MEDICAL RELIEF.

HC Deb 16 March 1848 vol 97 cc632-91

LORD ASHLEY

rose to move the resolutions of which he had given notice, founded on the evidence taken before the Medical Relief Committee in 1844. It would be his earnest endeavour to economise the time of the House, and spare the necessity of any repetition in the argument. Looking on the evidence as extremely dry, though very important, he thought the best course was, after a few preliminary observations, to take the resolutions in detail. They were founded on the evidence taken in 1844 by the Committee of which he had moved the appointment, in consequence of a very strong feeling which was manifested that some remedy Ought to be applied to the state of things as regarded the administration of relief to the sick. The Government acquiesced, and the result was a ponderous volume of evidence. The Committee did not report till the close of the Session of 1844. It was impossible, therefore, to do anything that Session. In 1845, the pres sure of business was so great that he was unable to give the evidence due consideration. During the Sessions of 1846 and 1847 he had not the honour of a seat in that House. He did not think it necessary to make reference to the state of things prior to 1844. Great improvements had been introduced into the system of medical relief. But still very great abuses remained. He should carefully abstain from considering the poor-law at large, and confine himself to the administration of medical relief, and more particularly of medical relief to those parties to whom the first resolution referred. He might be met by the statement that the administration of medical relief was altogether beyond the scope of the poor-law, which ought to be entirely confined to food and shelter. But the Legislature had practically affirmed the principle that medical relief should be administered; and from that principle they could not now depart. If medical relief was to be administered at all, it ought to be efficient. He should assume, also, that the right hon. Gentleman (Mr. C. Buller) was well acquainted with the evidence which had been nearly four years before the House, and which, though voluminous, was not very various. Though hon. Members might not have studied the subject minutely, they could scarcely have failed to form an opinion as to the necessity of improvement in the system. Whether the remedy now proposed was the true one was another question. But there was a general feeling throughout the country that the present system of medical relief was on the worst possible footing. He had placed the most important resolution in the forefront of the battle. The others, however valuable as subsidiary resolutions, would be useless by themselves. The first resolution he had to propose was— That every woman claiming medical assistance from the parish in consequence of being pregnant, shall be entitled, in all cases, to the aid of the medical officer with her first child, and also with the second or others which may follow, provided she present a certificate from the medical officer who attended her in her previous confinement, stating that circumstances had occurred in it out of the ordinary and natural course of events which rendered it desirable that she should have medical attendance on the next occasion of delivery. The boards of guardians, in giving orders, did not act with the care and judgment required, in reference to the necessity of making proper provisions for first cases of delivery. Most frequently a refusal of me- dical relief occurred in reference to a first case, though such cases especially required the interposition and assistance of a medical attendant. What he demanded was, that every woman claiming medical assistance, should be entitled to make that claim without receiving an order from the board of guardians or relieving officer. The applicants were exposed first to refusal, then to delay. In the matter of delay the whole evidence went to show that such delay was frequently studied and intentional, in the hope that the woman might be driven from her application, and, as often happened, that delivery would take place in the mean time, and that then her case would resolve Itself into one not for a special order on the medical man, or for extra allowances or comforts, but a case to be treated as an ordinary case of sickness. Mr. Barnett, surgeon of the Stepney union, stated that— Cases have occurred of mischief from delay, by the difficulties thrown in the way of obtaining orders of the board of guardians. I recollect one whore, in consequence of this delay, the labour was so protracted, that terrible results took place, and the woman died. She told mo, that the difficulty thrown in the way of getting an order was such, that if the woman applies, they will not grant it; it must be the husband, who is probably at work. In this case her husband could not go. An ignorant midwife was called in, who, in fact, killed her. The guardians insisted on the attendance of the husband, who could not give it, except at the loss of a day's work. In this case delay was interposed. The woman could wait no longer. She called in a neighbouring midwife, who treated her so unskilfully and brutally that she died. There were other cases in which boards of guardians and relieving officers took upon them to decide whether a woman should be attended at all by a medical man, or by some midwife, though the matter was such as boards of guardians and relieving officers were not qualified to determine. What he had said was confirmed by the testimony of several other learned men—by Mr. Prankerd, surgeon, of Lang-port, and by Mr. Bellamy, of the same place, who added that the giving of orders would be delayed till delivery should take place. That the after-treatment is frequently the most necessary and important. He has applied for payment, and been refused, because he did not deliver the child. What was the consequence? In many cases the after-treatment was more important than the treatment at delivery; and at that time questions in regard to nutriment and the like had to be determined, which required the superintending care and skilful knowledge of a medical attendant. The consequence of such delay was, that, in a great number of instances, women were compelled to send for ignorant persons, who performed the duties required in so rude, coarse, and almost brutal a manner, that, in some instances, mutilation and permanent injury had been the result. He regretted exceedingly that he should have to make such a statement. He had much rather the matter had been adjusted otherwise. But he must enter into details for the purpose of showing the absolute necessity of making the provision he now proposed to make for such cases. [Mr. C. BULLER: There was an order which would meet the object.] The right hon. Gentleman said that an order would meet the object of the resolution. Those resolutions, however, were not proposed in behalf of persons actually receiving relief, but in behalf of persons who were in a destitute condition, requiring relief. The order did not apply unless to parties who were actually on the list of paupers.

MR. C. BULLER

thought it would, perhaps, save the time of the House if he stated what was the nature of the order. It was an order for giving medical relief to any woman in the workhouse or on the pauper list, or whom the guardians might subsequently determine to have claims from her destitute condition. His interpretation and decision on that order would be, that in any case where the board of guardians held the case of a woman to be one in which she could not be delivered without parochial relief, they might treat it as a pauper case.

LORD ASHLEY

continued: If the medical man attended without an order from the guardians he would not be remunerated; if the guardians decided that the woman was not in such a situation as to require assistance, the medical man would not be remunerated. When the husband was in receipt of 6s. or 7s. per week, the woman would not be entitled to assistance. The protection which was sought for the ratepayer must be obtained in some other way. But it was the refusal and delay to which those women were exposed, that drove them in so many instances to seek the aid of incompetent midwives. Mr. Byles, surgeon, of Whitechapel, stated that "he had seen cases in which the lives both of mother and child had been lost by employing ignorant women as midwifes." He mentioned a case of hæmorrhage in which the midwife, in alarm, left the patient, who died. He described how, in another case, there was the presentation of an arm; the midwife was very unskilful, and endeavoured to turn the child; she twisted the foot over the shoulder and was for many hours pulling at the foot without making any advance towards delivery. The surgeon who made the statement was called in, and had to perform an operation which lasted no less than three hours. He added, that had he been called in at first the difficulty might have been obviated by the application of the most ordinary means. In the appendix, p. 920, there appeared a letter from Mr. Barnett, surgeon of the Stepney union, in which he stated three cases where women. On refusal of medical relief, resorted to the services of unskilful midwives. The first was a very severe case of hæmorrhage. He did not know whether he ought to read the evidence to the House; and yet he did not know how he could prove his case unless he did so. ["No, no!"] He was entirely in the hands of the House; but he put it to the Gentlemen who heard him to consider that by withholding evidence which he believed to be irresistible and overwhelming, his statement might not otherwise be sufficient to carry the sense of the House with him. He admitted that the details were thoroughly disgusting and minute, and all he should say, therefore, was, that in consequence of the delay in giving the order which ought to have been given for medical attendance to certain miserable women, they resorted to unskilful practitioners, and, after having been mutilated and almost cut to pieces, one survived and two died under their hands. Another case was detailed in the evidence given in 1844, upon the authority of the President of the College of Surgeons, where there was not only great delay in giving the order, but other circumstances of cruelty, in consequence of the refusal of 2s. 6d. to provide a suitable room during the delivery. As he saw the House was very much averse to hear the minute and disgusting details connected with these cases, he certainly should not so much offend their feelings and good taste as to impose upon them evidence which he knew must be painful for them to hear. But he must make this appeal to them, that if, in deference to the House, he withheld the evidence, he hoped and trusted that that would not be allowed to count against him when the House came to divide upon his resolution. He did not mean to say that midwives might not be used with advantage in a great number of cases; but certainly in no one instance of a first case of childbirth. In second and third cases, &c., they might be used, and beneficially; but in all such cases midwives should be used only under the supervision and control of a medical man, and should never be allowed to act without his sanction and responsibility. This was the full extent of the resolution he proposed. The first objection that would be made to his proposal was, that it would open a door to fraud—that a great number of persons not entitled to relief would make application for the assistance of a medical practitioner. He did not deny that to a certain degree a door would be opened to fraud; but, on the other hand, it would close the door against the repetition of the cruel and disgusting cases to which he had referred. He did not believe, however, that fraud would be very generally practised; but, if it were, the House had the remedy in their own hands. If the third resolution which he intended to propose was adopted, it would be necessary to have an Act of Parliament to carry it into effect; and in that Act a clause could easily be inserted, giving the boards of guardians a power of recovery, by attaching the Wages of those who had obtained relief to which they were not entitled. The second objection would be that the proposal, if adopted, would encourage immorality, because it made no distinction between married and unmarried women. This objection comprised two considerations: first, was it probable that immorality would be encouraged by the arrangement he proposed?—and, second, if it were probable, was that a time or mode in which society ought to inflict punishment? Could anybody believe that either directly or indirectly immorality would be encouraged by giving assistance on such occasions?—that a woman would actually enter on a course of guilt and immorality, merely because she knew that in the hour of her delivery she would have the benefit of a union surgeon? If any one entertained this opinion, he must go further for the repression of immorality, and must, by Act of Parliament, declare that no woman who had been guilty of this offence should either for herself or child receive parochial assistance. For surely immorality would be much more encouraged by the pros- pect of after-relief than by the mere prospect of receiving the assistance of a medical practitioner in the hour of her delivery. To show how cruelly the present arrangement operates, especially upon young women, married as well as unmarried, he would take a case which had occurred only a few weeks ago. At present it was expected that young women, many of them not more than sixteen or seventeen, should go to the relieving officer or the board of guardians, state the condition they were in, and demand an order for relief in the hour of their confinement. Now, he found upon inquiry that even married women had a great repugnance to go to the relieving officer, still more to go to the board of guardians, and the consequence was that in many instances through mere modesty they delayed going till the last moment. The following was the case to which he referred:— A few weeks ago a poor girl of seventeen, being with child irregularly, could not apply by her companion in guilt for an order on the doctor for her labour, neither had she the courage to face a hoard of guardians. She remained in her corner until her hour of trial came; she then begged assistance from an old woman, who was unable to give it properly. She was at last delivered, but so injured and torn from ignorance as to be unfit hereafter for the duties of a wife or mother. If she could have gone to the doctor and stated her case to him as a friend of the poor, the person to stand between her and the guardians, this would not have happened. If he really thought that his proposal would encourage immorality, he would certainly pause before he made it; but he would warn the House to take care that, in getting rid of one immorality, they did not introduce another of a more heinous character. There was no doubt that the necessary exposure thrown upon young women under the present system frequently led to infanticide; and he believed, that if they really wished to rebuke that crime, which was becoming so rife, one subsidiary moans must be to enable women to make application to the medical officer of the parish, who in most instances was regarded as the adviser, the friend, and patron of the poor. These were the grounds upon which he proposed to the House the first resolution. He had abstained from giving the evidence upon which it was founded in detail; but he felt quite sure that, if the House had listened to what he had said, they must feel that it was absolutely and essentially necessary to depart from the strict rule which existed at pre- sent. He begged, therefore, to move the first resolution.

