860

public, statements as discoveries, which areno discoveries, and which contain no fact orprinciple of the least importance, which isnot to be found in the notes of pupils whoattended Prof. Grant’s lectures in 1832,andin my own papers published in the " Trans-actions of the Royal Society " of the sameyear. The only difference to be observed,’is that between the words scorpion and lob- ster,-bat and bee.Your correspondent speaks of the " terms"

made use of in the discussion. I beg topresent him with the following original vo-cabulary of his own, in speaking of me,which will be found in page 715 of thisJournal :-

1. Decided misrepresentations:’2. Suppression of facts."3. « Passages not in strict accordance

with facts," &c. &c.I am, Sir, your obedient servant,

MARSHALL HALL.14, Manchester-square,

March 3, 1838.P. S. We have thus discussed at length

the subject of the third column of nerves inthe articulata ; may I inquire what has be-come of the fourth, which really belongs to your correspondent, and is so neatly engrav-ed in the " Philosophical Trausactions,"and copied into the fourth edition of Mr.May o’s Physiology ? Your correspondent reverts to the subject

of his scandalous note to his last paper. Ishould have thought he had had enough of it.Besides, it was unnecessary, for in a verbaldispute which we had upon the subject, Ifreely and frankly made him a present of thewhole affair, though, in fact, the experi-ments were repetitions of my own, madeat my suggestion, by means of my owninstruments sent to Sandwich for the expresspurpose, for me and my use. See extractfrom your correspondent’s letter, p. 749, be-ginning with "I am delighted and flatteredwith your entrusting me to make the impor-tant inquiries," &c. &c.

MUSCULAR ANOINTALIES.—M. Mercierhasobserved the following anomalies of themuscular system, in the arm of a woman.-First. The index finger was furnished witha proper flexor muscle, sent off from the in-ferior fibres of the flexor pollicis. Second.All the fingers were furnished with properextensors. The tendon of the proper ex-tensor of the little finger divided into twoafter having passed under the posterior liga-ment of the carpus, and terminated on thetwo last fingers. The inferior fleshy fibresof the extensor pollicis longus terminatedin a long tendon which passed to the middlefinger. The extensors of the middle andindex fingers did not present anything par-ticular.

MARSHALL HALL,

THE LANCET.

London, Saturday, March 10, 1838.

THE IRISH MEDICAL CHARITIES BILL,

ALTHOUGH the Irish Medical Charities

Bill does not appear, at first sight, to inter-fere with the appointment of the medicalofficers to infirmaries, hospitals, asylums, ordispensaries, this interference is evidentlycontemplated in the clause (4) which enti-tles the Medical Commissioners to make" such laws and regulations, and to appoint"such additional governors, directors, and

" committees, as the Conamzssioners may deeni"necessary for the prevention of any conjtict"between the objects and purposes of the iiie-" dical institutions, and the objects and pur-poses of the Bill for the Relief of the Poor"in Ireland." A clause in the latter Bill,now before Parliament, is equally explicitand more remarkable; for it vests the

power of visiting the medical institutionswhich are not wholly supported by voluntarycontributions, in the Poor-Law Commis.

sioners ; and enacts that the latter " may," from time to time, as they shall see fit," having reference to the charters and by-" laws, purposes and objects, of the Medical" Charities, make and issue all such orders as

° they shall think proper for the government of° every hospital, asylum, infirmary, dispensary,"mendicity, and other charitable institution," and the officers thereof, as the Commis-" sioners may deem necessary for the preven-"tion of any conflict between the objects" and purposes of this Act" (clause 46).

It will be recollected that one half of the

revenues of the Irish hospitals and dispen.saries is presented by the grand juries, andderived from the county rates. The grandjuries have themselves a very imperfectknowledge of the Medical Charities; andtheir entire direction is frequently left in thehands of the subscribers, reduced in manyinstances to the medical officer and his

friends, whose subscriptions he himself

makes good. Presentments are to cease on

the passing of the Irish Poor Relief Bill,

861AND ITS PROVISIONS.

and the monies formerly obtained from thissource are to become thereupon payable outof the poor rate ; so that it is probable the

representatives of the rate-payers will ob-tain a voice in the direction of the dispen-saries and lunatic asylums. This will

infuse fresh elements into the present com-

mittees, destroy the monopoly of a corpo-ration, and, to a certain extent, alter the

character of the electors who have the

choice of the medical, officers. Without dis-

cussing at present the propriety of this

change, or offering any remark on the silentand indirect manner in which its introduc-

tion is attempted, we ask how it happensthat two Bills, before the House of Com-mons at the same time-one introduced, theother supported, by Government, proposeto place the supreme direction of the IrishMedical Charities under two distinct

bodies, the Poor-Law Commissioners, andseven Medical Commissioners ?

