28 OVERCROWDING IN THE MEDICAL PROFESSION.

therapeutics ; but it is surely better to submit objectionsto the criticism of those most concerned than to send thembroadcast among the community at large.

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IN every profession there is a constantly recurring cryagainst overcrowding, and although it is sometimes assertedthat the Darwinian principle of the survival of the fittestmust tend towards ultimate improvement, this assertion lendsscant comfort to those who fear being crowded out. Fre-

quently, of course, the cry is scarcely justified, and means onlythat the high ambitious views of youth do not meet with theiranticipated early realisation. In the medical profession, how-ever, there are abundant signs that the cry does not arisefrom petulance, but that the conditions of competition arepressing severely in many quarters. The occasional irrita-

tion expressed against consultants by general practitioners,the more frequent complaints of the prescribing chemist,the ill-concealed feeling against specialists, orthodox andunorthodox, the friction between hospitals, provident dis-pensaries, and workhouse infirmaries, all afford evidence,not so much of petty jealousy, but of real distress, whichseeks the nearest scapegoat for the hardness of life.

Although there has been some decline in the number ofentries at the London medical schools, for many years pastthe numbers in .the medical profession have been inordi-nately increasing, and at the present time every announce-ment of even a small appointment is followed by a rush ofcandidates which sufficiently indicates the scarcity of

employment. Those who are already launched in town orcountry practice frequently confess in moments of candourthe difficulty they experience in making both ends meet;they have to take their place in society, they have to incurheavy expenses, and at the end of the year the outgoings aretoo often perilously near the income.The old question of the choice of a profession has re-

peatedly been answered merely in a negative form. In

lieu of advice, warnings are given against the selection ofany profession which is overstocked. In short, an anxious i,parent might well be distracted and disheartened to the ’,extent of regarding offspring as surplus population.SWIFT’S "modest proposal" for preventing the children of ’,the poor from being a burden to their parents or countrymight be summed up into a recommendation to feed them and then eat them ! In the medical profession the answerto the problem seems to be rather to starve them after theyare fully qualified. Regarding the question with becominggravity, the General Medical Council has arrived at a moreprudent solution so far as qualified men are concerned, andit has done so in a manner which might scarcely have beenrealised but for a few casual remarks. The end in view

was apparently only the general legitimate improvement ineducation; as science became more exacting it was thoughtthat practice was declining, and, with a proper considera-tion for clinical instruction, measures have been adoptedfor ensuring an increased amount of practical work. This,at least, appeared to be the intention, but, as we pointedout recently, the resolution is stultified by uncertainty,and resolves itself merely into an expression of opinionthat in future five years are to be passed from the

commencement of a student’s career to the time of

his qualification. Whatever is done with the fifth year,

there can be no doubt that the initial cost to the

student or parent will be largely increased, and in this

increased expenditure some members of the professioncomplacently anticipate an arrest of overcrowding.While there is a certain amount of worldly wisdom in this,it is impossible to feel that it is a wholly satisfying solution.Probably many will be deterred from competition bythe increased expense. The ranks of the professionwill be more restricted to those prepared to make

a large educational outlay, but there is no certaintythat the general scale of remuneration will undergo anyimprovement. After all there must always be a largenumber of poor in every town who require medical services.It cannot be anticipated that the most elaborate reorganisa-tion of medical charities will ever do away with the neces-

sity of humbler members of the profession who will ministerto their wants. If these are only to be supplied after fiveyears of expensive training, it would appear to involve a

very extravagant outlay for a very poor result.

Annotations.

THE PROVINCIAL COLLEGES AND THEUNIVERSITY OF LONDON.

.. Ne quid nimis."

