THE ORGANISATION OF THE PROFESSION.
1536
it would be a great injustice to omit any name. At last, on the motion ot Mr. N. L. U. Somers, it was decided to apply to the secretary of the Medical Union at Coventry for the Thus in the course of time a white-list will be names. issued, and this is the next most effective measure that can be taken short of publishing a black-list. There now followed a long array of proposed alterations of rules. For the sake of brevity it was proposed to drop the word " medical " in the title of the union, but it was objected by Dr. A. W. Aldridge that as they did not intend toinclude legal and dental practitioners they must specify clearly that they were a union of medical practitioners, and this view was adopted. The clause in the rules by which each member guaranteed the sum of £1was struck out on the ground that the money was not now wanted and that the rule could not legally be enforced. Mr. Somers now brought forward a motion proposed by Mr. E. R. Hennessy, as that gentleman was unavoidably absent. This motion involved a rather important principle. It established the right of any qualified medical practitioner to become a member of the union if he was proposed and seconded by any two members of the union and if he signed a written declaration of his willingness to abide by the rules of the union. Had this proposal been carried the right of the council to veto any such election would have been aboli6hed, but it was defeated by a large majority. Confidence in the discretion of the council was expressed, and a protest was very justly made that it was too early in the history of the union to begin to alter its con-titution. The rules had been drawn up with great care and after much deliberation and they had better be given a fair trial before attempting to patch and to alter them. There is every reason to believe that the confidence in the council which has thus been expressed by words and by vote is in every sen:e thoroughly justified and well-founded. But, putting this particular council and union altogether aside, and dealing with the matter purely as an abstract question, there is something to be said in favour of Mr. Hennessy’s proposal. It is a point I haveoften had occasion to insist. A on which militant organisation of this description must act in an inverse sense to the aim governing the management of most other societies. The object in this case is not to bring the most reputable and respectable men together, but rather the reverse. It is the practitioner of the class known as the " sixpenny doctor," who is the most to be feared. It is a case of rejoicing more over the one lost sheep than It is precisely these doubtful over the ninety-and-nine. must who be persons brought into line. It would never do to allow social considerations or personal feelings to rule The union should not be a such men out of the union. select society club, but a fighting body governed by considerations of the strategy necessary to achieve the end in view ; therefore it must use its best endeavours to recruit that class of men who by reason of their less favourable position are most easily induced to undersell or to undercut their fellow practitioners. But it is just conceivable that a council if left to itself might allow its dislike of an individual to override what should ooviously be the policy of the union. Again I repeat that these observations are not in any way meant to apply to the council of the Birmingham and District General Medical Practitioners Union, but are purely abstract considerations. The argument which prevailed at Birmingham was that it was preferable for the council to veto a candidate than that the union should have to expel him shortly after the election. A lengthy discussion now ensued which, though interesting in it-elf, had not any very urgent or direct bearing on the main purpose of the union. Mr. Somers moved :-
THE
ORGANISATION OF THE PROFESSION. THE BIRMINGHAM AND DISTRICT GENERAL MEDICAL PRACTITIONERS UNION, SECOND ANNUAL MEETING.
(FROM
OUR
SPECIAL
COMMISSIONER.)
THE Birmingham and District General Medical Practitioners Union has now been in existence for two years, and on Nov. 21st it held its second annual meeting at the I Birmingham Medical Institute. I hope subsequently to give some account of the formation, history, and action of this organisation ; but I would nrat describe the annual meeting which has just taken place. It was held in the library of the Medical Institute and some 50 general practitioners were present, which, in view of the bad weather and the consequent increase of sickness prevailing, was considered to be a fairly good attendance. Mr. H. W. Langley Browne was in the chair, as.,isted by the two secretaries, Dr. E. D. Kirby and Mr. J. Neal. The annual report of the council, for the year ending Sept. 30th, 1901, was discussed. According to this document the Birmingham and District General Medical Practitioners Union now numbered 253 members, which showed an increase of 64 members in 12 months. There had been one death and 12 resignations, due for the most part to removal from the district. Though the subscription was only 5s. a year there were £32 12s. in hand. In an adjoining room there was a map of Birmingham studded with pins. White pins stood where the members of the union resided and black pins, I was informed, represented the residences of those who refused to join. It was gratifyirg to note that the white pins were Then we.were informed in an overwhelming majority. that the medical practitioners of Walsall had joined en bloc, so that their local organisation had become one of the medical wards of the Birmingham and District Union. It is proposed that this union shall confine its action within the same boundary lines as the Midland Counties Branch of the British Medical Association, though these frontiers have not yet been accarately defined. I The annual report then described the success achieved in regard to the attempt made by the Hospital Saturday Fund, "at the instigation of Mr. Arthur Chamberlain and other capitalists," to impose on the public consultants of their own choosing. Not only was Dr. H. W. Irvine compelled to resign but such was the unanimity of the protession that intending candidates withdrew their applications. The affairs of the Coventry General Dispensary-an institution which has been repeatedly condemned by the Birmingham Branch of the British Medical Association-were next touched upon. The medical officers of this dispensary attend a third of the population of Coventry and yet receive barely 2s. per head per annum. The policy adopted was to refuse professional recognition of the medical officers of this dispensary, but certain consultants in Birmingham had disregarded this resolution and thus retarded the desired reforms. The report
