614

with any certainty; they trespass upon those hours which herequires to appoint for receiving patients at his own house;they break into his leisure, destroy his rest at night, andrender it impossible for him to maintain that serenity of mindand that method in his work without which no man can keepup with medical science, or fairly discharge his public duties,unless indeed he sustain a tension of mind and exhaustion ofbody which must end in premature death or decay.

I would beg you, Sir, also to consider our sisters as well asour "brothers," and to look at the extremities to whicheducated women, often the relatives of professional men,are driven for a livelihood; and I would ask what occu-

pation there is for which woman’s slender hand is more fittedthan for the practice of midwifery, for which she can qualifyherself in so short a time, and by which she can render herselfso really independent ? I could place in your hands lettersfrom the widows and daughters of medical men in all parts ofthe country, to whom this institution is likely to prove ofsignal service. How often does the wife of a disabled practi-tioner, or a widow unexpectedly left to struggle with theworld, look round without seeing how to utilize the sympathy,respect, and goodwill of old patients and friends ; yet theeasily acquired business of an accoucheuse would oftenenable her to turn such surroundings to the greatestadvantage. And not only are there these considerations infavour of this movement, but I believe that, if you will againfavour me with an opportunity, I shall be able to demonstratefrom the bills of mortality that the ordinary practice of mid-wifery should be separated from that of medicine and surgery,and that the hands of women are undoubtedly the best fittedfor its general duties.

I have the honour to remain, Sir,Your obedient and obliged servant,

Fitzroy-square, May 30th, 1866.JAMES EDMUNDS, M.D.,

Hon. Sec., Female Medical Society.

MEDICAL CONTRACTS.

T. OSBORNE WALKER, M.R.C.S., L.S.A.

To the Editor of THE LANCET.

SIR,-Medical contracts offer an exception to the rule ofcontracts in general, for in all other instances the pay is ap-portioned to the quantity of the article to be supplied oramount of work to be done which is contracted for ; but inthe instance of medical services stipulated for, this rule of

adjustment is lost sight of. Why should it be ? It is true thatin the case of Poor-law districts the medical officer is professedto be paid according to the number of parishes, population,and acreage ; and in the case of clubs, so much per case or permember. But how irrelevant and, consequently, erroneous andunsatisfactory such data must be, on which to base a calcula-tion for pay, which, under such system, though continuallyvarying, is always vastly under the mark, will be renderedmore evident by the juxta-position of an example of lay-contract. To instance the union baker. This functionary isbargained with to supply bread and flour of a certain qualityto a certain district or union at a certain price-not an annualstipend irrespective of quantity, as obtains with reference tocovenanted medical attendance; no, this he would reject atonce, and the guardians well know it-but at so much per loafor per stone.Now, a similar principle ought to govern all medical con-

tracts. Let the educated medical practitioner, no less thanthe uneducated tradesman, be duly remunerated for his com-modity-his time, his services,-and be no longer excluded aparticipation in the benefit of a principle universally recognisedexcept in relation to himself.Henceforth let the medical man be paid a fair remunerative

fee by all unions and clubs for visits, and for all operationsinvolving time and skill ; let him, exempli grcttia, take unionsand clubs at so much per visit according to distance traversed,and charge separately for operations according to a fixedmoderate scale ; in fine, let him be paid for what he actuallydoes, and be no longer content to receive a minimum price,and that for a fractional portion only of work done.

I am, Sir, your obedient servant,T. OSBORNE WALKER, M.R.C.S., L.S.A.

Blakesley,May, 1866.

THERE is such a dearth of physicians and surgeonsin the Austrian navy that the Government offers to engage ’,young men who have not yet completed their medical studies. ,’

"THE LANCET" COMMISSION AND THEST. GEORGE’S GUARDIANS.

THE chairman of the recent meeting at St. James’s Hall, byway of demonstrating "unfairness" shown to the guardians,made a very grave statement at the close of his address, ofwhich we are compelled to take some notice. Referring to thevisit of our Commissioners to the St. George’s Workhouse In.firmary in Mount-street, he said that, in reporting on thespace of the wards, " they actually intended to guess the

height of these wards without resorting to actual measurement,and they only took the latter course on being remonstrated

with by the house-surgeon. That was a challenge to Dr.Anstie and Mr. Hart, who were the gentlemen he alluded to."