The Medical Charities’ Bill has some

very singular anomalies, under the head ofQualification clauses, calculated probablyto exercise a most decided influence on

the future appointments to offices in the

Irish infirmaries, dispensaries, and lunatic

asylums. The 16th clause of the Bill ren-

ders none eligible to the office of surgeonwho has not obtained " letters testimonial" of qualification from the Colleges of Sur-"geonsof Dublin, Edinburgh, London, or" some other College, or University, in GreatBritain, duly authorised by royal charter," or statute, to grant the same ; " and nonewho cannot, in addition to a diploma, prove,to the satisfaction of the Commissioners of

Medical Charities, that" he has pursued" his professional studies in some hospital,44 or school of medicine or surgery, for five"

years ; that he has diligently attended the"practice of an hospital for three years at the" least ; and that he has been examined by a" Board of one of the Colleges, or Univer-" sities, for two hours: ’ The clause goeson to enact, that no person can be elected

physician to any charity who has not ob-tained a diploma, and who cannot " prove

" that he has pursued his medical education

"four years, and attended an hospital for two" years." The candidate, before being

elected, or employed, must have obtained acertificate under the hand of the Commis-sioners to this effect.

The Acts under which dispensaries havebeen established do not specify the qualifica-tions of the medical officers ; some personswithout diplomas, and without education,have consequently been placed at the headof these institutions, but " the greater" number have received a highly respectable" professional education."* This proves thatwithout legislative interference, the selec-tion of dispensary officers is not necessarilybad; at the same time every one will admitthat a man should not be allowed to prac.tise on the poor without having given assatisfactory evidence of competency as canbe obtained. In fact, no one, as we haveoften contended, should be permitted to

practise, who does not in future undergo a

searching practical public examination, be-fore a responsible National Faculty. Fur-

ther than this, sane legislation will not go ;yet here we have a Medical Charities’ Bill

meddling with medical education, prescrib-ing a curriculum, and dictating to examin-

ing bodies. If this extravagance be coun-tenanced where will it end? Every Jail,Lunatic, Poor, and other Bill will be encum-bered with clauses restricting the liberty ofmedical instruction. Instead of one definite

standard of qualification, a different coursewill be prescribed to every class of indi-

viduals employed in public institutions andin the public service. The curricula pre-

scribed by the Army and Navy Boards willbe referred to as precedents; but all ill

these curricula that does not spring fromaffectation in the men at the head of those

Boards, must be ascribed to the defectiveconstitution of the present examining bodies,which nothing but a specific measure can

* "Poor Inquiry, Ireland," Appendix B,p. 41. Barry, Corrie, and Roney, the Assist-ant-Commissioners, agree in this statement.

862 EFFECTS OF COLLEGIATE MONOPOLY

reform. After a code of .regulations has been instituted by a responsible National Faculty, and a candidate’s acquirements ’,

have been publicly authenticated, it wouldbe a piece of gratuitous impertinence in theheads of any department of the public ser-vice to set forth a separate curriculum, or tointerfere in any way with the regulations ofmedical education.The educational clauses in this Bill are,

besides, of the most offensive nature ; it is

not said that the candidates shall give directevidence by undergoing a public examina-

ion, by concours, or by any other adequatetest of sufficient or superior acquirements,but that he shall lay before the Medical Com-missioners certificates of five years’ study ina medical school, and of at least three years’attendance in an hospital! Such a clause willdisqualify nine-tenths of the medical prac-titioners of Ireland, the majority of whomcould produce no such certificates, or ad-vance any other claims than an ordinary

diploma, an unblemished character, and asound practical knowledge ; which are not

recognised as qualifications in the Bill.

The clause is evidently a concession to the

Dublin hospital monopolists, who have

howled so loudly and insolently around theCastle that the distant murmurs of the

thousands of practitioners scattered over

Ireland have been momentarily drowned.The surgeons of Meath Hospital and of

Illercer’s Hospital, who appoint their suc-cessors, restrict the offices to their own

pupils, and vend the vacant situations whichoccur to the best bidders, the longest purses,the most servile sycophancy, expect the

Medical Charities’ Bill to render three yearsattendance at the hospitals which they have

usurped, and three years’ fees, indispens-able preliminaries to office in the Irish hos-

pitals, dispensaries, and lunatic asylums.This will enhance the value of the next

official vacancies, and be a premium on the

stupidity of teachers, whose faith is appa-

rently greater in the efficacy of a compul-sory clause than in the intrinsic attractions

of their instruction. Undeceive yourselves,

gentlemen : the monopoly you have enjoyedso many years shall not, while it is taken

from your grasp by the right arm of Justice,be thrown heedlessly back to you in anotherform by hoodwinked folly. Your past his.tory must be brought to the light.