further explained that various objectionable forms of advertising had been checked and that a journal describing the work of the union would be issued. Then an increased rate of discount for drugs had been obtained by the action of the union and also reduced terms for insurances of various kinds. Finally a register for locum-tentants had been established. Altogether some useful and practical work had been achieved, but it was necessary to collect more statistics before the question of contract or club work could be taken in hand. For this purpose printed forms were distributed which, when filled up, would show the rate of payment That this meeting desires to express its disapproval of that portion received in proportion to the work done. of the Vaccination Act which authorises public vaccinators to call at. After this report and the minutes of the previous meeting the home of a child to be vaccinated without a special request from the had been adopted a discussion aro-e as to what action could person having custody of the child. That it degrading an honourable profession to require any of its be taken with regard to the consultants who still consented members is to offer their professional services unsolicited. to meet the medical officers of the Cov e itry Dispensary. By the timidity and the doubts manifested in regard to this The proposer of this motion was evidently grieved to matter it was easy to perceive that the members were as yet find that public vaccinators were far too amiable and new and inexperienced in the work of a militant organisainsinuating in their manners. They had been known, it tion of this description. First it was proposed that the appeared, to bestow new pennies on recalcitrant children. names should be published, but then fear was expressed that As for the distribution of sweets, this was a well-established a black-list might lead to a prosecution for libel. As a safer method of bribery and corruption. But, even worse than any course it was urged that a white-list might be issued. No such amiable weakness, there were instances where the public one, however, knew all the names of the consultants who vaccinator had actually given gratuitous medical advice. might thus be proclaimed as having stood by the union, and As an excuse for refusing vaccination the mother might say ’
.
1537
LIVERPOOL.-WALES AND WESTERN COUNTIES.
t
that her ctuid was nut well. Thereupon the public vaccinator would insist on seeing and examining the child. Then, if the child was really unwell, he would give advice and prescribe remedies, concluding by announcing that he would call again. On his return the child might be well, and the mother, in gratitude for the good advice received, would allow the child to be vaccinated. Thus the private practitioner lost both his fee for medical attendance and his fee for vaccinating the child. This was State competition against the private practitioner. It augmented the burdens of the ratepayer and was doubly hard on the privatepractitioner, for he lost his patient and found his rates increased. Mr. Somers, however, recognised that the public vaccinators held a very responsible position and he said that he would like to see them better paid, but at the same time they should not be put in a position to interfere Mr. H. W. Pooler delivered a with private practice. very able speech in reply, backing each argument with He thought that the object of their numerous statistics. union was to elevate the profession. Therefore it was more necessary to urge private practitioners to vaccinate more efficiently than to attack the public vaccinators who were consistently doing their duty. It was also the object of their union to try to obtain better fees ; why then should they strive to hit at the public vaccinators who, comparatively speaking, were fairly well paid ? It was necessary to inquire why domiciliary visits had been instituted before condemning them on the slender grounds that sweets were given to the children. The first point to ascertain was whether domiciliary visits had secured a more efficient vaccination of the population. Statistics showed that during the five years previously to 1877 there was an annual average of 4’7 per cent. of children unaccounted for. During the next five years the annual average rose to 5 8 per cent., and went on increasing till for the five years preceding the year 1897 the annual average of children who were not vaccinated amounted to 20’3 per cent. For 1898 the proportion was 21 per cent. It was then that the Act was passed authorising domiciliary visits, and before this law could be modified it was necessary to prove that it had failed to produce the desired effect. I she interests of the population at large must take precedence over the desire to protect the interests of any one particular class of medical men. The result of domiciliary visits was that in the first year 164.000 more vaccinations had been effected. But had this injured the private practitioners? In the Birmingham district of Aston, during the year previously to the Act, private pract.itioners had vaccinated 4620 children and the public vaccinator 2064 children. After the Act was passed the average annual increa-e of vaccinations effected by the public vaccinator amounted to 928 ; but this had not in any way injured private practitioners. The number of private patients whom they vaccinated had not decreased ; it! had remained stationary, or, rather, it had increased to the! number of 24. Thus, and w:thout injuring private practitioners, the number of vaccinations effected in the single district of Ast..n had been augmented to close upon 1000 per annum. Such solid advantages were not to be lightly set aside. In the course of the discussion that followed this speech protests were made that there was no desire to act against’ efficient vaccination, but only to prevent interference with private practice. On the other hand, it was urged that the private practitioner was the undisputed master of the situation during four months. It was for him to see that the children were vaccinated during that time and before the: public vaccinator had the right to pay domiciliary, visits. Ultimately the motion was rejected by a large ,
’
.
majority.
