666

the capital invested. Others have expressed a strongopinion that to interfere with dispensing would be to

reduce their practice, that their patients cannot afford to payseparately for advice and for medicine, that it is doubtfulwhether they could afford the time for separate visits to

the medical man and the druggist, that the possession ofa prescription might involve the employment of the samemedicine long after the conditions for which it had been

originally given had completely changed, and that a pre-scription given to one person for one disease might in courseof time be handed to another with ignorant good intent.

Broadly, then, the feeling appears to coincide with that

originally expressed in these columns-the conditions are not

yet ripe for such an innovation, the proposed change wouldpress too hardly upon the rank-and-file of the profession.In an ideal world each profession would keep rigidly tolines of demarcation and this principle would extend toevery branch of every profession. According to this idealconsultants would never be reproached with the wrongfulannexation of the patients of general practitioners. Phy-sicians would never operate, even upon tonsils or adenoids.

Surgeons would not prescribe, unless for the relief of

symptoms immediately following upon their operations.Obstetricians would occupy a well-defined position with nouncertainty as to whether they were physicians or surgeonsand they would never undertake the general care of a caseof infectious fever, even though it should arise in a child

whose entrance into the world they may have superintendedsome years earlier. General practitioners, accepting with

pleasure the cares and responsibilities assigned to them,would receive adequate remuneration to enable them

to live without struggling continually to meet necessary

expenses by the profits obtained from dispensing. Further,in this ideal world druggists would confine themselves to

dispensing and would never, even when asked to do so,

take the responsibility of prescribing or, shall we say, of

advising what drugs might be taken in certain circum-

stances. All these conditions might conceivably obtain inan ideal world and might satisfy the public if the condi-

tions were generally understood. Certainly every class

above mentioned would benefit from the limitations sug-

gested, since it is probable that greater concentration wouldlead to greater skill in every branch of work and clearlyin this at least the public would benefit. Bat while it

is pleasant to dream of Utopia it must be rememberedthat it is difficult to regulate human actions uponcounsels of perfection suggested by dreams, and it is scarcelypossible, when persuasion fails, to obtain consent to

arbitrary measures. In the matter of dispensing by medicalmen it is unwise to forget that the public must be con-sidered and that resentment might be aroused by suddenalterations of routine. The public may, perhaps, bydegrees be educated into acquiescence, thouoh publiceduation is proverbially slow and requires reasons rather

than regulations.Further, it must not be forgotten that the suggested rules

for the regulation of dispensing would have interfered byAct of Parliament with long-established custom and wouldhave touched the interests of a large class of medical menwho are already overburdened and oppressed by the necessityof heavy expenditure. This side of the question has appeared

in many of the letters which we have received and it is one

which cannot be ignored in any suggestions of change.While a cordial welcome should be extended to anymovement which would improve the status of the medical

profession as a whole, we are bound to look closelyinto any plan which would materially alter conditions ofwork. Many of our correspondents agree with our first

contention that the plan would facilitate and extend the

operations of the prescribing druggist. Sometimes it is urgedthat this is an imaginary evil, but the truth can readily be

gathered by the fact that an enormous number of privateformulae employed by druggists has recently been collectedand published by a contemporary to free them from the tax

imposed upon patent medicines. For these formulae to be

worth protecting against taxation necessarily implies that

they are frequently employed. Clearly they are not likely tobe prescribed by medical men ; if, therefore, they have-

any sale they can only be sold directly to the public by adruggist who assumes the responsibility of making a diagnosisor of treating a symptom without a diagnosis. Country prac.titioners have, unhappily, ample knowledge of the injury to’their practices and, more important still, of the numerous

risks which result from this unqualified treatment and weconsider that they are right in their contention that counter

prescribing should be rendered impossible before dispensingby medical men should be hampered by legislation. At

present any druggist can sell anything he likes with the

exception of scheduled poisons, and if a diarrhoea mixture

happens to be given to a patient with typhoid fever thedruggist is safe so long as he has not led the patient orhis frienda to believe that he possesses a medical qualifi-cation. This is the position of affairs which reformers,both within and without the ranks of the British Medical

Association, should keep before them as wanting effective

remedy.

The Study of Childhood.AT a time when a good deal of fermentation, real and

simulated, has been excited in the public mind with regardto education it is gratifying to see that the related questionsare receiving their due share of attention from the medical

profession. We have before us a lecture on " Some-

Elementary Aims in Education" by Mr. HAMILTON HALL,delivered under the auspices of the Childhood Society in

the library of the Sanitary Institute, and this will be

followed by three others, respectively by Professor W. A..

