injBLIC HEALTH LIBRi^
, LIBRARY
1 UNivouimr Of
rJ
SUFFERING LONDON
MR. EGMONT HAKES WORKS.
FAKIS ORIGINALS. I Vol. With 20 Etchings by Leon
RiCHETOX.
fLA TTERING TALES. \ \o\.
THE STORY OF CHINESE GORDON. 2 Vols. Illustrated.
GENERAL GORDONS JOURNALS FROM KHAR-
TOUM. With Portraits and Maps.
EVENTS IN THE TAE-PING REBELLION, i Vol.
With Portrait and Map.
THE UNEMPLOYED PROBLEM.
FREE TRADE IN CAPITAL ; or, Free Competition in the
Supply of Capital to Labour, and its bearings on the Political
and Social Questions of the Day. By A. Egmont Hake
and O. E. Wesslau. i Vol.
Suffering London
0A\ 7 HE HYGIENIC, MORAL, SOCIAL, AND POLITICAL
RELATION OF OUR VOLUNTARY HOSPITALS
TO SOCIETY
Bv A. EGMONT HAKE
WITH AN INTRODUCTION BY
WxALTKR BKSANT
X 0 11 ^ 0 11
THE SCIENTIFIC PRESS. LIMITED
140 STRAND
1S92
PUBLISHERS' NOTICE.
This book is the sole work of an able writer
who, having visited the Hospitals and indepen-
dently studied the questions affecting them, now
offers his own personal views to the public. It
should therefore be distinctly understood that
the great merit of the book is that the author
alone is responsible for the opinions expressed,
and that they must be accepted as the views
of one who has no official or other connection
with the Hospital World.
CONTENTS.
ERRATUM.
On page 20, lines 19 and 20, for hundreds of thousands
of accidents and deaths, read over five thousand accidents
and over one hundred deaths.
and histers as iNurses — 1 lie Hospitaller — 1 lie <_narge to
the Sisters — Fifteen Hundred Years without a Bath —
Before and After the Reformation — The Sick in Ancient
London — The Five Royal Hospitals— Stow, Citizen and
Tallow Chandler — Early Legacies — The Development of
AlmsCTivinjj- — Selfish Dives — Lazarus's Best Friend - xvii
CONTENTS.
INTRODUCTION BY WALTER BESANT.
An Allegory — Death Then and Now — Evils of Slavery--
The Rights of ISIan — The Fruit of the Tree — Saint
Martin — The P'irst Hospitals — Lazar-Houses — The De-
velopment of the Hospital — London in the Fourteenth
Century — Healers of Disease — The Templars, and other
Brotherhoods — A Ward in the Hotel-Dieu — Brothers
and Sisters as Nurses — The Hospitaller — The Charge to
the Sisters^Fifteen Hundred Years without a Bath —
Before and After the Reformation — The Sick in Ancient
London — The Five Royal Hospitals— Stow, Citizen and
Tallow Chandler — Early Legacies — The Development of
Almsgiving — Selfish Dives — Lazarus's Best Friend
X CONTENTS.
CHAPTER I.
THE PALE SPECTRE.
" Cities are the open wounds of a country P
London, a Subject of Wonder to Foreigners — Its Vivifying In-
fluence upon the World — Intense Business Activity — The
Street Traffic — Few Signs of Disease and Death — Behind
the Scenes — The Closing of the Ranks — The Victims of
Accidents— Masters and Servants— The Trains of the Dead
— London, a Healthy City with \'ast Numbers of Sufferers —
The Hardships of Home Nursing — The Charity of the Poor
to the Poor — Reasons for Low Mortality — Sick Children —
The Sweating System, a Cause of Disease— Hard Work, not
Vice, fills the Hospitals--Charity Quickened by our own
Sufferings ...----
CHAPTER II.
THE NECESSITY FOR HOSPITALS.
" /// the sick air."
EN(;lish Practicality — Want of System and Cohesion among our
Hospitals— Artificial Causes of Disease— Our Transitory
State— How we court Disease— Conforts with Dangers —
The Deceptiveness of Statistics of Railway Accidents— The
Drain Monster under our Feet— Rivers turned into Sewers
—Are the Beaches of our Watcring-Places Tainted? —
CONTENTS. XI
i-A»;ii
Neglect of Health in certain Trades — Victims of the
Sweater — Mortality among Children — English Mothers Cal-
umniated— Crammin^j the Brains of Starving Children —
Child Insurances — Utopian London Far Off — Hospitals
under Government or Municipal Control — Social Signifi-
cance of \'oluntary Hospitals — The Difficulty of Treating
certain Diseases at Home— The late Influenza Epidemic —
Government Hospitals a Feeble Bulwark against Pestilence
— The Black De.ith — The state of London during the Plague
— -Consequences felt for Centuries — The Possibility of a
Return of the Black Death— Preparing the (Ground for the
Seeds of Pestilence — Pestilence a Possible Consequence of
the Coming War - - - - - - i6
CHAPTER IIL
OUR HOSPITALS.
" On va nn pen an del, inals beaucoup a rhopital!''
Hospitals from the Outside—The Spirit of Charity— The Great
County Families — A Populous and Flourishing District —
Benevolent Governors — Expenditure and Income — The
Duty of a Citizen — Our Great Voluntary Hospitals —
Heaven's First Law — The Hospital Kitchen— The Wards
— Elements of Brightness in Hospitals— The Visiting Day —
The Children's Ward— The Variety of Cases— The Work of
the House- Sur::eon — The Work of the House-Physician - 41
Xll CONTENTS.
PAGE
CHAPTER I\'.
WHAT THE HOSPITALS DO FOR THE PEOPLE.
'"If it iverc not for the hospitals, we might expect London to be
cofisujned by fij-e from Heaven ^
Average Appreciation of Our Institutions — The Progress of
Medical and Surgical Science — Hospital Practice — Aniiy of
Nurses — The First Nursing" Institution — Florence Night-
ingale— The Scarcity of Nurses — State Interference — The
Bureaucratic System in Russia — Master and Servant — Sick
Servants — Employers Liability Act — The Labour Market —
The Wealthy Classes and the Hospitals — Thoughtless Alms-
giving— Organised Charities - - - - - 5^
CHAPTER V.
WHAT THE PEOPLE DO FOR THE HOSPITALS.
" They atiswer in a joint and co7-porate voice,
That 7102C' they a?-e at fall, want treasure, cannot
Do what they wouldT
The Inadequacy of Contributions — ^150,000 a Year Required
— More Personal Service Needed — Londoners and Charit-
able Institutions — Ignorance of Work dene by Hospitals —
InditTerence of the People, and Its Causes —The Protective
vSpirit — (lOvernment Hospitals and Voluntary Hospitals —
Relation of Employers of Labour to Hospitals — The Liquor
CONTENTS. XIU
i'A(;n
Traftlc — The Theatre-Goers and the Hospitals — Chanty and
Luxury — The FccJitcr W'trin and Destitute Children —
Fashionable Dinners and the Philanthropic Host — Huni'li-
ating Position of Londoners - - - - - 8;
CHAPTER VL
THE ORDKAF, OK CRITICISM.
" Jt is much easier 1o be critical than to be correct T
Importance of Criticism — The Hospitals and their Critics — The
Danger of Attacking the Hospitals^ — The Enquiry before the
Lords' Committee — The Influenza Epidemic — How Injus-
tice may be done to the Hospitals — A Case in Point — The
London Press and Hospital " Scandals" . . .
CHAPTER VII.
THE RESPONSIBILITY OF WEALTH.
" Expose thyself to feel ivhat wretches feel.
That thou niayst shape the superflux to them.
And show the luavens more Just."
Different \'ie\vs regarding- Wealth — Definition of the Word
Wealthy — The Millionaire and the Pauper — Power over
other People's Work — Charity of the Wealthy Classes —
XJV CONTENTS.
PAGE
Cheap Luxuries — Cause and Effect — The Monied Class and
the Toilers — A Practical Method of Charity — Misinterpreta-
tion of Christ's Teachings — Christianity and Socialism — The
Jewish Prophets and a Future Life — The Buddhists — The
Essence of Christianity — The Parable of the Talents — Per-
sonal Charity and Charitable Agencies — The Blessings
which flow from our Hospitals - - - - n?
CHAPTER VHL
THE PRESENT NEEDS OF OUR HOSPITALS.
" IP^ork 7vithout hope draws nee far in a sieve,
And hope without an object cannot live."
Numbers refused Admittance to the Hospitals— A Sacred Duty
Neglected — Proportion of Beds to the Population — Country
Patients in London Hospitals — London's Charity to Non-
Londoners— Income below Expenditure — The Wealth of
London — The Amount Required — Sanatoriums Abroad — Re-
distribution— Out-Post Hospitals — Usefulness of Branches
— The Need of more Personal Service — House \'isitors —
Cramped Sites ------ 123
CHAPTER LX.
A PRACTICAL SCHEME.
Noblesse oblige.
London and its Parliamentary Divisions— The Hospital Sunday
and Saturday Council — Proposed Hospital Guilds — London
CONTENTS. XV
I'AC.F.
Di\ision Lodges — Congregation Lodges— Appointment of
OtTiccrs- -Prestige of Metropolitan Members — The Bellani-
ists of America — The County Council — The Plousing of the
Poor — The Rookeries — Bad Housing — Socialistic Ten-
dencies of the County Council — Better Method of Support-
ing Voluntary Hospitals — Etitective Co-operation - - '4'
CHAPTER X.
CONCLUSION.
'"'' Hier sfe/ie icli und kaiin nicJit welter^
The Story of Swen Dufva — Generous Instincts — Stern Reality —
Scepticism and Pessimism — The Sophistries of Malthus —
The Feeling of Nationality — Mr. Fildes' Famous Picture —
Peace and Harmony Among Classes — The Armament of
European States — War of Races and Classes — Communal or
State Hospi:als not able to Replace \'oluntary Hospitals —
The Government and the People — The Socialistic Utopia —
The Hospital Sunday Fund — Difterent Religions and Sects
— Nathan the Wise — The Story of Saladin — The Moral
Value of a Creed — Goodwill among Men - - - \^i
Appendix - - - - - - - 172
INTRODUCTION.
A STORY is told in some book — I foro-et what — of
African travel how the voyager once came ui^on
a poor old woman lying under the shade of a
rock, at the point of death. She had been left
there bv her children and her orrandchildren be-
cause she was old and feeble, and could do no
more for herself or for others. The traveller
offered her food and drink. She refused, saying
that they w^ould only prolong her sufferings : she
wished to die before the vultures and the jackals
came and tore her to pieces ; she bade the
stranger go on his way, and leave her there to
die : which he did. As this old woman died, so
died all those of her own people whose lives were,
unhappily, prolonged beyond the time of their
strength. Most, fortunately for them, died on the
battlefield, or were smitten, before the age of senile
b
XVlll INTRODUCTION.
impotence and decay, by fever and swift pestilence,
and so escaped the lingering torture of exposure.
As it was with this old woman, so it has been
with countless men and women. Death, for most,
meant the slow agony of starvation, or the fangs
of the wild beast. The world, you see, has
always belonged to the hunter and the warrior
— who must be vounof — and to their mates.
The M'Orld still belongs, though in another and
a wider sense, to the hunter and the w^arrior ;
but those who can neither procure food, nor
meet the foe, are now allowed — nay, en-
couraged — to live as long as they can. To
begin with, all the wealth of all the world now
belongs to the old, with some exceptions. They
have the wealth, and they make believe that with
the wealth the world itself belono-s to them. Fond
delusion ! When the power to fight — to create
— to make — vanishes, the power to enjoy vanishes
as well. What have the old to do with the
realities of the world ? They can creep about
INTRODUCTION. XIX
their garclens and their houses ; they can put
on robes of authority ; they can give orders to
their servants : but the round world and all that
therein is, and is worth having, belongs, and always
will belong, to the young.
Formerly, then, the old were left to die : unre-
garded they lay down and starved when they
could do no more for themselves. It was an im-
mense advance in civilisation when children beQfan
to maintain their parents, and masters their ser-
vants, after they could work no longer. Among
the Romans, it was lawful to expose an aged, help-
less slave on the rock, and there to leave him till he
died. They also had the power, if they pleased, of
doing to death, in any manner they pleased, any of
their slaves. FloQ^Qfinof to death was not uncommon,
as is shown by a certain passage in Plutarch.
We have forootten all these horrors. The modern
terrors of slavery are not thought of any longer.
Yet even down to the first quarter of this century
— not to speak of the slavery in America — we had
XX INTRODUCTION.
the thing always before us in the sufferings of
those who fell into the clutches of the Moor and
the Algerine. It would not be difficult to show,
though this is not the place for such an investi-
gation, that w^hat w^e call sympathy, the sense of
brotherhood, the enthusiasm of humanity, the dis-
covery of interdependence, has grown and de-
veloped in inverse proportion to the existence and
the reality of slavery. When man has absolute
power over another man, he loses the sense of
respect for that man : the slave is oppressed ; the
slaveowner is hardened. If it is bad for the
slave, it is far, far worse for his master.
The growth of this sense, the recognition of what
used to be called the rights of man, has been slow in-
deed— but then the world is still very young ; and
childhood is an age sa7is pitie. The childhood of
mankind was — is still — brutal and cruel, regardless
of suffering, contemptuous of weakness. During
long centuries, it has been like a delicate plant
struggling to grow ; sometimes it has seemed to die
INTRODUCTION. XXI
away altogether, trembling and withering", poisoned
by the mephitic airs that blew upon it, choked by
the rank vegetation that flourished around it. Yet
it never wholly dies. While in the old times every
man's hand was against his brother; while, later on,
the rich man ground down the strength of the poor,
and cast him out to die in a ditch ; while the heart
of the poor was filled with hatred, and the hand of
the poor was red with murder — the plant drooped
and withered. Always, in every age, there are
those in presence of whom this plant hangs down
its head — always, in every age, there are those for
whom it puts forth its dainty leaves of a tender,
spring-like green, and bears its fruit, the fruit which
is the only remedy known — a sovereign remedy —
for the hatred of man for man, of class for class.
The fruit of this tree, again, bears divers names
— names given by those who admire it, though
perhaps they have not tasted of it. For it is
variously called the Love of God ; or the Love of
Christ ; or the Love of all the Saints ; or the
XXII INTRODUCTION.
Love of Man : these are amoiiQ^ the names
which we give to the fruit of this tree. For-
merly those who tasted it founded monas-
teries, where men, themselves sworn to poverty
and voluntarily cut off from all the pleas-
ures of the world, so that they denied them-
selves the love of woman, the joys of ambition,
the delights of meat and drink, the treasures
of earthly friendship, and even the simple
boon of uninterrupted sleep — left to themselves
one luxury, — the care of relieving and helping
the poor. For those who were well there
was supper in the refectory, with a bed upon the
straw before the fire, and a breakfast in the morn-
ing. For those who were sick there was the
injirniaria, with the service of the infirniaruis.
Again, when It was seen that the people in the
towns were but little helped by the monks in the
country, other men, calling themselves friars, began
to go about among the lanes and streets of the city,
living on charity ; and living hardly and poorly,
INTRODUCTION. XXIU
while they worked always for the poor. In
those clays that saint was the most popular who
had done most for the poor. What saint, for
example, so popular as Saint Martin — he who
divided his cloak with tlie bec^^Gf'ir ?
It has been asked whether the first hospitals
were the infirmaries of monastic foundations.
The origin of hospitals is doubtful : but I think
not. There must have been, in all times, some-
thing" corresponding to a modern hospital. Among
the earliest arts discovered were most certainly
the simple methods of tying broken limbs with
splints, of stanching blood and binding up wounds :
these thinofs belonof to the never-ceasinor wars of
ancient generations, when the son took up the sword
that his dying father laid down in battle. When
wars ceased between adjoining villages and became
tribal — international — wars of races ; when armies
began to move about, something in the nature of a
hospital became necessary. In the Roman Camp
was always the valetiidinariinu : and no doubt in
XXIV INTRODUCTION.
Still earlier times the great army of Xerxes carried
about its hospital tents. The thing that was
necessary in a camp was imitated in the towns :
a place for the hurt and the wounded, if not for
those smitten with disease, was very early
found necessary wherever a crowd of people
lived together. A Hotel - Dieu was established
at Lyons as early as 560 a.d. ; one at Paris
a hundred years later ; we in this country had
to wait for the coming of Archbishop Lanfranc,
who founded two hospitals — one for leprosy
and one for ordinary diseases. ^ Again, the
prevalence of contagious or infectious diseases —
those which did not, like a "putrid sore throat"
or a fever, kill in a few days, but lingered for
years with the sufferer — made it still more neces-
sary to isolate the sufferers. Therefore, in the thir-
^ I read in a biography of Lanfranc that he covered England
with hospitals and lazar-houses. That may be so, but the
statement looks like exaggeration, and nothing remains of any
of these numerous foundations, so far as I can learn, at the
present day, except his Hospital of St. John, at Canterbury.
INTRODUCTION. XXV
teenth century there were two thousand liospitals
for leprosy in France alone. How many there
were in this country one knows not ; but there are
traces and traditions of them in many places.
And there was certainly one great lazar-house to
which all others in the country were in some sort
subject — namely, that at the village of Burton-
Lazars, near Melton-Mowbray. The lazar-house
of London was the Hospital of St. Giles, whose
chapel stood on the present site of the Church
of St. Giles-in-the-Fields.
The development of the hospital was therefore
something as follows : — First, the rough and ready
surgery of the battlefield : then, when armies be-
came larofe. the tent or waof^on for the sick and
wounded ; next, the charitable reception of the poor
into Christian monasteries — this must have begun,
one cannot but believe, with the earliest monastery ;
then the Hotel-Dieu, administered by brothers and
sisters under rule ; then the houses for those afflicted
with leprosy and skin diseases. Thus, the first
XXVI INTRODUCTION.
general hospital in London was that founded by
Rahere, of which more immediately ; but there
were speedily established lazar-houses all over the
country.
Let us, next, consider London as regards its
hospitals in the fourteenth century. We find that
it had a great lazar-house in St. Giles, where stands
the present church. Skin diseases of all kinds were
treated in this lazar or lepers' house. Then there
was Rahere's hospital of St. Bartholomew, standing
on its present site close to the Priory of the same
name. The Prior had some control— perhaps as
official visitor — over the conduct of the hospital.
The Society consisted of a Master, eight Brethren,
and four Sisters, livino: under the AuQfustine rule.
There were three surgeons and one physician.
They made up one hundred beds. There was, next,
St. Mary's Spital, also without the walls of the city,
on the site in Bishopsgate Street Without, now occu- ,
pied by Spital Square : at the time of the Dissolu-
tion there were i8o beds at this hospital. There
INTRODUCTION. X.Wll
seem to have been no other general hos[)itals.
Almshouses there were already — the Papey, under
the wall at the north end of St. Mary Axe, for old
and decayed priests ; Elsing's S[)ital, for blind men ;
Whittington's College; Jesus Commons; with many
other colleo'es and asylums of i)riests and old
people, but not hospitals. St. Thomas Apostle,
Southwark, was an almonry ; and Bethlehem was
a Priory of Canons for Brothers and Sisters,
founded in 1235. But the latter foundation did
not become a hospital after the Dissolution.
It must not be believed that in those days, or
even still earlier, there were wanting wise men,
scholars, and quacks, who professed to heal diseases
of all kinds. The bonesetter was expert in his own
line ; the country women knew a good deal about
the virtues of herbs ; witches sold charms and
talismans to avert disease — they also cured nervous
disorders by methods akin to what we now call
mesmerism — but they called these methods magic.
Patients went on pilgrimages, and prayed at shrines
XXVlll INTRODUCTION.
— as they do to this day : they also touched rehcs,
sprinkled themselves with holy water, and made
offerings with prayer for the intercession of the
Saints. The serving Brethren of the monastery
practised and taught surgery in the convent infir-
mary, and, without doubt, in the town or village
that lay outside the convent walls : the sige-femiiie
practised her art, which was forbidden to men. It
was in a monastery, that of Monte Casino, that the
first medical school was established. The main
reason for the rise and growth of that school was
the possession of the relics of St. Matthew. Then
medical brotherhoods began to be established : there
were the Brothers of St. John, of St. Mary, of St.
Lazarus, of St. Anthony, of the Saint Esprit :
there were the Knights Templars and the Knights
Hospitallers — all of whom included the practice and
study of medicine in their rules. These brother-
hoods afterwards became specialised : some, like
the Templars, treated ophthalmia : others, as the
Lazarists, leprosy. Presently a new departure was
INTRODUCTION. xxix
made. The Hospitallers engaged the assistance: of
women as nurses. Hildegarde, Abbess of Ruperts-
berg, organised in the twelfth century a school of
nurses. Abelard exhorts the nuns of the: Paraclete
Convent to learn surgery for the service of the
poor.^ Then presently arose also the barbers, who
being at first permitted only to bleed, gradually took
upon themselves other functions, the performance
of which was permitted them by charter, because
the poor people could not afford to pay learned
physicians. They became a corporation. There
were thus three classes : the long-robed physi-
cians ; the short-robed surgeons ; and the barbers
with their own corporation.
The restoration of a mediaeval hospital is difficult.
But we can obtain glimpses in the literature of the
time and from illuminated MSS. For instance,
we read that in St. Mary's Spital there were i8o
beds, but we also learn in addition that there
were great beds and little beds, and that in the
^ See Lacroix. Science and Literature of t/ie Aliddlc Ages.
XXX INTRODUCTION.
great beds two, three, and even four patients were
laid side by side : even women in child-birth were
laid four in a bed. This seems incredible, but we
must remember, first, that i^eople in health always
lay as many in a bed as the bed would hold :
second, that habits are not changed more than is
necessary in times of disease. A very interesting
engraving is given by Lacroix, showing a ward of
the Hotel-Dieu. It is in three panels : the middle
panel in the chapel with the high altar : at
the entrance are two lofty pillars, with a saint
standing on each ; also there is kneeling a king
crowned and robed. On the right hand is
figured a ward, with two beds : the room is
meant to be large, the roof supported by
arches and pillars : at the head of each bed is a
screen to keep the occupants from draughts : two
patients are lying in one bed ; only one in the
other ; the patients are naked, except for the head,
which is swathed ; of course the body is covered
with blankets : three nurses in large aprons and
INTRODUCTION. XXXI
dark-coloured hoods are attendino^ the sick. In the
other panel there is only one bed, but there are two
patients in it. To one who is dying a priest ad-
ministers the Eucharist; the other is in the hands
of a nurse ; a woman kneels at the; bedside ; two
other nurses are sewing up what appear to be
bolsters, but may be dead men.
At the Dissolution, St. Bartholomew had only
one physician and three surgeons. Therefore the
Brethren and the Sisters must have been nurses and
attendants. Their duties may be learned from the
charges and admonitions drawn up for the various
officers on the reconstruction of the hospital some
years after the Dissolution. Such things as rules
and regulations for the management of a hospital
are not invented in a moment, they are the growth
— the slow growth, after many tentatives — of many
generations — of centuries — in this case, of four
hundred years of work. Under the new regime,
instead of eight Brethren and four Sisters prac-
tisino: the rule of Austin, we now have a
XXXll INTRODUCTION.
Hospitaller, a Renter Clerk, a Butler, a Porter,
a Matron, twelve Sisters, and eight Beadles, for
the service of the house and the sick. There
are three chirurgeons giving daily attendance.
The office of the Hospitaller is to receive the
sick, discharge those who are healed, keep a regis-
ter of the admissions and the diseases, receive and
distribute victuals, pray with the sick and adminis-
ter the Sacrament of the Holy Communion at con-
venient times. He was, therefore, a Clerk in Holy
Orders. The Matron has to see that the Sisters
"do their duty unto the Poor, as well in making
of their beds and keeping their wards, as also in
washing their clothes, and other things. . . . And
at such times as the Sisters shall not be occupied
about the Poor, ye shall set them to spinning or
doing of some other manner of work, that may
avoid idleness and be profitable to the Poor of
this House."
The following is part of the charge to the
Sisters — it will be seen that something of the
INTRODUCTION. XXXIU
monastic spirit remained. " Vc shall also faithfully
aiul charitably serve to hclj) the Poor in all their
Ciriets and Diseases, as well by keeping' them sweet
and clean, as in givini^ theni their Meats and
Drinks after the most honest and comfortable
manner. Also, ye shall use unto them g-ood and
honest Talk, such as may comfort and amend them :
and utterly to avoid all light, wanton, and foolish
\\ ords. Gestures, and Measures, using yourselves
imto them with all Sobriety and Discretion. And,
above all things, see that ye avoid, abhor, and detest
Scolding and Drunkenness, as most pestilent and
filthy Vices.
" Ye shall not haunt or resort to any manner of
Person out of this House, except ye be licensed by
the Matron : neither shall ye suffer any light Person
to haunt or use unto you : neither any dishonest
person either Man or Woman : and so much as in
you shall lie, you shall avoid and shun the Conver-
sation and company of all men. '
In the last admonition we discern a lingering of
XXxIv INTRODUCTION.
the sisterhood and the convent, otherwise the
rules might have been passed to-day for the
direction of a probationer. Care, gentleness, clean-
liness, kindness, sobriety in language and manners
— these be still the chief rules to be observed by
any hospital nurse.
Modern views of ventilation did not yet prevail ;
yet one cannot believe that a hospital could be
maintained at all without some attention to this
most important point. The patients were probably
put into hot baths, because the use of the hot bath
among the better ckiss was always prevalent both
as a luxury and a necessity. It was once publicly
stated, and not Ion"" ao;o, in the House of Commons
that for fifteen hundred years no one ever took
a bath — a most remarkable blunder, when we
consider that every visitor who arrived at a
mediaeval castle was conducted by the lady's hand-
maids to the hot bath, and that the bath was
always esteemed the greatest possible luxury.
It is not probable or conceivable, this being the
INTRODUCTION. XXXV
view of the bath, that paticMits in a hospital
could be placed in their beds without such a
necessary preliminary. As to the treatment of
diseases, the rules of diet, the practice of surgery,
the pharmacopeeia — these things belong to a medi-
cal work. They are too high for this place and
this writer.
We have seen, then, how before the Reforma-
tion there had grown up a complete hospital system,
with physicians, surgeons, nurses, and wards, much
after the modern plan, and, in respect to the nurses,
far in advance of the modern plan, until the changes
of the last twenty years.
The dissolution of the Religious houses, com-
menced in the year 1525, was completed in 1540,
over six hundred foundations being destroyed ;
with them perished, for the City of London, its
two great hospitals of St. Mary and St. Bartholomew •
What became then of all the sick ? They were
left at home to die. Consider, if you can, what that
means. All the sick carried out of the wards to
XXXVl INTRODUCTION.
their own homes : not only those in the two hospitals,
but those, if there were any, in the infirmaries of
Eastminster, of the Holy Trinity, of the Nuns
Minories, of St. Helen's, of Bethlehem, of Grey
r>iars, of Austin Friars, of Black Friars, of White
Friars, of St. Mary Overies, of Bermondsey. The
poor blind men of Rising Spital were turned into
the street ; the poor old priests of the Papey had
to give up their humble home and even their work,
if they were still able to work. The Religious
houses had grown careless and luxurious, perhaps,
but we cannot believe that they had departed from
all their ancient customs; there must have been left,
even in the most scandalous and corrupt foundations,
the relief of the poor, the care of the sick, the
education of the young. W hether they received
the sick or no, think only of the closing of St.
Bartholomew's, St. Mary's, Rising's, and the Papey.
Some years later, in a Lanicntaiioii against
London (Nuremburg, 1547), there occurs the follow-
ing passage :
1 X r ROD U CI 1 () X . X x \ \- 1 1
" O ye citizens, if ye would but turn even th«:
])r(3fits of your Chantries .ind your Obits, to th<;
finding of the poor with a politick and godly Pro-
vision ! Whereas, London beinof now one of th('
Flowers of the World, and touching worldly Riches,
hath too many, yea, an innumerable number of
Poor People forced to go from door to door, and
to sit openly in the streets a-begging. And many
not able to do for others, but lye in their Houses in
most grievous Pains, and die for lack of aid from
the Rich, to the great Shame of thee, O London !
I say, if ye would but redress these things, as ye be
bound, and sorrow for the Poor, so should ye
be without the Clamour of them, which also have
cryed unto God against you.
" But to their blind guides — " (chantry priests) —
*' ye be maintainers of their Idleness, and leave the
Lame, the Blind, and the Prisoner unholpen. Ye
will give six, seven, eight, yea, twelve pounds yearly
to one ot them to sinaf a Chantrv. to rob the livinsf
God of His Honour. ... I think, in my judg-
XXXV HI INTRODUCTION.
ment, under Heaven, is not so little Provision made
for the Poor, as is in London, of so rich a city."
But at this time ceased suddenly the endowment
of masses. Chantry priests vanished ; monks, friars,
nuns, brotherhoods, sisterhoods, and all the vast
army of those who lived upon the monastery
endowments — the bakers, brewers, embroiderers,
robe-makers, sextons, vergers, serving brothers — all
vanished together and were no more seen. Most
wonderful transformation ! The busy crowded
court of the monastery was silent and deserted ;
the candles in the chapel were extinguished ; the
altar was dismantled ; the kitchen and butteries
were silent, — where were the cooks ? — from the
infirmary no voice ; from the schoolroom no
sound ; all silent — all deserted. Where were
they all ? What became of all ? How did the
serving brethren fare — those who had grown up
in the service of the monastery and knew no
other service — a timid flock, accustomed to lie
within the precincts and walls of the cloister.
INTRODUCTION. XXXIX
s;ifc from the buffets ot a rude world — j)crhai).s
in the service of gentle nuns, and [)ani[)ered with
the kindness of the ladies ? Where did the old
monks seek refuge — those who had passed their
whole lives, first as boys at the altar, next as
deacons, lastly as monks in the cloister ? To
them the world was impossible : without their
midnight service, their lauds, their nones, and the
regular sing-song iteration of litanies that was to
them nothino^ but the orrindin"; of a mill whose
wheels must be kept going, they were lost. And
who would lead them to a refectory ? Who
would provide them with toothsome fish for fast-
infy and fat capons for feasting.^ As for the nuns,
they mostly crossed the seas and found shelter
in the low countries till civil war drove them
forth again.
How fared it in London, with the sick, the
poor, the aged, the impotent, the lame, the blind,
the lunatic, the broken-down? History says
little about the sufferinirs of that time. The
Xl INTRODUCTION.
contemporary document, however, which I have
quoted above, affords a glimpse. All of them
went begging. There was nothing else. They
must go begging or they would starve. Those
who were sick lay down to die in their
poor hovels, without attendance, w-ithout food ;
the only physician of the poor was the
wise woman, the herbalist : the only surgeon
was the barber. No hospitals, no asylums, no
almonries, no charities at all ! No schools,
even ! What a time ! One cannot picture it,
one cannot realise it. History says little or
nothing about it. The cares, and dangers, and
troubles of the State were so great at this crisis
— the decay of trade was so terrible — there was
no time to think of the dying, and the starving,
and the beggars. It is only when times are
tolerably quiet that men begin to think of the
weaker brethren. In the stress and storm of battle
the weak are ruthlessly trampled under foot —
trampled to death. But try to think of a city
INTRODUCTION. xll
without even ii Hotel-Dieu ! It is like a man
without a conscience ; a man without pity ; a man
who deliberately shuts his eyes to the distresses
of his neighbours ; a man deaf to all interests
save his own, Alas ! what tragedies were enacted
in those years — tragedies of death, and suffering,
and self-sacrifice, all unheeded and forgotten !
What hardening of hearts In the class above —
what monstrous births, and growths, and gather-
ings of hatred In the class below !
A few years later the City, awakened to shame.
restored the five Royal Hospitals of Bartholomew's,
Bethlehem, Grey Friars, St. Thomas's, and the
stately Palace of Bridewell. Two became great
hospitals for general purposes, one for lunatics,
one became a school, and one was converted
into a Workhouse and a House of Correc-
tion.
Then begins a new period with the history of
benefactions by bequest. This history may be
followed by the help of the parish records. It
xlii INTRODUCTION.
has never yet been written, and it should be
done speedily, before the memory of the former
City Charities is quite forgotten, because all these
bequests have now been swept into the coffers of
the Charity Commissioners. We are fortunately
able, for instance, to understand what kind of
will used to be made by the London citizen
under the old religion. It is useful for com-
parison. Stow ^ives us, with undutiful contempt
for superstition, the last will and testament of
his grandfather, citizen and tallow chandler, who
lies buried in the little green churchyard of St.
Michael's, Cornhill, near his father and orrand-
father, for there were many generations of Stows,
citizens and tradesmen. You can still see the
churchyard w^here the family ashes lie.
This good citizen, who was not rich, left to
the High Altar of his Parish Church, twelvepence ;
to the Jesus Brotherhood, twelvepence ; to Our
Lady's Brotherhood, twelvepence ; to the seven
Altars of the Church every year for three years.
INTRODUCTJON. xHil
twcMitypence ; for a watching-cantUc for every altar,
t'lve shillings ; to the Brotherhood of Clerks, for
drink, twentypence ; to a |)oor man or woman
every Sunday, one penny, to say three Paternosters
.md Aves, or a Credo, for his soul. This was the
kind of will made by everyone : they would save
their souls by candles, perfunctory prayers, and
b\' the paid mumblings of some poor old crone,
carried on for long years after they were dead.
This is what all of them did : only rich men
gave pounds or shillings, whereas this worthy
tallow chandler gave pence.
Suddenly everything was changed. The candles
were blown out ; the old crone, with all the willing-
ness in the world to oblige — quite ready to mumble
Credo and Ave for a small consideration — could find
no one to give anything for her Paternosters :
the heirs pocketed all the money left for masses.
Yet something must be done to mark the piety
of a testator. Perhaps a certain text now influ-
enced the worthy citizens, I'or the time of
xllV INTRODUCTION.
charitable bequests began, and has continued
ever since. They l)egan l^y leaving money for
sermons — what are we without sound doctrine ?
