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The Public and the Medical Profession.
36 A sanatorium for the prevention and curative treatment of consumption is rising
during
the
succeeding
years.
under the direct eye of His MAJESTY the KiNG, paid for by a layman, and constructed in accordance with the choice and directions of a committee which is partly composed of laymen and in the hands of which the management will later be vested, Yet medicine is
THE LANCET. LONDON: SATURDAY, JANUARY 2, 1904.
adequately-the public might even think preponderatingly-represented at every step of the proceedings. Research work into the origin of cancer is being busily pursued with funds largely subscribed by the public, and if the bulk of the investigations naturally falls to pathologists the help of all scientific students is freely p and acknowledged. It must be observed, too, d demanded the funds are being subscribed not by an ignorant t that ppublic who think that a certain sum of money being certain results must automatically follow, but by p paid a thoroughly intelligent public, again with the KING as a t the dominant spirit, who have grasped the point that d definite knowledge must not be expected too soon, or i: at any fixed period, from such labours as those indeed 1] undertaken by the workers in the pathology of cancer. No knows in which direction a profitable start may be c one r for such investigations, and here it is well to say made
The Public and the Medical Profession. beginning of the year is naturally made a season for moralising and we claim indulgence for a few words of serious reflection upon the relations now existing between the public and the medical profession. Each New Year’s day is a milestone at which we pause, now to look back on the road already covered and now to look forward at the track stretching ahead. Instinctively we try to prePart of sume tha future from the experiences of the past. such a necessary review of the position of things medical we have already presented to our readers, for in the Annus Medicus, published in the last number of the old THE
year, will be found a summary of the medical events of that year as they have been recorded, collated, or commented upon in our columns. It remains to surmise what
t that
great issues must not be attributed to the fact that c certain carcinomata, and new growths which have been ex-very generally classed as carcinomata, exhibit retrogression
the directions in which medical advances may be pected during 1904, while assu-ing our readers that no tunder treatment with radium or the x rays. The progress efforts will be spared on our part to assist the cause in i therapeutics thus implied is most important, and unIt is particularly desirable that we should idoubtedly during the year now begun medical practitioners of progress. be able to anticipate in thought the more importantwill mutiply their observations and experiments along this medical and professional tendencies, for, as we have fre- line ; but the public ought to understand from them that quently insisted, the work of THE LANCET is essentially many of the claims made for the treatment of cancer by the cooperative. We can only give to our readers the latestx rays and by radium are as yet unproved. That certain medical learning and the most practical professional in- cases have derived benefit is sure, and just so sure is it that formation if we, in our turn, are helped by our readers. no general therapeutic law has been revealed for the All editorial efforts would be futile if we did not findremedy of cancer. We need hardly multiply instances to that the public at large are aroused to a sense of among our public many willing and happy to communicate prove ] 1 us with their professional brethren, thus rendering the responsibilities of medicine and of the debt that is through Contributions to the hospitals our pages a bureau for the collection and redistribution ofowed to our profession. of It is that a which grows steadily higher our colon scale munificence valuable, therefore, knowledge. many laborators should know the directions in which useful are chronicled week by week ; the daily papers are developments, whether scientific or professional, may be: full of correspondence showing an almost embarrassing It is generally impossible to say that any interest in the affairs of the same institutions ; tropical looked for. are
.
one
fact contains a more useful lesson thanmedicine is recognised as an adjuvant to Imperial expanthat one question in medical ethics has a deeper sion, and hygiene is now steadily preached from pulpits. significance than another; and it is not in any The ignominious end to an eccentric onslaught made by the
pathological
another,
or
sociological
,
such manner that we would attempt to prophesy what new National Antivivisection Society upon the work of certain theories or what illuminating deductions may be awaited. physiologists showed the sensible public to be ranged as But it is not impossible to indicate what are the pre- one man on the side of the cause of true medicine. It is valent conditions of scientific research or how the cause ofE unnecessary to say more to show that in 1904 the medical the medical man, as a professional man, can best be: profession in this country will be carrying on their work in an environment which, despite occasional appearances, served. We think that the most noteworthy sign of the timesa will be favourable to the growth of medical science. in regard to medicine is the enormous interest that is: The lesson from all this we take to be that the medical taken by the public in affairs that were wont at one time profession would often be well advised to invite the public to be regarded as purely medical. This is the particularr more into their confidence. This country has, during difference to be observed nowadays both in the discussioni the past quarter of a century, been transformed by educaof purely scientific questions and in the consideration off tion, so that the public are able to appreciate the reasons medical politics ; and everything points to the fact that theafor scientific proceedings in a way which they could not fusion of medical and public interests will become closerr have possibly done in the days of our fathers. Much ,
.
