583

THE LANCET.

LONDON: SATURDAY, JUNE 25, 1853.

THE QUESTION OF THE MEDICAL ASSISTANTS.

ATTACHED to every learned profession there is a class of

men to whom fortune has denied the position to which perhapstheir education and character entitle them to aspire. 11 Non

omnibus contigit adire Corinthum." ’Whether it arise from

miscalculation of means to the end in view, from lack ofenergy or of enterprise, from deficient skill-although thisalone is no bar to success-from misfortune, or from othercauses, it is not our present purpose to inquire. The problemis, how to deal with the fact-how to alleviate the grievancesand improve the condition of those who, by the operation ofvarious forces, have been driven to the lower ranks of profes-sional life. Ambition, laudable in itself, but sometimes

o’ervaulting, impels crowds of young men to rush into theranks of the learned professions. The prizes are few: a

certain number, favoured by connexion or by other circum-stances, attain to competency; many barely achieve a respect-able position, and are obliged to struggle hard to maintain it;many, many more meet with just enough success to keep alivethe hope of better times; and then comes the crowd of mendoomed to disappointment, turned back in their career, orunable to mount above the first step of the ladder. In

the dispensation of human affairs it will often happenthat merit will be crushed at the bottom, whilst audacitywill lift the unworthy to the topmost place. The sting ofthe world’s injustice thus embitters the cup of disappoint-ment. Can nothing be done to smooth the asperities whichbeset the path of those who are unable to follow the beatenroad? 1

In most professions some effort has been made to soften thelot of the less fortunate members. The success of the attempthas been more or less commensurate with the resources of the

particular profession, or with the energy brought to bear uponthe object in view. The clergy, notwithstanding the opulenceof the Church, number a host of men of high education and ofrespectable connexions, who yet are unable to find a sub-sistence out of the proceeds of their profession. There are

bishoprics, deaneries, stalls, rectories, and other comfortableforms of life-annuity, and although many occupants of theseare gorged to repletion, hundreds, if not thousands, of theirbrethren are doing the real labours of the Church on pittancesinsufficient for their decent support. The clergy have verygreat advantages over the members of other professions in

appealing to the general public in the name of charity, and itmust be owned that they have not been remiss in callingthose advantages into operation on behalf of their poorerbrethren. " The Sons of the Clergy," and numerous other

institutions, attest the efforts that are made to relieve neces-sitous clergymen. The Law reveals a similar state of things-many splendid preferments, many prosperous practitioners,and many destined to hard work and scanty remuneration.In every attorney’s office of note may be found one or moremen who have passed the routine of professional training-perhaps admitted on the roll-of irreproachable character,and of admirable capacity for business, and who are neverthe-

less compelled by the force of circumstances to devote theirtime and skill to the service of others, in return for a verymoderate salary. The barristers’ and attorneys’ clerks have csought to provide against some of the casualties of their con-dition by the foundation of the " Provident Law Clerks’

Association."

The influences which operate upon the profession of

Medicine, and the depressed condition of many of its members,are in no respect different from those which are observed inthe Church and the Law. There are more of us than can

reasonably hope for profitable employment in independentpractice: those who have no alternative but to depend uponthe calling, in which they have been perhaps imprudentlylaunched, for a livelihood, must often encounter hardship andvexation. Our position at the focus to which all the rays of

intelligence affecting the medical profession converge possiblydisposes us to be more deeply impressed with the weight oftheir ills than with that which oppresses the sister professions;but making every allowance for the bias of our position and

