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THE ENDOWED HOSPITALS AND THE SICK POOR OF LONDON.
64 WE have received a, copy of Lieut.-Colonel Ewart’s report the proper principle of drainage to be adopted in the town of Bishop’s Stortford. We have not the space to notice it this week, beyond saying that the recommendations are nearly identical with those furnished by Colonel Ewart to AT the annual meeting of the Brighton and Sussex the Secretary of State for the Home Department on the Medico-Chirurgieal Society on the 6th inst., Dr. Moon was same subject in his report for the towns of Oxford, Eton, elected president for the ensuing year. Windsor, and Abington, which we had occasion to notice in terms of warm approval. DR. ROLF, of Gateshead, has acceded to the request of a ON Tuesday week Vice-Chancellor Malins gave judgment number of influential electors that he would become a candidate for a seat in the Town Council, now vacant. upon a case in dispute relative to the distribution of the effects of a lady who had left X200 to the Liverpool Royal THE Kentish ]j[e)’clO’Y reports that Mr. Farnall has been Infirmary, and, after certain legacies had been paid, the elected treasurer of the Royal Kent Dispensary; and also residue of her estate to three other Liverpool charities. The chairman of the bench of magistrates for the Greenwich decision was, that the just debts, funeral expenses, testadivision of the county. mentary gifts, and legacies ought first to be paid out of the general estate, and that after this the residue of the perTHE distribution of prizes at the London Hospital Medical sonal estate should go to the charities specified. College will take place on July 19th, at 2 P.M. The Right Hon. G. Joachim Goschen, M.P., President of the PoorDR. ILIFF, the medical officer of health for the Newington law Board, will preside. district, has reported to the vestry, with respect to the AT the Durham County Session, held last week, the over- arrangements for vaccination proposed by the Privy Council, crowded state of Sedgefield Lunatic Asylum, particularly of that he 11 cannot but regard them as throwing serious obits infirmary, was discussed; and ultimately it was decided stacles in the way, instead of furthering the object intended, to take measures for providing additional buildings. by reducing the vaccination stations in this large parish to two, and appointing one day in the week only for its perTHE members of the St. Andrews Medical Graduates’ formance." Association have arranged to make a holiday at St. Albans No doubt the interest of the place will on the 20th inst. THE ENDOWED HOSPITALS AND THE SICK induce many to avail themselves of the arrangements dePOOR OF LONDON. tailed in our advertising columns.
dians learn that the medical service is a preventive one, and that liberality to it invariably means economy in the end; whilst stinginess, on the contrary, leads to extravagant and constantly augmenting expenditure.
on
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AT a meeting of the Lambeth Vestry Mr. F. H. Fowler called attention to the objects for which the St. Thomas’s and other metropolitan hospitals were endowed, with the view of considering whether such hospitals, or some of them, should not be appropriated to the sick poor of the metropolis. Mr. Fowler stated that the question was of the deepest interest at the present moment, when it was proposed to expend more than one million in extending accommodation for the sick poor. He wished to ask why the immense sums which were collected and expended by the various metropolitan hospitals, and which were now to a great extent devoted to relieving the necessities, and administering to the wants, of many who could afford to pay for medical relief, should not rather be devoted to those indigent poor, who, from time to time, were thrown upon the unions, and for whom special accommodation was now required. In London, he said, there were 11 general hospitals, and 64 small ones, making up a total of 9192 beds ; and taking the number of inmates at 10 per bed annually, provision was made for 90,000 patients, whilst the total number accommodated last year was 78,000. In Charingcross, Middlesex, and the Royal Free hospitals there were a
THE Home Secretary has informed the Bolton authorities that he cannot sanction any further delay on the part of the Town Council in respect of the sewage of the borough, and has requested to be furnished with plans and estimates for the diversion of the sewage from the river Crool. CONSIDERABLE improvements have been carried out at Gloucester Gaol, as the result of an inquiry into the causes of the prevalence of fever therein; and the medical officer now reports that the health of the prison has greatly improved since the completion of the works. THE mansion at Highgate known as Cromwell House, has been converted into a convalescent hospital for children by the managers of the Children’sHospital in Great Ormondstreet. When fully occupied the house will receive about 100
patients.
