611 as well as in town. He must be a physician-at least until ; pneumonia and acute rheumatism be repealed. He must be ready to perform the office filled in London by the fashion- able " physician-accoucheur," although he may not have his pair of sleek horses, and his comfortable " brougham," like his metropolitan representative. Can Dr. Burrows call a man thus prepared to relieve suffer- ing humanity an " uneducated practitioner, of the lower grade of the profession" ? . The doctor seems to set great store by the Latin and Greek education which lifts the physician so far above the general practitioner. Truly, then, any boy from the upper forms of any of our public schools would make a capital physician. If the disease were puzzling, and the remedy doubtful, how soothing would it be to the patient and his friends to hear the " educated physician" pour forth a chorus from Medea. By the by, a stranger calling at Dr. Burrows’s theatre, during lecture time, would hardly imagine, from his delivery and language, (interlarded, as it is, with gross Cockneyisms,) that he himself was, in point of learning, raised so very far above that " profanum vulgus," his class. This is easily proved.-Believe me, Sir, your obliged reader, A BARTHOLOMEW STUDENT OF " HUMBLE MEANS." November 30th, 1847. THE POSITION OF THE GENERAL PRACTITIONER. T0 the Editor of THE .LANCET. SIR,-I believe in times gone by it was considered that the best provision for the fool of the family" was to send him to sea; but after attentively perusing the evidence of Dr. Bur- rows before the Select Committee on Medical Registration, I certainly should think it far wiser to make him a general practitioner, to bring him up to a profession, in which his requirements would merely be a sufficient amount of know- ledge to enable him to practise with safety to the public; and all matters of difficulty; all matters of advanced scientific knowledge; all matters requiring a profound, that is, a perfect knowledge of his profession; would be considered beyond his capacity, and be left to his superiors, the M.D.s, the higher grade. Pray, Sir, who are these rustics ? The public, the great mass, whose lives and limbs are of so little value, of whose safety we may be so regardless. If general practitioners were solely to hold poor-law medical appointments, I could readily understand the advantage of such limited knowledge; but the rural districts possess other inhabitants; even the denizens of the great metropolis, with its sacred area of seven miles, occasionally pay us a visit, and, unhappily, are subject to casualties, liable to disease, and to receive treatment from our half-educated class. But really the subject is too serious for a joke. Does Dr. Burrows mean to affirm, and expect belief, that five years spent in acquiring medical knowledge, two passed with a medical gentleman in the country, and three at a London Hospital, is so very far inferior to a five years’ sojourn at the latter place only ? Does he seriously wish to persuade that two additional years in town make all the difference between a perfect and scientific, and only a sufficiently safe knowledge of the profession; and then to argue the impossibility of our acquiring the additional learning, on the ground of expense ? I must beg to enlighten Dr. Burrows on one point with which he confesses he is little acquainted. I have never yet heard of a smaller premium than £150; and very frequently, £200, and even £300, are paid to the gentleman to whom a medical pupil is apprenticed. Is not that a sufficient sum to support the expense of two additional years in London, when ap- prenticeship is done away with ? In truth, it appears to me to be all in the name, and that of two persons devoting the same time to the same studies, at the same place, the one only who aspires to the membership of the College of Phy- sicians is a really well-grounded and scientific man. On what other grounds, then, is the physician so far superior to the general practitioner ? In answer to question 410, as reported in THE LANCET, Dr. Burrows states, " I should think that, from the subdivision of labour, men in their respective departments arrive at much higher eminence and much greater knowledge of their particular subjects;" and in reply to question 468, " That is so universally admitted in our pro- fession, that I should be surprised to find any man in our pro- fession who did not hold that opinion." If the correctness of this be admitted, what must be thought of his replies to questions 519, 520, and 521, referring to the still minuter sub- divisions of dentists, oculists, aurists, and obstetricians,- "There are very few men who devote themselves exclusively to it, and it is very much disliked in the profession; it is thought to be a very injurious thing to the public." Can this require comment ? I think not. The Medical Registration Bill, I take it, is brought forward with a twofold object, to raise the status of the profession, and to benefit the public at large; and I cannot imagine on what grounds Dr. Burrows can assert, in answer to question 576, that " it is not in accordance with the feelings of the pro- fession." Do not the petitions to parliament speak for them. selves ? I can imagine that it will not be for the good of those