150

THE LANCET.

LONDON: SATURDAY, AUGUST 18, 1855.

THE NEW PRESIDENT OF THE BOARD OF HEALTH.

THE acceptance by Sir BENJAMIN HALL of the Presidency ofthe Board of Works rendered it necessary to appoint a newPresident to the Board of Health, and the choice of the Crownhas fallen upon the Hon. W. F. COWPER.

Last week we expressed our opinion of the high importanceof the office now held by this gentleman; we stated that itwas a new office, in which new principles had to be tested andapplied, for which a new machinery must be organized, andfor which professional support and public confidence had to beachieved.

The profession would certainly rejoice to have seen the

favour of the Crown bestowed on a member of its own

body. Apart, however, from considerations of that descrip-tion, the selection of Mr. COWPER is one that is likely to beproductive of great advantage, and we received the announce-ment of his appointment with feelings of extreme satisfaction.Mr. COwPER thinks and acts with great independence of

spirit; and the uniform kindness of his disposition has obtainedfor him the respect of the House of Commons, in which place Iwe firmly believe he has not a single enemy. In truth, the !,well known benevolence of his character is calculated to disarmall hostility; consequently, when his opinions encounter oppo-sition, the purity of his motives are never for a moment ques-tioned.

In order to carry out sanitary measures to their fullest

extent it is really necessary that their originator and advocateshould possess those qualities of mind which induce him tosympathize with the. sufferings of the least fortunate of hisfellow-creatures ; because, after all, if sanitary laws do notstrike at the lowest depths of human disease and misery,they must ever fail to accomplish that amount of benefit

that might result from wisely-directed enactments. Mr.

COWPER long since turned his attention to the condition ofthe poor of this country, and to proceedings connected withsanitary reform. In 1843, he moved in the House of Commonsfor the appointment of a committee relative to making Allot-ments of Land amongst the Labouring Classes. The in-

quiry was productive of a great extension of that bene-

ficial practice, many landowners having apportioned, at nearlynominal rents, small pieces of ground amongst the labourers

employed by them, as well as amongst other poor persons resi-dent in their localities. In 1845, Mr. COWPER carried a Bill

through the House of Commons called the " Field-GardensBill," by which it was provided that vestries, church-

wardens and overseers might take land, and then re-let it tolabourers, for field-gardens, at very moderate rents. The Bill

was opposed in several of its stages, but it was strongly sup-ported by the late Mr. WALTER, Mr. JOHN FIELDEN, of Old-ham, and other well-known steadfast friends of the people. Themeasure was lost in the Lords; but in the same year Mr.COWPER succeeded in introducing in the General Inclosure Acta provision by which some portion of waste land must, in itsinclosure, be set apart for the occupation of labourers, as allot-ments for field-gardens, and the management of it was entrusted

to the clergyman, churchwardens, and two field-wardens. In

1839, Mr. COWPER supported the motion of Mr. SLANEY forthe appointment of a Committee to Inquire into the Health ofTowns, and became an active member of that committee, withwhich may be said to have originated the strictly-so-calledsanitary measures of the House of Commons. Mr. COWPER

was also a member of the Health of Towns Association; andwe observe his name in the list of the members of the existingSociety for the Improvement of the Dwellings of the Labouring

Classes, and he has been found invariably aiding every move-

ment for improving the sanitary condition of the poor.I Now, when it is considered that a gentleman who has thusdisplayed the benevolence of his disposition on so wide a scale,with reference to the masses of the population, has been

selected to occupy such a position as the Presidency of the Boardof Health, the appointment cannot be regarded otherwise thanas highly creditable to the judgment, motives, and views of thePrime Minister. Further, we would say that the choice is themore especially important to the public and the profession inconsequence of the near relationship which exists between LordPALMERSTON and the new President. By bringing, as it were,the proceedings connected with our profession, and also withthe welfare of the poor, into his own family, it may be fairly in.ferred that the Prime Minister does not regard as irksome, ortroublesome, or unworthy of notice, any measures which maybe suggested for the public advantage. We may, we think, now

confidently hope that a Government Bill, with a view to the-reformation of our medical laws, may be introduced into

Parliament in the next year, and that such a Bill will be

triumphantly carried, through all its stages, by the new Presi-dent of the Board of Health.

