- Email: [email protected]
THE LONDON MEDICAL REGISTRATION ASSOCIATION.
before a board of examiners appointed by the Lords held to be superior in rank and precedence to every officer under his command. Commissioners of the Admiralty. 10th. That such relative rank shall carry with it all prece3rd. That no Assistant-Surgeon shall be eligible for promotion to the rank of Surgeon until he shall have passed such ex- dence and advantages attaching to the rank with which it coramination as the Lords Commissioners of the Admiralty may responds, and shall regulate the choice of quarters, rates of require, and shall haveserved on full-pay with the commission lodging-money, servants, forage, fuel and light, or allowances of Assistant-Surgeon for five years, of which two, at least, shall in their stead, when medical officers of the Navy may be emhave been passed on board one of your Majesty’s sea-going ployed on shore on joint service with your Majesty’s Land
hygiene
ships.
4th. That no Surgeon shall be eligible for promotion to the rank of Deputy-Inspector-General of Hospitals and Fleets until he shall have served ten years in your Majesty’s Navy on full-pay, of which three, at least, must have been passed in one of your Majesty’s ships on some one or more foreign stations, with the rank of Surgeon. 5th. That no Deputy-Inspector-General of Hospitals and Fleets shall be eligible for promotion to the rank of InspectorGeneral until he shall have served five years at home, or three years abroad, in the rank of Deputy-Inspector-General. That in cases of emergency, however, or when the good of your Majesty’s service may render such alteration desirable, it shall be competent for the Lords Commissioners of the Admiralty to shorten the several periods of service above mentioned, in such manner as they shall deem fit and expedient. 6th. That the rates of full pay of the medical officers of your Majesty’s Navy shall, in future, be in accordance with the following schedule :FuLL-PAy.-Inspector-General of Hospitals and Fleets : after 30 years’ service on full pay, .62 5s.25 years, .62 5s.20 years, .62.* Deputy-Inspector-General of Hospitals and Fleets: 30 years, .61 14s. ; 25 years, ofllÛs.; 20 years, XI 8.* StaffSurgeon : 25 years, .615s.;20 years, .61 2s. Surgeon: 15 years, 18s. ; 10 years, 15,9.*Assistant-Surgeon: 10 years, 13s.; 5 years, 11s. 6d.; under 5 years, 10s. 7th. That every medical officer on the Active List, now on half-pay, and those who may be placed on it subsequently to the date of your Majesty’s Order in Council authorizing this proposal, shall be allowed the half-pay to which his period of service on full-pay shall entitle him, according to the following schedule :HALF-PAY.-Inspector-General of Hospitals and Fleets: after 30 years’ service on full-pay, .6117s. 6d. ; after 25 years, .6113s. 6cl,.after 20 years, ofl10s.* Deputy-InspectorGeneral of Hospitals and Fleets: after 30 years, .615s. 6d.; ‘ 25 years, ofl2s. 6d.;20 years..61Is.* Staff-Surgeon : after 25 years, 18s. 6d.; 20 years, 16s. 6d. Surgeon: after 15 years, 13s. 6d.10 years, 11s.** Assistant-Surgeon: after 10 years, 10s.; 5 years, 8s. ; under 5 years, 6s. 8th. That, with a view to maintain the efficiency of the service, all medical officers of the ranks of Staff-Surgeon and Assistant-Surgeon shall be placed on the Retired List when they shall have attained the age of sixty years; Deputy Inspectors-General shall be placed on such Retired List when they shall have attained the age of sixty-five, and InspectorsGeneral when they shall have attained the age of seventy years. Officers thus superannuated shall receive the rates of half-pay mentioned in the preceding schedule. 9th. That the relative rank of the medical officers of your Majesty’s Navy shall be similar to that conferred upon the medical officers of the Army, and shall be as follows : An Assistant-Surgeon shall rank as a Lieutenant in the Army, according to the date of his commission; and after six years’ service on full-pay, as a Captain in the Army, according to the date of the completion of such service. A Surgeon shall rank as Major in the Army, according to the date of his commission; and a Staff-Surgeon as LieutenantColonel, but junior of that rank. A Deputy Inspector-General of Hospitals and Fleets shall rank as Lieutenant-Colonel, according to the date of his commission ; and after five years’ service on full-pay as Deputy Inspector-General, shall rank as Colonel, according to the date of completion of such service. An Inspector-General of Hospitals and Fleets shall rank as Brigadier-General, according to the date of his commission; and after three years’ service on full-pay as Inspector-General, shall rank as Major-General, according to the date of completion of such service. Provided always, that no naval medical officer, while borne on the books of one of her Majesty’s ships, or employed on establishments on shore, shall be deemed superior in rank to the officer appointed to command such ship or establishment; but such commanding officer shall, under all circumstances, be *
Or
on
eompleted.
