wz 270 S951a 1819 I •• -^/ -./Jf AJJIjKI^oo DELIVERED BEFORE THE GOVERNOUR AND COUNCIL, MEMBERS OF TH^ JM1G1SLATURE, AND OTHER PATRONS OF THE MASSACHUSETTS GENERAL HOSPITAL. AT KING'S CHAPEL, BOSTON, JUNE 3, 1819. By R. SULLIVAN. Published by order of the Trustees of the Hospital. BOSTON : PRINTED BY WELLS AND LILLY. 1819. I ABBRESS. X he Trustees of the Massachusetts General Hospi- tal, believing that in all cases where the interests of humanity require an appeal to the public, that this appeal will not fail to command attention in a community so philanthropic, have ventured to as- semble you, Respected Fellow Citizens, to call your attention, once more, to the Hospitals. They remember how much, on former occasions, you have been influenced by the truth, that the activity of man's virtues may survive the day in which the grave shall close over him, by giving them a habi- tation in permanent useful institutions. By an unexampled liberality, the people of Massachusetts have accomplished a great public object, in the establishment of the Asylum for the Insane. Of its benefits, had there not been already testimonials* before the public, we might call those to testify, who, having surrendered up their afflicted friends to the asylum, as lost to them forever, have seen them raised from a more gloomy region than that of death, and restored to all the sympathies of life.f Appendix A. f Appendix B. 1 You have assisted at the ceremony of laying the corner stone of the Hospital for the sick. We wish we could speak to you of benefits already realized from this branch of the institution, but we have to lament, that the funds of the Corporation were exhausted, before the walls were completed. Not that we despair of soon hearing its advantages extolled. We have a sure pledge in this, that the legislature and people have given the fullest assur- ance of their conviction, that both Hospitals are of the highest importance to the welfare of the State— for never, since the settlement of the country, has the legislature opened the treasury with so liberal a hand to any public institution—never have you, my fellow citizens, sprung with more alacrity to a good work—never have you poured out your treasure in so full a stream ! You were deeply impressed by the truth, that neither private charity, almshouses, nor dispensa- ries were adapted to the wants of the sick, in the humbler walks of life, in all cases, and that nothing but the Hospitals could fill a void as reproachful to the community as it was shocking to humanity. No doubts remained on your minds, that the nar- row and comfortless apartments of the sick in the abodes of the common labourer, and the mechanic, combined with the neglect, brutality, and intemper- ance of attendants, was a cause of premature death to an alarming extent. If your own observation of the condition of the lower classes in society had not been such as to warrant this belief, you could not have heard without emotion and without con- 5 viction* the solemn attestation of the late Dr. Warren and the venerable Dr. Rand, " that of all who fall victims to disease, under the abovemen- tioned circumstances, one third party at least, might have been preserved from death by the accommo- dations and provisions which a General Hospital is calculated to afford." You were aware how numerous is the class of our citizens exposed to a fate so calamitous. That it comprised a considerable portion of the young- er mechanics, yeomen, domestics, seamen, and friendless strangers. Most of whom when afflicted with protracted sickness have no refuge but in the humanity of a temporary host, which often yields to calculations of interest, or is stifled by the con- flicting claims of stronger ties. Should an impulse of generous solicitude for the fate of so many de- serving fellow-beings lead you to inspect the clos- ing scene of their lives, you might see some cast upon the Almshouse, others retired to some hovel, having purchased with the remnant of their earn- ings the poor privilege of dying in neglect. Many will have survived a long train of distressing priva- tions, but of whom not a few who come again into active life, will be found burthened with debt, with constitutions broken, or morals corrupted by the scenes of depravity, with which their distress has made them familiar. All these evils and dangers affecting the happi- ness, the characters, and lives of so many valuable i- Appendix C. G citizens, not only wrought on your feelings as men and christians, but led you as citizens to look at their bearing on the welfare of the community. It could not be a matter indifferent to you that the morals and manners of your domestics, who are often the immediate guardians of your children, should thus be exposed to be corrupted—that the career of so many among the labouring classes, should be arrested by death, for want of the comforts of a Hospital. Who will undertake to fix a limit to the value of one of these lives? Have we not seen the gigantic mind of Franklin, (bene- factor to the whole family of man) rising from the same sphere ? We might vouch the name of Frank- lin in support of the cause we advocate; for he was among the most zealous promoters of the Penn- sylvania Hospital! There are, too, circumstances in the life of this great man which may serve to es- tablish the position, that a hospital may be of in- calculable importance as a means of preserving the lives of individuals qualified by nature to be em- inently useful to the public. Franklin at the age of seventeen entered the city of Philadelphia, a vol- untary exile from his kindred, poor and friend- less—What more probable, considering his com- fortless condition, and the constant liability of the human frame to disease, than that he should have become its prey? Suppose him attacked by fever — prostrate and helpless.—I will not detain you vith a calculation of the chances of an an^el of nercy appearing to bear him to some hospitable 7 mansion, where every comfort and solace awaited him. How much more probable that he would have suffered from neglect, and that the privations which naturally attach to a situation so exposed, would at once have terminated his life and extin- guished the light of his genius, which has been our guide in so many paths of science ! Here then the saving power of the Hospital might be acknowl- edged.