58

THE MEDICAL DEFENCE UNION.To the Editors of THE LANCET.

SIRS,-The proposed alterations in the articles of theMedical Defence Union are retrograde and revolutionary incharacter. Although the report of the committee, which pre-pared the new articles, was on the agenda of the last Councilmeeting in London, it was withheld at the last moment forsome ostensible reason. Hence it becomes necessary for meto appeal to the whole body of members. I shall merelyallude to the introduction of a section into the new articlesto prevent the annual meeting from petitioning againstlegislation injurious to the profession, as it did last time,contrary to the wishes of our valued, though somewhatself-opinionated, president. I believe this attempt to re-strict the Memorandum of Association to be futile andillegal. The really serious matter, however, is the proposedchange in the management of the Union. Hitherto all theofficials and the Council have been directly responsible tothe Union itself, each individual requiring annual re-election.This self-governing system has worked well and the Unionhas flourished. Now all this is to be changed. At the inext annual meeting twelve members of Council are to beelected, and to them will belong the power of electing all theofficials, the president of the Union, and as many vice-pre-sidents as they choose. Nor are the twelve to be rseponsibleto the Union by requiring annual re-election. Theyaremerelyto select from their number any three they choose to retire, lior stand their chance of re-election. Now, suppose that the ICouncil adopted a policy contrary to the wishes of the IUnion: an annual meeting could elect three members ofCouncil opposed to such policy; but the Council canneutralise their influence by its election of vice-presidents &c.Briefly, the twelve members of Council elected at the nextannual meeting under the new articles will have absolute andpractically irresponsible control of the Union. The Councilhas power to act for the Union, and the acts of the Councilare as the acts of the Union. This is a plain statement offacts, and I appeal to the members of the Union to pausebefore they hand over their powers to any twelve of theirnumber. I believe that such a step will prove disastrous tothe Union.-I am, Sirs, yours faithfully, IHUGH WOODS, M.D., I

Vice-President of the Medical Defence Union.Highgate, Dec. 22nd, 1891.

INFLUENZA.

To the Editors of THE LANCET.

SIRS,-After reading the paper by Dr. Althaus on Gripand the letters of some others on different aspects of thesame affection, I am tempted to reiterate the one or twopoints I ventured to bring forward in my note to you threeor four months ago, in which I suggested that for a nervousfever of which the characteristic and diagnostic sym-ptoms are to be found in tracts supplied by the tri-geminal nerve, trigeminal fever is a truer and more conno-tative name than either grip (which is by no means uni-versally descriptive of this disease, and might indeed, withas much or more propriety, be applied to other affections) orinfluenza (which is confessedly confusing and usurpative).Again, if there be anything in theory of eye infection or incollyrium treatment, then s7bill more fitting becomes thisterm, *’ trigeminal fever." The point upon which I desireevidence, with your kind assistance, is the following :-Inthe few hundred cases seen by me during this present yearthe one single diagnostic point has been in the upper gumand labial fraenum; this, indeed, has seemed as typicaland decisive as one symptom can be of one disease.Skeptomai means: "I look that I may see." Surely noman has the right to be sceptical in loose, conventionalparlance, unless he be such in derivative sense. PerhapsDr. Althaus would prefer the term 6 e bulbar fever "; butthis implies a theory which, however probable, is not quiteproven.-I am, Sirs, yours faithfully,Hastings, Dec. 14th, 1891. G. HASSALL HUNTLEY.

. NEW COTTAGE HOSPITAL’ AT LEDBURY.-Mr. M.BidduIph.M. P., has presented to the town of Ledbury, incommemoration of the coming of age of his eldest son, Mr.John Biddulph, a cottage hospital, at a total cost of aboutae.300 ).

THE ORIGIN AND INSPIRATION OF"THE LANCET."

WE are indebted to an old and esteemed correspondentfor the following article, which will, we are sure, be readwith interest :-The condition of the profession of medicine prior to and

at the time of the founding of THE LANCET has been muchtraversed, and writers of the period have pointed out thatin the hospitals as well as outside them there existedabuses such as would not be tolerated at the presentday. Monopolies, cliques, time-servers, and place-hunters.abounded, hindering most egregiously the progress of medi-cine as a science and the career of the medical student as.an individual. Colleges and universities were not much inadvance of the average state of matters, and, in some in-stances, it appeared that the unsatisfactory condition of thebody medical was mainly attributable to their conduct.Metropolitan hospitals existed, as they do now, for the benefitof the poorer classes of the community, and collaterallyto aid in the acquirement of a sound medical education.But they were practically closed to the medical profession.Men were appointed by influence to important positions inthem who had " neither eyes to see, ears to hear, nor tonguesto teach." That anyone should enter a hospital for the-purpose of making notes of a lecture for publication wasconsidered to be a species of poaching. The " game lawsof physic" were as stringent as the laws relating to hunting,in the time of William the Conqueror. The lecture was asecret-a mysterious thing of wonderful erudition-to theoutside world, and even to many members of the pro.fession. No one benefited from the opportunities of in-vestigating disease clinically save those who were fortunateenough to have obtained one of the hospital appointments,oftentimes through the payment of vast fees to the leadingmembers of the hospital staff. The public had no means ofjudging whether things were well managed or mismanagedwithin the walls of these medical sanctuaries. The medical

