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hundred and thirty thousand roubles. An excellent practice, worthy of being imitated, obtains in this hospital. Individuals who are charitably disposed, may found one or more beds for patients, to be recommended by them on paying a fixed annual sum to that effect. Prince Alexander Kourakine, and a merchant named Pickler, have each founded a bed in this manner with the permission of the Empress. Another was established by an anonymous individual, who presented the hospital with a capital of 50,000 roubles for that purpose.
I have elsewhere stated, that the Empress superintends in person all her charitable establishments, and receives in a direct manner, either from the Physician-in-Chief, or, as in the present case, from a nobleman who is named by herself, and acts gratuitously under the title of Honorary Guardian, the reports of the daily proceedings, as well as the monthly reports, making appropriate remarks thereon, and suggesting corrections or improvements, as may be required. In addition to this assiduous attention to the welfare of her hospital, her Majesty pays frequent visits to the establishment,-sometimes twice, at others, three times a week. These are not. visits of ostentation. Her Majesty makes her appearance without being previously announced; inspects the wards, inquires into the cases of several of the poor patients, and converses with some of them; endeavouring by her exalted example of devotion to their cause, to inspire them with confidence and comfort, while she stimulates every person employed in their service, to act with vigilance and philanthropy.
This is not the place to enter into any medical discussion as to the treatment of diseases which I observed in this hospital; nor to discourse on the results obtained in so well-conducted and magnificent an establishment of medical charity. In general, I must say, that the medical practice appeared to differ very little from that observed
in the other hospitals of the capital, and that the rate of mortality appeared to me to have been, on an average of ten years, much higher than in other European hospitals, and nearly double that of our English hospitals. It is but justice to say, at the same time, that the rate in question is taken from the tables of the first four years of the institution, and that probably improved methods of treatment have since diminished it. On the latter point, however, I have had no means of obtaining the necessary information for drawing a correct conclusion. Nor is this high rate of mortality confined alone to the hospital just described; but is common to the other civil hospitals, and precisely such as I should expect from the nature of the treatment. As I once before observed, I am in want of sufficient data to form an accurate idea of that rate in the other civil hospitals of St. Petersburgh. But that it is greater than in the hospitals of this country, I have a right to assume, from the official statements of the result of practice in 1811 and 1812, published by Mons. Hermann in the ninth volume of the Memoirs of the Academy of Sciences of St. Petersburgh, where it appears that the average mortality in the two principal civil hospitals for those two years, was eighteen and a half per cent., or triple what it is in London. An idea also may be formed of what is considered a successful result of practice in that capital, from the opinion of the same writer expressed in the following manner:-"Nous admettons que le dixième meurt en régle dans un hôpital bien administré, où il n'y a point de maladie contagieuse." Now I must say, that an hospital in which such a mortality takes place en régle (as a matter of course) cannot be "bien administré ;" but something wrong must necessarily exist somewhere, in regard to the treatment of diseases. From another table on which I can rely, and which is for the year 1818, I find that out of 9590 deaths, which occurred in that year in St.
