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THE POWER OF LOCAL AUTHORITIES TO PROVIDE HOSPITALS.
1793
out-patient department, when the balance of the amount POWER OF LOCAL AUTHORITIES necessary to complete the building to the satisfaction of the TO PROVIDE HOSPITALS. corporation shall have been raised, was also passed. Other Liverpool hospitals are also seeking corporate help. To the Editors of THE LANCET. Sir Alfred H. Keogh, K. C.B , , and the Medical Service for the SIRS,-The fact that local education authorities have, lerritorial Force. with due permission, the power to establish hospitals The Director-General of the Army Medical Service (Sir and children is of for school many great importance a well-attended and representative will have read your observations with interest. There Alfred Keogh) addressed of Liverpool medical men at the town ball on gathering or now one two further 1. which arise: are questions He placed before them an outline of the Dec. 10th. Have the education authorities power compulsorily to scheme by which it is proposed to organise a comprehensive sites for Must the authorities their 2. hospitals ? acquire volunteer medical and staff in connexion with the employ in the hospitals qualified medical practitioners new Territorial Force. sanitary The Lord Mayor (Dr. Richard Caton) intrust the treatment nurses to or can they acting under the supervision of the medical officer of health for the presided. The scheme, Sir Alfred Keogh said, was one which had been really devised by the Volunteer medical officers themcounty ? 3. Must the treatment be free; if not, can the selves. So ago as 1901 a meeting of Volunteer medical authority employ inquiry officers to ascertain which parents officers heldlong at Edinburgh put forward practically every one to whole which afford the or and of the cannot, can, pay part cost4. Can the authority admit to, or exclude from, the of the proposals embodied in the official scheme and more another of Volunteer medical officers hospitals the children of ratepayers who do not send their recently at the same meeting had been made. When he suggestions practically children to the elementary schools ? 5. Can the authorities took up the position of Director-General of the Army Medical and free of charge spectacles surgical appliances ? supply 6. Can the authority decide that a child requires Service his attention had been first occupied with the of the Volunteers, because, as was well known spectacles and that his father can afford to pay for them, organisation to student of military medical organisation, the existevery and if the child comes to school without spectacles, refuse him admission and then prosecute the father for not sending ing state of affairs was far from satisfactory. There was now a declared military policy of a definitely scientific I am, Sirs, yours faithfully, the child to school ? character, under which there would be an expeditionary J. S. force equipped to take the field abroad at a moment’s We make no attempt to answer our correspondent’s notice; and in the absence of that expeditionary force the interesting category of questions in the form of an editorial whole responsibility of home defence would be undertaken footnote. He has raised points which require consideration. by the citizen or territorial army. The absence of the expeditionary force implied the removal of the regular medical -ED. L.
THE
LIVERPOOL. (FROM
OUR OWN
CORRESPONDENT.)
Medical Students’ Annual DinnerPresentation to Professor Rushton Parker. THE Liverpool medical students’ annual dinner, which took place at the Adelphi Hotel on Saturday evening, Dec. 14th, with Professor Rushton Parker as chairman, was made the opportunity for presenting Professor Parker with his portrait in oils-the work of Mr. George Hall Neale-subscribed for by past and present students of the Liverpool Medical School and other friends. The occasion signalised is the recent retirement of Professor Rushton Parker from the post of honorary surgeon to the Royal Infirmary. Simultaneously with the medical students’ dinner, at which a large number of the medical profession was present, a gathering of ladies dined together at the same hotel in honour of Mrs. Rushton Parker. The presentation ceremony was arranged for 6.30 P.M. to enable the Lord Mayor (Dr. Richard Caton) to perform the function of unveiling the portrait as he had another engagement to dine elsewhere. The Lord Mayor said that he felt great pleasure in presenting to his old friend and colleague Professor Rushton Parker a tribute of the affection in which he had always been held by his students ever since the earliest days of the University Oollege, when he (the Lord Mayor) and Professor Parker had both been engaged in teaching there. He expressed regret at the retirement of Professor Parker from the active work of the Royal Infirmary. The Lord Mayor then unveiled the portrait, which is a speaking likeness and is one of Mr. Hall Neale’s happiest and best works. Professor Parker, who was greeted with great heartiness, said that he was much touched at the kind thought which had prompted his students and friends to do him honour in such a gratifying way. He expressed great delight at the portrait. He thanked his senior colleague, Dr. Caton, for his very kind words and he also wished to thank the large number of ladies for coming to do honour to his wife. The City Connoil and Grants to Hospitals. The city council at its last meeting agreed to a resolution, subject to the approval of Parliament, to contribute a sum not exceeding E5000 towards the rebuilding of the Children’s Infirmary, such sum to be paid so soon as the balance necessary to complete the rebuilding of the infirmary has been raised by the trustees thereof. A similar clause, providing for the contribution of f.4000 to the funds of the David Lewis Northern Hospital towards the erection of an
