210

POOR-LAW MEDICAL OFFICERS’ ASSOCIATION.

THE quarterly’ meeting of this Association was held onFriday evening, the 29th ult., at the Freemasons’ Tavern,Great Queen-street.The following members and visitors were present :-Dr.

Rogers, President; Dr. Nicholas (Wandsworth), Mr. BensonBaker, Dr. Montague Thomas (Marylebone), Dr. Welsh

(Bethnal-green), Dr. Pinder (Camberwell), Dr. Dudfield

(St. Margaret, Westminster), Dr. Richardson (Whitechapel),Mr. A. W. Wallis (Brentwood), Dr. R. Fowler (East London),Dr. E. Jones (Sydenham), Dr. J. E. Smyth, Mr. Munday(Lambeth), Mr. W. Scott (Stratford), Mr. H. E. Ramsden(Sydney), Mr. Eugene Goddard (Clerkenwell), Dr. J. T.

Forbes Firth (Rotherhithe), Mr. J. Vinall (Hackney), Dr.Whiteman (Putney), Dr. Tilbury Fox, Dr. King (Camber-well), Mr. W. Kelly, Mr. Jabez Hogg, Mr. G. H. Macna-mara (Uxbridge), Mr. Guazzaroni, Mr. Frost (Kensington),Mr. E. Sandwell (Westminster), Mr. R. Bruce (St. Luke’s,City), Dr. Pike (Weyhill, Hants), Dr. Dixon (Bermondsey),Mr. C. C. Claremont (St. Pancras), Dr. Cook (Hampstead),Dr. Ashforth (Market Overton), Mr. J. M. Ashforth (Sed-dlescombe), Dr. G. Slight, Mr. J. Norton (Holborn), Mr. J.Burrough, Mr. Baxter Langley, Mr. E. D. Barlow, &c. &c,The chair was taken by Dr. Rogers, the President of the

Association.The PRESIDENT rose and delivered the following address.

He referred to the steps taken to petition Parliament, andthen pointed out, as a natural result he had long prophe-sied, that the London ratepayers were so alarmed at thereckless and injudicious local expenditure to which theywere subject, that they were rising in rebellion against Mr.Hardy’s Act. Having reason to believe that the system ofmedical relief to the poor in Ireland was vastly superior toours, he had obtained some valuable information from thechief clerk to the Irish Commission. In thirteen monthsafter the Irish Charities Act came into operation dispen-saries had been established, and were in working order allover, and even in the remotest districts of, the island. Underthe first year’s working of the Act the total expenditure onthe poor was 937,556. After it had been in operationseven years the amount had diminished to .6513,048. Upto 1867 it had slowly risen again, doubtless owing to thedepressed state of the country. Notwithstanding this, thefigures for 1867 represented a diminution of .8142,662 uponthe outlay for 1852. Medicines and appliances for 1867 costae21,776. The salaries of medical officers amounted to.872,353, and the total was .8118,117. Deducting this from,8794,894, the amount expended for the relief of the poorduring the year 1867 would show the proportionate amountwhich medical relief bore to the general local poor rate.Starting from the same date a return issued by the EnglishPoor-law Board showed that the total amount expended forthe relief of the poor in 1852 was .84,897,685. From that

period to 1867 there had been a nearly constant and steadyincrease of taxation under this head, until in 1867 it hadreached the enormous sum of .86,959,841, or 6s. 61 4 d. perhead of population ; in fact, it had increased to the extentof 2,062,155. He had good reason for believing that if we Ihad the returns to the present time, still more damagingfigures would come out. The amount of money expended IIfor medical relief to the poor in England and Wales was.8272,235. In Ireland .8118,000 was expended for five and ahalf millions; in England .8272,225 was expended for apopulation of nearly four times the number. If, therefore,the English and Irish scales were assimilated, we shouldrequire the gross amount to be nearly .8200,000 more, inorder to secure for the English medical officer even the

scanty measure of justice now accorded to the Irish. Dr.

