1
27 THE College of Physical Science at Newcastle seems likely to justify the more sanguine expectations of its pro- moters in March. Upwards of .B22,000 has been already subscribed towards the required estimate of £35,000. BRIGHTON is thus early busying herself for the reception of the British Association in 1872. A numerous general committee has been named, and special arrangements are in progress to attract as many foreign savants as possible. IT is understood that Sir Edward Ryan will, at least for the present, discharge the duties of the Vice-Chancellor’s office, vacated by the death of Mr. Grote, in the University of London. ____ MR. CORRANCE, M.P., has given notice of his intention to move a resolution to the effect that it would be desirable to extend the provisions of the Irish Medical Charities Act to England. ____ M. PAUL BROCA, the distinguished physiologist and lec- turer in the College of Medicine, is among the candidates at the approaching Parisian elections. A RAID has been made upon the anti-vaccinationists at Cheltenham, who have been summoned for disobeying the law. In all the cases convictions were obtained. AN examination of assistant-surgeons to qualify for pro- motion will be held at the Naval Medical Department, Somerset House, on Tuesday, the 4th inst. NOTES ON PROVINCIAL HOSPITALS. THE MANCHESTER INFIRMARY. THE city of Manchester is rich in medical charities. Besides the Manchester Infirmary there are, including that at Salford, three general hospitals, in addition to special institutions for the diseases of children, for syphilitic, and for ophthalmic diseases. The Manchester Infirmary, however, deservedly occupies the first position, not only in size, position, and importance, but as being in the immediate neighbourhood of the me- dical school, and the chief place for the clinical instruction’ of its numerous students. The building is in the classical style, and was founded in 1752. Improvements have been made in it from time to time, especially during the management of the present re- sident medical officer, Dr. Reed, at whose suggestion many of the smaller wards have been thrown together, leaving central fireplaces, and greatly contributing to the airiness and improved ventilation and sanitary condition of the hospital. The medical wards are situate in one half, and the sur- gical in the other half of the building. No patients are accommodated on the ground-floor, the whole space being occupied by the out-patient department, and by the officers’ rooms, offices, &c. The resident staff is large, consisting of medical superintendent, two house-surgeons, and four phy- ’ sicians’ assistants. So large a staff is required in conse- quence of there being, in addition to the 270 in-patients, and a proportionate number of out-patients, a considerable amount of home visiting of patients, which duty is per- formed by the physicians’ assistants. There is some talk of extending the wings of the hospital laterally, but this is unadvisable, as the surrounding open space is now anything but extensive, and immediately out- side the hospital area, on either side, are huge warehouses and offices, which, to a great extent, prevent the access of air or sunlight. It would be infinitely wiser to build a new out-patient department on another site, and utilise the ground-floor of the present building for accidents, which at present have all to be carried to the upper floors. Many the accidents are now kept in a wooden annexe in the rear of the hospital, which was originally constructed for the accommodation of fever patients, but which is not used for that purpose owing to the remonstnnces of the mer- chants and manufacturers, whose premises are in the vicinity of the hospital, and who naturally feared that they or their numerous employes might suffer from infection. The fever cases are now treated in the topmost wards of the hospital, but will be removed shortly to the 11 Barnes " Fever Hospital, which is now in course of erection, and which will in a great degree add to the completeness, as well as con- tribute to the healthiness, of the present hospital. Every endeavour is made to prevent the accident cases suffering by removal from the basement to the upper floors, a capitally constructed bed on wheels (made by Cockshott, of Manches- ter) covered with india-rubber, and provided with springs, being used for that purpose. The floors of the wards are waxed and dry-rubbed. Erysipelas and pysemia are said to. be rare. Fractures are abundant, and are treated on the old principle; those of the leg with side splints, a starch case being put on at the end of a month. Machinery accidents. are of frequent occurrence. In the treatment of wounds carbolic acid is used extensively by Mr. Lund, while Mr. Southam appears to prefer the tincture of benzoin. . There are no separate wards for children or for burns, and consequently the odour common to burn cases is more or less prevalent in most of the surgical wards. , Erysipelas and pyæmia cases, being infrequent, have no , special place allotted to them; but should either disease . spring up in a ward, all the other patients are at once cleared out, and the ward as soon as possible submitted to a thorough cleansing. Many cases of interest were under treatment at the time of our visit, including excisions of the knee and elbow ; for the former, Dr. Patrick Heron Watson’s splint, and plaster- of-Paris apparatus were employed, and with tolerably good results. Heath’s splint is not used after the latter opera- tion, but the arm is laid on a pillow in an easy positionq and movement is commenced in about ten days. One case which is deserving of special notice was that of a man with fracture of the skull with depression, who survived the accident, but who continued to suffer from intense headache for many months. The agony he endured was so great that he was content to submit to any opera- tion, and accordingly trephining was performed at the seat of injury, immediately over the superior longitudinal sinus- (which, however, was not opened), and with perfect relief of the patient’s symptoms, and without the production of any constitutional disturbance. Lateral lithotomy is fre- quently performed one case, in a man aged seventy, was doing well. For the relief of stricture external urethrotomy is the favourite operation, Holt’s operation being rarely done in consequence of one or two unsuccessful cases having occurred, though not during the present house-surgeon’s term of office. Ovariotomy is rarely performed, and there is no special officer for the diseases of women. The physicians’ wards well repay a visit, but their con- sideration must be deferred for the present. THE ADVANTAGES OF POOR - LAW DISPENSARIES. WE have been requested to recapitulate the advantages of Poor-law Dispensaries. They may be reviewed from a public and a professional point of view. They secure prompt and adequate medical attendance on the sick poor, and they likewise tend to raise the pro- fessional position of the Poor-law service. It is not denied that the sick poor may and frequently do obtain all that they require under the existing system ; but there is no absolute security that they do so, and it cannot be doubted that the parish doctor does not generally enjoy a very high degree of confidence, and that the sick poor are in the habit of going to public hospitals and dispensaries under the im- : pression that they there get better advice, more attention, and a more liberal supply of drugs. The dispensary system

