666

THE LANCET.

London, Saturday, February 3rd, 1838.

THE DEATHS BY QUACKS GREATER THAN

CIVILISED nations have universally adopt-ed the practice of subjecting candidates fordegrees and licences to practise medicine asa profitable occupatioll, to some preliminaryexamination, compelling them to furnish

proof of possessing a certain degree of medi-cal knowledge and mental capacity. Some

chartered companies and trading bodies alsoformerly prescribed an apprenticeship, anddemanded evidences of ability and acquire-ment from those individuals who sought tobecome members of their fraternity; and, asis too well known, under the pretext of

protecting the public against incompetentdealers, they extorted large sums of moneyfrom young men who were settling in the

world, strove to uphold monopoly in all itsodious forms, and, instead of promoting,retarded the progress of their respectivearts.

Whenever the medical corporations haveexhibited the same corrupt tendencies, havelaid schemes of personal aggrandisement,have thrown vexatious obstacles in the wayof the medical student, have exacted heavyfees, or have sought to deprive the public ofthe services of meritorious individuals, the

independent portion of the medical presshas denounced their fraudulent designs,and the result of its labours has been

that no narrow views of medical policy canmuch longer be sustained, nor can any newattempts to shut out well-qualified men fromthe ranks of the profession, unless theycontribute to the treasuries of the corruptgovernors of the colleges and companies, fora moment hope to succeed. A rational sys-

tem of education recognises no such absurdilliberalities. It will allow a high standardof knowledge to be fixed, and rigid tests of

practical skill and scientific attainments to

be established ; but under it the adminis-

trators of the law would be enabled to de-

mand nothing more,-no proof of having

studied at Oxford or St. Andrews’; in Lon.don or at Aberdeen,-no certifiicates in tes-timony of a" diligent attendance" on the

prosy lectures of Professor A., or of proba-ble somnolence at the discourses of Mr. B.,-proof neither of 11 circumcision," nor of«uncircumcision,"-of orthodox credence

in the Thirty-nine Articles, or of ability toconstrue a few verses in the Greek Testa-

ment, before the Protestant and WorshipfulSenate of a London University.The right of the Legislature to prevent

ignorant and incompetent persons from treat-ing the sick, is founded on the basis that

security for life is one of the great ends ofcivil government. Criminal law, and thevast apparatus which is requisite for its ad-

ministration, have been established in orderto deter assaults on life, and the destructionof property, the product of labour, as labouris the offspring of health. To show the re-

lative injury which will arise from the in-

dulgence of personal violence in a commu-nity, and Lhe evils which are likely to occurfrom allowing ignorant persons to aggra-vate, or trifle with, diseases, it may be statedthat the number of individuals who were

committed to jail in England and Wales, on

charges of murder, during the ten years

which were included between the years

1824 and 1834, amounted to 672. The num-ber committed for shooting at, and stabbing,&c., during the same period, was 973. For

manslaughter, 1581. For infanticide, 232.For all these crimes a total of 3379. The

total number of deaths produced by dis-

eases, and all other causes, amounted, inthe ten years named, to three millions and aquarter. For every one person committedfor murdcr, 4836 died from other causes;and in Sweden, where the number of mur-ders is accurately registered, there was (in1805 to 1830) one murder in 5384 deaths;or, including cases of infanticide, one mur-der in 2868 deaths.

The three and a quarter millions of deathsin England and Wales implies at least 160

millions of cases of sickness. Let it be ad-

mitted, first, that under efficient medical

667THE DEATHS BY ACTS OF VIOLENCE.

treatment 3 millions would have died ; suicide? Should a government, professingsecondly, that, if left to Nature, 4 millions to represent the intelligence and the huma-would have perished; thirdly, that if the nity of the nation, suffer men to play suchwhole 160 millions of unfortunate patients desperate games with their own lives? orhad been placed at the mercy of quacks and allow reckless mercenaries to swindle the

uneducated prescribing-druggists, or other poor, the ignorant, and the superstitious, hypretenders, the fatality would have been in- impudent lies and cajolery, out of ex-

creased, either by a frustration of the efforts istence ?