That Mr. COWPER means to be actively employed in theposition which he has just assumed, may be fairly inferredfrom a passage in the speech delivered by him at his re-election,at Hertford, on Tuesday last, and reported in Tlte Times ofWednesday. Mr. COWPER, having been declared duly electedby the Mayor,"came forward, and was received with loud cheers. Hebegged leave to thank the electors most deeply and cordiallyfor the honour they had again conferred upon him. He valuedit more especially because it would enable him to do somework in the House of Commons which, he thought, would befor the advantage of the country."

WE have just narrowly escaped the perils of a great medico-legal contest, in fact, of a second "CuMMiNG case," with allits accompanying forensic mystic display, and all its unhappyclashing of medical opinions and theories! The Lords Justices

have - alas! for our legal friends - quelled the approachinghurricane, nipped the legal struggle in the bud; and have thuscruelly spoiled much medico-legal sport. It is unnecessary to

say that we refer to the case of Mr. EDWARD Torus, latelyargued before the Lords Justices in the Court of Appeal, anddisposed of by their Lordships in a manner that must everreflect the greatest credit upon their intelligence and humanity.Our readers will find a brief report of the proceedings in ques-tion in another part of THE LANCET.The history of the TopLis case is soon told. This gentleman,

after pursuing, successfully and honourably, the business of atobacco manufacturer in the eastern part of the metropolis,retired upon a considerable fortune. He has lived to the greenold age of seventy-five, is married, having been united to his

151

ALLEGED INSANITY: CASE OF MR. TOPLIS.

present wife for a period of fifty years. By this lady he has alarge family. It appears from the evidence, that Mr. TOPLIshas lived in terms of great affection with his wife for half a

’

century, and that during the last four or five years she has(like many other ladies occupying a higher station in society)taken a prominent part in her husband’s pecuniary affairs,saving, by her rigid economy, a considerable sum of money,which Mr. and Mrs. Torus agreed to invest in their jointnames. Mr. TOPLIS has not, however, been put entirely onthe shelf, for even up to a very recent period he has been inthe habit of collecting his own rents, of which he had kept aregular and business-like account. The sum saved by Mrs.TOPLIS’S thriftiness, amounted to several thousand pounds.Upon this money the children of this gentleman, it is alleged,fixed their avaricious eyes. They found that Mr. and Mrs.Torus were resolute in refusing to yield to their proposal, totransfer the amount thus invested solely to the account of Mr.TOPLIS, and it appeared probable that after their father’s deaththis sum of money would be left entirely at the disposal of thewife. They then raised the imputation of insanity ! Mr. TOPLIS’memory had of late become much impaired; but his recollection ’,of past events continued very vivid. It was also admittedthat he could not, if suddenly questioned, and without havingbefore him his account books, give a very accurate or detaileddescription of his property. 17pon such flimsy data, the childrenthought they could successfully prove a case of imbecility andmental incompetency, and thus obtain possession of the manage-ment of their father’s property. Affidavits were soon forth-

coming. Apart from the general practitioners who swore toMr. TOPLIS’S insanity, the solicitor acting for the petitioners,called to his aid one surgeon of great eminence -viz., Mr.

LAWRENCE, and two physicians, Drs. TWEEDIE and SUTHER-LAND. These three gentlemen were deputed to visit collec-tively, on a day and at an hour previously agreed upon, Mr.TOPLIS, with a view of supporting the allegation of insanity,and giving evidence at the expected commission of inquiry.Conscious of his perilous position, Mr. Torus, without delay,consulted a solicitor. Fortunately for himself, as the sequelproved, the fell into the hands of an able, active, and honour-able gentleman, Mr. WELLINGTON VALLANCE, who, with-

out a moment’s hesitation, determined’to prevent so unjus-tifiable an intrusion as that contemplated on Mr. TOPLIS’Sprivacy. He immediately intimated to the three medical gen-tlemen selected by the solicitor acting for the petitioners, thatthey would not, if they presented themselves, be admitted intoMr. TOPLIS’S presence.

