YOU may remember when I had the pleaſure of ſpending a day with you at your Seat in—ſhire, that the diſcourſe after dinner turned on the Subject of Hoſpitals, as lately erected in many of the Counties in England. The Company in general applauded ſuch undertakings; a few doubted whether they were always conducted in the moſt proper manner, while one perſon ventured to ſay, they did more harm than good. I perceived your Humanity was hurt at this laſt inſinuation, and ſaw by the ſignificancy of your Looks, that you wiſhed as you knew how highly I approve ſuch In⯑ſtitutions, that I would have ſtood forth in their defence.

What I then declined doing in converſation, I am very willing to do by Letter. I had two reaſons for not entering on the Subject at that time; One, becauſe I was not prepared to treat it fully; the other, becauſe a large company is very ſeldom an at⯑tentive one. You muſt often have obſerved that in [4]the unreſtrained freedom eſſential to ſocial debates, too many are apt to ſpeak at once; and thus bring ob⯑jections faſter and in greater number, than the defen⯑dant has time to remove or comprehend; whereas ſeveral objections would ſucceſſively vaniſh before an uninterrupted explanation; and arguments are known to derive accumulated force, from relative and ne⯑ceſſary connections.

It is poſſible I believe for minds to be ſo influenced by Error as to indulge ſpeculation to the excluſion of practical duties; it muſt have been from ſuch a principle that any one ever thought the life of a mu⯑tilated Slave, not worth preſerving, or that we were under the dominion of ſuch a Fatality, as rendered ſuccour to the ſick, needleſs.

It is not to ſuch as theſe I direct my thoughts, but to ſuch as convinced of the utility and neceſſity of this branch of benevolence, wiſh only to ſee it pract⯑iſed in the beſt manner it is capable of, and as little injured as may be, by the imperfections of human management.

The chief and foundation Stone of theſe benevolent Structures, is the relief of ſick and ſuffering Poverty. Thus far all build alike; this is the undoubted aim of every contributor. And yet though this principle ſeems of a very ſimple kind, it becomes when re⯑duced [5]to practice more complicated than could be wiſhed; and hence it is that the Rules and Orders of moſt Infirmaries, can ſo ſeldom be entirely complied with. They generally exiſt previous to any trial, how far they may chance to be more or leſs benefi⯑cial to the main deſign; Experience, and Experience only, can properly teach us this. There is a variety of perplexed circumſtances in the Caſe of many who petition for relief in Hoſpitals, which no Rule can regulate, and many Rules make worſe: while the relaxation of a rule, begins confuſion, and a tempo⯑rary ſuſpenſion compleats it.

The Rules and Orders of every Hoſpital are de⯑ſigned to operate in two points: for the benefit of the Patient, and the good order of the houſe; to ſtate what are the Qualifications that render the ſick, pro⯑per objects of charity; and what conduct of theirs is neceſſary to give them a chance for relief. To which is added, and with great propriety, what kind of Be⯑haviour is expected from them in return.

I ſhall ſpeak to each of theſe articles, by which it will appear how difficult it is to confine them to uni⯑form Rules.

With reſpect to Poverty, I would have that always reſt upon the Credit of the Recommender, as it would be impoſſible to examine into it, during the [6]time allotted for the admiſſion of patients; beſides that the ſtate which qualifies the Petitioner to be fa⯑vourably heard, does not entirely depend on his being in abſolute want. The poor Wretch who has by ſevere labour accumulated a few pounds, may be very unable to ſupport himſelf and family, under a ſevere illneſs, without ruining his little hoard; and ſpending perhaps in a few weeks, what was the la⯑bour of years to acquire. Humanity ſeldom errs, tho' judgement may.

But the nature of the diſtemper is a more difficult circumſtance. There is a certain fence between the Pauper and this kind of Charity, which one knows not eaſily where to place. There will in moſt Infir⯑maries be more Candidates for relief, than money to accompliſh the good deſign; it is very proper there⯑fore to lay it out where there is the greateſt likeli⯑hood of ſucceſs, and to withhold it from ſuch as ſeem incapable of benefit. On this principle is founded the regulation of excepted caſes. Some Diſorders pro⯑claim at firſt ſight the impoſſibility of a Cure, and are therefore properly rejected; others are ſo far ad⯑vanced that we have little chance of removing them; yet it is not always ſafe to pronounce the diſorder in the laſt ſtage, and the Patient in a dying Condition; here the Phyſician holds the ſcale with a trembling hand, to ſee whether Pity or Juſtice muſt preponde⯑rate. Monſtra fiunt in Medicinâ, is a well known and [7]indiſputable axiom, and to ſay exactly when nature has done her all, and Art can do no more, is in ſome Caſes impoſſible. You ſee by this that my Inclina⯑tion tends to admit of almoſt hopeleſs Caſes, in order for trial. How trifling does the objection of hazard⯑ing a little expence appear, when ſet in oppoſition to the attempt of ſaving a uſeful Life?

