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 11 ^ 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. 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CJ rt w •a c rt rt s^ H c •u c 3^ A -o f -C H "0 rt 5 ^o "rt ■5. ■a c _rt Ph 'a Z a rt H c fa 2 ■3, rt W "rt c •^ >> >. >* c c >, rt ^ 3 a; d Z a « P< K "^ !? 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 1^ Annual Expenditure on Maintenance and Administration. vo" m" »c" N "" " " " Ah 3 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. •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 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 '^ 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 ^ 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 ^ '5. 6 E _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 n ' '3 1 b 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 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 00 1 VO 1 ^^ 1 1 " •spag ' 1 t^ [^ 1 „ 1 M OO 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 W P "o. t s s U r i ^ •^ 1 •a i: a -7 5 1 ' 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 c > s 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 m •>^ J «>s» s < ^ H K^ t— I •->( Ph <^ ^J C/) f^ ^ O ^ X ■§ <^ ^ ..^ o ^ Q ■^ '^ ^ 'Ki o ^ J rN ^ ^ ^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 f n CO :;§s 1 <- M C cT l<^ ISI »- E o ' c r^ 1 ") r en r- T ■* ^ O IN 1 ■*• 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^ «: t>. I rj I -J f. ^ (N T 0^ O 1^ 1 r^ c ^i : c^ o- ^ -^ -^ 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 •> >£ '■J- "^ o CO -J- r. T O^ O S O M «. h. ■»? O ■<- T(- c^ -> rx ■2 c rt Oc Cs f l^ c ^ ■* vc M T O r ■) \o c c T vC C 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 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. 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