Petersburgh, 2260, or one in little less than four, were children, and sixty-two (!) from child-bed.*
The Maison des Enfan trouvés at St. Petersburgh is, next to that of Moscow, probably the most extensive, and certainly the best managed, of the kind in Europe. This building, or buildings rather, for there are several clustered together, in which the foundlings are received, without being very striking in their appearance, as the preceding institution is, may, nevertheless, boast of great extent and simplicity. Good order, great cleanliness, and the strictest discipline among the nurses, prevail in it. Afflicting as the idea must be of beholding hundreds of young babes deserted by their parents, collected together and taken
The mortality of children in St. Petersburgh is very considerable: indeed far greater than in any other capital in Europe; and this I must ascribe to the want of a proper school, wherein their diseases, so peculiar in their nature, and requiring so distinct a treatment, should be taught by physicians themselves, well versed in such matters. Even London was, till within the last ten years, far behind other cities on the Continent in this respect. The treatment of infantile complaints was acknowledged to be deficient, but the establishment of the present infirmaries for sick children has done a great deal, and may do still more, in improving that treatment; rendering it more rational, and consequently more successful. St. Petersburgh requires similar institutions even more than London; for, on the subject of children's complaints, professional skill, I must say, seemed considerably at fault. I have heard of one or two distinguished families losing one child after another of the same complaint, without the least attempt being made by the physician to improve a system of treatment which had proved so unavailable. Compared to the tables of mortality of sick children at the Royal Metropolitan Infirmary in London, that of St. Petersburgh (if report speaks truly) is really frightful. "Les enfans qui nous restent, (repeated to me a venerable Russian nobleman more than once), doivent être, au moins, de fer et invulnerables puisqu'ils ont echappé les effets d'un affreux climat, et les mauvais médecins." Should the Empress-mother establish an hospital for sick children, she will confer a real blessing on the country.
care of by strangers, it is consoling to see how much may be done to alleviate a destiny marked by hardship, cruelty, and injustice, from the first hour of their birth. The want of natural parents to a child could not be better supplied than by the regulations of this curious and interesting institution, which has been under the immediate superintendence of the Empress-mother for the last thirty years. No Sovereign, it may be boldly advanced, has done more for humanity in this particular department of charity than this princess. If any thing can excuse the necessity of such an establishment, it is, doubtlessly, the manner in which that of St. Petersburgh is kept by direction of her Majesty.
An idea may be formed of the number of children admitted annually, by this fact, that while I was standing within the lodge of the portier, or person deputed to receive them, on the 12th of November, two newly born babes were brought to him, which made the total number admitted on the register in that year, and up to that day, 3554; and also, that at the time of my visit there were not fewer than 465 children at the breast in the house. Some of these are brought from the lying-in department of the institution adjoining the establishment, in which every female who presents herself in the last stage of pregnancy is admitted without the least question being asked, and may even wear a mask if she desires it. To this part of the establishment no stranger is very properly admitted. Dr. Southoff, physician in ordinary and accoucheur, in the service of the Imperial Family, superintends the Lying-in Establishment, and resides in an adjoining house. This gentleman instructs in midwifery sixty young females, who are taken from the class of foundlings, remain in constant attendance on the patients, and, on being properly qualified, are sent, by order of the Empress, to different parts of Russia. This excellent arrangement is another valuable boon for which the nation, and particular
ly the country people, are indebted to that princess. There were no regularly instructed midwifes before to be found in Russia, as is pretty nearly the case to this day in England, much to the surprise of every well-wisher to this country.
I thought the treatment adopted in cases of illness, and the general management of the children, far superior to what I have had frequent opportunity of seeing in the Hospital of Enfans Trouvés, at Paris. Notwithstanding which, I was sorry to learn from Doctor Kühlweïr, the superintending physician, that the mortality among the children, within the first six weeks, is from thirty to forty per cent. The children are all brought up at the breast, and the wet-nurses appeared to me to be very healthy. They are allowed good pay, and a liberal diet. Sometimes the mothers, who have lain in at the Lying-in Establishment, will carry their own children into the foundling, and remain in it to nurse them, in which case they are paid as other wetnurses, and no questions, not even names, are ever asked.
When a child is brought for admission, a declaration in writing generally accompanies it, setting forth the day of the birth, the name given, and whether it has been baptized. These particulars are entered in a register, together with a description of the dress, and any mark which there may happen to be on the child's body. A counterpart of this register, with the corresponding number written on stamped paper, and signed by the Secretary, is delivered to the bearer of the child, around the neck of which the porter proceeds immediately to place a piece of ivory, suspended by a ribbon, which is fastened by a leaden seal, and is worn by the girls until twenty, and by the boys until twenty-two years of age, to show that they are under the protection of this establishment.
There are connected with this institution two other principal establishments, not of a medical nature, which I shall have occasion to describe shortly; and even in the