THE MEDICAL PROFESSION AND THE LUNACY LAW.

596 CHANGES AT ST. GEORGE’S HOSPITAL. THE recent

fresh courage at each natural remission of the fever; and, finally, on the last day, we read that A hot bath was ordered, to produce a weakening effect, (affaiblissement,) because they dared The surface was now cold, and so mustard no longer bleed. were plasters applied. Thus was this great Minister tortured, and brought surely within the clutches of death. Seneca chose to seek death by opening his veins in a warm bath, and there quietly allowing his life to ebb away. The substitution of seven successive bleedings, ad deliquium, with the intercurrent application of mustard plasters and cabinet councils, to conclude with the hot bath and more mustard plasters, seems to us to be a more cruel, but hardly a less sure device.

changes in the surgical staff at St. George’s Hospital entirely in accordance with the general opinion of the profession on a subject in which we have long led in the direction now pursued. The unlimited tenure of office by hospital surgeons is not desirable in their own interest, or in the interests of the profession, and not always so in the interests of the patients. Mr. Csesar Hawkins and Mr. Cutler, who have vacated their appointments at St. George’s Hospital, retire with vigorous and efficient physical powers, and after devoting many years of ripening experience and well-tried skill to the service of their wards. Their retirement is in voluntary and graceful deference to a principle of which they acknowledge the force, and not to any law of which they submit to THE MEDICAL PROFESSION AND THE the provisions. The example is one of considerable weight, LUNACY LAW. and we trust that it may serve as a precedent in certain quarters, where it might be advantageously followed. Mr. HawON the afternoon of the 7th instant a meeting of the medical kins had, during his term of office at St. George’s Hospital, profession of Scotland was held in the Hall of the Royal College reached, by virtue of the prestige which he won in ably filling of Physicians, Edinburgh, for the purpose of considering the that office, to the honours of the Presidency of the College of propriety of obtaining some modification of the provisions of law now affecting the insane. Amongst those present were Surgeons and of the Royal Medical and Chirurgical Society. -theDr. Alex. Wood, F. R. C. P. ; Dr. Douglas Maclagan, P. R. C. S.; He has colleagues on the Council of the College of Surgeons Drs. Andrew Wood, Newbigging, Combe, Halliday Douglas, who have held similar offices, and attained to the same dis- Seller, Maclagan, Peddie, Hamilton, Coldstream, Andrew tinction, but who have not shown any disposition to follow Thomson, Keiller, John Brown, Charles Bell, J. Gairdner, him in his present dignified course, although they have other Zeigler, W. T. Gairdner, John Struthers, Charles Wilson, Huie, strong physical reasons for yielding the reins which they hold Fairbairn, Wright, Scoresby-Jackson, Burt, Brodie, Jamieson, Myrtle, Malcolm, Murray-Thomson, Johnston, Sibbald, Benno longer with manly power. They may not, however, prove jamin Burt, Omond, H. Johnston, W. Brown, Cruickshank, much longer insensible to the gathering convictions which the Pridie, R. P. Ritchie, J. Coxe, T. Balfour, Stewart, Burn, and present events will serve to impress by example. The two Somerville; Messrs. B. Bell, Carmichael, and;;A. Dickson; Dr. surgeoncies at St. George’s Hospital will be filled by Mr. Pres- Smith, Lasswade ; Dr. Sanderson, Musselburgh; Dr. Brown, cott Hewett and Mr. Geo. Pollock, who have already given to Melrose; Mr. Mackenzie, Kelso; Dr. Brodie, Morningside; Dr. Craig, Ratho; Dr. Hislop, East Linton, &c. &c. the profession the fullest guarantees of the skill and high On the motion of Dr. NEWBIGGING, Dr. Alexander Wood, in character which befit their position. the absence of Professor Christison from indisposition, was are

COUNT CAVOUR AND HIS PHYSICIANS. THE enemies of Italy must erect a statue to Sangrado. But it is difficult for us to read the accounts transmitted to us of the disease and treatment of Count Cavour with patience. Surely the Papal and Austrian authorities will decree a mural crown to the three physicians who caused the illustrious Cavour to be bled thrice on the first day of his illness, twice on the second, and a sixth time on the third; and when finally he was at the last point of weakness, and beyond the possibility of venesection, placed his bloodless and enfeebled frame in a hot bath, and swathed him in mustard plasters. The combination of .fever, repeated loss of blood, heat of weather, hot baths, and mustard poultices, was, indeed, more difficult to sustain than any burden of diplomatic anxiety; and all Europe feels with indignation, that a life which could ill be spared has beensacrificed to the antiquated prejudices of the Italian physicians, who still brandish so recklessly the ancient ensign of surgery. We must not be unjust to those who undertook the grave charge of this great life, in which the liberties of Italy also lived, and we would not aggravate the grief and the pain which the unhappy event of their treatment must inflict. We may set down much of the alleged vacillation in determining the nature of the disease to the restless falsity of rumour, which is tactile in variations. The diagnosis seems to have been pretty clear from the first. The prior symptoms were febrile, and accompanied with cerebral congestion. The physicians ordered six bleedings, and at the end of these, on the second day, the symptoms were already announced in the bulletins to be " typhoid"-that is, weak and asthenic. The true origin of the fever was now clearly seen, for there were marked accesses and remissions of fever at stated intervals. The accesses were preceded by shivering fits, and the attack was declared to be double tertian ague. The loss of blood produced delirium in the periods of accession ; nevertheless the bleedings were continued up to the seventh time, the physicians apparently taking