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THE trustees of the Liverpool Northern Hospital have resolved to reduce from three to two the number of physicians to that institution. The post of junior surgeon is to cease after the resignation of the present occupant; and no number of empty beds, and in St. George’s one empty honorary medical officer will be eligible to serve on the staffgreat He wing. thought this accommodation, if properly and unless he has been engaged three years in private practice. economically administered, ought to be sufficient for the whole sick poor of the metropolis without any extra charge THE Central Committee of the Dutch Association for the, upon the rates. He thought some arrangement might be Care of Sick and Wounded Soldiers has resolved to hold, at; come to whereby these hospitals should take a portion of the sick poor, and thus save them the enormous expense of the Hague, in September, an exhibition of objects connected institutions, and the immense cost of the staff of _ with the transport, treatment, victualling, and lodging oi building officials which must follow. The large hospital of St. Thosick and wounded persons, and invites both contributor. mas, now in course of erection in their midst, might afford and visitors to it. Contributors should give notice to Dr. L the sick poor of Lambeth some accommodation, because, H. Verwey, the secretary of the Association, of any objectf3 like the other Royal hospitals, it was originally founded for the sick and indigent poor and strangers, and not for the they may intend to send before the 4th of August. ThE man who was able to earn his living. If there was any exhibition is expected to be opened about September 6th, or difficulty respecting funds, it would be better for the guardwhich day the European Statistical Congress is to be as. ians to pay towards the maintenance of the sick poor in those institutions than to build new ones. sembled at the Hague. .
,
’
’
65 The Chairman, Mr. Robert Taylor, supported the motion and said that he had no doubt the governors of St. Tho ’ mas’s Hospital would do all they could for the sick poor o: London, and that it would be desirable to see if by an means the usefulness of the hospitals could be increased. Mr. Fowler is to be commended for drawing the attention of the public to this important question. We have alread3 expressed an opinion that the hospitals of the metropolis There musi are used by many persons who ought to pay. be a large number of poor living on the brink of pauper. ism, who would escape their sad fate if admission to thesE institutions could be promptly obtained when sickness first Such cases would be more speedily and more comes on. perfectly cured than is possible in their densely-crowded dwellings, and they would be of the highest value in an instructional point of view. It is, indeed, quite impossible to exaggerate the importance of a better understanding between the managers of public hospitals and those who minister to the out-door poor. Many a Poor-law medical officer would be glad to send in for treatment cases which he cannot successfully treat himself ; and the boon to the poor person would, in that case, be of incalculable value, because it would restore him to health and independence without the degradation of associating with workhouse ,
.
at the Registrar-General’s mortality tables, observed that rr year by year these percentages vary" in consequence of epidemic disturbances ; so that in any one or two years it cannot be pronounced with certainty that the death-rate either increases or diminishes"-an admission the force of which he appears to have subsequently forgotten. To arrive at the truth, therefore, he threw the years into groups thus :-
ing
"
From these results it is made to appear that the present death-rate is about 1 per 1000 in excess of what it was thirty years ago. That our readers may form their own opinion upon this matter, we extract from the Thirtieth Annual Report of the Registrar-General the following deathrates for the English population during each of the years since registration came first into operation, as well as the rate of birth, which is an element to be considered:-
inmates.
MEDICINE, DISEASE,
AND DEATH.
IT will hardly be denied that in the papers which have appeared in this journal* under the above heading, Dr. Elam has raised points of very considerable interest to the profession. Starting with the general principle that " Medicine is, or ought to be, primarily and essentially, the Art of Healing, whatever it may be collaterally," he has been led - mainly, as it would seem, by an examination of deathrates-to the conclusion that the power of medicine in checking or controlling disease has diminished in this country. He has, in short, formulated three distinct propositions-namely : 1. That the average death-rate is slowly but constantly increasing. 2. That men die now at an earlier average age than they did thirty years back. 3. That even those diseases which are the best understood are increasing progressively in annual mortality, unchecked by any resources of art. And in developing his ideas upon these somewhat momentous questions Dr. Elam makes use of two lines of argument; one based entirely upon statistical inferences, and the other drawn from his own practical experience and knowledge. To the latter of these we shall address ourselves on a future occasion; taking this opportunity-the earliest that has occurred-of deprecating what appears to us to be the sweeping and exaggerated conclusion, that, even supposing the death-rate of the whole aggregate population to haveincreased of late years, it would It is plain upon the face of it that, in grouping several necessarily follow that our treatment of disease is less efficient together, the result will be materially affected by the years than it was. We cannot help thinking that, not only in the of selection adopted. Setting aside the rates for principle profession itself, but among those persons outside its ranks who have had any experience of statistical analysis and the the first three years, 1838-40, when registration was in its fallacies frequently met with in deductions therefrom, there infancy, and adopting Dr. Elam’s reason for throwing the will be many inclined to ask, with us, whether the statistics years into groups, we subjoin the mean annual rates of birth and death per 1000 of population, in equal periods of upon which Dr. Elam relies do really supply " the inexorable the Census year 1841 :logic of facts" assumed by him; or whether, on the con- five years, starting from trary, he has not been led astray by the semhlance of truth which figures are often apt to wear. Now we may say at once that we have little sympathy with the mistrust of statistics which with some minds amounts to a perfect craze. You may, in a sense, "prove anything mean rate for the two odd years 1866—67 is, of births by figures," just as you may by a perversion of logic prove that black is white; but the true recipe for using statistics I35-70 and of deaths 22-80. With a reservation in referis the same as Opie’s recipe for mixing colours—" With ence to the value for purposes of exact comparison of deathbrains, sir;" and used in that wise their value is undoubted. i rates for years since 1861, calculated on an estimated inLet us see first, then, how far it is true that the average ’ crease of population, it appears that, while the ratio of death-rate is constantly inereasing." Dr. Elam, on look- births has steadily and constantly increased, the quin-
The
i
11
Vol. i. 1569,
pp. 560, 775, and 809.