profession was kept profoundly ignorant of what was in pro-gress there. The student was neglected, any clinical in-struction worthy of the name had not yet been called intoexistence, and the medical prescriptions were models ofmystery.This was the condition of matters in the metropolitan

hospitals at the time when Napoleon the Great was onthe island of St. Helena, a period renowned for the dis-cussion of the question of the liberty of the Press, whenPitt the younger was Premier. It was a period of reformers,.though many who began as such turned tail on discovering:a policy which paid better. Men were replacing slaves inthe colonies, and Cobbet was advocating political reformsat home. At this period a young student from the county ofDevon enrolled his name in the archives of St. Thomas’sHospital. His robust appearance, athletic limbs, and generalmanly bearing, no doubt developed by two years’ seafaring.

life in the Indian merchant service as a midshipman,attracted the attention of some of his teachers, andshortly afterwards became a favourite with the majority)f his student colleagues. He was descended from theCeltic stock, the pure old British blood flowed inhis veins, and he possessed all the essential qualitiesof the Celt - fire, impetuosity, strength, that couragewhich means manhood, the standing up for rights anddoing battle in a noble cause. These were some of thequalities which young Wakley brought with him from thecountry hearth to the hospital on his entrance to themedical profession. His observation was keen, andhe was soon speedily and painfully alive to factsof the kind which I have recorded above. He wentthrough the dreary routine of the hospitals and theschools of that period and his spirit was stirred within himas he perceived in all quarters efforts to impart medicalknowledge according to methods that a Highland school-master of the last century would have been ashamed of. As’

59

time went on the abuses to be rectified grew upon his mindwith greater and greater intensity. He determined thatthe abuses so manifest should be rectified if possible. Thingsmedical had come to a critical period. The tension betweenthe various medical bodies was so strong that Mr. Wakleycould not fail to observe it, the strong feelings which existedbetween the more thoughtful of the students and those re-sponsible for thescant and often improper use which was madeof the material at their disposal for their instruction, and,above all, the acute condition of matters between hospitalteachers and the medical profession generally, started the trainof thought which caused the name of this young student inafter years to become synonymous with the champion ofmedical reform. The task he set himself was to remove,if possible, those conditions which had given rise to the hightension in the body medical. It required, he said, treatmentsimilar to that upon which in our forefathers’ time the phy-sician relied for the disappearance of those morbid products,or "humours" as they were called, and which often led in thecase of disease to complete recovery. Could the body medicalbe made subject to treatment of this kind. If so, itmight be possible to bring about a profound change in thesystem of things as they then existed. Hence the origin ofTHE LANCET. This little instrument of steel, which, thoughnow serving for the most part as a decoration for students’pocket-cases, must have afforded, according to high testi-mony, great relief to our forefathers, and, in many cases,must have prolonged life, notwithstanding the fact thatLord Byron has credited it with having slain more than thesoldier’s lance.The action of the lancet was never punitive, but con-

servative of life and energy, and an agent used to purify thebody from those deleterious products upon which its mortalills depended. It occurred to Mr. Wakley that, by usingthe quill for purposes similar to those for which surgeonsused the lancet, he might, in the body medical, get rid ofmuch that was harmful ; and, instead of its memberstottering with premature decay, despised by all men, theymight obtain a new lease of life and vigour, and be of greaterservice to the people in the country at large. Accordingly,in the year 1823, his energies were thrown with full powerinto a publication which was then indeed a " tiny instru.ment," and he issued, on the 5th of October of that year,the first number of THE LANCET. It extended only tothirty-six pages, but its effect was startling in the extreme;though tiny, yet so sharp and penetrating were the articles inthis number, and withal so bold, that many were astonishedat the apparent audacity of the little number. The com-fortable hospital doctors beheld its appearance with trepi-dation. Quacks held their breath, malpractitioners werein alarm, and the medical public were quiet and expectant.Its statements and criticisms were courageous and full ofmanly vigour, and it sounded in medical literature a

stirring note altogether different from the tone of its tamepredecessors.In illustration of the correctness of these statements a

brief sketch of the contents of this first number of THELANCET, published on Oct. 5th, 1823, at 6d., by A. Mead,201, Strand, will be sufficient. The preface expressesregret that no work existed which would convey to thepublic, to distant practitioners, and to students reportsof the metropolitan hospital lectures. Then follows a