promotion, should these periods
of service not have been
already
Forces ; but that medical omcers serving in the Fleet shall, notwithstanding the relativerank thus conferred upon them,
in all such details, and also in all matters relating to the duties of the Fleet, and the discipline and interior economy of your Majesty’s ships, be subject, as heretofore, to the authority of any executive officer of the military branch while on duty, under the general regulations which may from time to time be prescribed by the Lord High Admiral, or the Commissioners for executing the office of Lord High Admiral; and that medical officers shall share prize money according to the proclamation or proclamations which may be in force for the time being, for regulating the distribution of the proceeds of prizes in the
Royal Navy. llth. That medical officers shall be entitled to the same allowances, on account of wounds and injuries received in action, as combatant officers holding the same relative ranks. 12th. That the families of medical officers shall in like manbe entitled to the same allowances as granted to the families of combatant officers holding the same relative ranks. 13th. That medical office rs shall be held entitled to the same honours as other officers of the Royal Navy of equal relative rank.* 14th. That a medical officer retiring after a full-pay service of twenty-five years, may, in cases of distinguished service, receive a step of honorary rank, but withoub increase of halfpay. 15th. That good-service pensions shall be awarded to the most meritorious medical officers of the Royal Navy, under such regulations as shall from time to time be determined upon, on the recommendation of the Lord High Admiral, or the Commissioners for executing that office. 16th. That four of the most meritorious medical officers of the Royal Navy shall be named Honorary Physicians, and four Honorary Surgeons to your Majesty. We do, therefore, most humbly submit that your Majesty will be graciously pleased, by your Order in Council, to grant us the necessary authority for carrying the foregoing regulations into effect; the Lords Commissioners of your Majesty’s Treasury having signified their concurrence. Her Majesty having taken the said Memorial into consideration, was pleased, by and with the advice of her Privy Council, to approve of what is therein proposed; and the Right Honourable the Lords Commissioners of the Admiralty are to give the necessary directions herein accordingly. BATHPBST. ’WM. L. BATHURST. WM. ner
THE LONDON MEDICAL REGISTRATION ASSOCIATION. PUBLIC MEETING OF MEDICAL PRACTITIONERS IN ST. HANOVER SQUARE.
GEORGE’S,
THE seventh of the public meetings of the profession convened by this Association in different quarters of the Metropolis took place on Wednesday evening, May 25th, at the rooms of the Medical Society of London, which had been courteously granted by the Council of that body to the Association for that purpose. Shortly after eight o’clock, Mr. Lavies, V.P.y proposed that William Fergusson, Esq., F. R. S. (one of the vice-presidents of the Association), be invited to take the chair. The motion was seconded by Mr. Bottomley, the treasurer of the Association, and carried unanimously. Mr. Fergusson immediately occupied the chair, and after the advertisement convening the meeting had been read by Dr. Ladd, The CHAIRMAN opened the proceedings by observing that and history all present were doubtless familiar with the of the Association, which was, as it were, the embodiment of the Bill which had been lately rendered an Act by the Legislature. There was, indeed, an official body created by the Act; but the true spirit of the enactment was one vested in associations of the profession themselves, established to aid
origin
* This clause does not extend to the compliments to be paid by Garrison or Regimental Guards, as laid down in pages 29 and 30 of your Majesty’s Regulations for the Army, nor to corresponding honours paid on board your lktaiestv’s sWns.
569
and assist in carrying out its provisions. The Act had been often ref’.rredto as very imperfect, but we must remember that this was the drawback of all Acts of Parliament, and we must not expect perfection in anything at the outset. Many in the room were old enough to recollect after what a struggle the great Reform Bill was carried. Whilst some thought it objectionable, others who advocated it considered it a tinal measure ; yet it was curious that the same parties. did not now consider it so. (Hear, hear.) The same thing must happen with Medical Reform. " When I look," said Mr. Fergusson, " on the struggles of Medical Reform, I am astonished that we have now such an Act to speak of. Some such Act as that which we have was a continual topic; but it was constantly shelved in Parliament, and I was brought to think there was to be no such enactment, and, like most others of my brethren, was taken by surprise when I found that it had really passed. The general feeling of the profession is, that the Act, with all its defects, is to be received with pleasure; a large number have so received it, and especially the members of this Association. The Act must result in great good to the profession. The Registrar under it has been subjected to great difficulty. One of the main duties of this Association has been to assist the Registrar. We desire to see our names on the Register separated from dishonourable ones. There is no point on which there has been such unity of opinion as on the subject of registration. The object of those who have met this evening is to assist the Registrar, and therefore the Government, when in a difficulty, by preventing those that unjustly invade our rights from also defrauding the public. I am pleased that the profession have got the Act: it is the first demonstration that the Government has made of our recognition as a body; and it is for us to show our gratitude to the Government, and to provethat weare prepared to do of our own good will that which we have so often asked the Government to do for us. The want of unity has been hitherto the bane of our bodypolitic. It has been difficult in the extreme to insure co-operation, when so many hostile influences have been at work. The Secretary of State said, longago, to the profession,Show that are your own you put before us what proves that you have unanimity, and we will pass a Bill at once.’ This has been at length done, and further improvements will be admitted. [The Chairman added, with great force and earnestness,] One great reproach to us we havenow the means of removing : Me can get 1"id of bad company. It is painful to have to refer to examples of this, but at present the case is before the public, as will be shown by the Report of this Association, now to be read to you." The Chairman then called upon Dr. LADD, the Honorary Secretary, who read the "Report of the Proceedings of the London Medical Registration Association from its Formation to the Present Time,"after which, Mr. GANT moved, and Dr. HAWARD, of Harley-street, seconded, the first resolution, in acquiescence of the principles by which the Association had been guided. This and the succeeding resolutions were similar to those carried at the public meeting in St. Marylebone and other previous meetings, (and which were published in THE LANCET of May 21st, pp. 520-1.) They were all, as on former occasions, passed unanimously. Dr. MERYON, of Clarges-street, moved, and Dr. FRASER, of Grosvenor-street, seconded, the next resolution, which was to the effect that the meeting pledged itself to use every exertion to augment the number of members of the Association. Mr. C. CLARK, of Notting-hill, remarked that the Association had three main objects-lst, to prevent improper persons getting their names on the Register; 2ndly, to suppress illegal practice; and 3rdly, to watch the working of the new Medical Act. He urged either an alteration in, or addition to, the " name of the Association, to the effect of entitling it an Association for the Suppression of Quackery."" This suggestion, however, did not meet with any ardent
yourselves
friends,
support.
