727

stone from the bladder, and the completecure of the patient.

CASE 4.-In one of my journeys intoNottinghamshire, Robert Winfield, a shoe-maker, sixty-one years of age, consultedme, at the recommendation of Mr. Hicken-bottom of Nottingham. I was then onthe point of returning to London, andonly had time to sound the patient con-.jointly with Mr. Oldknow, surgeon to theNottingham hospital. A stone, of aboutan inch in diameter, smooth and move-able, was distinctly felt, and it was agreedthat the patient should come to Londonin a few days. On his arrival I presentedhim to Mr. Earle, who had the kindnessto procure him admission into St. Bar-tholomew’s Hospital, to be operated uponpublicly.Three applications of the percuteur were

performed before a considerable numberof medical gentlemen, and the pupils ofthe hospital. In the first, the stone wasseized and broken. In the second, theportions too large to be voided naturallywere reduced into smaller pieces and

powder, and the third indicated that therewere still a few fragments remaining, butso small, that they could be easily ex-pelled; the instrument was therefore with-drawn without acting upon them. In afew days the remaining pieces were void-ed, and the patient was perfectly cured,and dismissed from the hospital, with clearand healthy urine, and was able to walkseveral miles without the least inconve-nience. He was sounded by Mr. Earlebefore he left, and the bladder was foundfree from stone. To use the patient’s ownwords-" he felt himself twenty yearsyounger than when he came in."Mr. Oldknow also sounded the patient

on his return to Nottingham, and furtherconfirmed his cure.

CASE 5.-Mr. a a gentleman re-siding in Hampshire, of a good constitu-tion, and a renowned inamorato of fox-hunting, had been unable to follow thisactive and favourite exercise for severalmonths, on account of the pain and irri-tation which it occasioned in the bladderand urethra, and the hemorrhage whichwas sometimes produced. Uneasy, andalarmed at the increased severitv of thesesymptoms, Mr. *-** repaired to Londonand consulted Mr. Copeland, who dis-covered a stone in the bladder, and hadthe kindness to recommend the patientto me.The urethra and bladder were in good

condition, and the stone was about tenlines in diameter. Two short applications

of the percuteur, performed in the pre-sence of Mr. Copeland, Mr. Pope, and mypupil Mr. Biggs, sufficed to remove thisstone. The patient returned into Hamp-shire about a fortnight after his arrival inLondon, and resumed his athletic amuse.ments.

Mr. Copeland and Mr. Pope, conjointlywith myself, carefully examined the blad-I der before Mr. ***** left, and ascertainedI that no stone remained.

THE LANCET.

London, Saturday, August 31st, 1833.

SELF-SUPPORTING DISPENSARIES.

UNTIL March last we had not examined

with particular attention the principles onwhich the so-styled 11 self-supporting dis-

pensaries" were established. At that

time, however, we investigated the sub<

ject with strict deliberation and imparti&middot;ality, and it certainly occurred to us thatwe had mastered most of the difficulties

which appeared to beset the inquiry. Theinvestigation was not conducted in the

spirit of partizanship. The interests of

the particular factions were totally disre-garded, and we looked only, as was our

bounden duty, to the effects which we

considered such institutions were calcu-

lated to produce, both with respect to the

public and the profession.Previous to March we had, on one or

two occasions, judging from the scantymaterials then before us, hinted at, rather

than expressed, an opinion, unfavourableto self-supporting dispensaries; but be-lieving that the materials on which our

judgment was then founded were defective,we refrained from speaking in decisivelanguage, lest we should be in error, thus

produce mischief, and, besides, lay our.selves open to a charge both of precipiatancy and inaccuracy.The tendency to interrogation which

characterised our remarks, had the fortu-nate result of eliciting a fund of informa-tion from many intelligent correspondents.