service of the army, which was not, as a matter of fact, sufficiently large for the purposes of completely satisfying the needs of the expeditionary force, but was large enough to form a sufficiently good nucleus. The whole responsibility for the medical arrangements of the citizen army, if there were an invasion during the absence of the regular army, would devolve upon the medical profession. The leaders of military thought were thoroughly awake to the immense importance of the relation which the medical service bore to the army. There was a time when this was not so but military science was now being studied and it was now clearly realised that the battles of the future were not going to be won simply at the point of the bayonet but by the different sciences composing the army. The duty of the medical service might be summed up in the phrase-the maintenance of the fighting strength of the army. The British army being a comparatively small one made the prevention of wastage of fighting force in the field a factor of enormous value in the winning of battles. Military experts calculated that the wastage of strength in our army in the first year of a war was 80 per A large part of this cent. of the total strength. was to be attributed to medical shortcomings, lack of knowledge as to the origin and spread of disease in camps, and insufficient inspection of the men in hospital, many of whom were not sent back to fight when they were fit to take their place in the line. Large numbers of men were returned home from South Africa in the late war who ought to have been in the ranks. Our system of disease prevention and sanitation was defective in one respect-that the officers who were charged with the care of the hospitals were also charged with the sanitation of the surrounding area. That was utterly impossible, and for the correction of this defect they had the beginning of a sanitary service in connexion with which there was a sanitary school at Aldershot. Another proposal was that a sanitary committee of business men should follow the troops in time of war and assist the medical staff on the spot instead of holding a commission of inquiry after the battle. Dealing with the existing medical service of the volunteers Sir Alfred Keogh remarked that in many battalions there were four or five medical officers and no hospitals whatever. They had trained a number of men to pick up the wounded and to carry them. What they were going to do with them after picking them up and where they were to carry them nobody could say. Civil hospitals would not do for the accommodation of the citizen army. If a small army of
70,000
canvas
were
sent to
it would
only
and had to be kept under matter of a few days before 3000 on the sick list. That
Liverpool be
a
there were 20CO or condition would grow in intensity until, quite apart from epidemics, there would be 10 per cent. of the men in hospital. There was no sanitary service whatever connected
out-patient department, when the balance of the amount POWER OF LOCAL AUTHORITIES necessary to complete the building to the satisfaction of the TO PROVIDE HOSPITALS. corporation shall have been raised, was also passed. Other Liverpool hospitals are also seeking corporate help. To the Editors of THE LANCET. Sir Alfred H. Keogh, K. C.B , , and the Medical Service for the SIRS,-The fact that local education authorities have, lerritorial Force. with due permission, the power to establish hospitals The Director-General of the Army Medical Service (Sir and children is of for school many great importance a well-attended and representative will have read your observations with interest. There Alfred Keogh) addressed of Liverpool medical men at the town ball on gathering or now one two further 1. which arise: are questions He placed before them an outline of the Dec. 10th. Have the education authorities power compulsorily to scheme by which it is proposed to organise a comprehensive sites for Must the authorities their 2. hospitals ? acquire volunteer medical and staff in connexion with the employ in the hospitals qualified medical practitioners new Territorial Force. sanitary The Lord Mayor (Dr. Richard Caton) intrust the treatment nurses to or can they acting under the supervision of the medical officer of health for the presided. The scheme, Sir Alfred Keogh said, was one which had been really devised by the Volunteer medical officers themcounty ? 3. Must the treatment be free; if not, can the selves. So ago as 1901 a meeting of Volunteer medical authority employ inquiry officers to ascertain which parents officers heldlong at Edinburgh put forward practically every one to whole which afford the or and of the cannot, can, pay part cost4. Can the authority admit to, or exclude from, the of the proposals embodied in the official scheme and more another of Volunteer medical officers hospitals the children of ratepayers who do not send their recently at the same meeting had been made. When he suggestions practically children to the elementary schools ? 5. Can the authorities took up the position of Director-General of the Army Medical and free of charge spectacles surgical appliances ? supply 6. Can the authority decide that a child requires Service his attention had been first occupied with the of the Volunteers, because, as was well known spectacles and that his father can afford to pay for them, organisation to student of military medical organisation, the existevery and if the child comes to school without spectacles, refuse him admission and then prosecute the father for not sending ing state of affairs was far from satisfactory. There was now a declared military policy of a definitely scientific I am, Sirs, yours faithfully, the child to school ? character, under which there would be an expeditionary J. S. force equipped to take the field abroad at a moment’s We make no attempt to answer our correspondent’s notice; and in the absence of that expeditionary force the interesting category of questions in the form of an editorial whole responsibility of home defence would be undertaken footnote. He has raised points which require consideration. by the citizen or territorial army. The absence of the expeditionary force implied the removal of the regular medical -ED. L.
