673

THE LANCET.

LONDON, SATURDAY, DECEMBER 16, 1848.

THE BOARD OF HEALTH AND THE COLLEGE OF PHYSICIANS.

WE are glad to see that portion of a correspondence whichhas recently taken place between the president of the Col-lege of Physicians, Sir GEORGE GREY, and Lord CARLISLE, onthe subject of the Board of Health, and its medical notifica-tions. We have been given to understand that other corres-

pondence on the same subject has taken place between the col-lege and the authorities, and we regret’thatallhas not been pub-lished ; it could not but have been beneficial for the professionto have known exactly the precise position assumed by theCollege of Physicians towards the Board of Health. The

correspondence already published shows sufficiently that Dr.PARIS has very well followed up the letters of Sir BENJAMIN

BRODIE, and that, too, in his official capacity.The first letter professes to draw the attention of Sir GEORGE

GREY to the doings of the Board of Health, but it is more,placing, as it does, in a strong light the absurdities and con-tradictions of the Board of Health and the Privy Councilwith reference to quarantine, contagion, and the anti-choleradietary recommended by the Board. But our readers maycriticise for themselves the first letter to the Secretary ofState.

11 Dover-street, October l2th, 1848.

" SIR,—Having learned at the Home Office that your returnto town is uncertain, I forward to you, without delay, the en-closed resolutions, and, as I have not the advantage of a per-sonal communication, I must be allowed to avail myself of thepresent opportunity to offer a few remarks,

" As soon as the alarm of impending cholera had spreadthrough the town, it was felt necessary by myself and thecensors to constitute a committee of the physicians of ourgreat metropolitan hospitals, together with certain othereminent persons; and I trust you will regard the enclosed listas embodying the medical skill and experience of the country.This Committee will meet three times during the week, inorder to collect information, and, if necessary, to suggestmeasures for protecting, guiding, and sustaining the publicunder such heavv infliction.

" It is, Sir, most unfortunate that the public mind shouldhave been distracted, and general confidence shaken, by thedissemination of adverse and conflicting opinions, and diametri-cally opposed recommendations and directions, bv the severalauthorities to which the public were bound to look for ad-vice ; that while the Board of Health repudiates the idea ofcontagion as a mischievous fallacy, the Privy Council issueorders for the institution of quarantine; that while the formeragain forbid, as dangerous, vegetable food, the College ofPhysicians consider such a change of diet as the adoption ofthat advice would involve, as calculated to deteriorate, ratherthan to improve the health, and consequently to increase theliability it was intended to avert.

" I trust, Sir, you will receive these observations in no otherlight than that of a desire to call your attention to a subject ofthe highest importance. Amidst your numerous and anxiousduties, it is not to be supposed, nor indeed expected, since aBoard of Health has been appointed, that you should havedeemed it necessary to enter into all the details of so difficulta subject.-I have the honour to be, &c. &c.,

. " JOHN AYRTON PARIS."

Of course, Sir GEORGE GREY could only send a civil reply tosuch a communication. The following is his official answer:- (

"Whitehall, 18th October, 1848. I." SIR,—I am directed by Secretary Sir George Grev to ac- I

knowledge the receipt of your letter of the 12th instant,transmitting a copy of Resolutions agreed to by a Committeeof the Royal College of Physicians respecting the nature andtreatment of cholera, and I am to express to you Sir GeorgeGrey’s thanks for this communication.

" have the honour to be, Sir, your obedient servant,"G. CORNEWALL LEWIS."

After this, Lord CARLISLE addressed Dr. PARIS, evidentlymortified at the turn which affairs had taken. From this

letter we get the best exposition of the real motives and viewsof the Board which has yet appeared, and as such it is veryvaluable. As we formerly stated, Lords CARLISLE and AsHLEY,Mr. CHADWIOK, and Dr. SOUTHWOOD SMITH are determined toconstrue the Board of Health into a Board of Works; insteadof the Health of Towns, it should have been the Works ofTowns; instead of the Public Health Bill, it should have beenthe Public Works Bill. It certainly was unfortunate thatthese views did not peep up in Parliament during the passingof the Bill of Works, for, as it now appears, a vast amount ofsanitary enthusiasm was quite thrown away. It seems that

even for Dr. SOUTHWOOD SMITH, as a hanger-on of the Board,we are indebted to the cholera. It appears, too, from this

notification, that the notification proscribing vegetables andprescribing opium was drawn up by the medical member ofthe Board, so that Mr. CHADWICK must stand absolved fromthese sins. We certainly thought it impossible that such aproduction could have been the work of a physician. Other

points of Lord CARLISLE’S letters, which we subjoin, are worthyof consideration.

