It is perhaps, on the whole, a matter of congratulation that the London Hospitals are more eminent as schools of medicine and surgery than for their influence as social institutions. In Paris - of the deaths ( out of , in ) occur in the hospitals, but in London the proportion is only in ( out of ). The domestic feeling, or prejudice, if we like to call it so, of the English people is, generally speaking, believed to be adverse to that public association which is inevitable in an hospital. This is true to a great extent; but, on the other hand, it is also the limited capacity of the London hospitals which restricts the proportion of persons dying there to in . In general hospitals there does not exist accommodation for more than persons at time, and every

taking--in day

There is scarcely a district of London which is without its hospital of kind or another; but we shall notice the great hospitals, of which are of ancient foundation, and are historically interesting. The most ancient of these is St. Bartholomew's Hospital. Rahere, the minstrel of King Henry I., not content with founding the priory of St. Bartholomew, annexed to it an hospital, about the year , for the relief of poor and sick persons. Alfune, who, among other charitable works, built the church of St. Giles-without-Cripplegate, and was the

hospitaller,

The income of the hospital at present exceeds a-year. The bulk of the real estate is in London, and the London rents amount to a-year; landed estates in different parts of the country produce ; dividends on stock in the funds, ; rent-charges and annuities, ; and the benefactions and legacies for years averaged a-year. The pecuniary donations and bequests to the hospital, received up to , amounted to , including appropriated to building the wings between and .

St. Bartholomew's Hospital is situated on the south-east side of Smithfield Market. The principal entrance is through a large arch, ornamented with a statue of Henry VIII., and figures representing Lameness and Sickness. The main buildings consist of separate elevations of stories in height, faced with stone, standing detached on the sides of a quadrangle. They were completed from the produce of voluntary subscriptions raised between and . On the floor of the north wing there is a very handsome hall, feet by , and feet high, which is appropriated to general court meetings and the annual dinners of the governors. The grand staircase was painted gratuitously by Hogarth. The several stories of the south wing contain wards, and the west wing contains wards. The wards in the east and west wings are feet by ; and their height varies from to feet. In the south wing the wards are feet in length, and the heights are the same on each floor as in the east and west wings. To every ward an apartment for the sister in

was originally a religious establishment, founded by Richard, prior of , in . In its possessions were valued at ; and in the following year they were surrendered to the King. Before the middle of the century the suppressed hospital was purchased by the City of London; and a charter from the crown having been obtained in , and the building repaired and adapted for the reception of poor, lame, and diseased people, it was opened for their admission in . For some time the funds of the hospital were insufficient; and in the lands late belonging to the Savoy Hospital, and some other property, which had been granted to the hospitals united, were granted for the sole use of St. Thomas's, with a view, perhaps, of equalising the revenues of the several hospitals. Notwithstanding this assistance, in the treasurer was obliged to advance , and in a sum of was obtained by pawning a lease; but it soon afterwards emerged from its difficulties. The rents of property in London and the suburbs at present realise a-year; the rental of estates in the country ; and the dividends on stock From to the pecuniary gifts to the hospital amounted to The gross annual income applicable to the general purposes of the institution is nearly

is situated in the borough of , not far from the foot of . It consists of several courts or squares, in of which are statues; , in brass, of Edward VI. by Scheemakers, and the other , of stone, of Sir Robert Clayton, Lord Mayor in . A large part of the hospital buildings was rebuilt in , and additions were made to them in . A new north wing was completed in , at a cost of ; the south wing in ; and it is intended to rebuild the centre on an adopted plan, when the whole building will present a very imposing appearance. The site of the new north wing and a portion of ground north of the old north wing were purchased of the City for , which was at the rate of per acre! The Museum, Anatomical Theatre, Demonstrating Theatre, Lecturing Theatre, Dissecting-Room, and other appropriate offices attached, cost , and are built on a site formerly covered by slaughter-houses, brothels, and miserable tenements. The Museum and Dissecting-Room are feet by ; the Lecturing Theatre is circular and feet in diameter. The Museum contains about

The founder of was neither minstrel nor priest, and though claimed by booksellers as of their body, his property was acquired by stock-jobbing rather than by literature. At any rate he was a man of great benevolence, and had long been a munificent supporter of when he determined himself to be the founder of a new hospital. At the age of he commenced the erection of the present building, on which during his lifetime he spent nearly He died on the , and on the following patients were received into the hospital. In the sum of was carried to the account of his executors, as the residue of Mr. Guy's estate. This magnificent bequest has been laid out at different times in the purchase of real estates in the counties of Essex, Hereford, and Lincoln. The hospital has also been benefited by the enormous bequest of Mr. Hunt, who in left it a sum amounting to , besides other property which made the total amount , on condition of enlarging the hospital and providing additional beds. This legacy has also been invested in estates. The other benefactions received from the foundation of the hospital to the present time amount to about The gross income is now above a-year, and about a-year is directly applicable to the purposes of the charity. The rental of the hospital estates is a-year, of which is derived from the estates, and the dividends from funded property average about a-year.

