35

THE LANCET.

SATURDAY, JANUARY 8,BEING

No. 2OF THAT JOURNAL FOR THE YEAR 1859.

THE ROYAL SOUTH HANTS INFIRMARY.

THE attention of our readers who are medical officers of Poor-

law Unions is earnestly directed to an important notificationrecently issued by the Poor-law Board, which will be found at

p. 40. In order to prevent their disqualification to continue tohold office, it will be seen that it is necessary they should be

registered on or before the 2nd day of February next; and werecommend them to lose no time in applying to the Registrarunder the Act for that purpose.

As far as our space would allow, we pointed out, on a recent Ioccasion, a few of the very remarkable features in the con- ’stitution and administration of the Royal South Hants In-

firmary at Southampton. Quoting the laws, we showed thatthe very first condition under which public duties should beperformed-namely, under public observation, is violated in

the most singular manner. First, the medical officers are per-mitted to receive the out-patients at their own residences orprivate surgeries; thus are the out-patients withdrawn frompublic observation. Secondly, in the case of the in-patients,

As far as our space would allow, we pointed out, on a recentoccasion, a few of the very remarkable features in the con-stitution and administration of the Royal South Hants In-

firmary at Southampton. Quoting the laws, we showed thatthe very first condition under which public duties should beperformed-namely, under public observation, is violated in

the most singular manner. First, the medical officers are per-mitted to receive the out-patients at their own residences orprivate surgeries; thus are the out-patients withdrawn frompublic observation. Secondly, in the case of the in-patients,no medical practitioner is allowed to go into the wards, and noperson, professional or not, can witness an operation withoutthe permission of the medical officers. Thus, virtually, is thewhole practice of a so-called public charity conducted in secret,and made a strict monopoly in the hands of the staff. But if

we proceed in our analysis of the laws, we shall soon find thatthe principle of excluding the public is further carried out bythe adoption of every contrivance that the most narrow jea-lousy could conceive. We have already seen that members ofone family fill the incompatible offices of physician, surgeon,honorary secretary, general superintendent, and member of

the committee. A tolerably snug arrangement ! 1 But this is

not all. The monopoly might at any moment be broken upby the intrusion of a man of independent spirit upon the staff.This danger is met by the laws regulating the election of me-dical officers as follows:-First, no person shall be eligible forthe office of physician or surgeon " until after three years’residence in the town !" Now, in what way three years’ re-sidence in Southampton can confer a special medical or surgicalqualification it must be left to the committee to explain. To

the uninitiated in the Infirmary-government it might appearthat active practice or studies in London, or other large towmenjoying open hospitals, would be a better preparation thanresidence in Southampton, where the hospital is closed againstthe visits of practitioners. This rule cannot, therefore, be de-

signed to secure greater efficiency in the staff. We must concludethat there is some other motive. And since it is perfectly legitimate, in the case of public bodies, to canvass the motives o:

their public acts, we hold ourselves at liberty to conjecture,that the motive, in this instance, is to enable the ruling powers

of the Infirmary to form an opinion as to the moral and socialqualifications of candidates. They look with suspicion uponmere strangers. They fear lest inconvenience should arise

were they to follow the liberal policy of other hospitals,of inviting candidates from all quarters, relying upon the usualevidences of fitness, moral and professional, which respectablemen can mostly command. They wish, we are reduced

to infer, to obtain by this three years’ respiration of the South-ampton air, the opportunity of selecting men who shall notbe too independent-who shall, in short, be agreeable colleagues.

: But even with this extraordinary limitation of candidates, the

wrong man might have many friends, and in a contested

election might defeat the house-candidate. How is this diffi-

3ulty to be provided against ? There is no scheme so favour.

able to jobbery and nepotism as the plurality of votes.

Accordingly we find it is a law of the Infirmary, that the

right of voting shall be in proportion to the amount of dona-tions and subscriptions; each subscriber being entitled to onevote for every guinea annual subscription, up to eight votes.Now, as none but ladies can vote by proxy, and no governoris allowed to hold more than one of these proxies, the electionby this comfortable arrangement is virtually decided by a few

gentlemen under the influence of the committee, twelve of

whom might muster about one hundred votes. In a populationlike that of Southampton, it is not probable that there are manyindividuals-especially under the present dynasty of the Infir-mary-who would care to give more than an annual guinea;whilst the county subscribers are not likely to attend in num-bers. Not only may the committee thus enjoy a plurality ofvotes, but the physicians and surgeons themselves may enjoythe same privilege. By a law framed for their especial benefit,the physicians and surgeons are entitled to two votes apiece,as donors of ten guineas; and are further entitled to a vote for

every guinea they may subscribe, up to eight votes. Thus a

staff of five may have forty votes. Add to these the influence

of half a dozen clergymen who vote on the strength of collec-tions given by their congregations, and committee-men, andthere is at once a compact array of force which may bid defi-ance to the town and county. Under these conditions, what

independent man can enter the field with a hope of successagainst a nominee of the staff ?What the inhabitants of Southampton would do well to con.

