IS BLEEDING A SURGICAL OPERATION?
1
79 THE STATE OF THE MEDICAL PROFESSION IN LONDON. To the Editor of THE LANCET. SiR,—Wouldit not be possible,in yourparliamentarystruggle to save the surgical profession from the degradation threatened by the National Association, to devise some punishment for those of its members who disgrace us by such productions as the enclosed ?—Wishing you every success in the battle you are so nobly fighting, I remain, &c., A SusGEOtf. Maida Hill, Jan. 14th, 1845. [A CARD.] "MR. WILLIAM RICHARDS, SURGEON ACCOUCHEUR, ETC. 13, Hall Place, Maida Hill, Paddington." [A CIRCULAR.] "MR. RICHARDS, Member of the Royal College of Surgeons, London, and Licentiate in Midwifery, announces to the Public that he attends Confinements for Five Shillings.-Vaccination One Shilling. The best and purest Medicines given, but no charge made." IS BLEEDING A SURGICAL OPERATION? WHAT say the surgeons ? The following case shows how the lawyers must in future advise, that it is not, but merely a matter appertaining to the practice of an apothecary. Proud and others v. Mayall, decided last term, was an action brought by a firm practising at Wolverhampton, for the recovery of their professional bill, and tried in August last, at Stafford, before the under-sheriff. The only plea of the defendant was, that " he was never indebted." This being the case, and some of the items being in respect of attendances in the character of surgeons, the plaintiffs’ attorney (who raised the point for the sake of caution) was advised, that the expense of putting in, and proving the certificates of his clients as apothecaries, (which, as it was before the passing of the late act, would have materially increased the costs,) need not be incurred on the grounds,-first, that since what is called the New Rules of Pleading," no question but what is put in issue by the de- fendant’s denial need be proved; and, secondly, because a verdict would at least be safe for whatever items might be proved for medicines and attendances incurred in the depart- ment of surgery. At the trial, every item and charge in the bill was clearly established; but, except on the point of bleeding the defendant, no surgical attendance was positively proved. On the closing of the plaintiffs’ case, the defendant’s advocate submitted that they should be nonsuited on two points; but one only required to be previously argued, and which was, the omission to prove the plaintiffs’ certificates as licentiates of Apothecaries’ Hall. The under-sheriff decided in the plaintiffs’ favour by directing the jury to find a verdict for them to the amount claimed; but gave the defendant leave to move the court above to set it aside, and enter a nonsuit instead. Accordingly, in last Michaelmas term the motion was made, and a rule to show cause obtained, which was afterwards argued before a single judge (Mr Justice Patteson) in the Bail Court; and although he was pressed with the fact of an item for bleeding being at the least clearly in evidence, and hesitated some time before giving judgment,-he yet, to the surprise, it is presumed, as much of the lawyers as it will be to your readers-considered that such an operation was not of a surgical nature, and made the rule absolute for a nonsuit. By this decision, the new rules of pleading are made to have no effect in this case; but, what is more material to surgeons, it declares that the operation of bleeding a patient pertains to the practice of an apothecary, and renders the production of a licentiate’s certificate necessary on a trial for the fee, although it is notorious that such an exercise of the craft was, in former days, the peculiar and characteristic office of the ancient incorporation of "the Surgeon-Barbers." That a non- suit should have been directed, under these circumstances, permitting wrong to overbear right, not only on a doubtful technical point which arose on an almost obsolete statute, but by straining a point in order to force the operation of bleeding out of the practice of surgery, is the more to be wondered at, because the judge was evidently posed by the case. Surely there were sufficient grounds for giving the benefit of the doubt to those who had unquestionably the right. Had his lordship but slept upon the matter, he would have given a different judgment in the morning; but he did not, and the plaintiffs were cast. It will be observed that this case was heard by a single judge, and not by the full Court--an unfortunate event; and a further misfortune was, that by the press of business it did not come on till the last day of term, which debarred the plaintiffs from obtaining a rehearing of it by the rest of the judges, which, there is little doubt, would have- resulted in a, discharge of the rule. As it is, there is now no appeal, the ruling of the single judge is final-that is, there is no appeal at law; one is, therefore, made to the judgment of yourself, Mr. Editor, on behalf of a profession which the legislature and the law courts seem leagued to harass and wrong for the benefit of quacks and unprincipled patients. THE THEORY OF RESPIRATION. P. A. BRADY. To the Editor of THE LANCET. SiR,—In a work by Dr. Wilson and Dr. Gully, entitled, "The Dangers of the Water Cure Examined, &c.," at p. 58 the fol- lowing passage occurs:- " Whilst from the food thus changed, two elements, carbon and hydrogen, are derived, these are carried round with the blood- and meet with oxygen introduced at the lungs and through the skin, and combining with it in those places, carbonic acid and watery vapour are formed and expelled from the body." I confess that I was a good deal surprised on meeting in a work of the present day a theory so long exploded-that of the combustion of the carbon and hydrogen of the