i
quennial
ratio of deaths has fluctuated
more or
less both
dians learn that the medical service is a preventive one, and that liberality to it invariably means economy in the end; whilst stinginess, on the contrary, leads to extravagant and constantly augmenting expenditure.
on
____
I
-
-
AT a meeting of the Lambeth Vestry Mr. F. H. Fowler called attention to the objects for which the St. Thomas’s and other metropolitan hospitals were endowed, with the view of considering whether such hospitals, or some of them, should not be appropriated to the sick poor of the metropolis. Mr. Fowler stated that the question was of the deepest interest at the present moment, when it was proposed to expend more than one million in extending accommodation for the sick poor. He wished to ask why the immense sums which were collected and expended by the various metropolitan hospitals, and which were now to a great extent devoted to relieving the necessities, and administering to the wants, of many who could afford to pay for medical relief, should not rather be devoted to those indigent poor, who, from time to time, were thrown upon the unions, and for whom special accommodation was now required. In London, he said, there were 11 general hospitals, and 64 small ones, making up a total of 9192 beds ; and taking the number of inmates at 10 per bed annually, provision was made for 90,000 patients, whilst the total number accommodated last year was 78,000. In Charingcross, Middlesex, and the Royal Free hospitals there were a
THE Home Secretary has informed the Bolton authorities that he cannot sanction any further delay on the part of the Town Council in respect of the sewage of the borough, and has requested to be furnished with plans and estimates for the diversion of the sewage from the river Crool. CONSIDERABLE improvements have been carried out at Gloucester Gaol, as the result of an inquiry into the causes of the prevalence of fever therein; and the medical officer now reports that the health of the prison has greatly improved since the completion of the works. THE mansion at Highgate known as Cromwell House, has been converted into a convalescent hospital for children by the managers of the Children’sHospital in Great Ormondstreet. When fully occupied the house will receive about 100
patients.
-
THE trustees of the Liverpool Northern Hospital have resolved to reduce from three to two the number of physicians to that institution. The post of junior surgeon is to cease after the resignation of the present occupant; and no number of empty beds, and in St. George’s one empty honorary medical officer will be eligible to serve on the staffgreat He wing. thought this accommodation, if properly and unless he has been engaged three years in private practice. economically administered, ought to be sufficient for the whole sick poor of the metropolis without any extra charge THE Central Committee of the Dutch Association for the, upon the rates. He thought some arrangement might be Care of Sick and Wounded Soldiers has resolved to hold, at; come to whereby these hospitals should take a portion of the sick poor, and thus save them the enormous expense of the Hague, in September, an exhibition of objects connected institutions, and the immense cost of the staff of _ with the transport, treatment, victualling, and lodging oi building officials which must follow. The large hospital of St. Thosick and wounded persons, and invites both contributor. mas, now in course of erection in their midst, might afford and visitors to it. Contributors should give notice to Dr. L the sick poor of Lambeth some accommodation, because, H. Verwey, the secretary of the Association, of any objectf3 like the other Royal hospitals, it was originally founded for the sick and indigent poor and strangers, and not for the they may intend to send before the 4th of August. ThE man who was able to earn his living. If there was any exhibition is expected to be opened about September 6th, or difficulty respecting funds, it would be better for the guardwhich day the European Statistical Congress is to be as. ians to pay towards the maintenance of the sick poor in those institutions than to build new ones. sembled at the Hague. .
