§ SIR DENHAM NORREYS rose to move for an Address to the Crown for returns respecting Netley Hospital, showing by whom the site was selected, whether any reports were made on its salubrity and general eligibility for its purpose previous to selection, and by whom. By whom the original plans were prepared, whether they were submitted to any medical authority for approval, by whom they were officially sanctioned, and whether any report was made upon them, and by whom, previous to their being sanctioned; statement of the alterations of, or additions to the original plans which have been detertermined on, by whom they were recommended, to whom they were referred for approval; and Copy of Correspondence, or Reports relating thereto, which have led to the adoption of the amended plan. He said that as he understood the Motion would not be opposed, it would be unnecessary for him to make any formal statement on a subject respecting which he personally knew nothing. He based his Motion on the assertion of an hon. Member a few nights ago, that the site of Netley Hospital was improperly chosen, being most insalubrious; that no reference had been made to the proper medical authorities; and that the plans had been so badly drawn up that the estimate of £150,000 originally laid before the House had been increased by £110,000. His object in making the present Motion was to give the Government an opportunity of removing that which was a most disgraceful imputation on the official departments of this country. He was informed that as far as the salubrity of the site was concerned the Government made every effort to be satisfied on the point. As to the plans there could be but one opinion, that whenever plans were laid before the House they ought to be carefully drawn up in order to avoid additions being made to the estimate. 1476 The Estimates for the public offices would soon be before the House, but as there were many new Members, he, as an old Member, would warn them that, according to the practice of all Governments, those Estimates would not be brought before them until the dog-days had come and nine-tenths of hon. Members had gone out of town. Then, when the House was nearly empty, supplemental Estimates would be brought in. He heard some hon. Gentlemen talk about a mediæval plan for Netley Hospital, but he trusted that those who had to sanction the plan for the Hospital, would not have the bad taste to caricature the ruins of Netley Abbey by placing a mediæval Hospital near it. The hon. Member concluded by proposing his Motion.
§ SIR JOHN RAMSDENsaid, there was no intention on the part of the Government to oppose the granting of these returns, which he hoped would be the means of removing a misapprehension that prevailed with respect to Netley Hospital. To the report that the site for the hospital was chosen without proper consideration he could give the most decided contradiction. The site was not selected by any Government official at all, but by a gentleman of very high standing in the medical profession, who was directed to choose within certain limits the most eligible situation for an hospital. That gentleman made a Report, and the site was chosen in accordance with his recommendation. He had so recently explained the cause of the discrepancy between the original estimate and that now presented to Parliament that he should not be justified in wasting the time of the House by repeating the statement.
§ MR. STAFFORDsaid, that the return moved for by the hon. Baronet was exactly the return which he could wish, and, if honestly prepared, which he had no doubt it would be, could not fail to afford some important information to the House. Upon a former occasion he had stated that certain extensive alterations were made, or attempted to be made in the hospital at Netley after the erection of the foundation and a considerable portion of the superstructure. That was a serious charge to make against the Government, and he felt it was necessary and incumbent on him to support it. If the House would permit him to read the grounds upon which he made that assertion, and upon 1477 which he now ventured to adhere to it, he would be glad to do so; but the document to which he had to refer was one of several pages (cries of"Oh!"), and there might be an impatience on the part of the House, after the varied and interesting subjects to which its attention had been called that evening, to enter so largely into the paper which he held in his hand. The document in question, of which he would merely state the substance, was forwarded to Lord Panmure by all the medical men of the Middlesex Hospital, an institution second to none for its management and its construction. It entered into details with respect to the construction of the Netley Hospital; it stated that every one of the wards had to receive the air either through the corridor or else through windows looking to the north-east, which was well known to be the aspect least favourable to the recovery of patients. It severely criticized the height and width of the wards, the position of the rooms assigned to the orderlies, the whole system of ventilation, and the confined court, not extending above 170 feet, into which the windows of all the wards looked. It described the system of latrines as so dangerous that there would be constantly throughout the building what was called "an hospital atmosphere," in which it would be impossible for the attendants to maintain their health, or for the sick to escape from fever, hospital-gangrene, and other diseases. He would move for a return of this document, in order that it might be laid before Parliament in extenso, or that Government might take the responsibility of refusing it. It was signed by gentlemen whose names commanded so much respect, and who were of such great celebrity, that it was fitting he should refer to them more particularly than he had yet done. They were Drs. Francis Hawkins, Seth Thompson, and A. P. Stewart, physicians to the Middlesex Hospital; Messrs. Alexander Shaw, Campbell, De Morgan, and Charles H. Moore, surgeons to the Hospital; Drs. S. J. Goodfellows and Henry Thompson, assistant physicians; Mr. Mitchell Henry, assistant surgeon; Dr. R. T. Frere, physician accoucheur; and Mr. George Corfe, apothecary. But, further correspondence had passed between these gentlemen and the Secretary at War. He held in his hand their last communication to Lord Panmure, which, he was sorry to say, had not been favoured with an answer. It was dated 1478 the 4th of May, 1857, and commenced as follows—
