- Email: [email protected]
REPORT OF THE COUNCIL OF THE BRITISH MEDICAL ASSOCIATION ON THE PRESENT STATE OF THE POOR-LAW QUESTION,
750
colour, owing, evidently, to the presence of tity of oil is observed, on which, it would a vegetable powder, as was proved by seem, all their powers depend. The exterseparating and examining it with a mi- nal application upon a blistered surface Morenheim likewise gives us causes a discharge of a puriform character, croscope. the case of a female, thirty years of age, and it is therefore advantageous as a coun. who, determined to produce miscarriage, ter-irritant. took a strong infusion, which brought on a constant and fearful
vomiting. After a few days she suffered from the most excruciating REPORT OF THE COUNCIL pain; abortion took place, with a terrific OF THE died. from the womb: she haemorrhage Upon examination, a rupture of the gall- BRITISH MEDICAL ASSOCIATION ON THE bladder, with effusion of bile in the abdomen, was visible, together with inflamma- PRESENT STATE OF THE POOR-LAW
tion of the intestines. It would appear that QUESTION, where there is a tendency to miscarriage, AND ON THE STEPS WHICH THEY HAVE TAKEN where violent vomiting occura, that this IN CONDUCTING THE RECENT PARLIAMENTARY effect is produced by savin, but that it is by INQUIRY INTO THE EVILS OF THE SYSTEM. no means certain. Of the quantity that may be taken without producing miscarthe Poor-Law Amendment Act re, riage, Fodere, in the " Medecine Legale," WHEN has furnished us with a very striking in- ceived the sanction of the Legislature, and stance :-A female took every day, for 20 its provisions began to be acted upon, it days, no less than a hundred drops of the was evident that the extensive powers vest. oil, yet carried her child to the full time. ed in the authorities constituted under it, A female also took, without her being aware would very materially affect the interests, re. of it, a large quantity of the powder; she spectability, and independence of the medical suffered from nausea, singultus, vomiting, profession. The fearful experiment was tried heat in the abdominal region, and fever, of entrusting the appointment and dismissal which lasted during afortuight; these symp- of medical officers, and the arrangement of toms, however, did not prevent her delivery medical duties, to non-professional Boards, at the natural time. The Medical Faculty whether of Guardians or Commissioners,and at Leipsic pronounced it highly dangeruus, it was followed by the consequences which whilst, on the other hand, Wedelius, who might naturally have been expected. Howhas written on the properties of the savin, ever anxious these authorities might be to Haller, and Ray, have all considered it. discharge the duties which devolved upon harmless. In the time of Galen, this pro- them, in connection with the due administraperty of producing abortion was a popular tion of parochial medical relief, it was imopinion. That it produces a greater inten- possible that they could be competent judges sity of colour of the blood has long been of the nature and importance of these duobserved, and that it will produce haemor- ties,-of the qualifications of the medical rhage, but that these take pl.ace without an oilicers,-or of the remuneration which ought action upon the bowels is strongly denied. to be awarded for their laborious and arduHow far these two effects may be dependent ous services. The Poor-Law functionaries were utifortu. on each other it is not for me to say ; but much of the emmenagogue power is depen- nately armed with new and extensive powdent upon purgation, I believe. Home’s ers, from which the medical profession had clinical experiments show, that a scruple of no appeal, and which they could not at first the dried leaves taken twice a day will, successfully oppose, at the same time that a where the circulation is languid, excite it niggardly economy was recommended and into action, produce the obstructed excre- enforced in all the appointments. Without tion, and, if taken in the intervals, it has sufficient knowledge of the extent of duty the power of preventing a recurrence of in- required, without sufficient data from which terruption. It sometimes excites lmmor- to calculate and fix the remuneration, it is rhage from other tissues, and Haller gives not surprising that under such a system us a striking examp4e of haemoptysis, in a (which, however, it is fair to confess was young girl, arising from this’cause, simul- parity an experiment) the interests of the taneously with the excretion from the ute- poor and of the medical profession mate, rine system. The shrub from which the rially suffered. With a view to economy, large unions and leaves are obtained is a handsome dark evergreen, a native of the south of Europe medical districts were in general formed, and the Levant. The leaves are very small, which doubly affected the poor, by lessenof a bright green colour; these, together ing the number of their medical attendants with the tops, have a foetid and disagreeable and placing them often beyond their reach; odour; they yield up the whole of their while the salaries offered to the medical virtues to rectified spirit, and part to water; officers were miserably insufficient to enable and on distillation with water a large quan- them to do justice to themselves,and tosup-
751
ply adequate medical assistance and efficient t For
,
Per annum.
".
"
an individual maintaining himremedies to those placed under their care. self or herself (1 person) 3s. If the practitioners of a parish or union could not accept the terms offered to them, For a man and his wife (2 persons).. 4s. and remonstrated as to the amount of remu-For each child in a family, 6d. (say ........
neration, young
men
were
sent from the
public hospitals, or advertisements were immediately published inviting candidates from
a
distance to undertake the duties.
The system of medical contracts by tender.thus introduced, operated grievously on the interests and respectability of medi-
cal men, while it could be
4
persons)
....................
in the
And for every person family above the age of 2
persons)
2s.
same
16, 2s. (say
....................
4s.
13s.
.
Is Sd. " persons,-average, ’.. Such was the scale of remuneration arbitrarily fixed by one of the Assistant PoorLaw Commissioners, without any adequate knowledge of so important a subject, and offered to, if not forced upon, gentlemen of education and extensive acquirements, for medical attendance, medicines, and advice, one year,-not to paupers, be it observbut to the independent labourer, the domestic servant, and the mechanic and autizan. n the profession Pel haps it was well ,,’ that the system was carried so far beyond the point of endurance, otherwise the 9
,
no test of their and moral fitness for their oflicial duties. Thus a powerful engine was employed to lower the independence of the profession, and to force them to accept the terms arbitrarily fixed by the Guardians or Commissioners. Few could afford to see their practice interfered with by strangers, and the existence of themselves and their families placed in jeopardy; the Commissioners were omnipotent in London, but appeal to them was vain ; the Guardians equally powerful in their own localities, to offend whom might be to hazard half vions evils might have been silentlyinflicted Is it, therefore, their private to be wondered at that medical men, placed under such novel and embarrassing circumstances, should have frequently sacrificed their feelings and sense of independence to strances arose in all quarters against them, the dearer interests of their families ? but in vain,—no redress followed these There remained but another scheme to be founded complaints. In the meantime the set in motion, which, had it succeeded ac- profession were not idle. The Provincial cording to the wishes of its promoters, would Medical Association appointed a Committee have entirely blasted the prospects of the in 1836 to collect facts and to report upon humbler practitioner,-this was the intro- them at the following annual meeting. duction of the 11 Poor-Law Medical Clubs." At last the mischief reached the Hitherto the Poor-Law Commissioners, in polis, and in unison with the Poor-Law theirmedical arrangements, had only contem- medical arrangements, attempts were made plated the objects undertheir own authority, in Southwark and in Camberwell to estaviz. paupers, but, as if to complete the de- blish " Medical Clubs " upon the same gradation of the profession which had been terms, or nearly so, as those which have been previously begun, the plans and remunera- recited above ; but here a firm stand was tion which were disgraceful when even -tp- made against further encroachments. By piied to paupers, were to be extended to the prompt and zealous assistance of the inall the classes included between them and dependent medical press, the profession the middle ranks of society. Mechanics ! were roused to activit3, and became fully artizans ! handicraftsmen! domestic ser- alive to the dangers which threatened them. vants! and independent labourers, were in- The medical practitioners of the Borough vited, entreated, and almost compelled (for and of Camberwell met in large numbers, the wishes of the rich and powerful are too and after discussing the merits of the Poorfrequently laws to the poor) to join the Poor- Law Clubs, with their promoters, for seve. Law, or, as they were named, the " Indepen- ral nights successively, in each place, sigdent Medical Clubs." And what were the nally defeated the attempts to introduce terms which were offered to the medical them. It now became apparent, unless the promen, on the strength of which the Poor-Law authorities considered themselves entitled to fession resolved passively to submit to the interfere between them and their private pa- ruin and degradation which threatened them, tients-the poorer but most numerous classes that nothing but union and organisation, and of society in this country ? That they may taking their affairs into their own hands, rest on good authority they are taken from could possibly save them, as the Colleges the Poor-Law Report of 1836, and from a and Corporations, with their usual apathy parliamentary paper, and are as follows, and indifference, had paid little or no attention to their complaints and applications. viz.:—
qualifications
for ed,
’
"
for
were
practice.
