- Email: [email protected]
REMUNERATION FOR MEDICAL ATTENDANCE.
286 statue of the tyrant You are not, perhaps, awaie, that the of Agrigentum, seizes the patient by all hissuccessful candidate of this year, and who limbs, and forces him to remain motionless, emblazoned the sheets of the last week’s no matter to what operations he is subject- LANCET, had been studying midwifery more than three years at this metropolis under ed.-Lanc. Franc. Mr. Waller; yes, and to confirm the truth of this assertion, I will give you a correct MEDICAL MISSION TO POLAND AND RUSSIA. list of candidates, and the periods at which AT the Academie de Medicine, May 17, they commenced their obstetrical career. ’the President read a ministerial letter in- The examination took place on the 2d of viting the Academie to elect several phy- this month, when the following gentlemen sicians and surgeons to be sent into Poland took their seats :— and Russia at the expense of the state. In Mr. ALGER, attended cases and lectures in this letter the eruption of the cholera morthe year 1828. bus in Poland is declared, and the object of Mr. BURCHETT, a licentiate of the Apothe. the mission is stated to be for the purpose of caries’ Hall, five courses of lec. observingthe nature and means of treatingt) tures, and not less than 60 cases. this epidemic. Four physicians and two Mr. DYER, attended lectures and cases in the surgeons were required for Poland ; two early part of the year 1829. physicians and one surgeon for Russia. The Mr. GEE, attended cases and lectures since Russian and Prussian authorities have proJanuary 1831. tnised assistance and protection to the pro. Mr. SEARLE, attended cases and lectures in the year 1830. posed embassy. Thus you see that it matters not how long a pupil may have been studying this branch, MR. NEVILLE’S FRACTURE APPARATUS. neither does it signify whether he be an M.D., F.R.C.S., or a licentiate of the apo. To the Editor of THE LANCET. thecaries’ Hall, so that he is but a pupil. Sm,Ń-Having a short time since beeni This the lecturer himself cannot refute, as thrown out of a chaise, I broke the tibia and it has been verified this season. fibula of my right leg. At first I had theI And now I would ask what praise is due fracture treated with the old-fashioned wood-to this indefatigable prizer, for the examiners den splints, but hearing of Mr. Neville’s themselves admitted that there was but a newly-invented leg-splints, the surgeon who shade of difference, and that even Mr. Gee, was in attendance procured them on the who had only attended one course, had the fourth day. On examining my leg, how- highest encomiums conferred upon his inever, three weeks afterwards, be observed dustry, having the greater number of capital that the fibula had not been kept in its pro- answers.* It is, therefore, evident, that per position by the side-splints; for which the honour was conferred upon Mr. Alger, reason I do not consider the side-splints to not for industry and talent, but merely behe of sufficient strength and breadth ; I have, cause he was an old pupil ; for it is clear therefore, had the old ones replaced. Now, enough that his experience only made up Sir, in my humble opinion, if the side- for his industry, or why was he not a candisplints were constructed after the same date the first season ?1 fashion as the anterior or upper splints, In conctuding, Sir, I have only to state, only a little broader, it would be of great that you will greatly oblige the industrious service to fractured legs, and this I beg to by having this abuse corrected, which mav suggest to Mr. Nevdie, and am easily be accomplished, by confining the honour to those of the first season. Sir, your humble servant, A SUFFERINGMEDICAL STUDENT. I am, Sir, your obedient servant, E. L. April 27th, 1831.
chine, like the famous
WALLER’S
MR.
PRIZES.
REMUNERATION FOR MEDICAL
To the Editor of THE LANCET. Sin,ŃThat there is impartiality manifest-
ATTENDANCE.
