THE LATE CHARLES CLAY OF MANCHESTER.

838 in all importation of disease from remote in these figures the large sums in the aggregate earned that the conditions which favour diffusion abroad by pupil assistants.) Multiplying these figures together, one - are approximately the same amidst which the infection had arrives at the good round sum of P,.50, 000 annually lost to the been originally engendered." In view of the present fashion I members of the profession. This does not include the large believe it is physiological heresy to hint at a de maovo origin sums diverted from the pockets of highly educated and legally of aught else than the primordial unicellular organisni. which qualified men by other unqualified persons-quacks, bone-is idolised as the mother of us all ; and if the cause of setters, prescribing chemists, et h.oc genus omne The sum of cholera be particulate, bacteriology will deny to the disease £50,000 capitalised represents nearly £1,700,000 at 3 per origin other than from a pre-existent case. Still it is none cent. interest. Surely this £1,700,000 is a question worthy .the less true that predisposition, both communal and indi- of the attention of the General Medical Council. To men vidual, would appear to be at least as important in deter- struggling for mere bread-and-butter the minor details of ,mining attack as the presence of the virus itself. You educatioh pale into insignificance when the matter is looked say: "Life assurances are but little affected by cholera; at in this light. We should not hear so much of "sixpenny - the class of people who assure their lives do not commonly doctors " and medical aid associations and other undie of the disease, and if we could only place the poorer dignified struggles for existence if the General Medical classes of the population in the same position as those who Council fulfilled the objects of its existence more completely. .effect life assurances they would probably obtain a similar I would suggest that a limit should be set to the time a immunity." In this, as in so many public health questions, man might act as an " unqualified assistant," It would not It interfere with the system of apprenticeship to a general a solution appears to offer itself by way of social reform. is the old question of Dives and Lazarus, and if the latter’s practitioner if it were made illegal to act in any way as an -approaches upon higher grounds are repulsed he can yet unqualified assistant (say) five or six years after registration retaliate by contagion and infection. Means directed against as a medical student unless by special consent of the Council. This correspondence will not have been in vain if it induces bacilli-quarantine, notification and protective inoculationsmay be good, but sanitary reforms which shall make the soil even one member of the most powerful and influential body in aafe against invasion by raising the standard of comfort and the profession to ponder over these things and to realise the thestandard of health are better. meaning of at least £50,000 a year divided amongst his younger and poorer colleagues who have honestly and industriously I am, Sirs, yours faithfully, earned their positions in accordance with the law of tne land. W. J. COLLINS. Is it too much to hope that this important subject may be referred to a business-like committee at the next meeting of THE OVERCROWDING OF THE PROFESSION the General Medical Council ? I am, Sirs, yours faithfully, AND THE GENERAL MEDICAL COUNCIL. BERTRAM THORNTON. To the Editors of THE LANCET. SIRS,-If our minds had not been dulled by reading week :.after week editorial articles and letters in the medical THE LATE CHARLES CLAY OF press calling attention to the various forms of unqualified MANCHESTER. practice and quackery, we might be surprised that there To the Editors of THE LANCET. should be any need for such a letter as that of Dr. Batewhich appeared in THE man on unqualified assistants, SIRS,-In your brief notice in THE LANCET of Sept, 23rd LANCET of Sept. 16th. An eminent statesman has recently of the career of the late Mr. Charles Clay it is stated that preached the doctrine of pegging away." It is eminently "he regarded himself as being the originator of operation by necessary to peg away at this question if the existing abuses the ’large incision’" and that "his claim to be considered the The General Medical Council deserves I ’ Father of Ovariotomy ’ in England seems to be wellfounded."" are to be remedied. the gratitude and respect of all for its endeavours to raise In the sense of Paley, that "he alone discovers who proves," the standard of education, but it has not yet succeeded he is largely entitled to this distinction. It would be out of in protecting the public and the profession against half- place to trace minutely the history of ovariotomy. It was . educated men and downright impostors. This latter function suggested by William Hunter ; its practicability and the mode .is, after all, the primary object of its existence. At the of performing it were taught by John Bell ; and it was first present moment a person has only to refrain from qualify- practised, and that successfully, by an American-viz., Dr. ing himself and he can snap his fingers at the authorities. McDowell, a pupil of John Bell. Mr. Clay’s first operation The Society of Apothecaries is the only institution, except the was done in 1842, but I believe it had been done before this coroner’s jury, to act as a practical safeguard to protect public date in London. When a pupil and demonstrator of anatomy and professional interests. The famous infamous" clause to the late Samuel Lane I remember that he performed the can only be used on rare occasions and is useless against operation. This was earlier than 1842 One tumour removed the real offenders outside the profession. Half a century ago by him was preserved in the museum at Grosvenor- the Incorporated Law Society set us an example which it is place. Probably it was removed to St. Mary’s Hospital -not to our credit as business men to have neglected so long. when he took his museum there. Of course it would be superWhy has the General Medical Council refrained from any fluous at the present day to preserve ordinary specimens of .attempt to have the law amended ?‘! Germany, France and this kind ; but this particular tumour, being one of the firstother countries are far in advance of us in the laws regulating if not the first-example of a new operation, would possess ,medical practice. The apparent hopelessness of influencing exceptional historical as well as scientific value. This was ’-this Council probably prevents men from troubling themselves not Samuel Lane’s only case. He regarded the operation as in the matter or the columns of THE LANCET would be a great gain to surgery. If he did not often repeat it, it was invaded from all quarters. because he could not bring himself to cultivate any branch of It is easy to realise that the question of amending the the art that might lead him into specialism. This characteristic law in the desired direction is a complicated one and far- of the man was strikingly shown in his refusal to continue the reaching in its effects, but this is no reason for not making splendid course of lectures on syphilis which were begun in an attempt to solve the difficulty. Statistics referring to THE LANCET about the same time. He was a surgeon in the unqualified practitioners, quacks and others are unfortunately noblest sense. He did not work for fame or for money. -not easily available, but sufficient data could be obtained to I am, Sirs, yours faithfully, ,-make a case for the consideration of the Legislature. It is ROBERT BARNES. perhaps of no concern to laymen to note the pecuniary losses to the members of the profession, though our poorer and SURGERY OF THE AIR PASSAGES IN younger colleagues mayjustly consider matters from this point of view. It may assist members of the General Medical Council CHILDREN. to realise the gravity of the pecuniary issues at stake by To the Editors of THE LANCET. illustrating the question by reference to pounds sterling. In the absence of statistics it may not be an exaggeration to SIRs, -Permit me to make a few remarks on the second assume that in the United Kingdom there are as many as instalment in THE LANCET of Sept. 16th of the excellent 250 unqualified men in practice as professional unqualified address by Mr. Bernard Pitts on the Surgery of the Air assistants and it may not be unreasonable to assume that Passages in Children. I observe that the lecturer refers to they on the average earn for their principals, directly or the presence of adenoid vegetations as a not infrequently indirectly, as much as ;E200 a year. (I am not including associated condition of difficult respiration in children and

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