85

THE LANCET.

SATURDAY, JANUARY 15,BEING

No. 4OF THAT JOURNAL FOR THE YEAR 1859.

THE NEW CHARTER OF THE COLLEGE OF PHYSICIANS.

WiiAT is the meaning of the " Heads" of a Scheme issued I

by iilr. SOTHERON EsTCOURT? This question, amongst manyothers relating to Poor-law Medical Reform, is being constantlyput to us. Indeed, the communications we receive on this

subject are perfectly overwhelming. There seems to be no

certainty in the minds of the great body of our brethren as tothe tendencies or probable results of the new Scheme. Theyappear to be

" at sea" respecting it. Mr. GRIFFIN, Mr. LORD,and other gentlemen have taken great and praiseworthy in-terest in the cause of Poor-law surgeons-how do they inter-pret the " Heads?" Is, for instance, the pauper populationto be calculated only by the man and his wife in a family, orare the children to be enumerated ? What is the meaning of1.9. 6d. a case? Is that great sum to be paid for attendanceon each separate case of illness, or is the order to extend to a

period of three months from its receipt ? How is mileage tobe paid? Is it for every journey, or only for the first ?These questions, it must be admitted, are really important;

and, until they are satisfactorily answered, it is impossible todetermine what might be the effects of the new Scheme onthe public and the profession.

THE current of Medical Reform has, in its course, swept bythe stately portals of the College of Physicians: it threatens,if it meet with any obstruction, to swell into a torrent that

shall overwhelm that venerable institution. The College seesthe danger, and wisely applies itself to the urgent task of

averting it. The question presents itself to the public andthe body of the profession, whether the College of Physicians,under its present constitution, or under a regenerated one, is

calculated to render good service to medical science and thesystem of medical polity. As it is universally affirmed out ofdoors, and even admitted by the most conservative section in

the College, that the present constitution must be amended, it

is not necessary to discuss how far the College, as it now stands,is of public service. The practical question is, What are the

changes called for in order to fit the College of Physicians toact a dignified and useful part under the new organization ofthe medical profession ?The general proposition, that a College of Physicians is a

necessary member of the medical body politic, does not admitof dispute; or, if it be disputed, it will follow that the main-

tenance of a College of Surgeons is of equally doubtful expe-diency. The latter institution has no call to protect medicine;and, assuredly, medicine is vast enough, and important enough,in its bearings on the profession and the public, to need a specialbody to watch over its interests. If, in past times, tied downby effete and monopolizing statutes, and governed in an exclusivespirit, the College has earned a somewhat unpopular repute,that, indeed, is a strong argument for liberalizing, but none for

suffering the institution to fall into decay. Under a new:’ >

Charter, framed in harmony with the Medical Act and thenwants of the profession, the College of Physicians might fulfilthe most useful and most necessary functions as one of the

cognised heads of the medical practitioners of England.I It is from this point of view that the attention of the profe6-.sion is invited to the draft of a new Charter now under the

consideration of the College. Since the tide of common sense,

has fairly obliterated the seven-mile boundary, the change of title-,and of jurisdiction from London to all parts of the empire will be,universally assented to. The spirit of the Medical Act, ind’8ed:rinvolves this change. It is scarcely necessary to point out that.the terms and spirit of the Medical Act must govern those ofthe new Charter of the College. If these clash, the Collagewill soon be out of joint, and want repairing again. It is,.therefore, imperative to bear steadily in view the provisions ofthe Medical Act as a guide in preparing the new Charter. 141-1is proposed to convert the licentiates, or permissi, into mem--bers, and to include the members as a part of the body corpo rate. The government, however, is to be vested only in the,Fellows. We do not see that the licentiates will find their,

position very much improved by this change of name, for the

change does not amount to much more. The metamorphosis.of a Member into a Fellow can only take place by the act of,the Fellows. Vle are strongly of opinion that in addition tthe power of electing Fellows vested in the Fellows, a

popular mode should be provided. The members themselve

ought to enjoy the privilege of nominating annually a given.number of Fellows. For this purpose, the members ought to>have the power of meeting at the College. The function of

election ought not to rest exclusively with the Fellows. The

principle of representation ought to be frankly conceded. To,

withhold it, will be to damage the character of the whol’3-

Charter, and to preserve the worst of all existing impedimentsto the prosperity of the College. Let the ultra-conservative ’

section weigh the matter temperately. The concession is not.

