358

THE LANCET.

LONDON: SATURDAY, OCTOBER 28, 1854.

HEROISM AND LABOURS OF THE SURGEONS AT THE ALMA.

LET those who argue that the medical officer attached to our

armies is, in all essential respects, a civil officer; that his

duties are of a civil and not of a military nature ; that thescene of his labours, in great measure, preserves him from the

dangers to which other portions of the army are exposed; andthat his position, his honours, and his rewards should be regu-lated in accordance with this idea;-refer to, and well and

carefully read over again, that eloquent passage in the letter ofthe correspondent of The Times at the seat of war in theCrimea, which runs thus:-

" What is that grey mass on the plain, which seems settleddown upon it almost without life or motion? Now and then,indeed, an arm may be seen waved aloft, or a man raises him-self for a moment, looks around, and then lies down again.Alas! that plain is covered with the wounded Russians still.Seven hundred and fifty wounded men are still upon the

ground. * * * We have done all we can for them, andnow, unable as we are to take them along with us, or to sendthem away, we must depart."But striking and painful as this picture may be, let them

read a little further, and say-In the midst of this mass of750 wounded men, what further object presents itself to theview? Who is that single individual who, of all the host

which is marching away from the scene of its late triumph, isstill to be found upon that blood-stained field? and what is the

errand in which he can be engaged-there, alone amongst hisenemies, watching the retreating forms of his friends, his

countrymen, and gathering up his courage as best he may, toundertake those duties which, in obedience to the dictates of

humanity, it has become his stern duty to perform?" In order to look after their wounds, an English surgeon was

left behind with these 750 men. This most painful and desolateduty devolved on Dr. Thomson, of the 44th Regiment r * *

and then, provided with some rum, biscuit, and salt meat, hewas left alone with his charge."Well may The Tinaes’ correspondent describe his as a painful

and desolate duty! and well may we ask, if the courage requiredto sustain him in this most trying emergency was not at theleast equal to that demanded of our gallant soldiers whencalled upon to face such difficulties as those they had so

recently, so gloriously overcome?We desire particularly to direct attention to this incident,

as serving to show the nature of the duties our army surgeonsare liable to be called upon to undertake. We know that a

man, in the ardour of the fight, in the full tide of battle, sideby side with his comrades, with the eyes of his fellow-menupon him, will, in the moment of excitement, nerve himselfto face the cannon’s mouth, and to perform deeds of daringwhich in his cooler moments he would not venture to contem-

plate. But what is to be said of the heroism required to facedeath in the thousand forms in which it must have presenteditself to the mind of that lonely man, alone in the midst ofhundreds, with nothing to relieve his sense of desolation, and

supported only by that moral courage which the consciousnessof being engaged in the discharge of the noblest of duties-

that of humanity-could confer? We answer that, let the

deeds done by others in that gallant army be what they may,none are more worthy of mention, or required more real

courage, more heroic courage and self-devotion, than this ofDr. THOMSON, of the 44th. Melancholy to relate, two daysafter these noble and charitable exertions, Dr. THOMSON

was hurried from the scenes of his benevolence by that fearfulscourge, the cholera. He died after twenty-four hours’ ill-

ness,

But conspicuous as is this instance of heroism on the part ofone army surgeon, we know that the duties which the whole bodywere called upon to perform after the battle of the Alma weresuch as to demand the exercise of qualities of the very highestorder. The soldiers of our army fought for three hours. and trulythey did their work as English soldiers know how to do it. Butwe also read of the medical staff, that for forty-eight hours afterthe battle they were incessantly occupied in their dreadful andarduous duties ! and we do not hesitate to say that, during theseforty-eight hours, every one of these men underwent as muchdanger of death as any individual amongst the officers or menwho so gallantly stormed the heights two days before.

