GRATUITOUS ADVICE.

129 effect upon the living body, and this appears to have been quite the case as regards the new sanitary works at Croydon ; for, there does does not appear in that case to have been the least co-operation or communication between the engineer of those works and the medical department. . All the inquiries that have been made by the Local Board of Health, the General Board at Gwydyr House, and by Government, agree as to the cause and effect of the very severe fever at Croydon. That it has been occasioned by the extremely injudicious mode of carrying out the sanitary works is beyond a doubt, whereby human life has been sacrificed to a fearful extent, and in many cases it has produced the development of disease which might otherwise have remained dormant, such as consumption, It has also occasioned great loss to strumous affections, &c. property, trade has suffered much, and it has been ruinous to

epidemic

schools. With such an amount of evil it is necessary that the inhabitants of the town should make every legitimate exertion to obtain a remedy, especially as the Report above mentioned clearly points out the cause of the evil. As regards the carrying out the works, the Local Boards are placed under the direction of the General Board. According to Mr. Page’s report (page 51), a plan was submitted from the Croydon Local Board of Health to the General Board, which plan was placed in the hands of the General Board’s engineer, who disapproved of it, and who was sent down by order of the General Board with instructions from that Board to the Local Board that no works should be carried out without their engineer’s certificate, and no payment be made without his order; so that the whole management of these works was placed in the hands of the General Board, and through these means all the serious evils which have occurred here have been brought about. The General Board is very desirous of getting rid of the responsibility, and of throwing it upon theshoLtl’ers of the Local Board; wherever it rests all parties must admit that a remedy ought to be immediately carried out to remove the danger which is still hanging over the town and the neighbourhood. The question will naturally be asked-What is the remedy?

end it will not transfer the nuisance elsewhere, (a the Report so strongly protests,) but will It is to be deeply lamented, that in conse-quence of either some defect in points of Parliamentary punctilio, or of some blind oversight on the part of the Legislature in mistaking a Sewerage Bill for a mere Water Bill. Croydon should have lost the opportunity of commencing an effectual restorative régime in the present year, and should be exposed to a repetition of the horrors of the last autumn and winter; but the inhabitants (I need not say rate-payers, since the Bill does not propose to tax us) are already bestirring themselves, with the view of bringing before the Home Office the consideration of this whole question of a remedy for those evils which, through the energy of Lord Palmerston, have now been thoroughly exposed, and this exposure is undoubtedly the first step towards amendment. I am, Sir, yours obediently, GEORGE BOTTOMLEY, F.R.C.S. Croydon, July, 1853.

important

against which simply extinguish it. wrong

THE ADMIRALTY AND ASSISTANT-SURGEONS. To the Editor of THE LANCET. is SIR,—It right that it should be generally known that the Board recently appointed by the Admiralty for the examination of medical candidates for admission into the navy, notwithstanding the reduction of qualification, has hitherto had a sinecure of it. Only two candidates offered themselves prior to the last examination day, and one of these withdrew at the eleventh hour by desire of his father. The governor" had no doubt learned before it was too late that it was more advisable to give his son a chance somewhere else, than to subject him to the control of a sagacious legislating admiral and his enlightened

coadjutors.

