44

THE LANCET.

LONDON, SATURDAY, JULY 8, 1848.

THE "BRITISH AND FOREIGN MEDICAL REVIEW" AND MEDICAL ETHICS.

THE July number of the British and Foreign Medico-Chi-rurgical Review contains an article on Medical Ethics so ad-mirable in tone, and in every principal point so exactlyagreeing with our own convictions, that we feel bound at onceto record in its favour our sincere praise, and to give the sub-ject of it all the impetus in our power. It is one of the first

duties of a medical journalist, who has the welfare of his pro-fession truly at heart, on the one hand, to curb the vanity andegotism of men in high places, and, on the other, to repressthe depreciatory spirit (too often begotten of the former),sometimes seen in those who pursue the humbler, but not less

honourable, paths of medical practice. It is well that quar-terlies should ever and anon come down from their trimes-

trial stilts, and engage, hand to hand, in the work of mouldingand correcting the morals and manners, as well as the science,of medicine. On the present occasion, a strong and heartyshake is given to prejudices and conventionalisms which havehitherto seemed sacred among this class of critics. The in-

ternal moral life of the profession is examined; the relationsof the profession towards the whole human race are analyzed;the bearings of society towards medicine and medical menare discussed; and all are sifted in the highest and mostcandid manner, and brought to the test of the loftiest prin-ciples, both human and divine.A form of petty rivalry and disparagement is very well

described in the following passage. The Reviewer is speak-ing of the tendency to appeal to the prejudices and conceit ofthe public, by the vainglorious parade of particular qualifi-cations, and making the public the judges between this or thatform of medical education:

" We find one class who assume superior skill and talenton the ground of having been educated at a celebrated school,or at a school which they sedulously praise for the talent ofits teachers, the length of its curricula, or the difficulty of its ’,examinations; and will diligently inculcate the idea that arival, educated at some other school, or holding the diplomaof some other examining board, has completed his educationand passed his examination at an inferior institution, and istherefore less able to treat disease successfully, and less to betrusted professionally, than himself. The public knows littleof the relative merits of the schools and examining boards,and is perhaps quite unaware of the fact that a perfect block-head may make his way through any, or a paragon in industryand genius be ignominously repelled; lay people, therefore.can only award the palm to the most plausible and the mostloquacious, and hence arises a rivalry in petty arts of dis-paragement and self-laudation. The licentiate of Apothecaries’Hall will pass in disdain the licentiate of the Faculty ofPhysicians and Surgeons of Glasgow; the Oxford or Cambridge’man’ looks down with a certain condescension of mannerupon the Scotch doctor;’ and the fellow’ of a college willchuckle in his imagined superiority over the simple licen-tiate.’ There is truly no substantial difference; but the resultof this is mutual recrimination and the disparagement of all."Not but that every man may, and should, feel a just pride in

a professional education of the highest character; but thisshould show itself, not in a desire to depreciate his brethren,but rather to raise them, as far as possible, to the higheststandard.

Flunkeyism, the rage for aping the foibles of the great, isjustly and most severely scourged in the article before us.The rights of professional brotherhood are vindicated with

great ability. Truly, there is no man so high in the profession,that he can look down upon his fellows with supercilious con-tempt. The medical man, engaged in professional ministra,.tions upon the poor, trudging to the houses of sickness anddeath on foot, and preparing the necessary medicines with hisown hand, so he but follow his vocation with benevolence andhonour, is as much encompassed with professional dignity-asfull of the true ethos--as the more favoured dignitary of thecolleges, who ministers, in pomp and circumstance, to thesick of courts or palaces. Disease is the next leveller to

death, and the neglect of the professional spirit, and the cantabout respectability, is a bane of the profession.