Dr. KIRBY stated, as a member of the Committee of Obserthat it was the intention of the Committee, as soon as the Register was issued, to publish such corrections of it as might be found necessary in the medical journals. They had much information in their possession for the purpose. Mr. SERCOMB moved, and Mr. HARVEY, of Soho-square, seconded, the third resolution, which recognised the importance of submitting to the Committee of the Association all possible information concerning persons practising medicine illegally. Dr. O’CONNOR, who spoke to this motion, eulogized the conduct of Mr. Secretary Walpole whilst the Medical Bill was before Parliament, and the conflicting interests of twenty-two examining bodies had to be considered; and he spoke of the ultimate object of medical reform as being, that practitioners of
vation,
570
medicine and surgery, which were "one and indivisable,’’ should enter at one portal. Mr. iLLix&woRTH, of Arlington-street, Piccadilly, proposed the fourth resolution, which expressed satisfaction at the successful efforts of the Association hitherto for the putting down quacks, and asserted that it was highly desirable that the means of the Association for similar purposes should be enlarged by liberal contributions to its " Prosecution Fund." He remarked that he hoped the proprietors of such unseemly exhibitions as Kahn’s and others would be excluded from the Register. Hedeprecated changing the name of the Association, as on various grounds an injudicious proceeding. Dr. WiLLls, of Kensington, seconded the motion, and observed, that although the Bennett tribe had been put down, many other confederacies existed, to be similarly treated. The Medical Council, like other corporations, could not and would not act towards this end as would an Association such as the present; and he urged the necessity of subscribing to both the "general" and the "prosecution" funds, and inducing others to do so. Dr. KIRBY added his pleadings to those of Dr. Willis for the money support of the Association. The profession must know that if they do not come forward and help this body with substantial means to carry on its objects, it would be crippled in its efforts. The proceedings of the Association had been conducted with the strictest regard to economy, and much quackery had been exposed by its efforts. Amongst other instances, he mentioned one of a quack who had been the pest of the practitioners in Hereford, yet who, on receipt of one of the " warning letters"from the hon. secretary, had promptly decamped. The profession had no conception of the amount of quackery that existed, or of the enormous fees which were collected by the quacks, and which were really astounding. Mr. LAVIES, a Vice-President of the Association, pronounced an eulogy on the " Committee of Observation." The amount of work they had had before them no one could understand who had not, like himself, attended most of their meetings. He recommended that no change should be made in the name of the Association. He proposed a vote of thanks to Mr. Fergusson for his liberality in devoting his time and attention to aid of his profession by taking the chair that evening; and he congratulated the assemblage on the proof which the Chair. man had afforded in his opening address that he had come to the meeting fully impressed with the objects of the Association. Mr. FEttGt7sso, in acknowledging the vote, said that he appeared amongst them as an active member of the Association, and if he could induce others to do the same, he should be rejoiced. It is a feature in the proceedings of our Association, that its exertions are as much for the benefit of the public as for ourselves, and the public, if rightly informed, would see the matter in that light. Looking at ours as one of the noblest and grandest of professions, the public ought to recollect that we are bound to qualify ourselves to do our duty to the community at large, and they should at the same time see that the interests of qualified practitioners are cared for. As to the duties of the Medical Council in this respect, he was disposed to yield to that body every indulgence. Amongst their duties, they had the education of the younger members of the profession to provide for, and, as Dr. O’Connor had observed, they had much to do with the twenty-two Examining Boards, over which they would now exercise a control. One of the best functions of the Association had yet to be developed: it might call upon the Council to oblige some of these consti. tuted bodies to do their duty, and even to prosecute in certain cases, which they might do at the instance of the Association. Even now a step in this direction might be taken by the Executive Committee of this Association. In going along Oxford-street, one might see a place termed the Royal Institution of Anatomy. In this country, there is some considerable difficulty in obtaining the privilege to use the title " Royal.’’ The Colleges of Surgeons of England and Ireland enjoy such a designation, and as guiding the education of surgeons and guardians of anatomical and surgical science, he considered that the Council of the Royal College of Surgeons of England should be applied to, in order that they might ascertain if any privilege to use the title of "Royal" had been granted to the so-called institution in question, which was merely a private speculation. (The Chairman delivered these sentiments with great energy.) Kahn’s exhibition had not assumed the title "Royal," but lectures of a prurient and objectionable nature were delivered there; and is it not within the province of this Association to call the attention of the licensing magistrates to that and other places of resort having an immoral tendency t
(Cheers.)
A vote of thanks to the Council of the Medical Society of closed the use of their theatre, &c., proceedings; after which, subscriptions were received by the Treasurer and Hon. Secretary.
London for the gratuitous
Correspondence. "Audialteram partem."
arsenic to the ounce, for Eeinsch’s test is not suited for such a quantitative determination. Lastly, there is another question connected with the inquiry which deserves consideration. It is, whether the admixture of chlorate of potash with arsenic will prevent the latter from being retained in the animal system, so as to be discoverable in the body after death ? My own experience is, that in every case of poisoning by arsenic the mineral is to be found in the tissues of the liver by the appropriate tests, and this I hope to demonstrate in a future communication. I remain, Sir, yours, &c., H. LETHEBY, M.B., Ph.D., &c. London Hospital Laboratory, May, 1859.
