3
39 THE LANCET. LONDON: SATURDAY, JULY 11, 1857. THE MEDICAL REFORM QUESTION. IT is by a long and a weary road that approach is ever gained to perfect legislation. Many a pitfall must be avoided, and many a toilsome steep climbed; but every sound principle developed and accepted may be regarded as a landing-place, whence a fresh ascent may be effected to still surer ground. The cause of Medical Reform, by the majority of Wednesday week, landed unassailably on an eminence, where it rests no longer threatened by destruction, either from the interested machinations of individuals, or from the mistakes of select committees. A great principle was established w hen the voice of the House of Commons pronounced emphatically against ,centralization and Government dictation in the affairs of the medical profession, and decided in favour of self-government. That the country is with the profession,-that it acknowledges their superior judgment in the matter of self-education, and in all regulations pertaining to their own efficiency, and therefore to the interests of the public,-could not have been more Strongly enunciated. A majority of one hundred and forty- seven, or three to one, in support of a profession, who are backed by no great aristocratic influences, is a triumph to Mr. HEADLAM’S Bill, which might well excuse some exultation on -bhe part of its supporters. The vast body of the medical pro- fession, however, who have now united to obtain reform,-who have toiled so indefatigably and mutually conceded so un- selfishly,--have at this moment better work to do than to indulge in any boastful triumphs. Their duty ever before them is to inquire how these now firmly established great prin- ciples are to be best applied for the true benefit of all con- cerned. As there can be no doubt that a liberal Government must gladly co-operate in the good work of carrying out Mr. HEAD- LAM’S Bill according to the wishes of the profession and the fiat of the majority, it would be well to inquire what unim- portant details may be so modified as to induce the Govern- ment to undertake it. In considering the suggestions made by the Hon. Mr. COWPER, we find they involve no very essential deviations ’!from the provisions in Mr. HEADLAM’S Bill-none, at least, which may not admit of adjustment. The points on which Mr. COWPER chiefly insisted related to the Council, in the ’, ’organization of which he proposed to be satisfied with a veto on the part of the Crown. To this proposition we can foresee no insurmountable objection. If the Acts of the Corporations are intended to be just and expedient, we can conceive no reason why such a power should not rest in the Crown, to be employed by Her Majesty’s Secretary of State. We cannot suppose but that men who must be in possession of the greatest - possible amount of knowledge on the subject to be settled, having also honest views for that settlement, must be capable of showing a good and sufficient reason for all their decisions ; nor can we suppose that a Secretary of State would be unin- fluenced by such a display of practical knowledge, and there- fore the exercise of such veto on the part of the Crown would be deprived of all its danger-nay, might prove beneficial. We must make some concessions in order to induce the Government to take up the Bill with a fixed determination to pass it into a law. IN intimate relation to our "Greatest Social. Evil"-or to speak more correctly by ascending to causes, our " Great Sin" - stands the question, What shall we do to arrest the spread of syphilis, and mitigate the dire results of that disease, which are visited upon generation after generation, and thus sap the physical strength, as well as the moral health,, of the commu- nity ! Many well-meaning but over-prudish persons seek to escape from this as from every other question connected with our Great Sin," by resolutely shutting their eyes against the dangers that result to society, and by holding up their hands in virtuous protestation against having anything to do with the immediate victims, guilty and not guilty. Unfortunately, it is not in our power to avert a danger by affecting to ignore it. Come it will, gathering strength from our neglect. The folly of pretending that syphilis must be regarded simply as the natural punishment of those who sin, and therefore not a iitting claim for treatment in our medical charities, is not less than would be that of a man who upon hearing that a remote part of his house was on fire through the recklessness of his servants, should lock himself in his bed-room, exclaiming that those who had occasioned the mischief must bear the conse- quences. Were it possible to limit the effects of syphilis to those whose guilty indulgence creates and maintains the disease, some might indeed regard it as a just retribution. But viewed even from this assumption true Charity would hardly turn her back, and leave the victims of sin to suffer without hope or without an effort to relieve them. Since the day when the First Sin " Brought Death into the world and all our woe," it has been the inseparable quality of sin of every kind to involve the innocent in the affiictions of the guilty. So true is this, that we can hardly conceive a case of strictly self- punishing sin. We may imagine a man, without family, with- out dependents, without a friend, to destroy his health and ruin his worldly interests by addiction to drunkenness. Such a man has often been ignorantly called" No man’s enemy but his own." But even - in such a case, where the sin and folly seem most concentrated, both in origin and consequence, in the . sinner, would it be wise, would it be Christian-like, to ignore the evil, and leave the wretch to wallow in his vice before the world ? If unwise here, it is sheer madness to exclude the ! victim of syphilis from the pale of charity. Disregarding for a moment the immediate sufferer, as unworthy of compassion, we cannot shut our eyes to the fact that it is out of our power to limit the punishment to him. The passion that leads to this disease cannot, in the first place, be gratified except by , the concurrence of two persons. One of these may be, often is, innocent. Is the innocent person also to be excommunicated ? But again : upon the gratification of this passion depends , the perpetuation of the human race. A man or woman who has, no matter under what circumstances, contracted syphi- ; lis, will, if placed immediately under the supervision and - treatment of a skilful surgeon, be cured ; and here the . punishment mn.v perhaps be verv closelv restricted to the

