"FIXITY OF TENURE."

THE ROLL OF THE PROFESSION.

563

they should be so when the diffusion of profession over the empire is considered. The Registrar to the General Medical Council uses diligence to get accurate information ; the registrars of deaths have "Ne quid nimiR.0’ an inducement to supply it. But it would appear that success has not yet fully been attained, for the obituary THE ROLL OF THE PROFESSION. published in the current Medical Directory gives a larger THE Roll of the Profession for 1896 is before us. We may number of deaths. The Register also does not always at the outset congratulate the Registrar on the early contain the full description of a practitioner’s titles or somewhere about an accurate statement of address-even in the case of appearance of the Medical Register Feb. 17th. We had a similar congratulation to offer last some who would be thought likely to forward such year, and on this occasion it appears even earlier. We are information to the Registrar. This is, of course, the fault not without hope of seeing the Register appear early in of gentlemen themselves, whose description is thus inJanuary, and know no very clear reason why it, should not accurate, but we are disposed to think that there is room do so. Considering the despatch which is shown by the for some innovation in the method of getting information. officials of, and printers to, the Council during its actual sit- The Medical is the law and the Register testimony to which tings it is difficult to understand why a mere register should all must appeal in courts and in legal processes, and it is not be in a state of preparedness for publication during important that it should have the very last touches of the first few days of the year. The time that elapses can accuracy, and that in this respect it should have no rival. make no difference in the actual facts, and should make It is satisfactory to notice that only one person was removed very little in the collection of them, provided The Medical from the Register under the penal clauses in the year 1895. Register for 1896 contains the striking and unprecedented The penal powers of the Council are used sparingly-some number of 33,601 medical men. If all these gentlemen think too sparingly. But it is, after all, no mean testimony in the United with its population, say, to the honour and credit of a Kingdom practised profession, much tried and 39,134,166, it would give to each practitioner a clientele of often badly used, that only one out of its 33,601 has been 1164 or thereabouts. Fortunately ours is a widely spread removed from the Register under the penal clauses. We and fairly populous empire, and the gentlemen whose names must leave this indispensable volume, with its stores of are on the Register practise in all parts of it-the colonies information in the shape of tables and copies of all the and India and in our naval and military services-to say Medical Acts, to the study of our readers and of all who are nothing of foreign countries, in which they are by no means interested in the status of the profession. unrepresented. As a matter of fact, something over 6000 of the registered practitioners, or over one-fifth part, find their "FIXITY OF TENURE." residence or their occupation in fields outside the United THE Incorporated Society of Medical Officers of Health Kingdom. But even so, the numbers are somewhat appallhas had before it for consideration a report by the council of show no and off. ing they appreciable sign any falling After subtracting the 6209 as practising beyond the United embodying certain resolutions prepared by a special comKingdom, there remain 27,392 at home with a claentele of mittee on this important subject. The two main resolutions 1428 persons. If we take the numbers on the Register for were: (1) "That in the opinion of your council it is the last ten years it will be seen that they exceed desirable in the interests of public health that medical those of the preceding years respectively by 454, 794, officers of health in the provinces should, subject 693, 409, 815, 392, 1035, 1054, 993, and 964. These figures to the approval of the Local Government Board, show that the average yearly increase in the number have the same fixity of tenure as medical officers in accruing to the Register during the first five of these the metropolis ; (2) that in the opinion of your counci years was 633, that for the last five years being 887. the Local Government Board should be asked to make fixity It is true that in the last year there was a slight falling of tenure dependent on such an arrangement of sanitary conceivable that

Annotations.