pre-
andpatientlyborne. As the plans and ties became known the Poor-Law authoritice became put into prachnown and were tice iu ecountry,
pro esand remonwell-
Metro-
752 it was resolved that an Asso. 3rd. The incompetency of noil-profes. ciation should be formed upon principles sional persons to judge of professional conaltogether different from those of any society duct, whether for or against, or to fix the which already existed ; that it should not districts and professional remuneration. assume a scientific character, but should 4th. The practice of introducing strang. watch over and protect the interests and ers (often young and inexperienced men) respectability of the profession ; cultivate when the respectable and long-established feelings of amity among its members; form resident practitioners could not consciena benevolent fund ; promote salutary reforms tiously accede to the terms of the Guardians in the Colleges and Corporations ; and resist or Poor-Law Commissioners. injuries and abuses, from whatever quarter 5th. The want of uniformity in the medi. they might arise, to the utmost of their cal arrangements, or of any general plan in remunerating medical officers, some being power. It is unnecessary to trace step by step the paid by salary, some by the per-case system, foundation of the British Medical Associa- and others by the medical club system. 6th. The interference of the Poor-Law tion, and its progress onwards to its present authorities with the practice of medical men Suffice and influential prosperous position. it to state that after the Association was by introducing " Independent Medical fairly established, the Poor-Law question Clubs" for those who were not paupers, such engaged the earliest and most anxious at- as domestic servants, mechanics, artizans, tention of the Council. A Committee of the and others, aud fixing a scale of remuneraCouncil was appointed early in 1837 to in- tion which could not be just to the patients quire into the nature and extent of the evils or to the attendants. II. The evils which affected the poor complained of, and to consider of some plan for their removal, and for the general im- were :1st. The great extent of the medical disprovement of the whole system of parochial medical attendance. tricts, rendering it absolutely impossible This Committee examined the facts and that the poor could be efficiently attended. 2nd. The diminished number of medical evidence that had been laid before the profession and the public in the Poor-Law officers (being about half of those employed Reports, which were politely forwarded to under the whole system, bad as it was), and the Association by the Secretary, Mr. Chad- their increased distance from many of their wick,-in the various pamphlets and jour- patients. 3rd. The difficulty of obtaining orders for nals, and in the Report of the Provincial Medical Association ; they corresponded relief, the paupers frequently residing at a with their own members, and with indivi- distance from the relieving officers, andthere duals in various parts of the country, and being an increased reluctance to grant orders, inserted advertisements in the medical jour- especially when the remuneration was by nals, requesting that their medical brethren the per-case system. 4th. The appointment, in many cases, of would furnish them with any information in their power. It is a fact worthy of notice young and inexperienced, or even of unquathat but a scanty portion of information was lified medical men to the highly responsible supplied by country medical practitioners, office of attendants on the poor. 5th. The total want of medical superviwho being the first to feel the effects of the new system, had been the loudest in their sion and inspection, and consequently of complaints ; many of them evidently had responsibility. (ith. The absence of any provision for the fear of the Poor-Law authorities and of the Guardians before their eyes ; but much consultations in cases of great danger and valuable information was derived from other ditliculty, or in those requiring capital opesources, which enabled the Committee to rations. 7th. The inadequacy of remuneration to furnish two interesting reports to the Council within short periods. The first report the medical officers, by which a strong temp. fully bore out the charges brought against tation is held out to neglect their patients, the system of Poor-Law medical attendance, to supply cheap and inefficient remedies, and and showed that two classes of evils had to trust the lives of the poor to apprentices thence resulted, which, though very inti- and unqualified assistants. Such were some of the most prominent timately connected, might properly be divided into two heads :evils which presented themselves in consithe subject ; and that nothing might I. Those affecting the profession ; and be left undone by the Council in their endeaII. Those affecting the poor. vours to remove them, it was resolved that I. Under the first head the chief evils a communication should be opened with the were as follow :Provincial Medical Association, and espe1st. The very inadequate rate of remune- cially with the Poor-Law Committee; that, if possible, the efforts of the two Associaration, generally speaking. 2nd. The prevalence ot the degrading sys- tions should be joined in this laudable work. teiii of « tender." Accordingly, several members of the Conn-
Accordingly
during
753
cil having intimated then intention of being establishment of Medical Clubs ; the selecat Cheltenham during the anniversary meet- tion, in many cases, of young and inexperi-
ing of the Association there,
in
July, 1837,
Dr. Marshall Hall and Dr. Webster were deputed to represent the Council, and to take such steps as might appear to them neThese gentlemen cessary and expedient. were very courteously welcomed by Dr. Boisragon, the President, by Dr. Hastings, the Secretary, and other members of the Provincial Council, and as Dr. Webster’s sole object was the consideration of the Poor-Law question, he was introduced to Mr. Rumsey, the Secretary, and to the nrembers of the Poor-Law Committee, who imInediately invited him to join them, and take all active part in their proceedings. This he
practitioners, &:c.&c. That your petitioners are fully that the above-mentioned evils enced
persuaded highly
are
to the sick poor, unjust to the medical profession, and adverse to the public health. As the most likely means of effecting a just and equitable arrangement of this important question, your petitioners would respectfully suggest the establishment of a Medical Board (elected by the profession) to act in concert with the Poor-Law Commissioners, su as to superintend and regulate the duties and emoluments of parochial
injuiious
surgeons.
accordingly did, and at the general meeting That your petitioners, in the meantime, for transacting business, having become a pray that your honourable House will be member of the Association, he proposed that pleased to institute a full and searching inthe report which had been prepared on the quiryinto the alleged evils, and that you subject, should be read and adopted, which will order a return of all appointments, been done, he also moved that peti- number of medical officers, amount of salaembodying the recommendations of the ries, extent of districts, &c., before and since Committee, should be prepared and present- the introduction of the Poor-Law Amend-
having tions
ed to both Houses of Parliament ; this was ment Act; and that your honourable House seconded by Dr. M’Cabe, of Cheltenham, will be pleased to adopt such measuies as and carried unanimously. It was also under- you may consider most conducive to the stood that free communication should be public good, and the benefit of the medical held between the societies, with the view of profession. And your petitioners will ever pray, &c. settling this important question. The Report of the Poor-Law Committee The adoption of this petition was moved of the British Medical Association, was laid before the members at the first anniversary, bv Dr. Granville, seconded by Mr. Baiuwhieh was held on the 30th September, bridge, and carried unanimously, and it re1837, along with a second, or supplemental ceived numerous signatures in the course of report, statingthat the evils enumerated the evening. In consequence of the election of a new above not only still continued with unabated force, but were increasing with the exten- Council at the anniversary, it became necession of the Poor-Law Amendment Act in the sary to appoint another Poor-Law Committee, various localities of the kingdom, notwith- which was accordingly done on the 14th of standing the remonstrances and protests of November, 1837, for the purpose "of watchthe profession. The Report alluded to the ing over the proceedings in Parliament, and various remedies which would be necessary, elsewhere, respecting the New Poor-Law ; and recommended that a petition should be to take into consideration the plans that presented to Parliament praying for a re- should be adopted for reforming its operadress of the grievances complained of. Ac- tions; aud also to collect information genecordingly a petition was prepared, of which rally respecting it." The members were-
the
following is a
copy
:-
To the Honourable the Commons of Great Britain and trelcesd in Purliarneot assem-
bled. The humble petition of the undersigned members of the British Medical Association,
Showeth,
Bainbridge, J. N., Esq. Clarlce, John, Esq. Crisp, Edward, Esq. Davidson, Robert, Esq. Eales, William, Esq. Evans, E., Esq. Farr, William, Esq. Hilles, M. W., Esq. Lavies, John, Esq. Porter, Thomas, Esq. Rowe, Dr. Wagstaffe, M. F., Esq. C. H. Rogers Harrisson, Hon. Sec. At the same meeting of Council the following resolution was moved and carried
That your petitioners deeply regret the rontinuanee of the many grievances resulting from the Poor-Law Amendment Act, which have been so frequently and loudly romplained of by the great majority of their professional brethren. The chief of these are,—the system of contract by tender ; the unanimously :inadequate remuneration ; the small num. Resolved,—"That the Council of this ber of medical officers compared with the Association earnestly recommend their mpit extent of the unions and districts; brethren throughout the kingdom to
the dical
754 call
meetings in their respective districts
to
consider the grievances affecting the profession ; and especially to petition Parliament for a National Faculty of Medicine, and for an inquiry into the present system of medical attendance on the sick poor." Several communications had been received from Messrs. Rumsey and Ceely, of the Provincial Association, and these gentlemen were desirous that the efforts of the two Associations should be united and directed to the object in view. On the 19th of November last Dr. Webster received a letter from Mr. Rumsey stating that the Council of the Provincial Association had requested Mr. Sergeant Talfourd to become their advocate in Parliament, to watch any proceedings that might take that he (Mr. Rumsey) had requested Mr. Talfourd to receive Mr. Ceely, of Aylesbury, Mr. May, of Reading, and himself, as a deputation to confer on the best measures that could be taken during the ensuing session of Parliament, and he now begged the favour of Dr. Webster to accompany them,’ as he considered his doing so would on many accounts be of importance to the success of the cause." With this Dr. Webster readily complied, and the deputation was politely received by the learned sergeant. The gentlemen of the Provincial Association mentioned several plans they had in view. One was the appointment of a Select Committee of the House of Commons, if it could be obtained, to consider the medical department of the Poor-Law apart from the general question. Mr. Talfourd doubted whether this would be granted, and stated that if it were he could not act as its chairman, which would be expected of him as the mover : this plan was relinquished. Another was to endeavour to introduce a short bill into the House to remedy the grievances complained of; but Mr. Talfourd did not think this could be accomplished, and the idea was therefore abandoned. The honourable Member was then requested to obtain certain returns which had been suggested by the Provincial Poor-Law Committee. He expressed his willingness to move for them if his doing so would not interfere with any object in view ; though he was very doubtful whether they would be granted. It was then suggested that perhaps these would more likely be obtained in the House of Lords, and it was agreed that Lord Wharncliffe should be requested to move for them. Dr. Webster then thought it right to inform Mr. Talfourd that, as a member of the Council of the British Medical Association, and as a friend to the profession, Mr. Wakley was very anxious to bring the abuses complained of before the Poor-Law Committee of the House of Commons, and that it was his intention to endeavour to arrange
place ;
this as
soon
after Parliament met
as
possi-
ble ; and suggested that in any proceedings which might take place, it would be very
desirable if Mr. Talfourd and Mr. Wak. ley, as the representatives of the two Asso. ciations in Parliament, were to act together, especially as Mr. Wakley was master of the whole bearings of the subject. Mr. Tal. fourd at once said that if Mr. Wakley had any plan in view, he was so much better qualified to judge of such a question, and would be listened to in the House with so much greater attention on any medical question than himself, that he would wil. lingly give way to him, and endeavour to render him all the assistance he could, and would be happy in any way to promote the objects which the deputation seemed to have so much at heart. The deputation then waited on Mr. Vakley, and conferred with him on all the bear, ings of the case ; he entered most readily into the views which he entertained, and advised the deputation as to their future proceedings. He thought the inquiry before the Poor-Law Committee was the best mode of making known the grievances which the Amendment Act had brought upon medical men, and the most likely way of obtaining redress ; and that as soon as Parliament met he should bring the question before the Committee. He considered that returns from the Unions might throw much light on the subject, but doubted whether all those re, quired by the Provincial Association could be obtained, as several of them embraced circumstances and periods previous to the Amendment Act. Mr. Wakley thought there could be no harm in trying to obtain them, or as many as possible, through the House of Lords. The deputation then proceeded to Lord Wharnclifle’s to induce his Lordship to move for the returns, but he was from home. Dr. Hastings afterwards wrote to him for this purpose, and his Lordship made inquiries, but was informed that they could not be obtained for many months, that they would be very voluminous, and would cost many hundred pounds, so he did not think it prudent to move for them. The Poor-Law Committee of the British Medical Association held frequent meetings in furtherance of its various objects, and on several occasions the whole members of Council resolved themselves into a Poor. Law Committee. At one of such meetingsit was suggested that it would be highly important to obtain official and accurate returns on many points connected with the administration of medical relief, so that sufficient data might be procured (as none hitherto existed) from which to calculate the remuneration of the medical officers, according to the distance, number of patients, cases constantly on the sick-list, &c. &c, ; the average size of the districts, the population, and other particulars, showing the amount of