Pending these proceedings, an eminent Queen’s Counsel, whohad been consulted in the matter, advised that the case shouldbe put into the hands of two physicians of eminence, one to bechosen from the class engaged in general physicians’ practice,and the other to be a gentleman of reputation as a medicaljurist, and specially engaged in lunacy practice. Agreeably tothis suggestion, Dr. COPLAND and Dr. FORBES WINSLOW werenominated fully to investigate the case, and report their

opinion. If Dr. WINSLOW were disposed to favour the lunacyview of the question, there stood by his side the veteran Dr.COPLAND to prevent the operation of such a prejudice; butfortunately the physicians agreed after the.fi1’st examination asto Mr. TopLis’s perfect soundness of mind, and capacity tomanage himself and his affairs, and after making several exami-nations, they reported at length in favour of the sanity of the

, alleged lunatic. These gentlemen admit in their report, thatMr. TorLis’s memory is not very retentive, but they found hisaffections, his judgment, and moral sense in a sound and

healthy condition. ,

Dr. SOUTHEY was subsequently deputed by the Court tosee Mr. ToPLis and he concurred in the view taken byDrs. WINSLOW and COPLAND of the case. The expression"it can hardly be said that Mr. TOPLIS is perfectly of soundmind," used by Dr. SOUTHEY in his report, was taken

exception to by Lord Justice 1’r-NIGIIT BRUCE, and we admitthe force of his remarks. When commissioned, for legal pur-poses, to test the mental capacity of any person alleged to beinsane, it is the duty of the medical jurist to report as to themental soundness or unsoundness of the party, without any kindof qualification or reservation. The question at issue is,whether the mind be sound or unsound, competent or incom-

petent, for the management of himself and his affairs. The

expression, " not perfectly of sound mind," necessarily destroysthe practical value of an official report, and can be no guide tothose for whose assistance it is made. Such was obviously theeffect of Dr. SOUTHEY’s report on the Court, and consequentlythe Lords Justices had to fall back upon the elaborate affidavits

of Drs. WINSLOw and COPLAND, and upon those, coupled withtheir own examination of Mr. TOPLIS, they decided the casebefore the Court.

Drs. WINSLOW and COPLAND are entitled to much praise formaking so bold and so decided a stand in this important case.Had the attempt to obtain a Commission of Lunacy, as well as averdict of Insanity succeeded, the next step, in all probability,would have been to consign this poor old gentleman to anasylum.

Mrs. CUMMING was no more insane, in the right significationof the term, than is Mr. TOPLIS; and if it had not been esta-blished that a solicitor, who had acted as her legal adviser formany years, and often befriended her, and stood by her whenher own kith and kin had in reality stood aloof from her, hada beneficial interest in an unexecuted will, no British jury, wemaintain, would have dared to have decided that she was

otherwise than of perfectly sound mind. On that occasion,Dr. F. ,6fizrrsLOw and Dr. BARNES manfully contested, for six-teen days, every inch of the ground, maintaining that impairedmemory occurring ira old age was no proof of legal unsoundness

of mind, or mental incapacity to manage the person or property.Alas! their efforts to obtain a just verdict, in the case of Mrs.CUMMING, did not meet with the success they deserved, muchto the scandal of British jurisprudence.

In the case of Mr. TOPLIS, we trust that we have wit-

nessed the last attempt that will be made to establish

lunacy upon such unjust grounds. Dr. WiN’SLOW has alwaysoccupied a high position upon this question, and on more thanone occasion, in his official reports to the Court of Chancery,and in commissions of lunacy, has made an able stand againstthe monstrous and most dangerous doctrine which perverts theweakness of intellect necessarily associated with, and the result

of, old age, into valid evidence of legal unsoundness of mind,and mental incompetency.We sincerely trust that he will, in defiance of all opposition,

continue to pursue this honourable and just course. We never

recollect a case in which the Court of Chancery has spoken outso plainly, pointedly, and emphatically, as in the one now

under review. Lord Justice KNIGHT BRUCE and Lord Justice

152

PROFESSIONAL RIVALRY: EVANS VERSUS BURGESS.

