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882 THE LANCET. LONDON: SATURDAY, SEPTEMBER 22, 1900. A GOOD USE OF WEALTH. IT would be a libel on the wealthy men of Great Britain, who are yearly becoming wealthier in spite of wars and Chancellors of the Exchequer, to regard them as indifferent to the best voluntary use of their superfluous means and especially to the enormous amount of good that may be done by the endowment of medical science and research. The voluntary hospitals of this country are sustained in their blessed and benevolent work by a deeper personal sympathy with the sick poor than exists in most countries where such institutions are maintained by enforced rates or taxes. If we could convince the generous wealthy that the cause of - medical science is the cause of the poor and that the culti- vation of this science would help the work of hospitals as well as minister to the prevention and cure of disease among all classes, we should procure such bequests and legacies, not to say gifts during life, from benevolent men as would make Britain what Britain ought to be as the country of JENNER and of LISTER-the leader in those investigations which go to the very root and source of, disease with a view to its extinc- tion and suppression as well as its cure. There are indications that if such countries as ours are to pre- serve their power and their rule in the world they must not rely so much as heretofore on the tendency to multi- plication in the race which so far has well supplied our wants. We must husband the lives that we have in all stages of their existence and oppose with all the resources of reason and of law whatever can be demonstrated to be the cause of disease and premature sickness and death. It is only this demonstration that needs to be forthcoming to induce generous citizens to make endowments that might alter the whole outlook of many individual lives and of particular races. It is only the nature of the problems to be investigated that hinders. This is so abstruse and complicated and so much out of the track of common observation that it seems incomprehensible and un- interesting to the lay mind. Mr. ANDREW CARNEGIE, whose colossal wealth, if well used in this way, might without any noticeable impoverishment of himself be equal to the elimination of two or three of the great causes of death that are the despair of our large city com- munities, draws a distinction, especially with reference t) our own country, in this respect between the lay mind and the professional mind. He speaks of the splendid legacy of Sir ERASMUS WILSON to the Royal College of Surgeons of England and looks in vain for any similar liberality in the aristocratic classes of Great Britain. This comparison, or contrast, is only part of a larger contrast which Mr. CARNEGIE in his Triumphant Democracy " draws .between the alleged selfishness of the aristocratic classes and the liberality of the Republic of which he is so justly proud He is more right when he suggests that the contrast is due to personal differences in the intelligent appre- hension of the questions and problems to be studied rather than to the nature of the Government under which we live. He is naturally proud of the splendid educational institutions of the United States bestowed by individuals on the Republic -the Johns Hopkins University, the Cornell University, the Vanderbilt University, the Packer Institute, the Vassar College, the Wellesley College, the Smith College, the Bryn Mawr College, and the Stevens Institute, the Johns Hopkins University alone having cost .61,000,000. Mr. CARNEGIE himself has given$50,000 to build a laboratory in Belle Vue College. As we have said, the researches and investigations needed refer to problems of great complexity and are naturally understood better by the medical man than by the rich layman, whether aristocratic or democratic. Our belief is that we have only to make the nature and claims of these problems a little more clear to our wealthy compatriots to get from them as generous gifts as those which have founded and now maintain our voluntary hospitals. It was THOMAS GUY, himself a rich man, who built and endowed a hospital which for over 100 years ministered to 400 of the poor of south London, and the generosity of his suc- cessors has enabled the hospital to do a still larger service to the poor. There is every reason to wish that wealth should be devoted to medical science for its benevolence to man and beast, for both have promise of untold benefits from its researches. We have an object lesson at the present moment in Great Britain. In Glasgow a few cases of plague have appeared. Where is the panic that such an event would have occasioned a hundred or even fifty years ago ? It does not exist. Why ? Because medical science has defined the danger and the way to deal with it. In several quarters, even in this aristocratic country, many signs are appearing of the intelligent applica- tion of wealth in a benevolent way to medical science. Witness the munificent gift of Lord IvEAGH to the Jenner Institute of Preventive Medicine. Only last week we noticed the gift to Gay’s Hospital of £5000, the interest of which is to be used two increase and spread the knowledge of the means of preventing and treating disease." The gift is from A Friend of the Hospital" and tends to indicate that the same sympathy which provides hospitals will soon endow research and that such an intelligent use of wealth will be most natural in a country which has endowed colleges, universities, and hospitals for centuries back. The more Mr. CARNEGIE revolves this subject in his mind the more difficult will he find it to know for which mercy to be most thankful-that he was born a Scot or that he was nurtured an American. THE paper issued by the War Office last week containing the proceedings of the court of inquiry into the treatment of the British prisoners of war at Pretoria, with a covering despatch from Lord ROBERTS to the Secretary of State for War, is by no means pleasant reading. It discloses a very discreditable state of things on the part of the late Transvaal Government. It also contains a very emphatic expression of opinion on the part of the Field Marshal in regard to a member of the medical profession. After speaking in deservedly
Transcript
Page 1: THE LANCET