THE TESTS FOR ARSENIC WITH CHLORATE OF POTASH. USE OF THE MEDICAL COUNCIL. [LETTER FROM DR. LETHEBY.] To the Editor of THE LANCET. To the Editor of THE LANCET. SiR,—Will you allow me a little space in your columns to SIR, I demonstrated, in my last communication, that call the attention of the profession and the Medical Council to arsenic could be readily discovered in a solution of chlorate of a matter of moment ? I wish to ask, What is the use of the Medical Council, if matters of the first importance affecting potash by means of all the usual tests; and that, of these, the are to be settled without the Council even --
Reinsch’s test was singularly unfit for the purpose, because of the solvent action of the chlorine and chloric oxide on the copper employed for the precipitation of the arsenic. I now complete the inquiry by showing that Marsh’s test may, with a little care, be made as applicable to the investigation as any other. There are two methods of proceeding: one is, to evaporate the arsenical solution to dryness, after having added a little carbonate of soda; then igniting in a porcelain crucible, and using the residue with dilute sulphuric acid and zinc, in the usual manner, for the production of arseniuretted hydrogen. The other method is to treat the solution at once with sulphuric acid, adding the acid drop by drop until about a tenth part, by volume, of concentrated oil of vitriol has been used. When the mixture has cooled, it may be poured upon the granulated zinc, and arseniuretted hydrogen will be at once formed and disengaged. The gas may be recognised and tested in the usual way. It burns with the characteristic flame, and deposits a sublimate of metallic arsenic on a piece of white porcelain held in the flame. It blackens a solution of nitrate of silver, and furnishes an arsenical liquid, from which, after the separation of the silver, the arsenic may be obtained. It gives a brilliant sublimate of metallic arsenic when the glass tube is heated through which the arseniuretted hydrogen is passing. All these reactions are as certain as when the test is applied to a solution of arsenic in distilled water; and they are so delicate that an unskilled operator may easily discover the presence of the sixteenth part of a grain of arsenious acid in an ounce of a saturated solution of chlorate of potash. Looking at all these facts-namely, the facility with which the common tests for arsenic may be applied to a chlorate solution, the delicacy of the reactions, and the certainty of the results-looking also at the fact that every test succeeds but Reinsch’s, any that it is open to the double objection of losing the arsenic on the one hand, and introducing it on the other, the following evidence lately given on this subject is remarkable : "I then applied the tests for arsenic (to the chlorate solution), and every test I tried was destroyed, and failed to show the existence of arsenic, owing, as I supposed, to there being something in it; and my tests convinced me that there was something very peculiar about it that I had never met before. I tried Reinsch’s process, but I found that it dissolved the copper gauze as soon as I put it into the liquid. I then determined to exhaust this noxious agent, and continued to put in copper gauze until it no longer possessed the power to dissolve it. I then put in a piece of copper, which at once received the arsenic. I was able to decide by these tests that the mixture was chlorate of potash. I found there was of chlorate of potash seven grains to the ounce, and there was a grain of arsenic. ",,Now, a grain of arsenic in a fluid ounce of any liquid is a strong solution, for cold distilled water will only take up about seven grains to the ounce to become saturated; and seven grains of chlorate of potash in the ounce is only a fourth part of the quantity necessary to saturate it. Why, therefore, with such a solution "every test was destroyed, and failed to show the existence of arsenic," is a matter that requires explanation, for it is opposed to the very principles of chemistry, and to the experience of the rudest manipulator. Again, it is a question of some little importance how it was determined by Reinsch’s test that the chlorate solution contained exactly one grain of *
Vide The
Tirlies, Saturday, May 21st,
1859.
profession
being
consulted ? I refer chiefly to the bearing of certain forthcoming regulations as to the "qualifications"required for the Army medical service, and also to those now understood to be preparing by the Poor-law Board. It is more than rumourecl that the Army Regulations will decide that certain qualifications mentioned in the Medical Act as entitling to registration shall be alone sufficient, while others shall be only half qualifications ; that, in short, certain diplomas shall be received as whole diplomas, while certain others shall be only half diplomas. Now, Sir, I object to important matters of this kind being settled by a side-wind, and in a way which goes in the face of justice. I do not dispute the legal right of any board to make what rules it chooses; but the Army and Poor-law Boards are public boards, whose rules ought to be framed for the public good and on the principles of justice, and be publicly discussed before being promulgated as law. By all means, let have the proposed new regulations printed and discussed in the pages of THE LANCET too; but one would think that the least thing the Army and Poor-law Boards could do be to send their proposed regulations to the Medical Council, and ask their advice and opinion thereon. Indeed, considering that the Council represents the various universities and colleges, and the Crown too, it seems to be something more than a slight not to do so. There cannot be such desperate hurry for the appearance of the new Army Regulations that they cannot wait till after the meeting of the Council in August; but if there is, surely the Council would at once assemble for such good cause. At any rate, why has it not had the opportunity offered ? This question does not interfere with the Army or Navy I setting forth such curriculum, and holding such examinations as they see fit, nor is it to interfere with their laudable endeavour to raise the education and status of their medical
us
very
would
Boards men.
They
are even
at
liberty
to
require
no
diploma
at
all,
their own examination, if they choose. It is merely that they be not permitted as public boards to determine, indirectly but no less certainly, and it may be with great injustice, questions affecting the profession at large; for the decision of these public boards will virtually settle the matter for the pro-
trusting to
fession
at
large.
The Medical Act
(clause 31) leaves, perhaps intentionally,
in profound mystery whether a qualification in medicine or surgery is constituted (a) by one diploma, for which there was an examination in medicine as well as in surgery, thereby putting it in the power of every individual, university, or college, to give a complete diploma if it choose; or (b) by two diplomas, one from a body entitled by its charter to grant a licence in medicine, the other from a body entitled to grant a licence in surgery, thus throwing every college back on its charter, while, however, its chartered privilege was, by the Act, extended to the whole of her Majesty’s dominions. Which of these interpretations is the correct one can be settled only by a supplementary Bill, or by a decision in the courts of law, or practically by the regulations of such boards as the Army, Navy, or Poor-law. But let it in justice be settled according to one or other of these interpretations; not, in the face of justice, by such boards declaring that they will receive certain diplomas as both medical and surgical, and certain others for only one or other, but not as both. If rumour is wrong, and no injustice about to be done, there can be no harm in submitting the proposed regulations to the Medical Council-the right course, indeed, under any circum-
571
hygiene
ships.
