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SELF-SUPPORTING DISPENSARIES.
195 board that it should be speedily considered in relation to an can hope for remuneration from the class alluded to, but by such a prepayment!1 I have proof that sums varying from amended law on the subject. His lordship again promised that he would specially com- £60 to £140 per annum are received by medical gentlemen, municate with the president of the poor-law board with re- who, from the same sources, under ordinary circumstances, ference to the objects sought by the deputation, which then would have their ledgers encumbered with questionable withdrew. accounts, or would not receive a farthing. If the medical _____
committee "permit improper objects" (perhaps their own or their neighbours’ former patients) "to creep into these institutions, the fault is theirs, not that of the system." It is not apparent whether your foot-note on Mr. Bryan’s letter is intended as an answer to my second communication. "Audi alteram partem."’ I must, however unwillingly, demur to your assertion, that I have repudiated the institutions in the towns you name. I THE INCOME-TAX AND MEDICAL PRAChold that they affirm, although practically modified, the correctness of Mr. Smith’s views. It is your statement as to the TITIONERS remuneration afforded that I repudiate. The Northampton MR. GREENTIOW, of Newcastle-on-Tyne, has forwarded to us has not hitherto occupied my attention ;but for publication a letter which he has addressed to Sir C. Dispensary within the last few days the reports have been transmitted to. Wood, the Chancellor of the Exchequer, on the unfair pres- me; and the fourth annual report (I believe the last) indisure of the income-tax on those who derive their resources from cates that X130 has been paid to one of the medical gentletheir personal exertions. Wehave not space to insert the men, and proportionate amounts to others. We will allude whole of his letter, but we extract from it the following pas- , to the Janus idea hereafter ! If Mr. Bryan’s letter mean: sages: we first learn that remuneration is accorded to anything, " Admitting that I possess a property in my professional medical men beyond what you have admitted. We next labours, it cannot, contingent as it is in so many casual in- learn that Mr. Bryan is the contractor for thirteen benefit fluences to which all men are liable, be valued at more than clubs-the most disgraceful institutions, next to poor-law three years’ purchase, whereas fixed property is worth from unions, affecting the profession, realizing, indeed, the assertwenty to thirty years’ purchase, and the simple rule of three tion, that each member " will have his pennyworth for his will enable you to calculate the relative degree of protection penny." By what accident did it happen that Mr.Bryan, if afforded by the state to each. In the one case it is clear that so dissatisfied with his position, retained it in the dispensary the tax ought to be from seven to ten times greater than in the four years ! Does this gentleman mean to have it understood that all the fifty patients enrolled under his name were ill in other. " But look for a moment at the conditions under which the one year ? If so, he was unfortunate; if not, whence arises two estates are acquired. The proprietor of a fixed estate, it that he had so few among the numbers enrolled ? Was it from his first possession, has all the advantages of the in- that he was unpopular ? or was it that his station in society come it yields to him, and every sum judiciously expended took him out of the class to which reference is made ? Mr. in draining, manuring, and improving his estate adds to its Bryan is, I understand, a gentleman of great respectability; value, and increases its proceeds. As a contrast, let me in- hence nothing is to be expected from him but the most stance some individual case in my own profession, say that honourable conduct; and such I most willingly concede. His of my own son, a youth aged twenty-one. His head and his i letter is important in the question, as from it we likewise hands are his estate, but they will yield no proceeds till the learn, that, notwithstanding his lukewarmness, his patients age of 25, when he will endeavour to become a Fellow of the increased from fifty to 651 in a series of years, although it is College of Surgeons. In the meantime, his estate requires the quite clear he was not remunerated upon Mr. Smith’s plan. most careful cultivation. Draining and manuring must not Is it unquestionably to be understood that Mr. Bryan’s ideas be spared, or anything that can bring the head and hands as to statistics are not running upon his own clubs, rather than into the best practicable condition; and if he should die in the upon Mr. Smith’s dispensary system ? The " degrading supermeantime, all is lost. Nor is it certain that with all this out- vision" attaches to the former, but not to the latter, if medical lay he may become one of Fortune’s favourites, and receive a men are true to each other. You, Mr. Editor, will estimate these points, and I rely upon your integrity and candour. proper and reasonable return. . " But hence comes the I am, Sir, your obedient servant, capital invested in these most needJOSEPH MOORE. Savile-row, Feb. 5,1851. JOSEPH ful, but equally uncertain, measures of cultivation, draining, and manuring? They can only be supplied from my own precarious income, on which I am required to pay seven or ten times as large a proportional amount of premium for proTHE ROYAL MEDICAL AND CHIRURGICAL tection, as the most wealthy possessors of landed or other SOCIETY. realized property in the country. To the Editor " of THE LANCET. Who can wonder that professional men and others should writhe under a mode of direct taxation so galling and unjust?’