’ Now this statement is, of course, entirely erroneous. It is

a very serious one, because it imputes gross unfairness to ourCommissioners, and a recklessness of the truth, if not a de.liberate intention to misrepresent the truth. The facts arethat our Commissioners adopted for this house the officialmeasurement of cubic space which had very recently beenmade by a surveyor at the request of the board. In theirvisit they were accompanied by Dr. Bloxam, the gentlemanreferred to, and the master. Finding that, although awakenedto the propriety of ascertaining their cubic space, the guardianshad not yet inquired into the floor-space or area per bed, theCommissioners requested permission to see these measure-ments, which was accorded. These measurements were madeby a servant of the guardians. The taking the height of thewards at all was, under these circumstances, superfluous. Dr.Bloxam entirely corroborates these details ; and, therefore,we cannot doubt that Major Lyon will regret and with-draw the unfounded imputation. Whatever our differencesmay be with boards of guardians as to the question of the pre-sent management of the sick, we hope to be able from first to,last to agree with them on matters of fact. It is impossible,we apprehend, that amongst gentlemen any doubt should ariseas to simple questions of veracity in matters of fact; and wedo not doubt that on inquiry the St. George’s Board of Guar-dians will find reason to confirm the statement which we havehere made.

Medical News.ROYAL COLLEGE OF SURGEONS OF ENGLAND.-The,

following Members of the College, having undergone the-

necessary examinations, were admitted Licentiates in Mid-wifery at a meeting of the Board on May 30th :-Anderson, David Hawley Burn, Edinburgh; diploma of membership dated

April 24, 1866.Bolton, Reuben, M.D. & M.C. Queen’s University of Ireland (1865),

Bangor, Co. Down. (Not a Member.)Byles, James Cotton, Albert-terrace, Victoria-park-road ; June 24, 1859.Creed, John Mildred, Melbourne, Australia; April 24, 1866.Ferguson, Hugh, Haverstock-hill; April 24, 1866.Gibbes, J.lI1urray, M.B. & M.C. Aberd., Sidmouth, Devon; Nov. 15,1865.Johnston, David, Magherafelt, Co. Derry; May 22, 1866.Riley, Joseph, Barnes; April 27,1866.Shannon, G., M.D. Queen’s University of Ireland, Magherafelt, Co. Derry;

Jan. 26, 1864. -

Smith, Joseph William, Weaverham, Cheshire; April 27, 1866.Stocks, Frederick, Wakefield; April 25, 1866.Thurston, William French, South-bank, Notting-hill ; April 27,1866.

It is stated that three of the fifteen candidates failed to acquitthemselves to the satisfaction of the Board.

APOTHECARIES’ HALL. - The following gentlemenpassed their examination in the Science and Practice of Medi.

cine, and received certificates to practise, on May 24th :—Aveling, Charles, St. Thomas’s Hospital.Hills, Rowland, Conisborough, Doncaster.Phillips, Edward England, Norfolk-crescent, Bath.Williams, John, Fishguard, Pembrokeshire.

The following gentlemen also on the same day passed theirfirst examination :-

Hickman, Thos. Henry, St. Bartholomew’s Hospital.Salzmann, Frederick William, Guy’s Hospital.Smith, Frederick, Westminster Hospital.

THE cholera has disappeared in the Halifax quaran.tine, and is rapidly abating in the New York quarantine.THE Registrar-General’s April return for Scotland

shows that there were registered in that month 3329 births, anumber which was exceeded in April, 1864.

615

BY the last accounts from the West Indies cholera

prevailed at Martinique, but the other islands are reportedLealthy.MRS. DAVID CADDICK, wife of a grocer in Langham-

street, Kirkdale, died the other day from eating a custardfavoured with the essence of almonds.

