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"ACUTE EPIGASTRIC PAIN IN PUERPERAL ALBUMINURIA."
91
passed professionally patients to London hospitals of late years. As long as great hospitals compete for inmates and gladly receive any and all comers, the public naturally think (if they trouble themselves at all in the matter) that the staff are remunerated somehow and sufficiently. One remedy would be for our great consultants to resign their hospital appointments earlier in life; a second, a more systematic weeding out of "ACUTE EPIGASTRIC PAIN IN PUERPERAL hospital patients. At this moment there are several poor
in, while augmenting the value
of the
and socially, Both of these points we want, if the profession is to have due weight in the State, and such are the thoughts which have passed through the brain of ONE OF ITS MEMBERS. July, 1887. -
ALBUMINURIA." To the Editors of THE LANCET.
SIRS,—I beg to enclose extracts from a private letter recently received from Dr. G-oss, giving additional evidence of the value of the symptom I alluded to inrecent issue:-
sufferers in my neighbourhood whom I would gladly send away for severe operations, but they cannot face the cost of the journey; at the same time rich shopkeepers, large farmers, and prosperous business men, who can get up to town, are eagerly received again and again. Moreover, I must demur to the singular statement that consultants are a different class to general practitioners. The distinction between barristers and solicitors will not continue; public opinion is against it. Consultants are not always better qualified or more competent than general practitioners. With the exception of part of the staff of certain London hospitals, there are hundreds of consultants (so-called) whose edu-
"Roxbury, Boston, Mass., U.S.A., April 28th. 1887. a case of ’Acute Epigastric Pain in Puerperal Eclampsia,’ published in THE LANCET of the 2nd inst., you do me the honour to refer to a case published by me in the Boston Medical and Surgical Journal in 1884. Towards the close of your article you say : " The above cases, five only in number, are all I have been cation, diplomas, and standing are precisely the same as able to meet with.’ It may interest you to know that since those of good general practititoners. One of our local club the publication of my case others of a similar nature have doctors is a London University scholar. The corporations been observed in this vicinity. In the Boston Medical and can do nothing ; Parliament cannot and will not interfere; as for the Medical Council, what right has it to interSurgical Journal, vol. cxi., Dec. 18th, 1884, p. 580, Dr. C. F. and fere ? Combination will effect nothing. Our leading men Withington gives an account of the malady in question, and must in vol. cxiii. of the same publication, Sept. 24th, 1885, p. 299, protect themselves from downward competition, and the late Dr. F. II. Lombard published a case reported to the our younger men must have more self-respect. I am, Sirs, yours truly, Boston Obstetrical Society....... tn spite of all reasonable June, 1887. care, the presence of renal trouble will sometimes escape AN OLD OXONIAN. our notice till a catastrophe occurs. Dr. Lombard reported that the urine of his patient had been examined monthly up A THERAPEUTICAL SOCIETY. to within a fortnight of her decease, without discovering To the Editors of THE LANCET. any abnormality, and there was nothing in the condition of SIRS,—I sincerely hope that the scheme of a Therapeutical my patient to lead me to suppose her situation to be critical. " The renal affection must be at times very rapid in its Society, as mooted by Dr. A G. Bateman, will be carried out development, and the microscopical examination of the to a successful issue. To general practitioners, intimately urine in both Dr. Lombard’s case and my own confirms this concerned as they are with the actual and immediate treatstatement. The urine resembles that often found in the ment of disease, such a society would be of inestimable acute nephritis of scarlet fever. value. As a matter of fact, a great number of practitioners "Trusting, &c....... Yoars, very truly, scan the medical papers with avidity that they may pick FRANCIS W. Goss. any therapeutical crumbs which perchance might fall up " John Phillips, Esq., B.A., M.B., M.R.C.P." from those in high places, and truly they are, as a rule, but I may also say that I have received letters from two crumbs, the feast itself generally consisting of pathology or practitioners detailing single cases in which this very impor- etiology. In other words, the science of therapeutics has tant and too-little noticed symptom was well marked. not received the same amount of attention as other branches T am Sirs yours truly of medicine have, and is still, as your correspondent states, JOHN PHILLIPS. in a " chaotic condition," from which, however, a TherapeuHarley-street, W., July 6th, 1887. tical Society would go far in helping it to emerge. Trusting that the idea may be taken up with the enthusiasm it "A DOCTOR’S INCOME." deserves T romain Sirs yours truly To the Editors of THE LANCET. J. STENSON HOOKEB. Hastings, July 7th, 1887. SIRS,—My good friend Dr. Paget Thurstan, who is better qualified than many hospital physicians, has succeeded in VANS AND INFECTION. raising a lively discussion on this-to us doctors-most (From a Correspondent.) interesting question. Permit me, as a man who knows the world better I suspect than some of my