, the tendency of our sympathies, we think it cannot be deniedthat the prizes attainable among us are fewer, the average

income smaller, and the expenditure of toil greater, than areknown in the other professions. The will is as good-we hadalmost said better-among the more prosperous to aid theless; but the means at our disposal fall far short of the

necessity. Like the other professions, also,we are not withoutsome organized provisions for the relief of our distressedbrethren: we have our Benevolent Fund, our Society for theRelief of Widows and Orphans, and lastly, the splendid projectof Mr. PROPERT, the Medical Benevolent College. It may be

said, however, that all these are inadequately supported, andare adapted to meet special cases. Not one of them meets

the want which it is our present object to indicate; not one ofthem embraces the organization of that section of the profes-sion who are engaged in its subordinate duties; not one ofthem contemplates that most desirable object which associa-tion may attain-that of lending systematic aid in facilitatingthe relations between practitioners and assistants.ZVe have, outweighing many other pressing claims upon us,

freely opened our columns to the numerous and sometimesrather vehement expressions of what appeared to us to be an

urgent evil, one calling for the anxious consideration of all! classes of the profession. The case of the medical assistants

is not theirs alone; it is one which intimately concerns thewhole medical body. The character, the status, the influenceof the profession of medicine are intimately involved in thecharacter and conduct of the humblest of its members. The

character and conduct of the assistants is in immediate de-

pendence upon their social position. The man who is badlypaid, indifferently treated, and made to occupy an equivocalposition between the kitchen and the parlour, holding by aslender thread upon the ties of society, is but too apt to losehis self-respect, to become reckless in his behaviour, and to

bring disgrace upon himself and his employer. Tha reaction

of all this increases the evil. The employer, soured by pastexperience, thinks he has no choice but to widen the distancebetween his assistant and his family, and is brought to lookupon him as a necessary evil. There is a sense of irritation on

the one side, and of degradation on the other. Such at least

is the picture drawn by some of our correspondents. Others,

we rejoice to say, describe a happier state of things, one which

584 INFLUENCE OF THE MEDICAL PRESS ON THE PROFESSION.

we are well assured is more in harmony with the feelings ofthe general practitioners of this country.We cannot undertake, in the compass of a single article, to

enumerate all the grievances which have been urged upon ourreaders; but we think it may be useful to refer to the one

-upon which the greatest stress has been laid-the smallness ofthe salary usually given to assistants. We think it desirableto remind assistants who complain, and we freely admit, justlycomplain, that the salaries they obtain are not so large as menof character and education should receive, that the amount of

salary is a matter admitting of very limited control either onthe part of the employer or the assistant. Salary is a problemdetermined by a variety of circumstances. Regard must behad to the nature and profits of the profession-to the meansof the individual employer-to the capacity and standing ofthe individual assistant-and to the supply of assistants in thefield. In the first place the practitioner’s income is hardlyearned and precarious, he is oppressed with the cares of anestablishment, and taxed at every turn; and if he be surgeonto a parish union-and such a man must have an assistant-itis akin to drawing blood from a stone to expect a large salaryfrom one whose occupation is often carried on at a loss. In

such a case the union should pay an additional allowance for

an assistant. It is clear, again, that the assistant who has noqualification-who is only competent to dispense medicines-cannot reasonably look for more than a very moderate salary.His duties are of a mechanical and humble nature, and he has ;,

to compete with thousands of druggists’ assistants who areequally competent to discharge them. The case of the

qualified assistant is somewhat different, and we heartily wishthat his remuneration were better. But let us examine the

facts. We have it on the authority of daily advertisements,and the testimony of an agent of extensive business, that anassistant possessing the double qualification is not to be had,and that the youngest surgeon or apothecary may commandJE50 a year. Let the medical assistant with X50 a year

compare his position with the curate who has gone throughan expensive education at Oxford or Cambridge, who gets nomore, and has to keep himself; or with the attorney’s clerk,whose professional attainments may fairly be ranked with hisown. We repeat, that we heartily wish the salary could begreater; but we must at the same time express our surprisethat, remembering the disgraceful laxity of the examinationsat the Royal College of Surgeons, and the crowds of youngmen annually shovelled into an overstretched profession, so

large a salary can be obtained.If the amount of salary were the only grievance of the

assistants, we should strongly counsel them to shun any com-bination. No combination could be effectual in forcing anincrease of salary; but it might, and undoubtedly would, pro-duce the very opposite result. It is impossible to dictate toan employer what he shall give. It is equally impossible toexact more than the natural amount of wages,-an amount

determined by the rotation of supply and demand. But there

are other ills and wants which affect the body of medicalassistants, and which a proper organization might to a greatextent remove.

