631

THE LANCET.

LONDON: SATURDAY, JUNE 29, 1861.

THE AMENDMENT OF THE PENAL CLAUSE OF THE MEDICAL ACT.

THAT the penal clause of the Medical Act has proved en-tirely inoperative, in consequence of the manner in which itis worded, is now well known. The clause (40) is as follows :-

" Any person who shall wilfully and falsely pretend to beor take or use the name or title of a Physician, Doctor ofMedicine, Licentiate in Medicine and Surgery, Bachelor ofMedicine, Surgeon, General Practitioner or Apothecary, or anyname, title, addition, or description implying that 7te. is regis-tered under this Act, or that he is recognised by law as a Physi-cian, or Surgeon, or Licentiate in Medicine and Surgery, or aPractitioner in Medicine, or an Apothecary, shall, upon asummary conviction for any such offence, pay a sum not

exceeding .620."The words which we have placed in italics furnish the loop-

hole by which the charlatan escapes. The plain reading, in.accordance with the well-known intention of the clause as

expressed in the preamble to the Act-" Whereas it is expe-" dient that persons requiring medical aid should be enabled" to distinguish qualified from unqualified practitioners,"-was at first accepted; the words " Surgeon," " Surgeon-Accoucheur," " Surgeon-Dentist," disappeared from many a

door-plate; and several decisions by county magistrates weregiven in accordance with that common-sense view. Highercourts, however, have decided otherwise. The decision of the

justices was reversed in the Court of Common Pleas in thecase of PEDGRIFT V. CHEVALLIER on the 28th of May, 1860. *

As the word " Surgeon " was on the appellant’s door, but hisname not in the Register, the justices had convicted him of

wilfully and falsely pretending to be a surgeon. The Court

said there was nothing to show that the appellant had not a

diploma or other qualification so as to give him the right touse the word " Surgeon;" and that the proposition that everyperson who calls himself a " Surgeon " without being on theMedical Register was liable, could not be sustained. No at-

tempt, it should be remarked, was made on the part of theappellant to show that he had a diploma of any kind, nor washe called upon by the Court to do so in justification of hisusing the word " Surgeon."In another appeal case before the Court of Queen’s Bench,

Nov. 21st, 1860, (vide THE LANCET, Dec. 1st, 1860,) that ofSTEELE v. HAMILTON, the respondent had the word " Surgeon"in large letters over his door; the words, "Boston, U. S.," invery small letters below it, and the words " Anti-registeredSurgeon" in small letters on the glass panel of his door. The

Court confirmed the decision of the magistrate in refusing toconvict. Mr. Justice WIGHTMAN referred to the penal clauseof the Medical Act, and said that, to bring the case within it,it must be shown that the party falsely pretended to be asurgeon, &c., "implying that he is registered under the Act,or that he is recognised by law as a physician or surgeon," &c.

Lord Chief Justice COCKBURN said there was nothing in the Actto prevent a person from merely practising as a surgeon withoutbeing registered. At the same time he thought that a personwho wrote up " Anti-registered" in very small letters was not

* THE LANCET, June 2nd, 1860.

entitled to costs. As in the preceding case, no attempt wasmade to show that the defendant had a diploma of any kind,nor was he called on by the Court to do so. The practical reosult of these decisions is, that any unregistered person may usea professional title whether he has a qualification or not; thatit will not be inquired into whether he has or has not, and thathe is not liable to be called on to show whether he has. It is

to be observed, that although it may be possible to prove thatthe person has no diploma such as entitles him to be registeredunder the Medical Act, it is impossible to bring proof that hehas not obtained some make-believe diploma which might beheld to give him some ground of pretence to a title, althoughit might not serve for registration under the Act. But even

such a plea is unnecessary under the literal, as distinguishedfrom the common-sense, reading of the penal clause, underwhich it is only necessary, without requiring to have recourseto the device of putting 11 anti- registered," or the like, to pleadthat in using the professional title he does not imply that he isregistered under the Act, or that he is recognised by law as aphysician, surgeon, &c. Another view, it is true, might betaken of the phraseology in the clause, that it means that themere use of the titles enumerated implies being registered, andthat the use of these titles, or the possession of the qualificationson which they are founded, alone constitutes being " recognisedby law," or that being registered alone constitutes recogni-tion by law; but a clause which is open to two oppositereadings, one of which renders its aim nugatory, it need hardlybe observed, is worse than useless.The plain intention of the clause being thus defeated, it be-

hoves the Medical Council, now sitting, to take steps to intro-duce an Act of Parliament to have it amended, so as to carryout the intention of the Act. We do not undervalue the im-

portance of registration. Only the registered can recovercharges in a court of law, hold public appointments, or signvalid certificates; but it is evident that the intention of the Act,to enable the public to distinguish the qualified from the un-qualified, is frustrated so long as any unregistered person is freeto deceive them by decking himself in professional titles.

