COMMUNICATIONS TO THE BOARD OF GUARDIANS OF THE WHITECHAPEL UNION, ANNOUNCING THE RESIGNATION OF MR. LIDDLE AS MEDICAL OFFICER TO THAT UNION.

24 2. It must be numerous enough to give to its public discussions the greatest weight. 3. It must be independent. It should meet weekly to discuss publicly the numerous questions on medical subjects referred to it by Government. Their solution would thus embody the most enlightened opinions of the profession.

profession.

under government sanction,) and X500 for office and minor expenses. A trifling expenditure, indeed, when compared to the amount of benefits which would result to the community. In sanitary measures the responsibilities of the Home Office, would thus be perfectly covered, and to the profession would be given an importance it has never yet possessed in this country, (but an importance to which it is fairly entitled,) and the public would then be able to rely in perfect confidence on the advice it would receive. I trust you will excuse my thus trespassing on your time andspace, but as this plan has been approved of by many friends, (though neither alluded to in your review of my pamphlet, nor in the flattering notices of the same in many of the daily papers,) I offer it to notice in a more tangible form than I have already presented it in print, and I should feel obliged by your giving it increased publicity. through the medium of your valuable paper. I am. Sir. obedientlv vours. EDWARD J. TILT. Gloucester-road, Hyde.park, Dee, 1818.

