1293 general expressions of regard and sympathy from the public THE SWISS FEDERAL DIPLOMA. IN MEDICINE.- and the public bodies with which he was connected, who We understand that Dr. Tucker Wise has obtained the were officially represented at the funeral. above diploma after examination. It may be mentioned that the examination is conducted in French. RICHARD A. D. ROBB, M.B. BEQUESTS.-The late Mr. Thomas Talma Hodgkin,. DR. RICHARD A. D. ROBB died on the morning of Monday, of Horsegate, Leeds, and Lindhead Lodge, Clougnton, May 18th, at his residence, 8, Carlton-place, Glasgow, and bequeathed :fl00 each to the Royal Northern Sea-bathing by a very wide circle of friends, both lay and professional, Infirmary, Scarborough, the Scarborough Hospital, and the the intelligence of his death was received with the keenest Dispensary and Cottage Hospital, Scarborough.-The late regret. The immediate cause of death was a sarcomatous Mrs. Margaret Platt, of Stalybridge, who died in August, infiltration of the lungs. During the time Dr. Robb was 1888, left a sum of money to her executors for distribution,. absolutely confined to bed-a period of less than two at the expiration of three years from her death, amongst months-he suffered from an irritating, and almost inces- certain charities she named. The Devonshire Hospital and sant cough, and towards the end from extreme and painful Buxton Ba.th Charity is one of these, the treasurers of breathlessness. These sufferings-for the alleviation of which have just received f500 from Mrs. Platt’s executors. which every effort was made-were endured with much CORK.-The resignation, and without complaint, and, with charac- QuEEN’s COLLEGE, following prizes. teristic unselfishness, Dr. Robb, the last of have been awarded in the Faculty of Medicine :--Practical during days second H. J. 2nd. his life, was concerned lest he should be too Anatomy, year :.W. Garde, 1st; Reid, troubling Third Wm. W. Rountree and much those whose privilege it was to wait by his bedside. year : Scott, 1st; Wm. MeMath, Dr. Robb will be remembered as a man of and equal. Anatomy and Physiology, second year : W. H. strong 1st. Third W. A. Wm. generous impulse, and as one who was ever ready to forget Garde, year : Rountree, 1st; Scott, his own comfort in an unselfish coasideration for that of 2nd. Histology: W. Rountree and W. A. Scott, equal 2nd;.;. Wm. 3rd. Practice of Medicine : William others. Dr. Robb was only thirty-five years of age. McMath, Scott, 1st; William MeMath, 2nd. Surgery : William Scott, 1st. Midwifery : C. M. Corkery, 1st; W. C Sullivan, 2nd ; D. O’Driscoll, 3rd. Materia Medica : W. H. Garde, 1st John Dundar,3rd. Medical Jurisprudence : D. J. Collins and P. T. O’Sullivan. equal 1st; C. Corkery and W. C. Medical News. Sullivan, equal 2nd. Exhibition in Practical Medicine : P. WEST LONDON MEDICO-CHIRURGICAL SOCIETY.- T. O’Sullivan. UNIVERSITY LIVERPOOL.-At a The annual dinner of this Society will take place at the COLLEGE, meeting of the Council on the hon. treasurer Criterion Restaurant on Wednesday, June 10th, at 7 P.M., College Wednesday the President, T. Gunton Alderton, Esq., in the chair. read a letter from Mr. George Holt enclosing a cheque for 10,000 for the endowment of a chair of physiology. It was EPSOM COLLEGE.-At a meeting of the Council, resolved: "That the Council return their held after the annual unanimously immediately general meeting, Sir cordial thanks to Mr. G. Holt for his generous gift of and the Rev. E. W. Joseph Fayrer, M.D., K.C.S.I., .610,000 for the endowment of a chair of physiology, which Northey, M.A., were elected chairman and deputy chair- they accept with special gratitude, warmly appreciating the man of Council. respectively the object of his benefaction, in which they recognise an added ROYAL BERKS HOSPITAL, READING.