The Dublin College of Surgeons is a trades’union perverted ; it differs from other

trades’ unions inasmuch as the proceedingsof its members are directed against thegreat majority of the profession that it wasfounded to protect : it limits the number of

members ; for no one could obtain a licencewho had not been apprenticed to one of itsown body, and paid 300 or 350 guineas to

him, besides 50 guineas to the faction at

its head. It restricts the number of ap-

prentices (a procedure so offensive to many);and although certain members, like Mr.

CUSACK, have had 34 apprentices at one time,the premium has always been exorbitantlyhigh. These taxes have been intolerablyoppressive; and, as a natural consequence,not more than one in four of the Irish praL-titioners possesses the College licence. The

members and licentiates amount to little

more than 500: one to 16,000 inhabitants.The Dublin College of Surgeons has exercisedall its influence te deprive the mass of theIrish population of medical aid; and aI,

though three times the numbers admitted topractice, by this society, have merited andobtained licences or honours in other coun-

tries, vast numbers of the people wasteaway and die in remote districts without

experiencing the advantage of those reme-dies and assuagements that medicine affords

against sickness and suffering in other coiin-tries. In the low huts spread over fields,on the edges of waste bogs, up remote val.leys, on the hill sides, and in the narrowlanes of cities, the aged father is left alone

to watch over the expiring life of a well-loved son; the mother to see fever blighther children unresisted, and snatch away

her hopes one by one, because a faction inthe Dublin College of Surgeons has a monopolyto support. Liks a palace cemented with

863ON MEDICAL CHARITABLE INSTITUTIONS.

blood, that fabric is upheld by the sufferings clause in the present Bill adopts, extends,and unmitigated diseases of a nation. and perpetuates their radical vices.

Members or licentiates of the Dublin Col- The governors of Mercer’s Hospital avow,

lege of Surgeons alone are eligible to the in a petition to the House of Commons, that

office of surgeon in the; county infirmaries they view the Medical Charities’ Bill with

(36 Geo. 3); and no person that has not "apprehension and alarm." This is a fa-

been " certified to be duly qualified under vourable sign, and sufficient of itself to

" the seal of the King and Queen’s College of prove the necessity of public inspection and"Physicians can be appointed physician to better regulations. The apprehension of theany county infirmary." (7 and 8 Geo. 3.) monopolists is well-founded. No one can tellBut this description is not sufficiently nar- so well as the governors of Mercer’s Hospitalrow, particularly since the enlarged Char- how many abuses inspection will disturb,ter of the year 1828. No individual can or how much their interests will suffer,now be elected surgeon to the Irish county when medical offices in the Irish charities

infirmaries without previously producing a are made accessible to every qualified prac-certificate, specifying " that he is qualified titioner in Ireland. Besides the alarm ofto be a surgeon to said infirmary," from the the corporations, there is, unfortunately,surgeon-general, the visiting surgeon, the too much evidence of abuse in the Medical

two assistant-surgeons, and the resident sur- Charities of Ireland : the Reports of thegeon of Steven’s Hospilal, forming a corpo- Medical Commissioners, in the Irish Poorration with the five senior surgeons of Mer- Inquiry, present, in dark relief, the inva-cer’s Hospital, who, it will be recollected, riable consequences of irresponsible manage-appoint their successors, and, as teachers, ment. We shall select one or two instances.

turn the patronage at home, and in the COUNTY INFIRMARY, ARMAGH.-Examina-

county infirmaries, to account, it placing them, tions taken by Sir David Barry, M.D. andwith a minimum expenditure of labour, and Dr. Corrie. Persons who attended this exa-

a less supply of talent, on a par with other mination ; four clergymen, the medical at-schools. While the Medical Charities’ Bill tendant, and the apothecary.destroys this monopoly, it defeats its pur- The infirmary contained 32 patients; the

pose, in rendering three years attendance at wards would hold 40 beds. The expendi-hospitals necessary, not only in the surgeon ture, in 1833, amounted to 10481.; drugsto an infirmary, but in the surgeon to dis- cost 1041.; 438 in-patients, and 2289 out-

pensaries, where no shadow of the monopoly patients were treated. The average dailynow extends. expense of one patient at the infirmary was

