2
1159 want to find himself in such hands any more. The witness then pro- ceeded to give details of the working of the provident system, and the committee adjourned. On Thursday, the 22nd inst., the first witness to be examined was Mr. Bruce Clarke, of St. Bartholomew’s Hospital. Referring to the out-patient department, he said that there were from 250 to 260 patients seen in an hour. but there were between ;’ortyand fifty persons to attend to them, consisting of ten house surgeons and numerous dressers, all working under supervision. Chairman : So that when we hear of about sixty patients being examined in an hour, it by no means signifies that they are seen by one medical man? Witness: Certainly not, so far as St. Bartho- lomew’s is concerned. In his opinion it was practically impossible for students to see patients on their own responsibility. Referring to the class of people applying for assistance at the hospitals, he said no doubt a few might be able to pay for treatment ; but there was no system )f inquiry by any responsible official. He referred to the mode of admission of patients to the hospital, and stated that practically no patients were sent away from the hospital on the authority of a porter.-By Lord Cadogan: Would you say that any of the best medical men were excluded from the hospital staff by reason of not having a London diploma ?-Witness : No, certainly not.-Chairman : In London the London qualification is required. Is that because you think it a higher test?-Witness : Partly for that reason and partly because we think that if a man is educated in London, by a sort of esprit de corps, he should be elected. On the subject of the ad-lalgaiiiation of medical schools, he thought it would be a mistake to attempt to amal- gamate all the schools, though their number might be reduced with advantage. Lecturers in medical schools should be in practice, in order to know the practical bearings of the subjects taught. He gave it as his opinion that men who devoted their whole time to teaching were more apt to teach the scien- tific aspect of their subject and neglect what was more prac- tical. He denied that Mr. Nelson Hardy’s evidence gave a correct representation of the state of the out-patient department, and in reply to the chairman stated that the meaning conveyed on the surface of his evidence was undoubtedly erroneous as far as St. Bartholomew’s Hospital was concerned. In reply to Lord Thrmg, the witness thought much misconception prevailed on the subject of discipline and moral superintendence of medical students, and explained that at St. Bartholomew’s Hospital there was a discipline committee. He thought that the discipline in that hospital was complete, both with respect to in-door and out-door students. The supervision exercised was of a very strict kind, In reply to Lord Cadogan, the witness said he only objected to a Medical Univeisity which would be attended by officers entirely outside the hospitals. Sir Morell Mackenzie was then examined. He stated that he had been a student of the London Hospital, and had had a great deal of ex- perience of its working as a member of its medical staff. He thought that both general and special hospitals were required. General hospitals were required for educational purposes, but special hos- pitals were also required, although not to the same extent. There was not the same concentration of interest manifested in the treatment of cases in a general hospital as in special hospitals, and on that account the treatment in a general hospital was not carried out with the same success as in special hospitals. Then their organisation for the treatment of special diseases attracted much more special cases, and, although special hospitals required pay- ment, they were numerously attended by patients who had to make these payments. He would like to see that principle adopted in all hospitals, inasmuch as he thought the graduated system of payment according to the means of the patients was advisable. He thought that if a general system of payment existed it would not at all inter- fere with medical men. Some medical practitioners in the poorer neighbourhoods thought that the system of payments would take away some of their patients from them. That he attributed to ignorance of the working of the system. As a matter of fact, the result of establishing this system of graduated payment in the Golden-square Hospital had reduced the number of patients very considerably, and had acted as a protective to general practi- tioners. Those hospitals were most necessary which had the most technical modes of examination, such as hospitals for the eye, throat, nervous diseases, and diseases of women and children, which were difficult to carry out in a mixed general hospital. Then there were hospitals like the cancer and chest hospitals, which afforded useful asylums for patients with chronic or long-standing ail- ments, such as general hospitals disliked very much to take in; and he thought that they did a great deal of good in that way. In special hospitals everything was made secondary to the cure of the patients, whereas in the general hospital the special department was starved for want of proper. and special appliances. He would not like to see any restrictions of special hospitals. It was a question of free trade really. He was quite sure that a hospital which did not do good would soon cease to exist. Referring to the origin of these hospitals, he