Statistics in Medical Research: Developments in Clinical Trials
MEDICAL TRIALS
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550 vague notions of its defectiveness, as well as of its liability to induce disease, floating in the weak minds of obstinate and self-opiniated parents. Reasoning and facts are thrown away upon such persons, and nothing but rigidly enforcing the ope- ration in every house by a duly-qualified staff of competent practitioners, adequately paid, will ever drive the hideous monster from these shores. I remain, Sir, very faithfully yours, J. J. MACGREGOR, M.D. THE STATE OF THE INDIAN MEDICAL SERVICE. To the Editor of THE LANCET. SIR,—If, although the Indian local armies are marked for annexation to the Line, there he any hospital students who, allured by descriptions of what these services were, and the guarantee of their rights and privileges, think of competing at the India Office in January, let them look over a file of an Indian newspaper. Advertisements for candidates are apt to show only the rosy side of the picture: a competency from the date of landing; the prospect of lucrative civil employment; princely retiring allowances from the medical funds. A local publication, however, especially in a minor presidency, is more apt to show the other side: the shifting for two or three years from one into another kind of travelling order-rail and transit and river, palki and tent and rail; the share of one’s pay that goes to the Peninsular and Oriental Navigation Company; pro- motion indefinitely postponed; the way in which the Royal Warrant has been extended to India. The Secretary for India, when questioned on the subject of the Warrant, had the cool- ness to answer that the Line and local services in India were " on a footing of perfect equality." When the litigants re- ceived each a shell of the celebrated oyster, they were doubtless " on a footing of perfect equality." The shell granted to the Line in 1858 was emptied of the improved rates of pay by " a corresponding deduction from allowances." The shell granted to the local services in 1860 was emptied by simply omitting every clause in which pay or pension was mentioned. If the Line officers are to hold the best appointments hitherto monopolized by the local, they must look sharp, ere they be all abolished. A deputy inspectorship (southern division) has been lately lost to Bombay, another (centre division) to Madras, and one or two more are expected to follow. The stations in Burmah are now nearly comfortable enough to be handed over to the major presidency. If they be handed over, the natural consequence will be a large reduction of the present Madras army, and possibly of its establishment of full surgeons by one for every regiment broken up. At present, the full are to the assistant surgeons as two to five. The new police battalions are, in the southern presidency, so far organized as to promise a further and earlier reduction. To appoint su.rgeons to these battalions would be a violation of the economical principles on which they are levied. Their medical wants are supplied, as yet, from the civil dispensaries, making civil employment more valuable than ever as a field for practice. Fully agreeing with your correspondent, " Impromptil," that a surgeon ought to have other and higher aspirations than to draw the sword and wear the sash," I would suggest a limitation to his -remark that a medical officer " knows about military matters, although he associates with soldiers daily, less than a rifle volunteer of one month’s standing." He knows less of shouldering arms and forming squares ; but I have known a mess enlightened by the doctor as to Marlborough’s campaigns; a party, mainly military, and including an artillery officer, indebted to a civilian, for a description of Armstrong’s (a civilian’s) gun; a mess party who discovered, on comparing notes, that a medical non-combatant and a pure civilian were the only men present who had " heard a shot fired." Such instances may not be usual, but I suspect that, in the junior ranks at least, they are not rare. Whether has an army in quarters or an army in the field the larger proportion of medical officers? T am, Sir, yours respectfully, October, 1860. MEDICUS INDICUS. TESTIMONIAL TO A PHYSICIAN.