The President (Mr. H. W. Langley Browne) then calledI upon me to deliver an address and I had the pleasure of’ explaining the methods of organisation adopted by medical men in different countries on the continent, comparing what was done abroad with the movement in England. It is not for me. however, to describe my own speech, and I will content myself with expressing my gratitude for the hearty reception which I received. Dr. Kirby followed, pointing out the great service which THE LANCET had rendered by the articles that it had published on the economic position of the medical profession in the Birmingham district. They had helped to awaken medical[ men to a sense of the dangers by which they were menaced and had rendered the w ork of organisation more easy. After this the officers of the union were elected for the year and the annual meeting was brought to a conclusion.
LIVERPOOL. (FROM
OUR OWN
The Work of the Malarial
CORRESPONDENT.)
Expedition of the Liverpool
School
of 2ropical Medicine. THE Governor of Sierra Leone (Sir Charles King-Harman) has stated in a letter recently received by Major Ronald Ross, F.R S., that out of 400 public servants only three were on the sick-list at the end of October, and these were not from malarial disease. The nursing home was His Excellency added that he had inspected the work which was being done by the Liverpool expedition under Dr. Logan Taylor, in draining and cleansing the town, and he had been surprised at the improvement which Dr. Taylor had effected. The inhabitants were much interested in the mosquito question, and they had the intelligence to appreciate the good that was being done for them by the united efforts of the Liverpool School and of the Government of Sierra Leone. The figures quoted suggest that the sickrate in Sierra Leone has fallen below 1 per cent. This, if it lasts, will be wonderful. Even in India the sick-rate among European troops is about 10 per cent., and among the native troops about 3 per cent.
suffering empty.
The School
of Trovical Medicine and
Sir Alfred L.
Jones, K. G’.M. G.
The following resolution of congratulation to the chairman of the above school, Sir Alfred L. Jones, K.C.M.G., was adopted at a special meeting of the committee :That the Liverpool School of Medicine desires to express to its chairSir Alfred Jones, K.C.M.G.. warmest congratulations on the honour paid to him by His Majesty the King. The committee of the school wish to take this opportunity of expressing their own high appreciation of the value of their colleague’s (S r Alfred’s) services to humanity by his foundation of this school and by his willing sacrifice of time, money, and energy in the furtherance of its objects.
man,
Hospital Saturday Fund. meeting of the subscribers to The
The annual the Hospital Fund was held on Nov. 18th, the Lord Mayor being in the chair. The annual report te,tified to the continued success of the fund, stating that the amount rai-ed was steadily increasing. Firms were gradually being induced to adopt the weekly system of collection, the most efficient and beneficial to the fund, and also the easiest one for the subscribers. The amount realied from the workshop collections this year was .f.6645 15s. 2d., an increase on that of 1900 of .E371 5s. 10d., or nearly 6 per cent. Unfortunately, the ladies’ street collection was somewhat lower-viz., .f.767 7s 3d., against .6829 7s. 6d. in the previous year, making a total of e7413 2s. 5d.,. being a net gain for the year of E309 5s. 7d. That amount, together with the Hospital Sunday collection, which showed a substantial increase, had been divided amongst the medical charities of the city, the total amount so distributed being .f.13.365 10s. The expenses were heavier than u-ual, the committee having found it necessary to employ more asistance efficiently to carry out the organisation, and also to provide a large number of additional boxes to meet the growing demand.
Saturday
Presentation to a Police Surgeon. The members of the F Division of the police force have presented one of their late medical officers, Dr. T. Gerald Garry, on his departure for Florence with an illuminated address as a token of the esteem and respect in which he was held by the division. Dr. Garry was connected with the police force for over six years. Nov. 26th.
WALES AND WESTERN COUNTIES. (FROM OUR OWN CORRESPONDENTS.) Colour-blindness among Swansea Schoolboys. ONE of the medical officers of the Swansea School Board (Dr. Rhys Davies) has recently been subjecting some of the boys attending the schools to the Holmgren wool test and has also been testing their acuteness of vision and hearing. Altogether 1500 b’ys were examined, 50 being taken from each school, and 81, or 54 per cent., were found to be