of Nature, or the administration of unsuitable If any measure were brought before Par-

medicines, to 4! millions. This is a mode- liament for the entire suppression of quackery,rate computation, but after every possible objectors would arise, and ask if the at-

deduction has been made, the deaths which tempt were not an infringement on the libertyare likely to occur from the ill-treatment of of the subject,-whether an impotent oldthe sick by quacks and prescribing druggists, man might not, if he chose, use "Balm ofthrow into shadow all the murders and all Gilead," or a young man" Antisyphiliticthe deaths from violence that could happen Drops," or one of the other sex consult ain any state of society, the murders of war druggist on the mysteries of the" turn ofbeing excepted. life," and feminine disorders,-without theA murder, it is true, becomes speedily interference of Parliament,-or whether the

notorious ; the cry for vengeance upon the people should be denied the use of " ape-shedders of human blood is loudly and rient pills," or prohibited from "purifyingwidely heard, while persons whose deaths their blood," by legislative enactments ?

are wrought by the quack and the medical And, in the event of suppression, " whatpretender, fall silently into the grave, and 11 was to become," it would be asked, 11 ofare lost, unheeded, amid the numbers which "the thousands of prescribing druggists,no skill can preserve. Many fatal events, "the vendors of patent medicines, the

indeed, are consummated by misadventurous " quacks, and other such practitioners of all

patients themselves, in prescribing for their " descriptions?"own diseases, unfortunate in their own judg- Ambubaiarum collegia, pharmacopolæment, and unfortunate in their friends. The Mendici, hsirux, Bállatrones: hoe genns omne.

quack, or the prescribing druggist, will tell These inquiries develope two circum-

us that he visits his patients from motives stances on which the existence of quackeryof humanity, and not from mere love of depends,-the propensity of one part of

lucre. But what is the result of his con- mankind to indulge in extravagant follies,duct? A drowning man vociferates for and the interest of another class in furnish-" help !" A knave intrudes in the garb of ing aliment to those follies. Resting onthe Humane Society, and, seeming to these, unhappily too secure, foundations," help," prevents emcient aid from being quackery can no more be entirely suppressedrendered by others, and the victim of his than theft; but it may be gi eatly diminishedimposition perishes, plunged beneath the if the law, instead of sanctioning, forbade themerciless waters. sale of quack medicines, and punishedA distinction will be drawn between an quacks and pretenders, in whatever garb

instant murder, committed by violence, and a they might be found. The public would,slow, or a sudden death, under the hands of assuredly, sanction any regulations which,a prescribing druggist, pretender, or quack. while they secured an abundant supply of ableIn the latter case, the patient voluntarily well-educated practitioners, protected the

places his life at the disposal of an ignorant ignorant and the weak-minded from the artsperson; no violence is perpetrated. But of death-dealing pretenders; for, althoughcan the community sanction such an act of many quack aostrums are inert and innoxi-

668

ous, others are violent in their action, and to many other places. We admit the sound-in the highest degree dangerous. ness of the opinion and the existence of theThe great mass of chemists and druggists facts, but we are surprised at the recom-

in England receive no professional educa- mendation of the Leeds Committee on

tion; they are ignorant of the scientific and Quackery, that a clause embodying theirpractical parts of chemistry, and they have wishes respecting a summary process beforeno general acquaintance with pharmacy, as a magistrate, should be added to the Apo-it is understood in Germany and France. thecaries’ Act. Why, the Act of 1815 is

To say that they have not the slightest one great source of quackery in England.knowledge of the human frame, or its dis- The Fellows of the College of physicianseases, is unnecessary. The only means of have been educated at Oxford or Cam-

improving this important department of the bridge; the Licentiates at Edinburgh, Glas-

healing art, would be to subject every che- gow,Aberdeen,orSt.Andrew’s; the surgeonsmist and druggist in the kingdom to an ex- in general practice chiefly at the Londonamination in pharmacy. This might have schools. This diversity of place constitutesthe effect of producing a large and respect- the only professional difference amongst theable body of plcanmaciens, such as exist in various practitioners of medicine in Great

