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15 THE LANCET. LONDON: SATURDAY, JULY 7, 1877. ARMY MEDICAL ORGANISATION. IT is little more than twenty years since the Crimean war, and in the interval the map of Europe has been reconstructed, dynasties have perished, old powers have passed away, and new ones arisen in their place; the science of war has under- gone remarkable development, and the art of war has been revolutionised. And what is the present political outlook ? i A spirit of profound mutual distrust in reality underlies all international professions of amity; it arrests national progress by drying up the sources of wealth and strength, and it saps the foundations of political morality. Europe is a vast standing camp, and the law of self-preservation presses heavily on all Governments alike. England has, of all powers, the greatest need perhaps of self-reliance at the present time. Changes have taken place of late years in our army organisation which promise to be the prelude to a radical remodeling of our whole system. By some these changes are regarded as indications of decadence ; by others they are regarded as the promise of further progress and development. The whole system for the army is now one of localisation, and there are not wanting signs that the attempt will be made to weld the battalions of the regulars with the militia, volunteers, and army reserve in some ter- ritorial scheme which shall prove a substitute for what is alleged to be, in reality, a disjointed regimental system, based on a kind of numerical connexion. The opponents of such a change regard it as antagonistic to all our military traditions, and as destructive of that IJsprit de corps which has been bound up with our regimental system, and stood the test of time and experience. Its advocates, on the other hand, look to the spirit of emulation being widened and developed by identifying the military traditions of a regi- ment with the county in which it has been raised, and the locality where it has been quartered; to the greater sympathy that will exist between the battalion in the field and the militia at home which they hope to see feeding it ; to the increased efficiency and economy which will be developed out of a closer connexion of the line, militia, and reserve, by a military training in common; and, last of all, to the creation of a large reserve force. Be all this as it may as regards the army at large, we do not think that anyone calmly and dispassionately viewing the old system of hospitals as organ- ised at the time of the Crimean war would be bold enough to assert that it was adapted to the exigencies of modern warfare. Under the system that then obtained, or that which imme- diately superseded it, hospitals were organised as regimental or general. The former were equipped for regimental use only, conducted regimentally, and administered internally by non- commissioned officers and privates drawn from the ranks of the corps, and relegated to attend to the requirements of the sick. The’ general hospitals were professionally conducted by staff medical officers, but dependent upon the fighting ranks of the army for their executive and nursing staff. Dovetailed into, but independent of, this dual system of hos- pital organisation, there existed another department-that of the purveyors,-created for the maintenance of hospital economy, and as a check on the medical officers, and entirely beyond their control. The purely medical element., composed of two parts, one half of which was to a certain extent re- moved from the control of its own head, was dependent on the good feeling of the military. Without properly trained sick attendants, with no separate transport or organ- ised ambulance system, the medical officers were ignorant of, or doubtful as to, the proper channels through which to address themselves for their supplies for the sick and wounded, the channels themselves being often indirect and circuitous, and presenting so many impediments in the way of effective administration. To this indirectness of aim was added a weight of moral responsibility relieved by no cor- responding power or authority ; and a medical officer might find himself cumbered with useless medical and surgical stores of which another regimental surgeon or hospital stood in dire need, liable to be checked, counterchecked, and frus- trated ; sometimes overwhelmed with work, sometimes idle, but expectant, while another medical officer was being over- whelmed-such has been the past condition of the medical service in the field. And this powerlessness, except to write and represent, ran like a thread from the Director-General down to the youngest assistant-surgeon. Could anything be more ineffective or unmanageable than such a system-more injurious to the good name of the department, or more unfair to the reputation of the good men in it ? If every regiment had its miniature hospital establishment, with its due proportion of transport, the obstruction to the advance or retreat of men and guns in a campaign would be such as to compromise the safety of a division. Instead of thus frittering away the medical strength of an army, it has been found absolutely necessary to concentrate the hospital staff and establish- ments on certain points to which the wounded can be removed, and afterwards systematically transferred to the rear. There should be an intelligible working connexion and inter-communication extending from the first line to the base hospitals and to the floating hospitals. Other things being equal, the army that can march the furthest and quickest, with the lightest and smallest amount of field equipment, must win; and, as military success is everything in warfare, a medical service, to be effective, must be based upon clear and practical working principles; it should be self-contained and self-governed ; responsibility and power should balance one another; every medical officer should know his place, and be in it, and know how to proceed, where and to whom to apply, and not left to seek information or make arrangements when he is called upon to act with promptitude and judgment, which can only spring out of confidence and assurance in the integrity and effective working of the arrangements that have been already made. The principle on which the medical organisation for an army on active service must evidently be based is the sepa- ration of the sick and wounded from the active force in front, and their transfer to the rear until they are able to return to duty, be invalided, or otherwise disposed of. The disabled soldier has in this way the best chance of recovery, and the different corps are not hampered by ineffectives.
Transcript
Page 1: THE LANCET