called to the chair. Dr. DOUGLAS MACLAGAN moved the first resolution, which was as follows :-" That the present medical certificate is unThat it should simply bear, that the undersigned suitable. medical men separately visited and examined (A. B. on such a date), and found him to be of unsound mind, and requiring confinement in an asylum. That this certificate, coming from two qualified practitioners, appears to be amply sufficient, and to require no statement of facts to be appended to it." Dr. HuiE seconded the resolution, which was unanimously

agreed to.

Dr. MACKENZIE, of Kelso, moved the second resolution, which follows :-" That the period during which a person may be confined on an emergency certificate is too short, and should be extended from twenty-four hours to three days." Dr. CRAIG, of Ratho, seconded the resolution, which was was as

unanimously adopted.

Dr. PEDDIE said-The resolution which I have been

reo

quested to move is the following:-" That many cases of excessive intemperance depend on disease, and constitute a form of insanity. That such cases cannot be treated without con-

finement more or less strict. That in the present condition of the law such treatment is frequently unattainable. That some cases of the kind require treatment by confinement not different from that enforced on other insane persons. That for many more a different system of treatment is desirable. That although such a system of treatment has already been established in various institutions in Scotland, into which persons are admitted with their own consent, yet it seems necessary in certain cases to afford the means of enforcing admission into such institutions; and that such institutions should be licensed, subject to the jurisdiction of the Lunacy Commissioners, and conducted under such regulations as the Act may direct." Dr. ANDREW WOOD moved the adoption of the next resolution, which was as follows :-" That it is desirable that the consent of some public functionary be interposed-as is now the practice in Scotland-between the medical certificate and the confinement of the insane person; and that no public functionaries appear to be better suited for this purpose than the sheriffs of counties and their substitutes." Dr. CHARLES BELL said that, in the absence of Dr. Burt, who had been unexpectedly obliged to leave the meeting, he had been called to move the following amendment to the motion now proposed:-°° That it is not desirable that the consent

597

practice

to him, and bottles of hot water were placed to his feet and of any public functionary be interposed, as is now the in Scotland, and nowhere else required, between the present sides. His pulse soon began to be felt at the wrist, and, conmedical certificate and the confinement of the lunatic; the pre- sidering the extreme state of collapse he was in, surprised me sent system being only derogatory to the profession, being preju- by getting rapidly of considerable strength; his breathing also, dicial to the patient, forming, as has been found, no protection from being scarcely perceptible, soon began to be laboured and whatever against vexatious prosecutions, and converting that quick. The injury being so extensive, precluded scarcely a which ought to be a strictly private professional duty into a chance of his recovery; but we thought it advisable to support chest and ribs with a bandage, and Mr. Woodcock stopped public judicial act which unavoidably associates it with the idea of criminality. That, as a substitute for the present form with him whilst I went home for one. On my return I found of procedure, it should be required that intimation be made that air had become effused in the cellular tissue of the chest, without delay to the Commissioners in Lunacy of the confine- and was rapidly spreading ; indeed so rapid was the effusion, ment of the lunatic, with copies of the documents on which the that in less than fifteen minutes it had diffused itself all over removal has proceeded, they being invested with full powers." the body, and respiration had ceased, his body as it lay on the Dr. W. T. GAIRDNER said he could not vote either for the bed resembling a very large pillow-case distended with air. motion or the amendment, but he could vote for the following A few minutes after respiration had ceased, I thought I amendment, which he begged to proposed:-"That the existing would examine the extent of the injury, and on placing my form of the Sheriff’s jurisdiction in cases of insanity is objec- hand over the heart I was surprised to feel it beating through tionable, as tending to delay and obstruction in the admission of the swollen integuments, and to be so felt, even indistinctly, it must be beating with great force ; but it was beating distinctly cases of urgency into asylums, and also as interfering with the physician’s province, which is to judge of the circumstances and very perceptibly to the hand, and was still more disunder which treatment in asylums is required; and that the tinctly to be heard with the ear. I directed Mr. Woodcock’s security of the public requires only that the competency and attention to it, and we felt for the pulse at the wrist, but there good faith of the medical men signing the certificate should be was none perceptible. We then held a looking-glass to his placed beyond suspicion. That the Lord Advocate be requested face, but the glass remained dry and free from the least moisto take these circumstances into his consideration, with a view ture. The heart could be felt beating for some time after I either to the amendment of the Sheriff’s jurisdiction or to its first perceived it, and I am sure I speak without exaggeration being replaced ’Iby some other provision for accomplishing the when I say that I felt it so beating more than twenty minutes after all respiration had ceased. I am sorry, and was sorry object in view." Dr. RITCHIE seconded the amendment of Dr. W. T. Gairdner. then, that the exact time was not noticed ; but I did notice Dr. Charles Bell withdrew his amendment in favour of Dr. that more than a quarter of an hour elapsed after I first perGairdner’s, at the suggestion of Dr. DOUGLAS MACLAG.4-N, who ceived the heart beat before I felt it totally cease. remarked that some, like himself, could vote for Dr. Gairdner’s I am not aware that a case of this kind has been placed on amendment, though they could not vote for that of Dr. Charles record before; but as Dr. Waters has brought the question before the profession, I have thought it right to send you these Bell. A vote was then taken by a show of hands, when Dr. W. T. few particulars of this case of emphysema, proving, as it posiGairdner’s amendment was carried by a large majority. tively does, that the heart can continue to beat after all respiA vote of thanks was given to the Chairman, on the motion ratory movement has ceased. An examination was not permitted. of Dr. JOHN GARDNER, which terminated the proceedings.