who would wish an inferior class should exist; who would sacrifice the majority to the minority; but those who harbour such wishes have not the good of the profession at heart. If our education is imperfect, let it be remedied, and not endeavour to insinuate that our acquirements are on a par with poor-law remuneration. If this were done, we should attain our proper position; no longer would poor-law com- missioners and poor-law guardians look upon our services as valueless; and if they did not, who would then be most com- petent to add to our stores of knowledge ? Is not practical experience, after all, the fountain from which our art is derived, by which it is nurtured, and from which its advance. ment must accrue ? Does the physician advance medical knowledge from his studies of books ? No ; that a good general and classical education is a very great advantage and adjuvant, all must admit; but the bedside of the patient is our most important volume, and in the study of this, the phy- sician in his hospital has no advantage over the general prac- titioner in his workhouse, and in his daily attendance on the numberless poor: but stay, I am wrong, the physician goes to his duties unfettered, with time on his hands, for his emolu- ments are great; the general practitioner must struggle with intense bodily and mental fatigue, and with the knowledge that time spent in the endeavour to benefit his patients, and medicines supplied with the same object, ctre all to his own loss. Shame, shame, I say, on those in our profession who would wish to establish, to perpetuate, an inferior grade. Surely these are times for " awful agitation." I am, Sir, your very obedient servant, November, 1847. K. Q. House of Commons. Tuesday, Nov. 30th. Mr. WAKLEY stated that he rose for the purpose of moving for the appointment of a committee to inquire into the state of the laws which relate to the medical profession in the United Kingdom of Great Britain and Ireland. The House would recollect that a committee upon this important subject was appointed in the last session of Parliament; but owing to the early termination of the session, the labours of the committee were necessarily incomplete, and no other report was made than was contained in the volume of evi- dence which the committee had presented to the House. In moving for the appointment of another committee, it was his object to continue and complete the inquiry that had been already commenced; but he regretted to have to state, that the general election had made sad havoc amongst the members of the committee of last session, as, out of fifteen members-of which number the committee consisted-only seven had been returned to the new Parliament, and amongst the number not reëlected, it was with deep regret he found the name of the right honourable gentleman the late member for Edinburgh, Mr. Macaulay. That distinguished gentleman had been chairman of the committee, and in that office his services had proved to be most valuable. If the House con- sented to the motion he was about to make, he would post- pone the nomination of the members of the committee to another day, in the sincere hope that he should again see Mr. Macaulay resume his seat, or at any rate he hoped to hear that the time was not far distant when the public would again obtain the benefit of his services in the House of Com- mons. Before the committee of last Session, witnesses had only been examined who had attended on behalf of the London College of Physicians and London College of Sur- geons, and the evidence had been specially taken against the Medical Registration Bill of last year. The inquiry -would now take its widest range, and embrace the whole subject of medical law and government throughout Great Britain and Ireland, and he sincerely hoped that the labours and report of the committee would prove satisfactory and beneficial to the members of that distinguished profession to which he had the honour to belong. The motion he had to make was
Transcript
611
as well as in town. He must be a physician-at least until; pneumonia and acute rheumatism be repealed. He must be
ready to perform the office filled in London by the fashion-able " physician-accoucheur," although he may not have hispair of sleek horses, and his comfortable
" brougham," likehis metropolitan representative.Can Dr. Burrows call a man thus prepared to relieve suffer-
ing humanity an " uneducated practitioner, of the lower gradeof the profession" ?
.
The doctor seems to set great store by the Latin and Greekeducation which lifts the physician so far above the generalpractitioner. Truly, then, any boy from the upper forms ofany of our public schools would make a capital physician.If the disease were puzzling, and the remedy doubtful, howsoothing would it be to the patient and his friends to hearthe " educated physician" pour forth a chorus from Medea.By the by, a stranger calling at Dr. Burrows’s theatre,
during lecture time, would hardly imagine, from his deliveryand language, (interlarded, as it is, with gross Cockneyisms,)that he himself was, in point of learning, raised so very farabove that " profanum vulgus," his class. This is easilyproved.-Believe me, Sir, your obliged reader,
A BARTHOLOMEW STUDENT OF " HUMBLE MEANS."November 30th, 1847.
