FLEXIBLE STETHOSCOPE.

49

unlikely

MR. KEY. OF GUY’S HOSPITAL.

TO THE PUPILS

Mr. Key, our senior surgeon, has deviated from that course of rectitude and veracity, which, as a teacher, he should have scrupulously observed, and

GENTLEMEN,—As

as

he has

objected

for his conduct,

explain or to apologise gentlemen, callour disapprobation. Had

to

we

are, as

ed upon to mauifest he attacked our persons, should we not have resented it. And we ought to be alike prompt in protecting our characters against degradation. If Mr. Key refuse us the title of gentlemen, as pupils we have a claim upon his veracity. For his broken promises, weare

entitled,

at

least,

to

nour to

people

use

who sell

drugs, may

of them.

be, Sir, Your humble servant, A POOR GENERAL PRACTITIONER.

explanation or apology,

which lte has not had the honour to propose, The pledges nor we the spirit to demand. given in an introductory lecture are and ought to be considered as part of the contract between lecturer and pupil. If a prize was promised, a prize should be given. Perhaps, indeed, many gentlemen may not have intended to compete for it ; but it was to the class that the promise was made, therefore every individual in it participates in the insuit. Can we then receive him on Friday evening next with the same cordiality as heretofore No. Let us show him that we are neither insensible to his injustice nor his insults. And by the punishment of one who has mocked us with broken promises, and insulted us by refusing to explain, let us show to the lecturers of other schools, that the pupils of Guy’s Hospital know how to defend their characters and

that

In doing this, they do not consider they obtain a good medical opinion, but take the chance of getting one, and of being- cured cheaply. I confess, [ cannot find fault with the druggists ; their business is to sell as much physic as they can ; what matters it to them if it be useful to their customers or not? It is, however, much to be lamented, Mr. Editor, that some regularly educated medical men have submitted to confound themselves with druggists, but I verily believe that these very men are the first to cry out about the confusion, which they themselves have created. I have the hoknow the

London,

21st

September.

FLEXIBLE STETHOSCOPE.

To the Editor of THE LANCET.

SIR,—Having to

the

postpone for

drawing

been some

unexpectedly obliged days the sending of

and report of the effects of the

stethoscope, with which both ears can be simultaneously employed, I shall feel much

if you will, in your next Number, goodness to publish the following brief notice of the comparative utility of the inflexible and the flexible stethoscopes. In acute thoracic diseases, and in chronic cases in which pain is excited by pressure or motion, it may perhaps be predicated, rights as gentlemen. A SENIOR PUPIL. that the flexible stethoscope should, with few, if any exceptions, be employed. But in other cases, the original stethoscopethat is, the lowest tubes of the flexible instrument to which the ear-piece, with a STATE OF THE PROFESSION.—DRUGGISTS. female screw, can be united, should generally, though perhaps not always, be preTo the Editor of THE LANCET. ferred. This does not imply that the anguSIR,—Several letters have lately appear- lar joint injures the transmission of sound ed in your journal, relative to the state ofIt means only, that proximity- that is, that the profession ; as rny opinion differs from the lowest tube, seems to be exclusively the chief of them, I hope you will excuse necessary for accurately hearing certain low me in addressing you on the subject. Your thoracic sounds. And it may be allowable correspondent complains of the innovations to state, that other gentlemen, as well as of the surely this is unjust, if the myself, have concluded, after accurate exmatter is viewed impartially. Though there aminations, that the flexible stethoscope are few people so ignorant of the state of the conveyed, in some cases, louder sounds, medical profession in England, as not to than as good an instrument of the original know that there are avast number of able men kind as could have been obtained at Paris. engaged in it in every neighbourhood ; yet If, therefore, the tube of a flexible stethomany of them, when they find a necessity scope were not longer than the tube of the for medicine, will consult an old woman or a original instrument, it may perhaps be confriend, whose experience may enable them cluded, that sounds conveyed through the to recommend a remedy. It is on this prin- former would not, in any case, suffer by The flexible is only the origi. ciple they consult a druggist, tlliuking it not

obliged

have the

druggists;

transmission.