Rogers, after entering into a vast array of statistics, drewthe following conclusions :_H Now what should be theremedy for this state of things? Having so excellent aPoor-law medical service in the sister island, I would urgethat it should be made the basis of any alteration in Eng-land and Wales. Above all things, I must press that allmedicines and appliances should be provided at the publicexpense, not grudgingly, but at the discretion of the medicalofficer, subject of course to the supervision of persons com-petent to judge his requirements; and that dispensaries

should be established in all fitting localities, and, in popu-lous places, dispensers appointed. Should this be done, itwould involve a probable annual outlay of, say, in roundnumbers, .8500,000, of which some 86,000 would have tobe expended in medicines and medical appliances-i.e., ar-guing from the Irish figures-leaving .6414,000 available forthe salaries of medical officers, dispensers, and for contin-gencies. The question now arises, from what sources shouldthis sum be raised? I utterly despair of ever inducing thegeneral body of guardians throughout the country to actjustly, or even with an intelligent regard to the public in-terest in this matter (cheers) ; and as the sickness of thepoor should be a matter of national concern, I would throwthe whole of the salaries of the officers-instead of, as atpresent, the half of them -upon the consolidated fund,compelling boards of guardians to find medicines." (Cheers.)The PRESIDENT moved the adoption of the quarterly re-

port of the Council, which detailed their labours in en-

deavouring to obtain parliamentary support for the viewsof the Association.

Dr. FOWLER (East London Union) seconded the adoptionof the report, and expressed the deep debt of gratitudewhich they must all feel to their President for his excellentaddress. The figures alone must have cost him greatlabour; for great care was necessary to place them out ofreach of the antagonism of busy brains and busy fingers,that would try to take them to pieces. He was of opinionthat a better treatment of the sick poor was true economy,and if this had been done before, Mr. Hardy’s lavish Actwould never have been needed. Preventable diseases wouldalready have been, in great measure, stamped out in thedwellings of the poor. There was one drawback to theproper appreciation of this subject by the public. Theamount placed under the head of " medical relief " by thePoor-law Board seemed a considerable sum. Now, speakingfor his own Union, he could say that the expense under thishead had largely increased, while the medical officers hadreceived no increase of salary at all. The fact was thatunder this head were comprised not only medical officers’salaries, but medical appliances, drugs, subscriptions to

public hospitals and infirmaries, and even wine and spiritsgiven to the sick. The ratepayers saw this item constantlyincreasing, and yet the medical officers still grumbled. Dr.Fowler contended that this want of proper specification wasunjust to medical officers, and that the public ought, byevery available means, to be set right on this point.

Dr. DixoN (of Bermondsey) moved the first resolution :-That this meeting is of opinion that the salaries of thePoor-law medical officers have been fixed by the guardiansarbitrarily, and without regard to any uniform standard ofremuneration ; that they have not been raised in proportionto the increase of the population, the ratio of pauperism,and the diminished value of money; and that, for the mostpart, they are very inadequate to the onerous and respon-sible duties which the medical officers are required to per-form." Dr. Dixon considered it indisputable that, con-sidering the nature of their duties, the risks they had torun from contagious diseases, the time and expense bestowedupon obtaining their double qualification, medical officerswere wretchedly paid. Parish cases were more troublesomethan private cases. They might decline to attend, or theymight send an assistant to a private patient, while theycould not do so to a parish patient. The average fee percase in the metropolis was Is. 5d., the average cost ofmedicine 114d. ; about 6d. per case, therefore, remained torepay the medical man for his time, patience, and skill inattending a case, which might last twenty-one days. The

average cost, per case, of medicine in the country wasIs. 5’d., the average pay was 3s. 3’d.; leaving Is. 9. forprofessional skill and time. Nor was even this miserableallowance uniform; in some cases it fell as low as 3d. percase. A skilled mechanic was better paid. Parish practicewas also detrimental to private practice. People who hadonce received medical relief from the parish seldom paid fora doctor afterwards. He thought some line ought to bedrawn-say when the husband is receiving .61 per week-beyond which medical relief should not be given out of theparish rates. Of the 168 medical officers in the metropolis16 receive less than Is. per case ; 48 receive Is., and lessthan 2s. ; and two-thirds receive less than 3s. per case,