—On the 23rd ult., a very handsome and valuable time-piece was presented to Dr. Philip H. Williams, of Worcester, with a purse containing 125 sovereigns, as an acknowledgment by the subscribers to the Dispensary in that city of his services rendered to the institution during the neriod of twelve years. MEDICAL TRIALS. COURT OF QUEEN’S BENCH, WESTMINSTER, Nov. 21. (Sittings in Banco, before Lord Chief Justice COCKBURN and Justices WIGHTMAN, HILL, and BLACKBURN.) STEELE (APPELLANT) V. HAMILTON (RESPONDENT). THIS was a case stated by the stipendiary magistrate -&f Liverpool for the opinion of this Court, and it raised the ques. tion whether the facts set forth in the case were sufficient in law to warrant the conviction of the respondent, whom the magistrate had declined to convict, of an offence against the 40th section of the new Medical Act. It appeared that the appellant, Arthur Brown Steele, hop. secretary to the Liverpool Medical Registration Society, had caused the respondent, John Hamilton, to be summoned before the magistrate upon an information which charged that he, on the 21st of February, 1860, wilfully and falsely pretended to be a surgeon, general practitioner, or apothecary, and used the name of surgeon, general practitioner, or apothecary, or some name, title, addition, or description, implying that he was registered under the Medical Act, or that he was recognised by law as a surgeon, practitioner in medicine, or apothecary, whereby he had become liable to a penalty of 1;20. When the respondent appeared before the magistrate it was proved that he had signed the following certificate :- ’’ MEDICAL CERTIFICATE. I hereby certify that I attended William Hayes, late of 110, Mill-street, that died the 21st day of February; cause of death, enteritis; and that I have no reason to attribute his death to poison, violence, or criminal neglect. " JOHN HAMILTON, " Profession, Botanic Surgeon. "Day of February 22nd, 1860." "Residence, 94, Mill-street. It was also proved that over the door of the house where the respondent carried on his business was painted in large legible letters, " J. Hamilton, Surgeon," and in very small characters underneath, "Boston, U. S.;" and upon a glass panel of the door itself was painted J. Hamilton, Anti-Registered Sur- geon." The words " anti-registered" were considerably smaller than the words " J. Hamilton, surgeon," and so as to be ille- gible, except upon close inspection. The magistrate dismissed the information, but, being required by the appellant to state a case, he submitted the following question to this Court,- namely, " Whether the evidence was sufficient in law towar- rant a conviction under the 40th section of the Medical Act. If the Court are of opinion that the evidence was sufficient i law, then the magistrate prays the Court to make such order or conviction as the Court shall think fit. " Mr. L. TEMPLE, who appeared for the appellant, feared ;the case must be governed by the decision in the Court of Common Pleas, "Pedgrift v. Chevallier" (29, L. J., M. C., 225), unless it could be shown that the respondent was not in practice be- fore the 1st of August, 1815. Nothing was stated on that sub- ject in the case ; but as the respondent, he believed, was only about forty years of age, he applied that the case might be sent back to be amended. Mr. Coon- EvArrs (with whom was Mr. Seymour), for the re- spondent, said the case had already been before the magistrates, both of whom had refused to convict, and he hoped the case would not be sent back. He should contend that the case was concluded by the decision in the Common Pleas, where it had been held that for a person merely to call himself a surgeon, without being duly registered, was no offence against the 40th section. Mr. TEMPLE contended that the respondent had falsely pre’ tended to be a surgeon by signing a medical certificate -for burial. The 37th section of the Medical Act enacted that no certificate required by any Act of Parliament should be walid unless the person signing the same be registered under the Act. Mr. EVANS said that the 37th section referred to cases where the certificate of a. surgeon was required-for instance, in the case of an insane person whom it might be proposed to send to a lunatic asylum. But the certificate as to the cause of death might be given by any person who was present at the death. Mr. Justice HILL referred to the 25th section of the Regis- tration Act (6th and 7th William IV., cap. 86), and said that it was so. Mr. Justice BLACKBURN thought that part of the case was disposed of. Mr. TEMPLE proceeded to call attention to the case, in which it was found that the words " auti-r.egistered" were written in
Transcript of MEDICAL TRIALS
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vague notions of its defectiveness, as well as of its liabilityto induce disease, floating in the weak minds of obstinate andself-opiniated parents. Reasoning and facts are thrown awayupon such persons, and nothing but rigidly enforcing the ope-ration in every house by a duly-qualified staff of competentpractitioners, adequately paid, will ever drive the hideousmonster from these shores.
