Medical Care at the Kent and Canterbury Hospital, 1836-1876

MEDICAL CARE AT THE KENT AND CANTERBURY HOSPITAL, 1836-1876 JOHN WHYMAN The Kent and Canterbury Hospital has served the medical needs of both in- and out-patients since 26th April, 1793. For 144 years it was located in the city's south-eastern surburbs in Longport where today only a plaque denotes its original site. Since 1937 its home has been in South Canterbury. 1 Prior to its absorption into the National Health Service in 1948, it functioned as a voluntary hospital. Headed by a President its administration and committees relied on the goodwill of governors and honorary officers. Medical provision was directed by honorary physicians and surgeons. Financially it was launched, maintained, extended and improved from subscriptions, benefactions, legacies and specific fund-raising collections and events. Prompted by a substantial legacy of £4,500 bequeathed by James Tillard, Esq., of Street End Place, the original hospital was greatly enlarged by two wings, which were constructed over the years 1829-30 and 1837-38, when substantial alterations were also made to the centre of the building. The total cost of these works absorbed £9,783 5s. 9d.2 By the end of the 1830s Canterbury and its surroundings possessed a much enlarged and completely remodelled hospital, which occasioned considerable gratification at the time. Its in-patient capacity had now increased to between 120 and 130 beds.3 1 For an illustrated history of the hospital, see F. Marcus Hall, Richard S. Stevens and John Whyman, The Kent and Canterbury Hospital 1790-1987, (Canterbury, 1987), copies of which may be obtained from the Kent Postgraduate Medical Centre at Canterbury. 2 lbid., 15, 16, 17-20, drawing upon the hospital's archives which are located in the Library of the Kent Postgraduate Medical Centre. 3 Dr John McDivitt, 'Statistics of the Kent and Canterbury Hospital', The Medical Annual, or, British Medical Almanack, (1839), 179. He wrote this article as one of the physicians to the hospital. 1 N PLATE I The Kent and Canterbury Hospital as it appeared during Queen Victoria's Reign. The wording below the engraving states that "This View representing the Kent and Canrerbury Hospital is respectfully dedicated to the Patrons of that Institution'. The view looking down Longport. with the cathedral and the remains of St. Augustine's monastery in the distance. shows very clearly the front of the hospital following the extensions of 1829-30 and 1837-38. The well-dressed pedestrians passing by would have been inadmissible for admission under the hospital's rules. (Source: Reproduced from F. Marcus Hall, Richard S. Stevens and John Whyman. The Kent and Canterbury Hospital, 1790-1987, (Canterbury, 1987), 89.) THE KENT AND CANTERBURY HOSPITAL, 1836-1876 During 1839 the hospital's total income was £2,170 15s. ld., slightly exceeding a total expenditure of £2,164 16s., including £1,190 ls. 5d. on housekeeping, £404 17s. ld. on salaries and wages and £385 14s. 5d. on medicines and the dispensary. The Annual Report for that year noted how 'the experience of a complete year has now proved the possibility of conducting the Hospital on its present establishment with an annual expenditure of £2,200 .... As to the Patients [in-patient admissions that year totalled 548], ... they have been well and faithfully attended to; and those who have been discharged [524], have uniformly expressed to the weekly boards their satisfaction at the comforts which they have enjoyed in the Hospital.' Consumed therein that year were 29,633 meals delivered to inpatients, involving 14,135 lbs. of meat, 2,013 lbs. of butter, 395 lbs. of cheese, 227 \bs. of tea, 2,016 lbs. of sugar, 2,697 eggs, 346 bushels of potatoes, 4,519 qts. of milk, 4,140 gallons of table beer, 180 gallons of ale, 106 gallons of porter, 624 lbs. of candles, 672 lbs. of soap and 100 tons of coal. Supporters of the hospital were further informed that 'many cases have been very severe .... The numbers have been proportionate to the increase of accommodation afforded by the addition to the former Building. The average of the whole year's attendance has been eighty-one In-patients [ and) the demand of numbers is not likely to be less. '4 Early in January 1840 the number of in-patients peaked at 102. They were under the care of one honorary consulting physician (Dr Harry William Carter), two honorary physicians (Dr John McDivitt and Dr Alfred Lochee), one honorary consulting surgeon (Mr William Fitch) and four honorary surgeons (Mr D.B. Major, Mr W.H. Renwick, Mr Henry Denne and Mr P.B. Hallowes), who were assisted by a paid resident establishment comprising a house surgeon and apothecary (Mr C.H. Browne), a dispenser (Mr William York), a matron (Mrs Ann Banfield), a porter, nurses and servants.5 Of these listed names Dr Alfred Lochee (1811-90), who in 1861 was President of the British Medical Association, served as an honorar􀁻 physician to the Kent and Canterbury Hospital from 1838 to 1883, a tenure of office of 45 years extending beyond the period covered by this article. In his early days in Canterbury he had published at the local Kentish Observer office two reports on the medical and surgical cases treated in the hospital covering almost a 4 General Kent and CanJerbury Hospital Annual Report for 1839. 5 Ibid. 6 G.H. Brown, Lives of the Fellows of the Royal College of Physicians of London 1826-1925, (1955), 52. 7 Hall, Stevens and Whyman, op. cit., 81. 3 JOHN WHYMAN four-year period from 16th October, 1838, to 1st June, 1842.8 From his personal findings and from figures found in the hospital's Annual Reports historians can begin to assess the nature and success of medical care in the Kent and Canterbury Hospital during Queen Victoria's reign. Some of the conclusions drawn from this evidence must remain tentative, however, until a fulJ and detailed analysis has been completed of the surviving In- and Out-Patient Registers in the hospital's archives. What a voluntary hospital was all about was very well understood before the end of the eighteenth century, not least of all in a long Jetter compiled possibly by a well-informed London physician which was published during October 1790 in The Kentish Gazette, a few weeks after 43 'Gentry and Clergy of the County of Kent, and of the City of Canterbury' had inaugurated on 13th September 'a General Hospital ... near the City of Canterbury, under the Name of the Kent Hospital'. 9 In setting out the case for a charitable hospital this letter distinguished between the differing needs of in-patients and out-patients, recognized the value of convalescence and pointed out the opportunities of practical education offered to physicians and surgeons. Post-operative treatment 'in the habitations of the poor' could not be recommended. 'It must be sufficiently obvious that ... the want of convenient apartments and beds, the disturbance and anxiety occasioned by a numerous family, the visits and advice of officious neighbours, improper articles of diet, irregularity in the administration of drugs, and other impediments ... will very often render the most judicious medical advice ineffectual, when the poor are visited at home. It is only by bringing together the patients under the same roof, that the necessary attendance and means of relief become any way practicable, [viz: in] hospitals, where there is a certainty of the ready and constant attendance of skilful physicians and surgeons. ... Care is taken that the apartments be of a proper temperature, and sufficiently ventilated; that the medicines be good in their several kinds, and that they be regularly administered, with every proper attention to diet ... . The poor patient ... has the consolation to see the same endeavours to restore him to health ... that the most opulent amongst us can expect in his own case.' 8 Dr Aldred Lochee, A descriptive and tabular Report of the medical and surgical Cases treated in the Kent and Canterbury Hospital, from Oct. 16, 1838, to Oct. 16, 1840, (Canterbury, 1841) and A descriptive and tabular Report of the medical and surgical Cases treated in the Kent and Canterbury Hospital, from October 16, 1840, to June I, 1842, (Canterbury, 1842). Born in London and having studied medicine at the Middlesex Hospital he was by 1841 well established in practice in Canterbury, being the 'Senior Physician to the Hospital', ibid., and Brown, op. cit., 52. 9 Hall, Stevens and Whyman, op. cit., 6, 7; Register of Proceedings No. 1, running from 13th September, 1790, to 29th March, 1793, 1-2. 4 THE KENT AND CANTERBURY HOSPITAL, 1836-1876 In addition to in-patients, 'there will constantly be a large proportion of cases, in which the means of relief may ... be obtained by an occasional attendance at the hospital, [or] it may be deemed expedient and salutary by the physician or surgeon to send out, in a state of convalescence, patients who are recovering from some disease, or from an operation, but who still require, from time to time, a supply of medicines or dressings, for which their occasional attendance will be sufficient. [Such] persons, ... living within a convenient distance, may be relieved as out-patients.' Physicians who came into contact with hospitals secured 'the means of acquiring a practical knowledge of diseases', thereby 'adding to [their] stock of experimental knowledge'. Hospitals, too, benefited surgeons and surgery to the extent that 'when we had no County Infirmaries we had few, if any, eminent surgeons out of London; but now we are able to enumerate many celebrated names of surgeons, in different parts of England, who have greatly assisted in bringing the chirurgical practice of this country to its present state of perfection'. In essence 'County Hospitals ... afford signal relief to the sick poor, [ and] serve at the same time, as schools of physic and surgery, [being] eminently useful to mankind. They prepare students for the larger hospitals of the metropolis; and they diffuse useful knowledge not only among the few who are immediately employed in them, but likewise amongst all the neighbouring practitioners.'10 Much the same sentiments were penned by the physician, Dr John McDivitt, in 1839, for whom hospitals assumed a dual role, firstly as 'places of refuge where our sick poor are kindly and skilfully treated, ... their primary use' and secondly as 'rich storehouses of authenticated facts, which ... serve as materials for forming correct theories of diseases' .11 Dr Lochee's understanding of a hospital was as 'an asylum for a certain class of the sick poor, where they are received under its roof, and housed, fed, nursed, and "healed and cured", under the eyes of regular medical and surgical attendants, without the slightest expense to themselves during the term of their stay in it; in a word, where "In-patients" are admitted'. 