THE ROYAL MEDICAL BENEVOLENT COLLEGE.

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prescribing as gentlemen, instead of tinkering in profession to combine to start men, by guarantee, who drugs as tradesmen, have mistaken their vocation, and had will. The practice of a medical man having some arrangebetter don the apron and use the scissors behind the counter at ment about his drugs and prescriptions with local chemists, Such men, surely, pay themselves but a poor com- I look upon as not a whit less disgraceful and undignified once. pliment when they acknowledge that without their cheap than having a shop in his own house in which to bait his hook for patients with a cheap bolus. If the question of physic their services would be in no request. As a doctor I have travelled over the greater part of the medical reform be sincere, let us determine at once whether world, and nowhere have I seen the medical profession, as medical men are to be doctors or druggists, professional a whole, occupying so high a position socially as at Edingentlemen, or petty tradesmen. Many other common burgh. Of Edinburgh I had a pretty intimate knowledge, practices greatly detract from our dignity as a profession, and I make bold to say that out of the very great number such as brass posters, a yard square, on every available of medical men residing there such a thing as a man sending wall, corner, and railing about a professional man’s house; out a bottle of physic was unknown. Any man doing so the existence of partnerships, and firms so large as almost would never have been supposed even to pretend to the to be co-operative societies-all of which would be con. position of a professional gentleman. But remember, sidered impossible amongst barristers and clergymen; but, "As the twig is bent, so is the tree inclined." We in the meantime, let us hear some authoritative expression shall be told that in many places it is necessary for a of opinion as to whether or no it be fit and proper for medical man to dispense his own drugs. My answer to a professional man to engage in the sale of drugs, in this is that in such a place we shall find a man (probably an however veiled a form.-I am, Sir, yours truly, M.D. UNIV. EDIN. Apothecary Smith or Brown) wishing to be considered a June 7th, 1882. medical gentleman, but who is not too proud to cater for popularity by the sale of cheap physic. Let Apothecary THE ROYAL MEDICAL BENEVOLENT Smith cease to undersell the legitimate tradesman, and the COLLEGE. chemist and will soon on the druggist appear professing while

scene. We shall further be told "the system possesses l’o tlte Editor of THE LANCET. great convenience for the public." If this is to be considered SIR,—In your impression of last week you very briefly before professional dignity, then let me suggest to Apothenotice the benevolent and generous act of a member of the the addition of and tea, tobacco, cary Smith sugar to his Mr. France, who a second time places a presenta. have to profession, shop. What right such "druggists" expect any social position other than that accorded to petty tradesmen ? tion to the St. Ann’s Asylum at the disposal of the Council

Could a medical officer in the army expect that his brother officers should sit down with him at the mess-table if they knew that he had been engaged during the day in selling drugs, rolliog up pills, and wrapping up bottles ? and if such occupation is unbecoming an officer and a gentleman in the army, why should it be less so in civil practice ? But what reason can men engaged in practice in large towns-ay ! physicians ( ?) and surgeons to public hospitals-advance for such a procedure ? Surely none other than that of catching patients with the bait of cheap pills. At a medical meeting held in Brighton last year, no one with the reputation and credit of the profession at heart could have listened without blushing when some of the gentlemen (?) present advocated the necessity of apon the ground of teaching embryo physicians " the counter trade of the profession." Are these the men who expect an increase of social status ? Are these the men who by virtue of their profession ought to be worthy of wearing Her Majesty’s uniform, or to be presented at Court? But, worst of all, are these the men with whom oneself is liable to be classed as a brother physician ? Surely the respectable non-dispensing members of the profession are numerous and strong enough to commence a reform, and in doing so let us strike at the root of the evil, and teach our medical students to aspire a little higher than the obtaining of a licence from a commercial company, at present driving a roaring trade between the sale of drugs and medical licences. At the meeting before mentioned we were told that "young medical men appeared for the examinations for the army and navy so ignorant that they could only exercise their profession at the risk of the lives of their unfortunate patients." These men were, of course, rejected for the services, but, being qualified, are in practice as civilians somewhere-where ? Are these the men, I wonder, who can only get on by selling cheap pills ? But what we should all want to know is this : From what schools these men came, and what qualifications they held. It ought to be possible, for the great good of the profession, to obtain through the War Office and Admiralty the number of rejected men, their schools and qualifications, during the last ten years, and in future to have after each army examination the number, schools, and qualifications of the rejected published in THE LANCET. If this be done, I fancy I know of a licence which will occupy unenviable precedence. The question of druggists’ prices may be one which the medical profession, on behalf of the public, may have to go into, as there is no reason why a druggist should receive more than an ordinary trade profit any more than the grocer. We know by the advertisements of leading pharmaceutists, that drugs of the best quality can be more than ordinarily well compounded and sold at a very low rate, so that if the druggist of the present day will not lower his prices to what will leave only a legitimate trade profit, it may be possible for the medical