15

THE LANCET.

LONDON: SATURDAY, JULY 7, 1877.

ARMY MEDICAL ORGANISATION.

IT is little more than twenty years since the Crimean war,and in the interval the map of Europe has been reconstructed,dynasties have perished, old powers have passed away, andnew ones arisen in their place; the science of war has under-gone remarkable development, and the art of war has beenrevolutionised. And what is the present political outlook ? iA spirit of profound mutual distrust in reality underlies all

international professions of amity; it arrests national

progress by drying up the sources of wealth and strength,and it saps the foundations of political morality. Europe isa vast standing camp, and the law of self-preservationpresses heavily on all Governments alike. England has, ofall powers, the greatest need perhaps of self-reliance at the

present time. Changes have taken place of late years in ourarmy organisation which promise to be the prelude to aradical remodeling of our whole system. By some these

changes are regarded as indications of decadence ; by othersthey are regarded as the promise of further progress and

development. The whole system for the army is now one of

localisation, and there are not wanting signs that the

attempt will be made to weld the battalions of the regularswith the militia, volunteers, and army reserve in some ter-ritorial scheme which shall prove a substitute for what is

alleged to be, in reality, a disjointed regimental system,based on a kind of numerical connexion. The opponents ofsuch a change regard it as antagonistic to all our militarytraditions, and as destructive of that IJsprit de corps which hasbeen bound up with our regimental system, and stood thetest of time and experience. Its advocates, on the other

hand, look to the spirit of emulation being widened anddeveloped by identifying the military traditions of a regi-ment with the county in which it has been raised, and the

locality where it has been quartered; to the greater sympathythat will exist between the battalion in the field and the

militia at home which they hope to see feeding it ; to theincreased efficiency and economy which will be developed outof a closer connexion of the line, militia, and reserve, by amilitary training in common; and, last of all, to the creationof a large reserve force. Be all this as it may as regardsthe army at large, we do not think that anyone calmly anddispassionately viewing the old system of hospitals as organ-ised at the time of the Crimean war would be bold enough toassert that it was adapted to the exigencies of modern warfare.Under the system that then obtained, or that which imme-

diately superseded it, hospitals were organised as regimentalor general. The former were equipped for regimental use only,conducted regimentally, and administered internally by non-commissioned officers and privates drawn from the ranks ofthe corps, and relegated to attend to the requirements of thesick. The’ general hospitals were professionally conductedby staff medical officers, but dependent upon the fightingranks of the army for their executive and nursing staff.

Dovetailed into, but independent of, this dual system of hos-pital organisation, there existed another department-thatof the purveyors,-created for the maintenance of hospitaleconomy, and as a check on the medical officers, and entirelybeyond their control. The purely medical element., composedof two parts, one half of which was to a certain extent re-moved from the control of its own head, was dependenton the good feeling of the military. Without properlytrained sick attendants, with no separate transport or organ-ised ambulance system, the medical officers were ignorant of,or doubtful as to, the proper channels through which toaddress themselves for their supplies for the sick and

wounded, the channels themselves being often indirect andcircuitous, and presenting so many impediments in the wayof effective administration. To this indirectness of aim was

