875

twenty-eight years, was placed in my esta-blishment ; she had previously been confinedin a county asylum : she spoke of hermiserable situation there in correspondingterms with the lady before-mentioned. Shewas discharged cured from hence in themonth of April following. She has conti-nued on the most friendly terms with thefemale managers in this asylum ever since.But what says " A LOOKER-ON," " the remu-neration of the superintendents must ceaseto be dependent upon the continuance of thedisorder." Why, if he were not absolutelystone blind," he would perceive that theremuneration of the superintendents is de-pendent upon the celerity with which theydischarge their patients cured, and upon thehumane treatment they bestow upon themwhilst in confinement.In the course of this present summer, the

wife of a medical practitioner of consider-able eminence and large practice was placedunder my care, afflicted with puerperalmania ; in a few weeks she recovered, andnow again presides over and guides herdomestic affairs as usual. She came hereon a visit a very few days since, bringinghandsome presents for all my children (sixof them), and expressing the warmest feel-ings of gratitude and attachment to thoseladies in this establishment who watchedover and consoled her during the continu-ance of her malady. Has A LooKER-ON"seen results as gratifying in any large publicasylums? I am far from denying that theydo occur, but that the very reverse prevailsto a large extent I can prove; yet " ALOOKER-ON" would sweep this private esta-blishment from the face of the earth : lethim" look on this picture, then on that,"and it is to be hoped he may give us some-thing practical, some foundation on which hewould " effect those changes," which are togive to the wealthy the blessings of thehumane system enjoyed by the pauper pa-tients in county and large public asylums.

Feeling conscious of no ill-intentions inthese remarks, I shall not seek to screen

myself from the responsibility of them un-

der any feigned signature, but beg to sub-scribe myself your very obedient servant,

GEORGE BODINGTON.Driffold House, Sutton Coldfield,

Warwickshire.

GEORGE BODINGTON.

NAVAL ASSISTANT-SURGEONS.

To the Editor of THE LANCET.SIR:—In answer to your invitation to

give you my reasons for having recom-mended the junior members of the professionto avoid the navy, allow me, in the first in-

stance, to apologise for the length of thedetails I shall be obliged to send you, inorder to show you the position of the naval

medical officer in the service as at presentconstituted, not only with reference to hisown peculiar duties, but as a subordinateofficer in the navy ; both having to be care-fully considefed before taking the first de-cisive step in life under his own soleguidance.

I commence with his entry as assistant-surgeon ; his position as such has beenmuch canvassed lately, especially in a terseand well-written letter byDr.Tweeddale:my statement will, therefore, prove to someextent a repetition, but as I wish to embodythe whole of my own impressions of the ser-voice, I must in this one instance solicit someforbearance to all which may seem likeiteration.

It would appear that the especial wish ofthe magtiates of the navy, is to render theirmedical officers unfit for any other mode ofprofessional life ; at once to check theirprogress in, and to damp their zeal for, pro-fessional acquirements; or why place theman, to whom study should be as regtdar ashis daily food, in a midshipman’s berth ? aplace generally well crowded in the smallerrates, not allowing him two feet space whichhe can call his own, and so surrounded byboys and young men, that if one amongthem only choose to be noisy, he couldhardly read a novel to understand it, muchless a medical work. In addition to theessential privations and rliscomforts of sucha dwelling, one very moderate-sized chest isthe only space allotted for his clothes, andin small vessels for his books and instrn-ments also ; the size of this not being at allregulated by the instructions, but left en-tirely to the caprice of the captain, or ratherto the first lieutenant, to whom all power isnow-a-days delegated, and whose genericcharacteristic is, to sacrifice every comfortof his subordinates to smartness and show.Such, sir, is the first position of a gentlemanof liberal education and acquirements; ofmature years ; the member of a highly im-portant profession ; and such, consideringpresent appearances, will be the fate of allthose who are unwary enough to choosesuch a home. From his status in generalsociety, he has a right to expect some degreeof consideration in the arrangements madefor him ; on his arrival on board, however,he finds himself but little better treatedthan the 11 Morgans" of " the old school :"he can demand nothing specific as a right,for if allowed a chest for his clothes, and ahammock for his night’s repose, it is verycommon in the service to be ordered to dockboth the one and the other-the chest,because it is somewhat larger than accordswith the captain’s or first lieutenant’s ideaof neatness ; the second, because it is toolarge in circumference, as compared withthe men’s, with which it is stowed in the

hammock.netting, and is, therefore, un.

sightly.

