AN ALLEGED BREACH OF MEDICAL ETIQUETTE.

540

settled,

it most

certainly never will

be settled

by such experi-

ments as those detailed in Mr. Duun’s paper. The case and the instrument were equally unsuitable to its solution. But, Sir, I do not think the question is unsettled. For many years I have continued to subject my paralytic patients to the mild influence of the galvanic current in such a manner as to make it a test of the irritability of the muscular or nervi-mus-

-

P.S.—Even whilst I am writing this note, I receive a in accordance with all my experience in this matter. The mode of proceeding is so simple, that the little patient’s father has become at once the operator and observer.

report

11

Brighton, Nov. 4, 1850. DEAR SIR,-We have been watching the result of the galvanism since we had the pleasure of hearing from you, and we find that the affected or paralytic side is moved more than the other, the hand in particular." I have wondered that the profession has not been favoured with Dr. Pereira’s more recent experiments. I am aware that that gentleman provided himself with the proper galvanic apparatus. I will speedily send you a full account of M. Duchenne’s paper, who has repeated in Paris pretty nearly what Dr. Todd had done in London.

cular fibre—that is, the galvanism was used of low intensity, its force or quantity being gradually augmented, until its influence in inducing muscular contraction isfrst perceptible; whilst cases were chosen of an unequivocal kind, and uncomplicated by shock, by spasm, or by alteration of tissue. The effects are then uniform. The sole exception to the rule -of augmented irritability in cerebral paralysis and of diminished irritability in spinal paralysis-has arisen from defect in the previous diagnosis, or selection, of the cases, as ’ in this of Mr. Dunn. If all this be true, how important is the fact!-how important THE MEDICAL PROTECTION OFFICE. in physiology and in diagnosis, and, therefore, in practice! To the Editor of THE LANCET. But Mr. Dunn has not confined himself to his case. He has proceeded to adduce experiments-the experiments of the SIR,—In the advertisement issued by the committee of this late Professor J. Reid. Now, Sir, with every respect for Office, on the 8th ult., it is stated that Mr. Beckitt had another, and a departed and most worthy member of our pro- " handsomely given to them the possession of all books and fession, I am compelled to say that Professor J. Reid’s experi- documents." ments were erroneous. This is pointed out at length in a I have lately transferred my accounts to the Medical and recent paper in the London Yledical Journal. Surgical Practitioners’ Society, and have given an order to Professor J. Reid mistook an electrogenic state-the(dter- the Medical Protection Office to hand over to them my list natif’ of writers on this subject-for diminished irritability, of debtors’ accounts, and other documents connected with my and by this mistake is led to a wrong conclusion, as I have business. On inquiry to-day, as to how this order had been shown in the paper just alluded to. complied with, I was surprised to learn that the clerk of the One word more in reply to M. Duchenne. What will your Society of which I am now a member had applied for what I readers think of the following case as a case of Spinal Para- had ordered to be delivered to his principals, but had been lysis?? I met by the committee of the Medical Protection Office, who In 1847, a man, aged thirty-eight, a vine-dresser, was in the were sitting at the time, with the objection, that Mr. Beckitt St. Felix ward, affected, during seven years, with a general had possession of all books, documents, &c., and would not chorea, (!) with muscular debility." (!) "The emaciation was allow them to give any papers or information inquired for. not very considerable, the muscle presenting everywhere conI have thought it my duty to acquaint you, Sir, with this siderable prominence; in the vertical position, his head and fact, for the information of other members, and as a proof of body were so agitated (!) that standing was impossible; in the how little reliance can be placed on the statements and horizontal position, the least muscular effort, whether of the promises of the Medical Protection Office. I am, Sir, your obedient servant, superior or inferior extremities, induced general trembling. When he wished to take hold of anything, his arms described G. Z. HILLAS, M.D. arcs, and moved to the opposite side. The muscular weakness Sydney-place, Brompton, Nov. 6, 1850. was considerable, the patient being scarcely able to walk with the assistance of an arm, and incapable of squeezing the hand. The voice was attended by convulsive spasms of the diaphragm. AN ALLEGED BREACH OF MEDICAL ETIQUETTE. No cutaneous anaesthesia; general health good," &c. [LETTER FROM DR. HELSHAM.] M. Duchenne, whilst glorying in this supposed exception to To the Editor of THE LANCET. the law which I have laid down, for spinal paralysis, admits that it is the only one. Your readers will perceive that it is SIR,—In reply to the charge made against me by Mr. no case of paralysis whatever, and therefore no exception Mackin, I have to observe, that the profession cannot judge whatever to that law. "as to which of us may be right," unless they are rightly inNo progress can be made in this or any other important formed ; and as I can have no objection to furnish my version question, until our proceedings are conducted with a little of the story, I beg to say, that late in the evening of the 23rd more precision. to j of September last, I was requested, by the son of Mr. I will extract one brief paragraph from my second paper visit his father, residing at Pimlico, a distance of five miles read before the Royal Medical and Chirurgical Society :from my house, and who, he stated, had been suddenly taken "Having made these preliminary and precautionary re- ill on the previous day, with symptoms of paralysis; that in marks, I proceed to the detail of a series of new experiments the hurry of the moment they had sent for the nearest medical and observations. My task will then be terminated, and I man, Mr. Mackin ; that he was a stranger to them; that they trust the Society will be convinced that it was not without had no confidence in his treatment; and as he had proposed due caution and care that I gathered together the facts which to bleed, they had become much alarmed, and wished me to I ventured formerly to lay before it, and that I drew my in- attend immediately to this request, as I had previously atferences from them. This is the reward of my labour-that I tended a part of the family, and was on visiting terms with them. I at once acceded. have nothing to retract, nothing even to modify." On my arrival, and after an examination of the patient, I Now, Sir, this result is not accident; it is the effect of thoughtful care in devising and performing my experiments; found the symptoms to be such as not to require bleeding or and if Dr. Todd, M. Duchenne, &c., will do as I have done, any other depleting measures, and I assured his friends that our results will doubtless be the same. quietude and a well-regulated diet would soon restore him to I should not have re-entered upon this discussion, but for health. Before I took my leave, Mr. Mackin called, and I briefly the importance of its results—viz., 1. That in cerebral paralysis, by which I mean any disease stated to him my view of the case, in which he apparently which severs the influence of the cerebrum, and consequently acquiesced, and I left with an understanding that the patient the acts of volition, from the paralyzed limbs, the irritability was not to be bled, that if any unfavourable change should take place, I was to be sent for, and that I would see him is augmented, whilst 2. In spinal paralysis, by which I mean any disease which again, but made no appointment, as my visits were honorary, nor did I suggest any alteration in the medicine he was severs the influence of the spinal marrow from those limbs, the at the time which Mr. Mackin informed me was is tested case diminished;—the taking galvanism irritability by being saline draughts. Indeed, I considered them to be as good in its simple current, and of low intensity. 3. That Galvanism, so employed, becomes a source of Dia- as anything else, under the circumstances, and I felt no desire to interfere with his interests. gnosis. 4. That the cerebrum, or volition, is the exhauster, whilst the Continuing to receive a favourable account of his progress almost daily from his son, I did not call again for several spinal marrow is the soztree and restorer of this property. I am, Sir, your obedient servant, days. On finding, however, he was still taking the saline MARSHALL HALL. Grosvenor-street, Oct. 25, 1850. medicine, I gave a prescription for a tonic mixture, and a -

