167

fail to give the subject your attention, Ihave the honour to be, Sir, your obedient

servant,J. I. IKIN, Surgeon, &c.

Leeds, April 25, 1842.J. I. IKIN, Surgeon, &c.

THE OSTEOTOMIST OF THE LATEPROFESSOR DAVIS.

To the Editor of THE LANCET.

SIR,—In my former communication mymain object was a defence of the oteotomist,and not any comparison of the merits of thatinstrument and those of the kephalepsalis.The statements which I then made are fullyborne out by the reputation the osteotomisthas had awarded to it for a number of yearsas a valuable means in difficult instrumentaldeliveries. I have, however, in compliancewith the request of Dr. Campbell, directedmy attention to the properties of the kepha-lepsalis, and I must in fairness allow its

competence to exert a considerable power,an amount of power, indeed, far exceedingthe demands of any case. Its dimensions,however, are such that it necessarily occu-pies more space at the brim of the pelvis thantheosteotomist, and this would greatly dimi-nish the safety of an operation in a pelviswith a conjugate measurement of only oneinch and one-eighth, or even in one of a lesscontrac;ed diameter, especially when weconsider that there must be room allowedfor the points of two fingers for the purposeof guarding the soft parts of the mother

against injury. While examining the newinstrument, I was shown what was supposedto be a good specimen of the osteotomist.On trial it proved, indeed, to be a bluot in-strument ; the elasticity of its handles pre-vented nearly all pow"r of leverage, and inother respects the instrument was badly con-structed. That the osteotomist is not essen-

tially a blunt instrument is evident from its

competence to remove, when accuratelymade, with the sharp-cutting edges of itscounterparts so mutually adapted as to passeach other closely when in action, cleanlycut sections from a piece of writing-paper, orof card. It also makes its way through thechild’s skull with perfect facility. Thebeautiful simplicity apparent in the con-

struction of the osteotomist, its well-adaptedmeasurements, its perfect competence toeffect its desired object without the least Idifficulty, as I shall be happy to prove toany gentleman, are strong grounds in favourof that instrument. I am, Sir, your obedientservant,

JOHN HALL DAVIS, M.D.,Physician-Accoucheur to the Royal

Maternity Charity.17, Russell-place, Fitzroy-square,

April 26, 1842.

JOHN HALL DAVIS, M.D.,Physician-Accoucheur to the Royal

Maternity Charity.17, Russell-place, Fitzroy-square,

THE LANCET.

London, Saturday, April 30, 1842.

ON THE INFLUENCE OF TROPICAL CLIMATES.

IN three recent numbers of THE LANCET

we gave some account of the population and

prevalent diseases of Calcutta, founded uponthe official Report of the Committee of

Inquiry, and information in the recent valu-able work on the influence of TropicalClimates by Dr. JAMES JOHNSON and Mr.

MARTIN. Through the apathy and the wantof intelligence in the Indian medical autho-rities to appreciate the importance of syste-matic records in the public service, our

knowledge of the diseases of India is still

very incomplete. The description of morbid

appearances in the best works is vague.

Etiology is conjectural. Number, weight,and measure are little known. The nume-

rical method is scarcely understood. We

must quote the words of Mr. MARTIN—a

perfectly competent witness-on the conductof the medical establishments :-" The subject of statistics is one that has

been altogether neglected in the medicalestablishments of the Bengal Presidency ;and though the example of the hospitals ofher Majesty’s army, from which the mostcomplete returns are made, has now beenfifteen years before us, this important branch- the very central point of medical science-can scarcely be said to have been approachedby us. It is the deficiency here complainedof that has caused the omission in this reportof all mention of the hospitals of Calcutta,and of the General Hospital in particular;an institution that has existed for more than

seventy years, and in which tens of thou-sands of European soldiers have been treatedunder three or four different medical sys-tems, yet no one fact, out of the numerousand important observations made during thatlong time, is known to any of us. All thisand much more has been urged by me inwhat I thought the right quarter, and in themost emphatic manner; and though my pro-position met with no very flattering recep-tion, I have yet the satisfaction to know thatI have produced some action, tardy perhaps,yet such as will lead to some ultimate im-provement. We are in India continuallykept in mind of that law of our nature, bywhich old men are disinclined from under-taking anything, however excellent, of whichthey cannot be expected to see the end.

