X AT NIGHT m A HOSPITAL. BY E. LYNN LIXTOX. {IL''pri)ited by permission from " Belgnivin" for Jiilij, 1879.) TuE London Hospital in Wliitecliapcl Road, instituted A.D. 1740, while George II. was king, is an object familiar enough to all who pass that way ; familiar too in a mournful if helpful sense to sundiy poor souls who live in its neighbourhood and who are struck down by accident or disease. ' Situated on a high road of great traffic, in the midst of a district con- taining about one million i)ersons, with extensive manufactories on all sides, and in close proximity to the various docks of the metropolis and to great railway centres ; the London Hospital administers medical and surgical relief to a population pre- eminently exposed, by its density, to disease, and, by the nature of its employments, to sudden and painful accidents ;" and is thus, j}«7' excellence, the hospital for sm-gical cases and the treatment of such diseases as come from poverty and insanitary con- ditions. "It is virtually a free hospital" — these quotations are made from the Eeport for 1874 — ■" nearly three-fourths of the patients being received vfithout the recommendation of subscribers, and admitted into the wards according to the severity of their cases as adjudged by the medical and sm^gical officers ; while no accident, or similarly urgent sase, fi'om whatever quarter it may come, is ever tm'ned away." In the past year (1878), of in-patient-s, 4794 were admitted fi'ee, while 1654 were recommended by Governors — total, G448 ; of out-patients 29,215 were 2 AT NIGHT IN A HOSPITAL. treated free, while 20,o7G were recommended by subscribers — total, 49,791: — gross total of those treated by the hospital, 5G,239. It has 790 beds ; a fixed income of les;; than £14,000 a j'^ear, and an expenditure of more than thrice that amount. It is the largest hospital in the countiy, and essentially the hospital for the eastern half of London and the suburbs adjoining, where the population is, as we all know, the poorest in the metropolis and the most needing aid in times of distress. Like almost all valuable things this hospital has grown to its present size and importance from com- paratively humble beginning; its first start as "the London Infirmary" being made (1740) "in four bouses (with 13G beds) hired on lease in Prescot Street, Goodman's Fields. These houses being a constant source of outlay for repairs, the Governors opened a subscription in order to ' piu-ehase a piece of gi'ound, and build a house more proper for en- larging and perpetuating their benevolent designs.' " The foundation stone was laid October 15, 1752, by Admiral Sir Peter Warren, Bart., K.B., and the building was finished by December 1759. The new hospital was fitted up with 130 beds ; eleven wards remained unutilised, however, fi-om want of funds." Since then, by slow degrees, and with fluctuations of now pinch and now plenty — now a wing added here to meet the pressing demands of the time, and now wards shut up there for want of means to kee-p them open — the plan has grown into what it is ; tiU, by the last new addition of the " Grocers' Company's Wing," for which that worshipful body gave a dona- tion of £25,000, the number of beds was raised to its present total of 790. This, then, is a brief summary of the London Hospital in Whitechapel ; the bones of the matter as it were to which living circumstances give flesh and human interest. AT NIGHT IN A HOSPITAL. 8 The present condition of the London Hospital is one of veiy great technical perfection. Those five- and-a-qiiarter acres of flooring, which room and ward, passage and staircase measure when added together, are as clean as if they had been laid down yesterday fresh from the plane ; there are separate lifts for the food and the coals and the poor dead bodies when the last breath is drawn and the last act played out; speaking tubes and telegraph-bells cany orders and summon attendance without the loss of one moment of precious time ; the fii'e brigade is in perfect organisation, and there is no cul-de-sac anywhere, so that in case such a calamity as a fii'e should occm% the patients could escape riirlit and left all throusrh the building. Add to this the important fact that there is no well staircase in the more modern additions ; and thus the infected wards can at any time be shut off by cross-doors, which, with open windows, effectually isolate and ventilate. In this manner the erysipelas wards are shut off from the rest of the hospital; the niu-ses have their own staircase ; the service has its own organisation ; and the x^atients are absolutely