sufficient funds were forthcoming for their support; because, when such institutions are established, they speedily become a necessity for those that apply to them, who would suffer were they to cease abruptly.

As the Bishop of London refuses to consecrate churches not properly endowed, so should the government refuse to allow of the establishment of voluntary hospitals not likely to be supported. But in the event of general hospitals being supported by a rate, the charitable would have more money at their disposal for the support of special charities, and therefore there would be less fear of their decadence.

The importance of the subject of hospital reform must, we think, be apparent from the facts we have adduced in the previous pages. Owing to the very independent style in which our charitable hospitals are conducted, it has been impossible for us to obtain all the information we could have desired respecting them; and owing to the number of heterogeneous elements that are mixed up together in the Poor Law system, and the reticence of the Poor Law authorities, we have been unable to eliminate to our satisfaction many points regarding the administration of the hospitals connected with workhouses. Enough however, has been adduced to shew that the hospital accommodation of London is insufficient, and in one part of it disgracefully bad; and a fair case has been made out for instituting further enquiry respecting it, with a view to its total and immediate reform.

We hope the subject may be taken up by our government; or, if they are indisposed to move in the matter, that it may rouse the energies of some independent member of Parliament. More permanent applause is to be won in providing adequate hospital accommodation on a secure foundation for our sick poor, and in cleansing that Augean stable, our workhouse hospital system, than cven in reforming army abuses, or in plucking undeserved laurels from the brows of incapable generals. He who shall succeed in removing from England the stigma of providing insufficiently for her sick poor, while she makes a hypocritical profession of superlative charity, and who shall effect such a reformation in our hospital system as shall secure the

best treatment, and the most perfect hygienic conditions for our sick poor, will deserve the title of the Howard of Hospitals.

The first thing that is needed is a full and complete return, by order of Parliament, shewing the entire system of hospital administration throughout the country, similar to that drawn up by M. de Watteville by command of the French government. This admirable report might serve as a model for our imitation, with some necessary modifications to meet the peculiarities of our system of hospitals. The return should enumerate the various hospitals in the different towns and counties of England, distinguishing the Poor Law and charitable hospitals. It should likewise mention those towns and districts that are unprovided with hospital accommodation, if such there be; it should give a full detail of the sources of the revenues of the various charitable and endowed* hospitals, and of the expenditure of each, as also of the actual expence of the workhouse hospitals, if this can be ascertained; it should give the actual number of beds, single and double, in each hospital, together with the average number occupied during the year, the ratio of beds to the population, and the average cost per bed; it should shew the number of patients treated in each hospital, distinguishing males, females, and children, and shewing the average duration of their sojourn in hospital, the mortality per cent. per annum, the ratio of patients to the population, and the average cost per patient; it should give a list of the employés in each hospital, distinguishing the paid from the unpaid.

These and some other details which it might be useful to obtain, would form the data from which the necessity of a thorough reform of our hospital system would be made apparent, and they would serve to guide the statesman in the preparation of a plan of hospital administration probably more efficient than that we have hinted at as advisable in the foregoing pages.

* In the case of the endowed hospitals, the Charity Commission receives a full account of their income and expenditure.

ON CATARRHAL PNEUMONIA OF INFANTS,

BY DR. TRINKS.*

THE pneumonia of infants is regarded by all physicians as one of the most dangerous diseases of childhood, and is by very many placed in this respect by the side of croup. From the homœopathic point of view we cannot accept this unfavourable prognosis of either, for there exist in the homoeopathic materia medica certain remedies for both. Croup, at its commencement, is one of the easiest inflammations to cut short; and even in an extreme case, which had been allowed to linger on by allopathic quackery, in which the allopathic physicians declared that suffocation was no longer to be prevented, I saw a cure effected by homœopathic medicines, which allopathy was unequal to, even by tracheotomy, and which remains a melancholy testimonium paupertatis. This spring I saw a child of very scrofulous constitution who had undergone the operation of tracheotomy for a very bad attack of croup. It was rescued from death by croup, but the wound would not heal, but remained open, shewing all the appearances of tuberculous ulceration of the larynx and trachea, with high fever, &c., and as I learn, the child has recently sunk under this disease.

