+ All Categories
Home > Documents > ABUSES AT THE LONDON HOSPITALS

ABUSES AT THE LONDON HOSPITALS

Date post: 05-Jan-2017
Category:
Upload: vodang
View: 217 times
Download: 3 times
Share this document with a friend
2
116 peculiar tint while producing the test colour of the strychnine, and consequently in no way interferes with the result. Upon the capabilities of this adjustment the real value of the bichromate depends. It is obviously impossible for us to give the precise proportions of sulphuric acid and bichromate of potash (chromic acid will do quite as well) for the quantity of strychnine; but every operator, by experimenting with solutions of strychnine of known and diminished ratios, will soon learn for himself. We have stated that the solution of strychnine should be in chloroform; for while, with the precautions and manipulations that we have published, we believe that preference will almost universally be given to this fluid over ether, benzole, &c., for the purpose of ,first separating strychnine from the subject of analysis, still we readily admit that the fluid chosen for this purpose is not of such paramount importance as that the solu- tion of this poison finally prepared for treating should be in chloroform, for the simple reason that, while the other fluids, such as ether, have a remarkable tendency to spread over the surface on which they are put for evaporation, and so dilute, as it were, by extension, chloroform, by having a con- trary tendency, leaves the strychnine on a smaller space than the fluid occupied at the moment of its transference to the porcelain. We observe with satisfaction that Dr. Glover, in his letter published in your columns of the 12th inst., has expressed an opinion identical with ours published by you on the 28th ult. We are, Sir, your obedient servants, J. E. D. RoDGERS, M.R.C.S.E., &c., Lecturer on Chemistry at the St. George’s School of Medicine. G. P. GIRDWOOD, Assistant-surgeon, Grenadier Guards. Laboratory, St. George’s School of Medicine, July, 1856. J. E. D. RODGERS, M.R.C.S.E., &c., Lecturer on Chemistry at the St. George’s School of Medicine. G. P. GIRDWOOD, Assistant-surgeon, Grenadier Guards. NERVES AND GANGLIA OF THE UTERUS. T. SNOW BECK. To the Editor of THE LANCET. SIR,—The feeble and evasive reply of Dr. Robert Lee, in THE LANCET of the 12th ult., cannot be accepted as an answer to the questions which have been several times publicly ad- dressed to him. Some further explanation is requisite than the statement of Dr. Lee-viz., " I have not been guilty of furtively destroying the structures which I had discovered, and to display which so much time and labour has been expended." No one has accused Dr. Lee of destroying structures which have no existence, but he is accused of certain practices which can only be characterized as scientific frauds. Three of these I have particularized:- 1. He has created a deceptive appearance of continuity between the hypogastric nerves and the muscular system of the uterus, by paring, with scissors, the surface of the connect- ing cellular tissue, previously blanched and hardened by lengthened maceration in alcohol. 2. When this deceptive appearance of continuity was no longer required, as in the dissections of the virgin uterus, he has furtively removed the cellular tissue, apparently in order to make the nerves of the virgin uterus appear smaller than those of the gravid organ; and whilst doing this in private, has publicly declared the removal of this neurilerama " unwarrant- able," "unjustifiable," "unprecedented," and that dissections so treated become I I mutilated specimens." 3. He has described in his own handwriting, and caused to be figured, upwards of fifty ganglia on the surface of the heart, which have no existence in nature. Each of these charges I am prepared to substantiate by re- ference to his own dissections and his own writings. It is therefore not sufficient for Dr. Lee to say, " I have not been guilty," for by his own works it can be proved that he has put forth statements which cannot be substantiated, and that he has caused structures to be represented which do not exist in nature. Perhaps you will allow me to offer a few words in explana- tion of the course I am now adopting. It is upwards of ten years since Dr. Lee began a system of misrepresentation with regard to my researches on the constitution of the sympathetic nervous system, and the nervous supply of the uterus and neighbouring organs; and during this long period, I have allowed these misrepresentations to pass almost unanswered, in the expectation that the author of them would cease to put them forth, and that the researches to which they referred would be finally estimated in accordance with