1
760 of all chemists and the patient pays for the prescription. After all, if the patient uses a prescription on another occasion than that on which it was prescribed, he does so at his own risk. But it is undeniable that a prescription given to the patient for a fee is his property, to be used by him at his discretion. To think that Parliament, as is suggested, could be got to pass an Act to stop this practice is to have much more faith in Parliament than seems to be warranted. Speaking candidly, these letters are not very practical. There is one evil which they entirely ignore, and which is of far graver import than those complained of-viz., the assumption of an air of medical knowledge and learning by druggists in cases that would puzzle medical men them- selves; and the use to which they put their familiarity with prescriptions-viz., repeating them for others and prescribing them. Some druggists-we should be sorry to think more than a few,-by a system of inquiry learn the general nature of the cases for which prescriptions are written, and then apply them to what they regard as similar cases. If general practitioners and chemists are to come to better relations, there must be a more perfecb and delicate understanding on such practices. THE MEDICAL REGISTERS FOR 1892. THE Medical, the Dental, and the Medical Students’ Registars, printed for the General Medical Council at Her Majesty’s Stationery Office, are now ready. The election of direotrepresentatives necessitated the revision of the ltegister with more than ordinary care. The number of practitioners registered during 1891 has somewhat increased, being 1315, as against 1266 in 1890. Deducting those names which have been removed from the Register owing to death or from other causes, the number of names added to the Register is 392. The total number is 29,555, as against 29,163 in the previous year. Of the new registrations, 683 were effected in England, 502 in Scotland, and 160 in Ireland. The registration of colonial practitioners under Part II. of the Medical Act, 1886, now includes 10 names. The Dentists’ Register for 1892 will be found to contain 79 persons more than that for 1891, making a total of 4896, of whom 1179 practitioners, or 24-07 per cent., possess the qualification of Licentiate in Dental Surgery ; while 3698, or 75’55 per cent., are registered as "in practice before July 22nd, 1878." This shows a marked diminution con- tinuously going on from the percentage 90’87 of those who were so registered in the year 1879. The number of foreign dentists now registered is 19, or nearly 0’4 per cent. The Medical Sbudents’ Register shows that 2405 students registered in 1891. This is the maximum hitherto recorded, being 559 more than in 1890. This may be accounted for, no doubt, by the new regulations with regard to the five years’ curriculum that came into operation on January lst, 1892. Following the practice adopted for many years past, statistics are given showing the respective preliminary examinations that these students passed and the various medical schools or other " places of study " at which they commenced their professional career. I MEDICAL LEGISLATION IN NEW SOUTH WALES. THE Sydney papers, in leading articles and letters, continue to discuss the Medical Bill and its fitness to secure the chief ends of medical legislation-the clear differentiation of the qualified from the unqualified. The Sydney Morning Herald objects that, while special arrangements are made for the registration of persons who have been practising without qualification, men who have passed through a curri- culum and who hold qualifications or degrees may be left out or remain unregistered. There is some ground for the first objection. When medical legislation was first introduced it was reasonable to admit to the Register persons actually in practice and without diplomas. But that can hardly be held now, when for many years, in most civilised communibies, men have been required to show proof, in the shape of diplomas, of being qualified to practise. Ab any rate, if there is still to be a clause of grace in favour of men without diplomas, it should provide that they shall be registered under a separate head, not on the score of possess. ing a diploma, but on giving satisfactory proof of having been for many years in practice, To make clear such a distinction is only fair to men who have taken diplomas at great cost of time and money, and fair also to the public. The Herald also objects, apparently, to regis. tered men being disfranchised or taken off the Register on the ground of their diploma being taken away by the body that gave it on the score of mere "misconduct" or a breach of professional etiquette. Our contemporary would surely admit two things. First, that "conduct" is an essential element in the worth, and even the qualifica- tion, of a medical man. If a man dissociates himself from the obligations of his profession and its methods, he has no right to complain if his profession disowns him. It is in the public interest that he should be disowned. Medicine is a calling in which public deception and fraud can easily be practised if once the honourable and ethlcal side of it be disregarded. The second point is that no persons are so fib to judge in such a matter, and so likely to judge mercifully, as those composing the body from which the diploma proceeds. By all means let the Medical Council be required to deal directly with charges of misconduct, and to j judge for itself ; but in any case the judgment of a man’s alma mater should count for much, and its disciplinary powers should be upheld. It is true, as our Sydney con- temporary points out, that the Universities which should be most exemplary in the use of their disciplinary powers cease to have any after graduation. This is a monstrous state of matters, from which it results that graduates of ancient and honourable Universities occasionally bring their alma mater into great discredit with impunity. But that is a reason for giving to all bodies which grant diplomas full disciplinary powers, not for withdrawing them from those which already possess them. Ib is noticeable, as pointed out by a correspondent in the Sydney Daily Telegraph, that the judicial powers of examining bodies are only contemned by those who fear the exercise of them. THE USE OF COCAINE IN SURGERY. AT the Islington Medical Society recently Dr. Wood- roffe read a paper on the Use of Cocaine in Surgery. He wondered how general practitioners got on formerly without it. He specified the following cases in which he had used it with satisfactory results-nasal polypi, adenoma of the naso-pharynx, excision of the tonsils, cystic growths of the scalp, tarsal cysts, scraping out of tubarcular abscesses and sinuses in the neck, small false aneurysm in the palm, villous growth in the female urethra, internal haemorrhoids, fistula in ano, tenotomy of anterior and posterior tibial muscles, also of the ligamentous sternal insertion of the sterno-mastoid in wryneck, fissure in ano, and abscesses of various kinds. Dr. Woodroffe would never use a general anaesthetic for internal piles save at the direct request of the patient. The expulsive power is saved by cocaine, and is a great advantage to the surgeon. He injects separately into the base of each pile. He has never used more than one grain, generally half that quantity. He had had two cases of poisonous effect, and had come to the conclusion that such a result depends far more on idiosyncrasy than on the quantity of the drug used. In one the quantity injected was half a grain; in the other only a quarter. The first was a woman, the second a girl about fifteen. Such cases have led him to be cautious in

