MONOPOLY OF HOSPITAL APPOINTMENTS BY THE FELLOWS OF CORPORATIONS.
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641 tion which are already so well manifested in the modest and useful articles which have set a stamp of value upon its earliest volumes. Correspondence. WOOLSORTERS’ DISEASE. "Audi alteram partem." To the Editor of THE LANCET. SIR,—For nearly twelve months have we been clear in this neighbourhood of any cases of the above justly-dreaded disease. It appears, however, we have not arrived at the stage of complete immunity, notwithstanding all the pre- cautions which have been adopted-the steeping of unopened bales, washing the wool in a sud of water at from 100° to 120°, passing through rollers, sorting the wool when damp, &c. The whole of these processes had been gone through prior to the wool reaching the workman who has now suc- cumbed to this malady. Whether the washing process had been imperfectly carried out, or what is just as likely, that the workman became infected from having access to other departments where the washing of the wool was con- ducted, it is difficult to say. John G-, aged sixty-one, a " filler (in the combing department) of boxes with brown Van mohair which had been washed and sorted, had been at work for seven years, and had enjoyed previous good health; said to have been always temperate, and looked so. On Thursday the 7th ult. he observed a papule on the outer border of the right radius, two inches above the wrist; he paid no attention to it as he was free from pain. The top of the papule was knocked off on the 9th while cleaning some boxes. On the 10th the papule began to enlarge and became slightly inflamed. Continued to work till late in the evening of the 12th. Got up on the morning of the 13th to go to work, but said he would not go, although he did not apprehend any- thing serious. In the evening of this day I was called in, and found him lying on his back, looking anxious, pale, and sweating moderately ; answered intelligently any questions, no delirium, complained of a little pain in the epigastric region. Above the right wrist I found an eruption about the size of a shilling, having a black sloughing centre with a vesicular rim, about one-eighth of an inch broad, loaded with a sero-sanguinolent fluid, which was trickling down on to the bed. The hand and half way up the arm was cedematous. Tongue moist, coated with white fur. Respiration 33 and shallow ; physical examination did not reveal anything abnormal. Pulse 84, regular. Heart sounds very indistinct, could scarcely be heard at all. Bowels loose, from taking some sulphate of magnesia. Urine had just been voided when the bowels were moved, and could not be observed. Temperature in axilla was subnormal. Treatment : Stimulants, beef-tea, and milk ordered ; sulphite of soda in drachm-doses every three hours, and a lotion of the same kept constantly applied to the pustule. The patient died seven hours after I saw him. Autopsy, twelve hours after death.—Rigor mortis marked; livid discoloration on back, flanks, and back of left upper arm, whole of left side of neck ; left external jugular vein distended ; lividity of ears, fingers, and finger nails. Lungs emphysematous, not shrinking back after chest was opened ; liypostatic congestion over posterior aspect of both lungs ; very small quantity of prune-juice looking fluid, in right pleural cavity, none in left, no pleuritic adhesions ; lungs crepitant all over. Heart : Cavity of pericardium con- tained half an ounce of bloody fluid; right ventricle collapsed and empty, both auricles empty; left ventri- cuiar wall thickened, cavities small; all the valves were normal; inner coat of aorta slightly stained, healthy otherwise. Abdominal cavity contained a large quantity of amber-coloured serum ; between the layers of the large omentum there was a thick gelatinous deposit, extending over the right half of the omentum, including and covering the transverse colon, and half way down the ascending colon ; patches of livid congestion existed in small intestines. Spleen twice as thick as natural, convex surface of capsule was dense, white, and opaque. Kidneys healthy; the capsules stripped off easily. Liver : surface rough, nodu- lated, tough, and hard, resisting breaking up by the fingers ; right lobe diminished, left lobe not so much altered in size. Bowels healthy, no haemorrhages; the valvulæ conniventes were swollen from contained gelatinous material. The glands at the root of the lungs were not enlarged or softened. In removing the pustule on the arm, a quantity of serum which had become gelatinised, was observed beneath. Microscopic examination of the fluids of the body, notably from the spleen, revealed the bacillus believed to be, by many, the materies morbi. Subcutaneous injection with these fluids, containing these bacilli, was fatal to animals, the fluids from these animals again showing the same micro- organism. I am. Sir. vour obedient servant. L. S. MACKENZIE, L.R.C.P., &c. MONOPOLY OF HOSPITAL APPOINTMENTS BY THE FELLOWS OF CORPORATIONS. To the Editor of THE LANCET. SIR,—The following passage on page 447 of your issue of September 16th induces me to address you as to what I feel to be a grievance : "Since the late Mr. Wakley founded THE LANCET to protect the rights of the public and to assert the rights of the profession against encroaching corporations." Also on page 449: "TheAct of 1858 broke down the territorial privileges of the licensing bodies, and made a licence valid anywhere in the United Kingdom." The latter is only half the truth. It