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inquire why this prominence should have been given to asingle development of a widely diffused evil ? Bad as he is

everywhere, the venereal quack in long-settled countries isnot worse than many others; not worse, for example, thanthe dealer in sham electrical appliances, by whose advertise-ments, as every neurologist knows, patients are constantlynot only defrauded of their money but are frequentlyprevented from seeking competent advice until the time atwhich it might have been useful to them has passed away.It is possible, of course, that the social and climatic con-ditions of New Zealand may be unfavourable to the develop.ment of the neurotic and dyspeptic affections which furnishrich harvests to the quacks of older communities ; but it is,so far as I know, the only country in which women havevotes for the members of the colonial parliament ; andevery medical man has had experience of the constantsolicitude of mothers about the sexual relations of theirsons. It is worth while to inquire whether the law underconsideration has been an outcome of the influence of afeminine electorate upon the legislative body, and to

speculate whether any analogous effects would be likelyto follow from the institution of female suffragein this country. The late Mr. Lecky, in ;hisvery thoughtful consideration of the suffrage ques-tion in "Democracy and Liberty," pointed out thatwomen, and especially unmarried women, are on thewhole more impulsive and emotional than men; moreeasily induced to gratify an undisciplined or misplacedcompassion, to the neglect of the larger and more permanentinterests of society; more apt to dwell upon proximate thanupon more distant results. To whatever extent this aspectof the female character may be correct, it would pointtowards a probability of hasty legislation for the removal ofadmitted evils, and it more than suggests the possibilitythat the consequences of such hasty legislation might some-times be even more prejudicial than the evils it was designedto remove. Having said this :much, we cannot avoid theinquiry whether the New Zealand legislation be not of thenature sometimes irreverently described as "I grandmotherly

"

-that is to say, whether it may not be calculated to keepthe community in leading strings from which it might withadvantage be emancipated.Gambling and quackery are great social evils, perhaps the

greatest against which an advanced civilisation is called uponto contend. Gambling strikes at the roots of honest industryas quackery strikes at the roots of health, and both alike areindications of profoundly diseased conditions of the bodypolitic. The question is whether attempts should not bemade to grapple with them at their sources rather than toapply repressive legislation to their effects. Schools whichwould teach the principles of rational conduct, and school-masters who would remember the saying of a great Americanthat the turning-point of a boy’s life was often the firstoccasion on which he saw a chance of obtaining a dollarwithout squarely earning it, would certainly diminish thepublic interest in "Limericks" and in " Winners," just aseven a smattering of physical science would often suffice todisplay the absurdity of the pretensions of quacks. Oureducational methods so far have made scarcely any appre-ciable advance upon those of the eighteenth century, anduntil they do so the superstitions and follies of the

eighteenth century will still impede the progress of nationalprosperity. I am, Sir, yours faithfully,Feb. 24th, 1908. F.R.C.S.

DONATIONS AND BEQUESTS.-Under the will ofMr. Jesse Jacob the Miller Hospital, Greenwich, will receiveI:.200 and the Seamen’s Hospital, Greenwich, £100.-Thetreasurer of St. Peter’s Hospital for Stone has received.61000 to endow a bed to be called °’ The Jacob and RachelVallentine Bed."-The trustees of the Annie Zunz Trust havepromised a contribution of E5000 towards the rebuilding ofthe Royal National Orthopaedic Hospital in Great Portland-street. -The following bequests have been made under the willof Miss Katharine Stewart Forbes of Ascot: £10,000 to theBrompton Hospital for Consumption ; .610,000 to the CancerHospital, Brompton; E5000 to the Middlesex Hospital forthe Cancer Ward ; .BlOOO to the Royal Hospital for Incurablesat Putney; and £1000 to each of the following institutions :the National Hospital for the Paralysed and Epileptic,Fincbley; the Royal Berkshire Hospital ; the Hospital forSick Children, Great Ormond-street; the British Home forIncurables, Streatham ; and the Surgical Aid Society. ’

THE ORGANISATION OF THE MEDICALPROFESSION IN FRANCE.

(FROM OUR SPECIAL COMMISSIONER.)

REMARKABLE UNANIMITY IN THE DEPARTMENT OF THESOMME.-ILLEGAL MEDICAL STRIKE AGAINST THE POORRELIEF AUTHORITIES.-THREATENED PROSECUTION OFTHE MEDICAL SYNDICATE BY THE GOVERNMENT -M.MILLERAND, FORMER CABINET MINISTER, ENGAGED TODEFEND THE MEDICAL PROFESSION.

