487

THE LANCET.

LONDON: SATURDAY, NOVEMBER 19, 1853.

NEGLECT OF A KNOWLEDGE OF INSANITY.

A CAREFUL observer of the aspects of our profession, and a

good judge of its weak and strong points, recently enlargedupon the importance of Teaching, as the great means of pro-fessional progress. The College of Physicians was instanced asone example of the unfortunate results of the practical separa-tion of a great public body from the offices of teaching. Other

examples might have been given of the deleterious effect of

the same isolation upon particular branches of practice. In

no other speciality is this so obvious and remarkable as in thepractice of lunacy or psychological medicine. No other depart-ment has been so completely segregated from teaching and stu-dents, and no other department has so obstinately lagged behindin this unexampled age of medical progress. The revelations

of Bethlehem last year came on the profession and the publicat large as a surprise. The parade of such scandalous practicesas those which had been rife in our greatest metropolitancharity for the insane was felt by medical men as a stab to thehonour of the entire profession. The result was, that the

insane were defended, and the profession flagellated, by threeor four acts of parliament in the last legislative session. Poeti-

cally speaking, the fetter had been loosed from the insane ageneration ago, and no one dreamt that in London, in the

second half of the nineteenth century, the spectacle wouldbe presented of the inmates of a public hospital, tortured, andmaltreated or well-treated, entirely at the caprice of keepersand nurses. To none did the surprise prove more startling thanto medical men, though these things were not done in a corner,but apparently under the eyes of the profession. The truth is,however, that in its almost entire seclusion from teaching andpublic medicine, the great hospital for the insane, standingwithin a mile from the palace of Westminster, was, and is, ’,nearly as much out of professional view as though it had beenerected in Kamskatka or Nova Zembla.

But Bethlehem has been reformed; parliament has enactednew stringencies; the public has spoken its word, and thoughtits thought, against our profession ; and medical men, after

feeling an unpleasant sting, have passed on to other matters ofmore pressing interest or occupation. Those conversant with thesubject of insanity, know, however, that abuses existed in otherplaces besides Bethlehem; that St. Luke’s required reform notless than the Royal hospital; that probably we shall anon bestartled from our propriety by other exposures; and that nogates of triple brass, in the shape of lunacy bills, can defend ourpresent lunacy arrangements from grave and serious abuses. Nolaw but the law of teaching, no rule save the rule of habitualpublicity, can ever guard the lunatic from outrage, or preservethe repute and ensure the progress of the psychologicaldepartment of medicine. The student would prove the truest

friend of the insane, the lecturer on insanity the best lawgiverin all that relates to lunacy. The improvement of the medicaltreatment of insanity may be urged on from without, but itcan only be brought about effectually by changes within theprofession. We shall contribute to this end in no mean

degree if, we can bring the profession to assent to the proposi-

tion we have now made respecting insanity, and which maybe enforced by numberless arguments. It is certain that we

cannot look for any radical improvements from those engagedin the treatment of insanity upon the old methods.Look at the present system, and look at its results. Let us

judge of the tree by its fruit. We live in a time of unparalleledprofessional activity. Every other speciality besides insanitycan boast of rapid progress. Yet with one or two excep-

tions, all the physicians of our great public charities for theinsane have entirely neglected their opportunities, and thepathology of cerebral disease is, for all that the modern Londonschool has done to further its advancement, almost whollystationary. With the praiseworthy exception of the lecturesof Dr. CONOLLY, and the labours of the Editors of the Psycholo-gical lo2ctntal, the chief current literature of insanity is positivelyonly to be found in Acts of Parliament for the correction of thosemedical men who practise in this department ! Journalism

offers one of the conditions of publicity and psychologicalimprovement, but the authors of the above journal have hadto complain that with scarcely any exception, those who holdwhat is called the lead in lunacy practice, have held alooffrom the support of a praiseworthy undertaking.Let us pass more deeply to the core of this system. The provi.

