424

THE LANCET.

LONDON, SATURDAY, APRIL 15, 1848.

PROSPECTS OF MEDICAL LEGISLATION.-THE INQUEST AT BARNES.

THE representatives of the various London Colleges ancExamining Boards have now notoriously failed in settling th<data of their several Charters and a Medical Reform BillThe combined wisdom of the College of Physicians, the Collegeof Surgeons, the Apothecaries’ Society, and the quasi NationalInstitute, appears to have suddenly melted away like summer’ssnow. The names of Presidents, Registrars, and Masters, gofor nought; the bills they draw are dishonoured. The first

blunder of the allied corporation was in the affixing wrongdates to the clauses sent forth by the Council of the ProvincialAssociation, for the discussion of the provincial physicians.The next was, in the exposure of the utter want of under-

standing between the high officiating parties, before the

Parliamentary Registration Committee. It required but afew plain questions to knock all the wise heads together insevere and painful concussion. The 11 Principles" disappearedlike magic before two or three humble notes of interrogation.There are few men now in the profession sanguine enough tobelieve that the so called "heads" can arrange even the basis

of an acceptable measure of reform. Four bodies cannot

legislate for forty different interests. London will not be

allowed, through its two colleges and its one drug company, togive laws to all the British Universities, and to all the Collegeshnf.h nf Frlinhnrah <1,ntf Tlnhlin.

Under this phase of the subject, when the select corporationshave failed, why should not a body representing the interestsof all medical classes in the United Kingdom be formed inLondon to attend the solution of the medical Sphinx.Surely CErus will as probably be found among the

men as among the magnates of the profession. At

all events the trial is worth being made. In the

first place, as a reason for this measure, the actual state ofthe medical profession must be considered AS IT IS. Presi-

dents and censors have a strong tendency to recur to primi-tive charters, which, although not actually subverted by kingsregnant, have long ago been overthrown by King CommonSense-the most mighty and enduring monarch, after all, inthese days. But we repeat it-medicine must be looked atas it is ; we must study the living, breathing body politic, andnot the gaunt and bony configuration of the skeleton whichexisted two or three centuries ago.We take it for granted, that there is in London, at this

time, actively engaged in practice, men educated under everymedical body in the three kingdoms. To pass by graduatesof the universities of Oxford, Cambridge, and London; thefellows, licentiates, and extra-urbem licentiates of the LondonCollege of Physicians; the fellows and members of the Col-lege of Surgeons of England; and the intra and extra urbemlicentiates of the Apothecaries’ Society;-to pass by these,we assume that London can produce specimen.<; from all the

universities and colleges of Scotland, and from all the uni-

versities, colleges, and halls of Ireland. Why, therefore,should not a body formed of all these elements be organizedin London, to deliberate upon legislative measures for theweal of the profession at large 1 They would certainly be aslikely as the more select few to settle the first principles of

medical reform; and at all events they have not tried their

hands, like the latter, and failed; and they certainly would

- be quite as fairly the representatives of the profession.-

But there are even more classes within the profession thanthose made by universities, colleges, and halls. There are

surgeons practising as physicians; apothecaries as surgeons,I

and surgeons as apothecaries; men with only a surgical, or amedical, or an apothecary’s qualification, are practising as

.

general practitioners; and men with two, or all three of these’

qualifications, are doing the same thing. There has been,.

owing to the neglect of the authorities, the absurdity of the’

laws they have had to administer, and the absolute require-ments of the public, such a general emigration and immigra-tion going on between the different ranks of the profession,that the Gordian knot can neither be untied, because of itsintricacy, nor cut arbitrarily without manifold injustice. In

such a dilemma, either the power of action must be given toone man, or one trustworthy body; or the general suffrages ofall the parties concerned must be consulted. The latter is theone most consonant with the times and the temper of the pro-fession, and it is one which we believe should be tried. Men

of all ranks-qualified men practising under every variety ofcircumstance-should meet together, and discuss the presentcondition of the profession.

Without some such general deliberation, we may go on foryears without progress. In results affecting the good or illof a whole body, like the medical profession, and all otherscientific bodies essentially republican, no one class can bejustly omitted from the deliberations. The Oxford graduatemay sneer at a convention between himself and the Dublin

apothecary; but nevertheless the voice of both must and willbe heard; for the experience of the past most assuredly is, thatany one class in the profession, however humble, may prove

obstructive to legislative measures. We have only the choiceof seeing our noble profession torn and wounded by internaldissensions, and injured by external quackery in every form,or a fraternal reconciliation between all its now dissonant and

disjointed members. With such a choice what true ZQ1Je1’ Q/inedicine would hesitate ?

