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

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.

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$5 Maii 1890.] Lieut. Colonel E. Montefiore, r.a. [ Continued. Chairman— continued. iflicient treatment. In fact, out-patient work, is generally conducted, neither conduces to the sound advancement of professional knowledge, ior to the advantage either of the students or the jjublic.” At a large general hospital I timed the cases in the casualty department (this is in the casualty department connected with the out- patient department). The medical officer in the first twenty minutes which I noted, dealt with '46 cases; in the second, 48; in the third, 42: pnaking a total of 136 in the hour, which is less than 30 seconds for each patient. The next sub- head is (c) The crowd, &c., “increases the discomfort and pain of those who are suffering from severe maladies, and occasions much vexa- tious and needless waiting.” The best state- ment on this point would be a description of what may ordinarily be seen in an out-patient depart- ment. Persons are admitted into a waiting-room or hall, and placed so as to see a medical officer in turn. Various plans for arranging this are adopted. Sometimes there is a fixed maze or zig-zag; sometimes benches are placed in a similar form, upon which each patient as he comes takes his place. The patients are then, in many hospitals, seen first by the house surgeon or physician, or by a medical officer specially appointed for inspecting all patients that enter the hospital. By some such officer the cases are roughly sifted from a medical or surgical point of view. Some are given a letter to see the assis- tant physician or surgeon on duty, others are given papers to see the house surgeon or physician on duty, others are passed on to the surgery or casualty department to receive a dose of medicine or some slight bandage or dressing. Of these many wish to see the assistant physician or surgeon, and will wait for hours in the hope of doing so. This process of sifting takes a very long time, often two hours. Admitted to the several rooms, the patients wait for the physicians or surgeons on duty, and then take their turn to be seen. A patient suffering from acute illness might thus often remain in the crowd and bustle of the admission hall and out-patient’s rooms for three or four hours. Around them would be patients who had previouoly been at the hospital, and who might be comparatively well. There would be also mothers with their children brought to the hospital, sometimes because they are ill, sometimes because the mother is ill and cannot leave them at home. There are persons in all stages of illness. For those who require refresh- ment, tea, coffee, &c. are often provided at low charges. There is much evidence of the “ vexa- tious and needless waiting;.” The Islington committee of the Charity Organisation Society report amongst recent cases the following :— A. “ Mother said she should like to take Walter to No. 1 hospital.” 53. Which is No. 1 ?—I do not name those hospitals ; I do not know whether your Lord- ships wish me to give the names ? 54. Yes, if you please?—No. 1 hospital here re- presents the Great (Jrmond-street hospital for children ; “ Mother said she should like to take Walter to No. 1 hospital.” I used to get a letter myself by going at 8.30 a.m. and waiting till 3 p.m. B. “ Waited all the afternoon at the No. 2 hospital,” (which represents the Great Northern (69.) Chairman—continued. Central Hospital) “ for a certificate to be signed, and then was told it was too late.” C. “Mother neglected to take child to No. 1 hospital ” (the Great Onnond-street Hospital) “ about an instrument, because of the long delay in the waiting-room.” Another of our district com- mittees, Camberwell, reports the following cases :—D. “ says she took her child twice a week for three weeks, and received no attention. At first, stayed from 9 a.m. to 5 p.m. Later, she found it was no good staying on, and left after the doctor made his rounds between 12 and 2.” (There was no hospital stated there in the evidence sent me.) E. “ Waited from 9 a.m. to 8 p.m. before being attended to.” F. “Waited from 2 p.m. to 8 p.m.” G. “Waited from 11 to 3, and then the surgeon refused to examine the child : she took it to the infirmary.” “I am told that it is common to have to wait from 9 a.m. to 5 p.m. at the No. 3 hospital” (which represents the Evelina Hos- pital). “ Complaints as to waiting four hours at No. 4. hospital (St. Thomas’s), and a long time at No. 5 hospital (that is Broinpton, the hospital for consumption).” The Mary'e: one committee said that this waiting “ is so inevitable in the circumstances and so much a matter of common notoriety as scarcely to need re-statement.” Two cases of the evil results of the present system may be mentioned. The first comes from the Poplar committee, “ Instances of the evils attendanton the long waiting in crowded rooms are of constant occurrence, not the least being the sometimes trying ordeal of prolonged close proxi- mity to persons suffering from disfiguring or other unpleasant complaints. In one case coming under the committee's notice bad management in this department almost cost the patient her life” (the hospital is not stated). “She was sent by a private practitioner to one of the general hospitals for treatment by an eminent obstetrician. Just as she was to have been exa- mined, surgeon and students were called off to a more urgent and more interesting case, and she was kept waiting for two hours with no covering beyond a light dressing-gown. When the sur- geon at length reappeared, the patient, as may easily be imagined, was hardly in a fit, state to undergo what even under ordinary circumstances would have been a painful examination. A serious attack of inflammation of the lungs fol- lowed.” The Paddington committee furnished the second case. They say : “ One case, as an example : a man suffering from a fracture of the ribs, applied three days running for admission into a hospital, being told each time to come again; and pneumonia was brought on chiefly by the exertion of walking backwards and forwards.” The long delay is a constant cause of complaint amongst the poor. Another point worthy of mention is the occurrence of infectious cases in crowded out-patient rooms. I believe that such cases are not infrequent; and of late I have noticed that some of the hospitals have adopted the plan of appointing a trained nurse to inspect all patients on their entry. By way of illustra- tion, I may mention two cases that struck me particularly, and which suggest the very great necessity of care, especially while our out- patient departments are managed as they are at a 4 present$