ORIGINAL CORRESPONDENCE.

Oamaru Mail, Volume IV, Issue 1179, 27 January 1880, Page 2

ORIGINAL CORRESPONDENCE.

TO THE EDITOR OF THE OAMAIIU SIAIL._ Sir,—l noticed with some degree of interest a letter in your issue of tho inst. signed "In Utrumque Paratus.' It is a matter of regret that your correspondent did not write to you a little earlier on the subject, for in order to change the system of medical administration in tho Oamaru Hospital the rules requiro at least 14 days advertisement notice. Therefore, although perhaps too late to discuss tho subject vet, the matter cannot bo decided at the meeting this evening, possibly it" might be made, the subject of a special general ■ meeting. I would myself not have taken any notice of tho letter had it .not been written so temperately and apparently with such a desire of acquiring information on certain points which ha\o hitherto been stumbling blocks in the minds of many persons. "I. U. P." asks—l. Will the institution work without a responsible head. 2. Would the medical men be under tho same control of the Committee as at present 1 3. How about the Warder's duties with so many masters 1 These questions are really the main obstacles in the minds of many which iuduce them to encourage the old system. With regard to his first query, I may say at once that I do not consider "that any institution can bo successfully carried on without a responsible head, and certainly that is provided for here. As I the position of this and other similar institutions, it la pretty much that the warder and servants are responsible to the medical superintendent, who is in like manner responsible • to the Committee, who in. their turn aro responsible to the subscribers, who again, and perhaps this is not fully recognised, are responsible to the public and to the state. This latter fact has been decided by the action taken lately at Timaru. • Some people say that the outside public have nothing to do with the Hospital unless they are subscribers. Those holt. - ing that opinion class the institution as a private hospital, confining its charity in accordance with the more or less extended views of its subscribers. Really, the public have the most to do in tho matter, for they, in the most part, depend upon its charity ; not so the subscribers, who aro supposed to be in a' position to deal out that charity in such a way that the suffering poor may obtain the utmost benefit that can be derived from a public hospital. It may be as well to prove that tlio medical superintendent is responsible to the Committee; for oven that has been denied. In a copy of the rules which I have before me, rule 2 states, " Hospital shall be managed by a President, Vice-President,' Treasurer, Secretary, and Committee of sixteen, all of whom shall be elected annually," &c. Thus clearly laying down the responsibility ; and. this is corroborated by rules 5, 23, 24, 20, and 27, all of which show that tho medical superintendent is responsible to and under the control of the Committee. No. 5 states, " The Committee shall have power to suspend-the medical superintendent." 23, "The medical superintendent shall superintend and control the servants and report thereon to the Committee." 24, 25, and 27 also have clauses requiring that the superintendent report to tho Committee. By these rules, therefore, it is quite clear that the Committee, and not the medical superintendent, i 3 the responsible head. Perhaps your correspondent " I. U. P." meant a responsible medical head. Ifso, that question is just as easily dealt with. For instanoe, were there two medical men attached to the Hospital, they would individually be responsible for the treatment each of his own cases. The beds would be divided between the two, each having his own patients and his own days of regular attendance, which, howover, would not prevent him from attending on other days to see his own cases if he considered it necessary. Thus you would distribute the work now done by one man between two, and make it much easier. This being so, it is no less easy to divide the work amongst, say, four. The work would fall much lighter, and could be done moro easily, and therefore cheapor. The indi* vidual responsibility would remain the same as now, and the general and collective responsibility divided. I am writing now on some six years' experience in one of the large London hospitals. There as resident surgeon for six months I had smple opportunity of observing the management and internal economy of the wards. There wel'e fouy surgeons in charge of the beds, Two divided the beds on one side of the ward, and two on th§ other side. Each saw, attended to, treated, and was responsibly for the welfare of his own patients, not interfering in any way with the others, except in oase of oxtreme emergency, such is unavoidable absence, &c. I, as resident surgeon, was responsible to the Committee simply to see that food was not wasted, and nursing properly carried out, and that there was proper attendance ready for accidents, and that is really where a resident surgoon is required, • We treated from ten to fifty cases of accident daily, and that is when a resident surgeon ia required ; as for tho in-patients, he is merely a servant of tho visiting surgeons to carry out their instructions on their own patients. Now, sir, these four visiting surgeons wore men not simply of British or European fame, but bearing a world-wide. reputation. It might surprise ypu to learn that these men could find it in them to devote two hours three times a week to administer to the sick poor, and to do so willingly for charity, without pay. I believe I am correct in stating that none of the medical staff in-any London hospital receive pay. As to thp segon4 question, it follows aa a matter 'pf course were the Hospital thrown open; the medical men would be subject to the Qommittee under tho same rules as nOw, or else forfeit their right to attend patients there. The third question about the warder ia still more simple. He has simply to oavry out the instructions, written or verbal, given to him, These should generally be written to avoid mistakes. In cases of emergency he must just send for further instructions, and use those talents whioh have placed him in his position, aa he doea , now.—l am, &c,, Harry A. de Lautour.