But ſuppoſing our hope of ſucceſs ſhould be too ſanguine, and the impoſſibility of giving any relief confirmed, and the Patient during the experiment become too bad for removal, what is to be done then? I make no ſcruple to anſwer, the Patient ought to die with us. I acknowledge that the primary Inten⯑tion of theſe Charities is the Reſtoration of Health and Eaſe, and that when the undertaking appears very unfavourable, we ſhould deliberate before we determine to receive the Patient; but ſhould we be accidentally obliged to let the Patient die with us, I inſiſt we are Charitable ſtill. There are ſome ſuf⯑ferings at the cloſe of ſome lives, which Humanity muſt ever wiſh to ſoften; and which theſe Inſtitu⯑tions certainly do; nay the letting one ſingle Life ex⯑pire with us, may be the preſervation of many. The pauper would probably at home have expired (per⯑haps offenſively) in the ſame ſmall bed, with his wife and infant family; Diſtemper might thus be propa⯑gated, for want of Air and Room, to a whole Cottage, and ſeven periſh inſtead of one. We improve on [8]Humanity, while we prevent thoſe evils which we are not certain we could cure, and do as much good and at leſs expence, by obviating as by removing complaints.

It is acknowledged on all hands, becauſe it is de⯑monſtrable, that the expence of the In-Patients is conſiderably encreaſed by the length of time they are obliged to ſtay in the houſe; but would the ſuperfi⯑cial readers of our annual accounts, or the rigid ad⯑vocates for unremitting Oeconomy, but deign to vi⯑ſit theſe Scenes of ſuffering, they would acknowledge their money was not wantonly expended, and that the number of wretched ſufferers muſt occaſion a conſiderably larger diſburſement; ſtill however as far as may be, to reconcile Oeconomy with Humanity, let it be ſeriouſly remembered, that would the Pau⯑pers themſelves, or their friends or Pariſh Officers for them, ſend them for help at the beginning of Sores, Hurts in the Joints, &c. their Cures would be compleated in a much ſhorter time, with infinitely leſs pain to themſelves, and proportionally leſs ex⯑pence to us. If they come to us however in a far advanced State of Evil, in God's name let us ſpare no expence for their recovery. I had rather Addenbrooke's Hoſpital ſhould never be any bigger than it is, than figure away in our account with twenty times the number of Patients, and not do half the good.

To obviate however every objection of this kind as much as may be, and to keep clear of a tax which Infirmaries moderately endowed can ill ſupport, it is one of our rules, that Patients living at a great diſtance where we cannot examine them ourſelves, ſhould ſend by an Apothecary or Surgeon, the exact ſtate of their Caſe, that their coming may be pre⯑vented, if deemed unneceſſary or improper.

One of the Caſes generally refuſed admittance into Hoſpitals is that of Epileptic Fits, and with great propriety; as the ſight of them has been known to occaſion the ſame diſorder, in perſons not before afflicted with them. Indeed they are in many In⯑ſtances ſo unconquerable, that all attempts to relieve them are fruitleſs. But even to allow theſe Objects every poſſible Chance, they are conſtantly admitted on the Liſt as Out Patients. It were however to be wiſhed that all Objects of this kind could reſide in the ſame Town in which the Infirmary is placed; as ſuch perſons being obliged to walk a conſiderable way, to or from an Hoſpital, may chance to fall in going over narrow planks, walking by the ſide of Ditches, &c.

The only poor to whom I think we ſhould deny, or but ſparingly afford our aſſiſtance, are the Vete⯑rans in iniquitous Habits; not from any want of common humanity, or from a preſumptuous con⯑demning [10]of others, but becauſe we here ſtrive againſt the Stream, we attempt impoſſibilities. The Diſeaſe, as well as Habit, is become incurable from a repeti⯑tion of the ſame Cauſes, which firſt produced it, and the conſtant continuance of which feeds and inflames it. Habitual Drunkenneſs is therefore the greateſt diſqualification of an object that deſires relief in this way. And indeed the very few Patients of this Claſs, who have not entirely drowned their under⯑ſtandings, are ſenſible enough of the impropriety of their application, and acknowledge their expectation of relief to be very little; becauſe they own they have drank hard in their time, which generally means, as long as they were able.

Another ſpecies of Diſeaſe, at leaſt in an advanced State is rejected, becauſe very troubleſome in its conſequences, very tedious in its Cure, requiring ſometimes uncommon attendance, and uſually the lot of the very profligate. Our Hoſpital, as far as it can, endeavours to ſend out its patients more vir⯑tuous than it receives them; endeavouring to pro⯑mote as will hereafter be obſerved, every good diſ⯑poſition by Prayers, Advice and Books.

