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"MEDICAL GEOGRAPHY AS AN AID TO CLINICAL MEDICINE."
415 health. Another
A woman developed case was as follows. diseases of the ovary and other organs in the pelvic basin, any previous knowledge of such a disorder being disavowed by her relatives. About two years after her death her widower, who was a hearty man to all appearance, contracted epithelioma; he then admitted that his father had died from an abdominal tumour in another country about thirty years previously and that his sister had died from " internal complaint." Almost contemporaneously the intimate lady friend of the lady and widower, who was engaged to be married to the latter, developed scirrhus, and, as usual, denial was made of any historical taint. The aseociate of husband and wife dwelt in a part situated miles away from her fellow sufferers. The following is an additional instance. In the case of a female who had resided in this colony for fifteen years easily recognised malignant disease appeared after certain dyspeptic symptoms, coupled with alternate diarrhoea and sickness, had prevailed for some days. She had always been strong, but her only son had been killed in a tragic fashion, and her illness dated from the crisis of the catastrophe. As usual, denials were made of the pre-existence of similar disease in the members of her family, but the coincident was announced in the person of her husband’s sister, who was not a blood relative and who had never been to the antipodes, but had died from cancer at the other side of the globe a few months previously.
HOSPITAL ABUSE. SPECIAL COMMISSIONER.) (BY
malignant
*
*
*
*
*
*
*
To sum up. A definite material organism in every individual has a concomitant mind depending upon it, and in pathology, agreement or a law of similarity obtains, which, operating as the attraction of cohesion, governs the incidence of mating. I am, Sirs, yours faithfully, LAVINGTON G. THOMPSON, M.D.Aberd. Launceston, Tasmania, June, 1897. * ’"On account of the great length of the original communication we have been compelled slightly to curtail the introductory part and to omit several of the illustrative cases.-ED. L.
"MEDICAL GEOGRAPHY AS AN AID TO CLINICAL MEDICINE." To
the
Editors
of THE LANCET.
SIRS,-Will you kindly let the following corrections in my Medical Geography, published in THE LANCET of be made in your next issue. Read at p. 238, col. 2, third line from top : " but this is due to the fact that cancer affects the river-valley systems, which protect and shelter the phthisical, whilst they harbour the materies mo,-bi of rheumatism, and its too frequent sequel heart disease," instead of what now stands; p. 239, col. 1, line 35, instead of 92, read 92.3;and at line 37, instead of "a little over I am, Sirs, yours faithfully, 12"read 10.8. ALFRED HAVILAND. Aug, llth, 1897.
address
on
July 31st,
OUR
XII.-BIRMINGHAM (continued).1 Abuse at the General Hospital.-The Measures taken at the Queen’s Hospital-The General Dispensary as the Chief Offender.-The Committee Captured by the Workmen. THE attempt at hospital reform which was initiated under the most favourable auspices some seven years ago having, nevertheless, and as described, utterly collapsed, it is now necessary to describe the present state of affairs. My first, care was to call on one of the visiting staff of the General Hospital, at which hospital the ticket system is in force except for urgency cases and accidents. If, however, any member of the staff thinks that a patient can afford to pay for medical attendance the patient can be referred to the office for inquiry. But this is not done often. There aretoo many patients for the members of the staff to think about such questions. It takes less time to prescribe than to inquire into the social position of the patient. That the majority of the applicants are poor people is proved by thefact that their numbers fluctuate according to the condition of trade. At the present moment trade is more prosperous,, so the number of patients in the out-door department has considerably decreased, thus suggesting that many of the working classes do pay for private medical advice when they As for the proposal made with a. are in full employment. view to reduce the number of out-patients, it was frankly admitted that the hospital visiting staff, but more especially the surgeons, liked to have a large number of out-patients. That cases of abuse existed at the General Hospital was. not denied, and tickets were often very injudiciously distributed. Thus an in-patient, on being told that he would soon have to leave as the time generally allowed was almost terminated, replied that he bad ’’instructed his solicitor to procure him a second ticket." In the out-patients’ depart-ment a young girl was receiving explanations as to the street where she should go so as to obtain an elastic stocking when she replied, "Oh, do not bother; the cabman will know I" But whatever fault might be found with the General Hospital for treating patients who could afford to pay my informant was of opinion that far greater abuse of this description prevailed among the frequenters of the Birmingham General Dispensary. Further, he complained that the wordcharity"had been left out of the recommenda tion tickets, and the words "a proper subject for relief " substituted. This spread the idea that hospitals were not charitable institutions and accounted for much of the abuse> This conception was still further accentuated by those hoEpitals which compelled the patients to pay registration fees. On account of subscribing to the Hospital Saturday Fundand the registration fees there were not a few working people who imagined that they only received from the hospitals that for which they had made a full and sufficient
MEDICAL MAGISTRATE.-Mr. Charles Harrison payment. Calling on one of the leading surgeons who has taken a, M.D. St. And., M.R C.S. Eng., D.P.H. Camb., has been prominent part in the agitation for hospital reform, but whoplaced on the Commission of the Peace for the city of is not on the staff of the General Hospital, I found that he Lincoln. was disposed to criticise severely this institution. A new for the General Hospital was now almost completed, building CLAYTON HOSPITAL, WAKEFIELD. - The 110th cost would amount to about £ 600 annual meeting of the Clayton Hospital, Wakefield, was held and it was said that the bed. How the medical staff ask for economy in could per on the premises on July 28th, Mr. Tew, J.P., the President, the face of such conditions? If they objected to this luxurious in the The the chair. showed that being report during past it hurt the feelings of the wealthy and eminent. year there had been 654 in-patients and 3960 out-patients. display might Both the income and the expenditure had been materially laymen who sat on the hospital committee. It was a source less than in the preceding year. Mr. J. W. Walker, one of of personal satisfaction to these committee men to be conthe surgeons, read a letter from Mrs. Louisa Milnes-Gaskell, cerned in the building of a palatial and model hospital, widow of Colonel Milnes-Gaskell, J.P., of Lupset Hall, near and they were not likely to study and understand what Wakefield, the purport of the letter being that on account might be the economic consequences on the interests of the of the
great interest which her late husband felt in the
she offered to enlarge the wing containing present Gaskell Ward so as to make an upper and a lower ward, each with beds for sixteen patients. A portrait of the late Mr. Samuel Fozzard Harrison, who not long ago bequeathed nearly R25 000 to the hospital, was subsequently unveiled by Dr. T. G. Wright, the senior physician. The portrait has been presented to the hospital by Colonel W. W. Clapham, of Manchester, and will be hung in the board-
Clayton Hospital the
room.