The entrance to is in , by an iron gate opening into a square, in the centre of which is a statue, in brass, of Mr. Guy, by Scheemakers, the pedestal on which it stands bearing on side an inscription recording Mr. Guy's benevolence, and on the other sides are relievos of Mr. Guy's arms, Christ healing the Impotent, and the Good Samaritan. The main building consists of a centre and wings, containing residences for the Treasurer, Chaplain, Steward, Apothecary, Butler, Porter, and the

Dressers;

taking--in

The constitution of the London Hospitals is not uniform, though in all of them the ruling body consists of the governors; but the powers of the various officers to whom the immediate management and superintendence of the hospital is entrusted are exercised under less control in some cases than in others. Since there have been classes of governors at St. Bartholomew's, the chartered or corporation governors and the donation governors.

At St. Thomas's there are kinds of governors. The corporation of London is represented by the lord mayor and aldermen and common councilmen, as at St. Bartholomew's; and they do not derive their authority from the other governors, but from the charter of the hospital and the Act of . The special governors consist almost entirely of retired officers, and the executors of benefactors are occasionally appointed. This class of governors is not required to contribute towards the funds of the Hospital, and it is this only which distinguishes them from donation governors. It has invariably been the practice to admit as donation governors any person willing to pay who can procure governors to propose and them.

The government of was settled by the founder. The number of governors must be at least and not exceed , with a committee of , to whom the immediate management of its affairs is entrusted, and of this number - retire annually. The governors are chosen from a list presented at a general court by the president and treasurer, and no division has ever taken place on their admission: no donation is required, and the appointment is for life.

The next important department of the hospitals consists of the medical and surgical establishment, including the

sisters

dressers

sisters

The majority of persons received as patients into the London Hospitals are mechanics, labourers, reduced tradesmen, or servants. There are, however, numerous admissions of individuals of both sexes, and particularly females, of the very lowest class of society and the worst character. The most common offences against the regulations are smoking, swearing, gambling, and fighting, and refusals to attend to the directions of the medical officers. Instances have occurred in which the lives of the sisters or nurses have been threatened by

At St. Thomas's and Guy's the general medical economy, arrangement, and regulations are of much the same nature as at St. Bartholomew's, and it is unnecessary to enter into a minute detail of them. At St. Thomas's there are wards, each of which is superintended by of the sisters, who were formerly selected from the nurses, but are so no longer. There is always candidate for the office in training. The nurses are divided into day-nurses and night-watchers, the latter of whom enter upon their duties at in the evening and remain until the next morning. It is found very difficult to get persons fitted for either of these offices, as the duties are onerous and disagreeable, and the stipend small. The total number of in and out-patients to whom relief was administered in was , classed as follows: Physicians' out-patients , surgeons' out-patients , midwifery out-patients , apothecary's out-patients ; and of in-patients there were discharged during the year and died. The remainder were under cure on the . When a patient dies, the body is laid out, and, after remaining in the bed about hours, is taken to the dead-house; the bed and bedding are thoroughly washed and cleansed; the bed is entered as a

dead bed,

At Guy's the number of beds which can be made up on an emergency is . The average number of applications for admission on the regular day is , of whom on an average are admitted and rejected. The deaths are about per week. On the death of a patient, a screen is placed round the bed; but it is rarely possible to conceal the circumstance from the others in the ward, and within or hours the body is removed to the undertaker's room. The out-patients of this hospital amount, perhaps, to a-year. About

The importance of the great London Hospitals as schools of medicine is well known. Nearly every medical and surgical practitioner has

walked the hospitals,

come up

medical students

There are schools of medicine in London, but the most important are those connected with the great hospitals, though it is chiefly within the last years that they have attained their pre-eminence over the private schools of medicine. The lectures of John Hunter, in , about , were the complete course ever delivered in the metropolis; and in all the dissections carried on in London--were confined to school, that over which John Hunter's brother presided. But even at St. Bartholomew's Hospital the introduction of lectures is of very recent date. Mr. Percival Pott, a distinguished surgeon of this hospital nearly years ago, was in the habit--of delivering occasional instruction in this manner; but the late Mr. Abernethy, about years ago, may be said to have been the father of the system as it at present exists. The institution of a medical school in connexion with an hospital adds to the emoluments of the medical officer; furnishes, through the medium of the pupils, additional and gratuitous attendance on the hospital patients; and, lastly, imparts a medical education to the pupils themselves by lectures, illustrated during their personal attendance on the patients, by observation of the progress and symptoms of disease, the mode of treatment adopted, and the results. The governors of this hospital have since expended above in buildings intended to facilitate the acquisition and communication of medical science. The museum was built so recently as .

