POOR-LAW MEDICAL REFORM.

POOR-LAW MEDICAL REFORM.

the previous year, was so clearly theria and putrid sore-throat and kindred diseases, was the described as to leave no room for doubt in the mind of t...

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the previous year, was so clearly theria and putrid sore-throat and kindred diseases, was the described as to leave no room for doubt in the mind of the presence, in diphtheria, of an adventitious tissue, which could reader as to its being an epidemic of true diphtheria. The be separated from the subjacent membrane, the surface of which was intact. It was of great importance to detect the manner of distinguishing the disease from scarlet fever, malignant sore throat, &c., was given, and even the very characters real nature of the disease, in order that its extent and prevaof the exudation pointed out. Regarding the nature of the lence might be accurately determined. He was in favour of false membrane affecting the throat in diphtheria, Dr. Harley Dr. Harley’s view respecting the thickened mucous membrane. said that various and inappropriate names had been given to Bretonneau had, indeed, described it as consisting of a conit, such as fibrinous, plastic, and fibro-plastic, all of which cretion, or a distinct number of laminae. Dr. ROGERS having replied, the Society adjourned. terms were very apt to mislead the mind as to its true nature. He had examined it in twelve cases, and found it to consist neither of fibrin nor fibro-plastic cells, but simply of the epithelium, mucus, and mucous cells proper to the part of the When blood-corpuscles were POOR-LAW MEDICAL REFORM. throat from which it came. found in the exudation, their presence was due to some accidental abrasion of the mucous membrane. Pus-cells were also CONFERENCE OF THE MEDICAL OFFICERS OF THE occasionally present, especially in those cases where ulcers had METROPOLITAN UNIONS AND PARISHES. formed after the application of caustic. The false membrane, Dr. Harley believed, was composed of a hyper-secretion of the A NUMEROUSLY attended conference of the medical officers ordinary mucus, and the presence of fungi on it was due to of all the metropolitan unions and parishes was held on ThursIn the twelve cases he had some accidental circumstance. examined, the oldium albicans was absent in all except one; day evening, Jan. 13th, at the Freemasons’ Tavern, for the and even in that case the fungus did not grow upon the mem- purpose of eliciting their opinions on the ‘‘ Heads of a Scheme brane until fifty-six hours after its removal from the patient. for a New Arrangement of Medical Relief," lately While speaking of the leptothrix buccalis, he related a very received from the President of the Poor-law Board; and also interesting case of diphtheria that occurred in University Col- of devising suitable and (if possible) unanimous replies to the lege Hospital. Several yellowish-coloured masses taken from several points. John Guyse Sparke, M.D., of the City of the pharynx, ossophagus, and stomach, after death, when examined with the microscope, were thought by some expe- London Union, in the chair. rienced microscopic observers to contain numerous algeo. Dr. The CHAIRMAN having briefly introduced the details of th& Harley pointed out to the Society, however, how he had been Scheme, able to demonstrate that the supposed algæ were, in reality, The SECRETARY pro tem. (Dr. Robert Fowler) read letters crystals of fatty acids. But he did not mean to deny that from Edward Moore, M.D., of the Bethnal-green Union; J. algte were sometimes found on the diphtheritic membrane; Nathan Bainbridge, Esq., of the parish of St. Martin-in-thefor, as they constantly occur upon the tongue and between fields ; and Charles Maynard Frost, Esq., of the Kensington the teeth of the most cleanly individuals, it is reasonable to Union; regretting their inability to attend the meeting, and suppose that they may occasionally attach themselves to the expressing an opinion adverse to the suggested Scheme. false membrane. What Dr. Harley wished to be understood It was then proposed by HENRY BLEXKARNE, Esq., of the to mean was, that neither fungi nor algas were essentially com- City of London Union, seconded by JAMES LEONARD, Esq., of ponents of the exudation, far less could they be regarded as the parish of St. Martin-in-the-Fields, and carried unaniconstituting the disease. Diphtheria was, in his opinion, as mously,-1. " That, whilst expressing its satisfaction to the much a blood disease as either small-pox or typhus, and the President of the Poor-law Board for the fulfilment of his proexudation on the throat merely one of its characters. mise, made on May 7th, 1858, to the