likely to entail a very formidable revolution. The licentiates,

are not such terrible democrats ; they form a respectable.body of men. To give them the power of electing annuallyfour or six members of the governing body of their Colleges.would not be analogous to the introduction of the principle o&

universal suffrage into the parliamentary Reform Bill. The.

licentiates should bestir themselves at once, lest it be objected,,that, since they are not solicitous for the privilege, it would bs,absurd to grant it.

It is further proposed to embrace a large body of gentlemen’ practising as physicians by virtue of University degrees, by.admitting them to membership on payment of ten guineas, -and without examination. The liberality of this proposal is _

unquestionable, when it is remembered that all the present,licentiates, including University graduates, have had to un-

dergo examination, and to pay a much heavier fee. There is-

still a question about filling up the fourth column of th,Medical Register, specifying the professional rank, or ratherstyle, of the person registered. This has been postponed bythe Medical Council. But we believe it cannot be put aside

altogether. It may be useful at present to indicate in a State:

register intended for public reference, whether such a man be-a physician, a consulting-surgeon, or a general practitioner.It would infallibly lead to confusion, and serve to embarrassthe public, to omit this designation at this period. The proper.

86

COOKERY AND DIET.

title to be classed as physician would be the diploma of a Col-lege of Physicians.The clauses relative to the creation of Fellows appear to ’!

require revision. We have already expressed our opinion thatthe members should have the power of nomination. The pro-vision, that members of four years’ standing may be admittedafter examination, ought to be expunged; or, if retained, itought to be limited to those members who have been admittedoriginally without examination on the strength of their Univer-sity degrees. To introduce a distinct Fellowship examinationwould be inconsistent in principle, invidious in its application,and mischievous in practice. A member of the College ofPhysicians ought surely to be a competent physician, and notto be subject to the slur that he has only undergone an in-ferior or preliminary test.

Another mode of elevation to the Fellowship will meet withmore favour. It is proposed to give the Council the power of

nominating, during twelve months after the acceptance of theCharter, members for electian-we presume, without restriction

as to numbers. This power would enable the Council to

strengthen the Fellowship at starting, and thus to popularizethe College. It will, however, be necessary to lay down somewell-defined principles of selection, so as to obviate the ap-pearance of arbitrary action.

By another provision, a supplementary power is given tonominate members of four years’ standing, who have distin-guished themselves in the practice of medicine, or in the pur-suit of science and literature. This is to come into operationtwelve months after the granting of the Charter.But these and other matters in the Draft Charter, inas-

much as they affect only a limited portion of the profession,are of insignificant importance when compared with a clausewhich contemplates the placing of the entire body of generalpractitioners of England in the same relation to the College of

Physicians in regard to medicine as they now occupy in regardto surgery at tie College of Surgeons. There seems nothingmore consistent, nothing more logical-since no one now dreamsof a College of General Practitioners-than that the College of

Physicians should conduct the medical examination of candi-dates for general practice in the same way that the College of

Surgeons conducts the surgical examination. There cannot be

a doubt that it would conduce far more to the dignity, and befar more consonant with the self-respect of the General Phy-sician and Surgeon, to be diplomatized by the Colleges ofPhysicians and Surgeons, than by the Apothecaries’ Company.The time h,,s come when the candidate for medical honours

should seek an authoritative testimonial of his fitness from the

recognised head af medicine, and wending his way to Blackfriars’when he is ia want of drugs. WThy should the surgical branchof his profession-that which is least praetised-be speciallyhonoured and distinguished, and the medical branch be de-

graded by unworthy associations ? ‘’ We cordially approve alsoof the proposal to institute an examination in midwifery atthe College of Physicians. Obstetrics seem even more closelylinked to medicine than to surgery; and the most eminent

London teachers belong to the College of Physicians.The remaining clauses relate entirely to the internal govern-

ment and administration of the affairs of the College. These

we need not discuss. We submit the leading proposals whichaffect the general interests of science and the profession to ourreaders, inviting them to a careful and candid examination.

