A General Survey

Is hospitals were commercial organizations, which they are riot, it would be possible for_them to ensure their eontinuity.by the_use_ of the accepted methods of publicity which help to sustain and develop big business. King's College Hospital, for example, might cover the outside of its walls with im- pressive inscriptions in enormous letters proclaiming its rare and admirable virtues. The composer of such advertisements Would be able to exercise -his ingenuity to the full; having such a wealth of merit to extol. But in these matters con- ciseness is the essential characteristic ; and it would be difficult to find a better slogan for King's than an adaptation of an existing one that meets the eye on every highway

" Fill up here with health ! " .

And in what advantageous circumstances would the slogan be displayed ! It would be read by thousands of people every day. For King's College Hospital stands in one of the most commanding positions in South London where many highways, carrying a great volume of traffic, intersect a thickly populated and ever-growing residential district. Denmark-Hill ishigh--its name implies as mush—it is healthy, and it is ac44ssible. Moreover a hospital; like a city, that is set on a hill cannot he hid. The entire suitability-of the site must be apparent_ to_everybody who,...visiting_ the hospital, gives the matter a moment's consideration. The hospital was inaugurated' here bYifie King in 1918-;-- four- yeare after the foundation-stone of the_ new buildings had been laid by King

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Hitherto_ King's had been on the north side of Aldwych, in the very :heart of that! dismal and squalid area which was transformed in the great rebuilding scheme which produced Kingsway -and refashioned the district thit lies between the Strand and Oxford Street. There it was opened in 1839, on the site of the old St. Clement Danes Poor House, to minister fx: a penurious and much afflicted population. Faithfully it Willed this mission through a long period of difficult years, until, with changing times and an altered environment, it became expedient that it should be moved to another part of London. It was then that the Denmark Hill site was chosen, and the work that the hospital has been able to do and is doing there has abundantly justified the choice.

The hospital site is one of twelve acres, separated only by a railway cutting from Ruskin Park, an inviolable open space.

There is no great hospital near to it ; but at its very doors• are the .teeming .populations of Wandsworth and Balham, Brixton, Stockwell and Camberwell, Peckham, New Cross and Deptford. The site was. given by ;Lord Hambleden 1904. County Council trams pass the hospital, and close by are important omnibus routes and Denmark Hill railway station,. From every point of view, then, the hospital has been established where it is most able to maintain its. beneficent service to the greatest 'number of people. It stands in the Borough of Lambeth, and, as the Eighty-ninth Annual Report shows, although patients who are suitable for the care of the Poor Law authorities are transferred to Lambeth Hospital, its geographical position is such that King's is much closer to St. Giles' and Southwark Hospitals. In any plan for co-or- dinating the work of Local Authority Hospitals with that of voluntary hospitals the natural affinity of Lambeth Hospital is with St. Thomas's. On the other hand Southwark Hospital, although receiving patients from the borough in which Guy's Hospital is situated, is much nearer to King's than to Guy's. King's College Hospital has, therefore, o triple relationship to its neighbours—to Lambeth Hospital, to the support of which it contributes through the rates, and the two other hospitals with which it has working associations. It-has also an arrange- ment with the Deptford Borough Council for the care of maternity patients requiring special attention. Moreover, although no definite scheme of co-operation has been embodied in a written agreement, the association between King's and the neighbouring Maudsley Neurological Hospital, which is under the control of the London County Council, is a close one.

So much then, in brief review, of the geographical position of King's College Hospital and its relationships with its neighbours. What it stands for we know ; how it fulfils its mission we shall see hereafter. Meanwhile let us consider the urgent fact that no hospital, not even King's, can maintain its existence entirely 'on its own virtues. To appreciate the air at Denmark Hill, to admire the rural beauties o?--Ruskin Park, to praise the imposing facade of the substantial English Renaissance „hospital buildings may delight. the ears of the hospital authorities and encourage them in good works, but are not practical contributions-To the solution of their financial problems. The. present buildings_ cost over £500,000, of which some L82,000 is Mill - on, mortgage. These buildings have accommodation for 400 patients. But the present income is not sufficient to allow all the beds to be occupied by the poor patients for whom the hospital exists, and part of the space available is used for other purposes. The income required to maintain the hospital on its present establishment is about £100,000 a year.

Moreover let it be remembered that the effects of war service and war strain lie as heavily on institutions as upon individuals. During the War King's became a military hospital, occupied by nearly 81,000 sick and wounded from the front, while 145,000 civilian patients were attended to at the same time. The payment received from the War Office did not cover the expense so incurred, and for. three years after the Armistice King's was putting up a stern fight against tremendous financial odds. The fight goes on. Help has been forthcoming-from -King Edward's Hospital "Fund, and generous friends, of whom the late Lord Hambleden was the chief, have made contributions ; but a heavy burden of debt remains, hampering and hindering the great work of mercy directed from Denmark Hill. Whoever sees that work in progress, whoever hears but the barest detail of its varied nature, whoever realizes in the least degree precisely what is the significance of the continuity of King's in the Hires of the great population south of the Thames, must be impelled to covet the honour of having some share in an enterprise so splendid and so essentially charitable. King's presents to every man and woman. who -reads these lines the opportunity of individual service according to his and her individual ability. The best service that can be rendered to King's to-day is a gift, and the best gift is an annual one.

ACCOMMODATION FOR MIDDLE-CLASS PATIENTS.

Every student of social welfare knows that the sheer inability to pay for it is too often the cause which prevents great numbers of people, particularly among the middle classes, from obtaining specially skilled medical and surgical attention even when it is a vital need. For many the private nursing home is an impossibly expensive luxury, although they would gladly pay some fee for the care and treatment that they require. King's College Hospital makes special arrangements for such cases. Two wards for paying patients have been opened, and it is hoped that increasing use will be made of them. The charge for a patient admitted to one of these wards is based on the average cost of each patient as ascer- tained from the accounts of the previous year. At present it is five guineas a week. A bed is available in a paying ward for every subscriber who has paid two annual subscriptions of not less than one guinea in the two preceding years, or for the wife or a child under sixteen of such subscriber, who is approved for admission by a member of the honorary staff of the hospital.

A subscriber will be free to make his own arrangements with the member of the honorary staff of the hospital by whom the patient is introduced in respect of the payment of his fees ; but, so far as the account for maintenance in the hospital is concerned, the subscriber may claim that the amount of his subscription since January 1st,' 1920, not already claimed, be allowed in reduction thereof. Additional charges are made for special nurses and for massage. In addition private patients are admitted to private rooms on the recommenda- tion of a member of the medical staff of the hospital. This part of the hospital's service enables patients to make a con- tribution to the work of the institution by which they benefit and is an important source of income. More and more people are availing themselves of this scheme, and it certainly should make a very strong appeal to the middle classes, who are always glad to support a good cause so far as it is within their Power, and who, jealous above all things of their independence, are more zealous in nothing than in paying their way.

Now a hospital is a many-sided institution. It is more than a curative centre and a casualty station. It provides in struction as well as treatment and dispenses information as well as medicine. It teaches while it heals. If we take " Fill up here with health " as the true and fitting slogan of King's College Hospital we may add " knowledge " to " health" so as to make it applicable to the Medical and Nursing Schools, two of the several adjuncts, and not the least important, of King's. EDUCATIONAL WORK.

To the Medical School, which is a thoroughly up-to-date one, finely equipped with laboratories, lecture theatre, library

and museum, students come from many parts of the world to receive their medical training. Some 300 men and women students are at present enrolled, India, Ceylon, South Africa, New Zealand, Australia, Canada, West Indies and the United States being represented among them. The women students live in hostels or in their own homes. For the men there is "The Platanes," a fine building near the hospital on Champion Hill, having accommodation for eighty students.. Attached to it are an acre and a-half of grounds with excellent tennis courts. Although "The Platanes" is near to many highways it is remarkably quiet and its atmosphere is essentially conducive to study. It is arranged in a number of bed-sitting rooms, with a capacious common room and billiard room, dining room, reading and smoking rooms and so forth. The Medical School has always been a great friepd of sport. It inns three Rugby football teams and two hockey teams, as well as strong cricket and tennis teams. In the first Rugby fifteen this year are D. J. MacMyn, the Scots International, and R. Cove-Smith, captain of the England InternatiOnai team in 1928.

