The History of the Hospital

KING'S COLLEGE HOSPITAL is a voluntary hospital. It is now nearly a hundred years old. It was founded in 1839 by King's College, which itself had been founded just ten years before. It was to be a place in which patients could be treated by the medical professors and staff of the College, and in which the students of the Medical Department—one of the earliest Departments of the College—could receive their practical training. For a time the Hospital found its quarters in an old building, formerly a workhouse, in Portugal Street, —a street lying towards the southern end of the present Kingsway, in which the Portuguese Minister had at one time resided. Here it was not far from the College in the Strand ; and the medical staff and students could thus pass to and fro, in a few minutes' time, between the Hospital and the College. In 1861, at a cost of £100,000, a new Hospital was erected on the same site. It was, in its beginnings, the best and most scientific example of contemporary Hospital building, and it was generally regarded as a model Hospital for London.

The Hospital built in 1881 had an existence of about fifty years. During that time it was an integral part of King's College. The Medical Department and its Hospital—like the other departments of " General Literature and Science," Engineering and Theology—were governed by the Council of King's College, a body of no small distinction, in which bishops (and especially the Bishop of London) played a pro- minent part, and of which, in his day, Mr. Gladstone was a member. The Council governed the Hospital and the Medical Department generally with wisdom and understanding. Great surgeons, such as Lord Lister, served on the medical staff ; and the Hospital did valuable work among the poor population which crowded the dense area round Drury Lane. It was not only a College Hospital : it was a local hospital also, rooted in local service and local affection. Mr. W. H. Smith, for example, who had built up a great business in the Strand (the business which now goes by the name of W. IL Smith and Son), and whose family connexions lay round about the area of the Hospital, was drawn into its service as long ago as 1849, and laboured in its cause until his death in 1891. That service and those labours became a tradition in his family. They were nobly continued by his son and successor, whose recent loss the Hospital deplores, Lord Hambleden.

London changes : education changes. And with the changes in London and in education King's College Hospital found itself also compelled to change. The dense area which the College Hospital had served was largely cleared of its population by the improvements which created Iiingsway and Aldwych ; residents in Central London became fewer and fewer ; and it became necessary to think of moving the Hospital to some more crowded centre of life, somewhere " across the bridges," where its services would be still greatef and its work could be done on a better—because larger—* scale. In 1903 a scheme for the transfer of the Hospital to South London was approved ; in 1904 Lord Hambleden pre. sented a site of twelve acres on Denmark Hill for the building of a new Hospital. Meanwhile changes in educational ideas were beginning to affect King's. College—and with it the Hospital. The old College, in the form in which it stood for the first eighty years of its life, from 1829 to 1909, was general and comprehensive institution. It included a boys'. school (now King's College School at Wimbledon) ; it included a Hospital and a whole system of medical instruction; from the preliminary to the clinical stage ; it included depart. ments for University teaching in Arts and Science, Theology and Engineering. The new ideas of education were in favour of less comprehension and more specialization. Accordingly; the boys' school was separated from the College and placed under a separate governing body ; and in the same way, and at the same time, in the autumn of 1909, the Hospital and the advanced (or clinical) teaching conducted in the Hospital were made entirely independent of the Council of King'S College, and placed under an independent governing body.

The stage was now set for a new and independent life of King's College Hospital. There was no quarrel—no atom or suspicion of a quarrel—when the Hospital was separated from the College by which it had been originally founded and by which it had been so long maintained. The Hospital simply became independent, as a son becomes independent when he leaves his father's house ; but it remained in close connexions of sympathy and co-operation with its parent College. In the same year in which it became an independent body the erection of its new buildings on Denmark Hill began. By 1913 the building was occupied ; and henceforward the Hospital, already separate in government from the College, became also separate in space, and conducted its work at some miles' distance from the Strand and its associations.

On its present site and in its present building King's College Hospital is new—the newest general Hospital in. London. Once more, as in 1861, it is the most scientific example of contemporary Hospital building. But it is an incomplete example. If its buildings were occupied in 1918, they were not completed. Blocks of the original designg, remained unbuilt ; they still remain unbuilt ; and they will continue to remain unbuilt until the Hospital can secure the necessary funds for their building. Planned to provide 600 beds, the Hospital at the present time can only provide 350 and until it can provide the remaining 250, it will remain imperfect and stunted—unable to attain " the measure of the stature " of the service which it owes to the dense population of South London. , PRESENT PosrnoN.