WiTHiK the last few weeks a warm discussion has been goingon in a leading daily journal upon the art of dining! And itis from this art, or rather from the want of it, that the medicalattendants, both of the rich and the poor, get-the latter,their patients-the former, their fees. You dine freely in

Paris, it has been said-you feel no sense of oppression. You

dine freely here, and you are stupid all the evening. There

cookery is a science; here it is hardly an art. What fills Bath

and Cheltenham with the dyspeptic ennuyécs of Mayfair, anddrives the Mistress HARRISES and GAMPS of the Dials to re-

lieve their flatulency by so many teaspoonfuls of rum in theirtea? How is it that his " Lordship" leaves his mayoralty ina paroxysm of podagra? and BILL SYKES vanishes from his

padding ken," literally belching and vomiting forth oaths ‘’Nothing less than a horribly-unscientitic cookery, and a badly-regulated diet. "Il faut que tnut le monde vive," said HENRI

QUATRE, as he threw a tartlet to the young page who had

hardly earned it. Yes, everyone must live; and what more

important method to discover than how best to manage it,quoad diet ? Yet we Britons sadly miss the mark. We goneither the better nor the cheaper way to attain it. It is the

same with the middle and poorer classes of English as withmost of the "upper ten thousand." " It is true that he who

has money and taste may be exempt from accusation ; for, iF

he choose his cook properly, he will rarely suffer martyrdomlike poor " G. H. M.," and have his entrées absolntely andirretrievably annihilated by " plain potatoes," or be shamedat the appearance upon his table " of a chocolate souffléwhere a leading sauce has been à la Batelieoe." To such

gastronomes like The Tin-tes’ correspondent, " G. H. M.,"the axiom of the delightful SAVARIN—the discovery of a newdish benefits the human race more than the discovery of a newstar--will appear undoubtedly true; for of stars we surelyhave enough ; but of dishes ?-go on, create, so long as theyare good, ye priesthood of the cordon hleu ! But there can beno doubt about the matter. The ordinary cookery and carteof the well-to-do middle classes are abominable, and producedat an expense which, in foreign hands, guided by technicalknowledge and genius, would really go to

" Make a dainty dish to set before the king !"

We say genius, for we accept SAVARIN’S other motto-yott maybecome a cook, but you must be born a roaster. But if peoplewho have got money choose thus to spend it-i. e., in eating fromgreat heavy joints, and then allowing half of what remains ofthem to be wasted ; in stuffing themselves with such ponderousfood as chains them somnolent afterwards for a couple of hours;in regaling on such barbarous messes as" mock turtle," so-called" sonps," thick as paste, in which you may stick your spoonuprinht,-they must do so, though it be not with impunity.Let them add to these some "full-bodied port," and " justone tumbler of brandy-and-water," and they will discover theconsequences.But it is with the miserable cookery and diet of the working

classes that we are here most interested. The Englishwomanbuys her joint, and afterwards throws away its fat and bones!If she make any dish, it will cost her husband double the

money that a Frenchwoman would have done it for." Compare," says a contemporary writer, " (to descend at

once to the cheapest dinner,) the Nouvelle Californie the’ Barrière Mont Parnasse, in Paris, with the cheapest food

supply of Clare-market. Why, the French rag-picker, for

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MEDICAL REPRESENTATIVES IN PARLIAMENT.

twopence-halfpenny, has his soup and meat and vegetables, allexcellently cooked, and not unpalatable. He dines much betterthan the English mechanic, because our mechanic’s wife throwsone-third of her husband’s dinner into the dust-bin."