— side by side with money for the poor. They left
money to clothe the poor, to heal the poor, to teach
the poor, to feed the ])oor, to bury the poor. No-
thino- more suo-cjestive of the radical chansfe
in religious opinion than the records of the
London City churches. Almshouses began to
spring up outside London. By the end of the
last century all the suburbs were dotted w^ith
almshouses. New hospitals were founded ; special
hospitals were beginning ; charity was no longer
recognised as a dole casually given to the first
applicant ; it was becoming organised, methodi-
cal, a thing calculated and systematised ; but
always voluntary ; always the work of those
who love their fellowmen. Charity adminis-
tered by the State, indeed, ceases to be
charity. W'e should have to call it by another
name.
INTRODUCTION. xlv
Relief, and help given to the poor grow and
chanofe and take various forms as the Qrenerations
j)ass and the development of humanity slowly pro-
ceeds. First, we have the tossing of a penny to
the beQ;P-ar — that is somethinq- — it shows that the
starving man may have a claim u[)on us. Next
we have the saint sharing his cloak with this
beggar — always, obser\e. there is the beggar.
The conditions change, but always there is the
outstretched hand and the hungry eye — sometimes
admirably counterfeited — always the beggar. He is
the leprous beggar, starving because he cannot
work, loathsome with his dreadful sores : the saint
washes him and refreshes him. and feeds him be-
fore he dies. He is the beggar with the withered
limb : the saint takes him in and gives him his own
bed. He is the sturdy tramp : the monks take him
in, give him supper, a bed, and breakfast. Pre-
sently it occurs to someone that all such people
would be better brought under one roof, and at-
tended by skilful physicians and nurses : there we
xlvi IXTRODUCTION.
get the lazar-hoiise, the Hotel- Dieu, the infirmary ^
the modern hospital.
In the })ag"es that follow, the writer has so strongly-
put the case for hospitals that it would be foolish
in me to add anything of my own. We must have
hospitals : we must have Voluntary Hospitals : we
must do something of our own free will — a thing
that is not a tax — an offering, a tribute, a recogni-
tion of Lazarus as our brother. The cause may be
pleaded on religious grounds : it is so pleaded, year
after year, and not without effect. It may be
pleaded on civic or national grounds for the advance
of science, the discovery of things preventive and
things curative : the stoppage of things contagious
and infectious. It may be pleaded also on purely
selfish principles, because the selfish Dives is safest
in his luxury when the sufferings of the poor are
alleviated by his hand out of his plenty. Charity
by cheque may be a very poor kind of charity ; but
the motive concerns the giver : it may be left to
him. The cheque may mean brotherly love and
INTRODUCTION. xlvii
pity : it may mean love of science and the advance-
ment of knowledge : it may mean pure selfishness —
a sop to the needy — something to keep him quiet.
The motive concerns the giver. But he must
WALTER BESANT.
SUFFERING LONDON.
CHAPTER I.
THE PALE SPECTRE.
" Cities are the open wounds of a country P
London, a Subject of Wonder to Foreigners — Its Vivifying
Influence upon the World — Intense Business Activity — The
Street Traffic — Few Signs of Disease and Death — Behind
the Scenes — The Closing of the Ranks — The Victims of
Accidents — Masters and Servants — The Trains of the Dead
■ — London, a Healthy City with Vast Numbers of Sufferers —
The Hardships of Home Nursing — The Charity of the Poor
to the Poor- — Reasons for Low Mortality — Sick Children —
The Sweating System, a Cause of Disease — Hard Work, not
\'icc, fills the Hospitals — Charily Quickened by our own
Sufferings.
Millions are born, live, and die in London without
realising- the significance of their surroundings. The
average Londoner generally remains indifferent to
the siofhts and historical landmarks of the Metro-
polis. He takes but a languid interest in its
wonderful institutions, its gigantic movement, and
2 SUFFERING LONDON.
its world-wide potency. He is familiar with mar-
vels of which distant nations read with astonishment,
and spends his time phlegmatically amidst conditions
which would put an intense strain upon the nerves
of a foreigner. If London is a subject of wonder
to every educated human being residing outside its
boundaries, it is not because of its many square
miles covered with bricks and mortar, and its teeming
population. Nor is it because it is the capital of
the greatest Empire in the world and the residence
of an Empress. It is because London is the greatest
centre of human energy. It is like a sun that sends
forth its radiations into every corner of the habitable
globe. From this colossal dynamo emanate the
greatest, political, commercial, industrial forces, and
these speed round our planet, quickening life and
intensifying activity. The vivifying influences from
London renew the life of flagging States and re-
kindle the impulses of whole populations. Messages
of war and peace, administrative enactments, diplo-
matic devices, treaties, warnings, and threats go forth
from the capital of the Empire to shape the destiny
of the world. Able and brave Britishers, leaders of
men, start from our Metropolis to protect commerce,
advance civilisation, and widen the scope of human
enterprise. The manifold and complex threads of
finance centre in our city, and every great under-
taking must court the support or gain the sanction
of London financiers. All English-speaking races
look to London for advance in science, literature,
THE PALE SPECTRE, 3
pciintlng. music, and drama. To them London is
the dial which tells the hour of our civilisation.
From London come the best things that money can
buy, the highest good that culture can produce, the
newest ideas, the latest crazes of the day, the whims
of the hour, and fashions in vice.
No wonder that this agglomeration of energy
should present a panorama of life and activity intense
enough to strike the minds of strangers with awe
and admiration. The universal sway exercised by
London, as well as the unceasing exertion of its
population, suggest an almost superhuman vitality
and superabundant health — physical, moral, mental
health.
Every morning pour into the city torrents of
men whose looks and whose bearing mark them as
eminently fit to carry out the divers aims on which
they are bent. They rather suggest the units of
one vast working-machine than so many frail sons
of Adam. Each goes straight to his goal, and there
is among them none of the careless loitering so
noticeable in the streets of other European capitals.
During business hours every man, every youth, and
every boy is on the alert and up to the full bent of
his nerve-power, doing as much business and accom-
plishing as much work in an hour as our forefathers
would have scarce dared to compass in a week. This
is made possible by the aid of telegraphs, telephones,
tape-quotations, type-writers, and a host of other
contrivances calculated to keep practical work
4 SUFFERING LONDON.
abreast with the thoughts of excited minds. When
business is done and the tide of the human river
runs backwards, the same intense energy is displayed.
Every minute must be saved to prolong the en-
joyment of home, sport, and conviviality. Grey-
haired men, rather than lose five minutes, race like
boys to catch their train, and the very time spent on
the road is used to glean the financial or political
news from the papers.
And the West End — what a perpetual swirl of
human motion it is. AVherever you turn, activity and
the redundance of health encounter you, — every-
where the bright faces of men, women, and children
hurrying on to their various goals, now picking their
way through the tangle of the traffic, now lingering
admiringly over the multifold beauties of the shops.
An endless procession of carriages, cabs, and omni-
buses rattling through the streets, crowded trains
rushing, here under the foundations of the houses,
and there over the roofs. The open spaces of the
suburbs are alive with sports and outdoor games.
The river and the canals are made bright with smart
rowinof-boats anci canoes. At niofht, miles of London
streets are ablaze with illuminated shops, eager
crowds struggle for admission to the places of
amusement, the restaurants, cafe's, public-houses are
thronged, and all pleasure-supplying businesses
flourish. Loncj before carriaQ^es and hansoms have
borne the ball guests and belated revellers home, the
heavy roll of market-vans and the crash of hurrying
THE TALE SPKCTRK. 5
milk-carts Havc bec^un : London never subsides into
sleep.
Thus the great Metropolis of the Empire pre-
sents to the visitor and the superficial observer an
ever-moving jxmorama which suggests nothing so
little as disease and death. But the visitor and the
superficial observer look at the shifting scenes from
the auditoriuni ; they see nothing of the comi)lex,
heavy, and often dangerous machinery which pro-
duces this grand effect of vigour and life ; they have
no idea of the amount of work, sufferino- and sacri-
fice of human life needed to keep that machinery
in motion. The world beholds with wonder the
prodigious and potential activity of the smart busi-
ness man, but the reaction which {prostrates the
overworked man, which deprives him of sleep,
shatters his nerves, and sometimes unhinges his
mind, are only witnessed by his family, his partic-
ular friends, and his doctor. When men and women
fail to put in an appearance at the daily roll-call of
work, they are speedily replaced by eager aspirants
for their places, and the ranks are as complete as
before. But those who are hors dc combat are
hidden in their homes and in the hos])itals. The
millions, each of whom fulfil so promptly and ener-
getically their several functions in this huge system
of co-operation, sometimes under fairly good, some-
times under exasperating and life-shortening condi-
tions— all these, who appear so eminently fit for and
identified with their occupations, hold their own
6 SUFFERING LONDON.
simply In obedience to the law of the survival of
the fittest. When one falls the gap is instantly
filled, and the weak ones fall early. Modern work,
facilitated and accelerated by powerful machinery
and ingenious processes, produces marvellous and
pleasing results which we praise. h>ut we say
nothing about the dangers to health and life in-
volved. The constant streams of injured workers
that pour daily into the hospitals and disi)ensaries
are only witnessed by those who attend to them.
The smart shop-girls and barmaids who to the exact-
ing customer have to appear perpetual automatons,
warranted to work politely and cheerfully during, per-
haps, sixteen hours out of the twenty-four, are made
of flesh and blood after all. The manifold causes
which, in addition to overwork, undermine their
strength and sap their health, have lately been
dragged out into the light by the press. Even in
the comfortable Enoflish home thinfjs are not what
they seem. The trim and healthy serving-maid is
not trim and healthy because she lives in a big
house, but she is allowed to live in the big house
because she is trim and healthy. When her appear-
ance and working-powers are impaired, either by
accident or by the fault of her employers, she is
either discarded as a used-up tool and returned on
the hands of her generally poor relatives, or packed
off to the hospital.
Thus, as is natural with human beings, the
dazzling aspects of health and life are conspicu-
TIIK PALE Sl'KCTKE. 7
OLisly exhibited and eagerly conteniphited, whih,'
disease, decay, and death are carefully hidden
and ignored. The very hour when the sprightly
ballet, the enchanting opera, the ridiculous comedy,
are the centre of attraction, when the excitement of
the gay ballrooms is at its height, the army of silent
sufferers, often ill-cared for and sorely in want of the
primary necessaries, are counting the dreary hours,
hundreds are struggling with the last gasp, and the
midnight trains, loaded with the dead, are stealthily
leaving the great Metropolis.
In spite of fogs, smoke, and a capricious climate.
London is by no means an unhealthy place. The
soil on which it is built is eminently suitable to a
crowded city. The system of drainage is certainly in
advance of anv town in the world. Broad thorouQ^h-
fares traverse the populous districts; parks, squares,
and other open spaces, have been reserved on all
sides; and a superb, winding river divides the Metro-
polis in two halves. These hygienic advantages
keep the mortality of London low enough to suggest
that little sickness prevails. How London com-
pares in this respect with other cities there are no
statistics to show. But that there is an appalling
amount of sickness and suffering may be gathered
from the number of patients who have applied for
advice and medical aid. The number of patients
benefited by those medical charities, which partici-
pated in the grant made by the Metroi)olitan Hos-
pital Sunday Fund, was 1,236,059. In this return
5 SUFFERING LONDON.
only new cases are included and many thousands of
casualty cases are omitted. This means that one
quarter of the whole population is benefited by the
hospitals and dispensaries.
But figures can give no idea of suffering London.
Healthy, hard-working, and gay London may be
observed from the outside. But to study suffering
London we ought to have the assistance of an
Asmodeus, that " Diable Boiteux," who had the
power to lift the roofs from the houses.
Most of niy readers know what sickness is
in the homes of the upper and well-to-do middle
class. With the best medical attendance, trained
nurses, plenty of space, and all the comforts
and luxuries which money can buy, sickness,
even in the wealthiest homes, is a calamity
which is keenly felt by most of the inmates. The
very day on which I pen these lines I hear of
a home where two members of a family were
simultaneously struck down by two different
diseases, and where a devoted sister, in spite of
every assistance in nursing and every precaution,
has gone through such a period of anxiety and
mental suffering that her hair has turned white
in three weeks. Another member of the family, a
young lady, during the same time, by the assistance
she has volunteered and the sympathy she has felt,
has so strained her nervous system that her life has
been endano^ered.
WHien sickness can work such havoc where
THE TALE Sl'ECTKK. 9
there is an ample supply of all reciuisites, what
must it be in the working-man's cottage, in the
tenements, or in the crowded single room of
the poorest ? When it is the father of the family
who is struck down, the source of supplies dries up
the moment the demand for extra expenditure sets
in. If the patient remains in the house his discom-
lort, his intensified pains, and the chances against
his recovery go far towards counteracting the happi-
ness of being nursed by his family. If there are
children in the house, it would be almost impossible
to secure the quiet which in many cases is essential
to recovery. The daily work of the house, and the
noises of the street would in any case be a serious
drawback. The room would be sure to be small
and ill-ventilated, too hot in summer, and in the
winter too cold for want of fuel. The mental suf-
ferings of the patient would tell considerably against
him as he realises what a source of inconvenience
and privation he is to his family, as he feels that his
small resources are fast ebbing, and that every dose
of medicine, any stimulant or delicacy he takes, in-
volves a sacrifice upon his wife and his children.
W hat they have to go through when they have to
nurse a beloved patient in a small, crowded cottage,
or room, only those know who have experienced it.
The result is too often that when the wife has nursed
the husband through an illness endinir in convales-
cence or death, it is her turn to become the patient
When other members of a working-man's familv
lO SUFFERING LONDON.
are laid up by sickness, the bread-winner, If of a
sympathetic nature, Is to be pitied almost as much.
Working the whole day, watching at night, his small
savings dwindling, his mind racked with the dread
that the patient will succumb for want of proper
nourishment and care, he is on his trial Indeed.
The large amount of home-nursing undertaken
among the working-classes would be impossible if it
were not for the great charity of the poor to the
poor. Some people call this charity want of thrift,
want of foresight, prudent reciprocity, or else
foolishness. But It seems blasphemy to call It any-
thing but true, lavish, and unostentatious charity.
If the contributions of the wealthy classes to suffering
London were in proportion to the sacrifices of the
poor for the poor, our hospitals would have manifold
larger funds than would be required. To give a
portion of their work, a portion of their sleep, and a
portion of their scanty resources to their neighbours
afflicted by illness, is not an exception, but a rule,
amonor our workinof-classes.
The small mortality In the presence of so much
illness and suffering In London Is partly accounted
for by the fact that a constant stream of young
people keeps pouring Into London In search of em-
ployment. There is, therefore, a very large popula-
tion which has passed Its babyhood and childhood—
that is the stage which mostly swells the mortality
rate — out of London. Nor does the majority of
them die In London. Many of the doomed return
THE PALE SPECTRE. 1 I
to their friends as the last chance of recovery. Ikit
London is the scene of their sufferings, though not
of their death.
They have no homes in the true meaning of the
word, but Hve in cheap lodgings, or the large estab-
lishments where they are employed. The long
hours, the meagre living, the unhealthy dwellings,
make them an easy prey to disease, and when on the
bedofsickness,among strangers, with small resources,
they are indeed to be pitied. They are the victims
of a transitory stage through which our civilisation
is passing. At a time when the commercial system
had not superseded the feudal system in the country,
what we may call the guild system prevailed in the
towns. The apprentices and the craftsmen lived
with their masters, and, in case of illness, were
cared for by them. At present, under a highly-
developed commercial system, all patriarchal respon-
sibility has ceased. The employee is bound to the
employer by a one-sided contract which allows the
latter to act pretty much as it pleases him towards
the people in his employ, and impaired health is
often a reason for dismissal. The sufferings of this
class are none the less intense because hidden under
the veneer of gentility.
There is another class of sufferers in London —
a class which cannot be reproached for the charity
it receives — for their life depends on love and charity.
I mean the children. If by any possible means the
aggregate sufferings of the children of London
J 2 SUFFERING LONDON.
could be made palpable, if their feeble moans could
be gathered into one mighty appeal for help, wealthy
London would pause in the midst of its business and
its pleasure, and be moved to compassion. Rich
parents of healthy children, and parents who have
lost a little son or a little daughter, would deem it a
Christian duty, nay a privilege, to make the small
sacrifices which would suffice to alleviate the sufferincrs
of, and restore to health thousands of little victims
of poverty and destitution. The child-patient who
has tender but poor parents must suffer considerably
more than the sick child of the rich, and the children
of drunken and dissolute parents or guardians must,
when ill, in their wretched homes, lead an existence
and suffer agonies the very thought of which should
mar the happiness of Fortune's favourites.
One of the unforeseen effects of the Factory Acts
has been to drive many of those London industries
which are carried on by the aid of little or no
machinery from the factories Into the homes of the
people. The result of this is that the evils which
were attacked in the factories have broken out again
in the dwellings of the poor under greatly aggravated
circumstances. A small dwelling which is made
Into a workshop, filled with material, half-ready and
finished goods, and where the noise of sewing-
machines and tools is going on early and late, is
as unsuitable a place for patients as can well be
Imagined. Yet such dwellings are the only places
where the victlnis of our vast sweating system can
THE PALE SPECTRE. 1 3
nurse such of their sick as are not achnitted to the
hospitals.
Among the healthy and well-to-do of our nation
an opinion prevails that poverty and illness in the
lowest station of society are for the most part self-
intlicted. and frequently the result of self-indulgence,
especially in the matter of drink. The prevalence,
as well as the stubbornness, of the opinion, is made
manifest by the great trouble which is taken and the
large amount of money spent in agencies, the objects
of which are to elevate the poor religiously, morally,
and aesthetically. Though it cannot be denied that
in many individual instances drink is often the cause
of poverty and suffering, it is patent to everyone who
has really studied the working-classes that poverty
and suffering are two great causes of drunken-
ness.
The cases which are treated in our hospitals show
that the conscientious fulfilment of duty and the
strenuous efforts to gain a livelihood produce vastly
more illness among the working-classes than does
vice. In our general hospitals and workhouse
wards we find, besides those who have been the
victims of accidents — the soldiers of labour who
have fallen at their post — a great number of patients
sufferiuQf from diseases which seem to doof the
trades in which they have been engaged. There
are overworked mechanics laid up with phthisis,
bakers suffering from bronchitis, outdoor labourers
racked by rheumatism and pneumonia, painters who
14 SUFFERING LONDON.
are martyrs to colic, domestic servants with diseases
plainly traceable to their work, overworked opera-
tives of all kinds, afflicted with paralysis in some
form, discharged soldiers subject to aneurism. A
great number of these can, with proper treatment,
be cured ; and those who are incurable have an
extra claim upon our sympathy and our help.
Those who are acquainted with the manifold
maladies under the care and treatment of the Lon-
don hospitals, those who have witnessed the various
forms of suffering by which the patients are afflicted,
who have seen the haggard, careworn, pain-rent
features, the distorted limbs, the many ghastly forms
in which disease expresses itself — those who have
seen these things must have asked themselves by
what bountiful chance it is that they, unlike these
sufferers, have escaped the scourge by which so
many of their fellow-men are visited.
Amidst the business, the pleasure, the general
hurry of London life, it is not wonderful if the
spectacle of the pain-stricken and the fever-
tainted population is rarely called to mind, if the
groan of anguish that goes up to Heaven is not
heard by men. " We learn in sorrow what w^e
teach in song," has been well said by one of our
greatest poets, and the majority of the healthy
and the strong realise little or nothing of the
trials and terrors of disease, and take little heed of
how they are diminished or assuaged by those very
institutions to which they themselves owe in a large
THE PALE SPECTRE. 1 5
measure the sturdy health they enjoy. When their
turn comes — and few men are spared such visitations
— then it is that they reah'se the awful loneliness of
their lot. Like the sufferers for whom they once
had no thought, they dream through many a
mournful hour of the mighty crowd, that, like a
hydra-headed symbol of Self, moves on, amid
laughter and song, unconscious of the pale spectres
of the slowly dying.
CHAPTER 11.
THE NECESSITY FOR HOSPITALS.
" In the sick airy
English Practicality — Want of System and Cohesion among our
Hospitals — Artificial Causes of Disease — Our Transitory
State — How we court Disease — Conforts with Dangers —
The Deceptiveness of Statistics of Railway Accidents — The
Drain Monster under our Feet — Rivers turned into Sewers
— Are the Beaches of our Watering-Places Tainted ? —
Neglect of Health in certain Trades — Victims of the
Sweater — Mortality among Children — English Mothers Cal-
umniated— Cramming the Brains of Starving Children —
Child Insurances — Utopian London Far Off — Hospitals
under Government or Municipal Control — Social Signifi-
cance of Voluntary Hosjjitals — The Difficulty of Treating
certain Diseases at Home — The late Influenza Epidemic —
Government Hospitals a Feeble Bulwark against Pestilence
- — The Black Death — The state of London during the Plague
— Consequences felt for Centuries — The Possibility of a
Return of the Black Death — Preparing the Ground for the
Seeds of Pestilence — Pestilence a Possible Consequence of
the Coming War.
One of our national characteristics is our disposition
to tackle the practical solution of problems without
much study of theories. This trait, if analysed,
IG
rilK MXllSSITV FOR IIOSriTALS. 17
might be foiincl to consist of love of work, the
desire for gciin, the spirit of self-reH;ince, and the
dread of dependence and poverty. Our commerce,
our industry, our colonies, and the whole Empire all
bear the stamp of what we may call English practi-
cality. Foreign industries are often the result of
much theorising, schooling, artificial State protec-
tion, and elaborately constructed plans. In Eng-
land most of the larcre industrial undertakings
have grown out of small beginnings, and have often
been started by working-men with hardly any
knowledge except that gained by experience in a
trade. Not many years ago there was many a
large employer of labour in England unable to
write even his own name, but perfectly capable of
highly improving his products and of Inventing
complicated machinery. Government technical
schools on the Continent, and particularly in Ger-
many, are numerous and highly developed, while
In England there is just now a great outcry about
the want of such schools. This does not prevent
a large number of German manufacturers from em-
ploying English managers and English foremen as
the only means of competing with the practical
English manufacturer. The whole of our Empire
Is the outcome of spontaneous action and practical
expediency, called forth by the necessity of the
moment. It has not been constructed on the plan
of any sovereign or minister, and at this moment
it hanofs together without any svstem. ThouQ-h it
15 SUFFERING LONDON.
is acknowledged that a system is needed, neither
Parliament nor the Imperial Federation League are
able to devise one. Nevertheless, each Govern-
ment makes a practical addition to our possessions.
Our Voluntary Hospitals are the result of this
same characteristic of ours. There was a want to
be met, there were generous impulses prompting
action, and the result was our Voluntary Hospitals.
As with the parts of the Empire, they lack system
and cohesion.
The gradual growth and slow development of
these institutions, each meeting a special demand
as it arose, has caused us to regard them as natural
appendages of civilised society, and prevented us
from realising how indispensable they are.
To consider the present amount of hospital accom-
modation and medical aid as indispensable under
any circumstances, would be to take a despairing
view of humanity. That it is now indispensable
and largely insufficient nobody will deny. But this
London of ours, taken as a whole, can in no way
claim to be considered as a model community.
Without beinof a devotee of medical science I have
no hesitation in expressing my belief that, at least,
nine-tenths of the maladies and casualties of the
people of London are preventible, and produced by
unnatural causes.
There are many examples of savage races who
live a natural, though by no means an exemplary
life, and who are remarkably free from disease.
THE NI':CKSSITV FOR HOSPITALS. 1 9
Even in our capricious climate there are plenty of
instances to prove that lonnr, healthy lives result
from favourable conditions. Thus, the loni^evity of
the clergy is a case in point, irrespective of the fact
that even among them there are many who impair
their health and shorten their lives. The extension
of the average life of the British people, through
improved hygiene and advance in medical science,
shows that disease has been checked, but it does
not tell us yet what may be achieved in that field.
Why should not the ultimate end of civilisation be
to attain, by means of knowledcje, trainin"-, and
social institutions, to as good results as the ignor-
ant and isolated savages enjoy.
But, though we advance, we are as yet in a
transitory stage, and probably far even from that
highly improved condition of things which our
present knowledge allows us to conceive. Science
is beo^inningf to show us where the dangers to
health and the causes of innumerable diseases may
be found, but we have hardly begun to take heed
of its warnings : nor shall we be able to do so
until certain remedies and easy modes of prevention
are discovered. Our manner of living is not cal-
culated to improve our health. We live too much
indoors. We are awake when we should be sleep-
ing, and sleeping when we should be awake. Few
of us take anything like sufficient exercise. Neces-
sity or ambition causes us to over-strain both body
and mind. Care and worry are with us night and
20 SUFFERING LONDON.
day. Our food is unsuitable and often taken at the
wrong- time. Our drinks are more stimulating than
wholesome. Our dwellings are imperfectly v^entil-
ated, and their temperature irrationally regulated.
The intense competition in trade has led to a
marvellous system of adulteration in food, drink,
and even medicine, ao^ainst which we have not
learned how to defend ourselves. Even the wealthy
gourmet does not know what he swallows when he
imaofines himself to be drinkingr wine. The real
wines are often doctored and coloured by dangerous
poisons. Our clothing, our carpets, our furniture
stuffs, contain aniline, arsenic, and other chemicals
which are either dangerous to the touch, or
pollute the 'air we breathe.
Many of the comforts and time and work-saving
appliances of modern life can only be enjoyed at
the risk of serious accidents. The enormous
traffic of London causes hundreds of thousands
of accidents and deaths during the year. Re-
volver and gun accidents are frequent, as we know
from the papers. Leaking gas-pipes cause explo-
sions, and the death-roll, for which that new agent,
electricity, is responsible, is already considerable.
Each severe frost brings its crop of boiler
accidents. Paraffin lamps continue to explode,
despite the many patentees who claim to have
made them safe. Every day or every night there
are fires, many of which lead to frightful accidents
and often death. .
TllK NKCKSSrrV FOR HOSl'ITAI.S. 2 1
Our railways arc the cause of a vast nunibcr of
injuries to life and liml), though everything; con-
nected with them has been brought to a hi.^h pitch
of improvement. The yearly statistics of accidents on
the lines are calculated to mitigate our fears : for when
we find that out of seven millions of passeng^ers only
one is killed, and out of about half a million one is
injured, each of us seems to have a fair chance of
escape. But this view does not tally with the fact
that so many of our friends and acquaintances have
been in a railway accident, and many of them in
several. The explanation of this apparent contradic-
tion is easy. The millions of travellers on which the
percentage is reckoned are, in reality, only so many
journeys, and those who travel twice a day and more
must, if they want to know the risk they run, multiply
the number of deaths and accidents given by the
statistics by about 6co. The man who travels in this
fashion during thirty years must multiply his risk by
1800, and, if we take for granted that in each railway
accident ten per cent, of the passengers are injured,
18,000 must be his multiplication, if he wishes tO'
arrive at the risk he runs of being in a disaster. It
is therefore not surprising that so many of us are
sufferers, notwithstandinof the reassurinof character
of the statistics. The moral of this is : buy an in-
surance ticket when you travel, and, above all, sub-
scribe liberally to the hospitals.
The large masses of people gathered together
in a huge city like this are exposed to constant
22 SUFFERING LONDON.
attacks from those insidious, unseen enemies
the bacteria. The more we learn about the
origin and spread of disease, the more easily can
we conceive that London, with its dust in the
streets and roads, its ash-pits behind every house,
its fogs and its smoke, must offer enormous facili-
ties for the ravages of bacteria. The ground under
London is honey-combed with drainage - pipes,
large and small, measuring thousands of miles.
Each mile of drain is charo^ed, sometimes at his^h
pressure, with poisons sufficient to kill hundreds of
the healthiest men. It is enough to make us shudder
to think that only a few feet divide us from a gigan-
ric death-dealing octopus mighty enough, if freed,
to destroy us all. Like Frankenstein, we have
created our monster which haunts and doQfs us, ever
ready to force its poisonous antennae through the
tiniest crevices left open by careless workmen, or
produced by the tooth of time. We are forever
imprisoning this monster by means of brickwork,
pipes, and water-traps ; but we are not always
successful. Every year it claims numerous victims
from all ranks. Even Royalty has not been
spared.
In London, many of the small tributaries to the
Thames have been converted into gigantic sewers,
and their contributions tend to turn our beautiful
river, already polluted by other towns and villages,
into one vast sewer. Thus, our helplessness in
face of the drainage problem has changed the
THE NECESSITY FOR IIOSriTALS. 23
river Thanvjs, which should be a source of health
and pleasure to Londoners, into an agency of dis-
ease and death.
Legislation against the pollution of our rivers,
though of momentous importance, makes no head-
way. It is surprising that we, the English i)eople,
who consider ourselves to be of specially cleanly
habits, should regard with equanimity the sad
plight, in which the inhabitants of many a town
find themselves, who have to wash in, bathe in,
cook in, and even drink the water from a river
into which several other towns pour their sewage.
To all of us it is revolting to think that our rivers
should carry such a mass of uncleanliness into the
sea, and poison the water around our coasts. Scien-
tists tell us that the ocean is the great purifier of
our Q-lobe, and that it does not become defiled. Let
us hope they are right. In the meantime, bathers
at several watering-places complain of the presence
of sewaofe in the water ; and if amoncr the inhabi-
tants of these localities there were such an " Enemy
of the People " as Ibsen's zealous Dr. Stockmann,
we should very likely hear more about this.
So far, we have only considered those causes of
sufferinof and disease which attack Londoners of
all classes, rich and poor alike. The working, the
be-sweated, and the out-of-work classes are not
only exposed to all these evils in an aggravated
degree, but their ranks are decimated by maladies
and accidents arising out of the special conditions
24 SUFFERING LONDON.
of their lives and occupations. There are a number
of trades in London, as well as all over England,
which are peculiarly unhealthy. There can be no
doubt that in such trades the precautions recom-
mended by scientific men are sadly neglected. It
is only justice to say that this is as often as much
the fault of the men as of the masters. No man is
compelled to work in unhealthy workshops, but
competition for employment leaves workers little
choice. In many cases, the precautions cannot
be taken without some expense, and in others,
the only excuse for neglecting them on the part of
the men is that they cannot be bothered. Can it
be that their lives, the old age they might look
forward to, offer so few attractions, and so they
become callous and even negligent ? Be the causes
what they may, the fact is there — in London many
trades are carried on which bring disease upon
the workers.
The sweating system undermines health in many
ways, of which most of us have heard. A most
serious matter is the bad effect which the long
hours, the severe application to work, and the un-
healthv rooms exercise on the female workers.
Whoever has been to the city must have noticed
the pale, undersized, narrow-shouldered girl, who
carries a huge parcel of finished goods or materials.
Her eye is dim and drowsy, circled by a dark ring ;
her face is thin and fallen ; her skin is sallow and
waxen ; her lips are thin, and of a sad and weary
THE XKCKSSITV FOR HOSPITALS. 25
expression ; and her gait has lost ah thcj elasticity
of youth. Such is the type of thousands of young
cr'irls destined to be the mothers of future crenerations.
Even before marriage they have little strength to
resist sickness and disease, and, when they become
wives and mothers, they too often lack the stamina
required for the trials they have to face.
The appalling statistics of mortality among chil-
dren, so humiliating to Englishmen, indicate that
many causes are active in producing suffering and
death among the helpless little ones. Insuffi-
cient food and insufficient clothing are the normal
state of a vast proportion. Coroners are constantly
hinting: that neQflect, sometimes wilful, has been a
greater factor in the investigated tragedy than is
admitted. If all we hear on this subject be true,
child murder in Enerland miofht be thouofht as
common as in China. But we must guard ourselves
against believing that all we hear is true. Generally
speaking, the poorest English mother is as fond of
her child as the wealthiest lady, and when we re-
gard the condition under which those classes live,
among whom the mortality of children is the
highest, there are sufficient causes to account for
it all, without imputing infanticide to the mothers.
What probably has led many people to such im-
putations is, that among the London poor there are
strong temptations to regard child life with in-
difference. The system of baby insurance renders
the death of their children a source of income to the
26 SUFFERING LONDON.
parents. The difficulties of rearing delicate children
at home are so great as to make it probable that the
parents leave the matter to be worked out by the
law of the survival of the fittest. The modern
thouQ^htless leo^islation with resfard to children, which
forbids them to earn money, even when such earning
is their only chance of a meal, and which compels
the parents to send them to school under difficult
circumstances, has done much to make children a
heavy burden to their parents. Our national educa-
tional system is compulsory, and as all compulsion,
if it is to be bearable, requires a considerable
amount of sweeteninof with State charitv, the aboli-
tion of the school pence was a tardy justice to the
children, which ought to have been simultaneous
with the compulsion. But, while an evil has been
removed which wounded the feelings of the children,
one remains which injures the minds and the
bodies of the poorer — namely, the system of "cram-
ming" on empty or under-fed stomachs. Without
being an expert in medical science, I think it safe to
say that this cruelty by Act of Parliament is calcu-
lated to produce ill-health in the victims, both during
childhood and in after life.
Lastly, I must express my belief that the teach-
ing, or shall I say the misinterpretation of the
teaching, which is common with preachers of
many denominations, gives rise to suspicion against
parents. This teaching is to the effect that
the child which dies while innocent is, when once
TIIK NECESSITY FOR HOSPITALS. 27
baptised, sure to go to Heaven, while by far the
great majority of grown-up people are sure to suffer
eternal perdition. When mothers realise that their
children are doomed to grow up in squalor, sur-
rounded by vice and bad examples, exposed to
strong- temptations, and consequently extremely
likely to follow the crowd on the broad way which
leads to eternal flames, what is more natural than
that these mothers with their unsophisticated way
of accepting religious teachings literally should, de-
spite their better instincts, look upon death as the
best thing that can happen to a child ? Depend
upon it, some such ideas are often at the bottom of
the saying we hear at times from mothers, " I hope
the Lord will take hini ;" words which set the un-
generous thinking of the Insurance Company.