There is yet one kind of Patients more who muſt ever be deemed proper Objects of our Charity. I mean thoſe, who are taken ill during a conſtant re⯑ſidence here in a diligent exerciſe of their employ⯑ment, [11]though barely ſufficient for the maintenance of themſelves, or family. To ſend theſe in a dangerous or languiſhing State to ſuch Hoſpitals as from their ſettlement they would have a claim to, would be often impoſſible, and always inhuman. And it ſhould be remembered that the benevolent Founder of our Hoſ⯑pital, meant it to be for any poor ſick perſon what⯑ever, not limiting them to Place or County; and what⯑ever regulations have been obliged to be introduced of this kind, are entirely owing to the impoſſibility of fulfilling his wiſh, and the propriety of giving a preference, when neceſſary, to our Town, County, and the Iſle of Ely.

Having now finiſhed my Obſervations on what ſeem the neceſſary Qualifications to render Patients proper Objects for an Infirmary to relieve, it comes next in turn to conſider by what methods the relief of each can beſt be attempted.

As no Hoſpital can properly contain the num⯑bers that every week ſollicit to be admitted, the ſick are on this account neceſſarily divided into In and Out Patients. This is unavoidable, and atten⯑tion is therefore paid to the moſt immediate diſtreſs, and Objects of this ſort preferred to be taken in. But it often happens that patients are not excluded for want of room, but becauſe they cannot find time to come in. The heads of families cannot always be [12]ſpared from home. If a mother, ſhe is wanted to look after the children; if a Father, he muſt try to work, however little, to maintain them. Whatever be the Cauſe, the conſequence is clear, that Out Pa⯑tients cannot have equal aſſiſtance, with thoſe within; and ſome inconveniences follow, and cannot be a⯑voided both to themſelves, and the Charity that aſſiſts them. Aſſiſtance can only be given to ſuch Suffer⯑ers by obliging them to come to the Hoſpital for Advice and Medicines. They muſt come for theſe upon a ſtated day of the week, whatever may chance to lengthen the Intervals between their coming. If they come in bad weather, they encreaſe their com⯑plaints; if they wait too long for good they are with⯑out medicines. It often happens that they come miles, and almoſt always that they walk. Theſe circumſtances it is to be feared, abate the efficacy of preſcriptions, and ſometimes entirely fruſtrate their deſign. Beſides which the treatment cannot always be ſo well adapted to their complaint, as in the Houſe; ſome remedies require caution in the admi⯑niſtring, and moſt find an auxiliary in proper diet, little of which I ſuppoſe is to be met with in poor Cottages; nay the very form of the medicines parti⯑cipate in ſome meaſure of the inconvenience, and as the time of year happens, ſuch as will keep longeſt muſt have the preference to others that would exert their effect more ſpeedily or powerfully.

And here let me note a prevalent error among the ignorant part of mankind in general, and that is a notion that the firſt preſcription is always meant for the immediate eradication of the Diſeaſe, and there⯑fore if they find themſelves diſappointed in this, they give over, and take no more. Whereas ſome Caſes and conſtitutions require a little previous prepara⯑tion to give medicines a Chance of doing good, and perhaps to prevent them doing harm. Bleeding and ſome other evacuations, belong to this introductory Claſs of Relief. And I have ſometimes had reaſon to ſuſpect that more harm has been done by thus un⯑ſeaſonably ſtopping ſhort, than would have followed from having done nothing at all.

I have dwelt the longer on this explanation, in order to account for the reaſon of the great number of Out Patients generally remaining on Hoſpital Books, as alſo for the tediouſneſs as well as additional expence of their Cure, which probably would not in ſome Inſtances have been greater in the houſe.

There is no ſtronger Inſtance of the ſuperior ad⯑vantage of being an In, to that of being an Out Pa⯑tient, than what is taken from thoſe complaints which ariſe entirely from the want of proper warmth and nouriſhment, and which is often the fate of the Country Poor. I have ſeen ſome of theſe in vain [14]attempted to be relieved at home, who when they came into the houſe ſcarce wanted any other pre⯑ſcription than a warm bed and a full belly, and which often compleated their cure in a fortnight.

Nor let it be ſaid that relief in theſe circumſtan⯑ces is rather given to the pariſh than to the poor, for diſtempers are equally ſuch, whether brought on by poverty or any other Cauſe. Nay ſuch a ſufferer ſurely deſerves double compaſſion, who owes his ſuf⯑ferings to a neglect he dares not complain of, and yet wants ſtrength of conſtitution to ſupport.

Pariſhes are often burthened with a numerous Poor; and like the reſt of their fellow creatures, there are good and bad among them. It is not eaſy for Officers to know the exact merit of each family; it is more likely that to ſave themſelves trouble, they will lay down one uniform mode of relief, without nicely diſtinguiſhing between them; to which the modeſt will ever ſubmit without reply, whatever fatal conſequences it brings upon their health.