In considering the amendment of the clause, a question ariseswhether a person not registered, but possessing a diploma en-titling him to be registered, can now be regarded as "recognisedby law" as a member of the profession, or as authorized to usethe title of physician, surgeon, &c.; or whether he is so re-

cognised, and can use a professional title, only after the legalityof his diploma has been certified by registration. The 32nd

clause of the Act declares that none but the registered can re-cover charges in a court of law; the 34th clause, that theregistered alone shall be understood when the medical profes-sion is referred to in Acts of Parliament; the 35th clause, that

only the registered shall be exempt from serving on juries or inthe Militia; the 36th clause, that none but the registered canhold any medical appointment in the Army, Navy, Poor-lawservice, or in any public Hospital, Asylum, or other institu-tion ; and the 37th clause declares that no medical certificate

required by any Act of Parliament shall be valid unless signedby a registered practitioner. As to practice, the unregisteredholder of a diploma is legally on the same footing as the alto-gether unqualified, there being no penalty against any onepractising; and even a registered practitioner being liable, asanyone else, to an action for malapraxis. It thus appears that no

one can be regarded as legally qualified, or as " recognised by

632 THE AMENDMENT OF THE PENAL CLAUSE OF THE MEDICAL ACT.

law," who is not registered. Although it may seem harsh to What is wanted is a clause which shall, by means of regis-say that the man who holds his College licence or his Uni- tration, draw broad and clear the distinction between the qua-versity degree is not as yet a legally qualified practitioner, the lified and the unqualified; but a clause such as that proposedAct, notwithstanding, declares by the clauses above referred by the Committee, while imperfectly accomplishing this, couldto that he is not so unless he is registered ; and the object is not fail to open the way to endless dispute and even litigationevident, for the necessary registration, so far from being a bar within the profession, for it would enable any registered prac-to the legality of his licence, is the means by which that titioner to be prosecuted on the mere question of titles equallylegality is attested, thus enabling it to be distinguished from with the quack. A line of demarcation must be drawn be-

those which cannot be registered. The same reasons apply tween these two cases, not only as otherwise insulting to the

against the use of professional titles by any but the registered. profession, but as opening the way to constant heartburningsIt may appear hard that a qualified man who is not registered and dispute. The intention of the 40th clause of the Act was

should be forbidden to use a professional title ; but his non- that it should operate as a penalty against persons pretendingregistration is his own lac7tes, and the restriction is the lesser of to belong to the profession, not that it should be used as a

two evils. Otherwise it would be impossible to distinguish means of annoying and creating dissension amongst memberspublicly between him and the unqualified, especially the of the profession themselves. The fourth or title column of

holders of American or other foreign quasi-diplomas. The the Register, it will be recollected, it was found necessary topenal clause in that case would require to run thus-that " no leave blank ; for who could have decided the appropriate title"one who is not registered under the Act, or shall not prove belonging to each qualification ?-whether the College of Sur-own challenge that he possesses one or more of the qualifica- geons man alone is

" Surgeon," the College of Physicians man"tions entitling him to be registered, shall," &c. Such a posi- alone "Physician," or the University man alone I I Doctor" ’.,tion of the law would, however, have the effect of shielding But to enact a title clause penal as between registered mem-the altogether unqualified until challenge in a court of law. bers of the profession would be to bring on ourselves in fullThe only method, then, to prevent all doubt is so to phrase force the evils which the omission of the title column for-the clause as to confine the use of the professional titles, as tunately enabled us to escape.well as the right to hold appointments, &c., to those who are Were a clause with this bearing expedient, it should be dis-registered. tinct from the other, and could not be complete without atThe Committee of the Medical Council, appointed last year the same time defining who should be " surgeon," who " phy-

to consider the defects of the Medical Act, reported to the sician," and so on; questions, we presume, on which neitherCouncil on this question in the following terms, recorded in the members of the Medical Council nor of the profession arethe minutes of June 22nd:- likely to agree, and the question is one on which we heartily

