557

Correspondence.

THE MEDICAL PROFESSION AND BOARDSOF GUARDIANS.

" Audi alteram partem."

To the Editor of THE LANCET,

SiR,-T beg to lay before you the following correspondencebetween the Weymouth Board of Guardians, the Poor-lawBoard and myself, believing it will be interesting to yourreaders. To this I have subjoined a letter to the Unionsurgeons of Great Britain calling upon them to unite with mein an endeavour to obtain a redress to our grievances.

I am, Sir, your obedient servant,Royal-terrace, Weymouth, Dec. 1, 1855. RICHARD GRIFFIN.In June last, I addressed a letter to the Weymouth Board of

Guardians and the Poor-law Board, complaining of the triflingsalary I was receiving compared to the duties I had to per-form, and praying for an increase of the former. This letterI omit sending you on account of its length, and because itssubstance is repeated in a subsequent one of three months laterdate. With the official letter, I sent the following one to thePoor-law Board.

Royal-terrace, Weymouth, June 29th, 1855.MY LORDS AND GENTLEMEN,—I beg to lay before your

Honourable Board the accompanying copy of a letter addressedby me to the Weymouth Board of Guardians, and their reply.It may be well to premise that I accepted the appointmentunder the impression that as the salary was inconsiderable,the duties to be performed would not be arduous ; and wastherefore greatly surprised at the extent to which my energieswere taxed, and my pocket likewise. I therefore consider ita duty I owe, not only to myself, but to my professionalbrethren, many of whom are overworked and wretchedly paid,and yet dare not complain, that I should bring my case beforeyour Honourable Board, and ask for your aid, with the hopethat an inquiry into the management of the medical affairs ofthis Union may be followed up by a like investigation through-out the kingdom, and ultimately lead to a proper adjustmentof the salaries, and an elevation of the Union surgeons to theirjust position. It may possibly appear to your HonourableBoard, at first sight, as well as it has to the Guardians, thatmy application, after only three months’ service, is premature;and such would be the case, were the Union only just formed,but under present circumstances, to have waited longer, would,I believe, have been attended with no different result. The

unequal division of the salary also, appears to me to demandinquiry, as nothing can justify one medical men receivingIs. 4d. per case, whilst another, under nearly if not preciselysimilar circumstances, has 10s. 3. I respectfully submit toyour Honourable Board that the salaries should be raised to afair and equitable standard, and that the extras be restored,as it is unreasonable that I should have to perform so importantan operation as amputation above the knee, without any addi-tional remuneration, or that a fraction over one half-pennya-day should be deemed sufficient pay for so formidable anoperation, with its necessary attendance, both before andafter, and that my professional brethren, four of whom assistedme at the operation, and three of them at the consultationpreviously, should go entirely unrewarded. ·

I have the honour to be, my Lords and Gentlemen,Your obedient servant,

____

RICHARD GRIFFIN.

The Guardians, in reply to the letter I have omitted, statedthey considered my application extremely premature, havingheld the appointment only three months, at the same time

acknowledging " the past quarter had been heavy, but it didnot follow that the current or future quarters would exceed theusual average ; they therefore did not see any necessity fortheir interference in the matter."The Poor-law Board replied:-

Poor-law Board, Whitehall, July 10th, 1855.SiR,—I am directed by the Poor-law Board to acknowledge

the receipt of your letter of the 29th ultimo, in reference tothe application which you have made to the Guardians of theWeymouth Union for an increase in your salary as medicalofficer of the Weymouth district.The Board desire me to state that the midwifery and

surgical fees payable under the General Consolidated order inthe Weymouth Union were commuted in 1850, and in con-

RICHARD GRIFFIN.

sideration of those fees being no longer allowed, the totalamount of the salaries of the medical officers was increasedfrom X250 to X350 per annum. The Board presume that youaccepted your office with the knowledge that your fixed annualsalary was to include your remuneration for performing suchsurgical operations as that referred to in your letter; and,under all the circumstances, the Board do not see any groundsfor directing that fees shall again be allowed on account ofsuch services. *

The Board concur with the Guardians in thinking thatalthough the number of cases attended by you during theperiod for which you have held your office may have beenunusually large, it is by no means certain that the duties havepermanently increased.The Board can only now add, that if this should be the case,

they will give the subject of your salary their future consideration.I am, Sir, your obedient servant,

CouxTr 4y, Secretary.COURTENAY, Secretary.