AT page 426 we publish a report of an inquest at Barnesupon the very rare and remarkable case to which we havepreviously alluded. It is, we believe, the first public inquiryinto a death resulting from the accidental entrance of airinto a vein during an operation. The case itself occurred in

the practice of Dr. WILLIS, of Barnes, and it is not a littleremarkable that Dr. WILLIS should have had in his neigh-bour, Dr. CORMACK, the gentleman first called upon to assistand also the practitioner who in this country was the firstto investigate this subject experimentally in a satisfactorymanner. We cannot but agree with Drs. WILLIS and CoR-

MAOK, and Mr. SYME, in their view of the proper treatmentof such an accident; indeed, the symptoms during life, andthe post-mortem appearances as witnessed in experiments,forcibly suggest the treatment required.

Dr. CORMACK, in his prize thesis, (Edin. 1837,) has the fol-lowing passage, which contains the gist of the entire subject:" The deleterious effects resulting from the entrance of air"during operations is purely mechanical, and the death ofthe patient depends simply upon the contractions of t" right side of the heart being arrested and greatly im,4ded

425RETIREMENT OF MR. COOPER.-ARMY AND NAVY SURGEONS.

"in consequence of the presence of that elastic fluid. Hence assembled pupils; could they but have seen the testimoniesit is naturally suggested that the means most likely to of respect and attachment towards the teacher, mingled with&laquo; afford safety to the patient, will consist in relieving the those of disgust at hearing that any member of the institu-heart with the greatest possible expedition :’ Dr. CoR- tion could be found capable of rendering his position un-MACK’s experimental inquiry appeared also in 183’7. In 1843, comfortable or painful; could they but have seen that feelingDr. WATTMANN, of Vienna, published an elaborate memoir rise to an outburst of indignation, when it came to be under-on "A more sure method of treatment in the rapidly dan- stood that his retirement was extorted, and not voluntary;gerous entrance of air into the veins; and on its medico- they would be disposed to pause and inquire what were thelegal importance." A critical analysis of this work is means by which such an end had been accomplished, andgiven in the Edinburgh Monthly Journal for July and Sep- what could be the objects its promoters had in view Thetember,1844. Others have also published on the same sub- chair of surgery, however, is now vacant at Universityject. College, and the circumstances which have led to that

With reference to the Barnes Inquest, it is scarcely neces- vacancy form a subject of general conversation. We thereforesary to observe that the unfortunate death of RICHARDS was thus early inform the Council that their steps in makingsimply an accident, and one attaching no blame whatever to a new appointment will be closely watched by the pro-the operator, but upon whom the case reflects credit, for fession. Another serious error committed at this juneture,having at once recognised the exact nature of the accident. and the ruin of the medical department of the College willTo the correctness of the diagnosis we must attribute the become inevitable. Of course the vacancy will be publiclyfact that the patient’s life was prolonged so many hours-a announced, and that the election will be bon&acirc;fide and abovecircumstance which we believe has rarely if ever happened suspicion.in any previous case. One point may possibly suggest itself to On this occasion it will not be tolerated that the gentlemenoperators-namely, the utility of substituting issues for who have been educated at University College should be ex-setons in the cervical region, where the suction-like action of eluded from the contest for the vacant chair.

inspiration renders this accident possible whenever a vein -may chance to be divided. IT is impossible that, in the present shifting attitude of

human affairs, under the influence of tempered and salutaryTHE Medical School of University College has just received innovation, injustice shall be persistently done to an entire

another shock, scarcely less severe than that caused by the class, forming at once one of the most deserving and mostlamented death of Mr. LISTON. The Chair of Surgery is no necessary portions of the community, whether military orlonger occupied by Mr. SAMUEL COOPER. This gentleman deli- civil, if that class but unites in defence of its just rights andvered the concluding lecture of his course a few evenings privileges.ago, and announced the fact of his retirement to his class. We would here refer generally to the depressed conditionHe added, that the proceedings of one or two of his col- of the entire medical profession, as compared with that of theleagues had recently been of such a character that he could law, the church, the navy, and the army; but such a col-be no longer happily associated with them, and that therefore lective exposition in any single article is impossible, and wehe had resolved on withdrawing from the institution. He therefore direct our present remarks to the ill-treatment, bybegged that it might be distinctly understood; that neither exclusion from honours and rewards, of the surgeons of the

advancing years nor declining health had led to this determi- army and navy, remarking, that we shall not cease to agitate-nation, but that it was solely owing to the feeling that one or for their rights as a salient portion of the rights of the entiretwo individuals exercised an undue influence over the Council body medical. It is now painfully felt, that whilst everyand the Senate-an influence which permitted them to assume other class of officers in the public service is rising higher, thea dictatorial and an unjust power in all the proceedings of medical officers are falling lower. This, indeed, is every-the College. This is truly a painful and an alarming statement where the result of exclusion; for exclusion is a fact for everto be thus wrung from any man, but more particularly from prominent in the public eye; but not so the merits and desertsa gentleman who for seventeen years has discharged the duties of the excluded. The superiority, too, claimed in consequenceof his important -office with the highest distinction and suc- by the party exclusively possessed of honours and privileges,cess. His pupils have at all times looked to him with the though not a whit more deserving than those deprived ofmost sincere devotion. His writings have obtained for him a them, greatly aggravates the sense of injustice; and it is now,deserved celebrity, both at home and abroad, whilst his up- for this and other reasons, beginning to be felt intolerable byright and honourable demeanour towards all men has ac- army and navy medical men.

