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THE LANCET.

LONDON: SATURDAY, FEBRUARY 17, 1855.

ALwAYS have we considered it to be a great misfortune to our

profession that it should be so miserably represented at Courtas it has been since the accession of her Majesty Queen VICTORIA.Very many evils, social and political, have during the last twentyyears arisen from this source. Upon the recent job, in thematter of the Examining Board of the East India Company,we have already commented. That trick resulted in draw-

ing a less number of candidates than there were appointmentsto make,-a pretty significant hint of the estimation in whichour young surgeons hold the new examiners and their exami-

nations. At the present time, we have the profession insultedand the public service endangered by a still more odious pro-ceeding.The war authorities, at home and abroad, have, in their

foolishness, since the commencement of the war, done their

utmost to ill-use and degrade the medical officers of the armyand navy. Their suggestions have been treated with con-

tempt ; their means of transport have been taken from them;they have been left without drugs or instruments ; their nameshave been ignored in gazettes; and, amongst all the folly andmisrule which have consigned thousands of our gallant soldiersto death from preventible diseases, the Commander-in-chiefhas, as yet, found none but medical officers worthy of beingdisgraced by censures in " general orders ! " We declare thefault has not been with the medical departments, for we knowthat, before the army went to the Crimea, the authorities were

implored by medical officers of the highest rank to have hospi-tals ready at Scutari for at least 5000 men. Nothing of thekind was done till after the sick and wounded began to accu-mulate in the camp to an unmanageable extent, and thus allwas done in haste, confusion, and disorder.The military surgeons are now to be further insulted by the

formation of a " civil hospital" at Smyrna, under the manage-ment of Sir JOHN FoRBEs. We have no objection to the esta-blishment of a " civil hospital" at Smyrna, but it ought to beplaced under the control of the military medical authorities.Otherwise, we shall have all the evils of divided command

and divided responsibility. It is the evident intention of Go-

vernment to make this hospital different in every respect fromthe " military hospital" at Scutari. This will be considered

an insult by every medical man in the army. Yet the

authorities expect the military surgeons at Sebastopol andScutari to expose themselves for their miserable pay, in the

most devoted manner, to all the casualties of war, famine, and

plague. The pay of the chief " civil" medical officer at the

new hospital of Scutari is to be £2000 a year. This sum, with

the perquisites attached, in the way of lodgings and rations,exceeded the salary of Sir JAMES M’GRIGOR, after the best partof a life spent in the service of his country, and when he hadthe whole medical organization of the army to superintend.As Director-General of the Medical Department of the Army,with the expenses of a town establishment, the emoluments ofSir JAMES M’GRiGOR barely exceeded X2000 a year. The

salary of the present Director-General of the Army, Dr.ANDREW SMITH, has been pared down to .61200 a year. Yet it

is proposed to give the head of a " civil" hospital, in connexionwith the army, a salary of .;82000 a year. The same dispropor-tion is exhibited in the pay of the subordinates in this, we donot hesitate to say it, infamous job. The young medical men

who are to accompany the head of the Smyrna medical corpswill get, it is said, salaries varying from .;81000 to £ 1500 a year.Yet these gentlemen are no whit superior in professional accom-plishments, to the assistant-surgeons who are now enduring un-heard-of hardships and privations in the camp before Sebastopolfor the pay of 10s. 6d. per diem. When the tocsin of war first

sounded, the pick and choice of the young men at our varioushospitals offered themselves for service in the army. And this isthe way in which they are to be treated! In the name of justice,and in the sacred interests of the remains of the heroic menwho went with our army to the East, we protest againstthe monstrous injustice which is now in course of perpe-tration.

The name of the chief officer of this new adventure and ex-

periment would excite a smile, if it were not for the solemninterests involved. How can Sir JOHN FoRBES look any sane

man seriously in the face while he sets about this extraordinarybusiness? We do not hesitate to say that the authorities

could not, if they had wilfully intended to go wrong, havemade a greater blunder than they have done in this instance.What are his qualification for such a responsible office?

