It thus happens that the administration of the hospital is in great part confided—as, with _some restrictions_, it ought to be—to the medical officers. The interests of these gentlemen, it may be assumed, would be best promoted by carrying out in the most efficient manner the benevolent objects of the institution: and we believe, looked at fairly and comprehensively, this would be really the case. The duties of a large hospital, however—if they are to be performed conscientiously—require much time, not a little labour, and some health to boot. Now all these, in a crowded community, are very costly articles; and which must, in justice—and, what is material, in fact too—be fairly remunerated. The public never _really_ pay so dearly, as when they _appear_ to get labour for nothing. Here we come to the first defect in the "Hospital System." It might be supposed that, with ample means, the Governors of Hospitals, by adopting such previous tests as were in their power, would have secured the most efficient officers, by paying them remunerative salaries; and, having retained them as long as their services were deemed efficient, or the duration of them justified, that they would have released them from the necessity of further exertion by a retiring pension. No such thing. The Hospital gives nothing: actually, there is a small nominal retaining fee, as it were, of about £60 to £100 a year, and the medical officer is left to obtain his remuneration for time, trouble, and health, by such private practice as his reputation or the _prestige_ of being attached to an hospital may afford; from fees from pupils, or such other means as the position he occupies may place within his power. He very naturally sets to work to do the best he can; and from this first budding, we very soon arrive at the full blossom of the System; one effect of which is, that, in hospitals, which have so large a care of public health—institutions which, whether correctly or incorrectly, give so much of the tone to the medical opinions of the day, which exert, either directly or indirectly, an influence on the claims of hundreds to public confidence—that in these hospitals there is _not one single surgeoncy that is fairly and bonâ fide open to scientific competition_. Let us now examine a little into the machinery by which these results are brought out. The experience afforded by the hospitals necessarily supplies abundant means for instructing students in surgery. They are accordingly admitted on paying certain fees to the surgeon; and this at once supplies a large revenue. This revenue is of course regulated by the number of pupils; and as there are in London many hospitals, so it follows that there is an active competition. Thus, some time before the season commences, the advertisements of the medical schools occupy a considerable space in the public journals, and circulars are also liberally distributed.