Amiens, March 1st, 1908.A sERious contest has arisen in the department of the

Somme which interests all members of the medical pro.fession who have intrusted to them the care of the sick

poor. In France there are two official organisations for therelief of the poor. These are the Bureau de Bienfaisance inlarge towns and the Assistance Departementale for smalltowns and rural districts. The latter is organised andcontrolled by the Conseil G6n6ral which to some extentcorresponds to our county councils. The law says thathelp must be given but leaves the local authorities todecide how this shall be done. The income consists of asmall subvention from the State, much larger subventionsfrom the communes which belong to the department, and thelargest sum is derived from a special tax which the departmentitself has a right to impose for local government purposesand which is known as the additional centimes. Thedepartment of the Somme contains 556,000 inhabitants butfrom this we must deduct the inhabitants of the chief townAmiens, numbering 91,000, then 20,000 for Abbeville, and15,000 for three other towns which have Bureaux deBienfaisance. Thus there remain 430,000 inhabitants forwhom the Assistance Departementale is responsible. Outof this population from 36,000 to 37,000 persons claimmedical relief in the course of the year; the actualfigure for the year 1906 was 36,303. Interested in thisor in other medical services, such as contract work forbenefit societies, there are no less than 250 medical practi-tioners. They do not all live in the department but areso near it that their practice overlaps into the depart-ment. Rather less than a year ago a medical syndicate wasformed, with its headquarters at Amiens, under Article 13 ofthe Law on Medical Practice of 1892. When the law of1884 was enacted sanctioning the formation of syndicates-a term which in France practically means trade unionseither of the employed or of the employers--such societieswere allowed to possess property and to proceed at law ; theunions of the medical profession were not at that timestrong enough to be included in the benefits of the law.This was remedied in 1892, but Article 13, whilegiving to the medical profession the same rights to formsyndicates as are given to all other professions and trades,stipulates that the medical syndicates thus formed mustnot attack the State or the local authorities. It will atonce be seen that this clause cripples the action of medicalmen when dealing with such institutions as hospitals andasylums, for these are for the most part State or municipalinstitutions ; and this is also the case with regard to poorrelief. Up to the end of 1906 the medical practitionerswho attended to the poor did so under the contract

system. They received through the prefecture, but fromthe Conseil General or county council, 2 francs perannum for every poor person inscribed on their lists.This sum is not only very insufficient but complaintwas made that all the persons entitled to medicalassistance at the public expense were not inscribed onbhe books of the medical men. Very often they were)nly inscribed when they had actually fallen ill. Thenfrancs instead of 2 francs were paid but that again was

ibsolutely insufficient. Contract work can only be re-

nunerative and that but to a very modest extent when manyare inscribed and but few are ill.In some other departments of France, and notably in the

ieighbouring department of the Seine Inferieure whichias Rouen for its capital or principal town, a much)etter system was some years ago willingly establishedn response to the efficient organisation of the medical pro-ession. Here two great principles are recognised. First.hat the patient shall have the right to select the medicalattendant whom he prefers. Secondly, that the medicalattendant shall be paid according to the work done. Theee which medical men receive from the local authorities

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of the Seine Inf6rieure is 1 franc or 10d. for everyconsultation in their own surgeries; 1.50 francs (1s. 3d.)for every visit within their own commune; 2 francs(1s. 8d.) if the patient lives outside the commune and1½d. per kilometre when going to see the patient ; nothingis allowed for the return journey. This is considereda fair arrangement and in August, 1906, the ConseilGénéral of the Somme decided in favour of abolishing thecontract system and that the medical men should be paid1 franc per consultation given in their own houses ; only1.25 francs (Is.) per visit to the patient’s house, and in specialcases only 25 centimes per kilometre. The advantages,however, of this offer were entirely destroyed by an appealmade by the Conseil G6n6ral to the medical profession toconsent to a " last sacrifice in favour of public assistance," itbeing proposed that the total honorarium paid to the medicalmen in 1907 under the new system and the total cost ofmedical relief should not exceed the sum paid in 1905. Duringthat year and in round numbers the total expenditure formedical relief by the Departmental Assistance, that is in therural districts, amounted to 252,000 francs. Of this sum themedical men received as subscriptions paid under the con-tract system 63,900 francs, for operations 2500 francs, andfor accouchements 7700 francs, or a total of 74,100. But thebill for drugs amounted to 89,000 francs and that for surgicalapparatus to 1500 francs. Now in England for contract workat 5 francs a year, that is, 4s., the cost of drugs is estimatedat only about a third of the amount. If, instead of 2 francs,the contract had been 5 francs, the medical men would havereceived 159,650 francs and thus it will be seen that the

drug bill would have represented a rather large third ofthe outlay. As in France medical men do not providemedicine the 2 francs given was a net receipt. The further

expenses were 3500 francs to midwives and 83,000 francs paidto the hospitals in the towns for the patients sent to themfrom the rural districts. This makes a total of 251.100 francs.