THE LANCET. LONDON: SATURDAY, JULY 11, 1857

  • Upload
    doananh

  • View
    214

  • Download
    0

Embed Size (px)

Citation preview

39

THE LANCET.

LONDON: SATURDAY, JULY 11, 1857.

THE MEDICAL REFORM QUESTION.

IT is by a long and a weary road that approach is ever

gained to perfect legislation. Many a pitfall must be avoided,and many a toilsome steep climbed; but every sound principledeveloped and accepted may be regarded as a landing-place,whence a fresh ascent may be effected to still surer ground.The cause of Medical Reform, by the majority of Wednesdayweek, landed unassailably on an eminence, where it rests no

longer threatened by destruction, either from the interestedmachinations of individuals, or from the mistakes of select

committees. A great principle was established w hen the voiceof the House of Commons pronounced emphatically against,centralization and Government dictation in the affairs of the

medical profession, and decided in favour of self-government.That the country is with the profession,-that it acknowledgestheir superior judgment in the matter of self-education, and inall regulations pertaining to their own efficiency, and thereforeto the interests of the public,-could not have been more

Strongly enunciated. A majority of one hundred and forty-seven, or three to one, in support of a profession, who arebacked by no great aristocratic influences, is a triumph to Mr.HEADLAM’S Bill, which might well excuse some exultation on-bhe part of its supporters. The vast body of the medical pro-fession, however, who have now united to obtain reform,-whohave toiled so indefatigably and mutually conceded so un-

selfishly,--have at this moment better work to do than toindulge in any boastful triumphs. Their duty ever beforethem is to inquire how these now firmly established great prin-ciples are to be best applied for the true benefit of all con-cerned.

As there can be no doubt that a liberal Government must

gladly co-operate in the good work of carrying out Mr. HEAD-LAM’S Bill according to the wishes of the profession and thefiat of the majority, it would be well to inquire what unim-portant details may be so modified as to induce the Govern-ment to undertake it.

In considering the suggestions made by the Hon. Mr.

COWPER, we find they involve no very essential deviations’!from the provisions in Mr. HEADLAM’S Bill-none, at least,which may not admit of adjustment. The points on whichMr. COWPER chiefly insisted related to the Council, in the ’,

’organization of which he proposed to be satisfied with a vetoon the part of the Crown. To this proposition we can foreseeno insurmountable objection. If the Acts of the Corporationsare intended to be just and expedient, we can conceive noreason why such a power should not rest in the Crown, to be

employed by Her Majesty’s Secretary of State. We cannot

suppose but that men who must be in possession of the greatest- possible amount of knowledge on the subject to be settled,having also honest views for that settlement, must be capableof showing a good and sufficient reason for all their decisions ;nor can we suppose that a Secretary of State would be unin-fluenced by such a display of practical knowledge, and there-

fore the exercise of such veto on the part of the Crown wouldbe deprived of all its danger-nay, might prove beneficial.We must make some concessions in order to induce the

Government to take up the Bill with a fixed determination to

pass it into a law.

IN intimate relation to our "Greatest Social. Evil"-or to

speak more correctly by ascending to causes, our " Great Sin"- stands the question, What shall we do to arrest the spreadof syphilis, and mitigate the dire results of that disease, whichare visited upon generation after generation, and thus sap thephysical strength, as well as the moral health,, of the commu-nity ! Many well-meaning but over-prudish persons seek to

escape from this as from every other question connected withour Great Sin," by resolutely shutting their eyes against thedangers that result to society, and by holding up their handsin virtuous protestation against having anything to do withthe immediate victims, guilty and not guilty. Unfortunately,it is not in our power to avert a danger by affecting to ignoreit. Come it will, gathering strength from our neglect. The

folly of pretending that syphilis must be regarded simply asthe natural punishment of those who sin, and therefore not aiitting claim for treatment in our medical charities, is not lessthan would be that of a man who upon hearing that a remotepart of his house was on fire through the recklessness of hisservants, should lock himself in his bed-room, exclaiming thatthose who had occasioned the mischief must bear the conse-

quences.Were it possible to limit the effects of syphilis to those whose

guilty indulgence creates and maintains the disease, some mightindeed regard it as a just retribution. But viewed even from

this assumption true Charity would hardly turn her back, andleave the victims of sin to suffer without hope or without aneffort to relieve them. Since the day when the First Sin

