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THE LATE MR. CHARLES CLAY OF MANCHESTER.
THE RIGHTS OF MEDICAL PRACTITIONERS.
1402
THE RIGHTS OF MEDICAL PRACTI-
TIONERS.
his responsibilities are concerned. The guardians regret very much that the observations made upon this unprecedented visitation by diphtheria at their schools in your much quoted journal for the guidance of the medical profession, might also convey a misleading impression as to the management and general condition of the schools. It is true that during a few weeks last winter the total number of children exceeded the certificate (678), but it was quite an exceptional occurrence, and at that time there was no available accommodation at other schools. In dealing with the large number of children then chargeable choice therefore lay only between the contracted and otherwise imperfect accommodation for children at the workhouse of the parish (the reconstruction of which is still incomplete), and the schools at Leavesden, situated in the open country, with facilities for isolation. It should also not be forgotten that at the time diphtheria appeared at the schools it was epidemic in the metropolis. The cause of the outbreak at the Leavesden Schools could not be traced, even by experts, with absolute certainty. In the report by Dr. Sykes, he pointed with reserve to various possible sources of infection; but apparently emphasised his opinion that in one or two sections of the school the ventilation had become curtailed by the additional means of heating the dormitories and class-rooms. The better heating of those rooms had been adopted upon suggestions made to the guardians for the benefit of the children of low vitality, and with beneficial results to children of that class. This points to one of the oft-recurring puzzles of ventilation, so difficult to solve where the health conditions of the occupants of the rooms are so varied. Several valuable suggestions arising out of the report by Dr. Sykes have since been promptly adopted. The guardians have many reasons to be proud of their splendid establishment at Leavesden, as the annual reports upon the results of their management will show. I enclose copies of the last three years’ reports, containing, inter alia, tabular statements, by which it will be seen that with a general population of upwards of 600 children, the average number of deaths has been less than 6 per annum ; and in nearly every instance the cause of death has been unconnected with the influence of the school. I am, Sirs, yours faithfully, ALFRED A. MILLWARD,
To the Editors nf THE LANCET. SlES,—Some time ago Mr. Bryant delivered a most excellent lecture on some points of medical practice, notably our relation to Medical Aids and Midwives. May I say that as a provincial medical practitioner, and therefore a victim of ’, that spirit of rivalry mentioned by Dr. Wilks, I was delighted ’ with the tone of Mr. Bryant’s speech. It was the first time I had known a London surgeon of the highest standing take a practical interest in these questions. The London consultant, as a rule, stands aloof from such matters. He is willing to see our patients at two guineas a consultation. He I is willing to perform an operation for us for a hundred I guineas, and attracts to himself the wealthier portion of the community by his greater scope of practice in the hospitals, and his position in a medical school. i As a rule he cares nothing that his profession is de- ’ graded by a system of low contracts, by which the ’, public are taught that a medical attendance is worth about twopence or threepence. He fails to see that in time the consultant will also be asked to contract for his services, and that by his foolish refusal to stand shoulder to shoulder with his provincial brothers he is slowly but surely thinning the cord by which a sword is suspended over his own neck. Degrade the position of one medical man and all must suffer. Teach the British public that medical service is worth little, they will demand medical attendance at their own price, and we shall cease to be allowed to estimate in any way the value of our work. Lawyers are wiser than we. They know their profession must stand or fall as a whole, and that each one is a part of the whole. Mr. Bryant has spoken out more clearly than any other of his class, and I much regret the small support he appeared to receive in the Council. I hope he will not be discouraged in his unselfish championship of the just rights of medical practitioners ; but will strike again, and harder, at the of the Council. If the General Medical Council cannot represent us on matters such as these, it is quite time it should be disestablished and disendowed, and some more practical body elected by the vote of the profession. The general practiClerk to the Guardians. May 28th, 1894. tioners are the backbone, as they are the majority, of the profession, and they require a fuller representation on the Council than they have at present. They require that THE LATE MR. CHARLES CLAY OF questions which to them are of interest and importance shall not be shelved or evaded by " weak-kneed resolutions " The MANCHESTER. Council must awake to this fact, as it has awoke to others, To the Editors of THE LANCET. and must learn that it will have to be something more than a SIRS,-The representatives of this distinguished surgeon mere debating class as to the amount of preliminary educacation necessary for the average medical student. For many have placed at my disposal a mass of material for the preof a suitable memorial of him, including an autoyears it filled that rolelately it has been more active, but paration biographical sketch of much interest. Unfortunately, the it still needs the pressure of the democratic