21 A person seeking admission either as an in- or out-patient had to be 'a real object of Charity'. Securing entry into a voluntary hospital was subject to several restrictions, including formidable lists of exclusions or inadmissible cases.F rom the outset the following were 10 The Kentish Gazette, 22nd-26th October, 1790, 3 a b; for a fuller reference to this interesting letter, see Hall, Stevens and Whyman, op. cit., 210-2. 11 McDivitt, op. cit., 179. 12 Lochee, (1842), op. cit., 91. 5 JOHN WHYMAN not admitted: children under seven years of age, pregnant women, those likely to die, those with fits, phthisis or suspected venereal infections, and those who were either va􀁵rants or could afford private medical treatment in their own homes. 1 From 1827 the General Kent and Canterbury Hospital was governed by 165 Rules and Regulations covering its name, purpose and government, governors, subscribers, boards and committees, patients and honorary and paid medical staff. There were three Rules under the heading 'INADMISSIBLE CASES'. '55. - No person is to be admitted, either as an In- or Out-patient, who can maintain himself, and pay for Medicines and attendance. 56. - No Patient who has been discharged for irregularity can be re-admitted, unless in case of accident. 57. - The following description of persons shall be held disqualified for admission as In-patients; and if inadvertently [ admitted], shall be discharged by the Weekly Board: Pregnant Women. Lunatics. Children under seven years of age, unless for operation. Those subject to Fits. Those suspected to have Venereal Infections, or contagious Diseases. Those having habitual Ulcers, and Consumptions, or Dropsies in their last stages. Those in a dying condition, or evidently incurable. Those who have not had either the Cow or Small Pox. Those who are not clean in person and apparel. Vagrants, or persons of bad character. '14 Under these Rules applications were rejected for both financial and medical reasons. In the former category, for instance, the Weekly Board of 1st April, 1842, refused out-patient admission to Harriett Bolton, 'the Party being deemed able to pay for Medicines'. 15 On 10th May, 1872, Susan Davey was denied admission as an out-patient since 'she was not ''a real object of Charity", her father being considered in good Circumstances as a Cow keeper, etc.' .16 Prior to being admitted as an out-patient, on 31st March, 1876, George A. Coveney 'was ordered to stand over, to ascertain if he is "an Object of Charity'".17 Exactly how many recommendations were rejected purely on medical grounds is not known. Instances abound, however, in the Weekly Board records, including the following. 1·' Hall, Stevens and Whyman, op. cit., 27, 32-3, 61-2. 14 Rules and Regulations for the General Kent and Canterbury Hospital, (Canterbury, 1827). 14. 15 Weekly Boards, 1841-1846. 16 Weekly Boards, 1870-1874. 17 Weekly Boards, 1874-1877. 6 THE KENT AND CANTERBURY HOSPITAL, 1836-1876 25th October, 1842, 'Clara Luckhurst recommended by the Faversham Union to become an In-patient was not admitted Mr. Denne having certified to the Board of her having "been Seven Months in the Hospital with it (Ulcerated Leg) before, and turn'd out Incurable'". 1st July, 1845, 'William Curtis recomended by the Milton Union to become an In-patient was not admitted, being under Seven Years of Age, inadmissible according to the Rules'. 10th June, 1870, 'Mary Ann Young was not admitted an Out-patient Mr. Hutchings stating to the Board that her ailment was Pregnancy'. 2nd June, 1871, 'Arthur May recommended by the Bishop of Dover to be an Jn-patient was not admitted, being "under Seven Years of Age", tl1erefore "Inadmissible"'. 11th August, 1871, 'Alice Amos of Chilham recommended by Charles S. Hardy Esq. to become an In-patient was not admitted, Mr. Reid having certified that she was suffering from "Primary Syphilis", therefore Inadmissible'. 8th March, 1872, 'Sarah Doughty reported by Dr. Lochee as "not a fit Patient for the Hospital, is out of her mind'". 8th November, 1872, 'Emma Horn, of Faversham, reported by the House Surgeon as having "had Fits for 10 years which seem to be of an Epileptic Character", was not admitted an In-patient, being "lnadmissible'".18 The passage of time inevitably produced some flexibility in the interpretation and execution of the hospital's Rules. On 25th June, 1850, in-patient Hannah Higgins was granted 'Permission ... to go to her home till Sunday next in consequence of the sudden death of one of her children, Dr. Lochee her Physician having no objection to it'. 19 Aged 35 from Bonnington she was admitted with 'Ovaries Enlargmt etc.' and remained in the hospital for 12½ weeks before being discharged on 23rd August having received 'Benefit'. 2° From Stowting Rectory, the Rev. Frederick Wrench, M.A., enquired from the hospital on 14th April, 1851, 'whether the rules ... allow a Child of 9 months to be admitted with his Mother who [has] a proper recommendation?' In the hope that this request would be acceptable 'the Medical Man who has attended the Mother', Mr. J.W. Pittock, surgeon, Sellinge, wrote on 15th April, 1851, to point out that 'John Laker's Wife has been a sufferer from Illness for 3 Months, and would be benefitted (sic] by admission to the Hospital. - She has an Infant which from disease requires much care and attention, and she is so unwilling to part from the Child, that unless the Weekly Board of the Hospital can admit both Mother and Child, I fear the poor Woman's admission would not benefit her.· Mindful that 'the only Rule regarding Children under 7 Years of Age is that they are inadmissible except for Operation or in case of Accident' and that in practice 'a Child admitted for Operation has 18 Weekly Boards, 1841-1846, 1870-1874. 19 Weekly Boards, 1846-1851. 20 In Patients Register From June 11th 1847 to Feby 25th 1851, 129. 7 JOHN WHYMAN been allowed the attendance of its Mother who has been admitted with it, and . . . a Mother with a Child at the Breast regularly admitted as a Patient has been allowed the admission of her Child with her', the Weekly Board resolved that while 'there is no express Rule of the Hospital respecting Women and Children at the Breast (as the Child in the present Case is assumed to be), ... the wife of John Laker, provided her case is admissible, be admitted an Inpatient with a proper recommendation and if the Child is still at the Breast, that she be allowed to bring him with her to receive such care and treatment during the stay of his Mother, as her Medical Officer shall think needful'. Accordingly on 22nd April, 1851, Catherine Laker and her child were admitted as in-patients.21 On 8th March, 1870, 'Arthur May aged 3½ years recommended to become an ln•patient was made an Out-patient, being "under seven Years of Age"'. Acting upon the recommendation of one of the honorary surgeons, Mr James Reid, Eliza Webb was admitted on 11th February, 1870, for an operation, 'which could not ... be satisfactorily undertaken at her own home', but with 'her Husband ... being in a small way of business at Petham, a Donation to the Hospital funds was promised from him to reimburse expenses'. While not accepting George Standen as an in-patient on the recommendation of Earl Amherst, the Weekly Board did agree to admit him as an out-patient on 30th August, 1870, Dr Lochee seeing this as 'not an acute case altho' a bad one'. Although 'not considered proper Objects of Charity' Thomas Boulden and Thomas Jezard were two out of twenty nine out-patients admitted on 6th February, 1872, 'on condition of paying 10s. each [as a] donation to the Hospital'.22 While Dr Lochee felt that it was a wise policy on the part of hospitals not to admit under their roof 'very young children, and persons labouring under disorders said to be contagious', he tacitly admitted in 1842 to the admission 'of what are called improper cases; that is, of patients, whose diseases, on account of their incurable or lingering nature, are decided to be inadmissible by the Rules', including 'judiciously-selected consumptive cases'. 23 Concerning one of the 1827 inadmissible categories namely 'those who have not had either the Cow or Small Pox', the public had good reason to be grateful to the hospital when from 9th May, 1804, it offered free inoculations against smallpox, with the Annual Report at the end of the year being able to claim that 21 Weekly Boards, 1846-1851. 22 Weekly Boards, 1870-1874. 23 Lochee, (1842), op. cit., 97, 125. 8 THE KENT ANO CANTERBURY HOSPITAL, 1836-1876 PLATE 11 Dr Alfred Lochte (1811-1890), Prcsidenr of rhe British Medical Associarion in 1861. and llonorary Physician 10 the Kent and Canterbury Hospital from 1838-1883. (Source: Photographed from an original oil painting hanging in the refectory or St. Augustins"s Monustcry. reproduced hy kind permission or the Headmaster or the King's School, Canterhury.) 