113

THE LANCET.

LONDON: SATURDAY, JULY 19, 1884.

SIR LYON PLAYFAIR AND THE MEDfCAL BILL.

WE deeply regret to have to say that the Government arein danger of surrendering the most vital point in theirMedical Bill, and we confess to feeling the utmost anxietyas to the measure. If there is one thing more than anotherwhich all medical reformers have desired, and for whichthey have laboured from the time of the founder of this

journal till now, it is the creation of a single portal tothe profession, through which all its members would haveto pafse. Whatever higher title they might attain, all wereto pass through this one gate. The public is often dupedwith titles. Many bodies, even universities, have been wellknown to dispose of their highest titles on the lowest terms.There is nothing in a high title to guarantee a high exami-nation. And many a meritorious medical man with humble

title is placed at a disadvantage by a neighbour who hasfound medical authorities base enough to give him a high-sounding title on low terms in respect of everything butmoney payment. The Bill of the Government as originallyintroduced provided two or three safeguards against thetrade in high titles. It provided that higher titles were onlyto be registered on condition of the Medical Council beingsatisfied that they were obtained after higher examinationsthan those for the licence to practise. This safeguard wasabandoned last year. The Bill further provided-as every Billfor the last fifteen years has provided-for the creation of asingle board in each division of the kingdom, the examinationof which every medical man was to pass. The passing of thisexamination alone was to entitle the successful candidate

to a licence to practise. Though a minimum examination,it was to be essentially a sound, honest, and disinterestedone As a common test, it was to try not only everystudent’s work, but the work of the schools in which he hadbeen educated, and incidentally the nature and stringency ofthe examinations of other bodies which he might have

passed. It will not readily be believed that the Governmentis going to abandon this essential provision of their Bill andof all similar Bills. If they do so, they will deeply dis-appoint the profession.The gentleman under whose persuasive eloquence they are

said to have been induced to take this step is Sir LYONPLAYFAIR. The Government will make a great mistakeif they attach too much importance to the somewhat

crotchety and warped views of Sir LYON PLAYFAIR.

They should remember that he is not a member of

the medical profession, and that the near approach of ageneral election, in which he is threatened with the loss

of his seat, may explain his protesting so much about

the interests of the Scotch universities. Sir LYON boasts

of the number of his medical constituents. But he

greatly mistakes the views of medical men if he thinks tcadvance his political interests, or those of the Government,by inducing the Government to abandon the One-portalsystem. Medical men will never forgive such a use of his,not medical, but quasi-professoria position in the House

Better far to be represented by a lawyer, by one who hasno half knowledge of the profession, giving a false valueto his views, than to be thus misrepresented. The more

closely Sir LYON PLAYFAlR’S amendment is examined,the more does it appear full of most doubtful suggestionsand statements : as that " the profession is undermanned,"whereas almost every place is overstocked, the last year’sRegister containing several hundred more names than thatof 1882 ; that "conjoint examinations alter the case and

guarantee satisfaction to the State," whereas the greatestscandals brought to light by the inquiry of the Royal Com.missioners have reference to bodies which have been actingconjointly for years ; that the "creation of a sound and in.dependent minimum examination will lower all examina-

tions and make men more indifferent to higher degrees anddistinctions," as if the raising of the basis of a pyramidcould lower its apex ; that " the highest professionalauthorities in the Commission were Mr. HUXLEY and

1’rof. TURNER," leaving Sir WILLIAM JENNER and Dr.

McDoNNELL out of account as supporters of a Final Board;and that " the universities of Scotland will be injuredand the demand for their degrees lessened by the creationof such an examination." How comes it that such Scotch

graduates as Sir ANDREW CLARK, Dr. DUCKWORTH, Dr.SPENCER COBBOLD, and others, have besought the Govern.ment to pass their Bill ’.’ Seriously, Sir LYON PLAYFAIRis degrading the Scotch universities by representing themas afraid of such a small measure in the interest of the

State ; and he is sacrificing the interests of the medical

profession, by whom hitherto he has been largely supported.We have throughout supported the Bill of the Govern.

ment. Not that it satisfies us. But in the present im.