4th. That no Surgeon shall be eligible for promotion to the rank of Deputy-Inspector-General of Hospitals and Fleets until he shall have served ten years in your Majesty’s Navy on full-pay, of which three, at least, must have been passed in one of your Majesty’s ships on some one or more foreign stations, with the rank of Surgeon. 5th. That no Deputy-Inspector-General of Hospitals and Fleets shall be eligible for promotion to the rank of InspectorGeneral until he shall have served five years at home, or three years abroad, in the rank of Deputy-Inspector-General. That in cases of emergency, however, or when the good of your Majesty’s service may render such alteration desirable, it shall be competent for the Lords Commissioners of the Admiralty to shorten the several periods of service above mentioned, in such manner as they shall deem fit and expedient. 6th. That the rates of full pay of the medical officers of your Majesty’s Navy shall, in future, be in accordance with the following schedule :FuLL-PAy.-Inspector-General of Hospitals and Fleets : after 30 years’ service on full pay, .62 5s.25 years, .62 5s.20 years, .62.* Deputy-Inspector-General of Hospitals and Fleets: 30 years, .61 14s. ; 25 years, ofllÛs.; 20 years, XI 8.* StaffSurgeon : 25 years, .615s.;20 years, .61 2s. Surgeon: 15 years, 18s. ; 10 years, 15,9.*Assistant-Surgeon: 10 years, 13s.; 5 years, 11s. 6d.; under 5 years, 10s. 7th. That every medical officer on the Active List, now on half-pay, and those who may be placed on it subsequently to the date of your Majesty’s Order in Council authorizing this proposal, shall be allowed the half-pay to which his period of service on full-pay shall entitle him, according to the following schedule :HALF-PAY.-Inspector-General of Hospitals and Fleets: after 30 years’ service on full-pay, .6117s. 6d. ; after 25 years, .6113s. 6cl,.after 20 years, ofl10s.* Deputy-InspectorGeneral of Hospitals and Fleets: after 30 years, .615s. 6d.; ‘ 25 years, ofl2s. 6d.;20 years..61Is.* Staff-Surgeon : after 25 years, 18s. 6d.; 20 years, 16s. 6d. Surgeon: after 15 years, 13s. 6d.10 years, 11s.** Assistant-Surgeon: after 10 years, 10s.; 5 years, 8s. ; under 5 years, 6s. 8th. That, with a view to maintain the efficiency of the service, all medical officers of the ranks of Staff-Surgeon and Assistant-Surgeon shall be placed on the Retired List when they shall have attained the age of sixty years; Deputy Inspectors-General shall be placed on such Retired List when they shall have attained the age of sixty-five, and InspectorsGeneral when they shall have attained the age of seventy years. Officers thus superannuated shall receive the rates of half-pay mentioned in the preceding schedule. 9th. That the relative rank of the medical officers of your Majesty’s Navy shall be similar to that conferred upon the medical officers of the Army, and shall be as follows : An Assistant-Surgeon shall rank as a Lieutenant in the Army, according to the date of his commission; and after six years’ service on full-pay, as a Captain in the Army, according to the date of the completion of such service. A Surgeon shall rank as Major in the Army, according to the date of his commission; and a Staff-Surgeon as LieutenantColonel, but junior of that rank. A Deputy Inspector-General of Hospitals and Fleets shall rank as Lieutenant-Colonel, according to the date of his commission ; and after five years’ service on full-pay as Deputy Inspector-General, shall rank as Colonel, according to the date of completion of such service. An Inspector-General of Hospitals and Fleets shall rank as Brigadier-General, according to the date of his commission; and after three years’ service on full-pay as Inspector-General, shall rank as Major-General, according to the date of completion of such service. Provided always, that no naval medical officer, while borne on the books of one of her Majesty’s ships, or employed on establishments on shore, shall be deemed superior in rank to the officer appointed to command such ship or establishment; but such commanding officer shall, under all circumstances, be *
Or
on
eompleted.
promotion, should these periods
of service not have been
already
Forces ; but that medical omcers serving in the Fleet shall, notwithstanding the relativerank thus conferred upon them,
in all such details, and also in all matters relating to the duties of the Fleet, and the discipline and interior economy of your Majesty’s ships, be subject, as heretofore, to the authority of any executive officer of the military branch while on duty, under the general regulations which may from time to time be prescribed by the Lord High Admiral, or the Commissioners for executing the office of Lord High Admiral; and that medical officers shall share prize money according to the proclamation or proclamations which may be in force for the time being, for regulating the distribution of the proceeds of prizes in the
Royal Navy. llth. That medical officers shall be entitled to the same allowances, on account of wounds and injuries received in action, as combatant officers holding the same relative ranks. 12th. That the families of medical officers shall in like manbe entitled to the same allowances as granted to the families of combatant officers holding the same relative ranks. 13th. That medical office rs shall be held entitled to the same honours as other officers of the Royal Navy of equal relative rank.* 14th. That a medical officer retiring after a full-pay service of twenty-five years, may, in cases of distinguished service, receive a step of honorary rank, but withoub increase of halfpay. 15th. That good-service pensions shall be awarded to the most meritorious medical officers of the Royal Navy, under such regulations as shall from time to time be determined upon, on the recommendation of the Lord High Admiral, or the Commissioners for executing that office. 16th. That four of the most meritorious medical officers of the Royal Navy shall be named Honorary Physicians, and four Honorary Surgeons to your Majesty. We do, therefore, most humbly submit that your Majesty will be graciously pleased, by your Order in Council, to grant us the necessary authority for carrying the foregoing regulations into effect; the Lords Commissioners of your Majesty’s Treasury having signified their concurrence. Her Majesty having taken the said Memorial into consideration, was pleased, by and with the advice of her Privy Council, to approve of what is therein proposed; and the Right Honourable the Lords Commissioners of the Admiralty are to give the necessary directions herein accordingly. BATHPBST. ’WM. L. BATHURST. WM. ner
THE LONDON MEDICAL REGISTRATION ASSOCIATION. PUBLIC MEETING OF MEDICAL PRACTITIONERS IN ST. HANOVER SQUARE.