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Page 1: MEDICAL LEGISLATION IN NEW SOUTH WALES

760

of all chemists and the patient pays for the prescription.After all, if the patient uses a prescription on anotheroccasion than that on which it was prescribed, he does soat his own risk. But it is undeniable that a prescriptiongiven to the patient for a fee is his property, to be used byhim at his discretion. To think that Parliament, as is

suggested, could be got to pass an Act to stop this practiceis to have much more faith in Parliament than seems to bewarranted. Speaking candidly, these letters are not verypractical. There is one evil which they entirely ignore, andwhich is of far graver import than those complained of-viz.,the assumption of an air of medical knowledge and learningby druggists in cases that would puzzle medical men them-selves; and the use to which they put their familiarity withprescriptions-viz., repeating them for others and prescribingthem. Some druggists-we should be sorry to think morethan a few,-by a system of inquiry learn the generalnature of the cases for which prescriptions are written, andthen apply them to what they regard as similar cases. If

general practitioners and chemists are to come to betterrelations, there must be a more perfecb and delicate

understanding on such practices.

THE MEDICAL REGISTERS FOR 1892.

THE Medical, the Dental, and the Medical Students’

Registars, printed for the General Medical Council at HerMajesty’s Stationery Office, are now ready. The election ofdireotrepresentatives necessitated the revision of the ltegisterwith more than ordinary care. The number of practitionersregistered during 1891 has somewhat increased, being 1315,as against 1266 in 1890. Deducting those names whichhave been removed from the Register owing to death orfrom other causes, the number of names added to the

Register is 392. The total number is 29,555, as against29,163 in the previous year. Of the new registrations, 683were effected in England, 502 in Scotland, and 160 inIreland. The registration of colonial practitioners underPart II. of the Medical Act, 1886, now includes 10 names.The Dentists’ Register for 1892 will be found to contain 79persons more than that for 1891, making a total of 4896, ofwhom 1179 practitioners, or 24-07 per cent., possess thequalification of Licentiate in Dental Surgery ; while 3698,or 75’55 per cent., are registered as "in practice beforeJuly 22nd, 1878." This shows a marked diminution con-

tinuously going on from the percentage 90’87 of those whowere so registered in the year 1879. The number of foreigndentists now registered is 19, or nearly 0’4 per cent.The Medical Sbudents’ Register shows that 2405 studentsregistered in 1891. This is the maximum hitherto recorded,being 559 more than in 1890. This may be accounted for,no doubt, by the new regulations with regard to the fiveyears’ curriculum that came into operation on January lst,1892. Following the practice adopted for many years past,statistics are given showing the respective preliminaryexaminations that these students passed and the variousmedical schools or other " places of study " at which theycommenced their professional career. I

MEDICAL LEGISLATION IN NEW SOUTH WALES.