said they were established in a manner similar to the general hospitals, by a number of gentlemen combining and asking their friends for sub- scriptions.. That was the system of the origin of any hospital nowadays. He condemned the out-patient department as being unnecessary to the hospital for teaching purposes. It had frequently been said that they were required for teaching students; but, as a matter of fact, the students were not required to attend this department at all, and in a hospital of 150 students only some five t.tudents would be found to be amongst these out-patients during the day. The question of the relative value of medical degrees for hospital appointments was then gone into, when the witness characterised the existing restrictions as an anachronism, going back to the time when the Colleges of Physicians and Surgeons were able to direct the whole of the medical education in London. He gave it as his opinion that some of the best men were excluded by this protective system. In reply to Lord Cadogan, he said that it was within his knowledge that such exclusion did exist. Witness then proceeded to make the suggestion that a great saving could be made if the large general hospitals could be removed out of London altogether and several smaller hospitals instituted throughout the metropolis proviling accident wards for urgent cases. It had been pointed out by Sir James Simpson many years ago that that would be a much more healthy condition of affairs. The sale of the ground on which these hospitals were built would give very substantial properties for building such smaller temporary hospitals. The Committee then adjourned to Monday, June 9th. METROPOLITAN ASYLUMS BOARD. Return of Patients remaining in the severaL Fever Hospitals of the Board at midnight on May 20th, 1890. SMALL-POX.—Atlas hospital ship, 4. Appointments. Successful applicantsfor Tacancies, Secretaries of Public Institutions, ana others possessi)zg information suitable for this column, are invited to forward it to THE LANCET 0 *glee, directed to the Sub-Editor, not later than 9 o’clock on the Thursday morning of each week for publication in the next nticmber. ----- BENSON, H. T., L.S.A., has been appointed Medical Officer for the St. Nicholas Second District of the Spalding Union. BUNCOMBE, WM. DEWEY, L.R.C.P., M.R.C.S., has been appointed Assistant Medical Officer to the Infirmary of the City of London. Union, Bow-road, vice Wm. Gem, L.R.C.S.I., L.K.Q.C.P.lrel., & L.U.,. resigned. CARGILL, L. V., M.R.C.S., L.R.C.P., L.S.A., has been appointed Ophthalmic Clinical Assistant, King’s College Hospital. FREEMAN, J. P. W., M.D. Durh., M.R.C.S., has been appointed Medical Officer for the Fourth District of the Andover Union. GREENLEES, THOS. DUNCAN, M.B., C.M. Edin., Assistant Medical Officer to the City of London Lunatic Asylum, has been appointed Medical Superintendent of the Graham’s Town Asylum, Cape or Good Hope, vice Robert Hullah, M.D., deceased. HOPKINS, G. HERBERT, M.R.C.S., L.R.C.P. Lond., has been appointed Resident Medical Officer to the Swansea Hospital, vice H. E. Rawlings, resigned. JOHNSON, P. P., M.B., C.M.Edin., has been appointed Medical Officer for the Seventh District of the Bedminster Union. KNIGHT, H. E., M.B. Lond., M.R.C.S., L.R.C.P., has been appointed House Surgeon to the Stockton-on-Tees Hospital and Dispensary. LATTEY, A., L.R.C.P.Lond., M.R.C.S., has been appointed Medical Officer for the Banstead District of the Epsom Union. LEECH, PRIESTLEY, M.B., B.S. Lond. Univ., F.R.C.S. Eng., has been appointed Honorary Medical Officer to the Halifax Infirmary, vice F. E. Macaulay, M.B.C.S., L.S.A., deceased. LUMSDEN, GEO., M.B., C.M.Glas., has been appointed Medical Officer for the Pateley Bridge Rural District, vice Jardine. MARTIN, CHRISTOPHER, M.B., C.M. Edin., has been appointed an Honorary Medical Officer at the Birmingham and Midland Hospital for Women. PAPILLON, T. A., L.R.C.P., L.M. Edin., has been appointed Medical Officer for the Empingham District of the Oakham Union. RISDON, W. N., M.D., B.S. Lond., M.R.C.S., L.R.C.P., has been appointed Second Medical Officer to the Sun Life Office. SELBY, P. G., L.R.C.P. Lond., M.R.C.S., has been appointed Medical Officer for the Fourth District of the Faversham Union. SPENCER, WALTER, L.R.C.P. Edin., has been appointed Medical Officer and Public Vaccinator for the District of Gringley-on-the-Hill, of the Retford Union. TEICHELMANN, E., L.K.Q.C.P.Irel., M.R.C.S., has been appointed ’ Medical Officer for the Workhouse of the Parish of Birmingham. TOMORY, J. KAY, M.B. Edin., has been appointed Medical Officer to the Parish of New Abbey. WASHBOURN, J. W., M.D.Lond., has been appointed Assistant Physician to Guy’s Hospital. WHITCOMBE, C. H., F.R.C.S.Edin., has been appointed Medical Officer for the Workhouse of the Sevenoaks Union. ’ WHITE, W. HALE, M.D.Lond., has been appointed Physician to Guy’s Hospital. WILL, J. C. 0., M.D.Aberd., has been appointed Consulting Surgeon to the Royal Infirmary, Aberdeen. Vacancies. Forfurther information regarding each vacancy 2-efei-eizce should be mads to the advertisement. BOROUGH OF BOLTON.-Medical Officer of Health and Public Analyst for the Borough. Salary £400 per annum. (Apply to the Town Clerk, Town Hall, Bolton.) BRISTOL GENERAL HOSPITAL.-Ophthalmic Surgeon and an Assistant Physician-Accoucheur. CENTRAL LONDON OPHTHALMIC HOSPITAL, 238A, Gray’s-inn-road, W.C House Surgeon for six months. Rooms and board.
