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 adminis. tration of hospitals are referred to the 'British and Foreign Medico. Chirurgical 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:

Mr A. will register, i.e., write the names, etc., in a book kept for the purpose.

Mr B. will prescribe, i.e., write the prescriptions dictated to him.

Mr C. will dress anything that requires such atten

tion.

Mr D. will make himself generally useful, or will be away on leave.

The next day they change like artillerymen at gundrill-A. takes B.'s duty, B. takes C.'s, and so on.

The patient comes in at one door and goes to Mr A. to be registered; this is done, and he receives a prescription-paper with his name written on it; then he goes to the doctor, who asks him a few questions, and dictates the name of the disease and the prescription; B. writes these, and passes the patient on with his paper to C.; C. puts on whatever dressing is ordered, and sends him out of the other door to get his medicine from the dispenser.

One soon grows very tired of this, for you get scarcely any interesting cases, and you are so glad. when your six months of office have expired that you wonder how your "Governor," poor man, can go on with it year after year.

Then you become out-patient clinical clerk to an assistant-physician, and discharge similar duties for medical cases; but Mr C., the man who dresses for the surgeon, has to undress for the physician. That is to say, he has to get people ready for "auscultation," to examine various things they bring, and report on them. But the "undressing" is the most troublesome. Till you see them, you can scarcely believe how voluminously some men are enveloped in aprons, belts, straps,

comforters, chest-protectors, and other abominations. It is half an hour's work to get them unrigged and rigged up again. With the women the bonnet-strings are the greatest nuisance; they are constantly in the way, and their rustling is most distracting when you I want to listen to their chest sounds. It is all the more annoying, because out-patients always come in such swarms that you can spare a very short time for each. Medical out-patients are only a degree more interesting than surgical, so that you pity the assistantphysician as much as the assistant-surgeon, and turn with a sense of relief to the in-patients.

Assistant-physicians and assistant-surgeons have, or ought to have, one or two beds apiece in the hospital, as a set-off to those tedious out-patients.

There is one fault that should be noticed common to all out-patients, whether surgical or medical; far too many men and women are for weeks and months outpatients at hospitals who could very well afford to pay for advice and medicine, if we may judge by the glossy cloth coats and the showy silks they wear. This is a most unjustifiable abuse of charity; but it would soon cease if every doctor were as independent and courageous as one eminent physician, who, when he had care of out-patients, used to astonish any smart woman whom he saw enter the room by calling her to the front of all the others, and catechising her in this strain :

"Pray, ma'am, what is your husband's employment?" “A mechanic, sir—a skilled mechanic." (That is the favourite answer.)

"And may I inquire what his wages are?"

"Three guineas a-week, sir." (Sometimes it is even more.)

"Just what I expected; more than a hundred and sixty pounds a-year, you see! Are you aware that an immense number of clergymen and other gentlemen have less than £160 a-year? Yet what would you say if the clergymen's wives were found coming to the hospital? Poor dear ladies, if they did come, I am sure they could not find all those smart silks that you come rustling in.” Here they generally beat an ignominious retreat, at which-"Yes, you may well retire; but you must not go to some other hospital.”

He would then turn to the students present, and remark, "But she will go, gentlemen, for all that, and her husband will consider she was very ill-used because we would not admit her here. Women of this stamp crowd into the maternity hospitals, and fleece those charities to even a greater extent than they do us, not with the connivance only, but also with the approbation of their husbands. And these knaves, gentlemen," the stanch old Tory would add," are the model 'working-men' of that pugnacious 'friend' of theirs, the vociferous member for Birmingham!"

Abuses of this kind are owing to the flunkeyism which still pervades society in the British realms to such a degree, that really one would think we were totally destitute of such blessings as the 'Saturday Review,' to say nothing of 'Punch' and the 'Owl.' But, pshaw ! we are doing these papers injustice. What "beadleocrat," to coin a word, as the anatomists do, ever craved any higher intellectual food than the daily bombastic pennyworth of Telegraph' or ' Star'?

It occurs thus: nearly all hospitals are supported by voluntary contributions, and the subscribers are named governors, because for a certain sum they can command