In 1907, the subscription of 2 francs being abolished and afee per consultation substituted, the amount which themedical men should receive would probably be a little morethan double what was paid to them under the old system in1905. As a matter of fact, instead of paying them double,it is proposed to give them only about two-thirds of the sumwhich they received in 1905. This extraordinary result hasbeen brought about because of the understanding that the totalcost for medical relief should not exceed that of the year1905. As no such arrangement was made with the otherdepartments of medical relief-such as the hospitals, thedruggists, and the midwives-the medical men alone areleft to suffer. The total outlay in 1907 amounts to about.614,000, while in 1905 it was £10.080. Therefore themedical men instead of receiving about E5500 for their year’swork are offered only about £1700, and the remainingE3800 due to them are to be utilised to reduce the budgetof 1907 to the figure of the budget of 1905. The druggistswill not suffer, they will on the contrary receive more thanbefore, and so will the hospitals and the midwives ; but themedical men are to forego something like two-thirds of theirtenpenny and shilling consultation fees. Considering thatmedical men as taxpayers contribute their full share of thecost of medical relief for the poor why should they andthey alone be called upon to make such an enormoussacrifice ? During the course of the year 1907, foreseeing that some-

thing like the above result would occur, a syndicate of themedical practitioners of the Somme was formed and out ofthe 250 medical men concerned 230 signed a declarationpledging themselves to observe the principles of the syndi-cate, while 180 paid their subscriptions and enrolled them-selves as members. This was certainly a very remarkabledemonstration, though the local authorities do not seem tohave understood its significance. This was all the moreregrettable as the most urgent question which the medicalprofession wished to bring forward was precisely the matterof poor relief. This they might, of course, discuss but asalready explained Article 13 of the Law of 1892 speciallydebars them from taking action. The medical syndicatedecided that while submitting to the great loss describedabove for the year 1907 they would not continue in theservice during the year 1908 unless the same terms weremade with them as already exist in the Seine Inferieure.But the local authorities failed to realise the gravity of thisthreat. They thought that the organisation of the professionwas not serious. It was even rumoured that the whole move-ment was merely a political intrigue conceived for the purpose

of annoying’ the prefect and discrediting the Government.Medical men having always allowed themselves to beimposed upon from time immemorial it was difficult tobelieve that at last they were really in earnest. When, how-ever, it became evident that matters were more serious thanwas at first anticipated and that the medical men would notserve any longer, the prefect announced that he was aboutto prosecute the medical syndicate under Article 13 of thelaw of 1892 for taking action against a local authority. Tomake it quite evident that the medical syndicate was notactuated by any political and anti-Republican motivethey engaged for their defence M. Millerand who wasMinister of Commerce in 1900. M. Millerand advisedthe syndicate to dissolve and to reconstitute itselfunder the Law on Associations of 1901 which allows allFrenchmen to form an association, but such bodies cannotpossess property unless they make a declaration at the

prefecture notifying their existence. An associationpossesses not quite as many rights as a syndicate but itescapes Article 13 of the Law on Medical Practice of 1892.

It may be questioned whether it would have been betternot to have effected this transformation. A small fine and a

reprimand would not have done the syndicate any harm butthere was the danger of being suppressed. With a fewverbal alterations the rules of the new association are

practically the same as those of the dissolved syndicate, butit will cause considerable trouble to enrol anew allthe members, though a large majority have come forwardof their own accord and joined. Then throughout Francethe medical profession have expressed such warm sympathywnn Dneir lenow practitioners or cne ueparIimen1j or 1jne

Somme that the syndicate might have stood its ground.Time passed and yet no arrangement was made, so finallythe whole medical staff ceased to work for the authorities onJan. lst of this year. On the other hand, from motives ofhumanity and also in a smaller degree from motives of policy,they declared that they were willing to continue to attendthe poor till April, 1908. This they would do unofficially andgratuitously. When they give a poor man a prescriptionthey no longer employ the official yellow sheets, con-

trived to facilitate the keeping of books and statistics.They use their own ordinary paper and prescribe whatthey choose and not the fixed remedies arranged forby the authorities and the dispensing chemists. There-upon the latter refused to make up the prescriptionsunless countersigned by the local mayor and it is quitepossible that dearer drugs have occasionally been prescribed.All these irregularities are giving the administration con-siderable trouble; but as what the medical men prescribethey prescribe gratuitously, from motives of humanity, andwill not and cannot be paid for their services, they cannotbe compelled to use the yellow official forms, for they are nolonger officials. Thus has this peculiar sort of strike con-tinued since the commencement of the year. The prosecu-tion threatened by the Government seems to have beenabandoned and the question is whether some friendlyarrangement will be effected before the month of April.The prefecture finds that the movement and the organisationof the medical profession are such that they cannot be dealtwith lightly and therefore a favourable issue is thoughtprobable.

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BIRMINGHAM.(FROM OUR OWN CORRESPONDENT.)

The University.THE annual meeting of the court of governors was held on

Feb. 21st, the Vice-Chancellor (Alderman Beale) acting asPresident. The meeting was well attended and it was theoccasion of an important statement which must of necessitybe interesting to all the Midland counties. After a reviewof the year’s work, in which he drew attention to thesatisfactory character of the results so far secured, Mr. Bealeproceeded to show that as a consequence of the well-con-sidered policy of the past and in order to provide for thenecessities of the near future it would be necessary beforelong that the University should again make an appeal to thepublic for a large sum of money. The money is necessarynot only to replace that which has already been taken fromendowments but also for the completion of the magnificentbuildings which are still being erected at Bournbrook. Itis also known that within a period of two or three years,