Doubtless, the perils of the surgeon are surrounded by no haloof glory; they have no such thrilling accompaniments as belongto those encountered at the cannon’s mouth, or when chargingupon the sword of the foe. But the dangers are no less real: theenemy is to the full as deadly, and his aim as sure : they occurfor the most part silently and insidiously ; they were everpresent during his labours for the two days and nights upon thefield of fight, exposed to the chances of death from fatigue, fromcold and dew, and from the tainted atmosphere which the

neighbourhood of the wounded and dying inevitably brings;and they are present in a peculiar manner when he is called

upon in camp or in hospital to incur the risk of contagion fromcholera or other pestilence which accompanies constant in-

tercourse with the sick, in addition to the ordinary liabilityto the illness which he shares in common with the rest of the

army from residence in the infected district.

The dangers being thus at least equally shared by thewhole army, we should of course expect that the rewards ofsuccessful daring would be equally divided also. Whether this

is so our readers are but too well aware.

In THE LANCET of last week we adverted to the fact that, inthe despatches received from Lord RAGLAN, no mention. is madeof his medical staff, or of the vast services which they must haverendered immediately after the battle; not one word to cheer orinspirit them; they are passed over in silence; their very exist-ence forgotten. The public, indeed, now that the emergencyhas arrived, and upon the mere suspicion of a deficiency in thisparticular, has shown, by unmistakable signs, that they feelto the full extent the exact value of the medical staff attached

to an army, and are willing to recognise the vital importanceof this arm of military science. But the Government of this

country (and, consequently, the agents of the Government)evidently look upon them as performing duties of a verysecondary nature; and although upon their skill and devotionto their calling the restoration of our soldiers and friends tolife and health, and, in many instances, their restoration witha whole body instead of a maimed trunk, entirely depends,any extraordinary encouragement, or any greater stimulus toexertion in their labours, or any other object of honourableambition for which to strive, than is provided by their ownconsciences, their sense of duty, the calls of humanity, or thedistant prospect of promotion in the ordinary course of things,is systematically denied to them. A man can, without diffi-culty, be rewarded by knighthood or a baronetcy for a success-

359VACCINATION AND SMALL POX.

ful speech in parliament, or for a vote which has saved a

ministry; but for the man who has saved hundreds ot

thousands of his fellow-countrymen, by services to the army,any such distinction is considered to be entirely unnecessary.

- ---°-----

IF the prevention of epidemics be one of the chief cares

properly devolving on the Board of Health, it follows that theprophylaxis of small-pox, than which no zymotic disease is moreterrible, or requires more constant vigilance, ought, in the

nature of things, to be under the charge of that department.No example can more strikingly illustrate the present confusionthat prevails throughout our sanitary legislation, than the lawsand practices professing to have for their object the preventionof small-pox. We have on former occasions exposed, from thestatistics of the Small-pox Hospital, drawn up and analyzed byMr. MARSON, the not very creditable fact that England, the

birth-place of JENNER, the country to which all other countriesowe that discovery of all others the most valuable in its resultsthat medicine ever gave to the human race, exhibits not onlythe most imperfect vaccination, as regards the diffusion of thatoperation throughout the population, but also the worst in pointof individual performance. This fact is incontrovertibly provedby authentic and consistent observations, extending over many i

years. Vaccination, often bad when performed at all, and thetotal neglect or refusal of vaccination by a large portion ofthe population, necessarily left never-failing sources for themaintenance and spread of small-pox. The CompulsoryVaccination Act of Lord LYTTELTON was passed in the hopeof making vaccination universal and effective. It cannot

be doubted that, could that object be attained, small-poxwould be, if not entirely expelled from the land, at least

kept within such narrow limits as to cease to be a nationalinfliction and a national reproach. Does the Act hold out anyreasonable hopes of attaining this point? The most undeniable

evidence proves that the Act has failed. Vaccination has not

been extended. Small-pox has not been diminished. It was

obvious to those who had studied the subject of sanitary police,that failure would ensue. At the time when the Bill was

under discussion, we pointed out the defects in its principleand in its provisions which surely foreboded that result. We

have now the means of exhibiting the state of the country, asfar as regards small-pox and vaccination, since the attempt hasbeen made to bring the Act into operation. We conceive that

we shall discharge an urgent duty, and render a good serviceto the cause of Sanitary Reform, by showing the manner andthe causes of the failure of this Act. The materials from which

we draw our conclusions are contained in the " QuarterlyReturn of the Registrar-General" ending in June last.