882

THE LANCET.

LONDON: SATURDAY, SEPTEMBER 22, 1900.

A GOOD USE OF WEALTH.

IT would be a libel on the wealthy men of Great Britain,who are yearly becoming wealthier in spite of wars and

Chancellors of the Exchequer, to regard them as indifferentto the best voluntary use of their superfluous means and

especially to the enormous amount of good that may bedone by the endowment of medical science and research.The voluntary hospitals of this country are sustained in theirblessed and benevolent work by a deeper personal sympathywith the sick poor than exists in most countries where such

institutions are maintained by enforced rates or taxes. If

we could convince the generous wealthy that the cause of- medical science is the cause of the poor and that the culti-

vation of this science would help the work of hospitalsas well as minister to the prevention and cure of disease

among all classes, we should procure such bequests and

legacies, not to say gifts during life, from benevolent menas would make Britain what Britain ought to be as

the country of JENNER and of LISTER-the leader

in those investigations which go to the very root

and source of, disease with a view to its extinc-

tion and suppression as well as its cure. There are

indications that if such countries as ours are to pre-serve their power and their rule in the world they mustnot rely so much as heretofore on the tendency to multi-

plication in the race which so far has well supplied ourwants. We must husband the lives that we have in all

stages of their existence and oppose with all the resources of

reason and of law whatever can be demonstrated to be the

cause of disease and premature sickness and death. It is

only this demonstration that needs to be forthcoming toinduce generous citizens to make endowments that mightalter the whole outlook of many individual lives and of

particular races. It is only the nature of the problemsto be investigated that hinders. This is so abstruse and

complicated and so much out of the track of common

observation that it seems incomprehensible and un-

interesting to the lay mind. Mr. ANDREW CARNEGIE,whose colossal wealth, if well used in this way, mightwithout any noticeable impoverishment of himself be

equal to the elimination of two or three of the greatcauses of death that are the despair of our large city com-munities, draws a distinction, especially with reference

t) our own country, in this respect between the lay mindand the professional mind. He speaks of the splendidlegacy of Sir ERASMUS WILSON to the Royal Collegeof Surgeons of England and looks in vain for any similar

liberality in the aristocratic classes of Great Britain. This

comparison, or contrast, is only part of a larger contrastwhich Mr. CARNEGIE in his Triumphant Democracy " draws.between the alleged selfishness of the aristocratic classes andthe liberality of the Republic of which he is so justly proud

He is more right when he suggests that the contrast

is due to personal differences in the intelligent appre-hension of the questions and problems to be studied ratherthan to the nature of the Government under which we live.

He is naturally proud of the splendid educational institutionsof the United States bestowed by individuals on the Republic-the Johns Hopkins University, the Cornell University, theVanderbilt University, the Packer Institute, the Vassar

College, the Wellesley College, the Smith College, the BrynMawr College, and the Stevens Institute, the Johns HopkinsUniversity alone having cost .61,000,000. Mr. CARNEGIE

himself has given$50,000 to build a laboratory in Belle VueCollege. As we have said, the researches and investigationsneeded refer to problems of great complexity and are

naturally understood better by the medical man than bythe rich layman, whether aristocratic or democratic. Our

belief is that we have only to make the nature and claims ofthese problems a little more clear to our wealthy compatriotsto get from them as generous gifts as those which have

founded and now maintain our voluntary hospitals. It was

THOMAS GUY, himself a rich man, who built and endowed a

hospital which for over 100 years ministered to 400 of

the poor of south London, and the generosity of his suc-

cessors has enabled the hospital to do a still larger serviceto the poor.There is every reason to wish that wealth should be devoted

to medical science for its benevolence to man and beast, forboth have promise of untold benefits from its researches.

