Trite as this remark may be, the caution it involves is just that which is too frequently overlooked or unobserved. By a careful attention to the distinction it implies, we may develop the elements of rational reform, as contrasted with Utopian schemes; which, whatever of abstract truth they may contain, are frequently useless, simply because they are impracticable. We cannot effect any material change in human nature by any summary legislation, nor prevent the obtrusive necessities of daily life from bringing down the soaring aspirations of mind, to the humble level of the practicabilities of matter. Whoever, therefore, expects that any body of men, invested with irresponsible power, will hesitate to exercise it so as to procure, as they believe, the maximum of advantage to themselves,—might just as hopefully quarrel with the negro on account of his complexion. Do what you may, Man is Man "for a' that;" but whilst it is necessary to remember this, it is by no means so, to do it in a spirit of unkindness or hostility, nor in any sense opposed to brotherly love; but, on the contrary, in a tone of mind which, alike mild and uncompromising, desires to promote universal harmony and good feeling, by removing the temptations which experience has shown to be influential in disturbing such relations.
Neither should we quarrel with a man who endeavours to do the best he can for his family and friends. Should he, even in this pursuit, compromise his duty to the public, it is very possible that the objects which he had in view may have been in themselves praiseworthy, and therefore, instead of exasperating our blame, may readily extenuate faults which it may be impossible to excuse.
The truth is, that the interests of the public and of individuals are seldom, if ever, incompatible; the occasions on which they appear to be so are not unfrequent; those in which they really clash are extremely rare.
Wherever circumstances occur in which the temptation of a present fruition is found habitually to lead men to courses which, however apparently promotive of their own interests, are really detrimental to those of the public,—it becomes very necessary that the public should impose safeguards against such an injurious exercise of power.
The hospitals of London, as we formerly observed, are, in the main, very fine institutions. They are many of them very wealthy, which generally means powerful also.
The Governors, as they are termed, consist of certain noblemen and gentlemen; the latter being, for the most part, drawn from the more wealthy sections of the mercantile and trading classes.
The knowledge possessed by these gentlemen of the requisitions of a large public hospital, must (special instances excepted) be very measured; and be, in the main, derived from the medical officers with whom they are associated.
It thus happens that the administration of the hospital is in great part confided—as, with some restrictions, it ought to be—to the medical officers. The interests of these gentlemen, it may be assumed, would be best promoted by carrying out in the most efficient manner the benevolent objects of the institution: and we believe, looked at fairly and comprehensively, this would be really the case. The duties of a large hospital, however—if they are to be performed conscientiously—require much time, not a little labour, and some health to boot. Now all these, in a crowded community, are very costly articles; and which must, in justice—and, what is material, in fact too—be fairly remunerated. The public never really pay so dearly, as when they appear to get labour for nothing.
Here we come to the first defect in the "Hospital System."
It might be supposed that, with ample means, the Governors of Hospitals, by adopting such previous tests as were in their power, would have secured the most efficient officers, by paying them remunerative salaries; and, having retained them as long as their services were deemed efficient, or the duration of them justified, that they would have released them from the necessity of further exertion by a retiring pension. No such thing. The Hospital gives nothing: actually, there is a small nominal retaining fee, as it were, of about £60 to £100 a year, and the medical officer is left to obtain his remuneration for time, trouble, and health, by such private practice as his reputation or the prestige of being attached to an hospital may afford; from fees from pupils, or such other means as the position he occupies may place within his power.