stitutions are constantly being started, often under very doubtful auspices; and many already existing are obviously maintained mainly as a means of livelihood for the staff. The number of officials employed is returned as 4,359. The 238 "medical charities are computed to enjoy an annual income of about £1,196,471, of which some £485,502 comes from rates, at least £50,000 from property (endowments), at least £100,000 from legacies, about £50,000 from the "Hospital Sunday Fund" and "Hospital Saturday Fund," probably £50,000 from patients' payments, and some £300,000 from subscriptions, donations, the proceeds of bazaars, concerts, "fairs," "fêtes," and all the thousand and one devices invented by officers at their wits' end for funds to maintain the 17,830 occupied beds (5,729 remained empty last year from lack of money), the 122,047 in-patients (one in 40 of the population) and the 1,576,905 out-patients of the year. The total expenditure is estimated at £1,207,749, or about 9d. in the pound on London's rateable value (more than a third being already defrayed by rates). Few persons realize that we are rapidly municipalizing our hospitals. "It is worthy of remark that during the last 20 years about 12,000 hospital beds have been provided by the Poor Law authorities for the sick poor of the metropolis, a number far larger than that of the total of all metropolitan hospitals put together." (Report of Poor Law Inspector, p. 52 of Local Government Board Report, 1887-8, C-5526). These include 9,639 "occupied beds" in the Poor Law Infirmaries and Sick Asylums, and 1,820 in the hospitals for infectious disease. The total in the "voluntary hospitals is only 6,415. Nor are these mainly or exclusively for paupers. By an order dated 7th July, 1887, admission is granted to any person affected with fever or small-pox whose removal is advised by any duly qualified practitioner (pp. li. and 9 ibid). Under this order the magnificent public hospitals of the Metropolitan Asylums Board are, in times of epidemic, steadily becoming more and more generally used by Londoners. By Sec. 7 of the Diseases Prevention (Metropolis) Act, 1883, this is not deemed "parochial relief." The Metropolitan Asylums Board (see p. 17) accordingly spent, in 1887, £303,640 (p. 262 of C-5526). One in 12 of London's population will die in one of these institutions: this is the annual proportion of deaths in hospital to the total deaths (see page 7). Probably four out of five of London's adult population use one or more of these so-called "medical charities" during their lives. Yet, except in the workhouse infirmaries and the hospitals of the Metropolitan Asylums Board, the public have at present absolutely no control over the establishment, the property, the expenditure, the management, or the extinction of any of these institutions. Only three of them render their accounts to any public authority. No public superintendence controls their jobbery: no public audit checks their waste. There is absolutely no general supervision, or even inspection, of these essentially public institutions. taken by boards of guardians and managers of utilizing the industry of the children" (Report of Local Government Board, C-5526, pp. 95-97). Only 3,551 children in all England are "boarded out," about 500 being from London (ibid, pp. 99 and 198). (b). The aged poor, instead of being imprisoned in "Bastilles," with husband and wife often illegally separated, and always condemned to a grim lingering out of life, must be humanely provided for by pensions or almshouses as they may prefer; and be regarded, not as semi-criminal incumbrances, but as receiving honorably the willingly given pensions to which lives of hardship, toil and want spent in the service of the community have abundantly entitled them. (c). The sick, the chronically infirm, and the "industrial martyrs" of our civilization, suffering from the evergrowing number of accidents, should be treated generously in the public hospitals-no longer to be stigmatized as "workhouse infirmaries "-and in convalescent homes and asylums, administered by the Public Hospitals Board hereafter referred to (p. 22). (d). The "temporarily unemployed" should be recognized as a necessary incident of our present industrial life. "The modern system of industry will not work without some unemployed margin some reserve of labor."* For these it will nearly always be possible to find temporary employment in connection with the large quantity of work of every kind constantly being done by the County Council, Vestries, District Boards, &c., if only there were any real desire to cope with the problem. The Local Government Board has in vain urged local governing bodies to take this course. The Chelsea Vestry † and a few other bodies, have already attempted it with marked success. But in order to enable this to be adequately extended, it is necessary to insist on : All public bodies dispensing as far as possible with contractors, (e). For the chronic cases of sturdy vagrancy, idle mendicity, and incorrigible laziness, we must have recourse to organised pauper labor, strictly disciplined and severely supervised. These classes, like the criminals, are the "failures" of our civilization; and whilst they must be treated with all just kindness, and offered opportunities of earning their subsistence, they must nevertheless be sternly denied all relief until they are willing to repay it by useful labor. The present Poor Law system quite fails to deal with them: even individualistic reformers urge further public action. "Thorough interference on the part of the State with the lives of a small fraction of the population would tend to make it possible, ultimately, to dispense with any Socialistic interference in the lives of all the rest." And again, we must “ open a little the portals of the Poor *C. Booth, "Life and Labor in East London " (Williams and Norgate), p. 152. † See Report by J. STRACHAN, Surveyor. C. Booth, "Life and Labor in East London" (Williams and Norgate) p. 167. Unions. Law or its administration, making within its courts a working guild under suitable discipline" (ibid, p. 168) and eliminate the idle loafers from society by making their existence in the ordinary community. more and more impossible, whilst we on the other hand offer them constantly the alternative of the reforming "Labor Colony ", to which all incorrigible vagrants and beggars could be committed by the magistrate for specified terms. To effect these