CHAPTER V.

CHARITABLE INSTITUTIONS.

BY C.E. MATHEWS.

=The Birmingham General Hospital.=--At the commencement of the second half of the last century, Birmingham was a small manufacturing town with a population but little in excess of 30,000 souls. At that time no medical or surgical relief could be obtained by its suffering poor except at the Infirmary attached to the Workhouse. But in November, 1765, Dr. Ash, an eminent member of the local medical profession, called a meeting of the principal inhabitants “to consider the advisability of establishing a general hospital for the relief of the sick and lame.”

A public meeting was held at the Swan, November 21, 1765, which resulted in “Benefactions” £1,555 18s. 0d. and “Annual Subscriptions” £424 10s. 0d.

Little was done (other than the creation of a building debt) until the year 1779, when this great charity fairly entered upon its long career of humanity, usefulness, and honour.

Its income in those early years was scanty, its patients few and far between, it had no endowment whatever. It was a privileged institution, that is, except in cases of extreme urgency, its benefits were given only to the holders of subscribers’ tickets.

During the year 1885, 3,545 in-patients and 38,501 out-patients were treated at this Institution. Its subscription list amounted to £5,448; the income of its endowments reached the respectable figure of £2,787, and the total income from all sources, ordinary and extraordinary, was nearly £15,000.

It is still in theory a privileged institution; but more than two-thirds of the in-patients, and more than half of the out-patients were admitted in 1885 as “accidents and urgent cases” without recommendation.

In recent years enormous improvements have been made both in the laws and in the administration of this Hospital.

The old system by which every Governor had a vote in the election of a Medical Officer has been abolished, and vacancies for the much coveted position of Physician or Surgeon to the charity are now filled by a sufficiently large and representative Committee.

The legacies, which are very numerous, are funded to the extent of one half of their amount; and the annual reports are models for clearness and accuracy of information.

A great extension of the hospital work has recently been made. A branch Hospital for chronic cases has been established by the munificence of Mr. John Jaffray, and has recently been opened by the Prince of Wales. The Endowment Fund of this department already exceeds £30,000, and special subscriptions have been obtained amounting to nearly £500 a year.

The great Triennial Musical Festivals, which in late years have ceased to be peculiar to Birmingham, were first established in connection with the Birmingham General Hospital. A Committee of the Governors is specially appointed to carry out these important undertakings, and they have spared no effort in procuring the finest music from the ablest Composers, rendered by the foremost artists of the time. The Elijah of Mendelssohn, the Eli and Naaman of Costa, the Light of the World of Sullivan, the St. Peter of Benedict, and the Redemption and Mors et Vita of Gounod, are some of the great works first produced at Birmingham under the management of the “Orchestral Committee,” whose aim has been on the one hand to obtain the perfection of music, and on the other to augment the income of the Hospital.

These Festivals have been held since the year 1768, and have resulted in a net profit to the Hospital of over £120,000. Since the year 1849, the gross receipts at any Festival have never been less than £10,000, and in one year they exceeded £16,000. In the year 1885, when the last Festival was held, the gross receipts were £13,715, and the net profit accruing to the Charity was £3,500.

=The Queen’s Hospital.=--This great Hospital is the second general Hospital in Birmingham. It was founded in the year 1840, in connection with the Birmingham School of Medicine and Surgery; a School which in 1843 became incorporated under the name of the “Queen’s College.”

It has an unusually large acting Medical and Surgical Staff consisting of three Physicians, four Surgeons, one Physician for Out-patients, two casualty Surgeons, an Ophthalmic Surgeon, a Dental Surgeon, and an Obstetric Officer. It was established as a privileged Institution, but in the year 1875 the regulations then existing were changed, and it became a Free Hospital. From that time no privileges of any kind have been given to subscribers, and the suffering and deserving poor have been received and treated without any conditions or qualifications other than the urgency of their need of relief.

There is no doubt that since the Hospital became free, it has gained greatly in public confidence and popularity.

The In-patients treated in 1885 were 1,944, the Out-patients were 24,063. Some years ago it had a considerable endowment, but great enlargements and improvements of the Hospital were necessary, and were carried out a few years since at a cost of £26,000, of which sum £10,000 was taken from the endowment, and the remainder was raised by an active and intelligent Committee. The present endowment is only about £5,000. The annual income from all sources may be taken at £8,000, and the annual expenditure is about the same, though there is no doubt that with a larger income the Committee could provide in the present buildings a great increase in the number of beds, and so materially reduce the average cost per patient. The ordinary income of a medical charity is derived from subscriptions, donations, legacies, and the income resulting from investments. By the laws of many charities legacies are invested, and the income only of such investments is applied to the annual purposes of the charity.

The Queen’s Hospital has not been able to take this course; all legacies paid in any year being applied to the general purposes of the institution.

In the year 1885 the income of the Hospital was made up as follows:--From Subscriptions £2,648, from Donations £256, from Legacies £1,621, from Registration Fees £852, from Income of Investments £197; but these figures amount in all only to £5,574, and it has been stated that the income of the Hospital is about £8,000 a year. How then has the balance been obtained? In England there is no compulsory rate in aid of our charitable institutions. M. Guizot left it on record that when he first visited this country nothing surprised him more than the constant recurrence of the words that met him at every turn in London--“supported by voluntary contributions.” But the income arising from “ordinary sources” was rarely sufficient to enable Hospital managers to cope with the responsibilities thrown upon them without incurring constant deficits and sometimes financial disaster.

Twenty-five years ago some Birmingham men, amongst whom the late Rector of Birmingham (Dr. J. C. Miller) deserves most honourable mention, grappled with the difficulty. The various Clergy and Ministers of Religion, assisted by prominent lay townsmen, determined to organise a general Collection once a year in all the Churches and Chapels of the town and neighbourhood, for the benefit of the local Medical Charities. Thus originated “Hospital Sunday.” It was resolved that every third year the whole collection should go to the General Hospital, every third year to the Queen’s Hospital, and every third year that it should be divided among the smaller Medical Charities in certain proportions based upon the number of patients relieved.

“Hospital Sunday” became immensely popular, and the example set by Birmingham was imitated by the metropolis and by the larger towns and cities of England. Since its establishment up to last year the medical charities of Birmingham have received from the Hospital Sunday Fund the enormous subsidy of £124,430.

From this source the Queen’s Hospital has received, up to the year 1884, £42,188; its triennial collection amounted to £4,356 in 1881, and to £4,181 in 1884. But the year 1873 witnessed a new departure. It was felt that it was not enough to make collections only from the habitual frequenters of churches and chapels, most of whom might be assumed to be regular subscribers to the various charities or donors to their funds. It was felt too that the great body of the artisan population were able and willing to do something for the support of the great institutions founded almost wholly for their benefit; and thus “Hospital Saturday” became a friendly but formidable rival to “Hospital Sunday.” Once a year collections are made in all the manufactories and large workshops in the town and district, and up to, and including the year 1885, the hospitals have been subsidised from this welcome source to the extent of £46,800. Not only so, but these annual collections are steadily growing in amount, to the great credit of the industrial population and to the lasting benefit of the charities of the town.

It is interesting to note the increasing annual amount the Queen’s Hospital has thus received. In the year 1880 it was £670; in 1881, £711; in 1882, £852; in 1883, £931; in 1884, £1,056; in 1885, £1,135, and the accounts for the present year shew a large increase on any figures hitherto recorded.

=The Birmingham General Dispensary.=--This Institution is the oldest medical charity in Birmingham except the General Hospital. It was founded in 1794, and has deservedly enjoyed a very large share of public confidence. It is a strictly privileged institution. Every subscriber has so many tickets for his subscription, and has also the power of procuring supernumerary tickets. There are of course no beds, all patients being attended at their own homes. Accidents or urgent cases, such as sometimes put great pressure upon the resources of a general hospital, are here extremely rare. There is, therefore, no debt. The services of the medical staff can be purchased at a rate sufficient to cover the cost. Consequently the subscription list has always been large, the finances invariably prosperous, the revenue always in excess of the expenditure. So great has been the success of this institution, that the managers sometimes hardly know what to do with their money.

