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Provincial Medical &Surgical JournalSource: Provincial Medical and Surgical Journal (1840-1842), Vol. 2, No. 36 (Jun. 5, 1841), pp.191-193Published by: BMJStable URL: http://www.jstor.org/stable/25490410 .

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PRINCIPLES OF MEIIICAL REFORM. 191

excruciating pain; indeed, for some weeks past it has increased so much, that he was obliged to use the greatest care in walking, as any sudden shake

would aggravate the pain exceedingly. He had I numbness in the right arm, and still more in the left, which he could scarcely extend along his side: he had also, from the first, great difficulty in get ting into the recumbent position and raising him self in bed; when there, he could lie only on his back, and had to be carefully sup)ported With pillows, and suffered most distressing pain, whether in bed or up, on endeavouring to keep his head and neck in a straight direction; his speech was

much affected, not being able to articulate his words; and in mastication, but especially in swal lowing, he experienced great difficulty and pain in the affected vertebrw; he has also a tingling sen sation in the front of the neck, as if the parts were asleep: his tongue is covered with a moist white fur, and his pulse is rather frequent, 96.

The patient was first laid upon the inclined )lane on the 23rd of October, having gentle extension Imade upon the vertebrw; a headstrap being placed under the chin, and tIme cord over the pulley, with the necessary extension at the feet, as particularly explained in my work on Curvatures of the Spine, page 111: he was also or(lered a cooling antiphlo gistic diet, and a course of alterative, aperient

medicine. He soon felt the good effects of the treatment,

the p)ain at the end of the second wveek being much relieved, and was felt onl wlhen he had occasion to raise himself up; at the end of the fourth week he could keep his head quite erect, and articulate his w^ ords quite distinctly, the other symptoms im proving in an e(qual degree.

On the 16th December, having been quiite free from pain, and all displacement of the vertebrae,

&c. having disappeared for ten days or a fortnight, he gave up the use of the apparatus.

April 10. He is now in better lhealtli than he has heen for somne years, anid hias not h;ad aniy re turn of the symptoins under whichi lhe formerly laboured.

PROVINTCIAL

MEDICAL & SIURGICAL JOURNAL.

SATURDAY, JIUNE 5, 1841.

To conmpare and analyse the suggestions thrown

out by various writers as to the changes required to place our medical institutions anld polity on a renewed basis, would afford much curiouis matter for speculation, and possibly also some p)rofit to the inquirer. MIuch available information has been collected, and several plans, looking well in theory at least, been proposed for the future con stitution of the medical body; but we fear that in the desire for some new thing, the advantages and value of what is established have not unfrequently

been overlooked, while an ideal standard of per fection lhas been too commonly substituted for that wvhich is practicable, and capable of being attained to.

'l'he simple costume of the ancient Greek or Roman may be mnore dignified or better calculated to display the symmetry and graces of the lhuman figure, than the grotesque clothing and complicated habiliments in which the highly civilized man of modern times inv-ests his person. It certainly ac cords better wvith the chasteness of a purely and correct ideal taste; for who could tolerate a stattue of Neptune in a cockedl hat and(I epaulettes, or a

painting of Venus arising froin the froth of tile sea, laced up in a pair of modern corsets? yet it

would scarcely be thought fitting to the habits and customs of the present age, were peers to mingle with the crowds of our thronged and busy thoroughfares, attired in the toga of a IRomanl senator; wsere a county member to add(lress the Speaker of the Comnmnons I-louse of Parliament encased in the armiiouir, anid invested Nwith the golden spurs of a kimight of the slire ; or a la(ly of

the bedchamber to attend her Majesty on a court day, in the no-attire of a nymph of the golden age.

Much of the propriety of man rests witlh hiis out ward covering. 'lWho, as the clever author of Sartor Resarttus observ,es, can imagine "a naked Duike of Windlestraw addressing a naked House of Lords ?" The forimi an(l fashioin require atten tion, as wvell as the substance, and the aptitude and congruity of these with the eircumstances of time and place mnust be pmreservred, or the effect of the

whole will 1( iniharnmonous; aii(l discoridant, thoug'h p)ossibly strictly conforlilable to somiie standard of

i(leal perfection. Something like this may lbe discovered in

the attempt at remo(lelling the constitution of the medical profession. The whole frame-w%rork of modern society is bound together by cer tain recognized forms, and the clerical, the legal, and the medical professions, are each a )art of

the frame-work. 'T'o remnodel any one of these after a form wlichl, howev-er excellent in itself, ab stractedly considered, is elntirely irrespective of

what already exists, anid does not lharmonize vith

other parts of the social system, would be to the

full as discordant and incongruous as the fa

miliar illustrations to wbhiel w%ve lhave referred.

| 'I'lie remioval of abuises wlicll time lhas gene

rated, and the adoption of practical improvements

in accordance with the spirit of the times, shiuld

be the aim of the mnedical reformer, rather than

the introduction of extreme or unicalled-for change.

