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September 2, 2017

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The infirmary at the end of the universe

May 11, 2017

Gentle reader: it is many years since I last regaled you with the miraculous tales of my perilous peregrinations; you may indeed recall reading reports of my voyages to Lilliput and Brobdingnag, to Laputa and Balnibarbi; and of my safe return from the land of the Houyhnhnms and the Yahoos, when it was my avowed intent to adopt the sedentary life of a country physician. As the years passed, however, I became ever-more weary of domestick endeavour; I longed for the open seas, for far-off lands, in short, for adventure. So, one morning, whilst the air was still brisk in the early sun’s cool rays, I kissed my sleeping wife gently on the forehead, dressed, retrieved the small carrying case I had secretly packed the night before, and, gently closing the door behind me, made for Bristol. Whereat, by the harbour, I espied a likely vessel, and duly took ship on the Enterprise, a proud three-master; Master, Fitzroy FitzGeorge.

 

 

                                      Jonathan Swift, 1667 - 1745 

 

 

I shall not detain your patience with a description of the voyage; suffice it to say that FitzGeorge and I found ourselves kindred spirits, and became companionable shipmates. We ventured to places both strange and exotick, epithets that apply only too truly to the land, far beyond the Lunar Sea, that I swiftly describe here.

 

At first sight, the land of Gloopnost presents a charming, even handsome, aspect. As the Enterprise rounded the promontory of Scilly Ness heading towards landfall, I observed that the buildings along the water-front formed an harmonious assembly, being neither too tall nor too squat, neither too ornamented nor too plain. It was not until I walked among the narrow streets of the capital that I noticed a distinct peculiarity. Everywhere was the sound of the coughs and the sneezes, interrupted on occasion by a more vigorous, but yet more heart-rending, cry of anguish. At first, I had presumed that the local population suffered at large from some as yet unknown (in our fine land, at any rate) form of the ague, bearing a condition that was inconvenient rather than life-threatening; of an intensity that did not require the services of a practitioner of physick. However, as my observations increased in number, and as I drew on my own extensive knowledge of the ailments that afflict mankind, I came to a different conclusion: it appeared that the population was chronically unwell, with almost everyone in need of medical attention.

 

As my perambulations continued, I became increasingly fearful lest I myself might succumb to some unfortunate malady, when, to my surprise, I fell upon the most splendid building. Wide steps of gleaming marble led to a portico of Ionic columns of the utmost elegance and grace, beneath a pediment of statuary of which the very ancient Greeks would indeed have been most proud. To one side and the other stretched a two-storey façade, interspersed with large, well-proportioned windows. My immediate impression was that this was the palace of a king, if not a veritable emperor; my astonishment was hence unbounded when I saw the notice: Publick Infirmary!

 

I mounted the steps and went inside the main door. This was clearly an assembly area, for I saw row upon row of well-upholstered chairs, no doubt to allow prospective patients to sit in comfort prior to their being attended to; such a change from the melancholy, crowded, waiting halls experienced in our land, where the discomfort of the seating is as likely to cause back injury to the otherwise healthy. Furthermore, since the assembly area before me was empty, the attentiveness offered here could be nothing less than unsurpassed, with everyone receiving the appropriate treatment immediately on arrival.

 

I walked to the desk marked ‘Reception’, my footsteps ringing loudly on the marble floor, and echoing around the stately apartments. The reception clerke was earnestly devoted to some important papers, and, after a short while, looked up, and asked, in a manner extremely polite, if I might be kind enough to take a seat; explaining that I had been expected, and that I would be attended shortly. And, shortly thereafter, I was indeed attended by a periwigged gentleman, of noble disposition, who stated that he was both honoured and pleased to have the opportunity of guiding me on my tour of inspection, and who introduced himself as Count Bihnz. I trust my experience of strange situations did not cause me to display my puzzlement, and so I courteously bowed before the Count, and expressed my gratitude for his taking so much of his valuable time etc, etc…

 

And so began a voyage as peculiar as any of my entire experience. As a man of physick, I have seen many institutions for the care of the sick and the noble practice of the art of surgery. But nowhere have I ever seen an infirmary as splendidly equipped, as immaculately clean, as meticulously administered as that I saw on that day; the alchemist’s room contained vessels of the very latest type; the apothecary’s cabinet was comprehensively stocked with herbs, potions and tinctures; the tools of the surgeon were freshly honed and sturdy. Everywhere, staff were cleaning and polishing, scrubbing and washing; nurses in pristine starched uniforms were busy completing manuscripts, presumably relating to the histories of their patients; groups of physicians hurried to and fro in ardent conversation. The wards too were sparkling clean, freshly aired, and formed the most convivial atmosphere for rehabilitation.