I remain, Sir, very faithfully yours,J. J. MACGREGOR, M.D.
THE STATE OF THE INDIAN MEDICALSERVICE.
To the Editor of THE LANCET.SIR,—If, although the Indian local armies are marked for
annexation to the Line, there he any hospital students who,allured by descriptions of what these services were, and theguarantee of their rights and privileges, think of competingat the India Office in January, let them look over a file of anIndian newspaper. Advertisements for candidates are apt toshow only the rosy side of the picture: a competency from thedate of landing; the prospect of lucrative civil employment;princely retiring allowances from the medical funds. A local
publication, however, especially in a minor presidency, is moreapt to show the other side: the shifting for two or three yearsfrom one into another kind of travelling order-rail and transitand river, palki and tent and rail; the share of one’s pay thatgoes to the Peninsular and Oriental Navigation Company; pro-motion indefinitely postponed; the way in which the RoyalWarrant has been extended to India. The Secretary for India,when questioned on the subject of the Warrant, had the cool-ness to answer that the Line and local services in India were" on a footing of perfect equality." When the litigants re-
ceived each a shell of the celebrated oyster, they were doubtless" on a footing of perfect equality." The shell granted to theLine in 1858 was emptied of the improved rates of pay by " acorresponding deduction from allowances." The shell grantedto the local services in 1860 was emptied by simply omittingevery clause in which pay or pension was mentioned.
If the Line officers are to hold the best appointments hithertomonopolized by the local, they must look sharp, ere they beall abolished. A deputy inspectorship (southern division) hasbeen lately lost to Bombay, another (centre division) to Madras,and one or two more are expected to follow. The stations inBurmah are now nearly comfortable enough to be handed overto the major presidency. If they be handed over, the naturalconsequence will be a large reduction of the present Madrasarmy, and possibly of its establishment of full surgeons by onefor every regiment broken up. At present, the full are to theassistant surgeons as two to five. The new police battalionsare, in the southern presidency, so far organized as to promisea further and earlier reduction. To appoint su.rgeons to thesebattalions would be a violation of the economical principles onwhich they are levied. Their medical wants are supplied, asyet, from the civil dispensaries, making civil employment morevaluable than ever as a field for practice.
Fully agreeing with your correspondent, " Impromptil,"that a surgeon ought to have other and higher aspirations thanto draw the sword and wear the sash," I would suggest alimitation to his -remark that a medical officer " knows aboutmilitary matters, although he associates with soldiers daily,less than a rifle volunteer of one month’s standing." He knowsless of shouldering arms and forming squares ; but I haveknown a mess enlightened by the doctor as to Marlborough’scampaigns; a party, mainly military, and including an artilleryofficer, indebted to a civilian, for a description of Armstrong’s(a civilian’s) gun; a mess party who discovered, on comparingnotes, that a medical non-combatant and a pure civilian werethe only men present who had " heard a shot fired." Suchinstances may not be usual, but I suspect that, in the juniorranks at least, they are not rare.Whether has an army in quarters or an army in the field
the larger proportion of medical officers?T am, Sir, yours respectfully,
October, 1860. MEDICUS INDICUS.
TESTIMONIAL TO A PHYSICIAN.—On the 23rd ult., avery handsome and valuable time-piece was presented toDr. Philip H. Williams, of Worcester, with a purse containing125 sovereigns, as an acknowledgment by the subscribers tothe Dispensary in that city of his services rendered to theinstitution during the neriod of twelve years.
MEDICAL TRIALS.
COURT OF QUEEN’S BENCH, WESTMINSTER, Nov. 21.(Sittings in Banco, before Lord Chief Justice COCKBURN and
Justices WIGHTMAN, HILL, and BLACKBURN.)STEELE (APPELLANT) V. HAMILTON (RESPONDENT).
