An essay on humanity: or a view of abuses in hospitals. With a plan for correcting them. By William Nolan.

AN ESSAY ON HUMANITY, &c.

IT is no less a compliment to the libe∣rality and wisdom, than to the huma∣nity of Great Britain, that it takes prece∣dence of all other states in Europe for the number, variety, and affluence of its cha∣ritable institutions. The large voluntary subscriptions in supporting hospitals for every species of calamity, entailed on hu∣man nature, excite sentiments of the most exalted sensibility in the feeling breast.— All benevolent descriptions of mankind must sympathetically partake of blessings thus indiscriminately diffused. And though our feelings may be wounded, either by the sight or recital of the afflictions insepara∣ble from the constitution of human nature, yet we are in a great measure consoled by the reflection, that these mansions of hos∣pitality are erected for their alleviation.— The great mass of mankind ever has been, and ever will be, formed of two compo∣nent parts, good and bad.—The one ever

solicitous to promote the happiness of their fellow-creatures; the other to counteract these laudable efforts. This is a truth so well established by the experience of suc∣cessive ages, that a further commentation on it here, might be justly considered an impertinent prolixity. I am led to this reflection from the wanton abuse which is known but too generally to prevail in the above mentioned god-like institutions.— Where avarice and insensibility in the offi∣cers and servants (not to say neglect in the physicians and surgeons) belonging to these establishments frequently prevent the un∣happy patients from receiving that conso∣lation in them that the nature of their ma∣lady demands, and which was the primi∣tive object of their pious and humane foun∣ders. To correct these enormities is the avowed object of the present work, and success in the undertaking, will be to me the most acceptable reward of my labour. It will ever be admitted by the advocates for humanity, that the greater the distress of the object, the greater his recommen∣dation to the care of philanthropy; but some instances, which I shall hereafter men∣tion, seem to confirm, that they maintain a contrary opinion in hospitals; and that the greater the distress of an object, solicit∣ing relief there, the greater the difficulty of removing it should seem necessary.—

The following circumstance (which may be depended upon as authentic) I shall mention, as well for its singular cruelty, as a confirmation of the imputation just men∣tioned Curiosity led me to St. Bartholo∣mew's hospital on a taking-in-day, as it is termed) when a patient was admitted into the ward where I was; and after pass∣ing through the extra-formalities necessary for such admission, he was introduced by one of the beadles to the sister of the ward, who at first received him with that affect∣ed cordiality and seeming tenderness which pecuniary expectations make low minds as∣sume; after which she asked him,—"Had he got his wardage?"—The unhappy man said, "He had no money—That the last six-pence he had in the world he gave to the beadle who shewed him into the ward." The tender hearted sister on this informa∣tion flew into the most outrageous passion, and in an imperious elevation of voice, in which were blended insolence, ignorance, and barbarity, demanded, "How he dare come there without it? Did he not know it was customary? and that it was her due or perquisite?"—with a number of other interrogatories equally divested of decency, as humanity. The trembling patient mo∣destly replied, He believed it might be customary; but alledged his inability as his only reason for non-compliance to it. This

affecting confession, so far from softening the heart of the inexorable sister, exaspe∣rated her still more, in so much, that she absolutely insisted on his turning out of the ward immediately, and actually proceeded to push him out: shock'd at such unexam∣pled inhumanity, I arrested her in the ex∣ecution of her unfeeling purpose.—"Hold, monster, said I, here is your wardage, and may the gin you procure for it, rid human nature of so great a reproach to it!" This inveterate imprecation I could not restrain, in the moment of my indignant resentment and detestation, for such unparrallelled in∣sensibility of soul!

I shall leave the mind of sensibility to make its native sympathetic comment on unfortunate wretches in the situation above described, and shall only observe, that such inhumanity is in diametric opposition to the very name and nature of an hospital; and shews a lamentable degeneracy of the institution.

This perquisite of wardage operates va∣riously to the disadvantage of patients;—It makes the sister look with the eye of anx∣iety on the patient in all the progressive si∣tuations and stages of his cure; not from a humane concern for the restoration of his health, but with an avaricious expectation

of having him discharged, as she is to get 3s. from the person whom accident or de∣cease makes his successor; and as, perhaps, she has no other bed in her ward to accom∣modate such casual successor with, but that occupied by some half-cured patient. It is therefore very evident, that the number of cures effected in the ward committed to her humane superintendance, is not so much the object of her solicitude, as the number of patients admitted into it, as she has 3s. for each. It is very reasonable to infer, from this circumstance that her tenderness will not be much exerted towards the pati∣ents: the very reverse is justly to be appre∣hended, as she must know from experience, that moroseness and brutality might induce some to quit the hospital before their cures were accomplished, though tenderness and humanity would be an additional induce∣ment to them to stay for that very desirable purpose, to be accomplished.

Another infamous practice of these wretches, to multiply their perquisites, is to prefer complaints to the steward against the unhappy patients; for if in the acute∣ness of their pains they are guilty of the least vehement expression, they are imme∣diately represented to the steward as intol∣lerably noisy and troublesome. Thus for not having the constancy to maintain an

equality of temper in the extremity of pain, they are painted out as intolerable and for no other human reason, than that perhaps their agonies are so! and a dismission soon after, notwithstanding any pathetic remonstrance to the contrary, is frequently the conse∣quence.