"Government would then have its own board of medical to advise with in ordinary cases, or in cases of great emergency; and in all other cases of interest to the community; it would benefit by the decisions of a public body representing the whole of the profession. " The experience of a neighbouring country proves that this plan is susceptible of working well. The Académie de Medecine of France was expressly founded, in 1820, to be the great sanitary council of government, and to answer all questions respecting epidemics, epizootics, medical jurisprudence, vaccinew remedies, secret remedies, and mineral waters. nation, Since then, the French Minister of the Interior has been in constant communication with this body, seeking and obtaining information which enables him to meet medical emergencies in the best manner. "No public body would be better calculated to perform the COMMUNICATIONS TO THE BOARD OF GUARDIANS OF THE WHITECHAPEL UNION, ANNOUNCING duties, and accept the responsibilities, of such a council, than the College of Physicians, to which it would impart fresh life THE RESIGNATION OF MR. LIDDLE AS MEDICAL and additional importance. The adoption of such a measure OFFICER TO THAT UNION. would relieve Ministers from many an anxiety, would give 4, Alie.p!ace, Goodman’s-fields, Dec. 22, 1848. greater confidence to the public in seasons of epidemic visftaGENTLEMEN,—In consequence of the contemptuous manner tions, and would give to the profession its proper importance, with which my letter to the Board, bearing date 19th making it the medical adviser of the community as it is the was treated by you, I beg to resign my office as one of Dec., your medical attendant of each individual. Should the College of district medical officers. the of this decline responsibilities accepting high Physicians The following is a copy of that letter:office, the Royal Medico-Chirurgical Society-a chartered so" 4, Alie-place, Goodman’s-fields. which has often called the ’ of the been parliament prociety, "GENTLEMEN,-I have to demand an apology from Mr. fession’-is worthy of the honour, and would be found well calculated to carry out the plan suggested. Indeed, this Brushfield, as the chairman of your board, for the unfounded he made at the inquest which was held yesterSociety will, in the eyes of many, be considered the most ap- assertions at the Windmill of the as a because it embodies day public house, respecting mv conduct in two, sanitary council, propriate the whole profession represented by the physicians; the sur- not reporting to you the state of the courts in Blue Anchorgeons, and the general practitioners, who are fellows of this yard, and thereby throwing upon me that blame which the celebrated Society. jury thought was attached to some party. " " I could readily have forgiven the remarks Mr. Brushfield Now is the proper moment for making so necessary an innovation, for the medical profession is on the verge of its made during my presence, by supposing they were made in reorganization. A Bill for medical reform has at length ignorance of the fact, but aftertoI had corrected his error it was on his part have reiterated the same obthrough its multitudinous elaborations, and, as we learn, most unjustifiable passed after I had left the inquest-room. will be presented to parliament early next session; and it is servations " I assure you, gentlemen, I would most willingly have borne to be sincerely hoped that after conference with the College of Physicians respecting the minor details of the plan sug- my proportion of any blame which might, either justly or ungested, provisions for a supreme court of medical advice will justly, be attributed to all who are concerned in the onerous be embodied in the forthcoming Bill, and thus in future give and unpleasant duty of administering the poor-laws, but it wasto the public the best guarantee for the proper decision of all neither just nor generous to endeavour to fix the alleged blame upon me, more especially as Mr. Brushfield, who, asmedical questions." On mature consideration, I am inclined to think that the the chairman of your board, ought to have known that it was duties of a medical state council should rather be allotted to only about three weeks ago since I reported to the board that the Royal Medico-Chirurgical Society, because the different epidemic, endemic, and contagious diseases prevailed in every branches of the profession there meet on a footing of perfect court in Blue Anchor-yard, and after I had still more recently equality. The Society is already in working order, and few stated (viva voce) to the boardofthat I had, within the last few attended several cases alterations in its laws would be required to enable it to fulfil days, malignant cholera. 11 I have the honour to be. gentlemen, vour obedient servant. the additional duties it would assume. The staff of the " J. LIDDLE. "To the Board of Guardians of Society might remain as it is now constituted, the president the Whitechapel Uuion." and secretaries chosen by the fellows; but there should be I have held the appointment which I now resign nearly added to the staff a permanent government secretary, who might communicate with the government, and receive and sixteen years, and it is with no small feeling of regret that I At the outset am compelled to take the present step. With many memanswer all communications on state medicine. of the ordinary meetings he would read all the official corre- bers of the board I have formed a friendship which I hope to spondence, and give his attention to the business department entertain to the latest period of my existence, and I have of the Society. That over, the medical secretary would, as reason to believe that some of the guardians will very relucusual, read the contributions of the fellows, in nowise inter- tantly accept of my resignation. It is, however, impossible fering with the government communications. The meetings for me to hold office when confidence between the employers might take place at the usual hour, but it would be necessary and the employed is broken, which I now feel to be the case for the Society to meet every week instead of every fort- between the board and myself, andI have no hope that a recinight, and to shorten the time of its vacation. The fellows procal feeling of esteem will ever be re-established. It apmight still be chosen as at present, and to a certain number peared to me that all the recommendations I made, during my of the standing committee might be referred letters and interview with you on Thursday, the 14th inst., were received ministerial questions previous to their general discussion. in a very uncourteous manner; they were sneered at by some, There should be standing committees for public hygiene, for and at length rejected. The recommendations contained in epidemics, for medical jurisprudence, for vaccination, for the joint letter of the medical officers to the board respecting the investigation of new and quack remedies, &c., &c. The the supply of drugs and appliances for cholera patients additional expense attending this modification of the Society (although we hold the power of enforcing the adoption of them) should of course be defrayed by government, and need not were treated with something worse than contempt: when I be very considerable. In fact, .S2000 a year would cover proposed that a supply of ether and chloroform, for inhalation, all expenses ; £800 to the government secretary of the should be provided at the workhouse, I was told, " that by Society; £500 to the chief clerk, (these two officers should be contract I was bound to supply all necessary drugs and apfellows of the Society, and elected by ballot under the sanc- pliances;" and when I further stated, that the medical officers tion of government.) £200 to the under clerk (who should might not deem such remedies to be absolutely " necessary," not be a medical man, though also elected by the Society, a feeling of indignation was expressed by some members of men

