MEDICAL OFFICERS UNDER THE POOR-LAW.

524 I am greatly deceived if the nipples do not a single year, but for a long term of years, heal in less time, with less pain to his pa- when the father of a family is cut off in the tient, and more satisfaction to himself. If prime of life, leaving his widow and chilany other practitioner in midwifery should dren a legacy to the parish? say nothing of give the catechu a trial, I hope to see the individual suffering—nothing of the demo. results in THE LANCET, with the time of ralising effect which contact with a worktreatment stated in days, as precisely as it is house always produces, and which is ra. in the communication of Mr. Hopgood. pidly extending amongst the poorer classes, I ought to apologise for meddling where I so much so, that it bids fair at no distant day have so little right ; but as I know from ob- to sap the foundations of society. If the servation how inconceivably painful this Home Secretary should ever have supposed complaint often is, I could not help express- such a case as this, it may have struck him ing the gratification I felt that Mr. Hopgood that alt had not been done for the poor man had enabled a mother in a few days to which might have been done by efficient sersuckle her child " with comfort and plea- vices. That the picture is not overdrawn, sure." I am, Sir, yours, &c. may be inferred from the following extract WILLIAM FARR. from a letter addressed to Sir Robert Peel, General Register Office, signed " E. Dewdney," and which apJune 27, 1842. peared a few days ago in the Times :-"I P. S.-To complete this communication, I could give yon proof that in a very large add the following extract from an instructive union the whole of the midwifery, and almost note of Mr. Pye H. Chavasse (Birmingham), all the rest of the medical department, was under the care of a youth, an apprentice to in the last LANCET, p. 475 :11 The tincture of catechu is the very best the medical officer of the union, so grossly application I ever tried ; it has never failed ignorant, that it is probable that even with to afford almost immediate relief, and after a the most diligent cramming, he will not be few applications to effect a cure. I recom- able to pass his examination ; that he had mend my patients to apply the remedy by the sole care of patients in the extremity of means of a camel’s-hair brush every time fever ; and when he used to report to his directly after the child has been suckling. master that he did not know what to do, was The nipple should be dried before each asked, ’Have you done all that you can?’ Then things must take their Yes.’ application." course ! But," says Mr. Dewdney, " every was a saving to the parish." With MEDICAL OFFICERS UNDER THE the last sentence I cannot agree, whilst I POOR-LAW. admit that every death of the aged or infirm may be a saving to the parish ; yet with a To the Editor of THE LANCET. very experience in parish have affairs, I truly believe that the death of one SIR,—The poor-law commissioners abolished the disgraceful " medical con- healthy man, leaving a widow and helpless tract system," and have ordered to be substi- family, more than counterbalances (in point tuted in lieu thereof fixed salaries. Boards of expense) the deaths of fifty of the aged of guardians have already advertised for: and infirm. The family entertheworkhouse, _ medical officers—the Brentford for one. The they become paupers, they in time beget salaries varv for the different districts (acand from generation to generation cording to the area and population) from they continue paupers ! 151. to 60l. per annum ; and the salary is That the fact stated by Mr. Dewdney is stated to include attendance, medicine, and not a solitary one, but that it is generally the all surgical appliances whatsoever ! Yet case throughout the length and breadth of the Viscount Courtenay publicly saysin the House land, can scarce be doubted; and what is of Commons, that he agrees with the honour- the reason? inadequate remuneration. Nineable member for Finsbury, " that it was tenths of the medical practitioners of Engessential to the welfare of the poor, as well land are morally compelled to take charge of as due to the respectability of the medical these unions ; they have no resource (unless should be they should happen to be in independent cirprofession, that medical adequately remunerated."cumstances) ; they must consent to take Sir James Graham, in a late debate on the charge of the district for whatever sum the the guardians please to offer; they must consent poor-law, brings as a charge against Keighley board of guardians, " that they to take charge even without payment; or had inadequately remunerated their clerk, they must consent to deprive themselves and by giving him only 701. per annum ; so that their families of their daily bread, by admit. the law expenses in that union amounted in ting a junior competitor into a district where a single year to upwards of 5001." Sir two cannot exist. James can perceive this fact, because it is I am persuaded that nine-tenths of the broadly placed before his eyes; but does he medical practitioners throughout the country ever, as a reflective statesman, calculate would resign their unions to-morrow, were it " what the cost may be to the union," not for not that a junior would be immediately