sions for the public reception of lunatics are extensive, howeverfaulty in other respects. We have in London the Royal Hos-

pital of Bethlehem, St. Luke’s Hospital, an insane ward intheMarylebone Infirmary, and the splendid asylums at Hanwelland Colney-hatch. The insane inmates of the public asylumsand hospitals in the metropolis amount to nearly four thousandsouls. Yet in all these institutions, and among all these patients,the voice of teaching has hitherto not been heard, except occa-sionally at Hanwell; and now that Dr. CONOLLY has left theHa.nwell Asyliim, we look in vain for any physician likely tooccupy an equivalent position in psychology. All this vast field

of cerebral pathology remains utterly uncultivated. As yet, theprovisions for the attendance of students at Bethlehem are un-proved, and there is no great promise about them. Our corporatebodies make no provision whatever for the instruction of studentsin the pathology and treatment of insanity. This is the case at

least with the Colleges of Physicians and Surgeons and the

Apothecaries’ Society. The University of London does, it istrue, enforce a very complete examination in mental philosophy,but, strange to say, this is unaccompanied by any regulationwhatever for the attendance upon the practice of hospitals forthe insane, or lectures on psychological medicine. The onlyinducements to this special study which exist are those heldout by our public services, as those of the Army and EastIndia Company. Our sailors and soldiers have in this respect an

advantage over the general public. The consequence is, that asthere are no students of insanity, there are no teachers, andmedical men engaged in the practice of insanity devote their

energies, or rather lower their faculties, to a form of lodging-house keeping, instead of rising to the scientific cultivation of

psychology.We have here hit one of the main blots of the present

system. Public hospitals without teaching are little better

than penitentiaries or model prisons. These institutions are

in much the same state as were our general hospitals somefifty years ago, when the teaching within their walls was merelynominal. The head of a private asylum, when the lunacy prac-titioner is the proprietor, and stands to the patient not only in

488 NEGLECT OF A KNOWLEDGE OF INSANITY.

the relation of physician, but as the purveyor of his meat and cavities of the chest, abdomen, and pelvis, are abundantlydrink, lodging and washing, are, in one sense, nothing more cared for, but the cranium, the most important of all, receivesthan huge lodging-houses for lunatics. Whatever arguments little attention, except in the matter of gross material injuries,of convenience or custom may be used, it must be confessed and its least momentous diseases. The brain and its pathologythat it is most derogatory to the respectability of professional are, to a great extent, withdrawn from the province of themen, that they should be concerned in such housekeeping general physician on the one hand, and neglected by the spe-details, and that, too, as a personal question of profit and loss cialists on the other. Insanity, the direst disease of the mostrelating to their patients and themselves. What should we noble organ of the body-of that brain which is the seat ofthink of surgeons or physicians who not merely operated intellect and reason-is almost entirely ignored in the grandly-and prescribed, but lodged and boarded their patients en mass, endowed hospitals of St. Bartholomew’s, St. Thomas’s, andand avowedly looked to the profits of such a speculation for a Guy’s, whose revenues equal those of small kingdoms; andlarge slice of income? This evil custom weighs, we are not less so by the modern charities which depend upon volun-convinced, as an incubus upon psychological medicine, and tary contributions. It is a disgrace to our profession that suchthe sooner it is abolished the better. It renders the special should be the case. Without doubt the separation of insane

practice of lunacy discreditable, or at least suspicious in the patients from general medicine, dates from, and originated in a

eyes of the public. It removes the question of success in the period when insanity could not well be treated in a generaltreatment of insanity from that of intellect and capacity to one hospital. When insanity was held to be synonymous with de-of-mere house-keeping. No student need care to devote himself moniacal possession, it escaped from the domain of the phy-to the study of this special subject, because unless he possess sician. The stripes and manacles of former times, and the

capital, he cannot hope to set up a lunatic lodging-house, and howlings of the tortured maniac, could not well remain undertherefore he cannot hope to succeed in this speciality. The the same roof with ordinary patients. But now the matter is

genius of PINEL or ESQUIROL could not, according to our very different, and there can be no reason why every hospitalpresent arrangements, succeed in London without a private in London should not have a ward for the reception of recentasylum. Qualifications far removed from mere fitness are by cases of insanity. Of the benefit of such a reform to poorthe present system absolutely necessary to success. A psycho- suffering insane persons, and of the ultimate advantage bylogical physician may buy the good-will of an asylum and the the stimulus it would give to cerebral pathology and thecare of its inmates, just as a tradesman may buy the good-will treatment of cretial disease, there can be no doubt. There

of an hotel. The proprietor of an asylum filled with chronic could be no more useful benefaction to the human race as far as

cases of lunacy amassed in a long course of practice, dies and medicine is concerned, than for some rich persons to endowleaves it to his son, just as he would make him his successor in wards for the insane in some of our general hospitals. Such

a farm or a brewery. It cannot be gainsaid that such a state an event would be the beginning of a vast reform in all thatof things, looked at rigidly, is far more demoralizing to the relates to the study and the improvement of cerebral diseasesprofession and to those concerned in this branch of practice, and their treatment. Insanity would be properly treated; itthan any amount of polypharmacy or medical shopkeeping would become a subject of constant clinical instruction, studentswould be. would devote themselves to the subject, and a new race of psy-

