SOCIALISTIC PHILANTHROPY.
DURING the week that ends to-day, six meetings have been held in London by way of preparation for "Hospital Sunday." The object of each meeting has been to stimulate local liberality, and so to fill the purses, now yearly getting leaner, of the local hospitals. Hitherto, this diminution of income has not led to any appreciable diminu- tion of the work done. The operations of the several hospitals have not been curtailed, though in order to avert this neces- sity, all the available resources have been drawn upon and large liabilities incurred. Neither of these expedients can be resorted to without limit. The funds that have been diverted from their original purposes become exhausted, and even benevolent institutions cannot honestly contract debts when they have no reasonable prospect of paying them. The first of the six meetings had for its chairman Sir Andrew Clark, and in his hands, it is needless to say, the subject lost nothing that enthusiastic advocacy could supply. There was a judicious array of argu- ments why every one should give largely to hospitals, and an attempt—not quite so judicious—to explain why many have of late given less largely. We do not enough remember the services which hospitals render to others than their actual patients. It is no paradox, indeed, to say that among these patients are to be reckoned thousands who never enter their doors. There is not an operation well performed, not a case suc- cessfully treated, that does not saddle those who have benefited by the surgeon's or the physician's skill with a direct obligation to the hospital in which that skill was in the first instance gained. If all our hospitals had to be closed for want of funds, it is not the poor only who would be the losers. The well-to- do would suffer just as surely,—in person, if they remained closed ; in pocket, if they were opened on some other basis than voluntary benevolence. The closing of the hospitals would mean the closing of the medical schools. Without the great body of instances which are there brought together, the medical teaching would be reduced to a disquisition on symptoms which the teacher had seen, but the pupils had not. A great doctor could not take his pupils the round of his private patients ; he could at most read them his notes of what he had noticed in the course of his practice. Con- sequently, the succession of great doctors would come to an end with the present generation. After that, medical science would
become a system of guesswork, tempered by tradition. It is quite certain, however, that things would not be suffered to reach this pass. Human selfishness is too enlightened to put up with bad doctoring when its removal is only a matter of money. But the prevention of the evil must be effected in one of two ways, and to each of them there are serious objections. The doctors might combine to keep hospitals going for the sake of the medical schools connected with them,—in which case they would have to recoup them- selves out of their paying patients, and medical attend- ance would become the most costly of luxuries ; or hos- pitals would have to be maintained as State institutions,— a plan which would saddle the taxpayer with a large addi- tional burden, give the patients an injurious sense of being paupers, and raise a variety of inconvenient controversies upon questions of hospital management. It is easy, for instance, to imagine the increased acrimony which would have been im- ported into the recent dispute about the rules of nursing sisterhoods, if University College Hospital had been supported by the Government or the Municipality.
Unfortunately, however, these evils are too remote to make much impression on a public which is too apt to assume that hospitals will be supported somehow, whether the subscriptions go on or stop. There is no question that the general want of money has injured hospitals in several ways. The endowed hospitals are, perhaps, the worst sufferers, because their repu- tation for wealth clings to them after the wealth itself has departed. As it turns out, their wisest course would have been to sell their lands when land was valuable, and to invest the money in Consols. Even a fluctuating income is a bad income for a hospital, and of late incomes derived from land have been apt to decline without fluctuations. An endowed hospital has come, by no fault of its own, into the position of the unjust steward. It cannot farm its unlet lands, and it is ashamed to ask for subscriptions. Nor, indeed, could it ask for them to much purpose. The voluntary hospitals have their own sorrows. They depend upon voluntary liberality, and voluntary liberality is failing them. People have less money to spend than they had. If they are in trade, they feel the lessening of profits. If they are in the professions, they feel the lessening of business. If they are landholders, they feel the pressure of bad seasons and increased competition. If their income is derived from investments, they have to face falling values and reduced dividends. From whatever quarter the pinch comes, the hospitals are sure to feel it. If their friends have hitherto supported them to the utmost of their ability, the contribution must contract pan i passu with the ability. If, as more often happens, they have supported them out of their superfluity, their superfluous expenses are naturally the first to be cut down.
It is this last class that Sir Andrew Clark had chiefly in mind when speaking at Lambeth. He will not hear of "bad times" as an explanation of diminished subscription-lists. "Balls and banquetings " by night, "jauntings and junket- ings" by day, go on as before. The Row and the Ring are as crowded as usual ; there are as many changes of gowns as ever ; the money spent on flowers at a single reception is still enough to support a whole ward of sick people for a week ; and to keep all these things going, " poor people labour, toil, suffer, and die." If Sir Andrew Clark merely means that there is a great deal of luxury and extravagance which might be usefully curtailed, we shall certainly not contradict him. It is the common fault of all times ; and if in this respect we are not worse than our fathers, we are probably no better. But the class to which this censure applies is not the class whose subscriptions to hospitals have fallen off. The subscriptions of the thoroughly selfish rich have probably never exceeded the sum required to secure a bed for a sick servant, and it would be inconvenient to reduce them below this amount. Those to whom Sir Andrew Clark's words apply have at least some excuse for what they do. No
• doubt, though they have given liberally, they have given of their abundance. They have not put themselves to inconvenience in order to keep hospitals open. Their subscriptions have, so to say, been rather a first charge upon their profits, than a part of their working expenses. Upon these well-meaning people Sir Andrew Clark now seeks to impose a new and a tremendous obligation. 'Sell, if not all, at least a great part of that thou hast, and give to the hospitals.' Is not this to forget what St. Peter said to Ananias 1—" Whiles it remained was it not thine own I" If heroic benevolence is to be preached as an absolute and universal duty, the result will be that only a few will care to be benevolent. The majority will resent the sacrifices demanded of them, and plead that as they can- not give cheerfully if they are to give so much, they had better not give anything. Nothing is gained by confound- ing precepts with counsels of perfection. The average nature cannot soar so high ; consequently, it ceases so much as to spread its wings. Again, Sir Andrew Clark takes no account of the suffering which would be produced by the spasmodic change he is anxious to see accomplished. If the "poor people" he speaks of no longer laboured and toiled to keep the machinery of society in motion, they would but suffer the more and die the sooner. If the hospitals are to have their incomes at once brought back to their old amounts by means of a sudden contraction of social expenditure, what is to become of the thousands and ten thousands who are supported by that expenditure ? Hasty economy may do as much mischief as thoughtless extravagance. If the one calls an industry into being without considering whether the demand for what it produces will be more than a fleeting fashion, the other puts an industry out of existence without stopping to contemplate the fate of those who have been bred to it, and who have looked forward to living by the practice of it. An economy which begins and ends at the item " charity" is contemptible. But an economy which stops at nothing in order not to lessen the item " charity " may not always be the best for mankind.
Nor is it necessarily an unmixed evil that hospitals should at times be compelled to look closely into their expenditure. Even philanthropy will not be the worse for learning how to make money go as far as possible, and we are not quite certain that in some hospitals the lesson may not be wanted.
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