The Express.
London, England, 1852-09-30 00:00:00

LORD SHAFTESBURY'S CONFIDENTIAL
REPORT ON BETHLEHEM HO.:PITAL.

The following is extracted from the Report founded
on Evidence taken before the Commissioners in
Lunacy, and referred to in the Erpress yesterday.
To-morrow we propose to continue our publication
of the statements of the witnesses:
TO TUZ MIGHT HON. sin OZOROZ OBEY, DART., &C.
February, 7, 11352.
Sla,—We, the Commissioners in Lunacy, report
that, by virtue of your order dated 13th June, 1841, autho-
rising two or more of us to visit Bethlehem Ifospi,ul, tour
memb. ra of this board visite d that institution on the 7th
July last, and saw all or the greater number of the patients
resident therein, and made ■ general inspection of the
wards, rooms, and exereim grounds sppropriated to their

i.pan that occasion the visiting commissioner* were ac-
companied by the matron during their passage through
the wards used by the female patients, aid by the re-
sident apothecary dining their inspection of the entire es-
tablishment. Alter having visited the weeds, and before
leaving the hospital, the • ommiesioners made various in-
quiries of the resident apothee iry, of the matron, of Dr.
Munro, one of the visiting physicians of the institution
(who call. el at the hospital during the continiuioners•
visit), and two of the nurses of the estublisliment, in re-
ference to certain points to which their at ..ration had been
directed, and also as to the care and attention generally
bestowed on the patients; end the answer, given to these
inquiries diecaosed frets that appeared to tau commissioner*
to deserve a more minute scrutiny.
It will be in your recollection that Our anlication to you
far an order to visit this hospital, was founded mainly 04
the ease of Miss A. M., respecting which information bad
been laid before us, together with certain matters of com-
plaint, into the accuracy of which, as a h hied ,ap, (attend-
ing the general treatment of lunatic patiente in England,
wo felt it to be out duty to inquire. Subsequently to the
visit made on the 7th of July, it became known that sin
inquiry was lending bs tore this board into soma matters
connected with Bethlehem Hospital, and th. reapon cer-
tain evidence was volunteered to be laid before us, which
we did not think it right to reject; the more cap, (dolly
as it appeared to bear materially on the gen. rat ehject of
I our inquiry.
We, therefore, at different times riunmoned before us
and examined various witnesses, end required the produc-
tion of several documents, tending to snow, nat only the
special treatment adopted in reference to pruticular pa-
tients, but also the character r f the general arrangement
and supervision of the hospital in which the treatment of
the cases brought especially wider our cognizance was im-
mediately or indirectly involved.
It is right to state that every facility was ;afforded by the
Governors of Bethlehem Hospital to enable us to pursue our
inquiries.
Before submitting the result of our inqatiry, it will I'3
convenient to advert to the leading characteristics of the
institution.

The net income of the estate applicable to the purposes
n( the chanty appears from the generel account of IS iO.SL
to be 17,40,1. per annum, which is exclusive of about
3,000/. per annum pail by government for the maintenance
land care of criminal patients, making a total income of
abut 20,400/.
The hospital is united with the hospital of Bridewell,
both of which, with their revenues, were granted to the
corporation of the City of London, and are now nominally
under the general direction of a body of severacirs at pre-
sent eicteding 300 in number. Out of this general body is
elected a managing committee, consisting (besides the pre-
sident and treasurer) of forty-two governors, and this com-
mittee subdivides itself into various sub-committees.
Amongst others, a sub-committee of seven menders is sum-
moned by rotation to attend weekly at Bethlehem 11,spi-
tat This sub-committee, however, is open to the whole
body of governors.
It is customary for four, five, or six governors to attend
the Bethlehem sub-committee, the duties of which are to
determine on the admission and discharge of patients ' • " to
inspect those in the house ;" to audit bills, etc.; and for
general purpose,.
Sometimes it is said that the treasurer, who, in the ab-
sence of the president, is the standing chairman, is alone
present, and constitutes in his own person this sub-commit
tee. Tue sub-committee go through the wards of the hos-
pital once a month, but never at night.
The sub-committee report to the general committee of
forty-two governor., who meet at Bridevrell, and by whom
the proceedings of the subcommittee are riquired to bo
confirmed.

The principal officers are the president, the trenswer
(who ranks neat to the president), two visiting physicians,
one consulting surgeon, the reaident alto' hecary, a steward,
a matron, and various subordinate officers.
The treasurer is a responsible officer, to whom the execu-
tion of various important duties is committed. In consi-
deration of his services to the institution and to the Bride-
well Hospital he has the free use of a furnished house at
Bridowell, in which he resides. His powers appear to be
very extensive. His duties, as stated by himself, are to
superintend the affairs of the hespital, " both as to its at-
tendants and details." He has no power, however, he
suttee, to interfere with the medical officers, or matron,
I emotes an individual member of the board, or to rescind
any of the exis:ing rules. Neverthele es, he sere that in a
case of emergency he takes upon himself to rt mind a rule,
reporting such interference on his part Mimed:eV:ly to the
committee. On one occasion, indeed, he atents to have st.+-
I signed to the matron, in our opinion very injudiciously, the
very important power of clarsifyint, employing, and gene-
rally of managing and arranging the &mak patients, with-
out reporting such alteration to the committee, or obtaining
their sanction thereto.