is quite true that the possessor of any regis- trable degree or diploma may now practise anywhere in the country without let or hindrance ; but it is equally true that he cannot, unless he be a Fellow or Member of the Royal College of Physicians, hold any appointment in London which is worth having, and very few, indeed, in the provinces. The same obtains if not in Scotland at least in Edinburgh, where very recently a candidate was disqualified from com. peting because he was not a Fellow of the Edinburgh Col- lege of Physicians. I consider that this system is a grievous abuse; for it cannot be pretended that those who hold the degrees of Edinburgh, London, Dublin, Glasgow, Oxford, and Cambridge are, in point of scientific acquirements, in- ferior to members of the Colleges of Physicians ; and that the exclusion of graduates of the universities from hospital ap- pointments is a breach or evasion of the letter and spirit of the Medical Act before mentioned. It maybe urged that private bodies have a right to nominate their own officials. I con- cede this, but must point out that, with the exception of Guy’s, St. Bartholomew’s, and St. Thomas’s, all the other hospitals in London participate in public charity, and receive a share of Hospital Sunday collections, and that the same obtains in the provinces where, I imagine, there are no endowed institutions. But the fact remains that not only does this monopoly exist, but it goes on steadily increasing, and to this grievous abuse I hope you will turn fyour atten- tion. There can be no possible objection to imposing certain conditions on hospital physicians-i. e., that they shall not be in partnership with anyone, and that they shall not practise midwifery. But beyond this, and a prohibition against dis- pensing, I do not see at present any reason for going. I apprehend that the statistics of cottage hospitals, which as a rule are not under the control of Fellows and Members of the Colleges, will show that, making allowance for country air, the patients in them do.just as well as in those institutions where only Fellows and Members of the Royal College of Physicians are allowed to practise. In writing to you I do so in confidence, as I am fully aware of the boycotting propensities and practices of the Royal College of Physicians. I have been repeatedly urged to join them by Members and Fellows, and had it more than hinted that they were very clannish as a body and would have nothing to say to outsiders; and this I believe, from my personal observation, to be the case. Setting up for purists in practice and ethics, I know of one Fellow who has his name on a huge placard (of the style of " no tres- passers allowed ") at a considerable distance from his house, and another who does not disdain to put up a fracture when there are surgeons in plenty at hand. T am Rir yours &s., M.D. Edin. and Paris.
Transcript of MONOPOLY OF HOSPITAL APPOINTMENTS BY THE FELLOWS OF CORPORATIONS.
641
tion which are already so well manifested in the modest anduseful articles which have set a stamp of value upon itsearliest volumes.
Correspondence.WOOLSORTERS’ DISEASE.
"Audi alteram partem."
To the Editor of THE LANCET.
SIR,—For nearly twelve months have we been clear inthis neighbourhood of any cases of the above justly-dreadeddisease. It appears, however, we have not arrived at thestage of complete immunity, notwithstanding all the pre-cautions which have been adopted-the steeping of unopenedbales, washing the wool in a sud of water at from 100° to120°, passing through rollers, sorting the wool when damp,&c. The whole of these processes had been gone throughprior to the wool reaching the workman who has now suc-cumbed to this malady. Whether the washing process hadbeen imperfectly carried out, or what is just as likely, that the workman became infected from having access to
other departments where the washing of the wool was con-ducted, it is difficult to say.John G-, aged sixty-one, a " filler (in the combing
department) of boxes with brown Van mohair which hadbeen washed and sorted, had been at work for seven years,and had enjoyed previous good health; said to have beenalways temperate, and looked so. On Thursday the 7thult. he observed a papule on the outer border of the rightradius, two inches above the wrist; he paid no attention toit as he was free from pain. The top of the papule wasknocked off on the 9th while cleaning some boxes. On the10th the papule began to enlarge and became slightlyinflamed. Continued to work till late in the evening of the12th. Got up on the morning of the 13th to go to work, butsaid he would not go, although he did not apprehend any-thing serious. In the evening of this day I was called in,and found him lying on his back, looking anxious, pale, andsweating moderately ; answered intelligently any questions,no delirium, complained of a little pain in the epigastricregion. Above the right wrist I found an eruption aboutthe size of a shilling, having a black sloughing centrewith a vesicular rim, about one-eighth of an inch broad,loaded with a sero-sanguinolent fluid, which was tricklingdown on to the bed. The hand and half way up thearm was cedematous. Tongue moist, coated with whitefur. Respiration 33 and shallow ; physical examinationdid not reveal anything abnormal. Pulse 84, regular.Heart sounds very indistinct, could scarcely be heard atall. Bowels loose, from taking some sulphate of magnesia.Urine had just been voided when the bowels were moved,and could not be observed. Temperature in axilla wassubnormal. Treatment : Stimulants, beef-tea, and milkordered ; sulphite of soda in drachm-doses every threehours, and a lotion of the same kept constantly applied tothe pustule. The patient died seven hours after I sawhim.Autopsy, twelve hours after death.—Rigor mortis marked;