9 JOHN WHYMAN 'prompted by motives of genuine philanthropy the Physicians and Surgeons of the Hospital have, in addition to their former services, liberally offered to impart to the poor the benefit of that invaluable discovery, the VACCINE INOCULATION; in consequence of which every Annual Subscriber of Two Guineas has now ... the extensive privilege of recommending any number of poor persons as Out-patients, 􀁟o be inoculated with the Cow-pock; by which means 271 persons have been already preserved from the ravage of that most fatal of distempers, the Small Pox. '24 By 1831, 16,175 out-patients had been inoculated gratis with the cowpox.25 In- and out-patients could be discharged for irregularity, following which readmission was refused except for accidents. As from 1827 thirteen rules governing the in-patients were hung up in every ward, with the Weekly Board deciding on 14th July, 1871, to recommend to the Board of Management that 'means should be taken to have the Rules ... duly read over to the Patients in every Ward on the morning next after the admission days'.26 Under the 1827 Rules, no in-patient was 'to go beyond the Hospital Field, without leave In writing from the House Surgeon'; all patients were to 'punctually observe the directions of their Physician or Surgeon, the other Officers of the Charity, and the Nurses'; there was to be no smoking in the wards; 'no Patient shall receive any liquors or provisions from their friends, ... nor play at cards or any other games'; 'the Patients shall not waste or damage anything belonging to the Hospital' and 'such Patients as do not exactly conform to these Rules, shall incur the disgrace of being discharged for irregularity, which will render them incapable of future admission to the benefits of this Charity'. In-patients were to be allowed, however, visits from family and friends on Wednesdays and Saturdays between 2.00 and 4.00 p.m. and on Sundays 'by special leave . . . if they live at a distance'. Out-patients were liable to be discharged for non-attendance. They were to be assisted with 'Advice and Medicines only' and in no other way were they to be chargeable to the hospital. They were to 'regularly attend their Physician or Surgeon at 11 o'Clock every Friday morning, at the Hospital, and oftener if required', following which they 'shall go away as soon as their business is done, and not loiter about the Hospital'. Finally, 'if these Rules are not strictly attended to, or any misconduct is observed, Out-patients will render 24 Report of the State of the Kent and Canterbury Hospital, By the Auditors, for the Year 1804, I. 25 General Kent and Canterbury Hospital Annual Report for 1831; also Hall, Stevens and Whyman, op. cit., 68-9. 26 Weekly Boards, 1870-1874. 10 THE KENT AND CANTERBURY HOSPITAL, 1836--1876 themselves liable to be dischar􀁦ed, and if discharged, they will never again be admitted as Patients'. 7 A Black Book was introduced listing the names of all former patients who had been declared ineligible for re-admission. The Weekly Board minutes recorded instances of dismissal for a variety of reasons: 14th September, 1841, 'Norman Saunders an Jn-patient was discharged this day, Mr. Denne his Medical attendant having reported to the Board as follows:- "The Boy appears to be of an unsound mind, and so noisy that he disturbs all the Patients in the.Ward, and has several times attempted to run away'". 17th June, 1842, 'Alice Golder an In-patient was discharged by the Board for infringing the Hospital rules respecting the introduction of provisions'. 13th February, 1844, 'Mary Stone who was discharged this day had Cheese in her Locker'. 4th February, 1845, 'Mary Ann Jordan an In-patient was "discharged" for counterfeiting a disease'. 4th March, 1845, 'Catherine Ladd an In-patient was discharged "for Impertinence to her Physician'". 29th June, 1847, 'Charles Cook an In-patient was this day "dismissed in consequence of complaints made by H(ouse) Surgeon"'. 31st May, 1850, 'Henry Partridge an In-patient was discharged on the 29th inst. "unmanageable"'. 27th September, 1850, 'Edward Tomlin an In-patient left the Hospital without permission yesterday Evening and return'd again this Morning, and left again today before the Meeting of the Board. Ordered, that his name be placed in the "Black Book"'. 24th January, 1851, 'William R. Austen was discharged on the 22nd inst. "summarily for refusing to comply with the order o( his Physician and with the directions of the Nurse"'. 12th May, 1871, 'Constance Emma Cuthbert an In-patient discharged, with "an Expression of dissatisfaction but no definite complaint". Name to be put into the "Black Book'". This incident was in sharp contrast to 2nd December, 1845, when Edward Field on being discharged, having 'made complaints in his Ward respecting his Diet', then 'expressed himself perfectly satisfied durir1g his stay in the Hospital [since 24th October], as to his Diets, attendance and every thing that had been done for him'.2 8 Warnings saved a few patients from the ignominy of dismissal. When admitted as an in-patient on 3rd June, 1845, John Adley 'was cautioned, on account of former Misbehaviour in his Ward, against a repetition of similar Misconduct'. On 10th June, 1864, Matthew Hustwit attracted complaint for having smoked tobacco 'in the large Ward a short time ... in the Night', following which 'he acknowledged having done so to endeavour to destroy Nausea through 27 Rules and Regulations, (1827), op. cit., 27-9. 28 Weekly Boards, 1841-1846, 1846--1851, [870-1874. 11 JOHN WHYMAN taking Cod Liver Oil, [promising] not to offend again'. A similar complaint was brought against Albert McHenry and Henry Andrews on 14th July, 187 1, 'for smoking in the Water Closet of their Ward'. Following this incident for which they were reprimanded the Weekly Board advised the Board of Management to extend 'the Rule prohibiting smoking by the Patients ... to every part of the interior of the Hospital'.29 In reality the chances of being discharged for irregularity were absolutely minimal. Over the fourteen years, 1839 to 1852 inclusive, in-patient admissions totalled 8,784. The numbers and percentages discharged for 'irregularity' or for being 'improper' were very low, respectively three (0.03 per cent) and eleven (0.13 per cent), or a total of fourteen for the two categories (0.16 per cent).30 Thereafter, unfortunately, there are no surviving Annual Reports for 1853, 1855, 1858-64, 1867 and 1868. During 1857 four in-patients were discharged for irregularity being no more than 0.66 per cent of the 606 who were admitted that year.31 For earlier periods, too, very few in-patients in fact were discharged for irregularity so that a consistent trend is observable. No more than twenty of the 9,884 in-patients who were admitted between 26th April, 1793, and 3 1st December, 1825,w ere so discharged, giving a very low percentage of 0.2 per cent. 32 Concerning out-patients no year passed without some being discharged for 'non-attendance'. Of the 14,4 17 out-patients who were admitted between 1839 and 1852 inclusive, 224, or at most 1.6 per cent, were so discharged. The numbers involved varied from year to year ranging from 38 in 1839 (5.3 per cent of that year's 720 admissions) to as low as ten, or 0.9 per cent, of the 1,102 admitted during 1845. 33 The Canterbury physician, Dr Alfred Lochee, writing in 1842, was impressed by the fact that 'comparatively few are discharged for "non-attendance"; and, in fact, the regularity with which the out-patients attend at this Institution, is well worthy of notice, since it proves what may be done in this important particular; the neglect of which, at many other Hospitals, is a constant source of regret to the medical officers; neither is this observation, as to the regularity of attendance, only applicable to those patients who reside in the immediate neighbourhood, for those .also who come from a distance, even from Ramsgate, Dover, etc., are equally exact in this respect, and are always eager to avail themselves of the charity, even at the inconvenience of coming so far, for the benefits it affords. '34 29 Ibid., /841-1846, /86/-1865, /870-1874. 30 General Kent and Canterbury Hospital Annual Reports for 1839-1852. 31 Ibid. for 1857. 32 Hall, Stevens and Whyman, op. cit., 60. 33 General Kent and Canterbury Hospital Annual Reports for 1839-1852. 34 Lochee, (1842), op. cit., 73-4. 12 THE KENT AND CANTERBURY HOSPITAL, 1836--1876 Having overcome the many hurdles associated with admission into the Kent and Canterbury Hospital it is clear that the vast majority of patients were content to see through to completion whatever forms of treatment were being administered to them. Being able to surmount all the regulations governing entry into the hospital, having in particular the backing of a subscriber, being seen not to be in a position financially to afford private advice or medicines, and not falling within the category of inadmissible cases, the final hurdle to be overcome was the Weekly Board's approval of each 'Letter of Recommendation'.35 Under the 1827 Rules 'every such letter must contain a short statement of the case, drawn up by a Physician, Surgeon, or Apothecary: such letters shalJ be considered ... and answers returned as soon as possible, stating when the persons recommended can be admitted. But the Weekly Board are to be at fulJ liberty to reject such patients, if their cases shall appear to have been misrepresented.'36 It was further stipulated that 'all persons admitted as In-patients are required to be clean, and to bring with them proper changes of linen and other necessaries'; furthermore, 'no In-patient shall be admitted, (excepting in cases of accident,) without bringing a security from some substantial person, to defray the expences [sic] of burial or removal'.37 Patients whose admission was deferred for want of room in the hospital were to be treated in the meantime as out-patients.38 Out-patients on being admitted were issued with tickets, which had to be preserited before any medicines were dispensed; on beinfs discharged their tickets had to be returned to the house surgeon. 9 The only admissions without recommendation under the 1827 Rules arose out of accidents, or the need for 'immediate surgical operations'. Out-patients requiring operations could be admitted at any time without a recommendation; likewise any person, 'who may be attacked with a sudden and dangerous illness, shall be admitted on the request of any of the Physicians or Surgeons, who shall state the case to be of that nature'. 