11 Castle Howard, October 17th. 1848." Sir,—As Chairman of the General Board of Health, I hope

to be excused for the liberty I take in addressing myself toyou; but I have learned with concern that some suggestionscontained in a recent notification issued by the Board on thesubject of Asiatic cholera have met with the disapproval ofthe College of Physicians.

" I would observe, in the first place, that the General Boardof Health, in its ordinary operation, and with the exceptionto which I will presently refer, is mainly a Board of Worksfor sanitary purposes, for the prevention of disease, as far asit may be effected by such works, and its members do not pro-pose, as far as they can avoid it, to enter into any questions ofthe treatment of disease. These they would gladly leave tothe representatives and ornaments of the medical profession.But, in the second place, I have to advert to the exception Ihave named, and to the apparent deviation on the part of theBoard from the course I have described. Under the Act oflast session, for the prevention of contagious and epidemicdiseases, the General Board of Health are, upon the arrival orapproach of such a disease as the Asiatic cholera, entrustedwith functions which under the previous Act were exercised bythe Privy Council. Even under these circumstances, theBoard would be extremelv reluctant to trench upon anydepartment in the more legitimate possession of others ;but they were daily assailed by representations that peoplewere waiting to hear from them what, upon the arrival of thecholera, they ought to do. The notification in question wasdrawn up by the medical member of the Board, who has givenyears of unremitting inquiry to this special class of subjects; inso far as it received any modification, it was upon consultationwith other gentlemen of the medical profession, who gave thekindest and most disinterested attention to the matter, andwhose names would be a guarantee for the value of theiropinions. The Board of Health were not, at that time, in-formed that any other public body were moving in the busi-ness ; no time could be spared; and they conceived themselvesto be, even at the risk of some mistakes and deficiencies,under a moral obligation to impart to the public what appearedto them to be the preponderant evidence with respect to themeans of prevention. They hoped, too, they had guarded againstmisconception, by occasioning it to be inferred that they ad-dressed themselves mainly to those who were removed fromthe opportunities of special advice, and by distinctly abstain-ing from prescribing for the advanced stages of the disease,on the ground of their hope, that in every such case recoursewould be had to regular professional advice.With these feelings, and with respect to the future, I haveonly to add, that the General Board of Health will receive,with respect and deference, any observations, suggestions,corrections, respecting their own views, with which theCollege of Physicians may be pleased to favour them; theywill gladly use any means at their disposal for conveying tothe public any information and advice which may be obtainedfrom so high a source; and even, if at any time the same

674 THE BOARD OF HEALTII AND HEALTH-OF-TOWNS ASSOCIATION.

should not be in accordance with the opinions they have beenled to adopt, they will still feel themselves bound to insert allsuch communications in their official circular, and let themhave the weight which must attach to the views of such aneminent body.

I must further request allowance for the hurry and imper-fection of the present communication, which is written upon aday when my attention is otherwise painfully occupied; butI was anxious that no time should elapse without an attemptto remove any misapprehension which may have unfortunatelyarisen, and to tender an explanation which may be justly due." I have the honour to be, Sir, your very obedient servant,

" MORPETH."

But the best letter of the series is the last, which is fromDr. PARIS to Lord CARLISLE. In this communication the Board

of Works is treated as a board of works, and castigated prettyseverely for meddling with medical matters.

" Dover-street, October 23rd, 1848.

" My LORD,—I have to acknowledge with many thanks yourlordship’s communication of the 17th inst., and to express, onthe part of the College of Physicians, a gracious acknowledg-ment of the courtesy and con&ideration with which you havebeen pleased to recognise and appreciate the just authorityand influence of that body in all matters relating to medicalpolity and legislation."On public grounds I most sincerely join in the concern ex-

pressed by your lordship, that the suggestions contained in arecent notification issued by the Board of Health on the sub.ject of Asiatic cholera, should have been in direct oppositionto opinions unanimously entertained by the College of Phy-sicians.

