SURGEONS TO EMIGRANT SHIPS.

504 if such

an announcement should be made for the ensuing summer, it would be a-novelty taking every one by surprise. It is not mentioned in the advertisements of the summer session either at St. George’s or Guy’s, published April 15, 1853, for

instance.

Again, it is a most singular fact, that until very lately the pure surgeons and the pure physicians never took any interest in vaccination as an essential part of the practice of medicine and surgery, for it is a combination of both. They seemed to think that the art of vaccinating properly came into the pupils’ mind by a sort of intuition, just as they, not long ago, seemed to consider midwifery as a part of practical medicine and surgery, requiring no better wits than those of an old nurse. In truth, a thorough knowledge-of midwifery, and particularly the profession of it, disqualified its professor from any very high consideration in the upper ranks of his profession. I am not sure that vaccination was thought much better of. But now, since vaccination has attracted the attention of the House of Lords, the tables are turned, and the pure surgeons and the pure physicians step forward with restless anlility to show " the powers that .be" how deeply interested they are in the legislation of a most important part of medicine, which they have never hitherto condescended to teach their pupils, or to practise publicly themselves. Sir, this exhibition is one of the most amusing pieces of by-play that I have ever had the pleasure of witnessing since it has been my good fortune to belong to our liberal profession. Hitherto, vaccination has been left altogether unguarded and unheeded in the hands of surgeons in general practice, or of those physicians who practise midwifery, vaccination, &c., like the general practitioner. It has been left unguarded and unheeded in their hands. No one is responsible to any recognised authority for the manner in which he vaccinates, nor for the lymph he thinks proper to circulate. He has no warrant to show the public that he is capable of knowing the precise difference between a genuine and a spurious vaccination, or that he has ever been taught the first principles of a discovery, the nature of which is at once so original and astounding, that it has earned for Jenner the extravagant and transcendent epithet of" Immortal !" Sir, it is high time to speak the truth, and to make some attempt to place vaccination on its proper basis. The legislature should know-only there is no way of letting them know, except through the public press-that practical vaccination rests in the hands of surgeons in general practice ; that the real vaccinators have taught themselves, but have never been taught, ex cathed2-d, how to vaccinate; and that, considering the singularly unaccountable neglect of this part of their education, the wonder is, not that genuine lymph should now be failing, but that any creditable supply of it should have been kept up till the present time. The National Vaccine Institution has fully done all it could to effect the object for which it was set on foot; but no pupil is bound to attend this establishment, nor is it authorized to supervise the vaccinators of Great Britain. In short, vaccination has been mainly supported throughout the kingdom by the unaided good sense of the surgeons in general practice alone. I am, Sir, &c., J. A. HINGESTON. J. Brighton, May, 1853. GRIEVANCES IN THE BENGAL MEDICAL SERVICE. To the Editor of THE LANCET.

SiR,-The present time, when the subject of the East India affairs is under the discussion of Parliament, seems to

