"A CENTRAL HOSPITAL BOARD FOR LONDON."

404

twenty- !

and

ARMY MEDICAL RESERVE OF OFFICERS. Paisley it is the lowest for the past In Aberdeen years with the exception of 1894. Surgeon-Captain James Drummond, M.D., 3rd Durham In Dundee, Volunteer it is lowest with the exception of 1885. Artillery (Western Division, Royal Artillery), to with the exception of three years, it is also the lowest be Surgeon-Captain. for the past twenty-one years, and in Perth with the VOLUNTEER CORPS. exception of four years Comparing the mean death-rate in the decade 1876-1885 and 1886-1895, we find it was lowered Rifle:: 3rd (Cambridgeshire) Volunteer Battalion thein the latter period in all the eight towns except Leith, Suffolk Regiment : Surgeon-Captain F. P. F. Ransom, 4th Volunteer Battalion where it rose fractionally; but last year, again, Leith had M.D., resigns his commission. the Cheshire Regiment : Ralph Bennett Sidebottom, gent., an exceptionally low death-rate. Following the classification Ist (Cumberland) Volunteer of the Registrar-General we find the causes of the 28,877 to be Surgeon-Lieutenant. deaths in 1896 to be as follows :-Specific febrile or zymotic Battalion the Border Regiment : Surgeon-Lieutenant C. W. diseases, 4116; parasitic diseases, 8; dietetic diseases, 115 ; Graham is appointed Second Lieutenant. 2nd Volunteer constitutional diseases, 5631; developmental diseases, 1947 ; Battalion the Durham Light Infantry: Surgeon-Major J. local diseases (including those of the nervous, circulatory, Mitchell to be Surgeon-Lieutenant-Colonel. respiratory, digestive, and urinary systems), 14,748 ; violence, THE VICTORIA CROSS. 1150 ; ill-defined and not specified causes, 1162. Generally The are the names referred to by Dr. Jameson, following speaking, the mortality from all causes was under the Director-General of the Army Medical Staff, at the conthe first six months of the it for for and over average year the second six months. The highest monthly mortality was clusion of his address, reported at p. 368 of our current in November and December, when the deaths from issue :-Surgeon-Major Thomas Egerton Hale, M.D., V.C. ; Henry Thomas Sylvester, V.C.; inflammatory affections of the respiratory organs (not Assistant SurgeonSirWilliam James Mouat, K.C B , V C. ; SurgeonSurgeon-General including phthisis or whooping-cough) constituted 265 General Sir Anthony Dickson Home, K.C.B., V.C. ; Surgeonand 24’0 per cent. respectively of the total deaths. As might have been expected from the low general Lieutenant-Colonel E. B. Hartley ; Deputy-Inspector-General Herbert death-rate, the mortality from miasmatic diseases was rela- of Hospitals Joseph Jee, C.B , V.C.; Surgeon-GeneralW. G. N. Reade, C.B , V.C. ; Taylor Surgeon-General Deputy tively light last year. From January to May whoopingWilliam Temple, C.B., V.C. ; Manley, Brigade-SurgEon the most fatal of the All was the towns epidemics. cough except Perth were affected, Glasgow, Aberdeen, and Paisley M.B., V.C. ; Brigade -Surgeon Campbell Millis Douglas, most markedly so. From that date to the end of the year M.D., V.C. ; Brigade - Surgeon - Lieutenant - Colonel James measles was the most fatal epidemic, Glasgow and Paisley Henry Reynolds, V.C.; Surgeon-Major John Crimmin, V.C. ; F. S. Le Quesne, V.C. ; Surgeon-Major being the chief sufferers. Scarlet fever was also noticeable in Surgeon-Captain 0. E. P. Lloyd, V.C., and Surgeon-Captain H. F. Whitein Leith and and There were no Paisley. September August deaths last year from small-pox in any of the eight towns. church. Roughly speaking, the temperature was higher and the rainfall lower than the average in the first half of last year, and the reverse was the case in the second half. one

Correspondence. "Audi alteram

THE SERVICES.

partem."

"A CENTRAL HOSPITAL BOARD FOR ARMY MEDICAL STAFF. SURGEON-MAJOR H. E. R. JAMES, lately returned from Hong-Kong has joined the Army Medical Staff in the Home District, and Surgeon-Major W. G. Clements has joined for duty at Chatham. Surgeon-Major E. A. Roche has taken over Medical Charge of Officers, Women and Children, and the Female Hospital at the Curragh. Surgeon-Major B. T. McCreery has been posted to Dublin for duty. SurgeonMajor J. L. Hall has joined at Woolwich for duty. SurgeonMajor W. Heffernan embarks at Southampton for Bombay. Surgeon-Lieutenant-Colonel William M. James retires on retired pay. INDIA AND THE INDIAN MEDICAL SERVICES. Surgeon- Lieutenant- Colonel Charlesworth, A.M.S., has been transferred from the Mhow District to the Bombay District. Surgeon-Captain Halt, A.M.S., on arrival from England, has been posted to general duty, Bombay District. Surgeon-Lieutenant Morgan, A.M S., has been posted to general duty, Poona District. Surgeon - Lieutenant Smith has been transferred from the Poona District to the Quetta District. Surgeon-Captain D. G. Marshall (Bengal), is appointed to officiate as Professor of Materia Medica and Pathology in the Lahore Medical College during the absence on furlough of Surgeon-Captain J. Murray, or until further orders. Surgeon-Captain J. Davidson, Bengal Establishment, is appointed to be on special duty in connexion with the famine operations in the Allahabad Division. SurgeonCaptain A. W. T. Baist, offioiating Civil Surgeon, is transferred from Ferozepore to Jhelum, relieving SurgeonCaptain J. N. Macleod.