livid discoloration on back, flanks, and back of left upperarm, whole of left side of neck ; left external jugular veindistended ; lividity of ears, fingers, and finger nails. Lungsemphysematous, not shrinking back after chest was opened ;liypostatic congestion over posterior aspect of both lungs ;very small quantity of prune-juice looking fluid, in rightpleural cavity, none in left, no pleuritic adhesions ; lungscrepitant all over. Heart : Cavity of pericardium con-tained half an ounce of bloody fluid; right ventriclecollapsed and empty, both auricles empty; left ventri-cuiar wall thickened, cavities small; all the valveswere normal; inner coat of aorta slightly stained,healthy otherwise. Abdominal cavity contained a largequantity of amber-coloured serum ; between the layers ofthe large omentum there was a thick gelatinous deposit,extending over the right half of the omentum, including andcovering the transverse colon, and half way down theascending colon ; patches of livid congestion existed in smallintestines. Spleen twice as thick as natural, convex surfaceof capsule was dense, white, and opaque. Kidneys healthy;
the capsules stripped off easily. Liver : surface rough, nodu-lated, tough, and hard, resisting breaking up by the fingers ;right lobe diminished, left lobe not so much altered in size.Bowels healthy, no haemorrhages; the valvulæ conniventeswere swollen from contained gelatinous material. Theglands at the root of the lungs were not enlarged or
softened. In removing the pustule on the arm, a quantityof serum which had become gelatinised, was observedbeneath.
Microscopic examination of the fluids of the body, notablyfrom the spleen, revealed the bacillus believed to be, bymany, the materies morbi. Subcutaneous injection withthese fluids, containing these bacilli, was fatal to animals,the fluids from these animals again showing the same micro-organism. I am. Sir. vour obedient servant.
L. S. MACKENZIE, L.R.C.P., &c.
MONOPOLY OF HOSPITAL APPOINTMENTSBY THE FELLOWS OF CORPORATIONS.
To the Editor of THE LANCET.SIR,—The following passage on page 447 of your issue of
September 16th induces me to address you as to what I feelto be a grievance : "Since the late Mr. Wakley foundedTHE LANCET to protect the rights of the public and to assertthe rights of the profession against encroaching corporations."Also on page 449: "TheAct of 1858 broke down the territorial
privileges of the licensing bodies, and made a licence validanywhere in the United Kingdom." The latter is only halfthe truth. It is quite true that the possessor of any regis-trable degree or diploma may now practise anywhere in thecountry without let or hindrance ; but it is equally true thathe cannot, unless he be a Fellow or Member of the RoyalCollege of Physicians, hold any appointment in London whichis worth having, and very few, indeed, in the provinces.The same obtains if not in Scotland at least in Edinburgh,where very recently a candidate was disqualified from com.peting because he was not a Fellow of the Edinburgh Col-lege of Physicians. I consider that this system is a grievousabuse; for it cannot be pretended that those who hold thedegrees of Edinburgh, London, Dublin, Glasgow, Oxford,and Cambridge are, in point of scientific acquirements, in-ferior to members of the Colleges of Physicians ; and that theexclusion of graduates of the universities from hospital ap-pointments is a breach or evasion of the letter and spirit of theMedical Act before mentioned. It maybe urged that privatebodies have a right to nominate their own officials. I con-cede this, but must point out that, with the exception ofGuy’s, St. Bartholomew’s, and St. Thomas’s, all the otherhospitals in London participate in public charity, and receivea share of Hospital Sunday collections, and that the sameobtains in the provinces where, I imagine, there are noendowed institutions. But the fact remains that not onlydoes this monopoly exist, but it goes on steadily increasing,and to this grievous abuse I hope you will turn fyour atten-tion. There can be no possible objection to imposing certainconditions on hospital physicians-i. e., that they shall not bein partnership with anyone, and that they shall not practisemidwifery. But beyond this, and a prohibition against dis-pensing, I do not see at present any reason for going.I apprehend that the statistics of cottage hospitals,which as a rule are not under the control of Fellows andMembers of the Colleges, will show that, making allowancefor country air, the patients in them do.just as well asin those institutions where only Fellows and Members ofthe Royal College of Physicians are allowed to practise.In writing to you I do so in confidence, as I am fully awareof the boycotting propensities and practices of the RoyalCollege of Physicians. I have been repeatedly urged tojoin them by Members and Fellows, and had it more thanhinted that they were very clannish as a body and wouldhave nothing to say to outsiders; and this I believe, frommy personal observation, to be the case. Setting up forpurists in practice and ethics, I know of one Fellow whohas his name on a huge placard (of the style of " no tres-
passers allowed ") at a considerable distance from his house,and another who does not disdain to put up a fracturewhen there are surgeons in plenty at hand.
T am Rir yours &s.,
M.D. Edin. and Paris.