If the old Hospital in Portugal Street was rooted in local service and local affection, the same may almost he said of the new Hospital on Denmark IBM Situated immediately in the Borough of Lambeth, it also serves the adjoining Boroughs of Camberwell and Southwark. Serving three of the poorest and most thickly populated . of the London boroughs, it has vastly increased the measure of its local service ; and it has also begun to establish itself in local affection. There is a courtesy and a spacious good temper about the name " King's," and about everything associated with that name, which naturally and inevitably wins regard. Local affection has translated itself into local support ; and the Hospital has good reason for gratitude to many neigh- bouring districts—Herne Hill, Dulwich, Sydenham, Peckham, and Brixton—which have organized branches of its Ladies' Association and given comfort and aid to its work. But the boroughs of South London, however warm their sym- pathy and however strenuous their endeavours, have not the wealth of Central London at their command ; and any South London Hospital is necessarily compelled to look for aid to the general community of London at large, and is entitled to do so since patients come from all parts of the country.

The annual accounts of King's College Hospital show that it is a solvent and healthy concern. It does not increase a load of debt year by year ; on the contrary, it is able at the present time to reduce the load annually by the savings it makes on the year's accounts. None the less, the accumulated debt still stood, at the end of last year, at the figure of 272,000 ; and while some amount of debt is not an unhealthy sign in an expanding institution, a debt of £72,000 is not encouraging to a Hospital which has been keeping itself, of late years, rigorously within its borders, and must look for- ward, within the next few years, to enlarging the place of its tent and stretching forth the curtains of its habitations. Such a Hospital cannot but desire, and desire fervently, to extin- guish its existing debt before it incurs the load of new obliga- tions which any expansion must bring.

Assume the debt extinguished ; the balance sheet clear ;

the accounts all fair and square. What is the expansion desired ? And why is it desired ? The expansion consists in the building of one—and one only—of the three blocks of the original design which still remain unbuilt. The new block would contain, on its upper floors, two or three wards for paying patients : it would contain, in its basement, accom- modation for the growing and valuable work of the Massage and Electrical Departments—departments which strengthen the weak hands and confirm the feeble knees ; which renew and rejuvenate bodies stunted by poor conditions of life in a poor environment. With a new block specially built for private patients, the wards in the existing blocks which they now occupy would be set free for general patients : the general accommodation of the Hospital would be increased by some seventy beds ; and the sick need no longer be sent away unrelieved.

But why should a new block be built for private patients ?

And why should a general Hospital concern itself with such patients ? Are there not such things as nursing homes for the private patient ? And does not the general Hospital, sustained as it is by charity, belong to the general patient ? There are answers—cogent answers—which can be given to these questions. In the first place a general Hospital, though it must largely depend on charity, is none the worse—indeed, it is all the better—if it can partly earn its own way. The receipts from private patients in King's College Hospital last year amounted to over 215,000 ; the annual subscriptions given by way of charity amounted to £7,000. The sum of £15,000 was not all gain ; but a proportion of that sum was earned income—income earned for the Hospital by the services of its staff, who may well be proud of the earnings they have made not for themselves, but for the institution which they serve. In the second place, there is a middle class in England as well as a poorer class ; and the members of the lower middle class have their own acute problems in times of illness. The private patients' ward of a general Hospital is a God-send for such people in such times. The writer himself has been a patient in King's College Hospital ; his daughters have both been patients ; and none of the three can think how things would have gone with them if there had not been the refuge of that

hospitable home. And if this be the case—if the Hospital gain by private patients, and private patients gain by the Hospital —does not the system of private patients stand justified ? No private patient excludes a general patient. On the con- trary, each new private patient (provided a limit be fixed to the total number) makes it more readily possible for a Hospital to admit a new general patient.

Given, then, a new block with two or three wards for private patients ; given, in connexion with that, the setting free of some seventy more beds for general patients—what else remains to be done ? An answer comes readily and instantly —springing into sight in the twinkling of an eye—if we think of the needs of equipment. The progress of science never stands still : the discoveries of medicine are always being made ; and each progress, and all discoveries, seem to involve new instruments and apparatus. Consider, for example. the Massage and Electrical Departments, of which mention has already been made. What a field for service is here. What an opportunity for restoring vitality, and the happiness it gives, and the efficiency it restores for doing one's share in the work of the world. There are postural defects and spinal deformities to be cured in adolescent boys and girls ; there are rheumatism and arthritis to be dealt with in adults ; there are massage and exercises to be given to women fresh from child- bed, that they may go home strengthened and renewed for the burden of household work they have to carry. It is calculated that £18,000 is required for these methods of physical treat- ment. More massage rooms are required ; two new gymna- siums, one at least four times the size of the present room, are urgently needed ; the Electrical Section and the Artificial Light Department are as young birds opening their beaks for food.

