TAKEN IN.
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._
There are diviner, truer laws,
That teach a nobler lesson still.
_Procter._
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.