"Sect. 40. - It is proposed to substitute ’or’ for and deprecate any legislation.between the words ’Medicine and Surgery’ in two places The difficulties surrounding the question of titles, as distin-of the section where the words ’Medicine and Surgery’ are guished from qualifications, will be best left to settle downused’ and to introduce the following words after or an guiahed _ .... , . _ , from qualifications, will be best left to settle r.. downA po th ecary " - introduce the following words after our use under the common sense of the profession. Time and reflectionApothecary—’or who shall wilfully and falsely take or use the title of Physician, Doctor of Medicine, Bachelor of Medi- lead more and more to the conviction that there is less in a

cine, Licentiate in Medicine or Surgery, Surgeon, General mere title than appeared to some in the heat of controversy;Practitioner, or Apothecary.’ that there is really no distinctive education, nor examinationalThis alteration is suggested, as it appears to the Com- test, necessary for, or declared by, each particular title; and

mittee that if a person registered under this Act under one that the same title, medical or surgical, is very far from mean-title should assume in addition some title, qualification, or

..1 , , . , , .,degree to which he is not entitled, the section would not apply ing the same thing in all parts of the three kingdoms; while _

degree to which he its not en Ie, the section would not apply ,..., , ’.

to him, as the penalty, in the present words of the section, the equalizing influence of the Medical Council’s regulations ISwould be only recoverable against him for assuming a title im- daily rendering less and less the differences which before ex-plying that he is registered." " isted. The public and the profession take their own estimate

It is not difficult, however, to see that this proposed amend- between one professional man and another, whatever their re-ment is defective, as well as that it confounds two things spective titles may be; and while we are far from thinkingwhich should be kept distinct. The changes of "or" for that some qualifications do not testify more than some others," and" are technical merely. For the rest, it leaves the great we think, at the same time, that the superiority is likely to bepart of the clause unaltered, and as useless as before; while conveyed less by the mere title than by making known the namethe addition proposed after the words " or an Apothecary," of the institution from which the qualiflcation was obtained.which would be the only effective part of the clause, limits the While the Medical Council will, therefore, we trust, avoidtitles which would be penal, so that the charlatan, using any the error of legislating on this intra-professional question, weevasive title which he might coin, would still laugh at the Act. earnestly urge on its members not to allow another year to

But still more, the addition, as proposed, would apply as well pass without endeavouring to procure such an amendment ofto the question of the use of titles within the profession; and, the 40th clause of the Act as shall fully carry out its originalindeed, the Committee appear to have been thinking more of intention of enabling the public to distinguish between thosethe vexed question of titles as bearing on the petty interests of who do and those who do not belong to the profession. Wethe bodies which they represent, than on the right the profes- have pointed out that the distinction must turn on registration;sion has to demand that the distinction be drawn between that the line cannot be drawn unless none but registered personsthose who are and those who are not members of the profession. be considered as members of the profession, or be permitted toThe object of the Act is to enable the public "to distinguish use a professional title. For the 40th clause, let there be aqualified from unqualified practitioners." clause substituted, declaring plainly that

633GATTIE VERSUS HALFORD: .A QUESTION OF CONTRACT.

" Any person who is not registered under the Act who shall thetical case before him, and that the accidents alleged mightpretend to be, or take the name or title of a Physician, Doctor have happened in skilful hands. For the defendant appearedof Medicine, Licentiate in Medicine, Bachelor of Medicine, Sir CHARLES LOCOCK, who related several cases in whichMedical Practitioner, Surgeon, Licentiate in Surgery, Surgical partial paralysis had lasted some months, and who in the-Practitioner, General Practitioner, or Apothecary, or who shall t d h’ .. th Mr. H h hadtake or use any other name, title, addition, or description im- strongest manner expressed his opinion that Mr. iiALTORY) hadtake or use any other name, title, addition, or description im- strongest manner expressed his opinion that Mr. HALFORD had

plying or conveying the impression that he is in any way a treated the case with all proper skill ; Dr. RAMSBOTHAM, who

member of the medical profession, shall, upon a summary con endorsed all that Sir CHARLES had deposed; Mr. BAKER

viction for any such offence, pay a sum not exceeding £20." Bpowx, who said that to give chloroform was not proper in

Such a clause alone would be worth passing as a Medical Mrs. GATTIE’S case, as it had under him arrested the action of

