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recognise in the management of that institution the realisa-tion of principles and methods which ensure the success ofthe industrial, manufacturing, and commercial enterprisesof their town and country. Therefore the confidence of thepublic and its preference for the special hospital increases,to the great detriment of both the specialist and the generalpractitioner.Thus there is a clearly defined reason for the growing ten-

dency to abuse special hospitals. On the other hand, someprecautions are taken at the Eye and Ear Hospital ofLiverpool to prevent such abuse. The applicant must firstgive his name and address to a clerk, who then refers to thePostal Directory, where it will be found, if the applicant is aman of means. Should doubts be excited, the patient isreferred to the matron, who asks several questions. But I wasruefully informed that, though the applicants thus rejectedbecame private patients, they rarely paid their bills. Theygenerally proved to be bankrupt tradesmen, or some similarpretext was forthcoming. The consultants would have lostless time in treating them at the hospital. More abuse,however, arose from those cases sent by subscribers, as theywere very often persons who should be paid for by theiremployers or who could themselves afford to pay. The

hospital authorities were not at liberty to treat them withthe usual rigour, for it was unwise to run the risk of

offending a subscriber. Formerly, when the Eye Hospital wasin Mount Pleasant, there were more abuses because manypatients came from Wigan and other towns. They couldnot be so easily traced. Now many of these places havespecial hospitals of their own, so that the patients need nolonger come up to Liverpool. Another great offender wasthe tradesman in difficulties. He ran up a bill with his privatepractitioner, might keep him waiting two years before paying,and only paid when his business had taken a favourable turn.But if he wanted to see a consultant it was necessary to

pay at once ; and, to avoid this, he tried to see the sameconsultant for nothing at the hospital. It was also urged that,when general practitioners complain that their patients goto the hospital, their loss was more apparent than real. Such

patients very often belong to the class which owes bills butdoes not pay them. Is is only natural to conclude that theperson who does not scruple to avail himself of a charity towhich he is not entitled would also not scruple to leave hismedical man’s bill unpaid.

’

These excuses and explanations are very well in their way,and everyone will be pleased to know that there are some ex-tenuating circumstances, for the evils are only too apparent.But the worst feature of the case is that these evils, if thepresent system continues, must increase immeasurably.Hospitals, like other institutions, are suffering from theexcessive development of the competitive system. The Eyeand Ear Hospital in Hope-street is the oldest, but not theonly, special hospital for these diseases in Liverpool. It wasfounded twenty-five years ago. At that time there werethree surgeons on the staff. Another surgeon wanted to doeye work, but could not come to an agreement with thisstaff, so he started another special hospital of his own. Atfirst it was looked upon as a purely private affair, butnow, as it shares in the Sunday Hospital Fund, it maybe considered as a public charity, and, to distinguishit from the parent institution, is known as St. Paul’sEye and Ear Hospital. Consequently these two hospitals arerivals and compete fiercely one against the other. Both mustshow to the subscribing public that they do an immenseamount of good work. If one of these hospitals were toreduce the number of its patients by checking abuses therival institution might accept the rejected patients. Itwould thus increase its popularity, secure what would seemlike better results, and therefore possess a more effectiveplea to place before the charitable public. This is not an

imaginary contingency. It is well known that patients whohave been rejected at one institution have gained admis-sion to the rival hospital. Nor is this all. The StanleyHospital and the Royal Infirmary have now both opened eyecliniques. Thus the applicant who has been rejected by oneof these institutions has three other places where he mayagain try to elude scrutiny and detection. Nor is this scrutinylikely to be very severe considering that all four institutionsare competing against each other, and, to secure subscrip-tions, must swell the numbers of their patients. Some fifteenyears ago, when the Eye and Ear Hospital was re-built, therival institution was not well known, so provision was madefor the likely requirements of the town. Now, however,that there are three other hospitals and cliniques the Eye and

Ear Hospital is too large ; half the beds are empty, not fromwant of patients, but of funds. Nevertheless, the managersof the St. Paul Eye and Ear Hospital propose to erect newbuildings, and are seeking to obtain trust money for thispurpose. Of course, as competitors it is not their businessto inquire whether the beds of the parent institution are allfull. Doubtless they would be better pleased if they wereall empty. But though competition may be justified inbusiness it is absurd and wasteful in charity.

