635

THE LANCET.

LONDON: SATURDAY, DECEMBER 18, 1858.

THE ROYAL SOUTH HANTS INFIRMARY, SOUTHAMPTON

THE constitution and administration of our medical charities

must always, in this country, be objects of watchful interest.These charities form so remarkable a feature of the character

of Englishmen and of English institutions, that their liberaland orderly government may be said to be a matter of nationalconcern. Public hospitals amongst us are not, as elsewhere,the eleemosynary gift of a paternal or despotic government;they are not supported by forced imposts drawn frbm everyclass of the community; they are not directed by Governmentor other central authority. In this country, hospitals arisefrom the spontaneous munificence of individuals, and are go-verned, like our municipal institutions, by the free votes ofthose who support them by their voluntary contributions.Therefore it is that a double duty devolves upon the subscriberto a public charity. To give an annual guinea is an easy

matter; and no doubt in many cases, where wealth and bene-volence are not united with capacity or opportunity for takingpart in the management of the charity, money gifts are allthat can be expected. But connected with every hospitalthere are men who not only feel that they are called upon todo more, but who seek in the administration of its affairs a fit-

ting exercise for their superabundant mental energies. Such

men are the most valuable and the most typical of English society.Upon such men rests the task-never more important than atthe present day-of maintaining and proving the superiorvitality and efficiency of self-government. Under this aspectof the case, the right administration of our hospitals, greatand small, assumes an importance which cannot be limitedby the amount of the benefit immediately dispensed to theafflicted persons who apply to them for relief.These reflections, of course, apply to every hospital in the

country. The admirable liberality of constitution, and theexcellent economy of administration of many of them, are

sufficient proofs, not only of the benevolence, but also of thepublic spirit of their supporters. But it would be affectation

to deny that in the government of some others, abuses exist.It has always been a point of duty with us to observe theseabuses narrowly, and to expose them boldly. We have alwaysfound, where an hospital is badly governed, where local

bickerings are rife amongst the public and the medical profession, that an attempt has been made to wrest the institutiorfrom its public character and uses to some individual and selfislpurposes. Such, we are sorry to say, we fear is the case witlthe Royal South Hants Infirmary at Southampton.There are certain general principles in the constitution o

public bodies, which experience has sufficiently proved cannobe departed from without imperilling both safety and creditOne of these is, that the executive body, which is charge<with the immediate administration of the funds, and with thedirect control of the establishment, shall be so constituted thanone of its members shall fill several incompatible offices. I

is clearly antagonistic to the first principles of public businessand exposes the executive to serious animadversion, if no

suspicion, to allow one person to fill two posts, one of whiel

should check the other. It is not to be expected from ordinaryhuman nature that a man shall always strictly, and with fairregard to the rights of others, check his own conduct in twocapacities. Now, we find from the Report of the Royal SouthHants Infirmary that three gentlemen of the same name fill theoffices of honorary secretary,-generally a post of considerableinfluence,-physician, surgeon, and members of the committeeof management. We turn to the rules, and observe that

amongst the duties, or rather powers, of the honorary secre-taries-one of whom may act-are : to generally superintendthe condition of the Infirmary, and the observance paid to its rules; with the chairman of the committee of management, orwith one of the weekly visitors, to authorize the payment’ofthe weekly and quarterly expenditure by signing the orders’ Band checks; to report to the weekly committee whatever theythink it desirable for them to know in connexion with the In-

firmary ; to examine all bills, and, together with the auditor,sign them before they are brought to the committee of manage-ment ; to take charge of all bills, receipts, and books; to pre-pare an annual Report and statement of accounts ; and to calla meeting of the committee of management quarterly, and whenever else they consider the business of the institution re-

quires it.These powers might be considered sufficiently ample even if

entrusted to persons who had no interest by themselves ortheir relatives in any other office in the institution. But what

can be said in defence of the existing arrangements by whichone of the honorary secretaries is empowered to " superintend"the proceedings of himself and brother who fill the offices of

physician and surgeon ? Virtually, may it not be said, thatthe brothers BULLAR first, in the discharge of one part of their’official duties, do what they think right, and then in the dis.charge of another post, approve what they have done ? Would

it be tolerated in a public company that an officer should inone capacity do certain acts, and incur certain expenses, and,

straightway, with little or no control, superintend, approve;and pass those acts and accounts ? Yet this appears to be very,much the position of the Royal South Hants Infirmary. We