Amendment Act. the uterus, and who generally concurred with Drs. LOCOCK—————————— and RAMSBOTHAM. It was affirmed more or less distinctly by

these three gentlemen that the plaintiff had only suffered fromA CASE of considerable public and professional interest was the effects of the pressure of the child’s head, that she was not

brought into the Court of Exchequer before Baron MARTIN and actually suffering from paralysis, and that the forceps had nota special jury last week. Mrs. GATTTE and her husband caused the injury. But as Dr. BARNES was the only witnessbrought an action for damages against Mr. HALFORD, a surgeon who had thought it necessary to examine the patient, his evi-practising at Hammersmith. The allegations were, that Mrs. dence upon this point could. hardly be rebutted by generalGATTIE, having suffered two severe labours, one of which had opinions arrived at in the absence of direct inquiry ad 7toc.been terminated under chloroform by the forceps by Mr. BAKER The jury, after a deliberation of two hours, returned a verdictBROwN, and being again pregnant, was not unnaturally soli- for the defendant.citous to secure competent aid in her approaching confinement; That the verdict is consistent with justice and the generalthat in engaging Mr. HALFORD, who was a comparative merits of the case we have no doubt. It will be received withstranger to her, she represented these circumstances to him, universal satisfaction by the profession. The charge of mala-making an express stipulation that in the event of instruments praxis could not be supported; and, apart from the question ofbeing required he should send for Mr. BROWN or some other contract, it would probably never have been the basis of anobstetric practitioner; that, notwithstanding this agreement, action at law. The verdict, however, also seems to imply thatMr. HALFORD, in the face of the contemplated emergency there was no contract. We are bound to conclude that there

occurring, had declined to avail himself of further assistance, was none. Still this trial is instructive. It has raised theand had used the forceps himself; and that the plaintiff was in important question whether a patient can make such a con-consequence injured, and was actually suffering from lameness tract with a practitioner, when engaging him to attend her inand partial paralysis of the left leg. It may be here stated labour, as shall be binding upon him, and render him liable tothat the child was still-born, bearing marks of the forceps on damages if injury result from his neglecting to carry out thethe right brow and on the left side of the neck. It was inti- understanding. We think it must be admitted that there maymated by Serjeant SHEE, in opening the case, that the child’s be circumstances rendering it perfectly justifiable for patientdeath was also caused by the injudicious use of the forceps; and practitioner to enter upon such an undertaking. This is abut this was not urged, and indeed no evidence was adduced in right which the public cannot be expected to surrender; andsupport of it. Mrs. GATTIE was very anxious that chloroform it involves no injustice to the practitioner, who is at liberty toshould be given. This Mr. HALFORD evaded-no doubt for decline the engagement if he thinks proper. The argumentgood reasons-by staying in an adjoining room. The child was obviously applies to surgical cases in general, as well as toat last born, some time after the forceps had been withdrawn, obstetrical cases. Setting this question aside, we congratulateby the natural pains. Mr. HALFORD upon the issue of the trial. His character as aHere were two separate charges : first, that Mr. HALFORD medical practitioner comes out untarnished.

had broken a distinct contract to call in another practitionerto apply instruments; secondly, a charge of malapraxis, based

.

on his having used the instruments unskilfully. The defendant THE erection of several new hospitals within the last fewdenied both having made the contract and having manifested years, and the untoward results consequent upon much of our

any want of skill. The learned Judge at one period of the hospital administration abroad during the Crimean war, gavetrial was disposed to decide that there was no legal contract ; occasion at the time to much discussion. Architects, physio-but ultimately, as we understand, this point, as well as that of logists, and actively-engaged practitioners freely gave theirmalapraxis, was submitted to the jury. For the plaintiff were opinions as to the best plan upon which these institutionscalled Mr. MARGETSON, who saw her and the dead child the should be built. The merits of the pavilion and block systemsday after delivery, and who attended her at a later period; were canvassed and generally admitted; the small ward andProfessor MURPHY, who expressed his opinion that the forceps corridor method found favour with a few, whilst others inclinedwas not called for in the case, and had been unskilfully used; towards large wards and few of them. Here and there an

and Dr. BARNES, who gave evidence as to the actual condition admirer of the so-called " double wards" was to be found, andof Mrs. GATTIE, affirming the existence of some degree of para- another, quite opposed to him, maintained that nothing wouldlysis of the left leg, the result of a crushing of some fibres of be discovered so effective as an hospital composed of a numberthe, sciatic nerve, and that her pelvis was fairly proportioned. of separate and small rural-like cottages. Whilst one partyUpon the question of malapraxis, this physician gave only were for immediately moving our infirmaries to Blackheathqualified opinions, stating that, with but an imperfect know- and Wimbledon Common, another regarded this scheme as aledge of the conditions of the labour, he had at best a hypo- wild and impossible idea, and erected their establishment along

