823

this point, are neither less nor more than

impostors under that name. What plan of

change in or addition to our medical lawswill take this great aim and hit the mark,quickly or eventually, is another question,which, if not readily penetrated by all, will

perhaps be yielded, for its conception andconstruction, to that judgment which the

majority may honour with the greatest faith.

WHEN the Medical-Reform Bill, whichMr. WARBURTON, at the end of the recentSession of Parliament, obtained leave to in-troduce into the House of Commons, is

procurable by purchase, a notification to

that effect shall appear in THE LANCET.

The words which are reported in the

number of the " Dublin Medical Press,"dated August 19, as having been spoken byMr. WAKLEY in the House of Commons, onthe 10th inst., are incorrectly given. He didnot say, that " he believed the Bill was every

way worthy of the public and the profes-sion," but that he hoped that the Bill wouldbe in every way worthy its author, and ad-vantageous to the public and the profession.

The Principal Baths of Germany considered,with Reference to their Remedial Efficacyin Chronic Disease. By EDWIN LEE, Sur-geon. London: Whittaker and Co., vol. i.,pp. 172.

THE subject of baths and of bathing, as itconcerns the preservation of health, the pre-vention of disease, and the establishmentof the proper functions of the skin, is oneof great and universal importance, and onewhich, unfortunately, is but too little at-

tended to by the inhabitants of this island.The dependance of local disease upon con-stitutional causes was long since pointedout by an eminent professor of this town,who, with great professional attainment,united a narrowness of views, with regardto medical politics, which will always beremembered in association with his name,and which unfortunately appears to have

descended as a heir-loom upon the hospitalwith which he was connected. The repa-ration of the " wear and tear" of the ani-mal machine, the use of bathing, the respitefrom money-getting cares, the acquisitionof agreeable and intelligent society, in a

beautiful and nature.gifted country, con.

tribute to form no small share of the bene-fit derivable to the chronically diseased bythe means upon which the author descants.’We are quite willing to regard with afavourable eye the labours of the writer inthis department of hygienic medicine, tolisten to his positions, and to give himevery credit for the solid sense of his under-

taking ; but we are equally determined tospeak with justice upon his merits, and topoint out any trace of learned subterfuge,or private interest, which too frequentlyform the mass of works of this kind,should we find them to exist. Before, how-ever, entering upon the review of the

volume, and canvassing the deserts of thebook, we are induced to place before ourreaders the postscript which precedes thework, as a subject of much interest to theprofession, and to such invalids as may belikely to visit the bathing establishmentsof Germany. A statement of the apparentilliberality of the police authorities, andthe jealousy of the native physicians, reachedus some time since; but the account givenby Mr. Lee is so clear and so much to thepoint that we extract it without furthercomment.

" I consider it due to myself and to theBritish visitors at Wisbaden, to annex abrief statement of the circumstances con-nected with some recent transactions re-

lative to their being prohibited from avail-ing themselves of the professional assist-ance of their own countrymen, but willpreviously quote a passage from a pam-phlet which was published more than twoyears ago, wherein the writer, after statingas one of the inconveniences of Wisba-den the absence of a sufficient supply ofgood physicians experienced in the use ofthe waters, says-, The permission to Eng-lish physicians to write prescriptions with-out risking arrest by the police, it is hopedwill either be granted, or competent personswith a knowledge of their own professionand of our language be appointed to attendthe place: otherwise the English, to whomWisbaden is most indebted, will be in asomewhat destitute condition ; for theirknowledge of French being much upon apar with that of the local physicians, thedialogue cannot always have a very satis-factory, or indeed be otherwise than ofdoubtful result.’" The season before last, Dr. H., who

accompanied the Duke of C., was summonedto appear before the police, on the informa-tion of Dr. P., one of the physicians of thetown, whom he had called in to consult upon

