Medical Establishments: The General Infirmary

MEDICAL ESTABLISHMENTS.

THE GENERAL INFIRMARY.

INFIRMARIES stand at the head of the public charities that abound in England; and certainly few have been so extensively useful as this establishment. It was commenced in the following manner: Early in 1751, the members of a respectable Society in Newcastle (fn. 1) resolved, on account of the deaths of some, and the advancing age of others of their body, to discontinue their stated meetings; but, previous to their doing so, to leave some permanent memorial of the society having existed, by the proposal of some project of public utility. On the day appointed for this benevolent purpose, the late eminent surgeon, Mr. Richard Lambert, then a young man, suggested the establishment of an Infirmary; and this, appearing more beneficial than any other project which had been presented, met with the unanimous concurrence of the meeting. In consequence, a letter, signed K. B. was inserted in the Newcastle papers, strongly recommending a subscription for effecting so desirable an object.

This appeal was followed by a public subscription, which was spiritedly commenced on the 9th of February, 1751; and on the 7th of March was published, on a sheet in folio, with the list of the subscribers, a short dissertation, containing motives for establishing public Infirmaries. In order also to keep alive the benevolent feelings of the public, a sermon was reprinted which had been preached before the governors of the London Infirmary, at St. Lawrence, Jewry, March 31, 1748, by Joseph Butler, then bishop of Bristol, In a short time, the annual subscriptions amounted to above £1200. (fn. 2)

On April 13, 1751, a subscription was opened for building the new Infirmary, on a part of the Forth Banks, granted by the corporation under the charge of a small annual rent. (fn. 3) At the same time, the following officers and servants were chosen:—Treasurer, Mr. Joseph Airey; Physicians, Dr. Askew, Dr. Cooper, Dr. Johnson, Dr. Lambert; Surgeons, Mr. Samuel Hallowell, Mr. Richard Lambert; House-apothecary, Mr. Henry Gibson; Secretary, Mr. Thomas Turnbull; Matron, Mrs. Dorothy Jackson. There were also chosen a house-committee of thirty-six gentlemen; twelve of each of the counties of Durham, Newcastle, and Northumberland. A similar committee was appointed to settle the plan, and regulate all matters relating to the building. Twelve trustees for the intended building, four of each county, were also chosen; and three trustees for laying out money in the public funds, one of each county. It was, at the same time, resolved to carry the charity into immediate execution. For this purpose, a house was taken in Gallowgate, capable of containing twenty-three beds; and, on the 23d of May, it was opened for the reception of patients. On this occasion, a large number of the governors met at the Exchange, and from thence went in procession, accompanied by the magistrates in their formalities, to St. Nicholas' church, when the Rev. Archdeacon Sharp preached a sermon from Luke, chap. x. ver. 36, 37, and which was afterwards printed at the request of the committee. After divine service, the committee went to the Infirmary in Gallowgate, where seven in-patients and four out-patients were admitted, after being examined by the receiving physician and surgeons, and approved of as proper objects. On the 30th, seven more patients were admitted; and, shortly afterwards, the applicants for admission became so numerous, that the committee hired what lodgings could be procured in the neighbourhood.

On September 5, 1751, the foundation-stone of the new building was laid by the Right Rev. Dr. Joseph Butler, Lord Bishop of Durham, when a great number of the governors dined with the Sons of the Clergy, at the Turk's Head, from whence they went in procession to the Forth Banks. A plate of copper was fixed on the stone, with the following inscription:—"The foundation of this Infirmary was laid on the 5th day of September, in the 25th year of the reign of King George II. 1751, by the Rt. Rev. Joseph Lord Bishop of Durham, Grand Visitor." And on the reverse,—"The ground was given by the Corporation of Newcastle: Ralph Sowerby, Esq. Mayor, William Clayton, Esq. Sheriff."

After the ceremony was over, the company retired to the Forth House, where £147, 17s. was subscribed towards the building. The same day, Dr. Rotheram, of Hexham, paid into the hands of the treasurer £42, being part of the produce of a course of lectures on experimental philosophy, given by him at Hexham, for the benefit of the Infirmary. In the evening, Mr. Avison gave a concert of vocal and instrumental music, at the Assembly Room, for the same benevolent purpose, and which produced £36, 15s.; the performers having given their assistance gratis.

The building was carried on with such spirit and diligence as to be finished and opened for the reception of patients on October 8, 1752. It is computed to have cost above £3000. Including additional bedding, linen, and furniture, the total disbursements towards the new building amounted to £3697, 7s. 9¾d. (fn. 4) The receipt for the first year, ending April 6, 1752, amounted to £2643, 1s. 2½d. when it appeared 133 patients had been cured. The next anniversary was held June 17, 1753, when the bishop, with the nobility and gentry, were entertained at dinner by the mayor (Henry Eden, Esq.), on which occasion a turtle was served up, supposed to be the first of its kind exhibited at an entertainment in the north of England.