THIS was a case stated by the stipendiary magistrate -&fLiverpool for the opinion of this Court, and it raised the ques.tion whether the facts set forth in the case were sufficient inlaw to warrant the conviction of the respondent, whom themagistrate had declined to convict, of an offence against the40th section of the new Medical Act.
It appeared that the appellant, Arthur Brown Steele, hop.secretary to the Liverpool Medical Registration Society, hadcaused the respondent, John Hamilton, to be summoned beforethe magistrate upon an information which charged that he, onthe 21st of February, 1860, wilfully and falsely pretended tobe a surgeon, general practitioner, or apothecary, and used thename of surgeon, general practitioner, or apothecary, or somename, title, addition, or description, implying that he wasregistered under the Medical Act, or that he was recognisedby law as a surgeon, practitioner in medicine, or apothecary,whereby he had become liable to a penalty of 1;20. When therespondent appeared before the magistrate it was proved thathe had signed the following certificate :-
’’ MEDICAL CERTIFICATE.I hereby certify that I attended William Hayes, late of
110, Mill-street, that died the 21st day of February; cause ofdeath, enteritis; and that I have no reason to attribute hisdeath to poison, violence, or criminal neglect.
" JOHN HAMILTON," Profession, Botanic Surgeon.
"Day of February 22nd, 1860." "Residence, 94, Mill-street.It was also proved that over the door of the house where therespondent carried on his business was painted in large legibleletters, " J. Hamilton, Surgeon," and in very small charactersunderneath, "Boston, U. S.;" and upon a glass panel of thedoor itself was painted J. Hamilton, Anti-Registered Sur-geon." The words " anti-registered" were considerably smallerthan the words " J. Hamilton, surgeon," and so as to be ille-gible, except upon close inspection. The magistrate dismissedthe information, but, being required by the appellant to statea case, he submitted the following question to this Court,-namely, " Whether the evidence was sufficient in law towar-rant a conviction under the 40th section of the Medical Act.If the Court are of opinion that the evidence was sufficient ilaw, then the magistrate prays the Court to make such orderor conviction as the Court shall think fit. "
Mr. L. TEMPLE, who appeared for the appellant, feared ;thecase must be governed by the decision in the Court of CommonPleas, "Pedgrift v. Chevallier" (29, L. J., M. C., 225), unlessit could be shown that the respondent was not in practice be-fore the 1st of August, 1815. Nothing was stated on that sub-ject in the case ; but as the respondent, he believed, was onlyabout forty years of age, he applied that the case might besent back to be amended.
Mr. Coon- EvArrs (with whom was Mr. Seymour), for the re-spondent, said the case had already been before the magistrates,both of whom had refused to convict, and he hoped the casewould not be sent back. He should contend that the case wasconcluded by the decision in the Common Pleas, where it hadbeen held that for a person merely to call himself a surgeon,without being duly registered, was no offence against the 40th
section.Mr. TEMPLE contended that the respondent had falsely pre’
tended to be a surgeon by signing a medical certificate -forburial. The 37th section of the Medical Act enacted that nocertificate required by any Act of Parliament should be walidunless the person signing the same be registered under the Act.
Mr. EVANS said that the 37th section referred to cases wherethe certificate of a. surgeon was required-for instance, in thecase of an insane person whom it might be proposed to send toa lunatic asylum. But the certificate as to the cause of deathmight be given by any person who was present at the death.
Mr. Justice HILL referred to the 25th section of the Regis-tration Act (6th and 7th William IV., cap. 86), and said thatit was so.
Mr. Justice BLACKBURN thought that part of the case wasdisposed of.
