740

THE

ORGANISATION OF THE PROFESSION.

(FROM OUR SPECIAL COMMISSIONER.)(Continued from p. 666.)

Origin and Formation of the County of Durham MedicalUnion.—Strikes Hastily Organised and InsufficientlySupported.—Partial Successes and Partial Failure.—Extensive Importation of Outside Practitioners.—TheGradual Strengthening of the Medical Union.—Dissatis-faction with the Imported Opponents and Return of theMiners to their Former Medical Advisers.

THE first step taken towards the foundation of a medicaunion is always a matter of considerable practical interestThere are many medical practitioners scattered about thEcountry who feel the necessity of organisation but do n01know how to set to work so as to create a medical union. An3information as to the means which can be adopted for thhpurpose must therefore be of use. Sometimes it is felt thaino one in the neighbourhood holds a sufficiently prominentposition to be justified in assuming the leadership. In thaicase it is well if some old-established medical society can takethe initiative; but it sometimes occurs that there is no suchsociety available or that it is not disposed to move in thematter. More especially is this the case where the populartion is widely scattered, as in mining districts. Also theposition and material circumstances of the colliery surgeondo not lend themselves to the participation of this section ofthe profession in the social gatherings and scientific discussionsheld by the old-established medical societies that exist invarious parts of the country and which have their head-quarters in the larger towns. The sense of isolation is certainlya strong deterrent to all forms of organisation and constitutesa serious obstacle to the formation of strong and well-disciplined unions among the rural practitioners and thecolliery surgeons. These difficulties were undoubtedly pre-sent in the minds of the three practitioners who met togetherin the month of October, 1898, and resolved to makesome effort to unite in one association all their colleaguespractising in the county of Durham. For the momentit would be more prudent, I am told, not tomention the names of these three bold pioneers.Their names may be handed down to fame when theacuteness of the present struggle has worn itselfaway. For the present it will suffice to say that they allthree practise in the north-east corner of the county, thatthey felt they had not sufficient personal influence to movethe profession at large, and they very modestly entertaineddoubts as to their organising capacity. Nevertheless, theydetermined to make an effort and hit upon the very in-genious idea of asking a firm of solicitors to help them.They therefore requested Messrs. Graham and Shepherd, soli-citors at Sunderland, to send out circulars to all the medicalmen practising in the county, urging the necessity of form-ing a medical union. Including in this appeal the town aswell as the rural practitioners, this meant the distributionof more than 400 circulars. The fact that this was done bya firm of solicitors helped to inspire confidence. It couldnot be said that some particular medical man was seeking topush himself forward, assuming a leadership to which he badnot been appointed. The fear also of blunders, of legal errors,was in a measure dispelled by the fact that a business-likefirm of solicitors were engaged in the work. The formationof an association is, indeed, a very delicate matter. Hereare, for instance, some 400 practitioners; if a few amongthem, six, or even a dozen, medical men, had formed anucleus there might be ever so many personal objections tosome or all these men. It is true that self-appointed com- ’,mittees, secretaries, or presidents only hold these positionspro tem., and the society when definitely organised may electother officials. In practice, however, this rarely occurs. Itis generally felt, and rightly so, that those who have takenthe first steps and done much arduous and unrequited workdeserve to be elected as the permanent officials Thus a

personal impress is given to the society at its very birth;and if these personalities are not universally popularthis is a source of weakness. Rather than go and vote

against the felf-appointed committee or secretary, and thusappear to be ungrateful, men who might have been goodmembers stop away altogether. In this case, however, therewas no secretary, no committee, no president, only a firmof solicitors who could not be looked upon us rivals by any

of the medical men to whom they addressed the circularsThus, the personal rivalries, jealousies, and enmities whichat the very onset constitute a formidable obstacle to thework of organisation were avoided. Oonsequently no lessthan half the practitioners who received this first circular

replied in a sympathetic manner.Encouraged by such widespread support Messrs. Graham

and Shepherd sent out another batch of 400 circulars,inviting all the members of the medical profession to meetat the Freemasons’ Hall in Durham on Dec. 8th, 1898,and there to discuss the advisability of forming a union. 51practitioners were present and as everyone had been invitedthe meeting was sufficiently representative to take action.The proposal to form a union was adopted and Dr.Edward Jepson of Durham was elected its president. Thena council of 12 members was also appointed and the servicesof Messrs. Graham and Shepherd were retained as secre-

