211

THE LANCET.

LONDON, SATURDAY, FEBRUARY 24, 1849.

A £500 MEDICAL REFORM FUND.—STATE MEDICINE AND THE MEDICAL CORPORATIONS.

THE Evidence given before the Parliamentary Committeeof last session, which has lately appeared in THE LANCET,and is still publishing in our columns, is sufficiently en-

couraging to the practitioners throughout the kingdom, toinduce them to make renewed efforts for their emancipationfrom the operation of degrading and insulting laws. While

the profession slumbers, the most pernicious watchfulness ismaintained within the walls of the corporations and colleges.The enemies of the great body of the profession-the mightypures of both classes-still cling to the hope of thrusting manythousands of able and respected practitioners in medicine,surgery, and midwifery, into an inferior institution, a thingcalled a college, but having, in fact, neither medical norsurgical title, although there are to be maintained Colleges ofPhysicians and Colleges of Surgeons, with the government ofneither of which is the profession, as a body, to possess eitherconnexion or influence.

The time rapidly approaches when Parliament will decidefor the profession questions which the profession is too apa-thetic and negligent to decide for itself. Such a result

cannot be contemplated without feelings of apprehension.The corporators and other intriguers, although weak innumbers, are strong in organization. The thousands of the

profession, in being totally disorganized, and having neithercouncil, society, committee, nor secretary, to act either withor against the associated diplomatists from the corporations,are betraying a degree of weakness, at this important andthreatening crisis, which it is fearful to contemplate.Amongst the correspondents who have addressed us on this

subject during the past week, one has suggested a plan forraising a " £ 5OO MEDICAL REFORM FUND," with a view to thedischarge of the necessary expenses incurred by a committee,aided by a secretary and clerks, constantly at work during thefew weeks occupied in the preparation of the Bill and its passingthrough Parliament. A description of the plan will be foundat p. 220, amongst our answers to correspondents. Until there

are guaranteed subscriptions to the required amount, the pro-position is, that not any money should be paid. Our corre-

spondent justly considers, that a sum of less amount, byproving insufficient, might lead to an useless expenditure, andto a great loss of time and labour. We perfectly agree withhim in opinion. But if well directed, a nve hundred-poundeiwould soon open some breaches in the citadels of medical cor-

ruption.The striking advantages in the projected plan are, first, that

the sum to be subscribed is of adequate amount for fighting ahard battle; and secondly, in order to avoid a waste of moneyby engaging in a contest without sufficient means, that no sub-scription should be paid until the sum of at least X500 beguaranteed by respectable subscribers. Is there a medical

reformer in the kingdom who, at such a time, and for such apurpose, would refuse to contribute to the fund, to at leastthe extent proposed? If the profession be really in earnestin the cause of medical reform, the projected S500 fund willbecome a ael000 fund within one month from this date. Afte]

a sufficient number of guaranteed subscriptions has been re

ceived, the subscribers would have to assemble, and elect theirtreasurer, president, and acting committee; and then full

preparation would be really made for inflicting the requisitenumber of final blows on the hydra-headed monster whichhas so long guarded the portals of corrupt, negligent, and un-sympathizing medical corporations, and above all, and beforeall, the means would be provided for obtaining a NEW MEDICALLAW, which should be worthy the acceptance of the membersof the medical profession.

$

, THERE was one reference made at the late meeting of Poor-law Medical Officers, with which we especially agree. In-

deed, it concerns a point which we had again and again arguedin THE LANCET. We allude to the proposal for a separateadministration of poor-law medical affairs. This, it appears,was advocated by the late lamented Mr. CHARLES BULLER;and this, we are convinced, must be approved of by everydispassionate inquirer into the subject. Poor-law medical

affairs can never go on well while medicines are doled out,or rather the pay for medicines, on precisely the same prin-ciple as that which regulates pauper food and clothing; andwhile the medical man stands upon much the same footing asthe relieving officer, or the head porter of the union work-house.