! have not the slightest desire to reflect upon the character of

the gentlemen who fill these, in our opinion, incompatible. offices. They may, and no doubt do, discharge the duties’

they have undertaken honourably and efficiently. We who

do not live at Southampton, and are not governors of the In-, firmary, can only remark, that their character must indeed be

high to justify the almost unlimited confidence reposed inL them by the governors. The governors appear to have re-

- served to themselves little else than the task of providing thet funds.

l We go on to consider the duties of the medical staff. Thingsido not improve as we advance. There are, two physicians only.

Each is to attend the Infirmary every alternate month. This

f implies, we presume, that every month the patients are shiftedbover from one physician to the other. We do not see that this

arrangement is the best calculated to keep alive the profes-1 sional interest of the physicians in their cases, to secure the,3 benefit of the patients, or to advance medical science. What

t governor would think it rational to transfer the medical care oft his family from one physician to another every month ? If it is

inconvenient for the two physicians to give unintermittent at-tendance, it might be better to appoint a third, so as to facili-tate a more common sense distribution of the work. But we

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THE ANALYTICAL SANITARY COMMISSION.

read on, and presently our eye rests upon the following singularprovision :-" Each physician and surgeon shall appoint one"day in the week for the attendance of his out-patients at" the Infirmary, or at his own residence, and shall make sucharrangements as will ensure their being duly attended to,"&c." This arrangement, no doubt, has been made for the con-venience of the medical officers, to economize their time. But

again we submit that this end might be much better accom-plished by increasing the staff, so as to bring the attendance ofeach member at the hospital on hospital-duty within reason-able limits. We know not how it strikes people at Southamp-ton, but we believe that elsewhere the reception of hospital-patients at the private residence of the medical officers wouldneither be tolerated by the governors, nor countenanced bythe profession.Again we read on, prepared by this time, nil admirari:-" No medical gentleman not belonging to the establishment

shall be permitted, on any pretext whatever, to enter thewards of the Infirmary, without permission of the physiciansand surgeons of the Infirmary, or unless in company with aphysician, surgeon, or house-surgeon of the institution.

"Visitors, professional or otherwise, may be admitted atoperations by permission, but not without permission, of theoperating surgeon."For our professional readers, who owe a great part of their

.scientific and practical knowledge to the very different arrange-ments adopted in most medical charities, not a word of com-ment is necessary to expose the illiberality, exclusiveness, or

danger of such restrictions. But the governors might do wellto consider the matter in reference to the interests of the poor

patients, and the credit of their institution with the public.By this law, a medical man, although also a governor, is notpermitted to visit the hospital towards the support of whichhe contributes. The hospital is deprived of the benefit it

might derive from the observation of those whose experiencequalifies them to offer the most valuable suggestions for itsimprovement. It is a direct injury to the public to debar theirmedical advisers from such opportunities of professional studyas a public hospital affords. It is hard to believe that these

exclusive powers are exercised for the advantage or comfort ofthe medical staff. All public duties ought to be performed inthe face of day. Especially would no right-thinking man shunthe observation of his professional brethren. The only excep-tion to this rule should be in cases where female delicacy claimsrespect.

Arrived at this point in the physiology and pathology of theconstitution of the Royal South Hants Infirmary, we find ourlimits compel us to postpone for another occasion the task ofcompleting its history. Enough, we hope, has been said forthe present to arrest the earnest attention of the intelligentand enterprising inhabitants of Southampton to a state of

things which reflects little credit upon the town.

