be done to abolish, at once and for ever, all these horrors, and to put the treatment of our sick poor on a proper footing? In the article published ten years ago, so often alluded to, we recommended "a complete and thorough separation of the proper workhouse for the reception of paupers in health, and the hospitals for the reception of the sick poor." "The accommodation, ventilation, and medical care of the latter should be of the very best description." "There should be a fixed minimum space for each patient." .."A sufficient number of paid medical officers should be appointed to take care of the patients, and they should not, to use the words of a Parliamentary Report, have their duties and their interests placed in very unfavorable contrast by a disgraceful contract for the medicines used in the hospitals;" and we pointed out the cruelty of appointing any but trained and paid nurses. We further recommended that these hospitals should be supported by a special hospital tax or rate, that the commission of management of the hospitals should be immediately under Government control, but the ratepayer's interests should be represented in it. "The example of France," we said, "in the matter of local hospital administration is worthy of being followed."

We are gratified to find that not only have the deficiencies and imperfections of the present system of providing for our sick poor, which we expressed in our article of ten years back, been fully endorsed by the Lancet Commission, the Association for the Improvement of the Workhouse Infirmaries, and the recent investigations of the Poor Law Board, but that the identical reforms we then proposed have been recommended by these authorities. Thus, the chief medical men connected with the Association just alluded to, having been requested to express an opinion of the principles which should guide any efforts to improve the state of treatment of the sick poor in workhouse infirmaries, stated that any scheme, in order to be satisfactory, should be based upon the following principles :

"1. The sick poor should be separated from the ablebodied paupers, and their treatment should be placed under

a distinct management. 2. In lieu of sick wards annexed to each workhouse, consolidated infirmaries should be provided, where the following rules of hospital management should be adopted under skilled supervision. They are those generally accepted in this and other European countries.

"I. The buildings should be specially devised for the purpose, of suitable construction, and on healthy sites. The rules laid down by the Barrack and Hospital Commission may be consulted with advantage on this subject.

"II. Not less than 1000 (and for particular classes of cases 1200 to 1500) cubic feet of air should be allowed to each patient.

"III. The nursing should be conducted entirely by a paid staff, and there should be not less than one day nurse, one night nurse, and one assistant nurse, for each fifty patients.

"IV. There should be resident medical officers in the proportion of not less than one for each 250 patients.

"V. The medical officers should not have any pecuniary interest whatever in the medicines supplied, nor should they be charged with the duty of dispensing them.

"VI. A judicious classification of patients should be strictly observed: the epileptic and imbecile, the acutely sick and the aged and infirm, being treated in separate wards.

"VII. The aged and infirm, the chronically sick, and the convalescent, should be provided with day rooms, separate from the dormitories.

"(Signed) THOMAS WATSON, M.D.,

"President of the College of Physicians. "GEORGE BURROWS, M.D.,

"President of the General Medical Council.

"JAMES CLARK, M.D.

"WILLIAM JENNER, M.D.

"EDWARD SIEVEKING, M.D.

"WILLIAM FERGUSSON.

"JAMES PAGET."

The Association further proposes that the present workhouse infirmaries should be done away with and six large new hospitals constructed, each to contain 1000 beds; that

the funds for these new hospitals and their support should be raised by a general rate raised from the whole metropolis; that these six hospitals should be under the management of a central board, in which each parish should be represented by a delegate, the whole to be placed under the control of the Poor Law Board. The French system of hospital administration is strongly commended.

In an article expressing the views of the Association, by Mr. E. Hart, proprietor (we believe), and one of the commissioners of the Lancet, nothing is said about the existing voluntary hospitals, except that they would not be interfered with by the new workhouse hospitals. In our article of ten years ago we proposed a kind of amalgamation of these voluntary hospitals with the new workhouse hospitals, and gave our reasons for this, which we need not repeat here, but which seem to us to have lost none of their cogency.

