529

THE LANCET.

London, Saturday, Jan. 15, 1831.

MEDICAL REFORM.—DUBLIN UNIVERSITY.

EvERY succeeding day affords some fresh

proofs that our predictions of the ultimatetriumph of Medical Reform are fulfilling,and furnishes additional motives to exer-

tion in the cause. It is not exclusively tothe efforts of the profession, however deepmay be the determination of the members

to obtain their rights, that we look for theaccomplishment of this great national ob-ject ; we trust, equally, for its consumma-tion, to the omnipotent will of a people whohave at length been taught, by necessityand the labours of the press, to understand

the nature of their grievances, and haveresolved on their removal. Medical, in fact,must stand or fall with political reform; forit is because the vices of our professionalcorporations have formed a part of the

system by which we are oppressed, that

they have hitherto escaped correction. Thatthe dissolution of the state monster which

vitiates whatever it touches, and the birthof a better order of national government, is

at hand, no one who appreciates the presentcondition of the public mind can for a

moment doubt, since there is not an indi-vidual in the empire, unblinded by igno-rance or prejudice, who is not convinced ofits expediency, the attention of the publicbeing at length directed to " measures,"instead of " men." The camelion of diplo-macy may, therefore, vary its hues to suit

the tints of prevailing parties, as often andas rapidly as it pleases ;-may pass throughthe intermediate shades from the saintly jetof Toryism, in which every ray of philan-thropy is absorbed in the darkness of self-aggrandisement, to the more luminous butless permanent colouring of Whiggery, inorder to preserve its integrity at the slightexpense of consistency of external appear-

ance ; but there is a spirit abroad too all.seeing and intelligent to be longer deludedfrom its purpose by mere semblances of

amelioration. However tardy in its march,it is at least consolatory to be certain thatthis philosophic spirit of reformation is onits way to our medical institutions, and itis the duty of every medical reformer, atthis particular period, to hasten its progressby every means in his power.With this view we proceed with our out-

line of the constitution of the medical

school of DUBLIN, whose absurdity has

long given its EDINBURGH contemporaryso decided a superiority over it. This la-

hour might be indeed completed with a fewlines of the pen, by stating that it was the al.most complete antithesis to the system which

prevailed in the capital of SCOTLAND. We

prefer, however, to enter somewhat moreinto detail, without encumbering the draftwith minute particulars. In the first place,the professors of the University, half of theIrish school of physic, were appointed bythe Board of the University; and as an

exemplificatiou of the efficient manner inwhich they performed that important duty,we may state, that not a single indivi.

dual, in the long course of their adminis-tration of this trust, with the exception ofthe present professor of anatomy, ever left,or is likely to leave, any important record ofhis labours or professional existence. The

election of the other moiety of the schoolof physic in IRELAND, the professors ofSir PATRICK DUNN’s establishment, whichis vested in the College of Physicians, mustbe either defective in theory or grosslyabsurd in practice, since the system hasnever secured to the school of DUBLIN a

man of any celebrity in science. Yet thoughthe power of appointment has been unfor-tunately confided to medical men, we shouldbe sorry to see it transferred, as in

Edinburgh, to the " Worthy Corporation"of DUBLIN, for in all probability, in-

stead of an anatomical teacher, " their

530 THE EDINBURGH AND DUBLIN SCHOOLS.

Honours " might fill the chair of anatomy we may say of medicine, in the Irish pro.or chemistry with some well-fed Alderman vinces.

of their own body. Along with being thus From the brief sketches which we have

in part appointed by the tainted suffrages of given of the schools of Edinburgh and Dub.the profession to which they belong, the lin, the superiority of the former over the

additional incentive to indolence of a salary latter must be manifest to every unpreju.independent of exertion, has been granted diced mind, preferring practical utility to

to them. The sum is certainly small, but the useless refinements of a theoretical sys.even that little appears to be too much, since tem of education. We do not however

it must only tend to lessen the attention to propose it as a model for unqualified adop.their pupils. If they only discharged their tion by the other schools ; faults it certainlyduties with common ability, they would be committed ; but with every allowance for its

amply remunerated by pupils’ fees ; the imperfections, it has done more for the ad.