If we examine the reports of the local Registrars, we shallfind abundant evidence of the extent to which this loathsome,and fatal, and preventible distemper has prevailed; and distinctindications of the causes which entertain it.The Registrar of St. George’s, Hanover-square, says :-

Small-pox has prevailed with fatal effect, principally in un-vaccinated persons." In Lambeth, it is reported that " there"have been many cases of small-pox. The Registrar has no"means of ascertaining how far the Vaccination Act is complied"with, there being no appointed public vaccinator in his

" district," " At Kingston, in Hampshire, the Registrar says:" Small-pox is on the increase. Like fever, it has been most"fatal in those localities where drainage, sewerage, and

’’ ventilation are most wanted. I am of opinion the disease is

"propagated by mothers and nurses, who purposely take the"children. into infected houses!" In Landport, " the increase"in the deaths above the average is attributable to the ravages"of small-pox, -which has been, and continues to be, epidemic"here." In Southampton, "small-pox has continued to be"very fatal during the first two months of this quarter." At

Leighton-Buzzard, in Bedfordshire, the disease "has been very"prevalent." At Luton, "the increase of deaths above the

"average is mainly caused by small-pox; but I believe thatthe disease has been fatal only to those who had neglectedvaccination. " At Norwich, "small-pox continues to be

epidemic, but only one death has occurred where vaccinationhad been previously performed." A Registrar says:" regret to add, that many of the poor and uneducated parentsare extremely averse to having their children vaccinated."At St. Thomas’, in Devonshire, "vaccination is still objected

to, and duplicate certificates are slowly returned." At

Plymouth, "there have been twenty deaths from small-pox. "

At Stogumber, "small-pox has been raging. Parents pay very" little attention to the vaccination of their children, and"many refuse, notwithstanding the Vaccination Act, and" when the disease is spreading around them." At Taunton," the Vaccination Act is not carried out." In Droitwich," small-pox still continues to rage." At Ashbourne, in Derby-shire, " small-pox is still very prevalent." From Stockport wefind an almost solitary testimony in favour of the Act, andeven that testimony carries an important qualification :" The Compulsory Vaccination Act is working well. There

" are a few parents that have strongly objected to it, but by" reasoning with them they have given way. The chief diffi-

" culty arises from apprehension that the vaccine matter’ maybe ta7cenfrom unhealthy children." In Bolton, " the Act is

evaded." In Yorkshire, " small-pox has been prevalent at" Topeliffe. Two deaths had been registered, in neither of" which had the parties been vaccinated. Vaccination is still

" much neglected by the labouring classes." In Kendal," small-pox has been very prevalent."Such are examples of the evidence supplied by the Registrars.

That evidence leaves no doubt as to the prevalence of small-pox. It affords also the most distinct proof that vaccinationis still obstinately resisted. It is equally proved that the

Compulsory Vaccination Act is unequal to the charge of

diffusing vaccination.In considering the amount of the evils inflicted by small-

pox, it must be borne in mind that that amount is not to be

measured by the deaths. Many who recover with their livessuffer from a variety of secondary evils; blindness, deformity,debility, scrofula, insanity, impair the enjoyment of life, andpredispose to early death.But why has the Vaccination Act failed? Upon this point

we have the most certain information. Our own observation,and the uniform testimony of the medical profession, who,more than any other class of the community, enjoy the oppor-tunity of ascertaining the unbiassed feelings of the poor,concur in demonstrating that the association of the Boards ofGuardians with the execution of the Act constitutes the one

great and insurmountable obstacle. The special and peculiarduty of Boards of Guardians is to administer the Poor Law.