deputation of the PoorDr. FULLER, with reference to the recommendation of law Reform Association, of framing a new measure of medical hygienic means for the prevention of the disease, mentioned relief, andof communicating the same, in draft, toevery the following curious circumstance :-He had been requested medical practitioner holding office in the administration of the to see a gentleman at a village in Hertfordshire, where the dis- Poor a view to learn their opinions on the provi ease was very prevalent. The village contained four hundred sions this meeting is nevertheless of opinion that the inhabitants. There had been fifty cases of diphtheria, and for a suggested New Arrangement of Medical Relief’ fifteen deaths. About one-half of the village consisted of ill- will not, in its present shape, conduce either to the comfort of the sick poor, or to the alleviation of thedrained, ill-ventilated, badly-situated, and wretched hovels; the other half, of healthily-situated model-houses, excellently grievances of the Poor-law medical officers." drained and ventilated. The disease was confined entirely to by GEO. E. NICHOLAS, Esq., of the Wandsworth the latter dwellings. He did not attempt to explain this: he and Clapham Union, seconded by JAMES G. GERRANS, Esq., of St. and carried unanimously,merely mentioned the fact. He agreed with Dr. Harley as to ‘‘ That this meeting views with extreme concern and surprise the nature of the secretion, and that there was no abrasion of of duty against the Poor-law medical the surface beneath, in most instances; but he had, in two charge which is implied in the words,’by conducing to a more cases, seen ulceration of the tonsils and velum. In the village to which he had referred, the disease came and disappeared carefu.l attendance upon the sick poor,’ contained in the letter of entirely in the course of six weeks. It attacked persons of all the private secretary to the President of the Poor-law Board, to the Poor-law medical officers on the 2nd Dec. ult. ages, from infants at the breast to adults. Pigs also died of the complaint. It could not be called an inflammatory disease, Such a charge never having before been advanced against the for although at first there was slight febrile excitement, the Poor-law medical officers, this meeting respectfully but most tongue soon became clean and the skin moist. The best treat- earnestly repudiates and protests against the justness of the ment he had found to be large quantities of stimulants. Theimputation." 3. Proposed by J. VixALL, Esq., of the Hackney Union,. young gentleman whom he had been called to see, though unaccustomed to stimulus, borewell, and, indeed, with advan- seconded by J. G. FRENCH, Esq., of the parish of St. James, tage, three bottles of port wine a day. Under this treatment Westminster, and carried unanimously,-" That this meeting the secretion quickly stopped, and recovery took place. With desires to express most strongly its disapproval of the proposed respect to tracheotomy, he thought it should be employed when cessation of ’existing appointments’ of medical officers ’at a there was no reasonable hope of arresting the disease by other given period’ (Head 1), and ofthe appointments’ being made. remedies. onlyfor a period of three years’ (Head 4), believing that not Dr. DRUITT considered that it was now settled that the dis- only are the interests and welfare of the sick poor best served, ease was a blood disease, that the early febrile symptoms disbut also that more respectable practitioners are likely to comappeared very soon, and that these were followed by extreme pete for the post of union medical officer, under the rule of calmness and feebleness. Dr. Druitt then showed, by the sta- permanency of appointment, as recommended by Mr. Pigott’s tistics of the parish of St. George, Hanover-square, that, Committee of the House of Commons in 1654; and this meetduring the past year, cases of diphtheria had formed a serious ing is of opinion that the appointment oftwo medical officers item in the mortality. With respect to the cause of the dis- for each parish,’ in the manner suggested by Heads 3 and 13, ease attacking one habitation in preference to another, he could is highly objectionable, not only as being unnecessary for the not tell; but he would remark, that in every house where it requirements of the sick poor, but as being calculated to perhad attacked persons in his district, there was sufficient cause petuate, and be the constant source of, professional disagreefor it. ment and ill-feeling; and this meeting is further of opinion Dr. SEMPLE said, that the distinctive mark between diph. that the cessation of theexisting division of unions and