professors, therefore, have not been fairly vancement of medical science, and has con.dealt with, by throwing this temptation to sequently conferred more benefits on the

idleness in their way, while they have been population of these countries, than all theendowed with the fatal power of regulating other universities put together, simply be.what the pupils are to pay. With the cer- cause it accomplished what they merelytainty of a salary without labour, and the professed. It is surely better to communi.means of compensating for its deficiency by cate some instruction, than to exclude per.extravagant fees, it is no wonder the pro- sons from obtaining it by impracticablelessors of the school of DUBLIN should ex- laws, as was ridiculously done in the Uni.hibit an example of idleness and extortion versity of DUBLIN. The great defeat of its

Tmprecedented in the records of any scien- system was its facility of being abused; for

tific institution. To complete the folly of it is more than probable, that the mercenarythese arrangements, it was required that spirit of its professors too often accommo-previous to graduation in medicine in the dated the examination, which was alwaysUniversity of DUBLIN, the student should private, to the capacity of the student. Thishave also graduated in arts. The time and privacy of examination was, in fact, the

money spent in the acquisition of this pre- weak point of the EDINBURGH system; forliminary to graduation in the University of as none could be cognizant of the nature of

DUBLIN, fully equalled, or perhaps exceed- the examination but the parties concerned,ed what was required by the University the examiner’s fame was safe, however theirof EDINBURGH, for obtaining the full de- sense of justice might be wounded. As to

gree of doctor of medicine. But when to the aristocratic outcry raised against the

these are added the expenses and time re- cheapness of its degree by the other schools,quired for the medical degree, we have an so far from approving of this jealous and’obstacle to the success of the DUBLIN vulgar complaint, we deem the modera-

school, which no local advantages could tion of expenses in the EDINBURGH school

possibly overcome. Besides, if such a sacri- one of its greatest advantages. The attemptfice of time and money were to have been to establish an aristocracy in science hasmade by the Irish student, the degree, met with the fate which so odious an enter-

when secured, afforded him no advantage prise justly deserved, and principally, wewhatever (if we except the eligibility to must all admit, through the instrumeutalitycertain medical situations in DUBLIN alone) of the EDINBURGH University. Hence the

over the Edinburgh graduates, who conse- graduates of OXFORD, CAMBRIDGE, and

quently monopolized the whole practice, the DUBLIN University, do not bear the

531MEDICAL FEES.

proportion of one to fifty to those of EDIN-

BURGH.

What, therefore, would be the state of

society, if left to the csro of these few pre-eminently educated practitioners of the En-

glish and Irish universities ? Neither the

circumstances nor the profits of practiceamong the mass of practitioners in this

country, can afford a compliance with such

a system of education. Such a scheme of

instruction in medical science is, in fact, notmore irreducible to practice than it is unjust i

in principle. The poorer orders constitute

the great mass of the population of everycountry; to them health is, of course, of

still greater importance than to their supe-riors, as they are called, but they are unfor-

tunately unable to procure medical assist-

ance when required, at the rate it is metedout by these aristocratic doctors. Are the

poorer classes then to be deprived of the aidof medical men, who, from the cheapness oftheir education and unassuming habits of

life. are willing to afford it at an accessible

price ? Or are there to be two sets of physi-cians and surgeons, one to cure the rich, theother to kill the poor ? As there is no pro-fession for the exercise of which there is so

general a demand, or for the practice ofwhich such an equality of information is

necessary, it is fortunate that both objectsmay be attained without the tedious end ex-

pensive process of these impracticable plansof education. Every-thing, in [fact, that

these systems promise, can, and has been

accomplished by leaving the student to ac-quire information where and at the cheapestrate he can. To society it is a matter of

perfect indifference where the practitioner’sknowledge is acquired; the possession ofit is the only thing in which they are inte-

rested ; and that he does possess it, may, it isnow universally conceded, be ascertained byexamioation alone. From the comparisonwhich we have drawn of these two schools,we conceive that it may be fairly concludedthat the appointment of professors by medi-

cal men has not been followed by such salu-tary consequences as election by unprofes-sional pei sons ; that permanent salaries, in-stead of inducing men to advance theboundaries of science, and to promote theinterests of their pupils, have an oppositetendency, atleast in these countries, howeverthe example of others may be cited againstsuch an inference ; that there cannot be two

prices for medical instruction in contiguousestablishments, any more than there can betwo prices forlabourfor any length of time in

neighbouring provinces; and lastly, that tohave a practical and well-attended school ofmedicine, the means of the pupils and theprofits which they are likely to derive fromthe exercise of their profession should be afundamental consideration.

