"THE ETHICAL POSITION OF THE MEDICAL PROFESSION."

THE ETHICAL POSITION OF THE MEDICAL PROFESSION. ’ It seems to us that the tendency of the reorganisation, on the whole, will be to simplify the working and increase the efficiency of all departments, including the medical, as part of the military machine. The principal medical officer of Her Ma j esty’a forces in India will be at the head of the military medical ser ices and in direct connexion with the supreme government, as he has long been in name if not in fact. According to recent articles in the Pioneer Mail on the proposed Indian army reorganisation the medical department will be reconstituted as follows :-"One surgeon-general of Her Majesty’s forces at army headquarters with secretary; four surgeons-general of armies, each with a secretary ; fourteen deputy-surgeons-general on the administrative staff of districts and four brigade-surgeons surplus to present establishment ; total, twenty-eight against twenty-nine." As regards patronage fcr the higher military appointments it will be shared, as at present, by the Home and Indian authorities.

121

Correspondence. "Audi alteram partem."

"THE ETHICAL POSITION

OF THE MEDICAL PROFESSION."

To the Editors of THE LANCET. SIRS,-I would crave your indulgence, your attention, and’ a little of your space. Recently there has been a good deal in the columns of THE LANCET with reference appearing to suggested improvements in the medical curriculum, overcrowding of the profession, and allied subjects. Your last pronouncement has reference to the recent Harveian oration. delivered by Dr. Pye-Smith at the Royal College of PhyEXAMINATIONS OF ARMY CANDIDATES. The Globe of the 10th inst. published some remarks on the sicians of London. In that article there is much that is above subject with which we imagine not a few medical admirable on "professional etiquette," but I desire to refer officers will agree. After some observations on the great more particularly to your second paragraph in it, where you value and practical utility of a knowledge of colloquial say that there are two or three ways in which the leaders of French and German to officers, apropos of the low maxks the medical profession and the Fellows of the Royal Colleges allotted to this subject at these examinations, our con- can greatly help to uphold the standard of professional conduct. Well, I am neither one of the "leaders " nor one of temporary urges as of even greater importance the application the "Fellows." but I have thought much on these subjects, of physical tests to army candidates. The question that I have something to say that may prove of and perhaps may confronts us at the present time is whether our examination scheme provides us with the best possible officers for the practical utility towards settling a question. On this matter I have had a definite thought for a long time, and the army. The possession of a strong physique and proved nearest approach to it I have seen in your columns or else-be the for exercise to would appear aptitude bodily among is in the second sentence of that second paragraph. A fair edu- where more essential qualifications for that calling. You the first and by far the most important " way to say " in cation is, any case, indispensable ; but the question the standard of professional conduct is by"raising still is whether we are not by our competitive system of uphold the standard of preliminary education in those applyhigher examination attracting an undue proportion of book-workers into the army.. Our contemporary evidently thinks we are, ing to be registered as medical students"; but even this is and that we do not give sufficient attention to the physical indefinite. To be practical we must be definite. Let me reduce your abstract statement to a concrete form and say, qualifications of army candidates. "Let it be compulsory that all ’those applying to be THE LATE SURGEON-COLONEL A. H. HILSON, as medical students’ shall first hold the degree of registered M.D. EDIN., C.1.E. B A. or M. A." We much regret to record the death of a distinguished The medical profession, in my opinion, will never be right member of the Indian Medical Service. Surgeon-Colonel until in this respect it is placed on a similar footing to the Hilson joined the service in 1857. He served with distinction legal. No man can simply apply to be registered as a law during the Indian Mutiny, and was Inspector-General of student-he must first be a B A. ; and in this way a higher Civil Hospitals, Bengal, during the latter part of his career. and more uniform standard of excellence is at once secured During the Mutiny Campaign he was present at engagements in that profession. The "weeds" are cut off at a stroke. at Sohunpore, Phoolpore, Belwa, Amora, and Judgespore, True, the strainer may not be fine enough in its mesh to keep where he was severely wounded. He also served in the out all coarse material, but only a very small proportion can Bhootan Expedition of 1865, and on his retirement from the pass through. This sifting process of course applies only to service received a reward for distinguished service. the intellectual, not to moral, characteristics ; hence the Our contemporary, the Broad Arro7v, says: It is rumoured expression, "There are black sheep in every flock." I that the appointment of Secretary to the Principal Medical remember one of my medical professors used to be known Officer in India, at Simla, held at present by Surgeon-Lieu- amongst us students as one who rather sneered at M.A.’& tenant-Colonel Exham, A.M.S., is to be abolished, the second who began their study of medicine in his particular branch, secretary, an Indian medical officer for native troops, taking but we used to think in return (and perhaps with our younger over the dual duties. conceit) that it was a case of "sour grapes " with him ; In THE LANCET of Jan. 6th we notified the appointment but, all the same, the M. A.’s, with few exceptions, succeeded of Surgeon-Colonel Walsh as Principal Medical Officer in in taking the highest places during their curriculum, and my Madras. This will involve the immediate return home of experience of some fifteen years’ pra.ctice shows me that as in the actual’ Surgeon-Colonel Davis, who can fulfil so short a period of a rule they keep their high places afterwards As things are, there is no question in my service on promotion that he was, we presume, considered battle of life. mind that there are many men in the medical proineligible for the post. It would be (or An examination for eligible surgeons desirous of qualifying fession who would be better out of it. for the rank of staff-surgeon in the Navy will be held at would have been) better for them and it would be better for their patients. They have mistaken their calling. The Haslar Hospital on Jan. 17th. advantage that would accrue from such a compulsory sifting would be incalculable. The overcrowding (which is so muchMEDICAL MAGISTRATES.—The Lord Chancellor complained of) would be done away with in the first place. has, on the recommendation of the Lord-Lieutenant, placed That in itself brings immediate bemfit to all concerned. The the name of William Job Collins, M.D. Lond., L C C., upon patients get a superior class of men to attend them ; the the Commission of the Peace for the county of Lcndon.-Mr. medical men themselves, being a priori men of higher culture. Francis Clowes, M.R C.S. Eng., L. S A., of Stalham, Norfolk, and breeding, are less likely to have a life of worry caused has been placed on the Commission of the Peace for the by friction (from jealousy and kindred reasons) with their county of Norfolk. professional brethren, and they receive better pecuniary remuneration for their work. THE COUNTESS OF DUFFERIN’S FUND. - The Another enormous advantage of having this superior class fifth annual report of the United Kingdom branch of this of men would be that in the course of time the whole fund, the objects held in view by the promoters of which art medical profession would be placed on the higher standwell-known to our readers, is not of so roseate a character in the eye of the public which is its rightful position. as might have been wished. The financial statement show: ing In your leading article on the funeral service over the mortal that the present subscriptions are insufficient to meet tht remains of the late Sir Andrew Clark, in the same number of It would appear that an income of al THE current expenses. " it is a LANCET, you refer to this very point in saying, least £1000 a year is required to carry on the work designec man science is to bulk the times that the of of beginning sign to be accomplished, whereas the fnnds at present available 1 amount to only £215. THE LANCET, Nov. 18th, 1893. ,

