the general court, and the fees paid by the hospital pupils are divided equally among them. Each of the principal surgeons has the privilege of nominating six dressers, who, in addition to the ordinary fee of twenty-five guineas for attending the surgical practice, pay a further fee of twenty-five guineas each. Out of these one is named as his house-surgeon for the year, for which a further fee of fifty guineas is paid. In going through the wards the principal surgeon of the day is attended by the pupils, frequently from sixty to eighty in number, or even a hundred. The assistant-surgeons only act for their respective principals, and have neither salary nor any participation in the fund arising from the pupils' fees; but they usually succeed to the office of principal surgeons. The house-surgeons superintend and direct the dressers in the absence of the surgeons, perform minor surgical operations, and receive a salary from the hospital of 251. a-year. The services of the eighteen "dressers" are highly useful in extending the advantages of the hospital. They attend to casual injuries of minor importance in cases where there is no necessity for the patient either being received into one of the wards or admitted as an out-patient, and they contribute to the comforts of the in-patients by watching the symptoms of their disease. On a patient being admitted into one of the wards, the dresser writes on the paper hung up at the head of each bed the name and age of the patient, the name of the complaint, the date of admission, and his own name, with a minute of the diet, medicines, and local applications ordered by the surgeon. They are required to collect a history of each new case, to report the progress of old cases, and to take down a full history of such cases as may be pointed out to them. They dress fractures, wounds, ulcers, and all cases that require local applications. The "sisters" of the wards are twenty-nine in number, one superintending each ward and one attending upon the casualty patients. They have usually been persons who have received some education and have lived in a respectable rank of life. Recently they have been at times selected from some of the most active and trustworthy among the nurses. The majority of the sisters receive from 14s. to 20s. a-week, the four seniors from 22s. to 31s. 6d., and on Sundays a dinner is provided for them at the cost of the hospital. The duties of a sister consist in a general superintendence of the ward to which she is attached, in carrying into effect the directions of the medical officers, taking charge of and administering the medicines, reporting to the cook the daily diet required for the patients, and giving information to the medical officers of any change of symptoms in the patients. The nurses, seventy-five in number, act under the sisters, two of them being attached to a single and three to a double ward. They perform the usual duties of servants, in waiting on and cleaning the patients, the beds, furniture, wards, and stairs; and are paid 7s. a-week, and partly dieted at the expense of the hospital. The majority of persons received as patients into the London Hospitals are mechanics, labourers, reduced tradesmen, or servants. There are, however, numerous admissions of individuals of both sexes, and particularly females, of the very lowest class of society and the worst character. The most common offences against the regulations are smoking, swearing, gambling, and fighting, and refusals to attend to the directions of the medical officers. Instances have occurred in which the lives of the sisters or nurses have been threatened by patients of the lowest and most abandoned class. In all ordinary cases it is necessary that an applicant for admission should obtain the recommendation of a governor by his signature to a printed petition, of which forms are procured at the hospital. Many are admitted without any other recommendation than the urgency of their case. Cases of accident are admitted on all days, at any hour whatever; but at every hospital one day in the week is set apart as the regular day of admission, when the applicants attend in the patients' waiting-room one hour before the meeting of the board. Small-pox is the only disease against which the doors of the hospital are absolutely closed. The admissions average between fifty and sixty on the regular days, which is also the average number of the accident admissions and others which take place on other days. The outpatients consist of such as, being in want of medical aid, either do not apply for, or from the nature of the case or the want of room cannot obtain, admission into the hospital; or of convalescents, who, when partially cured in the hospital, are removed to make room for others. The casualty patients include all who apply on any day in the week between ten and twelve for surgical assistance. They are seen by the dresser in attendance, and the case is treated and a record of it entered under the direction of the house-surgeon. The number of beds at St. Bartholomew's is 533, and the number of in-patients is between 5000 and 6000 a-year, of out-patients between 8000 and 9000, and of casualty patients upwards of 20,000. The deaths amongst in-patients are about one in eighteen, or about 360 a-year. At St. Thomas's and Guy's the general medical economy, arrangement, and regulations are of much the same nature as at St. Bartholomew's, and it is unnecessary to enter into a minute detail of them. At St. Thomas's there are nineteen wards, each of which is superintended by one of the sisters, who were formerly selected from the nurses, but are so no longer. There is always one candidate for the office in training. The nurses are divided into day-nurses and night-watchers, the latter of whom enter upon their duties at eight in the evening and remain until ten the next morning. It is found very difficult to get persons fitted for either of these offices, as the duties are onerous and disagreeable, and the stipend small. The total number of in and out-patients to whom relief was administered in 1836 was 46,674, classed as follows: Physicians' out-patients 14,404, surgeons' out-patients 19,870, midwifery out-patients 1451, apothecary's out-patients 5965; and of in-patients there were 3025 discharged during the year and 298 died. The remainder were under cure on the 31st day of December. When a patient dies, the body is laid out, and, after remaining in