2. Cases in Surgery Illustrative of the New Method in Applying the Wire Ligature in Compound Fractures of the Lower Jaw. By HUGH ART. XIII.—The Life, Character, and Writings of Benjamin Bell, F.R.C.S.E., &c. By his grandson, BENJAMIN BELL, F.R.C.S. E., &c. ART. XIV.-Infantile Temperatures in Health and Disease. By WILLIAM ART. XV-Cataract and its Treatment. By JABEZ HOGG, F.L.S. ART. XVI.-Phthisis and the Stethoscope; or, the Physical Signs of Con- ib. ART. XVII.-Diaphoresis; a Powerful Aid in the Arrest and Removal of Human Disease, and thereby Prolonging Life. By CHARLES CLARK, ART. XVIII.—On the Nature and Treatment of Hereditary Disease with reference to a Correlation of the Morbific Forces. By J. M. WINN, ART. XX. De la Contagion seule cause de la Propagation de la Lepre. Par ART. XXI.-Hooping Cough; its Pathology and Treatment. By PATRICK ART. XXII.-Essentials of the Principles and Practice of Medicine. A Hand- ART. I.-On Spontaneous Combustion. By ALEXANDER OGSTON, M.D., Aberdeen; Assistant-Professor of Medical Jurisprudence in the Uni versity of Aberdeen, and Ophthalmic Surgeon to the Aberdeen Royal ART. II.—On the Variety of Periosteal Disease of the Skull generally known as Fungus of the Dura Mater. By LAWSON TAIT, Assistant-Surgeon ART. III.—An Inquiry into the Real Nature of Hysteria. By D. De BERDT ART. IV. The Causes of Insanity in Arctic Countries. W. LAUDER LINDSAY, M.D., F.R.S.E., Physician to the Murray Royal Institution ART. V.-The Functions of the Tympanum. (A note to an "Original Com- munication,” thus entitled, in this Review,' in the year 1867.) By JAMES JAGO, M.D. Oxon., A.B. Cantab.; Physician to the Cornwall Official Memoranda respecting Scarlatina and Relapsing Fever Chronicle of Micrology. By J. F. STREATFEILD, F.R.C.S. Chronicle of Physiology. By HENRY POWER, F.R.C.S., M.B. Lond. Report on Surgery. By JOHN CHATTO, M.R.C.S.E. THE BRITISH AND FOREIGN MEDICO-CHIRURGICAL REVIEW. JANUARY, 1870. Analytical and Critical Reviews. I.-Medical Politics.1 ASSOCIATIONS formed for the purpose of exercising influence rather than of gaining legal powers are a new feature in our profession. Being a novelty, they are somewhat uncertain of their position, cautious in proclaiming their real character, and prone to disguise it by the assumption of scientific or benevolent intent. As we see no shame in the true bond of union, we shall, for the nonce, ignore these by-ends, and, without apology for lifting their veils, salute the British Medical Association and its twenty provincial branches, the Medico-Political Association, the Medical Teachers' Association, and several ethical societies scattered throughout the kingdom, as true political leagues. We welcome them with peculiar joy. Their use to the student of human affairs is very great, for they give him an opportunity of knowing the opinions of visible numbers of visible men, instead of trusting to their self-elected reflection in anonymous periodicals. It is needless to say that their primary object is to raise the rank of the profession in the commonwealth, and they come before the public as looking to the aid and protection of the State in various forms with this intent. The introductory question which naturally must occur is— 1 The Medical Profession and its Educational and Licensing Bodies. By E. D. Mapother, M.D., Professor of Anatomy and Physiology, Surgeon to St. Vincent's Hospital, &c. Dublin, 1868 (Carmichael Prize Essay). General Medical Council; Report of the Committee on Professional Education, with Appendices. London, 1869. Reports of Meeting of British Medical Association at Leeds, British Medical Journal, August and September, 1869. Address of Samuel D. Gross, M.D., President of the American Medical Association. Philadelphia, 1868. 89-XLV. 1 Why should the State interfere at all? What are the gravamina which its power is evoked to remove? (1) In the first place medical men have to complain that the profession is rendered less influential as a body, and its individual members lessened in social consideration, by the legalised admission into their flock of incompetent practitioners, who do not receive, because they do not deserve, the confidence of their countrymen. Let any of our readers go to a chemist's shop in the artisans' quarter of any large town after work hours, and the crowds paying cash for advice and medicine, which they might at will get either gratis or on credit, or for a very small sum, from a registered practitioner, will make him hang his head and sadly confess that the millions do not receive the present legal guarantee as any evidence of the capacity of a medical man. Dr. Heslop, of Birmingham, in a terribly suggestive pamphlet on "The realities of medical attendance on the sick children of the poor in large towns," gives the statistical details of an inquiry which he has conducted as to the means adopted by a consecutive series of 384 parents among the lower classes for relieving the ailments of their offspring. He found that nearly half had been without any advice at all, fifteen, or two fifths of the whole, had obtained it solely from a druggist or herbalist, and only forty-two had been to a medical man. At a colliery, in which the present writer was interested, a neighbouring practitioner of some standing, M.D., M.R.C.S., L.R.C.P., London, L.S.A., was salaried to attend the underground hands. He enjoyed a sinecure; for a deputation from the gangs waited on the foreman and represented that the owner's kindness was thrown away; since they preferred, when ill, to take their burnt skins or disordered stomachs to what they suggestively called "the regular bonesetter." The unregistered practitioner was evidently viewed in the West Riding as a more orthodox institution than his titled rival. Examples of this temper among the working masses will occur to every one, if he will temporarily remove from his eyes that bandage which esprit de corps has lovingly bound round them. In the case which is the