876

In a short time he begins to find out all ten shillings in the ward-room, of course ex-the agrèmens of his appointment ; he finds clusive of wine and spirits in both, is by nothat the marine officer, with rank of ensign means important to the assistant-surgeon:in the army, frequently fresh from some indeed, it is more than saved by the differ-country school, and some four or five years ence of comfort ; for I have always foundhis junior in life, has a cabin, a man-servant that the deprivation of this on board leads(a marine of his own choice), a place at the to a more reckless expenditure on shore :ward or gun-room table; and, what is in- while in the article of wine and spirits muchfinitely more galling, when he first goes to depends upon the individual, as is provedsea, he having rank as lieutenant in the by the marine officers meeting all their ex.army, is thrust to leeward ; while the penses upon five shillings and threepencemarines, and some lieutenants younger than a-day, their uniform being much moreex-himself, are proudly parading the weather pensive than the assistant-surgeon’s. Thoseside. It is true, that he has sometimes the who wish for economy may practise it in thecompany of some unfortunate old mates, or ward-room with as much, if not more, faci-clerks, who are deficient in the required in- lity than in the midshipman’s berth.terest, and to whom the service is even less " A Surgeon of the Old School" has en-alluring than to him; but this diminishes deavoured to answer Dr. Tweeddale’s plainnot the hardship of his own position. Thus facts on some of these points, and instead ofsituated, the knowledge he has already ac- fairly arguing the propriety or improprietyquired must be gradually diminished, for no of the present arrangements with referencememory can retain all the facts of the vari. to the whole corps, advocates the presentous sciences which constitute the physician system upon a series of contingencies merely,and surgeon, without constant exercise by and those by no means very reputable to apractice, and frequent reference to books. medical officer ; and were they so, not likelyIn ships of the line, the assistant-surgeon to affect the many : thus, /i6 could read formay do much in the latter way in the sick an hour after turning in, by the sentinel’sbay; in the lesser rates, let the advocates of lantern ; and by being on friendly termsthe present plan say what they may, he with the boatswain, he enjoyed the felicitycannot: and with reference to the former, I of a curtain of her Majesty’s bunting; thesincerely believe that to gain much either in loblolly-man hung up his cot (it was not histhe taleut of observation, or in the know- duty, and the first lieutenant or surgeonledge of experience, is, from the very nature might have prevented him doing it). Again,of our practice, impossible, as all our most the assistant-surgeon might have aged pa-serious cases in the smaller rates go to the rents, and by sending them a remittancehospital whenever an opportunity occurs of might render himself an object of greatersending them ; and, injustice to the patients interest and merit to his superior officers.themselves, it should be so ; and from the And then he talks about " crude and inex-care taken in entering sailors, chronic cases perienced opinions;" I can fancy, sir, thatare comparatively rare; besides which our in the times of " the old school," the assist-pharmacopoeia is very limited. ant-surgeon might have crude and inexpe-

Deprived thus during his earlier servitude rienced opinions : but in later times I haveof all personal comfort, unable to console known many, and I have never met onehimself for these privations by a conscious- among them likely to express such crudeness of advancement in professional or other opinions or argument as the " Surgeon ofacquirements, and living from hand to the Old School" has advanced ; and withmouth (for that assistant-surgeon is econo- reference to drunkards, I can truly say thatmical who can lay by a sufficient fund to I have met with more belonging to " the oldmeet the contingencies of hdif-pay, and school" than to the new. In one point I can,re-stock himself with clothes, &c., for liowevei-, agree with the 11 Surgeon of theanother appointment), he is at length, after Old School," that the assistant-surgeonan average of twelve or fifteen years,, under might make enemies of some of his elders,the new arrangements of pay, &c., promoted whose excellent opportunities for study hadto the rank of surgeon. not been sufficiently improved ; the senior in

But, before considering him in his new such case might not like many of his crudeposition, allow me to meet one objection, opinions so freely canvassed as they wouldwhich might, from the tenor of the last necessarily be, were the assistant-surgeon aparagraph, be raised to his entry to the member of the ward-room mess. That theward-room mess while assistant; viz., that parade and etiquette of a ward-room messif he find it so difficult to keep within would prove a serious drawback to an

bounds while messing with the midshipmen, assistant’s improvement, is to me quite un-this difficulty would be increased in the intelligible; one would think that the greaterward-room. This, however, is not the fact ; part of the ward-room officers’ time is takenthe generality of ward-room messes are by up in dressing, and that we have more for-no means extravagant ; and the difference malities and compliments to interchangebetween thirty shillings per month in the than a set of Chinese mandarins. What

midshipman’s berth, and about two pounds parade ?-w bat etiquette? Howinthe name

877

of patience, prove a serious drawback? Or gun sloops; in the new ones (much largerwhy should the assistant-surgeon’s inexpe- vessels) the surgeons’ cabins are hot, nar-rience in discipline, render him subject to row, and confined, something like largethe penalties of a court-martial ? when the coffins, and placed in the centre of the shipveriest youngster learns and knows his true at the fore part of the gun-room ; and this is