But we have contended, not only for the proper administra-tion of poor-law medical affairs; we have denounced thestraggling, inefficient manner in which all the various items GfState-Medicine are regulated in this country.The true light in which we must look at poor-law medicine

is as a branch, and a highly important branch of StateMedical affairs. Nothing, we are convinced, will be well withpublic medicine, until all its branches are united together inone great department, and presided over, in great part atleast, by medical men.Let us glance, as we have glanced before, at the extraor-

dinary way in which Medicine is at present connected withthe State and the Public Health, as distinct from its privateand scientific mission. An office here, an office there; alittle in one place, and a little in another, appear in most ad-mired weakness and confusion.

In the first place : what public functions are performed byany of the old London colleges and corporate bodies ? What

relation is there between public medicine and Apothecaries’Hall, for instance ? In what way does the WorshipfulSociety contribute to public health, as distinct from its

private function as an examining and drug-trading body ?The reply is obvious. The Hall has no public existencewhatever, except, perhaps, in connexion with the BotanicGardens at Chelsea, and there even, we believe, the keepingof the statue of Sir HANS SLOANE in order is too heavya burden for this effete body. In fact, it is rumoured that theservants there are as much in the pay of the professionalgrinders as of the Hall. Then, again, what relationship existsbetween the College of Surgeons and the public health ?

When did the College ever do the State a service in a publiccapacity ? We can think of nothing connecting the College,even remotely, with Preventive or State-Medicine. Lastly,what has that venerable body, the College of Physicians, to dowith tho public service, except by an occasional growl, whenstirred up by some of the younger Fellows to something like a

protest against the inactivity to which it is condemned by suc-

212 STATE MEDICINE AND THE MEDICAL CORPORATIONS.—POOR-LAW MEDICAL CONVENTION.

cessive governments, as on a recent occasion, when the Presi- men, doctors, soldiers, and politicians ? Compare the presentdent and Lord CARLISLE really did have a smart skirmish ? administration of State-Medicine at a dozen different offices,With such trivial exceptions as these, the dronish report issued and in a dozen subordinate departments, with ONE great organi.from time to time under the seal of the President, about the zation, which should include the administration of all these

progress of vaccination, is all that the present generation can scattered subjects. What department of the public service,remember of the College of Physicians as the guardians of Home, Foreign, or Colonial, is there, which could equal inthe public health. Even the vaccine function is but a dignity or utility that of State-Medicine, properly combinedmiserable fragment of the entire subject of vaccination, the and developed On the score of expense, too, much maygreater part of which is controlled by the Poor-law Commis- be said. The present incongruity and division must not onlysioners. Thus the present medical bodies have no public weaken the efficiency of all the medical departments of theexistence worthy of the name ! public service, but it must increase the expense to theLet us now glance at the various fragmentary administra- country. The prevailing system, or rather want of system,

tions of public medicine, such as it really exists. It presents a inevitably combines inefficiency with prodigality. Privatevery curious picture, and one which will be somewhat wondered practitioners may think these things of little immediate im-at fifty years hence, when the great public functions of the portance to themselves, but we can assure them it is farprofession have been properly consolidated, as we doubt not otherwise. Private medicine and the individual medical manthey will be, long before that time.

,

will never take their just rank and position in this country,There is the Army Medical Department, in -St. James’s- while public medicine is in its present anomalous and dis-

place, under the superintendence of Sir JAMES’ MACGRIGOR graceful position.M.D. There-is the Medical Department of the Navy, at the Admiralty Office, Somerset House, directed by Sir WILLIAM

NExT week we intend to commence a series of articles on theM.D. We wou ld be unders sto od as n ot sayi

. NEXT week we intend to commence a series of articles on theBURNETT, M.D. We would be understood as not saying any-

Report issued by the Council of the Institute respecting thething to the disparagement of these able public officers and Report issued by the Council of the Institute respecting thephysicians, to both of whom the military present condition of the Medical Reform question. We arephysicians, to both oi whom the military and naval surgeons the find our silence has been construedare largely indebted. mi. there is the Ordnance nf t- Al urged to do this, as we find our silence has been construed

