SUGGESTIONS CONCERNING THE APPOINTMENT OF A MEDICAL INSPECTOR-GENERAL AND DEPUTY INSPECTORS UNDER THE POOR LAW,

238 session; in fact, that great object required first of which he

a series of Bills, the hoped to be able to propose to the House before

Easter. MR. WAKLEY trusted that the statement of the noble lord would be verified, and that the Bill would be produced within a fortnight or three weeks. A Bill of such importance should be on the table of the House before the measure now before it became law. (Hear.) The noble lord was aware that medical men had made great exertions with respect to sanitary measures - that they had applied unremitting industry, great ability, and incessant labour, to this important subject. (Hear.) And how were they rewarded? The lawyers who drew this Bill had excluded from it everything relating to medical officers. It would scarcely be credited, that in this Bill relating to the public health there was not a single provision for the introduction of medical officers. He had no doubt there were lawyer candidates twenty deep for all places that could be filled by lawyers; but from the way in which the medical practitioners were treated by the Bill,

they might regard themselves as insulted,-not by the

noble lord, interest in medical matters, but in a manner which medical men did not very much admire. Under this Bill, the General Board of Health was to consist of five persons, the Chief Commissioner of Woods and Forests, and four others, two of whom were to be paid. Would the noble lord object to the introduction of a clause, providing that the two who were to be paid should be duly qualified members of the medical pro-

who took

an

fession ?

LoRn MORPETH could not admit that the medical profession slighted; for, in the first place, the Bill gave power to the Treasury of appointing such a number of superintending inspectors as might be thought fit, and from the nature of the thing a considerable number of them ought to consist of medical men or engineers, as circumstances might require. Then the Bill gave power to the local Boards to appoint officers to carry out the provisions of the Bill, who might be medical men. With respect to the two members of the General Board in London, it was the determination of the Government, if called upon to exercise a choice, to select the two fittest men they could find, and he could not bind himself by any more stringent declaration

were

as to

who

gers. But was it likely that legally-qualified members of the medical profession could be obtained as surgeons to emigrant ships for .620 a voyage, with the prospect of some £10, £15, or .620, which might be given them by the owners in addition to that miserable stipend? The average duration of the voyage was six or seven weeks; and for a voyage outwards of seven weeks, and homewards of seven weeks, the surgeon was to receive .620! Why, it was preposterous to suppose that competent medical men could be obtained for so paltry a pittance. The Government, however, had not struck at the root of the evil; and he was satisfied, that without placing in every emigrant ship a competent medical practitioner, it was impossible to remedy many of those evils which had been deplored by the right hon. gentleman who introduced the Bill. He (Mr. Wakley) regretted to express his conviction that this measure fell far short of what the unfortunate people of Ireland and the public had a right to expect; and he hoped the right hon. gentleman would reconsider the subject, with a view of ascertaining whether, by adopting proper measures, it was not possible to obtain a sufficient number of competent medi’, cal practitioners. In connexion with the three medical colleges ’, in England, Ireland, and Scotland, there were not less than 17,000 surgeons, besides licentiates of the various colleges of physicians of other societies, and he was satisfied that if a proper remuneration was offered, no difficulty would be experienced in obtaining the services of duly qualified medical men. He wished to state, however, that these services were not likely to be obtained for such a reward as was offered by the Government last year to the medical officers of fever hospitals in Ireland. Would the house believe that the pay of physicians and surgeons, whose duty it was to attend persons suffering from typhus fever in the fever hospitals of Ireland, had been 5s. a day ? And what had been the mortality among those men ? One in fifteen had fallen victims to the discharge of their perilous duties ; and he hoped, if an appeal was made to that house by their widows and orphans, it would not be made in vain. He (Mr. Wakley) was convinced that if a proper inducement was held out, there would be no difficulty in obtaining a sufficient number of medical men as surgeons of emi-

grant ships.

they might be.

MR. HENLEY quite agreed with the hon. member for Finsbury, that medical men would be better fitted than the members of any other profession to fill some of the offices which were now proposed to be created. After a few words from Mr. SLANEY, The Bill was read a second time.

Correspondence. SUGGESTIONS CONCERNING THE APPOINTMENT OF A MEDICAL

INSPECTOR-GENERAL AND DEPUTY INSPECTORS UNDER THE POOR LAW, AND PROPOSALS FOR REGULATING THE PAYMENT OF UNION SURGEONS.