I believe homœopathy to possess certain remedies against the pneumonia of infants, and that this disease would not be a cause of dread if the physician can attack it early enough, and it have not been allowed to pass into its last stage by improper

treatment.

We find a true picture of the phenomena of this disease given by the older physicians; and to this in recent times, we have had in addition the objective appearances by which it is more perfectly recognizable.

In the cases which I have observed, the disease came on suddenly, and without any premonitory symptoms, with strong fever of a synochal type, characterized by very quick pulse, dry burning skin, and great thirst; the cough when present came in

* From the Fourth Number of the 6th Vol. of the Homœop. Vierteljahrschrift, 1855.

On Catarrhal Pneumonia of Infants, by Dr. Trinks. 259

short but violent fits, while the little sufferer could not breathe deeply, was mostly of a dry character, without any expectoration, for only the saliva which collected in the mouth was ejected. In one case the cough was entirely absent-a fact noticed by other observers in very young children. It was attended at first by a sharp sonorous cry; at a later period, dull stifled short whimper. Before the cough the children were restless and uneasy. The cough was excited by movement, sucking, and swallowing. These cannot be considered pathognomonic indications, as they attend other diseases of the respiratory organs, and some of them are not unfrequently absent in this.

The breathing is very frequent then, varying from 70 to 90, or even 120 respirations in the minute (according to Cumming in Froriep's Notizen, 21st Book, No. 22); it is superficial, short, difficult, painful, diaphragmatic, and abdominal; often interrupted by sudden paroxysms of coughing; the breath is very hot, as well as the lips and the whole buccal cavity; the nostrils are rapidly moved by the breath, and drawn outwards. This change in the breathing is in every case the pathognomonic indication of the disease, and must always at once lead the observer to its recognition, which the other phenomena will enable him to confirm with certainty.

The percussion-sound is of an empty character only when there is a considerable extent of the pulmonary substance affected, and crepitation is not to be detected unless the inflammation has embraced a large portion of the lung; besides these the strong rattle which attended the original catarrhal affection (?) is to be heard, although in general, all physical examinations are attended with difficulty, if not rendered impossible, owing to the restlessness, crying and whimpering of the children.

The countenance has an expression of extreme restlessness and uneasiness; the redness of the face which characterized the commencement of the attack alternates frequently with paleness; the eyes have an extraordinary dazzling appearance, and move restlessly; the root of the nose and angles of the mouth at a later period are surrounded by a blue or violet circle, as observed by Billard, and which I saw in a case that ended fatally; the

children prefer to lie upon the back, and are restless when laid on their side, in which posture their feet are drawn up to the abdomen. These symptoms are associated, for the most part, with a white-coated tongue, total loss of appetite, gastric and intestinal catarrh, vomiting caused by the cough, sleeplessness, excessive restlessness, or in older children, starting up out of sleep, slight twitches of the limbs, and delirium, and in the last stage, sopor.

In the cases that came under my notice, the patients were children of scrofulous parents; and they had been exposed to the influence of a sharp north-east wind during a rather low general temperature in the months of February and March.

I find in my diary the case of inflammation of the right lung in a boy of two years of age, of scrofulous constitution, which came into my charge in the cold winter of 1845. It was not till the ninth day of the disease that I was called in to attend it, when already a fatal termination was looked upon as by far the most probable issue. Two allopathic physicians had already employed the resources they had at their command without producing the slightest improvement, and I made a trial of the effects of phosphorus to induce a curative action; but even this failed, and the boy died on the eleventh day of the pneumonia. The post mortem examination exhibited grey hepatization of the whole lower right lung.

A second case had a more favourable termination. E. K., a scrofulous, ill-fed boy of sixteen months old, was exposed in the month of March, 1851, to a sharp north wind one forenoon, and was taken ill the same afternoon. I saw him the same evening, and found a rather high fever, with very frequent pulse, great heat, skin hot, and face red, a short, unfrequent croupy cough, which made him cry and be restless. The boy had previously suffered from an attack of croup, with very superficial, hurried diaphragmatic breathing, great restlessness, inclination to cry and whimper, frequent desire to drink, &c.

Auscultation revealed vesicular crepitation, with coincident rattle at the lower part of the left lung. The breath, as well as the lips and mouth, were hot. The child lay on his back with the legs drawn up; he drank often, but little at a time, and the