4° Finally, the rules covering patients allowed for their discharge after a certain interval of time if they were unlikely to be cured. Thus, from 1827, '50. - Every In-patient shall be discharged whose name in the adjoining column of the overtime book, the signature of their Physician or Surgeon does not appear.T his 35 Hall, Stevens and Whyman, op. cit., 33. 36 Rules and Regulations, (1827), op. cit., 11. 37 Ibid., 11, 13. 38 Ibid., 12. 39 Ibid., 28. 4o Ibid., 12-3. 13 JOHN WHYMAN signature shall be understood to certify that there is a prospect of benefit being derived, if the patient remains a reasonable time longer in the Hospital. 51. - All Out-patients shall be discharged who have been on the Books twelve weeks, but may be re-admitted on a fresh recommendation, when further assistance is necessary.'41 By the end of 1838 the Kent and Canterbury Hospital had admitted 15,254 in-patients and had seen 21,929 out-patients since opening its doors on 26th April, 1793.42 From the beginning of 1839 until the end of 1876 a further 27,615 in-patients and 49,792 out-patients pushed up these totals since 1793 to 42,869 and 71,721, respectively.43 What had been an initial tendency for in-patient admissions to exceed the number of out-patients treated did not extend beyond 1795. For every year thereafter more out-patients were treated than in-patients were admitted,44 thereby testifying to the prediction made in 1790 that 'the great good resulting from the institution will, in this way at a comparatively small additional expence [si􀁱, be very extensively diffused among all lower classes of people. '4 As a county institution the hospital attracted patients from places well beyond Canterbury. Any suggestion that a city intake took precedence over the county was strongly refuted as early as 1797. 'Lest any suspicion arise that the City of Canterbury reaps an undue proportion of benefit Crom this charity, to the detriment of the county at large, ... of the 404 Patients [admitted and under treatment during that year], 55 In- and 137 Outpatients were residents of this city or suburbs, and 110 In- and 102 Out-patients, of the county .... In-patients ( who it is needless to say are attended with by far the greater expence [sicJ) are recommended by the county, in the proportion of two to one. •46 Of the 164 in-patients and 180 out-patients receiving treatment from Dr McDivitt, 1836--37, no more than 62 of the in-patients compared to 119 of the out-patients were 'from Canterbury, or from some place within one mile of the hospital'. 47 Calculations made by Dr Lochee at the begmnirig of the period covered by this article suggest that from the moment the hospital opened down to the end of 41 Ibid., 13. 42 General Kent and Canterbury Hospital Annual Report for 1838. 43 Ibid. for 1876. 44 Hall, Stevens and Whyman, op. cit., 59. 45 Ibid., 211, quoting The Kentish Gazette, 22nd-26th October, 1790, op. cit. 46 Report of the State of !he Kent and Canterbury Hospital, by the Auditors, for !he Year 1797, 1. 47 Dr John McDivitt, Report of medical Cases treated at the Kent and Canterbury Hospital, during the Year 1836-7, (1838), 3, 4. 14 THE KENT AND CANTERBURY HOSPITAL, 1836--1876 1841 applicants living within the city district accounted for about 35 per cent of in-patients and nearly 62 per cent of out-patients. 48 The amount and proportion of Canterbury out-patient treatment for the years 1839, 1840 and 1841 can be tabulated as follows. 49 OUT-PATIENTS Year Total Number Seen From Canterbury % From Canterbury Male Female Male Female Male Female 1839 285 435 197 310 69.1 per cent 71.2 per cent 1840 362 489 229 332 63 .2 per cent 67.9 per cent 1841 332 509 197 331 59.3 per cent 65.0 per cent The local intake was lower for in-patients. 50 IN-PATIENTS 1839 266 282 78 83 29.3 per cent 29 .4 per cent 1840 324 268 87 92 26. 9 per cent 34.3 per cent 1841 294 312 79 101 26.9 per cent 32.4 per cent Between 16th October, 1840, and 1st June, 1842, 914 in-patients received medical and surgical treatment in the Kent and Canterbury Hospital, 454 males and 460 females.51 Of the 454 males, 220, or 48.5 per cent, were married, whereas of the 460 females, 206, or 44.8 per cent, were unmarried. Their age composition was as follows. 48 Lochee, (1842), op. cit., 73. 49 Ibid., 72. 50 Ibid., 120. SI Ibid., 109-11. 15 JOHN WHYMAN Ages Males Females Number % Number % Under 10 22 4.8 18 3.9 10-20 110 24.2 195 42.4 20-30 93 20.5 135 29.3 30-40 69 15.2 46 10.0 40-50 73 16.1 32 7.0 50-60 47 10.4 21 4.6 60-70 34 7.5 7 1.5 Over 70 6 1.3 6 1.3 454 100.0 per cent 460 100.0 per cent Because the hospital's Rules excluded children under seven years of age, except for operations, not surprisingly the majority were of working age. The age categories ten to fifty accounted for 76 per cent of males (345) and 88. 7 per cent of females ( 408). The single age band ten to twenty provided the largest percentage both for females ( 42.4 per cent) and males (24.2 per cent). In the case of females, 71.7 per cent were aged between ten and thirty, as against 44.7 per cent for males. Almost a third of the males were aged between thirty and fifty (31.3 per cent), compared to only 17 per cent of females. The oldest male and female in-patients were respectively 78 and 85 years of age. s2 What, then, of their occupations? Excluding thirty-five children and twenty-two whose occupations are unknown the remaining 397 of the 454 male in-patients were employed as follows: Field Labourers 248 Tailors 4 Outdoor Servants 15 Basket Makers 2 Indoor Servants 13 Bricklayers 4 Shoemakers 20 Bakers 5 Gardeners 5 Coachmen 3 Carpenters 17 Painters, etc. 5 -'2 Ibid., 110-1. 16 THE KENT AND CANTERBURY HOSPITAL, 1836-1876 Blacksmiths Mariners Ostlers 14 28 8 Brewers Policemen Paper-maker 3 2 1 Total: 39753 Here was a reflection of the local economy based on agriculture and related activities, trades, transport and the sea. As befitted the essentially agricultural and maritime character of east Kent, 248 agricultural workers accounted for 62 per cent of the 397 in-patients whose occupations are known. The second largest category, 28 mariners, represented just 7 per cent, the same percentage as for indoor and outdoor servants added together. Deducting thirty-one children and ninety-five with no occupation from the 460 female in-patients produces the following occupational breakdown: Domestic Servants Seamstressess Shoebinders Straw-plaiters Outdoor Servants 265 30 15 12 12 Total: 33454 Domestic service was by far the largest occupation, accounting for 79 per cent of the 334 females in-patients whose occupations are known. Of the 731 occupations attributed to in-patients who were treated in the Kent and Canterbury Hospital between 16th October, 1840, and 1st June, 1842, 553, or 75 per cent, were directly employed in agriculture or domestic service, whether indoor or outdoor. Such then were 'the objects of charity' who could not afford private medical treatment. Eighteenth- and nineteenth-century hospitals have been seen as hotbeds of disease, gateways to death, 'horrific institutions in which most of the patients died'. 55 It is further alleged that hospitals 53 Ibid., 110. 54 Ibid., 111. 55 John Woodward, To do the sick no harm. A Study of the British voluntary Hospital System to 1875, (1974), 123. 17 JOHN WHYMAN positively harmed rather than cured their patients. Demographic historians have tended to the view that they contributed little to falling mortality from the 1750s onwards. Dr Woodward, in a well-researched study of the British voluntary hospital system up to 1875, questions these damning indictments, which do not appear to be substantiated when the records of individual hospitals are investigated. He concludes his book overall by suggesting that 'the miserable reputation that they have endured has little foundation. Voluntary hospitals may not have been the most hygienic or the most pleasant of institutions by the standards of today; nor may the standard of medical care have been very high; but they provided a service for a section of the population which had previously been neglected with some degree of success, and historians should judge them accordingly. •56 Indeed, they achieved 'what appears to be a remafkable degree of success in treating their patients', such that 'mortaHty remained at a low level throughout the period, generally being under 10 per cent of the patients admitted'. 57 These conclusions are borne out in the archives of the Kent and Canterbury Hospital. The death rate was low, even allowing for a wide variety of inadmissible cases. As from 1839 in- and out-patients were discharged under the following headings: In-patients Cured Well Convalescence Received Benefit Received No Benefit Made Out-patients At Own Request Incurable Died Improper Irregularity S<, Ibid., 146. 57 Ibid., 142. Out-patients Cured Well Convalescence Received Benefit Received No Benefit Made In-patients At Own Request Non-attendance Having been 12 weeks on the Books Incurable Died Improper Irregularity 18 THE KENT AND CANTERBURY HOSPITAL, 1836-1876 The results of treatment knew only two extremes, cures as opposed to deaths, with most other cases having received more or less benefit. A lower death-rate than might be envisaged and a contemporary awareness of the problems inherent in defining terms such as 'cured', etc. were among the themes which were carefully explored in the reports of Drs McDivitt and Lochee, published between 1838 and 1842. Dr McDivitt's 1838 report, first published in The MedicoChirurgical Review, dealt with his experiences in treating 164 in- and 180 out-patients between 9th April, 1836, and 1st May, 1837. While the proportion of deaths occurring in the hospital appeared to be only a fraction more than 3 per cent (5: 164), four deaths occurred among those who were made out-patients increasing the proportion to almost 5½ per cent (9: 164), but 'in addition to these, I find, on strict enquiry, that of those discharged as "relieved" there died subsequently four; and of those who had received ''no benefit" five; thus making 18 deaths in the whole. This gives a proportion of one death in rather more than 9 patients, or nearly 11 per cent.' This was felt to be a 'high rate of mortality', but in nine of the fatal cases, the disease was phthisis. 