IT could hardly have been expected that the provincialcolleges would accept the position in which they are placedby the "further revised scheme" of the University of Londonwithout a protest. It is clear that the basis of the schemeis to entirely change the constitution of the University infavour of the London teaching colleges, whilst the positionof the provincial colleges remains practically unaltered, andthis has formed one of our chief arguments against theattempt of the existing University to remodel its constitu-tion and change its work and duties so as to become atonce an Imperial Examining Board and a local TeachingUniversity for London. But if such a compromise is to beeffected, the London teaching colleges must necessarily havedue power and authority in the government of the newinstitution, or the new departure cannot take place. The

objections from the provincial standpoint are most ably andclearly set forth in a protesting letter to the Lord Presidentof the Council, which is being extensively signed by theauthorities of the provincial colleges and schools of medicine,and may be briefly stated as that-(1) The open characterof the examinations, and the impartiality of the syllabusesof the subjects of examination, will be destroyed ; and

(2) the provincial colleges will be without representation onthe Senate, the Boards of Studies, and the standing com-mittees for the appointment of examiners. These objec-tions are, to a great extent, true ; and the reasons whythey may be expected to act prejudicially to provincialstudents are put at length. In the last paragraph of theletter the petitioners say : It is in no spirit of oppositionto the creation of a Teaching University for London thatobjection is made to the schemes of the Royal Commissionand of the Senate. Objection is raised against the trans-formation of a national institution like the present Uni-versity of London, whose domicile is naturally in the

metropolis, into a local University, with merely theadditional power to grant degrees to outsiders." Yet ifthe proposals of the Royal Commission are to be carriedout by the Senate of the University, this is the onlyfeasible plan, and the Royal Commissioners very decidedlypoint out that the opposition of the provincial colleges

29

should not be allowed to exercise a controlling influenceover the scheme. " There will be no risk of any prac.tical injustice being done to candidates for degrees whocome from country colleges, or from no colleges at all.

Nothing will be taken from either class which it now

possesses, or has any right to claim. It is not reasonablethat country colleges should have a negative voice upon theenlargement of the present University for teaching purposes,especially concerning the metropolis." The Senate of the

University has, therefore, to ignore either the recommenda-tions of the Royal Commission or the objections of itsnumerous provincial supporters, who have formed heretoforethe main portion of its graduates, and the conflict can onlybe determined when the final scheme of the Senate is laidbefore Convocation for its acceptance.

MEDICAL AGENTS.

A CORRESPONDENT who thinks himself badly used by afirm of medical agents sends us a report of an action inwhich he was recently adjudged liable to pay a commissionupon a business transaction which he considered that hehad himself carried through without the assistance of a

business agent. The facts appear to have been that headvertised his practice for sale, and received, among otherreplies, one from a firm of medical transfer agents, whoenclosed their prospectus, setting out the terms uponwhich they would be prepared to undertake his negotia-tions. The vendor replied, furnishing particulars as to

his practice, under the impression apparently that his

correspondents were acting for an intending purchaser andwithout meaning to authorise them in any way to actfor him. The agents thereupon communicated with oneof their clients, who, in his turn, wrote direct to the vendorand eventually concluded an arrangement with him. Thevendor’s view was that the client was the agent’s prin-cipal and that to him they would have to look for theirremuneration, and accordingly, when asked to pay thestipulated commission, he declined to recognise any suchbargain as binding on himself. It would appear, however,that he had written what from this point of view was avery indiscreet letter, in which he said that if the intend-ing purchaser bought the practice " he supposed he wouldhave to pay them their usual commission." Apparently thisadmission weighed with the jury, who in the event gavethe plaintiffs a verdict for the full amount demanded. Thecase is one which illustrates the great importance in allbusiness matters of having a clear comprehension as to thefooting upon which the parties stand. It is easy to under-stand that in such a case as our correspondent brings to ournotice both parties were acting with perfect good faith,and, although we do not feel ourselves able to re-echo ourcorrespondent’s complaints, we sincerely sympathise withhim in the annoyance which he will naturally feel at

having drifted into what is, relatively to his own intentions,

Ia wholly false position. -

CALF LYMPH FOR PUBLIC VACCINATION.