the

of those relative ranks is one to twenty-three. A looks towards his next step with something like a certainty of enjoying increased rank, emolument, and command; but the surgeon feels that, with the rank which he has attained, all that he can prudently expect, as the prospect of attaining the rank of superintending surgeon, implies a sojourn in the country beyond the calculations of prudence in such a climate as India. The present senior superintending surgeon entered the service in 1811, and the senior surgeon in 1819. II. There is a great disproportion of the various gradations in the medical service. There are at present eleven permanent and one acting superintending surgeon, who are supposed to have what is a mere nominal supervision of the medical department of an army and country, extending from Burmah to Peshawur. The circles of supervision are, however, so large, that superintending surgeons in reality can do little more than the work of headclerks, countersigning requisitions for stores, &c., and forwarding to various departments returns and papers from medical officers in their divisions. In the field, an army is distributed into divisions and brigades, to each of which certain staff-officers are attached; but in Bengal, one superintending surgeon is deemed sufficient to conduct the supervision of the medical department of the whole force, although some portions of that force may be acting in a part of the country widely remote from the rest. In the Company’s service the rank of staff-surgeon is unknown. III. The deficiency of effective medical officers has ever been felt in Bengal, so that, during all the late campaigns (and the last Punjab war was no exception) it was found necessary to remove European medical officers from civil stations, and even to deprive the presidency of part of its medical staff, in order to supply the wants of the army in the field. Even after such efforts, it is notorious that neither regiments nor the field hospitals were, on many occasions, properly and efficiently supplied with professional aid. It was often found necessary in the field to deprive native regiments, 1100 strong, of their medical officers, in order that latter might be sent to do duty in the crowded field hospitals. IV. A medical officer compelled by sickness to leave his duties, and repair to any sanitarium, loses the whole of his staff-allowances ; whereas officers in all other departments, whether on regimental or the general staff, under similar circumstances, only lose half of their staff-pay. But, further, medical officers absent on duty are deprived of their staff allowances, although employed by order of the authorities, and in the service of Government. V. A surgeon in medical charge of a regiment receives, as staff salary, 300 rupees a month. An assistant-surgeon, with the same charge, and exactly similar duties and responsibilities, receives 165 rupees. But a captain and an ensign receive the same sum for command of a company; and a lieutenant and lieutenant-colonel for command of a regiment. Were the rule such that assistant-surgeons, after ten years’ service, received the same staff allowance as a surgeon for the charge of a corps, there would be less cause of complaint. To the above statement of facts nothing need be added. The remedy for each grievance seems evident. The consequence of the present state of things is, that surgeons generally retire as soon as they can, after becoming entitled to a pension-viz., after seventeen years-although at this period their services are most valuable to the state ; they being still young and active, and having acquired experience in the diseases of the climate, and a familiarity with the language and manners of the people. I am, Sir, yours most obediently, Fort William, Calcutta. A SURGEON.

proportion

captain

the

Company’s

afford a good opportunity for soliciting your attention to several SURGEONS TO EMIGRANT SHIPS. grievances under which the Bengal Medical Service labours, in INSUFFICIENT SUPPLY OF STORES. that be induced to the hope lend the powerful aid of you may To the Editor Qf THE LANCET. your pen towards obtaining their redress, in the same way as you have done for the naval and other branches of the profession. been at sea some years ago (in 1845-6) in medical SIR,—Having The list of grievances is a long one ; but I shall briefly specify charge of a ship crowded with troops to Calcutta, and in another the chief of them, which were recently submitted to the East vessel freighted with coolies from that port to Trinidad, I feel India Directors in the form of a memorial. This memorial, like anxious to confirm the very practical and excellent observations

many former ones from the medical branch of the service, has of a correspondent in your last number, as to the deficient and received no favourable consideration, and all matters remain in faulty supply of the medicine-chest. Of drugs that are cheap and rarely wanted in any great quantity, sulphur for instance, their former condition. 1. Assistant-surgeons who may now enter, or have recently the supply is prodigious. I gave mine away on the ° Line," to entered the service, have little chance of promotion for seventeen make a blazing car for old Neptune. It would seem as if the or eighteen years, while their rates of emolument do not compenauthorities who have the arrangement and direction of the medical sate for retarded promotion. The allowances of an assistant- stores had never been at sea, and consequently had no experience " surgeon in charge of a corps are less than those of the other regi- of their application. What your correspondent says as to bottles" mental staff officers, although the latter are frequently his juniors is true enough. When at sea I would have given a guinea for a both in years and in the service; while the allowances of a dozen half-pint or pint bottles and a few corks. "Dispensing"is 99 surgeon hardly rise to the lowest class of army staff appoint- to be accomplished on the top of a small box, in the dark cabin ments, or the higher grade of uncovenanted servant." In the of a rolling ship, every package being tightly wedged in strair military branch of the service the proportion of field officers to and tow, weighing and measuring being almost impossible ; and those of inferior rank is one to eight; but in the medical branch 1f the medicine he fluid, a sailor’s grog-can must hold it, if one