" Your lordship observes, that the general Board of Health,in its ordinary operation, is mainly a Board of Works for sani-tary purposes. To question the wisdom with which the Boardcontinues to discharge such functions, would very properlyexpose the college to the charge of an officious and unjustifi-able interference in matters alien to their studies and duties;but the objections of the college, as your lordship will per-ceive, rest exclusively upon the medical directions publishedby the Board over which your lordship presides; and when Istate that any professional advice would have issued withfar greater propriety and effect, under the advice and sanc.tion of the chief medical institution of the kingdom, yourlordship will admit that I do but adopt your own opinion, foryou would gladly leave such advice to the representatives ofthe medical profession, unwilling to trench upon any depart-ment in the more legitimate possession of others." Your lordship states that the Board of Health, in drawing

up the directions, or advice, contained in the notification inquestion, was assisted by gentlemen of the medical profession,whose names would be a guarantee for the value of their opi-nions ; upon which I have only to observe, that persons whoconsent to give opinions upon so momentous a subject, oughtat least to be prepared to incur the responsibility attached tothem.

_

"There is one passage in your lordship’s letter which I feelbound to notice, as it may be supposed, indirectly, to inculpatethe College of Physicians, and to raise a suspicion that it hadnot come forward with the energy and promptness commen-surate with the importance of the occasion. Your lordship ob-serves that the Board of Health were not informed that ’anyother public body were moving in the business.’ Allow meto observe, my lord, that until the present instance, I believewithout any exception, the government, in all great medicalquestions, has uniformly called upon the College of Physi.cians for its opinion and co-operation, and I feel satisfied, thathad the Board of Health so acted upon the present occasion,the college would cheerfullv have responded to the call." I have the honour to enclose a copy of resolutions

passed by a committee of the college, and transmitted to Se-cretary Sir George Grey, and I would observe that these reso-lutions are still under consideration, with a view, should itso appear expedient, to amplify, or otherwise to modify them,and that I shall have the honour of forwarding to the Boardof Health a copy of the same at the earliest opportunity.

"I have the honour to be, my lord," Your lordship’s obedient servant,

" JOHN AYRTON PARIS,President of the Royal College of Physicians."

In the fourth clause of the letter the responsibility of theopium and anti-vegetable orders is very neatly placed on theshoulders of Dr. SOUTHWOOD SMITH. It is, however, somewhat,

odd that Dr. SouTHWooD SMITH is one of the Cholera Com

mittee formed by the College of Physicians, and which thPresident hopes will be considered as embodying the medicaskill and experience of the country." Dr. PARis’s remarks oi

the fact that this is the first time any government has eve]moved in a matter of public health without consulting witlthe medical profession, is very happy. Though the action ofthe College of Physicians was rather tardy,-it did not stir untilTHE LANCET had touched the subject again and again,-theprofession will feel grateful to Dr. PARIs and his advisers.The Board of Health, or rather, Works, are in an unpleasantposition. That portion of their " works" embodied in theirofficial circular must be anything but pleasing to contemplate.One notification contradicts another most gloriously, and thepublic will witness the snubbing given to all the notificationsby the presidential letters.

THE Journal qf Public Health is ostensibly connected withthe Board of Health, being its officious, if not its official, organ.We were therefore not surprised at finding an unsuccessfuljustification of the Board in the editorial columns of that paper.