—The assiduities, the comforts, the sympa- thy, so rarely found beyond the paternal roof, we might suppose afforded to him, at a moment when no other hand was held out to relieve and to pre- serve him. Were this fact and not fiction, the expression of his gratitude would have come down to us in a glowing eulogy on an institution so be- neficent—he would have taught us in an impres- sive manner, that as disease and death are not res- pecters of persons, an establishment designed for the succour of the poor, the homble, and the friend- less, may sometimes minister to the necessities of an- gels unawares,—It would not be unreasonable to suppose that his zeal for the establishment of a Hospital had grown from a retrospect of his early life, and that a feeling sense of the dangers to which he had been exposed when no such institution ex- isted, influenced him to so great and persevering exertions to obtain for others a blessing which his own necessities had taught him to value so justly. Would you estimate the blessings of a well re- gulated Hospital aright, let not the gloomy impres- sion, too prevalent, have a place in your minds. 8 It is not the abode of pestilence and hopeless mis- ery—the ear of sympathy is always open to the sighs and groans of the sick and dying—if it should chance to be the closing scene of a poor man's life, his bed is as rarely visited here, as elsewhere, by the terrifying spectres, which sometimes lead on the catastrophe of a tragedy. No! Inspect public Hospitals where you may, they will remind you of the comforts of the sick chamber in your own well ordered dwellings. Abuses have, indeed, crept into some of the Insane Hospitals in Eng- land. But the universal indignation which burst forth throughout the nation on the discovery—the promptness of the parliamentary inquiry, and the horror which the disclosures, resulting from it, so generally inspired, must convince us, that such an institution is viewed by the people of that coun- try as beneficial and humane in it design. And we trust that so melancholy an instance of the truth that no spot on earth, however sacred, is inaccessi- ble to human depravity, will influence them, as it should us, to greater vigilance and a more consci- entious care in the superintendance of charitable trusts. And at this moment we may venture to say with confidence, that as well the Hospitals of Great Britain as those on the Continent of Europe and in this country, are the abodes of quiet, order, and christian sympathy. It must be a source of great happiness to you, my hearers, that you can now offer an Asylum from the world, to those unfortunate beings, who no long- 9 er see in it any thing but the monstrous and terri- fying creations of their own fancy—who, bereft of reason and the power of self-controul, are them- selves objects of dread to their own kindred and friends. This awful calamity, immeasurable often in duration as an affliction, poisons every source of comfort, joy, and hope, in the domestic circle which it enters. Was the unhappy subject of this malady once amiable, he is now malignant and sus- picious—was he gentle and placable, he is now 4rrjf<'ilih' nnrt revengeful. He beholds nothing in the kind offices of sympathy and affection, but the stratagems of enemies to win his confidence, in or- der to lure him to ruin. All that is wayward in fancy, all that is gross in appetite, all that is de- moniac in passion, is alike free to enter, when the barrier of reason is broken down. Can you con- template this horrible change, this reign of anarchy in the soul and behold its effect on the peace of families, and not desire to know, what under pro- vidence would be your best resource, were your families visited with this midnight of calamity ? Did no public Asylum exist, your own dwelling, would, in most cases, become the prison-house of the suf- ferer. Not a corner of it but would echo with his vociferations, groans and complaints. Your children are stricken with terrour, your domes- tics disheartened by the long, continuance of the same unvaried scene of horror, and wearied with perpetual watching, desert you. Your own strength exhausted, you are compelled to look abroad for 2 10 assistants. But where will you find them? Money cannot purchase skill and experience, where they are not to be found. The habit of patient endu- rance—gentleness combined with firmness—the power to soothe with the talent to command, constitute that rare union of qualities in attend- ants by which alone they can be rendered compe- tent. While for persons possessing these quali- fications you are inquiring in vain, month after month passes, and with the flight of each the pros- pect of a cure diminishes! Nay, it may be, and no doubt is, sometimes, rendered altogether hope- less, by capricious or negligent indulgences on the one hand, or by unreasonable or even wanton coer- cion, not to say cruelty, on the other. There is often an appearance of systematical address and calculating malignity in the conduct of maniacs, which exhausts the kindness and sympathy of even their nearest relatives, more especially among the common class of people, and impels them in the indulgence of an unreflecting indignation, to treat the perverse actions of the patient, as springing from conscious wickedness, but which, neverthe- less proceed from no deliberate design, and flow from a bosom, which, amidst all its wild disorder, is still innocent and pure in the sight of God. If there be any truth in this description, the wretched condition of hundreds of families in this Commonwealth, must be left to your imaginations to conceive. Some of them, blest with prosperity in every thing else, but into whose high courts 11 this baleful and humiliating despot ascends as fearlessly, and reigns therein as triumphantly as in the cottage, were until now as destitute of relief for their friends visited with insanity, (with the honorable exception of a few private medical houses) as the mass of the people. It is, however, true that opulent families were protected by their more prosperous condition from many incidental evils which, under bereavement by insanity, afflict those in the humbler walks of life, and which grow from household ^disorder, increased expense, in- terruption of business, and corroding care. It is, indeed, painful to reflect how ample have been the resources of this community, through a long course of