1
The previous articles on this subject were published in THE LANCET the following dates: (1) Sept. 26th, 1896, Plymouth and Devonport; (2) Oct. 10th, 1896, Exeter; (2 concluded) Oct. 17th, 1896, Exeter; (3) Oct. 31st, 1896, St. Thomas’s Hospital, London ; (4) Nov. 14th, 1896, Liverpool; (4 continued) Nov. 21st, 1896, Liverpool; (4 concluded) Dec. 12th, 1896, Liverpool; (5) Jan. 2nd, 1897, Manchester; (5 continued) Jan. 9th, 1897, Manchester; (5 concluded) Jan. 23rd, 1897, Manchester ; (6) Feb. 6th, 1897, Leeds; (6 concluded) Feb. 13th, 1897, Leeds ; on
(7) April 17th, 1897, Coventry; (8) May 1st, 1897, The Royal London Ophthalmic Hospital; (9) May 8th, 1897, France, United Action and Legislative Action; (10) May 15th. 1897, Leicester; (11) June 5th, 1897. Nottingham; and (12) July 31st, 1897, Birmingham.
A woman developed case was as follows. diseases of the ovary and other organs in the pelvic basin, any previous knowledge of such a disorder being disavowed by her relatives. About two years after her death her widower, who was a hearty man to all appearance, contracted epithelioma; he then admitted that his father had died from an abdominal tumour in another country about thirty years previously and that his sister had died from " internal complaint." Almost contemporaneously the intimate lady friend of the lady and widower, who was engaged to be married to the latter, developed scirrhus, and, as usual, denial was made of any historical taint. The aseociate of husband and wife dwelt in a part situated miles away from her fellow sufferers. The following is an additional instance. In the case of a female who had resided in this colony for fifteen years easily recognised malignant disease appeared after certain dyspeptic symptoms, coupled with alternate diarrhoea and sickness, had prevailed for some days. She had always been strong, but her only son had been killed in a tragic fashion, and her illness dated from the crisis of the catastrophe. As usual, denials were made of the pre-existence of similar disease in the members of her family, but the coincident was announced in the person of her husband’s sister, who was not a blood relative and who had never been to the antipodes, but had died from cancer at the other side of the globe a few months previously.
HOSPITAL ABUSE. SPECIAL COMMISSIONER.) (BY
malignant
*
*
*
*
*
*
*
To sum up. A definite material organism in every individual has a concomitant mind depending upon it, and in pathology, agreement or a law of similarity obtains, which, operating as the attraction of cohesion, governs the incidence of mating. I am, Sirs, yours faithfully, LAVINGTON G. THOMPSON, M.D.Aberd. Launceston, Tasmania, June, 1897. * ’"On account of the great length of the original communication we have been compelled slightly to curtail the introductory part and to omit several of the illustrative cases.-ED. L.
"MEDICAL GEOGRAPHY AS AN AID TO CLINICAL MEDICINE." To
the
Editors
of THE LANCET.
