HOSPITALS AND CONVALESCENTS.

BY

MR. JOSEPH ADSHEAD.

[Read at the "Public Health" Section of the National Associstion for the Promotion of Social Science, at its Meeting held at Glasgow, Friday, September 28th, 1860.]

Ir is the object of this paper to endeavour to awaken attention to a subject which has doubtless, more or less occupied the thoughts of the Faculty, with regard to the physical condition of cases discharged from our hospitals, and as to the importance of an intermediate restorative provision (for such cases as are considered by their medical attendants as requiring it) between the hospital ward atmosphere and the home of the patient.

If convalescence be that of progressing to a state of recovery, or returning to a state of health, there scarcely need be urged the great desirableness of endeavouring to accelerate that recovery by every available means; and this will appear the more important when it is known that amongst the many thousands of persons annually passing through our hospitals from such multiplied causes, there are those who in so many instances are the main stay of the family,-those on whom the family is dependent for support,--and the withdrawal of the ordinary sustaining agency is fraught with consequences most inconvenient and serious.

With the more opulent, or those in better worldly circumstances, there may be a removal from the sick

room to the sitting-room,-from the town residence to the country mansion; or it may be to the inland retreats of Cheltenham, Harrogate, or Buxton, or the more remote sea-coast retreats, such as Scarborough, Brighton, the Isle of Wight, and other usual summer sea-side resorts; and at such places will not only be found those who have emerged from the sick chamber in the convalescent state, to enjoy the advantages of change of scene and the invigorating influence of change of air, but there, periodically, will be found the healthy visitor, who appears to consider it an essential element of existence to preserve as well as to promote the continuance of good health, that there must be some relaxation, some recreation; and thus there is the family transfer, for its month or two in the season, to some of the places to which reference has been made, and such changes and family transferences have at length almost become a fashionable necessity. Now, if such beneficial changes are deemed so important for restoration to health by the more wealthy, let an endeavour be made to extend these benefits to the humbler or more dependent classes. The physical ailments are the same in the one as in the other. The rich and the poor are alike liable to the same diseases and casualties; the broken arm, the amputated limb, the deranged or disordered system, must be subject, in the one case as in the other, to the same medical and surgical appliances; and, it is worthy of remark, that even the rich cannot have more skill brought to bear in their cases than is exercised in regard to the inmates of our hospitals; such institutions, in their respective localities, enjoying the great advantage of having as their officers the most eminent medical and surgical practitioners.

But where is the difference? It is when the patient, whether he be rich or poor, arrives at the convalescent state, that the strengthening, the invigorating, recreating influence is needed: the rich can have it; the poor convalescent cannot, unless it be provided for him. To advocate the importance of such a provision in a

penditure, £372. 6s. 3d. Out of this last amount £153. 12s. was contributed by the patients.

On the Yorkshire coast, near Redcar, a Convalescent Institution is about to be established. It is proposed, as a commencement, to afford accommodation for thirty patients. The charity will doubtless have to enlarge its borders. Interesting notices could be given of the Sea-bathing Hospital at Margate, also of Buxton Bath Charity and Devonshire Hospital, but they do not come within the range of the design of this paper. Before, however, proceeding with the consideration of the general question, the Metropolitan Convalescent Hospital must receive a notice.

The

THE METROPOLITAN CONVALESCENT INSTITUTION, at Walton-on-Thames, Surrey, was established in 1840. Its objects, as stated in its report, are to provide an asylum in the country for temporary residence of the convalescent or debilitated poor, whose restoration to health is impracticable in the hospitals, and their own unhealthy and ill-provided homes, but may be speedily effected by pure air, rest, and nutritious food. last report of the institution remarks-"The hospital surrounds them with every condition calculated to impart health and strength,—such as pure air, abundance of good food, airy dormitories, and healthful recreation. Patients from various hospitals and dispensaries, and from the crowded alleys all over the metropolis, are constantly being received, and are in general sent back to their employment, with their health fully restored, in little more than three weeks." It may be said, "Here is the philosophy of the whole intent of convalescent retreats."

This hospital contains 134 beds, with intended additions. Within the last ten years the institution has doubled the extent of its usefulness. In 1849, 684 patients were admitted; in 1859, 1,326 patients were admitted; and its expenditure for 1859 was £2365.5s. 7d. The estimated cost of maintenance for 1859 was £1.3s.3d. per patient; including all charges, £1. 15s. 8d.; and the

average time in the institution three weeks and two days.

It will appear that the subject of sea coast retreats has been urged upon public attention. Mr. Roberton, of Manchester, in 1831, printed a pamphlet under the title, "General Remarks on the Health of English Manufactories, and on the need which exists for the establishment of Convalescent Retreats on the sea coast, as subservient to the Medical Charities of our large towns." Dr. J. K. Walker, of Huddersfield, in 1840, also advocated a similar provision, not to accommodate the invalids of the humbler classes of Lancashire only, but also Cheshire, North Wales, and the West Riding of Yorkshire.

In their degrees, as sea coast convalescent retreats, the Southport Charity, the Rhyl and New Brighton Institutions carry out the objects to which allusion has been made; and whilst the usefulness of sea coast convalescent institutions will be readily admitted, and should be more extensively promoted, it is now proposed to bring under notice the desirableness and high importance of establishing auxiliary institutions in connection with our large hospitals and infirmaries, and which may constitute a timely and needed recourse for discharged cases, for a brief sojourn from the hospital ward, to a healthful convalescent retreat, only to the right objects for such a provision, and under such regulations as may secure the proposed advantages.

No name can be quoted which has given a more decided impulse to the consideration of the subject referred to (by her truly valuable notes on hospitals, and the very important evidence given to the Royal Commissioners), than that of Miss Nightingale-a name worthy of all honour-an authority which may be well quoted from both lengthened experience and extensive observation. This will appear most conspicuous in noting a reply of Miss Nightingale to an inquiry of the Royal Commissioners:-"What British and foreign hospitals have you visited?"

a more extended, and in a form more adapted to circumstances and exigency than at present found in any existing institution, is the design of the present essay. It is but a just tribute to Christian benevolence to show what, in a limited degree, has been done, both inland and on the sea coast, in the establishment of the different classes of convalescent retreats; and amongst the early institutions of this character is,

THE SOUTHPORT STRANGERS' CHARITY.-It is situate on the West Lancashire coast; was established in 1806, by a small beginning, namely, by some ladies. It is said "These worthy ladies, the late Miss Walcot, Miss Leigh, and Miss Johnson, who were some of the first residents in Southport, took a very active part in the formation of the charity, with the aged Miles Burton, surgeon, who was the first medical friend of the institution and its first treasurer." The objects of the institution are thus stated-" It is to place within the reach of the poorer inhabitants, of erowded manufacturing districts especially, the means of recruiting their debilitated bodies and recovering their shattered health, which the salubrious atmosphere of this highly-favoured locality (Southport) so eminently affords."

The following brief details show the progressive usefulness of the institution, as indicated by the three following periods:-1809: 42 patients admitted; expenditure, £78. 1s. 6d. 1830: 386 patients admitted; expenditure, £483. 19s. 6d. 1859: 1,455 patients admitted; expenditure, £1,886. 1s. Of this last amount-cash paid by subscribers for 1,445 patients, £1,172. Os. 11d. In 1853 a new building was erected, calculated to accommodate 106 patients.

RHYL CONVALESCENT INSTITUTION.-An appropriate building was erected in 1854, on the sea-coast at Rhyl, a station on the Holyhead Railway, about thirty miles from Chester. It has now accommodation for 34 male and 12 female patients, or a total of 46 patients. The objects of the Institution are thus described: