535STEELE VERSUS SAVORY.

THE LANCET.

LONDON: SATURDAY, MARCH 5, 1892.

OUR readers will have observed that at a meeting of theCouncil of the Royal College of Surgeons of England heldon February llth the Council, in pursuance of a resolution

passed on March 4th, 1889, proceeded to the considerationof the infraction of By-law xvii. by certain Fellows andMembers in February, 1889, by issuing notices convening ageneral meeting at the College without the sanction of theCouncil. After considerable discussion, the Council re-

solved to defer the consideration of the matter to its next

meeting on March 10th, and meanwhile to inform the Fellowsand Members concerned of this intention. It may, we

think, fairly be presumed that in this postponement theCouncil was influenced, at least in part, by a desire toleave the door open for a conciliatory adjustment of

differences by affording to those who had been led

by mistaken advice on technical points into a breach

of discipline an opportunity of retracing their steps,making the amende honorable, and acknowledging the

legitimacy of the authority bestowed upon the Council inthe Charters and by-laws. Should this course be pursued,there can be very little doubt that all sources of irritation

will soon be removed, and that harmony will be completelyrestored. That this will be the outcome of the struggle weare encouraged to hope by the letter from Dr. GEORGEDANFORD THOMAS, chairman and treasurer of the Asso-ciation of Members, which appeared in our columns lastweek. Dr. THOMAS states that a special committee of theAssociation has been formed for the purpose of consideringthe position of affairs and obtaining the means of meetingthe liabilities incurred by the secretaIies and members ofthe committee who were made parties to the suit

"STEELE V. SAVORY." "The question of an appealagainst the judgment of Mr. Justice ROMER was proposedand carefully considered, and, after weighing counsel’s

opinion, the committee determined that no further legalaction should be taken." This determination of the specialcommittee not to appeal against Mr. Justice ROMER’S

decision will meet with general approval; for, notwith.standing the voluminous evidence collected by the plaintiffsand the substantial justice of their pleas for liberty of

meeting and discussion, the prospect of upsetting Mr.

Justice RoMER’s interpretation of the law, summary as itwas, must be regarded as extremely remote. Much as

we regret the issue of the struggle, and fully as

we recognise the inherent greatness of that attributeof Englishmen of not knowing when they are beaten, wemust frankly acknowledge that no good end could be servedby keeping up the strained relations between the Council ofthe College and the Members whose sympathies generallyhave followed the action of the Association. To remove

all traces of conflict without for one moment abandoningthe principles whose too zealous assertion led to the pre-sent situation of affairs is the proper course for the Asso-ciation to pursue. The adverse decision on the specialpoints raised in the pleadings does not in the least affect

the soundness of the principles on which the demand forreform of the Royal College of Surgeons is founded, ordiminish the claims of the Members of the College to avoice in its management and in the election of its Council.If it has any effect at all it intensifies those claims be-

cause it imposes upon the great constituency of the Collegethe necessity of being governed by charters and by-lawswhich are from fifty to a hundred years old, and aretherefore in direct antagonism with the spirit of the

age. It also requires from the Members of the Collegegenerally a fresh and united effort for the pur-

pose of freeing themselves from the fetters which

deprive them of the liberty to which they are justlyentitled. The recent action was at least a courageous efforbto serve the whole body of the Members, and it has involvedthe promoters in expenses which ought not to be left to bedefrayed by the few who happen to be legally responsible.First efforts in the cause of freedom are often unsuccessful,but they pave the way for future success; and such futuresuccess may be ensured if the Members of the College willbestir themselves and unite heartily to further the commoncause. A large accession of members to the Association ofMembers ought to be the immediate result of a reparablereverse, an accession which would at once be a demonstra-

tion of the earnestness of the Members in their desires for

reform and a welcome replenishment of the treasury of theAssociation. If each Member of the Collegewould contributea small sum, and support the committee of the Associationin any steps which may be deemed desirable for the purposeof obtaining a due recognition of the Members’ claims,the whole complexion of the contest would be changed.It will always be assumed by the Council of the College, asit has been hitherto, that the Association of Members

