HOSPITAL ORGANISATION.*
" LES institutions charitables d'un peuple ne sont que le rad de sea institutions sociales et politiques," says M. D'Haussonville, in his admirable paper on "Hospital Management," in the Revue des Dear Mondes for March. We are concerned to inquire into the mode in which that statement applies to ourselves. M. D'Haussonville ap-
plies it somewhat severely,—i.e., the English, he says, have, "Pour les pauvres recommandjs, toutes lea ressources de is science et tons les ingenieux raffinemens de la charite privee ; pour lea pauvres inconnus, l'insuffisance et la rudesse de is charite publique ;" that we have, in fact, created a sort of aristocracy in misery, " celle des pauvres qui ont des relations." This conclusion was forced upon his mind when visiting the principal hospitals in this metropolis. He was, he says, at first much struck by the absence in the wards of the men and women " epuises par la misere, abrutis par le gin," whose existence was everywhere else patent to him, and inclined to ask if the true poor of London escaped sickness, or if medical assistance was not organised for them? He found, or thought he found, the true solution of his question in the history of the foundation of many of the principal hospitals. He found they owed their being and their preservation mainly to voluntary subscriptions, that to attract subscribers they must be granted privileges, and the privilege most coveted was, of course, the right to nominate or recommend patients ; that as a result, those who can most easily obtain admission into our hospitals are servants, the employes of large firms, and artisans generally ; while the poor who groan in our crowded courts and alleys, and are unfurnished with a letter signed by some merchant in the City, or inhabitant of Belgravia, are practically excluded. That the charge is not utterly without foundation is proved by various reports which have been addressed to Parliament on the subject. But whatever may have been the state of the case in the past, it is only a half-truth in the present.
D'Haussonville, when speaking of the children's hospital in Ormond Street (about which we shall have a word to say presently), says that in consequence of the immense popularity of the hospi- tal, it is necessary before admission to obtain a letter stamped by the Charity Organisation Society, which has in London alone thirty- seven offices ; but he does not perhaps recognise that the agents of that Society are in hourly contact with the mass of human misery he thinks unfairly dealt by, and that never, save in the last extremity, do they relegate those whom they try to help to the wards of those workhouse infirmaries which it would be welt for some of us to see through his spectacles. We do not see that the industrious workman and the hardworking shopkeeper
• Hospital Organisation, uith Special Reference to the Organisation of Hospitals fir Children. By Charles West, M.D. London: Macmillan and Co. 1817. have any cal/Ito be taxed that "the victims of gin" may have
their last hours made specially easy, and do not, therefore, see the afifairness of our hospitals being largely filled with the worthy poor, whose hours of sickness and misfortune he must he a hard man who would not wish to alleviate. Indeed, we would gladly see hospital privileges extended to the most highly paid artisans, who would thankfully contribute as much as the suffering member of the family would ordinarily 'cost at home, to secure the additional skilful medical aid and extra nourishment it is so impossible for him otherwise to pro- cure. Specially may the idea of unfairness be got rid of when we consider that all our principal hospitals are open to the victims of accident or sudden disaster and injury ; that three of the principal hospitals—St. Thomas's (a little town in itself), St. Bartholomew's, and Guy's—are absolutely free. But it is in the infirmary attached to the workhouse that the lowest classes of our population, the worn-out drunkards, the thriftless and debased, are to be found in sickness. These infirm- aries have been greatly improved during the last twenty years, and since 1867 have generally occupied a building separate from
the workhouse. At the best these are but sad places of refuge, the best and most ably managed having but one doctor, who is also surgeon and general director. One of the very best infirmaries in London has five nurses to two hundred and fifty inmates, while there still exists one (we fear more than one), and that in the most populous quarter in London, where the infirm, the imbecile, and the sick are crowded into an ill-lighted, ill-ventilated build- big; with one doctor, who does not even reside in the house, for five hundred inmates, and but three nurses who are not themselves paupers. We trust that even while we write this state of things is about to cease, but M. D'Haussonville, whose report we quote, witnessed within these walls—the walls of the infirmary at Hol-
born—scenes of misery, one of which alone he describes, but it is one which those who read will not soon forget. We have said that it is to these refuges (which as a nation we are hastening, in the interests of common humanity, to improve) that the drunken -and debased come at last ; and were they the only inmates found here, even then light and air and decent tendance, kindliness and able administration, with all that may tend even so late in the day to reclaim the outcast and the wanderer, would be claimed from us, were it only by way of showing thankfulness for lives more kindly 'circumstanced. But unhappily these are not the only inmates of these dreary homes ; they are too often the long-dreaded resting- place of the worthy but friendless poor, the asylum of the .chronically afflicted, the man who through no fault of his own finds himself, through his rheumatism, or his blindness, or failing brain, permanently disabled. It is for such as these we -want more medical aid, more easy asylums, better food, the helping hand that grasps with a sense of brotherhood. But two classes remain, and to one of these Dr. West's little book, just published, -calls attention, namely, the sick children, who, through his own un- -ceasing labours, are now so, we had almost said, magnificently cared for. We earnestly commend his little work to those interested in the management of our hospitals and the administration of those funds which, notwithstanding the strenuous appeal now annually made, are so altogether inadequate not only to meet the misery with which they have to grapple, but to represent, we hope, the attitude of the well-to-do towards that misery. But Dr. West does not trouble himself about the raising of money, he is interested rather in its careful spending, and 'he evidently considers the estimates at Ormond Street excessive. The published statement of the cost of each bed there is 174 10s., and without endorsing Dr. West's statement that economy is
the touchstone by which the management of a hospital may fairly he tested, we think it is easy to see that that cost is excessive. With the following statement we utterly disagree :— " The effect of the over-indulgence is most injurious to the child itself. it is so easy to spoil a child, the process in the doing is so pleasant to both parties, especially when the spoiler does not see the full result of the mischief done. Bat when a little child, indhlued, fondled, treated as if it were a prince, cries at returning home again, one cannot but ask oneaelf whether it were well done to make a hospital pet, and to send the little one back again, cured indeed of its bodily ailments by womanly tenderness, and care, and love, but discontented with its home, unfitted to take its place again about the hearth where all had mourned its absence."
