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METROPOLITAN PHILANTHROPY IN 1879.

A PERIOD of commercial depression almost invariably carries with it a diminution in the incomes of the charitable societies and institutions which depend upon the ready money contributions of the public, and the experience of the year 1879 forms no exception to the rule. In the case of one great church society it was found necessary to make a public announcement that unless additional funds were immediately forthcoming the society's agents would be reduced in number, while in some of the metropolitan hospitals which, though lacking the noble endowments of the older institutions, are doing a most beneficent work, it was only by a special effort that the closing of several of the wards was avoided. The obvious inference from this fact is that systematic alms-giving is still very far from being a familiar practice with the majority of the people, and that their liberality is rather spasmodic than regular, and is therefore at once affected by any sudden change in their domestic finances. To place the incomes of the London Hospitals beyond the reach of any such fluctuating benevolence is, if they are maintained at all, little short of a public duty, for there is perhaps no more serious injury to a district with a large and poor population than is involved in shutting the doors of one of these institutions. Another lesson which is taught just as plainly by the influence of such a season as that through which we have passed is the urgent necessity for a more careful administration of all hospital funds, for it can scarcely be denied that in some institutions money is made to do far more work than it accomplishes in others, just as in our homes and orphanages the cost of the inmates' maintenance varies very considerably without any corresponding difference in the provision made for the comfort of the children. But, while the year which is closing as we write has thus been marked by "hard times " for the London charities, the exceptional healthiness of the season has relieved us from the necessity for any extraordinary effort to meet special cases of distress; and the attempt to create an impression that there was widespread want in East London was happily nipped in the bud before the needless benevolence of the public passing through the ready hands of professional almoners had literally created the distress for the purpose of relieving it. The correspondence on the subject in the daily newspapers gave evidence of the complete

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change of view which has taken place of late years upon public alms-giving, and which has led the philanthropist to realise the truth that the relief of the poor is in reality a scientific work, in which, although there ought to be no stereotyped adherence to any hard and fast line, rules of investigation must be adopted, or there will be a perpetual risk of doing more good than harm. In this case the local representatives of the Charity Organisation Society, supported by the ministers of religion in the East End parishes, were able to prove that there was no unusual poverty in the district, and thus an appeal for what would probably have developed into a large fund, with a costly staff for its administration, was judiciously prevented.

Turning to the actual work of the year in the formation of new institutions, we find that the true function of charity as the handmaid of thrift and self-help is being recognised on all sides. The institutions established during the twelve months under review owe their origin in nearly every case to this principle of wise discrimination between cases which need temporary help and those for which a permanent provision is essential, and the Homes for Working Girls, the House of Rest for Milliners, and other kindred establishments which might be mentioned, are calculated to prove of immense value, in the same way that a small loan at the right moment is often far more serviceable and more really beneficial than a gift which tends to pauperise the recipient. In many of these Homes, as in the admirable institutions for giving to the over-worked, the sickly, or the convalescent a few weeks of much needed rest and country air, we find a sliding scale of payments, so that persons who can afford to contribute wholly or partially towards their maintenance can be received as well as those who are absolutely without funds or friends. The Homes for Working Girls and the similar institutions for boys in the metropolis form a most important and deserving class of institutions which may be said to be a recent fruit of philanthropic effort; and it is to be hoped that, while the model lodging-house movement extends, the wants of those for whom some community of life and intercourse is desirable will also be considered in every district of the metropolis.

In connection with the medical charities of London, the most important movement which has taken place during the year has been the exposure, by a special committee of the British Medical Association, of the evils, long admitted, but still virtually condoned, and increasing rather than diminishing, of the out

patient system at the hospitals. In the first place, there can be no question as to the injurious effect of the plan of opening the doors of the hospital surgery to almost every applicant, without reference to his capacity to pay for medical advice and medicine in his own neighbourhood. As an illustration of the extent to which the evil has grown one gentleman stated to the committee that, in a parish in Westminster, so demoralised were persons of the well-to-do class, that the guardians had given instructions tɔ the relieving officer to send to voluntary hospitals those who applied for medical aid at the Poor-Law dispensary. But there is, secondly, the question whether, as at present worked, the outpatient system involves, from a medical point of view, anything less than a sham. On this point Mr. Timothy Holmes, as the mouthpiece of a deputation to the managing board of the Metropolitan Free Hospital, stated that the British Medical Association -a body of at least 8,000 practitioners-had come to the conclusion that a very great deal of the medical and surgical attention given to the out-patients of hospitals was absolutely worthless, and that, to throw open the doors of an institution with the idea that a few medical men could perform the duty of attending to the whole of the medical and surgical wants of a large district, was most mischievous and misleading. Yet to such an extent has this idea taken root, that of the 4,000,000 population of London fully a fourth pass through the out-patient departments of the hospitals every year. The governors of the hospitals are actuated by the best and purest motives, but the working of the system has caused a thorough failure of adequate medical aid to the sick poor. Its existence has prevented any complete success in the establishment of provident dispensaries, and if it were abolished or reformed it would involve no hardship even to those who cannot afford the few pence required to insure for a family medical attendance and medicine in sickness in a provident dispensary, for they can have proper attendance and medicine in the Poor-Law dispensaries established under "Gathorne Hardy's Act" ("Metropolitan Poor Law Amendment Act, 1867"). Mr. Holmes, on this occasion, insisted strongly on the worthlessness, from a medical point of view, of the treatment given to out-patients, and cited the case of the Metropolitan Free Hospital, with its 100 new patients a day, or 38,000 a year, and altogether nearly 80,000 patients a year, and he submitted that these numbers could not be seen in a manner to give any real relief. A few seconds' look at a patient would not enable