755
labour actually performed. The Council nesses, to engage a temporary office near the unanimously requested Mr. Farr, one of House of Commons, and to make all necestheir own number, to draw up the forms sary arrangements. It consisted of which he thought best adapted to obtain the Davidson, R., Esq., (Chairman
required information, which he at agreed to, and prepared the requisite dules. When these forms
were
drawn up
once
sche-
they
Eales, Wm., Esq., (Secretary.) Farr, Wm., Esq. Hilles, M. W., Esq. Lavies, John, Esq. Wakley, Thos., Esq., M.P: Webster, Dr. These gentlemen held frequent meetings
who informed the Council that through his representations the whole of the Returns were ordered by the House of Commons, in New palace-yard, Westminster, they corwith the full concurrence of Lord John responded with the Medical Association at Russell. It is but just to add that the Bridgewater, with the Stroud Medical AsPoor-Law Commissioners afforded all the sociation, with Messrs. Rumsey and Ceely facilities in their power, and in one or two of the Provincial Association, and with other’ gentlemen in different parts of the points made additions to the returns. The Parliamentary Committee Almost immediately after the meeting of country. Parliament Mr. Wakley presented the peti- consented that Mr. Wakley, as one of the tion of the Association to the House, and members, should be put in possession of the moved that it should be referred to the returns as fast as they were received, in Poor-Law Committee, which was accord- order that the whole of them might be exingly done, and he was also able, previous to amined and arranged by Mr. Farr, so as to the Christmas recess, to arrange, with the exhibit the general results. The informaconseit of Lord John Russell and the Com- tion contained in the 11 Returns;’ which had mittee, that an inquiry into the medical come in from the parochial medical officers, abuses and the examination of witnesses clerks of guardians, masters of workhouses, should take place at any period during the &c., had been so far classified, and the session that would be most convenient to general bearings of the question determined, himself and the petitioners. Owing to the that it was agreed about the beginning of tardiness with which the medical returns June that the examination of witnesses came in, and other circumstances, it was might take place at a very early period. several months before the inquiry could Mr. Wakley had arranged with Mr. safely be brought on. Fazakerly, the Chairman, and the members In the meantime the Poor-Law Committee of the Poor-Law Committee, as to the mode of this Council were engaged in maturing in which the inquiry should be conducted. their plans, and they presented a "Report"It was properly and wisely agreed that no to the Council with " suggestions for an particular abuses, nor instances of neglect, amended system of medical relief." These or of professional malpractice, should be suggestions," after being submitted to the brought forward, but that evidence should deliberate consideration of the Council, be adduced to prove generally, in the first were printed and distributed among the instance, the evils of the system as laid down members of the Association. The Report and continued by the Poor-Law authorities ; condemned the system of medical contracts that that system was fraught with danger by TENDER adopted by the Poor-Law to the poor, with injury and degradation to authorities, and the establishment of ill- the profession, and with injustice to the constituted MEDICAL CLUBS, as inju- community. It was, however, necessary rious to the poor, delusive to the public, and fOI the advocates of medical practitioners to unjust and degrading to the medical profes- do more—it was incumbent on them not only sion. After stating that the Council were to prove that the present system was inefdesirous of recommending for adoption, in- fective and injurious, but to lay before the stead of the mode in use, a plan which Committee and the public a plan which should secure to the poor the fullest should be free from theobjections of the old amount of benefits which could be conferred one, and which should be so based as to by medical assistance, and to the gentlemen carry the judgment of all reasonable persons engaged in preserving the public health a in its favour. The witnesses to be examined fair remuneration for the services which they were thus to speak only to the injuriousness were constantly performing, the Report of the present system, and to offer opinions went on to offer the several suggestions on any better plan that should be proposed, with which the members of the Association the Committee having, of course, the power are already well acquainted. to sift the evidence and opinions, and to Onthe2’lth March the Council considered cross-examine the witnesses : hut to save it expedient to appoint a Sub-Committee on time and to prevent a protracted inquiry, it the Poor-Law Question to procure and ar- was at once admitted by the Chairman that range evidence preparatory to the Parlia- an inquiry was necessary, that some abuses mentary Inquiry, to determine what names did exist, and that no witnesses should be should be suggested as those of the wit- called on the part of the Poor-Law authori3 C2
placed
were soon after
in Mr.
Wakley’s hauds,
756 ties to contend for the present system as a A Plan for an Amended System of Parochial Medical Relief and Inspection,—compre perfect one. It was, however, distinctly understood if the evidence adduced should hending— fail to convince the Committee of the neI. The population and extent of medical cessity of extensive alterations, that then districts. the advocates of the profession should be at 1st. In dense populations, as inthemetro. liberty to bring forward the subject afresh, polis, large towns and cities, the number of inquiry, so as to place before in a medical district not
and renew the the the the instances Committee poor, and and toandthe abuse which had of poor, of
resulted
oppression
had affected the profession,
well as of neglect and malpractice on the part of the medical officers of unions. The convenience of all parties having been consulted, it was arranged with Mr. Fazakerly, the Chairman of the Committee, that the examination of witnesses should commence on the 19th of June ; and on the ltith, the previous, an meeting of the Council of the Association, several of whom were to be examined, and of others interested in the question, took place at Westminster. cases
evening
ought
10,000, that number to be reduced accordingto the state of pauperism. present average is aboutl5,000 all
the instances power
as
inhabitants
extraordinary
The object of this meeting was to consider the various suggestions which had been made by different societies and individuals, and to throw them into a detailed plan, which all present might be able to agree to and offer to the Poor-Law Committee, Messrs. Rumsey and Ceely having had considerable experience of the operations of the new law in the country, and having collected a great number of facts from their medical brethren, were asked if they were prepared with the details of any measure which they wished finally to recommend to the Committee? Mr. Rumsey replied, that they were not, but having given much time and attention to the subject there were many facts that they could speak to, and opinions they could give, on the different points. Some of these Mr. Rumsey detailed, and especially considered that the salaries of the medical officers should be paid by a percentage of from 4 to 7 per cent. on the poorrate, or the money absolutely expended on the poor, varying the rate per cent. according to the nature and extent of the duties ; he thought that the election of the officers should be restored to the rate-payers, that Medical Assessors should be appointed, and a Medical Commissioner. The · suggestions" of the Council of this Association were then considered. After a very extended discussion, embracing all the important features of the question, and eliciting opinions from most, if not all, of the gentlemen present, the following plan was unanimously agreed to. In drawing up this plan the great importance of the parliamentary returns and of the statistical results deduced from them by Mr. Farr was discovered ; in fact, the greater part of the details must been been guesswork without such accurate sources of information :--
to exceed
Note.—The each medical distnct, 1 nbt " bitantsin aseerthe parliamentary returns alluded tained by to. as
2nd. The size of rural districts should average from 10 to 12 square miles, which would give an average population of 2500. Note,-The present average size of rural districts is 21 square miles; average number of inhabitants,, 5000. - (Extracted from
returns.)’)
11. Remuneration. This should be by a salary calculated on the number of cases, the number constantly on the sick-list, the distance or extent of districts, the density of population, the cost of medicines, the value of skill and time, &:c. 2nd. Separate charges should be allowed for midwifery, capital operations, dislocations, fractures, and vaccinations. 3rd. The average charge for one person constantly on the sick-list should be about R.55s" or for each case from 6s. to 7s. Note.—These charges would amount to about 6d. a head oil the whole population. The prime cost of drugs alone for each case of illness calculated on hospital and dispen. sary practice, is from 2s. 6d. to 3s. 6(!. Now, the present average cost allowed by the Poor-Law Commissioners for medicines, attendance, and medical appliances to each case, as shown by the returns, is 3s. 3d. in the country; in the metropolis,
1st.
2s.
1d.
JII. Medical supervision.-It is recom’ mended1st. That there should be a Medical Com, missioner or Director appointed by the Crown to superintend the whole parochial medical arrangements, and to whom all points of difference between the proposed Medical Guardians or Assessors,or between the medical officers and the ordinary guar. dians, should be referred. 2d. That a Medical Guardian or Assessor should be elected for each Union by the resident medical practitioners (or a majority of such resident practitioners), to act on their behalf, with another appointed by the Guardians on behalf of the Union. These Assessors should calculate the amount of salary to be paid to the medical officers, according to the rate recommended above, taking into account the circumstances of each locality, determine the size [of the
757
Should the medical water, in Somersetshire,* and of Stroud, in medical districts, &c. practitioners decline to elect an Assessor then Gloucestershire, who could have spoken to the Medical Commissioner is to appoint one. particular as well as general abuses. When,
The Medical Assessor might act as the con- however, the excellent arrangements alsulting practitioner for the Union, give the ready mentioned was made by Mr. Wakley Guardians advice on any case that may with Mr. Fazakerly, this was quite unnearise at the boards requiring medical know- cessary, and the Council were anxious to ledge, draw up an annual report of the give as little inconvenience to their medical health of the Union, &c., and be the medium brethren in the country as possible, and to of communication between the medical call those witnesses only who were consiofficers and the Commissioners. He should dered competent to prove the case of the probe remunerated by a salary proportioned to fession generally. It was also possible that the duties he would have to perform. Such the evidence of these gentlemen might still was the plan agreed to at this important be required if the desired effects were not meeting, or rather the outlines of a plan to produced, and the Poor-Law Committee be filled up or modified according to cir- should consider that a case had not been cumstances:* made out against the present Poor-Law The examination of witnesses by the system. be impossible to go at length Parliamentary Committee commenced on Tuesday the 19th of June, and was conti. into, or to give extracts from the evidence. nued throughout the week; the Committee The whole has been printed in one volume part of the Poor-Law inquiry, sitting five or six hours daily (much beyond as a their usual time), that as short a period and the members of the profession may have might be occupied, and as little inconve- access toitthrough the kindness of their nience as possible given to the medical gen- parliamentary friends.t It may, however, be proper to state in general terms, for the tlemen. information of the members of the AssoThe witnesses were examined in the fol- ciation and of the profession, the objects lowing order :kept in view, in calling and examining the different witnesses, and what their evidence 1. Mr. Rumsey, of Chesham. 2. Dr. Webster, Surgeon, of Dulwich. went to prove. Mr. Rumsey, Dr. Webster, Mr. Ceely, 3. Mr. Ceeley, of Aylesbury. Dr. Rowe, Mr. Evans, and Mr. Toogood, 4. Dr. R. D. Thomson, of London. were examined as tofacts, which proved the 5. Dr. Rowe, Surgeon, of Chigwell. the poor and evils of system 6. Mr. Farr, of London. the which had come under their 7. Alr. Evans, of Southwark. own observation. All these gentlemen had 8. Dr. John Elliotson. a practical knowledge of the subjects and 9. Mr. Toogood, of Bridgewater. from their own experience, and 10. Dr. Marshall Hall. in addition, some from their offices, had also 11. Sir Astley Cooper. 12. Dr. Kay, Assistant Poor-Law Com, had a voluminous correspondence with those who had a practical knowledge, and missioner. who had pledged themselves to the truth of Several other gentlemen were facts contained in their statements. All and among them Dr. Yelloly and Mr. Soulby, the evils complained of were fully borne out of Ashe, but some were prevented attending of these witnesses, and they by the and others did not arrive in time to be ex- all in the necessity of the extensive agreed amined. and immediate alterations which were reThe Council had intended to have many commended to the Committee. more witnesses called in the first instance, of these witneeses The and a number of gentlemen were written to by the members who were supposed to be in many parts of the country, whose most friendly to the Poor-Law did not in dence, from the abstracts forwarded to the any way shake the facts and opinions which Council, would have been most valuable, as they advanced. These facts and opinions for example the practitioners of Bridge- went to prove that the medical districts were too large ; the medical officers too few ; the remuneration inadequate; the knowledge
It would
distinct
.