The treasurer generally presides at the weekly meeting.,
when reports from the steward end medical officers s.re
submitted to the board, and the case-book (so far only as
relates to patients who are from time to time discharged)
is laid before, and signed by him. The hiring and dis-
charge of attendants also rest with him. In the case of
hiring male attendants at d servants, he acts on the teem-
raendation of the resident apothecary and steward respec-
tively, and on hiring female attendants, on the recom-
mendation of the matron. His power of dismissal
appears to be absolute. The diet of the patien.a, together
with much of the internal economy and comfort of the in-
stitution, appears to be under his ii.fluence.
It does not appear that any periodical visits to the wards
are comprehended in the list of the treasurer's duties, but
he does visit them about once a fortnight, and sometimes
at uncertain times, but at night.
Practically, the treasurer is the principal authority at
I the hospital, holding the position of a managing director,
and the officers and others resident therein appear to be in
a great measure under his control.
The visits of the treasurer and other member' of the nub-
committee are fur the most part made at times when the
attendants may expect, and be prepared for them; very
rarely, if ever, at night, and after the patients are in bed;
and their attention on such occasions appears in general to
be principally directed to the state of the ward., in regard
to cleanliness, ventilation, and warmth, and to seeing that
the patients are tranquil and orderly, sod the attendants
are in their proper places.
It is to bo regretted that the visitors on these inteections
are invariably accompanied by an attendant, so that the
patients have no separate opportunities of making cem-
plaints ; and further, that no detailed entry or report re-
cording the fact of the visit, and the particular matters ob-
served, as calling (or reprehension, inquiry, or amendment,
is made or preserved in a written form.
The internal good order of the establ'shment, however,
and the general comfort and well being of the patients, in
ordinary circumstances must depend mainly on the degree
of vigilance with which the attendant, are superintended in
the performance of their daily duties by the resident officers
of the hospital.
The duties of the visiting physicians consist in each of
them visiting the hospital four days a week, one of these
days being on Friday, when the sub-committee assemble.
Upon these visits, each physician generally sees the patients
placed under his own care, or such of them as require
medical treatment, but not those under the can of his col-
league.
The precise duration of these visits cannot be easily
ascertained ; the physicians themselves estimating that
they respectively last two or three hours, and sometimes
only one hour, whilst another estimate fixes them at about
one hour each. They are evidently of no long duration,
for we understand that the limited attendance of one
of the visiting physicians has already been made the
subject of complaint by one of the governors of the
iastittition.

On reference to the duties of the physicians, as set
forth in the printed rules and orders, they appear to
be (inter olio), to inform the committee of soy nc,slect or
abode, and to suggest rofOrmatien ; to examine and pre-
scribe for the patients ; to visit every part of the hospital,
a..d to record their visits ; and to sign the cue-hook, which
(according to the rules and orders) is to contain the par-
ticulars of each case, as taken by the physician of the week,
with en account of the remedies prescribed, and the result
of such treatment.

How tar the visiting physicians have made themselves
acquainted with neglects and abuses, and have suggested
remedies, we have no means of ascertaining, except in the
several cams hereafter specially noticed. But it does not
appear that they prescribe fur all their patients, or that
they visit all parts of the hospital, or that they sign anysuch
esae•books as are required to be kept by the rules and
orders.

The surgeon's duties are mainly to attend in those eases
only where a patient has any disorder requiring his assis-
tance, and to vi•w the bodies of patients after death, and
leave a statement respecting them with the resident apo-
thecary. It does not appear that he is called on to attend
patients is ordinary or simple surgical eases, which are left
to the care of the resident apothecary.
The duties of the resident apothecary (amongst many
other things) are : First, to enter in a register the particu-
lars of each case as taken by the physicians, with a weekly
record of the bodily and mental health of every curable
patient, sod of any change from time to time in their con-
dition, together with the effects of all medicines adminis-
tered ; 2nd, to visit the patients end wards daily, and to
keep a record of such visits, and to report to the physicians
any alteration which he may make in the treatment of pa-
tients ; 3rd, to make occasional visite to the wards after the
patients are in their "leeping-roome, and to report such vi-
sits, with his observation' therem ; and, 4th, to regulate, in
the abarnes of the physicians, the clauiticatinn, employment,
amusements, and general management of the patients.
• • •

Amongst other things, there is much reason oo fear that
ectnces have prevailed in tome of the wards, which indi-
cate the existence of great harshness and violence on the
put of some of the attendants, and are in themselvis
utterly unjustifiable. We allude mcro particularly to the
practice alleged to have been resorted to of laying down