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parishes into medical districts’ ’at a given period’ (Head 1) would, as a rule, be neither advantageous nor advisable, but that, where necessary, a more equitable adjustment of districts

medical officers, and will not be conducive to the interests of the poor; the meeting therefore resolves that the following amendments be made to the plan, and the President be respectfully requested to take them into consideration :1. Appointments of medical officers shall be permanent to those parishes now held by them, subject to the General Order of the Poor-law Board, dated May 25th, 1857 (see Circular of Poor-law Board, 6th June, 1857, art. 5), and to the rules now in force as to good conduct, but they shall have power to resign on giving a reasonable notice, as is the case at present. 2. Existing contracts and existing division of unions and parishes into medical districts shall cease at a given period. 3. The qualification of future medical officers shall be double (medical and surgical), and of the class laid down in the 21st and 22nd Vict., cap. 90, but none of the present medical officers shall be removed for want of those qualifications. 4. Guardians may, where parishes are very large, appoint two or more medical officers to each, and divide the parish in such manner as they may think desirable, subject to the approbation of the Poor-law Board. 5. The contract with a medical officer shall be made for a period of three years, renewable on a fresh calculation of the three preceding years. The payments to be quarterly, as at

should be effected." 4. Proposed by R. HARLAND WHITEMAN, Esq., of the Wands worth and Clapham Union, seconded by J. ROGERS, M.D., of the Stmnd Union,-" That this meeting is of opinion that, as regards the important question of salary, this portion of the grievances of the Poor-law medical officers would not be satisfactorily arranged unless by fixing Item 2, Head 12, at Is. 6d. per case, the guardians providing all the drugs or at 2s. 6d. per case, the medical officers providing all tlee drugs; and further, whilst it cannot perceive either the advisability of extending to each individual guardian the power of giving orders for medical relief (Head 6), or the advantage or humanity to the sick poor (setting aside the suspicions imputed to, and the distrust implied of, the medical officer), by the adoption of Head 10, this meeting would thankfully receive the measure of the President of the Poor-law Board, if amended in accordance with the whole of the above suggestions." G. E. NICHOLAS, Esq., proposed, and J. LEONARD, Esq., seconded, the following amendment:-" This meeting is of opinion that the most simple, just, and satisfactory mode of remuneration which could be devised would be by the pay- present. 6. The contract with each medical officer shall be to this ment of a certain fixed sum in accordance with the minute of the Poor-law Commissioners in 1839. It is also of opinion that effect: that he will attend, when applied to, without an order, the sum per case should, in justice, vary in different districts, any poor person in the parish named in the list which shall be according to the distance from the medical officer’s residence, furnished to him half-yearly or oftener, by the relieving officer or other local circumstances. This meeting is also of opinion of all persons in the receipt of relief, or who have been so that the determination of the question of the amount of re- within the last six months. With an ordermuneration per case might safely, and most satisfactorily to all Any poor person named in such order. parties, be referred to the Medical Council appointed under the 7. Orders for medical relief may be given by each guardian new Medical Act. The original motion was withdrawn, and the amendment, of the parish, as well as the relieving officer, in all cases where being then put as a substantive resolution, was carried unani- a poor person is unable to procure medical aid at his own charge, and by the overseer in urgent cases. mously. 