The British vestryman would not be true to himself, his imaginary vested rights, and his perverted principles, were he to hear of a proposal for remedying an evil with which he is connected and not utter a howl of indignation. Accordingly the plan now proposed for withdrawing the helpless sick poor from his cruel mercies, and placing them so that they may have a few more chances of recovery than at present, is denounced by this wonderful specimen of British doggedness, ignorance, and conceit, as a mere scheme of the doctors to get more hospitals and pay, as an architect's job, a secretary's job, an interference with the rights of selfgovernment, that integral part of the British Constitution, though, as to that, we think the principle of self-government is violated if the sick poor have no voice in determining the manner in which they are to be treated. The circumstantial exposure of the horrors of the workhouse hospital is held up to public execration as "a desire for sensational obscenity on the part of some prurient greybeards," or something to that effect.

In spite of the British vestryman's frantic screams the indignation of the public who are not vestrymen has roused the poor-law authorities to make inquiries into the actual management of the workhouse hospitals, though how, with

their inspectors constantly reporting to them, they should have been ignorant of the workhouse mismanagement, it is difficult to understand,* and, if not ignorant, why they should have permitted the continuance of this mismanagement is still more incomprehensible.

In the mean time we heartily wish success to the main scheme proposed by the association for the establishment of half a dozen or more large well-ordered hospitals in place of the thirty-nine or forty-one miserably managed workhouse infirmaries that disgrace our age and outrage our charitable feelings. But we think that in establishing such new hospitals some plan should be adopted for securing the best medical care, differing from the time-honoured British system of making such appointments a mere matter of votes given by persons utterly incapable to decide as to the respective merits of candidates. Here, if anywhere, the principle of competitive examination should come into play, and the best man should bear off the prize, as in the French concours. To the voluntary hospitals may be left the silly practice of appointing the man who, by dint of hard canvassing, can collect the greatest number of governors' votes. The government hospitals should be the reward of real merit, the prize of superior acquirements. And to make this prize worth contending for, the right of a medical man to be well paid for his work should be recognised and acted on. Were the state hospitals conducted on these principles the voluntary hospitals would be compelled sooner or later to conform to them also, and we should cease to see the present eager canvassing of rival candidates for the barren honour of a hospital appointment obtained not by merit generally but by persevering pushing.

Another point well worth the consideration of the Government in regulating these hospitals would be to

* Mr. Farnell, C.B., chief inspector to the Poor Law Board, has recently explained this mystery, by stating that he trusted entirely to the reports of the paid officials as to the state of the workhouse hospitals, though one would have thought that his chief, if not sole duty, as inspector for the Poor Law Board, should have been to inspect these same paid officials and see that they performed their duties. It could scarcely be expected that these officials would expose their own delinquencies to this easy-going inspector.

inquire which of the rival systems of medicine is the most successful and the most economical, and if it should turn out on inquiry, as we know it will, that the homœopathic system is the most economical, both of life and money, the hospital administrators should not hesitate to insist on its introduction into their hospitals. In the event of the Association scheme for new workhouse hospitals being carried out, some representative body of London Homœopaths should be prepared to urge upon the Government the claims of Homoeopathy to have a share in the treatment of the sick poor in the proposed new hospitals. We would recommend this to the serious consideration of the British Homœopathic Society, which, by its connexion with the London Homœopathic Hospital, is most favorably situated for impressing the authorities with the advantages of the homœopathic treatment.

NOTES ON CAUSTICUM. By FRANCIS BLACK, M.D.

FEW symptoms present themselves so frequently in winter and spring as cough, and hardly one medicine in the Materia Medica is to be met with which does not contain its pathogenesis. But this embarras de richesses is most puzzling to the practitioner, especially to those commencing practice. There is no portion of Hahnemann's Materia Medica where the want of the detailed proving is so much to be regretted as in the thoracic sections. The lack of the journal of the proving renders many symptoms of little or no à priori value, so that clinical experience is necessary to assign to them their proper place; but clinical information is but an imperfect substitute for the full proving, for there alone can be found the order and connection of the symptoms, and on these depends their diagnostic value. In the schema of Hahnemann the including of pulse under the head of fever, and separating it from heart and pulmonary system, diminishes the value of the proving. Again, among the multiplicity of coughs, pains, and disorders of the respiration, often detailed with a painful minuteness, the in