58 Dr Lochee looking at mortality over the five years 1837-41, as being 'always an important point to ascertain', found it to be not surprisingly higher among males than females, 5 per cent as against 4.2 per cent for in-patients, and 3.5 per cent compared to 1.6 per cent for out-patients. 59 % AGE MORTALITY AMONG \N. AND OUT-PATIENTS. 1837-1841 Year In-patients Out-patients Male Female Male Female 1837 3.9 3.7 2.0 2.0 1838 6.7 3.6 4.3 1.4 1839 4.5 3.5 3.5 1.6 1840 6.7 6.7 4.1 2.0 1841 3.4 3.5 3.6 I.I Average 5.0 4.2 3.5 1.6 58 McDivitt, (1838), op. cit., 3, 4. 59 Lochee, (1842), op. cit., 121, 124. 19 JOHN WHYMAN Averaging out as between males and females produced for the same five years a mortality proportion of 4.6 per cent among in-patients, and 2½ per cent among out-patients. Confirmation of Dr McDivitt's findings exists in Dr Lochee's overall conclusion in 1841 that 'if, however, it had been possible to have [followed through] the results of some of the cases discharged, the rate of mortality would have been higher .... Probably, then, the absolute number of deaths, out of the whole number admitted, is about 9½ per cent, which, in fact, I take to be a very near approach to the real rate of mortality. This appears to be rather high, ... but, ... as an explanation of it here, it must not be over-looked, that exactly one-fourth of the whole number of deaths, occurring among the medical patients, is from consumption alone! - a frightful proof of the ravages of this one disease.'60 Dr McDivitt was certainly of the opinion in 1839 that 'the proportion of "deaths" among out-patients is always considerably greater than is recorded', allowing for non-notified deaths as well as those arising out of non-attendance, while among in-patients 'the proportion of deaths is really greater than is usually stated, for many die after having been made out-patients, and several after having been completely discharged, the progress of their diseases continuing uninterrupted'. 61 Revised estimates of mortality relating to the period 1836 to 1841, ranging from 9½ per cent to 11 per cent, may be compared with an average mortality of 9.6 per cent among in-patients, and 7.6 per cent amon! out-patients, between 26th April, 1793, and 31st December, 1825. 2 Of the 8,784 in-patient admissions over the fourteen years, 1839 to 1852 inclusive, there were 424 deaths, giving an average mortality rate of 4.8 per cent, compared to Dr Lochee's average of 4.6 per cent between 1837 and 1841,63 a figure making no allowances for the qualifications made above. Within this period, as in the earlier years, there were annual fluctuations: there were 42 deaths out of 669 in-patient admissions during 1843, giving a mortality rate of 6.3 per cent, compared to 2.7 J'er cent for 1849, based on only 18 deaths among 659 in-patients. For 1866 a basic in-patient mortality rate of 6.8 per cent was reported (37 deaths out of 541 admissions), 8 per cent being recorded ten years later when there were 43 deaths among 537 admissions.65 60 Lochee, (1841), op. cit., 22. 61 McDivitt, (1839), op. cit., 181. 62 Hall, Stevens and Whyman, op. cit., 59, 61. 63 General Kent and Canterbury Hospital Annual Reports for 1839-1852 and Lochee, (1842), op. cit., 124. 64 General Kent and Canterbury Hospilal Annual Reports for 1843 and 1849. 65 Ibid. for 1866 and 1876. 20 THE KENT AND CANTERBURY HOSPITAL, 1836-1876 Turning to out-patients 14,417 were accorded treatment between 1839 and 1852, of whom 266 died, giving an average mortality of 1.8 per cent, compared to Dr Lochee's average of 2½ per cent between 1837 and 1841. 66 Again there were annual fluctuations: 3 per cent for 1845 (33 deaths out of 1,102 seen), down to 0.9 per cent for 1850 when there were only ten deaths among the 1,151 out-patients of that year.67 During 1866 there was an almost equally low mortality rate among 1,294 out-patients of 1 per cent (thirteen deaths) and this figure was halved for 1876 (0.49 per cent), when eight deaths were recorded among the 1,628 out-patient admissions for that year.68 If the Kent and Canterbury Hospital was not 'a gateway to death' ,69 how successful was it in effecting cures? Dr McDivitt claimed a cure rate of 43.3 per cent, covering 71 of the 164 in-patients under his care between 9th April, 1836, and 1st May, 1837.7° For the five years 1837-41 Dr Lochee produced the following results.71 % AGE CURED AMONG IN- AND OUT-PA TlENTS. 1837-1841 Year In-patients Out-patients Male Female Male Female 1837 43.4 43.0 32.6 32.4 1838 31.6 28.9 32.5 42.3 1839 36.8 35.0 38.5 37.9 1840 30.0 44.4 30.0 36.8 1841 44.8 37.8 40.3 42.0 Average 37.3 37.8 34.7 38.2 Discerning members of the medical profession at the time admitted to a certain elasticity in defining some of the discharge headings or categories which were currently being employed. Dr Lochee firmly believed that some allowance had to be made 'for the different degrees of strictness with which different men adhere to the exact meaning of terms [ such as] Cured'. 72 Dr McDivitt readily admitted 66 lbid. for 1839-1852 and Lochee, (1842), op. cit., 124. 61 General Kent and Canterbury Hospital Annual Reports for 1845 and 1850. 68 Ibid. for 1866 and 1876. 69 Adopting the title of Chapter 10 of Woodward, op. cit., 123-42. 70 McDivitt, (1838), op. cit., 3, 4. 71 Lochee, (1842), op. cit., 121. 72 Ibid., 124. 21 JOHN WHYMAN that his 43.3 per cent cured 'would have risen to a much greater number but for my extreme caution not to discharge as "cured" any patient, in whom there could be detected the slightest remnant of organic disease', particularly since 'in affections of the chest, when the general symptoms appeared to warrant me in recording a "cure", the stethoscope discovered the existence of morbid changes, far beyond the power of our art to rectify, and calculated sooner or later to destroy life. It has frequently happened, besides, that a patient, though perfectly cured of the disease for which he entered the hospital, has laboured under some other infirmity of long standing, and which has been to a certain extent at least, the cause of the more recent affection. In every such case the patient has been discharged merely as "relieved", even though he has thought himself quite recovered, and has left the hospital with the intention of immediately resuming his employment. '73 Too liberal a definition of 'cured' explains the high figures claimed in earlier Annual Reports, covering the period, 26th April, 1793, to 31st December, 1825, viz: 63.9 per cent for in-patients and 68.9 per cent for out-patients.74 Dr Lochee welcomed the decision from 1839 onwards to add the category 'well' between 'cured' and 'received benefit'. Indeed, in 1841, he was quite explicit in stating his preference for 'well' over 'cured', when assessing 'the degree of relief': the 'latter term is rarely applicable, and the former one, which implies that the patient is dismissed free from the symptoms of disease, expresses quite as intelligible a fact, and is more consistent with the real results of medical treatment'. 75 The recorded results of treatment for the fourteen years, 1839 to 1852 inclusive, and for the single years 1866 and 1876, as reported in the Annual Reports for those years, is tabulated opposite. 76 The reason why the 1876 figures return a percentage of 87.6 per cent is be cause they omit 109 out-patients discharged for non-attendance and 56 for being 'unable to attend' which if included would add a further 10.1 per cent. Several points of interest emerge from this table, apart from reported mortality rates of well under 10 per cent. A stricter definition of 'cured' reduced the percentages under that category over time; likewise the 'well' category for in-patients as between 1866 and 1876, and for out-patients between 1839-52 and 1866. For both in- and out-patients the convalescence percentages rose over time, 7.1 McDivitt, (1838), op. cit., 4-5. 74 Hall, Stevens and Whyman, op. cit., 59, 61. 75 Lochee, (1841), op. cit., 6-7. 76 General Kent and Canterbury Hospital Annual Reports for 1839-1852, 1866 and /876. 22 THE KENT AND CANTERBURY HOSPITAL, 1836--1876 In-patients Out-patients 1839-52 1866 1876 1839-52 1866 1876 Admitted 8784 541 537 14417 1294 1628 Discharged No. % No. % No. % No. % No. % No. % Cured 1008 11.5 17 3.1 3 0.6 1447 10.0 33 2.5 9 0.5 Well 1889 21.5 138 25.5 56 10.4 3352 23.2 156 12.0 219 13.4 Convalescence 149 1.7 45 8.3 125 23.3 56 0.4 15 1.2 55 3.4 Received Benefit 2746 31.3 200 37.0 181 33.7 6405 44.4 723 55.9 824 50.6 Received No Benefit 184 2.1 9 1.7 5 0.9 317 2.2 11 0.8 11 0.7 Made Out-patients 2019 23.0 70 12.9 98 18.2 - - - - - - At Own request 309 3.5 13 2.4 26 4.8 60 0.4 4 0.3 7 0.4 Incurable 17 0.2 2 0.4 - - 8 0.06 - - - - Died 424 4.8 37 6.8 43 8.0 266 1.8 13 1.0 8 0.5 8745 99.6 531 98.l 537 99.9 Made In-patients 524 3.6 28 2.2 34 2.1 Having been l2 Weeks on the Books 1615 11.2 213 16.4 259 16.0 4050 􀀤.26 1196 92.3 1426 87,6 most noticeably for the former. The percentages receiving no benefit were very low compared to those receiving at least some benefit, which can be taken as a further measure of the hospital's success in treating those patients who were accepted through its door. A not insignificant percentage of in-patients finished their treatment as out-patients. Low percentages chose to discharge themselves at their own request. While relatively few out-patients were taken into the hospital as in-patients, not insignificant percentages were discharged under the hospital's rule of 'having been 12 weeks on the Books'. On this last point the bulk of out-patients was treated for periods extending between eight and twelve weeks. Over the fourteen years, 1839 to 1852, inclusive, 10,661 of the 14,417 who received treatment did so over eight to twelve weeks, amounting to 74 per cent, compared to 2,297, or 16 per cent, over four to eight weeks and 1,375, or 9.5 per cent, over one to four weeks. During 1866 of 1,294 out-patients 974, or 75 per cent, were treated over periods of eight to twelve weeks. 77 77 Ibid. for /839-52 and 1866. 