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question being at Andover in Hampshire in the middleof a garden, which has been manured with the excre-

mental refuse of some twenty cottages for more than tenyears. I trouble you with this correction because I hope tobe at Andover during August and September and it will be,as it always has been, a pleasure to me to exhibit thiswell and garden to any of your readers who are interested in

questions of rural hygiene. You are quite right in sayingthat the choice of methods is largely an economical question,and I fully agree with you in thinking that no one method isuniversally applicable. We are apt to be too procrustean inthe matter and to forget that circumstances alter cases

With regard to the economical aspects of the case, may Iremind you that there are economic limits to crowding andthat locomotion in central London is pairfully slow fromthis cause. I would further remind you that the rates ofthis house have risen 87 per cent. in the last twenty-fiveyears, while the interest on money has steadily decreased;and that in your valuable report on plumbing you estimatethat it costs from .:E400 to £600 in order to make the averageLondon house fairly secure against the dangers of putrefac-tion which are going on beneath and around it. Are we not

approaching our economic limit?I am, Sirs, yours truly.

.

lYimpole-street, W., July 14th, 1896. G. V. POORE.

DINNERS FOR CONVALESCENTS.To the Editors of THE LANCET.

SIRS,-I trust you will allow me to appeal in your columnsto all who have the welfare of the deserving working menand women of this metropolis at heart for assistance in acharity which for the last fifteen years has been helpingthem at a time when sickness has so reduced their strengthas to render them, although convalescent, unfit to return tothe work by which they earn daily bread " for themselvesand their families. The number of convalescent homesis only sufficient to provide for a very small propor-tion of those thus situated, and the ConvalescentDinners Society undertakes the duty of supplementing thisdeficiency by granting to well-authenticated cases an orderfor fourteen daily dinners on a coffee tavern near to the con-valescent’s home. The application form has to be filled inand signed by a clergyman or by a recognised district visitor,and, when passed by the committee, the order for the dinnersis sent to one or other for delivery, thus guarding againstfrand and misrepresentation. The value of this charity isacknowledged by all those who work amongst the poor ; andthe working men and women who reap the benefit of it arevery grateful for the good food which enables them to returnto their work so much sooner than would otherwise be thecase. During the last nine months the Convalescent DinnersSociety has granted fourteen daily dinners to nearly 1000poor convalescents. Its funds are. however, now exhausted;and I, therefore, confidently appeal for assistance to all whocan afford to give, so that the society may be enabled to con-tinue its good and useful work.

Donations may be sent either to myself as hon. treasurer orto Miss Carbonell, hon. secretary, 114, Queen’s-gate, S.W ,or can be paid into the account of the Convalescpnt DinnersSociety at the London and County Bank, South KensingtonBranch. I have the honour to be, yours faithfully,

CHELMSFORD.Chairman, Convalescent Dinners Society.

.5, Kziar4esboro’-place, S.W , July, 1896.

THE BRITISH MEDICAL ASSOCIATION: THEANNUAL TEMPERANCE BREAKFAST.

To the Editors of THE LANCET.

SIRS,—Will you kindly allow me to announce that theusual temperance breakfast will take place on Thursdaymorning, July 30th, in the Great Central Hotel, Carlisle, ateight o’clock, when the Lord Bishop of Carlisle, a vice-presi-dent of the League, will preside, supported by Mr. MilesMacInnes, J.P., Dr. Henry Barnes, president, and othermembers of the British Medical Association. It is par-ticularly requested that members who desire to attendwill make early application for invitations to Mr. J. L. Fenn,.33, Paternoster-row, London, E.C.

I am, Sirs, yours truly,London, July 13th, 1896. ROBERT RAE, Secretary.

’THE REMUNERATION OF MEDICAL MEN."To the Editors of THE LANCET.

