901

sential degree, a malady, which, in spite ofthe rapid advancement of medical science,still bids defiance to all human skill. Whatis here aimed at, is to place Jersey in itstrue position among climates of a similarnature, and to draw inferences of practicalvalue, concerning particular morbid actions,which, though sometimes the consequencesof phthisis, have, not unfrequently, a sepa-rate existence, and admit of a successfultreatment. Of this kind is haemoptysis. Ibelieve it to be generally admitted, by mo-dern pathologists, that the latter disease,when simple, is very rarely occasioned bythe erosion of a large blood-vessel; and that,in the majority of cases, the haemorrhage re-sults from an exhalation of blood on somepart of the mucous membrane of the respi-ratory channels. Now, the state of the mu-cous membrane predisposing to this affec-tion, is certainly not common in this island ;a state widely different from that which in-duces the diseases, known by the generalterm catai-i-hal, prevalent under the meteoro-logical influences which characterise thisclimate.

" From the preceding g observations, it maybe seen that I consider Jersey entitled to avery high character, among the Englishclimates most suited to invalids labouringunder incipient pulmonary consumption, andidiopathic haemoptysis."

POISONING WITH ARSENIC, PERVAGINAM.

MORGAN J.

To the Editor of THE LANCET.

SIR:—Regarding the different modes inwhich arsenic has been administered as apoixon, allow me to mention the followingvery unusual one :-In the 11 Comment deRebus," Leipsic, 1793, tom. 35, and in" Metzger," p. 390, we find the story of twowomen-" Quibus per vaginam oxidum ar-senici marito admotnm est. Occubuere am-bae; harum una inopinato et perdurantehorrore et urente vaginæ dolore correpta estet post vomitus fere continuos et deliria,elapsis 28 horis ab applicatione veneni,mortua est. Sectio monstravit abdomennon tumidum, nnllas in cute maculas, labiaoulvae magna paulum tumida et rubra; invagina, patula flacida pauca grana arsenicicrystaHini/’ Permit me to take this opportu-nity of adding, that I think that the publica-tion of the valuable Lectures of Professor A.T. Thomson have considerably advancedour knowledge in medical jurisprudence,a branch which had hitherto been so muchneglected. I am Sir, yours, &c.

August 31,1837.

THE LANCET.

London, Saturday, September 16, 1837.

POISONING.—RIVALRY IN PRACTICE.

THE subject of medical education, whichwe last week noticed as one that was parti-cularly suited for discussion at the presentmoment, overflows with interest and import-ance, not only to parents and pupils, but tomedical practitioners themselves, who have

quitted the closet of study for the field

of experience. The road of connection be-

tween the quarters of the medical studentand the domain of the surgeon is a brief

threshold, and the practitioner who thinksthat he may cease to regard with anxiety the

proceedings in the one, can attach but littleinterest to the privileges, the profits, andthe reputation of the other. He may not be

an examiner at the College or the Hall, orlive in Lincoln’s-Inn-Field or Blackfriars,in such a position as to witness the ceaselessinnux of new competitors from the little

schools of medicine to the great school of

practice. But to suppose for an instant that

he can regard with indifference the possi-bility of his being either ruthlessly trod-

den under foot by a crowd, or honourablyand effectually assisted in his labours as a

physician and aman of science, by colleaguesfresh from the halls of science,-this is to

suppose the practitioners of England insane,or conceited, or criminally indifferent to animmeasurable extent, where reason, the com.monest prudence, and praiseworthy sensibi-lity, should be prominent characteristics oftheir thoughts and actions. Indeed,were thereno other motive to incline them to watch nar-

rowly the condition of medical education, thisalone should suffice to induce a minute at.

tention to its details,-that the mark on thescale of knowledge which the candidate forrank in the profession is required to reach;determines the number and character of ri-

vals in the arena of practice ; for it is pastall question that a large amount of scientificattainments is inconsistent with an excessive

902 MEDICAL EDUCATION.

number of medical licentiates and diplo.matists.

