Report from the Select Committee of the House of Lords on Metropolitan Hospitals, &c. : together with the Proceedings of the Committee, minutes of evidence, and appendix. / Ordered, by the House of Commons, to be printed, 15 August 1890.
- Date:
- 1890
Licence: Public Domain Mark
Credit: Report from the Select Committee of the House of Lords on Metropolitan Hospitals, &c. : together with the Proceedings of the Committee, minutes of evidence, and appendix. / Ordered, by the House of Commons, to be printed, 15 August 1890. Source: Wellcome Collection.
Provider: This material has been provided by Royal College of Physicians, London. The original may be consulted at Royal College of Physicians, London.
35/632 (page 23)
![5 May 1890.] Lieut. Colonel E. Montefiore, r.a. [ Continued. Earl of Kimberley—continued. infirmaries as a clinical school for senior students who had done their hospital work, and had no examination in view, fully qualified men who would be capable of teaching themselves. There would be no objection to the occasional intro- duction of a class by a country physician or surgeon. Mr. Vallance, being invited to express his opinion, said that he would have preferred to listen and learn. He saw administrative diffi- culties and the danger of divided authority. The feeling of the Whitechapel Board was in favour of the change, but they had been deterred by the fear of friction. Dr. Bridges had also come as a listener, but he thought that he might con- tribute to the historical side of the question, as he had watched the rise of these great institu- tions. Formerly there existed no separate provision for chronic diseases amongst the destitute. They were ‘ warehoused ’ in work- houses. Then Miss Louisa Twining began her work, and was succeeded by the ‘ Lancet ’ Commission and the Act of 1867. Gradually the infirmary system was built up after a separate struggle with the board of guardians in each union. The underlying principle was adequate indoor relief. So gradual had the growth been, that the medical profession were only just beginning to realise what had been done. If it had been less gradual, the ratepayers would have rebelled That was a lesson cf caution and patience in making further improvements. The St. Pancras Board had appointed two fully qualified assistants from University College Hospital for a period of 12 months. The practica- bility of appointing consultants would depend a good deal on the opportunities of each district. In the neighbourhood of a hospital it would be comparatively easy to obtain men. Mr. Albert Pell contended that the qualification for admis- sion to a hospital was disease, and the qualification for admission to a poor law infirmary was destitu- tion. The one object of the medical superintendent should be to get his patients out again ; he did not mean by the hands of the undertaker. He had voted against the proposed alterations, because he dreaded interference with poor law institutions, and with the authority of the resident officer. Mr. Patter, medical superintendent of the Kensington infirmary, stated that the Ken- sington Board had accepted his proposal for the admission of six students for three hours daily, but that the Local Government Board had put them off; and when he renewed the proposal the guardians had rejected it. He believed that the introduction of students would stimulate the resident medical officers. Rev. IL TI. Hadden, Guardian of the City of London Union, was personally in favour of the changes, but quite sure that his board would not approve them. The first step was to obtain consultants. A pre- mature attempt to introduce students would wreck the whole scheme. He advocated caution and the granting of a permissive order by the Local Government Board. Mr. Russell Bar- rington, a guardian of the parish of Kensington, shared Mr Pell’s fears. He regarded with alarm any tendency towards State hosnitals. The great obstacle to hospital reform was the demand of the medical profession for schools. It would be a misforture to introduce the same (69.) Earl of Kimberley—continued, difficulty into Poor Law administration. The infirmary ought to be reserved for the destitute, and the destitute alone. Colonel Montefiore, in reply, argued that the proposed reforms would be of advantage to the ratepayer as well as to the medical profession, ft was economical to get a destitute patient cured as soon as possible. He recognised the necessity of caution in intro- ducing changes, and the practical difficulties by which the whole question was beset. What he pleaded for was that they should keep in view the general aim of closer co-operation between the hospitals and the poor law guar- dians, for upon the proper adjustment of the mutual relations of those two bodies depended the success of our charitable provisions for the medical relief of the poor. The chairman wel- comed the proposal as an attempt to link charity with the Poor Law.” 204. I observe that Mr. Barington said that “ he regarded with alarm any tendency towards State hospitals.” Is it not the fact that these infirmaries are State hospitals ?—Thev are State hospitals ; decidedly so. 205. Now I find in this statement that the number of beds in these infirmaries is no less than 12,195, of which 6,803, according to this statement, are in hospitals very admirably built and constructed ; do you not think that it is an extremely unfortunate arrangement that a very large number of beds in hospitals that to all intents aud purposes are State hospitals should be withdrawn altogether from one of the most important objects of hospitals, namely the teaching of the medical profession?—I distinctly said so. 206. .And the Committee of this House on the Poor Law two years ago reported that they were “ disposed to agree with Dr. Bridges, the Local Government Board Medical Inspector for London, that ‘ with proper precautions ’ clinical teaching could be allowed in the interests of the patients of the infirmary and also in the interests of the public ; ’’ should you be disposed to agree with that recommendation ?—Distinctly. 207. The only reservation probably you would make would be that one which was very wisely made by several who took part in your discussion, that, looking to some prejudice that may exist in opposition, the charge should be introduced with a great deal of caution, and that only by degrees should such alterations be made?—Distinctly with that reservation. 208. Dr. Bridges before that Committee stated that there was a special necessity for admitting the medical profession generally to these hospitals because of the number of clinical cases that were to be found in them, which could not be well studied elsewhere ; should you agree with that from what you have heard?—From what I have heard I should think so, that many cases of distinct interest to hospital teachers cannot be seen at their termination in the hospitals as they can be in the Poor Law infirmaries. 209. With reference to the objection that the poorer classes may have entertained to these infirmaries being opened to the medical pro- fession, do not you think that the fact that they resort in such large numbers to the hospitals sufficiently answers that. Why should they O 4 object](https://iiif.wellcomecollection.org/image/b28040193_0037.jp2/full/800%2C/0/default.jpg)