potence of Parliament, and in the absence in it of even onemedical man who can rise above the standpoint of the cor.poration interests of nineteen medical bodies-half of whichare superfluous and need disestablishment-we were con.tent to take it as a measure of reform. But if legislationis to become a mere piece of accommodation, if the Scotchand Irish bodies are to dictate their own terms, if effete

bodies are to be perpetuated at the expense of the professionin the form of conjoint schemes, if the One-portal system isto be abandoned-then our interest in the Bill is gone, the

surrender of Ministers is complete, and the incompetence ofParliament to deal with such a momentous question is well-nigh demonstrated. We look forward anxiously to Mondaynight, in the hope that Mr. MUNDELLA will see through theweakness of the platitudes and the plausibilities of Sir

LYON PLAYFAIR’s amendment. In a very short time he

could demolish them with his own strong common sense, and

carry the House in support of the Final Board demanded bythe profession, recommended by the Royal Commission,and accepted by the House of Lords.

WERE the matter otherwise of isuflicient importance, it

would be an interesting etliical investigation to discover

what moral maxim, if any, underlies the action of the

dominant party in the Council of the Royal College of Sur.geons of England. It will be remembered that at the

general meeting of the Fellows and Members, held in theCollege on March 24th last, a question was asked respectingthe signiticaxice of a resolution of the Council. "Was it

114 "RESOLUTIONS" OF COUNCIL OF THE COLLEGE OF SURGEONS.

not a fact that it had been held in the Council that a Reso-

lution adopted by one Council did not bind another ?"

"Yes," said the President. "Then a Resolution of the

Council may at any moment become a dead letter ?" " Not

unless it were distinctly rescinded," promptly answered thePresident; " and no rescission of a Resolution of the Councilcan take place without notice, argument, and confirmation.The Council really ought to be treated as gentlemen " (!)Pressed a little more closely, the President devised thememorable but confusing duplex classification of Resolutionsof the Council-namely, first, " Resolutions which were in-tended to be directly operative when confirmed," and second," Resolutions which were not of an operative kind." It is

necessary to bear this discussion and apology in mind if wewould appreciate the meaning of a motion brought forward,after many postponements, by Sir SPENCER WELLS, at themeeting of Council held on the 10th instant, and referred toin our columns last week. Sir SPENCER WELLS pro-

posed to move-" That all confirmed Resolutions of the

Council be considered as in force until they have been for-mally rescinded, and that any existing Resolutions which arenot binding on the Council be rescinded." This was at lengthdivided into two parts. First, the Council was asked to pledgeitself to the view that all Resolutions of the Council shouldbe considered as in force until formally rescinded; in otherwords, that the Resolutions should in reality be directly" operative." This motion was negatived ; hence it logi-cally follows, in spite of the indignant remonstrance andprotest of the ex-President, that all the Resolutions of theCouncil shall as heretofore be considered as not in force, andthus they shall all continue to remain in the category of" inoperative " Resolutions. The second part of Sir SPENCERWELLS’ motion, " That all existing Resolutions not bindingon the Council shall be rescinded," was withdrawn.Now, what are the Resolutions which the Council has in

times past deliberately adopted, but which it now, as

always, with equal deliberation refuses to act upon ?They are chiefly these :-First, that no one who has beentwice elected a member of the Court of Examiners shall,at the expiration of his period of office, be eligible forimmediate re-election. Second, that it is desirable that

not less than one-half of the members of the Court of

Examiners shall be Fellows who are not, and have notwithin twelve months, been members of the Council.

Third, that the Minutes of each meeting of the Council shallbe posted in the Hall of the College within five days ofeach meeting. The first of these Resolutions was adoptedand confirmed eighteen years ago; the second and the

third fourteen years ago ; and yet we believe that not onehas ever been" operative." " As regards the first Resolution,it may be said that the present senior Vice-President is enjoy-ing his third period of office in defiance ofa confirmed Resolutionof the Council, As to the second, it is enough to recall thefact that at the present time every member of the Court oiExaminers is also on the Council, as well as one member ojthe Board of Examiners ; while as to the third Resolution,we doubt whether, outside the Council, twenty Fellows andMembers are aware that they are, by a confirmed h,esolutiorof the Council, entitled to read in the Ilall of the CollegEthe Minutes of the Council meetings within live days oi

the holding of such meetings. But when we remembe]

how the Council to the very last persistently and wilfullydisregarded a solemn obligation of a Charter respectingmembers of the Council who had ceased from the bond-fidepractice of the profession of a surgeon, it is not difficult to

account for the small value it sets on its own resolutions.