any value they might possess. But in this I appear to have been mistaken; the misrepresentations continue, and even now, after so many 1]6 years, there does not appear any probability that they will cease. Under these circumstances, I feel forced to terminate this almost unceasing annoyance, and find I can only do so, with a chance of success, by exposing the practices which have been put in requisition to bolster up these assumed and much- vaunted discoveries. Any defence of my own researches would only have led to further mispresentations and improper insinua. tions. The reluctance with which this course has been adopted, and the pain which this denunciation even now gives me, may be estimated from the fact, that I have borne a continued in- jurious misrepresentation for upwards of ten years rather than have recourse to it. I am, Sir, &c., Langham-place, July, 1856. T. SNOW BECK. To the Editor of THE LANCET. SIR,—" Dr. Snow Beck has two specimens," says Dr. Herschfeld, " in the preparation of which he employed eight months, removing from day to day, with forceps and needles, (as he told me himself,) not merely the cellular tissue, but the neurilemma even, so that he has left only the fasciculi of the nervous tubes. It seems to me that the work of this anatomist ought not to be appealed to, when the subject of the volume of the nerves of the uterus is agitated, for they only present the nerves deprived of one of their constituent parts—the neuri- lemma. " I have read Dr. Beck’s paper on the Nerves of, the Uterus in the " Philosophical Transactions" for 1846, and have not been able to find the most remote allusion to the fact above stated, and now admitted to be correct. Will you permit me to inquire of him why this fact was not explicitly stated in the paper, and if it was made known to Dr. Todd, Dr. Sharpey, or Mr. Bowman, the individuals through whose exertions chiefly the Royal Medal was fraudulently awarded in 1845 ? I am, Sir, yours, &c., July, 1856. INVESTIGATOR. ABUSES AT THE LONDON HOSPITALS. To the Editor of THE LANCET. SIR,—Permit me to call attention, through the medium of THE LANCET, to what must be considered a most serious evil in one, at any rate of the London schools of medicine-viz., St. Bartholomew’s. Whether the evil exists in other schools I know not, but that it does exist in St. Bartholomew’s I do know, having been a student there for the last few years. The evil to which I allude is the great want of punctuality of some (I may venture to say, of most) of our physicians and surgeons in their daily visits round the hospital wards. Every student who has at all diligently attended the ward practice of this hospital must long ago have felt the serious inconvenience and loss of valuable time which he has had to put up with, from the inattention to punctuality of those whose ward practice he has been attending. In the school, the professors have stated times for the delivery of their lectures, and they observe these hours most scrupulously. In the hospital, also, the physicians and surgeons have hours fixed for them to visit the wards; but many of them observe these hours only so long as they have no private engagements to call them away. Now, many of these gentlemen, having large private practices, have many private engagements, and as they allow these engagements to interfere with their hospital visits, the consequence is, that their visits to the wards are made very irregularly, and clinical instruction is given in a most hurried and negligent manner. I could mention one or two gentlemen at this hospital, who, while scrupulously punctual in the delivery of their professional lectures, pay their visits to the hospital wards pretty much as it suits their convenience. Now, Sir, is this just to the stu- dents attending their practice, who mostly pay pretty hand- somely for that privilege ? If, as is generally allowed, ward practice is by far the most important part of one’s hospital career; and if punctuality is demanded (and obtained) in the daily delivery of lectures in the theatre, surely it should be in- sisted upon in the daily visits to the bedside. , What is the consequence of this evil and what is the remedy for it? The consequence is, that clinical instruction, from being irregularly and negligently given by the teachers is often totally neglected by the pupils. I remember not a few who gave up "going round" in disgust ; finding day after day that the physician’s or surgeon’s visit was most uncertain, and that when he did make his appearance his only object was to hurry over the cases as rapidly as possible and be off again. When we compare the manner in which clinical instruction is given
Transcript
Page 1: ABUSES AT THE LONDON HOSPITALS