body by the venous blood to the lungs, there to enter into chemical com- bination with the inspired oxygen. I was still more surprised on finding, in a marginal note, that Liebeg was referred to in support of this theory; but on turning to " Liebig’s Animal Chemistry," I could not find a single passage bearing on the subject which was not diametri- cally opposed to this obsolete hypothesis. For instance, at p. 30 we read as follows :- " The singular idea that the nerves produce animal heat has obviously arisen from the notion that inspired oxygen com- bines with carbon in the blood itself, but, as we shall hereafter see, there cannot be a more erroneous conception than this." Again, at p. 60: The globules of the blood which can be shown to take no share in the nutritive process, serve to transport the oxygen, which they give up in their passage through the capillary vessels. Here the current of oxygen meets with the compounds produced by the transformation of the tissues, and combines with the carbon to form carbonic acid, and with hydrogen to form water." And in his chapter on the theory of respiration, he states, that " the carbonic acid thus formed combines with the iron of the globules, de- prived of their excess of oxygen, is carried by the venous system to the lungs, when the globules taking up the oxygen they have lost, the carbonic acid is separated, and, with the vapour of water, is exhaled." The mistake which Messrs.Wilson and Gully have evidently made, is not, perhaps, calculated materially to affect their argu- ments in favour of cold water. It appears strange, however, that Liebig should be so egregiously misquoted on a subject involving one of the most important doctrines of animal che- mistry, by authors who found their strongest arguments in support of their propositions on the theories he has advanced. I am, Sir, your very obedient Servant, London, 31st December, 1845. P. A. BRADY. THE "FIVE-YEARS APPRENTICESHIP SYSTEM." To the Editor of THE LANCET. SiR,—Allow me, through the medium of the far-famed LANCET, to make some remarks relative to the formula of medical education required by the Apothecaries Hall. At a time when every science and every art is pushing on to the utmost; at a time when inferiority is not tolerated, and when mediocrity is left to sink; and when the science of medi- cine throughout the civilized world is daily gaining the respect and confidence of the well informed; still does an apothecary’s shop in the citypresume to govern and direct the medical pro- fession of England. Some say they perform their task well: this assertion I venture to deny. When five years, out of the allotted seven, are required to be passed in the drudgery of an appren- ticeship, and three given for going through the whole scien- tific and practical course required of the candidate, none, surely, can have the hardihood to sanction any senseless praise of such an anomalous system. Thus has a youth the educa- tion of a mere mechanic given him up to the age of twenty or twenty-one, and then, with a mind untrained to investiga
Transcript of IS BLEEDING A SURGICAL OPERATION?
79
THE STATE OF THE MEDICAL PROFESSIONIN LONDON.
To the Editor of THE LANCET.SiR,—Wouldit not be possible,in yourparliamentarystruggle
to save the surgical profession from the degradation threatenedby the National Association, to devise some punishment forthose of its members who disgrace us by such productions asthe enclosed ?—Wishing you every success in the battle youare so nobly fighting, I remain, &c., A SusGEOtf.Maida Hill, Jan. 14th, 1845.
[A CARD.]"MR. WILLIAM RICHARDS,
SURGEON ACCOUCHEUR, ETC.
13, Hall Place, Maida Hill, Paddington."[A CIRCULAR.]
"MR. RICHARDS, Member of the Royal College of Surgeons,London, and Licentiate in Midwifery, announces to the Publicthat he attends Confinements for Five Shillings.-VaccinationOne Shilling.The best and purest Medicines given, but no charge made."
IS BLEEDING A SURGICAL OPERATION?WHAT say the surgeons ? The following case shows how thelawyers must in future advise, that it is not, but merely amatter appertaining to the practice of an apothecary. Proudand others v. Mayall, decided last term, was an action broughtby a firm practising at Wolverhampton, for the recovery oftheir professional bill, and tried in August last, at Stafford,before the under-sheriff. The only plea of the defendant was,that " he was never indebted." This being the case, and someof the items being in respect of attendances in the characterof surgeons, the plaintiffs’ attorney (who raised the point forthe sake of caution) was advised, that the expense of puttingin, and proving the certificates of his clients as apothecaries,(which, as it was before the passing of the late act, would havematerially increased the costs,) need not be incurred on thegrounds,-first, that since what is called the New Rules ofPleading," no question but what is put in issue by the de-fendant’s denial need be proved; and, secondly, because averdict would at least be safe for whatever items might beproved for medicines and attendances incurred in the depart-ment of surgery.At the trial, every item and charge in the bill was clearly
established; but, except on the point of bleeding the defendant,no surgical attendance was positively proved. On the closingof the plaintiffs’ case, the defendant’s advocate submitted thatthey should be nonsuited on two points; but one only requiredto be previously argued, and which was, the omission to provethe plaintiffs’ certificates as licentiates of Apothecaries’ Hall.The under-sheriff decided in the plaintiffs’ favour by directingthe jury to find a verdict for them to the amount claimed; butgave the defendant leave to move the court above to set itaside, and enter a nonsuit instead.