" The word respectable is perhaps the most ill-used word inthe vocabulary; it is the phrase of a bilious mediocrity; gene-rally speaking, the attempt to be respectable is nothing moredignified than a mere pandering to dulness. Anything thatis poor, or ministers to the wants of the poor, is not respect-able. The union-surgeon is, according to those who pridethemselves upon this quality, anything but respectable; thepractitioner who prefers to walk rather than to drive a pair,is not respectable; the man who has his surgery by the street,and red and green bottles glaring in his window, is not re-spectable. This twaddle is by no means peculiar to themedical profession; the clerical is quite as bad. An Irish clergy-man, it would appear from the papers, is somewhat of a pariahin the diocese of London; a’ St. Bees’-man’ is hardly respect-able ; the Cambridge graduate thinks his degree decidedlymore respectable than that of Durham; Oxford prides itselfas being more respectable than either. It will well becomethe medical profession, however, to throw off such petty pre-judices, and consider the ends of their being, their training,their glorious knowledge of human nature."

The London College of Physicians, and that most justly,comes in for a share of earnest reprobation. It might havebeen expected, that the professedly highest medical body inthe three kingdoms would in themselves, and in their inter-

nal regulations, shine forth as ethical lights to their brethrenof lesser pretensions. Facts are humiliating. Fellows and

licentiates are not freer than other men from squabbles, dis-sensions, and breaches of professional etiquette. The greatrules for upholding the dignity of the higher branch of theprofession, as the college delights to designate those in com-munion with it, are-

"Every physician, whether fellow or licentiate, shall attachto each prescription which he writes, the day of the month,the name of the sick man, and his own initial, on pain ofbeing fined five pounds. No member of the college shall

! hold a consultation in London, or within seven miles, with aphysician not being a member, on pain of the same penalty."Such is the ethical grandeur, the lofty generosity, the noble

inexclusiveness, of our Royal College of Physicians, as ex-hibited in their by-laws!We are much struck, though the subject is not new to our

pages, with the dignified rebukes given to the" clarissimuspræses," for his assumption, before the Medical RegistrationCommittee, of higher qualifications for the London than theProvincial physician; his outrageous declaration, that "a

higher order of physicians should be secured for the metro-polis ;" and that the millions beyond the magic intra-urbanboundary should be satisfied with a lower order of medicalskill than those within it! The Senior Censor, an old offender,comes in for his share of flagellation, for his cockney dispa-ragement of "the goodness of the article" in provincialschools, meaning, thereby, to include in one overweening de-preciation all the distinguished teachers of medicine, and allthe medical schools of the provinces. Another college wit-

ness, and sometime Censor, is made to writhe, for his evidence

45NAVAL ASSISTANT-SURGEONS—MESMERIC QUACKERY.

zespecting the extra-licentiates of his own college, all of

whom, with their licence, examined for, paid for, and parch-mented, are stigmatized as an " abomination." The questionis very well asked :-

"How can members of parliament and the educated classesesteem a profession, the members of which mutually disparageeach other? Z It can never follow, in the judgment of theeducated and enlightened portion of the public, that the dis-coverer of the motes in his brother’s eye has his own freefrom them; while they believe as to the motes in the onecase, they will suspect the existence of a beam in the other;and thus a low estimate is entertained of all. This is noimaginary evil; for we happen to know an English nobleman,’who, struck with the depreciating tone in whi ch his Londonphysician spoke of the provincial practitioner, mentioned itto the latter; and the result was a reciprocity of criminationinjurious to the character of both."But there are no passages in the article we are referring

to with which we more cordially agree than those which

describe the unworthy jealousies which rise between someamong the different classes of the profession, when any mandares to step out of his proper line; when the physician orsurgeon, for instance, trenches upon the province of the

general practitioner; when the general practitioner aspires tothe work of the surgeon or physician; or when the physicianand surgeon dare to defy artificial distinctions, and pass fromone department to the other.

" Physicians fully engaged in practice will bitterly regardthe young physician who, feeling the pressure of the res

angusta domi, may exercise any surgical talent he may possess,or who, suspecting that his medicamina are not well com-pounded, or of a spurious quality, may look to the manu-facture of his powder, or point his own guns. A submissionto conventionalism is demanded in preference to submissionto a moral or professional duty, and the patient must die,rather than the physician be guilty of bloodletting or phar-macy. But in the face of the great duties of the professionalman, what sad trifling is this!" "