taries. The council was not only instructed to preparea set of rules but was authorised to adopt them without.convoking another general meeting- This work of organisa-tion was rapidly carried out and terminated at a meeting ofthe council held on Jan. 10th, 1899, and from that date itmay be said that the County of Durham Medical Union wasdefinitely constituted. There was not much time lost before-a move was made. Hardly was the medical union fairlyin existence than a deputation was appointed to waiton the miners’ leaders. The deputation consisted of’Dr. Edward Jepson, President; Dr. J. F. Armstrong, Vice-President, from South Shields; Dr. C. F. G. Mann, fromWashington ; and Dr. J. Murphy from Sunderland. Theywere received at the Miners’ Hall, Durham, by Mr. JohnWilson, M.P., Mr. Johnson, the miners’ financial secretary;Mr. Henry Cann, their treasurer; and others. Represen-tations were made showing that 6d. per fortnight formedical attendance upon an entire family was insufficient.This sum was fixed some 50 to 60 years ago when the cost ofliving was much higher and the pay received by the minerswas very inferior to what they are now earning. Underthe present altered and more favourable circumstances theminers could well afford to pay 9d. per fortnight. On theother hand, the cost of medical education, of drags, and ofsurgical instruments had greatly increased. The miners’

representatives did not attempt to controvert any one ofthese statements. They simply explained that they had nopower to deal with the matter. The miners were free tomake whatever arrangement suited them best for medicalattendance. Such questions should be negotiated with themen themselves or with whatever local organisation theymight have established for the purpose of securing medicalaid.

Thereupon the medical union at once prepared a letterwhich was forwarded on Jan. 26th, 1899, to every miners’lodge or organisation throughout the county, numbering inall 181. The letter inclosed a printed report of the meetingheld by the members of the medical profession at which thequestion of raising the fortnightly subscription from 6d. to8<. had been discussed and asked that the matter should belaid before the members of these organisations. If therewere any objections the medical union would arrange for adeputation to meet the subscribers and discuss the matteramicably. This circular had been sent everywhere and notmerely to those districts where the medical men had joinedjhe medical union.On March 2nd, 1899, the council of the County of Durham

Medical Union met to discuss the answers received. Fromihe 181 lodges, &c., only 42 replies had been received.rhe great majority evidently refused even to consider,he proposal. Some desired to discuss with a deputation,LS had been suggested; only a few accepted and under-took henceforth to pay 9d. instead of 6d. per fortnight. Itvas thus early rendered evident that the position of the)rofession was not to be improved, at least on a large scale,vithout a struggle, and perhaps a severe struggle. Conse-luently there would be victims, and therefore the first stepvas to make good provision so as to come to their assist-,nce. A general meeting was convoked in Durham on

garch 7th, 1899, and it was then resolved to establish whatvas called an Indemnity Fund. So as to start this fund twonedical men each subscribed .610 10s. Five others gave5 5a. each. 14 practitioners promised to give 10s. weeklynd seven put themselves down for 5s. per week. A circulariving these results was issued and it brought further sub-criptions. It was decided that this fund should be adminis-sred by the President and the Vice-President only, so as tovoid unnecessary publicity. Members who were in need

741

- of such assistance were requested to apply to the dsecretaries and to show their books establishing the loss s4

they had experienced to the solicitors. They were n

.assured that they would then receive every help, financial h-and otherwise. Those members who had obtained the n

increased rate of payment through the efforts of the union i)were urged to subscribe liberally; at the same time they a

were informed that they would not be called upon to fulfil 11their promises unless the money was really needed. This a

’fund had barely been constituted when two practitioners had c

to be indemnified. In answer to their demand for the 9<?. n

the miners had imported a medical practitioner who at first Jdid all the work, and the two old-established practitioners v

found themselves without patients and without income. t

’Fortunately, these imported practitioners rarely give satis- a

faction, and the miners gradually, one by one, came back to itheir old practitioners, so that the two practitioners who tat first received financial assistance have now no longer any 1need for help from the indemnity fund. <

Unfortunately, all the colliery surgeons had not thecourage to hold out. Indeed, and as often happens (

&deg;in such cases, it was some of those who had been 1the loudest in clamouring for immediate action and in i

proposing a general strike who were the first to give <

way. They seemed to think that such contests are won by amere words and that the miners would yield at once. 1

