DR. FARR ON THE REGISTRATION CLAUSES OF THE VACCINATION BILL.

721 the presence of additional examiners, chosen from the profession at large by the Senatus. Dr. Leet considers that, with some qualification, ’’ the examinations for degrees in medicine and surgery are conducted with great care and impartiality." University of Dublin. -The visitor was Dr. Leet. Candidates are examined in class, not separately. They do not seem to be examined clinically. Though Dr. Leet says that the candidates, in all the papers submitted to him, evidenced scholarship and considerable professional knowledge, he recommends "that the standard for the degrees be fixed higher." College of Surgeons, Irelctnd. Dr. Aquilla Smith, being alone, was only able to watch the examination of one student. The questions werepractical and fair tests. He was not present at the preliminary examination, not having been informed of the time of it. Mr. Hargrave King and Queen’s College of Physicians. gives only a vague account of the examination of one candidate for a licence in medicine, and of another for the diploma in midwifery. Both candidates were successful. There is a want of the clinical element in all the Irish examinations. -

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DR. FARR ON THE REGISTRATION CLAUSES OF THE VACCINATION BILL. THE remarks of Dr. Farr, at the late meeting of the Parlialiamentary Committee of the Metropolitan Counties Branch of the British Medical Association, held at Soho-square, on the objections to the working of the registration clauses of the Vaccination Act, are so important at this moment that we insert them entire. Dr. FARR.-Upon the invitation of your Committee, I have had great pleasure in attending this meeting to discuss a subject of much interest to the British Medical Association, of which I am an old member. By the resolution moved by your Secretary, you are asked to recommend that all the clauses of the Vaccination Bill relating to registration should be struck out. Before you come to a decision, it may be convenient for me to state what part of the measure, in the opinion of the Registrar-General, should be retained, and what part should be rejected. Without at all entering on the delicate question of the policy of compulsory vaccination, I venture to say that the Registrar-General desires to promote, as far as he has the power, the practice of vaccination; that he is not opposed to improvement; and that he would be glad in any way to aid the members of the medical profession in any of their efforts for the public good. Before mentioning his views, permit me, for myself, to state generally that I agree with those gentlemen who condemn the Vaccination Act. Than its registration clauses nothing can be conceived more impracticable. Anyone who has the slightest administrative capacity could have foretold its failure from the most casual consideration of its clauses. It is a piece of amateur legislation for which, as far as I know, no Government department is responsible. I hope Dr. Seaton will be able to disclaim, on the part of the Privy Council, any hand in it. Lord Palmerston, convinced by the Registrar-General that the registration clauses would not work, intended to propose their omission in Committee, but happened unfortunately to be absent from the morning sitting at the end of the session, and the Bill passed as it came down from the Peers. Under that Act the parent or informant was supplied with a notice filled up by the registrar; and the vaccinator was required, besides entering the full particulars of the case in his own vaccination-book if he succeeded in getting a sight of his patient on the eighth day, to enter in a certificate for the father or mother &c. the following particulars: (1) name; (2) age; (3) father’s name; (4) residence of child-namely, street, parish, and county; (5) date of grant of certificate; (6) signature and professional titles. He had to fill up a duplicate of this certificate, and to copy further a most essential particular - the number of the entry in the birth-book-from the noticepaper given to the father, mother, or other person, to be kept by them, and to be presented to the vaccinator when the vaccinated child is taken to him for inspection; then, after folding this duplicate certificate, he had to -write out, as its superscription, the name and address of the registrar (taken also from the notice-paper), if the child was vaccinated in the subdistrict of its birth. If the child was vaccinated in another sub-district, as often happened, he was instructed to send it to the registrar of that sub-district; consequently the registered

