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THE SURGICAL ASPECT OF TUBERCULOSIS.
UNQUALIFIED ASSISTANTS AND THEIR PRINCIPALS.
1134
weekly payment of one halfpenny each. Nor is this offer without warrant, because when illness does occur a medical man drives up in a smart victoria, the coachman’s hat being decorated with a cockade.
to be precluded from earning their living as assistants ? I should hope not. It was misfortune-not their fault-that obliged them to abanSuch a don a profession they would have aclorned. In the notice printed in man was my late assistant. THE LANCET above the advertisements affecting those gentlemen you state that the General Medical Council do not object to their being employed by practitioners when resident in or near their employers’ houses. Permit me to state that my assistants are always under my immediate supervision. We work at the same surgery, and I always take the greatest precaution before accepting the services of unqualified men to warn them that none of the privileges which principals have imposed upon them by the General Medical Council must be ever broken through. Whether those conditions were broken through in this case or not your readers I certainly do not think so. can now see for themselves.
spent studying medicine,
,a
T
fUT!.
Sirs.
vours
faithfullv,
ADMIRER.
Oct. 29th, 1895.
To t7to Editors of THE LANCET. of Convocation of Victoria University, held at Manchester on Wednesday, Dr. John Brown moved a resolution, which, in view of the forcible articles now appearing in your pages under the title"The Battle of the Clubs," will be read with particular interest : " That, in the opinion of Convocation, it is desirable that medical graduates of Victoria University should decline to .accept any appointment of any medical aid or similar association in which the conditions of the appointment are such as to degrade the professional man to the position - of a paid servant in a trading company." The motion was not proceeded with, but I submit that it is the kind of action taken by Dr. John Brown that is most required if the profession at large is to preserve its self-respect and indeI am, Sirs, yours faithfully, pendence. .1U...D. Kensington, Oct. 31st, 1893.
SIRS,—At the annual
meeting
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T
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qirz
Vnllr.<1
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JAMES J. PHELAN, L.R.C.S. 84, Rodney-place, New Kent-road, S.E., Oct. 31st.
I ,
Irel.,
&c.
THE SURGICAL ASPECT OF TUBERCULOSIS. To the Editors ot THE LANCET.
SiRS,-In common with many of your readers, I have read Mr. Treves’ address in THE LANCET of Oct. 26th with great UNQUALIFIED ASSISTANTS AND THEIR interest. It is refreshing to read his vigorous comments on PRINCIPALS. the use of that "ghostly relic of the past"-the word To the Editors of THE LANCET. "scrofula." So-called 11 tonic," cod-liver oil, and iodine Sms,-In your issue of the 26th inst. I notice that you paint he dismisses with as much contempt as on previous have drawn the attention of your readers to an inquest held occasions he has dealt with that belated ghost, the linseed the previous week in the Newington Mortuary (S.E.) on the poultice. May they all be comfortably buried in the ninebody of Ellen Preswell, an infant of seven weeks. The teenth century. There is, however, one point in Mr. mother resided at 77, Pollock-road, Walworth, and was con- Treves’ paper that I think deserves greater emphasisfined of twins early in September. In commenting on this viz., the importance of insisting on climatic treatment in the earliest stage of surgical tuberculosis. This .case you state that you have derived all your information from the Daily Teleqg-ap7t, and you add further that you principle is readily admitted in theory, but, judging from shall be glad if there be any incorrectness in your version of my own experience, is not always acted upon in actual the facts to have them corrected by the principal in the case. practice. It is pitiable to see the hopelessly incurable cases I gladly avail myself of your kind offer. The report is not that drift down to this district after they have wasted months and even years in trying the effects of .correct, because, in the first place, it would make it appear valuable I that my assistant attended Mrs. Preswell in her accouchehypophosphites,"cod-liver oil, and so-called tonics. The ment ; and, secondly, that he received a fee for so attending. profession and the public have at last recognised the useSuch is not the case. I, personally, attended her, and, with lessness, if not cruelty, of sending cases of advanced the exception of the nurse, no one else, certainly no medical pulmonary tuberculosis to linger and die away from Is it too much to ask that surgical tuberculosis man, was present during her delivery. The mother after- home. should be considered from the same standpoint ? I am wards made a very good recovery, but of the children I had aware that the tubercle bacillus in attacking the It assistant a is true that quite quite very slight hopes. my paid few visits to Mrs. Preswell when she was in the convalescent lung is attacking a vital organ ; at the same time the is sufficiently exact to demand a similar method of stage, and on one of these occasions he received my fee for analogy treatment. There are dozens of excellent health resorts in is I thinkher. There about that, attending nothing wrong in to the use of the word England adapted for cases of surgical tuberculosis; in fact, nothing, justify my opinion, "fraud," nor