Both in the metropolis and in the provinces, certain families chological practitioners, and an improved cerebral pathologyhave fastened upon lunacy, and it must be confessed with would arise.

advantage to themselves rather than to the interest of cerebral We may illustrate these remarks by a very forcible example.pathology. Given certain names, and we know that by here- A few weeks ago a poor creature, suddenly affected with in-

ditary succession, their wearers can be nothing else but mad- sanity, was sent to London by a careless and unfeeling master,doctors. This preservation of the race of lunacy physicians, without a proper attendant. The patient found his way tolike the castes of ancient Egypt, is an impediment to progress, the Middlesex Hospital, but here there was no proper meansand is opposed to excellence in the department in which it of treatment, and he was subsequently sent to Hanwell,prevails. It is a kind of professional breeding in-and-in, which where he died. At the inquest held upon his body, it wasis no more wholesome in a moral, than it is found to be in a proved that his death had been probably caused by the in-

physical point of view. Nothing is more rare than for any par- juries he had done himself from having been improperlyticular talent to run through three or four successive generations. treated while he was confined in London. Can a more graveIn the law, where competition is more open and severe than reflection upon our present system be wanted than this?

it possibly can be in particular provinces of medicine, we hear In any one of our twelve general hospitals any other diseaseof no legal families, except indeed amongst the abuses of of the brain, except insanity, would have been admitted; butDoctors’ Commons. The tendency to the formation of family in insanity, the most terrible of all the diseases of the cere-parties, and the lodging-house system, in psychological medi- brum, a patient meets, not relief, but mortal injury!cine, render this branch of practice an object of suspicion to If our examining bodies would render some attendance uponthe public. Every trial relating to lunacy affords evidence that lunacy practice compulsory upon all students, we should thenthe friends of lunatics suspect their medical attendants, far have efficient teaching in hospitals for the insane, or an insanebeyond the common suspicions of self-interest which attach, in ward in every general hospital, and the stimulus of teachingsome degree, to nearly all professional men, not only in Medi- would soon move this sluggish department of pathology on-cine, but in the Law and the Church. ward. If, on the other hand, the legislature could be brought

It is scarcely less than monstrous that the magnificent general to forbid, as illegal, the keeping of asylums by medical men,hospitals of London should contain no provisions whatever for students might then aspire to success as practitioners in thisthe proper treatment of insanity. The diseases of the great department as well as in any other. Intellect would become

489THE SCANDALOUS PROCEEDINGS OF THE ADVERTISING QUACKS.

the best professional capital, instead of money. As the case at

present stands, the practice of lunacy is little better than amonopoly. There are no facilities for the study of insanity,no stimuli to its advancement; and for those who turn tothis speciality, capital, or hereditary succession, or a fancy forlodging-house keeping, and not the true capabilities-scienceand education-is the first condition of success.

.

QuACKERY flourishes right heartily in the United Kingdom,and its votaries discover in it a productive and congenial soil. ’,,Every description of gross imposture, every phase of impudent !fraud, every concoction of flimsy deception, so long as it is ’,put forward with unabashed audacity and unflinching assur-