With this the speaker contrasted the pay and treatment ofmedical men in the naval service, and even in gaols, and

211

concluded by urging members to put the facts of their cases Iboldly before their respective Boards, from which the Poor-law Board would be sure to hear of them.

Dr. WELCH, in seconding the resolution, said he had been I,fourteen years medical officer for Bethnal-green. The ’,number of cases he attended in 1865 was 1213; in 1866 theyhad amounted to 1871; and in 186S to 2198. His

salary for all this work and 10,917 mixtures andmedicine was X120 per annum. He had applied foran increase of salary under these circumstances, butthe guardians had put off the consideration of his appli-cation. In the cholera year a professional gentlemanwas engaged for a certain time to take a part of thework, and he had calculated that if he (Dr. Welch) werepaid according to the same scale as that gentleman waspaid-and the charge was sanctioned by the Poor-lawBoard-he ought to be in receipt of 61600 a year. Insteadof this, the Bethnal-green guardians were hesitating as towhether he was to have more than 6el20 a year. He gavethem the facts of his own case, but he believed he mightjustly say, ex uno disce ornnes.

Mr. HOGG, a member of the St. Giles’s Board of Works,wished to impress upon the Association the necessity ofmaking known all this to the public out of doors. He wassure the facts were not known as they ought to be. SirJohn Gray and Mr. Torrens had told him they were power-less in the House unless public sympathy went with them.He would therefore move, if he were not out of order, thatthe President’s speech should be printed and extensivelycirculated.

Dr. FIRTH (Rotherhithe) seconded the motion, which wasput and carried.

Dr. GODDARD moved the third resolution: 11 That per-manence of appointment is essential for the due and inde-pendent discharge of the duties of Poor-law medical officers."In support of the resolution the mover quoted from the evi-dence of the Rev. Chairman of the Hampstead Board ofGuardians before a Select Committee. That gentleman,while he wished no change to be made in respect of medicalofficers, strongly maintained that in the case of chaplains,permanence of appointment was essential. Dr. Goddardmaintained the two cases were parallel. Permanence wasas necessary for effective and independent action in the onecase as in the other.

Dr. THOMAS briefly seconded the resolution, which wascarried unanimously.Mr. BENSON BAKER moved the fourth resolution, which

affirmed H that the medical officers are justly entitled tosuperannuation allowance in common with the members ofthe Civil Service." The medical officers had no half-holiday,no vacation. Their duties were perpetual ; and he, there-fore, maintained they were as well entitled to a retiringallowance as any other public servants.The resolution was seconded by Dr. SMYTHE, and carried.The PRESIDENT read a letter which he had received from

a country medical officer, who expressed his sympathy withthe Association’s views, and gave him permission to lay hiscase before the meeting. He had been a Poor-law medicalofficer over forty years; he had received testimonials-atone time a silver salver, at another a piece of plate, pre-sented to him by the poor-and yet all his applications foran increase of salary were without effect. After forty yearshe was still receiving C75 a year for attending to a countrypopulation of 6000 inhabitants.

Other resolutions were passed, to the effect that a petition,embodying the foregoing resolutions, should be presentedto the House of Commons; likewise that the report of theCouncil and of the meeting should be forwarded to thePresident of the Poor-law Board; and the meeting termi-nated with a vote of thanks to the Chairman and theCouncil for their zealous services.

