287

it was simultaneously, and at once, rejectedby the skilful surgeon who then affordedhis assistance, and myself, both conceivingthat no benefit could possibly be expectedto arise from its performance at so late adate.As I, like Dr. Knox, can honestly dis-

claim all wish to enter the arena of criticism,he will perhaps have the courtesy, in hispromised letter, to afford me answers to thetwo following queries :-Has Dr. Knox ever seen a case of injury

from the pseudo-boa ?Is the doctor positive as to the familiar

knowledge possessed of this species inIndia ?

’

Mr. Corbyn, whose reputation as a lite-rary and scientific man stands high in India,did not know the snake from the descrip-tion of it that he received ; which, had itbeen frequently met with, he surely wouldhave done.The snake in question was, I know, pre.

served, and is, in all probability, by thistime in England. I am, Sir, your obedientservant, J. G. BRIGHTON.

OVARIAN CYSTS.

W. JEAFFRESON, Surgeon.

To the Editor of THE LANCET.

SIR:—In reply to Mr. Gorham’s veryelaborate and valuable observations on ex-cision of ovarian cysts, in THE LANCET ofOctober 5th, I beg to state that I was per-fectly sincere in claiming the more simplemode of operating in these cases, as thesuggestion of my own mind, never havingseen or heard of Dr. Hunter’s paper on thesubject. Indeed, I think that it is the defer-ence which has been paid to the giganticauthority of John Hunter, more particularlyto his theory of " Continuous Sympathy,"which has kept abdominal surgery in com-parative abeyance.

Since the publication of my last paper onthis subject I have witnessed the extirpationof an ovarian cyst by my friend, Mr. Crisp,of Harleston, Norfolk, from the abdomen ofa lady residing in that town, which hadexisted during more than 20 years, and forthe relief of which she had twice submittedto tapping. It contained about three gallonsof fluid, but had formed no adhesions to thesurrounding viscera, nor to those points ofthe reflected portion of the peritoneumwhich had been punctured in the previoustappings. This lady perfectly recovered,and is still in good health.-I am, Sir, your’svery respectfully,

THE LANCET.

London, Saturday, November 16, 1839.

THE MISERIES OF HOSPITALS.

WHEN the proprietors of the King’s College found that their shares were every daydeclining in value, that the medical classeswere at the lowest ebb, that the Professorhad to address empty benches, and that hy-pocritical observances could no longer besubstituted for scientific acquirements, theyappealed to the public for subscriptions,and cast about to build an Hospital for thepoor. They have partially succeeded intheir object. A 41 King’s College Hos.

pital" is to be erected, certainly not in thehealthiest locality of the metropolis. Mr.

ARNOTT, in his printed lecture, traces

Hospitals to the benignant fountain of

Christianity, and strenuously advocates

their extension in this’ country. We are

quite ready to admit that the medical at.

tendance upon our sick poor is inefficient;and that it is upon public charity, and theassistance of the wealthier classes, that theymust always look for relief, as they can-

not, by any exertions or sacrifices of their

own, remunerate medical practitioners.But we cannot admit that the Hospital anddispensary system at present in opera-

tion, is calculated to meet the exigencies ofthe case. They are imperfect institutions atthe best, and are, in every respect, very in.adequate substitutes for attendance uponthe sick poor at their own houses. Instead

of sinking immense sums of money in build-

’ ing more Hospitals, would it not be better toimprove the dwellings of the poor, and toprovide them with the means of warmth,ventilation, and cleanliness, at home? In-

stead of placing them at the mercy of nursesand strangers, would it not be more humaneto provide the wife with the means of watch-

ing over her children, or her sick husband?Instead of electing three or four officers towalk with great ceremony, or to hurry withindecent haste, through the wards upon oneor two days in the week, would it not be

288 DOMESTIC MEDICAL CARE.

wiser to expend the funds of the medical treated medically. The Temples of ÆSCU-

charities in paying the neighbouring medi- LAPIUS were resorted to by all classes; andcal practitioners for assiduous attendance ? they were planned so judiciously, that littleWe shall be prepared to answer these ques. doubt can be entertained of their superioritytions by and by; in the mean time, it is our over Hospitals, in many respects, if superi.deliberate opinion that the medical profes. ority be measured by the proportion of re-sion and the public would be better em. coveries. The Greek Temples of Healthployed in placing the Hospitals which are were not placed, like the Hotel Dieus, thealready in existence, upon a satisfactory St. Bartholomews’, the St. Thomases, or the

footing, than in founding new establishments London Hospitals, in the midst of a crowded,infected with all the vices and imperfections unhealthy city. They were built, as PLU-of their predecessors. TARCH remarks, out of the cities, upon high,

It is true, as a general statement, and was isolated spots; in the suburbs of the town,remarked by Mr. ARNOTT, that the Greeks as in Cos; in open plains, as that of Clitonis,and Romans had no Hospitals of any kind. in Arcadia; surrounded by gardens or sa.But Dr. BOURAS, a Greek Physician, has cred groves, which intercepted the insalu.rendered it probable, in a very able Treatise brious winds, and purified the air. In Elis,on Hospitals, that the Cynosarges, at Athens, the Temple was upon Cape Hyrminia, sur.was a Foundling Hospital (Brephatrophia); rounded by the most fertile and delightfuland that there was an institution of the same lands of the Peloponnessus; the celebratedkind in Rome, by the Columna Lactaria.* Temple of Epidaurus, near the sea, wasTo account for the absence of Hospitals, overlooked by fot’est-crowned hills. Mi.

