and of Assistants in the College of Surgeons amount only to about 70 persons, while the remaining practitioners in England and Wales are estimated at 15,000. A contention between the two parties must, as it ought, be unfavourable to the former. Thirdly, "That the magistrates at the quarter-sessions shall be authorized to license every ignorant pretender to medical skill who thinks fit to apply." Here, too, I am at issue with your correspondent. According to my conception of the Bill, the magistrates are only empowered to license such as are really in practice when the act shall be obtained, and in the way " in which they shall have formerly acted." They cannot accept or sanction future candidates. Their authority being limited and confined to the present establishment, empirical practice must terminate with this generation. Whatever sentiments we may entertain of the matter, it cannot be denied that irregular pretenders have so many friends in the higher orders of society, that no bill would be passed by the legislature the object of which went to an immediate extinction of quacks. All that can be safely attempted is to secure the suppression of notorious offenders, and provide for the termination of the remainder with their natural lives, or at the will of the magisterial bench. Suppose the magistrate to disallow only nine in ten at their first meeting, much good will immediately result to the faculty as well as to the society at large from the diminution, because a greater number of the sick must thereafter apply to the regular fraternity, and their disorders being, I trust, better understood, would be more skilfully treated. Fourthly, "The sale of stamped medicines shall be countenanced and legalized in omnia secula seculorum. Here again your correspondent and I entertain very different opinions. In my judgment the Bill neither affords additional "countenance, nor legalizes the sale of stamped medicines.” They are left in statu quo. They are at present sanctioned by the legislature, and the bill merely declares that it does not "extend to prevent or hinder any person or persons from selling any drugs or medicines on the sale of which any stamp duty is by law imposed, in like manner as they might have heretofore done." It would be folly in these times to try to oppose the stream of popular prejudice, and therefore the contest is prudently avoided. The gentlemen of the Law deemed it necessary to insert the clause in question, to shew that no interference was intended with the present law relative to quack medicines, and of course their advice was admitted. Having briefly noticed, and I trust fully defended the Bill * See Dr. Harrison's Address, p. 110. from from the four objections stated above, I have to observe that. to my knowledge it did include other clauses, which on the recommendation of parliamentary advisers, were omitted in the printed sketch. It was by them judged most prudent to avoid whatever might irritate the corporate bodies, from a belief that with their approbation the bill would experience no difficulties in its progress through parliament. Notwithstanding this courtesy shewn to the colleges, it is proved by their obstinacy that no friendly communication can subsist between them and the partisans of the Bill. They will have no connection with alieni homines as they are pleased to call the friends of reform. The framers of the bill had to consider and provide for three distinct parties, whose prejudices, passions, and interests, unhappily for mankind, are openly opposed to each other, viz. the public, the corporate bodies, and independent practitioners. In some few points they have similar feelings, and may therefore be expected to unite their cordial exertions. To catch and act upon general views has always been a primary consideration with the active partisans; for they well knew that by dividing the force they should weaken the efforts, and probably frustrate the whole plan. Under this impression they limited their endeavour to the gradual amendment of medical men, by filling up vacancies as they occur in the regular establishment with confidential and respectable practitioners. Such is the cardinal hinge, the fundamental object of all their deliberations, and to which the machinery of the bill is made subservient. This, it is true, is slow, gradual, and to the consideration offers a distant mode of obtaining the end. It does not, therefore, accord with the zeal and impatience of sanguine tempers. With them every thing is to be attempted immediately and at once. Nothing must be left for others to achieve. Were the whole attainable and within grasp, I should indeed blame the associated faculty for substituting a timid policy to a bold enterprize. Under existing difficulties, without a medical representative in parliament, we must rely wholly on the justice and obvious tendency of our complaints. Nothing involved, nothing doubtful, nothing concealed, should be hazarded. By attempting too much we shall lose all by carrying on the proceedings with deliberation, we may ultimately obtain every thing. Nor is the end so remote as many suppose. The present generation will soon pass away, and a new one be substituted. Suppose the medical establishment of England and Wales to be 15,000, under the various denominations of Physicians, Surgeons, Apothecaries, and Venders of Drugs. The aggregate lives may, I conceive, be individually worth about seven years' purchase. According to this estimate 2000 new practitio : ners ners will be admitted the first year. Every succeeding year will increase the number. These having been regularly trained and fitted for their momentous duties will act towards their seniors and employers with greater propriety, than we now experience from each other. They will not be led to practise the low arts of the half informed and half instructed, who are the assassins of professional respectability, and of every thing commendable in the art. If persons can at pleasure call themselves Physicians, Surgeons, Apothecaries, and Druggists, without undergoing a competent measure of study, and without possessing a diploma or indentures of apprenticeship, surely some check is wanted to stop the supply of these dangerous fellow labourers. That such things can and are daily committed, no observer