The Medical School numbers among those who have passed through it since 1880 a notable list of physicians, surgeons and specialists. It was one of the first of such institutions to open a dePartnient for the special study of the diseases of children, and "the hospital was the first, it is believed, to appoint a professor in this subject. It gave an opportunity, when &herr had fefused, to the great Lister to do his immortal Work for huminity.

staidenti are trained in the Medical School, there are, of course, no examinations for degrees held there. The student, having entered the School at the age of, say, eighteen, and having passed his preliminary and intermediate examina- tions, finally takes his 'clinical studieia there, and is then examined at his University.

In 1928 there were 285,848 attendances at King's College Hospital in the casualty and out-patients departments, apart from in-patients. This means that a wonderfully varied field of experience is at the disposal of the students, who have every possible encouragement to attain proficiency by attending the lectures and practical demonstrations by the medical staff of the hospital. The School makes provision for all the courses leading to the various examinations for medical degrees and diplomas. For the preliminary and intermediate subjects— namely chemistry, physics, biology, anatomy, physiology and pharmacology—instruction is given by the University professors and lecturers of the University of London at King's College, Strand ; while the whole of the final medical studies, excepting the classes for infectious fevers and vaccinations only, are taken at King's College Hospital and Medical School.

The Dental School is a section of the Medical School. It was opened in 1923 and has now forty students. During this period it can claim eighty per cent. of successes in examina- tions. The studies of the dental students are carried on jointly at King's College and King's College Hospital, prin- cipally at the latter. Such a strong point is made of the rela- tionship between the health of the mouth and the general health of the body that a student may follow the course of a patient who requires dental treatment as well as medical treatment.

The Nursing School at King's has a reputation as well founded as that of the 'Medical School. A preliminary training school has been opened in connexion with it, where an oppor- tunity is also given for girls who have received their general education in secondary schools and colleges to obtain a course in elementary nursing and domestic arts. The object is to provide a Course in the nature of a finishing term in practical subjects forming a supplement to the education which has already been given elsewhere. It includes a wide number of subjects, and at the end of it pupils are expected to undergo an examination in them, and receive a testimonial upon completing a satisfactory course. At the end of seven weeks the pupils are allowed to take some practical part in the work of the hospital. The Preliminary Training School is accommodated in a large house, surrounded by a beautiful garden and adjoining the hospital. The pupils join in the general social life of the nurses of the hospital, and enjoy the privilege of using the tennis courts and other facilities for games. Candidates who wish to be trained as nurses must attend the Preliminary Vining School for twelve weeks, and must be between the' ages of twenty and thirty years, although the Sister Matron may at her discretion admit particularly suitable candidates above or below these ages. The preliminary training is divided into two parts, in the first of which the candidates receive instruction in -.-riumerous essential - subjects, while during the second they are trial in the Wards of the hospital. A three years' course of training as nurses in the hospital follows. Candidates are also required to enter for all the obligatory State examinations for nurses. On the completion of the second year of service candidates receive, if suitable for the position, an appointment as staff nurse.

Another department of King's concerned with teaching is the School of Instruction in Radiography, Radiotherapy and kindred subjects. The course of instruction at this school is for women students only. It has been mapped out on a very generous scale and occupies eight months. As in the case of the Nursing School, applicants for admission must be between the ages of twenty and thirty years ; but here again the rule is not so hard and fast, and may be waived in special cases. An interesting point with regard to the fee is that in the cases of applicants who have obtained a nursing certificate at King's, or hold the certificate of C.S.M.M.G. for massage and electrical treatment, it is reduced by one-third.

The Massage School was opened in 1915. It provides courses of instruction, also for women only, in massage, medical gymnastics, and medical electricity, in preparation for the examinations of the Chartered Society of-Massage and Medical Gymnastics. No previous training.is necessary; but according to the regulations of that Society the course of instruction in anatomy, physiology and theory and practice of massage and medical. gymnastics and elementary medicine and surgery must be forty-eight weeks, and in medical electricity foUr months. In order to allow for holidays and possible illness, as well as for the time requisite to acquire a thorough know- ledge of the work, twenty-two months are desirable for the full course in all three subjects. A special feature of the course- in medical electricity is that instruction is given in high- frequency and diathermy treatments and artificial sunlight to those students who desire it, in addition to the instruction required for the examination of the Chartered Society. The school is in an airy-building on Denmark Hill, and eommuni: cation between it and the hospital is through a large garden in which classes are held in the summer. There is also a veranda on which open-air classes are held. Massage, remedial exer-. eises and electrical treatment are grouped together in one department which draws cases from the various out-patients' clinics as well as from the casualty department. As students are also sent to treat cases in the wards, a great variety of cases is available for them.