II
To the Editot- of THE LANCET. ed by most of the teachers at the Medical School, Aldersgate Street, in awarding their SIR,-It has been for some time past matprizes, cannot be denied; and why Mr. i ter of surprise to me, that after so much Waller’s is
adopted by ma ; for
xot
his
a more
occurred in
a
conducted upon the system
colleagues, is
unequal
to me an
examination
medical establishment.
has il
been said relative to the mode of remu.
enignever
*
The answers were all
Ivalued.
equally numbered
or
287
nerating medical men, the old fashion oftion without the concurrence of others, I giving attendance gratuitously, and sending shall in the next place proceed to consider a large and unnecessary quantity of medi- the particular mode in which this is to be cine at an exorbitant price, by way of re- effected. compense, should still be adhered to. This, Your correspondent Chirurgus, in THE I believe, is not to.be attributed to disin- LANCET of the 2d instant, appears to think clination on the part either of the public or the only eligible mode to be, making a the profession to making an alteration, but contract to attend families by the year. is owingto inattention to the subject on the This plan, however, can only be carried indiof the and to fear former,
into effect in a limited number of cases. in at- Families who have recently taken up their tempting to make an alteration, their prac- abode in a neighbourhood, and those who tice should suffer. That this fear is with- who are not likely to stay for any long peout foundation, a short account of my own riod, will not be likely to engage a medical proceedings relative to this subject, I hope, man by the year; and there are many who will prove. will be afraid their medical attendant will In April 1829, when I commenced prac- be less attentive, when he receives the same tice alone, having separated from a gentle- pay whatever duty he may he required to man with whom I had previously been in perform. Some medical friends of mine partnership, I determined, if possible, to make a low charge for medicine, and send make an alteration in the mode of receiving only what the patient requires, making up remuneration for my services, and to charge the difference by charging for attendance ; for my visits, instead of depending upon the but I fear this plan, if generally followed, price of my medicine for compensation. As would bring us back in a short time to the this was at that time almost an unheard-of present practice. Many young men upon plan in London, I began very cautiously. I their beginning business, and others who first made special agreements with those of find a difficulty in obtaining practice, would my patients who were my personal friends, offer their services without charging for atand afterwards with others. no tendaace, representing that patients would objections made to my proposals, I next be at so much less expense, though they began to charge in my bills for visits, in- might, at the same time, make up the differcluding medicine in the amount, without ence by the quantity of medicine they sent. any special agreement, taking care, however, I think, therefore, when it does not suit that my charge for visits should never much the parties to engage a medical man by the exceed what, according to the old mode, year, the best plan is to charge by the visit, would have been made for medicine. Since and to make such a charge as shall render Christmas 1829,1have continued the same it unnecessary to charge for medicine at all. plan, charging a certain sum for a visit, and Upon this plan a patient knows what exmaking no difference whether the patient pense he is going to when employing a took a single pill or half a dozen draughts. medical man, and is not surprised, at the By this mode my patients are satisfied that termination of his illness, by an enormous the medicine I send them is only such as it bill for which were never intended is intended they should take, I having no to be draughts that have been thrown taken, pills interest in sending more than is necessary ; &c. &c. away, aud, on my part, having nothing to think of The next point to be considered, relative when prescribing but what will most benefit my patients, I am not obliged to rack my to this subject, is the amount to be charged brains to consider into how many draughts per visit. As to combinations of medical I can divide a dose of Epsom salts, how men for fixing charges, and obliging the many leeches I can persuade my patients to members of the profession to abide by their bear, and whether they will submit to an regulations, I think them as absurd in theory unnecessary blister or two. I should think as impossible in practice. It must be evithat little need be said to convince the most dent that if all medical men were obliged to superficial observer, that the patient’s case make the same charges, those whose repumust receive much more attention from the ’ tation does not stand very high would have medical attendant when these no business, while those in whom the pubtions are not regarded. I have now acted lic place greater confidence would have all on this plan about two years, and am not the patients. I think, however, that a aware that I have ever lost a patient in general expression of the opinion of the consequence. I am likewise acquainted profession, as to what charges would be with other medical men who act in a some- equivalent to the present mode of receiving what similar way, and whose reports are remuneration in the form of paymen for equally favourable. Having, I hope, said medicine, would be of great service, leaving tnough to show that it is in the power of it afterwards to individuals to fix their own any individual to make the desired alteraaccording to the estimation in which
part
viduals
composing
among
the latter,
lest,
Finding
considera.