SIRS,-I have read with much gratification the letters of"M.D." and "M.R C.S., L.R.C.P." in THE LANCET on theabove subject. It seems a strange thing to me, consideringthe extremely congested state of our profession, that theparents and guardians of young men do not warn them

against entering upon a calling where competition is so verykeen and remuneration for the most part so dreadfully small,especially when the cost of a medical education is so heavyand the examinations are so difficult. There are men whoseeducations have cost as much as £2000 who now, since theyhave passed their final examination, are glad to accept asixpenny fee and give a bottle of medicine (?) as well.Again, why do young people choose our profession as a

means of gaining a living when they have not the slightestlove for the work and when there are other occupationswhere the expenses are less, the work easier, and paygreater. I heard a young surgeon remark the other day:" I am sorry I ever went in for this starving-out job." Ihave met many of this type. Young medical men are oftenblamed for taking miserably low fees, but what is a man todo on finding himself fully fledged, with the accompanyinghonour of course, and not a farthing in his pocket, all

having been spent in getting him into our noble profession ?He soon forgets the honour part of the business and turnsto undersell his struggling brethren as the only means ofobtaining patients and a living. He thus contrives to makea miserable livelihood until he in his turn is underbid by anew arrival who also must have bread, and so down gothe fees and down, down goes the profession, and thestruggle of the poor practitioner becomes harder andharder. In the meantime more are joining and theflow of fresh men into our ranks is for ever in-

creasing. On, on they come, without a thought, it seems,of what they are coming to. And what are our consultants,

lecturers, and examiners doing all this time ? They pockettheir big fees, lecture at the hospitals, and hold out everyinducement for men to enter the profession through theirindividual classes. They never say a word, as far as I know,about the struggle and hardship to get bread in after years.I cannot persuade myself that our great men are ignorant ofthe deplorable state of things amongst the rank and file ofthe profession. If not, what about duty to their brethrenwho are practising and to the youth who would become apractitioner ? and, more, what about the honour of the greatand noble profession ? They talk most about its dignity, butdo they attempt any reform ? and still the power is all intheir hands. I agree with 11 M.R C.S., L.R.C.P." when hesays "the numbers can be reduced by raising the standardof the entrance examination and making it competitive thatonly a fixed number of new men are admitted yearly." This,I think, would be a point in the right direction, but I wouldsay some broader and further reaching scheme is required,for, with the number of men qualifying each year in vastlyincreasing numbers, if something is not soon done the out-look for the bulk of us as well as for those who are to comeis gloomy and sad indeed. For my own part I have beenscouring England for the past twenty-one months in searchof an opening where setting up would not mean the sharpestof competition, but I have failed to find such a spot. I am,therefore, forced to be idle as I do not like the idea oftaking a part of another man’s living away from him-aliving which he has had a great struggle to get Had I notpossessed some small private means I fear ere now I wouldmyself, notwithstanding my dislike of the idea, have beenforced to join the already large army of sixpenny doctors.The pinch of poverty makes us do strange things at times.As it is I must wait, like hundreds of my brethren, " tillsomething turns up," and do my best in the meantime touphold the dignity of our noble calling. Concluding. I begforgiveness for occupying so much of your space, and as ahumble member of the profession I thank you for taking upthe subject, which so much requires discussion, for by sodoing you are conferring a benefit upon all of us and deserveour hearty support and thanks.

I remain, Sirs, yours faithfully, - ---

June 27th, 1896. ONE OF THE CROWD.

To the Editors of THE LANCET,

SIRS, - " Another M.R.C.S., L R.C.P." is hard upon" M.R.C.S., L.R.C.P." He is so angry with him that he

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cannot even understand a sentence the meaning of which isobvious, though its construction is not quite flawless. Butit is not easy to see how so much indignation is justified.Does a man act contrary to the canons either of medicalmorality or of general probity who, having (for instance) achild brought to him with practically no morbid symptombeyond a slight rise of temperature, prescribes a simplerefrigerant and requests to see the patient again next day ?At the moment he has not made, and cannot make, adiagnosis. Yet if he says ‘° I don’t know what is the matterand therefore I will do nothing," he will most probablylose his patient. Perhaps he ought, conscious of hisown rectitude, to be large-minded enough to ignore suchunpleasant consequences ; but his landlord and hisbutcher are probably men less nobly planned, who will

prefer a cheque to any moral sentiment, however exquisite,which he may be able to offer them. Sirs, I think a manmay be honest and upright without either being, or pretend-ing to be, Quixotic. As to the other proposals of which yourcorrespondent so heartily disapproves they would doubtlessprove difficnlt to realise, but do not on that account deservehis scorn. That there should be more general practitionerson the General Medical Council seems to me only just andfair, and a competitive entrance examination, while itwould relieve the overcrowding which is so crying an evil,would inflict upon the embryo doctor no hardship greaterthan that which the intending army officer and civil servanthave already to bear.-I am, Sirs, yours truly,

.............. 1T.. -n-

July 6th, 1896. NO PHARISEE.

