SOME OBSERVATIONS ON THE Oeconomy and Government OF HOSPITALS. SOME OBSERVATIONS ON THE Oeconomy and Government OF HOSPITALS, Chiefly regarding MEDICINE. Most humbly addressed To all PRESIDENTS, VICE-PRESIDENTS, and GOVERNORS of HOSPITALS in and about LONDON. And to the Friends of the POOR, and of the ART OF PHYSIC and SURGERY. I was sick and ye visited me. Matt. ch. xxv. v. 36. LONDON: Printed for T. BECKET and P. A. DE HONDT, in the Strand. MDCCLXIII. (Price One Shilling.) [5] SOME OBSERVATIONS ON THE Oeconomy and Government OF HOSPITALS. IT is evident that every man who acts in a public capacity, and is ambi- tious of the name of a gentleman, or even of an honest man, ought intirely to lay aside all private views, either of in- terest or ambition, in so far as they ob- struct the public good. This holds equally true in great and in small mat- B ters, [6] ters, in the government of kingdoms and in that of lesser societies. Hospitals for sick and lame are a species of the latter. In no city of the world are there so many Hospitals as in London; and tho’ the spi- rit of charity abounds in this opulent and generous nation, yet allow me to say, in no country is Charity more abused, or Hospitals of less utility in promoting of improving the practice of Medicine. This last appears by the few publications of note on that important subject, in propor- tion to those of foreign nations. For tho’ Medicine is honoured and re- warded, in this free and enlightened na- tion, more than in any other country, and tho’ the opportunities of improving it are at present far superior here to those of any former period, or of any other nation, yet such is the general indolence and ne- glect of almost the whole medical order, that notwithstanding our great opportu- nities, [7] nities, there is very little done in that no- ble and important art, and the whole has too much the appearance of one great and enormous scene of quackery and abuse; our News-papers alone displaying a field of low quackery, that the very Hottentots would be ashamed of. But waving at present the general corruptions of Medi- cine, I shall confine myself to that of Hospitals only; the disorders of which I take to proceed from two great causes. First, the general corruption of manners, viz. the indolence, luxury, spirit of party and opposition that has so long and fatally reigned in this country, like a disease, among all ranks and orders of men, so as almost to eat out all public spirit, all pri- vate virtue and rational enjoyment. And, secondly, to the gros errors and neglects in the regulation and conduct of Hospi- tals. It has been long my wish, to see the conduct and spirit of my profession, B2 and [8] and particularly that of Hospitals, upon a new and better footing; not only for the advantage and honour of our noble profession, which in former days has shone so bright in this nation, but for the general good of mankind. And happy will that Hospital be, which shall set the first example to the rest, of a no- ble and spirited regulation, conducted with firmness and resolution, in spite of all the opposition of private interest or envy. But alas! in the state things are now in, and have been for a long time past, there is little hopes of this happy revolution; and yet, when I consider the real cha- racter of this great nation, and of many eminent and respectable men who are pre- sidents or governors of Hospitals; and above all, when I consider how highly acceptable all such useful improvements must be to his Majesty, as co-operating with his virtuous and vigorous admini- stration, [9] stration, I cannot help still allowing a beam of hope to rise upon my mind. It is needless to talk of mending trifles, and that now and then when a gap ap- pears; no, we must re-consider and re- examine the whole plan of Hospitals, in order to new model them, and establish order by penal laws; I mean the laws of the Hospitals themselves; and that by such a salutary and thorough reforma- tion, as not only order and harmony may be established between all the great de- partments of these Charities, but also (which is one great end of Hospitals) that the profession of Medicine may be by their means further improved and em- bellished. Were such a reformation once established, or even begun, in one Hos- pital, it would soon run through every other in London, and even extend itself over the kingdom, and into foreign parts, to [10] to the honour and advancement of the art of Medicine, and the great benefit of mankind. How unhappy is the case of some Hospitals, that while the acting go- vernors, on the one hand, manage its finances and oeconomy in the most exact manner, and the medical gentlemen, on the other, at least some of them, are al- lowed to be eminent in their profession, and remarkable for their diligence and humanity; I say, how unhappy is it, that notwithstanding all this, the most incu- rable divisions have hitherto prevailed, and are still likely to prevail, to the disgrace and ruin of these Hospitals, and the re- gret of every person of worth and ho- nour concerned therein? Alas! did these gentlemen attend and exert themselves with spirit and impartiality, such divisions and disorders would soon be at an end. Why do noblemen and gentlemen allow their names to stand in the list of gover- nors [11] nors of a Charity, which they think it below them to attend to? Is the care of sickness and poverty so little meritorious in the eye of Heaven, or of wife and good men, that no person of rank and educa- tion will trouble themselves therein? Or is the improvement of the art of Medicine below their notice? A profession that some time or other all men must trust their lives to; a profession