This despotic act of power in the Lord Steward is faithfully copied by the Lady Matron in her department, with this dif∣ference only, that the delicacy of the com∣plaints, which females frequently labour under, will not dispense with so immediate a dismission, but in any circumstances where they will, her plenitude of arbitra∣ry authority will be as severely, and as in∣stantaneously exercised; and for the same iniquitous reason already mentioned.

Is it not a melancholy consideration, that the health, or perhaps the life, a use∣ful member of society should thus fall a facrifice either to the avarice of the sister, or the captice of the steward? and it a∣mounts to more than a presumption, that this is frequently the case, when patients are turned out of the hospital before their cures are effected. The disorder, upon the point, perhaps, of being conquered by the regimen prescribed and followed, when the process of medicinal application is inter∣rupted,

returns to its wonted strength, at a time that the body is considerably exhaust∣ed by the abstinence imposed by regimen: when a conflict between recruited disease, and harrassed nature ensues, which must necessarily terminate in human dissolu∣tion.

The number of evils arising from this pernicious perquisite of wardage, are as obvious as they are distressing to the poor afflicted part of the community; it is there∣fore hoped, the governors and subscribers to hospitals will apply a radical cure to the evil, by totally suppressing it, and substi∣tute in its room an additional equivalent of salary to the sisters and nurses; for, to the eternal reproach of human nature, I must own, that while the degraded princi∣ple or passion of self-interest, stands in op∣position to the discharge of any duty, there will be found very few, especially in the inferior orders of mankind, who will not make that duty subservient to their interest, however important to society the faithful discharge of such a trust may be! And indeed I may venture to affirm, that the ills and calamities ideally ascribed to Pan∣dora's box, will be realized by the conti∣nuance of this, with other prohibitions on humanity, which I shall hereafter mention. How many are the unfortunate objects, who

from having large families, painful illness, or a long want of employment, are in ac∣tual want of subsistence, it is not therefore strange, that under the pressure of any, or all of these calamities, they should want a few shillings; but it is very strange indeed, that this want should be the foundation on which the want of being cured is built, as they can not get into the hospital without it, as has been already sufficiently demonstrat∣ed? This illustrates and explains that ne∣gative text in the scripture, so remarkable for its obscurity, "And from those that have nothing, even that which they have will be taken from them."—It applies immedi∣ately to the peculiarly unfortunate wretches I have been just describing—having nothing but hope, and even that is taken away from them by this ill-timed rejection of their double claim to compassion.

It is also customary (nay indeed it is in∣dispensibly necessary, in order to be admit∣ted into the hospitals) for the patient to bring two clean shirts with him besides the shirt he wears, which must be clean also; to the propriety, decency, and utility of this regulation, I very readily subscribe, where the circumstances of the patient will admit of a conformity to it. I admit it is also a co-operative assistance in the restora∣tion and preservation of health in the course

of medical application—for as filth is as obnox ous to health as to sense so is clean∣liness as useful to the one as agreeable to the other. But do all these reasons united justify the cruelty of rejecting an unhappy patient for non-conformance to this hospi∣tal mandate, especially when unrelenting necessity is the cause? Will any good, in∣tended to be promoted by it, counterba∣lance the evil promiscuously entailed on every unhappy wretch thus rejected? No—I am confident it will not! Let us for a moment enter into the thoughts of the unhappy creature thus disappointed.—All his less acute sorrows, which before lay in a state of torpitude, are now new-edged by this recent aggravation of his calamities! His poverty, his hapless helpless irremedi∣able poverty he justly considers as the cause of this consummation of human woe! his mind is alternately torn with the passions of grief and despondence, when he sees even the probability extinguished of hav∣ing his health re-established!

Though the above is a melancholy, yet it is a true picture of the human mind bending under the complicated lead of grief, poverty, and pain.—Therefore, how∣ever commendable it may be, to relieve the misfortunes of our fellow creatures, it

is much more so to prevent them, by the timely exertions of wisdom and liberality in their behalf. For accomplishing so me∣ritorious a purpose, I would recommend it to the governors, &c. to have half a dozen or a dozen of coarse cloth shirts in each ward, and that the sisters and nurses might be ordered to accommodate such unfortu∣nate patients as above described, in such manner as their respective necessities should demand. The object of additional expence on this occasion would be very inconsider∣able, but when put in competition with the blessings resulting to individuals, and to society at large from it, it would entirely vanish. This indulgence not to be extend∣ed to any but those whose necessities alone should entitle them to it. How many useful members of society, by the exten∣sion of this well timed benevolence, would be enabled to resume a life of honourable industry, who might, through the want of this means of seeking to recover their health, become an incumbrance to society, as would also their relatives, whose imme∣diate subsistence was drawn from the exer∣cise of their trade?

WORKHOUSE PATIENTS.