23 JOHN WHYMAN In 1838, Dr McDivitt admitted to 'the habit of retaining the out-patients' names upon the books for a considerable period (often for three or four weeks) after their recovery has been established. This is done chiefly with a view to prevent, by keeping up the restraints of medical discipline, a speedy return to former pernicious habits, which is so common a cause of dangerous relapses, particularly among the lower classes of society. '78 Concerning the twelve-week limit for out-patients, Dr McDivitt felt that it was perfectly justified. 'Before this restrictive law was passed, it was not unusual for patients to attend irregularly for a period of many months; and, in some cases, even for one, two, or three years .... In 1824, the average attendance of the out-patients was 208 days! In 1836, it was 69 days, being still more than three-fourths of the whole allowable time. Since the passing of the law above alluded to, the attendance has been much more regular; but to secure this, much habitual strictness on the part of the medical officers has been necessary. '79 It was his practice to 'insist, as much as possible, on a strictly regular weekly attendance', which applied to over two-thirds of the out􀁉 patients under his own care, but 'several from the country receive medicines for a fortnight; and some, living at a distance of ten miles or upwards, and labouring under diseases of very long standing, are not reCJJ:,ired to attend oftener than once in three, or even four weeks'. Dr Lochee, too, felt that it was necessary to counter public criticism concerning how long patients were being treated. 'It has been urged, even by those who are supposed to be sufficiently well informed upon the subject, that the patients are allowed to remain in the Hospital an unreasonable length of time, to the impoverishment of its already scanty finances. This assertion, if it means anything, implies that they are kept there longer than they ought to be, or longer than is prescribed by the Rules: but what is the fact? The term allowed by the laws for the stay of each patient, before he is declared to be "over time", is, for the In-patients, eight weeks, or fifty-six days, and for Out-patients, twelve weeks, or eighty-four days .... Neither of these classes of patients, during the last five years, has remained, on the average, even up to its full time on the Books, much less beyond it; the term being fifty-four days, in the one case, and seventy-one days in the other .'81 78 McDivitt, (1838), op. cit., 4. 79 McDivitt, (1839), op. cit., 182. 80 Ibid., 182-3. 81 LocMe, (1842), op. cit., 121-2. 24 THE KENT AND CANTERBURY HOSPITAL, 1836-1876 Year 1837* 1838* 1839 1840 1841 Average AVERAGE NUMBER OF DAYS ON THE BOOKS, 1837-184182 In-patients 47 58 56 56 54 54.2 Out-patients 73 70 72 70 73 71 • During these two years, from June, 1837, to June, 1838, when the enlargement and alteration of the building was going on, no female in-patients were admitted into the hospital; consequently, the number of female out-patients was greater than usual. The second new wing was opened on 29th May, 1838. Apart from the 1837 in-patient figure, there was a remarkable consistency over five years. While feeling charitable to the hospital's critics, Dr Lochee also felt that it was his duty to put the record straight. Criticisms arose 'from innocent ignorance of the real state of the case. . . . Doubtless, it is easy enough, to pick out individual examples, where the treatment in the House has been continued for a great length of time, and hence to descant upon the expense attending them; but this is not even an honest way of dealing with the question, which can only be fairly decided by taking the average of the whole; and then, as regards those protracted cases, everybody who knows anything of hospital practice, will know also, that they must frequently occur, both in medicine and surgery, without there being any help for it: and, thank Heaven, the itch for saving has not yet reached to such a point, as to cause the inmates of a public "CHARITY" to be sent about their business, as soon as they are able to crawl, merely because they happen to have been a few weeks longer in it than is customary . ... [Patients) ill enough to require medical assistance, and likely to be benefited by an extension of it, ... ought to be kept, though the recommendation be a year old. '83 Whatever the justifications it remains a fact that, compared with present-day standards, the average in-patient stayed in hospital for a very much longer time in the nineteenth century. The following results emerge for 1839-1852 inclusive, 1866 and 1876.84 82 Ibid., 72, 120. 83 Ibid., 122. 84 General Kent and Canterbury Hospital Annual Reports for 1839-1852, 1866 and 1876. 25 JOHN WHYMAN TREATMENT WEEKS Period 1-4 4-8 8-12 12-16 16--20 20+ or Year No. % No. % No. % No. % No. % No. % 1839-52 2234 25.4 3303 37.6 1847 21.0 625 7.1 238 2.7 146 1.7 1866 174 32.1 234 43.3 88 16.3 17 3.1 15 2.8 15 2.8 1876 161 30.0 214 39.9 109 20.3 23 4.3 11 2.0 19 3.5 The proportion of 'overtime' in-patients beyond eight weeks averaged out at about one-third over the fourteen years, 1839 to 1852 inclusive, compared to one quarter for 1866 and 30 per cent for 1876, roughly two-thirds of whom remained in the hospital for up to three months. The longest individual stay between 1839 and 1852 ranged from 21 to 58 weeks, during 1843 and 1840, respectively, and, as if to underline the necessity on occasions for long periods of hospitalisation, one person was discharged during 1876 after 67 weeks in the hospital. Dr Lochee was right to attribute in 1841 lengthy stays in hospital 'to the character of the diseases met with, which rarely admit of a speedy cure'. 85 Drs McDivitt and Lochee analysed in great statistical detail the complaints which were being treated over the years 1836 to 1842. For Dr McDivitt in 1839, 'the diseases which prevail most in Canterbury and its neighbourhood, are phthisis, . . . scrofulous affections of the joints, sub-acute gastritis, rheumatism, chlorosis, intermittent fevers and neuralgia, affections of the heart, and dropsies.' From the records of the hospital he was very much struck with both the frequency and fatality of rheumatism and asthma. Among in-patients medical and surgical cases were nearly equal, with the balance tilted very much towards medical cases among the outpatients. Most cases admitted into the hospital were 'of a chronic nature', and a high proportion of the surgical cases consisted of diseased joints, periostitis and extensively uJcerated legs, 'diseases which do not admit of out-attendance'. 86 Dr Lochee, in identifying 'the most common disorders' distinguished between males and females, those of the former being 'Rheumatism; Continued, Intermittent, and Remittent Fevers; 85 Lochee, (1841), op. cit., 21. 86 McDivitt, (1839), op. cit., 181-2. 26 THE KENT AND CANTERBURY HOSPITAL, 1836-1876 Inflammatory Affections of the Thoracic Viscera; Ph thisis Pulmonalis (in great proportion), and those organic lesions of the great abdominal viscera which give rise to Dropsies, Anasarca, Marasmus, etc.'. Females, too, were prone to fevers, 'with the exception of agues', plus 'Chlorotic Fever, Gastric disorders, consequent on secretional and nervous derangement, Neuralgic affections of the head and face, Ascites from visceral congestions, Cardiac diseases ( chiefly functional), together with the innumerable forms of Hysteria, and those disorders of the uterine functions peculiar to the sex'. 87 Again 'the chronic nature of the majority of the diseases' treated in the hospital was stressed, with 'many cases admitted, where even a moderate degree of relief cannot be expected under three or four months' persevering attention', so that 'unless this chance be given to the sufferers, they must remain either invalids, or cripples, for the rest of their lives'. 88 As to out-patients' diseases they were for Dr Lochee 'similar to those which are met with among the in-patients', differing 'only in degree from them'. However, they did comprise 'all that varied class of maladies, which are decided by the rules to be inadmissible: infectious, or contagious disorders of every kind, and all the diseases of children, under seven years of age'. Acute inflammations were rare among out-patients, but 'structural diseases, consequent upon them' were 'exceedingly common; those of the lungs, heart, stomach, and kidneys, taking the lead'. Prominent, too, among the complaints of out-patients were 'chronic cutaneous disorders', particularly psoriasis and herpes. Surgical cases among the out-patients were 'for the most part, trivial, or presenting diseases of such long standing, as to be scarcely within the reach of remedies'. Some among the out-patients were discharged in-patients completing the cures proposed for them. There was one further category 'not to be passed over without notice', namely 'the immense number and variety of the diseases of the eye', especially pustular ophthalmic, strumous ophthalmic and chronic inflammation of the conjunctiva.89 Out-patient disorders, 'though for the most part slight', were 'generally more dependent upon local causes [and] more characteristic of local influences'. 90 In 1836, the Canterbury Dispensary was established. Eleven years later its surgeon, Mr George Rigden, produced a report in which from personal experience he argued that p;/ i..ochee, (1841), op. cir., 17. 88 Lochee, (1842), op. cit .. 119. 89 Ibid., 74-5. 90 Lochee, (1841), op. cit., 17. 27 JOHN WHYMAN 'RHEUMATISM ... is beyond exception the most prevalent disease of the neighbourhood, [being] peculiarly distressing to the sufferer, [ and] preventing him from following his employment'. 