The sun. [volume] (New York [N.Y.]) 1833-1916, 1879-05-13
HOSPITAL REF ORM IN ENGLAND.

corrected. thanks TO The scathing disclosures Of
Charles Dickens and Charles Ieade. 1t seems
these were not tho only institutions which re-
quircd investigation and Improvement. OF late
physicians and philanthropists have aroused
public attention to the hospital system Of Lon
don. and have demonstrated the need of prompt
and sweeping reform in this direction. The
enormous value Of the endowments possessed
by the so-called royal hospitals. of which there
are five. has been contrasted with the results
achieved and the objects have been defined to
which all this wealth should riRhtfully be APP
Piled 1t Is these practical suggestions that we
may note with profit. because some Of them
may be applicable to analogous establishments
In the United States.
In London. rs in New York. large schools OF
medicine have grown up Ia connection with the
hospitals. II Is natural enough that the staff OF
such an institution. enjoying as they do excep-
tional facilities for observing diseases. should
draw around them wide circle OF pupils. 1t
Is clear, too, that some sort OF out patient de-
partment can scarcely DO avoided because
when patients arc discharged they often need
to DO kept under supervision for a time, and
supplied with medicines until their recovery is
complete. But it is charged against the English
institutions that there has been n tendency to
transform their opportunities OF professional
training into private speculatons. 1t is said,
too. that on the plea Of Offering outdoor medl-
cal assistance tho staff OF employees has teen
organized on scale out Of all proportion to
the proper scope and purpose OF eleomosynary
establishments. Tho number of out patients
who receive attendance from the London metro
politan hospitals is now computed nj n million
and the aggregate OF salaries paid on this nc
count goes far to exhaust the enormous income
derived from the appreciation OF real estate en-
dowmonts. This state of things provokes vehe-
mcnt remonstrance from that largo part Of the
medical fraternity which neither enjoys nor
hopes 10 win tho favor of tue boards dispensing
this vast amount OF official patronage. On the
othor hand. economists and sagacious states
men detect grave social mischief in this ex-
cessiye development Of gratuitous medical ser
vice. They believe TINT, like the plan Of whole
sale indiscriminate almsgiving sanctioned by
the British Poor laws. this system Of outdoor
attendance has reached proportions dangerous
20 habits OF self-reliance and self-help in large
section OF the community
II is claimed. In fact that tho number Of per.
sons who fall strictly within the purview Of
charitable hospitals is quite limited. The really
INDECENT are provided for by the Poor law medi-
cal officers. who. in virtue OF their relation to
tho parochial system at large. can obtain for q
sick paupcr moro permanent relief than could
tho functonaries OF the richest cleemosynary
institution. II appears. however. that in the to-
tai number OF out patients cared for by the Lon
don hospitals those who belong to the pauper
class. and are in constant receipt OF parochia
relief constitute at least fifteen per cont. Again
some nifty per cent are persons who might rea-
sonably DO expected to contribute toward the
cost OF their own medical treatment. and TO
whom. on that account assistance should be ad-
ministered with the greatest care and discrimi-
nation. After these deductions from the aggre-
gate Of hospital out patients. there remain only
about third who can. on any grounds. be
deemed proper applicants for charity II is
averred that out-patient departments ought to
be vigorously reserved. flrst for those who have
been treated In the wards, and who need to be
kept under observation second. for those who
are suitable for admission. and are merely
awaiting their turn and finally. for that limited
class OF persons who may be described as the
struggling poor-who are above the level Of par
ish relief. on the one hand. but who. from some
exceptional cause. are unable ut the moment TO
pay for medical attendance. II is affirmed that
the restriction Of hospital aid 10 these catego-
riee IL social reform Of prime importance.
and one that calls for Legislative interference
quite as distinctly rs the abuses which time had
engendered in the disposition OF university en-
dowments.
As we have seen. the medical service of the
British metropolis is in large part performed
by gratuitous practitioners supported by funds
originally intended 10 supplement. not super
sede. the heathful. self-sustaining energies OF
the community. \ resolute purpose Is evincod
10y discussion in and out Of Parliament TO nut
an end to such a state Of things. II is obvious
that 10y curtailng the out-patient departments
the hospitals could save large amount Of rcyc-
nue.. and that many now employed in outdoor
work as assistant physicians and surgeons
would find their official occupation gone. II is
urged that the money thus saved might be used
IN developing system of cooperative dis
pensaries. Of which many examples already
exist in England. In the latter institutions
members are enrolled. as in q club they pay n
smnl weekly or monthly subscription and in
return. are entitled TO attendance and medicine
when they are ILL., Such IL society constitutes n
species Of insurance against the medical ex-
penses OF illness. and its advantages have been
repeatedly demonstrated during the last eight
years. We believe. indeed that n similar instl-
tuition has for some time been successfully
working In San Francisco. 1t has been re-
marked in England. however. that these co.
operative dispensarics are sure 10 fail when
opened in the immediate neighborhood Of
medical charities. whereas elsewhere the in
dustrial classes show q readiness TO enroll
themselves as members.
How largo proportion OF hospital funds nre
wasted upon persons who have no claim to
charity may be inferred from the results Of in
vestigntions made In Manchester. In 1875.
when the inquiry began, forty per cent. Of the
outdoor patients were found TO be able 10 nay
dispensary charges In 1876 the proportion fell
to twenty-one per cent. and the year afterward
TO nineteen per cent. showing that those who
had no right TO gratuitous attendance were re-
strained from asking 1t by dread Of exposure.
In the same city, by the way. an interesting ex-
pertinent has been set on foot the object of
which is 10 open cooperative dispcnsary in
each distric, OF Manchester aud Stafford. Six of
these have been started. one Of which is alrenly
seli-supporting, while the other five REQUIRE
only small subsidy from the funds of the asso-
citation. In one year the sums paid in amounted
To- nearly $4,000, aud even greater SUCCESS has
attended an analogous project in NORTHAMPTON.
Now ench Of tho five London hospitals forms
the medical centre OF large and populous dis
lfiet, and II is proposed that part OF tho largo
endowmcnts should be- used in starting co.
operative disponsaries. providing suitable
nj tl,.,,