It frequently happens, that parish patients are brought to Hospitals, to the very great prejudice of the patients who are before warded in them, as these parish patients have a distinction paid them very injurious to the convenience, and sometimes to the health of those other patients, who are re∣moved out of their beds, though they should be even in the extremity of a fever, to make room for the parish patients; and only for the pitiful consideration of four∣pence a day! which the parish allows in such cases; and which becomes the per∣quisite of the servants belonging to the hospitals. This is a bare-faced partiality, and a flagrant outrage on the rights of hu∣manity, and consequently calls loudly for redress.

The FOOD for PATIENTS.

With respect to the quality and quantity of food appointed for the use of the pati∣ents, it appears to me, in a general sense, tolerably well calculated to answer the ends proposed by it; but notwithstanding, some alterations and additions might be made in some particular cases, exclusive of the hos∣pital

allowance, especially to such patients as are afflicted no otherways than by wounds or sores of little or no malignity, and whose constitutions are not debilitated through antecedent excess. An abstinence from a sufficiency of food, in a constitution thus circumstanced, lays the foundation of seve∣ral disorders—as belchings, windy cholics, dizziness in the head, &c. &c. and in juve∣nile constitutions it is the undoubted fore∣runner of a consumption—a line of distinc∣tion should be therefore accurately drawn between those who, from the nature and malignity of their complaints, can not eat so much as the hospital allowance, and those who from contrary reasons could eat more, without endangering their health, or retard∣ing their cure. Such patients should by all means have an additional allowance, lest the restraining them in this particular should be productive of the unhappy consequences above particularized.

Though this encrease of food would incur a small additional expence, yet it would be a temporary one, and in its consequences would prove a saving. As this assertion has the mysterious appearance of a paradox, I solve it thus—Many patients, of the de∣scription now in question, contract those windy consumptive complaints when in

the hospital for want of a sufficiency of food, who are obliged to go back there again for their cure, and perhaps stay there until they become infinitely more expen∣sive, than by giving them the necessary ad∣dition of nourishment above mentioned, the first time they were in the hospital.

Security to bury Patients who die in the Hos∣pital, or to lodge a Deposit equal to the Expence that such Interment may amount to.

THIS regulation appears to me fraught with cruelty and inhumanity; as it is un∣doubtedly the cause of several of the most unhappy of our fellow-creatures breathing their last in the poor and obscure environs of this extensive metropolis!

Every patient is (according to this law or regulation) obliged to find one or two house∣keepers, to subscribe to an undertaking to bury him, in case he dies in the hospital; and unless he can procure such responsi∣bility, or advance a stipulated deposit him∣self, to defray the incidental expence, what∣ever may be his claim to humanity, from the complicated wretchedness of his con∣dition,

he is utterly precluded admission. The degrading vice of self-interest, which in a great measure pervades all descriptions of mankind, will immediately point out the insurmountable difficulties which will attend—a friendless—sickly—and pennyless individual in procuring such responsibility! But this is not the only instance which shews a manifest perversion of the inten∣tion of those temples of compassion!— Though it is enough to shew, that at pre∣sent the internal as well as external regula∣tions of them are only directed to the re∣lief of such as are in part distressed, those that are wholly so, they seem to think, should remain so—as is sufficiently evinced in the instance now under consideration! Why should not this inexorable law be dispensed with, in cases where there is not the least human likelihood of the patient's dying in the hospital? And in cases where such a fatality may with justice be apprehended— is not (though shocking to humanity to relate) the wretched objects body a suffi∣cient forfeiture for this temporary mitiga∣tion of the calamities which terminate with life!

PHYSICIANS and SURGEONS.

Having now pointed out some of the Enormi∣ties of the Servants, I shall take the Liberty of making some Observations on the Con∣duct of the Gentlemen belonging to the Hospitals.

Immediately antecedent to a patient's dis∣charge from the hospital, he passes through a very ridiculous unnecessary formality:— He is called into a room where the Physi∣cians and Surgeons attend, and asked—If he has any complaint against the sisters or nurses, &c. In the name of common sense I would ask—admitting he had—Of what consequence would it, or could it be, to say so then? What advantage would result to him, to tell the gentlemen, That he was not treated with the tenderness he expect∣ed? and which from the intention, as well as constitution of the charity, should be shewn him? or that the peculiar circum∣stances of his complaint demanded:—Of what utility could it possibly be to him, just at the moment he was to be discharged, to say, he was not tenderly or carefully nurs∣ed. Such information now, would, like a malicious accusation, especially when it could not have for its object the redress of

such grievances, as to himself! Had these questions been proposed to him during his residence in the hospital, for instance (the first week after his admission) the fear of incurring the displeasure of the gentlemen might exact that tenderness from the sisters and nurses, which the fear of violating the obligations of humanity could no. This therefore I take to be an after-piece of at∣tention, and consequently nugatory and unavailing: for if any thing can equal its absurdity, it is its palpable inutility.