prenticeships

of the Royal Medical Benevolent College, for the education of an orphan daughter of a medical man. I would, for the sake of the widow and orplian, there were many more amongst us able to follow so noble an example. There is one other subject in connexion with the Royal Medical Benevolent College which just now has special interest for a large number of your readers, but which has not been noticed in your pages. I refer to the result of the recent election of foundation scholars and pensioners. It will gratify those who were anxious for a change in the mode of election to know that all the candidates recommended by the Committee of Examination were duty elected : a proof of the success which has attended the working of the new rule, and of the confidence of the governors in the judgment of the committee. With reference to the pensioners, the result was not quite so successful, as only one of the two recommended was elected. This is to be accounted for thus: There were twenty-one candidates on the list to fill two vacancies, and several of these brought up a large cumulative vote from former elections. It was but natural, indeed only generous and considerate, of the governors to wish to save from further disappointment and expense those candidates whose claims had been urged year after year without success, even before the new rule came into force. At the same time it was satisfactory to find that an aged member of the profession (eighty-nine years of age) up for election for the third time, and whose chance had hitherto not been great, was placed at the head of the list of the unsuccessful candidates, and will in all probability be elected at the next vacancy. It is, however, much to be deplored to find that, while the list of candidates for pensionerships and scholarships is on the increase and more urgent, the income of the College is lagging far behind what it ought to be, and is, in truth, quite inadequate to meet current expenses, so that we have the melancholy satisfaction of knowing that not a tenth part of the poor widows and orphans can ever hope to be successful. A more generous response on the part of the great body of the profession to the special appeal lately issued by the Council (10s. a year from the body of 20,000) would help to carry glad tidings to those overtaken by misfortune and broken down by age, and to the orphan child of a brother who succumbed early in the battle of life, and without leaving any provision behind for a dear one now doomed to appeal in vain for help. That there is great need for a larger-hearted charity amongst us was vouched for by the chairman of the annual meeting, Dr. Jonson, who, as is well known, has for many a long year taken a deep and active interest in the welfare of the College, and with whose testimony to this effect I trust you will allow me to close this communication. His words have a wider value, also, as an expression of opinion on the working of the new rule which governs the elections. Dr. Jonson said : ’ With regard to the duty imposed on the Committee of Examination, speaking more