This is the contrast in which we feel interested, and inwhich we are convinced there is so much need of reform. The

servant who threw away fat, bones, vegetables, and bread, intothe pig-tub, or concocted therefrom, with other cuttings, her per-quisite of " kitchen-stuff," when in the house of her master,treats the same " odds and ends" and ingredients not less

wastefully when she has become the wife of the journeyman I

mechanic. From not knowing how to make much out of little,as we say, many and many a mother is contented to feed her-

self and her children for more than half the week upon tea

and bread-and-butter, when, by a little knowledge and con-trivance, she could have laid before them for several days some

palatable cooked-up and renovated scraps from the joint &c. of

the Sunday’s dinner. But no: her pale-faced, puny children,as they run from her door-way, meet these very scraps lyingin the gutter. Even the bread that is bought is not of themost economical kind; it is bought too new and recent, cutinto irregular hunks and the butter placed upon it, and tiaenheld before the fire. To know what should be bought to gofarthest at least expense,-to know how to cook i most easily,cheaply, and palatably,-and to find out what will, with con-trivance, furnish most variety and least waste, are de8iderata

of which the English cook-wives of the industrious classes haveyet to become possessed. The medical profession, no doubt,benetits by the occurrence of disease from over-repletion anddietetic errors amongst the rich. But that view of the sub-

ject is much too selfish for us to adopt, preservers as we

should be of the public health. But as regards the poor,everyone must confess that the personal benefit is little indeedthat the medical practitioner derives from their "troubles in the.interior" and from their " stomach and its difficulties." The

only advantage we know of is, that such things much increasethe number of patients at the hospitals, and so enlarge thebounds of the medical man’s experience when gaining knowledgeas a student. One-third of the out-patients at the London hos-

pitals want the cook, and not the doctor ; but many want both,and they are sources of instruction. Anæmia, struma, rickets,atonic dyspepsia, menorrhagia, leucorrhœa, a train of nervousaffections, cutaneous diseases, &c., follow as the sequences of

semi-starvation and an improper kind of diet. Their owners

come with such complaints to the hospital after having calledat the union with their hunger. At the latter they find-so,at least, says DICKENS-" a board of fat governors, spendingtheir time in diluting gruel and writing reports;" at the formerthey hear of cod-liver oil, ammonia, and quinine, and vainlyhope to make such things go a little way for nourishment. It

has been said that the destiny of nations depends upon themanner in which their people are nourished. There is here, asusual in such sayings, much truth as well as exaggeration; yetwe may remark, that MACAULAY (layman as he is) has com-mented as a statesman and historian upon the marked changein the character of disease since the introduction of the potatoand other roots and esculents into the diet of Great Britain.

When we ate almost exclusively wheat-bread and meats, thealbuminous group of ailments was in excess, and a predominanceof gouty and calculous disease was seen. When the diet of the

people was altered by the introduction of new vegetables and

fruits, the lithous affections markedly diminished. Amongstthe poor, who so frequently exist on what is called " tea"

(" GoD save the mark," as says Othello) and vegetable aliments,we find rheumatism taking their place; whilst the fresher classof the latter being scarce and dear, and their place beingsupplied by rice, &c., then purpura and scurvy are common in

"unions," and not unfrequent amongst the people at large.But the relations of diet are manifold and. important, whether

as regards the sensuous gratification of the palate, or the

support and the health of man. We may touch currente calamoupon the " art of dining," or treat with the weight of scienceupon the dietetics of a race. In both undertakings we shall seethere exists the point we have been aiming at-viz., that thereis a science of aliment, and of how to cook it, which the medical

practitioner should appreciate, and upon whose aid he mustconstantly rely. -

MR. BRIGHT, in his speech at Bradford on the new Reform

Bill, expressed himself as follows, with respect to medical re-

presentation in the House of Commons :- .

Again, some one has proposed that the doctors should beenfranchised. I presume that all the doctors who live in £10

houses vote in Bradford or elsewhere. If you talk to a doctorabout politics, he generally te!ls you that, as he goes into thehouses of gentlemen of all parties, he really does not care tomix himself up in public matters, or that his occupation is so

onerous and responsible that he cannot devote any portion ofhis time to subjects beyond the range of his profession. Imaintain that doctors and lawyers, though highly educatedand intelligent, and devoted to the great interests of society,are not specially learned upon political questions, and have,therefore, no more right to the franchise than any other classof their countrymen."We do not complain in the abstract of Mr. BRIGHT’S theory ;

but what analogy, we might ask, is there between the positionof doctors and that. of lawyers in the House of Commons ? Mr.