the

-

off in the rate of increase, and that in the two last years there was less addition than in the preceding two. But when all allowances are made there is no ground for hoping that in any early years the great overcrowding of the profession will be remedied. This is made all the clearer when we pay attention to the new registrations rather than to the mere numbers on the Register. These are some. times depleted by a somewhat wholesale, though onl3 temporary, removal from the Register under Section 14 0: the Medical Act, empowering the Registrar to remove fron the Register the names of gentlemen who do not respond t( his inquiries as to their present address. This is the explana tion of an apparently small addition (392) to the Registe in 1891, though there were actually 1345 new registrations Last year 1446 was the number of new registrations, o which 731 were in England, 565 in Scotland, and 151 in Ireland. This exceeds the number in 1894 by 20 but it falls short of the average of five years by 16 The number of deaths in the profession is, happily, greatl less than that of the new additions. Last year it was accord ing to the Register, 538. Strange to say it seems to be diminishing number, for whereas in the last twenty year 561 died annually on an average, in the last five years th average has been only 536. It must, however, be unde] stood that these figures are not accurate. It is scarcel

and salaries as will secure medical officers of health of suitable qualifications and the carrying out of necessary sanitary improvements." At the meeting of the society held to discuss the council’s report it was decided by a majority of one (10 votes to 9) to delete the second resolution. The effect is to resolve that fixity of tenure should be unconditional. We doubt whether this is quite a wise decision. It is certainly in the interests of sanitation that every health officer should be in a position to act without fear or favour, and, so far, the resolution is most commendable. But it is also in the interests of sanitation that administrative areas should be large and should be supervised by medical men who are not engaged in private practice. In some degree these two interests would clash if resolution No. 1 were carried into effect without qualification. The permanency of appointment of a single officer, with a small district and a small salary, might have the effect of preventing the creation of a large combined area to include all the small districts of the neighbourhood. In Scotland, under the Local Government Act of 1889, a very satisfactory way was found out of a similar difficulty. Power was given to abolish all or any local health appointments which were found unnecessary under the new system of large sanitary areas, but the abolition was in every case to be accompanied by such compensation as would

areas

, : i .

,

HEALTH IN THE POST OFFICE SERVICE.

564

to civil service appointments similarly dealt with. venture to suggest, is the via media-the golden way it might be called-out of the present difficulty. To make fixity of tenure apply only to appointments in which private practice was to be debarred might in some cases have a

apply This,

we

very bad effect.

examination by the Departmental Committee, was put to Mr. Wilson for his opinion, when he replied that he did not think the conclusion arrived at a proper one. The work of a telegraphist, he said, becomes mechanical after a certain time and would not cause wear-and-tear. In an annotation in our issue of Aug. 31st, 1895, on the "Grievances of Telegraph Service Clerks," we commented on the absence of reliable statistics, remarking that from some suggestions made by Mr. Spencer Walpole it would seem that better statistics are accessible, and expressing the hope that they would be laid before the committee. These figures have, however, not been forthcoming, and in their absence it is impossible to decide as to the merits of either the official or the employés’ figures. Until the authorities produce reliable and accurate data, however, the benefit of the doubt may be given to the employés.

Some short-sighted sanitary: authorities general grounds to join a combination might refrain from doing so because, the combination involving a whole-time appointment, power to dismiss the medical officer would disappear, while by remaining isolated and continuing to employ a medical man in general practice the power of dismissal would remain. To such a proposal, therefore, there would be objection perhaps quite as strong that which applies to the decision arrived at by as the 10 to 9 majority. The correct way is to subordinate purely private interests to the public good, but at the same time to give adequate compensation for loss of office. Wherever a proposed large LOCAL ANÆSTHESIA IN SURGERY. scheme is looked on favourably by adjoining local DR. THEOPHILUS PARVIN, writing in the Philadelphia authorities the whole proposal should not be liable to be Mediaal and Surgieal Reporter, gives an interesting account thwarted by the existence of a medical officer in one part of of the utility of the system of local anaesthesia introduced the area having an expectation of life extending, perhaps, Dr. Schleich of Berlin and obtained by the hypodermic to thirty or forty years, and not being subject to dismissal by of solutions of cocaine of varying strength. The At the same time no unrelievable injection even under compensation. most generally useful solution consists of 2 parts chloride of hardship ought to befall the officer through deprivation of sodium, part of muriate of morphia, and 1 part muriate of office. We repeat that the experience of the northern cocaine in 1000 parts of water, 20 drops of a 5 per cent. kingdom, where many ex-officials are now in receipt of carbolic acid solution being added to each litre. Of this pensions corresponding to their former salaries, should be solution 100 c.c. may be used for an operation. Each injection utilised in dealing with the question as it applies to the causes a white weal, near the circumference of which provinces in England. another puncture and injection are made, and so on till the part to be incised has been rendered insensible to pain, the HEALTH IN THE POST OFFICE SERVICE. line of incision corresponding with the line of punctures. IN a recent annotation we drew attention to the evidence The insensibility of the skin lasts for a time varying from

