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same as the surrounding parts. This treatment equally appliesto lupus, and many other external growths not of a cancerousnature."In closing the above remarks, I would respectfully state
that there is nothing in my treatment which I could wish tohide from any medical man, further than the ingredients usedfor extraction.......
11 1 shall now only a(1(1, in committing the ubo2e inf01’mationto the public, that it is as nLitc7b a matter of hwnadity with rrae asof pecuniary interest, as 2)ty bw:iiless na,ukes me pelfeetly incle-pendeut of anything connected with the treatment of cance2JOHN WATSON, clothier, 23 & 25, Newmarket-s;;reet, Ayr."
THE VACCINATION ACT AND ITSDEFICIENCIES.
(COMMUNICATIONS OF MR. RICHARD GRIFFIN WITH THE PRIVYCOUNCIL, THE POOR-LAW BOARD, AND THE REGISTRAR-
GENERAL. )13, Royal-terrace, Weymouth, July 1st, 1859.’
My LORDS AND GENTLEMEN,—The Right Hon. the Earl ofShaftesbury having, during the last session of Parliament,called the attention of Government to the defective state of
vaccination, I have been induced to examine the public records
on the subject, and find that from the inefficient state of th®isters it is impossible to arrive at any accurate conclusion asto the extent to which vaccination is performed in Englandand Wales. To obviate this deficiency, and insure a perfectsystem of vaccination, requires that a joint committee shouldbe appointed by your honourable Boards, in order that uniformregulations may be issued, and then would cease that curiousanomaly of the Privy Council, the Poor-law Board, and theRegistrar-General, each issuing separate orders on this onebranch of the legislature.
I beg to submit that the present system requires amendment! in the following respects:-
That order should be withdrawn which directs a medicalman to fill up two sets of certiticates—the one for the parent(No. 1), the second for the registrar (No. 2), with their dupli-cates on the fly-leaf; also, Nos. 3 and 4, in the case of the
public vaccinator, who has the additional task of making twosets of entries in his book for the guardians. The length oftime occupied in completing these documents is of so serious anature that many medical men refuse to fill them up, as willbe seen by examining the accompanying table, which showsthat although 411,268 vaccinations were paid for by the public,only 376, 798 were returned to the registrars, and, doubtless,very many of these were furnished by medical men who did notreceive payment from the guardians, proving incontestably thateven in the case of the public vaccinators, the order is felt tobe so irksome that it is not complied with.
PAYMENTS MADE TO THE MEDICAL OFFICERS.
As a remedy for this uncertain mode of registration, I beg
the birth of a child, should be abbreviated, and have No. I
to suggest that, in future, the printed paper (No. 5) now given appende 1 to its foot, the registrar filling up the blanks thereinby the registrars to the parents, or other parties registering with the names of the child and parent and the residence,
leaving the other blanks only to be filled up by the vaccinatoon the child being successfully vaccinated. On the return othis paper to the registrar, he should be authorized to pay thevaccinator a small sum for the same, and, in the case of thpublic vaccinator, his fee in addition ; thus insuring, at leasta return to the registrars of all public vaccinations. On thE
registrar making a record of the vaccination in his books, hEshould affix his name and seal of office (a die-stamp) to the medicacertificate, and give it to the parents of the child on applicatiorfor it, he retaining the other half of the printed paper, whiclshould contain the vaccinator’s receipt for his fee to produce t(the guardians as his voucher that the payment has been made.Should the public vaccinators be paid by the registrar, and iraccordance with the number of printed certificates they produce, it will be necessary for the registrars to furnish the publicvaccinators with blank forms for revaccinations, and somerule should be laid down as to the age at which revaccinationsmay be paid for.
Mr. Simon, medical officer of the Privy Council, in the Ap.pendix to his Report of 1858, says-" Do not revaccinate per’sons who in infancy have been efficiently vaccinated, unlessthey be more than fifteen years of age; or if during any im.mediate danger of small-pox, more than twelve years oj
It has been said that a repugnance on the part of the peopleexists against vaccination ; but, as far as my experience goes,this is not the case, except with the very few. Apathy withsome, and procrastination or postponement with others, untilthey hear of some neighbour’s child who is healthy " to bedone from," are the prevailing obstacles to surmount. It is,therefore, most desirable that at the expiration of a givenperiod (say twelve months from the birth of a child, for bythat time most of the unhealthy will have ceased to exist, as106,634, or about one-sixth of all the registered births, die
’during the first year of life) a quarterly list of those then living,and not registered as vaccinated, should be made out by theregistrars, and sent to the vaccinators of their respective dis-tricts, whose duty it should then be to call upon the parents,or other persons having the custody of those children, and urgeupon them the necessity of immediate vaccination; failing theircompliance with this request, he should make his return ac-cordingly, and the registrar should forthwith sue for the penal-ties, unless a medical certificate be produced to him that thechild is not in a fit state to be vaccinated. For conductingt’his inquiry, and making a report to the registrar, the publicvaccinator should be entitled to a fee of one shilling for eachcase, in addition to the usual fee for vaccination if performedby him. Registrars who have not registered the birth of achild, receiving certificates of vaccination, should be orderedto forward duplicates of them to the registrar of the placewhere the child’s birth was registered. As many