THE Sydney papers, in leading articles and letters, continueto discuss the Medical Bill and its fitness to secure the chiefends of medical legislation-the clear differentiation of thequalified from the unqualified. The Sydney MorningHerald objects that, while special arrangements are madefor the registration of persons who have been practisingwithout qualification, men who have passed through a curri-culum and who hold qualifications or degrees may be left outor remain unregistered. There is some ground for the firstobjection. When medical legislation was first introducedit was reasonable to admit to the Register persons actually

in practice and without diplomas. But that can hardlybe held now, when for many years, in most civilisedcommunibies, men have been required to show proof, in theshape of diplomas, of being qualified to practise. Ab anyrate, if there is still to be a clause of grace in favour ofmen without diplomas, it should provide that they shall beregistered under a separate head, not on the score of possess.ing a diploma, but on giving satisfactory proof of havingbeen for many years in practice, To make clear such adistinction is only fair to men who have taken diplomasat great cost of time and money, and fair also to

the public. The Herald also objects, apparently, to regis.tered men being disfranchised or taken off the Registeron the ground of their diploma being taken away bythe body that gave it on the score of mere "misconduct"or a breach of professional etiquette. Our contemporarywould surely admit two things. First, that "conduct" isan essential element in the worth, and even the qualifica-tion, of a medical man. If a man dissociates himself fromthe obligations of his profession and its methods, he has noright to complain if his profession disowns him. It is in the

public interest that he should be disowned. Medicine is a

calling in which public deception and fraud can easily bepractised if once the honourable and ethlcal side of it be

disregarded. The second point is that no personsare so fib to judge in such a matter, and so likely to

judge mercifully, as those composing the body from whichthe diploma proceeds. By all means let the Medical Councilbe required to deal directly with charges of misconduct, andto j judge for itself ; but in any case the judgment of a man’salma mater should count for much, and its disciplinarypowers should be upheld. It is true, as our Sydney con-temporary points out, that the Universities which shouldbe most exemplary in the use of their disciplinary powerscease to have any after graduation. This is a monstrousstate of matters, from which it results that graduates ofancient and honourable Universities occasionally bring theiralma mater into great discredit with impunity. But that is

a reason for giving to all bodies which grant diplomas fulldisciplinary powers, not for withdrawing them from thosewhich already possess them. Ib is noticeable, as pointedout by a correspondent in the Sydney Daily Telegraph, thatthe judicial powers of examining bodies are only contemnedby those who fear the exercise of them.

THE USE OF COCAINE IN SURGERY.

AT the Islington Medical Society recently Dr. Wood-roffe read a paper on the Use of Cocaine in Surgery. Hewondered how general practitioners got on formerly withoutit. He specified the following cases in which he had usedit with satisfactory results-nasal polypi, adenoma of thenaso-pharynx, excision of the tonsils, cystic growths of thescalp, tarsal cysts, scraping out of tubarcular abscesses andsinuses in the neck, small false aneurysm in the palm,villous growth in the female urethra, internal haemorrhoids,fistula in ano, tenotomy of anterior and posterior tibialmuscles, also of the ligamentous sternal insertion of thesterno-mastoid in wryneck, fissure in ano, and abscesses ofvarious kinds. Dr. Woodroffe would never use a generalanaesthetic for internal piles save at the direct requestof the patient. The expulsive power is saved bycocaine, and is a great advantage to the surgeon. He

injects separately into the base of each pile. He hasnever used more than one grain, generally half that quantity.He had had two cases of poisonous effect, and had come tothe conclusion that such a result depends far more onidiosyncrasy than on the quantity of the drug used. Inone the quantity injected was half a grain; in the otheronly a quarter. The first was a woman, the second a girlabout fifteen. Such cases have led him to be cautious in