" Brought Death into the world and all our woe,"

it has been the inseparable quality of sin of every kind toinvolve the innocent in the affiictions of the guilty. So true

is this, that we can hardly conceive a case of strictly self-

punishing sin. We may imagine a man, without family, with-out dependents, without a friend, to destroy his health andruin his worldly interests by addiction to drunkenness. Such

a man has often been ignorantly called" No man’s enemy buthis own." But even - in such a case, where the sin and follyseem most concentrated, both in origin and consequence, in the

. sinner, would it be wise, would it be Christian-like, to ignorethe evil, and leave the wretch to wallow in his vice before the

world ? If unwise here, it is sheer madness to exclude the

! victim of syphilis from the pale of charity. Disregarding fora moment the immediate sufferer, as unworthy of compassion,we cannot shut our eyes to the fact that it is out of our power

to limit the punishment to him. The passion that leads tothis disease cannot, in the first place, be gratified except by, the concurrence of two persons. One of these may be, often is,innocent. Is the innocent person also to be excommunicated ?

But again : upon the gratification of this passion depends, the perpetuation of the human race. A man or woman who

has, no matter under what circumstances, contracted syphi-; lis, will, if placed immediately under the supervision and- treatment of a skilful surgeon, be cured ; and here the. punishment mn.v perhaps be verv closelv restricted to the

40

THE PAST SESSION OF THE MEDICAL SOCIETIES.

proper objects. But neglect this man or woman, spurn themfrom our hospitals, treat them as outcasts from society-aswretches whose shame is so deep that Charity herself blushesto relieve them, abandon them to the hands of those mercenaryharpies that prey upon the miseries of mankind, and the dis-ease can no longer be thus restricted to the first, perhapsguilty, sufferers ;-it assumes a form that lingers in the frame,and generates a chronic poison still capable of being trans-mitted to an innocent wife, and to children still unborn. The

Returns of the Registrar-General exhibit an alarming numberof deaths from syphilis in infants; but this column is far in-deed from expressing all the moral and physical evils thatresult. How much of the scrofula, consumption, idiocy, andinsanity that create such havoc in our population, and encumberour asylums, is the indirect effect of syphilis, can never beaccurately estimated. But it is certain, that the hereditarytransmission of the syphilitic taint operates largely. These

evils can only be checked by staying the cause at its very root.It is a matter of the clearest policy, to say nothing of Christiancharity, to encourage every wretch who has contracted this

disease, to place himself immediately under inspection at ourinstitutions. When we keep an enormous evil constantly undersurveillauce, we may hope to control it. Arguments of this kindhave had weight with all thinking men. There are now but veryfew hospitals that are not freely open for the treatment of thisscourge. When we hear of an exception, we are naturallylost in conjecture as to what the constitution of the govern-ing body of such an institution can be. The authority ofthe medical staff cannot be predominant. The influence of

Christian ministers cannot have due weight. The voice of the

magistrate and the statesman must be silent. Ignorance and

bigotry alone can rule. Every medical practitioner knowsthese things; every clergyman knows them; every man ofhigh or low estate knows them. It is affectation, hypocrisy,or moral cowardice to spurn them, and to turn away the syphi-litic patient from our hospitals, invoking that exact limitationof punishment which can be the attribute of no mortal sin, and

especially not of this our "Great Sin," " Be the evil uponhis own head."

ON the 23rd ult. the Session of the Medical Societies

terminated with the last meeting of the Royal Medical and

Chirurgical Society. It has been our object, in the pages ofTHE LANCET, to show, by the reports of their proceedings, towhat extent these societies have contributed to the advance of

the art and science of medicine. It will be admitted by an

impartial judge, that the session just terminated has been in-ferior to none of its predecessors in the value of the papersread, or the discussions which ensued thereon. The Medical

