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SIR WILLIAM BLIZARD.
550 the
possibility
of
infection, the problem becomes; the statutory precautions in selling poisons and in one or
Annotations. I
"Ne quid nimis."
THE ADMINISTRATION OF THE PHARMACY ACTS. .
THE
most satisfactory feature of the annual of the Registrar of the Pharmaceutical report Society, which was presented to the council at the February meeting, is that section of it which shows’ the numerical strength of pharmacy. The report issued a year ago revealed a falling off in the number of qualified persons, and for several years the growth of the Register had been very slow and the number of candidates for the qualifying examination disappointingly small. The outlook was, in fact, not altogether hopeful and there were some who prophesied that before long something drastic would have to be done to reinvigorate the pharmaceutical business. It is evident, however, from this year’s figures that the period of depression was only a passing phase, for the current Register of Chemists and Druggists contains 278 more names than last year’s, the total number of registered persons being 16,608. There has also been a substantial increase in the number of registered apprentices, which is a promising sign. The membership of the Pharmaceutical Society numbers nearly 8000, which is 1500 more than ten years ago. The report contains some interesting’ details concerning the work involved in the administration of the penal clauses of the Pharmacy This is a much heavier task than it Acts. was a few years ago, partly no doubt because of the obligations imposed upon the Society by the Poisons and Pharmacy Act, 1908. Under this Act at new class of poison-seller was licensed to deal in1 agricultural and horticultural poisons, and it iss required that the certificate of qualification of the3 chemist by whom a pharmacy is conducted shall be3 exhibited in every shop. Last year over 4000 shops were inspected with a view to ascertaining if the certificate were duly exhibited, and as no statementt is made to the contrary it is probably correct to) 1 assume that on the whole the provision, which certainly tends to facilitate the administration1 of the Acts, is properly observed. In itss efforts to check the sale of poisons by unqualified persons and other irregular practicess the Society’s law department investigated lastt cases of alleged infringement, orr year 1619 than in the 250 more previous year. In1 306 cases-as against 238 in 1912-it was foundI necessary to institute proceedings against the3 offenders, and it is worthy of note that the council1 did not lose a single case. As in previous years, the3 class of offence which seems to be most common1 among unqualified persons is the dual one off keeping open shops for the sale of poisons and1 selling poisons, practices which are contrary to Section 15 of the Pharmacy Act, 1868, the penalty for each offence being £5, recoverable through a county court. In some cases proceedings were3 instituted against persons who had failed to observe3 ,
: ; -
’ ,
-
.
i
-
against non-registered persons who had used other of the pharmaceutical titles reserved for those who have passed the qualifying examination. In several instances the council commenced proagainst chemists who used the letters ceedings " M.P.S.," thereby implying that they were members of the society when such was not the case. In 117 cases the offenders against whom proceedings were instituted were unqualified drug store proprietors, and in 70 limited companies trading as chemists; there were also 39 chemists among the defendants, and the remainder included one ironmonger, one grocer, one pawnbroker, one oilman, one stationer, one confectioner, and one general storekeeper. In five cases of alleged infringement which had been reported it was found upon analysis that the poison asked for had been omitted from the articles purchased, and proceedings could not therefore be taken under the Pharmacy Acts; but in one of these cases a person who had sold a preparation labelled " paregoric" (which contained no opium) under the Merchandise was proceeded against Marks Act and convicted for selling an article to which a false trade description was applied. Another interesting feature of the report is the statement that the register of pharmacists who are superintendents of joint stock companies trading as chemists contains 605 names, an increase of nearly 150 on the previous register. Since the Insurance Act came into operation there has been a rapid growth in the number of limited companies formed to carry on the business of pharmaceutical chemists, and hence the increase in the number of It is names in the register of superintendents. impossible to form an estimate from these figures of the number of chemists’ shops under the control of the companies, as some of them have many branches, but it is obvious that company trading is becoming a more and more important factor in others
rather of deliberately regulating the age at; which measles shall occur than of attempting to prevent it altogether. The possibility of vaccination against measles was tentatively suggested, but not’ received encouragingly. one
pharmacy.
____
SIR WILLIAM
BLIZARD.
