348 "SPECIALISM tN MEDtCINE.’’-BRMINGI-AM.

askance at the claims for the Fellowship of those of itsmembers whose chief work is avowedly surgical"-that isto say, that an obstetric physician may operate as much a.she likes from below: remove fibroids, cure fistula, extirpatethe uterus and ovaries per vaginam as hitherto, but once lethis knife wander above the level of the mons veneris, eventhough he feels convinced he can save his patient more surelythan by operating per vaginam, he puts himself outside thepale-the Fellowship of the College is not for such as he.This statement, Sirs, is such a serious one that in theinterests of many present-and of all future-obstetricphysicians, it surely calls for some definite ruling on

the part of the authorities of the College. Of all theobstetric physicians and assistant obstetric physiciansin London and the provinces there are, I believe, onlyfive who do not perform abdominal section ; of the five onewas a very successful ovariotomist until the claims of anextensive midwifery practice caused him to cease doingthese operations; two are prevented by the rules of the

hospital to which they have become attached from continuingto perform abdominal sections ; and the remaining two have,I believe, never so operated.

Sir W. Priestley suggests that those obstetric physicianswho perform abdominal section should take the Fellowshipof the College of Surgeons ; but as one who possesses thisvaluable diploma I would respectfully point out to the

president and council of the Royal College of Physicians that ifthey refuse the Fellowship to obstetric physicians who operateon the female pelvic organs per abdomen, and give it, as hasbeen done for many years, to those who operate per vaginam,a grave injustice will be inflicted on many gentlemen who,on becoming obstetric physicians, looked forward to beingmade Fellows of their College in due course, provided theyhad done nothing derogatory to the dignity of the pro-fession. By all means, if it is thought desirable, let it bea law that in fitture obstetric physicians who performabdominal section shall not be eligible to become Fellowsof the Royal College of Physicians, but in common justice let:such law not be retrospective. Sir W. Priestley asks : "Areour antiseptic methods a sufficient safeguard against the

possible contamination of lying-in patients by one whoundertakes extensive surgical work in addition to obstetricpractice?" " I answer emphatically " Yes ; and a man whohas operated on a pyosalpinx or a suppurating ovariantumour can, in a quarter of an hour, make it perfectlysafe for him to attend a lying-in woman." Let meask Sir W. Priestley this question, " Which is more likely tokeep himself aseptic, the obstetric physician who performsabdominal section, and who from the very fact of doingthese operations is imbued with the profound importance ofkeeping himself and all his paraphernalia aseptic, or he whodoes not so operate, but who may at any moment have toattend a midwifery case soon after examining a patientsuffering from a stinking vaginal discharge?" " Thesolution of the difficulty as to the obstetric physicianoperating Sir W. Priestley finds in "appointing a gynae-cological surgeon to every hospital, who shall work in

conjunction with the obstetric physician." If by this hemeans that every disease of the female peculiar to her sex(caruncles, polypi, vaginal cysts, uterine cancer, &c.) maybe diagnosed by the physician, but must be handed over

to the surgeon for operation, then I say that no obstetric

physician of repute will hold office under such conditions ;but if he means that the obstetric physician may (as at

the Samaritan Hospital) do whatsoever operation he likes

per vaginam, but must pass on all cases requiring abdominalsection to the surgeon, then I say that in my humble opinionit is a case of " straining at a gnat and swallowing a camel."For my part I agree with what Dr. Herbert Spencer of

University College Hospital said in a paper which he readbefore the Medical Society, that it would be a wise and

gracious act on the part of the surgeons in every hospital tohand over to their obstetric colleagues all the cases of disease ofthe female generative organs requiring abdominal section ; thishas, I believe, been done for some years at King’s College Hos-pital without friction between Dr. Playfair and his sur-

gical colleagues. In conclusion, let me repeat now what I saidin the discussion on Dr. Spencer’s paper: "As the art ofobstetrics is in great part surgical, those who practise thatart should be called obstetric surgeons, that the qualificationfor holding such a post at a hospital should be the F.R.C.S.and not the F.R.C.P., and that the existing anomaly wasthe fault not of the College of Physicians, but of the Collegeof Surgeons, which in years gone by refused to shelter

under its wing the obstetrician." Apologising for the lengthof this letter, I am, Sirs, yours faithfully,I Harley-street, Aug. 3rd, 1895. WILLIAM DUNCAN.WILLIAM DUNCAN.

"SPECIALISM IN MEDICINE."To the Editors of THE LANCET.