We thus find that this huge metropolis, far from
employing such means as science can supply for the
prevention of such evils as our flesh is heir to,
evolves an appalling number of artificial causes of
ill-health and physical suffering. Habits, traditions,
prejudices, selfishness, ignorance, vice, poverty,
absence of leQ-islation, wrono^ leo-islation, and over-
legislation — all these factors are busily at work
among Londoners in producing a plethora of
patients for our hospitals and dispensaries.
Such artificial means as are being employed to
promote health counteract only a very small pro-
portion of the sickness produced artificially by the
above-named factors. Nobodv will denv that our
28 SUFFERIXf; LONDON.
hospitals and dispensaries are the most useful and
necessary of all palliatives in cases of disease, aris-
ing both from natural and artificial causes. A time
may come when London will stand less In need of
hospitals, and when Nature alone will be responsible
for physical suffering among the Inhabitants. But
we are very far from such a state of things at
present, for It can only be attained through far-
reaching economic, financial, and social reforms. So
far we are hardly In the right groove yet : for the
present tendency Is to combat Isolated results, to
disguise and hide effects and suppress tell-tale-
phenomena, Instead of attacking causes. Nor are^
the legislative attempts of a nature to Inspire much
hope of good : for we are apt to pass bills more
calculated to fall In with the prejudices of voters
than to really accomplish the desired object. While
we are scientific and systematic In everything else,
we legislate In a hap-hazard fashion, with a lofty dis-
regard for first principles which will astonish pos-
terity. Utopian London Is, therefore, far off, and
while its population goes through the slow process,
of education by experience, purchasing every Inch
of progress at the price of an Immensity of suffer-
ing and the loss of thousands of lives, the existence
of our hospitals and dispensaries Is a necessary
condition for the rational workuiQ- of our social
system.
The admirable aid which our \'oluntary Hospitals-
ungrudgingly give, to all comers within, of course^
THE NECESSITY EOR 1 loSI'ITAl.S. 29
the limit of their means, allows (nir working-classes
to face the troubles of life with more rc^signation
than would be possible without them. If we had
not our Voluntary Hospitals we should probably have
to fall back upon such institutions as exist in most
Continental countries — namely, pay hospitals, into
which a limited number of free patients are ad-
mitted. In these institutions, most of which are
under Government or Municipal control, the patients
are generally divided into three classes — namely,
fully-paying patients ; patients who, by an appeal to
their self-respect, are induced to pay as much as
they can ; and patients who pay nothing at all.
Those who are acquainted with official management
in general can easily imagine that the treatment,
the comforts, and the diet of the inmates are of
varying quality, the best for the rich, the worst for
the poor. The result of this is, that the free wards
are anything but an attractive refuge for the poverty-
stricken sufferers, and that a strong prejudice exists
against hospital treatment among those who cannot
afford to pay for it. If such hospitals were the
only ones in London, our working-classes would
strive to avoid them as they strive to avoid the
workhouse. The great majority of patients would
be nursed in their homes, and the discomfort, misery,
and suffering among the working-classes would be
greater in proportion. Besides, fevers and all in-
fectious and contagious maladies would be consider-
ablv increased.
30 SUFFERING LONDON.
It is, therefore, certain that without our Voluntary
Hospitals the political discontent of the masses
would far exceed its present degree of intensity.
As the political power is now vested in the labourers,
a state of things calculated to produce exasperation
among the working-classes might well exercise a
baneful influence upon the destiny of the country.
Our Voluntary Hospitals are, therefore, among the
most reliable safety-valves which, during our
painful social evolution, avert catastrophies which
mio"ht otherwise result in the devastation of the
country. Few arguments indeed w^ould more tend
to deter working-men from joining in onslaughts
upon freedom and capital, than the dread that in
case of anarchy the hospitals would disappear, and
in case of Socialism that the hospitals would be in
the hands of the bureaucrats.
Nothing better demonstrates the necessity for hos-
pitals than the many great difficulties which stand in
the way of nursing patients through certain illnesses
in private homes. Typhoid fever, for example,
even in moderately severe cases, may extend over
five or six weeks, and the term of convalescence
may extend over the same period. And typhoid
fever is, unfortunately, very common among Lon-
doners. This is not astonishing when we consider
the drains under our feet, the water we drink, the
state of most cisterns, and the insidious manner in
which most of the so-called water filters spread dis-
ease. In the working-man's family where the pre-
THE NECESSITY FOR HOSPITALS. 3 1
caution of boiling water is not taken, and where
seldom, if ever, efficient water-filters are found, the
proportion of typhoid fever cases is very large.
The supply of milk is frequently the cause of numer-
ous cases of typhoid. There have been instances
which prove that a farmer can produce typhoid fever
throughout whole streets, simply by watering his
cattle in stagnant and foul pools. Nor can the milk
supplied from cowsheds in towns be relied upon.
In many of these closer and low-roofed sheds the
poor animals are crowded together, having hardly
room enough in which to lie down. The poorer
the family, the more it is, of course, exposed to the
dangers of typhoid. The cost of private nursing
is above the means of most labourers. The patient
should be seen by the doctor at least once or twice
a clay for many weeks, and during the stage of con-
valescence at least twice a week. In typhoid fever
intellio;ent nursinir is half the battle, and errors in
nursing might easily aggravate a case or kill the
patient. The strictest diet is absolutely necessary,
and the food required by the patient is expensive.
Without the hospital an attack of typhoid fever
would cost the working-man, if he had to pay the
expenses himself, from forty to fifty pounds, which
would, of course, spell ruin.
The general hospitals of London, excluding the
Poor Law infirmaries, receive yearly about three
thousand patients suffering from typhoid alone.
Rheumatic fever is apt to last even longer than
32 SUFFERING LONDON.
typhoid fever. Including the period of conval-
escence, its duration is from six weeks to six
months. The London hospitals treat from five to
six thousand of these cases annually. An attack of
rheumatic fever is a calamity to anyone, especially a
working-man. Excruciating pains for days, and
perhaps weeks are often not its worst feature. It
frequendy affects the heart and exposes the patient
to future attacks and complications. A young or
middle-aged man may rise from his sick-bed appa-
rently twenty years older. Treatment of such a
disease in the small homes of the working-classes
would involve a terrible amount of suffering, and the
sacrifice of several hundreds of lives.
Pneumonia and bronchitis patients are treated to
the extent of nine to ten thousand annually in the
London hospitals. It is a well-known fact that in
cases of infiammation of the lungs and bronchitis,
plenty of fresh air is required. An atmosphere
containing impurities and limited in the supply of
oxygen is simply poison to the patient. It can
therefore be easily imagined how severely it must
tell against the patients to breathe the air of
a small sick-room in a tenement or cottage in the
midst of a densely populated neighbourhood. In
this disease a trained nurse can never be safely
dispensed with.
The number of accidents alone in London appeals
strongly to the generosity of everyone who feels
for the sufferinofs of his fellow - beinofs. Those
TIIK NKCKSSITY FOR HOSPITALS. 33
treated in the London hospitals, inckidini^ the
suburban ones, must be estimated at from two
hundred and fifty thousand to three hundred
thousand. In one hospital alone 20,766 cases
were treated during- last year, of which 1,297 were
accidents of a serious nature.
We have abolished quarantine, and allow ships,
cargoes, and even passengers from infected ports
free access to our country. In doing so we rely on
the excellence of our hospitals, and the sanitary
system which they have been so instrumental in
promoting. Should any devastating epidemic find
its way into the country, we are supposed to be
fully equipped to meet it. This would certainly not
be the case without our Voluntary Hospitals. The
last influenza epidemic put our hospital accommoda-
tion and nursing institutions to as hard a strain as
they could well bear. As a matter of fact, influenza
patients should not go to the general Voluntary
Hospitals. Yet complaints were rife that they could
not receive the patients, and that nurses could not
be had. Influenza is after all a mild epidemic com-
pared with the terrible scourges which sometimes
affect humanity. That Government hospitals are
poor bulwarks against such invasions is proved by
the ravages of cholera in such quarantine-protected
countries where Voluntary Hospitals are scarce or
non-e.xistent.
The experience of our forefathers teaches us to
what dangers a big city is exposed when hospitals
34 SUFFERING LONDON.
arc Insufficient, sanitation is defective, medical
science is undeveloped, and nursing is irrational.
The horrors of the Black Death which visited Lon-
don in the fourteenth century have often been de-
scribed. There are some who flatter themselves
that we are too civilised, or that we stand too well
in the books of Providence, to be agfain visited
with such a scourge. This may one day prove
a delusion. There can be no doubt that the
want of hospitals, of scientific knowledge, and
of nursing in the olden times, greatly facilitated
the spread of the Black Death. A writer, dealing
with this subject, says :
" There were no hospitals in those days, no
buildings in which the plague-stricken could be
separated from the healthy, no floating vessels on
board which they might have the benefits of un-
contaminated air ; above all, no scientific physicians
who understood the nature of the terrible problems
to be solved, and no trained nurses ; in short, no
effective means of any kind for dealing with so
ruthless and devastating an enemy. Physicians,
priests, and people alike were paralysed by the over-
whelming flood of pestilence. Those who felt
themselves attacked fell down in intolerable ano-uish
and despair where they were seized. We can picture
the terrible scenes ; the narrow and undrained
streets and roadways choked with plague-stricken
forms : the wretched houses with their filthy rooms
filled with the curses of the living", the frroans of the
THE Ni-:ci:ssiTY for irosriXALS. 35
dyino', and a horrible stench from the dead, which
carried the fatal poison into the veins of all who in-
haled it. But no words can approach a realistic
description of the horrors of such a time. Yet it is
but five hundred years since all this happened.
'' It is often taken for granted, even by intelligent
}:)ersons, that a fatal epidemic bears clown like a
flood upon a devoted population, and passes away,
also like a flood, in a few days or weeks, leaving no
traces behind. But the very opposite is the actual
truth. The Black Death visited England in 1342,
and remained to scourge and terrify the inhabit-
ants for six years, until 1348. Even that was onl)^
a small part of the horrors which followed in its train.
The general effect of that terrible visitation can only
be described as a collapse of civilisation for a period,
Hecker, indeed, affirms that the consequences have
continued to be felt for centuries ; that a ' false im-
pulse' was then communicated to civil life, which in
England has extended even to modern times.
" One might suppose that such a visitation would
be eminently favourable in its after consequences to
religion and public and private morals. The truth,
however, was that for a lonof time morals and re-
ligion were utterly paralysed and destroyed. Over
large tracts of country the churches were entirely
deserted, and public worship was no longer carried
out. The schools shared the fate of the churches,
and education ceased to be desired. Ignorance,
grossness, barbarity, and animal selfishness every-
36 SUFFERING LONDON.
where prevailed. With a touch of grim humour
Hecker tells us that one class alone prospered in
the midst of the general degradation. Those were
the lawyers of the period. ' Covetousness,' says the
chronicler, ' became general ; and when tranquillity
was restored the great increase of lawyers w^as
astonishing, to whom the endless disputes regarding
inheritances offered a rich harvest. The sittings of
Parliament, of the King's Bench, and of most of the
other courts were suspended as long as the malady
raged. The laws of peace availed not during the
dominion of death.'
'' The practical business of life, as well as its
religion and its law, was for a time almost entirely
suspended. The amenities of civilisation were for-
gotten, and the restraints of public opinion ceased
to operate. The lowest and worst passions of men
came uppermost, and were indulged without let or
hindrance. England became practically a savage
country for several years. The fields were in many
places untilled, and the cattle, for want of herdsmen,
ran wild in the forests and on the h'lls by tens of
thousands. The whole country was thrown back-
wards in its development by a period of years which
cannot be computed. 'At the commencement of the
epidemic,' says the historian, ' there was in England
a superabundance of all the necessaries of life ; but
the plague, which seemed then to be the sole ciisease,
was soon accompanied by a fatal murrain among the
cattle. Wandering about without herdsmen, they
TIIK NECESSITY FOR HOSPITALS. 3/
fell by thoLisiinds ; and tlu- birds and beasts of prey
are said not to have touched them. In consequence
of the murrain and the impossibility of removing
the corn from the fields, there was everywhere a
great rise in the price of food.' The wholesale
destruction of the cattle and the crops, following so
closely ui)on the devastation and death which every-
where accompanied the epidemic completed a
picture of desolation and ruin of which adequate
description is impossible.
"It is necessary to recollect what has already
been stated, that all this happened little more than
five centuries ago. Comi)ared with many of the
prominent facts of history, the Black Death was
quite a modern event. The writer does not hesitate
to say that such a visitation ought to have been im-
possible. It could not have happened except in the
complete absence of hospitals, nurses, and scientific
medical resources. It was a disgrace to the civilisa-
tion and science of the times. Nothing more con-
vincingly shows the poor mental capacity of the
average man than the miserably ineffective way in
which the approach of the epidemic was met. The
physicians capitulated at the first appearance of the
enemy. The priests were powerless, and the public
authorities might as well have been non-existent.
The plague took absolutely its own course, exactly
as it would have done in the Britain of the Druidi-
cal period, or in the most savage regions of the
Darkest Africa of to-day."
2,^ SUFFERING LONDON.
It is to be fervently hoped that our country may
be never again visited by a Black Death. But who
would be bold enouQ^h to sav that it could not
happen ? Thanks to our Voluntary Hospitals and
the improvement that has followed in their wake,
we may be said to be prepared to grapple with any
pestilence that may arise amongst us or invade us.
But can the same thinof be said about the countries
with which we are in daily communication ? Even
such an epidemic as cholera, which the medical men
of Europe have had so many opportunities of study-
ing, cannot be effectively met in most of the Con-
tinental States. What would the condition of things
be in Europe if the East were to send us a new
pest, or one of the old ones which we know only
by tradition ?
The fact that the Black Death and other fearful
epidemics have raged before, proves that they may
rao-e aofain. Whether the varieties of bacilli are
limited like the elements, or whether they develop
and increase by evolution, has not, I suppose, been
ascertained by scientists ; but, to judge from obser-
vation, it appears probable that new conditions and
new habits are capable of producing new diseases.
And in the state of intense activity and strain in
which we live, with the new powers \\c are con-
stantly acquiring over the forces of Nature, and
under the peculiar circumstances of our modern
industrial system, we are continually traversing un-
explored regions of which the past experience of
THE NECESSITV FOR HOSPITALS. 39
mankiiul can teach us iKHhinL;'. Mii^ht it not he
that in this vast ]Mctroi)oHs wc arc unconsciously
l)rcparing the ground for the seeds of some new or
ancient pestilence ? In the East End and other parts
of London, especially where the sweating system
flourishes, we foster a population whose physique
and condition of life are calculated to make the
people an easy prey to epidemics. Matters are
not improved by hordes of immigrants from the
very country which always sends us our plagues.
To judge from the political horizon there is every
fear that we are on the eve of events which might
well expose us to greater risks of pestilence than
we have run for centuries. The great military
Powers of the Continent are actually preparing for
a war which, if it breaks out, will be more terrible
than any yet recorded. The alarming part of it is
that the concentration of troops will probably be in
Hungary, Russia, and Poland, where the sanitation
of the towns and villages is appallingly defective,
and where epidemics always find a congenial soil.
Larger numbers of troops than Russia ever mustered
before will be brought together, and their camps will
be formed with the usual disregard for the crudest
notions of sanitation. For it is a deplorable fact
that the bureaucratic conspiracy which rules the
Russian Empire, and the leaders of which constantly
aspire to the conquest of new territories and the
subjection of other nationalities, are, with regard to
government and administration, too incapable to
40 SUFFERING LONDON.
protect the Russian peasantry from death by starva-
tion, and the Russian soldier from camp fever.
When half a million of Russian soldiers and Cos-
sacks are herded together, the result will be the
same as during the last campaign — that the Czar
and his staff will have to give the camp a wide berth
in order to escape infection. If the Russian army
were to remain a long time in the field, Europe
should prepare itself for dangerous epidemics.
The battlefields of the threatening Eastern war
will probably testify to the efficiency of modern
death-dealing appliances. We shall have battles
raging for days over extensive grounds, hurried and
disorderly retreats, desperate pursuits, and, conse-
quently, miles of country strewn with carcases and
corpses.
Who would wonder if to this tragedy Nemesis
were to add her epilogue — pest !
W^hen in the daily papers we read that the in-
trigues and machinations of those conscienceless
diplomats of the Eastern Empire, who still carry on
their polities after the criminal manner of the Middle
Ages, tend towards war, we should remember that
the heat of the Eastern summer may generate from
the neo-lected battlefields in Poland and Russia
billions upon billions of bacteria destined to be
wafted all over Europe and to reach our coast — and
that our best self-defence, indeed our surest safe-
guard against their ravages, is a liberal support of
our hospitals.
CHAPTER III.
OUR HOSPITALS.
" Cii va ii?i />cii an cicl, inais beaucoup a iliopitair
Hospitals fiom the Outside — The Spirit of Charity — The Great
County P'amiHes — A Populous and Flourishing District —
Benevolent Governors — Expenditure and Income — The
Duty of a Citizen — Our Great Voluntary Hospitals — -
Heaven's First Law — The Hospital Kitchen — The Wards
— Elements of Brightness in Hospitals — The Visiting Day —
The Children's \\'ard — The Variety of Cases — The Work
of the HoustJ-Surgeon — The Work of the House-Physician.
Our hospitals, looked at from the outside, con-
vey Httle to passers-by, either as to their work or
their needs. To the general public they are known
for the most part as landmarks by the way, or as
only part and parcel of our huge thoroughfares.
What are the objects they attain, what methods
they employ for their attainment, what means they
may have with which to carry out their aims, how
far they succeed, or how f u- they fail : these are
questions which few ask themselves, and still fewer
are competent to answer. Yet Londoners pass by a
hospital on an average every day in pursuit of their
41
42 SUFFERING LONDOX.
various avocations. 1 hey have probably observed
the Brobdingnagiaii writing- on the wall, " Sup-
ported by voluntary contributions." They have
noted that outside the portals is a box, with
an inscription soliciting donations. They have
observed a knot of ill-clad, pale-faced men and
women, waiting to hd admitted to the out-patient
department. They have seen two men shouldering
a stretcher, upon which may be descried the outlines
of a human form through the scant covering which
has been thrown over it. They encounter nurses
in their picturesque uniforms, grave-faced doctors,
intent on their divine mission of relief.
All these are familiar scenes enouQfh ; but how do
they affect the majority ? How many of us can say
that they have moved us to compassion and led us
to contribute to those institutions ? How many of
us have been so far stirred as to pay a visit to
the hospital, the exterior of which we know so
well ? How many of us have taken the trouble
to even enquire whether the hospital of his
district be rich or poor ? To how many of us has
it occurred to offer our services in carrying on the
administration ? Few of us indeed. Yet such a
state of things cannot be ascribed to apathy, in-
ability, or selfishness. The spirit of charity is in
most of us ; but to the Londoner, as he lives his
busy life, few concerns save his own are any busi-
ness of his. In the provinces we find people taking
an intimate interest in their local hospital, contribut-
OUR IlOSriTALS. 43
ing to its supi)ort with both money ;ind ncrviccs.
But the hospitals of London may be said to owe
their maintenance to a handful of its citizens.
The position of affairs is largely due to the fact
that Londoners are misled by their impressions, that
they take for granted that because a hospital
stands where it does, and continues to do its good
work from month to month, and year to year, it is
Nourishing, and needs no such small help as they
could afford This is notably the case with regard
to those hospitals which occupy a conspicuous place
in our busiest and most flourishing thoroughfares.
There is one of these institutions, for example,
standing midway between two royal palaces : it
is bounded by the mansions of the wealthiest.
Rank and fashion are forever streaming past
its doors, and it faces one of the chief pleasure-
grounds of the world. The bare truth of the
matter is, that though more favourably placed than
many of the London hospitals, it is the recipient of
litde spontaneous support, and its history for many
years may be summed up as one long struggle for
existence. It is a fact, and one over which we may
well pause, that many years ago some attempt was
made to discover in how far the denizens of so wealthy
a neighbourhood contributed to the support of this
admirable institution, and amonof other things that
came to light it was found that only three dwellers
in one of our most fashionable squares were among
its subscribers. The explanation is this. The
44 SUFFERING LONDON.
great county families subscribe handsomely to
their County Infirmary and other local charities,
and when they come to town for the season they
find a thousand claims upon their money. They
should, however, remember that in their quest of
pleasure they are often the indirect cause of sick-
ness and casualties among those who cater for their
enjoyment, and that when themselves in London,
stricken down by disease, the medical aid and the
nursing so necessary to them are an outcome of
these charitable institutions.
Let us take another case. There is a hospital,
which occupies a prominent place in the very centre
of a scene of almost unceasing activity. To this
point fiock from all parts of the world the envoys
of the nations. From this district emanates the
legislation which is to affect the interests not only
of the whole country, but through the example
set by the fatherland, the whole interests and
destiny of the Empire. Almost within sight are
gathered daily during the session of Parliament,
the most powerful and most popular men of the
day. Near at hand stands an ancient Abbey with
Its staff of clergy ever ready with their tender care
for the souls of men. Here are the great Govern-
ment offices with their gigantic network of official
routine, and radiating from an imposing broadway
are thorouo-hfares of hu^^e buildino^s crowded with
workers from early in the morning till late at
night.
OUR IlOSl'ITALS. 45
One might well sui^posc from the; importance of
this famous vicinity, from the magnitude of the
undertakings, and the prestige and character of the
various workers, that an institution for the sick
occupying so conspicuous a site, would not suffer
neglect. Yet the hard battle which a hospital has
to fiorht in order to fulfil its hic^h and humanisino-
mission, is not unknown even amidst such appar-
ently favourable surroundings.
If we take other institutions less conspicuously
placed, we find a similar, and, in some cases,
an even worse order of things. For example, there
are hospitals, situated in populous and flourish-
ing districts, the residences, if not of the pluto-
crats, at least, of prosperous citizens, whose
money-making powers are largely dependent on
their enjoyment of sound health. It would be
interesting to know how many of them are aware
that one hospital alone has treated no less than over
44,000 patients during the current year, that its
expenditure, like that of many another hospital, is
in excess of its income, and that unless those for
whom it does so much come speedily to its aid, it
will again find itself obliged to encroach upon its
not too plentiful capital. There must be few who
realise these facts, as well as the sore need this par-
ticular institution has of the ventilation so important
to the progress of its inmates towards health. It
occupies a relatively small portion of a self-contained
site, a site surrounded by streets, the whole of which
46 SUFFERING LONDON.
ought to be placed at the service of the hospital, so
as to secure the necessary supply of air and light.
At another hospital, not far distant, benevolent
governors have gradually acquired a similar site
for the work of their institution, and at yet another,
the same work is now in progress. But in many
cases the cost is so great as to be almost prohibitive
without the aid of the millionaire.
Another hospital, one of our most handy re-
ceptacles of broken limbs, which stands within
sound of one of our busiest West End thorough-
fares, it might be well supposed, could not fail
to be at least in a fairly flourishing condition.
But if those who are familiar with its exterior
will take the trouble to investigate the latest
report of its affairs, they will discover that its
expenditure is ^14,924, and its total income is
^8,894.
In the case of another hospital, in a not less
central district, we find a similar state of things.
There is an annual expenditure of some ^17,000,
and only a total income of about ^11,000 with
which to meet It.
A long list, indeed, might be made out of those
hospitals which, having all the air of prosperity, are
far from prosperous. Such a list, in fact, exists,
and those whose interest I may succeed in awaken-
ing in this great question should glance through
the pages of the " Appendix." There they
will find a story of deficits which should arouse
OUR HOSPITALS. 47
in them that spirit of citizenship which tells every
waking- conscience that to do nothing outside the
narrow circle of your own little life is not to know
how to live, is not to perform the common duty
of a citizen, and, consequently, when that last and
unknown of all experiences comes — not to know
how to die.
Those who know nothing of all this, those
who are merely acquainted with the names of the
London hospitals, their outside appearance, or are
fitfully reminded of their existence by the sight of
some victim of our bewildering street traffic, would
do well to pay a visit to some of these institutions.
Thev would then see for themselves what Q-reat
humanising- work is achieved for their own good,
as well as for the crood of their fellows.
What strikes one above all things in going over
any one of our great Voluntary Hospitals is the
quiet and unobtrusive method with which the
stupendous work of these huge buildings is done.
There is absolutely no fuss. All is silently got
through as if by the agency of some invisible
hand. The responsible heads have clearly real-
ised for themselves, and act upon it as the
foremost rule of their code, that order is
Heaven's first law. The effect of all this is
impressive in the extreme. To pass from the
crowded, bustling streets, with their whirr of
wheels, into the noiseless atmosphere of spacious
wards, seems like a taste of peace after war.
48 SUFFERING LONDON.
Like true Art these quiet wards bear all the strength
and grandeur of repose, and the impressions they
call up lift the spirit into a wider and loftier world.
Few thinofs in this life of ours are more touchinof
than the sight of these wards, where suffering wan-
derers find a resting-place. Here, whatever ails
them, they are, if not completely restored to health,
always relieved. To the majority, the food they
eat and the shelter they receive in sickness is
far better than what they have experienced in
health ; for the poor and the struggling have
been always, and are, the majority. And to many
who have rarely met with human sympathy
and kindness, but have been beaten and buffeted
through their purgatory of a life, the gentle-
ness and generosity they encounter must be
like a foretaste of that Heaven of which they have
dimly dreamed. For in our Voluntary Hospitals
patients are received and looked after with a tender-
ness and a care which, to those acquainted with
Government-regulated institutions of a similar kind,
form a striking contrast. They are not there as
subjects for scientific experiment, and, save for the
regulations which administration on a larsre scale
render imperative, they are as free and as well
cared for as in a wealthy home.
Many people, who judge by first impressions or
superficial signs, are disposed to imagine that the
many applicants who seek advice often meet
with a scant welcome. It has been often remarked,
OUR IIOSriTALS. 49
for exanij'jlc. that it is not right that the out-patients
who crowd the hospital door should be kept waiting
so long as they sometimes are. But it should be
taken into account that stated times for the reception
of patients are fixed, and that each individual of the
knot of pale-faced men, women, and children that
lingers for an hour or more at the threshold before
the appointed time is there of his own choice — is
there in the hope of being the first to be relieved.
It would be as ridiculous to censure the manaQfers
of the theatres for the often obstructive crowd of
pleasure-goers outside the pit and gallery entrances
of places of amusement, who take their stand with
the intent to scramble to a front place, as to blame a
hospital for not instantly admitting the sufferers. The
•attention they receive, when they pass one by one
through the hands of surgeon or physician, must have
struck all who have witnessed the spectacle. Many
of the patients of course are disposed of in a couple of
minutes, but in all cases their complaints are cor-
rectly, if speedily, diagnosed, and they are given
the advice or the aid they seek. Rapid decisions
must be the order of the day where the man
of science has to deal with nearly a hundred
patients in a couple of hours, and if at times
there is the indication of curtness, it is merely
apparent, and the curtness of a friend whom time
will not allow to indulge in the graces of courtesy.
The almost miraculous power of summing up the
evidence in disease in the out-patients' department
50 SUFFERING LONDON.
of a great London hospital — and, above all, in the
special hospitals — is a sight not to be missed by
those who would study the feats of modern science.
Another interesting department is the kitchen.
Were you taken into one of these without knowing
the history of their handiwork, you might imagine
that here was the source of supplies for a household
of fastidious giants. Everything is on an enor-
mous scale. The battery of huge cauldrons,
pots, and pans, might serve as, w^hat the theatrical
people call, " splendid properties " for the scene of
a pantomime. Here, too, you find the same quiet,
systematic workmanship going on, and all is
achieved by the aid of such modern appliances as
we have. In most hospitals gas is used for culinary
purposes much more extensively than coals. The
time at which to visit the kitchens is about twelve,
when all hands are busy in getting ready the mid-
day meal for the patients.
It is a favourable time, too, at which to see the
wards, for then the sufferers, in many cases, while
the meal is being served, seem diverted for the
moment from the monotony of their life and the
anguish of their pain.
The wards are classified under the heads
of medical wards and surgical wards, women's
wards and men's wards, accident wards and
children's wards. In the old days these wards
were dreary and comfortless in the extreme,
with their bare walls and Q-eneral colourlessness.
OUK HOSPITALS. 51
But in recent times an element of brightness has
been introduced in the shape of red or other
coloured coverlets to the beds, pictures or engravings
on the walls, with a profusion of flowers on the
tables, sent by some thoughtful patron. To pass
through the avenue of beds in these vast dormitories
and note each face with its history of suffering or
wrong, to meet the smile of the saint-like nurses,
who have cheered many a lonely soul on the road
to its last resting-place, should stir the most callous
heart to sympathy.
The various cases which mark the stages between
life and death In these institutions are most striking.
In one bed you may come upon a patient, wan,
gasping, in the twilight of his last hour ; in
another, one who has passed into the stage of
convalescence, cheerfully engaged in reading or
knitting, and contemplating a re-entrance into the
healthy world.
Then, how interesting it is to inspect these wards
at the visiting hour. Chiefly neatly dressed women
concerned in the welfare of their kindred or
friends, holding quiet conversation with the sick,
enquiring into their condition, their comfort, and
their wants, bearing the appearance of strangers in
such a scene, who bring messages of sympathy from
the home circle.
It must always be a delight to those who visit
the children's ward to see how happy and playful
these little creatures become so soon as they are
0-
SUFFERING LONDON.
free from pain, some in the keen enjoyment of their
toys, some with their toys beside them as if they
too were sick.
Then the Accident Ward. How readily one
recognises a broken hmb, with the leg raised, or the
arm in a sling. Some have their face bandaged,
the consequence of a fray, which may be sooner
forgotten than the cause.
The impression which everyone must receive
from visiting those sick-chambers is the patience
with which suffering is borne, encouraged no doubt
by the hourly ministration of the attendants.
It is only the professional man who knows how
ereat a varietv of disease is relieved in these bene-
ficent institutions. The consumptives, who are
most to be pitied of all our fellow-creatures, find
their declining lives at least made supportable, their
sufferings being promptly met and alleviated, their
nights quieted. Even now, when Scepticism is in
full force as to the value of medicine in disease,
there is one thinof that is undeniable : it is that
remedies for mitigating pain are constantly increas-
ing in number and power, so that many a paroxysm
that reaches anguish may now be instantly allayed,
instead of the sufferer passing through hours of
torture. Look at the ague-stricken who come up
from the Essex marshes, now shivering, now burn-
ing with fever, to which for weeks past they have
been martyrs every other day. Here the remedy
is at hand. The disease is at once arrested, and
OUR HOSPITALS. 53
the piUicnt is gTciduiilly restored to his former
healthy condition.
Here is a man who was bhnd, and he can now
see. Here is another who was deaf, and he can
now hear. Go on to another bed, and you come
upon one who for months had lain awake through
the night listening to every sound, his eyes now on
the night-lamp, now on the window, looking for the
first streaks of dawn. At last he knows what it is
to restfully close his eyes and pass into the forget-
fulness of sleep.
All miQ:ht visit with advantao;e to their better
feelings the hospitals for the paralytic, if they would
thoroughly realise how the strong may be struck
down, how those who once trod the streets
so briskly, moving from place to place on business
or pleasure, can now, as they lie helpless, think
only of the blessings they have lost. And yet
may some of these be seen in the different stages
of recovery : progressing from a motionless posi-
tion to a creeping movement, from one part of a
ward to another, to finally reach the courtyard, and
once more enjoy the outer air ; then, after a time,
throw aside either one or both their crutches.
The working-day can be best illustrated by
sketchino: the routine work of the interne at a larq-e
general hospital. The interne — house-surgeon or
house-physician — represents to the public the
hospital itself — it is his skill that the out-patients
describe to one another with gusto ; it is his possible
54 SUFFERING LONDON.
mistakes which receive such bitter and garbled
notice in the daily press.
Early in the morning, at nine generally, the house-
surgeon attends at the out-patient department to see
old " casualty patients." This requires a little ex-
planation. The casualty patient, at the time that the
casualty — cut, fracture, poison, or what not — occurs,
presents himself in the accident ward of the hospital
(open day and night), and is there seen by the interne
of the clay, and advised. These cases divide them-
selves into two classes, those that can be treated
outside, and those that require admission to the
hospital. Of those that are admitted to the hospital
more anon ; but those whose ailments can be met by
out-door relief are told to come to the out-patient
department on a certain day at nine in the morning
to report progress. In this manner the house-
surgeon will collect about himself a private clientele
who will absorb about an hour of his morning time,
when complaints are comparatively trivial, and who
for the most part receive no treatment save at his
hands. In this way the house-surgeon acts as a
barrier between the public and the staff of the
hospital ; for by thus sifting the cases he is able to
present for the consideration of his superiors such
cases as require experience for their attention, and
to obviate the waste of their time by simple and
trivial matters.
The house-suroreon will next make a round of his
wards. Here he will find two sets of cases awaiting
OUR HOSPITALS. 55
him — new and old. The new patients are admitted
either by order of the lay governors, by sanction of
one of the medical staff, or by the house-surgeon from
the casualty department. The latter are the most
urgent, and form the most important surgical cases
in the hospital. It is the house-surgeon's duty to
inform himself as to what is the exact condition of
these new cases, and to elicit from them any in-
formation that miofht tend to make the diag-nosis
easier and clearer. But It is not his duty to initiate
the treatment of them. Every new case is placed
under the care of one of the medical staff, who con-
firms or contradicts the house-surgeon's view, and
lays down the lines upon which treatment is to be
carried out. The house-surgeon's duty is to carry
out this line of treatment, and to keep notes of the
result for the information of his superior at his next
visit to the sufferer.
The round of the wards will be lengthy and
arduous exactly in proportion to the number of beds.
If a house-surgeon has fifty or sixty beds under him,
ten or a dozen of them occupied by new patients, and
another ten or a dozen requiring daily changes of
dressing, or daily assistance, it can be readily seen
that his morning will be full. If he has a large pro-
portion of old cases, whose condition has already
been accurately ascertained, the round can be made
quite conscientiously with great rapidity.