_______
THE POSITION OF THE GENERAL PRACTITIONER.T0 the Editor of THE .LANCET.
SIR,-I believe in times gone by it was considered that thebest provision for the fool of the family" was to send him tosea; but after attentively perusing the evidence of Dr. Bur-rows before the Select Committee on Medical Registration, Icertainly should think it far wiser to make him a generalpractitioner, to bring him up to a profession, in which hisrequirements would merely be a sufficient amount of know-ledge to enable him to practise with safety to the public; andall matters of difficulty; all matters of advanced scientificknowledge; all matters requiring a profound, that is, a perfectknowledge of his profession; would be considered beyond hiscapacity, and be left to his superiors, the M.D.s, the highergrade.Pray, Sir, who are these rustics ? The public, the great
mass, whose lives and limbs are of so little value, of whosesafety we may be so regardless. If general practitionerswere solely to hold poor-law medical appointments, I couldreadily understand the advantage of such limited knowledge;but the rural districts possess other inhabitants; even thedenizens of the great metropolis, with its sacred area of sevenmiles, occasionally pay us a visit, and, unhappily, are subjectto casualties, liable to disease, and to receive treatment fromour half-educated class.But really the subject is too serious for a joke. Does Dr.
Burrows mean to affirm, and expect belief, that five yearsspent in acquiring medical knowledge, two passed with a medical gentleman in the country, and three at a LondonHospital, is so very far inferior to a five years’ sojourn at thelatter place only ? Does he seriously wish to persuade thattwo additional years in town make all the difference betweena perfect and scientific, and only a sufficiently safe knowledgeof the profession; and then to argue the impossibility of ouracquiring the additional learning, on the ground of expense ?I must beg to enlighten Dr. Burrows on one point with whichhe confesses he is little acquainted. I have never yet heardof a smaller premium than £150; and very frequently, £200,and even £300, are paid to the gentleman to whom a medicalpupil is apprenticed. Is not that a sufficient sum to supportthe expense of two additional years in London, when ap-prenticeship is done away with ? In truth, it appears to me tobe all in the name, and that of two persons devoting thesame time to the same studies, at the same place, the oneonly who aspires to the membership of the College of Phy-sicians is a really well-grounded and scientific man.On what other grounds, then, is the physician so far superior
to the general practitioner ? In answer to question 410, asreported in THE LANCET, Dr. Burrows states, " I should thinkthat, from the subdivision of labour, men in their respectivedepartments arrive at much higher eminence and muchgreater knowledge of their particular subjects;" and in replyto question 468, " That is so universally admitted in our pro-fession, that I should be surprised to find any man in our pro-fession who did not hold that opinion." If the correctness ofthis be admitted, what must be thought of his replies toquestions 519, 520, and 521, referring to the still minuter sub-divisions of dentists, oculists, aurists, and obstetricians,-"There are very few men who devote themselves exclusively
to it, and it is very much disliked in the profession; it isthought to be a very injurious thing to the public." Can thisrequire comment ? I think not.The Medical Registration Bill, I take it, is brought forward
with a twofold object, to raise the status of the profession, andto benefit the public at large; and I cannot imagine on whatgrounds Dr. Burrows can assert, in answer to question 576,that " it is not in accordance with the feelings of the pro-fession." Do not the petitions to parliament speak for them.selves ? I can imagine that it will not be for the good ofthose who would wish an inferior class should exist; whowould sacrifice the majority to the minority; but those whoharbour such wishes have not the good of the profession atheart. If our education is imperfect, let it be remedied, andnot endeavour to insinuate that our acquirements are on a parwith poor-law remuneration. If this were done, we shouldattain our proper position; no longer would poor-law com-missioners and poor-law guardians look upon our services asvalueless; and if they did not, who would then be most com-petent to add to our stores of knowledge ? Is not practicalexperience, after all, the fountain from which our art isderived, by which it is nurtured, and from which its advance.ment must accrue ? Does the physician advance medicalknowledge from his studies of books ? No ; that a goodgeneral and classical education is a very great advantage andadjuvant, all must admit; but the bedside of the patient isour most important volume, and in the study of this, the phy-sician in his hospital has no advantage over the general prac-titioner in his workhouse, and in his daily attendance on thenumberless poor: but stay, I am wrong, the physician goes tohis duties unfettered, with time on his hands, for his emolu-ments are great; the general practitioner must struggle withintense bodily and mental fatigue, and with the knowledgethat time spent in the endeavour to benefit his patients, andmedicines supplied with the same object, ctre all to his own loss.Shame, shame, I say, on those in our profession who would
wish to establish, to perpetuate, an inferior grade. Surelythese are times for " awful agitation."
