108

THE LANCET.

LONDON: SATURDAY, JULY 31, 1852.

THE INCOViE TAX AND THE PROFESSION.

THE proceedings of the Select Parliamentary Committeeon Income and Property Tax have just been published, andwe refer to as much of them as may prove interesting tomedical men. The report of the Committee is only a partialone, in consequence of the early termination of the last

session, but there can be little doubt the subject will berenewed in the next session. In the mean time it will be well

for the profession to understand the suggestions which havebeen made for their relief, in common with others enjoyingtemporary incomes. The most important parts of the pro-ceedings of the Committee are three draught reports, pro-posed by Mr. HuME, Mr. SOTHERON, and Colonel RoMILLY, but ofthese gentlemen only Mr. HuME and Mr. SoTHERON have been re-turned to serve in the present parliament. Among the witnessesexamined were, Mr. FARR, of the office of the Registrar-Gene-ral, Mr. J. STUART MILL, Mr. BABBAGE, and Mr. WARBURTON.The draught report proposed by Mr. HUME submitted, as a

preliminary, " that the act for granting duties on profits, profes-"sions, trade, and offices violates the principle of equitable" taxation in several respects."The following propositions are undoubtedly true, and

especially so of the profession of medicine, where the profitsare liable to vary from year to year, and are contingent uponpersonal exertion to an extent unknown in the other

professions.

"Nearly the whole of the incemes of persons in professionsand offices, assessed under schedules D and E, are derivedfrom the direct exercise of industry and skill. To the con-tingencies of business are here added ill-health and the

certainty of death, when labour and income cease. Thatincomes from profession are therefore in the nature of lifeannuities, which they cannot exceed in value; the capital in-vested at risk in subsistence, education, and protracted prepa-ration, may be lost by untimely death, but is returned as in-come when large numbers or classes are concerned. A taxon the current income of all the persons assessed underschedules B, D, and E, is consequently unjust, as it is a taxnot only on profit, but also on a variable proportion of capital."

The equity of these propositions is manifest in all but oneparticular. Medical incomes are certainly not strictly com-parable with life annuities. A life annuity ceases only withlife, but a medical income depends upon health of mind andbody. The following is Mr. HUME’S proposition for dealingwith the taxation of the professions, our own among the

number, and it appears to us that it is perfectly fair andequitable :-

"That as the property of persons engaged in farms, ir,manufactures, commerce, p1"’q(essions, and offices, consists partl3of stock, and partly of the direct produce of skill and industrythe simplest course would be to tax the stock on its valueas it actually appears in an ordinary balance-sheet, and afte]deducting the interest on such capital, to tax the rest of thEindustrial income at its capitalized value :’

By capitalized value is meant the estimated value of a professional income, as calculated by actuaries, taking all contingencies of health, life, and variability into considerationDifferent modes of effecting taxation according to this prin

ciple were proposed by the actuaries examined by the Com-mittee. Of these, the following appears the most feasible :-

" By the third mode proposed for making the tax more

equitable, the tax is to be assessed at one uniform rate upon allkinds of property ; that is, upon the present capitalized value ofindustrial incomes, which are called inherent property, as well asupon all external property, whether personal or real. This mode

appears to your committee both equitable and practicable. It hasbeen shown in the evidence, that by using the English life table,and taking the interest of money at risk in trade at five per cent.,the tax on the value of industrial incomes can be assessed withan approximation to accuracy sufficiently near for all practicablepurposes. It has also been proved to the satisfaction of yourcommittee, that tables may be framed of as easy application, inall ordinary cases, as the common tables of interest; and tableshave been given in as an example. The mode of dealing withmixed cases is a matter of detail into which it is unnecessary toenter."

By this plan, the amount of capital engaged in a profession,the annual income derived from the same, and the age of the

party practising being all given, the average value of the in-come, for purposes of taxation, can be obtained with some-

thing approaching to certainty and precision.In the draught resolution proposed by Mr. SOTHERON, he

objected that no plan had been laid before the Committee forthe capitalization of incomes which was not " open to somegrave objections." He, however, was equally convinced withMr. HUME, of the unjust bearing of the present system uponprofessional men, as the following extract will show :-

" It is repugnant to public feeling to impose the same rate oftax upon incomes derived from permanent realized property,enjoyed without exertion or risk, and incomes derived fromtrades, professions, and salaries, which are subject to both."