We have the honour to inform your Lordship that a deputation from our body attended on Tuesday, the 28th, at the War-office, on the subject of the proposed Royal Victoria Hospital. Captain Laffan explained to us the nature of certain alterations which the military authorities had decided upon making in the internal arrangements of the building, and especially in the position of the latrines; and he also entered at considerable length into the system of artificial ventilation which he stated would probably be ultimately adopted.He might here mention that the plan of Captain Laffan was to draw the cold air from a field in the vicinity by means of an enormous tunnel, and to suck it up through the building by means of a vast furnace placed on the top of the hospital, every window, of course, being kept shut. The deputation pressed upon Captain Laffan the perils of such a plan of ventilation; told him that the natural mode of opening the window would be far better; that the furnace would cause an enormous expense; that if at any time the heat should be diminished, the bad air would not ascend, but descend, and that the proposal of forcing up the effluvia of latrines by means of steam had been tried and proved a failure. They then went on to say—While we admit that the adoption of some of our suggestions is likely to be productive of a certain amount of benefit, we are yet unanimously of opinion that the whole plan of the hospital is radically faulty, and we are persuaded that the contemplated scheme of artificial ventilation, as explained to us by Captain Laffan, will in all probability aggravate the very evils which it is intended to remedy. We were informed that the plan of the building had received the approval of several of the medical officers connected with other of the metropolitan hospitals, but we have reason to believe that there may be some misconception on the minds of the Committee at the War-office as to the extent to which this is the case. In this statement we refer especially to the size of the wards, to the construction of the corridor, and to the proposed, but highly objectionable method of artificial ventilation,—which we may be allowed to mention are the three most important points connected with the sanitary economy of the hospital. We think it a matter of regret that the medical gentlemen whose opinions were desired had not the opportunity afforded to them of meeting together and investigating the plans as well as the proposed alterations, as such a course would have insured a more satisfactory result than is likely to be arrived at by merely asking the opinions of individuals who had had no previous intercommunication, upon isolated points unconnected with the general arrangements of the building. In conclusion, we have only to express our earnest hope that your Lordship will not sanction the present plans, which may, and in our opinion will, simply convert a large and costly building into a hotbed of 1479 erysipelas and hospital gangrene. It was mentioned to us that this would probably form only the commencement of extensive military buildings in the neighbourhood of Netley, and if this be the case your Lordship may consider whether it would not be a move prudent, as well as eventually a more economical course, to abandon the intention of completing the present buildings as an hospital, for which they are so ill adapted, and to convert them into barracks, or other military structures requiring less peculiar sanitary arrangements.That was the statement of men whose character and eminence no one could question. He hoped it was not too late to carry into effect the suggestions which they had made from practical experience in their own hospital. When the return was laid upon the table they would be able to see what professional gentlemen—engineers or medical men—had boldly taken upon themselves the responsibility of an hospital, open to such criticism. They were supposed now to be founding a model hospital for the troops. He said nothing of the difficulties of the foundation. He said nothing of the increased expense which the muddy nature of the soil had required for that foundation. He said nothing about the site and the muddy banks left bare at low tide. He would not enter into those questions nor give much weight to the alarm about ague, which was stated to be one reason against the situation of the building. He rested his objections upon this—that alter the building as they might, they could never make it such an hospital as ought to be constructed with their present knowledge of sanitary arrangements, and with the experience which had been so dearly bought. They had voted the money, and the building was now in progress. He commended it specially to the care of the Government. He did not wish them to take the statement of the Middlesex Hospital gentlemen as not open to contradiction. Let them examine men who had characters to lose, who had reputations to sustain, whose names would carry weight through the country, and if it were possible, even now, let them desist from spending hundreds of thousands of pounds in order to erect a building which in site perhaps, but certainly in construction, far from being a credit, would be a disgrace, and, far from saving the lives and restoring the health of our soldiers, would, as stated in the opinion he had quoted, be "a hotbed of erysipelas and hospital gangrene." He thanked the hon. Baronet for bringing forward the subject. He was glad the Government had made up their minds to 1480 grant the Return, and he hoped that Return would speedily be laid upon the table of the House.