What may be done to remedy the exist-ing regulations of the Dublin school, weknow not ; but we conceive that we have

shown that it is impossible it can ever be..

come a great school of medicine, or com-

pete with the school of Edinburgh, while itadheres to its present pernicious code of

laws. Of this truth we are also aware, that

all its professors are thoroughly convinced,and that some of them at least are as anxious

as we are, that these laws should be forth-

with repealed. We have already alluded

generally to the cause of this adherence tf)a vicious system of instruction ; on some

future occasion we shall consider it more in

detail, and hope to be able to show that it

has been the misfortune of MEDICINE to betaught under the same roof with ’ STATE

RELIGION," and that it is time this con-

nexion, which has so materially injured theinterests of science in Great Britain, was

effectually and for ever dissolved.

Irr another part of our Journal will be

found a scale of fees which has lately been

arranged by the medical gentlemen of the NEWCASTLE aDd GATESHEAD Associa-

tion." Of the policy of attempting to

carry into effect, or to act upon, auy such

532 MEDICAL FEES AND PER-CENTAGE DUBS.

arrangement, we entertain very strong half. It cannot, however, be admitted, thatdoubts. Similar schemes have been tried these men have any claims to rank with

in numberless places, over and over again, medical practitioners, having no pretensionsbut they have failed to accomplish the de- to the characters ofmen of science, except the

sired object in every instance. In principle science of extortion, in the practice of whichsuch an agreement is unsound, as it is the they are surpassingly persevering and skilful.foundation of the very essence of monopoly ; With physicians, DUBS and all, "dignity,"and, further, it is unsound in its being an 11 importance," and all that sort of thing, theendeavour to estimate the value of mental tax of pernicious interference is fixed at oneacquirement and skill, by the gross, in- pound one. (" Gold-headed canes," prayefficient test of a metallic standard. Be- forgive us.) Craftiness, meanness, shufflingsides, it will be said by young practitioners, underhand dealing, fraud, deception, quack-and probably with some degree of justice, ery, and humbug, in the shape of ’ Doc.that such a measure would effectually de- tors," " Graduates," ° DuBS," 11 Ineep-prive them of the opportunity of making tors," and even " Fellows,"-aye, the

their way amongst the poorer classes of so- hugged and beloved of the royal dame inciety. But the range of the scale itself PALL MALL EAST,—have sold their mental

proves, beyond all question, that no endea- filthiness, compounded with jalap, fundun.vour of the kind can prove in the least de- gus, asafcetida, and. other such horrible

gree successful ; for where the highest sum drugs, attwo shillings and sixpence.Forought to be adopted by a practitioner, he further particulars, apply at the per-centagemay often select the lowest, and thus defeat hells in OXFORD STREET, HOLBORN, andthe object of the association at the broadest half a thousand other places. Oh these

portion of the principle the measure was de- vilifiers of surgeons in general practice!signed to establish ; for there might be much Oh these abusers of the sound and well-edu-greater injury and impropriety in a member cated physician ! Oh the hypocriticalof the association making the charge of one wretches, who have the insolence not to

guinea where he had the opportunity of fear the keenness,-and the ignorance not tocharging two, than an individual, not a admire the polish,-of this little instrument.member of the association, charging two Alas! how uncertain are human opinionsshillings and sixpence, where a member of and feelings’ Presto a a few touches, and

the association might have an opportunity they will display most agreeable sympathyof charging five shillings. We are aware it -admirable wonder.-The knaves! We

may be replied, that this arrangement en- will pierce them to the hilt, and in order tosures profitable payment ; but this is a great aid us in this object, we solicit all good men

error ; for the payment, in every instance, and true, to convey to us at our office in the

must be contingent upon employment, which Strand, by all and every description ofmes-neither this plan, nor any other, can long senger, whether DUB or PURE, quack or im-secure in the absence of professional talent. pure, cyclops or haggler, owL or BAT, the reoWith barristers there are no regulations for ligioiis christian name, and the filthy surname,fees. With attorneys there are, to be sure, of every Fellow, Dus, or Pure Chirurg.,certain fixed three-and-four-penny and six- who is in the habit of " prostituting" at theand-eightpenny charges ; but then look at stews of their per-centage partners with

the bills of these land-sharks after they have open doors, accommodation rooms, (lightsbeen taxed, and as they come from the in the passage,) on Mondays, Wednesdays,hands of the Allocator-generally cut down and Fridays, or Tuesdays, Thursdays, and

one-fourth, often a third, and sometimes one Saturdays., from 10 till 12 at noon, and 8 to

533RUSSIAN CHOLERA.—HYDROPHOBIA.—DEAFNESS.