TURNER, expressed in the most unequivocal manner, and ingood homely Saxon-English, their unmitigated disgust at theconduct of all parties concerned in the attempt made to fixthe odium of lunacy upon poor Mr. TOPLIS. Lord Justice

KNIGHT BRUCE, at the conclusion of his judgment, said-

" that the present petition was without justification, without

apology, and without excuse; and he believed it to be thepro-"duction of avarice, Jealousy, and acrimony, and one which" ought to be dealt with accordingly, by dismissing it with"costs." Lord Justice TURNER, in delivering his judgment,said-" that the whole conduct of parties and solicitor for theapplicants, filled him with indescribable disgust." So ended

this remarkable and instructive case. May it prove a warningto all those who may feel disposed to commit similar scan-dalous outrages upon the liberty of the citizen, under the

allegation of insanity. Should the precedent that the naturaldecay of old age may be wrested into evidence of legal insanitybe confirmed, consequences must follow most destructive to

morality, and subversive of the ties of nature and society. ’

THE case of EVANS versus BURGESS is one of a class that

cannot fail to give rise to the most painful reflections in allwho have the welfare of the medical profession at heart.

It is impossible that either the interests or the dignity ofthe profession can be advanced if practitioners are to be

found amongst its ranks who do not scruple to violate thoselaws of courtesy and honour which ought to regulate themutual intercourse of professional men. -These laws call uponno man to do violence to an upright conscience; they do notbind him to sacrifice truth or justice to an arbitrary conven-tionalism ; they simply-by reminding us that, as our art em-braces many doctrines and rules of practice that are open to bedifferently interpreted, that, as men’s minds vary, and thereforecannot on all occasions construe the same facts in the same

manner; that, above all, as all of us are liable to err-imposeupon us all the obligation of forbearance towards one another.We doubt whether it could be justified before honourable menof any profession that one practitioner should seek to throw aslur upon the reputation of another, even in the case of cleardeficiency of medical knowledge. But no one will hesitate to

condemn the conduct of one who attempts the ruin of a rival

practitioner, by representing to unprofessional persons, necessa-rily ignorant of the difficulties of medical practice, that he hasbeen guilty of malapraxis, when the case was one of doubtfuldiagnosis, and admitting of legitimate diversity of opinion asto the treatment.

The leading facts of this case, as gathered from the evidence,are as follows :-

On the 10th of June, 1852, the plaintiff, Mr. EvANS, wasthrown from his horse, and received an injury in the foot andankle. Mr. BURGESS and Mr. NICHOLS, surgeons, being sentfor, were both in attendance, but the charge of the case was

given to Mr. BURGESS. The accident appears to have caused I

a dislocation of the tibia from the astragalus, and fracture of Ithe fibula. Both surgeons concurred in the propriety of at-mpting reduction by extension. Extension was tried by Mr. I’

BURGESS, but without success, and the presence of inflamma-tion, together with the violent conduct of the patient, whothreatened to knock the doctors’ brains out with a stick, pre-vented a renewal of the attempt. All that could be done was

to apply splints and bandages in such a way as to secure themost favourable result possible under the circumstances. This

Mr. BURGESS did, and the patient recovered with a limb quiteas useful as might reasonably have been expected. He made

no complaint until applied to for the bill. Mr. EVANS resisted

payment, now alleging that he had been improperly treated.Mr. BURGESS brought an action in the County Court, but wascompelled to withdraw, on finding, to his just astonishment, thatMr. NICHOLS, who had attended the case with him, was preparedto support the plea of Mr. EVANS. The matter rested for a periodof about three years, the patient " walking a little, as he ad.admitted, with a stick," attending races, and once even ridinga trotting-match. At the end of this time, Mr. EVANS, relying,no doubt, upon the aid of Mr. NICHOLS, if not directly in.stigated by his representations, brought an action against Mr.BURGESS, laying the damages at £2000. On the trial, Mr.NICHOLS accordingly gave evidence, accusing his brother

practitioner of having grossly misconducted the case. Uponwhat did Mr. NICHOLS support this grave allegation ? Uponnothing better than certain dogmas of his own. " He should