,
’
’
65 The Chairman, Mr. Robert Taylor, supported the motion and said that he had no doubt the governors of St. Tho ’ mas’s Hospital would do all they could for the sick poor o: London, and that it would be desirable to see if by an means the usefulness of the hospitals could be increased. Mr. Fowler is to be commended for drawing the attention of the public to this important question. We have alread3 expressed an opinion that the hospitals of the metropolis There musi are used by many persons who ought to pay. be a large number of poor living on the brink of pauper. ism, who would escape their sad fate if admission to thesE institutions could be promptly obtained when sickness first Such cases would be more speedily and more comes on. perfectly cured than is possible in their densely-crowded dwellings, and they would be of the highest value in an instructional point of view. It is, indeed, quite impossible to exaggerate the importance of a better understanding between the managers of public hospitals and those who minister to the out-door poor. Many a Poor-law medical officer would be glad to send in for treatment cases which he cannot successfully treat himself ; and the boon to the poor person would, in that case, be of incalculable value, because it would restore him to health and independence without the degradation of associating with workhouse ,
.
at the Registrar-General’s mortality tables, observed that rr year by year these percentages vary" in consequence of epidemic disturbances ; so that in any one or two years it cannot be pronounced with certainty that the death-rate either increases or diminishes"-an admission the force of which he appears to have subsequently forgotten. To arrive at the truth, therefore, he threw the years into groups thus :-
ing
"
From these results it is made to appear that the present death-rate is about 1 per 1000 in excess of what it was thirty years ago. That our readers may form their own opinion upon this matter, we extract from the Thirtieth Annual Report of the Registrar-General the following deathrates for the English population during each of the years since registration came first into operation, as well as the rate of birth, which is an element to be considered:-
inmates.
MEDICINE, DISEASE,
AND DEATH.
IT will hardly be denied that in the papers which have appeared in this journal* under the above heading, Dr. Elam has raised points of very considerable interest to the profession. Starting with the general principle that " Medicine is, or ought to be, primarily and essentially, the Art of Healing, whatever it may be collaterally," he has been led - mainly, as it would seem, by an examination of deathrates-to the conclusion that the power of medicine in checking or controlling disease has diminished in this country. He has, in short, formulated three distinct propositions-namely : 1. That the average death-rate is slowly but constantly increasing. 2. That men die now at an earlier average age than they did thirty years back. 3. That even those diseases which are the best understood are increasing progressively in annual mortality, unchecked by any resources of art. And in developing his ideas upon these somewhat momentous questions Dr. Elam makes use of two lines of argument; one based entirely upon statistical inferences, and the other drawn from his own practical experience and knowledge. To the latter of these we shall address ourselves on a future occasion; taking this opportunity-the earliest that has occurred-of deprecating what appears to us to be the sweeping and exaggerated conclusion, that, even supposing the death-rate of the whole aggregate population to haveincreased of late years, it would It is plain upon the face of it that, in grouping several necessarily follow that our treatment of disease is less efficient together, the result will be materially affected by the years than it was. We cannot help thinking that, not only in the of selection adopted. Setting aside the rates for principle profession itself, but among those persons outside its ranks who have had any experience of statistical analysis and the the first three years, 1838-40, when registration was in its fallacies frequently met with in deductions therefrom, there infancy, and adopting Dr. Elam’s reason for throwing the will be many inclined to ask, with us, whether the statistics years into groups, we subjoin the mean annual rates of birth and death per 1000 of population, in equal periods of upon which Dr. Elam relies do really supply " the inexorable the Census year 1841 :logic of facts" assumed by him; or whether, on the con- five years, starting from trary, he has not been led astray by the semhlance of truth which figures are often apt to wear. Now we may say at once that we have little sympathy with the mistrust of statistics which with some minds amounts to a perfect craze. You may, in a sense, "prove anything mean rate for the two odd years 1866—67 is, of births by figures," just as you may by a perversion of logic prove that black is white; but the true recipe for using statistics I35-70 and of deaths 22-80. With a reservation in referis the same as Opie’s recipe for mixing colours—" With ence to the value for purposes of exact comparison of deathbrains, sir;" and used in that wise their value is undoubted. i rates for years since 1861, calculated on an estimated inLet us see first, then, how far it is true that the average ’ crease of population, it appears that, while the ratio of death-rate is constantly inereasing." Dr. Elam, on look- births has steadily and constantly increased, the quin-
The
i
11
Vol. i. 1569,
pp. 560, 775, and 809.
i
quennial
ratio of deaths has fluctuated
more or
less both