The Testimony of Ireland. 179 Education is far from having so much influence on the propensity to crime as is generally supposed. Moreover, moral instruction is very often confounded with instruction in reading and writing alone, and which is most frequently an accessory instrument to crime. It is the same with poverty; several of the departments of France, considered to be the poorest are at the same time the most moral. Man is not driven to crime because he is poor, but more generally because of an inadequacy to supply the artificial wants he has created. 'Of 1129 murders committed in France during the space of four years, 446 have been in consequence of quarrels and contentions in taverns, which would tend to show the fatal influences of the use of strong drinks. Thus we pass from one year to another, with the sad perspective of seeing the same crimes reproduced in the same order. The causes we now want to ascertain, and as soon as we are acquainted with them, we shall determine their influence on society, just in the same way as we determine effects by their causes in physical science. I am, however, far from concluding that man can do nothing for man's amelioration. He possesses a moral power of modifying the laws and influences which affect him. Also, I cannot repeat too often, to all men who sincerely desire the well-being and honour of their kind—and who would blush to consider a few coins more or less paid to the treasury as equivalent to a few lives more or less sacrificed by the executioner-that there is a budget which we pay with a frightful regularity-it is that of prisons, chains, and the scaffold-it is that which, above all, we ought to endeavour to abate.' The facts and statistics already given, tend to illustrate the saying of the first Napoleon, that under whatever relation we view man, he is as much the result of his physical and moral atmosphere as of his own organization.' It is on this ground that we claim the support of the philanthropist and politician, since it appears evident from facts that we can only realize and perpetuate the blessings of education, of free institutions, and of sanitary laws, upon a foundation of temperance which shall exclude the proved causes of disease, degradation, and crime. The statistics of Ireland, as embodied in an able paper read in 1857 before the British Association at Dublin, by Mr. James Moncrieff Wilson, the actuary, strikingly confirm this view. The year 1851 is selected in preference to any other, because it furnishes the reliable census returns, and because it was a period not disturbed by those frightful causes of distress which operated from 1845 to 1850, when want became the almost compulsory cause of crime. Nevertheless, the Census Commissioners have remarked, to the honour of the nation, that while numbers, indeed, were sent to prison for petty crimes, often committed to save themselves or children from starvation, yet the slight amount of crime of a serious nature was remarkable.' They were, during that period, both by necessity and moral suasion, a temperate people. Strong drink was not so active in its usual work of depraving and exciting. Of crime, generally, the proportion perpetrated by males, as compared with females, is as 54 to 21, or above two-thirds of the whole the average of both is 7620 per cent. 1 criminal to 131 persons. We We summarize and class together the statistical elements of (1) Education, (2) Occupation, (3) House-Accommodation, (4) Drinkeries, (5) Drunkenness, and (6) Crime. The following are the clear deductions drawn by Mr. Wilson: 'I. That education combined with occupation tends powerfully towards the diminution of crime, more especially towards the decrease of offences against property, without violence. II. That low-class dwelling-house accommodation tends towards the increase of crime. III. That the sale of intoxicating liquor has perhaps as powerful an effect upon crime in increasing it, as education and occupation combined have in lessening it. "Thus Connaught is by far the worst-educated province in Ireland, with the largest unoccupied population, yet the tendency to crime is less than in any other province, except Ulster. This can only be accounted for by the considerations that in Connaught there are 42 drink-houses fewer to every 100,000 of the population than in any other province; and that the per-centage of committals for drunkenness does not amount in Connaught to one-half the like per-centage for the average of Ireland." + IV. That were intoxicating drinks less freely used, education, as a means of reducing crime, would become most powerful.' In conclusion, let us remember that no theory will avail to cure crime; but solely the removal of the great temptation: for man's social environment overrides all theories. As society creates a mass of crime by a special organization, so it can suppress it in great part by withdrawing its license. It needs only that a nation shall will it. The responsibility, therefore, rests solely with the people. There is no external power, no mysterious law, which places even the slightest impediment in the path of a reform more beneficent than society, by any other agency, has ever yet realized. The suppression of the traffic will be better than the gradual *It must be noted, that 44 per cent. of persons charged or held to bail are acquitted. The above represent convictions. Connaught, twice as ignorant, three times as dirty, and greatly more idle, is nevertheless less drunken, and scarcely more criminal, than Ulster; and much less criminal than the other two provinces. We add the important fact, that in Donegal and Tyrone (Ulster), there were from March, 1855, to December, 1856,-1131 cases of detection of illicit distillation, against 248 for Galway, Mayo, and Sligo (Connaught), showing the fallacy of supposing that decreased facility for the sale of drink promotes illicit manufacture. reform reform of our institutions,' for it will render half of them superfluous, and do more than all of them put together to reduce the oscillations of habit to their minimum, and to inaugurate those conditions which shall be adequate to the supply of our normal wants. ART. VII-UNION SURGEONS. The Grievances of the Poor Law Medical Officers. Nos. 2 and 3. By Richard Griffin, J.P., M.R.C.S., &c. Londou: Simpkin, Marshall, and Co. R EFORM is again a household word. That to which we now apply our pen derives its interest neither from politics nor party, but bases its appeal to the legislature on the simple grounds of justice. Medical reform, after repeated trials and disheartening failures, is now un fait accompli; the reform we advocate refers to a large section of the same profession. Were the existence of abuses alone necessary to obtain redress, the poor law medical officers of this kingdom would have an easy task, and require no aids from us; but although at various times occasional questions have been asked and stereotyped answers obtained in the houses of parliament, they have, as a body, remained without redress, and, we might almost add, without sympathy. The author of the pamphlets before us has most thoroughly identified himself with the cause of poor law medical reform. We do not wish to ignore the efforts of Mr. Lord and others who have attempted a solution of the difficulties, but they will, we are assured, award to Mr. Griffin the position which he has formed for himself. He is now the acknowledged head of an association, numbering almost half the existing medical staff; he has enlisted the sympathy of many members of the lower house; and has successfully pointed out to the Poor Law Board the importance of the subject. The result of his efforts has been the acknowledgment, by the late President, of the hardships endured, and the circulation of a scheme for relief among those interested in the matter. To this scheme of Mr. Estcourt's we shall presently advert; but from it we gather no unfavourable opinion of the ultimate issue. Some of our medical Vol. 2.-No. 6. friends may consider this of trivial importance; to us it appears a prelude to increased exertion and an earnest of success. Granted, that it requires modification-that it has in some details misunderstood the profession with which it proposed to deal-it still proves a desire on the part of the powers that be' to remedy grievances. From its courteous circulation amongst the class whom it proposes to affect; from the desire evinced for their opinions; from the unvaried urbanity displayed by the late President to the various deputations whom he has met, we can arrive at no other conclusion than that he is influenced by a sincere desire to serve a very ill-used class. In common with all who are interested in the cause of poor law medical reform, we regret the removal of Mr. Estcourt from office. The pamphlet opens with an address to the legislature; this embraces most of the controverted points, and proves that the grievances are not mere fictions of medical imagination. The pamphlet No. 2 was forwarded to every member of the houses of parliament. The new house will have its attention called to many matters of extreme importance, but few can surpass this in interest. On this point many pertinent remarks will be found in the early portion of the address, to which our space compels us to refer the reader. Observant spectators cannot fail to remark that governments do not place that value on life, especially of the bulk of population, which it deserves. Under some conditions it is esteemed beyond price. Ought it not to be more attended to in those who, compelled to labour hard, and frequently to live harder, are yet the classes from whom our fleets and armies are replenished, and to whom we commit the important trust of our national position? Health is their only heritage, a legacy of inestimable value, and the constitutional vigour and ability to withstand ex posure posure and disease depend on the treatment which that heritage receives. Hence, mere selfish motives, apart from higher principles, should induce every government to guard carefully the stainina of the matériel which is so essential. The welfare of four millions of the poorer portions of her majesty's subjects is bound up in this verdict. For sanitary measures in health, for medical treatment under disease, these millions depend on the services of more than three thousand members of the medical profession. Had these been meted out to invalided pauperism on a scale commensurate with the payment, the relief would have been, indeed, infinitesimal; but, as a body, greatly to their honour, no lack of duty can be laid to their charge. Among the disabled poor of this country, whether in the abodes of humble poverty or the haunts of infamy and vice-dens where the lifegiving air of heaven in its maiden purity cannot penetrate-where pestilential vapours, reeking with typhus and cholera, hold undisputed empire, greeting the visitor with their insidious and too-often fatal embrace-in abodes which defy the approaches of sanitary commissioners, or, if external measures are successful, internal arrangements proportionably neutralize the benefit, there plods, often with weary step and haggard eye, the 'parish doctor.' The picture is neither far-fetched nor imaginary; it is not the romance of fiction; it is well known and keenly felt by many a district officer in the metropolis, in large provincial towns, or in densely-populated parishes; it has been painfully felt by surviving widows and orphans, as the records of the Medical Benevolent College can, in its hitherto brief career, bear ample testimony. What recompense do these officers receive? and, as we write, we are sensible of the satire conveyed in the term. Listen, gentle reader, the fact we are about to state is not a mistake. The average payment, from 500 returns taken promiscuously, is two shillings and ninepence farthing per ease! This is the recompense for wear and tear of body and mind, for drugs and appliances-often for the additional requisite, a horse. This is the rate that local boards-sanctioned, be it remembered, by the Poor Law Board-offer for services which, whatever they might once have been, are now marked by skill and ability of no mean charac ter. We have stated that this is the average payment; it will perhaps be scarcely credited that, according to returns obtained by Lord Elcho, the rate in some districts is as low as twopence per case, while out of the 3,000 medical officers 79 receive under one shilling and 290 above this sum, but under two shillings! As if in contrast, the average duration of attendance is found to be 28 days, or under one penny a day at the higher rate of payment! No calculation is necessary to enable us to determine the profit at this average rate of payment, but we will allow an extract at page ix to reply:'A report on the beneficent institutions of the metropolis has lately been issued by the Statistical Society of London. From this work it will be seen that 232,878 patients were attended in the metropolitan dispensaries in one year at a cost of 28. 