On Friday, October 18, 1754, being St. Luke's day, the chapel of the Infirmary, dedicated to that evangelist, and the burying ground adjoining, were consecrated by the bishop of Durham, and a sermon preached on the occasion by the Rev. Thomas Dockwray, M. A. (fn. 5)

The number of surgeons being found too limited, it was resolved, April 3, 1760, "that the number of surgeons to this Infirmary be augmented from two to four."

This institution continued to produce the most beneficial effects: but, at length, many of the original statutes for its regulation fell into disuse; while others, from the great improvements in the management of hospitals, became unavoidably defective. Dr. Clark (fn. 6) directed the attention of the governors of this hospital to these evils; and, at length, a special court was held, November 9, 1800, on this business, when, in consequence of a report he laid before them, it was resolved, "That a committee of governors be appointed, to take the statutes, rules, and orders, into consi deration, and to frame a code for the future conduct of the charity," with a further direction, to lay the result of their labours before the next quarterly court, or, at latest, before the general court in April. The alterations which Dr. Clark proposed were highly important, and extended to every branch of the management of the institution. The original building was itself, in many respects, defective; some of the wards were too large, and incapable of sufficient ventilation; many accommodations for the medical officers, which appear essential, were wanting; no separation of the medical and surgical patients could be made; and, finally, there was not room enough for the numbers claiming admission, and the difficulty of rejecting those who were proper objects, often led to the wards being in much too crowded a state. Dr. Clark proposed many judicious alterations to remedy these defects, and also drew up several very important regulations for the future conduct of the charity. He endeavoured to secure economy in the application of its funds, by the revival of the weekly committee, and by introducing a new mode of appointing the members, calculated to render it effective. A rule was established to prevent the election of medical officers being influenced by private solicitations or party spirit, which, where they take place, must often operate to the exclusion of merit. Nor did he overlook another most important object of hospitals, "The Improvement of Medical Science." With a view to this, he recommended, "The keeping a journal of all instructive cases, or dissections, to be preserved in the hospital for the inspection of the physicians and surgeons; the keeping and preserving monthly and annual returns of the several diseases of the persons admitted; and, lastly, the appropriation of a place in the Infirmary for the reception of anatomical preparations, and of a professional library." (fn. 7)

The suggestion of the above improvements appeared of so much importance, that the court unanimously resolved, "That a committee should be appointed to take the statutes, rules, and orders, into consideration,—and to frame such a code for the future conduct of the charity as should appear to them necessary and expedient, from change of circumstances, and from the improved knowledge of hospital arrangements." This committee adopted the proposed improvements, and presented a new code to the general court held April 2, 1801; when a special court was appointed to meet on the 25th of June following, "To consider the expediency of the proposed internal improvements of the Infirmary, and to procure plans of the intended extension of the building, and estimates of the expense attending the same." A report of their proceedings and opinions thereon was ordered to be printed, and circulated among the governors before their anniversary meeting in August. At that general meeting, it was unanimously resolved, "That the Infirmary, in its then state, was but ill calculated to answer the benevolent purposes of such an institution; a committee was empowered to carry the projected improvements into execution, and a subscription opened to defray the necessary expenses." The plan of the alterations in the old Infirmary, and the plan and elevation of the extension of the building, with estimates of the expense, were prepared by Mr. John Stokoe, an ingenious architect, under the direction of Dr. Clark, who spared neither trouble nor expense to obtain plans of the most improved infirmaries and hospitals in the kingdom, and descriptions of the best modes of ventilation. These plans were approved of at this meeting, a committee for improvement was formed, and a subscription was directed to be made to carry the proposed design into execution. (fn. 8)