MR. C. BULLER

felt not a little embarrassed by the course taken by the noble Lord in placing upon the table of the House a notice of a variety of resolutions impugning the present mode of medical relief, and suggesting a large and material alteration therein—an alteration applying to the whole system and principle upon which medical relief was administered under the poor-law at the present moment, and in now coufining himself to one particular resolution. He felt the more aggrieved by that course because, on looking through the resolutions proposed by the noble Lord, stated to have been founded upon the evidence taken in 1844, he found the noble Lord had proposed those resolutions without taking any notice of what had been done by the Poor Law Commissioners in the interim. The consequence was, that it would appear from the resolutions before the House, that it was necessary to rectify certain deficiencies and abuses which he would undertake to show had been long ago much more efficiently rectified by the Poor Law Commissioners than they would be by the course proposed by the noble Lord. It was with great pain that he opposed the noble Lord on the present occasion. He felt the difficulty, in any case affecting humanity and the interests of the poor, of opposing the noble Lord, who was justly regarded as one of their best and most zealous friends. He remembered too, that on one memorable occasion he had had the honour of supporting the noble Lord against what was conceived to be sounder views of political economy; and of vindicating with him the right of the working classes to protection from the law, thereby conciliating the feelings of that class by an act of justice and wise humanity, and doing much to secure their cordial co-operation. On another occasion, when he had felt it necessary to submit a Motion to the House affecting the great mass of the labouring community, he had had the honour to be seconded by the noble Lord. He assured the noble Lord that the subject which he now submitted to the House had occupied his painful and frequent, he might say his constant, attention, since he had had the honour of holding his present office. It appeared to him, that both in principle and detail it was at the same time one of the most anomalous and important, and one of the most difficult, connected with the administration of the poor-law. Indeed, he might say, without hesitation, that it was by far the most difficult. He should be exceedingly happy if the result of his consideration of the subject should be to enable him to fix upon any of the many plans which had been proposed to him for putting the administration of this part of the poor-law upon an entirely new and satisfactory footing; for he could not deny that there was much of the present system for the medical relief of the poor which appeared unsatisfactory as well to his own feelings of humanity as to the general feelings of humanity of an enlightened and civilised community. He did not attempt to disguise that he wished he could consistently with his duty propound or support any new plan of medical relief for the poor through the agency of the poor-law, which would appear to him calculated to place that branch of its administration upon a more satisfactory footing; but he must fairly say, that with all the consideration which he had been able to give the subject, it was impossible through the poor-law to give relief upon any general system more satisfactory than the present. His deliberate opinion was, that if they wished a larger and more complete system of medical relief for the poor, it was not possible to administer it through local agency or by a change upon local funds, but that they must devise some system of central administration, and give from the funds of the country a system of medical relief adequate to their ideas. He did not deny at all that there might not be great improvement made in the present system of medical relief as administered through the poor-law. He was perfectly willing to consider that subject. Many of the suggestions which had been made to him appeared to deserve great consideration; and he assured the House that they should have his best consideration. But he confessed that it seemed to him that his object, and the object of the House, should be to improve the details of the present system of administering medical relief through the agency of the poor-law, rather than to change the general system itself. When he looked back to what had been the effect of the poor-law in regard to medical relief, he thought he might fairly challenge the most hostile inquiry into the subject. He was sure he might appeal to the candid opinion of all who had been cognisant of the state of the poor for years, when he said that there had been no more marked improvement, with respect to the administration of relief to the poor, than with respect to medical relief. He thought, indeed, that he might fairly challenge a comparison between the effects of the old and the new poor-law upon the industrious and meritorious poor, in all matters. It appeared in their houses, in their clothing, in their attendance, and in their dietary. He appealed with confidence to the House whether, in all these respects, the new law was not vastly superior to anything ever seen under the old poor-law? This had been done, too, with a saving to the ratepayers. He thought it was a fortunate thing that they had been able to combine that economy which was necessary to the burden bearing of the ratepayers with such a great improvement in the moral condition of the poor. But with respect to the medical relief of the poor, he would go still further. It had been found that the actual expenditure for the medical relief of the poor had of late years been constantly increasing. Now, the increase of medical relief to the poor—however it might indirectly tend to it—was undoubtedly not in itself an increase of any bad kind of pauperism; and they might, therefore, appeal to the fact that this expenditure had been constantly augmenting, as a proof that the economy with which the poor-law was now administered had never shown itself at the expense of the suffering sick. The sum expended annually in medical relief under the poor-law could not be ascertained from any return; but many Gentlemen were old enough to recollect the old system of parochial relief; how precarious and rare a thing it was; that it was by no means uncommon for a doctor to be appointed to attend to the whole parish for 5l. a year; and that he did this without any superintendence, there being generally no one but a negligent overseer to look after him. Lot the House compare this with the administration of medical relief at the present moment, when in every district they found a sufficient number of medical men to look after the poor, under the vigilant superintendence of the boards of guardians, and under the vigilant superintendence of public opinion, which was brought to bear upon the administration of the poor-law. The subject of medical relief had been brought before Committees of that House on two occasions; the first in 1838, and the last in 1844. He begged to call the attention of the House to the increases which had taken place in the actual amount of money expended in medical relief from 1838 to 1846 inclusive, consisting chiefly of salaries of medical officers. In 1838 the estimated population of England and Wales was 15,155,000; the amount expended in medical relief was 136,775l. In 1846 the population was 16,851,000; the amount expended in medical relief was 175,190l. The result was that between 1838 and 1846—making an allowance for the increase of population—the increase of expenditure should have been from 136,775l. to 152,080l. It had, in fact, increased to 175,190l., being 23,110l. above the old vote, which was an increase of about one-sixth above the old rate of payment. But this important result he should wish to impress on the attention of the House—that the increase of payment for medical relief between 1838 and 1846 had been one-sixth of the old rate of payments. Nor was that the only increase that had been made in the relief of the sick poor under the administration of the new poor-law. He saw some hon. Gentlemen in various parts of the House who—he hoped he might say it without offence—were old enough to recollect the working of the old poor-law system, and who might have been applied to as justices of the peace to give orders under that system. Those hon. Gentlemen would recollect that to give any extra amount of nourishment under that system was a thing almost practically impossible; the system of extra nourishment had almost entirely arisen under the new poor-law. He had no materials to enable him to state what the amount of that extra nourishment had been; but he had selected a few days ago from the report of the Committee in 1844 the following particulars. He found that in one union, that of Stepney, 646l. had been spent in one year for that purpose; and Sir J. Walsham, in his evidence, said that he had attended an Essex union in the preceding week, and that no less than 108 orders, mostly for 2lb. of meat each, had been made out for extra nourishment. He did not, however, mean to say that there did not exist great room for improvement under the present law. He would confess, that great as had been the increase that had been made to the salaries of the medical officers, he thought that some further increase ought to be made. In many districts he thought their salaries were insufficient. But let the House not understand him to say that he thought that generally the salaries were insufficient. In many districts he thought they were exceedingly large, or quite sufficient. In the most prosperous, but not the best managed counties of England, they were large. Sir J. Walsham, before the Committee in 1844, said that in Norfolk and Suffolk they were large; while in Northumberland and Cumberland the amount was very much smaller; but if the payment in Northumberland and Cumberland was very much less, nearly one-half in proportion to the whole population of Norfolk and Suffolk, it was double or treble in proportion to the number of paupers. The worst system of medical relief was given in those counties in which the general administration of relief was the most satisfactory, in which the poor-rates had never swelled the extent of pauperism, and the condition of the people was incomparably superior to that of other districts. If they compared the counties of Northumberland, Durham, Cumberland, Westmoreland, and Cornwall, which were about the least populated districts in England, with others, they would find that those were counties in which the most inadequate provision was made for medical relief, simply because the people in those old counties were the least accustomed to give it, from the feeling which induced them to reject increasing pauperism; and so long as they worked the poor-law through boards of guardians, so long would they find it difficult to make those counties as liberal in medical relief as in those districts where the sick poor were of old accustomed to be charged upon the poor-rates. At the same time, he must beg the House to observe the great difficulty there was in laying down a general system as to the salaries of medical officers. He should be sorry to see the House adopting any general system, because his own conviction was, that that was a matter which must be left free to try in various districts a system the most suited to the feelings of those who had to administer the poor-law, and that if they attempted to administer it according to one invariable system, which should be forced upon those districts, it would not be administered the best. His own opinion was, that as a general rule throughout England, the safest course was to remunerate medical men by salaries; but it was by no means that which would be most satisfactory. On the contrary, he feared the most satisfactory relief that was administered in England, was administered on a different system from that of salaries. In the first place, there was a system of a fixed amount being paid to the medical men, allowing them also to carry on private practice with their salaried practice from the union. But there were many cases in which no private practice was allowed. In Nottingham and Leighton Buzzard unions, where the medical relief was well administered, the system had been to have medical officers with a fixed salary, which was found sufficient to obtain the best medical men, and for which they gave up their private practice, and devoted their whole time to administering medical relief to the poor. He believed that at Nottingham the salary was 120l. a year, with board and lodging. In Wayland union, which he believed worked about as well as any system in England, there was a mixed plan of payment, partly by salary and partly by case. And now he must advert to a plan entirely different, and upon which he had received more private suggestions than upon any other since he had been in office. It was a plan which the hon. Member for Fins-bury, in conversation with him, had been kind enough to say was one which he thought might be satisfactory; and it had been acted upon under the auspices of Lord Stradbroke in Blything union. By that plan there was no medical officer at all. The union determined beforehand what was the amount they ought to spend in medical relief; they allowed the medical officers to attend without any order, and at the end of the year they divided the sum amongst all the cases attended; and that was the remuneration of those officers. In proposing this to persons conversant with the working of the law, they told him that no system was so liable to abuse; but it worked well in Blything and other places, and he believed that if they could get an energetic chairman of an union, such a plan as that would work better under his auspices than one that was more faultless. But he should be extremely loath upon any opinion of his own or the opinion of the House, at any particular moment, to force upon the boards of guardians throughout the country an observance to any uniform practice contrary to that which they had adopted. The great object in those cases was to secure the payment of adequate salaries; and he thought he had shown that a great deal had been done in that respect by the late Commission. He looked to the maintenance of the character of public servants as one of the main securities for the efficient discharge of the public service, and he thought it was absolutely necessary that medical officers should receive a more adequate remuneration for their labour. It would be his endeavour, as much as was in his power, to secure them that in every individual instance. Undoubtedly the duty was imposed upon them by the Parliamentary grant of the 70,000l. a year for medical relief; and he trusted that, by the judicious application of that grant, they might be enabled to insure an adequate remuneration to medical officers throughout England. He confessed that there was one part of the present medical arrangements about which he had a little doubt. It had been adopted with the assent of the medical profession, and yet he had heard many complaints from the profession against it—and that was the system of fees for certain operations. He saw, on the one hand, that it was liable to great abuse; but, on the other, there were many recommendations in its favour. The other day he had received a statement that the Totness board of guardians had come to a resolution that they should not allow any such extra fees. He did not say that he had ordered that resolution to be set aside as illegal; but he had directed an inquiry to be made; and if the inquiry were satisfactory, he should not hesitate to adopt their recommendation. There was one other point of far graver importance in the present system, and which he did not think was satisfactory, and that was, the present mode of supplying the poor with medicine. He thought the system of throwing the charge of drugs upon the medical man was liable to great abuse; but he must confess that his power to remedy the abuse was very inadequate with the power of perceiving it. He thought that, in the process of time, they might be able to organise some better mode of dispensing the drugs. He could not see, however, how it could be done without the cordial co-operation of the residents of the district. If they could get private charity to aid them, not with money, but in dispensing medicine, he thought a great improvement might be made; and that was a subject to which he should give his particular attention. He had no plan, he could have no plan, which he would attempt to force upon unions; but, if he could induce the intelligent men who served as poor-law inspectors to give their aid to the clergy and gentry of the country, with the boards of guardians, to establish some better plan of dispensing drugs, he believed that he should have done a great service to the poor of this country—and he must here beg pardon for stating his opinions in their present crude and doubtful form. He was stating them as they passed through his mind. But it was a matter of great difficulty to form a sound opinion upon, requiring the experience of as many years as he had been months in office, and he was almost ashamed to propound any opinion upon it at present. He would, however, throw himself on the indulgence of the House, and he would assure them that if he had advanced any crude or unsound opinions, his docility should be exemplary. He thought that in some cases evil arose from an undue fettering of medical officers in supplying relief, although he confessed that he thought a great part of the complaints on this subject arose with reference to cases which existed under the old system prevalent in the first years of the new law. His own opinion was, that these were matters in which the relieving officer should have very little power of discretion. For the relieving officer to elevate himself into a judge, and to decide the question as to whether a person alleging himself to be sick was so or not, was a matter which he was totally incompetent to pronounce any opinion upon. The only question for the relieving officer to determine was, whether the applicant was a pauper or no pauper; and he must say that, generally, he should hold it to be the best administration of the poor-law if the medical officers were entrusted with the discretion, on their own responsibility, of attending such sick poor as applied to them for relief, subject to the approval or non-approval of the next board of guardians; and that the board of guardians, and not the relieving officer, should decide the question of pauper or no pauper. He thought, however, that the danger was on the other side, for, looking to the ordinary principle of human nature, it struck him that more diligence must be exercised to prevent a man from not attending those for which he got nothing, than to prevent another from refusing charity which cost him nothing. But that was exactly the case under the present system of the poor-law, because, by the general consent of the medical profession, boards of guardians throughout the country had agreed to adopt the salaried system; and medical men were paid the same salary, whatever was the number of cases they attended; and there was a condition to supply drugs in all those cases. He found the other day, by a return in the Poor Law Office, that out of 568 unions in England, in 551 the medical officers were paid by salary, and by cases in only 17. It was quite clear that in all instances in which the medical officers were paid by fixed salaries, there was no inducement, on the one hand, to make work for themselves by attending patients they ought not to attend; and, on the other hand, that the relieving officer could have no inducement to prevent their attending on those cases, because it cost him nothing. It seemed to him that the danger was all on the other side—of the salaried officers not being kept sufficiently alive to their duty, having no sufficient inducement to attend to it; and during his short experience in his office of the ordinary practice of poor-law relief, he had had no complaint made of a relieving officer refusingg to allow the medical officer to attend; but he had had complaints from boards of guardians against medical officers for not attending when they ought. He knew there had been cases of complaints, when there were certain fees for operations or midwifery cases, that the medical men were not allowed to attend; but in all the cases that had come before him, it had not been the boards of guardians or the relieving officers that had been in fault. There were cases which had lately occupied the attention of the public; but he would rather not advert to them unless they were brought more particularly before the House. He could not, however, but say that that was the real difficulty; and he should thank the noble Lord if he would help him to devise some plan by which, if medical officers were paid by fixed salaries, they could be kept up to a faithful and zealous discharge of their duty. Having said thus much on the general subject, he wished to make a few remarks on the resolutions of the noble Lord. He thought he might reiterate his complaint, that the noble Lord had made rather an unfair impression as to the working of the new poor-law, by bringing forward as existing evils those which had been already rectified. He would take, for instance, the 5th resolution— That no medical person be appointed surgeon or medical officer to a union unless he possess a diploma in surgery, and a degree, diploma, or license in physic, from one or other of the Universities or Colleges of Physicians or Surgeons, or Societies of Apothecaries of the United Empire, legally entitled to grant respectively such licenses, diplomas, or degree; and that if, under any circumstances, it should be found necessary to employ unqualified persons, such unqualified persons must have a special permission granted by the Poor Law Commissioners, under their handwriting, with the reasons for such permission annexed. All such permissions to be annually laid before Parliament at the commencement of the Session. He should like to know what there was in that that had not already been provided for by the articles 168 and 169 of the Consolidated Orders? There was in the article 168 a long specification of the persons who were qualified to act as medical officers; and he believed the only difference between those orders and the noble Lord's resolution was, that, whilst the legal advisers of the Poor Law Commissioners had drawn their order legally, the resolution of the noble Lord was contrary to law; for the noble Lord would leave it open to certain practitioners of Scotland and Ireland to be the medical officers of unions, whilst they were not by law entitled to practise in this country. That was a subject upon which he was in the habit of receiving letters almost daily, complaining of the ill-treatment of Scotch and Irish practitioners under the present law; but he thought they had done all they could under the present law to secure properly qualified men. There were certain cases in which qualified men could not be got in every district of England; but those cases were provided for by the 169th article. The 5th resolution of the noble Lord would not, therefore, in his opinion, do much good. Then there was the 6th resolution; but if hon. Gentlemen would turn to the 75th and 76th articles, they would find that the Poor Law Commissioners went further than the noble Lord, and that they did not stint the medical relief to the pauper, but the medical officer went on attending the pauper without any order or approval whatever, until he thought it unnecessary to continue it. In those two respects the resolutions of the noble Lord seemed to cast an unjust slur upon the poor-law. The noble Lord had confined his arguments, on the present occasion, to his 1st resolution, relating to women claiming medical assistance in consequence of being pregnant; and he (Mr. Buller) had been in hopes, when he handed to the noble Lord the order of the Poor Law Commissioners upon that point, that it would have satisfied him. He had thought that the noble Lord was not one of those who wished for uni- versal pauperism in the country, and that he wished to draw a line of distinction between the idle pauper and the honest and industrious poor, and not to hold out an inducement to every person in every emergency to come to the parish for relief. To maintain a sense of that distinction intact and sacred in the minds of the poor, was a matter of the highest importance; it was essential to the sound administration of the poor-law, and essential to the sound social condition of the people of this country. Far be it from him to participate in that indiscriminate philanthropy which regarded all the poor alike, and refused to extend more approbation and encouragement to the honest and industrious man, whose pride it was to have maintained and brought up his family without resorting to the parish for assistance. As the noble Lord had framed his resolution, it was an invitation to every woman, married or unmarried, to claim relief from the parish. He would not now dwell upon the question of morality. He agreed with the noble Lord that it was not the time when a woman was in the extremity of physical suffering to vindicate the claims of morality, but that relief should at once be extended, and then, if she were immoral, to let her be afterwards branded for her immorality. But without reference to the question of morality, and taking the case of married women alone, the resolution of the noble Lord, as it stood, was a direct invitation to the wives of ratepayers in all circumstances, to the wife of the humble tradesman or the small farmer, to apply for parochial assistance in the case of childbirth, and this while you were crushing poorer ratepayers of the country to pay for better medical attendance upon paupers than they could afford for themselves. You invited such persons to come to the ample feast of parochial charity at the expense of the poor farmer or tradesman, who, for the necessities of himself or his wife, was obliged to put up with half the amount of medical assistance. This was scandalous injustice, and, however he might be taunted with entertaining a desire to refuse medical relief to the poor, he would contend that even that was less unjust than throwing the burden of providing such relief upon those who could not afford it. If it were desired to break down the ample provisions of public charity, a better course could not be taken than to represent to the poorer classes of ratepayers the picture of inequality and injustice perpetrated upon themselves by the operation of the poor-law. He was not at all inclined to underrate the pains and perils of childbirth; but he must be permitted to remark that there was at least one feature of that condition which rendered it less necessary to open the door to indiscriminate relief—namely, that it could not happen without timely notice. A woman could not be delivered without being aware of her condition; she had plenty of time to apply for relief. The noble Lord had remarked that a woman would not apply to the relieving officer, but would seek the doctor, whom she regarded in the light of a father. Now, when the noble Lord spoke of the parental position in which medical gentlemen stood towards poor women, he must say that if allowance were to be made for such feelings as these, to the extent of refusing to impose any restraint or limit to the applications for medical relief in these cases, merely because women would not apply to the relieving officer, it would be idle to attempt to preserve any safeguard whatever upon the poor-rate. He had handed to the noble Lord the order that had been made by the Poor Law Commissioners applicable to these cases: it was in article 182. The right hon. Gentleman read the order of the Commissioners, which was to the following general effect:— That in cases in which any medical officer, either for the workhouse or the district, shall be called upon by the order of persons duly qualified to make such order to attend a woman immediately after childbirth, or shall, under circumstances of difficulty and danger, without such order, visit such woman receiving relief, or whom the guardians should subsequently decide to be in a destitute condition, such medical officer shall be paid not more than 20s. nor less than 10s. The House would observe that the order might be obtained from persons properly qualified. But there might be cases in which an order had not been applied for; and in such cases did the general order of the Commissioners prohibit relief being given? Not at all; but, on the contrary, the order provided that in such cases the medical man might attend, and the board of guardians would afterwards decide whether the woman was a proper object. Would any one tell him of a better mode that could be invented, without throwing open the door indiscriminately to everybody? Would any one tell him of any other rule by which the wife of the richest farmer in a parish could be prevented from applying, if she chose, to the union doctor? It appeared to him that the rule went as far, under such circumstances, as was possible, with a due regard to the interests of the ratepayers. The medical men, and those who took their part in that House, used very different language now from that which they employed in the Medical Committee, for there it had been held that medical gentlemen were the best judges of the question of pauper or no pauper; for it had been asked, did he not know best whom he should and should not attend? If the noble Lord wished to provide a remedy in these cases, it should be by the institution of some power of appeal from the boards of guardians—not that he advised such a course, and there was a power of appeal in certain cases to the magistrates. But he would not then enter upon the question of opening the door, to the authority of justices of the peace in the administration of the poor-law. He had thought it his duty on this the first occasion of addressing the House since holding the office he had the honour of filling, to state those general principles in regard to medical relief, upon which he thought the poor-law ought to be administered. He had given his opinion upon the resolutions proposed by the noble Lord, and it was for the House to decide upon them. That decision, he trusted, would be against the resolutions, for he believed them to be both dangerous and unnecessary. The right hon. Gentleman concluded by moving the previous question.