.
37 medical research is the pursuit along specialised lines: for practical purposes the old routine of quarantine has of general scientific procedure ; many therapeutic measures: ceased. The whole question has passed into the hands of are but a particular application of a common know- the medical profession who rely, for the safeguarding of ledge of chemistry or some ancillary science. When the public, on early diagnosis of the disease and prompt there were but three learned professions, and when removal of the patient from his home to an isolation hospital. At the same time the place which he has occupied is disa large proportion of the public was completely illiterate, on the and all persons who have been exposed to infection infected no good purpose was served by any attempt part of the medical man to explain his actions. No are kept under constant observation until the period of member of the laity would have understood the elements incubation of the disease has expired. In India this system Bat now that fails entirely, for the apathy of the population and their of what he proposed to talk about. medicine touches the borders, or passes over into the dislike of European interference lead to wholesale conterritory, of so many other sciences, and now that none cealment of the presence of the disease and to murderous of the public can be called completely illiterate, while a attacks on the sanitary officials with occasional rioting large proportion of them enjoy as good education as the on the removal of a patient to a hospital. Dr. average medical man, there is no need for the medical man YERsiN, as is well known, established the fact that an to feel that he cannot discuss a professional topic with a attack of plague is due to invasion by a specific bacillus, layman. We are not advocating the publication by medical the microscopic recognition of which either in the actual or after cultivation or inoculation forms the men of popular views on disease in the daily press-such un- patient of the modern diagnosis of the disease. There professional action is open to grave abuses and occasionally basis does serious harm. But we are suggesting that medical men are, in fact, only a few other diseases the presence or should be quick to seize on this assistance of laymen, absence of which can be determined with similar rapidity which events prove can be obtained if it is intelligently and precision. Much, however, still remains to be done in sought. The sympathy of the public need not be expressed explaining the etiology of plague and some printed reports only by the support of large educational schemes or the which have reached us show that Dr. J. A. TURNER, erection of splendid buildings. The payment of medical executive health officer of Bombay, has been recommen for the discharge of State or municipal duties, the fees mending that competent bacteriologists should be enof medical witnesses and public vaccinators, the position of couraged to study the relation of plague outside the body medical men working for provident institutions-we quote to the organism which is associated with the disease in The frequent occurrence of plague in these as a few examples-are subjects in which our pro- its clinical aspect.
fession and the public have equal interests.
On the surface frank discussion
these interests may be opposed, but between intelligent men would soon show on which side justice lay. It is this entente eordiaze that we would urge our readers to cultivate during the year now opening.
Plague Research in India. improvement of the public health, and especially for the prevention of epidemic disease, there can be little success unless the general population cooperates with the sanitary authorities. A convincing proof of this is to be found in the behaviour of plague in Asia and Europe respectively, for in India and China it has IN all schemes for the
the lower animals shows that the human subject is not the only host of the specific bacillus, and Dr. TURNER believes, no doubt with perfect correctness, that light might be thrown, by investigation in this direction, upon the prevalence of plague in India. Dr. TURNER’S suggestions, made to the municipality of Bombay, were eventually submitted to the Governor of the Presidency, who approved of them so far that in the beginning of November certain appointments for the purpose of facilitating the proposed research were announced, but since that time nothing seems to have been done. Considering that hitherto all in India have yielded almost to the disease check attempts no result it is obvious that every effort of whatever kind should be made to throw more light on the pathology and propagation of plague. But the serious question of inducing the population to acquiesce in sanitary precautions will still remain, and for this dilemma there would seem to be no
annual loss of life for the last eight years, whereas in European maritime countries the landing of plague patients from vessels coming from Indian ports has never been followed by remedy. v any considerable extension of the disease. Differences of climate do not account for this recent immunity of the The Functions of the General western nations, for all regions of Europe except the most Medical Council. northerly have been the scene of devastating epidemics at NOTWITHSTANDING much that has been written and intervals during the last 600 years. In Europe, however, at various times with regard to the powers, the the idea has always been held that protection was to be printed ] obtained by interposing some barrier between the sick and duties, and the responsibilities of the General Medical the healthy. In former times it was hoped that thisiCouncil, we frequently receive evidence that these are not so could be accomplished by rigorous quarantine and by correctly i understood in the profession as they should be. cordons round infected often ; Letters reach us describing possibly some serious towns ; many persons also, military where circumstances permitted it, deserted their homes aptabuse or some crying evil and indignantly inquiring why the first alarm of plague and lived elsewhere till the danger the Council permits this, that, or the other subject of comwas past. In modern times the underlying idea is the same plaint, or why the Council does not put a stop to the ] but the method of applying it is so much improved that conduct, of whatever nature, that is impugned. A letter caused seven
an
or
enormous
during
the
succeeding
years.