never give up such a case as that until the dislocation was"reduced"! Yet, is it not quite possible that Mr. NiCHOLSmight have failed as well as Mr. BURGESS ? Other surgeons,

perhaps more skilful and experienced than Mr. NICHOLS, havedone so in similar cases. But if the examination in chief did

not elicit from Mr. NICHOLLS substantial grounds for his

scientific conclusions, the cross-examination fully succeeded inthrowing light upon his motives. It appeared that subsequentlyto this accident of Mr. EvArrs, a patient of his had left him, toput himself under the care of Mr. BURGESS. In reference to

this matter, Mr. NICHOLS said Mr. BuxGrss "was a personhe would not meet in practice."The jury very properly intimated that they had made up

their minds to find a verdict for the defendant; but the case

being proceeded with, witnesses were called for the defence,when many of the statements made by Mr. NICHOLS as to theoccurrences during the attempted reduction were directly im-pugned, and several practitioners of respectability expressedtheir approbation of Mr. BuRGESS’s treatment.We do not think it necessary to quote the opinions of the

surgeons who were called on either side. The weight of evi-dence was decidedly in favour of Mr. BURGESS. It is enoughto establish that the case was one admitting of doubt as to theexact nature of the injury, and of great difficulty in the treat-ment. This is enough to satisfy every man of right feelingthat this action ought never to have been brought, much lessto have been instigated or supported by one medical prac-titioner against another.

If such conduct were ever to be sanctioned amongst us, noone could practise with comfort to himself or advantage to thepublic. The medical profession would speedily sink in cha-racter below the position of the most degraded of callings, andno honourable man would enter its ranks.

IT seems hardly necessary to make any further demands,either upon facts or arguments, to convince every calm, rational,unprejudiced mind that the method in which the governors ofour hospitals organize and employ their medical staff is a pal.pable mistake. Nevertheless, it is quite possible that somemay be found with minds so warped by personal interest, or so

153

POSITION AND PROSPECTS OF HOSPITAL MEDICAL OFFICERS.

wedded to ancient usages, as to attempt some defence of the

present hospital system. There are two arguments frequentlyemployed to bolster up a feeble cause, the force of which, asapplicable to the present question, it may be useful to examine.Thus it may be said, "that every institution of human con-trivance is of necessity imperfect;" and again, "that it is somuch easier to suggest errors and urge changes than to indicatereal improvements." Such abstract propositions, no doubt,contain some truth; but if acted upon in all cases would strikeat the root of progress and reform. In the present instance

they have no force; the mistake is too palpable, the remedytoo easy, to give even a specious pretence to such objections asthese. It is only because the governors of our hospitals havenever had these subjects forcibly laid before them, and are,from the nature of their occupations, their education, and theirmodes of thought, incapable of estimating such evils, unlessclearly explained, that the present anomalous state of the

various hospital staffs has been so long permitted to exist.

Suppose some impartial person, some foreign surgeon, for ex-ample, visits one of our large hospitals; he is introduced to amember of the staff; he bears a name that is familiar to him,that has long been familiar to him, as a man of original re-search, as a teacher, as one even it may be who has been

selected to deliver a course of lectures to the College of Sur-geons, as an author of works that enjoy a European reputation;he sees a man somewhat past the meridian of life, in good con-

sulting practice, a favourite with the pupils and with the public.Our foreigner is anxious to attend the clinique of such a man,to hear his practical remarks, to see him operate. Imagine hisastonishment when he learns that he has no patients in the hos-pital under his care, and that if he ever performs an operation,he is obliged to ask permission of his senior, which may ormay not be granted. Well may he be astounded to find a

man in the very zenith of his power, admired by men of fscience, consulted extensively by the profession, trusted bythe public, loved by his pupils, and yet, as regards the hos.pital, a nonentity. That great institution, which seemed tohave the most right to him, and the most need of him, whichhad so much important work for him to do, and might havehad his first young energies, his disinterested labours, the verycream of his mind, has allowed him to exhaust all his powersand all his interests elsewhere, and has kept nothing but the dregsand the leavings for itself, after the reputation is made, andthe ambition is slaked, and the position is established. Our