’But the miners felt that if the medical men’s cause was <

really a good cause it was worth fighting for, and if the 1medical men had so little faith in their own claims as not 1to fight for them then the miners need not trouble to make,financial sacrifices on behalf of such milk-and-water indi- 1viduals. The fact that there were a considerable number of iweek-kneed practitioners who mildly submitted to the refusal 4

made by the miners rendered the struggle all the harder for 1those who had the courage to hold out. At FramwellgateMoor, at South Moor, and at Craghead, the colliery surgeons Iheld out well. Opponents were imported, the colliery surgeons 1lost their patients, but still they persisted and the patients Islowly returned to them. At the onset only a few medicalmen stuck to their point. There was no general battle but 1scattered skirmishes occurred, and when one colliery surgeonhad won the day then some others in the neighbourhood would ’pluck up courage and enter the lists. Whenever the minersadvertised for an outside practitioner to come and to establishhimself in their district the County of Durham Medical’Union immediately published counter advertisements in thesame papers urging no medical man to accept these offerswithout first communicating with the secretaries of the I

medical union. This led to a great mass of correspondence ;but, to the credit of the profession be it said, not a singleone of the correspondents accepted the offers made by the Iminers after they had been informed of the true state ofaffairs. Thus the offers were only taken up by a class

I

-of men who find it difficult to get employment otherwise.That there is such a class is a fact that cannot now bedenied and it is an important fact which must be dealt with.’In the county of Durham alone some 20 such men have beenimported.The first annual meeting of the County of Durham Medical i

Union was held on June 6th, 1899, some six months after thedefinite creation of the union. It was then shown that214 medical practitioners had adhered to the principles ofthe union and that 201 had paid their subscriptions asmembers of that organisation. As there are, in all, about430 practitioners in the country, and as the union had not yetdealt with the interests of the town practitioners, this totalof membership cannot be considered otherwise than satis-

factory, at least for a beginning. The objects of the unionare wide and far reaching, but so far the union has onlyattended to the one question of raising the subscriptionfor contract work for the colliers. Unlike the North-,umberland and Newcastle Medical Association, which isworked on the principle of centralisation, the rulesof the county of Durham Medical Union admit theformation of district committees. It is true that themembers of these local associations are to pay their annualsubscription to the central body, but they are to be allowedby the general council any reasonable expenses incurred incarrying out the work of local organisation. At the firstannual meeting it was stated that 10 such local committeeshad been formed and that the South Shields Medical Associa-tion had been affiliated to the County of Durham MedicalUnion. It was also reported that the colliery surgeons ineight districts had from the very first adhered to their notices

demanding the increase. Strangers had been imported inseven out of these eight districts. At Southmoor five medicalmen had been imported, but only one remained; the othershad left after a few weeks’ experience of the unpleasant-ness of their situation. In the Stanley district theinaction of the majority of the local practitioners was

a great source of weakness. Mr. Ingram-Johnson andMr. S. J. Fox alone refused to accept less than the 9d.,and they had to contend, not only against the importationof eight outsiders, but also against their colleagues andneighbours who were too timid to persist in the demand.At Washington also some of the local practitioners gaveway, but Dr. Mann and Dr. W. Jacques held out manfully,though an opponent was imported to compete against themand is still in the district. Little by little the miners haveindividually returned to these practitioners and consentedto give the 9d., so that these two surgeons have now gainedback their former position, and in the course of time it willdoubtless be considerably improved.

On Jan. 24th, 1900, a large general meeting of the Countyof Durham Medical Union was held. The union had thenbeen in existence a full year, but complaints were stillmade of want of courage. The local committees were indread of the family clubs organised by private practitionersand which could not be controlled. The report suggestedthat a minimum fee should be established for such clubs.

: On the other hand, the members present were cheered by: the announcement that at Monkwearmouth 1400 miners; were now paying the 9d. Five more collieries had been: notified and four had got one practitioner from outside whom, they shared between them, but he did very little harm. The! Stanley district was again warned. Two practitioners hadl each received 950 from the indemnity fund, but there had

been no other calls for such assistance. The employment ofan unqualified assistant had been discovered by the council

I of the union and he had been denounced and had now leftI the county. It was urged that all members of the unionI should set a good example in this respect and not employl unqualified assistants. Canvassing which had beenj practised at Auckland was reported to the Generall Medical Council, but this body asked for affidavits whichl were difficult to procure. As the expenses had been veryI heavy it was found necessary to increase temporarily thel annual subscription from half-a-guinea to one guinea. Dr.l Alfred Cox of Gateshead gave a report in regard to a con-I ference held at Newcastle during the previous month of; November on the question of direct representation on theI General Medical Council, with the result that the meetingj passed the following motion :-I That this meeting is of opinion that the medical profession is notI sufficiently or properly represented on the General Medical Counciland it is strongly recommended that all representatives from univer-;

sities and corporations be elected by the individual votes of medicalgraduates of each university and members of such corporations.