To think of the Hospital is to think of Hospital Nurses— sisters of cheerfulness and mercy, engaged in the purest work of womanhood, and engaged, only too often (such is the stringency of Hospital finance), for rewards that are all too little and a comfort of life that is all too small. Something has been done for their welfare at King's of late years : they them- selves would be the last to ask for more ; but there is more which remains to be done. Nurses are now brought under a pension scheme, by which the Hospital adds double of what they contribute themselves ; and a small Benevolent Fund, which is growing slowly, has been started for the aid of nurses in times of distress. But additions to the Nurses' Home are required (to speak of nothing else) ; and it is calculated that these additions will cost £15,000. No cause, among all the many causes which constitute the appeal of a Hospital, has a greater claim or a juster title to consideration.

This is not all ; but it is all that can here be said. Is it not enough to win the regard of the reader ? Let some few figures end this account of the present position of King's. Con- siderably more than a quarter of a million of attendances of out-patients were registered last year. Over 6,000 in-patients were admitted ; nearly 700 babies were born in the Hospital. Every malady was treated ; every method of treatment was applied—from extractions of teeth (24,000, says the Annual Report) to faradaic foot-baths and exercises for flat feet. A Hospital is a busy and universal world. It is a world that has to be made to go round. The proverb says that it is love which does that. And another word, which is a synonym for love, is charity.

THE VOLUNTARY PRINCIPLE.

In these days we look more and more to the State, and expect it to do more and more on our behalf. Ought we to expect the State to take care of the sick, and should we sub- stitute the machinery of the Public Grant for the quiet virtue of Charity ? One can only say that the State does well, and had better do, whatever needs uniform method, exact adminis- tration, precise inspection—in a word, whatever demands the discipline of Law. But besides the discipline of Law, there is such a thing as the service of Love, which is a free and volun- tary service ; and there are great areas of human life in which this service is the only right instrument of action. " The life of a family is a life of the service of Love, and not of the discipline of Law ; and the life of a Hospital, which is a great family of doctors and nurses and patients, is a life of the same sort of service. Our Lord healed the sick in love-; and wherever we have the sick healed in love, and by virtue of loving service freely given, we are following His example. On lie more human ground, there is a large and unanswerable gage for the voluntary hospital, rooted and grounded in the klve which is also called charity. It is a better thing for the physicians and surgeons who serve voluntarily on the visiting staffs of voluntary hospitals that they should he working for !Iry than that they should be working as officials of the State it is a better thing for medical students (when medical students Nte attached to a Hospital and its medical school) that they gliould be trained in the atmosphere of a voluntary Hospital fliau in that of a State institution ; above all, and beyond all, it is a better thing for the sick that they should be tended in love than treated by law. Lord Cave's Committee put this point simply and clearly in its final report of 1921 :—" That personal relation between the patient and the doctor and nurse Which is traditional in voluntary hospitals, and which in many doses renders the time spent in the wards the happiest period of a patient's life, would be difficult to reproduce under an Official regime." Nor is it only a matter of loving care in the Hospital. It is also a matter of loving interest which flows from outside into the Hospital. One may quote another passage from the same report :—" The outlook is altogether different where the Hospitals are State institutions. The Hospitals are practically closed places, into which nobody goes except the people who are authorized. There are no Committees of one kind and another interesting themselves in the welfare of the patients, and the idea of sending food and flowers does not exist."

" The greatest of these is charity." That is the conclusion of the whole matter. It is a conclusion which all members of the community—gentle and simple, rich and poor—can alike affirm ; and in affirming it together they can be drawn together in the common service of love. Friendly societies and labour organizations can contribute the pence of their 'members, which may well be as great a gift—indiSrldually, foe the giver ; collectively, in the aggregate given—as are the

gifts of the rich: In this way the Hospitals can bind us to one another as well as to themselves ; they can be the magnets which draw the common virtue of the service of Love from the whole of the general community. In -this way they have a still larger function in the community than even their great and primary function of tending the sick. They elicit and enlist, the voluntary service of society at large : they add to them-: selves and their own staff a cloud of witnesses and co- . operators ; and we see them in their true nature when we see • _them surrounded and encompassed by the company and

fellowship of all the servants they draw to their service. • The writer cannot conclude without speaking—as indeed he has all along been thinking—of one who was a great and , generous servant of the cause of Hospitals in general, and, particularly of that of King's College Hospital. Lord; Hambleden succeeded a father who had served King's College Hospital fur thirty-two years ; and in a life cut short before: his sixtieth year he served it, in his generation, for thirty-seven years. For twenty of those years he was Chairman of its Committee of Management, and during those years he guided- its development, through change upon change, with unerring. sagacity. He was unwearied in giving ; but even above. the abounding gifts which he made from his wealth was the 1 perennial gift which he made of his time and his thought and' his love. The year 1928 made a great gap in King's College Hospital. But above the sense of irremediable loss is. the sense of a stirring and noble example ; and in that sense,; and the strength which it gives, it remains for his successors to: dedicate themselves to the accomplishing of the work which he: so well began, and so far nobly advanced.

ERNEST BARKER.