GEORGE’S,
THE seventh of the public meetings of the profession convened by this Association in different quarters of the Metropolis took place on Wednesday evening, May 25th, at the rooms of the Medical Society of London, which had been courteously granted by the Council of that body to the Association for that purpose. Shortly after eight o’clock, Mr. Lavies, V.P.y proposed that William Fergusson, Esq., F. R. S. (one of the vice-presidents of the Association), be invited to take the chair. The motion was seconded by Mr. Bottomley, the treasurer of the Association, and carried unanimously. Mr. Fergusson immediately occupied the chair, and after the advertisement convening the meeting had been read by Dr. Ladd, The CHAIRMAN opened the proceedings by observing that and history all present were doubtless familiar with the of the Association, which was, as it were, the embodiment of the Bill which had been lately rendered an Act by the Legislature. There was, indeed, an official body created by the Act; but the true spirit of the enactment was one vested in associations of the profession themselves, established to aid
origin
* This clause does not extend to the compliments to be paid by Garrison or Regimental Guards, as laid down in pages 29 and 30 of your Majesty’s Regulations for the Army, nor to corresponding honours paid on board your lktaiestv’s sWns.
569
and assist in carrying out its provisions. The Act had been often ref’.rredto as very imperfect, but we must remember that this was the drawback of all Acts of Parliament, and we must not expect perfection in anything at the outset. Many in the room were old enough to recollect after what a struggle the great Reform Bill was carried. Whilst some thought it objectionable, others who advocated it considered it a tinal measure ; yet it was curious that the same parties. did not now consider it so. (Hear, hear.) The same thing must happen with Medical Reform. " When I look," said Mr. Fergusson, " on the struggles of Medical Reform, I am astonished that we have now such an Act to speak of. Some such Act as that which we have was a continual topic; but it was constantly shelved in Parliament, and I was brought to think there was to be no such enactment, and, like most others of my brethren, was taken by surprise when I found that it had really passed. The general feeling of the profession is, that the Act, with all its defects, is to be received with pleasure; a large number have so received it, and especially the members of this Association. The Act must result in great good to the profession. The Registrar under it has been subjected to great difficulty. One of the main duties of this Association has been to assist the Registrar. We desire to see our names on the Register separated from dishonourable ones. There is no point on which there has been such unity of opinion as on the subject of registration. The object of those who have met this evening is to assist the Registrar, and therefore the Government, when in a difficulty, by preventing those that unjustly invade our rights from also defrauding the public. I am pleased that the profession have got the Act: it is the first demonstration that the Government has made of our recognition as a body; and it is for us to show our gratitude to the Government, and to provethat weare prepared to do of our own good will that which we have so often asked the Government to do for us. The want of unity has been hitherto the bane of our bodypolitic. It has been difficult in the extreme to insure co-operation, when so many hostile influences have been at work. The Secretary of State said, longago, to the profession,Show that are your own you put before us what proves that you have unanimity, and we will pass a Bill at once.’ This has been at length done, and further improvements will be admitted. [The Chairman added, with great force and earnestness,] One great reproach to us we havenow the means of removing : Me can get 1"id of bad company. It is painful to have to refer to examples of this, but at present the case is before the public, as will be shown by the Report of this Association, now to be read to you." The Chairman then called upon Dr. LADD, the Honorary Secretary, who read the "Report of the Proceedings of the London Medical Registration Association from its Formation to the Present Time,"after which, Mr. GANT moved, and Dr. HAWARD, of Harley-street, seconded, the first resolution, in acquiescence of the principles by which the Association had been guided. This and the succeeding resolutions were similar to those carried at the public meeting in St. Marylebone and other previous meetings, (and which were published in THE LANCET of May 21st, pp. 520-1.) They were all, as on former occasions, passed unanimously. Dr. MERYON, of Clarges-street, moved, and Dr. FRASER, of Grosvenor-street, seconded, the next resolution, which was to the effect that the meeting pledged itself to use every exertion to augment the number of members of the Association. Mr. C. CLARK, of Notting-hill, remarked that the Association had three main objects-lst, to prevent improper persons getting their names on the Register; 2ndly, to suppress illegal practice; and 3rdly, to watch the working of the new Medical Act. He urged either an alteration in, or addition to, the " name of the Association, to the effect of entitling it an Association for the Suppression of Quackery."" This suggestion, however, did not meet with any ardent
yourselves
friends,
support.