isolated ii-om the rest of the hospital. The cooking is done by steam and gas ; and since this method was adopted, about £G20 a year in money is saved by the less vraste of raw meat. And to save waste at the spit is no small matter when we remember that daily rations have to be cooked for nearly one thousand persons — the force of the London Hospital when all the beds are full. (The paid staff numbers two hundred and fifty persons, fi'om the Governor down to the charwomen. The honoraiy visiting staff is twenty-six.) The laundry, too, is managed by steam, which is also a saving of money and labom*, and when '* soap, &c.," figures at £294 Os. Id., we can imagine that any economy, which is economy of method not stint of service, is 4 AT NIGHT IN A HOSPITAL. of infinite importance in the wise management of matters. Going on ■with the accounts, tliese items are n&t miinteresting. Of artificial ice fi'om 17 to 18 cwt. is used weekly; the milk bill is over £'2100 yearly ; cgfgs cost more than £820, and vegetables stand at only a few pounds less ; butter is £G53 19s. 4d. for the year; bread stands at £138G 14s. 3d.; meat at £5477 ISs. 7d. ; there is hot and cold water from gaiTct to basement, and the water bill is £190 7s. 8d. ; while firing and light come to £2G58 7s. 2d. Most of us have been through the vrards of a hospital by day, but few have been admitted as visitors in the night. This valuable privilege and rare experience vrere granted to one other and myself, both taken in the skirts of a dear and gracious lady, the wife of one of our leading physicians, and herself well known for her zeal in hospital work and sanitai-y matters generally. The very drive in the late evening fi'om one of the fashionable "West-End centres through the slacken- ing traffic of the city, and on to that toiling, noisy, crowded Whitechapel with its look of sitting up all night, and where even the children never seem to go to bed, doing its business as diligently at mid- night as at noonday, and as careless of rest as of repose — this drive itself is an experience worth having. At first we meet only the carriages of the rich and great whirling off their v.'e.althy occupants to stately dinner-parties which chef a and cordons hiem make works of art as well as of science, and where the whole roimd of beauty and luxuiy is complete. Then the private carriages cease, and we come into the region of street cabs and omnibuses filled with the subordinates of the business world going home to their little villas in the suburbs ; and, finally, these add to themselves tramcars, carts and baiTOWS, AT KIGHT IN A HOSPITAL. O blocking up streets where all the shops are open and the gin-palaces are in full force, and where apparently the whole population is astir, and active life at its briskest. Through them we steer our way with more or less difficulty, till we come to the immense building, stretching out its two hospitable arms, which we have set out to see. There we are received by the Governor, who has undertaken to be our guide and local encyclopedia, and our work of visiting begins. All the offices below are in a blaze of light, ready for use at an instant's notice. The dispensaiy and receiving-room are in full working order, and the one object of existence is how to mitigate the pain and save the life of the first poor creature who may be brought in, crushed, maimed, poisoned, paralysed, or in any way whatsoever reduced from the ranks of capable and healthy humanity to those of suffering and disease. The place is thus kept open and active up to three o'clock in the morning ; and even when the principal officials have gone to bed, the hospital is still available, and help still at hand. The house sm-geon and physician of the week live just over the entrance ; and should any case of severity, demand- ing instant treatment, be admitted, they can be roused in a moment and at their blessed craft of healing, in almost as little time as it takes to tell. By the way, one of the present house sm*geons was taken prisoner dm'ing the Turkish War, and carried off as one of the valuable captm-es made by the chance oi the horn-. While vrc are looking round the room we hear the shrill shrieks of a child, and a group of women sympathisers, suiTounding an agonised mother, rush in with a baby which has hurt its arm. No bones, however, are broken ; and we leave the room while the sm'geon is examining the poor screaming mite, and go upstairs into the wards which are being got 6 AT NIGHT IN A HOSPITAL. ready for the night. We go first into the children's ward, where most of the httle ones are