 

My only puzzlement was the total and complete absence of patients.

I am of course certain that I need not relate that, given his breeding and character, Count Binhz was a most courteous and informative host. It transpired that he was expecting an inspection from the imperial authorities, and had evidently mistaken me accordingly; a misapprehension which I took to encourage rather than alleviate; for I considered that this would give the loquacious Count every opportunity to explain the as-yet unresolved mystery of the missing patients. Which, in due course, he did, as I shall now relate.

 

The good Count explained firstly that this infirmary, around which it was his honour to escort so distinguished a guest as myself, was renowned throughout the land as the most ‘efficient’. This was a word that frequently fell from his lips, for it appears that ‘efficiency’ was the most highly esteemed of all attributes. Every year, he explained, at the annual spring Ceremony of Endowment, he - and all his colleagues from other infirmaries - received their own personal Pot-of-Gold, containing monies to be used for the infirmary for the coming year, until the next Ceremony. During the year, each infirmary could spend the contents of its Pot-of-Gold, but not a Nichol more; if it were to spend a Nichol less, any sums left in the Pot-of-Gold were returned, and deducted accordingly from the next year’s Pot-of-Gold. Great honours were bestowed on those who spent exactly the contents of their Pot-of-Gold, honours which he, Count Binhz, had been the humble recipient these last four years.

 

The secret, he explained, was divination. At the beginning of the year, he opened his Pot-of-Gold and counted it; divided this sum by fifty-two and therefore divined how much he could spend every week; as long as he spent this sum and only this sum, he could be sure that his Pot-of-Gold would last the year exactly. He had stumbled upon this secret five or more years ago, when he had observed the great predicament of his predecessor; a man whose anxiety burgeoned steadily during the year as he discovered to his ever-increasing disconsolation that his Pot-of-Gold was being depleted far too quickly. One year, there had been an epidemic of the influenza, and the infirmary had never been more full. The poor stricken patients had been well looked-after, and many recovered their former healthy constitution; the same, unfortunately, could not be said of the infirmary: much money had been spent on extra nursing care and the apothecary’s remedies; so much so that the Pot-of-Gold had become exhausted – a problem aggravated by the fact that the influenza had struck in the winter, by which time the Pot-of-Gold given the previous spring was already sorely depleted. As a consequence, his predecessor had suffered much approbium. And the following year was even worse: a new physician had come to practice at the infirmary, bringing with him a host of new-fangled ideas for treating his patients, including a revoltingly unhealthy contraption which he put - forgive my indiscretion oh gentle reader but those of nervous disposition may choose to skip the next few words - into the mouths of the diseased, claiming that this helped him understand the nature of their affliction! Whether or not this was indeed the case, no-one will ever know; what we do know is that the expenditures of the infirmary soared uncontrollably. And so his predecessor became his predecessor.

 

On his appointment, Count Binhz implemented the policy that has since gained him much renown; the secret of efficiency, the solution to the mystery of divination. He had discovered that his predecessor’s inability to divine the infirmary’s expenditures was attributable to one and only one cause: patients. Patients have different maladies, at different times, at different intensities; patients can be treated in many different ways, by many different doctors; patients, in short, are unpredictable and so cause unpredictability. So, he reasoned, if the infirmary were no longer to admit patients, the problem of divination is solved: the costs of doctors and nurses can be divined with total certainty, as can the apothecary’s costs, for all that needs to happen is the replacement of those herbs which are no longer fresh; as regards cleaning and domestick services, well, that is easy too. He soon discovered that he was now able to control his expenditures with perfect precision, and he could ensure that his annual Pot-of-Gold was spent down to the last Nichol, and only the last Nichol. 

 

When I observed that this policy, though extremely effective from the point of view of economick husbandry, might be perceived by his local population as less advantageous, his response was immediate. Those who were particularly unwell could, he replied, attend a neighbouring infirmary, for the transportation facilities to the nearest town were both frequent and inexpensive; those who were unwell, but not sufficiently so to cause them to travel, were clearly not unwell enough to be treated in his infirmary, and therefore could be well-enough looked after by the local parish; the local parish, of course, not being exchequered by the Pot-of-Gold of our elegant and astute Count Binhz.

 

On my return voyage from Gloopnost to England, I puzzled mightily. The story of Count Binhz was so rational, so logical, so sensible. But then somehow it made no sense at all. Yet I could understand the problem of the Pot-of-Gold, and I could understand the solution too. But surely there must be a better way. I wonder what it is?

 

 

 

 

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