Society of London, which, from its seniority, is entitled to ourfirst consideration, has upheld its character as a practical insti-tution. With less pretension than some other similar bodies,it is second to none in the influence which it exercises on the

profession at large. It may fairly be called the House of ’,

Commons of Medicine. It may not possess the cold dignity ofthe Royal Medical and Chirurgical Society, or number amongstits fellows so many members of the Young England of Physicand Surgery as the Pathological; but it ever encourages its

younger members to contribute, both by papers and by dis-cussion, to the progress of legitimate medicine.The Royal Medical and Chirurgical Society is fast recovering

from the injury inflicted upon it some time since by a few of itsturbulent and unworthy members. Under a justly-popular andable president, the ensuing session promises to be one of greatprosperity and usefulness. Sir CHARLES Lococm has shown,during his tenure of office, an earnest anxiety to encouragefreedom of discussion and practical papers. It would be well,however, if the contributors to the " Transactions" of this

Society would bear in mind that papers of a practical cha-racter-not too tedious or discursive-ought, in justice, to formthe staple commodities of the annual volume. It cannot be

denied that occasionally the papers read before the memobers have been unnecessarily lengthy and speculative. The

natural consequence has been that the discussions partaking ofthe character of the paper have been more verbose than pointed.Whenever a really practical paper has been read, the ensuingdiscussion has been equally practical and instructive. The

friends of the Society have still to lament, however, that themore experienced members of our profession continue to be

silent hearers instead of speakers. The reason for this is obvi-

ous. They are naturally unwilling to enter into a theoreticalor speculative debate which, however it may serve to exhibitthe learning or acquirements of facile and ready speakers, canadd little or nothing to the advancement of the healing art.We make this objection to some of the papers recently readbefore the Royal Medical and Chirurgical Society in a kindly

spirit, and with the hope of mitigating a serious evil.’, The Pathological Society numbers amongst its fellows thegreat majority of those who will have to fill important posi-tions in our profession. To some of these a word of advice

may not be out of place. If the Society fail, it will be bybecoming less a Pathological than a Morbid Anatomy Society.Cases in medicine or in surgery are of little value when the

mere results of disease are exhibited. To make such specimenspractically interesting, the previous symptoms must be por-trayed which have led to the post-mortem appearances. Theymust, in fact, connect the cause with the effect. Whilst some

of the members have merely placed upon the table a morbidspecimen, as a rare or unique illustration, with no history andfew words of comment, others, on the contrary, have elaborateda thesis or propounded a lecture upon a commonplace instanceof disease. The consequence has been that, in a practical point ofview, the Pathological Society has so far failed to fulfil the objectsfor which it was instituted. Discussion, the mainstay of allsuch societies, has been so much interfered with, as to amountin reality to an inconsiderable item in the proceedings of theevening. The above evils have been appreciated and com-mented upon by more than one president of the Society. Let

us hope, for the future, not without effect. One word with

respect to the choice of president. Upon the character and

abilities of this officer the welfare and utility of the Societymainly depend. It is requisite that he should possess not onlythe confidence but the esteem of the members. Mere seniorityshould be no claim to distinction. To insure his full measure

of usefulness he must be personally popular, and combine withthe suaviter in modo thefortiter in 2-e.

A GREAT principle has been asserted at St. Mary’s Hospital.It has been decided that all the medical and surgical staff areto have the designations respectively of physicians and surgeons.The title of assistant is thus to be abolished at once and for

41

MEDICAL ANNOTATIONS.

ever in this hospital. Men who are no longer young, whohave wide-spread reputations, and who are fellows of their

respective colleges, are not any longer to use the degradingtitle of assistant. A physician in fact is to be a physician innosocomial phraseology ; and thus a hardship which has longoppressed the very élite of the profession is removed at one

hospital.It is a happy thing for mankind that new institutions from

time to time arise, unfettered by the worn-out traditions of an

antique period. It is so much the tendency of old bodies, old

corporations, old societies, or institutions of all kinds, to become

clogged with effete ideas and hampered by mouldy precedents,that a new society is of immense service to all its congeners.

Saint Mary’s Hospital has thus proved itself a nidus in whichnew and good ideas can be developed. What may have been

selon les regles in the days Of PEITCIVAL POTT, Esq., of Mr.