asleep, but some are awake and tranquil, and one is coughing and ciying feebly. It has abscess of the lungs, and there will evidently be a sharp struggle here with death, and hea^^ odds against the ultimate victoiy ! One little poppet of three months old is sleeping quietly with its bottle by its side, and a broken thigh as the reason why it is here at all ; one beautiful bright-eyed creature stares at us mutely as we pass betore its bed, and wonder when those bad bm-ns will be healed, and if it will ever grow up into maturity. It is a child lovely enough to have made the pride of many a wealthy house where heirs are wanting ; in its own it has not so much care taken of it as our cook's pet cat receives, and it is an even chance whether it will ever live to grow up at all, running the gauntlet of the thousand dangers by which it is beset through ignorance, poverty, neglect, and evil conditions of all kinds. Here, again, is one whose arm is not much thicker than a pen- holder, and whose legs and body are wasted by starvation to less than the average size of a new- bom infant. The Sister who is with us turns down the bedclothes from the unconscious sleeper, and we see what is not easily forgotten — that fearful evidence of hunger and want ! How much that poor little creatm'e of ten months old has already suffered ! My lady's lapdog is fed with the choicest dainties beyond the reach of the ordinary middle class ; my lord's horses are pampered and petted till life within them waxes so strong that it tm*ns to the hurt of those who have fostered it to such excess ; but this poor little human being, this miserable child of man, Las been left to starve out of all semblance to its kind; so that as it lies there it is more like a monkey wanting the fur than the heir of all the ages, and the possessor, as we are taught to believe. AT NIGHT IN A HOSPITAL. of an immortal soiil. But what poverty has done on the one hand, this good hospital has been trying to undo on the other ; and by a little judicious feed- ■ ing and care, perhaps om* little furless monliey may become once more human, and be placed in such conditions that its brain can grow and its body become strong. Another little creature is really — to unaccustomed eyes — an awful object. It has a hare lip, and they are growing a (in a sense) new nose which exists at present as an engrafted bulb, and which is to be brought down and thrust into the cavity. This will then be sewn over it, and from a hideous gaping deformity that engrafted bulb wuU transform the mouth into something quite bearable, though always scanned and marked. This is a wonderfully ingenious operation, more wonderful, indeed, than the famous Taliacotian ; but we have by no means exhausted the possibilities of medical science, and as years pass by and know- ledge increases we shall do something more yet than even make a hare-lip and cleft palate sightly and seiwiceable. About all the babies' cots are toys and pictm'es, some of which are retained for the amuse- ment of the restless little wideawake ; but the most part are laid aside till the sleeping time has passed, and the small sufferer wakes once more to life and light ; and everywhere are flowers supplied by the Flower Mission, and greatly prized by young and old. There are many, very many cases under seven years of age ; and scalds, burns, broken limbs, and accidents generally are of terribly frequent occurence among the children of the district. Passing from the babies we go into the men's wards, were the lights are still turned up as the surgeon is makiuGj his last round for the nii^ht. A handsome young fellow, a skater, has his bitter portion dealt out to him in the shape of abscesses. One in his arm sucks all the strength out of him, he sr.ys with 8 AT XIGIIT IN A nOSPIT.Ui. a sigh. Whatever food he puts hito his body goes to feed it, not him — he is none the better for it ! The bad place in his arm drains him diy as soon as he is full ; and it's just a waste of good material, that's where it is in his opinion ! He is unmarried, and he lived in lodgings where he had eveiything to do for himself; and when he was first taken ill and his back was so bad, it made him, he thinks, worse to have to do for himself with no one to help him. He is Tv^ell off now, he says, and the gentlemen and nurses do all they can for him. In the same vrard is another case of desperate, almost unmanageable ulceration ; where five hundred bits of healthy skin have been taken from the living body and engrafted into the sore. This is a very common operation nowadays ; and one lad bared his arm where a small