43 attending the casualty department-, had increased of latt- HOSPITAL REFORM. years with excessive rapidity. while there had also been an increase of out-patients, and that many cases in both departments were of a trivial character which could be dealt A SPEClAL meeting of the Council of the Charity Organisa- with satisfactorily by general practitioners and for which tion Society was held on June 20th at the United Services hospital aid was unnecessary. The practical suggestions Institntiouto discuss suggestions for the reform of the which he submitted as the result of conference with others were that all cases should a casualty and out-patient departments of London hospitals. casualty be seen by medical officer, who should select from them cases which were urgent Sir JOSHUA FITCH was in the chair and there was a large or of value for educational purposes, referring the rest in attendance. general terms to local medical men or an approved provident Mr. T. CLINTON DENT, surgeon to St. George’s Hospital. dispensary. In the out-patient department also the selec- described an experiment which is about tu be made in tion was to be made by a medical officer. but the suggestions connexion with the New Belgrave Hospital for Children. for disposing of them were more complicated, including a It was proposed to guard against the overgrowth of the limitation of the number of new cases to 15 or 20, a prefer- number of out-patients by limitation of new cases and ence for members of friendly societies, provident dispen- selection and at the same time to place a check upon the saries, and others recommended by their own medical undue multiplication of casualty patients. Mr. Dent pointed attendants, and the reference of destitute cases to the Poor- out that unless this were done any rule limiting the number law. The suggestions also included the employment of a of out-patients, however strictly observed, would be useless. trained almoner to make inquiries. Mr. Kesteven suggested Although the number of applicants in the surgery of a the advisability of hospitals ceasing to provide drugs and children’s hospital was infinitely smaller than in a general giving instead ; this would bring the expendi- " prescriptions hospital, it was of equal importance to avoid the treatment ture of hospitals within their means and would secure more of ineligible cases and to prevent the surgery from becoming experienced treatment for the sick poor who had to resort to a vicarious out-patient department. Of course, if a case them. brought to the surgery was so serious that it could not be. A discussion followed in which several medical men took sent away it would have to be admitted to the in-patient part. department; but generally speaking the same inquiry would Mr. GARRETT HORDER congratulated the Charity Organ- be made in the surgery as in the out-patient department isation Society on having secured two such practical papers as to the circumstances of the parents and the same after years of talk. He questioned the wisdom of Mr. regulations would apply. The chief difficulty in a children’s Kesteven’s suggestion that prescriptions should be given hospital was to guard against indiscriminate prescribing. instead of medicines and he referred to the successful Mr. Dent contested the view that every patient who applied working of admission committees at Oldham and Dorchester. as a "medical casualty’’ must necessarily receive treatment. It seemed to him to be a suitable plan for small hospitals. Mr. Dent described in detail the measures which were Mr. NELSON HARDY welcomed the Belgrave Hospital proposed for the limitation and selection of cases. The scheme as the first serious attempt on behalf of an estab- number of new cases to be seen by the medical officer at. lished institution to deal with a problem which had been each attendance would be limited to fifteen. Preference agitated for thirty years and more. would be given first to the most serious and acute cases. Dr. WARING (Brighton) gave some figures, which have Next in order of preference would come those recommended already appeared in THE LANCET, showing that over a, by medical practitioners, while third in order would come quarter of the inhabitants of Brighton and Hove appear tov those bearing certificates from governors of the hospital. have been in receipt of hospital relief in 1896. He also It was not likely that this last class would be numerous, stated that in a recent vear no less than one-third of the but great importance would be attached to the recom- ’ births had taken place in the West-street Lviiig-iii Hospital. mendations of medical practitioners. In fact, the principle Other speakers took part in the discussion, and after brief underlying the whole scheme was the desire to work with, replies from Mr. DENT and Mr. KESTEVEN the meeting- and not in antagonism to, the general practitioner. The best closed with a vote of thanks to Sir Joshua Fitch for possible arrangement in his opinion would be for the general presiding. practitioner to be practically the almoner of the charity, as no one would probably be so well qualified to judge of the necessities of the case or better informed as to the circum- stances of the parents. As to this point it was intended to THE ROYAL COMMISSION ON THE employ an inquiry officer as an experiment. The benefits of METROPOLITAN WATER-SUPPLY. the hospital would also be guarded by a wage-limit estimated on the proportion of the family income to the family. The wage-limit had been purposely fixed low in order that the THE twenty-seventh sitting of the Royal Commissioners benefits of the to the hospital might go very poor, for whom was held at the Guildhall, Westminster, on Monday, they were intended. A register would be kept of the out- June 27th. With the exception of Mr. Cripps, Q.C., all the- forth age, name, and address, the dates of patients setting Commissioners were The first of the admission and discharge, and the occupations and wages of present. part sitting the of Mr. James the parents. This register would be open for the inspection was occupied by hearing evidence Bigwood, of local practitioners and the representatives of charitable M.P., the Chairman of the Parliamentary Committee of the: institutions. Middlesex County Council, and Member of Parliament for The most novel feature in the new scheme was an arrange- the Brentford Division of Middlesex. The latter part of the ment by which the hospital should be available for consulta- was in hearing the evidence of Mr. E. J. tion by people who, though able and willing to pay the sitting occupied the Chairman of the Council. moderate fees of general practitioners, could not afford a con- Halsey, Surrey County sultant’s fee. Any registered medical practitioner would be Mr. BIGWOOD, in answer to the CHAIRMAN, said that the allowed to bring to the out-patient department patients under area over which the Middlesex County Council had jurisdic- his own care for consultation with members of the honorary tion was partly within the limits of supply of the Xew River, medical staff. The actual attendance of the practitioner at the West Middlesex, the Grand Junction, and the East such consultations would be eminently desirable and written London water companies, and that the most thickly popu- statements would only be received in exceptional cases. No lated part of Middlesex, which was close to the boundary of treatment would be given at the hospital in these cases, but London, was supplied by the three first-mentioned companies. the diagnosis made and the treatment advised would be com- The actual sources of the water were situated in the county municated to the practitioner. The question of charging a fee and in the opinion of the witness Middlesex had a claim to for such consultations had been considered and the com- the water found in the county. A large quantity is obtained mittee were in favour of a small payment. Mr. Dent pointed in Middlesex by the New River Company at White Webbs. out that the scheme was only experimental. Highfield, Campsbourne, and Bettstile wells, situated respec- Mr. Dent’s description of the proposed arrangements in tively at Enfield, Edmonton, Hornsey, and New Southgate. - connexion with the new Belgrave Hospital was followed by a During the last twenty-five years the population of Middlesex short paper entitled Suggestions for the Reform of Casualty has practically doubled. The people of Middlesex wish tu and Out-patient Departments, contributed by Mr. W. H. be a separate body, independent of London both as regards KESTEVEN. It was admitted that the number of cases rating and in every other respect, and the Middlesex County