634 HOSPITAL HYGIENE.

side a dense market-place, and over a shut-up overflowing standard they have been in modern times constructed pur-burial-ground. Whilst locality, ground-plans, and forms of posely to attain, purely on account of some neglect in whatwards were discussed, improved methods of ventilation were have been most unfortunately regarded as subsidiary orbrought forward, and the exact number of cubic feet of air secondary arrangements. A forcible illustration of how these

necessary to each proposed inmate was again determined. latter are neglected came before us the other day when weIn fact, all of what we may term the broad features of hospital entered the male wards of a London hospital. At the time of

erection and management (as regards the building) received the visit, a nurse, or cleaner, was actively engaged in scrubbingpretty fair consideration. Much direct benefit has, no doubt, the well-worn, spongy, wooden floor. After the wet boards hadaccrued from the discussion, but certainly not that amount had their final rub, some old clothes were thrown over them nearwhich might have been expected; for a great deal that was the beds of the patients. As we walked along, a creeping sen-admitted to be theoretically correct has been neglected (on sation of cold and dampness ascended from our feet. In these

account of pecuniary and other motives) to be carried out in wards we have observed this floor-scrubbing to be a commonpractice. We could point to one modern hospital, whose wards practice, and in parts where the boards are most worn, and in.are so poorly lighted as to give one the idea of entering a con- damp weather, the floor continues for a long time like a half-vent or a cloister instead of a place for the recovery of the sick. dried sponge. We are not aware that sloughing, erysipelas,We could refer to another, a certain range of whose wards is and pyæmia are common in these wards, but certainly wefrequently so repulsive in smell, as to make us wish we had should not be surprised if they were frequent. At anynever entered it. To a third, in which the draughts are so rate we would here impress upon the administrators of hos-great, as to seem (to use a common phrase) "enough to cut your pital arrangements no longer to permit the frequent washinghead off;" and to a fourth, whose approaches are through stink- of the wooden floors. Some institutions in London, we are

ing fish and rotten vegetables. If Sir JOHN PRINGLE’S axiom aware, no longer practise it, but substitute the frequent use ofbe correct,-and of this there can be no doubt,-that the the slightly-damp mop, and what sailors call " dry scrubbing"more fresh air that can be let into an hospital the less is the instead. It would seem not to require any very great amountdanger to the sick and their attendants, there is another rule of knowledge to discover the evils of the system which permitswhich must be added to it--viz., that the rapid renewal of this of the use of readily absorbent materials for the floors, walls,fresh air must be managed in a proper manner. If it be abso- and ceilings of hospital buildings. The amount of noxious par--

lutely necessary to have hospitals within the limits of cities,- ticles given off by respiration, and in other ways, from theand it certainly is so,-care should be taken to procure for patients, is such, that the floors &c. become in time saturated

them the most eligible sites, and not to select ground charged with effete organic matters, which only await being moistenedwith putrefying organic matter. If one main cause of the un- to pour forth an atmosphere of deleterious effluvia. Miss

healthiness of large numbers of men congregated in one great NIGHTINGALE states that at Scutari, where the wards were

building, even with sufficient cubic feet, be a disproportionately overcrowded, the cases offensive, and the floors ill-laid, rotten,small window space, it will be but of partial use to let in fresh and dirty, the accumulated saturations of weeks and months

air, if that great vital stimulus, solar light, be not freely ad- were such that the floors could not be scoured without what

mitted. Miasma may be said, roughly speaking, to diminish must be termed poisoning the patients. Indeed, when hospitalas the square of the distance, and, with good ventilation, not floors are being washed, the smell of something very differentto extend much beyond three feet from the patient. But miasma from soap and water is so plainly perceptible, that there cannotfrom the excretions may exert an influence to a much greater be a doubt that the frequent washing of such floors is one causelimit, and hence the utmost care must be bestowed upon the of erysipelas in hospitals. The proper remedy in the future

