2
1809 Notes, Short Comments, and Answers to Correspondents. REMINISCENT OF THE FOUNDER OF "THE LANCET." THE story of THE LANCET in its turbulent days of infancy, the per- tinacity with which its Founder waged war against what he con- sidered to be abuses, the bitter spirit which animated the strong defending forces in their attempts to repel their enemy, and the ultimate success of the cause of justice and medical reform, are matters which have been minutely dealt with in these columns when lapse of time allowed them to be discussed dispassionately. Strongly confirmatory of much that we published on the matter, and ef additional value because they contain the opinions of an eminent physician who was a contemporary of Mr. Wakley, are the following extracts from an autobiographical work of much interest published by Messrs. Smith, Elder, and Co. in 1884—viz., " Memoirs of Life and Work, by Charles J. B. Williams, M.D., F.R.S., Physician Extraordinary to H.M. the Queen, &c." A regular cooperator in our labours has brought them to our notice. Regretting the inadequacy of medical representation in Parliament, Dr. Williams proceeds to define the qualities which belong to a medical Member of Parliament. He should be- " ...... one well acquainted with the past history and present state of the medical institutions of the country, and who is sufficiently known and respected to possess the confidence of a large portion,- if not a majority, of the members of the Profession. Such a repre- sentative,-always well informed and accurate in his subject, and speaking with corresponding decision and a certain amount of self- assertion,-would always command the attention of the House, and become somewhat of a power in the State. The only M.P. who seems to me to have ever attained to anything like this position was the late Thomas Wakley. The early part of his career, as a censorious and radical journalist, was very different from that of his later years as a very popular Member of Parliament and coroner for the Metropolitan county. The journal,-which he created, and which iaade him,—in spite of its early ribaldries and abusive per- sonalities, was interwoven with a web of truth and justice which gave strength to its attacks and gained the attention and support of the public ; notwithstanding the bitter opposition and persecution from old corporations and long-established monopolies brought in array against it....... "When I first came to London [1830] the Lancet’ was already a power, which had made itself felt :-relished by the profession at large, which has rather a democratic taste, and hailed as champion of their rights,-received with curious interest by the public, which is alive to anything strong or sensational: -but by the aristocracy of the Profession, including the accused Hospital authorities and Corporations-branded as malignant and revolutionary; and to be opposed in every possible way, private and public. To be suspected of connection with the Lancet was to be tabooed by societies and respectable bodies ; and woe to the student going in for examina- tions, if he were supposed to have supplied it with reports! Nevertheless the Journal continued to increase in circulation; and no wonder; for over and above the censorious and scurrilous matter, which served for sauce, it supplied useful food for the minds of its readers, in copious medical news and reports of lectures. Wakley showed his ability as an editor, not only in his own slashing and incisive articles in which he attacked abuses and held up to ridicule and condemnation the in- efficiency and neglect of institutions and of their officers, but also in his gathering around him a staff of really clever and well- informed men, who could supply to his pages the most recent knowledge, and guide his counsels by the scientific spirit of progress, ’required by the forward movements of the times. "At St. George’s Hospital I was in the anti-’ Lancet’camp, and was strongly prejudiced against that journal. In fact, I never read it; and all my support and contributions were bespoken by Dr. Macleod, physician of the Hospital, in behalf of the * London Medical Gazette,’ which he edited, and which was said to have been started in opposition to the ’Lancet.’ At University College Mr. I Wakley’s sons were my pupils, and I soon began to receive from him marks of courtesy and confidence. He placed several members of his family under my care, and he recommended a number of patients to consult me. Among these were several Members of Parliament. They familiarly called him ’Tom Wakley,’ and all testified how much he was liked and respected in the House bv all parties ......... " Although I had these repeated proofs of Mr. Wakley’s goodwill towards me, I knew little of him personally, till he consulted me for his own health in the autumn of 1861. I was agreeably sur- prised with the gentleness and geniality of his manners, and the homely simplicity of his conversation. His ill-health had impaired the vigour of his expression; Lut there was an earnestness in his look, with an occasional twinkle of his eye, showing forth the work- ings of energy and of humour in his nature. The hopeful courage and self-confidence, which had borne him up