122

"EXCISION OF GUMMATA OF THE TESTICLE."

more largely in the public eye " ; and from this you naturally castrations are performed for simple neoplasms of the testicle, conclude that "if the nation thus does honour to the healer which might be dissected out as in the case I recorded. I am, Sirs, yours truly, dead, it needs must follow that the healer living and ARTHUR NEVE. working should be equally entitled to the respect and Mission Hospital, Kashmir, Dec. 12th, 1893. confidence of his fellow citizens." Of course it should follow ; and the public itself should be the first to recognise merit and to acknowledge that the class of men forming "CHLOROFORM IN NASAL GROWTHS." the medical profession were really worthy of and entitled to To the Editors of THE LANCET. respect and confidence. Unfortunately, in some parts of the world the tendency of the population as a whole is !, SIRS,-Dr. Holloway, in his note in the last issue of to regard a medical practitioner and a shopkeeper as on THE LANCET on Chloroform in Nasal Growths, surely It is not for me to say why this is so-whether rather limits himself to one set of operators, for most a level. it is owing to any peculiar matter-of-fact way the people certainly if he took a wider range he would find have of looking at things or to the fact that the medical surgeons who take a much longer time than he allows.

I can o ly s th

they have in their midst are not men to win Each may, perhaps, be a their respect and confidence. factor, although I am inclined to think, judging from my own experience, that the latter is the true fons et origo mali. Now, if anything could be done to rectify this state of matters it would be such a plan as I have ventured to - suggest. We secure at once a better class of men as medical practitioners, we gain the respect to which we are fairly entitled, but which the public has hitherto withheld, we benefit our patients by our greater skill in our art, and we benefit ourselves by lessening competition and friction (an immense gain). In concluding your leading article on Dr. Pye-Smith’s oration you say that " the sister profession of the law has set us a good example " in enforcing the great morals of its practice and increasing that concord of the legal profession which is so essential to its prosperity and its honour. I have ventured to suggest that it sets us a good example .also in its rules for the admission of its intending students. Until such a rule, however, is passed by those in authority in matters medical it is strictly incumbent on the Royal Colleges to use that disciplinary control on the exercise of which their privileges and their monopolies were originally made can- tingent-a control which you are careful to indicate has been .allowed to fall into desuetude. How, again, on this point is it with the legal profession? What machinery can the legal authorities not call into instant action if necessity arises ? What man of them all is safe if he commits an unprofessional act? Can his name not be immediately struck off the roll? Hence, ..even if for no higher motive, a member Jf the legal profession has to be exceedingly careful to do that which is right, not ’merely in his own eyes, but in the eyes of all in his profession. In medicine there is no such safeguard, or, if there is, it is surely in abeyance ; but my main object in this communication, as I have said, is to call attention to a definite plan having reference to the time before a man enters the medical profession, and it seems to me, judging from the tenour of public prints, that my idea is to the point and also timely. If it should meet your views and find its way into your columns, or you should think anything is to be made of the idea, it will be a great satisfaction to me to know that I have been the means of raising and upholding the status of the medical profession, and thereby benefiting it acd the public alike. I am. Sirs. yours trulv. GEORGE A. LEGGE. M.A., M.D., C.M. Somerset East, Cape of Good Hope, Dec. llth, 1893. *Our correspondent is surely in error as to the entrance of a student into the legal profession.-ED. L. men