This apology for the Board of Health is prefaced by somepeculiar information relative to the Contagious Diseases Pre-vention Act, which, we are gravely told, is the " mainstay andsecurity of the country against the devastations of cholera."Now, The Times daily informs us that the provisions of theBill are insufficient even to enable us to remove those palpablygross nuisances to be smelt in Bethnal-green, and in otherlocalities. The Board of Health, veering and vacillating con-flicting opinions, is to be, forsooth, our mainstay and security !No; so far as health is concerned, the country has shown thatit will seek its security in the guidance of the profession; andits mainstay is that common sense which enables it to reco-gnise absurdities, under whatever garb and colour they mayappear disguised.The Heal th-of-Towns Association, we are told, succeeded in

placing responsible medical men on the Board, insertingvarious amendments, &c. We do not in the least wish to de-

tract from the merits and influence of the Health-of-Towns

Association; we willingly recognise their great influence inthe framing of the Bill; and thus giving them their full meedof responsibility, we must lay at their door the manifold im-perfections of the Bill they have fathered. Having carefullypraised themselves and their Association for what they havedone, they begin in a delicate way to abuse tho Board ofHealth " for having exaggerated, from want of energy, the in-efficiency of the A ct." Hard is the fate of this poor Board-tobe abused even by its own friends, and to be accused of wantof energy when it has been most chivalrously running atiltagainst everything it could oppose-treated the medical pro-fession with contumely, and deprived thousands of the

community of their ordinary sustenance in times of .pro-vidential arrangements which man cannot alter. If

they had accused it of want of discretion, of want of moral

fear, or of common sense, we could have agreed with them;but it is too bad to accuse the Board of want of energy, and

then seriously to tell them " that it is their duty to themselves"and the public to demonstrate the difficulties under which" they labour, so that their hands may be strengthened." It

is their heads which want strengthening, not their hands, andthey have, we trust, amply demonstrated the difficulties under

675OBITUARY-MR. JAMES SCOTT.

which they labour, the cephalic nature of which no parliamentcan modify. What parliament could make doctors of LordCARLISLE, of Lord ASHLEY, or even of Mr. EDWIN CHADWICK.But the best is still to come.

They contend, that by Section 10 of a certain amendment,which they call the Health-of-Towns Association Amendment,the Board of Health may issue all sorts of directions and regu-lations deemed by them expedient, (this has been done

with a vengeance!) and they evidently show that they com-

plain of the Board of Health not having had sufficient energyto name them as medical officers to superintend large districtswith proportionate pay. We perfectly agree with our con-temporary in his observations on the apathy of local Boards.It is evident that they should be obliged to receive, and alsopermitted to ask for, improvements conducive to the generalhealth. If we were only to permit our children the use of soapand water, their bodies would remain in a permanent state ofuncleanliness. We must, however, observe, that the Board ofHealth has been so unlucky in its proceedings, in the jumblingof advice, physic, and old women’s stories, yclept notifications,that the country cannot be required to place great faith inthe healing virtue of its regulations.Having found so much blame with its patron, the Board of

Health, it is not surprising that the Journal of Public Healthshould not show much respect to the College of Physicians;and accordingly, this venerable body is accused of littleness ofcltaracte1", because it could not assent to the medical heresies

of Gwydir House. In truth, the College of Physicians was toolong silent. But, thank God! it did at last come forward

to rescue the honour of the profession from the thick-comingfancies of deluded gentlemen. Is it, then, a crime for the

College of Physicians to differ in opinion to the irresponsiblemedical acquaintances of those who sit in Gwydir House ?Dr. PARIS, as the official head of the College of Physicians, issingled out for peculiar animadversion. What dietetic

advice should a College of Physicians give but one marked byprudence ? The people were not told to live on cabbage andon cucumbers, as our contemporary seems to imply, but tofollow the diet they had always found to agree with them.

DR. PARIS " carefully-elaborated rules" held good during acholera visitation, as in ordinary times, and these rules havebeen so carefully prescribed by him for the preparation ofvegetables, that even cabbage may be harmless, though cholerabe at hand. Why does not the Journal also blame the Collegeof Physicians for not having adopt ed the wholesale system ofquackery propounded by the three state Apollos of GwydirHouse ? The College of Physicians have not sought to

put opium " within the reach of all; " they have no infanticidalinstructions to answer for.

Obtiuary.M R. J A M E S S C O T T.