will venture to deny. Arrest this torrent for five years only, and I dare hazard an opinion, that the face of things will in that short time be much mended. Lord Kenyon's Bill, as it is called, has not, I think, operated more than ten years, and its effects upon the legal profession are strikingly obvious. The Attornies are already become a different race of men, though many of them commenced their career as humbly as any in medicine, viz. in the two-fold capacity of apprentice and stable-boy, or house-servant. The increased respectability of the young attorney is communicated to the senior members, and general professional character is daily improving, equally to the benefit of the Law and the Clients. Such would, I doubt not, be the pleasing result by securing a better education and preliminary examinations as provided in the bill. Let these improvements be suffered to operate till circumstances will admit of an additional bill. This again may be followed by others. Thus, by zealous co-operation and vigorous exertions, a full and complete reformation may at length be obtained. Such is the prudent, and as it appears to me, the only safe way of proceeding, in a compli cated undertaking where so many interests require to be reconciled, and in an assembly too, where we have no professional brother to defend our cause. H. R. To the Editors of the Medical and Physical Journal. GENTLEMEN, HAVING favoured my former communications with a place in your useful Journal, I have only to request your insertion of the following. Feeling Feeling extremely obliged to SENEX for his information on Scarlatina, as well as his candid remarks on my paper, I should be wanting in gratitude did I not immediately comply with his request.. "It would greatly assist us in estimating the value of Mr. Hamilton's paper on Scarlatina, to be informed whether he has met with any fatal instances from the immediate effects of the disease; or whether the cases he has given us should be regarded as comprising a summary of his whole experience on that head, and as warranting a conclusion, that his practice has been attended with universal success?" To this I answer, that during the prevalence of the disease here (about a year and half) no fatal instance occurred under my immediate care, in which the practice alluded to was early and rigidly pursued. While I announce this success, I ingenuously confess that in two or three instances the disease terminated fatally, in all of which, being either prevented by prejudice, or called too late, the above treatment was not adopted. No fatal instance even of the remote consequences, enumerated by your correspondent SENEX, occurred to me, where the antiphlogistic regimen had been strictly followed. I am also much obliged to T. F. R. for his observation on the same subject, and request he will give venesection a fair trial the first opportunity, when I have little doubt of his complete conviction of its success. I speak thus warmly in favour of phlebotomy, having met with no instance in which its effects seemed the least injurious, but on the contrary, highly beneficial even at an advanced period of the disease. I remain, Gentlemen, With great respect, Ipswich, April 2, 1811. W. HAMILTON. For the Medical and Physical Journal. Account of the Hospitals at Berne, in Switzerland. THERE are in Berne two hospitals, one of which is appropriated to the sick, and the other to the infirm and aged. These are handsome buildings, finely situated, and appear to be well conducted. The hospital for diseases has been built about forty years, and is formed on the plan of those in England. It contains several several airy wards of different sizes, and is capable of receiving 100 patients. The bedsteads are of wood, and without curtains. Patients in this hospital are divided into two classes. One comprehends all those cases which are under the immediate management of the physician; the other takes the cases in surgery. Each class has its appropriate ward. There is also a ward set apart for children; a circumstance of much importance, on account of the frequency of strumous affectious. Several attendants (infirmières) are attached to each ward; and a man and his wife sometimes undertake the care of the men's ward, where the most severe chirurgical cases are placed. It is common in Switzerland for men to become nurses (garde-malades); and even in several towns they get their living by undertaking this employment in private families. Two surgeons and a physician are attached to this hospital. The surgeons have the appointment for life, but the physicians, of which there are four, attend alternately each three months. They receive from the government an annual salary of 1200 francs. There has lately been added to this establishment hot and cold baths, and a small ward for unusually severe cases, and particularly for epileptics) and cases of insanity so recent as to afford hopes of cure. 4 The Hôpital de la Ville is upon a much larger scale than the preceding it is a fine building, has a court before it planted with trees and flowers, and is divided into several quarters. Two wards are set apart for the reception of sick! servants belonging to families both of the town and country, and others are appropriated to the reception of beggars, &c. who receive board and lodging for one night. The aged and infirm occupy other parts of this hospital, and there is a! range of apartments, let at a small price to poor citizens 'capable of going out to work, but who likewise receive assistance from this public charity. The magistrates and physicians visit daily, and the whole establishment is kept in excellent order. At half a league from the town there are three other hospitals, under the care of the same physicians, but whose interior administration belongs to the canton. These are old and inconvenient, and are inferior in every respect to the preceding establishments. They are considered as hospitals of ease to the others; one receives the insane patients, the other the syphilitic, and the third is appropriated to epileptics, cancerous, and incurable cases of scrofula, &c. The first of these contained in August, 1805, sixty incurable lunatics, each in a separate apartment: almost the whole of these had the hair and eyes black, and were melancholy. " |