! During the ensuing month of March a circular was sent to. all the practitioners of the county urging those who weret not already enrolled to join the union and pointing out

that at least 100 members had already had their incomesl substantially increased by the efforts of that organisation.But it was necessary to deal, not merely with the contractt work of the colliery surgeons, but also with family clubs,E friendly societies, yearly boxes, midwifery fees, certificates,> &c. In several places these questions had been taken int hand and with success. Soon after this, in June, 1900, thet second annual meeting was held, when it was reported that1 success had been achieved in some more collieries, but thatthere was a prolonged struggle at Bishop Auckland and that1 the state ot affairs in the Stanley district was still veryydeplorable. The imported practitioners had now departed1 from the Craghead district. At the Wardly Colliery district- it had been difficult to get the colliery surgeons to act

s together. One of them was not a member of the union ;s nevertheless, the demand for the increase had been madee and in reply a somewhat inoffensive opponent had beene imported. In another district an imported practitioner had.1 been compelled to appear before the General Medicald Council to answer the charge of employing an unqualifiedn assistant. Some districts still refused to give the increase;t and a few practitioners had suffered substantial loss. At

s Sunderland, South Shields, and Stockton the friendly- societies had been approached with a view of improvingd the position of their medical officers.n All last year the work of organisation was continued ands actively pressed forward. Throughout the President of

742

the union, Dr. Jepson, had been indefatigable, travellinglong distances to interview recalcitrant practitioners, tattend local committees, or to address meetings of medicamen so as to explain the action and policy of the unionThen there had been all manner of efforts made to get ricof the imported practitioners, and they, too, had beerinterviewed and many letters had been written to themOf course, they were boycotted and none of the members ojthe union would meet them in consultation. Even thE

practitioners who were not members of the union joined inthis boycott. If a second opinion was desired the importedpractitioner must retire from the case. When the lastannual meeting was held-and it took place on Feb. 5th,1901-still further progress was reported. During the course ofthe year that had elapsed a considerable amount of importantwork had been done. In various districts, which at firsthad not joined in the movement, the members of the unionwere pressing for the increase and had met with at leastpartial success. It was strongly felt that the demand forthe increase must be made at once while the high rate ofwages still prevailed. There were very emphatic indicationsthat the present state of prosperity would not last, and itwould be very difficult for the colliery surgeons to obtain arise in the face of a downward tendency in wages. AtHetton the local practitioners had been induced by the unionto stand out for the increase and they had been entirelysuccessful. Similar applications were made in the adjoiningdistricts of Seaham and Silksworth, but one of the localpractitioners hesitated to press forward his claim and preferredto renew his application at a later period. At Silksworth thecolliery surgeon held out, and the colliery manager, actingin consequence of a notice he had received from the miners,determined that he would not retain any sum from theirwages for medical purposes. The miners here threatened toform a medical aid association, but the local practitionerswere striving to meet this by persuading individual miners tosign an agreement to pay the 9d. and arranging to have thissum collected independently of the colliery office. This hadbeen so successful that out of 830 houses the inhabitants of710 houses had accepted the proposal and were now payingthe 9d. to a collector. It was suggested that this method ofproceeding might with advantage be more generally intro-duced in other districts. At Crook strenuous efforts hadbeen made to persuade an imported practitioner to leave, andthough this was not achieved he was induced to raise hischarge from 8d. to 9d. per fortnight, and therefore themembers of the union were now competing with him on equalterms. Perhaps, however, the greatest event recorded wasthat the practitioners in the Stanley district had at last beenbrought into line. They had once again plucked up courage,made their demand, and this time stuck to it. The result was acomplete success. A few malcontents were striving to get apractitioner to come to the district and to practise at theold rate of payment, and went about canvassing to secureadherents. Thereupon Messrs. Graham and Shepherd wroteand threatened them with legal proceedings, and thishad somewhat damped their ardour. They had almostsecured the services of an outside practitioner; but whenthe latter found that there was a chance of his being broughtup before the General Medical Council for being in theservice of an organisation that practised canvassing he

promptly disclaimed any connexion with the concern. Themembers of the medical union who resided in the town ofSunderland, but who attended to patients who worked inneighbouring collieries, had also secured the 9d. and were nowpressing similar claims on the friendly societies establishedin the town. In this latter direction some improvements hadalready been effected. The report presented at the thirdannual meeting then went on to say :-Our members will no doubt have noticed that attempts to form

medical aid associations are in progress all over the country. This is aquestion that the General Medical Council ought to take up. Theyhave already expressed disapproval of practitioners canvassing forpatients and it is felt that they ought also to condemn and declare thatit is infamous conduct in a professional respect for any registered prac-titioner to become the paid servant of any medical association formedand carried on by working men. The council intend, when sufficient ’’

evidence is obtained, to lay the facts before the General MedicalCouncil and press them to take the matter into their consideration.