PHYSICAL. TREATMENT..

There was a time, and many of us can remember it, when children deformed in limb or body, or deVeloping tendencies to mis-shapeness were thrust into heavy and- -unsightly ap- pliances, which were to them a burden and tOo-oftento their companions an objeCeof mordant jesting. In some cases the use of an appliance is still, no doubt, essential ; but the cura- tive exercise, as, practised and taught at -King's, is displacing it rapidly. In the gymnasium there, where the Windows are always wide open and there is plenty of light, one may see the classes of youngitera happily going through physical exercises devised to put right whatever .tendency to inishaPeline* may he developing in 'them. And what is more one may see the cure working, the fiat Chests day by day expanding, the round shoulders growing more nearly square, the faltering hips and

rounded backs receiving new strength and suppleness. - The healthy, the vigorous and the normal n shape can hardly realize how great is the load' Of sorrow carried from day to day by a malformed or muscularly weak child. The youngster is conscious of being different from other children, and by that :difference he is debarred from sharing in the general playground games and stands apart, a marked figure, sometimes pitied—though pity is not always inseparable from contempt ; sometimes derided—and the pointed finger may pierce the spirit as surely as the arrow pierces the flesh. No man or woman who was teased at school about some physical defect needs to be reminded of the consuming anguish engen- dered by such treatment.

. If 1cft alone the physical imperfections -developed -in child

hood will (*collie perman` eth, an- d'Rie man or woman inherits from it a lasting handicap. But this is a place of light and hope and healing, where the crooked may be made straight and the infirm strong. It does not follow that every faulty body can be made sound. There are cases that do not and will not yield to treatment ; there are others for which only the wearing of an appliance of some sort represents the only hope of cure or of improvement ; but at the same time there are many, many cases which, taken in their early stages and treated with intelligence and perseverance, will and do yield to the curative processes of physical exercise. There is some indefinable aspect of the healing of children which grips by the very heartstrings those who are concerned in it and those who observe it. Can those who read of it only allow themselves to be less moved ? Assuredly they will so coin their sympathy that this splendid work may go on and the hands of those whose privilege-it is to be engaged in it may be strengthened.

Close to the gymnasium that has just been mentioned is the ultra-violet rays plant, where are generated rays of what is in effect -artificial sunlight. These rays pour from a mercury vapour lamp of dazzling brightness, and the patients who are receiving treatment sit in a circle about the lamp exposing their bodies to the beams, which are particularly beneficial in cases such as tuberculosis of the bones, in healing wounds after operations, and for wasting, rickets and so forth. The actual direct effect of the rays is to heighten in the body the powers of resistance to disease. The first visible effect is that-the patient becomes " sunburnt." So far most of the cases treated have been those of boys and girls ; but what is wanted is more room and more powerful apparatus and par- ticularly the money to pay for them.

Not unrelated to the department which is concerned with ultra-Violet rays is that where curative electricity is applied. Hither conic patients of all ages to be treated for rheumatism, rheumatoid arthritis, flat foot, dropped instep and so forth. The visitor watching the cure in process will see, if lie looks closely, slack muscles being knit up and inelastic tendons, infused with new vitality, moving to and fro in the process. Rheumatism is a. malady far more widespread than many people imagine. It is also an extremely ancient affliction of the human race, and probably in the dark ages of medicine, when quacks flourished and every sufferer believed in charms, rheumatism induced the wearing of more amulets than did any other disease. Only now is rheumatism receiving the attention which its prevalence demands, and at King's the equipment with which it is fought is of the very latest design. The apparatus, which is costly, can for obvious reasons be installed in the home in a few cases only ; moreover it ought not to be handled by the inexpert. At King's, however, it is ready and available for great numbers of sufferers, who day by day receive treatment under the supervision of operators skilled in the handling of the mechanism and well versed in the appliea- tioaof the-curative properties of electricity. Sonic rheumatic patients are also treated by means of exercises in the gymnasium.