It is wiser to repair and alter a dwvelling, the de

fects of wlhich are known, and its conveniences

appreciated, than to bring it tumbling about the

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192 PRINCIPLES OF MEDICAL REFORM.

ears of the inhabitants by meddling with its foun dations, and attempting to reconstruct it after a variety of plans, concerning which no two of the would-be architects are agreed. MIedical reform, in the minds of certain parties, wvould seem to narrow itself into an o)pposition to, and extinction of, all existing institutions. Now, the real object to be sought, the practical question to be deter

mined, is the best metho(d of amalgamating existing interests, and making those institutions, which the progress of civilization and the requirements of the public have established, subservient to the efficiency of the whlole body.

For our own parts, we confess that wve regard many of the points raised as purely speculative, and involving considerations not essential to the settlement of the question on grounds advan tageous to the public. It matters little to those seeking relief in sickness, whether the

whole body of medical practitioners are incor porated together under one head, or whether the distinctions wlhich time has recognised in prac tice, shall be kept up also in the government of the profession. The nants of the public have established the grades of physician, surgeon, and apothecary, 'and more recently of general )rac titioner; and whether the individual practitioner belonging, respectively, to each of tllese grades, shall be placed under the control of one general board, or of three or more bodies, so long as proper regulations are adopted to secure compe tent skill in medical practitioners of all grades, the public are reall) but little interested in the form of governmrsent under wrhich this object is attained. On other grounds, there are serious objections to the incorporation of the whole body into one fa culty, which require to he well considered and

thoroughly balanced with the presumed advan tages before they are too hastily cast aside as futile. Each grade of the profession should be fairly represented in such a faculty; at least, no

medical practitioner should be excluded from a share in its construction, and a representative voice in its government. The most strenuous ad vocates for one general faculty w ill, we conceive, at once admit this, but who and what are medi cal practitioners ? Are they the duly qualified and licensed persons provided by existing lawrs

only? On the contrary, we believe that it mnay safely be affirmed that in large towns, the number of persons openl) practising ine(licine without li cense or ascertained qualifications, is at least equal to that of tlle legally qualifiedl. Leaving out of the question the whole tribe of professed charla tans, empirics, and nostrum-moingers, whether ocomotive or stationary, we have the chemists

and druggists almost universallv prescribing and

dispensing medicines to every applicant, and, more over, contending for the right to do so. 'This evil has deeply taken root; so deeply, indeed, that we much question whether it is in the power of the' legislatire to eradicate it. There are limits to the

powver of the law, and any legal enactment which is

in epposition to the general feeling of the commu

nity will either be openly set at naught, ingeni

ously evaded, or, after a time, gradually fall into desuetude.

We have, as our readers know, strenuously opposed the riglht assumed by the chemist and druggist to engage in medical practice; we have exposed the injury resulting to the public from their neglecting their own proper vocation, and interfering with matters of which they are profoundly ignorant; but we cannot conceal from ourselres that the community have acquired the habit of frequenting the druggists' shops, the only open shops for the sale of medicine, not only for the purpose of procuring the dose of rhubarb or aperient salts required for domestic purposes, but also with the further view of soliciting advice in every light ailment, and often in those more se vere ones, where the experience of the Lady Boun tiful of the neighbourhood fails her. The fact is, that the respectable old apothecary, who, keeping open shop, was in the habit of answering the de mands of all comers, and at the same time acted

as the consulting referee of the aforesaid Lady Bountiful, has, by his retirement from the field, transferred his retail transactions to the druggist and his aproned apprentice. This is, no doubt, one of the results of the Apothecaries' Act ; and if the public have tlhereby gained a better instructed, and altogether more highly qualified race of me dical advisers, they have also lost their old and confidential friends, who, by their gossiping ha bits and imposing gravity of demeanour, we re

usually in possession of the good opinion, and, consequently, of the physicking of their neighbours generally. The druggist, notwithstanding the ad mixture of the mental attribute of the aged female, which mingled occasionally w,ith the sound com mon sense and Jong experience of his predecessor, the apothecagm, is ill fitted to supply the place of the by-gone race. I The indigent mother, with her squalid infant in her arms, is unceremoniously handed over to the servitor in the shop, whose whole stock of medical lore is comiiprised in a knowledge of the cliaracteirs

and hieroglyphics by wvhich the driugs in common use are designated, while the more sleek and portly

dame, the stout yeoman, or mayhap the retired

officer, are obsequiously ushered into the back shop, where their complaints are listened to and prescribed for by the master of the establishment