Dr. Bouttns adduces the testimony of various neral waters, or rivers for baths, wereancient writers, to show that the moderate near. Sometimes’ gymnasia were erected.

poverty of the people, the humanity of rich The sick were rigidly dieted; their mindscitizens and physicians, general hospitality, were calmed or excited by the popu.watchfulness on the part of governments, lar superstition; and, living in the vicinitythe mode of living, salubrious habitations, of the Temple, they were not crowded

mildness of climate, and diseases (particu- within its walls, but were introduced, atlarly those of a chronic character) less fre- intervals, to receive the visits and prescrip.quent than in the present day, enabled the tions of the God. The priests upon theseGreeks and Romans to exist without Hos- occasions called mystery and illusion into

pitals. He maintains, notwithstanding, that play, and are exquisitely ridiculed byHospitals are of essential advantage at all ARISTOPHANES; but they preserved short

times; and his book is written to recommend histories of the cases, which served as a

their erection in Greece. The soundness of basis for the immortal works of HIPPOCRATES.

this recommendation is very doubtful, and The poorer citizens, no doubt, resorted to

it is not at all probable that diseases were the Temples of ÆSCULAPIUS, and the disciplesever less frequent, or less fatal, than in the of HIPPOCRATES would not turn them away,

present day ; but it does not follow, because as they, by oath, were enjoined to give gra.the Greeks and Romans had no Hospitals, tuitous advice to the poor.

that they had less humanity, or did less, Imperfect as was the provision for medi.with the means at their disposal, for the cal attendance upon the poor,-particularlypromotion of public health, than the founders the slave population, among the Greeks,of the institutions of the middle ages, in what are we to think of the Professors of a

which the sick were lodged, but never school of Medicine, who, looking down with————————————————————— something like pharisaic contempt upon the

* Paris, 1831. This Treatise is in modern . , . like pharisaic contemptupon theGreek, and is one of the first medical works inhumanity of the ancients, propose in the

t has appeared in that language. 19th century, with the experience of past

289ORIGIN OF HOSPITALS.

ages before them, and the discoveries of away the exhalations from their bodies.

modern science at their command, to erect The wretches were imprisoned in the lazar-an Hospital in a narrow street of London, houses, or, where these did not exist, in hutswhere fever is scarcely ever absent, and to (cucurbitæ, stellæ); but they received no

collect the sick poor within the walls of a medical treatment; and if the lazar-house

dreary house; looking neither upon groves, was a blessing, it was one for which it

streams, smiling fields, nor hills, but upon would not have been difficult to find a sub-

a damp, putrid churchyard ? And what are stitute. Medical treatment in the Hospitalswe to think of the men-who notoriously un- of the middle ages there was none; or it

dertake this project to support a declining was of the most delusive and irrational de-

school-when they appeal to the benevolent scription. As a body, the monks had no

public, invoke Christianity, and arrogate to knowledge of medical science ; their fan-

themselves a peculiar sanctity ? tastic doctrines, their credulity, and theirTo return to the history of Hospitals. duplicity, combined to render them incapable

Christianity created Hospitals and Monas. of investigating the laws of nature, and theyteries in the same age. The sick were had recourse to senseless signs, holy water,nursed by monks and fanatical parabolani. and extreme unction. The hospital knights,It is evident that Hospitals existed before the distinguished surgeon, Guide Cauliac, ob-the age of JUSTINIAN, for in his code, con- served, 11 Cum conjurationibus et potionibusstructed from the ancient laws, mention is et olea et lana atque caulis folio procurantmade of legacies left to establish Asylums ‘‘ omnia vulnera, fundantes se super illo,for pilgrims and sick persons. JUSTINIAN quod Deus posuit virtutem suam in verbis,beautified an Hospital founded by St, SAM- herbis, et lapidibus!" Could the institu-

SON in Constantinople. Several Hospitals for tions in which the treatment of the sick was

pilgrims were established in Jerusalem, in the carried on upon these principles, be of the7th century; the first was erected there by the slightest service to mankind ? And when it

merchants of Amalfi. In the lith century, the is recollected that the sick were often