frequent removal of the latter, or the proper isolation of beds for this evil is, of course, to make the floors of some non-ab-will go almost for nothing. The arrangement and system of sorbent material. Impervious cement, or composition, used as,ventilation of wards may be faultless in themselves, but may it is in Italian houses, would well answer the purpose intended.be sadly detracted from by an improper adaptation of sinks, It is true that it has great conducting power; but this mightlatrines, and lavatories. Fresh air may be wafted in at the easily be counteracted by allowing a small slip of cocoa-nut fibrewindows above, whilst foul air is ascending from the drains and matting to be placed by each hedside, as well as a pair of listwater-closets below. It is well known that in some modern slippers. Next to this, oak wood, well seasoned, is the best,institutions, constructed apparently upon more than an average if no saw-dust or other organic matter, capable of rotting, besoundness of general principle, the mortality is so high, and placed beneath it. The floor should rest upon a thin stratum

the occurrence of erysipelas, hospital gangrene, and pyaemia so of concrete, or some similar indestructible substance. The

frequent, as evidently to show that certain points of detail reason for employing oak wood is, that it is capable of absorb-have been overlooked, and by which those unwholesome con- ing only a very small quantity of water. Miss NIGHTINGALE.ditions are produced, which thus insidiously exercise so detri- whose experience in the matter has been very great, advisesmental an effect upon the duration of illness and the termina- that even this small capacity for moisture should be as much astions of cases. Some of these faulty arrangements are at once possible diminished. To effect this she recommends

evident in their nature, whilst other errors of construction and " The filling up of the grain of the wood with bees’-wax andadministration require more than ordinary acumen in demon- turpentine, like the French parquet, or oiling and lackering-strating their action. The general result, however, is, that i. e., saturating the floor with linseed oil, and then rubbing it

whilst, upon the one hand, we have establishments for the the over with a peculiar laque varnish, and polishing it so as to

, ..’. -. resemble French polish, like the Berlin Hospital floors. Both

recovery of the sick, with a high mortality evidently neces- processes render the floor non-absorbent; both processes dositated by the fundamentally faulty construction of the whole away with the necessity of scouring altogether. The French

building, we have others falling far short of the high sanitary floor stands the most wear and tear, but must be cleansed by a

635

frotteur, which cleansing is more laborious than scrubbing, anddoes not remove the dust. The Parisian floor requires re-preparing every three years. But the wet and dry rubbing isfar less laborious than either frottage or scrubbing, and com-pletely removes the dust, and freshens the ward in the morn-ing. By either process the sick would gain much in England.The Berlin flooring is by no means perfect, on account of itsdeficient durability of surface, and might be improved."As to the walls and ceilings of wards, plaster or bricks

whitewashed are equally objectionable. Both require very

frequent lime-washing to keep them healthy. Pure, white,polished, non-absorbent cement should be employed in prefer-ence for hospital walls. Parian and glazed tiles would form

admirable covering for the surface of them. All stairs and

landings should be of stone; corridors should be floored withdiamond-shaped flags or tiles, and terraces paved with asphalte.We are neither so exacting nor so enthusiastic as to expect all

our faulty hospital walls will be knocked down and built upafresh simply upon our own or others’ recommendation. But

this we do require, that for the future all additions to old

buildings and the rearing of new ones shall be effected con-formably to those rules which require the habitation of sick

people not to be constructed like an enormous sponge, suckingin year after year effete, infectious, organic efHuvia. As regardsthe flooring, however, of our present institutions, surely someremedy may be at once introduced by which the frequentsrubbing of a parcel of dirty, rotten old boards, immediatelybeneath the noses of the patients, may be obviated. As soon

as this is effected, it may be depended upon we shall hearless of gangrene, pyaemia, and erysipelas.

—————————————

ALL prospect of any amalgamation betwixt the several

Medical Societies, which was lately mooted in Berners-

street as elsewhere, being now hopeless, the Royal Medicaland Chirurgical Society are at present occupied with the

question whether important changes may not be effected

by the Society itself, without external co-operation. Alreadythe Council have appointed a sub-committee to consider

the whole matter, and report their opinion thereon. In

order to encourage the authorities in this desirable movement,a requisition is now in course of signature by non-official Fel-lows, "urging on the Council of the Royal Medical and Chi-"rurgical Society the propriety of considering how far it maybe expedient to carry out certain propositions, recently the"subject of discussion, by sections of the Society selected for"that purpose." Such document has, we hear, received

numerous signatures, both of parties who were in favour andof those against any junction with other Societies, of whommany were previously agreed respecting the advantages ofinstituting various reforms in the Society, in order that it

might keep pace with the times, and not lag behind in themarch of progressive improvement.