I
fees
288
they found public.
their services
were
held
by -
the to take this use
opportunity of ex borting you to
temperate language in your
further
I have considered five I efforts to ameliorate the state of the professhiliings a visit a fair remuneration ; and sion, and believe me to remain consistently when my patients have only a limited in- yours, T. KING. come, or are burdened with a large family. P.S. Do not forget that moderation gives I am satisfied with three-and-sixpence, and in some cases still less ; when they come strength. to me before I leave home in the morning, Thursday evening, I consider half-a-crown a full charge. In 10, Hanover St., Hanover Sq. fact, I consider the exertions of medical men In mv
a
own case
public benefit, to be supported, upon the plan as a national government, by all,
same
according to their means, every one receivNEW POISON AND ENEMA SYRINGE.* ing the same care and attention when his MR. GRAY, the surgical instrument-maker case requires it. It has been objected to me that my fees of Prince’s Street, has submitted to our in. do not equal what others are in the habit of spection an instrument under the above generally known as a stomachreceiving in the old way ; but being un- name, more which he has latelv constructed, and supported by my neighbours, I thought it pump, is to introduce to the notice necessary to make such a charge as would of endeavouring the profession. We shall not attempt to convince my patients they were not paying me more than another medical man would give a description of it, for without an en. not be easy to explain the charge. When, however, allowance is made graving it would for the saving of time, bottles, and medi- construction ; but as our opinion has been cine, in sending a six-ounce mixture in- requested on it, we do Mr. Gray the justice stead of six draughts, and in sending no to state that it is a model of simplicity, and in operation is equal to any instrument of more medicine than is necessary, the loss to
the kind we have yet seen. To these recommendations the maker has added another—lowness of price. The instrument Your most obedient servant, JOSEPH CURTIS, M.R.C.S. M.R.C.S. before us is very beautifully made, is accompanied by all the necessary appendages Camden Town, April 22, 1831. for its use, and is enclosed in a good mahogany case at the price, we are informed, of shillings. So well-manufacMR. KEATE’S LETTER TO MR. KING. tured, efficient, meritorious, and cheap an apparatus, we have seldom inspected ; and considering it well worthy the notice of To the Edito/’ of TH LANCET. medical practitioners, we recommend it to SIR,—You ask me whether you had any their attention. knowledge of the letter addressed to me by * Mr. Keate, in which it is intimated that From a highly respectable correspondent, on something would be done to induce the whose judgment we can rely. Lords of the Admiralty to rescind the order complained of by the members of the College of Surgeons1 Most certainly you had TO CORRESPONDENTS. Keate wished me to consider it a 7to<. Mr. beg to acknowledge the receipt of the courteprivate and confidential communication. I ousWeletter of our correspondent at Louth. We shall did so in the most sacred sense of the terms. It is I be happy again to meet with him at an early day in that
medical
men
will
not
appear
so
great.
I am, Sir,
thirty-five
singular enough, although applied to him several times for permission to publish that letter, he eonstantly declined granting it; but if really the Council wished the commonalty to know that they (the Council) were interfering on behalf of the naval surgeons, why did they not state
the field of medical literature. A Subscriber to THE LANCET, cannot practise as he describes without the license. The city freedom is not necessary. Quœsitor. It is not legal to do so. Let A General Practitioner, Fleet Street, put his name to his letter and it shall be published. The pttbhcfition of Tria Juneta in Uno, would offence in a quarter which the writer did not it at once ? As 1 told Mr. Keate, I had no- give probably intend it to reach. H, W. cannot for a moment seriously expect us thing to do with any person or persons as- to S.entertain the proposition he has made. I acted as an sembled at the We have not seen the letter of Mr. Francis White individual after the of Dublin, and eannot, therefore, tell whether the to him, and his answer returned. That an- strictures of A Medical Cfrsderot are justified, which, swer was to the purport, that the Council at any rate, would be more appropriately published in the paper in question. could not interfere, because our The letters respecting Mr. Gathrie’s lectures Allow me were at the ( next week.
CoUe,;e, ouly resolution was presented proceedings
Cullege
irregular.
chine, like the famous
WALLER’S
MR.
PRIZES.
REMUNERATION FOR MEDICAL
To the Editor of THE LANCET. Sin,ŃThat there is impartiality manifest-
ATTENDANCE.