The income for the year 1885 from all sources was considerably in excess of £6,000. The whole expenditure was under £5,000, and the managers were able out of the income of the year to put by £1,500. The income from investments alone was £608. There was a considerable sum on deposit, and a large credit balance at the Bank. There is a central dispensary in Union Street, and branches at Camp Hill, Aston, and Ladywood, all with Resident Surgeons attached.

In former days it had a large midwifery and vaccination department, but the former was abandoned in 1869 and the latter in 1870. The dispensary, therefore, now addresses itself only to the ordinary medical treatment of the sick poor. All the medical officers, including the consulting officers, are paid for their services. The patients who, in 1871, numbered 10,570, had increased in 1885 to 21,888.

=The Orthopædic and Spinal Hospital.=--This small but useful institution has existed since the year 1817. It has three Acting-Surgeons, and one Assistant Surgeon. The Surgeons attend daily and give gratuitous advice to the deformed poor. Ordinary cases are admitted without letters of recommendation, but in the numerous cases where supports or instruments are required, subscribers’ tickets are necessary to cover the cost. The instruments supplied in 1885 cost upwards of £500. The new cases in that year were 1,654, the attendances 7,439. The total expenditure was about £1,400.

=The Eye Hospital.=--The Birmingham and Midland Eye Hospital is one of the best special Hospitals in the provinces. It has not only been of incalculable service to the poor of the town and neighbourhood, but it has founded an important school of ophthalmic science in the Midland district. Diseases of the eye cannot be adequately dealt with at general hospitals. Where the delicacies and difficulties of any disorder are such as to require minute manipulative skill and practitioners of great experience, a special Institution is imperatively necessary. This Hospital has had a really splendid career. It was founded in 1824, and commenced its operations in a humble manner in Cannon Street. It then migrated into improved premises in Steelhouse Lane. In 1861 it found a third home in Temple Row, and in 1884 a new Hospital was erected and opened in Church Street capable of accommodating 70 beds.

The acting Medical Officers of the Institution (exclusive of House or Resident Surgeons) are by the laws to consist of not less than four and not more than six Honorary Surgeons, so that ample provision is made to secure the adequate surgical treatment of the present patients and of any probable increase in their number.

In order to insure the maximum of surgical ability every acting Surgeon is bound to resign his appointment on his attaining the age of 55 years, or on becoming physically unable to discharge his duties in an efficient manner.

In the year 1885 there were 925 in-patients and 13,461 out-patients. 590 operations were performed during the year on in-patients alone.

The annual income is large, but as yet hardly adequate to meet the requirements of the new Hospital. The income for 1884 was £3,807, and the expenditure £3,213; but the income for 1885 was only £3,098, whilst the expenditure was £4,187.

=The Lying-in Charity.=--This is a small but most useful and deserving Institution. It was founded as a Lying-in Hospital in the year 1842. Its original managers attempted to deal not only with lying-in cases in the wards of the Hospital, but also with the ordinary diseases of women, and with children. The Institution was never successful, chiefly because it attempted too much. As a rule no Institution devoted to more than one speciality succeeds. Moreover, when the statistics of Lying-in Hospitals came to be examined, it was discovered that there was a great difference in the mortality of patients treated in Hospitals and of patients treated at their own homes. In the year 1874, the system of the charity was remodelled, a large building was abandoned, and patients were attended only at home. The change has proved eminently successful. Four competent Midwives are regularly employed, all of whom have large experience. The medical staff consists of a consulting Surgeon and four acting Surgeons who are called in in cases of difficulty or danger. The competence of the Midwives is best tested by the fact that the services of the members of the honorary medical staff are only required on an average once in 44 cases.

In the year 1885, 931 cases were attended at a cost of less than £500. Few institutions in Birmingham have in recent years done better work at a more reasonable cost than the Lying-in Charity.