From to the schools of surgery of St. Thomas's and Guy's Hospitals were united, and the fees paid by the surgical pupils of both hospitals were put into common fund, and divided equally amongst the surgeons and apothecaries of the establishments. Medical lectures only were delivered at , while surgery, together with anatomy, was taught at St. Thomas's. For many years the late Sir Astley Cooper, who was surgeon at Guy's, filled the office of anatomical lecturer at St. Thomas's. This union was dissolved in , in consequence of the governors of the institutions differing respecting the appointment of a lecturer on anatomy; though we believe there is still some traces of the old connexion to be found in existing regulations. In it was resolved that the means of surgical education should be provided within the

We can scarcely do more than mention the names of the other hospitals. The , opposite the Abbey, was established in , and was the institution of the kind supported by voluntary contributions. It contains accommodation for patients. Hospital was established in , by a dissentient party in the management of the , and Lanesborough House was at engaged for the purpose. The principal front of the present building is feet long, faces the , and is of rather imposing design. It contains a theatre for the delivery of lectures and an anatomical museum, and the number of beds is . The was established in , and in was removed to its present situation in Whitechapel

New institutions of this nature are every year springing up, especially those intended for the reception of special classes of disease,--as consumption and the diseases of the chest, cutaneous diseases, diseases of the eye and ear, &c. &c.- though some of these new establishments are dispensaries rather than hospitals.

Sanatorium,

Besides the institutions just enumerated, there are numerous lying--in hospitals in different parts of the metropolis: none of them are as yet a century old, the earliest (the British Lying--in Hospital in ) having been established in . Comparing the years of its existence with the years of the present century, it appears that the deaths of mothers had fallen from in admitted to I in , and the deaths of children from I in to in . Dispensaries, for supplying the poor with medicine and advice gratis, are also found in every part of London. Some of them have been in existence about years; but they originated at the close of the last century, and led to those medical squabbles which made the subject of Garth's poem. These institutions are often made use of by persons of a very different class from those whom they are more particularly intended to benefit.

The Lunatic Hospitals and Asylums, though widely differing in most respects from the medical and surgical hospitals, are still institutions of the same class. Above lunatics and idiots are in confinement within the limits of the metropolitan Lunacy Commissioners, above half of whom are confined in licensed houses, about at Bethlem, above at , at Guy's, and nearly at Hanwell. Bethlem and only come within our province on the present occasion.

, or the House of Bethlem, as it was originally called, was founded as a convent by Simon Fitz-Mary, a citizen of London, in . The founder directed, that in token of subjection and reverence, sterling should be paid yearly at Easter to the Bishop of Bethlem or his nuncio. The date of this house being converted into an hospital is not known, but in , less than a century after its foundation, it had acquired this designation. In the brethren of the house were dispersed abroad collecting alms, and an application on their behalf was made to the mayor and aldermen to be received into their protection. The earliest notice which can be found of lunatics having been received at Bethlem is . There were then in the house men deprived of reason, and sick persons, as appears by an inquisition taken at the above date. The purchase of Bethlem by the city took place in . In - it was for a short time, along with the other hospitals, under the same government as ; but in it was placed under the control of the governors of , treasurer being appointed for both houses. This union still subsists, and was confirmed by the act of , for regulating the royal hospitals. The affairs of the hospitals are transacted at the same courts, and the proceedings are recorded in the same books, as if the houses were foundation; but the accounts are kept in separate ledgers.

In , it appears, by an account rendered to the Governors of , that the

yerely issues and proffittes

Stow says that the church and chapel of Fitz-Mary's Hospital were taken down in the reign of-Queen Elizabeth, and houses built instead by the governors of . The Charity Commissioners give an extract, made in the muniment book in , which is the earliest description of the hospital they could find. The old house contained

below stairs a parlour, a kitchen,

two

larders, a long entry throughout the house, and

twenty-one

rooms wherein the poor distracted people lie, and above the stairs

eight

rooms more for servants and the poor to lie in, and a long waste room now being contrived and in work, to make

eight

rooms more for poor people to lodge where there lacked room before.

one

messuage newly builded of brick, containing a cellar, a kitchen, a hall,

four

chambers and a garret, being newly added unto the old rooms.