MR. WAKLEY

said, that the right hon. and learned Gentleman had concluded his speech by saying, that the present occasion was the first on which he had addressed the House since holding his new office. It was to be regretted, that the right hon. Gentleman had made so bad a commencement, for the very first thing he had done was to oppose a change in favour of humanity which had been made by the noble Lord the Member for Bath. After the speech of the right hon. Gentleman, he could not help wondering why the hon. Gentleman now sitting opposite to him (Mr. C. Lewis) was out of office. That hon. Gentleman must now consider that he had been very ill-used in being removed from a situation he had held for so many years, and in which he had, according to the statement of the right hon. Gentleman, made everything so perfect and complete that scarcely any change was requisite. The disappointment out of doors would be very great when it was found that, after the inquiry that had been made, and all that had been said about the administration of the poor-law under the former system, no change whatever was to be made under the new system—that everything was to be maintained in its integrity, and that there was no prospect of a remedy to those evils which had been so much complained of. It appeared that the Poor Law Commission had been abolished, to relieve certain persons; but that with respect to the administration of the law itself not the slightest alteration was to be expected. The right hon. Gentleman had gone over the whole subject, and had not confined himself to the first resolution moved by the noble Lord, which was the question now before the House; but the right hon. Gentleman seemed to consider that he had got an absolute sinecure. No change was to be effected—no modification—everything was perfect. There was nothing at all to alter, and everybody ought, of course, to be perfectly contented. Did the right hon. Gentleman really believe that the present system could be continued? Medical practitioners were not only discontented, but in many instances exasperated. Surely the interests of the poor and of medical men ought to be considered as well as those of the ratepayers. The right hon. Gentleman knew very well that the whole subject of the poor-law must, at no distant period, be brought before the House. The change in the constitution of the Commission had led the public to believe that there would be an alteration in the administration of the law, and that the grinding, severe system which had been pursued, would be superseded by one that was milder and more humane. But it seemed that there was now not the slightest hope of such a consummation; on the contrary, the right hon. Gentleman appeared to think that the law was admirably perfect. According to that right hon. Gentleman, some two or three trifling matters might be changed at some future day; but to judge from his speech, the present generation would never witness any change at all as the Board was now constituted. A very small part of the right hon. Gentleman's observations had been directed to the first resolution which had been proposed by the noble Lord, in consequence of the representations of a great variety of medical witnesses, all competent to understand the question; and the right hon. Gentleman himself had stated his belief that medical men were the best persons to judge whether a party was destitute or not. [Mr. BULLER: They are very capable.] Why not, then, leave it to their decision, and not to boards of guardians? The medical man visited the sick woman, attended her for forty-eight or sixty hours, beheld her pains and sufferings, and then, after having performed one of the most important functions incident to his profession, he was to make his application to the board of guardians for payment; and it rested with them to decide whether he should or should not receive his paltry beggarly dole of 10s. or 20s. That was the manner in which medical practitioners were treated, and in which the poor women of this country were treated. The right hon. Gentleman could not be aware of the suffering and privation which a destitute woman had to undergo in childbirth. The right hon. Gentleman had never been engaged in matters of that kind; they were foreign to his pursuits. Indeed, it would be well to know what the Government considered to be the proper qualifications for a Poor Law Commissioner. The right hon. Gentleman was an able, acute, and eloquent man; but his pursuits were foreign to matters such as these. His mind had not been disciplined to them, and yet he had been put into office to superintend all the duties connected with the administration of the poor-law, as if he had been engaged for half his life in workhouses and in the administration of relief. He would not say that the appointment was unfortunate until he had had further opportunities of judging; but he must say, as a general remark, that in appointments of this kind the previous occupations of gentlemen, and not their power of addressing the House, ought to be taken into consideration. It would be too painful to describe the terrible sufferings which were endured by poor women in the cases to which the resolution of the noble Lord particularly referred. He had witnessed them; they had frequently fallen under his observation, and it was impossible, by any terms he could employ, to exaggerate in the slightest degree the misery, destitution, and privations of those poor creatures. By giving them the opportunity of applying to a medical practitioner at such a crisis of peril, the House would be conferring an inestimable blessing, and affording to them comfort and consolation they could derive from no other source. But, instead of extending to them such a privilege by law, it appeared that the matter was to be left to the discretion of boards of guardians. What the noble Lord desired was that an Act of Parliament should be passed in which such a provision should be embodied. He did not want to open the door to abuse, or to prevent the interests of the ratepayers from being properly protected. Was the right hon. Gentleman aware of the character as well as the incapacity of the persons who were employed as midwives? They were often women of the worst character, addicted to drink, and frequently attending lying-in patients while in a state of intoxication. In many cases women perished under the violence used by these ignorant creatures. The mother was lacerated and the infant ruptured, and there were even instances in which the intestines of women had been torn out to the extent of many feet. These facts were familiar to professional men; and if the House was not prepared to act upon the principles of justice and humanity, the whole catalogue of horrors should be disclosed. If the noble Lord would not undertake the task, he would. The right hon. Gentleman had talked about the wives of farmers, and other ratepayers, seeking aid from the union doctor, if the noble Lord's resolution were to be carried out. Why, the right hon. Gentleman believed nothing of the kind himself—he used it as an argument, and it had its effect in that House. The right hon. Gentleman knew very well to whom he was speaking, and he had calculated the effect of that statement beforehand. But in how many cases would such applications be really made? Occasionally, perhaps, there might be some person destitute of all self-respect, destitute of those feelings which should influence the minds of persons in that class of society, who might make application to the union doctor to be attended as a pauper; but was not the right hen. Gentleman perfectly certain that in the vast and overwhelming majority of cases such applications would proceed only from the poorest and most miserable? In consequence of the want of proper medical attendance in these cases, miserable ricketty children were born, who became permanent burdens upon the parish, thus entailing a great expense upon the ratepayers, because the expenditure of 10s. or 20s. was grudged at the proper time; and thus it might be said, that from the inadequate remuneration of medical officers much of the pauperism of the country arose. The medical practitioner was himself an important ratepayer. Generally speaking, he had connexions and relatives in the district who were also ratepayers. He had a direct interest in keeping down the expenditure; and he was, therefore, not a man likely to give false information to the board of guardians. The character of the medical man, in this country, stood too high to expose him to such a suspicion; and the right hon. Gentleman might also place every confidence in the discretion of this officer. The right hon. Gentleman had referred to the mode in which orders for food and nourishment were given. Did the right hon. Gentleman know the manner in which the medical and relieving officers were compelled to act towards each other in this matter? The relieving officer gave an order to anybody who applied, and they thus created a wholesale pauperism, the most profligate system ever adopted. They would not pay the medical officer an adequate salary; but they compelled him, at an inadequate salary, to attend to all for whom he received an order from the relieving officer. In many districts, in the great majority of cases, when he visited a destitute person, he found him in a state of disorder, arising, not from any positive disease, but from want of food. The duty of the medical officer, then, was not to give hark or quinine, or any tonic medicine, but to order proper nourishment. He gave, in such an instance, an order for food, and frequently the poor person had to walk 20 miles—such was the construction of some of the unions—before that food could be obtained; perhaps a paltry 2lbs. of meat. ["No, no!"] That undoubtedly was the case in many of the rural districts in England; he had five miles to walk to the relieving officer, and five miles back again; five miles for the relief itself, and five miles back again after getting it. This had happened again and again in this very county under his own observation. If the medical officer was what was called "liberal" of these orders for nourishment, he speedily lost favour with the guardians; and the right hon. Gentleman would recollect, according to the rules of the late and of the present Poor Law Commissioners—for it appeared the system was too perfect to be changed—that before the poor person could receive the food required, the order had to be confirmed by the relieving officer; or, in other words, the relieving officer stood above the medical officer in reference to an order given medically, and given, too, for food. Now, how were their criminals—men who had violated the law—treated in their gaols? He knew how they were treated, under the authority of the right hon. Baronet the Secretary of State for the Home Department; and, to his honour it should be spoken, they were treated well. Were the sick poor treated in the same manner as they treated criminals in the infirmaries of gaols? It was said that the medical officer of the union could order whatever he thought necessary; but he had shown that this was not done; for if the medical officer did what was required, he would not remain in his office. In gaols, on the contrary, without stint or restriction, and without the rebuke of the magistrates under whose observation he acted, the medical officer was authorised to order any quantity of nourishing food which he might deem advisable; and such things as arrowroot, sago, tea, and wine, were frequently granted. When persons were sick they were entitled to this extra consideration; he knew that some poor-law officers were generous enough; but in the great majority of cases the rule was precisely the reverse. Some returns throwing light upon the subject would shortly be moved for; and he hoped that the right hon. Gentleman would not object to furnishing information which would show the comparative diet in workhouses and gaols, and the comparative treatment of sick criminals and of sick poor. But, returning to these resolutions, he would ask, had the right hon. and learned Gentleman urged a single argument why they should not be adopted? Had he at all invalidated the evidence which was already before the House, and from which the noble Lord had so copiously quoted in support of his case? The demand was simply that these poor women should not be left to the humanity or discretion either of relieving officers or of boards of guardians, but that they should have a right, by law, to the attendance of the medical officer of the union when in labour with their first child. The right hon. and learned Gentleman must be well aware that applications for such attendance would come only from the destitute; the noble Lord, in fact, proposed, if the resolution were embodied in a Bill, to shield the ratepayers from every abuse of this concession. In the south and west of England such women as those for whom the noble Lord desired to legislate, were married to men who were in the receipt only of 6s., 8s., or 9s. a week; and at the moment when called upon to hear the agonies of child-labour they were in the most miserable of dwellings, and with scarcely anything deserving of the name of comfort around them. They were in a state of extreme destitution, and their whole family, consisting perhaps, of five or six or seven persons, was crowded into one room; but they were not considered paupers, inasmuch as they had avoided applying for relief from the union, and they were refused the privilege of having the medical officer to attend on them. This privilege was very small, in reference to the expense which would be entailed upon the country, but most important considering the vital service which it conferred upon the poor, and he did not see on what ground it could he withheld. He should be glad if the noble Lord would inform them from whom he received advice on this subject. It was to be hoped in this matter, even if it were so in all others, that he had not listened to the admonition of those who had preceded him in his office. He trusted that the right hon. Gentleman would act for himself on such questions—that he would remove all prejudices from his mind—and that, when he came down to the House, he would listen fairly to those remarks which might be offered in favour of a change in the present system. If things were to remain just as they had so long existed, great as were the talents and the capacity of the right hon. Gentleman, the country would be unable to discover what it had gained by the recent alteration in the Commission. He begged of the right hon. Gentleman not to persist in moving "the previous question." If he looked at the matter impartially he could not fail to see the propriety and necessity of the amendment in the law which the noble Lord now recommended. He would not enter into any of the other resolutions; he hoped that, on this one point at least, the right hon. Gentleman would relent, and thus indicate that he was not resolved, under all circumstances, to adhere to the principles which had governed the conduct of the former Commission.