THE contrast between the present and the past a century ago is exemplified in nothing more strongly than in the manners of the medical profession then and now. In the early part of the last century pompousness verging on absurdity characterised the official leaders of the profession both in their acts and speeches, while a biting sarcasm, sometimes quite witty and sometimes laboured to futility, which to-day would lead to libel actions, was prominent in the medical press. Official demeanour found its great representative in Sir William Blizard, of the London Hospital, who at the age of 70 or so, was Master of the English College of Surgeons : humorous invective flourished in the leading articles of THE LANCET. When at a still more advanced age Blizard was President of the College in 1824, an article appeared in these columns headed " The Foreign Journals, and Sir W. Blizard’s Horror of Hats," a modern reproduction of which would be quite outside our decorous range to-day. After paying a very qualified compliment to Abernethy, whom he accuses of swearing profanely, and a very warm compliment to Sir Astley Cooper, the writer ranges down the catalogue of prominent contemporary surgeons until he comes to Sir William Blizard, whose peculiarity it seems to have been to preface every the Members ceremony at the College by asking " Weremember an present to take off their hats. observation of another ornament of the profession,
of
551
Pepys, that if he had a failing in life itadmission to 100, and she was readily delivered, overweening passion for chicken broth.with the aid of instruments, of a fully developed Sir William’s besetting propensity seems to be a !stillborn child. The appearance of the patient was passion for desiring the Members of the College of very striking, the curves of the neck being almost Surgeons to take off their hats !/ Let him take a obliterated by the swelling, which gave her a curious lesson from an anecdote of the ancestor of the frog-like aspect. Dr. Gilbert at first ascribed this to Prince de Levi." This ancestor, the article con- cedema from straining or from nephritis threatening tinues, is represented in a pedigree from the Flood eclampsia; but examination of the chest gave the downwards as standing next the Virgin Mary, from key to the mystery, for crepitant sounds were heard whose mouth a scroll issues inscribed with the everywhere until obliterated by firm pressure with legend, " Mon cousin, mettez le chapeau." Sir the stethoscope. This crepitancy was traceable William’s punctiliousness in the matter of hats was over the whole of the face and neck, even into the evidently xegarded as absurd by a generation that eyelids and lobes of the ears, and downwards as far not only in Parliament, but in many places of assem- as the level of the nipples and to the inferior angles blage kept on its hat partly to avoid draughts, partly of the scapulae. It appeared earlier and extended also to assert the independence of free-born further on the right side than on the left. There Englishmen. To us it would appear strange to was some respiratory distress with frequent cough see a learned assembly hat on head. Quite in the lasting two days after delivery, but examination of the chest revealed no evidences of pneumothorax manner of a past age was Blizard’s stately procedure after the judicial hangings of the time. or other pulmonary lesion. The emphysematous The College owned a house in Cock-lane, whither areas were slightly tender, probably from distension " the surgeons’ mob," so often referred to in the of the skin. It appears from monographs of writers Newgate Calemdclr, were in the habit of bringing who have collected records of cases, numbering over the corpses of criminals, newly hanged at Newgate. a hundred altogether, that the condition owes its Sir William Blizard, when President of the College origin to rupture of air vesicles at the’root of the of Surgeons, we learn from Dr. Norman Moore, lung, the air escaping beneath the visceral pleura Sir Lucas
was
an
attended at this house in full Court dress to receive the bodies from the hangman; and the contrast between the President’s elaborate costume and formal manner and the surly shabbiness of the executioner has been described by Professor Owen, who witnessed the scene, as ghastly but almost ludicrous. Owen’s father-in-law, William Clift, Hunter’s famous assistant, and Conservator of the Hunterian Museum of the College, also describes these scenes, and has left to posterity, in the College library, a number of curious water-colour sketches of the hanged subjects. During many years at the close of his long life Blizard used to return to his country house at Brixton, after the College examinations were over, well armed with pistol and hanger. Guthrie, the sardonic army surgeon, who was twice President of the College, one day found the sword in the secretary’s office, and remarked to Sir William that it did not appear to be often drawn and must be getting rusty. Whereupon, the ancient President flourished the sword and cried " " Well out, I am ready to face the devil with it." then, Sir William," came the droll answer, " in that case I think you should certainly have it put in your coffin." At his advanced time of life Sir William Blizard had begun to fail as an operator, and it was even hinted that patients died because of his lack of skill. There was point in Guthrie’s sarcasm, which rings so strangely in our ears to-day, that " Wakley’s agitation for medical senile coroners was greatly owing to Blizard’s failures and the deaths therefrom resulting." The Wakley in question, the founder of THE LANCET, was coroner for Middlesex.
e
to the anterior mediastinum and thence to the neck and chest. Some writers, however, seem to think the lesion lies in the upper reaches of the respiratory tract. The patients are always primiparae, and there is a history of strong straining efforts during labour, favoured by resistance, as in the case of a large child or a small pelvis. Pain is sometimes noted in the region of the seventh or eighth rib. Recovery is the invariable rule. THE
RATIONAL USE OF TUBERCULIN.