824

the case of his distinguished patient, and from Frankfort to visit some patients; andwith whom he believed himself to be upon that both these gentlemen had been sum-friendly terms. In reply to the inquiries moned before the police, and prohibited’made. Dr. H. stated that he had merely from practising; but the first intimation I.given his professional assistance to some received respecting myself was from an

persons of his acquaintauce, and that he had apothecary’s, where I had called to givejto intention of practising at Wisbaden. He some directions respecting a prescription Iwas, however, informed, that he was acting had written for a person seriously ill, andcontrary to the laws, of which he had pre- was shown an order which had just come- viol1sly no idea. The case was thought by from the police, prohibiting the preparation4he English visitors to be one of great hard- of my prescriptions as well as those of the,ship, and several influential persons pro- physician from Frankfort. Being desirousposed to represent the matter to the Duke of of doing something for the relief of myNassau : the proposition was, however, patient, I called upon Count -, whom,given up, on the representation of Dr. H., however, I could not see, and consequentlythat he was about to leave the place in a few addressed a letter to him, to which I re-

.,days, and was unwilling to make any stir ceived no answer; and a day or two afterin the matter. A little before this I was at an employ called upon me to request mySchwalbach, having made a tour of inspec- attendance at the police, where I was in-tion of several mineral springs in the duchy, formed that I was not allowed to practise ;which I had not previously visited. The but on my stating that I had written to theduke was also there, to whom I inclosed a count, a sort of half permission was grantedcopy of my work on the continental water- me to attend the patients under my care, tilling-places; and stated to his chamberlain, such time as I received an answer. A fewthat I was desirous of having it suggested days afterwards, I was called to a distantto his highness to establish lodging-houses watering-place by a person iJl, sufferingat Fachingen, to enable persons to use the greatly, and unable to make the local phy-water upon the spot, as I considered that it sician, who could not speak English, under-migbt thus be made more applicable to the stand the peculiar circumstances of the case;treatment of several diseases. I was recom- and on calling at the police to have my pass-mended to wait upon the head of the govern- port signed, was informed that my havingment, Count -, upon the subject, which I been previously summoned there was a rnis-accordingly did on my arrival in Wisbaden, take, the summons having been intendedwhere I found the above interference of the for another person. I accordingly, on mypolice the theme of conversation ; and men- return, concluded that the restrictions weretioned it in my interview with the count, at an end, and continued to prescribe, aswho appeared not to have been aware of the usual, till the 29th July, when a policecircumstance. At the same time, I stated employé again made his appearance at mythat my advice had been requested by seve- apartments, and desired me to be at theral of my countrymen, but that I should de- otfice at eleven o’clock, whither I accord-cline seeing any one professionally, if it were ingly repaired; and shortly afterwards thecontrary to the laws. The count replied, English physician, to whom I have alluded,that the propositions must be submitted to came in, having also received an order tothe consideration of the duke. However, I attend. A paper was then read to us,heard nothing more of the matter, but con- stating that we were not permitted to prac-ceiving I had a tacit permission, I continued tise, and must leave the town in two days.to advise and prescribe for such of my On my return home, I found an officialcountrymen as did me the honour of consult- paper, to the effect that permission to prac-ing me during the remainder of the season, tise was refused to me by the authorities, on" also practised the whole of last season which I addressed the following letter to

in Wisbaden, living in the house of the the director of the police :-director of the police, with whom I had aconversation on the subject; and understood < Sir:-I have just received a notificationthat although foreign medical men were not which repeats what was already announcedallowed to establish themselves in the duchy to me this morning at the police-office, viz.,for the purpose of practising medicine ge- that I was not permitted to practise medi-nerally, yet that no objection would be cine in Wisbaden. As far as regards myselfmade against a person of known reputation personally, I should not hesitate to leave thepassing the bathing season at Wisbaden, to town immediately after the affronts andafford his assistance to such of his country- annoyances to which I have been subjected ; ;,men as might require it. but having patients who refuse to see any

" On my return, last June, I heard that one else professionally (among whom areinformations had been laid by the same phy- two ladies who have been confided to mysician against two English professional gen- care by their relations, who were obliged totlemen: one, being at Wisbaden for his leave on urgent business), it is inconsistenthealth, having given two or three prescrip- with my sense of duty and honour to aban-tions to his friends; the other, having come don them in the condition in which they are,