DURING the thunder-storm on Saturday night a

.coastguardsman, while going his round, on the cliffs betweenEast-end-larie and Scrapsgate, in the Isle of Sheppy, wasblinded by a flash of lightning.THE export of meat and cattle from France has

increased considerably within the last two years. It amounted

during the first three months of the present year to the valueof 12,000,000 francs.ONE of the female nurses in the cholera ward at

the Liverpool Workhouse was attacked with the disease onWednesday morning, and died at eight o’clock the same even-ing. No cases are reported in the town of Liverpool.AT the last meeting of the Paris Academy of Sciences

a report, accompanied by two drawings, was read on the sub-ject of a monster recently born, which had no brain, six fingerson each hand, seven toes on each foot, and other peculiarities.It lived a few hours only.THE French Senate was to debate, this week, the

question of laying a heavy tax on absinthe, suggested bystatements made regarding the injurious results of the im..mense consumption of that liquor in Paris. These statementsare contained in petitions drawn up by Dr. Decaisne and M.Agry.

COLLEGIATE ELECTION.-From a notice in theLondon Gazette it appears that the annual election of Fellowsinto the Council of the Royal College of Surgeons of Englandis appointed for Thursday, the 5th proximo, when two vacan-cies will be declared, by Mr. James Luke and Mr. John Hiltongoing out in rotation, but who are eligible for re-election, andwho no doubt will again offer themselves. It should not be

forgotten that the names of candidates must be sent in on orbefore June 10th.

BRITISH MEDICAL ASSOCIATION. - At the tenthannual meeting of the East York and North Lincoln Branch,held at the Hull Infirmary on the 23rd of May, the followingofficers were elected :-President Elect: Mr. H. M. Lepping-ham. Committee : Dr. Humphry Sand with, Sir Henry Cooper,M.D., Dr. Owen Daly, Mr. Slight, Mr. R. M. Craven, andMr. Henry Gibson. Secretary: Mr. J. F. Holden. Treasurer:Mr. Joseph A. Locking.EXTIRPATION OF SCAPULA.-M. Michaux of Louvain

has lately presented a memoir to the Academy of Medicine ofParis giving an account of the case of a boy, aged fifteen, fromwhom he successfully removed the right scapula, for an en-cephaloid tumour involving that bone and its muscles, in

November, 1864. The shoulder-joint was disarticulated andthe arm left, the scapula having been turned forwards fromthe ribs, and the disarticulation being effected with the ecra-seur. The boy recovered from the operation, but died in thefollowing September of a cancerous tumour of the medias-tinum.-Gaz. Médicale.

COLLEGE PRIZES.-There are two Jacksonian prizesfor the present year on the following subjects-viz., "Ovario-tomy ; Pathology and Diagnosis of Cases suitable for thisoperation, with the best method of performing it, and theResults of recorded Cases. And " Fractures into Joints, theirModes of Union, with the Treatment "-the dissertation to beillustrated by cases, preparations, and drawings. There arealso two subjects for prizes for the ensuing year, 1867 -namely,"The Injuries and Diseases of the Jaws, including those of theAntrum, with the treatment by operation or otherwise -thedissertation to be illustrated by preparations and drawings.And " The various Deformities resulting from Severe Burns onthe Surface of the Body, the Structural Changes occasioned bythese Injuries, the best modes of preventing Deformities, andthe Treatment, operative or otherwise, adapted to correct’them "-the dissertation to be illustrated by cases, drawings,photographs, and casts. The subject of the Collegial TriennialAnatomical Prize, of fifty guineas, is " The Anatomical Struc-ture of those parts of the Eyeball which are contained withinthe Sclerotic and Cornea " - with illustrations drawn fromeach of the five great divisions of the Vertebrata. The disser-tation to be sent in at Christmas, 1867.

To Correspondents.’

A Father should consider the subject well between now and next October,the time when his son ought to commence his duties. Without a strongdesire on the part of the latter to enter the profession, another sphere oflife had better be sought for him. There will be found much hard work

t and not much pay in the vocation of the general practitioner.

t Dr. W. DmaderdrzLe.-Such circulars as that issued by Mr. H. Popham gene-

rally defeat the object for which they are promulgated.

THE MEDICAL AMENDMENT ACT.To the Editor of THE LANCET.

SIR,-Before the above Act is submitted to the consideration of Parlia-ment, will you allow me to make a few observations upon it.

