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genital hydrocephalus, which the authorattributes to some inflammation of themembranes during intra-uterine life, orto a certain nutritive hypertrophy of thebrain itself; he also thinks that all treat-ment of the disease is perfectly useless,and that we should confine ourselves to a

few simple precautions of diet, &c., the

chief object of which would be to avoidcerebral excitement.

Besides inflammations, there is an af-fection peculiar to the brain of infants,which M. Billard denominates 11 noun-

inflammatory ramollissement," and which,according to him, is evidently the effectof congestion in the organ:-

" This state of softening exists some-times only in one lobe, at others in bothlobes together ; in many cases the wholecerebral substance is destroyed and re-

duced into a black soft mass, mixed withclots of blood and pulpy flocci; the mem-hranes are always sound, notwithstandingthis extensive destruction of the brain.The ramollissement of which we speak, isordinarily the result of the mixture of thecerebral pulp with extravasated or infil-trated blood, but, in some few cases, vari-ous points of the brain have been foundsoftened, though no effusion of blood intoits substance could be traced. The symp-toms of this affection are, an excessive de-

gree of prostration, congestion of the in-teguments, pulmonary congestion-in a

word, the greater part of those that indi-cate congestion of the brain, which is theessential cause of the disease."

The other affections of the brain in

children are successively treated by theauthor, and we regret that the length towhich our observations have already gone,will not permit us to analyze his excellentaccount of them. On the whole, we re-gard the work before us as a most usefuladdition to those which have preceded iton the same subject, and is peculiarly valu-able from the care which has been be-stowed in referring the phenomena ob-served after death, to the several symp-toms noticed during life. This is a taskwhich the author has executed in a man-ner worthy of the school in which he

was educated, and which will for a longtime render his book almost a standard

work, notwithstanding some few defectswhich we have not thought it worth whileto mention in the present notice.

THE LANCET.

London, Saturday, November 30, 1833.

THE BASIS OF MEDlúAL REFORM

ALTHOUGH the defects in the medical

constution of this country cannot fail of

being obvious to the most careless ob-

server, yet it would appear, from the

writings of the agents of corruption, andfrom the discussions of some inexperiencedmembers of the profession, that the re-

medies are by no means simple or easy ofapplication. Unfortunately it has been toomuch the fashion to view the question of me-dical reform, as one relating to mere privi-lege with respect to medical practitionersthemselves, thus forgetting entirely that thegreat end to be attained by medical edu-cation, medical examinations, and medical

degrees, is the conservation of the publichealth, in which consideration is involvedthe chief physical source of the moral andintellectual enjoyments of every civilized

nation.

In condemning, however, both the hy-pocritical and the ignorant disputants onmedical politics, it ought to be recollectedthat with respect to philosophical laws and

practices, theory has been their only guide,-experience at the same time having, as

invariably, illustrated those things whichought to have been shunned rather than

respected and adopted. Argument to besure has been employed somewhat pro-fusely, in the pages of this journal, to ex-plain those laws and regulations which areadvantageous to the profession and the

public, but it does not follow that the per-sons who are capable of detecting abuseswill always devote a sufficient share ofattention to an important subject, to un-derstand in what manner those evils maybe removed and prevented, the existenceof which they are so earnest and sincerein deploring. That a sound medical consti.

375

tution is easy of construction we th:’1k is and a third in Strasbourg. The other

undeniable. Where are the difficl:’ties? schools,-those of Lyons, Bordeaux, Tou-

Are they to be found in the sordid pre- lon, &c., are called "secondary" schools;judices of - the ignorant, hard-hearted and do not enjoy this prerogative.monopolists ? Why, if the obstacles could The School of Paris, or, as it is termed

only be found in such quarters as these, "The Faculty of Medicine," is composedthere would be no sin in passing an Act of of twenty-four professors, including a