I am, Sir, your very obedient servant,November, 1847. K. Q.
House of Commons.
Tuesday, Nov. 30th.Mr. WAKLEY stated that he rose for the purpose of
moving for the appointment of a committee to inquire intothe state of the laws which relate to the medical profession inthe United Kingdom of Great Britain and Ireland. TheHouse would recollect that a committee upon this importantsubject was appointed in the last session of Parliament; butowing to the early termination of the session, the labours ofthe committee were necessarily incomplete, and no otherreport was made than was contained in the volume of evi-dence which the committee had presented to the House.In moving for the appointment of another committee, it washis object to continue and complete the inquiry that hadbeen already commenced; but he regretted to have to state,that the general election had made sad havoc amongst themembers of the committee of last session, as, out of fifteenmembers-of which number the committee consisted-onlyseven had been returned to the new Parliament, and amongstthe number not reëlected, it was with deep regret he foundthe name of the right honourable gentleman the late memberfor Edinburgh, Mr. Macaulay. That distinguished gentlemanhad been chairman of the committee, and in that office hisservices had proved to be most valuable. If the House con-sented to the motion he was about to make, he would post-pone the nomination of the members of the committee toanother day, in the sincere hope that he should again seeMr. Macaulay resume his seat, or at any rate he hoped tohear that the time was not far distant when the public wouldagain obtain the benefit of his services in the House of Com-mons. Before the committee of last Session, witnesses hadonly been examined who had attended on behalf of theLondon College of Physicians and London College of Sur-geons, and the evidence had been specially taken against theMedical Registration Bill of last year. The inquiry -wouldnow take its widest range, and embrace the whole subject ofmedical law and government throughout Great Britain andIreland, and he sincerely hoped that the labours and reportof the committee would prove satisfactory and beneficial tothe members of that distinguished profession to which hehad the honour to belong. The motion he had to make was
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this: " That a Select Committee be appointed, to inquire intcthe registration of legally-qualified practitioners in medicineand surgery, and into the laws and charters relating to thepractice of medicine and surgery in Great Britain and Ire.land, and to report the evidence, with their opinion thereuponto the House. He was happy to state that the motion wasmade with the sanction of Her Majesty’s Ministers." (Carriecnem. con.)
Medical News.’
ROYAL COLLEGE OF SURGEONS.- The following gentlemen,having undergone the necessary examinations for the diplomaof the College, were admitted members on the 26th instant-viz., Messrs. Robert Dowell, Redcar, Yorkshire; HenryWilliam Hayward Richardson, Chilmark, Wiltshire; MichaelThomas Mason, Newington, Surrey; Thomas Henry Mitchell,Kington, Herefordshire; Joseph Marshall, Upwell, Norfolk;Edward Stride, Sheerness; George Fletcher Banks, Shemston,Worcestershire; John Robinson, Carlisle; and Thomas Smith,Whateley, Oxfordshire. At the same meeting of the Court,Mr. Philip Porter passed his examination for naval surgeon;this gentleman’s diploma from the above College is datedApril 24th, 1839.