825

whatever may be the consequences to my- for, as far as I am individually con-

self, unless I am compelled by force. cerned, it is a matter of little moment," ’ I beg you to make my resolution known as, in all probability, I should not have

to the authorities.’ returned to Wisbaden this year, had I44 On the following day I received a letter not partly engaged with some persons to be

from the director of the police, to the effect, there : my chief object in passing the las.ttlaat in as far as the particular case of the two or three summers in this duchy being totwo ladies was concerned, I might remain have a better opportunity of observing thetill such time as their health was improved ; action of a class of remedial agents hithertobut requiring me to send in their names, to much neglected in England ; and though it iswhich I replied by the following note :- probable, had no impediment been made,

,

"’ Sir:&mdash;I have had the liouour of receiving that I might have returned to pass the sum-an official note from you, which informs me mer months during the two or three years Ithat! amallowedto remain in Wisbaden until may be on the continent, yet it is just assuch time as the health of the two ladies of probable that I might be in some other part.,whomlspoke be re-established ; but there are " From what I have heard, my impressionother persons seriously ill at present under is, that the authorities are not averse to

nny care who require constant attention. If I English practitioners attending those ofparticularly mentioned the case of the two their own countrymen who might prefer it;ladies, it was in order to let you see that but that, upon informations being madecompliance with the peremptory orderwhich against individuals, they conceive theyarahad been given me to quit the town in two bound to act according to a law whichdays, did not depend upon myself; but in existed long before this state of thingsthe position in which I am placed with re- arose, that is to say, before the Englishspect to them, I do not feel myself authorised resorted in any considerable numbers to theto give up their names, as I would not risk baths of the duchy ; and that the onus of theexposing them to the inquisition of the po- business rests chiefly, if not altogether, uponlice, and which, moreover, I should con- the individual to whom I have alluded, whosider derogatory to my dignity as an English having had, during some years, the principalgentleman, inasmuch as I regard the request share of practice among the English, thusas an offensive doubting of my veracity. [have shows his gratitude and care for them, bynot visited any new patients since I received endeavouring to prevent their falling intothe prohibition (thoughhavingrestricted my- any other hands than his own; though heself to practising solely among persons from does not understand English, and his Frenchmy own country, several of whom were known is not very intelligible, while many of thoseto me before coming to Wisbaden, I do not who come from England do not speak anyconceive that this can be interpreted as other language than their own.* I could.

being contrary to the law which prohibits wish to say nothing more of the person inforeigners from the general practice of medi- question, though, when a medical practi-cine), and it is for you to judge whether tioner can so far lower himself as to turn

your laws authorise you to force me to quit informer against others, when he is in manythe town. For my part, under existing cir- cases incompetent to render invalids efficient-cumstances, I cannot act otherwise than I service, the ordinary rules of professionaldo; but I declare, that if any personal vio- etiquette, which forbid one’s giving an opi-lence be used towards me, you must be nion unfavourable to another, might well beanswerable for the consequences which may dispensed with. Finding that his conduct

’

ensue. I have the honour, &c.’ had created a strong sensation among the" Thus the matter rests at present ; but as English, as well as among the townspeople,

it is felt to be one which materially concerns I understand he alleges, that the duke looksthe British actually at Wisbaden, as well as upon him as responsible, should any accidentthose who may come at any subsequent happen from foreign medical men recom-period, some influential persons have called mending the waters to patients on the spot ;a meeting to take the circumstances into but the informations which were sent to theconsideration, and to discuss the inconveni- police had no reference to the waters,havingences and danger resulting from the prohi- been founded upon prescriptions sent to the-bition to English medical men giving their apothecaries ; and who, I should like toadvice to their countrymen ; and I have no know, is to be responsible for the mishapsdoubt, when the circumstances are repre- which have arisen, and must constantlysented in the proper quarter, that the Eng- arise from the patient’s language not beinglish resorting to Wisbaden may reckon on not being deprived of the advantage they * It was proposed by him to a lady, sub-are allowed in other parts of the continent sequently under my care, to bring an inter-frequented by invalids. It is on these preter at his following visit. As the case

grounds that I feel principally interested, was of a delicate and complicated nature,having endeavoured to make these waters, the doctor could not be surprised that, afteras well as others, more generally known making a similar proposition, his furtherand appreciated by the British public; attendance was dispensed with.

