1528 PAUPER LUNACY FEES.
think a saflicient case has been made out for the adoptic n
of a special system or the abolition of any of the methods
which have been discussed. At the present day we have
become such victims to fashion that it permeates into our
lives and affects our actions more than we care to admit.
Religion itself is not free from its effects. In the legitimate
branch of our own profession it exerts a baneful influence
and on the illegitimate side the harm it does is appalling.
Yesterday it was Count Mattei, to-day it is the violet leaves,
and to-morrow who knows what it will be? We must be
careful in considering the punishment of our young people
not to allow ourselves to be swayed by such an influence.
In choosing methods of punishment I cannot help think-
ing that it would be a wise plan to endeavour as far
as possible (if I may use a well-known phrase) I Ito make the
punishment fit the crime." For instance, while, on the
one hand, I should not approve of a form of punishment
which kept a lad indoors and so deprived him of the neces-
sary fresh air and physical exercise, on the other hand it
appears to me that if a boy fails to learn his lesson the
natural punishment is to keep him in after school hours
while he does learn it. It is probable that instead of devoting
the time he should have devoted to the preparation of his
lesson he was playing about, perhaps out-of-doors, so that in
the end you will not deprive him of his necessary exercise.
Of course, in such a system it is essential that the master
should sufficiently gauge the capacity of his pupil so that he
may not be set a task beyond his ability. Corporal punish-
ment should be reserved for really serious sins, such as un-
truthfulness, theft, immoral practices, &c., and should be
administered with some degree of comparison to the offence.
No one, I think, can defend the system of ear-boxing, pinching,
pin-pricking, or roasting, and the old custom of slashing boys
on the hands is equally to be condemned. It is far better for
their bodies and more humiliating to their minds if the punisli-
ment is inflicted upon that portion of their body which nature
appears to have specially designed for that purpose. The
object of this punishment is to produce pain without damag-
ing the soft parts, consequently it should never be performed
with a fine cane, which is liable to cut the skin, nor should
it be applied to the skin without any covering or in too rough
or too extensive a manner. If the recipient is made to
kneel down and a good thick cane be used half a dozen
smart stripes could rarely do harm. Boys have a great idea
of justice, and providing that this is exercised they will
generally accept their punishment in a proper spirit and
profit by it, but I should like in conclusion to put in a plea for
the personal factor. Every boy is a study in himself, and if
a master observes his pupils as he ought he will soon ascer-
tain that a form of punishment which is most suitable to one
boy is totally unsuitecl to another. While I should like to
feel that all could be dispensed with I am sure that it would
be most undesirable to fix upon any one method, and the wise
master is he who makes use of them all in the cases to which
they are applicable.
I am, Sirs, yours faithfully,
J. LIONEL STRETTON,
Senior Surgeon to the Kidderminster Infirmary and
Nov. 26th, 1901. Children’s Hospital.
PAUPER LUNACY FEES.
Zb the ll’ditors of THE LANCET.
SiRs,-I commenced practice in this town in May, 1880 ;
my predecessors then had been in practice many years,
probably some of them 40 years. I at that time accepted
he proffered fee of £1 11s. 6d. for examining and certifying
pauper lunatics. This I presumed was the usual fee, as I was
not likely to be given a higher fee than my predecessors
had been in the habit of accepting. This fee has been paid
ever since until this year in the neighbourhood of this town.
At a town distant about seven miles the fee has been one
guinea. On August 2nd the following circular letter was
forwarded to every magistrate :—
DEA-IT SIR.-I am directed to inform you that the guardians of this
union have had under consideration the question of the fee usually
allowed by the justices to medical practitioners for certifying as to the
state of mind of an alleged lunatic, which fee the guardians have to
pay ; and on Saturday last they directed me to inform every magistrate
that in their opinion the amount usually allowed-viz.. £1 Ils. 6d.-is
too high for ordinary cases. Yours faithfully,
-, Clerk.
You will observe, Sirs. that the fee of £1lls. 6e-l. is in this
letter admitted to be usual. Subsequently to the knowledge
of this circular letter the following was sent to the medical
men practising in this union :—
DKABSIR,-A resolution has been passed by the -
Guardians
to apply to the magistrates to retluce the fee payable to medical
men for certifying pauper lunatics from Pl 11s. 6d. to JE1 ls. May I
add your name to the list of medical men practising in the union
who are determined to resist this reduction and refuse to certify for
less than a fee of .E1 lls. 6d.? If so will you sign and return this card ?
The replies were 20 in favour, four doubtful, and one against.
On Oct. 31st, at a meeting of medical men, the following
motion was passed unanimously :-
That we, the medical men practising in the --
Union, do
in future refuse to take a less fee for certifying pauper lunatics
than .El lls. 6d. (one guinea and a half) and that a copy of this
resolution he forwarded to the Editors of the British Medical Journad
and THE LAfcn’r.
wish to elicit is your opinion on our case with,
What we
perhaps, comments on the action of the one practitioner who
refused to join us. I regret that only nine attended the
meeting, but the others were unfortunately prevented. May
I add that the magistrates who so far have allowed the guinea
fee only are likewise guardians. On the other hand, when the
circular in question was laid before the bench of magistrates
then sitting it was unanimously decided that the usual fee
was not too high and a letter from the chairman of the bench
to a medical man on this question is as follows :-
Justice’s Clerk’s Office, Town-hall, -, Nov. 5th, 1901.
Be Examination of Lunatic.
DEAR SIR,-The chairman ...... has handed me your letter to him of
the 3rd inst. touching this matter and has directed me to write you in
reply thereto. While the magistrates consider the amount of allow-
ance to the medical man is a matter in the discretion of the justice
condacting the examination, after consideration of the circumstances
peculiar to each examination they think the amount, .El11.9. 6d.,
seeing that the justice has to rely almost implicitly on the medical cer-
tificate, is not an excessive fee, more so as the medical man is frequently
called upon to exercise minute inquiry and much caution before giving
his certincate, which inquiry and caution it is desirous to encourage.
Yours obediently,
-, Clerk.
I wish to add it is feared that the abstention of the one
medical man may seriously endanger the success of the com-
bination ; the reason he gives for doing so is that he has
entered into an "agreement" with a relieving officer to
accept the fee of one guinea.
I am, Sirs, yours faithfully,
Nov. 15th, 1901. R. W.
We understand the matter to be
governed by the
Lunacy Act of 1890, Section 285, Sub-section (1). The
fee is to be such reasonable remuneration as the justice
"
thinks proper." We have no hesitation in saying that the
fee of £1lls. 6d. is not unreasonably high, and that
the letter of the clerk to the justices states precisely
and with admirable exactness the reasons why it is not
excessive. The guardians may have the right to lay before
the magistrates any objections which they have to paying the
amount usually allowed in the district, but the matter is abso-
lutely in the magistrates’ discretion. We must point out also
that although it is incumbent on the guardians to consider
the public purse it is primarily their duty to consider the
public welfare, or rather the welfare of those persons for
whom the medical examination to be remunerated is to be
provided. The "minute inquiry and much caution"to
which the clerk to the magistrates refers is a necessity in
such cases and the fee must be such that self-respecting
medical practitioners will accept it. The certificates
in question should not be given after hasty examination
or accepted from a practitioner willing to undersell
his colleagues.-ED. L.
THE FORTHCOMING ELECTION OF
DIRECT REPRESENTATIVES.
To the Editors of THE LANCET.
SIRS,-With regard to the position of parochial medical
officers in Scotland, for 30 years as a parish medical officer
and since I have ceased to hold such a post I have in season
and out of season advocated that my late colleagues should
have the right of appeal against dismissal to the Scottish