At mid-day the staff arrives — certain surgeons and
physicians having certain days allotted to them.
56 SUFFERING LONDON.
The staff-surgeon goes round his cases with his
house-surgeon, receives the reports of progress or
decHne, and gives instructions as to the new patients
that have come under his care since his previous
visit. It is at this round that all the clinical teach-
ing in our London schools is chiefly done, if the
material before him leads the surgeon into lengthy
and interesting exposition. It may be late in the
afternoon before it is completed. When it is com-
pleted, and the staff-surgeon has gone, the house-
suro-eon's work beofins apfain. First, he must start
the treatment of the new patients in accordance
with the orders he has received ; and, secondly, he
must make any changes that have been suggested
to him in the remedies of the old patients — these
changes being dictated partly by the daily notes and
partly by the staff-surgeon's observations. He will
then be free — unless he happens to be the interne
on duty during the whole day — until it is time to
make the night round. The hour at which this is
made varies in different hospitals.
It is impossible to do more than hint — in
this way — at the daily routine inside the
hospital.
With regard to the out-patients, they again are
recruited from three sources : — The old in-patients,
whose case is sufficiently advanced to warrant their
being treated as out-patients ; persons recommended
by the governors as suitable for out-patient relief;,
the more important casualties that have come under
OUR IKJSPITALS. 57
the internes notice' The out-patients attend at a
certain hour in the department set aside for them,
and are seen by the assistant staff-officers of the
hospital. Any details in their treatment that require
alteration, any surgical assistance, any instrumenta-
tion that may be necessary, will be placed in the
hands of an assistant house-surgeon, who is to the
assistant staff-surgeon what the house-surgeon Is to
the staff- surgeon.
In addition to the general out-patient department
of the hospital, there are in every hospital special
departments. Certain hours and certain of the out-
patients' rooms are given up to these cases, and the
specialists upon the staff attend to them, deciding
the line of treatment to be adopted, and handing
over the patients to the care of their assistants during
the treatment. There will be In a big Institution
facilities for special patients available every day, and
the routine of the working-day will always Include
the admhilstratlon of one or two such departments.
■^ Different institutions have different regulations with regard to
their out-patients. These are the regulations common to two of
our general hospitals, and one special institution.
CHAPTER IV.
WHAT THE HOSPITALS DO FOR THE PEOPLE.
^^ If it zvsre not for the hospitals we might expect London to be
consumed by fire from Heaven.^''
Average Appreciation of our Institutions — the Progress of ]\Iedical
and Surgical Science — Hospital Practice — Army of Nurses
— Tlie First Nursing Institution — Florence Nightingale —
The Scarcity of Nurses — State Interference — The Bureau-
cratic System in Russia — Master and Servant — Sick Servants
— Employers Liability Act — The Labour Market — The
Wealthy Classes and the Hospitals — Thoughtless Almsgiving
— Organised Charities.
If an averasfe Enorlishman were asked what insti-
tutions were of most service to him, he would
probably enumerate a great many before he came
to the hospitals. With the usual praiseworthy
loyalty he would, if a Conservative, in the first
instance, cite the Royal Family and the Court, then
the House of Lords. If a Liberal, he would
probably regard the House of Commons as indis-
pensable to his happiness. Religious people would,
in contradiction to each other, each place the church
of their own persuasion at the top of the list. Many
would not consider their lives secure without the
army and navv. Timid people would not think life
58
WHAT THE HOSPITALS DO FOR THE TEOPLE. 59
worth living;- if it were not for the pohce. Those
who have not convinced themselves of the useful-
ness of competition, would probably consider our
National Postal Institution as one of the most indis-
pensable factors in our civilisation. Our commer-
cial men would probably look upon the Bank of
England as our greatest national mainstay, at least
so long as we can go on without suspending the
Bank Act.
As to our hospitals, most people would not
think of them at all, or would place them at the
bottom of the list. Yet it is an undeniable fact
that our hospitals, while marking the progress of
civilisation more than any other institutions, are
indispensable to society as a whole in its modern
form, and a safeguard to the individual against mis-
fortunes and sufferings worse than death. That this
great truth is not realised is not surprising. The
times we live in put a strain upon human energy
which leaves but little leisure for reflection. Action,
business, speculation, and practical politics — these
are the watchwords of to-day.
Individual success is the first and immediate
goal. All other considerations are too often
banished to be taken up when the harbour of
success is reached. And with most men the
harbour of success is never attained. It looms
still in the distance, more brilliant, more seduc-
tive than ever, when, fata morgana like, It dis-
solves and earth claims Its own again. The poor
6o SUFFERING LONDON.
man looks upon a moderate competency as his
measure of success ; the man with a competency
desires a fortune ; and the capitaHst longs to be a
millionaire. The citizen dreams of civic honours.
When all this is realised, it is Parliament that fas-
cinates him ; and, incredible as it may seem to the
philosophic mind, successful politicians in their old
age snatch at a title or a peerage as eagerly as a
child at a new toy, indifferent seemingly to the
impression which their eagerness for honour con-
veys, namely, that vanity and not duty has been the
mainspring of their lives.
It is characteristic of the age that superficial
views should take precedence of great funda-
mental facts, and that the problems of the mo-
ment should be considered from a narrow, per-
sonal point of view, with expediency for its aim,
while first principles are ignored. The intense
excitement of pleasure, business, and work, and the
moments of prostration which supervene, render us
unfit and disinclined to take the healthy plunge into
serious and logical thought. Easy-going cynicism
and selfish pessimism represent the compass of our
philosophy. We dispense with opinions and lazily
follow some authority, or we blindly endorse the
latest popular notion of the day. Our measure of
merit and ability is success. The blatant but suc-
cessful rogue or charlatan we hail as the practical
man of the aoe, and we lauQ^h at the sincere but
unsuccessful enthusiast. The man who reasons,
WHAT THE HOSPITALS DO FOR Till-: PEOPLK. 6 1
who Stands up for principles, who looks to the future
as well as to the present, is voted a bore ; while
scoffing and persiflage seldom fail to secure a
hearinof.
This indifferentism, or what our fastidious con-
temporaries would call it, this /in de sicclc tone, has,
like all social phenomena, its excuses and its causes.
The causes will disappear, and, when they do, a new
spirit will preside over the people. But, while things
remain as they are, it is no wonder if so few-
evince an interest in our hospitals — these institu-
tions which are our pride, which are the expres-
sion of our most humane instincts, and our best
defences ao-ainst disease and death.
A little reflection, however, ought to convince
English men and women that the hospitals deserve
a very different support to that which they receive.
Most people who have passed their years of youth
are more or less impressed with the fact that sick-
ness and accident may at any time make their life
a burden to them. When mention is made in con-
versation of a painful malady, or a serious mishap
having befallen somebody, we always hear ques-
tions being asked about the individual's age, his
mode of living, his heredity. These questions
prove that the inquirers are asking themselves
in their own minds what risk they would run
under similar conditions. It is in moments like
these, when Illness and bodily pain are by the
experience of others brought vividly before the
62 SUFFERING LONDON.
imaorination, that our thouo^hts dwell with some self-
gratulation on the great progress which medical
and surgical science have made, and are every
dav making:. But how often is it remembered to
what a great extent such progress is due to our
hospitals ?
How difficult, not to say impossible, would be
modern training for the medical profession without
the hospitals. It would take a student a lifetime to
learn what he now learns in five years, and it would
be out of the question to form such teachers as we
have in the present day. The wonderful facility
and security with which the most delicate opera-
tions are performed at a minimum of suffering to
the patient, are due to the exhaustive study, the
methodical observation, the large experience con-
veyed to many by each particular case, all of which
is a chrect outcome of our hospital system.
It is no insult to the medical men of the past to
say that some of our worst doctors nowadays are
better fitted to benefit their patients than their pre-
decessors of some generations ago. The rich man
who liberally pays the skilful doctor remains largely
indebted to our hospitals for the cures effected in
his household. That hospital practice is the best
way for a doctor to advance in skill is an universally
acknowledged fact ; but, in England and in other
countries where a similar system of remunerating a
doctor for his services is prevailing, hospital practice
is of special importance. As the doctor is paid for
WHAT TIIH HOSPITALS DO FOR TIIH I'KOrLE. 63
SO much per visit or consultation, a great majority
of the private cases which come before him add
nothing to his experience. He sees the patient, he
gives a prescription, recommends a certain diet,
certain exercise, baths, change of clothing, etc. But
he is not able to judge of the effect of the treatment
when he never sees the patient again. As far as
the doctor knows, the patient may have succumbed
or have been cured. The patient might have found
himself so much better that he regarded another
visit to the doctor as superfluous. He might have
consulted other medical men. He might not have
taken the recommended medicine or have followed
the doctor's advice at all.
There are a great number of cases which
the practitioner may follow up to a certain point,
but which he is not allowed to attend up to com-
plete recovery. Nor can the experience gained
in private practice, even in cases watched by
the doctor from beginning to end, be so depended
upon as that gained in the hospitals, because in
houses where trained nurses are not engaged, the
advice of the doctor regarding treatment is too
often neglected, and the treatment he prescribes
carried out in an imperfect manner. When
wealthy people of this country compare the medical
assistance they can command with that which their
forefathers had to submit to, they should not forget
that the country that wishes to have good doctors
should have good hospitals.
64 SUFFERING LONDON.
But good doctors are not the only benefactors
which are vouchsafed by the hospitals to the wealthy.
The great army of trained nurses receive their in-
struction in these wonderful institutions. It is with
the trained nurses as with many other blessings of
our time : when we once become used to them,
we wonder how it was possible to do without
them. It is a pity that we cannot pass a law that
such wealthy Englishmen who do not support our
hospitals according to their means should, in case
of illness, be nursed by women of the Mrs. Gamp
type, in order that they might realise the tragic side
of Dickens' sketch as keenly as in health they enjoyed
its comedy ! Foreign readers of Dickens, while
acknowledging the value of his works, often com-
plain that he was in the habit of overdrawing his
characters and turning them into exaggerated cari-
catures. But if they knew this England and this
London of ours better than they do, they would
probably change their opinion. A friend of mine,
a foreigner, who had held the general Continental
opinion about Dickens, but who lately had ample
opportunity of studying us, expressed his belief that
there were plenty of people in London who made
it a point to constitute themselves into plagiarisms
of Dickens' characters.
The sick-nurses before 1840 cannot be said to be
libelled at all by Dickens' creation. A better drawn
type than Mrs. Gamp can hardly be conceived. We
must not forget that in this country the great bulk
WHAT THE HOSPITALS DO FOR THE PEOPLE. 65
■of the people used to consider and. I am afraid, still
•consider it as the hei^-ht of Qrentilitv to do nothinLT.
and in former days sick-nurses were not held in
•estimation according to their usefulness to their
fellow-beings, but were despised because they under-
took unpleasant and badly paid work. To have
their heart in their mission, and a natural aptitude for
the profession, was out of the question altogether.
Nurses were considered qualified as long as they
were not of Irish nationality or not given to drunken-
ness. /A doctor tells me that these nurses were
alwavs eno^aored without a character, because no
respectable people would undertake so disagreeable
an office, i
Since 1840, when Mrs. Fry and Lady Inglis
founded the first Nursing Institution in Osnaburgh
Square, under the patronage of Queen Adelaide,
and at the suggestion of Dr. Good and the poet
Southey, and especially when ^liss Florence
Nightingale, by her devotion and heroism, had
fanned into fiame the spark of self-sacrifice and
sympathy with suffering, which lies deep in every
true woman's breast, the small armv of trained
nurses has been steadily on the increase.
It is to the snobbish and hypocritical spirit
which prevailed in this countrv during the first
half of this century that we must attribute the
opinion that ministering to the sick and the
.suffering was a degrading occupation. The
.ancient nations discovered early that women had
■66 SUFFERING LONDON,
been well fitted for the part of ministering angels.
In the dawn of civilisation they alone were en-
trusted with the care of the sick, and were held
in esteem for the services they rendered. In the
Scandinavian countries, during the Viking days,
every mother instructed her daughters in nursing
the sick and, what among them was a far more im-
portant work, the tying up of wounds. From the
Middle Ages up to the present time the Sisters of
Charity on the Continent have devoted themselves
to sick-nursing, and have looked upon their mission
as the best way of following the Master they wished
to glorify : while, in modern England, we have a.
considerable number of religious sisterhoods which
devote themselves to nursing.
All this proves that woman is endowed by nature
with the ability and willingness so valuable at the
bedside of the sick. But natural ability and willing-
ness are of little avail without the skill which train-
inof alone can o-ive.
As long as the heart of English women remains
what we know it to be, we shall never lack the best
raw material for nurses. But to train them in such
numbers as the Interest of our sufferers demands
obviously necessitates considerable outlay. Funds
are needed for nursing Institutions, for convalescent
homes, but more especially for hospitals, where
alone the requisite experience can be acquired.
Anyone who looks over the present list of nursing
institutions In Great Britain, and compares it with
\V1IAT THE HOSPITALS DO TOR THE PEOrLE. 6/
what it was some years ag-o, iiiio;-ht think that the
demand for nurses is fairly well met. But this is
1)\' no means the case. On the contrary, the
iiixurv of a trained nurse is far from beincT within
the reach of the great majority of sufferers. It is as
yet a novel institution, vouchsafed only to the
privileged inside and outside our hospitals. Nor
are the nursing institutions all that they should be
— and all for the want of funds.
During the recent epidemic the well-to-do classes
ot London, able and willing to pay for trained
nurses, had a slight experience of what scarcity
of sick nurses implies. Disappointment and discon-
tent were freely expressed all over the city, and in
many cases those grumblings against Government
were indulged in, which threaten to become
the characteristic of a people once boastful of
being the most self-reliant nation in the world.
Strange to say, it is hardly likely that a single one
of those who complained of the scarcity of nurses
gave any thought to the amount they had con-
tributed towards nursing institutions or towards
hospitals, or whether indeed they had contributed
to them at all.
If the votaries of grandmotherly government
are under the impression that hospitals and nurses
can be supplied by government without contribu-
tions from those who have the wherewithal to pay,
it is no wonder that the protective spirit has,
in spite of its baneful influence abroad, at last
68 SUFFERING LONDON.
invaded England. If State interference is pushed
to the extent of placing our hospitals and nursing
institutions at the mercy of the barnacles of the new
bureaucracy, a bitter disappointment is in store for
the advocates of State Socialism: for we learn from
the experience of Russia and other countries, where
the bureaucratic system is highly developed, that
instead of having hospitals without paying for
them, we are likely to have to pay for hospitals
without having them.
All the upper classes and the middle classes, down
to the families who keep only one servant, are
benefited by our hospitals in a way that saves not
merely a considerable outlay, but a mass of trouble
and inconvenience, to which few modern homes are
equal, and responsibilities which few house-wives
are fit to bear. To send off to the hospital any
servant who falls ill or meets with an accident is,
nowadays, a custom so firmly established, that
householders have come to look upon it as a
natural rieht. If this facilitv did not exist, the
present relations between servant and master would
be impossible.
In this respect, as in many others, society is in
a transitory state. The old feudal and patriarchal
systems are dying slowly, and the new commercial
system is asserting itself more and more. While
this slow transition lasts, the relations between
masters and servants are framed on a hybrid prin-
ciple, and for this reason give satisfaction to neither
wiiAi" riii-: iiosriTAi.s no for the pf.oi'LK. 69
the one nor the other. In olden times domestic
serv;ints were paid ludicrously small wages, but the
patriarchal system involvetl advantages for the
servants which it is difficult to estimate in money.
They were not only supplied with all the necessaries
of life, but they were made to feel that the house in
which they served was a real home. They shared
the joys and the sorrows of the family, and took
their respective place at the daily meals, ceremonier,
and festivities of their masters, in a way of which
the present stiff and formal marshalling of the
household to family prayers is a parody. At the
time when such mottoes as that of the Prince of
Wales, " Ich Dien,"' were emblazoned on the shields
of the nobility, to serve was considered less dero-
gatory than to do other manual work. In noble
households the children shared with the servants
the duty of attendance on elders and guests, and
the youthful scions of noble families were exchanged
in order to serve as pages.
The system had great advantages both for the
servant and his master, but it was not without
its drawbacks. It took large resources and a big
establishment to extend the paternal care to all
the servants in the house, often from their birth
and generally to their death, to provide them with
all their wants, to educate and instruct them, to pro-
tect them and advise them throughout life, and care
for them in their old age. All these duties heavily
taxed the administrative ability of masters. A certain
JO SUFFERING LONDON.
consideration in the treatment of servants was also
necessary, because to chano-e a servant was trouble-
some and dangerous, and if by bad treatment the
servant was demoralised and his temper soured, the
master suffered. Besides, it was necessary to treat
servants in such a manner in order to secure, through
their fidelity, alfection and esteem — what we now
expect from them in return for money.
As the commercial system advanced, and the
constant increase of payments in cash caused finan-
cial embarrassments even to the richest masters, it
became more and more difficult to keep up establish-
ments on the old, broad, feudal footing, and the re-
lations between masters and servants were based on
a contract and short notice. As compensation for
what they lost, the servants obtained higher wages ;
but while their privileges speedily disappeared one
after the other, their wages rose very slowly. The
masters, being less particular as to who served them,
went into the open market for servants, and there
the supply was plentiful.
Thus it happens that nowadays English house-
wives are prone to indulge in Jeremiads, because
it is so difficult to get good servants, even at
wasfes which are so much hio^her than those
that were paid of old. It is so easy to com-
pare two sums of ready cash representing the
old and the new wages, but few housewives have
an idea wiiat the servants have lost by the modern
system. in England, we have a comparatively new
WHAT THE HOSPITALS UO FOR THE TEOPLE. /I
middle-chiss who possess no feudal traditions, and
who have never heard of any other relations be-
tween master and servant than those familiar to
themselves. The housewives of this class are gener-
ally more exacting and more apt to complain about
servants than the descendants of the feudal masters,
and they are, as a rule, extremely liable to err on
the side of harshness. They are anxious, to use
their own expression, that the servants " should be
kept in their place," evidently, because they see so
small a difference between themselves and the ser-
vants, that the breaking down of the artificial
barrier of petty tyrannies would lead to that famili-
arity which breeds contempt.
The present unfortunate relations between master
and servant are partially due to the impulse which
the transition from the patriarchal to the commer-
cial system received in the middle of this century.
The Free Trade Reform, some other steps towards
individual freedom, and the abolition of a host of
State-nieddling Acts, all of which characterised the
Cobden era, increased enormously the prosperity
•of the country, and the incomes of most people
improved. An incredible number of families rose
from the ranks of the workincr-classes to that of
the wealthy middle-class. They all wanted ser-
vants, and while the price of female labour rose in
the mills and the workshops, there was an extra
■demand for servant girls on the part of the new
jiiistresses.
/-
SUFFERING LONDON.
The results were that wages rose, that trainee?
servants became scarce, and that servants coulcf
show more independence. A French proverb'
says, "Tel maitre, tel valet," and there can be
no doubt that the complaint we nowadays hear
about bad servants ought to be translated into a
criticism of the mistresses. The newly-fledged
housewives, without education, presiding over numer-
ous servants, resented the high wages and the
independence of the servants : the servants, learn-
ing little of their mistresses, did not serve them
with the willingness with which they serve what
they call " real ladies," and in this way, the same
animosity which characterises the relations between
employers and employed in trade became the
leading feature of the relations betw^een master and
servant in all classes.
In this deplorable state of affairs, it cannot be
expected that the masters and mistresses should
cheerfully tender to their servants those cares which
suffering and illness demand. The contract be-
tween them being a harsh business transaction, in
which the one has paid as little as possible, and the
other has only rendered strictly prescribed services,
the master has come to regard his responsibility at an
end when the wages are paid. In so doing he feels
no compunction : he does not damage his character
in the eyes of his surroundings. Sad to say, even
people who are ostentatiously religious, and who
wish to be looked upon as patterns of morality and
WHAT THE HOSI-riALS DO I'OR THK PKOIT.K. /J,
charity, too often forget that charity l^egins at
home, and dismiss their servants, especially the
female ones, as soon as sickness has rendered
them incapable of doing their work. Once they
have left the house, either to go to the hospital, to a
poverty-stricken home, or to perish in the streets,
they are entirely and forever out of the mind of
the employer.
It has more than once been attempted to render
the X'oluntary Hospitals partially responsible for
this harsh treatment. "Why," it is said, "should
we be burdened with sick servants when there are
hospitals where they would be well treated ? "
But this is not logic ; it is subterfuge. If the hos-
pitals were ample enough to accommodate all the
sufferers of the nation, if they were all as com-
fortable as a middle-class home, and if they were
supported entirely out of the rates, it is most pro-
bable that, like all socialistic institutions, they would
provoke those sociological reactions which are seldom
foreseen. For such reactions are generally found
out only through experience. It often happens that
socialistic institutions introduced in the hope of
bringing about a small temporary good, produce a
widespread and lasting evil. But our best London
hospitals are not socialistic institutions ; they are the
outcome of free co-operation between free citizens
who are actuated by their sense of justice and charity.
If, therefore, the existence of our Voluntary Hospitals
encourages the harsh treatment of servants, it is
74 SUFFERING LONDON.
because the master, either through meanness or
ignorance, takes advantage of the hospitals without
■contributing to the hospital funds.
With regard to labourers, State Socialism has been
resorted to in the form of the Employers' Liability
Act. So far it has been only a partial success. It has
been a source of expense to the employers without
affording the hope of protection to the labourers.
Its inefficiency has been glaring enough to call for a
new Bill from Parliament. This new Bill will be an-
other attempt to assert more stringent clauses — more
compulsion and more restriction upon the freedom
of contract. All this Parliament can do, but it can-
not prevent the sociological reactions more than an
engineer can increase the speed of a machine with-
out loss of power. At the promulgation of the
Employers' Liability Act, the first thing that hap-
pened was the establishment of Insurance Companies
to overtake the risks of the employers.
Discontented working-men say that the object of
these insurances is to place the poor disabled working-
man in the unfair position of having to fight before
the tribunals a company with millions at its back
before he can get his compensation. But in fairness
to the employers it must be said that the insurance
.against the liability which the Act imposes upon
them is the natural outcome of our commercial
.system. Without insurance the risk was undefined,
.and could not be charged on the price of the goods
they produced. The insurance premium can be
^V11AT TlllC llOSriTALS DO FOR THE PKOPI.K. 75
•calculated to a nicety and is put down as part ot
the wages; it appears in the price list of the goods
and acts as a factor in the diminution of sales, and
the encouragement of foreign competition. It thus
reduces the export, the ©importunities of work, and
lowers waees. Throuoh this lowerinof of wafjes the
working-men lose far more than they gain by their
nominal protection. I may repeat here what I said
about the hospitals in bureaucratic countries : when
Socialism is resorted to, working-men have to pay
for protection without getting it.
The masters of domestic servants do not insure
against their liabilities because they are moral and
not legal — and if they were legal, the servants,
like the working-men, would get the worst of it.
Wti find, then, that the transition from the feudal
system to the commercial system has made it
easy for the masters to shirk feudal liabilities
— towards their servants in case of illness and
■old age, — though the commercial system is not
sufficiently developed to free them from moral re-
sponsibility. They simply take advantage of the
excess of supply over demand in the labour n'larket,
while they use the Voluntary Hospitals as an
insurance on which they are, however, very back-
ward in paying their premiums, if, indeed, they ever
pay them at all.
I do not think that I sin on the side of harsh-
ness if I compare householders, who employ
ilomestic servants without contributing proportion-
76 SUFFERING LONDON.
ately to the hospitals, to shippers of goods who'
are protected by an open policy, but are mean
enough not to declare on that policy, and not to
pay the premiums for such goods as arrive safely,
but claim from the company every loss they make.
I hasten to add, however, that if so great a number
of householders subscribes little or nothing to the
hospital funds, it is because they have never realised
their moral obligation in this respect, and I feel sure:
that v^hen their real position in relation to the
hospitals is made clear to them, in their English love
of fairness they will frankly admit their obligation.
They cannot fail to see that the hospitals, besides,
affording many other benefits, are defraying the
expenses of medical aid and relief, nursing and
nutrition, for their servants during sickness, which,
were we still living under a feudal system, the
masters would themselves have to pay.
Invaluable as are the strictly practical advantages-
which the wealthy classes derive from the hospitals,
they do not, however, exceed a moral advantage
which cannot be enough insisted upon. For, while
the hospitals care for and cure the bodies of both
rich and poor, they offer a genuine opportunity for
the rich to exercise that charity, without which the
soul of the most easy-going would sicken and the
life of Fortune's ofreatest lavourites would become
insipid. »
As this book should appeal not only to the
followers of Christ, but to all sects, as well as to those
WHAT rilK IIOSI'lTALS DO FOR THE ri-OTLK. //
whose tendencies are towards Ag-nosticlsni and
•Scepticism, it is out of the question for me to regard
this subject froni a sectarian, or even from an cx-
•clusively reHgious point ot view,
Charity existed before Christianity, and long be-
fore humanity profited by Christ's example and
teaching, it had learned by experience that all our
misfortunes come from ourselves, and all our happi-
ness comes from others. \ oltaire said that if God
did not exist, it would be necessary to invent him ;
.and one might say that if there were no oppor-
tunities for the exercise of charity, it would be neces-
sary to make them. Be it the voice of Nature,
•divine promptings, or the effect of education, the
•craving to sacrifice on the altar of charity is with us
all. It is, or has been made into an irresistible
yearning which can only be suppressed at the cost of
moral and intellectual degradation. We all know
•cases where self-indulgence and luxuries of all kinds
have been resorted to in order to silence the still
small voice, and we have all seen how such attempts
have resulted in vicious habits and uncontrollable
journeyings towards greater and more unhealthy
excitement, in the destruction of health and happi-
ness.
In these times in which we live, it is not
possible to taste the cup of pure delight save
by ministering to the wants of our sufferin^i-
fellow-beings. The Roman Catholic Church pre-
.scribcis charity to the poor as an indispensable
78 SUFFERING LONDON.
condition for a religious life, and is said to^
have thereby encouraged much mendicancy and
much thriftlessness. It is not for me to sit in
judgment and determine as to whether the social
evils which universal almsgivings are supposed to-
have introduced, have been worth the charity
which prompted them. But in England at this-
moment no educated person can with any self-
satisfaction indulo-e in thoughtless almsgiving, for
the mischief it might produce is persistently de-
scribed in our sermons, our literature, and our press.
To exercise charity towards those who best deserve
it, and who would be elevated instead of degraded
by it, is not a difficult task, but it requires a great
deal of personal exertion, much time, as well as.
judgment and a tact which are not given to all.
Now, time and work are just what so many
people in our full-speed life can ill spare, and in
many cases charity must be exercised by deputy or
it will tarry the source from which the good gifts
tiow. It is such circumstances which have pro-
duced the demand for organised charities. jMost of
these are excellent in their way, though, of course,,
many of them work with a great amount of friction.
I do not here refer to the municipal charities dis-
pensed by the workhouses. The anxiety of the
authorities and the officials to keep the statistics of
pauperism low has made those benefits which reach
the poor through the Unions so distasteful that,
some of the people prefer suicide.
WHAT THR TTOSriTALS DO FOR TIIK PKorLi;. 79
Charity so little preferable to death cannot
\k: called charity at all. Most institutions of
organised charity, even those entirely supported
b\- voluntary contributions and free from bureau-
cratic taint, have drawbacks and defects which
render it impossible for them to take: the place
of direct. Christian, personal charity. A great
deal of the money contributed, instead of directly
btMiefiting the poor, is spent in administration
and supervision. Sometimes the bulk of the
funds is expended in preventing the little that is
left from miscarrying. By undue patronage,
intrigue, and traffic in votes, the acutest, but not the
most deserving, easily become the beneficiaries of
charitable institutions.
But of all objections against charity by deputy
— or Christianity made easy — the strongest are,
that it humiliates the beneficiaries, easily wounds
the feelings of the sensitive, and that it reaches
the most clamorous rather than the most deserv-
ing. To have paid the poor rate and to have
subscribed to the Charity Organisation Society will,
therefore, not satisfy the conscience of such well-to-
do people who recognise that life has its responsi-
bilities. And yet we know that, unfortunately, such
taxes and such contributions are, in many cases,
quoted as excuses for withholding a helping hand
even where help is most urgently needed.
The \'pluntary Hospitals are the one form of In-
direct charity against which hardly any one of the
So SUFFERING LONDON.
above objections can be cited. To be nursed in
such institutions can lower no man in his own or
•other people's estimation. It must be remembered
that there is nothing degrading in receiving charity,
when circumstances which render it necessary do
not oriq^inate in a personal defect of our own.
Every human being is the object of human charity
from others from his birth up to the age of discretion.
Illness and bodily ailments render the most wealthy
4md powerful dependent on the charity of their sur-
roundings. A shipwreck, a railway or carriage acci-
dent, or any other momentary abnormity or unfore-
seen incident in our plans or our supplies render us
fit objects of Christian charity without degrading us.
A man disabled by illness or accident, which
•evidently demands the care of a hospital, does
not suffer in his dignity because his fellow-citizens
volunteer to tender him such cares as he cannot
-command himself. Nor can there be much mis-
•carriage of charity in our hospitals. The need
of such help as they proffer is generally too
<ivident to allow of many mistakes. Besides,
•our hospitals are not entirely charities by agency.
Already a great deal of personal service is given.
Philanthropic ladies render invaluable aid as nurses,
or by supervising and inaugurating nursing institu-
tions. The services of men are wanted on the
comimittees and many business departments of the
institutions. With few exceptions all the medical
■offic3rs give their services for nothing.
WHAT T]I1': HOSPITALS J)0 FOR 'J'lIK PEOPLi:. 8l
On these ijrounds, I claim that our Voluntary
Hospitals offer the very best opportunity of exercis-
ing charity to all those members of the well-to-do
classes who find it impossible or difficult to practise
direct and personal charity, as well as to the work-
ing-classes who may fear that their offerings may be
too small to do irood sino-le-handed. Collective and
spontaneous charity cannot possibly take a better
form than hospital aid. For the charity proffered
by these institutions of which our nation is justly
proud is like mercy —
'' It droppeth as the gentle rain from Heaven
Upon the place beneath ; it is twice blessed :
It blesseth him that crives and him that takes."
CHAPTER V.
WHAT THE PEOPLE DO FOR THE HOSPITALS.
" They anstver in a Joint and co)-porate voice.
That no-iu they are at fall, loant treasure, cannot
Do what they would."
The Inadequacy of Contributions — ^150,000 a Year Required
— More Personal Service Needed — Londoners and Charit-
able Institutions — Ignorance of Work done by Hospitals —
Indifference of the People, and Its Causes — The Protective
Spirit — Government Hospitals and Voluntary Hospitals —
Relation of Employers of Labour to Hospitals — The Liquor
Traffic — The Theatre - Goers and the Hospitals — Charity
and Luxury — The Ftchter Verein and Destitute Children —
Fashionable Dinners and the Philanthropic Host — Humil-
iating Position of Londoners.
To maintain in repair, to carry on and develop the
sixty Voluntary Hospitals in London, the five millions
of inhabitants who all benefit more or less from
them supply in money ^191,800. This is accord-
ing to last year's accounts. It would, of course, be
impossible to defray all the expenses of the hos-
pitals out of this small amount. Dividends from
invested property, and some small sources of income
bring the total amount of the yearly revenue of the
hospitals up to ;^4i 2,077. In the small amount
82
WHAT THE PKOrLK DO FOR THE HOSriTALS. 8
O^
which the Loiulon i)ul)Hc contributes is included
^71,350 in donations, as well as ^64,669 in lega-
cies. Subscriptions are only ^35,590. The Hos-
pital Sunday and Saturday Funds, of which we
hear so much, bring in, the former ^45,000, and
the latter nearly ^20,000.
The smallness of this amount will probably sur-
prise most people, and it is amazing when we con-
sider the immense wealth of this metropolis, the
enormous profits of its trades, and the vastness of
its financial operations throughout the world. The
total contributions of Londoners do not represent one
per cent, of one day's turn-over in the Clearin^:-
House, and if we compare it with the amounts
which are spent at drinking- shops, places of amuse-
ment, and in the purchase of a thousand and one
useless articles of luxury, London charity to
hospitals is a discredit to its inhabitants.
To put all our hospitals on an efficient footing
without much extending the present scale, at least
^150,000 a year would be required, while to develop
the hospital system to what it ought to be in our
free, wealthy, and Christian city, a far larger amount
would be needed.
But it is not money alone that is wanted. More
personal services for committee work, house-
visiting, and supervision would be warmly wel-
comed. London in these matters is consider-
ably behind provincial towns. There is always a
great difficulty in getting young men to join com-
84 SUFFERING LONDON.
mittees, though the MetropoHs, perhaps, contains
proportionally a larger leisured class of young men
than any other city in the kingdom. The work is
generally done by middle-aged or elderly gentlemen
who, as a rule, have plenty of their own business
to attend to. And the sacrifice they make is not
always appreciated. The other day, a busy city
man was asked by a friend, who does no work for
the hospitals at all, whether he was going home.
" No," said the former, " I am going down to the
hospital." — " Ha ! your brain is tired, so you are
willing to devote it to charity." But what is to be
done when those who never had tired brains in
their lives decline to give up a few hours of pleasure
and club-lounging for hospital work }
Such indifference to so important a civil and
moral duty is difficult to comprehend in the case of
the capital of a nation reputed to be charitable and
religious. It is, therefore, only just to point out
that this is not due to any lack of public spirit : it
is clearly traceable to special causes. To discover
these causes is the first step towards a better state
of things.
In the first place, the good work done by the
hospitals is known only to a few outside those who
bear the burden and those who have been nursed
in their wards. Fewer still have ever realised what
London would be without hospitals. Nor are the
wants of the hospitals understood by the public at
large.
