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sL-M/'n-  /'.y'  ^t,;^  •                                          Boston, August 20, 1810.
  1           : P     SIR,

                It has appeared very desirable to a number of respectable gentlemen, that a hospital for the re-
         ception of lunatics and other sick persons should be established  in this town.  By the appointment of a
         number of these gentlemen, we are directed to adopt such methods, as shall appear best calculated to
         promote such an establishment.  We therefore beg leave to submit for your consideration proposals for
         the institution of a hospital, and to state to you some of the reasons in favour of such an establishment.
             It is unnecessary to urge the propriety and even obligation of succouring the poor in sickness.  The
         wealthy inhabitants of the town of Boston have always evinced that they consider themselves as " treasu-
         rers of God's bounty" ; and in Christian countries, in countries where Christianity is practised,  it must
          always be considered the first of duties to visit and to heal the  sick.  When  in  distress every man be-
          comes our neighbour, not only if he be of the household of faith, but even though his misfortunes have
          been induced by transgressing the rules both  of reason and religion.   It is unnecessary to urge the
          truth and importance of these sentiments to those, who are already in the habit of cherishing them ; to
          those,  who indulge in the true luxury of wealth, the pleasures  of charity.  The questions, which first
          suggest themselves on this subject, are whether the  relief afforded by hospitals is better than can be
          given in any  other way ; and whether there are in fact so many poor among us, as to require an esta-
          blishment of this sort.
             The relief to be afforded to the poor, in a country so rich as ours, should perhaps be measured only
          by their necessities.  We have then to inquire into the situation of the poor in sickness, and to learn
          what are their wants.   In this inquiry v/e shall be led to answer both the questions  above stated.
             There are some, who are able to acquire a competence in health  and to provide so far against any
          ordinary sickness, as  that they  shall not then be deprived of a comfortable  habitation, nor of food for
          themselves and their families ;  while they are not able to defray the expenses of medicine and medical
          assistance. Persons of this description never suffer among us.  The Dispensary gives relief to hundreds
          every year ;  and the individuals who practice medicine gratuitously attend many more of this descrip-
          tion.   But there are many others among  the poor, who have,  if we may so express it, the form of the
          necessaries of life, without the substance.   A man may have a lodging, but it is deficient in all those ad-
          vantages, which are requisite to the  sick.  It is a garret, or a cellar, without light  and due ventilation,
          or open to the storms of an inclement winter.   In this miserable  habitation he may obtain liberty to
          remain during  an illness ; but, if honest, he is harassed with the idea of his accumulating rent, which
          must be paid out of his future labours.  In this wretched situation the sick man is destitute of all those
          common conveniences, without which most of us would consider it impossible to live, even in health.
          Wholesome food and sufficient fuel are wanting ; and his own  sufferings are aggravated by the  cries of
          hungry children.   Above all, he suffers from the want of that first requisite in sickness, a kind and skil-
          ful nurse.
             But it maybe said that instances are rare among us,where a man, who labours  with even moderate
          industry, when in health, endures such privations in sickness as are here described. They are not however
          rare among those, who are not industrious ; and who, nevertheless,when labouring under sickness, must
          be considered as having  claims to assistance.   In cases of long protracted disease, instances of  such
          a description do occur amongst those of  the most industrious  class.  Such instances are still less rare
          among those women,  who are either widowed, or worse than widowed.   It happens too frequently that 
modest and worthy women are united to men, who are profligate  and intemperate, by whom they are
left to endure disease and poverty under the most aggravated  forms.   Among the children of such fa-
milies also instances are not rare of real suffering in sickness.  To all such as have been described, a
hospital would supply every thing which is needful, if not all they could wish.  In a well regulated hos-
pital they would find a comfortable lodging in a duly attempered atmosphere ; would receive the food best
suited to their various conditions ; and would be attended by kind and discreet nurses, under the direc-
tions of a physician.  In such a  situation the  poor man's chance for relief would be equal perhaps to
that of the most affluent, when affected with the same disease.
    There are other persons also, who are of great importance in society, to whom the relief afforded
by a hospital is exceedingly appropriate.   Such are generally those of good and industrious habits, who
are affected with sickness, just as they are entering into active life, and who  have not had time to pro-
vide for this calamity.  Cases of this sort are frequently occurring.  Disease is often produced by the
very anxiety and exertions, which belong to this period of life ; and the best are the most liable to suffer.
Of such a description, cases are often seen among journeymen mechanics, and among servants.
