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44 THE ORIGIN OF

Mr. Paterson referred to a case of per- is that of the origin and gradual evolutioll forated ulcer, in which it was absolutely of our highly-organized scientific institu- impossible to suture the perforation at all, tionls, particularly the development of but he had performed gastro-jejunostomy, modern hospitals. On inquiring into the and the had made a complete re- derivation of that familiar word "" covery. He pointed out that two objection-s it is discovered that it springs from the had been raised to this procedure. The first word "hospes," meaning equially was that the tissues are not in a conditioln "guest " or " host." for a operation, anid the second that The first form of " hospital " was entirely it unduly prolongs the operation, but in; his ecclesiastical, and many of them, as shown opinion, neither objection is valid, his ex- by their consecration vows, xvere especially perience being that,, even in cases of septic associated with bishops ; the peritonitis, the -peritoneal surfaces unite being pre-eminiently for the refreshment of perfectly well if kept in apposition by the the soul, the care-and more rarely the cure firm pressure of a continuous suture. With -of the body being a secondary considera- regard to the second objection, he considers tion. At first hospitals wvere primarily that the procedure ought not to pr-olong the of rest for travellers, more especially operation more than five or seveni minutes. for pilgrims of whom at one period in our He mentioned that several times he had island histor-y there were a great number. sutured a perforated ulcer and performed For about a huindred years after tne Corn- gastro-jejunostomy in less than twenty-five quest there was an immense amount of miinutes. He thought too, that gastro- journeying up and down the couLntry, in jejunostomy was more specially indicated in spite of the difficulties of transport, and the later, and not so much in the earlier many were the pilgrimages undertaken to cases, although the contrary has been asserted such places as the Shrine of St. Thomas of by a well-known writer. Canterbury. This necessitated the pr-ovision In this particular case it would have been of rest-houses for the pilgrims, and these futile simply to suture the ulcer, as, owing places were made to fill the twofold ftunc- t1o the hour-glass constriction, the patient tion of guest- and infirmary. Towards would have continued vomiting, and so have the end of the thirteenth century genuine had little chance of recovery. pilgrimages were on the decline, but the The patient, on her return to the ward, rest-houses or hospitals continued to be had continuous saline by the rectum. The filled by an incr-easing number of rogues woman- gradually r-allied, and was in fairly and vagabonds, who found it a simpler form good condition by the evening. *She left the of acquLiring and board than by honest Hospital five weeks later quite well, and in work. This vagrancy became an ever-ini- better.health than she had been for many creasing problem, and the tenidenicy grew to years. discriminate among the applicants at the hospitals anid slowly to provide more beds for chronic sufferers than for casual way- THE ORIGIN OF farers. Of the hospitals at presetnt existing (in a HOSPITALS. very different form from their original NOWADAYS when one is so accustomed to foundation) in or near Londoni, St. Bartholo- take everything for granted it is sometimes mew's and Bethlem 'provide some of the well worth inquiring into the origin of most inter-esting history. St. Bartholomew's, instituitions with which one is familiar. of course, was founded in the twelfth cen- Perhaps one of the most interesting subjects tury by the monk Rahere, as the direct result 45 T149THI. ORIOINORIGIN OF HOSPITALS 45 of a vision vouchsafed to him. The land founded in