25 same city hardly one-tenth.of the applications for relief, during the reign of the epidemic, came from those parts which had been rebuilt, after the destructive fire, on more improved sanitary principles; that in Coatbridge, (Scotland,) a place patient. Moreover, the board, so far from affording to the surrounded by filthy ditches, forty cases a day occurred in a medical officers the assistance which they (in their letter) de- population of 10,000; and so much as 140 per diem were resired in the discharge of the arduous duties entailed on them ported in Glasgow, where filth and overcrowding are extreme. by the present epidemic, ordered a placard to be printed, and The disease is essentially an affection of the blood; all the circulated in the union, which will have the effect of increasing well-known phenomena are only secondary to the original those duties fourfold. I also informed the board that extra poisoning of the vital fluid, and the discharges are an effort of medical assistance was required in my district, not because I Nature to get rid of the noxious substance introduced into the had more than an average number of cases of illness to attend, system. The secretion of bile is not arrested, the gall-bladder but because there was prevailing at the present time a disease is ever found full; but it seems that something arrests the which was of so serious a nature as to demand the almost reflex action which impels the biliary fluid into the ducts. constant attention of the medical officers. The recommenda- The surest sign of the disease is the suppression of the renal tions of your medical officers which would have incurred ex- secretion, and the kidney takes the morbid characteristics of pense were set aside, while those which cost you nothing were Bright’s disease. Mr. Grainger concluded his excellent address by pointing out how lamentably ignorant most classes adopted. In taking leave of you, gentlemen, I have the heartfelt of society still are regarding sanitary questions; the Irish at satisfaction of having most conscientiously done my duty, both Glasgow fancy the medical men want to poison and get rid of towards the poor and towards you, and of being able to say them; numbers of parochial boards contend that houses can that many of the localities where the class of patients I have do very well without certain conveniences; and so many as been called upon to attend, reside, are now in a better condi- one hundred families live in a limited row of buildings at Glastion than they were a few years ago. Nor can it be denied gow, who, with a verv wealthy man as a landlord, have but that the improvement which has taken place has been almost one water-closet for them all ! BRISTOL DISPENSARY.-At the annual meeting on the 28th entirely caused by my own exertions. I daily receive the thanks of the poor for the improved condition of their neigh- of December last, the following gentlemen were elected on

the board, as though I would withhold what was truly requisite in any case. They appeared to think, that as I received the liberal pay of about one shilling per case, I was expected to expend about four shillings for the treatment of each cholera

bourhoods. I have only, in conclusion, to add, that I hope you will lose no time in filling up the vacancy which my resignation occasions.-I have the honour to be, gentlemen, your obedient servant. To the Board of Guardians of J. LIDDLE. the Whitechapel Union.

To the Editor of THE LANCET. SIR,—One day last week I forwarded to you a copy of my letter addressed to the Board of Guardians of the Whitechapel Union, announcing my resignation of the office of district medical officer, but I forgot to furnish you with the reasons which obliged me to resign my appointment. It is well known to that portion of the public who have paid any attention to the science of public health, that I have, for many years past, devoted a good dealof time to the study of that important question ; and having witnessed a large amount of distress and physical suffering among the poor, I have repeatedly raised my voice in their behalf, and have consequently incurred the ill-will of many individuals who are interested in keeping things as they are. No fault, however, was publicly found with me for endeavouring to ameliorate the condition of the poor inhabitants of the wretched localities which abound in the Whitechapel Union ; but the chairman of the board of guardians, who attended to watch the proceedings at an inquest which was recently held on the bodies of four persons, whose deaths were said to have been occasioned by the filthy state of the district, threw upon me the blame of causing such a catastrophe, in consequence of my neglect in not having informed the board of all those places where disease was prevalent ; when it appeared, from the minutes of the board, that only three weeks before the inquest was held, I had, in writing, informed the guardians of the unhealthy condition of these very places. The chairman stoutly denied that I had made a report, and it was in consequence of such ungenerous conduct that I demanded an apology from the board. My letter was laid aside, and no notice taken of my demand. Your obedient servant. Alie Place, Jan. 1849. JOHN LIDDLE.