MR. HUME

agreed with his hon. Friend (Mr. Wakley) as to the distress and destitution generally prevailing, and he wished it was in their power to ameliorate that necessary and inevitable state of poverty. Having, however, such a state of things to deal with, they ought to be cau- tious, lest, by legislative measures, they made matters worse. He was willing to admit that poor women, in the condition described by his hon. Friend, ought to have every possible comfort around them; but he looked to the probable effect of the resolution of the noble Lord, if carried, and he was decidedly of opinion that, instead of causing an improvement, it would be productive of more mischief than it intended to remedy. They had already passed many measures of a similar tendency, avowedly on the plea of humanity, and the consequence had been, that they had destroyed in a very great degree that habit of self-dependence, and that spirit of self-reliance, upon which alone they could depend for the well-being of a people. He thought that, to give to every poor woman, as the resolution proposed, the right to the attendance of the medical officer of the union on the occasion of her being in labour, would remove all incitement to precaution and preparation in families, and would only make bad worse. [Mr. WAKLEY: It is only proposed for the first child.] In all ordinary cases families did prepare and provide for such occasions; and to eradicate this habit of self-dependence would be to create a great social evil. It would, indeed, be a most dangerous proceeding in that House to establish such a legal claim upon the unions; it would take away occupation from a numerous class of women whose business it was to attend to child-births. He had acted upon this principle in abstaining so long from approving of the poor-law; and he had always been of opinion that families would manage much better, generally speaking, if left to their own exertions in all such cases as those in which the noble Lord suggested interference. The poor-law had, undoubtedly, had the effect of weakening the feeling of independence among the people. He was entitled to say so from what he had heard from many intelligent men in Scotland; the introduction of the poor-law there, and the principle upon which it proceeded, had not, they stated, operated beneficially. This was the conviction of many of his own friends, who were observers and administrators of the law in Scotland; and they predicted that the people of that country would soon suffer from the absence of that prudence in their social dealings which formerly particularly distinguished them. On these grounds, he thought the House ought not to agree to these resolutions. His right hon. Friend, it appeared to him, had pointed out that the existing facilities were sufficient to effect all that was necessary in all cases of real distress. He was sorry to differ on such a question from his hon. Friend, whose humane motives were unquestionable; but he could remember many mistakes they had made in this sort of legislation, and he felt that he would not be doing his duty to agree to the present proposal.

MR. C. BULLER

would answer the question put to him by the hon. Member for Finshury. The hon. Member expressed some doubts of his (Mr. Buller's) experience in these matters, and asked him by whose advice he had acted in opposing the resolutions of the noble Lord? This reminded him of a fact which he had forgotten to mention, and which, in justice to himself, he would now state to the House. Before deciding on this question, he had sent a copy of the resolutions round to every one of the gentlemen, lately assistant commissioners, who were now poor-law inspectors, in different parts of England and Wales. He attached great importance to the opinions of these gentlemen, from the ability they displayed in the zealous and energetic discharge of their duties, and from their intimate acquaintance with the subject. With respect to the first resolution, he had received written answers from seven of these nine gentlemen; he had verbal communications with other two gentlemen, who entirely agreed with the others; and they all, with the exception of Sir John Walsham, objected to the resolution, and took precisely the same objection. Sir John Walsham said that he did not see any objection to that resolution, provided only that some reasonable definition of the class of persons were substituted for the comprehensive words "every poor woman."

MR. HENLEY

was disposed to do every justice to the motives which had actuated the noble Lord in bringing forward this subject of medical relief; and he did not regret the discussion, inasmuch as it afforded him an opportunity of bearing testimony to the admirable mode in which the right hon. and learned Gentleman (Mr. C. Buller) had discharged the high and important duties of the office to which he had been recently appointed. It was quite true that there had been no material alteration in the rules and regulations of the Commission; but it was said on all sides, that the spirit in which the business was carried on was very different, and very much better for all parties. The right hon. and learned Gentleman had spoken of the estimate which was made in 1838 of the cost of the poor; but if he had examined the records of what was then going on throughout the country, he would have seen that the cause of the inquiry which was then made was the extreme dissatisfaction felt at the low rate at which the Poor Law Commissioners set down medical relief. They had, in the union with which he (Mr. Henley) was connected, procured a return of the amount paid in all their parishes for medical relief, and they found that the sum was 450l. They had discovered that in a union in Hampshire of the same area, and with the same population, the Poor Law Commissioners allowed only 300l. to the medical officer; and they put the matter before the medical gentlemen employed by them, and these persons agreed to accept that sum. The agreement was reported to the Poor Law Commissioners, who replied that they would not permit such a waste of money, and they cut the 300l. down to 295l. This was what originally took place; but the cost had again increased, and they had now to pay 450l. He did not think, therefore, that the medical officers had much reason to complain. He was far from saying that they were sufficiently paid; but, comparing their position with the circumstances in other unions, they had reason to be satisfied. They were, he knew, liberal enough in the orders referred to by the hon. Member (Mr. Wakley), and the poor had certainly not to walk twenty miles for relief. He regretted he could not give his support to the resolution of the noble Lord; but it was an universal proposition, and it did not apply to the persons most in need of relief. The hon. Member for Finsbury painted cases in very high colours; but, practically, in the great majority of instances, the poor were attended by medical men. He did not know why a woman wanting a certain kind of medical assistance should not apply beforehand for an order; but if her sense of modesty was so great, he did not see why her husband might not apply to the medical officer. For these reasons, although he was satisfied that the noble Lord's first resolution was brought forward with the best and kindest feelings, he thought great risk would be incurred, if it were adopted, of opening a door to indiscriminate relief.

SIR. W. CLAY

was satisfied that no better choice could have been made than the right hon. Gentleman (Mr. C. Buller) for the important office he filled, and that that was the general feeling of the country; still, the reasons assigned by the right hon. Gentleman for resisting the Motion of the noble Lord were not convincing, and he (Sir W. Clay) must support the noble Lord's Motion. There was no form of eleemosynary assistance either so important to the poor or so little liable to abuse as the one in question; it was a form of medical assistance which the poor were least able to obtain. The expense of medical relief to the poor amounted to 175,000l. per annum, out of 5,000,000l., the amount of the whole expenditure, or little more than 2 per cent. They were, therefore, not dealing with a branch of poor-law relief of great extent; nor could they be led to believe that a small addition to it would occasion abuse. No doubt, under the terms of the noble Lord's Motion, any person might apply for relief, even the wife of the squire of the parish; and the Motion was undoubtedly open to that objection; but the noble Lord met it in this way—if it should appear that any improper use were made of the power he meant to give to the poor, he proposed to give the power to attach wages. With respect to the objection as to the impolicy of interfering in this way, and thereby destroying the self-reliance of the poor, that had been already done, and this was only a modification of past legislation. If the right hon. Gentleman persisted in moving the previous question, he (Sir W. Clay) must support the Motion of the noble Lord; but he would rather that the noble Lord withdrew his Motion, upon an assurance from the right hen. Gentleman that he would take care to embody the resolutions in the regulations of the Poor Law Board. For these reasons, though with extreme regret, he must, if persevered in, oppose the Amendment of the right hon. Gentleman.

VISCOUNT EBRINGTON

said, though he differed from the noble Lord in the result at which he had arrived, he sympathised with his motives, and gave him credit for the manner in which he had brought forward his Motion. The object of the noble Lord's first resolution seemed to be provided for by a general order of the late Poor Law Commissioners. The hon. Baronet who spoke last said, if the power proposed to be given by him to the poor were abused, he was willing to let the wages be attached. Under the present law, if a medical officer, suo periculo, attended a woman, and it was found that she was not entitled to relief under the poor-law, there was nothing to prevent the Commissioners from declaring that the assistance was obtained by way of loan, and attaching wages. In reply to the hen. Member for Finsbury, he would state, from his personal knowledge as vice-chairman of a board of guardians, that where a medical officer administered assistance in urgent cases, it was almost always sanctioned by the board at the next meeting. He agreed with those who thought that such legislation would break down the spirit of independence and self-reliance of the poor. If the subject of medical relief was dealt with, it must be dealt with as a general question.

CAPTAIN PECHELL

hoped, that in the course of the next vacation, the right hon. Gentleman (Mr. C. Buller) would consider it a part of his duty to go down and visit all the poor-law unions, the boards of guardians, and the medical officers; he would then see the way in which medical relief was applied in the Gilbert as well as the other unions. He believed, with the hon. Member for Finsbury, that there was not one case in a thousand of improper application; and he believed that was the only objection to the resolution urged by the economical Gentleman sitting in his neighbourhood (Mr. Hume). He should certainly give his cordial support to the Motion now before the House, for he thought that no money could be better bestowed than that which it was intended to expend in carrying these resolutions into practical effect. There was no one who attended the proceedings of the Committee which investigated the case of the Andover union that could for a moment doubt the conclusions at which that Committee had arrived. With the recollection of the case fully before them, he hoped that the House would see the necessity, or at all events the expediency, of enabling the noble Lord to create an opportunity of seeing what could be done. It had been stated before the Andover Union Committee, that when an ablebodied man applied for relief, the relieving officer insisted upon his going into the workhouse, put him to hard labour, and that was what they called testing. In the 8th Resolution of the Committee, on the subject of relief, they said— That on the application of an ablebodied man for relief, on account of sickness in his family, and also in some instances where the applicant has been partially disabled, the Andover board have required as a condition upon which such relief is made dependent, that he should perform a certain task of work at the workhouse, the amount of food allowed to him not being supplied until such task is completed; and although, as stated by some witnesses to have been the case, this practice may have been only adopted as regards the ablebodied applicant, where he is out of work (and under circumstances, therefore, which, were it not for the sickness in his family, would render admission to the workhouse the only relief applicable in that union to the case), still the Committee think, that the annexing this condition to the relief otherwise deemed necessary, and especially where parties are brought long distances from their homes to execute the task imposed, is (except under suspicion of fraud or gross imposition) an unduly severe mode of administering relief. That was but one case—many more equally flagrant cases might be quoted; and he should certainly hereafter take an opportunity of drawing the attention of the House to those cases, if, after having given a fair trial to the right hon. Gentleman, he should be found wanting. He agreed with the hon. Member for Finsbury in denouncing the manner in which medical men had been treated by the poor-law officials; and he also agreed with him in opinion that the poor suffered severely in consequence of such treatment. There was Mr. Westlake, the surgeon of the Andover union—he was an able and a zealous officer, and he had been snubbed by the guardians, and forced from his office merely for doing his duty. He had gained the respect of all in his neighbourhood, but he was ousted from his office; and it was well known that medical men were generally ruined in their profession if they did their duty to the poor. By doing his duty to the poor, Mr. Westlake had acquired the ill-will of the board of guardians, with the Rev. Dr. Jobson at their head, and he had lost his office in consequence. But when he was ousted from his office, the poor still came to him; and he, from motives of humanity, attended them without a reward; but the vengeance of the guardians was called down upon all those unfortunate persons who went to Mr. Westlake, and they all suffered in consequence. Then there was the case of the Halifax union, of which the right hon. the Chancellor of the Exchequer was a guardian. The surgeon of that union had stated the area in acres of the union, the amount of the population, and the amount of the expenses which he had incurred. It appeared that he was required to do for a small salary that which could not be well done even by two medical officers. The surgeon of that union, Mr. Gar- nett, stated that he had paid 685 visits to paupers in one quarter of a year, and that over and above the amount of his salary he had dispensed in that period 985 mixtures, 2,285 pills, 879 powders, and numerous lotions, liniments, and plasters; in all he had dispensed 4,063 articles more than he had been paid for. The area of the union was 6,990 acres, and the population was 19,881. His salary for attending the paupers of this district averaged 4s. 4½d. per head per annum. By the present system, the medical profession was aggrieved, and the character of the poor was lowered. He hoped the noble Lord would persevere in his resolution, and he would stick to the noble Lord.

