HOSPITAL OUT-PATIENT REFORM.

144 2. A. E. T-aged eighteen months, male (No.in Mr. Hutchinson’s appendix). A fat, well-grown, hearty-looking boy. On the left arm are two large dusky-coloured marks of vaccination, which are scaling on the siirface, but not ulcerated; these have a thickened base precisely similar to the preceding case. There is a general mottling of the trunk, which is fading, and a few small scaly spots resembling those in foregoing patient, and scattered over the abdomen. The glands in each groin are very distinct. There is well-marked ulceration of both tonsila. The mother of these children is a healthy-looking woman. She had not suffered from illness. A rigid cross-examination failed to elicit any history of previous syphilis in herself or either of her children. 3. W. C-,aged ten, male (No. 3 in Mr. Hutchinson’s z, appendix. This case was not reported at the Royal Medical and Chirurgical Society). A spare lad, but not unhealthy in appearance; his mother says he has lost flesh lately. On the left arm the cicatrices of vaccination in infancy show plainly, and below these are two large sores covered with crusts, with well-defined thickened circumscribed bases, surrounded by a dusky areola. The glands in the corresponding axilla are enlarged. The inguinal and post-cervical glands are very perceptible to touch. There is a scaly eruption, for the most part in small annular patches, On each tonsil over the trunk and limbs, which is fading. is a deep vertical ulcer, with a grey unhealthy surface. The mother is a tall, healthy-looking woman. She has never had any serious illness, and no history of previous syphilis in herself or her boy could be obtained. These three cases were vaccinated on the same day, and the ulcers resulting have never healed, but have slowly increased in size. There has been no treatment in any of them. In our opinion these three cases present unequivocal evidence of constitutional syphilis, and we see no reason to doubt, from the appearances presented by the arms, and fr0m the history of the cases, that the disease had been conveyed by vaccination. As to the method in which vaccination was performed in these cases, and the character of the fluid inoculated, whether lymph, blood, or both, we could obtain no satisfactory evidence, and with regard to this question we may refer to the remarks made by Mr. Hutchinson in the appendices to his paper, where such facts as could be elicited are recorded. SAMUEL WILKS, CsEO. G. GASCOYEN, (Signed) WM. S. SAVORY, THOMAS SMITH.

The following case was shown to Dr. Wilks by Mr. Hutchinson on May 19th, being one of the second series. in Mr. Hutchinson’s 4. Female, aged fourteen (No. second appendix). There was a round red sore on the arm, raised and granulating. Over the body and arms was a well-marked eruption of bronze-coloured, scaly, raised spots. The tonsils were swollen, and slightly ulcerated. SAMUEL WILKS. (Signed) ,

HOSPITAL OUT-PATIENT REFORM. THE Committee appointed at the late meeting to carry O’.1t the resolutions for reforming the out-patient department of hospitals had a conference with the Council of the Charity Organisation Society on Monday last, when it was resolved that the Council should co-operate with the Committee, and accompany a deputation to the President of the Poor-law Board. The Committee also invited Dr. Stewart, the secretary of the Metropolitan Branch of the British Medical Association, and Dr. Rogers, of the Poor-law Medical Officers’ Association, to accompany the deputation. At the interview with Mr. Stansfeld, Sir Charles Trevelyan opened the proceedings, and gave a history of the movement. He drew attention to the extremely valuable reports issued by the Committee on out-patient reform, and said that the one on General Hospitals was drawn up on the soundest principles, and was highly honourable to the profession from which it emanated. The deputation asked for the assistance of the Poor-law Board on the ground that there should be no systematic gratuitous medical relief which was not under the control and supervision of the

Poor-law authorities ; and that it was most important that the Poor-law medical relief should be greatly improved. Dr. Stallard, after giving a history of the out-patient system, which he said had grown to its present magnitude in consequence of the shortcomings of the Poor Law, drew attention to the recommendations of the Committee for the improvement of the Poor-law medical relief. Whilst admitting that great improvements had been effected, and many very well managed dispensaries had been recently introduced, there was still very much remaining to be done, and the Committee asked the President to put such an amount of pressure upon the guardians as to induce them to carry out the Metropolitan Poor Act uniformly throughout the metropolis. He thanked the President for having already fulfilled one of the recommendations of the Committee by issuing regulations for the government of these dispensaries; and they hoped he would adopt another by placing them under the charge of a special inspector, who should be authorised to visit them regularly, and rpport to Parliament annually as to their efficiency. Such inspectors would act as educational agents to the guardians, and obviate the necessity of putting any objectionable central authority in force. He further pointed out that the Committee did not wish to put all gratuitous medical relief under the Poor Law with the object of extending it to any class which ought to be called upon to pay for it; but rather to prevent persons from obtaining gratuitous assistance who were able to pay, the Poor-law authorities alone having the necessary machinery of investigation. The Committee further offered to the President a line to determine who were destitute, for if a man could not contribute a penny per week to a provident dispensary, he was undoubtedly in a position to require gratuitous relief. Addresses were made by Mr. Timothy Holmes, Dr. Stew art, Dr. Rogers, and Dr. Hawksley. Dr. Stewart gave his experience as to the pauperising tendency of the present system. He suggested that this manufacture of paupers must be a matter of deep interest to the President of the Poor-law Board, and that the hands of those engaged in reforming it would be greatly strengthened if the President would ask the governing bodies of the hospitals and dispensaries for information, and express his opinion on the matter in Parliament or otherwise. Mr. Stansfeld, who expressed himself as greatly obliged to the deputation for laying the facts he had received before him, said he was most desirous of meeting with members of these societies for the purpose of discussing these questions. He was convinced of the evils of which they had spoken, and he well knew the value of voluntary efforts in aid of the legal or regular forces in lessening those evils. Their opinion, as he gathered it, was that there should be no gratuitous medical relief, except under the Poor-law Board. The Poor-law Board could not control the free action of institutions supported by voluntary subscriptions, and this could only be done by appealing to the public, and by influencing the organs of public opinion to stop such evils by exposing their dangers. He stated that the Poor-law Board was proceeding to urge forward the dispensary system in town, under the Act of 1867, and even in the country, where the board had no power of enforcing its views on this point as yet, the system was being adopted by guardians, whom he had found generally willing to take advice. Speaking of a proposed "general system," he expressed his confidence in a local rather than in a centralised system, and he thought that, though local action caused delay sometimes, yet that, on the whole, it worked better than the over-ruling and over-governing found in a centralised system. He quite agreed as to the necessity of the provident dispensary system, but said it rested with the

public. The

deputation thanked Mr. Stansfeld

and Mr. Hibbert,

M.P., for their attention, and withdrew.

DINNER TO MM. RICORD AND DEMARQUAY. ON the 17the inst. a most touching demonstration took place at Willis’s Rooms-a demonstration which does considerable credit to the élife of the profession of London, and which must have been most gratifying to the eminent who were the subjects of the cordial welcome bestowed

men