THE
LIVERPOOL. (FROM
OUR OWN
CORRESPONDENT.)
Medical Students’ Annual DinnerPresentation to Professor Rushton Parker. THE Liverpool medical students’ annual dinner, which took place at the Adelphi Hotel on Saturday evening, Dec. 14th, with Professor Rushton Parker as chairman, was made the opportunity for presenting Professor Parker with his portrait in oils-the work of Mr. George Hall Neale-subscribed for by past and present students of the Liverpool Medical School and other friends. The occasion signalised is the recent retirement of Professor Rushton Parker from the post of honorary surgeon to the Royal Infirmary. Simultaneously with the medical students’ dinner, at which a large number of the medical profession was present, a gathering of ladies dined together at the same hotel in honour of Mrs. Rushton Parker. The presentation ceremony was arranged for 6.30 P.M. to enable the Lord Mayor (Dr. Richard Caton) to perform the function of unveiling the portrait as he had another engagement to dine elsewhere. The Lord Mayor said that he felt great pleasure in presenting to his old friend and colleague Professor Rushton Parker a tribute of the affection in which he had always been held by his students ever since the earliest days of the University Oollege, when he (the Lord Mayor) and Professor Parker had both been engaged in teaching there. He expressed regret at the retirement of Professor Parker from the active work of the Royal Infirmary. The Lord Mayor then unveiled the portrait, which is a speaking likeness and is one of Mr. Hall Neale’s happiest and best works. Professor Parker, who was greeted with great heartiness, said that he was much touched at the kind thought which had prompted his students and friends to do him honour in such a gratifying way. He expressed great delight at the portrait. He thanked his senior colleague, Dr. Caton, for his very kind words and he also wished to thank the large number of ladies for coming to do honour to his wife. The City Connoil and Grants to Hospitals. The city council at its last meeting agreed to a resolution, subject to the approval of Parliament, to contribute a sum not exceeding E5000 towards the rebuilding of the Children’s Infirmary, such sum to be paid so soon as the balance necessary to complete the rebuilding of the infirmary has been raised by the trustees thereof. A similar clause, providing for the contribution of f.4000 to the funds of the David Lewis Northern Hospital towards the erection of an
service of the army, which was not, as a matter of fact, sufficiently large for the purposes of completely satisfying the needs of the expeditionary force, but was large enough to form a sufficiently good nucleus. The whole responsibility for the medical arrangements of the citizen army, if there were an invasion during the absence of the regular army, would devolve upon the medical profession. The leaders of military thought were thoroughly awake to the immense importance of the relation which the medical service bore to the army. There was a time when this was not so but military science was now being studied and it was now clearly realised that the battles of the future were not going to be won simply at the point of the bayonet but by the different sciences composing the army. The duty of the medical service might be summed up in the phrase-the maintenance of the fighting strength of the army. The British army being a comparatively small one made the prevention of wastage of fighting force in the field a factor of enormous value in the winning of battles. Military experts calculated that the wastage of strength in our army in the first year of a war was 80 per A large part of this cent. of the total strength. was to be attributed to medical shortcomings, lack of knowledge as to the origin and spread of disease in camps, and insufficient inspection of the men in hospital, many of whom were not sent back to fight when they were fit to take their place in the line. Large numbers of men were returned home from South Africa in the late war who ought to have been in the ranks. Our system of disease prevention and sanitation was defective in one respect-that the officers who were charged with the care of the hospitals were also charged with the sanitation of the surrounding area. That was utterly impossible, and for the correction of this defect they had the beginning of a sanitary service in connexion with which there was a sanitary school at Aldershot. Another proposal was that a sanitary committee of business men should follow the troops in time of war and assist the medical staff on the spot instead of holding a commission of inquiry after the battle. Dealing with the existing medical service of the volunteers Sir Alfred Keogh remarked that in many battalions there were four or five medical officers and no hospitals whatever. They had trained a number of men to pick up the wounded and to carry them. What they were going to do with them after picking them up and where they were to carry them nobody could say. Civil hospitals would not do for the accommodation of the citizen army. If a small army of
70,000
canvas
were
sent to
it would
only
and had to be kept under matter of a few days before 3000 on the sick list. That
Liverpool be
a
there were 20CO or condition would grow in intensity until, quite apart from epidemics, there would be 10 per cent. of the men in hospital. There was no sanitary service whatever connected