This brings me to the blackest side of the problem-namely, Is it charity that invariably determines the creationof a special hospital ? On the contrary, more than oneeminent physician or surgeon has bitterly complained thatsuch institutions were multiplied in accordance with therequirements of members of the profession and not in

response to the necessities of charity, and instances weregiven to me of special hospitals that are to be organised insmall neighbouring towns. It must be borne in mind that themembers of the profession are not only becoming more andmore numerous but they are better educated and better fittedto do special work. Therefore, the number of these specialhospitals will increase. It is one of the most obvious means

by which a struggling man can make a career for himself.When a medical man founds a hospital the newspapers publishall the details concerning the enterprise. At present nolimit can be put to the number of these special hospitals.Evidently a central authority is required to prevent privatehospitals and private dispensaries figuring as public charities.The managers of these speculative ventures in their eagerness tosecure more patients than their rivals encourage and facilitateevery form of abuse. How such a central authority can be con-stituted is, of course, a big question on which I will seek toobtain the opinion of competent judges so as to be able todiscuss it on a future occasion.In the meanwhile, abuses continue and everything

seem to indicate that they are likely to increase. Forinstance, one of the ophthalmic surgeons of Liverpoolrelated to me that a well-to-do tradesman asked whathis fee would be to remove a cataract. He was toldfifteen guineas. This seemed too much, so the tradesmanwent up to town and gained admission to the London

Hospital, where the operation was performed for nothing.His daughter, however, who was likewise suffering from hereyes, did not like to go to a hospital. She went to theophthalmic surgeon and was accompanied by her father,who himself related how he had been operated on in London.His daughter proved to be a good paying patient, and asher brother is a clergyman of the Church of England it isquite evident that this family has no right to trespass on thecharities intended only for the poor. A near relative to a

wealthy member of Parliament was wounded in his eye. Aahe was studying engineering and doing some practical workhe was wearing workmen’s clothes and was besmeared withworkshop dirt. He was, therefore, readily admitted t&the Eye Hospital. But as he had the same name as

the well-known member of Parliament this attractedattention and led to several energetic expostulations.Many other similar instances could be mentioned,but it is scarcely necessary to emphasise what is notdenied. There is one other matter which I shouldmention before quitting the subject of the Liverpool EyeHospitals. The committee of the Type Writers’ Societywrote to the Eye and Ear Hospital explaining that, thoughtheir members were willing to pay and did not wish to availthemselves of a charity, still they could not possibly affordto give guinea fees. The staff of the hospital discussed thematter and decided to meet the demand of the members ofthis society by receiving them as private patients for a feeof 7s.6d.

(To be continued.)

MANCHESTER.(FROM OUR OWN CORRESPONDENT.)

The Mersey and Irwell Joint Committee.AT the last monthly meeting of this committee a letter

was read from Mr. Bythell, chairman of the Ship Canal,stating that the recent heavy floods had brought downfrom the upper reaches of the Irwell a quantity ofrefuse and sewage, estimated at 200,000 tons, and de-

posited it in the canal and docks above Mode Wheel to

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an average depth of over four feet, so that dredging hadto be carried on night and day to remove it. It is thebusiness of the committee to prevent all this. There hasbeen a good deal of complaint as to the standard of purityrequired being impracticable, and Mr. T. W. Killick madean important statement as to the principles on which thejoint committee are working. In December, 1891, it was de-cided, on the recommendation of Sir Henry Roscoe, not " to’define the maximum amount of pollution to be allowed, butto insist on the best practicable and available means being’used in each case " ; and in November, 1894, he further said:.. The standards named are only adopted for the purpose ofcriticising and comparing the results in these particularcases and must not be taken as definite standards." Thelimits of impurity are based on experimental evidence provingthat an effluent below or up to them would not putrefy whendischarged into small streams or into sluggish waters, such.as the Ship Canal, but above them putrefaction would arise,.and it may be observed that "at all sewage works in thewatershed where only chemical treatment is adopted the.effluent is almost always above, and, on the other hand,where sewage works adopt filtration the effluent is below,those limits." The joint committee was formed to cleansethe rivers within its district from their polluted and filthycondition and if the solids in suspension only be removed,’"leaving the soluble putrescible organic matter liable tosecondary decomposition present in the effluents, not

,only will the provisions of the Rivers Pollutions Actbe contravened, but the condition of the rivers must- ever remain prejudicial and hurtful to the health andwell-being of the inhabitants in the water-shed." At thismeeting, in the absence of Sir J. T. Hibbert, AldermanJoseph Thompson was in the chair, and said he would beglad to define exactly the position of the Manchester Cor-poration with regard to its sewage, but he was "very.awkwardly placed." As chairman of the Rivers Committeeof the corporation he was anxious that the scheme of theRivers Committee should be adopted. As deputy-chairmanof the joint committee he wished the schemes of this com-mittee to be carried out. Then he was a director of the

Ship Canal and a commissioner of the Upper MerseyNavigation. He said the corporation had gone as far.a,s they could with chemical means of purification andit was simply impossible for them to get enough landFor filtration. He did not see how the requirements of the committee were to be met. One cannot but feel

sorry for Alderman Thompson. With the very best inten-tions he finds himself in a most anomalous position and ’,says lie is sorry he happened to be the chairman of theRivers Committee. No oae can wonder at this, for his breastmust ever be the scene of contending emotions. It is strangethat he has so long been content to try to serve two masters-two at the least. But his is not the only anomaly, forSir Henry Roscoe is the adviser both of the corporation andof the joint committee, and so far his advice to the formerhas not led to very satisfactory results.