Let ns not be misunderstood,—though bythis time parentheses of explanation are

hardly necessary to ensure a comprehensionof the views and language of THE LANCET.

Referring to a high scale of medical ac-

quirements in the student, we have in viewno plausible scheme of recognised " lec-

" tures and " dissections," "indentures"‘

and hospital attendance," strained to thehighest point of exaction,-the screw car-ried to its last turn,—a curriculum to emptythe pocket. Oh, no ! Against Hall " Re-" gulations" and College " Proofs"—" Tes-" timonials" and " Certificates,"—thoseemblems of false education,-the professionare already at war,-constantly struggling intheir arduous duties to themselves and the

community. Our pages incessantly teemwith evidence of the miserable strengthwhich can be covered by a mail of " certifi-cates." We advocate not the presentationof a single testimonial of any qualificationbut that of morality, of any fact but thatof age, and it is the fallacy of every other

certifying document that we would impresson the minds of our brother seformers.Even those which we recommend are opento falsification, but they do at least affordsome evidence on matters the truth of

which cannot be estccblislaed in any other man-

ner, while there does not exist a singlepoint in medical science on which the stu-dent cannot be efficiently tested by examina-

tion, nor one in which written assertions

may not involve, either forgery, or misre-presentation,-a circumstance which has

become so common, so notorious, that theCollege of Surgeons has itself issued an-nouncements and prospective cautions on

the subject.But the system of admitting candidates

to examination without the presentation of"certificates " relative to time and place of

education, is fraught with advantages to theprofession which have hardly even been

broached. In the propriety of testing can-didates by the amount of their knowledge, as

an efficient means of ascertaining their com

petence to practice medicine, the efl’ect on

the mind, and manners, and disposition, of the

preliminary study, which is likely to be

wrought under the new system, has been

almost wholly overlooked." Didicisse fideliter artes,

Emollit mores, nee sinit esse feros."

Worthy of universal honour and assent isthe saying, and, with a slight parody, espe-cially applicable to medicine. The heart-

rending contests in the field of practice arenot carried on with men possessing claimsto rank as pathologists and physiologists,as chemists and botanists,--established likethe claims of those of our students who have

really acquired for themselves the characterof accomplished scholars,—but with the

shedders of tears, the exhibitors ofpihtols,the brain-stumbling, jalap-puzzled fellowswho creep or bully through the Halls and

Colleges, with a keen sense of having dearlypaid for every certificate named in the regu-lations of those institutions, and being there-fore entitled to receive the quid jx’o quo,—the exchange of the small currenev of the" recognised," for the large curreney of the" recognisers."The first advantage that would result

from adopting the new terms of admissionto practice, would take its date even so farback as the earliest stage of medical popi-lage. With a clear knowledge of the highstandard of qualification which must dis.

tinguish future candidates, parents wouldnot indiscriminately devote to the study ofmedicine either son of an unequally en-

dowed family. They would select the

youth with a careful estimate of his naturalqualifications, and then, frem the first, di.

rect the energies of his mind to those pre-paratory branches of learning which formthe outskirts of the science. At no time

would he be voluntarily placed for longintervals where nothing that was accessaryto medicine could be reached; and in dueseason he would have secured to him the in-

struction of an efficient friend and master,who would at the same time subject him

903BAD MEDICAL GOVERNMENT.

to the softening influences of good society.The discipline to which the mind of a

youth would thus naturally, and in self-

defence, become subjected, would eventu-

ally have the most important and permananteffects on his intellect and inclinations, sup-plying to the country a highly accomplishedand polished physician, and to the profes-sion a suitable and welcome associate. At

present, however small may be the minorityof those who do not bear this character on

their entrance into practice, the number is

quite sufficient to effect the most deplorableand mischievous consequences on the wel-

fare and happiness of the great bulk of themedical community+A calm consideration of these facts al

lows English surgeons in general practiceno alternative, as friends to their own inte-rests and the public good, but to pronouncea verdict of " abolition" against the presentsystem, and demand the adoption of an iini-form and perfectly free plan of medical edu-

cation, crowned by public examinations.