ORTHOPHONICS.

The -Orthophonics Department at King's was started in 1924 as an experiment for one year, for the purpose of treating King's College Hospital patients who had undergone opera, tlons involving the speech organs. At the end of the experi- mental period the department was established permanently and the scope of its work was extended to include the treat- ment of all speech disorders, except those due to mental deficiency or complete deafness. The phrase " all speech dis- orders " is widely inclusive, and the five classes into which it may be divided are delayed speech, articulation defects, organic defects and deficiencies, nervous disorders and had habits.

The delayed speech cases are those of children from the age of.. about three years, whose speech has not developed nor- mally, Some do not speak at all ; others have evolved an entirely unintelligible language of their own. Such defects need not be due to mental deficiency ; the children are often very intelligent. Articulation defects are found in both children and adults, and the term applies to lisping and general sound substitution;--" thikthpenth " for "sixpence," "wed wose for red rose," " dood for " good," " tat " for " cat," and so forth. Among the organic defects are con- genital imperfections like cleft palate and- hare-lip, making normal speech impossible. In such cases it is necessary for an operation to be performed, or for an appliance to be fitted'

before normal speech is a possibility, and the services of a

speech specialist are generally essential. In post-operation eases like laryngo-fissure (removal of part or the whole of a

meal chord) and total laryngectomy (removal of the larynx)

special handling is necessary to enable the impaired speech organs to produce a form of speech approximating as nearly as

possible to the normal. The removal of laryngeal nodes, adenoids and tonsils often leave the patient's speech affected and in need of adjustment. The nervous disorders class includes stammering in all its many forms, which ooeurs in children and adults and is far more frequently found in men and boys than in women and girls. Functional aphonia, how- ever, is most generally found in adult women. The victims of bad habits of speech are often teachers, clergymen, auc- tioneers, telephonists, drill-sergeants and others who put an excessive strain on their voices, producing chronic pharyn- gitis, hyperphonia, hoarseness, forced voice with little carrying power, and so forth.

This is a formidable list of maladies that are treated in one way and another in the Orthophonics Department at King's,

Treatment and the apparatus employed must vary with the ease, and before reviewing these in brief let us look at the essentially human side of the matter. The object of the depart- ment is, by the use of scientific methods, so to educate or re- educate the entire speech mechanism that it will produce normal speech ; that is to say, that form of speech which calls

for the minimum of effort on the part of both the speaker and the listener. Where some parts of the speech mechanism have been removed by operation, entirely normal speech cannot be developed.

Stammering and allied disorders of speech in children receive—as they must—the most sympathetic treatment at King's in an atmosphere of the utmost friendliness. The problems are acute, for in these maladies there is not one par- ticular concrete fault on which attention may be focussed, while the basis of the trouble is essentially psychological. A method of beginning treatment that has been followed with success consists in interviewing the child's parents and the child independently, in order that by seemingly casual questions and careful observation an accurate idea of their attitude one to the other may be obtained, it being essential to dis- cover in what kind of a home atmosphere the child lives.

There follows a simple test of speech, and it is generally found that the first time the child speaks he is at his worst. That is to be expected ; for the youngster is probably rather scared at what to him is something of an ordeal. The child is then allowed to lie down and let his muscles relax, and a further

discussion with the parents follows, when it is explained that the child is not suffering from any organic or mental disease but from the result of a faulty habit originating in a cause which may or may not be known ; further, that this habit can be eradicated if the child is consistently encouraged to help in his own cure.

This form of stammering is deeply personal and sympathy towards the patient is the first essential of the curative treat- ment. It may be, and indeed often is, alleged against the child that he has a bad temper, that he is vicious and that he is a fighter. What else is to be expected ? Speech is the common outlet of all of us, and if the Child, every time he attempts to speak, draws attention to a peculiarity in himself, it follows that he will be distressed and exasperated. He will avoid speech and sulk in silence, or he will try to speak and suffer this maddening sense of defeat. What good temper would survive against the experience, which is not inter- mittent but the inevitable humiliation of every waking hour Pity, in these cases, must not be used excessively ; the child has to develop Self-assurance. But he must not be irritated. Irritation increases the acuteness of the malady.

