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for with a parliamentary grant by the nation, there will be an ample field, and an adequate stimulus, for the exercise of such 'intelligent interest.' Attention may also be directed to the very great interest already shown in the various forms of technical education during the last five or six years. And it will hardly be suggested that for the chance of adding a little to that which has been already manifested it would be worth while to incur the risk, which amounts indeed to a certainty, of kindling, with reference to secondary education, the blaze which has burnt so fiercely and so detrimentally with regard to elementary education around the question of religious teaching.

There are, it must be remarked with regret, already some clouds lowering upon the horizon which threaten a storm when the wind really gets up and fills the sails of secondary education. One sees in the newspapers from time to time signs that the religious question is not to be allowed to be quietly settled, nor will even the present peace be permitted to continue undisturbed.

But it is tolerably certain that if the functions of county educational authorities with regard to secondary education could allowed to be developed as occasion requires, without legislative restriction in religious matters, and if provision of secondary schools by rate becomes a necessity, the religious denominations will see efficiently to the provision of such teaching as they desire, and there will be no more sectarianism in county councils about secondary schools than there has been about roads and asylums.

The difficulties natural to the position of village public elementary day schools will not arise. Various denominations have already shown their capacity for establishing successful and efficient secondary schools. And the wise course in this respect is to let well alone, and leave it to each denomination to provide religious teaching for its own children.

What is really wanted is a free hand, coupled with adequate realisation of responsibility and adequate powers. If these are conferred upon the education committees of county councils, strengthened in the manner suggested (as mentioned above) by the recent Royal Commission; and if these committees are not overwhelmed by work, and smothered with details which do not properly appertain to them, and for which they are in no way fitted and are not at present capable of adapting themselves, there is no reason to anticipate failure.

If the Government are in earnest about education, let them pass quickly an efficient measure for the registration of teachers; let them provide for the constitution of a central authority which, through the system of registration, and as a centre of advice, and possibly of sanction, may render valuable assistance to local authorities; let them strengthen and set free the hands of county council committees, and give them adequate powers with regard to rating and endowments. But no further burden need be placed on the Department. Evening continuation schools may be taken off its hands. No Imperial grant need be given for secondary education, and therefore no departmental interference will be necessary.

With such encouragement as would thus be given to the practical manifestation of intelligent interest in education,' and with the prospect which would be afforded of some speedy, practical result, there can be no question that local energy would be quickly and effectually stimulated.

Evening continuation schools, exhibitions, scholarships, various grades of secondary schools, public and proprietary, will be provided to meet local requirements. The supply of qualified teachers, registered by a central authority, will be developed by the demand, and it may be hoped, if not confidently anticipated, that the universities will rise to the occasion, and seize the opportunity thus opened to them of guiding, stimulating, and to a large extent providing, the instruction for which an appetite is among all classes manifesting itself in the reception of the efforts already made to perform a task for which county councils have, as far as in them lies, proved their fitness by their success.

CHARLES THOMAS DYKE ACLAND.

1896

HORSE AMBULANCES

ANONG the many remarkable movements of the present generation for the relief of suffering humanity, none are more worthy of support and encouragement than those having for their object the wider dissemination of the means whereby temporary help may be given in the case of illness or accident, and the better and quicker transportation of the patient.

There can be no doubt that the lessons in giving first aid imparted by skilled instructors to the police, the army, and to numerous other classes and individuals throughout the country, have resulted in numberless instances in the prevention of a vast amount of needless suffering, that would otherwise have ensued as the result of unskilful handling of the patient in the first instance.

But it may be doubted whether that part of the ambulance system that deals with the actual transportation of the sufferer from the scene of accident to the hospital or home has advanced as rapidly towards perfection.

The ambulance in England is still, as a rule, in the nature of a hand stretcher.

The more rapid system of an ambulance wagon drawn by either one or two horses is seldom, if ever, employed, as it is in New York, where the system originated, in other cities of the United States, in Vienna, and to a limited extent in Paris, where it was started at the time of the war between France and Germany.

The idea of instituting horse ambulances, that should be summoned and sent out in cases of illness or accident with the same speed and regularity with which fire engines are called and despatched in the case of fire, originated in the year 1868 with Dr. E. B. Dalton, at that time the superintendent of the New York Hospital. Owing to a change in the disposition of that institution's property the suggestion was not acted upon at the time, but in the following year the Department of Public Charities and Correction approved of Dr. Dalton's proposals and the code of rules he had drawn

and in consequence an ambulance service was adopted at Bellevue, the Municipal or Free Hospital of New York.

