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So many " friendly societies” have failed and ruined the families of working men, and so much of the money was spent improvidently, that Mr. Gladstone's Assurance and Annuity Act (27 and 28 Vic. cap. 43) was a real benefit. The sum must not exceed £100, and therefore the fee for medical examination could not be made higher than 2s. 6d. The appointment of medical examiner is made by the Postmaster-General. 809 insurances were made in England in the first year of the Act.
(i.) EDUCATION.--For all new appointments special and full study of hygiene, or the application of the laws of natural philosophy, chemistry, physiology (including the use of the microscope), pathology (including vital statistics), and of mental disease, should be insisted on. It is to be regretted that these studies are not adopted by medical men generally, as by means of social science reports, parliamentary blue books, and the abstracts of them which newspapers publish, the public will become better informed and more interested in these subjects. It may happen that for want of special acquirements, the most successful practitioner of the district would not be best fitted for such scientific duties. After a certain date none should be appointed to the office save those who by special education and examination had proved their aptitude. The Royal College of Surgeons in Ireland anticipated any other institution in the United Kingdom by twenty years in the foundation of a chair of Hygiene.
(j.) REMUNERATION.-For reasons which will be apparent from what has been stated, payment by a fixed sum would be greatly to be preferred. What would judges or chairmen say if it were proposed to pay them by cases ? The rate of £100 yearly for every 5,000 inhabitants of the district would be reasonable. The combined fees in each case of coroner (one and a half guinea), medical witness (one guinea for evidence, two
guineas for post mortem, averaging one and a half guinea) two guineas per day in court if summoned, and two pence per entry as superintendent registrar, would probably average this rate, so that the sanitary duties, now so neglected, would be performed without cost to the community. When the pauperizing tendency of deaths among the remunerative members of society by preventible disease, and the cost of their interment is calculated, expenses towards checking disease are really economical. Insurance fees and, in cities, hospital or professional duties would considerably increase the emoluments.
These offices would likewise constitute the machinery for the scientific study of epidemics among men and animals. The invaluable observations, as regards the nature and prevention of zymotics which medical men commissioned to study the cattle plague recorded, should have stimulated the government to a liberal encouragement of such investigations. Yet, after having granted many thousands of pounds for the study of the cattle plague, not as many hundreds were apportioned for the investigation of cholera.
If a central government department of health were established, or one for each of the three kingdoms, all those important statistical, topographical, and meteorological facts which concern the well-being of the nation should be collected by it from the medical supervisors and yearly published.
POOR-LAW SERVICE. I shall now endeavour to exhibit the labours of him who undertakes the care of his poor countrymen, and how these good services are recompensed. In England poor-law officers are appointed by the guardians of each union, and approved of by the board. The guardians cannot assign more than 15,000 acres, or 15,000 people for the superintendence of one officer--a wholesome
restriction not in force in Ireland. The qualifications necessary to obtain these appointments are a surgical diploma and a medical degree or licence of the Society of Apothecaries, having been in practice before 1815, or an army or navy commission. Before this regulation became law, 550, or one-third of the entire poor-law officers in England, had no surgical qualification. The remuneration is so small that they are merely accepted as introductions to practice, and to keep out a rival. Besides the salary fixed by guardians, there is a scale of fees for extra services in clause 177 of the Consolidated Order. For example-for amputation of leg or operation for hernia, £5. However, it is oddly arranged that if the patient dies within thirty-six hours, the fee is only £2 103.
“ In any surgical case, not provided for in article 177, which has presented peculiar difficulty, or required and received long attendance from the district medical officer, the guardians may make to the said medical officer such reasonable extra allowance as they may think fit and the commissioners may approve.” The payment for midwifery cases ranges from 10s. to 20s., or for very difficult cases, to £2. The poor-law physician is obliged to supply medicines, to examine pauper lunatics, and to enforce certain sanitary regulations under the Nuisance and Disease Prevention Act, but for which axtra remuneration is granted. The contracts vary very widely, from £5 to £150, but the average is about £60-a very inadequate recompense, but the number of paupers is very small, and private cases in general afford a very considerable amount of income. In workhouses, however, the remuneration is most insufficient. In the Bodmin workhouse (the bad arrangements of which were last month ex. posed) the medical officer is paid £23 17s. for attending and supplying with medicine, except cod liver oil, 180 patients on the average in the house. Through the fear of the established practitioner and the hopes of the
ENGLISH POOR-LAW SERVICE.
new-comers, such contracts are accepted; unt in common honesty they should not be, on either the part of the guardians or the officers. Besides, it is trusting too much to human disinterestedness to leave him the choice of giving medicines, some of which will cost twenty times as much as the others. If the comparison be not offensive, whether would a publican who contracted to supply stimulants, choose whiskey or champagne ? We have known practitioners who blamed their assistants for giving such medicines as iodide of potassium, for which no cheaper substitute could be used. The great fault in the Poor Law undoubtedly is the practice of compelling the medical officer to supply medicines. It is objectionable on many manifest grounds, but owing mainly to the untiring exertions of Dr. R. Griffin, the system is likely to be soon abolished. The distribution of medical comforts, including food and stimulants, is allowed in England. The generosity of the English poor-law physicians was exemplified in a striking manner a few years ago. The season happened to be one of unusual distress, and the doctor freely stated his opinion that in most of the cases food and stimulants were the “ medicines" needed. The guardians were indignant, and the chairman, one of those self-important personages who feel that the honour of their presence at the board is a discharge in full of all the obligation they owe their tenants and poor fellow-beings, asserted that the doctor was bound, according to his contract, to supply these provisions if they were to be considered " medicines.” The noble friend of the poor thereupon took from his pocket butchers' and grocers' bills for goods supplied to his starving patients, the amount of which exceeded bis yearly salary. The supplying of medicines and cost of separate dispensary, according to the Irish average, would be about 1s. per case relieved.
By the Metropolitan Poor-Law Act, 1867, the relief
SCOTCH POOR-LAW SERVICE.
of the poor of London in dispensaries and hospitals has been closely assimilated to the Irish system, and the rural districts are likely to be changed after the same excellent model. According to absurd regulations in some dispensaries supported by voluntary contributions, Liverpool, for example, the officers are debarred from private practice.
In Scotland the poor-law system does not differ essentially from that of England, save that the rate of recompense is still lower. The sums paid for medical relief in a few of the parishes during the year ending May, 1866, may be quoted. Ayr, population 9,305, £101 3s.; Bourtie, population 547, £1 18.; Dunbog, population 207, 4s. 3d.; Inverkeithny, population 880, 10s. Mr. Burt of Edinburgh thus alluded to the service : “ Are they to rear a race of physicians skilled in all languages, living and dead, perfect masters of logic and metaphysics, adepts in all the sciences, and pundits in all the ologies, and then invite them to settle down in the remotest districts of our country and its dependencies, achieving by means of all this learning what is poetically called an honest independence, which, being translated into the vernacular, means somewhat less than £150 per annum, garnished with the vulgar vituperation of parochial boards." The circumstances of the profession are little altered since this honest and truthful appeal, for the awards are usually contemptible and unequally rated, as the above examples show.
IRISH POOR-LAW SERVICE. In Ireland up to 1851, the medical relief of the poor was performed under the Act of 1805, by dispensaries with ill-defined boundaries; and in places with a scanty number of resident gentlemen no dispensary whatever was to be found. In 1836, with a population about onefourth greater than that of 1851, there were but 494