represents but a few of the Members of the College, unlesspositive proof to the contrary can be produced, and thisidea strengthens greatly the opposition to the most moderateconcessions to the Members of the College. The strongestarguments have and will have no effect while they as abody display apathy and indifference. The very extent ofthe constituency renders it the more difficult to influenceand to arouse, and it may be that an organisation of theAssociation is required which will make provision for

provincial representation and the formation of branches indifferent parts of the kingdom. Whatever may be the propermeasures to quicken the interest and engage the activecooperation of the Members of the College, we trust thatthe committee of the Association will take the subject intoserious and early consideration. All who are interested in

the reform of the College must sympathise both with thecause itself and with those who have fought the battle andfind themselves burdened with costs amounting to jE2000.We therefore trust that the Members for whom the strugglewas commenced will respond to the appeal of Dr. DANFORDTHOMAS, and, to use his words, will "by their generousassistance testify to the courage and self-abnegation dis-

played in the important contest" in which the plaintiffswere engaged on behalf of the Members generally.

A PARTICULARLY interesting article on the influenceswhich affect the power of voluntary muscular contractionsappears in the first number of the Journal ot Physiology.

536 THE INFLUENCES AFFECTING MUSCULAR ACTION.

written by Dr. WARREN P. LOMBARD, Professor of Physio-logy in the Clark University, Massachusetts. The influenceof surrounding conditions, or, as HERBERT SPENCER termsit, of our environment, is more or less distinctly recognisedby all. To one man, light, fresh air, and freedom of move-ment, whether in the form of hunting, or fishing, or

mountaineering, are essential to the enjoyment of life. Tohim the confinement and restricted activity of the literarystudent are insupportable. To another a free supply of

food is an absolute necessity, whilst yet another will behappy on the grey peas and water diet of Friar TucK.

Some feel wine, or some substitute for it, and tobacco to beindispensable; others can cheerfully dispense with either orboth. CHARLES DICKENS required the bustle and activity ofa great city tostimulatehim to his best efforts. WORDSWORTHpreferred to commune with nature alone. But in everyinstance the influences of the great forces that surround us,as well as of the minor agents, may be traced in the vigourand energy with which the ordinary avocations of life are

performed. There are fluctuations both of muscular and

nervous power which are manifested in the quantity andquality of the work done, whether this be the productionof a " Messiah" or of an " Alexander’s Feast," or in someviolent and protracted muscular effort. Dr. LOMBARD’S

essay is an endeavour to ascertain what are the influences

which determine the activity and fatigue of the centralnervous mechanisms exciting the voluntary muscles toaction. With this object in view, he made a series of

experiments on the flexor muscles of the second finger of thelefb hand. The arm rested on a firm supporb, the first and

third -fingers were enclosed in closely fibting brass tubes,and a firm cushion was placed behind the knuckles; a leathercollar was fastened round the second phalanx of the secondfinger, to which was attached a cord passing over a pulley,and supporting a weight of two or more kilogrammes. The

movements of the finger and of the weight were recordedby an ingenious but simple apparatus on a revolving drum.Amongst the more interesting of the results obtained byDr. LOMBARD were that, in the first place, the central

nervous mechanisms become more quickly fatigued thanthe motor nerves and the muscles, for when voluntary con-traction is no longer possible the muscles are still capableof contracting and of raising the weight when either themuscles themselves or the motor nerves supplying them arestimulated by an electrical current. Yet the experimentsshowed that the will power in general is unabated, for whenthe subject was unable to bring the exhausted muscles ofthe second finger into play he could make as strong con-tractions as ever with the extensor muscles of the thumb or

of those of the same finger of the opposite hand. HenceDr. LOMBARD concludes that the fatigue is located in someof the lower centres, perhaps of the spinal cord. It is remark.