told that this admiral has more than once spoken disof the assistant-surgeons of the navy, and in the House of Commons designated them by the name of ‘ 8uckiizg" doctors. Can this be true? If so, it showed little wit and less wisdom. But it will open the eyes of the profession and the public to the spirit which animates the Board of Admiralty, and Although large sums have been expended, would it not be most show that the cockpit education acquired by admirals and capprudent to advise that a total alteration in the plan and system tains, and the jealousy, and spite, and ignorance of the midshipshould he immediately adopted-viz., the main streets to have men’s berth, are carried to the Admiralty, and are indulged in well-coustructed brick sewers, and every large house draining there-nay, even impertinently exhibited in another place, which directly into them; and where there is a cluster of small houses, ought to be kept free from ribaldry. Now I hear it is reported that the Admiralty, " if not pushed," they should be connected by pipe drains of sufficient calibre and are to grant before the next session of parliament all that has and have the connected with the main thickness, joints properly sewers, and the absurd back-drainage system should be altogether been so long and so unjustly withheld from the medical departexploded? The main sewers ought to terminate in a subterranean ment. I do not believe a word of it. There has heen already culvert, such as is proposed to be executed by the " Wandle too much mulish obstinacy shown by these heavy-headed, outSewerage and Water Company," to which you allude in your grown midshipmen at Whitehall. Our efforts must not be review, and for which the inhabitants of Croydon petitioned relaxed by any false lures. Must we not cry out for the Parliament long before the commission to Dr. Arnott and Mr. removal of an act of injustice lest we should offend the perPage was issued, from a conviction that the plan would provide petrators of it? The possibility of such a thing is a damning a proper sewage outfall for Croydon, and would abolish the commentary on the conduct of the Admiralty. It implies that this Board, which is almost without control, is capable of perse. pestiferous filter-house. The plan proposed, as I understand, by their Bill, is, that a vering in a bad course for no other reason than perhaps some large subterranean brick culvert or sewer is to commence wht-re rudeness in the mode of demanding that to which we are entitled. I am, my dear Sir, yours always, the present sewage filter-house (which it is proposed to remove) AN OLD MEDICAL OFFICER. now stands; and this culvert, which is to he about fifteen feet Aug. 1853. below the surface of the ground, to be well cemented, and to have a fall of fifteen feet per mile, is to be carried along the valley of the Wandle, at about the same depth, near the junction of ttiat GRATUITOUS ADVICE. river with the Thames at Wandsworth; and it is gratifying to yo the Editor of THE LANCET. find that in this instance the engineer has been laudably attentive to those medical and sanitary considerations whi:h have been so SIR,-The subject of the gratuitous services rendered by the strangely disregarded by the so-called General Board of Health, profession in this country, and the very inadequate payments for his scheme I find, on inquiry, embraces special engineering made in those cas s where salaries are attached to public medical works for collecting the sewage at different points along the main appointments, demands the serious attention of the profession, sewer, and for deodorizing it by scientific processes, and disPGsing and thanks are due to you for opening your columns to a disof it for agricultural purposes, exactly as is recommended in cussion of this crying grievance. The evil is not confined to Mr. Page’s Report; so that the residual fluid to be passed into dispensaries and Poor-)aw appointments, but exists even in the the Thames would be rendered innocuous before it reached that situations held and eagerly sought for by the leaders in the proriver from the proposed new outfall at Wandsworth. fession. When men like Travers, Green, Roots, &c., consider If we have such a plan throughout, no one can doubt its suc- it an honour and a privilege to hold appointments, and perform cessful and beneficial effects on the town of Croydon, which town onerous duties, the importance and responsibility of which cannot is most happily situated for such a system of drainage-in fact, be overrated, receiving as the only direct payment a salary that it is almost without a parallel, being situated at the head of a wou!d be indignantly refused by a fashionable footman, it is easy valley which has a fall of’one. hundred and thirty feet to the to understand how the example reacts on younger and less noted Thames, a distance of little more than eight miles and a quarter. members of the profession. A simple system of main-street brick sewers (having sluiceThe hospital at which I served a five years’ apprenticeship, drains running directly into them) terminating in the Company’s (one of the oldest, richest, and largest in the metropolis,) had at proposed culvert before described, and taking the whole of our that time, 1835-40, a staff consisting of three surgeons and three many miles away, cannot be otherwise than most effective phy sicians. The salary attached to each of these appointments sullage in restoring health and prosperity to Croydon ; and, as I have was X40 a year, paid quarterly. The really remunerative part shown in my brief description of the plan, whilst effecting this of the appointment was indirect, and consisted of the sums exI

am

paragingly

(

130 fees from the pupils. The general expenditure at this exceeded ,;E20,000 a year; out of which the sum allowed for the medical and surgical staff (without which the institution would have been not a hospital but a poor-house, therefore the very soul and essence of the establishment) was X240 a year, divided amongst six of the most efficient members of the profession. Like starving individuals amongst the lower animals, they stayed their appetites by preying on their own young, (as it were,) increasing the miserable stipend by extracting from the pupils large fees for dresserships, hospital attendance, &c. Do not let it be supposed that the managers of the hospital were so over-careful of its funds in order that the largest possible amount might be expended on the suffering patients-oh dear no! The said hospital occupied nearly the whole of a parish, and contained the parish church within its walls. The extra hospital parishioners must have been less than a dozen in number - surely, it might be supposed, that the rector of this parish and his curate might (for it is not a bad living) have performed the clerical duties, instead of which there were at that time, and I believe still is, a hospital chaplain, with a salary of several hundreds a year, and even an assistant-chaplain, receiving also At the time I was a student, the a large annual payment. dinners eaten by the treasurer and friends (I think the medical staff were invited) on the days of auditing the accounts, cost the hospital more annually than all the medical and surgical staff combined. The salaries at this institution have been since that period increased, but only by making the surgeons and physicians give up the pupil’s fees to the general fund, and receiving them back in the shape of increased salary. Taking these high appointments as starting points, the rationale of the tarff of payment becomes evident. Full surgeon to a large hospital, X40 a year. Ditto to a dispensary, an annual vote of thanks. Ditto to a Poor-law district, the sum he expends in

tracted

as

hospital

drugs, horse, &c.

