the present day. Probably it is not too much to say that to-day hospitals occupy the most important position in the social economy of nations.
Classification of Hospitals.—Having dealt with hospitals as a whole it may be well very briefly to classify them in groups, and explain as tersely as possible what they represent and how far it may be desirable to eliminate by consolidation or to increase by disintegration the number of special hospitals.
General Hospitals.—These establishments consist of two kinds, (a) clinical and (b) non-clinical, each of which, under the modern system, should include every department of medicine and surgery, and every appliance and means for the alleviation of suffering, the healing of wounds, the reduction of fractures, the removal of mal-formations and foreign growths, the surgical restoration of damaged and diseased organs and bones, and everything of every kind which experience and knowledge prove to be necessary to the rapid cure of disease. The clinical hospital means an institution to which a medical school is attached, where technical instruction is given by able and qualified teachers to medical students and others. A non-clinical hospital is one which is not attached to a medical school, and where no medical instruction is organized.
Special Hospitals.—Up to about 1840 the general hospital was, speaking generally, the only hospital in existence. Twenty years later, as the population increased and medical science became more and more active, some of the more ardent members of the medical profession, especially amongst the younger men, pressed continuously for opportunities to develop the methods of treatment in regard to special diseases for which neither accommodation nor appliances were at that time forthcoming in general hospitals. In a few cases, where the managers of the great general hospitals were men of action and initiative special departments were introduced, and an attempt was made to make them efficient. The conservative spirit which, on the whole, represents the British character for the most part, resulted, however, in a steady resistance being offered by the older members of the medical staffs and existing committees to the advocates of special departments. In the result, especially as such special departments as there were in connexion with general hospitals were too often starved for want of means and men for their development and improvement, the younger spirits called their friends together and began to start special hospitals. To-day every really efficient clinical general hospital has within its walls special departments of almost every description, which have been made as efficient and up-to-date as money and knowledge can make them. Unfortunately the causes already referred to led to the establishment of hundreds of the smaller special hospitals, many of which were started in unsuitable buildings, and some of which have ever since maintained a struggling existence. Others, on the contrary, through the energy of their original promoters and the excellence of the work they have done, have obtained a position of authority and reputation which has had a very important bearing for good upon the development of medical science in the treatment of disease. If the world had to-day to organize the very best system of hospital accommodation which could be evolved, there is no doubt that few or none of the special hospitals would find any place in that system. As matters stand, however, the special hospital has had to be accepted, and nothing which King Edward’s Hospital Fund has done in London has met with greater popularity and professional approval than the labours which its council have undertaken in promoting the amalgamation of the smaller special hospitals of certain kinds, so as to secure the provision of one really efficient special hospital for each speciality. No doubt this policy of amalgamation will be steadily pursued, and in the course of years every great city will gradually reorganize its hospital methods so as to secure that, whether the patients are treated in a general hospital or in a special hospital, the average efficiency in every institution shall be as high and as good as possible.
We will take now the special hospitals in detail.
Cancer Hospitals.—The justification for efficient cancer hospitals must be found in the circumstance that most scientific men of experience believe that, if adequate resources were placed at the disposal of the medical profession, the origin of cancer might be discovered, and so the human race would be freed from one of the most awful diseases which affect humanity. Pending such a discovery the experience of the cancer department connected with the Middlesex Hospital in London proves to demonstration that the provision of adequate and special accommodation for the exclusive treatment of cases of cancer is not only desirable but necessary on humanitarian grounds alone.
Hospitals for Consumption.—For many years it was held that this group of hospitals was not a necessity, and the patients were treated in the ordinary medical wards of the general hospitals. Since the contagious character of tuberculosis became known, and improved methods of treatment have been developed, every one agrees that this type of special hospital is desirable, though it is believed by the more advanced school of scientists that before long it may be happily rendered obsolete owing to the discovery of methods of treatment which will stay the disease at its commencement and restore the patient to health.
Children’s Hospitals.—These hospitals were very much opposed at the outset. There can be no doubt that the children’s ward or wards in a big voluntary hospital is a most valuable asset to the managers, so long as the children are treated in separate wards. There is no reason of course why a hospital should confine its work to the treatment of children, exclusively. Still this special hospital is popular with the public; it has led to many discoveries and developments in the treatment of children’s diseases; on the whole the administration of these establishments has been good; and we believe they will continue to flourish, however many children’s wards may be provided in general hospitals. Children’s hospitals with country branches for the treatment of chronic ailments, such as hip disease, are a valuable addition to the relief of suffering in cities.
Cottage Hospitals.—These hospitals, established originally in 1859 by Mr Albert Napper at Cranleigh, Surrey, have fulfilled a most useful function. Many of them are very efficient both in regard to equipment and treatment. They have become essential to the well-being and adequate medical care of rural populations, as they attract to the country some of the best members of the profession, who are able, with the aid of the cottage hospital, to keep themselves efficient and up-to-date, so that all classes of the community are benefited in this way by this type of hospital.
Ear, Throat and Nose Hospitals.—The history of this type of hospital bears out in every particular the reason we have given above for the establishment of special hospitals in the first instance. There can be no doubt that the best conducted throat hospitals have been beneficial to the poorer inhabitants of great cities.
Fever Hospitals.—Incidentally we have dealt with these institutions, which are usually supported out of the rates and administered by the medical officers of health, who are paid by the county or municipal authorities.
Maternity and Lying-in Hospitals.—This is one of the oldest types of special hospitals, and has done a great deal of good in its time. Owing to modern methods of treatment and hygienic developments the maternity hospital never occupied a stronger position than it does to-day.
Mental Hospitals.—In Great Britain the insane are provided for in asylums (see Insanity, ad fin.), though such establishments, if properly conducted, are essentially hospitals. Scientific and public opinion tend towards the establishment of mental hospitals to which all acute cases of mental disease should be first relegated for treatment and diagnosis before they are consigned to a permanent lunatic hospital. Too little attention on an organized plan has been given to the continuous study of mental disease in its clinical and pathological aspects. It is probable, therefore, that the advent of the mental hospital may lead to important developments in treatment in many ways.
Ophthalmic Hospitals.—Of all special hospitals this is one which would probably be the least necessary, providing general hospitals everywhere were properly equipped and organized. No special hospital has probably been so abused in the material sense by the free relief of patients who could well afford to pay for their treatment at the ophthalmic hospital. Several of the existing ophthalmic hospitals have entailed an enormous expenditure, and their modern equipment is wonderfully efficient.
Orthopaedic Hospitals.—It is very doubtful whether this type of hospital is really desirable or necessary. Its necessity may be advocated on the ground that orthopaedic cases may require prolonged treatment, and that the pressure upon the beds of general hospitals by acute cases is nowadays so great as to render the orthopaedic hospital more necessary than ever before.
Paralysis and Epileptic Hospitals.—Seeing that the percentage of those who are at present attacked by paralysis and nervous disease shows a continued tendency to increase under modern conditions of life in large cities, hospitals of this type are necessary, and London at any rate, like most foreign towns of importance, possesses, at present, far too little accommodation for this class of case.
Skin and Photo-Therapy.—Up to the end of the 19th century hospitals for diseases of the skin were a constant cause of scandal and criticism. The introduction of modern methods of treatment by
