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The Pamphlet Collection of Sir Robert Stout: Volume 86

V.—Collective Provision for the Sick

page 13

V.—Collective Provision for the Sick.

Few persons realise how rapidly we are "municipalising" our hospitals. The workhouse infirmary is coming to be more and more accepted as the proper home of the wage-earners who are seriously ill. In London, where our magnificent voluntary hospitals, 78 in number, provide about 6,415 occupied beds, the 27 Poor Law infirmaries and "sick asylums" have 9,639, and the eight hospitals of the Metropolitan Asylums Board 1820, a total of 11,459. Nearly two-thirds of our Metropolitan hospital accommodation is therefore now provided from public funds.

Nothing could be more advantageous from the public point of view than that every case of serious illness should be treated in hospital. It is to the public interest that the worker should as quickly as possible recover his health and strength, with the least possible privation to his family. The great advance in medical treatment during recent years has been in nursing and in antiseptic treatment, neither of which is possible in a crowded home. The isolation of infectious disease is an obvious public gain. But when 80 per cent. of our households are those of manual wage-earners—when in our great cities 30 to 40 per cent. herd in single rooms, and as many more in two or three room-tenements, neither isolation nor proper nursing are possible in the home. The treatment of the sick must necessarily become more and more a matter of collective provision; and it is fortunate that the subjective demoralisation which we have done our best to attach to it by making (in London) two-thirds of the inmates technically paupers, is dying away before the common sense of the doctors and the patients. It was stated to the House of Lords' Committee that, "in consequence of the excellence of the treatment in these infirmaries, and their separation from the workhouse, the poor are so ready to resort to them that there is a tendency to regard them as a kind of 'State hospital,' entrance to which does not imply that the patient is a pauper."*

This excellent discrimination seems so horrible to the Birmingham Guardians that "they have determined to make all persons who come to their infirmary pass through the gate which leads to the workhouse grounds, so that they may not draw a distinction between the workhouse and the infirmary."

This sapient instance of the deliberate "pauperisation" of those free from this taint is characteristic of far too much of the existing Poor Law administration. We are often so intent on reducing the cost of the collective provision for our poorer brethren that we even prefer to make that provision as demoralising to them as w e possibly can, on the chance that we may thereby exclude (to their detriment and occasional starvation) some of the more dignified among them.

* Report of House of Lords' Committee on Poor Law Relief, H.L. 363, 1888, P-viii.

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As regards medical aid, however, public opinion is now running too strongly to be resisted. By sec. 7 of the Diseases Prevention (Metropolis) Act, 1883, treatment in the magnificent public Hospitals of the Metropolitan Asylums Board is not deemed "parochial relief." In 1884 Parliament provided that the receipt merely of medical relief should not disqualify a man for exercising the franchise. In the next Parliamentary Registration Bill, a clause will inevitably be carried, which few members of Parliament will dare even to resist, defining "medical relief" to include treatment in a Poor Law Infirmary or Sick Asylum. Why, moreover, should we deprive a man of the rights of citizenship because he has had the misfortune to have his wife or child compul-sorily removed from his care as dangerously insane, and remitted to a public lunatic asylum?*

The existing distinction between the voluntary and the rate-supported hospital cannot possibly be maintained; and it may be hoped that some order will soon be introduced into the barbaric chaos of London hospital administration. What appears to be wanted is the complete separation of medical and hospital relief from the Poor Law system. In large cities the provision for the sick needs classification according to the kind of disease, rather than according to the haphazard distinction of how each particular institution is maintained or administered. We require in London an elected Hospitals Board, managing all public provision for the sick and the insane, and auditing, supervising and controlling all "voluntary" hospitals. Such a Board would relieve the London County Council of its burdensome care of lunatic asylums, and take over the hospitals of the Metropolitan Asylums Board. In other counties it would probably be found sufficient to give similar powers of hospital management and control to the existing "Asylums Committee" of the County Council, thus removing all provision for the sick from any contact with Poor Law Administration.

* Nor is there any valid ground for depriving any other pauper of the right Of citizenship. (See Fabian Tract No. 14, "The New Reform Bill," clause 3.)