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"FIBRINOUS COACULA IN THE HEART AND PULMONARY ARTERY"
659
they found the test inferior to nitric acid. And justly so; no doubt that the Government will be quite reasonable in but if it had simply occurred to them to use it as they did reconsidering this proposal. As to our correspondent’s the latter-that i, after Heller’s method, without allowing second point, the insufficiency of the penal clauses, we are admixture of the two fluids, they could never have come to advised by those capable of forming an opinion that the this conclusion. But simple things require to be discovered, clauses of the Medical Bill are the best that have ever and it is a remarkable fact that this method is even of more penal value with picric acid than it is with nitric acid. Indeed, been suggested. 2. The proposal to "put down quackery looks obvious and easy. From the statesman’s point of apart from this the former is valueless. Dr. Johnson must have been quite ignorant of the exis- view it is simply impossible. What he ought to do is to tence of my paper, and it is to be presumed his son was make all false titles and representations punishable. This besides the coincidence in our manner of equally so. Yet, is done in the Bill more effectually than under the existing using the test, there is another circumstance which appears tome somewhat singular. He states that he has used the laws. Let our correspondent ask himself what is possible test for about two years,l just about the time which has in Parliament, ani he will not bs dissatisfied with this porelapsed since my paper appeared. He further informs us tion of the Bill. But the penal clauses must not be relaxed. of it came from his after some exthat the "
suggestion periments performed
son,
and published by the latter in 1874. suppose that the suggestion was made at the same time, and if so it does seem singular that Dr. Johnson did not act upon it till seven years afrerwards, and that the time of his doing so should so closely coincide with the publication of my paper on the subject. It seems, from some jubilant remarks in the British Medical Joacrn.ccl of March 17th, in its summary of the events of the week, that this method of using picric acid solution, which I cannot but regard as mine, is now to be recognised as Dr. Johnson’s test. Be it so, my principal objectin the paper alluded to was to call attention to some facts and views which I considered of greater importance to chemists and the profession than the merits of the disputed test. I have still to complainn that these have attracted as little attention as my remarks on the picric acid test have apparently done. How far this is due to want of any intrinsic merit, or bow far to the fact that it was written by an obscure practitioner like myself, instead of emanating from some high authority in London, is not for me to decide.- I am, Sir, yours truly, ROBERT KIRK, M.D. Partick, Glasgow, March 26th, 1883.
Wemust
It is but
ju-)t, when making severe laws for regulating the acquisition of medical titles, to give these titles additional security and sanctity. As tothe third point, the College of Surgeons might do worse than take much of our correspondent’s advice to heart. We should scarcely like to see the College revert to the complete ignoring of medicine and mid wifery ; but the suggestion to make the Membership of the College a distinction in surgery, instead of a mere licence, is one evidently not held by ourselves alone. Our correspondent, we may add, is a Member of the College.-ED. L. "FIBRINOUS COACULA IN THE HEART AND PULMONARY ARTERY"
To the Editor of THE LANCE T. SIR,-Press of professional work having delayed my reading of the last two or three numbers of THE LANCET, I was much interested to-day, when looking for the first time at the copy for January 6t,h, to see Sir Joseph Fayrer’s article on the above subject. I was particularly struck by it, because THE NEW MEDICAL BILL. a few days ago (in fact since the appearance of the article), it To the Editor of THE LANCET. was my lot to observe an instance of sudden death resulting SIR,-I think the views expressed by you will meet with from this condition. A female infant, aged eight months, had general acceptance by most of the profession. With your been under my care, in a neighbouring village, suffering from permission, though, I would like very briefly to direct atten- debility and a large ulcer on the arm, said to have been the result of vaccination. The ulcer had contracted very much, tion to a few points. 1. It is proposed to give leave to the new Medical Council and was healing satisfactorily, when, on Monday, January to exact an annual fee for retaining our names on the 8th, I was hurriedly called to see the child, who, I was was dying. On reaching the house I found my patient Register. Now, whatever the advantages of such a plan in told, for breath. There was ’no pulae persecuring a perfect Register, it is unjust to those already livid andatgaspmg the wrist, and on auscultation with a binaural ceptible We have five as a life paid registered. guineas registration fee. To demand an additional annual payment now would stethoscope no action of the heart was audible. Some coarse be a fraud. Our five guineas would, in fact, have been râles were to be heard in the trachea and large bronchi. The obtained from us under false pretences. Moreover, the pro- child died two or three minutes after my arrival, continuing to the moment of her death to make inspiratory efforts. posed levy might pave the way for an annual tax, as in up From the symptoms, I imagined that a thrombus must have some other countries. 