Sir JOHN FORBES was, some fifty years ago, an assistant-

surgeon in the navy. We believe he never reached a higherrank than this in the public service. About twenty years ago, heretired from the post of physician to the Chichester Infirmary,one of the smallest of our provincial establishments, where theaverage number of patients, to be divided between four officers,is fifty-two. About seven years ago, Sir JOHN FoRBES retired

from the management of the British and Foreign Medical Re-2aezv, and he publicly alleged the infirmities of advancing yearsas his reason for retiring from this not very onerous post. Since

that date, the profession has heard from time to time of Sir JOHNchiefly at meetings and dinners, when making excuses for shortspeeches and early hours, on the ground of old age. As a phy-sician, his principal medical works are, " Travels in Switzer-

land" and ’’ Ireland," and, besides these, he has dandled a littlewith mesmerism, hydropathy, and homoeopathy ! His chief

public appointment is that of physician to the household of herMajesty, in which the beefeaters, footmen, and occasionallypages or maids of honour, may be supposed to be his patients, ifthe post be not altogether a sinecure. Yet this is the gentle-man who has been selected by the Government to remedy allthe medical errors of the present war, by organizing and pre-siding over a "civil hospital" at Smyrna. Except by amiracle, such a Quixotism must prove disastrous to the Govern-ment which so permits itself to be deluded by court physicians,and to those more immediately concerned in it. Our onlyhope rests in the exposures which must take place before

Colonel IioLnEPO’s proposed committee of inquiry into medicalaffairs. This committee will, we trust, have to sift this andother monstrous jobs, in relation to medicine, which havearisen as outgrowths of courtly patronage and incapacity.The insult offered to military surgeons, by this scandalous job,will neither be forgotten nor forgiven.

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THE second sanitary measure brought in by Sir BENJAMIN definite proportional mortality. The average mortality in aHALL is a Bill to alter and amend the Public Health Act of thousand of population throughout England is 9 in a 1000.

1848. That the Act in question is, in essential points, unequal But this figure certainly does not express the minimum ofto accomplish the purpose for which it was enacted, and in deaths that may be expected to occur in a district sedulouslysome respects vexations, has been sufficiently proved by the guarded by conformity to all the dictates of sanitary law.experience of the late and present Boards of Health. Amend- Therefore any great excess of deaths above the averagement is therefore no less necessary than in the case of the may not unfairly be assumed as evidence either of some

Nuisances Removal and Diseases Prevention Act. The Bill general cause of insalubrity inherent in the site, which

drawn up by the President of the Board of Health for this pur- may or may not be remediable, gr of some accidental causes

pose, consists of one hundred and sixty-three clauses, and con- connected with the habits, occupations, and neglect of thetains some very important proposals, inhabitants, which it is less doubtfully possible to prevent orIn order to give a comprehensive idea of the nature and modify. The President of the Board has fixed upon a mor-

scope of the Bill, it will be convenient to consider it, under tality of twenty-three in a thousand as the excess above thethe four heads into which it is divided. The first part relates average ratio which shall render it expedient and justifiableto the General Board of Health, its constitution and powers ; for the Board to step in and impose subjection to the laws ofthe second, to the adoption and application of the Act, and cleanliness and health upon the rebellious adherents to the

the constitution of local authorities ; the third part to the black standard of dirt and disease. As might be expected, thepowers and duties of local authorities ; and the fourth, to the proposal of Sir BENJAMIN to establish a mortality of twenty-repeal of former Acts. three in a thousand as the mark which the " dirty " party arePART I.-The General Board of Health is to consist of a not to overstep without bringing themselves, nolentes volentes,

President, who shall be the only salaried member, and who under the dominion of the General Board, has been the occa-shall not be precluded from sitting in Parliament, together sion for the display of a little wit on the part of some of ourwith the Secretaries of State and the President and Vice-Pre- contemporaries. It has been suggested that the clean party ofsident of the Board of Trade. All powers vested in the Board a district, if in a minority, should imitate the patriotism ofmay be exercised by the President alone or by any two mem- CURTIUS, and immolate themselves for the public good in orderbers. The Board is to continue for two years after the date of to carry the mortality over the golden number twenty-three-the Act. the boundary between the rule of cleanliness and dirt. We

PART II.-The provisions as to the adoption and application decidedly object to this proposal. Members of the clean partyof the Act are remarkable, and have given occasion to some are far too valuable members of the community. We wouldcriticism. Without following closely the order of the clauses, infinitely rather sacrifice the " unwashed," whether great orwe may state generally, that the extension of the Act to towns, small.