THE BATTLE OF THE CLUBS.—XXXVII.1(FROM OUR SPECIAL COMMISSIONER.)

(Continued from p. 147.)

FRANCE :-THE MUTUALIST MOVEMENT OF 1848. - THEGENEROSITY OF THE MEDICAL PROFESSION. - THEORGANISATION OF MEDICAL UNIONS.-THE LAW ONDISPENSING.—THE STATE RECOGNITION OF A MINIMUMFEE.

To thoroughly understand the relations of medical menin France with the benefit societies it is necessary to enterinto the spirit of that great popular upheaval, the Revolutionof 1848. We must know something of the romantic schoolwhich then reached its apogee. We must appreciate the fullforce of the great wave which for a while swept over Europe.The mcvement originated in France. In its first explosion itdrove Charles X, from the throne, and in its final triumph itsubstituted the Republic for the Liberal Constitutionalism ofLouis Philippe. The workman then became the object,not merely of a widespread sympathy and commiseration,but also of exaggerated admiration and respect. He was theembodiment of all civic virtues. By giving him politicalpower, the right to vote, he would surely regenerate theworld. All classes combined to help him to raise his

position; and in this generous endeavour none were more

willing and more active than the members of the medical

1 The previous articles on this subject were published in THE LANCETon the following dates: (1) Aug. 24th, 1895, Brussels; (2) Aug. 31st,1895, Brussels; (3) Sept. 21st, 1895, Portsmouth; (4) Sept. 28th, 1895,Portsmouth; (5) Oct. 5th, 1895, Eastbourne; (6) Oct. 12th, 1895,Lincoln; (7) Oct. 26th, 1895, Lincoln; (8) Nov. 2nd, 1895, Grimsby;(9) Nov. 9th, 1895, Bexhill-on-Sea; (10) Nov. 16th, 1895, Hull; (11)Nov. 23rd, 1895, Hull; (12) Dec. 7th, 1895, York; (13) Dec. 14th, 1895,Northampton; (14) Dec. 21st, 1895, Fermanagh Medico-Ethical Asso-ciation; (15) Dec. 28th, 1895, Northampton ; (16) Jan. 4th, 1896, Bir-mingham; (17) Jan. 18th, 1896, Birmingham; (18) Jan. 25th, 1896,Club Practices in Rural and Mining Districts; (19) Feb. 1st, 1896,The Formation of a Provident Medical Association at Folkestone;(20) Feb. 8th, 1896, The Manchester Medical Guild and Medical AidAssociations; (21) Feb. 15th, 1896, The Leicester and LeicestershireProvident Dispensary; (22) Feb. 22nd, 1896, The Organisation of theProfession at Leicester ; (23) March 7th, 1896, Loughborough: LocalEfforts defeated by Consultants from Neighbouring Towns; (24)March 14th, 1896, Medical Aid Societies in Small Heath ; Medical Clubsat Stockport; (25) March 21st, 1896, General Meeting of the Professionand the Formation of a Union at Nottingham; (26) April 4th, 1896,Nottingham; the London and Manchester Industrial Assurance Com-pany, Limited; the Public-house Medical Aid Clubs ; United Action atLincoln; (27) April 11th, 1896, Leicester and Wolverhampton; a HastingsDispensary wound up; (28) April 25th, 1896, Walsall, Formation of aMedical Union; the Medical Profession and the Friendly Societies;Trade and Medicine; the Family Clubs; Women’s Public-house Clubs;(29) May 9th, 1896, Sheffield: An Ancient Medical Society; WorkmenSweaters; The Old Grievances; Probable Formation of a Medical Union;(30) May 16th, 1896, Lincoln: Medical Protection Fund started; Benefit

