Provincial Medical & Surgical Journal

1841 BMJ (Clinical Research Edition)  
One of the difficulties connected with the im. provement of the condition of the medical profession, and not the least important in relation to the interests of a large body of practitioners, is the mode of remuneration of the general practitioner. However much changes, calculated to place the existing institations on a level with the advanced spirit of the times, may be required, it is still more necessary that the numerous and highly intelligent class referred to should be elevated to a
more » ... elevated to a position corresponding with their professional attainments. The general practitioners have now almost superseded the mere apothecary, and, at this time, constitute what may be termed the commonality of the profession. They are, for the most part, deservedly in possession of the confidence of the public, and cases of severe and dangerous disease are now entrusted to their care, equally with the ordinary attacks of sickness, in which the advice of the physician or surgeon is rarely sought. The interests of this body of practitioners, in any scheme of reform which may be adopted, will, therefore, require special attenition. The existing Apothecaries' Company, whatever may become of it as a pharmaceutic board, has obviously but small claims to exercise future control over a numerous body of professional gentlemen, whose educational and general attainments are so superior to those contemplated by the company as requisite in their own licentiates. To submit a superior class of men to the rules of an inferior order, can scarcely be contended for. A new aculty, college, or incorporation must therefore be constituted, in which the general practitioners may be enrolled, and under which their privileges may be defined, and their interests protected. We believe that the most efficient general reform of the profession, and the most desirable which, inder present circumstances, can take place, would be the constitution of such a faculty or college on liberal and comprehensive principles; the tlhrowing open the Colleges of Physicians and Surgeons; the converting of the Company of Apothecaries into a pharmaceutical college; and the combining the powers of these different bodies in one general council, a portion of which should consist of extra-professionial members appointed by, and connected with, the government. The main difficulty to be provided for in such a scheme would be the constitution of the newbody. Into this we have now no intention of entering; bu't the one pdiiit td which we have alluded, the mode of remuneratiah, forms so important a feature in the practical working of any measure which may hereafter be adopted, that we are induced to devote a few' observations especially to this topic. That which at present exists is manifestly the very worst that could be devised. It is equially bad in principle and injurious in practice. The attempt at obtaining remuneration for skill, and compensation for valuable time, by a high charge for drugs or a larger supply of medicines than the circumstances of the case call for, is a species of practical deceit which is equally discreditable to the practitioner and disadvantageous both to himself and the public. This injurious and fraudulent custom, and the degradation attendant upon it, must be got rid of; and though the difficulties connected with its abolition are great, perlhaps more than have yet been fathomed, we would fain hope that they are not insurmountable. Several methods by which the medical attendant might be remunerated upon less objectionable principles, have been at different times suggested, some of which appear deserving of more extended consideration than they have met with. The proposal to relieve the general practitioner from the mechanical process of compounding and dispensing medicines, and to separate altogetlier the practice of pharmacy from that of medicine, surgery, and obstetrics, is, perhaps, that which most completely obviates the main objections urged against the existing modes of remuneration. It is to be feared, however, that in country districts it would scarcely be possible to carry such a proposition into effect. The requirements of a thinly scattered population are too limited to support an express pharmaceutical establishment, and in such cases there appears but little prospect of providing medicines and other remedial agents for the inhabitants by any other means than throughthe medium ofthe residentmedicalpractitioner. There is, moreover, no sufficient reason why medicines should not continue to be thus supplied. There is no actual degradation in the practice of pharmacy; many of its processes require considerable manual dexterity, and scientific knowledge of some depth b&cdcnes necessary to comprehend the principles on which they are founded. It is the abuses which have sprung up in connection with it-the charging for the drug or medicine supplied, at a price often extravagantly high, in relation to its marketable value, and the estimating the time of the prescriber, and the far higher qualities of genuine medical attainments, skill, and experience, at naught, which tend to conivert the supply of medicine, after this manner, into an extortionate trade, and to lessen the respectability, and injure the character of the practitioner. Were the reveries of Hahnemann to prove correct, and could medicine be administered with effect in the infinitismal doses of the homcmopathist, nothing would be more easy than the abolition of all pharmaceutical establisliments for the dispensing of medicine. The physician and the general practitioner might then carry about with them their pocket cabinet of medicinal agents, stored with globules of aconite, of arnica, of pulsatella, &c., in sufficient quantity, to supply the wants of itleir patients for an indefinite period; and it would become as much a matter of couirse for them to do so, as it now is for the surgeon to cariy hiis pocket case of inistruments. So far also from any degradation attaclhing to it-the neatness of the whole -= I i I 230
doi:10.1136/bmj.s1-3.12.230 fatcat:7q2vmwnjafejtpwxcdg6cbrwpe