a medical man to become sufficiently acquainted with the peculiarities of the case to deal properly with it, and though it might be said that some cases were slight and the few serious, yet this gave a reason in itself why the medical men should not be harassed by increased numbers. Under the system it was impossible that the medical man could give the patients what they came for the advice and medicine by which they could be cured. What was necessary was that the out-patients' department should be limited to such numbers as could be adequately and properly treated; that the governors should encourage the people to subscribe to provident dispensaries; that persons who could afford to pay for medical assistance should not be provided with it gratuitously; that the public (Poor-Law) dispensaries should be brought to the notice of those applicants who were proper subjects of such relief; and that, on the second application of patients after adequate advice had been given, they should be requested to afford information of their work, families, and income.

Such recommendations as these are, it may be objected, only the natural suggestion of the medical practitioners, who see their fees swept away by the extension of a system which enables any well-to-do person, who is not ashamed to apply for a free hospital ticket, to avoid a doctor's bill; but such a criticism is altogether beside the real question at issue, which involves, as we have shown, not merely the mischievous operation of pauperising those who throng the hospital rooms, but the question whether the work which is undertaken by the medical officers can be accomplished with full justice to the patients. The obvious remedy is to extend the provident dispensary as widely as possible, and to establish in every district a provident hospital, on the plan now in operation at Battersea, to the commencement of which, by Canon Erskine Clarke, reference was made in the "Companion" for 1879.

In connection with the internal administration of our hospitals, the step taken by the Queen during the year, in founding an Order of Merit for Hospital Nurses, must be recorded with intense satisfaction. Named after the ancient Hospital of St. Katherine an institution which will, it may be hoped, under its new Master, fulfil more completely than it has done of late years the objects of its founder-the nurses, honoured with admission to the roll, are to be known as St. Katherine's nurses, and are not merely to receive a badge or armlet with the

monogram "St. K." worked upon it, but are to have a reward of 50l. a year. The appointment is to be held for three years, during which the recipient also has her ordinary salary at the hospital where she is employed, while another sum of 50l. is paid to the hospital for her maintenance during the period. Such a handsome recognition of a body of women, who have done and are doing much noble service to their race, cannot be too warmly applauded.

While the Queen has thus shown, in a tangible form, her appreciation of the labours of hospital nurses, the Prince and Princess of Wales have been among the foremost during the year in exhibiting their sympathy with some of the most useful institutions in the metropolis. On the 17th of July, the Prince laid the first stone of a new building for the Brompton Hospital for Consumption, the first wing of which was commenced with a similar ceremony in the year 1844, by the late Prince Consort. On another occasion their Royal Highnesses went down to Putney to lay the foundation stone of a new wing of the Hospital for Incurables; while on a third day, in July the Prince and Princess journeyed out to Ham Common, to present the prizes annually given by Lady Peek to the former inmates of the National Orphan Home, who, after being placed out in the world in domestic service, are able to bring up good reports from their employers. Such encouragement offered to institutions of high public utility, is a happy illustration of the ready interest which the Prince and Princess always take in cases where it is really deserved, and it may be pointed out, that no charities more worthy of distinctive notice could have been selected. The Home for Incurables especially is one of the too few institutions which open their doors to those who are, by the very gravity of their disease, excluded from the ordinary hospital, and it would be a fitting result of the thoughtful benevolence of the Royal visitors if similar Homes were to be established in every quarter of the metropolis.

In reference to the working of the Charity Commission, an important correspondence between the Commissioners and the Treasury upon the question of the taxation of charities, in order to meet the expenses of the Charity Commission, has been issued. In 1868, it appears, the Lords of the Treasury, having regard to the resolution of the House of Commons that the expenses of the Commission ought not to be borne by the public, submitted to the Commissioners whether, by a stamp or charge upon orders