sider is this: whether an hospital conducted on such exclusiveprinciples is to be regarded as a public institution, representingthe benevolence and liberality of the town and county-aninstitution which they can point to with pride, in which theycan take the smallest interest; or whether it be not more pro-per to regard it as one of those quasi-public establishmentstrading under false pretences for the exclusive benefit of a fewindividuals ?

We are disposed to conclude that the people of Southamptonview the affair in the latter light. Their enterprise and intel-

ligence are visibly stamped upon the locality. The rise, pro-gress, and material prosperity of Southampton are objects of

general admiration. Why is its hospital so poor, so meanlysupported? If it were an institution enjoying the sympathyof the inhabitants-if it attracted the good-will of those who,have done so much in honour of Southampton in other matters,

there can be no doubt that it would long ago have been raised

to a conspicuous place amongst the public monuments of thetown

36

SCIENCE IN COURTS OF LAW.

But have the inhabitants done right to their poorer neigh-bours, or justice to themselves, in tacitly abandoning the hos-pital to the uncontrolled government of a section ? If theyreflect upon the matter, we are sure they will see occasion forself-reproach. It only needs a little vigorous action on thepart of the men of business and independence of Southamptonto form such a body of governors as might in a short timereform the most intolerant and stupid laws of the Infirmary,infuse new blood into the committee and staff, and raise theinstitution to a proud position amongst the great charities

that reflect such peculiar honour upon the national characterof Englishmen.

AT the first meeting of the Association for the Advancementof Social Science, held at Birmingham, Mr. ANGUS SMITHbrought before the meeting the subject of " Science in Courtsof Law !" He has again called the attention of the more think-

ing and truth-loving portion of the community to it by an ablecommunication in the Atlaenceurrc of Dec. llth. Mr. SMITH I,touches upon a topic of great importance, and one crying forimmediate reform. It is a subject, moreover, peculiarly in-teresting to the profession of Medicine, as it is far more fre-

quently in relation to our own department, or that the scien-tific witness has been educated as one of ourselves, that wesee science represented in the legal arena. What can be more

melancholy for us to be conscious of than that science has nota fair standing in Courts of Law ?-that the man who hashitherto appeared before us as a scientific herald of the laws ofNature, an exponent of her wondrous manifestations, and who is

accepted almost without demur because clad in the vestmentsof veracity, shall be either induced or forced to show that hisinterest, on any occasion, was not in absolute truth, but in

gaining a cause in which he was merely a partizan. Induced

by vanity, the love of sophistry, or the love of gain, to strainall his ingenuity and his intellect to prove that some specialfact (as the one before the Court, for example), comes undersome particular and exceptional law of Nature, and thusfavour the interest of the " side he is upon;" knowing all thewhile that he is obliged to bend both fact and law thus to meet- each other, which in the peaceful quiet of his study he neverwould have dreamt of doing; or forced, it may be, by snbjec-tion to the cross-examination of some adverse barrister, to showthat he has been dealing with truth but partially, lest the wholeshould rather cover than make clear the point he is aiming at.

That such exhibitions frequently occur no one can deny.Not a year passes scarcely but we see men of high scientificacquirements pitted against each other, like to, and just as it Isuits, the pleading barristers, whose business it so often is, not ’,to establish truth as truth, but simply to pull down that ad-vocated by their opponents. Scientific men should be wit-

i

messes, and not advocates, and are justified in disputation onlywhen there really is a difficulty in arriving at veracity. Such

men, too, as Mr. SMITH well observes, like other witnesses, aresworn to speak the truth, the whole truth, and nothing but thetruth. The mere legal advocate knows but what suits his pur-pose, and alone employs it; and thus constantly is the truthexposed but partially. But the man of science degrades him-self and his calling when he trifles thus with the whole truth.As Mr. SMITH pointedly observes, " the legal licence of bar-‘ risters, and the social dignity of a well-earned judgeship, can’’give no right to nvf*rm1f the words and- in them the