It is a feasible plan to provide a central office for the inter-communication of the various members of the body; where a

register might be kept of vacant appointments, and of assist-ants seeking employment. Engrafted upon this, a plan might

be struck out for a provident fund against sickness, and pos-sibly to aid in promoting the interests of individual membersin other ways. The suggestion of one of our correspondentsof aiding assistants to complete their education is of question-able practicability. They must not be too sanguine; theywill accomplish a great deal, if they succeed in the two objectswe have already referred to. There is reason to hope thatsuch an association would exercise a beneficial influence over

the character of the assistants. The bond of union would

impart a feeling of security and confidence, and the necessaryconditions of membership would prompt them to be jealousof their fair fame, and raise them in their self-respect.One word as to the name of the projected institution. The

name is not unimportant: it should convey a clear idea of

the nature and objects of the association. The word " College"we think objectionable; that is now by general consent

applied to educational establishments. A title answering tothe " Provident Law Clerks’ Association" would probably bebetter.

The eagerness with which the proposition has been greetedon all sides bears strong evidence that the want of some

organization is widely felt. If carried out with good will, andif a few, simple, and widely-useful objects be steadily kept insight, there is every reason to anticipate success. For our

own part, being deeply convinced of the necessity of main-taining the respectability of the important class of medicalassistants, and of uniting them by the most friendly feelingsto the general practitioners, we cordially invite every oneinterested in a project calculated to effect much in promotingthese ends, to join in the work of establishing the associationof the medical assistants on a sound and liberal foundation.

+

THE political press of this country has been called a FourthEstate, and certainly its influence, which increases with everygeneration, will last as long as either Queen, Lords, orCommons. Every discovery in science, every advance incivilization, contributes to its facilities for diffusing informa-tion, and for guiding and controlling the public mind. The

political press had been long established before the severalprofessions and separate interests of the community acquiredtheir special organs of journalism. Medicine has not been

behindhand with the other professions, and, holding the

honourable position of leading the medical press of the

British empire, we can affirm that no profession in existencehas owed so much to a periodical press as the science andpractice of medicine. There are persons now living who canremember the time when the few papers issued at uncertain

intervals by the College of Physicians as Transactions, werealmost the only and sole periodical publication relating to theprofession of medicine in all its branches. Our great hospitalswere silent, except for the few who could enter their walls; ourmedical societies were either not in existence, or they weremuch beyond the rooms in which their meetings took place;our corporations were in a state of the most deplorable dark-ness, irresponsibility, and corruption. From all these thingsthe medical press has forwarded the instrument of escape,

fighting at every step of professional emancipation, with themanifold agencies interested in the perpetuation of abuse andmismanagement.There are, we have heard, some few antiquated bigots who

585THE NAVAL ASSISTANT-SURGEONS AND THE ADMIR, ALTY

look upon the weekly medical press as a weekly desecration ofmedicine; but the great mass of the profession would feelas if deprived of a sense, if any one week could pass bywithout the appearance of a medical journal, and with thesudden cessation of all intercourse between the thousands of

the members of the medical profession, except that suppliedby private sources. Medicine is in these days a militant

profession-a profession fighting for its right of place with thestate, with the public, with quacks within and without its ownbody, and with imperfect institutions. What other agencycould adequately carry on this struggle save an independentmedical press ? The mission of the medical journalist is

indeed a noble one if properly understood and fulfilled.It is, however, of the first importance, both to the medical

press and the profession, that those in any way connectedwith the conduct of the press should entertain a due sense of

the power they wield and the responsibility attached thereto,in no other way can they obtain that view of the dignity oftheir calling which really belongs to it, and which should