THERE is, we believe, a critical epoch in the life of every

man, when his noblest energies are aroused, and by the course hethen adopts his future destinies are determined. It may be that

the social status of an individual is at stake; and the sagacity,firmness, and energy he then exhibits will establish his futuregrade in the scale of society. A great occasion now presentsitself to the Members and Fellows of the Royal College of Sur-geons of England to determine their future professional positionbv now asserting their corporate riehts. In virtue of the liberal

i provisions of the Medical Act passed last session of Parliament,each member of the College of Surgeons is entitled and invitedto exercise his corporate privilege in returning his State repre-sentative to the General Council of Medical Education andRegistration. The Council of the College have, in conformitywith their habitual cliquism and invidious exclusiveness, nowmade their culminating effort to usurp the rights of the entirecorporation, and degrade more than ten thousand surgeonspractising in all parts of the kingdom. The recent election bythe College Council of one of their own body as the represen-tative of the College in the General Medical Council, clearlyimplies that in their opinion the general body of surgeonsshould, and shall if possible, be henceforth unrepresented andunrecognised. It would be an idle equivocation of the CollegeCouncil to refer to their legal advisers in explanation of theirignoble conduct. The whole question assumes a more solemnimport when we contemplate the augmented powers with whichthe new General Council will, in all probability, at no distantperiod be invested. For the first time in the annals of the UnitedKingdom has the profession, as a body, been engrafted on theState, and we may reasonably anticipate that in due time theGeneral Council will exercise further powers than those which

pertain to medical education and registration. The time maycome when the special interests of the general practitioners willbe confided to the discretionary powers of the State Council.What consideration can be taken of those interests, if repre-sented through an exclusive election by and from four-and-twenty men, who, as a body, have ever proved themselvesopposed to the welfare of the many ? Further comment is un-

necessary. These remarks will prove suggestive. It is for the

general body of surgeons now to determine what position theyare henceforth to occupy in the profession and in society.It remains for the Members and Fellows of the Royal Collegeof Surgeons of England to decide in conference, on Mondayevening next, the 20th instant, at the Freemasons’ Hall,whether they are to possess corporate rights under the newAct, or whether they are to be mere puppets in the hands ofan insolent Council.

WE beg to direct the attention of our readers to the Reportof the Analytical Sanitary Commission, contained in THE

LANCET of the present week, on the pigments employed incolouring articles of Sugar Confectionery.From this Report i t appears that metallic pigments, of a

highly-dangerous and even poisonous character, containingchromic acid, lead, copper, mercury, and arsenic, are com-

monly used in the colouring of such articles.We, therefore, desire to caution the public against the use of

Sugar Confectionery of all kinds, both coloured and uncoloured;the former because of the hurtful and deleterious colouring-matters employed; and the latter because, as shown in the

Report of the Commission made in November last, of their

extensive adulteration with DUCK, DAFF, or plaster-of-Paris, ofBradford notoriety. The caution against the use of SugarConfectionery is a general one, and stands good so long as thepresent highly-improper and dangerous system of adulterationis persisted in; but it carries with it more than ordinary forceat the present time. It is at Christmas, of the whole year,that the greatest consumption of these articles occurs, and thisby young persons and children of tender age.The necessity of this caution is shown by the fact, that not

637

MEDICAL ANNOTATIONS.

a Christmas ordinarily passes away without the occurrence of

many cases of illness, more or less serious, and sometimes even

fatal, resulting from this cause.The articles to be specially avoided are cheap lozenges of

all kinds, especially peppermint and ginger lozenges, conver- sation cards, sugared almonds, and comfits; whilst of the I

coloured articles, those containing yellow or green pigmentsshould be particularly avoided. The confectionery containingessences and flavourings of various kinds should also be ab-stained from, as they are, for the most part, very unwhole-some.

We have again to give expression to the earnest hope thatthe ensuing session will not be permitted to pass away with-out something being done to put an end to the disgrace-ful and dangerous adulterations, at least of Sugar Confec-tionery, if not of those of articles of Food and Drink gene-

rally. We trust that the lives lost through the Bradfordcalamity will not have been sacrificed in vain, and that thewarning afforded by that catastrophe, as well as by the

exposures contained in THE LANCET of this week, will pro-duce some practical result, and be the means of causing theadoption of such measures of precaution as will afford the pub-lic some protection for the future. It is to be regretted thatthe Chairman of the Parliamentary Committee on Adultera-tions, Mr. SCHOLEFIELD, M.P. for Birmingham, is now absentin America, and therefore that he will not have become fullyinformed as to the extent and fearful character of the Bradford

poisonings, and the alarm excited thereby in the minds of thepublic. However, it is quite competent for any other memberof the Adulteration Committee, or indeed of the House of

Commons, to take up the subject and to introduce a Bill nextsession. We know that other members of the Committee

were deeply and warmly interested in the subject of adulte-ration, and we should be rejoiced to find the matter activelytaken up by them in the House of Commons.