for the insinuation that I allowed my un- they outnumber by ten to one the resorts suitable for cases of disease, because in the treatment of the former a qualified assistant to do the most important part of my pulmonary work. Although, from the beginning, I had very little hopes calm and equable temperature is not of such great importof either of the infants surviving, I refused a certificate on ance. Much more could be said on this subject, but I do the death of the second child as a protest against what not wish to labour the point. We who live away from are able to testify to the sometimes extraappeared to me to be negligence on the part of those crowded cities most responsible for seeing it was properly attended to. ordinary effects of plenty of fresh air and sunshine with It is not because the child was of premature birth and appropriate surgical treatment. I am glad to see such ,delicate that every care should not be taken to preserve a distinguished authority as Mr. Treves protesting against At any rate I did over-operating in gland cases. Many glands that I have its life or prolong its existence. not, under the circumstances, feel justified in giving a reluctantly given the benefit of the doubt have disappeared, the use of the knife, tonics, or even certificate, and as my conscience rules my conduct, I am to my surprise, without afraid under similar conditions I would again feel obliged to hypophosphites. I know of few problems more difficult to refer the matter to the coroner. My assistant did not give a decide than the exact time to operate in some cases of - certificate in the case of the child first dead. When she tuberculous glands. I trust that it may not be presumptuous a provincial practitioner to have called special attention applied for it I was ill in bed, and to save me the trouble he for the importance of the climatic treatment of tuberculosis simply filled in the blank spaces and I certified the cause of to - death. I could, of course, do so in this case, as the interval of bones, joints, and glands at the earliest possible period, between birth and death was comparatively short, besides and that this variety of the disease should be treated on the same principles as obtain in the treatment of tuberculous having warned the mother when the child was born that nhthisis. I am. Sirs. vours faithfullv. The more likely than not she would not be able to rear it. BERTRAM THORNTON. Oct. 1895. 29th, seen Margate, other I had not for some weeks previous to its death. Was I not right to refuse a certificate ? I think so. "Unqualified assistant" seems now to be a term of reproach. INFECTIOUS DISEASES IN MAN AND Why I know not. Many men that I know of passed creditably BEAST : A SUGGESTION. .every examination but the Final, and previous to its coming oN were obliged through death or unexpected reverses of To the Editors of THE LANCET. fortune to leave their college and earn their own living. those men to of even as SIRS,-The my knowledge led, subject which I venture to bring before your Many students, exemplary lives ; some of them gave evidence of superior readers is of such wide scope that I must condense my intelligence-and are they now, after the years they remarks as much as possible. It is now fully recognised,
1134
weekly payment of one halfpenny each. Nor is this offer without warrant, because when illness does occur a medical man drives up in a smart victoria, the coachman’s hat being decorated with a cockade.
to be precluded from earning their living as assistants ? I should hope not. It was misfortune-not their fault-that obliged them to abanSuch a don a profession they would have aclorned. In the notice printed in man was my late assistant. THE LANCET above the advertisements affecting those gentlemen you state that the General Medical Council do not object to their being employed by practitioners when resident in or near their employers’ houses. Permit me to state that my assistants are always under my immediate supervision. We work at the same surgery, and I always take the greatest precaution before accepting the services of unqualified men to warn them that none of the privileges which principals have imposed upon them by the General Medical Council must be ever broken through. Whether those conditions were broken through in this case or not your readers I certainly do not think so. can now see for themselves.
spent studying medicine,
,a
T
fUT!.
Sirs.
vours
faithfullv,
ADMIRER.
Oct. 29th, 1895.
To t7to Editors of THE LANCET. of Convocation of Victoria University, held at Manchester on Wednesday, Dr. John Brown moved a resolution, which, in view of the forcible articles now appearing in your pages under the title"The Battle of the Clubs," will be read with particular interest : " That, in the opinion of Convocation, it is desirable that medical graduates of Victoria University should decline to .accept any appointment of any medical aid or similar association in which the conditions of the appointment are such as to degrade the professional man to the position - of a paid servant in a trading company." The motion was not proceeded with, but I submit that it is the kind of action taken by Dr. John Brown that is most required if the profession at large is to preserve its self-respect and indeI am, Sirs, yours faithfully, pendence. .1U...D. Kensington, Oct. 31st, 1893.
SIRS,—At the annual
meeting
r
T
<>111
qirz
Vnllr.<1
ffnthfnilv
JAMES J. PHELAN, L.R.C.S. 84, Rodney-place, New Kent-road, S.E., Oct. 31st.
I ,
Irel.,
&c.
THE SURGICAL ASPECT OF TUBERCULOSIS. To the Editors ot THE LANCET.