the ptofession,
affecting
couldspeak
summoned,
the
evidence
cross-examination
evi-
’
It ought to be stated that Messrs. Rumsey and who were present at the above meeting, * Mr. Toogood was examined on some general wished it to be understood that they were so only being taken of his presence in points, 11 in the characters of witnesses," having been London,advantage to be examined at length before the Poorsummoned by Mr. Wakley, at the suggestion of the Law Committee of the House of Lords, on the alCouncil of this Association ; but the Council of the medical and other abuses in the Bridgewater 1’roviucial Medical Association had previously ap leged Union. pointed Mr. Farr, the talented. member of the Council of the British Medical Association, to be t The whole evidence may be purchased for Is. 7d. their delegate at the ensuing inquiry, with ful at the Parliamentary Papers Office, in Abingdonto measures on their hi take such behalf as Westminster; it may be forwarded through powers the booksellers. might see fit.
Ceely,
street,
-
758
subject possessed by non-profussiunal and which genuine drugs could not be purby far too limited ; medical superin- cilasell at, had been offered to them by che. tendance wanting ; and the system of tender mists for the Poor-law consumption, know. nnd medical clubs as constituted by the mg that these gentlemen attended the poor. The examination of Dr. Kay, an Assist. Commissioners, discreditable to tmy hrufessiou. ant Poor-Law Commissioner, must be Hut as these witnesses might be supposed viewed as of much importance, inasmuch from their situations and pursuits to take a as he at once admitted that evils to a consi. partial or prejudiced view of subjects derable extent existed at present, and that of the
men
the average scale of remuneration recommended by the witnesses was a very mode. rate and fair one; and that in many of the districts under his superintendence thesa. abilities, placed them beyond any such sus- laries paid to the medical officers, were even picions. Accordingly, Sir Astley Cooper, more liberal. In his arrangements, he had Dr. Elliotson, and Dr. Marshall Hall,were always wished to make the medical districts severally examined on the facts and opinions small ; he had never resorted to tenders; advanced, and the plan recommended, endeavoured as little as possible to disturb Having perused the evidence given by Mr. existing medical officers and had never sn. Rumsey and Dr. Webster, which had been perseded any of them, because they might printed immediately and sent to them, they not approve of or belong to medical clubs. in the amplest manner supported what had Dr. Kay felt some delicacy in offering an been advanced by’ these witnesses, and opinion as to the appointment of a Medical gave it as their deliberate opinion, that the Commissioner or of Medical Assessors, but extent of the districts, the inadequate remu- rather disapproved of them than otherwise. It is gratifying to the Council to believe neration, the want of superintendance, and the prevalence of tender and medical clubs that the mass of evidence thus brought formust be injurious to the poor, to the profes- ward, consisting of facts, figures, and opision, and to the public health. nions, all bearing on a question so important Mr. Farr’s evidence was altogether of a to the health of the poor, and the best in. different kind, it was neither circumstan- terests of the medical profession, has not tial nor derived from his own knowledge of been collected and adduced in vain. It was facts; nevertheless, it was equally import- quite evident to any one who was present ant, and of more general application than and witnessedthe examination, that a very that of any other gentleman, being derived considerable and salutary impression was from the parliamentary returns which have produced on the members of the Poor-Law been mentioned, and from other authentie Committee. It appears likely that the evils arising documents. Figures and statistical tables, as well as verbal statements, were thus from, and comprehended under, the heads brought to bear on the question, so as to "Extent and Size of Medical Districts," and prove beyond a doubt, that the allegations "Inadequate Remuneration," will be re, raised against the Poor-Law system were medied, but the Council deeply regret that not groundless. their recommendations for an efficient plan Dr. R. D. Thomson, a scientific chemist of " medical superintendance and inspee. in London, was examined to prove the very tion " did not seem to meet with that appro. common practice in the drug trade, of adul- bation from the Committee or the Poor-Law terating medicines, especially the more authorities which its great importance so active and energetic ones. This he did to imperatively demands. It is feared that the satisfaction of the Committee by per- little, if anything, will be done on this head, forming before them a few experiments on but should the Council be disappointed at drugs, which he had procured from retail present in obtaining a Medical Commissioner chemists, and which were found to be very and Medical Guardians or Assessors, the impure and deteriorated in quality. His subject must not be lost sight of, as in their evidence also showed that all the usual me- opinion the want of a proper plan of profes’ dicines could be purchased at two or even sional superintendance would more or less three prices, which proved the difference vitiate the working of the whole system, and of quality, and that all powders were in would also impede the scientific results general much adulterated by the drug- which might be so readily obtained under grinders. The inference to be drawn from the organised plan recommended by the Counthese circumstances, was that medicines cil. It is true that Dr. Kay, who has been either inert, or of a very inferior kind, would so active as an Assistant Poor-Law Commis. most likely be used for the poor, where the sioner in Norfolk and Suffolk, and who, by salaries of the medical officers were below, hisjudiciousarrangements, deserves well of or not more than equal to the prime cost of his medical brethren, is now appointed to the medicines which ought to be employed the metropolitan districts. The Commisin each case of illness. Two witnesses sioners, it seems,are aware of the importance stated that medicines at a very low price, of having a medical adviser to refer to, and
which somewhat affected their own interests, it was deemed prudent to call for examina tion men whose high characters and standing in the profession, and whose talents and
759
benefits may result to the profession has taken place in such a manner as to bring from Dr. Kay’s liberal feeling and 11 esprit their wrongs and the wrongs of the poor du corps," but he is altogether irresponsible before Parliament and the public. It affords to his medical brethren, and entirely depen- another excellent illustration of what may be dent upon the Commissioners who appoint accomplished by union, energy, and organhim, and may remove or translate him to isation, and is a pleasing proof of the another district if they should see fit. He utility of such associations, when based upon However may, therefore, recommend,but has no power, sound and liberal principles. individuals might have been, and, indeed, no medical coadjutors to enable him to carry out any plan of inspection, even andhowever much they might have tried to supposing it should meet with the approba- effect on such a question, it is evident that tion of the Commissioners, they could not have commanded the same It would be an act of the deepest ingrati- sources and amount of information, the same tude were this Report to conclude without varied talent and persevering industry and alluding to the debt which the profession application necessary for such an underas a number of persons can do, at large, and especially the Council of this Association owe to one of their own when united to effect a purpose in which all members, without whose exertions and in- feel a deep and common interest. It also fluence they fairly believe that the Parlia- shows what unity, perseverance, and a just mentary Inquiry could not efficiently have cause may, and doubtless will, sooner or taken place ; it is almost unnecessary to later, effect in removing the many other inmention that Mr. Wakley is alluded tu; to jurious abuses which at the present moment him the profession are indebted for their affect the medical profession. The Council, earliest information of the evils which he confidently expecting the reform of these foresaw would result from the system about abuses, earnestly request the active co-opeto be established ; by him were contracts by ration and encouragement of their medical tender, the self-supporting dispensaries, and brethren in their various endeavours to unite the Poor-Law Medical Clubs, denounced the now divided and discordant branches of and strenuously opposed ; to him the Council their profession into one body or faculty, owe the medical returns, which in Mr. Farr’s which shall have a representative and rehands have been so useful and important in sponsiblesenate,possessingadequate powers the inquiry; and but for Mr. Wakley, and his for the government of the members and for position in Parliament and in the Poor-Law the regulation of all matters affecting their Committee, the Council are extremely interests and respectability. Had unanimity doubtful whether any inquiry at all would prevailed, or had such a faculty been formed have taken place ; but it is quite certain that 9, few years since, most of our professional no other man, whether in or out of Parlia- abuses would have been swept away, and ment, could have brought the same know- the numerous evils of the Poor-Law could ledge of facts to bear on the subject, nor never have existed. The Council would only farther add that have conducted it with such tact, judgment, and prudence as he did, and which all who the members of the Association and their were present will readily acknowledge ; and professional brethren may depend upon their when it is considered that he sacrificed his being constantly in observation at their personal feelings in a time of the severest posts;that they will watch with jealous eyes domestic affliction to render a service to the the extent of the ameliorations contemplated profession it will greatly tend to enhance the by the Poor-Law Committee and the mode in which they may be carried out by the debt which the profession owe to him. That this important inquiry was conducted Commissioners; that they will still endeavour to the satisfaction of all parties may be pre- to obtain a proper system of medical supersnmed from the remark of the Chairman of vision ; and, if it should be necessary, that the Poor-Law Committee, who, in thanking they will use their utmost efforts to remove the witnesses for their attendance, observed any other abuses that may remain after the that it had been carried on in a way ex- proposed amendments are adopted. tremely pleasing to himself and the ComINDIGO IN EPILEPSY.—Dr. Roth, of Mamittee ; and when the examination had closed Dr. Webster requested permission to thank yence, has published a paper on the employthe Committee for the very courteous man- ment of indigo in spasmodic affections, espeIt is given in the shape of ner in which all the witnesses had been cially epilepsy. examined, and especially for the kindness, an electuary made with syrup and water the patient attention, and the great interest two parts, indigo one part; of this mixture which the Chairman had shown throughout an ounce is a fair dose. In the form of the inquiry. powder it is apt to create irritation and The Council cannot conclude without spasm of the fauces. A tendency to diarcordially congratulating the profession in hoea sometimes follows its employment, and general, and particularly the members of must be checked by astringents. Nausea this Association, on the present aspect of the and vomiting are produced by a large dose, Poor-Law question, and that this inquiry It was beneficial in many cases,; some