added a weight of moral responsibility relieved by no cor-responding power or authority ; and a medical officer mightfind himself cumbered with useless medical and surgicalstores of which another regimental surgeon or hospital stoodin dire need, liable to be checked, counterchecked, and frus-

trated ; sometimes overwhelmed with work, sometimes idle,but expectant, while another medical officer was being over-whelmed-such has been the past condition of the medicalservice in the field. And this powerlessness, except to writeand represent, ran like a thread from the Director-Generaldown to the youngest assistant-surgeon. Could anything bemore ineffective or unmanageable than such a system-moreinjurious to the good name of the department, or more unfair tothe reputation of the good men in it ? If every regiment hadits miniature hospital establishment, with its due proportionof transport, the obstruction to the advance or retreat of menand guns in a campaign would be such as to compromise thesafety of a division. Instead of thus frittering away themedical strength of an army, it has been found absolutelynecessary to concentrate the hospital staff and establish-

ments on certain points to which the wounded can be

removed, and afterwards systematically transferred to therear. There should be an intelligible working connexionand inter-communication extending from the first line to thebase hospitals and to the floating hospitals. Other things

being equal, the army that can march the furthest andquickest, with the lightest and smallest amount of field

equipment, must win; and, as military success is everythingin warfare, a medical service, to be effective, must be based

upon clear and practical working principles; it should be

self-contained and self-governed ; responsibility and powershould balance one another; every medical officer should

know his place, and be in it, and know how to proceed, whereand to whom to apply, and not left to seek information ormake arrangements when he is called upon to act with

promptitude and judgment, which can only spring out ofconfidence and assurance in the integrity and effective

working of the arrangements that have been already made.The principle on which the medical organisation for an

army on active service must evidently be based is the sepa-ration of the sick and wounded from the active force in

front, and their transfer to the rear until they are able toreturn to duty, be invalided, or otherwise disposed of. The

disabled soldier has in this way the best chance of recovery,and the different corps are not hampered by ineffectives.

Page 2: THE LANCET

16 ARMY MEDICAL ORGANISATION.

In the tables showing the personnel, camp equipment, andtransport required by the medical department for an army"corps, that have been just issued with the War Office

Circulars, the method devised to effect these objects is

clearly indicated, and, as will be seen, is essentially basedupon the German system practised in the Franco-Germanwar. The personnel and equipments for a bearer column,consisting of four bearer companies, are detailed. There

will be one company with each division, and one, dividedinto two sections, between the Cavalry Brigade and theCorps of Artillery and Engineers. The equipment formountain warfare is, moreover, laid down for a bearer

company. These bearer companies, with the medical

officers attached to corps, would form the first line of

assistance in the field. With each company there are two

lines of ambulance waggons, the first consisting of ten

waggons moving in connexion with each bearer company;the second line of waggons, numbering twenty-three, willbe in the rear, ready to replace or supplement those infront. Each company will have 110 trained sick-bearers,exclusive of non-commissioned officers. There are two

-surgical waggens with material for dressings and surgicalapparatus, and instruments for performing such primaryoperations or resections as may be absolutely necessarybefore sending the wounded to the movable field hospitals.These hospitals constitute the second line of medical

assistance, and they form an integral portion of each armycorps. <Each’ hospital accommodates 200 sick, and they arespecially equipped with two pharmacy waggons, containingmedical and surgical equipment, and four field hospitalstore waggons, with clothing, cooking, and ward utensils.Like the bearer companies attached to divisions, each

movable field hospital is divisible into two, each half beingcomplete as regards personnel and mat6riel. Of these twelve

field hospitals, six are told off (two to each division), andsix are for a reserve at the disposal of the Army MedicalDepartment, the responsible officer of which will advise thegeneral commanding as to the position they are to occupyThe six field hospitals attached to divisions will have their

transport, so as to move at a moment’s notice; but only threeof the reserve will have transport, as it is not likely that a

greater number will be moved in any one day.The third line of medical assistance would be the thirteen