scar showed that a piece had been taken from it for his own leg. He was immensely proud of the trans- action ; so was another, whose ankle, he said, was like a map — he had a bit of a Scotchman and a bit of an Ii'ishman in it, and Lord knows vrhat more ; good luck that he had not added a bit of a negro as well, repeating in the wards of the London Hospital the famous miracle of S.S. Cosmo and Damian in the desert ! The accident wards are fall of painful interest containing as they do men struck down in the prime of life, and from health and vigour reduced to help- lessness and anguish. One fine fellow, a railway porter, was run over by an engine and desperately hurt, but not quite killed. He lay for six hours on the line before he was found and taken up. He is now recovering ; but they have had a hard fight for it ! Another was ripped right up the back, the spine being laid bare and the bone.j slightly injured; but neither concussion of the brain nor paralysis super- vened, and he is now recovering, if slovrly. One old man had been a teetotaller, to which he attributes AT NIGHT IN A HOSPITAL. 9 his safe and speedy recoveiy from a horrible accident that befell him one unlucky day ; and one man, a butcher, had the narrowest escape fi'om unintentional suicide on the Japanese x^laii, for, missing his stroke, he cut, not the joint, but his own abdomen, and nearly bled to death before they could sew up th^ wound. This hospital is, as we have said, the place, j-jar excellence, for accidents, also, it would seem, for strange and skilful operations. There is a curious case of deformed leg at this moment under treatment, and we see both the cast of the original limb and the living member as now rearranged. This — a case of twisted knee — a knee so much turned inwards as to make the leg and thigh almost at right angles with each other. A small incision Avas made at the side of the knee, and then with a chisel and a hammer the bone was broken, and reset so as to make a straight limb. It was then slung in a fi'acture cradle ; ice applied to the joint ; in due time a weight attached to the foot to help in preventing contraction ; and when the bone is thoroughly reset, the lad will be almost like any other, with perhaps a slight shorten- ing of the leg that had been deformed. Another similar case, where both legs were in-kneed, was treated in the same manner, and a complete cm-e effected ; and another of like nature was what is called anchylosis of the hips, that is, a complete stiffness by the joint becoming a solid mass wdth no play or action. This case, which w^e did not see, was that of a little street waif sent to the hospital by a London magistrate. Ho was between five and six years old, and both limbs Avere stiffened. Placed imder the proper anesthetics the bones were broken as in the foregoing instances, and as so much marble might be crushed, and now the little fellow goes about gaily, fit to take his place with the rest of the running and walking race. 10 AT NIGHT IN A HOSPITAL. These tremendous operations would scarcely be possible without the two great blessings of what is called mixed narcosis and Lister's antiseptic treat- me-nt. The first consists of an injection of morphia under the skin, under the influence of which the patient is carried gently downstairs to the operating room. There lie is further narcotised by chlorofoiTQ or ether — the foiiner if he be before twelve or after sixty ; the latter if between those two periods, as ether is too stimulating for the very young or old — and the operation begins. The effect of the ether passes when the operation is completed ; but that of the morphia remains, and the patient sleeps through what was once the worst time, thus lessening the chances of fever and preseiTing his strength. Pain naturally comes with the return of consciousness, but it is mitigated and can be borne better because there has been so much less exhaustion ; also by the new method which almost totally prevents the loss of blood in amputation, much exhaustion and suffering are spared. But I will come to this presently. By Lister's antiseptic method of treating wounds and operations all fever is prevented, and pya3mia or gangrene is almost stamped out. The wound or place operated on is placed under a fine continuous carbolic spray ; all the appliances of di'essing are steeped in the same fluid ; the wound is washed with carbolic acid ; and no germs from the atmosphere — that source of infection and surgical fevers — can find a nidus where they can propagate. The wound heals kindly and in far less time than even under the most favourable natural conditions, thus preventing many after effects which are worse than the original evil. Thus, a poor lad was brought in with a wound in his forehead, from the inner corner of his eye upwards, which laid the bone bare, the skin lying down like a loose flap. Mr. Couper took the case in hand, and the boy so far aided in that he lay absolutely and AT NIGHT IN A HOSPITAL. 