Without intending the least disparage∣ment to the respectibility of their profes∣sion, or the integrity of their principles, I would earnestly recommend to these gen∣tlemen a more humane regard to the feel∣ings of their unhappy patients. I have fre∣quently heard, and beheld with astonish∣ment, gentlemen who arrived to the highest pitch of eminence in their profes∣sion, use exceeding harsh language and ap∣parently unfeeling treatment to their pati∣ents, when in the most agitating mental anxiety, and under the most excruciating corporeal pain. This is a conduct which is by no means reconcileable to the dignity of the gentleman, the sensibility of the man, or the profession of a surgeon. Peo∣ple of this assumed or natural austerity of

manners, should reflect, that there are some constitutions so delicately constructed by nature, that though they have arrived to maturity in years, are but infants in the great virtues of patience and resignation; and consequently require the same cordia∣lity and affability in their treatment.

Another prevailing practice in an hospital, and which, to excite general indignation, needs only to be mentioned, is, That if a Surgeon's patient has the misfortune to have a leg or an arm dangerously afflicted, am∣putation is immediately proposed, without any previous consultation, whether a pos∣sibility exists of effecting a cure, without having recourse to this desperate alterna∣tive! Surely in a matter of such magni∣tude to human nature, as the mutilation or dissolution (which frequently follows it) of one of our species, it merits the utmost professional deliberation, before such unre∣lenting resolutions are decidedly adopted.— For, exclusive of the horrible fears that an∣ticipation unavoidably excites in the pa∣tient's mind, preparatory to amputation, the excrutiating pain of the operation must be indescribeably great! Why then wanton∣ly or incautiously condemn a fellow-crea∣ture to such intolerable pains of mind and

body, if there are any possible human means to avoid it!

But long experience and impartial obser∣vation suggest to me a consideration, which at the same time that it accounts for this inhuman premature propensity to amputa∣tion, reflects very little honour on the prin∣ciples of the chirurgical tribe, which is,— That experiments of this desperate nature are made on the POOR, that they may be practiced with more probability of success on the RICH. Though this is a harsh imputation, yet I conscientiously believe it to be true in vari∣ous instances; but, for the honour of hu∣man nature, I hope there are a number of exceptions to it.

Indeed I am confident to assert, and ready to prove, that in many instances, there is not that attention paid to hospital patients that there ought to be; for, unless some singular affliction attracts the attention of the gentlemen, the patients frequently lan∣guish under common complaints with as little prospect of redress in the hospital, as out.

In order to the substantiating what is al∣ledged above relating to amputation, I shall recite the following instance, which came under my own immediate knowledge.

Some few years ago there was a patient in St. Bartholomew's Hospital, who labour∣ed under a violent inflammation in his left arm: a certain great professional character, whose amputating abilities are as universal∣ly known as admired, ordered amputation immediately on the first sight of the arm, without ever consulting the patient, or giv∣ing himself a moment's time to enquire into his habit of body, or disposition of mind, on so momentous an event. The man anticipated his advice from his general character, but absolutely refused to comply with it, very rationally considering, that if a course of medicine was prescribed, for the purpose of correcting and purifying the blood, it would probably abate the in∣flammation, and on that event's taking place, external applications might operate more effectually. This reasonable expec∣tation was soon afterwards justified, for in less than the short space of a month, the patient was discharged from the hospital with his arm perfectly healed! a living mo∣nument of the cruelty and justice of hav∣ing recourse to amputation, unless in cases where the unequivocal symptoms of mor∣tification make it indispensibly necessary. I have every reason to apprehend the in∣stances of such cruel inattention are not few, nor the still more cruel consequences

with which they are attended; nor can the circumstance of this unrelenting practice, not being more generally known, in the least invalidate the probability of those humane apprehensions being just, as can be very rationally inferred from the case just mentioned.

Respecting the Clergyman who attends the Hospital.

Having now represented what bodily in∣conveniencies patients labour under, I shall proceed to examine the inattention shewn to the still more exalted and important concern, their souls.

Ingratitude, it is justly observed, is a crime of Syrian dye; but alas! it is a crime from which very few of the human race can plead an exemption; particularly to that supreme Being whose mercies to us demand our most animated gratitude! while in the meridian of health and prosperity we neglect those great duties we ought to perform, and which, when descended under the clouded horizon of sickness and adversity, we cannot perform. It is in this state the mind resumes its salutary attribute of reflection—It is then she would wish, by a life of prudence and penance in fu∣ture,

to ward off calamities which ante∣cedent intemperance or impiety make her dread for the present, both as to body and soul! When the human mind is in this susceptible disposition, a wise and humane clergyman should avail himself of its situ∣ation (as in it we are more inclined to hear and follow good advice than at any other time) by visiting patients in such situati∣ons, and admonishing them to refrain from a repetition of those irregularities, which perhaps laid the foundation of their present sickness; and that such sickness was the consequent punishment, of their criminal neglect of the performance of their religi∣ous duty:" or in any other pathetic manner, that the love or duty of Christianity might dictate.—For, as the state of heat, in me∣tallic substances, is the state wherein they are made capable to assume new or beau∣tiful forms, so the state of affliction is the state to mould the human mind to every pursuit that is congenial to the dignity of its nature. But, I am extremely sorry to say, that there is very little attention paid to the discharge of this indispensible duty in an hospital; more especially at the time that it is most necessary, towards the ap∣proach of death!—For, it is truly lamen∣table to see, how shamefully negligent in this momentous concern, are the people

