This must be a great relief to the patient's family, and, as everything is paid for, it is not considered infra dig. to go to the hospital in this way.

Surely the adoption of this plau in London, and in other large towns, would be of incalculable benefit to many ladies and gentlemen with small incomes, whose means will not allow them to procure the necessary comforts and attentions which materially tend to make an illness less harassing, as well as to hasten recovery. We are a commercial nation, therefore permit us to add, "Might it not be made a source of pecuniary advantage to the hospitals themselves?"

Provincial towns might, we think, manage their hospitals on a different plan from the present with great advantage. The method we now venture to propose would give relief to a larger number of patients at less expense, and in a better manner, than is done by the prevailing system.

Suppose we take a place with from 50,000 to 100,000 inhabitants the hospitals in it will probably be (1) a general hospital, with 150 to 200 beds; (2) a children's hospital, with 20 to 40 beds; (3) an eye hospital, 20 to 30 beds; and (4) a maternity hospital, 10 to 20 beds: in all, 200 to 290 beds. Usually it will be found that only the general hospital has a resident medical officer, consequently any severe cases in the others are obliged to be sent thither.

But they will all have matrons, more or less ignorant, and secretaries and rates and taxes and rent to pay, while the larger general hospital commonly pays no rent, because the site was either presented or bought at the time of its erection.

Collect these in different wards of one building, and

F

it is easy to see what a saving of expense will be effected, while then all the different varieties of patients will be protected by an efficient resident medical officer.

It may be argued, "That will be too much for one man to attend to." Granted; but we have a remedy for that.

Besides these hospitals there will also be found one or two dispensaries, each having an expensive establishment to keep up, and each blessed with a resident medical officer.

Dispensaries are held only by men who are looking out for something better, so they are continually changing their residents. These appointments are most uninteresting, for the practice is of the most wretched description; and when tired with his long rounds of visits, the resident has to dispense no end of medicine, and he has no society to enliven his cheerless home.

Is that fit for a man who has but lately finished an expensive course of training, and who has just left a large medical school, where he was surrounded by congenial friends? Combine the dispensaries with the hospitals in this way don't bother a medical man with dispensing medicine-contract with a druggist in each district of the town to do that, and to provide a room in which the patients might be seen by the physicians at stated times.

All ordinary cases they would treat as out-patients, but severe cases they would send to the hospital, which might now be provided with two resident medical officers. This would be more comfortable for them, and a saving in expense to the town. At some places where this plan is already to a certain extent adopted, the only visiting analogous to dispensary visiting is done by the house-surgeons among bad cases waiting to come into

the house as soon as there is room; and they take it by turns to see in-patients and out-patients on alternate days, so that one is always in the hospital to receive accident-patients, who may come in at any moment.

Two house-surgeons can easily manage 300 in-patients, with the few out-patients we have mentioned; and the improved practice would be so inviting that it would attract far better men than those who drag out a weary existence at a dispensary.

Moreover, a hospital ought never to be left entirely without protection. One medical man ought always to be at hand for emergencies; and as there is such difficulty now in procuring medical pupils, the plan suggested ought to receive consideration.

If two men found the above work rather heavy for them, assistance could readily be obtained, at a very slight expense to the hospital.

We have elsewhere remarked (p. 21), that a certain number of students break down every year, and there are always some men who find London disagree with them, so that if they could finish their studies in a more congenial climate they would be very glad of the chance.

All the requisite lectures are over by the end of the third. year; the fourth year is devoted to hospital practice and preparation for the last examination-all the others have been passed.

Now, though country hospitals are not medical schools, yet the practice of those which have 150 beds is recognised by all the examining boards. Very well; let them offer to appoint an assistant who, in return for his services, should receive no pay, but his board and lodging in the hospital, with the privilege of attending its practice free of charge. We have no doubt that numbers of

these delicate fourth-year men would jump at the offer, and thus the proper attendance on the patients by three men would not be irksome, as at present, but, on the contrary, would be cheerful, and therefore efficient as well as inexpensive.

The fourth-year student would thus have an opportunity of attending the requisite number of maternity cases in comfort, instead of groping his way at night through filthy slums to miserable dens in London.*

* Those who wish to know all about the construction and administration of hospitals are referred to the 'British and Foreign MedicoChirurgical Review' for January and October 1866 (No. 73, p. 1-28, and No. 76, p. 371-397), which criticises the whole subject. No. 76 also contains (p. 471-473) a review on admitting patients.

CHAPTER VIII.

OUR OUT-PATIENTS- -HOSPITAL ABUSES AND HOSPITAL REPORTS.

Division of labour by out-patient dressers-By out-patient clinical clerks-Very uninteresting-Muffles and bonnetstrings-Abuse of hospitals by out-patients-A nut for Mr Bright to crack-Cause of the abuse, and suggestions for its remedy-Governors' letters-Out-patients at hospitals and dispensaries—Annual reports at present mere balancesheets, while they might be good statistics.

Now that we have told you what wards are like, we must let you know what the students do there. But stay we forgot. A man does not get his in-patient appointments till after the out-patient ones. These may be dismissed in a few words, as it is impossible to take any interest in out-patients: they are all very well for diagnosis (i.e., for finding out the disease), but you cannot in the least depend on the treatment, as you have no means of enforcing it.

You become first, as we said, out-patient dresser, and you meet your "Governor," an assistant-surgeon, on his days, say Monday, Wednesday, and Friday, in his room about 1 P.M., and attend his practice till about three. If he have four dressers, they will probably divide the duty in some such way as this: