MEDICAL RELIEF.
THE medical branch of the New Poor-law administration has been the opprobrium of the law. The medical profession has from the first cried out against it. Many cases of neglect which have been brought to light show that it must otten bear bard upon the really suffering. The medical part of the law is a fertile source of abuse : persons who by the letter of the law are pre- cluded from out-door relief often receive it from Guardians, lax in their notions or hostile to the present Poor-law, under the name of " medical relief." In one union, an imaginary patient is conjured up in the pauper's family, in order that the head of the family may have needless "medical relief" ; in another, the dy- ing pauper is neglected. A very gross case of neglect is just now before the public— "On the let of this month, James Dement, a labourer residing within the limits of the Woodbridge Union, found upon returning home from his day's toil, that his wife had been taken suddenly ilL He sat up with her that uight, and betook himself again to his labour at six in the morning; leaving her a little re- covered, with a woman to take care of her. At half-past two in the afternoon, the nurse came to him in the fields, telling him that his wife had been taken much worse. He repaired to his dwelling, and finding that she was indeed in danger, he ran to the overseer, to procure an order for the attendance of the district-surgeon. The overseer was not at home; but the wife of that officer gave him the necessary order, and he set off for Woodbridge to deliver it. It WU half-past four before the poor man could walk over the number of miles and go through all the prescribed forms which were necessary to secure attention to the deathbed of a pauper. When he did arrive at the surgeon's house, and commu- nicated his message, he was informed by that functionary that he should have come before; that it was impossible doctors could be riding about all day; and that if he had but made his case known earlier, it could have been taken in the ordinary round of visitation. Inquiry, however, was made into the symptoms of the patient, and the husband was supplied with the medicines conjectured to be necessary, and despatched with such aid to watch his dying helpmate through the struggle of another night. But the end came sooner than was expected. The poor woman had sunk so rapidly, that even the medical experience of the nurse told her that the surgeon's prescriptions were no longer applicable; and at eleven that night she expired."
In juxtaposition with this statement the Times puts another- " It is a summary of the duties performed, and the stipend received, by the medical officer of the Halifax Union for the quarter terminated last month. During this period, Mr. Garlick, the fortunate possessor of the appointment, paid 685 visits, and dispensed over and above, at his own costs and charges, 985 mixtures, 2,255 pills, 879 powders, 37 lotions, 12 liniments, 42 ointments, and 53 plasters; the area of the district under his superintendence being 990 acres, and the population 19,881. For these services and these disbursements he is re- munerated by a fixed salary of 201., being at the rate of 43. 41d. per diem."•
This is in part the secret of the mismanagement. Nothing can be more irksome and disagreeable than attendance on those classes of society most debased by ignorance, vice, and poverty, when further lowered by the prostration of sickness ; yet for that most thankless part of his duties the medical officer is so ill paid that the post is scarcely "an object" to him. By the system of ten- ders, the lowest amount that a respectable medical man will take is accurately ascertained ; and thus you get "cheap" physic for the paupers. But the medical man owes no allegiance to the Board of Guardians; he is often hostile to them ; he always re- tains a grudging sense that be is underpaid ; a very troublesome case, or an unusual number of cases, is a virtual encroachment on his bargain ; paupers are commonly a nasty and unmanage- able class of patients : in short, the medical officer is chronically in that state of mind which prompts a man to throw up his situa- tion—he is aggrieved, unwilling, and careless. Add to all this, that he is at times harrassed by stupid objections from Guardians quite ignorant of what be ought to do, and that he is under no superintendence from any professional superior : we have here almost all the elements of irresponsibility.
By its nature the contract system cannot take effectual security for duties which are varying, and which require immediate atten- tion at unexpected moments. The medical officer of a union ought to be like the surgeon of a ship—amenable to command, and responsible for the proper performance of each duty. But to secure that kind of performance, demands a set of motives be- yond the pale of the contract system. That system can only be effectual in the case of fixed duties, or averages very broadly cal- culated, as they may be by large capitalists in the case of ship- insurances. The medical officers' emoluments are calculated upon an average of duties ; and it is not wonderful if he supplies merely an average of performance. If you want zeal, discipline, and high " officerlike " honour, you must appeal to other motives • A subsequent number of the Times contains a letter signed "C. Barstow, Clerk of the Halifax Union," in which It is asserted that Mr. Garlitk has 801. a year for the town of Halifax, balder/fees; and that there are eleven other district medical officers. We cannot say where the mistake lies. The Times goes upon documentary evidence ; and whatever may be the case in the Halifax Union, It 15 notorious that medical offi- cers generally are underpaid.
than the stipulated penalties of a contract, or the threat of losing a post that is really not worth having.
Now this is to be done without lavish expenditure. No doubt, the expenditure might be larger under an effective system of me- dical relief than it is now ; it should at all events be sufficient ; but whatever were the gross amount, it might be so distributed as to bring into play better motives than those created by the con- tract plan. The motives most obviously deficient in the present system are, a proper spirit in the relation of the officer to his' superiors, superintendence, and prospective advantage : all these motives would be set to work if the medical administration of the Poor-law were consolidated into one system ; if the posts were graduated, and subjected to a routine of promotion offering high prospective advantages to the occupant of the lowest post, and ex- tending to the whole body of officers the social consideration which pertains to posts of dignity, and to those who are eligible to such posts—as the dignity of the Admiral is reflected, however distantly, on the smallest of Midshipmen. Perhaps there might be difficulties in establishing such a con. solidation of the medical staff under the Poor-law machinery ; but during the growth of a "Board of Health" department, already budding in the Sanatory Commission, it is a very proper question, to consider how far it would be possible to include in the ramifications of that department the supply of medical relief to the helpless poor, in or out of the workhouse. There would be advantages of mutual supervision if the medical officers, though under effectual control and strictly responsible to the central exe- cutive, were not dependent on the Poor-law authorities. There - would no longer be a chance of giving improper relief under the name of medical relief; nor would paupers be stinted in physic—. the worst of all parsimonies. But, as a check on an improper re. sort to gratuitous advice, the application to a medical officer with- out grounds of real destitution mie,..ht be recognized as an act of fraudulent pauperism, and punished by a specific penalty.
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