SiRS,-In common with many of your readers, I have read Mr. Treves’ address in THE LANCET of Oct. 26th with great UNQUALIFIED ASSISTANTS AND THEIR interest. It is refreshing to read his vigorous comments on PRINCIPALS. the use of that "ghostly relic of the past"-the word To the Editors of THE LANCET. "scrofula." So-called 11 tonic," cod-liver oil, and iodine Sms,-In your issue of the 26th inst. I notice that you paint he dismisses with as much contempt as on previous have drawn the attention of your readers to an inquest held occasions he has dealt with that belated ghost, the linseed the previous week in the Newington Mortuary (S.E.) on the poultice. May they all be comfortably buried in the ninebody of Ellen Preswell, an infant of seven weeks. The teenth century. There is, however, one point in Mr. mother resided at 77, Pollock-road, Walworth, and was con- Treves’ paper that I think deserves greater emphasisfined of twins early in September. In commenting on this viz., the importance of insisting on climatic treatment in the earliest stage of surgical tuberculosis. This .case you state that you have derived all your information from the Daily Teleqg-ap7t, and you add further that you principle is readily admitted in theory, but, judging from shall be glad if there be any incorrectness in your version of my own experience, is not always acted upon in actual the facts to have them corrected by the principal in the case. practice. It is pitiable to see the hopelessly incurable cases I gladly avail myself of your kind offer. The report is not that drift down to this district after they have wasted months and even years in trying the effects of .correct, because, in the first place, it would make it appear valuable I that my assistant attended Mrs. Preswell in her accouchehypophosphites,"cod-liver oil, and so-called tonics. The ment ; and, secondly, that he received a fee for so attending. profession and the public have at last recognised the useSuch is not the case. I, personally, attended her, and, with lessness, if not cruelty, of sending cases of advanced the exception of the nurse, no one else, certainly no medical pulmonary tuberculosis to linger and die away from Is it too much to ask that surgical tuberculosis man, was present during her delivery. The mother after- home. should be considered from the same standpoint ? I am wards made a very good recovery, but of the children I had aware that the tubercle bacillus in attacking the It assistant a is true that quite quite very slight hopes. my paid few visits to Mrs. Preswell when she was in the convalescent lung is attacking a vital organ ; at the same time the is sufficiently exact to demand a similar method of stage, and on one of these occasions he received my fee for analogy treatment. There are dozens of excellent health resorts in is I thinkher. There about that, attending nothing wrong in to the use of the word England adapted for cases of surgical tuberculosis; in fact, nothing, justify my opinion, "fraud," nor for the insinuation that I allowed my un- they outnumber by ten to one the resorts suitable for cases of disease, because in the treatment of the former a qualified assistant to do the most important part of my pulmonary work. Although, from the beginning, I had very little hopes calm and equable temperature is not of such great importof either of the infants surviving, I refused a certificate on ance. Much more could be said on this subject, but I do the death of the second child as a protest against what not wish to labour the point. We who live away from are able to testify to the sometimes extraappeared to me to be negligence on the part of those crowded cities most responsible for seeing it was properly attended to. ordinary effects of plenty of fresh air and sunshine with It is not because the child was of premature birth and appropriate surgical treatment. I am glad to see such ,delicate that every care should not be taken to preserve a distinguished authority as Mr. Treves protesting against At any rate I did over-operating in gland cases. Many glands that I have its life or prolong its existence. not, under the circumstances, feel justified in giving a reluctantly given the benefit of the doubt have disappeared, the use of the knife, tonics, or even certificate, and as my conscience rules my conduct, I am to my surprise, without afraid under similar conditions I would again feel obliged to hypophosphites. I know of few problems more difficult to refer the matter to the coroner. My assistant did not give a decide than the exact time to operate in some cases of - certificate in the case of the child first dead. When she tuberculous glands. I trust that it may not be presumptuous a provincial practitioner to have called special attention applied for it I was ill in bed, and to save me the trouble he for the importance of the climatic treatment of tuberculosis simply filled in the blank spaces and I certified the cause of to - death. I could, of course, do so in this case, as the interval of bones, joints, and glands at the earliest possible period, between birth and death was comparatively short, besides and that this variety of the disease should be treated on the same principles as obtain in the treatment of tuberculous having warned the mother when the child was born that nhthisis. I am. Sirs. vours faithfullv. The more likely than not she would not be able to rear it. BERTRAM THORNTON. Oct. 1895. 29th, seen Margate, other I had not for some weeks previous to its death. Was I not right to refuse a certificate ? I think so. "Unqualified assistant" seems now to be a term of reproach. INFECTIOUS DISEASES IN MAN AND Why I know not. Many men that I know of passed creditably BEAST : A SUGGESTION. .every examination but the Final, and previous to its coming oN were obliged through death or unexpected reverses of To the Editors of THE LANCET. fortune to leave their college and earn their own living. those men to of even as SIRS,-The my knowledge led, subject which I venture to bring before your Many students, exemplary lives ; some of them gave evidence of superior readers is of such wide scope that I must condense my intelligence-and are they now, after the years they remarks as much as possible. It is now fully recognised,