IN view of the doubts which at present exist as to the value of tuberculin in the treatment of pulmonary and other forms of tuberculosis, a reasoned explanation of the basis of such a procedure by one of the leaders of tuberculin therapeutics deserves In the February issue of the careful study. Edinburgh Medical Journal Professor Edmond Beraneck, of Neuchatel, explains the ideas on which his method is founded. The means of defence against the tubercle bacillus may, he states, be divided into two parts-the antibacterial substances and the process of elimination of necrosed tissue and cicatrisation of the part. The cells respectively concerned may be called the " protective and the " reparative respectively, and rational treatment must be directed to stimulating especially the protective elements. This may be done by educating the cells by inoculation of attenuated or dead bacilli or their toxins. Now the bacilli growing in the body already produce toxins, and it is irrational merely to inject more of these; yet, according to the prevailing theory of the essential unity of all SUBCUTANEOUS EMPHYSEMA ORIGINATING tuberculins and tuberculous toxins, this is what is DURING PARTURITION. done by injecting tuberculin. Professor Beraneck Ia the Attsti-ala,,;ian Medical Gazette for Dec. 27th, holds that the poisons formed in the body differ 1913, Dr. H. Gilbert, of Adelaide, records an example from those obtained in culture media. In support of an unusual complication of labour, which, though of his view that such differences may exist he alarming to the patient, is of little prognostic shows that the toxins present in his broth cultures import. His patient, a primipara, aged 22, was of the bacilli are soluble in water, whereas those admitted to hospital after being in labour almost which he extracts with orthophosphoric acid from 48 hours. Six hours after her admission he was the bodies of the bacteria are not. The latter are called to the hospital because the pains were going precipitated by neutralising their solution while off and the patient’s face and neck were swelling up the former are not, and a precipitate forms on rapidly. The pulse-rate had risen from 88 on mixing the two solutions. The essential points
injured
.
possibility
of
infection, the problem becomes; the statutory precautions in selling poisons and in one or
Annotations. I
"Ne quid nimis."
THE ADMINISTRATION OF THE PHARMACY ACTS. .
THE
most satisfactory feature of the annual of the Registrar of the Pharmaceutical report Society, which was presented to the council at the February meeting, is that section of it which shows’ the numerical strength of pharmacy. The report issued a year ago revealed a falling off in the number of qualified persons, and for several years the growth of the Register had been very slow and the number of candidates for the qualifying examination disappointingly small. The outlook was, in fact, not altogether hopeful and there were some who prophesied that before long something drastic would have to be done to reinvigorate the pharmaceutical business. It is evident, however, from this year’s figures that the period of depression was only a passing phase, for the current Register of Chemists and Druggists contains 278 more names than last year’s, the total number of registered persons being 16,608. There has also been a substantial increase in the number of registered apprentices, which is a promising sign. The membership of the Pharmaceutical Society numbers nearly 8000, which is 1500 more than ten years ago. The report contains some interesting’ details concerning the work involved in the administration of the penal clauses of the Pharmacy This is a much heavier task than it Acts. was a few years ago, partly no doubt because of the obligations imposed upon the Society by the Poisons and Pharmacy Act, 1908. Under this Act at new class of poison-seller was licensed to deal in1 agricultural and horticultural poisons, and it iss required that the certificate of qualification of the3 chemist by whom a pharmacy is conducted shall be3 exhibited in every shop. Last year over 4000 shops were inspected with a view to ascertaining if the certificate were duly exhibited, and as no statementt is made to the contrary it is probably correct to) 1 assume that on the whole the provision, which certainly tends to facilitate the administration1 of the Acts, is properly observed. In itss efforts to check the sale of poisons by unqualified persons and other irregular practicess the Society’s law department investigated lastt cases of alleged infringement, orr year 1619 than in the 250 more previous year. In1 306 cases-as against 238 in 1912-it was foundI necessary to institute proceedings against the3 offenders, and it is worthy of note that the council1 did not lose a single case. As in previous years, the3 class of offence which seems to be most common1 among unqualified persons is the dual one off keeping open shops for the sale of poisons and1 selling poisons, practices which are contrary to Section 15 of the Pharmacy Act, 1868, the penalty for each offence being £5, recoverable through a county court. In some cases proceedings were3 instituted against persons who had failed to observe3 ,
: ; -
’ ,
-
.