I247, derived its name from the on which the present hospital still stands Basilica of the Nativity built in Bethlehem, was granted to the monik by Henry I; to Palestine, by the Emperor Constantiine. In the original site was added two further plots its early years it was situated in Bishopsgate in Smithfield given by Edward II in 1326, Without (), which was then a country anld finally in I9Of the hospital took over site "without" the old London Wall; the the site of the Bltue Coat School when Broad Street stationi of the Great Eastern Christ's Hospital was removed to Horsham. Railway and the Metropolitani Railway now St. Bartholomew's had a very fluctLiating occupies most of this site, which is well career in its ear-ly days, and an interesting within the boundaries of Greater London. coincidenice is that ill I754 a complaint was There is no record of the building having macle " of the resort of idle, loose and dis- been used as an asylum for mental cases persons, beggars and others, cryinig until I377, but sinice that date it has always and selling all manner of commodities very been associated with psychological cases. improper for the in and about the The hospital, like St. Bartholomew's, ex- staircases and wards . . . to the great perienced manv tips and downs, and the discredit of the good government of the following incidents taken at random from house," and apparently during the late war the detailed records are of interest. a certain amount of difficulty was experi- As far back as I367 the Mayor and eniced with a similar class of person, who Aldermen of London wrote to the then managed to penietrate into the wards on Bishop of " Bedlem," who resided in France, var-ious pretexts when it became knowin that praying him not to "farm out" the hospital soldiers with a certain amount of money to to the highest bidder-apparently quite a spenid were inmt-iates. usual practice in those days. It was nearly Some initerestinig characters in history forty years later that Henry IV commis- have lived -within the hospital precincts at sioned an inquiry into the charges of mis- various times, of whom the following may management, and this was followed some be mentioned: Dr. Caius, founder of Caius thirty years later by yet another inquiry into College, Cambridge; Dr. Roderigo Lopez abuses. Iron chains, manacles and stocks (fir-st to the hospital, who was for the restrainit of mad persons are mentioned hanged, drawn and quartered for having in the inventory of I398. brought about the death of Queen Elizabeth); In the sixteenth century a brother of the Dr. Timothy Bright, "father" of shorthand, unhappy Queen Anne Boleyn was appointed and abridger of Foxe's " Book of Martyrs"; as Master of the Hospital, and only Sir Thom-ias Bodley, founder of the Bodleian seventeen days before his death, in 1547, Library, Oxford (he, by the way, paid an Henry VIII ratified a deed of covenant annual rent of f5 6s. 8d. for his house); and which granted the " mayor, commonialty, and Colonel Thomas Pride (of " Pr-ide's Purge " citizens and their successors " to be " masters, fame), who lived there in the time of the rulers, and governors of the hospital, or Commoniwealth. house, called Bethlem." During Queen The hospital was rebuilt in the eighteenth Mary's reign Bridewell Hospital and Beth-' century and James Gibbs, who gave his lemn were placed under the same management. services free, was the atrchitect; other build- There is a record that in I609 the keeper ings to this same architect's credit being at Bethlem was given an increase of St. Mary-le-Stranid, St. Martins-in-the-Fields, remuneration from sixpence per patient per St. Peter's, Vere Street, the Radcliffe Camera, week, to sevenpence "on account of the Oxford. dearness of the times," and in I693 a nurse The , which was was installed " as an experiment" POST-GRADUATE NEWS