It appears that it is in contemplation to provide that the penalty clauseshall be so framed as to include anyone assuming a medical title, without

t requiring proof that such person shall have assumed that he is duly regis-tered. The words of the penalty clause are: " If any person practising medi-cine or surgery, or engaged in the cure or treatment of diseases or injuries,

; not being registered under the Medical Acts, takes or uses any of the desig-nations," &c. &c. Then follows a list of every designation that can be

’

assumed. In other words, a man may practise provided lie avoids any desig-nation which may induce the public to believe that he is duly qualified. Thisis surely a practical contradiction.What is to be considered as assuming a medical title ? Will the Act extend

to a man who, not qualitied, has on his door-plate Mr. -, and on a door’ adjoining the word " Surgery" ? If not, how are the public to distinguish

such a man from many members of our profession ? Will the Act extend toadvertising quacks, who advertise themselves as Dr. -, or Mr. -, orMessrs. -, and announce their address where they may be consulted?Again, will the Act extend to men who, unqualified, place on their door-plates initials not included in the penalty clause, but which the public can-not discriminate ? A man in my neighbourhood places the initials " L.M.D."after his name (the explanation being " Lie. Mid. Dublin," the only qualifi-

. cation he possesses), and has a large practice, and yet many people might be

’ and are deceived; for all they can tell to the contrary, it might be "M.D.t London."

The Medical Council have very powerful means at command, by which thepublic might not only distinguish registered from unqualified men, but

’

also be compelled to employ the former, and that is by means of certificates.L It is notorious that many hundred deaths are yearly certified to by unqua-

lified men, and recorded by the registrars as "not certified," or in some cases, are even accepted as certified. Now if it were made law that every death,

must be certified to by a duly registered medical practitioner, or, failing that,’

a Coroner’s inquest must be held, the public would, rather than submit tosuch annoyance, avail themselves of proper medical attendance, and thereign of quacks would be short.Again, who is to " bell the eat?" or, in other words, " who is to prosecute ?"

It is very hard that it should be left to local medical men, to whom the ex-pense is often a great consideration, and who are always assailed by the old

’ cuckoo cry, imputing to them interested motives. Surely we might ask theMedical Council to take the necessary proceedings, else what is the benefit ofregistering ?By a strict system of death registration, and a sharp decisive series of pro-

secutions, the public would be protected, and young men who are now quali-fying would register with far more satisfaction than they do at present. Atpresent, when quacks are to be seen in town and country doing large prac-tices, and from the present unsatisfactory state of affairs quite unassailable,they may well ask not only what is the use of registering, but even what is

’

the use of qualifying at all. Yours truly,May 29th, 1866. A CONSTANT READER.

Custos.-Abernethy was connected with St. Bartholomew’s Hospital. His

country house was at Enfield.A. Fellow. (Tunbridge Wells.)-The person named would not be allowed tovote at the next election of Fellows into the Council.

CERTIFICATES OF DEATH.A CORRESPONDENT, under the signature of Iatros, calls our attention to the

necessity of caution in giving certificates of death under certain circum-stances. He says :-

" Among the working class you are frequently called upon to give acertificate of the cause of death of a child. You are told that the childwas brought to your house, say a week or so ago, or you may have visitedthe child; and, in addition to the form of certificate for the registrarof the deaths, you are asked to give an additional one in order’that theparents may obtain a sum of money from some Friendly Society,’ inwhich you are told the life of the child was insured. Suppose a caseof fraud, where the child so insured is not dead. The payment of themoney is made upon the faith of your certificate. What I wish toask is-1. Are you warranted in giving ’such a certificate ? 2. In theevent of attempted fraud on the part of the parents (i. e., the death not

having occurred), would you be liable to prosecution as a particepscriminis ?"

The practitioner who gave a certificate under such circumstances, withoutexercising due caution, and satisfying himself of the actual death of thechild, might be proceeded against for misdemeanor under the RegistrationAct. There is reason to believe that cases of the kind mentioned occa-

sionally occur in large towns.

CONVALESCENT HOSPITALS.To the Editor of THE LANCET.

SIR,-Would any of your readers inform me how or where I can procurestatistics of the cost per patient, management, &c., of a Convalescent Hos-pital, and give me any information that might be useful in establishing one ?The proposed hospital is to hold twenty beds. Yours, &c.,May 29th, 1866. F. R. S.