Medical News. ST. THOMAS’S HOSPITAL.-MR. GRAINGER o2cr own

Reporter.)—The

ON

CHOLERA.—(By Grainger

announcement that Mr.

would deliver a discourse on cholera attracted a crowded assembly of medical and non-medical hearers to the great hall of this hospital on Wednesday last. Mr. Grainger sketched a very animated parallel between fever and cholera, and endeavoured to show that both these affections are epidemic, but not contagious, maintaining that if they were communicable from man to man their progress could not possibly be arrested. He remarked that the poor at Hamburgh suffered five times more in parts surrounded by stagnant ditches than the same classes in healthy localities of the town; that

in the

the medical staff of that institution :Honorary Physicians: Dr. Robertson and Dr. Stanton.Honorary Surgeon Accoucheur: Mr. Edward Martin. Messrs. James, Smith, and Herapath were also re-elected to the latter office. PATHOLOGICAL SOCIETY OF LONDON. - The third annual general meeting of this Society was held at its rooms, 21, Regent-street, on Monday evening, January lst. A report was read, setting forth the eminently useful and successful progress of the Society during the past year, and the following gentlemen were elected office-bearers for the present year .-President: C. Aston Key, Esq.—Vice-Presidents: B. G. Babington, M.D., F.R.S.; Richard Bright, M.D., F.R.S.; C. J. B. Williams, M.D., F.R.S.; J. Moncrieff Arnott, Esq., F.R.S.; Caesar Hawkins, Esq.; Richard Partridge, Esq., F.R.S.Treasurer: James Copland, M.D., F.R.S.—Council: Herbert Davies, M.D.; H. M. Hughes, M.D.; George Johnson, M.D.; EL Bence Jones, M.A., F.R.S.; T. B. Peacock, M.D.; Richard Quain, M.D.; F. H. Ramsbotham, M.D.; E. A. Parkes, M.D.; Henry Jeaffreson, M.D.; John Scott, M.D.; John Avery, Esq.; John E. Erichsen, Esq.; William Fergusson, Esq.; Prescott G. Hewett, Esq.; John Hilton, Esq., F.R.S.; Henry C. Johnson, Esq.; John Quekett, Esq.; Ebenezer Smith, Esq.; Alexander Shaw, Esq., F.R.S.; Nathaniel Ward, Esq.—Honorary Secretaries: Edward Bentley, M.D.; George Critchett, Esq. DEATH FROM CHLOROFORM.-The Glasgow Herald states that recently a young gentleman returned from Australia to visit his relatives in the neighbourhood of Govan. Before leaving the colony, he met with a slight accident in the foot, which being, perhaps, neglected during the passage home, caused the great-toe nail to grow into the flesh. To remove the pain and inconvenience, the gentleman resolved to submit to an operation, which a respectable surgeon in Govan was employed to perform on Tuesday last. Preparatory to doing so, the surgeon resolved to make use of chloroform; but the patient, after inhaling the gas, almost instantly expired. ### This statement is quoted in The Times of Wednesday last, but the detail of circumstances is so meagre that we cannot determine what degree of credit it deserves. THE CHOLERA IN FRANCE.—Dr. Delpouve, of St. Omer, has addressed a letter to L’ Union Médicale, wherein he mentions that the cholera is making sad havoc in that city. The attacks have been sudden and without previous diarrhoea; most of those who have suffered were in excellent health, and died in five, six, eight, and twelve hours. There have been about thirty deaths within the last two months, and very few recoveries. The disease is reigning principally in the suburbs, which are intersected by water-courses, mostly in a filthy state. The poorer inhabitants have hitherto been the only sufferers. CHOLERA AT THE INFANT PAUPER ASYLuM, TOOTING.—Considerable alarm has been occasioned by information forwarded to the boards of guardians of the unions of the outbreak of cholera at Mr.Drouet’s Infant Poor Establishment at Tooting. Up to Friday last the children, upwards of 1,400 in number, exhibited a healthy appearance, when some of them were