Accordingly, in last Michaelmas term the motion was made,and a rule to show cause obtained, which was afterwardsargued before a single judge (Mr Justice Patteson) in theBail Court; and although he was pressed with the fact of anitem for bleeding being at the least clearly in evidence, andhesitated some time before giving judgment,-he yet, to thesurprise, it is presumed, as much of the lawyers as it will beto your readers-considered that such an operation was not ofa surgical nature, and made the rule absolute for a nonsuit.By this decision, the new rules of pleading are made to haveno effect in this case; but, what is more material to surgeons,it declares that the operation of bleeding a patient pertains tothe practice of an apothecary, and renders the production ofa licentiate’s certificate necessary on a trial for the fee,although it is notorious that such an exercise of the craft was,in former days, the peculiar and characteristic office of theancient incorporation of "the Surgeon-Barbers." That a non-suit should have been directed, under these circumstances,permitting wrong to overbear right, not only on a doubtfultechnical point which arose on an almost obsolete statute, butby straining a point in order to force the operation of bleedingout of the practice of surgery, is the more to be wondered at,because the judge was evidently posed by the case. Surelythere were sufficient grounds for giving the benefit of thedoubt to those who had unquestionably the right. Had hislordship but slept upon the matter, he would have given adifferent judgment in the morning; but he did not, and theplaintiffs were cast.
It will be observed that this case was heard by a singlejudge, and not by the full Court--an unfortunate event; anda further misfortune was, that by the press of business it didnot come on till the last day of term, which debarred theplaintiffs from obtaining a rehearing of it by the rest of thejudges, which, there is little doubt, would have- resulted in a,discharge of the rule. As it is, there is now no appeal, theruling of the single judge is final-that is, there is no appealat law; one is, therefore, made to the judgment of yourself, Mr.Editor, on behalf of a profession which the legislature and thelaw courts seem leagued to harass and wrong for the benefitof quacks and unprincipled patients.
THE THEORY OF RESPIRATION.
P. A. BRADY.
To the Editor of THE LANCET.SiR,—In a work by Dr. Wilson and Dr. Gully, entitled, "TheDangers of the Water Cure Examined, &c.," at p. 58 the fol-lowing passage occurs:-
" Whilst from the food thus changed, two elements, carbonand hydrogen, are derived, these are carried round with theblood- and meet with oxygen introduced at the lungs andthrough the skin, and combining with it in those places,carbonic acid and watery vapour are formed and expelledfrom the body."
I confess that I was a good deal surprised on meeting in awork of the present day a theory so long exploded-that ofthe combustion of the carbon and hydrogen of the body by thevenous blood to the lungs, there to enter into chemical com-bination with the inspired oxygen.
I was still more surprised on finding, in a marginal note, thatLiebeg was referred to in support of this theory; but onturning to " Liebig’s Animal Chemistry," I could not find asingle passage bearing on the subject which was not diametri-cally opposed to this obsolete hypothesis. For instance, at p. 30we read as follows :-
" The singular idea that the nerves produce animal heat hasobviously arisen from the notion that inspired oxygen com-bines with carbon in the blood itself, but, as we shall hereaftersee, there cannot be a more erroneous conception than this."Again, at p. 60: The globules of the blood which can beshown to take no share in the nutritive process, serve totransport the oxygen, which they give up in their passagethrough the capillary vessels. Here the current of oxygenmeets with the compounds produced by the transformation ofthe tissues, and combines with the carbon to form carbonicacid, and with hydrogen to form water." And in his chapteron the theory of respiration, he states, that " the carbonicacid thus formed combines with the iron of the globules, de-prived of their excess of oxygen, is carried by the venoussystem to the lungs, when the globules taking up the oxygenthey have lost, the carbonic acid is separated, and, with thevapour of water, is exhaled."The mistake which Messrs.Wilson and Gully have evidently
made, is not, perhaps, calculated materially to affect their argu-ments in favour of cold water. It appears strange, however,that Liebig should be so egregiously misquoted on a subjectinvolving one of the most important doctrines of animal che-mistry, by authors who found their strongest arguments insupport of their propositions on the theories he has advanced.
I am, Sir, your very obedient Servant,London, 31st December, 1845. P. A. BRADY.
THE "FIVE-YEARS APPRENTICESHIP SYSTEM."To the Editor of THE LANCET.
SiR,—Allow me, through the medium of the far-famed LANCET,to make some remarks relative to the formula of medicaleducation required by the Apothecaries Hall.At a time when every science and every art is pushing on
to the utmost; at a time when inferiority is not tolerated, andwhen mediocrity is left to sink; and when the science of medi-cine throughout the civilized world is daily gaining the respectand confidence of the well informed; still does an apothecary’sshop in the citypresume to govern and direct the medical pro-fession of England. Some say they perform their task well: thisassertion I venture to deny. When five years, out of the allottedseven, are required to be passed in the drudgery of an appren-ticeship, and three given for going through the whole scien-tific and practical course required of the candidate, none,surely, can have the hardihood to sanction any senseless praiseof such an anomalous system. Thus has a youth the educa-tion of a mere mechanic given him up to the age of twentyor twenty-one, and then, with a mind untrained to investiga