    Journeymen mechanics commonly live in small boarding houses, where they have accommodations
which are sufficient, but nothing more than sufficient, in health—When sick, they are necessarily plac-
ed in small, confined apartments, or in rooms crowded with their fellow-workmen.  They are sheltered
from the weather, and have food of some sort, and these  must in many cases be  the extent of their ac-
commodations.  Persons of this description would do well to enter a hospital, even if they had to pay
the expense of their own maintenance.  In most cases they would  suffer less, and recover sooner by so
^m-■.:-■•   >'•"•:.-!;, as sometimes  happens, they have not the means of payment, they become objet  - of rha-
rey . una the welfare of such  persons should be considered among  the strong  motives in favour of esta-
blishing a hospital.
    Servants generally undergo great inconveniences at least, when afflicted with sickness ; and  of-
tentimes much more than inconveniences.  With so much difficulty is the care of them attended in pri-
vate families, that many gentlemen would pay the board of their servants at a hospital, in preference to
having them sick in their own houses.  In some cases however, neither the master nor servant can  af-
ford the expense of proper care in sickness.  Not uncommonly a young girl is taken sick in a large  fa-
mily, where she is the only servant.   She lodges in the  most remote corner of the house, in  a room
without a  fire-place.  The  mistress is sufficiently occupied with  the  unusual labours, which  are
thrown on her, at a time, perhaps, when she is least fitted to perform them.  Under such circumstances
how can the servant receive those attentions, which are due to  the  sick.  Of what use is it  that the
physician leaves a prescription to be put up at the Dispensary.  He  goes the next day, and  finds that
there has not been time, even to procure  the  remedies,  which he had ordered  ; meanwhile the pe-
riod, in which they would have been useful, has passed by, and the incipient disease of yesterday has
now become confirmed.
    Persons of these descriptions would not be disposed to resort to a hospital on every trivial occasion.
But, when  afflicted with serious indisposition, they would find in such  an Institution an  alleviation of
their sufferings, which it must gladden the heart of the most frigid to contemplate.
    There is one class of sufferers, who peculiarly claim all that benevolence can bestow, and for whom
a hospital is most especially required.  The virtuous and industrious are  liable  to become  ubjecis v;'
public charity, in consequence of diseases of the mind.  When those, who are unfortunate in t^e  ;
spect, are left without proper care, a  calamity which might have  been transient, is prolonged through
life.  The  number of such persons, who are rendered  unable to provide for themselves, is probably
greater  than the public imagine ;  and  of these a large proportion claim the  assistance of the affluent. 
 The expense, which is attached to the care o"f the insane in private families, is extremely great; and
such as to ruin a whole family, that is possessed of a competence under ordinary circumstances, when
called upon to support one of its members in  this situation.  Even those, who can  pay the  necessary
expenses, would perhaps find an Institution, such as is proposed, the best situation, in which they could
place their unfortunate friends.  It is worthy of the opulent men of this town, and consistent with their
general character, to provide an asylum for the insane from every part of the commonwealth.   But if
funds are raised for the purpose proposed, it is probable that the Legislature will  grant some assistance.
with a view to such an extension of its benefits.
    Of another class, whose necessities would be removed by the establishment of a hospital, are women,
who are  unable to provide for their own welfare and safety, in one of nature's most trying hours.  Hou-
ses for lying-in women have been found extremely useful in the large cities of Europe ;  and although
abuses may have arisen  in consequence, these are such as are more easily prevented in  a  small, than
in a large town.
    There are many others, who would find great relief in a hospital, and many times have life preserv-
ed, when otherwise it would be lost.  Such especially are the subjects of accidental wounds and frac-
tures, among the poorer classes of  our citizens ; and  the subjects of extraordinary diseases in any part
of the commonwealth, who may require the long and careful attention of either the physician or surgeon.
    It is possible that we may be asked, whether the almshouse does not answer the purposes, for which
a hospital is proposed.   That it does not is very certain.  The  town is  so much indebted  to  the libera-
lity of those gentlemen, who, without compensation, superintend the care of the poor, that we ought not
to make this reply without an explanation.  The truth is that the almshouse could-not serve the purpose-
of a hospital, without such  an entire change in the arrangements of it, as the overseers do not feel them-
selves authorized to make  ; and such as the town could not be easily induced to direct, or to support.