position with reference to his superiors in done in order to give the captain’s stewardless than a week after joining. Believe me, a large berth abaft : the captains will soonsir, there is nothing so very mysterious in have half the ship to themselves. In shipsour etiquette, parade, or discipline, as to of the line, the surgeons are stowed in theprevent the initiation of even one of the old cockpit ; in frigates, right aft, close to theschool in less than a week. That some gun-room and steward’s berth : all the bestmedical pupils may deserve the castigation cabins being assigned to the executives,received in the " Heads of the People" I am although the civilians may be old and grey-aware ; but that this is their characteristic headed, and may have had their present rankas a class, still less that it generally applies before half the lieutenants were breeched.to those who enter either of the services, I In the army, on the contrary, executives andutterly deny. The whole letter appears to civilians choose their own quarters by se-me an attempt to cast an unmerited slur niority in their respective ranks. He is nowupon that class of the profession to which entitled to a second-class boy, as servant,he belongs ; the very tenor of it is a great one under thirteen, and who must leave himproof that he cannot advance one single when rated as first-class boy, which is

reason, applicable to the corps as a body, usually when he is just becoming largewhy they should not at once be admitted to enough to be of service. This boy is alwaysthe just rights of their rank and position in employed when the idtos are called ; has tolife. As my object, however, is not so much clean gun-screws, &c. &c., in the morning ;to advocate the cause of those who already and the surgeon may consider himself luckybelong to us, as to prevent disappointment if the first lieutenant is gerttlemanly or con-to those who may think of becoming so ; siderate enough to allow the boy time in theand convinced that during the present gene- morning to clean his shoes and bring himration, at least, the admirals who may be water. In this mal-arrangement, however,appointed lords of the Admiralty will nei- the executives (with the exception of thether have liberality nor judgment enough to marine officers) suffer as well as the civi-

agree to any change, I shall proceed to de- lians. It is magnificently asserted in the

pict the medical officer advanced to the rank instructions, that dispensaries are now fittedof surgeon. If by long service in small up for the reception of medicines on boardvessels he has been absolutely prevented of all ships, sloops included ; and, as mightfrom continuous study, and has thus ob- have been expected, they are all, except intained fixed but contrary habits, is he likely ships of the line, placed in the worst possi-to retrace his steps, and to endeavour to ble situations. While our modern architectmake up for lost time by becoming studious can find room for splendid cabins for theand devoted to his profession ? Such a case captain’s steward, with a view, I presume,may be, and I dare say often does arise from of gaining the favourable opinion of thosea principle of rectitude only; but is it wise captains who command his vessels, and thatin our rulers to trust to this ? But consider- too by removing certain subordinate officersing his status in a more worldly and selfish further forward, the surgeons are forced topoint of view, what advancement has he see their patients, and dispense their medi-made in life? Just so many of the best cines in any hole or corner in which he mayyears of his existence are past, and lost- think fit to stow them. Thus, in some of theyears in which he can scarcely recall one new-built sloops, there is a chain-locker

really pleasurable, because satisfactory, re- conveniently placed under the dispensary ;miniscence : if he have not retrograded in and the cable runs through it. In the sixth

professional knowledge, he has but little ad- rates, the dispensary is in the cockpit, with-vanced-he has lost all the enthusiasm of out inclosure, and very small ; and aroundhis student’s life; and the chief store he has this are the doors of the purser’s, captain’s,laid up, in a worldly point of view, is the marines’, and other store-rooms. Henceaccumulation of so many years’ servitude: flour, peas, chakos, and physic, are fre-an accumulation which is of no use to him, quently distributed simultaneously, to theunless he complete the full term of twenty- great augmentation of the surgeon’s and hisfive years. And how few of those who assistants’ respectability; and yet in theseembark in the pursuit do so ?-how many ships the captain’s clerk has a good cabin ondie on the road, to enable one survivor to the lower deck. In surveys upon invalids,reap his thirteen shillings a-day fo: the short the captains are seated, and their clerk ; butremainder of a frail existence? His personal I have never known a surgeon asked to takecomforts, however, are somewhat enlarged ; a chair. Nor can I see what captains havehe is entitled to a cabin, but which with the to do with invaliding : if the Admiraltypurser’s is invariably the worst in the ship : cannot trust a board of three surgeons tothe only exception was in the old eighteen- invalid those who require it, I should re,