II
To the Editot- of THE LANCET. ed by most of the teachers at the Medical School, Aldersgate Street, in awarding their SIR,-It has been for some time past matprizes, cannot be denied; and why Mr. i ter of surprise to me, that after so much Waller’s is
adopted by ma ; for
xot
his
a more
occurred in
a
conducted upon the system
colleagues, is
unequal
to me an
examination
medical establishment.
has il
been said relative to the mode of remu.
enignever
*
The answers were all
Ivalued.
equally numbered
or
287
nerating medical men, the old fashion oftion without the concurrence of others, I giving attendance gratuitously, and sending shall in the next place proceed to consider a large and unnecessary quantity of medi- the particular mode in which this is to be cine at an exorbitant price, by way of re- effected. compense, should still be adhered to. This, Your correspondent Chirurgus, in THE I believe, is not to.be attributed to disin- LANCET of the 2d instant, appears to think clination on the part either of the public or the only eligible mode to be, making a the profession to making an alteration, but contract to attend families by the year. is owingto inattention to the subject on the This plan, however, can only be carried indiof the and to fear former,
into effect in a limited number of cases. in at- Families who have recently taken up their tempting to make an alteration, their prac- abode in a neighbourhood, and those who tice should suffer. That this fear is with- who are not likely to stay for any long peout foundation, a short account of my own riod, will not be likely to engage a medical proceedings relative to this subject, I hope, man by the year; and there are many who will prove. will be afraid their medical attendant will In April 1829, when I commenced prac- be less attentive, when he receives the same tice alone, having separated from a gentle- pay whatever duty he may he required to man with whom I had previously been in perform. Some medical friends of mine partnership, I determined, if possible, to make a low charge for medicine, and send make an alteration in the mode of receiving only what the patient requires, making up remuneration for my services, and to charge the difference by charging for attendance ; for my visits, instead of depending upon the but I fear this plan, if generally followed, price of my medicine for compensation. As would bring us back in a short time to the this was at that time almost an unheard-of present practice. Many young men upon plan in London, I began very cautiously. I their beginning business, and others who first made special agreements with those of find a difficulty in obtaining practice, would my patients who were my personal friends, offer their services without charging for atand afterwards with others. no tendaace, representing that patients would objections made to my proposals, I next be at so much less expense, though they began to charge in my bills for visits, in- might, at the same time, make up the differcluding medicine in the amount, without ence by the quantity of medicine they sent. any special agreement, taking care, however, I think, therefore, when it does not suit that my charge for visits should never much the parties to engage a medical man by the exceed what, according to the old mode, year, the best plan is to charge by the visit, would have been made for medicine. Since and to make such a charge as shall render Christmas 1829,1have continued the same it unnecessary to charge for medicine at all. plan, charging a certain sum for a visit, and Upon this plan a patient knows what exmaking no difference whether the patient pense he is going to when employing a took a single pill or half a dozen draughts. medical man, and is not surprised, at the By this mode my patients are satisfied that termination of his illness, by an enormous the medicine I send them is only such as it bill for which were never intended is intended they should take, I having no to be draughts that have been thrown taken, pills interest in sending more than is necessary ; &c. &c. away, aud, on my part, having nothing to think of The next point to be considered, relative when prescribing but what will most benefit my patients, I am not obliged to rack my to this subject, is the amount to be charged brains to consider into how many draughts per visit. As to combinations of medical I can divide a dose of Epsom salts, how men for fixing charges, and obliging the many leeches I can persuade my patients to members of the profession to abide by their bear, and whether they will submit to an regulations, I think them as absurd in theory unnecessary blister or two. I should think as impossible in practice. It must be evithat little need be said to convince the most dent that if all medical men were obliged to superficial observer, that the patient’s case make the same charges, those whose repumust receive much more attention from the ’ tation does not stand very high would have medical attendant when these no business, while those in whom the pubtions are not regarded. I have now acted lic place greater confidence would have all on this plan about two years, and am not the patients. I think, however, that a aware that I have ever lost a patient in general expression of the opinion of the consequence. I am likewise acquainted profession, as to what charges would be with other medical men who act in a some- equivalent to the present mode of receiving what similar way, and whose reports are remuneration in the form of paymen for equally favourable. Having, I hope, said medicine, would be of great service, leaving tnough to show that it is in the power of it afterwards to individuals to fix their own any individual to make the desired alteraaccording to the estimation in which
part
viduals
composing
among
the latter,
lest,
Finding
considera.
