1
903 assistant-surgeons, is, indeed, a mine of instruction and experience to the student, of which the value can scarcely be over-estimated. The simple fact is that in every depart- ment of the hospital there is always a plethora of material I, for teaching purposes, and the veriest glutton, hungering and thirsting after knowledge, can only partake of a portion ’,, of what is daily set before him. So much for surgical work only. Possibly, with your permission, some further information may at another time be given as regards our clinical opportunities in other departments. The present instalment will, however, demon- strate on what substantial grounds we may contest the claim adduced on behalf of the metropolitan schools. I am, Sirs, yours truly, , JAMES HARDIE. THE MEDICAL STAFF AND RANK. To the Editors of THE LANCET. SIRS,—Mychief reason fornow addressing you isthe under- lying inference of your recent annotations and the letter of a recent correspondent that the medical staff in asking for rank is departing from its proper status as a professional body; and if you will allow me, I will try to make our views (or, at least, those of a section) plain. The question is admittedly not one of personal likes or dislikes, but rather what is necessary to honestly and efficiently carry out the duties entrusted to us. In itself we care nothing for military rank, and to anyone so inclined it can be reached through the ordinary portal for the combatant officer far easier and with less expenditure of brains and money than through the doubtful and indirect mazes of the medi- cal staff; it is not that we regard our profession as secondary to any other, but rather that, valuing it highly, and seeing how, in developing, its threads ramify through all the segments of the military machine, we desire reasonable freedom and a defined position for ourlabours. There are many among the older members (and I am myself among the number) who viewed with personal dislike depar- tures ultra-professional taken step by step, until now we have work to do identical with that of the combatant officer; but we cannot but acknowledge that this is the normal sequel of unification, and the logical and necessary outcome of our present duties is rank. If anyone suppose that, as at present placed, we are merely medical men charged with care of sick, let him run his eye over the medical regulations of the army detailing also sanitary work, charge of sores, command of Medical Staff CJrps, which embraces duties as essentially military as any that a combatant officer can be called upon to do. These are the duties which during peace, and doubly so during war, call for a defined status for the responsible individual; one not liable to dis- turbance through the jealousies of the combatant ranks, or by personal interpretations of orders and warrants, and whittlings and twistings to meet a given end. It was utter absence of all trust and faith in the acts of the military towards the medical staff which constituted the motive power in the recent outcry over relative rank, and it is this which now makes us look with more than doubtful eyes over the proposed amendment of the paragraph which almost word for word repeats the preceding paragraph on honorary rank, while stopping short of the logical step of granting the latter. The present disturbance is not our act, it has been thrust upon us; and now that the Secretary of State for War has told us (much to our astonishment) that relative rank is ameaning- less phrase, we cannot but see in our present state a condition fraught with misunderstanding and friction with other segments, and with probable failure when next tested in the field. We seem to have come to the parting of the ways; the better we are professionally the less we feel the possibility of contentedness; and what we now ask for is that the War Office should know its own mind and give us fair play. If our work is to be limited to purely profes- sional topics, we can regard our then position as medical men in Government employ with complacency. What suffices for the chaplains will suffice for us, with stripping of our trappings and gaudy uniforms, spurs, swords, and salutes, the complements of different military ranks-all a pure mockery to rankless men and an obstacle in attendance on sick men. If, however, unification is to normally evolve, we cannot but be an integral part of the military machine, and our status must be defined in it on the only recognised method-rank ; and experience has now shown that this system carried out to its logical conclusions contains elements of the greatest value to the Army, State, and even also to the medical profession. It entails ultra-professional duties, and necessitates a designation embracing them ; but the latter need not disturb our peace of mind, as it already exists in three of our present grades. Moreover, in a department complete in itself, some of us think we see an escape from the blot, which you so forcibly put forward in your issue of the 23rd instant-- award of honours for service centred in the military head ; and you do us a kindness in giving it prominence. To speak plainly, it is nothing short of a disgrace, it saps all loyal feeling towards our departmental superiors, it stifles the growth of all professional culture and progress. But will not unity, strength, and proper recognition of us as military- medical officers performing multiform duties carry also proper and due authority and influence of our head among the other heads of the army sections, and a dominant (if not sole) influence in the internal economy of the department, including promotion as well as rewards? and will not division of our present work into professional and ultra- professional, with outside men and officers to carry on the latter, by so much deprive us of weight in the military sphere, and equally reduce the influence of our head on the points mentioned ? The present blots are relics of the past, of a time when our duties were more strictly pro- fessional than they now are. and when the head possessed a, lessened importance; and it seems to some of us that our present position without rank and the misplaced power over awards and promotion await the same solution--emancipa- tion from the unreasonable supremacy in our affairs of the military caste. I am, Sirs, yours truly, April, 1887. ONE OF THEM. We have much pleasure in inserting the above letter from a distinguished officer of the Medical Department though we cannot quite agree with the writer on some of the points he advances.-ED. L. THE LUNACY BILL, 1887. To the Editors of THE LANCET. SIRS,—The new clause inserted on Feb. 22nd last into the’ Lunacy Bill of the present year, at the instance of Lord MonksweU, to the effect that "when any officer is trans- ferred from one county asylum to another his service in all’ such asylums shall count for the purpose of computing the pension or superannuation allowance," is good so far as it goes. But there are officers who have served a sufficient number of years to earn a pension whose service has not been confined alone to county asylums, who have trans- ferred their services from one of the county asylums to one of the borough or metropolitan district asylums, or vice ve7-sd. Those gentlemen will naturally be of opinion that, in fair- ness, the operation of the clause in question ought to be- extended to them. It will not, I venture to say, be con- tended that the work in the borough or district asylums is less anxious, onerous, and responsible than it is in the county asylums, and, moreover, probably one effect of the exclusion of the officers serving in them from this pension. clause would be to deter the best men at present serving in the county asylums from offering themselves for such, appointments in future. I am. Sirs. vour obedient servant. JAMES ADAM, M.D. THE ERASMUS WILSON BEQUEST. To the Editors of THE LANCET. SIRS,—I venture to think that the petitions which have. been lately presented to the Council of the Royal College of Surgeons by persons desirous of the suppression of experi- ments on living animals place the question of the disposal of the funds which have accrued to the Royal College of Surgeons in a new aspect. Before these expressions of opinion by a section of the public, any disposition of the funds of the Erasmus Wilson bequest was a matter of interest mainly to the body into whose hands they had fallen, and in a secondary degree to the medical profession in general. The decision must now lie between the opinions of the leaders of the profession, as expressed in the largely

