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THE HARDSHIPS AND RISKS OF THE MEDICAL PROFESSION AND THOSE ENGAGED IN THE TREATMENT OF BODILY AND MENTAL DISEASE.
1619
Correspondence. "
Audi alteram
partem."
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
Correspondence. "
Audi alteram
partem."
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