foreigner, who is accustomed to see hospital surgeons all overthe Continent brought into the full, active, and responsibleexercise of their powers, in the early vigour and prime of life,is at a loss to conceive how such a state of things could havearisen, or, yet more strange, could have been perpetuated fromyear to year. Surely, he thinks, it cannot be on account of

yonder septuagenarians-it cannot be for the fear of diminishingtheir profits, disturbing their monopolies, instituting damagingcomparisons with their operations and antiquated opinions!Surely the maturity of age might be made to co-operate ratherthan to antagonize with the vigour and originality of earlydays ! If the case is not always so palpably strong as this, itwill be found, on examination, that it is gradually workinginto the same condition, and differs in degree rather than inessence. The foreigner is introduced to another gentleman,whose peculiar position excites his wonder. He is spoken ofas promising and rising, and likely to do something some day;

he is probably attached to the medical school; he is no longera young man. As regards the hospital he is an expectant, andhopes some day to be elected an assistant-surgeon; as yet he ispractically an untried man, and seems likely to remain so,judging from the probable progress and rapidity of hospitalpromotion, until in his dotage, or until the messenger arrives tosummon him hence.

Thus everything is kept slow and behindhand. One part ofthe plan tallies but too well with the other, and much valuabletime is lost after every qualification is attained, before even theduties of an assistant-surgeon are commenced. Such a systemmight be tolerated if Mons. FLOURENS’ hypothesis was practi-cally correct, and the age of man was a hundred, but as we areat present constituted, it is singularly defective. If the go-vernors of our hospitals had aimed in a special manner at theexclusion of all vigour and originality from the medical staff,they could have devised no better scheme for the purpose thanthe one now in force. It is useless, then, to suggest as an argu-ment against us, that "it is easy to find fault." Why, thewhole plan is one huge fault from beginning to end ! Equallyuseless is it to found an objection to these remarks on the

ground " that it is difficult to suggest a suitable remedy."Shall we be deterred by such miserable arguments as these whenwe find feebleness, and rottenness, and decay, in a systemupon which the practical education of our profession depends ?Shall every foreigner who knows the working of Continentalhospitals be filled with pity, wonder, and contempt ? Shall

every disinterested person lament our suicidal arrangements ?Shall we see a system adopted that would swamp any Govern-ment, and give force and vitality to any " Administrative Re-form Association ?"-a system that draws its resources from thefeebleness of age rather than from the vigour of youth-thatallows all its best materials to rust out rather than to wear out

-and shall we not strive to draw aside the veil ?-shall we not

endeavour to explain, whilst we" Nothing extenuate, or set down aught in malice,"

the immense practical evils of such a plan ! Shall we not show

to the profession, the governors, and committees of hospitals,and to the public, that the tendency of such arrangements isto paralyse the workings of our hospitals, and degrade themfrom their high office, as the great source and centre of profes-sional education and advancement, to perform the miserablefunction of giving the name " hospital surgeons" to a fewprivileged individuals ? 2

IN LUNACY.—IN THE MATTER OF TOPLIS.

THIS petition was presented by Mr. James Toplis, of High-street, Whitechapel, tobacco manufacturer; Richard Toplis,of Smithfield-bars, oil and colour man; Benjamin Fleet, ofEast-street, Walworth, soda-water manufacturer; Thomas

Pagett, of Brompton-road, music-seller; and John Cayley, ofSmithfield-bars, chemist and druggist, (the two former sons,and the three latter sons-in-law, of Mr. Edward Toplis, ofTrafalgar-place East, Hackney-road,) praying a reference toone of the masters in Lunacy to inquire whether the last-named gentleman is of unsound mind. The allegations in thepetition and affidavits mainly were that Mr. Toplis was ofvery weak mind, occasioned by a former course of intoxication ;that his wife, to whom he had been married fifty years, exer-cised great control over him; that the savings out of hisincome had been invested in the joint names of the husbandand wife, with a view to her obtaining the full dominion overthe stocks if she survived; that Mr. Robert Jeffs, surgeon, ofNo. 1, Finsbury-place; Mr. George West, surgeon, of No. 2,Hackney-road-crescent; Mr. John Chambers, of No. 3, Tra-