able, however, that, even when fatigue is complete, oncontinu-ing the efforts to raise the weight periodic returns of powerwere observed, which were probably of central origin. Speak.ing broadly, muscular power is greater in the morning thanat night, though this is liable to vary under the influence ofmeteorological conditions, and the fall of the curve of powerthrough the day is checked at regular intervals by the meals.The effect of exercise was very noticeable in increasing the

power. Thus it appeared that whilst, when the first

observation was taken, it was only possible to raise the two.kilogramme weight thirty times with a total amount ofwork of 2’92 kilogrammetres, on the twenty-third day noless than 778 contractions were made before exhaustion

occurred, with a total amount of work of 36 86 kilogram.metres, the actual strength being thus increased nearlythirteen times, which is very encouraging to those flaccidinhabitants of large towns who endeavour to renovate theirdebilitated bodily powers by moderate exercise in the openair for a month or so in summer or in autumn. Theeffect of alterations of atmospheric pressure were carefullyexamined, with the result that, though no constant relationbetween the work and the absolute atmospheric pressurewas found, it was noticed that the power often increasedwhen the barometer was rising and decreased when it was

falling ; and, as the research advanced, Dr. LOMBARD

became more and more convinced that he was in.

fluenced by the changes in the height of the barometerrather than by the absolute atmospheric pressure ; so

that modifications in the power of his muscles were

very observable coinciding with the diurnal altera.

tions in the barometric pressure, and quite independentof the general height of the mercury. There appearedto be two well-marked maxima in the twenty-fourhours, the maxima occurring at 10-11 A.M. and P.M. andthe minima at 3-4 A.M. and P.M. The influence of tobaccoand of alcohol was finally investigated, and with resultsthat are certainly remarkable. These drugs seem to havean antagonistic effect. Tobacco acts rapidly as a depressingagent, and its influence quickly passes away. Alcohol, onthe contrary, acts as a stimulating agent, and it increases the

endurance of the muscles. In one experiment with tobaccothe total work in kilogrammetres at 8.30 A.M. was 10’25,bub eighteen minutes after smoking a cigar of mediumstrength the total work fell to 6 kilogrammetres, and anhour after to little more than 2 kilogrammetres. But at

11.30 A.M. it had risen again to 10’25. This is a result well

worthy of the attention of all smokers about to engage in anyphysical contest. The effect of alcohol is not less marked

m the opposite direction. The whole of this communication

is very suggestive, and is deserving of the careful attentionof physiologists and of physicians.

THE profession in the colonies of Great Britain is, on thewhole, sound in its determination to be faithful to the

great traditions of professional method and conduct. It is,perhaps, not remarkable that in countries so young, withsociety in a democratic form, and a large admixture of menof an independent and unconventional type, some libertiesshould be taken with old-established professional modestyand reserve. Some time ago we made allusion to thisstate of matters in Victoria with regret, but with a

sense of duty. A correspondent in Australia forwards usillustrations of the fact that in New South Wales mattersare even worse than in Victoria. Not only is the number ofavowed quacks much greater, but the practice of advertisingby qualified practitioners is deplorably common. He sendsus several specimens. "Dr. M. PERRY, M.R.C.S., L.S.A-,"adverbises himself as a specialist for nervous complaints.His work on nervous diseases is free, and he has medi-

537MEDICAL ETHICS IN AUSTRALIA.

cated electrical baths specially adapted for the treatment ofnervous complaints. The following are two other advertise-ments:-"Dr. THOMAS. Examinations passed: M.R.C.S.and L.M. Eng., L.R.C.P. Eng. Dr. THOMAS offers safe and

skilful treatment for the cure of nervous, skin, and con-

tagious diseases. Consulting rooms: 244, Castlereagb-reet, opposite the Royal Standard Theatre. Hours from

9 A.M. till 8 P.M." "Dr. ALEXANDER PATERSON, A.M.,M.D., Specialist Chronic and Nervous Diseases &c.*’

Dr. ALEXANDER M. JoHNSON, however, modestly con-

tents himself with the announcement that he is a legallyqualified practitioner. Such advertisements in the chief

daily papers of the great cities show a decided laxityin professional ethics. Our correspondent adds further

illustrations from his own personal knowledge. He has

known a graduate share a case with a quack. In a

consultation he has heard the consultant offer further

attendance, and in another case attend without offering,until refused admission. He complains that the medicallaws and General Council of the colony permit such"flagrant breaches of moral and professional etiquette."We firmly believe: that such conduct has the strongreprobation of the bulk of the profession. But the pro-fession must bestir itself to denounce and disown all who