DR. CAMERON and others have long urged the public useof calf lymph in public vaccination for those who prefer it.It is certainly wise in sanitary authorities to use everyavailable means for removing the objections or the pre-judice that hinder parents conferring on their children theimmense advantages of vaccination. We learn with muchsatisfaction that in some districts the "authority" " hassanctioned a system by which a regular supply of calflymph is sent to the public vaccinator on the day for publicvaccination. If we mistake not, this system has been forsome time in operation at Kensington. It has lately beenadopted by the guardians of Islington, on the suggestion ofMr. Rowntree, one of the public vaccinators. It is supplied

moist and in tubes at the expense of the authority. It issaid to "take" with almost unerring certainty. We com-mend the example of Kensington and Islington to othervaccination authorities. With ordinary care in the selectionof lymph, of children, and in the use of scrupulously cleanand disinfected instruments, few operations are safer or

simpler than vaccination with human lymph; but by allmeans let authorities vie with each other in meeting theviews of all reasonable people.

THE CAMBRIDGE MEDICAL GRADUATES’ CLUB.

THE annual dinner of this club was held at Limmer’sHotel on Friday, June 27th. The chair was occupied byDr. C. J. Hare. Among the members of the club who werepresent were Professor Humphry, Dr. W. H. Dickinson,Professor Latham, Dr. E. Liveing, and several other lead-ing Cambridge medical graduates in London and from theprovinces. The guests included Sir Geo. Stokes, Bart.,M. 13., the President of the Royal Society, and Mr. JonathanHutchinson, the President of the Royal College of Surgeonsof England. The club has greatly increased in numbers,and now has 261 members. Dr. J. K. Fowler, who has beenone of the honorary secretaries since its formation, hasresigned his post, and Dr. H. D. Rolleston has been selectedto fill his place. A unanimous vote of thanks was passedto Dr. Fowler for his unremitting devotion to the interestsof the club, to which its present prosperity is greatly due.

WOMEN AND HIGH CULTURE.

IT may reasonably be asked in the interests of the com.munity at large what will be the effect on women, and

through them on future generations, of the prolonged mentalstrain to which they are now-partly voluntarily, partlyowing to the suggestion and the inducements held out tothem by others-submitting themselves ? Will it hurt theirconstitutions ? Will it make them a bag of bones, and bodyand mind alike hard and angular? Will it render themless prolific, or make them the mothers of a feeble anddegenerate race, prone to epilepsy and insanity ? Will it,by engendering a feeling of independence, render themless lovable, less disposed to enter the married state, or,being married, make them careless of home ties, the

nursing and teaching of infants, and the proper householdduties which devolve on a woman under the conditions ofmodern civilisation ? Or will it act in a contrary way ?Will the mathematical or the classical lady scholar, de-corated with medals and rich with prizes and exhibitionsand scholarships, still be open to the assaults of love ? Willher wider knowledge foster domestic happiness ? Will the

children, even if fewer, be better developed, more intellectual,better fitted as they grow up to cope with the other greatnations in the conflict for wealth and power and all that thesecommand ? Will she still be as the sweet gentle mother is now,the very focus and centre of the house ? These and manysimilar questions must have passed through the minds of mostthoughtful persons in contemplating the present tendenciesof female education. From a physiological point of viewsomething may be said on both sides. Given a robust and

healthy woman of seventeen or eighteen years of age, therecan be no harm in continuing her education till she is oneor two and twenty; at the same time the objects andmethods of her education might well be different from thoseof men. Female Bentleys and Porsons, Newtons and

Herschels, will certainly not be numerous, and if signs ofsuch commanding genius displays itself, by all means let itbe cultivated to the utmost. But every girl might be sotaught that her mind, instead of being devoted to frivolousobjects, should be educated in the true sense of the term,and made to recognise the importance of early training andthe value of application to useful objects in order that she