willing

on

-

of Mr. Arthur Wilson, chief medical officer to the General Post Office, before the Departmental Committee presided over by Lord Tweedmouth, on Dec. 6th last, at the House of Lords. From the figures given by Mr. Wilson it appeared that the health of the employes, who do not consider themselves a very healthy body, compared more than favourably with men of the same age engaged in other occupations. His statistics were, indeed, surprising considering the nature of the post office employés’ occupation, as the death-rate for the whole of the staff was given as 4’2 per thousand, a rate lower than that of the clergy between the same ages. This has called forth a rejoinder from the telegraph staff of the General Post Office, in which they state that "the assumption underlying the whole of the medical officer’s evidence is that 4’2 represents a class mortality and it is compared with class mortalities, whereas it only represents the mortality of those dying on full pay. On showing signs of serious ill-health likely to result in ultimate death men are invalided from the service and it is notorious that few persons long survive their retirement." The death-rate as given in the rejoinder is 10’5, but this, it is explained, probably under-estimates the real rate. In THE LANCET of Aug. lst, 1885, in the course of some remarks on the conditions of the work of telegraphists, we made the following remarks: ’’ His [the telegraphist’s] work is mental and it is also monotonous. It involves long harping on one chord of his intelligence, with but little intermission ,and little variety. We have frequently to do, therefore, with a badly nourished brain, subject to sustained impulses passing along the nerve of hearing and obliged by concentrated and generally uniform effort to convert these into visible expressions. Thus the brain, losing the exercise of invigorating reflection and acting merely as a higher reflex centre, is apt to be driven to exhaustion.by sheer wear-and.tear of certain lines of its nervous tissue." This passage, which was referred to by Mr. Garland in his 1

THE LANCET, Dec. 14th, 1895.

fifteen to

twenty minutes.

Dr. Schleich

uses

this local

only in minor surgery but even for abdominal operations such as cholecystotomy and ovariotomy.

anaesthesia not

THE WAIL OF A FRENCH PHILANTHROPIST. PROFESSOR E. MASSE of Bordeaux, editor of the interesting Gazette gebdomadaire des Sciences Médicales, like all patriotic Frenchmen, is gravely concerned at the threatened depopulation of his country, and with reference to " the slaughter of the innocents"expresses himself in a recent number1 to the following effect : " France loses one-sixth of her infants before they attain to the age of one year, and the pity of it is that, with a little more care, a great number of them could be saved. Mothers ought to suckle and bring up their own children. Out of 94,000 enfants assistes (that is, put out to nurse at the expense of the State) the average number of deaths last year was equal to 68 per cent. M. Lagneau, who drew the attention of the Académie de Medecine to this lamentable fact, is of opinion that the amount allowed for the upkeep of derelict infants is not sufficient; and he likewise advocates the subvention of poverty-stricken mothers who, neverthe. less, strive to fulfil the duty towards their offspring which has been imposed upon them by nature. The law recently passed for the protection of infants ought to be far more rigorously enforced." In this country we are not at present confronted with the problem of a diminishing population which is so disquieting to our neighbours ;but who shall say that the generation now growing to manhood will be equally fortunate ? From answers to correspondents"in various periodicals and other sources of information which it is impossible to ignore (we published a letter on the subject headed A Horrible Trade" in THE LANCET of Feb. 1st), there can be no doubt that the practice of preventing conception is One journal in particular on the increase in our midst. 1

Jan. 19th, 1896.