We have an object lesson at the present moment in Great

Britain. In Glasgow a few cases of plague have appeared.Where is the panic that such an event would have occasioneda hundred or even fifty years ago ? It does not exist. Why ? Because medical science has defined the danger and the wayto deal with it. In several quarters, even in this aristocratic

country, many signs are appearing of the intelligent applica-tion of wealth in a benevolent way to medical science.

Witness the munificent gift of Lord IvEAGH to the

Jenner Institute of Preventive Medicine. Only last week

we noticed the gift to Gay’s Hospital of £5000, the

interest of which is to be used two increase and spread the

knowledge of the means of preventing and treating disease."

The gift is from A Friend of the Hospital" and tends toindicate that the same sympathy which provides hospitalswill soon endow research and that such an intelligent use ofwealth will be most natural in a country which has endowed

colleges, universities, and hospitals for centuries back. The

more Mr. CARNEGIE revolves this subject in his mind themore difficult will he find it to know for which mercy to be

most thankful-that he was born a Scot or that he was

nurtured an American.

THE paper issued by the War Office last week containingthe proceedings of the court of inquiry into the treatmentof the British prisoners of war at Pretoria, with a coveringdespatch from Lord ROBERTS to the Secretary of State forWar, is by no means pleasant reading. It discloses a verydiscreditable state of things on the part of the late TransvaalGovernment. It also contains a very emphatic expression ofopinion on the part of the Field Marshal in regard to a memberof the medical profession. After speaking in deservedly

Page 2: THE LANCET

883THE TREATMENT OF BRITISH PRISONERS OF WAR AT PRETORIA.

appreciative terms of the efforts made by Dr. P. H.

HAYLETT and Dr. R. vorr GERNET to ameliorate the con-

dition of their patients in the hospitals at Racecourse andWaterval and of the timely aid and effective cooperationrendered by some gentlemen resident in the neighbourhood,Lord ROBERTS goes on to say: " On the other hand,it would be difficult to condemn too strongly the

conduct of Dr. H. P. VEALE, M.B. Cambridge, whose heart-lessness in ignoring the disgraceful treatment of the

sick prisoners and the remonstrances addressed to him by the medical officers in immediate charge of them calls forthe severest reprobation." We have thought it right to quotethe exact words used by the Field Marshal because theyserve to indicate the feeling of indignation which a perusalof the whole of the documentary evidence evidently arousedin the mind of Lord ROBERTS, who is universally recognisedas a just and humane man.

It is necessary, however, to remark that the War Officedocument is incomplete in that many of the letters referredto in the text are not published, and it is only fair to Dr.VEALE to state that in his examination before the

court of inquiry he said that he was one of the three medicalmembers of the Transvaal branch of the Geneva Red Cross

Society; that he had nothing to do with the sanitaryarrangements of the prisoners of war at the Racecourse,although he allowed that it would be his duty as medicalofficer attending the sick to represent and try to remedyanything which he found prejudicial to health, and this hedid; that he disclaimed all responsibility for the medical and

sanitary arrangements for the prisoners of war at Waterval ;and that he denied having received most of the letters

alleged to have been addressed to him by Dr. HAYLETT

representing the grievous condition of the hospitals and their

occupants. We propose to defer any comment of our own

on Dr. VEALE’S conduct until sufficient time has been givento permit of his making public what he has to say in

justification or explanation of his action.Whilst we are upon this unpleasant subject we may add

that we are glad to believe that there are not many clergymenin the Church of England like the Rev. J. GODFREY

who under colour of consideration of his duty to the

Transvaal Government and in order to gratify his ’’ desireto maintain the honour due to his position" discontinuedthe regular ministrations of the services of the Church

because a prisoner, and he a non-combatant, had escaped.We commend to the notice of the Rev. J. GODFREY a studyof the life of Father THOMAS of Algarve who refused hisransom in order to minister to the Portuguese prisoners ofthe Moors in the dungeons of Al Araish.As regards the general question of the treatment of the