through life against any amount of opposition and difficulty, did not forsake him in the danger which now threatened him. I have not the notes of his case by me; but so far as I can recollect, it was one of inflammatory origin, rather than of tuberculous consumption : but it certainly went on to the formation of cavities, which rendered the prospect of the future very serious : and the more so, as his sanguine tem- perament and active mind tended to make him impatient of the restriction necessary for any chance of recovery....... In the balmy air and quiet of Madeira he so far improved as to pass the winter fairly without any material increase of disease. His death, which took place in May, was from haemorrhage, brought on, after a boat- ing excursion, by a fall in landing on the steep sloping beach (which I remember well, and the difficulties experienced in landing). The occurrence shows that he was still in possession of considerable activity and strength, and suggests the possibility that his ardent temperament was still apt to lead him beyond the bounds of prudence. " Without doubt the works of Thomas Wakley entitle him to the foremost rank as a great Medical Reformer; and the successful results of his labours in correcting abuses and neglects of institu- tions, and in promoting and improving the means of medical education and diffusion of knowledge, have earned for him the gratitude of the Profession and of the Public. No one has ever so consistently and successfully defended the rights and best interests of the Medical Profession in Parliament, in Courts of Law, and through the Press ; and if in his early life, his daring and asperities raised against him a host of enemies, they were mostly pacified, and many converted into friends, in his later years, when the beneficial fruits of his efforts became apparent." LARGE INCISIONS. To the Editor of THE LANCET. SIR,-It is somewhat rash, I admit, for a general practitioner, espe- cially after only one or two cases, but I should like to ask operating ,surgeons whether extensive abdominal incisions are justifiable. I have had two patients recently, in each of whom the incision was made from the pubes to above the umbilicus, and each survived less than 12 hours. Such an event cannot be considered satisfactory from a surgical point of view. In one of the cases there was no doubt as to the human improbability of survival, but still it would have been more satisfactory had the patient succumbed as a result of a fight with the disease. Such an extensive incision, with the unavoidable consequent exposure of the abdominal viscera and prolonged exploration, does not, in my humble opinion, give the patient a ghost of a chance. Of course, it is important that local encysted collections of pus should be liberated, but the fact of a collection of pus being encysted shows that nature has been successful to some extent. It would appear better to leave such a collection alone in the absence of sufficient diagnostic points to localise it than to explore the general abdominal cavity. In the case referred to the chief seat of disease was in the pelvis, from which had spread a general septic peritonitis, with pus in the upper abdominal regions, but not encysted. The acute symptoms had lasted only about 12 hours previous to the time of admission to hospital and 24 hours from the time of operation-that is to say, the patient was up and about as usual 12 hours before going to the hospital and six hours before I was sent for. As regards the other case, there was no reason that I could see, except the extensive incision and exposure, why the patient should not have survived. Of course, the operation was absolutely necessary, but what I am calling in question is the extent of the incision. I have had a third case which may be mentioned here, general peritonitis having supervened on an obscure cause. The patient was sent to a hospital. An incision was first made in the left iliac region where nothing was found except the peritonitis, but when another incision was made in the right iliac region the seat of the trouble was found. The patient recovered. In my own mind I have no doubt that had such an extensive incision as was made in the other two cases been made in this case the result would not have been successful. It would be better to improve our diagnostic methods in localising disease, so that we need not resort to extensive explorations. I am, Sir, yours faithfully, Dec. 1sot,1910. X. SCHOOL-GIRLS AND DOMESTIC HYGIENE. AT Brighton a school for home training is now at work. It was opened in September, and it is hoped that 80 girls will every year pass through the school after leaving their elementary studies. So far, only a score or so of children have availed themselves of the course of lessons, whereas no fewer than 300 had left school. A member of the board has proposed that the course of home training should be compulsory for girls during the last three months of their school life, and this seems to be exactly the indication of the Board of Educa- tion Memorandum on the Teaching of Infant Care and Management in Public Elementary Schools which has just been issued. After *eferring to the importance of girls and women being taught how