years, to have restored so many subjects of this distressing malady, who have yet lingered out a miserable existence, or sunk to an untimely grave, because these resources have been suffered to sleep. Let us rejoice that they are now awakened, we trust, to sleep no more. Our Hos- pitals are temples dedicated to God in the names of mercy and charity ! It can no longer be a re- proach to this people that the study of mental dis- eases on an extensive theatre of observation—their symptoms—their variety—the means of alleviation and cure, is neglected, or that it does not form a distinct branch for exclusive attention to some among the faculty. How can mind be better employed than in the conservation of mind ? What pursuit is there, in the whole circle of man's occu- pations, which promises results more important 12 and lastingly beneficial, when men, conscientiously devoted to duty, at once discreet, zealous and in- telligent, embrace it? It ought not to be urged as good cause, for depriving the afflicted among the wealthy of the benefit of the Asylum, that it is a public institution. It is no otherwise public than as it was erected by the public. Besides, why is it that invalids of all ranks are contented to meet together at our medicinal watering places ? Is it not that they offer benefits that can no where else be obtained. It ought also to be remembered, that at the Asylum, tranquillity, privacy, and an unbro- ken series of courteous and humane attentions, are among the means of cure principally relied upon. In furtherance of the same scheme of moral man- agement, gradations will be found, in the style of the apartments, and manner of living, adapted to the previous habits of the patients. It may be said, my respected Fellow Citizens, that we have spoken too liberally of your bounty, and too respectfully of that of the Legislature— that we have exonerated you inconsiderately from the charge of want of patriotism and philanthropy and a due regard to your own best interests, be- cause the General Hospital remains in an unfinish- ed state from the failure of our funds—and because the Asylum requires a further endowment. No. You have given us ample reason to believe that you thought no duty more plain—no obligation more sacred—no command of heaven more clear, than that you, of this generation, should erect, en- 13 dow, and transmit to posterity, these Hospitals. We have not spoken too confidently of your libe- ral intentions as commensurato-with the wants of these institutions—what you know is proper to be done, and freely acknowledged to be so, and can so easily perform, we doubt not you will do, with a promptitude as ready as the occasion is urgent. From the millions of wealth, then, in this Com- monwealth, which need never be taxed to supply the necessities of those to whom it is subservient, in what manner shall the little modicum be drawn, which is necessary to make our hospitals as flour- ishing as their design is benevolent, and the good to the community certain? To you, my respected auditors, who are high in office and in the confidence of the people—ma- gistrates—legislators—we with the more boldness recommand the interests of these establishments, because the files of your executive and legislative proceedings, rank them among the greatest pro- spective blessings of the people. The loca- tion of the General Hospital in the Capital, is the best location for the whole people, be- cause the people no where congregate from all parts of the State so much as there. No where else, are there ever so many persons distant from home, who in sudden sickness, or suffering from casualties, would avail themselves of the comforts of a well-regulated Hospital; you, perhaps, should not expect to find elsewhere that degree of surgi- cal skill (acquired by continual and various prac- 14 tice) able to cope with a considerable diversity of morbid affections requiring delicate treatment. In a population so ^pai'c as that of the country at large, the number of surgical cases of an extraor- dinary character, which may fall within the obser- vati6n of any one physician, must be few; per- haps not more than one in a whole life. And yet the aggregate of such cases in the Commonwealth is great. Who then, that is not ignorant of the conscientious integrity and intelligence of the gentlemen of the faculty in the country towns, will believe, that with an experience so limited, or with none at all in the particular case, which may present, they would put at hazard the life of a patient by an operation under their own hand ? But suppose a desire to do good and the hope of affording the sufferer partial relief, at least, should influence the surgeon to yield up his judgment to an inconsiderate zeal, he attempts an operation, (easy andj safe with appropriate instru- ments in skilful hands, but painful, lingering, and dangerous in the extreme, with the poor instru- ments of which he is possessed and the still poor- er hand which holds them), the operation will pro- bably prove abortive, if the issue of it be not fatal. There must be, the welfare of the community requires that there should be, some central point of recourse in such cases, that is, where the lar- gest experience in the greatest variety of diseases is to be found—the Capital. Unless, indeed, as sometimes happens, the expense of a residence or 15 the difficulty of obtaining one which is suitable, should be an obstacle. It is now almost impossi- ble to obtain the necessary accommodations and at- tendants at boarding houses, patients must be indulged with quiet—the assiduous attention of good nurses is often important—airy and con- venient apartments may be indispensable. The difficulties which oppose themselves in the search for these comforts and conveniences are often in- superable. The wealthy may have to contend with no embarrassments of this kind ; but patients of the middle and lowest classes have deeply felt and deplored them. The preservation of their lives even, we could name to you individual cases of unquestionable authority to prove it, has rested on the sole point of being able to obtain a suitable place of temporary residence, while under the care of the surgeon, and, (can you believe it ?) within three years, instances have occurred in which, no such accommodation being to be found, (for which the poverty of the patients must in these instan- ces account,) they were dismissed by the surgeon, with the comfortless sentence—return into the country to inevitable death—but if you can remain and place yourselves in a situation to undergo the necessary operations and appropriate treatment, your cure will, with certainty, he accomplished ?