493

THE LANCET.

LONDON : SATURDAY, MAY 12, 1855.

NECESSITY FOR ACCURATE REGISTRATION OF DEATHS IN MILITARY HOSPITALS.

THAT the Sebastopol Committee will fully succeed in

eliciting evidence enough to prove the utter rottenness of ourwhole system of Administration, including that of the PublicMedical Service, we entertain no doubt; but we at the sametime believe, that very many of the defects of principle and,detail that preclude the efficiency of the service, as a whole,and neutralize the most zealous efforts of the individual mem-

bers, will escape detection, owing to the absence from the

Committee of practical information fitted to direct in a propermanner this branch of the inquiry. It may be true that the

Committee have expressed themselves competent to investigatethe causes of the inefficiency of the Transport Service, and the.consequent wastefulness of life and money that have thrownsuch deep disgrace upon the administration of the Government,without having amongst them any one specially versed in.nautical affairs, but we nevertheless submit, that in order toconduct a thorough, a fair and candid investigation into theconduct of the Medical Department, the assistance of somegentleman belonging to the medical profession, and knowingsomething of the peculiar duties that devolve upon medicalofficers, is desirable. It seems difficult to put questions that.shall always be judicious, unless some accurate general know-ledge of the subject inquired into guide the questioner. Those

who have not yet lost confidence in the universal talents of our

governing classes may urge, that if there is not a medical man,.there is what is better, a noble Lord, upon the Committee, who

having been for many years a Commissioner in Lunacy, must,in addition to that general intuitive capacity which all lordsare presumed to possess, have acquired a practical acquaintancewith medicine; but that is an argument which does not com-mand our respect, and which will probably before long losevery much of its weight with the public.We pass over for the present our inquiry into the defects of

constitution and organization of the Army Medical Service asubject to which we have already adverted, and to which weshall have occasion to return, and proceed to call attention toone cause that has operated most injuriously, not only in im-

peding the advance of medical science, but also in thwartingthe immediate object of the Committee-that of tracing to.their source the disasters of the Crimean campaign. Upwardsof ten thousand of our soldiers have perished. Of this number,about 1500 may be estimated-we have no precise information-to have died of wounds either on the field or subsequently. Of

what diseases have the remaining 8500 perished? The ques-tion is important. We hardly know of one more deservingthe attention of the Sebastopol Committee. A diligent in-quiry, directed by familiarity with medical science, might,and no doubt would, lead to the discovery of great portionof the truth. But if the country demand a categorical returnof the cause of death of every man that has perished in herservice,-if sorrowing relations seek to know the nature of thedisease that has bereft them of a husband, a father, or a

brother,-if science calls for those details that can alone throw

light upon the morbific agencies that have lead to this frightfulmortality, the humiliating answer must be made that thehospital-records supply no data to satisfy these demands.To exhibit the deficiency of our actual administration in the

most striking light, it is only necessary to state the simplefact :---more than 8000-probably many more-of our troopshave, within eight months, died of disease; and there is no t’e-gistration to show the causes of their death!No registration? What mean, then, those columns that -we

scan with such painful interest in the daily papers-columnsthat seem to set forth, with individual minuteness, the causesof death in the pestilential hospitals of the East? Are we not

told in those columns that Private A. B. died of gelatio;Private C. D. of febris; Private E. F. of dysentery; SergeantG. H. of scorbutus; Corporal I. K. of diarrhoea; Private

L. M. of catarrh; and so on, a specific cause of death beingassigned to every soldier? What more can be required? We

require nothing more than security that the causes assigned betrue. And unfortunately they are not true. The columns we

have referred to are neither more nor less than official fictions.

The system pursued is so admirably contrived to defeat theobject set forth, that it is just possible that out of one hun-dred deaths, not one shall be set down to the real cause. In

fact, while the records kept are entitled " Causes of Death,"something altogether different has been under consideration.The genius of Routine revels in mystification; and we defythe establishments of the War Office, of the Admiralty, Home,Colonial, or any other State departments to produce so elabo-rate and so ingenious a mystification as that enshrined in theArmy Returns of the Causes of Death. The mechanism of-the

process we will endeavour to explain: the motives, the prin: ’

ciple of that process are beyond our powers. We will supposethat one hundred patients are admitted into a General Hos-

pital, and are distributed under the care of two medical officers.Each medical officer is required, on receiving charge of his