quired for him an amount of professional respect and personal Why, then, do not medical officers of the public services,regard, which few can hope to attain. We can readily picture on the retired lists, address their petitions to the House ofto ourselves, then, how painful it must have been to such a Commons ? We feel assured that a tithe of the facts andman to separate from those with whom he had for so long a reasonings recently advanced in this journal, if placed in theperiod maintained that friendly and affectionate intercourse form of petition by the sufferers from injustice, would cer-which grows up between the teacher and the pupil, and how tainly meet with some consideration. The claims of thethat pain must have been aggravated by the reflection that medical officers of the army and navy are so plainly un-the separation was pressed upon him by the conduct of some answerable, that they must be heard. Petitioning, we regretof those with whom he was associated as a colleague. Could the to state, is the only course. We advise our friends, whoseCouncil but have witnessed the effect which the announcement interests are concerned, to lose not ime in this matter. Their

of Mr. Cooper’s retirement, and the cause of it, had on the longsuffering and silence are already being construed to

426 ARMY AND NAVY MEDICAL OFFICERS.-THE INQUEST AT BARNES.

their prejudice by their enemies. Men who never complainare but too apt to be overlooked or considered devoid of realgrievance. This misrepresentation and injustice should nolonger be tacitly permitted. Let Mr. GUTHRIE, and otherslike him, who have bled for their country without reward,bestir themselves, as is their duty, and this grievous ill-usageof some two thousand of our brethren will be remedied. To

mortify a man’s natural pride, to limit his resources, and set amark of exclusion, privation, and consequent degradation,upon him, is the only species of persecution of which thefeeling and cultivation of the age will admit. This kind of

persecution has long been applied to the medical officers of

the army and navy, because they have never acted in resist-ance to it. How long is this supineness to last ?To these remarks we appropriately append two memo-

randa, drawn up by as brave an officer as ever served hiscountry. It describes a career of forty years of danger andprivation, without a single honour or privilege, except thebare pay and professional promotion, which, as it falls bydeath or rotation, without desert, brings but little considera- ’tion to the possessor, and is no encouragement to others. If

such a man had entered the army as an ensign, his position,after twenty years’ service, would have been infinitely betterthan it was in the medical department after forty years." Memorandurn of the S’ervices of Staf-surgeon Donald Macleod,

M.D., presented to the Duke of Wellington.

Previously to entering the regular service, I was surgeon’smate of the 1st battalion, and surgeon of the 2nd battalion ofthe Breadalbane Fencibles, from the 25th February, 1798, to24th March, 1799. I served with the Duke of York, inHolland, in 1799; in the Mediterranean, to the end of thewar in 1802 ; at the capture of the Cape of Good Hope,under Sir David Baird; at Monte Video, under Sir SamuelAchmuty; and at Buenos Ayres, under General Whitlock.I went to Portugal with Sir Arthur Wellesley, and was in allthe operations of that campaign, to the battle and embarka-tion at Corunna.

" I was at Walcheren during the whole time it was occupied,and returned to the Peninsula in May, 1811. I was in thebattles of Salamanca and Vittoria, and at the sieges ofBurgos and St. Sebastian, and in all the actions fought in theneighbourhood of Bayonne and Orthes. I embarked at Bor-deaux, for Canada, with the brigade commanded by Major-General Robinson, and served there for a year, during whichperiod I was present at Plattsburg, and at most of the ope-rations on the lower frontier. On my return, I joined thearmy in France, and remained there till the formation of theArmy of Occupation." I did duty at Dover and in London, from June, 1816, to

May, 1821. On retiring on half-pay, I went to New SouthWales, with the governor, Sir Thomas Brisbane, where I Iremained about four years, and although not absolutely em-ployed in the medical department of the army, I was still inthe king’s service. , " , , " .

"I am now returning as staff-surgeon to that colony, withoutone single advantage, and with nothing but the bare payof the rank I have held for twenty-four years, in every.quarter of the globe. This is my position, after a service oftwenty-nine years and four months.