British prisoners of war-the bad quality and insufficientquantity of the rations, the neglect of all sanitation, thetreatment of the colonial corps prisoners, and so forth-weneed not dwell upon a subject which has been already sofully discussed in the daily journals. Happily that is allover and a thing of the past now.

i

THE A6?c Tork Medical Record of August llth contains afull abstract of an address on American Medicine, deliveredat the International Medical Congress in Paris by Dr. JACOBIof New York, which gives a very interesting account of

the development of the profession and of medical scienceand literature in the United States. There are parts of theaddress with regard to which opinions may differ. We

observe that our contemporary in its issue of August 25thtakes exception to Dr. JACOBI’S criticisms on American

medical journalism, and it must be admitted that Dr. JACOBIis very candid in the denunciation of hundreds of medical

journals which, according to him, represent rather " the

growing commercialism " of the century than any ardentdesire to advance medical science or medical literature.

He declares that there are 300 such journals and thatneither medical science nor medical ethics would suffer

if the number were reduced to 50. Such a greatnumber of journals and the competition implied therebyDr. JACOBI thinks to be inconsistent with the in-

dependence of the editors and with high aims on

the part of the proprietors. Our contemporary resents

such aspersions with some warmth, and if we thoughtthat Dr. JACOBI meant his criticism to be applied indis-criminately to American journalism we should regard theresentment as reasonable. But we must take his arith-

metical and other facts into consideration. His figures are

certainly startling apart from his positive statement,which most of us in Europe can confirm, that many

journals seem to exist to puff proprietary articles. Perhapshe is wrong in regarding them as in any proper sense

medical journals. Certainly no such number of real and

honest journals could be supported even by the largenumbers of the American profession. For the class of

papers which he condemns no censure is too severe and

it seems to us that all honest medical journals should feelgrateful to an independent critic for plain speaking on thesubject. The one necessary thing for the respectability of

journalism, professional or otherwise, is independence. It

would be unreasonable to expect proprietors to be above allconsiderations of profit, but it will be a bad day forscientific journalism if an independent medical critic cannot

say what he thinks of the fitness of the journals of the

profession to advance its science and its dignity.Dr. JACOBI is almost equally severe on the number of

medical societies in America. In Colonial times there were

two ; in 1876 nearly every State in the Union had its medical

society, and most counties in each State have their ownmedical society. All the state societies are represented in theAmerican Medical Association, save one. The exception is a

great one-that of the State of New York. This State is

excluded, and it is instructive to notice that the reason for

its exclusion is an ethical one. There is no central authorityin the United States vested with any legal disciplinary powerover members of the profession as is the case to a certain

extent with the medical authorities and the General Medical

Council in the United Kingdom. The disciplinary power inthe United States lies in the societies, and chiefly in

the American Medical Association in which all the

State societies are represented. The State societies

exercise their disciplinary power by refusing member-

ship to medical men who take out patents for medi-

cines, or who advertise themselves or allow themselves

to be advertised by others; and the American Medical

Association has its code of ethics based, we are proud to

say, on the classical work of PERCIVAL, our own great

Page 3: THE LANCET

8 84 DR. JACOBI ON AMERICAN MEDICINE.

medical moralist. It expects all associated State societiesto fall into line with the requirements of this code and,failing to do so, it excludes them from representation orexpels them as in a significant case in 1882. The questionof holding relations with homoeopaths arose in that year.

There was the same universal feeling against such relationsas obtains in this and in all European countries. It

obtains, also, in the United States, but in the New

York State Society a special point was raised and

contended for strongly. This Society admitted the generalimpossibility and incongruity of consultations between

regular practitioners and those committed to the dogmasof HAHNEMANN, but it was argued that in some cases it

would be inhuman to refuse a consultation and the Societymodified their law to meet exceptional cases and cases of

emergency. For this modification, of which Dr. JACOBI

speaks approvingly, the State of New York was expelledfrom representation in the American Medical Association.