SIR H. VERNEY

thought it was absolutely necessary the poor, even in childbirth, should have all the assistance that science could render to them; and, therefore, he should support the resolution. There was no danger of destroying the character of the lower classes by supplying them with medical relief. They need not be afraid of being too lavish of medical relief to the peor, for they would never apply for that species of relief unless they absolutely required it. Boards of guardians could not be too economical as regarded other sources of expenditure; but with regard to medical relief, he felt that they had not been sufficiently—he could not say liberal, but—easy in their treatment of the poor. He hoped the noble Lord would not only press this resolution, but that he would persevere in his other resolutions also. He thought that if these resolutions were agreed to, they would be productive of the utmost advantage to the poor. He was not at all satisfied with the statement of the right hon. Gentleman; and he believed, that under the old system the poor, as far as regarded medical relief, were much better attended to than they were under the present system. This was the first step taken in a right direction, and he had great satisfaction in supporting the noble Lord.

MR. ADDERLEY

said, that the more legitimate way of meeting the difficulty complained of by the noble Lord, and which he sought to remedy by his resolution, would be to encourage parochial lying-in societies. There were many such in existence at present, which were supported by the poor themselves; but if this resolution were carried, not a single person hereafter would enter one of these societies. If the Government would encourage these so- cieties, they would remedy the evil of which complaint was made, in a more legitimate manner than by consenting to this resolution, which proposed, in order to arrive at a doubtful good, to inflict a positive evil.

The House divided on the previous question:—Ayes 37; Noes 50: Majority 13.

List of the AYES.
Anstey, T. C.	Perfect, R.
Brotherton, J.	Plowden, W. H. C.
Cabbell, B. B.	Raphael, A.
Clay, J.	Reynolds, J.
Clay, Sir W.	Scholefield, W.
Cowan, C.	Stuart, Lord D.
Drumlanrig, Visct.	Thicknesse, R. A.
Duncan, G.	Thompson, Col.
Fagan, W.	Trevor, hon. G. R.
Fitzroy, hon. H.	Turner, G. J.
Haggitt, F. R.	Verney, Sir H.
Hardcastle, J. A.	Wakley, T.
Hindley, C.	Walmsley, Sir J.
Hood, Sir A.	Wawn, J. T.
Jones, Sir W.	Westhead, J. P.
M'Naghten, Sir E.	Williams, J.
Muntz, G. F.	Yorke, H. G. R.
O'Connor, F.	TELLERS.
Pearson, C.	Ashley, Lord
Pechell, Capt.	Spooner, R.

List of the NOES.
Abdy, T. N.	Langston, J. H.
Adderley, C. B.	Lewis, G. C.
Armstrong, R. B.	M'Gregor, J.
Baring, rt. hon. F. T.	Magan, W. H.
Barnard, E. G.	Maitland, T.
Bennet, P.	March, Earl of
Berkeley, hon. Capt.	Masterman, J.
Blackall, S. W.	O'Brien, J.
Buller, C.	O'Brien, T.
Burroughes, H. N.	O'Connell, M. J.
Campbell, hon. W. F.	Parker, J.
Cubitt, W.	Pilkington, J.
Deering, J.	Prime, R.
Devereux, J. T.	Romilly, J.
Dundas, Adm.	Scrope, G. P.
Ebrington, Visct.	Smith, J. B.
Fox, R. M.	Somerville, rt. hn. Sir W.
Fox, W. J.	Thornely, T.
Gibson, rt. hon. T. M.	Willcox, B. M.
Graham, rt. hon. Sir, J.	Wilson, M.
Grey, rt. hon. Sir G.	Wood, rt. hon. Sir C.
Hayter, W. G.	Wyld, J.
Heathcote, Sir W.	Wyvill, M.
Henry, A.
Hume, J.	TELLERS.
Keppel, hon. G. T.	Hill, Lord M.
Labouchere, rt. hn. H.	Tufnell, H.

The resolution accordingly was not put.

LORD ASHLEY then moved— That in the event of its being considered necessary to destroy the child, in order to save the life of the mother, the union surgeon shall be at liberty to seek the assistance of another competent practitioner, if he see fit, before the necessary operations are performed, and who shall be paid for the assistance rendered, on producing to the union or proper officer the joint certificate of the union surgeon and himself that such consultation and aid were essential, previously to the expected legal and necessary deprivation of life.

MR. C. BULLER

assured the noble Lord that in respect to this resolution every thing that could be done by instructions from the Commissioners would be done.

LORD ASHLEY

having that assurance from the right hon. Gentleman, withdrew the resolution.

LORD ASHLEY

, in moving the third resolution, said that it was important there should be a competent person who should see all that was going on in the union, should make his observations, and report his progress to the Central Board sitting in London. It was essentially necessary that there should be some supervising body of this description. Hon. Gentlemen would bear in mind that the number of poor-law medical officers at this moment amounted to nearly 3,000 persons, and that was a body of men discharging very important duties, who ought to be subjected to some system of regular inspection. There were inspectors for the Army and Navy medical staffs; and when the great importance of the interests at stake was considered, the vast number of persons who were engaged, and the great duties they had to perform, and the real concern which the whole country had in the due performance of those duties, it must be acknowledged that it was necessary to have a body of officers who should keep the Government daily apprised of everything that was going on. It was necessary to have some authority to settle the disputes which were constantly arising between the boards of guardians and the medical men. Many other duties might be given to this body of men. It might be their duty to make a supervision of all the drugs, for he believed that a vast deal of money was thrown away by the administering of inferior drugs. The House had no knowledge whatever of the general system of medical relief. He believed that the board of Somerset House was utterly ignorant of the whole system of medical relief. The fact was, that these parties, having great and responsible duties, were left altogether without control, except the local control of the board of guardians, and which the board of guardians was incapable of exercising. It would also, he believed, have a very beneficial effect in keeping all these medical officers alive and active in discharge of their duties; because the periodical inspectors should not only report what was done, but the mode in which relief was administered. This might appear from their case-books. There was another duty which might devolve upon them. He believed that nothing was more beneficial to the condition of the poor, and the right administration of public business in this matter, than the regular medical inspection of all union houses throughout the country; and that should be done, not by persons locally interested, but going the circuit from the central body, who would without fear or favour report all they should see. If there could be any doubt of this, look at the document which had just been laid on the table of the House. This document was a report on the capabilities of metropolilan workhouses for the reception of inmates. It reported on thirty-eight metropolitan union houses. Of those thirty-eight more than thirty had one great and leading defect, viz., that they were decidedly hostile to the health of the inmates: thirty-three were in a bad state of ventilation. They were beset by nuisances of all descriptions, not only nuisances belonging to the establishment, which it was difficult to remove, but nuisances occurring in the centre of the building, under the control of the authorities, which might be removed. Take the case of the White-chapel union. In 1844, when the evidence was taken, the Whitechapel union was stated to be in a very bad condition. What was the report in 1848? The present state was horrible. Mr. Reid, the medical officer, died some time ago of typhus fever; his successor, Mr. Forster, also died. The next medical officer, after a trial, resigned. Observe what total want of economy this was. He did not believe there was any one system so utterly wanting economy as this system, which made no provision for clearing away the nuisances and for ventilation. The fact was that these houses, through ignorance or inattention, bred the very disorders they wished to avoid. If the relief were duly administered, and if there existed a body of men whose business it should be to look into these matters, in a short time they would more than cover the slight increase of expenditure. His right hon. Friend would admit to him that a very large proportion of the business of the poor-law was taken up with medical matters, a large proportion of which might be settled on the spot, by the medical inspector adjudicating the matter between the guardians and the medical men. He had been looking at the evidence given by a former Poor Law Commissioner, who said— Complaints against medical officers as to the performance of their duties are extremely common—I think more common than any class of complaints. I have been told that a very large proportion of the correspondence in cases which the Poor Law Commissioners have to decide, is from cases arising out of disputes between the guardians and medical officers. He believed, above all, that the establishment of these inspectors would have a beneficial effect on the state of these union workhouses, in making some provision for the public health, so that people might be restored, instead of having their disorders confirmed. He therefore moved— That it is expedient that medical inspectors be appointed by the Poor Law Commissioners, or by the Secretary of State, or with his sanction; one to each district to which an assistant poor-law commissioner or inspector is attached, at a salary not exceeding 600l. a year, exclusive of travelling expenses, and exclusive of allowance of a clerk, if the duties should require one. That the duty of the medical inspectors should be to inspect and report on, the medical treatment of the poor of the different unions, and on the fitness of the medical men appointed by the unions; to inquire particularly into the treatment of the sick poor in the union workhouses, and to regulate such treatment; to inquire into and report on the diets and healthful condition of the poor within them generally, together with such other sanitary duties of every kind as may be required of them by the Secretary of State, or by the Poor Law Commissioners; and particularly with respect to the number of medical officers who ought to be employed in each union, and under the sanction of Poor Law Commissioners, to fix the salaries which ought to be awarded to them for their services in each particular union, or part of a union, in the district.