POTTS, Dr. D. SOMERVILLE, and Dr. H. R. JONES. It is

worthy of remark that the two last-named gentlemen arediplomates in Public Health so that their selection as

lecturers may be regarded as a recognition of the intimaterelation which must exist between the proper upbringingof a generation and the immunity from preventable diseasewhich it is likely to enjoy. The society to which we areindebted for the course is one of two which are, we believe,.of American origin and which apply themselves respectivelyto the consideration of the mental and of the physicaldevelopment of the young, subjects which must necessarilyt3nd to overlap one another, although they are sufficientlydistinct to be considered from different standpoints in manyrespects. The societies have hitherto chiefly appealed to

667

teachers and have striven to produce a somewhat more pr;

intelligent examination of the conditions and oppor- tunities of their calling than had previously been le

customary in their ranks. Endeavours have been made pe

systematically to investigate the mental operations of us

childhood and their relations to growth and physical well- im

being, as the only safe foundations of successful teaching, on

whether intellectual or moral, and as the necessary bases of in !

those habits of mind and body which it is the first object of if

a judicious parent or tutor to establish. There have from ex

time immemorial been a few teachers whose insight into theminds of the children under their care has been instinctive cc

and whose success has been proportionate to the resulting Si

harmony; and it has been among the chief objects of the of

Childhood Society to confer a similar insight as a result of 2careful training. In this work Mr. EARL BARNES has been

an eminent pioneer both in this country and in America, P

and there can be no doubt that a more intelligent m

appreciation of childhood has been among the conse- ti

quences of his teaching. So far, however, it may be e’

feared that the good results which he has obtained have

been chiefly confined to teachers of the elementary or b

kindergarten class and that little or nothing has been done d

to invalidate Dr. DUKES’S well-known statement that "the h

education of the youth of the upper and middle classes in ti

England is the only business for which a man is not c

trained." An evening paper has lately contained a series k

of dismal complaints concerning the prospects of young t

university graduates who become assistant masters in r

private schools, and it can hardly be said that any one of r

the numerous correspondents upon the question has betrayed Ithe slightest idea of the existence of any difference between 1

teaching and education, c

With the exceptions of ROGER ASCHAM’S ° ‘ Scholemaster " t

and of MILTON’S letter to Master SAMUEL HARTLIB, the first

attempt made in this country to lay down sound principles of veducation was that of the great philosopher, who was also a physician, JOHN LOCEE. LOCKE rightly maintained the 4

primary importance of care of the bodily health of the young,although he was somewhat too Spartan in his notions of the 1means by which the desired end was to be attained. The physiology of his day, moreover, if indeed physiology could be said to exist, was too much occupied with hypothesesabout animal and vital spirits, and such like, to have anyclear notions of the absolute dependence of mental activityupon the welfare of a single material organ-the brain, whileit is the daily increasing knowledge of brain structure andbrain function which invites the physicians of our own dayto carry on the work which LOCKE began, helping themto lay down principles by adherence to which the mens

sana in corpore sano is most certain to be secured. Mr.

HAMILTON HALL has kept this principle before his mind

and his lecture was a most instructive one. Our onlycriticism upon it is that his admonitions on the sub-

ject are possibly somewhat wanting in definiteness ; nor’

is there, perhaps, a sufficient recognition of the greatdifferences which of necessity exist between the results

which should be aimed at in the education of different

classes of the community and between the methods bywhich these may respectively be attained. It will be

conceded without difficulty by most of those who have any

ractical acquaintance with the subject that nine-tenths oftie teaching of ordinary elementary schools-teaching whicheads to progress from standard to standard and for which

ecuniary grants are paid by a confiding public-is utterly.seless to the enormous majority of those to whom it is

mparted; even without reference to the pertinent questionmce printed in an official report by one of His MAJESTY’Snspectors, "To what purpose in after life is a boy taughtf the intervention of a school vacation is to be a sufficient

:xcuse for entirely forgetting his instructions ? "The subjects of the three remaining lectures of the present.

course, which also will be delivered in the library of the

3anitary Institute (the first before these lines reach the eye)f the reader and the second and third on March 15th and

24th), are the Protection of Feeble-minded Children beforeand after School Age, Physiology in the Curricula of

Primary and Secondary Schools, and Child Punish-

ments. These subjects present many and obvious dis-

tinctively medical aspects. The teaching of physiology, in

elementary schools at least, is more likely to be suc-

cessful the more it avoids technicalities and is conducted

by example, while it is not incapable of being so con-

ducted as to do mischief. In America, for instance, it

has been largely perverted into a vehicle for the inculca-

tion of extreme teetotal doctrines, and the text-books in

common use are of such a kind that physiologists of sound

knowledge refuse to be concerned in communicating to’

the young the perversions of fact which they contain. As

regards Child Punishments every family practitioner musthave witnessed many examples of injudicious or excessive

punishment and some at least of flagrant injustice. It

has often been said that the average teacher is incapableof distinguishing the consequences of physical defects fromthose of idleness or stupidity, and that very few childrenwith defective sight or hearing escape punishment for faultswhich they are wholly unable to avoid. Apart from thismany parents have no reasoned convictions with regardeither to the uses of punishment or to the methods bywhich it should be inflicted, and Dr. JONES, by whomthe lecture upon this theme will be given, will render

good service to many hapless children if he will condense

the principles underlying the question into a form in whichthey may be made available by the family medical adviserwho may thus be helped to rescue his younger patients fromunmerited and oftentimes injurious suffering, as well as from

penalties such as written impositions and the like which

have certainly no tendency to the promotion either of mentaldevelopment or of a love of learning.

Annotations.

THE BRITISH MEDICAL ASSOCIATION ANDMEDICAL DEFENCE.

" Ne quid nimle."

AT a meeting of the council of the Medical Defence Unionheld at the offices on Feb. 18th the following motion wasunanimously passed :-That this council resolves to do all in its power to maintain the

integrity of the Medical Defence Union as at present existing.The motion was obviously passed by the council of theMedical Defence Union with an eye upon the proposed