Weymouth, September 29th, 1855.My LORDS AND GENTLEMEN,—Three months since, I ad-

dressed a letter to your honourable Board, praying for anincrease of salary, and received a reply, dated July 10th,"6D""

-55, in which was the following paragraphThe Board concur with the guardians in thinking, that

although the number of cases attended by you, during theperiod for which you have held your office, may have been un-usually large, it is by no means certain that the duties hapermanently increased. The Board can only now add, that ifthis should be the case, they will give the subject of yoursalary their further consideration."On the faith of this letter, I have continued to carry on myduties for a second quarter, and regret to say they have beenmore onerous than heretofore, as will be seen by a reference tothe subjoined list. That they will still further increase duringthe winter half of the year I fully believe, as, during the pastsix months, we have had fine weather, and consequently onlyordinary cases of illness. My predecessor attended 642 caseslast year, and received for them 110. I have attended 252cases in the half-year, and have received only cE17 10s.;whereas, had I been paid in the same ratio, I should have re-ceived -S43 Is., or X25 11s. more than I have been paid. Hehad, on an average, 3s. 5d. per case; I have only Is. 4’d. Itwill be seen, by a reference to the books, that I return weekly,on an average, 43 cases, for which I receive 13s. 5 ½d, or 3 3/4d.each, or a half-penny per day per case for attendance, opera-tions, medicine, &c.,-a sum so grossly inadequate to theduties to be performed, that I must either give my services fornothing, or violate the trust reposed in me by neglecting thepoor-the latter an effectual method to reduce the number ofapplicants for medical relief, but one that I cannot adopt. Iaccepted the appointment under the impression that my dutieswould be no more than my predecessor’s, and that the paymentwould be in proportion to his. In this I have been mistaken,and must therefore respectfully solicit you to reconsider mysalary, which can now be done, as none of the medical contractsare signed; and even if they were, I should imagine, by givinga month’s notice, they could be readjusted. I wish not to sayaught against my colleagues, who, I believe, give entire satis-faction to the guardians and the poor, but it does appear to memost unreasonable, and which nothing can justify, now thatthe duties are ascertained, that one man should receive for 25orders a similar sum to myself who have had 252; or that asecond, whose farthest patient resides closer to his house thanmy nearest one does to mine, should be paid £5 per annummore than myself, particularly when it is considered he hashad one-fifth less cases. It may appear strange that thenumber of cases should have increased so suddenly, but thoseresiding on the spot, particularly the relieving-officer, canreadily account for it. The truth is, the poor are satisfied withthe care that is now taken of them, and therefore do not, in ageneral way, seek aid of private charity or public institutions.I trust I have said enough to satisfy you that I am not paid formy labour, and therefore hope you will direct an inquiry intothe subject, and give me a fair remuneration for my services,which, I believe, are entitled to some consideration at yourhands, as, during the half-year, in addition to my ordinaryduties, I have amputated a leg above the knee, removed a,large tumour, of seven years’ growth, from the chest of a child,and amputated a finger near the wrist-joint of a man.

I have the honour to be, my Lords and Gentlemen,Your obedient servant,

The Poor-law Board. - - -

RICHARD GRIFFIN.

558

Summary of Duties performed during the Half-year endingSeptember 29th.

12, Royal-terrace, Weymouth, Sept. 30th, 1855.GENTLEMEN,-I beg to lay before you the accompanying

copy of a letter which I forwarded yesterday to the Poor-lawBoard. They will most probably communicate with you onthe subject. Should they do so, I must respectfully solicityour aid in support of my views; and if they should not, Itrust you will give the subject your earnest consideration; and,in conclusion, beg to quote the words of Judge Willmore in arecent trial at Yeovil: "If medical officers are screwed downtoo tight, they are placed in a very painful position-eithertliey must be wanting in their dnties to the poor, or they mustbe out of pocket, and one would not like to make a man sufferfor his honesty. I am glad, therefore, for anything whichpromotes a liberal tendency in these matters."

I have the honour to be, Gentlemen, ’

Your obedient servant, The Board of Guardians.Weymouth Union. RICHARD GRIFFIN.

Poor-law Board, Whitehall, October 2nd, 1855.

SIR,,-I am directed by the Poor-law Board to acknowledgethe receipt of your letter of the 29th ultimo, and to inform youthett the statements which it contains will meet with their con-sideration.

I am, Sir, your obedient servant,____

COLJRTENAY, Secretary.

Royal-terrace, Weymouth, November 13th, 1855.My LORDS AND GENTLEMEN,-I have just received informa-

tion that the Board of Guardians of the Weymouth Union haveagain refused to augment my salary, postponing its considera-tion until next March. This of course will be officially com-municated to you. I need scarcely say the course pursued isso manifestly unjust to me, that I pray your honourable Boardwill insist upon justice being at once rendered, as you did inthe case of a medical officer in the Guildford Union a shorttime since, and for which the medical profession thanks you.I will not now go further into details, as my letters of Marchand September are before you, farther than to say my numbersof fresh orders last week were fourteen, and that in all respectsmy duties are as laborious as ever; therefore to ask me to workfour months and a half longer, when I have already earnedtwice as much as my whole year’s salary, is positively unjust.