stationary field hospitals, and these, we presume, would besituated either along lines of communication or at the base.They do not appear to have any special transport, but avail-- able waggons would no doubt be employed to convey thenecessary medical equipment to suitable positions, advantagebeing taken of existing buildings for shelter.With regard to hospital tents, these would comprise the

portable shelter provided for the movable field hospitals.The pattern laid down is the double circular, without liningThe hospital marquees, however excellent they may other.wise be, have the great disadvantage of being bulky, un.wieldy, and not easy to pitch or strike on emergencies. The

advantages of the double circular tents are that they arEmore easily carried, and capable of being pitched on suit.able ground in shorter time and in number correspond ng t(the immediate requirements. The walls of these tents arE

higher than those of the ordinary bell tent. Each tent wil

accommodate four patients. Hospital marquees would ofcourse be available for base hospitals.Although no mention is made of medical officers for regi-

ments, it may be safely assumed that there would be one foreach corps; and here, en passant, we may state that therewill be two men per company of every battalion trained as

bearers, and placed at the disposal of medical officers, andavailable for the removal of wounded to the dressing stations.With the staff of the bearer companies, and twelve field

hospitals for the immediate reception of sick, the regimentalmedical work would be reduced to a minimum, and the chief

duty of a surgeon doing duty with a corps would be to renderfirst aid in all cases of emergency, and attend generally toits sanitation.

As the main object of this organisation is, apparently, tomake the medical service responsible for all the medical

arrangements in the field and for the care of the sick andwounded, it must be intended to invest medical officers withthe requisite authority also, otherwise all the foregoingarrangements will be of little avail.Such is, then, as far as we can understand, an outline of

the organisation for field medical service, and it seems to usa vast improvement on what it was; but-and this is

obviously an important reservation-it presupposes for itsproper working the presence of a large force of doctors and

, army hospital corps men, together with an abundant supply, of well-arranged equipment of various kinds. It is as to

! these details, and not as to the care and judgment dis-

, played in developing a scheme on paper, that the publicL naturally feel anxious, but on these points no information. has been vouchsafed. Still Sir WILLIAM MUIR is to be

L congratulated on having succeeded so far in making unifica-tion a reality and something more than a name.

L THE opinion that the suppression of the functions of theL skin produces on man profoundly deleterious effects is as

old as the time of GALEN, and is a belief almost universallyheld. It has of late years received remarkable countenance

r from the experiments upon animals in which the covering ofa large part of the skin with an impermeable coating of

L varnish is followed by systemic disturbances ending almost

invariably in death. It has been assumed that we are

1 justified in applying the conclusions thus obtained to man,3 by certain effects whick are known sometimes to follow the. destruction of a large part of the skin by a burn, and by the- well-known instance of the unintentional experiment per-3 formed on an Italian boy, by gilding him to play a part in3 some theatrical performances, with the result of causing

his death in a few hours. These facts have seemed to

e lend colour to the influence on the functions of the

. skin which sudden chills, according to popular pathology,

. have been supposed to produce, and by which they are- believed to cause their deleterious effect. But a considera-- tion of what we know of the functions of the skin renders it

e difficult to understand the mechanism by which suppressione of these functions, such as an impermeable coating produces,,- can cause so grave consequences. The perspiration is now

o known to consist almost entirely of water, and there is

e reason to believe that no product escapes with it which could

II not be easily removed by another channel; and the chain of

Page 3: THE LANCET

17THE SUPPRESSION OF THE FUNCTIONS OF THE SKIN.

reasoning that the simple suppression of the cutaneous

functions in man is followed by consequences analogous tothose which result in animals, presents the grave defect thatit is unsupported by any careful and purposed observations.The investigations of SENATOR, however, furnish us withsome very important and unexpected information, and ifnot numerous enough to be absolutely conclusive, they areof a most significant and suggestive character. Some of

them were made four years ago, and other more recent

observations are described in the current number of

ViRcHow’s Archiv.