"opinions, of scientific men." To make scientific men re.

spected, they must not afford opportunity to be regarded ascapable of witnessing to aught but absolute truth, and as quiteincapable of taking part, as a matter of course, with that clientwho pays first or who pays best. Six law advocates may,

according to legal and conventional licence, argue on one daywith much eloquence for a truth, and six other advocates mayargue against it. The next day the six may change sides,argue conversely, utterly forswear themselves. And this will

be considered a mere formality. But the man of science mustbe above bringing the truths of science into court thus to bedealt with; and yet, if we speak plainly, we must confess thatscience has no standing in a court of law except as an advocatein the form of a witness, and this witness the court will notbelieve until attempts have been made to confuse him throughcross-examination, in order that he may be seduced into makinga mistake !

" If he should blunder in expression, and raise a laughagainst himself, the great law falls to the ground. The bar-rister by his art has put Nature to shame. A glorious positionfor a barrister ! I can imagine a wretched street-boy puttingmajesty itself to shame for an instant, but not to the honour ofthe imp."

In some few cases, worthy of all remembrance, the barristerhimself shrinks from the privilege usually granted him of

alternately arguing for opposing facts. He is too honest for

chicanery and dissimulation. For instance, Lord BROUGHAMhad to explain to the House why he did not follow up a certaincase: he observed-" I was retained as counsel on the opposite side. This was

the reason why I proceeded no further in the business of thepetition. The delicacy of my situation forbade it. I felt my-self bound, right or wrong, to discharge my duty as a counsel;and to advocate the interests of one party before the PrivyCouncil one day, and the interests of the rival party in theHouse upon the next: how was it possible for me to do it ?"

To obtain a purer representation of science in courts of law,Mr. SMITH proposes, 1st, that a kind of scientific tribunal shouldbe formed, to prepare the necessary questions coming before

inquiry, and for judgment; the tribunal to be formed by eachparty appointing a scientific adviser, and the court doing thesame, in order to overrule any unjust arrangements. 2nd. That

the opinions on the scientific points shall be given in writing.This would set aside, in great measure at least, the verbal

equivocations and undignified truth-extraction which sometimesmake our courts so amusing, to the disgrace both of law andscience. Scientific men, too, as Mr. SMITH observes, accus-

tomed to weigh well their words quietly at home, are not alwaysable to express themselves with equal deliberative accuracyvivu voce, in the bustle of a court. 3rd. That acknowledgedscientific facts, and the opinions of individuals, shall be stateddistinctly under these heads. This defines where the point ofdisputation shall begin, and will help to remove much of thatconfusion so often thrown upon a subject by its partizans andadvocates. Lastly: if the opinions proceeding from the scien-tific tribunal require explanation, the judge, or one who is

neither advocate nor partizan, shall elicit it before the cross-

questioning of the bar commences. This latter propositionclaims for science an independent position in the court, or oneat least not under the barrister, and one which must be re-

spected by the judge.But not only is Science shorn of her beams under the influ-

37

MEDICAL ANNOTATIONS.

ence of the great luminary, Law: she is " not yet fully recog-" nised as a power in the State, as well as a great social re-11 former." If we believed in science, in absolute truth, as we

ought, we would not grudge, says the correspondent of theAtlaenceum, the support of fifty men-of-war for its promotion,and the world would soon bless us for our help. Mr. SMITH

states that he has already spoken to scientific men and lawyersupon the needed reformation, and that they all agree thereis much evil in the present practice. He believes also that if

the question be taken up by lawyers, they will probably bebest able to sift it, and to find out a method which will bestsuit the peculiar capacities of themselves and those who are

engaged in science. This proposal, of leaving the settlementof the matter, or its method, in the hands of the bar, is en-

tirely opposed to our views on the subject.