under the direct eye of His MAJESTY the KiNG, paid for by a layman, and constructed in accordance with the choice and directions of a committee which is partly composed of laymen and in the hands of which the management will later be vested, Yet medicine is
THE LANCET. LONDON: SATURDAY, JANUARY 2, 1904.
adequately-the public might even think preponderatingly-represented at every step of the proceedings. Research work into the origin of cancer is being busily pursued with funds largely subscribed by the public, and if the bulk of the investigations naturally falls to pathologists the help of all scientific students is freely p and acknowledged. It must be observed, too, d demanded the funds are being subscribed not by an ignorant t that ppublic who think that a certain sum of money being certain results must automatically follow, but by p paid a thoroughly intelligent public, again with the KING as a t the dominant spirit, who have grasped the point that d definite knowledge must not be expected too soon, or i: at any fixed period, from such labours as those indeed 1] undertaken by the workers in the pathology of cancer. No knows in which direction a profitable start may be c one r for such investigations, and here it is well to say made
The Public and the Medical Profession. beginning of the year is naturally made a season for moralising and we claim indulgence for a few words of serious reflection upon the relations now existing between the public and the medical profession. Each New Year’s day is a milestone at which we pause, now to look back on the road already covered and now to look forward at the track stretching ahead. Instinctively we try to prePart of sume tha future from the experiences of the past. such a necessary review of the position of things medical we have already presented to our readers, for in the Annus Medicus, published in the last number of the old THE
year, will be found a summary of the medical events of that year as they have been recorded, collated, or commented upon in our columns. It remains to surmise what
t that
great issues must not be attributed to the fact that c certain carcinomata, and new growths which have been ex-very generally classed as carcinomata, exhibit retrogression
the directions in which medical advances may be pected during 1904, while assu-ing our readers that no tunder treatment with radium or the x rays. The progress efforts will be spared on our part to assist the cause in i therapeutics thus implied is most important, and unIt is particularly desirable that we should idoubtedly during the year now begun medical practitioners of progress. be able to anticipate in thought the more importantwill mutiply their observations and experiments along this medical and professional tendencies, for, as we have fre- line ; but the public ought to understand from them that quently insisted, the work of THE LANCET is essentially many of the claims made for the treatment of cancer by the cooperative. We can only give to our readers the latestx rays and by radium are as yet unproved. That certain medical learning and the most practical professional in- cases have derived benefit is sure, and just so sure is it that formation if we, in our turn, are helped by our readers. no general therapeutic law has been revealed for the All editorial efforts would be futile if we did not findremedy of cancer. We need hardly multiply instances to that the public at large are aroused to a sense of among our public many willing and happy to communicate prove ] 1 us with their professional brethren, thus rendering the responsibilities of medicine and of the debt that is through Contributions to the hospitals our pages a bureau for the collection and redistribution ofowed to our profession. of It is that a which grows steadily higher our colon scale munificence valuable, therefore, knowledge. many laborators should know the directions in which useful are chronicled week by week ; the daily papers are developments, whether scientific or professional, may be: full of correspondence showing an almost embarrassing It is generally impossible to say that any interest in the affairs of the same institutions ; tropical looked for. are
.
one
fact contains a more useful lesson thanmedicine is recognised as an adjuvant to Imperial expanthat one question in medical ethics has a deeper sion, and hygiene is now steadily preached from pulpits. significance than another; and it is not in any The ignominious end to an eccentric onslaught made by the
pathological
another,
or
sociological
,
such manner that we would attempt to prophesy what new National Antivivisection Society upon the work of certain theories or what illuminating deductions may be awaited. physiologists showed the sensible public to be ranged as But it is not impossible to indicate what are the pre- one man on the side of the cause of true medicine. It is valent conditions of scientific research or how the cause ofE unnecessary to say more to show that in 1904 the medical the medical man, as a professional man, can best be: profession in this country will be carrying on their work in an environment which, despite occasional appearances, served. We think that the most noteworthy sign of the timesa will be favourable to the growth of medical science. in regard to medicine is the enormous interest that is: The lesson from all this we take to be that the medical taken by the public in affairs that were wont at one time profession would often be well advised to invite the public to be regarded as purely medical. This is the particularr more into their confidence. This country has, during difference to be observed nowadays both in the discussioni the past quarter of a century, been transformed by educaof purely scientific questions and in the consideration off tion, so that the public are able to appreciate the reasons medical politics ; and everything points to the fact that theafor scientific proceedings in a way which they could not fusion of medical and public interests will become closerr have possibly done in the days of our fathers. Much ,
.
.