WHAT Tin; I'KOri.K DU I'OK TIIK 1 lOSI'ITAl.S. 85
Charitable Londoners liberally support hosts of
institutions here and abroad, the usefulness of which,
with few exceptions, cannot be compared with that
of our hospitals. The reason for giving preference
to less worthy institutions can alone be explained
by the fact that they are well advertised, and collec-
tions for their support are systematically and per-
severingly kept up.
In many of our charitable institutions and move-
ments there are numbers of people who may be
actuated by the best motives in giving their time
and their work to some cause they consider worthy
of great sacrifice. At the same time they draw the
whole of their income from the institution they
administer, or the movement they lead. This Is
not the case with our Voluntary Hospitals. The
governors not only work for nothing ; they sub-
scribe. Nearly all the doctors and physicians
give their services gratuitously. The whole of
the paid staff in no way depends upon the
hospital for their livelihood, but can obtain
similar employment elsewhere. The work of enlist-
inof subscribers and collectinsf contributions has,
therefore, never been arranged on such an effective
and business-like footing as is the case with many
other institutions.
There Is every reason to believe that, If the
case of the hospitals could be thoroughly brought
home to Londoners, liberal annual subscriptions
could be readily obtained. This Is clearly proved
86 SUFFERING LONDON.
by the experience of three great MetropoHtan
hospitals, where the subscriptions, during- the last
twenty years, have increased to a considerable
extent.
And it is annual subscriptions which those who
advocate the cause of the hospitals should aim at :
for they may be regarded as the backbone of a well-
managed charity. When a man has once become a
subscriber he is called upon every year to renew his
subscription, and it is often augmented when a sub-
scriber has had a successful year, or when his income
has increased. Besides, the regular subscriber is
most likely to take an active interest in an institution
he regularly supports. He naturally becomes in-
clined to look into its management, and possibly to
take part in it.
I have saici that the well-to-do Londoners know
too little of the useful work accomplished by the
hospitals. Yet, anomalous as it may seem, there
never was a time when all classes of the people were
more ready, when ill or suffering from accident, to
avail themselves of the great advantages which the
hospitals afford. The upper classes are, if anything,
more willinQf to be removed to these institutions
than the working-classes.
The fact is that people, so long as they enjoy
sound health, take no heed of the hospitals, but so
soon as they are afflicted by a serious disease or
meet with an accident, their enquiries soon elicit the
fact that in these admirably managed institutions
WHAT THE PEOPLE DO FOR THE HOSPITALS. 87
they will meet with the best treatment obtain-
able.
Another cause of indifference is, that the sacrifices
of time, work, and money seldom bring reward in
the shape of decorations, titles, political and social
preferment. I simply state the fact ; I offer no
opinion as to the advisability of encouraging this,
the greatest and noblest of all charity, by such forms
of recompense. In my view, it is good that there
should be such opportunities for exercising true
philanthropy dissociated from the stigma of self-
promotion. Even if I am wrong, no blame can be
attached to anyone, because it is in the nature of
such philanthropy to go unrewarded by the autho-
rities of the State. Political power in this country
is wielded through party politics : active partisans
must, therefore, necessarily take precedence in the
disposition of rewards, and hospital work is entirely
independent of politics. As to rewards and distinc-
tions emanating from powers who are independent of
party considerations, they must necessarily be given
to those whose services produce the greatest sensation
rather than to those whose deeds result in the greatest
amount of good, or involve the highest sacrifice. It
has been, and always will be thus, especially in a
free country where all governmental and public
actions must be more or less influenced by popular
opinion. If the opposite line of action were at-
tempted— if the widow's mite were to be considered
as much as the million of the millionaire — the choice
88 SUFFERING l^ONDOX.
of candidates for honours would be extremely diffi-
cult, and probably give rise to endless dissensions.
But of all the causes which tend to stem the
current of funds which should flow to the hospitals,
the now most potent, and the one which threatens to
bring ruin upon the voluntary system in the future,
is the protective spirit. I use the term protective
spirit not as indicating any popular desire for Pro-
tective Duties, but as the strong tendency which
has invaded us from abroad — a tendencv to look
upon liberty as a source of danger, and to trust to
Government regulation and Government manage-
ment in all social, and often private, matters. So
all-permeating is this new mode of thought, or rather
confusion of thought, that every question before the
public is more or less affected by it. Whether they
be debates, leading articles, treatises, or platform
speeches, so soon as their subject has anything to
do with legislation, politics, administration, public
instruction, finance, and in fact with anything re-
lating to the social and economic life of the nation,
they resolve themselves into this question : Socialism
or not Socialism.
Our Voluntary Hospitals will be more affected by
the growth of Socialism than any other institutions,
because they are at this moment the best standing
example of free co-operation we possess, and in no
other institutions would the application of the
socialistic principle work such havoc. When I add
to this that, for reasons to be o-iven, the socialisation
WIIAT Till': rKOlM.K IK) I'OR THK llUSl'ITALS. 89
of our hospitals would niark an important step to-
wards complete Socialism, and that the (question of
placing the hospitals under Government supervision
has already formed the subject of a Conference, it
will be understood that if this work can do nothing
to prevent such a national calamity, it might as well
remain unwritten.
In order to thoroughly understand to what an
extent the growth of Socialism affects contributions
to our Voluntary Hospitals and threatens to destroy
them altogether, it is necessary to make clear the
aims and expose the illusions of both conscious and
unconscious votaries of Socialism.
They start with the supposition that if the
relations between individuals are left free to shape
themselves according to the laws of political economy,
the land-owning and capit^ilist classes would have
it in their power to monopolize all those good
things which make life enjoyable. They conclude,
that to establish an order of things which would be
bearable and satisfactory, the State must protect
the working - classes, and for this purpose inter-
fere with contracts, individual freedom, and private
property. This mode of thought, when not ex-
treme, we call State Socialism, and, when extreme,
Socialism.
I say, purposely, that the protective spirit has
invaded England, because there was a time when
this country was freer from State interference than
any country in the world. To this freedom many
90 SUFFERING LONDON.
eminent thinkers have attributed our national advant-
ages in industry, commerce, and finance, as well as
many of those qualities in the English character
which have enabled us to become the dominant
race of the world.
The progress of Socialism in this country, and
the lame defence of the Individualists are beyond
the scope of this work. I shall only refer to the
question in so far as it affects the hospitals. And
it does affect them vitally, as, Indeed, it must
do every institution and every individual in the
country.
The great struggle now is whether freedom shall
be maintained in England or whether the present
increasins: tendencv to centre evervthinof in the
hands of Government will lead to what dreamers
and poets call Socialism, but would prove in reality
to be State despotism, or bureaucratic tyranny.
Government management is nowadays held up
as the remedy for all evils and shortcomings in our
institutions and our social life ; and there can
be no doubt that this modern new-born faith in
bureaucrats exercises a strong influence on hospital
funds and hospital work.
Of the many ways in which this influence makes
itself felt, I shall here only notice two, and the first
one quite briefly, because whatever I may say about
it will not counteract it.
The protective spirit and the retrogressive legisla-
tion which it has fostered during the last twenty
WHAT THE TEOrLE DO FOR THE HOSPITALS. 9 1
years has kept clown the incomes of the hospitals
and has increased the demands upon them.
During the Cobden era the country progressed,
as we all know, by " leaps and bounds." The
demand for labourers increased at a rate which
foreshadowed a time when it would so outstrip the
supply as to keep our working-classes in a high
state of prosperity. The increased intensity of
Protection in foreign countries and our colonies
re-acted unfavourably on our labour market, not so
much because the duties on English goods pre-
vented us from exporting, but rather because the
consuming power of the protected States decreased
and their financial embarrassment auo^rnented. In-
stead of parrying the effect of the hostile tariffs by
freeing our industry and our workers from such
shackles as still remained, our Parliament fell back
on socialistic legislation. This took the shape of
regulations, limitations, and extra expenditure im-
posed on employers of labour in this country, from
which foreign employers were for the most part
free.
This amounted almost to a persecution of industry,
resulting in keen competition, small profits, trouble-
some business, and heavy losses. This was not a
state of things calculated to further charity; and it
is not surprising, therefore, that the contributions
to the hospitals have become items of expenditure
which have been either persistently overlooked or
struck out. Had business and waofes continued to
92 SUFFERING LONDON.
grow as they did twenty years ago, there can be
little doubt that the incomes of the hospitals would
be considerably larger than they are now.
It is natural that scarcity of labour, under-con-
sumption, low wages, and the increase of the
sweating system, should greatly augment the de-
mand upon the hospitals : for, as I have already
remarked, the majority of the patients in these
institutions are those who have been disabled in
the struofpfle for the survival of the fittest. Drink
and other vices, it is true, send a great number of
people to the hospitals ; but, as all of us know,
who have given serious attention to social problems,
poverty is by far the most potent of all causes of
drunkenness and other vices. Constant privation,
squalor, and despair are enough to drive men and
women into seeking oblivion in drink ; and from the
raking up of the social depravity of our great Metro-
polis, which some years ago scandalised society, at
least one hopeful fact emerged — namely, that of all
the instances given of young English girls willing to
barter away their virtue and beauty, by far the great
majority, if not all, were driven to it by want.
The second way in which the growing protective
spirit diminishes the contributions to the hospitals,
and which I shall endeavour to overcome to some
extent in these pages, is the ready excuse it has
inspired for not contributing to the hospitals.
We meet frequently with the following reasoning:
" I do not subscribe to hospitals, because in doing
WHAT THE TEOPLE DO FOR THE HOSI'ITALS. 93
SO I should give charity to the rich and not to the
poor. The hospitals ought to be supported out of
the rates, and by maintaining Voluntary Hospitals
we only save an outlay to those tax-payers who can
well afford to pay for the support of these institu-
tions. Besides, by giving the advantages of
hospitals voluntarily out of charity we pauperise
those whom we benefit, while the patients would
only make use of legal rights if the hospitals were
maintained out of the rates. Our hospitals should
be socialised."
It is not difficult to show the hollowness of such
arguments.
From observations made in this and other
countries, I can confidently state that the more ig-
norant people are, the greater is their belief in the
omnipotence of Government. That Government is
already overburdened with responsibilities is entirely
overlooked. But those in whose imagination the magic
word Government conjures up an almighty and omni-
scient factor, who have but an incomplete idea of the
way in which Government works, generally take
for ofranted that whatsoever Government undertakes
is accomplished. To those who stand near enough
to Government to be intimately acquainted with its
members, and the courses which they are obliged to
adopt to keep things in decent working order at
all, it is perfectly clear that Government has already
too much on its shoulders. On the other hand,
those who are far removed socially from Govern-
94 SUFFERING LONDON.
ment circles are apt to regard Parliament as a second
Providence.
Whatever function the State undertakes in our
social life must be fulfilled through the agency
of a bureaucracy ; and in what country has it ever
been possible for a Government to make the ap-
pointment of its officials free from political, social,
and family bias ? Has it not been an universal
experience that wherever a bureaucracy has been
created, its tendency is to increase its numbers, its
prestige, and its dominance ? The children of
bureaucrats become bureaucrats, and the parents
naturally exert themselves to place their sons in
good official positions. Thus it seldom happens that
the best man is appointed for a vacant post in
countries where bureaucracy has grown into a
power. Each additional function placed in the
hands of Government increases the influence of the
bureaucracy. If, therefore, the hospitals were placed
under State management, the ranks of government
officials would be considerably increased.
A elance at such institutions abroad as are under
Government management should warn us against
the folly of raising bureaucratic masters over us :
for in many continental States it is evident that the
officials do not exist for the sake of the people, but
the people for the sake of the officials. In England,
it can still be said with a certain amount of truth,
that the officials are the servants of the public.
Here unhampered manhood suffrage controls the
^VIIAT THE TEOPLE DO FOR THE HOSPITALS. 95
Government, an unfettered press throvvs a vivid
light on the doings of all authorities, and yet we
find that bureaucracy is already a power. Its
social influence and its esprit de corps form around
it a barrier against public investigation and public
control. Any minister who attempted to step be-
yond it and peremptorily redress abuses would be
unable to maintain himself in power. Any rash
attempt in this direction would set the whole body
of officials against him, and bring the Government
to a deadlock. Hence the glaring difference be-
tween the results of Government and private
management.
A host of English medical men who have visited
the Government-manai^ed hospitals on the Contin-
ent will testify to the baneful influence which
officialism exercises over such establishments. It
is only too conspicuous in all of them that, no matter
what interest is dominant, the poorest and non-
paying patient is the least considered.
The votaries of Socialism are apt to quote certain
examples of Government administration, abroad and
at home, which they look upon as unqualified suc-
cesses. Thus the German army is held up as an
illustration of good Government management — of
how perfect a military system has been established
at a comparatively small expenditure. But the
German army is in itself the outcome of bureau-
cracy, and every advantage which it presents is an
advantage gained for bureaucracy at the cost of the
96 SUFFERING LONDON.
people. It is not surprising that militarism is
carried to perfection in Germany ; for it is the sup-
port and the ally of a powerful bureaucratic system
which would crumble without a strong army. In
Germany the soldiers are paid nothing, but are
compelled to serve. So long as they are with the
colours, almost every hour of their life that can be
snatched from rest, is either devoted to training or
army work. If Germany is to be held up as an
example of successful Government management, it
should be proved that the German nation is free,
prosperous, and happy, and not that it is sacrificed
to a military system.
Amongst English institutions our Post-office has
been pointed to as a socialistic success. But it must
not be forgotten that the chief improvements in the
Post-office have come from the outside, and have
been forced upon it in obedience to party exigencies.
As a Government institution the Post-office is a
success. Regarded as a business, we have to de-
plore high postages, low salaries, tyranny over the
employees, three or four hours for delivery of letters
from the city to the west end, monopolist proclivities,
and similar shortcomings — these are the characteris-
tics of our Post-office as of all socialistic institutions.
It is surprising that people who quote the Post-
office as a socialistic success cannot perceive that
this institution is based on two principles, namely,
co-operation and Socialism, and that all the benefits
which it confers upon us spring from the co-opera-
WHAT TIIK J'KOrLE DO FOR 'I'll 10 HOSPITALS. 97
live principle, while its drawbacks are traceable to
the socialistic principle.
Our \'oluntary Hospitals are the outcome of free
co-operation, and to this fact they owe their enor-
mous advantages over the State-managed hospitals
of other countries. If we w^ere to socialise them we
should certainly deprive them of these advantages
and indict upon them the deteriorating bureaucratic
taint.
It is easy to say, let us socialise all our institu-
tions, but few people realise what this would involve.
Their socialisation would only be part and parcel
of the general socialisation. Such a development
would enormously increase the influence of the
bureaucratic caste, subject the people to stricter dis-
cipline, weaken the popular control and smother
public opinion. Thus, the very conditions which
have so largely tended towards keeping our present
socialistic institutions within the bounds of modera-
tion, and largely assisted them in obtaining the
.success they have obtained, would totally disappear.
We should be surrounded by entirely new circum-
stances, altogether in favour of bureaucratic abuse
and ao^ainst self-defence— a state of thinofs which
only those Englishmen have experienced who have
resided abroad, in countries where most of the
institutions have been socialised.
As to the theory that those who are benefited by
Voluntary Hospitals suffer more loss of self-respect
than those who are treated in infirmaries maintained
G
98 SUFFERING LONDON.
out of the rates, It acquires all its plausibility from
the gratuitous supposition that the State-supervised
hospitals would be as well and as kindly admin-
istered as our Voluntary Hospitals.
In our so-called free country the citizen who
presents himself at the workhouse or its infirmary
to claim his right as a quondam tax-payer does
not meet with a reception calculated to raise him
in his own estimation. When this can happen to
the free-born Englishman, the holder of a vote, a
part-ruler of this great Empire, what might not
happen to the poor working-bee in a socialistic
hive, whose lot from birth had been compulsory
labour, and who would be undefended by public
opinion ?
It is not alone the harsh treatment by the work-
house officials, and the marked difference which
exists between the workhouse infirmaries and the
Voluntary Hospitals, which cause the workhouse
inmate to experience a sense of humiliation from
which the patient in the Voluntary Hospital is
entirely free. There is also the knowledge in the
mind of the workhouse inmate that the doles he
receives are not contributed voluntarily but obtained
from the tax-payers by compulsion, and that this
renders him a nuisance to his fellow-beings and
constitutes him a pauper. On the other hand, the
patient In the Voluntary Hospital receives from his
fellow-men such tender care as a friend would re-
ceive from a friend, a brother from a brother, or a
WHAT TIIK TKOPLK DO FOR THE HOSPITALS. 99
child from a parent. He therefore can not possibly
feel humiliated.
Those who maintain that the recipients of vState
charity suffer no humiliation often quote Mr. Ruskin
as their authority. But I think tliat Mr. Ruskin
and his followers must confess that in recommendinof
the socialisation of our institutions, they have given
no thought to the harsh treatment on the part of the
officials, nor to the unwillingness of the contributors.
It seems to me that before they attack that highest
form of large scale charity, and that most Christian
as well as most useful result of brotherly co-opera-
tion— our V^oluntary Hospitals — they should, at least,
submit a scheme of complete socialistic organisation,
capable of bringing about such an Utopian state of
affairs as their method of reasoning pre-supposes.
Perhaps it might happen to them, as it has happened
to many who have tried to ex-cogitate practical
socialistic constitutions, that they would cease to
advocate Socialism lest they should advocate slavery.
I have thought it useful to show how weak are
the grounds on which some people, influenced by
the protective spirit, base their excuses for not
contributing to the hospitals, because there is
every reason to believe that their number is con-
siderable. If they could be brought to see what a
calamity the socialisation of our hospitals would be,
they might be moved to undertake a small part of
the expense of institutions which are upheld largely
for their benefit. For the voluntary principle has
lOO SUFFERING LONDON.
this advantage, that all classes can, by contribution
according to their means, save themselves the
humiliating feeling of being directly or indirectly
beneficiaries of institutions supported entirely by
the charity of others.
There is one class of Londoner who contributes
only a fraction of what they ought to do to our
hospitals : I mean the employers of labour. From
the manifold mills and workshops of London num-
bers of labourers are daily brought to the hos-
pitals. They have injured their health, or met with
accidents while working for their employers, and it
is meet that the masters should evince a little more
interest in the welfare of establishments from which
they and their workpeople derive such advantage.
With few exceptions, the contributions of such em-
ployers, who subscribe at all to the hospitals, fall
considerably below the expenses incurred by the
hospitals for the invalided men from their factories.
Employers of labour may object that they are not
liable to supply medical aid to their men save in
such cases as are provided for in the Employers'
Liability Act. Those who are in the habit of
transferring such liability to Insurance Companies
might suggest that these companies should con-
tribute to the hospitals instead of the employers.
But these arguments do not hold good. If there
were no Voluntary Hospitals, there would be certain
to be State or Communal hospitals, and to such the
employers would be compelled to contribute, and
WHAT Tin: iMioi'i.i: no for tiik iiostitals. loi
this, despite any number of premiunis p;iicl to Insur-
ance Companies. Besides, there can be no doubt
that the assessors of the taxes would have to charge
the employers under this head rather more than the
hospitals spend on their working-men : for they
would have to pay their share as citizens, and the
other tax-payers, who employ no working-men
themselves, would certainly object to pay for those
of others.
Though the employers have no legal obligation
to supply medical aid to their staff except under the
Act, the fact that such good hospitals are ready to
help those men who fall sick, or who meet with
accidents when not at work, is a considerable
advantage to the employers. The life of many a
good working-man is saved, his absence from work
is curtailed, w^hile the happier state among the
working-people, largely due to hospital influence,
cannot fail to produce beneficial effects in the
workshops.
Then, as to the Insurance Companies, it should
be borne in mind that if it were not for the Voluntary
Hospitals and the great progress made by medical
science which they have promoted, the Insurance
Companies could not take the risks they now do at
the same low rates.
When all this is considered, I think it will be
granted that the small ness of the subscriptions to
the hospitals from London employers of labour is
not only deplorable but shows great want of foresight.
102 SUFFERING LONDON.
There are many other classes in London besides
employers of labour who, if they came to realise
their relation to those who stand in need of free
medical aid, would probably see their way to support
our Voluntary Hospitals in a systematic manner.
Let us take, for example, the brewing and publican
trades, a numerous and wealthy class whose fortunes
have been largely built up by contributions from the
poorer classes, I have no sympathy with the pro-
hibitionists who are prone to blame the licensed
victuallers for the poverty and crime which drink is
supposed to produce. There must be somebody to
supply drink, as well as other necessaries and lux-
uries of life. If the keeping of public-houses were
not sanctioned by law, there would be secret dram-
shops and more home drinking ; if there were no
respectable refreshment-places, there would be dis-
reputable ones. There are grave doubts in many
minds as to whether our licensing system is con-
ducive to sobriety or drunkenness, and as this is a
question which it would be cut of place to discuss
here, I shall content myself by saying that the pub-
licans are not responsible for our licensing laws.
Regarded as a whole, I believe the publicans of
London would be sorry to profit by the ruin of their
fellow-men. Indeed, many of them are aware that
this they cannot do, because if they were to induce
men to ruin themselves through drink, they would
only kill the geese that lay the golden eggs. But,
however anxious a retailer of drink may be to carry
WHAT THE TEOPLE DO FOR THE HOSPITALS. IO3
on his business without injury to his fellow-men, it
still remains a fact that part of the business which
enriches him impoverishes others. This the pub-
licans cannot help, but they can subscribe to the
hospitals in a reasonable proportion to their gains, as
they now subscribe to many of their own institutions
— for example, the Licensed Victuallers' Permanent
Relief Fund.
The theatre-going public should remember that
the great number of choristers, supers, dancers, and
attendants, who contribute so much to the pleasure
of the audience, are generally poorly paid. They
might, in case of ill-health or accident, be exposed
to great hardships, should they belong to those four-
fifths of the applicants for admission to the hospitals
for whom there is no room in the wards. Dramatic
Benevolent Funds and Trade Unions there are of
course, but these cannot increase the number of beds
in our hospitals, and the fewer cases that are admitted,
the w^orse for the Funds of such Trade Unions.
Those Londoners who are sufficiently w^ell-off to
spend pleasant evenings at the theatres, and other
places of amusement, might propitiate the Fates by a
small sacrifice in favour of those who cater for their
amusement. A slight contribution from every
habitual theatre-o^oer, thouQ^h a small matter to the
individual donor, would bring in a larger amount for
the hospitals.
While enoraofed on this work I have been more
than once impressed by the amazing amount of
I04 SUFFERING LONDON.
money spent on luxuries in London, and how a small
portion of it would place our hospitals in a prosper-
ous condition. It seems an anomaly that people
should derive pleasure from decking their person
with ornaments representing enough wealth to save
many fellow-beings from misery and despair. Con-
sidered in the abstract, this love of display must
seem a barbaric way of proclaiming one's own sel-
fishness. And yet, I should be sorry to attempt to
dogmatise on charity z'cj'sus luxury. The question
has so many sides : the moral, the religious, the
eesthetic, the artistic, the diplomatic, and the com-
mercial. To take only one— the commercial — this
alone bristles with difficulties. It might clash en-
tirely with the religious side, as was proved in Paris
when the great Colbert was Minister of Finance.
An eloquent monk was preaching against luxury
with an effect akin to that of Savonarola in Florence.
The Parisian ladies besran to discarci all useless
fineries, and adopted a puritanical simplicity of dress.
Paris was at that time, as now, the source of ladies'
fashions, and the tabooing of luxuries spread first all
over France and then to other countries. But, unfor-
tunately, the trades of Paris consisted chiefly of the
production of luxuries and fineries, and when orders
ceased to How in, the state of the industrial workers
of the city threatened to become serious. Where-
upon Colbert sent for the preacher and told him
that though his precepts might be profitable from
a religious standpoint, they were ruinous from a
WHAT TIIK I'KOrLK DO FOR TIIK IIOSriTALS. IO5
commercial, and Induced him to chcinge his sub-
ject.
Though a general return to severe fashions may
thus inllict grav^e injuries on poor producers of lux-
uries, we cannot flatter ourselves that we benefit the
toilers or, as the phrase goes, do good to trade, by
wasting our substance on pleasant superfluities in
the matter of dress and food. Such a method ot
improving matters is frequently advocated by the
superficial. To help others by making them minister
to our foibles would be agreeable enouo^h, as it would
permit us to practise unselfishness in a selfish way.
We might all of us have good reasons for displaying
or enjoying such luxuries as we are partial to, but,
certain it is, that labour which is expended on an
article of luxury can not be expended on those
necessaries of which so many are deprived.
Nothing could be more wrong-headed than to
estimate the charity of persons by the simplicity of
their lives; for experience teaches us that generosity
and a taste for luxury often go together.
I have no desire nor intention to indulge in any
wholesale condemnation of luxury. My sole object
in referring to it has been to point out its relation
to hospitals. As we are all aware, the production
of the endless variety of little knick-knacks, on
which it is so tempting to spend our money, in-
volves hard, often unhealthy and ill-paid work.
The well-meaning suggestion that we should avoid
purchasing the products of the sweaters would be
106 SUFFERING LONDON.
impossible to carry out in practice, as we should not
be able to distinguish them from fair-wage goods.
It may be useful, therefore, to remember that we
can benefit the producers of luxuries by not neglect-
ing the hospitals, as we are too apt to do now.
In Germany an association has been at work for
some years under the name of the Fechter Verein,
which shows how much can be done for the few by
the many at a minimxum of expense. The members
do not contribute any money at all, but save and
send to the Society's headquarters such things which
usually are thrown away as rubbish and only acquire
a value when collected in large quantities. In this
way a considerable amount is yearly realised, which
is devoted to the maintenance of destitute children.
I hesitate to give the number of the little ones pro-
vided for in this way, as the figures before me seem
exaggerated. The late Emperor was the President
of this Fechter Verein, and the members are re-
cruited from ail ranks of society, especially, as I
understand, among young men.
I do not refer to this Verein in the hope that the
German example will be emulated in this country.
Circumstances are different here. Our time is far
too valuable to be devoted even fractionally to
doings productive of only small results. The hours
it would take to collect, pack up, and send away,
say, used-up steel pens, old newspapers, etc., would
represent more money than such articles of waste
would realise. Besides, amono^ us, there is a disin-
WHAT THE PEOl'LE DO FOR THE HOSriTALS. IO7
clination to resuscitate wares wliich have already
clone service. But by adapting the methods to
English circumstances the German plan of co-
operation among young people might be utilised in
favour of the London hospitals. A slight practice
of self-denial would easily produce amongst us
greater results than the laborious collection of waste
materials. By abstaining from brandies and soda
one day in the week, by consuming one bottle of
wine, or one Havana the less, by now and then
saving a cab fare, and by similar small sacrifices,
a considerable amount could be raised for the
Hospital Funds without entailing any outlay on the
part of the contributors. The members of such a
society would certainly benefit themselves. Many
of us moderns are apt to regard acts of penance as
out of date ; but will not the practice of self-discipline
be useful as a method of moral training, so long as
man continues to be his worst enemy ?
Some time ago it was proposed that everybody
who gives a dinner-party should, before coffee and
cigars, offer the guests an opportunity of contribut-
ing one shilling each to the poor. Here again is an
idea which is capable of being turned to account in
favour of the hospitals. If it be true, as was once
said, that no man can be religious with cold feet, it
must be true that no man can be charitable when
hungry. The natural corollary of this should be that
the right moment at which to reach a man's heart is
at what Lord Beaconsfield in " Lothair " called the
I08 SUFFERING LONDON.
happy moment of the clay — when the fragrant Moca
produces a mild and Oriental ecstasy, and lends to
our view of the world and of ourselves that roseate
hue which in the imagination of Osmans conjures
up a glimpse of a material paradise.
I)Ut there is a grave defect in this idea of ex-
ploiting the softening of hearts in favour of the
hungry poor which a good dinner brings about
among the rich. To expect a host to solicit contri-
butions from his guests is to place him in an invidi-
ous position, especially as he cannot know to what
extent his friends may practise secret charity. A
better plan would surely be for the host to send, say,
one shilling to the hospitals for every guest he
invites. To many a generous man it might be a
solace to feel that while feasting the unappreciative
wealthy he was extending his hospitality to the ap-
preciative poor. Once such a fashion were set on
foot, the guests would often request the host to add
their contributions to his.
All these things, and many more, Londoners could
do for the hospitals, and thus save the inhabitants
of this great Metropolis from the disgrace of hav-
ing such a splendid opportunity of genuine charity
taken from them. The alternative is that, under the
lash of the tax-gatherer, they will have to pay heavily
for bad hospitals. It was once said by the present
King of Denmark, when his Parliament refused to
vote funds for his horse-Qfuards, "A nation that does
not want horse-o-nards does not want a kinQf." It
WHAT rill'; ri:oi'i,F. do for tiik iiosimtals, 109
may be said with equal perspicacity that a people
that cannot maintain its W)luntary Hospitals cannot
maintain an Empire.
It is humiliating for London that the yearly sub-
scriptions to the general hospitals represented in
1889 only 8*64 per cent, of their total income, while
the provincial hospitals received in 1889 28*58 per
cent, of their income in subscriptions. Or, to put
it in a different way, while the total income of the
general hospitals of London was ^^4 12,077, of which
annual subscriptions brought in / 35.590, the pro-
vincial hospitals, with a total income of ,/^443,73i,
received ^126,808.
From all that I have said In this and the fore-
going chapter, I think it may be fairly concluded
that what Londoners do for the hospitals is entirely
out of proportion to what the hospitals do for
Londoners.
CHAPTER VI.
THE ORDEAL OF CRITICISM.
" // is much easier to be critical than to be correct'''
Importance of Criticism — The Hospitals and their Critics — The
Danger of Attacking the Hospitals — The Enquiry before the
Lords' Committee — The Influenza Epidemic — How Injustice
may be done to the Hospitals — A Case in Point — The
London Press and Hospital "■ Scandals."
Benjamin Franklin, philosopher and diplomatist,
was of opinion that we commit a great mistake in not
cheerfully accepting criticism : for by resenting cen-
sure we discourage our friends from criticisinof us at
all, and thus deprive ourselves of our best chances
of self-improvement. I have always admired this
wise maxim, all the more as observation has taught
me to what a great extent criticism, friendly and
unfriendly, assists a man to temper his soul in the
bracing waters of truth, and thus maintain it in
youthful vigour.
The successful man, who is ever surrounded by
dependents, whether at home or in his business or
profession, all ready to meet his smallest wishes,
and who would resent correction, is apt to rise
enormously in his own estimation. He soon quells
TlIK ORDKAL OK CRITICISM. Ill
ccnsLirc of any kind, and his family dependents take
good care to pamper him. The result is that such a
house tyrant soon attains to worse than second child-
hood and becomes prematurely old. Not so with
men who are freely exposed to criticism. Take,
for instance, our great politicians. Everything they
do, every word they utter, is jealously watched by
political opponents, and the first sign of weakness,
self-indulgence, or age, is seized upon and trumpeted
forth all over the world. Men like Mr. Gladstone,
the late Lord Beaconsfield, and many others, no
doubt owe largely that self-control, which public
life enforces, to the advantage of having their fac-
ulties in better working order than men of half
their aQ^e.
What is true of men in the matter of criticism is
also true of institutions ; and I should not be a
friend of the Voluntary Hospitals were I to dis-
courage their critics. But there is criticism and
criticism, and our Voluntary Hospitals are in a
peculiar position which entitles them to considerate
treatment at the hands of censors. If we criticise
an author or an actor, the public can judge for
themselves whether our appreciation be justified,
and if it is, the author and actor have learned some-
thing and can mend their ways. If we unfavour-
ably criticise Government officials, it is for their
chiefs to either clear them or correct them ; and
there the matter ends. But if we attack the
Voluntary Hospitals, we propagate statements which
I I 2 SUFFERING LONDON.
the public, in nine cases out of ten, is unable to
verify. Nor is this all. Censure upon their
management could have but slight coercive effect
on those in power, as the most responsible among
them give their services for nothing. But the
effect it is sure to produce is a falling off of con-
tributions. While, therefore, we hold up for public
inspection, errors or shortcomings of hospital offi-
cials, in the belief that we serve the interest of the
poor sufferers, we actually inflict punishment upon
the poor men, women, and children for the mis-
takes of some member of a staff.
From what we hear in private conversations, and
what we read in letters to the papers, it is evident
that a great number of people think that the
Voluntary Hospitals exist specially for the benefit
of those who manage them. For, when some-
thing goes wrong with one of the half million cases
which are yearly dealt with, often under the most
trying circumstances, there are plenty of hints that
if such a thing should happen again, the fountain of
charity should cease to flow.
It is a pity that the zeal in pointing out one de-
fect should cause all the immense good accom-
plished to be overlooked, that in order to reprimand
one official, suffering should be inflicted upon a vast
number of patients. We know by experience that
the harshest critics are found among those who do
not work for the hospitals, and who fail to contribute
to them. This is not unnatural : for those who take
THE ORDEAL OF CRITKTSNr. II3
-un interest in these gigantic charities generally
realize the difficulties to be overcome, the im-
mensity of the task, and the meagreness of the
resources.
There is certainly no occasion to jumj) at un-
favourable conclusions at the first bruiting abroad
•of shortconiings. The Enquiry before the Lords'
Committee on Hospitals, has given our voluntary
■system a testimonial which should go a long way
towards cautioning irresponsible censors against mere
•conjecture. Lord Sandhurst, Chairman of the Com-
mittee, gave expression to the opinion that the
Voluntary Hospitals in London are about the best
managed, and the freest from defects, of any institu-
tions in the world. Such a tribute from such a source
should serve as a deterrent to hasty criticism, and
induce the would-be critic to carefully investigate
facts before taking upon himself the responsibility
•of diverting other people's subscriptions.
It often happens that sheer ignorance is at
the root of unjust comments. Thus, for ex-
ample, there was during the influenza epidemic
an often repeated complaint, not to say outcry,
against our hospitals for not admitting influenza
•cases. It was of course not known that influenza,
being a highly infectious disease, is necessarily
■excluded by the rules of every well-regulated
general hospital. If the officials had yielded to
such unreasonable demands, and had admitted in-
ikienza patients in the general hospitals of London,
114 SUFFERING LONDON.
where the beds are too few for legitimate cases^
they would have committed a great error and caused
indescribable misery.