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HENRY

Correspondence. "Audi alteram partem."

ASHTON, L.R.C.P.E.

HEALTH OF CHILDREN. — THE CENTRAL LONDON DISTRICT SCHOOLS, HANWELL. To the Editor of THE LANCET.

HOW LONG DOES THE HEART BEAT AFTER SiR,—My attention has been directed to a letter in last ALL RESPIRATORY MOVEMENT week’s LANCET from Dr. Wilkinson, of Sydenham; and as some

HAS CEASED? portions of it require explaining, and others correcting, I shall feel obliged by the publication of a brief reply, if you consider To the Editor of THE LANCET. the subject of sufficient interest to be discussed in your columns. I have not the pleasure of being personally acquainted with SiB,—On reading the discussion following the reading of Dr. Waters’ able paper at a late meeting of the Royal Medical and Dr. Wilkinson, but I have inspected the North Surrey Schools; Chirurgical Society, I thought the following short history of a and although the very favourable return of death-rates is case of general emphysema, which I have taken the liberty of doubtless due very much to the skilful medical and general sending you, and to which I was called about thirteen years superintendence of the children, I think something must be since, might assist in solving the question, " How long does allowed for the localities whence they come, and their comthe heart beat after all respiratory movement has ceased ?" paratively good constitutions. How many of these children A. B--, a railway porter, was standing on the side of a have been brought up-as the majority of those at the Central luggage waggon, which was under an archway entrance to a London District Schools, Hanwell, have been-without that warehouse, at Ramsbottom, of very little more than sufficient light and air which are as necessary to physical development, width to permit the waggon to pass into the warehouse. The and to the resistance of tubercular disease and struma genewaggon was, I believe, the last of a train of waggons, to the rall , as is their daily bread itself? What I mean will beend of which, furthest from the warehouse, an engine was readily shown if I place side by side the unions and attached, and the train had been backed to the warehouse. parishes represented by each school. He was standing on the side of the waggon, "holding by one North Surrey S’chool. Central Lond. Dist. School. of his hands to the goods with which it was laden," immeEast London. and Wandsworth Clapham. diately outside the arch, when unfortunately the engine began City of London. Croydon. to move backwards, and he was wedged between the archway West London. Kingston. and the waggon. I was immediately sent for, and Mr. Wood! St. Saviour’s (Southwark). Lewisham. cock, surgeon, who had just called upon me, kindly went with ! St. Martin’s. Richmond. me. We found him lying outside of the warehouse, suffering St. Luke’s (Chelsea). ! from the shock of the accident, and we had him carefully conJ St. Pancras. veyed to the station-house, which was only a short distance from the warehouse. He complained the most of his chest, The first column mainly represents pleasant suburban or and to examine his injuries we had his upper outer clothing country neighbourhoods, where the poor enjoy fully the benecarefully removed. This gave him so much pain that we did fits of abundant light and a pure atmosphere; the second not take off his shirt, but opened it at the front, when it was column includes the whole of the City of London, and large sufficiently evident to the eye that most of the true ribs on portions of that dense mass of houses which surround it. The both sides were broken, and the grating of their ends was most pauper element of the last parish alone in Dr. Wilkinson’s list distinctly felt on placing the hand lightly on the chest. On - St. Pancras--may to some extent be taken as assimilating account of the pain a minute examination could not be made, in condition to that of the whole of the district whence the but in addition to the fractured ribs there was dislocation of children at the Central London District Schools have been the right clavicle from the sternum. Some hot tea was given drawn; but as large numbers of the St. Pancras children are

most