After the Fire of London the governors resolved to build the house on a larger scale, and the City granted them a lease of some ground, feet long by deep, adjacent to , for the site of their new building, which it was intended should be capable of accommodating lunatics. The lease was granted for years, subject to a rent of Is. if demanded, with a provision that the lease should be void in case the building was devoted to any other purpose. The new hospital (as it was recorded on an inscription over the entrance) was commenced in , and completed in . This was the centre of Old Bethlemn Hospital, and it was similar in design to the Tuileries. Its length was feet, and breadth feet, besides the wall which enclosed the gardens before it,

which were neatly ornamented with walks of freestone round about, and a grass-plot in the middle, beside which garden there was another at each

end for the lunatic people, when they were a little well of their distemper, to walk in for refreshment.

chiefly of

two

galleries

one

over the other,

193

yards long,

13

feet high, and

16

feet broad, not including the cells for the patients, which were

12

feet deep. These galleries were divided in the middle by

two

iron gates, so that all the men were placed in

one

end of the house, and all the women at the other, each having their proper conveniences, as likewise a stone room where, in the winter, they had a fire to warm them, and at each end of the lower gallery a larger grassplot to air and refresh themselves in the summer, and in each gallery servants lay to be ready at hand on all occasions; besides, below stairs there was made of late a bathing-place for the patients, so contrived as to be a hot or cold bath as occasion required.

A site being thus provided, premiums were offered for designs for the intended building, and plans were sent in. The surveyor of the hospital and architects selected from this number, and on the basis of these, but with such alterations as he might consider necessary, Mr. Lewis was directed to form a plan for a building to contain accommodation for patients, but with offices on a scale sufficient for twice that number. Further steps were taken to obtain the necessary funds, for the governors had commenced, in , to reserve a portion of their revenues for building purposes. Grants of public money were also obtained to the amount of ,; the benefactions of public bodies amounted

Under the Act of the united establishments of and Bethlem are governed by a president and treasurer elected by the general courts; the court of aldermen and councilmen; and an unlimited number of nomination governors. The number of governors at present is . Bethlem is exempt from the visitations of the Commissioners of Lunacy, a privilege which has not been of much advantage to it, for it has the demerit of having carried into operation, to a period of less than years ago, the unenlightened and brutal system of treatment which distinguished the century. In the inquisition of the iron chains with locks and keys, and the manacles and stocks there spoken of as belonging to , indicate but too plainly the system of that day. There are several passages in Shakspere which show that bonds, darkness, and flagellation were the remedies adopted for the recovery of the lost reason! A passage in

Lear

at least

400l.

a-year from the indiscriminate admission of visitants, whom very often an idle and wanton curiosity drew to these regions of distress.

London Spy

One

of the side-rooms contained about

ten

patients, each chained by

one

arm or leg to the wall, the chain allowing them merely to stand up by the bench or form fixed to the wall or to sit down again. The nakedness of each patient was covered by a blanket-gown only. The blanket-gown is a blanket formed something like a dressing-gown, with nothing to fasten it in front: this constitutes the whole covering. The feet even were naked.

their nakedness and their mode of confinement gave this room the complete appearance of a dogkennel.

for lunatics, in , was opened in , and was intended for the reception of those who could not obtain admission into old . It has always been favourably distinguished for its

The great for the county of Middlesex, situated at Hanwell, a short distance to the left of the Great Western Railway, and about miles from London, is of the most remarkable establishments in the country: and though it is somewhat out of our limits, we cannot pass it by without a brief general notice.[n.384.1]  The Asylum is intended for inmates, and accommodation will probably be eventually provided for . The present number of servants and officers exceeds . The grounds contain acres, of which are cultivated as a farm, as a garden, as an orchard, and nearly are shrubberies. The airing-grounds and courts occupy a space of eighteen acres, and the asylum buildings cover above and a half acres. The ancient bodily restraints, on which entire reliance was formerly placed, have been disused, and even severity of tone has almost ceased to be employe.d. We can here only say of the system, that it is in every respect precisely opposite to that which, until within a comparatively short period, was acted upon at Bethlem.

[n.383.1] Rev. Mr. Bowen's Account of the Hospital, 1783.

[n.384.1] We take the opportunity (as we have not space for details) to recommend all who are interested in the subject to the admirable Reports of Dr. Conolly, the physician at Hanwell, and also the Reports of the Visiting Justices, by whom his enlightened efforts have been supported in a most excellent spirit. Bethlem Hospital.