37 medical research is the pursuit along specialised lines: for practical purposes the old routine of quarantine has of general scientific procedure ; many therapeutic measures: ceased. The whole question has passed into the hands of are but a particular application of a common know- the medical profession who rely, for the safeguarding of ledge of chemistry or some ancillary science. When the public, on early diagnosis of the disease and prompt there were but three learned professions, and when removal of the patient from his home to an isolation hospital. At the same time the place which he has occupied is disa large proportion of the public was completely illiterate, on the and all persons who have been exposed to infection infected no good purpose was served by any attempt part of the medical man to explain his actions. No are kept under constant observation until the period of member of the laity would have understood the elements incubation of the disease has expired. In India this system Bat now that fails entirely, for the apathy of the population and their of what he proposed to talk about. medicine touches the borders, or passes over into the dislike of European interference lead to wholesale conterritory, of so many other sciences, and now that none cealment of the presence of the disease and to murderous of the public can be called completely illiterate, while a attacks on the sanitary officials with occasional rioting large proportion of them enjoy as good education as the on the removal of a patient to a hospital. Dr. average medical man, there is no need for the medical man YERsiN, as is well known, established the fact that an to feel that he cannot discuss a professional topic with a attack of plague is due to invasion by a specific bacillus, layman. We are not advocating the publication by medical the microscopic recognition of which either in the actual or after cultivation or inoculation forms the men of popular views on disease in the daily press-such un- patient of the modern diagnosis of the disease. There professional action is open to grave abuses and occasionally basis does serious harm. But we are suggesting that medical men are, in fact, only a few other diseases the presence or should be quick to seize on this assistance of laymen, absence of which can be determined with similar rapidity which events prove can be obtained if it is intelligently and precision. Much, however, still remains to be done in sought. The sympathy of the public need not be expressed explaining the etiology of plague and some printed reports only by the support of large educational schemes or the which have reached us show that Dr. J. A. TURNER, erection of splendid buildings. The payment of medical executive health officer of Bombay, has been recommen for the discharge of State or municipal duties, the fees mending that competent bacteriologists should be enof medical witnesses and public vaccinators, the position of couraged to study the relation of plague outside the body medical men working for provident institutions-we quote to the organism which is associated with the disease in The frequent occurrence of plague in these as a few examples-are subjects in which our pro- its clinical aspect.
fession and the public have equal interests.
On the surface frank discussion
these interests may be opposed, but between intelligent men would soon show on which side justice lay. It is this entente eordiaze that we would urge our readers to cultivate during the year now opening.
Plague Research in India. improvement of the public health, and especially for the prevention of epidemic disease, there can be little success unless the general population cooperates with the sanitary authorities. A convincing proof of this is to be found in the behaviour of plague in Asia and Europe respectively, for in India and China it has IN all schemes for the
the lower animals shows that the human subject is not the only host of the specific bacillus, and Dr. TURNER believes, no doubt with perfect correctness, that light might be thrown, by investigation in this direction, upon the prevalence of plague in India. Dr. TURNER’S suggestions, made to the municipality of Bombay, were eventually submitted to the Governor of the Presidency, who approved of them so far that in the beginning of November certain appointments for the purpose of facilitating the proposed research were announced, but since that time nothing seems to have been done. Considering that hitherto all in India have yielded almost to the disease check attempts no result it is obvious that every effort of whatever kind should be made to throw more light on the pathology and propagation of plague. But the serious question of inducing the population to acquiesce in sanitary precautions will still remain, and for this dilemma there would seem to be no
annual loss of life for the last eight years, whereas in European maritime countries the landing of plague patients from vessels coming from Indian ports has never been followed by remedy. v any considerable extension of the disease. Differences of climate do not account for this recent immunity of the The Functions of the General western nations, for all regions of Europe except the most Medical Council. northerly have been the scene of devastating epidemics at NOTWITHSTANDING much that has been written and intervals during the last 600 years. In Europe, however, at various times with regard to the powers, the the idea has always been held that protection was to be printed ] obtained by interposing some barrier between the sick and duties, and the responsibilities of the General Medical the healthy. In former times it was hoped that thisiCouncil, we frequently receive evidence that these are not so could be accomplished by rigorous quarantine and by correctly i understood in the profession as they should be. cordons round infected often ; Letters reach us describing possibly some serious towns ; many persons also, military where circumstances permitted it, deserted their homes aptabuse or some crying evil and indignantly inquiring why the first alarm of plague and lived elsewhere till the danger the Council permits this, that, or the other subject of comwas past. In modern times the underlying idea is the same plaint, or why the Council does not put a stop to the ] but the method of applying it is so much improved that conduct, of whatever nature, that is impugned. A letter caused seven
an
or
enormous