116

peculiar tint while producing the test colour of the strychnine,and consequently in no way interferes with the result.Upon the capabilities of this adjustment the real value of

the bichromate depends. It is obviously impossible for us togive the precise proportions of sulphuric acid and bichromateof potash (chromic acid will do quite as well) for the quantityof strychnine; but every operator, by experimenting withsolutions of strychnine of known and diminished ratios, willsoon learn for himself.We have stated that the solution of strychnine should be in

chloroform; for while, with the precautions and manipulationsthat we have published, we believe that preference will almostuniversally be given to this fluid over ether, benzole, &c., forthe purpose of ,first separating strychnine from the subject ofanalysis, still we readily admit that the fluid chosen for thispurpose is not of such paramount importance as that the solu-tion of this poison finally prepared for treating should be inchloroform, for the simple reason that, while the other fluids,such as ether, have a remarkable tendency to spread overthe surface on which they are put for evaporation, and sodilute, as it were, by extension, chloroform, by having a con-trary tendency, leaves the strychnine on a smaller space thanthe fluid occupied at the moment of its transference to theporcelain.We observe with satisfaction that Dr. Glover, in his letter

published in your columns of the 12th inst., has expressed anopinion identical with ours published by you on the 28th ult.

We are, Sir, your obedient servants,J. E. D. RoDGERS, M.R.C.S.E., &c.,

Lecturer on Chemistry at the St. George’sSchool of Medicine.

G. P. GIRDWOOD,Assistant-surgeon, Grenadier Guards.

Laboratory, St. George’s School of Medicine, July, 1856.

J. E. D. RODGERS, M.R.C.S.E., &c.,Lecturer on Chemistry at the St. George’s

School of Medicine.G. P. GIRDWOOD,

Assistant-surgeon, Grenadier Guards.

NERVES AND GANGLIA OF THE UTERUS.

T. SNOW BECK.

To the Editor of THE LANCET.

SIR,—The feeble and evasive reply of Dr. Robert Lee, inTHE LANCET of the 12th ult., cannot be accepted as an answerto the questions which have been several times publicly ad-dressed to him. Some further explanation is requisite thanthe statement of Dr. Lee-viz., " I have not been guilty offurtively destroying the structures which I had discovered, andto display which so much time and labour has been expended."No one has accused Dr. Lee of destroying structures whichhave no existence, but he is accused of certain practices whichcan only be characterized as scientific frauds. Three of theseI have particularized:-

1. He has created a deceptive appearance of continuitybetween the hypogastric nerves and the muscular system ofthe uterus, by paring, with scissors, the surface of the connect-ing cellular tissue, previously blanched and hardened bylengthened maceration in alcohol.

2. When this deceptive appearance of continuity was nolonger required, as in the dissections of the virgin uterus, hehas furtively removed the cellular tissue, apparently in orderto make the nerves of the virgin uterus appear smaller thanthose of the gravid organ; and whilst doing this in private, haspublicly declared the removal of this neurilerama " unwarrant-able," "unjustifiable," "unprecedented," and that dissectionsso treated become I I mutilated specimens."

3. He has described in his own handwriting, and caused tobe figured, upwards of fifty ganglia on the surface of the heart,which have no existence in nature.Each of these charges I am prepared to substantiate by re-

ference to his own dissections and his own writings. It istherefore not sufficient for Dr. Lee to say,

" I have not beenguilty," for by his own works it can be proved that he has putforth statements which cannot be substantiated, and that hehas caused structures to be represented which do not exist innature.