subject of the last anecdote the contempt for the authorized adviser was quite unmerited; but when we read in Dr. Heslop's pages "ignorance, recklessness, and hardness of heart," attributed to the established attendants on the labouring classes, we can easily understand the ill savour of the ointment, even though we should allow that no greater source of fetor than dead flies ap pear on the surface. The distrust generated by individual instances is reflected upon our whole body. Ask an ordinary club cynic, who is declaiming against "the doctors," a reason for the faith, or rather want of faith, which is in him, and he is sure to answer by citing cases of wholesale or retail stupidity; and these are held to justify a disbelief, not only in physicians, but in physic altogether. Now, the disgrace brought on us by unworthy members is, with a considerable amount of justice, ascribed to the imperfection of the tests which the State sanctions as enough to prove a man's competency to practise. Those who have the power of helping themselves reject those tests altogether. The army authorities submit candidates to a second examination, not on military but on general subjects. They consider that a medical adviser, who has been pronounced good enough to prescribe for the squire and the ploughman, is not proved thereby sufficiently expert to attend their brothers, the captain and the private. The Admiralty is equally careful of the lives of those who enter its service. Hospital authorities act in a similar way; they require private certificates of professional ability from the candidates of house-surgeoncies, and sometimes they submit them to a special examination. County magistrates and conscientious guardians think nothing of the diplomas of those seeking their patronage, but, to justify their choice, demand testimonials by the score, which they are sadly apt to count instead of weighing. (2) Another complaint is that the just gains of qualified persons are intercepted by those who, without any medical training, pass themselves off on the public as competent advisers. As they have spent no time or money on their education they require smaller profits, and, as they have not the knowledge needful for inquiring into the cases of the sick, they can dispense over the counter remedies much quicker and cheaper than any one who tries to cure the patient. The death-rate of the United Kingdom is wonderfully inflated through this broad-casting of drugs by chemists and other shop-keepers out of sheer ignorance, and without any bad intent. or (3) A still more serious evil to the State, though one can scarcely affirm it affects the profession, is license given to persons calling themselves "Coffinites," "Herbalists," "Botanists;" who too often conceal the profitable trades of procurers and aborters beneath the thin veil of selling peculiar drugs. Under the same category come indecent advertisers and prurient museum-keepers. As Englishmen we may abhor their duplicity, but we cannot accuse them of injuring us as medical men. And we must also allow that Government gives them no direct encouragement, and tries to punish their offences after committal. (4) We must, however, bring the very serious charge against Parliament of deriving a dirty addition to the revenue from pledging its authority to patent quack medicines, by which the credit of the medical profession, and the viscera of the Queen's lieges, are injured in a much greater degree than the budget is benefited. People are encouraged, by the dignity of the Royal stamp and special protection afforded to these compounds, to think that in the view of our legislators the drug contributes everything, its administrator's knowledge nothing, towards the cure of disease. This partnership of our honoured Sovereign with a low class of retail dealers is a mode of money-getting compared with which the source of Vespasian's famous tax was cleanly-to the moral sense decidedly "OLET." (5) Medical men also complain that the mode of election, and the tenure of official appointments, under the Poor-law, are not such as to encourage those who seek them to acquire the higher qualities of head or heart. The guardians in populous places usually are of a class not fitted to judge of professional skill or natural tact; and the power to make the appointment of parish surgeon an annual one is a distinct notice that the stingiest ratepayer must have his avaricious cravings satisfied. The plan also of making the salary include the supply of medicines is a temptation to dishonest parsimony, which ought not to be placed before one who works hard for his bread. They complain also that struggling practitioners are driven to work on unremunerative salaries by the implied threat of introducing a rival which is held over them. We might easily add to this list of grievances a good many which, perhaps even more than the above named, seriously afflict the souls of men ambitious and jealous of the honour of their chosen profession. But we are anxious to avoid all capable of being represented as sentimental complaints, and to confine ourselves to the most substantial and universally recognized evils. Let us now come to the remedies proposed, on which we think it more convenient to comment as we go on, rather than to enumerate them first, and then to club our observations together at the end. There appears to be a general consent, not only here but also in the United States, that the presence in our ranks of members morally and intellectually unworthy of the confidence of their countrymen is promoted and kept up by the multiplicity of Licensing Bodies employed by the State. It is said to be the interest of each of them to attract candidates by over-facility, and at the same time to hoodwink the outside world by a false show of high-class requirements. Doubtless the attraction of attention to the matter, and the bringing public opinion to bear by the formation of the Medical Council of Education, has of |