826

understood, and from the adoption of treat-ment unsuited to English constitutions, se-veral of which mishaps I have been calledupon to rectify? When an invalid has a

choice of professional attendants, and selectsone, he acts upon his own responsibility;when, however, his choice is restricted toone or two, in whom he has no confidence,while he is prevented from calling in anotherwhom he would prefer, the responsibilitydevolves upon others."

This extract has occupied so much of

our space, that we must postpone for thepresent the further notice of the work,which, in the mean time, from the glance wehave cast over it, we can recommend to theperusal of those professional men who maybe wishing to advise their patients upon afitting place for the sojourn of a few months,with some likelihood of benefit to their

health.

An Inquiry into the History and Influence ofthe Lichfield Waters: intended to show theNecessity of an Immediate and Final

Drainage of the Pools. Lichfield : Lomax.1840.

THE nature of this little work is sufficientlyexplained by the title. It is publishedanonymously, but the author is understoodto be a physician, well known in Lichfield.He contends that the stagnant pools aroundLichfield are injurious to the health of theinhabitants, and urges several reasons for

draining, and filling them up. This is ob-

jected to by certain lovers of the pic-turesque ; and by another very oppositeclass of persons, who button up their

breeches-pockets very closely, that the money may fructify there," when a call

is made upon them for any public purpose.Dr. - has arguments for all these classes,and they are arguments which deservecareful consideration." During the sixteenth and seventeenth

centuries, five if not six plagues raged inLichfield! It is true, that at this dateEngland at large suffered from the samescourge ; but, the whole country considered,not any thing like to such proportionate ex-tent as this small district."--p. 40.

In Lichfield the author states, that 51 percent. died of plague in 1593-4, and 32 percent. in 16456.

" Such things have been called, in a mostwicked sense of idle resignation, Visita-tions of Providence. But miracles excepted

- though modern times have nothing todo with miracles-the very highest prac.tical authorities, on questions of infection,have expressed themselves as convinced, asthey have felt of an existence, that no pes,tilential disease has ever yet originated, inany part of the world, without an imme.diately previous violation of natural lawthere. And when such disease has spreadto other regions as an epidemic, its ravageshave been, allowing for the influences ofclimate, &c., invariably greatest in the lo-calities visited, which have been least de.fended by medical police. * * *

" The town, during the visitations ofplague, was eminently characterised by. filthy’ pools and choked-up ditches. Itpresented air-polluting marshes and rush.fields ; its common muck-hill’ was so

ample as to furnish a rent equal to that ofthree acres of good land at this time; butits ’ common channels’ were so imperfect,that the water frequently stagnated inthem.’ The general consequences, medi-cally considered, were what have just beenalluded to." For precise views of epidemic disease,

in Lichfield, adequate-because not suffi-

ciently pointed-statistics are wanted. Butfrom some few statistics of high authority,quoted in ’ Harwood’s History,’ the follow-ing table has been deduced :-

Statistics of the Plague in Lichfield, in1645-6.

NORTH TOWN.

Beacon-street, Gaia-lane, Shaw-lane, theClose, value &pound;8.&mdash;Chiefly on ridge land,and all well ventilated, except the vicarage.The Close ditch was drained in 1643, andpart of Beacon-street burned down, duringthe plague.

SOUTH TOWN.

Market-street, value f4 18s 4d; deaths38 ; per cent. 18.-Defended by domesticcomforts.

Dam-street, Butcher-row, Tamworih-street, Boar-street, the Woman’s Chyping,value :f4 14s 8d ; deaths 200 ; per cent. 36.- Exposed to external ventilation, exceptone side of Butcher-row ; but partly adjoin-ing the most infected districts, and contain-ing a common channel, with stagnant waterin it.

Stow-street, Lombard-street, Bird-street,Sandford-street, value:f4 2s 7d; deaths 262;per cent. 41.-The extreme parts, smallhouses close to the pools. Bird-street, inthe centre, being so narrow, that it has sincebeen widened by act of Parliament.! Green-hill, George-lane, St. John-street,Frog-lane, Wade-street, value &pound;3 13s 7d;deaths 321 ; per cent. 47.&mdash;Partly inter-sected by the Common Ditch and CommonMuck-hill of the town, parallel to, but underthe level of which were Frog-lane andWade-street while John-street was hemmed

827

in between these and the Bishop’s Marsh.- pp. 41-43.