NOTES ON PROVINCIAL HOSPITALS

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27

THE College of Physical Science at Newcastle seems

likely to justify the more sanguine expectations of its pro-moters in March. Upwards of .B22,000 has been alreadysubscribed towards the required estimate of £35,000.

BRIGHTON is thus early busying herself for the receptionof the British Association in 1872. A numerous generalcommittee has been named, and special arrangements arein progress to attract as many foreign savants as possible.

IT is understood that Sir Edward Ryan will, at least forthe present, discharge the duties of the Vice-Chancellor’soffice, vacated by the death of Mr. Grote, in the Universityof London.

____

MR. CORRANCE, M.P., has given notice of his intentionto move a resolution to the effect that it would be desirableto extend the provisions of the Irish Medical Charities Actto England. ____

M. PAUL BROCA, the distinguished physiologist and lec-turer in the College of Medicine, is among the candidates atthe approaching Parisian elections.

A RAID has been made upon the anti-vaccinationists at

Cheltenham, who have been summoned for disobeying thelaw. In all the cases convictions were obtained.

AN examination of assistant-surgeons to qualify for pro-motion will be held at the Naval Medical Department,Somerset House, on Tuesday, the 4th inst.

NOTES ON PROVINCIAL HOSPITALS.

THE MANCHESTER INFIRMARY.

THE city of Manchester is rich in medical charities.Besides the Manchester Infirmary there are, including thatat Salford, three general hospitals, in addition to specialinstitutions for the diseases of children, for syphilitic, andfor ophthalmic diseases.The Manchester Infirmary, however, deservedly occupies

the first position, not only in size, position, and importance,but as being in the immediate neighbourhood of the me-dical school, and the chief place for the clinical instruction’of its numerous students.