505

borrowed

or spared, Possibly the surgeon and supply the surgeon with

be dose.

can

and the may, as

patient

must

guess at the

great favour, wash

a "

"

out

an empty anchovy" or Burgess’ sauce" bottle ; but this is uncertain, even if it be requisite to administer ether or ammonia. But I had no ether on board, which

it does not regard the certificate of successful vaccination as the only defence against the penalty. That the onus of transmitting a duplicate of the said certificate to the registrar of births and deaths would, to-say the least, be unreasonable, seeing that the medical officer is shut out from all remuneration under the provisions of this Bill. That to declare expressly that no medical officer shall be entitled to any fee or remuneration for the additional duties and multiplied certificates imposed on him by this Bill, is virtually to

the bottle if that were half filled. A case of "amputating instruments," say the authorities, is imperative,-true, the chance of their being wanted is extremely small, and then the sea-air will rust them most beautifully,—but not a word about a tooth-key, (the sea-air I suppose is good for toothache,) of nitrate of silver, or the preparations of morphia, or even sulphate of copper or digitalis. Let the surgeon be sure to take his own supply ; let him not trust there will be catheters on board, male or female, or midwifery instruments, unless the arrangements are very different from what they were in my day. Were I to go to sea again, there are many common and useful compounds known to every dispenser that might with convenience displace the heaps of cheap and rarely-demanded drugs. The powdered extract of colocynth, powdered aromatic confection, a few scores or hundreds of a good plain purgative pill in five-grain doses, emetics in half-drachm papers, calomel and jalap similarly divided,—all these and many others will occur to the mind of any one accustomed to much dispensing. It would be no bad plan for the surgeon of an emigrant ship to see to these arrangements for the convenience of himself and the sick before going on board ; for obviously if the old "medicine-chest," got up by druggists, will serve for the use of the captain and crew, himself being the dispenser, twenty times the same quantity of the same drugs will not answer for a ship whose living "cargo" is men, women, and children. As emigration is going on at a fearful rate, I hope the importance of the subject may justify my effort to confirm the expostulations of your correspondent, and to rouse attention in the proper quarter to a better provision for the crowds among whom epidemic fever or ophthalmia may arise in any emigrant ship. Obviously it is of little use taking on board an " experienced surgeon," if he is to be denied the convenience and even the means of prescribing what his " experience" dictates. I am, Sir, yours very respectfully, JOSEPH ASHBURY SMITH, M.R.C.S., late Surgeon of the Stag and Medusa. Tledusa. Glossop, May, 1853.

might be safely prevented from bursting only

prohibit any increase of a payment already inadequate, and that a compulsory law will fail to accomplish the end proposed, the success of which is made to depend on the efficiency of ill-paid

medical officers. Your petitioners therefore humbly pray your honourable House to make such alterations in, and amendments of, the Vaccination Extension Bill as in your wisdom you may deem desirable. And your petitioners will-ever pray, &c. J. L. BARDSLEY, M.D., President. JOHN AIKENHEAD, M.D., Secs. W. C. WILLIAMSON,

Hon.

THE

PROPOSED NEW CHARTER OF THE COLLEGE OF PHYSICIANS. To the Editor of THE LANCET.

SiR,-In your journal for April 30th, appears a letter from Hawkins, the Registrar of the Royal College of Physicians

Dr.