The poorer classes will naturally contract a dislike, that maybe a prejudice, against those who are charged with this un-popular office. Vaccination coming from them, and coming

360 MEDICAL ARRANGEMENTS OF THE ARMY.

with the additional drawback of compulsion, will necessarilybe regarded with suspicion. Whatever is forced upon the

labouring classes by the Poor-law officials assumes the odiousform of Poor-law relief. The vaccinators are appointedby the Guardians. The poor are told that they must carrytheir children to be vaccinated by medical men who may bestrangers to them. They apprehend-and the apprehension isnot altogether unfounded, or unshared by the educated classesthat the vaccine matter employed may carry with it the

seeds of other diseases not less loathsome than the one it is

intended to prevent.The consequence of this wide-spread discontent is what we

have seen : diminution of vaccination, and increase of small-

pox. What is the remedy? what is the course to be adopted?Is it not obviously to withdraw the charge of extending vacci-nation from the inefficient hands of the Boards of Guardians,to entrust it to that department whose special and naturalfunction it is to prevent epidemics, and to watch over the

general health of the community?There is surely no valid reason why small-pox should be

made an exceptional case; why one zymotic disease should bepicked out from its congeners, and the care of preventing ittaken away from that department which is alone able to copewith it in a comprehensive manner; and without wounding thehonest pride of large classes of the people.

GREAT as is the cause for animadversion upon the conduct of

our medical establishments, we would emphatically express ourbelief, that, in the preparation of medical and surgical meansfor the service of our army now in the field, Dr. ANDREWSMITH, the respected head of the medical department of thearmy, did all that was needful. If necessaries were wantingin the field, or in the hospitals at Scutari, we must look tothe executive authority on the spot for the explanation. This

is a point not understood by the public, and hence the unjustobservations of some portion of the daily press.

In a most fair and liberal article on the alleged neglect ofour wounded soldiers, the Examiner-one of the ablest of theweekly journals-does ample justice to Dr. ANDREW SMITH,and to those acting under his orders. The Editor declares

his belief, that every fresh information will increase our satis-faction with the medical arrangements-a belief in which we

altogether concur. Referring to the sentiments expressed bythe French press on this subject, the Editor of the Examineroffers the following important observations, which we commendto the attention of the profession:-

" A word in conclusion on the way in which this alleged failure of our medical arrangements, as to which we have beenremarking, has been discussed by our friends the French. Itmay turn out worth while to have been somewhat misled inthe matter for a little useful plain speaking. Reports, withprobably little truth in them, elicit remarks that have un-questionably a great deal of truth in them.

" The French say, then, that such a failure would be

mainly due to the fact that the medical profession hasachieved for itself no adequate honour or reputation in

England. In France, during the last half century, there is nocouncil board, no administration, no society, in which themedical profession has not found itself represented, whether atthe Court of the Sovereign, amongst the Peerage, or in theLegislature. Physicians of the Institute take their placenaturally amongst the first of the land. Their views, their dis-coveries, their cares, their piofessional ideas and suggestions,must be listened to, cannot be neglected, and may never betreated as intrusive; nor had Napoleon fewer physicians andsurgeons for friends, councillors, and dignitaries of state than

he had of any other profession. But in England all such in-terests find themselves either unrepresented, or not representedworthily, and the best of her.physicians is good only to amass.money, or, at the highest, to get a baronetcy. What importantor salutary medical influence has made itself felt in the publicadministration since the wounds of Waterloo were healed? andwhere, in all those years, except to born lords and baronets,have we had the means of looking for sanitary wisdom orsuggestion? For answer, we are referred to the whole historyof our sanitary and medical administration. Provided only a.man be born baronet or lord, we are ready to accept him for a.born scavenger and born physician as well; nor can anyamount of science or learning be esteemed paramount to ourregard, except the science of addressing and managing con-stituencies, or the knack of palavering either House. Theremay be some exaggeration in this, but it will be safe to admitthat there is also considerable truth; that though the text isinaccurate enough, there is something in the comment it pro-vokes ; that honour and influence in this country tend far too-much in one direction; and that, so far from our men of merelearning and science finding easy access to their Sovereign orher councils, they have only too much reason to be thankfulwhen they get the ear or be worthy the attention of an Under-Secretary of State."