The whole system is faulty, and requires entirely remodelling. The emoluments received by medical men are so inadequate, that I really believe they amount to less than their expenditure, the balance being made up by the proceeds from private property held by them. In all other businesses the amount received over the expenditure accumulates, and constitutes wealth. I believe there is no such fund accumulating amongst the profession as

a case of fever, and then gave him a note to Train and Co., thereupon actually engaged him for £ 8, to go out as surgeon to a ship (the lYinclernaere) carrying 470 passengers. Now this young man could not give me the symptoms or treatment of the simplest affecrions, nor could he tell the name of a single instru. This class of men is, I believe, pre. ment in my pocket-case. ferred by many American captains, as they save them some trouble in serving out provisions, swearing at and bullying the The Government Emigration agent requires emigrants, &c.

treat

who

ships bound for British America to carry qualified surgeons, as also those bound for the United States, having more than 500 passengers; but in all other cases druggists are eligible. Hoping that this, as well as the many other exposures which have been made from time to time in the columns of THE LANCET, may soon lead to a better state of things, I am, Sir, your obedient servant, M.B. LOND. July, 1853.

THE MEDICAL PROFESSION AND LIFE ASSURANCE OFFICES. To the Editor of THE LANCET. SIR,-I beg to enclose the following correspondence, which you may think worth publishing. Any comment would be unnecessary from, Sir, Your obedient servant, WALLER LEWIS. Hinde-street. Manchester-square, July, 1853. No. I.

Consisted of a

printed set of queries from the Legal and General Life Assurance Company concerning a patient, to which queries t was requested to furnish answers. No allusion was made to any fee.

No. II. Was my

reply, refusing

to

practise gratuitously.

No. III. body; that they are getting poorer, and vast numbers are partly either supported by property bequeathed by extra-professional Was from the Secretary, as follows:parents, or assistance rendered to them by friends and relatives Legal and General Life Office, London, July 14, 1853. engaged in more lucrative paths of life. answer to your communication of yesterday, I beg to SIR,-In Do not let the subject drop; it is deeply interesting to the proyou that on receipt of your replies to the official inquiries fession, and the opinions you have expressed in your leaders will inform of G. H. L-, Esq., to you, relative to the health &c. submitted be heartily echoed throughout the country. I shall be happy to remit you the usual fee of half-a-guinea. I am, Sir, your obedient servant, I remain, Sir, your very obedient servant, MULTUM RESTAT. July, 1853. Waller Lewis, Esq., M.D..ToIiN NETTLETON, Sec. a

"SURGEONS" TO EMIGRANT SHIPS. To the Editor of THE LANCET.

SIR,-Having

No. IV. 3, Hinde-street, July 14, 1853.

SIR,-Never having been asked by any Assurance Company to give an opinion for half my usual fee, which is one guinea, I

lately been across the Atlantic as surgeon to an American emigrant-ship, I am enabled to furnish some informaso now. tion as to that service, which may be of some interest to many of beg to decline to do I am, Sir, your obedient servant, your readers. WALLER LEWIS. John Nettleton, Esq. Ileft Liverpool for Boston, U.S., last April, in charge of 340 for Train and of to Co., emigrants, Liverpool, having stipulated receive, in consideration of my services, a free cabin passage to No. V. and fro, and a gratuity of .610. Of the treatment I received on and General Life Office, London, July 16, 1853. Legal my way out, I have no reason to complain; but on my passage SiR,-On submitting your communication of the 14th inst. to home I was thrust into the second cabin, together with five other Directors, I am desired to inform you that (the amount for so-called doctors, who had gone out in charge of ships belonging to the same house. Four of these persons were druggists, who which Mr. L- proposes to assure being a large ’one) on receipt had made a specific agreement to return in the second cabin; of your replies to the inquiries relative to his health &c., your fee but the fifth was a qualified Irish gentleman, whose advanced of one guinea will be remitted. I remain, Sir, &c., age should have secured him from such an insult, which was felt JOHN NETTLETON, Sec. Waller Lewis, Esq. JOHN the more as there were some first cabin passengers in the ship. to to listen the most abominable oaths We were constantly obliged and the most disgusting language, indulged in not only by the THE POSITION OF THE MEDICAL PROFESSION. mates, but also by some of those pretenders whom our laws :To the Editor of THE LANCET. and the These assume name of to drugsully surgeon. permit SIR,—There seems but one opinion concerning the position of gists had obtained their appointments by means of a Liverpool druggist, who charges them £1out of the £10 which he usually our profession: society despises, the church and bar look down procures for them, and who supplies most of the Liverpool upon us, and we ourselves, while complaining with child-like emigrant ships both with their surgeons and medicine, the garrulity, seem impotent to suggest a reformation. Each little quality of the latter being, to judge from what was furnished to squabbler sees in his peculiar ill the error. None, I think, comit in its broad true spirit. The fault springs from the my ship, much on a par with that of’ the former. One of these spurious surgeons told me he had been in business as a druggist, head. The governing bodies, councils, and heads of colleges had failed, and afterwards had spent some time in prison. are the impediments to our advance. From their apathy, arro. Another, who was a runaway druggist’s apprentice, said that he gance, and cupidity, springs the obstacle that impedes the onward went to the above Liverpool agent, who asked him how he would movement of a noble science, Puffed up with their position—

the

prehend