541 protest against the whisky-and-water, in which he was allowed to indulge ; in fact, I thought this liquid might have been a fancy of his own, and certainly not a very safe beverage even in" the simplest form of cerebral congestion." On the following day, I received Mr. Mackin’s first letter, in which my conduct was stigmatized as "intrusive" and unprofessional," "officious" and " unwarrantable," and concluding with a threat to show me up in THE LANCET, which he has not thought

publish, and which I subjoin:—"From the curious grammatical inaccuracies contained in the recipe which you

proper to

condescendingly left for my approval, I think so classical a production should not be lost to the medical public, it will there-

fore remain for consideration whether a statement of the whole matter, with a copy of your prescription, shall be sent to THE LANCET." His second letter I returned unopened. I am at a loss to know what all this can mean; certainly it cannot be all about etiquette, for he has condescended to notice even an intentional inaccuracy. I have done more to uphold the honour of the profession than Mr. Mackin, notwithstanding all his quibbling; and I shall never be deterred from doing my duty fearlessly to a friend, or a patient, whatever may be the conventional forms of "the leading practitioners of Pimlico," or the insinuations of Mr. Mackin. I have to apologize for the length of this letter, but Mr. Mackin’s assertions are much more easily made than supported. I also enclose a note from the son of the patient, corroborating these statements, which you may use if you please, as he was present during the whole of my interview with Mr. Mackin. I am, Sir, your obedient servant, AUTHUR HELSHAM, Park-place, Mile-end-road, Nov. 1S50. HELS]aAll, M.D.

without losing anything in the eyes of his brother officers, who have probably more sensible ideas of what really constitutes the dignity and usefulness of medicine. The great error in our present system, and which has been entirely overlooked by Mr. Gallwey, in the warmth of vituperation, is, not the dispensing, but the charging for medicines-the custom of sending patients an invoice of their drugs at fictitious prices. This is an evil which cannot be defended on any score; but it is one which the growing intelligence and liberality of the age will soon enable us to remove. Having replied to the strictures of your correspondent, I will conclude by stating what is, in my opinion, the cause of the low esteem in which the profession is held by the public. I believe it is not the dispensing nor vending of drugs-but certain vices and failings in the professional character, that are as conspicuous now as in the days of Moliere and Le Sage. I mean, the dissensions and bickerings among ourselves, the jealousies and intemperate abuse of rival systems, the puffing and touting; and more than all, the presence in our ranks of men who are totally unfitted, either by nature or education, for the exercise of their calling-men with coarse manners, and coarser minds, without any scientific acquirements, or even a competent knowledge of their art, who would degrade any profession to the level of a trade, and whom no external rank or distinctions could elevate to the character of " divine philosophers." If 1:.Ir. Gallwey can suggest any remedy for these evils, I shall be happy to hear of him again. I am, Sir, your obedient servant, HENRY TAYLOR. Guildford, October, 1850.

