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is no epidemic prevalence, are competent to deal with the scattered
fever cases which occur; and even in the presence of an
epidemic are competent to afford a certain amount of relief.
But experience has shewn that this amount of relief is really
very limited; and I may add, that in my belief the resources
and arrangements of these institutions are wholly inadequate
to meet all the exigencies of an epidemic.
First, as regards the general hospitals; these have only a
limited number of beds, 3 or 4000 in all; their income is
limited, for they are supported either by a fixed annual revenue
or (as in the majority of cases) by charity alone ; and they have
to meet as much during the presence of epidemics as at other
times, all those ordinary claims upon them which they were designed
to meet and which they cannot even at these times with
justice neglect. 1 may add that, for my own part, I advocate and
always have advocated the admission into these hospitals of a
certain proportion of fever cases, and that the practice of at all
events the larger London hospitals has been hitherto in accordance
with this opinion. There are, nevertheless, some serious
objections to this practice, and many persons both amongst physicians
and lay managers of hospitals regard them as sufficiently
serious to justify the exclusion of all fever cases from these institutions.
Under any circumstances, the general public cannot
demand of subscription hospitals any form of benefit beyond
w hat the subscribers to these institutions think it right to offer ;
and even in the case of the endowed hospitals, of which there are
but three, all that could be insisted on (taking the very broadest
view of the claims of the general public upon them) is that which
is at present granted, viz. that fever cases should be received
into them in a certain proportion. Altogether then I have no
hesitation in declaring that general hospitals, as at present constituted
and supported, do not provide for and cannot meet the
necessities which an epidemic creates.