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1021 beds and forty free, but in each case the attendance was precisely the same. The question of throwing two or three of the smaller wards into larger ones had not b’een considered during his tenure of office.-- By Lord Lauderdale: The average number of beds occupied last year was fifty, and the average cost per bed was ,,c2 2s. 6d. per week —By the Chairman: No plan of the drains was kept in the office. If any- thing was out of order it would at once be reported to him. He looked upon himself as being responsible to the committee, and there was no special sanitary officer employed to inspect the buildings. Miss Squier, the matron of the hospital, gave an account of the nursing arrangements of the hospital. They had four sisters, three staff nurses, ten ordinary probationers, and two paying probationers. They occasion- ally sent out nurses, but only on the recommendation of the doctors. Mr. Richard T. Smith, M.D. Lond., M.R.C.P., saw no reason why members of the staff of the general hospital should not be on the staff of the special hospital. Special hospitals could with much advantage cooperate with the general hospitals. Notwithstanding the great advance that had been made by the general hospitals, he was of opinion that the necessity for some special hospitals was as great as ever, because there was difficulty in providing accommodation for students in the general hospital, and women objected to be examined by a great many medical students; therefore the number of students who could take a deep and personal interest in the cases was rather limited. His hospital limited the number of students taking an active part to four in one day, to some extent out of consideration to the patient, and also from want of space. Special provision would have to be made even in general hospitals for the performance of special gynmeological operations.- In reply to Lord Kimberley, the witness stated that though he had no objection to special operations being performed in general hospitals, he would except cases of abdominal surgery, which, in his opinion, should be done in separate buildings. As regards the study of disease, he thought special hospitals promoted science, and possibly led to new discoveries.-By Lord Thring: The witness personally would not object to women being admitted as students into this hospital.- Lord Thring: Doctors object to these hospitals because they injure the schools, and not because they injure the patient. They say special hospitals are bad because they prevent the acquisition of a knowledge of these particular diseases.-The Witness : Of course it takes away a certain number of patients from the general hospitals. With regard to the education of a medical man, the witness thought that no young man ought to study any speciality until he was thoroughly versed in general medicine. . Gordon Hospital for Fistula. Captain Hincks, secretary of the hospital, said that the patients were admitted for the most part free, but many of them paid. There were only twenty-five out-patients daily. It was originally called the Western Hospital, and the name was changed by the coin- mittee to the Gordon Hospital. The witness could give no par- ticular reason for the existence of such a hospital, except that many patients came there who were unable to pay the surgeons’ fees, and who objected to being treated at a general hospital. They did not receive the full grant from the Hospital Sunday Fund, on account of the expenses of management being too great. They raised money through appeals in the ordinary way. — By Lord Lauderdale : The hospital consisted of eight rooms, and was taken on a twenty-one years’ lease in the name of two of the surgeons, Mr. Bentham, who was since dead, and Mr. Whitmore.-Lord Sandhurst : Do you think that as a general principle the work of a hospital, with an average of nine working beds, could not be undertaken as well in a general hospital ?-The Witness : I should very much like to see the work of the Gordon Hospital extended. It meets the wants of those patients who would not go to a general hospital. Mr. Whitmore, F.R.C.S. Edin., said he started the hospital in view of the great want of such a hospital in London. In answer to the ques- tion whether patients could not be treated as well at the general hos- pital he read the following letter, dated February, 1891, and addressed to the secretary of the hospital :—" beg, through you, to bring my case under the notice of the Gordon Hospital Committee, and to bear testimony to the very efficient manner in which I was treated at that hospital. In.September, 1889, I became ill. Shortly afterwards I entered a hospital here, and underwent an operation, and remained six weeks. In January, 1890. I went into another hospital, where I was again operated on, and was detained nearly twelve weeks, and without receiving any benefit whatever. In May I obtained admission to the Gordon Hospital, where I was operated on for fistula, and where I was under Providence cured."-By Lord Sandhurst: He was not in a position to contrast or criticise the treatment in the general hospitals as compared with the treatment in this hospital. He maintained that the expenses of the paid officials, as compared with other hospitals, were merely nominal, and the hospital itself was in embryo. He had advanced a sum of money for the promotion of the hospital, which he would never bother the committee to repay unless he saw they had sufficient funds. He considered it money well spent.-Lord Kim- berley : I asked you whether it was desirable that hospitals should be established on so small a scale that the expenses are too large for the maintenance of the establishment?-The Witness: It appears to me that it is in proportion to the amount of good that is obtained. He was in favour of special hospitals for all diseases ; they would not detract from the educational value of the general hospitals. Students could study a subject much better at the head centre of specialism than at the general hospitals if the theory were carried out fully. The large hospitals, he thought, were at present running to seed.