=Free Hospital for Sick Children.=--This Hospital has been one of the most successful ever founded in Birmingham. It is a general Hospital so far as regards disease, but a special Hospital so far as regards age.

It was founded in 1861, and was opened for the reception of patients on the 1st January, 1862, and during that year its income and expenditure were about £700. In the year 1885, its in-patients were 713. Home patients, 27. Out-patients, 12,692. Its income and expenditure exceeded £4,000.

Few local institutions have ever enjoyed greater popularity. The Charity from its very name appeals to a very wide circle, and the administration has been marked by foresight and discretion. Not only was it the first Free Hospital in the town, but it was established on principles then considered novel, but which have since in part at least been adopted by other local institutions.

For instance, the tenure of office of physicians and surgeons is limited, and the medical officers, though absolute in their own department, cannot sit upon the Board of Management.

Again, at this Hospital, first in Birmingham, was an honest effort made to limit the relief given to the _Hospital population_ only, that is to those who were above pauperism, but below the capability of paying for medical advice. Here too, the system was first adopted of paying the Junior members of the Medical Staff, and here also was the principle first laid down of vesting the election of medical officers of the charity in a large and representative Committee. This rule has been almost unanimously followed by other local institutions.

The Hospital has a dispensary and out-patient department in the centre of the town, an in-patient department with detached fever wards in Broad Street, and a convalescent department with separate management, many miles from the town. 151 children were received in the convalescent home during the year 1885.

The work of the Committee of Management of this Hospital is supplemented by the kindly aid of a large Committee of Lady Visitors, and by a Special Committee of Ladies for the management of the Convalescent Home.

=The Ear and Throat Hospital.=--This is a small institution, having for its object the treatment of diseases of the ear and throat. It has lately been reconstructed upon a new basis. It is rather a dispensary than a hospital, having no in-patient department. Tickets can be obtained by patients desiring the advice of the Medical officers. The subscription list is under £100 a year, the income being made up by contributions from the Hospital Sunday and Hospital Saturday Funds, together with the amount realised by the sale of supplementary tickets. The total number of cases treated during the year 1885, was 2,398.

=The Dental Hospital.=--This institution was founded in 1860, and should rather have been termed the Dental Dispensary than the Dental Hospital. It has five honorary dental surgeons and four honorary administrators of anæsthetics. Thus the advantages and resources of modern dentistry are placed within the reach of those who but for this institution would undergo much preventable pain. Every fitting applicant suffering pain is entitled to advice and attention, but special operations are performed only upon patients who have a recommendation from a Governor.

There were 9,453 patients in 1885. The expenditure was less than £300.

=The Sanatorium.=--This Institution was founded in 1866, and has proved a most valuable supplement to the work of our local hospitals. It enables convalescent patients to obtain rest, pure air and nutritious diet at one of the most healthy and beautiful spots within a reasonable distance of Birmingham.

Some years ago a fund had been raised for relief of distress in the cotton districts, and when the distress had subsided a considerable portion of the fund remained undisposed of. With the consent of the donors £4,500 was devoted to forming a nucleus for the Building Fund of the Sanatorium. The work was completed in 1873. The total cost of the site, buildings, and furniture was £16,800.

The institution receives 40 male, and 40 female patients, and every possible effort is made to provide for their health and their amusement.

No privileges are given to subscribers; but patients are received either from the Medical Charities in Birmingham, or from the general public, on the recommendation of a medical practitioner.

The income and expenditure are about £2,000 a year. The charity applies all donations exceeding £10 to a deposit or investment fund, and ten per cent. of the amount of the fund so created is withdrawn each year for the current purposes of the institution.

=The Homœopathic Hospital and Dispensary.=--This hospital is supported by the friends of the system of homœopathy. It has one honorary physician and five honorary surgeons. It is a general hospital, and has departments for in-patients, out-patients, and home patients. The in-patient system is different from that of most general hospitals, a certain number of beds being reserved for patients who can afford to pay for the benefits they receive. Again, all in-patients are admitted at the discretion of the medical staff, so that as regards this department the hospital is free, no subscriber having the privilege of ensuring a bed. Subscribers have tickets for out-patients and for home visits. This provision for visiting patients at their own homes is of great value in connection with this Charity. The in-patients in 1885 were 167. The home-patients 584. The out-patients 18,752.