vaccinations of a sub-district do not correspond with the birth registers of that sub-district. The registrar, upon receiving a certificate of successful vaccination, has to look through his vaccination book to find the child’s name and to complete the entry; or, upon not finding it, to enter as many of the parti. culars as he finds in the vaccination certificate. Should the child be " unfit" for vaccination, the vaccinator fills up a special certificate to that effect; and if the child be insusceptible, the insusceptibility is also certified. You will thus see the amount of clerical labour which is thrust upon the surgeon. The inquiry into the facts, and their record, must evidently, on the face of it, be much greater and much more distasteful to an expert surgeon, who rarely likes to put his pen to paper, than the operation of vaccination. What hindrance these certificates throw in the way of a man whose station is full of children, or who wants to get away to other patients, or to a woman at a distance in labour, What has happened under these cirwe can easily conceive. cumstances ? Why simply that not only private practitioners, but even the public vaccinators, have generally not filled up these duplicate certificates-have not forwarded them to the registrars-where they had the means, which would be wanting in many cases. It is quite an exception to find the Registers of Successful Vaccination filled up; and the cost of the books, as well as the labour of the registrars, is completely thrown away on these incompleted entries. Here is the Birthbook of Dr. Allen, of this very sub-district in which we are meeting (St. Ann, Soho); and here is one of his Vaccination Register books, containing 500 entries, of which, in his exceptional case, 287 are certified as successful, for the simple reason that Dr. Allen is at once an able and energetic practitioner, a public vaccinator, and a registrar of births : in fact, of the 287 completed cases, 186 are cases vaccinated and certified by Dr. Allen himself. In his case many of the vaccinated children are not in his Birth-book, and conversely. 213 of the entries are not completed. Dr. Allen has nineteen books full of this class, and has never found them to be of any use. Under the Act (16 & 17 Vict., c. 100, s. 8) the registrar is to allow a search for a fee of one shilling, and to grant a certificate from his book for sixpence. He has been applied to for one search in the course of his experience, and so unpractised was the Doctor that he was cheated of his shilling by the party, who declared that they did not want a certificate. This is a conclusive proof that if the greater part of the entries were completed, the registration would be of no use. I have a book from another sub-district of this Strand Union : nearly all the columns for the registration of results are blank. Two books from Hastings contain, in 1000 entries, 239 completed, 761 being incomplete and consequently worthless. Of the 239 children 98 were born out of the district. An average book of Mr. Butterfield (Islington), one of the most diligent London registrars, contains, in 500 entries, only 65 completed : the deficiency is 87 per cent. Dr. Seaton names districts where the entries are tolerably complete, and such instances no doubt are found. But if you will name any half dozen sub-districts at random, I will engage to get the books, and prove to you that the measure, tried by the results, has been a complete failure. The registration machinery of the new Bill is in some respects more objectionable than the machinery of the last. It imposes the task of writing out the certificate on every public vaccinator, and of transmitting it to the registrar under a penalty for default of twenty shillings (sec. 29). Upon request, under the same penalty, he is bound to supply the parent with a duplicate. The parents are to be supplied by the registrar with three forms of certificate-one suited to successful cases, one for the unfit, and one for the insusceptible ; and these parents, large numbers of whom cannot read or write, are to keep the forms, to lay them before the vaccinator, and, if he is a private practitioner, to get him to fill them up, and then to transmit the certificates to the registrar. How many parents will do this I leave you to divine. That great numbers will fail, whom it would be useless to sue for the penalty, cannot be doubted. Thus all the labour, trouble, and annoyance of these certificates upon certificates is maintained under the proposed Bill, and parents and medical men have impending over their heads a new cloud of penalties. That could be borne, and would be borne, if the registration could be rendered complete, and was at the same time productive of results at all commensurate with the labour, risk, and expense to be But it is not the case. incurred. The registers will, I believe, be of little or no statistical use. The whole of the information required may be got from the registers of the public vaccinators, supplemented with such additional infor-

722 mation

could be procured periodically from private pracwho would be, no doubt, willing to keep a list of their cases in a prescribed form, and supply returns for moderate fees. In Scotland the registration of births is very properly made compulsory, and there the Vaccination Act is worked with the greatest rigour; but as, unlike the English Act, it contains no provision for the verification of success, I cannot concluding, from the numbers returned, that in Scotland help " vaccination"and" successful vaccination are often used as convertible terms. In Scotland the Registrar-General was probably consulted, and the whole apparatus and expense of "registers of successful vaccination" books is got rid of ; the certificate is sent to the registrar of the birth, who writes simply " vaccinated as per certificate, dated May 30th, 1866," in his birth register. That works in Scotland, but in the large districts of England it would be more difficult, in consequence of the birth registers passing quickly into the hands of the superintendent registrar. And to enable you to trace all the children it would be necessary to write off those who died, as well as those vaccinated with or without result. The simplest course is undoubtedly to abolish the "registration of successful cases"altogether, to save the expense, and to free the practitioners of the kingdom from the onerous grant of certificates of no value, enforced by vexatious penalties: trusting for information, on the one hand, to the registers of the public vaccinators, supplemented by private records ; and, on the other, to inspection of the arms of children for marks. It is evident that no one in his senses would propose to prosecute the parents of all the children whose vaccination was not registered; for only a few would be selected as examples, on well-considered grounds, about whose conviction there could be no difficulty. I am not prepared to deny the force of what Dr. Seaton has stated about the possible influence of the registrars ; but hitherto they have been badly treated under the Act, and have just grounds of complaint against its injustice. I need not say that, in suggesting the abolition of the useless parts of the Vaccination Bill, I do not intend to call in question the value of the services of Mr. Simon or of Dr. Seaton and his colleagues in promoting and improving our system of vacas

titioners,

cination.