ALTHOUGH cholera has spread to some few outlying placesin France, yet the disease is still limited as an epidemic toToulon and Marseilles ; but in both these towns the averagedaily number of deaths has undergone an increase since lastweek. This is especially the case as regards Marseilles,where the deaths have for some days past varied from aboutfifty to seventy. What is in store for France and for

Europe cannot as yet be foretold. Twenty years ago, whenMarseilles received the cholera infection from Alexandria,it infected the rest of France, and before France admitteditself as infected, Valencia had received a serious amount ofinfection through it, and through Valencia all Spain becameinvolved. The policy of concealment, which has so largelyinfluenced the attitude of those who are in authority inFrance, is the least hopeful feature of the subject, and it isprobably to this attitude that some of the rumours as to thespread of the scourge are due, for the people themselvescannot believe that the Government allow the whole truthto be known.

The Academy of Medicine has wisely decided against anyattempt at an inland quarantine and sanitary cordons, deem-ing such measures to be impracticable in a commercial andpopulous country like France. They have also entered a

protest against the futile and vexatious processes of so-calleddisinfection to which people are subjected on entering Parisand other towns. This is a wise step, and it is to be hopedthat the energy which has been thrown away in this direction

will now be devoted to general sanitary measures, which, bythe removal of conditions of filth, will make the towns and

villages to which the infection may be brought less sus-ceptible of the disease. The danger as regards secondarycholera centres may be more and more removed as the

adoption of adequate sanitary measures shall bring withincontrol the conditions which usually lead to the spread ofwhat are known as filth diseases. It is also on these

measures that we must ourselves rely in case infection isimported into this country; and it specially behoves thesanitary authorities of ports and towns in frequent com-munication with France to set their houses in order from this

point of view, and so to hold themselves in readiness both asregards the removal of filth and the provision of means ofisolation that they will at once be prepared to face acy emer-gency. Scares are sure to arise, and the majority of themwill be either altogether or nearly unworthy of credit. One

has passed quietly by this week. The Carthagena has

arrived safely at its Welsh port, the few men who wererecovering from choleraic diarrhoea have been isolated, andthe danger is apparently over.During the past few days cases of so-called cholera are

alleged to have occurred in l,ondon. That they were notinstances of the genuine disease is tolerably certain fromthe subsequent history of the places and families in whichthey arose ; and we cannot too forcibly urge medical

practitioners to be careful as to the diagnosis which theymay make when called in to treat cases of severe diarrhcoa

115SMALL-POX IN SOUTH AFRICA.

such as always occur in the metropolis during the hot

summer months, and which are so often misnamed cholera.At the present moment the right course is to adopt the strictest preventive measures as regards isolation and dis- infection with respect to every case that may presentdoubtful features, and it will be policy in all such cases tocommunicate with the local medical oflicer of health; butit is at the same time no less important not to create a

panic by proclaiming a case to be cholera merely becauseit is fatal and has been accompanied by some of the signs ofthe epidemic disease. Some of our neighbours have alreadylost their heads ; during, at least, one of our previous epi-demics of cholera people in this country did the same

thing. It will be well to learn by experience, and to

remember that in the face of a common danger everymember of the community has a definite duty towards hisneighbour, and this duty he will certainly not accomplishby running away and so tending to increase a panic. There

is still time for householders to disconnect their houses from

the drains, to secure a current of air through all house drains, toremove all offensive appliances, fittings, and accumulations,and to see that water cisterns are clean and overflow into the

open air; and having done this they may, by the observanceof the most ordinary precautions, remain where they are, ata risk which is but trivial compared with that which manyare now running because they have not abolished from theirhomes conditions favourable to the spread of some of ourcurrent but very fatal preventable diseases.