728 SELF-SUPPORTING DISPENSARIES ILLUSTRATED

Thus fortified on the only possible insecureside of our battery, we opened, as we hadthought, not only a successful, but an an-nihilating fire, on these bastard outworksof the temple of " Charity."But it would seem that the attachment

for these unsightly and pestiferous bau-bles is not so easily dissipated. The

proneness of liuman nature to persist inerror is often demonstrated. An acknow-

ledgment of wrong amounts, obviously, toa confession of a certain degree of incom-

petency. Yet the disgrace which an ad-hesion to error involves, is incomparablygreater than that which attends the for-mation and acknowledgment of an erro-neous opinion. At first, we were tauntedwith having spoken with undeserved se-

verity of these dispensaries, although no-

thing could have been more guarded ordispassionate than was the language inwhich our sentiments were published. Onsubsequent occasions we spoke out more

boldly, and our justification of a firm tonewas furnished by the official reports issued

by the conductors of these " charitable "

establishments. If we had condemned with

severity, in general terms, without refer-ence to documentary evidence, we shouldhave acted unjustly to the governors andsubscribers, to our readers, and to the

public. Having propounded the question," What objects do the promoters of theseinstitutions seek to attain?" we soughtfor a legitimate answer in the results pre-sented to our view in the second report ofthe Derby self-supporting dispensary, andother similar papers. In short, we madeit our business to refer to the actual opera-tions of the machine, and not to the

avowed expectations of its manufacturers.WG knew, indeed, that the self-supportingdispensaries were designed to provide the" best medical attendance " for the reallydestitute sick,-" to furnish efficient medi-cal aid and occasional cordials and warm

clothing to the free members of the insti-

tution who were capable of subscribing acertain weekly sum as a partial equivalentfor such advantages." Further, the systemof farming the sick poor was to be brokenup by this new mode of arranging things’and, finally, medical practitioners were tobe secured a just reward for whatever ser.vices they might render to the poor. Suchwere the exhilarating promises,-such thebright expectations, held forth! t But,alas ! how were they realized! Here are

the facts, issued, indeed, not under any

feeling of discomfiture,-not under anyapprehension that the results were lessfortunate than the expectations were fa-vourable and sanguine,-because the Com-mittee of the Derby self-supporter issuedtheir second annual report with " greatself-satisfaction," in consequence of the

institution having experienced such 11 ex-

traordinary success."Well, then, let us again revert to the

circumstances which elicited this feelingof self-satisfaction. There were admitted

during the year, 796 persons belonging tothe free class, that is, the subscribers of a

penny a week, and 638 attached to the

charity class, making a total of fourteenhundred and thirty-four poor patients. Outof this number there were 23 cases of

midwifery. For the cure and relief of the

hundreds of diseases thus presented at the

infirmary,-for the payment of rents,

rates, and taxes,-for the discharge of the

druggists’ bills,-for the salary of the dis-penser and housekeeper, and for the pay.ment of house-keep,-there was sub-

scribed for the free members and ho-

norary governors-how much? Why,252 1Os. 3d.,-payment in salaries to theseven surgeons and honorary and consult-ing physicians having amounted to 7813s. 0d. This was the just remunera-tion for attendance, during one year, on1434 patients, including the accouchementof 23 women ! !

Now if men will have the folly and im-

729BY REFERENCE TO THE DERBY ESTABLISHMENT.

pertinence to contend that such details

exhibit unequivocal proof of the successof these establishments, they are unworthyof aught but the contempt which an expo-sure of their incomparable fool-hardinessis certain of bringing on them.Here in this very report we have an

acknowledgment in the summary of facts,that the dispensary has wholly failed torealize the objects of its designers; yetthe documents put forth by the committeewith a feeling of "great satisfaction," pre-sent one of the most ludicrous falsifications

of high-sounding predictions ever wit

nessed. This, be it remembered, was notone of the institutions in which the work-

ing of the self.-supporting system was

" problematical," the triumph having been

signal and complete. Yet, what rewarddid this extraordinary success bring to

the seven surgeons for their vigilant at-tendance on one thousand four hundred

and thirty-four patients ? Precisely se-

venty-eight pounds thirteen shillings and

a halfpenny ! The physician of the es-tablishment choosing to be called an

"honorary officer," acted without reward,so the surgeons were sufficiently fortunateto divide the great fund of seventy-eightpounds amongst them. Now if this be

sacccess, what is ill success ? For we are

utterly at a loss to conceive a clearer ex-

ample of the complete failure of a veryfoolish scheme.