The experiments were suggested both by a desire to

ascertain how far the results obtained on animals were

applicable to man, and further by a consideration of certainfacts which show that the functions of the skin can be inter-

fered with to a considerable degree, without prejudicial re-sults. SENATOR points out that inunction of the skin, andthe application of plasters to large portions, are constantlyadopted without any ill-effects referable to the interferencewith its function, and occasionally no special result can betraced from an extensive burn, comparable to that which

would result from the varnishing of a corresponding area ofthe skin of an animal. Frequently the whole skin is so

changed by disease-psoriasis, ichthyosis, &c.-that its func-

tion must be gravely interfered with, and yet no ill resultfollows.

In his experiments on pyrexia SENATOR varnished areasof the body, and noted the relation between the area

covered and the body-weight, and the effect on the tempe-rature. He made his observations especially on personswith an abnormally high temperature, in the hope of

finding a therapeutical indication for the practice. The

skin was rendered impermeable by sticking-plaster, thickointment, flexile collodion, and a solution of gutta-percha inchloroform. Finding that no prejudicial effects resulted

from varnishing a moderate area of the skin, he becamebolder, and covered the abdomen or thorax and back in

addition to one extremity. He concluded that no ill-effects

could be attributed to the rendering impermeable an areaof the skin equivalut to one half the body area, which cer-tainly could not have been thus treated in animals withoutproducing grave symptoms. On two grounds, however, thevalidity of these conclusions is open to objection. In the

first place, these observations were made on patientssuffering from fever, especially typhoid fever, and it is notcertain that the same results would be obtained with

healthy men. In the second place, the knowledge that theeffect of an application to the skin is marked in inverse

proportion to the size of the animal suggests the idea thatin man the area of the skin covered may not, after all, have

been sufficient to produce those effects which occur when asimilar proportional area, in a smaller animal is coated. For

these reasons SENATOR has made three other observations.

AU the varnishes used upon animals cannot be employed inthe case of man, for obvious reasons, so the extremities of

three apyrexial individuals were well covered with adhesiveplaster, and the backs with flexile collodion. Where, throughmovement, the plaster might be loosened, it was additionallysecured by collodi, ,no Such a covering would certainlycause the death of an animal if maintained for several days.

Collodion, however, has not been commonly employed isvarnishing warm-blooded animals, and therefore SENATORmade some special experiments, and found that it was

equally effective upon them as the varnish commonlyem-ployed. A third observation was made by coating the skinwith tar, which he ascertained caused in the animal the

same effect as varnish. The results of these experiments onman, compared with those upon animals, were entirelynegative. None of the striking consequences, manifested byanimals where only one half of the surface of the.body hasbeen covered with varnish, were to be detected in man.There was no sign of the depression of temperature,muscular weakness, dyspnoea, spasm, paralysis, albuminuria,diarrhosa, serous effusion, which animals manifest. In one

case there was some nausea and vomiting, but it subsidedbefore the removal of the application. In one case there

was a slight irritation of the bladder, but this was attributedto the absorption of the turpentine from the plaster. One

case presented an increase in the quantity of urine. In the

case in which the surface was smeared with tar there was a.

slight indication of the absorption of carbolic acid; and a

very slight fall in the temperature in one case SENATORascribes to the exposure of the body and the evaporation efthe ether employed in the varnishing. The conclusionwhich he draws is that suppression of the functions of theskin has not the same effect on man as on animals.

To this conclusion, however, the case of the 11 gilded boyseems, at first sight, to be opposed. SENATOR pointsout that the opposition is rather apparent than real.for it cannot be admitted that the death of the lad re"

sulted from the same mechanism as that which causes the

death of varnished animals, since the boy died the same

night, and animals always live for several days, even whenmanifesting the greatest susceptibility to the procedure. He

suggests that the details of the case render it far more pr8-bable that the boy’s death resulted from the absorption ofsome poison emp’oyed in the gilding, and that the comparison.with the varnished animals is misleading.