Suggestion and persuasion will goa 1014 way to help him ; while if it is made a point of honour with the child to try to

control his temper he will generally respond readily. The

younger he is when his case is taken in hand the better his chance of getting cured. He will have his ups and downs, but a bad week will generally be followed by a good one, and while treatment is continued the graph of his progress will usually have a continuously upward tendency. He will need to be encouraged-- in-order-that- his-confidence may be strengthened. Over-confidence, however, is a symptom to be watched carefully, for the outcome of the exercise of the will to improve, against regularized control of energy, is apt to produce a lack of balance, resulting in spasmodic speech. Sudden cures are very rare, the process being generally a slow one.

The Orthophonics Department at King's, therefore, as well as benefiting the stammering child by correcting his speech, helps those among whom the child lives and is educated, by making their dealings with him easier ; at the same time the child is enabled more easily to receive his education. More- over the stammering child is generally one of particularly bright intellect, although he may give the opposite impression. His inability to express himself must, therefore, be doubly galling ; and to be rated ignorant when one is only unable to articulate is to be the victim of a particularly exasperating form of injustice. Apart from all other considerations the correction of stammering in children is of the utmost import- ance as a means of bettering their chances of good employ- ment when the time comes for them to leave school.

A note may be added with regard to functional aphonia, which has been referred to already. This condition may sometimes be traced back to an attack of laryngitis or other such ailment, the aphonia (voicelessness) remaining long after the original trouble has passed away. More often, however, it occurs suddenly, owing to general over-fatigue of both body and brain, with the result that the speech mechanism, though actually sound, refuses to work normally. The treatment is rest and nourishment, followed by stimulation and suggestion. Although the trouble exists only in the imagination of the patients, it is very real to them. Sudden and even violent treatment will produce temporarily good results, but the use of shock on the whole is to be deprecated, and the electrical treatment, which can be repeated and which does not irritate or cause nervous disturbance, is generally favoured at King's. In the case of bad habits sometimes a wholly new way of using the vocal mechanism is taught.

In the space at disposal it is not possible to describe fully the very fascinating instruments and apparatus that are used for purposes of phonetic research, diagnosis and various forms of treatment given at King's in this department. Some reference, however, must be made to them. There is the kymograph, by which the movements of the vocal chords and other organs of speech are so recorded that the most careful analysis of them may be made ; the stroboscope, properly called the laryngo-stroboscope, by means of which the move- ments of the vocal chords are observed in detail and in slow motion during phonation ; the synchronized stimulator for administering electrical stimulation to the vocal chords, and the velar electrode for massage of the soft palate.

TREATMENT OF DIABETES.

While it may be comparatively easy for qualified and experienced people to prescribe a diet for a patient whose case demands such treatment, it is extremely difficult to ensure that the patient eats what he is told to eat. Diabetes is a malady, formerly inevitably fatal, for which a very important part of the treatment, as everybody knows, is dieting. How- ever this does not mean that the old methods whereby a patient's diet was reduced to such low dimensions that he was as likely to die of actual starvation as from the malady of which it was sought to cure him still prevail. The diet now given is based on scientific calculations made to meet the personal needs of individual patients ; and at King's there is a diabetic kitchen where food is scientifically prepared on a basis expertly approved for diabetic patients. Such a diabetic kitchen is peculiar to King's. It was started four years ago and has proved itself to be of first-rate value. Not only are meals prepared for patients in the hospital, but out-patients also receiving treatment are taught how to prepare food con- taining the various contents proper to their needs for themselves.

Menus based on a knowledge of the constituent properties of foodstuffs are devised for the diabetic, every effort being made both to suit the various dishes to the particular tastes of the individual patients and to make the meals as varied as possible. People, therefore, having received their dietetic instructions at King's are able from a chart supplied to them to arrange their own meals at home.