The building is in the classical style, and was founded in1752. Improvements have been made in it from time totime, especially during the management of the present re-sident medical officer, Dr. Reed, at whose suggestion manyof the smaller wards have been thrown together, leavingcentral fireplaces, and greatly contributing to the airinessand improved ventilation and sanitary condition of thehospital.The medical wards are situate in one half, and the sur-

gical in the other half of the building. No patients areaccommodated on the ground-floor, the whole space beingoccupied by the out-patient department, and by the officers’rooms, offices, &c. The resident staff is large, consisting ofmedical superintendent, two house-surgeons, and four phy- ’sicians’ assistants. So large a staff is required in conse-quence of there being, in addition to the 270 in-patients,and a proportionate number of out-patients, a considerableamount of home visiting of patients, which duty is per-formed by the physicians’ assistants.There is some talk of extending the wings of the hospital

laterally, but this is unadvisable, as the surrounding openspace is now anything but extensive, and immediately out-side the hospital area, on either side, are huge warehousesand offices, which, to a great extent, prevent the access ofair or sunlight. It would be infinitely wiser to build a newout-patient department on another site, and utilise the

ground-floor of the present building for accidents, whichat present have all to be carried to the upper floors. Many

the accidents are now kept in a wooden annexe in the

rear of the hospital, which was originally constructed forthe accommodation of fever patients, but which is not usedfor that purpose owing to the remonstnnces of the mer-chants and manufacturers, whose premises are in the

vicinity of the hospital, and who naturally feared that theyor their numerous employes might suffer from infection.The fever cases are now treated in the topmost wards of thehospital, but will be removed shortly to the 11 Barnes " FeverHospital, which is now in course of erection, and which willin a great degree add to the completeness, as well as con-tribute to the healthiness, of the present hospital. Everyendeavour is made to prevent the accident cases suffering byremoval from the basement to the upper floors, a capitallyconstructed bed on wheels (made by Cockshott, of Manches-ter) covered with india-rubber, and provided with springs,being used for that purpose. The floors of the wards arewaxed and dry-rubbed. Erysipelas and pysemia are said to.be rare.

Fractures are abundant, and are treated on the oldprinciple; those of the leg with side splints, a starch casebeing put on at the end of a month. Machinery accidents.are of frequent occurrence. In the treatment of woundscarbolic acid is used extensively by Mr. Lund, while Mr.Southam appears to prefer the tincture of benzoin.

. There are no separate wards for children or for burns,and consequently the odour common to burn cases is moreor less prevalent in most of the surgical wards.

, Erysipelas and pyæmia cases, being infrequent, have no, special place allotted to them; but should either disease.

spring up in a ward, all the other patients are at oncecleared out, and the ward as soon as possible submitted toa thorough cleansing.Many cases of interest were under treatment at the time

of our visit, including excisions of the knee and elbow ; forthe former, Dr. Patrick Heron Watson’s splint, and plaster-of-Paris apparatus were employed, and with tolerably goodresults. Heath’s splint is not used after the latter opera-tion, but the arm is laid on a pillow in an easy positionqand movement is commenced in about ten days.One case which is deserving of special notice was that of

a man with fracture of the skull with depression, whosurvived the accident, but who continued to suffer fromintense headache for many months. The agony he enduredwas so great that he was content to submit to any opera-tion, and accordingly trephining was performed at the seatof injury, immediately over the superior longitudinal sinus-(which, however, was not opened), and with perfect reliefof the patient’s symptoms, and without the production ofany constitutional disturbance. Lateral lithotomy is fre-quently performed one case, in a man aged seventy, was

doing well.For the relief of stricture external urethrotomy is the

favourite operation, Holt’s operation being rarely done inconsequence of one or two unsuccessful cases havingoccurred, though not during the present house-surgeon’sterm of office.

Ovariotomy is rarely performed, and there is no specialofficer for the diseases of women.The physicians’ wards well repay a visit, but their con-

sideration must be deferred for the present.

THE ADVANTAGES OF POOR - LAWDISPENSARIES.

WE have been requested to recapitulate the advantages ofPoor-law Dispensaries. They may be reviewed from apublic and a professional point of view.They secure prompt and adequate medical attendance

on the sick poor, and they likewise tend to raise the pro-fessional position of the Poor-law service. It is not deniedthat the sick poor may and frequently do obtain all thatthey require under the existing system ; but there is noabsolute security that they do so, and it cannot be doubtedthat the parish doctor does not generally enjoy a very highdegree of confidence, and that the sick poor are in the habitof going to public hospitals and dispensaries under the im-

: pression that they there get better advice, more attention,and a more liberal supply of drugs. The dispensary system