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525 rror, in a great degree, consisted in omitting o add to the resolution, that the gentlemen signing it pledged themselves not to accept he paltry remuneration that was offered; iad that been the case, " no mistake" could 1ave occurred. Mr. Litchfield undoubtedly was consistent in refusing to sign, if he imtended to accept; but still he ought to have remembered, that though he might consider his district fairly remunerated, it was the general principle that was to be contested, only possible means of securing efficient at- and therefore he took a somewhat narrow tendance on the poor, is the making the office view of the subject. of medical attendant an object of such value The threat of the guardians to introduce that its loss would be carefully guarded strangers into the various districts ought against. I am, Sir, your obedient humble not to have the least weight, as any person who comes avowedly to accept a situation servant, &Dgr;∈&lgr;&tgr;a. which has been refused as infi-a dig. by the June 22, 1842. resident practitioners, will not be looked upon with much respect by the public, and, BRENTFORD UNION SURGEONS. of course, would not be likely to obtain a footing in private practice. As so much deTHE NEW ASSOCIATION. pends on the decision of the different boards of guardians, it behoves medical men throughTo the Editor of THE LANCET. out the country to exert themselves to secure SIR,— Iconsider myself in ameasure called the election of humane and intelligent men to upon to take some notice of the letter signed the office, for, as Sir R. Peel observed to the "Medico-Chirurgus" in THE LANCET of to-day. Conservatives, that the battle of the constiAlthough I am willing to believe the writer tution must be fought in the registration may be actuated by the best intentions, it is courts," so we should remember that the but right to inform your readers that he has cause of the medical profession must be been, to say the least, premature in some of contested at the nomination of guardians. With respect to the Brentford Medical the statements he has made. For instance, the guardiaras have not yet come to any decision Association, I think " Medico-Chirurgus" upon the steps they shall adopt, and have has not exhibited a sound discretion, or good determined not to advertise until after theii- taste. He, perhaps, forgets that" the secrenext meeting. In the next place, your cor- tary" was directed to write to a large numrespondent should have taken care to ascertain ber of practitioners residing beyond the the real facts of the case relative to the pre- boundaries of the Brentford Union, inviting sumedaceeptance of office by the gentlemen he them to join the society, and that the statenames, prior to speaking of them in so pub-. ments he has made will probably deter lie a manner. I have seen Dr. Day, of many of them from doing so ; but he also Acton, and Mr. Dodsworth, of Turnham- omits .the real fact, that the thin attendance green, and they both assure me that their on the occasion he mentions, was almost enletters to the guardians were merely in- tirely owing to the meeting having been aptended to signify that they had no objection pointed to be held on what is called " the to continue their districts, at the original rate grand day" at Hampton races, at which of payment they had hitherto received ; and most of the neighbouring medical men are Mr. Dodsworth has since written to the usually present., He likewise animadverts board to say that he did not intend to accept strongly on the conduct of the president in the recent terms. Dr. Day declares that he voting against the discussion of the remuneis perfectly ready to withdraw his letter, ration of the union medical officers, as conwhich he forwarded under the idea that it nected with the business of the association. was agreed to accept, in consequence of two Surely it is allowable for every one to exor three practitioners refusing to sign the late press his own opinion on the subject ; and memorial to the guardians. Mr. Wilkins, although I differ altogether from the idea of Ealing, positively states, that his accept- that the question ought not to be introduced ance was entirely owing to a misunderstand- at the association meetings, and consider it a ing, which I do not feel at liberty to mention, most important point for every medical so. and I believe will follow the example of the ciety to discuss, I agree with the president other gentlemen. Without presuming to ap- that it ought not to be supposed to be the pear in any way as the apologist for the ?r.ain object for which the Brentford associaabove parties, who will doubtless give their tion was formed, as it would undoubtedly own explanations, I must protest against preventmany highly respectable men frombecondemning them urrheard, though it cer- longing to it if that were the case. Lastly, I tainly is to be lamented that they took any must express a hope that " Medico-Chirurnotice of the guardians otrer. The original gus" will not hesitate to consider that he has

pushed into the heart of their private practice. When such facts as these are notorious, allow me to ask what chance has the poor man of the medical officer’s attendance, if his richer neighbour should require it ? The medical officer is compelled, in duty to himself,’to go to the rich man, or he will find his place occupied ; he feels that he was compelled to accept the office of attendant on the poor; and I believe duty unwillingly performed is seldom well performed. The