168 INFLUENCE OF TROPICAL CLIMATES ON THE MIND.

Through the operation of climate, also, we mount : but it is quite clear that where menhave too often to lament the premature dis- have evinced no particular talent they shouldplay of the contracting influences of age on .

the moral and physical constitution of man, never be raised, however long they may haveto the prejudice no less of public welfare served, to a situation of such responsibilitythan of private happiness." as the officers of the Medical Board occupy.

This is severe ; but it derives all its seve- The lives of thousands of men depend on therity from its truth. It would appear that advice which they give the Supreme Go-

the " Medical Board" has never suggested vernment, and the green life must not be

any measure of importance to the public sacrificed to gratify the grey head, withoutservice in India ; that it has never obtained, brain, wisdom, or understanding—neverin imitation of Sir JAMES M’GRIGOR kindled into energy except in resisting im-

(though it had the example fifteen years provements, which the sagacity of others hasbefore it), periodical reports on the medical suggested.topography of the country; and had even the Whether the Medical Board will c1ntinuc

effrontery to resist the proposition when it to repress the energies of the medical officerswas made in 1835 by MARTIN, and carried of India, or shake off their indifference,-into effect by an order of the Supreme Go- encourage and lead the way in medical re-

vernment. The " Medical Board" snc- search and discovery,-it is impossible to

ceeded in resisting a proposal to obtain form a conjecture. Nothing is more de-

reports from the military and civil hospitals, lightful than age, with the sap of youth inand still lies, like a paralysing incubus, on the soul, and bearing fruits to the last termthe medical departments of India. The ex- of prolonged existence. We do not attack theelusive principle of promotion by seniority is Board because they are old, but because theythe bane of the service. Longevity is re- have been idle. Nothing would give uswarded in India, and has alone any chance greater pleasure than to have to submit to

of promotion. It would be a happy circum- the profession here a practical proof of theirstance for England and for the people of efficiency, in a comprehensive summary ofIndia if the climate cut off only imbecility the sanatory state of the army of India. Asand incapacity, or if the length of life bore a set-off to the principle which Mr. MARTINany constant relation to the talents, industry, has adverted to, and which may have actu-and capacity of officers. But experience has ated them, we recommend to their considera-proved that this is by no means the case : a tion the maxim of a writer who, in pleadingman may defy the climate of India, and by the cause of age, had a right to give advicedint of circumspect listlessness, sleepy indo- —Aptissima omnino sunt, Scipio et Laeli,lence, cautious abstinence from wasting arma senectutis, artes, exercitationesquethought, weather storms fatal to his com- virtutum, qux in omni aetate cultæ, cum

panions, win the race by outliving his rivals, diu multumque vixeris, mirificos efferuntand thus glide quietly to the goal-the Me- foetus, non solum quia nunquam deserunt,dical Board, where he has an ample op- ne in extremo quidem tempore ætatis (quan-portunity for discouraging the virtues of quam id maximum est) verum etiam quiawhich he has experienced the inutility. If cozzsciezatia bene actæ vitæ, multorurtaquea man inherit enough vital tenacity from his benefactorum recordatio,jucundissima est.progenitors, he can laugh at zeal and trample Lord ELLENBOROUGH, when in the Houseon genius; for by the seniority system he is of Lords, took a somewhat active part in thesure to be placed at the head of his medical discussion of matters connected with thebrethren in India. public health, and, as he understands the