place the honest medical journalist on an equality with thehighest of the profession. Whether the influence exerted by Ithe press, or the amount of ability displayed weekly, be con-sidered, the press, individually and collectively, have, we Irepeat, the right to the highest consideration, and thesimplest duty of its members is that they should treat theirown calling with respect. In the nature of things the medicalpress cannot be a permanent body; it must necessarily con-sist of rising men, who labour in this vocation for awhile, andleave it as practice and its responsibility advances; or else ofmen who are continually extruded from its ranks throughthe want of that capacity and talent which the press

inexorably demands. When we see the spectacle of a writerabusing the body to which he belongs, we may pretty safelyplace him in the latter category. We say this with referenceto an extract from a contemporary, which we publish atpage 586. The observations of Dr. TYLER SMITH form an

eloquent vindication of the status of the medical press, andan exposition of the sentiments which should animate a

public writer.

THE maintenance of the health of our army is a subject ofmuch importance. Every means ought to be adopted to

strengthen the constitutions of our soldiers and avoid all

risks. It is generally acknowledged that damp, marshy landis not only unhealthy, but dangerous, even to the most robustamongst us. It is well known that miasma engenders inter-3nittent fever in those who are exposed to the emanationsfrom boggy, low, and swampy districts. Reports are in cir-culation to the effect that the soldiers encamped at Chobhamare already suffering from fever and various forms of diar-rhoBa.. We decidedly condemn the judgment of those whoseolrace it was to procure a healthy and dry situation for 10,000of our most efficient troops. The Common is in many placesstudded with pools of stagnant filthy water, which really isnot even fit for the horses to drink. It appears that alreadyone man has fallen a victim, having swallowed some kind ofVenomous insect. In fact we consider that a more unsuitable

place could not have been selected for a military encampment.If an actual war existed, and no other position offered, ofCourse exposure to certain obnoxious agencies would be un-

avoidable, but when this display is only intended as anexperiment, we emphatically protest against the neglect thathas taken place in protecting the health and lives of oursoldiers. In positive warfare it is seldom that soldiers are en-camped for any length of time in the same place, their quartersbeing continually changed. If the camp were removed to

a distance of only a few miles from its present site the

threatened outbreak might probably be avoided. Should

this suggestion be disregarded by the authorities, its im-

portance at no distant date may be proved by events. Weshould sadly deplore the breaking out of a fatal epidemic

fever in the ranks of our army. It is an event that could not

be contemplated without feelings of extreme apprehensionand anxiety.

..

STRANGE as it may appear after the report of the naval andmilitary commission, and the repeated promises made inParliament, the wrongs of the naval assistant-surgeons remainunredressed. That the injustice is continued without any ab-solute necessity is clearly proved by the fact, that in somecases proper accommodation has been provided for this im-portant class of officers. In the majority of instances, however,the assistant-surgeons of the navy have still no separate cabinallotted to them, but have to spend their time in the companyof the young and often giddy and noisy midshipmen. The

excuse for this injustice is untenable and absurd. Wherever

the captain has willed it a distinct cabin has been readilyfound for the assistant-surgeon.We have repeatedly shown the evils resulting from the

system pursued. These evils remain in many cases unmiti-

gated, and one of the most important branches of the publicservice is injured by the obstinacy of officials. That obstinacy,however, is to be overcome; the force of public opinion mustinfluence even the Board of Admiralty. One way of effectingthe good we have in view is to address Parliament; and wetrust that the petition, a copy of which is to be found at

page 586, will be numerously signed by members of the pro-fession. The petition has already received the signature ofthe President of the Royal College of Physicians, and of allthe medical practitioners in the borough of Greenwich.

