THE HARDSHIPS AND RISKS OF THE MEDICAL PROFESSION AND THOSE ENGAGED IN THE TREATMENT OF BODILY AND MENTAL DISEASE. 1’0 the Editors of THE LANCET. SIRS.—Many hardships and many risks are run both by the student and the practitioner of medicine ; and these hardships. these risks, are seldom thought of by the public, - rarely realioed by the would-be student, and certainly find no
and defence, which so takes up the attention of the combatant as to do away with his feelings of terror; and navy surgeons also run great risks. We have often heard of army surgeons in India and other remote parts who during epidemics of cholera and other diseases, such as dysentery, &c. have really died in harness owing to being medically alone during an epidemic, their high sense of duty preventing them from laying up or considering their own health when that of many others needed to be cared for. The Victoria Cross is given for distinguished bravery. According to the last-published Whitaker’s Almanack, there are at present on the list 260 who have gained it, and according to Churchill’s Directory 15 medical men hold it. The proportion of the medical service to the combatants in the army and navy is such that we may fairly be proud of our professional brethren in the service and wonder whether jealousy has to do with withholding from them the rank and status they wish for. Professionally it is a matter that we have just reason to congratulate ourselves on that from our earliest student days our teachers inculcated on us the self-denying, self-sacrificing nature of our profession and that their teaching really bears fruit. It is happily seldom that one hears of medical men shirking duty from cowardly personal fears, and to my mind and to most reasoning and reasonable minds the courage that enables a man calmly to pursue his duty in pest-smitten houses, in battlefields where the most recent discoveries of destructive science are at play, in warships where unknown the submarine torpedo affixed on the most approved principle may be on the point of launching all in the vicinity into eternity -is of a higher character than is necessary for the boldest combatant, while the reasoning power, the decision, the courage, the intrepidity, the coolness, the manual dexterity, and the immediate pdwer of resource required, possessed, and evidenced by most surgeons in great and critical operations demand powers, natural and acquired, greater than are required or called for in any profession that at present exists. The public asylum service in Great Britain has many medical men engaged in its work and the risks asylum physicians run in their daily routine duties are little known, for asylum men scarcely care to talk of the evils that befal them in case force of example, love of notoriety or other causes which actuate the insane, should bring worse on their heads. In 1887 I asked for particulars about injuries, &c., to officials from some forty-five English asylums, and found that though no suparintendent or medical assistant had been killed yet several had been seriously attacked. Lately two medical superintendents have had to retire from the results of injuries received from patients. During my experience a well-known and much liked commissioner, Mr. Lutwidge, was killed by a patient at Fisherton House. Dr. Wiglesworth, of Rainhill, had his internal carotid opened by a stab from a patient and nearly succumbed ; while Dr. Merson, of Hull, is still suffering from the effects of a stroke from a cricket bat. I need not allude to the attacks, fatal and other, that have occurred in America and abroad, but may remind you how a foreign pbysician-Endden-bravely suffered death in his efforts to prevent his royal but insane king and patient from drowning himself. I myself-though I do not believe I am worse liked than most medical superintendents by my patients-have had some narrow escapes I have been and have suffered somewhat in the flesh. attacked by a patient with a scythe who tried to cut my legs through ; by a patient with a knife; by a man who waited at the back of a door with a stone in his hand and who smashed my front teeth ; and I have had my spectacles smashed on my face-but I still live after thirty-two years spent in an asylum. Much of what I say equally deals with nurses and asylum attendants, and I am sure that the public if thoroughly cognisant of what is done by our profession and the nursing community would be less stingy in the matter of pay and more liberal in the granting of pensions than they are. I am, Sirs, yours faithfully, J. A. CAMPBELL, M.D. Glasg Glasg,, F.R S. Edin., Medical Superintendent of the Cumberland and Dec. 13th, 1897. Westmorland Asylum.