MR. C. BULLER

said: Sir, I am sorry that I feel obliged to take the same course with reference to this resolution as I did with regard to the previous one; but I must guard myself by saying at once that the objects which the noble Lord wishes to secure by means of a staff of medical inspectors are objects in which I fully concur, and that no person would properly administer the duty which I have undertaken, if he did not at least endeavour to attain them. My only objection to the plan of the noble Lord is, that I do not think the costly and complicated machinery which he proposes would afford the best means of arriving at the results at which he aims. I will not dwell much on the question of expense. But the noble Lord proposes that wherever there is a poor-law inspector, a medical inspector, with a salary of 600l. a year, shall be added. There are ten poor-law inspectors at the present moment. The Bill under which I hold my present office, as originally brought in, gave power to increase the number only to twelve; but that limitation was originally struck out, on a ground in which I entirely concur, namely, that the utility of the poor-law depends almost entirely on the labours of the inspectors. And here I must beg the House to observe, that though we hear so much of the powers of the Poor Law Board, those powers are in reality limited. It seems to me to be the proper function of such a board to superintend the whole administration of the poor-law. I think that all which passes in the different unions should be made known to the proper authorities—that uniformity of system should, as far as possible, be maintained—that obedience to the law should be enforced—that the guardians should, in every case of difficulty, have the advice of an inspector—that the inspector should ascertain, at the outset, the growth of any abuse existing in any particular union—and that the Poor Law Board, exercising its power in the way of supervision, of advice, and, very rarely, in the way of absolute control, should endeavour to keep the general administration of the law accordant with certain fixed principles. I rejoiced at the decision as to the number of inspectors, because I thought that an increase in that department would do more than any thing else to render the poor-law available for the well-being of the people of this country. But I must say that I shall be rather hampered in making such appointments, if every appointment that I do make is to carry double—if, that is, whenever I nominate a poor-law inspector, I am obliged to add a medical officer with a salary of 600l. a year. Take the case, however, as it now stands. At present there are ten poor-law commissioners. The noble Lord proposes at once to add ten medical inspectors, whose combined salaries will amount to 6,000l. a year; while another 6,000l. a year would probably be required for clerks. For any useful purpose this country would not grudge such an amount; but I think that in administering the poor-law, I should find my efforts impeded rather than assisted by the appointment of ten medical inspectors. Now, I do not mean to pledge myself against the appointment of any medical inspector; I have, from the very first moment of entering upon my office, suggested to my right hon. Friend the desirableness of having some persons who would be able to advise in medical cases. [An Hon. MEMBER: In every union.] There would then be 600 medical inspectors; and I must say, that if all the duties pointed out by the noble Lord are to be properly performed by means of inspectors, 600 would not be many. Let me state, however, what is the ground of difference between the noble Lord and myself. It seems to me an essential part of poor-law administration, that it should be very much in the hands of the local authorities. Before coming into office I strongly expressed my belief that the civilisation and prosperity of this country were mainly owing to our having the principle of self-government. I am perfectly sure that it is in consequence of the practice of local administration that the poor-law has not by this time become an intolerable abuse; and I hope that by the steps which this House may take while arriving to obtain perfection in the administration of relief to the poor, it will be careful not to shake the foundations of the poor-law by impairing the independence of boards of guardians, and causing relief to be entirely administered, not by the guardians, but by persons at Somerset House, and those who hold authority under them. I do not think that I at all compromise the principles which I have before expressed, by undertaking the administration of the poor-law as it at present exists, for I believe that the law combines the principle of supervision and the energy of local authority. Now, instead of leaving it to boards of guardians to determine as to the competency of medical officers, the noble Lord would take this authority out of their hands, and override them by a set of medical inspectors, who, however limited might be their powers at first, would ultimately administer relief instead of the guardians. The first object of the noble Lord is, that the inspectors should inspect and report on the medical treatment of the poor of the different unions, and on the fitness of the medical men appointed by the unions. This appears to me far too large a power to be intrusted to only ten men. I do not know why there is to be a report from ten persons as to the medical treatment of the poor generally. Supposing a medical inspector to visit a poor-law union for a few hours once in six months, I should like to know how he would thus be made competent to form a proper judgment on the vast and complicated question of the general medical treatment of the poor. Do not suppose that I object to the powers with which the noble Lord desires to invest me, from a feeling of laziness or from a wish to avoid responsibility. I do say, however, that if you wish the relief of the poor to be well administered, you ought to leave it to those who are locally qualified to judge, and not to a set of salaried functionaries, visiting the unions only for a short time after long intervals. The noble Lord wishes the inspectors "to inquire particularly into the treatment of the sick poor in the union houses, and to regulate such treatment." What does he mean by "the regulation of such treatment?" Is the officer, for his salary of 600l. a year, to go down to a workhouse, in which there are 400 or 500 persons, to ask the medical officer, "How do you treat this man?—What medicines are you prescribing for that man?" and then, after receiving answers to his questions, to turn round and say to the officers, "You have not been treating these people properly! "The only tendency of such a course must be to involve the medical inspector in a quarrel with every officer of every union workhouse which he visited. With regard to the diet, I will only say, that on that subject I am ready to give information so far as I can; and I think I can perform that duty quite as well as any medical gentleman could do if its discharge devolved upon him. There is one point on which I entirely agree with the noble Lord. I think that medical officers might from time to time, say once in two years, very usefully inquire into the general sanitary condition of workhouses. That is a matter upon which boards of guardians throughout the country are no doubt rather deficient. I do not wish to speak harshly of them, but their position is somewhat similar, perhaps, to that of the House of Commons in reference to ventilation and matters of that kind. It might be useful, I repeat, to have the opinion of medical men on such subjects, and, without prejudicing myself as to details, I will say, that I am prepared to take measures for securing that object. Then comes the question, which, coupled with the next resolution, appears to me exceedingly important, of having an independent medical establishment, extending, somewhat like the Church establishment, all over the country. The inspectors are also to report "particularly with respect to the number of medical officers who ought to be employed in each union." That is not a very difficult problem to solve; "and, under the sanction of the Poor Law Commissioners, to fix the salaries which ought to be awarded to them in each particular union, or part of the union, in the district." So that, you see, by this plan, the regulation of salaries is taken entirely out of the hands of the boards of guardians. The guardians are to have no authority in that respect. The salaries are entirely to depend on the report of the medical inspectors, and the decision of the Poor Law Commissioners. I must say, I do not think it would be either wise or just to vest the power of fixing salaries in a central board, without reference to the wishes or means of the district. If this proposal be acceded to, the House ought to go one step further, and make the charge national; for it does seem to me to be the height of injustice to impose the very same burden on the poorest union in Wales as you impose on the richest in London. There are parishes in Wales in which the average rental is about 6s. a year—there is the parish of St. George's, Hanover-square, in which the average rental (as was understood) is about 600l. a year. It is certainly requisite that there should be an adequate salary for medical men; and I think, therefore, that Parliament did right in deciding that half the amount should be paid by the Government itself. Now, lot us just see whether medical inspection on the plan proposed would tend to harmonise the working of the poor-laws. We already have reports from inspectors as to the salaries of medical men. A medical inspector, I will suppose, thinks that a particular salary is too small, and he goes to the board of guardians—states his opinion, and then lets the matter rest. I put it to any man in this House to say, from his knowledge of the world, whose recommendation would have the most weight with the boards of guardians—that of the poor-law inspector, who is not a medical man, and who says they ought not to raise a particular salary; or that of the man whom the guardians probably describe as "one doctor," recommending an increase. I say, that if your end be gradually to obtain for medical men throughout the country adequate salaries, unless you do not mean to allow boards of guardians any choice in the matter, the interference of medical inspectors will only place obstacles in the way. I think that by taking this matter entirely out of the hands of boards of guardians, and saying that medical inspection and relief shall be conducted without any reference whatever to their wishes and opinions, solely on medical authority, instead of securing what you desired, namely, a good system of medical relief, you will damage the whole system of poor-law administration from one end of the country to the other. But I can assure the noble Lord that I am not indifferent to any of the objects which he has in view; and if he will only allow me, in my slow way, to attempt to attain them, I will do the utmost in my power. I should not like this large staff of ten medical officers; nor do I think they would do any good. In my opinion the proposal is far too large to meet the end. But that end itself—the supervision, medical treatment, and general sanitary condition of workhouses—is one which I can assure the noble Lord I have at heart as much as he himself has. If the appointment of a medical inspector shall appear, as I think it will, necessary, he may be sure that I shall not shrink from supplying the void; and he may also rely upon it that in every other respect I will endeavour to promote the ends proposed in his resolution. In that resolution I may observe, he has spoken of "sanitary duties of every kind." At the present moment I think it would be unwise to make any great change in that respect, or to go beyond mere poor-law purposes; for there is before the House a very extensive measure with respect to the sanitary condition of the country, creating a very large, and, I hope, a very efficient, machinery for that purpose. Even if it be thought desirable that there should be a body of medical inspectors charged with the performance of sanitary duties, I must say it appears to me far better that we should wait until we see how far the machinery of that new system to which I refer is applicable to the purpose, than that we should at once adopt any extensive plan for increasing poor-law inspection. It is upon these grounds that I venture to meet this question in the way that I have done; unless, indeed, the noble Lord will take the assurance which I have held out as an earnest of my intention to do my best towards obtaining his objects, I will wait until circumstances shall enable the House to determine more satisfactorily than it could do at present, to what extent this increase in the medical or sanitary department shall proceed.

MR. WAKLEY

said, that the right hon. and learned Gentleman had acknowledged that as soon as he got into office he found he was in want of medical relief. That was a want which he thought likely to continue. He was afraid that the right hon. and learned Gentleman was in a very bad state. He believed that there never was such a persecuted state as that of the medical profession. The situation which the right hon. Gentleman occupied ought to have been filled by a medical practitioner, and that every man in England knew who was acquainted with the duties which the right hon. Gentleman had to perform. If a medical man had been placed in that office, he would not have wanted, as the right hon. Gentleman did, a medical adviser; he would not have required, like the right hon. Gentleman, a nurse to help him. It was lamentable to see that the right hon. Gentleman was getting bewildered, absolutely bewildered. That vivacity, that clearness of mind, that logical closeness in argument, which formerly distinguished him, were gone—absolutely lost. He was surprised to hear the sort of answer which the right hon. Gentleman had given to the noble Lord. He had stated that at present there were ton inspectors, whoso duty it was to inquire into the state of every union in England and Wales, These inspectors were to examine into the whole affairs of the union, and to ascertain in what manner all of the officers discharged their duties, and to look into the accounts as well. Well, then, the right hon. Gentleman asked whether the House could believe that ten medical inspectors could discharge the duties which the noble Lord's resolution would assign to them. Why, the medical part of the inquiry was but a portion of the duty which devolved upon the inspectors, and yet there was not one medical man among them. There was an editor of a newspaper appointed the other day, who probably never before saw the inside of a workhouse in his life. The right hon. Gentleman had certainly shown a favourable disposition towards the medical profession; but he (Mr. Wakley) recommended him to beware. What advisors there might be about the Poor Law Board he did not know, but he must say that hitherto it had exhibited a hatred of the medical profession. In all the places where medical men should he put, the country found lawyers he trusted that medical men would have sense enough to feel indignant at this treatment, and that in the end they would physic their oppressors. It was true that there had been one medical gentleman appointed. Dr. Kay, who rendered immense service to the poor, and gave great satisfaction in the unions which he visited. He must say it was a strange thing that when the noble Lord so properly, and generously, and consistently demanded the appointment of these medical officers, the plea of the Government was economy. It was said they might cost the country 6,000l., or even 10,000l Was that so great an item when so many millions of poor were concerned? He had known 75,000l. voted in that House for Royal stables, and 150,000l. for repairing a palace; but 10,000l. was a large sum, forsooth, for the poor! He maintained that the sum was not worthy of being mentioned, when the vast importance of the subject was considered. The noble Lord had rendered a great service to the poor and to the interests of humanity in making this proposition; and he could assure the right hon. Gentleman that he would live to know that without medical inspectors the poor would never receive proper medical treatment. Now, what were the duties which these men would be called on to discharge? He did not think that they ought to be called upon to decide as to the fitness of the medical officers, nor that it would be in their power to regulate the medical treatment of the poor. He thought the right hon. Gentleman quite right in his objections to these two points. The business of the medical inspectors should be to inspect and report; and it was on this account he regretted that among the Poor Law Commission there was no medical man who could understand their reports. They would have to go into a district, and make their inspection, and ascertain how the poor there were treated; whether they were adequately attended to, whether drugs were properly supplied, and if the drugs were of proper quality. They would furnish the Poor Law Board with the most perfect information on what was passing in the district, which the right hon. Gentleman could not obtain now. With all his acuteness, when he got into office the right hon. Gentleman found that he wanted medical information, and persons without his ability must want it still more. He must in fairness observe, that all the responsibility of these proceedings did not rest on the right hon. Gentleman alone, for the Secretary of State for the Home Department, and the Chancellor of the Exchequer, were members of the Commission, and the noble Lord sitting between them (Lord Ebrington) was its Secretary. How the noble Lord got his office he did not know; he supposed because he was considered capable of superintending the grinding of bone dust, the noble Lord having approved of that practice in the Barnstable union. The medical profession asked for appointments suitable to their profession—they were not selfish in their views—for no profession were less selfish or made more sacrifices than medical men. Look at the harrowing scenes of distress and misery which came under their notice, and which agonised their feelings, because often unable to relieve them. Such risk did they run, that some of the assurance offices would not insure their lives. Last year, in Ireland, one out of every fifteen of the medical officers died, in consequence of attending workhouses where fever raged. In England, also, many medical men had died from diseases caught in the exercise of their professional duties. They carried on business at the risk of their lives, and yet no class of men were so inadequately paid, or were more unfortunate in that House, when any application was made in their behalf. He held in his hand a petition from a medical man named Haslam, the surgeon of the Carnarvon union. The circumstances in this petition were emblematical of what would be found in every union in the United Kingdom. Ex uno disce omnes. The petitioner stated that the district which he attended averaged three miles in a straight line in extent. There were 11,000 persons, with a large proportion of paupers among them. The number of paupers was 2,600, and the stipend for providing them with medicine and surgical applications was 50l. per year. The petitioner had repeatedly represented these facts to the Poor Law Commissioners, and those facts had been verified by the assistant poor-law commissioner. The petitioner stated that his expenses were 40l. per annum, leaving only 10l. yearly for the occupation of his time and his medical services. It appeared, further, that this system was not to be altered. But how could a man support his wife and family, and continue to make such sacrifices for the poor? The petitioner stated that he appealed to the Poor Law Commissioners for an increase of salary, but without effect. He feared no change for the better would occur, as the poor-law guardians there were decidedly illiterate persons, and hostile to qualified practitioners. He wished to know whether the right hon. Gentleman was acquainted with this case. He be- lieved that the noble Lord and the right hon. Gentleman, both Commissioners, wished all poor-law petitions to be referred to their office. This was a novel mode of proceeding; and, assuming that the House would permit such a practice, he hoped the House would require the Poor Law Commissioners to make an official report on all petitions which might thus come before them. From the tone and manner with which the right hon. Gentleman had addressed the House, he feared the right hon. Gentleman had formed a decided opinion on the question, and was inflexibly hostile to the noble Lord's Motion. He begged to say that the noble Lord had paid the greatest attention to the subject when it was before the Committee in 1844. The noble Lord had seen and examined many medical practitioners; and the result of their evidence thus obtained was the present Motion. The right hon. Gentleman indirectly acknowledged the value of medical inspectors for medical matters, when he enlarged on the value the reports from other inspectors were to the Poor Law Commissioners. If the Poor Law Commissioners derived so much information from inspectors who were non-medical, hew much more information would they get from a qualified body of men? If the right hon. Gentleman proceeded with his opposition, he hoped he would be left in a minority. But he hoped the right hon. Gentleman would relent at the eleventh hour; for the noble Lord's Motion was not only intended to work advantage to the medical profession, but to prove a benefit to the poor themselves.

