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hospitals, which are cheaply and efficiently managed, the difference is not more than £20. The necessity for careful management is, however, apparent when it is realized that a difference of one egg per patient per day at a large hospital means a difference of £ 300 a year. In this connection many revelations could be made ; for instance, a change in a head dispenser at a large London hospital saved [800 in the first half-year. Another hospital is supplied with lemons on contract at three-halfpence each all the year round. The private contract system by which hospitals get their supplies deserves careful study. In 1897 the Metropolitan Asylums Board established a central store and a committee to judge the goods supplied. No less than 50 per cent. were rejected in the first year as inferior. What percentage of inferior goods finds its way into the charitable hospitals is not easy to determine. Sources of serious waste entailed by the competition for subscriptions are to be found in the heavy commissions paid for collection and the cost of advertising—including under this head the promotion of large, fashionable bazaars and entertainments to work the public up to be generous. The public, however, is far from being satisfied with the management of the voluntary hospitals, as is shown by the fact that a hospital fund initiated by the heir to the throne to commemorate the sixtieth year of the Queen's reign has failed to raise one-half of the sum solicited.
Hospitals are, in fact, fast losing their charitable character, and are now used as a right by a very large number of persons who could well afford to pay a doctor, but who prefer the hospital to the--not always competent-general practitioner. This is called "hospital abuse," and is a subject upon which the practitioner not unnaturally waxes eloquent. But it is high time for us to remove the last stigma of charity, and to recognize frankly that it is both just and economically advantageous for the community to provide for those of its members who have become incapacitated for the struggle for existence. We must have, in every district, urban or rural, at least one general hospital under public control, maintained out of the rates, and administered by persons directly responsible to those who find the money. We must, in fact,
Municipalize all our Hospitals. The existing public institutions supply the nucleus of a municipal hospital system. The Poor Law infirmaries must (1) be entirely dissociated from workhouses and from the Poor Law, (2) have a visiting and resident medical staff appointed, and (3) be made available for the training of nurses and doctors. With them must be combined the administration of the present municipal hospitals, lunatic asylums and inebriate asylums. By section 131 of the 1875 Public Health Act, any sanitary authority may provide a general hospital. It may also subscribe to other hospitals, or take them over. Hitherto these wide powers have been used chiefly to provide for infectious diseases. There are, already, hundreds of municipal hospitals in this country: nearly every borough has a fever hospital-Liverpool has five-and many have a smallpox hospital as well. The Metropolitan Asylums Board has decided to provide establishments for treating ring-worm and ophthalmia. Many county boroughs, like Nottingham, and practic. ally all county councils, maintain (under the name of lunatic asylums) what are virtually hospitals for brain diseases. But the power of local sanitary authorities (including Metropolitan Borough Councils) to provide hospitals is not confined to intectious diseases. Barry is building a hospital for accidents, and several towns are proposing to erect sanatoria for consumptives. Every town and district council ought to follow these examples.
It is generally acknowledged, then, that our municipalities and county councils are the fit and proper bodies to take charge of those suffering from fevers, smallpox, and lunacy. Accidents, consumption and other diseases are being added to the list. Why should they not treat all diseases ? Parliament gave the power to do this as long ago as 1875, and it should now give them power to take over from the Poor Law Guardians all provision for the sick poor.
It must be borne in mind that the responsibility for a vast amount of disease rests upon the community, which permits the wholesale manufacture of cases of "industrial poisoning” in our lead, phosphorous and chemical works, and tolerates the existence of those most potent disease-producing agencies—overcrowding and a practically unregulated drink traffic. In common justice, therefore, the community must bestow on its incapacitated members, freely and as a right, those means of "cure” which have been made necessary by its failure to employ to the fullest extent the more satisfactory methods of prevention.