Dr. KIRBY stated, as a member of the Committee of Obserthat it was the intention of the Committee, as soon as the Register was issued, to publish such corrections of it as might be found necessary in the medical journals. They had much information in their possession for the purpose. Mr. SERCOMB moved, and Mr. HARVEY, of Soho-square, seconded, the third resolution, which recognised the importance of submitting to the Committee of the Association all possible information concerning persons practising medicine illegally. Dr. O’CONNOR, who spoke to this motion, eulogized the conduct of Mr. Secretary Walpole whilst the Medical Bill was before Parliament, and the conflicting interests of twenty-two examining bodies had to be considered; and he spoke of the ultimate object of medical reform as being, that practitioners of
vation,
570
medicine and surgery, which were "one and indivisable,’’ should enter at one portal. Mr. iLLix&woRTH, of Arlington-street, Piccadilly, proposed the fourth resolution, which expressed satisfaction at the successful efforts of the Association hitherto for the putting down quacks, and asserted that it was highly desirable that the means of the Association for similar purposes should be enlarged by liberal contributions to its " Prosecution Fund." He remarked that he hoped the proprietors of such unseemly exhibitions as Kahn’s and others would be excluded from the Register. Hedeprecated changing the name of the Association, as on various grounds an injudicious proceeding. Dr. WiLLls, of Kensington, seconded the motion, and observed, that although the Bennett tribe had been put down, many other confederacies existed, to be similarly treated. The Medical Council, like other corporations, could not and would not act towards this end as would an Association such as the present; and he urged the necessity of subscribing to both the "general" and the "prosecution" funds, and inducing others to do so. Dr. KIRBY added his pleadings to those of Dr. Willis for the money support of the Association. The profession must know that if they do not come forward and help this body with substantial means to carry on its objects, it would be crippled in its efforts. The proceedings of the Association had been conducted with the strictest regard to economy, and much quackery had been exposed by its efforts. Amongst other instances, he mentioned one of a quack who had been the pest of the practitioners in Hereford, yet who, on receipt of one of the " warning letters"from the hon. secretary, had promptly decamped. The profession had no conception of the amount of quackery that existed, or of the enormous fees which were collected by the quacks, and which were really astounding. Mr. LAVIES, a Vice-President of the Association, pronounced an eulogy on the " Committee of Observation." The amount of work they had had before them no one could understand who had not, like himself, attended most of their meetings. He recommended that no change should be made in the name of the Association. He proposed a vote of thanks to Mr. Fergusson for his liberality in devoting his time and attention to aid of his profession by taking the chair that evening; and he congratulated the assemblage on the proof which the Chair. man had afforded in his opening address that he had come to the meeting fully impressed with the objects of the Association. Mr. FEttGt7sso, in acknowledging the vote, said that he appeared amongst them as an active member of the Association, and if he could induce others to do the same, he should be rejoiced. It is a feature in the proceedings of our Association, that its exertions are as much for the benefit of the public as for ourselves, and the public, if rightly informed, would see the matter in that light. Looking at ours as one of the noblest and grandest of professions, the public ought to recollect that we are bound to qualify ourselves to do our duty to the community at large, and they should at the same time see that the interests of qualified practitioners are cared for. As to the duties of the Medical Council in this respect, he was disposed to yield to that body every indulgence. Amongst their duties, they had the education of the younger members of the profession to provide for, and, as Dr. O’Connor had observed, they had much to do with the twenty-two Examining Boards, over which they would now exercise a control. One of the best functions of the Association had yet to be developed: it might call upon the Council to oblige some of these consti. tuted bodies to do their duty, and even to prosecute in certain cases, which they might do at the instance of the Association. Even now a step in this direction might be taken by the Executive Committee of this Association. In going along Oxford-street, one might see a place termed the Royal Institution of Anatomy. In this country, there is some considerable difficulty in obtaining the privilege to use the title " Royal.’’ The Colleges of Surgeons of England and Ireland enjoy such a designation, and as guiding the education of surgeons and guardians of anatomical and surgical science, he considered that the Council of the Royal College of Surgeons of England should be applied to, in order that they might ascertain if any privilege to use the title of "Royal" had been granted to the so-called institution in question, which was merely a private speculation. (The Chairman delivered these sentiments with great energy.) Kahn’s exhibition had not assumed the title "Royal," but lectures of a prurient and objectionable nature were delivered there; and is it not within the province of this Association to call the attention of the licensing magistrates to that and other places of resort having an immoral tendency t
(Cheers.)
A vote of thanks to the Council of the Medical Society of closed the use of their theatre, &c., proceedings; after which, subscriptions were received by the Treasurer and Hon. Secretary.
London for the gratuitous
Correspondence. "Audialteram partem."
arsenic to the ounce, for Eeinsch’s test is not suited for such a quantitative determination. Lastly, there is another question connected with the inquiry which deserves consideration. It is, whether the admixture of chlorate of potash with arsenic will prevent the latter from being retained in the animal system, so as to be discoverable in the body after death ? My own experience is, that in every case of poisoning by arsenic the mineral is to be found in the tissues of the liver by the appropriate tests, and this I hope to demonstrate in a future communication. I remain, Sir, yours, &c., H. LETHEBY, M.B., Ph.D., &c. London Hospital Laboratory, May, 1859.