Parliament for levelling the temples of "dean" or president. A majority of thesethose cormorant corruptionists with the individuals constitute a council, with

dust. Where, then, we ask, are the diffi- powers similar to, but much more limited

culties? The Government is with us ; the than those of the College of Surgeons in

intelligent portion of the legislature is on London. This Council decides on all

our side; the community demand protec- measures relating to the instruction of thetion from quacks and charlatans ; and the pupils, the discipline of the school, the

profession, with the exooptioI1 of " the few" expenses, &c. But the rules so ordained

who profit by dishonestly dealing in medi- are not binding until they have receivedcal honours, petition, in terms denoting the sanction of the Rector, or Royalanxious solicitude, for the success of that Council,-in other words, of the govern-

great cause which will ultimately place the ment.legal rights and professional privileges of The degrees conferred by the FacultyEnglish practitioners in medicine upon a are those of " Doctor in Medicine " andsecure, honourable, and scientific basis. " Doctor in Surgery." Besides theseLet us, however, in pursuing our inquiry there is an inferior order of practitioners,

,

to its final triumph, take especial care not called " Officers of Health," to whom weto exclude any portion of that evidence shall presently more particularly refer.with which experience has furnishci us, The student who proposes to obtain theeither for our guidance or our avoidance. degree of Doctor in Medicine or Surgery,It is our duty to extend our view be- must study for four years, during whichyond the shores of England, Ireland, and time he must "take out," as it is said,Scotland, to observe what has been done, sixteen inscriptions," one every threeand what is now doing, in Europe, in rela- months ; that is, he writss his name, ad-tion to medical science and the govern- dress, &c., in a register, and pays eachment of medical practitioners. Accord- time a moderate sum, the total of which

ingly we seize the present opportunity of may amount to 750 francs, making, withpresenting British practitioners in medi- the examination, thesis, &c., the wholecine with a summary of the national sys- expense of his medical fees amount totem of medical government and education 1100 francs, or 43 sterling. It should beat present sanctioned in France, and also remarked that entrance to all the hospi-of the improvements which have been sug- tals, and to lectures delivered by the Pro-gestedinthe report of the Commissioners fessors of the Faculty are gratuitous, andwho were appointed by the French Minis- that no certificates of any kind are re-

try to investigate the state of the medical quired from the candidate for a degree.profession in that country. During his four years of study the can-There are three principal schools in didate has to undergo the following exami-

France on which the privilege of granting nations, five in number. The first com-

degrees in medicine is conferred by law, prehends Natural History, Pharmacy,viz. one in Paris, another in Marseilles, Physics, and Medical Chemistry. This

376

examination must be passed after the But the officer of health can only establish

fourth "inscription," or first year’s study, himself in the department where he hasand before the fifth, or second year. The been examined, and cannot practise anysecond examination embraces Anatomy of the great operations in surgery withoutand Ph!/siology, to be passed at the end of the superintendence of a Doctor.the second year. The third examination Such is a very brief view of the requi-is on Medical and Sw’gical Patlaology. The sites for obtaining a medical degree in

fourth on Hygiene, Medical Juris)J1’Udence, France. But the want of a now medical

1’Vlhteria Medica, and Practice of P hy8i.c. organization has been for sonte tirne felt illThe fifth is on Internal Clinique and Mid- that country. Accordingly a commission

wijery. The three latter examinations was appointed at the end of the year 1829cannot be passed before the completion of to inquire into the subject. The revolu-

four years. Finally, having answered on tion of 1830, however, and the cholera

these several subjects, the candidate sus- disturbed the progress of this, as well as of

tains a thesis of his own choice, and is many other fair projects. It has very re-

admitted to the degree. Formerly there cently been renewed, and the commis-

was some slight difference between the sioncrs have now examined more particu-examination for the degree in medicine larly into the following questions:—1st,and that in surgery; but since the 11 th of the inexpediency of having different orders

October, 1831, they have been precisely of practitioners. 2ndly. The propriety of

the same. appointing medical councils in each de-

The inferior class of practitioners, or partment of the country. 3rdly. The

Officíers de Santé, has for a long time been propriety of wholly suppressing and abo.

considered as a blot upon medical organi- lishing secret remedies. 4thly. The crea.

