Edinburgh Hospital
 

Edinburgh Medical Hospital 

Edinburgh is at this moment in a sort of fever about the rebuilding of a medical hospital. It appears that the ancient institution which has flourished now under the name of the Royal Infirmary for a period of nearly 200 years, has survived its usefulness, and has become antiquated. What is more, it turns out to be positively injurious to the health of the unfortunate patients who are forced to seek admission within its portals. Notwithstanding the most strenuous efforts to improve it and add to it, the original defects of its construction appear to be incurable; it has been tried in the balance of hospital statistics, and found wanting; and during the course of the last year it was formally condemned by the proper authorities, and ordered to be razed to the foundation. Of course, as a necessary consequence, a new hospital has to be built; and on this question we may say a few words. It is hardly necessary to tell our readers that Edinburgh is the seat of a most ancient and celebrated medical school. Genoa is not more distinguished for its velvets, nor Lyons for its silk manufacture, than Edinburgh is for the profession of medicine. It may be added that in a city from which all political and even literary glory has gradually departed, the profession of such a school of medicine is not to be disregarded. To do them justice, the citizens of Edinburgh are in nowise guilty of neglecting this circumstance; and accordingly they have entered heart and soul into a movement to provide the necessary funds for erecting a building worthy of the city and the profession. Upon the Medical Hospital, of course, the wide reputation of the Edinburgh Medical School is based, has been reared, and will, no doubt, be extended; it is in fact, if we may venture to use an old metaphor, the corner stone of the building. The doctors, as far as we can discover, were the first to complain of the present building. This was, indeed, no more than their duty; but the most important initiative steps in the work were taken by the citizens themselves. 

During the month of April last year a great public meeting was held in Edinburgh. The Lord Provost took the chair, Lord Dalhousie, Lord Haddington, Lord Polwarth, the Lord Advocate - in esse (Gordon) The Lord Advocate - in posse (Moncrieff) the President of the College of Physicians, and the President of the College of Surgeons, together with an eminent publisher, Mr. Boyd, and a famous paper maker, Mr. Charles Cowan, addressed the meeting. It was announced that £100,000 was the sum needed; and of this sum, the managers could supply £40,000 from their own funds, chiefly derived, it would appear from former legacies. The response was hearty and immediate, £25,000 were subscribed on the spot. An influential committee of citizens was appointed to conduct the public subscription. A benevolent widow lady, Mrs Buchanan of Moray Place, first of all contributed £1,000 and then soon afterwards amended her donation to £5,000. The Earl of Moray gave £1,000, the Earl of Wemyss also gave £1,000. There were in all ten names followed by the magical complement of one numeral and three cyphers. The high constables undertook a domiciliary visitation of the working classes, who, to say of them what is only fair, have always been faithful supporters of the institution. Collections were made at the same time in those curious brass plates which stand on tripods at the doors of the city churches, and the result of this and more was, that towards the end of July the sum of £67,000 had been raised, which sum, added to the £40,000 we have mentioned of Infirmary stock, make up £7,000 more than the stipulate capital required for the rebuilding of the new hospital. We cannot tell as yet how far this continued appeal has met with success, for the subscription is still in progress. 

Hitherto - the movement - had been one of uniform success, peace, concord, and good-will. But we must now turn over another leaf in the history; and this, we are sorry to say, is by no means so full of sunshine, or rather of azure and gold. The best of - movements - somehow or other never will run smooth; the apple of discord is sure to fall to the surface sooner or later; and in the present case the split has arisen on the question of site. This is a vital question, and its importance cannot be over-estimated, but the considerations which should determine it are so simple, the condition so elementary, and the necessities so easily understood, that we are totally puzzled to discover the reasons for such a story and protracted warfare as it has caused in the newspapers and public meetings of Edinburgh. 

It may be desirable to explain here that the Infirmary of Edinburgh consists of two hospitals, the medical and the surgical. The medical hospital is the ancient institution we have referred to above, and the locus of the surgical consists partly of the old High School of Edinburgh, and partly of a comparatively new suite of buildings which were erected in the year 1852. The old High School contains the wards and class rooms of Professor Syme, the new buildings those of Professor Spence. Further, it may be added that this noble charity is under the management or supervision of a Board of Directors, partly elected annually from the body of contributors and partly composed of the Lord Provost and magistrates, who are managers by virtue of their office. The duties of the managers seem to be rather indefinite. But to proceed; the gentleman who played the part of the Goddess of Discord on this occasion was Professor Syme, a surgeon of long practice and high standing, who honourably fills the chair of chemical surgery to the University of Edinburgh. On the 16th day of November last year he addressed a circular letter to each of the subscribers; and in this letter he asserts, and ably supports, the six following propositions. :- 

1 - That the managers had resolved to spend nearly the whole of the money in the purchase of property adjacent to their own £69,000. 

2 - That they had also resolved to re-build the medical hospital partly on its present site and partly on the site so acquired, which consists of the shops and houses South Bridge Street, facing the college gates. 