patients, to enter the name, &c., of each man, and in an appro-

priate column to state the disease under which he is labouringat the time of admission. Each medical officer will thus have,say, twenty cases of diarrhoea, ten of fever, ten of dysentery,ben of catarrh. Those patients he must account for, and .hemust, aye, must account for them, under the exact denomina-tions assigned to them at their entrance. Thus we will imaginethat all his ten cases of catarrh contracted in hospital a pesti.lential fever, and died. Will their deaths be assigned topestilential fever? No, that is impossible! Such a course wouldthrow the whole system into hopeless confusion. Themedical

officer has got ten cases of catal’rh to account for; let them dieof what they may,-and catarrh is not a very probable cause;yet to catarrh must their death be laid ! Nothing so inflexibleas a system; and so in order to preserve this system the courseof Nature itself is subverted. This system requires us to be-lieve that, a disease once assigned to a sick man, he is hence-forth exempt from every other disease; or if not exempt, sinceit is so very inconvenient to have to record the change in his

pathological condition, although that change may be the occa-sion of his death, it is held to be best to ignore the new dis-ease, and deliberately to certify that a man who died of fever,died of a cold ! We are told that a medical officer-he was a

civilian (may his audacity be pardoned!)-once ventured toask whether he might not break through the routine, and

speak the truth Official amazement having subsided, the

494 THE EXAMINATION FOR THE MEMBERSHIP OF THE COLLEGE OF SURGEONS, LONDON.

following course was suggested to him: He might, in the case chemistry behind in the work of magnifying their respectiveof a man admitted under catarrh, but dying of dysentery, themes. And now, also, three years’ labour in this wideningfirst, discharge him as recovered; second, re-admit him as field is demanded of the student. Nevertheless, with all this

suffering from dysentery; and then thirdly, the patient being increased employment both for teacher and for taught, thedead all the while, report him as dead of dysentery! The examiners of our noble College have not augmented their ownbewildered civilian, seeing no way of being allowed to speak labours, and, with the true conservative spirit, still consecrateone truth, but by telling three lies, succumbed to routine, and a single hour to gather the fruit of so much seed-time, andwent on reporting falsehoods according to precedent and the examine the produce of such prolonged and elaborated tillage.rules of the service! Such is the system of Army Registration. One hour, to take the gauge of a human mind, trained for theTruth being inconvenient, Falsehood is boldly professed ! highest and noblest pursuits allotted to man on earth, whileWith such data, it would be idle to attempt to draw any the destinies of thousands and the well-being of all may be de-

general conclusions as to the causes of the mortality in the pending largely upon the healthy exercise and the fittingArmy-idle to reason upon the pathological characters of the acquirements of that intellect.diseases that have been rife-idle to attempt to draw up any It is, doubtless, the manifest impossibility to achieve suchcomprehensive or consistent medical history of the campaign. an object which has induced examining bodies generally toWanting those materials which a rational system of registra- satisfy themselves, for the most part, with laying down strin-

tion-one constructed on the principle of respecting truth, gent laws relating to the kind and quantum of study to berather than the exigencies of routine-would have furnished, imposed on all candidates for their diplomas. The task of

we are thrown back upon the individual experiences of the ascertaining whether the aspirant is practically qualified formedical officers who have had to do battle against those terrible exercising the healing art, has been commuted for the easierafflictions that have decimated our Army; we must look to engagement of ensuring his attendance, for stated periods,them for independent accounts of what they themselves have upon the means of knowledge. It has been mainly sought towitnessed in the wards of the hospitals or in the camp. From produce practical surgeons by enforced attendance upon lecturesthem only can we hope to obtain a trustworthy picture of the and compulsory peripatetics in the hospital wards. The ex-

sanitary history of the Crimean campaign. The papers of Dr. amination which has followed, has rather been designed toPYEMONT SMITH, the first of which we publish this week, will elicit a " confession of faith"-adhesion to the orthodox patho-on this account be perused with unusual interest. logy of the catechist, than to test the practical tact of theThe efforts and admirable suggestions of the Director-General catechised; and such a method is, naturally enough, just as

of the Medical Department of the Army, which, if they had successful in producing surgeons, as theological creeds and

been carried out, might have spared immense suffering and catechisms are powerful to ensure an exemplary moral and

mortality, were totally disregarded and ignored by the odious religious life in those who are compelled to learn them."routine" system. Hence, is not it notorious that the " college questions," and