France and Germany, well qualified to pre- Britain. Yet the Act of 1815 incorporatespare and compound medicines. Without the general practitioner with drug-dealers ;any organisation, any assistance, any stimu- makes it one of his duties to dispense the

lus, such as prevails on the Continent, there medicines prescribed by his inferior in a

are many trading men and dealers in this practical knowledge of medicine, the phy-country, who are well versed in the science sician ; and threatens the infliction of suc-of chemistry and its processes, and these, cessive penalties of five pounds, ten pounds,with assistance from other chemists, pro- and loss of his 11 licence to practise," forfessors of the science, both in and out of the refusing to prepare any articles in the Ma-

public institutions, might afford the means teria Medica which are directed by a

of forming a department of pharmacy in a legally-qualified DUB. At the same time it

NATIONAL FACULTY OF MEDICINE. provides for the appointment of a court ofBefore advancing any specific proposals old women, who, under the business-like

for the suppression of quackery, it would be title of" Examiners," are perfectly obscurenecessary to examine carefully its causes as individuals, and totally unknown as con-and present state in the three countries. tributors to medicine, but yet possess theBut this investigation we do not intend at power of rejecting from medical practice in

present to make. We are not inclined, all its branches, or stamping with the

however, to let the present opportunity pass despised name and brand of "APOTHFCARI’,"for offering a remark on the petition of the even the best educated and most talented

Leeds Medical Society on this subject, an youths of which the kingdom can boast!analysis of which appeared in the last num- This subject, of necessity, must undergober of THE LANCET. farther discussion. The present remarks

The subscribers to that document say have been elicited from us in consequencethat" the Apothecaries’ Act is totally in- of the views which are expressed in the

" adequate to redress their grievances ;" communication of a correspondent at Leeds,and, in proof of this allegation, they state whose letter will be inserted in the next

that in Leeds "the number of prescribing number of our Journal." druggists, and other illegal practitioners, " considerably exceeds that of the regular ONE of the most striking characteristics

" members of the profession there resident;" of mankind is the neglect which is mani-and that the same calculation is applicable fested in taking advantage of important dis

669CURE OF CLUB-FOOT.

coveries. It would appear that we cannot The operation is one which every surgeonescape from the common path of custom, is competent to perform, and removes, in awithout making an effort which the mind quick and eflicacious manner, a very dis-is not readily capable of accomplishing. If agreeable and distressing deformity to whichan improvement be acknowledged, if it be the name of a late noble poet has given aobvious to the dullest perception, if it be great degree of notoriety.founded on strictly scientific principles, The deformity is, generally speaking,then, generally, is the indisposition of the congenital, but may be acquired. It may

public to take advantage of it the most exist in one or both feet. It sometimes

strikingly displayed. If, on the other hand, consists in a simple retraction of certain

there be some mystery in the affair,—some muscles of the lower extremity; in other

secret which is closely concealed, like the cases it is complicated with a deviation of

singing process of ST. JOHN LONG, then is the the foot to the inner or the outer side. The

imposition called a discovery," and sought first form is denominated " pes equinus ;"after with a most energetic but morbid curi- the second, " varus internus vel externus."osity. Thus, quackery and fraud continue It is unnecessary to explain at length theto flourish in these our enlightened modern pathological anatomy of this atfection. It

times, while the improvements which are will suffice to say, that an analysis of the

positively effected by scientific discoverers, causes by which the foot is retained in theare neglected, or altogether forgotten. different abnormal positions described,The unobtrusive labours of men of science proves that the principal indication of cure

carry with them but few charms for the in cases of club-foot is to elongate the

public eye. Hence it happens that the muscles by which the foot is forcibly re-discoveries which are of the utmost utility tained in its distorted position. For this

to society fail, in the first instance, to ob- purpose various machines have been ill-

tain for their authors that reputation and vented. The practice of the late Mr. SHEL-honourable reward which they so richly DRAKE consisted in the employment of fric-

merit, and they are frequently only brought tions, which were regularly continued overinto use: as the prejudices of the gsne- the entire course of the gastrocnemii mus-ration in which they were made, slowly and cles, and, by bending the foot with the

almost imperceptibly subside. hand, endeavouring, from day to day, to

The refusal, during the past week, of a extend the heel to its natural position. This

hospital surgeon to perform the operation of treatment was adopted in a great variety of

