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LONDON VOLUNTARY HOSPITALS: A STATISTICAL REVIEW 1
401 It is to be spent partly of course college, and on new gymnasiums, playingfields, swimming-baths, and other means of healthy a
year after that.
on
the
new
recreation. central voluntary but grants will be
physical
It will not be handed
over
to
organisations for distribution, given to them mostly for some express project or to help them to assist local voluntary bodies. In particular grants are to be made to the Central Council of Recreative Physical Training, so that it may give expert advice on forms of physical recreation and provide for the training of teachers and leaders while the new college is being established. This central council, which is composed itself of all national organisations (over 100 in all) concerned in any form of physical recreation, only came into being about eighteen months ago. Already its activities are widespread and judging by its third " News Leaflet" it is engaged in encouraging just those activities that the Government wish to stimulate. It can be no mere coincidence that the Council was formed so opportunely, for it is proving an essential link between the Government organisation and the host of voluntary and other bodies with whom the Government plans to cooperate. Boxing, camping, cycling, dancing, games, athletics, and swimming are all within its province offering assurance that the Government plans to interpret physical recreation in a wide sense. Even these enjoyable employments cannot replace the delights of leisure in the country ; moreover, as the Manchester Guardian puts it, "lack of sun, bad atmosphere, small and insanitary houses, and, above all, too little of the right food and not enough of any will no more be cured by exercise than lunacy was cured by a strait-jacket." But regarding the Government’s proposals as a palliative rather than a panacea we must nevertheless accept them gratefully. LONDON VOLUNTARY HOSPITALS:A STATISTICAL REVIEW 1
voluntary hospitals had a beds ; in 1935 they had 18,020, which were, moreover, used to greater advantage, for not only has the average number of occupied beds risen, during the same period, from 11,070 to 15,110, but the average stay of each inpatient has been shortened by three days. The number of new in-patients admitted was 172,200 in 1921 and 274,100 in 1935. Less satisfactory from some points of view is the increase of the annual number of out-patients from 1,545,000 to 1,872,000 and of out-patient attendances from 6,661,000 to 9,777,000. These figures, showing over three million IN 1921 the London complement of 13,300
attendances in 1935 than in 1921, demand careful consideration in view of the suspicion, often expressed but difficult to prove, that the hospitals are here encroaching upon the domain of private practice. An ingenious if not entirely reassuring explanation of the increased attendances is offered by King Edward’s Hospital Fund in this statistical survey, where it is pointed out that the average number of attendances per out-patient was 4’3 in 1921, 5 in 1930, and 5-2 in 1935. The suggestion is that the large number of attendances is associated with the modern conception of the proper function of an out-patient department-i.e., its development on consultative lines and the provision of facilities for specialised long-term treatments ; while patients with more
trivial
complaints " that
do not
require hospital
treat-
1 Statistical Review of the Work and Finance of the London
Voluntary Hospitals for the year 1935. Published by King Edward’s Hospital Fund for London. Pp. 44. 1s.
ment or for which other more suitable agencies are available " are discouraged. Support is found for this theory in the fact that the annual number of new out-patients, which increased by 342,000 during the period under review, is now approaching a fairly constant figure, the increase having been only 67,000 in the last five years of the period. On the financial side the total receipts; including donations of capital and endowments, have risen from 3,440,000 to 5,100,000. It is of interest that in 1921 the percentage of the total receipts made up of voluntary gifts was 59-0 and in 1935 only 53-9, while the percentage of receipts for services rendered was respectively 25-8 and 33-2. Under this last are included from receipts contributory heading schemes, notably the Hospital Saving Association, from local authorities, and from patients direct, including pay-bed patients. The rest of the total receipts are derived from investments, in proportion (13 to 14 per cent.) of the total not materially changed since 1921. The annual maintenance income has risen from z2,751,000 in 1921 to what is described as the "imposing figure" of nearly 4,200,000 in 1935. This income has been sufficient to provide an aggregate credit balance in all but 2 of the 15 years for ordinary running expenses, though special help from the public is needed and will continue to be needed for any rebuilding, extension, or major improvements. Attention is drawn to the astonishing growth of voluntary payments by patients; this is a most encouraging feature in so far as it reflects public confidence in the voluntary hospitals and is not allowed to destroy their charitable purpose. We have known instances of refusal to attend, or to return to, a hospital by those ashamed to admit inability to contribute to the cost of their maintenance and treatment. This deplorable outcome of a too business-like reception is fortunately rare when the services of judiciously trained almoners are available and it is satisfactory to know that more and more
hospitals
are
employing them.
of Surgeons of England is dinner next Monday its Hunterian festival holding In the at 4 afternoon, o’clock, Prof. G. E. evening. Gask will give a special lecture entitled John Hunter in the Campaign in Portugal (1762-63). Sir Thomas Dunhill has chosen the surgery of the thyroid gland as the subject for the Lettsomian lectures which he is giving to the Medical Society of London on Feb. 15th, 24th, and March 1st. He.will speak at the house of the Society, 11, ChandosTHE
Royal College
street, W., at 9
P.M.
ON Thursday, Feb. 18th, and the following Tuesday Dr. P. M. D’Arcy Hart will deliver the Milroy lectures to the Royal College of Physicians of London at 5 P.M. He will speak on measures for the prevention of pulmonary tuberculosis among adults in Englandin the past and in the future. Members of the medical profession will be admitted on presentation of their cards.