brethren, to make a AN outbreak of measles has been traced at Grantham few remarks on the subject. The general public care little to some travelling showmen and hawkers who attended what a doctor does or is, provided they know his name well ; draw no distinction and fair recently held in the town. The case affords a between consultants so-called the they general practitioners, and, most naturally, we should do the good illustration of the danger to the public health same in their place-get the best advice at the lowest fees. which results from the extremely unsatisfactory character As long as hospitals, clubs, and dispensaries offer good treatment at low fees the public will accept all they can get, and of our sanitary system so far as it affects our nomadic This question was discussed at considerable no wonder. Our medical brethren in general quite forget population. that clubs do not exist to provide medical treatment; their length during the sittings of the Housing of the Working primary object is to supply their members with so much per Classes Commission two years ago. It was then shown week in sickness, and certain benefits at death. The medical that the van population -under which generic term attendance is thrown in in a secondary kind of way. Now, was included that numerous class who inhabit movable as long as twenty practitioners offer themselves for a club dwellings, whether vans or tents-were subject to no sanisurgeoncy, as long as club doctors holding the highest tary regulations whatever. A magisterial decision, that a qualifications are ready to go twelve miles to see club van was not a house, had been upheld by the High Court, patients-I speak of facts-the public would be lunatics to with the result that none of the enactments which reguoffer more than the 2s., 4s., or 5s. generally paid for medical lated the inhabitants of houses affected this vagabond attendance. I do not wonder at young men taking such section of the community. In some parts of the country, work. They want practice and are glad of anything to do, it is true, where van towns had sprung into existence, some but I am surprised at eminent men offering themselves. A attempts had been made to cope with the difficulty. At friend of mine, a senior surgeon to a great provincial Woodford, for instance, where the squatters ejected from hospital, held nearly up to his death many clubs. I do Epping Forest made a settlement, the local board sucnot know why. At one time he held forty clubs. Again, ceeded in compelling them to have a supply of take hospitals: from my neighbourhood several rich people, water. But it is doubtful whether this was a legal far better off than many of the local doctors, have gone as in- proceeding, and the settlement, of course, still reMY
DEAR
SIR,—In the report of
other
passed professionally patients to London hospitals of late years. As long as great hospitals compete for inmates and gladly receive any and all comers, the public naturally think (if they trouble themselves at all in the matter) that the staff are remunerated somehow and sufficiently. One remedy would be for our great consultants to resign their hospital appointments earlier in life; a second, a more systematic weeding out of "ACUTE EPIGASTRIC PAIN IN PUERPERAL hospital patients. At this moment there are several poor
in, while augmenting the value
of the
and socially, Both of these points we want, if the profession is to have due weight in the State, and such are the thoughts which have passed through the brain of ONE OF ITS MEMBERS. July, 1887. -
ALBUMINURIA." To the Editors of THE LANCET.
SIRS,—I beg to enclose extracts from a private letter recently received from Dr. G-oss, giving additional evidence of the value of the symptom I alluded to inrecent issue:-
sufferers in my neighbourhood whom I would gladly send away for severe operations, but they cannot face the cost of the journey; at the same time rich shopkeepers, large farmers, and prosperous business men, who can get up to town, are eagerly received again and again. Moreover, I must demur to the singular statement that consultants are a different class to general practitioners. The distinction between barristers and solicitors will not continue; public opinion is against it. Consultants are not always better qualified or more competent than general practitioners. With the exception of part of the staff of certain London hospitals, there are hundreds of consultants (so-called) whose edu-
"Roxbury, Boston, Mass., U.S.A., April 28th. 1887. a case of ’Acute Epigastric Pain in Puerperal Eclampsia,’ published in THE LANCET of the 2nd inst., you do me the honour to refer to a case published by me in the Boston Medical and Surgical Journal in 1884. Towards the close of your article you say : " The above cases, five only in number, are all I have been cation, diplomas, and standing are precisely the same as able to meet with.’ It may interest you to know that since those of good general practititoners. One of our local club the publication of my case others of a similar nature have doctors is a London University scholar. The corporations been observed in this vicinity. In the Boston Medical and can do nothing ; Parliament cannot and will not interfere; as for the Medical Council, what right has it to interSurgical Journal, vol. cxi., Dec. 18th, 1884, p. 580, Dr. C. F. and fere ? Combination will effect nothing. Our leading men Withington gives an account of the malady in question, and must in vol. cxiii. of the same publication, Sept. 24th, 1885, p. 299, protect themselves from downward competition, and the late Dr. F. II. Lombard published a case reported to the our younger men must have more self-respect. I am, Sirs, yours truly, Boston Obstetrical Society....... tn spite of all reasonable June, 1887. care, the presence of renal trouble will sometimes escape AN OLD OXONIAN. our notice till a catastrophe occurs. Dr. Lombard reported that the urine of his patient had been examined monthly up A THERAPEUTICAL SOCIETY. to within a fortnight of her decease, without discovering To the Editors of THE LANCET. any abnormality, and there was nothing in the condition of SIRS,—I sincerely hope that the scheme of a Therapeutical my patient to lead me to suppose her situation to be critical. " The renal affection must be at times very rapid in its Society, as mooted by Dr. A G. Bateman, will be carried out development, and the microscopical examination of the to a successful issue. To general practitioners, intimately urine in both Dr. Lombard’s case and my own confirms this concerned as they are with the actual and immediate treatstatement. The urine resembles that often found in the ment of disease, such a society would be of inestimable acute nephritis of scarlet fever. value. As a matter of fact, a great number of practitioners "Trusting, &c....... Yoars, very truly, scan the medical papers with avidity that they may pick FRANCIS W. Goss. any therapeutical crumbs which perchance might fall up " John Phillips, Esq., B.A., M.B., M.R.C.P." from those in high places, and truly they are, as a rule, but I may also say that I have received letters from two crumbs, the feast itself generally consisting of pathology or practitioners detailing single cases in which this very impor- etiology. In other words, the science of therapeutics has tant and too-little noticed symptom was well marked. not received the same amount of attention as other branches T am Sirs yours truly of medicine have, and is still, as your correspondent states, JOHN PHILLIPS. in a " chaotic condition," from which, however, a TherapeuHarley-street, W., July 6th, 1887. tical Society would go far in helping it to emerge. Trusting that the idea may be taken up with the enthusiasm it "A DOCTOR’S INCOME." deserves T romain Sirs yours truly To the Editors of THE LANCET. J. STENSON HOOKEB. Hastings, July 7th, 1887. SIRS,—My good friend Dr. Paget Thurstan, who is better qualified than many hospital physicians, has succeeded in VANS AND INFECTION. raising a lively discussion on this-to us doctors-most (From a Correspondent.) interesting question. Permit me, as a man who knows the world better I suspect than some of my brethren, to make a AN outbreak of measles has been traced at Grantham few remarks on the subject. The general public care little to some travelling showmen and hawkers who attended what a doctor does or is, provided they know his name well ; draw no distinction and fair recently held in the town. The case affords a between consultants so-called the they general practitioners, and, most naturally, we should do the good illustration of the danger to the public health same in their place-get the best advice at the lowest fees. which results from the extremely unsatisfactory character As long as hospitals, clubs, and dispensaries offer good treatment at low fees the public will accept all they can get, and of our sanitary system so far as it affects our nomadic This question was discussed at considerable no wonder. Our medical brethren in general quite forget population. that clubs do not exist to provide medical treatment; their length during the sittings of the Housing of the Working primary object is to supply their members with so much per Classes Commission two years ago. It was then shown week in sickness, and certain benefits at death. The medical that the van population -under which generic term attendance is thrown in in a secondary kind of way. Now, was included that numerous class who inhabit movable as long as twenty practitioners offer themselves for a club dwellings, whether vans or tents-were subject to no sanisurgeoncy, as long as club doctors holding the highest tary regulations whatever. A magisterial decision, that a qualifications are ready to go twelve miles to see club van was not a house, had been upheld by the High Court, patients-I speak of facts-the public would be lunatics to with the result that none of the enactments which reguoffer more than the 2s., 4s., or 5s. generally paid for medical lated the inhabitants of houses affected this vagabond attendance. I do not wonder at young men taking such section of the community. In some parts of the country, work. They want practice and are glad of anything to do, it is true, where van towns had sprung into existence, some but I am surprised at eminent men offering themselves. A attempts had been made to cope with the difficulty. At friend of mine, a senior surgeon to a great provincial Woodford, for instance, where the squatters ejected from hospital, held nearly up to his death many clubs. I do Epping Forest made a settlement, the local board sucnot know why. At one time he held forty clubs. Again, ceeded in compelling them to have a supply of take hospitals: from my neighbourhood several rich people, water. But it is doubtful whether this was a legal far better off than many of the local doctors, have gone as in- proceeding, and the settlement, of course, still reMY
DEAR
SIR,—In the report of
other