MANCHESTER MEDICAL SOCIETY. - The followinggentlemen were elected office-bearers for 1869, at the annualmeeting held on the 13th ult. President: Dr. Simpson.Vice-Presidents : Dr. W. Roberts, Mr. Windsor, Dr. Fletcher,Mr. Galt. Treasurer: Mr. Lund. Librarian: Dr. Little.Hon. Secretary: Mr. W. Heath. Committee: Dr. Finlayson,Dr. Gumpert, Dr. Hardie, Mr. Mellor, Mr. Melland, Dr. JohnRoberts, Dr. Lloyd Roberts, Mr. G. W. Smith, Dr. Stone,Dr. Thorburn, Dr. Wahltuch, Mr. Whitehead. Auditors:Dr. Browne, Dr. Nesfield.

Correspondence.

SOCIETY FOR RELIEF OF WIDOWS ANDORPHANS OF MEDICAL MEN.

Åudi alteram partem."

To the Editor of THE LANCET.

SIR,-By desire of the President of the Society for Reliefof Widows and Orphans of Medical Men, I beg to forwardyou the following particulars, thinking the information maybe acceptable to the members of the profession.During the last year, the total amount distributed in re-

lief was ae2504 10s., the number of recipients being fifty-fourwidows and twenty-six children. Additional relief was

granted to two widows and two children from the CopelandFund. This fund the directors were enabled, through thegreat liberality of the late Thomas Copeland, Esq., to formfor giving additional assistance to widows and orphansalready in receipt of ordinary relief, under special circum-stances of unusual distress from great bodily or mentalinfirmity.The Society, although at present able to meet the demands

made upon its funds, cannot continue to do so unless wellsupported by the richer members of the profession. Thenumber of applicants is yearly increasing, and likely to doso, as a reference to the list of members will clearly prove.

Trusting you will kindly accord a prominent notice inyour journal of the foregoing statement,

I am, Sir, your obedient servant,JOS. B. BLACKETT,

Berners-street, Feb. 4th, 1869. Secretary.JOS. B. BLACKETT,

Secretary.

CASE OF EXTROVERSION OF THE UTERUS.To the Editor of THE LANCET.

SiR,-The following most extraordinary case, whichoccurred in the practice of my father, may be considered notunworthy of record in the pages of THE LANCET.He was summoned, some time since. to attend Mrs. A-,

who had fallen in labour of her sixth child. The case wenton quite well, the patient being soon delivered; but on pro-ceeding to extract the placenta, and applying, with thatobject, a comparatively slight degree of force to the funis,the uterus, with the placenta still contained in it, descendedbodily below the os externum, falling below the patient’sthighs. My father, having carefully removed the placenta,while the uterus was thus abnormally situated, reduced theprolapsus, which was done with the utmost ease, and thecase went on afterwards without a bad symptom. Therewas very little haemorrhage. It is very remarkable that the

patient had never previously suffered from prolapsus uteri inthe slightest degree; nor has she been troubled with thatdistressing affection since.

I am, Sir, your obedient servant,ANTHONY CLARENCE FOSTER, M.E.C.S.

Park-place, Leeds, Jan., 1869.ANTHONY CLARENCE FOSTER, M.R.C.S.

HOSPITAL APPOINTMENTS.To the Editor of THE LANCET.

SIR,-I am anxious to call the attention of the professionto a great abuse in the present system of junior hospitalappointments. A striking example of the injustice I referto has lately occurred in connexion with one of the bestmetropolitan hospitals.

It is usual to advertise the vacant posts of residentmedical officer, house-surgeon, &c., in the medical journals.The objects are twofold-firstly, competition; secondly, thebest man for the place. But are such the practical results ?No. As regards competition, the candidate from the hos-pital school generally gets it. This seems only just. But

why put other candidates to expense and trouble withoutthe faintest chance of success 2 Why cannot the system inforce at one or two large provincial hospitals, with which Iam acquainted, be adopted generally? A notice of the

vacancy and requirements is posted up in the hospital for a