On the other hand, there are ſome Caſes which cannot bear the cloſe air of Wards, but require the purer effluvia of Hills and Country, and theſe are of courſe and with propriety refuſed admittance within.

Thus much is ſufficient to explain the different methods of relieving Patients. It remains in the laſt place to ſay ſomething of that Behaviour, which we expect from the Paupers to their Benefactors, the rules of which in ſome degree are not ſo convenient as could be wiſhed.

The Out Patients as well as In, are required when cured, to attend the Governors at the Board, to re⯑turn thanks for all favours received, when a little book of prayers or advice is put into their hands, if they or any of their family can read; and they are enjoined to return God thanks the firſt conve⯑nient opportunity at their reſpective places of worſhip for their Cure. Now the regular attendance of Pa⯑tients from great diſtances while under cure has been ſhewn to be in ſome inſtances ſcarce poſſible, and in many, what they do not like. In the preſent caſe it operates much ſtronger. Perſons of that Educa⯑tion which is uſually the lot of the illiterate, are more ſtrongly actuated by a preſent ſenſe of Pain, than by a ſenſe of gratitude when it is once paſt, eſpecially if attended with trouble to themſelves; in⯑deed in bad weather it is not required of them; where it proceeds from an ungrateful temper, no alleviation ſhould be propoſed: but where it is particularly in⯑convenient to them on account of the diſtance, or other unfavourable circumſtances, I think it might [16]in part be diſpenſed with by their returning their thanks to the Charity in the perſon of their Phyſi⯑cian, and being by him furniſhed with books and cuſtomary monitions; by which means too, their Boxes, Gallipots or Phials, would be more punctually returned, than at preſent.

Theſe Obſervations may appear trifling at firſt ſight, but are of ſome importance as connected with another rule, whoſe natural tendency operates to the diſadvantage of this unthinking claſs. It is always more deſirable to prevent faults, than to puniſh them; and an attempt at too much regularity, ge⯑nerally introduces confuſion. In proportion as you in⯑troduce allowances and admit exceptions, you get farther removed from, and inſenſibly deſtroy your firſt deſign. It were better to make laws if poſſible, of a comprehenſive nature at firſt, that ſhould virtu⯑ally include every power which we might in any caſe wiſh to exert, than ſuch as we muſt entirely run counter to, upon every unforeſeen event.

Now the reaſon of an unprofitable or faulty at⯑tendance of the Out Patients being ſo numerous, as has been explained, it is difficult to know when to adopt the uſually preſcribed puniſhment, of diſmiſſ⯑ing them for this fault, and rendering them incapa⯑ble of the Benefit of the Hoſpital for ever. This Interdiction indeed is directed to be taken off, when [17]they give a proper reaſon for their abſence. That Reaſon however ſometimes does not come till months after the Patient and his fault are forgotten, and 'tis often very difficult to know whether that Reaſon be a true one. It might therefore perhaps be better to ſubſtitute in its place, the obliging perſons to get a freſh recommendation, who have forfeited the rea⯑ſonable advantages of the firſt. Their friends to whom they would apply in this caſe, would if they found them faulty reprimand them properly, or re⯑fuſe them, and if innocent, vindicate them much better than they can do themſelves.

It is very difficult to make the Country poor un⯑derſtand the formalities, neceſſary for their admiſſion, they cannot comprehend what recommendation can be wanted to a Chriſtian Hoſpital, beſides the Pain, the Poverty, or Sores of the Object; all beyond is unintelligible to them, ſuch as that there muſt be a written or printed Recommendation, ſigned by a Subſcriber, that Subſcriber not three months in ar⯑rear, not having a Patient at the ſame time in the Houſe, nor having had more than a certain number, &c. They do not ſee how this tends to their im⯑mediate relief. And indeed the pathetic exclamation of "muſt I go back and die" accompanied with the haggard look of deſpair, may well get the better of the beſt planned ſchemes of prudent and provi⯑dent regulations. But for this difficulty alſo I would [18]ſuggeſt a Remedy, that thoſe Subſcribers who live in other Counties, or are never reſident within reach of the Charity to recommend for themſelves, ſhould leave their recommendations in the hands of ſome friend who would take care to uſe them only for the ſervice of proper Objects, when their own recom⯑mendations and thoſe of their neighbours were ex⯑hauſted.

But it is time to releaſe you, for I have made theſe obſervations longer than I intended. I cannot how⯑ever conclude without doing juſtice to the managers of our moſt excellent Charity. They are ever atten⯑tive to do all the Good they can with the money ap⯑propriated for that Uſe: to do good where they can, with ſtrict Oeconomy, but at all events, to do it. That uſeful Charities may ever abound, and that all Charities may be rendered as uſeful as poſſible, is the ſincere prayer of