’’

ance-so long as it is backed with sufficient impertinence,and enunciated with a due amount of sauciness and courage,is sure, at the present day, to find ready converts and

zealous partisans. Indeed, persons of acknowledged sense,experience, and talent every moment become the dupes oftheories, and disciples of creeds, which, on the most superficialinspection, obviously appear as erroneous in conception as

they are fatal in results; and though unmistakable proofs areagain and again constantly furnished of the puerile trickeriesand shallow cheats that can be habitually palmed off upon thepublic, still people in every class of life become just as heedlessand inconsiderate, and remain just as much unconvinced as if

reason were a phrase and common sense a byword. Thus it

is that impostors thrive, and that quackism and humbug areso prevalent and successful.But it is truly lamentable in the present age, when medicine

is spreading her beneficial sway, and more and more basingthe treatment and cure of disease, guided by a sound, rational,and enlightened pathology, upon simple and practical, yetascertained and well-established rules, and more and more

advancing her claims and successfully asserting the justice ofher pretensions not only to be designated, but to rank as ascience in the strictest, truest acceptation of the term; whenevery fresh discovery that arouses and excites public attentionhas for its first object the benefit of mankind; when monstrousabuses are being crushed and swept away, and rotten corpora-tions and corrupt institutions, however powerful, or rich, or

time-honoured, are made the subjects of strict scrutiny and

vigilant and impartial investigation; when oblivious and

decrepit functionaries are, as a class, no longer permitted toretain public appointments of importance and responsibilityafter their energies are inadequate to discharge in an efficient

manner the duties of their positions, — it is deplorable thatin such an epoch the basest impostures and most unprin-cipled extortionism should be allowed to pass current in

society, instead of promptly receiving deserved and richlymerited chastisement-especially when it is recollected that

the sole motives of the quacks, and knaves, and harpies towhom we refer, live upon the public by trading upon theirfears and imposing upon their credulity, and by these meansassuming a knowledge of the treatment and cure of diseasewhich can only be possessed by the educated and experiencedpractitioners of orthodox medicine.

It is indeed true that a great many other absurdities, besidesquackeries, are very much in vogue, and equally worthy ofreprehension and reproof; but we assert that no system, theory,or creed, however ridiculous and irrational it may be, can

work such universal and unmitigated harm, and be fraughtwith such irretrievable and appalling mischief as attends as anecessary sequence upon the operations of ignorant persons,whenever they attempt to tamper with the lives and health of

our fellow-creatures.Mere follies and inconsistencies excite a smile; tran-

scendental nonsense arouses derision, and esoteric solemnitiesprovoke a sneer. Dreamy Utopias and millenniary creeds,and princely Agapemones, may be objects of just criticismand most severe condemnation : but all these, ridiculous

and foolish—nay, insane as they are and really appearto reflecting and practical persons -are still comparativelyharmless proceedings, and only impose upon the silly foolswho acquire notoriety, and subject themselves to appropriateand merited detraction, because they choose to believe in

systems exquisitely ridiculous, and pin their faith upon notionsof the most unquestionable absurdity.But when follies are carried on that are by no means inno-

cuous ; when knavish humbug of the worst description is

designedly put forward to entrap the unwary and entice thethoughtless; when insolent assertions and filthy lies nnd in-serbion in respectable newspapers, and base harpies openlyattempt to gull the public by guaranteeing to czt2-c complaintsof the nature of which they are utterly ignorant, and the namesof which they can scarcely spell,-and this, too, by methodsthe most unprincipled, and schemes the most objectionable;- then, indeed, it is high time to put every body thoroughlyon his guard, and prevent persons from ruining their healthby placing faith in the false pretences, or wasting their sub-stance in credence of the gross falsehoods that are daily, nayhourly, published by these infamous and nefarious impostors.

Certainly quack advertisements assume all shapes and guises.One proffers a Cure for Cancel’,* and attracts the attention ofthe public by announcing, in eulogistic terms, that it is the"greatest discovery of the age;" and it certainly would be ifthe announcement were correct. Another describes in glowinglanguage the efficacious and beneficent properties of " Sarsa-parilla," or the panaceatic influence of "Vegetable Pills;"demonstrating in the most satisfactory and frank manner howone of those specifics will infallibly cure every ill to which thehuman frame is liable. Or a startling questionis pertinently putto us, requiring that we should decide at once whether or notCons2t?nption,;s cMt’ttMe. And if we reply in the negative, theadvertisement assures us that we are the most bigoted, self-willed of men, and beyond all doubt the victims of one of themost astounding fallacies of the age; or if we determine in theaffirmative, we are then informed that though we are perfectlycorrect in our decision, and though it is very true that con-

sumption is curable, and that without difficulty, still this mostdesirable consummation of things cannot be brought to passunless we purchase the sixpenny pamphlet which is offered

for our mature and deliberate consideration. Or perhaps thecareless reader is roused from his apathy by a sketch of thefearful warfare that is continually going on between Deathversus L-ife;" but after reading a line or two, he discovers,to his intense relief, that though the first-named combatantalways wins the battle, still the lucky individuals who willinvest their sixpences in the advertiser’s " little work" willattain longevities worthy of METHUSELAH. And then, wearywith all this-adding, as it were, abhorrence to disgust-we

* Vide a paragraph at page 495.