SIRS,-Will you kindly let the following corrections in my Medical Geography, published in THE LANCET of be made in your next issue. Read at p. 238, col. 2, third line from top : " but this is due to the fact that cancer affects the river-valley systems, which protect and shelter the phthisical, whilst they harbour the materies mo,-bi of rheumatism, and its too frequent sequel heart disease," instead of what now stands; p. 239, col. 1, line 35, instead of 92, read 92.3;and at line 37, instead of "a little over I am, Sirs, yours faithfully, 12"read 10.8. ALFRED HAVILAND. Aug, llth, 1897.
address
on
July 31st,
OUR
XII.-BIRMINGHAM (continued).1 Abuse at the General Hospital.-The Measures taken at the Queen’s Hospital-The General Dispensary as the Chief Offender.-The Committee Captured by the Workmen. THE attempt at hospital reform which was initiated under the most favourable auspices some seven years ago having, nevertheless, and as described, utterly collapsed, it is now necessary to describe the present state of affairs. My first, care was to call on one of the visiting staff of the General Hospital, at which hospital the ticket system is in force except for urgency cases and accidents. If, however, any member of the staff thinks that a patient can afford to pay for medical attendance the patient can be referred to the office for inquiry. But this is not done often. There aretoo many patients for the members of the staff to think about such questions. It takes less time to prescribe than to inquire into the social position of the patient. That the majority of the applicants are poor people is proved by thefact that their numbers fluctuate according to the condition of trade. At the present moment trade is more prosperous,, so the number of patients in the out-door department has considerably decreased, thus suggesting that many of the working classes do pay for private medical advice when they As for the proposal made with a. are in full employment. view to reduce the number of out-patients, it was frankly admitted that the hospital visiting staff, but more especially the surgeons, liked to have a large number of out-patients. That cases of abuse existed at the General Hospital was. not denied, and tickets were often very injudiciously distributed. Thus an in-patient, on being told that he would soon have to leave as the time generally allowed was almost terminated, replied that he bad ’’instructed his solicitor to procure him a second ticket." In the out-patients’ depart-ment a young girl was receiving explanations as to the street where she should go so as to obtain an elastic stocking when she replied, "Oh, do not bother; the cabman will know I" But whatever fault might be found with the General Hospital for treating patients who could afford to pay my informant was of opinion that far greater abuse of this description prevailed among the frequenters of the Birmingham General Dispensary. Further, he complained that the wordcharity"had been left out of the recommenda tion tickets, and the words "a proper subject for relief " substituted. This spread the idea that hospitals were not charitable institutions and accounted for much of the abuse> This conception was still further accentuated by those hoEpitals which compelled the patients to pay registration fees. On account of subscribing to the Hospital Saturday Fundand the registration fees there were not a few working people who imagined that they only received from the hospitals that for which they had made a full and sufficient
MEDICAL MAGISTRATE.-Mr. Charles Harrison payment. Calling on one of the leading surgeons who has taken a, M.D. St. And., M.R C.S. Eng., D.P.H. Camb., has been prominent part in the agitation for hospital reform, but whoplaced on the Commission of the Peace for the city of is not on the staff of the General Hospital, I found that he Lincoln. was disposed to criticise severely this institution. A new for the General Hospital was now almost completed, building CLAYTON HOSPITAL, WAKEFIELD. - The 110th cost would amount to about £ 600 annual meeting of the Clayton Hospital, Wakefield, was held and it was said that the bed. How the medical staff ask for economy in could per on the premises on July 28th, Mr. Tew, J.P., the President, the face of such conditions? If they objected to this luxurious in the The the chair. showed that being report during past it hurt the feelings of the wealthy and eminent. year there had been 654 in-patients and 3960 out-patients. display might Both the income and the expenditure had been materially laymen who sat on the hospital committee. It was a source less than in the preceding year. Mr. J. W. Walker, one of of personal satisfaction to these committee men to be conthe surgeons, read a letter from Mrs. Louisa Milnes-Gaskell, cerned in the building of a palatial and model hospital, widow of Colonel Milnes-Gaskell, J.P., of Lupset Hall, near and they were not likely to study and understand what Wakefield, the purport of the letter being that on account might be the economic consequences on the interests of the of the
great interest which her late husband felt in the
she offered to enlarge the wing containing present Gaskell Ward so as to make an upper and a lower ward, each with beds for sixteen patients. A portrait of the late Mr. Samuel Fozzard Harrison, who not long ago bequeathed nearly R25 000 to the hospital, was subsequently unveiled by Dr. T. G. Wright, the senior physician. The portrait has been presented to the hospital by Colonel W. W. Clapham, of Manchester, and will be hung in the board-
Clayton Hospital the
room.
1
The previous articles on this subject were published in THE LANCET the following dates: (1) Sept. 26th, 1896, Plymouth and Devonport; (2) Oct. 10th, 1896, Exeter; (2 concluded) Oct. 17th, 1896, Exeter; (3) Oct. 31st, 1896, St. Thomas’s Hospital, London ; (4) Nov. 14th, 1896, Liverpool; (4 continued) Nov. 21st, 1896, Liverpool; (4 concluded) Dec. 12th, 1896, Liverpool; (5) Jan. 2nd, 1897, Manchester; (5 continued) Jan. 9th, 1897, Manchester; (5 concluded) Jan. 23rd, 1897, Manchester ; (6) Feb. 6th, 1897, Leeds; (6 concluded) Feb. 13th, 1897, Leeds ; on
(7) April 17th, 1897, Coventry; (8) May 1st, 1897, The Royal London Ophthalmic Hospital; (9) May 8th, 1897, France, United Action and Legislative Action; (10) May 15th. 1897, Leicester; (11) June 5th, 1897. Nottingham; and (12) July 31st, 1897, Birmingham.