" It is, indeed, remarkable, that while in those societiesdevoted to the cultivation of medical science and art, as theRoyal Medico-Chirurgical Society, and as the numerous

medical societies in the provinces of the United Kingdom,all grades combine and act in harmony, without complaining,and without selfishness or pride, the educational institutionsraise their Shibboleth before the public, before parliament,and in the profession, and establish their differences wherethere is scarcely any distinction. Of the leading men in theCollege of Surgeons in London, how few are there who havenot only the qualifications of physicians, but the practice also.Take away the cases requiring medical treatment from thepractice of the surgeon, and the best portion is gone. To all

purposes, and in every way, the surgeon is a physician, withthe ability to operate chirurgically superadded to his medicalacquirements, and is conventionally permitted to operate,prescribe, and receive his fee, so long as he calls himself, surgeon.’ But let him but add M.D. to his name, andconventionalism forthwith binds up his right hand, severshim from his college, and circumscribes the sphere of his.usefulness ; he is at once disabled and disfranchised chirurgi-.cally; he may possibly attain to office in the College of Physi-cians, but the College of Surgeons is to him hermetically sealed.Now, if it could be proved that this line of demarcation, al-ready obliterated in the voluntary associations, is of any usewhatever to either the profession or the public when drawnbetween two classes of practitioners, in which the differenceof education and attainments is now at least really but nominal,we would acquiesce at once in the arrangement. But it has.yet to be shown that a union of these two educational institu- z’

tions, and a reorganization on a broad base of ethical prin-ciples, would either render the surgeon less skilful, or thephysician less educated or intellectual. The whole matteris indeed hardly capable of serious argument. It is manifest.that the private interests and feelings alone of influentialmetropolitan practitioners maintain the status y2co; we cannotdoubt, however, that the enlightened practitioners in the pro-- vinces will ultimately address themselves to the question,place the organization of the profession on its proper basis,and, looking to the kindred professions of the church and thebar, take that which is worthy of imitation from both."

Is not this an eloquent and unanswerable line of argumentin favour of ONE great ethical FACULTY OF MEDICINE! Weare proud of our convert and ally, and bid him God speed inhis career. How often have we dilated upon the same topic,and demonstrated the right of society, as a whole, to the"veryhighest medical qualification which can be secured; and howconstantly have we dwelt on the meretricious separation, theunworthy caste-division, which seeks to make the highestsurgeon lower than the physician, and the highest generalpractitioner lower than both! There are points relating tothe quackeries of medicine, and popular physic, in the

article upon which we have descanted, with which we shoulddiffer widely; but upon the great questions of medical ethics,the whole meets our warmest approbation, and is, in substance,the same as we have long advocated in season and out ofseason in our own columns.

WE are glad to insert, at page 48, the leading article fromThe TÌ1nes of July 4th, in which the rights of the NavalAssistant-Surgeons are temperately, but ably advocated. For

ourselves, it is now many months, we might almost sayyears, since we commenced the agitation of their claims.We have, with iteration, and reiteration, published articleafter article, and letter after letter, till we have even

been charged, by some parties, with giving too much of ourspace to this subject. But mark the gratifying result. The

cause of the naval assistant-surgeons is now advocated by allthe naval medical authorities, and it is supported by some ofthe highest naval officers in the service. It has obtained the

cordial support of the principal daily and weekly press, and ithas its representatives in the House of Commons. Nothingbut extreme pertinacity could have produced such a satisfac-tory state of things. The present condition of a cause wehave supported from conviction, is one of which we maywell be proud. We need hardly say that we shall not relaxin our efforts; neither must the assistant-surgeons themselves.The rest will come in due course of time. It will be impos-sible for the Admiralty, in the face of so much justice andenthusiastic determination, long to refuse to treat the navalassistant-surgeons as men and gentlemen.