8. If the medical officer shall have attended a case repre5. Proposed by JosrAR BLOMFIELD, M.D., of the Camberwell Union, seconded by THOMAS W. HoopER, Esq., of the sented to be of emergency and too poor to procure medical aid, same, and carried nnanimously,-" That this meeting cannot and the guardians shall afterwards determine that the further perceive either the advisability of extending to each individual attendance of the medical officer at the charge of the parish to be given, such case shall notwithstanding be guardian the power of giving orders for medical relief (Head 6), ought notand reckoned or the advantage or humanity to the sick poor (setting aside paid for according to the scale laid down. 9. Each medical officer shall make a report to the guardians, the suspicions imputed to, and the distrust implied of, the at each of their relief days, of the cases under his care. medical officer), by the adoption of Head 10." 10. Medical officers shall discontinue a practice which exists 6. Proposed by GRAS. F. J. LORD, Esq., of the parish of St. John, Hampstead, seconded by GEO. E. NICHOLAS, Esq., and in many unions, of ordering a specific quantity of nourishing carried unanimously,-"That the foregoing resolutions be em- food or drink to those who are feeble from old age only, but bodied in the form of a Memorial, signed by the medical officers they shall order the kind of treatment or nourishment which in of all the metropolitan unions and parishes, (or by the chair- their opinion the case requires. To those really ill they shall, man on behalf of the medical officers of all the metropolitan however, specify the particular kind of nourishment required, unions and parishes,) and returned, as their opinion of the sug- as well as the quantity. gested Scheme, to the President of the Poor-law Board." REMUNERATION. 7. Proposed by J. VIN ALL, Esq., seconded by CHAS. F. J. For 11. Workhouses:-A salary shall be fixed on a uniform LORD, Esq., and carried unanimonsly,-" That a subscription and definite system, with mileage of not less than Is. per mile, be entered into, amounting to 5s., from each of the medical officers of all the metropolitan unions and parishes, for the pur- where the distance of the house is above one mile from the residence of the medical officer, and the salary shall be revised pose of defraying the expenses of this movement, and that be Henry Blenkarne, Esq., 39, Dowgate-hill, E.C., appointed every three years, and a fresh contract made on the same Treasurer, and Dr. Robert Fowler, of the East London Union, principle. 12. For Parishes:-A salary shall be fixed by the guardians, 145, Bishopsgate-street Without, E. C., be appointed Honorary with the sanction of the Poor-law Board, for a period of three Secretary. years, upon the following basis :8. Proposed by J. BLOMFIELD, M.D., seconded by EDWIN 1. Not less than Is. 6(l. per head upon the average numand carried unaniof the Camberwell Union, CHABOT, Esq., ber of persons in the parish in receipt of relief, in the ,mously,-" That a committee, consisting of the medical officers llrst week of January and the first week of July in of the three City unions, with power to add to their number, each year. be formed to watch over the interests of the metropolitan 2. Not less than Is. 6el. per case upon the number of cases Poor-law medical officers." attended in the parish upon an average of the last A vote of thanks being accorded to Dr. J. G. Sparke for his three years, where the guardians find the medicines, able conduct in the chair, the meeting terminated at a late hour. and 2s. 6d. per case where the medical officer finds the medicines. 3. An additional sum per case, to be fixed by the guarPOOR-LAW MEDICAL REFORM ASSOCIATION. dians, with the sanction of the Poor-law Board, of not less than Is. for each mile the patient may live from AT a meeting of the Committee held Jan. 14th, 1859, at the the residence of the medical officer, as a remuneration Freemasons’ Tavern, Great Queen-street, Lincoln’s-inn-fields, in respect of the distance which the medical officer as well as medical several metropolitan ’, provincial Poor-law may have to travel in attending the sick poor, or in -officers being present, the following resolution was unanimously ’, respect of other local circumstances; also extras, as -carried:specified in No. 13. With an Order-That the thanks of this meeting are due and are hereby For all other cases requiring medical assistance, and for given to the Right Hon. the President of the Poor-law Board, for his submission to the medical officers for their opinion of a which an order may be granted, not less than 58. per new "Scheme for Medical Relief;" but this meeting considers case, with an additional sum for mileage, as in No. - the plan, in its present form, does not meet the views of the 12,-3.

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