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officers. I have long considered the want of an adequate retiring allowance after a reasonable length of service, and before the infirmities of age have crept on, as not only a hardship on individuals, but what is of more importance, one of the most serious drawbacks on the efficiency of the medical department of Her Majesty's service. This drawback becomes more remarkable when contrasted with the liberal provision upon which the medical officers of the Honourable East India Company are enabled to retire after a service comparatively short, and to this I would briefly advert. In either case, the medical officer must have attained the age of 21 before he can enter the service, and the Company's surgeon may retire after seventeen years' service in India, upon the full pay of a Captain, which, with an allowance from the medical funds at the several presidencies (to which his more liberal pay has enabled him to contribute) makes up a retirement of some L.500 a year, at a period when he has not necessarily attained more than 39 years of age. What, again, is the case of the Queen's surgeon ? He cannot retire until after twenty-five years' service, on full-pay -the greater part of this time spent, perhaps, in the most unhealthy parts of India, or even in some worse cliinates—upon fifteen shillings a day, and when he must necessarily be at least 46 years of age, seven years older than the Company's surgeon. Be it observed also, that the former service is continuous, not necessarily interrupted by anything except bad health, or the will of the individual in taking advantage of an optional furlough, while the time of a surgeon in the Queen's service may be broken in upon by alternate periods of full and of half pay, dependent, not upon the will of the individual, but upon the exigencies of the service. I am aware that the Company's surgeons have their grievances, and complain of something very like an ex post facto law, depriving them of the relative retirements, compared with their military comrades which they expected on entering the service; and this leads me to say a word on the comparative position, generally, of military and medical officers, and this in a spirit of equity, most assuredly not in a spirit of detraction.
“ The comparative exposure of military and Medical Officers when in actual contact with the enemy, has not, I think, been much dwelt upon of late, particularly since the liberal sentiments towards the latter expressed in the House of Commons, by Sir Howard Douglas, Sir De Lacy Evans, Colonel Boldero, and others, and particularly since the publication of an admirable pamphlet by Mr Martin, on the "Claims of Medical Officers to Military Honours,'-claims not impaired by the conduct of Mr Wilson, Mr Thomson, and others in the present campaign. But there are two points in which I think their comparative position has scarcely yet been done justice to the excess of work to which Medical Officers are subjected in hoth extremes to an army, whether of labour or of rest. If the active operations of a compaign are suspended by sickness, upon whom does the increase of duty fall? Who were the hardest worked men at Devna and at Varna? Again, all honour to their military comrades ! But I would ask, who have worked harder or more continuously than the Medical Officers in the Crimea, and in the hospital at Scutari While I readily admit that the military officer has the greatest risk and the hardest work in the day of battle, I would respectfully ask, who has the hardest work on the day following, and for many days after ? The other point in which Medical Officers are sometimes looked upon as having inferior claims, is in comparison with those officers who have paid money for their commissions. Considering the expensive and protracted education which he must necessarily go through, an Assistant-Surgeon may now be said to purchase his commission at a much higher rate than an ensign, and with this material disadvantage, that he necessarily purchases it from six to ten years later in life; the purchase, moreover, as involved in the expense of education, is imperative on all Medical Officers; and while their military comrades are permitted to sell, even in some cases where the commission has not been purchased, the Medical Officer is in no case allowed to do so. Looking again to the comparative rates of retirement, we see provision made for the retirement of military officers on
full-pay, after periods of service not very protracted, while no such thing is known in the medical department as a retirement on full-pay after any length of service.
“ In a period short of ten years service I do not consider that a young man has lost much ground if he desires to enter into private practice, and is not perhaps entitled to any permanent provision, unless in the exceptional cases of severe wounds or permanent disabilities contracted on service. But such a man who has come forward to serve the public with the intention and desire of devoting himself to the service for life; he has gone to an extra expense in his education and outfit ; and, if reduced, care should be taken that he does not suffer a pecuniary loss at a time when his prospects of advancement have been cut short, and when he must necessarily be condemned to a period of inaction before he can establish himself in private practice. Would it then be too much to expect that a young man in this position should have the expense of his outfit and extra education repaid to him on a liberal scale, and a gratuity of one or more years' full-pay, according to the length of time he may have served ? After ten years' employment in the service, a man, if he has made good use of his time, becomes a valuable servant to the public. He has lost ground in the race with his contemporaries, some of whom have established themselves in the very locality where, of all others, he had the best chance of success; he has necessarily attained 31, it may be 36 years of age, and he has become accustomed to habits of deference to his professional authority and obedience to his prescriptions, not conducive to his advancement in private life,-as witness the few instances of success amongst the medical officers of the army and navy who were discharged at the end of the last war. It is for the public interest that a man of this standing should be encouraged to remain in the service by the prospect of speedy promotion, or, if reduced for the public convenience, he should have the option, if he so chooses, of remaining permanently on the half-pay of his rank. A period being thus fixed for retirement in the junior rank, I would propose that when an officer has gained one step in advance-when he has been promoted to the rank of surgeon-if reduced for the public interest, and again called upon to serve, he should, unless disabled by wounds or infirmities, have the alternative presented to him of either resuming his duties, or reverting to the half-pay of an assistant-surgeon, and so on throughout each superior rank—the principle being this, that whatever length of service, or whatever degree of merit entitles an officer to a step of promotion, the same should entitle him to the permanent half-pay of the rank from which he was promoted. This would seem an arrangement more equitable than the commuted allowance-a measure, somewhat of an arbitrary character-where the allowance is calculated on principles, perhaps very intelligible to the actuary of an insurance office, but not, I believe, generally appreciated by the profession. The qnestion as to the light in which the half-pay is to be looked upon-questio valde vexata—would thus be put upon a footing equally obvious and indisputable. The half-pay of each superior rank would fall to be looked upon as a retaining fee, the half-pay of the rank immediately below as a reward for past services. The army and navy surgeon would thus see distinctly, from the moment of entering the service, what the public had a right to demand of him, and what the extent of the sacrifice he must make if not prepared to obey the public call. When an officer, recently promoted, if in receipt of the half-pay of a rank in which he has done little service, it seems only reasonable that the public should have the right to call upon him to do more duty in that capacity, provided always that the call should not be postponed until the individual is so far advanced in life as to render it impossible for him to complete the periods of 25 or 30 years' actual service specificd for retirement. If the national exigencies do not require a man, who has always been ready to move, to resume his duties at the active and useful period of his life, it would seem harsh, not to say unjust, to call
upon him at an advanced age, when physical infirmities would necessarily preclude him from serving for the length of time entitling him to a permanent retirement. I have confined myself almost exclusively to a cons sideration of the position of assistant and regimental surgeons, and this with the view of illustrating a principle, which, mutatis mutandis, may easily be applied to all other ranks-that of placing the half-pay after prolonged services, so nearly on a par with the full-pay, that there may be a comfortable retirement for men advanced in life. The objects which I have more immediately had in view, are the liberal treatment of those young surgeons who have come forward on the present emergency, and who cannot expect to be retained in the service after the termination of the war an encouragement to hale young surgeons on half-pay to resume their duties in the service, by · the prospect of a considerable sacrifice on the one hand, and of a more liberal retirement on the other the discouragement of superannuated surgeons from remaining in the service, by giving them a maximum of retirement after a period of life when their energies begin to fail.
“ The advantages which I should expect from the proposed plan are the more speedy reduction of what has, not very graciously, been termed a deadweight—the sequel of every war-and, above all, the greater efficiency of the medical department, by substituting young men in the vigour of life for those who are past their work.”
LATE PROCEEDINGS OF THE EDINBURGH COLLEGE OF
PHYSICIANS. We should have been satisfied if the few remarks on the late election at the Edinburgh College of Physicians, made in our last number, had been perinitted to pass without comment. But the parties concerned have been so foolish as to imitate the usual conduct of sly confederates, who on the exposure of their successful schemes, bluster, talk big, and speak of personalities and insults. Through the anonymous correspondent of a London journal, we are told that our observations have caused great dissatisfaction. The authority, it is true, is not much to be depended on, but if the statement be correct, we are delighted to hear it. The junto must necessarily be dissatisfied on seeing their secret plots laid open to the professional public, and honest men must regret seeing a Royal College, which, perhaps, they have hitherto respected, enslaved by a party of its younger fellows, organized at the supper-table of its Secretary. As to personalities, we have employed none, unless the truthful description of facts be such. For Dr Begbie personally, we have very great regard, and regret that he should have been elected by such equivocal means. He is a most respectable medical practitioner: who has ever said anything to the contrary ? But there are other gentlemen, his seniors on the roll of the college, of whom, without saying anything derogatory of Dr Begbie, we can declare, that their respectability is not inferior to his. The question we wish to have answered is this, Why the Edinburgh College of Physicians has found it necessary to elect an elderly Fellow of the College of Surgeons over the heads of so many of those who have supported and performed their duty to the Institution all their professional lives? When the principles or reasons which have led to this act are put forth, we shall be prepared to meet them. Let it be shown that Dr Begbie's talents, discoveries, writings, standing as a physician, or any other qualities, are suPERIOR to those of all the gentlemen who have been passed over, and we shall be among the first to applaud his election. But, while we acknowledge that gentleman's merits, we maintain that they are not pre-eminent over those of his seniors, and do not justify his election to their prejudice. They are, in fact, the parties to whom gross personality is offered, when a body of practitioners, constituting the majority of & Royal College, publicly declare them unqualified to fill a chair, in order to flatter or benefit a personal friend. It
is at least satisfactory to know that all the physicians of distinction in the college condemned the proceedings of the junto, refused to vote with them, and although they supported Dr Begbie as a member of council, they associated with him senior Fellows, all of whom were as well qualified for the office as himself, and whom it was the object of the junto to exclude, as they succeeded in doing. Would the College of Physicians of London or Dublin place an old established general practitioner over the heads of eighteen of his senior Fellows, simply because he had lately transformed himself into a consulting physician, and possessed friends who arranged with the junior Fellows (including his own son) so to constitute the council that he might be president? We cannot believe that such respectable bodies would have departed so much from propriety, or have shocked professional feeling by such extraordinary proceedings.
As to how far it is correct or even decent for the secretary of a Royal College of Physicians, constantly to make motions and amendments as a member of council to put himself on committees and examining boards, and then to organize, at his own supper-table, a party of the juniors in order to carry out his measures ?-how it happens that the anonymous correspondent of the Medical Times gets possession, and forwards to that journal, private documents of the College, containing its unanimous resolutions ?-and by what artful and petty tricks such “ unanimous resolutions” are arrived at these are questions into which we cannot now enter. We shall, at present, only express the conviction, that such proceedings are most derogatory to any public body; and that if the three members of the reform committee (there are only three, all of whom were active in securing Dr Begbie's election), hope thereby to carry out their measure of medical reform, they will certainly be mistaken. We are unwilling to prolong this disagreeable subject, but if our statements are called in question, we shall be prepared to substantiate them by names and documents, that must force conviction of their truth on the minds of the most sceptical. There is nothing, indeed, we desire more than to appeal from the junto to the profession at large, with a view of determining whether we or it have been guilty of what is called “ personality."
WHO OUGHT TO BE MEDICAL ADVISERS IN LEGAL CASES? It is not our intention to enter into the particulars of the recent trial,“ Glover versus Syme.” Neither shall we endeavour to answer the nice question raised by the lawyers, whether in the case of a party having a compound fracture and a lacerated wound, it be competent for a police surgeon in reporting on his capability of emitting a declaration, to declare on soul and conscience that he has examined the patient, when he has seen nothing below the splints and bandages. But we feel bound to say that the principle for which Mr Syme contended is perfectly sound ; and that it is most injurious to the cause of justice and to the honour of the profession, to permit the practice which has so long been followed in Edinburgh, of excluding those best qualified to give evidence, in order to enhance the emoluments of public functionaries, or favour the friends of sheriffs or procurators-fiscal. Every one must allow that nothing can be more intolerable to a medical practitioner, ihan to find that a professional brother, armed with a warrant, has without your permission forced his way to your patient, examined his case, reported his opinion thereon, and received a fee from the public purse for doing what you would have done much better. Not unfrequently where two witnesses have been required, the family practi. tioners of the legal functionaries have been sent, and the medical man in charge of the case entirely overlooked. We are aware that it has been stated, and with some truth, that many legal investigations have failed in consequence of the incompetency of certain medical men to draw up reports with sufficient care and exactitude. We believe that such a statement may not be altogether uufounded; but this would always be obviated by causing such reports to be drawn up by the public medical officer in conjunction with the practitioner in
attendance. We need scarcely say that the charge of ignorance against a surgeon of the Royal Infirmary, who has the care of clinical wards, is preposterous, and hence the peculiar absurdity of sending a stranger into those wards, to obtain the information which ought to have been obtained primarily froin the highest authority. In cases of suspected homicide, the law requires a report from two medical men as to the cause of death. For this purpose a postmortem examination is made, and a fee given to both the practitioners who append their names to the report. That a considerable knowledge of morbid anatomy is here often necessary, we need scarcely say, and yet it is consistent with our knowledge, that the family medical attendants of certain legal functionaries have been sent into the Royal Infirmary with a warrant for this purpose, to the exclusion of the pathologist of the institution. Now, when it is considered that this latter official probably opens and reports on more bodies in one twelvemonth than the said practitioners may have done in their whole lives, the injustice to him and the folly with regard to obtaining correct evidence must be apparent ? In every case, therefore, the medical practitioner in attendance, should be one of the parties consulted, and the police surgeon or the pathologist of the Infirmary, the other, according to circumstances. Considering also the peculiar skill which the latter official necessarily possesses on account of his office, it would be only a right thing to make him, as is the case in Vienna and other large continental cities, the consultant in the examination of dead bodies which are to be the subject of judicial investigation.
But after all, this would only be pursuing what appears to us the best course in a public point of view. How can Mr Syme hope to overcome what is obviously wrong when the private interest of individuals or of institutions are bound up in their retention ? The evil he has endeavoured, through his college and single-handed, to overthrow, is only the result of that degraded condition which the profession occupies in this country, and how can we expect the state, or the law officers, to respect us, when we do not respect ourselves? The medical colleges which ought to be capable of supporting the dignity and honour of the profession, are in no way regarded by the state or public bodies, because they are theniselves governed by petty influences, which fail to command for them the respect of honourable minds. Jealousies, divisions, junto's reign in our councils, and the result is universal misrule of the medical profession, in its relations to the state, to social policy, sanitary arrangements, the public services even in time of war, and the private arrangements of our civil institutions. All is job and clique, from the appointment of an army medical director and president of a college, down to a surgeon's dresser, or the nurse of a ward.
VARIETIES, THE BOARD OF Health.-The structure of the old board of health was doubtless one cause of its success, and the truly British propensity to job, which burst out with the utmost intensity in the endeavours of the central board to force their inspectors into business, rendered success impossible. We have now a minister of health, Sir Benjamin Hall, and the result of his policy is, to be guided by the majority of the rate-payers in a parish. The richer ratepayers are naturally the friends of cleanliness and health, but this levelling principle places them on an absolute equality with the poorest, most ignorant, and most uncleanly householder in the parish. This may be a consistent democratic principle, but it is, we fear, a fatal blow at the diffusion of sound sanitary influence throughout the country. The interests of cleanliness are handed over to the sons of dirt, and the care of health to men who habitually wallow amid the reeking elements of pestilence. If the Board of Health be a good thing, let its jurisdiction be general ; if a bad thing, let it be abolished altogether. But do not let us have this ridiculous compromise between the beadle and the minister ; do not let us first invest a public servant with power