that may be of the greatest use, at least all will allow its dis- orders may be of the greatest hurt to mankind; a profession that depends on so many noble arts, and on an entire cir- cle of learning; a profession whose essence is humanity, and that has done so much honour to this nation by the great men and great discoveries in the art that have had their birth here; tho’ at present it is in the most horrid confusion and disor- der, and loudly calls on all men, but espe- cially the legislative power, and those ap- pointed [12] pointed by it the guardians of Medicine and of the public health, to rouse them- selves, attack the many-headed Hydra of Quackery, and once more allow Medi- cine to appear in her native beauty and lustre. Since, therefore, Charity in general, and the art of Medicine in particular, are things worthy of the attention of the greatest characters in any nation, it is hoped that the governors of Hospitals, and especially the Presidents and Vice- presidents, will, from henceforth, for their own honour and the public good, employ some part of their time in so useful and honourable a work, and by no means leave the total management of things that require wisdom, honour, knowledge, re- solution, influence, and a disinterested pub- lic spirit, to the will and pleasure of a set of low tradesmen, who, however well inclined, can seldom raise their minds above [13] above narrow interested views, and whose education does not enable them to form and conduct noble and spirited plans. Surely the professors of Physic and Surgery have reason to complain, if they are left totally at the mercy of the inso- lence and ignorance of the meanest of mankind. It is an affront on learning in general, and on the art of Medicine, and reflects dishonour on these noblemen who, presiding in Hospitals, should be protec- tors and patrons of learning, if on a pro- per representation of these abuses redress is not given. Did these noblemen exert themselves in a proper manner, Hospitals would soon appear in a quite different character, and be of much greater use to the public, and particularly to the im- provement of the art of healing. I could mention many important regulations that are wanting in Hospitals, particularly in C the [14] the medical and chirurgical department; in which main and principal part, the end of all the rest, they are evidently most defective. But leaving this to a future occasion, I shall content myself at present with a few particulars, which will con- vince the judicious and liberal mind how defective our best Hospitals at present are, but particularly some few, which meerly from a party spirit, are at present a scene of disorder and confusion; by which means the increase, improvement, repu- tation, and ordinary business of these Hos- pitals, are greatly obstructed, to the dis- grace of all concerned therein. In the first place, therefore, I shall mention one grand and capital regulation, which of itself would introduce many others, and be soon fruitful of a thousand improvements in our Hospitals, and espe- cially of that harmony and order that is so [15] so much wanted, and is so essentially ne- cessary in every establishment. The re- gulation I mean, is to make a clear di- stinction between the two grand depart- ments in the management of an Hospital, the Oeconomical and the Medical. The confounding and not attending to this one distinction, is the cause of all the divi- sions and irregularity that usually happen in the London Hospitals. Now as it is evidently absurd and improper, that either the gentlemen of the professions of Medi- cine and Surgery alone, or the other go- vernors alone, should have the sole direc- tion of Hospitals, reason points out a na- tural middle way, by the want of which Hospitals have been so long defective and in confusion; and it is this: To establish two standing weekly committees, inde- pendant of each other, the one to have the sole direction of the finances, accounts, buildings, menial servants, and laws re- C2 lating [16] lating thereto. This I call the House Committee, or committee of finances and ordinary business. The other to be called the Medical Committee, who are to have the entire direction and superintendence of medical matters of every kind. These two great standing committees ought to be annually chosen by ballot at a general board, and ought to consist of the most respectable and skillful of the governors, and such as are most knowing in the sub- ject matter belonging to the department, and who are able and willing to attend. Of the latter committee, the physicians and surgeons of the Hospital, someone or more of each may be members, if chosen by the general board; but at least the one half of it should consist of men respec- table and knowing in matters of Physic and Surgery; and all of them ought, if possible, to be men of learning and edu- cation. In this committee, the apothe- cary [17] cary or house surgeon might, act as secre- tary, to save multiplicity of servants. By means of these two committees, the busi- ness of which is so intirely different (so that seldom the same men are fit for both) a thousand disputes and absurdities may be evited, and the same gentlemen will not be burthened with too much business, nor business of an opposite nature. The confounding of these two departments, has been the cause of almost all the absurdities and disputes in our London Hospitals be- tween the physical people and the other governors, and has been, and ever will be, a constant interruption to all noble im- provements; whereas the emulation be- tween the two committees, would most surely promote them. The above-mentioned disorders are evi- dent in almost