AT length the labours of those who have struggled for theclosure of the metropolitan graveyards are likely to be

crowned with success. An order in Council, lately issued,shows that the Home Secretary is fully determined to put astop to the monster evil of burial in towns. It cannot be longbefore every metropolitan graveyard will be closed, andone prolific source of disease effectually stopped. Then will

the medical profession have another strong claim on tha.gratitude of the public. It is to be feared, however, that the

public will not fully appreciate what the " doctors" have

effected in this matter. It will be forgotten, perhaps, that a

surgeon originated the movement: and that Mr. G. A. WALKERfor years carried on the agitation single-handed, and againstan opposition which would have effectually silenced most men;that most important assistance in the cause has been renderedby members of the medical profession without fee or reward,and often at large sacrifices of time and money. We haveno desire to make any invidious comparisons, but we cannothelp contrasting the conduct of the clergy with that of the

586

members of the medical profession respecting this question.The clergy, as a body, have obstructed the movement in everypossible way, and have no doubt been the means of prolongingthe evil. Indeed the greatest difficulties -with which the

graveyard reformers have had to contend have originated withthe clergy. They talked of their interests and 11 vested

rights." Honour to the members of our profession !-theycan be charged with no such conduct, but are entitled to thehighest commendation for pursuing a directly opposite courseof policy.

NAVAL ASSISTANT-SURGEONS.

To the Honourable the Commons of Great Britain and Irelandin Parliament assembled.

The Petition of the Members of the Medical Profession,HUMBLY SHEWETH,-Your petitioners being aware the

Council of the Royal College of Surgeons have on a formeroccasion represented to your honourable House that they arerequired to examine into the qualification of assistant-surgeonsof her Majesty’s navy, on their promotion, and that theyfound many who had neither improved nor effectually main-tained their knowledge of the art and science of surgery,The Council having further stated that the cause invariably

assigned for this deficiency was the want of such accommoda-tion in the vessels of the navy as was compatible with therequirements of study; and that from the inquiries they hadmade, they had ascertained that the assistant-surgeons of theRoyal Navy were placed under circumstances wholly unsuitedto the position and pursuits of the members of a liberal pro-fession.Your petitioners have just reason for believing that, in

consequence of these representations from the College ofSurgeons, and of similar petitions from the other medical andsurgical corporate bodies, as well as from many of the profes-sions at large in the United Kingdom, your honourable Househad passed a resolution on the 8th day of April, 1850, to theeffect that the accommodation provided for " assistant-sur-geons on board her Majesty’s ships of war is inadequate andinsufficient for securing the full benefit of their professionalservices."Your petitioners have learned with deep regret and dis-

appointment that the Court have not, since the declaration ofthat resolution, found the improvement they expected in theknowledge of candidates from the Royal Navy who have pre-sented themselves before the Court for the examination neces-.sary to qualify them for promotion-a circumstance whichthey cannot but believe is mainly owing to the regulationsissued by the Admiralty, since the passing of the aforesaidresolution, requiring the assistant-surgeons still to remainat least three years in the midshipmen’s birth after theiradmission into the service, or it may be until the periodof their coming before the Court for their second exa-

mination, and even after that time there are numerous in-stances in which they are denied the privileges of ward-roomrank.Your petitioners therefore cannot but repeat that they

view the continued want of improvement, and even of main-tenance of the knowledge formerly possessed, on the part ofthe assistant-surgeons of the navy, chiefly attributable to thisprobationary service of three years, placing them for so longa time in a position wholly unsuited to habits of study, (at aperiod when study is peculiarly valuable and desirable,) and-incompatible with their social and professional standing.

The members of the medical profession would also urge onthe consideration of your honourable House that, as regardsthe superior classes of naval medical officers, the recom-mendation of the Naval and Military Commission, that theseofficers should be placed on a footing of equality with’theirbrethren in the army, as to rank, pay, and retirement, hasonly been partially carried out, notwithstanding the vote of theHouse to the above effect; and being under the impression thatthe regulations at present existing tend to affect injuriouslythe entire naval medical service, and also to deter able sur-geons from entering her )Iajesty’s navy, again humbly prayyour honourable House to consider the grievances of whichthe medical officers complain.

z

"

And your petitioners will ever pray;

THE RANK OF THE MEDICAL PRESS.