surgical lecture, delivered on Wednesday, Oct. 1st, 1823, inthe theatre of St. Thomas’s Hospital, by Sir Astley Cooper,at which over 400 students were present, describing theduties of the profession, and advocating the practical aspectof medical education. General education was stated to beessential to the welfare of the profession. This lecture wasreported specially for THE LANCET, and led to a prolongedstruggle, which only terminated in the law courts. Thencomes a section headed "Politics," with a sketch of Mr. Pitttheyounger, who is described as "a character to whom Englandowes anything but gratitude. His admirers in rapturecalled him in his twenty-third year the boy statesman, andin his forty-seventh he was still the same, running after wild,impracticable schemes regardless of everything but thegratification of his own senseless and petty ambition." Anintimation follows of the intention of THE LANCET topublish in the next number particulars of a case whichexcited much attention at the time-namely, that of Dr.Collyer. Interesting criticisms of the drama are next givenfrom Drury Lane and from Covent Garden. In the medicaland surgical intelligence, Henry Earle defends himself fromSir Astley Cooper’s reply to his critical observations on

fracture of the neck of the femur, of which Sir Astley, whenhe read them, was led to exclaim, " Good God ! is thiswritten by an English surgeon ?" Next there is an

account of a case of anasarca successfully treated byacupuncturation, in which " the arms and trunk werereduced in the course of a week to their natural size."A case of hydrocephalus chronicus in which pressureproved most beneficial is recorded by J. F. Barnard, Esq.,of which the following gives the gist : 111 had the headshaved perfectly clean. I then applied broad strips ofadhesive plaster completely round the head from beforebackwards, and cross strips from the one side to the other,so as effectually to support the parietes of the cranium.

Having decided on my practice, I waited patiently theresult. The article ends : "It is now two months sincethe bandage was applied, and the child is in every respecthealthy except that the head still contains water, and islarger than it ought to be. I shall recommend the bandageto be worn until the bones are fully united." What would bethought of such a procedure now ? Mr. T. M. Greenhow,surgeon, records a case in which hydatids were dischargedin considerable quantities from the intestines. They wereof various sizes and of different colours, very nearly re-sembling boiled gooseberries and of about the same dimen-sions. An interesting ancient notion of the physiology ofrespiration is given in a paper on Obstruction of Blood in theLungs, reprinted from the Edinburgh Medical and SurgicalJournal, in which an attempt is made "to convince a

person that the blood stagnates in his lungs every time heinterrupts his respiration by uttering long sentences, andthat that interruption endangers the rupture of a blood-vessel or engenders tubercular consumption." A remark-able illustration of the fatal effects of fear in the opera-tion room, and a few medical extracts of an interestingcharacter, are followed by an account of the compositionof quack medicines, and three columns of table talk.The number concludes with a remarkable article on

Southey, the Poet Laureate, in which he is set forth asa "Sack-hunting, hypocritical rhymer" and a "pretendedmoralist." "

It was not for nothing that Mr. Wakley broke away withsuch violence from the trammels of professional precedence,and embarked in an enterprise which called for the mostunbounded courage and the most enduring self sacrifice. Atthe end of the first year of the publication of THE LANCET theyoung editor was able to say, " We have successfully resistedan attempt on the part of the three surgeons of St. Thomas’sHospital to gag the medical press. We have effected somemodification of the recent law of the College of Sur-geons, the effect of which is to destroy all competi-tion between surgical teachers. We are glad to announcethat, in respect of our efforts, a regulation has nowbeen adopted at the hospitals in the Borough, by whichclinical lectures both in Medicine and Surgery are to be de-livered weekly, and the surgeons in passing through thewards will be required to make observations to the studentsin an audible voice upon every case of importance." Aftermore than sixty eight years it is hardly possible for medicalstudents to realise what was meant by regulations of thiskind. In his efforts Mr. Wakley was well aware that hewould be assailed by much interested opposition, but, thatnotwithstanding, he declared be would faithfully and fear-lessly discharge his duty. Mystery and ignorance were tohim synonymous terms. The time, he declared, was comewhen ceremonies and signs had lost their charms; hiero-glyphics and gilded serpents their power to deceive. Thiswas the keystone of the edifice of reform he was destinedin after years to construct-the motive power which enabledhim so successfully to remove the cobwebs of tradition andignorance which overhung and obscured the condition of themedical profession. He was not the man to put his hand tothe plough and to look back, but against delusion, sham,and cant he maintained his stand, an unknown youth, teethclenched, and face determined, fronting the world and anti-cipating his own future in it, with something of thab feelingwhich, call it what we may, in the light of retrospection,has probably, by a divine law, filled every great and honestheart at the outset of a great career. The object for whichhe lived has been beautifully put by Professor Masson inspeaking of another genius whose life had been spent ina similar fight :-

Lay the vain impostors low,I3lochheads fall in eveiy foe,Splendour comes with every blow,

Let me do or die.