ABERNETHY, or Mr. CLINE, matters nothing to an hospitalwhich as yet can hardly be said to have a history. No precedenthas had to be reversed and no principle abnegated; no vene-rable mediciner, whose career dates from the last century, hashad to wring his aged hands in despair at the degeneracy of thetimes and the lapse from ancient custom. There are no pre-

judices to violate, no respectable delusions to be rudely ex-posed, no personal contests to wage, in effecting such a changeat a new hospital. The " laudatores temporis acti" have no"tempus actum" to fall back upon; and hence the assault

upon an old and rotten custom has been made under the most

favourable circumstances, and with the most complete success.To felicitate the individuals who are benefiting by the recent

change is not so much a part of our function as to congratulatethe profession upon a salutary innovation. If the older hos-

pitals will follow the example so wisely set them, a large number of deserving men will be rescued from a position of

improper subordination, and supplied with a stimulus to exer-tion which the present tedious expectancy does not provide.There are many reasons why the title of "assistant" " is de-serving of the desuetude into which it has fallen at St. Mary’s.The public is misled by it. The prevalent notion amongst thegenerality of even well-informed people is, that an assistant-

physician is a kind of satellite to the physician; that he per-ambulates the wards, drinking in with avidity the words ofwisdom which distil from his oracular senior; that he-i. e. theassistant-is a probationer who is hardly as yet to be allowedthe full exercise of his functions. The assistant is looked nponas an undeveloped possibility of something that may one daybe very great, but in the meantime he is supposed to be ofsuch feeble powers as to require the assistance of a species ofmedical go-cart. The term, moreover, is calculated to diminishthe confidence of those who are under the treatment of the

assistant-officers. It is commonly supposed by patients thatthere is an appeal to some higher authority than the assistant;whereas the legitimate idea should be that he is supreme in hisown department. The expectancy of promotion by the demiseor retirement of the seniors is, moreover, a consideration muchbetter abolished. The most generous natures can hardly butfeel that there is some antagonism between themselves andthose into whose places they hope one day to step. Such a

tone of feeling is not healthy; it is bad for the individual andbad for the body of officers. The entente cordiale is best

nourished, and the interests of an hospital best served, byeach officer feeling that he enjoys the meed of his merit. The

usufruct of arduous exertions, if too long withheld, is apt, andvery naturally, to beget indifference and impracticability oftemper.To institute a change, then, which has robbed no one-has

broken down elements of antagonism and discord-given thetitular counterpart to the actual function-is a merit which

belongs to St. Mary’s Hospital. It is a wise act; because it is

fair, liberal, and in accordance with the progressive genius ofmodern institutions.

Medical Annotations." Ne quid nimis."

THE satirist who exceptionally defined man in a high stateof civilization to be " an animal who cooke" might with equaljustice have defined woman, under the like circumstances, tobe " an animal that puts her children out to nurse." We fullyallow and lament the existence of social circumstances which,in some few cases, may prevent a mother ever knowing "howtender ’tis to love the babe that milks her." We are wellaware that physical causes often render it necessary to deprivethe child of its natural source of nourishment ; but we fear thattoo frequently it is the practice, where no such disability exists,to delegate to a stranger those duties which Nature has pro-vided that the mother should fulfiL We believe that we do notexceed the truth in asserting that this has of late years becomealmost a fashion, and one that in its nature and consequencesis a shame and disgrace to its upholders. It is, of course,amongst the wealthy that the evil custom most obtains, for allunnatural luxury is expensive ; and a contemptible femalevanity, or a love of frivolous pursuits, incompatible with adue discharge of the duties owed by the mother to her

infant, are too often the incentives. We believe, however,that oftentimes the woman, pur sang, is less to be blamedthan the false system of education by which she has beenbroken, like a circus-horse, to go round and round that dreary,barren area denominated a "fashionable circle." It is there-fore, in this view, a wrong done to the mother that the exi-gencies of an artificial life should be permitted to interfere be-tween her and her offspring, debarring her from those instinctivefeelings that " lay the firm foundations of the love whichcauses her to cling to her little one with a fondness that sur-passes all other affection, and which gives her the patience,gentleness, and untiring energy, that make her the child’s bestguardian, friend, and teacher during its early years."* Shecannot expect that her children should much love the motherwho risked their lives sooner than herself fulfil the duty ofsuckling them; or resign her eager pursuit of the " toilingpleasure" that so soon " sickens into pain." For the delegationof the duties of a nurse undoubtedly involves increased risk tothe child. When first born, the nutriment provided is fittedfor its requirements, and subsequently becomes modified as theexigencies of its growing frame require. Hence it is evidentthat only in very rare cases can the hired breast afford milkexactly adapted for the child. M. Benouistin de Chateauneufhas reduced to figures the result. He shows that of childrensuckled by their own mothers 18’30 per cent. die within a

year after their birth, whilst of those entrusted to a wet-nurse29 per cent. perish.But the greatest injury of all-and one near akin to that

narrated in the fable, wherewith Naaman rebuked David-falls on the most undeserving object. Too often it is only bythe sacrifice of the poor woman’s child that the offspring of thewealthy mother is preserved. As the latter thrives, the formerpines. To one child, existence is a continual feast; to the

other, life is but one long wail of tears. Whilst the rich matron