boroughs, and other places, may be effected in two ways: the We do not, however, feel it necessary to point out anyfirst, voluntary ; the other, compulsory, under certain condi- precise modes by which the clean party in a dirt-oppressedtions. But as there will, in all probability, remain some places district may procure emancipation by deliberately committingthat will not, of their own free will, adopt the Act, nor fall murder or suicide. If the adoption of an arbitrary line hasunder the conditions that render its application compulsory, been the source of some jocular criticism, we do not perceivethe Act will, after all, be partial in its operation. It will be that it is open to any serious objection. There never yet was

important to consider how far the partial exemptions may con- drawn an arbitrary line that did not admit of cavil; and Sirsist with the public safety, or impair the general efficiency of BENJAMIN HALL may justly urge, that whilst some such

the Act. arbitrary line is necessary in order to place a limit somewhereThe power to adopt the Act lies in the ratepayers, and the to the licence of those who might obstinately carry the doctrine

manner of proceeding to effect this object is minutely set forth. of the right of self-government to such an extent as to dissemi-Any ten of the ratepayers of a place may require the proper nate disease amongst their neighbours, and imperil the whole

summoning officer to call a meeting of the ratepayers to take community, he was not anxious to interfere with the right ofinto consideration the adoption of’ the Act. If the majority self-government without urgent necessity. It may also be

decide in favour of the measure, a petition is to be presented remarked, that if there exist in a district counteracting in-to the General Board praying for the application of the Act. fluences so strong as to render filth comparatively innocuous,Upon receipt of this, the General Board may send an inspector the intervention of extraordinary powers is, if not superfluous,to the district to make inquiry into such local matters as relate not urgently called for.to the subject. The inspector is to give seven days’ notice of his The next matter provided for is the mode of election of localintention by advertisement. Upon receipt of his report, the Boards of Health. This is on the freest representative system.General Board may, if it think fit, extend the Act directly by Their proceedings are also accurately defined.a provisional order, which must, however, be submitted to the PART III. —The third part of the Bill relates to the powers andapproval of the ratepayers. This obtained, the General Board duties of local Boards. These, it will be seen, are of an extensiveis bound to bring the provisional order before Parliament for character; and it appears to us that some care is necessary inconfirmation. limiting these, since there is scarcely a calling that man canSuch is the provision for those who wish to be clean and pursue, or even an act that he can perform, that may not, by

healthy; those who would fain live and die in dirt are, like an over-zealous sanitarian, be shown to have a bearing, morenaughty children, to be cleansed in spite of themselves, pro- or less direct, upon his own health, or upon that of the com-vided that the filth and other causes of insalubrity they have munity. The local Boards are to assume absolute power over

fostered have been such as to induce, or be accompanied by, a the sewerage; to regulate the drains from new buildings; to

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order the streets to be swept, cleansed, and watered, and the ing occupation in dragging forth abuses to the light of day, andremoval of all dust, filth, and rubbish. By a most useful most useful services do these gentlemen perform for wrongedclause, they will be enabled to provide public water-closets; humanity, whether in the political or social state. But how to

and the water-closets in new houses are to be constructed remedy the detected flaw, how to sow hopeful seeds of good inunder their approval. In any factory wherein more than soils hitherto productive of little else than evil demands pro-twenty people are employed, local Boards may enforce the founder thought and labour. Rank weeds cover broadcast the

construction of sufficient water-closets. surface of every waste. Good tillage must patiently break upThe barbarous custom of letting out cellars for human habi- the clods, and lay bare the hard ground beneath, ere whole-

tations is to be controlled. Every such place is to be at some fruits reward the toil.

least seven feet high; three feet of its height must be In pursuing steadily our views respecting a system of clinicalabove the level of the ground; there must be an open area in instruction which we have recommended to the consideration

front two feet and a half wide; the drainage must be good; of our professional brethren, we have advisedly abstained fromit must have a fireplace, and window of proper dimensions. finding fault with things as they are. Nothing would haveThese conditions would indeed make a model cellar-dwelling been so easy, nothing less worthy the name of a task. Manycompared to many dens now occupied; but bad is the best- deficiencies confessedly on all hands exist. There needed buteven the regulation-cellars will scarcely be healthy. a facile pen to sketch them, and a full pencil to deepen shades

Before erecting new houses, the builders will be required to and strengthen sombre tints, already dark enough without it.

satisfy the Board that their plans provide sufficiently for the Neither imagination, thought, nor judgment were required, yetfollowing points :-the thickness and materials of the walls, the product must have formed a striking, though not a pleasingthe dimensions of the rooms, the means of ventilation, water- picture.closets, cesspools, drainage, supply of water, and deposit of dry Such, however, was not our plan. We have said, inten.refuse. tionfolly, no hard things, and if unrecognised they have beenThe provisions of the "Towns Improvement Clauses Act, uttered, the system only, and not an individual, has been