THE subject of the present memoir, so long and so wellknown as " Scott of Bromley," whose death we recorded inthe last number of THE LANCET, was born at Royston, inHertfordshire, in the year 1770. His parents, who belongedto the middle class of society, both died when he was quite aboy, leaving but scanty provision for his future education.Thus was he called upon, at an unusually early period, toexercise and develope that energy which subsequently becameso prominent a point in his character. His preliminary edu-cation was somewhat limited, and at the usual age he wasapprenticed to Mr. Nunn, a surgeon at Royston; and at the

expiration of his apprenticeship he came to London, andentered as a pupil at the London Hospital. His pecuniarymeans must at this time have been very small, as is shown bythe fact that during the period that he was prosecuting hisstudies at the hospital he acted as assistant to Mr. Hvnam, awell -known surgeon at that time, in Ratcliff Highway.He was also for a short time resident medical officer to theEastern Dispensary. During the time of his attendance atthe London Hospital, he was particularly noticed by the lateSir William Blizard, whom he always highly esteemed-astrong proof of which he afterwards gave by apprenticing hisonly son, the late John Scott, to him; and it was in a greatmeasure owing to the high opinion formed by that gentlemanof his professional abilities and general character, that he wasselected to take charge of the practice of a Mr. Bradshaw, asurgeon at Bromley, during a severe attack of fever. He

acquitted himself of his duties so well, and so far succeededin gaining the esteem and confidence of this gentleman, thatthe latter urged him, on the completion of his studies, to re-turn to Bromley, and join him in practice.In the year 1792 he became a member of the College of

Surgeons, and he soon after this settled in practice at Bromley:,and owing to the retirement of Mr. Bradshaw, he speedily

obtained entire possession of his practice, which was at thattime about £ 300 a year, and which, in a few years, he in-creased to £ 1500 a year. Finding the surgical part of hispractice rapidly augmenting, and absorbing much of his timeand attention, he entered into partnership with a Mr. Taynton,who was also practising in Bromlev. with a view of shakingoff much of the routine and labour of general and midwiferypractice, and devoting his attention more exclusively to sur-gery.Now commenced a career that for brilliancy and success is

unparalleled in the annals of general practice. The nameand fame of Mr. Scott spread itself over the United Kingdom:patients flocked to him from all parts; and he has beenheard to say, that during the latter years of his life he nevervisited a town of any size without meeting some trophy of hisformer surgical labours.For several years his books showed a profit of at least

;ei0,000 a year; and he received tokens of gratitude frommany moving in the highest ranks of society. About eighteenyears ago, he retired to Clay Hill, in the neighbourhood ofBromley, where he continued to see some of his old patientstill within a few years of his death.

It may be neither uninteresting nor uninstructive to in-quire by what concurrence of circumstances one who, thusearly thrown upon his own resources, with less than theaverage amount of collateral advantages possessed by youngprofessional men on entering life, and with none of the ordi-nary roads to high professional reputation open to him,could yet win for himself so large a share of public notice.We will proceed, then, in the next place, to inquire whatwere those mental qualities that achieved such remark-able results. In the first place, he possessed a very strongattachment to his profession, and pursued it with untiringenergy : when interested in a case, however poor thesufferer, he would spare no labour or expense in accomplish-ing a cure; and he has been known, in early life, to admi-nister very costly medicines gratuitously, when lie could butill afford it. Another peculiar circumstance in his practice,to which he attributed much of his subsequent success, anddoubtless with reason, was, that he made it a constant ruleto apply every dressing and perform every surgical mani-pulation himself; this of course became immense labour whenhis practice was at its acme, but nevertheless, he never in anyinstance departed from it, and in this way acquired an amountof manipulary skill, and a" tactus eruditus" rarely, if everequalled. He possessed immense confidence in himself, andwas remarkably sanguine, and he had, moreover, a most happyand successful method of imparting this buoyant, hopeful feel-ing to his patients, whose confidence and attachment he rarelyfailed in gaining. He possessed great quickness and sagacity

in detecting the nature and extent of diseased action, andhe brought a large share of good strong common sense tobear upon the treatment. Such were the general profes-sional qualities exhibited by the subject of this brief memoir;but that feature in his career which formed its distinguish-ing peculiarity, and which brought out in bold and distinctrelief the originality of his mind, was the seizing hold of theprinciple of mechanical support, working it out in its vari-ous details, and applying it, with extraordinary dexterity,judgment, and success, to the various forms of chronic dis-ease to which it is applicable. It may, perhaps, be too muchto say that he discovered this principle, but he made it his