anxious private
taking
’
colour, owing, evidently, to the presence of tity of oil is observed, on which, it would a vegetable powder, as was proved by seem, all their powers depend. The exterseparating and examining it with a mi- nal application upon a blistered surface Morenheim likewise gives us causes a discharge of a puriform character, croscope. the case of a female, thirty years of age, and it is therefore advantageous as a coun. who, determined to produce miscarriage, ter-irritant. took a strong infusion, which brought on a constant and fearful
vomiting. After a few days she suffered from the most excruciating REPORT OF THE COUNCIL pain; abortion took place, with a terrific OF THE died. from the womb: she haemorrhage Upon examination, a rupture of the gall- BRITISH MEDICAL ASSOCIATION ON THE bladder, with effusion of bile in the abdomen, was visible, together with inflamma- PRESENT STATE OF THE POOR-LAW
tion of the intestines. It would appear that QUESTION, where there is a tendency to miscarriage, AND ON THE STEPS WHICH THEY HAVE TAKEN where violent vomiting occura, that this IN CONDUCTING THE RECENT PARLIAMENTARY effect is produced by savin, but that it is by INQUIRY INTO THE EVILS OF THE SYSTEM. no means certain. Of the quantity that may be taken without producing miscarthe Poor-Law Amendment Act re, riage, Fodere, in the " Medecine Legale," WHEN has furnished us with a very striking in- ceived the sanction of the Legislature, and stance :-A female took every day, for 20 its provisions began to be acted upon, it days, no less than a hundred drops of the was evident that the extensive powers vest. oil, yet carried her child to the full time. ed in the authorities constituted under it, A female also took, without her being aware would very materially affect the interests, re. of it, a large quantity of the powder; she spectability, and independence of the medical suffered from nausea, singultus, vomiting, profession. The fearful experiment was tried heat in the abdominal region, and fever, of entrusting the appointment and dismissal which lasted during afortuight; these symp- of medical officers, and the arrangement of toms, however, did not prevent her delivery medical duties, to non-professional Boards, at the natural time. The Medical Faculty whether of Guardians or Commissioners,and at Leipsic pronounced it highly dangeruus, it was followed by the consequences which whilst, on the other hand, Wedelius, who might naturally have been expected. Howhas written on the properties of the savin, ever anxious these authorities might be to Haller, and Ray, have all considered it. discharge the duties which devolved upon harmless. In the time of Galen, this pro- them, in connection with the due administraperty of producing abortion was a popular tion of parochial medical relief, it was imopinion. That it produces a greater inten- possible that they could be competent judges sity of colour of the blood has long been of the nature and importance of these duobserved, and that it will produce haemor- ties,-of the qualifications of the medical rhage, but that these take pl.ace without an oilicers,-or of the remuneration which ought action upon the bowels is strongly denied. to be awarded for their laborious and arduHow far these two effects may be dependent ous services. The Poor-Law functionaries were utifortu. on each other it is not for me to say ; but much of the emmenagogue power is depen- nately armed with new and extensive powdent upon purgation, I believe. Home’s ers, from which the medical profession had clinical experiments show, that a scruple of no appeal, and which they could not at first the dried leaves taken twice a day will, successfully oppose, at the same time that a where the circulation is languid, excite it niggardly economy was recommended and into action, produce the obstructed excre- enforced in all the appointments. Without tion, and, if taken in the intervals, it has sufficient knowledge of the extent of duty the power of preventing a recurrence of in- required, without sufficient data from which terruption. It sometimes excites lmmor- to calculate and fix the remuneration, it is rhage from other tissues, and Haller gives not surprising that under such a system us a striking examp4e of haemoptysis, in a (which, however, it is fair to confess was young girl, arising from this’cause, simul- parity an experiment) the interests of the taneously with the excretion from the ute- poor and of the medical profession mate, rine system. The shrub from which the rially suffered. With a view to economy, large unions and leaves are obtained is a handsome dark evergreen, a native of the south of Europe medical districts were in general formed, and the Levant. The leaves are very small, which doubly affected the poor, by lessenof a bright green colour; these, together ing the number of their medical attendants with the tops, have a foetid and disagreeable and placing them often beyond their reach; odour; they yield up the whole of their while the salaries offered to the medical virtues to rectified spirit, and part to water; officers were miserably insufficient to enable and on distillation with water a large quan- them to do justice to themselves,and tosup-
751
ply adequate medical assistance and efficient t For
,
Per annum.
".
"
an individual maintaining himremedies to those placed under their care. self or herself (1 person) 3s. If the practitioners of a parish or union could not accept the terms offered to them, For a man and his wife (2 persons).. 4s. and remonstrated as to the amount of remu-For each child in a family, 6d. (say ........
neration, young
men
were
sent from the
public hospitals, or advertisements were immediately published inviting candidates from
a
distance to undertake the duties.
The system of medical contracts by tender.thus introduced, operated grievously on the interests and respectability of medi-
cal men, while it could be
4
persons)
....................
in the
And for every person family above the age of 2
persons)
2s.
same
16, 2s. (say
....................
4s.
13s.
.
Is Sd. " persons,-average, ’.. Such was the scale of remuneration arbitrarily fixed by one of the Assistant PoorLaw Commissioners, without any adequate knowledge of so important a subject, and offered to, if not forced upon, gentlemen of education and extensive acquirements, for medical attendance, medicines, and advice, one year,-not to paupers, be it observbut to the independent labourer, the domestic servant, and the mechanic and autizan. n the profession Pel haps it was well ,,’ that the system was carried so far beyond the point of endurance, otherwise the 9
,
no test of their and moral fitness for their oflicial duties. Thus a powerful engine was employed to lower the independence of the profession, and to force them to accept the terms arbitrarily fixed by the Guardians or Commissioners. Few could afford to see their practice interfered with by strangers, and the existence of themselves and their families placed in jeopardy; the Commissioners were omnipotent in London, but appeal to them was vain ; the Guardians equally powerful in their own localities, to offend whom might be to hazard half vions evils might have been silentlyinflicted Is it, therefore, their private to be wondered at that medical men, placed under such novel and embarrassing circumstances, should have frequently sacrificed their feelings and sense of independence to strances arose in all quarters against them, the dearer interests of their families ? but in vain,—no redress followed these There remained but another scheme to be founded complaints. In the meantime the set in motion, which, had it succeeded ac- profession were not idle. The Provincial cording to the wishes of its promoters, would Medical Association appointed a Committee have entirely blasted the prospects of the in 1836 to collect facts and to report upon humbler practitioner,-this was the intro- them at the following annual meeting. duction of the 11 Poor-Law Medical Clubs." At last the mischief reached the Hitherto the Poor-Law Commissioners, in polis, and in unison with the Poor-Law theirmedical arrangements, had only contem- medical arrangements, attempts were made plated the objects undertheir own authority, in Southwark and in Camberwell to estaviz. paupers, but, as if to complete the de- blish " Medical Clubs " upon the same gradation of the profession which had been terms, or nearly so, as those which have been previously begun, the plans and remunera- recited above ; but here a firm stand was tion which were disgraceful when even -tp- made against further encroachments. By piied to paupers, were to be extended to the prompt and zealous assistance of the inall the classes included between them and dependent medical press, the profession the middle ranks of society. Mechanics ! were roused to activit3, and became fully artizans ! handicraftsmen! domestic ser- alive to the dangers which threatened them. vants! and independent labourers, were in- The medical practitioners of the Borough vited, entreated, and almost compelled (for and of Camberwell met in large numbers, the wishes of the rich and powerful are too and after discussing the merits of the Poorfrequently laws to the poor) to join the Poor- Law Clubs, with their promoters, for seve. Law, or, as they were named, the " Indepen- ral nights successively, in each place, sigdent Medical Clubs." And what were the nally defeated the attempts to introduce terms which were offered to the medical them. It now became apparent, unless the promen, on the strength of which the Poor-Law authorities considered themselves entitled to fession resolved passively to submit to the interfere between them and their private pa- ruin and degradation which threatened them, tients-the poorer but most numerous classes that nothing but union and organisation, and of society in this country ? That they may taking their affairs into their own hands, rest on good authority they are taken from could possibly save them, as the Colleges the Poor-Law Report of 1836, and from a and Corporations, with their usual apathy parliamentary paper, and are as follows, and indifference, had paid little or no attention to their complaints and applications. viz.:—
qualifications
for ed,
’
"
for
were
practice.
