The objections to civil hospitals as now stated may be said to be: 1. As institutions, they tend to weaken the family tie by separating the sick from their homes and their relatives, who are often too ready to relieve themselves of the burden of the sick and heirless of their family. Besides, when one or more of a family are removed those left at home are in an uncertain state of mind, and, in many instances in an unprotected condition. 2. The inmates of pauper hospitals are liable to come in contact with bad influences: familiarity with suffering, unaccompanied by the occupation of relieving those who are suffering, ends in hardening the sensibility, especially in the young. 3. Like all public and general charities without the safeguard that personal knowledge affords, hospitals tend to foster idleness and helplessness, and their natural results, pauperism and crime. 4. When badly constructed or badly managed, they are liable to cause hospital-diseases among the inmates, and become centres of infection, thus defeating the very object they are intended to promote.
On the other hand, the arguments in favor of civil hospitals are: 1. They are a necessity under many circumstances for giving shelter to the sick and helpless, and are supposed to be the most economical method of providing for the sick poor. 2. They are of very great value as affording an opportunity for the comparative study of diseases, and for giving practical instruction in the science of medicine and the art of nursing to the greatest advantage, and thus, by helping directly a few individuals, indirectly rendering a service of incalculable value to the world. 3. During contagious epidemics they are a ready means of providing for those who are infected, and, by their isolation, preventing the spread of disease.
As means toward checking the undesirable multiplication of expensive institutions, toward preventing hospitals from breaking up or interfering with the family tie, and at the same time to keep them from engendering pauperism, we suggest: 1. Do all that can be done to enlighten the poor to help themselves, and to avoid the causes of disease. 2. Give indirect help by improving the condition of the homes of the poor, by strict laws in regard to the existence and building of all dwelling-houses, manufactories, schools, etc., etc., and in regard to the sale of food. 3. Limit hospital accommodations to those who have no homes, and to those who cannot be assisted at their homes.
It is doubtful if the state can give direct out-door help, even medical help, without doing more harm than good. It can only be done wisely by establishing a Bureau of Intelligence in connection with the police department, with offices at each police station, where the names and the numbers of the inmates in every house in the precinct or district would be known, and where, from personal knowledge, a record of all individuals receiving help—as to their circumstances, the amount of aid given, etc.—would be kept. As far as possible, all help rendered should be guided by this knowledge, and it should be obligatory on