about an expiring wretch in an hospital— to whom custom, joined to innate insensi∣bility, has made it as indifferent to see a patient leaving the world, as leaving the hospital! This conduct is not only in∣human, but impious in the highest degree; as at this awful tremendous moment, de∣sponding fears and infidel doubts find an easy conquest of a mind, which, though not strengthened by Christian philosophy, is considerably weakened by disease. This, therefore, is the time to administer to the exhausted mind the lenient balsam of Christianity, by infusing into the anxious, trembling, palpitating soul a conviction, a hope, and a belief of its divine and merci∣ful author's protection in a future state! I would not dwell so long on this matter, but from an internal conviction, that vir∣tue and good morals are as often the means of preserving health, as medicine is in re∣storing it. A proper method of treating the minds and morals of patients shall be pointed out hereafter in its place; that is, immediately after suggesting a plan for the removal or mitigation of all the antecedent bodily inconveniencies alluded to.

The PLAN for Reformation.

Having now shewn the neglect and abuse of hospitals, I shall proceed to the method of correcting them; and in their room to recommend regulations which, if adopted, will be productive of the most salutary ef∣fects, with very little additional expence to the institutions. For the accomplishment of this desirable purpose, I would re∣commend it to the governors, subscribers, &c. to appoint a committee from amongst themselves, to be called, The Humane Com∣mittee, whose office might be to examine minutely into the arrangement and treatment of the patients; to discover any neglect or inattention to the cure of their respective maladies, in order as well to remedy them, as trace out the source from which such inhuman negligence originates.

This Committee should have a discreti∣onary power from the governors, &c. to examine, with the most scrupulous atten∣tion, the disposition and character of those who are candidates for any office, internal or external, belonging to hospitals. In order to have ample satisfaction in this momentous particular, I would recommend that each candidate should undergo the following, or some similar examination, viz.

What life did they lead antecedent to this particular period? whether moral or debauched? religious or profligate?

What capacity in the commerce of soci∣ety did they fill? whether they discharged with probity the relative duties annexed to such employment?

And particularly, what was generally re∣puted to be the natural bent of their dis∣pofition; whether morose or humane? for, from the man of humanity, the discharge of all social obligation is as reasonably expected, as their violation is to be appre∣hended from a man of a contrary stamp.

If the candidates could undergo a liberal examination of this tendency, corroborat∣ed by some respectable characters of their acquaintance, they might with propriety be admitted, otherwise not.

This would infallibly annihilate partial recommendation—the contaminated source from which various evils flow to the hu∣man race—as there is no line of discrimi∣nation or distinction drawn by it, between the worthy and unworthy, often bestowing upon ignorance and inhumanity appoint∣ments, to which in moral rectitude geni∣us,

us and philanthropy have the justest claim. I am very well convinced from my obser∣vations on human nature in the melancho∣ly stages of perturbation of spirit, and cor∣poreal pain, that a patient's cure is as much accelerated by the tenderness and humanity of the nurse, as by the most obedient con∣formity to the prescriptions of the doctor; and that to effectuate a cure in the body, I hold it absolutely necessary to maintain peace in the mind. It is evident from this, how essential it is to the health of a patient, to have an affectionate tender nurse; and consequently how necessary the precaution here recommended for the admission of such—as also the rejection of such others, as do not fall under this denomination.

This committee should have a power of suspending any officer or servant already employed in the hospitals, on preferring and substantiating any charge of injustice, inattention, or inhumanity against them; and also of substituting in their room others, who, after examination, should be found possessed of the qualifications already particularized.

The committee should consist of about eight persons, of which number a physi∣cian and surgeon should always make two. The necessity of adding professional gen∣tlemen

will appear obvious for the follow∣ing reasons:

• First. The patients under a physician may have a very just cause of complaint, and though the Humane Society might be dis∣posed to remove it, yet from a want of professional knowledge, they might (through the insinuations of the sisters and nurses) be induced to believe, that such treatment as the patient received, was necessary for the correction of his disorder; and that it was the doctor's express requisition to pursue invariably such and such prescrip∣tions: a gentleman of the faculty being of the committee, will easily discover, whe∣ther the treatment such patient receives is or was adapted to remove his complaints; or whether the process prescribed is sancti∣fied by experience, for being efficacious in removing maladies similar to those under which the patient labours. — If not, the report of the physician belong∣ing to the Humane Committee to the Hu∣mane Committee at large, would point out an abuse, which, for want of this profes∣sional investigation, would remain conceal∣ed; and which, in my opinion, would de∣serve particular reprehension. And if a remonstrance, from the Humane Committee to such physician, did not immediately

• produce a variation in the subsequent treat∣ment of his patients, a report then to be made to the governors, subscribers, &c. at large, who, on the impartial confirmation of such dangerous inattention, should pre∣vent a repetition of such delinquency by the suspension of its author.
• Secondly, The surgeon, to be added to the Humane Committee, to have an equal su∣perintending controul, and unlimited pri∣viledge of inspection as the doctor, into the surgeons patients, their maladies and manner of treatment; and also any neg∣lect, incapacity, or inattention in those gentlemen, whose immediate province it should be to attend this description of pa∣tients, and to make the necessary report as in the case of the physician.