I
fees
288
they found public.
their services
were
held
by -
the to take this use
opportunity of ex borting you to
temperate language in your
further
I have considered five I efforts to ameliorate the state of the professhiliings a visit a fair remuneration ; and sion, and believe me to remain consistently when my patients have only a limited in- yours, T. KING. come, or are burdened with a large family. P.S. Do not forget that moderation gives I am satisfied with three-and-sixpence, and in some cases still less ; when they come strength. to me before I leave home in the morning, Thursday evening, I consider half-a-crown a full charge. In 10, Hanover St., Hanover Sq. fact, I consider the exertions of medical men In mv
a
own case
public benefit, to be supported, upon the plan as a national government, by all,
same
according to their means, every one receivNEW POISON AND ENEMA SYRINGE.* ing the same care and attention when his MR. GRAY, the surgical instrument-maker case requires it. It has been objected to me that my fees of Prince’s Street, has submitted to our in. do not equal what others are in the habit of spection an instrument under the above generally known as a stomachreceiving in the old way ; but being un- name, more which he has latelv constructed, and supported by my neighbours, I thought it pump, is to introduce to the notice necessary to make such a charge as would of endeavouring the profession. We shall not attempt to convince my patients they were not paying me more than another medical man would give a description of it, for without an en. not be easy to explain the charge. When, however, allowance is made graving it would for the saving of time, bottles, and medi- construction ; but as our opinion has been cine, in sending a six-ounce mixture in- requested on it, we do Mr. Gray the justice stead of six draughts, and in sending no to state that it is a model of simplicity, and in operation is equal to any instrument of more medicine than is necessary, the loss to
the kind we have yet seen. To these recommendations the maker has added another—lowness of price. The instrument Your most obedient servant, JOSEPH CURTIS, M.R.C.S. M.R.C.S. before us is very beautifully made, is accompanied by all the necessary appendages Camden Town, April 22, 1831. for its use, and is enclosed in a good mahogany case at the price, we are informed, of shillings. So well-manufacMR. KEATE’S LETTER TO MR. KING. tured, efficient, meritorious, and cheap an apparatus, we have seldom inspected ; and considering it well worthy the notice of To the Edito/’ of TH LANCET. medical practitioners, we recommend it to SIR,—You ask me whether you had any their attention. knowledge of the letter addressed to me by * Mr. Keate, in which it is intimated that From a highly respectable correspondent, on something would be done to induce the whose judgment we can rely. Lords of the Admiralty to rescind the order complained of by the members of the College of Surgeons1 Most certainly you had TO CORRESPONDENTS. Keate wished me to consider it a 7to<. Mr. beg to acknowledge the receipt of the courteprivate and confidential communication. I ousWeletter of our correspondent at Louth. We shall did so in the most sacred sense of the terms. It is I be happy again to meet with him at an early day in that
medical
men
will
not
appear
so
great.
I am, Sir,
thirty-five
singular enough, although applied to him several times for permission to publish that letter, he eonstantly declined granting it; but if really the Council wished the commonalty to know that they (the Council) were interfering on behalf of the naval surgeons, why did they not state
the field of medical literature. A Subscriber to THE LANCET, cannot practise as he describes without the license. The city freedom is not necessary. Quœsitor. It is not legal to do so. Let A General Practitioner, Fleet Street, put his name to his letter and it shall be published. The pttbhcfition of Tria Juneta in Uno, would offence in a quarter which the writer did not it at once ? As 1 told Mr. Keate, I had no- give probably intend it to reach. H, W. cannot for a moment seriously expect us thing to do with any person or persons as- to S.entertain the proposition he has made. I acted as an sembled at the We have not seen the letter of Mr. Francis White individual after the of Dublin, and eannot, therefore, tell whether the to him, and his answer returned. That an- strictures of A Medical Cfrsderot are justified, which, swer was to the purport, that the Council at any rate, would be more appropriately published in the paper in question. could not interfere, because our The letters respecting Mr. Gathrie’s lectures Allow me were at the ( next week.
CoUe,;e, ouly resolution was presented proceedings
Cullege
irregular.