To show what an injustice may be done to the
hospitals by criticism without a knowledge of facts^
I shall here refer to an incident which took place
during the influenza epidemic. I feel all the more
impelled to do so, as the gentleman who thought he
had a serious grievance managed to get it published
in a newspaper, thereby causing considerable harm..
This gentleman, with ample means to provide for
his household, who wished to get rid of a servant
attacked by influenza, placed the poor woman
in a cab and sent her off to the nearest general
hospital. On the authorities declining to admit her,
he caused her to be driven from one hospital tO'
another, though the weather was cold, and the risk
to the patient's life considerable. At last the
authorities of one of the large hospitals to which
the servant was brought took the case in hand, and
telephoned to those of an institution admitting paying
patients, and asked them to receive the case. This
they did ultimately, and the servant was properly
provided for, despite the inhumanity of her master.
Here, then, is a case where a man, whose duty as
a master it is to look after his servants, hastens
to shift his responsibilities on the shoulders of the
general hospitals, regardless of the consequence to
the servant or the inmates. On the other hand, we
have the officials of a general hospital, whose dutjr
THE ORDEAL OF CRITICISM. II 5
It is to exclude inlluenza patients from the wards,
Impelled to provide for the girl from motives of pure
humanity. Yet the general hospitals get publicly
attacked : they are warned that their subscriptions
may decrease, though from no fault of their own.
I have quoted this occurrence, not as an example
of a masters neQ^lect of his duties, but as an Illustra-
tion of the misconception which exists with regard
to om- hospitals, and the deplorable errors which
may result from thoughtless criticism.
Innumerable subjects come under the notice of
the press. The promptitude with which matters ot
Interest arc- placed before the public Is astounding ;
and it would need omniscient and ubiquitous editors
and sub-editors to prevent every error and mis-
representation on the part of their contributors and
reporters. As, however, misrepresentations which
discredit our hospitals inflict extra sufferings on
poor patients, I feel sure that no London editor
will resent the suggestion that, when sensational
communications headed "Another Hospital Scandal,"
are brought to him, he might cause special Inquiries
to be made before giving publicity to the censure.
The London Press has always shown Its readiness
to admit legitimate corrections of erroneous state-
ments, as well as to express its sympathy with the
hospitals and the poor. But a correction of a mis-
statement in one Issue of a journal which has found
Its way Int<; a previous Issue does not always obliter-
ate the impression produced. An alleged scandal
Il6 SUFFERING LONDON.
becomes the topic of conversation, and is rapidly
spread, while the subsequent correction receives but
httle attention. Many of those, moreover, who have
helped to spread the scandal would probably boycott
the correction. As reports of mismanagement of
hospitals are apt to produce extraordinary impres-
sions, because they tell of undeserved and un-
necessary suffering in quarters where relief and
charity prevail, it seems justifiable to plead that
criticism of our hospitals be deferred until a judg-
ment can be formed on evidence.
CHAPTER VII.
THE RESPONSir.ILITV OF WEALTH.
" Expose thy se/f fo feel 7C'hat ivretches feel.
That thou inayst shape the si/pe?'fiix to than,
And shoic the heareiis /notr justy
Different Views regarding Wealth — Definition of the Word
Wealthy — The Millionaire and the Pauper — Power over
other People's ^\'ork — Charity of the W^ealthy Classes —
Cheap Luxuries — Cause and Effect — The Monied Class and
the Toiler — A Practical Method of Charity — Misinterpreta-
tion of Christ's Teachings — Christianity and Socialism — The
Jewish Prophets and a Future Life — The Buddhists — The
Essence of Christianity — The Parable of the Talents — Per-
sonal Charity and Charitable Agencies — The Blessings which
Flow from (jur Hospitals.
People's opinions as to the responsibility of wealth
differ widely. To begin with, the opinion of the
poor is diametrically opposed to that of the rich ;
and I have noticed when a poor man begins to
accumulate wealth, his views, as to the responsibility
which goes with it, are apt to change. But, apart
from such reasoning as is the unsophisticated out-
come of human nature and individual standpoint,
different views exist regarding what is incumbent
on the wealthy, even among those who, uninliuenced
by circumstances, strive to elicit the truth.
I do not pretend to lay down a doctrine upon a
117
1 I 8 SUFFERING LONDON.
question which has ever puzzled the world. But I
will attempt to point out one cause of dissension
which, when removed, will allow of a greater con-
census of opinion.
This cause of dissension is the want of a defini-
tion of the word wealthy. Most people, poor and
rich alike, think that they know very well what it is
to be wealthy. But the following parable should
serve to show that the definition most people would
give does not accurately describe the meaning which
the word wealthy has in our days, and should, at the
same time, throw more light on the question than
can be done by any dry definition.
There were two men in New York who hap-
pened to be very like one another in appearance.
The one was a millionaire, the other a pauper. The
millionaire determined to settle in England. He
sold his land, his town possessions, his bonds and
shares, his furniture, and everything he possessed,
save such things as he required for the journey.
For all these worldly goods he received a draft on
London, which he forwarded to a bank there, and
took the first steamer to Liverpool. On the same
vessel was the pauper working for his passage across
the Atlantic. The steamer was wrecked on the
Welsh coast, and both the millionaire and the pauper
saved their lives by swimming, but saved nothing
else. When they reached the shore, nobody would
have been able to tell who was the rich or who was
the poor man. Besides their appearance there was
THE RKSl'ONSir.ILITV OF WKALTll. II9
■.mother rcniarkahk: point of similarity between them :
neither of them could point to a shelter, a rag of
clothing, or a scrap of food as his property. All
the property which had belonged to the rich man in
America was in the hands of others, and all the
property in England had other owners. Still the
one remained a millionaire and the other a pauper.
The one could order clothes and food, travel
straight to the best hotel and live on the fat of the
land, while the other had to beg his way.
The question of course arises, where was the
millioQ ? It was wherever the millionaire liked to
iind it. The great difference between him and the
pauper was, that his name was written upon the
page of a ledger in a bank and, under it, on the
right hand side, the figure one and six nouijhts.
This little formality enabled the millionaire to take
for his use land, houses, furniture, and anvthinof else
he chose, including other people's services.
From this it will be seen that the correct defini-
tion of the word wealth, when applied to an indi-
vidual, is the right to dispose of other people's
services and command the result of other people's
work.
The wealthy are therefore in the same position as
an absolute despot or a large slave-owner, with the
only difference that their power is limited by the
amount of accumulated rights in their hands, and by
the want of such rights in others. The wealthy
can, if they desire, given certain circumstances, re-
I20 SUFFERING LONDON.
duce the poor to utter misery, through, for example,,
harsh contracts, usury, etc. They can take the Hfe:
of the poor so long as they are careful not tO'
infringe the law. It is clone every clay through
over-work, starvation wages, unhealthy workshops,,
and neoflect.
The fact that wealth simply means the power-
over other people's work, proves that a few large
individual fortunes are only possible through great
poverty among the many. For, if the poor were to.
acquire wealth, that is, a certain amount of power
over others, such an acquisition would neutralise a.
corresponding number of rights among the rich, and
in a country where all the inhabitants were equall)^
rich they would be equally poor.
When we consider that all the enormous advant-
ages which the wealthy enjoy in a country like ours,
spring from the fact that there are such vast num-
bers of people who are poor, it is not to'be wondered
at if the possession of wealth brings with it a strong
sense of responsibility, even in those in whom it has.
not been implanted by moral or religious teaching.
This sense is natural to all, and seems to be the in-
equitable outcome of the true relations between rich
and poor, though these relations are not understood.
Though it is generally felt it is by no means widelv
acted upon. Pessimism, class-hatred, worldly wis-
dom, induce many to look upon this sense of respon-
sibility as a weakness to be overcome. There are
many among the wealthy who ha\'e never realised
THE RESPONSIIJILirV OF AVKALTII. 121
that the comforts and luxuries they enjoy arc the
result of the poverty of others. The question of
resj)onsibility, therefore, never occurs to them.
They are readily persuaded that poverty, as a rule,
is self-inriicted ; they make much of the theory of
the surxival of the fittest ; and they dismiss all
thouo;-hts of the unfortunate, with the text, " For
the poor always ye have with you."
The wealthy classes of England are far from un-
charitable, and once they realise that others bear
for them the hardships of life, and that they bear
them bravely and cheerfully, the beneficiaries, the
rich, will certainly take a greater interest in their
benefactors, the poor.
Even a small amount of wealth can nowadays
command a considerable amount of comfort and
luxury, because industry is so highly developed, and.
production is carried to such perfection. Science,
machinery, and ability are important factors in
our industrial progress, but intense application to
piece-work, keen competition, and low wages have
much to do with cheap luxuries. We could not
get so much for our money if others did not get
miserably little for their work — if they did not
subsist on the smallest possible means. When,
therefore, we can dress ourselves comfortably and
even luxuriously at small cost, we should not forget
that it is because so many poor men, women, and
children are so wretchedly clad. If we can enjoy a
delicious little dinner at small expense, we should
122 SUFFERING LONDON.
remember that it is because so many subsist on
little food — so many starve.
Though it is good for all, and not least for the
wealthy, to impress these stupendous truths on our
minds, we must not commit the mistake so general
now among politicians, economists, and would-be
reformers, of confounding cause and effect. From
the fact that the advantages of the wealthy spring
from the disadvantages of the poor we must not
rashly conclude that destruction of individual wealth
would benefit the poor. The inequalities in the divi-
sion of fortunes can be abolished by levelling down-
Avards ; but the lot of the toilers would not thereby
be improved. On the contrary, it would bring about
not merely general poverty, but absolute famine.
The existence of oreat wealth in a few hands is,
therefore, not the cause of the suffering of the poor,
but one of the features of the system under which
production is accomplished.
This system can be amended ; but the tendency is
not to amend it, but to alter it from a partially indivi-
dualistic to a complete socialistic system. If this
change is ever accomplished, the new state of things
will deeply disappoint its advocates ; for they will find
that the compulsion to work for the wealthier, which
hunger and cold exercise over the poor, will not
have been abolished, but simply replaced by the
compulsion to work for the Government, exercised
by overseers, police, and a huge standing army, all
of which will involve harder work, less reward, and
less freedom.
The indispensable condition of all civilisation is
the organisation of production. If we are not pre-
pared to adopt official compulsion or slavery, there
is no other method possible than the competitive
system of modern times. This, at all events, has
the enormous advantage of leaving man, compara-
tively speaking, a free agent, of opening up chances
for ability and enterprise, and of establishing an
immutable solidaritv amono^ all classes.
In this free system the wealthy render the com-
niunity the important service of accumulating,
guarding, and supplementing capital, without which
modern work would be impossible. It is, therefore,
of the utmost importance not to countenance the
idea that individual wealth is the obstacle to pros-
perity among the masses ; and this in spite of the fact
that out of the comparative poverty of the masses
arise the privileges of the rich. Those who attack
individual wealth in the hope of thereby benefiting
the poor commit the folly of supposing that effects
will produce their own causes. The poverty of the
toiler enhances the value of wealth ; but the wealth
of the monied class does not increase the poverty of
the toiler. To destroy the rich in order to benefit
the poor would be as absurd as to lorce up the
quicksilver column in a barometer in order to
produce fine weather.
Rut, unfortunately, as we all know, the animosity
against the wealthy classes, which threatens to be
the characterising feature of the close of the century,
124 SUFFERING LONDON.
springs from Ignorance of such truths. And this
leads to the question of the responsibihty of the
wealthy to themselves and to their country.
If the rich use the immense power which wealth-
confers in such a manner as to aggravate the position
of the toiler, they intensify the discontent and under-
mine the basis of society far more than could the
most reckless demagogue. A rich man can, by the
use he makes of his fortune, assist anarchists and
dynamiters more effectually than the most daring
desperado. He succeeds in maddening the honest
worker and the sincere enthusiast, whom the fire-
brands fail to move. The wealthy man can, if he
so choose, take his pound of llesh : the present laws-
of England allow it. He cannot do this without
shedding many drops of blood, without the sacrifice
of human life ; but on such terms he renders his caste
guilty under the law of Nemesis.
The duty of the wealthy to themselves and to-
their country is, therefore, to use their wealth and
power in such a way as to make the lot of those
who are born in poverty, who are left behind in the
race of life, as bearable a lot as possible.
A time will, no doubt, come when discontent will
be less rampant, and when men and women will
have learned to look more to their own personal
qualifications and exertions, and less to political
reforms, as means towards improving their condition.
But such a state of things is far off, and at present
the tendency is the other way. In the meantime the
responsibility of the wealthy daily increases
Tin; RESPOXSIDILITV OF WI-.ALTII. I 25
In spite of bad laws, defective systems, prevail-
ing prejudices, there would be no class hatred were
men to adhere strictly to the teachinLTs of relieion
in the matter of charity. I say deliberately religion
.and not Christianity, because the Jewish, the
INIahomedan, and the Buddhist creeds hold up
-charity as a cardinal virtue. It is not my inten-
tion to add one more to the many treatises and
^discourses upon the evils of this life, all of which
■end with the foregone conclusion that we should
be happier if more religious. But, in view of the
fact that in this country there are a great number
•of sincerely religious people who, on religious
grounds, are willing to exercise all the charity
in their power, it may be useful to disentangle
the perplexities which confront us, and thus arrive
.at a practical method of charity.
It is useless to disguise the stern command-
ments which Christ has given us. The text which
-says that it is easier for a camel to go through the
eye of a needle, than for a rich man to enter into the
Kingdom of God, summarises Christ's opinion re-
garding the responsibility of wealth. We have
heard many ingenious, and sometimes even amaz-
ing, explanations of this passage. When a
wealthy parson preaches to a wealthy congrega-
tion, the plain, literal interpretation of this text
must, to say the least, appear embarrassing. One
accepted explanation of the text is extremely
quaint. It is to the effect that the phrase used, the
126 SUFFERING LONDON.
needle's eye, does not actually refer to the eye of a
needle, but to a small gate in the wall round Jerusalem,
through which a loaded camel could not pass, but
through which a saddleless camel could squeeze by
going clown on his knees. This interpretation,
bristles with pretty suggestions for symbolic dis-
course. Thus, it might be said, that the rich man's
soul can enter heaven if it unburden itself of its
load of wealth ; that the millionaire can gain salva-
tion by kneeling in prayer; that many wealthy people
prefer the high and wide gate, and so forth. It is
strange that this little gate in the walls of Jeru-
salem was not discovered before. It is evident
that the old churches, and especially the Catholic
Church, did not explain away the meaning of the
text, for poverty was one of the vows of most of
their religious communities. Then again, look at
the moral to which the accepted reading points.
Does it not obviously illustrate that a man can,
after all, serve two masters, God and Mammon —
a thing so utterly opposed to the whole of Christ's
teaching ? There are many other passages recorded
of Christ's sayings which cannot leave any doubt
of the meaning of His teachings and the example
of His life.
Did He not impress His disciples with the sinful-
ness of hoardinor riches ? Indeed, the first Christian
community thus came to be based on socialistic prin-
ciples— it condemned the retention of wealth for
personal purposes.
To such an extent had this leadino^ feature of
THE RESI'ONSIIUI.ITV OF NVKALTII. I 27
Christ's tcachini^ been obscured th;it the cry, " La
propricte, c'est le vol," emanated from frec;-thinker.s
as a protest against Christianity. These nien had
studied reliq-Ion in the Church, instead of in the
Scriptures, But in England of to-day, on the other
hand, the advocates of Socialism have not failed to
jjerceive how great a support can be drawn froni the
New Testament in favour of their Utopian dreams.
Many years ago a foreign friend of mine told me
that Socialism would never be acceptable to Eng-
land until it assumed a reliofious cruise, and that,
then, it would prove irresistible ; and it cannot now
be denied that many preachers are becoming
pnpular by blending Christianity with Socialism.
b'ew people seem to realise what should at once
be patent to anyone who studies the recorded
words of Christ with an unbiased mind. His
whole desire was to deviate and improve humanity
— to promote terrestrial happiness, as a means of
preparing us for a spiritual life. This, there can be
little doubt, is the true explanation of His allusion
to God's kingdom on earth. The Christian religion
has thus naturally become the religion of civilisation.
The Jewish prophets spoke seldom of a future
life, and looked for reward and punishment in
this. They avowedly made earthly bliss their great
aim, but their religion has not succeeded in realising
it, while the Christian religion, which avowedly
makes celestial happiness its aims and terrestrial
ha[)piness the first stage, has found votaries all
over the Mobe. The Buddhist relisjion aimed
128 SUFFERING LONDON.
at many thinii^s, but certainly not at terrestrial
happiness. With its stern precepts of self-sacrifice,
it is more calculated to produce painful asceticism
than earthly bliss.
What Christ impressed upon us was the misery
^vhich follows from man's selfishness. He strove to
show that a community of human beings resolved
upon securing advantages each for himself would
be a hell upon earth. He also wished us to realise
that, on the other hand, a community in w^hich
each individual resolved to do his utmost for his
fellows would achieve the highest degree of happi-
ness. This is the essence of Christianity. If ap-
plied and used as a guide in our social system,
amazine results would be achieved ; and then we
should recognise, in what the theologians call the
■Christian Brotherhood, that natural law — the soli-
darity of humanity.
If we bear in mind that Christ wished to impress
the minds of the people with the truth, that by
mutual aid they would attain to far greater happi-
ness than by general enmity, the meaning of His
doctrines regarding wealth cannot be misunderstood.
■Only by sharing their fortunes with the people could
the rich in Palestine two thousand years ago have
brought about the desired brotherhood. The actual
(i-iving away of their money was of secondary im-
portance in those days. The main object in view
was general happiness — God's kingdom on earth.
The rich man, who, under the social system of
that period, clung to his wealth for selfish motives —
THE KESPONsir.iLiTV OF ^\•I■:AT;l'l T. 129
und thus allowed misery to r;;row up around him —
was condemned by Christ.
If we apply Christ's words to modern circum-
stances, their meaninof is evident : we must remembc^r
that we hold wealth, not for the pur[)ose of grati-
fyino- selfish desires, but in trust for the general
i^ood. This interpretation is confirmed by the Par-
able of the Talents. No rich man would intelli-
gently carry out Christ's precepts who gave away
his fortune without considering the consequences to
society. To keep it and use it for good ends would
be better obedience. He is not the rich man re-
ferred to by Christ, except when he is selfish and
when his actions are detrimental to society ; he
does more than give away his wealth when he
uses his fortune in such a way as to favour the
general well-being, and permanently benefit the
sufferers from poverty. The man who has dedi-
cated his fortune and his life to good causes does
not die the rich man's death, alluded to by Christ,
as unable to enter Heaven. He is the faithful
servant who returns to his master after making
good use of the talents entrusted to him.
Those wealthy English men and women who
have resolved to be guided in their lives by
Christian tenets, can have no doubt about the
duties Christ has imposed upon them, nor need
they be perplexed by apparent contradictions be-
tween His words and modern social science : for if
they study the spirit rather than the letter of their
I
130 SUFFERING LOXDOX.
Master's precepts, they will find that, while Christ
solemnly lays stress upon the responsibility of
wealth, He always exhorts them to practise wisdom
in the fulfilment of duty.
Thus, religion, patriotism, philanthropy, and self-
preservation, all warn the wealthy to remember
and fulfil their responsibilities to their poorer
brethren. And, after all, this is the surest w^ay of
realising happiness. Neglect of urgent responsi-
bilities can only end in self-reproach and degradation.
The consciousness of such neglect would bring a
pang with every tale of woe, and would sit like a
spectre at every feast.
But in this country there is fortunately not so
much need to exhort the wealthy classes to charity
as to point out the best way in which charity can be
joractised with really good results. Large amounts
intended for charity are yearly wasted on unworthy
objects. The number of institutions which appeal
to the thriving classes for contributions is legion.
Thev could be divided into two classes, the useful
and the nugatory. The latter class again could be
subdivided into those promoted by rascality and
those promoted by fanaticism. Looked at under the
lens of logic, many would fall into the last cate-
gory which now enjoy a reputation of great useful-
ness.
We have had specimens of many vast schemes
munificently supported, which, though they looked
alluring on paper, have been wrecked on the old and
THE RESPONSIBILITY OK WEALTH. I3I
well-known rocks of faulty economy and antagonism
to the laws which refjulate human societies.
It goes without saying that of all charity, direct,
personal charity is the one to be first recommended.
But, as I have ^ilready had occasion to say, there are
large numbers of people whose opportunities for such
charity are altogether out of proportion to the sum
they are able and willing to devote to the victims
of misery. Therefore, in a busy and wealthy country
like this, charitable agencies are indispensable.
The subject of charitable agencies is one on
which a large book might be written, and, were it
written, our Voluntary Hospitals would have to be
.treated in the first chapter.
Where could we find institutions which, wiih such
small resources, confer such a vast amount of cjood,
not only on the poor and the suffering, but on
society as a whole ? The great danger of charity is
the humiliation and corruption it may produce ; but
the charity exercised through our hospitals can have
no such effect ; for only those are directly benefited
who are already dependent on somebody's charity
— that charity from which, for some inscrutable pur-
pose of Providence, no one can escape.
Nor is it often that the aid proffered by the
hospitals is abused. There are, of course,
malingerers, hypochondriacs, to be met with, but
they are, as a rule, easily detected, and do not inflict
o^reat loss on the hospital funds.
What makes illness among people of meagre
T32 SUFFERING LONDON.
means such a terrible calamity is the era of evils
which it marshalls in : cessation of wages, large
expenses, loss of situations, indebtedness, and
broken up homes. Anyone who has reflected on
causes and consequences must have been struck
with what an interminable series of consequences
may flow from one small cause. Scribe does not
exaggerate when, in his " Verre d'Eau," he makes a
glass of water produce a change of government and
peace with France. History shows that the most
trivial incidents have, by their consequences, enor-
mously influenced the destiny of hum.anity. Thus,
the evil that happens to one man may bring untold
misery, degradation, and vice to thousands from
generation to generation : for every incident in each
man's life affects the future of himself and others,
and so long as the world lasts each consequence
becomes in its turn the cause of many other
consequences.
It must, therefore, be of the utmost importance to
contemporary or future society to save a man or a
family from the many causes of evil which follow in
the wake of sickness. From this point of view the
blessings which flow from our hospitals are in-
calculable and eternal.
If it were given to the wealthy of this country to
behold in this or in a future life the good their
wealth has produced, or the evil it has prevented,
they would find that whatever they have spent on
the hospitals has been a splendid investment.
CHAPTER VIII.
THE PRESENT NEEDS OF OUR HOSPITALS.
" JVork untJioiit hope draws Jiectar in a sieve,
And hope unthoiit an object cannot live."
Numbers Refused Admittance to the Hospitals — A Sacred Duty
Neglected — Proportion of Beds to the Population — Country
Patients in London Hospitals— London's Charity to Non-
Londoners — Income below Expenditure — The Wealth of Lon-
don— The Amount Required — Sanitoriums Abroad — Redis-
tribution— Out-Post Hospitals — Usefulness of Branches —
The Need of more Personal Service — House Visitors —
Cramped Sites.
To all Londoners who are proud of their city it
should be humiliating in the extreme to learn that
<3ur duty towards the indigent sufferers is badly
fulfilled in consequence of insufficient means ; that
•out of six adult applicants for treatment in the
hospit?ils only one is received ; and, what is worse,
for each child-patient which gains access to the
hospitals, three little sufferers are sent away. This
refusal of assistance to vast numbers who stand
sorely in need of it, creates sufferings and troubles
in the homes of the poor to which clergymen,
doctors, and other visiting friends can testify.
Why should London be so deplorably back-
1:33
134 SUFFERING LONDON.
ward in the performance of a duty that every
reUgion in the world enjoins, — a duty that cannot be
neglected without violating our best instinct ?
The number of hospital beds in London is only
2 to each looo inhabitants, and by the influx of
cases from the country, only i bed to lOOO is^
available for the London poor. The great
medical skill, the wide experience in curing and
in operating which the Metropolis affords, the want
of well-conducted hospitals in country districts, the
predilection of country practitioners for those hos-
pitals in which they have studied and which they
can trust — all this naturally tends towards filling a
portion of the available beds with country patients-
Many of these could no doubt pay for the relief they
obtain, and others could probably make a partial
contribution. It seems to me just and desirable
that something should be done to induce such coun-
try patients as can pay to discharge at least a portion
of their obligation to the hospitals. As matters now
stand the teeming millions of London can only count
upon one bed per thousand, a proportion which is
unique among the large towns of Great Britain.
Glasgow, Newcastle, Wolverhampton have t,^ beds-
per lOOo; Edinburgh, 3I ; Dublin, 6| ; Norwich,
Belfast, Brighton, Liverpool, Manchester, and Bristol
have an average of 2^ beds per 1000, If, again
we compare London with the other capitals of
Europe, we find that our Metropolis is deplorably
deficient in hospital accommodation.
THE PRESENT NEEDS OF OUR IIOSrU'ALS. 1 35
The London Voluntary Hospitals provide u|;-
wards ot 8000 beds, of which, sad to say, about
2000, or 25 per cent., are unoccupied for want of
funds.
It is want of funds which prevents the develop-
ment of our free hospital system to the extent which
is needed, and which the fair name of London de-
mands. When I speak of want of funds, I do not,
of course, mean that London as a whole is too poor
to supply the tritie required for the hospitals ; nor
that there is more callousness or selfishness here
than in other places. That the upper and upper-
middle and well-to-do working-classes could supply
ten times the amount required without perceptible
denial, is, in my opinion, a fact ; and that we Lon-
doners are ever ready to relieve sufferings, not only
here but in any part of the globe, has been proved
over and over again. What is wanted is a general
awakening to the present disgraceful state of things
— a recognition of the sacred duty we neglect.
The reliable income of the Voluntary Hospitals
is, or at least was in 1891, ^250,000 below the ex-
penditure, with two thousand beds empty. The utilisa-
tion of these would necessitate another ^120,000.
To bring the occupied beds up to 2 beds for each
1000 inhabitants would entail ^300,000. The de-
ficiency in the income of the hospitals may, there-
fore, be put down at ^670,000.
This amount would be easily obtainable in London,
for it contains thousands of millionaires, or, at least.
136 SUFFERING LONDON.
people who have the incomes of millionaires, a
capitalist class which invests hundreds of millions in
bankrupt foreign Governments and foolish foreign
enterprises, tens of thousands of shopkeepers,
traders, and skilled artisans, whose incomes exceed
those of many a foreign Minister of State, and a
vast body of officials who divide between them a
goodly share of our hundred million Budget.
My belief is that twice the sum of ^670,000 could
easily be raised in London for the benefit of destitute
sufferers. This would represent only about six
shillings per head of the population, or about three
halfpence per week. And yet so small a contribu-
tion would confer immense advantages on society,
for it would be used on the principle of voluntary
co-operation, free from the socialistic and bureau-
cratic taint. Such an addition to the income of our
Voluntary Hospitals would enable London to give
extension to other institutions connected with them,
such as Medical Schools, Nursing Institutions, and
Convalescent Homes.
Without being a medical man I think I am safe
in concluding that if change of climate and winter
residence in such countries as the Riviera, Algiers,
and Egypt can save the life of the wealthy and their
children, it should do the same for the poor. It
would be easy for Londoners to complete the hos-
pital system, which I hope may one day be their
pride, with Convalescent Homes and Sanitoriums in
suitable climates. They might be so managed as
THE PRKSENT NEEDS OF OUR IIOSPITAl-S. 1 3/
to benefit not only the poor who cannot pay at all,
but also those who can pay the low rate of ex[)enses
which co-operation can effect, though not the consider-
able outlay involved in individual residence abroad.
1 do not expect the average Londoner to rise to the
moral height of Ibsen's minister, Brand, who sacri-
ficed the life of one, his own child, for the benefit of
the many. But it seems to me that when we allow
useful human life to perish, which could be saved at
the expense of a few pounds, the question aristjs,
How do we stand with regard to the sixth com-
mandment ?
One great need of our present hospital system,
— one great object for which funds are needed, is
redistribution. One effect of the want of system
which, as I have already pointed out, has character-
ised the development of the hospital movement, is
that the establishments are too close together — all
in the central districts. From this several serious
•drawbacks accrue. The sufferers have to be taken
long distances, when they come from the outlying
<.listricts, and their transport is inconvenient, painful,
and often dangerous to life.
The different districts not having their special
hospitals, the choice made by patients is often
<jrratic, and they are frequently taken far greater
distances than would be required were it the
rule or the custom to go to the nearest hospital.
One bad consequence of the inadequate distribu-
tion is that inhabitants take no interest and no j)ride
I3S SUFFERING LONDON.
in an institution the existence of which might be a.
matter of Hfe and death to them. Nor have they
sufficient knowledge of the hospitals. As a rule^
the average Londoner has never set his foot inside
a hospital, and, as matters now stand, few are likely
to enter the wards unless carried there. This lack
of acquaintance with the hospitals must be attri-
buted to the absurd notions which many people
have of such places. In the opinion of some
these institutions mainly exist for the supply of sub-
jects for dissection, while, as to fever hospitals, they
are apt to be looked upon as the old-world pest-
houses and as centres of infection. Such erroneous,
opinions are not only held by the uneducated, but
by many persons who ought to be better informed.
With such views current, it is not to be wondered at
if the importance and the usefulness of our healing-
establishments are overlooked, and the interest in
them is slight and ineffective.
According to the opinion of medical men and
others who have given a great deal of attention tO"
the question, a redistribution could be best carried
out by the establishment of what I may call out-post
hospitals in the centre of each district, especially in
those inhabited by the poor. They should be
branches of the great central hospitals, and be con-
nected with them. In this way the severely felt
want of four thousand beds should be met. It has.
been estimated that this could be done by an outlay
of ^600,000 to ^800,000, including sites and build-
[IIE PRESENT NEEDS OE OUR HOSITrAES. 1 39
ings. It can readily be understood what a boon
such an estabhshment in the centre of each district
would be, and what great services it could render to
the working-man, whose career is now often broken
because he and his family are left to struggle with
disease in their own honie. The inhabitants of the
districts, especially the employers of labour, would
certainly take a keener interest in a local establish-
ment than in the far-off central one, and the friendly
rivalry which would naturally spring up between the-
districts, with regard to the care of the hospitals,
would be productive of most beneficial results. The
prejudices against hospital treatment which, though
disappearing, still exist, would soon vanish before a
closer contact with these branches. A certain num-
ber of beds might always be kept in reserve in case
of great fires, explosions, or similar calamities, caus-
ing a sudden demand for aid.
There is another great need that must be met
before our Voluntary Hospitals can become what
they ought to be — the need of more personal
service As a non -expert, I would say that
there are many ways in which the personal ser-
vices of the leisured class could be enlisted ia
favour of the hospitals, and of the poor sufferers
in general. But, wishing to be as practical as
I can, I shall only refer to one need in this
respect, which is generally acknowledged to be
strongly felt, and one which, it is to be hoped, will
be speedily met. I refer to the personal services of
140 SUFFERING LONDON.
house visiting, a duty useful in itself, and indis-
pensable to those who desire to educate themselves
as governors, and to qualify for seats on the hospital
committees. In the present undeveloped state of
our hospitals there is room for about seventeen
hundred house visitors, and, if London awakens
from its present deplorable apathy with regard to
the suffering poor, a far larger number will be re-
quired. The duties are light and far from unpleas-
ant, and would certainly add a new and vivid interest
to many a young man's life ; and for any man who
aspires to civic or political honours, or any public
trust, the duty of house visitor to a hospital should
be the initial stage.
The cramped condition of many of the hospital
sites is another unsatisfactory feature which should be
remedied as soon as funds allow. Adjacent proper-
ties should, in many cases, be bought, so as to make
the site of the hospitals self-contained in one block,
with no other building between them and the streets.
In this way better working, greater ease, and more
fresh air would be secured.
CHAPTER IX.
A PRACTICAL SCHEME.
N'obkssc oblige.
London and its Parliamentary Divisions — The Hos[)ital Sunday
and Saturday Council — Proposed Hospital Guilds — London
Division Lodges — Congregation Lodges — Appointment of
Officers — Prestige of Metropolitan jSIembers — The Pellamists
of America — The County Council — The Housing of the Poor
— The Rookeries — Bad Housing — Socialistic Tendencies of
the County Council — Better Method of Supporting Voluntary
Hospitals — Effective Co-operation.
While the needs of the Voluntary Hospitals are
large and manifold, I think I am justified in saying
that all the funds required to meet them could
easily be supplied by London ; that the willing-
ness to help such a sacred and necessary cause is
with us as much as with any community.
What is wanted are suitable channels through
which the offerings of the charitable can reach the
hospitals, as well as information regarding their
needs, I shall, therefore, proceed to show how
an organisation could be formed for the awakening
of an interest in our hospitals and the furtherance of
hospital work.
The scheme, the outlines of which I shall submit,
is. no doubt, capable of great improvement and
141
142 SUFFERING LONDON.
•development, when elaborated by men who have a
wider experience of hospital matters than myself.
But I can say this for it, that it was in part sug-
gested by the Hospital Association, that it is prac-
ticable, and that it involves no new mechanism, no
■extravagant expenditure, and no elaborate manage-
ment.
London is already divided into such districts, each
of which ought to have its own hospital, namely,
the Parliamentary divisions. Each of these divi-
sions have their member of Parliament, and their
two County Councillors — national leaders of move-
ments in matters affecting the people.
The divisions also contain churches and chapels,
-each represented by the ministers of religion, church-
wardens, and sidesmen, who co-operate with the
Hospital Sunday Council.
Each of these divisions also have factories and
workshops, which are already co-operating to some
extent for the benefit of the hospitals under the
Hospital Saturday Council. These establishments
are at present represented for hospital purposes by
masters and foremen.
Thus there exists in London a complete organ-
isation for hospital purposes, and all that it is neces-
sary to do is to strengthen, develop, and vivify it.