We are not contending that regard should subject, will, we should hope for his own

not be had to length of service; for when sake, and for the sake of the Europeans injoined with ability its claims would be para- India, as well as for the benefit of the

169

natives, carry out the plan of improvements these proportions. Land yielding 10001.

elaborated in the Report of the Committee of a-year is a property of 25,0001.; a life-

Inquiry, and sketched with a master’s hand annuity at fifty of 10001. is a property of

by the Marquis of WELLESLEY in 1806. 12,869l. A property-tax of one-thousandth

One of the first questions which should part annually would yield 251. in the one

occupy the Medical Board is the cause of case, 121. 17s. in the other. It is outrageousthe enormous differences in the mortality of injustice to tax the two incomes to the samethe troops at different stations. It is cer- amount, for one, or three, or ten years ; it is

tainly not climate. The mortality, it will be inexcusable ignorance not to know the ratio

seen, varies from 2.5 to 10.2 per cent. of the two values ; and it is dishonesty to

annually. pretend that they are equivalent properties.From documents published by Inspector- Would any landed proprietor in the

General MACLEOD :- House of Commons give his estate of 10,0001.Annual a-year for a professional man’s income of

Aggregate Deaths to 100Streugth. Deaths. LIving. 10,0001. a-year? If their " means" (their

Berhampore 120 properties) are equal, they may be exchanged.years).... 13,766 1410 .. 10.2 The property-tax is to be paid by the contri-Secunderabad. 8,125 .. 638 ..7.9

Dinapore .................. 6.4 butors according to their means, yet weFort William............... 6.3 never expect to hear of Sir ROBERT PEELChinsurah ................. 6.3

giving an estate of 5001. a-year to anyCawnpore ................. 4.8Ghazeepore ................ 3.7 " Doctor" in exchange for the proceeds of aKurnaul .................. 2.6 medical man’s practice of 10001. a-year, orMeerut.................... 2.8 ’ .. ,

Agra...................... 2.4 even compounding with his apothecary, bygiving him 25001. in lieu of all his future

bills of 1001. a-year.ONE of the arguments that have been em- " But the land-lord, whose estate is en-

ployed against the doctrine which we have tailed, has only a life-interest in it." True ;advocated with regard to the property-tax but you tax the property, and not the man ;

is, that if the limited duration of life were you tax the professional man only becausetaken into account, a corresponding reduc- his labour, skill, and capacity, which maytion must be made in the contributions of be expected to last a certain time, are pro-the great landed proprietors whose estates perty.are entailed. It is one of the plausible fal- Is the landowner, whose estate remains,lacies which deceive shallow minds. The and passes by entail to his children, in thelanded property remains at the death of the same condition as the professional man,proprietor, the professional income ceases at whose property ceases with the terminationdeath. The land is, relatively speaking, an of life ?

imperishable source of income, with life the For whose advantage, again, does the lawprofessional source of income perishes. of entail exist? If the present proprietors ofLandis property to the extent of the money it landed estates wish it, they have the powerwill fetch in the market. A professional in their own hands, and can destroy the lawincome is inalienable except to a very limited of entail as easily as they can pass the

extent, but it is much less, and can never income-tax. Why do they not do so, if it beexceed, the present money-value of an a grievance ? If the law of entail is volunta-

equivalent life-annuity. Now, land yield- rily submitted to by them-if they prefer it

ing 1000l. a-year will sell for 25,OOOl., and a to the uncontrolled possession of their estateslife-annuity of 10001. a-year at the age of -if it be advantageous to their families, andfifty is worth 12,8691. A tax upon the two concentrate political power in their hands,incomes, reduced to property, would be in they can, of course, ask for no reduction, on

170

the ground that they have only a life-interestin their estates. They consider, as a body, Ithe life-interest and the entail of more value

than the unconditional interest enjoyedwithout the entail. The CHANCELLOR OF THE

EXCHEQUER is bound to take their own mea-

sure of value, and must arrive inevitably atthe same conclusion.