zation in France, and the labours of the tion of three new schools of medicine;medical commission have been chiefly di- and, 5thly, the appointment of physicians,rected to the placing of all practitioners, somewhat similar to our parochial sur-

whether in medicine or surgery, upon the geons under the poor-laws.same level as to education, rank, &c. The This is not the hour to descant uponstudent who proposes to become " an the inexpediency, the impolicy, the grossofficer of health is not compelled to absurdity, of permitting various grades ofstudy in the schools of medicine. If he practitioners in medicine. This injurioushave been the pupil of a Doctor in Medi- institution exists in almost every countrycine for six years,-if he have attended a in Europe, but it cannot last much longer.military or civil hospital five years conse- In our own country it has received a suc.cutively, or have studied during three cession of blows from which it never can

years in a school of medicine, he may recover. In Germany, Prussia, and Italypresent himself for examination before a it is true that there are but two classes-

medical jury, which sits for this purpose surgeons and physicians,-but the formerin the chief town of each department, and hold a secondary rank, and very few ofis composed of two doctors in medicine, I them, even after long labour, and by thejoined to some one professor from a chief exercise of high talent, reach the upperschool. The candidate is examined in ranks, and there, too, must the division

Anatomy, the Elements of Medicine, in end in amalgamation. In France the

Sur{Jery, and the most useful portions of commissioners propose, as a preliminaryphnrrrtacy. The expense of this degree is measure, the abolition of the rank ofnot more than 200 f"ancs or 8/. sterling. " officers of health."

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The second proposition relates to the

appointment of three additional Faculties.We have remarked already that Paris,

Marseilles, and Strasbourg, are the onlyplaces in France which enjoy at presentthe right of conferring medical degrees.It is now proposed to extend the privilegeto three other chief cities, as Nantes,Toulon, Bordeaux or Lyons, and to grantthem all the powers possessed by the

Faculty of Paris. By this means it is as-sumed that instruction will be more ex-

tended, and certainly be attained at a

cheaper rate; while, as the commis-

sioners observe, the pupils being moredisseminated, will be removed from the

tumults and passions of the capital. The

latter reason is perhaps more closely con-nected with politics than with medicine.In this country the appointment of

medical attendants under the poor-laws,though subject to much abuse, is in prin-ciple an excellent institution. In France

no provision of this kind has hitherto

been made. Hence the commissioners

propose the creation of district physi-cians (" medeeins cantonnaux ") in cer-

tain portions of the kingdom where the

poverty of the inhabitants is so great thatmedical men are debarred from settlingamongst them, or where the actual num-her of physicians or surgeons is not con-sidered sufficient to preserve the health

of the people. These gentlemen are to bechosen by the medical committee of the

department, on the recommendation of

the local authorities, after having exhi-bited satisfactory proofs of capability andcharacter. Their emoluments (?) are to

vary between G00 francs (24/.) and 1500francs (601.) according to the extent andresources of the district.

The mode of organising medical coun-cils or committees for each departmenthas occupied, at great length, the atten-tion of the commission. The subjectswere difficult, and required great delicacy

in the management. There are certain

rules of conduct to which every medical

man, especially in private practice, shouldconform himself, which are well under-stood by all, though they cannot be em-braced within the limits of a state law.

The neglect or breach of these rules doesnot, therefore, constitute a legal crime,but injures severely the dignity and best in-terests of the profession, while the offenderis only subject to such punishment as hisconscience or the opinion of his compeersmay inflict. Hence arises, in the view ofthe Commissioners, the necessity of ap-pointing some body of men, with authority,to watch over the interests of the pro-

fession, and to see that the laws, at pre-sent in force, are executed with impar-tiality and strictness. Another duty, notless important, of the medical councils,will be the exclusion from medicine of

every person who practises that art

without possessing a legal qualification inthe form of a medical degree. The coun-

cil are also to have the power to hinder

the distribution of secret remedies, whichare at once a disgrace to the age and acause of destruction to innumerable dupes.The institution of such a body as this,though it may be met by many objectiom,and will require much care to prevent itsabuse, will, it is expected, be in the main

highly useful. The Commissioners, in-

deed, seem to consider its value to be so

great, and so universatly acknowledgedthat we shall detail, at some length, themanner in which they propose that themedical councils should be organised, andwhat are the powers with which they areto be intrusted.