place in the estimate of the work of the profession when it is considered in its pecuniary aspect-a value often sparingly meted out. Some of the hardships and risks to life in the student’s career and in that of the practitioner may be shortly mentioned. Students are forced to adopt a given course of study though some of the subjects may be of doubtful value to them in their future career, and little option of studies of almost corresponding value are allowed them. Laborious dissection, the only mode of becoming aquainted with that real ground work of medicine-anatomy-is at first most repulsive to young students ; macy really suffer in health, have sore-throats, and from the slightest scratch severe dissection wound. I have in my own experience known several promising young men die from dissection wounds and I myself have suffered severely from post-mortem poisoning. In this aylum we have made since 1867 a postmortem on every patient who died under our care and I probably have been fpecially susceptible, but I have frequently suffered severely from a’most imperceptible scratches or skin lesicns and have at one time or other lost all the nails on my left hand. During hospital attendance custom only inures to the sights of human suffering in operative treatment. Risks from infection during student life are great in spite of all precautions. I in my limited experience have seen four or five house physicians in one hospital laid up at the same time with typhus fever. Every now and then one notices the death of a medical student recorded-more rarely since the treatment of infectious disease is conducted in separate hospitals ; but as I already alluded to it post-mortem work claims its share of victims and at times, unfortunately, renders even preselved lives miserable during their earthly sojourn by infection of specific disease. I have known several of such cases and one or two of which occurred in men now alive and of known standing in our profession. ’Medical men at all times run risks from post-mortem wounds, and in midwifery practice risks are often run of acquiring specific disease. Probably in the operative treatment of diphtheria as great risk is run as can be well imagined. The exposure of the country practitioner in long cold ’drives, especially when art has failed to overcome nature and roads are inaccessible to covered conveyances, often really produces ill bealth-of ten premature death : and there are still both in England, Scotland, and Ireland Gideon Grays who ’have in their practice like him "to traverse in darkness paths which to those less accustomed to them seem formidable in daylight ; through straits where the slightest aberration would plunge him into a morass or throw him over a precipice on to cabins which his horse might ride over without knowing they lay in his way, unless he happened to fall through the roofs, when he arrives at such a stately termination of his journey where his services are required either to bring a wretch into the world or prevent one from leaving it. The scene of misery is often such that, far from touching the hard saved shillings which are gratefully offered to him, he bestows his medicines as well as his attendance-for charity." This the case of Gideon Gray is still very often, I can assure you from personal know4edge, the case in many outlying districts in the present day. The mental anxiety experienced by all in the medical pro’fession is at times almost excessive; I have known many men of great eminence, however they endeavoured to conceal it, unable even after years to prevent themselves from suffering HOSPITAL ABUSE AT NEWPORT .from the effects of it. I know one surgeon of the greatest INFIRMARY. repute on account of his successes who yet feels the nervous Editors To the strain of great operations. of THE LANCET. In the Army Medical Service surgeons boldly risk their lives’ think will SIRS,—I agree with me in thinking that you in field service without any of the excitement of the attack Mr. Ensor’s case is one that requires the assistance of the
1620 medical press. I have looked over the rules of the Newport Infirmary and I cannot find any rule giving the directors the power to dispense with the services of their honorary medical officers. Believe me, Sirs, yours faithfully. T. GARRETT HORDER. Dec. 8th, 1897.
MR. ENSOR.] For more than twelve months there has been a feeling of annoyance among the honorary medical officers of the Newport Infirmary caused by patients presenting themselves for treatment (and bringing subscribers’ recommendations) when they are in a position t6 pay for what medical treatment they require. Many of these applicants regard the charity as a medical aid society or a club, and when asked if they regard themselves as objects of charity say that they support the infirmary and have a right to its benefits-their subscription being one or two shillings or more in the course of the year. the present year many subscribers’ notes have been referred to the infirmary directors for inquiry, and in no instance had a reply been sent back to the writer, till the time of the present dispute which extends back to the middle of October in this year when two patients presented themselves. one the daughter of a man earning 45s. a week or foIl7 per annum and the other,a boy whose weekly earnings (including his father’s) was 59s. per week or fo153 per annum. They both came from the same works, where the firm subscribed folD 10s. last year and the workmen fo61 2s. 11d. The writer declined to see these cases as he thought they were cases abusing the charity and they were not at all urgent ; thus protesting against the action of the directors in ignoring the subscribers’ notes previously sent to them. Being refused treatment these applicants caused complaints to be made to the directors (or committee), who caused a letter to be sent to the writer, calling his attention to a previous resolution of the board, viz., " that all doubtful cases are to be referred to the house committee for investigation and inquiry but in the meantime the patient must be treated." He replied protesting at being requested to see patients earning big wages. The committee ascertained that in one case the wage earner had been laid up for a few weeks and called upon him to attend the cases (writing to the applicants that they would be seen). The writer refused again hoping that by so doing the committee would adopt a wage limit or appoint an inquiry officer, and as a result he was dismissed from his appointment as ophthalmic surgeon. About eighteen months ago a subs.criber of two guineas sent a child to the infirmary whose father had a salary of Z100 per annum and was refused treatment by the house committee while the cases referred to above were deemed eligible when making Z117 and .6153 respectively, apparently for the reason that the works refused further contributions unless the directors sent a satisfactory explanation for the rejection of the cases. Windsor-place, Cardiff, Dec. 8th, 1897.