9 of the evening of each day. A new col-

lege, Master BROOKE, will clear these pesthouses, but a little, a leetel, phlebotomisingwill prove a salutary preparative to the

worthy inmates.

CHOLERA MORBUS.

ACCORDING to the last reports of the Me-dical Society at Moscow, the number of

patients, from the 21st of September (oldstyle) to the 3d of November inclusive,amounted to 5390, of whom 2849 died, and1718 recovered. From the 4th to the 8thof November, there were 154 new cases,and 88 deaths.In the Russian provinces on the other

side of the Caucasus, the epidemy had en-tirely disappeared ; from the 23rd of Augustto the 21st of September, the number of

patients was 1224, of whom 902 had died.From most of the statistical reports on thedifferent districts on this side of the Cauca-sus, it appears that in general more thanhalf of the cases were fatal. In the Ukraine,of 213 patients, 124 died ; in the district of

Novgorod (where the disease broke out justat the time of the fair), 1863 cases were

observed, 968 of which proved fatal.

HYDROPHOBIA.

In one of the late numbers of the’° Journaldes H6pitaux de Lyon," a M. Chardon pro-poses a new method of treating hydrophobia,which, however, we are afraid will not be

very acceptable to 11 hydrophobes," as itconsists in nothing less than drowning. Herelates that a rabid dog, after having beenapparently killed by drowning, had reco-vered, and was subsequently found to be

quite free from the disease. This fact, ofwhich M. Chardon was an eye-witness, in-duced him to try the effect of asphyxia inhydrophobia, and he says, that of five rabiddogs, two were actually cured in this man-ner. Shortly after these experiments, hemet with a female who had been bitten by arabid dog, and offered all the symptoms ofconfirmed hydrophobia. He immediatelyproceeded to try his new method, and, after I,having bled her, placed her in a warm bath, I,which] however, unfortunately did not con- I

tain a sufficient quantity of water to makethe immersion complete; moreover, shebecame so violently agitated, that she wassoon taken out of the water in a very alarm.

ing state, and died in a few minutes.

PRACTICAL OBSERVATIONS ON THE

PATHOLOGY AND TREATMENT

OF

DEAFNESS.

By JOHN FOSBROKE, M.D., M.R.C.S.,N.R.P.S. Edinb., &c.

My essay on the Pathology of the Kid-neys, having been favourably received bythe profession, I, in compliance with a wish,which has been very generally expressed,that provincial practitioners should makeknown more frequently the results of theirpractice, offer these observations, whichwere announced as the next in successionof my inquiries. They formed the subject-matter of an inaugural thesis at Edin-

burgh; but to have published them in thatform, would have been to throw what-soever was useful in them into a vault.In the first announcement of this essay,

five years ago, I stated that it was my de-sign 11 to show most disinterestedly the de-gree of dependence which is to be placed onthe treatment of deafness according to realexperience, for which purpose I have goneinto the inquiry." I have endeavoured al-ways to place the stability of my own cha-racter and professional communications,humble as they may be, upon the founda-tions of actual observation, and the unso.phisticated and independent averment of theplain truth. No bias of interest has induced,or ever shall induce me, knowingly, to exag-gerate the favourable, or conceal the dis-couraging results of my inquiries. An oldwriter observes, " I always, thank God,look upon it as most injurious, and one ofthe worst of wickednesses, in serious things,to impose upon the living, but much moreto banter and hand down a falsehood to pos-terity ; a fault, I doubt, too many of our

physic-observators have been guilty of."I endeavour also to draw my pictures andcolourings from nature, that those who tracethe same path may find their own observa-tions the picture and reflection of mine.

I am not what is called an 11 aurist." Theinterest which I have taken in the subjectwas casual in its origin, and the objectswhich I have in view in publishing thisessay, both in relation to the profession andto the public, are as follow :-,