490 THE SCANDALOUS PROCEEDINGS OF THE ADVERTISING QUACKS.

read in the very newspaper that we are about to place in thehands of a wife or child, one of those filthy, indecent, andscandalous notices that, alas! disgrace too many of our con-temporaries. We refer to a " bit of advice" from a quack ofthe manly vigmll’ stamp, who shocks all correct feeling by hislewd statements and detestable presumption.

Indeed, advertising quacks are a very curse to this country.Without education, without principle, without the liabilitiesof any stringent law or direct legal punishment to keep themin check, these scoundrels continue to pursue their horrible

career, and day after day are employed in publishing state-ments of the most audacious character, that are only notludicrous because they are credited. Knaves generally havesome " method in their madness," but the quacks have none,save the single principle of robbing the public. Actuated bythis motive, they change their plans every now and then,advocating, as it suits their purpose, the most opposite doc-trines, and asseverating their belief in the least reconcileableviews. It is all one to them, so long as they drive a successfultraffic.

It is almost invidious to draw any distinction of better or

worse between the crowd of rascally impostors that infest themetropolis and all large cities; but assuredly, if such a divisionwere made,-if the actual mischiefs of their relative proceedingswere nicely balanced, - it would be evident that the syphi-litic quacks do the greatest wrong, and inflict the greatestmisery upon mankind. Cruelly trading upon the fears of thetimid, heartlessly luring the young and thoughtless, panderingto the excesses, and, if possible, augmenting the riotous lustof abject sensualists, these venereal p1’ofe8S01’S at all times gaincommand over the fears, and thus shield themselves from thereproaches, of the weak persons they dupe and ensnare. Uponno disease is there such mystery and contradiction and mis-

representation,-upon none such bashfulness, hesitation, and Iequivocation, as when persons, having contracted this disease,profess to describe their symptoms. An otherwise honest man

of integrity and repute will, after he has contracted some

venereal taint, become disingenuous and equivocal in his

representations, and endeavour to mislead at every turn.

There is such a horror in some persons relative to any disorder

of their sexual organs, and patients are generally so utterlyignorant of any knowledge upon the subject, that they easilybecome the prey of harpies and nostrum-mongers. Timid and

hesitating, if they should be so silly as to go to an advertisingquack, however disgusted and appalled they may be by hisscandalous conduct and filthy grossness, still, through reluct-ance and a false sense of shame, they hesitate to quit the

,impostor and consult a qualified practitioner. And so theycontinue in their attendance for months, of course gettingworse and worse; for the quacks do not permit the disease totake its proper course, though that would be bad enough, butaggravate it with their nostrums and feed it with their

nostrums. Thus when the poor dupe has been for a long timeunder treatment, when his health and constitution are irre-

trievably ruined, and his means thoroughly expended, thesecharlatans turn from being fawning sycophants, and all at oncebecome exacting masters, and as the scales drop from the eyesof the victim he discovers the infamous manner in which he has

been duped and plundered. But he discovers this when it is toolate, and when medicines can as little restore him to health, asthey can give him quietude and peace of mind. Sad is it to reflect

that such an instance as this is no exceptionable one, but thatof the thousand passers-by whom we may meet in the greatthoroughfares of the metropolis, scores of persons have beengulled and ruined by these abominable impostors. Sad is it

to contemplate youth blighted, manhood wasted, old age madewretched !

But this class of imposture has nearly reached its climax; arewe to allow it to continue? Is it to grow still more enormous?

