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LETTER XX.: HOSPITALS. - Jeremy Bentham, The Works of Jeremy Bentham, vol. 4 [1843]

Edition used:

The Works of Jeremy Bentham, published under the Superintendence of his Executor, John Bowring (Edinburgh: William Tait, 1838-1843). 11 vols. Vol. 4.

Part of: The Works of Jeremy Bentham, 11 vols.

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LETTER XX.

HOSPITALS.

If any thing could still be wanting to show how far this plan is from any necessary connexion with severe and coercive measures, there cannot be a stronger consideration than that of the advantage with which it applies to hospitals; establishments of which the sole object is the relief of the afflicted, whom their own entreaties have introduced. Tenacious as ever of the principle of omnipresence, I take it for granted that the whole tribe of medical curators—the surgeon, the apothecary, the matron, to whom I could wish to add even the physician, could the establishment be but sufficient to make it worth his while, find in the inspection-lodge and what apartments might be added above it, their constant residence. Here the physician and the apothecary might know with certainty that the prescription which the one had ordered and the other made up, had been administered at the exact time and in the exact manner in which it was ordered to be administered. Here the surgeon would be sure that his instructions and directions had been followed in all points by his pupils and assistants. Here the faculty, in all its branches, might with the least trouble possible watch as much as they chose to watch, of the progress of the disease, and the influence of the remedy. Complaints from the sick might be received the instant the cause of the complaint, real or imaginary, occurred; though, as misconduct would be followed by instant reprehension, such complaints must be proportionably rare.

The separation of the cells might be in part, continued either for comfort or for decency. Curtains, instead of grating, would give the patients, when they thought fit, the option of being seen. Partitions of greater solidity and extent might divide the fabric into different wards, confining infection, adapting themselves to the varieties of disease. and affording, upon occasion, diversities of temperature.

In hot weather, to save the room from being heated, and the patients from being incommoded by the sun, shades or awnings might secure the windows towards the south.

I do not mean to entertain you here with a system of physic, or a treatise upon airs. But a word or two on this subject you must permit me. Would the ceilings of the cell be high enough? Is the plan of construction sufficiently favourable to ventilation? I have not the good fortune to have read a book published not long ago on the subject of hospitals, by our countryman Mr. Aikin, though I remember seeing some account of it in a review. But I cannot help begging of you to recommend to the notice of your medical friends, the perusal of Dr. De Maret’s paper, in the Memoirs of the Academy of Dijon for the year 1782. If either his facts or his reasoning are to be trusted, not only no loftiness of ceiling is sufficient to ensure to such a building a purity of air, but it may appear questionable whether such an effect be upon the whole promoted by that circumstance.*

His great anxiety seems to be, that at some known period or periods of the day, the whole mass of air may undergo at once a total change, not trusting to partial and precarious evacuations by opening here and there a window; still less to any height or other amplitude of room—a circumstance which of itself tends to render them still more partial and precarious. Proscribing all rectilinear walls and flat ceilings forming angles at the junctions, he recommends accordingly for the inside of his building, the form of a long oval, curved in every direction except that of the floor, placing a door at each end. By throwing open these doors, he seems to make it pretty apparent, that the smallest draught will be sufficient to effect an entire change in the whole stock of air; since at which ever end a current of air happens first to enter, it will carry all before it till it gets to the other. Opening windows, or other apertures, disposed in any other part of the room, would tend rather to disturb and counteract the current, than to promote it.

From the same reasoning it will follow, that the circular form demanded as the best of all by the inspection principle, must, in a view to ventilation, have in a considerable degree the advantage over rectilinear; and even, were the difference sufficiently material, the inspection principle might be applied to his oval with little or no disadvantage. The form of the inspection lodge might in this case follow that of the containing building; and that central part, so far from obstructing the ventilation, would rather, as it should seem, assist it, increasing the force of the current by the compressure.

It should seem also, that to a circular building, the central lodge would thus give the same aptitude to ventilation, which the Doctor’s oval form possesses of itself.

To save his patients from catching cold while the current is passing through the room, the Doctor allows to each a short screen, like the head of a cradle, to be rested on the bed.

Here the use of the tin speaking-tubes would be seen again, in the means they would afford to the patient, though he were equal to no more than a whisper, of conveying to the lodge the most immediate notice of his wants, and receiving answers in a tone equally unproductive of disturbance.

Something I could have wished to say on the important difference between the general and comparatively immaterial impurity resulting merely from the phlogiston, and the various particular impurities constituted by the various products of putrefaction, or by the different matters of the various contagions. Against these very different dangers, the mode and measure of precaution might admit of no small difference. But this belongs not necessarily to the subject, and you would not thank me, any more than gentlemen of the faculty who understand it better than I, or gentlemen at large who would not wish to understand it.

An hospital built and conducted upon a plan of this kind, of the success of which everybody might be an observer, accessible to the patients’ friends, who, without incommoding or being incommoded, might see the whole economy of it carried on under their eye, would lose, it is to be hoped, a great part of those repelling terrors, which deprive of the benefit of such institutions many objects whom prejudice, in league with poverty, either debars altogether from relief, or drives to seek it in much less eligible shapes. Who knows but that the certainty of a medical attendance, not occasional, short-lived, or even precarious, as at present, but constant and uninterrupted, might not render such a situation preferable even to home, in the eyes of many persons who could afford to pay for it? and that the erection of a building of this kind might turn to account in the hands of some enterprising practitioner?

A prison, as I observed in a former letter includes an hospital. In prisons on this construction, every cell may receive the properties of an hospital, without undergoing any change. The whole prison would be perhaps a better hospital than any building known hitherto by that name. Yet should it be thought of use, a few cells might be appropriated to that purpose; and perhaps it may be thought advisable that some cases of infection should be thrown out, and lodged under another roof.

But if infection in general must be sent to be cured elsewhere, there is no spot in which infection originating in negligence can, either in the rise or spread of it, meet with such obstacles as here. In what other instance as in this, will you see the interests of the governor and the governed in this important particular, so perfectly confounded and made one?—those of the keeper with those of the prisoners—those of the medical curator with those of the patients? Clean or unclean, safe or unsafe, he runs the chance that they do: if he lets them poison themselves, he lets them poison him. Encompassed on all sides by a multitude of persons, whose good or bad condition depends upon himself, he stands as a hostage in his own hands for the salubrity of the whole.

[* ]To an hospital lately built at Lyons, a vast dome had been given in this view. It had been expected that the foul air should be found at top, while that near the floor should have been sweet and wholesome. On the contrary, substances which turned putrid at the bottom in a single day, remained sweet above at the end of five days.