I have the honour to be, my Lords and Gentlemen,Your obedient servant,

The Poor-law Board. _____

RICHARD GRIFFIN.

Poor-law Board, Whitehall, November 22nd, 1855.SIR,-I am directed by the Poor-law Board to acknowledge

the receipt of your letter of the 13th instant, respecting yourapplication to the Guardians of the Weymouth Union for anincrease in your salary as medical officer for the Weymouthdistrict.

I am directed to inform you that the Board have communi-cated with the Guardians on the subject, and have received aletter from them, in which they state to the effect, that, havingconsidered your application, they see no sufficient grounds forincreasing your salary at present; but that on the expirationof twelve months from the date of your appointment they willgive the subject their further consideration.Under these circumstances, and looking to the short period

for which you have been the medical officer of the Weymouthdistrict, the Board must decline to interfere further in thematter.

I am, Sir, your obedient servant,CouRTENAY, Secretary.

RICHARD GRIFFIN.

COURTENAY, Secretary.

To the Medical Officers of the Unions of Great Britain.

GENTLEMEN,-My correspondence with the Poor law Com-missioners and the Board of Guardians of the Weymouth Unionis before you. From it you will gather I have had an immenseamount of work to perform, and have been most inadequatelyremunerated. It is true the Board of Guardians have promisedto consider the question at the end of the year, but I feel con-fident they will never give a sufficient compensation. My caseis, I know, similar to a vast host of others; indeed, I may say," ab uno disce omnes." As body we are shamefully underpaid,and not treated with that consideration due to men of our edu-cation. In early life I was for three years one of the honorarysurgeons to the Norwich Court of Guardians, and, therefore,well acquainted with the medical working of the Poor Laws,and subsequently held an appointment under the present Poor-law system, and had to attend a union house four miles frommy residence, and several country parishes, the furthest onebeing nine miles off. For this I was paid after the rate of £ 50per annum, and no extras. At the end of nine months I threwup the appointment with disgust, which I am sure will notsurprise you, as the labour was immense, and the pay mostpaltry. As individuals we are powerless; collectively we maydo much. I, therefore, propose that we form a union amongstourselves, and lay our grievances before Parliament. As someone must take the initiative, I will volunteer to be your hono-rary secretary to receive communications, in order to set thething going, until a general committee can be formed, andother arrangements made. I would advise that the surgeonsof each union be called together by one of their body, and forthem to appoint a local secretary to communicate with me inthe first instance, and afterwards the general committee. Itwill be necessary that subscriptions should be made-say 2s. 6d.each,-and forwarded to me, or be retained by the local secre-taries until further steps be taken, as expenses will have to beincurred in printing, drawing up petitions, &c. In the latecase of our naval brethren, Parliament would have been inun-dated with petitions had not the naval board yielded; we mustadopt a similar plan and make ourselves heard. There are up-wards of three thousand of us, therefore let us but put forthour strength, and justice will yet be rendered us. We must

pray to be removed from the control of the guardians, who areutterly incapable of appreciating our services, and are interestedin keeping us under-paid, as most of them are large rate-payers,and request to be placed under a medical board, with medicalinspectors, and our salaries entirely paid out of the consolidatedfund. A scale of payment should be laid down by which allwould receive alike,-say five shillings for each order,-withone shilling extra for each mile the patient resides from thesurgeon’s residence, with or without extras, as may be agreedon. The amount I merely put hypothetically, in order to drawattention to it. Our salaries might be annually regulated by acalculation of the orders of the previous year, or upon an ave-rage of years, as is the case with the clergyman under theTithe Commutation Act; this would meet a varying population.Vaccination should be placed under the same board, and eachcase treated as an ordinary order. Regulations should also beframed as to whom are entitled to medical relief. I must ownI am inclined to great liberality under this head, as it is desi-rable that every facility should be given to the poor, who arenot actually paupers, obtaining medical assistance.Many other suggestions will no doubt arise which can be

considered in committee.I have the honour to be, gentlemen,

Your most obedient servant,RICHARD GRIFFIN.

TREATMENT OF MENORRHAGIA BY OXIDEOF SILVER.

To the Editor of THE LANCET.

SIR,—Although I have long ceased to be a physician-ac-coucheur, and have occupied myself in the less laborious andless anxious avocations of medicine in general, I cannot resistthe inclination to publish in your journal, from which I havederived from time to time much instruction, a case of curethrough the agency of that invaluable preparation the oxide ofsilver, which I myself introduced to the profession in 1845, *"

and have prescribed more frequently than any other Englishmedical practitioner in cases of long persisting haemorrhage,diarrhoea, dyspepsia, &c., and in which my confidence (during

* Practical Remarks on some Exhausting Diseases. Seond Edition.Churchill, 1845.