THE trial of WOLLASTON v. GEORGE FRANKLIN, publishedat p. 43, is one which deserves to be recorded, as it " points amoral," from which the profession may derive great benefit.So long as petty jealousy and local rivalry stimulate men to doinjustice to their brotherhood, so long will the public withhold from them that respect to which an opposite line of conductwould entitle them. The Legislature, by the enactment ofwell-considered and beneficent laws, may do much to improveour position, but until we are true to ourselves, true to theethics of our noble profession, we must always remain inferiorto the other professions in the eyes of the public.We unhesitatingly affirm, that the medical evidence given in

the above case for the defence is highly derogatory to us, and

is a discreditable attempt to deprive an honourable and ablesurgeon of the fees to which he was most justly entitled.Surely in such a case it was the bounden duty of a professionalman to protect the just rights of his brother practitioner. Couldanything be more unseemly than an array of medical witnessesin a County Court attempting to upset the claim of a qualifiedsurgeon to what was indeed a most inadequate remunerationfor his services ? It made us blush when we read the report ofthis trial, the results of which might have been very differenthad not the judge, with a shrewdness and consideration whichdo him much credit, seen through the unwarrantable evidencegiven by Mr. KENNARD and his friends.The attempt to ruin Mr. W OLLASTON has recoiled with re-

tributive justice on those who had the meanness and temerityto attempt to inflict a serious injury upon him. We declare

that there was not the slightest possible ground on which thedefence could rest, and it would have been a gross injustice toMr. WOLLASTON if he had been deprived of a single farthing ofhis bill.

Mr. KENNARD’s " modesty is only a flambeau to his merit."He places his opinion on a question of surgery against that ofone of the most experienced and able professors of surgery inthis metropolis. Modest, indeed ! It is to be hoped that thishis last appearance as an amateur witness in " gross cases"of malpractice will teach him a little more discretion, and, ifpossible, a little more forbearance.

If the transaction to which these remarks have reference were

a solitary instance of the injury inflicted by an attempt uponthe part of medical witnesses to injure a brother practitioner,it might pass sub silentio, but we regret to say that this is not

the case. Such instances are unfortunately too common. If

gentlemen are desirous of distinguishing themselves as com-mentators on, and denouncers of, the practice of others, letthem exert their energies in a more legitimate and honourablemanner. Are there no ignorant bone-setters and prescribingdruggists in Berkshire, whose practices afford to Mr. KENNARDand his friends an opportunity of exercising their professionalknowledge and ingenuity ? If not, Berkshire indeed is happy inthe absence of such quacks and impostors. If the real object ofMessrs. KENNARD and Co. be to elevate the character of the

profession to which they belong, they must adopt a totallydifferent line of policy from the one pursued in this instance.We say to them, seek not to foul your own nest; dependupon it, if you do, your estimation in the eyes of the publicwill be lowered. They will now be condemned by all right-thinking and honourable men, and their condemnation, as ex-pressed in the words of the able judge on the recent trial, willbe echoed through the length and breadth of the land.

SCARCELY any disease is more insidious or more fatal than

diphtheria. It calls for immediate and energetic treatment;yet even under the most skilful hands is often incurable.

When neglected or mistaken, it is indeed a fearful malady.We protest, therefore, in the name of the public and the pro-fession, against the system which at present obtains of vauntingin the public papers of "remedies" and "specifics" for dan-gerous diseases. There is no " specific ;" and " remedies" arevalueless except when they are administered with judgment-a judgment which can be possessed only by the medical prac-titioner. Really it is time to put a stop to amateur doctoringin diseases of a fatal character. People may, if they please, inthe less severe or dangerous maladies, amuse themselves witha placebo or with globules; but when life is at stake, and delayor a mistaken line of treatment causes death, their folly be-comes crime, their rashness little less than murder.

Medical Annotations.

CHLOROFORM, AND ITS SAFE ADMINISTRATION.

’’Ne quid nimis."

THE administration of chloroform is still, it is to be feared,too often entrusted to the hands of inexperienced persons, whoare not sufficiently conversant with the indications of danger,or the means of averting it. There are many who still thinkthat chloroform may be administered conscientiously upon aloose handkerchief, without any means being taken to regulateexactly the intensity or the quantity of the dose. We are ofanother opinion. It is true that there are a few men of largeexperience, who have, by observation, attained to a sort of ruleof thumb, and who are enabled to manage the handkerchief soas to admit always a good and sufficient proportion of atmo-spheric air. But these are exceptional in their power; and it iscertainly not desirable that others should pass through the dan-gerous training necessary to attain the like dexterity. Thebest mode of administration now known is by Snow’s inhalerwith Dr. Sibson’s mask. It is only by the use of this instru-ment, at present, that anything like accuracy or exactness canbe attained. Mr. Martin Coates, of Salisbury, has just pub-lished a very excellent little pamphlet on "Chloroform, andits Safe Administration," in which he fully and ably endorsesthe views which THE LANCET has put forth on this subject;

’ and, at the same time that he narrates, and illustrates by cases,the nrincinal dangers and difficulties which are encountered in