pre-
andpatientlyborne. As the plans and ties became known the Poor-Law authoritice became put into prachnown and were tice iu ecountry,
pro esand remonwell-
Metro-
752 it was resolved that an Asso. 3rd. The incompetency of noil-profes. ciation should be formed upon principles sional persons to judge of professional conaltogether different from those of any society duct, whether for or against, or to fix the which already existed ; that it should not districts and professional remuneration. assume a scientific character, but should 4th. The practice of introducing strang. watch over and protect the interests and ers (often young and inexperienced men) respectability of the profession ; cultivate when the respectable and long-established feelings of amity among its members; form resident practitioners could not consciena benevolent fund ; promote salutary reforms tiously accede to the terms of the Guardians in the Colleges and Corporations ; and resist or Poor-Law Commissioners. injuries and abuses, from whatever quarter 5th. The want of uniformity in the medi. they might arise, to the utmost of their cal arrangements, or of any general plan in remunerating medical officers, some being power. It is unnecessary to trace step by step the paid by salary, some by the per-case system, foundation of the British Medical Associa- and others by the medical club system. 6th. The interference of the Poor-Law tion, and its progress onwards to its present authorities with the practice of medical men Suffice and influential prosperous position. it to state that after the Association was by introducing " Independent Medical fairly established, the Poor-Law question Clubs" for those who were not paupers, such engaged the earliest and most anxious at- as domestic servants, mechanics, artizans, tention of the Council. A Committee of the and others, aud fixing a scale of remuneraCouncil was appointed early in 1837 to in- tion which could not be just to the patients quire into the nature and extent of the evils or to the attendants. II. The evils which affected the poor complained of, and to consider of some plan for their removal, and for the general im- were :1st. The great extent of the medical disprovement of the whole system of parochial medical attendance. tricts, rendering it absolutely impossible This Committee examined the facts and that the poor could be efficiently attended. 2nd. The diminished number of medical evidence that had been laid before the profession and the public in the Poor-Law officers (being about half of those employed Reports, which were politely forwarded to under the whole system, bad as it was), and the Association by the Secretary, Mr. Chad- their increased distance from many of their wick,-in the various pamphlets and jour- patients. 3rd. The difficulty of obtaining orders for nals, and in the Report of the Provincial Medical Association ; they corresponded relief, the paupers frequently residing at a with their own members, and with indivi- distance from the relieving officers, andthere duals in various parts of the country, and being an increased reluctance to grant orders, inserted advertisements in the medical jour- especially when the remuneration was by nals, requesting that their medical brethren the per-case system. 4th. The appointment, in many cases, of would furnish them with any information in their power. It is a fact worthy of notice young and inexperienced, or even of unquathat but a scanty portion of information was lified medical men to the highly responsible supplied by country medical practitioners, office of attendants on the poor. 5th. The total want of medical superviwho being the first to feel the effects of the new system, had been the loudest in their sion and inspection, and consequently of complaints ; many of them evidently had responsibility. (ith. The absence of any provision for the fear of the Poor-Law authorities and of the Guardians before their eyes ; but much consultations in cases of great danger and valuable information was derived from other ditliculty, or in those requiring capital opesources, which enabled the Committee to rations. 7th. The inadequacy of remuneration to furnish two interesting reports to the Council within short periods. The first report the medical officers, by which a strong temp. fully bore out the charges brought against tation is held out to neglect their patients, the system of Poor-Law medical attendance, to supply cheap and inefficient remedies, and and showed that two classes of evils had to trust the lives of the poor to apprentices thence resulted, which, though very inti- and unqualified assistants. Such were some of the most prominent timately connected, might properly be divided into two heads :evils which presented themselves in consithe subject ; and that nothing might I. Those affecting the profession ; and be left undone by the Council in their endeaII. Those affecting the poor. vours to remove them, it was resolved that I. Under the first head the chief evils a communication should be opened with the were as follow :Provincial Medical Association, and espe1st. The very inadequate rate of remune- cially with the Poor-Law Committee; that, if possible, the efforts of the two Associaration, generally speaking. 2nd. The prevalence ot the degrading sys- tions should be joined in this laudable work. teiii of « tender." Accordingly, several members of the Conn-
Accordingly
during
753
cil having intimated then intention of being establishment of Medical Clubs ; the selecat Cheltenham during the anniversary meet- tion, in many cases, of young and inexperi-
ing of the Association there,
in
July, 1837,
Dr. Marshall Hall and Dr. Webster were deputed to represent the Council, and to take such steps as might appear to them neThese gentlemen cessary and expedient. were very courteously welcomed by Dr. Boisragon, the President, by Dr. Hastings, the Secretary, and other members of the Provincial Council, and as Dr. Webster’s sole object was the consideration of the Poor-Law question, he was introduced to Mr. Rumsey, the Secretary, and to the nrembers of the Poor-Law Committee, who imInediately invited him to join them, and take all active part in their proceedings. This he
practitioners, &:c.&c. That your petitioners are fully that the above-mentioned evils enced
persuaded highly
are
to the sick poor, unjust to the medical profession, and adverse to the public health. As the most likely means of effecting a just and equitable arrangement of this important question, your petitioners would respectfully suggest the establishment of a Medical Board (elected by the profession) to act in concert with the Poor-Law Commissioners, su as to superintend and regulate the duties and emoluments of parochial
injuiious
surgeons.
accordingly did, and at the general meeting That your petitioners, in the meantime, for transacting business, having become a pray that your honourable House will be member of the Association, he proposed that pleased to institute a full and searching inthe report which had been prepared on the quiryinto the alleged evils, and that you subject, should be read and adopted, which will order a return of all appointments, been done, he also moved that peti- number of medical officers, amount of salaembodying the recommendations of the ries, extent of districts, &c., before and since Committee, should be prepared and present- the introduction of the Poor-Law Amend-
having tions
ed to both Houses of Parliament ; this was ment Act; and that your honourable House seconded by Dr. M’Cabe, of Cheltenham, will be pleased to adopt such measuies as and carried unanimously. It was also under- you may consider most conducive to the stood that free communication should be public good, and the benefit of the medical held between the societies, with the view of profession. And your petitioners will ever pray, &c. settling this important question. The Report of the Poor-Law Committee The adoption of this petition was moved of the British Medical Association, was laid before the members at the first anniversary, bv Dr. Granville, seconded by Mr. Baiuwhieh was held on the 30th September, bridge, and carried unanimously, and it re1837, along with a second, or supplemental ceived numerous signatures in the course of report, statingthat the evils enumerated the evening. In consequence of the election of a new above not only still continued with unabated force, but were increasing with the exten- Council at the anniversary, it became necession of the Poor-Law Amendment Act in the sary to appoint another Poor-Law Committee, various localities of the kingdom, notwith- which was accordingly done on the 14th of standing the remonstrances and protests of November, 1837, for the purpose "of watchthe profession. The Report alluded to the ing over the proceedings in Parliament, and various remedies which would be necessary, elsewhere, respecting the New Poor-Law ; and recommended that a petition should be to take into consideration the plans that presented to Parliament praying for a re- should be adopted for reforming its operadress of the grievances complained of. Ac- tions; aud also to collect information genecordingly a petition was prepared, of which rally respecting it." The members were-
the
following is a
copy
:-
To the Honourable the Commons of Great Britain and trelcesd in Purliarneot assem-
bled. The humble petition of the undersigned members of the British Medical Association,
Showeth,
Bainbridge, J. N., Esq. Clarlce, John, Esq. Crisp, Edward, Esq. Davidson, Robert, Esq. Eales, William, Esq. Evans, E., Esq. Farr, William, Esq. Hilles, M. W., Esq. Lavies, John, Esq. Porter, Thomas, Esq. Rowe, Dr. Wagstaffe, M. F., Esq. C. H. Rogers Harrisson, Hon. Sec. At the same meeting of Council the following resolution was moved and carried
That your petitioners deeply regret the rontinuanee of the many grievances resulting from the Poor-Law Amendment Act, which have been so frequently and loudly romplained of by the great majority of their professional brethren. The chief of these are,—the system of contract by tender ; the unanimously :inadequate remuneration ; the small num. Resolved,—"That the Council of this ber of medical officers compared with the Association earnestly recommend their mpit extent of the unions and districts; brethren throughout the kingdom to
the dical
754 call
meetings in their respective districts
to
consider the grievances affecting the profession ; and especially to petition Parliament for a National Faculty of Medicine, and for an inquiry into the present system of medical attendance on the sick poor." Several communications had been received from Messrs. Rumsey and Ceely, of the Provincial Association, and these gentlemen were desirous that the efforts of the two Associations should be united and directed to the object in view. On the 19th of November last Dr. Webster received a letter from Mr. Rumsey stating that the Council of the Provincial Association had requested Mr. Sergeant Talfourd to become their advocate in Parliament, to watch any proceedings that might take that he (Mr. Rumsey) had requested Mr. Talfourd to receive Mr. Ceely, of Aylesbury, Mr. May, of Reading, and himself, as a deputation to confer on the best measures that could be taken during the ensuing session of Parliament, and he now begged the favour of Dr. Webster to accompany them,’ as he considered his doing so would on many accounts be of importance to the success of the cause." With this Dr. Webster readily complied, and the deputation was politely received by the learned sergeant. The gentlemen of the Provincial Association mentioned several plans they had in view. One was the appointment of a Select Committee of the House of Commons, if it could be obtained, to consider the medical department of the Poor-Law apart from the general question. Mr. Talfourd doubted whether this would be granted, and stated that if it were he could not act as its chairman, which would be expected of him as the mover : this plan was relinquished. Another was to endeavour to introduce a short bill into the House to remedy the grievances complained of; but Mr. Talfourd did not think this could be accomplished, and the idea was therefore abandoned. The honourable Member was then requested to obtain certain returns which had been suggested by the Provincial Poor-Law Committee. He expressed his willingness to move for them if his doing so would not interfere with any object in view ; though he was very doubtful whether they would be granted. It was then suggested that perhaps these would more likely be obtained in the House of Lords, and it was agreed that Lord Wharncliffe should be requested to move for them. Dr. Webster then thought it right to inform Mr. Talfourd that, as a member of the Council of the British Medical Association, and as a friend to the profession, Mr. Wakley was very anxious to bring the abuses complained of before the Poor-Law Committee of the House of Commons, and that it was his intention to endeavour to arrange
place ;
this as
soon
after Parliament met
as
possi-
ble ; and suggested that in any proceedings which might take place, it would be very
desirable if Mr. Talfourd and Mr. Wak. ley, as the representatives of the two Asso. ciations in Parliament, were to act together, especially as Mr. Wakley was master of the whole bearings of the subject. Mr. Tal. fourd at once said that if Mr. Wakley had any plan in view, he was so much better qualified to judge of such a question, and would be listened to in the House with so much greater attention on any medical question than himself, that he would wil. lingly give way to him, and endeavour to render him all the assistance he could, and would be happy in any way to promote the objects which the deputation seemed to have so much at heart. The deputation then waited on Mr. Vakley, and conferred with him on all the bear, ings of the case ; he entered most readily into the views which he entertained, and advised the deputation as to their future proceedings. He thought the inquiry before the Poor-Law Committee was the best mode of making known the grievances which the Amendment Act had brought upon medical men, and the most likely way of obtaining redress ; and that as soon as Parliament met he should bring the question before the Committee. He considered that returns from the Unions might throw much light on the subject, but doubted whether all those re, quired by the Provincial Association could be obtained, as several of them embraced circumstances and periods previous to the Amendment Act. Mr. Wakley thought there could be no harm in trying to obtain them, or as many as possible, through the House of Lords. The deputation then proceeded to Lord Wharnclifle’s to induce his Lordship to move for the returns, but he was from home. Dr. Hastings afterwards wrote to him for this purpose, and his Lordship made inquiries, but was informed that they could not be obtained for many months, that they would be very voluminous, and would cost many hundred pounds, so he did not think it prudent to move for them. The Poor-Law Committee of the British Medical Association held frequent meetings in furtherance of its various objects, and on several occasions the whole members of Council resolved themselves into a Poor. Law Committee. At one of such meetingsit was suggested that it would be highly important to obtain official and accurate returns on many points connected with the administration of medical relief, so that sufficient data might be procured (as none hitherto existed) from which to calculate the remuneration of the medical officers, according to the distance, number of patients, cases constantly on the sick-list, &c. &c, ; the average size of the districts, the population, and other particulars, showing the amount of