-By Lord Cathcart : The name "Gordon" was not given as a name with which to entice the public, but because it was considered a good name by the committee. On the Committee resuming on Thursday, Mr. Frederick Wallace, L.R.C.P., M.R.C.S., a general practitioner in Shoreditch, gave evidence to the effect that the establishment of the provident dispensary department of the Metropolitan Hospital at Shoreditch had damaged the practitioners in that district. He repre- sented a, number of general practitioners in that district who considered that it was in no way intended when the hospital was established that there should be attached to it this provident dispensary. It had un- doubtedly produced serious consequences among the practitioners in the neighbourhood. He complained of those dispensaries which were conducted by qualified men acting as assistants to another medical man who had perhaps as many as twenty or twenty-five of these establish- ments. He thought it must pay, as it had gone on now for some years. They were called Is. a week dispensaries. His objection to them was that the advice was inferior, and that it in many cases led to the offence called "covering." He presented’ a book in which he had collected various handbills advertising these dispensaries. The advertisements were issued by qualified men, but the cases coming to the dispensary were sometimes left to be attended by unqualified men. He mentioned the name of a medical man who had a large number of these dispensaries, but he believed they were attended by properly qualified medical men. He objected to such establish- ments, because these medical men were constantly leaving this employ- ment, and frequent changes were bad for the patient, and because they tended to sweat the profession.-Lord Thring: Does not the very number of these dispensaries show that they supply a public want ?- The Witness : I think there is a public want of a properly organised pro- vident scheme.-Lord Thring: But supposing that a man has twenty-five dispensaries handled by properly qualined men for the benefit of the public, what more do you want?—The Witness : They cut into the local general practitioner and sweat him.-Lord Thring : In other words, it is compe- tition.-The Witness : It is competition that we consider to be unfair.- Lord Thring : Why can’t you set up opposition dispensaries ?-The Witness: We could not do that. I should be very sorry to start a shilling dispensary.-Lord Thring : It would be infra dig ?-The Wit- ness : Certainly. If the patients got the full value for their money I should not have much to say against them.-Lord Thring : Does it not amount to this, that it is a professional objection ; that a certain class of men advertise in a way that is not thought consistent with the dignity of the medical profession ? -The Witness: Yes - Lord Lauderdale: Do you suggest that doctors should not be allowed to advertise, or what? Is the present law regarding qualified assistants not properly enforced -The Witness : That is so. I would like to see it enforced. The General Medical Council had prosecuted only a few of the cases of covering because of the difficulty there was in obtaining sufficient evidence. Personally, he did not think it was worth his while to obtain this evidence -By Lord Monkswell : The reason why he did not go to the General Medical Council in this matter was simply that it would be extremely difficult to get at the real facts. Qzteen Charlotte’s Lying-in Hospital. Mr. G. 0. M. Ryan, the secretary of the hospital, gave an account of the arrangements, income, and expenditure of the hospital. The nursing arrangements were also detailed. William Hope, M.D., M.R.C.P., M.R.C S.Eng., senior physician to the hospital, said that the evil reputation which the hospital had fifteen ears ago was due to its insanitary condition and the want of a knowledge of antiseptics. The mortality in single women was greater than in married ones, probably on account of the very young age of the patients. These patients varied in age from fourteen to twenty-five. They had cases as young as twelve, and to these the shock was very great. Such patients weie taken into homes now, where they are very carefully fed and cared for before they come to the hos- pital. A gentleman named Mr. Bousfield, who had given evidence, had stated that the presence of students was detrimental to lying- in cases. That statement he distinctly repudiated. Since medical students had been in Queen Charlotte’s Hospital the mortality had decreased. The patients considered themselves better attended to when medical students were present. He would like to see in all lying- in hospitals a resident medical officer on the regular visiting staff. London Fever Hospital. Lord Balfour of Burleigh, the President, said they divided the patients into ward patients and private patients. The ward patients pay three guineas for the whole case, the private patients pay three guineas per week. The families and servants of governors were admitted free. The hospital contracted with large firms for the treat- ment of their eniploilgs provided they subscribed to the hospital. His lordship gave an account of the history of the hospital from its foundation in 1802. This hospital at the present time does its work between the two social extremes, and assists those who could pay something. Those who could pay the cost were treated at a less cost to themselves in the hospital than in their own homes. The hospital offered advantages to the sufferer and also to the family in which the case had broken out, as well as to the community by removing a source of danger. All infectious diseases were taken in except small-pox. Major Christie, the secretary, was examined, and gave particulars of the financial condition of the hospital. E. 0. Hopwood, M.D.Oxon., the resident medical officer, said no nurse had died from infectious disease during his period of office. Day nurses were on duty for thirteen hours and night nurses for eleven hours. The matron was responsible for the conduct of the nurses. She was ap- pointed at a salary of 80, rising to £100 or £120. They could not send out their nurses with advantage to the hospital. The percentage mortality in 1889 from scarlet fever was 1’2, for enteric fever 5’2, diphtheria 17’6. In 1890 the mortality from scarlet fever was 2 3, for enteric fever 9, for diphtheria 4"5, and for measles 5’3. These he considered very low averages, quite 50 per cent. below the average of the Metropolian Asylums Board hospitals, and he attributed these low averages to the class of patients treated in this hospital. Appointments. Successful applicants for Vacancies, Secretaries of Public Institutions, and others possessing information suitable for this column. are inrrited to forward it to THE LANCET Office, directed to the Sub-Editor, not later than 9 o’clock on the Thursday morning of each week for publication in the next number. ANDERSON, JAMES, L.R.C.P., L.R.C.S. Edin., has been appointed Public Vaccinator pro te7)i. for Footscray, Victoria, Australia. BRETTINGHAM, C. E. SEPPINGS, L.F.P.S. Glasg., has been appointed Medical Officer of Health for the Eastern Diviaion of the Williton Union. BROWN, WM. H., M.R.C.S , has been appointed Medical Officer for the portion of the Colac Shire south of the boundary of the Counties of Polwarth and South Grenville, Victoria, Australia. BURTON-FANNING, F. W., M.B. Cantab. (formerly known as F. W. Burton), has been appointed Honorary Physicia.n to the Norfolk and Norwich Hospital, Norwich.