Department in Pall-mall, under the management, not of a into an acquiescence with the doctrines enunciated by the

:"P h YSlCla.n ,. orsurgeon, but of the Master-general, the Marquis authors of that Report, a surmise which will be found to be

of ANGLESEA ! Besides these branches of the public services, far, very far, from the truth. Medical Reform is now ;the

there is the Honourable East India Company’s Medical subject of subjects to the medical mind, and for the next six

Department, at the East India House, in which Dr. SCOTT months must occupy the attention of every thoughtful-man

holds the chief appointment. The registration of Births and in his profession. Our criticism of the Hanover . Square

Deaths is another department properly belonging to the pro- Report will enable us to give a digest, of the whole question

fession, but carried on at Somerset House under the manage- as it now stands.

ment of the Registrar-general, Major GRAHAM. The weeklybulletin of the public health in London, and the quarterly THE account of the meeting of the Poor-law Convention, on

return of the mortality in the chief districts in England, are Monday last, which is published on the opposite ,page, "mustissued by a soldier! Another public medical service should afford heartfelt pleasure to the numbers of poor-law union sur-be the regulation of Lunacy. This, which is so obviously, in its geons who, instead of being present with their brethren on that

most important features, a medical subject; is carried on at day, were obliged to be toiling at their vocation among the

,45, Lincoln’s-inn.fields, the two Masters in Luuaey -being poor. The meeting itself offered a most favourable contrastFRANCIS BARLOW and EDWARD WINSLOw, Esquires, Barristers- to the first meeting, and we trust the result will be still more

-at-Law, with Lord ASHLEY as Chairman of a Board of Com- favourable, as compared with the results of the former. We saymissioners, honorary and paid, in which the medical men are this without in any way desiring to undervalue the reaJJy.as three to eight! Then there is the Poor-law Medical De- valuable labours of those gentlemen who have with honest

partment, a service including 3000 qualified medical prac- zeal conducted the cause of the union surgeons thus far. It

titioners, the regulation of which is tossed to and fro between was quite refreshing to have a nobleman of Lord ASHLEY’Sboards of guardians and, the Poor-law Commissioners. In- standing, eloquently enlarging upon the rights and difficultiescluded in the poor-law medical management, or mismanage- of the poor-law surgeon,-on the rights of the poor, on the

ment, are all the provisions for the extension of vaccination in one hand, and of the medical profession, on the other, to a justEngland and Wales, which really exists. The Poor-law Com- system of remuneration for poor-law medical services. The

mission at Somerset House is presided over by Mr. BAINES, a opinion of Lord ASHLEY cannot fail to have great weight with

barrister and M.P. for Hull. Lastly, there is the Board of the poor-law commissioners: to the poor-law medical man it

Health at Gwydir House, under the presidency of Lord is of great value, considering the position of his Lordship-.as a

CARLISLE. member of the Board of Health, a body which, on the pointWe put it to the profession at large, whether such a disjointed of remuneration, is likely to come into direct contact with

machinery for the administration of affairs connected with the the poor-law medical man. On behalf of the profession, wePublic Health, in which MEDICINE should of right play the chief beg to tender our warm and grateful thanks to Lord ASHLEY,part, is not a disgrace to the age, and to the faculty to which for his efficient aid, and we can assure him, that neither raggedwe belong. What other profession or class but the medical schools, distressed needle-women, manufacturing operatives,would suffer such an abominable state of things to continue ? mining women and children, the reform of criminals, nor anyWould lawyers or clergymen suffer the church or the law of the various philanthropic objects in which Lord ASHLEY isto be administered by a mixed medley of lawyers, church- or has been engaged, can be of such real importance to the

213THE POOR-LAW MEDICAL CONVENTION.

poorer classes of this country, as a due provision for theirproper medical attendance when bowed down by sickness andwant.