vote. material is deficient in that period of his life which is of T 2,m- qirq- V()l1r;;: trnlv_ greatest interest-between 1842 and 1850. A still greater J. B. PIKE. May 29th, 1894. misfortune is that the great age to which Mr. Clay lived has left few who can tell much about him at that time. My own efforts by private inquiry have failed so far, and I am "DIPHTHERIA AT THE LEAVESDEN therefore compelled to trespass on your courtesy for perSCHOOL." mission to ask through your widely-read columns that any To the Editors of THE LANCET. who may be in possession of documents or recollections of SiRs,-Referring to the annotation appearing in your issue Charles Clay would be good enough to put me in possession I am, Sirs, yours faithfully, of the 5th inst. with reference to the late outbreak of diph- of them theria at the St. Pancras Schools at Leavesden, and the 7, The Crescent, Birmingham, May 29th, 1894. LAWSON TAIT. report thereon prepared at the request of the guardians by Dr. J. F. J. Sykes, the medical officer of health of St. Pancras, I am desired to intimate that the comments upon "THE SURREY DISPENSARY AND ITS the attitude of the guardians in relation to the precautions STAFF." necessary to preserve the health of the children may lead to a mistaken judgment. The guardians wish to correct a possible To the Editors of THE LANCET. inference, directly conveyed, that they have not only crowded the schools regardless of consequences but have persistently SlES,—As Dr. Ince’s second letter in THE LANCET of refused to give attention to their medical officer’s advice May 19th is very misleading I will, with your permission, on that point. The guardians have always well recognised the: reply to it briefly. The rules as to visiting home-patients in abilities and services of Mr. Adams Clarke, the medical force now and for many years past say that the physicians officer of the schools. It is the custom for him to attend and surgeons "shall visit home-patients when required"; every meeting of the schools visiting committee, and he, on that " the resident medical officer shall visit all new homehis part, must be willing to admit that the committee havei patients, to ascertain the nature of their cases, then report taken the keenest interest in his reports and sugggestions, upon the same to the physicians and surgeons, he retaining to which they have constantly attached paramount import- those cases which they may consider do not require their ance, and the committee have, in many instances, taken the: attendance"; also, I I he shall be held responsible for the initiative in steps for the better classification of the children, home-patients being seen regularly and systematically." and in improved arrangements for the treatment of the sick ;; This is ’ the arrangement " which Dr. Ince says I allfge and Mr. Clarke is invariably consulted on all matters in which was mad by the managing committee some years ago and ‘
apathy
h
.
.
1402
THE RIGHTS OF MEDICAL PRACTI-
TIONERS.
his responsibilities are concerned. The guardians regret very much that the observations made upon this unprecedented visitation by diphtheria at their schools in your much quoted journal for the guidance of the medical profession, might also convey a misleading impression as to the management and general condition of the schools. It is true that during a few weeks last winter the total number of children exceeded the certificate (678), but it was quite an exceptional occurrence, and at that time there was no available accommodation at other schools. In dealing with the large number of children then chargeable choice therefore lay only between the contracted and otherwise imperfect accommodation for children at the workhouse of the parish (the reconstruction of which is still incomplete), and the schools at Leavesden, situated in the open country, with facilities for isolation. It should also not be forgotten that at the time diphtheria appeared at the schools it was epidemic in the metropolis. The cause of the outbreak at the Leavesden Schools could not be traced, even by experts, with absolute certainty. In the report by Dr. Sykes, he pointed with reserve to various possible sources of infection; but apparently emphasised his opinion that in one or two sections of the school the ventilation had become curtailed by the additional means of heating the dormitories and class-rooms. The better heating of those rooms had been adopted upon suggestions made to the guardians for the benefit of the children of low vitality, and with beneficial results to children of that class. This points to one of the oft-recurring puzzles of ventilation, so difficult to solve where the health conditions of the occupants of the rooms are so varied. Several valuable suggestions arising out of the report by Dr. Sykes have since been promptly adopted. The guardians have many reasons to be proud of their splendid establishment at Leavesden, as the annual reports upon the results of their management will show. I enclose copies of the last three years’ reports, containing, inter alia, tabular statements, by which it will be seen that with a general population of upwards of 600 children, the average number of deaths has been less than 6 per annum ; and in nearly every instance the cause of death has been unconnected with the influence of the school. I am, Sirs, yours faithfully, ALFRED A. MILLWARD,