* But, it will be said, might they not have found one surgeon in the county in which they resided. * Appendix D 16 Sufficiently skilled to interpose between them and the grave, at a juncture so critical? But be the learning, the sagacity and intelligence of gentle- men of the profession what they may, it must not be overlooked, that the cabinet of the surgeon, who holds himself prepared for every sort of case which may present, comprises a variety of instru- ments of great expense, his library, the volumi- nous accounts of all recent improvements in the art; an art second to none in the importance of its discoveries within the last thirty years. Is it to be expected, then, that gentlemen, who from their local situation can be called in to but one, or, at most, a few cases, requiring instruments of a par- ticular construction and of great cost, in the whole course of their lives, can be prepared to operate, either with safety to the patient, or with honour to themselves? While this course of reasoning would seem to show conclusively, that the country must rely on the sur- geon of the city in a great variety of critical cases which might be enumerated, it brings us as conclu- sively to the result,that the skill of the surgeon may be called for in vain, in many instances, unless the auxiliary aid of a Hospital can likewise be obtain- ed. Let it not be intimated that the town and country have a distinct interest in the location of the Hospital. The constant efflux of the inhabi- tants of the town to the country, and influx of those of the country to the town, completely iden- tify them and their interests as they are concerned in this question. 17 One other view of the importance of the General Hospital, as affecting the welfare of the whole community, ought not to be passed over. Your own reflections may have anticipated me. For what argument can there be which will come more universally home to the feelings and interests of the community ? I allude to the connexion of the Hospital with the Medical school. Let it not, for a moment, be thought that the object of this con- nexion is, to give to students in medicine an op- portunity to experiment, at the expense of the feelings, health, and lives of the poor patients. If such depravity be ever indulged, where is it so likely to lay the scene of its diabolical labours as in the retired, humble dwellings of the poor, where neither the vigilant eye of respectable nurses, nor the jealous watchfulness of Hospital guardians, would oppose any obstacle to such re- volting inhumanity ? The members of this profes- sion stand too high in the public esteem to need to be defended against suggestions of this nature. It is well known that attendance on a Hospital, in a course of medical study, is deemed, both in Europe and America, an advantage, which amounts to the difference between a good and a bad education. The benefit to the student consists in being able to see and remark upon the progress of the great number and variety of diseases, which present in constant succession within the walls of the Hospi- tal. The treatment of almost every disease to which the human frame is liable, the whole round 3 18 of surgical practice, falls under the observation of the student in the compass of a short time. What substitute have we in Massachusetts for this ? None. Where falls the evil ? On the community. The profession feel it to be an evil, no doubt; they perceive it to be a more serious and fatal evil, than the rest of the community are aware of. Many of the younger physicians are left to acquire that experience by practice abroad in the com- munity, which they would frankly acknowledge ought to be an acquisition preliminary to any such practice. The medical school at Philadelphia is connected with the Hospital. Hence it is that it is so thronged with students. For the same reason it is that students in medicine, to whom expense forms no obstacle, cross the ocean to perfect their education at the Hospitals in London, Edinburgh, and Paris. The Hospitals offer themselves to the notice and patronage of the Legislature, under so many points of view, interesting to the State, that we cannot but entertain a confident hope that what- ever monies may be required to place them on a permanent footing, will be cheerfully and promptly granted from the public treasury. Institutions so obviously for the benefit of all, may with strict propriety be placed at the charge of the whole community. But self-interested calculations, which have been so honourably, and, we may say, uni- versally, waved by individuals who have contri- buted to the funds of the Hospitals, seem still less 19 to become the dignity of the State, in a case too, where if it could be said, the Commonwealth loses, it might, at the same time, be said, humanity gains; if the public purse suffers, the condition of the people is improved ; if an item more be car- ried to the account of public expenditure this year, for the Hospitals, it will be redeemed within the next five by savings in the diminished expense of the sick poor, chargeable to the Commonwealth. But this is mere solecism. The state is, every way, the gainer. The Constitution appoints you, legislators, as well the guardians of the health and lives, as of the property of the people. As much the founders and supporters of Hospitals, when obviously neces- sary to protect the first, as of courts of justice to protect the last. A still higher authority will sup- port us, in this appeal to you. Administer to the sick and necessitous, is a command as much address- ed to governments as to individuals. If it is the highest praise of men that their wills are subject to the will of the Most High, it is the highest praise of legislators, that his laws are written on their hearts and shine forth in their acts. The Legislatures of New York and Pennsyl- vania have richly endowed the Hospitals in those states. The funds have, principally, been derived from the Commonwealth. The Legislature of Massachusetts, will not permit it any longer to be said with truth, that the General Hos- pital of