676

THE LANCET.

LONDON, SATURDAY, DECEMBER 22, 1849.

FRIENDS AND ENEMIES IN THE COLLEGE COUNCIL.

IT is of great importance, in the present crisis, that themembers of the College of Surgeons should be accuratelyinformed of the views and sentiments of the Council. Other-

wise, great unnecessary suspicion and heartburning mayresult. A writer in the last number of THE LANCET, page 647,signing 11 a few words on the fellowship," has fallen into anerror respecting the essential points in the proposed alterationof the new charter, which may seriously mislead the membersof the profession. This must be corrected. The Coun-

cil proposes, not only to select the fellows from among thosemembers of twenty years’ standing at the date of the altera-tion of the projected charter, but to do the same on a givenday, year by year, with respect to all of a similar standing,until the whole of the members, the date of whose diplomasis anterior to that of the prospective charter, shall be gonethrough. We believe we can state this as a fact admitting of no dispute. With respect, also, to the observation ofthe same writer, that Mr. GUTHRIE told us he would take;° care of the old army surgeons, but would not trouble himself

"about anybody else," we are satisfied our correspondent is inerror. Mr. GUTHRIE said, in his evidence before the Com-mittee of the House of Commons, that the medical officers ofthe Army and Navy, and of the East India Company, had all,including the,heads of the departments, called upon him toprotect them; and as the members generally had not done so,he did not feel himself called upon to undertake a duty whichmight be considered presumptuous, without such confidencehaving been placed in him by them. This was, however, onlya delicate way, we are convinced, of expressing himself on hispart-for we must look to deeds as well as words, and Mr. *GUTHRIE has contended as firmly for one branch of the profes-sion as for another. We can state, with the utmost confidence,that he has never made the slightest distinction betweenthem; and that he is deserving of the warmest thanks of allconnected with the College for the untiring efforts he hasmade on their behalf.

If we are asked whether the proposed changes here men-tioned will be sufficient to satisfy the members of the College,we should be compelled to reply in the negative. Such

changes are, in fact, wholly unsuited to the present claims ofthe profession.

It was also hinted by our correspondent, that the Collegewould be none the worse for the retirement of the three senior

members of the Council. Now, we beg to mention, for the in-formation of our correspondent and the profession at large,that but for the zealous exertions of the three senior mem-

bers-namely, Messrs. KEATE, VINCENT, and GUTHRIE—no reso-lution would have been passed by the Council in favour of anapplication to the Crown for an amended Charter. It is to them,it is confidently stated, that we owe the present reformingtendencies of the Council. We are almost ashamed to say,that while those veterans have been fighting manfully for theprofession, some of those who have entered the Council-

chamber for the first time, within the past year or two-menwho before their election were noisy and liberal enough,-

have now turned their backs upon the profession, and are act-ing in systematic opposition to the movement headed by Mr.GUTHRIE. Their names have oozed out in various circles, andwe could, if we chose, at once publish them, and expose theirmoral turpitude to the profession. We are by no means sure thatwe shall not, at some future time, find means to publish thedivision lists, giving the names of the councillors, and the

way in which they vote upon the important questions which arenow to agitate the Council. This is the only way in whichthe Council can be made as responsible to the members andfellows of the College as the members of the House

of Commons are made responsible to their constituents andto the community at large. We believe there are now onlytwelve life-members of the Council, and the fellows will here-after have at least the satisfaction of dismissing in rotationthose among the elected councillors who may prove unworthyof the confidence which has been placed in them. We throwout this warning in time, and we commend it to the calm re-flections of those gentlemen who will, in no long time, haveto retire, and present themselves for re-election. The presentlife-members are-Sir B. BRODIE, Messrs. KEATE, VINCENT,GUTHRIE, GREEN, ARNOTT, SOUTH, COPELAND, LAWRENCE,

TRAVERS, STANLEY, and SWAN. The elected or representativemembers are-Messrs. CUTLER, C-assAR HAWKINS, GRAINGER,LUKE, SKEY, STAFFORD, BRANSBY COOPER, HODGSOX, WORMALD,BISaoP, and PILCHER, one seat being vacant. We give theselists, because it may be useful to familiarize the professionwith the names of those who ought to be, and who must be,made directly responsible to the electoral body, and also toremind those gentlemen of the peculiar position which theyoccupy, and which, we fear, some of them are but too muchinclined to forget.

THE College of Physicians has never recovered from themistake it committed in handing over its entire interest in the

general practitioners of this country to the College of Sur-geons and the Society of Apothecaries. In this age of ours,

nothing can compensate for want of numbers, for numbers canalone carry strength and wealth with them. The College-ofPhysicians is respectable, time-honoured; it has had amongstits members and fellows many of the greatest names in medi-

cine; it was long the teacher of those sciences upon whichsurgery as well as medicine depends; it has raised its scale of

charges for extra licences, licences, and fellowship, to such apitch as, in the opinion of many, is prohibitive, and leads toirregular practice, by the same rule that an exorbitant dutyupon any article leads inevitably to contraband traffic. Yet,notwithstanding all this, it is miserably poor. In its presentstate, the raising of the common road above the base of itspillars, in Pall Mall, is but a type and emblem of the sinkingof the College in the rapid professional movements of recentyears. We wish it were otherwise. We wish the College hadits proper influence and control over all the physicians of thiscountry. We should rejoice if it worthily became their trueAlma Mater. But even this would not compensate for theloss of all interest in the education, respectability, and govern-ment of the ten or twelve thousand gentlemen who are en-gaged in the general practice of medicine and surgery, notlike the old apothecaries, but with an energy, science, andabundance of resources, unknown even to the College Fellowof fifty years since.

677THE ANOMALOUS STATE OF THE COLLEGE OF PHYSICIANS.

In effect, the College of Surgeons gained what the Collegeof Physicians lost so short-sightedly. The College of Sur-geons became the real head, not only of the pure surgeon,but of those engaged in the general practice of medicine,surgery, and obstetrics. Though engaged in this threefold

practice, they were proud to be called surgeons; and the

anomalies of a connexion with a College which had no exami-nations or care for either medicine or obstetrics, were over-looked. Surgery was tacitly allowed to have the first, thepre-eminent place in the College; and the general practi-tioners contributed their thousands of pounds per annum tothe support of this Institution. Its riches, its power, andits growing influence were everywhere acknowledged andenvied. But most unwisely, and in an unhappy hour, theCharter of 1843 was obtained; and surgery, and what hadbeen called pure surgeons, were attempted to be placedhighly and invidiously above those who had enjoyed the mem-bership with them previously, upon equal terms. The one

gave strength and wealth; from the other, honour and pro-gress were gained. It was to the overwhelming preponder-ance and preference given, in 1843, to mere surgery, and the

contempt thrown upon general practice, that most of the pre-sent discontent of the profession has arisen. The pointof superiority was strained too far, and it has ended

in confusion and contempt for all authority. The for-

mer state of comparative contentment within the College, can only now be regained, by restoring, in some degree atleast, the balance between surgery and its two natural allies,medicine and obstetrics. This balance was wilfully violatedby the last Charter, and an unwise preference givento "pure" surgery. The fault belongs to the College. The

mischief is done; and it can only be repaired, by raisingup Medicine and Obstetrics, in the person of the surgeon ingeneral practice. Greater power and share in the governmentof the College, than was ever dreamt of before 1843, must nowbe conceded, or the College is in the utmost peril. The mass

of the profession will fall away from it, and this really nobleinstitution will become-what it should dread if it were wise-

a college of mere surgery, just as the College of Physicians isa college of mere physic. It will become equally haughty,equally aristocratic, impoverished, and feeble, and equallypoor and impotent with the College of Physicians; nay,more! for the expenses of the College of Surgeons are enor-mous and inevitable. Its library and its museum would,with scanty funds, become as a Frankenstein to the Council,overwhelming it with debt, humiliation, and difficulty.

Happily, the College of Surgeons has still to choose.Within the Council-chamber, the proposal for a new arrange-ment of the College has arisen. The stream has been set in mo-tion, and cannot be dammed back by any efforts which may nowbe made. The members of the College must acquire theirjust influence in the College, or they will at once and finallyretire from it. How this can be arranged we leave to

the College for the present; but the member of the Collegeof Surgeons must, upon his becoming a member, havesome share in the power and government of the Collegeforthwith. This share must not be merely prospective,but it must be present. It may be said, this cannot

be, because the medicine and obstetrics of the general prac-titioner are inferior to his surgery- Such is not the truth, or,if so, then let the medicine and obstetrics of the general sur-

geon be so raised that the surgical member of the Council andthe surgical examiner shall not be ashamed of the member ofthe Council who combines medicine and obstetrics with sur-

gery, or the examiner who examines in these important sub-jects. We write emphatically, because we perceive clearly thatthe College of Surgeons is passing into a position of greatdanger, one from which it may emerge, shorn of at least nine-

tenths of its number, strength, and wealth, unless the fair andjust requirements of the surgeon in general practice arespeedily conceded. For ourselves we have been patientenough. We have fought hitherto most strenuously andsuccessfully against the institution of a new College, and weconsider the present opening of the question of the reform ofthe Charter a full justification of our past exertions to

prevent the establishment of a second College of Sur-

geons. It is known, that but for these exertions, anew College, in direct opposition and hostility to the

present College of Surgeons would at this moment be

in existence. But we cannot promise that our patience maynot be exhausted; and most assuredly, if we ever relinquishall hope of the members of the College obtaining their justrank, influence, and representative power within their ownCollege, it will be our misfortune, and not our fault. The