NAVAL MEDICAL SERVICE. following appointments are announced : - Staff Surgeons : D. T. Hoskyn to the Canturion, additional, for Yokohama Sick Quarters. J. H. Thomas to the Orlando; A. H. Miller to the Royal Arthur for voyage home ; and F. J. Lilly to the Mildura, Surgeons : E. H. McSherry to The

the

Wallaroo ;

F. A. Capps to the Royal Arthur on paying off; E. C. Cridland to the Waterwitch; Stephens to the Centurion, additional, for the Esk.

Waterwztch and H. N.

LONDON." Editors of THE LANCET. SIRS,-Will you kindly allow me to give my reasons for moving the amendment (reported in your issue of Jan. 30th) to Sir William Broadoent’s resolution regarding the abovenamed scheme at the meeting of the Council of the Charity Organisation Society on Jan, 25th. In the first place, I should state that from my experience of the previous meeting of the Council I feared that unless some such amendments were moved there would be little or The Charity no attempt made to oppose this scheme. Organisation Society in its endeavour to obtain a better system of management of the London hospitals is undoubtedly proposing a good work and one which the society is specially fitted’ to undertake, and from the evidence so far obtainable thescheme of a Central Hospital Board meets with the approval of the general public and of a portion of the medical profession. Is not this, however, probably in great part due to the able advocacy of Mr. Loch and to the invaluable support of Sir William Broadbent ? In the draftscheme it is acknowledged that a Central Board of 169 delegates, as proposed, would be a large and unwieldy representative body. Consequently the Executive Committee would do the work, and in time this would pass to an inner ring of men and women who, by giving up their time to it, would hold the reins of power ; and what then would become of fair representation ? The Board should have, it is stated, an income of, say, £20,000 per annum, and it is proposed that the Board should make grants to hospitals and dispensaries to facilitate their removal, if requisite, to other districts and to meet other special needs, but no reference is made to the working expenses of this Board. Perhaps it is intended, as suggested by the Select Committee of the House of Lords, that these. should be defrayed by levying a small percentage on the income of the hospitals sending delegates. If this Board only obtained an income of .620,000 per annum of what use would that be towards giving grants, as proposed, to institutions whose combined incomes, exclusive of legacies, was in 1892. £600,000 per annum. If, on the other hand, the Central Board scheme were accepted by the public and legacies were: To

the

405

suggested) to this board, instead of to individualare humble and submissive may soon receive hints that they hospitals, a vast sum of money might in course of years passare not as strong and as capable of work as they were, and into its hands and with this a dangerously controling powerstronger persons take their places perhaps at lower wages. which would ruin the individuality of the hospitals, destroy In the course of years philanthropy may possibly be changed all healthy rivalry, bring them to one dead level, and if into a sort of tyranny. I think, too, I have had a hint that wielded by a small clique might sap the foundations of our some of the smallest hospitals had better be transported old and well-deserving charities. elsewhere, while the painful lives led by others are out of Perhaps I have pointed this in too strong colours but kindness to be cut short for the good of the rest. But, when surely it is a point worthy of the deepest consideration, and I think of the weakness and powerlessness of many hospital though it is distinctly stated that the Board does not intend beginnings I have known, extending over years and years to interfere with the hospitals, what will become of inten- when they lived almost upon hope alone, but have neverthetions when it holds these institutions in a golden grip ?7 less gained in strength so as to be of the greatest service to Then, with regard to inspectors, it is stated in the draft large districts, I tremble for the fate of some which are now scheme that there is no general system of supervision that in that unfortunate condition ; but I cannot see why in this insures that defects or abuses are brought to light by in- country, or on what principle, they should be destroyed. We spection and remedied by the common sense of the admini- are all familiar with weak and wretched babes in early stration stimulated by the fear of publicity." Such must be infancy and during childhood who grow into strong, useful, the duty of the Board’s inspectors "that it may act and and long-lived members of society. I doubt whether several report with a competent knowledge of the facts." of the youngest and best of our hospitals would in Surely our great hospitals which have stood some of their early years have parsed the ordeal of the proposed them the test of centuries do not require the super- Central Board in their infancy. I well remember the slow vision of a Central Board with its inspectors, whose progress of one of the last and best of our hospitals-now knowledge of their interior economy cannot be so great as admirably placed, arranged, and managed - the Great, that of their own boards. If, however, such inspections were Northern. I say nothing concerning the early life of my to be made, where are the qualified men and women to be own hospital, but I trust that help will flow direct to found who would devote their time to this work as volun- University College and that the 15,000 required may be teers ? Paid inspectors would have to be appointed of high sent to it direct before the fifty beds have to be closed and probity and special capability, and a serious expenditure long before the 20,000 a year is paid over to the Central incurred thereby. Board to be divided amongst us according to our merits as. Lastly, should this Board become all-powerful and dic- appraised by that authority that is to be. I am, Sirs, your obedient servant, tatorial, personal interest in individual hospitals would be much shaken thereby. Believing, however, that much LIONEL S. BEALE. Feb. 4th, 1897. might be done for the more systematic management of our hospitals, it occurred to me that the Charity Organisation THE TREATMENT OF MYOMA. Society could well draw up recommendations to such effectI To the Editors of THE LANCET.