APOTHECARIES’ HALL.-Names of gentlemen who passedtheir examination in the science and practice of medicine, and
. received certificates to practise, on Thursday, November 25th,1847:-Ezra Harle, Stansted, Essex; William Faithfull,Hurstpierpoint, Sussex; John Pince Challacombe, Bristol;George Hodges, Ludlow, Salop; Thomas Park, Lincoln.MORTALITY IN LONDON.-From tle last weekly report of the
Registrar-General, it appears that, during the past week, thenumber of deaths reported amounted to 544 males, and 542females,-total, 1086; the number of births registered in thesame period were 616 males, and 640 females,-total, 1256.The weekly average derived from deaths of 1842, 43,44,45,46,and corrected for increase of population, being 528 males, and518 females,-total, 1046.YELLOW FEVER.-Several fatal cases of yellow fever have
lately occurred on board the " Siren," (16,) CommanderChaloner, on the west coast of Africa, to which unhealthyclimate Mr. W. F. Daniell is about to proceed, having beenappointed Staff Assistant-surgeon; this gentleman has residedmany years on this pestilential coast, and contributed largelyon the medical topography of the bights of Benin and Biafra.
TiiE COLLEGE FELLOWSHIP.-The number of candidatesoffering themselves for this honour is gradually increasing;we are informed that a larger number than ever have enteredtheir names for the ensuing examination.WESTMINSTER HOSPITAL.-Mr. Hale Thomson, on Saturday
last, performed amputation of the thigh on a little girl, elevenyears of age, for scrofulous disease of the knee-joint. Shewas placed under the influence of chloroform, by Mr. Robin-son. The agent operated almost immediately. The leg wasremoved and dressed whilst the patient was under the influ-ence of the chloroform, and was quite unconscious of the pro-ceedings which had taken place.RAVAGES OF THE INFLUENZA.-For some -weeks this epidemic
has prevailed more extensively than perhaps has ever beforebeen experienced. The provincial newspapers report its pre-sence in many localities, especially in the north. Letters from
Edinburgh state that it is ravaging the east coast of Scotland,from Aberdeen to Arbroath and Dundee, and has also com-menced in Edinburgh. The teachers of the Edinburgh aca-demy found their classes so remarkably thin, at the end oflast week, that some holidays had to be granted; and the lordprovost gave liberty to suspend attendance on the classes inthe high school for a week, for the same cause. On Sundaythe churches were -all very thinly attended. In Montrose itis very prevalent amongst the young, and it is reckoned thatfifteen per cent. are absentfroni all the schools, or 810 in all.- In London and its neighbourhood influenza extensively pre-vails. It has been stated that several hundred boys, in theSt. Paul’s and Christchurch schools, are on the sick list, andMerchant Tailors’ School has been prematurely closed for theChristmas holidays, in consequence of the illness of a largeproportion of the pupils. The business of some of the publicoflices has also been impeded, from the clerks being affected’with the disorder, and in the busiest department of thepublic service-the post-office-140 clerks were reported to’be absent last week. In manufactories and wholesale housesmuch inconvenience has been felt from the same cause. Thebooksellers of Paternoster-row have had some difficulty in
getting through the business of " Magazine Day," from theabsence of a large number of their assistants. It has provedextensively fatal. The returns of the registrar-general ofdeaths, &c., for the week ending Nov. 27, show a great increaseof mortality in the metropolis, in comparison to that of thecorresponding season, which has averaged 1046 for the lastfive years. But there died in London and its vicinity,during the past week, no fewer than 1677 individuals, or 631-about sixty per cent.-above the average. The table showingthe causes of death, exhibits the greatest increase of casual-ties from bronchitis and pneumonia, diseases closely allied towhat is popularly termed influenza. It is rumoured thatdeaths have occurred in Greenwich Hospital during the lastfortnight at the rate of twenty per diem, out of a total numberof about 2000 pensioners. Yesterday, the registrar of birthsand deaths for the district ofSt. Martin’s-in-the-fields, receivednotice of the death of a woman and her five children in Bed-fordbury, Covent-garden, who have fallen victims to the pre-vailing disease.TnE LATE Dm. DIEFFENBACH.-A letter, dated Berlin, 20th
instant, published in the Journal des Debctt.c, states that theremains of the distinguished surgeon, Dieffenbach, for ninedays after his supposed demise, showed no signs of decompo-sition, but rather resembled a person in a profound sleep thanan inanimate body.