This is excellently well put, and to attain to the status ofthe general body of the profession in France we must bringabout a great reform within ourselves. We believe that the

political shyness of the profession ought above all things to beovercome. Where there is now one medical man in Parliament

there ought to be twenty. No man ought, in our opinion, tohold the position occupied by Dr. ANDREW SMITH without a.

seat in Parliament. His explanations of the medical arrange-ments for the East ought to be made in Parliament, face toface with those who are really responsible for the errors whichhave been committed. We wish, too, that Sir WILLIAM

BURNETT could be brought to believe that his leisure could bebetter occupied in serving some parliamentary constituency,and upholding the Medical Department of the Navy in theLegislature, than by bottling and sealing solutions of chlorideof zinc.

WHENEVER the important subject of the prevention of unqualified persons from practising medicine has come before thepublic, unprincipled quacks and ignorant legislators have

opposed any scheme for the purpose, on the absurd plea that itwould infringe the liberty of the subject. England has beencalled the " Paradise of Quacks," and a Minister of the Crownendorsed the axiom by his memorable quotation-

That the pleasure is as greatIn being cheated as to cheat."

One of his successors in office, however, not appreciating eitherthe morality or the expediency of such a doctrine, made latelya striking commentary upon it, by ordering the prosecution ofa notorious quack for having cheated a patient of his life. It

has been too much the fashion to regard the suppression of

illegal practice as affecting merely the practitioners of medicine- that their interest only is involved in the matter. There

never could possibly be a greater mistake. However much a

stringent law to suppress illegal practice might benefit the pro-fession, we unhesitatingly affirm that such a measure wouldconfer a far greater benefit upon the public at large. Those

whose daily duties call them to the bedside of the sick and

the suffering are constantly in the habit of witnessing the dan-gerous effects of the practice of medicine by ignorant persons.Cases occasionally come before the public in the report of apolice-court, or of a coroner’s inquest, of poisoning by somepotent drug ignorantly administered, or of death from some

. serious disease wrongly treated. But cases of this kind that

361THE LATE DR. ROUPELL AND THE "THIRD -YEAR’S STUDENT."

never meet the public eye are undoubtedly of daily occurrence.It is the practice of those who impose upon the public byfalse titles or quack nostrums to leave their patient in the timeof his greatest danger, and the qualified attendant is merelycalled in at the closing scene to give his assistance in a hopelesscase, and "a certificate of the cause of death." We do not over-

state the fact when we assert that thousands of lives are

annually sacrificed in England to the ignorance of unqualifiedpractitioners. That the members of our profession are deeplyinjured by the want of a stringent law to prevent illegal prac-tice, we are willing to admit. That they should be allowed tosuffer under such an injury is a disgrace to the Legislature.For thirty years we have fought for that protection in thepages of this journal, and until that act of justice is consum-

mated we shall continue the struggle.Those who can carry their memory back for the last quarter of

a century will see something of hope in the future. Parliament

and the public think very differently now to what they did onthe subject of protection, and it is certain that no measure ofMedical Reform will be carried that does not contain a stringentclause for the prevention of unqualified practice. Persons falselypretending to be lawyers are punished as criminals. An Act

of Parliament has decreed that the forger of the " Hall mark"upon base metal shall be treated as a felon. But the publichave no protection against any ignorant knave calling himselfa physician or surgeon, and practising as such. Property isheld sacred. Life is treated as worthless !

The result of the case of the Apothecaries’ Company versusBROWNRIDGE, as reported in the present number of THELANCET, must be highly satisfactory to qualified practitioners.From no class do they suffer so much as from the prescribingdruggists. To the injury inflicted by these persons are manyof the difficulties which beset the path of the young practitionerto be attributed. There is not a member of our profession whowill not readily assent to this. Mr. BROWNRIDGE is only a

type of his class. We trust that the just verdict obtainedagainst him will stop the prescribing career of many of hisbrethren. Notwithstanding legal quibbles and subterfuges,the law has reached the offender. It cannot be long, however,before a more summary mode of proceeding than suing forpenalties in the County Court will be instituted to stop thedangerous practice of ignorant and unqualified persons.