So far much of the work has fallen upon the
shoulders of the ministers of religion, and the laity
has not co-operated, or shall I say, has not had the
opportunities of co-operating to the extent required
A PRACTICAL SCHEME. 1 43
in order to briiiL;;' our hospital system to that per-
fection which the interests of London and the
nation demand. The ministers of religion have
already proved their willingness to do all in their
power, and as, moreover, they are in close contact
with those classes mostly benefited by hospitals,
■and are looked upon by their congregations as the
national leaders in noble and Christian work, they
are indispensable to the proposed development.
It is now suggested that each congregation of
all denominations should form a Hospital Guild of
its own, each of which, for clearness' sake, may be
•called a Congregation Lodge. Through delegates
■elected by their members all such lodges would
co-operate. The delegates of the Congregation
Lodges would meet and act together, and might be
called a Division Lodge. These Division Lodges,
again, might send delegates to a meeting in which
all the London Division Lodges would be repre-
sented, or else communicate direct with the hospital
authorities. The work of the Congregation Lodges
would be to make themselves well acquainted with
the hospital requirements of the people ; to qualify
the members for election as house-visitors ; to receive
information from such philanthropic bodies in con-
nection with their church or chapel regarding cases
which ought to be treated in the hospitals ; to
supply information to the people about the hospitals,
-SO that a sufferer can at once be taken to the right
place ; to hold meetings from time to time, at which
144 SUFFERING LONDON.
lectures should be given on subjects relating to
hospitals, hygiene, nursing, etc. ; to carry out, as
far as possible, recommendations and suggestions
coming from the Division Lodges ; to encourage,
by such means as may be thought suitable, contri-
butions to the church or chapel collections on
Hospital Sundays ; to induce employers of labour
belonging to congregations, or having works in the
district, to organise a systematic collection among
their men, and, if possible, to encourage their
working people by coming forward as donors them-
selves, in a certain ratio to the contributions of the
workers; to raise funds in any other way the lodges
may consider expedient.
The nucleus of each lodge should be formed by
the clergyman or minister, the churchwardens, the
sidesmen of the congregation, the doctor of the
district, and others — ^ ladies or gentlemen — who take
an interest in the movement. Gradually the
number should be increased, until deemed sufficient
for the work in hand. The members might be
divided according to the various missions to be
fulfilled, and thereby great extension could be given
to the lodge without encumbering the management.
A small yearly contribution might be demanded, it
not of all the members, at least of some of them.
All respectable people should be considered eligible.
I feel convinced that it will ha\^e the approval of
all large-minded, educated people if I suggest
that caste should be banished from the lodge. It is
A PRACTICAL SCHEME. 1 45
recognised that in this coiiiUry the opportunities for
the different chisses to meet are all too few. Com-
plete social equality belongs, probably, to the un-
realisable Utopias, and would most likely be as
unacceptable to the poor as to the rich, to the un-
tutored as to the learned. But for the different
classes to systematically avoid each other when any
good cause calls upon them to co-operate would
be despicable snobbery, fraught with dangers to
society. Charity to poor sufferers is surely a cause
which ought to make Christians forget the differ-
ences which result from accident. If these lodges
are established in the spirit of frank brotherhood
they will confer a direct, as well as an indirect,
benefit upon the country.
Each lodge should elect its own officers, who
would have to give their services gratuitously.
Simple rules should be framed for the management,
and should have the sanction of the Division Lodge,
in order to ensure harmonious working.
The Division Lodges should be formed, as
already explained, by delegates from the Congrega-
tion Lodges. Their object should be to forward
the information received from the Congregation
Lodges to a Central Lodge ; to arrange with the
Central Lodge about the accommodation provided
and the needs for further extension, and alterations
of the institutions of the neighbourhood ; to re-
ceive from the Congregation Lodges and remit
to the Central Lodo^e all monies collected for the
K
146 SUFFERING LONDON.
hospitals ; to arrange lectures on a larger scale, illus-
trated, for example, by magic lantern slides, or living
pictures, and spread the knowledge of hospitals by
any other means that may be thought judicious ; to
communicate with the hospitals as to available beds,
and direct patients to the right institution ; to en-
courage, in their turn, donations to the hospitals.
Rules should be framed and officers appointed, as in
the case of the Congregation Lodges, and, if re-
quired, a paid secretary should be secured.
Such is the scheme ; and, though it might seem
somewhat complicated to those who have not taken
an active part in associations, I trust it may be
found easy to realise.
For the initial steps, we must look to the London
Members of Parliament, the candidates, and the
County Councillors. The fact that those gentlemen
may belong to different parties, need not stand in the
way : charity and duty to our city, and to our
country, should be independent of party politics.
Our Members of Parliament, as well as our
candidates, cannot fail to eagerly embrace the oppor-
tunity of rendering so conspicuous a service to their
constituents at the expense of so little trouble, and
hardly any outlay. It is meet that such a move-
ment should be inaugurated by men who have
undertaken, or who are willing to undertake, the
care of London's interests at home, and all over the
world.
The prestige and influence of the Metropolitan
A PRACTICAL SCI I KM ll. 1 47
Members, as well as their ability, would go a lon^j
way towards awakenino- London's conscience to a
sense of what is duv. to its sufterers. To lend this
prestige would secure to the members a |)opularity
which no achievement in the House of Commons
can brinof about, because, so lonof as our constitu-
encies are divided into parties, it is next to impossible
to please all in legislation. To [)roniote the welfare
of the hospitals would be an item in their programme
which would not expose them to cavil, or heckling ;
but convey to every elector the impression of
genuine philanthropy and patriotism.
Party politics, necessary as they are considered to
be, have their disadvantages. From what I hear
from many quarters, the working-classes are not
enthusiastically attached to either of the two great
parties. According to what indi\'iduals say, the
reason of this is that workinof-men consider that
we have had too much legislation for the parties,
and too little for the country, and that the same
defect clings to the promises for the future. What
the poorer classes of this country expect is perhaps
not reasonable but natural ; they wish Parliament to
legislate in such a manner as to ease the pressure of
competition which weighs so heavily upon them,
and to render their share of the wealth they produce
materially larger. This problem is not easy of solution,
and it will be some time before either of the parties
seriously tackles it. Meanwhile, nothing could be
more beneficial than to stave off the serious conse-
148 SUFFERING LONDON.
quences which befal the working-classes through
disease.
It is a tradition in E norland that Members of
Parliament should be representative men outside St.
Stephen's, as well as inside. To them this is both
a responsibility and a privilege. Nobody knows
better than they how fallacious is the now some-
what popular idea that the nation can be made
virtuous and happy by Acts of Parliament, and how
easy it is to commit mistakes if the impossible is
attempted. They know how often recently passed
measures have to be amended or repealed. Of the
Acts during the present reign alone, over a thou-
s:ind, it seems, have been already repealed. The
scope of usefulness inside Parliament being thus so
limited by circumstances, it is good that our repre-
sentatives have the opportunity through the pres-
tige which goes with their power to take the lead
in anything which can effectively advance the wel-
fare of the people, and stimulate personal and civic
virtues.
What is here said of Members of Parliament,
applies to a great extent to County Councillors. It
is probably due to the party feeling which ran so
high during the elections, that many of our County
Councillors have been credited with extreme social-
istic tendencies. If these really have framed a pro-
gramme, similar to that of the Bellamists of America,
a programme to gradually socialise all our institu-
tions, it would be futile to suggest to them that they
A PRACTICAL SCI I KM 10, 1 49
should take the initiative in a niovenient, the object
of which Is to extend and improve our system of
Vokmtary Hospitals.
My belief is that few members of the Lon-
don Council aim at complete Socialism, and even
those who do would not refuse to assist a move-
ment whose object is to lessen the sufferings of the
working-classes during the transition. It is per-
fectly conceivable, and to my knowledge an actu-
ality in a great many cases, that men, sensible of
the sufferings of the poor, may advocate a great
many socialistic measures without aiming at com-
plete Socialism.
The County Council, like Parliament, exercises a
considerable influence on its members, and there
can be no doubt, that those who have been mem-
bers for some years, will perceive that enthusiasm
without logic is a dangerous guide in legislation.
The experience which the County Council, so far,
has Qfone throusfh, has, no doubt, demonstrated
what foreiQ-n leo^islation has tauQ^ht us lonij hq-q — •
namely, that to legislate without heeding the laws
of Political Economy and Sociology, is as perilous
as to attempt to navigate a ship without a compass.
Thus the question of the Housing of the Poor,
which has so long been before the public and the
County Council, has been elucidated through dis-
cussion and experience, which allow of at least some
absolutely irrefragable deductions. We know that
pulling down rookeries means creating a wider
150 SUFFERING LONDON.
circle of rookeries ; that building' new houses, and
letting them at their commercial value, does not
benefit the poorest, because they cannot afford to
take them ; that to let them at a losing rate means
to encourage thriftlessness at the expense of the
thrifty ; and that to build houses out of the rates is
to paralyse the activity of private building. All
this teaches us what we might have known before,
that the bad housinof is not the cause, but the result
of poverty.
The constant discussions and the crraduallv Qfained
experience may be regarded as sufficient antidotes
against a blind impulse for a good cause ; and in a
few years the socialistic tendencies of the County
Council will take a less acute shape. For me it
suffices that its members are zealously considering
how to ameliorate the condition of our working-
classes. Where there is a will the right way is sure
to be found in time. I have no doubt that the Coun-
cillors, irrespective of party, will all gladly give their
support and their influence to the cause of the
hospitals. To refuse it would be to endorse the
censure of their enemies.
If the London Members of Parliament and the
County Councillors are willing to initiate a move-
ment in favour of a better support of the Voluntary
Hospitals, and thus grapple with a most serious
cause of suffering and poverty among the working-
classes, all they have to do is to hire a hall in their
cliv'ision and call a meetinof with the view of forminir
A PRACTICAL SCllKMK. 151
a Hospital Guild there. Any member, councillor,
clergyman, or any other friend of the sufferers who
is willinsj;' to take the initiative, can, I think, count
upon effective co-operation. For my part, I shall
always be ready to put them in communication with
those who, throug'h long experience and unflagging
devotion to the cause of the hospitals, are able to
give most effectual assistance and trustworthy in-
formation.
CHAPTER X.
CONCLUSION.
" Hier stelie ich iind kann Jiicht ^ueiter."
The Story of Swen Dufva — Generous Instincts — Stern Reality —
Scepticism and Pessimism — The Sophistries of INIahhus —
The Feeling of Nationality — Mr. Fildes' Famous Picture —
Peace and Harmony Among Classes — The Armament of
European States — War of Races and Classes — Communal or
State Hospitals not able to Replace Voluntary Hospitals —
The Government and the People — The Socialistic Utopia — -
The Hospital Sunday Fund — Different Religions and Sects
• — Nathan the Wise — The Story of Saladin — The JNIoral
Value of a Creed — Goodwill among Men.
During the last heroic struggle made by the Finns
against the Russians, there was a country lad, Swen
Dufva by name, whose brief and pathetic career the
Finnish poet, Runneberg, recounts in one of his
poems. Dufva wanted to be a soldier and joined
the army, but, unfortunately, he was slow to learn
his drill and exasperated the drill sergeant. He
confounded right and left, and could not distinguish
betw^een the words retreat and bayonet. At last he
was told that he would never make a soldier, but,
152
CONCLUSION. 153
as men were; scarce, he was, however, employed on
the baggag-e- train. But the war thinned the ranks
and Diifwa had to shoulder a musket. One day he
was told oft' with twenty soldiers to guard a
narrow bridge of importance, but over which the
enemy was hardly expected to come.
Suddenly, however, the Russian vanguard ap-
peared on the other side, eager to cross before the
Finnish army knew of its whereabouts. As the
Russian army neared the bridge the young Finnish
ofiicer cried out, " Fire ! " The volley was replied
to, and of the twenty Finns only eight remained.
"Retreat" was the next command, but, as usual,
Dufva mistook the command and fixed his bayonet.
He sprang upon the bridge where the first Russian
had already set foot. Taking advantage of its
narrowness he engaged in a desperate hand-to-hand
hght with the most advanced of the enemy, who,
awed by his daring, paused while the bulk in the
rear were hurled by their officers on to the bridge.
Holdinof a wounded Russian as a shield, Dufva
dealt blow after blow upon his assailants. He held
the bridge until the Finnish reinforcement came up.
The Russian manoeuvre was frustrated and victory
was with the Finns. When the fight was over the
Finnish commander asked for the man who had
held the bridge. The answer came — " Dufva lies
dead at the water's edge." The general recognised
him, and pointing to a bullet-wound in the region
of the heart, said, "This bullet had more sense than
154 SUFFERING LONDON.
we ; it avoided his poor brain and went straight to
his big heart."
Now, it is my ardent hope that this work may go
straight to the heart of my countrymen : for only
thus could it fulfil its mission. I know that I
address a public with no lack of brain-power, and
that the nature of my task has compelled me to
appeal rather to intelligence than to sentiment.
Yet it is to British hearts I trust for a favourable
reception of this labour of love of mine. It is so
much easier to advance a sfood cause when the
sympathies of a people can be enlisted. When we
judge and when we are guided by our hearts, our
actions are so much more spontaneous than when
we are piloted by reason. Our intelligence is a tree
of knowledcje for Qrood or evil, and when it is made
the master of the heart instead of its handmaid, the
quality of its fruit is in danger.
We live at a time when intelligence has achieved
great triumphs and we have learned to trust to it,
and to expect still more from it. We have fallen
into the habit of calculating, analysing, dissecting ;
and if it be true that all pain be real and all pleasure
imaginary, we might make the reign of intelligence
responsible for the dying out of laughter.
There was a time when knowledge was small and
taken on trust ; when good things were enjoyed
without hesitation, and things of beauty beheld
without theorising. 71ie world was small, life
was long, and its mysteries, transformed into
CONCLUSION. 155
fables and [phantasies, threw over it a glow of
romance !
How diHerent now! We, the children of the
nineteenth century, know either too much or too
little to abandon ourselves to fanciful impulse and
generous instincts. To us the world is not an all-
absorbing and all-important stage. We know that
our planet is an insignificant grain in a mighty Uni-
verse, spinning around in endless space, supported
by a power which we have named but cannot under-
stand. We have measured and weighed other
worlds, but do not know for what purpose they
exist. We have studied our own bodies in every
detail, but we know not who or what we are. We
are born without knowing whether we have lived
before, and we die without havinof attained to one
single scientific proof of whether we are to live
aofain, or whether we shall cease to exist. Many of
the awful aspects of Nature are unveiled to us.
Painful facts are made salient. We behold suffer-
ings in all human beings, and even in irresponsible
animals! Everywhere disenchanted fables, dispelled
illusions, scattered ideals ; reality, stern reality, is
looming before us, in all its gloom, grandeur, and
inscrutability.
Maybe our knowledge is as yet one-sided, and
that we only behold the solemn and awful side of
reality. Maybe its brighter and lovelier features
have yet to be disclosed. vSuch. however, as our
knowledge is, it has produced among us two maladies
156 SUFFERING LOXDOX.
of the soul — Scepticism and Pessimism. They ofcen
reign supreme in our minds but they never van-
quish our hearts. With the famous sophistries of
Malthus before us we mio^ht decide that any causes
which destroy human hfe are welcome as a remedy
against over-population. But when the cry of dis-
tress from a fellow -being in danger of perishing is
heard, it goes to our heart, and we risk our life to
save his. Abstractly speaking, the feeling of na-
tionality can be proved an evil which has caused a
frightful amount of bloodshed and misery. But if
the cry went up that England's honour were at
stake, we should at once be ready to take the field.
The cruel methods of Nature and the miseries of
mankind might tempt us to cry out " There is no
God ! " but the sight of an enchanting landscape,
a beautiful human face or form, or even a tiny field-
llower, thrills the heart to a sense of admiration of
the Master behind those masterpieces.
It is the same with our sympathy for suffering.
The mass of misery, agony, privation, that comes
within our observation only through the medium of
statistics, newspaper reports and hearsay, leave us
comparatively cold. The generous impulses which
reported suffering awaken in us arc instantaneously
checked ; considerations of prudence, theories, and,
perhaps, the thought that, against such hosts of
evil, the exertions of one avail but little. But, when
sickness, want, or danger threaten the life of the
most abject being under our eyes, we are over-
CONCLUSION. 157
powered by the divine spirit within. 'J'o do its
bidding, we sacrifice more to save one, perhaps,
worthless hfe than we would do to save a hundred
noble lives of whose perilous position we have only
heard.
To rouse the apathetic to generosity, and the
generous to activity, is a work that could best be
imdertaken, as we know by experience, by our
clergy, our great writers of fiction, our poets, our
dramatists, and our artists. What I have chiefly
endeavoured to do has been to sweep away the
fallacies and prejudices which pessimists and
sceptics raise up against liberal charity, and thus to
leave the ground free to those more influential than
myself to sway the heart of London.
And the power of the man who combines genius
with talent can infiuence his fellow - beings enor-
mously. Among last year's pictures at the Royal
Academy was a now famous one by Mr. Luke Flldes.
It was well calculated to quicken our sympathy with
sufferers. It represented the fine type of an Eng-
lish medical man eagerly Intent upon snatching the
child of a labourer from the jaws of death. The
spectacle of an evidently eminent physician sacrific-
ing his night's rest and his probably valuable time
in favour of a little patient never likely to compensate
h m ; the full power of a great Intellect brought Into
play in order to secure for the labourer's child all
that could be done for a prince — all this so strongly
.brought forth the most beautiful side of human
158 SUFFERING LONDON.
nature, and so vividly suggested the ecstasy \\hich
is the reward of a charitable deed, that I was not
surprised at the emotion of the spectators. Prosaic-
looking city men, fashionable ladies, young dandies,
all sorts and conditions of men, were fascinated
by the picture, and often brushing away a tear of
admiration, formed a common scene before Mr.
Fildes' masterpiece.
All true literature and all true art aim, of course,
at the ennoblement of Humanity. Those who
imagine that they are disciples of literature and art
and yet remain dumb to such generous promptings
as sympathy with suffering may be sure that these
two great factors of civilisation have done as little
for them as for the grossest slum-dweller in our
cities or the most debased savage. But what leaders
of men in religion, literature, and art can do is to
indicate more directly than has hitherto been done
the magnificent opportunities for the gratification of
generous impulses which our \^oluntary Hospitals
present.
My part has been that of a sign-post, indicating
where a great civic and national cause is waiting for
sincere champions, and I am only too conscious that
if stronger men than myself do not espouse it, my
small contribution will go for nothing.
It has been my endeavour to show that London,
the centre of fabulous wealth, the rendezvous of
talent and genius, the metropolis of the world's
mightiest race, the site of thousands of churches, and
CONCLUSION, I 59
the home of over ;i hLindred reh^Ioiis sects, is also
the home of an incalculable amount of misery and
sufferinof — sufferlnof which, to a \ery laroe extent, is
preventible or artificially produced. The J uggernaut
of our industry advances o\'er the prostrate bodies
of honest men, delicate women, and helpless children.
There is no necessity for so many industries to be
fed, so to say, with human life and health. On the
contrary, it is evident that if there were prosperity
amongst the producers of goods they would them-
selves constitute a far better market than they do at
present.
I have explained that, though so much of this
suffering is unnatural, there is no immediate prospect
of a change for the better in the London trades, and
that, therefore, the aggregate of cases of sickness our
hospitals ought to deal with in the future are fairly
certain not to diminish.
I have called attention to the man)- dangers to
health and life which lurk all o\-er this great metro-
polis, especially among the poorer classes, and I
have warned Londoners that, thoucrh we have been
free from pestilence for a long period, we have no
fjuarantee that this scouro^e is extinct. It is evi-
dent that the well-to-do classes must expose
themselves to infection and premature death if they
allow the struggling classes to be taken by surprise
by some old or new pest. In normal and absolutely
peaceful times the Voluntary Hospitals are essential
to the welfare of all, including the wealthiest, not
l6o SUFFERING LONDOX.
only because they check and cure chsease, but be-
cause they mitigate the sufferings of the poor, and
tend to produce peace and harmony between the
cHfferent classes of society. But times are not
always normal and peaceful. There are unmistak-
able sio-ns both abroad and here that the close of
the nineteenth century will be more pregnant with
upheavals than those of previous centuries have
been. It seems that the end of the century will also
be the end of a long- historical epoch : for systems
and theories, mistakes and abuses, all threaten to
reach that point simultaneously beyond which they
cannot be developed. The armament of the great
European States cannot be carried much further
without breaking down by the sheer force of their
own weight. The indebtedness of many States is
reaching the limit of limit-credit, and has acquired
an alarming unmanageable self-grow^th. The pro-
tective system, and the consequent suffering of the
working-classes, have reached their culminating
point, and the financial system, which consists
of building company upon company, of issu-
ing paper against paper, shows signs of dis-
solution.
We are threatened not only with wars of nations
but with wars of races and classes. The hatred
aorainst the bourgeoisie on the Continent has attained
to an intensity which strongly recalls the animosity
against the nobility and the Church just one hundred
years ago, and will burst forth so soon as it has
CONCLUSION. l6l
spread sufficiently amongst the rank and file of the
standing armies which hold it at bay.
It is to be hoped that the dark clouds which hang
over Europe will be, by means not yet discernible,
swept away, and that the coming century will in-
augurate a happier period. But should the storm
come, will London be exempt from its effects ?
This is not possible ; for not only will our trade and
our politics be affected, but we have our own burn-
ing questions which, as matters stand, are daily
becoming more acute and will certainly be ripened
by everything which tends to hamper industrial
activity. The evils which the dangers of the
present political and social state of the world
threaten to bring about, can be mitigated socially
and physically by no other institutions better than a
system of well-provided Voluntary Hospitals.
I have thought it necessary to emphasize the
statement that Communal or State Hospitals could
not replace our Voluntary Hospitals — that, in fact,
the socialisation or municipalisation of our hospitals
would be equal to their abolition. This all the
more as the spreading belief of Socialism causes
many to regard the support of the Voluntary
Hospitals as of little moment, nay, as treason against
what in their belief is the social ideal. I have
endeavoured to keep this work free from the spirit
of party or sect, but I have felt compelled by duty
to dwell to some extent on the delusions which
tempt the unwary to look upon Socialism as the
1 62 SUFFERING LONDON.
solution of our social problems. The fact that so
many excellent men have of late foresworn Individ-
ualism, and that the very desire to benefit their fel-
low-beings, to which I would fain appeal, has made
them an easy prey to the modern hallucination, urged
me to this timely warning. Bellamy, Henry George,
and many more advocates of a gradual transition
from a free to a compulsory system,, base all their
reasoning on the supposition which, though plausible,
is fallacious. It is this : that to confer unlimited
power over everything upon Government, in order
that it shall be exercised in favour of all the citizens
of the State alike, is good and practicable so long
as the public exercises, as electors, full power over
the Government. The conditions, then, for the
success of Socialism is that the people shall exercise
unlimited power over the Government, and that the
Government shall exercise unlimited power over the
people. This is supposed possible because we have
the example of States where the Government has
unlimited power over the people, and also, in other
countries, where the people have unlimited power
over the Government. Of the two principles
working simultaneously in one country we have no
example, and to believe it possible is the funda-
mental fallacy in socialistic reasoning. Why it is
a fallacy will become at once obvious through the
following illustration. Two acrobats of the same
weight and strength become convinced, by practical
experience, that the one can lift the other, and con-
CONCLUSION. 1 6
^
elude that, this being the case, they can by lifting
each other simultaneously soar into the air. This
would, of course, be a fallacy, because we know that
each of them increases his w^eight in exact pro-
portion to the force he applies in lifting the other.
The case is the same with respect to the power of
Government and people ; for every iota of power
the Government gains, the people lose ; and vice
versa. The very term political power would be
meaningless if there were not people in proportional
subjection.
There is, therefore, not the slightest possibility
that we shall ever achieve the socialistic Utopia.
What we may get is a powerful bureaucratic class
difficult to shake off. In the meantime, the gradual
transition is painful, especially to the working-classes
— for the clunisy State interference hampering the
delicate mechanism of a free system tends to reduce
trade and wages, and dveprive the working-man cf
his opportunities of work.
Were we to socialise or municipalise our hospitals
and bring them up to the strength and efficiency,
which a just system should exact, a heavy increase
of taxation would ensue. The poor cannot pay more
than they pay. The burden would therefore fall
upon employers and capitalists. Now every penny
raised in this way diminishes the wage-fund and
drives capital out of trade in quantities far exceed-
ing the taxes collected. We know that the pros-
perity of a country's industry depends upon the
164 SUFFERING LONDON.
amount of capital embarked in it, and as that capital
diminishes, wages fall, and the number of unem-
ployed increases. The standard of living among
the working-classes has to be reduced, and their
resisting power is enfeebled. Thus hospitals created
in this fashion engender more patients than they
can possibly cope with. A small tax on capital is
therefore a severe tax on the working-man, and
hospitals, if they are to be a real benefit to the
working-classes, must be supported by voluntary
contributions.
I have appealed to all classes and all political
parties, not only because they are all certain to
sympathise with our suffering poor, but also because
it is to the advantage of the whole community that
the life of the toilers should be made as bright as
possible. The masses who depend on wages for
their daily bread are in this country numerous and
determined. What is more, they might by con-
certed action control the elections. If we allow the
Voluntary Hospitals to fall into decay for want of
means, as they now threaten to do, instead of bring-
ing them up to a state of perfection, we shall create
a powerful cause of discontent among the masses.
We shall expose the Empire to the dangers of reck-
less legislation, and approach that state of social
chaos which has overtaken many other great
Empires, when the indifference of the wealthy
classes has driven the poor and their friends to
desperation.
CONCLUSION. 165
I have appealed to the clergy and ministers of all
denominations, because they are the national advo-
cates of the poor, and have already given proof of
their willingness to help the Voluntary Hospitals.
Some do more than others. If all preachers did for
the hospital collections as much as certain clergy-
men in London do, the amounts received on
Hospital Sunday throughout the Metropolis would
be enormous, I know that many of them have to
ask their congregations to support a number of
other institutions, and that with regard to the
Hospital Sunday Fund, they stand in too isolated a
position. But if they can gain the co-operation of
the lay element, they will achieve a better result
with less anxiety to themselves.
Though I am aware that among freethinkers and
agnostics there are many generous-minded friends
of suffering humanity, I have specially appealed to
the religious congregations throughout London.
Through their existing organisations they are al-
ready in touch with the poor, and they know what
suffering and what misery could be avoided. If our
hospitals were what they ought to be. Besides, they
have in their spiritual leaders men who are not slow
in grappling with social problems, and who can there-
fore easily fall in with the proposed new movement.
There was a time when It would have been mad-
ness to ask the different religions and different sects
In London to join hands In one great work of
charity : for Intolerance and religious hatred reigned
l66- SUFFERING LONDON.
supreme. In our clay it is natural to expect rivalry
in tolerance and charity. We seem to have laid to
heart the beautiful teaching- which the German poet,
Lessing, sets forth in his famous drama, •" Nathan
der Weise," and as it appears to me to have
a peculiar application to my appeal to the various
religions and sects, I shall briefly retail it.
Saladin, who had a high opinion of Nathan's
wisdom, asked him which of the three relio^ions—
the Mahomedan, the Jewish, the Christian — was
the true one. Nathan replied in the following
parable : There was once a man who owned a
wonder-working ring. It had the power of render-
ing its possessor virtuous and happy. When, after
a long and happy life, the man realised that he was
about to die, it became his duty to bequeath the ring
to another. He had three sons, and, as he loved
them equally well, he could not make up his mind
to which of them he should Qriv^e the talisman. At
last it occurred to him to have two other rino-s made
exactly like the wonder-working ring. This he had
done, and then mixed them so that he himself could
not distinofuish the one from the other. He called
his sons, one by One, and gave to each a ring,
telling each that he loved him best, and therefore
gave him the talisman. When the father was dead,
each oi^ the sons claimed to possess the right ring,
and quarrelled over it. At last they decided to go
before a wise judge who lived near at hand and
asked him to act as arbitrator. His judgment was
CONCLUSION. 167
this : As the right ring will make Its owner virtuous
and happy, each of you should keep your ring as
long as you live, and the one of you whose life is
most virtuous and most happy, he it is who has the
rio-ht rino;-
There is no desire on my part to suggest that
contributions to the hospitals, or any sacrifice of
money, could possibly constitute a test of the moral
value of a creed. But I cannot help thinking that a
friendly rivalry in the work of succouring the poor
sufferers of London would tend towards peace on
earth and good wall among men.
My task is done. May my anxiety to serve a
Q-ood cause be allowed to tell In the balance agfalnst
the shortcomings of this book. If, from fear of
-saying too little, I have chanced to say too much, I
trust that my fault may not be visited upon the
suffering poor. If rriy work results in the attention
of leading men in religion, politics, and literature
being drawn to the needs of our hospitals and the
importance of maintaining them in a flourishing
state, I shall be content. What I have aimed at
Is to convey to my readers the Impression which
has haunted me during the writing of these pages,
that whatever we do or whatever we neglect in this
vital matter of the hospitals, will, through ever-
growing waves of cause and effect, produce good or
•evil throughout all eternity.
THE END.
APPENDIX OF PARTICULARS OF METRO-
POLITAN- HOSPITALS AND MEDICAL
INSTITUTIONS.
SPECIAL NOTE.
The particulars contained in this Appendix are published in the
hope that many readers may be induced to take an interest in
Individual Hospitals, and so to become regular subscribers. Should
any readers find a difficulty in making a selection, it is suggested
that they should send a cheque to the RIGHT Hon. the Lord
Mayor, as President of the Committee of Distribution of the
Hospital Sunday Fund, Mansion House, E.G. All sums so sent
will be distributed on the basis of award adopted by the Metro-
politan Hospital Sunday Fund Council.
169
APPENDIX.
The following Appendix contains the names and
particulars of the Hospitals and Medical Institutions
which receive a grant each year from the Metropol-
itan Hospital Sunday Fund. It Is given in order
to enable anyone to see what the Hospitals and
Kindred Charities are doing for Suffering London.
It will be observed that, to meet an expenditure on
maintenance and administration of ^586,172, the
reliable Income only amounts to ^344,550, so that
every year ^241,622 have to be raised In bene-
factions, to enable the work to proceed. Altogether
88,562 in-patients and 874,048 out-patients are
relieved annually by our Voluntary Hospitals and
Medical Charities, the number of occupied beds
being 7,729.
The object of the Appendix Is to show the actual
needs of our Hospitals, and the figures have been
compiled, as far as possible, from the statistics of
1 89 1. Contributions should be sent direct to the
Secretary of any Hospital or Institution which the
reader may select, or failing this, it may be sent
direct to the Lord Mayor at the Mansion House,
as explained In the Special Note over leaf.
170
"^
5;
.
,
ch ha
used
ly in
tions.
CO
in
U3 in
CO
2
in
0
0
00
CD in
^
0
(M
Q
CD
i>
^ CO
CO
i>
0
0
CO
t- CO
CO
0
0
Q
2K-5S
=^
00
(M
in i>
t-
CO
00
CO
■^
•*
(M .-1
I>
0
Q
0
Sumw
to be
Annu
Benefi
d'
n
CO CO"
^"
CK
10
■4 (M
'-'''
CO"
^
■-•"
4>
^oJ
s a
00
^
in 0
0
N
0
p
m -)■
N in
„
n
m
M
-0
yo
r^
in 1^
M 10
0
00
t^
« g
"^ ^
t^
t^ ^
•<t
in
^
»n
^ "^
CJ in
0^
io_
■i^
U1
in «
m
vo
"•^
10" ci"
M W
"
rn
0
M
0
H
«
3 a a
"^ (d 0
al Expend
on
ntenance
ministrati
, 0
0
8 £
0
CO
in
0
10
CO 0
00 0
m
8
X
r^
S< c^
?
■^
CJi
i=
J^
M t^
rn
0_
00
"«
3 ■S'o
g a<
<i
■~' —
—' —
~~
rn
ON
1^ 0
10
0
rN.
rr.
~N
in
-t- 0
N
0
r-^
n "^
M Ov
3
N
0
■? 1 "
CO
r^
r^
l^
c
0
rn
0^
1
t/;
0
m"
in
-f ' t^
ON
CO
cK
d!
c
vo"
i"^
r"
0
00"
I
C
"
£
M
i_t
M M 0
M
0
M
cr»
0
00 10
0
0
in
t^
c
0
0 CT- t^
d\
0 *
r^
t^
rn IN 0_
^-
^-
r^
^ CO
t> 1 \o
°~
^
•spag
~
IT) r^o
0
01
0
10
IC
CO
rn 1 r^
Cl
in
_i.
0
paidnooQ
t^
LD
01 - vo
0
^
vo
r^ r^
t^
Cl 1 ^
rn
H?
?^
•papunoj
0
0
in 10
'l-
f
C3\
0
0 10
'^ rn
m mco
^
M
rn
>o
:ivs\
"
CO CO
r^
"
00
"
t^ 00
CO t^OD
"
"
r^
"
e
Q.
c:
^
b
0
g
rt
w
(n
>^
5
C
s
Sccr
0
C § 3
C3 y. c5
?^
t
Joi
s
IS
i >o
•^
2 !^
CO
•n
s
b
1
>.
-s|
fa
^
■a
-a
S
«
u
fa 5=-^'
cJ
rt
>
CJ
«
M
rt -a
"0
-a
rt
H
rt
w
w
c'->d
>— .
fa
<
d a:
<; li;
0
)-
iJ
<i
fci
5 ^
!=^
d
OS
6
c
CJ
-^ <
J
0
0
d
-iT
CJ
U
cJ
u
: Is
5
CJ
^'
W
: ^'
: ^
w'
CO
^
]
^'
^'
3
0
^
u
-0"
:=
C
«j
'S.
d
ft
w
a
3
C
0
: f^
: >>
w i
CD
tJ5
u
rt
3
'rt
CO
■3
C
0
E
I-
0
fa
£
-a
c
I. ^
rt
-0
a
0
c
a
c
0
U
rt
fa
•T3
C
0
E
0
-0
CQ
0
<
3
0 _-
2 2
rt
E
0
-c
H
"rt
■5.