BRIGHT had just before stated, that there were a hundred

lawyers at least in that House. He might have spoken also oftheir influence in the House of Peers. What is the represen-tation of our profession in the Houses of Parliament? With

the exception of Mr. BRADY, we have no representative ineither. Where, then, is the analogy? The fact is, that weare nowhere. When the interests of the profession are broughtunder discussion in either House, how have the questions inrelation to the public health and the interests of Poor-law sur-geons been treated ? In the House of Lords, where have wefound a representative to expose and condemn the unjustaspersions of legitimate practitioners, and the advocacy ofarrant quackery? ot a voice was raised in our defence;but the unseemly attacks were received with cheers. In the

House of Commons, what could a solitary advocate effect

for us in the face of the Presidents of Boards of Guardians,backed by a host of others ? Literally, nothing. But how

different when a question affecting the interests of the

lawyers was concerned! " Touch but a cobweb in West-

minster Hall," and the whole host of lawyers are in arms

in defence of their profession and their brethren. We repeat,then, the question, What analogy is there between the

position of doctors and that of lawyers in the House of Com-mons ? Are the interests involved in the two professions, in re-gard to the welfare of the public, in the comparison of 100 to 1 ?The assumption iR ton to admit nf being entertained

88

MEDICAL ANNOTATIONS.

.for a moment. No ! We contend that the interests of our pro-

fession, which are so much combined with those of the publicthat you cannot separate them, demand that we should havea fair representation at least in the Houses of Parliament.

-How much more effective would the Medical Council be if it

had a mouthpiece in either House! But it has none. Let this

be a sufficient :answer to all cavillers against the rights of the.doctors, who, from their position in society, and their influenceupon the public welfare, are as much entitled as either the

< ,Church or the Law to be fairly and adequately represented inz- T the great councils of the nation.

Medical Annotations.11 Ne quid nimis."

TWO PERIODS OF QUACKERY.

AN American medium of considerable notoriety-a a, Dr.Randolph-who has figured prominently in all the clairvoyantand spiritual manifestations of modern Yankee philosophy,.has given to the world his revelations. He has shattered the

idols, and opened the arcana of the temple to the profane.He was a medium for eight years, during which time he made,three thousand speeches, and travelled far and wide, proclaim-

ing the new delusion. He confirms previous statements as to.the frequency with which insanity follows the mental excite-- went produced by these manifestations. Five of his friends- committed suicide: he himself attempted it. At the Zurich

Hospital there have been thirty cases of insanity attributed tosuch causes. Dr. Randolph winds up his confession thus:" Experience has taught me that sixty-five per cent. of the

.medical clairvoyants are arrant knaves, humbugs, and catch-’ penny impostors, and that they are no more clairvoyant than

- a brick-wall."It is almost a relief to turn from the quasi-scientific jargon

- ’of the spirit-rappers, the globulists, and the kinesipathists ;- dealers in senseless adjurations of the unknown, the doubtful,

..and the mysterious; blasphemers against nature, who press’ ’into their mercenary service the common reverence with whichmankind are wont to regard the spirit world and the finer

- essences of dynamic physiological force; lying philosophers,who mouthe about the unseen, and prate of invisible agencies,in the hope of leading the multitude by the nose. It gives a-mental refreshment to revert to the laughable orations of the- more honest mountebanks of bygone days-men who avowedthemselves quacks, cut their ridiculous antics to the sound of adrum, and with visible glee extracted from the laughing chaw-,bacon a groat in fee, rather for their oratory than for theirmedicines. Mr. Morley has just recalled to day some admirablespecimens of the mountebank oratory of the seventeenth cen-tury, from a little undated book published about the year1690, entitled "The Harangues or Speeches of several FamousMountebanks in Town and Country." Here is an inimitable

specimen of candid self-glorification and witty abuse of hiscontemporaries-an address by one of the cleverest, Tom Jones:*’ Gentlemen and ladies,-You that have a mind to preserveyour own and your families’ health, may here, at the expense6f a twopenny-piece, furnish yourselves with a packet whichcontains things of great use and wonderful operation in humanbodies against all distempers whatsoever. Gentlemen, becauseI present myself among you, I would not have you to thinkthat I am an upstart glister-pipe apothecary. No, gentlemen,*T am no such person; I am a regular physician, and havetravelled most kingdoms purely to do my country good. I amnot a person that takes delight, as a great many do, to fillyour ears with hard words, in telling you the nature of turpetmineral, mercuri dulcis, balsamum capiviet, astringents, laxa.