THE MEDICAL STAFF AND RANK

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903

assistant-surgeons, is, indeed, a mine of instruction andexperience to the student, of which the value can scarcelybe over-estimated. The simple fact is that in every depart-ment of the hospital there is always a plethora of material I,for teaching purposes, and the veriest glutton, hungering and thirsting after knowledge, can only partake of a portion ’,,of what is daily set before him.So much for surgical work only. Possibly, with your

permission, some further information may at another timebe given as regards our clinical opportunities in other

departments. The present instalment will, however, demon-strate on what substantial grounds we may contest theclaim adduced on behalf of the metropolitan schools.

I am, Sirs, yours truly, ,

JAMES HARDIE.

THE MEDICAL STAFF AND RANK.To the Editors of THE LANCET.

SIRS,—Mychief reason fornow addressing you isthe under-lying inference of your recent annotations and the letter ofa recent correspondent that the medical staff in asking forrank is departing from its proper status as a professional body;and if you will allow me, I will try to make our views (or, atleast, those of a section) plain. The question is admittedlynot one of personal likes or dislikes, but rather what isnecessary to honestly and efficiently carry out the dutiesentrusted to us. In itself we care nothing for militaryrank, and to anyone so inclined it can be reached throughthe ordinary portal for the combatant officer far easierand with less expenditure of brains and money thanthrough the doubtful and indirect mazes of the medi-cal staff; it is not that we regard our profession as

secondary to any other, but rather that, valuing it

highly, and seeing how, in developing, its threads ramifythrough all the segments of the military machine, we desirereasonable freedom and a defined position for ourlabours.There are many among the older members (and I am myselfamong the number) who viewed with personal dislike depar-tures ultra-professional taken step by step, until now we havework to do identical with that of the combatant officer; butwe cannot but acknowledge that this is the normal sequelof unification, and the logical and necessary outcome of ourpresent duties is rank. If anyone suppose that, as at presentplaced, we are merely medical men charged with care ofsick, let him run his eye over the medical regulations of thearmy detailing also sanitary work, charge of sores,command of Medical Staff CJrps, which embraces dutiesas essentially military as any that a combatant officercan be called upon to do. These are the duties whichduring peace, and doubly so during war, call for a definedstatus for the responsible individual; one not liable to dis-turbance through the jealousies of the combatant ranks, orby personal interpretations of orders and warrants, andwhittlings and twistings to meet a given end. It wasutter absence of all trust and faith in the acts of themilitary towards the medical staff which constituted themotive power in the recent outcry over relative rank, and itis this which now makes us look with more than doubtfuleyes over the proposed amendment of the paragraph whichalmost word for word repeats the preceding paragraph onhonorary rank, while stopping short of the logical step ofgranting the latter.The present disturbance is not our act, it has been thrust