Perhaps you will allow me to offer a few words in explana-tion of the course I am now adopting. It is upwards of tenyears since Dr. Lee began a system of misrepresentation withregard to my researches on the constitution of the sympatheticnervous system, and the nervous supply of the uterus andneighbouring organs; and during this long period, I haveallowed these misrepresentations to pass almost unanswered, inthe expectation that the author of them would cease to putthem forth, and that the researches to which they referredwould be finally estimated in accordance with any value theymight possess. But in this I appear to have been mistaken;the misrepresentations continue, and even now, after so many

1]6

years, there does not appear any probability that they willcease. Under these circumstances, I feel forced to terminatethis almost unceasing annoyance, and find I can only do so,with a chance of success, by exposing the practices which havebeen put in requisition to bolster up these assumed and much-vaunted discoveries. Any defence of my own researches wouldonly have led to further mispresentations and improper insinua.tions. The reluctance with which this course has been adopted,and the pain which this denunciation even now gives me, maybe estimated from the fact, that I have borne a continued in-jurious misrepresentation for upwards of ten years rather thanhave recourse to it. I am, Sir, &c.,Langham-place, July, 1856. T. SNOW BECK.

To the Editor of THE LANCET.SIR,—" Dr. Snow Beck has two specimens," says Dr.

Herschfeld, " in the preparation of which he employed eightmonths, removing from day to day, with forceps and needles,(as he told me himself,) not merely the cellular tissue, but theneurilemma even, so that he has left only the fasciculi of thenervous tubes. It seems to me that the work of this anatomistought not to be appealed to, when the subject of the volume ofthe nerves of the uterus is agitated, for they only present thenerves deprived of one of their constituent parts—the neuri-lemma."

I have read Dr. Beck’s paper on the Nerves of, the Uterusin the " Philosophical Transactions" for 1846, and have notbeen able to find the most remote allusion to the fact abovestated, and now admitted to be correct. Will you permit meto inquire of him why this fact was not explicitly statedin the paper, and if it was made known to Dr. Todd, Dr.Sharpey, or Mr. Bowman, the individuals through whoseexertions chiefly the Royal Medal was fraudulently awardedin 1845 ? I am, Sir, yours, &c.,

July, 1856. INVESTIGATOR.

ABUSES AT THE LONDON HOSPITALS.To the Editor of THE LANCET.

SIR,—Permit me to call attention, through the medium ofTHE LANCET, to what must be considered a most serious evil inone, at any rate of the London schools of medicine-viz., St.Bartholomew’s. Whether the evil exists in other schools Iknow not, but that it does exist in St. Bartholomew’s I doknow, having been a student there for the last few years. Theevil to which I allude is the great want of punctuality of some(I may venture to say, of most) of our physicians and surgeonsin their daily visits round the hospital wards. Every studentwho has at all diligently attended the ward practice of thishospital must long ago have felt the serious inconvenience andloss of valuable time which he has had to put up with, from theinattention to punctuality of those whose ward practice he hasbeen attending. In the school, the professors have stated timesfor the delivery of their lectures, and they observe these hoursmost scrupulously. In the hospital, also, the physicians andsurgeons have hours fixed for them to visit the wards; butmany of them observe these hours only so long as they have noprivate engagements to call them away. Now, many of thesegentlemen, having large private practices, have many privateengagements, and as they allow these engagements to interferewith their hospital visits, the consequence is, that their visitsto the wards are made very irregularly, and clinical instructionis given in a most hurried and negligent manner.

I could mention one or two gentlemen at this hospital, who,while scrupulously punctual in the delivery of their professionallectures, pay their visits to the hospital wards pretty much asit suits their convenience. Now, Sir, is this just to the stu-dents attending their practice, who mostly pay pretty hand-somely for that privilege ? If, as is generally allowed, wardpractice is by far the most important part of one’s hospitalcareer; and if punctuality is demanded (and obtained) in thedaily delivery of lectures in the theatre, surely it should be in-sisted upon in the daily visits to the bedside.