§ MR. SIDNEY HERBERTI was rather in hopes that the Government would have made some explanation in answer to the statement of the hon. Gentleman who has just sat down. I confess that I am not one of those who think that anything extraordinary has happened when an estimate made by the Government turns out to be insufficient for the ultimate completion of the works, because I have observed that in commercial undertakings and in private undertakings the same thing invariably happens. I do not find that railroads have been completed for the original estimate. I do not find that a Crystal Palace brings in the dividends which were originally contemplated. When works upon a great scale are in question, I think the Government must have that allowance made for them which is made to all other men, to all companies and associations, and that the difference of cost consequent upon the fallibility of engineers and architects must be paid by those who engage in the undertaking. I make no charge upon that ground, because I expect such a result when dealing with large sums. But here is a case of really very great importance. Our hospitals for the army are no doubt inferior, not only to our civil, but to our naval hospitals. The most cursory comparison will convince any one of that fact. We wish to remedy the evil by constructing a hospital worthy of the country and of the purpose to which it is devoted. As far as we can see at present, if not failure, great doubt as to success is thrown upon those charged with this construction. The hon. Baronet, the Under Secretary for the War Department, says he can show by the papers that the site was not adopted or the construction determined upon without great deliberation. That is quite possible, but great deliberation is very often followed by failure. In one sex we know it is equivalent to being lost. In this particular instance the multiplicity of counsels does not inspire confidence. The gentlemen of the Middlesex Hospital made representations with regard to the construction of this building, and it was fortunate they did so. The Government, when they saw the objections, inquired into the plans. The army hospitals at Chatham and Portsmouth are upon one construction, which has been condemned. Unfortunately in the plan 1481 adopted at Netley that identical construction was adopted. The fault of the construction in the hospitals at Chatham and Portsmouth is that they have a long corridor, from which open a series of narrow wards having only light by windows at the extreme ends. What is now received as the best plan for the construction of an hospital is—detached buildings, with windows opening on either side, so as to obtain a thorough draught from side to side instead of lengthways. If the windows are lengthways the opening then creates a draught, like the wind passing through a tunnel, and causes so much inconvenience, that they must be closed and the ventilation stopped. It is only fair to say that the wards in this hospital are not of great length. Not only is it necessary that the wards of an hospital should have plenty of air, but plenty of light and sun. A building with a large corridor in front may be made very architectural, the back opening upon offices, which are not very presentable. But if you make the corridor in front, you must put the lights at the back. In this instance a handsome frontage is put facing the river, and the windows for the passage of air into the wards are in the contrary direction. But the result is, that the windows look upon the north-east, which is a bad aspect, instead of upon the south-east, which is a good aspect. Subsequently to the remonstrance a very great improvement has been made. The corridor is to be constructed on a series of arches, which will be glazed in winter, and open in summer. So far as the defect of construction can be remedied it has been remedied, but defects still remain. But I believe if you built separate buildings there would be much less chance of infection, and that the draught and light from the two sides would render the place more healthy. As regards the site, there is a great difference of opinion. I always understood that Southampton Water was not what is called an unwholesome, but a relaxing climate. If this hospital is meant for the reception only of individuals coming from tropical climates, I do not think that a disadvantage. But I am informed that Southampton Water lies upon a bed of peat, with a coating of mud, not so deep but that the salt water percolates through the mud to the peat, and there generates sulphuretted hydrogen gas. It is not a very pleasant atmosphere to enter the windows of an hospital At the 1482 same time, I believe that the hospital has been sufficiently removed back, or the esplanade thrown so far into the water that any noxious effect from any gas of the kind will be prevented. But there is a radical error in the selection of the site. You are going to build an hospital of 1,000 beds. Your object will be twofold. First, it will be made a model for army hospitals; secondly, it is to become a medical school for young practitioners of the army. If it be an invalid hospital you will receive into it all men sent home pensioned and discharged from foreign countries. But it is not in connection with any existing garrison. If a man falls sick at Aldershot or Portsmouth you cannot compel that man to be shaken for a number of miles over a railroad, because you have built a large hospital, and want to fill the beds. And there will be this disadvantage, that those who are to receive instruction in this hopital will be confined to the study of chronic cases,—of men who have come ill from abroad, and not of men taken ill on the spot. I believe the faults of the construction of the hospital have been remedied to a great degree; but upon the question as to whether the hospital is in a position which will make it the most available for the use of the army, I confess I am bound to say the choice of a site has been most unfortunate.