Nearly five hundred vears after the Royal Institute of Public Hecalth, 37, RLISSCII foundation of the hospital, the first moove was Square, W.C. i. made from. Bishopsgate Without to buildinigs A course of lectur-es on "'The Health of in Moorfields, wher-e it stayed uniitil I8I5, the Citizeni " is in progress at the Institute when a second miiove was made to St. Lecture Hall, at 4 p.m. on Wednesdays. George's-in-the Fields. The last move was The lectures for December are as follows: mnade in I930, when the niew buildinigs were opened at Eden , niear Beckenham, ani December 9.-Professor E. L. Collis, M.D., amazing cotntrast in their efficiency anid comn- "The Health of the Industiial pleteness to the originial institutionis. Apart Worker" (with lantern illus- fromu the uisuatl accommodation for patients trations). and staff, there is a chapel, a recreation hall, December i6.-Sir Pend(lrill Varr-ier-Jonies, accommodation 'for- hiydrother-apy, massage, M.R.C.P., " The Welfare of the dental and electrical treatment, X-ray and Tuberculous Citizen " (with psychotlherapy, &c., developments certainly lantern illustrations). not foreseen by the originial founders. There is nio fee for attendance. Celitral Lonidonl Throat, Noseandl Ear Hospital, Gray's Inn , W.C.i. POST-GRADUATE NEWS. The following lectures will be given durinig December on Fridays at 4 p.m.:- Nattionlal Associationi for the Prevention oJ N. " Chroniic Intfant Mortality, Carnegie Hotuse, December Ii.-Mr. Asherson, II7, Piccadilly, W i. Otorrhcea." December X 8.-Mr. A. Lowndes Yates, " The The remaiiiing lecture in the cour-se of Complications of Catarrhlal lectures on Maternity anid Child Welfare Inflammation of the Nose." being giveni at the Infanits Hospital, Vincenit Square, will take place on Moniday, There is no fee for attendance. Decembel 7, from 6.30 to 7.30 p.m., is as The Nationial Council for Mental Hygiene, 78, follows:- Chandos House, Palmer Street, S.W.i. "Child Guidance," by Dr. William Moodie, , The Child Guidance The last lecture discussioIn of the series Council. beinggiven on Thur-sdays at 5.I5 p.m. at the Fee for the lecture is., payable in advanice, Lecture Room of the Medical Sociely of to Miss Richards, National Association for London, 1, Chandos Street, Cavendish the IPl-eventioni of Inifanit Mortality, 117, Square, W.i, is Is follows Piccadilly, W. i. DecemIiber io.--Dr. Ernest Jones, " IPsyclho- Anialysis." LECTURES. Tickets, price is. 6d. eaclh, may be obtainted The following lecture, arr-aniged by the from the Secretary of the Counicil or at the Fellowship of Medicinie, will be giveni at doors. 4 P.m. oni Wednesdays,at the Medical Society of Loindon, II, Chanidos Street, Cavenidish Royail College oj Snti-geonts, Litncolnl's Inn Square, W. i:-- Fields, W.C.2. December 9.-Mlr. Cecil A. joll, " Goitre, Trhe Vicarxv Lecture wvill be delivered on with Special Reference to Trf-uisday, December- IO, at 5 pui;., by Col. Thyrotoxicosis." WV. 1P. MacArthur. Tlher-e is nio fee for 'rhere is no fee for attenidance. attendance. POTGAUTPOST-GRADUATE NEWSES447 Kintg's ( ollege Hospital MedIical School, December 3I.-Dr. Normani Hendersoni, Deiniark Hill, S.E.5. "The Technique aniid Inter- The following lectures will be giveni on pretation of Barium Enemata." Thurscdays at 9 p.m. in the Lecture Theatre of the MIedical School. Coffee will be Royal Northern Hospital, Holloway Road, served in the Comnmlon Roomi at 8.45 p.m. N. 7. There is nio fee for attendance. The following lectures will be given on Decemllber io.-Dr. Wilfrid Sheldoni, " Dia- Tuesdays at 3.I5 p.m., as follows gnlOsis and Treatment of December 8.-" Sexual Neuroses." Dr. W. Astlhma in Childreni." R. Reynell. December I7.-Mr. Yates Bell, "Recent December i-.