MR. HENLEY

said, that this Motion had certainly not received so decided a negative as it ought to have received, for a Member of the Government said, in answer to it, "Only let me act in my slow way, and I will carry out the object which you have in view." He did not approve of the appointment of an additional number of inspectors, and, therefore, he should enter his protest against any mode of proceeding, slow or otherwise, which would effect that. The hon. Member who had last spoken seemed to have taken quite a different view of the question from him, for he had characterised it as one containing a very simple question. He (Mr. Henley) did not think that these resolutions contained a simple or narrow question. There was a wider question contained in it than the mere appointment of these ten medical inspectors. He believed that the difficulty under which the Government had laboured since the introduction of the new poor-law, was, that they had taken too much of the responsibility of its administration on themselves, and, therefore, the public was disposed to throw the whole onus of the law, and its execution, upon the Government for the time being. If this step were taken, it would throw upon the Government an additional share of responsibility, without enabling them to discharge their duties, in respect of the poor-law, any better than before. There were at present 3,000 medical men working under the new poor-law at the different unions. Supposing a medical inspector, such as those proposed, should work 300 days in the year, he could at best only overlook one officer in a day, so that in all probability he would only be enabled to sec each individual medical officer under his charge once in the year. He had heard it stated that evening that one medical officer overlooked a population of 11,000, 2,600 of whom were paupers. What would be the use of one day's inspection over the treatment of such an immense mass? Directly they appointed these medical inspectors they would virtually relieve the guardians from all responsibility. The medical inspectors would take it all on themselves, and yet be able to do very little. He had that day heard, on high authority, that it was the intention that each medical officer should be overlooked once in six months. The inspectors would not have time to do it. [An Hon. MEMBER: Barely.] These inspectors could not ascertain by personal inspection the condition of the poor in any particular district, and yet they were going to appoint some ten or more gentlemen, at a considerable public expense, to go about regulating the condition of the poor, when they could have but very slight grounds upon which to draw up a report, and who would relieve the only parties in reality responsible from those duties which devolved upon them, and in that way do the poor mischief instead of good. The system, however, did not stop at the appointment of these ten inspectors; for they were informed that these parties were to be perfectly independent of all authority. There was to be no control over them; and the House had heard the hon. Member who had just sat down say, in referring to the medical body, "Only let them get you into their hands, and then see how they will physic you." That was a good prospect; but he believed that the people of this country would rather be fed than physiced, and they would rather trust themselves in the hands of those whose duty it was to look after their being fed, than to the mercies of those who had only their physic to attend to. With regard to the question which bad been raised as to the duties of these gentlemen in looking to the diet of the workhouses, he could not see how a medical man should be better acquainted with the mode in which the diet of a workhouse was to be conducted than any other man; and if that power were given to them, it would relieve the local authorities from their duty. He felt that this result was fraught with the greatest evils, for even at present there was a difficulty in getting the local authorities to act. There would be no difficulty in carrying out the poor-law efficiently if they got proper persons to put it in execution; and, certainly, if they removed the higher and more important class of duties from the present officers of the law, they could not expect better men in their places unless they created machinery which was not now adopted. They could not, perhaps, as the noble Lord had said, get a central authority which would discharge more ably those duties which were at present indifferently discharged by the local authorities; and thus the poor would suffer in the end. These were his opinions; and he, for one, should therefore give his decided opposition to the Motion of the noble Lord.

CAPTAIN PECHELL

said, that the hon. Gentleman who had just sat down had not dealt fairly with this question. He had referred to the question of diet and to the poor wanting food. The hon. Member had stated that these medical officers would be deficient in their duty to the poor by ordering physic instead of food. The hon. Member for Finsbury had often referred to this subject, and had expressed his opinion that it was from the want of food that physic became necessary; and it was not to be supposed that the poor would be kept on such a diet as to keep them constantly in the hands of the medical man. This Motion had been objected to by a right hon. Poor Law Commissioner, on the ground that it introduced the new doctrine of interference with the local administration, and also upon the score of expense. Now, as to the score of expense, there were, he maintained, quite sufficient funds in the Poor Law Commissioners' Office, and the rest of the machinery connected with it, to sustain the additional expense of the noble Lord's proposition. A fair and equal adjustment of the income-tax would produce from the Poor Law Commissioners' establishment quite sufficient to defray the expenditure incurred. As to the interference with the local management, there was strong evidence to show that the interference of the Government authorities, if exerted at proper times, would be beneficial both to the ratepayers and recipients of parochial relief. The hon. Member for Finsbury had clearly shown that they might safely dismiss that point from their minds. There was a similar system of inspection in operation with reference to the naval hospitals, by a Commissioner at Somerset House, which was beneficial. It had been asserted that the appointment of these ten medical officers was uncalled for, for that any person could look after the diet. It was, however, the general practice to refer the question of diet in all public establishments to the medical officer. On board ship the inspection of even the cook's coppers was intrusted to the medical gentleman, though it might be supposed that any of the petty officers was competent to that duty. The hon. Member for Finsbury was perfectly correct when he said, that if they could shove in a lawyer, they would do so to the invariable exclusion of the medical man. He considered, however, that this Motion was a step in the right direction, and that it could not be fairly opposed on the ground of expense. The objection to its interference with local managements could not be maintained on any decent ground. He should be glad if the noble Lord would make one alteration in his resolution—the alteration suggested by the hon. Member for Finsbury; but sooner than lose the Motion he would be content to take it as it was. There was a power taken in a late Act of Parliament, by which when any complaint was made from any union, that an additional officer should be appointed to investigate it. The Poor Law Commissioners had nothing to do with the appointment, which was in the hands of the Secretary of State; and he should be glad to see that power continue to remain in his hands with regard to these officers. He objected to the resolution only on the ground of the provision which it contained for the appointment of these officers. With regard to the Poor Law Commissioners not having time to visit the unions, it was their business to do it, and they must find time for it. The Commissioner of the coastguard might say, that he had no time to go round in consequence of his onerous duties at Somerset House; but that Commissioner did find time to go his rounds, and to discharge those duties also. Why, therefore, should not the Poor Law Commissioners do so? They would neither visit the unions themselves, nor let the House appoint proper medical men to do so. The medical body were hardly treated, and he hoped that the attention of the noble Lord would be directed to that fact, and that he would not suffer the objections made by the Poor Law Commissioners to operate to the disadvantage of that useful and deserving class.

LORD DUDLEY STUART

said, that he was placed in some difficulty with regard to one part of this Motion, and from that portion he must withhold his assent. He thought, upon the whole, that great credit was due to his noble Friend for bringing this subject before the House, and he only regretted that it was brought forward amidst so thin an attendance of Members. The House was full enough when the subject of the income-tax was under discussion, as that affected the interest of the middle classes; but now, the subject vitally affected the interests of the poorer classes only, he was sorry to see so small an attendance. Why it was so he could not conceive, for the subject deserved greater and closer attention; for there was, in his opinion, nothing more important to the well-being of the poor than well-regulated medical relief. He entirely agreed with his hon. Friend the Member for Fins-bury in his observations respecting the medical board. He had never met a set of men who had displayed more true humanity and benevolence to the poor than the members of that profession. He had seen them sacrificing their money, their labour, their time, and even, in many instances, sacrificing health and life, in order to render humane and charitable assistance to such poor persons as required their aid. It was impossible to say too much of the merits of that profession. The difficulty he felt in voting for this resolution applied to the latter part of it—not that part imposing on the medical inspector to be appointed the duty of pointing out the number of medical officers which ought to be employed in each union, for in that he concurred. He objected to their imposing the duty of fixing the salaries to be given to the medical officers for their services. He had heard with great pleasure some observations which fell from the hon. and learned Chief Commissioner with regard to local rights and privileges. The Chief Commissioner had said, that on those local rights depended very much the welfare of the country. He entirely agreed in that observation, and hoped that the hon. and learned Chief Commissioner would remember that principle when he came to press forward his Sanitary Bill and the Bill promoted by the noble Lord at the head of the Woods and Forests with regard to the metropolitan districts. He hoped that he would adhere to the importance of keeping those rights inviolate. He would repeat that he had an objection to enabling these medical inspectors to fix the salaries of the medical officers of the union, as it gave them the power of putting their hands into the pockets of the ratepayers. If the question of emolument were left to the guardians, as usual, the unions would be much better served. If this objection were removed, he should certainly support the Motion; but if otherwise, he could not bind himself to support it, however much he admired the principle expressed in it.

MR. ADDERLEY

suggested that if there were such a sum as 6,000l. or 10,000l. to spare, it would be much better applied in increasing the salaries of those medical officers at present employed, than in forming a new body of inspection. He could not say that the proposed body of inspectors would be very useful, for having been for many years a member of a board of guardians, he could only remember one occasion when such a body would have been of any real utility. That was a case where the treatment adopted by a medical officer was called in question, and the dispute was finally decided by a reference to other practitioners, who decided in favour of the system of treatment which had been adopted.

MR. E. DENISON

did not think that the right hon. Gentleman (Mr. C. Buller) merited the observations of the hon. Member for Finsbury. It appeared to him that the right hon. Gentleman had spoken with excellent sense, sound judgment, and good feeling. The explanation which the right hon. Gentleman had given was most satisfactory; if, therefore, the noble Lord should go to a division, he must give his vote decidedly against him.

The House divided on the question, "That this question be now put:"—Ayes 19; Noes 101: Majority 82.

List of the AYES.
Anstey, T. C.	Raphael, A.
Crawford, W. S.	Roche, E. B.
D'Eyncourt, rt. hon. C. T.	Scholefield, W.
Drumlanrig, Visct.	Sheridan, R. B.
Hamilton, Lord C.	Thompson, Col.
Hood, Sir A.	Trevor, hon. G. R.
Horsman, E.	Williams, J.
Monsell, W.	Wyld, J.
Napier, J.	TELLERS.
O'Connor, F.	Ashley, Lord
Pechell, Capt.	Wakley, T.

List of the NOES.
Abdy, T. N.	Labouchere, rt. hon. H.
Adderley, C. B.	Langston, J. H.
Armstrong, Sir A.	Lascelles, hon. W. S.
Armstrong, R. B.	Lewis, G. C.
Baring, rt. hon. F. T.	Magan, W. H.
Bellew, R. M.	Maitland, T.
Berkeley, hon. Capt.	Marshall, J. G.
Blackall, S. W.	Masterman, J.
Bolling, W.	Matheson, J.
Bourke, R. S.	Matheson, Col.
Bramston, T. W.	Morpeth, Visct.
Brotherton, J.	Neeld, J.
Buller, C.	Nugent, Sir P.
Burroughes, H. N.	O'Brien, J.
Campbell, hon. W. F.	O'Brien, T.
Carew, W. H. P.	O'Connell, M. J.
Christy, S.	Paget, Lord C.
Clay, J.	Paget, Lord G.
Compton, H. C.	Parker, J.
Craig, W. G.	Pilkington, J.
Deering, J.	Plowden, W. H. C.
Denison, J. E.	Power, D.
Devereux, J. T.	Power, N.
Duckworth, Sir J. T. B.	Prime, R.
Duncan, G.	Reynolds, J.
Duncuft, J.	Ricardo, O.
Dundas, Adm.	Robartes, T. J. A.
Ebrington, Visct.	Romilly, J.
Estcourt, J. B. B.	Scrope, G. P.
Fagan, W.	Seymour, Lord
Fagan, J.	Smith, J. B.
Filmer, Sir E.	Somerville, rt. hn. Sir W.
Floyer, J.	Sotheron, T. H. S.
Fordyce, A. D.	Strutt, rt. hon. E.
Fox, R. M.	Stuart, Lord D.
Fox, W. J.	Tennent, R. J.
Gibson, rt. hon. T. M.	Thicknesse, R. A.
Greene, J.	Thornely, T.
Grey, rt. hon. Sir G.	Trelawny, J. S.
Hall, Sir B.	Turner, G. J.
Hardcastle, J. A.	Urquhart, D.
Hay, Lord J.	Walmsley, Sir J.
Hayter, W. G.	Ward, H. G.
Heathcoat, J.	Wawn, J. T.
Heathcote, Sir W.	Westhead, J. P.
Heneage, G. H. W.	Willcox, B. M.
Henley, J. W.	Wilson, M.
Henry, A.	Wood, rt. hon. Sir C.
Howard, hon. C. W. G.	Wyvill, M.
Jervis, J.	TELLERS.
Keppel, hon. G. T.	Tufnell, H.
Kershaw, J.	Hill, Lord M.

Question not put,

LORD ASHLEY

then moved the 4th resolution, viz.:— That from and after the month of March next the appointment of medical officers of unions shall be permanent during good behaviour, they being removable only by the Poor Law Commissioners, whose decisions shall be final. He would not trouble the House long upon this resolution, which entirely depended upon the evidence given before the Select Committee. No less than thirty-five witnesses were examined on the point, and of those thirty-one were very strongly in favour of the permanent appointment of the medical officers; four dissented, but one of those was not able to say "yes" or "no," so that only three gave a decided opinion against the appointment being permanent. Dr. Russell, the rector of Bishopsgate, and chairman of the East London union, stated that he had not the slightest doubt that the medical officers ought to be independent, to enable them to do their duty justly towards the poor. He was asked— Do you think that, in the matter of recommending relief to the sick, such as wine, beer, or meat, the medical men would make such recommendation if they thought that by so doing they would place themselves at variance with the guardians? The answer was— I do not think that they would; I think a medical officer who is re-elected annually is placed in a very uncomfortable position, both to the poor and the board. He cannot be independent: and I think a board of guardians would be very cautions in appointing a man if they knew they were to appoint a permanent officer. Mr. Barnett, a guardian of the Stepney union, said— It is better that medical officers should be permanently appointed. There are many cases that come before the boards of guardians connected with the medical men; I allude, particularly, to the removal of nuisances, A great number of guardians are owners of small houses; and, should their premises get into a bad state, and the medical officer report them, I think it very likely he would suffer for it at his next election. I think that annual election prevents his independence. Mr. Goodwin confirmed such statement, having been a sufferer; and Mr. J. Fox, union-surgeon, of Serne, in the county of Dorset, stated— The situation should be permanent. If elected annually, we are very much under the influence of the guardians. A case came under my observation a short time ago. A medical officer was attending a poor woman, pregnant, and suffering from painful ulceration of the leg and varicose veins. Five loaves a week were allowed by the guardians to the husband, in order to pay a woman for performing the domestic duties. After a fortnight one of the guardians called her an idle hussy, and stated that the bread should be stopped, and that the medical officer, who had been instrumental in procuring the additional relief, should, when the 25th of March came, not receive any more of their money. It is a temptation, when men are struggling with difficulties, to avoid making an order for meat, or bread, or for any little thing of the kind. The whole evidence went to show that the independence of the medical man was suspended by the knowledge that he was annually elected, and that in nine cases out of ten he did not dare to give those recommendations for the relief of the poor which he knew would be distasteful to the board of guardians. Every other officer connected with these boards was permanently appointed. The clerk, the relieving officer, and the chaplain, were all permanently appointed. He wished to know the reason why the medical man, who had such great responsibility thrown on him, should not also be permanently appointed? There was one answer given in the examination of a man of great authority, which bore directly on this point. It occurred in the evidence given by Mr. Lewis, at that time Chief Commissioner of the Poor Law Commission. In answer to a question put to him he said— I am certain that in case any difference should arise between the board of guardians and the medical man, if the medical man were elected annually, he would run a very good chance of not being re-elected. It was said, if medical officers were permanently appointed, that a bar would be raised to the employment of young medical men, and that the average age of the officers would be increased. But no adequate reason could be alleged why medical officers should not be placed in an independent position, so that if they ordered meat and wine, in cases where they thought it their duty, they might act without fear of removal by a board of guardians.