The profits of some trades and professionscan be transmitted unimpaired to children,provided the children have the industry and

capacity of the parents ; or the introductionto the practice-the " goodwill" of the busi-

ness-may be sold; but the gain from thissource is an inadequate compensation for the

contingencies of sickness, infirmity, and theuncertainty of practice. Moreover, on the

assumption we have made all along, the

wages of labour, comprising the greater partof the professional man’s income, will be

taxed at the same rate as the rent of land, orthe interest of capital ; a concession in favourof land and fundholders, of much more valuethan the advantage derivable from the sale

or transmission of " goodwill."Land cannot evade the tax any where but

in the Legislature ; and there may be somedifficulty in ascertaining the real incomes ofconsulting physicians and surgeons ; whenceit will be, perhaps, supposed that their

incomes will be under-rated. But the pro-

bability is that, as men of honour, they willreturn the true amount; for they are as

much interested in overstating as in under-

stating their professional incomes. The caseis well known of Sir EVERARD HOME, whoburnt JOHN HUNTER’S papers, and unfortu-

nately acted under no restraint of moral

principle : he exaggerated his income in thereturn under the old tax. The objection doesnot apply to the general practitioners, whokeep day-books and ledgers. After all, tomake the tax just, will be the best safeguardagainst evasion.

PHTHISIS.—In a report on phthisis madeat Martinique by M. Rufz, the reporterobserves, that phthisis is less an hereditarydisease transmitted from parent to child, thana congenital disorder proper to childrenissuing from the same family.

ROYAL MEDICAL AND CHIRUR-GICAL SOCIETY.

Tuesday, April 12, 1842.

Dr. WILLIAMS. President.

THE PLAGUE AND THE QUARANTINE LAWS," Notice of Cases of Plague contracted in the

Lazaretto of Constantinople, in a Letteraddressed to John Dary, M.D., F.R.S.,Inspector- General of Military Hospitals,By Mons. PEZZONI, Conseiller d’Etat aS. M.l’Empereur de toutes les Russes;attach a la Legation Imperiale pris laS. Porte, in proof of the Contagion ofPlague; with Remarks by the former."Communicated by Dr. HODGKIN.

DR. DAVY observes, that the long agitatedand very important question, whether theplague is truly a contagious disease, or

merely an endemic or epidemic, is not de-cided, appears clearly from two of the latestworks published on the subject, viz., thoseof Clot Bey and Mons. Boulard. By theformer an attempt is made to prove that theoriental plague is not contagious ; whilst bythe latter the contrary is maintained. Thisdifference of opinion is the more remarkable,as their researches were conducted chieflyin the same country, Egypt, and about thesame time, and in part in conjunction, bothof them having belonged to a commission,which, for a considerable time, devotedthemselves to the investigation of the maladywithin the walls of a plague hospital. Dr.

Davy remarks, that it is very desirable this

question should be brought to an end; forwhilst it is undecided, there is little proba.bility of anything of moment being attemptedin regard to the quarantine laws, whichstand in so much need of being revised andreformed.

Dr. Davy states, that he left England inNovember last, employed by her Majesty’sGovernment on particular service, with in-structions from the foreign secretary to makeespecial inquiries on the subject in question,in connection with the quarantine system.His mind, he says, was in a state of doubton the point at issue, but if he had a bias, itwas rather in favour of the noncontagionist,At Constantinople he found all the medicalmen of any experience decided contagionists,but his own opinion remained the same tillthe month of J une, when some facts came tohis knowledge which appeared to be demon-strative that plague is really contagious,These facts were briefly the following :-Ata time when Constantinople and its neigh-bourhood were free from plague, and hadbeen so for three years, a vessel arrived fromEgypt with cases of the disease on board,which, with the whole of the crew and pas.sengers, their effects, and merchandise, weredisembarked, and placed in quarantine in

the Lazaretto. Of the guardians andporters employed on this service, two con-