To the Editors nf THE LANCET. SlES,—Some time ago Mr. Bryant delivered a most excellent lecture on some points of medical practice, notably our relation to Medical Aids and Midwives. May I say that as a provincial medical practitioner, and therefore a victim of ’, that spirit of rivalry mentioned by Dr. Wilks, I was delighted ’ with the tone of Mr. Bryant’s speech. It was the first time I had known a London surgeon of the highest standing take a practical interest in these questions. The London consultant, as a rule, stands aloof from such matters. He is willing to see our patients at two guineas a consultation. He I is willing to perform an operation for us for a hundred I guineas, and attracts to himself the wealthier portion of the community by his greater scope of practice in the hospitals, and his position in a medical school. i As a rule he cares nothing that his profession is de- ’ graded by a system of low contracts, by which the ’, public are taught that a medical attendance is worth about twopence or threepence. He fails to see that in time the consultant will also be asked to contract for his services, and that by his foolish refusal to stand shoulder to shoulder with his provincial brothers he is slowly but surely thinning the cord by which a sword is suspended over his own neck. Degrade the position of one medical man and all must suffer. Teach the British public that medical service is worth little, they will demand medical attendance at their own price, and we shall cease to be allowed to estimate in any way the value of our work. Lawyers are wiser than we. They know their profession must stand or fall as a whole, and that each one is a part of the whole. Mr. Bryant has spoken out more clearly than any other of his class, and I much regret the small support he appeared to receive in the Council. I hope he will not be discouraged in his unselfish championship of the just rights of medical practitioners ; but will strike again, and harder, at the of the Council. If the General Medical Council cannot represent us on matters such as these, it is quite time it should be disestablished and disendowed, and some more practical body elected by the vote of the profession. The general practiClerk to the Guardians. May 28th, 1894. tioners are the backbone, as they are the majority, of the profession, and they require a fuller representation on the Council than they have at present. They require that THE LATE MR. CHARLES CLAY OF questions which to them are of interest and importance shall not be shelved or evaded by " weak-kneed resolutions " The MANCHESTER. Council must awake to this fact, as it has awoke to others, To the Editors of THE LANCET. and must learn that it will have to be something more than a SIRS,-The representatives of this distinguished surgeon mere debating class as to the amount of preliminary educacation necessary for the average medical student. For many have placed at my disposal a mass of material for the preof a suitable memorial of him, including an autoyears it filled that rolelately it has been more active, but paration biographical sketch of much interest. Unfortunately, the it still needs the pressure of the democratic vote. material is deficient in that period of his life which is of T 2,m- qirq- V()l1r;;: trnlv_ greatest interest-between 1842 and 1850. A still greater J. B. PIKE. May 29th, 1894. misfortune is that the great age to which Mr. Clay lived has left few who can tell much about him at that time. My own efforts by private inquiry have failed so far, and I am "DIPHTHERIA AT THE LEAVESDEN therefore compelled to trespass on your courtesy for perSCHOOL." mission to ask through your widely-read columns that any To the Editors of THE LANCET. who may be in possession of documents or recollections of SiRs,-Referring to the annotation appearing in your issue Charles Clay would be good enough to put me in possession I am, Sirs, yours faithfully, of the 5th inst. with reference to the late outbreak of diph- of them theria at the St. Pancras Schools at Leavesden, and the 7, The Crescent, Birmingham, May 29th, 1894. LAWSON TAIT. report thereon prepared at the request of the guardians by Dr. J. F. J. Sykes, the medical officer of health of St. Pancras, I am desired to intimate that the comments upon "THE SURREY DISPENSARY AND ITS the attitude of the guardians in relation to the precautions STAFF." necessary to preserve the health of the children may lead to a mistaken judgment. The guardians wish to correct a possible To the Editors of THE LANCET. inference, directly conveyed, that they have not only crowded the schools regardless of consequences but have persistently SlES,—As Dr. Ince’s second letter in THE LANCET of refused to give attention to their medical officer’s advice May 19th is very misleading I will, with your permission, on that point. The guardians have always well recognised the: reply to it briefly. The rules as to visiting home-patients in abilities and services of Mr. Adams Clarke, the medical force now and for many years past say that the physicians officer of the schools. It is the custom for him to attend and surgeons "shall visit home-patients when required"; every meeting of the schools visiting committee, and he, on that " the resident medical officer shall visit all new homehis part, must be willing to admit that the committee havei patients, to ascertain the nature of their cases, then report taken the keenest interest in his reports and sugggestions, upon the same to the physicians and surgeons, he retaining to which they have constantly attached paramount import- those cases which they may consider do not require their ance, and the committee have, in many instances, taken the: attendance"; also, I I he shall be held responsible for the initiative in steps for the better classification of the children, home-patients being seen regularly and systematically." and in improved arrangements for the treatment of the sick ;; This is ’ the arrangement " which Dr. Ince says I allfge and Mr. Clarke is invariably consulted on all matters in which was mad by the managing committee some years ago and ‘
apathy
h
.
.