Is it to attain a still more colossal height ? Are there no

means which can be taken to stop this crying evil?Now, in considering the injury that the infamous tribe of

quacks to whom we have alluded continually inflict upon thepublic, and the scandal which the publication of their filthyadvertisements casts upon newspapers, it must at once appeal-evident to every body, that if the editors of daily or weeklyperiodicals would resolutely and impartially refuse to publishthe abominable indecencies of these outrageous knaves, the

greater part of the evil would immediately be remedied. The

quacks would be thus deprived of half their notoriety andshorn of all their laurels. It is true they might still circulatetheir horrible handbills-touters might still throw them downareas, or thrust them into the unconscious hands of passengers,but there can be no question but that the greater part of thisnuisance would be diminished and abated. There exists in the

metropolis a Society for the Suppression of Vice,-why-and weonly throw it out as a suggestion-does it neglect to punishthe ignorant impostors for the gross indecency of their handbills,just as it chastises the rascally traders of Holywell or WychStreet for exposing in their windows lewd publications?-forprobably the quacks work the greatest harm of the two.Our powerful and respected contemporary The TÙnes, our

witty and clever friend Punch, the Mancheste1’ Guardian, and

perhaps another or two might be mentioned, adopt, andhave long adopted, the line of proceeding we suggest-viz.,that of refusing in the most absolute manner to publish anynotice or advertisement from any quack that contains in it theslightest approach to indecent or indelicate expressions; butthe great mass of editors will not follow the admirable andexcellent example set them by these papers, and for the sakeof what they conceive to be their own interests, consent dayafter day to disgrace and pollute their columns with noticesand advertisements that must shock every just mind by theirterrible immoralities, as much as they pain by their glaringand appalling falsehood.

It is neither our habit nor our custom to cavil at contem-

poraries, and seek to subject them to public odium andreproach; but as the long-acknowledged leading journal of theweekly medical press of the universe, we cannot permit themonstrous evil to which we have directed attention to continue

day by day to increase in bulk and enormity-cherished, aided,and abetted by advertisements in newspapers-without pro-testing, in severe and emphatic terms, against that portion ofthe English Press which, for the sake of an infamous gain,knowingly and willingly aid in perpetuating an abuse thatreflects upon society an extent of evil which language cannotadequately describe.

.. --

THE large measure of success which has already attended thegreat undertaking originated by Mr. PROPERT is an encouragingfact which should stimulate all to increased and continuous

exertion until the project be carried out to completion. The

491THE MEDICAL BENEVOLENT COLLEGE.

Medical Benevolent College is calculated to supply the most

pressing want of the profession. There has been no time when

hearty co-operation and assistance could effect more good thanat present. The first stone was laid under the most promisingauspices, in June last. In order to proceed vigorously withthe building operations, large sums will of course be necessary.If these large sums be abstracted from the permanent funds ofthe Institution, it is obvious that formidable obstacles to theworking of this noble scheme will arise just at the momentwhen it ought to be in full and beneficent operation. It is

therefore a point of vital importance to obtain at once largeadditions to the building fund, as well as to the list of sub-

scribers, so as not to trench upon the future income of the

College. In the first place, the prosperity of this Institutionmust obviously be chiefly dependent upon the hearty sym-pathy and liberal contributions of the medical profession, forwhose immediate benefit it is intended. But it is equallycertain that it has, in the second place, irresistible claims uponthe public at large. We have but recently called attention

prominently to the position which the public occupy in regardto the medical profession in times of pestilence. But of all

the independent, and professional, and mercantile classes,there are none who are brought into such immediate contactwith the sick and the dying. There are none who are called

upon to encounter such great personal risks, such incessantfatigue, such terrible responsibilities. There are none other

who are summoned to undertake public duties at their incli-vidual cos. The medical man who devotes his time and

his skill in the -public service risks all he possesses. And he

labours for the most part without fee or reward. If he fall in

this ungrateful service, what’is the lot of those whose existenceis wrapped up in his own? At the aspect of desolation

hanging over his family, would he not be well-nigh justifiedin withholding his gratuitous and perilous labour? But no!

generous self-devotion will ever be the noble characteristic

of medicine. Of all the professions in the world, experienceshows it to be the one which it is the least possible to pursue

I

in a selfish spirit. It is this fact which throws upon the

public the sacred and inalienable duty of contributing largelyto such an institution as the Medical Benevolent College.The clergy have to a great extent recognised this claim, and

many distinguished members of that body have followed theexample of the Rev. Mr. MACKENZIE in urging those claimsupon the public. It is with sincere gratification we learnthat the Rev. Mr. HARRISON is to preach a sermon in aid ofthe Medical Benevolent College, at St. Michael’s Church in

Chester-square. It is important that the profession shouldevince the deep interest they take in the Institution by attend-ing in large numbers upon this occasion. It would not be

reasonable to expect that those who have already contributedaccording to their means should then repeat their donations,but their presence would lend weight to the cause, and be ofessential service. We observe that a new List of Subscribersis to be advertised early in December; and we trust that itwill embrace the name of every member of the profession whohas not already contributed to the funds of this great under-taking.