We trust the 3000 will support the Convention in the mostenergetic manner, when we doubt not great and permanentgood will result from their exertions. In parliament, and outof parliament, the subject must be agitated as occasion offers,until the union surgeon no longer goes about his toilsomework with a rankling sense of injustice in his heart; until heis no longer tyrannized-over either by Poor-law Commissionersand Inspectors, or remains the slave of the freaks of Boardsof Guardians.

THE POOR-LAW MEDICAL CONVENTION.

MEETING ON MONDAY, FEBRUARY 19TH, AT THE HANOVER-SQUAREROOMS. THE RIGHT HON. LORD ASHLEY IN THE CHAIR.

THE noble chairman, on opening the proceedings, remarked-No one could read the copious evidence taken in 1844 bythe Committee of the House of Commons, of which he waschairman, on the subject of medical relief -for the sick poor,without coming to the conclusion that the relief afforded tothem was insufficient, and the remuneration which was grantedfor medical services inconsistent with the honourable positionwhich professional gentlemen occupied. He had.always beenof the opinion which he had stated on that Committee, thatthe medical officers appointed under the poor laws could notproperly discharge their onerous duties unless they receivedan income suitable to the laborious - offices- they had to per-form, and were rendered independent of the caprices of theboards of guardians. (Hear, hear.) They should be enabledto occupy the position of persons who,, knowing that they hadgrave and arduous functions to discharge, should be responsibleto professional authority and supervision, instead of being sub-ject’to the capricious control of men often ignorant, andsometimes insolent. He thought; also, that their situationsought to be permanent, for their duties were of the most com-plex and burdensome kind, and the cases which they encoun-tered -in their practice demanded a greater degree of responsi-bility and labour than fell on those who were engaged in

administering medical aid to the higher classes; for it was arecognised fact, that not only were the most complicated casesin medicine and surgery-found among the working people, buttheir treatment was rendered more difficult, in consequenceof the previous habits and mode of life of the patients. (Hear.)When, therefore, they found gentlemen of education andcharacter entrusted with the charge of perhaps ten or twentythousand persons; and paid by a miserable pittance scarcelysufficient- to provide the necessary medicines, their positionbecame an insult at once to the poor and to the profession towhich they belonged. He trusted, therefore, that they wouldhenceforward persevere in maintaining- the organization- theyhad -formed for the assertion of their claims, and continue topress on the legislature the propriety of introducing a systemwhich would enable them to render to the poor the amount ofrelief demanded not merely by justice, but by the first instinctsof humanity: (Hear, hear.) He would be most happy torender them all the assistance in his power to advance theircause. He would not promise to undertake any legislativeinterference for them ; but if he could be of service to themin any other way than by the introduction of a legislative pro-position, which the present amount of his parliamentary dutiesforbade him to undertake, they should find him ready to sup-port them, because he felt that he would be serving not merelythe numerous class of medical men discharging duties under thePoor-law Act, but the far more numerous class of the suffer-ing, sick, and destitute poor. (Cheers.)Mr. C. F. J. LORD read a report from the committee ap-

pointed at a former meeting, from which it appeared thatthey had received from district surgeons 805 reports as to theworking of poor-law medical relief. It was also stated thatthe most encouraging assurances of good fellow-feeling hadbeen received by their deputations to the Colleges of Surgeonsand Physicians and the Society of Apothecaries. The accountof the interview between members of their profession and theSecretary of State for the Home Department and the Presi-dent of the Poor-law Commissioners, was adverted to, and theprofession was reminded that the president of the poor-lawboard had stated, that he was inclined to consider medicalrelief as a question distinct from ordinary poor-lawadministra-