? SIR,--To your exertions in a great measure is to be attric buted the greater spirit of independence which for years back has been gradually developing itself among the fellows of the Royal Medico-Chirurgical Society, which last year displayed SELF-SUPPORTING DISPENSARIES. itself in a strong opposition to the nominees of the council, [LETTER FROM DR. MOORE.] and as there is no doubt that some dissatisfaction will be exTo the Editor of THE LANCET. pressed with the list about to be put forward by the council SIR,-I am somewhat at a loss, in the present stage of our at the next election, you will perhaps permit me to call the discussion, to understand our relative position. I am contend- attention of the fellows to a few points connected with it. Of ing for a principle, the practical application of which you have the merits of Mr. Hodgson, proposed as president of the declared degrading to the members of our profession, equally council, and the other surgeons who are considered as having with the recipients of their medical skill, although you do not stronger claims on the support of the fellows, sufficient has show whence such a result arises. You have, indeed, insi- already been said in Berners-street, on the ordinary days nuated that it is the inadequacy of the remuneration; and a of gossip. Of the vice presidents, the two new ones, Dr. recent correspondent has asserted that one its liable to be Mayo and Mr. Shaw, are objectionable, the first, in being called upon at any hour by these free members." I regret that placed over the heads of fourteen physicians who, besides both these elements prominently affect practitioners; and it is being his seniors in the Society, are in every other respect his to protect the profession from one class, at least, comprised superiors in fitness for theoffice. They are, Drs. Agers, Alderunder the two heads of objection, that Mr. Smith promulgates son, Ashburner, Barker, Cursham, Darling, Henry Lee, Moore, his plan. I show you, that by its adoption a much larger Pidduck, Roberts, Stroud, Todd, Webster, and Nelson; and pecuniary amount accrues to the practitioner than the poor- here I would remark that Dr. Nelson, whose father was one of law system or clubs afford. I have not adverted to persons the founders of the Society, and continued a fellow until his who are able, however unwilling, to pay for medical aid, but death three years ago, though he has been himself sixteen confine myself exclusively to those who, although not affluent, years a fellow of the Society, has never been even on the be kept steadily council. The objection to Mr. Shaw is, that should Mr. De are abovenopauperism. Unless this distinction in view, argument upon the system can be maintained, and Morgan be elected as the successor of Mr. Charles Hawkins, it is the error you commit in this particular that creates your the present surgical secretary-to whose unremitting care and own inconsistencies. Let me ask in what way the practitioner attention during this recess, the fellows are mainly indebted for
Correspondence.
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committee "permit improper objects" (perhaps their own or their neighbours’ former patients) "to creep into these institutions, the fault is theirs, not that of the system." It is not apparent whether your foot-note on Mr. Bryan’s letter is intended as an answer to my second communication. "Audi alteram partem."’ I must, however unwillingly, demur to your assertion, that I have repudiated the institutions in the towns you name. I THE INCOME-TAX AND MEDICAL PRAChold that they affirm, although practically modified, the correctness of Mr. Smith’s views. It is your statement as to the TITIONERS remuneration afforded that I repudiate. The Northampton MR. GREENTIOW, of Newcastle-on-Tyne, has forwarded to us has not hitherto occupied my attention ;but for publication a letter which he has addressed to Sir C. Dispensary within the last few days the reports have been transmitted to. Wood, the Chancellor of the Exchequer, on the unfair pres- me; and the fourth annual report (I believe the last) indisure of the income-tax on those who derive their resources from cates that X130 has been paid to one of the medical gentletheir personal exertions. Wehave not space to insert the men, and proportionate amounts to others. We will allude whole of his letter, but we extract from it the following pas- , to the Janus idea hereafter ! If Mr. Bryan’s letter mean: sages: we first learn that remuneration is accorded to anything, " Admitting that I possess a property in my professional medical men beyond what you have admitted. We next labours, it cannot, contingent as it is in so many casual in- learn that Mr. Bryan is the contractor for thirteen benefit fluences to which all men are liable, be valued at more than clubs-the most disgraceful institutions, next to poor-law three years’ purchase, whereas fixed property is worth from unions, affecting the profession, realizing, indeed, the assertwenty to thirty years’ purchase, and the simple rule of three tion, that each member " will have his pennyworth for his will enable you to calculate the relative degree of protection penny." By what accident did it happen that Mr.Bryan, if afforded by the state to each. In the one case it is clear that so dissatisfied with his position, retained it in the dispensary the tax ought to be from seven to ten times greater than in the four years ! Does this gentleman mean to have it understood that all the fifty patients enrolled under his name were ill in other. " But look for a moment