50

nal instrument, modified as little as conve. nience requires, and if well-made stethoscopes be employed, the writer will cheerfully await the decision of every judicious auscultator. To avoid disappointment in the workman. ship, I beg to offer a few remarks. The instrument being held perpendicularly, the horizontal bore of the two pieces that compose the flexible joint, should not proceed further than the parts where it should meet the perpendicular bores that are continuous with those in each limb of the cylinder. The female screws should not injure the horizontal bore. To render the joints airtight, a thin portion of cork, bored in the centre with the same instrument with which the tube was bored, should be introduced between the extremities of the male and fe. male screws, and between the extremities of the ’° tenants," about which also cork or cotton should be coiled. Attention to these directions will little increase the trouble of the turner. I have, by experiment, ascertained, that the sounds must be injured, if the continuity of the bore of the instrument be in. terrupted by chasms. The purchaser should, therefore, examine the stethoscope in these respects, before the ferrules be screwed to the joints. The diameter of the lower extremity might be advantageously less than an inch and a half, the latter being too great to be very readily adjusted to the irregular surfaces of portions of the chest, especially in young phthisical patients. Permit me to correct an unintentional inaccuracy with respect to the description of the ear-piece. Various kinds have been tried ; but that in ordinary use appears to be the best. The central portion should be moderately elevated, so as to approach, but not to touch the concha. The circumfeI expected rence should press the helix. that the angula and moveable ivory part, intended to approach the meatus auditorius externus, would have improved the conveyance of the sound. But that which I tried has not answered ; probably because it did not accurately fit—probably because the diameter of its bore was less than the diameter of the bore of the instrument-or, probably, because the substance deviated from. the homogeneousness of the internal part of the tube- I expected, before the transmission of the former letter, to have had an opportunity of trying the effect of this portion, but did not obtain it till too late ; and it escaped my memory to state, that I was only about to try the effect of such a portion. The instrument, however, answers well without it.’ I remain, Sir, your most obedient servant,

EXPENSES AT THE LONDON UNIVERSITY.

Of THE LANCET. SIR,—Relying your often-repeated de. clarations in favour of truth and impartiality, I venture to request you will oblige me, by giving a true statement of the expenses which are incurred by the students in at. To the Editor on

medical classes of the London there is an old proverb which says, " All is not gold that glitters;" and I feel confident that the profession, generally, are deceived by the prospectus just put forth, which I confess appears to me to be artfully contrived. I allude particularly to the " first division," "second divi. Now, if a division be equivalent sion," &c. to a course of lectures, and if a student is to remain (agreeably to the liberal regu. lations of the college) two seasons in the metropolis, it follows, as a matter of course, that the expense will be nearly as mitcli, again as would be incurred in any other school. Knowing you have never advocated the cause of the certificate system, nor of the exorbitant fees of lecturers, I trust you will give, in an early number of your excellent and truly useful journal, an impartial analysis of the " fee trade" of the London University, which I am sure will prove highly acceptable to the junior part of your readers, as well as to those immediately concerned in their welfare, and the dignity of the profession. I remain, Sir, ARGUS. September llth.

tending the

University. Sir,

PHYSICIANS.

To the Editor of THE LANCET.

SIR,—Will you inform me, how often when consultations are proposed, the choice of the

physician depends on the general practitioner? Will you also tell me, whether there is wisdom in the practitioner who selects, or acquiesces in the selection of, a who, affecting to give gratuitous physician, advice, picks the pockets of the poor by prescribing an expensive quantity of medicines, and directing them to be_prepared at a chemist’s in Southampton Row,or Oxford Street for example, and sharing the profits with his chemical acquaintance? As the phy-

NICHOLAS P. COMINS.

Edinburgh, Sept. 17,

1829,.

sicians insist upon the distinction, and contend for the utility of the classification of medical men, how is it that some (in Bedford Square and Russell Square for ex. ample) bleed their patients, draw teeth, dress sore legs, and practise midwifery, not in consultation ? It may perhaps be urged in defence of these petty larcenies on the general practitioners, that having been of that class themselves, these ingenuous doings are the result of habit. Is this a good defence1 Your obedient sexvant, .