dividing the tendo Achillis, for the cure of instances with the most signal and com-club-foot, accompanied by a declaration that plete success ; but the tediousness of thehe was "no admirer of the modern improve- process has prevented its general adoption.ments in surgery," furnishes a lamentable Several cases were related by Mr. SHEL-instance of the pertinacity with which even DRAKE, in his lectures, which were publishedmen of science will sometimes adhere to the in THE LANCET for 1828-9,vol. i., and one offorms and usages of long-established cus- the cases thereinrecorded, thatofJohnRobin-tom, and with what extreme reluctance it is son, at page 278, vol. i., fell under our ownthat the thoughts are directed into any observation. The effect of the friction and

newly-discovered channels. extension used in that instance, was extra-

Now, what is the history of the operation ordinary, and the removal of the defor myfor the cure of club-foot, which, although peculiarly rapid.one of the most simple and useful amongst The treatment by irons or machines, how-recent improvements in the art of surgery, ever, is tedious, often perplexing, gives risehas not been practised in proportion to the to severe pain, and, in a certain number ofadvantages which it is calculated to confer? cases, fails altogether to produce relief

670 CURE OF CLUB.FOOT.

From these causes a different mode of cure was very considerably relieved, and the

was deemed desirable, and was at length patient now walks with perfect ease, and isfound in the division of the tendo Achillis. capable of undergoing considerable fatigue,The first case in which this operation was while the shortening of the foot does nottried for the removal of club-foot, was that of exceed a quarter of an inch.a young girl, 17 years of age, who was said The imperfect degree of success which

to have suffered under the deformity from attended the only operation for club-foot

the time of birth. The operation was exe- that DELPECH ever performed, discouragedcutcd in the year 1782, by a surgeon even that distinguished surgeon, and divisionnamed 1...0 llENZ, at Frankfort, under the of the tendo Achillis was again forgottendirection of a physician, to whom the idea until the year 1833, when M. STROMEYER,of dividing the tendo Achillis first occurred. of Hanover, revived it, with some usefulA cure was effected in about six weeks. modifications. Instead of making two per-This example, though worthy of being fol- pendicular incisions, on either side of the

lowed, did not find a single imitator, and tendo Achillis, after the manner of DELPECH,the proceeding fell into disuse, until it was Dr. STROMEYER passed a small, narrow-revived in the year 1811, by a physician at bladed bistoury, from one side of the heel

Marbourg, who, however, committed the to the other, between the tendon and theerror of dividing only a portion of the tendo bones, and then, having directed the edgeAchillis. In the year 1812, SARTORIOUS of the knife backwards, divided the tendonoperated on a boy, 13 years of age, and, by without injuring the integuments, exceptingthe aid of proper machinery, obtained a at the place where the instrument entered.radical cure in a very short space of time. Another point in which STROMEYER devi-

In all the operations to which we have ated from the method of DELPECH, was, thatnow alluded, the skin was divided, as well he commenced the application of machineryas the tendo Achillis. Hence, when the heel three, four, or five days after the division ofwas brought down, the edges of the wound the tendon, whereas DELPECH allowed notwere forcibly separated, and troublesome less than twenty days to intervene betweenaccidents supervened. To remedy these in- the section of the tendon and after-treatment.

conveniences, M. DELPECH proposed a new Dr. LITTLE, who has paid much attention to

method, which he executed on the 9th of the subject of the " club-foot," and the

May, 181G, and which consisted in dividing means of remedying that deformity, andthe tendo Achillis, from before backwards, whose first publication on the distortion ap-with a convex bistoury, which he passed in peared in THE LANCET, vol..i,1836-7, consi-front of the tendon, from one side to the ders the Stromeyerian method to be the best;other. As he cut from before backwards, but M. BouviER, a French surgeon, wellthe whole of the tendon was divided, with- known for the improvements which he hasout any injury being done to the integu- introduced with respect to the treatment ofments which cover it on the back of the leg. deformities, commences extension of the footInstead of bringing down the heel immedi-’ immediately after division of the tendon, aately, and applying machinery, DELPECH practice which, in his hands, seems to havepermitted the ends of the divided tendon been attended with prompt and completeto unite, and then endeavoured, by gradual relief. The machinery generally employedextension, to elongate the intermediate for the after-treatment of club-foot, is that

uniting substance. This was a tedious and originally recommended by SCARPA, whichpainful process. Extensive inflammation, may be obtained at the house of any surgicalfollowed by suppuration, set in, and the instrument maker; but in the country, wherewounds were not healed after a lapse of it is sometimes difficult to procure the pre-three months. The deformity, however, cise article which is wanted, the ingenuity