tions, heart-burnations, circulations, vibrations, salivations,excoriations, scaldations. These quacks may fitly be calledsoliniates, because they prescribe only one kind of physic,for all distempers: that is, a vomit. If a man has bruisedhis elbow, take a vomit, says the doctor. If you have anycorns, take a vomit. If he has torn his coat, take a vomit.For the jaundice, fever, flux, gripes, gout,-nay, even the dis-tempers that only my friend the famous Dr. Tuff, whom youall know, knows as the hocognicles, marthambles, the moon.pauls, and the strongfives,-a vomit; tantum. Gentlemen,these impostors value killing a man no more than I do drawingan old stump of a tooth that has long troubled any of you; sothat I say they are a pack of tag-rag, assafostida, glister-pipedoctors. Now, gentlemen, having given you a short accountof this spurious race, I shall present you with my cordial pills,being the tincture of the sun, having dominion from the samelight, giving relief and comfort to all mankind. They cause alcomplexions to laugh or smile in the very taking them: theypresently cure all dizziness, dulness in the head, and scurvy.In the next place, I recommend to you my incomparablebalsam," and so forth. So that the world then, as now, wasfull of ‘‘ one-idea men," and the rogue had the wit to laughat them. His oration reads like a satire by Swift upon thequackeries of this present day. His men who " take delightto till the ears with hard words;" his "tincture of the sun,having dominion from the same light:" have not the quacksof the present times their congeners openly puffed, day byday ? Have they not their infallible pills, their nervo-arterialessences, their dynamized sugar-of-milk, their spiritual revela.tions, their magnetic sympathies : and are not these of thesame school ?

____

A LUNATIC LICENCE.

THE public and the profession look now with natural interestto the supervision of the lunatic asylums of the country. And

while, on the one hand, we are well convinced that misconductof the proprietors is a rare exception,-on the other, it is

satisfactory to know that such misconduct, when it does occur,will not be passed over with impunity.At the Essex Sessions at Chelmsford, application was made

for a licence for Mrs. Allen’s private lunatic asylum at HighBeach, which had been refused on a previous occasion. Muchwas said in favour of the asylum, and many testimonies ofsatisfaction from the friends of patients were quoted, withpromises of future good attention to the interests of the invalidsentrusted to her care. But the chairman called attention to aletter from Dr. Campbell, one of the commissioners, on the

subject of this asylum. His statement, containing a report ofhis visit, gave a very unfavourable picture of the asylum, andconcluded thus: " It is to be feared that no confidence can be

placed in the promises of Mrs. Allen, and that she is not fit tobe licensed for the care of insane patients." Additional testi-

mony was given in favour of the present management of theasylum by the Rev. Mr. Cockerell. Nevertheless, the licencewas refused by a majority of 18 against 11. This was a rigorous,but we cannot but think a just and necessary proceeding. Itis to be regretted that Mrs. Allen, having nothing on which tosupport herself and four children but what she derived fromthis establishment, and having lately expended &pound;500 in im-

provements, would incur ruin by the withholding of the

licence, according to the terms of her appeal. No doubt the

severity of the measure was duly felt by the magistrates; buthowever painful the proceeding, they had a clear duty to per-form in protecting the insane, and in exercising that carefulsupervision which they hold as a function of public trust. The

private asylums of Great Britain are, we believe, as a whole,conducted with a humanity, care, and skill, which reflect

honour upon their proprietors. It is but just to them that theyshould be protected from the depreciation of their character,which must follow if improprieties should be permitted to passunpunished in the conduct of any one of their body.