Dr. SENATOR’S facts and conclusions are doubtless of

great importance and value, but they leave certain ele-

ments of the problem undetermined, which further ob-

servation only can solve. It is probable that varnishedanimals die, not only from a toxic influence of the un-

excreted sweat, an influence which some experiments of

R&Ouml;HRIG substantiate, but from the rapid loss of heat con-

sequent on dilatation of surface vessels, and the rapid con-duction of heat fr m them by the varnished skin. This is

an element in the effect from which man is free, since the

patients experimented on were covered with bedclothes orwearing apparel, and the loss of heat from this cause wouldbe prevented. But this does not account for all the dis-

crepancy between the effects on animals and on man, since

prevention of loss of heat does not always prevent the dele-terious effects upon animals of the varnish, and there must

be, as SENATOR suggests, an essential difference between therelation of the two organisms to the functions of the skin.

&mdash;&mdash;&mdash;&mdash;&mdash;&mdash;&mdash;&mdash;&mdash;&mdash;&mdash;

THE recent discussion on the amendments to the

Prisons Bill afforded several honourable members an

opportunity of making reckless statements in reference to

Page 4: THE LANCET

18 THE MEDICAL DEPARTMENT OF THE CONVICT SERVICE.

the medical treatment of the "unhappy nobleman," andother criminals confined in our convict establishments.

These charges have been so often investigated and disprovedthat we had thought the mind of the public was quite atrest on the subject.

Dr. KENEALY, however, and his supporters claim privilegesfor convicts which would, if granted, convert a prison into akind of paradise. They ignore the fact that the vast

majority of those who occupy our gaols and prisons arecriminals, and not the comparatively harmless class of mis-

guided patriots who occasionally find their way into theseestablishments. For such persons nothing but the strictestdiscipline can be of any avail, and the abolition of the moresevere methods of punishment and restraint for offences

against prison discipline would quickly lead to results

fraught with danger, not only to officials, but to the prisonersthemselves.

But it is with another aspect of the subject that we arechiefly concerned. The medical officers of the convict prisonshave duties to perform which are not only most arduous andanomalous, but demand the exercise of the highest skill, andat the same time involve the greatest responsibility. Theyhave to decide for what kind of labour each prisoner is

physically fit, and to what punishment he may safely be

subjected for acts of violence, or other breaches of prisonrules. They are responsible for the general health con-ditions of the various convict establishments, and theyattend all the officers in the service, as well as their wivesand families. In addition, they examine and report on thefitness or unfitness of all candidates for admission into the

service. This involves repeated and careful physical ex-aminations, and represents a large amount of useful work.That it is efficiently done may be seen by a glance at the

published Reports of the Directors of Convict Prisons, whichshow the large numbers of sick who are treated, and thelow rate of mortality amongst those undergoing penalservitude.

The medical officers of these prisons have to deal with

malingering of every shape and form. The art, in fact, is

practised amongst convicts with a refinement that bafflesdescription, and seems attainable only by cunning thievesand lazy wretches, who prefer preying on society to earningan honest livelihood, and who for the most part occupy our

prisons. All this adds considerably to the difficulties of

their work, and if errors of diagnosis are made occasionally,they are generally in the prisoneis’ favour. Medical

officers are held responsible for their treatment not only byGovernment, whose servants they are, but also by the

public at larg, and even by the friends of the prisoner orby the prisoner himself, who may proceed against them atthe expiration of his sentence. Thus they have triple re-sponsibilities, and, from the fact of their having to decidein all cases of complaints of overwork and in all questionsof fitness for punishment, they are, in addition, speciallyliable to assault. Several have suffered serious injuries inthis way. The emoluments they receive in return are I

ridiculously inadequate, and by no means commensuratewith the work done.