(Signed) "DONALD MACLEOD, M.D.,"London, 15th August, 1827. "Surgeon to the Forces.

"There is little to add to the above statement. I sailedfrom the Cove of Cork on the 27th September, (being thefifth time I left that place for foreign service,) and landed atSydney on the 3rd of January, 1828. I remained as staff-surgeon and principal medical officer of the colonies of NewSouth Wales and Van Dieman’s Land, to the 17th of January,1830, when I sailed for Bombay, having been appointed deputy

inspector-general at Bombay, where I arrived on the 16th ofApril, and remained in that presidency till the 8th February,1834, when I was transferred to Madras, and from thencepromoted to be inspector-general in Bengal, in July, 1837.

"DONALD MACLEOD." r

DEATH FROM AIR ENTERING A VEIN IN THENECK, DIVIDED WHILST INSERTING A SETON.

a ON Wednesday, the 29th of March, an inquest was held atthe Red Lion Inn, Barnes, before W. Carter, Esq., coroner forEast Surrey, on view of the body of William Richards, aged

e thirty-nine, a coal-porter. The professional witnesses ex-

f amined were Dr. Willis, of Barnes, Dr. Cormack, of Putney,and Professor Syme, of University College, London.f SARAH RICHARDS&mdash;The deceased was my husband, and we_

lived together at Hammersmith, in the county of Middlesex.-

For the last ten weeks my husband had been ill, but he wascomplaining a good deal of his throat before that time. I

. understood from Dr. Willis that lie was suffering from in-flammation of the windpipe. On Saturday morning, (25th

’ March,) about half-past eight o’clock, he left home, to go toDr. Willis’s house. He would not allow me to accompanyhim, but as I understood that he was to have a seton put into

’

his throat, I followed him, thinking that he might perhaps’ feel sick, and require my assistance in walking home. I

waited for a long time outside, and at last became veryanxious. When I saw Dr. Cormack come out, I asked if he

had seen a poor man with Dr. Willis ? I was told that de-ceased was very ill. Dr. Willis, at Dr. Cormack’s request, cameout to me. He said that he was glad I had come, and askedme to go into the house. I found my husband insensible, andlying on the floor. Dr. Willis explained to me that his statewas owing to the operation, and advised me to prepare forthe worst. I have no charge to bring against Dr. Willis.Both my husband and I had perfect reliance in his skill, andwere grateful for his kindness. This inquiry has not beeninstituted at my request. The parties who are said to havewished it are not now present.DR. WILLIS&mdash;The deceased first applied to me for advice on

Saturday, the 11 th of this month. He was labouring underchronic laryngitis, which is inflammation of the upperpart of the windpipe. I first treated him by leeching, then byblisters, and lastly, proposed another method of counter-irritation&mdash;viz., a seton. This is a remedy by which I have curedsimilar cases. Chronic laryngitis is a very dangerous, andindeed, commonly, a fatal disease. The introduction of aseton, in the situation in which I operated in this case, is atrifling operation. Setons have been inserted hundreds oftimes in the same part, for the well-known disease termedgoitre, or swelled neck. On Saturday last, the 25th, deceasedcame to me about nine o’clock, and in a few minutes I wentinto my room, and prepared what was necessary. The de-ceased was most anxious to have the seton put in. I set himin a chair, instructing him as to the proper attitude. Hethrew back his head, which, by keeping the parts tense- he being much emaciated-was inconvenient. I desiredhim not to do this; I then pinched up the skin with thefinger and thumb of the left hand, and immediately thereafterthrust in the seton-needle, armed with a strip of lint. Theseton-needle used was about the size of a common bleedinglancet. It entered horizontally, about two inches and a halfabove the breast-bone, and not at all near the jugular vein,or any other important bloodvessel. At the instantof its entrance, I heard a slight, momentary, hissingsound. At first, 1 thought that I had opened into a sub-cutaneous abscess, communicating with the windpipe; butalmost at the same moment, I looked in the poor man’s face,and saw that another and far more serious event had occurred- that the rushing of the air was not out from the windpipe,but into some small vein which had been implicated in theoperation. The man was deadly pale, his features were set;he fainted, and subsequently became rigid and convulsed. Ikept my fingers on the openings, to arrest the farther entranceof air during inspiration; I caught the man, and laid himdown on the floor. At this time I was quite alone with de-ceased, but in a few minutes a servant came, whom I sent forone of my nearest neighbours, Mr. Coppleson, the rector. Ialso despatched my carriage to Putney, for Dr. Cormack, orany other medical gentleman who could be found at home.Dr. Cormack was with me in half an hour. The man wasthen rigid and insensible. I told the doctor what had occurred.He examined the case, and entirely concurred with me as to.the nature of the accident. We consulted together, andagreed that it would be neceseary to attempt to relieve the