this state resembles more a ruin than a 20 rising edifice. Let, then, a liberal appropriation be made from the public treasury. We ask it in the name of the people ; for what will benefit the peo- ple must be desired by the people. We ask it of you with becoming deference, but with confidence, because we believe not a dissenting voice would be heard within your walls. To the affluent, whose treasure in heaven has yet gained no accession from this field of charity, we would say, that the gates are still open and the harvest abundant. The holy scriptures, the records of all time, the earliest impressions of youth, the reason of middle life, the recollections of declining age, all attest, that a good name is better than riches. How splendid and invaluable a legacy is it to your children associated with riches ! While the latter secures to them only the outward homage of the interested, and the subser- viency of the dependent, a name with which bene- volence and charity are always associated in the public mind, predisposes to confidence and good will, and respect. Admonish, then, those, my fellow-citizens, who are laying up treasure for their children, to remember this also. I should feel it to be presumptuous, by language like this, to seem to invade the province of this consecrated desk, did I not recollect that charity, in an enlarged sense, is but another name for reli- gion ; and in any sense an essential part of it. Whoever then shall neglect to relieve the sick and to administer to the necessities of his fellow-men, 21 is, before God, as sounding brass and a tinkling cymbal. But how can we name the name of charity be- fore a Massachusetts assembly, and not remember the exemplary munificence of men of affluence among us ? In a community such as this, to enlarge on the duty of active benevolence, were to substi- tute precept in the proper place of eulogy. 1PPENDIX. AprtNDix (A.) The undersigned, the consulting Physiciaus of the Asylum for the Insaoe, established at Charlestowo, having recently visit- ed thatlnstiiution, think it incumbent on them to make the fol- lowing statement to the public. The buildings, by their size and arrangement, external and internal, appear calculated to answer the design of the Institu- tion in the most perfect manner. The situation of them is re- markably fortunate, inasmuch as it is retired and quiet, yet so near the metropolis, that the establishment can be under the con- stant inspection and guardianship of the Trustees; and in re- spect to salubrity and the beauty of the surrounding scenery, is rarely exceeded. The arrangements adopted in the Asylum, and general man- agement of the patients, deserve the greatest praise : mean- while the spirit and attention, with which its affairs are conduct- ed, are such as to promise those improvements, which skill and experience may from time to time suggest. In the apartments occupied by the patients, were all the ap- pearances of neatness and comfort. These appearances, and the deportment of the patients towards those who attend them, give an assurance that the duties of nursing and superintendence, as well as those which belong to the Physician, are performed with the utmojt tenderness and skill. It was particularly grat- ifying to the consulting Physicians to find that there was not a single patient under personal constraint: and to learn that the means employed for this purpose in cases of necessity are such as to demand their full approbation. They were also much pleased to find that the patients are not exposed to the iuspec- 23 lion of visitors; while each one maybe visited alone by his own friends. Under these circumstances, the undersigned Physicians have no hesitation in stating to the public, that for persons in all ranks of life, who have the misfortune (o become insane, this Asylum is vastly more eligible than such as are found in pri- vate families; and this whether regard be had to the comfort of the patient, while under confinement, or to an ultimate cure. It seems proper also to remark, that the interest of the unfortunate patients will be best consulted by placing them in this Institu- tion at an early period of disease, when the chance for effectual relief has not yet passed by. The experience of all similar institutions proves the importance of this remark; and so far as the limited experiments at this Asylum has produced, it fully supports the same opinion. The only persons hitherto discharg- ed are those whose cases were of less than a year's standing, and the degree of improvement in the other patients seems to be nearly in proportion to the duration of the disease before their admission to the Asylum. This Institution has been established and is conducted under the care of the Trustees of the Massachusetts General Hospital. It is known to the public that these are gentlemen of the very highest respectability in the metropolis: but it probably is not known to what an extent the personal attention of the gentle- men is carried. The whole board of Trustees hold a meeting once a week. The Asylum is constantly under the care of a Committee of three Trustees. One Committee continues its ser- vices for three months in succession. The members of this Committee visit the Asylum regularly twice in every week, and they then do not merely take a general survey of its affairs, but they examine into their details, so as to take an interest in the situation and welfare of every individual patient. The consulting Physicians think not of offering praise for those exercises of benevolence, which can spring only from mo- tives of the highest order. They have stated these particulars for the benefit of those, who from want of information, may be hesitating whether to entrust their unhappy friends to this Asy- lum- 24 To the public, and to the contributors to this Asylum in par- ticular, the undersigned offer their sincere congratulations on the successful establishment of this institution in so short a time. Liberal as is the offering to the cause of humanity, it must and will be repaid a thousand fold by the services it will render to that cause. May the hope be indulged that the General Hos- pital, commenced under the directions of the same Trustees, will not fail from want of the support, which an Institution cal- culated to be so extensively useful and so loudly called for, claims from an enlightened and prosperous