SIRS,—the growth of knowledge has rendered specialism"necessary. There was a time when the surgeon could com-

pass all knowledge, not only of medicine and surgery, butalso of hairdressing. Now only a Crichton could master thefacts of the various divisions of medicine and surgery, in-cluding ophthalmology, gynaecology, dermatology, laryngo.logy, otology, bacteriology, and the dozens of other " ologiespertaining to medical science. I agree, however, with theleading article in THE LANCET of July 20th when it says thatpractical experience of general medicine is advisable andnecessary before a special branch can be adequately dealt with.Unfortunately, it is becoming common for young men to studya subject with special industry before qualification with a viewto the beginning of practice at once in that subject only.To start on a professional career in this manner is likely toresult in practice of a one-sided and narrow character. Theseinfant specialists have no doubt studied the various branchesof medicine in which they are examined for theirdiplomas. But even this moderate knowledge of generalmedicine will be below that of the average newly qualifiedman on account of the undue attention given to theirselected special subject. Starting practice, then, with evenless than the average stock of general knowledge, and looking Z)

at everything with the coloured glasses of their speciality,how defective must be their apprehension and treatment ofdisease. On the other hand, he who has devoted some yearsof his life to general practice will see the inter-connexion ofthe general and special diseases, and of the latter with eachother, without which knowledge no special branch can besatisfactorily practised. Nothing else can supply this train.ing and insight, and the want of it gives a bias and narrow.ness that is the cause of most of the abuse of specialism inthose that take it up from their medical birth. Otherwise itis liable to abuse as much, and no more, than the practise ofgeneral medicine. It would be well if no one started in

special practice without having had ten years’ experience ingeneral work. I am, Sirs, yours truly,July 31st, 1895. A SPECIALIST.A SPECIALIST,

BIRMINGHAM.

(FROM OUR OWN CORRESPONDENT.)-

t

Action against a BU1’gcon.AT the present Warwickshire Assizes an action was brought

by Charles Stevenson against Dr. Eagar of Stourbridge torecover damages for alleged negligence. The plaintiff hadan accident which resulted in a dislocated shoulder, which itwas alleged had not been properly attended to. There wasskilled professional evidence on both sides as usual. It wasadmitted that the plaintiff was subject to epileptic attacks,and the defence asserted that any subsequent injury foundarose from this cause. The verdict was given for the

defendant, Dr. Eagar, who may be congratulated uponhaving cleared himself from the imputations made upon hischaracter and his skill.

Bcc7aX; Holiday.The exodus of a large number of inhabitants of the large

towns at this season of the year is growing to an enormousdegree. In this town the present time has broken record inthe enormous number who have availed themselves of cheapexcursions for short periods. And yet the advantages mustbe mixed with some alloy of risk to health. Packed in closerailway carriages, deprived of natural rest by night travelling,and subject to all the inconveniences and dangers of inclementweather, it may well be remarked that these English peopletake their pleasure sadly. The consequences follow thesedisturbed conditions of ordinary life in disorders of nutri-tion and exposure to wet and cold. If the demand forexcitement and change continues at the same rate of progresssome alteration must be made in the usual railwayarrm1ge-ments, or some measures taken to make the holidays lessuniversal. Appointing different seasons to various localities

349MANCHESTER.—SCOTLAND.—IRELAND.

as bank holidays would obviate much of the disorganisationwhich now exists.

1’lae Hospital Saturday P’Imd.Already the administrators of this fund have begun to

make arrangements and anticipate the wants of the comingyear 1896. A steady increase of the amount asked for yearby year has taken place, and now a penny a week from theworkmen of numberless establishments is sought for. Inview of all the advantages offered by the Hospital SaturdayFund-admission to the convalescent homes, nurses in case ofsickness at home, and surgical appliances and instruments-this cannot be considered too much to ask for. Nor does thisrefer to the contributions of women or boys employed at thevarious workshops and manufactories. The amount of<E13,500 is put down as the requirements of the succeedingyear, and active efforts will be made to obtain it.Aug. 6th.

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MANCHESTER.(FROM OUR OWN CORRESPONDENT.)

Ilrtcoats Hospital.THE annual meeting was held on Wednesday last, Sir

W. H. Houldsworth, M.P., occupying the chair. Foundedin 1828, and containing something over 100 beds, it has donemuch good work in a poor neighbourhood. But the report,as is too often the case, speaks of increasing work with anincreasing adverse balance at the bank. The total receiptsfor the year were C4174 19s. 2d. The expenditure was.B5347 Is. lld., leaving a deficit of .61172 2s. 9d. Duringthe past two years the adverse balance had increased by.B26216s.4d. The medical report showed increasing demandson the out-patient department. Sir W. Houldsworth men-tioned that a legacy of .E600 had been left to the hospital bythe widow of the late Bishop Fraser. He said hebelieved more hospital accommodation would have tobe provided in Manchester, and "he was convincedthat the future solution of the question wouldnot be the extension of any one hospital, but itwould be the establishment of local hospitals in variousparts of the city close to the people who required them."This opens such questions as the increased cost of adminis-tration, with a falling-off in funds, and the provision ofskilled physicians and surgeons, and the further question oftheir position and status. Are they to be what is called

"pure" physicians and "pure" surgeons, and, if so, are theyto live on their professional incomes, or will the staffs beformed from the neighbouring general practitioners ? 7