As it is at present constituted, the Medical Department ofthe Convict Service is not calculated to attract to its ranks

the class of men who should be secured for such importantpublic services. Mr. CROSS has lately said that they receive,for the most part, 11 considerable salaries"; but let us comparethem with those of other officers of the same service who

hold corresponding rank. Assistant-surgeons, on enteringthe service, rank with deputy-governors and assistant-

chaplains. They receive salaries varying from .B150 to .S200per annum, rising =85 each year, till ten years have elapsed,or till they get promotion to the post of medical officer. Oh

attaining this rank they receive salaries varying from .8300to ,8350 per annum, rising .810 each year till five years haveelapsed, when they attain their maximum. Hence it happensthat medical officers of five years’ standing find all hopes ofpromotion at an end. They are constantly, therefore, onthe look-out for more lucrative appointments, and in thisway much experience that is specially valuable in the medicalmanagement of criminals is lost to the service. Deputy-governors, who always enter the service in this capacity,begin on salaries ranging from .8300 to .8350 per annum-infact, on a par with medical officers-who have been alreadylong in the service. Their duties do not require specialskill, being such as are frequently done by a chief warder.They are generally young men, and the examination theyhave to pass is of a trivial character. They look forward to

being promoted to governorships, with salaries of from =8500to X700 a year, and moreover they have prospects,however remote, of attaining the position of directors.

Assistant-chaplains begin on .B200 to t250 per annum,

with an annual increase of .B5, and, on promotion to

the post of chaplain, they receive salaries which are

mostly higher than those of the medical officers, and riseto a higher maximum. It will thus be seen, we think, that

the medical staff have just grounds for dissatisfaction. Theyhave not only less pay and worse prospects than other

superior officers of their own rank, but many of them receiveeven less recompense than such subordinate officers as clerks

of works at the various prisons. The present scale of payfor the senior medical officers was, we understand, fixed at atime when these posts were given to retired military andnaval doctors, and was, under that system, sufficient. How-

ever, medical men who now enter the service young, if theyare to be efficient and to remain in it, must be offered more

advantages, and must have some more lucrative appoint-ments to look forward to after years of hard work. At

Woking Prison, which is entirely set apart for invalids, thereis at present the somewhat strange anomaly of a governorwith a salary of t200 a year more, and a deputy governorwith a salary not much less, than that of the senior medicalofficer, though the duties of the former at an establishmentof this kind must be very light in comparison with those ofthe medical department. This seems to us a great incon-

sistency. The convict invalid establishments require ex-perienced supervision, and special medical skill, such asshould be found in the senior medical officers. They would,we think, afford a suitable field for the bestowal of some

higher emoluments, which might have the effect of securingthe best and most competent men, and retaining them in theservice. The remedies we would suggest, therefore, are thatthe more responsible posts should have better pay attachedto them, so as to give the senior men prospects of promotion;

Page 5: THE LANCET

19REPORT OF THE PRESIDENT OF THE COLLEGE OF SURGEONS.

that the salaries of the medical officers should increase at a

definite rate on the completion of each four or five yearsafter they have attained their present maximum, and thatthe entire scale of pay for assistant-surgeons be somewhatincreased.

IN the early part of the year 1875 the Council of the RoyalCollege of Surgeons of England, having come to a knowledgeof the sense of their accountability to their constituents,passed a resolution to the effect that a report on the affairsof the College should be drawn up annually by eachPresident immediately before the expiration of his term ofoffice, with a view to its being published for the informationof the Fellows and Members. In compliance with thisresolution, Mr. LE GROS CLARK drew up the first report,which was approved, not only on account of the conspicuousaccuracy and care with which it had been compiled, but alsofor the freshness and liberality of many of its sentiments.

Expressing the satisfaction which he felt in preparing thereport, Mr. LE GROS CLARK generously remarked that

"freedom of intercourse between the governing body andthe constituents and membets of a corporate institution isthe best security for that mutual confidence which is

essential to its well-being." He further proposed that thereports should not only contain an account of the conditionof the various departments of the College, but should alsoinclude a record of the conclusions at which the Council had

arrived in their deliberations on all questions of importance.The lines thus broadly marked out were pretty closelyfollowed by Sir JAMES PAGET in his comprehensive reportlast year. Not only were the chief events of the year

narrated, and an explanation offered of the various functionsof the Council, but the important relations of the College tosome of the larger questions of medical interest, such as theconjoint examination scheme, the admission of women tothe medical profession, and the practice of vivisection, werecarefully considered. Compared with its two predecessors,the report which has just been issued stands unfavour-

