The Case of Gunner Charlton

of the great good some of the legitimate special hospitals do; but I fear that, in the majority of instances, the necessity for a special hospital, and the distinctly felt wants of such an institution, are becoming almost the last considerations which engage the attention of the wellintentioned people who, during the last few years, have shown so much energy in establishing, with needless frequency and almost endless repetition, new institutions for almost every disease to which flesh is heir. Will it be believed that, in the year i875, the income supplied by the public to thirty-six special hospitals, having amongst them 1, 1 3 beds, amounted to /io6,385 ; whereas the income of the eight chief Metropolitan hospitals, which are mainly supported by voluntary contributions, to all of which medical schools are attached, having amongst them 2,268 beds, only amounted to ii , i199 ? Nor is this all ; for, whereas the proportion of management expenses to maintenance at the former averaged upwards of 20 per cent. during the three years ending i875, at the latter the average cost of management during the same period and on the same basis only amounted to 7Y2 per cent. Did space permit, I would give the names of the special hospitals in detail; but, as this is impossible, I merely summarise them under their special heads. I may, however, state that I shall be happy to show the figures to any one who is connected with the management of any of the hospitals who may be interested in the subject. The special hospitals to which I refer are made up as follows: Three for diseases of the skin; five ophthalmic hospitals; one ear hospital; two dental hospitals; two throat hospitals; three women's hospitals; four women and children's hospitals; six children's hospitals; one cancer hospital ; three orthopoedic hospitals; two for diseases of the nervous system; one for diseases of the legs ; one for diseases of the heart; one for fistula; one for stone ; total, thirty-six. I believe if the public were aware that the average cost of manage. ment, at all but the best managed of these special hospitals, is three times as great as it is at the general hospitals having special departments, they would very soon discontinue their present practice of contributing to almost every special institution which is brought directly under their notice. Again, is it not a humiliating reflection, that so little discrimination was shown by the benevolent, in i875, that they actually contributed almost as much to support I, ioo beds in thirty-six special hospitals as the whole income available to maintain more than double the number, or 2,278 beds, in the eight large Metropolitan hospitals, mainly supported by voluntary contributions, viz., Charing Cross, King's College, the London, the Middlesex, St. George's, St. Mary's, University College, and theWestminster Hospital? I am fully aware that the managers of special hospitals maintain that the general hospitals do not make adequate provision for the treatment of the class of cases they desire to treat. But what are the facts ? At the present time, if we include St. Thomas's, St. Bartholomew's, and Guy s, with the eight hospitals just enumerated, I find that they collectively provide the following special departments: Nine for diseases of the skin; ten for diseases of the eye; eight for diseases of the ear; four for diseases of the throat; eleven for diseases of women and children ; one for cancer; and three for orthopedic surgery; or ten more than the whole of the special hospitals provide, including those institutions for diseases of the nervous system, of the heart, and of the legs, together with fistula and stone, all of which diseases can be seen by the sceptical within the walls of a general hospital, on any day, and probably all the year round. I think that the facts I have adduced provea. That, as compared with general hospitals, special hospitals are maintained at a needlessly ruinous expenditure for management. b. That the existence of many of them is, as the Lancet declares, " needless and useless", for every necessary provision is made at the general hospitals. c. That the philanthropic public have good reason to pause before they desert the general in favour of the special hospitals. But, apart from the point I have just been considering, I am convinced that the managers of the general hospitals will be wise to remodel their arrangements for procuring income. At the present time, the system adopted by the majority of the large general hospitals is to rely too much upon the spontaneous generosity of the public which has so long stood them in good stead. Unfortunately, however, the days have gone by when a standing advertisement in the hospital column of the Times, with such other advertisements in other papers from time to time as seemed desirable, is all that is necessary to procure the needful income. Some other means must be devised for arousing public atten. tion to the urgent necessities of our great London hospitals. My own opinion is that an attempt should be made to directly localise each institution; that is to say, the managers should endeavour in season and out of season to arouse the inhabitants of the district in which a hospitl1 is situated to a sense of its necessities. Surely, what has been done in Edinburgh anid in the country and manufacturing towns can be done in London. Thus, at Edinburgh, the managers of the Royal Infirmary organise a systematic house to house collection once each year. Everybody is asked to contribute; every sum, however small, is entered in the collector's book; and in this way £1,200 is raised annually in a few weeks. In the large provincial towns, where there are two or more hospitals, it is noticeable that each institution finds its chief supporters in the district immediately adjoining, and from which, of course, the patients are mostly received. To successfully carry out such a system as this, small subscriptions should be encouraged. The London and the Westminster Hospitals have in part successfully adopted some such plan as I suggest. To those who think this plan impracticable, I would say, try it on Hospital Sunday in June next. The arrangements will be inexpensive and simple; and at Birmingham it has produced each year a not inconsiderable increase in the subscription lists of the different hospitals. Let each hospital, or all those of a given district, combine for the purpose, and form a Committee to work the district in which their institutions are situated. With the consent of the clergy and ministers of religion generally, let them prepare pew forms and place them, with a short description of each of the institutions co-operating in the movement, in every pew and in all the places of worship on Hospital Sunday. Every minister will thus be enabled to direct especial attention to the need of the institutions with which both he and his congregation are especially familiar, much larger sympathies will be excited, and an opportunity will be afforded the liberal portion of the public everywhere to give annual subscriptions and donations. Thanks to the Rev. Canon Miller, D. D., I tried this plan with success last year on Hospital Sunday ; and I believe its universal adoption would materially add to the total sum subscribed throughout the metropolis. By all means, let us continue to bring the claims of our old established hospitals before the wealthy members of the community everywhere, but do not let us longer negJect to urge our claims upon neighbours who have too long remained unasked and uncanvassed. In ten years, one hundred cottage hospitals in different parts of the country have managed to raise an income from their immediate neighbours of upwards of /4o,ooo a-year. Shall it be said that, in our anxiety to persuade the wealthy outsider to contribute, we have ignored the well-to-do and thrifty members of the working and middle classes who have lived in our midst from the very commencement, and by whom the hospitals in the provinces are mainly supported ? I fear I have already occupied too much of your space; but I hope on a future occasion, with your permission, to return to the subject, which is too complex to be fully treated in a single letter.-I am, etc., Greenwich, March 28th, I877. HENRY C. BURDETT.