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1099 for himself, he might say, not only was he most be drawn in every instance, as much depends on the nature anxious to carry out the wish of the governors impartially of the disease or injury. We must remember that this and conscientiously, but he believed he and his colleagues apparently harsh refusal does not debar the patient from had fully succeeded in so doing in every way-a view en- obtaining any medical assistance whatever. Advice may be dorsed by the result of that day’s election. He was, at all had from hundreds of competent medical men for a fee no events, quite certain of this : that the comparative claims greater than the travelling expenses incurred by many sick and needs of the several candidates had, in every instance, people who visit the out-patient department. Should operabeen most carefully and fairly weighed before being adjudi- tions or special treatment be needful amongst this class, cated upon. The more thorough investigation made in each medical men, as a rule, recommend such cases to the hoscase had, possibly, occasionally struck a deeper chord of sympitals-a plan of inestimable value to students and staff alike. The apparent remedy for the well-known abuse of the pathy on behalf of one candidate than another, because of his having been brought more closely and intimately in contact medical charities is charity organisation, which might be with the friendless or more destitute among them ; but he attempted by the society that has already done so much was quite sure that in no case, on this account, had subgood in the guidance of charity. stantial justice failed to be done. He had also, perhaps, I am, Sir, yours obediently, become somewhat more forcibly impressed than he was ALFRED WISE, M.D. June, 1882. before-or he might say had become more conversant with the fact-that a good deal more poverty prevailed amongst "THE OPERATION OF SPAYING IN WOMEN." our brethren, especially in the poorer agricultural districts, To the Editor of THE LANCET. than he had an idea of. Numbers of medical men were barely able to supply their families with the necessaries of SIR,—It is evident that we are playing at cross purposes life ; what, then, could they do for the education of their with words. " Spaying a pig" is the removal of the healthy children? Absolutely nothing; consequently they were of a healthy animal. To call any operation I appendages in much was a state of This growing up ignorance. things to be deplored, and which could only be remedied by the have ever done " spaying" is just as reasonable as to describe exercise of a larger-hearted benevolence on the part of those the removal of a suppurating or cancerous eyeball as a case blessed with the means and willing to aid the Council in the of " Western gouging." This is proved by the facts that I have published all my cases, have publicly exhibited all my more active duties of charity-extending the blessings of the specimens, and that the majority of them have found perMedical Benevolent Royal College." manent resting-places in our public museums, particularly I remain, Sir, your most obedient servant, the museum of the Royal College of Surgeons, where you M. R. C. S. June 1882. Bedford-square, 26th, may see them for yourself.-I am, Sir, yours &c., LAWSON TAIT. Birmingham, June 20th, 1882. ARE HOSPITALS TO BECOME HOTELS ? **The term "spaying of women" means the removal of To the Editor of THE LANCET. the functionally active ovaries ; in German the operation is SIR,—Rather than diminish the swelled numbers in the called " Castration der Frauen."" Normal ovariotomy, out-patient room, would payments not attract more persons, Battey’s operation, are terms which have been applied to who would be less ashamed to enter when a fee was pay- the same procedure. We are not playing at cross purposes. able ; and would it not also compel the general practitioners We mean the operation which Mr. Lawson Tait has been living in the neighbourhood of hospitals to reduce their fees performing for some time past.-ED. L. to the insignificant charges of these institutions, or lose their lower middle-class patients ? If amongst the same class of "DISPLACEMENTS OF THE UTERUS." persons who now frequent the out-patient departments payTo the Editor of THE LANCET. ments were demanded, is it reasonable to suppose that a small fee in the hospitals would impel many to pay a a leading article published in to-day’s LANCET SIR,—In larger fee to an outside practitioner? Already the treat- you are good enough to quote a statement of mine for comment in large institutions has the advantage of being characterised as "higher treatment." Self-pride alone parison with one of Dr. Vedeler’s. This author’s researches deters thousands of the middle class from availing them- show that anteflexion occurs in 68 per cent. of virgins and selves of medical charity. Remove the charitable ele- nulliparous women. I am quoted to the effect that I found this condition in 48 per cent. of the same class-a number so ment and the pride will be extinguished. In the wards, we must remember that there is already an different from Dr. Vedeler’s that inaccuracy somewhere might insufficient number of beds for the present needs of deserving reasonably be suspected. Will you allow me to point out that 48 per cent. (to be persons, who when laid on a bed of sickness are unable to follow their employment, and have but a portion of the last exact, 47’7) is the proportion I found of pronounced anteweek’s wages in their pockets. That these are the folk flexion. If all cases, both slight and well-marked, be taken, portrayed trom pulpit and press when appeals are made to my figures show, out of III nulliparous women, 67 cases of the benevolent for funds, there can be no manner of doubt ; anteflexion, or a percentage of 60’5 per cent., a proportion and the public as a body intend their donations for bestowal not widely differing from that which Dr. Vedeler found in on this class only. It has been urged that payments should the same class of patients-viz., 66 per cent. I remain, Sir, yours, &c., be made by those persons a little above the needy class; G. ERNEST G. ERNEST HERMAN. " who could pay for ordinary medical skill, but Finsbury-circus, June 24th, 1882. could not always pay for the highest available degree of skill." If this refers to operations and other serious cases which require unusual or special treatment, the THE HERTFORD BRITISH HOSPITAL. answer is simple enough. These are not the patients which crowd the hospitals. A greater latitude should be given to (By a Correspondent.) the admission of such cases, as being of value for clinical THE Hertford British Hospital is an institution which the study and instruction. The overcrowding occurs in the outpatient departments, where the junior physicians and poorer classes of British nationality owe to the benevolent surgeons, especially the physicians, are saddled with num- generosity of Sir Richard Wallace. It originated as an bers far beyond their control. The prestige of the hospital to an ambulance during the two sieges of Paris in attracts these people, but they are fortunate if circumstances appendage and 1871, but within a year it became a distinct and 1870 their more or them to consult than once physician permit twice in a month, as the majority of them are under the ob- ultimately a permanent establishment. Early in January, servation of students. It is idle to contend that this is 1871, when the siege by the Germans was at its height, " higher treatment" than could be practised by any outside Sir Richard Wallace opened for the benefit of the sick medical man with ordinary capacity, unless we ignore the British shut up in Paris two wards adjoining his hosqualifications of the general practitioner to practise at all, pital forpoor the wounded in the Rue d’Agnesseau, and also a under the of shelter consultation. except The abuse of hospitals must be met by the cold refusal dispensary for the relief of out-patients. of charity to improper persons. No hard-and-fast line can On the 1st of August all the patients, both civil and mili-

particularly