QUEEN’S COLLEGE, BIRMINGHAM.—The council haveselected for the Warneford prize the following subject: " TheAnatomy and Physiology of the Organs of Hearing."

"

Correspondence.

DR. GAVIN’S REPLY TO THE CHARGES MADE BYMR. GIBSON.

" Audi alteram partem."

To the Editor of THE LANCET.SiR,—I should not have condescended to notice the libellous

communication of an individual, in a late number of your journal,in reference to the Board of Health and its officers, and inwhich it is attempted coarsely to drag forward my name, didI not think it desirable that the profession generally shouldknow some facts in relation to the late epidemic in Newcastle,which have been ignorantly (I would in charity hope) pervertedand improperly put before it by the individual in question.

Ist.-Misapprehensions as to the powers and duties of theGeneral Board of Health prevailed to a considerable extenteven among the best informed members of the profession inNewcastle on my arrival, and it was some time before theybecame, and many may not even be now, aware of the mistakeinto which they had fallen.The General Board of Health are only empowered, under

the Diseases Prevention Act, to take steps in relation to theprevention, &c. of epidemic diseases upon an order of the PrivyCouncil. This order was not issued till the evening of the 16thof September.The expediency of leaving till an epidemic t7ti,eateils, or is

actually in, a country, the institution of preventive measures,was determined upon by Parliament in 1849, when you, Sir,were in the House. The measure, it is true, was prepared tomeet the then threatened epidemic of cholera, and was forth-with applied; but at the end of eighteen months its operationwas suspended in consequence of the Privy Council not issuinganew order for its continuance. Its re-application to meet theexigencies of the occasion did not take place, as just stated, tillthe 16th of September.The Board of Heath and all sanitary reformers have con-

stantly represented (and none more frequently than myself,whether in the columns of the Journal of Public Health whenI edited it, or at the many sanitary associations with which Ihave been connected) that in order to successfully contendagainst an epidemic disease, it is essential that preventivemeasures should be undertaken and applied antecedent to theirruption of the epidemic, and, consequently, that the powerstemporarily conferred upon the Board of Health by the orderof the Privy Council, should aluxtys be in operation as a pro-

: gressive means of improvement and defence.Their representations hitherto have not been sanctioned bythe Government, or by the legislature. Possibly such self-evi-dent propositions may have more force in the ensuing sessionof Parliament. So much for neglect of representations.2nd.-The importance can scarcely be denied of furnishing a

uniform formula for the dispensing of medicines at depots anddispensaries during the prevalence of epidemic cholera. Other-wise a person suffering from diarrhoea may, on successive ap-plications, receive incompatible remedies. For example, atone depot he may receive chalk mixture and opium ; at another,acetate of lead and opium; at a third, sulphuric acid and sul-phate of iron.

Moreover, the medical attendant will, in such cases, knowthe nature and amount of the medicines taken by his patient.To prevent such occurrences as those referred to, it was

suggested to the ordinary medical officers of the NewcastleUnion, that they should agree upon some common formula,applicable for ordinary cases of choleraic disease in its premoni-tory stages, for the medicines to be dispensed at the depots.The medical officers of the Union, Messrs. Sang, M’Nay,

Winship, and Newton, and Mr. Rayne, surgeon to the TrinityHouse, agreed, at special meetings, upon the propriety of thisrecommendation, and adopted it. ’

The formulae employed by many of the house-to-housevisitors in London, in 1849, employed by many of those thenacting in Newcastle, and employed at the depôts when choleraraged in the Bahamas this and last year, were mentioned andapproved of by the gentlemen whose names have been justmentioned.

I may mention that the medical officers of Dundee andArbroath have recognised the expediency of the proposition ofcommon formulae, and have adopted those in question.The copy of the formulae in the communication of your cor-

respondent, taken from a newspaper, is evidently incorrect. I

append copies for your own satisfaction,with the printed instruc-tions which accompanied the distribution of the medicines.