*the " college answers" too, are pretty well known in certainTHE COLLEGE! portentous word! The examination there, extra-official quarters? and that they are opportunely pro-

always a subject of dread and apprehension to students, is not vided for the benefit of careless youths, falsely called " stu-due to its length. It always lasted and never exceeded an hour. dents," who have still " six weeks good" before the time arrivesIt does so still. The quantum of anatomical knowledge required at which they are expected by their friends " to pass"? And

of our forefathers was not great in their day, neither was the " pass" they will, too, as surely as their honest, earnest con-

study of physiology profound. A man was expected to distin- temporaries who have faithfully worked their time. Such are

guish at sight the upper from the lower end of a femur. His the natural fruits of the catechetical method of the college.examiner looked pleased and satisfied if he assigned the clavicle That it may not be very easy at once to divine a mode of

to its proper side without much hesitation; but a skilful adjust- conducting the examination in such a manner that it should

ment of the carpal or tarsal skeleton was certain to obtain really be a matter of no importance to ascertain how long the’’ the compliments of the Court" for the successful candidate. student had applied to his profession, nor how, nor where heVisions of dry bones always abounded at the College tables, had acquired his knowledge, may perhaps be admitted. But

just as they do to-day; but our readers need not us to tell until examination can thoroughly and completely develop athem how much more than this is expected from them now. man’s knowledge and physical qualifications to practise, with-Although a third of a century has passed away since at so out reference to personal history, the method must be defective,low a standard the ranks of surgery were recruited, and nume- and the sooner we try to amend it the better. All that we

rous have been the additions to the College curriculum since,- want is, to ascertain the fact of qualification. What can it

although in former times an active lecturer supplied just fifty matter whether the student gained it from A.’s book or B.’s

lectures in the winter session, and summer sessions scarcely lecture, in this hospital or that infirmary, provided he has

existed,-an hourwas employed in examining the candidate who gained it ? We don’t say that the present system of compellinghad for two years complied with the then slender requisitions. young men to take a hundred pounds’ worth of metropolitanHow altered now the scene of student - labour ! Anatomy instruction, with an extra expenditure of at least two or threeand physiology, formerly doled out together in fifty scanty hundred pounds for metropolitan board and lodging, is the

hours, now, thanks to HALLER, MuLLER, ScHLmnz;rr, VALEN- result of any artful design to victimize them on the part of theTIN, BiscHOFF, HALL, GOODSIR, and a host of other worthies, examining authorities, although this has been said, and withmake heavy demands upon two hard-worked professors, and some speciousness of truth too, it must be confessed. Never-each but sketches the outlines of his subject now in 150 demon- theless, we do not so believe. But it cannot be denied, thatstrations. Nor are their brethren of medicine, midwifery, or the system is a profitable one for those who make the regu-

495THE NEW POOR-LAW ORDER RESPECTING UNION SURGEONS.

lations, and constitute themselves the legal dispensers of ana-tomical and physiological instruction at a handsome rate perannum. No doubt it will be an unlucky discovery for thesegentlemen, when the efficient means of testing ability bymeans of examination shall have rendered unnecessary and

supererogatory the " annual course’’-when it shall have been

lucidly demonstrated that two courses of surgery and threecourses of anatomy are not equivalent to one surgeon. Nor

can we think that this discovery is far distant. It is very in-

teresting to observe how examinations of recent construction,and even the later forms of some old examining bodies, aremodified and remodelled, and all in the direction indicated;how oral examinations have become interchanged with writtenones; how hours have been extended to days ;-how ana-tomical questions have been superseded by anatomical dissec-tions ;-how, indeed,-most modern innovation ! the candidatehas even been, in some quarters, expected to examine a veri-table sick man, and to sketch a diagnosis of his disease, aprognosis, and a scheme of treatment.

Still, however, the College stands where it did-immovable,an ancient land-mark, a tidal monument-demonstrating howmuch good ground has been recovered for humanity from the

surges of ancient error. The examination which confers the

honour of its membership presents at this moment the minimumof exercise, associated as it is-not happily-with the maximumof pay.

-

BY issuing the late order for making the office of Union Surgeon a permanent one, the Poor-law Board have conferreda great boon upon the profession. The more prominent evils towhich the medical officer has been for a long period subjectedarose from his position in relation to the guardians. When it

suited the purpose of these functionaries, having his appoint-ment in their hands, subject as it was to annual renewal, theyhesitated not to heap upon him every species of injury andinsult. Even if he appealed in any case to the Poor-law Boardfor protection, and received their approval of his conduct, the

guardians took care to take their revenge on the next day ofelection.

Fortunately, the late order will take this arbitrary powerout of the hands of the guardians, and thus not only make themedical officer more independent of these petty tyrants, but itwill tend in every way to the advantage of the profession. It

will be seen from a letter of Mr. LUMLEY, inserted at page498, that the order alluded to has reference at present only tothose Unions which have been formed under the Poor-law

Amendment Act of 1834, and to certain Incorporated Hundreds,which have always acted under the regulations of the Poor-lawCommissioners. Giving the Poor-law Board full credit for anearnest desire to place the Union Surgeons of the kingdom inthe position which will enable them to perform their arduousduties most completely and satisfactorily, we trust and hope,not less for the profession itself than for the poor entrusted totheir care, that the Board will shortly issue the new order tothose places in which the relief of the poor is administered

under the provisions of a local act.