THE ORTHOPÆDIC HOSPITAL. THE OPEN-SHOP AND SURGERY QUESTION. A REAL CASE OF DEFORMITY. To the Editor of THE LANCET. To the Editor of THE LANCET. SIR,—In the letter of your correspondent, Mr. M. B. Gallhave been for many years a governor of the Royal are SIR,—I some strictures on the of conduct wey, general practitioners, in dispensing their own medicines. Every one willOrthopaedic Hospital, and am well aware that the surgical be disposed to admit the justice of his remarks as regards thestaff consists of a surgeon and two assistant-surgeons. In my intercourse with the patients, I have learnt, to my sale of drugs in an open shop; but the case is very different that one of the assistant-surgeons neither opewhen he applies the same censure to the practice of dispensing medicines in a private surgery. Mr. Gallwey believes he is rates nor, indeed, has had any patients under his care, for the three or four years; notwithstanding which, it appears possessed of all the arguments that can be urged in its favour, last and forthwith proceeds to demolish them, in a style and that the number of ont-patients is such, that an extra day is set apart, to get through the duty. This being the case, I manner quite characteristic of that arm of the service to should be glad to learn why two officers should be overworked,p which he belongs. It must be observed, however, that he has not stated these and the third remain idle. Perhaps, Mr. Editor, you will in ascertaining the reason of this apparently arguments at all fairly, while some of the most important are kindly assist me not even alluded to. Contrary to his assertion, there are strange affair, and discovering the spirit which animates the many villages in this part of the country which have no drug- governing body of an institution where such an anomaly gist, and where the demand for medicines is so small that no exists. Not only is this the fact, but rumour has sounded the note druggist could make a living, even if he had the whole field to that the appointment of a fourth medical officer is contemhimself. I contend, therefore, that in the villages there must often be a necessity for the dispensing of medicines in a plated !-for what? You, Sir, have been engaged in unravelling many knotty private surgery. Perhaps it has not occurred to Mr. Gallwey, that the poor, the infinite majority of our patients, could points, and succeeded beyond all hope; I therefore trust you in this case, lend a helping hand to fathom the hardly afford to pay both doctor and druggist, as he would re- will also, commend. In commercial language, there would then be two depths of this mystery. I remain, your obedient servant, profits to be made, one from the medical attendance, and one POLLUX. London, Nov. 5, 1850. from the drugs dispensed; whereas, by the present system, there is no profit sought to be made out of the drugs by the In this *%* noticing commmunication, it is necessary that practitioner ;-in point of fact, his fees are no higher than if we one sentence verbatim, - ° Perhaps, Mr. quote he simply prescribed without dispensing the medicines. will kindly assist me in ascertaining the reason of Another and a moreweighty argument in favour of the Editor, you this strange affair ; and discovering the spirit apparently with the is In is that it a present custom this, poor charity. animates the governing body of an institution where cases of long and severe illness, there is often so much expense incurred for medicines only, that few tradesmen such an anomaly exists." would be found to give the poor the necessary credit for In the first place, we must be allowed to observe that we them. Then it is that the professional man stands their can discover no reason in such a strange affair. Secondly, it friend, whether or no therebe any chance of his patient’s is a difficult matter to discover the which animates the spirit or to him of his he ever is recoverv, solvency, ready supply with what is needful in the way of drugs. This is a duty governing body, because it is quite evident the governing which I conceive will be held more binding on the profession body has no spirit, or else such discreditable proceedings than any considerations of social rank, or personal dignity-it would not be allowed amongst the officers of the institution. is this, and not the grovelling love of trade which Mr. Gallwey a spirit does animate a certain is It that clear equally would impute to us, that us to continue in our present governing body, and that the said spirit is a very evil one. If, course. After all, it remains to be proved whether the " honour and then, the nominal governors of the institution would but respectability of our calling" is in any way compromised by assume and exercise their proper functions, and be guided in the mere act of compounding drugs; and here I must take their proceedings by a just, honourable, and wise spirit, the leave to remind Mr. Gallwey that in dispensing our own evil one will either relinquish his functions, or be altogether medicines, weare doing nothing worse than is done by every cast out of the establishment. If much further tampering be medtcs.1 officer in her Majesty’s service; and I venture to say, that even in the Ordnance Department the surgeon has some- allowed with the management of this hospital, the chance of times to demean himself by " dabbling with drugs," and that its doing good will be much diminished. Wecan assure our

astonishment,

should

which

corn pels