It is a matter of no consequence to the unhappy patient, who loses his health for want of due care, whether his misfortune is attributable to the inhumanity of the nurse, or the inattention or ignorance of his doctor; and here I cannot avoid observ∣ing, that as much from these causes, as from any incurable obstinacy of his disor∣der, the patient's dissolution happens.—Whether abuses of this magnitude, fraught with consequences the most conspicuously subversive of the original intention of these

institutions, demand the interposition of the protecting hand of humanity, I leave it to the sensibility of the feeling mind to determine!

I would not be understood here to make the most distant insinuation, that the in∣stances are many, where patients suffer through the ignorance of the physicians or surgeons, and even when they do it is more from negligence than any professional inability; for if they will not sedulously examine the patient's complaint, they un∣doubtedly must be ignorant of it, and con∣sequently of the most efficacious manner of treating it. An imputation of this species of ignorance they very frequently and very justly deserve. I think inclina∣tion should co-operate with duty, in expe∣diting the cure of disorders which time makes—multiply in malignity—to the in∣supportable multiplication of the unhappy patient's afflictions!

These affecting considerations should be particularly attended to by the Humane Committee.

With respect to the young gentlemen who walk the hospital for information, that levity which is almost the inseparable characteristic of youth in any profession, pre∣vents

them from paying that compassionate attention to the present disorder (which without being radically cured lays the foundation of the future calamity) of pa∣tients, that they so pressingly demand.—To remedy this evil, it is indispensibly in∣cumbent on the senior practitioners to re∣commend by precept, and enforce by ex∣ample, the humane attention here recom∣mended, and a doubt cannot remain of such conduct being circumspectly copied: it would not only imperceptibly introduce a professional, but also a humane emulation amongst them, especially when they con∣sider, that humanity gives the highest polish to their professional character. I must as∣sert with regret, that at present, the majo∣jority of the young gentlemen who walk our different hospitals are very little under the dominion of the humane power of sympathy; for it is no uncommon thing to hear some of them (wrapt up in all the coxcombical consequence•• of self-admira∣tion) hum an opera tune while an operation is performing on a fellow-creature. To this perhaps it may be replied, that the frequency of operations and amputations familiarizes them to such affecting sights, and that there is a professional necessity for a surgeon's being divested of the feminine weakness of pity, in desperate eases. To the propriety of this I readily subscribe, so

far as courage is necessary to the perform∣ance of those hazardous undertakings; but this admission by no means implies, that insensibility is a necessary qualification in the constitution of a surgeon: the contrary, as has been already shewn, is the case. He must set out with very little humanity in∣deed, who has lost it all before he has ac∣quired so much knowledge in his profession as will in some sort apologize for the want of it. But as the consideration of youth makes this matter as much the object of admonition as reprehension, I would re∣commend it to those young gentlemen to consider, that humanity will always stamp a dignity on the profession, which morose∣ness will rob it of; and that in their en∣deavours to become surgeons, they should never forget—that they are men—and gen∣tlemen—appellations, to which a perseve∣rance in an unfeeling conduct of this kind, will utterly exclude them from having the least pretentions.

The Humane Committee should visit the hospital every week, that is, a physician and three other members, one week; and a surgeon and three other members, the next; and so on alternately: but if the intervention of any unexpected or extraor∣dinary circumstance made it necessary, ac∣cording as each division informed the other, the whole to attend.

That in the course of these joint exa∣minations, they should make a report to the governors or subscribers, &c. at their ge∣neral meetings of every thing, which in the course of such enquiry, presented itself to them as a proper object of reformation or correction, which must be collected prin∣cipally from the state and information of the patients—such as inattention, severity, or partiality, or any other inconvenience arising to the patients by omission or com∣mission, from the servants, nurses, &c. either by a censurable neglect, or a wanton violation of the sacred obligations of the institution.

It will probably be objected here, by some critic who has more imaginary wis∣dom than real humanity, that giving a power of so extensive a latitude to one physician and one surgeon, as to superin∣tend the practice and conduct of all the physicians and surgeons attending each re∣spective hospital, where this regulation should be established, would multiply the evil it was calculated to remove, by being productive of professional alteration. But this objection will be entirely obviated, when it is considered, that the physician and surgeon belonging to the Humane Com∣mittee being inverted with no further au∣thority, than to see that the patients are

not neglected in their respective professional department, their office consequently can∣not be considered as a tribunal to bring characters of well established abilities in their profession, to the bar of examination. Their abilities are not the subject or object of the committee's enquiry: it is the im∣partial, attentive and humane exercise of those abilities which will fall under their investigation. And as the idea of their superior abilities is generally and I think justly acquiesced in, so the exercise of them in the line of their dute should be enforced. Merit, it is true, is the principal recom∣mendation to any public employment whatever; but it is not the only one, for next to the indispensible necessity of know∣ing any public professional duty is that of saithfully performing it. But care should be always taken in accurately drawing a line of distinction between accidental and intentional guilt. That is, acting contrary to the spirit of the institution from igno∣rance, or from a depravity of sentiment. It will in such cases be in the discretion of the Committee to proportion the punish∣ment to the crime.