upon us; and now that the Secretary of State for War has toldus (much to our astonishment) that relative rank is ameaning-less phrase, we cannot but see in our present state a conditionfraught with misunderstanding and friction with othersegments, and with probable failure when next tested inthe field. We seem to have come to the parting of theways; the better we are professionally the less we feel thepossibility of contentedness; and what we now ask for isthat the War Office should know its own mind and give usfair play. If our work is to be limited to purely profes-sional topics, we can regard our then position as medicalmen in Government employ with complacency. Whatsuffices for the chaplains will suffice for us, with strippingof our trappings and gaudy uniforms, spurs, swords, andsalutes, the complements of different military ranks-all apure mockery to rankless men and an obstacle in attendanceon sick men. If, however, unification is to normally evolve,we cannot but be an integral part of the military machine,and our status must be defined in it on the only recognised

method-rank ; and experience has now shown that thissystem carried out to its logical conclusions containselements of the greatest value to the Army, State, and evenalso to the medical profession. It entails ultra-professionalduties, and necessitates a designation embracing them ;but the latter need not disturb our peace of mind,as it already exists in three of our present grades.Moreover, in a department complete in itself, some of usthink we see an escape from the blot, which you so

forcibly put forward in your issue of the 23rd instant--award of honours for service centred in the military head ;and you do us a kindness in giving it prominence. To speakplainly, it is nothing short of a disgrace, it saps all loyalfeeling towards our departmental superiors, it stifles thegrowth of all professional culture and progress. But willnot unity, strength, and proper recognition of us as military-medical officers performing multiform duties carry also

proper and due authority and influence of our headamong the other heads of the army sections, and a

dominant (if not sole) influence in the internal economyof the department, including promotion as well as rewards?and will not division of our present work into professional and

ultra- professional, with outside men and officers to carry onthe latter, by so much deprive us of weight in the militarysphere, and equally reduce the influence of our head on thepoints mentioned ? The present blots are relics of thepast, of a time when our duties were more strictly pro-fessional than they now are. and when the head possessed a,

lessened importance; and it seems to some of us that ourpresent position without rank and the misplaced power overawards and promotion await the same solution--emancipa-tion from the unreasonable supremacy in our affairs of themilitary caste. I am, Sirs, yours truly,

April, 1887. ONE OF THEM.

We have much pleasure in inserting the above letterfrom a distinguished officer of the Medical Departmentthough we cannot quite agree with the writer on some ofthe points he advances.-ED. L.

THE LUNACY BILL, 1887.To the Editors of THE LANCET.

SIRS,—The new clause inserted on Feb. 22nd last into the’Lunacy Bill of the present year, at the instance of LordMonksweU, to the effect that "when any officer is trans-ferred from one county asylum to another his service in all’such asylums shall count for the purpose of computing thepension or superannuation allowance," is good so far as itgoes. But there are officers who have served a sufficientnumber of years to earn a pension whose service has notbeen confined alone to county asylums, who have trans-ferred their services from one of the county asylums to oneof the borough or metropolitan district asylums, or vice ve7-sd.Those gentlemen will naturally be of opinion that, in fair-ness, the operation of the clause in question ought to be-extended to them. It will not, I venture to say, be con-tended that the work in the borough or district asylums isless anxious, onerous, and responsible than it is in thecounty asylums, and, moreover, probably one effect of theexclusion of the officers serving in them from this pension.clause would be to deter the best men at present servingin the county asylums from offering themselves for such,appointments in future.

I am. Sirs. vour obedient servant.JAMES ADAM, M.D.

THE ERASMUS WILSON BEQUEST.To the Editors of THE LANCET.

SIRS,—I venture to think that the petitions which have.been lately presented to the Council of the Royal College ofSurgeons by persons desirous of the suppression of experi-ments on living animals place the question of the disposalof the funds which have accrued to the Royal College ofSurgeons in a new aspect. Before these expressions ofopinion by a section of the public, any disposition of thefunds of the Erasmus Wilson bequest was a matter ofinterest mainly to the body into whose hands they hadfallen, and in a secondary degree to the medical professionin general. The decision must now lie between the opinionsof the leaders of the profession, as expressed in the largely