decree has gone forth; 12,000 practitioners, holding surgicaldiplomas, have announced to the government and to the legis-lature, that it is their desire to be intimately connected withthe government of the College of which they are members. Noadministration or Parliament can feel indifferent when such a

claim is urged; in our municipal towns the right of representa-tion has been conceded to the occupant of the humblest dwell-ing. Shall such a right be withheld from the surgeons of thiskingdom, when they ask to be connected with the manage-ment of their own institution ? The practical answer to thisquestion has now to come from the Council of the Royal ’Ool-lege of Surgeons of England. Again, we would beseech of thatCouncil to deliberate calmly and dispassionately before theyadopt their final decision. They have to choose betweenobtaining the ardent and energetic co-operation and supportof many thousands of their professional brethren, and ofseeing that support transferred, under the stimulus, probably,of wounded feelings, to another institution, which a con-

tinuance of an unwise policy in their own may, almost as bymagic, raise into a flourishing state of existence._

ON Wednesday last, at four o’clock, the deputation appointedat the Conference, on the 20th of November, attended at the

College of Surgeons. The members of the deputation con-sisted of Mr. CLIFTON, chairman of the Conference, Mr.

BOTTOMLEY, chairman of the Committee of Associated Sur-

geons, Mr. SMITH, of St. Mary’s Cray, Mr. SOUTHEE, of Cam-bridge, Mr. PROPERT, Dr. WEBSTER, Mr. HooD, Mr. SQUIBB,and Mr. ANCELL. They were received by the president, Mr.GREEN, and the two vice-presidents, Messrs. ARNOTT and

SOUTH. The interview lasted a considerable time, and wehave reason to believe that, at its conclusion, all parties weresatisfied with the manner in which the discussion had been

conducted.. --

AMONGST the vast number of communications which we

, have received from members of the profession, on the subject’ of the late trial in the Court of Queen’s Bench, the following

678 LONDON HOSPITAL SURGERY.

has been addressed to us by Dr. FORBES WINSLOW. The termsin which Dr. WINSLOW has expressed himself, and the proposedlie has made, must be equally gratifying to the defendant, towhom a favourable verdict from his professional brethren can-not but prove to be a source of proud satisfaction.One fact of great importance in this extraordinary case

has not yet been mentioned, Lut it is due to Mr. T. H. WAK-LEY that it should be publicly recorded, and universallyknown. On the morning- of the trial, at the moment the

judge was about to take his seat, the representative of thedefendant was called out of court, by one of the Council en-gaged in the cause, and an offer made to him, that if the de-fendant would consent to pay £1 00 costc, a " handsome speech"should be made for him, and the prosecution aban-

doned. " No," was the reply; " the defendant would not con-’" sent to pay 100 sixpences costs, and he has resolved through-" out, not to be made the victim of extortion, lie feels that

he has nothing to fear from the trial, but that lie has every-" thing to fear from compromising such an action. It has now" been brought into court, and the canse must proceed."

This fact is an appropriate climax to an action winch sprungout of as foul a conspiracy as ever was designed. We attach Ino blame to Mr. OLDKNOW, the solicitor for the plaintiff, or ’,to his counsel. They were completely deceived hy the scan-dalous falsehoods which had been promulgated; and it wasnot, we believe, until the last moment, that they discoveredthe extent to which they had been deluded.TnE RECENT ACTION IN THE COURT CF QUEEN’S BENCH.- QUELCH v. T. 11. WAKLEY.

To the Editor of THE LANCET.

SIR,—The profession, particularly that section of the medicalbody officially associated with the Metropolitan hospitals, andother charitable institutions for the gratuitous administrationnf relief to the sick, owe a deep debt of gratitude to Mr. T. H.Wakley, of the Free Hospital, for the bold, uncompromising,and spirited manner with which he has, in a public court, re-sisted the recent attempt, not only to extort money from him,but to damage his surgical reputation. Mr. T. H. Wakley had.an important pubdic duty to discharge; and having nobly foughtthe battle, we offer him our humble, but sincere congratula-tions on the triumph he has achieved. What was Mr.Wakley’s case last week may be Mr. D. Cooper’s or Mr.Stanley’s the next.As a body we sail in the same boat, and are liable to similar

cruel, unjust, and vexatious actions at law. We must there-fore rally round and support those who, at a pecuniary sacrifice,and often being exposed to much anxiety, uphold the dignity,character, and usefulness of our greatly maligned, but nobleprofession. In defending the recent action, Mr. Wakley musthave incurred heavy liabilities. He is a young gentleman,just entering upon the battle-field, struggling, with high hopes and aspirations, for professional eminence. We must not for-sake him under existing circumstances. The profession, theliberal portion of its members, would be neglecting an im-portant duty if they did not by public subscription contributetowards the payment of Mr. T. H. Wakley’s legal costs. The

duty Mr. Wakley discharged in opposing the cruel attackmade upon his deservedly high professional character was apublic one. The cause was tllat of the profession; and weshould manifest great want of proper feeling, and be guilty ofa serious dereliction of duty, if we permitted Mr. Wakley topay the expenses of the late contest out of his own pocket. Itherefore suggest that a committee be formed to receive sub-scriptions for this purpose, and I shall be happy to contributelive pounds towards the fund.