Mr. TEMPLE proceeded to call attention to the case, in whichit was found that the words " auti-r.egistered" were written in
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very small letters, so as to be illegible except upon close in-spection.Mr. Justice WIGHTMAN referred to the 40th section, and
suggested that, to bring the case within it, it must be shownthat the party falsely pretended to be a surgeon, &c., " imply-ing that he is registered under the Act, or that he is recognisedby law as a physician or surgeon," &c.Lord Chief Justice COCKBURN said there was nothing in the
Act to prevent a person from merely practising as a surgeonwithout being registered. His Lordship thought that thedecision of the magistrates should be affirmed, but, at the sametime, he thought that a person who wrote " anti-registered" invery small letters was not entitled to costs.The other Judges were of the same opinion.Judgment affirmed, without costs.
DUMFRIES CIRCUIT COURT.
DAVID GIBB, medical student, Glasgow, was charged, on
Sept. 28th, before Lord Cowan, with the crimes of " falsehoodand forgery, in so far as, on or about Tuesday, the 3rd of July,1860, at or near Rosehall, in the parish of Dumfries, the saidDavid Gibb, being desirous of obtaining the appointment ofassistant-surgeon to the Dumfries, Roxburg, and SelkirkshireMilitia, did wickedly and feloniously, at aforementioned place,write and fabricate, or cause to be written or fabricated, asimulated document purporting to be a diploma of competencefrom the Faculty of Physicians of Glasgow, and did utter anduse such document, he well knowing it to be a forgery." Thepanel pleaded guilty of uttering and using such document.
Mr. A. T. BoYLE, prisoner’s counsel, in extenuation, said thatthe panel, as student in the Andersonian University of Glas-gow, bore the most irreproachable character. Mr. Boyle pro-duced certificates to that effect from Professors Bell, Moreton,and Penny, of the Andersonian University, Glasgow, and fromDr. Watson, of the Royal Infirmary there. Mr. Boyle said ithad not been out of any sordid motives that his client haduttered this document. Mr. Gibb had made every reparationin his power by repaying the small sums he had received assalary while performing the duties of assistant-surgeon.Lord COWAN said that it was one of the most painful cases
he had ever met. It was within his recollection when forgerywas visited with the highest penalties of the Court. Luckilythis case was not one such as the forgery of bank bills, but onewhich had been of little benefit to the panel. But, even look-ing at the present offence in its mildest form, he could not,sitting there to award impartial justice, visit it with a lesspenalty than twelve months’ imprisonment, in order to showall that in this country no good could be attained by evil. He
hoped that when the prisoner was restored to society thiswould prove a lesson to him.
e
PARISIAN MEDICAL INTELLIGENCE.
(FROM OUR SPECIAL CORRESPONDENT.)
THE papers read at the last meeting of the Academy ofMedicine were almost exclusively on the one subject of ob-stetrics. The explanation of this somewhat unusual occurrencemay be found in the fact that the vacancy existing in the mid-wifery section of this body is about to be filled up (next Tues-day, indeed, the preliminaries of election will be arranged);and most of the candidates are desirous of trying their pacesbefore entering the course. Dr. Mattei, a Corsican, a soi-disantobstetrical reformer and inventor of the leniceps (a mildervariety offorceps), came forward, with some pomp and promiseof novelty, to read a paper " On the several Points of MidwiferyPractice still requiring further Study;" and after making hisaudience undergo all the tortures of a tedious delivery, disap-pointed them as to the realization of the promise of originality.The chief conclusions deduced by the author in his communi-cation to the Academy are the following :-The function ofdelivery being a natural operation, its accomplishment oughtto be spontaneous, and consistent with the perfect safety ofboth mother and child. This condition of safety to mother andchild being moditied by civilization, more especially in largecities, Dr. Mattei’s object is to endeavour to place the womaninhabiting the town in the same favourable position for child-bearing as the peasant, and so counteract the vicious perversionof the natural status during the terms of pregnancy, labour,