, What is the consequence of this evil and what is the remedy

for it? The consequence is, that clinical instruction, from beingirregularly and negligently given by the teachers is oftentotally neglected by the pupils. I remember not a few whogave up "going round" in disgust ; finding day after day thatthe physician’s or surgeon’s visit was most uncertain, and thatwhen he did make his appearance his only object was to hurryover the cases as rapidly as possible and be off again. Whenwe compare the manner in which clinical instruction is given

Page 2: ABUSES AT THE LONDON HOSPITALS

117

here with the manner in which it is given in the French Hos-pitals, we ought to blush.The remedy for this evil is simple enough. Our physicians

and surgeons must never allow private engagements to inter-fere with their hospital duties. If they willingly accept thesepublic posts, they are bound to perform the duties attached tothem, at any sacrifice of private practice ; not to neglect theseduties and use the appointment merely as a stepping-stone tohelp them into private practice.

I enclose my card, and remain, Sir, yours, &c.,July, 1856. BARTHOLOMŒENSIS.

THE TREATMENT OF HOOPING-COUGH.

P. J. HYNES, M.D., M.R.C.S.E.

To the Editor of THE LANCET.

SIR,—Having received more than one communication frommedical gentlemen, remarking upon the strength of the doseof the tincture of lyttæ ordered in the paper which you did methe honour of publishing in THE LANCET of the 19th inst., "Onthe Abortive Treatment of Hooping-Cough," I wish to correcta very serious error which has crept into that paper, and whichmight lead to alarming results. The formula in Barker andMontgomery’s Pharmacopoeia, is as follows :-

R Tinct. cinchonæ, iv." cantharidis, 5iij." opii camphorat., gss.

Sumat cochleare parvum ex cochleare magnoinfusi lini. ter in dies.

Your readers will observe that only half an ounce of tinctureof cinchonas, four drachms instead of four ounces, is mentionedin the paper alluded to. I may also add that the tincture ofcantharides of the Dublin Pharmacopœia, is considerably weakerthan that of London, and is made as follows :-

R Tinct. lyttse, 5ii.Spirit tenu., Oiss.

Macera per dies septem, dein fola.I am, Sir, your very obedient servant,

Nottingham, July, 1856. P. J. HYNES, M.D., M.R.C.S.E.

ON POISONING BY STRYCHNIA.To the Editor of THE LANCET.

SIR,—AS so much has been written and said about poison-ing with strychnia, I should not have thought it advisableto relate a case which happened in my practice nearlytwenty years ago, had not a letter in your number of the 12thinst., from Dr. Glover, thrown some doubt whether strychniawas the instrument of death employed by Palmer in Cook’s case.What I am about to relate happened soon after the discovery ofstrychnia, and the only knowledge I possessed at the time wasfrom reading an article on the subject published in THELANCET of that day, in which the symptoms produced by anoverdose were described.

Mrs. W-, a lady about forty-five years of age, of a veryexcitable temperament, had been suffering for some time fromscrofulous enlargements of the joints, for which she had beenunder my care.One evening I received an urgent message to attend imme-

diately. I found her sitting in a chair, herself, her daughter,and attendants being in great alarm. Before I could ask anyquestion, she screamed, " My dear Doctor, do something forme." In an instant the eyes appeared to be starting from theirsockets; the head was forcibly drawn round, the arms and legshorribly convulsed, she being conscious at the same time. Thislasted about a minute or two, when she became calm. I hadno knowledge that she had applied to any other medical man,or that she had taken any medicine excepting what she hadreceived from me ; but it flashed across my mind that it wasthe effect of strychnia. I said to the daughter, "Good God!your mother is poisoned; she has taken strychnine!" She nowconfessed that her mother had consulted the late Mr. Shorland,of Ilchester, and that he had given her some small pills, one totake twice a day ; that she thought they were so small theydid her no good, and therefore had taken two pills at one time.I gave her a dose of castor oil; afterwards a mixture withcamphor, ether, and opium. The spasms gradually subsided,and the next day she was pretty well. On Mr. Shorland’sarrival he acknowledged that the pills contained one-eighth ofa grain of strychnia. She had therefore taken one quarter ofa grain. I think there is no doubt twice the quantity wouldhave killed her.

