The District Medical Officers are obliged to visit all patients who have obtained a medical order and to supply them with medicines as desired. Every fortnight they have to make a return of their cases to the Clerk for the inspection of the Guardians. Where the districts they serve are some distance from their surgery, the Guardians may call upon them to provide a branch surgery.
The payment made by Boards of Guardians is not excessive. A few instances may be mentioned :—Medical Officer with 220 cases in twelve months, Urban District, 1'80; Medical Officer, 160 cases, rural, £100 ; Medical Officer, 85 cases, urban, £60; Medical Officer, 100 cases, area of 10,000 acres, rural, £70; Medical Officer, 65 cases, area of 5600 acres, rural, £40; Medical Officer, 400 cases, area of 4350 acres, urban, £120. In certain instances, subject to the approval of the Local Government Board, the Medical. Officer may obtain special fees for extraordinary services. These are practically all scheduled and include the payment of £5 for "treatment of compound fracture of the thigh, or treatment of compound fracture or compound dislocation of the leg, or amputation of leg, arm, foot, or hand, or operation for strangulated hernia." The Guardians cannot pay, however, until the Local Government Board approve in writing.
age of sixty-five, or if he has served forty years he may claim this at sixty. He pays every year 2 per cent. of his salary as a contribution towards the Superannuation Fund. The maximum allowance for forty years' service is two-thirds of the emoluments he has received for an average of five years before his superannuation. For twenty years of service the allowance is reckoned as twenty-sixtieths or one-third.
A Resident Medical Officer at a Workhouse receives from £150 per year, with furnished quarters and rations. An assistant officer starts with about £90 to £100.
Public Medical Officer of a Workhouse or a parish may also receive the appointment of Public Vaccinator for his district. The Medical Officer of a Workhouse is entitled to receive not less than 2s. 6d. for each first vaccination or re-vaccination. In the case of a parish officer he is to be paid 2s. 6c1. for a visit to the patient's home for vaccination in London or a borough of 50,000 population, and 3s. 6d. in other cases. The
fees vary according to the distances travelled by the officers. The conditions governing the operation are carefully prescribed by the Local Government Board.
Master of the Master is in supreme charge of the Workhouse. Usually a joint appointment is made : the husband is appointed Master and the wife Matron. Matters of administration affecting the women in the house are referred to the Matron. She also cuts out many of the necessary garments and controls the stock of clothes for the inmates. Workhouses usually have attached thereto three or four or more acres of land and the Master directs gardening operations, the care of pigs, wood chopping and many of the minor repairs to be executed by the inmates. Like the Relieving Officer, both the Master and Matron, but especially the Master, must be thoroughly conversant with the consolidated orders in which are detailed his own duties and obligations as well as those of the other officers.
The Master usually secures his appointment after serving as porter or Relieving Officer. In some cases he may be appointed entirely from the outside, but this is very seldom. The appointment can only be adequately filled by one who has served in some such capacity as that indicated. The Matron by preference should have been a certificated nurse, or Assistant Matron. In a fairly large Workhouse the joint salaries will amount to £150 (V100 to the Master and £50 to the Matron), including rations, furnished apartments, servant, &c.
Superintendent large and up-to-date Workhouses possess infirmaries where are treated the pauper patients who cannot obtain the necessary care and nursing in their own homes. To all intents and purposes these infirmaries are equivalent to ordinary hospitals supported by voluntary subscriptions. They are placed under the supervision of a Superintendent Nurse who is responsible for her patients to the Medical Officer from whom she receives her instructions. Matters of discipline usually remain in the hands of the Master. The Superintendent Nurse must be certificated in midwifery and general nursing. Her salary varies from £40 to £60 with quarters, rations and washing. Workhouse infirmary nursing is now calling forth a much better class of nurse than was formerly the case.