Commonwealth. Isaac Rand, Aaron Dexter, John Jeffries, William Spoonek, Lemuel Hatward, James Jackson, David Townsend, John C. Warren. Thomas Welsh, Boston, March 22, 1819. Appendix (B.) Asylum for the Insane May 28, 1819. Application for the admission of, Females 15 Males 33—48. Three letters of inquiry not included, although upon the file of application. Admitted, Females 10, Males 27—37. Received since October 6th, 1818, Females 9, Males 19—28. Unfit subject Male 1—27. Of the above 27 cases, are * recent 8 Old 19—27. Improved 6 Much Improved, that is, nearly cured 3 Cured 4 Remain, Females 8 Males 10—18. * Cases are considered recent when the Insanity has appeared within one year, all others are old cases. In two of the former cases, the patients are insane for the third time, and in one the sixth time. 25 Appendix (.C-) Letter of Doctors Rand and Warren. From observation and experience, we sincerely believe, that great numbers of the different classes of journeymen mechan- ics, and labourers, whether strangers from other states or citi- zens of various parts of this commonwealth, taken sick, or meeting with accidents in the streets amid their daily occupa- tions (with broken limbs, or mangled bodies) and lodged in crowded boarding houses, where they are destitute of necessa- ries, such as careful nursing under persons of experience, (one of the most essential requisites for a cure) and the means of ventilation and personal cleanliness; are persons of a descrip- tion, for which qo existing institution furnishes any suitable provision. That servants of both sexes, many of them without friends or connexions, attacked with disease, in families where they are at service, frequently suffer much before they desist from their employments, get their complaints, especially of a chronic nature, confirmed; and when at length wholly taken off from labour, (besides being exceedingly burdensome to the fami- lies in which they reside) must generally be without proper nursing, and other accommodations which their circumstances require. For these and many other classes of persons, which it would be unnecessary to mention, neither the Almshouse nor the Dis- pensary is a suitable provision. The Almshouse,it is well known, is not an establishment calcu- lated for the sick, and the dispensary is only for the prescriptions and attendance of the physician, and how useless must these be without good nursing, and diet, and other accommodations, to render them efficacious, is too obvious to require remark. Thirteen patients were received between the 6th October and 17th December 1818. Of these four have been cured, an equal proportion of cures may be expected in the number received since January 12Ui, 1819. The cured are Bridge, Blake, Crocker, and Knowles. Four discharged by request, were unable to defray their expenses, or were consider- ed incurable, and placed here for greater comfort during the ninttr, than could be afforded in the most convenient private bouses. 4 26 On these considerations it is our decided opinion, that a well- regulated hospital, in the town of Boston, or its vicinity, is an establishment imperiously demanded by the voice of charity and humanity, and that by such an institution the sufferings of a large number of persons of various descriptions would be greatly alleviated, their diseases often speedily cured, and themselves restored to health and usefulness, and in some instances preserv- ed from those temptations to vice and profligacy, which pover- ty, whether brought on by sickness or otherwise, is too apt to originate. And further, it is our serious and decided opinion, that of those, who fall victims to disease under the above men- % tioned circumstances, one third part, at least, might have been preserved from death by the accommodations and provisions which a general hospital is calculated to afford. June, 1811. Isaac Rand, m. d. John Warren, m. d. (Consulting Physicians to the Boston Dispensary.) Appendix (D.) To a Member of the Board of Trustees. dear sir, I have been requested by a friend, who takes a great interest in the establishment of a hospital here, to make minutes of some of those cases which so often present themselves as the objects of such an institution, and to communicate the same to you. While I can say, with truth, that few days pass over my head in which I do not feel the deepest regret that such a means of relieving distress does not exist; yet I have experienced con- siderable reluctance in speaking of those details of private prac- tice which it is thought necessary to mention. When, however, it has been urged that private feeling should be made to yield to a public and most important interest, I have at length consented to trouble you with a few cases of disease in one department of the medical profession, which are perhaps not the most striking, and which I have mentioned without the addition of any of those circumstances that are calculated to excite compassion. The number which I have mentioned is necessarily very limit- ed ; but I can assure you that instances of as great suffering ar« 27 occasionally witnessed by almost every physician I know, and that in my own experience such instances are constantly arising in a succession which is truly painful. Among all these, it is difficult to select such as are best fitted to display the extent of the misery of the sick poor, and I shall therefore mention those which most readily occur. At this moment, there present themselves two poor patients, one of whom applied to me to-day, the other yesterday, who are both affected with the same disease, and both curable under proper management; but 1 fear neither of them under existing circumstances. One of them is a very decent hard-labouring black, of this town, who has a family. This man has entirely lost the sight of one eye, and is fast losing that of the other, and will soon be totally blind. If 1 attempt an operation on this man, it must be done in a small, dark, and close room; and there the patient must remain two or three weeks ; exposed to light, heat, and confusion, either of which would, perhaps, be sufficient to defeat the best operation. What is to be done in this case ? I have no alternative, but to perform the operation and leave the rest to accident.