We have given rather a detailed noticeof this work, because we are glad to see asubject of public health zealously pressedon the attention of the inhabitants of Lich.

field ; and hope to see other specimens ofmedical topography from practitioners in

every town of the kingdom. Medical men

will conduct these inquiries much more

satisfactorily than the Poor-Law Commis-sioners.

EASTERN MEDICAL ASSOCIATIONOF SCOTLAND.

EXCERPT of Minute of a Special Meeting ofthe Council of the Eastern MedicalAssociation of Scotland, held at Dun-dee, the 13th August, 1840.

ALEXANDER BELL, Esq., Vice-President, inthe chair.

The following Resolutions were unani-mously agreed to :-

1st, That the Council has observed withextreme regret, the custom of publishingparagraphs in the newspapers, for sometime past, laudatory of the operations andmode of treatment employed by certain prac-titioners in various diseases ; such means ofmaking public their practice being calcu-lated materially to injure the respectabilityof the Medical Profession.

2nd. That as one of the great objectsof the Association is the suppression of

quackery in all its forms, the Councilwould earnestly impress upon all the mem-bers of this Association, the necessity ofexerting themselves to discourage and pre-vent such proceedings for the future.At the monthly meeting of the Council

on the 5th instant, an unanimous vote ofthanks was passed in favour of Richard

Carmichael, Esq., President of the MedicalAssociation of Ireland, for his munificentdonation, and general exertions to forwardthe cause of Medical Reform.

THE

DIVISIONS AND CONDITIONOF THE

MEDICAL PROFESSION IN DUBLIN.LETTER II.

To the Editor of THE LANCET.SIR:&mdash;In my former letter (LANCET, page

794) I endeavoured to lay before you abrief history of the medical profession inDublin, in order that you might understandthe relation which the different classes ofvvhich it is composed bear to each other.

Let me now direct your attention tothe parties which represent these differ-ent interests, the objects of each, andthe causes which have led to our divi-sions. This is the more necessary to beexplained, because the terms by which theyhave been designated convey a meaning thatis contrary to the facts, and which have beenpurposely applied, in order to render popu-lar the party which is most clamorous andmost anxious to direct the reform which allperceive to be inevitable. Hence the " Re-formers," par excellence, are most studiouslycontrasted with &laquo; Anti-Reformers ;" and theorgan of the so-called reform party * de-nounces, in no measured terms, all who arenot among the initiated, as the " abettors ofmonopoly," the " supporters of nepotism,"and, in short, as the warm advocates of allthose " abuses" which it is the object of thesaid journal’s mostpatriotic and disinterestedexertions to correct.

In order to expose these fallacies, and tothrow a new light upon the position ofmedical parties, we shall take each class inits order.The physicians of the old school are by far

the least numerous as a body, but, from theireducation, demeanour, and adherence torules of etiquette, might well be describedas the " Ancien Regime" of this revolution-ary era. They have always acknowledgedwith reluctance the asserted equality ofuniversity medical graduates; they have longdenied the right of surgeons to practisemedicine, and look doubtfully upon the ad-vances of the apothecary. They have oneschool of medicine, which is only partiallyunder their controul, their authority beingshared with the Dublin University ; in thedetails of education they have, therefore,little interest. Their Professors are not

permitted to take any part in their delibera-tions ; their College, therefore, perfectlyrepresents the practising physician. Notbeing disposed to relax in any great degreethe barriers to admission into their body,their numbers are limited ; and in theirpresent policy, it is a question whether theywould suffer more from the future generalpractitioner, than they have already enduredfrom the aggressions of the surgeon ; it iseven possible that their aid may be morecalled upon than formerly; therefore, theyseem to hold a neutral position in the con-test going forward. In every thing whichis calculated to maintain the rank of theprofession they are willing to unite with thesurgeon, and object to the unlicensed ag.gressions from which they have suffered somuch ; but it is almost a matter of indiffer-ence to them, whether the surgeon hold theposition he has taken from them, or theapothecary mount up in his place.

,

The second, and the more numerous party,

* The Dublin Medical Press.