A VERY curious case was decided at Exeter a short time ago.Mr. PARKER, the medical ally of the Whipton mesmeric pre-tender, Mrs. BIRD, whose tricks we exposed on a formeroccasion, sued a poor woman, named HEARD, for medical andmesmerical attendance upon her for a wounded thumb. It

was shown that the patient had suffered from severe inflam-mation of the structures of the hand, in consequence of awound from a fish-bone. Mr. PARKER, not content, it appears,with ordinary remedies, thought the case adapted for mes-merism, and called in the old woman, Mrs. BIRD, in consulta-tion. The patient became affected with that contraction ofthe fingers so common in injuries of the hand, and so necessaryto be attended to. The woman’s instinct-wiser, we should say,than the mesmeric devotees, male or female,-cried out for

something to keep the fingers open; but mesmeric passes, insteadof mechanical aids, were chiefly relied on for this purpose.As she continued to get worse, the medical attendant, with amodest distrust of his own judgment, appealed to Mrs. BIRD’sclairvoyance, to know what was best to be done. The Whip-ton dreams were, however, found to be of no avail, and the

46 DEATH DURING INHALATION OF CHLOROFORM.

woman did not recover until she had passed under the care oothers. The learned judge decided that the practice of mesmerism was no bar to the recovery of fees by a medical manso long as other medical treatment was properly pursued, an(mesmerism merely added as so much moonshine-a dictunwith which we should be pretty much disposed to agree. Ir

delivering his judgment he put an extreme case not ver]complimentary to the mesmerico-medical plaintiff, Mr. PARKER

"Suppose" (said he) "a surgeon were called in to treat abroken leg, and after having set it well, and treated it in otheirespects most judiciously, found that the bone, in spite of althat he could do, was not uniting,-suppose this surgeon tootit into his head that music made the bones unite, and beside;all proper remedies, set a man to whistle’ God save the Queenall day by the patient’s bedside. I take it, that whateveropinion we might form of this last means of cure, it would noiprevent the surgeon from recovering a remuneration for hisotherwise judicious treatment."

C)

Ultimately, a small sum was allowed for the attendance;to be paid at the rate of four shillings a month, and costs on areduced scale.

Upon this case we would remark, that it is most humiliatingthat the very humblest and weakest-minded among us should

ever take the medical profession into a court of law, to bescoffed and jeered at as it must have been in this case. It

passeth foolishness, in our opinion, for a qualified member of alearned and liberal profession to be actually applying to thedelirium of an old woman for information as to the diagnosisand plan of treatment necessary in a given case. It is posi-tively worse than the augurs; worse than the examination ofblood and entrails by the superstition of the ancients.Such is mesmerism, carried out to its extreme; such is this

lamentable imposture and delusion with the full light of daybrought to bear upon it. The proceedings in the case of thispoor Devonshire woman are the natural result of the

mummeries and blasphemies against all science and humanreason, with which The Zoist has teemed for the two or three

years last past. The force of folly, however, cannot go furtherthan this; and with every respect for the vast extent of humancredulity and capability for humbug, we do think, with hopefulconfidence, that the brood of mesmerism are its own naturaland most powerful enemies, and that they must, in no longtime, utterly destroy their loathsome dam.

Coroners’ Inquests.DEATH DURING THE INHALATION OF THE

VAPOUR OF CHLOROFORM.AN inquest was held, on Saturday last, July 1st: beforeMr. WAKLEY, at the Apollo, Francis-street, Gower-street, onthe body of WALTER SAMUEL BADGER, Esq., solicitor, of Rother-ham, Yorkshire.THOMAs BADGER, Esq., Rotherham, on being sworn, stated

that he was an attorney, and also coroner for the county ofYork, and that the deceased gentleman was his son, and wastwenty-two years of age. That he (the deceased) left witnessat Rotherham on the Wednesday previous, between two andthree o’clock P.M. ; that he appeared to be then in perfectlygood health, and started for London; that he had been alwaysin good health. After running, or taking any violent exertion,deceased would, like other persons, be somewhat out ofbreath, but he had no difficulty of breathing, and was notsubject to fainting fits.A brother of the deceased, a barrister in the Temple, who

was in the inquest-room, and seated near the Coroner, hereremarked that, sometimes, after his brother had been run-ning, he would say, placing his hand on his chest,

" Feel here,how my heart is beating." This gentleman’s deposition wasnot taken on oath, as he soon afterwards left the inquest-room.