ably. Even when judged by itself it is extremely dis-

appointing, and altogether devoid of interest or originality.Mr. PRESCOTT HEWETT has not even taken the trouble to

reconstruct some of Sir JAMES PAGET’s sentences. With

the exception of a change of name, many of the sentencesare exactly the same as those of the preceding report.Poor beyond measure is the style of the report, and

meagre are its statements. A curt, formal narration of facts

already well known cannot possibly serve for the " inf orma-tion" of the Fellows or Members. As an instance of

the careless manner in which the last report has beenthrown together, we may refer to the notice of the recentattempt to alter the regulations relating to the Fellowship.We are merely told that "the legal requirements with

respect to the proposed new regulations for the Fellowshipnot having been as yet completed, the Council cannot atpresent give effect to them." Not a word is said as to the

propriety of these proposed alterations, and no reference madeto the annoyance and grievance which their adoption wouldentail. Three lines and a half are devoted to a discussion

of the Conjoint Scheme, and the question of the admission ofwomen occupies less than one half of a widely-printed page.

There are, however, not only faults of omission, but

subjects are discussed which are confessedly still sub judice.The reports were instituted to inform Fellows and Membersof the decisions of the Council on important matters, andyet nearly one- eighth part of this report is taken up with

the recommendations of the Committee on the Dental

Licence, which have not yet been brought before theCouncil.

To prevent the possibility of the publication of anotherreport like this, the Fellows must persist in their demandto have more opportunities afforded them of knowing exactlywhat their representatives in the Council say and do on the

questions which affect not only the welfare of the College,but also the interests of the profession generally. Either

the Fellows should insist on being admitted to the meetingsof the Council, or they should see that a copy of the Minutesof the meetings of the Council is suspended in the hall ofthe College, as is done at the Royal College of Physicians.

Annotations.

GERMS AND SPONTANEOUS GENERATION.

" Ne quid nimis."

DR. BASTIAN has been taken to task by Dr. Tyndall inThe Times, because he ventured to compliment the Pro-fessor for the honourable manner in which the latter hadcorrected his experiments. Dr. Tyndall repudiates the

compliment, and says that he has retracted no mistakes-of course, in regard to the germ question. We should besorry if this statement were exact, for we believe that Dr.Tyndall, as well as his opponents, has made mistakes, and,in the interests of truth, it is good that such mistakes shouldbe acknowledged. Dr. Tyndall assumes an infallibility towhich anyone working in science should not lay claim. Itis impossible for germ theorists and their opponents toavoid some errors in their attempt to solve the truth or notof their theories, and this Dr. Tyndall should not failto remember. The Professor, in his letter to The Times,charges Dr. Bastian with quoting Schwann and otherworkers in support of doctrines which they have publiclyrepudiated. But is this a crime ? An opponent of thegerm theory has a perfect right to quote from Dr. Tyndallhimself in favour of spontaneous generation, so long as hedoes not make false statements ; and the very fact that thegerm theorists have despised what their adversaries haveadvanced, and have refused to investigate their results,has weakened their position. It is, as Sir Thomas Watsonhas urged, of vast importance that the public should beinstructed aright on this subject, and with this end in viewwe have, on various occasions, stated our opinion freely asto the manner in which the public are being instructed.Are not passionate letters, sarcastically-turned sentences,and direct personalities to be deprecated, no matter whencethey come ? Outsiders get tired of this sort of thing,especially when the question seems to require a simple

answer-yes or no. Scientific men injure science when they; charge their opponents at random in an influential dailypaper with want of veracity, and, in plain language, with

a deliberate attempt to deceive the public. Dr. Tyndall is

l a lucky mortal if the satire which he writes of his opponent

L cannot be repeated against himself, as to being in a position

l to lay " claim to the spontaneous generation in his ownbrain of errors regarding the views of other people;" nor,

. we would venture to say, does the fact that the Royal


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