Organization of the Council.

1. A medical council shall he organisedin the chief town of each department.

2. It shall be composed of nine members,viz :-six doctors in medicine or surgery,and three apothecaries of the highestclass. Each member must be at least

thirty years of age, and have exercised

378

his profession for five years in the de-

partment.3. The members shall be chosen bv

ballot, by the physicians, apothecaries,and officers of health of the department,assembled in the chief town.

4. A third of the council shall go out

every three years by lot, and new mem-bers be chosen.

Duties of tile Medical Council.1. The medical councils shall make it

their business to examine the diplomas ofall persons who propose to exercise theart of medicine in the department, andshall verify their authenticity ; they shalldraw up exact lists of those who are le-gally qualified to practise, and publishthem from time to time.

2. They shall prosecute those who con-tinue to practise medicine without a di-ploma ; and shall also take cognizance ofany breach of the existing laws, as respectsthe sale of medicines, their preparation, &c.

3. They shall elect the county physicians,according to the form prescribed.

4. They shall visit, from time to time,as the law now directs, the shops and es-tablishments where medicines are pre-pared or sold.

5. They shall take cognizance of, andendeavour to reconcile, all disputes, &c.between the members of the profession,whether national or foreign.

6. Every three years they shall embodyall the suggestions and facts collected bythem during that period, and which relateto the medical topography or statistics oftheir department, the nature of epidemics,the history of the prevailing medical con-stitutions, &c.

7. They shall not, under any pretext,interfere with questions of doctrine, me-dical opinions, or instruction.

8. Their duty of superintendence is li-mited to the moral conduct of those who

practise in the department. The privateconduct of the members, unless of sucha nature as to produce public scandal, andthus tend to dishonor the profession, isnot to be interfered with.

9. The functions of the medical coun-cils are to be exercised gratuitously.

Penalties.

1. The penalties which the medicalcouncils are empowered to inflict, are, 1,admonition ; 2, reprimand; 3, privatecensure ; 4, a public censure.

2. Admonition consists in simple ad-vice, privately addressed to the offender.

3. Reprimand must be given vivd voce.4. The private censure shall be admi-

nistered by the president of the councilbefore the members only.

5. Public censure, before the public;-each individual so punished shall have theright of appeal to a higher council in,Paris, or to the royal courts of justice.There are several circumstances con-

nected with the foregoing regulationsworthy of attention. In the first place,there is no secrecy in the election of tne

members ; every physician and apothe-cary in the department has a voice in thedecision. There is no exclusion or aristo-

cratic distinction of grades, but the justprinciple of an universal suffrage is here

applied. The power confided to the

councils is, as may be seen, chiefly of amoral kind: although they are enjoinedto execute the laws already existing, and

applicable to each individual case, yet themain agent is the public stigma whichthe censure of a respectable body of men,representing the profession of the depart-ment, must inflict on the offender againstpublic morals or private duty. Finally,the services of the councils are to be gra-tuitous. The only recompense which themembers can expect for the exercise of

duties at once arduous, embarrassing, andof a highly delicate nature, is the respectand esteem which will naturally attach tothe character of a man who devotes his

time and labour to the benefit of his

fellows.

Such is a brief sketch of the modifica-

tions proposed to be introduced in the

medical policy of France.

WE are sorry to announce that Baron

DuPuYTREN is very seriously indisposed.He has been seized, it is said, with anattack of apoplexy, and it is not probablethat he will be able for a long period (ifever) to resume his clinical instruction atthe Hôtel Dieu. The duty of lecturing hasbeen intrusted to M. BRESCHET, who willcontinue to lecture until the Baron’s re-

covery, or until further arrangements aremade. Should this chief of French sur-

geons unfortunately not again be restoredto the profession, which he has contributed

379

so much to advance and adorn, his admir- ’able lectures will be read with the in-

creased interest which usually attaches tothe "last productions " of a great man, - one, indeed, who is inferior to no surgeon ’of the present age.