To the long-continued enemies of this greatand extensive change in medical law, allappeal is perfectly useless. Their sense of

justice, their sentiments of decency, theirfeelings of sympathy for the much-wrongedprofession, have by turns been supplicatedand provoked-all and ever in vain, and

they will finally quit their hold upon thereins of medical government without the

solitary merit of having conceded a singlereform, without having modified even oneprinciple, in their vicious system of mis-rule. It is for the profession at large to

hasten the emendation which so deeplyconcerns the public and private interests ofthe faculty of medicine in this country.The time is fast approaching for the em-

ployment of vigorous measures on this sub-

ject. Meetings should everywhere be held,and petitions, praying for the institution oj

a national faculty of medicine, founded orthose simple principles which we have overand over again shewn to be best calculatedfor the security of the public health, and thehonour of the profession, should pour it

from all quarters to the legislature on thenext meeting of Parliament. These demon-

strations of opinion will be rewarded in

proportion as they are clearly and firmlypronounced. It will be impossible in theface of the overwhelming majority of theprofession, and the astounding facts bywhich its petitions may be supported, to re-ject the prayer.The volume of Mr. DEKHAM, which we

noticed last week, contains many passageswhich we designed to quote in this Num-ber of our Journal. Space, however, will

only allow us to close ourobservations withthe following extract on two or three of the

subjects which have just occupied our at-

tention, simply remarking,—with referenceto the final sentence of the passage,—thatthe abolition of existing laws may suffice in

the way of abolition at present. Under a new

statute, and with a new " structure," the old

corporations and chartered bodies would

quickly enough abolish themselves:—It is indeed a melancholy fact that, to

whatever part we turn of medical affairs, weeither behold the supine indifference of Go-vernment to that which should be the firstconsideration of intelligent rulers, the pub-lic health, or the reckless want of publicprinciple in those who have assumed a supe-riority over their compeers, and have con-trived to rule them with absolute sway. Itis, however, to be hoped that a better stateof things is now dawning upon us, and thatMr. Warburton and the Committee of Medi-cal Inquiry, will be able to propound ascheme of medical reform, which, by en-forcing a uniformity of education for all me-dical men, and a consequent uniformity oftitle, will give to the public the best possi-ble security that their health and lives areentrusted to the care of able and scientificmen. When we consider how immense is

the number of practising surgeons in thiscountry, and reflect upon the vast amount ofmortality and disease that must come annu-ally under their view, we cannot but be-lieve, if they practised the profession as a.

science instead of as a trade, that they wouldOf necessity, long ere this, have arrived atmuch greater certainty in practice, and haveobtained far greater aptitude in the diagno-

sis and cure of disease. In the present stateof medical government many young surgeonshave to learn the practical part of their pro-

fession after they have undergone the ordealof obtaining a qualification from our licens-1 ing bodies ; and embarking, as many of them