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From that time forward the system has proved so useful and beneficial that it has gradually extended to all or nearly all the other hospitals in New York, as well as to many other cities in the United States, and has become an integral part of the hospital work, and numberless lives are saved by its agency, and by the speed with which help is brought to the sick and injured.

The ambulance service of New York is conducted by means of vehicles kept continually ready at the different hospitals, the stables being either in the grounds of the institution or at a very short distance.

The system employed varies in slight details in the different hospitals in New York, but, speaking generally, on a telephonic or telegraphic call for an ambulance being received at one of the hospitals, it is automatically and simultaneously transmitted to the room of the surgeon on duty, and to the driver and the gatekeeper.

The horses are immediately attached to the ambulance, improved methods of swing or suspended harness being employed-as in the case of the fire departments—all the parts adjusting themselves properly when pulled down on the horse, and being fastened by a few snaps, so as to reduce the time occupied to a minimum. The driver springs to his seat, the gates are thrown open, and the ambulance starts out, picking up on the way the surgeon, who has received a slip of paper on which is written the source of the call, and the time and the place where the accident has occurred, which last information he calls out to the driver.

The whole process from reception of the call to the start requires on an average about one minute.

The instructions to the driver are that 'in responding to a call the ambulance should always be driven at a rapid, but never at a dangerous rate. In returning, the rate should always be moderate, except when with cases which must be brought to the hospital without delay.

By Act of Legislature ambulances have the right of way over all vehicles excepting those of the Post Office and the Fire Departments, and each ambulance is provided with a gong, which the driver sounds when necessary, to warn other vehicles to keep out of the way, and not to obstruct its transit.

On arrival at the scene of the accident the surgeon applies such treatment as is immediately advisable, and with the help of the driver lifts the patient into the ambulance bed, which by an ingenious arrangement is run out from, but remains attached to, the wagon, and the bed is then carefully run back into its place. Should the patient express a desire to be taken to his own home, instead of to the hospital, his wish is complied with, provided he lives within the city limits, unless the surgeon, with whom the decision rests, sees any reason to the contrary.

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Should the patient be conveyed to the hospital, he is on arrival handed over to the care of the house physician, the ambulance surgeon making his report at the same time on the case. The ambulances, it should be added, are kept ready to start out at any hour of the day or night.

Such is the general system observed by the hospitals in sending out their ambulances, and it is to be specially noted that from first to last the whole service is entirely gratuitous, though naturally many of the patients, on leaving the hospital, present a donation towards its funds.

In reviewing next the means whereby the ambulances are maintained, distributed, and regulated, it may be best to give a brief description of the American hospital system generally, differing as it does in many respects from our own.

In the United States the chief cities provide, through their Department of Charities or other similar body, a free hospital, supported by yearly taxation, at which all citizens can obtain indoor or outdoor treatment. These hospitals, however, do not answer to the Poor-law infirmaries of Great Britain, but correspond more to such hospitals as Guy's, St. Thomas's, St. George's, the London, and other general hospitals in the English metropolis.

There are also in New York private or partially self-supporting hospitals, maintained by private charity or by endowments, at which the rule is to charge a weekly or daily rate graduated according to the room that is occupied, or, in the case of a bed in the general ward, by the circumstances of the patient. Many of these hospitals, however, admit a great number of free patients, but this does not alter their private character.

It may be mentioned in passing that the use of this free or municipal hospital is not looked upon in the United States as having the pauperising effect that admission to the English workhouse infirmary has; in a similar manner, in that country education is free-even to the higher grades—and the parents of children of all classes avail themselves of the advantage in their children's early education, a procedure that would probably provoke unfavourable criticism in England.

The hospital system in New York may be divided into three classes :

Municipal or free hospitals, supported and carried on by the city from money raised by yearly taxation; and private and public hospitals, supported by individual contributions or by income from endowments. The public hospitals are such private ones as have established public ambulances, and they are public only in so far as regards their ambulance service.

As has been mentioned before, the municipal or free hospital of New York is Bellevue, where the first ambulance service was adopted

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