INDEX TO " THE LANCET," VOL. II, 1936 THE Index and Title-page to Vol. II, 1936, which was completed with the issue of Dec. 26th, is now in A copy will be sent gratis to subreceipt of a post card addressed to the Manager of THE LANCET, 7, Adam-street, Adelphi, W.C.2. Subscribers who have not already indicated their desire to receive Indexes regularly as published should do so now.
preparation. scribers
on
year after that.
on
the
new
recreation. central voluntary but grants will be
physical
It will not be handed
over
to
organisations for distribution, given to them mostly for some express project or to help them to assist local voluntary bodies. In particular grants are to be made to the Central Council of Recreative Physical Training, so that it may give expert advice on forms of physical recreation and provide for the training of teachers and leaders while the new college is being established. This central council, which is composed itself of all national organisations (over 100 in all) concerned in any form of physical recreation, only came into being about eighteen months ago. Already its activities are widespread and judging by its third " News Leaflet" it is engaged in encouraging just those activities that the Government wish to stimulate. It can be no mere coincidence that the Council was formed so opportunely, for it is proving an essential link between the Government organisation and the host of voluntary and other bodies with whom the Government plans to cooperate. Boxing, camping, cycling, dancing, games, athletics, and swimming are all within its province offering assurance that the Government plans to interpret physical recreation in a wide sense. Even these enjoyable employments cannot replace the delights of leisure in the country ; moreover, as the Manchester Guardian puts it, "lack of sun, bad atmosphere, small and insanitary houses, and, above all, too little of the right food and not enough of any will no more be cured by exercise than lunacy was cured by a strait-jacket." But regarding the Government’s proposals as a palliative rather than a panacea we must nevertheless accept them gratefully. LONDON VOLUNTARY HOSPITALS:A STATISTICAL REVIEW 1
voluntary hospitals had a beds ; in 1935 they had 18,020, which were, moreover, used to greater advantage, for not only has the average number of occupied beds risen, during the same period, from 11,070 to 15,110, but the average stay of each inpatient has been shortened by three days. The number of new in-patients admitted was 172,200 in 1921 and 274,100 in 1935. Less satisfactory from some points of view is the increase of the annual number of out-patients from 1,545,000 to 1,872,000 and of out-patient attendances from 6,661,000 to 9,777,000. These figures, showing over three million IN 1921 the London complement of 13,300
attendances in 1935 than in 1921, demand careful consideration in view of the suspicion, often expressed but difficult to prove, that the hospitals are here encroaching upon the domain of private practice. An ingenious if not entirely reassuring explanation of the increased attendances is offered by King Edward’s Hospital Fund in this statistical survey, where it is pointed out that the average number of attendances per out-patient was 4’3 in 1921, 5 in 1930, and 5-2 in 1935. The suggestion is that the large number of attendances is associated with the modern conception of the proper function of an out-patient department-i.e., its development on consultative lines and the provision of facilities for specialised long-term treatments ; while patients with more
trivial
complaints " that
do not
require hospital
treat-
1 Statistical Review of the Work and Finance of the London
Voluntary Hospitals for the year 1935. Published by King Edward’s Hospital Fund for London. Pp. 44. 1s.
ment or for which other more suitable agencies are available " are discouraged. Support is found for this theory in the fact that the annual number of new out-patients, which increased by 342,000 during the period under review, is now approaching a fairly constant figure, the increase having been only 67,000 in the last five years of the period. On the financial side the total receipts; including donations of capital and endowments, have risen from 3,440,000 to 5,100,000. It is of interest that in 1921 the percentage of the total receipts made up of voluntary gifts was 59-0 and in 1935 only 53-9, while the percentage of receipts for services rendered was respectively 25-8 and 33-2. Under this last are included from receipts contributory heading schemes, notably the Hospital Saving Association, from local authorities, and from patients direct, including pay-bed patients. The rest of the total receipts are derived from investments, in proportion (13 to 14 per cent.) of the total not materially changed since 1921. The annual maintenance income has risen from z2,751,000 in 1921 to what is described as the "imposing figure" of nearly 4,200,000 in 1935. This income has been sufficient to provide an aggregate credit balance in all but 2 of the 15 years for ordinary running expenses, though special help from the public is needed and will continue to be needed for any rebuilding, extension, or major improvements. Attention is drawn to the astonishing growth of voluntary payments by patients; this is a most encouraging feature in so far as it reflects public confidence in the voluntary hospitals and is not allowed to destroy their charitable purpose. We have known instances of refusal to attend, or to return to, a hospital by those ashamed to admit inability to contribute to the cost of their maintenance and treatment. This deplorable outcome of a too business-like reception is fortunately rare when the services of judiciously trained almoners are available and it is satisfactory to know that more and more
hospitals
are
employing them.
of Surgeons of England is dinner next Monday its Hunterian festival holding In the at 4 afternoon, o’clock, Prof. G. E. evening. Gask will give a special lecture entitled John Hunter in the Campaign in Portugal (1762-63). Sir Thomas Dunhill has chosen the surgery of the thyroid gland as the subject for the Lettsomian lectures which he is giving to the Medical Society of London on Feb. 15th, 24th, and March 1st. He.will speak at the house of the Society, 11, ChandosTHE
Royal College
street, W., at 9
P.M.
ON Thursday, Feb. 18th, and the following Tuesday Dr. P. M. D’Arcy Hart will deliver the Milroy lectures to the Royal College of Physicians of London at 5 P.M. He will speak on measures for the prevention of pulmonary tuberculosis among adults in Englandin the past and in the future. Members of the medical profession will be admitted on presentation of their cards.
INDEX TO " THE LANCET," VOL. II, 1936 THE Index and Title-page to Vol. II, 1936, which was completed with the issue of Dec. 26th, is now in A copy will be sent gratis to subreceipt of a post card addressed to the Manager of THE LANCET, 7, Adam-street, Adelphi, W.C.2. Subscribers who have not already indicated their desire to receive Indexes regularly as published should do so now.
preparation. scribers
on