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ROYAL MEDICAL AND CHIRURGICAL SOCIETY.

himself. These practices of the druggist, and these habits of the public, have grown with thE growtlh of the existing generation; and though we feel most strongly the evils and inischiefs attendant upon them, and wVoul(l make every attemnpt to re strain and amend them, yet we see not howv they

are to be summarily got the better of. It is true

the practising of every unqualified person may and ought to be at once declared illegal, and, as such, the druiggist should be subjected to sufficient penal ties, on conviction of his infringement of the law; but the wants of the public must nevertheless be provide(ld for, and the best method of making the

requisite provision is not -ery apparent. 'Ilhe answer to the question of what is good for a pain in the head or stomnach must be forthcoming, and the (lose of tincture of rhubarb be attainable at an easy rate; and if the general practitioner is not prepared to afford the information sought for, and to sul)ply the required remedy, the druggist or some other will be resorted to, in the teeth of every law which may be devised.

A.s it appears to us, one of two courses only remains open under these circumstances. Eithier the general practitioner muist act in this re spect as did the apothecary of old, or some qualification should be required of the drug gist, some test of his competency for the office of prescribing for the trifling ailments which are of daily occurrence. 'T'he wants of the commlu nity are clearly made out, and ought to be pro vided for. If the general practitioner refuse to respond to these wants, and in order to do so he

must supply his own medicines, and occasionally, we fear, even to the pennyworth of rhuibarb for a penny, and the dose of salts at its marketable price, the public will not be restrained from seeking elsewvhere that assistance wvhich they are unable to procure from the only eligible souirce. The

me(licine wtill, doubtless, in such a case, be fortl comiiinr, buit the advice ivith which it should be accompanied is unattainable. The merits of this, however, are neither comprehended nor appreciated by them, and the recommenda tions of the drug-seller, mischievous as they

must for the most part be, are at length equally prized with those of the highly-educated and in every way competent medical practitioner.

This is an abuse which louidly calls for imme diate attention, and requires the application of a suitable remedy without loss of time, as every day both adds to the mischiefs resulting from

it, and tends to perpetuiate its existence. It is one to which the Apothecaries' Comipany ought es pecially to look, not only because it comes within their more immediate province, but also because it is under their mismanagement and neglect that it has

arisen. Whatever may become of other bodies, it is in the highest degreeimprobablethat the worship ful society can long retain the anomalous powers which they now possess, and sooner or later the ge neral practitioner must be emancipated from their control. Here, at least, as it is well observed by the author of the article published in our 34th num ber, there is no antiquity to plead, no prescriptive righdt to be defended. This company has been officiating in its newv capacity (as a board- for quali

fying medical practitioners,) for which it presents Inothing to mark its suitableness for the brief period of only twenty-five years, and can have ac

(luired no privileges to stanid in the way of more

suital)lc arrangements. It may, however, not un fitly be ultimately constituted a College of Phar inacy, and exercise that superintendence over the

drugg-ists and chemists w hich is so much required; and if it be thought desirable to meet the I)ublic wants for a medical practitioner of inferior attain inents and lower grade, to license certain of them, after (lue examination, to p)rescribe at their own establishments for the slighter ailments of such

persons as may resort to them for a(lvice. This

inferior class of practitioners is actually and ex tensively in existence, althouigh wholly without ascertained qualification; either let it be put down, if practicable, or if suffered to continuie, let it be recognized, and a qualification in some degree commensurate wvith the duties assigned to them be required of its members.

ROYAL 'MEDICAL AND CHIRURGICAL SOCIETY.

Tuesday, MIay 25, 1841.

The PRESIDENT in the Chiair.

READ, CASE OF SUBCLAVIO-AXILLARY AN-EU RISM SUCCESSFULLY T-aREATED BY OPERA TION, BY F. C. SKEY, ESQ. F.R.S., ASSISTANT SURGEON TO ST. BARrHOi,OMiEw'S HOSPITAL.

THE aneurismal tuimor in the case here re lated was of small size, and was situated at about an inch from the ouiter border of the left scalenuis

muscle. It ha(l existed about two months when the )atient puit himself under the care of the auithor, and as it was rapidly advancinfg, the opera tion was immediately determined upon. rhe

mo(le of perforiming the operation is thus described: I commenced an arched incision about three inches above the clavicle, close to the outer border of tlhe sterno-mastoid muscle, and carrie(d a little out

war(1s, curving it in towards the clavicuilar origin of the muscle, whicll I expose(d to somewhat more than one-half of its length. '1'his flap, convex towaards the acromion, I reflected with the platysma

myoides muscle. A little careful dissection with a blunt silver knife exposed the lower belly of the omo-hyoideus and a portion of the sac,

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