878

commend them to enter some that they couldhave confidence in. In their own ships,captains frequently assume a power nevercontemplated by the service; viz., that ofdictating to the surgeon what officers or

men shall be invalided, whether in healthor not ; and this notwithstanding an annualaffirmation which the surgeon has to make,that he has neither invalided nor sanctionedthe invaliding of any one whom he did notconsider a proper object. Let an officer,therefore, commit himself, or a man or boyprove himself useless or stupid, and thesurgeon is very coolly told that they mustbe invalided ; and if he demur, that he is

impeding the service.Down to the fifth rates, the surgeon is

allowed a man as sick-bay attendant; inlesser vessels he is entirely subject to thecaprice of the captain, or first lieutenant ;and the most stupid and useless boy in theship is invariably given him : this boy’sduty is to cook the victuals of those the sur-geon thinks fit to diet himself ; to maketheir poultices, fomentations, &.c.; attend tothe wants of those in their hammocks ; givethem drink, &c. &c. ; but he is one of thosecalled idlers also, and called on deck when-ever they are, and the patients of coursesuffer. It is a monstrous absurdity in theAdmiralty to leave any civilian’s duties sub-ject to the caprice or discretion of the cap-tain ; he is much too avaricious of men upondeck to allow a man to the sick unless indangerous cases. In many ships there isyet a good deal of the " whiffle" principleexistent.Of the emoluments of the assistant and

surgeon I shall say but little, as every onecan judge of these for himself; it is merelynecessary to remark, that to the last day ofhis servitude they will not permit him to

keep two messes respectably ; ergo, he mustnot marry unless he get money : and if hedo marry, he must live apart from his wifeeleven months out of every twelve on theaverage. I think, sir, that I have thus farproved that the naval medical officer derivesno advantage from his rank as assistant-surgeon, and but little as surgeon ; that theformer is entirely nominal, the latter nearlyso ; that ou his entry he must give up everyhope of life beyond a mere competence, andthat for himself only ; that for this compe.tence he must necessarily subject himself tomany privations and discomforts throughouthis (course, and that these, by the presentregulations, are very unnecessarily aug-mented ; that his duties are throughoutunsatisfactory, and in some instances de-grading ; and that under the present im-proved regulations he must not expect to befree’d from this thraldom, unless by death,in much less than thirty years, it not beingpossible to employ all surgeons continu-ously. If, sir, I further prove that even thissort of existence is by much more frail in its

tenure than a life under the ordinary riskson shore; that this tenure may be madestill more frail by the avaricious motives ofsuperior officers ; that the nature of the ser-vice at present is all but a perfect despotism,from the very slight responsibility of supe-rior officers, that thus when serving underunpleasant or unprincipled characters, he,the medical officer, may, like other subordi-nate officers, suffer much injustice, muchvituperation, and abuse, without the powerof retaliation, or the hope of satisfaction ;that if, on the contrary, when thus perse.cuted, he in the very slightest degree losethe command of his temper, and betray suchimpatience, either in language or deport.ment, as to be construed into contempt of hissuperior officer (and a very slight expressionwill serve this purpose in the navy), he willinevitably lose all his previous servitude,and thus find annihilated the only principleupon which he ventured into the service,viz., the certainty of his position and emo.luments, however disagreeable the one andsmall the other. If I prove these things, sir,I think I shall prevent those from enteringthe service who are not entirely dependent.These shall be the subjects of my nextletter. I am, Sir, your obedient servant,

A SURGEON OF THE NEW SCHOOL.

DISLOCATION OF THE WRIST,

To the Editor of THE LANCET.SIR :-I am much obliged to both 11 But-

ler’s Ghost" and to Mr. Robert Hancorne," arcades ambo," for their correction of mymisquotation from Butler. I am quite will-ing to " stand corrected" by these " word-catchers," and beg merely to observe, thatif neither of these writers should commit anygreater blunder than I have done in this in-stance, they need not be ashamed of them-selves, particularly if they should have

written, as I have done, nearly a thousandpages in a jotirnal like THE LANCET. Allowme to tell Mr. Hancorne, " for his futureinformation," that the nonsense or 11 twaddle"of the quotation in question does not consistin the first line, for if Mr. Hancorne hasnever known an instance of a man being" convinced against his will," he is a personof much less " experience" than he pro-fesses to be. 1 also beg to inform him forhis " future information," that the nonsenseof the distich as quoted by me, consists inthe man being of the same opinion, after hehas been convinced that it is wrong. Per-

haps Mr. Hancorne might advantageouslyhave Johnson beside him, when he turnscritic again.With regard to the question of dislocation

of the wrist and its possible occurrence, andof my 11 determination that the controversyshould stand still," I have merely to remark,that the question theoretically is valueless ; ;