1097 decima consurgit inde. Si autem quantum ad intrinseca dupliciter aut quo ad theoricam seu practicam et reliqua. Ideo si quidem sufficienciae modus ceteris posset adaptari quaesitis, ut quorundam est studium. Sed quia potius curiositatem cum prolixitate adducit quam utilitatem in his idque deinceps omittatur quaesitis. ,
a patient able to pay or the person whose negligence caused the accident refund the cost of the treatment had, at any rate in one instance, especially in regard to motor-car dents, worked admirably. On the suggestion of Dr. FRANK FOWLER We are indebted to the Rev. H. Lucas, S.J., of Stonyhurst words"whom the hospital board shall consider unable College, for assistance in the following paraphrase. The the to pay for medical attendance" were added to the original in one at least the text is obscure of :place meaning and the motion as amended was adopted. The object of the science of medicine is the human body, as capable proposal of cure. Like the other branches of learning, it may be considered from Pay,ntent for foot and Medicine. two points of view- namely, the intrinsic or the extrinsic. Of these two, the former may have reference severally to the formal, the HOLLAND (chairman of the London Hospital) Mr. SYDNEY material, the efficient, and the final cause. The formal cause-i.e., the moved :of if considered be "curableness," generally, may regarded quality either (1) in relation to the perfection itself, i.e., health, and so we That where they can afford to do so hospital patients ought to arrive at the first division, the " prima differentiarum," of the subject, be asked to pay for the food, medicines, and bandages supplied to in in is to be attained relation to the which the or (2) way perfection hem. in if more it be its But taken specially may regarded (3) (modus). entirety, or (4) as toits intellectual, or (5) its affective side. (This All hospitals, he said, especially London hospitals, were in i a serious financial passage is very obscure.) With regard to the material cause, the position. Hospital authorities were making (?), this may be regarded either (6) as an object of diagnosis or the a mistake in not asking patients whether they could great to of its or with the state reference ror defect, (9) knowledge present It was normal or permanent state to which it is to be brought. The efficient afford to contribute towards their treatment. cause of health is (7) the medical man (artifex), and (8) his drugs, unsound to give everything to everybody for economically rules for their use, &c. (ars). The final cause is (10) health. nothing, whether they could afford to pay or not. At the It will be noted that Petrus skips from No. 6 to No. 9 for no London Hospital last year 157,000 persons paid sums repreapparent reason. Thefour causes " above mentioned are senting E2000 without any pressure being put upon them. the Aristotelian causes. In the Middle Ages a great deal of The charitable work of hospitals ought to be restricted to ingenuity was expended on treating all manner of subjects providing for the sick poor that help which they could not in the light of this fourfold causality. Petrus, however, afford to pay for themselves. seems to have had an idea that arguments of this kind were Mr. W. CARNT (Manchester Royal Infirmary) said a large not altogether commendable, for it will be noted that the proportion of the in-patients at his institution paid sums passage which we have quoted concludes, " But as this ranging from 2s. 6d. to 7. 6d. per week. By this means discussion tends rather to vain and wordy disputation £ 1000 or 1200 ayear were added to the income of the than to any useful purpose, let us here cease from our Royal Infirmary. Mr. R. CAPES (chairman of the South London Hospitals inquiry."