THE annual distribution of medical prizes itook place at the Academy of Medicine, Paris,on Monday the 8th of November. Amongstvarious others, medals of 300 francs valuewere decreed to MM. VELrFau andBRESCHET, for their recent works on em-bryology. Several prizes were distributedfrom the MONTHYON fund, viz., to M.BAUDELOQUE 2000 francs, for the inven-tion of an obstetrical instrument, appli-cable to those rare cases in which thebirth of the child is rendered impossibleby deformity of the pelvis, and only to beused after the death of the child has beenascertained. 1500 francs to M. SCIPION

PINEL, for his anatomical and pathologicalresearches on the brain. 6000 francs to

Baron HEURTELOUP for the invention andsuccessful application of percussion as ameans of destroying calculi in the bladder.4000 francs to Professor JACOBSON of Co-penhagen, for the successful applicationof pressure with the same object. The aca-demy has, with great liberality, givenmedals of 1000 francs value to several

foreign writers on the cholera, viz., to Mr.ANNESLEY for his labours in India; to

MARCUs and JACHNICHEN of Russia; to

DIEFFENBACH and ScoTTOUTEN of Prus-

sia ; and to BOUILLAUD, GENDRIN, FoY,and many other natives of France. The

three latter were not disgraced by presentsof the cholera medals lately given by theGovernment.

INTERCEPTED LETTER.

" MY DEAR DR. MACMICHAEL,—Howdeeply I regret that I was not at homewhen you favoured me by calling yester-day, as I desired to see you very particu-larly ! You have, of course, seen the

shocking false report in the newspapers,scandalously hinting at an expected ma-trimonial alliance between the amiableand rinoffending Princess and myself. No-thing for some years past has caused me

so much pain. Although their M—shave most kindly and affectionately madeevery allowance for my feelings on theoccasion, still, I do not sit quite at easein the p . It is a subject, respect-ing which, of course, I can myself offerno explanation. It is altogether a mostdelicate and perplexing affair. Next tothe pain caused by the first announcementof the disagreeable paragraph, is the

contemptuous manner in which the re-port, silly enough in itself, has beentreated by some of the high and noble fa-milies, and here it is that I want your as-sistance. Should the subject be men-tioned to you now that you are attendingthe Duke of , in Square, andLord -, in St. you will, dear Dr.,render me an inestimable favour, by notregarding the subject as one of sport orjest, or by treating such an occurrence asan impossibility. You will greatly serveme, rather, by assuming that the reportin the newspapers was not altogether un-natural, when the rank is consideredwhich my further elevation offered, and apartiality which the Princess is known toentertain for me, in consequence of myunlimited professional and friendly atten-tions. By exercising, therefore, a littletact and address, you may materially con-tribute towards extricating me from a

disagreeable dilemma. Nothing wouldannoy me so much as the simple suppo-sition that my alliance with the Pwould be degrading to the R- F

" I have not discontinued my morningattendance at Kensington, and it is pro-videntially fortunate that I am thusenabled to sustain my ground, and showthe haut ton that I am, as ever, a wel-come visitor in that delightful quarter.Serve me, then, my dear Macmichael, byspeaking on the subject as one of seriousand natural import, and do not let it onany account be made an affair of sport orjest.

" Let me see you on your return from- Square on Monday, but should youbefore that time have any conversationwith the Duke on the delicate affair

already mentioned, fly to me instantly,as nothing can exceed my anxiety to

know the feelings of that nobleman con-cerning it. Your attendance at the Col-

lege must be frequent in the course of thenext fortnight, and I do hope that thelabours of the committee which we havejust appointed, will prove satisfactory tothe very troublesome licentiates. Wemust soften down some of the severity ofour laws, but as to admitting those fo-reigners to a full participation in the pri-vileges of our legitimate collegians ; why,it is quite impossible. I am still strivingn ...-.......