MR. P. SCROPE

hoped the Government would concede this point. He had voted against the noble Lord on other resolutions, relying on the kindly spirit evinced by the two Members who had spoken on the part of the Government. He had great confidence that the objects of the noble Lord would be effectually carried out. The officers of boards of guardians were permanently appointed, with the invidious exception of the medical officers. The Poor Law Commission itself had recommended that they should be appointed permanently. If the Commissioners had not power to make an order to that effect, it ought to be settled by legislative enactment.

MR. C. BULLER

regretted that he could not accede to the suggestion of his hon. Friend. The effect of the resolution would be to deprive the poor of their only guarantee for attendance by medical officers to their wants. He disclaimed any language which could imply the slightest reflection on the intelligence, public spirit, and humanity of medical men; but that was a very different question from the appointment of ten medical inspectors. The ground of issue was very narrow. The noble Lord wished to establish the rule that all medical officers should hold their offices permanently, or during good behaviour, not being subject to annual re-election, and that they should be liable to removal only on proof of misconduct before the Poor Law Commissioners. Due attention, he thought, could not be secured from medical officers holding office by a permanent tenure, and paid by salary. In about half the unions, the guardians had this hold over the medical man, that if he did not give them satisfaction, they would not re-elect him. The noble Lord wished to transfer that power to the Commissioners. He did not see the advantage of that transfer, though it might enable medical officers sometimes to go on fearlessly in the discharge of their duties. It would make medical officers practically irremovable. The office was not one to which the rude test proposed was applicable. Was it enough that a medical officer should not show gross ignorance—should not actually murder the poor by negligence—should not have moral delinquency proved against him? It would be hard dealing with the poor to subject them to treatment by one whom no one would employ in his own parish. Was it not necessary that the medical man should be skilful and learned in his profession—that he should be zealous in the discharge of his duties—that his manners towards the poor should be civil and kind—that he should not only have those qualities, but be reputed to have them? Who was the best judge of those qualifications—a Commissioner, sitting in Somerset House, acting through inspectors, or the board of guardians, the neighbours of the medical man, who knew him in all the relations of life, and were aware of the estimation in which he was held by the poor? He did not reject the task which it was proposed to impose on him because it involved too much trouble; but because he sincerely believed that a person in his position was not so competent to decide those questions as boards of guardians. No case had been made out for an alteration. An argument had been founded on the tenure by which the clerk, master of the workhouse, and relieving officers held their appointments; but these were constantly liable to be brought in opposition to the boards of guardians, and would not be re-elected if they refused to obey illegal orders given by the guardians. Those officers looked to the Commissioners, who thereby controlled the system. The duties of the clerk and others were few and definite; the qualifications of the medical man were far too delicate to be investigated by a central authority. He would never venture to remove a medical officer unless some specific offence were proved against him on inquiry, though notoriously deficient in ability, zeal, and kindness to the poor. He was not very squeamish in such matters; but he begged the House to consider whether it were wise, now that he was a Member of Her Majesty's Government, and holding his office by a political tenure, to make 3,000 gentlemen, many of them actively political, entirely dependent upon him throughout the country. This was a consideration which ought to have been suggested by the vigilant Opposition; but as the Gentlemen—the Opposition—seemed to have forgotten their principles, he felt it to be his duty to remember that he was an Englishman before he was a Commissioner, and to remind the House that they were incurring some danger in pressing upon him an amount of patronage which he did not wish. It was with great reluctance that he opposed the resolution of the noble Lord, embodying as it did a principle on which he understood the members of the medical profession entertained a strong feeling, and which was supported by many staunch friends of the poor on both sides of the House; but he trusted the House would believe that he did so only from a strong conviction that the change proposed was a most unwise one, and that it would damage the very cause which it was intended to promote. He begged to move the previous question.

MR. WAKLEY

remarked that the right hon. Gentleman had stated that one-half of the medical appointments were permanent. Did he mean to let them remain so? or did he mean to bring in a Bill to alter them? It was understood when the new poor-law was passed, that it was to introduce a uniform system—clearly defined and well understood; but where was the uniformity here? The noble Lord had proposed a resolution to which the medical profession looked with great anxiety, and what was its object? To make the one-half of the medical appointments similar in their tenure to the other. The right hon. Gentleman opposed the Motion. Now, this seemed to him to be very inconsistent. He could conceive nothing more so. He could easily believe that the right hon. Gentleman had had representations made to him that the medical officers who held permanent appointments were not sufficiently subservient. The fact was, however, that it was utterly impossible for the medical practitioners to do their duty unless they were made independent. The right hon. Gentleman must know—at all events he ought to know—that, in a great many instances medical men dared not act in an independent spirit and do their duty to the poor, in consequence of the manner in which they were treated at the end of the year, when their engagement expired. If one of them gave the slightest offence to a relieving officer, or any of the creatures about the board, some complaint was immediately raised against him, and he was got rid of. The House would remember the circumstances connected with Mr. Westlake's case, in the Andover union. Did the right hon. Gentleman think that medical men ought to be exposed to such persecution as that? In what way was Mr. Westlake treated? His was, no doubt, an extreme case; but there were many minor cases precisely of a similar character. Mr. Westlake exposed the abuses of the Andover union; and, in consequence of having done so, he was persecuted until he was under the necessity of leaving the town, and where he was now he did not know. If Mr. Westlake's appointment had been a permanent one, the tyranny exercised over him would not have been displayed, and he would have continued to hold his situation, greatly to the benefit of the poor. What had lately happened at Croydon, in Surrey? A Mr. Bottomly, a man of great skill in his profession, had held the office of surgeon to the union for six years, with great credit to himself, advantage to the neighbourhood, and satisfaction to the poor; and yet, in consequence of what the guardians had chosen to consider improper conduct in his partner, he was obliged to resign. The boards of guardians would always act in this way to medical men if they showed the slightest independence. The only remedy was, to make the appointment permanent. The right hon. Gentleman had failed to show why there should he any distinction made between one portion of the medical officers and another—why, in one union, their appointments should he permanent, and in another annual. This ought to have been explained to the House. He should vote for the Motion of the noble Lord.

CAPTAIN PECHELL

wished the medical officers to be permanently appointed. Had a permanent medical officer existed in the Andover union, the disgraceful abuses which were proved to have prevailed there would either have been exposed at an earlier period, or altogether prevented. The conduct of the board of guardians of that union towards Mr. Westlake was most tyrannical.

MR. WALTER

had accidentally been absent during the discussion which had taken place upon the first two resolutions proposed by the noble Lord the Member for Bath; had he been present, it would have afforded him great pleasure to support them, as he certainly would the resolution at present under consideration. He would take that opportunity of expressing the gratification with which he had heard the orthodox doctrine propounded by the right hon. and learned President of the Poor Law Commission, that the reference of local questions to the Central Board was a thing to be deprecated. If the right hon. and learned Gentleman should continue to inculcate such doctrines, there would be some chance that, eventually, the central authority would be still further dispensed with. With respect to the present question, he thought it impossible that the House could conceal from itself that the choice of two difficulties lay before it. From his own personal observation he had had opportunities of knowing that the right hon. and learned Gentleman's statement, with respect to the incapacity of parish doctors, was fully home out. To declare that a parish doctor should in no case be superseded by the local authorities unless a specific charge should have been brought and proved against him, might be productive of injury to the parishioners. That was one difficulty. On the other hand, the results of his experience prompted him to concur in the statement of the hon. Member for Finsbury, that parish doctors frequently laboured under a disadvantage, and were, indeed, in some cases prevented from doing their duty in consequence of the disinclination of the guardians to allow that which was very often more necessary for the afflicted poor than physic—nourishing food. Of the two evils he would choose that which would be least injurious to the poor. Believing that under the circumstances of the case it would he hotter to make the medical officer a permanent appointment, he would vote for the noble Lord's resolution.

LORD DUDLEY STUART

suggested that the words "during good behaviour" should be omitted.

MR. HINDLEY

was very much opposed to the annual election of medical officers; but he did not see so much objection to their being made permanent, with the exception that they should be removable only by the boards of guardians. The proposition of the noble Lord, however, was quite of a different character. He believed the medical officers of prisons were removable by the parties who appointed them, and he thought it would be best if the dismissal of union medical officers were vested in the local boards of guardians. It might happen that the local authorities might have a perfect knowledge that the medical man did not duly or satisfactorily attend to the poor, and yet find it impossible to make out such a ease as would cause his removal by the Poor Law Commissioners, supposing them to have the exclusive power to dismiss him. And it often occurred that sonic circumstances, at the bottom of which it was difficult to get, engendered such a dislike to a particular medical man on the part of the poor themselves as rendered his services distasteful to them; and though it might sometimes be hard to assign any very valid reason for their objection to him, such as would convince those unacquainted with the immediate district, yet, knowing how much the comfort of the poor depended upon their having the attendance of a medical man on whom they could rely, he considered it advisable that the local boards, who could better understand the true state of the ease, and sympathise with the feelings of the necessitous people in their respective localities, should have the power of appointing and dismissing the union medical officer.

LORD ASHLEY

said, he was quite willing to strike out the words "during good behaviour" from the resolution, and to substitute "removable only by the Poor Law Commissioners" in their place, in order to obviate the difficulty.

MR. C. BULLER

objected to the re- sponsibility that would be entailed upon the Poor Law Commissioners if such an arrangement were established.

The House divided upon the previous question, when there appeared:—Ayes 36; Noes 98: Majority 62.

List of the AYES.
Anstey, T. C.	Robartes, T. J. A.
Archdall, Capt. M.	Roche, E. B.
Brotherton, J.	Scholefield, W.
Clay, J.	Scrope, G. P.
Cobbold, J. C.	Sheridan, R. B.
Crawford, W. S.	Spooner, R.
Drumlanrig, Visct.	Stuart, Lord D.
Dunne, F. P.	Thompson, Col.
Fagan, W.	Trevor, hon. G. R.
Fox, W. J.	Turner, G. J.
Hall, Sir B.	Vesey, hon. T.
Hamilton, Lord C.	Walter, J.
Henry, A.	Williams, J.
Hood, Sir A.	Willoughby, Sir H.
Monsell, W.	Wortley, hon. J. S.
Napier, J.	Wyld, J.
O'Connor, F.
Pechell, Capt.	TELLERS.
Perfect, R.	Ashley, Lord
Raphael, A.	Wakley, T.

List of the NOES.
Adderley, C. B.	Hardcastle, J. A.
Anson, hon. Col.	Hay, Lord J.
Armstrong, Sir A.	Hayter, W. G.
Armstrong, R. B.	Heathcote, Sir W.
Bagge, W.	Heneage, G. H. W.
Baring, rt. hon. F. T.	Henley, J. W.
Bellew, R. M.	Howard, hon. C. W. G.
Berkeley, hon. Capt.	Keppel, hon. G. T.
Bolling, W.	Kershaw, J.
Bouverie, hon. E. P.	Labouchere, rt. hon. H.
Bowring, Dr.	Langston, J. H.
Boyle, hon. Col.	Lewis, G. C.
Bramston, T. W.	Magan, W. H.
Buller, C.	Mahon, The O'Gorman
Campbell, hon. W. F.	Maitland, T.
Carew, W. H. P.	Marshall, J. G.
Carter, J. B.	Masterman, J.
Christy, S.	Matheson, J.
Clements, hon. C. S.	Matheson, Col.
Compton, H. C.	Morpeth, Visct.
Cowper, hon. W. F.	Morris, D.
Craig, W. G.	Mulgrave, Earl of
Deering, J.	Neeld, J.
Denison, J. E.	Nugent, Sir P.
Devereux, J. T.	O'Brien, T.
Drummond, H.	O'Connell, M. J.
Duckworth, Sir J. T. B.	Paget, Lord G.
Duncan, G.	Parker, J.
Duncuft, J.	Pearson, C.
Dundas, Adm.	Pilkington, J.
Ebrington, Visct.	Plowden, W. H. C.
Estcourt, J. B. B.	Power, Dr.
Fagan, J.	Power, N.
Filmer, Sir E.	Prime, R.
Floyer, J.	Repton, G. W. J.
Fordyce, A. D.	Reynolds, J.
Fox, R. M.	Ricardo, O.
Gibson, rt. hon. T. M.	Rich, H.
Greene, J.	Romilly, J.
Grey, rt. hon. Sir G.	Somerville, rt. hn. Sir W.

Sotheron, T. H. S.	Walmsley, Sir J.
Strutt, rt. hon. E.	Ward, H. G.
Sullivan, M.	Watkins, Col. L.
Tenison, E. K.	Wilson, M.
Tennent, R. J.	Wood, rt. hon. Sir C.
Thicknesse, R. A.	Wood, W. P.
Thompson, Ald.	Wyvill, M.
Thornely, T.
Urquhart, D.	TELLERS.
Vane, Lord H.	Tufnell, H.
Verney, Sir H.	Hill, Lord M.

Resolution not put.

Remaining resolutions withdrawn.