at the conditions under which the one year ? If so, he was unfortunate; if not, whence arises two estates are acquired. The proprietor of a fixed estate, it that he had so few among the numbers enrolled ? Was it from his first possession, has all the advantages of the in- that he was unpopular ? or was it that his station in society come it yields to him, and every sum judiciously expended took him out of the class to which reference is made ? Mr. in draining, manuring, and improving his estate adds to its Bryan is, I understand, a gentleman of great respectability; value, and increases its proceeds. As a contrast, let me in- hence nothing is to be expected from him but the most stance some individual case in my own profession, say that honourable conduct; and such I most willingly concede. His of my own son, a youth aged twenty-one. His head and his i letter is important in the question, as from it we likewise hands are his estate, but they will yield no proceeds till the learn, that, notwithstanding his lukewarmness, his patients age of 25, when he will endeavour to become a Fellow of the increased from fifty to 651 in a series of years, although it is College of Surgeons. In the meantime, his estate requires the quite clear he was not remunerated upon Mr. Smith’s plan. most careful cultivation. Draining and manuring must not Is it unquestionably to be understood that Mr. Bryan’s ideas be spared, or anything that can bring the head and hands as to statistics are not running upon his own clubs, rather than into the best practicable condition; and if he should die in the upon Mr. Smith’s dispensary system ? The " degrading supermeantime, all is lost. Nor is it certain that with all this out- vision" attaches to the former, but not to the latter, if medical lay he may become one of Fortune’s favourites, and receive a men are true to each other. You, Mr. Editor, will estimate these points, and I rely upon your integrity and candour. proper and reasonable return. . " But hence comes the I am, Sir, your obedient servant, capital invested in these most needJOSEPH MOORE. Savile-row, Feb. 5,1851. JOSEPH ful, but equally uncertain, measures of cultivation, draining, and manuring? They can only be supplied from my own precarious income, on which I am required to pay seven or ten times as large a proportional amount of premium for proTHE ROYAL MEDICAL AND CHIRURGICAL tection, as the most wealthy possessors of landed or other SOCIETY. realized property in the country. To the Editor " of THE LANCET. Who can wonder that professional men and others should writhe under a mode of direct taxation so galling and unjust?’? SIR,--To your exertions in a great measure is to be attric buted the greater spirit of independence which for years back has been gradually developing itself among the fellows of the Royal Medico-Chirurgical Society, which last year displayed SELF-SUPPORTING DISPENSARIES. itself in a strong opposition to the nominees of the council, [LETTER FROM DR. MOORE.] and as there is no doubt that some dissatisfaction will be exTo the Editor of THE LANCET. pressed with the list about to be put forward by the council SIR,-I am somewhat at a loss, in the present stage of our at the next election, you will perhaps permit me to call the discussion, to understand our relative position. I am contend- attention of the fellows to a few points connected with it. Of ing for a principle, the practical application of which you have the merits of Mr. Hodgson, proposed as president of the declared degrading to the members of our profession, equally council, and the other surgeons who are considered as having with the recipients of their medical skill, although you do not stronger claims on the support of the fellows, sufficient has show whence such a result arises. You have, indeed, insi- already been said in Berners-street, on the ordinary days nuated that it is the inadequacy of the remuneration; and a of gossip. Of the vice presidents, the two new ones, Dr. recent correspondent has asserted that one its liable to be Mayo and Mr. Shaw, are objectionable, the first, in being called upon at any hour by these free members." I regret that placed over the heads of fourteen physicians who, besides both these elements prominently affect practitioners; and it is being his seniors in the Society, are in every other respect his to protect the profession from one class, at least, comprised superiors in fitness for theoffice. They are, Drs. Agers, Alderunder the two heads of objection, that Mr. Smith promulgates son, Ashburner, Barker, Cursham, Darling, Henry Lee, Moore, his plan. I show you, that by its adoption a much larger Pidduck, Roberts, Stroud, Todd, Webster, and Nelson; and pecuniary amount accrues to the practitioner than the poor- here I would remark that Dr. Nelson, whose father was one of law system or clubs afford. I have not adverted to persons the founders of the Society, and continued a fellow until his who are able, however unwilling, to pay for medical aid, but death three years ago, though he has been himself sixteen confine myself exclusively to those who, although not affluent, years a fellow of the Society, has never been even on the be kept steadily council. The objection to Mr. Shaw is, that should Mr. De are abovenopauperism. Unless this distinction in view, argument upon the system can be maintained, and Morgan be elected as the successor of Mr. Charles Hawkins, it is the error you commit in this particular that creates your the present surgical secretary-to whose unremitting care and own inconsistencies. Let me ask in what way the practitioner attention during this recess, the fellows are mainly indebted for
Correspondence.
.
’