Letter to the Editor from TYLER SMITH, M.D.

W. TYLER SMITH.

SIR,-In the notice of the annual dinner of the medical officersof the army, on the 21st ult., you refer to the circumstance ofthe names of Dr. Cormack, Dr. Semple, and myself, having beengiven with the toast of the Metropolitan Medical Press; and youobserve: "Dr. Tyler Smith remarked, that his connexion withjournalism belonged more to the past than to the present : andDr. Semple stated, that he was only an interim editor-that hehad no wish to be anything else; for he thought there wereother professional occupations less responsible and more re-

spectable."It has been supposed, from this, that I joined with Dr. Semple

in turning my back upon the medical press, and speaking of itin derogatory terms. Nothing could be more repugnant to myfeelings ; and, to remove any such impression, I beg to forwardwhat I really did say on the occasion in question. I certainlyknow of no occupation in the profession which is either more"respectable" or more "responsible" than that of the uprightmedical journalist.

I am, &c.,7, Upper Grosvenor-str2et, June 13, 1853. W. TYLER SMITH.

" I feel it an honour that my name should have been associatedwith the toast of ‘The Medical Press of London,’ by the chair-man, (Mr. Guthrie,) a gentlemen not less distinguished in theliterature of the profession than in the practice of civil andmilitary surgery. My own connexion with the medical pressbelongs rather to the past than to the present ; but I shall everremember with pride that many of the best years of my lifehave been devoted to a field of labour so useful and honourable.Speaking as I do in the presence of the Presidents of the Col-leges of Physicians and Surgeons, I feel that I cannot, like thosegentlemen, appeal to the antiquity of the institution I represent.The medical press is emphatically a new power; but it hasalready proved itself not the least of the powers of the profession.Only yesterday, as it were, the medical press was almostentirely occupied in discussing the symptoms of this or thatdisease, and the doses and effects of this or that medicine. Suchis not, in my opinion, the highest vocation of the press. Itsnobler objects are the discussion of the condition of the medicalbody politic, and the formation and expression of public andprofessional opinion on every topic relating to the rank ofmedical science, and the welfare of its followers. At the presenttime able men connected with the medical press pursue theseobjects with such zeal and integrity, that no delusion can longpass undetected, no imposture unexposed, and, I will add, nowrong unredressed. It is thus that the medical press must be-come more powerful than Halls or Colleges in uniting thewhole profession as one body, and in urging medicine onwardsto that rank in the state to which she is justly entitled. SirDe Lacy Evans has said that, in his successful effort to obtain themilitary honours of the Bath for distinguished military and navalsurgeons, he acted chiefly as a channel for conveying informa-tion between the advocates of this great concession and the

government. It is within my knowledge, that the same penswhich supplied the gallant general with the data upon which heproceeded, also argued the question continuously in the medicalpress. The press can never be employed more nobly than inpromoting the spirit of union among the entire profession. Onlya few years ago those who followed the military and naval

departments of medicine were as widely divided from civil, practitioners as though they had belonged to some different

: calling. It is now far otherwise; and I believe that no injury’ could be inflicted upon a naval or military surgeon in anyl part of the world, without exciting the ready sympathy and

support of the civil branches of the profession ; and I am surei

that, in the prosecution of any just object, naval and militaryl surgeons may count upon the aid of their brethren of all grades.

- I say it with pride, but I do not think that such a change asthis could have been effected without the existence of a medicalpress."-Association Medical Journal.

DEATH OF MRS. CATHERINE CuMMING. Ņ Thisunfortunate lady died at her house at St. John’s-wood on Tues-day last. The physical infirmities consequent upon her advancedage had of late increased rapidly, and the incessant anxieties towhich she has been subjected no doubt hastened her end. Her

melancholy history presents a sad illustration of the viciousnature of our lunacy laws, and of the facilities they afford for theI most affiicting abuses.