—At a special guarantee for the completeness and stability of the College Court of the Governors, held on the 26th ult., a resolution in strengthening the medical department and creating a it and as a was adopted, approving of the recommendation of the new bond of union between the College whole." Board of Management that additional accommodation for It was also decided to request Mr. Holt to permit his name attached to the nurses be giving eight rooms, with space for to be permanently professorship. The fourteen beds,provided, bath-room, &c., and that the old laundry present holder of the chair (Dr. Caton) sent a letter resign- in of work of other be suitably adapted as a dining room for the nurses. ing the position consequence increasing kinds, and that the munificent gift of Mr. Holt THE AFTER-CARE ASSOCIATION.-The annual meet- rejoicing woufd realise his long-cherished hope of securing a highly ing of this Association, established for the benefit of poor qualified professor to devote the whole of his time to the and friendless female convalescents on leaving asvlums duties. The committee expressed their gratitude and obli- for the insane, will be held at 83, Lancaster-gate, W., on gation to Dr. Caton for his bervices. June 15th, 1891, at 3 P.M. The Earl of Meath Monday, SOCIETY FOR RELIEF OF WIDOWS AND ORPHANS OF will preside. Tickets may be obtained from H. Thornhill Roxby (secretary), Church House, Daan’syard, West- MEDICAL MEN.-The annual general meeting of the Society minster, S.W. was held at 20, Hanover-square, on Thursday, May 28th, at 5 r. M. The Sir James Bart., took the MEDICAL DEFENCE UNION.-At a of the president, Paget, meeting chair. From the report read by the it was shown members of the East and Midland to be secretary Anglian Division, that the members of the Society were 324, against 333 last held in a room at the New Theatre of and Anatomy Physio- year; seven only had been elected and sixteen had died or on June at 2 30 after logy, Cambridge, Thursday, 18th, P M., resigned. The number of widows relief was the of the address and the of the receiving sixty- delivery president’s reading four, fifteen were and three and the transaction of other C. E. orphans receiving grants, report general business, orphans were on the Copeland Fund. Two widows and four Abbott, Esq. (Braintree), will propose : " That members of had been added to the list, and three the division be in event of orphans only orphans requested, any legal difficulty had become ineligible through age for further grants. The to forward at once a statement of the facts either to arising, grants for the year amounted to E3151 10s., including a sum the divisional a or the divisional president, county president, of E360 given as a present to the widows and orpbans at as most convenient to and are advised to secretary, them, Christmas. The expenses of the year were E255 15s. 6d. take no 8teps personally, unless they have been advised A of E1500 had been received from the executors thereon."" legacy of Miss Carpue, and one of f500 from those of Edward MEDICAL BENEVOLENT SOCIETY, BIRMINGHAM.— Robson Jones, Esq. The fanded property had been increased The annual meeting of the Medical Benevolent Society was by the purchase of E3100 stock. The total grants and ex- held in the Medical Institute on the 29th ult., Mr. Bennett penses for the year amounted to JE3407 5s. 6d., and the May (vice-president) being in the chair. Dr. Rickards moved receipts available for payments to :f3248 13s. 10d., leaving a. the following resolution in reference to the death of the pre- deficit of jE158 11s. 8d. on the transactions of the year, due sident of the Society, Mr. T. H. Bartleet : "That this Society to the Christmas present. The following gentlemen were desires to record its deep sense of the loss it has sustained elected to fill the vacancies in the court of directors :-Dr. in the death of Mr. T. H. Bartleet, and to convey to Mrs. Russell Reynolds, Dr. Church, Dr. Ogle, Mr. Durham, Mr. Bartleet and family its sympathy with them in their bereave- Vasey, Dr. Hickman, and Mr. G. Keele. A vote of thanks ment."-Dr. Morgan of Lichfield was appointed president, was passed to the editors of the medical journals for their and Mr. Garner president-elect for the ensuing year. Mr. kind assistance in making known the objects and working Herbert Bracey and Mr. Hartill were appointed vice-pre- of the Society. A special grant of E26 was made to a widow.