1847," with respect to certain matters, such as the improve- aimed at. If clinical instruction in its present form and actionment of the line of streets, the dealing with ruinous buildings, falls far short of the wants of the age, we believe there are

the prevention of smoke, the supplying buildings with fresh many causes operating to retard its progress, which it has notair, &c., are to be incorporated. been within the power of the profession to remove. There is

The powers of the Boards are to embrace the water-supply, true wisdom in dealing with things as they are, in employingwatching, and lighting. the instrumentality we have, in shaping the means before us

Slaughter-houses are to be licensed, and regulated by them; to the end in view. Ours is the spirit of reform, not of revolu-and markets and fairs are to be in certain respects subject to tion. Conservative of innumerable happy and spirit-stirringtheir control. associations of the past with the time-honoured haunts andPower is to be given for the formation of public pleasure- habits of our craft and mystery of chirurgery in this noble

grounds. metropolis, we ’have sought to strengthen and to consolidate,To describe the powers proposed to be conferred upon the not to rebuild, our ancient institutions. Thus, also, no in-

ocal Boards of Health, it might be said comprehensively that vidious comparisons have been drawn between our own andthey constitute a complete system of domestic police. It is continental Schools. We are too well aware of the differences

obviously necessary that powers so vast should be jealously which exist between our students and theirs, in point of socialguarded; and it is quite certain that in a constitutional coun- position, habits of thought, and national character, not to betry they could never be exercised except by free consent and convinced that differences must exist, and some differences,under a responsible form of government. too, that we are content to see. We desire no servile imitation

The remaining clauses relate chiefly to matters of detail of that which is exotic, simply because it is so. We are not

concerning the execution of the Act. All that we think it amongst those who believe not in British surgery. We dare

necessary to point out especially is the provision for defraying to match its results with those of any practice in the world.the expenses of the local Boards of Health by the levying of a It is with such views and feelings that our plans respectingDistrict Rate. clinical instruction have been matured and committed to the

We have thus given a summary view of the leading features consideration of our professional brethren. By them shallof the second of Sir BENJAMIN HALL’S Bills for the promotion of they be judged. On these grounds it is that the appoint-Sanitary Reform. We have not space at present to enter upon ment of no new officers is advocated-the erection of no new

the task of criticism. This we must defer to an early occasion. or complicated machinery proposed. The existing materialsBut we cannot withhold our opinion that, howsoever marked the are amply sufficient. Full surgeons, assistant-surgeons, andability with which the measure has been drawn up, and how- dressers-using the last-named term in its generic significationsoever well calculated in’many respects to accomplish the ends -are all the officers and hospitals required for the active duties

proposed, the aid sought from the medical profession is far of the wards. A resident medical officer for superintendence,from being so great as in a question of Public Health might rather than for action, is of course a necessary addition.

have been expected, or as is undoubtedly desirable, in order to "House-surgeon" is a name often unwisely substituted for.give it the utmost degree of efficiency. "resident dresser.’’ " It serves no other purpose than to furnish

———————————— a title for the wearer, which, heading an article or gracing f6IT is proverbially easier to find fault than to mend. It lies page, often imposes largely on the simple notions of the public,

within the capacity of every man to detect an error, or point out if not sometimes also upon our country brethren. A bare half-a fault. Hence "ARGUS" and " SCRUTATOR" find never-fail- year of active dressing confers no just claim to a title which

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may be, nay, has been, confounded in many minds with thatof exalted hospital rank. The evil is greater than may appearat first sight to many, or it would not have received even

passing notice here.There is one class of hospital officers, who, most valuable as

they are, would become, in our clinical system, more importanteven than at present-viz., the assistant-surgeons and phy-sicians. Their participation in clinical labour should be a largeone; it has been already delineated in outline. The claims of

-a rapidly-increasing population are already demanding, and insome cases have led to, an augmentation of the hospital staff,by the appointment of an increased number of these officers.The requirements of the students, and of a higher standard ofeducation, endorse these claims with still greater authority.The number of officers which ought to be appointed to anygiven hospital by no means, therefore, necessarily correspondsto its tale of beds, or its attendance of out-patients. The

magnitude of the School is a great element in the account.Just so far as they are to be employed in the impartation ofinstruction to the students must their number be proportionedto that, amongst other ends. No considerable hospital andschool should, we conceive, have less than three of each, sothat by means of a bi-weekly attendance the daily duty maybe always provided for. Doubtless, in some cases, a largernumber might be employed with advantage to the interests ofthe institution, to the promotion of medical science, and forthe benefit of the students, the coming men of our profession.