left (as

which, after consultation, would

meet with the cordial

I

render SIRS,—The statement made in the columns of THE LANCET all its of Jan. 23rd that the Gynaecological Society had for three or four years insisted that total extirpation of the uterus was the best treatment for these tumours seems to me somewhat premature, as I do not think that many, if any, ARTHUR B. R. MYERS, cases of this operation had occurred so far back as four years Brigade-Surgeon-Lieutenant-Colonel. Brigade-Surgeon-Lieutenant-Colonel, Gloucester-street, S.W., Feb. lst, 1897. ago in British practice. Those who gave utterance to this sentiment as that of the society form, no doubt, an extremely important section of it; but it is equally certain that an To the Editors of THE LANCET. important minority will not give their sanction to any such SiRS,—! wonder if it has occurred to Mr. Loch and his opinion. I think it probable, for example, that Dr. Bantock friends that our hospitals were not built or managed by and myself could make up a larger list of cases of myoma them, that those who have given largely to the existing treated in vatious ways than all the other members of the hospitals do not often complain of their extravagance or bad Gynaecological Society put together, but neither he norl. management and do not inquire, for instance, how many have made up our minds as yet definitely on the subject-at chickens our sick consume in a year or tell us we have least, I can speak for myself. I have tried a number of cases of the so-called" pan-hysterecbomy," and have a list much no business to order chickens and such-like dainties to people who are classed as "proper objects"of charity. longer than any yet published in England, and I do Perhaps I am wrong, but I never like to ask a person, sick or not find that it commends itself to me in preference well, whether he or she is an object. I don’t think, to Koeberle’s method save in the one particular of however, I have been more often deceived during the being somewhat easier. Indeed, in those cases for which last forty years than the best of "organisers," and it is adapted I cannot understand how an hour and a half certainly have seen a few organising friends mis- or even an hour can be spent over it unless the proceeding Its. taken in their judgment. But I daresay I am pre- is much interrupted by unnecessary conversation. judiced against this organising business as regards sick primary mortality, so far as my own work is concerned, people. Considering that a dose or two of what costs but a is much the same as the clamp operation, but it is too early small fraction of a halfpenny may give relief in cases of to speak positively upon this important point. As adverse severe pain, I should order the medicine or send the patient arguments to the operation there are several points to conto bed without considering in what class of objects he ought sider, the first being that there is a distinct group of cases. to be placed. Few among us, I should think, would like to for which it is absolutely inapplicable, and these, unfortuask a patient before examining and prescribing whether nately, are the cases which demand hysterectomy most of he had his fee ready, and few of us quite like to all-I mean the soft oedematous myomata. In the tumours put up in large print near the door or in the , having uterine tissue at their base, firm, not given much to dining-room—Mr. X’s fee is so much, though I have shrinking, and with vessels well-defined and separate, the been told by students that, when about to pay for the operation can be easily applied. On Thursday last I operated for one of the former class of luxury of going in for a certain examination, before the door tumours and started with the intention of trying the panwas opened wide enough to see anything inside a voice was heard "Hev yer got yer fee?" All this, however, is a hysterectomy, but found it absolutely impossible. It is, matter of opinion, and we don’t need to be set right (or however, upon secondary results that the fate of this operation will depend, and I have seen already enough of them towrong) by a Central Board. Several hundreds of the profession have given their make me suspect that it will be speedily discarded. The support to the proposal, but probably few have thought hjwreason is the unfortunate effects of the ligature, a paper on the Board would work. They would give great power towhich I published some time ago. In this operation the the Beard, but has it occurred to them that Central Boards! ligature is not dropped into a peritoneum, which speedily are prone to gain in importance as they get older, and the digests and absorbs it, but is pressed among tissue peculiarly more oower they acquire the more they demand. After aL apt to resent interference. fex Board generations, those who worked for the earlier ones; Concerning the lower ligatures it must be borne in mind as free men become poorly paid servants, and unless they they are placed with nothing between them and the

approval of well- constituted hospital committees and the formation of a Central Hospital Board, with attendant expenses, quite unnecessary. I am, Sirs, yours faithfully,

r that