The American Medical Association has no legal relation tothe legislature of the United States as the State societies ’,have. It is nevertheless a powerful body, more powerful insome respects for being voluntary and unrestrained by law,and is capable, as we have seen, of making its views felt by thesocieties of individual States. The action of the association

in this particular question was the more resolute and strikinginasmuch as homceopathic and eclectic practitioners in theStates are legally recognised as much as regular practi-tioners, but this is only an additional reason for regularpractitioners in voluntary associations emphasising the

difference between them and their fanatical competitors.The peculiar legal position of the profession in the United

States is well shown by Dr. JACOBI and must be rememberedby all who wish to judge fairly the difficulties in the wayof medical practitioners and medical teachers there. Of

late years, with an enormous advance in medical education

and in medical practice, there has been actual retrogressionon the part of the States in respect of medical legislation.In 1840 the legislatures of nearly all the States had laws forprotection of the citizens from quacks.. Between 1840 and1850 most of these laws were repealed or not enforced

out of deference to unlicensed practitioners. The power to

confer degrees rests in the different States on the most variousconditions of law. In New York and Pennsylvania theconditions are satisfactory, but in Illinois, where so muchhas been done by medical teachers to improve educa-

tion, legislation like that of New York has been defeated.In Ohio and Nebraska the statutes require only the nominalendowment of$5000 for the creation of a degree-conferringinstitution. In other States and Territories any body of men

may form an educational corporation with power to conferdegrees. So wide is the difference of standard of medical

education and qualification that it is difficult for the differentStates of the Union to arrange for reciprocity of medicalpractice between their graduates.

Such are the disadvantages of the medical profession ina new country having democratic institutions based on an

exaggerated view of the rights of the individual in regionswhere he can have no rights not acquired by study and

special knowledge. But such disadvantages can only raiseour esteem for those who, prevailing over all difficulties,have brought the medical profession to a pitch of efficiency,

alike in the region of research and the domain of practice,which compares favourably with the standard of any

European country. The number and competition of the

schools, of which in 1899 there were 156, with 24,119students, having a very inadequate check on their degree-con-ferring powers, only makes us wonder the more that withinrecent years it has been possible in many States to extendthe medical curriculum to three or four years, and to reportthrough societies and journals an amount of good workwhich implies a very high standard of education in somequarters and a very high pitch of medical and surgical abilitydiffused throughout the enormous area of the United States.Dr. JACOBI, while severe enough in his criticisms on medicaljournals and medical societies, leaves us in no doubt that heis proud of his confreres and not altogether prepared tocondemn that democratic constitution which has created

medical libraries and medical laboratories that are the envyof older countries.

Annotations.

THE WORK OF THE GOVERNMENTLABORATORY.

"Ne quid nimis."

THE work of the Government Laboratory grows apace andincreases in interest every year. There can be little doubtthat the appointment of Dr. Thorpe a few years agoin succession to Dr. (now Sir James) Bell led to a

considerable amount of reorganisation of this importantdepartment. The annual reports at any rate show thatthe operations. conducted in the Government Laboratoryhave been reduced to something like a system. Asa result of this improvement in the equipment ofthe department together with the erection of new andmodern constructed laboratories in Clement’s Inn-passage,the Government has called into greater requisition the

services of its laboratory department. The old SomersetHouse laboratory was primarily instituted for the purposeof controlling Inland Revenue regulations which referred

chiefly to beer and spirits. The work now not only relatesto Customs and Excise but to the examination of foods,water-supplies, sewage effluents, Government office supplies,and a number of miscellaneous articles with which thevarious Government departments come into contact. Further .

than this the principal of the laboratory practically occupiesthe position of a consultant and adviser to the Government,a rôle which cannot be fulfilled without the institution ofsome amount of original research. Dr. Thorpe was calledupon, for example, to inquire into the use of lead

compounds in pottery manufacture, and this involvedthe making of a number of experiments on the com-

position of "frits" which could be regarded as least

likely to produce lead poisoning. The inquiry, as

we know, has led to excellent results which have stimu-lated the pottery industry to abandon the use of raw leadand in some cases to discard the use of lead altogether forglazing purposes. Again, Dr. Thorpe’s assistance has beenin request - in an inquiry into the composition of defectivesteel rails, and other subjects have been referred to himrelating to the defects of boiler-plates, shafting, and cranksin connexion with accidents under investigation by theBoard of Trade. The work of the principal of the labora-tory has been considerably increased also by the fact that hehas been appointed by the Local Government Board, in suc-cession to the late Sir Edward Frankland, to undertake theanalyses of the London water-supplies. In our opinion this


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