2. The penalties for illegal practice are insufficient. formed in the right side of the heart, and have become imin the orifice of the pulmonary artery; but, at the Quackery should be put down. Our own corporations have pacted been deficient in this, but now we are to have a new Bill, same time, in view of the existing uncertainty of the correctness of my surmise, and the sudden and unexpected we should put strong pressure on the Government to induce them to insert more stringent clauses prohibiting practice character of the death, I suggested to the parents the advisability of an autopsy, to clear up the matter. At the by unqualified persons, and prescribing by chemists. 3. If the College of Surgeons, instead of standing in the examination, which was not made till forty-eight hours after death, I found a very firm decolourised clot, filling the right way, were to abandon the position of a licensing body, but ventricle and closely entangled in the musculi papillares, raise the standard of its M. R. C. S. examination somewhat The in surgery, whilst ceasing to examine in medicine and mid- but not extending far into the pulmonary artery. and the left ventricle contained bloodless, appeared lungs it the of and increase its prestige membership wifery, might have an honourable career before it. The M. R. C. S. could only a small and very soft red clot. With the exception of then be registrable, as a higher diploma in surgery, and its the liver, which was much enlarged and had a slight nutmeg : further was noticed at all abnormal. possessor would then be, not merely as now, one just appearance, nothing I , am, Sir, yours faithfully, licensed to practise, but one who, having passed the State ALBERT E. MAY, L R.C.P. Lond. examination, had gone a step further, and taken an addiMoreton Hampstead, Jan. 20th, 1883. tional qualification in surgery. The College would gain by the change, as many would take it as a half-way step to the Fellowship. The new M.R.C.S. would, in fact, more NOTE ON THE TREATMENT OF INSANITY. nearly resemble the M.R.C.P., and the two Colleges occupy To the Editor of THE LANCET. similar positions.-I am, Sir, yours truly, ONE OF THE CROWD. second portion of his interesting communicaApril 7th, 1883. the SIR,-In on treatment of insanity, Dr. Campbell alludes to We tion the with our in the %* agree correspondent disapproving annual fee for registration, especially in the case of those the use of tonics. His remarks recall to my recollection a who have already paid a, large fee for registration. Wehave somewhat striking case which fell under my observation about three years ago, the main facts in connexion with 1 In his first paper (THE LANCET, Nov. 4th, 1883), he states that he which I shall state as briefly as possibly. The patient in had used the solution only for some months.
I
they found the test inferior to nitric acid. And justly so; no doubt that the Government will be quite reasonable in but if it had simply occurred to them to use it as they did reconsidering this proposal. As to our correspondent’s the latter-that i, after Heller’s method, without allowing second point, the insufficiency of the penal clauses, we are admixture of the two fluids, they could never have come to advised by those capable of forming an opinion that the this conclusion. But simple things require to be discovered, clauses of the Medical Bill are the best that have ever and it is a remarkable fact that this method is even of more penal value with picric acid than it is with nitric acid. Indeed, been suggested. 2. The proposal to "put down quackery looks obvious and easy. From the statesman’s point of apart from this the former is valueless. Dr. Johnson must have been quite ignorant of the exis- view it is simply impossible. What he ought to do is to tence of my paper, and it is to be presumed his son was make all false titles and representations punishable. This besides the coincidence in our manner of equally so. Yet, is done in the Bill more effectually than under the existing using the test, there is another circumstance which appears tome somewhat singular. He states that he has used the laws. Let our correspondent ask himself what is possible test for about two years,l just about the time which has in Parliament, ani he will not bs dissatisfied with this porelapsed since my paper appeared. He further informs us tion of the Bill. But the penal clauses must not be relaxed. of it came from his after some exthat the "
suggestion periments performed
son,
and published by the latter in 1874. suppose that the suggestion was made at the same time, and if so it does seem singular that Dr. Johnson did not act upon it till seven years afrerwards, and that the time of his doing so should so closely coincide with the publication of my paper on the subject. It seems, from some jubilant remarks in the British Medical Joacrn.ccl of March 17th, in its summary of the events of the week, that this method of using picric acid solution, which I cannot but regard as mine, is now to be recognised as Dr. Johnson’s test. Be it so, my principal objectin the paper alluded to was to call attention to some facts and views which I considered of greater importance to chemists and the profession than the merits of the disputed test. I have still to complainn that these have attracted as little attention as my remarks on the picric acid test have apparently done. How far this is due to want of any intrinsic merit, or bow far to the fact that it was written by an obscure practitioner like myself, instead of emanating from some high authority in London, is not for me to decide.- I am, Sir, yours truly, ROBERT KIRK, M.D. Partick, Glasgow, March 26th, 1883.
