' Oct. 19, 1895. THE HOSPITAL. SI The Institutional Workshop. HOSPITAL EXPENDITURE?THE patients is divided in striking the average cost of pro- visions per "bed among the number of patients. In the COJYIJYIISSARIAT. Metropolitan rather more than the cost of one official Note.?The authorities of King's College Hospital alone refuse to supply has to be borne by each bed, whereas in the Seamen's the information to enable that necessary institution to be compared Hospital the cost of each official would be spread over with its fellows in the present inquiry. four beds. The result is apparent at once in the III.- -THE nearly QUESTION OF NUMBERS. cost of provisions, if the former table be compared. The stands not in the number In estimating the expenditure of a household, the Metropolitan highest only of inmates, but in for both very first step is to count heads. In reckoning the average provisions among London and Next to it stands cost of hospital provisions, it has been usual to stop provincial hospitals. the North-West London with again one short at counting heds. It is of course taken for nearly official to every patient, and a correspond- granted always that a large proportion of the expense bed. And third on the of victualling an institution must he incurred for ingly high average per London list stands the Middlesex with an those whose business it is to look after the inmates unusually high average of provisions for this reason, that the proper, but the variations arising from the endless hospital being closed for three months the number of modes of administration in use are not by any means patients was diminished, but the number of permanent clearly understood, nor is the difference appreciated officials, whose work was rather increased than which such variations must of necessity cause in the diminished the alterations, was not affected in any- expenses of provisions. These variations may be by thing like the same proportion. Hence the percentage of' advantageously studied in the following table, show- the rose to forty, and the cost of house- ing percentage of patients and of persons other non-patients estimated bed shows a than patients contained in the entire resident popula- keeping per corresponding increase. tion of the more important London hospitals, and of some Turning to provincial hospitals the same results Scotch, Irish, and provincial hospitals. may be noted. The Addenbrooke Hospital, where London. only 56 out of 153 beds were available, shows the high Percentage of of 50 other than and a Patients. Nonpatents. percentage persons patients, Metropolitan 48 ... 52 rise to ?32 5s. per bed for provisions in consequence. North-West London 58 ... 42 Nothing could show more clearly than these examples ... Middlesex ... ... ... 60 ... 40 of the increased cost incurred by the household during ChariDg Cross 62 ... 38 St. ... ... an decrease in the number of the Bartholomew's 63 ... 37 imperative patients, Sti. George's ? ...\ oe want of wisdom involved in closing wards from motives 64 - 36 Royal Free items of London J of economy. In certain savings can, course, 65 ... 35 St. be effected on a reduction of but it is abso- Thomas's ? \ oa patients, Great Northern Central J to reduce any institution house- St. lutely impracticable Mary's ^ oo to and the inevitable result of - hold scale, Guy's 6? attempting Gt-rman m) to save money by excluding some is to raise ... 73 ... 27 patients ... the cost of all the others. Westminster ... ... 75 ... 25 University (without nurses) ... 77 ... 23 So far we have considered only the hospitals over- ... Seamen's ... 21 79 weighted with officials. At the other end of the scale Provincial, Scotch, and Irish. come those which are exceptionally free from inmates Cambridge ... 50 ... 50 other than the London hos- Oxford patients. Among larger *" ^ 60 the three the lowest average for Bristol ... pitals, showing pro- General ... J visions are where the nurses are not Derbyshire Royal ... 61 ... 39 University, Sussex County boarded by the hospital; Westminster, and the Aberdeen ... Royal Infirmary J Seamen's, all three showing a correspondingly low BirmiDgham General \ Dundee of officials boarded. Those Royal Infirmary ... > 65 ... 35 proportion provincial Ayr County ) hospitals only can be indicated from which returns Birmingham Queen's ... ... \ have been and here the Belfast Norfolk and Norwich received, Royal )" stands the number of non-patients* Halifax ... ^ Hospital lowest, ??? Wolverhampton ... f boarded (again without including nurses) amounting Leeds General to hut 18 per cent of the total inmates. Newcastle ... Royal Infirmary It will be seen if the figures are studied Sheffield General ... ... clearly | and with the tables cost Edinburgh Royal Infirmary ... 70 ... 30 attentively compared showing Glasgow Royal Infirmary ... I of provisions, that the reckoning of heads, although West ... Glasgow Infirmary | a valuable assistance in fluctuations of Dublin Meath judging cost, ...J one factors Bradford ... is of many which determine 71 29 only expendi- Hull has Riyal ... ... ture. It been shown to have an share- Infirmary 72 ... 28 important York ... County *" 73 27 in producing extremes. But it would be idle to sup- Kilmarnock ... ... ... gQ 20 that of can ... pose numbers uni- Belfast ... uniformity Royal ... g2 lg produce formity of cost, and it may be noted that among To realise the full significance of these it figures seven an identical of 30 must rm hospitals showing proportion be mbarei that the board o? all these non- per cent, of officials, and hence an identical rate of ? 52 THE HOSPITAL. Oct. 19, 1895. provisioning per bed, no two show precisely the same average cost of provisions. It will be necessary to look more closely into the elements which go to make np the large proportion " of persons other than patients" boarded in the hospitals. .