At this time, Dr. Clark laboured to effect "a wise, economical, efficient, and permanent co-operation of the Infirmary and Dispensary," in forming a Board of Health for the eradication of febrile contagion, and for supporting patients received into the fever-house annexed to the Infirmary, which the building committee had enlarged so as to contain 20 patients. But when the committee, that met at the Dispensary to carry these important objects into execution, communicated with the weekly committee of the Infirmary, it was discovered that a difference of opinion prevailed amongst the medical officers of that establishment as to its safety. Dr. Clark was greatly surprised and grieved at this unexpected opposition; and a warm controversy ensued. Supported by the highest medical authority, this learned physician contended that the fever-house could not extend infection to the Infirmary; in which opinion he was defended by Dr. Ramsay, and Mr. R. B. Abbs and Mr. R. Keenlyside, surgeons; and opposed by Dr. Wood, and Mr. Horn and Mr. W. Ingham, surgeons. Dr. Steavenson thought that perfect safety depended upon a wall of separation. (fn. 9) At a general meeting of governors, held June 24, 1802, the plan of opening the fever-wards at the west end of the new building was rejected by a great majority. Dr. Clark, however, being firmly convinced that without such wards "every infirmary must be very defective," recommended an application to the bishop of Durham, as Grand Visitor of the charity, to appoint a general meeting to take into consideration the propriety of this vote. A requisition, very numerously and respectably signed, was accordingly transmitted to his lordship, who, in compliance with it, directed a general meeting to be held on the 12th of October. At that meeting, a much more numerous attendance of governors took place than had ever been known; but as the plan for admitting contagious diseases into the fever-wards had excited very great alarm, it was not thought for the interest of the charity to press the question. A compromise therefore took place, by which it was agreed, that if a separate fever-house, approved by the Grand Visitor, were not ready by the 31st of October, 1803, he should be empowered to open the fever-wards of the hospital for the general reception of patients. This resolution accelerated the erection of the Fever House.

The Infirmary stands in an open, dry, elevated situation, at a short distance from the town, and from the river Tyne; but during the east winds in the spring months, it is considerably annoyed by immense clouds of smoke brought from the town and glass-houses. The out-grounds are convenient, and command a pleasing prospect of the adjoining country. The old building is of stone, and presents a plain but elegant front to the south. From the eastern extremity there runs northward a spacious wing, fronting the east. The principal, or south front, contains four stories; the basement, the ground-floor, the chamber, and the attic. The wing is two stories high, with an attic ward at its northern extremity. The ground floor is 13 feet, the chamber 12, and the attic story 9 feet high. The front and the wing nearly form a quadrangle; but in erecting the new building, it was an object to avoid this form, for which reason it commences immediately where the front galleries of the old building terminated towards the west. By this means, both houses were made to communicate, and a thorough ventilation is secured. This new erection is built of brick, and is 125 feet long. The basement story is 11 feet high, and the second and third stories 14 feet high. Patients are now well accommodated, and the wards are kept remarkably clean, airy, and neat. All the bedsteads are made of hammered iron, with joints, to turn up in the day-time; and some of them have a screw to raise or lower the back, for altering the position of patients when in a weak state. The wards in the south front have strong Venetian blinds on the outside; and every window has a portion of each pane in the top of the upper sash cut away, and a moveable frame of glass placed on a cross bar, in order to admit more or less air at pleasure. Many other ingenious contrivances are adopted to obtain a succession of pure fresh air. Such patients as are able to sit up are removed to the dining-rooms, or cross galleries, for a few hours daily, while their beds are carried into the open air, and the wards exposed to ventilation. Each story in the new house has a gallery six feet six inches broad, in which the patients walk when the weather is wet; and every floor is furnished with a nurse's room, scullery, and water-closet, conveniently situated, and abundantly supplied with water from a large leaden cistern, placed on the top of the new building, where it joins the old Infirmary. Warm baths, on an improved plan, were erected by subscription in 1817. The other numerous and important improvements introduced into this hospital have insured wholesome accommodations to the sick and convalescent, and rendered it one of the most complete charities of the kind in England. The east wing contains the physicians' and surgeons' consulting-rooms, a waiting-hall, and a dispensary. In the governors' room are elegant portraits of Sir Walter Blackett, Bart. by Reynolds; Matthew Ridley, Esq. by Webb; Dr. Joseph Butler, bishop of Durham; Dr. Benson, bishop of Gloucester; William Ingham, Esq.; and one of Shute Barrington, the late bishop of Durham, painted by Owen; all of whom were great benefactors to this charity.

Since the commencement of the Infirmary in 1751, to March 31, 1826, no less than 59,877 cures have been performed. During the last Infirmary year, 1447 persons were restored to their friends and the community wholly freed from their complaints. Of this number, 803 were in-patients. By the last report, it also appears that 115 patients remained in the house. Persons meeting with sudden accidents, or labouring under diseases requiring the immediate help of surgery, are admitted, without any recommendation, at any hour of the day or night; but all other patients are admitted on Thursdays only, by a letter of recommendation from a subscriber or benefactor. Those not admissible into this charity are, women big with child; children under seven years of age, except those upon whom surgical operations are to be performed; persons judged to be incurable, (fn. 10) or in a dying condition, or labouring under insanity, the small-pox, or other infectious distemper, or afflicted with cancer not admitting of operation, or with consumption, scrofula, or dropsy, in the last stage.