671DR. ARNOTT ON WARMING.-POISON TEST-CASE.

of the surgeon will readily suggest the sim-

ple apparatus that is required.The short historical sketch which we

have drawn of the operation for the radical cure of club-foot, demonstrates the truth ofthe principle with which we set out, viz.,that in surgery, as well as in other sciences

and arts, the most simple and useful improve-ment has frequently to struggle for yearsagainst prejudice, on the one hand, or

apathy and neglect on the other, before it

becomes extensively adopted; and, strangeto say, the last places in which they findfavour are the wards of our metropolitanhospitals; but we trust that the few obser-vations which we have now made will aid in

preventing the Stromeyerian operation fromagain falling into oblivion.

On Warming and Ventilating ; with Direc-tions for Making and Using the Thermo-meter Stove, or Self-regulating Fire, andother New Apparatus. By NEIL ARNOTT,M.D., Phys. Extra, to the Queen, Authorof the " Elements of Physics," &c. Lon-

don : Longman, 1838. Post 8vo.

On Warming and Ventilating; with Direc-tionsfor Making and Using the Thermo-meter Stove, or Self-regulating Fire, andother New Apparatus. By NEIL ARNOTT,M.D., Phys. Extra. to the Queen, Authorof the " Elements of Physics," &c. Lon-

don : Longman, 1838. Post 8vo.

IN this small, unpretending volume, whichextends to only 138 pages of type, there isa fund of really useful knowledge which isnot to be discovered in most publicationsof nearly twenty times the size. The sub-

jects which are discussed in this work, re- late to the ventilation of private dwellings,and of every description of public institu-tion. Also to the best modes of warmingrooms, halls, churches, and all other placesin which human beings congregate eitherfor the purpose of engaging in manual occu.pation, or for mental recreation and improve-ment.

The two subjects of ventilation and warm-ing are treated in a masterly manner,-inprecisely such a mode as we should expectto witness when the task was to be execut-ed by the mind and pen of Dr. Arnott. The

work, we repeat, is a really useful publica-tion. It is a great benefaction bestowedupon the public. It is a contribution tohealth and economy, which must be highlyappreciated by all the intelligent portion ofthe community.

Without a reference to the diagrams thetext might be misunderstood ; we thereforeabstain from making any quotations. With

regard to the Thermometer, or Self-regulat-ing Stove, we may observe, that it has beenseen by us in operation in different places,and we can confirm all that Dr. Arnott hasadvanced of its two great advantages,-First, that of supplying a perfectly uniformtemperature throughout the whole of an

apartment; and, secondly, the productionof that great benefit at a cost of a mosttrifling amount. We know that an expen-diture of a penny a day in fuel would besufficient to maintain a temperature of 60degrees in a room measuring 18 feet by 15.Hence it becomes a matter of certainty, inall situations where the cost of fuel is a

point for consideration, that the Self-regu-lating Stove will be brought into operation.Divers sufferings from smoky chimneys, ill-working stoves, and defectively ventilatedapartments, induce us to hope that archi-tects will not be the last persons into whosehands this publication will fall.As a production relating particularly to

the science of health, it will, we are sure,be regarded as a valuable production by themembers of the medical profession.

THE POCKET TEST-CASE FOR

POISONS, AND COMPANION.

(Arranged by Bailey, Potter, and Co.,Chemists, London.)

WE have much pleasure in recommendingto the notice of our readers the Pocket Test-Case for Poisons, of Messrs. Bailey and Co.It will be found a highly useful and conve-nient appendage to the armamenta of medi-cal practitioners, and will, we have no

doubt, receive the patronage which it de-

serves ; for, as a knowledge of medical

jurisprudence becomes more diffused, pro-fessional men will naturally be more anxiousto possess themselves of every means bywhich a discovery of the true cause of

death, in doubtful cases, may be obtained.The Pocket Test-Case does not exceed, in

size, a moderately-sized dressing-case, andcontains nearly all the tests which are ordi-narily required for the detection of the

metallic, acid, and vegetable poisons. Thus,in the list of contents, we find an apparatusfor sulphuretted hydrogen or tube retort,