JANE CORNWALL deposed, that she is servant to Mr. Robinson, surgeon-dentist, of Gower-street, and that she was present at the death of the deceased gentleman, in the surgerof Mr. Robinson’s house, on the previous day (Friday, Jun;30th); stated that she always attended Mr. Robinson whe]he administered the chloroform or ether to ladies, and thashe was present when gentlemen were the subjects of operation, if the footman happened not to be in the way. That th,whole time, from the period when the deceased gentlema]entered the surgery to that of his death, was not more thatfive minutes. That the bell rang, and she went in as usualand, on entering the room, saw the deceased sitting in th,operating-chair. That Mr. Robinson said to him, " If yoifeel afraid, don’t take the chloroform;" when deceased replied, that he did not feel afraid, and he would take it. MrRobinson observed, "Then I’ll give it to you; we’ll sit doivrand take it very quietly." Believes that deceased wantecsome stumps of teeth extracted. Before deceased had takelsix inhalations, he said that the chloroform was not strongenough. The apparatus or inhaler was held by Mr. Robinsonat a distance of an inch and a half or two inches from deceased’s mouth and nose; it was not applied close to hiJmouth and face. When deceased remarked that the chloroform was not strong enough, Mr. Robinson said, "Let mEtake them out without." In a moment the gentleman’s hauedropped from the part of the chair whereon it was restingand then his head, and witness never heard him speak or savhim move after. He was talking the instant before his heaeand hand dropped, and said to Mr. Robinson, " It is verypleasant." Perhaps the inhaler had been taken from beforehis mouth a second or so, before his head and hand fell. 11was held by Mr. Robinson himself, and was not before deceased’s mouth and nose a minute altogether. Of that she icertain. Immediately after deceased’s head and hand droppedMr. Robinson applied cold water to his face. A surgeon walsent for instantly, and Mr. Hardy and Dr. Waters attendedand tried to bleed him. Bleeding was attempted in less thaitwo minutes after deceased’s head dropped. The doctors lai(the deceased on the floor. Witness has lived upwards of thretyears with Mr. Robinson, and firmly believes she has seerhim administer the chloroform seven or eight hundred timesand has never seen any ill effects from it at any time; has seerno one fair.t from its use; and has not heard any one complairof its effects; is positive that the deceased himself asked tchave the chloroform administered, and Mr. Robinson reo

quested him not, but to have the operation performed with-out.ALBERT SALTON, footman to Mr. Robinson, deposed, that he

was present at the death, or immediately after the death, oithe deceased gentleman. The bell rang; he went to the sur-gery. Mr. Robinson said, " Come here!" He went and helddeceased’s hand. Deceased seemed going off in a fit, and inhalf a minute Mr. Robinson sent witness for a doctor, and hereturned with one in about a minute. That an attempt wasmade to bleed deceased, when only a few drops of dark-coloured blood were obtained. When witness entered theroom, deceased was in the operating-chair, and appeared tobe leaning backwards. Dr. Waters laid him on the floor.Witness had let the deceased in when he knocked at the door;he then appeared in good health. Has seen Mr. Robinsonadminister chloroform in hundreds of cases; ladies havesometimes fainted; Mr. Robinson has not administered etherfor six or eight months past, but has used chloroform only.JAMES RoBiNSOjf, surgeon-dentist, Gower-street, deposed that

he had never seen the deceased gentleman until Thursday;that he applied to witness on that day to have an operationperformed on his teeth, but that being engaged, he (Mr. Robin-son) was obliged to make an appointment for the followingday, (yesterday.) Just after deceased had entered the surgery,he said that his heart failed him, and that he would not havehis teeth out without taking the chloroform. Told him thatit would be over in a moment, and that he had better not.He persisted: witness then called in the female servant, thefootman being engaged. Put a drachm and a half of chloro-form on the sponge of the inhaler; that is the usual quantity;then held the inhaler at a distance from his mouth, and hehad not inhaled a minute, before he said, " It is not strongenough; make it stronger." Witness then asked the girl forthe bottle containing the chloroform, but before he could takeit from her, to apply more to the sponge, the head and handof the deceased gentleman dropped. Witness immediatelyapplied cold water to his face with a towel, and poured coldwater on his head from a pitcher. He also immediatelydispatched his servant for the doctor, and slit up the sleeve ofhis (the deceased’s) coat, for the purpose of bleeding him. At