practise it. For such persons grow bold by their own

defiance of established ethics and construct theories

for their own justification. A remarkable instance is

forwarded to us in the batch of papers from which the

above unseemly and discreditable advertisements are taken.It is in the form of a letter signed by ALEXANDER PATERSON,A.M., M.D., F.R.C.S.—presumably the same graduate whoadvertises himself as a specialist in chronic and nervous dis-eases. The occasion of Dr. PATERSON’s letter is the fact of

a Bill being before Parliament at present, which has for itsobject, as our Medical Act has, to enable the public todistinguish between qualified and unqualified practitioners,and which very properly contains a clause giving to theMedical Council of New South Wales power to strike off

the Medical Register the name of any practitioner whosename has been erased from any recognised body from whichhe obtained his qualification. Dr. PATERSON points outthat the qualifying body may remove the name of a personfor conduct derogatory to the honour and dignity of the pro-fession-" that is, for a matter of etiquette or sentiment, notmisconduct." He uses strange words to denounce such actionand powers on the part of the qualifying bodies, and asks :" What have the public todowith maintainingthehonour anddignity of the profession?" We answer unhesitatingly thatthe public has everything to do with the honour and dignityof the profession, and that its representatives are highly wisein enacting laws that tend to the maintenance of them.Dr. PATERSON makes two points : First, that so-long as aman is " qualified," in the sense of being competent, he hasa right to be on the Register. The second is that if a

medical man errs in conduct he should be judged by theordinary courts, and not by a professional tribunal. He

should have the same justice as a common culprit. The

argument may sound plausible ; but it is hollow, and it is

discreditable. Every other profession regulates itself andlays down its own standard of honour. The Law andthe Church have each its own domestic and internal

authority and discipline. It has ever been so in the

medical profession. And we see no reason for departingfrom it. Dr. PATERSON must know that it is the satisfac-

tion of a man to be judged by his peers, and that onlyprofessional men can be judges of professional conduct.

The public has the greatest possible interest in the

maintenance of a high code of professional conduct whichrepresses pretension and vaunting after the manner of

quacks. It is only professional men that can be judges of thepublic evil done by such a system and by other acts andmethods of men who hold themselves out as being some.thing superior. The very development of specialism makesthe maintenance of the strictest professional methods in

practice essential. Otherwise the public will be hope-lessly injured. Men like these advertising practitionerswant incongruous and inconsistent advantages. Theywant to be in a profession and have all the honour and

respectability that attach to its code of morals and its

traditions, and they wish to have all the freedom of quackdoctors and nostrum vendors. They may have one or theother of these, but they cannot have both. If theythink so little of the judgment of a professional counciland value it so lightly they should show more dignityin bearing the natural consequences of such judgment.We are asked in effect, What is mere etiquette or honourcompared with qualification ? The answer is that from

HIPPOCRATES downwards the moral character and the

dignified behaviour of medical men have been regarded as anessential part of their "qualification" for the great dutiesentrusted to them. In the judgment of the public theduties of medical men are so important, and withal sodelicate and refined, that it has made the profession thejudge of its own members alike in the public and the pro-fessional interest. This is found to be for the good of themother country. It is not likely to be less beneficial in hercolonies. Medical authorities have no pleasure in erasingthe names of their diplomates, and the public may beassured that when they do so it is for good public andprofessional reasons.

Annotations.Ne quid nimis."

NOTIFICATION OF MEASLES.

THE District Committee of the First or Upper Districtof the County of Renfrew has determined to addmeasles to the list of diseases to be notified underthe Notification Act. The following is the resolution ofthe committee: "The District Committee of the First or

Upper District of the County of Renfrew, as local authorityunder the Public Health (Scotland) Act, 1867, within thebounds of the said First or Upper District of the County ofRenfrew, hereby order that the Infectious Disease (Notifica-tion) Act, 1889, shall apply, in their district, to the follow-ing infectious disease-viz., measles; and further orderthat this resolution shall come into force eight days afterthis order has been approved of by the Board of Supervisionand publication of the advertisement thereof, in terms ofthe Act of Parliament-that is to say, on the eighth day ofFebruary, 1892." Dr. Munro, in forwarding this circularto the medical men of the district, properly invites notifica-