i
-
against non-registered persons who had used other of the pharmaceutical titles reserved for those who have passed the qualifying examination. In several instances the council commenced proagainst chemists who used the letters ceedings " M.P.S.," thereby implying that they were members of the society when such was not the case. In 117 cases the offenders against whom proceedings were instituted were unqualified drug store proprietors, and in 70 limited companies trading as chemists; there were also 39 chemists among the defendants, and the remainder included one ironmonger, one grocer, one pawnbroker, one oilman, one stationer, one confectioner, and one general storekeeper. In five cases of alleged infringement which had been reported it was found upon analysis that the poison asked for had been omitted from the articles purchased, and proceedings could not therefore be taken under the Pharmacy Acts; but in one of these cases a person who had sold a preparation labelled " paregoric" (which contained no opium) under the Merchandise was proceeded against Marks Act and convicted for selling an article to which a false trade description was applied. Another interesting feature of the report is the statement that the register of pharmacists who are superintendents of joint stock companies trading as chemists contains 605 names, an increase of nearly 150 on the previous register. Since the Insurance Act came into operation there has been a rapid growth in the number of limited companies formed to carry on the business of pharmaceutical chemists, and hence the increase in the number of It is names in the register of superintendents. impossible to form an estimate from these figures of the number of chemists’ shops under the control of the companies, as some of them have many branches, but it is obvious that company trading is becoming a more and more important factor in others
rather of deliberately regulating the age at; which measles shall occur than of attempting to prevent it altogether. The possibility of vaccination against measles was tentatively suggested, but not’ received encouragingly. one
pharmacy.
____
SIR WILLIAM
BLIZARD.
THE contrast between the present and the past a century ago is exemplified in nothing more strongly than in the manners of the medical profession then and now. In the early part of the last century pompousness verging on absurdity characterised the official leaders of the profession both in their acts and speeches, while a biting sarcasm, sometimes quite witty and sometimes laboured to futility, which to-day would lead to libel actions, was prominent in the medical press. Official demeanour found its great representative in Sir William Blizard, of the London Hospital, who at the age of 70 or so, was Master of the English College of Surgeons : humorous invective flourished in the leading articles of THE LANCET. When at a still more advanced age Blizard was President of the College in 1824, an article appeared in these columns headed " The Foreign Journals, and Sir W. Blizard’s Horror of Hats," a modern reproduction of which would be quite outside our decorous range to-day. After paying a very qualified compliment to Abernethy, whom he accuses of swearing profanely, and a very warm compliment to Sir Astley Cooper, the writer ranges down the catalogue of prominent contemporary surgeons until he comes to Sir William Blizard, whose peculiarity it seems to have been to preface every the Members ceremony at the College by asking " Weremember an present to take off their hats. observation of another ornament of the profession,
of
551
Pepys, that if he had a failing in life itadmission to 100, and she was readily delivered, overweening passion for chicken broth.with the aid of instruments, of a fully developed Sir William’s besetting propensity seems to be a !stillborn child. The appearance of the patient was passion for desiring the Members of the College of very striking, the curves of the neck being almost Surgeons to take off their hats !/ Let him take a obliterated by the swelling, which gave her a curious lesson from an anecdote of the ancestor of the frog-like aspect. Dr. Gilbert at first ascribed this to Prince de Levi." This ancestor, the article con- cedema from straining or from nephritis threatening tinues, is represented in a pedigree from the Flood eclampsia; but examination of the chest gave the downwards as standing next the Virgin Mary, from key to the mystery, for crepitant sounds were heard whose mouth a scroll issues inscribed with the everywhere until obliterated by firm pressure with legend, " Mon cousin, mettez le chapeau." Sir the stethoscope. This crepitancy was traceable William’s punctiliousness in the matter of hats was over the whole of the face and neck, even into the evidently xegarded as absurd by a generation that eyelids and lobes of the ears, and downwards as far not only in Parliament, but in many places of assem- as the level of the nipples and to the inferior angles blage kept on its hat partly to avoid draughts, partly of the scapulae. It appeared earlier and extended also to assert the independence of free-born further on the right side than on the left. There Englishmen. To us it would appear strange to was some respiratory distress with