1s. 3d. The receipts in 1831 amounted toIn lieu of the present clauses, let it be 10571. ; 4001. from grand jury presentments;

enacted, that one Medical Commissioner 891. from a parliamentary grant; 88l. fromshall hold a public court, before which petty sessions fines, and 108L from annualcandidates for office may exhibit their subscribers, The surgeon is elected by theclaims in the best mode that can be de- governors (subscribers); the treasurer holdsvised for eliciting and determining their the money, and has the principal directionrelative qualifications. It were absurd, in in his own hands. The surgeon is engagedany case whatever, to insist on other preli- iu private practice ; his salary is 139l. a

minaries than the possession of a diploma year ; he lives in the infirmary, and occupiesfrom the bodies by which these documents 5-12ths of the institution. The land—four

are legally conferred. The imperfection of acres-has been surrendered to the surgeonthe Medical Boards of Great Britain and by an express resolution of the Board ; and

Ireland are too inveterate to be remedied extensive out-offices, such as stables, cow-

by an indirect enactment; 1 and the obaoxioui houses, a coach-house, &c., have been re

864 IRISH MEDICAL CHARITIES BILL

cently erected in the rear of the house. A nothing can be more surprising than the

huilding which cost,in 1831-2, 154l.10s.10d., space the Dublin graduates occupy. Men

and is not directly connected with the accom- of slenderer dimensions than a silk-skein in

modation of the patients, left the institution ille)-ce7-’s Hospital, are no sooner placed in1701. in debt, for which interest has been the centre of a county infirmary, than theypaid to the amount of 551. 7here are eight suddenly dilate in every possible direc-

or ten medical men resident in Armagh, but tion ; advance, recede, extend their arms tonone of them are legally qualified to fill the the right haud and to the left, till half

office of surgeon to the infirmary. The p2-e- the building is filled. Then the patientssent medical attendant is a physician, atad a cannot appear in front of the house, over.

graduate of the Royal College of Surgeons in looked by the surgeon’s windows, and hisIreland. family; they cannot enter the grounds at theWhen theAssistant Commissionersexamin- back of the house, for there are his garden

ed the diet rolls of the infirmary, two cir- and farm-yard. In one infirmary the Sur.cumstances attracted their attention. (1.) geon occupied apartments capable of con.The striking excess of the present low diets taining 48 beds, besides two stables, twoover full diets,as compared with the diet rolls coach-houses, harness-room, barn, and seve-of the early part of 1832. (2.) The large and ral other offices.-(First Report of the Board

increasing portion which milk. has formed of Health.) We take a modern instance :-

from that period, both of full and low diets; GALWAY COUNTY INTIRMARY.—" The sur-but particularly of the latter. Every pa- geon occupies three-sevenths of the whole

tient, whether on full or low diet, is entitled house, not counting the addition just men-

tioned ; that is to say, three windows onto one pint of milk daily ; all patients on each of the two upper floors, and one win-low diet have an extra pint of milk nearly dow and a hall-door on the ground-floor,

, , belong to his apartments. The room lightedevery day, and often a pint of buttermilk by the third window on the ground-floor isbesides Patients on full diet are entitled used as the consulting room for extern pa-to an extra pint of new milk, 11 instead of tients. The ground in front of the house isin the occupation of the surgeon (aboutmeat or troth," on Mondays and Fridays. three-quarters of an acre), partly as a pota-The surgeon orders all extra allowances. toe field, partly as a kitchen garden. From

the latter the kitchen of the patients isHe framed the dietary, and proposed it to supplied with garden-stuff, but the surgeonthe governors, by whom it was adopted in is paid 51. per annum for a gardener. The

1831. The surgeon, also, supplies the infir- produce of the rest of the ground is appro-priated by the surgeon. Five pigs are now

mary with milk, and receives the amount kept in a stye in the hospital yard, but therefrom the treasurer, through the matron of is no space, that we could observe, laid out

for the recreation of the convalescents; andthe hospital, giving his receipt as a voucher this is an almost invariable result of thefor that disbursement. He is the contractor chief medical officer of a county infirmaryfor that article; and although he has the being provided with apartments in the

building. The patients cannot appear illland, the graduate of the Royal College u front of the house, for cannot the sur-Surgeons in Ireland charges the institution geon’s windows and his family; they can-at the rate of -. 7 a quart for the milk, d. not enjoy the grounds in the rear, for thereat the rate of 2J. a quart for the milk, -I 2 d. is the surgeon’s garden and his farm-yard ;a quart for the buttermilk ; while the Fever they must, therefore, and do generally re-