Sir James . sidents, Sawyer and Dr. Savage0 treasurers, and A vote of thanks to the chairman for his kindness in Mr. Haglam secretary. presiding at the meeting closed the proceedings. 1291

EAST LONDON HOSPITAL FOR SHAD- sex Hospital is an institution which has received a much larger sum CHILDREN, than in either of the previous cases. It has received in legacies the sum WELL -The Earl of Strafford, the president, occupied the of £83,433 9s., but no part of this has been brought into the account, chair at the annual Court of Governors, held last week. It and consequently the comparison of income and expenditure account of these three institutions would the mind of the reader was stated that the total number of under treat- produce upon patients who went no further the impression that the London Hospital and St. ment during the eight months ended December last was George’s Hospital had received substantially the same sum in legacies, 18,426, an increase of 2675 on the number in the correspond- and that the Middlesex Hospital had received no sum at all, the fact St. ing months of 1889. The income for the same period was being that the London Hospital had received the least, George’s :f!634. An site had been obtained Hospital rather more than double that of the London Hospital, and the S3855, against eligible Middlesex Hospital more than double that of St. George’s Hospital. for the new buildings to be erected for out-patients and The magnitude of theseitems shows how difficult it is to form any just con- for the accommodation of the nursing staff. The building ception of the magnitude of the financial operations of the hospital from fund amounted to E1500 still to be collected. a mere inspection of its public accounts. The next institution to which 5760, leaving I desire to call your lordships’ attention is the Charing-cross Hospital, which has a different course. The outcomeof the accounts in this GROSVENOR HOSPITAL FOR WOMEN AND CHILDREN. pursued case is that there is no general account in the ordinary sense in which there The annual for the states is a account in the institutions to which I have re- report past year, just issued, that, general already . ferred. There is called the and it is owing to the increased demands on the institution, an what is general account here, an account which the part of the income and ex- extension of the was The of an comprises greatest building required. tenancy penditure of the institution, but it is supplemented by seven other adjoining house has been secured, and a waiting-room for accounts. Two of them are accounts which are incorporated by the out-patients erected at the back of the hospital. Beds can carrying of several of their balances to the general account, but five of them are accounts which are distinct from the now be for the totally general provided eighteen in-patients. During past account, and in order, therefore, to get a complete view of the twelve months 107 women were admitted, the out-patients finances of this institution during the year one has to refer to and numbered 1981, and the total attendances were 9084. As mentally and manually to incorporate the results of six different compared with 1890, the income shows an increase of accounts. As to some of those, the reason is perfectly obvious, and per- 8d. The extension fund at amounts to haps it may be said that they are substantially the accounts of affiliated £ z3G 9s. present and subordinate institutions, and therefore rightly kept separate. X658 4s. 2d., but to rebuild the hospital at least jE16,000 One is a convalescent home account ; another is the Samaritan fund will be needed. account; and there are probably very good reasons indeed for keeping these accounts separate. One of these is called the "extension" account, and as a matter of fact to that account all legacies above £100 are carried, and all payments on what may be called capital expendi- THE METROPOLITAN HOSPITALS INQUIRY. ture are carried on the other side. Now that, as your lordships will imagine, is a very substantial sum ; it amounts to nearly £6000 on this occasion. HOSPITAL particular UNIFORM ACCOUNTS. Lord Spencer : A year ?-Witness : It amounts to f:551S in this par- THE Committee of the Lords’ Committee appointed to inquire into the ticular year, but if some particular accounts to which I have already condition of the Metropolitan Hospitals resumed its deliberations on directed your lordships’ attention had been treated in the same Monday last, after the Whitsuntide recess. There were present the way, the sum would be very much larger. Now, my lords, in order Earl of Sandhurst, Chairman of the Committee, who presided ; and the therefore to get what is a substantially correct view of the other members of the Committee present were Earl Spencer, the Earl of accounts of this institution for the year, it its obviously necessary Kimberley, Lord Sudley, Lord Saye and Sele, the Earl of Lauderdale, to incorporate that account, and in order to get an accurate view it Lord Thring, Earl Cathcart, Lord Monkswell, Lord Lamington, and is absolutely necessary to incorporate the smaller accounts. It would Lord Zouche of Haryngworth. be impossible to establish any strict comparison without the great The first witness to be examined was Mr. J. W. Gordon, barrister, labour of incorporating all these various accounts. Now the next 4. Plowden-buildings, who appeared on behalf of THE LANCET to offer case to which I will refer is the London Lock Hospital and Asylum, evidence in support of a uniform system of keeping hospital accounts. which is somewhat different from the one to which I have already The principal points on which he wished to criticise the existing system referred in this respect, that there are three affiliated institutions would be dealt with in order. His lirst point was that the various substantially one institution. There are two hospitals and an asylum ’hospital accounts were presented to the public in a most bewildering which are worked together, and the accounts of these are kept diversity of form, so that it was impossible to establish any satisfac- separately. There, again, the total result is shown in one account, tory comparison between the accounts of the different institutions. I because a general balance is kept, and a debit balance arising upon the do not think he could do better than illustrate that point by drawing one account, or credit balance arising upon another account are both the attention of the Committee to some accounts which he had before carried to the general balance sheet, and in that way all the accounts are him. I have made a list of those accounts, and perhaps it would be incorporated in substance by a bookkeeping operation at the end of convenient to refer to them not under the names of the various insti- the year. At the end of the year the balances are distinguished, and tutions, but by numbers. ’ presented as a statement of account or of expenditure. It shows only The Chairman : It would be ’more convenient if you would give the the balances of income and expenditure shown by the separate names, in case the institutions referred to should wish to give explana- accounts, and therefore, in order to get at the result of the financial tions.