frequent cough see a learned assembly hat on head. Quite in the lasting two days after delivery, but examination of the chest revealed no evidences of pneumothorax manner of a past age was Blizard’s stately procedure after the judicial hangings of the time. or other pulmonary lesion. The emphysematous The College owned a house in Cock-lane, whither areas were slightly tender, probably from distension " the surgeons’ mob," so often referred to in the of the skin. It appears from monographs of writers Newgate Calemdclr, were in the habit of bringing who have collected records of cases, numbering over the corpses of criminals, newly hanged at Newgate. a hundred altogether, that the condition owes its Sir William Blizard, when President of the College origin to rupture of air vesicles at the’root of the of Surgeons, we learn from Dr. Norman Moore, lung, the air escaping beneath the visceral pleura Sir Lucas
was
an
attended at this house in full Court dress to receive the bodies from the hangman; and the contrast between the President’s elaborate costume and formal manner and the surly shabbiness of the executioner has been described by Professor Owen, who witnessed the scene, as ghastly but almost ludicrous. Owen’s father-in-law, William Clift, Hunter’s famous assistant, and Conservator of the Hunterian Museum of the College, also describes these scenes, and has left to posterity, in the College library, a number of curious water-colour sketches of the hanged subjects. During many years at the close of his long life Blizard used to return to his country house at Brixton, after the College examinations were over, well armed with pistol and hanger. Guthrie, the sardonic army surgeon, who was twice President of the College, one day found the sword in the secretary’s office, and remarked to Sir William that it did not appear to be often drawn and must be getting rusty. Whereupon, the ancient President flourished the sword and cried " " Well out, I am ready to face the devil with it." then, Sir William," came the droll answer, " in that case I think you should certainly have it put in your coffin." At his advanced time of life Sir William Blizard had begun to fail as an operator, and it was even hinted that patients died because of his lack of skill. There was point in Guthrie’s sarcasm, which rings so strangely in our ears to-day, that " Wakley’s agitation for medical senile coroners was greatly owing to Blizard’s failures and the deaths therefrom resulting." The Wakley in question, the founder of THE LANCET, was coroner for Middlesex.
e
to the anterior mediastinum and thence to the neck and chest. Some writers, however, seem to think the lesion lies in the upper reaches of the respiratory tract. The patients are always primiparae, and there is a history of strong straining efforts during labour, favoured by resistance, as in the case of a large child or a small pelvis. Pain is sometimes noted in the region of the seventh or eighth rib. Recovery is the invariable rule. THE
RATIONAL USE OF TUBERCULIN.
IN view of the doubts which at present exist as to the value of tuberculin in the treatment of pulmonary and other forms of tuberculosis, a reasoned explanation of the basis of such a procedure by one of the leaders of tuberculin therapeutics deserves In the February issue of the careful study. Edinburgh Medical Journal Professor Edmond Beraneck, of Neuchatel, explains the ideas on which his method is founded. The means of defence against the tubercle bacillus may, he states, be divided into two parts-the antibacterial substances and the process of elimination of necrosed tissue and cicatrisation of the part. The cells respectively concerned may be called the " protective and the " reparative respectively, and rational treatment must be directed to stimulating especially the protective elements. This may be done by educating the cells by inoculation of attenuated or dead bacilli or their toxins. Now the bacilli growing in the body already produce toxins, and it is irrational merely to inject more of these; yet, according to the prevailing theory of the essential unity of all SUBCUTANEOUS EMPHYSEMA ORIGINATING tuberculins and tuberculous toxins, this is what is DURING PARTURITION. done by injecting tuberculin. Professor Beraneck Ia the Attsti-ala,,;ian Medical Gazette for Dec. 27th, holds that the poisons formed in the body differ 1913, Dr. H. Gilbert, of Adelaide, records an example from those obtained in culture media. In support of an unusual complication of labour, which, though of his view that such differences may exist he alarming to the patient, is of little prognostic shows that the toxins present in his broth cultures import. His patient, a primipara, aged 22, was of the bacilli are soluble in water, whereas those admitted to hospital after being in labour almost which he extracts with orthophosphoric acid from 48 hours. Six hours after her admission he was the bodies of the bacteria are not. The latter are called to the hospital because the pains were going precipitated by neutralising their solution while off and the patient’s face and neck were swelling up the former are not, and a precipitate forms on rapidly. The pulse-rate had risen from 88 on mixing the two solutions. The essential points
injured
.