91 It was Dr Lochee's experience that 'in this part of the country, where the working classes are chiefly field labourers, atmospheric changes, and constant exposure to cold and wet, .. . never fail, in the end, to determine the character of the resulting diseases: thus we have, in abundance, inflammatory affections of the pleura, the lungs, and the air-passages; obstinate rheumatisms of muscular parts; and neuralgic affections from cold, sometimes amounting to complete paralysis. '92 It has been noted already how the Kent and Canterbury Hospital admitted 454 male and 460 female in-patients, for medical and surgical treatment, between 16th October, 1840 and 1st June, 1842, following which Dr Lochee produced detailed statistics relating to the nature and results of their treatment.93 The breakdown as between medical and surgical was as follows: Males Females Total Medical 246 343 589 Surgical 208 117 325 Total 454 460 914 The treatment which they were offered had the following results. Males Females Total Medical No. % No. % No. % ·--- Well 94 38.2 173 50.4 267 45.3 Great Benefit 33 13.4 52 15.2 85 14.4 Relieved 25 10.2 20 5.8 45 7.6 No Benefit 23 9.3 19 5.5 42 7.1 Made Out-Patients 55 22.4 66 19.2 121 20.5 Died 16 6.5 13 3.8 29 4.9 Total 246 343 589 91 George Rigden, The sanitary Condition of Canterbury, with a nosological Table of the Diseases for which poor Pa1ients have applied for Admission to the Benefits of the Canterbury Dispensary, (Canterbury, 1847), 14. 92 Lochee, (1841), op. cit., 19. 93 Lochee, (1842), op. cit., 102-9, Tables III-VI. 28 THE KENT AND CANTERBURY HOSPITAL, 1836--1876 Males Females Total Surgical No. % No. % No. % Well 92 44.2 37 31.6 129 39.7 Great Benefit 21 10.1 26 22.2 47 14.5 Benefit 25 12.0 12 10.3 37 11.4 No Benefit 16 7.7 9 7.7 25 7.7 Made Out-Patients 41 19.7 27 23.0 68 21.0 Operations 9 4.3 - - 9 2.8 Died 4 1.9 6 5.1 10 3.0 Total 208 117 325 The above figures point to a low death-rate, the highest being among males undergoing medical treatment, followed by female surgical patients. A fairly consistent 20 per cent or just over were discharged as out-patients. The proportions receiving 'no benefit' never exceeded 10 per cent, as against well over one-third who were discharged 'well'. A total of 39 deaths resulted from the following complaints. Medical Males Females 1 Typhus Fever 1 Acute Hydrocephalus 1 Tubercular Disease of Brain 1 Sanguineous Apoplexy 1 Sanguineous Apoplexy 3 Phthisis Pulmonalis 1 Phthisis Pulmonalis 1 Hypertrophy of Heart 2 Hypertrophy of Heart 1 Dilatation of the Heart 1 Dilatation of the Heart 2 Acute Peritonitis 1 Rheumatic Pericarditis 1 Enteritis and Peritonitis 1 Aneurism of Ascending 2 Ascites Aorta 2 Ascites 1 Tubercular Ulceration of the Kidneys 1 Inflammation of Transverse Colon 1 Carcinoma of the Pancreas and Liver 1 Paraplegic from Inflammation of Medulla Spinalis 1 Poisoning 1 Psoriasis Total: 16 Total: 13 29 JOHN WHYMAN Surgical Males Females I Fractured Ribs with wound of 1 Simple Fracture of both Thighs the Lung I Fractured Femur and tom 1 Fractured Neck of Thigh bone Artery (gunshot) 1 Burns l Internal injury from blows on 1 Chronic Ulcerative disease of Abdomen the Knee 1 Fungoid Tumor in the 2 Abscess of Hip Pharynx Tora!: 4 Total: 6 Deaths from fractures occurred among the surgical patients, heart problems and consumption among the medical patients. Apart from giving for each disease or injury the number of patients affected and the results of treatment, Dr Lochee also stated the average number of days spent in the hospital, ranging from one male patient with 'Syphilis (inadvertently admitted)', one day in the hospital, up to 168 days for a ten-year old female surgical patient with a 'Stone in the Bladder'. The following are some of the complaints which were treated medically between 16th October, 1840, and 1st June, 1842. Males Disease No. of Average Well, patients no. of days benefited No affected in hospital or relieved benefit Died Chronic Bronch1tls 15 46 !S Phthisis Pulmonalis 18 46 4 7 I Capsular Rheumatism 28 48 24 Muscular Rheumatism 18 43 17 Ascites 8 59 3 2 2 Chronic Hepatitis 8 58 5 I Chronic Gastritis 6 47 3 Sciatica 7 52 4 Females Billious Remittent 19 48 18 Fever Hysteria 30 64 16 2 Anaemia 18 48 14 Chlorosis 25 56 19 Chronic Bronchitis 13 50 13 30 THE KENT AND CANTERBURY HOSPITAL, 1836-1876 (Table continued:) Females Disease No. of Average Well, patients no. of days benefited No affected i11 hospital or relieved benefit Phthisis Pulmonalis 12 39 4 2 Capsular Rheumatism 10 51 7 Muscular Rheumatism 7 63 6 Ascites 3 48 l Hepatitis 12 47 9 1 Sub-acute Gastritis 8 57 8 Sciatica 4 65 3 Gastralgia Nervosa 16 58 13 Died 2 N.B. Out-patients accounted for the difference between Well, Benefited or Relieved, No Benefit arid Died, as against the Number of Patients affected. Under the heading of surgical treatment were the following. Males No. of Average Well, Injury or Patients no. of days benefited No Emergency affected in hospital or relieved Benefit Died Simple Fracture of Leg 7 77 7 Compound Fracture of 2 175 2 Leg Contusion of Joints 10 27 7 Back Injuries from Falls 6 46 3 Chronic disease of Knee 10 96 7 1 Joint Irritable Ulcer of Leg 7 78 6 Varicose Ulcer of Leg 18 49 16 Abscess in Thigh 5 74 4 Abscess in Hip 3 76 2 Females Simple Fracture of both 1 68 I Thighs Fractured Neck of 1 10 I Thigh Bone Contused and Sprained Joints 8 54 5 Back Injuries 2 54 31 JOHN WHYMAN (Table continued:) Females No. of Average Well, Injury or patients no. of days benefited No Emergency affected in hospital or relieved benefit Died Chronic Ulcerative 13 51 9 1 disease of Knee Irritable Ulcer of Leg 12 61 10 1 Varicose Ulcer of Leg 4 51 4 Scrofulous Ulceration 4 50 4 of Thigh Ulceration Glands of 5 41 3 Neck Abscess in Hip 3 59 1 2 N.B. Again out-patients accounted for the difference between Well, Benefited or Relieved, No Benefit and Died, as against the Number of Patients affected, apart from two amputations of knee joints among the male surgical patients. What is most surprising from the records is the paucity of surgical operations between 16th October, 1840, and 1st June, 1842. There were none involving female in-patients and only nine insofar as the male in-patients were concerned, viz. Treatment Age, or Days, or average Result average age no. of days in hospital 1 amputation for compound 62 109 Well fracture of Metatarsus 1 operation for Strangulated 41 3 Reduced Inguinal Hernia 1 excision for Fungoid disease of 40 91 Well Testis I crushed Stone in the Bladder 77 98 Well 2 amputations for chronic disease of Knee Joint 32 96 Well I amputation for Strumous 21 131 Well disease of Ancle Joint 2 excisions for Cancerous Ulcer 62 36 Well of Lip 32 THE KENT AND CANTERBURY HOSPITAL, 1836-1876 Surgical operations were relatively few despite the hospital having more honorary surgeons than honorary physicians. During the eighteenth and early nineteenth centuries a 'surgical operation' was an exceptional event due in part to the Rules of the hospital, the differing status of physicians and surgeons and the extent of surgical knowledge and skill. The status of physicians demanded their prior consultation before any amputations or 'principal' operations were carried out. Under the 1827 Rules, it was stipulated that 'no capital operation shall ever be undertaken, without a previous consultation being called of all the Physicians and Surgeons, excepting in cases of immediate necessity'. 94 Quite apart from the fact that much of the work undertaken by surgeons was of a non-serious nature, it was the superior status of physicians which dictated their prior approval before an amputation or serious operation could be performed. In effect, surgeons were a subordinate kind of practitioner as was made all too clear in 1830: 'the practice of the physician, as it is universally understood, as well by the College as the public, is to be properly confined to the prescribing of medicines to be compounded by the apothecaries, and . . . superintending the proceedings of the surgeon as to aid his operations by prescribing what [is] necessary for the general health of the patient and for the purpose of counteracting any internal disease'. 95 This view upheld the supreme position of physicians within a hierarchical structure at the apex of the medical profession. Quoting again from the same source the peculiar practice of surgeons 'consists in the use of surgical instruments, ... and in the care of all outward diseases whether by external applications or internal medicines. Several diseases which may sometimes be regarded as internal complaints have been recognized as within the scope of their practice- syphilis, letting of blood, drawing of teeth, ... all wounds, ulcers, ... fractures, dislocations, ... tumours, etc. '96 Cases other than those already cited by Dr Lochee included concussions of the brain, lacerated wound of the hand, an extensive burn from boiling pitch, spinal distortions, enlarged glands of the neck, gunshot wound of the leg, cancers and tumours of the breast, etc.97 It must also be remembered that prior to the introduction of anaesthesia in 1846 the frequency and scope of surgical operations were limited. The growth of surgery was hampered by a lack of knowledge of the function and anatomy of many of the organs of the 94 Rules and Regulations, (1827), op. cit., 18. 95 J.W. Willcock, The Laws Relating to the Medical Profession, (1830). 96 Ibid. 97 Lochee, (1842), op. cit., 106-9. 33 JOHN WHYMAN body. Surgeons, too, disliked operations since they inflicted great pain on the patient as well as shock to the body. Death from shock was not an uncommon cause of mortality so far as operations were concerned, so that 'in pre-anaesthetic days operations were rushed through at lightning speed and under conditions of appalling difficulty. The most hardened surgeons had to steel themselves to perform operations which they knew would cause agony to their patients and nerve-racking distress to themselves. '98 In addition to all these factors, hospitals did not publish information on all the operations which they performed. One is left with the possibility, therefore, that in various parts of the hospital, other than in the operating theatre, the honorary surgeons conducted what is ordinarily thought of as surgery, namely dealing with wounds, fractures, hernias, amputations and the various injuries arising from accidents, without involving the presence of the honorary physicians. Surgery, as defined above and as understood today, must have formed a much larger part of the hospital's daily routine than the records suggest. It was hidden work until with a greater application of anaesthetics and of Listerian antiseptic methods surgery was increasingly pushed into the operating theatre from the 1880s onwards. Between the 1830s and the 1870s the hospital was called upon to deal with out-patient emergencies. A recent unpublished study has emphasized the environmental unhealthiness of mid nineteenthcentury Canterbury.99 In 1849, there was a national outbreak of cholera, the threat of which resulted in a 'Meeting of the Medical Practitioners of Canterbury' being convened for 23rd July, with Dr Lochee in the chair. The meeting agreed unanimously to recommend to the hospital, 'that in the present state of Canterbury with respect to Cholera, immediate relief ought to be given to all poor persons affected with relaxed Bowels and that for this purpose the Board of Management of the Hospital be requested to authorize their Medical Officers to furnish persons applying with such disorder of the Bowels with the necessary remedies as Cases of Emergency'. 