This committee should be perpetual, as well to prevent future, as to correct present abuses. It should be chosen annually, or quarterly, &c. as the wisdom of the go∣vernours

should point out, or as the necessity of the patients might demand. A salary to be appointed to the use of the physician and surgeon, bearing proper proportion to their merit, and the fidelity with which they would be found to discharge the humane appoint∣ment they should be now called to.

Wisdom and experience have found it ne∣cessary in discharging the great commercial constitutional duties of the state, to institute reciprocal checques in the different departments of it—and to this institution is principally owing the fidelity with which these important trusts are discharged. The rule will immedi∣ately apply to the discharge of the offices of humanity in hospitals,—and surely the one is not less important than the other—conse∣quently demands an equal vigilance in its ad∣ministration.

I would have the Humane Committee see that the clergyman should visit the hospital every day—preparing those that are likely to die, for so tremendous a change, and admonishing those that are likely to live, to pursue the paths of virtue, as the most likely means of preserving future health, and procuring hap∣piness—for it is an indelible reproach to Christianity, the general neglect of this great—this important consideration at present. And as divines in general are not remarkable for doing more than their duty, I would see that

in the present case they should not do •••• less. And that this additional labour should not militate against their interest, they should have an additional salary for performing it. This would make their duty their interest.—and I believe (without intending any offence to the cloth) I may say would be one reason why they would perform such duty with alacrity.

Observations to enforce the foregoing Motives of Reform.

Though the internal regulations of hospi∣tals may vary in particulars, yet their general object is the same. They are all appropriat∣ed to some benevolent purpose or other—for the relief of human misery, in whatever vari∣ety of shapes it may assume, and to comfort the comfortless. As this is a fact univer∣sally known, what I write respecting one ap∣plies to all. I therefore most pathetically re∣commend a general enquiry to be made into the abuses here complained of—and sincerely wish, that a general reformation may be the consequence. There cannot be a more ample field for the exercise of general benevo∣lence than such an investigation—and if en∣tered upon with the spirit of unanimity, must rescue the national character from the illiberal, though unjust imputation of foreigners, on the intolerable abuse of our public charities, who say, "That there are very few monu∣ments of our humanity here besides stone!"

I have chalked out the foregoing line for accomplishing this much-to be-wished-for re∣formation, without being the least tenacious, whether the plan I have delineated will be literally pursued or not. To the superior wis∣dom of the governors, &c. I implicitly sub∣mit my humble efforts, in recommending a better regulation in our hospitals than at pre∣sent characterizes them, and if the moae I have suggested does not meet their approbation, as to manner, I have the pleasure to anticipate it will be adopted as to matter. It is indifferent to me what means are pursued so the end is ob∣tained. An effectual reformation of the a∣buses here alluded to, was my motive in tak∣ing up my pen, and I have a secret pleasure in hoping, that the co-operation of the go∣vernors, &c. will bring, to a benevolent con∣clusion, what I had the good fortune to begin, not doubting, but their humanity will adopt the hint, and their wisdom point out the most effectual means of carrying it into execution.

The French nation (though distinguished for peculiar levity and national volatility) are by no means divested of the exalted feelings of humanity. Their hospitals are many, and under excellent regulations, particularly since a reformation of the nature here recommend∣ed has taken place there, which brought to light a number of enormities that otherwise would have lain covered in the oblivion of venality. But there is not so extensive a field

for abuse in their charities as in ours—as in point of wealth our hospitals have a decided superiority—and this advantage, which could be converted to the additional accommodation of these receptacles of affliction, is one of the sources from whence the majority of the evils here complained of flow—for, exten∣sive wealth will ever give birth to peculation, and peculation to infidelity, in the discharge of lucrative trusts.—

As it must be admitted, that we frequently copy the fashionable absurdities of our Gallic neighbours, let us convince them and the world, that we are also capable of imitating their virtues, by adopting a plan similar to that they have pursued, for correcting the flagrant abuses committed in the adminis∣tration of our public charities: a work, which whoever sets on foot, that will redound no less to their immortal honour, than the endow∣ments of these hospitals do to their godlike founders, and will, in conjunction with such dignified names, hand theirs down to the latest posterity, with the veneration and respect, that disinterestedness and humanity will ever re∣ceive from a sensible and generous people.

Humanity is the most distinguishing cha∣racteristic of human perfection—any man di∣vested of it, should be divested of all the so∣cial privileges of a rational being. It is in

man, what mercy is in the gracious author of our existence! and the greatest possible degree of excellence our nature (considering its inseparable imperfections) is capable of arriving at, is to be humane—It comprehends every social obligation that unites man to man. Religion is but a name, and man a two leg∣ged monster without it. As humanity is therefore the unadulterated religion of nature, I would wish to impress this consequential truth on the minds of mankind; THAT AN EXTERNAL CONFORMITY TO GOSPEL IN∣JUNCTIONS, CAN NEVER BE ACCEPTABLE TO GOD, UNACCOMPANIED BY INTERNAL MOTIVES OF HUMANITY, AND THE AC∣TUAL DISCHARGE OF ITS OBLIGATIONS.