53d. per case.' And at page xix we find the cost of each patient at the South Stafford General Hospital (out-patients) 28. 113d.; Great Yarmouth Hospital, do., 38. 8d.; Reading Dispensary, do., 68. 5d.; Bury, do., 88. 44d.; Spalding, do., 78. 114d.; Leeds, do., 48. 5d. It is not our duty to determine whether the strictest economy is carried out in the several institutions mentioned. They are not singular. The list could be easily extended, but we have here sufficient to support our position. Generally, these institutions cannot afford any reckless expenditure, whilst, from using large quantities, they obtain their drugs at lessened cost; yet, with these important advantages, the average of metropolitan dispensaries nearly equals the average payment of a poor law medical officer; the former being solely the expense of drugs, while the latter is paid for time, skill, and drugs. Glancing at some of the provincial institutions, the sums mentioned as cost of drugs per case would be considered a princely payment by many union surgeons. Further, in unions, where the guardians provide the drugs, the cost has averaged one shilling and sixpence per case; yet, with these startling facts to guide them, boards of guardians still pay 63 surgeons, out of the 500 returns before mentioned, under this amount. We have heard of a pauper striking for an advance on sixpence, the payment offered for fetching medicines once, while the medical officer Replies of Guardians to Appeals. officer received far less for medicine, labour, and skill combined. Nor do we imagine this strange anomaly to be of rare occurrence. As some set-off to remuneration, so unworthy of the name, we might expect a lax state of discipline, and a very natural disinclination both of the guardians to complain of neglect, or of the Poor Law Board to countenance the charge. Here, however, we should be deeply mistaken, as Draconic severity is the order of the day. It may be urged, Why should the legislature be asked to remedy these grievances, when a special board exists whose pleasing office it might be to serve their staff? Mr. Griffin's own case, we presume, is not rare; he may possibly have been more importunate than some of his brethren. The result is chronicled at page vi. We quote from the pamphlet, merely premising that Mr. G. receives 18. 3d. per case. The replies of the Poor Law Board to these letters were as follows: "Oct. 2, 1855.-To inform you that the statements which it contains will meet with their consideration. "Nov. 22, 1855.-The guardians will, at the end of twelve months from the date of your appointment, give the subject of your salary their further consideration. Under these circumstances, and looking to the short period for which you have been medical officer of the Weymouth Union, the board must decline to interfere further in the matter. "March 10, 1856.-To inform you that the statement which it contains shall meet with their consideration. "Dec. 18, 1856.-To inform you that the subject to which it relates will receive their attention. "April 18, 1857.-To acknowledge the receipt of your letters of the 4th and 15th instant, in reference to the remuneration which you receive for your services as the medical officer of the Weymouth district of the Weymouth Union. "April 29, 1857.-To acknowledge the receipt of your letter in reference to the amount of your remuneration as the medical officer of the Weymouth district of the Weymouth Union. "Oct. 15, 1857.-With reference to the alleged inadequacy of the salary which you receive for your services, as the medical officer, the board can only refer you to the communications 183 which they have addressed to you on the subject. "Feb. 11, 1858.-The Board have considered the statements which you have submitted to them on this subject, but are of opinion that there are not sufficient grounds for their interference."' During the same period of time a colleague of Mr. Griffin's received 168. 3d. per case. We can hardly wonder at the somewhat natural warmth of feeling which characterizes Mr. G.'s remarks on this correspondence; and to those without the pale of official red-tapeism the matter appears somewhat incomprehensible. Nor does it tally with the strict carrying out of their oath to 'faithfully,' *impartially' (the italics are our own), and honestly execute,' &c., &c. Apart from this phase of the subject, it cannot be denied that there is a vein of irresistible humour in the letters quoted, worthy of our sister isle. We notice these results of Mr. Griffin's appeals, to prove that they are alike unsatisfactory and futile; and that the hope deferred' in similar cases may well render 'the heart sick,' and the duties of the office more distasteful. Again, it is supposed by some persons that considerable improvement has taken place in the salaries of poor law surgeons. Such an idea would be strengthened by the reply of the Right Hon. Mr. Bouverie in the lower house to Mr. Pigott:- The Poor Law Board had directed the guardians to take into consideration the salaries of the medical officers, and considerable increase was going on.' Again the italics are our own. To this, at p. vii., Mr. G. says: Take the corresponding augmentation of the population, and what is it? In 1848 our salaries averaged, on the entire amount of population, 3d. In 1855, when the last return was made, it was still the same. In 1853 the population of the unions was 17,797,763; salaries of medical officers 141,2221. In 1855 the population was 17,831,942; salaries 144,8557., a trifling increase of 2,0721., which, if divided amongst the 3,033 officers, what is it to boast of? But even against this there is the increase of population to the extent of 29,280.' The words are plausible enough, but on a nearer examination the considerable increase' turns out a very inconsiderable benefit! But from the returns before us let |