"EXCISION OF GUMMATA OF THE TESTICLE." To the Editors of THE LANCET. SIRS,-With regard to the editorial comments upon a case .of excision of a tumour from the testicle, published in THE LANCET, Nov. 4th, if the description had been less abbreviated the necessity for the operation would have been apparent, for the two tumours dissected out of the body of the testicle were both full of pultaceous semi-fluid material. Perhaps the word "gumma " in this connexion is more open to doubtI can only say that the age and history of the patient pointed that way ; while the naked-eye characteristics were more those of softened subcutaneous gummata than of tuberculous ’cysts, of which I have had a large surgical experience in other parts of the body, though not in the testicles. But the special object in sending the case referred to was to show the
My experience as from thirty seconds

to the time for these operations is to thirty minutes (half an hour). The

cases can be done easily with gasalene or continued whiff of ether as in slightly prolonged dental operations ; the longer cases cannot be done with gas alone. If this be so-and as regards the length of time for the operation the surgeon can alone be responsible, and must be the best judge-what are we to administer to effectively anæsthetise the patient ? My fairly large experience is that ether, with the preliminary gas, should be given to the full anæsthetisation of the patient; then, by an ordinary Junker, with two or three drachms of chloroform, we can continue the anaesthesia for any length of time required by blowing into the mouth. I dare say this proceeding looks a little complicated, if not fussy ; but we have alone to consider the safety of our patient and must disregard anything that an on. looker may think. For myself I have not seen any untoward symptoms result from this method ; but I am most emphatic on the need of commencing with gas and ether. All opera. tions about the nose and pharynx are of the gravest nature, chiefly from the possibility of asphyxiation from hæmorrhage, and no one can undertake them with a light heart. I cannot help thinking that in some of the cases reported as "misadventure from chloroform " the death is not always due to the anaesthetic ; but unfortunately they appear as such in the lay journals, and hence it behoves us to have them fully reported in our own journals that they may be thoroughly and professionally discussed. This surely is the great value of our new Society of Anxsthetists, where we can all fully report, in the most open manner, our failures and I am, Sirs, yours truly, successes. GEO. H. BAILEY. Queen Anne.street, Jan. 8th, 1894.

shorter

with

a

" THE DETERMINATION OF SEX." To the Editors of THE LANCET.

SIRS,-This subject, again opened up by Mr. Andrew Wilson in your issue of Dec. 30th, 1893, is one of the greatest interest and importance ; and while his facts may be accepted, his theory, built upon them, requires careful investigation and discussion. I think there is no doubt now as to the general acceptance of the truth of the facts as laid down by Mr. Wilson, corroborated as they are by the strong array of cases that he has adduced. Similar results are seen to follow in the lower animals (mammalia), as dogs, cattle &c., where it is found that if impregnation takes place imme’ diately after the cessation of the "heat " (which corresponds to the human menstruation) the resulting offspring are more likely to be females than if the impregnation is delayed for some days. The interval of menstruation being shorter in the human mammal than in many of the others may stand in relation to a more rapid maturation of the ovum and, therefore, to a shorter time wherein the process that leads to a determination of sex is carried out. And now as to Mr. Wilson’s theory. Unfortunately we have to construct a theory partly on supposition, for one of the chief factorsis missing-i. e., we do not know the time of the extrusion of the ovum from the ovary (ovulation) in relation to menstruation. Imust here quote a few sentences from Mr. Wilson’s "II hold still that paper for the sake of reference. the ovum which is fertilised pre-menstrually, being a stronger and more vital one, tends towards the male side, and that the ovum which is fertilised post-menstrually, haring lost much of its vitality [the italics are mine], gets a bias towards the female side. Therefore, it needs a more vigorous ovum in is the quadruped [’’ mammal] to develop into a male than for that) a female I maintain is What required conception. given fertilisation, it is a question of vitality and nutrition on