The expenditure for 1885 was £1,640. The income £1,380, leaving a deficit of £260.

Ladies as well as gentlemen serve on the Committee of Management.

=The Hospital for Women.=--This is a valuable and important Institution. When the Lying-in Hospital gave up the treatment of women’s special diseases and devoted itself exclusively to midwifery, there was an opening for an institution for the reception and treatment of women afflicted with diseases peculiar to their sex.

Two classes of patients are admitted. Paying patients who contribute the whole or part of the cost of treatment, and general cases, which are admitted without any subscriber’s ticket of recommendation. The expenditure for the year 1884 (no report has been issued for 1885) was £1,736. The income was £1,466, leaving a deficit of £270.

During the same year the out-patients were 3,299, and the in-patients 294.

The acting Medical staff consists of five Surgeons, one of whom is a lady. It will be obvious that in a Hospital of this character many operations of cardinal importance are constantly performed. No fewer than 217 operations were performed during the year 1884.

=The Skin and Lock Hospital.=--This Institution was opened in 1881 for the treatment of skin and lock diseases. There was ample room for it, no special department for cases of this kind existing in any of the general Hospitals of the town.

During the year 1885 nearly 2,000 cases were treated. The income of the year amounted to £1,081, and the expenditure only to £624. The Committee of Management, however, are desirous of erecting a Hospital, and thus be enabled to deal with serious cases as in-patients. A site has been secured for this purpose in John Bright Street. It is estimated that £5,000 will be required. £1,200 of which has already been obtained.

The Hospital is conducted on the free system, but some patients are received on payment of a sum sufficient to cover the bare cost of their treatment.

=The Deaf and Dumb Institution.=--This Charity is an educational establishment. It was founded nearly three quarters of a century ago for the instruction of deaf and dumb children. 70 boys and 58 girls were on the books during the year 1885. The Charity is supported by voluntary contributions, supplemented to a considerable extent by payments on behalf of the inmates.

Children are admitted by election, and the election takes place at the Annual General Meeting. Every Governor is entitled to one vote in respect of a donation of £10, or an annual subscription of £1. 1s. Children admitted without election pay £25 per annum. Elected children pay £10 if they come from Warwickshire, Worcestershire, or Staffordshire; £15 if they come from other Counties, and £20 if maintained by Boards of Guardians. The system of education is excellent. Children are taught not only by means of the manual alphabet but by articulation and lip reading, in cases where that system can be advantageously employed.

The Institution is placed in a healthy and beautiful situation in Church Road, Edgbaston.

The income for the year 1885 was £2,726, made up as follows:--Subscriptions £461, Legacies £804, Donations £63, Interest on Investments £400, Payments for Pupils £986, Sundries £12. Total £2,726.

The expenditure was about £100 in excess of the income. There is no rule as to funding legacies. The charity does excellent work and is deservedly popular.

=The General Institution for the Blind.=--This Institution has been of immense benefit to the town and neighbourhood. The buildings are handsome and commodious, and are situated in a charming part of Edgbaston, about two miles from the centre of Birmingham. The Charity was founded thirty-eight years ago. The expenditure in 1885 was a little in excess of £4,200, whilst the income, including sales of materials manufactured by the inmates, reached the large sum of £6,270. The subscriptions and donations amounted to £778, Legacies £2,119, the interest on investments was £734. Payments by Pupils £765, Sales £1,874. Here too the legacies are not funded. But the large sum received from legacies in 1885, together with the balance in hand at the commencement of that year, enabled the managers to invest over £2,000 out of the year’s income.

46 males and 32 females were in the Institution in 1885, and 257 adult blind persons were visited and taught at their own homes.

Great efforts are made by the managers to find permanent employment for pupils who have been taught at this excellent charity. Many pupils are turned out fully competent organists, and many become professional piano tuners, and follow the trade of basket making.