3 - That a larger, healthier, more salubrious and cheaper site could be got in the grounds of Watson's Hospital. 

4 - That the managers only proposed a new medical hospital. 

5 - That there was as much need, if not more, for a new surgical hospital. 

6 - That if the new infirmary be erected on the present site, all the existing buildings must be removed before the foundation stone could be laid. In that case, Edinburgh would be without a hospital for at least three years. 

We will only quote two sentences from Professor Syme's argument under his fifth proposition in order to illustrate their character. "Although the ordinary surgical wards are not so bad as they were - still that terrible pyoemia -the scourge of unhealthy hospitals - is distressingly frequent, together with other indications of imperfect ventilation. "It is therefore with no pleasant feeling that receive the visits to our hospital, so frequently paid, by members of the profession from all parts of the world, who must necessarily make injurious comparisons of the spacious, convenient, and well-ventilated wards seen elsewhere with the mean, rambling, and altogether incoherent arrangements of our surgical department. It is hardly necessary to say that this letter made at once a powerful impression on the contributors and the public. We do not see how it could operate otherwise; for the facts seem to us indisputable and the arguments unanswerable. But it an unfortunate characteristic of our medical schools, that their doctors differ in their opinions, and still more in their practice. Edinburgh, we are sorry to say, is no exception to the rule. Indeed, if we are to credit all we hear, we believe that diseases of the antagonistic and pugnacious type break out there with uncommon virulence and intensity. Since the days when Dr. Sangrado pulled his opponent's ears there has been no such scene witnessed as one professor of the same college publicly burning the pamphlets of another professor in his class-room. 

Our readers, therefore, will not be astonished to learn that within a week, another doctor of the same school, Professor Spence, the Professor of Surgery proper, also published a letter in reply to that of Professor Syme, in which, if not with equal skill, at least with more command of statistics, he urged the following counter-propositions. 1 - That Professor Syme's letter contains statements regarding the sanitary conditions of the surgical hospital which, if allowed to pass unchallenged, must prove injurious to the reputation of the institution, and of the medical school of Edinburgh. 

2 - That he [Spence] knows these statements to be incorrect as regards the department under his charge. 

3 - That he, as the senior acting surgeon of the infirmary, had never made or joined in such complaints; neither had the acting surgeons as a body. 

4 - That he had had actual experience in every ward of the surgical hospital. Professor Syme never had had charge of any one of them. He might, therefore, feel justified in calling in question his [Syme's] competence to pronounce an opinion. 

5 - That the statistics of amputations for disease during a quinquennial period in the published reports will compare favourably with those of any great city hospital. 

6 - That he holds strong opinions as to the advantages of the present site. 

We have no room, even if we had the inclination, to wade through the terrible mass of newspaper controversy which followed on these rival letters. 

"Strewed were the streets with milk-white reams. 

Flowed all the Canongate with inky streams." 

All the great Edinburgh writers - medical, legal, ecclesiastical, mercantile, economical, municipal, and architectural - seem to have exhausted their wit and invention in fetching arguments and digging up sites. One writer recommended that the hospital should be put beyond the boundaries of the city, after the fashion of the ancient Jews, - and very wisely too. Another suggested the city poor-house; a third, the cattle-market; a fourth, George Heriot's Hospital; a fifth, the Queen's Park. One doctor, obviously half-eccentric, proposed an iron bridge over the Cowgate to a site among the lowest slums of the High Street. and another doctor of equal eminence proposed that there should be no hospital built at all, only a provision of movable pavilions constructed with cast-iron plates. The medical profession, as far as we can judge, are about equally divided in their opinions; and in fine, the question as between the two professors is substantially unaltered. But when doctors disagree, who shall decide ? 

We need not venture to answer the question. With regard to public movements of this sort, the proverb is somewhat musty. The science of public health, for example is perhaps more indebted in our generation to the engineer than to the physician; but, at all events, no man in his senses will be governed in his opinions by the statistics of one department of a hospital. Professor Spence's may be, and doubtless are, correct, so far as they go. But no statistics in the world will make a plain man believe that the site of Christ Church Hospital in Newgate Street, is as salubrious as St. George's Hospital at Hyde Park Corner. And such, or nearly so, we believe - is the analogy between the present site of the Royal Infirmary at Edinburgh, and the site which Professor Syme recommends at George Watson's Hospital, which lies with a southern exposure, on the northern slope of the Edinburgh meadows. We cannot choose but support the view which gives the suffering inmates of a hospital the chances of more sunlight, better ventilation, and purer atmosphere. We hear that Mr. Bryce, the architect to the Royal Infirmary, has been requested to report on the comparative merits of the two sites. This ought to have been a preliminary step. It is unfortunate that the managers have lodged their bill, and scheduled the property on the old ground, without the least reference to another and, it may be, improved site. However, better late than never. 
Source: The Builder 1869 Vol XXVII 16th January 1869 p.042
Submitted by Alan Longbottom.

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