if the child does indeed return to a hearth where "all have mourned its absence," it will have small reason for discon-
tent; if, as too often happens, it returns to the reverse, it may be well through a hard life to remember there is kindness, even indulgent kindness, somewhere. It is the only page, however, to which we take exception. Dr. West deals with the whole question of hospital management, and makes suggestions which appear to us as wise as they must be well weighed, and which are the result of a life of careful observation. In a book of less than a hundred pages, he considers the whole question of sisterhoods in their relation to hospitals ; the pro- blem whether the nursing of the sick should be placed in their hands, or entrusted to lay agents ; the much-vexed subject of lady-nurses, into all which questions we have not space to enter, —we can only give a general resume' of what we take to be Dr. West's opinion. He would have the administration of the funds of the hospital, its government, in fact, strictly under secular control ; as a rule, he would take the poor to wait upon the poor ; he would have no false sentiment on the subject of paid and unpaid work, a most important point, as those well know who are called upon to deal much with amateur labour. The lady-volunteer should have no advantage, no privileges, over the regular paid nurses, but take her place side by side with them. Sisterhoods are good, if the administration be secular and strong, but above all things, he looks with disapprobation on the intro- duction into the army of nurses of women, who, in the expressive words of a hospital manager to the present writer, are only seeking to comfort themselves, and quotes the now well-known letter of Charles Kingsley to the lady who sought his advice about entering a sisterhood :— "Whenever we leave the station where God has placed us, be it fornever so seemingly self-sacrificing and chivalrous and saintly an end, we are yielding most utterly to that very self-will which we are pretending to abjure Bat, Madam, be sure that be who is not faithful in a little will never be fit to be ruler over much. He who cannot rule his own household will never (as St. Paul says) rule the Church of God; and he who cannot keep his temper, or be self-sacrificing, cheerful, tender, attentive at home, will never be of any real and permanent use to God's poor abroad."
The name of Kingsley brings before us the last class we desire to name. While commending Dr. West's little book to our readers, we cannot but remember that this last class does not come into his category ; it is the one for which there is the least provision, the one with which it is most difficult to deal, namely, incurable children, not children mentally afflicted—for them there may be a refuge in Earlswood or elsewhere—but the tiny, prematurely old little ones,whom disease of the spine, like hopeless spinal curva- ture, or paralysis has rendered ineligible, because incurable, for the ordinary hospital, who require the constant care and surgical aid they cannot get at home, and who too often, through the impos- sibility of being tended elsewhere, are landed in the workhouse infirmary ; for these, permanent homes are needed. The present writer has visited the little city of refuge so graphically described by Miss Thackeray, the little-known, old-fashioned house in Cheyne Walk, Chelsea, where some seventeen of these little sufferers find a real home, from which they will not be sent away, but the number who can obtain admission is at present terribly small. Another house is, however, about to be added to the present one, and a friend of the late Charles Kingsley, whose love for children is well known, proposes the endowment of a Cot, to be called the "Charles Kingsley Memorial Cot," the cost of which would not exceed £500. Probably there are- many who will be grateful for the possibility thus afforded them of testifying their love for a good man's memory, by mitigating some of the suffering he spent his life in trying to prevent. We have said we do not exactly endorse Dr. West's statement that "economy is the touchstone by which the management of a hospital may be fairly tested," but we leave it a problem yet to be solved why it is neces- sary that the cost of each bed in the Ormond-Street Institution should be £74 a year, and one in a sufficiently-officered one like this little Home in Chelsea cost only £40. The smallness of a Home is a distinct gain to the children ; if it be also so mach more economical, why not multiply these, instead of larger institutions ?
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