With your permission I will tell myself last year. I must premise that I Royal College of Surgeons of London and a am licentiate of the Apothecaries’ Company; that I was educated at the University of Edinburgh, and at the University College,

on

new

thewhat proposed occurred member of the

Charter.

to

you

a

London ;

also that I am forty-five years of age, and have been in the constant practice of the profession for twenty-three years. Last summer I occupied my leisure hours in refreshing my memory upon anatomy, chemistry, and other elementary studies, and was thus led to entertain the idea of taking the degree of M.D., not, be it observed, with any intention of using the title at present, but simply that I might possess a diploma in case any might arise hereafter to render it desirable to have it contingency in my power to practise legitimately as a physician. While in this frame of mind I read over the regulations of the Royal ColTHE VACCINATION EXTENSION ACT. lege of Physicians of London, and among other clauses I found PETITION AGAINST CERTAIN CLAUSES. the following:" To the Editor of Tar LANCET. Candidates who have already been engaged in practice, and attained the age of forty years, but have not passed through of the Medicohave are instructed the committee SIR,—We by Ethical Association of this city to request you to publish in THE the complete course of study above described, may be admitted to LANCET the following petition against certain provisions of the examination upon presenting to the Censors’ Board such testiVaccination Extension Bill. The petition has been entrusted to monials of character, general and professional, as shall be satisMr. Bright for presentation to the House of Commons. factory to the College." It occurred to me that this exactly met my ease, and instead of We are, Sir, your obedient servants, a German degree, or travelling 1100 miles to obtain one buying JOHN AIKENHEAD, Hon. Hon. Hon. Hon Secs Secs. Secs. at Aberdeen, I determined to write a letter to Dr. Hawkins asking Manchester, May, 1853. W. W. C. C. WILLIAMSON, permission to be admitted to an examination by the College. To To the Honourable the Commons of the United K ingrlom of Great my surprise I received a very uncourteous and ungentlemanly Britain and Ireland in Parliament assembled. reply, saying that it was quite impossible for a man acting as a practitioner to be admitted to examination, and adding The Petition of the undersigned members of the medical general that the clause in question was only intended as a great honour on of behalf a itself the Manprofession, Society calling to be conferred on individuals of extraordinary merit. This chester Medico-Ethical Association, rebuff at once caused me to abandon the idea of adding M.D. to Humbly showeth,— my name, and I fancy I have lost nothing on that account. That the Vaccination Extension Bill now before-your honourNow, Sir, after having received such treatment at the hands of able House is calculated to supply a desideratum for the further Dr. Hawkins I am puzzled to know what object he has in wishing protection of the public, and that the principle of compulsory to perpetuate a power that is never meant to be used, or only vaccination meets with their entire approbation. once in a century ? But I ould ask this simple question-What That, nevertheless, some of the provisions of the said Bill are is the use of the Royal College of Physicians at all, now that we not only defective in themselves, but also bear with considerable have a University of London, and a reformed College of Surgeons? hardship on the members of the medical profession. Imagination fails even to suggest one single useful purpose that That the appointment of stations, to be not more than one mile it serves. It neither possesses the power nor the will to protect from the furthest limit of the district, would demand from the its licentiates, nor does the possession of its licence confer either medical officer, especially in thinly-populated districts, a seriously dignity or honour upon its possessor. Compare the names of the Examiners in Medicine at the University of London, and of the increased consumption of time and labour. That the desirable mode of vaccinating directly from the arm is Council of the Royal College of Surgeons, with those composing already adopted whenever practicable, but to do so in all cases the College of Physicians, and I will not insult the profession by is entirely impossible; that to report every exceptional instance saying which are the most eminent in science and in learning. to overseers or guardians of the poor would answer no useful Among the regulations of the College are the following words: purpose; and that the exercise of the power to vacate the con- —" Unqualified persons practising are to be admonished. ’ Qui tract under such circumstances would be arbitrary and inex- monitum hoc neglexerit, legibus regni obnoxius erit."’ Is this sense or nonsense, or dignified twaddle? pedient. If the College continue to act as it has done for the last half That while the Bill enforces vaccination within a given time, and renders the parents or guardians of the child responsible for century, no infusion of new blood or widening of the constituency its omission, it does not enforce the obligation to return for in- will avail. The profession must petition the legislature to abolish institution not in harmony with the times, and some other spection, and for supplying the medical officer with lymph, andI

WILLIAMSON,

"

,

’

,

I an