A TRIAL, of the utmost importance to the medical professionat large, has just been concluded in Paris. The homoeopathsof the French capital have been signally beaten; and we aresure that every legitimate practitioner will be happy to hearthat these gentlemen were foiled in their attempt to exact

heavy damages from L’ Union M6dicale, a highly-esteemed andcourageous journal, which did not shrink from the task of

applying the proper epithets to the deceits and juggleries ofHAHNEMANN’S followers.

It would appear that, as far back as October 24th of lastyear, a review was published, in L’Union M&eacute;dicale, on a

homoeopathic pamphlet. This review had been undertaken

upon the especial desire of the author, who was told that thepseudo doctrine would be severely dealt with. M. GALLARD,the author of the review, certainly spared not the rod; andthe homoeopaths so winced under it, that they formed a largecommittee, which decided that twelve of the members should

bring an action for slander against the journal, laying thedamages at &pound;2000.The whole profession of Paris was thrown into a state of

great excitement by this conflict, and much sympathy wasexpressed for the prosecuted journal. Pamphlets were writtenon both sides; the most talented counsel were engaged; andon the 17th of November last the trial came on. Adjourn-

ments took place to the 1st, and afterwards to the 3rd, ofDecember; and after most brilliant speeches, and a very lucid

summing-up, the verdict was given for the defendants,-viz.,the writer of the review and the editor of the paper.

This verdict was mainly founded on the fact that the articlemade no direct allusion to any particular person; that the

twelve homoeopaths had no legal claim to form a body ofplaintiffs; and that discussion on scientific subjects was per-fectly free and unrestricted.We heartily congratulate our Paris contemporary; and we do

so the more readily as we have always been foremost in thebattle against quackeries of all kinds, amongst which homceo-pathy may claim a distinguished rank. Law suits are ever

harassing affairs; and we fear that L’Union Medicale has

been considerably worried on account of the good cause. That

journal is therefore entitled to the sympathy of the whole pro-fessional body and the medical press of the civilized world.

I If the editor of L’Union Medicale has been put to any con-

siderable expense by this unjust prosecution, we firmly believethat the orthodox practitioners throughout Europe would feel

great pleasure in contributing their mites so as to free himfrom all costs and charges attending the action. He has foughta great battle, and won a splendid victory.

Medical Annotations." Ne quid nimis."

LIFE CHEAPLY BOUGHT.

IT has been objected to the comparative statements of theRegistrar-General that the ideal of health upon which he baseshis calculations of an excess of mortality is theoretical in itsproportions and unsubstantial in foundation. He effectivelyanswered these cavils by a reference to the sanitary progressof Ely.The operations of the Board of Health at Macclesfield have-

been attended with as great success and as great saving of lifeas at Ely, from which he drew so striking an illustration.Their sixth yearly report states, that before the operations ofthe Board, the rate of mortality in the borough was thirty-three in a thousand, while for the last five years it has beentwenty-six in a thousand, so that 1015 lives have been saved.In funeral expenses alone, calculated from the returns of 232burial clubs, &pound;8729 have been saved. But a larger item wouldaccrue under the head of diminished sickness, there having been28,420 less cases of illness ; and the cost of these cases beingestimated, according to the data furnished by friendly societies,at one shilling a day for twenty days, &pound;28,420 would thus besaved. Here nothing is assumed. Again, an actual insteadof an assumed contrast can be presented, with no less agreeableresult in the average length of life. The average age of allwho died in the first period was twenty-four years (in theadjoining rural district it was thirty-four years); in the lastfive years it has been twenty-seven years. Each year gainsan accession, the last year’s average being twenty-eight yearsand a half. Length of days by three years has thus beenadded to each inhabitant.A few years ago, statements such as these received but little

favour; indeed, many people affected to ridicule them. Now,however, such vital statistics have assumed an authority whichprevents even the ignorant from questioning their real valueand tendency.

All the facts are alike conclusive, and point to the same

result, and any one will be as intelligible as the rest: thedeaths of children under one year have decreased 16 3 per cent.,