I remain, Sir, your obedient servant,FORBES WINSLOW, M.D.

APP0INThiENT.-Dr. Radelyffe Hall, of Clifton, has beenelected physician to the Bristol General Hospital, in theplace of Dr. Beatty, resigned.

A MirrorOF THE PRACTICE OF

MEDICINE AND SURGERYIN THE

HOSPITALS OF LONDON.

ST. THOMAS’S HOSPITAL.

Fungoid Tumour attached to the Spinc.— Dr. Leeson hadlately under his care a woman of sixty-five, who was admittedinto Elizabeth ward (October 30) in a very debilitated state.She could hardly give an account of herself; but the most pro-minent. symptom was extreme powerlessness, and inability tomove the lower limbs. There was likewise great irritabilityof the bladder, and abundant phosphatic deposits in theurine. She was placed on a water-bed, had diuretics, andafterwards quinine, with a sedative at night, and stimu-lating applications to the nates. The paralysis soon ex-tended to the upper extremity, she became gradually worse,and died on the 17th of November. We are induced to noticethe case, on account of the very remarkable appearancesfound on a post-mortem examination, for the details of whichwe are indebted to Mr. Adams, demonstrator of morbidanatomy at the hospital.—General Appearances: Ordinarystature; extremely emaciated ; large gangrenous spots on

the nates, and a small gangrenous spot on the inner side of in-step of left foot.—Head : Membranes and substance of thebrain healthy; patches of atheromatous matter in the largerarteries of the base of the brain.——Chest : Both pleuræ healthy,with the exception of a few old adhesions on either side; bothlungs collapsed and healthy.—Heart : Of natural size; mus-cular structure firm and contracted; mitral and aortic valvesslightly thickened and opaque. On the mitral were severalpatches of atheromatous deposit. Along the attached bordersof the aortic valves were several irregular nodules ofbone; at the base, and through the ascending portion ofthe aorta, were several patches of atheromatous matter, whichexisted in much greater abundance through the thoracic andabdominal portions, where there were a few flakes of bone,and also in the iliac arteries.—Abdomen : Liver, spleen, pan-creas, stomach, and intestines healthy. On the bodies of the

first and second lumbar vertebræ was a medullary fungoidtumour, of flattened form, and about an inch in thickness,which was found to extend through the intervertebral fora-mina into the spinal canal, where it was connected with a growthof precisely similar character, attached to the external sur-face of the theca vertebral is, for nearly two inches of itslength; the internal surface ot the theca at this part was ap-parently healthy. The cauda equina, at its commencement,was diminished by compression to about half its natural size,but the nerves themselves appeared to be otherwise healthy.A tumour, of a medullary fungoid character, and about aninch in diameter, was also imbedded in the lumbar mass ofmuscles, on the left side, and was directly continuous with thegrowth over the bodies of the vertebrae. The part and thetissue in which the disease had commenced were obscure; thegrowths in the three situations above referred to were all con-tinuous. The bodies of the vertebrae were in some partsslightly roughened, but not implicated to any extent.-Bladder: The mucous membrane of the bladder was highlyinjected, and presented numerous irregular ulcerations; thelymph adhering to these ulcers, and to other parts of themucous membrane, contained a considerable quantity of phos-phatic deposit. The lining membrane of both ureters, andthe pelves of the kidneys, were irregularly injected, thick-ened, and altered by chronic inflammation; in many parts itwas superficially ulcerated and coated with adherent lymph.The left ureter was folded upon itself, about three inchesfrom the kidney, and its canal almost obliterated, the resultof contraction after inflammation and ulceration at this part.A tripartite fungoid growth of this kind, reaching within

the canal, and there compressing the cord, hardly finds a placeamong the cancerous tumours usually described. Cancer ofthe bodies of the vertebrae is extremely rare, for Dr. Walshesays, p. 527, in his work on the subject, that " he is ac-

quainted with but two cases in which vertebral cancer canbe even supposed to have constituted the primary manifesta-tions of the diathesis;" and such a malignant growth lying onthe spine, and finding its way into the canal, is certainly of

l unfrequent occurrence, particularly in the absence of any. external cancerous manifestation. The case, however, is in

accordance with previously observed ones as regards the state