[5] Dr. Thomson tells me that he has known white precipitate of mercury sold in hundred-weights as calomel, and in one case (he believes by accident or ignorance) as trisnitrate of bismuth. In my text I have endeavoured to adduce such illustrations as I suppose to be most notorious; but I may refer the reader to various interesting papers published, through the last two or three years, in the Lancet (Analytical Sanitary Commission) from one of which I quote the astounding instance, given above, of variations in the strength of laudanum. Mr. Thomas Taylor, of Vere Street, informs me that, whereas an ounce of laudanum should contain about four grains of morphia, he finds the actual quantity varying in different specimens from two grains to six; and that in two specimens of solid opium, outwardly alike and supposed to be of equal quality, he has found the per centage of morphia to vary from 31⁄2 to 10. It requires little instruction in medicine to appreciate these facts.
Again, with the promiscuous sale of poisons, what incredible laxity of government! One poison, indeed, has its one law. Arsenic may not be sold otherwise than coloured, nor except with full registration of the sale, and in the presence of a witness known to both buyer and vender. Admirable, so far as it goes! but why should arsenic alone receive this dab of legislation? Is the principle right, that means of murder and suicide should be rendered difficult of access for criminal purposes? Does any one question it? Then, why not legislate equally against all poisons?—against oxalic acid and opium, ergot and savin, prussic acid, corrosive sublimate, strychnine?
Nor can our past legislators be more boastful of their labours for the medical profession—either for its scientific interests, or for the public protection against ignorance and quackery.[6] Nearly two dozen corporate bodies within the United Kingdom are said to grant licences for medical practice; and I hardly know whether it lessens or aggravates this confusion, that such licences are in many cases partial; that one licentiate may practise north of the Tweed, but nowise to the south; that one may practise in London, another only seven miles beyond it. Not that the licence seems much to matter! for innumerable poachers in all directions trespass on what the law purports to sell as a secured preserve for qualified practitioners: their encroachments are made with almost certain impunity; and—as for the titles of the Profession, any impostor may style himself doctor or surgeon at his will. Even where licences are held, conveying identical titles, they imply neither equal privileges (as I have said) nor even uniform education. The law has troubled itself little as to the terms on which they shall be granted; and the qualifications exacted from candidates—the conditions preliminary to their becoming eligible for licence, vary in so remarkable a degree among the many corporate bodies which are fountains of this honour, that the credentials conferred have really little meaning, apart from a context which the public is unable to supply. It is charged against particular institutions, that their degrees and licences are attained with a very inglorious facility; and when it is recollected that the issuing of such testimonials is a source—sometimes a chief source—of income to the corporations which grant them, it will be felt that at least there must exist great danger of this reproach being sometimes deserved. If a national title to practise medicine is to be granted by several Boards, and if yet the tenure of that title is to determine public confidence in favour of its holder, it would seem indispensable that some guarantee should be given for these several licences representing equal qualifications—some guarantee that the holder in each case possesses professional knowledge, and has enjoyed professional opportunities, at least above some uniform standard recognised as a minimum qualification by all the diplomatising bodies. Indispensable, however, as this may seem, years of endeavour have failed to attain it. What is called medical reform has been agitated longer than I can remember; and more than one minister has been willing to legislate for its promotion. Unfortunately the very magnitude of the evils has delayed their cure. With the constitution I have described—a system of conflicting jurisdictions, of licences without titles, and titles without licences, how could we escape internal dissension? how escape the antagonism, perhaps the jealousies, of rival corporations and of different professional classes? Home-Secretaries have had little leisure to fathom these things to the bottom. Unexamined and unadjudicated by any competent authority, such influences have bewildered public judgment, made statesmen regard us with despair, postponed legislative correction, and maintained us in a state of anarchy and confusion, best to be appreciated when we compare with our own the organisation and government of the legal profession.
