundem artem to teach the young idea how to shoot. The junior in charge of the case, reads his report of the physical signs, family history, diagnosis and prognosis of the case, with the treatment proposed, while the lecturer verifies or objects to the statements of the record. He is so thoughtful, so kind and sympathising with the poor fellow on whom he is going to discourse for the next half-hour, that having noticed he is distressed by the process before it is fairly begun, he, in his most mellifluous tones, asks, “Would you like a little wine or brandy, my friend?” And the poor man thinks he would. Then have at him, lads! for here is a pretty case, a typical text-book case, and all you who are going up for examination had better get all you can out of Tom Smith, for here are “minute crepitations,” “vesicular murmurs,” “obscured resonance,” and if you watch the progress of the disease you may get “tubular breathing,” “bronchophony” “increased vocal vibration,” and no end of good things. Tom Smith remains in the hospital six weeks before he is “discharged cured.” He has suffered many things at the hands of his physicians; he has cost St. Bernard’s say about a pound a week, besides his medical attendance. Who says he has gone out without paying his bill? It has occurred to no one concerned, least of all to the patient, that there is anything wrong in all this treatment. In their passionate eagerness to acquire information that can only be obtained at the bedside, the assiduous students are of course delighted to have Mr. Smith amongst them. The house physician is soon going into private practice, and he wants to consolidate and confirm all his knowledge of the various forms of disease; the lecturer loves nothing better than to exhibit his really admirable powers of clinical observation to a body of rising men, who can send him many patients and more guineas. The patient is usually delighted that so much interest is taken in his case, and contrasts the hurried “Put out your tongue; give me your hand; take this medicine, and I will see you again in two or three days;” all in a hop, skip, and jump style, of the club doctor, with this elaborate marshalling of great medical forces for the purposes of his cure, sadly to the discredit of the club doctor’s hasty method.

Nobody sees through it all;—yes, the sisters and the nurses do. The former do their very utmost to soften by their kind assiduity evils which they think are inseparable from the work of a public hospital. The nurses do what they have to do; it is their business to execute orders, and they usually say little, whatever they may think. Then says the reader, “Who is aggrieved? What is there wrong in the system?” What is wrong? Everything! From the long waiting in the out-patients’ ward; the exposure of such a case while the preliminary examination is made; to the long and dangerous examinations of the stripped sufferer in the ward upstairs: with their constant repetition by so many persons; so that it is probable he would have made a better and speedier recovery under the care of the club doctor, who seemed hasty because full of business, but who thoroughly knew what he was about, and only did not waste time over matters his quick eye took in at a glance, and whose large experience was an additional sense. All that auscultation had nothing to do with the man’s cure, but a great deal to do with the education of those concerned in it; and as the treatment consisted in salines, tonics, poultices and rest, with suitable food at suitable times combined with good ventilation and cleanliness, the elaborate exhibition of therapeutic force was very much like cracking a nut with a Nasmyth hammer, only the cracking of the nut was but a detail!

It is possible that if all this could be knocked into Tom Smith’s uneducated head, he might not again lend himself so readily to the business; still less is it probable that all those cheques would be drawn in favour of St. Bernard’s, if the subscribers knew just how the case stood. They might ask with much cogency, “Cannot we get our nuts cracked without the use of those costly steam hammers?” And, after all, that is a very important factor in the case. For consider! It is only by much begging and by resorting to many stratagems that the governors can keep these charities going. Now if the charitable Christian public chooses to crack its nuts with steam hammers, we cannot offer any objection. It seems costly, but that is their business; but if they think their nuts can be cracked by no other and less costly method, they are very much in the dark. Let alone the fact of so much unconscious cruelty, wrought in the name of charity and mercy. Of that we have said enough. The fees for a complete hospital curriculum average a hundred guineas for the four years’ course, an absurdly small sum for such an education. In what other learned profession could such advantages be obtained for twenty-five guineas a year? But then the charitable public does not assist other professions so liberally as that of medicine.