every Hospital, but espe- cially in some where the medical gentle- men [18] men are not only excluded by an express law from any right of governors, even in making these very laws which they are obliged to obey; whereby they are not only degraded as gentlemen and members of a noble and liberal profession, but even robbed of that liberty which is the glory of the meanest British subject, viz. of be- ing governed by laws to which they give their consent. But this is not all; for by means of this law, some of the most ig- norant and contemptible governors of these Hospitals presume to usurp on every branch of the medical department, and to make their own ignorance and low ideas the rule of conduct in many things re- lating to medicine; the consequence of which it is easy to foresee. And this they are the more emboldened to do, by the assistance of some little understrapper of the profession, who, conscious of his own unworthiness, is on all occasions ready to sacrifice 2 [19] sacrifice as far as he can, the rights and honour of the profession, to please the ignorance and vanity of these low preten- ders to power and government; who are generally men that have been used to ty- rannize over the servants of some little shop or ware-house, and having got a little money, commence ridiculous Es- quires, but retain the manners and senti- ments of their original, without the ideas or spirit of gentlemen; a species of ani- mals in which this overgrown capital abounds. Now such gentlemen as these would have sufficient field, and be employed in what they really understand, in collect- ing and giving out the money, in deal- ing with tradesmen employed by the house, and in all the variety of domestic management. But all matters that con- cern science and learning, should be managed [20] managed by another set of men, who perhaps less fit for the business of the other committee, are perfectly fitted for this. Till the grand regulation of two committees be once established, it is im- possible that any true order and harmony can exist; and it is also impossible that Hospitals can appear with that respect and dignity that they ought to have, or that they can be improved by regulations which are necessary to bring, them to the degree of usefulness and perfection, of which they are capable, so that it would be a pleasure and improvement for men of a liberal mind to attend their meet- ings, and see the good that was there lone in curing the poor, and improving the art of Medicine. These two com- mittees may occasionally send messages to each other, or have conferences toge- ther, when the nature of the business requires it, and ought to give regular re- ports [21] ports to the general boards, which per- haps ought to be more frequent lest the committees should gradually usurp too much power. This simple improvement on the oeco- nomy of Hospitals, would soon be pro- ductive of an infinity of others, for the emulation between the two committees, and the improvements proposed by each, would open men's eyes to see every thing in a new and enlarged manner; things would occur, that few people at present think of, and the attention of the public would be more turned to these charities, not only to contribute their money there- to, but to assist by their thoughts and observations in their œconomy and im- provement. Many new and useful regu- lations occur even to my thoughts; judge therefore what would be the case when many gentlemen of rank and education D were [22] were met together for that purpose; and when different Hospitals endeavoured to vie with each other, for order and oeco- nomy. The present short differtation, is only intended to awaken the minds of men, and turn them to this important and much neglected subject; and I am fully per- suaded, that were our Hospitals once put under proper order and regulations, this nation would soon rub off the reproach of gross indolence and quackery in matters of Medicine, and that noble art would again revive in this nation, and flourish with the lustre of former times; new Harveys and Sydenhams would appear, new Arbuthnots, Friends and Meads, with a numerous band of such Physicians and Surgeons, as adorned this great city, and our Universities, in the more learned periods of this nation, when interest was not [23] not the sole governing principle, and when men had not lost all courage and inclination to support and admire truth, honour and science, or any noble attempt to revive them. But to confine myself to Hospitals alone: did proper regulations once take place, every one would soon become a noble school of Physic and Surgery, where these useful and noble arts would be re- gularly taught in all their branches; in consequence of which, the nation would no longer be over-run with Quacks and half-educated Doctors of every kind; and no paltry Lecturers in Medicine and Sur- gery would appear, provided the Go- vernors attended well to the characters of those they chose to fill the places of Phy- sicians or Surgeons in Hospitals, without favour, partiality, or party views; so that not only the natives of the British em- pire, but foreigners, struck with the su- perior 9 [24] perior opportunities and oeconomy of Me- dicine and Surgery, as with the other ad- vantages of this great nation, would yearly flock to London (as they have often done to famous Universities all over Europe) as the most useful and illustrious school of Medicine, and of true knowledge, that ever appeared in the world; especially if the British Museum was erected into a noble school of Arts and Learning, and of manly exercises, suited to the charac- ter of this enlightened age, and of a great, free, and commercial people. FINIS.