-No. 1 (London Hospital) is a hospital account which presents,in operation, it is necessary to incorporate several different stages or the form of one account a complete statement of receipts and ex- phases of this account. The next illustration I have is from the report penditure. From this account it appears-to draw attention only to of the Deaconess’s Institution and Hospital, Tottenham. It exhibits one point in this connexion-that this institution received .821,500 odd as a peculiarity in a singular way-a condition of hospital accounts which legacies last year, and those legacies are duly brought into the account. is not easily exhibited by a comparison of separate accounts-viz., The Chairman: Was there a particular heading "legacies"?-There in some institutions the annual statement is a statement of income is a particular heading " legacies," my lord, and the legacies are entered and expenditure; that is to say, of cash (money or money’s worth), 1mder two heads—.66664 6s. 2d. under legacies simply, and under the incoming or expended during the year. In other cases the corresponding heading "ditto received in stock as per contra" .IS 14,9] 7s. 3d., making account is a cash account of money received and money paid, and of ;a total of B21.685 13s. 5d. As to the first item, jE6664 6s. 2d., it was in course these two things are not identical. Money received and money no way distinguished from other receipts ; and as to the second, it is incoming is probably the same, but money paid is by no means the entered as "per contra." Credit is taken for the amount of stock as same thing as money expended, because there are outstanding accounts for stock purchased, so that the £14,919 7s. 3d. appears as an item of in any case at the end of the year. Now, very singularly, in the case expenditure. St. George’s Hospital is an institution which has in of this institution we have both the accounts presented. There is a ’point of fact received a larger sum in legacies, but they are cash account, which is an account of money received and money paid, dealt with differently. There is also here a heading "legacies," and there is an income and expenditure account, which is an account and the various legacies are set out in detail, the value being of money incoming and expended. It hardly needs to be said also shown. They amount to .821,602 9s. 2d., but there is added that the explanation of these two accounts is very perplexing, to that a note against one of the legacies that in addition to these- because they appear to be inconsistent the one with the other. They that is, to the amount entered as paid upon legacy-in addition to these appear to cover precisely the same period, but, as your lordships will see, the sum of ze26,371 10s. ld. at 23/4 per cent. was transferred in the names in a different way. The one shows money received and money spent, of the trustees of the hospital, and that sum does not appear in the the other shows money receivable and money expended during the year. account at all. It is not brought to account at all. It is simply identi- Why the two accounts should be present in that form I confess I have fied in the way I have alluded to. not an idea. But the same is the case with a number of other institu- The Chairman : That sum goes, I presume, permanently to increase tions, to which I need not more particularly refer. It need hardly be the endowment ?-I imagine not, my lord. If I understand your lord- said that if one institution presents two accounts like this, it ship’s question, I do not think it is to be dealt with in a way that is practically certain that other institutions which present only would prevent its being used for the purposes of the institution ; but, one account, the account presented, will sometimes be a cash as a matter of fact, I think it did go to increase the investments of the account of money received and money paid, and sometimes institution, for this reason, that the income, apart from that, shows a an account of money receivable and money expended, and so balance over the expenditure brought to account. So that there was no far as I know there is no means of saying by a mere inspection of the occasion to draw upon that. account. The Miller Hospital affords another illustration of the The Chairman : Are they of the nature of temporary investments ?— same thing. The next illustration is taken from the East London I suppose that the investment is temporary-in other words, that it mayHospital for Children and Dispensary for Women, and is an example in some future time be necessary to draw upon it ; but I imagine that of a statement of account which to me is very perplexing and diffi- the investment does not differ in character from other investments ofcult, to understand. In the statement, of account I find a very the institution. Another sum to which I need not make any specialelaborate statement of all the various items of exoenditure set out - reference is a sum of £4200, which is exactly on the same footing to thatwith the minutest detail, as indeed is customary in hospital accounts, to which I have referred. Taking these two statements of account,and among these items of expenditure which are accredited to archi- which appear to be parallel to one another, supposing that one desiredtects. There is a payment of C500 and another payment of £50 on to compare these two institutions in respect of their yearly accounts,account of architects, and I can find no commensurate expenditure one would get an impression that the London Hospital had receivedL in the buildings account, and it is perfectly obvious, therefore, that, substantially the same amount in legacies as St. George’s Hospital, the! although in the case of this account, which appears to be a complete fact being that St. George’s Hospital had received more than double; and full statement, there must be important items which for some the amount of legacies, but has only brought a proportion to them-- reason or another have not been brought into this account. Now, my less than one-half the amount received-into its account. The Middle-- lord, those are illustrations, I submit, of the perplexing diversity there