I Mr. SOTHERON himself proposed the following as a substitutefor the plan of Mr. HUME. He suggested that schedule D,

’ or the professional classes, should be treated in the follow-ing manner, but which, we think, would not be a sufficientrelief to professional incomes. According to Mr. SOTHERON,-

. " The average relation of schedule D to the other schedulesshould be put as three to four; so that the incomes under that

’ schedule should be assessed at three-fourths of the amount levied, upon all other kinds of property."! Colonel ROMILLY was of opinion that the inquiry of the Com-. mittee should be extended; that before the income tax could

: be re-arranged, the whole system of taxation must be inquired: into.

Thus, though nothing has been definitively accomplished,the way, we trust, has been cleared towards the relief of the

professional classes from the iniquities of the present income- tax. After the labours of this Committee, incomplete as they1 have confessedly been, it will be impossible to continue the

I plan of treating the hazardous income of the professional many upon precisely the same terms as the rents of the landed pro-; prietor. We conclude our observations with a striking ex-

i tract from the propositions of Mr. HUlIlE, which will be re-echoed by every professional man in the kingdom:-

" Your committee is convinced that the income tax, in its1

present form of inequality, cannot be made a permanent tax.Y The inquiry establishes the truth of the public judgment on itse "

injustice." .r

e ONE of the questions of the greatest importance, in the presentday, to medical practitioners, is that of the enormous amount

1- of gratuitous service rendered to the public by the profes-l- sion. In a condition of society never equalled in the historyi. of the world for industry and competition, we of the profes-t- sion of medicine stand alone in this particular. If the pro-

109EVILS OF GRATUITOUS MEDICAL SERVICES.

fession, as a body, were salaried by the state, the extent oftheir public labours producing no direct emolument couldnot be greater than it is at present. This, the vice of our

system, is universal; it infests, more or less, all our greatinstitutions, and it enfeebles every individual practitioner inthe kingdom. If we were a set of idle monks, instead of being,as we are, the hardest-worked portion of the educated commu-nity, the unpaid calls upon our time could not be more

absorbing. Without any disloyalty to the pure and holysentiment of charity, it well becomes us to inquire, whetherthe continuance of such state of things can be intrinsicallyright, or prove beneficial to the profession individually orcollectively. We conscientiously believe that many of thosewho might become the improvers of medicine and surgery,sink, under the present system, into mere drudges, their

intellects failing when they should strengthen; and that num-bers are dragged down to mediocrity by unceasing toil, withoutleisure for study or for reflection. We are wont to pity thecondition of the assistant naval surgeon on board ship; butreally in society our profession, as a body, is in much the

same position. Numbers amongst us suffer from corrodingcares during a weary lifetime, vainly struggling against

11 Poverty’s unconquerable bar,"

and dying, after a life of fruitless toil, leaving widows andOrphans portionless and unprovided. But our gratis work,while it pierces our own sides, does not insure to us eitherthe esteem or the gratitude of the public. On the contrary,we are despised and contemned, because we ourselves set solow a value upon the exercise of our art. We are verily theknight-errants of modern civilization, doing battle with diseaseand death for the mere honour of the thing, and as the ageof chivalry has long since evaporated, we do not even get theempty guerdon of public praise and approbation.

’

There is no department of our profession from which wemight not select apt illustrations of the truth of these remarks.From the lowest to the highest, the leprosy of unpaid workinfects our profession, and puts us really in the position ofidlers and spendthrifts; for to labour profitless is in its resultsmuch the same as idling or squandering. Let us take on this

occasion the general hospitals of the metropolis, and the busyhive of medical men who serve and suffer in their service, andspread the influence of a bad example over the whole pro-fession.

Modern London contains for its nearly three millions of in-habitants thirteen general hospitals, all of them well appointedwitheveryappliaucefortlierelief of suffering humanity. In thislist we include St. Bartholomew’s, St. Thomas’s, Guy’s, theWestminster, St. George’s, the London, the Middlesex, Uni-versity College, Charing-cross, King’s College, the Royal Free,and St. Mary’s. The thirteen hospitals possess a collective

staff of from 140 to 150 physicians and surgeons, all of whomwe must suppose to be fitted for the highest duties of the pro-fession. Besides the accredited medical staff of each hospitalat least an equal number of qualified medical practitioners areattached to them as resident medical officers, pathologistsregistrars, and assistants of various kinds. The poor personsand others-for all hospital patients are not poor-seekinfrelief from our hospital system, amount to no less than th<

astounding number of 300,000 annually. We have extracte(this amount, without any wish to exaggerate, from the bes

returns, as furnished by the hospitals themselves. The figure

will be accredited when we state that the largest of our noso-comial establishments, the Royal Hospital of St. Bartholo-mew, succours nearly 5500 in-patients annually, and that its inand out-patients nearly reach 80,000 in the year. Yet this

vast system of relief, and the immense amount of medical and

surgical skill consumed in its bestowal, are nearly-we hadalmost said, entirely-gratuitous. Was ever such a spectacleof gratuitous toil exhibited as that which is involved in thesefigures? We believe not. Moreover, we are convinced thatthe most exalted charity could never justly call upon anyset of men for such an enormous self-sacrifice.