THERE seems no improvement in the lamentable conditionof affairs that for many months has distracted the inhabitants

of the Diamond Fields. The Kimberley Board of Health,having expended over £16,000 in the attempted suppressionof a singularly fatal epidemic, finds itself in pecuniarydifficulties. Nor is this to be wondered at when one con.

siders that the great mining interest which represents themain source of income to the districts of Kimberley, Bult-fontein, and Dutoitspan has been led by what we venture tothink the mistaken policy and action of certain medical men.Surely it ought to be sufficient to convince the most scepticalthat a mortality of twenty-two out of fifty-three cases hasobtained in one district alone-the native location in the divi.

sion of Hay or Herbert. What does it matter to the victims

whether the plague of which they suffer and die is small-poxor "a disease allied to pemphigus," or the still more pro-blematical "varioella hmmorrhagica"? We have alreadyexpressed our firm conviction that there has been a visita-tion of genuine variola, notwithstanding Drs. JAMESON andWOLFF have declared to the contrary. In the Cape Timesof June 10th is the doctors’ report from Griqualand West.It is there stated that, whilst the epidemic ia causing greatalarm in Kimberley, Dr. WOLFF, one of the surgeons to themining boards, winds up a report with words to this effect :" The disease is a miasmatic one (like malaria), and notcontagious ; and the isolation of a hospital is hardly neces-sary, and the destruction of suspected contagious fomitesis a useless expense." Can it be matter of surprise that thelocal executive authorities find their work brought to a dead.lock when they are confronted with such compromisingprofessional opinion? A general idea of the confusion thatprevails may be gathered from the fact that at a meeting of

the Beaconsiield Town Council the following question wasformally put to the members : "Is the disease ’ small pox ’or ’so-called small-pox "?" It says something for the saga-city of these gentlemen that by a large majority they votedin favour of the latter description of the pestilence. 117e see

it is recommended that a commission composed of leadingmedical men in Cape Colony should determine the point indi9pute. Certainly a competent official tribunal ought to in-vestigate the whole matter; for as it stands at present, it isa scandal and a disgrace to the medical profession, and asource of immeasurable mischief to the community. Cannot

the Secretary to the Colonies see his way to sending out askilled and unbiased observer to examine and reporton the nature of the outbreak ?

Annotations."Ne quid nimis."

THE PRESIDENCY OF THE ROYAL COLLEGEOF SURGEONS.

IN our report last week of the meeting of the Council ofthe Royal College of Surgeons of England held on the 10thinst., we inadvertently omitted to state that Mr. Heath’smotion, "That at the ordinary meeting of the Council inNovember next, the Council do consider the mode of electingthe President and any alterations suggested in the methodof proceeding in the election," was carried nemine contra-dicente. At the meeting in November Mr. Heath will beprepared to present a scheme for electing the President, andit may be confidently assumed that this scheme will notonly depart from the existing absurd system of electing thePresident by rotation, but that it will provide for the electionin some such way as that suggested in a recommendationadopted at the general meeting of Fellows and Membersheld at the College last March.

I DIARRHCEAL MORTALITY IN ENGLISH TOWNS.

THE outbreak of cholera in the south of France investsthe usual advent of summer diarrhoeal fatality in our

English towns with more than the usual amount of interest.Although May was exceptionally warm, the mean tempera-ture and the amount of rainfall in June differed but slightlyfrom the average, and the deaths attributed to diarrhœaldiseases in the English towns during June were very con-siderably below the corrected average. In London, for

instance, the recorded deaths from diarrhoea and dysenteryin the four weeks ending June 28th were only 95, thecorrected average number in the corresponding period of theten years 1874-83 being 177. The materials for a similar

comparison as regards the mortality from diarrhœa and

dysentery in the twenty-seven provincial towns are not

available, but for present purposes it is enough to state thatthe diarrhceal mortality during last month was also below theaverage in these towns. At the beginning of the presentmonth, however, concurrently with a marked increase in thetemperature, the mortality from diarrhoea, showed a rapidincrease. The deaths referred to this cause in London,which had been but 21 and 39 in the last two weeks of

June, rose to 104 and 336 respectively in the first two weeksoi July, the latter number exceeding the corrected averagenumber in the ten preceding corresponding weeks by 115.In the twenty-seven provincial towns the deaths fromdiarrhoea, alao showed a marked increase, but the increasewas not nearly so great as that recorded in London; theywere 34 and 51 in the last two weeks of June, and rose to 71