APPOINTMENTS.—Mr. William Thomas Fernie, house-surgeon to the Royal Portsmouth, Portsea, and Gosport Hos-pital, has been appointed resident medical officer to the

Birmingham Workhouse.-Dr. Smiles has been appointed oneof the physicians to the St. Pancras Royal General Dispensary.

ANNUAL MEETING OF THE GRADUATES OFTHE UNIVERSITY OF LONDON.

THE graduates of the University of London held their annualmeeting at the Freemasons’ Tavern on May lst, Dr. BirkbeckNevins, of Liverpool, in the chair.Mr. SHAEN, honorary secretary, read the following Report

from the committee :-" Your committee have this year to record the important

fact, that the Bill prepared under their auspices in the lastsession of Parliament, for placing the medical graduates of theUniversity of London on a footing of perfect equality with thoseof Oxford and Cambridge in respect of the right to practisephysic, passed both Houses of Parliament, with some slightalterations, and received the Royal assent on the llth of

August, 1854, In their last Report, the committee, in referringto this subject, expressed their anticipation that your Billwould meet with no important opposition. In this they weredisappointed. The Bill was stoutly contested in both Houses,and underwent the ordeal of several divisions. In the beliefthat the Universities of Oxford and Cambridge had, at all

events, the right to confer a license to practise surgery, theBill was so framed as to extend such right (if any) to the Uni-versity of London. It was, however, stated in Parliament,

that the right, if it existed, had fallen into abeyance, and itbecame necessary to yield to the efforts made to confine themeasure to the practice of physic, excluding not only surgery,but also pharmacy and midwifery. The committee believe this

modification to be of very small importance, and that theobjects of the graduates have been practically and triumph-antly secured. Considering the small number of Bills of anykind introduced by private members, which passed in the lastsession, the very late period at which the Bill was brought in,the strenuous opposition which it received (headed in the House

.

of Lords by the Duke of Argyll, a Cabinet Minister), and thefailure of all previous attempts of every party to modify theexisting laws affecting medical practice, your committee can-not but regard the history and progress of your Bill as afford-ing an additional and decisive proof that the efforts of thegraduates have now placed the University in a position fromwhich it can never be dislodged. The graduates owe a largedebt of gratitude to the members of both Houses of Parliament,both in and out of the Ministry, by whose votes the measurewas passed ; and especially to Mr. Bell and Mr. Thornely, whohad charge of it in the House of Commons; to Lord Monteagle,

who acted in a similar capacity in the House of Lords; and toLord Palmerston, who on this occasion lent a cordial andeffective support as Home Secretary. Special mention mustalso be made of the services of Professor Foster, which werethen, as ever, freely given to the cause of the graduates. TheSenate voluntarily came forward to aid the progress of the Bill

after its introduction, and supported the interests of the Uni-versity with vigour and effect."The committee sincerely regret that they have not suc-

ceeded in accomplishing the internal reform of the University.During the concluding part of the last session of Parliament,the committee deemed it advisable to direct their efforts mainlyto secure the passing of the University of London MedicalGraduates Bill. They did not, however, omit also to apply tothe Home Office upon the subject of the Charter which theyhad requested that the law officers of the crown might bedirected to prepare. No satisfactory answer, however, wasreceived previously to the end of the long vacation. Subse-quently to this, the incompleteness of the arrangements of theministry, and the general aspect of public affairs, rendered itimpossible to act upon the Government with any useful result,either by private representation or parliamentary pressure.When it was understood that the ministerial changes were atan end, application was made to Sir George Grey, the Senatehaving long ago referred the whole question to the Home Office.The reply made it clear that the long and elaborate letter ofthe 8th of February, 1854, from Lord Burlington, as Chan-cellor of the University, to Lord Palmerston, as Home Secre-tary, which was printed in the last Report of your committee,had actually been overlooked altogether, and that the presentHome Secretary believed that he was still waiting for an ex-pression of the views of the Senate. To have the settlement ofthe question delayed by mistakes of such a character in such aquarter may well tax the patience of the graduates. Thecommittee can only assure them that they will use all theefforts which, in the present position of public affairs, have anychance of success, to press forward the claims of the graduates,either in Parliament or at the Home Office, as circumstances maydictate.