Governors, who are either annual subscribers of two guineas or upwards, or benefactors of twenty pounds or more at one time, have the direction of the affairs of the Infirmary. Four general courts are holden in each year, viz. on the first Thursday in April, July, October, and January, for the dispatch of extraordinary business, and auditing and ordering payments of the quarterly accounts; and a committee of governors attends weekly on Thursday, to admit and discharge the patients, to examine the weekly accounts, to superintend the conduct of the officers and servants, and to control the expenditure of the house. The duties of this committee (which, in its constitution, is an open committee) are, in their nature, important and various; the presence, therefore, of any governor, not named on the committee, on a Thursday, at the Infirmary, is particularly solicited. Two, also, of the neighbouring governors are appointed, in weekly rotation, to visit the house, and to enquire into the conduct of the different departments, and into the behaviour of the patients and servants, and to report their observations to the house committee, in "The House Visitors' Book," in the governors' hall; and governors, as well those residing in the country as those not so, are also requested to take the trouble of visiting the house whenever they have an opportunity.

Subscribers, who commenced their subscriptions prior to the 2d day of April, 1807, may recommend, for one guinea, yearly, one in-patient, or two out-patients; for two guineas, double this number; and so in proportion for larger sums. Benefactors of ten pounds have the same right of recommendation as subscribers of one guinea yearly; and benefactors to a larger amount, after the same ratio. But those subscribers who commenced their subscriptions on and after the 2d day of April, 1807, recommend, for one guinea yearly, not more than one out-patient; and, for two guineas yearly, not more than two out-patients, or one in-patient: and this is a scale of recommendation which belongs to benefactors whose benefactions were made on or since the 2d of April, 1807, and will govern all future benefactions.

The revenues of the Infirmary arise partly from funded property, but principally from annual contributions and donations. The disbursements are much diminished, in consequence of great quantities of coals being given by the principal coal-owners in the neighbourhood. The greater part of the pecuniary capital belonging to the Infirmary hath been invested (in virtue of the power of an act of parliament, passed in the 1st year of his present majesty's reign, for amending the savings banks acts of parliament passed in his late majesty's reign) in the names of Sir Matthew White Ridley, Bart. M. P. and Cuthbert Ellison, Esq. M. P. as trustees for the Infirmary, which investment produces interest at the rate of £4, 11s. 3d. per centum per annum, and by which a permanent advantage has accrued to the institution, namely, an increase of capital to its funds, and annually to its receipts; the dividends formerly arising yielding only £199, 4s. annually, whereas the present interest received from the savings bank yields £289, 17s. 1d. annually, being an annual increase of £90, 13s. 1d. in favour of the charity; and this change was effected very seasonably, as a reduction of interest, from £5 to £4 per cent. had taken place on certain moneys belonging to the institution, to the amount of £30 a year. An accurate idea of the accounts of the Infirmary may be obtained from the following abstract, from 1st April, 1825, to 31st March, 1826, inclusive:—

The establishment of the Infirmary, for the 75th year, ending the 31st March, 1826, was as follows:—

Grand Visitor, The Honourable and Right Reverend the Lord Bishop of Durham. Presidents, His Grace the Duke of Northumberland; His Grace the Duke of Portland; The Right Honourable the Earl Grey; The Most Noble the Marquis of Bute; The Right Worshipful the Mayor of Newcastle; The Right Honourable the Earl of Tankerville. Vice-presidents, Sir Matthew White Ridley, Bart. M. P.; The Right Honourable Lord Ravensworth; Thomas Richard Beaumont, Esq.; Charles John Brandling, Esq. M. P.; Sir John Edward Swinburne, Bart.; Cuthbert Ellison, Esq. M. P. Stewards, for Northumberland, Sir H. D. C. St. Paul, Bart. M. P.; John Davidson, Esq.: for Durham, William Barras, Esq.; Samuel Walker Parker, Esq.: for Newcastle, George Shadforth, Esq.; Thomas Wailes, Esq. Preacher of the Anniversary Sermon, The Reverend William Hawks, B. D. Physicians, Thomas Emerson Headlam, M. D.; Noel Thomas Smith, M. D.; Darnell Bulman, M. D.; Thomas M'Whirter, M. D. Surgeons, Mr. Thomas Leighton; Mr. Edward Smiles; Mr. William Moore; Mr. John Baird. Treasurer, William Boyd, Esq. Secretary, Mr. Nathaniel John Winch. House-surgeon, Mr. James Church. Chaplain, The Rev. John Parkin. Matron, Mrs. Eleanor Pattison.