LIST OF AUTHORITIES. There has been as yet little public discussion of Hospital Municipalization. See article by HONNOR MORTEN in National Review for January, 1900; "The State Organization of Hospital Management,” by J. B. JAMES (London ; 1888); “Our State Hospitals,” by T. M. DOLAN (Leicester ; 1894); “Municipal Dispensaries,” by Dı. SANDERS, Medical Officer of Health for West Ham, in Public Health, June, 1900 ; "Suffering London: Relation of Voluntary Hospitals to Society," by A. E. HAKE (London ; 1892); “ The Reform of our Medical Charities,” by R. R. RENTOUL (London ; 1891); "Nationalization of Health," by HAVELOCK ELLIS (Unwin; 1892). Valuable information is contained in the Special Report on London Medical Charities by the C.O.S., 1886; Reports of the Metropolitan Asylums Board ; Report of the Birmingham Hospital Reform Committee, 1891; the Report and Evidence of the House of Lords Committee on London Hospitals, 1892; and the Report of the House of Commons Committee on Hospitals, Exemption from Rates (No. 273 of 1900. Is.); Full particulars as to hospitals will be found in Sir H. BURDETT'S "Hospitals and Asylums of the World” (London ; 4 vols. ; 1891-3)-vol. III. deals with Hospitals, and vol. IV. contains a useful bibliography; and his " Hospitals and the State" (1881). For latest statistics, see BURDETT's " Hospital Annual” (25. 6d.); and "The Municipal Year Book” (25. 6d.).
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The Fabian Municipal Program (Second Series), No. 8.
A GREAT CITY possessing a natural waterway enjoys unrivalled facilities for cheap and pleasant means of locomotion. In taking advantage of such facilities few great cities have been so neglectful as London. Private enterprise has been spasmodically at work, but has wofully misused its opportunities. Since 1840 seven companies and several private venturers have been concerned in supplying Thames steamboat services. Nearly all have achieved temporary success, only to sacrifice it through faults common in privately-managed concerns. Up to October 1900 the Thames Steamboat Company kept up an intermittent service, which is little likely to be renewed. The fares have always been too high and the scale too complex, with that most objectionable of practices, a higher scale for Sundays and holidays.
The best private service, too, would be hampered by the present chaotic pier system. Within the County of London--that is, from Hammersmith to Woolwich-there are in use 29 steamboat piers, the ownership of which is divided among the Thames Conservancy, the County Council, Thames Steamboat Company, East India Dock Company, Greenwich Pier Company, three railway companies, and a lord of the manor. The Conservancy exercises statutory control over most of these piers, and the Board of Trade certain departmental control over all, whilst the Commissioners of Woods, Commissioners for the Lord High Admiral, and others have statutory rights in respect to certain piers.
One vital condition of a Thames steamboat service must be the simplification of pier-tolls and the unification of pier-control, if not of ownership.
Successful Municipal Steamboats. There are several flourishing municipal river steamboat-services in Great Britain.
BIRKENHEAD. The Birkenhead Corporation works the principal ferries between Birkenhead and Liverpool. There are ten large steamers, three being for goods and vehicles. The Woodside service runs day and night, at intervals of from ten to thirty minutes. The fare is id., except from midnight to 4.30 a.m. Some 25,000 passengers use the service daily, rising at holiday times to some 80,000. The opening of the Mersey tunnel and railway in 1884 temporarily injured the service, the annual receipts falling from £55,000 to £37,000, but by new boats, improved service and careful management the lost ground has steadily been recovered. To March 1900 the receipts were £ 50,600 ; working expenditure, £ 32,272 ; sinking fund, £ 2,265; reserve, £7,335; net profit, £8,727.
WALLASEY. Another Mersey service is that worked by the Wallasey (Cheshire District Council, whose boats run between Liverpool,' Seacombe, Egremont and New Brighton. The fares are: to Seacombe id., Egremont 2d., New Brighton 3d., the respective distances being m., 1 m., and 3m. The boats, being built to cope with heavy seas at New Brighton, are large and expensive, and the fares are correspondingly high. Boats run to Seacombe night and day. From midnight to 4.30 a.m. special fares are charged. The total loan raised was £ 472,000, which is being rapidly paid off. To March 1900 the receipts were 579,241 ; working expenses, depreciation, &c., £ 57,080; interest and sinking fund, £20,000 ; net profit, £ 2,161. The object of the Council is not to make a large profit, but to give a safe, rapid and comfortable service, in which enterprise it has succeeded remarkably well. There are eleven fine steamers, with certificates for 13,500 passengers. Most of the boats measure over 150 feet in length, and 25 feet to 45 feet in beam, the original cost ranging from £9,000 to £13,000. Each one has a general saloon, a smoking saloon, and a fine promenade deck, and all are lighted by electricity. Between 1885 and 1895 the increase of revenue was 25 per cent. ; of working expenses, 19 per cent. In the same period the annual number of passengers increased from seven millions to eleven millions. Last year there was a traffic of fifteen millions.