vaccinationdistricts are so small that it is impossible to keep up a supplyof lymph from their own population, it is desirable when va-cancies occur amongst public vaccinators, which average 270annually, the smaller districts should be united. By the tableit will be seen there are 915 vaccinators who receive less than£5 per annum each, and many of these only a few shillings.Should a fresh Act of Parliament be introduced on the subjectof vaccination, or a Medical Poor-law Bill be brought forward,as promised by the Right Hon. T. Sotheron Estcourt when Pre-sident of the Poor-law Board, I trust the subject of the pay-ment of the public vaccinators will be made a part of one ofthe said Bills, and a definite system laid down. At present thepayments are capriciously made, one board of guardians payingIs. per vaccination, whilst another board gives 2s. 6d., or evenhigher. The annexed table shows this remarkable disparity ofpayment, even in -whole divisions of the kingdom. In thesouth midland division, 2s. 6¼d. is the average remuneration,whilst in the metropolis it is only Is. 0¼d., and the officers ofthe union houses have no fees at all. With such a system it isno wonder the Acts of Parliament are so imperfectly carriedout. As the labour of vaccinating and inspecting 500 caseswould not occupy five times as long as 100 cases, I would sug-gest a graduated scale of payment-say 2s. 6d. per case for thetirst 100 cases per annum, 2s. per case up to the next 400, andabove this Is. 6d. per case, and an extra sum to be allowed forall those cases vaccinated at a distance from the residence ofthe medical officer. Vaccinators not giving certificates of hav-ing performed vaccination when it has been successful, or givinga certificate without having ascertained by inspection that thechild has been successfully vaccinated, to be subjected to a fineof 20s., recoverable in like manner as other fines under the’Vaccination Acts. One half of all fines should go to the partiessueing for the penalties, and the other half to the poor’s rate.
Trusting these suggestions, which are of a practical nature,may meet with due consideration,
I have the honour to be,My Lords and Gentlemen,
Your obedient servant,The Hon. The Privy Council, RICHARD GRIFFIN.
" The Poor-law Board, andThe Registrar-General.
THE TITLE OF "DOCTOR."
To the Editor of THE LANCET.
SIR,—In your journal of the 9ch inst. is inserted a corre-spondence which has occurred between certain M.D.s of
Southampton, Professor Christison, of Edinburgh, and Dr.Hawkins, the Registrar, concerning the right of the recentlymade licentiates of the Royal College of Physicians of Edin.burgh to assume the title of Doctor. There are certaindiscrepancies in these communications, which I hope you willallow me to point out.
Dr. Christison, in his first letter, says-" In Scotland, theright of assuming the title of Doctor can be acquired by amedical man only by graduation at a university." In thesecond, he says, again, he is " not aware of any right, eitherin law or in courtesy, by which a licentiate of the EdinburghCollege of Physicians can call himself Doctor, unless he is agraduate of a university." In the next paragraph he says-"The simple reason is, that, until a few weeks ago, no suchanomalous individual was known in Scotland at all as an un-graduated licentiate of the College of Physicians."Now, Sir, if such an individual has not existed, how can the
right of title by "courtesy" have been determined? Thelicentiates had all previously acquired the title of Doctor bytheir university degree; and hence, although the licentiateshipmight give an equal right in itself, it became merely confirma-tory of the previously existing title.According to Dr. Christison’s own showing, the question of
right by courtesy-as, of course, determined by usage-cannever have been decided in Scotland; so the corollary whichhe subsequently draws, that "the said licentiates, having nosuch right in Scotland, have no right to call themselves Doctorsin England," falls to the ground.The Southampton triumvirate are equally inconsistent and
illogical when they say-‘ We have the fullest authority forstating that, in Scotland, ungraduated licentiates are, neitherin practice, courtesy, or law, styled in a formal way Doctor;"and immediately after prefix their deprecation of the gentle-manly remonstrance of Dr. Hawkins by saying, "this being anew thing," &c.
According to Dr. Christison’s own showing, and I piesumehe is the authority to whom they refer, all licentiates in Scot-land are called Doctors-were called so before they becamelicentiates, so of course could not take the title de Hopo. Hadthey not, however, previously been called Doctors, I opinethey would have considered themselves entitled to that desig-nation merely in virtue of the licentiateship.
If Doctor be the title-and it certainly is the only popularlyunderstood one-which specifically distinguishes the practi-tioner of medicine from the practitioner of surgery, what isthere in justice or equity rendering it improper for the formerto assume the appellation of Doctor when he becomes a legally-constituted physician ? It has long been a reproach to a nobleprofession that the trade-name of Apothecary should attach tothose members of it holding the best legal status. The exami-nations and requirements at the Hall are, at least, equal tothose of St. Andrews, Aberdeen, and, for aught I know, tothose of the I niversity of Edinburgh itself; and hence it is mostunjust that licentiates of the former body should take a lowersocial or professional standing or title than those of the latterbodies. This being the case-and it is universally admitted tobe so, except by the narrow minded,-I cannot see what in-justice would be done to the M.D.s of these Universities byconferring on the licentiates of the Apothecaries’ Society thetitle of Doctor, or one analogous to it and equally honourable.It would be, in fact, merely remedying an existing injustice.If this be so, à fortiooi the physician who is, par excellence, thelegitimate practitioner of medicine, should take the highest