1101

LONDON: SATURDAY, OCTOBER 17, 1903.

King’s College Hospital.A a special court of the governors of King’s College Hos- po;

pital held on Monday last (an account of which will be found bel

at p. 1110 of our present issue) the removal of that institu- 1

tion to a site in South London was approved and formal co]

motions were passed to enable the council of King’s College tio

and the committee of management of the hospital to acquire su:

a suitable and adequate site and to apply to Parliament for re

an Act to confer the necessary powers to effect the pro- po

posed removal. In passing these resolutions the governors are ca

supporting the unanimous recommendation of the medical Ct

. staff which had previously been submitted to prolonged hand anxious consideration by the council of the College, al

by the committee of management of the hospital, and by of

a special committee of influential men appointed to investi- sv

gate the advisability of removing the hospital. sixThe most sanguine supporters of such an important change w

must have expected some degree of opposition. This was CI

but natural, since in every hospital there are hallowed tl

associations which cannot be transplanted ; beds, wards, and d

operating theatres bear names intended to commemorate iE

former benefactors and former workers whose labours have pcontributed so largely to the relief of suffering humanity and i]

to the advancement of medical science. The names of the h

various wards-Todd, Cheere, Twining, Wigram, Craven, a

Sambrooke, Fergusson, and Johnson-amongst King’s Col- a

lege men evoke memories of familiar forms and though it is t

doubtless intended to retain these names in the new hospital s

they will seem less real when remote from the scenes of 1

their work. These sentimental considerations, together with 1

a spirit of conservatism, have perhaps weighed much with ]the members of the committee of the hospital who resigned Iwhen it became evident that their opposition to the scheme ]of removal was clearly out of harmony with the wishes of a

large majority. :

On the other hand, the reasons for urging the removal

appear to be of overwhelming force. Dr. BUZZARD, in a

conciliatory speech, briefly enumerated the chief arguments,referring frequently to a more detailed document addressedto the governors and signed by numerous members of

the council and of the committee of management of the

hospital. It is evident that although the hospital was

originally admirably planned to supply the needs of a

crowded district and to afford adequate training for medical

students, it has for many years past inevitably fallen behindmodern requirements. Sufficient space was originallydevoted to medical, surgical, and obstetric cases, and as

planned the hospital was light, cheerful, and well venti-

lated in all parts. In time, however, numerous specialdepartments were created and for their proper developmentthese required some ward space as well as properly lighted

out-patient rooms. Frequent efforts were made to improvethe accommodation and by re-arrangement to providefor these new departments, but the result has been to

produce overcrowding and consequent inconvenience in theworking of almost every department. The structural altera-

tions could not be effected satisfactorily without remodellingor rebuilding a large part of the hospital. For a long timethe authorities have felt that it was imperative to constructnew out-patient rooms, new quarters for the resident officers,and new wards for the special departments. Upon theground belonging to the hospital it has been found im-

. possible to achieve all these objects even if funds could haveL been collected for this purpose.- Meanwhile, although within the hospital there have been1 continual growth and activity, the local need of the institu-tion has been steadily diminishing owing to alterations in itse surroundings. The building of the Law Courts and morer recently the Strand improvements have cleared and de-

- populated large areas which formerly supplied numerouse casualties to this hospital, to St. Bartholomew’s, and totl Charing Cross. The distribution of the hospitals in Londond has long attracted the attention of those engaged in the, allotment of the various charitable funds. The opinion hasy often been expressed that while some districts are too richlyi- supplied with facilities for obtaining gratuitous medical and

surgical treatment, there are wide areas densely populated;e with poor people who have to travel some miles before theyis can obtain relief. In hospital management it is a truism

Jd that large numbers of patients invariably come from greatid distances to attend the out-patient departments ; that therete is a process of selection or exclusion which cannot be

ve prevented and can hardly be explained. In hospitals, asid in private work, certain individuals or certain departmentshe have a reputation for skill and kindliness that serves as

n, an attraction which outbalances distance or difficulty ofol- access and in this way, although through depopulationis the supply of casualties may be greatly reduced, somebal special departments may become inconveniently crowded.

of Those concerned with the distribution of charitable funds

ith look, however, to an ideal distribution of the hos-

ith pitals in the immediate neighbourhood of the greatestled congestion, of the greatest distress, and from this stand-me point it is obvious that the Strand and Fleet-street are too,f a well supplied while South London languishes. Meanwhile

it is on all hands admitted that ground in central Londonval is so valuable that lavish expenditure must be made by any1 a hospital attempting to put its house in order on modern

its, lines. The rent of a requisite area would absorb too largesed a proportion of the income of any hospital in which it wasof desired to centre the best clinical teaching in every depart-

the ment and it must be remembered that the best teachingwas leads to the most efficient work of a hospital.E a The present position of King’s College Hospital in centralical London possesses numerous advantages which cannot be

kind lightly overlooked. It is of easy access from all suburbs, so

ally that students may be drawn to it through almost any of theL as channels linking town and country. It is close to the

inti- College, it is close to the Royal College of Surgeons of

icial England and to the Examination Hall It is so near

nent to the medical district that daily visits offer no greattited difficulties to members of the staff. All these advantages

1102

are, however, being put aside in the desire to move

with the times, to transplant the hospital to a site

Iwhere it is more urgently needed and where it will be

possible to construct a hospital replete with every moderndevice for the general and special treatment of the sick.

