are invited to a mess in the name of the officers of a regiment, the senior combatant officer must always preside, and no second place is to be recognised."

Despite of all regulations the medical officer will not meet with respect unless he be a refined and educated gentleman.

The Abyssinian expedition is about to try the medical organization of the army, and it is earnestly to be hoped that it will be found improved since the Crimean campaign.

The service of the Honorable East India Company was for many years the height of the student's ambition; and to its great credit be it recorded, it was the first to open its appointments to fair and open competition. Its officers numbered 885 on active service and 336 retired-1,221 in all, when it was about to be placed under direct control of the War-office. From the admirable conduct of the examination, and the value of an appointment by extra allowances and literary and scientific offices, the Indian service will be always esteemed a most desirable prize. The position Ireland has acquired in the competitive trials she need not be ashamed of. Her sons have been awarded some first and very many high places in the army and India examinations.

The militia is another service which offers a great number of appointments to medical men. It is but an uncertain employment, however, and is at present only under payment when called out. In England there are 171 surgeoncies and assistant-surgeoncies-also 45 in the yeomanry; in Ireland 76, and in Scotland 27 similar appointments-499 in all.

There are several hundred surgeoncies and assistantsurgeoncies in the English and Scotch volunteer corps, but they are all honorary appointments.

The naval service offers honorable employment for those to whom this form of life is suited. The assistant

surgeon formerly suffered great inconvenience from the want of recognition of his proper position, and the denial of fit apartments, and great injustice from the inferiority of pay. These wrongs have been gradually relieved, and the naval surgeon may chiefly thank the manly exertions of students in medicine who nobly advocated his rights. Even the poorest of them refused to be subsidised, according to an absurd proposal last year, to bear the expense of their education if they bound themselves to serve in the navy. There are at present in the service 237 assistant surgeons against 272 and 251 in January, 1866 and 1867-186 surgeons and 85 staff-surgeons on the active list. To compete for the naval service the candidate must submit proofs of 1, age (over 20 and under 28); 2, character; 3, health; 4, medical and surgical qualification; 5, having performed operations on the dead body. Certificate of all lectures must be also obtained, which gives much trouble to candidates and lecturers, and is quite unnecessary. On passing, he is usually sent to Haslar or Plymouth Hospital. The candidates of the year who pass the best, second best, and third best examinations, will be promoted after five, six, and seven years service respectively. Before promotion, a second examination must be passed before the Naval Medical Board, and officers encouraged to take a higher rank in their profession, such as a university degree or fellowship, by being granted some months leave for the purpose. The extra allowances and prize money, and the greater opportunity for economy than in the army, make the navy a favourite with some young men.

In the United States, naval medical officers complain much of exclusion from the cabin mess, and it appears that their share of prize-money is not very equitable. A fair recompense is given also by many of the lines of vessels which sail from Liverpool, London, and Southampton to their surgeons, but the want of retiring allow

42

RESPONSIBILITY OF TEACHERS.

ances induce many of them to leave the service after a few years. Passengers' vessels should invariably carry surgeons; but in trading ships, for the care of the crew, some knowledge of medicine should be possessed by the mate, and made part of his examination before promotion. The increasing importance of England's vast colonies, too, has created many opportunities for the man of rectitude, talent, and perseverance. So great then is the diffusion of British medicine, that the responsibility of the teacher of medicine and surgery is proportionally great. This, the great Dr. Graves confesses: "The British teacher of practical medicine exercises an inflnence without parallel in importance and extent, and lis opportunities in benefiting or injuring his fellow-men are incalculably great. If he neglect his duty, if he teach erroneously, his negligence and his errors in practice are multiplied indefinitely by means of those whom he ought to have better instructed; the scene of his guilt, for it deserves no better name, becomes fearfully enlarged, for there is no country so remote that it may not contribute victims to the incapacity of his pupils. But, on the contrary, if he works with zeal and diligence, if he labours conscientiously and perseveringly in performing the important task he has undertaken, a compensation awaits him, to which a member of scarcely any other profession can attain. The hero and the despot may extend a sovereignty over distant regions, may exert an unlimited control over millions of vassals; they may, like Alexander, grieve at the narrow limits of a conquered world and sigh for other scenes of glory. But they cannot chase away pain-they cannot bid the burning thirst to cease, or give back repose to the sleepless; they cannot impart feeling or motion to the paralysed, or sight to the blind; and, above all, they cannot imitate that almost God-like function of the healing art, by which man is enabled to recall to his fellow-man reason long banished, and restore to society the hapless victim of insanity."

MEDICAL OFFICERS OF HEALTH.

43

STATE MEDICINE.

We now proceed to discuss these important functions of medical men which may be best described under the head of state medicine.

Medical Officers of Health are appointed under the Towns Act (10 and 11 Vic. cap. 34), and in Ireland only two towns have availed themselves of the power— namely, Dublin and Derry. In England there are 92 such officers in the provinces, and 48 in the metropolitan districts, under a special Act passed in 1856. The areas and populations in the provinces vary absurdly-namely, from Liverpool, with half-a-million, to a town of 214 people. The salaries range from £1,000, in Liverpool (practice being resigned), to nil in many. Surely the qualifications, duties, tenure, and salary of these officers ought to be defined. The duties are, to report on the occurrence of infectious disease-information being obtained by co-operation with the death registrars and registrars of fever hospitals, and the measures for their suppression which the inspectors of nuisances carry out; to certify to, and give evidence upon the chemical and other nuisances which arise, and to advise the local authority on the best means of ventilating public buildings, preventing injury to health from special trades, and such subjects connected with public health. Where no city analyst exists, the examination of adulterated food, water, and gas, also form part of his functions.

In Ireland, where the system of curative medicine is most admirable, that of preventive medicine is very badly organised. Thus, there is no central body for regulating health inspection, or the duties of these officers; and the Sanitary Acts-extended to us after having been enjoyed by England for seventeen years-although comprehensive, are arranged at random. The Poor Law Commission directs the local authorities-that is, the Guardians of rural districts. It is to be regretted that

medical men find so few places on these boards. In England there is a special department of the Privy Council to control public health, with so able a sanitarian as Lord Robert Montagu at the head of it during the present ministry. There are a medical officer, several medical assistants and inspectors under the allied body, the local government office. The fullest investigations are by this admirable machinery conducted in places of which complaints are made, or where the death returns appear excessive, and the annual blue-book is invaluable. In Scotland, by the Public Health Act of last session, the Board of Supervision of the Poor may appoint inspecting medical commissioners, and direct the local authorities to appoint medical officers-powers which they have already exercised. In a forcible appeal for the extension of sanitary reform, the Rev. Charles Kingsley says, "Why a permanent staff of government sanitary inspectors should not be appointed it is difficult to say. We have now factory inspectors, mine inspectors, school inspectors, and they all work well. Not an argument can be brought against the institution of sanitary inspectors which was not brought against them."

coroner.

We will next contrast the registration systems of England, Ireland, and Scotland, for in each division of the United Kingdom they are different. In England a penalty of £10 is inflicted on undertakers, clergymen, or others concerned in burial of a body without the cause of death being certified by either medical attendant or This insures aid to sick persons, 66 as there is such bother about the registry," which might otherwise be neglected. In Ireland there is no such penalty, and this may account for the admittedly imperfect returns of deaths. In the returns from provincial towns, published by the Registrar-General, the rural districts should be excluded: in these returns the deaths appear some weeks to be two or three times greater than in others, while it is impossible that diseases can fluctuate