CITY ORTHOPÆDIC HOSPITAL.-The annual meeting ofthe governors was held in the Board-room of the hospital,Hatton-garden, on the 14th instant, when the Duke of Marl-borough took the chair. The report, read hy Mr. Tillett,stated that during the past year, 1851 cases of deformity hadbeen treated. Since the opening of the hospital on Midsummerday, 1851, no less than 8058 patients had been received. Thereceipts of the year had been .6556 9s- 3fZ., and the expenses£6 lls. Od. in excess of that amount. The liabilities of thehospital amount to £572 18s. 7d.

Correspondence."Audi alteram partem."

DR. CHAMBERS’ LECTUREON

GONORRHŒA AND IMAGINARY SPERMA-TORRHŒA.

To the Editor of THE LANCET.

SIR,-In THE LANCET of Saturday last appeared a letterfrom Dr. Dawson, of Finsburycircus, disputing the truth ofcertain facts related by me in a Clinical Lecture on a fatalcase of Instrumentation in Imaginary Spermatorrhœa. As Ithere stated, the facts were taken from the deposition madeby the patient, properly attested and witnessed, just before hisdeath. The deposition is as follows :-

"I, J. S--, of -, believing that my life is in greatdanger, and that I probably shall not survive my present ill-ness, hereby solemnly depose to the truth of the following factsregarding myself and the communication which I have hadwith Mr. Dawson, surgeon, of Finsbury-circus. I wrote toMr. Dawson a letter expressing my wish to have an operationperformed for congenital phimosis, which letter he answeredon March 27th, 1861. By his appointment I went to himon the succeeding Friday, and had the operation performedby him. I went again on the Monday following, and thensaid I thought I had spermatorrhoea, because I had during thetwo previous years frequently observed my flannel clothingstained with coloured stains, which were not removed by wash-ing. I did not make complaint of any other symptom what-ever, or of any sensations accompanying the above-nameddischarge. Mr. Dawson asked me no questions about my symp-toms, but then and there passed into the urethra an instrument.like a catheter, with a central piece and with lateral holes,which instrument he filled with an ointment about the consist-ence of lard, which he injected out from the instrument bymeans of an apparatus at the end. Very slight pain wascaused by it. I attended Mr. Dawson every Monday andThursday for the purpose of having the instrument passed.Usually the ointment appeared to be injected about threeinches into the urethra, but on two occasions it was injectedinto the bladder, as appeared to my sensations. A fortnightafter the instrument was first passed, irritation in the situationof the prostate gland and in the perinæum cummenced; Ipassed urine with difficnlty, and pus was discharged from theurethra with and without the passage of nrine. I went againto Mr. Dawson, and he again passed an instrument and drewoff water from the bladder. I then consulted Dr. Sanderson,and he also called to see me on Saturday, May llth, when Icould not bear the irritation. I went to see Mr. Dawson againon the Monday following, and he ordered me copaiba capsules.I went again on Thursday, May 16th, when he injected lauda-num and camphor into the rectum. On the following day,May 17th, he came to see me at home, and drew off my urinewith a catheter, which he smeared with a brown tincture. Ihad that morning written to Dr. Chambers, who came herewhile Mr. Dawson was here with a gentleman he brought withhim, and whose name he said was Venables. I have heard theabove read over to me, and sign it with a solemn belief in itstruth. "

The patient died the same evening.It is a solemn thing to be the depositary of the words of a

fellow-man, spoken just as he is stepping into the dark river ofdeath, with his senses and memory perfect. I should shudderat the idea of disbelieving it, and religiously used the verywords of the deposition in my lecture; yet Dr. Dawson’saccount which you printed last week differs most materially.

The documents allege- Dr. Dawson states in his letter-I. That "an instrument like 1. That "nothing but a

a catheter, with a central piece sound was ever introducedand lateral holes," was in- into the urethra."serted.

2. That it was "filled with 2. That this was onlyan ointment," which was " in- "covered with lard."jected out from the instrumentby means of an apparatus atthe end."

3. That at: the first and 3. That the patient at his