The initial outlay involved must necessarily be very greatbut it is to be hoped that the self-denial and public-spirited-ness of the staff in making this great step in obedience tothe needs of South London will receive that financial sup-

port which will enable the scheme to be carried into effect

at a very early date.

The Children’s Committee of the

Metropolitan Asylums Board.A DEPARTMENTAL committee of the Local Government

Board was appointed in 1894 to consider the whole questionof the treatment of children under the care and jurisdictionof the Poor-law and its report strongly recommended theformation of a central authority with the duty of makingspecial provision for these children within the metropolitanarea. This was the origin of the children’s committee of the

Metropolitan Asylums Board which was constituted in 1897and which has recently issued its fifth annual report. The The committee receives from the guardians the following classes Iof children : those suffering f -om ophthalmia, ringworm, 1and tuberculosis, those requiring treatment in country (

homes, and those children who, being mentally or physically s

defective, are cared for in homes in London. Homes B

have been opened by the committee for the reception r

of children under magisterial remand who, it will be re- c

membered, were formerly, and most unfortunately, sent c

to the workhouse. The groups of children thus indicated, g

some with bodily illness and others with mental or moral T

deficiency, have to be cared for and educated by the State, tl

and the report of the children’s committee shows the b

machinery employed and the result. The sick children 4(

appear to us to be excellently treated, while the cases of ra

psychological interest at any rate command every care. c

But very great skill and scientific experience should be T]

brought to bear upon the betterment of these unfortunates. plThe varied phases of educational work demanded by the ce

conditions and special needs of mentally defective children ti(

call for much labour and special knowledge on the part of re

the committee, and it is impossible for us not to recognise th

that the personnel of the committee includes few among its ch

members who are prominent in the medical and scientific mi

world for their first-hand acquaintance with modern methods relof training as adapted to the necessary end. This might, relwe think, be set right. The Local Government Board has ill-

the power to nominate a certain number of representatives dej

to the Metropolitan Asylums Board in addition to the or

members sent by the boards of guardians, and it would sigbe well if opportunity were made to add to the children’s poicommittee some educational authorities with the neces- attl

sary knowledge and training who might assist in the tior

lischarge of the difficult and important duties which onl;Me continually extending as new social problems have expi8 be solved in the public interest. We observe that thal

boards of guardians do not make all the use that thrc

hey might of the accommodation provided by the groi

nove

Metropolitan Asylums Board for mentally defecth

site children, a condition of affairs which would probably 1

l be remedied if the children’s committee were reinforced b

iern one or two members who would be universally regatded adck. experts. It must be remembered that efforts for the in

reat provement of children who are feeble-minded and physited- cally defective necessitate the services of a more high!e to trained staff than may be required in cases of sickness

;up- The children are collected from the metropolitan Poor-lafect schools and boarded in small homes in London under tb

care of a matron, so that they may attend special classes’in the neighbouring board schools. It would probably prov4more advantageous to the children, for whom town life is nol

1e desirable, if the children’s committee saw its way to pro.vide suitable homes for them out of London and a more

ent complete educational scheme to be carried out under its

ion own direction. Were this plan followed we should haveion more hope of its success in dealing with these cases afterhe the age of 16 years; the methods of training might beng continuous, each stage being planned to impart ability foran future work in industrial life.

he The kind of expert knowledge which, in our opinion,97 the children’s committee somewhat lacks is in the

he matter of psychological training for the children who

es are mentally defective : those physically ill appear to

n, be well cared for. As to the latter cases Dr. T.

ry COLCOTT Fox, for example, gives a most encouragingly account of the treatment of the children under his super-es vision who are suffering from ringworm. The average)n peri3d of treatment required to effect a cure of the

e- children so affected was about nine months. Dr. Fox has

it carefully tabulated 317 cases in his report arranged in two1, groups, cases of microsporon and c,ses of trichophyton.d The former cases constitute something like 90 per cent. of

!, the cases met with at the hospitals in the metropolis,e but in the board schools it is to be noted that some

n 40 per cent. suffer from what has been considered a much

f rarer disease in London-viz , trichophyton. These latter

. cases came mostly from Hackney, Southwark, and Poplar.3 The conclusion that Dr. Fox draws is that the tricho-

. phyton. may go unobserved for a long time and form

} centres of contagion especially apt to spread in institu-

t tions where children are collected. We instance Dr. Fox’s

, report as an example of the kind of systematised knowledgei that we should like to see infused into the treatment of the

! children who are mentally defective. The children’s com-

mittee ought to be in a position to deal with analogousreports from psychological experts, but we find in its own

report only slight indications of any effort to improve the

ill-developed brains of the children under its care on anydefinite plan. The mere fact of a child being ignorant, dull,or stupid does not prove that he is feeble-minded ; physicalsigns seen in defective action should be carefully noted andpointed out to the teachers as special objects for their

attention. There appears to be a general idea among educa-tional authorities that weak-minded children should have

only short periods of teaching during the day, but the

experience of those who are conversant with their care is

that active control of these children by trained teachersthroughout the day is most valuable to effect a healthygrowth and to implant good methods of action. Whatever