-ED. L. Committee) said if the hospital authorities would reduce the number of out-patients by sending trivial cases to the THE UNITED HOSPITALS CONFERENCE. general practitioner they would have enough money for their other requirements. Dr. HENRY DAVY (President of the British Medical THE third United Kingdom Hospitals Conference was held Association) opposed the proposition and said the question of on April lst and 2nd at University College, Gower-street, payment raised that of the whole charitable hospital system London, W.C., under the chairmanship of Mr. CHARLES of the country. He preferred the German system of muniLUPTON, chairman of the General Infirmary, Leeds. There cipal hospitals. Dr. G. A. HERON (City of London Hospital for Diseases of was a large representative attendance. the Chest) said the sooner reliance on State support of eligibility for Hospital Treatment. hospitals came the better. This system of payment, small On the opening day, April lst, Mr. H. C. GOSNELL (City though it was, struck at the root of all true charity. There of London Lying-in Hospital) in discussing this question was the greatest difficulty in separating those who were argued that poverty or want of means should not be con- necessitous from those who were not. He knew of people sidered the only test in determining a patient’s inability to in receipt of q800 per annum who habitually used the outpay for hospital treatment. Among the middle classes, and patient department of free hospitals. Mr. R. G. PATERSON (Glasgow Eye Infirmary) said the particularly the lower middle clashes, there were a large number of persons who wore black coats and who showed no working class who supported that institution looked upon external evidence of poverty, yet who were equally as de- treatment as a right and to ask for payment would shut off serving of the benefits of charitable institutions as the a large portion of their income. labouring classes. As an amendment to the proposal dis- Dr. E. L. Fox (Plymouth) supported the proposal. cussed at the last conference-namely,’’ That inability to Mr. SYDNEY HOLLAND said his hospital had never lost a pay should be the consideration for the admission of all farthing support in consequence of making a charge nor had the system either increased or decreased the number of patients," he movedThe class that the hospitals existed for was the That in determining the question of the suitability of patients for patients. admission into hospitals, particularly with reference tc/ their inability class just above the necessitous poor. The clerk in receipt to pay for adequate treatment, poverty or want of means should not of .E200 a year was a proper person for help but he ought to be deemed the only test of the patient’s eligibility for admission, but be asked to pay for the food, medicine, and bandages supplied persons should be deemed eligible whether they belong to what are termed the working or industrial classes or not, if, owing to their him. obligations being disproportionate to their means, they are unable to The proposition was carried. pay for the professional services of a medical attendant. Mr. R. B. DoBSON (Brighton) seconded the amendment Investigation of Cases. which on being put to the vote was lost. The original proLieutenant-Colonel MONTEFIORE (Charity Organisation posal discussed at the last conference was therefore endorsed Society) moved :by the present conference. That in the opinion of this conference the appoinment of trained hospital almoners constitutes one of the best methods for checking the Gratuitous Treatnaent n Compensation Cases. misuse of hospitals and for rendering more effective the economic value of an out-patient department. Mr. HARRY JOHNSON (Leicester Infirmary) moved :This on being seconded was carried. That it is desirable to supply gratuitous hospital treatment to those ’ who are provided for by the Workmen’s Compensation Act. Paynaent by Patients at Cottage Hospitals. He pointed out that it would be wrong to deprive persons On the second and concluding day, April 2nd, the proreceiving benefit under the Workmen’s Compensation Act, which could not exceed 1per week, of the help which they ceedings commenced with the adoption of a proposition by would otherwise receive. The best way to obtain payment Colonel J. G. CURTIS (Deal and Walmer Victoria Hospital) to from the working classes was to ask them to contribute the effect that some definite steps should be taken to ascertain the ability or the contrary of each patient at a during health. Dr. J. A. MACDONALD (Taunton) urged that the hospital cottage hospital to pay for his or her maintenance. almoner should deal with cases on their ’merits. He said Hospital ACC01tntS. there were instances in which men who came under the Act On the motion of Dr. Fox the committee was instructed to received substantial sums weekly from friendly societies. Mr. J. H. SHAW (Southport) said that the rule of making consider how the uniform system of accounts recommended
acci(Bournemouth)
body I’
to
.