JJIancltester Grarmnar School.This ancient school had its speech-day on the 31st ult. in

the Free Trade Hall. Mr. King, the high master, presided.He said that Sir Frank Lockwood, the chief name on theirlist of honours for this year, had promised to attendand give an address, but was unable to do so. Therewas a long list of old pupils who had achieved dis-tinction, and the honour list showed that the schoolhad this year obtained eight open and three close scholar-ships at Oxford and Cambridge. "The honours won

by former scholars of the school afforded fresh evidence,if evidence were needed, that from an industrial centrelike Manchester they could send some to tread the paths ofliterature and scholarship. E. T. Whittaker had won theSheepshanks Astronomical Exhibition at Cambridge, and hadalso been bracketed second in the mathematical tripos. Thiswas the third time in the last five years that the SecondWrangler had been an old Mancunian ...... No fewer thanten scholarships at Owens College had been won by grammar-school boys." In addition to these, five science, six com-mercial, and three art scholarships and exhibitions offeredby the Lancashire County Council and the Manchester Cor-poration had been won by grammar-school boys.

31-agic7tester llTuse2cm, Owens Oollege.Some short time since the Museum Committee memorialisecl

the Corporation for aid in its maintenance, there being anannual deficit of .E1200. The Museum was visited on

May 2nd by the Free Libraries Committee, and they weremuch impressed with its admirable arrangement and greatvalue as an educational agent. The committee considersthis claim reasonable, but as the Museum is open to, andused by, many who are neither residents nor rate-

payers of Manchester, it thinks it may be expedient for

the Museum authorities to invite the co-operation of other

neighbouring corporations and county and district councils.The committee recommend a grant of 400 a year to bemade out of the public libraries rate, on condition that &pound; 800a year be obtained from the Lancashire and Cheshire

County Councils and from local district councils. The

report of the committee is to be considered at the CityCouncil to-morrow, where it is to be hoped the memorial willbe favourably considered.

C7aiZcZ Pa1lpe?’S and Potato-pie.This subject still affords matter for discussion among

the Salford guardians, one of whom at their last meetingreported a diminution in the thickness of the crust from 3 in.to 4 in. to three-quarters of an inch, "which was a greatimprovement." Though fit for children aged from nine tofifteen, he agreed with the medical officer that it was unfitfor those aged from three to five. The chairman thoughtpaste three-quarters of an inch thick was not fit for youngchildren, with which opinion most of us would agree. Itwas not stated that they were to have some other delicacyinstead of it. The medical officer is said to be dissatisfiedstill with the pastry, which he may well be, if it is to be thefood of children aged from three to five.Aug. 7th.

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SCOTLAND.

I (FROM OUR OWN CORRESPONDENT.)

- SA University Graduation Ceremonial.THE graduation ceremonial in medicine at Edinburgh took

place last week. The degree of Doctor of Laws was con-ferred upon two medical men. One of these was Dr. ThomasEdmonstone Charles of Rome; the other Dr. S. Weir-Mitchell of Philadelphia. Both these gentlemen were pre-sented in appropriate speeches to the Vice-Chancellor bySir Ludovic Grant, who pointed out that they might serveas a bright example and encouragement to those who werereceiving degrees that day at the termination of a suc-

cessful student career. Thereafter a large number ofDoctors of Medicine and Bachelors of Medicine were intro-duced and officially capped. Professor Greenfield deliveredthe address to the graduates, congratulating them upontheir achievements and urging upon them to do their utmostto promote the renown and success of the University and toincrease its material prosperity. He alluded to the fact thatin spite of the noble buildings the part devoted to pathologyhad not been completed and was devoid of the accommoda-tion and appliances essential to the most important part ofpathological research. From this the lecturer turned tomatters affecting the graduates themselves, and concludedby an eloquent exposition of the proper relations that shouldexist between a medical man and his patients.

-zvetv Hospital Site fom -EcZigibitry7t.The Leith Corporation have had a request from the Edin-

burgh authorities for ground on which it is proposed to erecta temporary hospital in room of the hospital which is to beremoved from the Queen’s Park. Some technical difficultyregarding the ownership of the land having arisen the Leithauthorities have decided to delay consideration of it.

The School of -31-edicine of the Edinbzr7a Royal Colleges.As was mentioned in THE LANCET some weeks ago a

scheme was on foot to more closely affiliate the extra-muralmedical school in Edinburgh to the Royal Colleges. This, itis understood, has now passed its final stage and beenaccepted by the colleges. The governing body is to consistof fifteen members, five of whom are elected by the RoyalCollege of Physicians, the Royal College of Surgeons, and theAssociation of Lecturers respectively. It is to exercise super-vising and disciplinary functions. The school is to be calledthe Medical School of the Royal Colleges.Aug. 6th.

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IRELAND.(FROM OUR OWN CORRE8POND:WN’l’8.)

Bl’utal Otitrage in Belfast.A BRUTAL case, such as rarely occurs in Ireland, has

occasioned a good deal of comment in Belfast. It seemsthat on Saturday, July 20th, a woman was found lying in afield on the Shore-road ; she was thought to be the worse for