THE IMPORTANCE OF HISTORY IN DIAGNOSIS. To the -Editors of THE LANCET.
SIRS,-During the winter of 1895-96 I attended a man suffering from persistent and uncontrollable vomiting for
had failed, moderate doses of quinine were prescribed with the result that the vomiting absolutely stopped and the man returned to his work highly delighted with his recovery. He was told to continue the remedy as long as he found it necessary. The points I would especially draw attention to in this case are : (1) that although there could be little doubt that the vomiting was malarious in origin the patient could give no history of an attack of malaria either’ whilst residing in a malarious district or during his subsequent ten years’ residence in a healthy locality in England ;9 and (2) the importance of history in diagnosis and as a causal indication for treatment in otherwise somewhat I am, Sirs, yours faithfully, obscure cases. ALEXANDER C. U. GURNEY, M.B. Lond. Eastbourne, Dec. 13th, 1897.
"DR. RENTOUL’S CLAIM FOR FEES FROM THE
To the Editors of THE LANCET. SIRS,-With reference to a letter addressed to you by Dr. Rentoul and inserted in your last week’s issue, in which he characterises as "grossly untruea statement of Sir’ Dyce Duckworth" that Dr. Rentoul had got the Chief Constable of Liverpool to measure the distance from his residence to the railway station," I am directed to request that you will be good enough to insert the following copy of a letter sent to this office by Dr. Rentoul on June 5th, 1897. I am, Sirs, yours faithfully, H. E. ALLEN, General Medical Council Office, 299. OxfordRegistrar. street, W., Dec. 14th, 1897. [COPY.] "Liverpool Constabulary Force, Hackney Carriage Department, " Municipal Offices, Sir Thomas-street, " June 2nd, 1897. " DEAR SIR,-I am directed by the Head Constable to acknowledge receipt of your letter and in reply to inform you that the distance from 78, Hartington-road to Lime-street Station (main entrance in Limestreet) is 2 miles 370 yards and the legal cab fare is 2s. 6d. "I am, dear sir, your obedient servant, D. BREESE, BRERSE, Inspector. (Signed) Inspector, " B. R. Rentoul, Esq., M.D.. 73, Hartington-road, "
THE VENTILATION OF HOSPITALS. To the Editors of THE LANCET. SIRS-I shall be greatly obliged if any of your readers who have practical experience of the forced (plenum) system of ventilation and heating as applied to hospitals will give me information on the following points: (1) what form of forced ventilation do you regard as the best? (2) is it easily managed and is it a thorough success ? (3) does it ever get out of order, say, in frost ? (4) do you know of any place where the system has been a failure so that it has been found necessary to give it up in favour of the ordinary methods by fires, hot air or steam, and windows, &c. ? and (5) does its adoption add much to the initial cost of a I am, Sirs, yours faithfully, hospital ? JOHN W. BYERS. Dreenagh House, Lower-crescent, Belfast, Dec. llth, 1897. *,* The " plenumsystem of ventilation as applied to hospitals was fully described in an article in THE LANCET of May llth, 1895, p. 1203.-ED. L.
which he had been treated for some months with all the THE RESULT OF THE ADOPTION OF usual remedies, but without success. He was a spare looking All his organs man with an anxious, worn expression. HOLMGREN’S TEST BY THE BOARD appeared to be healthy. His urine was natural, his temperaOF TRADE. ture normal. On inquiring minutely into his history I found To the Editors of THE LANCET. that ten years previously he had been in the United States of America and had worked as a labourer in a district in SIRS,-According to the reports which have been issued which malaria was somewhat prevalent, though he himself Holmgren’s test has been used for two years and four had never had an attack. For the last ten years of months by the Marine Department of the Board of Trade. his life he had lived in England, during which time he Let us consider whether there has been any improvement in had not had any symptoms of malaria and had been in the results obtained since the adoption of the test. The good health until a few months before I saw him when percentages of failures in colour vision since 1885 are as vomiting without any apparent reason commenced and had follows :-1885-86, 1.39; 1886-87, 1 ’12; 1887-88, 1 ’01 ; continued off and on ever since, entirely preventing him from 1888-89, 1-03 ; 1889-90, 0 94; 1890-91, 1-19 ; 1891-92, 0-82; working and making his life a misery. There were no other 1892-93, 1-17; from June, 1893, to August, 1894, 1’27; from September, 1894, to December. 1895, 1’37; and facts in his past history bearing on his complaint. Taking this somewhat slender history into account together from January to December, 1896. 1’02. Holmgren’s test One of the chief with the fact that all ordinary remedies for his symptom J has been used since September, 1894.