« AnteriorContinuar »
placed conceitedly to one's own credit solely. Other physicians alone are fit judges of a practitioner's actions, and therefore it is that such need exists for the highest moral and charitable tone. Many a time will the reward of a physician alone be a sense of accomplished duty to his fellow and his God. However, it must be acknowledged that such virtues as charity, honour, or selfdenial are inborn or developed by sound parental training. Temperance is an indispensable quality, but so little do the public judge rightly of practitioners that many men notoriously drunken in olden times have been freely patronised.
Sir A. Cooper, in admitting members of the College of Surgeons while President, hundreds of times addressed them on the true means of success : Firstly, on a good and constantly increasing knowledge of your profession; secondly, on an industrious discharge of its duties; and, thirdly, upon the preservation of your moral character. Unless you possess the first, knowledge, you ought not to succeed, and no honest man can wish you success.
Without the second, industry, no one will ever succeed ; and unless you preserve your moral character, even if it were possible you could succeed, it would be impossible you could be happy.” He also stated that his own success in practice arose from not allowing any patient to leave without baving satisfied them on the nature and proper treatment of their
The habits of physicians in regard to the enjoyment of polite society and rational amusements should be those of the rest of the educated world. It is time that such antiquated remnants of quackery as white neckcloths, exclusively black cloth, and other peculiarities of dress, should cease to distinguish the followers of a noble and most learned profession from other gentlemen. Such habits may push a trade, but they sink the science.
Under the head of general practice, some remarks on
the rate of remuneration will be made ; but here it may be allowed that junior practitioners should not expect as high a rate of payment in receiving fees as frequently as their seniors. If they do, patients in cities at least will be divided between the consultants and the apothecaries. His only prospects, then, consist in the retirement of the senior when fortune is amassed, but this is a much rarer event in medicine than in other professions. While the public should never begrudge the fee of the consultant, remembering that charity urges them to refuse many a fee, he should in justice to his senior brethren, never accept a lesser sum from those able to pay. The practice of a yearly sum for attendance was usual in Ireland during the last century, and is still extant in Germany. This may not be adviseable, but while the consultant should receive his honorarium immediately after the visit, the junior may be content to wait till the end of the attendance, and receive payment for each visit in the proportion of from one-fourth to one-half of the consultant's fee. However, if a medical man were paid for any unusual service, such as a serious illness or accident, the plan of accepting a yearly sum as the adviser on all health subjects, does not seem objectionable.
Medical men have been mulcted or punished for malpractice, arising from ignorance, want of attention, an avaricious desire to save medicine or medical or surgical appliances, and from intent to do harm. By the statute of Henry VIII., the London College of Physi. cians was granted power of fining or imprisoning practitioners for such offences, and other bodies have similar powers, but it is by civil action that redress is usually sought.
Notwithstanding all the personal discomforts and mortifications the physician mnst endure, his life, if he pursues his profession with elevated motives, is more full of happiness than that of any other rank. Another
PUBLIC MEDICAL SERVICES.
circumstance may gladden the seniors and cause their successors to be patient. Professor Guy, Mr. Neison, the eminent actuary, and Professor Caspar, of Berlin, have all testified to the longevity of medical men. They have shown that the average years of a general practitioner are 52:27; of a physician or surgeon, 61.13 ; and of the medical officers in the army or navy services, 58.52. It may be encouraging to some to record that marriage makes an additon of two and a half years.
PUBLIC MEDICAL SERVICES. Foremost amongst the public services which duly compensate their medical officers is the Army Medical Department, which was so much exalted and improved by the Warrant of 1858. It declared four grades—1, Inspector-General of Hospitals ; 2, Deputy-InspectorGeneral of Hospitals; 3, Staff or Regimental Surgeon, who, after twenty years full-pay service in any rank, shall be styled Surgeon-Major ; 4, Staff or Regimental Assistant-Surgeon.
The following is the Royal Warrant of 1867 for pay and non-effective pay of medical officers :
2 0 0 30 1 17 0 Deputy Inspector-General 1 0 0 30 1 5 6 Surgeon-Major
1 7 0 After 25 years' service .. 1 7 0
1 0 0 Surgeon
0 17 6
15 0 13 6 Assistant-Surgeon, pointment
0 10 0 (under 5)
0 6 0 After 5 years' service 0 12 6
08 0 0 15 0
10 0 10 0 15
0 17 6 Or on promotion, should not these periods be already completed. The widow of a surgeon-major has from £70 to £100 a-year pension, and each child a small sum besides.
ARMY MEDICAL SERVICE.
It is, then, in respect to remuneration, rank, and retiring allowances, a service that any disinterested adviser should recommend for adoption by young surgeons, if they do not grieve at the barriers to marriage and domesticity which it certainly presents.
As regards admission to the service, any gentleman producing the following certificates may compete : 1, age (under 28 and over 21); 2, character ; 3, bealth ; 4, diplomas in surgery and medicine. The pass examination (riva voce, written and demonstrative) includes anatomy, physiology, surgery, medicine, and pharmacy; but candidates are placed according to additional knowledge in natural history. The successful candidates then study for four months, at Netley Hospital, hygiene, military medicine, and surgery, and pathology most exhaustively. During this time he is allowed 5s. a-day and quarters.
Candidates who come next to the successful ones are offered places in the Gold Coast service, but the dangers of the climate deter many. For every year served there, a year at home is allowed, all the time counting for promotion.
When the competitive system was established, the service required great numbers of officers, and it was not difficult to obtain places. But now competition will become more keen, and it behoves students to work earnestly from the beginning. In this way medical education has been most beneficially stimulated.
Previous to promotion, an examination in all practical branches of his profession must be passed by the assistant-surgeon, an arrangement which has done much good, and induced officers to keep pace with the progress of medical science. If, however, the obtaining by examination the Fellowship of his College of Surgeons or a University degree, titles which are added in the army list, were deemed equivalent, the same object would be attained, and the professional rank of the
ARAY MEDICAL SERVICE.
officers likewise raised. The required statistical and topographical report should, of course, be submitted to the director-general. The service at present includes 1 director-general, 3 inspectors-general, 31 deputyinspectors-general, 97 surgeon-majors, and 261 surgeons.
The number of assistant-surgeons is at present 697. The rate of promotions for the ten years ending 1866 was not more than 22, and the death and retirement vacancies 10. From these data an assistant-surgeon could not count on promotion till he had served over twenty years, and has become entitled to a surgeonmajority. At this time the retiring allowance is 12s. a-day, or if invalided permanently, 16s. 6d. It is hard, indeed, to be kept in a subordinate position so long, even if some increased pay be allowed, for a man of mature age and experience bas no right to be merely the assistant of seniors who, in many instances, may render the service most intolerable. Among all the grades 89 promotions occurred in 1867-namely, 4 inspectors-general, 19 deputy-inspectors, and 66 surgeons. In the Indian service promotion is obtained necessarily after twelve years' service, if two of them have been passed in charge of a native regiment. A similar rule may, in all justice, be demanded for the home service.
With regard to rank and precedence, the following order has just been issued : " Medical officers are for the future to be exempted from serving as members of all boards except medical boards. Should a medical opinion be required by a military board, reference must be made to the medical officer, who will furnish his report in writing, or give evidence in person if thought necessary. Medical officers having the relative rank of field-officer are to provide themselves with chargers and horse-furniture, and to appear mounted when required to attend parades. On official occasions when guests