The other half of the story of the treatment of diabetes, so

far as it can here 4e told, isteonemied with insulin, which itiscoy'zieil m Canada in 1827. Briefly:it may be said that the diabetic state arises from an insufficiency of insulin in the system, and the practice is to increase the amount by intro- &icing it into the body by injection. Given by.the mouth it is ineffective. The dose varies with the patient ; but its 'regular use enables him to lead an ordinary life. At King's g40 out-patients are being so treated._ While the death-ras.e prom diabetes in the United -Kingdom used to be relatively. high, it has been iubstantially reduced since the introduction of the insulin treatment. . Difficulties that have had to be met in home treatment have been a lack of faith in the efficacy of the scheduled diet and a eliainclination to persevere with it. Much missionary work liar had to be undertaken to enlighten the sceptical and very good results have been achieved, but carelessness still proves in some cases a stubborn obstacle. Insulin is prepared from the pancreas of the bullock. Now that it is manufactured_ , in this country the price is comparatively low—two shillings for a standard sized bottle, which five years ago cost i-wenty-five shillings.

A GENERAL LOOK ROUND.

' Enough has been written to show that King's College Hospital is a great institution of research and education as well as a great centre of healing. It -remains to add some details about the hospital buildings themselves. Their very size. is impressive. The main corridor itself is 900 feet king from east to west Therefrom the six completed blocks containing the 'wards extend south: ward, and are so arranged as to catch a maximum amount of sunlight. The ground between the blocks is divided into tennis lawns, grass plots and flower beds ; while at the end Of each ward there is a balcony on to which patients may be *heeled to enjoy the open air. The wards.; themselves are high; bright and airy. The windows have been designed to admit Plenty of light and air without draught. Heating is done by radiant heat and low-pressure steam-radiators. There are twenty-four beds in each of the general wards. In the maternity ward, where the average number of confinements is approximately two a day, the standard number of twenty- four beds has often to be increased, but even so there is too little room and many women fail to gain admittance. Extra cots, also, have often to be set up in the children's wards.

At the eastern corner of the hospital there are the out- patient and casualty blocks, with a waiting hall, examination ooms and so forth. Provision is made for the immediate reatment, both medical and surgical, of major and minor casualties. An observation ward is also provided, with beds in separate glass-screened cubicles. The waiting hail for out-patients is furnished with a buffet and is close to the surgical consulting rooms and to the various departments for treatment.

The operating theatres are on the north side, and in every particular are of essentially modern construction and equip- ment. There is a special laboratory for research work in con- nexion with the use of radium in therapeutics, and in the cardiographic department the most modern instruments for diagnosis are employed. The pathological and post-mortem block are near the ophthalmic and operating theatres, and in the same neighbourhood there are the mortuary chapel and the isolation block. The vast hospital kitchen is in the base- ment, and there also are the headquarters of the engineering department where lighting, heating, power, and ventilation are controlled and directed. The 'chapel in the centre of the hospital bears witness to the spirit in which the work at King's is carried out.

This in brief is the remarkable story of a remarkable under- taking, and the most remarkable thing about it is that it is a voluntary undertaking. That is an inspiring thought, but it Is also a very sobering one. The continuity of King's College Hospital and all its great capacity for doing good depends entirely on good will. Whose good will ? The answer is bound up with the answer to another question asked many centuries ago, but as vital now as then—Who is my neighbour ? We have 2,000,000 neighbours in South London who may be succoured through our good will if we express it by helping to snainte.n the service of King's for and among them. How is that to be done ? By giving a -little more than we think we can comfortably spare ; _by . contributions, by annual sub. scriptions, ,by: bequests made by will and through it simple scheme of insurance. The ideal memorial is the one that p erpetuates a memory while benefiting a living person. A erson or an occasion may be commemorated at Rides by the gift of £1,000 towards the endowment of a bed for an adult or £500 towards the endowment of a cot for a child; or £150 to make anyone a governor for .eyer, or £60 for the annual support of a bed, or £30 for the annual support of a cot. While every gift, however small, is welcome to those who have the, administration of King's upon their shoulders, it must:be realized that their burden is appreciably lightened by receiving regular subscriptions, thereby providing an annual income on which they may budget. Consistent help is what is wanted. No machine can be expected to function if it is sought to run it on intermittent and varying infusions of power, and no hospital can be expected to maintain its service at the high level of King's unless the means are con- sistently forthcoming. If every fit man and woman who reads these lines would determine to express the value he and she places on that fitness in terms of a recurring subscription to King's, the income required by the hospital would be secured. Do we value our health ? If so, let us give this affirmative concrete answer, and thereby help our neighbours