0
in
c
0
"rt
r
12
0
rt
0
u
•a
>i
0
•a
•a
u
«
2
<D
13
Q
0
'5,
d
£
u
(n
"a,
0
c
Q £
_- u
S c
•5, S
S -5
c ^
3
o-
"rt
■|
0
n
.3
0
K
to
■3
U
IS
rt
a
0
8
E
0
a
0
•a
■f
0
c
0
■c
c
"rt
'S.
- 0
a
rt
1
0
c^ 1
c
2
■5.
d
!_
_rt
a.
"rt
"S.
b
fai
■rt
"S.
0
a
0
CJ
s
■a
rt
"o
1— >
J3
0 0
3
0
■fl
w
0
1^
0
2
" 0
;s IS
&
0'
rt
W
CO
Cfl
1/2
00
•S-s-S s
ll^l
C6 O
^
O
I>
'i'
CO CD
in
■^
CD
,,•> '"
M*
O
(M
CO
rjH o
CO
CO
CO
qji> CD
of in"
CD
o
of
10
O '1
CD" 05
o
CO
CD
co"
CO
CO"
a*'<n
CO
«
2
ct .
«i
vS
vo
'r
(^
< Ov
n o
p!
%
-
■ 9
SA
c^ oo
•a- in
■o
^
"
M
o
H
a>
5 -Sc
:3 ".S
g S"S
c
CO
•»*■
vo
in
rj
o m
o
CN
o
2^ a ci m
^?^2
-> 'l-
o
r^
vo
o •-
0
•i S S.2
0
0_
0_
t-
r>.
all
ntei
tnin
?
iT
vo"
C?
vo"
n
o ^^
in
vo
O
3 -3 -a
§ a^
<j
^
cc
CO
„
vo
in
Ov «
o
in
N Ov
3
•^ m
r^
00_
^
w
rj m
oo
o_
1
•/
o
r
0
ocT
-^
CO
vo
r> fn
cT
cfv
I
s
Ph
m r^
Ci
"1-
"
M M
^
«
oo
^
0
vo -J-
0
Ov
n
r;
1
O
n t^
o
Ov
q_
1
^
vo
r^
r-
•spag
^ O
^
^
^
TT
r^
0
f,
patdnDOQ
-<*- ^■
K"
"^
O
^
vo in
'''
^
•pspuno^j
•:^ C)
Tj-
1
r^
VO
ov
oo M
0
vo
■*
S
4K3A
"
t-^
1
"
"2
"
CC
=2
"2
=2
b
j:
C3
OJ
_o
5
c
'p
u
rt
.2
S
J
A
I)
c
rt
^
?^
-•
3
c
13
"o
C
='
2
tSi
o
v
g
i S
j3
rt
U
c
0
c
o
1
>—>
•5
C
0
i
"3
c
1 1
H
C
U,
Z
z
oi
ty5
H
HH
'►J
o
•—1
«
^.
^
J*
rt
o
E5
a3
5
>
^;
rt
o
si :
— ' :
J- :
"rt
s
js"
in
w
^
rt
1
yj
a
U
S" CJ •
'S.
d
?
0 c
1 s
c
u
) o
B
o
c
o
- o
's
u
3
C
rt
ir.
-3
03 • "o
^ 1 ^
o
D.
£
o
d,
S
a
K
c"
u
"o
^1*
<
•a
c
1
1 1
0 _
„ c
e8 0
1 "^
0 ■:
o
"S.
o
"c
"rt
■p.
o
■a
c
1
'5
c
s
'a
o
a:
^ "o
U
><
0 "7
'E.
6
w
c
_o
c
►3
2
M
■p.
d
>-•
E^ ^ b
ft -S
^^
"o «
_o
c.
E
3
O
o
"rt
.2
3.
E
p
c
o
U
c
o
-a
c
o
o
d
•s.
5
"rt
d
.o =
'- o •/■
Ids
d.y M
^~"l
i
I
'f
E-
>
^
O
(2
"rt 2 J5
/J
c
•S -2 >»S
.C ►< 01 «
S o e S
a *'<n
P.- ''is
« o'g
paidnoDQ
•papuno^j
CO
o
O
CO
CO
in
(M
,H
00
'^t^
fS
n
Q
o
CO
CO
t-Vj
0(3
(N
^
CD
eg
in
lO
CO
uu
in 00 t- t-
CO CD t- (M
^ rl< ^ CO
o
eil .
11
00 0
Ov
8
1^
«
„
0
n
n
M
^
CO
M
?\
'^
fo'
>;>s
H
w t^ ^o
CO lO 00 00
I !:-
) M CO VO
N N ro
1^ ro VO
^ B
■3 5
^ < <
3 Pi
■p .a K
u
C
w
^'
1
:5
iT
^S
f )
^
"
rt
-3
r!
P3
"rt
W
-3
^
m
-a
fc/)
-a
>
rt
(A
S
>>
"rt
V
3
3
1
."2
'3
S
rt
o
c
rt
rr,
o
«
^
c
n
c«
oi
n
U
S:i
>.
c
c
On
3
^?
-a
^
a
y> v2
:: Q 5
H-. . — en
TJ n3 r::
C
o
<
^
<
(n
O
(zh
rt
S
o
w
r/1
^
u
is
-f
w
^
^ rt HJ
o
-^ :5 a -2 ~J^
X >->
t -"^
r^ QJ ^^ ^
c> i-J c 0, u
& -s; ^ B S
j2 rt > o o
u w w ffi ffi
rj Ln ^
■" c
.2" >
D.
Oh
O
hd
fl-a<
d-a
ho i;
Oh
;^T3
c
n
C
en
u
rt
T)
n
T!
1
4J
b
§
G
IS
>>
rt
fi
3
rt
t:
f
CO
D3 o C>
„ o
ca u o c
174
a
^-s-s s
1
j3 "» >>2
o
-^
^
CO
in
(M
CQ
CO
©
cq
^
o -3 3 '-S
00
CO
CD
CO
CO
CO
CQ
0
eg
^
CO
■whi
be ri
nua
efac
^
in
10
CO
10
CO
q
Oi
in
0
CQ
in
'.^^
ta
o
,a
a ,
li
S
o>
0
<»
Uj
«5
1-
%
•^
1
r^
CO ri
m
r^
r^
-J
0_
NO_
3^5
■^
"
"
N
CO
^
^
^
•^
o
H
«
1 -rt .
2 « c
^ cd o
r^ "H
g si«
S.fl c^
ON
0
0
NO
VD
r^ ID
0
r^
0
0
rs.
alEx
0
nteni
mini!
S5
3
"
"^
VO
0
0"
;:"
0
:s-
"
=^ ■S'«
g i^
<
""oT
u-1
„
«D
m
ro
CO
00
r^ -1-
N 0
0
3
m
t^
rr
in
»-
0
1
I
1
CO
r^ w
t^
c
o
rr,
"
yj"
tC t^
1
s
/i
~
^
^
NO
fl
„
Cf
NO
&H
c
0
1
1
t^ fO
1
1
On
•Sp3i[
0
m
„
C-1
0
m
1
^
1
w
1 m
.0
paidnoDQ
tt-
^
^
""
u^
1
t^
1
CJ
«
'"
•papunoj
M
^
^
-T r^
NO
1
0
1
;n
r^ NO
NO
^v^^\
"
°"
°"
"
1
°"
1
00
tv
"
E
rt
-d
iZ
OJ
•d
ri
r-
ri
W
0
c
0
C
c
_c
0
s
•a
c
"3
0
o
•^
u
<5
V
3
U
C
S
X 5
l3
rt
P
<
c
0
X
U
T
">
d
S
S
(U
be
0
0
e
<2
^
s
0
3
<
bo
u 0
fcJ)
•^
in
o
Pi
5
c
>
CJ
•a
0
g
0
1^
■a"
0
(A
-d~
0
'J
w
rt
0
Pi
-a
c:i
•J
•>■
Pi s
"o.'s.
rt J,
p^
o
C
1
1
S
a-
C4
1
3
0
-0
c
0
c
'-§,
ir.
■3
0
p.
."3
u
0
1:;
bfl
o
0)
3
1
c
c
-^ hi-
rt
S
^
0
>
"ri
'3
<^ 4J
(S
•a
-a
<
C
r!
S
12;
a
03
o
m
ft
'■§.
o
(O
■3.
0
K
ri
c
>
"5.
0
W
0
c
>
c
c/"
c
E
1-
'c
e
_ 0
i2
■3.
0
On:
"rt 4,
a-
"2
■5.
s
V
1
0.
e
0
u
Da
S
5
"E
d
K
>
c
0
T3
3
a
>
'3
I..
•2
c"
0
T3
i2
0
■- 0
•P
'o.
W
>2
"ri
'5.
0
0
iS
0
e
ri
in
!3
CJ
0
^-1
0
c
w
6~
b
^75
«
CD rH
CO
0
CO
0
2
0
0
0
CO
o-3i:>-s
?? 05
OJ
0
iM
0
r-
0
OQ
S ^rt S
QjP, (M
Oj
in
03
CJ
0
co
I?
(M
(M
^^g-S
CO
CO
iH
B o S S
§■"<«
CO
o
lo
ii
■* r^
^.
i
N
8
o\
0
0
in
^
VJOO -"f
Ov
vo
^ c
ro
rn
t^
sa
VC
N
"
^
^
M
o
H
«
5 1»-
=3 ^2
0 s-s
S. - c h
S?£
•Tf
vo"
■*-+
fp
8
0
%
8
-1-
0-
f^
"i .s s
2 rt-o
g S<
<s
~
m
00
vo
ro
m
cT
in
0
VO
~
-1 o\
r^
0
m
0.
vo
■^
3
Ox iH
in
•*
1
1
o_
1
1
1
t/.'
l^
^^
c
0
ri 00
t
vo"
6\
N
^
1
vo"
rC
•^
cT
^
•n
Vj
rt
0 r^
0\
Ph
C
Tj-
1
1
1
1
1
1
1
1
1
"^
■vl
;:i
•span
0 ro
0
*0
0
1
1
1
0
1
1
;
»
0
^
Ov
^-^
paidnooQ
r^ M
0
-1-
1
1
1
>n
1
1
1
"
n
^
— '■
^^
•papunojj
0 <^
in -f
0
1^
^
■O
1
1
%
1
1
1
'tJ-
^
cS"
VO
1
ivsx
°i
00
'S
"2
"2
1
1
°i.
1
1
1
M
M
^H
c»
d
Q
<
^
«
'T.
j^
c^
Ch
{3
S
g
■ri
c
rt
X,
dn
0
rt
^
>x
^
c
"
U)
•
<
g
•a
<
6
1^
E
0
U
0
rt
c
3
3
rt
5
i
c
c
0
0
0
0
0
3
1=5
s
.2
^
1
W
(5
0
0
0
0
0
n
J3
0.
0
M
i
(I
0
H
0
^
Is
e
^
S5
12:
s
^'
a
d
c.
cJ
u
i
>-■
cJ
W
>"
^'
•jj
0
c
Pi
^
'p.
b
"o
•a
<;
•a
c
r:
1
rt
11
•al-
"3 -<
<D ^
■5,
W
•5
3
-a
_>.
"rt
rt
Ph
z>
•2.
K c
n|
.2^
0
"s
"rt
a
0
c
f 0
•a
0
'' 1
CJ
w
in
u
0
0
J
"rt
i
0
c
0
■a
c
►3
"rt
CO
0
cS
0
c
_o
c
0
0
C/5
u
bo
c
0
U
"0
-G
!B
a,
0
1)
■|
"rt
?-
tT
rt
0
rV
C
0
<=5
0"
i
a
0
c
u
c"
-a
rt
c
0
rt
"rt
'3,
d
-3
0.
0
0
(h
-a
c
rt
0
^'S
•3
H
D.
0
"rt
0
■a
0
"rt
■£,
6
S
0
■-3
c.
0
0
u
t/i
E
2
Cn
in
"0
rt
5
'a
C
3
0
u
"rt
'0.
6
w
c
0
-□
rt
C3
0
U
iT
0
^o
'S.
6
"i-
1;
c
hH
■>-.
CJ
rt
w
•a
c
rt
rt
0
s^
H
c
0
•u
c
3^
A
-o
0
0
f
-C
H
"0
rt
5
^o
"rt
■5.
■a
c
_rt
0
Ph
'a
Z
a
rt
0
H
c
0
fa
2
■3,
0
rt
W
"rt
c
•^
>>
>.
>*
c
c
>,
rt
0
0
0
^
3
0
0
a;
d
0
0
Z
a
«
P<
K
"^
0
!?
lA
K
J
^
U
K
ij
«
176
Sum which has
to be raised
Annually in
Benefactions.
3,520
40O
100
1,737
254
611
36
362
541
959
100
M 0
1^
Annual Expenditure
on
Maintenance and
Administration.
vo" m" »c" N "" " " "
Ah
3
0
III ill! 1
„ Moo^f^o Cm
^ t^ V010|M|rr).a-n InIm
•spsg
p3idn300
cSII ?:[:!, ISI5^§-S 1^!^
•p3punoj[
JE3A
I^JI c||lll|||- i§l|
5
6
E. Wilson Taylor.
J. F. Pink.
A. G. Klugh.
Ch.Trles Holmes, 32 Sack-
viUe Street, W.
No Return.
Lt.-Col. E. Neville.
No Return.
G. Cookman.
J. W. Cuningbam.
Rev. T. F. Kitto.
No Return.
Miss Mary Wardell.
No Return.
R. W. Maude.
■3.
0
•a
-a
•a
c
s
Special Hospitals— C<;«//;/?<(V!'.
Other Special Hospitals — Continued.
London Temperance, Hampstead Road, N.W. ..
Dental Hospital, Leicester Square, W.C
National Dental Hospital, Gt. Portland Street, AV.
Convalescent Hospitals.
Metropolitan Convalescent Institution * .... )
Be.vhill Convalescent Institution, Nr. Hastings. )"
.\11 Saints Convalescent Ho.spital, Eastbourne
Mrs. Gladstone's Convalescent Home, Woodford..
Hanwell Convalescent Home
Herbert Convalescent Home, Bournemouth
King's Col, Hos. Conv. Home, Hemel Hempstead
Mrs. Kitto's Convalescent Home, Reigate
Mrs. Marsbam's London and Brighton Female
Mary Wardell Conv. Home, Stanmore
Morley House, Conv. Home for Woi king-Men . .
Princess Frederica's Conv. Home, East Mulesey
//
•
1
I-P.5^
bich:
raise
aUy
actioi
w
^
CD
^
I>
o
O
CO
0)
CQ '
00
1
IC
CO
CO
o
CO
o
tj<
eg
1
I>
ci^
r-(
eg
CO
co_
w
1
Sum w
to be
Annu
Benef
'
f-f
*-<"
1
_«
3
1 '^ V
1 3a
**
0?
1
On
1
8
8
nS
0
CO
J "
\o
OO
1
e«
I
1 3l
cT
^
C«
1 o
H
o
S -Sd
^ tA O
Expend
on
enance i
.nistrati
^?;
On
t^
8
\
1
0
'^
o
NO
o-
o
•3 sa
3 'S-a
g a<
o
3
o
1
1
1
1
1
1
1
1
1
1
8
0^
1
1
M
3
rt
r^
1
CO
VO
m
in
t
r^
m
■^
M
1
(M
P-i
c
o
1
NO
"
-
r^
NO
o
-
1
■spaa
^
0
NO
^
in
1
CO
NO
OO
^
1
o
paidnooQ
"
N
^
r^
1
NO
"^
^
1
•papuno^j
-
1
1^
S
r^
ON
1
NO
s
r^
^
1
r^
JE3^Y
"
1
"
?
"
OO
1
00
"
~
-
1
"
u
^
OS
B
9J
s
_:
O
■d
5
c
:/3
>
u
3
«
Pi
1
1
1
1
•a
o
Q
SQ
1
1
c
3
c"
>N
C
o
5
o
E
.^
O
o
^'
>5:s
%
S
S5
oi
'^
05
£
-
— —
~"c~
~^
■^
J
^
o
.2?
o
CJI
rt
M
.s
u
5
(^
c
o
^
CO
■^'
O
U
1
'C;
•T3
"5.
G
1
S
U
*rt
c5
Pi
2
•H
r!
c
r3
S
•2
0
^
'5.
6
E
0
_5?
[rt
6
o
ID
"ft
'5.
6
o
c
o
u
o
►J
o
a
>■
b/)
rt
CO
•a
"rt
rt
O
r'
rt
<
c
8
w
a
ID
o
(C
1
fl
o
o
c
i
>
5
U
V
■r.
>
C
o
U
y:
S
c
o
U
u
rt
c
o
O
J
c
o
U
u
c
3
3
'^
U
jO
E
c3
c
M
E
o
>■
c
E
o
X
c
i
>
c
o
O
w
1
1
o
o
'5.
o
rt
o
U
E
U
3
O
rt
U
-a
c
rt
"rt
>
o
U
b
r
c
O
■a
c
rt
D.
3
» .-a
'5
■r
0
n
0
' '3
0
1 b
0
3
1
■^
u
g
'c
o
c
o
>>
U
^4
rt
■a
i. c
3 f
L U
u
2
c
<
-3
<
o
■— N
if.
u
."3
rt
■r.
o
^
a
rt
23
!■
IS
e
3
c
M
178
j3 '^ >>S
9
o
CD
o
M
CO
t-
1
cq
il '3 s -g
1
00
o
rj^
1
CO
1
(M
o
t- I
CO
,a *^ 2 cs
OJ
»-H
1
CD
t-
(M
^
w
1
1
i
CO
1
fi o s e
to
O
^
tf >
• ^ «
« a
c
00
.^
I
VO
N
VC
VO
C4
p^i
■-^
r--
1
^
^
VC
8
^
■3,5
■^
>n
^
•^
*»
o
H
«
3 "H •
■" c c
^ "'I
a <» -y
a u oj
p* -. c _h
C
0
VO
1
OS r.
1 t
-*
M 5 cd m
ty
1
w °?-s
"^
r^
o
^
1
o
C
T 1
o-
'^ V P
cT
cj;
H
1
^
nnua
Main
Adm
<i
3
1
1
1
1
1
1
1
1
ii
o
1
1
1
I
1
ro
1
1
1
c
^
I
T^ 00
to
1
■*
1
^^
(t
1 oc
1
■*
Ph
i
> 00
1
VO
1
^^
1 1
"
•spag '
1
t^ [^
1
„
1
M
OO
0
1
„
paidnoDQ
1
1
1
^
"
CN
1
I?
•papuno J
S ^
r
^
1
«
1
5s
-
«
1
o;
1
r^
1
t>.
J^3A
■^
^
^
•^
r;
u
e
'J
c
■J
a
o
1
o
cc
s
c
O
V
(^
X
3
a!
O
3
'S
p^
1
^
o
ST
"rt
<
o
•si
o
m
;;?
o
^'
— .
s
S
■-A
^
«
^
<
S
Cil
JZ
^
^
ji
"
^"
o
g
3
o
.^
"j
;s
S
'^
s
u
re
o
J
2
"B.
■^
^^
P3
5
.3
s
g
B "i
.
X
o.
cT
L.
rt
c
-A,
re
M
'5.
o
W
"re
1
m
•a
to
0
W
P
"o. t
s s
U r
i ^
•^ 1
•a i:
a -7
5 1
' 0
c -
'■> 'f
^ c
5 S
\ I
J "7
'5.
o
> 5
> O
3 U
'c
c
1
c
C
c
c
<
CO
a
o
+3
to
" C
l-H
i
5
1
s
o
c
O
c
i
c
"rt
'E
o
6
o
-o
o
u
.9
D.
s
3
c
o
u
e
3
O
c
1=5
i
13
C
bJ)
rt
ci
in
c
c
£
if
<
c
E
c
c:
E
c
0
c
>
s
0
1
o
X
c
"3
>
o
U
c
c
rt
E
O
^ 1
i a
5 3
1
1
E
1/3
'a
S
X
"rt
;§• s
4 P
-. *
S i
1 "O
3 cJ5
'i
w
!5
o
>
I
u
t^ X
1
179
0
m
•>^
J
«>s»
s
<
^
H
K^
t— I
•->(
Ph
<^
^J
C/)
f^
^
O
^
X
■§
<^
^
..^
o
^
Q
■^
'^
^
'Ki
o
^
J
rN
^
^
^<i
p^
5i
^
D
O
•^
?:
fv.
'>0
^
^s::
•o
.2 C «
14 ~ s
« >>-2
M C
ri 1^ f-
n r
n M U
n 1
"t N
D -J- r
-1 vo ^^ 1
■""il
•-.J-
^
r^ c
oo_ c
•J 00 -^
- vO
o 3>»2
o> >
T 0 f
n CO
:;§s
1 <-
M C
cT
l<^
ISI
»-
E
o
'
c
r^ 1
") r
en r-
T ■*
^ O IN
0
1 ■*• 0 C
t^ ^
^S
_ "t ^
T >0 M ^
-
in
OJ
"1 «-" o:
<> f
T O" •■
W f
1 -rp
3
00 r
"5
Oi
u
3
cc
t^ c^ 0
«:
t>. I
rj I
-J f.
^ (N
T 0^ O 0 1^
1 r^
c
^i :
c^
o- ^
-^ -^ 0 o:
~1 O"
r.
VC
vo" d> r
r> ex
■o"
Cl,
-) Tf- H
>0 M
.-
K
'^
lO
W
o *o c
^ o\ o H
r^ c
•> >£
0 '■J-
"^
o CO 0 -J- r.
T O^
O
0
S O M «. h.
■»?
O
■<- T(- c^
->
rx
■2
c
rt
Oc
Cs
0
f
l^ c
^ ■* vc
M
T O r
■) \o
c
c
T vC
C
0
f; ■!■ C
\I
J 1/
M -r Mi' i-i
t^ »-
c
co"
CO
"S
■||
-) 1/
~1 ^ (N
o> ^ C
3 * oc
o
t^ -^ u
1 CT. 'J- o r
VO VO
^
T r^
s«
ro
rC
o
o
4^
o
3
H
'5
~
d
'2
c
a
c
'c
0
1
c
"c
2
'c
c
hi
c
c
E
c
' 1
"i.
c
< <
E
c
a
1
C
1 =
O
j:
■>
■» ^
c
c
c
c
O
(_
tr
C
'■_
C
1
^
c
u
T VC
IJ.
-J , c-
1 o
LIST OE lEW AND RECEIT BOOKS
PUBLISHED BY
THE SCIENTIFIC PRESS, LTD.
JUST READY.
IMPORTANT WORK ON INSANITY'.
Demy Svo., liaiulsoiue clotli l)o;ir(ls, about 200 ])p., piice 3.s. Gd. (post fiee).
OUTLINES OF INSANITY.
Designed for the use of jNIedieal Practitioners, Justices of the Peace, and
Asylum .Managers, by FRANCIS H. WALMSLF.Y, M.D., Leavesden
Asylum, Metropolitan Asylums Board, Member of (.'ouncil f)f Medico-
ps\chologioal Association.
IN THE PRESS.
New work on Invalid Diet ; a1)0ut .300 pages, demy Svo., cloth boards.
THE ART OF FEEDING THE INVALID.
By a Medical Practitioner and a Lady Professor of Cookery.
This important work has been undertaken to supply a long-felt want in
hospitals and institutions of all kinds where invalids are treated. It com-
prises about L3 chapters on the nature and teiulency of diseases n)ost
frequently met with, and a general outline upon which the diet of the in-
valitl should be regulated. Corresponding with the chapters are lists of
new and original recipes, which are intended for daily use and reference.
The labour and anxietj' of providing suitable diet for invalids will, Ijy the
use of this book, be reduced to a minimum.
NEARLY READY.
NEW WORK ON MASSAGP].
Demy Svo, cloth boards, (about) 200 pp., profusely Illustrated.
MASSAGE. By A. CREIGHTON HALE.
This work will embody the results of many years' experience, and will
be entitled, for that reason, to recognition as a standard authority Many
new and original movements are explained, and the book is profusely
illustrated with nearly a hundred drawings specially taken under the direc-
tion of the authoress.
SECOND EDITION. 4th THOUSAND.
Profusely Illustrated with 167 cuts ; many new Chapters, especially written
for this Edition ; carefully revised ; and bound in cloth, crown Svo,
about 400 pp. Price 3s. 6d. (post free).
THE THEORY AND PRACTICE OF NURSING.
A TEXT-BOOK FOR NURSES.
By PERCY G. LEWIS, M.D., M.R.C.S., L.S.A., A.K.C.
Always a standard work on Nursing ; it now occupies the position of a
classic, being used tliroughout the woi'ld in Training Schools and by
private Students.
"Nurses will tind the l)ook full of interest and instruction, whieli cannot
fail to assist them in their work." — 7'hi; Brifis/i Mcdica/ Journal,
LIST — continued.
"Dr. Lewis, through many years of hospital experience, has earned the
right to speak with authority upon the subject of nursing. Dr. Lewis
treats the subject as a physician would be expected to do. He advises the
nurse wliat steps she should take when her patient is in a critical condition,
under what circumstances she should call in the doctor, and in what manner
she should assist his work, either when he is present or absent. In carry-
ing out this plan Dr. Lewis has produced an extremely able and instructive
book. The author's grasp of his subject is not least conspicuously shown
in tlie readable, lucid style of liis writing. Tiie chapters on surgery call
for special praise. No professional nurse can afford to dispense witli the
work." — The Queen.
" The fact that the first edition of this nursing Manual has been quickly
exhausted in very little more than a year shows that it well supplies an
ever-increasing demand for knowledge amongst nurses \Ve have
read tlie book with interest, and can warmly recommend it as a nursing
Manual Tlie section on the Administration, of Medicine, on
Fractures and Splint Making, on the Female Pelvic Organs, and on Con-
valescence, are especially good. The illustrations are well executed and
plentiful. The hospital Nurse, for whom the book is especially written,
will find it full of useful hints and information." — The Birmiwjham
Medical Review.
"The remarks on disinfectants and disinfection are very good, so also
are the rules to prevent the spread of infection Dr. Lewis is a
faitliful disciple of Listerism ; and expounds the tiieory and practice of the
art at great length, giving minute instructions to the nurse as to the man-
agement of the various antiseptic dressings in the treatment of woiuuls of
all kinds The instructions close with some good remarks on the
ventilation of the sick-ioom, and on the duties of private nurses
Nurses will find the book full of interest and instruction, which cannot fail
to assist them in tlieir worI» Dr. Lewis is successful in pointing
out the main duties a nurse has to perform at tlie bedside, and in warning
her what not to do, which is often more important." — The British Medical
Journal (second notice).
Third year of issue, 600 pp., crown Svo, gilt boards, post free, 3s. 6d.
BURDETT'S HOSPITAL ANNUAL AND YEAR-
BOOK OF PHILANTHROPY.
"Contains a review of tlie position and requirements of the voluntary
charities, and an exliausti\ e record of hospital work for the year. It will
also be found a trustworthy guide to British and Colonial hospitals, dis-
pensaries, nursing and convalescent homes, schools of medicine, asylums,
and all institutions of the kind. Mr. Burdett has made his book as com-
plete and accurate as possible. He gi\es us not only thoroughly trust-
worthy statistics, but also several special chapters of considerable interest
on nursing, expenditure, and other kindred subjects. The value of the
book is considerably increased by an index, and the insertion of statistical
tables. ... A vast number of interesting facts may be gathered from
' The Annual.' The statistics given may be considered official, inasmuch
as they are taken from the audited accounts of the several institutions." —
The Timex.
"Mr Burdett lias supplied us with a long-felt want by a publication
which must prove a valuable ac<juisition to those engaged in hospital man-
agement, as well as to the medical profession. . . . We hail the appearance
of this book with greater satisfaction, since it not only makes an excellent
LilST—cnnthuiriJ.
book of reference, but afTonls a reaily guide to strangers, who wish to be
informed of the enornunis development of our voluntiiry system of medical
relief. . . . Mr. Burdett has productnl a work of much labour and fore-
thougiit, and one which cannot fail to be of great public utility." — I'he
British Mtdiral Jounud.
" It is needless to say tliat it is full of interesting figures."— 77ie Sprc/ator.
"It is a volume of over (illO pages, cr.iuuneil with infoiinntion. ... It
now includes <,'eneral ])liilanthropy in the survey. . . . Tlie entries in the
index, eacli referring to a separate institution, run to nearly tiiree thousand.
. . . Mr. Biirdctt's ciia|)ters . . . are of the highest value, practical and
suggestive." — 'J'he Daily Xeirs (leading article).
" Much new matter and information is included in the present volume,
wlucii now forms a thoroughly exiuiustive record of the hospital and
philanthropic work of the year." — 7'Ae 7e/cgraph.
" Mr. BurdettV name is a guarantee of good and careful work, and his
' Hospital Year Book ' is winning for itself a distinct place among our
handy annuals." — 7'he Daily (Irajihic.
"... A work full of interesting information about London and Pro-
vincial hospitals." — The Globe
"... Fully jtxstities its second title of the ' Year Book of Philanthropy.'
. . . Tiie earlier chapters are of special interest, and have been carefully
and judiciously compiled by the editor, Mr. Henry C. Burdett. ... A
valuable analysis is given of the income and exj)enditure of the various
classes of hospitals, . . . and finally a directory of hospital information of
various kinds." — 7'he Scotsman.
" ^Ve reviewed the preceding issue of this work with satisfaction, and
we find the new edition an advance upon it. The editor has bestowed
upon it great labour and pains, and has made it a wf)rk of much value.
. . . Important additions have been made to the chapter on nursing. . . .
The volume contains so much information that we do not think anyone
who consults it will be disappointed, whetiier seeking for statistical,
practical, or any other purpose. It deals with all branches of philanthropic
work of the most important descriptions." — The Queen.
"... Glad to speak favourably of so well-arranged and clearly-printed
a guide to British au<l Colonial hospitals, dispensaries, nursing and con-
valescent institutions, and asjdums." — The Daily Chronicle.
Now Ready. Third Thousand.
Demy 16mo. (suitable for the apron pocket) ; handsomelj' bound
in terra-cotta cloth boards, 140 pp., price 2s.
THE NURSES' DICTIONARY.
Compiled by HONNOR MORTEN.
" Honnor Morten has compiled a book for the use of nurses which is
likely to be of service. 'The Nurses' Dictionary' explains medical terms
and al)breviations, besides giving much information regarding everything
to be encotnitered in the ward or sick-room. Brevity and simplicity are
the key-notes of this little volume, which is pul)lislied by The Scientific
Press, Limited, 140 Strand." — The Mornimj Post.
" Now that the scope of a nurse's education is so widened as to make a
certain amount of medical reading imperative, the need of some siich ex-
planatory handbook follows as a matter of course. Miss Morten pi'ojioses
to fill this gap, and is successful." — 7he Hospital Gazette.
IjlST—rontlnUfd.
" This is a very useful little book for reference purposes, and some such
sliould he at the disposal of every nurse, more especially in the early days
of training. It comprises not only what its name implies, Init a description
of the common abbreviations used, of many instruments, drugs, &c." — The
Birmiwiham JSLcdical Review.
"This is a small and convenient manual, compiled for the use of nurses
more particularly, and, therefore, including technical terms, the precise
significance of which may not always l)e readily remembered. A portable
handljook of this kind, which can l)e consulted at a moment's notice, will
prove a boon, if only for the saving of much of the time and lal>our involved
in searching into books whicli are not only larger but more complicated.
The aim of the work is unpretending ))ut practical, and the plan of it is to
be commended. Where mere definitions alone are not thought enough,
particulars are given in a very commodious form.'' — The Queen.
In handsome cloth boards, 150 pp., illustrated, price 2s. 6d. (post free).
MINISTERING WOMEN.
By GP^ORGE W. POTTER, M.D.
"Is full of interest, and the sale of the book will be stimulated by the
fact that the profits of the author are to be devoted to the ' Junius S.
Morgan Benevolent Fund.' An excellent portrait of tlie Princess of Wales
forms a suitable frontispiece." — Liverpool Courier.
•' It sliould commend itself to all — women especially — who can appreciate
the noble work undertaken \)y those true sisters of mercy and self-denial,
our hospital nurses. The record is full of touching intei'est. . . . The
l)ook is well worth the half-crown charged. . . . Every nurse should
possess herself of a copy." — 7 he Lady.
Demy 16mo. (for the apron pocket), 72 pp., strong boards. Second
Edition. Price 6d., or 4s. 6d. per dozen (post free).
THE HOSPITAL NURSE'S CASE BOOK.
A Book of Tables specially prepared for use by Nurses in the
Ward and in the Sick-Room.
Containing Twenty-Six complete Tal>les, each being ruled to last one
week, for keeping an exact record of a Patient's condition, including notes
on Temperatui'e, Pulse, Respiration, Motions, Age, Sex, Name, Atldress,
Occupation, Treatment, History, Name of Medical Attendant, Number of
Case, and Date of Admission.
Nurses should comljine together and order parcels of over a dozen to
profit by the special discount terms, i.e. 4s. 6d. per dozen (post free).
Demy Svo. , 30 pp., stitched, price Is. per copy (post free).
A NATIONAL PENSION FUND FOR WORKERS
AMONG THE SICK IN THE UNITED
STATES. By HENRY C. BURDETT.
Stitched. Price 3d. (post free).
THE REGISTRATION OF NURSES.
A reprint by desire of articles which appeared in The Hospital upon
this subject.
London: THE SCIENTIFIC PRESS, Ltd., 140 STRAND, W.C.
2 0 8 4 8 7
PUBLIC HEALTH LIBRARJ
UCBFRKELEY LIBRARIES
CDmbSb^^s
Live Music Archive
Librivox Free Audio
Metropolitan Museum
Cleveland Museum of Art
Internet Arcade
Console Living Room
Books to Borrow
Open Library
TV News
Understanding 9/11