Instead, then, of insisting upon the deficiencies of the

system, if such it can be called, of clinical instruction at presentpursued, further, indeed, than was absolutely necessary inorder to indicate the form and direction which improvementsought to take, it has been our object to present a broad, nothighly finished, sketch of a plan for the education of studentsin practical medicine and surgery, interspersed only withmajor details and hints for their realization. The subject isstill pregnant with suggestions for the fall accomplishment ofthe end in view.

It is a matter of legitimate complacency that we have re-ceived numerous communications from students especially, andalso from those who have ceased to experience, but have notforgotten, the wants of their pupilage, awarding a hearty ap-proval to our labours. Rarely has it been our lot to meet souniversally-pronounced and unreserved a welcome from theranks whose welfare we have sought to advance. We hail

sRch expressions of sympathy with the most cordial response,and accept them as a true augury that we have understoodand appreciated the requirements of the student. It is due to

our numerous and enthusiastic correspondents to assure themthat we shall not cease to advocate the establishment of a

sound, rational, and practical system of clinical teaching in theschools of our country. Their suggestions and co-operation,while seeking to elevate the character and augment the reosources of medical education, will ever be esteemed the highestproof that we are not labouring in vain.

SURGEONS FOR THE BRITISH AND TURKISHARMIES IN THE EAST.

WE have authority for stating that medical gentlemen arestill required for service with the army in the East, and alsofor service with the Turkish army at Eupatoria. Applicationshould be made to Dr. Andrew Sm th, 13, St. James’s-place,London.

THE HUNTERIAN ORATION AT THE ROYALCOLLEGE OF SURGEONS.

FEBRUARY 14TH, 1855.

MR. HODGSON was the orator. The attendance was rathersmaller than usual; and we observed few distinguished visitorspresent. Mr. Guthrie, the president, was in the chair; andmost of the members of the council were present.The orator commenced with the statement, that this was

the thirty-seventh occasion on which they had met to dohonour to the memory of the great John Hunter. His prede-cessors in that office had left him little room to expatiate uponthe great services that Hunter had rendered to the professionand mankind, and had exhausted every topic relating to hislabours and to his biography. It might be asked, what werethe great merits of John Hunter? It might be answered, thathe was the founder of scientific physiology, and that he hadgiven to surgery the character of a science. His labours

had been devoted to the investigation of the phenomena.of the vital power, by the elucidation of facts which had

tended to establish some of the great truths connected withlife. He had not attempted to determine the origin of thecauses which influenced the various changes which occur, be-lieving that these are beyond the grasp of man’s observationand intellect; but his observations on the blood, on the pro-cesses of assimilation and secretion, had thrown the greatestpossible light upon physiology. His observations in regard toanimal heat were founded upon just and right principles; butthe orator believed that the true explanation of this pheno-menon must be solved by the addition which Sir BenjaminBrodie had made to Hunter’s discoveries, that the nervoussystem played an important part in the matter.Mr. Hodgson then referred to the extraordinary labour

which Hunter must have undergone: he had lectured inches-santly for nearly thirty years, notwithstanding that he hadan extensive private practice, and he had been engagedassiduously as surgeon to a great public hospital. But, aboveall, he had founded the magnificent museum attached to the’College-a museum which knows no rival, and which had’been productive of so much benefit to medicine and the naturalsciences. He paid a high tribute to -the labours of Owen, andof those immediate followers in Hunter’s footsteps-Abernethyand Sir A. Cooper. He made an eloquent and touching allu-sion to the loss of Mr. Bransby Cooper, with whom he hadbeen associated in early life, and paid a high tribute to themany excellent qualities of that most estimable surgeon. He

referred, in terms of high praise, to the great benefits whichJenner-a pupil of Hunter-had conferred upon the humanrace; and drew a striking and forcible parallel between themillions that the great discoverer of vaccination had preservedwith those that were destroyed by war. He concluded an ableand eloquent address amidst general applause.

Medical Societies.MEDICAL SOCIETY OF LONDON.

SATURDAY, FEBRUARY 10TH, 1855.MR. HEADLAND, PRESIDENT.

]’,1. REYBARD’S INSTRUMENT FOR TREATING STRICTURE OF THEURETHRA.

j MR. HENRY THOMPSON exhibited to the Society an instrn--ment of French design, and manufactured for the internal in-cision of strictures of the urethra. It was sent to him byCharriere, of Paris, as the instrument employed by M. ReybaI14-