11 rigidly still. The wound was first well cleansed with carbolic acid ; the dressing was made under the Lister spray, the edges were adjusted as neatly as one adjusts the most delicate broken porcelain, then the skin was sewn up from the eye to the scalp. The boy had no fever, and in three days the wound was *' as dry as a bone." Had there been inflammation or suppm-ation he would have lost his eyesight and perhaps his life. As it is, he escaped with a scar — balafre certainly for life — but with his eyesight un- impaired, and his health and reason as good as ever. In the vromen's wards the most interesting case we see is that of a delicate looking girl who had been in a trance for a fortnight, during which time they had been forced to feed her through her nose. She is now scarcely awake to the world about her, half- dozing, half-swooning ; but she can be roused ; and the Sisters and nurses take care that she does not fall back into her old condition for want of ^ rousing. Another case is that of a woman whose temperature rose to the incredible height of 112°, and yet she lives : and a case is recorded of a paradoxical tem- perature of 115° : — which surely could have lasted but a very short time, else the patient must have perished. The temperature card is the true storm- signal in all sm-gical cases. The dot gives the note of danger before the finger has found it out ; and no matter how well the wound looks, the chart of the temperatm-e tells its own tale, and when that is high bad results may be expected. But it seems that we have to modify the current belief that no one can live vrhose temperature goes beyond 107°. " Temperature gone clean over the top of the card, sir ! " says a bright-eyed Irishman ; and that top of the card marks 108. In the Jews' ward we come upon a different phy- siognomy and certain differences of condition. To 12 AT NIGHT IN A nOSPITAL. begin with, the poorer Israehtcs have all a German's horror of vontihition, and draw their bed-curtains close about their heads and faces whenever they have the chance. They have all things separate and ap- propriate ; their own meat killed according to the law by their own butcher ; the two distinct waste-pipes, by which their own kitchen refuse is can-icd away, 60 that the washings of the plates and dishes wliere meat has been may not be mingled with other articles of food ; during Passover separate milk ; and a special cupboard where all utensils used dm-ing Passover are kept, and never touched nor even looked at in the interim. The cupboard might swaim with mice or cockroaches, red ants or blackbeetles, but it would not be opened even for the purposes of cleansing — so strict are these ancient people in the smallest as well as the greatest matters of tlicir faith. A piece of Passover cake is fastened over the door of the ward appropriated to them, renewed yearly ; and the Scroll of the Law, in a small tin cylinder, remains as the sign and shield of the race which it both demonstrates and protects. As time wears on the most interesting experience begins. One Ijy one the lights are turned down, and the wards are in that half visible darkness proper to the sick room. Through the long corridors we see the dim figures of Sister and nurse quietly moving about the beds Avhere the restlessness of the patient needs attention. Here a whispered conference between Sister and doctor marks somethini^ of im- portance — who knows what ? There a screen dravrn round the bed, a bright light behind, and shadows thrown upward on the wall, betray the fact of some necessary operation — perhaps tapping a patient for ■dropsy, or it may be the sad watching for the last moment so near at hand. For tlie deaths are some- ■times many in this hospital : not because of want of ^are and skill, emphaticall}^ No ! but because the AT NIGHT IX A HOSPITAL. 13 cases brought in are so exceptionally severe that not even all the care and skill of the best surgeons and physicians can save them. Seven hundred deaths in the year, or ten and a half per cent., rank high in the death average ; but those who know why are not dioheartened ; on the contrar}^ the wonder is that there are not more. In our rounds we come upon a private room where the m