—The other is a boy from a remote town with the same disease, in the most favourable state for operation. I offered to cure him without any expense, if he would get boarded in town three weeks; but his poverty waa such as to discourage him from remaining; and he will undoubt- edly be taken back, without the operation.* In some of these cases the operation has been performed with complete success; but the bad situation of the patient afterwards has exposed him to circumstances which have brought on inflammation and com- pletely defeated the operation. These instances of loss of sight by cataracts are so numerous, that hardly any of us ought to consider himself exempt from the danger of the disease at some period of life, and of consequence we may be more ready to feel for those who suffer this dreadful privation. A short time since a person applied to me with a cancerous swelling; on examining, I found the complaint could be cured by an immediate operation; but that if it was deferred the can- cerous poison would extend too deep to be eradicated. On * It gives me pleasure to mention that a very benevolent and respectable gentleman, on knowing the case of this boy, offered to assist him as far as possible; but unfortunately he was already -beyond ray reach. 28 communicating this to the patient, he said that bis only objec- tion was poverty; that he lived in the country, and had no friends nor acquaintance here to whom he could apply. I advised him to look round, as I had no doubt he could get accommodated in some way; he left me and has not since ap- peared ; so that by this time his case must be irrecoverable. It is not long since a man came to me from the District of Maine, which he had quitted for the express purpose of putting himself under my care, to get cured of one of the most difficult, painful, and yet frequent diseases; a stricture in the urethra, or obstruction in the urinary passages. He communicated his case to me with remarkable intelligence and precision ; and informed me he had been under the care of various practitioners in remote places, who for want of that kind of habit acquired by practice, which is peculiarly necessary in this complaint, had not been able to make any progress in the cure. 1 found his case would require a regular treatment of between two and three months; and after much discussion, and finding him unable to pay, although his case required considerable time, 1 agreed to attend him gratuitously. After a great deal of trouble and many efforts to make proper arrangements, he finally told me that he must go home and die, as it wras impossible for him to remain here. I gave him the best directions 1 could; but firmly believe he must perish; though not until after a year or two of miserable suffering. It has been my lot to be called on to perform the operation for the stone in the bladder four times on poor patients. They were all, as it happened, wretchedly indigent, and suffered ex- tremely for want of proper accommodations; so that though they actually recovered, 1 thought it almost miraculous that either of them escaped with his life. If four more patients should present themselves under similar circumstances, the pro- bability would be thai two, at least, would die for want of good nursing. A very common case of mUfortune is that of white swelling and with this may be connected other diseases of the joints. These can be cured, at an early stage and regularly attended; but the poor when attacked with these complaints have no asy- l'im where they can remaih quiet a number of months and sul.mit to the necessary treatment; they therefore resist the disease so long, that it becomes incurable, and then suffer the k.ss of a lim!>, or of life. 29 The instances of misfortune alluded to, though few in com- parison to what are actually witnessed, will perhaps serve as a specimen of the numerous cases of suffering from diseases in the midst of poverty. There are also cases which might be relieved by a hospital, and which are not relievable by any other means than those such a benevolent institution would afford. To a Member of the Board of Trustees. Boston, March 21st, 1816. DEAR SIR, In consequence of the conversation lately had with you, I am induced to send you a few of the facts which occur to me at the present moment, as tending to illustrate the necessity of a General Hospital, and the incompetency of any institutions at present existing among us, to supply its deficiency. During three years, in which I was a physician to the Boston Dispensary, I was obliged to witness frequent and melancholy instances of the effects produced among the lower classes of society, by a combination of poverty and sickness. The Dis- pensary provides medicines and medical attendance to the sick, but nothing more. It has not the means of affording relief to many of the most urgent wants of destitute patients. The Dis- pensary physician is often called to persons suffering extreme distress, to whom he can afford no medical relief, because no medicine? are remedies for cold and hunger. I have visited patients in the most obscure and miserable hovels, without fire, and with the snow driving in at a multitude of crevices; and yet have been told, that even this shelter must be abandoned because the last week's rent had not been paid. It is not uncommon for physicians to avail themselves of a privilege in the dispensary to prescribe a few ounces of arrow root or sago to patients, suffering from want of nourishment; where bread and meat would have answered the purpose infinitely better. It has been even necessary to spend time in endeavouring i0 impress upon the minds of feverish and bewildered patients, the time and quantities in which to take their own medicines; be- cause not a single attendant was to be found, who could he intrusted with this charge. Even where the interferences of the charitable has been obtained, its intentions have been frequently 30 misapplied or frustrated, by the indiscretion of the patient's friends, the dishonesty of attendants, and above all by the intemperance of husbands and parents. Cases of this sort, it is obvious, admit of no direct relief, except by placing the patient in a situation, where he can be insured the comforts and attendance which his condition re- quires, and where the control of arrangements respecting him, can be placed in the hands of proper persons. Many instances of individual distress might be brought to exemplify the above statements. I will however mention only one, which is of a nature still different. I was called in October last, to visit Mr.