EMIGRANT VESSELS. MR. LABOUCHERE, in the course of his address, having moved the second reading of this Bill, remarked,-It had been strongly urged on the Government, that every emigrant ship should be obliged to take out a surgeon. (Hear, hear.) He (Mr. Labouchere) wished he was in a condition to recommend the house to pass some such enactment; for not even the presence of a respectable superintendent could make up for the want of a medical officer. The noble earl, the Colonial Secretary, had been most anxious to propose such a clause, but the Emigration Commissioners stated that it would require so many surgeons in a few months, some of them at every port from which emigrants might proceed, that many families would be sent back disappointed, in consequence of the owners not being able to procure a surgeon. But he (Mr. Labouchere) was not without hope that a regulation, obliging every emigrant ship to take out a superintendent, would indirectly induce owners to send out surgeons far more often than at present; for it was the intention of the Colonial Office and the Emigration Commissioners, where there was a competent and trustworthy surgeon taken out, to appoint him superintendent under this Bill. (Hear, hear.) MR. WAKLEY thought the present system of emigration was highly discreditable to the Government and to the legislature. It had been officially stated by the right hon. gentleman (Mr. Labouchere) that deaths had occurred in emigrant ships to the extent of seventeen per cent. The Emigration Commissioners might be justified, by the evidence they had received, in making the report they had made to the house with regard to the difficulty of providing surgeons for emigrant ships ; but this subject bad been under the consideration of the house last year, and he (Mr. Wakley) then said, that if surgeons were adequately paid, there would be no difficulty in obtaining their services. He (Mr. Wakley) believed that no persons could be more efficient as superintendents of emigrant ships than medical practitioners, who were men of good education, who were fully aware of the necessity of preserving discipline, and who were well acquainted with the requisites for ensuring the comfort and health of the passen-

DR. GARRETT DILLON, in remarks:Webster, "

a

letter addressed to Dr.

George

I fully agree that a medical man, as INSPECTOR-GENERAL of the medical department of the poor laws, ought to have a seat and full powers as a commissioner, at the Board in London; and for every three or four Unions there ought to be a deputy-inspector, to have surveillance over the practice of Union-surgeons, and to meet them in consultation in every case of doubt and difficulty, where, in the ordinary course of practice, a second opinion would be considered desirable. This officer should have the double qualification of surgeon and physician, and his pay should not be less than that of a deputy-inspector of hospitals in the army. He ought, too, to have the privilege of engaging in private practice, but not as an accoucheur or apothecary, as such occupations might occupy too much of his time, and clash with the duties of his public office. The grievances of which Union medical officers are complaining are rather to be ascribed to their own conduct than to the acts of the commissioners or of the guardians. The commissioners or guardians know nothing whatever about the nature or cost of remedies or medical appliances, or about the extent of time or amount of skill necessary in the treatment of disease; nor can they calculate to what probable extent disease may prevail in the Unions under their ad-

ministration. This is kind of knowledge that

falls entirely within the medical man, and it is not to be expected that the kind of men who generally work their way into the petty authority of guardians should possess it. They, in fact, know little or nothing about such things, so that they proceed entirely, in fixing the salaries, upon inferences. Those inferences they draw from the acts of the medical men, themselves, competing for such appointments. Such competitors, nnfortu. nately for the poor, under-bid each other, and undertake to perform the most grave and responsible duties that man can engage in, at a remuneration that would scarcely pay their errand-boys! Young medical men rush after those appointa

province of the

239 new unions, it would be the best. Soon resigned the office I held, that system was abolished, the physician denied a salary, and the whole medical establishment broken up as too expensive. The poor have been ever since farmed out, and it has been found the cheaper way. If every Union workhouse were in a central position, such a system might be advantageously established, and it would,

ments, for the moment, regardless of the salary, but solely with practicable in the the view of acquiring experience, and in the hope of getting On the other hand, an introduction into private practice. there are established practitioners who take the appointments at any salary, sooner than let them fall into the hands of, and give a footing to, the young adventurers, who might, in time, out of such a beginning, become their too successful competitors in private practice. Such men, in the one case or in the other, have no right to complain, yet they are scarcely settled in office, when they begin to grumble, and, as was the case at the Hanover-squarerooms, the vials of their wrath are poured forth most abundantly on the devoted heads of the pinch-pauper guardians. The guardians, it must be admitted, incompetent as they are to fix a scale of remuneration for the Union-doctors, are not free from moral guilt in this business. They see clearly enough the motives of the competing candidates, and sordidly take advantage of them, playing the one party off against the other. This is, to say the least of it, very reprehensible, forI the commissioners and the guardians must know, judging from the main-springs of human actions, that when the doctor is

after I

in the aggregate, be less troublesome to the poor to send to the Union for the medicines prescribed, than to the houses of the medical attendants. In any case there ought to be a medical attendatzt for every parish. One for a whole Union would be insufficient, even if all his time were given, exclusively, to the Union practice. London, 1848.

THE FATAL CHLOROFORM CASE AT NEWCASTLE. To the Ed1:tOJ’

SiR,—The

recent fatal

of Tas -LANCET.