Proposed Purchase of Heaton Park.At the same meeting of the council a strong feeling was

expressed that Heaton Park should be purchased if it couldbe got at a suitable price," that asked being said to be quiteout of the question. There were one or two objectors only.M acquired it would "furnish a place for parades and driUsof cavalry and volunteers and would provide facilities forrecreation for every class of the community." There is

.evidently a fear lest the fiasco of the sale of Trafford Parkwhile the council hesitated should be repeated. ’lhis is

really the last chance for Manchester to obtain a large andornamental open space within easy reach of the city, forthere are no others to be had. This hesitation ought not tobe fatally prolonged.

LIVERPOOL.(FROM OUR OWN CORRESPONDENT.)

The Report of the Hospital Sunday Fund for 1896.THE committee of the Hospital Sunday Fund, in presenting

their twenty-sixth annual report, note an increase in theamount of the collections in the various churches andcha,pels, not only on the year immediately preceding’, which, it will be remembered, was particularly unfortunate with regard to the weather on that Hospital Sunday, but also a

slight increase on those of the year 1894. The collectionsfor 1896 amounted to £6333, against £6155 for 1895 and.S6364 for 1894. The returns from the Hospital SaturdayFund have also shown an increase on the year preceding.The committee have been enabled to distribute a largersum by Z400 than in the year before-viz., £11,000; whilea larger balance has again been carried forward-viz., £389.This sum of £11,000, it may be worthy of mention, isthe largest distributed since the Fund was established, whilethe expenses of the joint Funds are rather less than in the yearbefore. The question of the distribution of the Funds hasagain occupied the attention of the committee on manyoccasions, and it having been found that no scheme sug-gested would fit the peculiar circumstances of all thecharities interested, a proposal for a general re-adjustmenton the basis of the knowledge acquired by the numerousdiscussions was resorted to and unanimously agreed to.This the committee venture to think has given almostuniversal satisfaction, the distribution being based on a

reasonable and equitable review of the claims of all con-cerned. The report concludes by an expression of thanksto the citizens of Liverpool for their continued support ofthe Fund.

The Assi:es.Mr. Justice Bruce, in his charge to the -grand jury at the

autumn assizes now in progress, strongly commented on theserious evils resulting from the trial of every case of indecentassault in open court. That the details of assaults uponyoung children should be given in open court was a matterwhich he could not help regretting. Of course, if necessaryfor the purposes of justice the grand jury must find truebills, but he thought that in this class of cases the grandjury in their discretion were justified in looking a little morenarrowly into them than into others, because of the

great mischief of trial by familiarising the minds ofthe idle and thoughtless with revolting details at-

tending acts of this kind. He had duriog thatcircuit been obliged to hear many of these cases-some

very revolting-in crowded courts, where large numbers ofidle men had listened with open mouth and unashamed faceto the relation by young children and modest women of themost degrading incidents. He was well aware of the valuethey attached in this country, and properly attached, topublicity, and he did not think the public would ever allowthe liberty of any man, even the humblest or most degradedof the Queen’s subjects, to be taken away by secret proceed-ings. But he could not think that it was impossible to find amiddle course. The idle men who thronged the court duringthe hearing of the cases afforded no real security for the properadministration of justice. Assuming there were the repre-sentatives of the press, who always in such cases exercised awise discretion ; assuming that the jurymen in waiting, whodid truly represent the public, were always present; thatmembers of the legal and medical professions were present;and that the friends of the prisoner and of the prosecutorwere not excluded, he could not help thinki.ng that no harmwould be done if discretion were given to the judge toexclude other members of the public.

Liverpool City Council.Dr. Thomas Clarke has been re-elected chairman of the

Port Sanitary and Hospitals Committee of the Liverpoolcity council.

A Rebuke to the Urban District Council of Garston.The urban district council of Garston have made repre-

senta,tions to the West Derby board of guardians regardingthe serious injury to the public health of the district owingto the children of pauper patients being allowed to remain athome not isolated while suffering from infectious diseases-notably from small-pox. The communication was accom-panied by a list of such cases which had been reported tothe! council. The guardians in reply, whilst recognisingthe danger to the community occasioned thereby, saythat they do not accept responsibility for the existingstate of affairs so far as the same is brought about by alack of means of isolation. In all other districts inthe union the local authorities responsible for sanitaryadministration and the protection of public health, havingmade satisfactory arrangements for the prompt removaland isolation of persons suffering from infectious diseases,have met with ready support from the guardians, whohave always been prepared to pay, according to fixed rates,for the maintenance of pauper cases removed for purposes ofisolation and treatment to a properly established hospital.