The love of God is religion; the love of man, humanity. So that it is evident it is no less a Christian duty, "To love God above all things, than our neighbours as ourselves."— The latter duty, left unperformed, makes the pretentions to the former as absurd as impious. How necessary therefore to recommend and enforce this secondary obligation of mankind! especially as our own happiness is so immedi∣ately connected with the discharge of this benevolent duty—as we have the most une∣quivocal assurance, from the divine author of our redemption, that if we act with huma∣nity towards our distressed brethren, he will act with mercy towards us; that is, if we shew benevolence, we shall find mercy. This

is a consideration of the greatest magnitude that can possibly attract the attention. or ex∣ercise the rational faculties of man! and con∣sequently the most useful to be preached and practiced. This is the religion which every man should openly profess and inwardly believe; and in which no man need be ashamed to live or afraid to die! Humanity with any system of Chistian religion must be acceptable to hea∣ven; any without it, an abomination!

I hope therefore the united motives of Christianity and humanity will animate every generous spark of benevolence in the mind of the governors, &c. (in which those vir∣tues appeared to be suspended by suffering with impunity the abuses and neglects here complained of), and that they will accord∣ingly take such necessary steps as will guard those benevolent institutions from abuse, neg∣lect, or degeneracy. What a heart-felt con∣gratulation it must be to them, in every sub∣sequent stage of life, to reflect, that at one and the same time, they have discharged the sacred duties of Christianity, and complied with the natural dictates of humanity! but, on the contrary, how agonizing would it be to their exalted sensibility, to apprehend that those pious and humane intentions should be counteracted by the depravity of the persons entrusted with the execution of them. The native benevolence of his own mind, prevents a good man from even suspecting that such

depraved characters as are here described, have an existence—his own innate goodness being the standard by which he charitably, tho' erro∣neously, estimates the characters of others by: but though this unsuspicious good-nature is the most infallible characteristic of a generous mind; yet it by no means implies a necessary knowledge of mankind, for it is well known, that both in principle and practice, no two distinct things, stand in more diametric op∣position to one another, than man and man. It is therefore but half of a good man's duty to act well himself; the other half consists in making those under his immediate controul act well also.

In a matter of such importance to society at large, as the restoration of the health of perhaps some thousands, so as to be enabled to resume lives of independent industry, too much care cannot be taken, to see that the operations for so salutary a purpose are not retarded by the intervention of any sinister or interested motives, or even by the neglect of those, whose immediate province it is to see these benevolent purposes carried into execu∣tion. Humanity is capable of degenerating into a criminal forgiveness in good-natured minds. From this misguided notion of its principle, good-natured men frequently for∣give through compassion, what they ought to punish through justice. This error they are insensibly led into by endeavouring to a∣void

the opposite character of severity. But, it should be engraved with an damantine pencil, on tablets of the most lasting temper∣ed steel, as a maxim for the regulation of the conduct of mankind—That there should always be a WREATH for the ADVOCATES, and a ROD for the ENEMIES of Humanity.

I shall make no apology for the above di∣gression, from a conviction, that my humane readers will coincide with me in the opinion, that any deviation from the immediate subject which is calculated to enforce the absolute necessity that exists of a reformation in our Hospitals (and also the general good likely to arise from it) cannot be considered as un∣interesting or unimportant.

Should the adoption of the foregoing hints of reformation be thought likely to conduce to the obtaining the ends proposed, The Hu∣mane Committee would, in the exercise of their new-invested authority, inavoidably be present∣ed with numberless objects of correction and reformation at the same time. This consider∣ation restrains a great many particulars; which I otherwise would here recommend to their attention. But should I have the happiness to see, that these labours of mine should be productive of an enquiry into the abuses al∣luded to, and that any consequent resolutions should be entered into for the final accom∣plishment of so benevolent a purpose, I will

chearfully give any assistance in the power of my circumscribed abilities, towards suggest∣ing or digesting a plan, for the better disposi∣tion and arrangement of the reformation here recommended; and for the facilitating and carrying into execution, such a scheme in all its possible latitude, and with as little additi∣onal expence as may be, to the respective in∣stitutions.

There is shortly, it is reported, a general regulation and reformation intended to take place in our prisons and work houses by a revision of the statutes relating to them. I devoutly wish it may be true! for humanity calls loudly for it. Why should the temporary legislators of hospitals be backward in setting or copying so laudable an example? The ob∣jects in hospitals have a stronger claim to compassion than either the inhabitants of prisons or workhouses, upon this very inte∣resting ground of humanity.—That the latter are generally in ••ealth, and the former gene∣rally first ••or •••• pain; and it will, I think, be admi•••••••• without hesitation, that sickness and corpo••al pain are the bitterest ingredients in the 〈◊〉〈◊〉 cup of life, and consequently more 〈◊〉〈◊〉 ••••m••diate objects of human com∣passion 〈…〉〈…〉 subordinate calamities in∣cident 〈◊〉〈◊〉 For—

Beneath the weight of sickness and of pain, The body and mind an equal share sustain.

FINIS.