-" The Breast" (lecture- Advances in ." demonstration), Mr. Hamilton Bailey. Heiamlpstead Gentc-al Hospital, Haverstock There is nio fee for attendance. Hill, N.W.3. The folloxving lectures will be given onl DEMONS'rRATIONS. Wednesclays at 4 p.m. Tea, will be served rhe following demonstrationis will be after the meeting. There is nio fee for- given during December. There is nlo fee attendanice. for attendanice. December 9.-Dr. Rickword Lane, " Per- In Medicinie:- ricious Anwmia." Monday, December 7, 6 p.m.-St. John's, December i6.-Mr. T. W. Letchworth, Leicester Square. Dr. S. E. "Toxic Ambliopia and Retro- Dore (O.P. Dept.). bulbar Neur-itis." l'uesday, December 15, 2 p.m.-Royal Wlater-loo, Waterloo Road, UCniversity College Hospital Miedical School, S.E.i. Dr. Bernard Myers, Gower Street, W.C.l. Pulmonary Affections of Child- The following lecture in hood. will be giveni during December on Tuesdays, In Snigcry: at 5.I5 p.m., in No i Lecture Theatre of the Tuestlay, December 8, 3.30 p.m .-Royal . There is no fee for Northernil, Holloway Road, N.7. attendanice. Mr. Hamilton Bailey (in Clinii- December- 8.-Dr. R. T. Granit, "Tlhe cal Lecture Room)). Pathology of E ndocarditis ThuLrsday, December I7, I 1 a.m.-Miller` (No. III). General, Greenwich Road, S.E. Mr. Reginald Ledlie, Varicose St. Ma(rk's Hospitail, City Road, E.C. Veini lijections. The following lectures will be giveni at 4.30 p.mn. oni Thursdays. There is nio fee Un versiti' of Biriniiighant. for attendance. The University Clinical Boarcd has December io.-Dr. Cuthbeit Dukes, "The arranged post-graduate instruction in prac- IPathology of I ntestinal. tical midwifery (and anite-natal) at the Obstructioll." . For this December 17.-Mr. . r. c. Milligan,l course, which is of one miionth's durationi, Pr'octo-Colitis." meldical practitioner's miiust reside in the 48 POST-GRADUATE NEWS

Hospital. The fee for the instruction is Six clinical and two pathology evenings at 5 guineas, payable to the University of the London Temperance Hospital, Hamp- Birmingham. The cost of board and resi- stead Road, at 8 p.m. as follows:- dence in the Hospital is arraniged separately. Monday, Februalry 22 (Clin1ical). The University Clinical Board has also Friday, February 26 (Clinical), arranged post-graduate instruction in Monday, February 29 (Clinical). venereal . This Course is held at Friday, March 4 (Clinical). the General Hospital, Birminigham, and Monday, March 7 (Clinical). medical practitioners attend during three Friday, March ii (Clinical). months, as arratnged with the Venereal Monday, March I14 (Pathology). Diseases Officer; and at the end of the Friday, March i8 (Pathology). course a certificate of attendance is granited providing two of the Five demonstrators, eachi which complies with the requirements cases, will be present each clinical evening. Ministry of Health for appointments as Post-graduates wvill be limited to 25, and Medical Officer (Venereal Diseases). The fee divided into groups, each group to the will be for this course is I5 guineas, payable going to each demonstrator in tuIrIn to University of Birmingham. examine the cases and be questionied on the and treatment. ADVANCE NOTICES. diagniosis Four eveninig lectures xwill be giveni at the Fellowship of Metlicinle. Medical Society of London, ii, Chandos A Course of six evening lectures on Enido- Street, Cavendish Square, at 8.30 p.m. on crinology will be given by Dr. W. Langdon Wedniesdays, February 24, March 2, Mar-ch 9 Browni at the Medical Society of London, anid March i6. II, Chandos Street, Cavendish Square, W.i, The lectures will not be limited as r-egards at 8.30 p.m., as follows:- attendance of post-graduates, anid tickets Monday, Janiuary ii.-" The Endocrines may be taken at the door, if desired. The and the Sympathetic Nervous fees for the clinical evenings anid lectures System." are not yet fixed, but will be aninouniced Friday, JanLuary I5.-" Iinfanitilism and the later. Copies of the syllabus may be ob- Retarding Glanids." tained, as soon as printed, from the Fellow- Monday, January i8.