The resumption of this subject has beenalmost forced upon us, in consequence of

a communication which has been ad-

dressed to the poor-law Commissionersby Dr. CALVERT, the physician of theDerby Self-supporting Dispensary. In

this address the pretensions of these in-stitutions to public favour, are urged onthe attention of the inquirers into the

effects and abuses of the poor-laws. This isnot the place for commenting on the compe-tency or incompetency of the poor-lawCom-missioners ; but we believe they are about

as well acquainted with the poor-laws andtheir consequences, as is Dr. CALVERT

with the success of his self-acting dis-

pensary. How should these commis-

sioners comprehend the subject ?-the ma-

jority of them, never, to our knowledge,having seen the actual state of the poorin their own habitations,-never havingwitnessed the vile atrocities committed

under the select-vestry system, - neverhaving assisted at the making or at thedistribution of a poor-rate,-in short,

knowing little more than that the Bishopof LONDON is at their head, and that theythemselves are briefless barristers, hired

writers, or lecturers (to empty benches)on the odious dogmas of the politicaleconomists. But a truce to the commis-

sioners.

Frequently have we had occasion tonotice that medical " charities" are, in

nine cases out of ten, flagrant jobs. Now

it is somewhat curious to remark on this

occasion, that Dr. CALVERT, who is advertised as the honorary physician of theDerby Self-supporting Dispensary in 1832,was busily engaged at Althorp, Northamp- *

tonshire, in 1831, in addressing letters tothe inhabitants of the parishes in that

neighbourhood, with a view to explain theimmense advantages which would arise

from the institution of the " Self-support-ing Dispensary Associations;" but as theDoctor, at page 5 of his published pam.phlet, declared, " that he was not writing"from interested motives,-that he should" never get one farthing from any dispen-

"sarywhatever," we are bound to believehim, the more readily, of course, becausewe find that he is honorary physician of &pound;

the dispensary at Derby, and thus de-clined to receive an eighth share of theseventy-eight pounds allotted as a just re-ward for attendance, during one year, onfourteen hundred patients in a " particu-larly successful" institution !We again ask, " Have we poor laws in

730 SELF-SUPPORTING DISPENSARIES.

England ? When this question ’is an- " in writing to the committee to be fairswered, as it must be, in the affirmative, " and reasonable." Secondly, " These

we desire to know how it is possible that " patients are to be sent to the Dispen-the self-supporting dispensaries" can, " sary with a ticket from the overseer."on the rules laid down, benefit either the Thirdly, " The dispenser- shall report to

parochial poor or the profession. The des- the overseer when they discontinue

titute sick are entitled by law to medical their attendance at the Dispensary, and

aid; and medical practitioners are entitled are fit to return to work." Fourthly,by law to a just remuneration for what- " They are to attend during illness ex-

ever services they may confer. True, the actly at the times appointed,&mdash;are alwaysfarming of the poor is a nuisance,-an evil to give place to the free and charityof grievous weight. But it owes not its " members, either in the consulting-roomexistence to statutory enactment, but to a " or in the Dispensary." Fifthly, " If

want of an esp1’it du eorys,-to the absence cordials, &c., are required for them, theyof a proper feeling in the profession. As " are to look to their respective overseers;to these " dispensaries," in what re- the dispensary will merely supply them

spect are they calculated to remove so "with drugs and advice." Sixthly," Theyheavy a burden? In not one. On the " will be attended at their own dwellings,contrary, it is acknowledged, in the Derby " if severe illness render it necessary."report, that that portion of the scheme Such are the charitable regulations for

which relates to the parochial medical the members of the pauper class, who are

system had completely failed-a circum- represented to be " dependent on the

stance at which we heartily rejoice; be- labour of others." Here we have evidence

cause we know that it is infinitely better enough of shallowness of mind, and of afor the poor that they should be under the want of a due comprehension of any onecontrol of one respectable medical man, principle of justice. Is it not stipulatedthan that they should be turned over to in the foregoing rules, that the Committee,the honorary committee of a self-sup. with the authority of the surgeons, shall

porting dispensary." A few brief sentences agree with the overseers of parishes towill show the spirit of " charity" and jus- provide or. fair and reasonable terms, me-tice in which this Derby Dispensary, for dicine and attendance for their sick poor?instance, was got up. We find, in the And yet, despite this fair and reasonable

rules for the free class of members, " that remuneration,’ the paupers who are thus" each adult member shall subscribe one entitled by laws to these privileges, are to