the bed about four hours, is taken to the dead-house; the bed and bedding are thoroughly washed and cleansed; the bed is entered as a "dead bed," and remains unoccupied about a week. 6 At Guy's the number of beds which can be made up on an emergency is 600. The average number of applications for admission on the regular day is 100, of whom on an average 43 are admitted and 57 rejected. The deaths are about per week. On the death of a patient, a screen is placed round the bed; but it is rarely possible to conceal the circumstance from the others in the ward, and within three or four hours the body is removed to the undertaker's room. The out-patients of this hospital amount, perhaps, to 40,000 a-year. About 60 sur gical tickets are issued per week; 80 surgical casualties per day; 30 eye-cases per week; 90 physician's tickets per week; 6 cases per day relieved at the apothecary's shop; 20 obstetric cases per week, and 30 ordinary lying-in cases; or taking three weeks as the average of attendance of each class of cases, there is an average of above 100 persons in the daily receipt of medicine or attendance, independently of slight casualties relieved. The importance of the great London Hospitals as schools of medicine is well known. Nearly every medical and surgical practitioner has "walked the hospitals," as the phrase gocs; and though the recognition of provincial medical schools renders it no longer absolutely necessary that a medical student should have attended a London hospital, yet the number who "come up" for this purpose is but little diminished. The vicinity of the hospitals swarms with these incipient Galens; and they are so thick on the ground in some quarters, particularly in the neighbourhood of the Borough hospitals, as to give the district a distinctive character. Certainly the "medical students" are entitled as a class to figure amongst the social lights and shadows of this great metropolis. There are thirteen schools of medicine in London, but the most important are those connected with the great hospitals, though it is chiefly within the last twenty years that they have attained their pre-eminence over the private schools of medicine. The lectures of John Hunter, in Windmill Street, about 1768, were the first complete course ever delivered in the metropolis; and in 1749 all the dissections carried on in London were confined to one school, that over which John Hunter's brother presided. But even at St. Bartholomew's Hospital the introduction of lectures is of very recent date. Mr. Percival Pott, a distinguished surgeon of this hospital nearly eighty years ago, was in the habit of delivering occasional instruction in this manner; but the late Mr. Abernethy, about twentyfive years ago, may be said to have been the father of the system as it at present exists. The institution of a medical school in connexion with an hospital adds to the emoluments of the medical officer; furnishes, through the medium of the pupils, additional and gratuitous attendance on the hospital patients; and, lastly, imparts a medical education to the pupils themselves by lectures, illustrated during their personal attendance on the patients, by observation of the progress and symptoms of disease, the mode of treatment adopted, and the results. The governors of this hospital have since expended above 5000l. in buildings intended to facilitate the acquisition and communication of medical science. The museum was built so recently as 1835. From 1760 to 1825 the schools of surgery of St. Thomas's and Guy's Hospitals were united, and the fees paid by the surgical pupils of both hospitals were put into one common fund, and divided equally amongst the surgeons and apothecaries of the two establishments. Medical lectures only were delivered at Guy's Hospital, while surgery, together with anatomy, was taught at St. Thomas's. For many years the late Sir Astley Cooper, who was surgeon at Guy's, filled the office of anatomical lecturer at St. Thomas's. This union was dissolved in 1825, in consequence of the governors of the two institutions differing respecting the appointment of a lecturer on anatomy; though we believe there is still some traces of the old connexion to be found in existing regulations. In 1825 it was resolved that the means of surgical education should be provided within the pre cincts of Guy's Hospital. Accordingly, the building which contains the anatomical schools, museum, &c. was erected at a cost of about 8000l. Sir Astley Cooper was appointed principal lecturer in surgery, his nephew succeeding him. as surgeon. On this occasion Sir Astley was desirous of presenting to Guy's Hospital his anatomical models and preparations, when the governors of St. Thomas's refused to surrender them, but ultimately gave him 1000l. for his interest in them. A few years ago, in consequence of some offence given by them, the privileges of the students of Guy's, in being admitted to see the practice of St. Thomas's, was restricted to some extent by the authorities of the latter establishment, when a most serious riot took place. The refractory students were indicted for the offence, and a slight punishment was awarded by the court. The fees paid by pupils entering the medical and surgical practice of this hospital are about 3000l. a-year, which is divided amongst the principal physicians, principal surgeons, and apothecary. The pupils admitted yearly to the house-practice vary from 100 to 130, and an attendance of three years is required by the Apothecaries' Society. We can scarcely do more than mention the names of the other hospitals. The Westminster Hospital, opposite the Abbey, was established in 1719, and was the first institution of the kind supported by voluntary contributions. It contains accommodation for 200 patients. St. George's Hospital was established in 1733, by a dissentient party in the management of the Westminster Hospital, and Lanesborough House was at first engaged for the purpose. The principal front of the present building is 180 feet long, faces the Green Park, and is of rather imposing design. It contains a theatre for the delivery of lectures and an anatomical museum, and the number of beds is 317. The London Hospital was established in 1740, and in 1759 was removed to its present situation in Whitechapel 1 Road. The patients are chiefly watermen, and labourers employed in the docks - New institutions of this nature are every year springing up, especially those |