But some of the thirteen hospitals do present their medicalofficers with a yearly gratuity. Guy’s Hospital, for instance,pays its medical men much the same annual salary as theporters at its gates receive. Grave and reverend men, over-

flowing with the love of the profession, receive pittancesinferior to the wages they pay their own butlers or footmen.Much has been said of the penny-club system, and of self-

supporting dispensaries. But really these cheeseparings aremore insignificant than the remuneration of either clubs or

’ dispensaries. We see from time to time public revelations

relating to deans and chapters, explaining how a certain sumbeing left for the nourishment of those saintly personages whomanage capitular revenues, and how this sum has grown yearby year, generation by generation, century by century, until aperfect plethora of income has been reached. It has been far

otherwise with our profession. Revenue has with us stood stillor retrograded. The footman’s wages which the physician atthe Borough hospital receives, represents a sum and a timewhen fifty pounds was a large amount compared with the fiftypounds of the present day. Yet Governors are not ashamed,amid their accumulated riches, to pay medical men in the

poorest coin; and medical men, to their shame be it said, stoopto receive it with humble and unrepining thanks. Such beingthe state of affairs, can we wonder that the aspect of the pro-fession should be prostrate and need t

IT would be difficult to overrate the importance of the

study of cerebral diseases, and yet how lamentably deficient arewe in our means of obtaining a knowledge of the subject. It

is to be feared, that so long as the hospitals for the insaneremain under the control of lay visitors, aldermen, and countymagistrates, we shall gain but little. Whether these gentryconsider that there is " a royal road" to the study of braindiseases, or that an acquaintance with them is acquired in-tuitively, we know not; but it is certain that they seem deter-mined to prevent any knowledge being gained in the only man-ner in which it is possible to acquire it. No sooner is a boon

granted in one direction, than its benefit is counteracted inanother. The doors of Bethlem are thrown open; those of

Hanwell are immediately closed. The election of a phy-sician and clinical instructor to perhaps the most importantof these institutions is vitiated, it is reported, by family

- interest. The subject is more particularly called to our at-,

tention by the report of a trial which took place at Derby, on) the 20th inst., before Mr. Justice COLERIDGE, and the main

facts of which may be thus briefly stated:-DANIEL FREEMAN, thirty-four years of age, was indicted for

1 the murder of an old woman named SARAH WALTERS. When

t the prisoner was called upon to plead, he appeared unable tos understand what was said to him, and the case was in conse-

110 PROVINCIAL MEDICAL AND SURGICAL ASSOCIATI01T.

quence allowed to stand over until the arrival of a medical

man. At the end of the day, he pleaded " Not guilty," atthe same time remarking, that if any one would come forwardand say that he had murdered any one, he would be hungwithout judge or jury. From the evidence, which was not

disputed, it appeared that in the middle of the day of the29th of June last, the prisoner went into the cottage in whichthe deceased lived with her husband, at Sawley, and made amost violent attack upon her, beating her about the head andface with a poker, &c. The attention of a neighbour wasattracted by seeing the prisoner in the yard attached to thehouse, leaning over the dead body of his victim, and scatteringflour upon it, calling out " Flour, you &mdash;&mdash;." Great difficultywas experienced in seizing the prisoner, owing to his violentconduct; but having been struck with a stone upon thetemple, he lost a quantity of blood, and became quieter. Mr.

Serjeant MILLER ascribed the commission of the act to theungovernable frenzy of a madman; and he called witnesses toprove that the prisoner’s father had been insane, that theprisoner himself had previously been in an asylum, and thatonly a day or two before this tragical occurrence the prisonerhad been going about the country, near Ashby-de-la-Zouch,almost naked; that he had been taken into custody, and exa-mined by a surgeon, who pronounced him to be insane, andcautioned the authorities at the workhouse to keep strict

guard over him, lest he should do mischief to himself orothers. He was, however, permitted to go at large, and onthe following day found his way to Sawley, as above men-tioned. In reply to this case, Mr. DOUGLAS Fox, the surgeonof the gaol, was examined; and he stated that, from theopportunities which he had had of observing the prisoner, hehad formed the opinion, that though he was a person ofimbecile mind, he was not insane, so as not to know the

nature and consequences of his acts. The Judge summed up,commented with severity upon the conduct of the officers ofthe Ashby union, and the Jury returned a verdict of "Guilty,"with a recommendation to mercy on the ground of imbecility.Sentence of death was recorded.