" penny weekly, and each child one half- give place, as well in the consulting room

" penny." The members of the charity as elsewhere, both to the charity patientsclass are to be entitled to admission on and to the individuals who subscribe one" presenting a white ticket from thehono- penny weekly. Yet, notwithstanding this" rary subscribers." favour shown to the free members, we

Now observe :-In the rules for the observe, in the report already quoted,pamper class it is stipulated, first, "that that out of the 800 individuals who had" the committee shall have power to con- subscribed as free members, 330 had

" tract with the overseers of parishes for ceased to belong to that class in this

medicine and attendance for paupers, on vastly flourishing and successful institu." such terms, by the year, in respect to tion!

" each pari’sh, as any five or more of the Upon the whole we are inclined to be-

surgeons of the Dispensary shall certify lieve, that. these " self-supporting dispen-

731UNJUST EJECTMENT OF A STUDENT.

saries" may be ranked amongst the fore-most of our modern medical humbugs.In title they are delusive; in operationthey are defective. Inciting as they areto the creation of a new set of harpies tocombine with the select vestries and hired

overseers, in persecuting infirm labour-

ing men who have a right to obtain sub-sistence out of parochial funds, they can-not be too severely reprobated by the well-intentioned portion of the community; and

now that an efficient inquiry into me-dical abuses is about to be instituted

before Parliament, we hope that medical

practitioners who have opportunities ofobserving the mischievous tendency andeffects of these establishments, will em-brace every opportunity of denouncing the " self-supporters before individual

members of the legislature.

ABOUT four years since we had the

disagreeable duty of announcing a ruf-

fianly assault which had been committedby an hospital surgeon and lecturer, in the theatre of one of our schools of medicine.

Guy’s Hospital was the scene of that

disgraceful outrage. Fortunately, the ex-posure had the effect of inducing manymedical students to shun that institution,and to pursue their studies in other esta-

blishments which were regulated by theinfluence of gentlemanly feelings. In

avoiding Guy’s Hospital, medical studentshave proved that they are not insensibleof what is due to their characters and

their station in society. Had the Gover-

nors of Guy’s Hospital discharged theirduty to the public on that occasion, thelecturer who committed the assault would

have been expelled from the establish-

ment ; or, at any rate, would have securedhis office only by an apologetic atonementto the grossly-insulted and injured party.In this instance the Governors of the

hospital pa8sively concurred in a violent

personal attack on a student. But we

have now to advert to an occasion in

which the Governors of a hospital,&mdash;THELONDON,&mdash;have been the active perpetra-tors of an outrageous invasion of personaland professional rights and privileges.The facts are, briefly, these :--At the London Hospital there having

lately been some trifling convivial irregu-larities on the part of two or three of the

pupils, the managing Committee of Go-vernors were supposed to have spoken ofthe entire body of students in disrespect-ful terms. This circumstance happeningto come to the knowledge of the pupils,one of them, as a Governor was a fow

days since passing down the steps, indi-cated his feelings of wounded pride anddisapprobation by slightly hissing. ACommittee was summoned, the young

gentleman was called in, and this interro-gatory put to him from the chair :=‘&deg; Are

"you the gentleman who offered Mr.

" CURRIE, the Governor, an insult. It is" a simple question. Yes, or no ?"-

PUPIL. "Yes, Sir, I am the person, and

"cannot deny it."&mdash;CHAIRMAN. "Very" well, Sir; you may retire."

Very soon afterwards, the pupil wasagain called in, and thus addressed by theChairman :&mdash;" Sir; it is my painful duty11 to inform you’ that the Committee have

" unanimously resolved that you shall no" longer remain a pupil of this establish"" ment."