904 GUY’S HOSPITAL.—APOTHECARIES’ HALL.

do, in practice, as soon as their hospital stu-dies are finished, without, probably, anyprivate resource to support their station insociety, and without, perhaps, feeling anyvery ardent love for science, it is not verymuch to be wondered at that they forget thedignified character of the profession theyhave chosen, and follow it with scarcely anyother view than that of mere emolument.Nor is the course of study which studentsgenerallypursue in London much calculatedto excite their feelings for the cause of sci-ence ; for the whole routine of educationthere, notoriously, has been but little adaptedto bring into action the latent powers ofmind; and it is equally notorious, from theway in which examinations are conducted,that the possession of the diploma, or theempty title of M.D., is no proof whatever oftalent in the possessor, for the examiners,good souls, having themselves imbibedlaro-ely the milk of human kindness,’ whena candidate falters in his examination, veryconsiderately set it down to his mental per-turbation, and believe that the appearanceof their august selves has turned his mindquite topsy turvy ; doubtless forgetting thatan individual who thoroughly understands asubject, can find no difficulty in so arranginghis ideas as to be able to reply to any ques-tion that may be proposed respecting it.Here again the iniquity of self-perpetuatingmedical corporations rises to our view, andwe scarcely know which to condemn the most,whether the sins of those chartered bodies,or the all but criminal indifference of Go-vernment. Had our medical corporationsbeen differently constituted, and the indivi-duals at the head of them, instead of beingbehind, been but a little in advance of the, spirit of the age,’ the indifference of Go-vernment to protect the public health wouldhave operated but little to the general preju-dice, and results the most beneficial to thepublic and to science would inevitably haveoccurred. As it is, we can only lament thedegree of selfish weakness to which humannature is often obnoxious, but being able tosee their error, we should profit by the cir-cumstance, and bear in mind that it shouldalways be the endeavour, even of corporatelaw-makers, to obtain the greatest happi-ness for the greatest number.’ Of this, how-ever, I am assured, that no ’ reform’ of thoseinstitutions that can be effected will be oflasting avail, they must be altogether and ttt-terly abolished, and a renovated structure raisedin their stead.’—P. 64—67.

Guy’s HOSPITAL.—(From a Correspond-ent.)—To those who are acquainted with themanagement of affairs at Guy’s Hospital,little surprise will be created by the ap-pointment of Dr. BABINGTON to the office ofphysician, left vacant by the death of Dr.CHOLMONDELEY, and the consequent dis-

placement of Dr. HODGKIN. Many years ofsevere duty at Guy’s, as curator of the Mu-seum, as lecturer on pathology, as demon-strator of auatomy, with the most profuseadulation of the treasurer during that pe-riod, and continued avowals of extravagantadmiration of everything as it existed in thatinstitution, would seem to present strongclaims in favour of Dr. HODGKIN, but KingHARRISON thinks otherwise. It seems thatDr. HODGKIN is a Dissenter-that he is sup-posed, under the rose, to be liberal in poliotics, and, above all, he is one of the membersof the new London University! Is it won-derful, then, that the distinguished medicalacquirements of Dr. BENJAMIN GUY HAR-RISON BABINGTON should supersede everyother consideration or claim? Sic volo, sicjubeo.

’ *** Why, yes, this is rather hard treat-

ment, considering the services rendered toHis Majesty, from the time of the death ofSTEPHEN POLLARD to the present moment.

GUY’S HOSPITAL OPERATIONS.

To the Editor of THE LANCET.SIR:—The two following instances, which

have occurred within the last month, willshow how the pupils of Guy’s Hospital aresometimes treated. Going through the

wards, on a Thursday, Mr. Key said, "I’lloperate on that man next Tuesday, gentle-men." When Tuesday came, the operationhad been performed four days. On the fol-lowing Wednesday Mr. Key said, "I’ll re-move that man’s testicle, gentlemen, on

Friday." On going to the hospital on Fri-day, to see the operation, the first questionthat 1 was asked was,

" Have you seen thepatient who was operated on yesterday?"" No ; what was the operation ?" "Mr..Key removed that man’s testicle, because itwould save him the trouble of coming tothe hospital to-day." I am, Sir, your obedi.ent servant, A PUPIL or Guy’s.

Guy’s Hospital, Sept. 1807.

EXAMINATIONS AT APOTHECA-RIES’ HALL.

THREAT OF SUICIDE.

To the Editor of THE LANCET.SIR:—It has afforded me great satisfac-

tion to see in your widely-circulated Jour-nal the recent exposures of the system ofexaminations conducted at Apothecaries’Hall, which must operate most injuriouslyto the best interests of society. Probably youwill allow me to mention a circumstance thatoccurred on the night on which I presented