tion, and one which should be put on a separate and more com-prehensive footing. At the meeting of the Provincial Medicaland Surgical Association, which was held last autumn, at Bath,they had also received encouragement and promises of ce-operation. The report stated that out of the 8,000,000l. raisedfor the nominal relief of 3,000,000 of poor, the largest amountdivided in any one year among the 3000 gentlemen engagedin administering medical relief to them was 175,000l., in returnfor journeys through the country, medicines, professional skill,&c.! The cost of drugs required in each case of illness at-tended in hospitals was 4s. 2d. ; in dispensaries, 2s. M.; whilein urban unions only Is. 6;d. was allowed, and in rural unions;2s. 2d. The opinion of Sir George Grey was quoted, that thequestion of expense was subordinate to what was necessary tosecure efficient medical relief." A statement of receipts and ’expenditure of the committee- was appended to the report,from which it appeared that the subscriptions received hadbeen insufficient to cover the outlay, and that a sum of221. 17s. 9d. was due to the treasurer.The report was then received and adopted.Moved by WM. LOBB, Esq., seconded by PETER MARTIN,

Esq., (Reigate,) and resolved unanimously,-"That the evidence laid before this convention and the cor-

respondence of its committee, prove an universal and increas-ing dissatisfaction among the medical officers of unions,-that .how much soever the poor-law board may feel the necessityofaltering the present vicious system of poor-law medical reliefithey are so hampered by the boards of guardians that theyare unable to carry into operation the very measures whichthey have deemed to be right; there is therefore great cause forthe medical profession, and the poor-law medical staff moreespecially, to seek directly, from parliament, redress from- the,hardships and injustice under which the sick poor and theunion surgeons are suffering while the present system con-tinues, it is therefore urged, that as the government at presentpay half the medical salaries, it is expedient that it should paythe whole, and remove from boards of guardians-the power.tointerfere with wise regulations and salutary improvements."Mr. MARTIN observed that -there was a strong-feeling among;

the profession in favour of placing thewhole charge for medicalrelief on the consolidated fund, and thus depriving theguar...dians of any ground for the idea that all the money,paid tosurgeons came out of their own pockets. The present timewas favourable for attempting the change, and-if thatfirstatepawere taken, other - ameliorations - would very soon follow. The’resolution then passed nnanimously:Moved by JoHN LIDDLE, Esq., seconded by JAMES LORD,

Esq., and resolved;-" That the plan for an improved systemof medical relief, suggested by the committee of the - conven-tion, and laid before the government in their memorial to theRight Hon. Sir George Grey; contains the three -importantprinciples which are best calculated to render - any systemacceptable to the medical profession, and in the highestdegree useful to the poor-viz., payment proportioned to duties;permanence of appointment, and responsibility to professionalauthority."Mr. LIDDLE believed it was admitted universally, that so

long as medical officers were subject to the control of boardsof guardians, there was no hope of improvement in their con-*dition. They knew nothing of the labour, expense, and sacri-fices by which professional competency was attained, .andthey thought that men were sufficiently paid by the honourof being elected to the office! (A laugh.) A great numberof surgeons were elected annually, and if they ran. counter tothe guardians, by recommending more relief from the work...house than they liked, they very soon said to them, " Weknow what to do with you next year." (Hear.) In supportof the opinion that the most proper authority to which theycould be subjected was professional authority, he quoted Dr.Southwood Smith, who recommended that the inspection andsupervision which worked so well in military hospitals, shouldbe extended to union surgeons, and expressly stated that theboards of guardians were altogether incompetent-nay, thatthere were occasions when the poor-law commissionersthemselves would be in need of the advice and assistance ofa qualified superintending medical officer.Moved by Dr. SIBSON, seconded by EDw. BAINBRIDGE, Esq.,

of Tooting, and resolved,-" That the board-of health havingimposed upon the poor-law medical staff, through powersgiven in the Nuisance Removal and Diseases PreventionAct,’ new duties of a distinct kind, relating to sanitary pur-poses, without providing payment for the same, this meetingclaims protection against such exaction."Moved by EDWARD DANIELL, Esq., Newport Pagnell,

seconded by HENRY W. LIVETT, Esq., Wells, Somerset, and