-------, who had a large family; his wife had been recently and dangerously sick. He had been long known by his employers and neighbours, as a man of industry, punctu- ality, and the most regular habits. He had been able to support his family in a very decent and comfortable manner. When I saw him, he had been taken suddenly insane, and was raving violently. lie made a determined resistance to all attempts at confiuing him, became outrageous, and repeatedly escaped, not without danger to his family and others. The situation of his wife rendered it impossible that he should be kept at home, and as there were no means of defraying his board in an expensive situation he was carried to the Boston almshouse. There he was lodged in a small, dark, and uncomfortable cell, without fresh air, and hardly long enough for him to lie down. In this situation he refused food, and was found every morning sitting naked on the straw of his crib, having divested himself of clothes during the night. He became rapidly emaciated and his strength sunk so far, that it was found necessary to remove him to the sick room, to save his life. By the humane atten- tions of the physician of the house, he recovered strength enough to lie taken out aud carried to the house of a relative, but his family having no means to support him or themselves, their situation became very wretched. At this time I furnished a statement of his case, which was presented to some charitable individual?, who subscribed about $J00 for his relief. On the strength of this he was sent to Andover, where he remained at the last accounts. The sum subscribed will support him five or six months, at the end of which time should his lunacy con- tinue, he must again become a miserable object of uncertain charity. 31 With my sincere hopes that your benevolent exertions may be successful in providing an asylum for the distressed, I am, &c. To a Member of the Board of Trustees. Boston, March 20th, 1816. DEAR SIR, I comply with great pleasure with the request made me in the course of conversation yesterday. The cases in surgery which have appeared to me, from my own practice, to require in a very particular manner the medi- cal attentions of a hospital, were those which were occasioned by accidents, falls, wounds, &c. Almost all the cases of this kind which have fallen under my notice, or care, have happen- ed to the labouring class of the community—to men who in per- fect health, have been able to procure only the absolute neces- saries of life, and who have not only been cut off from the or- dinary means of support, in consequence of the injurjr they have suffered, but have wanted most of the necessaries of sickness. The most unfortunate part of their lot however has been, that at the moment they have met with any severe injury, the im- mediate spectators in the exercise of benevolence have hur- ried them at once to some most unsuitable place for the purpose of operation, and as soon collected medical gentlemen from all parts of the town to afford assistance. Surgical skill of course in such confusion can hardly be taken into the account, and to a greater certainty, under such circumstances, can it hardly be exerted if possessed. Thus in an instance which fell under my notice recently, I witnessed the operation of trepanning in a part of the head most difficult for the operation, in a low room with no windows in it, and during a storm of rain and wind which made it necessary to keep the door nearly closed. The patient was extended on a low seaman's chest, and the surgeon kneeling in order to reach his patient. The patient, a fine looking, promising young sai- lor, died that night. Nothing can exceed the confusion that necessarily attended the whole of the operation. A great crowd, which it was impossible to disperse, the darkness, a total want of proper dressings, and various other circumstances, tend- ed most powerfully to diminish the few chances the case af- 32 forded for relief. Now how much might have beeu done in a well regulated hospital, in a case which uuder existing circum- stances could not have been attempted ? A case of mania has recently come under my notice, accompanied by circumstances peculiarly distressing. The patieut, a male, was, before the oc- currence of mania, remarkable for his industry and the comfort- able circumstance in which it placed him. His wife suffered a tedious and dangerous confinement with her last child. Her husband however was remarkably self-possessed, and waited with great composure the termination of her illness. This at length was terminated favourably. A very short time after this, her husband was seized with furious mania, and escaped naked from the house. He was soon secured at the house of his mo- ther, a few doors from his own abode. From this time till he was removed, his miserable wife, very much reduced by her ill- ness, was within hearing of his perpetual shrieks and impreca- tions. This man is now in consequence of an extraordinary exertion of benevolence at an asylum for the insane in a neigh- bouring town. It is impossible to say in the present instance how far this case admitted of an early cure. But probably if this man had at once been removed to an asylum, where he might have received those attentions, without which in such a case the best medical treatment will often fail, this industrious individual might long before this period, have been restored to his friends, and a large family been supported by his industrious exertions. I have this day learnt that this man is in a way to recovery. A case of what was called spotted fever, occurred some time since in my practice. The patient, a strong athletic man, ha- ving no connexions in town, lived at a miserable house on a wharf. He was seized on the second day of the fever with de- lirium. His only attendant was a woman, with a family of small, children about her. It was utterly impossible to afford medical assistance in this case, with a shadow of probability that it would be successful. Nursing was out of the question. This man died in five days. I will not trouble you, sir, with any more details. I cau only most ardently hope that your benevolent purposes will be most perfectly successful. THE END. NATIONAL LIBRARY OF MEDICINE nlm oanmio m NLM031941904