CORRESPONDENTS.Evidence before the Registration Committee.-We have received at least
a dozen letters from respectable general practitioners, condemning, in themost indignant terms, the vulgar censures passed upon their older by theCollege of Physicians, and particularly by the Senior Censor. Some of theseletters we shall publish.
X. Y. Z. will need no other qualification as long ashe remains anassistant,but in the present state of the law he could not legally engage in generalpractice on his own account, in England.M.R.C.S.-Though there is no law which could prevent any man from
acting either as surgeon or chemist separately, the practice of the twotogether would come under the penalties of the Act of IS15.
Alpha writes to say that the person mentioned in the last week’s LAXCET,in dietetic connexion with Dr. Spurgin, has no qualification whatever. Ourcorrespondent is right in consideiing this another proof, if such were want-ing, of the necessity for a Registration Bill.
Bristoliensis.-We have received the Bristol Mercury, containing the dis-graceful account of a series of mesmeric lectures and exhibitions, whichhave recently taken place at the " Philosophical Institution, Park-street."The managers of this institution ought to know, that over and over agamthe itinerant and other mesmeric lecturers have been convicted of the
grossest frauds and complicities with the parties they pretend to operateupon. That such lectures should have been permitted is a disgrace to thePhilosophical (?) Institution in question, and every respectable medicalman in this city ought to withdraw from such a body.V.-The letter on fluid quackery, fluid camphor, and fiuid magnesia,
shall be published.IF. C.-Of course the officers of the Society can demand a sight of the
certificate; the refusal to produce it would be prima facie evidence that itwas in some way or other fraudulent.
Juvenis.-The practical works of Liston or Fergusson, or Cooper’s Dic.tionary, would supply the want of our correspondent.Dr. Carey.-We regret the delay, but we have set the paper by for pub-
lication as early as possible.A Constant Reeide)-, who encloses his name, and who is one of the most
respectable general practitioners of the metropolis, hands us the followingnote from a patient :-" Will Mr. - be so obliging as to send a little somithing to give a
favorite cat?-she has been kittening since Saturday, and we fear she willdie-she has three kits, but is still large and in great pain."Such an application is a very good commentary on the evidence of the
College of Physicians as to 11 the humble means" and the just-so muchknowledge" of the "majority" of general practitioners. The public onlyattempts to degrade the general practitioner a degree lower than the esti.mation in which the College holds them.A Young Pracbitioner.-Dr. Watson’s lectures is one of the best woiks
on the practical medicine of the present day.Fides.-The excellent letter of our correspondent shall be inserted.Communications have been received from-Dr. Carey, (Guernsey;) An
Old Naval Surgeon; A Dispensary Surgeon; Mr. J.Mackenzie, (Derby;)Mr. Elliot Dalolish; A General Practitioner; Juvenis; Amicus; VeruataAlter ; A Doctor of Medicine of the University of Edinburgh; A YonngPractitioner : X. Y. Z. ; The Secretaries of the Medical Registration Com-mittee ; J. M. ; M.D. (Edin.;) A Provincial-taught Surgeon; Dr. JamesShepherd, (Stonehouse ;) A Constant Reader ; Mr. Vertue Edwaids, (TowerHamlets Dispensary ;) Fides; W. C.; Mr. Vallance, (Brixton;) Dr. Hitch-man, (Hanwell;) Mr. W. F. Barlow, (Royal Infirmary fer Children;) Mr.Baker, (Burton-crescent;’ John Gibson, (St. Pancras Workhouse:) Casti.gator ; M.R.C.S.E. and L.A.C. ; Alpha; M.R.C.S.E.; Mr. Atkirson, (Rom-ney-terrace ;) A Country Looker-on; Mr. Obre; Mr. Richardson, (Salvs-bury ;) Mr. Reed, (Hertford.)