We do not think the foregoing case requires many remarks.From the history, we entertain but little doubt of the prisoner’sinsanity: three medical practitioners, at least, entertained thatopinion-the practitioner at Ashby, and the two gentlemenwho signed the certificate consigning FREEMAN to the asylum.Mr. Fox merely considered him a person of imbecile mind"-a convenient phrase, it appears to us, signifying nothing. The

verdict of the Jury must, however, be set aside; and as theJudge evidently believed in the prisoner’s madness, or hecould not have reproved the officers of the union, this will inall probability be quickly done.In alluding to this trial, our object has been, not to throw

blame on any individual, but to prove that our present systemof education is imperfect. The study of insanity must bemade compulsory upon students of medicine. Unless this is

done, and unless greater opportunities are given for impartingpractical instruction upon this subject, grievous errors andaccidents will continually happen, society at large will suffer,and our profession will incur undeserved disgrace.

.

TnE enterprising Mr. MEcni has recently given a festivalat Tiptree Hall, the little farm in which he demonstratessome of the most important problems relative to sanitary

reform and agricultural progress. The Hygeia of the fields isthe same goddess with the Hygeia of the towns. As Mr.

F. 0. WARD, one of the most active among the sanitarians,remarked, sanitary reform is but the cultivation of healthier

crops of men, just as agricultural improvement is the cultiva-tion of healthier crops and more flourishing herds. Mr. Mscni

has on his farm at Tiptree a perfect tubular organization forthe capillary distribution of liquid sewage manure in everyfield and furrow. The result is a model of fertility and culti-vation. A few such experiments would do more than a worldof preaching or writing to bring about a proper organizationof the enormous waste of manure in our large towns. Insteadof squabbling about Lobos, and sending fleets in search of guano.islands, why should we not realize the wealth we have at hornedIn the words of Lord PALMERSTON, at Lewes, that which is dirtand filth to the towns would be wealth and health to thefarm and the garden. The physiological bearings of sanitaryand agricultural reform are most intimate, and none know thisbetter than medical men. There are, indeed, so many diseases

among patients of the poorer class for which " the big loaf andthe bright water-jug" are the medicines most required, and somany chronic maladies among persons of every rank, whichare traceable to pestiferous evils as the cause of their first

generation and subsequent obstinacy, that we need make noapology for referring to this subject. We may hope thatwhen political parties are tired of opposing each other, someadministration may take for its standard the health of the

people, in all that relates to food and drink and external

physical conditions.

TWENTIETH ANNIVERSARYOF THE

PROVINCIAL MEDICAL AND SURGICALASSOCIATION,

Held at Oxford, July 21st and 22nd, 1852.

REPORT OF THE PROCEEDINGS.(Concluded from p. 89.)

WEDNESDAY, JULY 21.AT two o’clock the ceremony of conferring the honorary

degree of D.C.L. on three distinguished members of the Association-namely, Sir Charles Hastings, of Worcester; Dr. JohtForbes, of London; and Dr. John Conolly, of Hanwell&mdash;tootplace at an Academic Convocation, convened for that expresipurpose. The Vice-Chancellor presided, and was supported b3numerous members of the University in their robes. Amonthe large assemblage of medical men and others, we ’noticedseveral ladies, some of whom were the wives of members ojthe Association, who were enjoying, with their husbands, thEtreat of this annual holiday. On the same occasion two of themedical graduates of the University of Cambridge-viz., DrBurrows, of London, and Dr. Ranking, of Norwich, both members of the Association-took their ad eundem degree of Doetotof Medicine of the University of Oxford.Dr. Acland’s-evening conversazione has already been noticed.

SECOND DAY.&mdash;THURSDAY MORNING, JULY 22ND.

About 200 members breakfasted together at the Star, and altwelve o’clock an assemblage much larger than at the meetingof the previous day met at the House of Convocation&mdash;Professo]OGLE in the chair.

Dr. Coo>iv‘-ol;TaY, as chairman of a committee appointed otthe preceding day to consider the privileges to be extended bJthe proposed new Charter of the College of Physicians, reportedthat the committee had met, and resolved to invite all the pro-vincial physicians, now assembled at Oxford, to communicalEwith the College of Physicians in London on the provisions ojthe Charter, in order that, before any steps were taken, a correct