case

of inhalation of chloroform

appears to confirm in a melancholy manner the remarks contained in my paper in THE LANCET of the 12th instant, insufficiently paid, the pauper-patient must in one way or respecting the danger arising from the cumulative property another be the sufferer. This, in fact, was admitted, avowed, of the agent when administered on a handkerchief. The and by no one contradicted, at the late convocation at Hanover- alarming symptoms came on after the cloth with chloroform square. was removed from the patient’s face. Some of Dr. Simpson’s It is now established beyond a doubt, that a grievance and observations on this case confirm the view I have taken. a loud crying evil do exist in the medical department of the He says-"have seen in a few cases such a blanched state new Poor Law. The question, then, is, what is the remedy of the lips and features come on, under the use of very for this evil ? whence is it to come1 who is to apply it ?t powerful and deep doses of chloroform, simulating syncope, From the guardians, the doctors say that there is nothing to and with the respiration temporarily suspended." It may be be expected. From the commissioners, just as little. I ven- presumed, that the cases Dr. Simpson has seen were under ture to say that neither the commissioners nor the guardians his immediate superintendence; and this makes the danger know how to devise a remedy. Who, then, does?Why, still more evident; for if any one could prevent his patient medical men themselves; but, strange to say, often and vehe- from getting into a state which cannot be looked on otherwise mently as they complain, it has never entered into their heads than as one of imminent peril, it would be the authority todothis. The resolutions passed at the Hanover-square Rooms who introduced the agent, and recommended this method of

do nothing towards so desirable an end. A committee has been appointed, with various instructions, but it has not been referred to that committee to collect the necessary evidence, and settle upon a scale or scales of remuneration adapted to town and country practice respectively. Without agreeing it is utterly useless to memorialize the comupon such scales missioners or the Secretary of State. These functionaries would say, ’Gentlemen, you do not state exactly what you

want, and, therefore, we

cannot

help you.’

poor-law medical officers agree upon such scales of remuneration, and then approach the commissioners and the Secretary of State with memorials signed by all the Union surgeons, declaratory of their inability to do justice to the poor, without injury to themselves, for less than that remuneration. Above all, let them go to Parliament with petitions to the same purport, and similarly signed. The fixing upon such scales of remuneration would, at all events, have a great moral influence, but the probability is, that it Let the

legislative enactments that would settle the question definitely and satisfactorily. In arranging such scales of remuneration much useful information could be derived from the dispensary system, as respects the cost of drugs and medical appliances for every would lead to

for every hundred, or for any given number of It would be well to enter into such statistics, and adduce such evidence to meet any objections that might be made to the statements of Union surgeons, as coming from parties too deeply interested. The probable cost of medicines for any given number of cases being once settled upon, it would be easy to regulate the payment for the purely professional services of the medical attendant, which would of course be less in great cities and towns, where the duty lay within a narrow compass, than in rural districts, more extended, with greater distances between the residences of the patients. When I inform you that I passed twelveyears of the most active part of my life in dispensary and parochial practice, you will admit that I have had ample opportunities of forming an opinion upon this very important subject; and perhaps you will think, as I do myself, that at this trying crisis I am morally bound to express it. When I was engaged in parochial practice as surgeon to the parish of St. Pancras, in this metropolis, then containing a population of one hundred and twenty thousand souls, the medical officers had nothing to do with supplying the medicines to the patients. There was, at the workhouse, a dispensary, and a medical assistant resided there to dispense the medicines, and distribute them to the patients, as prescribed by the physician and surgeon. It has been always my opinion, that if the same system were

thousand, or cases.

its administration. On January 10th, two days after I read the remarks at the Westminster Medical Society, respecting the effects of chloroform increasing after the inhalation was left ot’l; M. Scdillot related, in the Academy of Sciences of Paris, that he had observed the pallor, smallness of pulse, feebleness of respiration, and coldness, to augment in an alarming manner after the employment of the chloroform had been discontinued. His observations were reported in the Gazette .J.’Wédicale of January 15th. I agree with Dr. Simpson, that it was not advisable to give brandy, or even water-the more so, as I do not think with him that there was syncope; but that these liquids caused suffocation, filling up the pharynx, and being partially drawn into the larynx, seems improbable. This question, however, can be only determined by those who observed the symptoms at the time of death, and the nature of the froth found in the bronchi afterwards, as there is nothing in the reported evidence of the appearances on dissection which might not be caused by the kind of asphyxia liable to be induced when the effects of chloroform are carried too far; and these appearances are quite incompatible with Dr. Simpson’s supposition that there was syncope. Preventing the recovery from syncope would not cause the state of the heart and lungs, which is characteristic of the opposite kind of death-that by asphyxia. In a certain number of those who are drowned, the heart and lungs are not congested,but the contrary, and it is believed by medical jurists, that those persons have fainted on falling into the water.-I remain, Sir, your obedient servant, JOHN SNOW. JOHN Frith-street, Soho.

THE ALLEGED DEATH FROM CHLOROFORM AT NEWCASTLE. To the Editor of THE LANCET.

SIR,-For the sake of science, humanity, and justice, I am glad to observe Dr. Simpson’s able and triumphant reply to the pathological verdict of the jury in the case of the girl Greener. I am glad also to observe the manly tone of THE LANCET in supporting Dr. Simpson’s views, and vindicating the cause of truth. Dr. Simpson had a painful duty to perform, but he came boldly forward, and put the case on a proper footing, for which he well deserves the thanks of the profession. In my humble opinion, however, Dr. Simpson has omitted The medical report states, " there some points of importance. was congestion of the brain, of the lungs, of the liver, of the kidneys, and of the spleen." Now, by what medical logic was the cause of death fixed on " congestion of the lungs"? Why,