Some years ago, a Birmingham medical man—Mr West—in a very ably written contrast between English and French surgery, drew attention to a kind of hospital common abroad, and much appreciated there by the class for whose benefit these institutions are intended, but of which in Britain we have no examples, or at most one or two experimental wards on a very limited scale. These institutions are hospitals where patients of the middle class who can afford and are willing to pay a moderate sum, can be received when serious illness or accident unfortunately necessitates medical aid—'a special kind of hospital,' said Mr West, 'unknown in England, which I think of great utility, and of which there is, I believe, an urgent need, not only in London, but also in every large town throughout the provinces.'

Mr West's paper does not appear to have borne much fruit at the time; but recently the question has appeared again, and this time, so much has been done to give prominence to the movement, that a public meeting was held last June at the Mansion House, to discuss points in connection with this great subject. There cannot be two opinions as to the general advisability of establishing such hospitals in this country, and as was to be expected from the honourable desire of the medical faculty always to do what appears best for suffering humanity, we find that the scheme has the cordial approval of the presidents of the great medical bodies and the chief members of the profession in London, who agree that this is a much-needed institution.

Out of England, there are various examples of such hospitals, such as the State Hospital at Christiania, which is entirely supported by such paying patients; the famous Maison Municipale de SantÉ in Paris; and various institutions in Germany and the United States, where for a moderate fixed payment, men or women of limited means, or who have no home in a large city, can obtain adequate care and proper nursing in case of illness. The great French hospital, the Maison Municipale de SantÉ, is a model of what such an establishment should be. It is under the control of the municipal authorities, and has nearly six hundred beds ready for the treatment of sick and wounded persons of the class now alluded to, who, for a daily payment varying from four to twelve francs, can obtain medical and surgical advice—medicine, food, baths, and all else necessary for their proper alleviation or cure. There are two physicians and a surgeon on the staff of the hospital; but if the patients choose, they can call in consultation any of the Parisian hospital doctors, and the fees paid to them are the only extra expense that inmates are liable for. 'The hospital,' says Mr West, 'is clean, well-furnished, comfortable, and contains every variety of bath that the patients can possibly require.'

What a boon such an establishment would be, not only for the large numbers of clerks and assistants in our shops and warehouses, who live in lodgings, and are far from the tender hands of a loving nurse, but also for a class who are anxious to have the advantages of a well-managed hospital and its careful nursing, rather than subject near and dear ones at home to all the trouble and anxiety of nursing and watching, besides the great risk of infection. There is certainly a strong and no doubt very natural feeling against the idea of being away from home when sickness overtakes us; but in process of time this dislike must yield to the undoubted fact, that in a well-organised hospital, a case has, as a rule, a far better chance than elsewhere of being thoroughly attended to according to the directions of the physician. The loving hands that smooth the pillow under the uneasy head need not be absent here; but it must be remembered that it is not given to every mother or wife to be a good nurse. Nervousness and inexperience, over-anxiety from the very great interest in the issues of life and death for the loved one, are often causes of risk to the patient. Then, too, house accommodation may be limited: perfect isolation of the infected patient, especially in the 'flats' of such a town as Edinburgh, may be well-nigh impossible; while the disease may be, like small-pox, of a kind that drives all but the most self-sacrificing of friends away.

In one of the many letters written on this subject we get a pitiable instance of such a case as this: A young man, living with a lady and her daughters, became ill with small-pox. His mother was dead, his father in India. When it was clear what disease he had, every one left him but one servant. His doctor sent him to a small-pox hospital, but it was full; and he had to be brought back again, and put under the care of a nurse from an Institution; but at ten P.M. this Mrs Gamp was found to be quite drunk, and another had to be sent for. But how infinitely better would it have been if he could have been sent to a paying hospital. The present writer knew of a case some years ago that peculiarly illustrates the value of such institutions. A young married man of limited but not straitened means was seized with illness at home about a week before the 'flitting term,' at which time he was to remove his household goods to another town. The doctor pronounced it fever, and said that if he was to be removed at all, it must be immediately. It was absolutely necessary he should leave his house when his tenancy expired; and as they had no friends in town to whom to go, no course was open but to send the sick man to the public hospital; which was done. Here was a distinct perversion of the objects of such an institution; and though in this case some compensation was made in the form of a donation, yet here again, how much better for all parties if that hospital had had a wing, where he could have been taken in on the distinct footing of payment for its advantages.

Various proposals have been made as to the mode of instituting such hospitals. Sir Rutherford Alcock is in favour of a certain number of wards in good existing hospitals being set aside for the accommodation of paying patients at varying rates, to suit their varying means; others advocate the building of distinct wings or pavilions to existing hospitals; while many think that buildings separate in every way should be specially built. The advantages in favour of connection are that in these hospitals there is already an organised staff of physicians, surgeons, and nurses; and that while the extra expense of an expansion of this staff would be comparatively small, the payments from the new class of patients would largely help the funds of the hospital in its charitable purposes. It is probable, however, that a distinct institution—an 'Hotel Hospital' it is proposed to call it—will soon be set on foot, as a limited liability company is spoken of for the purpose.

The London Figaro some time ago advocated the establishment of dispensaries where a man of the middle class could get for a small fee first-rate medical advice. In this material respect the workman is decidedly better off than the struggling member of the middle class, who, if he has to consult a leading physician, must pay fees beyond what he too often can afford, while to the poor man the highest medical advice in the kingdom is as free as the air he breathes. The Figaro shews how this would be not only a great advantage to middle class people but to the medical profession, in which at present many young men have to be content with a local practice, because they have no opportunity for obtaining hospital practice, which is so necessary for qualification as a general physician.