Such are the most salient facts connected with the historyand development of the County of Durham Medical Union.Like all other movements, this union has had to learn

by experience and has blundered from want of experience.There were at first over-confidence and a tendency to makeefforts without due preparation and consequently they were

not efficiently and strenuously sustained. The miners, on.

their side, complained that the medical men were lacking intact in the way in which they opened negotiations. Somepractitioners had a tendency to lay down the law and assumeda tone that unfavourably impressed. the miners. After all,there were two sides to a bargain, and when some collierysurgeons declared that henceforth they were not goingto do this or that, as if the decision rested entirelywith them, the miners took the other view and thoughtthat they also had a voice in the matter; and as

there seemed to be no disposition to consult them theydetermined to act independently and to import medicalmen who would accept without question their terms. Thisfeeling and attitude were not general, but they existed insome localities ; and there could be no doubt but thatsome colliery surgeons were lacking in tact. They seemed tohave forgotten that the miners, by the strength and dis-cipline of their trade unions, had compelled the collieryowners to treat them on a footing of equality, and theyexpected to be treated by the medical men, whom they paid,with at least as much deference as was shown to them bythe colliery owners from whom they derived their wages.But apart from this somewhat sentimental aspect of thequestion there was the material grievance that the minersdid not get proper medical advice. Anybody seemed goodenough to attend a miner when he was ill. Any unqualifiedassistant was sent to see the patient. Hardly any minersreally object to pay the 9d. per fortnight or think thesum too large if they obtain in exchange careful treatmentfrom a fully qualified practitioner, but they object to paythis sum if they are to be attended only by an unqualifiedassistant, and such unqualified assistants still exist in thecounty of Durham.

It will be seen from the above that the County ofDurham Medical Union is quite in agreement with the minerson that question and that active measures have been taken toget rid of all the unqualified assistants. Under all thesecircumstances, and when time has rubbed off a few roughcorners, there is every hope that both sides will come toterms amicably. The leaders of the miners-and I have

lengthily discussed the matter with them-are really anxiousto be on the best of terms with the members of the medicalprofession. There are’mutual interests that should unitethem. The Miners’ Union give sick allowance to theirmembers during illness, and it is therefore to their interestthat malingering should be prevented and that the sick shouldbe cured and return to work as soon as possible. On theother hand, the medical practitioners, if they do their bestto insure these results, have the right to claim to be re-munerated sufficiently. Thus with the abolition of the un-qualified assistant, with a greater show of deference on eachside, with a better understanding of each other’s interests,peace may ultimately be brought about and the remainingcontentions set at rest.Durham, Feb. 25th.

NOTES FROM INDIA.(FROM OUR SPECIAL CORRESPONDENT.)

The Plague Epidemic.&mdash;The Famine Fund.&mdash;Hospital Shipfor China.&mdash;The Queen Victoria Indian Memorial.

THE mortality from plague proceeds apace-declining insome places while it is rapidly rising in others. For thewhole of India there were 3415 deaths last week, as against3396 in the previous week and 1869 in the correspondingweek last year. The chief increase has occurred in Bombaycity, where the general mortality has risen to 1941, including786 deaths from plague. This is a rise in one week of 320plague deaths and of 522 in the general mortality. When itis mentioned that the normal mortality should not exceed,say, 500, the disastrous nature of the outbreak will beunderstood. This fifth outbreak looks as unfavourable asany that has preceded it. By comparison with previouscharts it can be seen that the rising death-rate is proceedingon exactly parallel lines and indicates that there willbe a still higher mortality for several weeks to come. In

Bengal the total number of plague deaths has not increased,only 2129 deaths having occurred as compared with 2261during the preceding week. Patna reports 1212 deaths,Saran 514, Mongbyr 245, Gya 36, and Calcutta 71. Theoutbreak in Calcutta is developing, more cases having