[6] Legislative passiveness towards scientific medicine is not the only evil we have to complain of. Surely, in selling Letters Patent for the protection of quack-medicines—in seeming to sanction and authenticate whatever lies their proprietor may post upon the wall, the State demeans itself into complicity with fraud, and soils its fingers with something fouler than the Vespasian tax. It illustrates the curious forgetfulness shewn towards medicine by the Legislature, that this immoral practice of giving patents for pretended cures of disease should have been allowed to continue—as of course it must have continued, solely by oversight, till past the middle of the nineteenth century.
And be it noted, how this reacts upon the State. So completely is our government dissevered from Science in general, and, most of all, from the sciences relating to Life, that, on such subjects, there exists not for state-purposes anything like a tribunal of appeal. The Legislature recognises no Medical Authority. Occasionally this fact stands out in painful conspicuousness, and brings most injurious results. In contested cases requiring scientific testimony—before Parliamentary Committees, for instance, and in a variety of legal proceedings,—instead of the Court having satisfactory power of referring particular questions to skilled impartial adjudicators, the uniform practice is, that scientific men are retained on opposite sides, to support partisan interests. The advantages, such as they are, which belong to this system, might, I believe, easily be obtained under altered arrangements: the disadvantages are glaring. It might be invidious to refer to illustrations of their reality: but it is of course impossible to doubt of the working of this system, that, in so far as it makes each witness feel himself engaged to maintain the views of his employer, it tends towards a moral prostitution and subornation of science. In the interests of truth, it would surely seem desirable that scientific evidence should be tendered, so far as may be, in a judicial spirit towards the suit; either that the technical point should be referred to a technical jury, or that the technical witness should be summoned at the Court’s discretion, should be examined in-chief by the Court, and should be subject only to such cross-examination as may procure the most complete statement of his knowledge on the matter in hand.
Having said so much on the defects and the wrongs of our existing sanitary condition, perhaps I may venture to speak of the almost obvious remedy. ‘Almost obvious’ I say; for surely no one will doubt that this great subject should be dealt with by comprehensive and scientific legislation; and I hardly see how otherwise, than that it should be submitted in its entirety to some single department of the executive, as a sole charge; that there should be some tangible head, responsible—not only for the enforcement of existing laws, such as they are or may become, but likewise for their progress from time to time to the level of contemporary science, for their completion where fragmentary, for their harmonisation where discordant.
If—as is rumoured, the approaching re-constitution of the General Board of Health is (after the pattern of the Poor-law Board) to give it a Parliamentary President, that member of the Government ought to be open to challenge in respect of every matter relating to health. What, for this purpose, might be the best subordinate arrangements of such a Board, it would take a volume to discuss. But at least as regards its constituted head, sitting in Parliament, his department should be, in the widest sense, to care for the physical necessities of human life. Whether skilled coadjutors be appointed for him or not; engineers—lawyers—chemists—pathologists; whether he be, as it were, the foreman of this special jury, or, according to the more usual precedent of our public affairs, collect advice on his own responsibility, and speak without quotation of other authority than himself, his voice, unless the thing is to be a sham, must represent all these knowledges.
The people, through its representatives, must be able to arraign him wherever human life is insufficiently cared for.
He must be able to justify or to exterminate adulterations of food; to shew that alum ought to be in our loaves, or to banish it for ever; to shew that copper is wholesome for dessert, or to give us our olives and greengages without it; to shew that red-lead is an estimable condiment, or to divert it from our pepper-pots and curries.
Similarly with drugs and poisons—the alternatives of life and death—a minister of Public Health would, I presume, be responsible for whatever evils arise in their unlicensed and unregulated sale. He would hardly dare to acquiesce in our present defencelessness against fraud and ignorance; in doses being sold—critical doses, for the strength of which we, who prescribe them, cannot answer within a margin of cent. per cent.; or in pennyworths of poison being handed across the counter as nonchalantly as cakes of soap.[7] Surely, before he had been six months in office, he would have procured some enactment to remedy this long neglect of the legislature, by providing that the druggist’s trade be exercised only after some test of fitness, and in subjection to certain regulations.