The gentleman, thus unceremoniouslyand unwarrantably ejected, entered aboutsix months since to the surgical practiceof the hospital for three years, havingpaid for the same the sum of sixty guineas.On that occasion he saw nothing of the

governors, knew nothing of them. The

compact was made between him and the

surgeons. Now, on the occurrence of a

misunderstanding, a third party steps in;he is expelled from the hospital, (nothaving yet expended a sixth part of the

732 CONCOUAS.&mdash;ENCEPHALOUS CHILD.-ACCIDENT.

time for which had entered), is insultedand has his character attacked, and is

minus sixty guineas!That the money must be returned is

certain; but this can scarcely make repa-ration to the injured feelings of this younggentleman and his family. Surely if this

student, without cause, had been malignedby the Governors and the misconduct ofother pupils, his giving indication, byslightly hissing, of his sense of the injury,was a very excusable offence. We are

anxious to learn what course the medical

officers pf the London Hospital will adoptin this emergency, but we confidentlyexpect that they will immediately presenta strong and dotermined remonstrance

against the harsh and precipitate con-

duct of the small Committee of Go-

vernors.

PARISIAN MEDICAL CONCOURS.

The concours for the chair of External

Pathology terminated at six o’clock on

Saturday, 17th inst., in the nomination ofM. GERDY, one of the surgeons of St. Louis.This concours, in which MM. VELPEAU,BLANDIN, and SANSON, of the Hotel

Dieu, particularly distinguished them-

selves, was conducted with the greatestorder, and gave occasion to the exhibitionof talents of the highest rank. It has com-pletely effaced any bad feeling which mayhave been engendered by the corruptand ill-advised proceedings of the medicaljury who appointed M. ROSTAN. The

nomination of M. GERDY is the more

satisfactory to the friends of the concours,as he is a young man totally independentof any party in the Academy of Sciences,or the Faculty, and was supported solelyby a rare combination of knowledge andpower of elocution, which drew down theapplause of all who heard him. The jurywas composed of twelve surgeons, with M.Roux as a president. On the first scru-

tiny, there were for GERDY four votes,for VELPEAU and BLANDIN three each, forSANSON two. It then became a questionwhether MM. VELPEAU or BLANDIN

should compete with GERDY in the se.

cond scrutiny, and the jury being equallydivided on this point, the President gavea casting voice in favour of M. BLANDIN.The contest now lay between the latter

and M. GERDY, who was elected by a ma.I jority of seven to five.

l DEATH OF THE ENCEPHALOUS CHILD.

I Academy of Sciences, Palris, Aug. 12.

M. SERRES announced to-day, by let-ter, the death of the encephalous childwhich we described in a late Number ofTHE LANCET. The autopsy was perform-ed with the greatest care by Dr. Solle,surgeon to the hospital of Chlons, andwe shall take care to make the resultsknown as soon as they are published; in

the meantime we may state, that the cii-

cephalous infant was united to its sister

by two principal arteries,-one (a continu-ation of the internal mammary of the left

side) furnished the two brachial arteries;the other (which came from the neigh-bourhood of the coeliac) gave vessels to thepelvic viscera and lower extremities; butwhat is most extraordinary (if well es-tablished), Dr. Solle says he could find notrace whatever of veins in the organi-zation of the monstrous infant.

ST. BARTHOLOMEW’S HOSPITAL.

DISLOCATION OF THE LEFT KNEE, WITHFRACTURE OF THE RIGHT TIBIA AND

FIBULA AND LEFT SCAPULA.

JOSEPH MAYALL, aged 42, a carpenter,was brought to the Hospital, August 14th.He stated, that in erecting a large brest-summer, twenty feet long by one foot

square, the rope by means of which it waslifted broke, and the beam fell on his back,whilst he was stooping to get a wedge;he was immediately felled to the ground,and at the same instant experienced asevere pain in his left knee and rightleg, both of which he then fancied werecrushed to pieces. He was immediatelyconveyed to the Hospital, when, on

examination, it was discovered that thetibia on the left side was luxated outwards,so that the external articulating surface ofthe femur rested on the internal semilu-

nar cartilage of the joint; whilst the pa-