Hospital pays but 1d. a quart for milk. main all day in their wards, whatever bethe state of their convalescence, or of theOne ward, capable of containing eight beds, weather. It is not so in any other nation inis unoccupied. Further details will be Europe with which we are acquainted, andfound in the Irish Poor-Law Inquiry, Ap- ought not to be permitted in Ireland. The

above observations are not meant to applypendix B, p. 11, and pp. 379—382. exclusively to this infirmary ; they are ap-Some of the surgeons to infirmaries reside plicable to all such institutions that we

have as yet seen where the surgeon residesat a distance ; at ten infirmaries the sur- within the building. geon is resident, and, iu the latter case, "There are some other circumstances com-

865IRISH MEDICAL CHARITIES BILL.

mon to several county infirmaries, relating" session of a diploma for at least seven

to the class of cases which we found in years prior to his eligibility to this ap-them, and the length of time which these cases had been under treatment. In the pointment, and shall give evidence of

Galway County Infirmary we noticed a very" having been engaged in active practice,large proportion of indolent scrofulous or attached to some public recognisedulcers and sore legs. One of the latter, a reduced shopkeeper, had been in the house medical institution." Such a restrictionfive months, but the sore on his leg was still is unnecessary; and the Lord Lieutenantopen, and likely to continue so for some , .... , ..time. A young woman with chronic oph- should be on his guard in taking inspectorsthalmia, the active stage of which must from the medical institutions, on any otherhave been long past, had been in for the ground than that which recommendedsame length of time. Others had been in

.

in the house three months, others two ; yet, viDOCa to a high oflice in the Frenchwith this extensive commodious building, police.thus occupied, and possessing so many ca- pahilities, situated in a town containing

We admit that there is an absolute neces-

between 30,000 and 40,000 inhabitants,-an sity for medical inspection, and for one

accident, however severe and urgent, occur- general system of statistical returns. Thering in that town, could not be taken in, and - .

would be absolutely refused admission in this, places of inspectors and of medical officersthe only surgical hospital in either the county to the infirmaries, dispensaries, and lunaticor the town."—(Poor Inquiry, Ireland. Ap- asylutns, should be open to every legallypendix B, p. 13.)

qualified medical practitioner, and untilAll the surgeons to the Irish Medical there shall exist a NATIONAL FACULTY OF

Charities are engaged in private practice. MEDICINE the respective merits of rivalIn many instances the Commissioners found candidates should be canvassed publiclythe drugs of the charity intermingled with before a well-appointed medical jury. Inthe surgeon’s private stock; and the great- the infirmaries the medical officers shouldest irregularities existed in the charges for be in no way connected with the domestic,medicine. The returns of the numbers or economical, management of the establish-treated, cured, relieved, and dead, were ment.often fictitious. Instead of five inspectors let there be four,

It is not our intention to refer here to the one for each province, and one responsiblewaste, peculation, and jobbing of the trea- Commissioner at the head of the office with

surers and other parties connected with the a salary of 1000L a year, the additional

county infirmaries, although it has been our 400l. being derived from the salaries of thepainful duty to expose and reprobate the two Inspectors-General of Prisons, whomean trafficking and dishonourable conduct will no longer have to inspect the Lunaticof several of the monopolists in these insti- Asylums, and now have each 900l. a year,tutions. It is pleasing to add, that many with an addition of 20l. for each annualof the medical officers have performed their local report made to the grand juries. Ifduties at the county infirmaries with zeal the accounts, reports, and returns, publishedand honour; nor is it probable that so many and unpublished, be made accessible at thedelinquencies would have occurred among office to all who take an interest in thethe members of an honourable profession if Medical Charities, public criticism willthe temptations had not been extraordinary; prove a more effectual check on the inspec-and if the county surgeons had not been tors than seven 2anpaicl jobbing Commis-somewhat demoralised by the corruption, sioners.and avarice instilled into their minds at the

hospitals and medical schools in early life. HERPES EXEDENS.—Dr. Schuster recom-

This is the place to advert to the qualifi- mends baths containing corrosive sublimatefor this disease ; from half to three drachms

cations of inspectors. The 7th clause enacb of the bichloride are to be dissolved in eachthat the inspector " shall have been in pos- bath.