755
labour actually performed. The Council nesses, to engage a temporary office near the unanimously requested Mr. Farr, one of House of Commons, and to make all necestheir own number, to draw up the forms sary arrangements. It consisted of which he thought best adapted to obtain the Davidson, R., Esq., (Chairman
required information, which he at agreed to, and prepared the requisite dules. When these forms
were
drawn up
once
sche-
they
Eales, Wm., Esq., (Secretary.) Farr, Wm., Esq. Hilles, M. W., Esq. Lavies, John, Esq. Wakley, Thos., Esq., M.P: Webster, Dr. These gentlemen held frequent meetings
who informed the Council that through his representations the whole of the Returns were ordered by the House of Commons, in New palace-yard, Westminster, they corwith the full concurrence of Lord John responded with the Medical Association at Russell. It is but just to add that the Bridgewater, with the Stroud Medical AsPoor-Law Commissioners afforded all the sociation, with Messrs. Rumsey and Ceely facilities in their power, and in one or two of the Provincial Association, and with other’ gentlemen in different parts of the points made additions to the returns. The Parliamentary Committee Almost immediately after the meeting of country. Parliament Mr. Wakley presented the peti- consented that Mr. Wakley, as one of the tion of the Association to the House, and members, should be put in possession of the moved that it should be referred to the returns as fast as they were received, in Poor-Law Committee, which was accord- order that the whole of them might be exingly done, and he was also able, previous to amined and arranged by Mr. Farr, so as to the Christmas recess, to arrange, with the exhibit the general results. The informaconseit of Lord John Russell and the Com- tion contained in the 11 Returns;’ which had mittee, that an inquiry into the medical come in from the parochial medical officers, abuses and the examination of witnesses clerks of guardians, masters of workhouses, should take place at any period during the &c., had been so far classified, and the session that would be most convenient to general bearings of the question determined, himself and the petitioners. Owing to the that it was agreed about the beginning of tardiness with which the medical returns June that the examination of witnesses came in, and other circumstances, it was might take place at a very early period. several months before the inquiry could Mr. Wakley had arranged with Mr. safely be brought on. Fazakerly, the Chairman, and the members In the meantime the Poor-Law Committee of the Poor-Law Committee, as to the mode of this Council were engaged in maturing in which the inquiry should be conducted. their plans, and they presented a "Report"It was properly and wisely agreed that no to the Council with " suggestions for an particular abuses, nor instances of neglect, amended system of medical relief." These or of professional malpractice, should be suggestions," after being submitted to the brought forward, but that evidence should deliberate consideration of the Council, be adduced to prove generally, in the first were printed and distributed among the instance, the evils of the system as laid down members of the Association. The Report and continued by the Poor-Law authorities ; condemned the system of medical contracts that that system was fraught with danger by TENDER adopted by the Poor-Law to the poor, with injury and degradation to authorities, and the establishment of ill- the profession, and with injustice to the constituted MEDICAL CLUBS, as inju- community. It was, however, necessary rious to the poor, delusive to the public, and fOI the advocates of medical practitioners to unjust and degrading to the medical profes- do more—it was incumbent on them not only sion. After stating that the Council were to prove that the present system was inefdesirous of recommending for adoption, in- fective and injurious, but to lay before the stead of the mode in use, a plan which Committee and the public a plan which should secure to the poor the fullest should be free from theobjections of the old amount of benefits which could be conferred one, and which should be so based as to by medical assistance, and to the gentlemen carry the judgment of all reasonable persons engaged in preserving the public health a in its favour. The witnesses to be examined fair remuneration for the services which they were thus to speak only to the injuriousness were constantly performing, the Report of the present system, and to offer opinions went on to offer the several suggestions on any better plan that should be proposed, with which the members of the Association the Committee having, of course, the power are already well acquainted. to sift the evidence and opinions, and to Onthe2’lth March the Council considered cross-examine the witnesses : hut to save it expedient to appoint a Sub-Committee on time and to prevent a protracted inquiry, it the Poor-Law Question to procure and ar- was at once admitted by the Chairman that range evidence preparatory to the Parlia- an inquiry was necessary, that some abuses mentary Inquiry, to determine what names did exist, and that no witnesses should be should be suggested as those of the wit- called on the part of the Poor-Law authori3 C2
placed
were soon after
in Mr.
Wakley’s hauds,
756 ties to contend for the present system as a A Plan for an Amended System of Parochial Medical Relief and Inspection,—compre perfect one. It was, however, distinctly understood if the evidence adduced should hending— fail to convince the Committee of the neI. The population and extent of medical cessity of extensive alterations, that then districts. the advocates of the profession should be at 1st. In dense populations, as inthemetro. liberty to bring forward the subject afresh, polis, large towns and cities, the number of inquiry, so as to place before in a medical district not
and renew the the the the instances Committee poor, and and toandthe abuse which had of poor, of
resulted
oppression
had affected the profession,
well as of neglect and malpractice on the part of the medical officers of unions. The convenience of all parties having been consulted, it was arranged with Mr. Fazakerly, the Chairman of the Committee, that the examination of witnesses should commence on the 19th of June ; and on the ltith, the previous, an meeting of the Council of the Association, several of whom were to be examined, and of others interested in the question, took place at Westminster. cases
evening
ought
10,000, that number to be reduced accordingto the state of pauperism. present average is aboutl5,000 all
the instances power
as
inhabitants
extraordinary
The object of this meeting was to consider the various suggestions which had been made by different societies and individuals, and to throw them into a detailed plan, which all present might be able to agree to and offer to the Poor-Law Committee, Messrs. Rumsey and Ceely having had considerable experience of the operations of the new law in the country, and having collected a great number of facts from their medical brethren, were asked if they were prepared with the details of any measure which they wished finally to recommend to the Committee? Mr. Rumsey replied, that they were not, but having given much time and attention to the subject there were many facts that they could speak to, and opinions they could give, on the different points. Some of these Mr. Rumsey detailed, and especially considered that the salaries of the medical officers should be paid by a percentage of from 4 to 7 per cent. on the poorrate, or the money absolutely expended on the poor, varying the rate per cent. according to the nature and extent of the duties ; he thought that the election of the officers should be restored to the rate-payers, that Medical Assessors should be appointed, and a Medical Commissioner. The · suggestions" of the Council of this Association were then considered. After a very extended discussion, embracing all the important features of the question, and eliciting opinions from most, if not all, of the gentlemen present, the following plan was unanimously agreed to. In drawing up this plan the great importance of the parliamentary returns and of the statistical results deduced from them by Mr. Farr was discovered ; in fact, the greater part of the details must been been guesswork without such accurate sources of information :--
to exceed
Note.—The each medical distnct, 1 nbt " bitantsin aseerthe parliamentary returns alluded tained by to. as
2nd. The size of rural districts should average from 10 to 12 square miles, which would give an average population of 2500. Note,-The present average size of rural districts is 21 square miles; average number of inhabitants,, 5000. - (Extracted from
returns.)’)
11. Remuneration. This should be by a salary calculated on the number of cases, the number constantly on the sick-list, the distance or extent of districts, the density of population, the cost of medicines, the value of skill and time, &:c. 2nd. Separate charges should be allowed for midwifery, capital operations, dislocations, fractures, and vaccinations. 3rd. The average charge for one person constantly on the sick-list should be about R.55s" or for each case from 6s. to 7s. Note.—These charges would amount to about 6d. a head oil the whole population. The prime cost of drugs alone for each case of illness calculated on hospital and dispen. sary practice, is from 2s. 6d. to 3s. 6(!. Now, the present average cost allowed by the Poor-Law Commissioners for medicines, attendance, and medical appliances to each case, as shown by the returns, is 3s. 3d. in the country; in the metropolis,
1st.
2s.
1d.
JII. Medical supervision.-It is recom’ mended1st. That there should be a Medical Com, missioner or Director appointed by the Crown to superintend the whole parochial medical arrangements, and to whom all points of difference between the proposed Medical Guardians or Assessors,or between the medical officers and the ordinary guar. dians, should be referred. 2d. That a Medical Guardian or Assessor should be elected for each Union by the resident medical practitioners (or a majority of such resident practitioners), to act on their behalf, with another appointed by the Guardians on behalf of the Union. These Assessors should calculate the amount of salary to be paid to the medical officers, according to the rate recommended above, taking into account the circumstances of each locality, determine the size [of the
757
Should the medical water, in Somersetshire,* and of Stroud, in medical districts, &c. practitioners decline to elect an Assessor then Gloucestershire, who could have spoken to the Medical Commissioner is to appoint one. particular as well as general abuses. When,
The Medical Assessor might act as the con- however, the excellent arrangements alsulting practitioner for the Union, give the ready mentioned was made by Mr. Wakley Guardians advice on any case that may with Mr. Fazakerly, this was quite unnearise at the boards requiring medical know- cessary, and the Council were anxious to ledge, draw up an annual report of the give as little inconvenience to their medical health of the Union, &c., and be the medium brethren in the country as possible, and to of communication between the medical call those witnesses only who were consiofficers and the Commissioners. He should dered competent to prove the case of the probe remunerated by a salary proportioned to fession generally. It was also possible that the duties he would have to perform. Such the evidence of these gentlemen might still was the plan agreed to at this important be required if the desired effects were not meeting, or rather the outlines of a plan to produced, and the Poor-Law Committee be filled up or modified according to cir- should consider that a case had not been cumstances:* made out against the present Poor-Law The examination of witnesses by the system. be impossible to go at length Parliamentary Committee commenced on Tuesday the 19th of June, and was conti. into, or to give extracts from the evidence. nued throughout the week; the Committee The whole has been printed in one volume part of the Poor-Law inquiry, sitting five or six hours daily (much beyond as a their usual time), that as short a period and the members of the profession may have might be occupied, and as little inconve- access toitthrough the kindness of their nience as possible given to the medical gen- parliamentary friends.t It may, however, be proper to state in general terms, for the tlemen. information of the members of the AssoThe witnesses were examined in the fol- ciation and of the profession, the objects lowing order :kept in view, in calling and examining the different witnesses, and what their evidence 1. Mr. Rumsey, of Chesham. 2. Dr. Webster, Surgeon, of Dulwich. went to prove. Mr. Rumsey, Dr. Webster, Mr. Ceely, 3. Mr. Ceeley, of Aylesbury. Dr. Rowe, Mr. Evans, and Mr. Toogood, 4. Dr. R. D. Thomson, of London. were examined as tofacts, which proved the 5. Dr. Rowe, Surgeon, of Chigwell. the poor and evils of system 6. Mr. Farr, of London. the which had come under their 7. Alr. Evans, of Southwark. own observation. All these gentlemen had 8. Dr. John Elliotson. a practical knowledge of the subjects and 9. Mr. Toogood, of Bridgewater. from their own experience, and 10. Dr. Marshall Hall. in addition, some from their offices, had also 11. Sir Astley Cooper. 12. Dr. Kay, Assistant Poor-Law Com, had a voluminous correspondence with those who had a practical knowledge, and missioner. who had pledged themselves to the truth of Several other gentlemen were facts contained in their statements. All and among them Dr. Yelloly and Mr. Soulby, the evils complained of were fully borne out of Ashe, but some were prevented attending of these witnesses, and they by the and others did not arrive in time to be ex- all in the necessity of the extensive agreed amined. and immediate alterations which were reThe Council had intended to have many commended to the Committee. more witnesses called in the first instance, of these witneeses The and a number of gentlemen were written to by the members who were supposed to be in many parts of the country, whose most friendly to the Poor-Law did not in dence, from the abstracts forwarded to the any way shake the facts and opinions which Council, would have been most valuable, as they advanced. These facts and opinions for example the practitioners of Bridge- went to prove that the medical districts were too large ; the medical officers too few ; the remuneration inadequate; the knowledge
It would
distinct
.