THE TESTS FOR ARSENIC WITH CHLORATE OF POTASH. USE OF THE MEDICAL COUNCIL. [LETTER FROM DR. LETHEBY.] To the Editor of THE LANCET. To the Editor of THE LANCET. SiR,—Will you allow me a little space in your columns to SIR, I demonstrated, in my last communication, that call the attention of the profession and the Medical Council to arsenic could be readily discovered in a solution of chlorate of a matter of moment ? I wish to ask, What is the use of the Medical Council, if matters of the first importance affecting potash by means of all the usual tests; and that, of these, the are to be settled without the Council even --
Reinsch’s test was singularly unfit for the purpose, because of the solvent action of the chlorine and chloric oxide on the copper employed for the precipitation of the arsenic. I now complete the inquiry by showing that Marsh’s test may, with a little care, be made as applicable to the investigation as any other. There are two methods of proceeding: one is, to evaporate the arsenical solution to dryness, after having added a little carbonate of soda; then igniting in a porcelain crucible, and using the residue with dilute sulphuric acid and zinc, in the usual manner, for the production of arseniuretted hydrogen. The other method is to treat the solution at once with sulphuric acid, adding the acid drop by drop until about a tenth part, by volume, of concentrated oil of vitriol has been used. When the mixture has cooled, it may be poured upon the granulated zinc, and arseniuretted hydrogen will be at once formed and disengaged. The gas may be recognised and tested in the usual way. It burns with the characteristic flame, and deposits a sublimate of metallic arsenic on a piece of white porcelain held in the flame. It blackens a solution of nitrate of silver, and furnishes an arsenical liquid, from which, after the separation of the silver, the arsenic may be obtained. It gives a brilliant sublimate of metallic arsenic when the glass tube is heated through which the arseniuretted hydrogen is passing. All these reactions are as certain as when the test is applied to a solution of arsenic in distilled water; and they are so delicate that an unskilled operator may easily discover the presence of the sixteenth part of a grain of arsenious acid in an ounce of a saturated solution of chlorate of potash. Looking at all these facts-namely, the facility with which the common tests for arsenic may be applied to a chlorate solution, the delicacy of the reactions, and the certainty of the results-looking also at the fact that every test succeeds but Reinsch’s, any that it is open to the double objection of losing the arsenic on the one hand, and introducing it on the other, the following evidence lately given on this subject is remarkable : "I then applied the tests for arsenic (to the chlorate solution), and every test I tried was destroyed, and failed to show the existence of arsenic, owing, as I supposed, to there being something in it; and my tests convinced me that there was something very peculiar about it that I had never met before. I tried Reinsch’s process, but I found that it dissolved the copper gauze as soon as I put it into the liquid. I then determined to exhaust this noxious agent, and continued to put in copper gauze until it no longer possessed the power to dissolve it. I then put in a piece of copper, which at once received the arsenic. I was able to decide by these tests that the mixture was chlorate of potash. I found there was of chlorate of potash seven grains to the ounce, and there was a grain of arsenic. ",,Now, a grain of arsenic in a fluid ounce of any liquid is a strong solution, for cold distilled water will only take up about seven grains to the ounce to become saturated; and seven grains of chlorate of potash in the ounce is only a fourth part of the quantity necessary to saturate it. Why, therefore, with such a solution "every test was destroyed, and failed to show the existence of arsenic," is a matter that requires explanation, for it is opposed to the very principles of chemistry, and to the experience of the rudest manipulator. Again, it is a question of some little importance how it was determined by Reinsch’s test that the chlorate solution contained exactly one grain of *
Vide The
Tirlies, Saturday, May 21st,
1859.
profession
being
consulted ? I refer chiefly to the bearing of certain forthcoming regulations as to the "qualifications"required for the Army medical service, and also to those now understood to be preparing by the Poor-law Board. It is more than rumourecl that the Army Regulations will decide that certain qualifications mentioned in the Medical Act as entitling to registration shall be alone sufficient, while others shall be only half qualifications ; that, in short, certain diplomas shall be received as whole diplomas, while certain others shall be only half diplomas. Now, Sir, I object to important matters of this kind being settled by a side-wind, and in a way which goes in the face of justice. I do not dispute the legal right of any board to make what rules it chooses; but the Army and Poor-law Boards are public boards, whose rules ought to be framed for the public good and on the principles of justice, and be publicly discussed before being promulgated as law. By all means, let have the proposed new regulations printed and discussed in the pages of THE LANCET too; but one would think that the least thing the Army and Poor-law Boards could do be to send their proposed regulations to the Medical Council, and ask their advice and opinion thereon. Indeed, considering that the Council represents the various universities and colleges, and the Crown too, it seems to be something more than a slight not to do so. There cannot be such desperate hurry for the appearance of the new Army Regulations that they cannot wait till after the meeting of the Council in August; but if there is, surely the Council would at once assemble for such good cause. At any rate, why has it not had the opportunity offered ? This question does not interfere with the Army or Navy I setting forth such curriculum, and holding such examinations as they see fit, nor is it to interfere with their laudable endeavour to raise the education and status of their medical
us
very
would
Boards men.
They
are even
at
liberty
to
require
no
diploma
at
all,
their own examination, if they choose. It is merely that they be not permitted as public boards to determine, indirectly but no less certainly, and it may be with great injustice, questions affecting the profession at large; for the decision of these public boards will virtually settle the matter for the pro-
trusting to
fession
at
large.
The Medical Act
(clause 31) leaves, perhaps intentionally,
in profound mystery whether a qualification in medicine or surgery is constituted (a) by one diploma, for which there was an examination in medicine as well as in surgery, thereby putting it in the power of every individual, university, or college, to give a complete diploma if it choose; or (b) by two diplomas, one from a body entitled by its charter to grant a licence in medicine, the other from a body entitled to grant a licence in surgery, thus throwing every college back on its charter, while, however, its chartered privilege was, by the Act, extended to the whole of her Majesty’s dominions. Which of these interpretations is the correct one can be settled only by a supplementary Bill, or by a decision in the courts of law, or practically by the regulations of such boards as the Army, Navy, or Poor-law. But let it in justice be settled according to one or other of these interpretations; not, in the face of justice, by such boards declaring that they will receive certain diplomas as both medical and surgical, and certain others for only one or other, but not as both. If rumour is wrong, and no injustice about to be done, there can be no harm in submitting the proposed regulations to the Medical Council-the right course, indeed, under any circum-
571