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refers; being least in the German States, and greatest in England and Wales.
Ratio of suicides by poison to those effected by
all other means in various countries.
This is the prompt and decided exercise of a power placed by the legislature in the hands of the suicide--but he also has a slow and insidious
soothing” system—though not a less certain or less extensive mode of destruction. The evil of opium-eating, or even opium-smoking, which various authorities have testified is a fast-increasing one in this country, is thus alluded to in a pamphlet recently published by Major-General Alexander, entitled the * Rise and Progress of British Opium Smuggling in China.' He says, after dwelling on our iniquity in this respect, “Nor let any one imagine that England is allowed to encourage crime with impunity.* Retribution is overtaking us, and the plague is spreading, especially among our working classes, and with the votaries of fashionable life. Besides the use of opium in other ways, I am informed by an eye-witness that miscreants, who probably learned the trade in China or India, have established smoking dens in London, at which victims are intoxicated cheaper than with gin."
* The modes of death in Bavaria were by “ drowning, hanging, shooting, cutting, and stabbing," excepting forty-six, which are not tabulated; of these, twenty-three are assigned to poison in this table. See ' Foreign Statistics, Blue Book,' 1855.
It cannot be denied that a very large amount of mortality arising from all the above sources, besides the “five or six hundred persons who are ascertained to die by poison every year in England” alone, t may at least, in some measure, be prevented by restrictions on the sale of poisons, such as exist in every other country.
Surely if one suicide by precipitation from the Monument of London caused that eminence and others to be covered with iron grating, it cannot be fair to grant so much indulgence to the suicide (as well as the murderer,) who chooses this less bold and therefore more tempting mode of death, I unless it
* How truly verified by our present frightful calamities in India ! The revenue derived by the Honorable East India Company from their traffic in opium with China was in the year 1856 estimated at upwards of £5,000,000. See ‘N. British Rev.,' Feb., 1857, p. 527.
t'Appendix to Third Annual Report of Reg.-Gen.,' p. 14. I See · Lisle du Suicide,' p. 100.
be argued, on the one hand, that so quiet and unobtrusive a method is not so offensive to the public, and therefore may be better tolerated, or that the large emolument arising from this extensive trade cannot be interfered with, and, on this account, its continuance may be justified here as well as in China. Any honest man would of course repudiate such motives; yet, can no better reason be adduced. It may be thought such facts as the above are foreign to our subject, but it must be confessed that all the evils that we have depicted and many others are directly or indirectly connected with the unrestrained trading in drugs, legalised by the Act of 1815; and inasmuch as the office of the physician is connected with this trading, and his sanction given to such a mode of practice, just in an equal proportion must be share the odium and bear the degradation attaching to it.
I have but glanced at a few of the many evil effects of the mode of practice pursued EXCLUSIVELY in England and Wales; the mode of remuneration is neither less varied nor less degrading in its results.
Although few would now contend for either, as adopted in all its purity by each of the three great innovators I have described, in their pristine state, -such as the superstitious practices of a corrupt church, the cure “par le fer ou le feu," or that by poly-pharmacy, so peculiar to this kingdom,-yet there are abundant traces of the effects of each of
these corruptions in the several divisions of the profession.
Numerous and ridiculous are the evasions and subterfuges that have gradually crept in, so as to modify and render each acceptable to the varied taste or means of the public, and at the same time remunerative to the practitioner.
Who can with justice defend, as a mode of remuneration for the ORDINARY medical attendant or family physician, the daily outstretched hand at the bedside of the sick or dying, for the one uniform* physician's fee? This characteristic fee in its purity and orthodoxy, is demanded by the “pure” physician of yesterday's creation as well as by the veteran of fifty years' experience, † alike from the widow or the orphan, the millionnaire or the mechanic, whether labouring under a formidable fatal disease or a trifling ailment.
Can this be tolerated as an ordinary mode of remuneration ? It cannot; and what then are the numerous devices and evasions to escape the evils of such a course resorted to both by the patient and his physician ? On the part of the patient who presumes to seek his aid as ordinary attendant, amongst a multitude of other contrivances, the late calling in-the protracted intervals between the
* See Commission of 1834 : Sir A. Carlisle, 5976.
+ “The etiquette of the profession compels him to place himself on a par with Sir James or Sir Benjamin as to fees.” See “ Hospital Physicians and Surgeons,” • Lancet," July 18, 1857.
visits—and the early dismissal—are made in some measure to compensate for the magnitude of “the fee."
Again, the frequent resort in minor ailments to the shops of every thoroughfare, whether kept by licensed or unlicensed practitioners, is another mode of avoiding the dreaded fee. On the part of the physician, “ friendly visits” interposed, or “gratis attendance proffered, are the least offensive manner of
escape from this unhappy dilemma.* Are not all these subterfuges at least as dangerous, if not certainly injurious, to the health of the patient, as to the moral tone of the physician, when the latter stands in the relation of ordinary medical attendant ? The same difficulties apply with equal force to the “pure” surgeon when placed in the same relative position; and what is the consequence? Why, that at least nine tenths of the public refuse the care of physician or surgeon as their ordinary attendant, and are therefore subjected, more or less, to the evils of the third great innovator on medicine.
The junior physician or surgeon who subscribes to this system, in spite of all the humiliating devices adopted, is thus excluded from active engagement in the practical duties of his profession as ordinary medical attendant. He generally commences his
* See • Medical Times and Gazette,' October 18, 1856: “Dr. Green's” experience on this subject. Also, October 25, 1857: that of the late Dr. Chambers and Sir James Eyre.