1098 The amendment was seconded by Dr. HERON and, being by King Edward’s Hospital Fund could be made applicable to the requirements of provincial hospitals and to make accepted by the Rev. Mr. BLISSARD, was carried unanimously. recommendations to the next conference. Medioal Men and Hospital Boards. County Hospital Guild. Dr. J. h’oRV ANDERSON proposed :Mr. R. H. KiNSEY (Bedford County Hospital) discussed That with the view of securing the cordial support of hospitals by the organisation of county guilds for the support of hospitals, medical practitioners, it is desirable that they should nominate repreof sentatives for election to boards of in their in Bedfordshire, as an alternative to the extension of the work of the League of Mercy in the provinces. He proposed a motion approving of the scheme adopted by the Bedfordshire County Hospital. This institution supplied the hospital needs of an area containing 150,000 people. Every year it treated about 1000 in-patients and 5000 out-patients. The guild gave an opportunity to a large number of people to do good to their neighbours, it increased the annual income of the hospital by gathering in a large number of small subscriptions, and it increased the utility of the hospital by doing supplementary charitable work. Their idea was to secure in every little town and village throughout North Bedfordshire some representative of the hospital who would be constantly bringing its claims before his or her neighbours. Lord AMPTHILL (chairman of the Bedford County Hospital) said the proposal was simply a measure for coordinating and systematising existing efforts in order to prevent overlapping and to secure that there should be an equal distribution over the whole area of all the public-spirited and philanthropic efforts which were already made. It was a decentralisation of effort and a concentration of control, giving to the smaller organisations all that additional strength which resulted from united effort. The scheme consisted of the division of the area into districts with responsible officers in each, people who had local knowledge and would take care that abuses would not occur. Dr. Fox said that the time had come when the consideration of the King should be called to the condition of provincial hospitals, and he proposed an amendment on the subject which the CHAIRMAN ruled out of order. After some discussion the following was adopted :— as
management hospitals respective localities and that such nominations should be carried out a an such as division of the British by organised professional body, Medical Association.
Mr. MANSFIELD, M.P. (General Hospital, Northampton), the proposal which on being put to the vote was lost. On the proposal of Dr. T. W. GRIFFITH (Leeds) it was declared desirable that temporary accommodation should be provided in hospitals for certain cases of unsoundness of mind for purposes of observation. The proceedings then concluded.
opposed
LYNN THOMAS AND SKYRME FUND. THE following subscriptions have been received between March 28th and April 3rd by Mr. William Sheen, M.S. Lond., F.R.C.S. Eng. (2, St. Andrew’s-crescent, Cardiff), honorary secretary to the fund. Snbscribers of Five Guineas. Forfarshire Medical Society, per Walter Tate, London. W. E. Foggie, Dundee. Sir John Tweedy, London. Leonard Wilson, Garndiffaith, Fylde Medical Society, Subscribers H. Brunton
W.
per
Molloy, Blackpool.
of
Two Gicineas.
Newcastle-
Angus,
J. Ernest Lane, London.
Farquhar Macrae, Glasgow.
on-Tyne.
H. C. Bevan, Blaina, Mon. H. T. Butlin, London. Evan N. Davies, Pen-y-Graig,
Sir Malcolm Morris, K.o.v.a., London. Rodman, Hovenden and Hovenden, London. Simeon Snell, Sheffield.
That this conference has heard with interest of the scheme of the Bedfordshire Hospital Guild as a means of increasing local interest in Rhondda Valley. the county hospital and extending its usefulness by promoting more J. Magee Finny, Dublin. intelligent efforts for the prevention of disease and for the better after- i, W. C. Humphreys, Swansea. care of convalescents.