the ptofession,
affecting
couldspeak
summoned,
the
evidence
cross-examination
evi-
’
It ought to be stated that Messrs. Rumsey and who were present at the above meeting, * Mr. Toogood was examined on some general wished it to be understood that they were so only being taken of his presence in points, 11 in the characters of witnesses," having been London,advantage to be examined at length before the Poorsummoned by Mr. Wakley, at the suggestion of the Law Committee of the House of Lords, on the alCouncil of this Association ; but the Council of the medical and other abuses in the Bridgewater 1’roviucial Medical Association had previously ap leged Union. pointed Mr. Farr, the talented. member of the Council of the British Medical Association, to be t The whole evidence may be purchased for Is. 7d. their delegate at the ensuing inquiry, with ful at the Parliamentary Papers Office, in Abingdonto measures on their hi take such behalf as Westminster; it may be forwarded through powers the booksellers. might see fit.
Ceely,
street,
-
758
subject possessed by non-profussiunal and which genuine drugs could not be purby far too limited ; medical superin- cilasell at, had been offered to them by che. tendance wanting ; and the system of tender mists for the Poor-law consumption, know. nnd medical clubs as constituted by the mg that these gentlemen attended the poor. The examination of Dr. Kay, an Assist. Commissioners, discreditable to tmy hrufessiou. ant Poor-Law Commissioner, must be Hut as these witnesses might be supposed viewed as of much importance, inasmuch from their situations and pursuits to take a as he at once admitted that evils to a consi. partial or prejudiced view of subjects derable extent existed at present, and that of the
men
the average scale of remuneration recommended by the witnesses was a very mode. rate and fair one; and that in many of the districts under his superintendence thesa. abilities, placed them beyond any such sus- laries paid to the medical officers, were even picions. Accordingly, Sir Astley Cooper, more liberal. In his arrangements, he had Dr. Elliotson, and Dr. Marshall Hall,were always wished to make the medical districts severally examined on the facts and opinions small ; he had never resorted to tenders; advanced, and the plan recommended, endeavoured as little as possible to disturb Having perused the evidence given by Mr. existing medical officers and had never sn. Rumsey and Dr. Webster, which had been perseded any of them, because they might printed immediately and sent to them, they not approve of or belong to medical clubs. in the amplest manner supported what had Dr. Kay felt some delicacy in offering an been advanced by’ these witnesses, and opinion as to the appointment of a Medical gave it as their deliberate opinion, that the Commissioner or of Medical Assessors, but extent of the districts, the inadequate remu- rather disapproved of them than otherwise. It is gratifying to the Council to believe neration, the want of superintendance, and the prevalence of tender and medical clubs that the mass of evidence thus brought formust be injurious to the poor, to the profes- ward, consisting of facts, figures, and opision, and to the public health. nions, all bearing on a question so important Mr. Farr’s evidence was altogether of a to the health of the poor, and the best in. different kind, it was neither circumstan- terests of the medical profession, has not tial nor derived from his own knowledge of been collected and adduced in vain. It was facts; nevertheless, it was equally import- quite evident to any one who was present ant, and of more general application than and witnessedthe examination, that a very that of any other gentleman, being derived considerable and salutary impression was from the parliamentary returns which have produced on the members of the Poor-Law been mentioned, and from other authentie Committee. It appears likely that the evils arising documents. Figures and statistical tables, as well as verbal statements, were thus from, and comprehended under, the heads brought to bear on the question, so as to "Extent and Size of Medical Districts," and prove beyond a doubt, that the allegations "Inadequate Remuneration," will be re, raised against the Poor-Law system were medied, but the Council deeply regret that not groundless. their recommendations for an efficient plan Dr. R. D. Thomson, a scientific chemist of " medical superintendance and inspee. in London, was examined to prove the very tion " did not seem to meet with that appro. common practice in the drug trade, of adul- bation from the Committee or the Poor-Law terating medicines, especially the more authorities which its great importance so active and energetic ones. This he did to imperatively demands. It is feared that the satisfaction of the Committee by per- little, if anything, will be done on this head, forming before them a few experiments on but should the Council be disappointed at drugs, which he had procured from retail present in obtaining a Medical Commissioner chemists, and which were found to be very and Medical Guardians or Assessors, the impure and deteriorated in quality. His subject must not be lost sight of, as in their evidence also showed that all the usual me- opinion the want of a proper plan of profes’ dicines could be purchased at two or even sional superintendance would more or less three prices, which proved the difference vitiate the working of the whole system, and of quality, and that all powders were in would also impede the scientific results general much adulterated by the drug- which might be so readily obtained under grinders. The inference to be drawn from the organised plan recommended by the Counthese circumstances, was that medicines cil. It is true that Dr. Kay, who has been either inert, or of a very inferior kind, would so active as an Assistant Poor-Law Commis. most likely be used for the poor, where the sioner in Norfolk and Suffolk, and who, by salaries of the medical officers were below, hisjudiciousarrangements, deserves well of or not more than equal to the prime cost of his medical brethren, is now appointed to the medicines which ought to be employed the metropolitan districts. The Commisin each case of illness. Two witnesses sioners, it seems,are aware of the importance stated that medicines at a very low price, of having a medical adviser to refer to, and
which somewhat affected their own interests, it was deemed prudent to call for examina tion men whose high characters and standing in the profession, and whose talents and
759
benefits may result to the profession has taken place in such a manner as to bring from Dr. Kay’s liberal feeling and 11 esprit their wrongs and the wrongs of the poor du corps," but he is altogether irresponsible before Parliament and the public. It affords to his medical brethren, and entirely depen- another excellent illustration of what may be dent upon the Commissioners who appoint accomplished by union, energy, and organhim, and may remove or translate him to isation, and is a pleasing proof of the another district if they should see fit. He utility of such associations, when based upon However may, therefore, recommend,but has no power, sound and liberal principles. individuals might have been, and, indeed, no medical coadjutors to enable him to carry out any plan of inspection, even andhowever much they might have tried to supposing it should meet with the approba- effect on such a question, it is evident that tion of the Commissioners, they could not have commanded the same It would be an act of the deepest ingrati- sources and amount of information, the same tude were this Report to conclude without varied talent and persevering industry and alluding to the debt which the profession application necessary for such an underas a number of persons can do, at large, and especially the Council of this Association owe to one of their own when united to effect a purpose in which all members, without whose exertions and in- feel a deep and common interest. It also fluence they fairly believe that the Parlia- shows what unity, perseverance, and a just mentary Inquiry could not efficiently have cause may, and doubtless will, sooner or taken place ; it is almost unnecessary to later, effect in removing the many other inmention that Mr. Wakley is alluded tu; to jurious abuses which at the present moment him the profession are indebted for their affect the medical profession. The Council, earliest information of the evils which he confidently expecting the reform of these foresaw would result from the system about abuses, earnestly request the active co-opeto be established ; by him were contracts by ration and encouragement of their medical tender, the self-supporting dispensaries, and brethren in their various endeavours to unite the Poor-Law Medical Clubs, denounced the now divided and discordant branches of and strenuously opposed ; to him the Council their profession into one body or faculty, owe the medical returns, which in Mr. Farr’s which shall have a representative and rehands have been so useful and important in sponsiblesenate,possessingadequate powers the inquiry; and but for Mr. Wakley, and his for the government of the members and for position in Parliament and in the Poor-Law the regulation of all matters affecting their Committee, the Council are extremely interests and respectability. Had unanimity doubtful whether any inquiry at all would prevailed, or had such a faculty been formed have taken place ; but it is quite certain that 9, few years since, most of our professional no other man, whether in or out of Parlia- abuses would have been swept away, and ment, could have brought the same know- the numerous evils of the Poor-Law could ledge of facts to bear on the subject, nor never have existed. The Council would only farther add that have conducted it with such tact, judgment, and prudence as he did, and which all who the members of the Association and their were present will readily acknowledge ; and professional brethren may depend upon their when it is considered that he sacrificed his being constantly in observation at their personal feelings in a time of the severest posts;that they will watch with jealous eyes domestic affliction to render a service to the the extent of the ameliorations contemplated profession it will greatly tend to enhance the by the Poor-Law Committee and the mode in which they may be carried out by the debt which the profession owe to him. That this important inquiry was conducted Commissioners; that they will still endeavour to the satisfaction of all parties may be pre- to obtain a proper system of medical supersnmed from the remark of the Chairman of vision ; and, if it should be necessary, that the Poor-Law Committee, who, in thanking they will use their utmost efforts to remove the witnesses for their attendance, observed any other abuses that may remain after the that it had been carried on in a way ex- proposed amendments are adopted. tremely pleasing to himself and the ComINDIGO IN EPILEPSY.—Dr. Roth, of Mamittee ; and when the examination had closed Dr. Webster requested permission to thank yence, has published a paper on the employthe Committee for the very courteous man- ment of indigo in spasmodic affections, espeIt is given in the shape of ner in which all the witnesses had been cially epilepsy. examined, and especially for the kindness, an electuary made with syrup and water the patient attention, and the great interest two parts, indigo one part; of this mixture which the Chairman had shown throughout an ounce is a fair dose. In the form of the inquiry. powder it is apt to create irritation and The Council cannot conclude without spasm of the fauces. A tendency to diarcordially congratulating the profession in hoea sometimes follows its employment, and general, and particularly the members of must be checked by astringents. Nausea this Association, on the present aspect of the and vomiting are produced by a large dose, Poor-Law question, and that this inquiry It was beneficial in many cases,; some
anxious private
taking
’