Wemust
It is but
ju-)t, when making severe laws for regulating the acquisition of medical titles, to give these titles additional security and sanctity. As tothe third point, the College of Surgeons might do worse than take much of our correspondent’s advice to heart. We should scarcely like to see the College revert to the complete ignoring of medicine and mid wifery ; but the suggestion to make the Membership of the College a distinction in surgery, instead of a mere licence, is one evidently not held by ourselves alone. Our correspondent, we may add, is a Member of the College.-ED. L. "FIBRINOUS COACULA IN THE HEART AND PULMONARY ARTERY"
To the Editor of THE LANCE T. SIR,-Press of professional work having delayed my reading of the last two or three numbers of THE LANCET, I was much interested to-day, when looking for the first time at the copy for January 6t,h, to see Sir Joseph Fayrer’s article on the above subject. I was particularly struck by it, because THE NEW MEDICAL BILL. a few days ago (in fact since the appearance of the article), it To the Editor of THE LANCET. was my lot to observe an instance of sudden death resulting SIR,-I think the views expressed by you will meet with from this condition. A female infant, aged eight months, had general acceptance by most of the profession. With your been under my care, in a neighbouring village, suffering from permission, though, I would like very briefly to direct atten- debility and a large ulcer on the arm, said to have been the result of vaccination. The ulcer had contracted very much, tion to a few points. 1. It is proposed to give leave to the new Medical Council and was healing satisfactorily, when, on Monday, January to exact an annual fee for retaining our names on the 8th, I was hurriedly called to see the child, who, I was was dying. On reaching the house I found my patient Register. Now, whatever the advantages of such a plan in told, for breath. There was ’no pulae persecuring a perfect Register, it is unjust to those already livid andatgaspmg the wrist, and on auscultation with a binaural ceptible We have five as a life paid registered. guineas registration fee. To demand an additional annual payment now would stethoscope no action of the heart was audible. Some coarse be a fraud. Our five guineas would, in fact, have been râles were to be heard in the trachea and large bronchi. The obtained from us under false pretences. Moreover, the pro- child died two or three minutes after my arrival, continuing to the moment of her death to make inspiratory efforts. posed levy might pave the way for an annual tax, as in up From the symptoms, I imagined that a thrombus must have some other countries. 2. The penalties for illegal practice are insufficient. formed in the right side of the heart, and have become imin the orifice of the pulmonary artery; but, at the Quackery should be put down. Our own corporations have pacted been deficient in this, but now we are to have a new Bill, same time, in view of the existing uncertainty of the correctness of my surmise, and the sudden and unexpected we should put strong pressure on the Government to induce them to insert more stringent clauses prohibiting practice character of the death, I suggested to the parents the advisability of an autopsy, to clear up the matter. At the by unqualified persons, and prescribing by chemists. 3. If the College of Surgeons, instead of standing in the examination, which was not made till forty-eight hours after death, I found a very firm decolourised clot, filling the right way, were to abandon the position of a licensing body, but ventricle and closely entangled in the musculi papillares, raise the standard of its M. R. C. S. examination somewhat The in surgery, whilst ceasing to examine in medicine and mid- but not extending far into the pulmonary artery. and the left ventricle contained bloodless, appeared lungs it the of and increase its prestige membership wifery, might have an honourable career before it. The M. R. C. S. could only a small and very soft red clot. With the exception of then be registrable, as a higher diploma in surgery, and its the liver, which was much enlarged and had a slight nutmeg : further was noticed at all abnormal. possessor would then be, not merely as now, one just appearance, nothing I , am, Sir, yours faithfully, licensed to practise, but one who, having passed the State ALBERT E. MAY, L R.C.P. Lond. examination, had gone a step further, and taken an addiMoreton Hampstead, Jan. 20th, 1883. tional qualification in surgery. The College would gain by the change, as many would take it as a half-way step to the Fellowship. The new M.R.C.S. would, in fact, more NOTE ON THE TREATMENT OF INSANITY. nearly resemble the M.R.C.P., and the two Colleges occupy To the Editor of THE LANCET. similar positions.-I am, Sir, yours truly, ONE OF THE CROWD. second portion of his interesting communicaApril 7th, 1883. the SIR,-In on treatment of insanity, Dr. Campbell alludes to We tion the with our in the %* agree correspondent disapproving annual fee for registration, especially in the case of those the use of tonics. His remarks recall to my recollection a who have already paid a, large fee for registration. Wehave somewhat striking case which fell under my observation about three years ago, the main facts in connexion with 1 In his first paper (THE LANCET, Nov. 4th, 1883), he states that he which I shall state as briefly as possibly. The patient in had used the solution only for some months.
I