Subscribers of One Guinea. E. H. Addenbrooke, Kidder- S. Moore, Leeds. i minster. S. G. Morris, Mardy, Glam. The Rev. W. BLISSARD proposedSir W. H. Allchin, London. A. W. Murray, Liverpool. That tuberculosis should be included among notifiable diseases, with W. M. Abbott Anderson, London. J. D. O’Sullivan, Aberbeeg. a view to the isolation of such patients in publicly provided hospitals. H. R. Andrews, London. Arthur and A. de St. L. Periga T. W. Bevan, Nantyglo, Mon. New Barnet, Herts. Tuberculosis, he said, was the scourge of modern civilisation. J. E. M. Brown, London. G. H. Ransome, Bungay, Suffolk. Alonzo G. Rider, Devonport. Hospital treatment for this disease was quite inadequate E. F. Buzzard, London. G. J. Robertson, Oldham. Tuberculosis might be looked upon as a condition resulting Claude Douglas, Leicester. H. P. Rowlands, Towyn, MeriDukes, Rugby. from all those activities which were building up the wealth Clement E. B. Ffennells, Hindhead, Essex. oneth. and the prosperity of the nation. From this point of view Charles Gibbs, London. G. H. E. Shears, Liverpool. J. Shinlaw, Ferryhill, Co. Durham. he urged that public provision should be made for the F. L. C. Greaves, Derby. Collier Green, Derby. R. Sinclair, Dundee. accommodation of tuberculous patients, as the position was E. W. F. Haslam, Birmingham. James Somer, Exeter. far beyond that which could be dealt with by voluntary R. W. Haslett, Pontypool. J. L. Thomas, Brynmawr. R. S. Thomas, Exmouth, Devon. effort and he made a strong appeal to public conscience and K. R. Hay, London. de Vere Hunt, Cardiff. Wm. Thomas, Birmingham. public power. The expense would probably be heavy, but D. H. Hunter, Haughley, Suffolk. Sir Edgecombe Venning, London. unless some such proposal was carried out there would be a G. C. A. Lee, Hull. H. S. Walker, Leeds. loss of lives which, if saved, would be of the greatest use in T. Lettis, Great Yarmouth. E. C. Warren, Gillingham, Kent. D. V. Lowndes, Surgeon, R.N. W. M. Crawford Watson, Harrobuilding up the national prosperity. G. H. Mapleton, Goudhurst, Kent. gate. Dr. DAVY moved as an amendment F. Marsh, Birmingham. G. F. Welsford, Tiverton. M. W. London. J. H. Whelan, Cardiff. of the of That-the consideration the notification of tuberManuk, propriety W. M. Willis, Nottingham. culosis be postponed, and that the Government be asked to appoint a Sir John Moore, Dublin. commission to recommend the best way to deal with tuberculosis. Subscribers
’lhe Prevention
.
near
Pontypool.
of Tuberculosis,
He said the notification of tuberculosis was a very complicated matter. Dr. H. T. Bulstrode, who had lately published the result of a long inquiry into the subject, had suggested that tuberculosis was dying out and would die out as sanitation improved. He (the speaker) was not at all satisfied, however, to leave things as they were. Roughly speaking, some 60,000 persons died from tuberculosis each year in the United Kingdom. People could not be willing to leave the subject alone when they believed that more than half of that death-rate could be prevented by carefully considered measures of prevention. Such measures should be carefully devised by a body of men who would be influential enough to command the respectful attention of the nation. This question affected every part of our national life and could not be dealt with as if it were a question merely of the notification of the disease. He suggested that a body of influential unbiased men, laymen and medical men, should consider the question, and they could only be called together by a Royal Commission.
of Half-a. Guinea.
T. W. H.
Garstang, Altrincham. Hugh Kenshaw, Pudsey. H. Lucas, Huntingdon. Colin D. Lindsey, Plymouth. A. A. Lipscomb, Wrotham, Kent. W. H. Maidlow, Ilminster.
Pain, Durham. F. S. Penny, Capt. R.A.M.C. J. R. R. Pollock, Tiverton. Radcliffe. Oldham. Gordon Sharp, Leeds. H. Sandford Smith, Eltham.
A. Frank
Subscribers of Ten Shillings. James Arthur, Wingate, Durham.William Fuller, London. Subscribers of Five Shillings. G. G. M. Black, Tomintoul, Banff- T. Martin, Bristol. shire. L. F. Marks, Mumbles. T. A. Cambridge, London. Henry Stear, Saffron Leonard Grant. London. Essex. J.
G.
Macaskie,
Northumberland.
Bamburgh, Subscribers of Half-a-Crown.
P. H. D. A. Greenwood, London. A. Harris, London. A. Howie, London.
Shoyer, London. Dr. Simpson, London. Staunton, London. H.
J.
A. F.
F.
Walden,