Some years ago, a Birmingham medical man--Mr West--in a very ably
written contrast between English and French surgery, drew attention to
a kind of hospital common abroad, and much appreciated there by the
class for whose benefit these institutions are intended, but of which
in Britain we have no examples, or at most one or two experimental
wards on a very limited scale. These institutions are hospitals where
patients of the middle class who can afford and are willing to pay
a moderate sum, can be received when serious illness or accident
unfortunately necessitates medical aid--'a special kind of hospital,'
said Mr West, 'unknown in England, which I think of great utility, and
of which there is, I believe, an urgent need, not only in London, but
also in every large town throughout the provinces.'
Mr West's paper does not appear to have borne much fruit at the time;
but recently the question has appeared again, and this time, so much
has been done to give prominence to the movement, that a public
meeting was held last June at the Mansion House, to discuss points in
connection with this great subject. There cannot be two opinions as
to the general advisability of establishing such hospitals in this
country, and as was to be expected from the honourable desire of the
medical faculty always to do what appears best for suffering humanity,
we find that the scheme has the cordial approval of the presidents of
the great medical bodies and the chief members of the profession in
London, who agree that this is a much-needed institution.
Out of England, there are various examples of such hospitals, such as
the State Hospital at Christiania, which is entirely supported by such
paying patients; the famous Maison Municipale de Santé in Paris; and
various institutions in Germany and the United States, where for a
moderate fixed payment, men or women of limited means, or who have no
home in a large city, can obtain adequate care and proper nursing in
case of illness. The great French hospital, the Maison Municipale de
Santé, is a model of what such an establishment should be. It is under
the control of the municipal authorities, and has nearly six hundred
beds ready for the treatment of sick and wounded persons of the class
now alluded to, who, for a daily payment varying from four to twelve
francs, can obtain medical and surgical advice--medicine, food, baths,
and all else necessary for their proper alleviation or cure. There are
two physicians and a surgeon on the staff of the hospital; but if the
patients choose, they can call in consultation any of the Parisian
hospital doctors, and the fees paid to them are the only extra expense
that inmates are liable for. 'The hospital,' says Mr West, 'is clean,
well-furnished, comfortable, and contains every variety of bath that
the patients can possibly require.'
What a boon such an establishment would be, not only for the large
numbers of clerks and assistants in our shops and warehouses, who
live in lodgings, and are far from the tender hands of a loving nurse,
but also for a class who are anxious to have the advantages of a
well-managed hospital and its careful nursing, rather than subject
near and dear ones at home to all the trouble and anxiety of nursing
and watching, besides the great risk of infection. There is certainly
a strong and no doubt very natural feeling against the idea of being
away from home when sickness overtakes us; but in process of time this
dislike must yield to the undoubted fact, that in a well-organised
hospital, a case has, as a rule, a far better chance than elsewhere
of being thoroughly attended to according to the directions of the
physician. The loving hands that smooth the pillow under the uneasy
head need not be absent here; but it must be remembered that it is
not given to every mother or wife to be a good nurse. Nervousness
and inexperience, over-anxiety from the very great interest in the
issues of life and death for the loved one, are often causes of
risk to the patient. Then, too, house accommodation may be limited:
perfect isolation of the infected patient, especially in the 'flats'
of such a town as Edinburgh, may be well-nigh impossible; while the
disease may be, like small-pox, of a kind that drives all but the most
self-sacrificing of friends away.
In one of the many letters written on this subject we get a pitiable
instance of such a case as this: A young man, living with a lady and
her daughters, became ill with small-pox. His mother was dead, his
father in India. When it was clear what disease he had, every one left
him but one servant. His doctor sent him to a small-pox hospital, but
it was full; and he had to be brought back again, and put under the
care of a nurse from an Institution; but at ten P.M. this Mrs Gamp
was found to be quite drunk, and another had to be sent for. But how
infinitely better would it have been if he could have been sent to a
paying hospital. The present writer knew of a case some years ago that
peculiarly illustrates the value of such institutions. A young married
man of limited but not straitened means was seized with illness at
home about a week before the 'flitting term,' at which time he was
to remove his household goods to another town. The doctor pronounced
it fever, and said that if he was to be removed at all, it must be
immediately. It was absolutely necessary he should leave his house when
his tenancy expired; and as they had no friends in town to whom to go,
no course was open but to send the sick man to the public hospital;
which was done. Here was a distinct perversion of the objects of such
an institution; and though in this case some compensation was made in
the form of a donation, yet here again, how much better for all parties
if that hospital had had a wing, where he could have been taken in on
the distinct footing of payment for its advantages.
Various proposals have been made as to the mode of instituting such
hospitals. Sir Rutherford Alcock is in favour of a certain number of
wards in good existing hospitals being set aside for the accommodation
of paying patients at varying rates, to suit their varying means;
others advocate the building of distinct wings or pavilions to existing
hospitals; while many think that buildings separate in every way should
be specially built. The advantages in favour of connection are that
in these hospitals there is already an organised staff of physicians,
surgeons, and nurses; and that while the extra expense of an expansion
of this staff would be comparatively small, the payments from the
new class of patients would largely help the funds of the hospital
in its charitable purposes. It is probable, however, that a distinct
institution--an 'Hotel Hospital' it is proposed to call it--will soon
be set on foot, as a limited liability company is spoken of for the
purpose.
The London _Figaro_ some time ago advocated the establishment of
dispensaries where a man of the middle class could get for a small fee
first-rate medical advice. In this material respect the workman is
decidedly better off than the struggling member of the middle class,
who, if he has to consult a leading physician, must pay fees beyond
what he too often can afford, while to the poor man the highest medical
advice in the kingdom is as free as the air he breathes. The _Figaro_
shews how this would be not only a great advantage to middle class
people but to the medical profession, in which at present many young
men have to be content with a local practice, because they have no
opportunity for obtaining hospital practice, which is so necessary for
qualification as a general physician.