Emperor ALEXIS built an immense establish- brought from the open country, and alwaysment, open to the poor, the orphan, and the crowded in the Hospitals as closely as thewidow. It was two stories high, and had a beds would stand together, while the win-

chapel for convalescents ; the sick were at. dows were small, and the whole establish-tended by monks, and the directors gave ment was dirty, no doubt can be entertainedin their accounts annually. In the 12th cen- that they destroyed twice as many as theytury, the Hospital of Byzantium enjoyed saved.

a high reputation ; it was called the Hospi. It will be right, nevertheless, to give thetal of the Forty Martyrs; the relics of the Christians of the middle ages credit for goodlast of whom had cured JUSTiNIAN of a intentions, although they would have donedangerous disease ! Hospitals rapidly in- better to restrict themselves more literallycreased after the Crusades. The Knights to the obedience of the divine injunction,Templar, the Knights of St. John of Jerusa- "Visit the sick," instead of collecting the

lem, of St. Lazarus, of the Holy Spirit, sick and infirm under the same roof, to save

sprang out of the wealth devoted to Hospi- trouble and expense.tals by the piety of Europe. Leprosy pre- The utility of Hospitals as medical

vailed ; thousands of lazar-houses were schools, is unquestionable; and it is remark-founded. able, that Heretics and Mahometans founded

Lepers were driven from society; If they the first Hospitals for clinical instruction.met a traveller upon the road, they were The Nestorians had in Dschondisabour ancompelled to By precipitately ; or to place Hospital, where medical students acquiredthemselves so that the wind might carry the treatment of diseases; and into which

290 THE SANATORIUM.

they were only admitted after having un-dergone certain examinations. Mr. ARNOTT

said nothing of this in his lecture; perhapsbecause the pain of mentioning Nestoriansamong the orthodox, would have over-

balanced the pleasure he must have felt in

stating that in Dschondisabour, as well as

in the Strand, it was necessary to have readthe Psalms of David, before being permittedto commence clinical study. The Arab

Caliphs established a College of Medicinein Bagdad, so early as the eighth century ; ;and it was the duty of the directors of theCollege to examine all candidates who

were destined to practise medicine. The

Caliphs also founded the first Hospitals andColleges of Pharmacy in Bagdad, to promotethe study of medicine. This was an enlight-ened step, and its policy cannot be ques-tioned. Mr. ARNOTT dwells on the utilityof Clinical Hospitals, and says, emphati-cally :-" We are indebted for the origin of Hos-

pitals to the promulgation of that religion ,,

which it is one of the main objects of this Col-lege to encourage and support."But he suppresses the notorious fact, that

the Mahomedans first founded Hospitals forthe medical treatment of the sick, as wellas for clinical instruction; and thus un-

generously insinuates that science and huma- !inity are the exclusive offspring of the creedwhich the College " supports," or, more

accurately, " which supports the College."The history of Hospitals in this country

begins with the Foundation Hospitals of

St. Bartholomew and St. Thomas. We shallreturn to the discussion of this importantsubject.

THE SANATORIUM.

To the Editor of THE LANCET.

SIR:—I trust that your vigilance will pointthe attention of the profession to a reportwhich has appeared in the public prints, of ameeting for the establishment of a concern,

which the projectors are pleased to call aSanatorium. The principle of this appears tobe, to extend the dispensary or medical-clubsystem to the higher ranks of life, and thecircumstance that the proposal has ema.nated, not from an exigent public, but chieflyfrom a few individual members of the pro.fession, is sufficient to create a suspicion asto its motive.

Notwithstanding that I believe it to be

impracticable to work this hybrid creation-half hospital, half tavern, as it is intendedto be,—I feel that the medical public arecalled upon to denounce the principleof it, as a piratical attempt, under the flagof CHARITY, to rob the profession, and par.ticularly the younger members of it, forthe benefit of a few. The statements whichare advanced in support of such an esta.

blishment imply that,,as a body, the pro.fession is grasping and oppressive, and thatthe heads of families and offices are regard.less and cruel to those who are immediatelydependant on them, whilst it offers a bonusto those who are really so. I should not befearful of leaving the public to decide thefirst part of this statement, and the profes.sion the latter, but sure I am that the medi-cal man deserves every imputation whichmay be brought against him, if he have notsufficient esprit de corps, or sense of justicetowards himself, to resist by his own effortsand the enlistment of his friends, the recog.nition of an establishment, which is at onceso unjust and unnecessary. The advocacyof Mr. Chadwick is, perhaps, more grace.less than that even of its medical friends,who, having done so much to degrade anoble science, by working, ex officio, themedical part of the New Poor-Law, to theinjury and insult of the profession, volun.teers his support for further encroachmentsupon their common. If, however, thesegentlemen have so large a stock of philan-throphy, unexpended and unemployed, letthem seek a more legitimate object, and ifit should occur to their minds that there aremembers of their own body, more destitutethan the objects their fancy has pourtrayed,let them at least pause before they narrowtheir means of support.

I would willingly go through the pro.spectus, but at this moment I have hardlytime to write even thus hastily upon the

subject; but for fear no one else shouldnotice it, I was desirous of calling your