I mention this case to show that the symptoms were sostriking and so different from those produced by any otherdisease as to carry conviction to the mind at once, and confirmsthe opinion you gave in an excellent article in THE LANCETimmediately after the trial-that the physiological evidence inthis case is of more importance than the chemical; in whichopinion I fully concur, and were I a juryman, in a case of lifeand death, I should hesitate before I gave a verdict on theevidence of a person, be he ever so scientific, who asserted hehad discovered the 50,000th part of a grain of poison in thedead body.

I consider Dr. Hall’s frog test a physiological one, and themost valuable in chemistry.A friend and neighbour of mine, a few years ago, had a

number of pigs poisoned. The contents of the stomach of onewas taken to him, but he failed to discover the cause of death,although it could not be doubted the pigs were poisoned.

I am, Sir your obedient servant,Martock, July 14th, 1856. R. W. MARTYN.R. W. MARTYN.

WHAT IS AN M.D. OF A BRITISH UNIVERSITY?To the Editor of THE LANCET.

SIR,-You would, of course, reply to my query that he isone who holds the highest academical degree in Medicine.But is he a physician, surgeon, or apothecary ? I have justhad this matter solved, although not quite to my satisfaction.I met a friend-who I am often in the habit of meeting—a.fellow of the London College of Physicians. After writing theprescription and signing his initials, he asked my Christianname, and said, " As you are not connected with the College,of Physicians, although you hold the degree of Doctor ofMedicine, I must write your surname, and style you as sur-geon." Thus, Sir, my recognised title was ignored, as M.D.was omitted after my name. What think you of that ? I wasquite aware that the College of Physicians could not grant thetitle of Doctor, and I have yet to learn that its fellows orlicentiates can disavow this degree. I am aware that theCollege most unwarrantably styles all its licentiates Doctors,when some hold no degree in medicine, and that such callthemselves Doctor without any right to do so. Let graduatesin medicine not connected with the London College look tothis, and for the future call persons by their right names-e. g.,licentiates, not M.D.’s, Mr., and not Dr. If this is to be themanner of showing honour to whom honour is due, let themseek more for consultations amongst their ouna class thanamongst those who are capable of such illiberal and unfairbehaviour. I have yet, too, to learn that ollly those connectedwith the London College have the right to sign their initials totheir prescriptions.All graduates in medicine must now know that they are

surgeons. But if a man only holds the degree of Doctor ofMedicine, and possesses no diploma, what is he ? Pray, Mr.

Editor, tell me. Such cases exist. Before the recent Act ofParliament, M.D.’s of the University of London were eithersurgeons, apothecaries, or-? but not physicians. Accordingto a matter of dry law, M.D.’s of Dublin, Edinburgh, andelsewhere, are not physicians until these universities obtainsimilar privileges; and yet forsooth the London College haswisely and liberally offered, by way of medical reform, to admitM. D.’s of any British University to the privileges of theirCollege, provided it obtains the advantages it desired !

But, Sir, the London College is a monopoly too expensivefor some to join in, whilst others, who could afford to pay forits diploma, could not afford to be connected with it on accountof the restrictions which it enjoins. Thus talent alone is notits portal. Whilst the majority of its fellows are men of skill,are none to be found not up to the present state of knowledge,and whose knowledge, too, of auscultation, &c., is inferior tothat of a modern apothecary ?The London College, were it to enforce its legal powers of a

bygone time, would not be tolerated, and, like its more humbleneighbour, the Society of Apothecaries, must act with similarliberality, though less in degree. For most men who obtainthe degree of Doctor of Medicine have undergone an examina-tion in no way inferior to the London College, whilst those whopractise medicine merely with the diploma of the College ofSurgeons of England have undergone no examination in medi-cine whatever.In concluding, I would desire to give a hint to some of the

modern members of the College of Physicians. Not unfre-quently some of them, on meeting an M. D. surgeon or apothe-cary, write a prescription and hand it to the gentleman met

117


Recommended