-"The Pituitary Body ship of , i, Wimpole Street, W.i. anid the Diencephalon." Friday, January 22.-" The Thyroid and Tavistock , 5I, Tavistock Square, Carbohydrate Metabolism." W.C.I. Monday, January 25.-" The Parathyroids Twenty Lectures on Psychological Types and Calcium Metabolism." and Mechanisms, an initroductory course Friday, January 20.-"The Adrenals and of Psychological Medicine for the General the Gonads." Practitioner, will be giveni at the Friends' Fee -3 3s. for the series, or 12S. 6d. per House, Euston Road, N.W.i, on Wednies- lecture. Copies of the syllabus may be ob- days, beginning January 20, I932. tained from the Fellowship of Medicine, The lectuires will be given by Dr. E. I, Wimpole Street, W.i. Graham Howe, from 3 to 4 p.m., and by Dr. H. Crichton Miller, from 4.30 to 5.30 M.R.C.P. EVENING COURSE. p.m. An evening Course will be held for the The fee for either series will be .£i i is. 6d., M.R.C.P. examination as follows:- or b2 2S. for both series. Tickets may be POST-GRADUATE NEWS 49 obtained from the Fellowship of Medicine, MEDICAL SOCIETIES. i, Wimpole Street, W.i. Society of Medical Officers of Health. Golden Square Throat, Nose and Ear Hospital, A Meeting will be held on December i8, W.I. at 5 p.m., when Sir Hubert Bond, K.B.E., and Dr. P. K. McCowan (Medical Supt., From the beginning of January regular Cardiff City Mental Hospital), will open a clirnical demonstrations will be held on1 discussion oni " The Mental Treatment Act, Monidays and Wednesdays at 3 p.m. There 1930." is no fee for attendance and the will be carried on indefinitely if the attendance Medical Society. makes it worth while. Car-diff A Cliniical Meeting will be held at the Londont Light atnd Electrical Clinlic, 42, Royal Infirmary, Cardiff, on December I5. Ranelagh Road, S.W.i. A post-graduate Course of twelve lectures Colchester Medical Societv. on Physiotherapy will be given at the A paper will be r-ead by Dr. G. H. Oriel London Light and Electrical Clinic on on " and its Clinical Applications Wednesdays, at 8.30 p.m., starting on on Friday, December [1, at 8 p.m. January 6, I932; Observations can be made of treatments in the wards during the day- Lcicester Medictal SocietA. time. Fee 4 4s., payable to the Secretaly A Clinical Evening will be held at the of the London Ligl)t and Electrical Clinic, Royal Infirmary, Leicester, at 8.45 p.m. on 42, Ranelagh Road, S.W.i. Copies of the Wednesday, December 9. detailed syllabus may be obtained from the Clinical Afternoons will be held at the Fellowship of Medicine or from the, Clinic. Royal Infirmarv on Wednesdays at 4.45 p.m., as follows Hospitalfor Consu inption, Brompton, S.W.3- December 2, by Mr. W. 1. Cumberlidge. The following lectures will be given on December i6, by Dr. R. McD. Cairns. Tuesdays, Janiuar-y 12 and 26, at 5 p.m. Doctors atteniding should iniqtuire at the January I2.-Dr. Batty Shaw, "Tuberculosis Porter's Lodge as to the Ward. of the Lungs determinable on Skiagraphic evidence: Idio Torquiay & District Medical Society. Skiastic Tuberculosis of the A Joint Meeting with the Exeter and Lungs." Medical Societies will take place Januar-y 26.-Sir James Duindas-Granit, at the Torbay Hospital at 8.30 p.m. on "Tuberculous Laryngitis." December I7. Coffee will be served at There is no fee for attendance. 8.I5 p.m. Fellowship of Medicine, i, Wimpole Street, York Medical Society. W.i. A Meeting will be held on Saturday, It is hoped to arrange series of evening December 5, at 8.30 p.m., when Sir D'Arcy clinical demonstrations for practitioners in Power will speak on " The Barber , in , and in Companies of York and London; their Electro- early in the new year. Full Resemblances and Differences." details as to time, place and fees will be A Clinical Meeting will be held on available shortly. Application should be Wednesday, December 9, at 3 p.m., at the made to the Fellowship of Mledicine. York Hospital.