reforms the administration of the Poor Law must be brought under democratic control: the existing Boards of Guardians and Metropolitan Asylums Board with their electoral anomalies should be swept away, and replaced by an elected Board responsible for the care of the whole of the aged, the sick, insane and destitute of London. As five-twelfths of the Hospital expenditure must inevitably be under its management, it would seem best for this work to be united with that of the control of London's hospitals; and the Hospitals Board (see p. 22) might well become a general "Charities Board," formed of elected representatives from each Parliamentary constituency on the existing municipal register, charged with the whole central administration, and assisted by elected district committees for local work. Only by some such system can the existing Metropolitan Asylums Board be adequately replaced; the burdens of the poor-rate equalized; effective democratic control established over the welfare of our sick and poorer brethren; the County Council relieved of its burdensome care of lunatic asylums; and London's myriad charities, now often hidden, stolen, jobbed and misapplied, rescued, and the public property of the poor made as secure as the private possessions of the rich. Notwithstanding social obloquy and rigorous treatment, the number of persons driven to seek Poor Law relief is enormous. LONDON PAUPERS, 1st JANUARY, 1888. 3,401 2,393 2,616 11,532 10,636 7.323 1,793 2,274 401 796 43,165 508 498 374 3,327 2,986 4,003 502 628 147 128 13,101 274 239 50 1,154 906 1,609 107 131 42 53 4,565 4,183 3,130 3,040 16.013 14.528 12.935 2,402 3,033 590 977 60,831 594 313 129 8163,336 8,960 2,097 8,700 1,155 2,640 3,990 16 64 32,368 1,036 1,8366,372 16,904 3,663 14,902 1,908 3,870 5,736 21 75,529 15,245 8,699 28,346 13,264 (Report of Local Government Board, C-5526, pp. 192-202 ) But the relief is not usually given permanently to obtain the number of different individuals who receive relief during a year, we must multiply the daily number by three (Mr. Mulhall," Dictionary of Statistics," p. 346) or by 3 ("National Income," by Dudley Baxter, p. 87). This gives a pauper class seeking relief in London during any one year of about 400,000 persons, or 1 in 11 of the total population: 1 in 9 of the wage-earning class. LONDON'S HOSPITALS. AN energetic attempt is being made to induce the London wageearners to become regular subscribers to the London hospitals. Opportunely enough, a memorandum on the whole of the metropolitan medical charities has just been published by the Charity Organization Society (15, Buckingham Street, Strand), which reveals some of the waste and confusion engendered by our competitive individualism even at the sick-bed. London's sick are provided for by 11 great hospitals with medical schools; eight smaller general hospitals; 67 special hospitals (many of these unnecessary); 26 free dispensaries; 13 part paying dispensaries; 34 "provident dispensaries"; 27 workhouse infirmaries and sick asylums; 44 poor-law dispensaries; and eight public hospitals for infectious diseases. These 238 SEPARATE INSTITUTIONS compete with one another for funds, for patients, for doctors, for nurses, and for students. They are distributed geographically over London without the least regard to local necessities; and hardly in any single case is there any co-operation among them. New in stitutions are constantly being started, often under very doubtful auspices; and many already existing are obviously maintained mainly as a means of livelihood for the staff. The number of officials employed is returned as 4,359. The 238"medical charities" are computed to enjoy an annual income of about £1,196,471, of which some £485,502 comes from rates, at least £50,000 from property (endowments), at least £100,000 from legacies, about £50,000 from the "Hospital Sunday Fund" and "Hospital Saturday Fund," probably £50,000 from patients' payments, and some £300,000 from subscriptions, donations, the proceeds of bazaars, concerts, "fairs," "fêtes," and all the thousand and one devices invented by officers at their wits' end for funds to maintain the 17,830 occupied beds (5,729 remained empty last year from lack of money), the 122,047 in-patients (one in 40 of the population) and the 1,576,905 out-patients of the year. The total expenditure is estimated at £1,207,749, or about 9d. in the pound on London's rateable value (more than a third being already defrayed by rates). Few persons realize that we are rapidly municipalizing our hospitals. "It is worthy of remark that during the last 20 years about 12,000 hospital beds have been provided by the Poor Law authorities for the sick poor of the metropolis, a number far larger than that of the total of all metropolitan hospitals put together." (Report of Poor Law Inspector, p. 52 of Local Government Board Report, 1887-8, C-5526). These include 9,639 "occupied beds" in the Poor Law Infirmaries and Sick Asylums, and 1,820 in the hospitals for infectious disease. The total in the "voluntary hospitals" is only 6,415. Nor are these mainly or exclusively for paupers. By an order dated 7th July, 1887, admission is granted to any person affected with fever or small-pox whose removal is advised by any duly qualified practitioner (pp. li. and 9 ibid). Under this order the magnificent public hospitals of the Metropolitan Asylums Board are, in times of epidemic, steadily becoming more and more generally used by Londoners. By Sec. 7 of the Diseases Prevention (Metropolis) Act, 1883, this is not deemed "parochial relief." The Metropolitan Asylums Board (see p. 17) accordingly spent, in 1887, £303,640 (p. 262 of C—5526). One in 12 of London's population will die in one of these institutions: this is the annual proportion of deaths in hospital to the total deaths (see page 7). Probably four out of five of London's adult population use one or more of these so-called "medical charities" during their lives. Yet, except in the workhouse infirmaries and the hospitals of the Metropolitan Asylums Board, the public have at present absolutely no control over the establishment, the property, the expenditure, the management, or the extinction of any of these institutions. Only three of them render their accounts to any public authority. No public superintendence controls their jobbery: no public audit checks their waste. There is absolutely no general supervision, or even inspection, of these essentially public institutions. |