100 In other words, the hospital adopted the same policy as agreed also in July by the Salisbury General Infirmary whereby all persons suffering from 'premonitory symptoms of cholera' should be treated as out- <>S W.J. Bishop. The early History of Surgery. (1960), 155. "" Audrey Bateman, Public Health in mid nineteenth- Century Canterbury, University of Kent Diploma in Local History Dissertation, (1988). tm Weekly Boards, 1846-1851. 34 THE KENT AND CANTERBURY HOSPITAL, 1836-1876 patients without letters of recommendation. 101 The Kent and Canterbury Out-Patients' Register shows the first application for treatment arising on 24th July, involving Mary Holness, aged 28, from Tyler Hill, 'Pain in Bowels - An Emergency', who on 10th August was discharged 'Cured'. Up to 30th August, 94 out-patients were treated for 'Pain in Bowels', 'Relaxed Bowels' or 'Bowel Complaint', all as 'Out-patient Emergency Cases', with treatment extending mostly over two weeks or more. Daily admissions thereafter rose to as high as 22 on 14th September, 1st October and 10th October, by which time 562 people had been seen. 102 Looking back over 1849 the Annual Report referred to 'the Epidemic' and to 675 people being 'relieved . . . on their own application', 103 all of whose names were entered in the hos£ital's records, with the last applicant being seen on 19th November.1 4 When cholera reared its head again five years later its prevention in 1854 was attributed to the free dispensing of medicine to 3,462 people.105 During 1857, 1,638 out-patients 'had Medicine supplied them for Diarrhoea'. 106 In the Annual Report for 1876 it was announced that 'a new feature . . . is a tabulated statement drawn up by the House Surgeon [Mr Samuel J. Thomson, M.R.C.S.] of the cases treated in the Hospital during the year', viz: a 'Classification of Diseases, etc., of In-Patients Discharged during the year 1876'. 107 The overall results of the treatment afforded to the 537 in-patients of that year have already been noted: 0.6 per cent were 'cured', 10.4 per cent were discharged 'well', 33. 7 per cent 'received benefit', 0. 9 per cent 'no benefit' and 8 per cent died, the remainder discharging themselves or proceeding to convalescence (23.3 per cent) or to out-patient treatment (18.2 per cent). At their service were one honorary physician (Alfred Lochee, M.D., F.R.C.P.), one consulting honorary surgeon (Mr P.B. Hallowes, F.R.C.S.), four honorary surgeons (Messrs. James Reid, F.R.C.S., Charles Holttum, F.R.C.S., Henry E. Hutchings, M.R.C.S., and Frank Wacher, M.R.C.S.), one honorary dental surgeon (Mr Robert J. Bell, L.D.S.), the house surgeon as already noted, an assistant house surgeon and disEenser (Mr Rayley Owen, LS.A.) and the matron (Miss Gardiner). 08 101 Hall, Stevens and Whyman, op. cit., 69. 102 Out-Patient's Register 1846-1849, 176-84; Weekly Boards, 1846-1851, entries 31st August to 10th October. 1849. to) General Kent and Canterbury Hospital Annual Report for 1849. 104 Weekly Boards, 1846-1851, entry 19th November. 1849. 105 General Kent and Canterbury Hospital A1111ual Report for 1854. i0o Ibid. for 1857. 107 Ibid. for 1876, S. 8. 40--3. 108 Ibid., S. 35 JOHN WHYMAN Dental treatment was one of the greater innovations of the second half of the nineteenth century. An expansion of the hospital's services occurred when on 12th July, 1866, the Governors, meeting as a General Board, created a new office, that of honorary dental surgeon to the hospital, electin9 Mr Bell to fill that office.109 During 1876 he treated 728 patients.11 The admissions of 1876 included 51 accidents and 21 emergencies. 111 In-patient treatment that year embraced the following:112 Complaint Diseases Ague Acute Rheumatism Chronic Rheumatism Syphilis Tumours Cancers Scrofula Pulmonary Consumption Diabetes Tuberculosis Anaemia Cerebral Paralysis Tetanus Epilepsy Hysteria Neuralgia Eye Diseases Heart Disease Laryngitis Bronchitis Asthma Pneumonia Pleurisy Gastritis Dyspepsia Hernia Haemorrhoids Liver Disease 109 Ibid. for 1866. 110 Ibid. for 1876, 7. l ll Ibid., 38. 112 Ibid., 40-3. No. of Patients Males Females 5 2 8 2 7 3 1 3 2 2 8 8 0 2 14 6 3 0 9 5 0 13 6 3 6 0 1 0 1 0 0 8 6 3 10 4 12 5 2 0 8 3 6 0 7 2 I 0 I 1 2 2 1 2 2 1 4 1 36 Results of Treatment Total Cured Relieved Died 7 0 7 0 10 4 6 0 10 2 8 0 4 2 2 0 4 3 1 0 16 2 9 5 2 0 2 0 20 0 13 7 3 0 3 0 14 I 10 3 13 2 11 0 9 1 7 1 6 2 4 0 I 0 0 1 1 0 l 0 8 0 8 0 9 2 7 0 14 5 9 0 17 0 12 5 2 0 2 0 11 2 9 0 6 0 6 0 9 2 4 3 1 I 0 0 2 0 2 0 4 0 4 0 3 3 0 0 3 1 2 0 5 0 3 2 THE KENT AND CANTERBURY HOSPITAL, 1836-1876 (Table continued:) Complaint No. of Patients Results of Treatment Diseases Males Females Total Cured Relieved Died Jaundice 2 0 2 0 2 0 Retention of Urine 3 0 3 2 0 1 Disease of Hip 13 5 18 5 13 0 Disease of Knee 2 3 5 3 2 0 Weak Ankles 2 2 4 3 1 0 Eczema 5 5 10 4 6 0 Ulcer of Leg 26 15 41 23 18 0 Ulcers 5 2 7 4 3 0 Abscess 7 3 10 6 2 2 Old Age 5 1 6 0 2 4 Debility 4 6 10 2 8 0 Injuries Scalds aad Bums 1 0 I 0 I 0 Shock 1 0 1 0 0 1 Bite from Dog 1 0 1 0 1 0 Contusions and 32 4 36 24 11 1 wounds to face and body Sprains to knee and 4 0 4 4 0 0 ankle Fractures 23 6 29 25 4 0 The hospital was remarkably successful in treating injuries during 1876, recording only two deaths under this heading, one of which resulted from shock. It was here that the cure rate was impressive: 100 per cent in the case of sprains to the knee or ankle, 86 per cent for fractures and two in every three cases of contusion and wound to the face or body. Of six in-patients suffering from old age only two could be relieved and four died. The most common diseases of 1876 were not very different from those of the early 1840s, viz.: rheumatism, consumption and tuberculosis, anaemia, diseases of the heart and the hip, bronchitis, hysteria and leading the field leg ulcers. AU the cases of hysteria involved women. Of sixteen in-patients treated for c'lmcer, five died from cancers of the uterus, breast, face, stomach and throat. There were no cures for heart disease, only twelve relieved and five deaths. One in-patient who contracted tetanus died, and there were three deaths from tuberculosis and seven from pulmonary consumption. Pneumonia claimed three lives among nine in-patients admitted. There is considerable evidence of positiv􀁕 and beneficial medical 37 JOHN WHYMAN care at the Kent and Canterbury Hospital between 1836 and 1876. As a voluntary hospital it was not without its medical and surgical successes. Indeed, these were matched by expressions of gratitude for treatment received, to cite but two examples. During 1845 John Chandler of Sturry gave five shillings to the hospital 'for Benefit received by his son'. 113 The relevant In-Patients' Register lists as in-patient no. 111 for 1844 William Chandler, aged ten, from Sturry, who on 22nd February was admitted by Mr D.B. Major, F.R.C.S., honorary surgeon to the hospital from 1825 for over thirty years, as 'An Accident' case, suffering from an 'Injury to Face from Gunpowder'. Following treatment extending over twelve days, resulting in a cure, he was removed by his father on 5th March.114 In a similar vein the rector of Adisham, the Rev. W.W. Dickens, generously donated five guineas to the hospital during 1846, 'for attention paid to his Servant whilst a Patient'.1 15 The two honorary physicians Drs McDivitt and Lochee were at one in commending the overall performance of the Kent and Canterbury Hospital. The former boldly declared in 1839, 'I may, without fear of appearing boastful, assert, that the medical officers of the Kent and Canterbury Hospital have no reason to dread a comparison of the results of their labours with those of any other medical staff in the kingdom'. 116 In 1842. Dr Lochee offered a more cautious appraisal, mindful that 'a deficient medical staff is ... an evil of the greatest magnitude .... quite sufficient, of itself, to nullify the advantages otherwise derivable from these charities.'117 This accusation in his opinion could not be levied at the Kent and Canterbury Hospital. where 'the proportion of cures . . . seems to indicate a tolerable degree of success, ... the officers of this institution [having] no reason to fear a comparison with others in this respect'. 118 Twenty-seven years later. at the end of 1869, the hospital was reported to be in a •flourishing condition·, the Board of Management wishing 'specially to mention the very many small amounts received from persons in humhle circumstances, and from Patients who have experienced the benefits of the Institution, which convey a striking testimony of its practical usefulness·. It was also thought appropriate 'to acknowledge, with gratitude. the invaluable services of the Medical Staff which have.􀂡as usual. been rendered with punctuality and promptitude•.m 11.• Grneral Kem and Camerbury Hospital A11n11al Report for 1845. 11' /11-P11tie111s Register. /8./3-1847. 26. 11􀀐 G,·11t'ral Kc•m and Ca111erb11ry Hospital Annual Report for 1846. 11􀀑 McDivitt. ( 1839). op. cit .. 186. 117 Lochec. (18-t:!). op. cit .. 9.5. 1 IS lhicl .. 12.t. 11􀀒 Gt'11er11I Kem and Ca11terb11ry Hospital Annual Report for 1869. 8. 38