I will now read briefly what the Registrar-General has proposed for the improvement of the measure before Parliament.

He proposes to omit the register and its attendant certificates; to give notices to parents through the registrars ; and to supply forms to medical men gratuitously; leaving parents liable to prosecution for neglecting the vaccination of their children, and boards of guardians to select the requisite number of cases

for

prosecution.

into, under certain conditions, with those countries whose university degrees are admitted to the English Register. the

Medical Act in The advantages of any relaxation of this direction should not, I think, be entirely on the side of Your obedient servant, holders of foreign degrees. GEORGE F. HELM, M.A. Cantab., F.R.C.S. Rugby, June 3rd, 1867.

the

UNIVERSITIES AND MEDICAL PRACTITIONERS. To the Editor

of THE

LANCET.

SIR,—The article on " Universities and Medical Practitioners " in last week’s LANCET will, I trust, rouse the profession to work for a much-needed reform in the requirements of the universities. No man worthy of the degree of M.D. would wish the examinations to be anything but rigorous, and many would welcome such a change as you indicate. " The St. Andrews Medical Graduates’ Association," the formation of which you noticed last week, has at present full occupation for its energies in the alteration of the clause in the new Scotch Reform Bill, which excludes from the franchise all Doctors of Medicine of the University of St. Andrews, except the very small number who have attended classes in the University or have graduated since 1863 ; but I trust, that work being accomplished, it will address itself to the task of effecting such a reform of the regulations of the University,

as, while testing in the most stringent manner the qualifications of candidates for its degrees, will not limit the admissions of non-resident graduates to ten in each year. As you justly observe, it is not the severity of the examination which is prohibitory, but the necessity for residence during term, or, as in the case of the University of London, the requirement of attendance on lectures and hospital practice during the intervals between the different examinations for the degrees. I am not empowered to speak for the Association, I am merely uttering my own sentiments, but I have reason to believe that your article represents the views of the other officers also, and to hope that before long the Association will move actively in this matter. I am. Sir. faithfully vours. LEONARD W. SEDGWICK, M.D., Hon. Sec. St. Andrews Medical Graduates’ Association.

Gloucester-terrace, Hyde-park,

June

3rd, 1867.

MATRICULATION AT THE UNIVERSITY OF LONDON. To the Editor ofTHE LANCET.

SIR,-Permit me to call your attention to an advertisement appeared in the Philosophical Magazine for April, rewhich some explanation seems desirable. It is headed specting " Audi alteram partem:’ ’’ University College : June Matriculation Examination of the University of London;" and announces a course of Chemistry THE REGISTRATION OF COLONIAL DEGREES. by Professor Williamson, F. R. S., assisted by Mr. C. H. Gill, F.C.S.,—the course to consist of about twenty lessons in To the Editor of THE LANCET. Chemistry, and as many oral lessons. The fee is mentioned. A reference to the Calendar shows that Professor SIR,—There seems to be amongst the members of the Practical General Medical Council and the profession at large a very Williamson is the gentleman who will examine in Chemistry at the June matriculation of the University of London. Were proper disposition to admit to the Register the names of I about to matriculate, I should certainly enter the Professor’s persons who possess foreign or colonial degrees, provided that class, and should be disposed indeed to think that anyone who the licensing body granting the degree satisfies the Medical did not avail himself of this convenient arrangement desened Council that its recipient has undergone such a course of study rejection. But this is from the student’s point of view, which and examination as "guarantees the possession of sufficient is perhaps somewhat prejudiced. The Senate of the University is probably not aware that intending candidates for matricuknowledge and skill for the efficient practice of medicine and lation from all sides are thus invited to enter the class of This is to desirous of simply justice foreigners prac- their future examiner. Or is this a plan by which it is sought surgery." tising in England, and also to many Englishmen who hold to mitigate the well-known severity of the University examinaforeign diplomas, though there are probably very few but have tions ? an English qualification as well. obedient servant. I My object in writing this letter is not to advocate justice June, 1867. am, Sir, your very INQUIRER. and liberality towards foreigners only, but to suggest that the Medical Council in their deliberations on this subject should not forget that in one foreign country at least—France—the DUBLIN. Englishman is not permitted to practise without undergoing OUR OWN CORRESPONDENT.) (FROM an examination. It certainly would be advisable that the Council should take some steps whereby the same liberality A YEAR memorable in the annals of the Royal College of may be obtained for the Englishman desirous of practising in foreign countries that is accorded to the foreign resident in Surgeons, Ireland, was brought to a close by the annual elec England. A kind of "reciprocity treaty " might be entered tions held yesterday in its board room. Memorable inasmuch

Correspondence.

which