profession. If a workman owed his medical adviser100 francs the latter was quite willing to accept 20 francsor 25 francs in settlement of his claim. It was, indeed, thecustom to send in a bill claiming the usual fees and thenperhaps a quarter of the sum would be accepted in settlement.This system had at least the great advantage of placing theworkman under a moral obligation to his medical adviser.The workman was then able to realise the extent of thesacrifice the medical man had made so as to help him inhis poverty. At that time, however, what is known on theContinent as the mutualist movement met with generalsupport. The creation of benefit societies was advocated onall sides. It was suggested that workmen should insurethemselves against sickness by the weekly payment of a,

small sum. So much can be said in favour of this formof foresight and thrift that, as might naturally be ex-

pected, the medical profession enthusiastically supportedthe movement. It must be remembered that we are now

describing the period when the romantic school was in theascendant. Realism in literature barely existed and scienceas applied to sociology was not yet a political factor. Itwas not, therefore, to be expected that the medical professionwould be able to realise the likely consequence of their acts.Yet it was not long before medical practitioners began to.perceive that they did not, under the mutualist system,obtain more from the workmen. This would not havemattered. Medical men in all countries have been willingto attend on the deserving poor for little or no pay ; but theynaturally expect some show of gratitude, some appreciationof the sacrifices they are making. As a member of a

mutualist society the workman felt and expressed no

gratitude to his medical attendant. On the contrary, helooked upon him as his paid servant who at best only did hisduty. Yet the medical attendant received no more, as oftenas not he received even less, than the same workman hadgiven him previously to the formation of a mutualist society.Nevertheless, even this ingratitude might be endured were itnot followed by other and greater evils.The mutualist societies were at first founded exclusively

for the benefit of working men. In a little while, however,.small tradesmen, clerks, and others manifested a strong-desire to participate in the benefits of these organisa-tions. Then some workmen became rich, and in theirturn employed other workmen. The more scrupulous.among them recognised that they had no right to

participate in the benefits of institutions organised solelyfor the purpose of helping the poor. They, therefore,withdrew from the benefits ; and if, out of love for the cause,they continued to pay their subscriptions they enrolledthemselves as honorary members. Others more selfish andmore avaricious continued to pay and continued todraw the benefits. Then commercial men, small trades-men, pensioners, and persons living on small incomes

began to establish mutualist societies and insure them-selves against sickness. The philanthropic object, thedesire to help the poor, was soon merged in a selfisheffort to economise the money of the well-to-do, and this ofcourse at the expense of the medical profession. As a result,the mutualist societies have amassed a large capital, andthis in spite of the fact that the subscriptions paid by themembers is altogether insufficient. Yet there have beenno economies realised in the out-of-work allowances, thepharmaceutical expenses, and the burial expenses. The

saving has been effected on the work of the medical men.In 1881 Dr. Beraud of Charlieu wrote a report on

this subject. He then estimated that the medical officers

only received 35 centimes (3½d.) for each visit paid to

Societies and Medical Men; Medical Union at Nottingham; (31) May 30th,1896, Derby: The Abortive Movement of 1872; the Apathy of the Pro-fession : Female Canvassers; the Gainsborough Dispensary; LincolnMedical Protection Fund; "A Doctors’ Strike"; (32) June 13th, 1896,The Bitter Cry of the Medical Aid Associations ; letter from a Memberof the Manchester Executive; Lincoln: the Provident Medical Asso-ciation ; Lincoln Medical Protection Fund; Fifeshire Medical Associa-tion and Medical Aid Appointments; (33) June 20th, 1896, the GeneralMedical Council and the Medical Aid Associations; (34) June 27th,1896, Leeds : Club Patients at the Infirmary ; Failure of Former Effortsto control Club Work; Malingering; Methods of Competition; "Six-penny and Shilling Doctor!!"; " One Mark Vaccination; West Wilt-

shire and Surrounding Districts; Lincoln Medical Protection Fund;(35) July 4th, 1896, Brussels: A Twelve Months’ Strike; the MedicalMen fully Compensated out of the Strike Fund; the Labour Party andthe Medical Men; Increased Strength of the Medical Union; theDifficulties and Troubles of the Benefit Societies; Medical Aids andInsurance Canvassing; the Coventry Public Medical Service; MedicalPractice by Contract as viewed in California; (36) July llth, 1896:Lincoln Medical Protection Fund; Nottingham and District MedicalUnion.