    The almshouse receives all those, who do not take care of themselves, and who are destitute of
property, whether they be old and infirm, and unable to provide means of subsistence ; or are too vi-
cious and debauched  to employ themselves in honest labour ; or are prevented from so employing them-
selves by occasional sickness.  This Institution  then is made to comprehend what is more properly
meant by an almshouse, a bridewell or house of correction, and  a hospital.   Now the  economy  and
mode of government cannot possibly be adapted at once to all these various purposes.  It must necessa-
rily happen that in many instances the worst members of the community, the debauched and profligate,
obtain admission into this house.   Hence  it has become in some measure disreputable to  live in  it, and
not unfrequently those, who are the most deserving objects of charity, cannot be induced to enter  it. To
 some of them death appears less terrible, than a residence in the almshouse.
    It is true, that the sick in that house are allowed some greater privileges  and advantages, than are
 extended to those in  health.  Yet the general arrangements and regulations are, necessarily,  so different
from those required in a hospital, that the sick, far from having the advantages afforded by the medical
 art, have not the fair chance for  recovery, which nature alone would give them.   Most especially they
suffer for the want of good nurses.   In these officers  must be placed trust and confidence of the highest
nature.   Their duties are laborious and painful.  In  the almshouse they are  selected from among the
more healthy inhabitants—but  unfortunately  those,  who are  best  qualified,  will always prefer more
profitable and less laborious occupations elsewhere.   It must then  be obvious that the persons employ-
ed as nurses cannot be such, as will conscientiously perform the duties of this  office.
    In addition to what has already been stated, there are a number of collateral advantages, that would
attend the establishment of a hospital in this place.   These are the facilities  for acquiring knowledge,
which it would give to the students in the medical school established in this town.  The  means of me- 
dical education in New-England are at  present  very limited, and totally inadequate to so important a
purpose.  Students of medicine cannot qualify themselves properly for their profession, without incur-
ring heavy  expenses, such as very few of them are able to defray.   The  only medical school of
eminence in this country is that at Philadelphia,  nearly four hundred miles distant from Boston ;  and
the expense of attending that is so great, that students from this quarter rarely remain at it longer than
one year. Even this advantage is enjoyed by very few, compared with the whole number.  Those who
are educated in New-England have so few opportunities of attending  to  the  practice of physic, that
they find it impossible to learn some of the most important elements of the science of medicine, until
after they have undertaken for themselves the  care of the health and lives of their fellow citizens. This
care they undertake with very little knowledge except that acquired from books ;—a source whence it
is highly useful and indispensable that they should obtain knowledge ; but one, from which alone, they
never can obtain all that is necessary to qualify them for their professional duties. With such deficiences
in medical education, it is needless to show to  what evils the community is exposed.
    To remedy evils so important and so extensive, it is necessary to have a medical school in New-En-
gland.  All the materials necessary to form this  school exist among us.  Wealth abundantly sufficient
can be devoted to the purpose without any individual's feeling the smallest privation of any, even of the
luxuries of life.   Every one is liable to suffer from the want of such a school ; every one may derive di-
rectly or indirectly the greatest benefits from its establishment.
    A hospital is an institution absolutely essential to a medical school, and one which would afford re-
lief and comfort to thousands of the sick and miserable.   On what other objects can the superfluities of
   ■ rich tx" -.. w-U i.esio-w-u
    Tht amovee • •.' : ib;d forvi> . ^^Oi.ntiOii proposed eu   "t first s *ht, appear large   ] ''O i^ m >:• c^osf
to appeal su, wneii ,/e ce;.^.«ui .iu-i. ni= to idluia ruiel, ^^ ouly t  those who may r>  x  ic assistance
during  the present year, or present age; but that it is to erect a most honourable monument of the mu-
nificence of the present times, which  will ensure to its founders the blessings of thousands, in ages to
come ;  and when we add that this amount  may be raised at once, if a few opulent men will  contribute
only their superfluous income  for one year.  Compared with the benefits, which such an establishment
would afford, of what value is the pleasure of accumulating riches in those stores, which are  already
groaning under their weight ?
    Hospitals and infirmaries are  found in all the Christian cities of the old world  ; and our large cities
in the middle states have Institutions of  this sort, which do great honour to the liberality and benevo-
lence of their founders.   We flatter ourselves  that in this respect, as in all others, Boston may ere long
assert her claim to equal praise.
                                               We  are, sir,
                                                    Very respectfully,
                                                          Your obedient servants,
                                                                         JAMES JACKSON,
                                                                         JOHN C. WARREN. 
 
 
 
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