THE CLYDE. The Clyde Navigation Trust has two ferries for vehicles and six for passengers, also a service between Glasgow and Whiteinch, extending 31 miles, fare for any distance id. The boats are light and rapid, and, running at short intervals, the delay at landing-stages is reduced to a minimum. The profits are small, owing to the low fares.
THE TAY. The Dundee Harbor Trust runs an effective service for passengers and goods between Dundee, Newport and Tayport; but no separate accounts are published.
Woolwich. The Woolwich Free Ferry, established and worked by the London County Council, has enormously increased the cross-river traffic at that point, and renders invaluable service to the district.
The Case of the Thames. The means of communication other than steamers between the riverside districts of London are better than those in most of the towns previously mentioned. Moreover, the variation of tidal currents and the stretch of mud flats between London Bridge and Westminster are difficulties in the way of an efficient steamer service. It must be remembered that some of these difficulties have been overcome even by competing companies, under the existing divided pier authority, and they could be faced with infinitely greater success under a centralized municipal service conducted by a committee of the County Council. The tidal difficulties will want the careful study of experts
so that the boats may be specially constructed. The companies never attempted to cope with these difficulties. Yet their failures were never due to their hopeless unpunctuality, but to general bad man. agement and false economy, and above all to over-capitalization and other financial follies.
Failure of “ Private Enterprise." Since 1840 seven steamboat companies and several private owners have plied upon the Thames. For twenty-five years the London, Westminster and Vauxhall Steamboat Company ran seven boats between London Bridge and Vauxhall, any distance for id. The service was fairly good, and was profitable. The company promoter stepped in ; a new company bought up the service and raised the fares. High fares and over-capitalization brought bankruptcy:
The City Steamboat Company was established in 1848 with eight boats. The company paid 10 per cent. and an occasional bonus, and built a new boat every two years out of revenue. In 1875 the London Steamboat Company bought them out, with the usual resultbankruptcy.
The River Thames Navigation Company, which followed, collapsed through bad management. A syndicate of financiers bought them up for $24,000 and immediately afterwards sold the concern to the Victoria Steamboat Company for £75,000. The new company within a few months wrote up their property to £90,000. The traffic continued to increase rapidly, despite a system of fares unparalleled for complexity. Moreover, despite inexplicably high expenditure, handsome profits were made from the first, but these were immediately divided, no proper allowances were made for reserve, depreciation, etc., and the accounts generally were very badly kept. In the last three years of the company's existence its average gross earnings were £70,000, and its average annual profits, after allowing for depreciation, £6,450. But the over-capitalization and financial mismanagement led to bankruptcy in 1894. In 1896 the Thames Steamboat Company commenced the service which was intermittently kept up until the past autumn.
Practical Proposal for a Municipal Service. The report to the Rivers Committee of the County Council, presented in 1895 and revised in July, 1900, advocates a central service of short interval traffic in conjunction with extensions up and down the river : the central service to run from London Bridge to Vauxhall, about 28 miles, calling at Blackfriars, Waterloo, Westminster and Lambeth ; the eastward extension to run down to Woolwich, about 91 miles, calling at Cherry Garden, Limehouse, Greenwich and Blackwall; the westward extension to run to Hammersmith, about 67 miles, calling at Chelsea, Battersea, Wandsworth and Putney. On the central service the fare would be id. for any distance ; the same for any points between Vauxhall and Wandsworth, or between Wandsworth and Hammersmith, going west ; and