and subsequent periods. During the term of pregnancy hisobject is to augment as much as possible the plasticity of theblood and the vital force of the woman by fit hygienic andtherapeutical measures; opposing at the same time, wheneverpresent, tendency to uterine congestion, as the principal causeof deviation from the normal accomplishment of the functionof parturition. By means of external manipulation duringpregnancy as well as at the commencement of labour, unna-tural presentations, such as those of the feet, trunk, or face,are to be converted into that of the head. Should the expul-sion of the child not be effected within the space of four hourssubsequent to the rupture of the membranes, the author re-commends the application of his afore-named leniceps. Bythis means, instead of meeting with a fatal case in every thirtyor forty births, M. Mattei’s practice has, he alleges, been mostsuccessful. He has found labour prompt and safe; the strengthof the mother has been husbanded; and the uterus, unex-hausted by prolonged and ineffectual efforts, has been able to-contract vigorously, and so oppose the most effectual barrier tothe occurrence of haemorrhage. Moreover, the lochial dischargehas been moderate, and the secretion of milk abundant and un-accompanied by fever. When febrile symptoms do set in afterdelivery, they are almost invariably the result of injury doneto the soft parts during labour; and when these injuries deter-mine absorption into the blood of decomposed animal matter,pyasmia, and phlebitis ensue. The author considers that byprompt interference, and by the assistance of his leniceps, thepatient may be preserved from this primary cause of purulentinfection-namely, traumatic lesion to the soft tissues. Incases in which such injury may have been unavoidable, M.Mattei believes that women may be secured from the deadlyeffect of the absorption of pus into the blood by the free ad-ministration of the ergot of rye, and the production and main-tenance of forced contraction of the uterus. All the medicinesvaunted as possessing a protective power against this gravestof all complications, are classed by the author in the categoryof stimulants of uterine contraction; in this class he includesboth ipecacuanha and digitalis. If, however, in spite of allthe above precautions, symptoms of purulent infection dooccur, M. Mattei recommends the sulphate of quinine andstimulants to the surface of the skin. By following such asystem, the author declares to having encountered-out of tW0hundred accouchements accomplished with his aid in Paris-only one case with a fatal termination.Another paper, also on an obstetric subject, was read by M.
Hatin, likewise a candidate for the vacant academical arm-chair. This communication bears chiefly upon the question efthe performance of the Caesarean operation after the death ofthe mother, and the legal difficulties connected therewith. Itappears that as the law now stands in France, no operation forthe preservation of the unborn child can be undertaken withinthe twenty-four hours subsequent to the mother’s decease.This law is based upon the presumed doubt as to the deathhaving really occurred ; but, meanwhile, the delay is in-evitably fatal to the infant. M. Hatin, therefore, invokes theassistance of the Academy, and solicits its active interferencein procuring the rescinding or rectitication of so absurd a judi-cial regulation.The Faculty of Medicine, at the request of the Minister of
Public Instruction, has forwarded its list of candidates for thevacant chair of Internal Pathology. The two names sent inare those of MM. Monneret and Beau. The appointment ofthe latter gentleman would be very popular amongst the stu-dents. The clinical lectures of M. Beau, at the Charite, arepractical, original, and interesting; and although he occasion-ally may ride his hobbies beyond measure hard, yet there is nogeneral course of pathology and therapeutics (even includingthat of M. Trousseau) more useful to the student in after-lifethan that of M. Beau.
Two new psychological journals are about to be founded inParis at the beginning of next year. The first, entitled CliiaicalArchives of Mental and Nervous Disorders, with M. Baillargeras principal editor; and the second, founded by M. Delasiauve,under the name of the Journal of Mental Medicine. The
object of the latter is to popularize amongst the non-specialistportion of our profession, and amongst magistrates, the scienceof mental pathology and of forensic medicine in connexion withinsanity.A Lyons newspaper (the Courrier de Lyon) announces that
a plan for the assembling of a Sanitary Congress at Lyons is atthis moment on the eve of execution. Each of the principaltowns of France and of the Mediterranean coast is to be repre-sented by a deputy, and the operations of the Congress will
shortlv be commenced.