THERE is in The Times of October 25th, an article so forciblytrue, that it must excite the attention of every medical officerwho has served in the field. It is a fact, now, in relation tothe Crimea, and has always been a fact in every British

military expedition, that medical officers and their stores havebeen the last to be provided for, and hence the prevalence offormer and present neglect of our sick and wounded. The

very sutlers are provided for before our surgeons and themeans of relieving those who fall in battle. This lamentablestate of things, as the article referred to truly states, is broughtabout by the utter want of all independent action in themedical staff of our armies. The military medical officers

ought to be masters both of their own men and of their ownstores. If this were the case, our superior military surgeons,whether in home or foreign administration, would become justlyresponsible, both to their commanders and to the Govern-ment. The truth has been exactly as now stated in the publicpress, and it has ever been, and always will be so, with our

medical stores and medical officers, until an independent action’ is permitted. They ought no longer to be under the entire! control of generals-in-chief or generals of division, but they

should have everything within themselves. They should thenbe responsible to their generals and to the authorities in thiscountry for the use made of the means at their disposal. This

is what is wanted in our fleets and armies. The commissaries-

general and their superior officers enjoy on service a completelyindependent action, and yet they are as thoroughly responsibleas the lieutenant-colonel or the major to the generals and tothe Government. It is for this kind of independent actionthat we contend, as being absolutely necessary alike to theefficiency of the medical department and to the welfare of thesoldier. More than enough of medical officers and stores weresent with the army from this country; but the generals leftthem at Varna, and no doctor had even the privilege to com-

plain. Sir ROBERT PEEL states, on the information of the

authorities, that courts-martial are to be held in the East uponthe recent blunders. No good can come of this. The inquiry,to be efficient, should be made in this country, and it wouldhave to begin with the highest places and personages concernedin the conduct of the war.

Correspondence.

THE LATE DR. ROUPELL AND THE "THIRDYEAR’S STUDENT."

" Audi alteram partem."

To the Editor of THE LANCET.

SIR,-My attention has been directed, through the courtesyof a friend, to a recent number of a medical periodical which Iseldom peruse. In its impression of the 7th inst. some observa-tions occur in eulogy of the late Dr. Roupell, propoundedin the very feeblest language, that makes reference to a trivialand brief criticism which, under the title of the " ThirdYear’s Student," was published many months since in thecolumns of THE LANCET. Had not my name of late been so

frequently associated, both privately and publicly, with thecontributions of the " Third Year’s Student," it would mis-become, as well as be unnecessary for, me to notice the re-marks to which I refer; but the profession is cognisant thatsuch is not the case, and as I believe it to be a most salutaryprinciple that a wilfully malicious statement published in ajournal, of however limited a circulation, should, if thetopic is of moment, suffer immediate refutation in the mosteffectual manner, I scarcely conceive that I make an idlerequest in asking the attention of your readers to the subjectof this letter.Now permit me to quote the passage in question. It is as

follows :-"In the wards he (Dr. Roupell) was always accessible to the

students, ready to communicate, and full of practical know-ledge. We would not willingly, on the present occasion, alludeto a disagreeable subject, but, in justice to his nzemory, cannothere omit to state, that no one than he less deserved the imper-tinent and personal criticisms which recently appeared in thecolumns of a contemporary as the contribution of the ThirdYear’s Student."’ The italics are mv own.Those whose recollection of the "Letters" " is by this time

obliterated will naturally ask, What are these " impertinentand personal criticisms?" Sir, they were embodied in a singleobservation. The nature of this remark (although I shouldhave considered it sufficiently intelligible to have been sus-ceptible of comprehension by the least educated person) was,at the period of its publication, misunderstood by a corre-spondent, and therefore, in a subsequent number of THELANCET, this criticism was thoroughly elucidated. With yourpermission, I will cite the entire passage :-"The charge of ignorance which I am asserted to have

’lodged’ against Dr. Roupell is contained in a single remark.’Dr. Roupell, indeed, uses it, (the stethoscope) but more, Ibelieve, pro foranu, than from any confidence he himself putsin it.’ How far this is ’lodging a charge,’ I leave others to