§ VISCOUNT PALMERSTONNo doubt this is a question of considerable importance, because when a large sum of money has been laid out in the construction of an hospital, it is desirable that the building, both in regard to site and construction, shall be calculated to cure and not to prolong or create disease. With regard to the difference between the original estimate and the subsequent one, my hon. Friend (Sir J. Ramsden) gave what I thought a proper and satisfactory explanation. He stated that when the estimate was first presented it had not been found possible, from want of time, to frame an estimate according to a given plan, but that the estimate was framed from what was assumed from former experience to be the cost of an hospital of a given size and on the old plan by practical men. A rough plan was afterwards made, and it was found necessary to frame an estimate for a larger sum than was originally put upon the Votes with regard to the building in question. With reference to the site, I certainly never heard that that side of Southampton Water was called unhealthy. 1483 We all know that the Forest, which is on the opposite side, being on very low ground and wet, has been considered to a certain degree unhealthy; but the spot on which this hospital is to be erected rests upon gravel, and is elevated and open to currents of air, and there has been no reason to suppose that it would be unhealthy, or not adapted to the purpose for which it is intended. With regard to the construction, all who have attended to the subject, know that there is considerable difference of opinion as to the proper mode of constructing a building designed for an hospital. My right hon. Friend (Mr. Sidney Herbert) states that the most approved plan is one in which there is a corridor, with blocks of buildings attached, separated from each other by spaces, and stretching away at right angles. There are certainly advantages in that arrangement, because it enables you to get a draught by side windows through each ward. But those blocks, separated from each other by spaces, look into narrow and confined courts, because the very blocks make confined courts of themselves, and so prevent a free and complete circulation of the air. Neither can the air come so rapidly out of confined courts through side windows as through windows at the end, supposing the wards were not too long. [Mr. S. HERBERT: You should have windows at the side as well as the end.] But if the whole of the wall consisted of windows, it would be difficult to place the beds so as to be free from draught. Again, it has generally been found that large wards are bad, and that it is much better that there should be a small number of patients in each ward. I can only assure the House that this matter has attracted the serious attention of the Government, and that great pains have been taken to get men capable of giving an opinion upon it. The papers which my hon. Friend (Sir J Ramsden) has agreed to produce will show what steps have been taken on the subject; but to a matter of such important as this, great attention should be paid, so that the building shall be fit for the purpose to which it is intended, and the House may rest assured that we shall not with our eyes open erect an edifice which shall be a source of sickness and disease, in stead of a source of health.
§ MR. TITEsaid, that from the attention he had paid to the subject of ventilation with reference to the rebuilding of the general Hospital at Bath, he was convinced 1484 that the only good system of ventilating any building was to adopt the old-fashioned and simple plan of opening the windows. He deprecated the construction of shafts, furnaces, and a complex apparatus. The windows ought to be large and lofty, and capable of being opened at any height. A costly experiment had been made of a different system at Guy's Hospital, the leading feature of which was a large furnace, but he was informed it had failed; and, indeed, they had only to look to the House in which they were assembled, where, after enormous expenditure in experiments upon ventilation, recourse was at last had to open windows for a natural current of air. The best recently erected Hospital was that of King's College, which he recommended for a model, and hoped that it would be followed. He could not help thinking that in the matter of hospital accommodation this country was much behind the Continent, because at Milan there was a free establishment which was capable of accommodating 3300 patients, and the wards of which were magnificent. That hopital was constructed on natural principles, and the ventilation secured by opening the windows. He was of opinion, also, that warming could best be secured by open fire-places, and not by any system of stoves. He was well acquainted with Southampton, and did not consider that its neighbourhood was at all unhealthy or unfitted for the erection of an hospital for 1000 patients. The site of Netley Abbey was extremely beautiful to look upon, and he had great faith in the judgment of the monks, who originally adopted it. Still, as this was an important question, he hoped that before the hospital was proceeded with, these matters would be looked into and thoroughly understood.
§ SIR DENHAM NORREYS, in reply, said, that he was glad that he had brought the subject forward, considering the discussion it had occasioned. He certainly thought that there must have been something wrong in a plan which had to be altered within two years of commencing operations.
SIR FREDERICK SMITHcalled the attention of the House to the very great difference between the tenders for the construction of the hospital, which were fifteen in number, and the sums of which varied from the lowest—the accepted one—at £168,000, and the highest, at £256,000.
§ Motion agreed to.